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Mizobuchi S, Kojima K, Miyagawa M, Tanaka Y, Migita S, Fukumoto K, Koyama Y, Ebuchi Y, Takahashi K, Nakajima Y, Arai R, Murata N, Fukamachi D, Okumura Y. Association between aortic thrombi detected using non-obstructive general angioscopy and atrial fibrillation. J Thromb Thrombolysis 2024; 57:269-277. [PMID: 38017303 DOI: 10.1007/s11239-023-02917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/30/2023]
Abstract
Atrial fibrillation (AF) is an independent risk factor for stroke and systemic embolism. Cardiogenic and aortogenic emboli are causes of stroke or systemic embolism. Non-obstructive general angioscopy (NOGA) can be used to diagnose aortic intimal findings, including thrombi and atherosclerotic plaques, but little is known about NOGA-derived aortic intimal findings in patients with AF. This study focused on aortic intimal findings in patients with AF and evaluated the association between AF and aortic thrombi detected using NOGA. We enrolled 283 consecutive patients with coronary artery disease who underwent NOGA of the aorta between January 2017 and August 2022. Aortic intimal findings were screened using NOGA after coronary arteriography. The patients were divided into two groups according to their AF history (AF, n = 50 and non-AF, n = 233). Patients in the AF group were older than those in the non-AF group. Sex, body mass index, and coronary risk factors were not significantly different between the two groups. In the NOGA findings, the presence of intense yellow plaques and ruptured plaques was not significantly different between the two groups. Aortic thrombi were more frequent in the AF group than in the non-AF group (92.0 vs. 71.6%, p < 0.001). Multivariate logistic regression found that AF was independently associated with aortic thrombi (odds ratio 3.87 [95% CI 1.28-11.6], p = 0.016). The presence of aortic thrombi observed using NOGA was associated with AF in patients with coronary artery disease. The roles of aortic thrombi as well as cardiogenic embolism may require clarification.
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Affiliation(s)
- Saki Mizobuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Keisuke Kojima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Masatsugu Miyagawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yudai Tanaka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shohei Migita
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Katsunori Fukumoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yutaka Koyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasunari Ebuchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kurara Takahashi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yuki Nakajima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Riku Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Sakakibara S, Nishi H, Kitahara M, Goto T, Nakazato T. Successful "PETTICOAT" procedure assisted by aortic angioscopy for complicated type B aortic dissection: Case report. Int J Surg Case Rep 2023; 109:108475. [PMID: 37481972 PMCID: PMC10369472 DOI: 10.1016/j.ijscr.2023.108475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Thoracic endovascular aortic repair (TEVAR) is a useful treatment for acute type B aortic dissection (TBAD). A PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) procedure can be an alternative surgical option for a patent false lumen. Non-obstructive aortic angioscopy is an attractive modality that can visualize the aortic intima for things such as entry or re-entry tears that are difficult to detect with computed tomography (CT). Herein, we describe a successful PETTICOAT procedure assisted by aortic angioscopy for subacute TBAD complicated by lower limb ischemia. PRESENTATION OF CASE A 63-year-old man who had been treated with conservative therapy for subacute TBAD had intermittent claudication. Enhanced CT revealed a primary entry tear at the distal arch, and the true lumen at the thoracoabdominal level was narrowed by the patent false lumen. Therefore, the PETTICOAT procedure was performed. The postoperative course was uneventful, with normalized lower limb pressure. DISCUSSION Although PETTICOAT procedure is effective for treating complicated TBAD, there is no consensus on where and how far the proximal stent graft or distal bare stent should be implanted. Non-obstructive aortic angioscopy during PETTICOAT is useful to detect and cover the entry and re-entry tears. The PETTICOAT procedure assisted by aortic angioscopy could contribute to determining the appropriate coverage range of the stent graft. CONCLUSION Aortic angioscopy could contribute to the surgical success of PETTICOAT procedure for complicated subacute TBAD.
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Affiliation(s)
- Satoshi Sakakibara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan.
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takasumi Goto
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Taro Nakazato
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
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Komatsu S, Takahashi S, Yutani C, Takewa M, Ohara T, Kodama K. Multiple and Multidirectional Fissure Bleedings in a Patient With a Spontaneous Isolated Dissection of the Iliac Artery. Cureus 2023; 15:e38374. [PMID: 37139050 PMCID: PMC10150418 DOI: 10.7759/cureus.38374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/05/2023] Open
Abstract
A 63-year-old man with a history of hypertension and dyslipidemia on medication was found to have an enlargement of an asymptomatic iliac artery aneurysm with an ulcer-like projection on computed tomography angiography. The longer and shorter diameter of the right iliac was increased from 24.0 × 18.1 mm to 38.9 × 32.1 mm over four years. Preoperative non-obstructive general angiography revealed multiple, multidirectional fissure bleedings. Fissure bleedings were found where computed tomography angiography appeared normal at the aortic arch. He was diagnosed with spontaneous isolated dissection of the iliac artery and was treated successfully with endovascular treatment.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | - Chikao Yutani
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | - Tomoki Ohara
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Kazuhisa Kodama
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
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Komatsu S, Takahashi S, Takewa M, Ohara T, Yutani C, Kodama K. Demonstrating an Adult Ventricular Septal Defect Using Non-obstructive General Angioscopy. Cureus 2023; 15:e37673. [PMID: 37206487 PMCID: PMC10191451 DOI: 10.7759/cureus.37673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
A ventricular septal defect (VSD) is a common congenital heart disease, and the transcatheter technique for VSD requires practical guidance because it requires a complicated procedure. A non-obstructive angioscopy catheter system via the right ventricle successfully revealed an approximately 3-mm VSD with the shape of a rugby ball at the center of the white membranous septum of Kirklin type II in an older female with suspected coronary artery disease. A white membranous terraced septum was observed to be surrounded by a reddish ventricle. Conservative therapy was performed for her VSD because she did not meet the criteria for surgical treatment.
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Affiliation(s)
- Sei Komatsu
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | | | | | - Tomoki Ohara
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Chikao Yutani
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
| | - Kazuhisa Kodama
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, JPN
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Huang F, Li X, Zhang Z, Li C, Ren F. Comparison of two surgical approaches for acute type A aortic dissection: hybrid debranching versus total arch replacement. J Cardiothorac Surg 2022; 17:166. [PMID: 35739545 PMCID: PMC9229500 DOI: 10.1186/s13019-022-01920-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background The goal of this study was to determine the clinical outcomes of total arch replacement with frozen elephant trunk surgery and hybrid debranching surgery for acute type A aortic dissection patients. Methods From January 2017 to December 2019, the clinical data of acute type A aortic dissection patients were retrospectively collected and analyzed. There were 142 patients underwent total arch replacement with frozen elephant trunk surgery and 35 patients underwent hybrid debranching surgery. Result The age, the body mass index and the renal insufficiency of patients in the hybrid group were higher than those in the total arch replacement (TAR) group (all P < 0.01). The operation time, the cardiopulmonary bypass time and the aortic occlusion time of patients in the TAR group were significantly longer than those in the hybrid group (all P < 0.01). Patients in the debranching group had shorter ventilator-assisted breathing time, shorter postoperative hospital stay time and shorter intensive care unit (ICU) stay time. The incidence of pulmonary infection and transient neurological dysfunction were lower, and the transfusions of red blood cells and plasma during the perioperative period were smaller. The survival rates at 2 years were 91.9% and 85.9% in the TAR and hybrid groups, respectively. Conclusion Hybrid debranching operation is a safe and effective method for acute type A aortic dissection. Compared with TAR surgery, hybrid debranching surgery has the characteristics of less trauma, rapid recovery and lower incidence of complication.
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Affiliation(s)
- Feng Huang
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.,Department of Cardiovascular Surgery, Fujian Provincial Geriatric Hospital, Fuzhou, 350000, China
| | - Xiaofeng Li
- Department of the Third Internal Medicine, Anqiu Municipal Hospital, Weifang, 262100, China
| | - Zili Zhang
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Chunping Li
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Fei Ren
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001, China. .,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
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Yamana F, Maeda K, Hamanaka Y, Kodani N, Domae K, Hata M, Higuchi Y, Shirakawa Y, Masai T. Efficacy of non-obstructive aortic angioscopy for detecting a thoracic aortic graft rupture: a case report. Surg Case Rep 2022; 8:41. [PMID: 35286489 PMCID: PMC8921450 DOI: 10.1186/s40792-022-01394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy. Case presentation An 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation. Conclusions To our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-022-01394-w.
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Affiliation(s)
- Fumio Yamana
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuma Hamanaka
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan
| | - Noriko Kodani
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keitaro Domae
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masatoshi Hata
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Osaka Police Hospital, 2 Chome-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Kojima K, Komatsu S, Kakuta T, Fukamachi D, Kimura S, Fujii H, Matsuura M, Dai K, Matsuoka H, Higuchi Y, Ueda Y, Asakura M, Yutani C, Okumura Y, Eikelboom JW, Hirayama A, Kodama K. Aortic plaque burden predicts vascular events in patients with cardiovascular disease: The EAST-NOGA study. J Cardiol 2021; 79:144-152. [PMID: 34521582 DOI: 10.1016/j.jjcc.2021.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-obstructive general angioscopy (NOGA) can be used to diagnose aortic atherosclerotic plaques. We examine the association between the number of aortic plaques detected by NOGA and the risk of subsequent cardiovascular events. METHODS The Evaluation of AtheroScleroTic and rupture events by Non-Obstructive General Angioscopy (EAST-NOGA) was a prospective cohort study of patients with suspected coronary artery disease who underwent NOGA. RESULTS Of the 577 patients who underwent NOGA, 532 (92%) completed the follow-up (median follow-up: 13 months, interquartile range: 12-16). The median number of plaques per person was 6 (interquartile range: 3-12), and 567 (98%) had at least one aortic plaque. During the 13-month follow-up, 38 (7.1%) patients had a primary composite endpoint [including cardiovascular death, myocardial infarction, stroke, peripheral artery disease (PAD), or worsening renal function], which was significantly associated with chronic kidney disease, a history of PAD, a lower hemoglobin level, and large numbers of aortic plaques [11 (5-17) vs. 6 (2-11), p = 0.003]. A receiver operating characteristic curve analysis for the number of aortic plaques predicting composite endpoints revealed that the cut-off value of aortic plaques was 12. After multivariate adjustment, the presence of ≥12 aortic plaques remained a significant predictor for composite endpoint events (hazard ratio 2.53, 95% confidence interval 1.26-5.04, p = 0.010). CONCLUSIONS The number of aortic plaques detected by NOGA may predict subsequent clinical events.
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Affiliation(s)
- Keisuke Kojima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Sei Komatsu
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | | | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Hiroshi Matsuoka
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Imabari, Japan
| | | | - Yasunori Ueda
- Cardiovascular Division, NHO Osaka National Hospital, Osaka, Japan
| | - Masanori Asakura
- Department of Clinical Research, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chikao Yutani
- Department of Pathology, Amagasaki Central Hospital, Amagasaki, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - John W Eikelboom
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhisa Kodama
- Department of Cardiology, Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
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Can non-obstructive general angioscopy predict an aortic dissection before an attack? J Cardiol 2020; 77:106-108. [PMID: 32847757 DOI: 10.1016/j.jjcc.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/11/2020] [Indexed: 01/25/2023]
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Nakayoshi T, Ueno T. A new beginning of aortic angioscopy in diagnosis and treatment in acute aortic syndrome? J Cardiol 2020; 76:58-59. [PMID: 32291120 DOI: 10.1016/j.jjcc.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Takaharu Nakayoshi
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Fukuoka, Japan.
| | - Takafumi Ueno
- The Center of Cardiovascular Disease, Kurume University Hospital, Fukuoka, Japan
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