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Takaseya T, Itaya N, Sasaki KI, Sasaki M, Yokomizo M, Honda A, Oshita K, Azuma J, Fukumoto Y, Tayama E. Cusp overlap technique decreases paravalvular leakage in self-expandable transcatheter aortic valve replacement. Heart Vessels 2024; 39:48-56. [PMID: 37606754 DOI: 10.1007/s00380-023-02307-z] [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: 03/20/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage.
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Affiliation(s)
- Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan.
| | - Naoki Itaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Masahiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Michiko Yokomizo
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Kensuke Oshita
- Department of Anesthesiology, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Junpei Azuma
- Division of Radiology, Kurume University Hospital, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume-Shi, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume-Shi, Fukuoka, 830-0011, Japan
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Rawish E, Macherey S, Jurczyk D, Pätz T, Jose J, Stiermaier T, Eitel I, Frerker C, Schmidt T. Reduction of permanent pacemaker implantation by using the cusp overlap technique in transcatheter aortic valve replacement: a meta-analysis. Clin Res Cardiol 2023. [PMID: 36656375 DOI: 10.1007/s00392-022-02150-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The need for permanent pacemaker (PPM) implantation is a common complication after transcatheter aortic valve replacement (TAVR). Deep implantation position is a risk factor for PPM implantation. Thus, in the field of self-expandable (SE) transcatheter heart valves (THV) cusp overlap projection (COP) technique was implemented to reduce parallax, allowing a more precise guidance of implantation depth. AIMS This meta-analysis aims to report the outcome of patients undergoing TAVR with SE THV using COP versus conventional implantation technique (CIT). METHODS Systematical search in MEDLINE and EMBASE yielded five observational controlled studies comparing both implantation techniques for the SE Evolut prosthesis (Medtronic Intern. Ltd., CA, USA) and fulfilling the inclusion criteria for meta-analysis. RESULTS Totally, 1227 patients were included, comprising 641 who underwent COP and 586 CIT TAVR. Incidence of post-procedural need for PPM implantation was significantly lower in COP group (9.8% vs 20.6%; OR = 0.43; p < 0.00001). This was accompanied by significantly higher implantation position in COP group (mean difference distance from distal end of the intraventricular portion of the THV to the non-coronary cusp (NCC): - 1.03 mm; p = 0.00001). Incidence of new-onset left bundle branch block did not differ. Regarding procedural and 30-day mortality, technical success, post-procedural aortic regurgitation, and rates of multiple device implantation, no difference between COP and CIT was found. CONCLUSION COP is an effective and safe implantation technique to reduce the need for a permanent pacemaker implantation during TAVR with SE Evolut prosthesis.
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Sajima T, Onimaru T, Sawamura S. Temporary worsening of mitral regurgitation due to conduction disturbance after transcatheter aortic valve implantation. JA Clin Rep 2021; 7:87. [PMID: 34921670 PMCID: PMC8684564 DOI: 10.1186/s40981-021-00491-3] [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: 08/29/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Mitral regurgitation after transcatheter aortic valve implantation (TAVI) can be caused by various etiologies. Case presentation An 81-year-old woman with mild mitral regurgitation and complete right bundle branch block was scheduled to undergo TAVI under general anesthesia. After the deployment of the prosthetic valve, electrocardiography depicted a wide QRS wave and bradycardia, suggestive of complete atrioventricular block. Although there was no lesion indicative of tissue injury to the valve itself, worsening of mitral regurgitation was identified on transesophageal echocardiography. The hemodynamic condition was stable, and no additional procedure was performed. Electrocardiography depicted a return to a narrow QRS wave 3 days after surgery, and the mitral regurgitation appeared comparable to the preoperative grade. We assumed that the worsening of mitral regurgitation was caused by dyssynchrony in the left ventricle due to the conduction disorder. Conclusions Mitral regurgitation after TAVI needs observation, including the determination of the etiology and treatment principle.
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Affiliation(s)
- Takeyuki Sajima
- Department of Anesthesia, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Taichi Onimaru
- Department of Anesthesia, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Shigehito Sawamura
- Department of Anesthesia, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Tsuda M, Egami Y, Matsuhiro Y, Nakamura H, Yasumoto K, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Impact of sigmoid septum on periprocedural outcomes following transcatheter aortic valve implantation using current-generation valves. Int J Cardiovasc Imaging 2021; 38:171-180. [PMID: 34843040 DOI: 10.1007/s10554-021-02479-7] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/20/2021] [Indexed: 12/19/2022]
Abstract
The role of sigmoid septum (SS) observed using preprocedural transthoracic echocardiography (TTE) in patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. This study aimed to compare clinical outcomes of TAVI using the current-generation transcatheter heart valves in patients with and without SS. We divided 140 consecutive patients, excluding four patients who underwent pacemaker implantation before TAVI, into two groups (those with and without SS) and compared the periprocedural outcomes, including new pacemaker implantation, within 30 days post-TAVI. Thirty-five patients (25%; 32 female patients) had SS before TAVI. The body surface area and aortic annulus area measured using computed tomography were significantly smaller in patients with SS than in those without SS (1.40 m2 vs. 1.48 m2, P = 0.03; and 372 mm2 vs. 409 mm2, P < 0.01; respectively). Device success was achieved in all patients with SS. Postprocedural TTE on 30 days post-TAVI showed no significant differences in the valvular hemodynamics between patients with and without SS. No severe prosthesis-patient mismatch was noted on TTE, although the transcatheter heart valve size tended to be smaller in patients with SS. Within 30 days of the TAVI, three (8.6%) and eight (7.6%) patients with and without SS, respectively, had new pacemaker implantation (P = 0.86). The presence of SS was not associated with periprocedural outcomes following TAVI in patients without pre-existing pacemakers. No specific assessment or treatment strategy is required for the TAVI in patients with SS using the current-generation devices.
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Affiliation(s)
- Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, 591-8025, Japan
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Nakai T, Mano H, Ikeya Y, Aizawa Y, Kurokawa S, Ohkubo K, Nagashima K, Watanabe I, Okumura Y. Narrower QRS may be enough to respond to cardiac resynchronization therapy in lightweight patients. Heart Vessels 2019; 35:835-841. [PMID: 31776736 PMCID: PMC7198641 DOI: 10.1007/s00380-019-01541-8] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/22/2019] [Indexed: 01/14/2023]
Abstract
A prolonged QRS duration (QRSd) is promising for a response to cardiac resynchronization therapy (CRT). The variation in human body sizes may affect the QRSd. We hypothesized that conduction disturbances may exist in Japanese even with a narrow (< 130 ms)-QRS complex; such patients could be CRT candidates. We investigated the relationships between QRSd and sex and body size in Japanese. We retrospectively analyzed the values of 338 patients without heart failure (HF) (controls) and 199 CRT patients: 12-lead electrocardiographically determined QRSd, left ventricular diastolic and systolic diameters (LVDd and LVDs), body surface area (BSA), body mass index (BMI), and LVEF. We investigated the relationships between the QRSd and BSA, BMI, and LVD. The men's and women's BSA values were 1.74 m2 and 1.48 m2 in the controls (p < 0.0001), and 1.70 m2 and 1.41 m2 in the CRT patients (p < 0.0001). The men's and women's QRSd values were 96.1 ms and 87.4 ms in the controls (p < 0.0001), and 147.8 ms and 143.9 ms in the CRT group (p = 0.4633). In the controls, all body size and LVD variables were positively associated with QRSd. The CRT response rate did not differ significantly among narrow-, mid-, and wide-QRS groups (83.6%, 91.3%, 92.4%). An analysis of the ROC curve provided a QRS cutoff value of 114 ms for CRT responder. The QRSd appears to depend somewhat on body size in patients without HF. The CRT response rate was better than reported values even in patients with a narrow QRSd (< 130 ms). When patients are considered for CRT, a QRSd > 130 ms may not be necessary, and the current JCS guidelines appear to be appropriate.
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Affiliation(s)
- Toshiko Nakai
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Hiroaki Mano
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yukitoshi Ikeya
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yoshihiro Aizawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Sayaka Kurokawa
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kimie Ohkubo
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ichiro Watanabe
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Yamashita Y, Sonoda H, Ushijima T, Shiose A. Acute torrential mitral regurgitation during transcatheter aortic valve replacement: a case report. Surg Case Rep 2018; 4:35. [PMID: 29671237 PMCID: PMC5906411 DOI: 10.1186/s40792-018-0446-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/07/2018] [Accepted: 04/11/2018] [Indexed: 12/02/2022] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to aortic valve replacement. However, critical cardiovascular collapse can occur during the procedure for various reasons. Case presentation A 90-year-old man with severe aortic stenosis and left circumflex artery stenosis developed acute torrential mitral regurgitation (MR) during TAVR. The valve deployment process induced left ventricular dyssynchrony due to left bundle-branch block and myocardial ischemia in the left circumflex artery region with torrential MR. Transesophageal echocardiography clearly demonstrated the mechanisms of MR, which was successfully bailed out by left ventricular pacing and intra-aortic balloon pumping. Conclusions MR can be seriously exaggerated by various and complicated mechanisms during TAVR and should be rapidly assessed and appropriately managed depending on its mechanisms. Electronic supplementary material The online version of this article (10.1186/s40792-018-0446-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshiyuki Yamashita
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Gao N, Bai R. Clinical characteristics of conduction disturbance in patients with Behcet's disease. Clin Rheumatol 2018; 37:1921-5. [PMID: 29177984 DOI: 10.1007/s10067-017-3920-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
To summarized clinical features of Behcet's patients with conduction disturbances and explore the underlying risk factors. A retrospective case-control study was conducted in Anzhen Hospital, Capital Medical University. Demographic data, clinical features, laboratory results, treatments, and fatality rate during hospital stay were analyzed. We found 23.1% of Behcet's disease had conduction disturbances and 84.0% had aortic valvular insufficiency. The male percentage of the Behcet's disease patients with conduction disturbances was significantly higher than controls (88.9 vs. 61.7%, P = 0.03). The echocardiography showed left ventricular end-diastolic diameter [64.00 (18) vs. 48.00 (15) mm, P = 0.000]; left ventricular end-contraction diameter [47.50 (11) vs. 30 (13) mm, P = 0.000]; left atrial diameter [47 (17) vs. 34 (14) mm, P = 0.001]; and left ventricular ejection fraction [60 (10) vs. 63 (13) mm, P = 0.023] were significantly different between two groups. Aortic valvular insufficiency was an independent risk factor for Behcet's disease with conduction disturbances (OR = 17.830; 95% CI 2.106, 150.981; P = 0.008). Conduction disturbance in Behcet's disease deserved attention. The diagnosis of BD and evaluation of conduction disturbance should be kept in mind when accepting patients with valvular regurgitation.
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Hara H, Niwano S, Ito H, Karakawa M, Ako J. Evaluation of R-wave offset in the left chest leads for estimating the left ventricular activation delay: An evaluation based on coronary sinus electrograms and the 12-lead electrocardiogram. J Electrocardiol 2016; 49:148-53. [PMID: 26763306 DOI: 10.1016/j.jelectrocard.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 06/11/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The QRS duration does not always reflect the left ventricular (LV) activation delay in patients with ventricular conduction disturbances. The R-wave offset in left chest leads may more closely reflect the LV activation delay than the QRS offset. METHODS We evaluated 138 cases with left bundle branch block (LBBB, n=11), right BBB (RBBB, n=38), non-specific intraventricular conduction disturbance (n=11), narrow QRS (<120ms, n=56) and right ventricular pacing (n=22). Cases with right axis deviation (120 to 270 degrees) were excluded. The intervals from the QRS onset to the V-waves in coronary sinus bipolar electrograms (QCS) were measured, and the longest interval was defined as the QCSmax. In the 12-lead electrocardiogram, the interval from the QRS onset to the R-wave offset (QR) was measured and then averaged in leads I-aVL, II-III-aVF, V1-V2, V3-V4 and V5-V6. RESULTS Significant correlations (p<0.05) were found between QCSmax and QR in I-aVL (r=0.83), II-III-aVF (r=0.51) and V5-V6 (r=0.86) in cases with a normal axis (0 to 90 degrees, n=64); and I-aVL (r=0.90), II-III-aVF (r=0.31) and V5-V6 (r=0.69) in cases with left axis deviation (-45 to -89 degrees, n=52). Overall, the QRS duration was also correlated with QCSmax (r=0.72, p<0.001); however, this correlation was weaker than the correlation between QCSmax and QR in I-aVL (r=0.89, p<0.001) due to disparities in RBBB (p<0.001). CONCLUSIONS The interval from the QRS onset to R-wave offset in the left chest leads reflects the degree of LV activation delay regardless of differences in QRS duration and morphology.
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Affiliation(s)
- Hideyuki Hara
- Cardiology, Numazu City Hospital, Shizuoka, Japan; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiroshi Ito
- Cardiology, Numazu City Hospital, Shizuoka, Japan
| | | | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Ternacle J, Boiron P, Gallet R, Champagne S, Krapf L, Doan HL, Randé JLD, Teiger E, Lim P. Contribution of ultrasound contrast in predicting conduction disturbances during percutaneous alcohol septal ablation. Int J Cardiol 2015; 187:436-7. [PMID: 25841143 DOI: 10.1016/j.ijcard.2015.03.395] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Julien Ternacle
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France.
| | - Philippe Boiron
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Romain Gallet
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Stéphane Champagne
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Laura Krapf
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Huy-Long Doan
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Jean-Luc Dubois Randé
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Emmanuel Teiger
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
| | - Pascal Lim
- Henri Mondor University Hospital, Cardiovascular department and INSERM U955, Creteil, France
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Tsukada H, Fujii H, Aihara K, Tsuda I. Computational model of visual hallucination in dementia with Lewy bodies. Neural Netw 2014; 62:73-82. [PMID: 25282547 DOI: 10.1016/j.neunet.2014.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/31/2014] [Revised: 07/29/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
Patients with dementia with Lewy bodies (DLB) frequently experience visual hallucination (VH), which has been aptly described as people seeing things that are not there. The distinctive character of VH in DLB necessitates a new theory of visual cognition. We have conducted a series of studies with the aim to understand the mechanism of this dysfunction of the cognitive system. We have proposed that if we view the disease from the internal mechanism of neurocognitive processes, and if also take into consideration recent experimental data on conduction abnormality, at least some of the symptoms can be understood within the framework of network (or disconnection) syndromes. This paper describes the problem from a computational aspect and tries to determine whether conduction disturbances in a computational model can in fact produce a "computational" hallucination under appropriate assumptions.
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Affiliation(s)
- Hiromichi Tsukada
- Research Institute for Electronic Science, Hokkaido University, Sapporo 060-0812, Japan.
| | - Hiroshi Fujii
- Department of Intelligent Systems, Kyoto Sangyo University, Kyoto 603-8555, Japan
| | - Kazuyuki Aihara
- Institute of Industrial Science, The University of Tokyo, Tokyo 153-8505, Japan
| | - Ichiro Tsuda
- Research Institute for Electronic Science, Hokkaido University, Sapporo 060-0812, Japan; Research Center for Integrative Mathematics (RCIM), Hokkaido University, Sapporo 060-0812, Japan
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Sano M, Satoh H, Suwa K, Nobuhara M, Saitoh T, Saotome M, Urushida T, Katoh H, Shimoyama K, Suzuki D, Ogawa N, Takehara Y, Sakahara H, Hayashi H. Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis. Heart Vessels 2014; 30:779-88. [PMID: 24996373 PMCID: PMC4648959 DOI: 10.1007/s00380-014-0539-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/13/2014] [Indexed: 01/14/2023]
Abstract
Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p < 0.05), bundle branch blocks (57 vs. 6 %, p < 0.05), LV ejection fraction (LVEF) < 50 % (72 vs. 6 %, p < 0.01), LV asynergy (43 vs. 0 %, p < 0.01) and RVEF < 40 % (100 vs. 39 %, p < 0.01). There was no difference in disease duration, disease types, or prevalence of positive autoimmune antibodies or high serum NT-proBNP level (>125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction.
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Affiliation(s)
- Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Mamoru Nobuhara
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Takeji Saitoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hideki Katoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Kumiko Shimoyama
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Suzuki
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyoshi Ogawa
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Harumi Sakahara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideharu Hayashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
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