Search

Background: This study evaluated corrected relative flow reserve (RFR) derived from 13N-ammonia positron emission tomography (PET) combined with coronary computed tomography angiography (CTA).Methods: We analyzed 61 patients who underwent coronary CTA, 13N-ammonia PET, and invasive coronary angiography. Triple-vessel disease were excluded. Conventional RFRs were calculated as the ratio of hyperemic myocardial blood flow (hMBF) of hypoperfusion areas to those of non-ischemic lesions. Corrected RFRs were calculated using PET and coronary CTA to adjust coronary territories to their feeding vessels. Diagnostic performance was compared to detect obstructive coronary lesions.Results: Of the 180 vessels analyzed, 50 were diagnosed as obstructive lesions (≥ 70% stenosis and/or fractional flow reserve value ≤ 0.8). The coronary flow reserve (CFR), hMBF, conventional RFR, and corrected RFR of obstructive lesions were significantly lower than those of non-obstructive lesions. In receiver operating characteristic curve analysis, these quantitative PET measurements had area under the curve of 0.67, 0.71, 0.89, and 0.92, respectively. Diagnostic performance differences between corrected and conventional RFR were not statistically significant.Conclusion: In patients with single or double vessel disease, indices of RFR, with or without coronary angiographic guidance of the reference coronary territory, are better discriminators of flow-limiting stenoses than hMBF and CFR. [ABSTRACT FROM AUTHOR]

Coronary vasospasm sometimes coexists with Brugada syndrome (BrS) and is reportedly associated with poor prognosis. Although calcium channel blockers are considered first-line drugs to prevent coronary vasospasm, they also have the potential to induce ST elevation and ventricular fibrillation (VF) in BrS. Therefore, the optimal medication for such a complicated case is still underdetermined. We report a male patient who presented with VF due to BrS, which was later found to have coexisted with coronary vasospasm. He was treated with low-dose bepridil expecting both its anti-arrhythmic and vasodilatory effects, but a later acetylcholine provocation test showed no suppression of vasospasm. Based on these results, we decided to add nitrates to the medication. This case report illustrates that drug selection needs caution in BrS when complicated with vasospastic angina and that bepridil monotherapy may not be sufficient to suppress coronary vasospasm in such cases. [ABSTRACT FROM AUTHOR]

Aims: Identifying the manufacturer and the type of cardiac implantable electronic devices (CIEDs) is important in emergent clinical settings. Recent studies have illustrated that artificial neural network models can successfully recognize CIEDs from chest X‐ray images. However, all existing methods require a vast amount of medical data to train the classification model. Here, we have proposed a novel method to retrieve an identical CIED image from an image database by employing the feature point matching algorithm. Methods and results: A total of 653 unique X‐ray images from 456 patients who visited our pacemaker clinic between April 2012 and August 2020 were collected. The device images were manually square‐shaped, and was thereafter resized to 224 × 224 pixels. A scale‐invariant feature transform (SIFT) algorithm was used to extract the keypoints from the query image and reference images. Paired feature points were selected via brute‐force matching, and the average Euclidean distance was calculated. The image with the shortest average distance was defined as the most similar image. The classification performance was indicated by accuracy, precision, recall, and F1‐score for detecting the manufacturers and model groups, respectively. The average accuracy, precision, recall, and F‐1 score for the manufacturer classification were 97.0%, 0.97, 0.96, and 0.96, respectively. For the model classification task, the average accuracy, precision, recall, and F‐1 score were 93.2%, 0.94, 0.92, and 0.93, respectively, all of which were higher than those of the previously reported machine learning models. Conclusion: Feature point matching is useful for identifying CIEDs from X‐ray images. [ABSTRACT FROM AUTHOR]

Backgrounds: The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis (CA). However, the visual assessment of RASP is inconsistent, and the quantitative assessment of RASP is time‐consuming. This study aimed to compare assessments of RASP for the identification of CA with conventional assessments and investigate their reproducibility and relevance on the assessments. Methods: Forty patients with biopsy‐proven CA were compared with 80 hypertrophied patients matched for mean LV wall thickness. We compared the discriminative abilities of three assessments of RASP to identify CA (visual, quantitative, and semiquantitative). Nine patterns of semiquantitative RASP were investigated; finally, it was defined as "reduction of LS" (≥ −10%) in ≥5 (of 6) basal segments, relative to "preserved LS" (< −15%) in at least one apical segment. Results: The concordance between the two observers for visual RASP was modest (κ = 0.65). On the other hand, the consistency for semiquantitative RASP was perfect (κ = 1.00). The discriminative ability of semiquantitative RASP (area under the curve [AUC] = 0.74) was significantly better than that of visual RASP (AUC = 0.65) and equivalent to that of binary quantitative RASP. Conclusion: Semiquantitative RASP assessment is reproducible and accurately discriminates CA. This simple assessment may help readily refine the risk stratification of patients with diffuse LV hypertrophy. [ABSTRACT FROM AUTHOR]

Tolvaptan (TLV) is an oral selective vasopressin 2 receptor antagonist that acts on the distal nephrons, causing a loss of electrolyte-free water. To date, its early administration in very elderly patients after repeat hospitalizations for acute decompensated heart failure (ADHF) despite receiving optimal medical therapy has not been evaluated. Fifty-six ADHF patients who were >80 years old and had been repeatedly hospitalized were retrospectively enrolled in this study. Twenty-five patients (14 men; mean age 86.7 ± 5.3 years; control group) received standard therapy and 31 patients (15 men; mean age 85.5 ± 4.5 years; TLV group) received oral TLV within 24 h of admission. The rate of worsening renal function was significantly lower in the TLV group than in the control group (13 vs. 40%, P < 0.05). The duration of the return to body weight at a steady state was significantly shorter in the TLV group (5.3 ± 2.8 days) than in the control group (13.9 ± 9.2 days, P < 0.01). Consequently, the hospitalization period in the TLV group (13.5 ± 5.9 days) was significantly shorter than that in the control group (24.7 ± 12.3 days, P < 0.01). In conclusion, the early administration of TLV to very elderly patients who underwent repeat hospitalizations for ADHF resulted in immediate decongestion and thus reduced the hospitalization period with a lower incidence of worsening renal function. [ABSTRACT FROM AUTHOR]

Background Adaptive servo-ventilation (ASV) at home has been used for patients with chronic heart failure. However, its effect on acute cardiogenic pulmonary edema (ACPE) is not clear. The aim of this study was to elucidate the effect of ASV use in the emergency room in patients with ACPE. Methods We enrolled 198 consecutive patients with ACPE. Eighty patients received standard therapies, such as oxygen inhalation and vasodilators (conventional therapy group), and 118 received ASV in addition to standard therapy (ASV therapy group). ASV was initiated in the emergency room immediately after diagnosis. The procedure was switched over from ASV to endotracheal intubation (ETI) when oxygenation was insufficient. Results The ETI rate in the ASV therapy group was significantly lower than that in the conventional therapy group (3% vs. 21%, p < 0.01). The intensive care unit and/or high care unit length of stay in the ASV therapy group was also significantly shorter than that in the conventional therapy group (1.9 ± 2.1 days vs. 5.3 ± 6.8 days, p < 0.01). Consequently, the hospitalization period in the ASV therapy group was shorter than that in the conventional therapy group (19.3 ± 11.0 days vs. 26.3 ± 16.6 days, p < 0.01). Conclusion In patients with ACPE, rapid introduction of ASV in the emergency room reduces the need for ETI and decreases the hospitalization period. [ABSTRACT FROM AUTHOR]

BACKGROUND The aim of this study was to investigate the effect of sex on the correlation between arterial stiffness and left ventricular (LV) diastolic function in a healthy population without significant atherosclerosis. METHODS Subjects (n = 446) who had simultaneous echocardiography and arterial stiffness recordings were enrolled. From these subjects, 95 men and 72 age-matched women without atherosclerotic risk factors (hypertension, dyslipidemia, and diabetes mellitus) were included in the analysis. We measured brachial–ankle pulse wave velocity (baPWV) and carotid augmentation index (AIx) as arterial stiffness parameters. RESULTS Peak early diastolic mitral annular velocity (e′) was significantly correlated with baPWV (men: r = −0.428, P < 0.001; women: r = −0.515, P < 0.001) and carotid AIx (men: r = −0.295, P = 0.004; women: r = −0.558, P < 0.001). The ratio of early diastolic mitral flow velocity to e′ (E/e′) was significantly correlated with both arterial stiffness parameters in women but not men. Multivariable regression analysis revealed carotid AIx (β = −0.257; P = 0.02) was a significant independent predictor of e′ in women but not men. CONCLUSIONS These results suggest that the correlation between AIx and LV diastolic function is stronger in women than men in a healthy population. [ABSTRACT FROM PUBLISHER]

Background: Two-dimensional speckle tracking echocardiography (2D-STE) is a novel technology that directly measures regional left ventricular (LV) wall contraction. This study aimed to directly measure inner-layer thickening (radial strain) of the LV using 2D-STE, and to examine the relationship between radial strain and the degree of hypertrophy. Methods: The study enrolled 63 untreated hypertensive patients with normal geometry (N group, n = 32) or concentric hypertrophy (CH group, n = 31 ), classified according to LV mass index (LVMI) and relative wall thickness (RWT). Thirty normotensive subjects (C group, n = 30) served as controls. Radial strain (e) in the inner half (ei) and all layers of the LV wall (sa) were calculated from the LV short-axis view by 2D-STE. Results: LV ejection fraction did not differ significantly among the groups. However, ei and sa were significantly lower in the CH group compared with the C and N groups (p < 0.01 ). A ratio of ei to ea was significantly lower in the CH group compared with the C and N groups (p < 0.01 ). A multivariate regression model that included midwall fractional shortening, E/e', LVMI, RWT, and LV ejection fraction showed that LVMI (p = 0.002) and RWT (p = 0.014) were independent predictors (R2 = 0.59) of ei. Conclusion: Radial strain in the inner half layer of the LV wall decreases in parallel with the degrees of LV concentricity and hypertrophy in hypertensive patients. Radial strain in the inner half layer may identify subtle systolic dysfunction even in hypertensive patients with preserved LV chamber function. [ABSTRACT FROM AUTHOR]