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Examines the effectiveness of dobutamine stress echocardiography (DSE) in predicting reversible left ventricular dysfunction in conjunction with color tissue Doppler imaging (TDI) M-mode. Follow-up regular echocardiography as reference technique to define reversible dysfunction segments; Safety of DSE in the post-myocardial infarction setting.

Background: Tachycardia‐induced cardiomyopathy (TIC) is a reversible cardiomyopathy with ventricular dysfunction caused by tachyarrhythmias. Notably, atrial fibrillation (AF) is the most common causal arrhythmia leading to TIC. However, the risk factors for the development of TIC due to AF remain unclear. This study aimed to identify the associated factors of TIC due to AF. Methods: Persistent AF patients with heart rate (HR) ≥100 beats per minute who underwent initial catheter ablation were enrolled in this study. TIC was diagnosed as left ventricular ejection fraction (LVEF) < 50% during AF rhythm, which was recovered after the restoration of sinus rhythm. Non‐TIC was defined as LVEF ≥ 50% despite AF rhythm. The patient backgrounds were compared between the TIC group and the non‐TIC group to reveal the contributing factors of TIC. Results: The TIC group comprised 57 patients, while the non‐TIC group consisted of 101 patients. The TIC group was younger than the non‐TIC group (median 64 vs. 70, p = 0.006). Male sex was more frequent in the TIC group than the non‐TIC group (82.5% vs. 58.4%, p = 0.003). HR was higher in the TIC group than in the non‐TIC group (median 130 bpm vs. 111 bpm, p < 0.001). The number of smokers was significantly higher in the TIC group than in the non‐TIC group (p < 0.001). Multivariable analysis demonstrated that higher HR (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.37–2.21; p < 0.001) and current smokers (OR: 5.27; 95% CI: 1.60–17.4; p = 0.006) were the independent factors leading to TIC. Conclusion: Higher HR and current smokers were independent risk factors for the development of TIC due to AF. [ABSTRACT FROM AUTHOR]

Introduction: Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF). Methods: We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow‐up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one‐grade improvement of TR) and non‐improvement of TR: IM group and Non‐IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all‐cause death) more than 12 months after the RFCA. Results: IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event‐free survival than Non‐IM group. Conclusions: Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes. [ABSTRACT FROM AUTHOR]

Drug treatments of heart failure with preserved ejection fraction (HFpEF) have a little clinical benefit, but cardiovascular polypharmacy (CP) trend is observed in elderly HFpEF. We investigated the impact of CP on octogenarian with HFpEF. We examined 783 consecutive octogenarians (≥80 years) enrolled in the PURSUIT-HFpEF registry. We defined medications for hypertension, dyslipidemia, heart failure (HF), coronary artery disease, stroke, peripheral artery disease, and atrial fibrillation as cardiovascular medications (CM). In this study, we defined CP as ≥5 CM. We investigated whether CP was correlated with the composite end point (CE) of all-cause mortality and HF rehospitalization. The proportion with CP was 51.9% (n = 406). Background characteristics correlated with CP were frailty, history of coronary artery disease, atrial fibrillation and left atrial dimension. Multivariable Cox proportional hazards analysis showed CP was significantly and independently correlated with CE (hazard ratio (HR): 1.31; 95% confidence Interval (CI): 1.01–1.70) in addition to age, clinical frailty scale, history of HF admission and N-terminal pro brain natriuretic peptide. Kaplan-Meier curve analysis showed that, compared with the non-CP group, the CP group had significantly higher risk of CE and HF (HR: 1.27; 95%CI: 1.04–1.56; P = 0.02 and HR: 1.46; 95%CI: 1.13–1.88; P < 0.01, respectively), but not any-cause death. In addition, diuretics were correlated with CE (HR: 1.61; 95%CI: 1.17–2.22; P < 0.01), but antithrombotic drugs and HFpEF medications were not. CP at discharge is a prognostic factor driven by HF rehospitalization in octogenarians with HFpEF. In these patients, diuretics may be correlated with the prognosis. • Polypharmacy of cardiovascular medicines is a worse factor for octogenarians.HFpEF. • Frailty, coronary artery disease were correlated with polypharmacy. • Atrial fibrillation and left atrial dimension were also correlated with polypharmacy. • Reducing diuretics may be useful to alleviate polypharmacy in octogenarians. [ABSTRACT FROM AUTHOR]

Little has been reported on the impact of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in patients with left atrial enlargement (LAE). A total of 706 patients underwent an initial RFCA for AF between September 2014 and September 2019 in our hospital. These patients were categorized into two groups according to the pre-procedural left atrial diameter (LAD) measured by transthoracic echocardiography (TTE): LAE group with LAD ≥ 50 mm and non-LAE group with LAD < 50 mm. We compared the patient characteristics, ablation procedures, and late recurrence of AF (LRAF, defined as a recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) between the two groups. In addition, we performed follow-up TTE at 12 months after RFCA and investigated the factors associated with left atrium (LA) reverse remodeling in each group. LAE group and non-LAE group consisted of 155 and 551 patients, respectively. There were no significant differences in ablation procedures, procedure-related complications, and the incidence of LRAF between the two groups. Furthermore, non-PAF was identified as an independent predictor of LA reverse remodeling in LAE group by multiple regression analysis (P = 0.020). RFCA might be an effective and safe procedure even in patients with LAD ≥ 50 mm, using the contemporary 3D-guided mapping and ablation technologies. Moreover, RFCA can lead to LA reverse remodeling in 1 year if they have non-PAF before ablation. [ABSTRACT FROM AUTHOR]

At present, it remains unclear whether the effect on cryoinjury can be strongly exerted by contact of the balloon with the pulmonary vein (PV) ostium. The present study included 204 paroxysmal atrial fibrillation (PAF) patients who underwent an initial pulmonary vein isolation (PVI) using a cryoballoon from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The total balloon contact angle was measured from the equator line (sum of the angles of the upper side and bottom side in all PVs) under fluoroscopic imaging. The patients were stratified into three tertile groups according to the total balloon contact angle. We evaluated the relationship between the total balloon contact angle and clinical outcomes, including the value of acute myocardial injury marker (high-sensitive cardiac troponin I [hs-TnI]), arrhythmia recurrence, and PV reconnections in the repeated ablation. The total balloon contact angle was significantly associated with the hs-TnI value among the tertile groups (p < 0.001) and a multiple regression analysis showed that the total balloon contact angle significantly correlated with the hs-TnI value (standardized beta-coefficient = 0.572, p < 0.001). The balloon contact angle in PVs with PV reconnections was significantly lower than in those without (p = 0.044), while no significant differences in the recurrence of atrial fibrillation among the tertile groups were observed in the enrolled patients. The total balloon contact angle was significantly associated with the acute myocardial injury marker, hs-TnI. The total balloon contact angle was significantly associated with PV reconnections after cryoballoon ablation in patients who underwent a repeat ablation. [ABSTRACT FROM AUTHOR]

Background: Although much has been discussed about the early recurrence of atrial fibrillation (ERAF) after cryoballoon ablation (CBA), the clinical impact of very early recurrence of atrial fibrillation (VERAF) after CBA remains unclear. This study aimed to investigate the impact of VERAF after CBA. Methods: We enrolled 236 consecutive patients who underwent an initial CBA for paroxysmal atrial fibrillation between February 2017 and December 2020 in our hospital. These patients were categorized into three groups: VERAF group who experienced an initial recurrence of atrial tachyarrhythmia within 48 h after CBA, late‐ERAF (LERAF) group who experienced an initial recurrence of atrial tachyarrhythmia between 48 h and 3 months after CBA, and non‐ERAF (NERAF) group who did not experience a recurrence of atrial tachyarrhythmia within 3 months after CBA. We investigated the late recurrence of AF (LRAF, defined as recurrence of atrial tachyarrhythmia more than 3 months after CBA), and the incidence of non‐pulmonary vein (PV) triggers in the patients who experienced a repeat ablation procedure due to LRAF. Results: VERAF group had a higher incidence of freedom from LRAF than LERAF group (p = 0.032) and a lower incidence of freedom from LRAF than NERAF group (p = 0.002). Moreover, VERAF group had the highest incidence of non‐PV triggers at repeat ablation procedure among the three groups (p = 0.003). Conclusions: While ERAF was a predictor of LRAF, VERAF was less related to LRAF among the patients with ERAF after CBA. Furthermore, VERAF might be associated with non‐PV triggers. [ABSTRACT FROM AUTHOR]

Blood urea nitrogen (BUN) reflects decreased glomerular filtration rate (GFR). The effect of BUN on clinical outcomes, excluding the impact of GFR, in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. We enrolled HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure (HF) from PURSUIT-HFpEF registry which was prospective, multicenter and observational study. For excluding the effect of renal function on BUN value, propensity score-matching was performed using the variables which were associated with GFR. The incidence of composite of all-cause death and HF readmission among the patients stratified by BUN and the association between BUN and echocardiographic parameters in HFpEF patients were evaluated. We finally analyzed 1029 patients. In the present study, BUN cut-off value was defined as 24.4 mg/dL, which was the median value in overall population. The high and low BUN groups consisted of 193 patients after 1:1 propensity score-matching, respectively. The median follow-up duration was 401 days and the composite endpoint occurred in 129 patients (33.4%). Kaplan-Meier analysis showed the high BUN group had a significantly greater risk of the composite endpoint than the low group in the propensity score-matched pairs (p = 0.032). BUN value significantly correlated with left atrial volume index by multiple regression analysis using echocardiographic parameters (standardized beta-coefficient = 0.139, p = 0.043). BUN was a useful marker for the composite of all-cause death and HF readmission, regardless of the baseline renal function and correlated with left atrial function in HFpEF patients. UMIN000021831 < https://uplaod.umin.ac.jp/cgi-open-bin/ctr%5fe/ctr%5fview.cgi?recptno=R00002441 4>; PURSUIT-HFpEF. • High BUN was associated with the composite of all-cause death and HF readmission in HFpEF. • BUN affects clinical outcomes, regardless of renal function. • BUN correlated with left atrial dysfunction in HFpEF. [ABSTRACT FROM AUTHOR]

Introduction: Local impedance (LI) drop during radiofrequency (RF) application is monitored to assess the lesion formation. Recently, a novel ablation catheter has been introduced to clinical setting, which is capable of monitoring LI and catheter contact parameters including contact force (CF) and contact angle (CA). This study aimed to clarify the correlation between LI drop and catheter contact parameters. Methods and results: This prospective study included 15 paroxysmal atrial fibrillation (AF) patients who underwent initial pulmonary vein isolation (PVI). First‐pass encircling point‐by‐point PV ablation was performed by using a 4.5‐mm irrigated ablation catheter, with monitoring LI, CF, and CA. RF energy was applied for 30 s at each site with 30 W. Stable ablation points were analyzed to examine the correlation between LI drop and catheter contact parameters. Among 903 ablation points, 499 stable ablation points (55.2%) were analyzed. CA showed good correlation with LI drop (ρ = 0.418, p <.001). Maximum CF, minimum CF, average CF, and initial CF all showed weak correlation with LI drop (ρ = 0.201, p <.001; ρ = 0.224, p <.001; ρ = 0.258, p <.001; and ρ = 0.212, p <.001, respectively). Multivariate analysis demonstrated that CA was an independent factor of LI drop among the catheter contact parameters (β = 0.139, 95% CI = 0.111–0.167, p <.001). The LI drop in the blocked segments was significantly higher than that in the electrical conduction gap segments (27.3 ± 9.8 vs. 19.6 ± 6.4 Ω, p <.001) Conclusion: In clinical PVI use, both CF and CA were correlated with LI drop. More parallel CA could induce higher LI drop, which may lead to effective lesion formation. [ABSTRACT FROM AUTHOR]

Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) causes myocardial injury and induces high-sensitive cardiac troponin I (hs-TnI) release into the systemic circulation. Several factors are considered to be associated with myocardial injury after ablation, but few studies showed the relationship between the value of myocardial injury marker after the RFCA and relevant factors. AF patients who underwent primary RFCA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The relationship between hs-TnI after the RFCA and PV reconnection (PVR) was evaluated. The impact of relevant factors, including baseline patient characteristics, detail of procedure on myocardial injury was investigated. This study included 407 patients (median age was 71 years, the ratio of female was 30.7%). Late arrhythmia recurrence was observed in 111 patients (27.3%) and 66 patients were underwent repeated ablation. PVR was observed in 33 patients (50.0%). The hs-TnI level was significantly lower in the patients with PVR than those without PVR (1.150 ng/ml vs 1.921 ng/ml, p = 0.040). Paroxysmal AF and age were significantly associated with acute myocardial injury after the RFCA (standardized beta coefficient = 0.206 and p < 0.001, standardized beta coefficient = − 0.114 and p = 0.043, respectively). The hs-TnI after RFCA was significantly higher in PAF patients than PerAF (p < 0.001), even if application number and total application time were taken into consideration. Acute myocardial injury after RFCA was significantly lower in the patients with PVR than those without PVR. Age and AF type were significantly and strongly associated with acute myocardial injury after the RFCA. [ABSTRACT FROM AUTHOR]

Background: The detailed electrophysiological characteristics of atrial fibrillation (AF) initiating non-pulmonary vein (PV) triggers excluding origins from the superior vena cava (SVC) and left atrial posterior wall (LAPW) (Non-PV-SVC-LAPW triggers) remain unclear. This study aimed to clarify the detailed electrophysiological characteristics of non-PV-SVC-LAPW triggers. Methods: Among 446 AF ablation procedures at 2 institutions, patients with reproducible AF initiating non-PV-SVC-LAPW triggers were retrospectively enrolled. The trigger origin was mapped using the self-reference mapping technique. The following electrophysiological parameters were evaluated: the voltage during sinus rhythm and at the onset of AF at the earliest activation site, coupling interval of the trigger between the prior sinus rhythm and AF trigger, and voltage change ratio defined as the trigger voltage at the onset of AF divided by the sinus voltage. Results: Detailed electrophysiological data were obtained at 28 triggers in 21 patients. The median trigger voltage at the onset of AF was 0.16mV and median trigger coupling interval 182msec. Normal sinus voltages (≧0.5mV) were observed at 16 triggers and low voltages (<0.5mV) at 12 triggers. The voltage change ratio was significantly lower for the normal sinus voltage than low sinus voltage (0.20 vs. 0.60, p = 0.002). The trigger coupling intervals were comparable between the normal sinus voltage and low sinus voltage (170ms vs. 185ms, p = 0.353). Conclusions: The trigger voltage at the onset of AF was low, regardless of whether the sinus voltage of the trigger was preserved or low. [ABSTRACT FROM AUTHOR]

The article describes the case of a 79-year-old man with ischemic heart disease who underwent catheter ablation of persistent atrial tachycardia (AT). The man received a pulmonary vein isolation, left atrial (LA) posterior wall isolation, and lateral mitral isthmus linear ablation of atrial fibrillation and AT. Also discussed are the earliest activation site in the LA and the need of physicians to pay attention when using AT entertainment pacing in macro-reentrant tachycardias.

The article presents a case study of a 72-year-old man with regular narrow QRS tachycardia after pulmonary vein isolation and cavotricuspid isthmus (CTI) ablation. Topics include accidental ventricular premature depolarization timed to the His‐refractory period not reseting the tachycardia; and tachycardia being induced and terminated by atrial burst pacing and atrial extra‐ stimulation.

The article presents a case of a 72-year-old female who was presented for radiofrequency ablation of narrow QRS tachycardia with ventriculoatrial block (VAB) to discuss the mechanism of VAB in tachychardia. Also cited are the use of atrial extra-stimulation to monitor her dual atrioventricular nodal physiology and VAB during atrioventricular nodal reentrant tachycardia (AVNRT).

Abstract: Recent evidence has suggested an association between Chlamydia pneumoniae infection and coronary atherosclerosis. A significant association has also been detected between heat shock protein (HSP) 60 antibody and the severity of coronary atherosclerosis. The aim of this study was to define the relationship between instability of ischemic heart disease (IHD) and serum levels of HSP60 and C. pneumoniae antibodies. Blood samples for the measurement of serum antibody titers were obtained from 1131 patients with ischemic heart disease (65±9 years; male/female, 828/303) and 127 non-IHD controls with normal coronary arteries (64±9 years; male/female, 60/67) on the day of cardiac catheterization. The serum levels of anti-human HSP60 IgG antibody and anti-chlamydial IgM, but not IgG or IgA, antibody were significantly higher in ACS patients than in stable IHD patients or controls. These results suggest that acute C. pneumoniae infection with HSP60-related immunological responses may contribute to the pathophysiology of acute coronary syndromes. [Copyright &y& Elsevier]

The article describes a case of a male patient who was hospitalized due to symptomatic palpitations. Topics mentioned include the mechanism of a narrow QRS tachycardia with different atrial sequence during ventricular pacing, the atrial activation sequences of ventriculoatrial conduction, and the rare existence of atrioventricular nodal reentrant tachycardia with retrograde activation.

Cryoballoon ablation (CBA) and laser balloon ablation (LBA) were developed as alternatives to conventional radiofrequency ablation for paroxysmal atrial fibrillation (PAF). Pathological findings after ablation such as myocardial injury and inflammation are thought to be different between CBA and LBA. However, the different impact of myocardial injury and inflammation after ablation on short- and mid-term outcomes remains unclear. Consecutive PAF patients who underwent CBA and LBA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The difference of the acute myocardial injury marker (hs-TnI), and changes of inflammation markers (C reactive protein; ΔCRP, and white blood cell; ΔWBC) after catheter ablation and the difference of the short-term (within 3 months after ablation) and mid-term (from 3 months to 6 months after ablation) outcomes were evaluated between the two groups. The CBA and LBA groups consisted of 55 and 56 patients, respectively. After propensity score matching, CBA and LBA groups consisted of 37 patients, respectively. Hs-TnI value was significantly higher in CBA than LBA group, while ΔCRP and ΔWBC were significantly higher in LBA than CBA group. In the propensity score-matched pairs, the LBA group had a significantly greater risk of short-term arrhythmia recurrence than the CBA group, whereas no significant difference of mid-term arrhythmia recurrence were found between the two groups. Myocardial injury and inflammation status differ between CBA and LBA groups. LBA group had stronger inflammation after ablation and had a significantly greater risk of short-term arrhythmia recurrence after PVI than CBA group. • Myocardial injury and inflammation in cryo- and laser- balloon ablation. • Short-term and mid-term outcomes between cryo- and laser- balloon ablation. • Impact of pathological changes on outcomes between the different ablation methods. [ABSTRACT FROM AUTHOR]

Although several studies have suggested that catheter ablation (CA) of atrial fibrillation (AF) can improve left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF), the predictor of improvement of LVEF is unclear. A total of 401 patients with persistent AF underwent an initial CA between September 2014 and October 2019 in our hospital. Among them, we analyzed consecutive patients with moderately or severely reduced LVEF (< 50%) measured by transthoracic echocardiography (TTE) within 2 months before CA and underwent follow-up TTE during sinus rhythm at 6 months or more after CA. These patients were categorized into two groups: improve group (I group) with the absolute improvement of LVEF ≥ 10% at follow-up TTE, and non- improve group (NI group) with the absolute improvement of LVEF < 10% at follow-up TTE. We compared patient characteristics, ablation procedures, and clinical outcomes between the two groups. 81 patients were analyzed, and I group consisted of 48 patients (59%). In the univariate analysis, absence of ischemic cardiomyopathy, left ventricular end-diastolic diameter (LVEDD), and absence of recurrence of AF between 3 and 6 months after CA were associated with improvement of LVEF. A receiver operating characteristics analysis determined the suitable cut-off value for LVEDD was 53 mm (sensitivity: 62.2%, specificity: 86.2%, area under curve: 0.762). A multivariate analysis showed that LVEDD < 53 mm was independently associated with improvement of LVEF (odds ratio 2.58, 95% confidence interval 1.29–6.12; P = 0.021). In conclusion, LVEDD < 53 mm might be an independent predictor of improvement of LVEF after CA of persistent AF in HFrEF patients. [ABSTRACT FROM AUTHOR]

Introduction: It has not been clarified how to identify the electrophysiological junction between right atrium (RA) and superior vena cava (SVC). The aim of this study was to identify the electrophysiological RA–SVC junction according to slow conduction or conduction bock and to examine the electrophysiological SVC isolation procedure. Methods: Seventy‐three consecutive atrial fibrillation patients who underwent SVC mapping using a CARTO 3 system were enrolled in this study. Slow conduction or conduction block between the RA and SVC was identified by adjusting the lower threshold criteria of the early meets late function and was described as a white line. The SVC isolation was performed along the white line and with pacing maneuvers to confirm direct SVC capture. Results: Activation mapping (1296 ± 631 points) was obtained in 66 patients (90%) in 4.6 ± 1.8 min. Slow conduction or conduction block was observed in all patients. The threshold for detecting slow conduction or conduction block was 24 ± 8 ms. The location of the electrophysiological RA–SVC junction was higher in the anterior portion (anterior‐septal, anterior, and anterior‐lateral) than in the posterior portion (posterior‐septal, posterior, and posterior‐lateral) (−2.3 ± 6.2 mm vs. 7.1 ± 6.3 mm, p <.001). The SVC isolation at the electrophysiological RA–SVC junction was successful in all patients without any injury to the sinus node function. Asymptomatic phrenic nerve injury was observed in three patients (4.5%). Conclusion: In all patients, the electrophysiological RA–SVC junction determined by slow conduction or conduction block was identified and the electrophysiological SVC isolation was performed successfully and safely. [ABSTRACT FROM AUTHOR]

The method to perform a precise mapping of non-pulmonary vein (PV) triggers has not been fully investigated. The purpose of this study was to assess the efficacy of self-reference mapping for eliminating non-PV triggers in a large series of patients including the long-term outcomes. Among 446 atrial fibrillation (AF) ablation procedures in 431 patients at 2 institutions, we prospectively enrolled patients who had reproducible non-PV triggers. Non-PV triggers from the left atrial posterior wall (LAPW) and superior vena cava (SVC) were excluded. Ablation procedure and long-term clinical outcomes were evaluated. The origin of non-PV triggers were detected using a self-reference mapping technique, which does not require any other reference catheters. Instead of using signals obtained from a fixed intracardiac catheter as the reference, an operator repeatedly moved a multi-electrode catheter to the earliest site creating a new reference each time to map the non-PV trigger. A total of 32 non-PV triggers excluding origins from the LAPW and SVC were induced in 23 patients. All triggers were mapped using a self-reference mapping technique with 11.0 ± 10.2 min and eliminated by radiofrequency ablation with 10.7 ± 10.0 points application. No major complications were observed. During the follow-up (529 ± 270 days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures. No non-PV triggers ablated during the previous procedure were observed. A novel self-reference mapping technique is useful for eliminating non-PV triggers for the short- and long-term outcomes. • A total of 32 non-PV/LAPW/SVC triggers were induced in 23 patients among 446 AF ablation. • All triggers were successfully mapped using a self-reference mapping technique with 11.0 ± 10.2 min mapping time. • All triggers were successfully eliminated. • No eliminated non-PV triggers were induced during the following procedure in the patients with recurrences. [ABSTRACT FROM AUTHOR]

It is unclear whether uninterrupted oral anticoagulants (OACs) are acceptable in elderly patients as compared to non-elderly patients. This study aimed to assess the clinical impact of an uninterrupted OAC strategy during atrial fibrillation (AF) ablation in elderly patients. We enrolled 439 consecutive patients who underwent AF ablation with an uninterrupted OAC strategy at our institute. The incidence of bleeding and thromboembolic complications during the AF ablation or within 4 weeks after and the anticoagulation status during the AF ablation were compared between the elderly (age ≧ 75, n = 144) and non-elderly groups (n = 295). There were 22 bleeding complications in the elderly group and 31 in the non-elderly group (15% vs. 11%, p = 0.162) and 3 major bleeding complications in the elderly group and 2 in the non-elderly group (2% vs. 0.7%, p = 0.336). Thromboembolic events were observed in 1 patient in the elderly group and 2 in the non-elderly group (0.7% vs. 0.7%, p = 1.000). The ACT at the end of the procedure was longer in the elderly group than in the non-elderly group (350 s vs. 341 s, p = 0.007) and the proportion of a prolonged ACT of > 400 s (27% vs. 18%, p = 0.046) was more frequent in the elderly group than non-elderly group. A propensity score matched population excluding the age and body weight, revealed that the anticoagulation status during AF ablation was comparable between the two groups. Thus, in the patients undergoing AF ablation with uninterrupted OAC strategy, bleeding complications in elderly patients were similar to those in non-elderly patients. The anticoagulation status during the procedure in elderly patients was more prolonged than that in non-elderly patients. [ABSTRACT FROM AUTHOR]

Backgrounds: Several studies have shown the serum high sensitive cardiac troponin I (hs‐TnI) a biomarker of myocardium injury, and C‐reactive protein (CRP), a biomarker of inflammation, are associated with worse cardiovascular outcomes. We evaluated the relationship between the hs‐TnI level in patients with paroxysmal atrial fibrillation (PAF) after pulmonary vein isolation (PVI) and atrial fibrillation (AF) recurrence. Methods and Results: We enrolled 263 consecutive PAF patients who underwent PVI from May 2017 to April 2018. We investigated the difference in the relationship between the myocardial injury marker (serum hs‐TnI), inflammatory marker (CRP, white blood cell) at 36 to 48 hours after the PVI, and early or late recurrence of AF (ERAF; <3 months and LRAF; from 3 months to 1 year) between the radiofrequency ablation group (R group) and cryoballoon ablation group (C group). The R group consisted of 147 patients and the C groups consisted of 116 patients. The serum hs‐TnI level in R group was significantly lower than in the C group (2.33 vs 5.08 ng/mL; P <.001), while the CRP was significantly higher in the R group than C group (2.02 vs 1.10 mg/dL; P <.001). The incidences of an ERAF/LRAF were similar between the two groups. Conclusion: Cryoballoon ablation may cause more myocardial injury than radiofrequency catheter ablation, on the contrary, radiofrequency catheter ablation, may cause more inflammation than cryoballoon ablation. However, these phenomena may not affect the recurrence of AF after the PVI in patient with PAF. [ABSTRACT FROM AUTHOR]

Aim: In heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with long stays. In contrast, acute decompensated heart failure (ADHF) in older patients is associated with a high risk of a long stay. To manage older ADHF patients with HFpEF, it is important to reveal the risk factors for a long stay on admission. Methods: We enrolled consecutive older patients (aged >75 years) with HFpEF (ejection fraction ≥50%) who were admitted to control ADHF from May 2014 to April 2016 using the acute heart failure registry in Osaka Rosai Hospital. We compared various factors, including age; sex; body mass index; heart rate; systolic blood pressure (SBP); atrial fibrillation; atherosclerotic risk factors, including dyslipidemia, diabetes mellitus, hypertension, smoking and chronic kidney disease; laboratory data, including brain natriuretic peptide and albumin; and medications, including loop diuretics, on pre‐admission between short‐stay (<14 days) and long‐stay groups. Results: The long‐stay group consisted of 122 patients (59.5%). Multivariate analysis showed that male sex, SBP and albumin were independent predictors for long stays. According to the classification and regression tree and receiving operating characteristic curve analysis, all three factors on admission, including male sex, relatively low SBP (<155 mmHg) and hypoalbuminemia (<3.4 g/dL) could well predict the patients that would require long stays (area under curve 0.738). Conclusions: Among older ADHF patients with HFpEF, male patients with relatively low SBP and hypoalbuminemia on admission should initially undergo more intensive management to reduce the length of stay. Geriatr Gerontol Int 2019; 19: 1084–1087. [ABSTRACT FROM AUTHOR]

The article presents the case of a 56-year-old woman who was scheduled to undergo catheter ablation for supraventricular tachycardia (SVT) to discuss the mechanism of narrow QRS tachycardia with varying right atrial activation sequence. Topics include the observation of ventriculoatrial (VA) conduction from the electrode catheters positioned in her lateral right atrium (RA) and her differential diagnosis including focal atrial tachycardia (AT).

We report the autopsy case of 68‐year‐old woman who received cryoballoon (CB) ablation for paroxysmal atrial fibrillation 7 months before death. Both macroscopic and microscopic findings revealed no thrombus formation around pulmonary veins. Previous experimental studies have shown the lower risk of thrombus formation in CB ablation as compared to radiofrequency ablation. Our findings in the human autopsy case may support this merit of CB ablation. To confirm this benefit of CB ablation, further studies regarding histopathology of CB ablation should be performed. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) twist can be evaluated using two-dimensional speckle tracking echocardiography (2DSTE) by analyzing difference between apical and basal rotation. However, it is unable to evaluate global rotational dyssynchrony because it cannot assess mid-wall rotation. Recently developed three-dimensional STE (3DSTE) can investigate LV global rotational dyssynchrony. In this study, we investigated the role of torsion on the long-term effects of cardiac resynchronization therapy ( CRT) using 3DSTE. We evaluated 43 patients by 3DSTE: 12 CRT responders, 14 CRT nonresponders, and 17 healthy normal controls. Regional torsion and rotation were assessed using 3DSTE across 16 segments during CRT-off (native conduction) and CRT-on. The following parameters were calculated: global peak twist, Δ global peak twist (difference between CRT-on and CRT-off), and torsion delay index. The torsion delay index was considered to be the rotational energy lost by rotational dyssynchrony. Global peak twist did not show significant differences between the responders and nonresponders during CRT-off (4.0 ± 3.4° vs. 2.8 ± 2.3°, P = 0.295), but it significantly improved in responders compared to nonresponders after CRT-on (5.4 ± 3.5° vs. 2.6 ± 2.6°, P = 0.029). The torsion delay index during CRT-off was significantly higher in responders compared to nonresponders and normal controls (18.5 ± 11.3 vs. 8.6 ± 3.8 and 7.8 ± 5.5, P = 0.010 and P = 0.004, respectively). The torsion delay index during CRT-off significantly correlated with the Δ global peak twist (r = 0.503, P = 0.009). Improvement in LV global peak twist, which is one of the mechanisms for the long-term effects of CRT correlated with the torsion delay index during native conduction that can only be calculated by 3DSTE. [ABSTRACT FROM AUTHOR]

It has been reported that a major cause of coronary vasospastic angina (VSA) is endothelial dysfunction of the coronary artery. On the other hand, some studies showed that serum uric acid and lipoprotein(a) are correlated with endothelial dysfunction. Thus, we examined whether uric acid and lipoprotein(a), are correlated with VSA. Four hundred forty-one patients with suspected VSA who underwent a coronary angiogram with acetylcholine provocation (ACh test) during an 8-year period were enrolled. We divided them into a VSA group, who showed coronary spasm by the ACh test, and an atypical chest pain (ACP) group, who showed negative ACh test. We compared serum markers between the two groups, including low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a), fibrinogen, total plasminogen activator inhibitor-1, and uric acid. Uric acid, hs-CRP, and lipoprotein(a) were significantly higher in the VSA group than in the ACP group (all P < 0.05) while there were no significant differences in the other parameters. Multivariate analyses identified uric acid and lipoprotein(a) as significant independent markers for VSA. Uric acid and lipoprotein(a) are correlated with VSA, and medical intervention to decrease uric acid and lipoprotein(a) might be effective in controlling VSA. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 77-year-old woman with palpitations. An electrocardiogram during the tachycardia showed a narrow complex tachycardia with a long RP supraventricular tachycardia which was diagnosed as atypical atrioventricular nodal reentrant tachycardia (AVNRT) with a concealed nodofascicular (NF) or nodoventricular (NV) bypass tract. Also noted is the condition's termination by a ventricular premature depolarization (VPD).

The safety of sirolimus-eluting stents (SESs) in acute myocardial infarction (AMI) remains controversial. We compared long-term neointimal coverage after stent implantation for AMI evaluated by coronary angioscopy and 3-year clinical events between SESs and bare-metal stents (BMSs). Eighty-seven consecutive patients who received SESs or BMSs for AMI were enrolled. At 8 months after AMI coronary angiography with angioscopy was performed. Using angioscopy we evaluated maximum and minimum grades of neointimal coverage using an angioscopic score (0 to 3). We calculated the heterogeneity score as the maximum grade minus the minimum grade. We compared angioscopic parameters including minimum grade and heterogeneity score of neointimal coverage, thrombi and plaque color, serum parameters, and major adverse cardiac events for 3 years between the 2 groups. The restenosis rate of the SES group (n = 56) was significantly lower than that of the BMS group (n = 31, 9% vs 31%, p = 0.015). The SES group had a lower minimum grade of neointimal coverage and higher heterogeneity score and prevalence of thrombi than the BMS group, but from 8 months to 3 years after stent implantation there were no significant differences in major adverse cardiac events between the 2 groups. In conclusion, a lower minimum grade and greater heterogeneity of neointimal coverage and thrombi were shown for SESs compared to BMSs at 8 months after AMI. However, these findings did not correlate with cardiac events over a period of 3 years in our patients. [ABSTRACT FROM AUTHOR]

Background: Chronic effect of right ventricular (RV) pacing on left ventricular (LV) rotational synchrony is unknown. The aim of this study is to assess chronic effect of RV pacing on LV rotational synchrony using two-dimensional ultrasound speckle tracking imaging. Methods and Results: Thirty-one patients who underwent dual-chamber pacemaker implantation for complete atrioventricular block, and age- and sex-matched 10 healthy controls were assessed. We divided our patients into RV apical (RVA, n = 16) and RV outflow tract (RVOT, n = 15) pacing groups. We compared echocardiographic parameters such as LV rotational synchrony between pacing groups and healthy control. We defined Q to peak rotation interval as the interval from the beginning of the Q-wave to the peak apical counter-clockwise or peak basal clockwise rotation. We calculated apical-basal rotation delay by subtracting basal Q to peak rotation interval from apical one as the representative of rotational synchronization. Apical-basal rotation delay of RVA pacing was significantly longer than that of healthy control (100 ± 110 vs. −6 ± 15 ms, P = 0.002), while there was no statistically significant difference between RVOT pacing and healthy control (−3 ± 99 vs. −6 ± 15 ms, P = 0.919). Conclusions: LV rotation during RVOT pacing is synchronous at 15 months after pacemaker implantation, while RVA pacing provokes LV rotational dyssynchrony by inducing delayed apical rotation at 7 years after pacemaker implantation in patients with complete atrioventricular block. (Echocardiography 2011;28:69-75) [ABSTRACT FROM AUTHOR]

(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan–Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV. [ABSTRACT FROM AUTHOR]

Background: It has been reported that intramyocardial hemorrhage (IH) can be detected by magnetic resonance imaging (MRI) and IH correlates with the poor prognosis of acute myocardial infarction (AMI). We examined whether integrated backscatter (IBS) can disclose IH in patients with AMI. We recorded IBS images in 34 patients with AMI who underwent coronary angioplasty within 12 hours of symptom onset. Methods: We measured calibrated IBS (C-IB) and cyclic variation (CV) in the center of the risk area on the third day after reperfusion. C-IB was calculated as: average IBS value of risk area − average IBS value of intraventricular blood. MRI was performed within 3 days after reperfusion. Regional wall motion score index (RWMSI) was calculated as follows: sum of scores (0∼4) in risk area/number of segments of risk area. We evaluated left ventricular function using RWMSI shortly and one month after reperfusion. Results: RWMSI in the IH group (12 cases) was significantly higher than in the non-IH group (2.3±0.5 vs. 1.8±0.6: P<0.01) one month later, while RWMSI in both groups was almost the same shortly after reperfusion. The IH group showed a significantly higher value of C-IB than the non-IH group (18.6±2.0 vs. 16.0±1.4: P<0.01), while there were no significant differences in CV values between two groups. Using 17 as a cutoff value of C-IB, C-IB can detect IH with 92% sensitivity and 91% specificity. Using both CV and C-IB, however, IH can be detected more specifically. Conclusion: Ultrasonic IBS, especially C-IB, discloses intramyocardial hemorrhage in patients with reperfused AMI. [ABSTRACT FROM AUTHOR]

We evaluated the interaction between inflammation and survival benefit from statin therapy in patients who had acute myocardial infarction. Although 1-year mortality did not differ between patients who used statin therapy and those who did not, among patients who had C-reactive protein (CRP) concentrations in the lower 2 tertiles (&#60;2.9 mg/L), 1-year mortality was higher in patients who used statin therapy than in those who did not within the highest CRP-defined tertile (≥2.9 mg/L). Statin therapy significantly decreased the hazard ratio for 1-year mortality in patients who had high CRP levels to approximately the hazard present for patients who had low CRP levels and did not receive statin therapy. [Copyright &y& Elsevier]

Inflammation has been postulated to be a major contributor to restenosis after angioplasty. We examined the correlation between inflammatory and coagulatory reactions and the occurrence of restenosis, and how treatment with statins influences this correlation. A total of 243 patients with stable angina who were scheduled for a percutaneous coronary intervention (PCI) and follow-up coronary angiography were enrolled in the study. Eighty-one of these patients were treated with statins for at least 1 month before their PCI and throughout the study period. Blood was withdrawn on the day of the PCI and on the day of the follow-up catheterization. Patients with the highest hs-CRP at the time of the initial PCI maintained elevated hs-CRP levels over time and showed significantly higher rates of restenosis or TLR after 6±1 months than subjects with low initial hs-CRP. Statin treatment abolished this difference. Fibrinogen levels were also increased in subjects with high initial hs-CRP, both at the time of the initial PCI and at follow-up. In an univariate analysis, both initial and follow-up levels of hs-CRP and fibrinogen correlated with restenosis. However, both the initial and follow-up levels of hs-CRP only were independent predictors of increased restenosis in a multivariate analysis, except in the statin-treated subgroup. In conclusions, the persistent increase in CRP is a risk factor for restenosis in patients with stable angina who have not been treated with statins. [Copyright &y& Elsevier]

Statins, aspirin and angiotensin II modulators (A II-M: angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type I receptor blockades) may have an anti-inflammatory effect, but the relationship between the effects of statins, aspirin and A II-M on high-sensitive C-reactive protein (hs-CRP) levels remains to be determined. We examined serum hs-CRP levels in consecutive patients with stable ischemic heart disease (IHD) (n=1231; 65±9 years; male/female, 927/304) and without IHD (n=226; 64±9 years; male/female, 117/109). Blood samples were collected on the day of catheterization. The hs-CRP levels were significantly higher in the IHD than in the non-IHD patients (0.32±0.52 vs. 0.24±0.29 mg/dl, P<0.05). Treatment with statins was associated with significantly lower hs-CRP levels in both groups (non-IHD, 0.17±0.14 vs. 0.26±0.31 mg/dl; IHD, 0.27±0.34 vs. 0.35±0.59 mg/dl; both P<0.05). hs-CRP levels were significantly lower only in IHD patients treated with A II-M than in those not treated with A II-M (0.28±0.34 vs. 0.34±0.58 mg/dl, P<0.05). Aspirin did not have any effect on the hs-CRP level in either group. The hs-CRP levels were significantly lower in IHD patients treated with statins and/or A II-M than those treated with neither statins nor A II-M (statin+/A II-M+, 0.28±0.29 mg/dl; statin+/A II-M−, 0.26±0.36 mg/dl; statin−/A II-M+, 0.28±0.37 mg/dl; statin−/A II-M−, 0.38±0.66 mg/dl; P<0.01). These results indicate that statins and A II-M, but not aspirin, in commonly used doses have an anti-inflammatory action as assessed by measurement of CRP levels in IHD patients. [Copyright &y& Elsevier]

Predicting the effect of β-blockade therapy on the clinical outcome of patients with dilated cardiomyopathy (DCM) is difficult prior to the initiation of therapy. Myocardial fatty acid metabolism has been shown to be impaired in patients with DCM. We examined whether the extent of myocardial injury, as assessed by iodine-123 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy, is related to the response of patients with DCM to β-blockade therapy. Thirty-seven patients with DCM were examined using BMIPP myocardial scintigraphy before and after 6 months of treatment with metoprolol. Myocardial BMIPP uptake (%BM uptake) was estimated quantitatively as a percentage of the total injected count ratio. The left ventricular end-diastolic and end-systolic dimensions (LVDd, LVDs) and ejection fraction (LVEF) were also evaluated. The patients were divided into two groups according to their functional improvement (≥10% elevation of LVEF) after 6 months of metoprolol therapy. Twenty-eight patients responded to the therapy, while nine did not. Prior to the therapy, no significant differences in LVDd, LVDs or LVEF were observed between the responders and nonresponders. However, the %BM uptake was significantly lower in the non-responders than in the responders (1.0%±0.2% vs 2.1%±0.5%, P<0.001). The %BM uptake could be used to distinguish the responders from the non-responders with a sensitivity of 0.93 and a specificity of 1.00 at a threshold value of 1.4. After the metoprolol therapy, the %BM uptake improved significantly in the responders (2.5%±0.5%, P<0.01) but did not change in the non-responders. These results indicate that myocardial BMIPP uptake could predict the response of DCM patients to β-blockade therapy. [ABSTRACT FROM AUTHOR]

Background: Hemoconcentration (HC) has been proposed as surrogate for decongestion among patients with hospitalized acute heart failure (AHF), but the definition of HC has become controversial and its clinical impact is not fully understood. The purpose of this study is to clarify the clinical impact of in-hospital HC on prognosis. Method: We enrolled 167 consecutive patients hospitalized for AHF in a c u te heart failure r egistry in O saka R os a i Hospital (AURORA). HC was defined as an increased hemoglobin between admission and discharge. We evaluated the correlation between clinical factors including HC group the reduction in brain natriuretic peptide (BNP) reduction of =>30% at discharge, the incidence of worsening renal failure (an increase of >0.3mg/dl in serum creatinine) during hospitalization and composite of all-cause mortality and re-hospitalization at one year. Results: HC was occurred in 94 patients (56.2%).After multivariate adjustment, HC [Hazard ratio (HR) 0.406, 95% confidence interval (CI) 0.174-0.919, p=0.030], BNP reduction of =>30% at discharge [HR=0.348, 95%CI 0.140-0.990, p=0.048] and EF [HR=0.971, 95%CI 0.945-0.997, p=0.032]were significantly associated with a reduction of composite of mortality and re-hospitalization, but the other parameters including WRF [HR=1.006, 95%CI 0.431-2.653, p=0.990] were not significantly correlated with composite of all-cause mortality and re-hospitalization at one year (table). Conclusions: In addition to EF and reduced BNP, hemoconcentration is a simple and useful signal of adequate decongestion in AHF and is associated with better prognosis. [ABSTRACT FROM AUTHOR]

Backgroud: Several studies using optical coherence tomography(OCT) have shown that presence of uncover struts was associated with poor prognosis. However the predictor of the uncovered strut after implantation of 2nd and 3rd generation everolimus-eluting stents was not fully examied. Method: 42 patients with 44 consecutive lesions with 2nd and 3rd generation everolimus-eluting stents which had pre-stent, post-stent and 8-month follow-up OCT imaging between November 2016 and September 2017 were evaluated. According to the 8-month follow-up OCT findings, the lesions were divided into two groups: H-US group who had higher incidence of uncovered strut (higher interquartile with uncovered strut rate≧5.49%, n=22) and L-US group who had lower incidence of uncovered strut (lower interquartile with uncoverd strut rate<5.49%, n=21). We compared patient characteristicsincluding hypertension, dyslipidemia,diabetes mellitus, chronic kidney disease and acute coronary syndrome (ACS), procedures characteristics incluiding ratarathelectomy, laser atelectomy, thrombectomy, post dialation. pre-stent OCT findings including mimimu lumen area, lesion praques, dissection, ruptured plaques, post-stent OCT findings including underexpansion, malaposition, embedd struts distance, lesion plaques, thrombus, protruded plaques, which were smooth, irregular and disrupted, follow-up OCT findings including uncover struts between H-US group and L-US group. Results: H-US group comprised 22 (50%) in 44 lesions. Univariate analysis showed the incidence of ACS, ruptured plaques and less smooth protrusion were significantly correlated with uncovered strut. In multivariate analysis using the significant parameters which were determined by univariate analysis only less smooth protrusion was independently correlated with H-US group (table). Conclusion: Smooth protrusion in post-OCT findings may be correlated with uncover strut rate in the intermediate (8-month) follow-up OCT findings. [ABSTRACT FROM AUTHOR]

Introduction: Current guidelines for nutritional support in critically ill patients recommend early initiation (within 48 hour after intensive-care units (ICU) admission) of enteral nutrition. However, the efficacy of early enteral nutrition for the patients with severe acute heart failure is not well investigated. Hypothesis: Early enteral nutrition is effective for the patients with severe acute heart failure required invasive mechanical ventilation. Methods: We enrolled the consecutive adult patients (18 years or older) who admitted cardiac care unit (CCU) for acute heart failure required invasive mechanical ventilation from January 2013 to May 2018 in our hospital. Exclusion criteria were the patients with mechanical ventilation shorter than 48 hours, changing hospital during acute phase treatment, and DNR (do not attempt resuscitation) before nutrition therapy. We compared body mass index (BMI), etiology (ischemic or non-iscemic), ejection fraction, the incidence of chronic kidney disease, hemodialysis, diabetes mellitus, catecholamine treatment including dopamine, dobutamine, and noradrenalin, intraaortic balloon pumping, and percutaneous cardiopulmonary support, and therapeutic outcome including duration of mechanical ventilation and CCU stay, length of hospital stay, and mortality between early enteral nutrition group (early group) who start to receive enteral nutrition within 48 hour after CCU admission and non-early enteral nutrition group (non-early group). Results: Early group comprised 30 patients and non-early group comprised 31 patients. Early group had shorter duration of CCU stay and shorter length of hospital stay as compared to non-early group (8.9 [6.2-15.1] days vs 14.4 [11.2-26.3, p=0.0170 and 34.1 [18.6-47.6] days vs 52.1 [39.5-90.7], p=0.0019, respectively, table) while there were no significant differences between the two groups regarding patient characteristics, treatment and mortality. Conclusions: For the patients with acute heart failure required invasive mechanical ventilation, early enteral nutrition can reduce duration of CCU stay and length of hospital stay. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) is characterized by progressive arteriosclerosis due to a congenital increase of low-density lipoprotein cholesterol (LDL), and myocardial infarction and angina pectoris tend to develop in juvenile. Thus, early diagnosis and early intervention for FH is important, but the diagnosis rate of FH is extremely low. Achilles tendon thickness (AT-T), which is generally measured by soft X-ray radiography, is one of criterion for FH, but the imaging quality and radiation exposure in soft X-ray radiography are occasionally problems in clinical settings. Thus, in this study we investigated the clinical impact of ultrasonographic measurements in patients with stent implantation. Methods: We enrolled 50 consecutive patients who underwent stent implantation from October 2016 to September 2017 in our hospital. We measured AT-T using both soft X-ray radiography (X-AT-T) and ultrasonography (U-AT-T) at the same day. We also measured AT width (U-AT-W) and ratio of U-AT-W to U-AT-T (U-AT-ratio) using ultrasonograpy.. We evaluated the correlation between X-AT-T and U-AT-T. In addition, we evaluated the sensitivity and specificity to predict FH using each parameter. Results: There was significant correlation between X-AT-T and U-AT-T (y=0.75x-0.34, r=0.92, p<0.0001) (figure). FH group consisted of 5 patients. Using cut off value with 9mm as X-AT-T, 9.2mm as U-AT-T, 18.8mm as U-AT-W and 1.83 as U-AT-ratio, FH can be predicted with 100% sensitivity and 74% specificity, 100% sensitivity and 98% specificity, 80% sensitivity and 89% specificity and 100% sensitivity and 100% specificity, respectively. Cut off values using ultrasonographic parameters were determined by receiver-operating curves. Conclusions: It may be more important for detecting FH to measure not only thickness but also width of Achilles tendon. Thus, Achilles tendon ultrasonography is more useful to detect FH than soft X ray in the patients with stent implantation. [ABSTRACT FROM AUTHOR]

Background: Recently, the drug coated balloon (DCB) has been shown to reduce neointimal proliferation and target lesion revascularization (TLR) in small coronary vessels. However, intra coronary imaging guided PCI for very small vessel disease has not been well investigated. Purpose The aim of this study is to investigate how the intra-coronary imaging such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS) improve the clinical outcome for the PCI to the very small vessel (<2.5mm) treated with DCB compared with DES. Methods: This was an observational study whose aim was to investigate the outcome of consecutive series of patients with very small vessel disease. The size of DCB and DES were determined according to the intravascular imaging. We evaluated patient clinical conditions at 6 months. Results: Between August 2016 and August 2017, 29 patients were treated with DCB and 28 patients were treated with DES. six patients (20.7%) had a dissection estimated by angiography, while 16 patients (55.1%) had dissection estimated by OCT or IVUS (p=0.014). Follow-up coronary angiography at 6 months was performed in 20 patients (69.0%) with DCB. Complete vessel healing at angiography and intravascular imaging was observed in all patients with coronary dissection. At 6 months, DCB and DES showed similar rates of TLR (3.5 % vs. 0.0%; p=0.594), and target lesion failure (3.5% vs. 3.6%; p= 0.794). Conclusions: In this cohort of consecutive patients treated with very small coronary vessel, 'stent-less' PCI using DCB could be useful even in the DES era. [ABSTRACT FROM AUTHOR]

Background: Recent several studies demonstrated that uninterrupted oral anticoagulants (OAC) strategy during atrial fibrillation (AF) ablation was acceptable and safe. However, these trial numbers were limited and predictors of adverse events were not fully investigated. The aim of this study was to assess predictors of adverse events during atrial fibrillation ablation with uninterrupted oral anticoagulants strategy. Methods: We enrolled 219 consecutive patients who underwent initial AF ablation with uninterrupted OAC strategy in our institute. The incidence of thromboembolic events and bleeding events for 4 weeks after the procedure were assessed. Thromboembolic events were defined as the presence of deep vein thrombus, cerebral infarction and transient ischemic attack. Bleeding events were defined as any bleeding event requiring blood transfusion or surgical intervention, pericardial effusion with tamponade requiring drainage. In addition, a fall in hemoblobin level of 2 g/dl or more 2 days after the procedure was included in bleeding events. We assessed predictors of adverse events with following parameters: the incidence of male, paroxysmal atrial fibrillation, structural heart disease, ischemic heart disease (IHD), chronic kidney disease, hypertension, diabetes mellitus, estimated glomerular filtration rate (eGFR), the echocardiographic parameters including left ventricular ejection fraction and left atrial dimension, ablation methods and activated clotting time. Results: Thromboembolic event was observed in 1 (0.5%) patient and bleeding events were observed in 41 patients (19%), respectively. Multivariate analysis using IHD and eGFR which showed p<0.1 by univariate analysis revealed that only IHD was significantly correlated to bleeding events (table). Conclusion: We should pay attention for bleeding events in the patients with IHD, when we perform catheter ablation of AF with the uninterrupted OAC strategy. [ABSTRACT FROM AUTHOR]

Background: Several reports using optical coherence tomography (OCT) revealed that in-stent tissue protrusion (ITP) is correlated with clinical outcomes such as in-stent restenosis and stent thrombosis, but it is unclear on the difference of clinical impact of ITP between ST-segment elevation myocardial infarction (STEMI) and non STEMI (NSTEMI).The aim of this study was to compare the morphology of ITP and its relation of myocardial damage between STEMI and NSTEMI. Methods: We enrolled 72 consecutive patients with acute coronary syndrome who received drug eluting stent and post-stenting OCT. We compared the following post-stenting OCT parameters between STEMI and NSTEMI groups: minimum lumen area, malapposition struts lumen distance, area stenosis , in-stent dissection, ITP characteristics including thrombus, irregular and smooth protrusion, and protrusion area and area stenosis. In addition, we evaluate the correlation between ITP area and creatine kinase MB (CKMB), which is an indicator of myocardial damage, in STEMI and NSTEMI respectively. Results: STEMI group comprised 33 patients and NSTEMI group comprised 39 patients. In post-stenting OCT findings, a major part of ITP in both groups were irregular protrusion. The incidence of thrombus protrusion was significantly higher in STEMI group than in NSTEMI group and protrusion area tend to be larger in STEMI group than NSTEMI group while the other parameters including Minimum lumen area, Maximum malapposition struts lumen distance, area stenosis, in-stent dissection were similar between the two groups (table). In NSTEMI group, ITP area was positively correlated with the level of peak CKMB after percutaneous coronary intervention (y=85.8x + 14.2, p<0.01), but in STEMI group, the correlation was not found. Conclusions: The amount of ITP can affect myocardial damage in NSTEMI but not in STEMI, while the amount of ITP and the incidence of thrombus protrusion may be larger in STEMI than NSTEMI. It may be better to perform additional intervention if we find significant ITP at post-stenting OCT findings in NSTEMI. [ABSTRACT FROM AUTHOR]

Background: Recent several studies demonstrated that uninterrupted oral anticoagulants (OAC) strategy during atrial fibrillation (AF) ablation was acceptable and safe. However, these trials did not include enough proportions of elderly patients. The aim of this study is to assess the clinical impact of uninterrupted OAC strategy during AF ablation in the elderly patients. Methods: We enrolled 219 consecutive patients who underwent initial AF ablation with uninterrupted OAC strategy in our institute. We compared the incidence of male, paroxysmal atrial fibrillation, structural heart disease, ischemic heart disease, chronic kidney disease, hypertension, diabetes mellitus, the echocardiographic parameters including left ventricular ejection fraction and left atrial dimension, antiplatelet therapy, ablation methods, activated clotting time, thrombotic and bleeding events between elderly group (age≥75years old) and non-elderly group. The incidence of thromboembolic events and bleeding events for 4 weeks after the procedure were assessed. Thromboembolic events were defined as the presence of deep vein thrombus, cerebral infarction and transient ischemic attack. Bleeding events were defined as any bleeding event requiring blood transfusion or surgical intervention, pericardial effusion with tamponade requiring drainage. In addition, a fall in hemoblobin level of 2 g/dl or more 2 days after the procedure was included in bleeding events. Results: Elderly group consisted of 77 patients (35.2%). The incidence of chronic kidney disease, hypertension and average of activated clotting time were significantly higher in elder group than non-elderly group while there were no significant differences of the other parameters between the two groups (table). Thromboembolic event was observed in 1 patient (1%) in elderly group and not observed in non-elderly group (p=0.148). Bleeding events were observed in 11 patients (14%) in elderly group and in 30 patients (21%) in non-elderly group (p=0.199). Conclusion: In patients undergoing catheter ablation of AF, the uninterrupted OAC strategy in elderly patients was acceptable and safe. [ABSTRACT FROM AUTHOR]

Background: In heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with long stays. On the other hand, acute decompensated heart failure (ADHF) in elderly patients is associated with a high risk of a long stay. Therefore, to manage the elderly ADHF patients with HFpEF, it is important to reveal the risk factors on admission for a long stay. Methods: We enrolled consecutive elderly patients (>75 years old) with HFpEF (ejection fraction>50%) who were admitted to control ADHF form May 2014 to April 2016 uisng a c u te heart failure r egistry in O saka R os a i Hospital (AURORA). We compared various factors including age, gender, body mass index (BMI), heart rate, systolic blood pressure (SBP), atrial fibrillation, clinical scenario 1, atherosclerotic risk factors including dyslipidemia, diabetes mellitus, hypertension, smoking and chronic kidney disease (CKD), laboratory data including brain natriuretic peptide (BNP), hemoglobin and albumin and medications including loop diuretics on pre-admission between short-stay (<14 days) and long-stay groups. Results: The long-stay group consisted of 122 patients (59.5%). Univariate analysis revealed that male gender, CKD, BMI, SBP, BNP, hemoglobin, and albumin were significantly correlated with long-stay hospitalization. Multivariate analysis using these seven factors which correlated with long-stay hospitalization in the univariate analysis showed that male gender, SBP, and albumin were independent predictors for long stays (table). According to the classification and regression tree and receiving operating characteristic curve analysis, all three factors on admission including male gender, low SBP (<155 mmHg), hypoalbuminemia (<3.4g/dl) could well predict the patients that would require long stays (area under curve: 0.738). Conclusions: Among elderly ADHF patients with HFpEF, male patients with low SBP and hypoalbuminemia on admission should initially undergo more intensive management to reduce the length of stay. [ABSTRACT FROM AUTHOR]

Background: Several studies reported the urate-lowering treatment can reduce cardiovascular disease (CVD), but it remains unclear the detailed mechanism of control of uric acid (UA) on favorable effects for CVD. In this study, we focused coronary endothelial function (CEF). We investigated whether febuxostat, a potent xanthine oxidase (XO) inhibitor, which is considered as protect CEF, can produce more favorable effects on CEF than benzbromarone, which is not correlated with XO in the hyperuricemic patients with stable angina. Methods: We divided 15 hyperuricemic patients (male: UA ≥ 6.0mg/dl and femal: UA ≥ 5.0mg/dl) who implanted a stent for left anterior descending (LAD) or left circumflex (LCX) artery into the patients who started to receive febuxostat (F group) and those who received benzbromarone (B group) randomly to treat hyperuricemia. At 8-month follow-up, all patients underwent CEF evaluation by responses to intracoronary acetylcholine and optical coherence tomography (OCT) evaluation for non-culprit vessel (e.g. if the patient received LAD stenting, we evaluated LCX). We compared ratio of diameters induced by acetylcholine and nitroglycerin which were measured by quantitative coronary angiography (CEF ratio), thin-cap fibroatheroma (TCFA) and calcified plaque by OCT, UA, oxidative stress biomarkers including urinary 8-hydroxy-2-deoxyguanosine (8-OHdG) and malondialdehyde-modified low-density lipoprotein (MDA-LDL) before and after medication for hyperuricemia, the incidence of hypertension, dyslipidemia, diabetes mellitus and smoking between F and B groups. Results: Although UA levels were significantly lower at 8-month follow-up than before medications in both groups (F group: 5.3±1.6 vs. 7.7±2.0, p=0.02 and B group: 3.7±1.6 vs. 6.9±0.7, p<0.01), there were no significant differences in any of oxidative stress biomarkers, CEF ratio, coronary risk factors and OCT parameters between the two groups (table). Conclusions: Eight month-term inhibition of XO by febuxostat does not significantly protect impaired CEF in hyperuricemic patients with stable angina as compared to benzbromarone. [ABSTRACT FROM AUTHOR]