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Obstruction of a systemic venous pathway is relatively common after the Mustard operation. A helix‐fixation leadless pacemaker was successfully implanted in the subpulmonic but morphologic LV in a d‐TGA patient with post‐Mustard baffle stenosis and failure of a previously implanted epicardial lead.

We report the behavior of OptiVol2 fluid index (OVFI2) and intrathoracic impedance on remote monitoring before the appearance of signs of infection. A sustained rise in OVFI2 early after implantation reflects peri‐device fluid retention.

A new formula to predict heart rate at anaerobic threshold that considers beta-blocker effects in myocardial infarction patients was developed, and the accuracy of this formula was validated. The new prediction formula that includes use of β1-blockers as a predictor was found to have favorable accuracy.

The number of patients with chronic heart failure is increasing in Japan. However, the annual number of patients with heart failure who receive cardiac resynchronization therapy (CRT) has been constant in the last few years. In this study, we evaluated patients who did not receive CRT despite being eligible for this treatment to elucidate the clinical impact of CRT administration. We assessed 214 patients with a left ventricular ejection fraction (LVEF) ≤ 50% (excluding patients treated with CRT) who underwent transthoracic echocardiography between January and May 2020 at our institution. The patients were stratified into two groups: Group A (n = 26; patients eligible for CRT) and Group B (n = 188; patients ineligible for CRT); however, all patients only received pharmacological therapy. We retrospectively analyzed the prognosis of these patients with respect to the cumulative number of hospitalizations for heart failure and cardiogenic deaths. We observed no significant between‐group differences in age, sex, and severity/diagnosis of organic heart disease. Group A had a significantly higher number of hospitalizations for heart failure and cardiogenic deaths than Group B (log‐rank test, P< .01; hazard ratio, 3.05; 95% confidence interval, 1.31‐7.09; average follow‐up period, 675 days). This study shows that 12% of patients were eligible for CRT. However, the implantation rate was low and no one was implanted. CRT is underutilized in patients who have heart failure with reduced LVEF. Therefore, we strongly recommend CRT for patients with indications for CRT. This study evaluates the underutilization of cardiac resynchronization therapy in eligible patients with heart failure with a left ventricular ejection fraction less than 50%.

Tricuspid valve (TV) geometry gained attention when the prognostic significance of tricuspid regurgitation (TR) was determined. However, the TV geometric characteristics in Barlow disease (BD) have not been elucidated. This study aimed to clarify the difference in TV morphology between BD and fibroelastic deficiency (FED) and the effect of its geometry on residual TR after tricuspid annuloplasty (TAP) using three-dimensional (3D) transesophageal echocardiography.

The optimal management of asymptomatic aortic stenosis (AS) remains controversial. Although exercise stress echocardiography (ESE) has been applied to nonischemic heart disease, the evidence of the prognostic value for asymptomatic AS has been limited. This study aimed to investigate the value of ESE in patients with asymptomatic AS.

Pathologic left ventricular (LV) hypertrophy is closely coupled with adverse cardiovascular events. However, normal values of LV mass determined by three-dimensional echocardiography (3DE) have not been established in a large number of healthy subjects over a wide age range. The aims of this study were to (1) validate the accuracy of 3DE for LV mass measurements against cardiac magnetic resonance (CMR), (2) establish the normal range of LV mass index in healthy subjects, and (3) investigate the effects of age, gender, and ethnic diversity on LV mass index.

This study aimed to clarify the clinical impact of transient atrial fibrillation (AF) attacks themselves and the efficacy of cardiac resynchronization therapy (CRT) in patients with intermittent AF.

Es bien sabido que ocasionalmente una lesión coronaria angiográficamente aparentemente significativa podría no causar isquemia y viceversa. Por eso las decisiones terapéuticas basadas en un conocimiento de la fisiología coronaria son cada vez más importantes. El uso de la reserva fraccional de flujo (RFF), una herramienta útil para determinar en el laboratorio de hemodinámica las lesiones que se pueden beneficiar de revascularización, ha conseguido una indicación de clase IA en las guías de la Sociedad Europea de Cardiología. Recientemente, el índice diastólico instantáneo sin ondas, de más facilidad de uso que la RFF, se considera equivalente a ella. En esta revisión se repasan y se profundiza en los conceptos de RFF e índice diastólico instantáneo sin ondas y se revisan las evidencias que justifican su uso, así como sus perspectivas futuras.

We report the history and new insights of takotsubo syndrome based on the achievements that Japanese researchers have contributed and summarize the evidence originally presented from Japan. Takotsubo syndrome is a newly described heart failure characterized by transient left ventricular dysfunction. We should be aware of this entity as a syndrome, not actual cardiomyopathy. Japanese researchers focus on the experimental approaches for clinical diagnosis and treatment of takotsubo syndrome. As representatives from a country originally naming this syndrome takotsubo, a global registry for takotsubo syndrome including Japan should be established.

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Background:In patients with STEMI, primary PCI reduces the risk of cardiovascular death, whereases following myocardial reperfusion injury indicating poor prognosis. Post-conditioning is expected to limit reperfusion infarction but the long-term outcome is unclear. We investigated whether primary perfusion balloon angioplasty (PPBA) strategy might reduce reperfusion injury and improve prognosis.Methods:PPBA is maneuver treating as primary revascularization procedure with perfusion balloon angioplasty undergoing long-inflation (5-minutes or more) as post-conditioning. This study is a retrospective analysis from an observational registry which enrolled all consecutive 49 patients with STEMI undergoing PCI in PPBA strategy or conventional balloon angioplasty (CBA) strategy at a single center from February 2021 to January 2022. The primary outcome of the study was MACE as a composite of all-cause death, cardiac death, MI, CI-TVR, hospitalization because of heart failure, and cerebrovascular disease followed at 6 months. The secondary outcome was the composite of no-reflow or slow flow phenomenon, ST elevation, and VT or VF occurrence immediately after primary revascularization procedure.Results:24 patients were treated with PPBA strategy and 25 patients were treated with CBA strategy. At the 6-months, primary composite outcome occurred in 25% treated with PPBA strategy and in 52% treated with CBA strategy (HR, 0.38; P=0.04); the difference was driven by a lower incidence of cardiac death, MI, CI-TVR in PPBA arm. Immediately after primary revascularization, secondary composite outcome occurred in 4.2% treated with PPBA and in 56% treated with CBA (RR, 0.03; P=0.0001); the difference was driven by a lower incidence of no-reflow/slow flow and ST elevation in PPBA arm.Conclusions:PPBA strategy as primary cardioprotective revascularization expected post-conditioning reduces lethal reperfusion injury, resulting in a better prognosis in STEMI.

Background:The American Heart Association guidelines for resuscitation 2020 recommends emergency coronary angiography (CAG) in cases of out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC) with ST-segment elevation(STE) and, it is unclear how much CAG actually contributes to improved outcomes in various OHCA patient populations. The aim of this study is to estimate the impact of CAG on OHCA using a counterfactual machine learning model.Methods:We analyzed adult non-traumatic OHCA patients (43,977 cases) from June 2014 to December 2019 from the JAAM (Japan Association for Acute Medicine)-OHCA registry, which includes post-hospitalization data from 140 Japanese hospitals. We defined outcomes as favorable neurological outcomes (Cerebral Performance Categories (CPC) 1-2) and survival at 30 and 90 days. We estimated the outcome assuming that all patients had received CAG using a machine learning and counterfactual hypothetical model, and also estimated the outcome assuming that all patients had not received CAG. An average of each individual difference between the two estimations was calculated as average treatment effect (ATE) (%), which represents the effect of CAG on improving outcomes for the population. In addition, subgroup analysis was performed based on ROSC, STE and initial documented rhythm.Results:The ATE(%, 95% confidence interval) of CAG in all OHCA patients for CPC 1-2 at 30 and 90 days was 3.11% (2.92-3.30) and 1.85% (1.74-1.95), and survival at 30 and 90 days was 6.25%(5.93-6.57) and 2.20%(1.88-2.52), respectively. The subgroup analysis of ATE for CPC 1-2 at 90 days was particularly lower in the no STE group, initial pulseless electrical activity (PEA) group and initial asystole group than in the STE group and initial ventricular fibrillation(VF) group (Figure).Conclusions:In the JAAM-OHCA registry, we used a counterfactual machine learning model to estimate the effect of CAG on OHCA.

Approximately 2% of patients who present to hospital with suspected acute coronary syndrome have Takotsubo syndrome, with a predominance in postmenopausal womenMortality is higher than initially thought, and recurrence is seen in 1.2% of patients within 6 months and nearly 5% at 6 years, with no preventive therapy currently availableSystemic catecholamine surges can cause acute coronary and peripheral vasospasm followed by peripheral vasodilation; a common complication is cardiogenic shock, due at least in part to left ventricular systolic dysfunctionBiopsy samples taken during the acute phase of Takotsubo syndrome show morphological changes similar to those after catecholamine-induced cardiotoxic effects, supporting direct effects as well as vascular influencesThe apical myocardium of the left ventricle has a high density of β-adrenoceptors and, therefore, is the region most sensitive to circulating catecholaminesDuring extreme stress, excessive epinephrine levels cause a switch from the Gsα stimulatory to the cardioprotective Giα cardioinhibitory secondary messenger pathway within cardiomyocytes, thereby acting as a positive inotrope

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Stress cardiomyopathy, or Takotsubo syndrome, is a transient and reversible disorder that occurs suddenly after emotional or physical stress. It displays symptoms similar to acute myocardial infarction and is found predominantly in postmenopausal women. The underlying cause is still unknown. In this Review, the authors describe the published data relating to stress cardiomyopathy and discuss the possible mechanisms of this cardiac entity.

This review focuses on the prognostic implications and therapeutic approaches in cardiac cachexia – a syndrome that has been recognized for a long time, although it has only received increased attention lately.

An 80-year-old female was admitted for a persistent consciousness disturbance. Electrocardiography revealed ST-segment elevation in leads II, III, aVf, and V3[ndash ]V6. Coronary angiography demonstrated normal arteries, while left ventriculography revealed asynergy of apical akinesis and basal hyperkinesis. The creatinine kinase and creatinine kinase MB levels were not elevated after the initial measurement on admission. The diffuse ST-segment elevation reached a maximum level 24 hours after admission. In leads V3[ndash ]V6, ST-segment elevation continued for 48 hours, and was followed-up by deep inverted T waves. Within 24 days, the asynergy improved without any specific treatment, but the giant negative T waves were present on the electrocardiogram. The plasma norepinephrine and brain natriuretic peptide levels on the first hospital day were 2.9ng/mL and 906pg/mL, respectively. The left ventricular dysfunction appeared to be induced by the exposure to high-level plasma catecholamines. 123I-metaiodobenzyl guanidine scintigraphy also revealed transient dysfunction of the cardiac catecholamine dynamics.

Takotsubo cardiomyopathy (in Japanese language "takotsubo" is a fishing pot with a round bottom and a neck that is used for trapping octopuses) is a new syndrome, which is characterized by transient left ventricular dysfunction and by a typical left ventriculogram showing transient extensive akinesis of the apical and mid portions of the left ventricle with hypercontraction of the basal segment, from which this disease takes its name. Since 1990 sporadic cases of takotsubo cardiomyopathy were reported by Japanese authors, and only a few European reports are available. We report a case of takotsubo-like left ventricular dysfunction in an human immunodeficiency virus (HIV)-infected caucasian patient.

Introduction:Emergent coronary angiogram (CAG) followed if necessary by percutaneous coronary intervention (PCI) are currently a standard strategy in patients resuscitated from cardiac arrest with acute myocardial infarction (MI), especially in patients with ST-segment elevation myocardial infarction (STEMI). Spontaneous MI is related to a coronary plaque disruption with resulting intraluminal thrombosis, which is defined as type 1 MI by the universal definition of MI. For type 1 MI, the management includes early CAG and revascularization as appropriate. The aim of this study was to identify the predictor of type 1 MI in patients resuscitated from cardiac arrest.Methods and Results:A total of 74 patients who underwent immediate CAG after successful resuscitation from in-hospital and out-of-hospital cardiac arrest between January 2015 and December 2016 were analysed. Based on immediate CAG, 44 patients (59.5%) were diagnosed as type1 MI, and 39 (88.6%) of these patients underwent primary PCI after immediate CAG. A sign of ST-segment elevation after resuscitation was more frequently observed in patients with type 1 MI than in those without (71.1% vs. 6.9%, p<0.01). Prevalence of ventricular fibrillation or pulseless ventricular tachycardia as an initial rhythm did not differ between patients with and without type 1 MI (71.1% vs 62.1%, p=0.454). Even after adjusted for possible confounders, ST-segment elevation remained associated with type 1 MI (odds ratio: 89.0, 95% confidence interval 4.3 to 1824.7: p<0.01). Diagnosis by ST-segment elevation resulted in sensitivity of 71.1%, specificity of 93.1%, positive predictive value of 94.1% and negative predictive value of 67.5% for type 1 MI.Conclusions:Among patients who had been successfully resuscitated after cardiac arrest, ST-segment elevation on electrocardiography was a powerful predictor for type1 MI. A sign of ST-segment elevation is useful for rule in decision-making to determine the early invasive strategy.

Introduction:It is known that temperatures affect incident of cardiovascular diseases, but there is limited information how cardiovascular hospitalizations are affected by changes in temperatures.Aim:We sought to examine the association of temporal change in temperature with cardiovascular hospitalizations.Methods:We included 1,067,171 consecutive patients who were admitted to acute care hospitals in Japan. The primary outcome was the number of cardiovascular hospitalizations per day. Temperature change was defined as maxim minus minimum temperature before one day of the hospitalizations. Multilevel mixed-effects liner regression models were used to estimate the association of temperature change with cardiovascular hospitalizations adjusted for humidity, patients? characteristics, and hospital facilitation.Results:The increase in the within-a-day temperature change was associated with the greater number of hospitalizations (coefficient 4.540 [4.310 to 4.675], P < 0.001) after adjusting for (season, humidity, east/west Japan, number of hospital bed, presence of coronary care unit, cardiac surgery service, board certificated cardiologist, age, gender, height, weight, Brinkmann index, Charlson score, angina, acute myocardial infarction, heart failure, atrial fibrillation /flutter, aortic diseases, cardiac arrest, pulmonary embolism, pulmonary hypertension and Tetralogy of Fallot. (Figure)Conclusions:Greater within-a-day temperature change predicts increase in the number of cardiovascular hospitalizations.

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The pressure recovery–adjusted aortic valve area (AVA), called the energy loss coefficient (ELCo), is theoretically a more accurate parameter for evaluating aortic stenosis (AS) severity. The aim of this study was to compare the prognostic value of ELCo with that of conventional AVA.

Reliable assessment of aortic stenosis (AS) severity relies on stroke volume (SV) determination using Doppler echocardiography, but it can also be estimated with two-dimensional/three dimensional echocardiography (2DE/3DE). The aim of this study was to compare SV measurements and AS subgroup classifications among the three modalities and determine their prognostic strength in asymptomatic AS.

Aims Accurate assessment of disease severity is critical for appropriate treatment of patients with aortic stenosis (AS). This study investigated the influence of aortic-valve morphology on the determination of anatomical aortic-valve area (AVA) in patients with AS. Methods and results This prospective study included 126 patients with AS who underwent transoesophageal echocardiography (TEE). Aortic-valve area was measured using (i) planimetric two-dimensional (2D) TEE, (ii) volumetric three-dimensional (3D) TEE, and (iii) the continuity equation (CE) obtained with transthoracic echocardiography. Of these, 20 patients also underwent contrast-enhanced multidetector computed tomography (MDCT). Aortic-valve area was measured from multiplanar reconstruction of the MDCT images. Of the 126 patients, 20 (15.9%) were diagnosed with bicuspid AS and 106 were diagnosed with tricuspid AS. There was an excellent correlation between AVAADCT and AVA3DTEE (r = 0.83, P < 0.001) and a somewhat lower correlation between AVAADCT and AVA2DTEE (r = 0.63, P = 0.006). In the tricuspid AS group, both AVA2DTEE and AVA3DTEE significantly correlated with AVACE (r = 0.63, mean difference 0.13 ± 0.24 cm2, and r = 0.83, mean difference 0.03 ± 0.12 cm2, respectively, both P < 0.001). In contrast, in the bicuspid AS group, AVA3DTEE significantly correlated with AVACE (r = 0.83, mean difference 0.10 ± 0.18 cm2, P < 0.001), whereas AVA2DTEE did not (r = 0.42, mean difference 0.48 ± 0.32 cm2, P = 0.066). Conclusion Aortic-valve morphology influenced the assessment of anatomical AVA in patients with AS, and 3D TEE is useful for assessing anatomical AVA regardless of aortic-valve morphology.