@article{pmid41987368,
title = {Association of Lipid Core Burden Index With Early Progression of Cardiac Allograft Vasculopathy in Patients After Heart Transplantation},
author = {Kenta Otsuka and Sakae Takenaka and Toshiyuki Nagai and Takuma Sato and Takao Konishi and Atsushi Tada and Takeshi Hamaya and Yuki Mori and Akinori Takahashi and Sou Sasaki and Kento Tamano and Toshifumi Tamura and Sho Kazui and Yutaro Yasui and Yuta Kobayashi and Taro Temma and Kiwamu Kamiya and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1253/circj.CJ-26-0175},
issn = {1347-4820},
year = {2026},
date = {2026-04-01},
urldate = {2026-04-01},
journal = {Circ J},
abstract = {BACKGROUND: The association of the lipid-core burden index (LCBI), measured using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), with early progression of cardiac allograft vasculopathy remains unclear.nnMETHODS AND RESULTS: We prospectively examined 12 consecutive heart transplant recipients who underwent NIRS-IVUS and IVUS. Patients were stratified according to the median maximum LCBI in a 4-mm segment (maxLCBI) of 223 at 1 month. The magnitude of maximal intimal thickness (MIT) progression was greater in the higher maxLCBIgroup.nnCONCLUSIONS: Patients with a higher maxLCBIat baseline exhibited greater MIT progression during the first post-transplant year.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The association of the lipid-core burden index (LCBI), measured using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), with early progression of cardiac allograft vasculopathy remains unclear.nnMETHODS AND RESULTS: We prospectively examined 12 consecutive heart transplant recipients who underwent NIRS-IVUS and IVUS. Patients were stratified according to the median maximum LCBI in a 4-mm segment (maxLCBI) of 223 at 1 month. The magnitude of maximal intimal thickness (MIT) progression was greater in the higher maxLCBIgroup.nnCONCLUSIONS: Patients with a higher maxLCBIat baseline exhibited greater MIT progression during the first post-transplant year.
@article{pmid42036323,
title = {Prognostic Value of Mid-Range QRS Duration in Patients With Heart Failure With Reduced Ejection Fraction},
author = {Shota Saito and Taro Temma and Toshiyuki Nagai and Motoki Nakao and Isao Yokota and Atsushi Tada and Taro Koya and Suguru Ishizaka and Yoshifumi Mizuguchi and Fusako George and Yoshiya Kato and Yuki Takahashi and Shogo Imagawa and Ko Motoi and Yusuke Tokuda and Junichi Matsumoto and Masashige Takahashi and Hiroshi Okamoto and Masaharu Machida and Takahiko Saito and Toshihiro Shimizu and Toshihisa Anzai},
doi = {10.1253/circj.CJ-25-1084},
issn = {1347-4820},
year = {2026},
date = {2026-04-01},
urldate = {2026-04-01},
journal = {Circ J},
abstract = {BACKGROUND: Prolonged QRS is an established marker of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic significance of modest QRS prolongation (120-149 ms; mid-range QRS) remains unclear, especially in patients without cardiac implantable electronic devices (CIEDs). This study assessed the natural prognosis associated with mid-range QRS compared with narrow QRS (<120 ms) in a recent Asian cohort of patients with HFrEF.nnMETHODS AND RESULTS: We analyzed patients with HFrEF from the Epidemiological Multicenter Study for Tailored Treatment in Heart Failure (ELMSTAT-HF; January 2020-October 2023). QRS was measured from 12-lead electrocardiograms. Patients with wide QRS (≥150 ms) or CIEDs were excluded. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. Multivariable Cox models adjusted for the MAGGIC risk score and log-transformed N-terminal pro B-type natriuretic peptide were used. Among 415 patients, 328 had narrow QRS and 87 had mid-range QRS. Over a median follow-up of 547 days, the primary outcome occurred more frequently in the mid-range QRS group (34.5% vs. 12.5%; P<0.001). Mid-range QRS remained independently associated with adverse outcomes (hazard ratio 3.12; 95% confidence interval 1.91-5.11), consistent across non-left bundle branch block (LBBB) and LBBB subgroups.nnCONCLUSIONS: Mid-range QRS is an independent predictor of adverse outcomes in HFrEF, even in the absence of LBBB.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Prolonged QRS is an established marker of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic significance of modest QRS prolongation (120-149 ms; mid-range QRS) remains unclear, especially in patients without cardiac implantable electronic devices (CIEDs). This study assessed the natural prognosis associated with mid-range QRS compared with narrow QRS (<120 ms) in a recent Asian cohort of patients with HFrEF.nnMETHODS AND RESULTS: We analyzed patients with HFrEF from the Epidemiological Multicenter Study for Tailored Treatment in Heart Failure (ELMSTAT-HF; January 2020-October 2023). QRS was measured from 12-lead electrocardiograms. Patients with wide QRS (≥150 ms) or CIEDs were excluded. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. Multivariable Cox models adjusted for the MAGGIC risk score and log-transformed N-terminal pro B-type natriuretic peptide were used. Among 415 patients, 328 had narrow QRS and 87 had mid-range QRS. Over a median follow-up of 547 days, the primary outcome occurred more frequently in the mid-range QRS group (34.5% vs. 12.5%; P<0.001). Mid-range QRS remained independently associated with adverse outcomes (hazard ratio 3.12; 95% confidence interval 1.91-5.11), consistent across non-left bundle branch block (LBBB) and LBBB subgroups.nnCONCLUSIONS: Mid-range QRS is an independent predictor of adverse outcomes in HFrEF, even in the absence of LBBB.
@article{pmid41882902,
title = {The Diagnosis and Management of Cardiac Sarcoidosis},
author = {Toshiyuki Nagai and Toshifumi Tamura and Toshihisa Anzai},
doi = {10.2169/internalmedicine.7161-26},
issn = {1349-7235},
year = {2026},
date = {2026-03-01},
urldate = {2026-03-01},
journal = {Intern Med},
abstract = {Sarcoidosis is a systemic granulomatous inflammatory disorder. Cardiac sarcoidosis (CS) is a clinically important manifestation that may lead to conduction disease, ventricular tachyarrhythmias, heart failure, and sudden cardiac death. The recognition of CS has increased with advances in cardiac imaging; however, its diagnosis and management remain challenging. This review summarizes the contemporary concepts of CS pathophysiology, emphasizing the coexistence of active inflammation and myocardial scarring that develops a dynamic arrhythmogenic substrate. We outline practical diagnostic strategies, including when CS is suspected, the current diagnostic criteria, and the complementary roles and limitations of electrocardiography, echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. Management is discussed across three pillars: namely, immunosuppressive therapy centered on corticosteroids, heart failure therapy based on current guidelines, arrhythmia management incorporating pacing, implantable cardioverter-defibrillator therapy, and catheter ablation. Emerging evidence supporting imaging-guided risk stratification beyond conventional left ventricular ejection fraction thresholds has been highlighted.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sarcoidosis is a systemic granulomatous inflammatory disorder. Cardiac sarcoidosis (CS) is a clinically important manifestation that may lead to conduction disease, ventricular tachyarrhythmias, heart failure, and sudden cardiac death. The recognition of CS has increased with advances in cardiac imaging; however, its diagnosis and management remain challenging. This review summarizes the contemporary concepts of CS pathophysiology, emphasizing the coexistence of active inflammation and myocardial scarring that develops a dynamic arrhythmogenic substrate. We outline practical diagnostic strategies, including when CS is suspected, the current diagnostic criteria, and the complementary roles and limitations of electrocardiography, echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. Management is discussed across three pillars: namely, immunosuppressive therapy centered on corticosteroids, heart failure therapy based on current guidelines, arrhythmia management incorporating pacing, implantable cardioverter-defibrillator therapy, and catheter ablation. Emerging evidence supporting imaging-guided risk stratification beyond conventional left ventricular ejection fraction thresholds has been highlighted.
@article{Sasaki2026,
title = {Modular driveline cable exchange due to internal cable damage in a patient with HeartMate 3: a case report},
author = {So Sasaki and Sakae Takenaka and Toshiyuki Nagai and Toshihisa Anzai},
editor = {Vincenzo Nyuzzi and Dan Octavian Nistor and Ahmad Jomaa},
doi = {10.1093/ehjcr/ytag076},
issn = {2514-2119},
year = {2026},
date = {2026-02-02},
urldate = {2026-02-02},
volume = {10},
number = {2},
publisher = {Oxford University Press (OUP)},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{pmid41547482,
title = {Prognostic value of F-fluorodeoxyglucose positron emission tomography one month after initiation of prednisolone therapy in patients with cardiac sarcoidosis},
author = {Toshifumi Tamura and Sakae Takenaka and Toshiyuki Nagai and Satonori Tsuneta and Takeshi Hamaya and Kenji Hirata and Yoshiya Kato and Hirokazu Komoriyama and Yuta Kobayashi and Atsushi Tada and Sho Kazui and Yutaro Yasui and Akinori Takahashi and Kiwamu Kamiya and Taro Temma and Takahiro Sato and Ichizo Tsujino and Kohsuke Kudo and Satoshi Konno and Toshihisa Anzai},
doi = {10.1016/j.ijcard.2026.134181},
issn = {1874-1754},
year = {2026},
date = {2026-01-01},
urldate = {2026-01-01},
journal = {Int J Cardiol},
pages = {134181},
abstract = {BACKGROUND: Current guidelines for cardiac sarcoidosis (CS) recommend maintaining the initial maximal dose of prednisolone (PSL) for one month after initiation; however, the prognostic significance of F-fluorodeoxyglucose positron emission tomography (FDG-PET) performed at this time point remains unclear. We sought to investigate whether FDG-PET performed at one month after the initiation of PSL is associated with adverse events in patients with CS.nnMETHODS: We examined 109 consecutive CS patients who underwent FDG-PET at diagnosis and one month after initiating PSL between January 2010 and January 2025 in a university hospital. The change in maximum standardized uptake value (SUV) from baseline to one month was calculated. Responder was defined as those with an SUV reduction ≥25%, while non-responder had a reduction <25% or any increase. The primary outcome was a composite of aborted sudden cardiac death, sustained ventricular tachycardia, hospitalization of worsening heart failure, and all-cause death.nnRESULTS: Of the 109 patients, 83 were classified as responder and 26 as non-responder. Over a median follow-up of 4.9 years (interquartile range, 2.3-8.2), the primary outcome occurred in 37 patients. Non-responder had a significantly higher risk of the primary outcome, and this association persisted after sequential adjustment for established prognostic covariates.nnCONCLUSIONS: An inadequate reduction in SUV on FDG-PET performed one month after PSL initiation was independently associated with adverse clinical events in patients with CS. These findings suggest that non-responder represents a clinical challenge and even very early follow-up FDG-PET may provide prognostic insights.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Current guidelines for cardiac sarcoidosis (CS) recommend maintaining the initial maximal dose of prednisolone (PSL) for one month after initiation; however, the prognostic significance of F-fluorodeoxyglucose positron emission tomography (FDG-PET) performed at this time point remains unclear. We sought to investigate whether FDG-PET performed at one month after the initiation of PSL is associated with adverse events in patients with CS.nnMETHODS: We examined 109 consecutive CS patients who underwent FDG-PET at diagnosis and one month after initiating PSL between January 2010 and January 2025 in a university hospital. The change in maximum standardized uptake value (SUV) from baseline to one month was calculated. Responder was defined as those with an SUV reduction ≥25%, while non-responder had a reduction <25% or any increase. The primary outcome was a composite of aborted sudden cardiac death, sustained ventricular tachycardia, hospitalization of worsening heart failure, and all-cause death.nnRESULTS: Of the 109 patients, 83 were classified as responder and 26 as non-responder. Over a median follow-up of 4.9 years (interquartile range, 2.3-8.2), the primary outcome occurred in 37 patients. Non-responder had a significantly higher risk of the primary outcome, and this association persisted after sequential adjustment for established prognostic covariates.nnCONCLUSIONS: An inadequate reduction in SUV on FDG-PET performed one month after PSL initiation was independently associated with adverse clinical events in patients with CS. These findings suggest that non-responder represents a clinical challenge and even very early follow-up FDG-PET may provide prognostic insights.
@article{pmid41566075,
title = {Prognostic value of preprocedural pulmonary artery to ascending aorta ratio on non-contrast computed tomography in patients undergoing mitral transcatheter edge-to-edge repair},
author = {Hiroki Uehara and Toshiyuki Nagai and So Sasaki and Kento Tamano and Toshifumi Tamura and Akinori Takahashi and Takeshi Hamaya and Yuki Mori and Yutaro Yasui and Sakae Takenaka and Satonori Tsuneta and Suguru Ishizaka and Yuta Kobayashi and Atsushi Tada and Taro Temma and Kiwamu Kamiya and Toshihisa Anzai},
doi = {10.1007/s00380-025-02649-w},
issn = {1615-2573},
year = {2026},
date = {2026-01-01},
urldate = {2026-01-01},
journal = {Heart Vessels},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{<LineBreak>doi:10.1161/CIRCULATIONAHA.125.078277,
title = {Rapidly Progressive Pulmonary Hypertension: Importance of Vascular Disease Distribution},
author = {Atsushi Tada and Ahmed U. Fayyaz and Yogesh N. V. Reddy and Margaret M. Redfield and Barry A. Borlaug},
url = {https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.078277},
doi = {10.1161/CIRCULATIONAHA.125.078277},
year = {2026},
date = {2026-01-01},
urldate = {2026-01-01},
journal = {Circulation},
volume = {153},
number = {4},
pages = {285-289},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{AGATA2026c,
title = {Steroid-Refractory Fulminant Lymphocytic Myocarditis Successfully Treated With Tacrolimus Guided by Serial Cardiac Magnetic Resonance Imaging},
author = {Yu Agata and Atsushi Tada and Satonori Tsuneta and Noriyuki Otsuka and Utano Tomaru and Rui Katano and Kenta Otsuka and Yutaro Yasui and Toshiyuki Nagai and Kohsuke Kudo and Shinya Tanaka and Toshihisa Anzai},
url = {https://www.sciencedirect.com/science/article/pii/S2589790X26001733},
doi = {https://doi.org/10.1016/j.cjco.2026.05.003},
issn = {2589-790X},
year = {2026},
date = {2026-01-01},
urldate = {2026-01-01},
journal = {CJC Open},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{Agata2026,
title = {Intermittent Mechanical Aortic Valve Sticking Due to Pannus Formation Complicated by Coronary Embolism and Cardiac Arrest},
author = {Yu Agata and Atsushi Tada and Hiroshi Sugiki and Koji Sato and Rui Katano and Kenta Otsuka and Yutaro Yasui and Suguru Ishizaka and Toshiyuki Nagai and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1016/j.cjca.2026.01.010},
issn = {0828-282X},
year = {2026},
date = {2026-01-00},
urldate = {2026-01-00},
journal = {Canadian Journal of Cardiology},
publisher = {Elsevier BV},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{Agata2026b,
title = {Intermittent Mechanical Aortic Valve Sticking Due to Pannus Formation Complicated by Coronary Embolism and Cardiac Arrest},
author = {Yu Agata and Atsushi Tada and Hiroshi Sugiki and Koji Sato and Rui Katano and Kenta Otsuka and Yutaro Yasui and Suguru Ishizaka and Toshiyuki Nagai and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1016/j.cjca.2026.01.010},
issn = {0828-282X},
year = {2026},
date = {2026-01-00},
urldate = {2026-01-00},
journal = {Canadian Journal of Cardiology},
publisher = {Elsevier BV},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{pmid41067379,
title = {Blood Flow Dynamics of Self-Expanding versus Balloon-Expandable Transcatheter Aortic Valve Replacement in Patients with a Small Aortic Annulus},
author = {Takeshi Hamaya and Kiwamu Kamiya and Toshiyuki Nagai and Satonori Tsuneta and Noriko Oyama-Manabe and Hirokazu Komoriyama and Yuki Takahashi and Akinori Takahashi and Yuki Mori and Yoshifumi Mizuguchi and Sakae Takenaka and Suguru Ishizaka and Takuma Sato and Taro Temma and Yasushige Shingu and Kohsuke Kudo and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1016/j.cjca.2025.09.046},
issn = {1916-7075},
year = {2025},
date = {2025-10-01},
urldate = {2025-10-01},
journal = {Can J Cardiol},
abstract = {BACKGROUND: A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).nnMETHODS: We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR.nnRESULTS: In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups.nnCONCLUSIONS: In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).nnMETHODS: We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR.nnRESULTS: In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups.nnCONCLUSIONS: In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.
@article{pmid40803609,
title = {Neuropeptide Y Drives Ventricular Arrhythmogenesis in Chronic Ischemic Heart Failure via Calcium Mishandling},
author = {Jiro Koya and Taro Temma and Kei Kawakami and Fuyuki Karube and Zen-Ichi Tanei and Masahiro Kawasaki and Kintaro Shimano and Shota Saito and Daishiro Tatsuta and Kotaro Nishino and Hiroyuki Natsui and Takahide Kadosaka and Taro Koya and Motoki Nakao and Masaya Watanabe and Kiwamu Kamiya and Toshiyuki Nagai and Shinya Tanaka and Fumino Fujiyama and Toshihisa Anzai},
doi = {10.1016/j.hrthm.2025.08.011},
issn = {1556-3871},
year = {2025},
date = {2025-08-01},
urldate = {2025-08-01},
journal = {Heart Rhythm},
abstract = {BACKGROUND: Ventricular arrhythmias (VAs) in chronic ischemic heart failure (HF) are associated with high mortality and often refractory to β-blocker treatment, highliting the need for alternative therapeutic targets.nnOBJECTIVE: This study investigates the role of neuropeptide Y (NPY), a neurotransmitter released during sympathoexcitation, in the pathogenesis of VAs associated with ischemic chronic HF following myocardial infarction (MI).nnMETHODS: Using a mouse model of ischemic chronic HF after coronary ligation, we employed biochemical, electrophysiological, and calcium (Ca) imaging analyses to investigate the proarrhythmic mechanisms of NPY.nnRESULTS: Immunohistochemical staining revealed a significantly elevated NPY expression in both the MI and border zone, consistent with findings in human autopsy samples. In cardiomyocytes isolated from ischemic HF mice, NPY treatment increased Ca waves at a dose that did not elicit this response in normal heart cardiomyocytes, an effect suppressed by NPY Y1 receptor blocker. Additionally, the NPY treatment elevated the frequency of delayed afterdepolarizations at the membrane potential level. Similarly, NPY induced VAs that were suppressed by the NPY Y1 receptor blocker in Langendorff-perfused chronic ischemic failed hearts at a concentration that had no effect in normal hearts.nnCONCLUSION: We identified structural and functional changes in NPY within an chronic ischemic HF model, leading to increased arrhythmogenicity through Ca mishandling. Therefore, targeting NPY signaling may offer a novel therapeutic approach for treating VAs in patients with chronic ischemic HF.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Ventricular arrhythmias (VAs) in chronic ischemic heart failure (HF) are associated with high mortality and often refractory to β-blocker treatment, highliting the need for alternative therapeutic targets.nnOBJECTIVE: This study investigates the role of neuropeptide Y (NPY), a neurotransmitter released during sympathoexcitation, in the pathogenesis of VAs associated with ischemic chronic HF following myocardial infarction (MI).nnMETHODS: Using a mouse model of ischemic chronic HF after coronary ligation, we employed biochemical, electrophysiological, and calcium (Ca) imaging analyses to investigate the proarrhythmic mechanisms of NPY.nnRESULTS: Immunohistochemical staining revealed a significantly elevated NPY expression in both the MI and border zone, consistent with findings in human autopsy samples. In cardiomyocytes isolated from ischemic HF mice, NPY treatment increased Ca waves at a dose that did not elicit this response in normal heart cardiomyocytes, an effect suppressed by NPY Y1 receptor blocker. Additionally, the NPY treatment elevated the frequency of delayed afterdepolarizations at the membrane potential level. Similarly, NPY induced VAs that were suppressed by the NPY Y1 receptor blocker in Langendorff-perfused chronic ischemic failed hearts at a concentration that had no effect in normal hearts.nnCONCLUSION: We identified structural and functional changes in NPY within an chronic ischemic HF model, leading to increased arrhythmogenicity through Ca mishandling. Therefore, targeting NPY signaling may offer a novel therapeutic approach for treating VAs in patients with chronic ischemic HF.
@article{pmid40680495,
title = {Clinical Phenotyping and Treatment Response in Patients With Chronic Heart Failure},
author = {Daishiro Tatsuta and Motoki Nakao and Toshiyuki Nagai and Yoshifumi Mizuguchi and Isao Yokota and Taro Koya and Atsushi Tada and Suguru Ishizaka and Fusako George and Yoshiya Kato and Shogo Imagawa and Ko Motoi and Yusuke Tokuda and Masashige Takahashi and Junichi Matsumoto and Masaharu Machida and Hiroshi Okamoto and Takahiko Saito and Toshihisa Anzai},
doi = {10.1016/j.jacadv.2025.101972},
issn = {2772-963X},
year = {2025},
date = {2025-07-01},
urldate = {2025-07-01},
journal = {JACC Adv},
volume = {4},
number = {8},
pages = {101972},
abstract = {BACKGROUND: There are little data on clinically meaningful heart failure (HF) phenogroups, which are associated with treatment response across the wide spectrum of left ventricular (LV) ejection fraction.nnOBJECTIVES: The authors aimed to identify the phenotypes of patients with HF with different prognoses and responses to medical therapies.nnMETHODS: We examined consecutive 2,301 chronic HF patients from the ELMSTAT-HF (EpidemioLogical Multicenter Study for Tailored Treatment in Heart Failure) registry, a prospective multicenter cohort in which 2,317 patients were enrolled between January 2020 and September 2024. Latent class analysis was performed using 99 clinical features. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.nnRESULTS: The analysis subclassified the patients into 8 phenogroups: group 1, characterized by younger age with obesity; 2, less structural abnormality and comorbidity; 3, younger age with LV dilation; 4, LV hypertrophy; 5, older age with small LV and diastolic dysfunction; 6, ischemic cardiomyopathy; 7, advanced LV remodeling and ventricular arrhythmias; and 8, atrial myopathy. During a median follow-up of 597 (IQR: 302-932) days, the incidence of the primary outcome significantly differed between the phenogroups (P < 0.001). In phenogroup 5, patients taking beta-blockers or sodium-glucose cotransporter 2 inhibitors had a significantly higher rate of hospitalization for worsening HF (HR: 2.20; 95% CI: 1.04-4.68; HR: 4.27; 95% CI: 2.02-9.05, respectively).nnCONCLUSIONS: We identified 8 phenogroups with distinct clinical outcomes in patients with HF. This phenotyping provides appropriate risk stratification and may aid clinical decision-making in patients with HF.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: There are little data on clinically meaningful heart failure (HF) phenogroups, which are associated with treatment response across the wide spectrum of left ventricular (LV) ejection fraction.nnOBJECTIVES: The authors aimed to identify the phenotypes of patients with HF with different prognoses and responses to medical therapies.nnMETHODS: We examined consecutive 2,301 chronic HF patients from the ELMSTAT-HF (EpidemioLogical Multicenter Study for Tailored Treatment in Heart Failure) registry, a prospective multicenter cohort in which 2,317 patients were enrolled between January 2020 and September 2024. Latent class analysis was performed using 99 clinical features. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.nnRESULTS: The analysis subclassified the patients into 8 phenogroups: group 1, characterized by younger age with obesity; 2, less structural abnormality and comorbidity; 3, younger age with LV dilation; 4, LV hypertrophy; 5, older age with small LV and diastolic dysfunction; 6, ischemic cardiomyopathy; 7, advanced LV remodeling and ventricular arrhythmias; and 8, atrial myopathy. During a median follow-up of 597 (IQR: 302-932) days, the incidence of the primary outcome significantly differed between the phenogroups (P < 0.001). In phenogroup 5, patients taking beta-blockers or sodium-glucose cotransporter 2 inhibitors had a significantly higher rate of hospitalization for worsening HF (HR: 2.20; 95% CI: 1.04-4.68; HR: 4.27; 95% CI: 2.02-9.05, respectively).nnCONCLUSIONS: We identified 8 phenogroups with distinct clinical outcomes in patients with HF. This phenotyping provides appropriate risk stratification and may aid clinical decision-making in patients with HF.
Tada, Atsushi; Omote, Kazunori; Fayyaz, Ahmed U; Simard, Trevor J; Miranda, William R; Naser, Jwan A; Reddy, Yogesh N V; Redfield, Margaret M; Borlaug, Barry A
@article{Tada2025,
title = {Pulmonary arterial wedge pressure exceeding left atrial pressure: clinical implications},
author = {Atsushi Tada and Kazunori Omote and Ahmed U Fayyaz and Trevor J Simard and William R Miranda and Jwan A Naser and Yogesh N V Reddy and Margaret M Redfield and Barry A Borlaug},
doi = {10.1093/eurheartj/ehaf392},
issn = {1522-9645},
year = {2025},
date = {2025-06-24},
urldate = {2025-06-24},
publisher = {Oxford University Press (OUP)},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{pmid40451836,
title = {Chronic Active Myocarditis and Inflammatory Cardiomyopathy - Challenges in Diagnosis and Treatment},
author = {Toshiyuki Nagai and Masato Katsuki and Kisaki Amemiya and Akinori Takahashi and Noriko Oyama-Manabe and Keiko Ohta-Ogo and Kyoko Imanaka-Yoshida and Hatsue Ishibashi-Ueda and Toshihisa Anzai},
doi = {10.1253/circj.CJ-25-0246},
issn = {1347-4820},
year = {2025},
date = {2025-05-01},
urldate = {2025-05-01},
journal = {Circ J},
abstract = {Myocarditis is a heterogeneous disease with diverse etiologies and clinical trajectories. Traditionally, its diagnosis has been guided by the Dallas criteria, which focus on histopathological features. Clinically, myocarditis is categorized as acute or chronic based on the duration since symptom onset. However, recent expert consensus, particularly in Western countries, has redefined myocarditis as either acute myocarditis or chronic inflammatory cardiomyopathy, including inflammatory dilated cardiomyopathy, reflecting advancements in viral genome analysis and histopathology. In 2023, the Japanese Circulation Society proposed the concept of chronic active myocarditis, a high-risk phenotype characterized by persistent inflammation and ongoing cardiomyocyte injury. The transition from acute myocarditis to its chronic phase involves complex immune mechanisms, with sustained myocardial inflammation driving ventricular remodeling and progression to heart failure. Cardiac magnetic resonance imaging and endomyocardial biopsy remain pivotal diagnostic modalities, though their diagnostic yield varies according to disease phase. Management strategies focus on heart failure treatment, arrhythmia control, and, in select cases, immunosuppressive therapy, particularly for virus-negative inflammatory cardiomyopathy. Although antiviral therapy has shown promise, its clinical efficacy remains uncertain. Given the evolving understanding of the chronic phase of myocarditis, further research is warranted to refine the diagnostic criteria and optimize personalized therapeutic strategies. This review gives a comprehensive overview of the pathophysiology, classification, and management of chronic myocarditis, with an emphasis on emerging disease concepts and their clinical implications.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Myocarditis is a heterogeneous disease with diverse etiologies and clinical trajectories. Traditionally, its diagnosis has been guided by the Dallas criteria, which focus on histopathological features. Clinically, myocarditis is categorized as acute or chronic based on the duration since symptom onset. However, recent expert consensus, particularly in Western countries, has redefined myocarditis as either acute myocarditis or chronic inflammatory cardiomyopathy, including inflammatory dilated cardiomyopathy, reflecting advancements in viral genome analysis and histopathology. In 2023, the Japanese Circulation Society proposed the concept of chronic active myocarditis, a high-risk phenotype characterized by persistent inflammation and ongoing cardiomyocyte injury. The transition from acute myocarditis to its chronic phase involves complex immune mechanisms, with sustained myocardial inflammation driving ventricular remodeling and progression to heart failure. Cardiac magnetic resonance imaging and endomyocardial biopsy remain pivotal diagnostic modalities, though their diagnostic yield varies according to disease phase. Management strategies focus on heart failure treatment, arrhythmia control, and, in select cases, immunosuppressive therapy, particularly for virus-negative inflammatory cardiomyopathy. Although antiviral therapy has shown promise, its clinical efficacy remains uncertain. Given the evolving understanding of the chronic phase of myocarditis, further research is warranted to refine the diagnostic criteria and optimize personalized therapeutic strategies. This review gives a comprehensive overview of the pathophysiology, classification, and management of chronic myocarditis, with an emphasis on emerging disease concepts and their clinical implications.
@article{pmid40456426,
title = {Impact of Right Ventricular Reserve Function During Exercise on Aortic Valve Opening in Patients with Left Ventricular Assist Device},
author = {Sakae Takenaka and Takuma Sato and Toshiyuki Nagai and Atsushi Tada and Yuta Kobayashi and Sho Kazui and Yutaro Yasui and Takeshi Hamaya and Yuki Mori and Akinori Takahashi and Suguru Ishizaka and Takao Konishi and Taro Temma and Kiwamu Kamiya and Tomonori Ooka and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1016/j.healun.2025.05.009},
issn = {1557-3117},
year = {2025},
date = {2025-05-01},
urldate = {2025-05-01},
journal = {J Heart Lung Transplant},
abstract = {BACKGROUND: Although aortic valve (AV) opening during exercise has fewer adverse events in patients with a left ventricular (LV) assist device (LVAD), factors associated with it remains unclear. We hypothesized that right ventricular (RV) reserve function is associated with the AV opening status. This study aimed to explore the hemodynamic parameters observed at rest and during maximal exercise and investigate the association between the RV reserve function and AV opening status in patients with an LVAD.nnMETHODS: We prospectively examined 25 consecutive patients with an LVAD who underwent invasive exercise right heart catheterization with simultaneous echocardiography in the supine position. The AV opening status was assessed at rest and during exercise. The change in RV stroke work index (RVSWI) from rest to peak exercise (ΔRVSWI) was calculated to assess the RV reserve function. Patients were divided into three groups according to AV opening: AV opening both at rest and during exercise (n = 7), AV opening during exercise only (n = 8), and closed AV (n = 10).nnRESULTS: Patients with a closed AV had significantly lower ΔRVSWI and ΔRV dP/dt max than those with AV opening both at rest and during exercise and AV opening during exercise only, whereas changes in pulmonary artery wedge pressure and pulmonary vascular resistance were comparable across the groups. In a multivariable logistic regression analysis, ΔRVSWI was independently associated with AV opening even after adjustment for the change in LV ejection fraction from rest to peak exercise. During a median follow-up period of 743 (interquartile range, 483-1,037) days, the incidence of adverse events was higher in patients in the closed AV group than in those in the AV opening groups (p = 0.002).nnCONCLUSIONS: RV reserve function is associated with AV opening status in patients with an LVAD.nnCLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp/ctr/index.htm. Unique Identifier: UMIN000039001.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although aortic valve (AV) opening during exercise has fewer adverse events in patients with a left ventricular (LV) assist device (LVAD), factors associated with it remains unclear. We hypothesized that right ventricular (RV) reserve function is associated with the AV opening status. This study aimed to explore the hemodynamic parameters observed at rest and during maximal exercise and investigate the association between the RV reserve function and AV opening status in patients with an LVAD.nnMETHODS: We prospectively examined 25 consecutive patients with an LVAD who underwent invasive exercise right heart catheterization with simultaneous echocardiography in the supine position. The AV opening status was assessed at rest and during exercise. The change in RV stroke work index (RVSWI) from rest to peak exercise (ΔRVSWI) was calculated to assess the RV reserve function. Patients were divided into three groups according to AV opening: AV opening both at rest and during exercise (n = 7), AV opening during exercise only (n = 8), and closed AV (n = 10).nnRESULTS: Patients with a closed AV had significantly lower ΔRVSWI and ΔRV dP/dt max than those with AV opening both at rest and during exercise and AV opening during exercise only, whereas changes in pulmonary artery wedge pressure and pulmonary vascular resistance were comparable across the groups. In a multivariable logistic regression analysis, ΔRVSWI was independently associated with AV opening even after adjustment for the change in LV ejection fraction from rest to peak exercise. During a median follow-up period of 743 (interquartile range, 483-1,037) days, the incidence of adverse events was higher in patients in the closed AV group than in those in the AV opening groups (p = 0.002).nnCONCLUSIONS: RV reserve function is associated with AV opening status in patients with an LVAD.nnCLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp/ctr/index.htm. Unique Identifier: UMIN000039001.
@article{pmid40025059,
title = {Impact of snowfall on emergency medical system and mortality in patients with acute coronary syndrome},
author = {Yuki Mori and Sakae Takenaka and Toshiyuki Nagai and Kohei Saiin and Akinori Takahashi and Yoshifumi Mizuguchi and Takao Konishi and Toshihisa Anzai and Daisuke Hotta and Mitsunori Kamigaki and Seiji Yamazaki and Tsutomu Fujita and Takehiro Yamashita and Kandoh Kawahatsu and Takashi Suzuki and Yoichi Nozaki and Taku Sakurada and Takashi Takenaka and Yasumi Igarashi and Takao Makino},
doi = {10.1038/s41598-025-91092-y},
issn = {2045-2322},
year = {2025},
date = {2025-03-01},
urldate = {2025-03-01},
journal = {Sci Rep},
volume = {15},
number = {1},
pages = {7262},
abstract = {Acute coronary syndrome (ACS) requires rapid transportation by the emergency medical system (EMS). In snowy areas, traffic conditions may delay EMS transport times and increase mortality rate of ACS. However, there is a paucity of systemic data showing how snowfall affects the EMS and mortality in patients with ACS. This study aimed to investigate the impact of snowfall on the EMS transport times and in-hospital death in patients with ACS. We examined 2387 consecutive ACS patients who were transported via EMS to hospitals participating in the Sapporo City ACS network between April 2013 and April 2023. The patients were divided into two groups based on their arrival on either a snowy day (n = 612, 26%) or a non-snowy day (n = 1775, 74%), as determined by historical weather records from the Japan Meteorological Agency for the Sapporo area. The median age was 68 years, 1754 (74.6%) patients were male. Patients in the snowy day group had longer median time from an EMS call to hospital than those in the non-snowy day group (33 min [IQR 26-40] vs. 29 min [IQR 24-36], P < 0.001). Quantity of snowfall was associated with a delayed time from EMS call to hospital. The proportion of in-hospital death was higher in the snowy day group compared to the non-snowy day group (7.3% vs. 4.6%, P = 0.011). Multivariable logistic regression analysis showed that the snowfall was independently associated with higher incidence of in-hospital death (odds ratio 1.57, 95% confidence interval 1.00-2.47, P = 0.048). In conclusion, snowfall had a significant impact on the EMS and mortality in patients with ACS in an urban city in Japan.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Acute coronary syndrome (ACS) requires rapid transportation by the emergency medical system (EMS). In snowy areas, traffic conditions may delay EMS transport times and increase mortality rate of ACS. However, there is a paucity of systemic data showing how snowfall affects the EMS and mortality in patients with ACS. This study aimed to investigate the impact of snowfall on the EMS transport times and in-hospital death in patients with ACS. We examined 2387 consecutive ACS patients who were transported via EMS to hospitals participating in the Sapporo City ACS network between April 2013 and April 2023. The patients were divided into two groups based on their arrival on either a snowy day (n = 612, 26%) or a non-snowy day (n = 1775, 74%), as determined by historical weather records from the Japan Meteorological Agency for the Sapporo area. The median age was 68 years, 1754 (74.6%) patients were male. Patients in the snowy day group had longer median time from an EMS call to hospital than those in the non-snowy day group (33 min [IQR 26-40] vs. 29 min [IQR 24-36], P < 0.001). Quantity of snowfall was associated with a delayed time from EMS call to hospital. The proportion of in-hospital death was higher in the snowy day group compared to the non-snowy day group (7.3% vs. 4.6%, P = 0.011). Multivariable logistic regression analysis showed that the snowfall was independently associated with higher incidence of in-hospital death (odds ratio 1.57, 95% confidence interval 1.00-2.47, P = 0.048). In conclusion, snowfall had a significant impact on the EMS and mortality in patients with ACS in an urban city in Japan.
@article{pmid39923998,
title = {Prognostic Value of Reticulocyte Production Ability in Patients with Chronic Heart Failure},
author = {Motoki Nakao and Toshiyuki Nagai and Atsushi Tada and Taro Koya and Suguru Ishizaka and Yoshifumi Mizuguchi and Fusako George and Yoshiya Kato and Shogo Imagawa and Yusuke Tokuda and Masashige Takahashi and Junichi Matsumoto and Ko Motoi and Hiroshi Okamoto and Masaharu Machida and Takahiko Saito and Toshihisa Anzai},
doi = {10.1016/j.cjca.2025.02.004},
issn = {1916-7075},
year = {2025},
date = {2025-02-01},
urldate = {2025-02-01},
journal = {Can J Cardiol},
abstract = {BACKGROUND: Anemia is frequently observed and associated with mortality in patients with heart failure (HF). Although the quality of erythropoiesis is an intrinsic aspect of anemia's pathophysiology, its prognostic value in HF patients is unclear.nnMETHODS: Between January 2020 and October 2023, 1,328 symptomatic patients with chronic HF from a multicenter registry were prospectively examined. The reticulocyte production ability was evaluated by calculating the reticulocyte production index (RPI) using reticulocyte counts and serum hematocrit level. Patients were divided into four groups based on the presence or absence of anemia and the median RPI. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.nnRESULTS: During a median follow-up of 551 (interquartile range 321-712) days, the primary outcome occurred in 219 patients. The incidence of the primary outcome was high among patients in the anemia and higher RPI group (≥ 0.978) (P <0.001). Higher RPI was independently associated with a higher risk of the primary outcome, even after adjusting for prognostic covariates (adjusted HR 1.37; 95% CI 1.05-1.78). Erythrocyte counts were significantly higher in patients with higher RPI in the groups without anemia (P <0.001); however, no significant differences were observed between the groups with anemia (P = 0.923). Serum iron levels and transferrin saturation did not significantly differ between the RPI groups with or without anemia.nnCONCLUSIONS: Higher RPI, which may reflect impaired maturation or a shortened lifespan of erythrocytes, was associated with worse clinical outcomes in HF patients irrespective of iron status.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Anemia is frequently observed and associated with mortality in patients with heart failure (HF). Although the quality of erythropoiesis is an intrinsic aspect of anemia's pathophysiology, its prognostic value in HF patients is unclear.nnMETHODS: Between January 2020 and October 2023, 1,328 symptomatic patients with chronic HF from a multicenter registry were prospectively examined. The reticulocyte production ability was evaluated by calculating the reticulocyte production index (RPI) using reticulocyte counts and serum hematocrit level. Patients were divided into four groups based on the presence or absence of anemia and the median RPI. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.nnRESULTS: During a median follow-up of 551 (interquartile range 321-712) days, the primary outcome occurred in 219 patients. The incidence of the primary outcome was high among patients in the anemia and higher RPI group (≥ 0.978) (P <0.001). Higher RPI was independently associated with a higher risk of the primary outcome, even after adjusting for prognostic covariates (adjusted HR 1.37; 95% CI 1.05-1.78). Erythrocyte counts were significantly higher in patients with higher RPI in the groups without anemia (P <0.001); however, no significant differences were observed between the groups with anemia (P = 0.923). Serum iron levels and transferrin saturation did not significantly differ between the RPI groups with or without anemia.nnCONCLUSIONS: Higher RPI, which may reflect impaired maturation or a shortened lifespan of erythrocytes, was associated with worse clinical outcomes in HF patients irrespective of iron status.
@article{pmid39656827,
title = {Effect of Low-dose Administration of Carperitide for Acute Heart Failure: the LASCAR-AHF trial},
author = {Satoshi Honda and Toshiyuki Nagai and Yasuyuki Honda and Hiroki Nakano and Takanori Kawabata and Hirotada Maeda and Koko Asakura and Naotsugu Iwakami and Sakae Takenaka and Yoshiya Kato and Yusuke Tokuda and Takafumi Yamane and Yutaka Furukawa and Takeshi Kitai and Yasuhide Asaumi and Shuzo Nishihara and Atsushi Mizuno and Tetsuo Yamaguchi and Teruo Noguchi and Satoshi Yasuda and Toshihisa Anzai},
doi = {10.1093/ehjacc/zuae140},
issn = {2048-8734},
year = {2024},
date = {2024-12-01},
urldate = {2024-12-01},
journal = {Eur Heart J Acute Cardiovasc Care},
abstract = {BACKGROUND: The effects of low-dose carperitide on long-term clinical outcomes of patients with acute heart failure (AHF) have not yet been fully elucidated. This study aimed to evaluate the effects of low-dose intravenous carperitide on the long-term clinical outcomes of patients with AHF.nnMETHODS: In this multicentre, open-label, randomised controlled trial, 247 patients with AHF received low-dose carperitide intravenously with standard treatment or a matching standard treatment for 72 h from November 2014 to March 2021 across nine sites in Japan. The primary endpoint was a composite of all-cause death and heart failure hospitalisation within 2 years.nnRESULTS: The primary endpoint was observed in 36 of 122 patients (29.5%) and 35 of 125 patients (28.0%) in the carperitide group and standard treatment groups, respectively (hazard ratio 1.26; 95% confidence interval (CI) 0.78-2.06, P = 0.827). No significant differences were observed in the secondary endpoints, including cumulative urine volume at 72 h; change in the degree of dyspnoea over 72 h; and changes in brain natriuretic peptide, cystatin C, renin, aldosterone, and catecholamine levels at 72 h post randomisation between the groups. A greater decrease in the estimated glomerular filtration rate was observed in the carperitide group compared with the standard treatment group (inter-group difference -3.9 ml/min/1.73 m2; 95% CI -7.0 to -0.8).nnCONCLUSION: In patients with AHF, low-dose carperitide did not reduce long-term mortality or hospitalisation events when combined with standard treatment. Because patient enrolment was terminated prematurely, the study was underpowered and inconclusive.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The effects of low-dose carperitide on long-term clinical outcomes of patients with acute heart failure (AHF) have not yet been fully elucidated. This study aimed to evaluate the effects of low-dose intravenous carperitide on the long-term clinical outcomes of patients with AHF.nnMETHODS: In this multicentre, open-label, randomised controlled trial, 247 patients with AHF received low-dose carperitide intravenously with standard treatment or a matching standard treatment for 72 h from November 2014 to March 2021 across nine sites in Japan. The primary endpoint was a composite of all-cause death and heart failure hospitalisation within 2 years.nnRESULTS: The primary endpoint was observed in 36 of 122 patients (29.5%) and 35 of 125 patients (28.0%) in the carperitide group and standard treatment groups, respectively (hazard ratio 1.26; 95% confidence interval (CI) 0.78-2.06, P = 0.827). No significant differences were observed in the secondary endpoints, including cumulative urine volume at 72 h; change in the degree of dyspnoea over 72 h; and changes in brain natriuretic peptide, cystatin C, renin, aldosterone, and catecholamine levels at 72 h post randomisation between the groups. A greater decrease in the estimated glomerular filtration rate was observed in the carperitide group compared with the standard treatment group (inter-group difference -3.9 ml/min/1.73 m2; 95% CI -7.0 to -0.8).nnCONCLUSION: In patients with AHF, low-dose carperitide did not reduce long-term mortality or hospitalisation events when combined with standard treatment. Because patient enrolment was terminated prematurely, the study was underpowered and inconclusive.
@article{pmid39223348,
title = {Usefulness of frailty assessment using the revised Japanese version of the Cardiovascular Health Study on the prediction of clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement},
author = {Takahiro Abe and Toshiyuki Nagai and Atsunori Yuasa and Yusuke Tokuda and Suguru Ishizaka and Sakae Takenaka and Yoshifumi Mizuguchi and Motoki Nakao and Takuma Sato and Taro Temma and Kiwamu Kamiya and Toshihisa Anzai},
doi = {10.1007/s12928-024-01043-z},
issn = {1868-4297},
year = {2024},
date = {2024-09-01},
urldate = {2024-09-01},
journal = {Cardiovasc Interv Ther},
abstract = {Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Frailty assessment is essential for deciding the treatment strategy for patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Recently, the revised Japanese version of the Cardiovascular Health Study (J-CHS) criteria has been proposed for the frailty assessment; however, it is unclear whether the criteria are useful for the risk stratification in these patients. We investigated the impact of frailty assessment using the revised J-CHS criteria on clinical outcomes in patients with AS undergoing TAVR. We examined 205 consecutive severe AS patients who underwent TAVR at two tertiary hospitals from May 2018 to December 2022. Frailty was defined by the revised J-CHS criteria (score ≥ 3) before TAVR. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE). Among the studied patients, the mean age was 84 years and 65% were female. Frailty was present in 51% of patients. During a median follow-up period of 1000 (interquartile range 677-1210) days, MACCE occurred in 22 patients. Frailty was significantly independently associated with higher risks of the MACCE adjusted for confounders related to nutritional status, severity of AS, comorbidities [hazard ratio (HR) 5.09, 95% confidence interval (CI) 1.70-15.23; HR 3.94, 95% CI 1.34-11.55; HR 3.12, 95% CI 1.14-8.53; HR 3.31, 95% CI 1.21-9.02, respectively]. Frailty determined by the revised J-CHS criteria was associated with clinical outcomes, suggesting these criteria would be useful for risk stratification in Japanese patients with AS undergoing TAVR.
@article{pmid39226214,
title = {Characteristics and outcomes of heart failure in Japan: A hospital-based administrative database analysis},
author = {Yasuhisa Ono and Kazuhiro Yoneda and Naoki Okuyama and Toshiyuki Nagai},
doi = {10.1002/ehf2.15018},
issn = {2055-5822},
year = {2024},
date = {2024-09-01},
urldate = {2024-09-01},
journal = {ESC Heart Fail},
abstract = {AIMS: Epidemiological and outcome studies on patients in Japan with heart failure (HF) categorized by left ventricular ejection fraction (LVEF) are currently limited. The aim of this non-interventional database study was to provide further information on these patients.nnMETHODS AND RESULTS: Administrative claims data and electronic medical records from hospitals participating in the Voluntary Hospitals in Japan (VHJ) organization were used. Patients hospitalized with a primary diagnosis of HF between 1 April 2017 and 30 March 2020 were categorized by baseline LVEF on echocardiogram: HF with reduced EF (HFrEF, LVEF <40%); HF with preserved EF (HFpEF, LVEF ≥50%); and HF with mildly reduced EF (HFmrEF, 40% to <50% LVEF). Patients were evaluated for baseline characteristics, pre-admission diagnosis, prescription drugs, length of hospitalization, HF treatment cost, overall cost of hospitalization, and in-hospital prescription. An exploratory analysis compared post-hospitalization mortality and re-hospitalization rates. In total, 10 646 hospitalized patients from 17 VHJ hospitals were enrolled. Of these, 7212 were included in the analysis set and categorized into HFpEF (3183, 44.1%), HFmrEF (1280, 17.7%), and HFrEF (2749, 38.1%) groups based on baseline LVEF. Beta-blocker use increased during hospitalization, with a mean (95% confidence interval [CI]) of 23.3% (22.3-24.3) of patients receiving these agents before admission versus 69.4% (68.3-70.5) at discharge. Administration of diuretics, angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) showed a similar trend. Differences in treatments were observed between HF categories at discharge, with a higher proportion (95% CI) of ACE inhibitor use in the HFrEF group (40.6% [38.7-42.4]) versus HFmrEF (27.5% [25.1-30.0]) and HFpEF (20.6% [19.2-22.1]) groups (P < 0.0001), and more ARB use in the HFmrEF and HFpEF groups (32.5% [29.9-35.1] and 31.2% [29.6-32.9], respectively) versus HFrEF (25.1% [23.5-26.8]; P < 0.0001). Mean (standard deviation [SD]) length of hospitalization was 22.2 (23.3) days, and the median (interquartile range) was 17 (11-25) days. Estimated average cost of HF treatment per patient during index hospitalization was 300 090 yen with HFrEF treatment costing the most. Average total healthcare expenditure during hospitalization was 1 225 650 yen per index hospitalization per patient, with HFrEF also the most expensive. During a mean (SD) observation period of 324 (304) days, ~21% of patients in each group required re-hospitalization for HF, and 625 patients (8.7%) died.nnCONCLUSIONS: The proportion of patients in each HF category was largely consistent with existing data. Discharge medications indicated high prescription of guideline-directed therapy. This study provides real-world data on patients with HF in Japan that can help inform future clinical decision-making.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: Epidemiological and outcome studies on patients in Japan with heart failure (HF) categorized by left ventricular ejection fraction (LVEF) are currently limited. The aim of this non-interventional database study was to provide further information on these patients.nnMETHODS AND RESULTS: Administrative claims data and electronic medical records from hospitals participating in the Voluntary Hospitals in Japan (VHJ) organization were used. Patients hospitalized with a primary diagnosis of HF between 1 April 2017 and 30 March 2020 were categorized by baseline LVEF on echocardiogram: HF with reduced EF (HFrEF, LVEF <40%); HF with preserved EF (HFpEF, LVEF ≥50%); and HF with mildly reduced EF (HFmrEF, 40% to <50% LVEF). Patients were evaluated for baseline characteristics, pre-admission diagnosis, prescription drugs, length of hospitalization, HF treatment cost, overall cost of hospitalization, and in-hospital prescription. An exploratory analysis compared post-hospitalization mortality and re-hospitalization rates. In total, 10 646 hospitalized patients from 17 VHJ hospitals were enrolled. Of these, 7212 were included in the analysis set and categorized into HFpEF (3183, 44.1%), HFmrEF (1280, 17.7%), and HFrEF (2749, 38.1%) groups based on baseline LVEF. Beta-blocker use increased during hospitalization, with a mean (95% confidence interval [CI]) of 23.3% (22.3-24.3) of patients receiving these agents before admission versus 69.4% (68.3-70.5) at discharge. Administration of diuretics, angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) showed a similar trend. Differences in treatments were observed between HF categories at discharge, with a higher proportion (95% CI) of ACE inhibitor use in the HFrEF group (40.6% [38.7-42.4]) versus HFmrEF (27.5% [25.1-30.0]) and HFpEF (20.6% [19.2-22.1]) groups (P < 0.0001), and more ARB use in the HFmrEF and HFpEF groups (32.5% [29.9-35.1] and 31.2% [29.6-32.9], respectively) versus HFrEF (25.1% [23.5-26.8]; P < 0.0001). Mean (standard deviation [SD]) length of hospitalization was 22.2 (23.3) days, and the median (interquartile range) was 17 (11-25) days. Estimated average cost of HF treatment per patient during index hospitalization was 300 090 yen with HFrEF treatment costing the most. Average total healthcare expenditure during hospitalization was 1 225 650 yen per index hospitalization per patient, with HFrEF also the most expensive. During a mean (SD) observation period of 324 (304) days, ~21% of patients in each group required re-hospitalization for HF, and 625 patients (8.7%) died.nnCONCLUSIONS: The proportion of patients in each HF category was largely consistent with existing data. Discharge medications indicated high prescription of guideline-directed therapy. This study provides real-world data on patients with HF in Japan that can help inform future clinical decision-making.
@article{pmid39151481,
title = {Differential impacts of self-care behavior on clinical outcomes in patients with and without recent heart failure hospitalization},
author = {Taro Koya and Toshiyuki Nagai and Atsushi Tada and Motoki Nakao and Suguru Ishizaka and Yoshifumi Mizuguchi and Hiroyuki Aoyagi and Fusako George and Shogo Imagawa and Yusuke Tokuda and Yoshiya Kato and Masashige Takahashi and Hiroto Sakai and Masaharu Machida and Kenichi Matsutani and Takahiko Saito and Hiroshi Okamoto and Toshihisa Anzai},
doi = {10.1016/j.ijcard.2024.132452},
issn = {1874-1754},
year = {2024},
date = {2024-08-01},
urldate = {2024-08-01},
journal = {Int J Cardiol},
pages = {132452},
abstract = {BACKGROUND: Although clinical guidelines recommend self-care assessment for patients with chronic heart failure (CHF), its prognostic significance remains controversial. This study aimed to compare the prognostic significance of self-care behavior on mortality between patients with and without a history of recent hospitalization for heart failure (HF).nnMETHODS: We analyzed consecutive 1907 CHF patients from a Japanese multicenter registry (January 2020-June 2023) using the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9) at enrolment. Suboptimal self-care behavior was defined as a score < 70 on the EHFScBS-9. Patients were divided into recent (within 30 days post-discharge, n = 664) and no recent hospitalization for HF groups (n = 1263), respectively. The primary outcome was a composite of all-cause death and rehospitalization for HF.nnRESULTS: During a median follow-up period of 427 (interquartile range 273-630) days, the primary outcome occurred in 100 patients. Patients with suboptimal self-care behavior exhibited a higher incidence of the primary outcome in the recent hospitalization for HF group (p = 0.020) but not in the no recent hospitalization for HF group (P = 0.16). Multivariable regressions showed suboptimal self-care behavior was independently associated with the primary outcome in the recent hospitalization for HF group with a significant interaction (P = 0.029).nnCONCLUSION: In patients recently hospitalized for HF, but not in those without a recent hospitalization history for HF, suboptimal self-care behavior was associated with adverse events. This indicates the importance of self-care education for these patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although clinical guidelines recommend self-care assessment for patients with chronic heart failure (CHF), its prognostic significance remains controversial. This study aimed to compare the prognostic significance of self-care behavior on mortality between patients with and without a history of recent hospitalization for heart failure (HF).nnMETHODS: We analyzed consecutive 1907 CHF patients from a Japanese multicenter registry (January 2020-June 2023) using the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9) at enrolment. Suboptimal self-care behavior was defined as a score < 70 on the EHFScBS-9. Patients were divided into recent (within 30 days post-discharge, n = 664) and no recent hospitalization for HF groups (n = 1263), respectively. The primary outcome was a composite of all-cause death and rehospitalization for HF.nnRESULTS: During a median follow-up period of 427 (interquartile range 273-630) days, the primary outcome occurred in 100 patients. Patients with suboptimal self-care behavior exhibited a higher incidence of the primary outcome in the recent hospitalization for HF group (p = 0.020) but not in the no recent hospitalization for HF group (P = 0.16). Multivariable regressions showed suboptimal self-care behavior was independently associated with the primary outcome in the recent hospitalization for HF group with a significant interaction (P = 0.029).nnCONCLUSION: In patients recently hospitalized for HF, but not in those without a recent hospitalization history for HF, suboptimal self-care behavior was associated with adverse events. This indicates the importance of self-care education for these patients.
@article{pmid38811152,
title = {Validity and reliability of the palliative care needs assessment tool in Japanese patients with heart failure},
author = {Daishiro Tatsuta and Takuma Sato and Toshiyuki Nagai and Jiro Koya and Kotaro Nishino and Seiichiro Naito and Yoshifumi Mizuguchi and Taro Temma and Kiwamu Kamiya and Hisashi Narita and Kenkichi Tsuruga and Toshihisa Anzai},
doi = {10.1002/ehf2.14886},
issn = {2055-5822},
year = {2024},
date = {2024-05-01},
urldate = {2024-05-01},
journal = {ESC Heart Fail},
abstract = {AIMS: Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care, most HF patients do not receive timely intervention due to the absence of a standardized method for identifying those in need of palliative care. The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) assesses the palliative care needs of patients with HF. However, its validity and reliability have yet to be fully examined. We aimed to assess the validity and reliability of the NAT: PD-HF in Japanese patients with HF.nnMETHODS: We prospectively enrolled 106 consecutive patients with chronic HF admitted to our university hospital between February 2023 and July 2023. Their caregivers (n = 95) and healthcare providers (n = 17) were also included. The NAT: PD-HF was translated from English to Japanese using a forward-backward translation procedure and adapted based on Japanese cultural and medical backgrounds by our professional multidisciplinary team. We assessed the internal consistency of the Japanese NAT: PD-HF version with Cronbach's alpha coefficient and the inter-rater and test-retest reliabilities with Cohen's kappa coefficient. After using the tool, all participants were asked to complete a questionnaire about the tool to determine its validity.nnRESULTS: The proportion of female patients in this study was 47 (44%). The median age was 72 years [interquartile range (IQR) 59-81]. The median time spent assessing the patients' and their caregivers' needs using the Japanese NAT: PD-HF was 14 min (IQR 12-17). The Cronbach's alpha coefficient was 0.82, and the minimum kappa coefficient was 0.77 for inter-rater reliability and 0.88 for test-retest reliability. In total, 103 patients (97%) and all caregivers responded that the tool was easy to understand. One hundred (94%) patients and 89 (94%) caregivers felt that the tool would improve the quality of care, and 102 (96%) patients and 91 (96%) caregivers indicated that the discussions using this tool allowed them to confide in all their burdens and care needs. All healthcare providers expressed that this tool is helpful in understanding the burden and care needs of both patients and caregivers comprehensively.nnCONCLUSIONS: The NAT: PD-HF is a reliable and valid tool for Japanese patients with HF and their caregivers. This tool was very well accepted by patients, caregivers and healthcare providers to identify burdens and care needs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care, most HF patients do not receive timely intervention due to the absence of a standardized method for identifying those in need of palliative care. The Needs Assessment Tool: Progressive Disease-Heart Failure (NAT: PD-HF) assesses the palliative care needs of patients with HF. However, its validity and reliability have yet to be fully examined. We aimed to assess the validity and reliability of the NAT: PD-HF in Japanese patients with HF.nnMETHODS: We prospectively enrolled 106 consecutive patients with chronic HF admitted to our university hospital between February 2023 and July 2023. Their caregivers (n = 95) and healthcare providers (n = 17) were also included. The NAT: PD-HF was translated from English to Japanese using a forward-backward translation procedure and adapted based on Japanese cultural and medical backgrounds by our professional multidisciplinary team. We assessed the internal consistency of the Japanese NAT: PD-HF version with Cronbach's alpha coefficient and the inter-rater and test-retest reliabilities with Cohen's kappa coefficient. After using the tool, all participants were asked to complete a questionnaire about the tool to determine its validity.nnRESULTS: The proportion of female patients in this study was 47 (44%). The median age was 72 years [interquartile range (IQR) 59-81]. The median time spent assessing the patients' and their caregivers' needs using the Japanese NAT: PD-HF was 14 min (IQR 12-17). The Cronbach's alpha coefficient was 0.82, and the minimum kappa coefficient was 0.77 for inter-rater reliability and 0.88 for test-retest reliability. In total, 103 patients (97%) and all caregivers responded that the tool was easy to understand. One hundred (94%) patients and 89 (94%) caregivers felt that the tool would improve the quality of care, and 102 (96%) patients and 91 (96%) caregivers indicated that the discussions using this tool allowed them to confide in all their burdens and care needs. All healthcare providers expressed that this tool is helpful in understanding the burden and care needs of both patients and caregivers comprehensively.nnCONCLUSIONS: The NAT: PD-HF is a reliable and valid tool for Japanese patients with HF and their caregivers. This tool was very well accepted by patients, caregivers and healthcare providers to identify burdens and care needs.
@article{pmid38581302,
title = {Non-invasive assessment of left ventricular filling pressure in aortic stenosis},
author = {Hiroyuki Aoyagi and Hiroyuki Iwano and Yoji Tamaki and Michito Murayama and Suguru Ishizaka and Ko Motoi and Kosuke Nakamura and Mana Goto and Yukino Suzuki and Shinobu Yokoyama and Hisao Nishino and Sanae Kaga and Kiwamu Kamiya and Toshiyuki Nagai and Toshihisa Anzai},
doi = {10.1111/echo.15808},
issn = {1540-8175},
year = {2024},
date = {2024-04-01},
urldate = {2024-04-01},
journal = {Echocardiography},
volume = {41},
number = {4},
pages = {e15808},
abstract = {BACKGROUND: The assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently-proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score.nnMETHODS: We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LV FP. LV diastolic dysfunction (DD) was graded according to the ASE/EACVI guidelines. The VMT score was defined as follows: time sequence of opening of mitral and tricuspid valves was scored to 0-2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava was dilated, one point was added and VMT score was finally calculated as 0-3.nnRESULTS: Of the 116 patients, 29 patients showed elevated PAWP. Ninety patients (93%) and 67 patients (63%) showed increased values for left atrium volume index (LAVI) and E/e', respectively when the cut-off values recommended by the guidelines were applied and thus the algorism predicted elevated PAWP with a low specificity and positive predictive value (PPV). VMT ≥ 2 predicted elevated PAWP with a sensitivity of 59%, specificity of 90%, PPV of 59%, and negative predictive value of 89%. An alternative algorithm that applied tricuspid regurgitation velocity and VMT scores was tested, and its predictive ability was markedly improved.nnCONCLUSION: VMT score was applicable for AS patients. Alternative use of VMT score improved diagnostic accuracy of guideline-recommended algorism.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently-proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score.nnMETHODS: We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LV FP. LV diastolic dysfunction (DD) was graded according to the ASE/EACVI guidelines. The VMT score was defined as follows: time sequence of opening of mitral and tricuspid valves was scored to 0-2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava was dilated, one point was added and VMT score was finally calculated as 0-3.nnRESULTS: Of the 116 patients, 29 patients showed elevated PAWP. Ninety patients (93%) and 67 patients (63%) showed increased values for left atrium volume index (LAVI) and E/e', respectively when the cut-off values recommended by the guidelines were applied and thus the algorism predicted elevated PAWP with a low specificity and positive predictive value (PPV). VMT ≥ 2 predicted elevated PAWP with a sensitivity of 59%, specificity of 90%, PPV of 59%, and negative predictive value of 89%. An alternative algorithm that applied tricuspid regurgitation velocity and VMT scores was tested, and its predictive ability was markedly improved.nnCONCLUSION: VMT score was applicable for AS patients. Alternative use of VMT score improved diagnostic accuracy of guideline-recommended algorism.
@article{pmid38505484,
title = {Machine learning-based gait analysis to predict clinical frailty scale in elderly patients with heart failure},
author = {Yoshifumi Mizuguchi and Motoki Nakao and Toshiyuki Nagai and Yuki Takahashi and Takahiro Abe and Shigeo Kakinoki and Shogo Imagawa and Kenichi Matsutani and Takahiko Saito and Masashige Takahashi and Yoshiya Kato and Hirokazu Komoriyama and Hikaru Hagiwara and Kenji Hirata and Takahiro Ogawa and Takuto Shimizu and Manabu Otsu and Kunihiro Chiyo and Toshihisa Anzai},
doi = {10.1093/ehjdh/ztad082},
issn = {2634-3916},
year = {2024},
date = {2024-03-01},
urldate = {2024-03-01},
journal = {Eur Heart J Digit Health},
volume = {5},
number = {2},
pages = {152--162},
abstract = {AIMS: Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF.nnMETHODS AND RESULTS: We prospectively examined 417 elderly (≥75 years) with symptomatic chronic HF patients from 7 centres between January 2019 and October 2023. The patients were divided into derivation ( = 194) and validation ( = 223) cohorts. We obtained body-tracking motion data using a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the light gradient boosting machine (LightGBM) model. To evaluate the performance of this model, we calculated Cohen's weighted kappa (CWK) and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. In the derivation and validation datasets, the LightGBM models showed excellent agreements between the actual and predicted CFSs [CWK 0.866, 95% confidence interval (CI) 0.807-0.911; ICC 0.866, 95% CI 0.827-0.898; CWK 0.812, 95% CI 0.752-0.868; ICC 0.813, 95% CI 0.761-0.854, respectively]. During a median follow-up period of 391 (inter-quartile range 273-617) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (hazard ratio 1.60, 95% CI 1.02-2.50) after adjusting for significant prognostic covariates.nnCONCLUSION: Machine learning-based algorithms of automatically CFS rating are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF.nnMETHODS AND RESULTS: We prospectively examined 417 elderly (≥75 years) with symptomatic chronic HF patients from 7 centres between January 2019 and October 2023. The patients were divided into derivation ( = 194) and validation ( = 223) cohorts. We obtained body-tracking motion data using a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the light gradient boosting machine (LightGBM) model. To evaluate the performance of this model, we calculated Cohen's weighted kappa (CWK) and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. In the derivation and validation datasets, the LightGBM models showed excellent agreements between the actual and predicted CFSs [CWK 0.866, 95% confidence interval (CI) 0.807-0.911; ICC 0.866, 95% CI 0.827-0.898; CWK 0.812, 95% CI 0.752-0.868; ICC 0.813, 95% CI 0.761-0.854, respectively]. During a median follow-up period of 391 (inter-quartile range 273-617) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (hazard ratio 1.60, 95% CI 1.02-2.50) after adjusting for significant prognostic covariates.nnCONCLUSION: Machine learning-based algorithms of automatically CFS rating are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.
@article{Kazui2024,
title = {Prognostic Value of Combined Assessments of Late Gadolinium Enhancement and Fluorodeoxyglucose Uptake in Cardiac Sarcoidosis},
author = {Sho Kazui and Sakae Takenaka and Toshiyuki Nagai and Satonori Tsuneta and Kenji Hirata and Yoshiya Kato and Hirokazu Komoriyama and Yuta Kobayashi and Akinori Takahashi and Kiwamu Kamiya and Taro Temma and Takuma Sato and Atsushi Tada and Yutaro Yasui and Michikazu Nakai and Takahiro Sato and Ichizo Tsujino and Kohsuke Kudo and Satoshi Konno and Toshihisa Anzai},
doi = {10.1016/j.jcmg.2024.01.010},
issn = {1876-7591},
year = {2024},
date = {2024-03-01},
urldate = {2024-03-01},
journal = {JACC Cardiovasc Imaging},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{NAKAO2024132014,
title = {Iron supplementation is a residual piece of management in Asian patients with heart failure?},
author = {Motoki Nakao and Toshiyuki Nagai and Toshihisa Anzai},
url = {https://www.sciencedirect.com/science/article/pii/S0167527324006077},
doi = {https://doi.org/10.1016/j.ijcard.2024.132014},
issn = {0167-5273},
year = {2024},
date = {2024-01-01},
urldate = {2024-01-01},
journal = {International Journal of Cardiology},
pages = {132014},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{KOBAYASHI2024,
title = {Multimodal Assessment of Immunosuppressive Therapy in a Patient with Chronic Active Myocarditis 3 months following COVID-19 Infection},
author = {Yuta Kobayashi and Takeshi Hamaya and Toshiyuki Nagai and Yuki Mori and Takuma Sato and Satonori Tsuneta and Kento Wakabayashi and Kohsuke Kudo and Yoshihiro Matsuno and Toshihisa Anzai},
url = {https://www.sciencedirect.com/science/article/pii/S2589790X24001422},
doi = {https://doi.org/10.1016/j.cjco.2024.03.010},
issn = {2589-790X},
year = {2024},
date = {2024-01-01},
urldate = {2024-01-01},
journal = {CJC Open},
abstract = {There is limited evidence available regarding the efficacy of immunosuppressive therapy for post Coronavirus disease 2019 (COVID-19) chronic active myocarditis. We present a case of a 28-year-old woman with post COVID-19 virus-negative chronic active myocarditis. Immunosuppressive therapy improved the left ventricular ejection fraction from 21% to 42%, and ameliorated inflammatory activity as assessed by cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB). This is the first report to evaluate inflammatory activity before and after immunosuppressive therapy in post COVID-19 virus-negative chronic active myocarditis using both EMB and CMR.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
There is limited evidence available regarding the efficacy of immunosuppressive therapy for post Coronavirus disease 2019 (COVID-19) chronic active myocarditis. We present a case of a 28-year-old woman with post COVID-19 virus-negative chronic active myocarditis. Immunosuppressive therapy improved the left ventricular ejection fraction from 21% to 42%, and ameliorated inflammatory activity as assessed by cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB). This is the first report to evaluate inflammatory activity before and after immunosuppressive therapy in post COVID-19 virus-negative chronic active myocarditis using both EMB and CMR.
@article{YutaKobayashi2024CJ-23-0910,
title = {Chronic Active Myocarditis After Transapical Transcatheter Aortic Valve Implantation},
author = {Yuta Kobayashi and Toshiyuki Nagai and Kiwamu Kamiya and Satonori Tsuneta and Yasushige Shingu and Kento Wakabayashi and Kohsuke Kudo and Yoshihiro Matsuno and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1253/circj.CJ-23-0910},
year = {2024},
date = {2024-01-01},
urldate = {2024-01-01},
journal = {Circulation Journal},
volume = {advpub},
pages = {CJ-23-0910},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{pmid37591415,
title = {Association of longitudinal cardiac troponin trajectory with adverse events in patients with cardiac sarcoidosis},
author = {Sho Kazui and Sakae Takenaka and Toshiyuki Nagai and Yoshiya Kato and Hirokazu Komoriyama and Yuta Kobayashi and Akinori Takahashi and Kiwamu Kamiya and Takuma Sato and Atsushi Tada and Yutaro Yasui and Michikazu Nakai and Takahiro Sato and Ichizo Tsujino and Satoshi Konno and Toshihisa Anzai},
doi = {10.1016/j.ijcard.2023.131268},
issn = {1874-1754},
year = {2023},
date = {2023-10-01},
urldate = {2023-10-01},
journal = {Int J Cardiol},
volume = {389},
pages = {131268},
abstract = {BACKGROUND: Although high-sensitivity cardiac troponins may be sensitive and easily repeatable markers of disease activity in patients with cardiac sarcoidosis (CS), the association between longitudinal cardiac troponin trajectory and adverse events remains unclear. This study aimed to clarify whether longitudinal cardiac troponin levels were associated with adverse events in patients with CS.nnMETHODS: We examined 63 consecutive CS-initiated prednisolone (PSL) patients with available longitudinal high-sensitivity cardiac troponin T (cTnT) data between December 2013 and March 2023. The area under the cTnT trajectory, which reflected cumulative cTnT release, was calculated to assess the association between longitudinal cTnT levels and adverse events. Patients were divided into two groups according to the median area under the cTnT trajectory per month. The primary outcome was a composite of sustained ventricular tachycardia or fibrillation, worsening heart failure, and sudden cardiac death (SCD).nnRESULTS: In total, 463 cTnT measurements were collected over a median follow-up period of 30.4 (interquartile range [IQR] 15.6-34.2) months. The primary outcome was observed in 12 (19%) patients. A higher area under the cTnT trajectory was significantly associated with an increased incidence of the primary outcome (P = 0.027), while cTnT levels before and one month after initiation of PSL, and these changes were not related to adverse events (P = 0.179, 0.096, and 0.95, respectively).nnCONCLUSIONS: Longitudinal cTnT trajectory following PSL initiation was associated with adverse cardiac events in patients with CS, suggesting that longitudinal measurement of cTnT would be useful for the early identification of high-risk patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although high-sensitivity cardiac troponins may be sensitive and easily repeatable markers of disease activity in patients with cardiac sarcoidosis (CS), the association between longitudinal cardiac troponin trajectory and adverse events remains unclear. This study aimed to clarify whether longitudinal cardiac troponin levels were associated with adverse events in patients with CS.nnMETHODS: We examined 63 consecutive CS-initiated prednisolone (PSL) patients with available longitudinal high-sensitivity cardiac troponin T (cTnT) data between December 2013 and March 2023. The area under the cTnT trajectory, which reflected cumulative cTnT release, was calculated to assess the association between longitudinal cTnT levels and adverse events. Patients were divided into two groups according to the median area under the cTnT trajectory per month. The primary outcome was a composite of sustained ventricular tachycardia or fibrillation, worsening heart failure, and sudden cardiac death (SCD).nnRESULTS: In total, 463 cTnT measurements were collected over a median follow-up period of 30.4 (interquartile range [IQR] 15.6-34.2) months. The primary outcome was observed in 12 (19%) patients. A higher area under the cTnT trajectory was significantly associated with an increased incidence of the primary outcome (P = 0.027), while cTnT levels before and one month after initiation of PSL, and these changes were not related to adverse events (P = 0.179, 0.096, and 0.95, respectively).nnCONCLUSIONS: Longitudinal cTnT trajectory following PSL initiation was associated with adverse cardiac events in patients with CS, suggesting that longitudinal measurement of cTnT would be useful for the early identification of high-risk patients.
@article{pmid37880721b,
title = {Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement},
author = {Yuki Takahashi and Kiwamu Kamiya and Toshiyuki Nagai and Satonori Tsuneta and Noriko Oyama-Manabe and Takeshi Hamaya and Sho Kazui and Yutaro Yasui and Kohei Saiin and Seiichiro Naito and Yoshifumi Mizuguchi and Sakae Takenaka and Atsushi Tada and Suguru Ishizaka and Yuta Kobayashi and Kazunori Omote and Takuma Sato and Yasushige Shingu and Kohsuke Kudo and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1186/s12968-023-00970-9},
issn = {1532-429X},
year = {2023},
date = {2023-10-01},
urldate = {2023-10-01},
journal = {J Cardiovasc Magn Reson},
volume = {25},
number = {1},
pages = {60},
abstract = {BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR).nnMETHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR.nnRESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups.nnCONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR).nnMETHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR.nnRESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups.nnCONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.
@article{pmid37307781,
title = {Prognostic Value of Liver Fibrotic Markers in Patients With Heart Failure},
author = {Atsushi Tada and Toshiyuki Nagai and Yoshiya Kato and Noriko Oyama-Manabe and Satonori Tsuneta and Michikazu Nakai and Yutaro Yasui and Sho Kazui and Yuki Takahashi and Kohei Saiin and Seiichiro Naito and Sakae Takenaka and Yoshifumi Mizuguchi and Yuta Kobayashi and Suguru Ishizaka and Kazunori Omote and Takuma Sato and Takao Konishi and Kiwamu Kamiya and Kohsuke Kudo and Toshihisa Anzai},
doi = {10.1016/j.amjcard.2023.05.033},
issn = {1879-1913},
year = {2023},
date = {2023-08-01},
urldate = {2023-08-01},
journal = {Am J Cardiol},
volume = {200},
pages = {115--123},
abstract = {Several liver fibrotic markers are associated with prognosis in patients with heart failure (HF). However, the optimal markers for outcome prediction remain unclear. This study aimed to simultaneously investigate the prognostic value of liver fibrotic markers and the associations between these markers and clinical parameters in patients with HF without organic liver disease. We prospectively examined 211 consecutive patients with chronic HF between April 2018 and August 2021, excluding those with organic liver disease, using liver magnetic resonance imaging and ultrasound. A total of 7 representative liver fibrotic markers were measured in all patients. The primary outcome of interest was the composite of all-cause death and hospitalization for worsening HF. During a median follow-up period of 747 (interquartile range 465 to 1,042) days, the primary outcome occurred in 45 patients. Patients with higher hyaluronic acid and type III procollagen N-terminal peptide (P-III-P) levels showed a significantly higher incidence of the primary outcome than those without (p <0.001 and p = 0.005, respectively). The multivariable Cox regression analysis revealed that hyaluronic acid and P-III-P levels were independently associated with the risk of adverse events (hazard ratio 1.84, 95% confidence interval 1.18 to 2.87 and hazard ratio 2.89, 95% confidence interval 1.32 to 6.34, respectively) even after adjustment for a mortality prediction model, whereas the other 5 markers were not associated with the primary outcome. In conclusion, among the representative liver fibrotic markers, hyaluronic acid and P-III-P might be the optimal markers for outcome prediction in patients with HF.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Several liver fibrotic markers are associated with prognosis in patients with heart failure (HF). However, the optimal markers for outcome prediction remain unclear. This study aimed to simultaneously investigate the prognostic value of liver fibrotic markers and the associations between these markers and clinical parameters in patients with HF without organic liver disease. We prospectively examined 211 consecutive patients with chronic HF between April 2018 and August 2021, excluding those with organic liver disease, using liver magnetic resonance imaging and ultrasound. A total of 7 representative liver fibrotic markers were measured in all patients. The primary outcome of interest was the composite of all-cause death and hospitalization for worsening HF. During a median follow-up period of 747 (interquartile range 465 to 1,042) days, the primary outcome occurred in 45 patients. Patients with higher hyaluronic acid and type III procollagen N-terminal peptide (P-III-P) levels showed a significantly higher incidence of the primary outcome than those without (p <0.001 and p = 0.005, respectively). The multivariable Cox regression analysis revealed that hyaluronic acid and P-III-P levels were independently associated with the risk of adverse events (hazard ratio 1.84, 95% confidence interval 1.18 to 2.87 and hazard ratio 2.89, 95% confidence interval 1.32 to 6.34, respectively) even after adjustment for a mortality prediction model, whereas the other 5 markers were not associated with the primary outcome. In conclusion, among the representative liver fibrotic markers, hyaluronic acid and P-III-P might be the optimal markers for outcome prediction in patients with HF.
@article{pmid36635468,
title = {Fragmented QRS on 12-lead electrocardiogram predicts long-term prognosis in patients with cardiac sarcoidosis},
author = {Hikaru Hagiwara and Masaya Watanabe and Takahide Kadosaka and Takuya Koizumi and Yuta Kobayashi and Taro Koya and Motoki Nakao and Satonori Tsuneta and Yoshiya Kato and Hirokazu Komoriyama and Rui Kamada and Toshiyuki Nagai and Kohsuke Kudo and Toshihisa Anzai},
doi = {10.1007/s00380-022-02229-2},
issn = {1615-2573},
year = {2023},
date = {2023-06-01},
urldate = {2023-06-01},
journal = {Heart Vessels},
volume = {38},
number = {6},
pages = {803--816},
abstract = {Fragmented QRS (fQRS) on a 12-lead electrocardiogram is a known marker of fatal arrhythmias or cardiac adverse events in ischemic and non-ischemic cardiomyopathy patients. Nonetheless, the association between fQRS and clinical outcomes in patients with cardiac sarcoidosis (CS) remains unclear. Herein, we investigated whether fQRS is associated with long-term clinical outcomes in CS patients. A total of 78 patients who received immunosuppressive therapy (IST) for clinically diagnosed CS were retrospectively examined. Patients were classified into two groups according to the presence (n = 19) or absence (n = 59) of fQRS on electrocardiogram before IST. The primary outcome was the composite event of all-cause death, ventricular tachyarrhythmias (VTs), and hospitalization for heart failure. Results of late gadolinium enhancement on cardiac magnetic resonance imaging were also analyzed. During a median follow-up period of 3.7 years (interquartile range: 1.6-6.2 years), the primary outcome occurred more frequently in patients with fQRS than in those without (47% vs. 13%, log-rank p = 0.002). Multivariable Cox regression analyses showed that fQRS was an independent determinant of the primary outcome. The incidence of VTs, within 12 months of IST initiation, was comparable between the two groups; however, late-onset VTs, defined as those occurring ≥ 12 months after IST initiation, occurred more frequently in the fQRS group (21% vs. 2%, log-rank p = 0.002). The scar zone and scar border zone were greater in patients with fQRS than in those without it. In conclusion, our analysis suggests that fQRS is an independent predictor of adverse events, particularly late-onset VTs, in patients with CS.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Fragmented QRS (fQRS) on a 12-lead electrocardiogram is a known marker of fatal arrhythmias or cardiac adverse events in ischemic and non-ischemic cardiomyopathy patients. Nonetheless, the association between fQRS and clinical outcomes in patients with cardiac sarcoidosis (CS) remains unclear. Herein, we investigated whether fQRS is associated with long-term clinical outcomes in CS patients. A total of 78 patients who received immunosuppressive therapy (IST) for clinically diagnosed CS were retrospectively examined. Patients were classified into two groups according to the presence (n = 19) or absence (n = 59) of fQRS on electrocardiogram before IST. The primary outcome was the composite event of all-cause death, ventricular tachyarrhythmias (VTs), and hospitalization for heart failure. Results of late gadolinium enhancement on cardiac magnetic resonance imaging were also analyzed. During a median follow-up period of 3.7 years (interquartile range: 1.6-6.2 years), the primary outcome occurred more frequently in patients with fQRS than in those without (47% vs. 13%, log-rank p = 0.002). Multivariable Cox regression analyses showed that fQRS was an independent determinant of the primary outcome. The incidence of VTs, within 12 months of IST initiation, was comparable between the two groups; however, late-onset VTs, defined as those occurring ≥ 12 months after IST initiation, occurred more frequently in the fQRS group (21% vs. 2%, log-rank p = 0.002). The scar zone and scar border zone were greater in patients with fQRS than in those without it. In conclusion, our analysis suggests that fQRS is an independent predictor of adverse events, particularly late-onset VTs, in patients with CS.
@article{pmid36495060,
title = {Applicability of new proposed criteria for iron deficiency in Japanese patients with heart failure},
author = {Atsushi Tada and Toshiyuki Nagai and Taro Koya and Motoki Nakao and Suguru Ishizaka and Yoshifumi Mizuguchi and Hiroyuki Aoyagi and Shogo Imagawa and Yusuke Tokuda and Masashige Takahashi and Yoshiya Kato and Masaharu Machida and Kenichi Matsutani and Takahiko Saito and Toshihisa Anzai},
doi = {10.1002/ehf2.14265},
issn = {2055-5822},
year = {2023},
date = {2023-04-01},
urldate = {2023-04-01},
journal = {ESC Heart Fail},
volume = {10},
number = {2},
pages = {985--994},
abstract = {AIMS: Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). A recent study showed that ID defined by the current guideline criteria was not associated with worse clinical outcomes, and new ID criteria was proposed in patients with HF. However, the external applicability of the new proposed criteria is unclear. We sought to investigate the applicability of the proposed ID criteria in Japanese patients with HF.nnMETHODS AND RESULTS: We prospectively examined 763 patients with chronic HF from a Japanese multicentre registry. The proposed ID criteria were transferrin saturation (TSAT) < 20% and serum iron ≤13 mmol/L and the guideline ID criteria were serum ferritin <100 ng/mL or, when ferritin was 100-299 ng/mL, TSAT <20%. Among all patients (456 male, mean age 71 ± 13 years), 213 (28%) and 444 (58%) met the proposed and guideline ID criteria, respectively. During a median follow-up period of 436 days (interquartile range 297-565), the primary outcome of all-cause mortality occurred in 56 (7%) patients. There was no significant difference in the primary outcome between the patients with and without guideline ID criteria (P = 0.32), whereas patients with serum iron ≤10 μmol/L showed higher mortality (P = 0.002). In multivariable Cox regressions, the proposed ID criteria, but not guideline ID criteria, were independently associated with the risk of all-cause mortality (HR 2.01, 95% CI 1.16-3.51 and HR 1.32, 95% CI 0.76-2.28, respectively), even after adjustment for covariates.nnCONCLUSIONS: When defined by the proposed criteria and not the guideline criteria, ID was associated with higher mortality in patients with chronic HF, suggesting that the proposed ID criteria is applicable to the Japanese population.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). A recent study showed that ID defined by the current guideline criteria was not associated with worse clinical outcomes, and new ID criteria was proposed in patients with HF. However, the external applicability of the new proposed criteria is unclear. We sought to investigate the applicability of the proposed ID criteria in Japanese patients with HF.nnMETHODS AND RESULTS: We prospectively examined 763 patients with chronic HF from a Japanese multicentre registry. The proposed ID criteria were transferrin saturation (TSAT) < 20% and serum iron ≤13 mmol/L and the guideline ID criteria were serum ferritin <100 ng/mL or, when ferritin was 100-299 ng/mL, TSAT <20%. Among all patients (456 male, mean age 71 ± 13 years), 213 (28%) and 444 (58%) met the proposed and guideline ID criteria, respectively. During a median follow-up period of 436 days (interquartile range 297-565), the primary outcome of all-cause mortality occurred in 56 (7%) patients. There was no significant difference in the primary outcome between the patients with and without guideline ID criteria (P = 0.32), whereas patients with serum iron ≤10 μmol/L showed higher mortality (P = 0.002). In multivariable Cox regressions, the proposed ID criteria, but not guideline ID criteria, were independently associated with the risk of all-cause mortality (HR 2.01, 95% CI 1.16-3.51 and HR 1.32, 95% CI 0.76-2.28, respectively), even after adjustment for covariates.nnCONCLUSIONS: When defined by the proposed criteria and not the guideline criteria, ID was associated with higher mortality in patients with chronic HF, suggesting that the proposed ID criteria is applicable to the Japanese population.
@article{pmid36908170,
title = {JCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis},
author = {Toshiyuki Nagai and Takayuki Inomata and Takashi Kohno and Takuma Sato and Atsushi Tada and Toru Kubo and Kazufumi Nakamura and Noriko Oyama-Manabe and Yoshihiko Ikeda and Takeo Fujino and Yasuhide Asaumi and Takahiro Okumura and Toshiyuki Yano and Kazuko Tajiri and Hiroyuki Matsuura and Yuichi Baba and Haruki Sunami and Shingo Tsujinaga and Yasutoshi Ota and Keiko Ohta-Ogo and Yusuke Ishikawa and Hideo Matama and Nobutaka Nagano and Kimi Sato and Kazushi Yasuda and Yasushi Sakata and Koichiro Kuwahara and Tohru Minamino and Minoru Ono and Toshihisa Anzai},
doi = {10.1253/circj.CJ-22-0696},
issn = {1347-4820},
year = {2023},
date = {2023-04-01},
urldate = {2023-04-01},
journal = {Circ J},
volume = {87},
number = {5},
pages = {674--754},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{pmid36326882,
title = {Liver stiffness assessed by magnetic resonance elastography predicts clinical outcomes in patients with heart failure and without chronic liver disease},
author = {Atsushi Tada and Toshiyuki Nagai and Yoshiya Kato and Kazunori Omote and Noriko Oyama-Manabe and Satonori Tsuneta and Yusuke Kudo and Mutsumi Nishida and Michikazu Nakai and Yuki Takahashi and Kohei Saiin and Seiichiro Naito and Yuta Kobayashi and Sakae Takenaka and Yoshifumi Mizuguchi and Kiwamu Kamiya and Takao Konishi and Takuma Sato and Kohsuke Kudo and Toshihisa Anzai},
doi = {10.1007/s00330-022-09209-0},
issn = {1432-1084},
year = {2023},
date = {2023-03-01},
urldate = {2023-03-01},
journal = {Eur Radiol},
volume = {33},
number = {3},
pages = {2062--2074},
abstract = {OBJECTIVES: Evaluation of liver stiffness (LS) by magnetic resonance elastography (MRE) is useful for estimating right atrial pressure (RAP) in patients with heart failure (HF). However, its prognostic implications are unclear. We sought to investigate whether LS measured by MRE (LS-MRE) could predict clinical outcomes in patients with HF.nnMETHODS: We prospectively examined 207 consecutive HF patients between April 2018 and May 2021 after excluding those with organic liver disease. All patients underwent 3.0-T MRE. The primary outcome of interest was the composite of all-cause death and hospitalisation for HF.nnRESULTS: During a median follow-up period of 720 (interquartile range [IQR] 434-1013) days, the primary outcome occurred in 44 patients (21%), including 15 (7%) all-cause deaths and 29 (14%) hospitalisations for HF. The patients were divided into two groups according to median LS-MRE of 2.54 (IQR 2.34-2.82) kPa. Patients with higher LS-MRE showed a higher incidence of the primary outcome compared to those with lower LS-MRE (p < 0.001). Multivariable Cox regression analyses revealed that LS-MRE value was independently associated with the risk of adverse events (hazard ratio 2.49, 95% confidence interval 1.46-4.24). In multivariable linear regression, RAP showed a stronger correlation with LS-MRE (β coefficient = 0.31, p < 0.001) compared to markers related to liver fibrosis.nnCONCLUSIONS: In patients without chronic liver disease and presenting with HF, elevated LS-MRE was independently associated with worse clinical outcomes. Elevated LS-MRE may be useful for risk stratification in patients with HF and without chronic liver disease.nnKEY POINTS: • Magnetic resonance elastography (MRE) is an emerging non-invasive imaging technique for evaluating liver stiffness (LS) which can estimate right atrial pressure. • Elevated LS-MRE, which mainly reflects liver congestion, was independently associated with worse clinical outcomes in patients with heart failure. • The assessment of LS-MRE would be useful for stratifying the risk of adverse events in heart failure patients without chronic liver disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Evaluation of liver stiffness (LS) by magnetic resonance elastography (MRE) is useful for estimating right atrial pressure (RAP) in patients with heart failure (HF). However, its prognostic implications are unclear. We sought to investigate whether LS measured by MRE (LS-MRE) could predict clinical outcomes in patients with HF.nnMETHODS: We prospectively examined 207 consecutive HF patients between April 2018 and May 2021 after excluding those with organic liver disease. All patients underwent 3.0-T MRE. The primary outcome of interest was the composite of all-cause death and hospitalisation for HF.nnRESULTS: During a median follow-up period of 720 (interquartile range [IQR] 434-1013) days, the primary outcome occurred in 44 patients (21%), including 15 (7%) all-cause deaths and 29 (14%) hospitalisations for HF. The patients were divided into two groups according to median LS-MRE of 2.54 (IQR 2.34-2.82) kPa. Patients with higher LS-MRE showed a higher incidence of the primary outcome compared to those with lower LS-MRE (p < 0.001). Multivariable Cox regression analyses revealed that LS-MRE value was independently associated with the risk of adverse events (hazard ratio 2.49, 95% confidence interval 1.46-4.24). In multivariable linear regression, RAP showed a stronger correlation with LS-MRE (β coefficient = 0.31, p < 0.001) compared to markers related to liver fibrosis.nnCONCLUSIONS: In patients without chronic liver disease and presenting with HF, elevated LS-MRE was independently associated with worse clinical outcomes. Elevated LS-MRE may be useful for risk stratification in patients with HF and without chronic liver disease.nnKEY POINTS: • Magnetic resonance elastography (MRE) is an emerging non-invasive imaging technique for evaluating liver stiffness (LS) which can estimate right atrial pressure. • Elevated LS-MRE, which mainly reflects liver congestion, was independently associated with worse clinical outcomes in patients with heart failure. • The assessment of LS-MRE would be useful for stratifying the risk of adverse events in heart failure patients without chronic liver disease.
@article{pmid36705992b,
title = {Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device},
author = {Sakae Takenaka and Takuma Sato and Toshiyuki Nagai and Kazunori Omote and Yuta Kobayashi and Kiwamu Kamiya and Takao Konishi and Atsushi Tada and Yoshifumi Mizuguchi and Yuki Takahashi and Seiichiro Naito and Kohei Saiin and Suguru Ishizaka and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1152/ajpheart.00626.2022},
issn = {1522-1539},
year = {2023},
date = {2023-03-01},
urldate = {2023-03-01},
journal = {Am J Physiol Heart Circ Physiol},
volume = {324},
number = {3},
pages = {H355--H363},
abstract = {Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( = 0.59, = 0.003) and peak V̇o ( = 0.56, = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( = 0.44, = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( = -0.34, = 0.88), peak V̇o ( = 0.074, = 0.74), or EQ-VAS ( = 0.127, = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( = 0.59, = 0.003) and peak V̇o ( = 0.56, = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( = 0.44, = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( = -0.34, = 0.88), peak V̇o ( = 0.074, = 0.74), or EQ-VAS ( = 0.127, = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.
@article{pmid36122643,
title = {Determinants of exercise capacity in patients with heart failure without left ventricular hypertrophy},
author = {Suguru Ishizaka and Hiroyuki Iwano and Shingo Tsujinaga and Michito Murayama and Satonori Tsuneta and Hiroyuki Aoyagi and Yoji Tamaki and Ko Motoi and Yasuyuki Chiba and Asuka Tanemura and Masahiro Nakabachi and Shinobu Yokoyama and Hisao Nishino and Kazunori Okada and Brett A Meyers and Pavlos P Vlachos and Takuma Sato and Kiwamu Kamiya and Masaya Watanabe and Sanae Kaga and Toshiyuki Nagai and Noriko Oyama-Manabe and Toshihisa Anzai},
doi = {10.1016/j.jjcc.2022.09.004},
issn = {1876-4738},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {J Cardiol},
volume = {81},
number = {1},
pages = {33--41},
abstract = {BACKGROUND: Determinants of exercise intolerance in a phenotype of heart failure with preserved ejection fraction (HFpEF) with normal left ventricular (LV) structure have not been fully elucidated.nnMETHODS: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 44 HFpEF patients without LV hypertrophy. Exercise capacity was determined by peak oxygen consumption (peak VO). Doppler-derived cardiac output (CO), transmitral E velocity, systolic (LV-s') and early diastolic mitral annular velocities (e'), systolic pulmonary artery (PA) pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and peak systolic right ventricular (RV) free wall velocity (RV-s') were measured at rest and exercise. E/e' and TAPSE/SPAP were used as an LV filling pressure parameter and RV-PA coupling, respectively.nnRESULTS: During exercise, CO, LV-s', RV-s', e', and SPAP were significantly increased (p < 0.05 for all), whereas E/e' remained unchanged and TAPSE/SPAP was significantly reduced (p < 0.001). SPAP was higher and TAPSE/SPAP was lower at peak exercise in patients showing lower-half peak VO. In univariable analyses, LV-s' (R = 0.35, p = 0.022), SPAP (R = -0.40, p = 0.008), RV-s' (R = 0.47, p = 0.002), and TAPSE/SPAP (R = 0.42, p = 0.005) were significantly correlated with peak VO. In multivariable analyses, not only SPAP, but also TAPSE/SPAP independently determined peak VO even after the adjustment for clinically relevant parameters.nnCONCLUSIONS: In HFpEF patients without LV hypertrophy, altered RV-PA coupling by exercise could be associated with exercise intolerance, which might not be caused by elevated LV filling pressure.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Determinants of exercise intolerance in a phenotype of heart failure with preserved ejection fraction (HFpEF) with normal left ventricular (LV) structure have not been fully elucidated.nnMETHODS: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 44 HFpEF patients without LV hypertrophy. Exercise capacity was determined by peak oxygen consumption (peak VO). Doppler-derived cardiac output (CO), transmitral E velocity, systolic (LV-s') and early diastolic mitral annular velocities (e'), systolic pulmonary artery (PA) pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and peak systolic right ventricular (RV) free wall velocity (RV-s') were measured at rest and exercise. E/e' and TAPSE/SPAP were used as an LV filling pressure parameter and RV-PA coupling, respectively.nnRESULTS: During exercise, CO, LV-s', RV-s', e', and SPAP were significantly increased (p < 0.05 for all), whereas E/e' remained unchanged and TAPSE/SPAP was significantly reduced (p < 0.001). SPAP was higher and TAPSE/SPAP was lower at peak exercise in patients showing lower-half peak VO. In univariable analyses, LV-s' (R = 0.35, p = 0.022), SPAP (R = -0.40, p = 0.008), RV-s' (R = 0.47, p = 0.002), and TAPSE/SPAP (R = 0.42, p = 0.005) were significantly correlated with peak VO. In multivariable analyses, not only SPAP, but also TAPSE/SPAP independently determined peak VO even after the adjustment for clinically relevant parameters.nnCONCLUSIONS: In HFpEF patients without LV hypertrophy, altered RV-PA coupling by exercise could be associated with exercise intolerance, which might not be caused by elevated LV filling pressure.
@article{TAMAKI202362,
title = {Application of an echocardiographic scoring system of left ventricular filling pressure to diagnose acute heart failure in patients complaining dyspnea},
author = {Yoji Tamaki and Hiroyuki Iwano and Michito Murayama and Suguru Ishizaka and Ko Motoi and Hiroyuki Aoyagi and Kosuke Nakamura and Mana Goto and Yukino Suzuki and Shinobu Yokoyama and Hisao Nishino and Masahiro Nakabachi and Sanae Kaga and Kiwamu Kamiya and Toshiyuki Nagai and Toshihisa Anzai},
url = {https://www.sciencedirect.com/science/article/pii/S0914508723001004},
doi = {https://doi.org/10.1016/j.jjcc.2023.04.016},
issn = {0914-5087},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {Journal of Cardiology},
volume = {82},
number = {1},
pages = {62-68},
abstract = {Background
Dyspnea is a common symptom in acute heart failure (AHF) patients. Although an accurate and rapid diagnosis of AHF is essential to improve prognosis, estimation of left ventricular (LV) filling pressure (FP) remains challenging, especially for noncardiologists. We evaluated the usefulness of a recently-proposed parameter of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, to detect AHF in patients complaining of dyspnea.
Methods
Echocardiography and lung ultrasonography (LUS) were performed in 121 consecutive patients (68 ± 14 years old, 75 males) presenting with dyspnea. The VMT score was determined from the atrioventricular valve opening phase (tricuspid valve first: 0, simultaneous: 1, mitral valve first: 2) and inferior vena cava dilatation (absent: 0, present: 1), and VMT ≥2 was judged as positive. LUS was performed with the 8 zones method and judged as positive if 3 or more B-lines were observed in bilateral regions. The AHF diagnosis was performed by certified cardiologists according to recent guidelines.
Results Of the 121 patients, 33 were diagnosed with AHF. The sensitivity and specificity for diagnosing AHF were 64 % and 84 % for LUS and 94 % and 88 % for VMT score. In logistic regression analysis, VMT score showed a significantly higher c-index than LUS (0.91 vs 0.74},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Dyspnea is a common symptom in acute heart failure (AHF) patients. Although an accurate and rapid diagnosis of AHF is essential to improve prognosis, estimation of left ventricular (LV) filling pressure (FP) remains challenging, especially for noncardiologists. We evaluated the usefulness of a recently-proposed parameter of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, to detect AHF in patients complaining of dyspnea.
Methods
Echocardiography and lung ultrasonography (LUS) were performed in 121 consecutive patients (68 ± 14 years old, 75 males) presenting with dyspnea. The VMT score was determined from the atrioventricular valve opening phase (tricuspid valve first: 0, simultaneous: 1, mitral valve first: 2) and inferior vena cava dilatation (absent: 0, present: 1), and VMT ≥2 was judged as positive. LUS was performed with the 8 zones method and judged as positive if 3 or more B-lines were observed in bilateral regions. The AHF diagnosis was performed by certified cardiologists according to recent guidelines.
Results Of the 121 patients, 33 were diagnosed with AHF. The sensitivity and specificity for diagnosing AHF were 64 % and 84 % for LUS and 94 % and 88 % for VMT score. In logistic regression analysis, VMT score showed a significantly higher c-index than LUS (0.91 vs 0.74
@article{pmid35337935,
title = {Long-term preservation of functional capacity and quality of life in advanced heart failure patients with bridge to transplant therapy: A report from Japanese nationwide multicenter registry},
author = {Takuma Sato and Yuta Kobayashi and Toshiyuki Nagai and Takeshi Nakatani and Jon Kobashigawa and Yoshikatsu Saiki and Minoru Ono and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1016/j.ijcard.2022.03.044},
issn = {1874-1754},
year = {2022},
date = {2022-06-01},
urldate = {2022-06-01},
journal = {Int J Cardiol},
volume = {356},
pages = {66--72},
abstract = {BACKGROUND: Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients.nnMETHODS: We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation.nnRESULTS: During the follow-up period of 30 months (IQR 18-42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO, 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively).nnCONCLUSIONS: BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients.nnMETHODS: We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation.nnRESULTS: During the follow-up period of 30 months (IQR 18-42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO, 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively).nnCONCLUSIONS: BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx.
@article{pmid34634448,
title = {Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan: An International Comparison of Administrative Health Records on 413,385 Individual Patients},
author = {Varun Sundaram and Toshiyuki Nagai and Chern-En Chiang and Yogesh N V Reddy and Tze-Fan Chao and Rosita Zakeri and Chloe Bloom and Michikazu Nakai and Kunihiro Nishimura and Chung-Lieh Hung and Yoshihiro Miyamoto and Satoshi Yasuda and Amitava Banerjee and Toshihisa Anzai and Daniel I Simon and Sanjay Rajagopalan and John G F Cleland and Jayakumar Sahadevan and Jennifer K Quint},
doi = {10.1016/j.cardfail.2021.08.024},
issn = {1532-8414},
year = {2022},
date = {2022-03-01},
urldate = {2022-03-01},
journal = {J Card Fail},
volume = {28},
number = {3},
pages = {353--366},
abstract = {BACKGROUND: Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents.nnMETHODS AND RESULTS: We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%-1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%-4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%-6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%-6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively).nnCONCLUSIONS: Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Registries show international variations in the characteristics and outcome of patients with heart failure (HF), but national samples are rarely large, and case selection may be biased owing to enrolment in academic centers. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, health care resource use (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from 4 high-income countries (United States, UK, Taiwan, Japan) on 3 continents.nnMETHODS AND RESULTS: We used electronic health record to identify unplanned HFH between 2012 and 2014. We identified 231,512, 10,991, 36,900, and 133,982 patients with a primary HFH from the United States, the UK, Taiwan, and Japan, respectively. HFH per 100,000 population was highest in the United States and lowest in Taiwan. Fewer patients in Taiwan and Japan were obese or had chronic kidney disease. The length of hospital stay was shortest in the United States (median 4 days) and longer in the UK, Taiwan, and Japan (medians of 7, 9, and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in the United States (direct standardized rates 1.8, 95% confidence interval 1.7%-1.9%) and progressively higher in Taiwan (direct standardized rates 3.9, 95% CI 3.8%-4.1%), the UK (direct standardized rates 6.4, 95% CI 6.1%-6.7%), and Japan (direct standardized rates 6.7, 95% CI 6.6%-6.8%). The 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in the United States and lowest in Japan (11.9% and 5.1%, respectively).nnCONCLUSIONS: Marked international variations in patient characteristics, HRU, and clinical outcomes exist; understanding them might inform health care policy and international trial design.
@article{pmid33431716b,
title = {High-Density Lipoprotein Cholesterol and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Statins: An Observation from the REAL-CAD Study},
author = {Kazunori Omote and Isao Yokota and Toshiyuki Nagai and Ichiro Sakuma and Yoshihisa Nakagawa and Kiwamu Kamiya and Hiroshi Iwata and Katsumi Miyauchi and Yukio Ozaki and Kiyoshi Hibi and Takafumi Hiro and Yoshihiro Fukumoto and Hiroyoshi Mori and Seiji Hokimoto and Yasuo Ohashi and Hiroshi Ohtsu and Hisao Ogawa and Hiroyuki Daida and Satoshi Iimuro and Hiroaki Shimokawa and Yasushi Saito and Takeshi Kimura and Masunori Matsuzaki and Ryozo Nagai and Toshihisa Anzai},
doi = {10.5551/jat.59881},
issn = {1880-3873},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {J Atheroscler Thromb},
volume = {29},
number = {1},
pages = {50--68},
abstract = {AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.nnMETHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.nnRESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.nnCONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.nnMETHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.nnRESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.nnCONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.
@article{pmid34514715,
title = {Association of high serum soluble interleukin 2 receptor levels with risk of adverse events in cardiac sarcoidosis},
author = {Yuta Kobayashi and Takuma Sato and Toshiyuki Nagai and Kenji Hirata and Satonori Tsuneta and Yoshiya Kato and Hirokazu Komoriyama and Kiwamu Kamiya and Takao Konishi and Kazunori Omote and Hiroshi Ohira and Kohsuke Kudo and Satoshi Konno and Toshihisa Anzai},
doi = {10.1002/ehf2.13614},
issn = {2055-5822},
year = {2021},
date = {2021-12-01},
urldate = {2021-12-01},
journal = {ESC Heart Fail},
volume = {8},
number = {6},
pages = {5282--5292},
abstract = {AIMS: Although soluble interleukin 2 receptor (sIL-2R) is a potentially useful biomarker in the diagnosis and evaluation of disease severity in patients with sarcoidosis, its prognostic implication in patients with cardiac sarcoidosis (CS) is unclear. We sought to investigate whether sIL-2R was associated with clinical outcomes and to clarify the relationship between sIL-2R levels and disease activity in patients with CS.nnMETHODS AND RESULTS: We examined 83 consecutive patients with CS in our hospital who had available serum sIL-2R data between May 2003 and February 2020. The primary outcome was a composite of advanced atrioventricular block, ventricular tachycardia or ventricular fibrillation, heart failure hospitalization, and all-cause death. Inflammatory activity in the myocardium and lymph nodes was assessed by F-fluorideoxyglucose positron emission tomography/computed tomography. During a median follow-up period of 2.96 (IQR 2.24-4.27) years, the primary outcome occurred in 24 patients (29%). Higher serum sIL-2R levels (>538 U/mL, the median) were significantly related to increased incidence of primary outcome (P = 0.037). Multivariable Cox regression analysis showed that a higher sIL-2R was independently associated with an increased subsequent risk of adverse events (HR 3.71, 95% CI 1.63-8.44, P = 0.002), even after adjustment for significant covariates. sIL-2R levels were significantly correlated to inflammatory activity in lymph nodes (r = 0.346, P = 0.003) but not the myocardium (r = 0.131, P = 0.27).nnCONCLUSIONS: Increased sIL-2R is associated with worse long-term clinical outcomes accompanied by increased systemic inflammatory activity in CS patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: Although soluble interleukin 2 receptor (sIL-2R) is a potentially useful biomarker in the diagnosis and evaluation of disease severity in patients with sarcoidosis, its prognostic implication in patients with cardiac sarcoidosis (CS) is unclear. We sought to investigate whether sIL-2R was associated with clinical outcomes and to clarify the relationship between sIL-2R levels and disease activity in patients with CS.nnMETHODS AND RESULTS: We examined 83 consecutive patients with CS in our hospital who had available serum sIL-2R data between May 2003 and February 2020. The primary outcome was a composite of advanced atrioventricular block, ventricular tachycardia or ventricular fibrillation, heart failure hospitalization, and all-cause death. Inflammatory activity in the myocardium and lymph nodes was assessed by F-fluorideoxyglucose positron emission tomography/computed tomography. During a median follow-up period of 2.96 (IQR 2.24-4.27) years, the primary outcome occurred in 24 patients (29%). Higher serum sIL-2R levels (>538 U/mL, the median) were significantly related to increased incidence of primary outcome (P = 0.037). Multivariable Cox regression analysis showed that a higher sIL-2R was independently associated with an increased subsequent risk of adverse events (HR 3.71, 95% CI 1.63-8.44, P = 0.002), even after adjustment for significant covariates. sIL-2R levels were significantly correlated to inflammatory activity in lymph nodes (r = 0.346, P = 0.003) but not the myocardium (r = 0.131, P = 0.27).nnCONCLUSIONS: Increased sIL-2R is associated with worse long-term clinical outcomes accompanied by increased systemic inflammatory activity in CS patients.
@article{pmid34364907,
title = {Performance of the HFPEF and the HFA-PEFF scores for the diagnosis of heart failure with preserved ejection fraction in Japanese patients: A report from the Japanese multicenter registry},
author = {Atsushi Tada and Toshiyuki Nagai and Kazunori Omote and Hiroyuki Iwano and Shingo Tsujinaga and Kiwamu Kamiya and Takao Konishi and Takuma Sato and Hirokazu Komoriyama and Yuta Kobayashi and Sakae Takenaka and Yoshifumi Mizuguchi and Tomoya Sato and Kazuhiro Yamamoto and Tsutomu Yoshikawa and Yoshihiko Saito and Toshihisa Anzai},
doi = {10.1016/j.ijcard.2021.08.001},
issn = {1874-1754},
year = {2021},
date = {2021-11-01},
urldate = {2021-11-01},
journal = {Int J Cardiol},
volume = {342},
pages = {43--48},
abstract = {BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. Although the HFPEF score and HFA-PEFF algorithm have been proposed for diagnosing HFpEF, previous validation studies were conducted in stable chronic heart failure (HF). Moreover, information on their applicability in the Asian population is limited. We sought to investigate these scores' diagnostic performance for HFpEF in Japanese patients recently hospitalized due to acute decompensated HF.nnMETHODS: We examined patients with HFpEF recently hospitalized with acute decompensated HF from a nationwide HFpEF-specific multicenter registry (HFpEF group) and control patients who underwent echocardiography to investigate the cause of dyspnea in our hospital (Non-HFpEF group).nnRESULTS: The studied population included 372 patients (194 HFpEF group and 178 Non-HFpEF group; HFpEF prevalence, 52%). A high HFPEF score (6-9 points) could diagnose HFpEF with a high specificity of 97% and a positive predictive value (PPV) of 94%, and a low HFPEF score (0-1 point) could rule out HFpEF with a high sensitivity of 97% and a negative predictive value (NPV) of 93%. HFpEF could be diagnosed with a high HFA-PEFF score (5-6 points) (specificity, 84%; PPV, 82%) or ruled out with a low HFA-PEFF score (0-1 point) (sensitivity, 99%; NPV, 89%). The HFPEF score was significantly superior to the HFA-PEFF score in diagnostic accuracy (area under the curve: 0.89 vs. 0.82, respectively, p = 0.004).nnCONCLUSIONS: The HFPEF and the HFA-PEFF scores had acceptable diagnostic accuracy in diagnosing HFpEF in Japanese patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. Although the HFPEF score and HFA-PEFF algorithm have been proposed for diagnosing HFpEF, previous validation studies were conducted in stable chronic heart failure (HF). Moreover, information on their applicability in the Asian population is limited. We sought to investigate these scores' diagnostic performance for HFpEF in Japanese patients recently hospitalized due to acute decompensated HF.nnMETHODS: We examined patients with HFpEF recently hospitalized with acute decompensated HF from a nationwide HFpEF-specific multicenter registry (HFpEF group) and control patients who underwent echocardiography to investigate the cause of dyspnea in our hospital (Non-HFpEF group).nnRESULTS: The studied population included 372 patients (194 HFpEF group and 178 Non-HFpEF group; HFpEF prevalence, 52%). A high HFPEF score (6-9 points) could diagnose HFpEF with a high specificity of 97% and a positive predictive value (PPV) of 94%, and a low HFPEF score (0-1 point) could rule out HFpEF with a high sensitivity of 97% and a negative predictive value (NPV) of 93%. HFpEF could be diagnosed with a high HFA-PEFF score (5-6 points) (specificity, 84%; PPV, 82%) or ruled out with a low HFA-PEFF score (0-1 point) (sensitivity, 99%; NPV, 89%). The HFPEF score was significantly superior to the HFA-PEFF score in diagnostic accuracy (area under the curve: 0.89 vs. 0.82, respectively, p = 0.004).nnCONCLUSIONS: The HFPEF and the HFA-PEFF scores had acceptable diagnostic accuracy in diagnosing HFpEF in Japanese patients.
@article{pmid34217654,
title = {Applicability of the AHA/ACC/HRS Guideline for Implantable Cardioverter Defibrillator Implantation in Japanese Patients With Cardiac Sarcoidosis},
author = {Sakae Takenaka and Yuta Kobayashi and Toshiyuki Nagai and Yoshiya Kato and Hirokazu Komoriyama and Nobutaka Nagano and Kiwamu Kamiya and Takao Konishi and Takuma Sato and Kazunori Omote and Yoshifumi Mizuguchi and Atsushi Tada and Tomoya Sato and Hiroyuki Iwano and Kengo Kusano and Hatsue Ishibashi-Ueda and Toshihisa Anzai},
doi = {10.1016/j.jacep.2021.04.009},
issn = {2405-5018},
year = {2021},
date = {2021-11-01},
urldate = {2021-11-01},
journal = {JACC Clin Electrophysiol},
volume = {7},
number = {11},
pages = {1410--1418},
abstract = {OBJECTIVES: This study aimed to assess, among Japanese patients with cardiac sarcoidosis (CS), the implantable cardioverter-defibrillator (ICD) recommendations from the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death (SCD).nnBACKGROUND: Although ICDs are used to prevent SCD from ventricular tachycardia or ventricular fibrillation (VT/VF) in patients with CS, the generalizability of the AHA/ACC/HRS guidelines for Japanese patients with CS remains unclear.nnMETHODS: This study examined 188 consecutive patients with CS in 2 tertiary hospitals between 1979 and 2020. Patients were followed for a primary outcome of VT/VF or SCD.nnRESULTS: During a median follow-up of 5.68 years, the primary outcome occurred in 44 patients (23%). Patients with a Class I recommendation for ICD implantation showed the highest incidence of the primary outcome among patients in whom the guideline recommendations for ICD implantation were used (log-rank test; p = 0.03). However, compared with patients with left ventricular ejection fractions (LVEFs) ≤35%, there was no significant difference in the incidence of the primary outcome among patients with LVEFs >35% and those who required a permanent pacemaker (p = 0.31); similar results were observed in those with LVEFs >35% and late gadolinium enhancement during cardiovascular magnetic resonance imaging (p = 0.22).nnCONCLUSIONS: The American guideline recommendations for ICD implantation might be applicable to Japanese patients with CS. Implantation of an ICD may need to be considered in these patients if they require a permanent pacemaker or have late gadolinium enhancement, regardless of LVEF.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: This study aimed to assess, among Japanese patients with cardiac sarcoidosis (CS), the implantable cardioverter-defibrillator (ICD) recommendations from the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death (SCD).nnBACKGROUND: Although ICDs are used to prevent SCD from ventricular tachycardia or ventricular fibrillation (VT/VF) in patients with CS, the generalizability of the AHA/ACC/HRS guidelines for Japanese patients with CS remains unclear.nnMETHODS: This study examined 188 consecutive patients with CS in 2 tertiary hospitals between 1979 and 2020. Patients were followed for a primary outcome of VT/VF or SCD.nnRESULTS: During a median follow-up of 5.68 years, the primary outcome occurred in 44 patients (23%). Patients with a Class I recommendation for ICD implantation showed the highest incidence of the primary outcome among patients in whom the guideline recommendations for ICD implantation were used (log-rank test; p = 0.03). However, compared with patients with left ventricular ejection fractions (LVEFs) ≤35%, there was no significant difference in the incidence of the primary outcome among patients with LVEFs >35% and those who required a permanent pacemaker (p = 0.31); similar results were observed in those with LVEFs >35% and late gadolinium enhancement during cardiovascular magnetic resonance imaging (p = 0.22).nnCONCLUSIONS: The American guideline recommendations for ICD implantation might be applicable to Japanese patients with CS. Implantation of an ICD may need to be considered in these patients if they require a permanent pacemaker or have late gadolinium enhancement, regardless of LVEF.
@article{pmid33383123,
title = {Presence and Relevance of Midsystolic Notching on Right Ventricular Outflow Tract Flow Velocity Envelopes in Pulmonary Hypertension due to Heart Failure},
author = {Yasuyuki Chiba and Hiroyuki Iwano and Michito Murayama and Sanae Kaga and Ko Motoi and Suguru Ishizaka and Shingo Tsujinaga and Asuka Tanemura and Shinobu Yokoyama and Masahiro Nakabachi and Hisao Nishino and Kazunori Okada and Kiwamu Kamiya and Toshiyuki Nagai and Toshihisa Anzai},
doi = {10.1016/j.echo.2020.12.018},
issn = {1097-6795},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {J Am Soc Echocardiogr},
volume = {34},
number = {6},
pages = {690--692.e1},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
@article{pmid34176516,
title = {Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement},
author = {Hirokazu Komoriyama and Kiwamu Kamiya and Toshiyuki Nagai and Noriko Oyama-Manabe and Satonori Tsuneta and Yuta Kobayashi and Yoshiya Kato and Miwa Sarashina and Kazunori Omote and Takao Konishi and Takuma Sato and Shingo Tsujinaga and Hiroyuki Iwano and Yasushige Shingu and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1186/s12968-021-00771-y},
issn = {1532-429X},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {J Cardiovasc Magn Reson},
volume = {23},
number = {1},
pages = {81},
abstract = {BACKGROUND: Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR.nnMETHODS: We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR.nnRESULTS: After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034).nnCONCLUSIONS: In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR.nnMETHODS: We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR.nnRESULTS: After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034).nnCONCLUSIONS: In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
