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Kato S, Kitai T, Utsunomiya D, Azuma M, Fukui K, Hagiwara E, Ogura T, Ishibashi Y, Okada T, Kitakata H, Shiraishi Y, Torii S, Ohashi K, Takamatsu K, Yokoyama A, Hirata KI, Matsue Y, Node K. Myocardial Injury by COVID-19 Infection Assessed by Cardiovascular Magnetic Resonance Imaging - A Prospective Multicenter Study. Circ J 2024:CJ-23-0729. [PMID: 38556299 DOI: 10.1253/circj.cj-23-0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND This prospective multicenter study assessed the prevalence of myocardial injury in patients with COVID-19 using cardiac magnetic resonance imaging (CMR).Methods and Results: We prospectively screened 505 patients with moderate to severe COVID-19 disease from 7 hospitals in Japan. Of these patients, 31 (mean [±SD] age 63.5±10.4 years, 23 [74%] male) suspected of myocardial injury, based on elevated serum troponin or B-type natriuretic peptide concentrations either upon admission or 3 months after discharge, underwent CMR 3 months after discharge. The primary endpoint was the presence of myocardial injury, defined by any of the following: (1) contrast enhancement in the left or right ventricle myocardium on late gadolinium enhancement CMR; (2) left or right ventricular dysfunction (defined as <50% and <45%, respectively); and (3) pericardial thickening on contrast enhancement. The mean (±SD) duration between diagnosis and CMR was 117±16 days. The primary endpoint was observed in 13 of 31 individuals (42%), with 8 (26%) satisfying the modified Lake Louise Criteria for the diagnosis of acute myocarditis. CONCLUSIONS This study revealed a high incidence of myocardial injury identified by CMR in patients with moderate to severe COVID-19 and abnormal findings for cardiac biomarkers.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | - Takeshi Kitai
- Department of Cardiology, National Cerebral and Cardiovascular Center
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine
| | - Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Taiji Okada
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine
| | | | - Shunsuke Torii
- Department of Cardiology, National Center for Global Health and Medicine
| | - Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital
| | - Kazufumi Takamatsu
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Santos KSDC, de Brito GMG, de Melo EV, Sousa ACS, Martins-Filho PR, Campos MDSB. Cardiorespiratory optimal point in post-COVID-19 patients: a cross-sectional study. Rev Inst Med Trop Sao Paulo 2024; 66:e14. [PMID: 38381899 PMCID: PMC10881065 DOI: 10.1590/s1678-9946202466014] [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: 10/10/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
The varied clinical presentations of SARS-CoV-2 infection have raised concerns about long-term consequences, especially "long-COVID" or "post-COVID-19 syndrome." In this context, the cardiorespiratory optimal point (COP) within the Cardiopulmonary Exercise Test (CPET) emerges as a crucial metric for evaluating functional capacities and detecting cardiovascular and pulmonary anomalies post-COVID-19. This study aimed to assess COP values among post-COVID-19 patients and categorized them based on the initial severity of their disease. In this cross-sectional study conducted in the Northeast Brazil, 80 patients (26 females and 54 males) previously infected with SARS-CoV-2 underwent CPET. We clinically stratified patients into mild, moderate, or severe COVID-19 categories and assessed COP values and other cardiorespiratory metrics. We found differences in the predicted COP between patients with mild and severe COVID-19 (p=0.042). Additionally, patients with moderate and severe COVID-19 record had an average COP value exceeding 22. Other parameters, including respiratory exchange ratio, heart rate, and oxygen uptake efficiency slope, did not differ across the groups. Patients with a history of severe COVID-19 showed altered COP values, suggesting potential discrepancies in cardiovascular and respiratory system integration. The outcomes emphasize the importance of continuous monitoring and assessment of the cardiorespiratory domain for post-COVID-19 patients. Further research is needed to understand the relationship between elevated COP in post-severe COVID-19 and its long-term prognostic implications.
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Affiliation(s)
| | | | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe, Departamento de Medicina, Aracaju, Sergipe, Brazil
- Universidade Federal de Sergipe, Programa de Pós-Graduação em Ciências da Saúde, Aracaju, Sergipe, Brazil
- Rede D’Or São Luiz, Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
- Universidade Federal de Sergipe, Hospital Universitário, Divisão de Cardiologia, Aracaju, Sergipe, Brazil
| | - Paulo Ricardo Martins-Filho
- Universidade Federal de Sergipe, Programa de Pós-Graduação em Ciências da Saúde, Aracaju, Sergipe, Brazil
- Universidade Federal de Sergipe, Hospital Universitário, Laboratório de Patologia Investigativa, Aracaju, Sergipe, Brazil
| | - Milena dos Santos Barros Campos
- Universidade Tiradentes, Departamento de Medicina, Aracaju, Sergipe, Brazil
- Universidade Federal de Sergipe, Programa de Pós-Graduação em Ciências da Saúde, Aracaju, Sergipe, Brazil
- Rede D’Or São Luiz, Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
- Universidade Federal de Sergipe, Hospital Universitário, Divisão de Cardiologia, Aracaju, Sergipe, Brazil
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3
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la Roi-Teeuw HM, van Smeden M, Bos M, de Wilde SM, Yang B, Rutten FH, Geersing GJ. Estimated causal effects of common respiratory infections on cardiovascular risk: a meta-analysis. Open Heart 2023; 10:e002501. [PMID: 38016788 PMCID: PMC10685931 DOI: 10.1136/openhrt-2023-002501] [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] [Received: 09/23/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Literature supports associations between common respiratory tract infections (RTIs) and risk of cardiovascular diseases, yet the importance of RTIs for cardiovascular risk management remains less understood. This systematic review and meta-analysis aimed to estimate the causal effects of RTIs on occurrence of cardiovascular diseases in the general population. METHODS MEDLINE and EMBASE were systematically searched up to 4 November 2022. Eligible were all aetiological studies evaluating risk of cardiovascular outcomes after exposure to common RTIs within any follow-up duration. Evidence was pooled using random-effects models if data allowed. The ROBINS-E and GRADE approaches were used to rate risk of bias and certainty of evidence, respectively. All assessments were performed in duplicate. RESULTS We included 34 studies (65 678 650 individuals). Most studies had a high risk of bias. COVID-19 likely increases relative risk (RR (95% CI)) of myocardial infarction (3.3 (1.0 to 11.0)), stroke (3.5 (1.2 to 10)), pulmonary embolism (24.6 (13.5 to 44.9)) and deep venous thrombosis (7.8 (4.3 to 14.4)) within 30 days after infection (GRADE: moderate) and about twofold within 1 year (GRADE: low to moderate). Other RTIs also likely increase the RR of myocardial infarction (2.9 (95% CI 1.8 to 4.9)) and stroke (2.6 (95% CI 1.1 to 6.4)) within 30 days (GRADE: moderate), and to a lesser extent with longer follow-up. CONCLUSIONS RTIs likely increase the risk of cardiovascular diseases about 1.5-5 fold within 1 month after infection. RTIs may, therefore, have clinical relevance as target for cardiovascular risk management, especially in high-risk populations. PROSPERO REGISTRATION NUMBER CRD42023416277.
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Affiliation(s)
- Hannah M la Roi-Teeuw
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maureen Bos
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sophie M de Wilde
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bada Yang
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Metan G, Demir Çuha M, Hazirolan G, Telli Dizman G, Tanriverdi ES, Otlu B, Tas Z, Zarakolu P, Arik Z, Topeli A, Akinci SB, Ünal S, Uzun Ö. The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc15. [PMID: 36157382 PMCID: PMC9487780 DOI: 10.3205/dgkh000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.
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Affiliation(s)
- Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey,*To whom correspondence should be addressed: Gökhan Metan, Hacettepe Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Binası Kat: 1, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara, Turkey, E-mail: ,
| | - Mervenur Demir Çuha
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülsen Hazirolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey
| | - Elif Seren Tanriverdi
- Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Baris Otlu
- Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Zahit Tas
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pinar Zarakolu
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer Arik
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Section of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seda Banu Akinci
- Section of Intensive Care Medicine Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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5
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Whiteson JH, Azola A, Barry JT, Bartels MN, Blitshteyn S, Fleming TK, McCauley MD, Neal JD, Pillarisetti J, Sampsel S, Silver JK, Terzic CM, Tosto J, Verduzco‐Gutierrez M, Putrino D. Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of cardiovascular complications in patients with post-acute sequelae of SARS-CoV-2 infection (PASC). PM R 2022; 14:855-878. [PMID: 35657351 PMCID: PMC9347705 DOI: 10.1002/pmrj.12859] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan H. Whiteson
- Department of Rehabilitation Medicine and Department of MedicineRusk Rehabilitation, NYU Langone HealthNew YorkNew YorkUSA
| | - Alba Azola
- Department of Physical Medicine and RehabilitationJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - John T. Barry
- Good Shepherd Penn Partners, Penn Therapy & Fitness—University CityPhiladelphiaPennsylvaniaUSA
| | - Matthew N. Bartels
- Department of Rehabilitation Medicine, Montefiore Health SystemAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Svetlana Blitshteyn
- Department of NeurologyUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloNew YorkUSA
| | - Talya K. Fleming
- Department of Physcial Medicine and RehabilitationJFK Johnson Rehabilitation Institute at Hackensack Meridian HealthEdisonNew JerseyUSA
| | - Mark D. McCauley
- Department of Medicine, Section of CardiologyUniversity of Illinois at Chicago and Jesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Jacqueline D. Neal
- Physical Medicine and RehabilitationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Physical Medicine and RehabilitationPhysical Medicine and Rehabilitation, Jesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Jayasree Pillarisetti
- Division of Cardiology, Department of MedicineUniversity of Texas Health San AntonioSan AntonioTexasUSA
| | | | - Julie K. Silver
- Department of Physical Medicine and RehabilitationHarvard Medical School, Spaulding Rehabilitation HospitalBostonMassachusettsUSA
| | - Carmen M. Terzic
- Department of Physical Medicine and Rehabilitation and Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Jenna Tosto
- Department of Rehabilitation and Human Performance, Abilities Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - David Putrino
- Department of Rehabilitation and Human PerformanceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Tomidokoro D, Hiroi Y. Cardiovascular considerations during the COVID-19 pandemic: A focused review for practice in Japan. Glob Health Med 2022; 4:101-107. [PMID: 35586765 PMCID: PMC9066463 DOI: 10.35772/ghm.2022.01006] [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: 02/16/2022] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic is continuing to have drastic consequences for patients, healthcare workers, and the health system. Its cardiovascular implications have been well described in previous studies, but original reports from Japan are sparse. Validating overseas findings in the Japanese clinical settings is crucial to improve local COVID-19 care and to clarify the pandemic's impacts in the country. This review of available literature demonstrates that in Japanese patients and clinical settings too, there is a close relationship between COVID-19 and the cardiovascular system including cardiovascular complications. On the contrary, secondary effects on cardiovascular practice including service disruptions, telemedicine, and epidemiological changes in Japan have been relatively small.
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Affiliation(s)
- Daiki Tomidokoro
- Address correspondence to:Daiki Tomidokoro and Yukio Hiroi, Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail: (DT); yhiroi@hosp. ncgm.go.jp (YH)
| | - Yukio Hiroi
- Address correspondence to:Daiki Tomidokoro and Yukio Hiroi, Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail: (DT); yhiroi@hosp. ncgm.go.jp (YH)
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7
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Masumoto A, Kitai T, Matsumoto S, Kuroda S, Kohsaka S, Tachikawa R, Seo R, Doi A, Tomii K, Yonetsu T, Torii S, Komuro I, Hirata KI, Node K, Matsue Y, Furukawa Y. Impact of serum lactate dehydrogenase on the short-term prognosis of COVID-19 with pre-existing cardiovascular diseases. J Cardiol 2021; 79:501-508. [PMID: 35000825 PMCID: PMC8712257 DOI: 10.1016/j.jjcc.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/28/2021] [Accepted: 12/19/2021] [Indexed: 12/25/2022]
Abstract
Background Patients with coronavirus disease 2019 (COVID-19) and underlying cardiovascular comorbidities have poor prognoses. Our aim was to identify the impact of serum lactate dehydrogenase (LDH), which is associated with mortality in acute respiratory distress syndrome, on the prognoses of patients with COVID-19 and underlying cardiovascular comorbidities. Methods Among 1518 patients hospitalized with COVID-19 enrolled in the CLAVIS-COVID (Clinical Outcomes of COVID-19 Infection in Hospitalized Patients with Cardiovascular Diseases and/or Risk Factors study), 515 patients with cardiovascular comorbidities were analyzed. Patients were divided into tertiles based on LDH levels at admission [tertile 1 (T1), <235 U/L; tertile 2 (T2), 235–355 U/L; and tertile 3 (T3); ≥356 U/L]. We investigated the impact of LDH levels on the in-hospital mortality. Results The mean age was 70.4 ± 30.0 years, and 65.3% were male. There were significantly more in-hospital deaths in T3 than in T1 and T2 [n = 50 (29.2%) vs. n = 15 (8.7%), and n = 24 (14.0%), respectively; p < 0.001]. Multivariable analysis adjusted for age, comorbidities, vital signs, and laboratory data including D-dimer and high-sensitivity troponin showed T3 was associated with an increased risk of in-hospital mortality (adjusted hazard ratio, 3.04; 95% confidence interval, 1.50–6.13; p = 0.002). Conclusions High serum LDH levels at the time of admission are associated with an increased risk of in-hospital death in patients with COVID-19 and known cardiovascular disease and may aid in triage of these patients.
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Affiliation(s)
- Akiko Masumoto
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Medicine Center, 6-1 Kishibe-shinmachi, Osaka, Japan.
| | - Shingo Matsumoto
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shunsuke Kuroda
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryutaro Seo
- Department of Intensive Care, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken-Ichi Hirata
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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