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Hara H, Yamamoto S, Kii T, Kawabata R, Kawada J, Takeno A, Matsuyama J, Ueda S, Kawakami H, Okita Y, Endo S, Kimura Y, Yanagihara K, Okuno T, Kurokawa Y, Shimokawa T, Satoh T. 1387P Randomized phase II study comparing docetaxel vs paclitaxel in patients with esophageal squamous cell carcinoma who are refractory to fluoropyrimidine and platinum-based chemotherapy: OGSG1201. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Beheshti I, Sone D, Maikusa N, Kimura Y, Shigemoto Y, Sato N, Matsuda H. Accurate lateralization and classification of MRI-negative 18F-FDG-PET-positive temporal lobe epilepsy using double inversion recovery and machine-learning. Comput Biol Med 2021; 137:104805. [PMID: 34464851 DOI: 10.1016/j.compbiomed.2021.104805] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/03/2021] [Accepted: 08/23/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The main objective of this study was to determine the ability of double inversion recovery (DIR) data coupled with machine-learning algorithms to distinguish normal individuals from epileptic subjects and to identify the laterality of the focus side in MRI-negative, PET-positive temporal lobe epilepsy (TLE) patients. MATERIALS AND METHODS We used whole-brain DIR data as the input features with which to train a linear support-vector machine model in 63 participants who underwent high-resolution structural MRI and DIR scans. The subjects included 20 left TLE patients, 19 right TLE patients, and 24 healthy controls (HCs). RESULTS Using the DIR data, we achieved a robust accuracy of 87.30% for discriminating among the left TLE, right TLE, and HC groups as well as 84.61%, 97.72%, and 93.02% prediction accuracies for distinguishing left TLE from right TLE, HC from right TLE, and HC from left TLE, respectively. INTERPRETATION Our experimental results suggest that DIR data coupled with machine-learning algorithms provide a promising approach to identifying MRI-negative TLE patients, especially when fluorodeoxyglucose-PET is not available.
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Tsukui D, Kimura Y, Hajime K. SYK contributes to the development of atherosclerosis through via CD11C expression. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Honda M, Shimizu R, Teraoka S, Tsounapi P, Kimura Y, Yumioka T, Iwamoto H, Morizane S, Hikita K, Takenaka A. Orgasmic dysfunction after robot-assisted radical prostatectomy: Rates of occurrence and predictors. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kimura Y, Chiba E, Shigemoto Y, Sato N. [Diagnostic Imaging of Epilepsy]. BRAIN AND NERVE = SHINKEI KENKYU NO SHINPO 2021; 73:725-730. [PMID: 34127568 DOI: 10.11477/mf.1416201822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neuroimaging is the most important tool to treat epileptic foci. Preoperative detection of underlying structural lesions increases the likelihood of the successful surgical treatment of drug-resistant epilepsy. Imaging studies used for preoperative focal determination include morphological imaging modalities, such as computed tomography and magnetic resonance imaging, and functional ones, such as positron emission tomography and single photon-emission computed tomography. The keys to diagnostic imaging in epilepsy are appropriate protocols and extensive knowledge to make comprehensive decisions. This article comprehensively overviews neuroimaging techniques used in epilepsy.
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Kimura Y, De Riva M, Ebert M, Glashan C, Piers SRD, Trines SA, Wijnmaalen AP, Zeppenfeld K. Pleomorphic ventricular tachycardia in dilated cardiomyopathy is a strong predictor of VT recurrence after ablation independent of cardiac function: Comparison with ischemic cardiomyopathy. Europace 2021. [DOI: 10.1093/europace/euab116.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Compared to ICM patients, subgroups of DCM patients show higher VT recurrence rates after catheter ablation (CA), despite similar percentages of acute non-inducibility. Pleomorphic VTs (PL-VT) have been reported in ICM patients with fibrotic remodeling and progressive heart failure. Diffuse fibrosis is the dominant scar pattern in DCM. In these patients PL-VT may occur independent of cardiac function.
Aim
To investigate the prevalence, relation with cardiac function, and impact of PL-VT on long-term ablation outcome in patients with ICM and DCM.
Methods
Consecutive patients with ICM or DCM undergoing VT ablation (ICM 2009-2016; DCM 2008-2018) were included. PL-VT was defined as ≥1 spontaneous change of the 12-lead VT morphology lasting for ≥6 consecutive beats during the same induced VT episode. Complete procedural success was defined as non-inducibility of any VT at the end of the procedure. Patients were followed for VT recurrence and mortality.
Results
A total of 247 patients (86% men, age 63 ± 13 years) underwent CA for monomorphic VT, 152 with ICM (62%), and 95 with DCM (38%). Complete procedural success was achieved in 39% in ICM vs. 37% in DCM, respectively. PL-VT was observed in 22 and 29 patients with ICM and DCM, respectively (14% vs. 31%, P = 0.003). Among ICM patients, PL-VT was associated with a lower LVEF (PL-VT+ 28 ± 9% vs. PL-VT- 34 ± 12%, P = 0.02) and only occurred if LVEF was <40%. In contrast, in DCM patients, PL-VT was not related to cardiac function and occurred in 27% of patients with an EF >40%. After propensity score matching to account for baseline differences (age, gender, LVEF, prior VT ablation, VT storm, and amiodarone use), between ICM vs. DCM patients, the PLVT incidence was 4 times higher in DCM patients (7% [4/60] vs. 28% [17/60], P = 0.003).
During a median follow-up of 30 months, 79 (32%) patients died (ICM 48 [32%), DCM 31 [33%], P = 0.88) and 120 (49%) patients had VT recurrence (ICM 59 [39%], DCM 61 [64%], P < 0.001). In Kaplan-Meier analyses, inducibility of PL-VT was associated with mortality only in ICM but not in DCM patients. In contrast, PL-VT was associated with poorer VT-free survival in both ICM and DCM patients (figure). In multivariate analyses, PL-VT remained a significant predictor of VT recurrence in DCM (HR 3.00, 95% CI 1.75-5.11, P < 0.001), independent of LVEF, (likely) pathogenic genetic mutation, amiodarone, endocardial low bipolar/unipolar voltage areas, dominant anteroseptal substrate, and non-complete acute procedural success, but not in ICM.
Conclusions
PL-VT was associated with poor systolic function and mortality in ICM, whereas it was independent of LVEF and the most decisive parameter for VT recurrence in DCM. This data suggests that PL-VT in DCM is a marker of a complex arrhythmic substrate challenging to control by CA. Abstract Figure. Kaplan-Meier analyses
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Kimura Y, Beukers HKC, Ebert M, Wijnmaalen AP, De Riva M, Zeppenfeld K. Volume-weighted unipolar endocardial voltage: An excellent, novel parameter for predicting cardiac mortality in patients with dilated cardiomyopathy and ventricular arrhythmias. Europace 2021. [DOI: 10.1093/europace/euab116.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with dilated cardiomyopathy (DCM) and ventricular tachyarrhythmias (VT) are at risk for heart failure (HF) death. Global left ventricular endocardial voltage may reflect the amount of excitable viable myocardium and identify patients at risk for rapid progression to end-stage HF.
Aim
To determine if volume-weighted endocardial voltage, as a surrogate for the total excitable viable myocardium, predicts mortality in patients with DCM and VT.
Methods
Consecutive patients with DCM, who underwent high-density endocardial voltage mapping for VT or PVC ablation (2012-2018), were included. Mapping data were transferred from CARTO to ParaView after excluding valve areas. The volume-weighted UV and BV (vwUV, vwBW) were calculated by mathematically integrating the UV and BV over the whole LV (thereby correcting for mapping density heterogeneity) divided by the endocardial LV surface area and corrected for LV wall thickness determined by echocardiography. The prognostic values of vwUV and vwBV for cardiac function and cardiac death were evaluated.
Results
One hundred three patients (VT, n = 83 and PVC, n = 20; age, 57 ± 14yrs; LVEF, 39 ± 13%; [likely] pathogenic genetic variants 33 [32%]; amiodarone use 36 [35%]) were included. VwUV and vwBV were 9.94 ± 3.42 and 4.70 ± 1.46. During a median follow-up of 24 months, cardiac mortality was 18% (end-stage HF 16/19, the median time to death 5.7 months). Patients who died had a significantly lower vwUV and vwBV (vwUV 5.62 ± 0.93 vs. 10.91 ± 3.10, P < 0.001; vwBV 2.99 ± 0.70 vs. 5.04 ± 1.28, P < 0.001). The optimal cutoff of vwUV for predicting HF-related death was 6.64 (AUC, 0.98; Sensitivity, 94%; Specificity, 95%), superior to LVEF or vwBV (AUC, 0.77, 0.92, respectively, Figure A). In multivariable analysis, vwUV remained the only significant predictor for cardiac death (for one decrease, HR 2.66, CI 1.41-5.00, P = 0.002), independently of LVEF, NT-proBNP, vwBV, genetic variants, and amiodarone use. In a subanalysis, the correlations between vwUV and changes of LVEF over time after voltage mapping were analyzed in patients with mid-range (HFmrEF, EF40-49%, n = 27) and reduced (HFrEF, EF < 40%, n = 53) LVEF, respectively. In patients with HFmrEF, a significant LVEF deterioration (defined as an EF decrease >5% and transition to HFrEF) occurred in 22% and was strongly related with a low vwUV (6.65 ± 1.15 vs. 10.08 ± 2.92, P = 0.02, Figure B left). Furthermore, in patients with HFrEF, a significant LVEF improvement (defined as an EF increase >5% and transition to HFmrEF) was noted in 32% and was correlated with a high vwUV (11.68 ± 2.70 vs. 8.62 ± 2.69, P = 0.002, Figure B right).
Conclusion
VwUV is a newly proposed surrogate for the amount of LV viable myocardium, available from routine endocardial mapping and an excellent parameter to identify patients with DCM at high risk for rapid progression to HF-related death. Abstract Figure. vwUV and outcomes
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Chen HS, Jungen C, Kimura Y, Dibbets-Schneider P, Piers SRD, Androulakis AFA, Van Der Geest RJ, Lamb HJ, Scholte AJHA, De Geus-Oei LF, Jongbloed MRM, Zeppenfeld K. Global cardiac sympathetic denervation is associated with diffuse myocardial fibrosis in non-ischemic cardiomyopathy. Europace 2021. [DOI: 10.1093/europace/euab116.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Occurrence of ventricular tachycardias (VT) has been related to changes in sympathetic innervation and myocardial tissue in ischemic cardiomyopathy. In non-ischemic cardiomyopathy (NICM) patients with VT, the relation between global cardiac sympathetic innervation and non-ischemic fibrosis is less clear. The current gold standard in electrophysiology to identify non-ischemic fibrosis relies on unipolar endocardial voltage mapping.
Objective
To establish the relationship between global cardiac sympathetic innervation and global fibrosis.
Methods
29 patients (93% male, 58 ± 14 years, mean LVEF 38%±13) from the ‘Leiden Nonischemic Cardiomyopathy Study’ undergoing VT ablation between 2011-2018 were included. Endocardial voltage mapping was performed and the mean endocardial unipolar voltage (UV) was taken as a surrogate for global fibrosis. Global cardiac sympathetic innervation was analyzed by 123-I-MIBG imaging using heart-to-mediastinum ratio (HMR). A cut-off of 1.8 was used to delineate between normal (>1.8) and denervated (<1.8). HMR was correlated with mean UV.
Results
For patients with global cardiac sympathetic denervation a linear relationship was present between HMR and mean UV (R = 0.5278, P = 0.0431. There was no significant linear relationship for patients with normal cardiac sympathetic innervation between HMR and mean UV (R=-0.1696, P = 0.5795).
Conclusion
Global cardiac sympathetic denervation is related to myocardial fibrosis in patients with NICM and VT. The data support an interplay between denervation and fibrosis which may contribute to arrhythmogeneity, as observed in ICM. Abstract Figure.
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Jungen C, Chen HS, Kimura Y, Dibbets-Schneider P, Piers SRD, Androulakis AFA, Van Der Geest RJ, De Geus-Oei LF, Scholte AJH, Lamb HJ, Jongbloed MRM, Zeppenfeld K. Sympathetic innervation pattern in NICM patients with ventricular tachycardia -anteroseptal versus inferolateral substrates-. Europace 2021. [DOI: 10.1093/europace/euab116.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation - Projektnummer 447558597)
Background
Among patients with non-ischemic cardiomyopathy (NICM) two dominant ventricular tachycardia (VT) substrate locations, namely anteroseptal (AS) and inferolateral (IL), have been identified. The poor outcome after catheter ablation of AS substrates (ASS) compared to IL substrates (ILS) has been attributed to its deep intramural location. However, region specific tissue charateristics, including sympathetic innervation, as important determinant of arrhythmogeneity, may also contribute to the outcome disparity.
Aim
To evaluate the association between regional sympathetic denervation, myocardial fibrosis and VT substrates according to two dominant VT substrate locations.
Methods
Twenty-nine patients from the ‘Leiden Nonischemic Cardiomyopathy Study’, who underwent electroanatomical substrate mapping and radiofrequency catheter ablation (RFCA), LGE-CMR and 123-I-MIBG imaging between 2011-2018 were included. The 16-segment model was used to describe the distribution of endocardial low unipolar voltage (UV <25th IQR) (=electroanatomical surrogate for fibrosis), the location of abnormal local electrograms and VT related sites (= surrogate for VT substrate) and the presence of LGE. Regional cardiac sympathetic innervation was determined by 123-I-MIBG imaging and analyzed according to the 16-segment model. Regions with sympathetic denervation were correlated with low UV areas, VT substrate location and LGE. Patients were categorized according to the dominant VT substrate location in ASS or ILS.
Results
Ten patients had a dominant ASS, 12 patients a dominant ILS and 1 patient had ASS and ILS; 6 patients had other VT substrate locations. All but one patient with ASS and one with ILS also showed corresponding low UV (=surrogate for fibrosis) in segments with VT substrates. Eight patients with IL VT substrates but only 4 with AS substrates showed corresponding LGE in the VT related segments. All patients with inferolateral VT substrates showed sympathetic denervation in IL segments (100% matching segments), but only 3/11 (27%) with anteroseptal substrates had sympathetic denervation in AS segments (P = 0.0002). UV was not significantly different between matching (VT substrate and denervation) and not matching ASS segments (5.74 ± 2.69 mV vs. 4.64 ± 1.85 mV, P = 0.78) and between matching ASS and ILS segments (5.74 ± 2.69 mV vs. 7.61 ± 2.91, P = 0.43). LGE location was matching with sympathetic denervation in all patients with ILS but only in 33% of patients with ASS.
Conclusion
Despite low endocardial UV (=surrogate for fibrosis) for AS and IL segments harboring VT substrates, regional sympathetic denervation coincided with fibrosis only for IL VT substrates. The mismatch between regional fibrosis and preserved innervation for AS VT substrates may contribute to a VT substrate difficult to control by RFCA.
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Kimura Y, Ranjan R, Raghuraman N, Srimathveeravalli G. Abstract No. 85 Electric pulse assisted transcriptomic and proteomic profiling of tumors. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kimura Y, Ramesh A, Kulkarni A, Burrell W, Srimathveeravalli G. Abstract No. 207 Damage-associated molecular patterns released by irreversible electroporation–treated cancer cells skew macrophages to M2 phenotype. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kimura Y, Yamashita T, Seto R, Imanishi M, Honda M, Nakagawa S, Saga Y, Takenaka S, Yu LJ, Madigan MT, Wang-Otomo ZY. Circular dichroism and resonance Raman spectroscopies of bacteriochlorophyll b-containing LH1-RC complexes. PHOTOSYNTHESIS RESEARCH 2021; 148:77-86. [PMID: 33834357 DOI: 10.1007/s11120-021-00831-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
The core light-harvesting complexes (LH1) in bacteriochlorophyll (BChl) b-containing purple phototrophic bacteria are characterized by a near-infrared absorption maximum around 1010 nm. The determinative cause for this ultra-redshift remains unclear. Here, we present results of circular dichroism (CD) and resonance Raman measurements on the purified LH1 complexes in a reaction center-associated form from a mesophilic and a thermophilic Blastochloris species. Both the LH1 complexes displayed purely positive CD signals for their Qy transitions, in contrast to those of BChl a-containing LH1 complexes. This may reflect differences in the conjugation system of the bacteriochlorin between BChl b and BChl a and/or the differences in the pigment organization between the BChl b- and BChl a-containing LH1 complexes. Resonance Raman spectroscopy revealed remarkably large redshifts of the Raman bands for the BChl b C3-acetyl group, indicating unusually strong hydrogen bonds formed with LH1 polypeptides, results that were verified by a published structure. A linear correlation was found between the redshift of the Raman band for the BChl C3-acetyl group and the change in LH1-Qy transition for all native BChl a- and BChl b-containing LH1 complexes examined. The strong hydrogen bonding and π-π interactions between BChl b and nearby aromatic residues in the LH1 polypeptides, along with the CD results, provide crucial insights into the spectral and structural origins for the ultra-redshift of the long-wavelength absorption maximum of BChl b-containing phototrophs.
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Momozane T, Shigetsu K, Kimura Y, Kishima H, Kodama K. The histological diagnosis and molecular testing of lung cancer by surgical biopsy for intrathoracic lesions. Gen Thorac Cardiovasc Surg 2021; 69:1185-1191. [PMID: 33768496 DOI: 10.1007/s11748-021-01600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Accurate histological diagnosis and molecular testing using a sufficient tumor sample of advanced lung cancer, especially non-small cell lung cancer (NSCLC), are crucial for precision medicine. The aim of this study was to assess the feasibility and safety of surgical biopsy for intrathoracic lesions, and, in addition, overall survival after surgical biopsy. METHODS One hundred-one patients who underwent surgical biopsy for intrathoracic lesions of lung cancer at our hospital between 2011 and 2019 were retrospectively reviewed. Their clinical and pathologic records were reviewed. In addition to evaluating the oncologic safety of the surgical biopsy, the overall survival based on the biopsy results was estimated. RESULTS The total number of surgical sites of the 101 patients was 131, and common biopsy sites were the lungs (82, 62.6%) followed by hilar/mediastinal lymph nodes (27, 20.6%). There were 13 postoperative complications (12.9%) without surgery-related deaths. The median time from surgical biopsy to the initiation of treatment was 27 days. Appropriate amounts of specimens for diagnosis and molecular testing were obtained from all patients (100%). When limited to treatment-naïve patients with stage IV adenocarcinoma, patients treated with tyrosine kinase inhibitors (TKIs) or immune checkpoint inhibitors (ICIs) based on molecular testing had a better prognosis. CONCLUSIONS Surgical biopsy for intrathoracic lesions of lung cancer may be a safe and effective method to make a definitive diagnosis, including companion diagnostics for advancing precision therapy in selected patients with inoperable advanced NSCLC.
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Kimura Y, Sato N, Ishiyama A, Shigemoto Y, Suzuki F, Fujii H, Maikusa N, Matsuda H, Nishioka K, Hattori N, Sasaki M. Serial MRI alterations of pediatric patients with beta-propeller protein associated neurodegeneration (BPAN). J Neuroradiol 2021; 48:88-93. [DOI: 10.1016/j.neurad.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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Kusama M, Sato N, Kimura Y, Miyagi K. Quick MR Neuromelanin Imaging Using a Chemical Shift Selective Pulse. Magn Reson Med Sci 2021; 20:106-111. [PMID: 32074593 PMCID: PMC7952205 DOI: 10.2463/mrms.tn.2019-0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Not only magnetization transfer contrast (MTC) pulse, but also chemical shift selective (CHESS) pulse would be a useful additional one for shortening the scan time of neuromelanin imaging. We compared three sequences among turbo-spin echo (TSE) images with CHESS, MTC, and without an additional pulse in the same short time, 3 min 20 s. The TSE with CHESS image was the most useful for the diagnosis of neuromelanin within the limited time.
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Yagi Y, Kojima K, Sakurai T, Sakamoto T, In K, Tamiya A, Atagi S, Momozane T, Kimura Y, Kishima H, Kodama K. P78.14 The Efficacy and Safety of ICIs in Treating Postoperative Recurrence of NSCLC: Results of Two Hospitals in Japan. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shigemoto Y, Sone D, Okita K, Maikusa N, Yamao T, Kimura Y, Suzuki F, Fujii H, Kato K, Sato N, Matsuda H. Gray matter structural networks related to 18F-THK5351 retention in cognitively normal older adults and Alzheimer's disease patients. eNeurologicalSci 2021; 22:100309. [PMID: 33511292 PMCID: PMC7815816 DOI: 10.1016/j.ensci.2021.100309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/21/2020] [Accepted: 12/31/2020] [Indexed: 12/28/2022] Open
Abstract
Objective This study aimed to examine the alterations in gray matter networks related to tau retention in Alzheimer's disease (AD) patients and cognitively normal (CN) older individuals. Methods Eighteen amyloid-positive AD patients and 30 age- and sex-matched amyloid-negative CN controls were enrolled. All underwent 3D T1-weighted MRI, amyloid positron-emission tomography imaging (PET) with 11C-Pittsburgh Compound B (PiB), and tau PET with 18F-THK5351. The structural networks extracted from the T1-weighted MRI data based on cortical similarities within single subjects were analyzed. Based on graph theoretical approach, global and local network properties across the whole brain were computed. Group comparisons of global and local network properties were evaluated between the groups. Then, we correlated the global and local network measures with total cerebral 18F-THK5351 retention. Results AD patients moved toward more randomized global network compared to controls and regional differences were observed in the default mode network (DMN) area. No significant correlations existed between global network properties and tau retention. On a local level, AD and controls showed opposite relationships between network properties and tau retention mainly in the DMN areas; CN controls showed positive correlations, whereas AD showed negative correlations. Conclusion We found opposite relationships between local network properties and tau retention between amyloid-positive AD patients and amyloid-negative controls. Our findings suggest that the presence of amyloid and induced exacerbated tau retention alter the relationship of local network properties and tau retention. Correlation of structural network properties and tau retention. Positive correlations between local network properties and tau retention in healthy elderly. Negative correlations between local network properties and tau retention in AD.
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Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, Kikuchi T, Kusumi H, Arai H. The Influence of the COVID-19 Pandemic on Physical Activity and New Incidence of Frailty among Initially Non-Frail Older Adults in Japan: A Follow-Up Online Survey. J Nutr Health Aging 2021; 25:751-756. [PMID: 34179929 PMCID: PMC8074704 DOI: 10.1007/s12603-021-1634-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the influence of the COVID-19 pandemic on physical activity (PA) and the incidence of frailty among initially non-frail older adults in Japan. DESIGN A follow-up online survey. SETTING AND SUBJECTS Among the 1,600 baseline online survey participants, 388 adults were already frail, and 275 older adults did not respond to the follow-up survey. Thus, the final number of participants in this study was 937 (follow-up rate: 77.3%). METHODS We assessed the total PA time at four time points according to the COVID-19 waves in Japan: January 2020 (before the pandemic), April 2020 (during the first wave), August 2020 (during the second wave), and January 2021 (during the third wave). We then investigated the incidence of frailty during a one-year follow-up period (during the pandemic). RESULTS The total PA time during the first, second, and third waves of the pandemic decreased from the pre-pandemic PA time by 33.3%, 28.3%, and 40.0%, respectively. In particular, the total PA time of older adults who were living alone and socially inactive decreased significantly: 42.9% (first wave), 50.0% (second wave), and 61.9% (third wave) less than before the pandemic, respectively. Additionally, they were at a significantly higher risk of incident frailty than those who were not living alone and were socially active (adjusted odds ratio: 2.04 [95% confidence interval: 1.01-4.10]). CONCLUSION Our findings suggest that older adults who live alone and are socially inactive are more likely to experience incident frailty/disability due to decreased PA during the pandemic. Understanding this mechanism may be crucial for maintaining the health status of older adults.
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Sone D, Sato N, Kimura Y, Maikusa N, Shigemoto Y, Matsuda H. Quantitative analysis of double inversion recovery and FLAIR signals in temporal lobe epilepsy. Epilepsy Res 2020; 170:106540. [PMID: 33385946 DOI: 10.1016/j.eplepsyres.2020.106540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/29/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
This study aimed to quantitatively compare the signals from double inversion recovery (DIR) and fluid-attenuated inversion recovery (FLAIR) in temporal lobe epilepsy (TLE) with a focus on anterior temporal lobe white matter abnormal signal (ATLAS) lesions. We recruited 59 patients with TLE (32 left, 27 right) and 24 healthy controls (HCs). All patients underwent 3T-MRI scans including 3D DIR and FLAIR images, and the images were normalized and compared among the three groups by the software program SPM 12. We also explored the association of the ATLAS with disease duration, seizure types, and the existence of hippocampal sclerosis (HS). As a result, compared to the HCs, there were significantly increased DIR signals in the ipsilateral anterior temporal white matter of both the left and right TLE patients. There was no significant signal difference in FLAIR images between the HCs and patients except for a trend-level increase in left TLE. There was also no significant association between the ATLAS and disease duration, seizure type, or HS. These results quantitatively confirmed the significant signal increases of DIR in the ipsilateral anterior temporal lobe in both left and right TLE, whereas FLAIR revealed no significant between-group differences. These findings may indicate greater usefulness of DIR compared to FLAIR for detecting ATLAS lesions.
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Yoshizumi M, Yonezawa A, Kimura Y, Watanabe C, Sakurada S, Mizoguchi H. Central Mechanisms of Apomorphine and m-Chlorophenylpiperazine on Synergistic Action for Ejaculation in Rats. J Sex Med 2020; 18:231-239. [PMID: 33243689 DOI: 10.1016/j.jsxm.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We previously reported that the combination of the dopamine (DA) receptor agonist apomorphine and the 5-hydroxytryptamine (5-HT2) receptor agonist m-chlorophenylpiperazine (m-CPP) in rats potently and selectively facilitates the ejaculatory response through activation of D2-like and 5-HT2C receptors, respectively. AIM The aim of this study was to clarify the target level of the proejaculatory effects induced by combination of these agonists. METHODS For in vivo behavioral studies, apomorphine and m-CPP were given intracerebroventricularly and intrathecally alone or in combination with either drug administered systemically. Male rats were acclimated to observational cages bedded in paper towels, and the occurrence of ex copula ejaculation was assessed by evaluating the presence and weight of ejaculatory plugs dropped from the tip of the penis to the paper towels or adhered to the tip of the penis at 30 min after drug administration. For in vitro contraction studies, seminal vesicles isolated from rats were suspended in an organ bath to test contractile responses to drug combinations, and the effects of the combined drugs on the contractile response of noradrenaline were also tested. MAIN OUTCOME MEASURES The presence and weight of ejaculatory plugs produced by drug-induced ejaculation and the contractile responses of the seminal vesicle were evaluated. RESULTS Intrathecal m-CPP (10 μg), but not intracerebroventricular m-CPP, evoked the synergistic effects on ejaculation when used in combination with systemically administered apomorphine (0.1 mg/kg, subcutaneous). Moreover, the synergy between m-CPP and apomorphine was completely abolished by the intrathecal 5-HT2C receptor antagonist SB242084 (10 μg). Intrathecal or intracerebroventricular apomorphine (1-10 μg) evoked proejaculatory effects in combination with systemically administered m-CPP (0.3 mg/kg, intraperitoneal). The selective peripherally acting D2-like receptor agonist carmoxirole did not evoke ejaculation when used in combination with m-CPP. Furthermore, isolated rat seminal vesicles were completely insensitive to the combination of apomorphine and m-CPP. CONCLUSION These results indicated that the synergistic effects of the drugs on ejaculation were induced at the central level but not at peripheral sites. Our findings also suggested that the 5-HT2C receptor mediated the stimulation of the spinal ejaculatory pattern generator and was synergistically potentiated by the spinal DA receptor and that activation of the supraspinal DA receptor was also involved in mediating these synergistic effects. Yoshizumi M, Yonezawa A, Kimura Y, et al. Central Mechanisms of Apomorphine and m-Chlorophenylpiperazine on Synergistic Action for Ejaculation in Rats. J Sex Med 2021;18:231-239.
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Beheshti I, Sone D, Maikusa N, Kimura Y, Shigemoto Y, Sato N, Matsuda H. FLAIR-Wise Machine-Learning Classification and Lateralization of MRI-Negative 18F-FDG PET-Positive Temporal Lobe Epilepsy. Front Neurol 2020; 11:580713. [PMID: 33224093 PMCID: PMC7669910 DOI: 10.3389/fneur.2020.580713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: In this study, we investigated the ability of fluid-attenuated inversion recovery (FLAIR) data coupled with machine-leaning algorithms to differentiate normal and epileptic brains and identify the laterality of focus side in temporal lobe epilepsy (TLE) patients with visually negative MRI. Materials and Methods: The MRI data were acquired on a 3-T MR system (Philips Medical Systems). After pre-proceeding stage, the FLAIR signal intensities were extracted from specific regions of interest, such as the amygdala, cerebral white matter, inferior temporal gyrus, middle temporal gyrus, parahippocampal gyrus, superior temporal gyrus, and temporal pole, and fed into a classification framework followed by a support vector machine as classifier. The proposed lateralization framework was assessed in a group of MRI-negative unilateral TLE patients (N = 42; 23 left TLE and 19 right TLE) and 34 healthy controls (HCs) based on a leave-one-out cross-validation strategy. Results: Using the FLAIR data, we obtained a 75% accuracy for discriminating the three groups, as well as 87.71, 83.01, and 76.19% accuracies for HC/right TLE, HC/left TLE, and left TLE/right TLE tasks, respectively. Interpretation: The experimental results show that FLAIR data can potentially be considered an informative biomarker for improving the pre-surgical diagnostic confidence in patients with MRI-negative TLE.
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Hiraiwa H, Kasugai D, Okumura T, Kazama S, Kimura Y, Shibata N, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Kondo T, Furusawa K, Morimoto R, Murohara T. The prognostic impact of right ventricular dysfunction in patients with septic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sepsis is a systemic condition of profoundly impaired health in which an infection leads to a dysregulated host response, and consecutively causes organ dysfunction, shock, and even death. Septic cardiomyopathy (SCM) is one of the multiple organ dysfunctions. SCM is typically defined as left ventricular (LV) dysfunction, presented by decreased LV ejection fraction (LVEF). However, it remains unclear about the detailed mechanism of cardiac dysfunction. In addition, the prognostic impact of right heart dysfunction in SCM patients has not been fully investigated.
Purpose
The purpose of this study was to investigate the prognostic impact of right heart dysfunction in patients with SCM.
Methods
We used the MIMIC-III (Medical Information Mart for Intensive Care III) critical care database, which is a large, freely-available database comprising deidentified health-related data associated with over forty thousand patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. We retrospectively analyzed data of patients with septic shock on admission to intensive care unit (ICU). Septic shock was defined as the presence of any suspected infections, the need for vasopressors, and the lactate level exceeding 2 mmol/L, based on the Sepsis-3 criteria. Patients were performed portable transthoracic echocardiography (TTE) during hospitalization. LVEF and right ventricular (RV) function were determined predominately by visual estimation in the parasternal long-axis view. SCM was defined as having a minimum LVEF of 50% or less during hospitalization. Patients with hyperdynamic motion of LVEF >70% were excluded.
Results
In total, there were 2254 patients with septic shock. Of these, 604 patients who underwent TTE were enrolled, and 314 patients were diagnosed with SCM. At baseline, age, gender, Sequential Organ Failure Assessment (SOFA) score, maximum lactate levels, and maximum norepinephrine dosage were 70 [59–79] years, 194 males, 13 [11–15], 4.0 [2.7–6.2] mmol/L, and 0.20 [0.10–0.31] mcg/kg/min, respectively. All patients were treated with vasopressors. In Kaplan-Meier survival analysis, patients with SCM had increased 28-day mortality compared with those without SCM (log-rank, p=0.09). In addition, we divided SCM patients into two groups; SCM with and without RV dysfunction. SCM patients with RV dysfunction had significant increased 28-day mortality compared with those without RV dysfunction (log-rank, p=0.01) (Figure). In Cox proportional hazard regression analysis adjusted for age, male sex, SOFA score, and maximum lactate levels, RV dysfunction was an independent determinant of 28-day mortality (hazard ratio, 1.59; 95% confidence interval, 1.03–2.46; p=0.03).
Conclusions
The presence of RV dysfunction increased 28-day mortality in patients with SCM. It might be useful for predicting the prognosis of SCM to evaluate not only left heart function but also right heart function.
Kaplan-Meier survival curves
Funding Acknowledgement
Type of funding source: None
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Hiraiwa H, Okumura T, Sawamura A, Kazama S, Kimura Y, Shibata N, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Kondo T, Furusawa K, Morimoto R, Murohara T. Associations between spleen volume and exercise capacity in advanced heart failure patients with left ventricular assist device. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The spleen has been recognized as an important organ with several functions such as a reservoir of blood volume, and an involvement in iron metabolism by processing of aged red blood cells and recycling iron. During exercise, spleen contracts, and red blood cells pooled in the spleen are recruited into the systemic circulation. So far, we reported that spleen size changed in advanced heart failure (HF) with left ventricular assist device (LVAD). In addition, spleen volume was related to pulmonary capillary wedge pressure (PCWP) or right atrial pressure (RAP) as parameters of cardiac preload. However, it remains unclear about the relationship between spleen volume and exercise capacity in advanced HF with LVAD.
Purpose
The purpose of this study was to investigate the associations between spleen volume and exercise capacity in advanced HF patients with LVAD.
Methods
We enrolled 27 HF patients (21 males, 45±12 years) with LVAD (HeartMate II™; Abbott, Chicago, IL, USA) for use as a bridge to heart transplantation. All patients underwent blood test, echocardiography, right heart catheterization, computed tomography (CT) and cardiopulmonary exercise testing (CPET). Spleen size was measured by CT volumetry. We excluded patients with splenic infarction or aortic valve closure surgery.
Results
At baseline, body mass index, blood brain natriuretic peptide levels, hemoglobin levels, left ventricular ejection fraction were 21.4±3.1 kg/m2, 73.8 (51.9–165.8) pg/mL, 12.1 (10.6–13.4) g/dL, 24.8±14.7%, respectively. Total cardiac output (CO), the sum of pump flow and CO of native heart was 4.6±0.9 L/min, and spleen volume was 184.9±48.8 mL. As for parameters of CPET, peak heart rate (HR), peak VO2, and peak O2 pulse were 128±25 beats/min, 14.2±3.3 mL/kg/min, and 6.6±1.9 mL/beat. At rest, there were significant correlations between spleen volume and PCWP (r=0.382, p=0.049), RAP (r=0.406, p=0.035) or pulsatility index (r=0.384, p=0.047), despite no correlations with total CO or pump flow. During exercise, there were significant interrelations of spleen volume with peak VO2 (r=0.451, p=0.018) and peak O2 pulse (r=0.427, p=0.026). Furthermore, peak VO2 was interrelated with peak HR (r=0.481, p=0.011) or hemoglobin levels (r=0.649, p<0.001). Remarkably, spleen volume was significantly correlated with hemoglobin levels (r=0.391, p=0.043) (Figure). Interpreting these results based on Fick's formula, the proportion of native CO to total CO is very small at rest, but increases during exercise. The spleen during exercise may contribute to increased native CO, especially stroke volume. Moreover, the spleen may be related to both cardiac preload and oxygen carrying capacity, resulting in a significant association between spleen volume and peak VO2.
Conclusion
Spleen volume could be a useful predictor of exercise capacity in advanced HF patients with LVAD, reflecting splenic function to modulate cardiac preload and blood hemoglobin levels.
Spleen volume and exercise parameters
Funding Acknowledgement
Type of funding source: None
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Kuwayama T, Morimoto R, Oishi H, Kato H, Kimura Y, Kazama S, Shibata N, Arao Y, Yamaguchi S, Hiraiwa H, Kondo T, Furusawa K, Okumura T, Murohara T. Efficacy of right ventricular dysfunction estimated by pulmonary artery pulsatility index in stable phased dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dilated cardiomyopathy (DCM) is characterized by a reduction in left and/or right ventricular myocardial contraction, dilatation of biventricular cavity and major cause of heart failure with high morbidity and mortality rates. Right ventricular dysfunction (RVD) recently have been received attention because of 34% of DCM had RVD and considered as a powerful predictor of impaired prognosis in DCM. Pulmonary Artery Pulsatility index (PAPi) is a novel hemodynamic index shown to predict RVD in advanced heart failure, however, it is unknown that even at early phase, PAPi can reflects latent right myocardial damage and predict long-term prognosis in stable DCM patients.
Methods
From April 2000 to March 2018, we enrolled 566 consecutive patients with cardiomyopathy. All patients underwent laboratory measurement, echocardiography, and cardiac catheterization to evaluate their general conditions. After excluded secondary cardiomyopathy, ischemic cardiomyopathy, and valvular heart disease, finally 162 DCM patients were enrolled. All enrolled patients had NYHA I/II/III and NYHA I/II were 150 patients (92.6%). PAPi was calculated as (systolic pulmonary artery pressure – diastolic pulmonary artery pressure (Pulmonary artery pulse pressure: PAPP)) / right atrial pressure. Median followed up for 4.85 years. In this study 149 patients were performed endomyocardial biopsy in order to exclude secondary cardiomyopathies and 95 patients were assessed using Sirius red staining. Myocardial fibrosis in biopsy specimen was assessed using Sirius red staining, and the positive region was quantified as the collagen volume fraction (CVF).
Results
The mean age and LV ejection fraction (EF) was 50.9±12.6 years and 30.5±8.3%, respectively. When divided into two groups by median PAPi value [PAPi <3.06 (L-PAP) and PAPi ≥3.06 (H-PAP)], even though there were no significant difference in BNP, pulmonary vascular resistance and right ventricular stroke work index between two groups, the probability of cardiac event-survival was significantly higher in L-PAP than H-PAP by Kaplan-Meier analysis (P=0.012). Furthermore, cox proportional hazard regression analysis revealed that PAPi was independent predictor of cardiac events (hazard ratio: 0.624, P=0.025). In pathological analysis, there was no difference between H-PAPi and L-PAPi in CVF.
Conclusion
In the calculation of PAPi, PAPP reflects both RV contractility and left atrial filling pressure and this index considered as RV adaptive response to afterload. The denominator of the PAPP is defined by RA pressure, which serves as a marker of RV preload. Thus, PAPi reflect both preload and afterload of RV at the same time and even though estimated patients at early phase, RVD exists in DCM patients without severe myocardial fibrosis, and PAPi may help stratify DCM and predict cardiac events.
Kaplan-Meier analysis
Funding Acknowledgement
Type of funding source: None
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Kirigaya H, Okada K, Hibi K, Akiyama E, Kimura Y, Matsuzawa Y, Iwahashi N, Maejima N, Kosuge M, Tamura K, Kimura K. Post-procedural quantitative flow ratio gradient and target lesion revascularization after drug-coated balloon or plain-old balloon angioplasty. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Balloon angioplasty, including drug-coated balloon (DCB), is an important option of percutaneous coronary interventions (PCI), even in the drug-eluting stent era. Although quantitative coronary angiography (QCA) has been frequently used to determine the optimal endpoint of balloon angioplasty, physiological assessment may add incremental prognostic values. Quantitative flow ratio (QFR) has evolved as a novel 3D QCA-based physiological index to estimate fractional flow reserve without hyperemia nor pressure guidewire, offering both anatomical and functional lesion assessments. This study aimed to characterize post-procedural anatomical and physiological indexes by QFR and to compare their prognostic impacts on long-term clinical outcomes.
Methods
This retrospective study included 98 patients with de novo (n=39) or in-stent restenosis (n=59) lesions who underwent PCI with DCB (n=69) or plain-old balloon angioplasty (POBA, n=29). All lesions were analyzed by QCA and QFR. QCA analysis measured lesion length, reference lumen diameter (RLD), minimum lumen diameter (MLD) and percent diameter stenosis (%DS) at pre- and post-procedures as anatomical indexes. QFR analysis measured post-procedural QFR of target vessel (QFR-vessel) and QFR-gradient (ΔQFR between proximal and distal segments of the lesion) as physiological indexes. Primary endpoint was target lesion revascularization (TLR) within 1-year post-procedure.
Results
Target lesion profiles were as follows: lesion length 26.3±16.6 mm, RLD 2.90±0.70 mm, MLD 0.94±0.32 mm and %DS 79.3±18.6%. At post-procedure, MLD, residual %DS, QFR-vessel and QFR-gradient of target lesions were 1.88±0.49 mm, 34.7±10.6%, 0.84±0.13 and 0.06±0.04, respectively. During 1 year post-procedure, TLR occurred in 19 (19%) patients. Patients with TLR showed smaller MLD (1.66±0.45 mm vs. 1.93±0.49 mm, p=0.028) and QFR-vessel (0.79±0.03 vs. 0.85±0.01, p=0.06), and greater residual %DS (42.7±11.3% vs. 32.8±9.5%, p=0.0002) and QFR-gradient (0.12±0.06 vs. 0.04±0.02, p<0.0001) at post-procedure compared with those without. In multivariate analysis including several clinical characteristics and anatomical indexes, QFR-gradient at post-procedure was independently associated with TLR within 1-year, demonstrating higher prognostic value compared with post-procedural MLD and residual %DS (Figure). The receiver-operating characteristics curve analysis identified the best cut-off value of QFR-gradient as 0.08 for predicting 1-year TLR after balloon angioplasty, irrespective of balloon type (DCB or POBA) (Figure 1).
Conclusions
Post-procedural QFR-gradient within the lesion was an independent and stronger predictor of subsequent TLR, compared with anatomical indexes. Further studies are warranted to investigate whether QFR guidance to optimize PCI procedure could improve clinical outcomes in patients with balloon angioplasty.
Figure 1
Funding Acknowledgement
Type of funding source: None
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