Heart and Vessels最新文献

We appreciate the comments from Arshad et al. regarding our study on long-term outcomes of alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) in Japan. Addressing concerns about sex-related differences, our analyses revealed no significant differences between men and women in overall mortality (log-rank P = 0.759) or major cardiovascular events (heart failure admission, P = 0.521; pacemaker/implantable cardioverter-defibrillator implantation, P = 0.234; sustained ventricular tachycardia/ventricular fibrillation, P = 0.615; new-onset atrial fibrillation, P = 0.894). The 12% reintervention rate is consistent with reported rates from high-volume centers over 10 years (10-15%), suggesting appropriate patient selection. Primary risk factors for reintervention were thicker interventricular septum and residual mitral regurgitation, as previously reported. Sustained efficacy of ASA is supported by 75% of patients maintaining NYHA class I at 10-year follow-up. These findings, while acknowledging potential differences between Japanese and Western populations, reinforce the long-term safety and effectiveness of ASA for HOCM in Japan.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated significant cardiovascular benefits, including reductions in hospitalizations and mortality among patients with heart failure (HF). However, the mechanisms underlying these benefits, particularly their effects on autonomic nervous system activity, remain incompletely understood. This single-center, prospective observational study included 11 patients with chronic HF who were newly initiated on SGLT2 inhibitors. Sympathetic nerve activity was assessed using 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy, while parasympathetic activity was evaluated via heart rate recovery during cardiopulmonary exercise testing (CPET) conducted at baseline and three months post-treatment initiation. Echocardiographic and laboratory parameters were also analyzed. After three months of treatment, no significant changes were observed in MIBG-derived heart-to-mediastinum (H/M) ratios, washout rates, or heart rate recovery following exercise. Echocardiographic assessment revealed significant improvements in cardiac function. Laboratory findings demonstrated reductions in uric acid and HbA1c levels, improved liver function, and increased erythropoietin levels, while NT-proBNP exhibited a non-significant downward trend. Notably, free carnitine levels decreased significantly, possibly indicating enhanced energy metabolism within the failing myocardium. In patients with chronic HF, SGLT2 inhibitors had no significant effect on autonomic nervous system activity within the first three months of treatment. However, significant improvements in cardiac function and metabolic parameters were observed, supporting their cardioprotective role.

Bepridil are often administered after catheter ablation (CA) in patients with persistent atrial fibrillation (AF); however, it is unclear for how long it should be continued. We administered hybrid therapy consisting of CA and bepridil to 130 patients with persistent AF and left atrial (LA) enlargement (volume index > 48 ml/m²). After 2 months of hybrid therapy, bepridil discontinuation was attempted. All patients underwent echocardiography 6 months after CA. We investigated the relationship between the duration of bepridil administration and the recurrence of AF after bepridil discontinuation. After excluding patients who were unable to maintain sinus rhythm during bepridil administration (n = 18), and those who disagreed to bepridil discontinuation (n = 17), 95 patients were divided into the short-term continuation (bepridil discontinued for < 6 months [median 3 months] after CA [n = 63]), and long-term continuation (bepridil discontinued for > 6 months [median 11.4 months] after CA [n = 32]) groups. During the mean follow-up period of 28 ± 15 months, the groups showed a similar incidence of recurrent AF after bepridil discontinuation. In the long-term continuation group, 13 patients had recurrence, with 8 (62%) cases occurring within 4 months after discontinuation. A multivariate Cox regression analysis revealed that left atrial (LA) reverse remodeling (> 15% decrease in LA volume index at 6 months) was an independent predictor of recurrent AF after CA (p < 0.01). Long-term bepridil administration after CA did not affect the recurrence of AF after discontinuation. The assessment of LA reverse remodeling may be useful for decision-making regarding the discontinuation of antiarrhythmic drugs after CA.

Duchenne muscular dystrophy (DMD) is a progressive myopathy caused by a mutation in the dystrophin gene. Cardiac disease is currently the leading cause of death in patients with DMD; thus, early diagnosis and management of cardiomyopathy are essential. Intra-voxel incoherent motion (IVIM) analysis provides quantitative values from diffusion-weighted imaging (DWI) and may serve as a novel index for evaluating myocardial properties in DMD. We conducted IVIM analysis in patients with DMD and compared their results with those of healthy volunteers to confirm that IVIM analysis can detect myocardial damage more effectively than conventional imaging methods. Patients with DMD who underwent cardiac magnetic resonance IVIM were enrolled. D and F values were measured using DWI of the left ventricle. Six healthy volunteers served as the control group. Twelve male patients with DMD were enrolled (median age, 14 years). Creatinine kinase levels were elevated, brain natriuretic peptide values remained within the normal range, and troponin T levels were only mildly elevated. The D value in patients with DMD was significantly higher than that in healthy volunteers, indicating increased diffusion in the myocardium (2.59 vs. 1.85, p = 0.0057); however, the F value was comparable between the two groups (0.62 vs. 0.61, p = 0.60). The D and F values from IVIM analysis provided a more detailed reflection of myocardial properties. Myocardial diffusion in patients with DMD was elevated compared with that in healthy volunteers.

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.