Heart and Vessels最新文献

Our purpose was to determine the outcome of pregnancy and delivery in patients with coronary artery lesions and myocardial involvement caused by Kawasaki disease after half a century after the first report of this disease. We investigated 67 deliveries in 39 patients with coronary artery lesions caused by Kawasaki disease in our institution between 1991 and 2022. The age at delivery ranged from 18 to 42 years, with a median of 31 years. Twenty-four patients (62%) had stenotic lesions, including 11 with coronary arterial bypass grafting. Low-dose aspirin was given to 26 patients (67%). The deliveries were vaginal in 29 patients (74%), albeit that 16 required assistance by forceps or vacuum extraction under epidural anesthesia. Caesarean sections were performed in 10 patients (26%), 5 (13%) for cardiac disease. There were two patients with worsening ventricular tachycardia and two patients with ST-T depression on Holter monitoring during pregnancy. Three patients experienced an increase in isolated ventricular premature contractions during pregnancy. No severe maternal cardiac events occurred in any patients. There were four preterm babies less than 35 weeks of gestation (6%). The results of the pregnancy and delivery in patients without myocardial ischemia and involvement were favorable, even if they had stenotic lesions. Ventricular tachycardia can worsen during pregnancy in patients with myocardial involvement, and myocardial ischemia may also occur in patients with coronary artery occlusions. Their evaluation during pregnancy by Holter-electrocardiograms is helpful in deciding the management of the pregnancy and mode of delivery.

Myocardial flow reserve (MFR) obtained from ¹³N-ammonia PET is valuable for predicting the prognosis of patients with various heart diseases. The increase ratio (IR), a new parameter in ^99mTc-sestamibi SPECT, is an indicator of the relative increase in blood flow during stress compared to rest, and the concept is similar to that of PET-MFR. We investigated the relationship between IR and PET-MFR as well as their clinical significance. Patients who underwent ¹³N-ammonia PET and ^99mTc-sestamibi SPECT within one year of each other were enrolled and 33 patients (28 males, mean age 65.7 ± 12.9) were analyzed. Using adenosine stress and resting images of ^99mTc-sestamibi SPECT, the stress image count was divided by the resting image count, and IR was calculated. We investigated the correlation between IR and PET-MFR and validated the optimal IR cutoff value for detecting PET-MFR < 1.6 by receiver operating characteristic (ROC) analysis. IR was significantly lower than PET-MFR (mean IR, 1.198; mean PET-MFR, 1.910; p < 0.0001) and positively correlated with PET-MFR (Pearson r = 0.3567; p < 0.01). ROC analysis indicated that the optimal IR cutoff value for detecting PET-MFR < 1.6 was 1.06, yielding an area under the curve (AUC) of 0.683, with 50% sensitivity and 83% specificity. By combining summed stress score with IR, the detectability of PET-MFR < 1.6 improved the AUC of 0.798 with 83% sensitivity and 70% specificity. IR was positively correlated with PET-MFR. This suggests that IR may be useful for detecting patients with a low MFR in facilities that do not perform ¹³N-ammonia PET.

Elevated systolic blood pressure (SBP) increases myocardial oxygen demand, whereas low diastolic blood pressure (DBP) can impair coronary perfusion. The prognostic impact of this high-SBP/low-DBP (HSLD) profile in patients with ST-elevation myocardial infarction (STEMI) remains unknown. We analyzed 696 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) from a prospective 11-center registry in Japan. Patients were categorized based on pre-procedural SBP (≥ 120 mmHg) and DBP (< 70 mmHg) into four groups: high-SBP/low-DBP (HSLD) high-SBP/high-DBP (HSHD), low-SBP/high-DBP (LSHD), and low-SBP/low-DBP (LSLD). The primary endpoint was a 1-year composite of cardiovascular death, non-fatal myocardial infarction, or stroke. Median follow-up was 369 days. The 1-year cumulative incidence of the primary endpoint was 7 (9.5%) in the HSLD group, 19 (4.2%) in the HSHD group, 2 (2.8%) in the LSHD group, and 5 (6.0%) in the LSLD group (log-rank p = 0.007). In multivariable Cox regression, the HSLD was independently associated with the primary endpoint compared to the HSHD group (hazard ratio 3.20, 95% CI 1.04-9.87; p = 0.043). The prognostic value of HSLD was consistent across major subgroups. A pre-procedural blood pressure pattern of SBP ≥ 120 mmHg combined with DBP < 70 mmHg independently predicts a higher risk of adverse cardiovascular events at 1 year in patients with STEMI. This simple measurement at admission identifies a previously unrecognized high-risk phenotype and presents a valuable opportunity for early risk stratification.

Aortic stenosis (AS) is the most prevalent valvular disease in developed nations. Transcatheter Aortic Valve Replacement (TAVR) offers a minimally invasive alternative to Surgical Aortic Valve Replacement (SAVR), particularly for high-risk patients. However, TAVR adoption and outcomes in Japan remain understudied due to limited national database analyses and differences in patient demographics compared to major international trials. We conducted a retrospective cohort study of aortic valve replacement (AVR) procedures from 2014 to 2021 using the National Healthcare Reimbursement database. In total, 103,076 cases were analyzed, with 33,881 undergoing TAVR and 31,337 undergoing SAVR for aortic stenosis. TAVR patients were older (median age 85 vs. 76 years, p < 0.0001) and more often female (66.7% vs. 51.4%, p < 0.0001). TAVR was associated with lower in-hospital mortality (0.88% vs. 2.4%, p < 0.0001), shorter hospital stays (14 vs. 24 days, p < 0.0001), but significantly higher medical costs (¥5,303,722 vs. ¥3,945,622, p < 0.0001). Among patients younger than 75 years, no significant difference in mortality was observed. In this nationwide administrative database, TAVR was associated with lower in-hospital mortality and shorter hospital stays compared to SAVR, though at a higher cost. While patient backgrounds and clinical risks could not be fully adjusted due to data limitations, the observed differences in in-hospital outcomes between TAVR and SAVR reflect real-world practice patterns. These findings should be interpreted as descriptive, not causal. The absence of a mortality difference in patients under 75 years highlights the need for further evaluation of TAVR's long-term effectiveness and cost-efficiency in younger populations.

Reduced exercise capacity is a hallmark of heart failure with preserved ejection fraction (HFpEF), and this limitation is particularly pronounced in older patients with coexisting type 2 diabetes mellitus (T2DM), a high-risk population characterized by poor prognosis. Although previous studies have demonstrated that exercise training (ET) can improve exercise capacity in patients with HFpEF, its efficacy in older patients with coexisting HFpEF and T2DM remains unclear. Therefore, we evaluated the effects of ET on peak oxygen uptake (peakVO₂) and 6-min walk distance (6MWD) in older patients with HFpEF and investigated whether these effects differ based on T2DM status. A total of 99 stable outpatients with HFpEF aged 65 to 80 years were enrolled. Participants were classified into four groups based on T2DM and ET status: T2DM-ET (n = 25), non-T2DM-ET (n = 24), T2DM-usual-care (UC; n = 26), and non-T2DM-UC (n = 24). PeakVO₂ and hemodynamic responses during exercise were assessed using cardiopulmonary exercise testing and impedance cardiography. Additionally, walking distance, cadence, step length, and metabolic cost were assessed during the 6-min walk test. The interaction between T2DM and ET on changes in these parameters was analyzed using multivariable-adjusted linear regression. ET significantly improved peakVO₂ after 5 months; however, the magnitude of improvement was attenuated in the T2DM group (0.5 mL/kg/min) compared with that in the non-T2DM group (1.9 mL/kg/min; p < 0.001). This difference was primarily attributable to a blunted increase in arteriovenous oxygen difference, which increased by only 0.2 mL/100 mL in the T2DM group vs. 0.4 mL/100 mL in the non-T2DM group (p < 0.001). In contrast, improvements in 6MWD were similar between the groups (29 vs. 31 m; p = 0.651). Step length remained unchanged, whereas cadence increased in the T2DM and non-T2DM groups (11 vs. 8 steps/min, respectively), accompanied by a reduction in metabolic cost (- 0.06 vs. - 0.04 mL/kg/m), indicating enhanced walking efficiency regardless of T2DM status. Although T2DM attenuated improvements in peakVO₂, the walking efficiency and functional capacity improved with ET regardless of T2DM status. These findings highlight the potential value of ET in older patients with HFpEF, irrespective of T2DM status. This trial was registered with the University Hospital Medical Information Network, Japan (registration number: UMIN000045474; registration date: September 13th, 2021).

Objective: This study aimed to explore the short-term predictive value of the estimated glucose disposal rate (eGDR) for rehospitalization or death in elderly patients with acute decompensated heart failure (ADHF).

Methods: 117 elderly patients with ADHF admitted to our hospital from January 2020 to January 2022 were recruited and divided into control (80 cases) and event (37 cases) groups based on whether they were rehospitalized or died within 90 days following discharge. Basic information, clinical characteristics, and laboratory test results of them were collected, and the eGDR was calculated. Multivariate logistic regression analysis identified the independent factors associated with the short-term prognosis, and receiver operating characteristic (ROC) curves assessed the predictive value of eGDR.

Results: The event group had significantly higher rates of comorbid diabetes (DM), hypertension, Class IV heart failure, and cardiogenic shock, as well as a larger waist circumference, higher peak troponin I during hospitalization, greater glycated hemoglobin (HbA1c) and fasting blood glucose (FBG), and lower eGDR values compared to the control group (P < 0.05). Multivariate logistic regression showed that comorbid hypertension, DM, Class IV cardiac function, cardiogenic shock, FBG, HbA1c, and eGDR were independent factors associated with poor short-term prognosis in elderly patients with ADHF (P < 0.05). ROC curve analysis showed that the area under the curve for eGDR in predicting poor short-term prognosis was 0.84 (P = 0.04), with an optimal cutoff value of 5.31, a sensitivity of 83.8%, and a specificity of 70.1%. Patients with eGDR < 5.31 had a significantly higher incidence of rehospitalization or death within 90 days compared to those with higher eGDR (52.0% vs. 16.5%, P < 0.001).

Conclusion: eGDR is an independent predictor of poor short-term prognosis in elderly patients with ADHF: a low eGDR was associated with a higher risk of rehospitalization and death within 90 days.

Background: Anthracyclines are known to exhibit dose-dependent cardiotoxicity, leading to cancer therapy-related cardiac dysfunction (CTRCD). The significance of routine global longitudinal strain (GLS) measurements remains uncertain in patients at low or moderate risk for cardiotoxicity. This study aimed to investigate the appropriateness of the contemporary CTRCD surveillance strategy in this population.

Methods: We prospectively enrolled women with breast cancer undergoing anthracycline-based chemotherapy at Keio University Hospital from April 2018 to November 2023. Cardiotoxicity risk was assessed using the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) tool. GLS was measured by echocardiography at baseline (T0), completion of anthracyclines (T1), and 6 months (T2) and 12 months (T3) after initiating chemotherapy. CTRCD was defined as a > 15% relative decline in GLS from baseline. Repeated GLS measurements were analyzed using linear mixed models with post-hoc Tukey testing.

Results: Fifty-eight patients (mean age 53.8 ± 9.3 years) were included, with 53 (91.3%) classified as low or moderate risk. GLS significantly declined at T2 and returned toward baseline at T3. GLS-based CTRCD was observed in 4 (6.9%), 14 (24.1%), and 4 (6.9%) patients at T1, T2, and T3, respectively. The majority of CTRCD cases showed spontaneous recovery by T3. Persistent CTRCD at T3 was limited to a small number of patients and was significantly associated with higher high-sensitivity cardiac troponin T levels at T1 (area under curve = 0.836; 95% CI, 0.674-0.997), with a Youden index-derived cutoff of 0.016 ng/mL by receiver operating characteristic analysis.

Conclusions: In breast cancer patients with low to moderate cardiotoxicity risk, early GLS decline following anthracycline exposure was mostly transient. These findings support current surveillance recommendations and suggest a potential role for troponin in identifying patients at risk for persistent dysfunction.

Vascular calcification represents a significant clinical challenge, leading to cardiovascular disease, though its underlying mechanisms remain incompletely understood. Recent studies indicate that Toll-like receptor 9 (TLR9), a key element of innate immunity, plays a pathogenic role in vascular inflammation and atherogenesis. Therefore, we hypothesized that TLR9 signaling promotes vascular chondrogenesis and calcification. We compared apolipoprotein E-deficient (ApoE^-/-) mice and Tlr9^-/- ApoE^-/- mice after 24 -weeks high-cholesterol diet feeding. There were no differences between the groups in body weight gain, blood pressure, or plasma glucose levels, although total cholesterol levels were significantly lower in the Tlr9^-/- ApoE^-/- mice. The genetic deletion of TLR9 attenuated vascular calcification as determined by von Kossa staining (5.83 ± 1.14% vs. 3.04 ± 0.68%; P < 0.05), alkaline phosphatase (ALP-1) activity (P < 0.05), and chondroid matrix deposition as determined by Alcian blue staining (P < 0.05) in aortic arch compared with control mice. Immunohistostaining revealed that TLR9 deletion also decreased bone morphogenetic protein (BMP)-2 expression in aortic plaques (P < 0.05). In vitro experiments revealed that TLR9 activation by ODN1826, a TLR9 agonist, stimulated BMP-2 expression in murine peritoneal macrophages, but not in Tlr9-deficient macrophages. Although TLR9 agonists had no direct effect on vascular smooth muscle cells (VSMCs), the culture supernatants of macrophages stimulated with TLR9 agonist increased BMP-2 expression in VSMCs. TLR9 signaling promotes vascular chondrogenesis and calcification in ApoE^-/- mice. Our analyses suggest that TLR9 pathway contributes to bone morphogenic activation of macrophages and VSMCs at least partially, participating in the development of vascular calcification.

This study aimed to evaluate the clinical utility of a novel mitral valve repair technique, the Referring to the Anterior, Fixing on the Frontal (RAFF) method, which improves anatomical precision and enhances the reproducibility of loop-type artificial chordae ("neochordae") reconstruction. This retrospective study included 67 individuals who underwent isolated, elective mitral valve repair with neochordae between 2019 and 2024. Participants were divided into the RAFF (n = 36) and non-RAFF (n = 31) groups. In the RAFF technique, chordal length is determined by referencing the anterior leaflet chordae from the ipsilateral papillary muscle, with loop sets anchored to the frontal head of the papillary muscle. Leaflet resection was not performed in any case. Baseline demographics and lesion characteristics were similar between groups. The RAFF group demonstrated significantly less residual mitral regurgitation at the conclusion of surgery (p = 0.014). Use of the RAFF method was significantly associated with suppression of postoperative leaflet billowing and a lower recurrence rate of moderate or greater mitral regurgitation during follow-up. Frontal fixation of posterior leaflet neochordae, a defining feature of the technique, resulted in a significant increase in coaptation length without inducing systolic anterior motion or elevating transvalvular gradients. The method also significantly reduced aortic cross-clamp time without compromising hemodynamic performance. The RAFF technique offers a standardized and anatomically guided approach to neochordae reconstruction. It minimizes inter-surgeon variability and anatomical inconsistencies, and promotes durable mitral competence by optimizing leaflet coaptation without incurring adverse events.