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Shimeno K, Matsumoto N, Matsuo M, Hayashi Y, Abe Y, Naruko T, Fukuda D. Device Electrogram-Guided Determination of Output-Dependent QRS Transition in Left Bundle Branch Pacing. JACC Clin Electrophysiol 2024; 10:768-770. [PMID: 38363277 DOI: 10.1016/j.jacep.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/15/2023] [Accepted: 12/25/2023] [Indexed: 02/17/2024]
Affiliation(s)
| | | | | | | | - Yukio Abe
- Osaka City General Hospital, Osaka, Japan
| | | | - Daiju Fukuda
- Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Inno G, Takahashi Y, Naruko T, Matsumura Y, Abe Y, Aoyama T, Morisaki A, Nishiya K, Ueda M, Shibata T. Enhanced expression of neopterin in valve tissue of bicuspid aortic stenosis. J Thorac Dis 2024; 16:191-200. [PMID: 38410556 PMCID: PMC10894393 DOI: 10.21037/jtd-23-1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/24/2023] [Indexed: 02/28/2024]
Abstract
Background Aortic valve stenosis (AS) occurs in bicuspid aortic valve (BAV) patients at a relatively young age compared to tricuspid aortic valve (TAV) patients. However, the underlying cause of this phenomenon remains unknown. Neopterin, which is a by-product of the guanosine triphosphate (GTP) pathway, enhances the oxidative potential of reactive oxygen species. To clarify the role of neopterin in the aortic valve, we immunohistochemically studied the presence of neopterin in aortic valve specimens from patients with AS harboring either TAV or BAV. Methods Frozen aortic valve samples were surgically obtained from 68 patients with severe AS with TAV (n=34) and BAV (n=34). Normal aortic valves were obtained from cadavers who died of non-cardiovascular causes as controls (n=9). Samples were immunohistochemically stained with antibodies against smooth muscle cells, macrophages, T lymphocytes, neopterin, and 4-hydroxy-2-nonenal (4-HNE). Results Quantitative analysis showed that the percentage of macrophages, 4-HNE- and neopterin-positive macrophage score, and the number of T lymphocytes were significantly higher in BAV patients than in TAV patients (macrophages, P=0.013; T lymphocytes, P=0.011; neopterin, P<0.001; 4-HNE, P=0.008). Double immunostaining for neopterin and macrophages demonstrated that most neopterin-positive cells were macrophages in BAV patients. Conclusions Neopterin accumulation in macrophages may increase oxidative stress and contribute to the early onset of AS in BAV.
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Affiliation(s)
- Goki Inno
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takanobu Aoyama
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kenta Nishiya
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Makiko Ueda
- Morinomiya University of Medical Sciences, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Kagawa S, Matsumura Y, Matsumoto R, Abe Y, Terada A, Ishiguro T, Naruko T. Large Tissue Debris Causing Cerebral Embolism After Transcatheter Aortic Valve Replacement. Int Heart J 2024; 65:152-154. [PMID: 38296569 DOI: 10.1536/ihj.23-337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Cerebral vascular embolism is one of the complications of transcatheter aortic valve replacement (TAVR). Thrombolytic therapy is not expected to be effective when embolic material consists of a large tissue fragment. Instead, mechanical aspiration may be more effective therapy for acute cerebral infarction after TAVR. Here, we describe the case of an 87-year-old woman with aortic valve stenosis and heart failure who underwent TAVR using a self-expandable valve. Acute cerebral infarction with left middle cerebral artery occlusion caused by a large tissue fragment developed after the procedure.
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Affiliation(s)
| | | | - Ryo Matsumoto
- Department of Cardiology, Osaka City General Hospital
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Aiko Terada
- Department of Neuro-Intervention, Osaka City General Hospital
| | - Tomoya Ishiguro
- Department of Neuro-Intervention, Osaka City General Hospital
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Tamura S, Shimeno K, Hayashi Y, Naruko T, Fukuda D. Effective ablation of atrial tachycardia with an epicardial circuit-insights from endocardial scars sites: a case study. J Interv Card Electrophysiol 2024; 67:1-3. [PMID: 37991668 DOI: 10.1007/s10840-023-01687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
A previous study reported primary macroreentrant atrial tachycardia (AT) in the left atrium (LA), including the epicardial circuit on a left atrial anterior wall (LAAW) scar, without any prior cardiac intervention (Miyazawa et al. in J Cardiovasc Electrophysiol 2019; 30: 263-264). However, determining the target for terminating macroreentrant ATs is challenging. The mapping revealed a centrifugal pattern but did not fully elucidate the AT circuit. The reentrant mechanism of these ATs was confirmed using entrainment pacing. The earliest excitation site (EES) was traditionally selected as the ablation site, typically located in healthy tissue. However, our two cases provide new insights into AT termination, including the epicardial bridge across the endocardial LAAW scar, using minimum ablation points, without the need to ablate the healthy EES.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan.
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
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Tamura S, Abe Y, Shimeno K, Hayashi Y, Naruko T, Fukuda D. Acute impact of atrial fibrillation on pacemaker lead-induced tricuspid regurgitation: Case report. J Cardiol Cases 2023; 28:210-212. [PMID: 38024106 PMCID: PMC10658346 DOI: 10.1016/j.jccase.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/30/2023] [Accepted: 07/12/2023] [Indexed: 12/01/2023] Open
Abstract
We report a case of worsening lead-induced tricuspid regurgitation (TR) after new-onset atrial fibrillation (AF) evaluated using three-dimensional (3D) transthoracic echocardiography (TTE) from admission through TR improvement. An 84-year-old man experienced worsening lead-induced TR with new-onset AF, acutely resulting in low output syndrome. Less invasive interventions, such as rhythm control therapy and diuretics administration worked effectively. However, 3DTTE revealed consistent restricted motion of the septal leaflet with lead impingement. Right heart dilatation due to AF and worsened TR led to incomplete closure of other leaflets and tricuspid annular dilatation, which caused further deterioration of the TR. According to the course of our case, new-onset AF can cause acute worsening of lead-induced TR and low output syndrome in patients with cardiac implantable electronic devices (CIED). Our findings emphasize the importance of understanding the TR etiology in patients with CIED, which may prevent unnecessary CIED lead extraction. Learning objective Lead-induced tricuspid regurgitation (TR) can acutely deteriorate after new onset of atrial fibrillation (AF). AF-induced deterioration of TR may not depend on restricted motion of a leaflet with lead impingement but on incomplete closure of other leaflets caused by right heart and tricuspid annular dilatation. Rhythm control therapy and diuretics administration may improve AF-induced deterioration of lead-induced TR, and should be considered before performing invasive lead extractions.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Hayashi Y, Shimeno K, Tamura S, Naruko T, Fukuda D. 3830 lead extraction from two patients with left bundle branch area pacing. J Arrhythm 2023; 39:623-626. [PMID: 37560281 PMCID: PMC10407159 DOI: 10.1002/joa3.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/04/2023] [Accepted: 06/06/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Yusuke Hayashi
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Kenji Shimeno
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Shota Tamura
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Takahiko Naruko
- Department of CardiologyOsaka City General HospitalOsakaJapan
| | - Daiju Fukuda
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
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Shimeno K, Tamura S, Hayashi Y, Abe Y, Naruko T. Is narrowest QRS the best? A case of cardiac resynchronization therapy in a patient with left anterior fascicular block. Pacing Clin Electrophysiol 2023; 46:182-184. [PMID: 35993597 DOI: 10.1111/pace.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/13/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
The efficacy of cardiac resynchronization therapy (CRT) in patients with a narrow QRS duration has not been established. We present a patient with a narrow QRS duration and left anterior fascicular block in which CRT was effective. Left ventricular lead implantation at the optimal site and appropriately-timed left ventricular pacing (LVP) resulted in left ventricle reverse remodeling. Left ventricular dyssynchrony did not improve with LVP at a timing that resulted in narrower QRS than an intrinsic QRS duration. The optimization of LVP timing in CRT for patients with a narrow QRS duration is discussed.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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Morishita M, Abe Y, Matsumura Y, Shimeno K, Naruko T. Utility of Routine Transthoracic Echocardiographic Parameters to Predict Functional Recovery after Catheter Ablation Therapy in Patients with Atrial Fibrillation and Left Ventricular Systolic Dysfunction. Int Heart J 2023; 64:386-393. [PMID: 37258115 DOI: 10.1536/ihj.22-648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Arrhythmia-induced cardiomyopathy (AIC) occurring in patients with atrial fibrillation (AF) is a reversible form of cardiomyopathy characterized by LV systolic dysfunction. However, it is difficult to predict the reversibility before rhythm control therapy. We performed this study to develop a parameter for the identification of AIC in routine transthoracic echocardiography (TTE) in patients with presumptive AIC due to AF.We retrospectively studied 72 patients treated with catheter ablation therapy for persistent AF, and LV ejection fraction (LVEF) ≤ 45%. The patients were divided into 2 groups by follow-up TTE performed within 12 ± 6 months postoperatively. Patients with ≥ 15% improvement in LVEF or ≥ 10% improvement and ≥ 50% in LVEF were classified as the AIC group, and the others were classified as the non-AIC group.A total of 57 (79%) patients were classified as the AIC group. In the stepwise multivariate logistic regression model, LV end-diastolic dimension (LVDd) and e' (septal) were independent predictors of AIC. The sensitivities of LVDd ≤ 53 mm and e' (septal) ≥ 6.3 cm/second were 60% and 75%, respectively. Their specificities were 80% and 67%, respectively. The presence of either LVDd ≤ 53 mm or e' (septal) ≥ 6.3 cm/second had a higher sensitivity (90%); their co-occurrence had a higher specificity (93%) in predicting AIC.The functional recovery in patients with AIC can occur in LV systolic dysfunction without remodeling and impairment of relaxation. The combination of LVDd and e' (septal) is useful in predicting AIC due to AF with routine TTE.
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Affiliation(s)
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | | | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital
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Shimeno K, Tamura S, Hayashi Y, Abe Y, Naruko T, Fukuda D. Reply to "Is left ventricular septal pacing enough clinically, or must left bundle branch be captured absolutely?". J Cardiovasc Electrophysiol 2022; 33:2234. [PMID: 36041215 DOI: 10.1111/jce.15663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
We thank Drs Kailun Zhu and Qiang Li for their interest in our article and would like to reply to their interesting comment This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Daiju Fukuda
- Department of Internal Medicine and Cardiology, Osaka Metropolitan University, Osaka, Japan
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10
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Shimeno K, Tamura S, Hayashi Y, Abe Y, Naruko T, Fukuda D. Achievement rate and learning curve of left bundle branch capture in left bundle branch area pacing procedure performed to demonstrate output-dependent QRS transition. J Cardiovasc Electrophysiol 2022; 33:2183-2191. [PMID: 35842801 DOI: 10.1111/jce.15627] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recently, output-dependent QRS transition was reported to be required to confirm left bundle branch (LBB) capture in LBB area pacing (LBBAP) procedure. This study aimed to evaluate the achievement rate and the learning curve of LBB capture in LBBAP procedure performed with the goal of demonstrating output-dependent QRS transition, and investigate predictors of LBB capture. METHODS AND RESULTS The LBBAP procedure was performed in 126 patients with bradyarrhythmia. LBB capture was defined as a demonstration of output-dependent QRS transition. The following pacing definitions were used for evaluation: a) LBBAP, which met the previously reported LBBAP criteria, b) LBB pacing (LBBP), LBB capture was confirmed, and c) available LBBP, LBB threshold was clinically usable (<3 V at 0.4 ms). The learning curve was evaluated by division into three time-periods. The achievement rates of LBBAP, LBBP, and available LBBP were 88.1%, 41.2%, and 35.7%, respectively. The achievement rates of all three pacing definitions significantly increased with experience (p < 0.01), but the achievement rate of available LBBP was still 50% in the third period. As predictors of LBB capture, the interval between LBB-Purkinje potential and QRS onset ≥22 ms had high specificity of 98.3%, while R wave peak time in V6 <68 ms had insufficient sensitivity of 79% and specificity of 68%. CONCLUSION Even if LBB capture was aimed in LBBAP procedure, it was not easy to achieve, and there was a clear learning curve. Much of LBBAP may be left ventricular septal pacing that does not capture LBB. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Daiju Fukuda
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Yoshiyama T, Shimeno K, Hayashi Y, Ito A, Iwata S, Matsumura Y, Izumiya Y, Abe Y, Ehara S, Naruko T. Risk factors of pacing‐induced cardiomyopathy—Insights from lead position. J Arrhythm 2022; 38:408-415. [PMID: 35785399 PMCID: PMC9237288 DOI: 10.1002/joa3.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/20/2022] [Accepted: 03/28/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tomotaka Yoshiyama
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Kenji Shimeno
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Yusuke Hayashi
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Asahiro Ito
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | | | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Yukio Abe
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Shoichi Ehara
- Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Takahiko Naruko
- Department of Cardiology Osaka City General Hospital Osaka Japan
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Tamura S, Shimeno* K, Abe Y, Naruko T. A right-to-left atrial shunt via an iatrogenic atrial septal defect after atrial fibrillation ablation induced by a percutaneous left ventricular assist device. Eur Heart J 2022; 43:839. [DOI: 10.1093/eurheartj/ehaa1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka 534-0021, Japan
| | - Kenji Shimeno*
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka 534-0021, Japan
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Hayashi Y, Shimeno K, Tamura S, Naruko T. Severe sphincter of Oddi spasm after cryoballoon ablation: a case report of an unusual complication after atrial fibrillation ablation. Eur Heart J Case Rep 2022; 6:ytac082. [PMID: 35224440 PMCID: PMC8867818 DOI: 10.1093/ehjcr/ytac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/11/2021] [Accepted: 02/02/2022] [Indexed: 12/05/2022]
Abstract
Background Perioesophageal vagal nerve (VN) injury after atrial fibrillation (AF) ablation remains an important complication. The VN provides parasympathetic innervation to the majority of the abdominal organs—including the stomach and the sphincter of Oddi (SO)—and regulates smooth muscle contraction. We present an unusual case of SO spasm induced by VN injury after cryoballoon ablation (CBA). Case summary A 71-year-old woman presented to our institution with paroxysmal AF. The patient had a history of cholecystectomy and SO dysfunction. She had undergone CBA for AF. Immediately after the procedure, the patient developed epigastric pain. Computed tomography showed dilation of the intra- and extrahepatic bile ducts, with the diameter of the common bile duct measuring ∼15.6 mm. Blood tests on postoperative Day 1 revealed severely elevated aminotransferase levels (aspartate aminotransferase, 3156 U/L; alanine aminotransferase, 2084 U/L; lactate dehydrogenase, 2279 U/L; total bilirubin 1.7 mg/dL). Discussion It is known that VN denervation induces SO spasms. The right and left vagal trunks descend alongside the oesophagus, forming a perioesophageal plexus and innervating most of the gastrointestinal organs. In our case, SO spasm was induced as a result of the perioesophageal plexus injury caused by CBA. Underlying SO dysfunction and post-cholecystectomy also played an important role. Coupled with the absence of the gallbladder, which is the reservoir of bile juice and coordinator of SO, SO spasm caused severe elevation of the bile duct pressure. Care should be taken when performing AF ablation with regards to the stomach and the SO.
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Affiliation(s)
- Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
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Tamura S, Shimeno K, Nakatsuji K, Hayashi Y, Abe Y, Naruko T. Differences in the durability of left atrial posterior wall isolation based on the isolation process. J Interv Card Electrophysiol 2022; 65:45-51. [PMID: 34985641 DOI: 10.1007/s10840-021-01108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The best strategy for durable left atrial posterior wall isolation (PWI) after completion of pulmonary vein isolation (PVI) is not yet determined. This study aimed to examine the differences in the durability of PWI based on the isolation process and the predictors of the reconduction of PWI. METHODS Among the 221 patients (mean age, 65 ± 11 years) with consecutive non-paroxysmal atrial fibrillation (AF) who completed PVI and PWI, 50 patients undergoing repeat AF ablation were enrolled and divided into the following groups based on how PWI was achieved at the initial procedure: by only the first line on the roof and floor line (group A), by additional gap ablation to the first line or second liner ablation next to the first line (group B), and by adjunct ablation inside the PW revealing the earliest activation (group C). RESULTS Reconduction of PWI occurred in 24 of the 50 patients (48%). The durability of PWI in groups A, B, and C was 81% (17 of 21 patients), 75% (6 of 8 patients), and 14% (3 of 21 patients), respectively (p < 0.01). In a multivariate analysis, the ablation inside the PW for PWI was the independent predictor of the reconduction of PWI (p < 0.001). CONCLUSION PWI achieved by the ablation inside the PW resulted in a high rate of reconduction. It may be necessary to aim to achieve the PWI without ablating the inside of the PW to prevent reconduction.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan.
| | - Kenichi Nakatsuji
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
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15
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Kagawa S, Abe Y, Matsumura Y, Nomura N, Shimeno K, Naruko T, Murakami T, Takahashi Y, Shibata T, Yoshiyama M. The Impact of Aorto-Mitral Angle on New-Onset Atrial Arrhythmia after Mitral Valve Repair in Patients with Mitral Regurgitation. Int Heart J 2021; 62:1273-1279. [PMID: 34789640 DOI: 10.1536/ihj.21-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study, we hypothesized that post-operative aorto-mitral angle might be associated to the occurrence of post-operative atrial arrhythmia (AA), including atrial fibrillation and atrial tachycardia, after mitral valve repair in patients with mitral regurgitation (MR). Thus, this present study aims to determine the effects of post-operative aorto-mitral angle on new-onset AA after mitral valve repair with mitral annuloplasty for the treatment of MR.In total, 172 patients without any history of AA underwent mitral valve repair with mitral annuloplasty in our institution between 2008 and 2017. Patient information, including medical records and echocardiographic data, were retrospectively studied.As per our findings, AA occurred in 15 (8.7%) patients during the follow-up period (median, 35.7 months; range, 0.5-132 months). The patients with AA were noted to have a longer cardiopulmonary bypass time and a smaller aorto-mitral angle at post-operative TTE than the others (119 ± 6° versus 125 ± 10°, P = 0.003). No significant difference was noted in the degree of post-operative residual MR or functional MS between the groups. In a multivariate Cox proportional hazards analysis, the longer cardiopulmonary bypass time and the smaller post-operative aorto-mitral angle were independent predictors of the occurrence of AA during the follow-up period (odds ratio per 10 minutes 1.11; 95% CI 1.02-1.22, P = 0.019: odds ratio 0.91; 95% CI 0.85-0.98, P = 0.012).A small aorto-mitral angle at post-operative TTE was determined to be a predictor of new-onset AA after a mitral valve repair for treating MR.
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Affiliation(s)
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | | | - Nanaka Nomura
- Department of Cardiology, Osaka City General Hospital
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital
| | | | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City General Hospital
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16
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Shimeno K, Tamura S, Hayashi Y, Abe Y, Naruko T. Bachmann's bundle-ridge related biatrial tachycardia with a long epicardial circuit. J Cardiovasc Electrophysiol 2021; 33:134-136. [PMID: 34845784 DOI: 10.1111/jce.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
Biatrial tachycardia (BiAT), involving Bachmann's bundle in the circuit, has sometimes been observed after mitral anterior line ablation. In this article, we present a case of BiAT, involving a long epicardial circuit, composed of Bachmann's bundle and the left atrial ridge (LAR). We discuss the optimal ablation technique for this tachycardia based on our experience in addition to the relationship between Bachmann's bundle and the LAR. Furthermore, the evaluation method for the mitral anterior block line is also discussed.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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17
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Shimeno K, Tamura S, Nakatsuji K, Hayashi Y, Abe Y, Naruko T. Characteristics and proposed mechanisms of QRS morphology observed during the left bundle branch pacing procedure. Pacing Clin Electrophysiol 2021; 44:1987-1994. [PMID: 34662435 DOI: 10.1111/pace.14382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In performing left bundle branch pacing (LBBP), various QRS morphologies are observed as the lead penetrates the ventricular septum (VS). This study aimed to evaluate these characteristics and infer the mechanism underlying each QRS morphology. METHODS In 19 patients who met the strict criteria for LBB capture, we classified the QRS morphologies observed during the LBBP procedure into seven patterns, the first five of which were determined by the depth of penetration: right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP1 and IVSP2), endocardial side of left ventricular septal pacing (LVSeP), nonselective LBBP (NS-LBBP), selective LBBP (S-LBBP), and NS-LBBP with anodal capture. The parameters of the QRS morphologies in these seven patterns were evaluated. RESULTS Among the first five patterns, stimulus-QRSend duration (s-QRSend) was the narrowest in IVSP1 rather than in NS-LBBP, and stimulus-to-peak of R wave in V6 (s-LVAT) was significantly shortened in two steps, from RVSP to IVSP1 (96 ± 11; 82 ± 8 ms, p < .01) and from LVSeP to NS-LBBP (76 ± 7; 60 ± 4 ms, p < .01). The late-R duration in V1 was significantly prolonged in the order of LVSeP, NS-LBBP, and S-LBBP (45 ± 7; 53 ± 10; 71 ± 15 ms, respectively, p < .01). CONCLUSIONS s-QRSend was the narrowest in IVSP1 rather than in NS-LBBP among the QRS morphologies observed during lead penetration through the VS. The prolonged late-R duration in V1 and abrupt shortening of the s-LVAT in V6 may help determine LBB capture during lead penetration.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Shota Tamura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | | | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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18
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Ehara S, Mizutani K, Yamazaki T, Matsumoto K, Okai T, Yamaguchi T, Izumiya Y, Naruko T, Yoshiyama M. Relationship of high-intensity plaques on T1-weighted magnetic resonance imaging with coronary intraplaque hemorrhage: A directional coronary atherectomy study. Am Heart J Plus 2021; 10:100047. [PMID: 38560646 PMCID: PMC10978143 DOI: 10.1016/j.ahjo.2021.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/28/2021] [Accepted: 08/24/2021] [Indexed: 04/04/2024]
Abstract
Background Although intraplaque hemorrhage (IPH) has been identified as a key feature of rupture-prone plaques, noninvasive imaging-based features for its detection in coronary artery have not been clearly established. The aim of this study was to investigate the relationship of the ratio between the signal intensities of coronary plaque and cardiac muscle (PMR) on non-contrast T1-weighted imaging (T1WI) in magnetic resonance with IPH in the directional coronary atherectomy (DCA) specimens. Methods Fifteen lesions from 15 patients, who underwent DCA and T1WI, were prospectively enrolled. The snap-frozen samples obtained by DCA were used for immunohistochemical staining against a protein specific to erythrocyte membranes (glycophorin A) and macrophages. The percentage of glycophorin A and macrophages was graded using a scale from 0 to 4, with higher scores indicating higher percentages. Results PMR showed a strong positive correlation with glycophorin A scores (ρ = 0.772, p < 0.001), whreas, there was a weak correlation between the PMR and macrophage scores (ρ = 0.626, p < 0.05). The receiver-operating characteristic curve analysis showed that the optimal PMR cutoff value for predicting glycophorin A scores ≥grade 2 (glycophorin A-positive area ≥5% of the plaque) was 1.2 (area under the curve; 0.91, 95% confidence interval; 0.73-1.00), and this PMR value had a sensitivity of 8/9 (89%), specificity of 6/6 (100%), positive predictive value of 8/8 (100%), and negative predictive value of 6/7 (86%). Conclusions In patients with ischemic heart disease, a high PMR on T1WI is a predictor of coronary IPH as assessed by DCA specimens.
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Affiliation(s)
- Shoichi Ehara
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takanori Yamazaki
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Matsumoto
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsukasa Okai
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Yamaguchi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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19
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Abe Y, Saito T, Naruko T. Rare murmur in a patient with constrictive pericarditis. Cardiol J 2021; 28:500-501. [PMID: 34046883 DOI: 10.5603/cj.2021.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/28/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yukio Abe
- Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, 534-0021 Osaka, Japan.
| | - Toshio Saito
- Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, 534-0021 Osaka, Japan
| | - Takahiko Naruko
- Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, 534-0021 Osaka, Japan
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20
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Affiliation(s)
- Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Chika Ebesu
- Department of Clinical Laboratory, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Yoshiki Matsumura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
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21
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Abe Y, Kitai T, Furukawa A, Nomura N, Matsumura Y, Naruko T, Yoshiyama M. Assessing the true severity of low-gradient aortic stenosis using resting echocardiography. J Cardiol 2020; 77:327-333. [PMID: 32843207 DOI: 10.1016/j.jjcc.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dobutamine stress echocardiography (DSE) is required to determine whether low-gradient aortic stenosis (AS) with a small aortic valve area (AVA) is truly severe. The purpose of the present study was to evaluate the usefulness of ejection dynamics parameters at resting echocardiography for predicting the result of DSE performed in patients with low-gradient AS. METHODS The results of resting echocardiography and DSE performed on 51 AS patients with low mean-gradient (<40 mmHg) and small indexed AVA (<0.60 cm2/m2) were retrospectively reviewed. Acceleration time (AT) and the ratio of AT to ejection time (ET) were measured on the recorded images. True-severe AS was defined as that with indexed projected AVA < 0.60 cm2/m2. RESULTS Twenty-six (51%) patients had true-severe AS, while 22 (43%) patients had preserved left ventricular ejection fraction (≥50%). Baseline indexed AVA and AT/ET were independently associated with indexed projected AVA at DSE. AT/ET was the only independent determinant of valve compliance. Indexed AVA ≤ 0.493 cm2/m2 and AT/ET > 0.334 at baseline had sensitivities of 69% and 65% and specificities of 84% and 84%, respectively, for predicting true-severe AS. The presence of either indexed AVA ≤ 0.493 cm2/m2 or AT/ET > 0.334 had a higher sensitivity (88%), and their co-occurrence had a higher specificity (100%). CONCLUSIONS Indexed projected AVA at DSE was predicted by AT/ET, which represented valve compliance, along with indexed AVA. The true severity of low-gradient AS can be screened using a combination of resting indexed AVA and AT/ET without performing DSE.
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Affiliation(s)
- Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsuko Furukawa
- Department of Cardiology, Kochi Health Sciences Center, Kochi, Japan
| | - Nanaka Nomura
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | | | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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22
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Hayashi Y, Shimeno K, Nakatsuji K, Naruko T. What is the mechanism of narrow paced QRS duration during left bundle branch area pacing? A case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974479 PMCID: PMC7501936 DOI: 10.1093/ehjcr/ytaa239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/10/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although left bundle branch area pacing (LBBAP) can capture the His-Purkinje conduction system and create a narrower paced QRS duration, its mechanism has not been investigated. In this case report, ventricular activation patterns were evaluated using three-dimensional electroanatomical mapping during LBBAP and right ventricular septal pacing (RVSP). CASE SUMMARY An 81-year-old woman with sick sinus syndrome received LBBAP, followed 4 months later with atrial fibrillation ablation. We compared ventricular activation patterns during RVSP and LBBAP using a three-dimensional electro-anatomical mapping system. Paced QRS durations during RVSP and LBBAP were 163 ms and 115 ms, respectively. The activation pattern and the total left ventricular (LV) activation time were similar during RVSP and LBBAP (86 and 73 ms, respectively), despite the conduction system capture during LBBAP. The stimulus interval to the latest LV activation point during RVSP was 117 ms, and transseptal conduction time was 31 ms (117 - 86 ms). DISCUSSION Although LBBAP could capture the His-Purkinje conduction system, neither ventricular activation patterns nor total activation time changed dramatically. The mechanism of narrower paced QRS duration during LBBAP compared to that during RVSP can be attributable to passing over the slow transseptal conduction.
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Affiliation(s)
- Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Kenichi Nakatsuji
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
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23
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Akamatsu K, Abe Y, Matsumura Y, Shimeno K, Naruko T, Takahashi Y, Shibata T, Yoshiyama M. Etiology of Atrial Functional Mitral Regurgitation: Insights from Transthoracic Echocardiography in 159 Consecutive Patients with Atrial Fibrillation and Preserved Left Ventricular Ejection Fraction. Cardiology 2020; 145:511-521. [PMID: 32541142 DOI: 10.1159/000508279] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left atrial (LA) dilatation in patients with atrial fibrillation (AF) can induce functional mitral regurgitation (MR) despite a preserved left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the etiology of this functional MR. METHODS We retrospectively examined clinical and echocardiographic data from 5,202 consecutive cases that underwent transthoracic echocardiography. AF appeared in 544 patients, and we selected 159 with AF and LVEF ≥50% after excluding patients with other underlying heart diseases. RESULTS Significant (moderate or greater) degrees of functional MR were seen in 13 (8.2%) patients and were more frequently seen in patients with an AF duration of >10 years than in others (27 vs. 4%, p = 0.0057). Multiple regression analysis revealed that both the LA dimension index and the left ventricular (LV) systolic dimension index were independent determinants of the MR grading. Among the mitral morphologic parameters, the mitral annular (MA) dimension index and the hamstringing phenomenon of the posterior mitral leaflet were independent determinants of MR grading. Significant MR was not seen in patients without LA dilatations, but it occurred in 14% of patients with LA dilatation alone and in 55% with both LA and LV dilatations; the MA dimension index increased in this order. CONCLUSIONS The grading of functional MR occurring in patients with AF and preserved LVEF depends on both the LA dimension and the LV systolic dimension. The MR grading also depends on both the MA dilatation and the hamstringing phenomenon of the posterior mitral leaflet.
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Affiliation(s)
- Kanako Akamatsu
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan,
| | | | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University, Osaka, Japan
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24
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Matsuo M, Shimeno K, Yoshiyama T, Matsumura Y, Matsumoto R, Abe Y, Naruko T, Yoshiyama M. Utility of the combination of simple electrocardiographic parameters for identifying mid‐septal pacing. J Cardiovasc Electrophysiol 2019; 30:2433-2440. [DOI: 10.1111/jce.14174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/20/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Masanori Matsuo
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Kenji Shimeno
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | | | | | - Ryo Matsumoto
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Yukio Abe
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Takahiko Naruko
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine Osaka City University Osaka Japan
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25
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Nakagawa E, Naruko T, Makita T. Reproducibility and diagnostic usefulness of repeated sodium channel blocker test at higher precordial electrocardiogram recording in a patient with Brugada syndrome. HeartRhythm Case Rep 2019; 5:251-255. [PMID: 31193222 PMCID: PMC6522474 DOI: 10.1016/j.hrcr.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Eiichiro Nakagawa
- Division of Cardiac Electrophysiology, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
- Address reprint requests and correspondence: Dr Eiichiro Nakagawa, Division of Cardiac Electrophysiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka 543-8555, Japan.
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Toshinori Makita
- Division of Cardiac Electrophysiology, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
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26
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Yoshiyama T, Shimeno K, Matsuo M, Matsumoto R, Matsumura Y, Abe Y, Naruko T, Yoshiyama M. Efficacy of the current of injury in envisaging the dislodgement of leads implanted in the right atrial septum or the right ventricular septum. Pacing Clin Electrophysiol 2019; 42:603-609. [DOI: 10.1111/pace.13666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 02/25/2019] [Accepted: 03/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Kenji Shimeno
- Department of CardiologyOsaka City General Hospital Osaka Japan
| | - Masanori Matsuo
- Department of CardiologyOsaka City General Hospital Osaka Japan
| | - Ryo Matsumoto
- Department of CardiologyOsaka City General Hospital Osaka Japan
| | | | - Yukio Abe
- Department of CardiologyOsaka City General Hospital Osaka Japan
| | - Takahiko Naruko
- Department of CardiologyOsaka City General Hospital Osaka Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular MedicineOsaka City University Graduate School of Medicine Osaka Japan
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27
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Shimeno K, Yoshiyama T, Abe Y, Akamatsu K, Kagawa S, Matsushita T, Matsuo M, Matsumura Y, Matsumoto R, Kamimori K, Naruko T, Doi A, Takagi M, Yoshiyama M. The usefulness of right ventriculography to aid anchoring a pacing lead to the right ventricular septum. Europace 2019; 20:1154-1160. [PMID: 28679175 DOI: 10.1093/europace/eux165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Although right ventricular septal pacing is thought to be more effective in minimizing pacing-induced left ventricular dysfunction, the accurate way to anchor the lead to the right ventricular septum (RVS) has not been established. Our aim was to clarify the usefulness of right ventriculography (RVG) to aid accurate anchoring of the lead to the RVS. Methods and results Eighty-four patients who underwent pacemaker implantation were enrolled. We anchored the lead to the RVS by using an RVG image obtained at a 30° right anterior oblique view as a reference. We confirmed the actual lead position by performing computed tomography after the procedure and examined the characteristics of the paced QRS complex. Of the 81 patients, except 3 patients whose leads were anchored to the apex due to high pacing thresholds in the RVS, the leads were successfully anchored to the RVS in the 79 (98%) patients, and the number of leads placed in the high-, mid-, and low-RVS was 3 (4%), 58 (73%), and 18 (23%), respectively. The paced QRS duration in these 79 patients was 140 ± 13 ms. The paced QRS duration from mid-RVS was considerably narrower than that from high- or low-RVS (137 ± 12 ms vs. 146 ± 12 ms; P = 0.012). Conclusion Right ventriculography was very useful in aiding accurate anchoring of the lead to the RVS. Further, pacing from mid-RVS may be more effective in minimizing the QRS duration than pacing from other RVS sites.
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Affiliation(s)
- Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Tomotaka Yoshiyama
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Kanako Akamatsu
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Syunsuke Kagawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Tsukasa Matsushita
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Masanori Matsuo
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Yoshiki Matsumura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Ryo Matsumoto
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Kimio Kamimori
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, Japan
| | - Atsuhi Doi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan
| | - Masahiko Takagi
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Japan
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Morishita M, Abe Y, Matsumura Y, Shimeno K, Naruko T. Myocardial oedema lesion with echocardiography in a patient with cardiac sarcoidosis. Eur Heart J Cardiovasc Imaging 2019; 20:437. [PMID: 30596991 DOI: 10.1093/ehjci/jey207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mayumi Morishita
- Department of Clinical Laboratory, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan
| | - Yoshiki Matsumura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan
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Yoshiyama T, Sugioka K, Naruko T, Nakagawa M, Shirai N, Ohsawa M, Yoshiyama M, Ueda M. Neopterin and Cardiovascular Events Following Coronary Stent Implantation in Patients with Stable Angina Pectoris. J Atheroscler Thromb 2018; 25:1105-1117. [PMID: 29593175 PMCID: PMC6224201 DOI: 10.5551/jat.43166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/17/2018] [Indexed: 01/11/2023] Open
Abstract
AIM Neopterin is an activation marker for monocytes/macrophages. We prospectively investigated the predictive value of plasma neopterin levels on 2-year and long-term cardiovascular events in patients with stable angina pectoris (SAP) undergoing coronary stent implantation. METHODS We studied 123 consecutive patients with SAP who underwent primary coronary stenting (44 patients with bare metal stent: BMS group and 79 with drug-eluting stent: DES group). Plasma neopterin levels were measured on admission using HPLC. Moreover, one frozen coronary artery specimen after DES and three frozen coronary specimens after BMS were obtained by autopsy or endarterectomy, followed by immunohistochemical staining for neopterin. RESULTS Plasma neopterin levels were significantly higher in patients with cardiovascular events than in those without them (P<0.001). In subgroup analyses, higher levels of plasma neopterin in patients with cardiovascular events (P<0.001) and a positive correlation between neopterin levels and late lumen loss after stenting (P =0.008) were observed in the BMS group but not in the DES group (P=0.53 and P=0.17, respectively). In long-term cardiovascular events, multivariate Cox regression analysis identified the significance of the high-neopterin group as independent determinants of cardiovascular events (hazard ratio, 2.225; 95% CI, 1.283-3.857; P =0.004). Immunohistochemical staining showed abundant neopterin-positive macrophages in the neointima after BMS implantation but no neopterin-positive macrophages in the neointima after DES implantation. CONCLUSION These findings suggest that neopterin is associated with cardiovascular events after coronary stent implantation in patients with SAP. However, there might be a strong association between neopterin and cardiovascular events after BMS but not after DES in these patients.
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Affiliation(s)
- Tomotaka Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Sugioka
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Masashi Nakagawa
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Nobuyuki Shirai
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Makiko Ueda
- Morinomiya University of Medical Sciences, Osaka, Japan
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Abe Y, Akamatsu K, Ito K, Matsumura Y, Shimeno K, Naruko T, Takahashi Y, Shibata T, Yoshiyama M. Prevalence and Prognostic Significance of Functional Mitral and Tricuspid Regurgitation Despite Preserved Left Ventricular Ejection Fraction in Atrial Fibrillation Patients. Circ J 2018; 82:1451-1458. [DOI: 10.1253/circj.cj-17-1334] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | | | - Kazato Ito
- Department of Cardiology, Osaka City General Hospital
| | | | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital
| | | | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Medical School
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Medical School
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Kajimoto K, Minami Y, Otsubo S, Sato N, Sato N, Asai K, Munakata R, Aokage T, Yoshida A, Minami Y, Yumino D, Mizuno M, Kawada E, Yoshida K, Ozaki Y, Kogure T, Haruki S, Mizuno M, Kajimoto K, Nakao K, Sawamura T, Nuki T, Ishiki R, Yokota S, Fujinaga H, Yamamoto T, Harada K, Saito A, Kageyama N, Okumura T, Hata N, Murai K, Nozaki A, Kawanaka H, Tanabe J, Sato Y, Ishii K, Oiwa H, Matsumoto T, Yoshida D, Kato N, Suzuki H, Shimizu N, Keida T, Fujita M, Nakamura K, Chinen T, Meguro K, Kikuchi T, Nishikido T, Nakata M, Yamashita T, Nakata M, Hirono A, Mitsudo K, Kadota K, Makita N, Watanabe N, Kawabata M, Fujii K, Okuda S, Kobayashi S, Moriuchi I, Mizuno KO, Osato K, Murakami T, Shimada Y, Misawa K, Kokado H, Fujita T, Fukuoka Y, Takabatake S, Takata Y, Miyagi M, Tanaka N, Yamashina A, Sudo S, Shimamura K, Nagashima M, Kaneda T, Ueda K, Kato H, Higashikata T, Fujimori K, Kobayashi H, Fujii S, Yagi M, Ozaki Y, Takaki J, Yamashita E, Toyama T, Hirata T, Kamisihima K, Oka T, Komatsu R, Itoh A, Naruko T, Abe Y, Nakagawa E, Furukawa A, Kinou N, Uematsu S, Tabuchi I, Imai T, Sakamoto T, Todaka K, Koide Y, Maemura K, Yoshioka K, Yoshihisa A, Sato T, Takeishi Y, Ebina T, Kimura K, Konishi M, Kato M, Kinugasa Y, Ishida K, Sugihara S, Yanagihara K, Takeuchi T, Okada M, Hasebe N, Sakai T, Asano T, Minoura Y, Toshida T, Sato T, Yokota Y, Kondo S, Sakata Y, Komuro I, Otsu K, Yamashita S, Asano Y, Yoshida A, Kajimoto K, Kashiwase K, Ueda Y, Kondo T, Kawaguchi K, Sawamura A, Saito T, Higa T, Noguchi H, Yanagita Y, Nakamura K, Komaki T, Muramatsu T, Koizumi T, Nakajima Y, Kikutani T, Ikeda Y, Tamaki T, Funada S, Ogawa H, Sakuragawa K, Kohsaka S, Ando SI, Kadokami T, Ishida E, Ide K, Sotomi Y, Higuchi Y, Uehara M, Goto T, Ohte N, Miura M, Shiba N, Nochioka K, Shimokawa H, Ishihara S, Koga T, Fujishima S, Kaseda S, Haga Y, Kida K, Kamisihima K, Nakamura M, Sunagawa O, Miyara T, Taba Y, Touma T, Shinjo O, Nishimura Y, Kario K, Shimizu H, Uchida T, Amitani KI, Sato N, Shimada K. Ischemic or Nonischemic Functional Mitral Regurgitation and Outcomes in Patients With Acute Decompensated Heart Failure With Preserved or Reduced Ejection Fraction. Am J Cardiol 2017; 120:809-816. [PMID: 28705383 DOI: 10.1016/j.amjcard.2017.05.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the association of functional mitral regurgitation (FMR), preserved or reduced ejection fraction (EF), and ischemic or nonischemic origin with outcomes in patients discharged alive after hospitalization for acute decompensated heart failure (HF). Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 3,357 patients were evaluated to assess the association of FMR, preserved or reduced EF, and ischemic or nonischemic origin with the primary end point (all-cause death and readmission for HF after discharge). At the time of discharge, FMR was assessed semiquantitatively (classified as none, mild, or moderate to severe) by color Doppler analysis of the regurgitant jet area. According to multivariable analysis, in the ischemic group, either mild or moderate to severe FMR in patients with a preserved EF had a significantly higher risk of the primary end point than patients without FMR (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.12 to 2.29; p = 0.010 and HR 1.98; 95% CI 1.30 to 3.01; p = 0.001, respectively). In patients with reduced EF with an ischemic origin, only moderate to severe FMR was associated with a significantly higher risk of the primary end point (HR 1.67; 95% CI 1.11 to 2.50; p = 0.014). In the nonischemic group, there was no significant association between FMR and the primary end point in patients with either a preserved or reduced EF. In conclusion, among patients with acute decompensated HF with a preserved or reduced EF, the association of FMR with adverse outcomes may differ between patients who had an ischemic or nonischemic origin of HF.
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Nakagawa M, Naruko T, Sugioka K, Kitabayashi C, Shirai N, Takagi M, Yoshiyama M, Ohsawa M, Ueda M. Enhanced expression of natriuretic peptide receptor A and B in neutrophils of culprit lesions in patients with acute myocardial infarction. Mol Med Rep 2017; 16:3324-3330. [DOI: 10.3892/mmr.2017.7034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/09/2017] [Indexed: 11/06/2022] Open
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Shimeno K, Akamatsu K, Kagawa S, Matsushita T, Matsuo M, Yoshiyama T, Matsumura Y, Matsumoto R, Abe Y, Kamimori K, Naruko T. P1507Utility of right ventriculography for anchoring a pacing lead to the right ventricular septum. Europace 2017. [DOI: 10.1093/ehjci/eux158.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abe Y, Akamatsu K, Furukawa A, Ito K, Matsumura Y, Haze K, Naruko T, Yoshiyama M, Yoshikawa J. Pre-Load–Induced Changes in Forward LV Stroke and Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2017; 10:611-618. [DOI: 10.1016/j.jcmg.2016.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/27/2022]
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Yoshiyama T, Simeno K, Akamatsu K, Kagawa S, Matsushita T, Matsuo M, Matsumoto R, Matsumura Y, Abe Y, Kamimori K, Naruko T. P1696Utility of the plasma human atrial natriuretic peptide for predicting the left atrial reverse remodeling after the catheter ablation in patients with atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux161.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Matsuo M, Shimeno K, Akamatsu K, Kagawa S, Matsushita T, Yoshiyama T, Matsumoto R, Matsumura Y, Abe Y, Kamimori K, Naruko T. P1509Utility of the combination of simple electrocardiographic parameters for identifying the mid-septal pacing. Europace 2017. [DOI: 10.1093/ehjci/eux158.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Furukawa A, Abe Y, Ito M, Tanaka C, Ito K, Komatsu R, Haze K, Naruko T, Yoshiyama M, Yoshikawa J. Prediction of aortic stenosis-related events in patients with systolic ejection murmur using pocket-sized echocardiography. J Cardiol 2016; 69:189-194. [PMID: 27012751 DOI: 10.1016/j.jjcc.2016.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND We have previously reported the usefulness of our newly developed visual aortic stenosis (AS) score in screening for AS using pocket-sized echocardiography. The objective of this study was to investigate whether the visual AS score and/or conventional aortic valve calcification score derived from pocket-sized echocardiography can be used to predict AS-related events. METHODS One hundred and nine patients with systolic ejection murmur (SEM) or known AS (64 males, age 75±9 years) were enrolled and a visual AS score and an aortic valve calcification score were assessed using pocket-sized echocardiography. The primary endpoint was defined as AS-related events, including cardiac death and aortic valve replacement, during the follow-up period. RESULTS In a multivariate Cox proportional hazards analysis, AS-related events were independently predicted by an aortic valve calcification score ≥3 (HR, 3.5; 95% CI, 1.1-11; p=0.033) and a visual AS score ≥3 (HR, 15; 95% CI, 1.8-125; p=0.013). During 18±9 months of follow-up, the event-free survival rate was 98% in patients with both a visual AS score <3 and an aortic valve calcification score <3, 90% in patients with either a visual AS score ≥3 or an aortic valve calcification score ≥3 (p<0.0001), and 62% in patients with both a visual AS score ≥3 and an aortic valve calcification score ≥3 (p<0.0001). CONCLUSIONS The combination of visual AS score and aortic valve calcification score derived from pocket-sized echocardiography is useful for predicting AS-related events in patients with SEM.
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Affiliation(s)
- Atsuko Furukawa
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan.
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Makoto Ito
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Chiharu Tanaka
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kazato Ito
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Ryushi Komatsu
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kazuo Haze
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University Medical School, Osaka, Japan
| | - Junichi Yoshikawa
- Department of Cardiology, Nishinomiya-Watanabe Cardiovascular Center, Nishinomiya, Japan
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Nakagawa E, Abe Y, Komatsu R, Naruko T, Itoh A. Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade. J Arrhythm 2015; 31:313-5. [PMID: 26550089 DOI: 10.1016/j.joa.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 10/23/2022] Open
Abstract
Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.
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Affiliation(s)
- Eiichiro Nakagawa
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Ryushi Komatsu
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan
| | - Akira Itoh
- Department of Cardiology, HITO Hospital, 788-1 Kamibun-cho, Shikokuchuo City, Ehime Prefecture 799-0121, Japan
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Kato Y, Takanashi S, Fukui T, Naruko T, Shibata T, Shimizu Y. Does the complexity of coronary artery disease affect outcomes after complete revascularization with long segmental reconstruction of the left anterior descending artery using the left internal thoracic artery? Interact Cardiovasc Thorac Surg 2015; 21:308-14. [DOI: 10.1093/icvts/ivv146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/12/2015] [Indexed: 12/25/2022] Open
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Mizutani K, Itoh A, Sugioka K, Komatsu R, Naruko T, Yoshiyama M. Intravascular findings of fibromuscular dysplasia on optical coherence tomography. J Cardiol Cases 2015; 12:39-42. [PMID: 30524536 DOI: 10.1016/j.jccase.2015.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/05/2015] [Accepted: 03/30/2015] [Indexed: 01/24/2023] Open
Abstract
We present the case of a 29-year-old woman with right renal artery stenosis caused by fibromuscular dysplasia (FMD) who underwent optical coherence tomography (OCT)-guided percutaneous transluminal renal angioplasty. Using OCT, we could clearly observe intimal fibroplasia and medial hyperplasia that was indicative of FMD. Based on diagnosis of FMD by OCT, this patient was treated with plain old balloon angioplasty that resulted in adequate luminal opening without intimal dissection confirmed on final angiography and OCT. <Learning objective: Fibromuscular dysplasia (FMD) is most often diagnosed based on its characteristic appearance on angiography but it is insufficient. Although pathological examination is needed for definite diagnosis, it is not realistic. Therefore, it is important to assess the detailed intravascular findings of culprit and non-culprit lesions in FMD with optical coherence tomography.>.
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Affiliation(s)
- Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akira Itoh
- Department of Cardiovascular Medicine, Osaka City General Hospital, Osaka, Japan
| | - Kenichi Sugioka
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryushi Komatsu
- Department of Cardiovascular Medicine, Osaka City General Hospital, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiovascular Medicine, Osaka City General Hospital, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Sugioka K, Fujita S, Iwata S, Ito A, Matsumura Y, Hanatani A, Doi A, Takagi M, Naruko T, Ueda M, Yoshiyama M. Relationship between CHADS2 score and complex aortic plaques by transesophageal echocardiography in patients with nonvalvular atrial fibrillation. Ultrasound Med Biol 2014; 40:2358-2364. [PMID: 25023106 DOI: 10.1016/j.ultrasmedbio.2014.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/16/2014] [Accepted: 05/07/2014] [Indexed: 06/03/2023]
Abstract
The CHADS2 score is widely used for risk stratification of thromboembolism in patients with non-valvular atrial fibrillation (NVAF). Although the correlation of CHADS2 score with left atrial (LA) abnormality as detected by transesophageal echocardiography (TEE) has been reported in previous studies, the relationship between CHADS2 score and complex aortic plaque, which is also a significant risk factor for thromboembolism, has not been fully investigated. We assessed aortic plaques by TEE in 150 patients age ≥ 55 y with NVAF. The prevalence of complex aortic plaques increased along with increases in CHADS2 score (p = 0.001). In a multivariate analysis that included atherosclerotic risk factors and LA abnormality, a CHADS2 score ≥2 was independently associated with the presence of complex aortic plaques (odds ratio [OR] 3.39; 95% confidence interval [CI], 1.29-8.90). A high CHADS2 score is closely associated with the presence of complex aortic plaques, which explains, in part, the increased risk of thromboembolism in NVAF patients with high CHADS2 score.
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Affiliation(s)
- Kenichi Sugioka
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Asahiro Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Matsumura
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihisa Hanatani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Takagi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Makiko Ueda
- Department of Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Inaba M, Sugioka K, Naruko T, Yunoki K, Kato Y, Shibata T, Inoue T, Ohsawa M, Yoshiyama M, Ueda M. Enhanced expression of hemoglobin scavenger receptor and heme oxygenase-1 is associated with aortic valve stenosis in patients undergoing hemodialysis. Hemodial Int 2014; 18:632-40. [PMID: 24612419 DOI: 10.1111/hdi.12147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A high prevalence and a rapid progression of aortic valve stenosis (AS) in patients undergoing hemodialysis (HD) has been reported. In these circumstances, intraleaflet hemorrhage of aortic valve may be related to the development of AS in HD patients. We immunohistochemically examined the relationship among intraleaflet hemorrhage, neovascularization, hemoglobin scavenger receptor (CD163), and heme oxygenase-1 (HO-1) using surgically resected aortic valve specimens from AS patients undergoing HD. The study population consisted of 26 HD patients and 25 non-HD patients with severe AS who had undergone aortic valve replacement. Frozen aortic valve samples surgically obtained from AS patients were stained immunohistochemically with antibodies against smooth muscle cells, macrophages, glycophorin-A (a protein specific to erythrocyte membranes), CD31, CD163, and HO-1. Morphometric analysis demonstrated that the CD163-positive macrophage score, the number of CD31-positive microvessels, and the percentage of glycophorin-A and HO-1-positive area were significantly higher in HD patients than in non-HD patients (CD163-positive macrophage score, P < 0.0001; CD31-positive microvessels, P < 0.0001; glycophorin-A, P < 0.0001; HO-1, P < 0.0001). Double immunostaining for CD163 or HO-1 and macrophages revealed that the majority of CD163- or HO-1-positive cells were macrophages. Furthermore, CD163-positive macrophage score was positively correlated with glycophorin-A, HO-1-positive area, and the number of CD31-positive microvessels (glycophorin-A, R = 0.66, P < 0.0001; HO-1, R = 0.50, P < 0.0005; microvessels, R = 0.38, P < 0.01). These findings suggest a positive association among intraleaflet hemorrhage, neovascularization, and enhanced expression of CD163 and HO-1 as a response to intraleaflet hemorrhage in stenotic aortic valves in AS patients undergoing HD.
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Affiliation(s)
- Mayumi Inaba
- Department of Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Wada S, Sugioka K, Naruko T, Kato Y, Shibata T, Inoue T, Inaba M, Ohsawa M, Yoshiyama M, Ueda M. Relationship between oxidative stress and aortic valve stenosis in humans: an immunohistochemical study. Osaka City Med J 2013; 59:61-67. [PMID: 24575581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Oxidative stress contributes to plaque formation and the destabilization of coronary atherosclerotic lesions. It has been reported that disease processes and clinical risk factors of aortic valve stenosis (AS) are similar to those of atherosclerosis. In this study, we immunohistochemically examined the expression of 4-hydroxy-2-nonenal (4-HNE), an oxidative stress-related molecule, by using surgically resected aortic valve specimens from AS patients. METHODS The study was conducted using aortic valve specimens, surgically obtained from 24 patients with severe AS undergoing aortic valve replacement. We immunohistochemically investigated frozen aortic valve samples with antibodies against smooth muscle cells, macrophages, CD31 and 4-HNE. RESULTS Morphometric analysis showed that the percentage of the macrophage-positive area and the number of CD31-positive microvessels were significantly higher in AS patients than those in reference cases (macrophages, p < 0.005 and CD31, p < 0.0001). Furthermore, the 4-HNE-positive macrophage score was also significantly higher in AS patients than in reference cases (p < 0.005). CONCLUSIONS 4-HNE was expressed in the stenotic aortic valves in patients with severe AS, suggesting a close relationship between oxidative stress and the progression of calcific AS.
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Affiliation(s)
- Satoko Wada
- Department of Pathology, Osaka City University, Graduate School of Medicine, Japan
| | - Kenichi Sugioka
- Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yasuyuki Kato
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Mayumi Inaba
- Department of Pathology, Osaka City University, Graduate School of Medicine, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Osaka City University, Graduate School of Medicine, Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan
| | - Makiko Ueda
- Department of Pathology, Osaka City University, Graduate School of Medicine, Japan
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Yunoki K, Naruko T, Inaba M, Inoue T, Nakagawa M, Sugioka K, Ohsawa M, Iwasa Y, Komatsu R, Itoh A, Haze K, Yoshiyama M, Becker AE, Ueda M. Gender-specific correlation between plasma myeloperoxidase levels and serum high-density lipoprotein-associated paraoxonase-1 levels in patients with stable and unstable coronary artery disease. Atherosclerosis 2013; 231:308-14. [PMID: 24267244 DOI: 10.1016/j.atherosclerosis.2013.08.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/03/2013] [Accepted: 08/27/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Low high-density lipoprotein (HDL) cholesterol is well-established as a negative risk factor for coronary artery disease (CAD) and its anti-oxidant property has been attributed mainly to the HDL-bound enzyme paraoxonase-1 (PON-1). Recently, myeloperoxidase (MPO), a pro-oxidant enzyme released from activated neutrophils, has been shown to alter the atheroprotective function of HDL to a dysfunctional form. This study investigated the relationship between plasma MPO and serum PON-1 levels in patients with stable (SAP) and unstable angina pectoris (UAP). METHODS Plasma MPO levels and serum PON-1 concentration/activity were measured in patients with SAP (n = 226), UAP (n = 151) and in control subjects (n = 99). RESULTS Plasma MPO levels in UAP patients were significantly higher than those in SAP patients or in control subjects (UAP, 21.6[16.7-44.6]; SAP, 19.3[15.7-29.1]; control, 15.9[14.7-18.7] ng/mL; P < 0.0001). Serum PON-1 concentrations in UAP and SAP patients were significantly lower than those in control subjects (UAP, 55.6[45.9-69.7]; SAP, 55.0[46.9-64.9]; control, 62.5[51.1-78.8] μg/mL; P = 0.0002). Plasma MPO levels showed a weak inverse correlation with serum PON-1 concentrations in all subjects (R = -0.163, P < 0.0005). Moreover, in women, plasma MPO levels showed a significant inverse correlation with serum PON-1 concentrations and PON-arylesterase activity in SAP (concentration: R = -0.537, P < 0.0001; arylesterase-activity: R = -0.469, P < 0.001) and UAP (concentration: R = -0.340, P < 0.05; arylesterase-activity: R = -0.350, P < 0.05) patients, but not in men. CONCLUSION This study demonstrates that plasma MPO levels have a significant inverse correlation with PON-1 levels, especially in women, in SAP and UAP patients, and suggests that an imbalance between pro-oxidants and anti-oxidants may contribute to the progression of coronary plaque instability.
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Affiliation(s)
- Kei Yunoki
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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45
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Wada S, Sugioka K, Naruko T, Kato Y, Shibata T, Inoue T, Inaba M, Ohsawa M, Yoshiyama M, Ueda M. Myeloperoxidase and progression of aortic valve stenosis in patients undergoing hemodialysis. J Heart Valve Dis 2013; 22:640-647. [PMID: 24383374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Currently, there is an increased incidence of aortic valve stenosis (AS) in patients undergoing hemodialysis (HD), though the exact mechanisms are not fully understood. Myeloperoxidase (MPO) is a leukocyte-derived enzyme that catalyzes the formation of reactive oxygen species and is an index of oxidative stress. The study aim was to examine, immunohistochemically, the expression of MPO, using surgically resected aortic valve specimens from AS patients undergoing HD. METHODS The study population consisted of 15 HD patients and 19 non-HD patients with severe AS undergoing aortic valve replacement. Frozen aortic valve samples obtained surgically from AS patients were stained immunohistochemically with antibodies against smooth muscle cells, neutrophils, macrophages, T lymphocytes, CD31, MPO and 4-hydroxy-2-nonenal (4-HNE). RESULTS Quantitative analyses showed that the macrophage-positive area, and numbers of T lymphocytes, neutrophils, CD31-positive microvessels and MPO-positive cells in HD patients were significantly higher than in non-HD patients (macrophages, p < 0.0001; T lymphocytes, p < 0.0001; neutrophils, p < 0.0001; CD31, p < 0.0001; MPO, p < 0.0001). Moreover, the number of MPO-positive cells was positively correlated with CD31-positive microvessels and the 4-HNE-positive macrophage score (CD31, R = 0.73, p < 0.0001; 4-HNE, R = 0.49; p < 0.005). CONCLUSION These findings suggest that MPO is highly expressed in the aortic valves of AS patients undergoing HD. Furthermore, MPO is positively associated with neovascularization and oxidative stress, which contribute to a rapid progression of AS in HD patients.
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Affiliation(s)
- Satoko Wada
- Department of Pathology, City University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Sugioka
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Yasuyuki Kato
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Mayumi Inaba
- Department of Pathology, City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Pathology, City University Graduate School of Medicine, Osaka, Japan
| | | | - Makiko Ueda
- Department of Pathology, City University Graduate School of Medicine, Osaka, Japan
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46
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Yunoki K, Inoue T, Sugioka K, Nakagawa M, Inaba M, Wada S, Ohsawa M, Komatsu R, Itoh A, Haze K, Yoshiyama M, Becker AE, Ueda M, Naruko T. Association between hemoglobin scavenger receptor and heme oxygenase-1-related anti-inflammatory mediators in human coronary stable and unstable plaques. Hum Pathol 2013; 44:2256-65. [PMID: 23850497 DOI: 10.1016/j.humpath.2013.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/05/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
Heme oxygenase-1 (HO-1) is a cytoprotective enzyme that is induced by intraplaque hemorrhage and degrades free heme and releases ferrous iron, which is rapidly sequestered by ferritin. In vitro studies have shown that binding of hemoglobin to hemoglobin scavenger receptor (CD163) induces HO-1 and the anti-inflammatory mediator interleukin (IL)-10. We immunohistochemically examined the relationship between CD163 expression in macrophages and intraplaque hemorrhage, HO-1, IL-10, and ferritin using coronary atherectomy specimens from patients with stable (SAP) or unstable angina pectoris (UAP). A total of 67 patients underwent atherectomy for SAP (n = 33) or UAP (n = 34). Samples were stained with antibodies against smooth muscle cells, macrophages, glycophorin-A (a protein specific to erythrocyte membranes), CD163, HO-1, IL-10, and ferritin. To identify cell types of HO-1-positive cells, double immunostaining was also performed. Double immunostaining for HO-1 and macrophages revealed that the vast majority of HO-1-positive cells were macrophages. Morphometric analysis demonstrated that CD163-positive macrophage score and the percentage of glycophorin-A-, HO-1-, IL-10-, and ferritin-positive areas were significantly higher in UAP than in SAP patients (CD163, P < .005; glycophorin-A, P < .0001; HO-1, P < .0001; IL-10, P < .005; ferritin, P = .0001). Moreover, CD163-positive macrophage score was positively associated with the percentage of glycophorin-A-, HO-1-, IL-10-, and ferritin-positive areas (glycophorin-A, r = 0.60, P < .0001; HO-1, r = 0.67, P < .0001; IL-10, r = 0.45, P < .0005; ferritin, r = 0.61, P < .0001). These findings suggest that enhanced expression of HO-1 and HO-1-related atheroprotective molecules plays an important role in exerting anti-inflammatory, antioxidant, and scavenging functions, which could contribute to plaque stabilization.
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Affiliation(s)
- Kei Yunoki
- Department of Cardiology, Osaka City General Hospital, Osaka 534-0021, Japan
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47
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Kitabayashi C, Naruko T, Sugioka K, Yunoki K, Nakagawa M, Inaba M, Ohsawa M, Konishi Y, Imanishi M, Inoue T, Itabe H, Yoshiyama M, Haze K, Becker AE, Ueda M. Positive association between plasma levels of oxidized low-density lipoprotein and myeloperoxidase after hemodialysis in patients with diabetic end-stage renal disease. Hemodial Int 2013; 17:557-67. [DOI: 10.1111/hdi.12049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chizuko Kitabayashi
- Department of Pathology; Osaka City University Graduate School of Medicine; Tokyo Japan
| | - Takahiko Naruko
- Department of Cardiology; Osaka City General Hospital; Tokyo Japan
| | - Kenichi Sugioka
- Department of Internal Medicine and Cardiology; Osaka City University Graduate School of Medicine; Tokyo Japan
| | - Kei Yunoki
- Department of Cardiology; Osaka City General Hospital; Tokyo Japan
| | - Masashi Nakagawa
- Department of Internal Medicine and Cardiology; Osaka City University Graduate School of Medicine; Tokyo Japan
| | - Mayumi Inaba
- Department of Pathology; Osaka City University Graduate School of Medicine; Tokyo Japan
| | - Masahiko Ohsawa
- Department of Surgical Pathology; Osaka City University Graduate School of Medicine; Tokyo Japan
| | - Yoshio Konishi
- Division of Nephrology and Hypertension; Osaka City General Hospital; Tokyo Japan
| | - Masahito Imanishi
- Division of Nephrology and Hypertension; Osaka City General Hospital; Tokyo Japan
| | - Takeshi Inoue
- Department of Pathology; Osaka City General Hospital; Tokyo Japan
| | - Hiroyuki Itabe
- Department of Biological Chemistry; School of Pharmaceutical Sciences; Showa University; Tokyo Japan
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology; Osaka City University Graduate School of Medicine; Tokyo Japan
| | - Kazuo Haze
- Department of Cardiology; Osaka City General Hospital; Tokyo Japan
| | - Anton E. Becker
- Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Makiko Ueda
- Department of Pathology; Osaka City University Graduate School of Medicine; Tokyo Japan
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Fujita S, Sugioka K, Matsumura Y, Ito A, Hozumi T, Hasegawa T, Hanatani A, Naruko T, Ueda M, Yoshiyama M. Impact of concomitant coronary artery disease on atherosclerotic plaques in the aortic arch in patients with severe aortic stenosis. Clin Cardiol 2013; 36:352-7. [PMID: 23585299 DOI: 10.1002/clc.22121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/03/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) often occurs concurrently in patients with severe aortic stenosis (AS). However, the influence of concomitant CAD on the presence of atherosclerotic complex plaques in the aortic arch, which is associated with increased stroke risk, has not been fully assessed in patients with severe AS. HYPOTHESIS We hypothesized that concomitant CAD would be associated with the presence of complex arch plaques in patients with severe AS. METHODS The study population consisted of 154 patients with severe AS who had undergone transesophageal echocardiography (TEE) and coronary angiography (71 male; mean age, 72 ± 8 years; mean aortic valve area, 0.67 ± 0.15 cm(2) ). Aortic arch plaques were assessed using TEE, and complex arch plaques were defined as large plaques (≥4 mm), ulcerated plaques, or mobile plaques. RESULTS The prevalence of aortic arch plaques (87% vs 70%; P = 0.03) and complex arch plaques (48% vs 20%; P < 0.001) was significantly greater in AS patients with CAD than in those without CAD. After adjustment for traditional atherosclerotic risk factors, we found that concomitant CAD was independently associated with the presence of complex arch plaques (odds ratio: 2.86, 95% confidence interval: 1.23-6.68, P = 0.01). CONCLUSIONS In patients with severe AS, concomitant CAD is associated with severe atherosclerotic burden in the aortic arch. This observation suggests that AS patients with concomitant CAD are at a higher risk for stroke, and that careful evaluation of complex arch plaques by TEE is needed for the risk stratification of stroke in these patients.
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Affiliation(s)
- Suwako Fujita
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Yunoki K, Naruko T, Inoue T, Sugioka K, Inaba M, Iwasa Y, Komatsu R, Itoh A, Haze K, Yoshiyama M, Becker AE, Ueda M. Relationship of thrombus characteristics to the incidence of angiographically visible distal embolization in patients with ST-segment elevation myocardial infarction treated with thrombus aspiration. JACC Cardiovasc Interv 2013; 6:377-85. [PMID: 23523458 DOI: 10.1016/j.jcin.2012.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 11/14/2012] [Accepted: 11/21/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study sought to investigate the association between pathological characteristics of aspirated intracoronary thrombi and the incidence of angiographically visible distal embolization (AVDE) during primary percutaneous coronary intervention (p-PCI) in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombus aspiration. BACKGROUND AVDE of atherosclerotic and thrombotic material has been shown to impair myocardial perfusion and contribute to poor clinical outcome in patients with STEMI. Recent studies have shown that thrombus composition and size are associated with the incidence of AVDE. METHODS Aspirated thrombi from 164 STEMI patients within 12 h of symptom onset were investigated immunohistochemically using antibodies against platelets, erythrocytes, and inflammatory cells. RESULTS The angiographic results showed that AVDE during p-PCI occurred in 22 (13.4%) patients. Pathological analysis revealed that thrombi from patients with AVDE had a greater erythrocyte-positive area (60 ± 15% vs. 43 ± 21%, p < 0.0005) and more myeloperoxidase-positive cells (943 ± 324 cells/mm(2) vs. 592 ± 419 cells/mm(2), p < 0.0005) than those from patients without AVDE. Thrombus size, quantified as the thrombus surface area, was positively correlated with the erythrocyte component (r = 0.362, p < 0.0001). Moreover, multivariate logistic analysis demonstrated that erythrocyte-positive area in the thrombi, glucose levels on admission, larger vessel diameter (≥ 3.5 mm), and pre-balloon dilation were independent predictors of the incidence of AVDE. CONCLUSIONS This study demonstrated that the erythrocyte-rich component of aspirated thrombi may be associated with the incidence of AVDE during p-PCI in patients with STEMI.
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Affiliation(s)
- Kei Yunoki
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
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50
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Yunoki K, Naruko T, Sugioka K, Inaba M, Itoh A, Haze K, Yoshiyama M, Ueda M. Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction. J Atheroscler Thromb 2013; 20:524-37. [DOI: 10.5551/jat.17608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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