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Ueno Y, Imamura T, Oshima A, Onoda H, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Clinical Implications of Changes in Respiratory Instability Following Transcatheter Aortic Valve Replacement. J Clin Med 2022; 11:jcm11010280. [PMID: 35012019 PMCID: PMC8745862 DOI: 10.3390/jcm11010280] [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: 12/13/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Respiratory instability, which can be quantified using respiratory stability time (RST), is associated with the severity and prognostic impact of the disease in patients with chronic heart failure. However, its clinical implications in patients with severe aortic stenosis receiving transcatheter aortic valve replacement (TAVR) remain unknown. METHODS Patients who received TAVR and had paired measurements of RST at a baseline and one week following TAVR were prospectively included. Changes in RST following TAVR and its impact on post-TAVR heart failure readmissions were investigated. RESULTS Seventy-one patients (median age, 86 years old; 35% men) were included. The baseline RST was correlated with the severity of heart failure including elevated levels of plasma B-type natriuretic peptide (p < 0.05 for all). RST improved significantly following TAVR from 34 (26, 37) s to 36 (33, 38) s (p < 0.001). Post-TAVR lower RST (<33 s, n = 18) was associated with a higher 2-year cumulative incidence of heart failure readmission (21% vs. 8%, p = 0.039) with a hazard ratio of 5.47 (95% confidence interval 0.90-33.2). CONCLUSION Overall, respiratory instability improved following TAVR. Persistent respiratory instability following TAVR was associated with heart failure recurrence.
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Sakoda M, Asanoi H, Ohtani T, Nakamoto K, Harada D, Noto T, Takagawa J, Wada O, Nakane E, Inoko M, Kurakami H, Yamada T, Sakata Y, Sawa Y, Miyagawa S. Early Detection of Worsening Heart Failure in Patients at Home Using a New Telemonitoring System of Respiratory Stability. Circ J 2021; 86:1081-1091. [PMID: 34897189 DOI: 10.1253/circj.cj-21-0590] [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: 11/09/2022]
Abstract
BACKGROUND Early detection of worsening heart failure (HF) with a telemonitoring system crucially depends on monitoring parameters. The present study aimed to examine whether a serial follow up of all-night respiratory stability time (RST) built into a telemonitoring system could faithfully reflect ongoing deterioration in HF patients at home and detect early signs of worsening HF in a multicenter, prospective study.Methods and Results:Seventeen subjects with New York Heart Association class II or III were followed up for a mean of 9 months using a newly developed telemonitoring system equipped with non-attached sensor technologies and automatic RST analysis. Signals from the home sensor were transferred to a cloud server, where all-night RSTs were calculated every morning and traced by the monitoring center. During the follow up, 9 episodes of admission due to worsening HF and 1 episode of sudden death were preceded by progressive declines of RST. The receiver operating characteristic curve demonstrated that the progressive or sustained reduction of RST below 20 s during 28 days before hospital admission achieved the highest sensitivity of 90.0% and specificity of 81.7% to subsequent hospitalization, with an area under the curve of 0.85. CONCLUSIONS RST could serve as a sensitive and specific indicator of worsening HF and allow the detection of an early sign of clinical deterioration in the telemedical management of HF.
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Affiliation(s)
- Mika Sakoda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hidetsugu Asanoi
- Department of Chronic Heart Failure Management Global Center for Medical Engineering and Informatics, Osaka University
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Kei Nakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | | | - Osamu Wada
- Japan Community Health care Organization Takaoka Fushiki Hospital
| | - Eisaku Nakane
- Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | - Moriaki Inoko
- Kitano Hospital, Tazuke Kofukai Medical Research Institute
| | | | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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Koyama T, Kobayashi M, Ichikawa T, Wakabayashi Y, Abe H. Technology Applications of Capnography Waveform Analytics for Evaluation of Heart Failure Severity. J Cardiovasc Transl Res 2020; 13:1044-1054. [DOI: 10.1007/s12265-020-10032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/13/2020] [Indexed: 11/24/2022]
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Tobushi T, Hosokawa K, Abe K, Kon-No S, Kadokami T, Nakamura R, Tsutsui H, Ando SI. Changes in lung to finger circulation time measured via cardiopulmonary polygraphy in patients with varying types of heart disease. Heart Vessels 2020; 36:58-68. [PMID: 32613320 DOI: 10.1007/s00380-020-01657-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022]
Abstract
Cardiopulmonary polygraphy (PG) demonstrates not only parameters for sleep disordered breathing (SDB) but also hemodynamics. We previously developed a software that detects lung to fingertip circulation time (LFCT) derived from PG dataset and reported that those LFCT reflected the cardiac output. The purpose of this study is to investigate how the LFCT changes during clinical course and whether reflects the impact of in-hospital treatment on cardiac function. Consecutive patients (N = 89) who admitted to the cardiovascular division, underwent PG at the early and late phase of admission. Parameters for SDB and LFCT were compared between an acute decompensated heart failure (ADHF) group (n = 51) and non-ADHF group (n = 38). ADHF group was further divided into subgroups: preserved ejection fraction (pEF) (EF > 40%) and reduced EF (rEF) (EF ≤ 40%). Using our original algorithm, we obtained LFCT values from all of the patients, though 29.4% of ADHF and 44.7% of non-ADHF had no or mild SDB. LFCT significantly shortened in the ADHF-rEF group, in contrast to ADHF-pEF group or non-ADHF group (ADHF-rEF group: 26.9 ± 7.6 to 24.2 ± 6.1 s, p = 0.01; ADHF-pEF group: 25.3 ± 7.3 to 25.3 ± 6.9 s, p = 0.98; non-ADHF group: 21.5 ± 5.5 to 21.9 ± 5.0 s, p = 0.65). The respiratory disorder index in the ADHF group improved after treatment, irrespective of EF (pEF: 26.9 ± 16.1 to 15.8 ± 11.9/h, p < 0.01; rEF: 27.0 ± 16.5 to 20.7 ± 13.6/h, p = 0.03). Automatic detection of LFCT was feasible in almost all cardiac patients. LFCT value changed according to the heart failure treatment in ADHF-rEF patients and reflected cardiac function. LFCT might be a useful indicator of effective cardiac disease treatment.
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Affiliation(s)
- Tomoyuki Tobushi
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ko Abe
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Satomi Kon-No
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Toshiaki Kadokami
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Ryo Nakamura
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Koyama T, Kobayashi M, Ichikawa T, Wakabayashi Y, Toma D, Abe H. Laryngeal mask versus facemask in the respiratory management during catheter ablation. BMC Anesthesiol 2020; 20:9. [PMID: 31910797 PMCID: PMC6947869 DOI: 10.1186/s12871-019-0924-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to investigate if a laryngeal mask could improve respiratory condition during radiofrequency catheter ablation (RFCA). METHODS Twenty-four consecutive patients who underwent RFCA for atrial fibrillation were divided into two groups (Facemask group; n = 10, Laryngeal mask group; n = 14). All patients were completely sedated under intravenous anesthesia and fitted with artificial respirators during the RFCA. The capnography waveforms and their differential coefficients were analyzed to evaluate the changes of end-tidal CO2 (ETCO2) values, respiratory intervals, expiratory durations, and inspiratory durations. RESULTS During the RFCA, ETCO2 values of the laryngeal mask group were higher than those of the facemask group (36.0 vs. 29.2 mmHg, p = 0.005). The respiratory interval was significantly longer in the laryngeal mask group than those in the facemask group (4.28 s vs.5.25 s, p < 0.001). In both expiratory and inspiratory phases, the mean of the maximum and minimum values of CO2 was significantly higher when using a laryngeal mask than when using a facemask. The inspiratory-expiratory ratio of the laryngeal mask group was significantly larger than that of the facemask group (1.59 vs. 1.27, p < 0.001). The total procedure duration, fluoroscopic duration and the ablation energy were significantly lower in the laryngeal mask group than in the facemask group. The ETCO2 value is the most influential parameter on the fluoroscopic duration during the RFCA procedure (β = - 0.477, p = 0.029). CONCLUSIONS The use of a laryngeal mask could stabilize respiration during intravenous anesthesia, which could improve the efficiency of RFCA.
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Affiliation(s)
- Takashi Koyama
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, Habaue 9-26, Matsumoto, 390-8505, Japan.
| | - Masanori Kobayashi
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, Habaue 9-26, Matsumoto, 390-8505, Japan
| | - Tomohide Ichikawa
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, Habaue 9-26, Matsumoto, 390-8505, Japan
| | - Yasushi Wakabayashi
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, Habaue 9-26, Matsumoto, 390-8505, Japan
| | - Daiki Toma
- Department of Gasteroenterological Surgery, Matsumoto Kyoritsu Hospital, Matsumoto, Japan
| | - Hidetoshi Abe
- Department of Cardiovascular Medicine, Matsumoto Kyoritsu Hospital, Habaue 9-26, Matsumoto, 390-8505, Japan
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Tobushi T, Kadokami T, Takagawa J, Dohi K, Joho S, Wada O, Momomura SI, Koyama T, Haruki N, Ando SI, Asanoi H. Blood Oxygen, Sleep Disordered Breathing, and Respiratory Instability in Patients With Chronic Heart Failure - PROST Subanalysis. Circ Rep 2019; 1:414-421. [PMID: 33693078 PMCID: PMC7897548 DOI: 10.1253/circrep.cr-19-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background:
Respiratory stability index (RSI), a semi-quantitative measure of respiratory instability, was found to reflect congestive and other clinical status of acutely decompensated heart failure in the PROST study. Given that the association between RSI and another important factors affecting respiration, such as peripheral oxygen saturation (SpO2), and the influence of oxygen inhalation on this association were undetermined, and that the association between common sleep-disordered breathing (SDB) parameters and RSI was unknown, we performed a subanalysis using PROST data. Methods and Results:
Correlation analyses were performed to evaluate the relationships between RSI, SpO2, and other SDB parameters (3% oxygen desaturation index [3%ODI], respiratory disturbance index [RDI]) using Spearman’s rank correlation. RSI and overnight mean SpO2
were not significantly correlated either after admission (n=38) or before discharge (n=36; r=0.27, P=0.10 and r=0.05, P=0.76, respectively). This correlation was also not affected by presence or absence of oxygen inhalation. 3%ODI, RDI and RSI were significantly and inversely correlated both after admission and before discharge. Conclusions:
RSI and blood oxygen level were not significantly correlated irrespective of oxygen inhalation, while the SDB parameters were significantly correlated, suggesting that RSI reflects lung congestion independently of blood oxygen concentration and, thus, can be a useful indicator of the non-invasive assessment of lung congestion.
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Affiliation(s)
- Tomoyuki Tobushi
- Cardiovascular Medicine, Fukuokaken Saiseikai Futsukaichi Hospital Fukuoka Japan
| | - Toshiaki Kadokami
- Cardiovascular Medicine, Fukuokaken Saiseikai Futsukaichi Hospital Fukuoka Japan
| | - Junya Takagawa
- Cardiology Division, Imizu Municipal Hospital Toyama Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
| | - Shuji Joho
- Second Department of Internal Medicine, Toyama University Hospital Toyama Japan
| | - Osamu Wada
- Cardiovascular Medicine, Japan Community Health Care Organization Takaoka Fushiki Hospital Toyama Japan
| | - Shin-Ichi Momomura
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center Saitama Japan
| | - Takashi Koyama
- Cardiovascular Medicine, Matsumoto Kyoritsu Hospital Nagano Japan
| | - Nobuhiko Haruki
- Department of Cardiology, Matsue Red Cross Hospital Shimane Japan
| | - Shin-Ichi Ando
- Sleep Apnea Center, Kyushu University Hospital Fukuoka Japan
| | - Hidetsugu Asanoi
- Department of Chronic Heart Failure Management, Global Center for Medical Engineering and Informatics, Osaka University Osaka Japan
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