866 results on '"Yoshifusa Aizawa"'
Search Results
2. Incidence and Implications of J waves Observed During Coronary Angiography
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Akinori Sato, Koichi Fuse, Yoshiyasu Aizawa, Masaaki Okabe, Yoshifusa Aizawa, Yuta Sakaguchi, and Takao Sato
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Male ,medicine.medical_specialty ,Myocardial Infarction ,Myocardial Ischemia ,Contrast Media ,Coronary Angiography ,Angina Pectoris ,Angina ,Electrocardiography ,QRS complex ,Left coronary artery ,Cardiac Conduction System Disease ,Internal medicine ,medicine.artery ,medicine ,Humans ,Myocardial infarction ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Coronary arteries ,medicine.anatomical_structure ,Ventricle ,Right coronary artery ,Angiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
J waves may be observed during coronary angiography (CAG), but they have not been fully studied. We investigated the characteristics of J waves in 100 consecutive patients during CAG. The patients and their family members had no history of cardiac arrest. Approximately 60% of patients had ischemic heart disease, previous myocardial infarction, or angina pectoris, but at the time of this study, the right coronary artery was shown to be normal or patent after stenting. Electrocardiogram was serially recorded to monitor J waves and alteration of the QRS complex during CAG. In 12 patients (12%), J waves (0.249 ± 0.074 mV) newly appeared during right CAG, and in another 13 patients (13%), preexisting J waves increased from 0.155 ± 0.060 mV to 0.233 ± 0.133 mV during CAG. Left CAG induced no J waves or augmentation of J waves. Distinct alterations were observed in the QRS complex during CAG of both coronary arteries. Mechanistically, myocardial ischemia induced by contrast medium was considered to result in a local conduction delay, and when it occurred in the inferior wall, the site of the late activation of the ventricle, the conduction delay was manifested as J waves. In conclusion, J waves were confirmed to emerge or increase during angiography of the right but not the left coronary artery. Myocardial ischemia induced by contrast medium caused a local conduction delay that was manifested as J waves in the inferior wall, the site of the late activation of the ventricle.
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- 2022
3. Electrical Storm as an Independent Mortality Risk in Patients with Preserved or Moderately Reduced Left Ventricular Function
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Takashi Noda, Masaya Watanabe, Takashi Nitta, Isao Yokota, Takashi Kurita, Yoshifusa Aizawa, Tohru Ohe, and Hisashi Yokoshiki
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medicine.medical_specialty ,Ejection fraction ,Ventricular function ,Heart disease ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Hazard ratio ,Ventricular tachycardia ,General Medicine ,medicine.disease ,Implantable cardioverter-defibrillator ,Internal medicine ,Non-ischemic heart disease ,medicine ,Cardiology ,In patient ,Mortality ,Cardiology and Cardiovascular Medicine ,business - Abstract
Electrical storm (ES), defined by 3 or more occurrences of ventricular arrhythmias within 24 hours, has been shown to be associated with an increased risk of mortality; however, detailed information remains lacking. We aimed to examine the incidence and determinants of ES and its impact on mortality in patients enrolled in the nationwide implantable cardioverter-defibrillator (ICD) registry. We studied 1,256 patients (age 65 +/- 12 years) who had structural heart disease with an ICD. The patients were classified into reduced ejection fraction (EF < 35%; 657 (52%) patients) and preserved or moderately reduced EF (EF >= 35%; 599 (48%) patients). ES occurred in 49 (7%) and 36 (6%) patients in the EF < 35% and EF >= 35% groups (log-rank P = 0.297) during the median follow-up of 2.3 years. ICD with resynchronization therapy was associated with a lower incidence of ES in patients with EF < 35%. Non-ischemic heart disease and diuretics were associated with ES in patients with EF >= 35%. During the follow-up, 10/49 (20%) patients with ES and 80/608 patients (13%) without ES died in patients with EF < 35%, while 7/36 (19%) patients with ES and 38/563 patients (7%) without ES died in those with EF >= 35%. We have created 4 Cox multivariate models. All models showed approximately 2-fold higher hazard ratios in patients with EF >= 35% compared to EF < 35%. Our study showed that the determinants of ES differed between EF < 35% and EF >= 35%. The impact of ES for mortality was numerically higher in EF >= 35% than in EF < 35%, although a significant interaction was not detected.
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- 2021
4. Tissue repair after pulsed field ablation
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Yoshifusa Aizawa
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
5. Effectiveness of Implantable Cardioverter Defibrillator in Patients With Non-Ischemic Heart Failure With Systolic Dysfunction - Subanalysis of the Nippon Storm Study
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Shingo Sasaki, Takashi Noda, Ken Okumura, Takashi Nitta, Yoshifusa Aizawa, Tohru Ohe, and Takashi Kurita
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General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
The prospective observational Nippon Storm Study aggregated clinical data from Japanese patients receiving implantable cardioverter-defibrillator (ICD) therapy. This study investigated the usefulness of prophylactic ICD therapy in patients with non-ischemic heart failure (NIHF) enrolled in the study.Methods and Results: We analyzed 540 NIHF patients with systolic dysfunction (left ventricular ejection fraction50%). Propensity score matching was used to select patient subgroups for comparison; 126 patients were analyzed in each of the primary (PP) and secondary (SP) prophylaxis groups. The incidence of appropriate ICD therapy during follow-up in the PP and SP groups was 21.4% and 31.7%, respectively (P=0.044). The incidence of electrical storm (ES) was higher in SP than PP patients (P=0.024). Cox proportional hazard analysis revealed that increased serum creatinine in SP patients (hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.02-1.33; P=0.013) and anemia in PP patients (HR 0.92; 95% CI 0.86-0.98; P=0.008) increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation in PP patients (HR, 0.64 [95% CI, 0.45-0.91], P=0.013) decreased that likelihood.In propensity score-matched Japanese NIHF patients, the incidence of appropriate ICD therapy and ES was significantly higher in SP than PP patients. Impaired renal function in SP patients and anemia in PP patients increased the likelihood of appropriate ICD therapy, whereas long-lasting atrial fibrillation reduced that likelihood in PP patients.
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- 2022
6. P-wave indices in Japanese patients with ischemic stroke: Implication of atrial myopathy in subtype of ischemic stroke
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Kohei Akazawa, Yoshifusa Aizawa, Hiroshi Tachikawa, Shigetada Yamamoto, Hideko Ono, Minoru Tagawa, and Hiroshi Motoyama
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medicine.medical_specialty ,Lacunar stroke ,030204 cardiovascular system & hematology ,Brain Ischemia ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Muscular Diseases ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Myopathy ,Stroke ,Aged ,Ischemic Stroke ,Aged, 80 and over ,First episode ,business.industry ,P wave ,Interatrial Block ,medicine.disease ,Ischemic stroke ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
P-wave indices have been not fully studied in subtypes of ischemic stroke. We compared P-wave indices among embolic stroke, lacunar stroke and the control.P-wave duration, advanced interatrial block (aIAB) defined as P-wave duration ≥120 ms and biphasic (positive negative) morphology in inferior leads, and P-terminal force in lead V1 (PTFV1) were measured at the time of the first episode of cardioembolic stroke in 81 patients with paroxysmal atrial fibrillation (PAF), and in 64 patients with lacunar stroke, and compared with 100 control subjects. The latter two groups had no episode of PAF.The age of participants was 76 ± 11 years. Age, sex distribution, body mass index and CHADS2 score were comparable among three groups. Maximum P-wave duration, the longest across 12 leads, was significantly prolonged in cardioembolic and lacuna stroke compared to the control; 118 ± 12 ms and 118 ± 11 ms vs. 110 ± 11 ms, respectively (P 0.0001). P-wave duration ≥120 ms and aIAB were more prevalent in ischemic stroke groups than the control, and associated with a higher Odds ratio for stroke, more so in cardioembolic stroke. However, PTFV1 value and the prevalence of PTFV1 ≥ 4.0 ms·mV were significantly not different among the three groups. Abnormal P-wave duration and aIAB indicating the presence of atrial myopathy were present in cardioembolic and lacuna stroke.Atrial myopathy was present in cardioembolic and lacunar stroke, but it can't be the direct cause of small vessel occlusion in lacunar stroke. Roles of atrial myopathy in each subtype of ischemic stroke should be studied.
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- 2021
7. Efficacy of antitachycardia pacing for electrical storms in patients with implantable defibrillators
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Yuki Iwasaki, Hiroshi Hayashi, Takashi Noda, Takashi Kurita, Kenji Yodogawa, Yoshifusa Aizawa, Wataru Shimizu, Takashi Nitta, and Tohru Ohe
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medicine.medical_specialty ,medicine.medical_treatment ,Long QT syndrome ,030204 cardiovascular system & hematology ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Brugada Syndrome ,Brugada syndrome ,business.industry ,Cardiac Pacing, Artificial ,Odds ratio ,Implantable cardioverter-defibrillator ,medicine.disease ,Confidence interval ,Defibrillators, Implantable ,Shock (circulatory) ,Ventricular Fibrillation ,Tachycardia, Ventricular ,Antitachycardia Pacing ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
INTRODUCTION Although antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all-cause mortality have not been fully elucidated. METHODS AND RESULTS From 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all-cause mortality were evaluated. During a median follow-up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00-1.04; p = .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01-1.06; p
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- 2021
8. Small lipid core burden index in patients with stable angina pectoris is also associated with microvascular dysfunction: Insights from intracoronary electrocardiogram
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Sho Yuasa, Sonoka Goto, Yusuke Ohta, Takao Sato, and Yoshifusa Aizawa
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medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Balloon ,Electrocardiography ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Intravascular ultrasound ,medicine ,Humans ,Angina, Stable ,cardiovascular diseases ,030212 general & internal medicine ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Stent ,Hematology ,medicine.disease ,Coronary Vessels ,Lipids ,Plaque, Atherosclerotic ,Stenosis ,surgical procedures, operative ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Dyslipidemia - Abstract
Near-infrared spectroscopy with intravascular ultrasound (NIRS)-IVUS enables precise detection of lipid core burden. Intracoronary electrocardiography (ECG) can detect slight ischemia during percutaneous coronary intervention (PCI), indicating microvascular dysfunction (MD) by distal embolization, etc. Thus, this study aimed to investigate whether plaques with a low max-lipid core burden index (LCBI) at 4 mm (LCBI4mm) influence MD, using intracoronary ECG. We enrolled 40 consecutive patients who underwent PCI for stable angina pectoris (SAP) due to stenosis of the proximal segment of the left anterior descending artery in this study. Max-LCBI4mm was measured for each culprit lesion. Gray-scale IVUS data including plaque burden were measured. Intracoronary ECG was performed to measure the time from the initiation of ST-segment elevation from the isoelectric baseline after stent balloon inflation to the return of the ST-segment to the isoelectric baseline after the deflation of the stent balloon, which was defined as the severity of the MD. The patients were divided into two groups according to median max-LCBI4mm of 120 as follows: low- [n = 20] and high- [n = 20] LCBI groups. The overall mean Max-LCBI4mm was 120 ± 86. No differences in baseline characteristics, including prevalence of dyslipidemia, were found between both groups, as well as in the gray-scale IVUS parameters. The severity of the MD was greater in the high-LCBI group than in the low-LCBI group (16.6 ± 9.1 vs 4.7 ± 4.8 s, P
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- 2021
9. Patient‐by‐patient basis anti‐tachycardia pacing for fast ventricular tachycardia with structural heart diseases
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Takashi Noda, Masaomi Chinushi, Yoshifusa Aizawa, Osamu Saitoh, Takashi Kurita, Takashi Nitta, Tohru Ohe, and Hiroshi Furushima
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Male ,Tachycardia ,medicine.medical_specialty ,Heart Diseases ,Electric Countershock ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Amiodarone ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Heart rate ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Ejection fraction ,Receiver operating characteristic ,business.industry ,Cardiac Pacing, Artificial ,General Medicine ,medicine.disease ,Defibrillators, Implantable ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Anti-tachycardia pacing (ATP) delivered from an implantable device is an important tool to terminate ventricular tachycardia (VT). But its real-world efficacy for fast VT has not been fully studied. Methods Using the database of Nippon-storm study, effect of patient-by-patient basis ATP programming for fast VT (≥188 bpm) was assessed for the patients with structural heart diseases. Fast VTs were divided into three groups depending on heart rate (HR); Group A was 188-209 bpm, and Group-B and Group-C were 210-239 bpm and ≥240 bpm, respectively. Results During a median follow-up of 28 months, 202 fast VT episodes (209 ± 19 bpm) were demonstrated in the 85 patients. ATP terminated 151 of the 202 episodes (74.8%) in total. The success rate of the ATP was not different among the three groups: 73.3% in Group A, 80.6% in Group B, and 66.7% in Group C. ATP success rate of >50% and >70% was 77.6% and 64.7% of the patients, respectively. Left ventricular ejection fraction (LVEF) was significantly higher in the patients with rather than without successful ATP therapy, and receiver operating characteristic (ROC) analysis revealed that LVEF of 23% was the optimal cut-off value. ATP was less effective in patients taking amiodarone, but etiology of the structural heart diseases, indication of the device implantation, and all Electrocardiogram (ECG) parameters were not useful predictors for successful ATP therapy. Conclusions ATP highly terminated fast VT with wide HR ranges in patients with structural heart diseases, and should be considered as the first-line therapy for fast VT except for patients with very low LVEF.
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- 2020
10. The Determinants and Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation: SAPIEN 3 Study
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Yoshio Ikeda, Sho Yuasa, Satoshi Fujita, Minoru Takahashi, Yuji Taya, Yoshifusa Aizawa, Hitoshi Kitazawa, Masaaki Okabe, and Takao Sato
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Male ,Aortic valve ,medicine.medical_specialty ,Time Factors ,Heart Diseases ,Transcatheter aortic ,medicine.drug_class ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Risk Assessment ,Ventricular Function, Left ,Rapid pacing ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Troponin T ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Humans ,Medicine ,030212 general & internal medicine ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Significant difference ,Recovery of Function ,General Medicine ,medicine.disease ,Peptide Fragments ,Aortic valvuloplasty ,Treatment Outcome ,medicine.anatomical_structure ,Ventricle ,Aortic Valve ,Aortic valve stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background The effect of myocardial injury (MI) post-transcatheter aortic valve implantation (TAVI) on clinical outcomes is controversial. This study aimed to evaluate the effect of MI severity on clinical outcome and left ventricle function 30 days post-TAVI and determine MI post-TAVI predictors. Methods Overall, 138 consecutive patients who underwent successful transfemoral TAVI using SAPIEN3 and diagnosed using echocardiography and computed tomography were analyzed. High-sensitivity cardiac troponin T (TnT) was evaluated at baseline, immediately, and at 24, 48, and 72 h post-TAVI. Echocardiography findings and N-terminal pro-B-type natriuretic peptide (Nt-pro BNP) levels were evaluated 30 days post-TAVI. Results Mean age and STS score were 84.4 ± 3.5 years and 6.4 ± 3.2%, respectively. All cases showed severe aortic valve stenosis. Peri-procedural MI was observed in 48 of 100 patients (48.0%). Patients were grouped into MI (n = 48) and non-MI (n = 52), without significant difference in characteristics. Pre-balloon aortic valvuloplasty rate and total pacing time were significantly higher in MI vs non-MI. Total rapid pacing time (TRPT) was an independent predictor for MI (OR 1.06; 95% CI 1.01–1.16; p = 0.04). Echocardiography and Nt-pro BNP changes 30 days post-TAVI were similar between groups. Conclusion Peri-procedural MI, assessed by TnT changes, was observed in 48% of patients. The MI was not associated with overt cardiac dysfunction, and the recovery of left ventricular function and Nt-pro BNP level occurred similarly by 30 day post-TAVI between both groups. In multivariate analysis, TRPT was associated with MI after SAPIEN3 implantation. Trial registration number UMIN000036669.
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- 2020
11. Blood Pressure Increases Before Pulse Rate During the Nocturnal Period in Hypertensive Patients
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Masaaki Okabe, Yuki Kuramoto, Yasushi Sakata, Yoshifusa Aizawa, Masami Aizawa, and Miho Kuramoto
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medicine.medical_specialty ,Ambulatory blood pressure ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,Nocturnal ,Nocturnal blood pressure ,03 medical and health sciences ,0302 clinical medicine ,Cardiothoracic ratio ,Blood pressure ,Pulse rate ,Internal medicine ,Time course ,medicine ,Cardiology ,Clinical significance ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Ambulatory blood pressure monitoring (ABPM) is used for the evaluation of out-of-office blood pressure (BP), however, knowledge concerning the detailed behavior of nocturnal blood pressure (BP) and pulse rate (PR) is limited.A total of 190 participants (64 ± 15 years, 46.3% males) underwent ABPM for diagnosis of hypertension or evaluation of hypertensive therapy. BP and PR were measured automatically by the oscillometric method. From the hourly average ABPM values, the nocturnal time courses (0 AM to 6 AM) of SBP and PR were determined and compared to each other.In general, SBP fell to the lowest level at around midnight and started to increase progressively towards dawn while PR stayed unchanged until 7 AM. Age and gender affected the time course of SBP, most distinctly in the female patients aged ≥ 60 years. The time course of the increase of SBP was very similar in the patients, with BP dipping and non-dipping. The cardiothoracic ratio (CTR) slightly and renal dysfunction modestly facilitated the increase of nocturnal SBP. The nocturnal increase in SBP was not accompanied by an increase of PR in any group or subgroup. The pathophysiology and clinical significance of the early and exclusive increase in nocturnal BP need to be investigated.Average ABPM values in these hypertensive patients showed that BP starts to increase toward dawn without an increase in PR and that this discrepant behavior between BP and RP was most distinct in females 60 or older. The mechanism and clinical significance of such a discordant variation in BP and PR need to be elucidated.
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- 2020
12. Detection of Atrial Fibrillation Using Differential Entropy Obtained from Only 21 R-R Intervals
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Ryo Shinozaki, Taishi Matsui, and Yoshifusa Aizawa
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History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2022
13. Predictors and outcomes of ischemia-driven target lesion revascularization in deferred lesion based on fractional flow reserve: a multi-center retrospective cohort study
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Takao Sato, Sonoka Goto, Shohei Kishi, Kohei Yamaguchi, Takayuki Warisawa, Amane Kozuki, Suga Toshihiro, Keiichi Tsuchida, Hirokazu Yokoi, Kawai Kazuya, Kohei Akazawa, and Yoshifusa Aizawa
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Cardiology and Cardiovascular Medicine - Abstract
Fractional flow reserve (FFR) has become the gold standard for diagnosing ischemia in angiographically intermediate epicardial coronary artery stenosis. This study investigated the clinical outcomes and predictors of revascularization deferral based on FFR.In this retrospective cohort study, we assessed 474 lesions (440 patients) where revascularization was deferred based on the FFR value. Minimum lumen diameter and %-diameter stenosis were measured. Calcification was graded as none, mild, moderate, or heavy. The synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score I was also determined. The primary outcome was ischemia-driven target lesion revascularization (TLR) in deferred lesions within 3 years. Patients were also assigned into two groups based on FFR value.The average age of the patients was 69.7±10.4 years. The average FFR value was 0.86±0.05. Stable angina pectoris was noted in 298 (67.7%) cases, and in-stent restenosis (ISR) was present in 28 (5.9%). The average SYNTAX score was 7.2±4.2. The 3-year ischemia-driven TLR was 18 lesions (3.8%). Cox proportional hazard model revealed that the SYNTAX score and ISR were independent predictors for TLR in deferred lesions [hazard ratio (HR) =1.10, 95% confidential interval (CI): 1.01-1.19, P=0.03; HR =6.33; 95% CI: 2.25-17.8, P0.01, respectively]. The deferral group, with a low FFR value, tended to have higher TLR rates than other groups.Lesions with lower FFR values were associated with a higher incidence of ischemia-driven TLR than those with higher FFR values. SYNTAX score and ISR were predictors for ischemia-driven TLR at 3 years in the deferred lesions.
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- 2021
14. Electrical Storm as an Independent Mortality Risk in Patients with Preserved or Moderately Reduced Left Ventricular Function
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Masaya, Watanabe, Hisashi, Yokoshiki, Takashi, Noda, Isao, Yokota, Takashi, Nitta, Yoshifusa, Aizawa, Tohru, Ohe, and Takashi, Kurita
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Male ,Heart Diseases ,Stroke Volume ,Prognosis ,Defibrillators, Implantable ,Cardiac Resynchronization Therapy ,Japan ,Multivariate Analysis ,Tachycardia, Ventricular ,Humans ,Female ,Prospective Studies ,Registries ,Diuretics ,Aged - Abstract
Electrical storm (ES), defined by 3 or more occurrences of ventricular arrhythmias within 24 hours, has been shown to be associated with an increased risk of mortality; however, detailed information remains lacking. We aimed to examine the incidence and determinants of ES and its impact on mortality in patients enrolled in the nationwide implantable cardioverter-defibrillator (ICD) registry.We studied 1,256 patients (age 65 ± 12 years) who had structural heart disease with an ICD. The patients were classified into reduced ejection fraction (EF35%; 657 (52%) patients) and preserved or moderately reduced EF (EF ≥ 35%; 599 (48%) patients).ES occurred in 49 (7%) and 36 (6%) patients in the EF35% and EF ≥ 35% groups (log-rank P = 0.297) during the median follow-up of 2.3 years. ICD with resynchronization therapy was associated with a lower incidence of ES in patients with EF35%. Non-ischemic heart disease and diuretics were associated with ES in patients with EF ≥ 35%. During the follow-up, 10/49 (20%) patients with ES and 80/608 patients (13%) without ES died in patients with EF35%, while 7/36 (19%) patients with ES and 38/563 patients (7%) without ES died in those with EF ≥ 35%. We have created 4 Cox multivariate models. All models showed approximately 2-fold higher hazard ratios in patients with EF ≥ 35% compared to EF35%.Our study showed that the determinants of ES differed between EF35% and EF ≥ 35%. The impact of ES for mortality was numerically higher in EF ≥ 35% than in EF35%, although a significant interaction was not detected.
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- 2021
15. CORRIGENDUM: JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias
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Shun-ichiro Sakamoto, Masaomi Kimura, Atsushi Takahashi, Tsuyoshi Shiga, Takeshi Kimura, Yasushi Miyauchi, Yoshifusa Aizawa, Masaomi Chinushi, Hiroshi Tada, Takashi Nitta, Takashi Kurita, Haruhiko Abe, Koichi Inoue, Wataru Shimizu, Tomoshige Morimoto, Shinichi Niwano, Hideo Mitamura, Akihiko Usui, Akihiko Nogami, Morio Shoda, Nobuhisa Hagiwara, Michio Ogano, Takashi Noda, Yukio Sekiguchi, Shigeto Naito, Kengo Kusano, Hiroyuki Tsutsui, Yuji Murakawa, Hitoshi Hachiya, Hiro Yamasaki, Kenji Ando, Teiichi Yamane, Takeshi Aiba, Kazuo Tanemoto, Yu-ki Iwasaki, Naokata Sumitomo, Yasuya Inden, Akihiko Shimizu, Koichiro Kumagai, Katsuhiko Imai, Tohru Ohe, Yoshinori Kobayashi, Masataka Mitsuno, Kyoko Soejima, Kikuya Uno, Kazuhiro Satomi, Nobuhiro Nishi, Tsugutoshi Suzuki, Shingo Sasaki, Toshiyuki Ishikawa, Masahiko Takagi, Takashi Nishimura, Aya Miyazaki, Yuji Nakazato, Masahiko Goya, Takeshi Mitsuhashi, Yoshihiro Seo, and Kaoru Okishige
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medicine.medical_specialty ,Pharmacotherapy ,business.industry ,Medicine ,General Medicine ,Guideline ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Published
- 2021
16. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias
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Akihiko Nogami, Takashi Kurita, Haruhiko Abe, Kenji Ando, Toshiyuki Ishikawa, Katsuhiko Imai, Akihiko Usui, Kaoru Okishige, Kengo Kusano, Koichiro Kumagai, Masahiko Goya, Yoshinori Kobayashi, Akihiko Shimizu, Wataru Shimizu, Morio Shoda, Naokata Sumitomo, Yoshihiro Seo, Atsushi Takahashi, Hiroshi Tada, Shigeto Naito, Yuji Nakazato, Takashi Nishimura, Takashi Nitta, Shinichi Niwano, Nobuhisa Hagiwara, Yuji Murakawa, Teiichi Yamane, Takeshi Aiba, Koichi Inoue, Yuki Iwasaki, Yasuya Inden, Kikuya Uno, Michio Ogano, Masaomi Kimura, Shun‐ichiro Sakamoto, Shingo Sasaki, Kazuhiro Satomi, Tsuyoshi Shiga, Tsugutoshi Suzuki, Yukio Sekiguchi, Kyoko Soejima, Masahiko Takagi, Masaomi Chinushi, Nobuhiro Nishi, Takashi Noda, Hitoshi Hachiya, Masataka Mitsuno, Takeshi Mitsuhashi, Yasushi Miyauchi, Aya Miyazaki, Tomoshige Morimoto, Hiro Yamasaki, Yoshifusa Aizawa, Tohru Ohe, Takeshi Kimura, Kazuo Tanemoto, Hiroyuki Tsutsui, Hideo Mitamura, and the JCS/JHRS Joint Working Group
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Tachycardia ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac arrhythmia ,Catheter ablation ,Atrial fibrillation ,Arrhythmias, Cardiac ,General Medicine ,Guideline ,Guidelines ,Ventricular tachycardia ,medicine.disease ,Surgery ,Pharmacotherapy ,RC666-701 ,Practice Guidelines as Topic ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Humans ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Radical therapy ,business - Abstract
1 Current status of non‐pharmacotherapies in Japan Pacemaker treatment for bradyarrhythmia was first approved for national health insurance coverage in Japan in 1974, and its use rapidly became widespread thereafter. Approximately 40 years later, in 2017, the number of patients treated with this technology has increased to 60 137 (41 895 new cases and approximately 18 242 replacements). 5 Capsule‐shaped leadless pacemaker also became available in 2016, and this technology is being established as a new option. Non‐pharmacological treatment of tachy‐arrhythmia began in 1969 from when Will C. Sealy performed surgery in patients with Wolff‐Parkinson‐White (WPW) syndrome (Figure 1). Since then, the application of surgical treatment has expanded to conditions such as ventricular tachycardia (VT) and atrial fibrillation (AF), and surgery has been the pioneer of radical therapy for tachyarrhythmias. At the present time, many surgical methods have been replaced by catheter ablation; however, surgical treatment still remains an indispensable option for patients with a tachycardia resistant to other medical treatments. Open in a separate window FIGURE 1 History of non‐pharmacotherapy of cardiac arrhythmia
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- 2021
17. Asymptomatic Coronary Artery Disease in Japanese Patients With the Acute Ischemic Stroke
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Kiminori Kato, Shigekazu Takeuchi, Yukie Ochiai, Yoshinori Taniguchi, Makihiko Saeki, Hiroyuki Watanabe, Tsukasa Ohno, Minoru Tagawa, Yuichi Nakamura, Masaomi Chinushi, and Yoshifusa Aizawa
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Male ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,Coronary Artery Disease ,Coronary Angiography ,Scintigraphy ,Risk Assessment ,Asymptomatic ,Magnetic resonance angiography ,Brain Ischemia ,Coronary artery disease ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Japan ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,cardiovascular diseases ,Aged ,Aged, 80 and over ,First episode ,medicine.diagnostic_test ,business.industry ,Rehabilitation ,Middle Aged ,Prognosis ,medicine.disease ,Cerebral Angiography ,Stroke ,Stenosis ,medicine.anatomical_structure ,Positron-Emission Tomography ,Asymptomatic Diseases ,Disease Progression ,Cardiology ,Female ,Surgery ,Neurology (clinical) ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,Magnetic Resonance Angiography ,030217 neurology & neurosurgery ,Artery - Abstract
OBJECTIVE To investigate the prevalence and outcomes of asymptomatic coronary artery disease (CAD) in patients with the first episode of ischemic stroke. METHODS Patients admitted to our hospital between November 2001 and January 2009 for the episode of an acute ischemic stroke/transient ischemic attack were included. Stress-Tl-201 scintigraphy was performed and followed by coronary angiography (CAG). The prevalence and risks for asymptomatic CAD, and long-term outcomes were studied. RESULTS Of 1309 patients, only 15 (1.1%) patients presented with a history of CAD. Excluding 406 patients because of severity, systemic infection, early transfer to another hospital, or a refusal to participate, myocardial scintigraphy was performed in 903 patients (mean age, 72 ± 10 years, male 63.9%), and myocardial ischemia was diagnosed in 214 patients (23.7%). Of these patients, 76 patients underwent CAG, and showed significant stenosis (>75%) of a coronary artery in 61 (80.3%) patients. The risk factors for positive scintigraphy findings and CAG were high-grade premature complexes via Holter monitoring (P < .0001), enlarged left ventricle (P = .0051) and wall motion abnormalities (P = .0014) observed on echocardiography, and carotid artery stenosis observed in magnetic resonance angiography imaging (P < .0001). During the follow-up periods of 83 ± 47 months and of 91 ± 47 months, 17.2% of scintigraphy-positive and 2.8% of scintigraphy-negative patients developed episodes of myocardial ischemia, respectively (P < .001). CONCLUSIONS Symptomatic CAD was rare in Japanese patients with the first episode of ischemic stroke, but asymptomatic CAD was identified by stress Tl-201 myocardial scintigraphy in one-quarter of the patients. Positive scintigraphy was associated with asymptomatic CAD and future cardiac events.
- Published
- 2019
18. Prevalence, significance and reversal of abnormal P-wave indices in hypertension: A review and meta-analysis
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Kohei Akazawa, Takao Sato, and Yoshifusa Aizawa
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medicine.medical_specialty ,business.industry ,P wave ,New onset atrial fibrillation ,Electrocardiography ,Internal medicine ,Meta-analysis ,Atrial Fibrillation ,Hypertension ,Prevalence ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
19. Impact of atrial fibrillation/flutter on outcomes of patients with implantable cardioverter defibrillators: A sub-analysis of the Nippon Storm study
- Author
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Takashi Kurita, Tohru Ohe, Takashi Noda, Ryobun Yasuoka, Gaku Nakazawa, Takashi Nitta, Masahiro Maruyama, Yoshifusa Aizawa, and Tomoya Nagano
- Subjects
medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Heart Failure ,Atrial fibrillation flutter ,business.industry ,Cardiac arrhythmia ,Atrial fibrillation ,Stroke Volume ,medicine.disease ,Defibrillators, Implantable ,Treatment Outcome ,cardiovascular system ,Cardiology ,Observational study ,Cardiology and Cardiovascular Medicine ,business - Abstract
Implantable cardioverter-defibrillator and cardiac resynchronization therapy using a defibrillator (ICD/CRT-D) are established means of reducing mortality due to ventricular arrhythmia. Although atrial fibrillation/flutter (AF) is the most common cardiac arrhythmia in patients with heart disease, the impact of AF on the prognosis of patients with ICD/CRT-D remains controversial.We analyzed data from the Nippon Storm Study, a prospective observational study of 1570 patients that was conducted at 48 Japanese ICD centers. We allocated 1549 participants to AF and non-AF groups, compared their clinical data at the time of enrollment, and monitored the incidences of mortality, hospitalization, and appropriate and inappropriate ICD/CRT-D therapy during a median 28 months. When the AF (n = 257, 16.6%) and non-AF-(n = 1292, 83.4%) groups were compared, the AF group was older (67.7 vs. 61.4 years; p0.0001), and had lower left ventricular ejection fraction (38.0 ± 17.0% vs. 43.5 ± 18.9%; p0.0001). During follow up, mortality was significantly higher in the AF than the non-AF group (p0.0001). In multivariate analysis, AF was significantly associated with all-cause mortality [p = 0.013; hazard ratio (HR)=1.62]. Inappropriate ICD/CRT-D therapy occurred in 40/257 patients (15.6%) and AF was associated with a higher prevalence of inappropriate ICD/CRT-D therapy (p0.0001; HR=2.25).The presence of AF at ICD/CRT-D implantation carries subsequent independent risks of 1.62-fold for death and 2.25-fold for inappropriate therapy.
- Published
- 2021
20. J waves induced during coronary angiography in patients with vasospastic angina and its implication
- Author
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Akinori Sato, Yoshifusa Aizawa, Masaaki Okabe, and Hitoshi Kitazawa
- Subjects
Coronary angiography ,Angina Pectoris, Variant ,Male ,medicine.medical_specialty ,Myocardial ischemia ,Coronary Vasospasm ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Vasospastic angina ,business.industry ,Arrhythmias, Cardiac ,medicine.disease ,Contrast medium ,Right coronary artery ,Ventricular fibrillation ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Conduction delay - Abstract
Background J waves may develop during coronary angiography (CAG). Patients and results Seven patients (61±6 years, 6 male) had vasospastic angina. ST-segment elevation and ventricular fibrillation were documented in all patients. CAG revealed normal arteries, but slurring or notching (J waves) with an amplitude of 0.20±0.06 mV appeared for the first time (n=6) or in an augmented manner (n=1) with distinct alterations in QRS morphology when contrast medium was injected into the right coronary artery. Conclusion In patients with vasospastic angina, J waves observed during CAG can be a manifestation of a local conduction delay caused by contrast medium-induced myocardial ischemia.
- Published
- 2020
21. The Characteristics and Clinical Outcomes of Direct Oral Anticoagulantsin Patients with Atrial Fibrillation and Chronic Kidney Disease: From the Database of A Single-Center Registry
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Takao, Sato, Yoshifusa, Aizawa, Hitoshi, Kitazawa, and Masaaki, Okabe
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Atrial fibrillation ,urologic and male genital diseases ,Cardiology and Cardiovascular Medicine ,medicine.disease ,Single Center ,business ,Original Research ,Kidney disease - Abstract
BACKGROUND: This study aimed to evaluate the characteristics and clinical outcomes (major bleeding [MB] and thromboembolic events [TEEs]) of atrial fibrillation (AF) patients with chronic kidney disease (CKD)who receiveddirect oral anticoagulant (DOAC) therapy. METHODS: Data prospectivelycollected from a single-center registry containing 2,272 patients with DOAC prescription for AF (apixaban [n=1,014], edoxaban [n=267], rivaroxaban [n=498], and dabigatran[n=493]) were retrospectively analyzed. Patients were monitored for two years and classified into the CKD (n=1460) andnon-CKD groups(n=812). MB and TEEs were evaluated. RESULTS: The mean age was 72±10 years, with the CHADS2,CHA2DS2-VASc, and HAS-BLED scores being 1.95±1.32, 3.21±1.67, and 1.89±0.96,respectively.Incidence rates of MB and TEEs were 2.3%/year and 2.1%/year, respectively. The CKD groupwasolderand had lower body weight and higher CHADS2,CHA2DS2-VASc, and HAS-BLED scoresthanthe non-CKD group.Kaplan–Meier curve analysis revealed that the incidence of MB and TEEs was higher in the CKD group. Multiple logistic regression analysis in the CKD group revealed thatage andstroke history were independent determinants of TEEs, and low body weighttended to be a determinant of MB.The inappropriate low dose use was higher for apixaban than other DOACs in the CKD group. Consequently, for apixaban, the incidence of stroke was significantly higherin the CKD group than in the non-CKD group. CONCLUSIONS: Patients with CKDwere characterized by factors that predisposed them to MB and TEEs, such as older age and low body weight. In a single-center registry, only treatment with apixaban in the CKD group led to a higher incidence of TEEs.
- Published
- 2020
22. Systematic Evaluation of
- Author
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Asami, Kashiwa, Takeshi, Aiba, Hisaki, Makimoto, Keiko, Shimamoto, Kenichiro, Yamagata, Tsukasa, Kamakura, Mitsuru, Wada, Koji, Miyamoto, Yuko, Inoue-Yamada, Kohei, Ishibashi, Takashi, Noda, Satoshi, Nagase, Aya, Miyazaki, Heima, Sakaguchi, Isao, Shiraishi, Nobue, Yagihara, Hiroshi, Watanabe, Yoshifusa, Aizawa, Takeru, Makiyama, Hideki, Itoh, Kenshi, Hayashi, Masakazu, Yamagishi, Naotaka, Sumitomo, Masao, Yoshinaga, Hiroshi, Morita, Tohru, Ohe, Yoshihiro, Miyamoto, Naomasa, Makita, Satoshi, Yasuda, Kengo, Kusano, Seiko, Ohno, Minoru, Horie, and Wataru, Shimizu
- Subjects
Retraction - Published
- 2020
23. Systematic Evaluation of KCNQ1 Variant Using ACMG/AMP Guidelines and Risk Stratification in Long QT Syndrome Type 1
- Author
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Satoshi Yasuda, Yoshihiro Miyamoto, Mitsuru Wada, Aya Miyazaki, Hiroshi Morita, Nobue Yagihara, Takashi Noda, Takeru Makiyama, Yoshifusa Aizawa, N Sumitomo, Isao Shiraishi, Keiko Shimamoto, Hideki Itoh, Masao Yoshinaga, Hiroshi Watanabe, Takeshi Aiba, Masakazu Yamagishi, Heima Sakaguchi, Satoshi Nagase, Wataru Shimizu, Kengo Kusano, Hisaki Makimoto, Kohei Ishibashi, Tsukasa Kamakura, Kenshi Hayashi, Tohru Ohe, Yuko Inoue-Yamada, Naomasa Makita, Minoru Horie, Kenichiro Yamagata, Asami Kashiwa, Seiko Ohno, and Koji Miyamoto
- Subjects
0301 basic medicine ,Proband ,medicine.medical_specialty ,Syndrome type ,Molecular pathology ,business.industry ,Long QT syndrome ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Pathogenicity ,Gastroenterology ,QT interval ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Internal medicine ,Risk stratification ,medicine ,Medical genetics ,business - Abstract
Background - Mutation/variant-site specific risk stratification in long-QT syndrome type 1 (LQT1) has been well investigated, but it is still challenging to adapt current enormous genomic information to clinical aspects caused by each mutation/variant. We assessed a novel variant-specific risk stratification in LQT1 patients. Methods - We classified a pathogenicity of 141 KCNQ1 variants among 927 LQT1 patients (536 probands) based on the American College of Medical Genetics and Genomics (ACMG) and Association for Molecular Pathology (AMP) guidelines and evaluated whether the ACMG/AMP-based classification was associated with arrhythmic risk in LQT1 patients. Results - Among 141 KCNQ1 variants, 61 (43.3%), 55 (39.0%), and 25 (17.7%) variants were classified into pathogenic (P), likely pathogenic (LP), and variant of unknown significance (VUS), respectively. Multivariable analysis showed that proband (HR = 2.53; 95%CI = 1.94-3.32; p KCNQ1 evaluation was useful for risk stratification not only in family members but also in probands. A clinical score (0~4) based on proband, QTc (≥500ms), variant location (MS or C-loop) and P variant by ACMG/AMP guidelines allowed identification of patients more likely to have arrhythmic events. Conclusions - Comprehensive evaluation of clinical findings and pathogenicity of KCNQ1 variants based on the ACMG/AMP-based evaluation may stratify arrhythmic risk of congenital long-QT syndrome type 1.
- Published
- 2020
24. Blood Pressure Increases Before Pulse Rate During the Nocturnal Period in Hypertensive Patients
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Miho, Kuramoto, Masami, Aizawa, Yuki, Kuramoto, Masaaki, Okabe, Yasushi, Sakata, and Yoshifusa, Aizawa
- Subjects
Aged, 80 and over ,Male ,Cross-Sectional Studies ,Heart Rate ,Hypertension ,Humans ,Blood Pressure ,Female ,Middle Aged ,Aged ,Circadian Rhythm ,Retrospective Studies - Abstract
Ambulatory blood pressure monitoring (ABPM) is used for the evaluation of out-of-office blood pressure (BP), however, knowledge concerning the detailed behavior of nocturnal blood pressure (BP) and pulse rate (PR) is limited.A total of 190 participants (64 ± 15 years, 46.3% males) underwent ABPM for diagnosis of hypertension or evaluation of hypertensive therapy. BP and PR were measured automatically by the oscillometric method. From the hourly average ABPM values, the nocturnal time courses (0 AM to 6 AM) of SBP and PR were determined and compared to each other.In general, SBP fell to the lowest level at around midnight and started to increase progressively towards dawn while PR stayed unchanged until 7 AM. Age and gender affected the time course of SBP, most distinctly in the female patients aged ≥ 60 years. The time course of the increase of SBP was very similar in the patients, with BP dipping and non-dipping. The cardiothoracic ratio (CTR) slightly and renal dysfunction modestly facilitated the increase of nocturnal SBP. The nocturnal increase in SBP was not accompanied by an increase of PR in any group or subgroup. The pathophysiology and clinical significance of the early and exclusive increase in nocturnal BP need to be investigated.Average ABPM values in these hypertensive patients showed that BP starts to increase toward dawn without an increase in PR and that this discrepant behavior between BP and RP was most distinct in females 60 or older. The mechanism and clinical significance of such a discordant variation in BP and PR need to be elucidated.
- Published
- 2020
25. Placebo-Controlled, Double-Blind Study of Empagliflozin (EMPA) and Implantable Cardioverter-Defibrillator (EMPA-ICD) in Patients with Type 2 Diabetes (T2DM): Rationale and Design
- Author
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Takeshi Kato, Toyoaki Murohara, Nobutaka Kitamura, Yoshihiro Morino, Masafumi Watanabe, Kazuomi Kario, Hisako Yoshida, Kenji Ando, Empa-Icd investigators, Yoshifusa Aizawa, Hirofumi Tomita, Kenichi Iijima, Shigeto Naito, Masafumi Yano, Toshihisa Anzai, Koji Maemura, Keiko Ota, Yusuke Kondo, Koichi Node, Kazuyoshi Takahashi, Yasuchika Takeishi, Ippei Shimizu, Masaaki Okabe, Takeshi Mitsuhashi, Hiroshi Tada, Kenichi Tsujita, Nobuhisa Hagiwara, Daisuke Izumi, Junichi Nitta, Masaki Ieda, Shinya Fujiki, Wataru Shimizu, Shinichi Niwano, Yoshihisa Nakagawa, Kazuyuki Ozaki, Kengo Kusano, Takahiro Tanaka, Takeshi Kimura, Tetsuji Miura, Tohru Minamino, and Ritsushi Kato
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Sympathetic nerve activity ,030209 endocrinology & metabolism ,Implantable cardioverter-defibrillator (ICD) ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Placebo ,Sudden cardiac death ,03 medical and health sciences ,Study Protocol ,Type 2 diabetes (T2DM) ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,Empagliflozin ,medicine ,Clinical endpoint ,business.industry ,medicine.disease ,Implantable cardioverter-defibrillator ,Clinical trial ,Cardiology ,Ketone bodies ,Empagliflozin (EMPA) ,business ,Arrhythmia - Abstract
Introduction Type 2 diabetes (T2DM) is associated with cardiovascular death, including sudden cardiac death due to arrhythmias. Patients with an implantable cardioverter-defibrillator (ICD) are also at high risk of developing a clinically significant ventricular arrhythmia. It has been reported that sodium–glucose cotransporter 2 (SGLT2) inhibitors can reduce cardiovascular deaths; however, the physiological mechanisms of this remain unclear. It is, however, well known that SGLT2 inhibitors increase blood ketone bodies, which have been suggested to have sympatho-suppressive effects. Empagliflozin (EMPA) is an SGLT2 inhibitor. The current clinical trial titled “Placebo-controlled, double-blind study of empagliflozin (EMPA) and implantable cardioverter-defibrillator (EMPA-ICD) in patients with type 2 diabetes (T2DM)” was designed to investigate the antiarrhythmic effects of EMPA. Methods The EMPA-ICD study is a prospective, multicenter, placebo-controlled, double-blind, randomized, investigator-initiated clinical trial currently in progress. A total of 210 patients with T2DM (hemoglobin A1c 6.5–10.0%) will be randomized (1:1) to receive once-daily placebo or EMPA, 10 mg, for 24 weeks. The primary endpoint is the number of clinically significant ventricular arrhythmias for 24 weeks before and 24 weeks after study drug administration, as documented by the ICD. The secondary endpoints of the study are the change from baseline concentrations in blood ketone and catecholamine 24 weeks after drug treatment. Conclusion The EMPA-ICD study is the first clinical trial to assess the effect of an SGLT2 inhibitor on clinically significant ventricular arrhythmias in patients with T2DM and an ICD. Trial registration Unique trial number, jRCTs031180120 (https://jrct.niph.go.jp/latest-detail/jRCTs031180120). Electronic Supplementary Material The online version of this article (10.1007/s13300-020-00924-9) contains supplementary material, which is available to authorized users.
- Published
- 2020
26. The Effect of Dapagliflozin Treatment on Epicardial Adipose Tissue Volume and P-Wave Indices: An Ad-hoc Analysis of The Previous Randomized Clinical Trial
- Author
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Yoshifusa Aizawa, Sho Yuasa, Masaaki Okabe, Yoshio Ikeda, Satoshi Fujita, and Takao Sato
- Subjects
Male ,medicine.medical_specialty ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Nerve conduction velocity ,law.invention ,Coronary artery disease ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Randomized controlled trial ,Glucosides ,Left atrial ,law ,Internal medicine ,Epicardial adipose tissue ,Internal Medicine ,medicine ,Humans ,Dapagliflozin ,Benzhydryl Compounds ,P-wave indices ,Sodium-Glucose Transporter 2 Inhibitors ,Aged ,business.industry ,Biochemistry (medical) ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Volume (thermodynamics) ,chemistry ,Adipose Tissue ,Diabetes Mellitus, Type 2 ,SGLT-2 inhibitor ,Cardiology ,Female ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Pericardium ,030217 neurology & neurosurgery - Abstract
Aim: Epicardial adipose tissue (EAT) may be associated with arrhythmogenesis. P-wave indices such as P-wave dispersion and P-wave variation indicated a slowed conduction velocity within the atria. This study investigated the effect of dapagliflozin on EAT volume and P-wave indices. Methods: In the present ad hoc analysis, 35 patients with type 2 diabetes mellitus and coronary artery disease were classified into dapagliflozin group (n = 18) and conventional treatment group (n = 17). At baseline, EAT volume, HbA1c and plasma level of tumor necrotic factor-α (TNF-α) levels, echocardiography, and 12-lead electrocardiogram (ECG) were performed. EAT volume was measured using computed tomography. Using 12-lead ECG, P-wave indices were measured. Results: At baseline, EAT volumes in the dapagliflozin and conventional treatment groups were 113 ± 20 and 110 ± 27 cm3, respectively. Not only HbA1c and plasma level of TNF-α but also echocardiography findings including left atrial dimension and P-wave indices were comparable between the two groups. After 6 months, plasma level of TNF-α as well as EAT volume significantly decreased in the dapagliflozin group only. P-wave dispersion and P-wave variation significantly decreased in the dapagliflozin group only (−9.2 ± 8.7 vs. 5.9 ± 19.9 ms, p = 0.01; −3.5 ± 3.5 vs. 1.7 ± 5.9 ms, p = 0.01). The change in P-wave dispersion correlated with changes in EAT volume and plasma level of TNF-α. In multivariate analysis, the change in EAT volume was an independent determinant of the change in P-wave dispersion. Conclusion: Dapagliflozin reduced plasma level of TNF-α, EAT volume, and P-wave indices, such as P-wave dispersion. The changes in P-wave indices were especially associated with changes in EAT volume. The number and date of registration: UMIN000035660, 24/Jan/2019
- Published
- 2020
27. The utility of total lipid core burden index/maximal lipid core burden index ratio within the culprit plaque to predict filter-no reflow: insight from near-infrared spectroscopy with intravascular ultrasound
- Author
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Shohei Kishi, Minoru Takahashi, Masaaki Okabe, Sho Yuasa, Hitoshi Kitazawa, Yoshio Ikeda, Koichi Fuse, Tomoyasu Koshikawa, Yoshifusa Aizawa, Satoshi Fujita, Yuji Taya, Takao Sato, and Naomasa Suzuki
- Subjects
inorganic chemicals ,Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Culprit ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Intravascular ultrasound ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,Ultrasonography, Interventional ,Aged ,Spectroscopy, Near-Infrared ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Hematology ,Odds ratio ,Middle Aged ,medicine.disease ,Coronary Vessels ,Lipids ,Plaque, Atherosclerotic ,Confidence interval ,Conventional PCI ,Cardiology ,bacteria ,Cardiology and Cardiovascular Medicine ,business ,Lipid core - Abstract
Filter-no reflow (FNR) is a phenomenon wherein flow improves after the retrieve of distal protection. Near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS) enables lipid detection. We evaluated the predictors of FNR during PCI using NIRS-IVUS. Thirty-two patients who underwent PCI using the Filtrap® for acute coronary syndrome (ACS) were enrolled. The culprit plaque (CP) was observed using NIRS-IVUS. Total lipid-core burden index (T-LCBI) and maximal LCBI over any 4-mm segment (max-LCBI4mm) within CP were evaluated. T-LCBI/max-LCBI4mm ratio within CP was calculated as an index of the extent of longitudinal lipid expansion. The attenuation grade (AG) and remodeling index (RI) in CP were analyzed. AG was scored based on the extent of attenuation occupying the number of quadrants. The patients were divided into FNR group (N = 8) and no-FNR group (N = 24). AG was significantly higher in FNR group than in no-FNR group (1.6 ± 0.6 vs. 0.9 ± 0.42, p = 0.01). RI in FNR group tended to be greater than in no-FNR group. T-LCBI/max-LCBI4mm ratio within the culprit plaque was significantly higher in FNR group than in no-FNR group (0.50 ± 0.10 vs. 0.33 ± 0.13, p 0.01). In multivariate logistic regression analysis, AG 1.04 (odds ratio [OR] 18.4, 95% confidence interval [CI] 1.5-215.7, p = 0.02) and T-LCBI/max-LCBI4mm ratio 0.42 (OR 14.4, 95% CI 1.2-176.8, p = 0.03) were independent predictors for the occurrence of FNR. The use of T-LCBI/max-LCBI4mm ratio within CP might be an effective marker to predict FNR during PCI in patients with ACS.
- Published
- 2018
28. Intracoronary acetylcholine–induced augmentation of J waves: A case of idiopathic ventricular fibrillation
- Author
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Msaaki Okabe, Koichi Fuse, Shohei Kishi, Hitoshi Kitazawa, Yoshifusa Aizawa, and Takao Sato
- Subjects
medicine.medical_specialty ,business.industry ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cardiology ,Medicine ,030212 general & internal medicine ,Idiopathic ventricular fibrillation ,Cardiology and Cardiovascular Medicine ,business ,Acetylcholine ,medicine.drug - Published
- 2018
29. Analysis of variability of R-R intervals for the diagnosis of atrial fibrillation: A new algorithm
- Author
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Eiichi Watanabe, Ryo Shinozaki, Yoshifusa Aizawa, and Taishi Matsui
- Subjects
Male ,medicine.medical_specialty ,0206 medical engineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,Diagnosis, Differential ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Normal Sinus Rhythm ,business.industry ,Atrial fibrillation ,medicine.disease ,020601 biomedical engineering ,Predictive value ,eye diseases ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Differences in successive R-R intervals (RRIs) were normalized by RRIs before and after the indexing beats (normalized DRs) in individuals with normal sinus rhythm (NSR) and 98.89% of normalized DRs were found to distribute within mean ± 0.100 (≒mean ± 3SD), whereas 73.47% were out of this range in atrial fibrillation (AF). When 7 out 20 normalized DRs fell outside of 0.000 ± 0.100, NSR (n = 129) and AF (n = 108) could be discriminated with high sensitivity, specificity, and predictive values (>99.0% for all). This method will be used in detecting AF candidates from a small number of heart beats or arterial pulses.
- Published
- 2018
30. Significant impact of electrical storm on mortality in patients with structural heart disease and an implantable cardiac defibrillator
- Author
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Takashi Nitta, Tohru Ohe, Ken Okumura, Naoki Matsumoto, Takashi Kurita, Akihiko Shimizu, Takashi Noda, Hiroshi Furushima, Takeshi Toyoshima, Yasutaka Chiba, Yoshifusa Aizawa, and Hideo Mitamura
- Subjects
Male ,medicine.medical_specialty ,Heart disease ,Defibrillation ,animal diseases ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Article ,Sudden cardiac death ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Mortality ,Survival analysis ,Aged ,business.industry ,Incidence (epidemiology) ,Cardiac Resynchronization Therapy Devices ,Dilated cardiomyopathy ,Middle Aged ,medicine.disease ,Defibrillators, Implantable ,Ventricular Fibrillation ,cardiovascular system ,Cardiology ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Electrical storm (E-Storm), defined as multiple episodes of ventricular arrhythmias within a short period of time, is an important clinical problem in patients with an implantable cardiac defibrillator (ICD) including cardiac resynchronization therapy devices capable of defibrillation. The detailed clinical aspects of E-Storm in large populations especially for non-ischemic dilated cardiomyopathy (DCM), however, remain unclear. Objective This study was performed to elucidate the detailed clinical aspects of E-Storm, such as its predictors and prevalence among patients with structural heart disease including DCM. Methods We analyzed the data of the Nippon Storm Study, which was a prospective observational study involving 1570 patients enrolled from 48 ICD centers. For the purpose of this study, we evaluated 1274 patients with structural heart disease, including 482 (38%) patients with ischemic heart disease (IHD) and 342 (27%) patients with DCM. Results During a median follow-up of 28months (interquartile range: 23 to 33months), E-Storm occurred in 84 (6.6%) patients. The incidence of E-Storm was not significantly different between patients with IHD and patients with DCM (log-rank p =0.52). Proportional hazard regression analyses showed that ICD implantation for secondary prevention of sudden cardiac death ( p =0.0001) and QRS width ( p =0.015) were the independent risk factors for E-storm. In a comparison between patients with and without E-Storm, survival curves after adjustment for clinical characteristics showed a significant difference in mortality. Conclusion E-Storm was associated with subsequent mortality in patients with structural heart disease including DCM.
- Published
- 2018
31. Low-Dose Erythropoietin in Patients With ST-Segment Elevation Myocardial Infarction (EPO-AMI-II) ― A Randomized Controlled Clinical Trial ―
- Author
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Ken Toba, Daisaku Nakatani, Yoshio Ishida, Shungo Hikoso, Shuichiro Higo, Kiminori Kato, Kouji Yamamoto, Yasushi Fujio, Issei Komuro, Masaaki Okutsu, Hiroshi Suzuki, Yoshifusa Aizawa, Tetsuo Minamino, Ryo Araki, Takuya Ozawa, Epo-Ami-Ii study investigators, and Takahisa Yamada
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Pilot Projects ,030204 cardiovascular system & hematology ,Placebo ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,medicine ,Humans ,Treatment Failure ,cardiovascular diseases ,Myocardial infarction ,Platelet activation ,Adverse effect ,Erythropoietin ,Aged ,Ejection fraction ,Dose-Response Relationship, Drug ,business.industry ,Percutaneous coronary intervention ,Stroke Volume ,General Medicine ,Middle Aged ,medicine.disease ,Clinical trial ,030104 developmental biology ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
BACKGROUND Erythropoietin (EPO) has antiapoptotic and tissue-protective effects, but previous clinical studies using high-dose EPO have not shown cardioprotective effects, probably because of platelet activation and a lack of knowledge regarding the optimal dose. In contrast, a small pilot study using low-dose EPO has shown improvement in left ventricular function without adverse cardiovascular events.Methods and Results:We performed a multicenter (25 hospitals), prospective, randomized, double-blind, placebo-controlled, dose-finding study to clarify the efficacy and safety of low-dose EPO in patients with ST-segment elevation myocardial infarction (STEMI) under the Evaluation System of Investigational Medical Care of the Ministry of Health, Labor and Welfare of Japan. In total, 198 STEMI patients with low left ventricular ejection fraction (LVEF
- Published
- 2018
32. Aortic Regurgitation Presenting with Recurrent Detachment of a Prosthetic Valve, as the First Presenting Symptom of Cardiovascular Behçet's Disease
- Author
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Tohru Minamino, Yoshifusa Aizawa, Masahiro Ito, Takuya Ozawa, Akiko Sanada, Satoru Hirono, Tsugumi Takayama, and Tohru Watanabe
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Prednisolone ,Aortic Valve Insufficiency ,Anti-Inflammatory Agents ,Case Report ,Regurgitation (circulation) ,Disease ,Behcet's disease ,recurrent detachment of prosthetic valve ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Internal Medicine ,medicine ,Humans ,Heart Valve Prosthesis Implantation ,030203 arthritis & rheumatology ,Prosthetic valve ,Behçet's disease ,business.industry ,Behcet Syndrome ,Clinical course ,General Medicine ,medicine.disease ,aortic regurgitation ,Surgery ,Treatment Outcome ,Aortic Valve ,business ,Aneurysm, False ,medicine.drug - Abstract
A 33-year-old man with severe aortic regurgitation underwent initial aortic valve replacement (AVR). During the 2 years after AVR, 3 reoperations for prosthetic valve detachment were required. During hospitalization, he had no typical clinical findings, with the exception of a persistent inflammatory reaction; a pseudo-aneurysm around the Bentall graft developed 27 days after the 4th operation. This unique clinical course suggested the possibility of Behçet's disease. In the 8 years of follow-up after the administration of prednisolone, the pseudo-aneurysm did not become enlarged and the detachment of the prosthetic valve was not observed. We herein present a case of cardiovascular Behçet's disease, with a review of the literature.
- Published
- 2018
33. Risk factors for the first and second inappropriate implantable cardioverter-defibrillator therapy
- Author
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Takashi Kurita, Takashi Noda, Nobuhiro Nishii, Tohru Ohe, Yoshifusa Aizawa, and Takashi Nitta
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Nippon storm study ,Implantable cardioverter-defibrillator ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Risk factor ,Cardiac resynchronization therapy with defibrillator ,Proportional hazards model ,business.industry ,Hazard ratio ,Atrial fibrillation ,Inappropriate ICD therapy ,medicine.disease ,RC666-701 ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter - Abstract
Introduction: Various risk factors for the first inappropriate implantable cardioverter-defibrillator (ICD) therapy event have been reported, including a history of atrial fibrillation/atrial flutter (AF/AFL), younger age, and multiple zones. Nonetheless, which factors are concordant with real-world data has not been clarified, and risk factors for the second inappropriate ICD therapy event have not been well examined. This study aimed to clarify the risk factors for the first and second inappropriate ICD therapy events. Methods: We conducted a post-hoc secondary analysis of data from a multicenter, prospective observational study (the Nippon Storm Study) designed to clarify the risk factors for electrical storm. Results: The analysis included data from 1549 patients who received ICD or cardiac resynchronization therapy with defibrillator (CRT-D). Over a median follow-up of 28 months, 293 inappropriate ICD therapy events occurred in 153 (10.0%) patients. On multivariate Cox regression analysis, the risk factors for the first inappropriate ICD therapy event were younger age (hazard ratio [HR], 0.986; p = 0.028), AF/AFL (HR, 2.324; p = 0.002), ICD without CRT implantation (HR, 2.377; p = 0.004), and multiple zones (HR, 1.852; p = 0.010). "No-intervention" after the first inappropriate ICD therapy event was the sole risk factor for the second inappropriate ICD therapy event. Conclusions: Risk factors for the first inappropriate ICD therapy event were similar to those previously reported. Immediate intervention after the first inappropriate ICD therapy event could reduce the risk of the second inappropriate event.
- Published
- 2021
34. Different rate-dependent responses between J waves and the notches on an epicardial local electrogram in a patient with idiopathic ventricular fibrillation
- Author
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Yoshifusa Aizawa, Yosuke Kamikubo, Toyoaki Murohara, Yasuya Inden, and Tomoyuki Nagao
- Subjects
J wave ,medicine.medical_specialty ,EARLY REPOLARIZATION SYNDROME ,business.industry ,Idiopathic ventricular fibrillation ,Rate dependent ,Electrogram ,Case Report ,Epicardium ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Early repolarization syndrome ,RC666-701 ,Internal medicine ,Cardiology ,medicine ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
35. Genotype-Phenotype Correlation of SCN5A Mutation for the Clinical and Electrocardiographic Characteristics of Probands With Brugada Syndrome
- Author
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Kenichiro Yamagata, Yoshihiro Miyamoto, Takeru Makiyama, Michael J. Ackerman, Ryoji Kishi, Wataru Shimizu, Akihiko Shimizu, Naomasa Makita, Yukiko Nakano, Satoshi Ogawa, Yoshifusa Aizawa, Seiko Ohno, Hiroshi Morita, Nobuhisa Hagiwara, Hiroshi Watanabe, Masakazu Yamagishi, Masahiko Takagi, Takeshi Aiba, Keiichi Fukuda, Tohru Ohe, Harumizu Sakurada, Toshihiro Tanaka, Kenshi Hayashi, Minoru Horie, Hisao Ogawa, Satoshi Yasuda, Shiro Kamakura, Kengo Kusano, and Jamie D. Kapplinger
- Subjects
Proband ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Scn5a gene ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Genotype phenotype ,Correlation ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Brugada syndrome - Abstract
Background: The genotype-phenotype correlation of SCN5A mutations as a predictor of cardiac events in Brugada syndrome remains controversial. We aimed to establish a registry limited to probands, with a long follow-up period, so that the genotype-phenotype correlation of SCN5A mutations in Brugada syndrome can be examined without patient selection bias. Methods: This multicenter registry enrolled 415 probands (n=403; men, 97%; age, 46±14 years) diagnosed with Brugada syndrome whose SCN5A gene was analyzed for mutations. Results: During a mean follow-up period of 72 months, the overall cardiac event rate was 2.5%/y. In comparison with probands without mutations ( SCN5A (–), n=355), probands with SCN5A mutations ( SCN5A (+), n=60) experienced their first cardiac event at a younger age (34 versus 42 years, P =0.013), had a higher positive rate of late potentials (89% versus 73%, P =0.016), exhibited longer P-wave, PQ, and QRS durations, and had a higher rate of cardiac events ( P =0.017 by log-rank). Multivariate analysis indicated that only SCN5A mutation and history of aborted cardiac arrest were significant predictors of cardiac events ( SCN5A (+) versus SCN5A (–): hazard ratio, 2.0 and P =0.045; history of aborted cardiac arrest versus no such history: hazard ratio, 6.5 and P Conclusions: Brugada syndrome patients with SCN5A mutations exhibit more conduction abnormalities on ECG and have higher risk for cardiac events.
- Published
- 2017
36. The effects of pure potassium channel blocker nifekalant and sodium channel blocker mexiletine on malignant ventricular tachyarrhythmias
- Author
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Nobue Yagihara, Hiroshi Furushima, Goro Katsuumi, Masaomi Chinushi, Yoshifusa Aizawa, Akinori Sato, Daisuke Izumi, Tohru Minamino, Sou Otuki, Kanae Hasegawa, Kenichi Iijima, and Hiroshi Watanabe
- Subjects
medicine.medical_specialty ,Administration, Oral ,Mexiletine ,Pyrimidinones ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Amiodarone ,QT interval ,Nifekalant ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Sodium channel blocker ,Japan ,Recurrence ,Risk Factors ,Internal medicine ,Potassium Channel Blockers ,Prevalence ,medicine ,Humans ,cardiovascular diseases ,Retrospective Studies ,business.industry ,Electroencephalography ,Potassium channel blocker ,medicine.disease ,Survival Rate ,Treatment Outcome ,Anesthesia ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Sodium Channel Blockers ,medicine.drug - Abstract
Background Patients with repetitive ventricular tachyarrhythmias — so-called electrical storm — frequently require antiarrhythmic drugs. Amiodarone is widely used for the treatment of electrical storm but is ineffective in some patients. Therefore, we investigated the efficacy of stepwise administration of nifekalant, a pure potassium channel blocker, and mexiletine for electrical storm. Methods This study included 44 patients with repetitive ventricular tachyarrhythmias who received stepwise therapy with nifekalant and mexiletine for electrical storm. Nifekalant was initially administered, and mexiletine was subsequently added if nifekalant failed to control ventricular tachyarrhythmias. Results Nifekalant completely suppressed recurrences of ventricular arrhythmias in 28 patients (64%), including 6 patients in whom oral amiodarone failed to control arrhythmias. In 9 of 16 patients in whom nifekalant was partially effective but failed to suppress ventricular arrhythmias, mexiletine was added. The addition of mexiletine prevented recurrences of ventricular tachyarrhythmias in 5 of these 9 patients (56%). There was no death associated with electrical storm. In total, the stepwise treatment with nifekalant and mexiletine was effective in preventing ventricular tachyarrhythmias in 33 of 44 patients (75%). There was no difference in cycle length of the ventricular tachycardia, QRS interval, QT interval, or left ventricular ejection fraction between patients who responded to antiarrhythmic drugs and those who did not. During follow-up, 8 patients had repetitive ventricular tachyarrhythmia recurrences, and the stepwise treatment was effective in 6 of these 8 patients (75%). Conclusions The stepwise treatment with nifekalant and mexiletine was highly effective in the suppression of electrical storm.
- Published
- 2017
37. Accentuation of J waves by intracoronary administration of multiple agents in a patient with vasospastic angina: Implications for pathogenesis
- Author
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Hitoshi Kitazawa, Yoshifusa Aizawa, Koichi Fuse, Yuta Sakaguchi, Yoshio Ikeda, Masaaki Okabe, and Takao Sato
- Subjects
Qrs morphology ,Angina Pectoris, Variant ,Male ,medicine.medical_specialty ,Coronary Vasospasm ,030204 cardiovascular system & hematology ,Coronary Angiography ,Pathogenesis ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Ergonovine ,Vasospastic angina ,Transient ischemia ,business.industry ,Middle Aged ,Coronary Vessels ,Acetylcholine ,Contrast medium ,Right coronary artery ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
A 64-year-old man was resuscitated from out-of-hospital VF, and coronary spasm was provoked by ergonovine at catheterization. An ECG was analyzed before and after each intracoronary injection of drugs or contrast medium. The baseline ECG showed nondiagnostic J waves in leads II, III, and aVF, but administration of acetylcholine, contrast medium and nitroglycerin into the right coronary artery induced a distinct augmentation of J-wave amplitudes with changes in the QRS morphology. Transient ischemia induced by the intracoronary administration of these agents seemed to be the mechanism underlying the increase in J-wave amplitudes.
- Published
- 2019
38. The effect of the debulking by excimer laser coronary angioplasty on long-term outcome compared with drug-coating balloon: insights from optical frequency domain imaging analysis
- Author
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Yuji Taya, Sho Yuasa, Satoshi Fujita, Yoshifusa Aizawa, Masaaki Okabe, Minoru Takahashi, Takao Sato, Hirotaka Oda, Komei Tanaka, Yoshio Ikeda, Tomoyasu Koshikawa, and Keiichi Tsuchida
- Subjects
Neointima ,Male ,Time Factors ,medicine.medical_treatment ,Dermatology ,Balloon ,Coronary Restenosis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Restenosis ,Optical frequencies ,Angioplasty ,Image Processing, Computer-Assisted ,Medicine ,Humans ,Drug coating ,Angioplasty, Balloon, Coronary ,Aged ,business.industry ,030206 dentistry ,Cytoreduction Surgical Procedures ,medicine.disease ,Debulking ,Domain imaging ,Treatment Outcome ,Surgery ,Female ,Lasers, Excimer ,Laser Therapy ,business ,Nuclear medicine ,Follow-Up Studies - Abstract
This study evaluated the 1-year efficacy of excimer laser coronary angioplasty (ELCA) before drug-coated balloon (DCB) dilatation for the treatment of in-stent restenosis (ISR). Forty consecutive patients with ISR were treated by DCB with or without the use of ELCA (ELCA plus DCB, N = 20; DCB alone, N = 20). Debulking efficiency (DE) value was defined as the neointima area on optical frequency domain imaging (OFDI) debulked by ELCA. The patients in the ELCA plus DCB group were divided into two groups (greater DE (GDE), N = 10; smaller DE (SDE), N = 10) based on the median value of DE. Thereafter, the ISR segment was prepared with a scoring balloon, followed by DCB. At follow-up, binary restenosis and target lesion revascularization (TLR) were evaluated. There were no significant differences in baseline characteristics such as age, comorbidity, and ISR type. Overall, the incidence of neoatherosclerosis in the ISR segment was 17.5%. Post-PCI, acute gain of minimum lumen diameter on quantitative coronary angiography and of minimum lumen area on OFDI was numerically higher in the GDE than in the SDE and the DCB alone group. At follow-up, the occurrences of binary restenosis and TLR in the ELCA plus DCB group were 20.0% and 10.0%; these values in the DCB alone group were 20.0% and 20.0%, respectively. Two patients from the SDE and none from the GDE developed TLR. DCB alone treatment was inferior to ELCA plus DCB treatment. However, greater ELCA debulking might be required to obtain optimal outcomes.
- Published
- 2019
39. The Impact of Cancer on Major Bleeding and Stroke/Systemic Emboli in Patients Using Direct Oral Anticoagulants:From the Database of a Single-Center Registry
- Author
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Yoshifusa Aizawa, Minoru Takahashi, Koichi Fuse, Takao Sato, Masaaki Okabe, Yoshio Ikeda, Hitoshi Kitazawa, and Satoshi Fujita
- Subjects
Rivaroxaban ,medicine.medical_specialty ,business.industry ,Cancer ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Dabigatran ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,Edoxaban ,Melena ,Internal medicine ,medicine ,Apixaban ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,030217 neurology & neurosurgery ,Original Research ,medicine.drug - Abstract
BACKGROUND: Few data are available on direct oral anticoagulant (DOAC) use in patients with cancer and atrial fibrillation (AF). METHODS: We retrospectively analyzed prospectively collected data from a single-center registryon 2,272 patients who tookDOACs for AF (apixaban:1,014; edoxaban:267; rivaroxaban:498; dabigatran:493). Patients were monitored for 2 years andclassified into non-cancer (n=2009) and cancer group (n=263) (cancer onset during DOAC treatment, active canceratDOAC administration, and cancer history).Major bleeding (MB) and thromboembolic events (TEEs) were evaluated. RESULTS: The mean age was 73±10 years. CHADS2 and HAS-BLED scores were 1.95±1.32 and 1.89±0.96,respectively.In the present study, the prevalence of gastrointestinal and genitourinary cancer was 61% and 8%, respectively.The MB and TEEs incidences were 2.4 and 2.2 per 100-patient years, respectively. The appropriate dosing rate, body weight, and Ccrvalue in cancer patients were significantly lower than those in non-cancer patients. Cancer patients were significantly older than non-cancer patients. In MB patients diagnosed with gastrointestinal or genitourinary cancer during follow-up, the clinically relevant bleeding such as melena or hematuria occurred.Additionally, there was a significantly higher MB incidence in cancer patients than in non-cancer patients (p
- Published
- 2018
40. Conduction Delay-Induced J-Wave Augmentation in Patients With Coronary Heart Disease
- Author
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Yoshifusa Aizawa, Kazuhiro Satomi, Takashi Uchiyama, Yoshiyasu Aizawa, Masafumi Nakayama, and Mikio Yuhara
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Disease ,030204 cardiovascular system & hematology ,Angina ,03 medical and health sciences ,QRS complex ,Electrocardiography ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Internal medicine ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,J wave ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Coronary heart disease ,cardiovascular system ,Cardiology ,Female ,sense organs ,Cardiology and Cardiovascular Medicine ,business ,Conduction delay ,Follow-Up Studies - Abstract
Electrocardiogram records were surveyed for the presence of an atrial premature beat (APB) and J waves in patients with coronary heart disease and patients with noncardiac diseases. The prevalence and response of J waves to sudden shortening of the RR interval on the conducted APB were determined and compared between the 2 patients groups. The change in the QRS complexes on the APB was also determined. Among 17,013 patients, 243 patients who underwent percutaneous coronary intervention for acute myocardial infarction or angina pectoris had an APB, and J waves were observed in 16 patients (6.6%). In an additional 729 patients with noncardiac diseases and APB, 19 patients showed J waves (2.6%; p = 0.010). The clinical features were almost similar between the ischemic and nonischemic groups. J waves were located more often in inferior and high lateral leads in the ischemic group. When the RR interval shortened from 942 ± 228 to 621 ± 175 ms and 869 ± 158 to 570 ± 118 ms at baseline and in the conducted APB (p0.001 for both), the J-wave amplitude increased from 0.16 ± 0.04 to 0.19 ± 0.06 mV (p0.001) and 0.21 ± 0.07 to 0.24 ± 0.08 mV (p = 0.010) in the ischemic and nonischemic groups, respectively. J waves in patients with chronic coronary heart disease and in patients with noncardiac diseases were augmented at short RR intervals together with distinct changes in the QRS complexes, and an augmentation of J waves at short RR interval may represent a conduction delay.
- Published
- 2018
41. Comparison of second appropriate defibrillator therapy occurrence in patients implanted for primary prevention and secondary prevention – Sub-analysis of the Nippon Storm Study
- Author
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Takashi Kurita, Yoshifusa Aizawa, Gaku Nakazawa, Motohide Tanaka, Takashi Noda, Takashi Nitta, Yasuhito Kotake, Tohru Ohe, and Ryobun Yasuoka
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Cardiomyopathy ,Disease ,030204 cardiovascular system & hematology ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,mental disorders ,Implantable cardioverter defibrillator ,medicine ,Cumulative incidence ,030212 general & internal medicine ,Original Paper ,Primary prevention ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Implantable cardioverter-defibrillator ,Appropriate ICD therapy ,lcsh:RC666-701 ,Ventricular arrhythmia ,Observational study ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Patients with implantable cardioverter defibrillator (ICD) use for primary prevention (primary prevention patients) of sudden cardiac death have lower incidence of appropriate ICD therapy (app-Tx) compared with those with ICD use for secondary prevention (secondary prevention patients). However, detail analysis of a second app-Tx after a first app-Tx is still lacking. Objective This study aimed to compare the incidence of a second app-Tx in primary vs secondary prevention patients. Methods We conducted sub-analysis of the Nippon Storm Study, which was a prospective, observational study involving 985 patients with structural heart disease (left ventricular ejection fraction ≤ 50%). Of these, we selected 251 patients (62 ± 14 years old, 82% men) who experienced at least one appropriate ICD therapy, and compared occurrence of a second app-Tx between primary (n = 116) and secondary (n = 135) prevention patients. Results There was no significant difference in the incidence of a second app-Tx between primary and secondary prevention patients (the cumulative incidence for a second app-Tx was 59% at 1 year and 79% at 3 years in primary prevention patients vs the cumulative incidence for the second app-Tx was 59% at 1 year and 75% at 3 years in secondary prevention patients). Additionally, we evaluated the incidence of a second app-Tx according to basal structural disease (ischemic and non-ischemic cardiomyopathy) and found no significant difference between primary and secondary prevention patients. Conclusion Once app-Tx occurs, primary prevention patients acquire the high risk of subsequent ventricular arrhythmias because there is a comparable incidence of a second app-Tx in secondary prevention patients.
- Published
- 2021
42. A case of brugada syndrome presenting with ventricular fibrillation storm and prominent early repolarization
- Author
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Chifumi Iizuka, Yoshifusa Aizawa, Masaaki Okabe, Hitoshi Kitazawa, Kiyotaka Kugiyama, Yoshio Ikeda, and Masahito Sato
- Subjects
Male ,medicine.medical_specialty ,Benign early repolarization ,Early Repolarization Pattern ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,Diagnosis, Differential ,Electrocardiography ,Young Adult ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Brugada Syndrome ,Brugada syndrome ,medicine.diagnostic_test ,business.industry ,ST elevation ,Reproducibility of Results ,Hypothermia ,medicine.disease ,Anesthesia ,Ventricular Fibrillation ,Ventricular fibrillation ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 21-year-old man developed ventricular fibrillation (VF) while drinking alcohol and was admitted to our hospital. An electrocardiogram (ECG) on admission revealed remarkably prominent slurs on the terminal part of QRS complexes in the left precordial leads and a coved type ST elevation at higher intercostal spaces. After hypothermia therapy, he underwent implantation of an implantable cardioverter-defibrillator (ICD). Standard twelve-lead follow-up ECGs revealed early repolarization pattern and an intermittent coved type ST elevation. When the coved type ST elevation appeared, the early repolarization pattern in the inferior and left precordial leads was attenuated. Prominent early repolarization pattern was the most likely trigger of the VF storm in this Brugada patient.
- Published
- 2016
43. Comparison of circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome
- Author
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Takashi Kurita, Shinichi Niwano, Yoshiyasu Aizawa, Takehiro Kimura, Yoshiaki Kaneko, Takashi Noda, Takahiko Nishiyama, Minoru Horie, Akihiko Shimizu, Yoshifusa Aizawa, Takeshi Mitsuhashi, Keiichi Fukuda, Kotaro Fukumoto, Nobuhiro Nishiyama, Yoshinori Katsumata, Shiro Kamakura, and Seiji Takatsuki
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Nocturnal ,Ventricular tachycardia ,Sudden death ,Article ,03 medical and health sciences ,CRBBB, complete right bundle branch block ,0302 clinical medicine ,Electrical storm ,Internal medicine ,VT, ventricular tachycardia ,medicine ,Brugada syndrome ,Rhythmicity ,In patient ,Ventricular fibrillation ,030212 general & internal medicine ,Circadian rhythm ,ICD, implantable cardioverter defibrillator ,IVF, idiopathic ventricular fibrillation ,business.industry ,ES, electrical storm ,medicine.disease ,Implantable cardioverter-defibrillator ,BS, Brugada syndrome ,lcsh:RC666-701 ,Anesthesia ,Cardiology ,ECG, electrocardiogram ,VF, ventricular fibrillation ,SD, standard deviation ,Cardiology and Cardiovascular Medicine ,business ,MRI, magnetic resonance imaging - Abstract
In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients showed weekly and seasonal patterns. The patients with ESs had peak episodes of VF on Saturday and in the winter and spring, while episodes of VF in patients with single VF events occurred most often on Monday with smaller seasonal variation. Except for age, there was no difference in the clinical or ECG characteristics between the patients with ESs and those with single VF episodes.
- Published
- 2016
44. The response of NT-proBNP to intensified medication in advanced chronic heart failure
- Author
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Tomoyasu Koshikawa, Minoru Takahashi, Hiroki Nakano, Masaaki Okabe, Sho Yuasa, Yoshifusa Aizawa, Koichi Fuse, Akira Yamashina, and Masahito Sato
- Subjects
medicine.medical_specialty ,Advanced heart failure ,Endocrinology, Diabetes and Metabolism ,030204 cardiovascular system & hematology ,Nyha class ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Clinical significance ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,NYHA functional class ,Creatinine ,Ejection fraction ,business.industry ,medicine.disease ,Endocrinology ,chemistry ,NT-proBNP ,Heart failure ,Cardiology ,Uric acid ,Hemoglobin ,Cardiology and Cardiovascular Medicine ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
BackgroundThe clinical significance of excessively high serum NT-proBNP is poorly understood in chronic heart failure (HF).MethodsOne-hundred eighteen patients with advanced chronic HF (NYHA functional class III or IV) were admitted; of these patients, 42.4% exhibited NT-proBNP levels >10,000pg/ml. The patients were divided into three groups as follows: ≥400 and
- Published
- 2016
45. Electrical alternans induced by a brief period of myocardial ischemia during percutaneous coronary intervention: The characteristic ECG morphology and relationship to mechanical alternans
- Author
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Takeo Oguro, Yoshio Ikeda, Masahito Sato, Masatsune Fujii, Koichi Fuse, Hitoshi Kitazawa, Minoru Takahashi, Masaaki Okabe, Yoshifusa Aizawa, and Satoru Fujita
- Subjects
Electrical alternans ,medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,T wave alternans ,medicine.disease ,QRS complex ,medicine.anatomical_structure ,Physiology (medical) ,Internal medicine ,Conventional PCI ,Cardiology ,Medicine ,ST segment ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Electrical alternans (EA) has not been fully studied in the current percutaneous coronary intervention (PCI) procedure. Objective The purpose of this study was to evaluate visible EA and the morphology of ST segment during PCI. Methods The incidence of visible EA and ST-segment morphology were studied while the coronary artery was occluded for 20 seconds. When data were available, the relationship between EA and blood pressure was analyzed. The clinical and electrocardiographic data were compared with those of the age- and sex-matched controls. Results During balloon inflation, visible EA was observed in 5 of 306 patients (1.6%) in the last 2 years. EA was limited to PCI in the proximal left anterior descending artery. The ST segment elevated to 10.1 ± 3.2 mm, followed by an alternating QRS complex with a lower ST segment (5.6 ± 1.9 mm; P = .0047) with characteristic ST-segment morphology, which is known as lambda pattern. The mean age of the 5 patients was 68 ± 20 years, and 4(80%). were men. After the release of inflation, the ST-segment level returned rapidly to baseline, followed by normalization of J point. Compared with controls, the maximal elevated ST segment was significantly higher in patients with EA (5.7 ± 2.7 mm; P = .0028). The occlusion of the proximal left anterior descending artery with more severe ischemia seemed to be a prerequisite for developing EA. A higher ST segment was associated with a lower blood pressure and vice versa. Conclusion A short period of ischemia during PCI may induce visible EA and alternating QRS complexes with a characteristic ST-segment morphology. A higher ST segment was associated with a lower blood pressure and vice versa.
- Published
- 2015
46. ACUTE RECOIL AND LATE RECOIL AFTER ORSIRO CORONARY DRUG-ELUTING STENT IMPLANTATION
- Author
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Sho Yuasa, Takao Sato, Masaaki Okabe, Yoshifusa Aizawa, Minoru Takahashi, Yuji Taya, and Yusuke Ohta
- Subjects
medicine.medical_specialty ,animal structures ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Stent ,respiratory system ,equipment and supplies ,surgical procedures, operative ,Recoil ,Drug-eluting stent ,Intravascular ultrasound ,medicine ,Stent implantation ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Sirolimus-eluting Orsiro stent is an ultrathin stent, but its properties may easily lead to acute recoil and late after stent implantation. This study investigated the acute recoil and late recoil after Orsiro stent implantation based on intravascular ultrasound(IVUS). We enrolled 32 patients(40
- Published
- 2020
47. THE UTILITY OF SALINE-INDUCED RESTING FULL-CYCLE RATIO COMPARED WITH RESTING FULL-CYCLE RATIO ANDFRACTIONAL FLOW RESERVE
- Author
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Yusuke Ohta, Yoshifusa Aizawa, Yuji Taya, Takao Sato, Minoru Takahashi, Masaaki Okabe, and Sonoka Goto
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Flow (psychology) ,Gold standard (test) ,Fractional flow reserve ,medicine.disease ,Coronary pressure ,Stenosis ,Internal medicine ,medicine ,Aortic pressure ,Cardiology ,Functional significance ,Cardiology and Cardiovascular Medicine ,business ,Saline - Abstract
Fractional flow reserve(FFR) measured under hyperemic conditions has been the gold standard for measuring the functional significance of stenosis. Recently, saline induced distal coronary pressure/aortic pressure ratio predicts an FFR. The resting full-cycle ratio(RFR) represents the maximal
- Published
- 2020
48. Dynamicity of hypothermia-induced J waves and the mechanism involved
- Author
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Koichi Fuse, Yoshifusa Aizawa, Keiichi Fukuda, Masaaki Okabe, Yukio Hosaka, Yoshiaki Kaneko, Yoshiyasu Aizawa, Hirofumi Zaizen, Naohiko Takahashi, and Hirotaka Oda
- Subjects
Male ,medicine.medical_specialty ,Heart Ventricles ,RR interval ,030204 cardiovascular system & hematology ,Hypothermia induced ,Body Temperature ,03 medical and health sciences ,QRS complex ,Electrocardiography ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Hypothermia, Induced ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Cardiac transient outward potassium current ,business.industry ,Atrial fibrillation ,Depolarization ,Hypothermia ,medicine.disease ,Prognosis ,Ventricular fibrillation ,Ventricular Fibrillation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background J waves develop during hypothermia, but the dynamicity of hypothermia-induced J waves is poorly understood. Objective The purpose of this study was to investigate the mechanism of the rate-dependent change in the amplitude of hypothermia-induced J waves. Methods Nineteen patients with severe hypothermia were included (mean age 70 ± 12 years; 16 men [84.2%]). The rectal temperature at the time of admission was 27.8° ± 2.5°C. In addition to prolonged PR, QRS complex, and corrected QT intervals, the distribution of prominent J waves was widespread in all 19 patients. Results Nine patients showed changes in RR intervals. When the RR interval shortened from 1353 ± 472 to 740 ± 391 ms (P = .0002), the J-wave amplitude increased from 0.50 ± 0.29 to 0.61 ±0.27 mV (P = .0075). The J-wave amplitude increased in 7 patients (77.8%) and decreased in 2 patients (22.2%) after short RR intervals. The augmentation of J waves at short RR intervals was associated with a significant prolongation of ventricular activation time (35 ± 5 ms vs 46 ± 5 ms; P = .0020), suggesting accentuated conduction delay. Increased conduction delay at short RR intervals was suggested to accentuate the phase 1 notch of the action potential and J waves in hypothermia. None developed ventricular fibrillation, and in 2 of 9 patients with atrial fibrillation, atrial fibrillation persisted after rewarming to normothermia. Conclusion J waves in severe hypothermia were augmented after short RR intervals in 7 patients as expected for depolarization abnormality, whereas 2 patients showed a bradycardia-dependent augmentation as expected for transient outward current–mediated J waves. Increased conduction delay at short RR intervals can be responsible for the accentuation of the transient outward current and J waves during severe hypothermia.
- Published
- 2018
49. Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview
- Author
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Yoshifusa Aizawa, Ken Okumura, and Hiroshi Watanabe
- Subjects
medicine.medical_specialty ,Percentile ,education.field_of_study ,business.industry ,Premature atrial contraction ,Population ,Fascicular blocks ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Left ventricular hypertrophy ,QT interval ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Positive predicative value ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,education ,Featured Review - Abstract
Electrocardiograms (ECGs) have been employed to medically evaluate participants in population-based studies, and ECG-derived predictors have been reported for incident atrial fibrillation (AF). Here, we reviewed the status of ECG in predicting new-onset AF. We surveyed population-based studies and revealed ECG variables to be risk factors for incident AF. When available, the predictive values of each ECG risk marker were calculated. Both the atrium-related and ventricle-related ECG variables were risk factors for incident AF, with significant hazard risks (HRs) even after multivariate adjustments. The risk factors included P-wave indices (maximum P-wave duration, its dispersion or variation and P-wave morphology) and premature atrial contractions (PACs) or runs. In addition, left ventricular hypertrophy (LVH), ST-T abnormalities, intraventricular conduction delay, QTc interval and premature ventricular contractions (PVCs) or runs were a risk of incident AF. An HR of greater than 2.0 was observed in the upper 5th percentile of the P-wave durations, P-wave durations greater than 130 ms, P-wave morpholyg, PACs (PVCs) or runs, LVH, QTc and left anterior fascicular blocks. The sensitivity , specificity and the positive and negative predictive values were 3.6-53.8%, 61.7-97.9%, 2.9-61.7% and 77.4-97.7%, respectively. ECG variables are risk factors for incident AF. The correlation between the ECG-derived AF predictors, especially P-wave indices, and underlying diseases and the effects of the reversal of the ECG-derived predictors on incident AF by treatment of comorbidities require further study.
- Published
- 2017
50. Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry
- Author
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Masayuki Sakurai, Satoshi Ogawa, Naohiko Takahashi, Ken Okumura, Akiko Chishaki, Yuji Okuyama, Itsuo Kodama, Hirotsugu Atarashi, Osamu Igawa, Tetsunori Saikawa, Hideki Origasa, Yoshiaki Kaneko, Masaomi Chinushi, Yoshifusa Aizawa, Yukihiro Koretsune, Hiroshi Inoue, Naoko Kumagai, Masahiko Fukatani, Kazuo Matsumoto, Eiichi Watanabe, Shigenobu Bando, Takeshi Yamashita, Akihiko Shimizu, Yuichiro Kawamura, and Isao Kubota
- Subjects
Male ,medicine.medical_specialty ,media_common.quotation_subject ,Warfarin therapy ,Non valvular atrial fibrillation ,Hemorrhage ,Cohort Studies ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Prospective Studies ,Registries ,cardiovascular diseases ,Propensity Score ,Aged ,media_common ,Aged, 80 and over ,Selection bias ,business.industry ,Incidence (epidemiology) ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Hematology ,Middle Aged ,medicine.disease ,Cohort ,Propensity score matching ,Cardiology ,Female ,business ,medicine.drug - Abstract
Recently, direct-acting oral anticoagulants (DOACs) have been introduced, with increasing use in patients with non-valvular atrial fibrillation (NVAF). However, warfarin continues to be widely used and the benefits and risks of warfarin in NVAF patients warrant closer inspection.Thromboembolism, major hemorrhage, and total and cardiovascular mortalities were analyzed in 7,406 NVAF patients in the J-RHYTHM Registry from January to July 2009, prior to DOAC introduction. Propensity score matching analysis was performed to reduce the differences in clinical characteristics between non-anticoagulant (n=1002) and warfarin (n=6404) cohorts to reassess warfarin outcomes over 2years.The incidence of thromboembolism was significantly greater in the non-anticoagulant cohort (3.0%) than in the warfarin cohort (1.5%, P0.001) with less frequent major hemorrhage in the non-anticoagulant cohort (0.8%) than in the warfarin cohort (2.1%, P=0.009). Using propensity score matching, new subsets (n=896 each) were obtained, with matching of the clinical characteristics between warfarin and non-anticoagulant subsets. The warfarin subset had lower risk factors compared with the total warfarin cohort. The incidence of thromboembolism was higher in the non-anticoagulant subset (2.9%) than in the warfarin subset (0.7%, P0.001). However, major hemorrhage was not significantly different between the two subsets.Although warfarin was associated with a significantly higher incidence of hemorrhage in the unmatched cohorts, propensity score matching revealed that warfarin reduced thromboembolism without a significant increase in hemorrhage in the matched subsets with lower risks. Propensity score matching reduced selection bias and provided rational comparisons although it had indwelling limitations.
- Published
- 2015
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