Researcher Profile and Settings

Master

Affiliation (Master)

• Faculty of Medicine　Internal Medicine　Internal Medicine

Affiliation (Master)

• Faculty of Medicine　Internal Medicine　Internal Medicine

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Profile and Settings

Affiliation

• Hokkaido University Graduate School of Medicine, Department of Cardiovascular Medicine, Professor / Chairman

Degree

• MD（PhD）

Profile and Settings

• Name (Japanese)

  Anzai

• Name (Kana)

  Toshihisa

• Name

  200901028999263607

Affiliation

• Hokkaido University Graduate School of Medicine, Department of Cardiovascular Medicine, Professor / Chairman

Achievement

Research Interests

• heart failure   cardiomyopathy   Immune response   Dendritic cell   HFpEF   myocardial infarction   inflammation   aortic aneurysm   

Research Areas

• Life sciences / Cardiology

Research Experience

• 2017/09 - Today Hokkaido University Graduate School of Medicine Department of Cardiovascular Medicine Professor
• 2011/10 - 2017/08 National Cerebral and Cardiovascular Center Department of Cardiovascular Medicine Director
• 2010/09 - 2011/09 International University of Health and Welfare Professor
• 2007/01 - 2010/08 慶應義塾大学専任講師（循環器内科学）
• 2004/09 - 2006/12 慶応義塾大学医学部 学部内講師
• 1998/08 - 2004/08 慶應義塾大学助手（医学部内科学）
• 1995/09 - 1998/07 University of California, San Diego
• 1993/05 - 1995/08 Keio University School of Medicine
• 1991/05 - 1993/04 浦和市立病院（現さいたま市立病院）内科医員
• 1989/04 - 1991/04 Keio University School of Medicine
• 米国心臓学会ポストドクトラルフェロー

Education

•        - 1989  Keio University  School of Medicine
•        - 1989  Keio University  Faculty of Medicine

Committee Memberships

• 2022/04 - Today   COUNCIL FOR CLINICAL USE OF VENTRICULAR ASSIST DEVICE RELATED ACADEMIC SOCIETIES   Dirctor
• 2021/10 - Today   Japanese Onco-Cardiology Society   Director
• 2021/05 - Today   Japanese Circulation Association   Director
• 2020/07 - Today   Japanese Circulation Society   Director
• 2020/08 -2024/07   Editor in Chief of Circulation Journal

Awards

• 2021/03 Hokkaido University Graduate School of Medicine Award for Excellence in Research of the Hokkaido University Graduate School of Medicine
   Elucidation of Regulatory Mechanisms of Inflammation in Cardiovascular Remodeling
• 2014/11 Japan Medical Association Medical Research Encouragement Prize of The Japan Medical Association
  
• 2005 慶應義塾大学医学振興基金、特別研究奨励
  
• 2004 第３３回かなえ医薬振興財団 研究助成
  
• 2003 Finalist of Poster Competition, The 76th annual session meeting of American Heart Association Annual Scientific Meeting
  
• 2001 三四会研究奨励賞
  
• 2000 慶應義塾大学医学部 坂口記念研究助成B
  
• 1999 日本心臓財団 分子循環器研究助成
  
• 1999 武田科学振興財団 研究助成
  
• 1997 American Heart Association, California Affiliate, Post-doctoral Fellowship Award
  
• 1996 Young Investigator Travel Award, American Heart Association Council for Basic Science Research
  
• 1995 病態代謝研究会留学助成
  
• 1994 慶応医師会研究奨励賞
  

Published Papers

• Normalization of increasing shocking coil impedance with full output synchronized shock.

  Takahide Kadosaka, Masaya Watanabe, Motoki Nakao, Taro Koya, Taro Temma, Toshihisa Anzai

  Journal of cardiovascular electrophysiology 2024/08/21 

  INTRODUCTION: Impedance is a crucial parameter in cardiovascular implantable electronic devices (CIEDs). Clinically, most CIEDs measure impedance using low voltage sub-threshold measurement (LVSM). Although the LVSM of shock impedance (LVSM-SI) is generally comparable with high voltage shock impedance (HVSI), LVSM-SI might be inaccurate if peri-lead tissue degeneration occurs. METHODS AND RESULTS: We present a case of elevated LVSM-SI occurring 8 years post-lead implantation, possibly attributed to encapsulation of the right ventricular lead coil. After 0.1 J shock was delivered, a full output synchronized shock was administered to measure HVSI, revealing a normal value. Furthermore, LVSM-SI was normalized and maintained within the normal range during long-term follow-up. CONCLUSION: Our findings suggest conducting a full-output synchronized shock test to assess HVSI when abnormal LVSM-SI is detected in the remote phase post-ICD implantation, which may be considered to help normalize LVSM shock impedance.
• Differential impacts of self-care behavior on clinical outcomes in patients with and without recent heart failure hospitalization.

  Taro Koya, Toshiyuki Nagai, Atsushi Tada, Motoki Nakao, Suguru Ishizaka, Yoshifumi Mizuguchi, Hiroyuki Aoyagi, Fusako George, Shogo Imagawa, Yusuke Tokuda, Yoshiya Kato, Masashige Takahashi, Hiroto Sakai, Masaharu Machida, Kenichi Matsutani, Takahiko Saito, Hiroshi Okamoto, Toshihisa Anzai

  International journal of cardiology 132452 - 132452 2024/08/14 

  BACKGROUND: Although clinical guidelines recommend self-care assessment for patients with chronic heart failure (CHF), its prognostic significance remains controversial. This study aimed to compare the prognostic significance of self-care behavior on mortality between patients with and without a history of recent hospitalization for heart failure (HF). METHODS: We analyzed consecutive 1907 CHF patients from a Japanese multicenter registry (January 2020-June 2023) using the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9) at enrolment. Suboptimal self-care behavior was defined as a score < 70 on the EHFScBS-9. Patients were divided into recent (within 30 days post-discharge, n = 664) and no recent hospitalization for HF groups (n = 1263), respectively. The primary outcome was a composite of all-cause death and rehospitalization for HF. RESULTS: During a median follow-up period of 427 (interquartile range 273-630) days, the primary outcome occurred in 100 patients. Patients with suboptimal self-care behavior exhibited a higher incidence of the primary outcome in the recent hospitalization for HF group (p = 0.020) but not in the no recent hospitalization for HF group (P = 0.16). Multivariable regressions showed suboptimal self-care behavior was independently associated with the primary outcome in the recent hospitalization for HF group with a significant interaction (P = 0.029). CONCLUSION: In patients recently hospitalized for HF, but not in those without a recent hospitalization history for HF, suboptimal self-care behavior was associated with adverse events. This indicates the importance of self-care education for these patients.
• Public awareness of palliative care for heart failure in Japan: A cross-sectional study.

  Tatsuhiro Shibata, Atsushi Mizuno, Takashi Ohmori, Shogo Oishi, Kimitaka Nishizaki, Takeru Nabeta, Takuya Kishi, Toshiyuki Nagai, Toshihisa Anzai

  Journal of cardiology 2024/06/03 

  BACKGROUND: Palliative care (PC) benefits cancer patients and those with heart failure (HF), improving quality of life and symptom burden. Despite guidelines recommending the integration of PC into HF care, its use remains inadequate, partly due to insufficient public awareness. This study aimed to assess the public awareness of PC for HF in Japan and identify factors associated with awareness. METHODS: A cross-sectional online survey was conducted from March 6-13, 2023, using a panel operated by Intage Inc. (Tokyo, Japan), which has a pool of 3.78 million potential Japanese respondents. The survey included 51,790 participants, matched for sex, age, and region of residence. Participants were asked about their awareness of PC eligibility for HF, along with demographic information, history of hospitalization for sudden illness, outpatient visits, and health status in the previous 2 years. The χ2 test and Cramer's V were used to analyze associations between awareness and variables, and multivariate logistic regression was used to estimate awareness predictors. RESULTS: In total, 91 % of participants were unaware of PC eligibility for HF. Age group, healthcare professional occupation, and history of hospitalization for acute myocardial infarction, acute HF, acute pulmonary embolism, and ruptured aortic aneurysm had weak to moderate associations with awareness. Multivariate analysis revealed that a history of hospitalization for sudden cardiovascular illness and being a healthcare professional were positively related to awareness, while age, female sex, and being married were associated with lower odds of awareness. CONCLUSION: The low public awareness of PC for HF in Japan underscores the importance of increasing awareness of the eligibility of PC for HF, as well as cancer, to integrate PC into HF practice as basic care.
• Head-to-Head Comparison of Hepatic Vein and Superior Vena Cava Flow Velocity Waveform Analyses for Predicting Elevated Right Atrial Pressure.

  Michito Murayama, Sanae Kaga, Airi Onoda, Hisao Nishino, Shinobu Yokoyama, Mana Goto, Yukino Suzuki, Yusuke Yanagi, Yui Shimono, Kosuke Nakamura, Hiroyuki Aoyagi, Yoji Tamaki, Suguru Ishizaka, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Ultrasound in medicine & biology 2024/06/03 

  OBJECTIVE: Blood flow in the hepatic veins and superior vena cava (SVC) reflects right heart filling; however, their Doppler profiles are often not identical, and no studies have compared their diagnostic efficacies. We aimed to determine which venous Doppler profile is reliable for detecting elevated right atrial pressure (RAP). METHODS: In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker. RESULTS: HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = -0.350, p < 0.001; r = -0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = -0.211, p = 0.013) and mean RAP (β = -0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = -0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP. CONCLUSIONS: SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF.
• 肺動脈弁逆流速度計測に基づく右室一回仕事係数の非侵襲的推定法

  立石 優太, 村山 迪史, 加賀 早苗, 塚本 真帆, 後藤 真奈, 鈴木 ゆき乃, 柳 裕介, 横山 しのぶ, 西野 久雄, 石坂 傑, 岩野 弘幸, 安斉 俊久

  超音波検査技術 (一社)日本超音波検査学会 49 (3) 271 - 271 1881-4506 2024/06
• Simultaneous epicardial ablation based on intraoperative electroanatomic mapping during left ventricular assist device implantation.

  Kotaro Nishino, Masaya Watanabe, Tomonori Ooka, Takuma Sato, Toshihisa Anzai

  Journal of arrhythmia 40 (3) 632 - 635 2024/06 

  Intraoperative ventricular tachycardia (VT) ablation targeting the epicardial substrate using three-dimensional electroanatomic mapping (EAM) was performed during left ventricular assist device (LVAD) implantation. We proved that EAM can be safely performed during LVAD implantation and that an ablation strategy based on electrophysiological information may reduce VT recurrence after LVAD implantation.
• Validity and reliability of the palliative care needs assessment tool in Japanese patients with heart failure

  Daishiro Tatsuta, Takuma Sato, Toshiyuki Nagai, Jiro Koya, Kotaro Nishino, Seiichiro Naito, Yoshifumi Mizuguchi, Taro Temma, Kiwamu Kamiya, Hisashi Narita, Kenkichi Tsuruga, Toshihisa Anzai

  ESC Heart Failure 2055-5822 2024/05/29 

  Abstract Aims Although patients with heart failure (HF) frequently experience considerable symptom burden and require significant care, most HF patients do not receive timely intervention due to the absence of a standardized method for identifying those in need of palliative care. The Needs Assessment Tool: Progressive Disease‐Heart Failure (NAT: PD‐HF) assesses the palliative care needs of patients with HF. However, its validity and reliability have yet to be fully examined. We aimed to assess the validity and reliability of the NAT: PD‐HF in Japanese patients with HF. Methods We prospectively enrolled 106 consecutive patients with chronic HF admitted to our university hospital between February 2023 and July 2023. Their caregivers (n = 95) and healthcare providers (n = 17) were also included. The NAT: PD‐HF was translated from English to Japanese using a forward–backward translation procedure and adapted based on Japanese cultural and medical backgrounds by our professional multidisciplinary team. We assessed the internal consistency of the Japanese NAT: PD‐HF version with Cronbach's alpha coefficient and the inter‐rater and test–retest reliabilities with Cohen's kappa coefficient. After using the tool, all participants were asked to complete a questionnaire about the tool to determine its validity. Results The proportion of female patients in this study was 47 (44%). The median age was 72 years [interquartile range (IQR) 59–81]. The median time spent assessing the patients' and their caregivers' needs using the Japanese NAT: PD‐HF was 14 min (IQR 12–17). The Cronbach's alpha coefficient was 0.82, and the minimum kappa coefficient was 0.77 for inter‐rater reliability and 0.88 for test–retest reliability. In total, 103 patients (97%) and all caregivers responded that the tool was easy to understand. One hundred (94%) patients and 89 (94%) caregivers felt that the tool would improve the quality of care, and 102 (96%) patients and 91 (96%) caregivers indicated that the discussions using this tool allowed them to confide in all their burdens and care needs. All healthcare providers expressed that this tool is helpful in understanding the burden and care needs of both patients and caregivers comprehensively. Conclusions The NAT: PD‐HF is a reliable and valid tool for Japanese patients with HF and their caregivers. This tool was very well accepted by patients, caregivers and healthcare providers to identify burdens and care needs.
• Chronic Active Myocarditis After Transapical Transcatheter Aortic Valve Implantation.

  Yuta Kobayashi, Toshiyuki Nagai, Kiwamu Kamiya, Satonori Tsuneta, Yasushige Shingu, Kento Wakabayashi, Kohsuke Kudo, Yoshihiro Matsuno, Satoru Wakasa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 88 (6) 1008 - 1008 2024/05/24
• Is growth differentiation factor-15 a useful biomarker for chronic heart failure across body size?

  Atsushi Tada, Toshiyuki Nagai, Toshihisa Anzai

  International journal of cardiology 410 132204 - 132204 2024/05/23
• Announcement of the 2024 JCS Meeting Activities (2).

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 88 (5) 621 - 625 2024/04/25
• Acute onset of constrictive pericarditis due to acute myelomonocytic leukemia: A case and literature review.

  Naoki Kosaka, Takanori Uchiyama, Masahiro Onozawa, Jun Nagai, Jiro Koya, Suguru Ishizaka, Toshiyuki Nagai, Yohei Ikebe, Kenjiro Kato, Zen-Ichi Tanei, Jun Sakakibara-Konishi, Yuta Hasegawa, Hiroyuki Ohigashi, Hideki Goto, Daigo Hashimoto, Hideki Ujiie, Satoshi Hirano, Satoshi Konno, Toshihisa Anzai, Koji Taniguchi, Shinya Tanaka, Takanori Teshima

  Internal medicine (Tokyo, Japan) 2024/04/16 [Refereed]
   

  We herein present a fatal case of constrictive pericarditis (CP) due to acute myelomonocytic leukemia (AMML) in a patient who initially complained of an acute onset of chest pain two days after COVID-19 vaccination. An autopsy revealed pericardial infiltration of leukemic cells. CP is rarely associated with leukemia and only 14 cases have been reported in the literature. The etiology of CP in previous reports included leukemic infiltration, graft-versus-host disease, drug-induced, post-radiation, autoimmune, and otherwise unidentified. This case indicates that leukemic infiltration can cause CP and that clinicians should include leukemia in the differential diagnosis of CP.
• Non-invasive assessment of left ventricular filling pressure in aortic stenosis.

  Hiroyuki Aoyagi, Hiroyuki Iwano, Yoji Tamaki, Michito Murayama, Suguru Ishizaka, Ko Motoi, Kosuke Nakamura, Mana Goto, Yukino Suzuki, Shinobu Yokoyama, Hisao Nishino, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Echocardiography (Mount Kisco, N.Y.) 41 (4) e15808  2024/04 

  BACKGROUND: The assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently-proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score. METHODS: We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LV FP. LV diastolic dysfunction (DD) was graded according to the ASE/EACVI guidelines. The VMT score was defined as follows: time sequence of opening of mitral and tricuspid valves was scored to 0-2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava was dilated, one point was added and VMT score was finally calculated as 0-3. RESULTS: Of the 116 patients, 29 patients showed elevated PAWP. Ninety patients (93%) and 67 patients (63%) showed increased values for left atrium volume index (LAVI) and E/e', respectively when the cut-off values recommended by the guidelines were applied and thus the algorism predicted elevated PAWP with a low specificity and positive predictive value (PPV). VMT ≥ 2 predicted elevated PAWP with a sensitivity of 59%, specificity of 90%, PPV of 59%, and negative predictive value of 89%. An alternative algorithm that applied tricuspid regurgitation velocity and VMT scores was tested, and its predictive ability was markedly improved. CONCLUSION: VMT score was applicable for AS patients. Alternative use of VMT score improved diagnostic accuracy of guideline-recommended algorism.
• Iron supplementation is a residual piece of management in Asian patients with heart failure?

  Motoki Nakao, Toshiyuki Nagai, Toshihisa Anzai

  International Journal of Cardiology 406 132014 - 132014 0167-5273 2024/04
• Influence of epicardial adipose tissue inflammation and adipocyte size on postoperative atrial fibrillation in patients after cardiovascular surgery

  Hiroyuki Natsui, Masaya Watanabe, Takashi Yokota, Satonori Tsuneta, Yoshizuki Fumoto, Haruka Handa, Matsushima Shouji, Jiro Koya, Kotaro Nishino, Daishiro Tatsuta, Takuya Koizumi, Takahide Kadosaka, Motoki Nakao, Taro Koya, Taro Temma, Yoichi M. Ito, Hatanaka C. Kanako, Yutaka Hatanaka, Shingu Yasushige, Satoru Wakasa, Shuhei Miura, Takahiko Masuda, Naritomo Nishioka, Shuichi Naraoka, Kayoko Ochi, Tomoko Kudo, Tsugumine Ishikawa, Toshihisa Anzai

  Physiological Reports 12 (6) e15957  2051-817X 2024/03/28 

  Abstract Epicardial adipose tissue (EAT) is an active endocrine organ that is closely associated with occurrence of atrial fibrillation (AF). However, the role of EAT in the development of postoperative AF (POAF) remains unclear. We aimed to investigate the association between EAT profile and POAF occurrence in patients who underwent cardiovascular surgery. We obtained EAT samples from 53 patients to evaluate gene expression, histological changes, mitochondrial oxidative phosphorylation (OXPHOS) capacity in the EAT, and protein secretion in EAT‐conditioned medium. EAT volume was measured using computed tomography scan. Eighteen patients (34%) experienced POAF within 7 days after surgery. Although no significant difference was observed in EAT profile between patients with and without POAF, logistic regression analysis identified that the mRNA expression levels of tumor necrosis factor‐alpha (TNF‐α) were positively correlated and adipocyte size in the EAT was inversely correlated with onset of POAF, respectively. Mitochondrial OXPHOS capacity in the EAT was not associated with POAF occurrence; however, it showed an inverse correlation with adipocyte size and a positive correlation with adiponectin secretion. In conclusion, changes in the secretory profile and adipocyte morphology of the EAT, which represent qualitative aspects of the adipose tissue, were present before the onset of AF.
• Rapid Publication and Announcement of the 2024 JCS Meeting Activities.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 88 (4) 437 - 438 2024/03/25
• Prolonged delirium during hospitalization is associated with worse long-term and short-term outcomes in patients with acute heart failure.

  Yukio Aikawa, Soshiro Ogata, Satoshi Honda, Toshiyuki Nagai, Shunsuke Murata, Isao Morii, Toshihisa Anzai, Kunihiro Nishimura, Teruo Noguchi

  International journal of cardiology 399 131776 - 131776 2024/03/15 

  BACKGROUND: The association between prolonged delirium during hospitalization and long-term prognosis in patients with acute heart failure (AHF) admitted to the cardiac intensive care unit (CICU) has not been fully elucidated. METHODS: We conducted a prospective registry study of patients with AHF admitted to the CICU at 2 hospitals from 2013 to 2021. We divided study patients into 3 groups according to the presence or absence of delirium and prolonged delirium as follows: no delirium, resolved delirium, or prolonged delirium. Main outcomes were in-hospital mortality and 3-year mortality after discharge. RESULTS: A total of 1555 patients with AHF (median age, 80 years) were included in the analysis. Of these, 406 patients (26.1%) developed delirium. We divided patients with delirium into 2 groups: the resolved delirium group (n = 201) or the prolonged delirium group (n = 205). Multivariate Cox proportional hazards models for long-term prognosis demonstrated that the prolonged delirium group had a higher incidence of all-cause death (hazard ratio [HR], 1.52; 95% CI, 1.08 to 2.14) and non-cardiovascular death (HR, 1.84; 95% CI, 1.21 to 2.78) than the resolved delirium group. Regarding in-hospital outcomes, multivariate logistic regression modeling showed that prolonged delirium is associated with all-cause death (odds ratio [OR], 9.55; 95% confidential interval [CI], 2.99 to 30.53) and cardiovascular death (OR, 13.02; 95% CI, 2.86 to 59.27) compared with resolved delirium. CONCLUSIONS: Prolonged delirium is associated with worse long-term and short-term outcomes than resolved delirium in patients with AHF.
• Prognostic Value of Combined Assessments of Late Gadolinium Enhancement and Fluorodeoxyglucose Uptake in Cardiac Sarcoidosis.

  Sho Kazui, Sakae Takenaka, Toshiyuki Nagai, Satonori Tsuneta, Kenji Hirata, Yoshiya Kato, Hirokazu Komoriyama, Yuta Kobayashi, Akinori Takahashi, Kiwamu Kamiya, Taro Temma, Takuma Sato, Atsushi Tada, Yutaro Yasui, Michikazu Nakai, Takahiro Sato, Ichizo Tsujino, Kohsuke Kudo, Satoshi Konno, Toshihisa Anzai

  JACC. Cardiovascular imaging 17 (6) 710 - 712 2024/03/11
• Two-Year Clinical Outcome of MitraClip Transcatheter Edge-to-Edge Repair From the J-MITRA Registry Data.

  Teruhiko Imamura, Michikazu Nakai, Yoshitaka Iwanaga, Yoko Sumita, Misato Tao, Yohei Ohno, Kentaro Hayashida, Yoshihiro Morino, Yoshihiro Seo, Yoshikatsu Saiki, Toshihisa Anzai, Koichi Toda, Goro Matsumiya, Kazuhiro Yamamoto, Kenichi Hirata, Koichiro Kinugawa

  Circulation journal : official journal of the Japanese Circulation Society 88 (4) 539 - 548 2024/03/06 

  BACKGROUND: The introduction of transcatheter edge-to-edge repair for moderate-to-severe or severe mitral regurgitation (MR) utilizing the MitraClip system became reimbursed and clinically accessible in Japan in April 2018. This study presents the 2-year clinical outcomes of all consecutively treated patients who underwent MitraClip implantation in Japan and were prospectively enrolled in the Japanese Circulation Society-oriented J-MITRA registry.Methods and Results: Analysis encompassed 2,739 consecutive patients enrolled in the J-MITRA registry with informed consent (mean age: 78.3±9.6 years, 1,550 males, STS risk score 11.7±8.9), comprising 1,999 cases of functional MR, 644 of degenerative MR and 96 in a mixed group (DMR and FMR). The acute procedure success rate was 88.9%. After MitraClip implantation, >80% exhibited an MR grade ≤2+ and the trend was sustained over the 2 years. Within this observation period, the mortality rate was 19.3% and the rate of heart failure readmissions was 20.6%. The primary composite endpoint, inclusive of cardiovascular death and heart failure readmission, was significantly higher in patients with functional MR than in with degenerative MR (32.0% vs. 17.5%, P<0.001). CONCLUSIONS: The 2-year clinical outcomes after MitraClip implantation were deduced from comprehensive data within an all-Japan registry.
• Machine Learning-based Gait Analysis to Predict Clinical Frailty Scale in Elderly Patients with Heart Failure

  Yoshifumi Mizuguchi, Motoki Nakao, Toshiyuki Nagai, Yuki Takahashi, Takahiro Abe, Shigeo Kakinoki, Shogo Imagawa, Kenichi Matsutani, Takahiko Saito, Masashige Takahashi, Yoshiya Kato, Hirokazu Komoriyama, Hikaru Hagiwara, Kenji Hirata, Takahiro Ogawa, Takuto Shimizu, Manabu Otsu, Kunihiro Chiyo, Toshihisa Anzai

  European Heart Journal - Digital Health 5 (2) 152 - 162 2023/12/20 

  Abstract Aims Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF. Methods and Results We prospectively examined 417 elderly (≥75 years) with symptomatic chronic HF patients from seven centers between January 2019 and October 2023. The patients were divided into derivation (n = 194) and validation (n = 223) cohorts. We obtained body-tracking motion data using a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the Light Gradient Boosting Machine (LightGBM) model. To evaluate the performance of this model, we calculated Cohen’s weighted kappa (CWK) and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. In the derivation and validation datasets, the LightGBM models showed excellent agreements between the actual and predicted CFSs (CWK 0.866, 95% CI 0.807-0.911; ICC 0.866, 95% CI 0.827-0.898; CWK 0.812, 95% CI 0.752-0.868; ICC 0.813, 95% CI 0.761-0.854, respectively). During a median follow-up period of 391 (IQR 273-617) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (HR 1.60, 95% CI 1.02-2.50) after adjusting for significant prognostic covariates. Conclusion Machine learning-based algorithms of automatically CFS rating are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.
• Exercise Capacity and Clinical Outcomes in Chronic Heart Failure Patients with Mild Tricuspid Regurgitation.

  Kosuke Nakamura, Suguru Ishizaka, Kazunori Omote, Yutaro Yasui, Yoshifumi Mizuguchi, Sakae Takenaka, Yui Shimono, Ko Motoi, Hiroyuki Aoyagi, Yoji Tamaki, Sho Kazui, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Atsushi Tada, Yuta Kobayashi, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of clinical medicine 12 (23) 2023/12/01 

  AIM: The present study aimed to investigate the impact of mild tricuspid regurgitation (TR) on the exercise capacity or clinical outcomes in patients with chronic heart failure (CHF). METHODS AND RESULTS: The study enrolled 511 patients with CHF who underwent cardiopulmonary exercise testing (CPET) between 2013 and 2018. The primary outcome was a composite of heart failure hospitalization and death. Patients with mild TR (n = 324) or significant TR (moderate or greater; n = 60) displayed worse NHYA class and reduced exercise capacity on CPET than those with non-TR (n = 127), but these were more severely impaired in patients with significant TR. A total of 90 patients experienced events over a median follow-up period of 3.3 (interquartile range 0.8-5.5) years. Patients with significant TR displayed a higher risk of events, while patients with mild TR had a 3.0-fold higher risk of events than patients with non-TR (hazard ratio (HR) 3.01; 95% confidence interval (CI), 1.50-6.07). Multivariate Cox regression analysis showed that, compared with non-TR, mild TR was associated with increased adverse events, even after adjustment for co-variates (HR 2.97; 95% CI, 1.35-6.55). CONCLUSIONS: TR severity was associated with worse symptoms, reduced exercise capacity, and poor clinical outcomes. Even patients with mild TR had worse clinical characteristics than those with non-TR.
• Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement.

  Yuki Takahashi, Kiwamu Kamiya, Toshiyuki Nagai, Satonori Tsuneta, Noriko Oyama-Manabe, Takeshi Hamaya, Sho Kazui, Yutaro Yasui, Kohei Saiin, Seiichiro Naito, Yoshifumi Mizuguchi, Sakae Takenaka, Atsushi Tada, Suguru Ishizaka, Yuta Kobayashi, Kazunori Omote, Takuma Sato, Yasushige Shingu, Kohsuke Kudo, Satoru Wakasa, Toshihisa Anzai

  Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 25 (1) 60 - 60 2023/10/26 

  BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR). METHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR. RESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups. CONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.
• 心臓サルコイドーシス患者の免疫抑制療法開始後における心筋トロポニン値経時的評価の予後的意義

  數井 翔, 竹中 秀, 永井 利幸, 加藤 喜哉, 小森山 弘和, 小林 雄太, 高橋 昌寛, 神谷 究, 佐藤 琢真, 多田 篤司, 安井 悠太郎, 中井 陸運, 佐藤 隆博, 辻野 一三, 今野 哲, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 43 (サプリメント号) 64 - 64 1883-1273 2023/10
• 心臓サルコイドーシス患者におけるガドリニウム遅延造影心臓MRIとFDG-PETを用いた複合的画像評価の予後的意義

  數井 翔, 竹中 秀, 永井 利幸, 常田 慧徳, 加藤 喜哉, 小森山 弘和, 小林 雄太, 高橋 昌寛, 神谷 究, 天満 太郎, 佐藤 琢真, 多田 篤司, 安井 悠太郎, 中井 陸運, 佐藤 隆博, 辻野 一三, 工藤 與亮, 今野 哲, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 43 (サプリメント号) 65 - 65 1883-1273 2023/10
• 心臓サルコイドーシス患者の免疫抑制療法開始後における心筋トロポニン値経時的評価の予後的意義

  數井 翔, 竹中 秀, 永井 利幸, 加藤 喜哉, 小森山 弘和, 小林 雄太, 高橋 昌寛, 神谷 究, 佐藤 琢真, 多田 篤司, 安井 悠太郎, 中井 陸運, 佐藤 隆博, 辻野 一三, 今野 哲, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 43 (サプリメント号) 64 - 64 1883-1273 2023/10
• 心臓サルコイドーシス患者におけるガドリニウム遅延造影心臓MRIとFDG-PETを用いた複合的画像評価の予後的意義

  數井 翔, 竹中 秀, 永井 利幸, 常田 慧徳, 加藤 喜哉, 小森山 弘和, 小林 雄太, 高橋 昌寛, 神谷 究, 天満 太郎, 佐藤 琢真, 多田 篤司, 安井 悠太郎, 中井 陸運, 佐藤 隆博, 辻野 一三, 工藤 與亮, 今野 哲, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 43 (サプリメント号) 65 - 65 1883-1273 2023/10
• Impact of Cardiac Power Output on Exercise Capacity and Clinical Outcome in Patients With Chronic Heart Failure.

  Yui Shimono, Suguru Ishizaka, Kazunori Omote, Kosuke Nakamura, Yutaro Yasui, Yoshifumi Mizuguchi, Sakae Takenaka, Hiroyuki Aoyagi, Yoji Tamaki, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  The American journal of cardiology 206 4 - 11 2023/09/05 

  Less data are available regarding the impact of cardiac power output on exercise capacity or clinical outcome in patients with chronic heart failure (CHF). The study enrolled 280 consecutive patients with CHF referred for cardiopulmonary exercise testing and right-sided heart catheterization between 2013 and 2018. The primary outcome was composite of heart failure hospitalization or death. Cardiac power output was calculated as (mean arterial pressure × CO) ÷ 451. Patients with low cardiac power output (<0.53 W, n = 99) were older and had a higher brain natriuretic peptide level than patients with high cardiac power output (≥0.53W, n = 181). Cardiac power output was correlated with peak oxygen consumption (peak V̇O2), peak workload achievement, and ventilatory efficiency (V̇E/V̇CO2 slope) in cardiopulmonary exercise testing, whereas each of cardiac output or mean arterial pressure was not. There were 48 patients with events over a median follow-up period of 3.5 (interquartile range 1.0 to 6.0) years. Patients with low cardiac power output had about a 2-fold higher risk of events than those with a high cardiac power output (hazard ratio 1.97, 95% confidence interval 1.12 to 3.48). In the multivariable Cox regression, a 0.1-W decrease in cardiac power output was associated with 19% increased adverse events (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). In conclusion, cardiac power output was associated with reduced exercise capacity and poor clinical outcome, suggesting that cardiac power output is useful for risk stratification in patients with CHF. Further study is required to identify therapies targeting cardiac power output to improve the exercise capacity or clinical outcome in patients with CHF.
• Association of longitudinal cardiac troponin trajectory with adverse events in patients with cardiac sarcoidosis.

  Sho Kazui, Sakae Takenaka, Toshiyuki Nagai, Yoshiya Kato, Hirokazu Komoriyama, Yuta Kobayashi, Akinori Takahashi, Kiwamu Kamiya, Takuma Sato, Atsushi Tada, Yutaro Yasui, Michikazu Nakai, Takahiro Sato, Ichizo Tsujino, Satoshi Konno, Toshihisa Anzai

  International journal of cardiology 389 131268 - 131268 2023/08/15 

  BACKGROUND: Although high-sensitivity cardiac troponins may be sensitive and easily repeatable markers of disease activity in patients with cardiac sarcoidosis (CS), the association between longitudinal cardiac troponin trajectory and adverse events remains unclear. This study aimed to clarify whether longitudinal cardiac troponin levels were associated with adverse events in patients with CS. METHODS: We examined 63 consecutive CS-initiated prednisolone (PSL) patients with available longitudinal high-sensitivity cardiac troponin T (cTnT) data between December 2013 and March 2023. The area under the cTnT trajectory, which reflected cumulative cTnT release, was calculated to assess the association between longitudinal cTnT levels and adverse events. Patients were divided into two groups according to the median area under the cTnT trajectory per month. The primary outcome was a composite of sustained ventricular tachycardia or fibrillation, worsening heart failure, and sudden cardiac death (SCD). RESULTS: In total, 463 cTnT measurements were collected over a median follow-up period of 30.4 (interquartile range [IQR] 15.6-34.2) months. The primary outcome was observed in 12 (19%) patients. A higher area under the cTnT trajectory was significantly associated with an increased incidence of the primary outcome (P = 0.027), while cTnT levels before and one month after initiation of PSL, and these changes were not related to adverse events (P = 0.179, 0.096, and 0.95, respectively). CONCLUSIONS: Longitudinal cTnT trajectory following PSL initiation was associated with adverse cardiac events in patients with CS, suggesting that longitudinal measurement of cTnT would be useful for the early identification of high-risk patients.
• Association between Non-Lipid Residual Risk Factors and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Pitavastatin: An Observation from the REAL-CAD Study.

  Kiwamu Kamiya, Makoto Takei, Toshiyuki Nagai, Toru Miyoshi, Hiroshi Ito, Yoshihiro Fukumoto, Hitoshi Obara, Tatsuyuki Kakuma, Ichiro Sakuma, Hiroyuki Daida, Satoshi Iimuro, Hiroaki Shimokawa, Takeshi Kimura, Ryozo Nagai, Toshihisa Anzai

  Journal of atherosclerosis and thrombosis 2023/08/11 

  AIMS: We aimed to investigate the association between non-lipid residual risk factors and cardiovascular events in patients with stable coronary artery disease (CAD) who achieved low-density lipoprotein cholesterol (LDL-C) ＜100 mg/dL from the Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study. METHODS: The REAL-CAD study was a prospective, multicenter, open-label trial. As a sub-study, we examined the prognostic impact of non-lipid residual risk factors, including blood pressure, glucose level, and renal function, in patients who achieved LDL-C ＜100 mg/dL at 6 months after pitavastatin therapy. Each risk factor was classified according to severity. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, and unstable angina requiring emergency hospitalization. RESULTS: Among 8,743 patients, the mean age was 68±8.2 years, and the mean LDL-C level was 84.4±18 mg/dL. After adjusting for the effects of confounders, an estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2 showed the highest risk of the primary outcome (hazard ratio [HR] 1.92; 95% confidence interval [CI] 1.45-2.53). The combination of eGFR ≤ 60 and hemoglobin A1c (HbA1c) ≥ 6.0% also showed the highest risk of all-cause death (HR, 2.42; 95% CI, 1.72-3.41). CONCLUSIONS: In patients with stable CAD treated with pitavastatin and who achieved guidelines-directed levels of LDL-C, eGFR and HbA1c were independently associated with adverse events, suggesting that renal function and glycemic control could be residual non-lipid therapeutic targets after statin therapy.
• Cost-effective analysis of transcatheter aortic valve replacement in patients with severe symptomatic aortic stenosis: A prospective multicenter study.

  Makoto Amaki, Kensuke Moriwaki, Michikazu Nakai, Tetsuhiro Yamano, Atsushi Okada, Hideaki Kanzaki, Masaki Izumo, Hiroki Usuku, Tetsuari Onishi, Toshiyuki Nagai, Yoshihiro Miyamoto, Tomoyuki Fujita, Hiroya Kawai, Yoshihiro Akashi, Kenichi Tsujita, Satoaki Matoba, Junjiro Kobayashi, Chisato Izumi, Toshihisa Anzai

  Journal of cardiology 2023/08/03 

  BACKGROUND: Transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis (AS) does not benefit all patients. We performed a prospective multicenter study to investigate the cost-effectiveness of TAVR in a Japanese cohort. METHODS AND RESULTS: We prospectively enrolled 110 symptomatic patients with severe AS who underwent TAVR from five institutions. The quality of life measurement (QOL) was performed for each patient before and at 6 months after TAVR. Patients without an improvement in QOL at 6 months after TAVR were defined as non-responders. Pre-TAVR higher QOL, higher clinical frailty scale predicted the non-responders. Three models, 1) conservative treatment for all patients strategy, 2) TAVR for all patients strategy, and 3) TAVR for a selected patient strategy who is expected to be a responder, were simulated. Lifetime cost-effectiveness was estimated using incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life-year (QALY) gained. In comparison to conservative therapy for all patients, ICER was estimated to be 5,765,800 yen/QALY for TAVR for all patients and 2,342,175 yen/QALY for TAVR for selected patient strategy patients, which is less than the commonly accepted ICER threshold of 5,000,000 yen/QALY. CONCLUSIONS: TAVR for selected patient strategy model is more cost-effective than TAVR for all patient strategy without reducing QOL in the Japanese healthcare system. TAVR for selected patient strategy has potential benefit for optimizing the TAVR treatment in patients with high frailty and may direct our resources toward beneficial interventions.
• Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial.

  Shin Ito, Hiroyuki Takahama, Masanori Asakura, Yukio Abe, Masayoshi Ajioka, Toshihisa Anzai, Takuo Arikawa, Takaharu Hayashi, Yorihiko Higashino, Shinya Hiramitsu, Noriaki Iwahashi, Chisato Izumi, Kazuo Kimura, Koichiro Kinugawa, Hidetaka Kioka, Young-Jae Lim, Ken Matsuoka, Satoshi Matsuoka, Hirohiko Motoki, Sunao Nakamura, Takafumi Nakayama, Akihiro Nomura, Taishi Sasaoka, Shin Takiuchi, Shigeru Toyoda, Tomoya Ueda, Tetsuya Watanabe, Akira Yamada, Masayoshi Yamamoto, Takashi Sozu, Masafumi Kitakaze

  Scientific reports 13 (1) 12517 - 12517 2023/08/02 

  Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricular (LV) diastolic function in patients with hypertension and either HFpEF or HF with mildly reduced ejection fraction (HFmrEF) more than candesartan. In this randomized, open-label trial, we randomly assigned 193 hypertensive patients with HF and LV ejection fraction ≥ 45% to 20 mg of azilsartan (n = 95) or 8 mg of candesartan (n = 98), once daily for 48 weeks. After the initiation of treatment, changes in the doses of the study drugs were permitted based on the patient's conditions, including blood pressure (median dose at 48 weeks: azilsartan 20.0 mg/day, candesartan 8.0 mg/day). The primary endpoint was the baseline-adjusted change in the ratio of peak early diastolic transmitral flow velocity (E) to early diastolic mitral annular velocity (e') (E/e'). Adjusted least-squares mean (LSM) change in E/e' was - 0.8 (95% confidence interval [CI] - 1.49 to - 0.04) in the azilsartan group and 0.2 (95% CI - 0.49 to 0.94) in the candesartan group, providing the LSM differences of - 1.0 (95% CI - 2.01 to 0.03, P = 0.057). The median change in left atrial volume index was - 2.7 mL/m2 with azilsartan vs 1.4 mL/m2 with candesartan (P = 0.091). The frequency of adverse events related to hypotension and hyperkalemia did not differ between the groups. The current study did not provide strong evidence that azilsartan improves LV diastolic dysfunction, and further confirmatory study is required.
• Increased Piezo1 expression in myofibroblasts in patients with symptomatic carotid atherosclerotic plaques undergoing carotid endarterectomy: A pilot study.

  Takao Konishi, Kenji Kamiyama, Toshiaki Osato, Tetsuyuki Yoshimoto, Takeshi Aoki, Toshihisa Anzai, Shinya Tanaka

  Vascular 17085381231192380 - 17085381231192380 2023/07/27 

  OBJECTIVES: We aimed to investigate Piezo1 expression in myofibroblasts in symptomatic and asymptomatic patients undergoing carotid endarterectomy and its relationship with atherosclerotic plaque formation. METHODS: This cross-sectional study analyzed carotid plaques of 17 randomly selected patients who underwent carotid endarterectomy from May 2015 to August 2017. In total, 51 sections (the most stenotic lesion, and the sections 5-mm proximal and distal) stained with hematoxylin-eosin and elastica-Masson were examined. Immunohistochemistry was performed using antibodies to Piezo1. The Piezo1 score of a section was calculated semiquantitatively, averaged across 30 randomly selected myofibroblasts in the fibrous cap of the plaque. RESULTS: Of 17 patients (mean age: 74.2 ± 7.1 years), 15 were men, 9 had diabetes mellitus, and 13 had hypertension. Symptomatic patients had higher mean Piezo1 score than asymptomatic patients (1.78 ± 0.23 vs 1.34 ± 0.17, p < .001). Univariate linear regression analyses suggested an association between plaque rupture, thin-cap fibroatheroma and microcalcifications and the Piezo1 score (p = .001, .008, and 0.003, respectively). CONCLUSIONS: Increased Piezo1 expression of myofibroblasts may be associated with atherosclerotic carotid plaque instability. Further study is warranted to support this finding.
• Relationship between Canagliflozin, Sodium Glucose Cotransporter 2 Inhibitor, and Hematopoietic Effects in Patients with Diabetes and Mild Heart Failure: Results from the CANDLE Trial

  Daisaku Nakatani, Tomoharu Dohi, Shungo Hikoso, Atsushi Tanaka, Mamoru Nanasato, Wataru Shimizu, Koichi Node, Yasushi Sakata, Masayoshi Ajioka, Junya Ako, Rie Amano, Toshihisa Anzai, Mitsutoshi Asai, Kaoru Dohi, Kazuo Eguchi, Kenichi Eshima, Shinya Fujiki, Masashi Fujita, Shinya Hiramitsu, Satoshi Hoshide, Akihiko Hoshino, Yuki Ikeda, Yumi Ikehara, Takayuki Inomata, Teruo Inoue, Katsuhisa Ishii, Nobukazu Ishizaka, Masaaki Ito, Noriaki Iwahashi, Katsuomi Iwakura, Toshiaki Kadokami, Haruo Kamiya, Takahiro Kanbara, Yumiko Kanzaki, Ken Kashimura, Keisuke Kida, Kazuo Kimura, Satoru Kishi, Shuichi Kitada, Akihiro Kiyosue, Kazuhisa Kodama, Takayuki Kojima, Takumi Kondo, Yoshiaki Kubota, Kenya Kusunose, Noritaka Machii, Kazuo Matsunaga, Yasuto Matsuo, Yashushi Matsuzawa, Takeshi Mikami, Toru Minamino, Takahiro Nagai, Yasuko Nagano, Masashi Nagumo, Ikuko Nakamura, Katsunori Nakamura, Hiriyuki Naruse, Masami Nishino, Shinichi Niwano, Mitsutoshi Oguri, Nobuyuki Ohte, Masayoshi Oikawa, Takahiro Okumura, Masanori Okumura, Katsuya Onishi, Yukio Ozaki, Kan Saito, Tomohiro Sakamoto, Masashi Sakuma, Hisakuni Sekino, Kazuki Shiina, Michio Shimabukuro, Makoto Suzuki, Kunihiro Suzuki, Hiroyuki Takahama, Naohiko Takahashi, Yasuchika Takeishi, Shunsuke Tamaki, Akihiro Tanaka, Syuzo Tanimoto, Hiroki Teragawa, Tomoyuki Tobushi, Takafumi Toita, Kotaro Tokuda, Hirofumi Tomiyama, Hiroyuki Tsutsui, Hiroki Uehara, Masaaki Uematsu, Hirotaka Watada, Kazuyuki Yahagi, Takahisa Yamada, Hirotsugu Yamada, Tatsuya Yoshida, Akiomi Yoshihisa

  Journal of Cardiovascular Pharmacology 82 (1) 61 - 68 0160-2446 2023/07/19 

  Abstract:There were few clinical studies on the relationship between sodium glucose cotransporter 2 inhibitors (SGLT2i) and hematopoiesis in patients with diabetes (DM) and heart failure (HF) with consideration of systemic volume status. A total of 226 DM patients with HF enrolled in the CANDLE trial, a multicenter, prospective, randomized open-label blinded-endpoint trial, were studied. Estimated plasma volume status (ePVS) was calculated based on a weight-and hematocrit-based formula. At baseline, there was no significant difference in hematocrit and hemoglobin between the canagliflozin (n = 109) and glimepiride (n = 116) groups. Hematocrit and hemoglobin at 24 weeks, changes in hematocrit and hemoglobin difference (24 weeks-baseline), and hematocrit and hemoglobin ratio (24 weeks/baseline) were significantly higher in the canagliflozin than in the glimepiride group, respectively. There was no significant difference in ePVS at baseline and 24 weeks between the 2 groups. After adjustment for baseline parameters, canagliflozin correlated positively with changes in hematocrit and hemoglobin difference, and hematocrit and hemoglobin ratio by multivariate linear regression analyses. The difference in hematocrit and hemoglobin between the 2 groups became statistically significant at 3 and 6 months after randomization. There was no heterogeneity between canagliflozin and the characteristics of the patients for hematocrit and hemoglobin difference and ratio. A correlation of the changes in hematocrit and hemoglobin with cardiac and renal improvement was not observed. In conclusion, canagliflozin was associated with an increased hematocrit and hemoglobin in patients with diabetes and HF regardless of their volume status and characteristics.
• Paradoxical increase in global longitudinal strain by handgrip exercise despite left ventricular diastolic dysfunction.

  Ko Motoi, Hiroyuki Iwano, Suguru Ishizaka, Kosuke Nakamura, Yoji Tamaki, Hiroyuki Aoyagi, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Michito Murayama, Sanae Kaga, Toshihisa Anzai

  Echocardiography (Mount Kisco, N.Y.) 40 (8) 810 - 821 2023/07/14 

  BACKGROUND: Although global longitudinal strain (GLS) is recognized as a sensitive marker of intrinsic left ventricular (LV) dysfunction, its afterload dependency has also been pointed. We hypothesized that decrease in GLS during handgrip exercise could be more sensitive marker of intrinsic myocardial dysfunction. METHODS: Handgrip exercise-stress echocardiography was performed in 90 cardiovascular disease patients with preserved LV ejection fraction. LV diastolic function was graded according to the guidelines. Diastolic wall stress (DWS) and ratio of left atrial (LA) volume index to late-diastolic mitral annular velocity (LAVI/a') were measured at rest as LV stiffness. As well, LA strains were measured to assess LA function. GLS was expressed as absolute value and significant changes in GLS by handgrip exercise was defined as changes over prespecified mean absolute test-retest variability (2.65%). RESULTS: While mean value of GLS did not change by the exercise, substantial patients showed significant changes in GLS: decreased (group I, n = 28), unchanged (group II, n = 34), and increased (group III, n = 28). Unexpectedly, patients in group I did not show any clinical and echocardiographic characteristics, while those in group III were characterized by elevated natriuretic peptide levels, blunted heart rate response to handgrip exercise, and advanced LV diastolic dysfunction. Multivariable analyses revealed that DWS, left atrial booster strain, and grade II or more diastolic dysfunction determined the increase in GLS even after adjustment for elevated natriuretic peptides and the changes in heart rate by the exercise. CONCLUSION: In contrast to our hypothesis, paradoxical increase in GLS by handgrip exercise could be associated with advanced LV diastolic dysfunction in cardiovascular patients with preserved LV ejection fraction. Our findings suggest that HG exercise for heart failure patients does not enhance the afterload straightforward, resulting in variable changes of GLS according to the individual conditions.
• Prognostic Value of Liver Fibrotic Markers in Patients With Heart Failure.

  Atsushi Tada, Toshiyuki Nagai, Yoshiya Kato, Noriko Oyama-Manabe, Satonori Tsuneta, Michikazu Nakai, Yutaro Yasui, Sho Kazui, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Sakae Takenaka, Yoshifumi Mizuguchi, Yuta Kobayashi, Suguru Ishizaka, Kazunori Omote, Takuma Sato, Takao Konishi, Kiwamu Kamiya, Kohsuke Kudo, Toshihisa Anzai

  The American journal of cardiology 200 115 - 123 2023/06/10 

  Several liver fibrotic markers are associated with prognosis in patients with heart failure (HF). However, the optimal markers for outcome prediction remain unclear. This study aimed to simultaneously investigate the prognostic value of liver fibrotic markers and the associations between these markers and clinical parameters in patients with HF without organic liver disease. We prospectively examined 211 consecutive patients with chronic HF between April 2018 and August 2021, excluding those with organic liver disease, using liver magnetic resonance imaging and ultrasound. A total of 7 representative liver fibrotic markers were measured in all patients. The primary outcome of interest was the composite of all-cause death and hospitalization for worsening HF. During a median follow-up period of 747 (interquartile range 465 to 1,042) days, the primary outcome occurred in 45 patients. Patients with higher hyaluronic acid and type III procollagen N-terminal peptide (P-III-P) levels showed a significantly higher incidence of the primary outcome than those without (p <0.001 and p = 0.005, respectively). The multivariable Cox regression analysis revealed that hyaluronic acid and P-III-P levels were independently associated with the risk of adverse events (hazard ratio 1.84, 95% confidence interval 1.18 to 2.87 and hazard ratio 2.89, 95% confidence interval 1.32 to 6.34, respectively) even after adjustment for a mortality prediction model, whereas the other 5 markers were not associated with the primary outcome. In conclusion, among the representative liver fibrotic markers, hyaluronic acid and P-III-P might be the optimal markers for outcome prediction in patients with HF.
• Leadless Pacemaker With Acute but Transient Elevation of Lead Impedance and Pacing Threshold.

  Hikaru Hagiwara, Junpei Morimoto, Toshifumi Tamura, Akinori Takahashi, Hirokazu Komoriyama, Yoshiya Kato, Toshihisa Anzai

  CJC open 5 (6) 412 - 414 2023/06
• Application of an echocardiographic scoring system of left ventricular filling pressure to diagnose acute heart failure in patients complaining dyspnea.

  Yoji Tamaki, Hiroyuki Iwano, Michito Murayama, Suguru Ishizaka, Ko Motoi, Hiroyuki Aoyagi, Kosuke Nakamura, Mana Goto, Yukino Suzuki, Shinobu Yokoyama, Hisao Nishino, Masahiro Nakabachi, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of cardiology 82 (1) 62 - 68 2023/04/27 

  BACKGROUND: Dyspnea is a common symptom in acute heart failure (AHF) patients. Although an accurate and rapid diagnosis of AHF is essential to improve prognosis, estimation of left ventricular (LV) filling pressure (FP) remains challenging, especially for noncardiologists. We evaluated the usefulness of a recently-proposed parameter of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, to detect AHF in patients complaining of dyspnea. METHODS: Echocardiography and lung ultrasonography (LUS) were performed in 121 consecutive patients (68 ± 14 years old, 75 males) presenting with dyspnea. The VMT score was determined from the atrioventricular valve opening phase (tricuspid valve first: 0, simultaneous: 1, mitral valve first: 2) and inferior vena cava dilatation (absent: 0, present: 1), and VMT ≥2 was judged as positive. LUS was performed with the 8 zones method and judged as positive if 3 or more B-lines were observed in bilateral regions. The AHF diagnosis was performed by certified cardiologists according to recent guidelines. RESULTS: Of the 121 patients, 33 were diagnosed with AHF. The sensitivity and specificity for diagnosing AHF were 64 % and 84 % for LUS and 94 % and 88 % for VMT score. In logistic regression analysis, VMT score showed a significantly higher c-index than LUS (0.91 vs 0.74, p = 0.002). In multivariable analyses, VMT score was associated with AHF independently of clinically relevant covariates and LUS. In addition, serial assessment of VMT score followed by LUS provided a diagnostic flow chart to diagnose AHF (VMT 3: AHF definitive, VMT 2 and LUS positive: AHF highly suspicious; VMT 2 and LUS negative: further investigation is needed; VMT ≤ 1: AHF rejected). CONCLUSIONS: VMT score showed high diagnostic accuracy in diagnosing AHF. Combined assessment of the VMT score and LUS could become a reliable strategy for diagnosis of AHF by non-cardiologists.
• Heart failure with preserved ejection fraction phenogroup classification using machine learning

  Atsushi Kyodo, Koshiro Kanaoka, Ayaka Keshi, Maki Nogi, Kazutaka Nogi, Satomi Ishihara, Daisuke Kamon, Yukihiro Hashimoto, Yasuki Nakada, Tomoya Ueda, Ayako Seno, Taku Nishida, Kenji Onoue, Tsuneari Soeda, Rika Kawakami, Makoto Watanabe, Toshiyuki Nagai, Toshihisa Anzai, Yoshihiko Saito

  ESC Heart Failure 10 (3) 2019 - 2030 2055-5822 2023/04/12
• Vieussens' arterial ring forming a fistula that drains into the pulmonary artery through an aneurysm.

  Hikaru Hagiwara, Akinori Takahashi, Hirokazu Komoriyama, Yoshiya Kato, Toshihisa Anzai

  European heart journal. Cardiovascular Imaging 2023/04/04
• 静脈血流速度波形分析に基づく右房圧推定に肝静脈と上大静脈のどちらが優れるか

  村山 迪史, 加賀 早苗, 境田 ひな, 小野田 愛梨, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 石坂 傑, 岩野 弘幸, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 50 (Suppl.) S740 - S740 1346-1176 2023/04
• 静脈血流速度波形分析に基づく右房圧推定に肝静脈と上大静脈のどちらが優れるか

  村山 迪史, 加賀 早苗, 境田 ひな, 小野田 愛梨, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 石坂 傑, 岩野 弘幸, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 50 (Suppl.) S740 - S740 1346-1176 2023/04
• Multimodal Imaging of Constrictive Pericarditis Induced by Long-term Pergolide Treatment for Parkinson's Disease.

  Hiroyuki Aoyagi, Shingo Tsujinaga, Yuki Takahashi, Seiichiro Naito, Takuma Sato, Takuya Otsuka, Yoji Tamaki, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Kiwamu Kamiya, Hiroyuki Iwano, Toshiyuki Nagai, Satoru Wakasa, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 2023/03/31 

  We herein report the first case of constrictive pericarditis (CP) induced by long-term pergolide treatment for Parkinson's disease that was assessed using multimodal imaging in a 72-year-old patient with leg edema and dyspnea. The patient was correctly diagnosed with CP using multimodal imaging and successfully treated with pericardiectomy. The treatment history of Parkinson's disease and pathological findings of the removed pericardium suggested that long-term pergolide was the cause of CP. Properly recognizing pergolide as the cause of CP and accurately diagnosing CP using multimodal imaging may contribute to the early detection and treatment of pergolide-induced CP.
• Impact of COVID-19 pandemic on emergency medical system and management strategies in patients with acute coronary syndrome.

  Kohei Saiin, Sakae Takenaka, Toshiyuki Nagai, Akinori Takahashi, Yoshifumi Mizuguchi, Takao Konishi, Toshihisa Anzai, Daisuke Hotta, Mitsunori Kamigaki, Seiji Yamazaki, Tsutomu Fujita, Takehiro Yamashita, Kandoh Kawahatsu, Takashi Suzuki, Yoichi Nozaki, Taku Sakurada, Takashi Takenaka, Yasumi Igarashi, Takao Makino

  Scientific reports 13 (1) 5120 - 5120 2023/03/29 

  The global coronavirus disease-2019 (COVID-19) pandemic is associated with reduced rate of percutaneous coronary intervention (PCI). However, there were a few data showing how emergency medical system (EMS) and management strategies for acute coronary syndrome (ACS) changed during the pandemic. We sought to clarify changes on characteristics, treatments, and in-hospital mortality of patients with ACS transported via EMS between pre- and post-pandemic. We examined consecutive 656 patients with ACS admitted to Sapporo City ACS Network Hospitals between June 2018 and November 2021. The patients were divided into pre- and post-pandemic groups. The number of ACS hospitalizations declined significantly during the pandemic (proportional reduction 66%, coefficient -0.34, 95% CI -0.50 to -0.18, p < 0.001). The median time from an EMS call to hospital was significantly longer in post-pandemic group than in pre-pandemic group (32 [26-39] vs. 29 [25-36] min, p = 0.008). There were no significant differences in the proportion of patients with ACS receiving PCI, and in-hospital mortality between the groups. The COVID-19 pandemic had a significant impact on EMS and management in patients with ACS. Although a significant decline was observed in ACS hospitalizations, the proportion of patients with ACS receiving emergency PCI remained during the pandemic.
• Impact of right ventricular stiffness on discordance between hemodynamic parameter and regurgitant volume in patients with pulmonary regurgitation.

  Ko Motoi, Hiroyuki Iwano, Satonori Tsuneta, Suguru Ishizaka, Yoji Tamaki, Hiroyuki Aoyagi, Kosuke Nakamura, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Sanae Kaga, Atsuhito Takeda, Toshihisa Anzai

  The international journal of cardiovascular imaging 39 (6) 1133 - 1142 2023/03/17 

  BACKGROUND: Accurate detection of significant pulmonary regurgitation (PR) is critical in management of patients after right ventricular (RV) outflow reconstruction in Tetralogy of Fallot (TOF) patients, because of its influence on adverse outcomes. Although pressure half time (PHT) of PR velocity is one of the widely used echocardiographic markers of the severity, shortened PHT is suggested to be seen in conditions with increased RV stiffness with mild PR. However, little has been reported about the exact characteristics of patients showing discrepancy between PHT and PR volume in this population. METHODS: Echocardiography and cardiac magnetic resonance imaging (MRI) were performed in 74 TOF patients after right ventricular outflow tract (RVOT) reconstruction [32 ± 10 years old]. PHT was measured from the continuous Doppler PR flow velocity profile and PHT < 100 ms was used as a sign of significant PR. Presence of end-diastolic RVOT forward flow was defined as RV restrictive physiology. By using phase-contrast MRI, forward and regurgitant volumes through the RVOT were measured and regurgitation fraction was calculated. Significant PR was defined as regurgitant fraction ≥ 25%. RESULTS: Significant PR was observed in 54 of 74 patients. While PHT < 100 ms well predicted significant PR with sensitivity of 96%, specificity of 52%, and c-index of 0.72, 10 patients showed shortened PHT despite regurgitant fraction < 25% (discordant group). Tricuspid annular plane systolic excursion and left ventricular (LV) ejection fraction were comparable between discordant group and patients showing PHT < 100 ms and regurgitant fraction ≥ 25% (concordant group). However, discordant group showed significantly smaller mid RV diameter (30.7 ± 4.5 vs. 39.2 ± 7.3 mm, P < 0.001) and higher prevalence of restrictive physiology (100% vs. 42%, P < 0.01) than concordant group. When mid RV diameter ≥ 32 mm and presence of restrictive physiology were added to PHT, the predictive value was significantly improved (sensitivity: 81%, specificity: 90%, and c-index: 0.89, P < 0.001 vs. PHT alone by multivariable logistic regression model). CONCLUSION: Patients with increased RV stiffness and non-enlarged right ventricle showed short PHT despite mild PR. Although it has been expected, this was the first study to demonstrate the exact characteristics of patients showing discrepancy between PHT and PR volume in TOF patients after RVOT reconstruction.
• JCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis.

  Toshiyuki Nagai, Takayuki Inomata, Takashi Kohno, Takuma Sato, Atsushi Tada, Toru Kubo, Kazufumi Nakamura, Noriko Oyama-Manabe, Yoshihiko Ikeda, Takeo Fujino, Yasuhide Asaumi, Takahiro Okumura, Toshiyuki Yano, Kazuko Tajiri, Hiroyuki Matsuura, Yuichi Baba, Haruki Sunami, Shingo Tsujinaga, Yasutoshi Ota, Keiko Ohta-Ogo, Yusuke Ishikawa, Hideo Matama, Nobutaka Nagano, Kimi Sato, Kazushi Yasuda, Yasushi Sakata, Koichiro Kuwahara, Tohru Minamino, Minoru Ono, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 87 (5) 674 - 754 2023/03/10
• 日本人高齢患者における植え込み型除細動器の有用性(Benefit of Implantable Cardioverter-defibrillator in Elderly Japanese Patients)

  甲谷 次郎, 天満 太郎, 立田 大志郎, 西野 広太郎, 夏井 宏征, 門坂 崇秀, 小泉 拓也, 甲谷 太郎, 中尾 元基, 渡邉 昌也, 安斉 俊久

  日本循環器学会学術集会抄録集 87回 PJ113 - 4 2023/03
• 大動脈弁狭窄症患者に対する左室充満圧の心エコースコアリングシステムの適用(Application of an Echocardiographic Scoring System of Left Ventricular Filling Pressure for Patients with Aortic Stenosis)

  青柳 裕之, 岩野 弘幸, 後藤 真奈, 鈴木 ゆき乃, 村山 迪史, 横山 しのぶ, 西野 久雄, 中鉢 雅大, 中村 公亮, 玉置 陽生, 本居 昂, 石坂 傑, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久

  日本循環器学会学術集会抄録集 87回 PJ065 - 2 2023/03
• 心不全患者における複数の超音波指標を組み合わせたうっ血肝診断モデルの確立

  小野田 愛梨, 村山 迪史, 加賀 早苗, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 石坂 傑, 本居 昴, 青柳 裕之, 玉置 陽生, 中村 公亮, 岩野 弘幸, 安斉 俊久

  日本循環器学会学術集会抄録集 (一社)日本循環器学会 87回 CO1 - 3 2023/03
• Optogenetic termination of atrial tachyarrhythmias by brief pulsed light stimulation

  Motoki Nakao, Masaya Watanabe, Lucile Miquerol, Hiroyuki Natsui, Takuya Koizumi, Takahide Kadosaka, Taro Koya, Hikaru Hagiwara, Rui Kamada, Taro Temma, Antoine A.F. de Vries, Toshihisa Anzai

  Journal of Molecular and Cellular Cardiology 0022-2828 2023/03
• Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device.

  Sakae Takenaka, Takuma Sato, Toshiyuki Nagai, Kazunori Omote, Yuta Kobayashi, Kiwamu Kamiya, Takao Konishi, Atsushi Tada, Yoshifumi Mizuguchi, Yuki Takahashi, Seiichiro Naito, Kohei Saiin, Suguru Ishizaka, Satoru Wakasa, Toshihisa Anzai

  American journal of physiology. Heart and circulatory physiology 324 (3) H355-H363  2023/03/01 

  Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o2) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/dt than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD (r = 0.59, P = 0.003) and peak V̇o2 (r = 0.56, P = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS (r = 0.44, P = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD (r = -0.34, P = 0.88), peak V̇o2 (r = 0.074, P = 0.74), or EQ-VAS (r = 0.127, P = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD.NEW & NOTEWORTHY The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.
• Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure.

  Yutaro Yasui, Kosuke Nakamura, Kazunori Omote, Suguru Ishizaka, Sakae Takenaka, Yoshifumi Mizuguchi, Yui Shimono, Sho Kazui, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Atsushi Tada, Yuta Kobayashi, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  The American journal of cardiology 193 37 - 43 2023/03/01 

  The prognostic impact of peak workload-to-weight ratio (PWR) during cardiopulmonary exercise testing (CPET) and its determinants in patients with chronic heart failure (CHF) are not well understood. Consecutive 514 patients with CHF referred for CPET at the Hokkaido University Hospital between 2013 and 2018 were identified. The primary outcome was a composite of hospitalization because of worsening heart failure and death. PWR was calculated as peak workload normalized to body weight (W/kg) by CPET. Patients with low PWR (cut-off median 1.38 [W/kg], n = 257) were older and more anemic than those with high PWR (n = 257). In CPET, patients with low PWR displayed reduced peak oxygen consumption and impaired ventilatory efficiency compared with those with high PWR, whereas the peak respiratory exchange ratio was not significantly different between the 2 groups. There were 89 patients with events over a median follow-up period of 3.3 (interquartile range 0.8 to 5.5) years. The incidence of composite events was significantly higher in patients with low PWR than in those with high PWR (log-rank p <0.0001). In the multivariable Cox regression, lower PWR was associated with adverse events (hazard ratio 0.31, 95% confidence interval 0.13 to 0.73, p = 0.008). Low hemoglobin concentration was strongly related to impaired PWR (β coefficient = 0.43, per 1 g/100 ml increased, p <0.0001). In conclusion, PWR was associated with worse clinical outcomes, where blood hemoglobin was strongly related to PWR. Further study is required to identify therapies targeting peak workload achievements in exercise stress tests to improve the outcome in patients with CHF.
• Empagliflozin suppresses mitochondrial reactive oxygen species generation and mitigates the inducibility of atrial fibrillation in diabetic rats

  Takuya Koizumi, Masaya Watanabe, Takashi Yokota, Masumi Tsuda, Haruka Handa, Jiro Koya, Kotaro Nishino, Daishiro Tatsuta, Hiroyuki Natsui, Takahide Kadosaka, Taro Koya, Motoki Nakao, Hikaru Hagiwara, Rui Kamada, Taro Temma, Shinya Tanaka, Toshihisa Anzai

  Frontiers in Cardiovascular Medicine 10 2023/02/06 

  Introduction Recent studies have demonstrated that sodium-glucose co-transporter-2 inhibitors (SGLT2-i) reduce the risk of atrial fibrillation (AF) in patients with diabetes mellitus (DM), in which oxidative stress due to increased reactive oxygen species (ROS) contributes to the pathogenesis of AF. We aimed to further investigate this, and examine whether the SGLT2-i empagliflozin suppresses mitochondrial-ROS generation and mitigates fibrosis. Methods A high-fat diet and low-dose streptozotocin treatment were used to induce type-2 DM (T2DM) in Sprague-Dawley rats. The rats were randomly divided into three groups: control, DM, and DM treated with empagliflozin (30 mg/kg/day) for 8 weeks. The mitochondrial respiratory capacity and ROS generation in the atrial myocardium were measured using a high-resolution respirometer. Oxidative stress markers and protein expression related to mitochondrial biogenesis and dynamics as well as the mitochondrial morphology were examined in the atrial tissue. Additionally, mitochondrial function was examined in H9c2 cardiomyoblasts. Atrial tachyarrhythmia (ATA) inducibility, interatrial conduction time (IACT), and fibrosis were also measured. Results Inducibility of ATA, fibrosis, and IACT were increased in rats with DM when compared to controls, all of which were restored by empagliflozin treatment. In addition, the rats with DM had increased mitochondrial-ROS with an impaired complex I-linked oxidative phosphorylation capacity. Importantly, empagliflozin seemed to ameliorate these impairments in mitochondrial function. Furthermore, empagliflozin reversed the decrease in phosphorylated AMPK expression and altered protein levels related to mitochondrial biogenesis and dynamics, and increased mitochondrial content. Empagliflozin also improved mitochondrial function in H9c2 cells cultured with high glucose medium. Discussion These data suggest that empagliflozin has a cardioprotective effect, at least in part, by reducing mitochondrial ROS generation through AMPK signaling pathways in the atrium of diabetic rats. This suggests that empagliflozin might suppress the development of AF in T2DM.
• Fragmented QRS on 12-lead electrocardiogram predicts long-term prognosis in patients with cardiac sarcoidosis.

  Hikaru Hagiwara, Masaya Watanabe, Takahide Kadosaka, Takuya Koizumi, Yuta Kobayashi, Taro Koya, Motoki Nakao, Satonori Tsuneta, Yoshiya Kato, Hirokazu Komoriyama, Rui Kamada, Toshiyuki Nagai, Kohsuke Kudo, Toshihisa Anzai

  Heart and vessels 2023/01/13 

  Fragmented QRS (fQRS) on a 12-lead electrocardiogram is a known marker of fatal arrhythmias or cardiac adverse events in ischemic and non-ischemic cardiomyopathy patients. Nonetheless, the association between fQRS and clinical outcomes in patients with cardiac sarcoidosis (CS) remains unclear. Herein, we investigated whether fQRS is associated with long-term clinical outcomes in CS patients. A total of 78 patients who received immunosuppressive therapy (IST) for clinically diagnosed CS were retrospectively examined. Patients were classified into two groups according to the presence (n = 19) or absence (n = 59) of fQRS on electrocardiogram before IST. The primary outcome was the composite event of all-cause death, ventricular tachyarrhythmias (VTs), and hospitalization for heart failure. Results of late gadolinium enhancement on cardiac magnetic resonance imaging were also analyzed. During a median follow-up period of 3.7 years (interquartile range: 1.6-6.2 years), the primary outcome occurred more frequently in patients with fQRS than in those without (47% vs. 13%, log-rank p = 0.002). Multivariable Cox regression analyses showed that fQRS was an independent determinant of the primary outcome. The incidence of VTs, within 12 months of IST initiation, was comparable between the two groups; however, late-onset VTs, defined as those occurring ≥ 12 months after IST initiation, occurred more frequently in the fQRS group (21% vs. 2%, log-rank p = 0.002). The scar zone and scar border zone were greater in patients with fQRS than in those without it. In conclusion, our analysis suggests that fQRS is an independent predictor of adverse events, particularly late-onset VTs, in patients with CS.
• Empagliflozin attenuates arrhythmogenesis in diabetic cardiomyopathy by normalizing intracellular Ca2+ handling in ventricular cardiomyocytes.

  Takahide Kadosaka, Masaya Watanabe, Hiroyuki Natsui, Takuya Koizumi, Motoki Nakao, Taro Koya, Hikaru Hagiwara, Rui Kamada, Taro Temma, Fuyuki Karube, Fumino Fujiyama, Toshihisa Anzai

  American journal of physiology. Heart and circulatory physiology 324 (3) H341-H354  2023/01/06 

  Diabetic cardiomyopathy has been reported to increase the risk of fatal ventricular arrhythmia. The beneficial effects of the selective sodium-glucose co-transporter 2 inhibitor have not been fully examined in the context of anti-arrhythmic therapy, especially its direct cardioprotective effects despite the negligible SGLT2 expression in cardiomyocytes. We aimed to examine the anti-arrhythmic effects of empagliflozin (EMPA) treatment on diabetic cardiomyocytes, with a special focus on Ca2+ handling. We conducted echocardiography and hemodynamic studies and studied electrophysiology, Ca2+ handling, and protein expression in C57BLKS/J-leprdb/db mice (db/db mice) and their non-diabetic lean heterozygous Leprdb/+ littermates (db/+ mice). Preserved systolic function with diastolic dysfunction was observed in 16-week-old db/db mice. During arrhythmia induction, db/db mice had significantly increased premature ventricular complexes (PVCs) than controls, which was attenuated by EMPA. In protein expression analyses, calmodulin-dependent protein kinase II (CaMKII) Thr287 autophosphorylation and CaMKII-dependent RyR2 phosphorylation (S2814) were significantly increased in diabetic hearts, which were inhibited by EMPA. Additionally, global O-GlcNAcylation significantly decreased with EMPA treatment. Furthermore, EMPA significantly inhibited ventricular cardiomyocyte glucose uptake. Diabetic cardiomyocytes exhibited increased spontaneous Ca2+ events and decreased sarcoplasmic reticulum (SR) Ca2+ content, along with impaired Ca2+ transient, all of which normalized with EMPA treatment. Notably, most EMPA-induced improvements in Ca2+ handling were abolished by the addition of an O-GlcNAcase (OGA) inhibitor. In conclusion, EMPA attenuated ventricular arrhythmia inducibility by normalizing the intracellular Ca2+ handling, and we speculated that this effect was, at least partly, due to the inhibition of O-GlcNAcylation via the suppression of glucose uptake into cardiomyocytes.
• Plans for the Circulation Journal.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 88 (1) 1 - 1 2023
• Association of coronary plaque morphology with inflammatory biomarkers and target lesion revascularization in patients with chronic coronary syndrome: an optical coherence tomography study.

  Kohei Saiin, Takao Konishi, Sho Kazui, Yutaro Yasui, Yuki Takahashi, Seiichiro Naito, Sakae Takenaka, Yoshifumi Mizuguchi, Atsushi Tada, Yuta Kobayashi, Yoshiya Kato, Kazunori Omote, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Shinya Tanaka, Toshihisa Anzai

  American journal of cardiovascular disease 13 (5) 309 - 319 2160-200X 2023 

  BACKGROUND: The characteristics of high-risk coronary atherosclerosis evaluated using optical coherence tomography (OCT) can have a prognostic role. Inflammatory biomarkers may be related to the severity of coronary artery disease. This study investigated the association of high-risk morphological features of coronary plaques on OCT with circulating levels of inflammatory biomarkers and target lesion revascularization (TLR). MATERIALS AND METHODS: We prospectively analyzed the data of 30 consecutive patients with chronic coronary syndrome who underwent percutaneous coronary intervention (PCI) using OCT. The levels of interleukin-6, tumor necrosis factor-alpha, high-sensitivity C-reactive protein, pentraxin 3, vascular endothelial growth factor, and monocyte chemoattractant protein-1 (MCP-1) were measured in plasma samples. Coronary plaque characteristics were scored quantitatively in the form of coronary plaque risk score (CPRS). The estimated high-risk plaque characteristics for TLR were plaque rupture, plaque erosion, calcified nodule, lipid-rich plaque, thin-cap fibroatheroma, cholesterol crystals, macrophage infiltration, microchannels, calcification angle >90°, and microcalcifications. Each high-risk feature carries 1 point. Patients were defined as having a low CPRS (CPRS ≤3) or a high CPRS (CPRS ≥4). RESULTS: The primary outcome was TLR. TLR occurred in 6 (20%) patients within 15 months of PCI. High CPRS on OCT was directly correlated with TLR (P=0.029). In logistic regression analysis, CPRS was associated with TLR (odds ratio, 10.0; 95% confidence interval, 1.34-74.5). Serum MCP-1 level was significantly correlated with the CPRS (P=0.020). CONCLUSIONS: In patients with chronic coronary syndrome, CPRS may be a surrogate predictor of TLR. Serum MCP-1 may aid in the detection of high-risk coronary atherosclerosis.
• Closed VSDを合併した右室二腔症の手術症例

  齋藤 翔太, 石坂 傑, 下野 裕依, 甲谷 太郎, 神谷 究, 阿部 慎司, 加藤 伸康, 永井 利幸, 若狭 哲, 安斉 俊久

  日本成人先天性心疾患学会雑誌 (一社)日本成人先天性心疾患学会 12 (1) 200 - 200 2023/01
• Validation of Echocardiographic Estimation of Right Atrial Pressure: Reconsideration of Guideline-Based Secondary Indices

  Murayama Michito, Kaga Sanae, Onoda Airi, Okada Kazunori, Nakabachi Masahiro, Yokoyama Shinobu, Nishino Hisao, Aoyagi Hiroyuki, Tamaki Yoji, Motoi Ko, Ishizaka Suguru, Iwano Hiroyuki, Nagai Toshiyuki, Tsujino Ichizo, Anzai Toshihisa

  Japanese Journal of Medical Ultrasound Technology 一般社団法人 日本超音波検査学会 advpub 1881-4506 2023 

  Purpose: Sonographic measurements of the inferior vena cava parameters are common noninvasive methods for estimating right atrial pressure. In intermediate cases in which the inferior vena cava parameters showed indeterminate value, the current guidelines of the American Society of Echocardiography recommended using secondary indices, which include restrictive right-sided diastolic filling pattern, the ratio of early-diastolic transtricuspid flow velocity to tricuspid annular velocity, and the hepatic venous systolic filling fraction. We aimed to clarify whether the above secondary indices improve the diagnostic ability of elevated right atrial pressure using inferior vena cava parameters and to test the incremental predictive value of right atrial area measurement. Subjects and Methods: In 128 consecutive patients with various cardiac diseases referred for cardiac catheterization, the elevated right atrial pressure was defined as greater than or equal to 8 mmHg. Based on the inferior vena cava morphology, the estimated right atrial pressure was determined as 3, 8, and 15 mmHg (model 1). Additionally, the restrictive filling pattern, the ratio of early-diastolic transtricuspid flow velocity to tricuspid annular velocity, and the systolic filling fraction were evaluated to reclassify the intermediate value of 8 mmHg (model 2). The right atrial minimum and maximum area and volume were measured at ventricular end diastole and end systole, respectively, and the expansion indices were calculated. Results: Elevated right atrial pressure was observed in 29 patients. Logistic regression analysis showed that estimated right atrial pressure based on the inferior vena cava indices and systolic filling fraction were significantly associated with elevated right atrial pressure (p＜0.05). Restrictive filling pattern was not observed in any of the patients, and the ratio of early-diastolic transtricuspid flow velocity to tricuspid annular velocity was not associated with elevated right atrial pressure. Right atrial morphological and functional parameters were significantly associated with elevated right atrial pressure (p＜0.05). Notably, the minimum right atrial area demonstrated the strongest association with right atrial pressure elevation (odds ratio adjusted for right ventricular systolic function: 10.64, p＜0.01). The predictive ability of model 2 was comparable to that of model 1 (global χ² value＝9 for model 1, 11 for model 2; p＝0.28). In contrast, incorporated with systolic filling fraction and minimal right atrial area as secondary indices, the predictive ability of the new model was improved compared to that of model 1 (global χ² value＝9 for model 1, 25 for the new model; p＜0.01). Conclusion: Reclassification using guideline-recommended secondary indices failed to improve the predictive ability of elevated right atrial pressure. In contrast, a combination of systolic filling fraction and minimal right atrial area with inferior vena cava indices improved the predictive ability of elevated right atrial pressure.
• Applicability of new proposed criteria for iron deficiency in Japanese patients with heart failure.

  Atsushi Tada, Toshiyuki Nagai, Taro Koya, Motoki Nakao, Suguru Ishizaka, Yoshifumi Mizuguchi, Hiroyuki Aoyagi, Shogo Imagawa, Yusuke Tokuda, Masashige Takahashi, Yoshiya Kato, Masaharu Machida, Kenichi Matsutani, Takahiko Saito, Toshihisa Anzai

  ESC heart failure 2022/12/10 

  AIMS: Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF). A recent study showed that ID defined by the current guideline criteria was not associated with worse clinical outcomes, and new ID criteria was proposed in patients with HF. However, the external applicability of the new proposed criteria is unclear. We sought to investigate the applicability of the proposed ID criteria in Japanese patients with HF. METHODS AND RESULTS: We prospectively examined 763 patients with chronic HF from a Japanese multicentre registry. The proposed ID criteria were transferrin saturation (TSAT) < 20% and serum iron ≤13 mmol/L and the guideline ID criteria were serum ferritin <100 ng/mL or, when ferritin was 100-299 ng/mL, TSAT <20%. Among all patients (456 male, mean age 71 ± 13 years), 213 (28%) and 444 (58%) met the proposed and guideline ID criteria, respectively. During a median follow-up period of 436 days (interquartile range 297-565), the primary outcome of all-cause mortality occurred in 56 (7%) patients. There was no significant difference in the primary outcome between the patients with and without guideline ID criteria (P = 0.32), whereas patients with serum iron ≤10 μmol/L showed higher mortality (P = 0.002). In multivariable Cox regressions, the proposed ID criteria, but not guideline ID criteria, were independently associated with the risk of all-cause mortality (HR 2.01, 95% CI 1.16-3.51 and HR 1.32, 95% CI 0.76-2.28, respectively), even after adjustment for covariates. CONCLUSIONS: When defined by the proposed criteria and not the guideline criteria, ID was associated with higher mortality in patients with chronic HF, suggesting that the proposed ID criteria is applicable to the Japanese population.
• Associations of right ventricular pulsatile load and cardiac power output to clinical outcomes in heart failure: Difference from systemic circulation.

  Yasuyuki Chiba, Hiroyuki Iwano, Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Suguru Ishizaka, Michito Murayama, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of cardiology 81 (4) 404 - 412 2022/12/08 

  BACKGROUND: Although left ventricular (LV) cardiac power output (CPO) is a powerful prognostic indicator in heart failure (HF), the significance of right ventricular (RV) CPO is unknown. In contrast, RV pulsatile load is a key prognostic marker in HF. We investigated the impact of RV-CPO and pulsatile load on cardiac outcome and the prognostic performance of the combined systemic and pulmonary circulation parameters in HF. METHODS: Right heart catheterization and echocardiography were performed in 231 HF patients (62 ± 16 years, LV ejection fraction 42 ± 18 %). Invasive and noninvasive CPOs were calculated from mean systemic or pulmonary arterial pressure and cardiac output. LV-CPO was then normalized to LV mass (LV-P/M). Pulmonary arterial capacitance and the ratio of acceleration time to ejection time (AcT/ET) of RV outflow were used as parameters of RV pulsatile load. The primary endpoints, defined as a composite of cardiac death, HF hospitalization, ventricular arrythmia, and LVAD implantation after the examination, were recorded. RESULTS: Noninvasive CPOs were moderately correlated with invasive ones (LV: ρ = 0.787, RV: ρ = 0.568, and p < 0.001 for both). During a median follow-up period of 441 days, 57 cardiovascular events occurred. Lower LV-P/M and higher RV pulsatile load were associated with cardiovascular events; however, RV-CPO was not associated with the outcome. Echocardiographic LV-P/M and AcT/ET showed significant incremental prognostic value over the clinical parameters. CONCLUSIONS: RV pulsatile load assessed by AcT/ET may be a predictor of clinical events in HF patients. The combination of echocardiographic LV-P/M and AcT/ET could be a novel noninvasive prognostic indicator in HF patients.
• Canagliflozin independently reduced plasma volume from conventional diuretics in patients with type 2 diabetes and chronic heart failure: a subanalysis of the CANDLE trial

  Kazuki Shiina, Hirofumi Tomiyama, Atsushi Tanaka, Takumi Imai, Itaru Hisauchi, Isao Taguchi, Akira Sezai, Shigeru Toyoda, Kaoru Dohi, Haruo Kamiya, Keisuke Kida, Toshihisa Anzai, Taishiro Chikamori, Koichi Node, Masayoshi Ajioka, Junya Ako, Rie Amano, Mitsutoshi Asai, Kazuo Eguchi, Kenichi Eshima, Shinya Fujiki, Masashi Fujita, Shungo Hikoso, Shinya Hiramitsu, Satoshi Hoshide, Akihiko Hoshino, Yuki Ikeda, Yumi Ikehara, Takayuki Inomata, Teruo Inoue, Katsuhisa Ishii, Nobukazu Ishizaka, Masaaki Ito, Noriaki Iwahashi, Katsuomi Iwakura, Toshiaki Kadokami, Takahiro Kanbara, Yumiko Kanzaki, Ken Kashimura, Kazuo Kimura, Satoru Kishi, Shuichi Kitada, Masafumi Kitakaze, Akihiro Kiyosue, Kazuhisa Kodama, Takayuki Kojima, Takumi Kondo, Yoshiaki Kubota, Kenya Kusunose, Noritaka Machii, Kazuo Matsunaga, Yasuto Matsuo, Yashushi Matsuzawa, Takeshi Mikami, Toru Minamino, Toyoaki Murohara, Takahiro Nagai, Yasuko Nagano, Masashi Nagumo, Ikuko Nakamura, Katsunori Nakamura, Daisaku Nakatani, Mamoru Nanasato, Hiriyuki Naruse, Masami Nishino, Shinichi Niwano, Mitsutoshi Oguri, Nobuyuki Ohte, Masayoshi Oikawa, Takahiro Okumura, Masanori Okumura, Katsuya Onishi, Jun-ichi Oyama, Yukio Ozaki, Kan Saito, Tomohiro Sakamoto, Yasushi Sakata, Masashi Sakuma, Masataka Sata, Hisakuni Sekino, Michio Shimabukuro, Wataru Shimizu, Makoto Suzuki, Kunihiro Suzuki, Hiroyuki Takahama, Naohiko Takahashi, Yasuchika Takeishi, Shunsuke Tamaki, Akihiro Tanaka, Syuzo Tanimoto, Hiroki Teragawa, Tomoyuki Tobushi, Takafumi Toita, Kotaro Tokuda, Hiroyuki Tsutsui, Shinichiro Ueda, Hiroki Uehara, Masaaki Uematsu, Hirotaka Watada, Kazuyuki Yahagi, Takahisa Yamada, Hirotsugu Yamada, Tatsuya Yoshida, Akiomi Yoshihisa

  Hypertension Research 0916-9636 2022/11/15
• Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation

  Koshiro Kanaoka, Kenji Onoue, Satoshi Terasaki, Tomoya Nakano, Michikazu Nakai, Yoko Sumita, Kinta Hatakeyama, Fumio Terasaki, Rika Kawakami, Yoshitaka Iwanaga, Yoshihiro Miyamoto, Yoshihiko Saito, Satoshi Yuda, Masaya Tanno, Toru Takahashi, Hisashi Yokoshiki, Masahiro Toba, Toshihisa Anzai, Toshiyuki Nagai, Takuma Sato, Takashi Takenaka, Seiji Yamazaki, Yuki Katagiri, Toshiharu Takeuchi, Kazuya Sugitatsu, Shigeo Kakinoki, Tomoaki Matsumoto, Kazushi Urasawa, Michinao Tan, Ichizo Tsujino, Mitsunori Kamigaki, Hirofumi Tomita, Kenji Hanada, Motoi Kushibiki, Akihiro Nakamura, Yoshihiro Morino, Takahito Nasu, Satoshi Yasuda, Hideaki Suzuki, Kaoru Iwabuchi, Kanako Tsuji, Shigeto Namiuchi, Tatsuya Komaru, Masahiro Yagi, Shoko Uematsu, Toshiaki Takahashi, Satoru Takeda, Toru Nakanishi, Masafumi Watanabe, Masahiro Wanezaki, Motoyuki Matsui, Shigeo Sugawara, Yasuchika Takeishi, Masayoshi Oikawa, Nobuo Komatsu, Satoshi Suzuki, Hiroshi Okamoto, Noriyuki Takeyasu, Daiki Akiyama, Yutaka Eki, Tsunekazu Kakuta, Tomoyo Sugiyama, Tomomi Koizumi, Koji Ueno, Kazuomi Kario, Mizuri Taki, Yuri Matsumoto, Takanori Yasu, Osamu Nishioka, Shigeto Naito, Makoto Murata, Shoichi Tange, Katsumi Kaneko, Makoto Muto, Hiroshi Inagaki, Shuichi Hasegawa, Eizo Tachibana, Wataru Atsumi, Masahiro Suzuki, Toshihiro Muramatsu, Yoshihiro Yamada, Isao Taguchi, Yoshiaki Fukuda, Akihiro Matsui, Junji Kanda, Koji Hozawa, Akihiko Matsumura, Wataru Shimizu, Takeshi Yamamoto, Issei Komuro, Masaru Hatano, Takanori Ikeda, Shunsuke Kiuchi, Taishiro Chikamori, Yasuyoshi Takei, Kyoko Soejima, Toshinori Minamishima, Hiroyuki Tanaka, Shigeo Shimizu, Masashi Kasao, Tadayuki Kadohira, Tohru Minamino, Kazunori Shimada, Hiroshi Iwata, Yukihiko Momiyama, Takashi Ashikaga, Toshihiro Nozato, Yasumasa Fujiwara, Kenji Inoue, Tetsuo Sasano, Junji Matsuda, Yasuhiro Ishii, Yuichi Ono, Kengo Tanabe, Yu Horiuchi, Toshiro Shinke, Yusuke Kodama, Masao Moroi, Yoshiyuki Yazaki, Taisuke Mizumura, Hiroshi Ohta, Yoshihiro Akashi, Nozomi Kotoku, Yuji Ikari, Mitsunori Maruyama, Yasuhiro Sato, Koichi Tamura, Masaaki Konishi, Hiroshi Suzuki, Mio Ebato, Kazuki Fukui, Kazuhiko Yumoto, Takamasa Iwasawa, Takeshi Kashimura, Kazuyoshi Takahashi, Yoshinobu Okada, Bunji Kaku, Kazuo Usuda, Michiro Maruyama, Tomoki Kameyama, Toshinori Higashikata, Akihiko Hodatsu, Kazuo Osato, Yoji Nagata, Koji Maeno, Kazuo Satake, Takao Sawanobori, Noboru Watanabe, Koichiro Kuwahara, Hirohiko Motoki, Hiroshi Kitabayashi, Kyuhachi Otagiri, Tsunesuke Kono, Daisuke Yamagishi, Yoshikazu Yazaki, Toshiyuki Noda, Itsuro Morishima, Naoki Watanabe, Shinichiro Tanaka, Tomoya Onodera, Ryuzo Nawada, Akinori Watanabe, Masaki Matsunaga, Satoru Suwa, Hiroshi Sakamoto, Hiroki Sakamoto, Takeshi Aoyama, Norio Kanamori, Masahiro Muto, Yuichiro Maekawa, Hayato Ohtani, Yukio Ozaki, Kenshin Naruse, Kenji Takemoto, Haruo Kamiya, Takeshi Suzuki, Yasushi Tomita, Susumu Suzuki, Ryosuke Kametani, Hidekazu Aoyama, Hiroyuki Osanai, Ken Harada, Kenji Kada, Tomoaki Saeki, Koichi Kobayashi, Yasuhiro Ogawa, Akihiro Terasawa, Masanori Shinoda, Mitsutoshi Oguri, Kiyokazu Shimizu, Akinori Sawamura, Atsushi Sugiura, Kosuke Hattori, Shinji Mokuno, Kazuhisa Kondo, Kaoru Dohi, Keishi Moriwaki, Atsunobu Kasai, Tetsuya Nakakuki, Kazuaki Kaitani, Toshikazu Jinnai, Takashi Yamamoto, Hiroyuki Kurata, Atsuyuki Wada, Masaharu Akao, Yasuhiro Hamatani, Kazuya Ishibashi, Yoshiki Akakabe, Yasuhide Asaumi, Hideo Matama, Yasushi Sakata, Hidetaka Kioka, Hiroshi Takaishi, Yoshitaka Iwanaga, Toru Takase, Mitsuo Matsuda, Fumi Sato, Shinji Hasegawa, Kenichi Ishigami, Minoru Ichikawa, Takashi Takagi, Moriaki Inoko, Masaaki Hoshiga, Shuichi Fujita, Yoshihiro Takeda, Takahiko Kawarabayashi, Hideyuki Takaoka, Kenji Nakajima, Tadashi Yuguchi, Tatsuya Kawasaki, Yukinori Shinoda, Yukihito Sato, Masaharu Ishihara, Yuki Matsumoto, Hiroya Kawai, Tomofumi Takaya, Kouki Matsuo, Toshiaki Mano, Kenichi Hirata, Eriko Hisamatsu, Nobutaka Inoue, Koichi Tamita, Naoki Mukohara, Hisashi Shimoyama, Toru Miyajima, Toshihiro Tamura, Yodo Tamaki, Megumi Suzuki, Ryoji Yokota, Manabu Horii, Kazuo Yamanaka, Hiroyuki Kawata, Yukihiro Hashimoto, Yasuki Nakada, Hitoshi Nakagawa, Tomoya Ueda, Taku Nishida, Ayako Seno, Makoto Watanabe, Takashi Akasaka, Takashi Tanimoto, Mamoru Toyofuku, Kazuhiro Yamamoto, Yoshiharu Kinugasa, Masayuki Hirai, Hiroshi Nasu, Kinya Shirota, Tsuyoshi Oda, Takefumi Oka, Kazushige Kadota, Masanobu Ohya, Hiroshi Ito, Kazufumi Nakamura, Soichiro Ogura, Soichiro Fuke, Shiro Uemura, Hiromi Matsubara, Atsuyuki Watanabe, Nobuyuki Morishima, Yasuki Kihara, Takayuki Hidaka, Hironori Ueda, Yujiro Ono, Yuji Muraoka, Miyo Hatanari, Yoshinori Miyamoto, Keigo Dote, Masaya Kato, Masafumi Yano, Mamoru Mochizuki, Yasuhiro Ikeda, Hiroyuki Fujinaga, Shinobu Hosokawa, Masataka Sata, Koji Yamaguchi, Naoko Aki, Tetsuo Minamino, Yuichi Miyake, Yuichiro Takagi, Masayuki Doi, Yoshio Taketani, Hideki Okayama, Tatsuya Shigematsu, Akinori Higaki, Osamu Yamaguchi, Shinji Inaba, Shuntaro Ikeda, Kazuya Kawai, Hiroaki Kitaoka, Toru Kubo, Kenji Ando, Kaoru Inui, Yoshihiro Fukumoto, Kensuke Hori, Takehiro Homma, Tomohiro Kawasaki, Masahiro Mohri, Masaki Fujiwara, Hiroyuki Tsutsui, Tomomi Ide, Shin-Ichiro Miura, Takashi Kuwano, Hideki Shimomura, Toshiaki Kadokami, Masanao Taba, Katsuhiro Kondou, Toru Kubota, Daisuke Nagatomo, Yasushi Mukai, Ryuichi Matsukawa, Hideki Tashiro, Mitsuhiro Shimomura, Koji Maemura, Hiroaki Kawano, Koji Oku, Toshihiko Yamasa, Yoshihisa Kizaki, Tomohiro Sakamoto, Yudai Tamura, Teruhiko Ito, Kazuteru Fujimoto, Kenichi Tsujita, Seiji Takashio, Hirofumi Kurokawa, Naohiko Takahashi, Shotaro Saito, Masaya Arikawa, Yoshisato Shibata, Kensaku Nishihira, Toshihiro Tsuruda, Masahiro Sonoda, Nobuhiko Atsuchi, Mitsuru Ohishi, Koji Higuchi, Masaaki Miyata, Naoya Oketani, Yoshinori Akimoto, Tomohiro Asahi, Minoru Wake

  Circulation 146 (19) 1425 - 1433 0009-7322 2022/11/08 [Refereed]
   

  Background: Fulminant myocarditis presentation (FMP) is a rare and severe presentation of myocarditis. The natural history of FMP and its clinical features associated with poor outcomes are incompletely understood because there is a lack of generalizable evidence. Methods: This multicenter retrospective cohort study included patients hospitalized with histologically proven myocarditis who underwent catecholamine or mechanical support from 235 cardiovascular training hospitals across Japan between April 2012 and March 2017. Clinical features and the prognostic predictors of death or heart transplantation within 90 days on the basis of clinical and pathologic findings were determined using the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: This study included 344 patients with histologically proven FMP (median age, 54 years; 40% female). The median follow-up was 600 days (interquartile range, 36 to 1599 days) and the cumulative risk of death or heart transplantation at 90 days was 29% (n=98). Results from multivariable Cox regression analysis showed that older age, nonsinus rhythm, low left ventricular wall motion (<40%) on admission, and ventricular tachycardia or fibrillation on admission day were associated with worse 90-day survival. Severe histologic damage (damaged cardiomyocytes comprising ≥50% of the total cardiomyocytes) was associated with a worse 90-day prognosis in patients with lymphocytic myocarditis. Conclusions: The results from analyses of data from this multicenter registry demonstrated that patients with FMP are at a higher risk of death or heart transplantation in real-world settings. These observations inform which clinical and pathologic findings may be useful for prognostication in FMP. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000039763.
• Liver stiffness assessed by magnetic resonance elastography predicts clinical outcomes in patients with heart failure and without chronic liver disease.

  Atsushi Tada, Toshiyuki Nagai, Yoshiya Kato, Kazunori Omote, Noriko Oyama-Manabe, Satonori Tsuneta, Yusuke Kudo, Mutsumi Nishida, Michikazu Nakai, Yuki Takahashi, Kohei Saiin, Seiichiro Naito, Yuta Kobayashi, Sakae Takenaka, Yoshifumi Mizuguchi, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Kohsuke Kudo, Toshihisa Anzai

  European radiology 33 (3) 2062 - 2074 2022/11/03 

  OBJECTIVES: Evaluation of liver stiffness (LS) by magnetic resonance elastography (MRE) is useful for estimating right atrial pressure (RAP) in patients with heart failure (HF). However, its prognostic implications are unclear. We sought to investigate whether LS measured by MRE (LS-MRE) could predict clinical outcomes in patients with HF. METHODS: We prospectively examined 207 consecutive HF patients between April 2018 and May 2021 after excluding those with organic liver disease. All patients underwent 3.0-T MRE. The primary outcome of interest was the composite of all-cause death and hospitalisation for HF. RESULTS: During a median follow-up period of 720 (interquartile range [IQR] 434-1013) days, the primary outcome occurred in 44 patients (21%), including 15 (7%) all-cause deaths and 29 (14%) hospitalisations for HF. The patients were divided into two groups according to median LS-MRE of 2.54 (IQR 2.34-2.82) kPa. Patients with higher LS-MRE showed a higher incidence of the primary outcome compared to those with lower LS-MRE (p < 0.001). Multivariable Cox regression analyses revealed that LS-MRE value was independently associated with the risk of adverse events (hazard ratio 2.49, 95% confidence interval 1.46-4.24). In multivariable linear regression, RAP showed a stronger correlation with LS-MRE (β coefficient = 0.31, p < 0.001) compared to markers related to liver fibrosis. CONCLUSIONS: In patients without chronic liver disease and presenting with HF, elevated LS-MRE was independently associated with worse clinical outcomes. Elevated LS-MRE may be useful for risk stratification in patients with HF and without chronic liver disease. KEY POINTS: • Magnetic resonance elastography (MRE) is an emerging non-invasive imaging technique for evaluating liver stiffness (LS) which can estimate right atrial pressure. • Elevated LS-MRE, which mainly reflects liver congestion, was independently associated with worse clinical outcomes in patients with heart failure. • The assessment of LS-MRE would be useful for stratifying the risk of adverse events in heart failure patients without chronic liver disease.
• 抗ミトコンドリアM2抗体陽性筋炎17例の臨床的特徴

  長井 梓, 永井 利幸, 矢口 裕章, 藤井 信太朗, 上床 尚, 白井 慎一, 岩田 育子, 松島 理明, 堀内 一宏, 浦 茂久, 安斉 俊久, 矢部 一郎

  神経治療学 (一社)日本神経治療学会 39 (6) S263 - S263 0916-8443 2022/10
• 日本人心臓サルコイドーシス患者におけるAHA/ACC/HRSガイドライン植込型除細動器適応の外的妥当性

  竹中 秀, 小林 雄太, 永井 利幸, 加藤 喜哉, 小森山 弘和, 永野 伸卓, 神谷 究, 小西 崇夫, 佐藤 琢真, 表 和徳, 多田 篤司, 水口 賢史, 草野 研吾, 植田 初江, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 42 (サプリメント号) 64 - 64 1883-1273 2022/10
• Pharmacological nNOS inhibition modified small conductance Ca2+-activated K+ channel without altering Ca2+ dynamics.

  Taro Koya, Masaya Watanabe, Hiroyuki Natsui, Takahide Kadosaka, Takuya Koizumi, Motoki Nakao, Hikaru Hagiwara, Rui Kamada, Taro Temma, Toshihisa Anzai

  American journal of physiology. Heart and circulatory physiology 323 (5) H869-H878  2022/09/23 

  Atrial fibrillation (AF) is associated with electrical remodeling processes that promote a substrate for the maintenance of AF. Although the small-conductance Ca2+-activated K+ (SK) channel is a key factor in atrial electrical remodeling, the mechanism of its activation remains unclear. Regional nitric oxide (NO) production by neuronal nitric oxide synthase (nNOS) is involved in atrial electrical remodeling. In this study, atrial tachyarrhythmia (ATA) induction and optical mapping were performed on perfused rat hearts. nNOS is pharmacologically inhibited by S-methylthiocitrulline (SMTC). The influence of the SK channel was examined using a specific channel inhibitor, apamin. Parameters such as action potential duration (APD), conduction velocity, and calcium transient (CaT) were evaluated using voltage and calcium optical mapping. The dominant frequency was examined in the analysis of AF dynamics. SMTC (100 nM) increased the inducibility of ATA and apamin (100 nM) mitigated nNOS inhibition-induced arrhythmogenicity. SMTC caused abbreviations and enhanced the spatial dispersion of APD, which was reversed by apamin. By contrast, conduction velocity and other parameters associated with CaT were not affected by SMTC or apamin administration. Apamin reduced the frequency of SMTC-induced ATA. In summary, nNOS inhibition abbreviates APD by modifying the SK channels. A specific SK channel blocker, apamin, mitigated APD abbreviation without alteration of CaT, implying an underlying mechanism of post-translational modification of SK channels.
• Determinants of exercise capacity in patients with heart failure without left ventricular hypertrophy.

  Suguru Ishizaka, Hiroyuki Iwano, Shingo Tsujinaga, Michito Murayama, Satonori Tsuneta, Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Yasuyuki Chiba, Asuka Tanemura, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Brett A Meyers, Pavlos P Vlachos, Takuma Sato, Kiwamu Kamiya, Masaya Watanabe, Sanae Kaga, Toshiyuki Nagai, Noriko Oyama-Manabe, Toshihisa Anzai

  Journal of cardiology 81 (1) 33 - 41 2022/09/16 

  BACKGROUND: Determinants of exercise intolerance in a phenotype of heart failure with preserved ejection fraction (HFpEF) with normal left ventricular (LV) structure have not been fully elucidated. METHODS: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 44 HFpEF patients without LV hypertrophy. Exercise capacity was determined by peak oxygen consumption (peak VO2). Doppler-derived cardiac output (CO), transmitral E velocity, systolic (LV-s') and early diastolic mitral annular velocities (e'), systolic pulmonary artery (PA) pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and peak systolic right ventricular (RV) free wall velocity (RV-s') were measured at rest and exercise. E/e' and TAPSE/SPAP were used as an LV filling pressure parameter and RV-PA coupling, respectively. RESULTS: During exercise, CO, LV-s', RV-s', e', and SPAP were significantly increased (p < 0.05 for all), whereas E/e' remained unchanged and TAPSE/SPAP was significantly reduced (p < 0.001). SPAP was higher and TAPSE/SPAP was lower at peak exercise in patients showing lower-half peak VO2. In univariable analyses, LV-s' (R = 0.35, p = 0.022), SPAP (R = -0.40, p = 0.008), RV-s' (R = 0.47, p = 0.002), and TAPSE/SPAP (R = 0.42, p = 0.005) were significantly correlated with peak VO2. In multivariable analyses, not only SPAP, but also TAPSE/SPAP independently determined peak VO2 even after the adjustment for clinically relevant parameters. CONCLUSIONS: In HFpEF patients without LV hypertrophy, altered RV-PA coupling by exercise could be associated with exercise intolerance, which might not be caused by elevated LV filling pressure.
• 末期心不全患者の難治性不整脈に対するICD治療機能停止(deactivation)の検討を多職種で行った一例

  甲谷 次郎, 佐藤 琢真, 立田 大志郎, 西野 広太郎, 小林 雄太, 成田 尚, 敦賀 健吉, 青陽 千果, 池田 陽子, 小島 尚子, 古山 勇気, 小野田 紘子, 加藤 美香, 永井 利幸, 安斉 俊久

  日本心臓病学会学術集会抄録 (一社)日本心臓病学会 70回 C - 3 2022/09
• COVID-19で入院加療中に冠攣縮性狭心症を併発した褐色細胞腫の一例

  高橋 昌寛, 佐藤 琢真, 立田 大志郎, 甲谷 次郎, 西野 広太郎, 小林 雄太, 小西 崇夫, 永井 利幸, 安斉 俊久

  日本心臓病学会学術集会抄録 (一社)日本心臓病学会 70回 C - 5 2022/09
• Clinical features of anti-mitochondrial M2 antibody-positive myositis: case series of 17 patients.

  Azusa Nagai, Toshiyuki Nagai, Hiroaki Yaguchi, Shintaro Fujii, Hisashi Uwatoko, Shinichi Shirai, Kazuhiro Horiuchi, Ikuko Iwata, Masaaki Matsushima, Shigehisa Ura, Toshihisa Anzai, Ichiro Yabe

  Journal of the neurological sciences 442 120391 - 120391 2022/08/28 

  OBJECTIVE: In 2012, a large number of myositis cases with anti-mitochondrial M2 (AMA-M2) antibody, which had well been known as the serological hallmark for primary biliary cholangitis (PBC), were reported in Japan. Recently, some case series from Japan, France, America, China and India have shown that approximately 2.5% to 19.5% of patients with myositis have AMA-M2 antibody. The objective of this study was to clarify the prevalence, clinical features, treatment outcome, and severity determinants of AMA-M2 positive myositis. METHODS: This study was a multicenter observational study. We enrolled patients who were diagnosed with myositis during a ten-year period between 2012 and 2021. RESULTS: Of the total of 185 patients with inflammatory myopathy, 17 patients were positive for AMA-M2 antibody. The typical symptoms were weakness mainly involving paravertebral muscles, weight loss, respiratory failure, and cardiac complications. Thirteen of the 17 patients had cardiac complications. A strong correlation was found between respiratory failure and modified Rankin Scale (mRS) score. A strong correlation was also found between respiratory failure and body weight, indicating that weight loss can be an indicator of potential progression of respiratory failure. Six of the 17 patients were complicated by malignancy. CONCLUSIONS: This study showed significant correlations between % vital capacity (VC), body mass index (BMI), and mRS score in patients with AMA-M2-positive myositis. Immunotherapy often improved CK level and respiratory dysfunction. We therefore propose that %VC and BMI should be monitored as disease indicators in treatment of AMA-M2-positive myositis.
• Usefulness of Dual Gate Doppler in Assessing the Time Interval Between Pulmonary Venous and Transmitral Flows During Atrial Contraction

  Okada Kazunori, Okada Yuka, Murayama Michito, Kaga Sanae, Masauzi Nobuo, Nishino Hisao, Yokoyama Shinobu, Nakabachi Masahiro, Nishida Mutsumi, Motoi Ko, Ishizaka Suguru, Chiba Yasuyuki, Tsujinaga Shingo, Iwano Hiroyuki, Anzai Toshihisa

  Japanese Journal of Medical Ultrasound Technology 一般社団法人 日本超音波検査学会 47 (4) 353 - 362 1881-4506 2022/08/01 

  Purpose: The difference in duration between pulmonary venous (PV) atrial systolic reversal wave (PVA) and atrial systolic wave (A) of transmitral flow (ΔA_dur) reflects the late-diastolic left ventricular (LV) operating stiffness and has a limitation on reproducibility. Using the Dual Gate Doppler technique, simultaneous recording of PV and transmitral flows can be obtained, which may contribute to improving the accuracy and reproducibility of ΔA_dur measurements. Methods and Results: We examined 80 patients who underwent echocardiography using Dual Gate Doppler recording. Using the conventional Doppler recording, we measured the difference in duration between the PVA and transmitral A-wave (S-ΔA_dur). Additionally, the ratio of the time–velocity integral (TVI) of the PVA to that of the whole PV flow (F_PVA) and the ratio of the TVI in transmitral A-wave of the whole transmitral flow (F_A) were calculated, and F_PVA/F_A was obtained as an index of LV operating stiffness. From the Dual Gate Doppler recording of PV and transmitral flows, we measured ΔA_dur (D-ΔA_dur) and time from the end of transmitral A-wave to the end of PVA (D-ΔA_end). Results: Each of S-ΔA_dur, D-ΔA_dur, and D-ΔA_end significantly correlated with F_PVA/F_A (r＝0.50, 0.51, and 0.71, respectively), and the correlation between F_PVA/F_A and D-ΔA_end was significantly greater than that between F_PVA/F_A and S-ΔA_dur and between F_PVA/F_A and D-ΔA_dur (p＜0.001 for both). The intraclass correlation coefficients for the inter- and intra-observer comparisons were excellent for D-ΔA_end, adequate for D-ΔA_dur, and fair for S-ΔA_dur. Conclusion: Dual Gate Doppler-derived D-ΔA_end has higher reproducibility and usefulness for assessing late-diastolic LV operating stiffness than the conventional Doppler-derived S-ΔA_dur.
• Predictors of cardiovascular mortality after an electrical storm in patients with structural heart disease.

  Takuya Koizumi, Rui Kamada, Masaya Watanabe, Hisashi Yokoshiki, Taro Temma, Hikaru Hagiwara, Taro Koya, Motoki Nakao, Takahide Kadosaka, Hiroyuki Natsui, Masayuki Takahashi, Kazuya Mizukami, Hirofumi Mitsuyama, Toshihisa Anzai

  Journal of cardiology 80 (2) 167 - 171 2022/08 

  BACKGROUND: Electrical storms (ESs) in patients with structural heart disease (SHD) have been reported to be associated with a poor prognosis. However, the detailed cause of death and influence of implantable cardioverter defibrillator (ICD) therapy in ES patients have not been fully investigated. Therefore, we sought to explore the detailed clinical course after an ES and the impact of the ICD therapy in patients with SHDs. METHODS: We retrospectively analyzed 31 consecutive patients with ESs who had undergone an ICD implantation. ESs were defined as three or more ventricular arrhythmias within 24 h. RESULTS: During a mean follow up of 4.5 years, 13 patients died. Among them, cardiovascular death (CVD) was observed in 11/13 (85%), and the leading cause of the CVD was end-stage heart failure. A New York Heart Association class ≥III at the time of the ES occurrence (HR 6.51 95% CI 1.94-25.1, p = 0.003) and any shock therapy (HR 5.94 95% CI 1.06-112.2, p = 0.04) were associated with CVD. CONCLUSION: In the current single center study, the major cause of death in ES patients with SHDs was end-stage heart failure. Any shock therapy was associated with CVD. Arrhythmia management to avoid ICD shocks might reduce the mortality in ES patients.
• Usefulness of the pulmonary venous flow waveform for assessing left atrial stiffness

  Takehiro Abe, Kazunori Okada, Michito Murayama, Sanae Kaga, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Hiroyuki Aoyagi, Yoji Tamaki, Ko Motoi, Yasuyuki Chiba, Suguru Ishizaka, Shingo Tsujinaga, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  The International Journal of Cardiovascular Imaging 2022/07/16
• MitraClip実施後にたこつぼ症候群を呈した1例

  甲谷 次郎, 神谷 究, 立田 大志郎, 西野 広太郎, 高橋 勇樹, 斎院 康平, 内藤 正一郎, 竹中 秀, 多田 篤司, 水口 賢史, 石坂 傑, 小林 雄太, 佐藤 琢真, 永井 利幸, 安斉 俊久

  日本心血管インターベンション治療学会抄録集 30回 [YIA4 - 2] 2022/07
• Myocardial T-Lymphocytes as a Prognostic Risk-Stratifying Marker of Dilated Cardiomyopathy - Results of the Multicenter Registry to Investigate Inflammatory Cell Infiltration in Dilated Cardiomyopathy in Tissues of Endomyocardial Biopsy (INDICATE Study).

  Keiko Ohta-Ogo, Yasuo Sugano, Soshiro Ogata, Takafumi Nakayama, Takahiro Komori, Kazuo Eguchi, Kaoru Dohi, Tetsuro Yokokawa, Hiromitsu Kanamori, Shigeyuki Nishimura, Kazufumi Nakamura, Yoshihiko Ikeda, Kunihiro Nishimura, Genzou Takemura, Toshihisa Anzai, Michiaki Hiroe, Kinta Hatakeyama, Hatsue Ishibashi-Ueda, Kyoko Imanaka-Yoshida

  Circulation journal : official journal of the Japanese Circulation Society 86 (7) 1092 - 1101 2022/06/24 

  BACKGROUND: Dilated cardiomyopathy (DCM) associated with inflammation is diagnosed by endomyocardial biopsy; patients with this have a poorer prognosis than patients without inflammation. To date, standard diagnostic criteria have not been established.Methods and Results: This study analyzed clinical records and endomyocardial biopsy samples of 261 patients with DCM (201 males, median left ventricular ejection fraction; 28%) from 8 institutions in a multicenter retrospective study. Based on the European Society of Cardiology criteria and CD3 (T-lymphocytes) and CD68 (macrophages) immunohistochemistry, 48% of patients were categorized as having inflammatory DCM. For risk-stratification, we divided patients into 3 groups using Akaike Information Criterion/log-rank tests, which can determine multiple cut-off points: CD3+-Low, <13/mm2(n=178, 68%); CD3+-Moderate, 13-24/mm2(n=58, 22%); and CD3+-High, ≥24/mm2(n=25, 10%). The survival curves for cardiac death or left ventricular assist device implantation differed significantly among the 3 groups (10-year survival rates: CD3+-Low: 83.4%; CD3+-Moderate: 68.4%; CD3+-High: 21.1%; Log-rank P<0.001). Multivariate Cox analysis revealed CD3+count as a potent independent predictive factor for survival (fully adjusted hazard ratio: CD3+-High: 5.70, P<0.001; CD3+-Moderate: 2.64, P<0.01). CD3+-High was also associated with poor left ventricular functional and morphological recovery at short-term follow up. CONCLUSIONS: Myocardial CD3+T-lymphocyte infiltration has a significant prognostic impact in DCM and a 3-tiered risk-stratification model could be helpful to refine patient categorization.
• Cogan Syndrome with Aortic Regurgitation and Multiple Vasculopathy.

  Kohei Saiin, Takao Konishi, Keita Ninagawa, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 61 (12) 1921 - 1922 2022/06/15
• Luseogliflozin preserves the pancreatic beta-cell mass and function in db/db mice by improving mitochondrial function.

  Yuki Yamauchi, Akinobu Nakamura, Takashi Yokota, Kiyohiko Takahashi, Shinichiro Kawata, Kazuhisa Tsuchida, Kazuno Omori, Hiroshi Nomoto, Hiraku Kameda, Kyu Yong Cho, Toshihisa Anzai, Shinya Tanaka, Yasuo Terauchi, Hideaki Miyoshi, Tatsuya Atsumi

  Scientific reports 12 (1) 9740 - 9740 2022/06/13 

  We aimed to determine the mechanism by which the sodium glucose co-transporter 2 inhibitor, luseogliflozin, preserves pancreatic beta-cell mass and function in db/db mice. Six-week-old db/db mice were fed to standard chow or standard chow containing 0.01% luseogliflozin. After 4 weeks, DNA microarray analysis, real-time PCR analysis, and measurement of mitochondrial respiratory capacity and reactive oxygen species (ROS) generation were performed using isolated islets. Immunohistochemistry and electron microscopic analysis were performed using pancreatic tissues. Metabolites extracted from the islets were measured by capillary electrophoresis mass spectrometry. The expression of genes involved in the tricarboxylic acid (TCA) cycle and electron transport chain was upregulated by luseogliflozin. Luseogliflozin improved the mitochondrial complex II-linked oxidative phosphorylation capacity and reduced ROS generation. Mitochondrial morphology was normally maintained by luseogliflozin. Luseogliflozin increased NK6 homeobox 1 (NKX6.1) expression and TCA cycle metabolites. Relief of glucotoxicity by luseogliflozin may involve lower mitochondrial ROS generation and an improvement in complex II-linked mitochondrial respiration. Reducing ROS generation through preventing complex II damage likely increases NKX6.1 expression and ameliorate glucose metabolism in the TCA cycle, contributing to the protection of pancreatic beta-cells. Protection of complex II in pancreatic beta-cells represents a novel therapeutic target for type 2 diabetes.
• Long-term preservation of functional capacity and quality of life in advanced heart failure patients with bridge to transplant therapy: A report from Japanese nationwide multicenter registry.

  Takuma Sato, Yuta Kobayashi, Toshiyuki Nagai, Takeshi Nakatani, Jon Kobashigawa, Yoshikatsu Saiki, Minoru Ono, Satoru Wakasa, Toshihisa Anzai

  International journal of cardiology 356 66 - 72 2022/06/01 

  BACKGROUND: Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients. METHODS: We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO2], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation. RESULTS: During the follow-up period of 30 months (IQR 18-42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO2, 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively). CONCLUSIONS: BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx.
• Stimulation of the mitochondrial calcium uniporter mitigates chronic heart failure-associated ventricular arrhythmia in mice.

  Hikaru Hagiwara, Masaya Watanabe, Yoichiro Fujioka, Takahide Kadosaka, Takuya Koizumi, Taro Koya, Motoki Nakao, Rui Kamada, Taro Temma, Kazufumi Okada, Jose Antonio Moreno, Ohyun Kwon, Hisakata Sabe, Yusuke Ohba, Toshihisa Anzai

  Heart rhythm 19 (10) 1725 - 1735 2022/05/31 

  BACKGROUND: An aberrant increase in the diastolic calcium concentration ([Ca2+]i) level is a hallmark of heart failure (HF) and the cause of delayed afterdepolarization and ventricular arrhythmia (VA). Although mitochondria play a role in regulating [Ca2+]i, whether they can compensate for the [Ca2+]i abnormality in ventricular myocytes is unknown. OBJECTIVE: We investigated whether enhanced Ca2+ uptake of mitochondria may compensate for an abnormal increase in the [Ca2+]i of ventricular myocytes in HF to effectively mitigate VA. METHODS: We used a HF mouse model, in which myocardial infarction was induced by permanent left anterior descending coronary artery ligation. The mitochondrial Ca2+ uniporter was stimulated by kaempferol. Ca2+ dynamics and membrane potential were measured using an epifluorescence microscope, a confocal microscope, and the perforated patch-clamp technique. VA was induced in the Langendorff-perfused hearts, and the hemodynamic parameters were measured using a microtip transducer catheter. RESULTS: Protein expression of the mitochondrial Ca2+ uniporter, as assessed by its subunit expression, did not change between HF and sham mice. Treatment of cardiomyocytes with kaempferol, isolated from HF mice at 28 days after coronary ligation, reduced the appearance of aberrant diastolic [Ca2+]i waves and sparks and spontaneous action potentials. Kaempferol effectively reduced the VA occurring in Langendorff-perfused hearts. Intravenous administration of kaempferol did not markedly affect the left ventricular hemodynamic parameters. CONCLUSION: The effects of kaempferol in HF of mice implied that mitochondria may have the potential to compensate for abnormal [Ca2+]i. Mechanisms involved in mitochondrial Ca2+ uptake may provide novel targets to treat HF-associated VA.
• Two cases showing alterations of the order of tricuspid and mitral valve opening during loading manipulations: a new approach for quick assessment of stress-induced left ventricular filling pressure elevation.

  Michito Murayama, Hiroyuki Iwano, Ko Motoi, Suguru Ishizaka, Shingo Tsujinaga, Toshiyuki Nagai, Toshihisa Anzai

  Journal of medical ultrasonics (2001) 49 (3) 489 - 491 2022/05/30
• Visual echocardiographic scoring system of the left ventricular filling pressure and outcomes of heart failure with preserved ejection fraction.

  Michito Murayama, Hiroyuki Iwano, Masaru Obokata, Tomonari Harada, Kazunori Omote, Kazuki Kagami, Shingo Tsujinaga, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Yoji Tamaki, Hiroyuki Aoyagi, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Asuka Tanemura, Kazunori Okada, Sanae Kaga, Mutsumi Nishida, Toshiyuki Nagai, Masahiko Kurabayashi, Toshihisa Anzai

  European heart journal. Cardiovascular Imaging 23 (5) 616 - 626 2022/04/18 

  AIMS: Elevated left ventricular filling pressure (LVFP) is a powerful indicator of worsening clinical outcomes in heart failure with preserved ejection fraction (HFpEF); however, detection of elevated LVFP is often challenging. This study aimed to determine the association between the newly proposed echocardiographic LVFP parameter, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, and clinical outcomes of HFpEF. METHODS AND RESULTS: We retrospectively investigated 310 well-differentiated HFpEF patients in stable conditions. VMT was scored from 0 to 3 using two-dimensional echocardiographic images, and VMT ≥2 was regarded as a sign of elevated LVFP. The primary endpoint was a composite of cardiac death or heart failure hospitalization during the 2 years after the echocardiographic examination. In all patients, Kaplan-Meier curves showed that VMT ≥2 (n = 54) was associated with worse outcomes than the VMT ≤1 group (n = 256) (P < 0.001). Furthermore, VMT ≥2 was associated with worse outcomes when tested in 100 HFpEF patients with atrial fibrillation (AF) (P = 0.026). In the adjusted model, VMT ≥2 was independently associated with the primary outcome (hazard ratio 2.60, 95% confidence interval 1.46-4.61; P = 0.001). Additionally, VMT scoring provided an incremental prognostic value over clinically relevant variables and diastolic function grading (χ2 10.8-16.3, P = 0.035). CONCLUSIONS: In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it could also predict clinical outcomes in HFpEF patients with AF.
• SGLT2阻害薬はミトコンドリア機能の改善を介し膵β細胞量・機能を保護する

  山内 裕貴, 中村 昭伸, 横田 卓, 高橋 清彦, 川田 晋一朗, 土田 和久, 大森 一乃, 野本 博司, 亀田 啓, 曹 圭龍, 安斉 俊久, 田中 伸哉, 寺内 康夫, 三好 秀明, 渥美 達也

  日本内分泌学会雑誌 (一社)日本内分泌学会 98 (1) 361 - 361 0029-0661 2022/04
• Difference in left atrial myocardial dynamics during reservoir phase between hypertrophic cardiomyopathy and hypertensive heart determined using three-dimensional speckle tracking echocardiography

  Yusuke Yanagi, Kazunori Okada, Sanae Kaga, Taisei Mikami, Miho Aiba, Nobuo Masauzi, Michito Murayama, Asuka Tanemura, Shinobu Yokoyama, Hisao Nishino, Masahiro Nakabachi, Yoji Tamaki, Hiroyuki Aoyagi, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Shingo Tsujinaga, Hiroyuki Iwano, Toshihisa Anzai

  INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 1569-5794 2022/04 

  We aimed to investigate left atrial (LA) myocardial dynamics during reservoir phase using three-dimensional speckle-tracking echocardiography (3DSTE) focusing on its longitudinal-circumferential relationship in patients with left ventricular (LV) hypertrophy and clarifying the difference in LA myocardial reservoir dynamics between hypertrophic cardiomyopathy (HCM) and hypertension with LV hypertrophy (HT-LVH). We studied 4 age-matched groups consisting of 27 patients with HCM, 16 with HT-LVH, 22 hypertensive patients without LV hypertrophy (HT), and 18 normal controls. Using 3DSTE, we measured LA global longitudinal strain (LA-LSR), global circumferential strain (LA-CSR), and global area strain (LA-AS(R)) during the reservoir phase, as well as LV global longitudinal strain (LV-LS), global circumferential strain (LV-CS), and global area strain (LV-AS). LA-LSR was significantly lower in the HCM and HT-LVH groups than in the controls, but there was no significant difference between the HCM and HT-LVH groups. LA-CSR and LA-AS(R) were significantly lower in the HCM group than in the other three groups, among which no significant difference was detected. In all subjects, LA-LSR was significantly correlated with LV-LS but not with LV-CS. LA-CSR was correlated with neither LV-LS nor LV-CS. In conclusion, both longitudinal and circumferential LA myocardial expansion during reservoir phase were reduced in HCM, while only the longitudinal one was reduced in HT-LVH. Reduction of LA circumferential expansion may reflect a more serious and intrinsic impairment of LA myocardial distensibility in HCM. Measuring LA-CSR and LA-AS(R) using 3DSTE would contribute to a more accurate understanding of LA reservoir function abnormality in HCM.
• Prognostic value of an echocardiographic index reflecting right ventricular operating stiffness in patients with heart failure.

  Ryosuke Fujisawa, Kazunori Okada, Sanae Kaga, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Asuka Tanemura, Nobuo Masauzi, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Shingo Tsujinaga, Hiroyuki Iwano, Toshihisa Anzai

  Heart and vessels 37 (4) 583 - 592 2022/04 

  PURPOSE: We recently reported a noninvasive method for the assessment of right ventricular (RV) operating stiffness that is obtained by dividing the atrial-systolic descent of the pulmonary artery-RV pressure gradient (PRPGDAC) derived from the pulmonary regurgitant velocity by the tricuspid annular plane movement during atrial contraction (TAPMAC). Here, we investigated whether this parameter of RV operating stiffness, PRPGDAC/TAPMAC, is useful for predicting the prognosis of patients with heart failure (HF). METHODS: We retrospectively included 127 hospitalized patients with HF who underwent an echocardiographic examination immediately pre-discharge. The PRPGDAC/TAPMAC was measured in addition to standard echocardiographic parameters. Patients were followed until 2 years post-discharge. The endpoint was the composite of cardiac death, readmission for acute decompensation, and increased diuretic dose due to worsening HF. RESULTS: 58 patients (46%) experienced the endpoint during follow-up. Univariable and multivariable Cox regression analyses demonstrated that the PRPGDAC/TAPMAC was associated with the endpoint. In a Kaplan-Meier analysis, the event rate of the greater PRPGDAC/TAPMAC group was significantly higher than that of the lesser PRPGDAC/TAPMAC group. In a sequential Cox analysis for predicting the endpoint's occurrence, the addition of PRPGDAC/TAPMAC to the model including age, sex, NYHA functional classification, brain natriuretic peptide level, and several echocardiographic parameters including tricuspid annular plane systolic excursion significantly improved the predictive power for prognosis. CONCLUSION: A completely noninvasive index of RV operating stiffness, PRPGDAC/TAPMAC, was useful for predicting prognoses in patients with HF, and it showed an incremental prognostic value over RV systolic function.
• Right atrial pressure represents cumulative cardiac burden in heart failure with preserved ejection fraction.

  Reika Nagata, Tomonari Harada, Kazunori Omote, Hiroyuki Iwano, Kotaro Yoshida, Toshimitsu Kato, Koji Kurosawa, Toshiyuki Nagai, Toshihisa Anzai, Masaru Obokata

  ESC heart failure 9 (2) 1454 - 1462 2022/04 

  AIMS: Right-sided filling pressure is elevated in some patients with heart failure (HF) and preserved ejection fraction (HFpEF). We hypothesized that right atrial pressure (RAP) would represent the cumulative burden of abnormalities in the left heart, pulmonary vasculature, and the right heart. METHODS AND RESULTS: Echocardiography was performed in 399 patients with HFpEF. RAP was estimated from inferior vena cava morphology and its respiratory change [estimated right atrial pressure (eRAP)], and patients were divided according to eRAP (3 or ≥8 mmHg). Patients with higher eRAP displayed more severe abnormalities in LV diastolic function as well as right heart structure and function than those with normal eRAP. Cardiac deaths or HF hospitalization occurred in 84 patients over a median follow-up of 19.0 months (interquartile range 6.7-36.9). The presence of higher eRAP was independently associated with an increased risk of the composite outcome (adjusted hazard ratio 2.20 vs. normal eRAP group, 95% confidence interval 1.34-3.62, P = 0.002). Kaplan-Meier curves separating the patients into four groups based on eRAP and E/e' ratio showed that event-free survival varied among the groups, providing an incremental prognostic value of eRAP over E/e' ratio. The classification and regression tree analysis demonstrated that eRAP was the strongest predictor of the outcome followed by right ventricular dimension, E/e' ratio, and estimated right ventricular systolic pressure, stratifying the patients into four risk groups (incident rate 8.8-72.2%). CONCLUSIONS: These data may provide new insights into the prognostic role of RAP in the complex pathophysiology of HFpEF and suggest the utility of eRAP for the risk stratification in patients with HFpEF.
• Rapid Publication and Announcement of the 2022 JCS Meeting Activities.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 86 (4) 589 - 590 2022/03/25
• Impact of Tweeting Summaries by the Japanese Circulation Society Official Account on Article Viewership - Pilot Trial.

  Atsushi Mizuno, Kenya Kusunose, Takuya Kishi, Jeffrey Rewley, Chisa Matsumoto, Yuki Sahashi, Mari Ishida, Shoji Sanada, Memori Fukuda, Tadafumi Sugimoto, Miki Hirano, Daisuke Yoneoka, Masataka Sata, Toshihisa Anzai, Koichi Node

  Circulation journal : official journal of the Japanese Circulation Society 86 (4) 715 - 720 2022/03/25 

  BACKGROUND: The impact of promotional tweets from the official journal account (forCirculation JournalandCirculation Reports) on article viewership has not been thoroughly evaluated.Methods and Results:We retrospectively collected journal viewership data forCirculation JournalandCirculation Reportsfrom March 2021 to August 2021. We compared viewership between articles with (n=15) and without (n=250) tweets. After 1 : 4 propensity score matching (15 tweeted articles and 60 non-tweeted matched controls), journal viewership metrics within 7 days of the tweeting date (and the hypothetical tweeting date), was larger in tweeted articles than non-tweeted articles (median [interquartile range] Abstract page views 89 [60-104] vs. 18 [8-41]). CONCLUSIONS: This pilot study suggests a positive relationship between journal-posted promotional tweets and article viewership.
• Results of PRospect trial to Elucidate the utility of EchocarDiography-based Cardiac ouTput in acute heart failure (PREDICT).

  Hiroyuki Iwano, Hiroto Utsunomiya, Kentaro Shibayama, Hidekazu Tanaka, Akihiro Isotani, Toshinari Onishi, Masaru Obokata, Masaki Izumo, Kenya Kusunose, Atsuko Furukawa, Masahiro Yamada, Takeshi Kitai, Tetsuari Onishi, Masayoshi Yamamoto, Shunsuke Sasaki, Kotaro Nochioka, Yoichi M Ito, Toshihisa Anzai

  Journal of cardiology 80 (3) 218 - 225 2022/03/17 

  BACKGROUND: The predictive value of echocardiographic parameters for early worsening heart failure (WHF), worsening of symptoms of heart failure requiring intensification of therapy during an admission for acute decompensated heart failure (ADHF), has not been elucidated. METHODS: Sixteen centers in Japan prospectively enrolled 303 ADHF hospitalized patients who did not receive positive inotropic agents as an initial therapy. Physical and Doppler echocardiographic examinations were performed before the initial therapy and the association of low output findings and occurrence of early WHF were tested. RESULTS: Early WHF occurred in 63 patients with a median duration of 6 (IQR: 2-23) hours from the administration of the initial therapy. In patients with left ventricular (LV) ejection fraction <40% (N = 153), echocardiographic stroke volume index, and cardiac index showed greater c-index [95% confidence interval, 0.71 (0.61-0.79) and 0.72 (0.63-0.80), respectively] compared to single low perfusion finding (symptomatic hypotension, reduced pulse pressure, and impaired mentation) other than cool extremities. When physical findings were combined (low perfusion score), the predictive ability improved to the similar levels of echocardiographic LV output parameters [c-index: 0.69 (0.60-0.76)]. However, addition of cardiac index significantly improved the prognostic ability when added to low perfusion score [0.82 (0.74-0.87), p < 0.001]. In contrast, in patients with LV ejection fraction ≥40% (N = 150), low perfusion score, rather than LV output parameters, was predictive of early WHF [c-index: 0.73 (0.56-0.85)]. CONCLUSIONS: We demonstrated the predictive value of echocardiographic LV output indices for early WHF in ADHF patients with LV systolic dysfunction. These data support the motivation for routine use of echocardiography for initial assessment of ADHF.
• Circulation Journal Awards for the Year 2021.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 86 (3) 365 - 375 2022/02/25
• Clinical Utility of Superior Vena Cava Flow Velocity Waveform Measured from the Subcostal Window for Estimating Right Atrial Pressure.

  Michito Murayama, Sanae Kaga, Kazunori Okada, Hiroyuki Iwano, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Shingo Tsujinaga, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Kiwamu Kamiya, Mutsumi Nishida, Toshiyuki Nagai, Toshihisa Anzai

  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 35 (7) 727 - 737 2022/02/09 

  BACKGROUND: The superior vena cava (SVC) flow velocity waveform from the supraclavicular window reflects right atrial pressure (RAP) status. Recent guidelines have stated that the subcostal window is an alternative view for recording SVC flow, but the validity of this approach remains unclear. The aim of this study was to determine the usefulness of SVC flow evaluation from the subcostal window for estimating RAP. METHODS: Differences in SVC flow characteristics between opposite approaches were examined in 38 healthy adults. In 115 patients with cardiovascular diseases who underwent cardiac catheterization and echocardiography within 48 hours, the ratio of peak systolic to diastolic forward SVC flow (SVC-S/D) was measured, and the diagnostic ability of SVC-S/D for elevated RAP was tested. A validation cohort was used to confirm the diagnostic ability of SVC-S/D in 48 patients who underwent both cardiac catheterization and echocardiography within 24 hours. In 59 patients in the derivation and validation cohorts, the relationship between SVC flow and RAP was compared between the opposite windows. RESULTS: Both systolic and diastolic SVC flow velocities were higher in the subcostal than in the supraclavicular approach, and effect of position change on subcostal SVC-S/D was smaller than that on supraclavicular SVC-S/D in healthy adults. Measurement of SVC-S/D from the subcostal window was feasible in 98 patients (85%). RAP was inversely correlated with SVC-S/D (r = -0.50, P < .001) and was an independent determinant of SVC-S/D after adjustment for right ventricular systolic function (β = -0.48, P < .001). A cutoff value of 1.9 for SVC-S/D showed 85% sensitivity and 74% specificity in identifying elevated RAP. Additionally, SVC-S/D showed an incremental diagnostic value combined with inferior vena cava size and collapsibility (P = .006). When a cutoff value of SVC-S/D < 1.9 was applied to the validation cohort, it showed acceptable accuracy of 72% and incremental diagnostic value combined with inferior vena cava parameters (P = .033). SVC-S/D from the subcostal window correlated better with RAP than that from the supraclavicular window (P < .001, Meng's test). CONCLUSIONS: Measurement of SVC flow velocity from the subcostal window was feasible, and SVC-S/D from the subcostal window could be an additive parameter for estimating RAP.
• Cardiac Power Output Is Independently and Incrementally Associated With Adverse Outcomes in Heart Failure With Preserved Ejection Fraction.

  Tomonari Harada, Miho Yamaguchi, Kazunori Omote, Hiroyuki Iwano, Yoshifumi Mizuguchi, Shiro Amanai, Kuniko Yoshida, Toshimitsu Kato, Koji Kurosawa, Toshiyuki Nagai, Kazuaki Negishi, Toshihisa Anzai, Masaru Obokata

  Circulation. Cardiovascular imaging 15 (2) e013495  2022/02 

  BACKGROUND: Cardiac power output is a measure of cardiac performance, and its prognostic significance has been shown in heart failure (HF) with reduced ejection fraction. Patients with HF with preserved ejection fraction may have altered cardiac performance, but the prognostic relevance of cardiac power output is unknown. This study sought to determine the association between cardiac power output and clinical outcomes in HF with preserved ejection fraction and to compare its prognostic effect to other measures of cardiac performance including ventricular-arterial coupling and mechanical efficiency. METHODS: Cardiac power output normalized to left ventricular mass was assessed by echocardiography in 408 patients with HF with preserved ejection fraction. Load-independent contractility (end-systolic elastance), arterial elastance, its coupling (arterial elastance/end-systolic elastance), left ventricular global longitudinal strain, and mechanical efficiency (stroke work/pressure-volume area) were also estimated noninvasively. The primary end point was a composite of cardiovascular mortality or HF hospitalization. RESULTS: The primary composite outcome occurred in 84 patients during a median follow-up of 19.4 months. There was a dose-dependent association between cardiac power output and the composite outcomes, in which patients with the lowest tertile of cardiac power output had >3-fold risk than those with the highest tertile (hazard ratio, 3.04 [95% CI, 1.66-5.57]; P=0.0003). In a multivariable model, lower cardiac power output was independently associated with adverse outcomes (hazard ratio, 0.70 per 1 SD [95% CI, 0.49-0.97]; P=0.03). In contrast, left ventricular size, end-systolic elastance, arterial elastance, arterial elastance/end-systolic elastance ratio, and left ventricular mechanical efficiency were not associated with outcomes. Cardiac power output provided an incremental prognostic effect over the model based on clinical (age, gender, diastolic blood pressure, and atrial fibrillation) and echocardiographic markers (left atrial size, pulmonary pressures, global longitudinal strain, and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular tissue velocity; P=0.03). CONCLUSIONS: In patients with HF with preserved ejection fraction, cardiac power output was independently and incrementally associated with adverse outcomes whereas other markers of cardiac performance were not.
• Editorial Statistics and Best Reviewers Award for 2021.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 86 (2) 173 - 175 2022/01/25
• Left ventricular mass index-to-QRS-voltage ratio predicts outcomes in heart failure with preserved ejection fraction.

  Yoshiharu Kinugasa, Kensuke Nakamura, Hiroko Kamitani, Masayuki Hirai, Kiyotaka Yanagihara, Masahiko Kato, Toshiyuki Nagai, Tsutomu Yoshikawa, Yoshihiko Saito, Yasuchika Takeishi, Kazuhiro Yamamoto, Toshihisa Anzai

  ESC heart failure 9 (2) 1098 - 1106 2022/01/25 

  AIMS: Increased left ventricular mass index (LVMI) disproportionate to electrocardiographic QRS voltage has been reported to be associated with cardiac fibrosis and amyloid infiltration to myocardium. This study aimed to assess whether the LVMI-to-QRS-voltage ratio predicts clinical outcomes in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, and prospective registration of Japanese patients hospitalized with HFpEF (EF ≥ 50%). LVMI was assessed by echocardiography using the cube formula. QRS voltage was assessed by Sokolow-Lyon voltage criteria. We divided 290 patients in the registry who met inclusion criteria into five groups according to the quintile values of their LVMI-to-QRS-voltage ratio. In the highest quintile group (≥71.8 g/m2 /mV), approximately 50% of the patients had concentric hypertrophy and 30% had eccentric hypertrophy. These patients had the highest proportion of atrial fibrillation (61.4%) and history of pacemaker implantation (12.1%) among the five groups (P < 0.05). During the mean follow-up of 587 ± 300 days, 31.4% of all patients met the composite endpoint of all-cause death or rehospitalization for HF. Even after adjustment for demographic and baseline variables, the highest quintile group had a significantly higher incidence of the composite endpoints than the lowest quintile group (<30.7 g/m2 /mV) (hazard ratio: 2.205, 95% confidence interval: 1.106-4.395, P < 0.05). CONCLUSIONS: A high LVMI-to-QRS-voltage ratio is independently associated with poor outcomes in patients with HFpEF.
• Determinants of altered left ventricular suction in pre-capillary pulmonary hypertension.

  Yasuyuki Chiba, Hiroyuki Iwano, Satonori Tsuneta, Shingo Tsujinaga, Brett Meyers, Pavlos Vlachos, Suguru Ishizaka, Ko Motoi, Hiroyuki Aoyagi, Yoji Tamaki, Asuka Tanemura, Michito Murayama, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Sanae Kaga, Kiwamu Kamiya, Hiroshi Ohira, Ichizo Tsujino, Toshihisa Anzai

  European heart journal. Cardiovascular Imaging 23 (10) 1399 - 1406 2022/01/10 

  AIMS: Although the left ventricular (LV) dysfunction in pre-capillary pulmonary hypertension (PH) has been recently recognized, the mechanism of LV dysfunction in this entity is not completely understood. We thus aimed to elucidate the determinants of intraventricular pressure difference (IVPD), a measure of LV suction, in pre-capillary PH. METHODS AND RESULTS: Right heart catheterization and echocardiography were performed in 86 consecutive patients with pre-capillary PH (57 ± 18 years, 85% female). IVPD was determined using colour M-mode Doppler to integrate the Euler equation. In overall, IVPD was reduced compared to previously reported value in normal subjects. In univariable analyses, QRS duration (P = 0.028), LV ejection fraction (P = 0.006), right ventricular (RV) end-diastolic area (P < 0.001), tricuspid annular plane systolic excursion (P = 0.004), and LV early-diastolic eccentricity index (P = 0.009) were associated with IVPD. In the multivariable analyses, RV end-diastolic area and LV eccentricity index independently determined the IVPD. CONCLUSION: Aberrant ventricular interdependence caused by RV enlargement could impair the LV suction. This study first applied echocardiographic IVPD, a reliable marker of LV diastolic suction, to investigate the mechanism of LV diastolic dysfunction in pre-capillary PH.
• ドプラ心エコー法による肺動脈弁逆流重症度の過大評価の要因に関する検討

  本居 昂, 岩野 弘幸, 常田 慧徳, 村山 迪史, 加賀 早苗, 青柳 裕之, 玉置 陽生, 石坂 傑, 千葉 泰之, 辻永 真吾, 種村 明日香, 横山 しのぶ, 中鉢 雅大, 西野 久雄, 岡田 一範, 武田 充人, 安斉 俊久

  日本成人先天性心疾患学会雑誌 日本成人先天性心疾患学会 11 (1) 216 - 216 2022/01
• Neoatherosclerosis with silent plaque rupture in a saphenous vein graft causing no re-flow phenomenon assessed by optical coherence tomography and histopathology.

  Takao Konishi, Yuki Takahashi, Sho Kazui, Yutaro Yasui, Kohei Saiin, Seiichiro Naito, Sakae Takenaka, Yoshifumi Mizuguchi, Atsushi Tada, Yuta Kobayashi, Kazunori Omote, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Shinya Tanaka, Toshihisa Anzai

  Cardiology journal 29 (4) 718 - 719 2022
• Vulnerable plaque derived from aspirated thrombi in recurrent acute coronary syndrome with familial hypercholesterolemia despite intensive lipid-lowering statin therapy.

  Hiroyuki Natsui, Takao Konishi, Kohei Saiin, Youji Tamaki, Tomoya Sato, Sakae Takenaka, Atsushi Tada, Yoshifumi Mizuguchi, Yuta Kobayashi, Takuma Sato, Rui Kamada, Kiwamu Kamiya, Toshiyuki Nagai, Shinya Tanaka, Toshihisa Anzai

  Cardiology journal 29 (2) 362 - 363 2022
• Functional Tricuspid Regurgitation and Right Atrial Remodeling in Heart Failure With Preserved Ejection Fraction.

  Tomonari Harada, Masaru Obokata, Kazunori Omote, Hiroyuki Iwano, Takahiro Ikoma, Kenya Okada, Kuniko Yoshida, Toshimitsu Kato, Koji Kurosawa, Toshiyuki Nagai, Toshihisa Anzai, Barry A Borlaug, Masahiko Kurabayashi

  The American journal of cardiology 162 129 - 135 2022/01/01 

  Tricuspid regurgitation (TR) is common in patients with heart failure with preserved ejection fraction (HFpEF), but it has not been well characterized. We hypothesized that right atrial (RA) remodeling would be associated with TR in HFpEF, forming a type of atrial functional TR (AFTR). Echocardiography was performed in 328 patients with HFpEF. TR severity was defined using a guidelines-based approach. Ventricular functional TR was defined as the presence of right ventricular (RV) systolic pressure >50 mm Hg or RV dilation, and the remaining patients were classified as having AFTR if they had RA dilation or tricuspid annular enlargement. RA dilation was common (78%) in the significant TR group (more than mild), exceeding the prevalence of RV dilation (32%), and RA dilation was correlated with tricuspid annular diameter and TR vena contracta width (r = 0.67 and r = 0.70, both p <0.0001). Despite the absence of RV dilation and pulmonary hypertension, 38% of patients with significant TR had AFTR. Patients with AFTR and those with ventricular functional TR displayed higher heart failure hospitalization rates than those with nonsignificant TR (adjusted hazard ratios, 2.45 and 4.31; 95% confidence interval 1.12 to 5.35 and 2.44 to 7.62, p = 0.02 and p <0.0001, respectively). In conclusion, TR in HFpEF is related to RA remodeling, and the presence of AFTR was associated with poor clinical outcomes. The current data highlight the importance of RA remodeling in the pathophysiology of TR in HFpEF.
• Messages From the Editor-in-Chief.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 86 (1) 1 - 1 2021/12/24
• The Circulation Journal Official Impact Factor and the Most Frequently Cited Papers in 2020.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 86 (1) 2 - 5 2021/12/24
• Molecular ratio of mature B-type natriuretic peptide in acute heart failure: an indicator for ventricular contractile recovery.

  Akihisa Kimura, Hiroyuki Takahama, Toshio Nishikimi, Seiji Takashio, Tomohiro Hayashi, Chiaki Nagai-Okatani, Yasuaki Nakagawa, Satoshi Yasuda, Toshihisa Anzai, Naoto Minamino, Chisato Izumi

  ESC heart failure 8 (6) 5617 - 5621 2021/12 

  AIMS: The methodology to distinguish between the heart failure (HF) with recovered ejection fraction (HFrecEF) and those with continuously reduced ejection fraction (EF) (HFcrEF) on admission has not been established. We recently demonstrated that the ratio of plasma levels of pro-B-type natriuretic peptide (proBNP) to total BNP (proBNP plus mature BNP) is decreased on admission in patients with mild acute HF, but not in severe acute HF as a compensatory mechanism for activating cyclic GMP via increases of bioactive mature BNP. We aimed to test the hypothesis that the ratio of bioactive mature BNP to total BNP is associated with reverse remodelling capacity in patients with HF with reduced EF. METHODS AND RESULTS: Plasma proBNP and total BNP were measured in patients with acute decompensated HF by using specific and sensitive enzyme immunochemiluminescent assay. Estimated percent mature BNP (%emBNP) was calculated as ([total BNP - proBNP]/total BNP) × 100. We retrospectively identified the patients with reduced EF (≤40%, on admission) who had echocardiographic data after discharge (n = 93). We defined patients with increased EF by >10% during the follow-up term (median, 545 days) after the admission as HFrecEF group. We compared patient characteristics, %emBNP, and other biomarkers between HFrecEF and HFcrEF. Of the enrolled patients with HFrecEF (n = 32) and HFcrEF (n = 61), on admission, %emBNP was significantly higher in HFrecEF than in HFcrEF (44.1% vs. 36.9%; P < 0.05). There were no significant differences in left ventricular EF on admission between the two groups. The univariate analysis revealed that %emBNP on admission was associated with HFrecEF occurrence rate (P < 0.05), in contrast both total BNP and high-sensitive cardiac troponin-T levels were not associated with HFrecEF occurrence rate. CONCLUSIONS: The ratio of mature BNP to total BNP in plasma at the time of hospital admission may be predictive of left ventricular contractile recovery. Preservation of the capacity to convert proBNP to mature BNP, but not myocardial injury itself, is associated with future ventricular contractile recovery.
• Reduction of tethering distance by papillary muscle tugging approximation with mitral valve replacement for non-ischemic functional mitral regurgitation induces left ventricular reverse remodeling

  Takahiro Ishigaki, Satoru Wakasa, Yasushige Shingu, Yohei Ohkawa, Akira Yamada, Toshihisa Anzai, Yoshiro Matsui

  Journal of Cardiology 79 (4) 530 - 536 0914-5087 2021/11 

  BACKGROUND: Functional mitral regurgitation (FMR) is caused by left ventricular (LV) remodeling and subsequent tethering of the mitral valve (MV). If LV remodeling is irreversibly advanced, it could not be attenuated by the MV procedure alone, although the additional subvalvular procedure could induce LV reverse remodeling by forcibly reducing MV tethering. This study aimed to assess the anti-tethering effect of papillary muscle tugging approximation (PMTA) on LV reverse remodeling after mitral valve replacement (MVR) for non-ischemic FMR. METHODS: The study subjects were 19 patients who underwent MVR with and without PMTA [MVR + PMTA (n = 11) and MVR alone (n = 8), respectively] for non-ischemic FMR. The tethering distance (TD) and LV end-systolic volume (ESV) at the preoperative, postoperative, and follow-up periods were assessed in terms of their correlation and time-dependent changes. The intra-LV energy efficiency was also evaluated through vector flow mapping analysis. RESULTS: TD and ESV were comparable between both procedures preoperatively and did not change after MVR alone. In MVR + PMTA, however, a significant decrease was identified in TD and ESV at the early postoperative and follow-up periods, respectively [TD = 48, 30, and 31 mm (p < 0.001) and ESV = 159, 133, and 82 mL (p < 0.001) at the preoperative, postoperative, and follow-up periods, respectively]. Finally, at follow-up, the extent of change from the preoperative value in ESV significantly correlated with that in TD (ρ = 0.81, p < 0.001 for overall; ρ = 0.93, p < 0.001 for MVR + PMTA; ρ = 0.86, p = 0.011 for MVR alone). The ratio of TD to ESV was also significantly correlated with systolic energy loss to LV stroke work after MVR + PMTA (ρ = 0.81, p = 0.015). CONCLUSIONS: PMTA for non-ischemic FMR could induce LV reverse remodeling depending on the extent of postoperative TD reduction. A smaller TD to ESV was associated with a higher intra-LV energy efficiency after PMTA + MVR.
• Performance of the H2FPEF and the HFA-PEFF scores for the diagnosis of heart failure with preserved ejection fraction in Japanese patients: A report from the Japanese multicenter registry.

  Atsushi Tada, Toshiyuki Nagai, Kazunori Omote, Hiroyuki Iwano, Shingo Tsujinaga, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Hirokazu Komoriyama, Yuta Kobayashi, Sakae Takenaka, Yoshifumi Mizuguchi, Tomoya Sato, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai

  International journal of cardiology 342 43 - 48 2021/11/01 

  BACKGROUND: Diagnosing heart failure with preserved ejection fraction (HFpEF) is challenging. Although the H2FPEF score and HFA-PEFF algorithm have been proposed for diagnosing HFpEF, previous validation studies were conducted in stable chronic heart failure (HF). Moreover, information on their applicability in the Asian population is limited. We sought to investigate these scores' diagnostic performance for HFpEF in Japanese patients recently hospitalized due to acute decompensated HF. METHODS: We examined patients with HFpEF recently hospitalized with acute decompensated HF from a nationwide HFpEF-specific multicenter registry (HFpEF group) and control patients who underwent echocardiography to investigate the cause of dyspnea in our hospital (Non-HFpEF group). RESULTS: The studied population included 372 patients (194 HFpEF group and 178 Non-HFpEF group; HFpEF prevalence, 52%). A high H2FPEF score (6-9 points) could diagnose HFpEF with a high specificity of 97% and a positive predictive value (PPV) of 94%, and a low H2FPEF score (0-1 point) could rule out HFpEF with a high sensitivity of 97% and a negative predictive value (NPV) of 93%. HFpEF could be diagnosed with a high HFA-PEFF score (5-6 points) (specificity, 84%; PPV, 82%) or ruled out with a low HFA-PEFF score (0-1 point) (sensitivity, 99%; NPV, 89%). The H2FPEF score was significantly superior to the HFA-PEFF score in diagnostic accuracy (area under the curve: 0.89 vs. 0.82, respectively, p = 0.004). CONCLUSIONS: The H2FPEF and the HFA-PEFF scores had acceptable diagnostic accuracy in diagnosing HFpEF in Japanese patients.
• Hospitalization for heart failure in the USA, UK, Taiwan and Japan: an international comparison of administrative health records on 417,385 individual patients.

  Varun Sundaram, Toshiyuki Nagai, Chern-En Chiang, Yogesh Nv Reddy, Tze-Fan Chao, Rosita Zakeri, Chloe Bloom, Michikazu Nakai, Kunihiro Nishimura, Chung-Lieh Hung, Yoshihiro Miyamoto, Satoshi Yasuda, Amitava Banerjee, Toshihisa Anzai, Daniel I Simon, Sanjay Rajagopalan, John Gf Cleland, Jayakumar Sahadevan, Jennifer K Quint

  Journal of cardiac failure 28 (3) 353 - 366 2021/10/08 

  BACKGROUND: Registries show international variations in the characteristics and outcome of patients with heart failure (HF) but national samples are rarely large, and case-selection may be biased due to enrolment in academic centres. National administrative datasets provide large samples with a low risk of bias. In this study, we compared the characteristics, healthcare resource utilization (HRU) and outcomes of patients with primary HF hospitalizations (HFH) using electronic health records (EHR) from four high-income countries (USA, UK, Taiwan, Japan) on three continents. METHODS AND RESULTS: We used EHR to identify unplanned HFH between 2012-2014. We identified 231,512, 10,991, 36,900 and 133,982 patients with a primary HFH from USA, UK, Taiwan and Japan, respectively. HFH per 100,000 population was highest in USA and lowest in Taiwan. Patients in Taiwan and Japan were older but fewer were obese or had chronic kidney disease. LOHS was shortest in USA (median 4 days) and longer in UK, Taiwan and Japan (medians 7, 9 and 17 days, respectively). HRU during hospitalization was highest in Japan and lowest in UK. Crude and direct standardized in-hospital mortality was lowest in USA (direct standardized rates: 1.8 [95%CI:1.7-1.9]%)and progressively higher in Taiwan (direct standardized rates: 3.9 [95%CI:3.8-4.1]%), UK (direct standardized rates: 6.4 [95%CI:6.1-6.7]%) and Japan (direct standardized rates: 6.7 [95%CI:6.6-6.8]%). 30-day all-cause (25.8%) and HF (7.2%) readmissions were highest in USA and lowest in Japan (11.9% and 5.1% respectively). CONCLUSION: Marked international variations in patient characteristics, HRU and clinical outcome exist; understanding them might inform health care policy and international trial design.
• Sudden death after inappropriate shocks of implantable cardioverter defibrillator in a catecholaminergic polymorphic ventricular tachycardia case with a novel RyR2 mutation.

  Hideki Itoh, Takashi Murayama, Nagomi Kurebayashi, Seiko Ohno, Takuya Kobayashi, Yusuke Fujii, Masaya Watanabe, Haruo Ogawa, Toshihisa Anzai, Minoru Horie

  Journal of electrocardiology 69 111 - 118 2021/10/07 

  BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmogenic syndrome and a cause of exercise-related sudden death. CPVT has been reported to be caused by gain of function underlying a mutation of cardiac ryanodine receptor (RyR2). METHODS: In a family with a CPVT patient, genomic DNA was extracted from peripheral blood lymphocytes, and the RyR2 gene underwent target gene sequence using MiSeq. The activity of wild-type (WT) and mutant RyR2 channel were evaluated by monitoring Ca2+ signals in HEK293 cells expressing WT and mutant RyR2. We investigated a role of a RyR2 mutation in the recent tertiary structure of RyR2. RESULTS: Though a 17-year-old man diagnosed as CPVT had implantable cardioverter defibrillator (ICD) and was going to undergo catheter ablation for the control of paroxysmal atrial fibrillation, he suddenly died at the age of twenty-one because of ventricular fibrillation which was spontaneously developed after maximum inappropriate ICD shocks against rapid atrial fibrillation. The genetic test revealed a de novo RyR2 mutation, Gln4936Lys in mosaicism which was located at the α-helix interface between U-motif and C-terminal domain. In the functional analysis, Ca2+ release from endoplasmic reticulum via the mutant RyR2 significantly increased than that from WT. CONCLUSION: A RyR2 mutation, Gln4936Lys, to be documented in a CPVT patient with exercise-induced ventricular tachycardias causes an excessive Ca2+ release from the sarcoplasmic reticulum which corresponded to clinical phenotypes of CPVT. The reduction of inappropriate shocks of ICD is essential to prevent unexpected sudden death in patients with CPVT.
• Paravalvular leak vanishing at end-diastole during transcatheter aortic valve replacement.

  Yoji Tamaki, Shingo Tsujinaga, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of echocardiography 21 (2) 81 - 82 2021/10/06
• Influence of left ventricular systolic dysfunction on occurrence of pulsus tardus in patients with aortic stenosis.

  Suguru Ishizaka, Hiroyuki Iwano, Ko Motoi, Yasuyuki Chiba, Shingo Tsujinaga, Asuka Tanemura, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of cardiology 78 (4) 322 - 327 2021/10 

  BACKGROUND: Although the time difference between peak of left ventricular (LV) and aortic systolic pressures (TLV-Ao), which is considered to in part reflect pulsus tardus, is reported to be associated with clinical outcome in aortic stenosis (AS), its physiological determinants remain to be elucidated. We hypothesized that not only AS severity but also LV systolic dysfunction could be associated with occurrence of pulsus tardus. METHODS: TLV-Ao was measured by simultaneous LV and aortic pressure tracing in 74 AS patients and prolonged TLV-Ao was defined as ≥66 ms according to the previous report. Mean transaortic valvular pressure gradient (mPG) and effective orifice area index (EOAI) were estimated by Doppler echocardiography and severe AS was defined as EOAI ≤0.60 cm2/m2. Global longitudinal strain (GLS) was measured by using speckle-tracking method. RESULTS: Although a weak correlation was observed between EOAI and TLV-Ao, there was substantial population showing discordance between the parameters: severe AS despite normal TLV-Ao (10 of 47 patients) and moderate AS despite prolonged TLV-Ao (9 of 17 patients). In severe AS, mPG was significantly higher in patients showing prolonged TLV-Ao (57±20 vs 36±10 mmHg, p<0.0001) whereas GLS was comparable between the groups (-15.2±3.5% vs -14.8±3.2%). In contrast, in moderate AS, GLS was significantly smaller in patients showing prolonged TLV-Ao (-12.6±4.7% vs -17.4±3.4%, p=0.0271) while mPG was comparable (34±7 mmHg vs 35±8 mmHg). Multivariable analysis revealed that not only mPG but also GLS was an independent determinant of TLV-Ao. CONCLUSIONS: The occurrence of pulsus tardus could be associated with not only AS severity but also LV systolic dysfunction in AS patients.
• Influence of Left Ventricular Function on the "Aortic Regurgitation Index" Proposed for the Hemodynamic Assessment of Postprocedural Aortic Regurgitation.

  Hideaki Kanzaki, Makoto Amaki, Atsushi Okada, Hiroyuki Takahama, Chisato Izumi, Toshihisa Anzai

  International heart journal 62 (5) 1019 - 1025 2021/09/30 

  The aortic regurgitation (AR) index, proposed as an objective indicator of postprocedural AR, decreases in proportion to AR severity, besides reportedly providing additional prognostic information. Meanwhile, left ventricular (LV) function has also been considered an essential prognostic factor. This study aimed to clarify whether LV function affected the AR index using cardiac catheterization data.A retrospective study was performed in patients whose LV function was evaluated using a micromanometer-tipped catheter. Patients with grade 2 or higher AR were excluded to explore non-AR factors affecting the AR index value. The AR index was calculated as a ratio of the gradient between the aortic diastolic blood pressure (DBP) and the LV end-diastolic pressure (EDP) to the aortic systolic blood pressure (SBP): AR Index = [ (DBP - LVEDP) / SBP] × 100.A total of 64 patients [age, 62 (interquartile range: 48-70) years; LV ejection fraction, 19% (16%-26%) ] were examined. AR index values ranged from 18.3 to 68.6. Despite having no AR, two patients displayed an AR index < 25, indicating significant AR. Multiple-regression analysis revealed that LV diastolic stiffness (β = -0.750, P < 0.001), LV max dP/dt (β = -0.296, P = 0.006), and heart rate (β = 0.284, P = 0.011) were independent determinants of the AR index value.Patients with impaired LV diastolic function and preserved systolic function had low AR index values. The additional prognostic information of the AR index may be related to LV diastolic function.
• Application of the proximal isovelocity surface area method for estimation of the effective orifice area in aortic stenosis.

  Masahiro Nakabachi, Hiroyuki Iwano, Michito Murayama, Hisao Nishino, Shinobu Yokoyama, Shingo Tsujinaga, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Kazunori Okada, Sanae Kaga, Mutsumi Nishida, Takanori Teshima, Toshihisa Anzai

  Heart and vessels 37 (4) 638 - 646 2021/09/25 

  Although the echocardiographic effective orifice area (EOA) calculated using the continuity equation is widely used for the assessment of severity in aortic stenosis (AS), the existence of high flow velocity at the left ventricular outflow tract (LVOT) potentially causes its overestimation. The proximal isovelocity surface area (PISA) method could be an alternative tool for the estimation of EOA that limits the influence of upstream flow velocity. EOA was calculated using the continuity equation (EOACont) and PISA method (EOAPISA), respectively, in 114 patients with at least moderate AS. The geometric orifice area (GOA) was also measured using the planimetry method in 51 patients who also underwent three-dimensional transesophageal echocardiography. Patients were divided into two groups according to the median LVOT flow velocity. EOAPISA could be obtained in 108 of the 114 patients (95%). Although there was a strong correlation between EOACont and EOAPISA (r = 0.78, P < 0.001), EOACont was statistically significantly larger than EOAPISA (0.86 ± 0.33 vs 0.75 ± 0.29 cm2, P < 0.001). Both EOACont and EOAPISA similarly correlated with GOA (r = 0.70, P < 0.001 and r = 0.77, P < 0.001, respectively). However, a fixed bias, which is hydrodynamically supposed to exist between EOA and GOA, was not observed between EOACont and GOA. In contrast, there was a negative fixed bias between EOAPISA and GOA with smaller EOAPISA than GOA. The difference between EOACont and GOA was significantly greater with a larger EOACont relative to GOA in patients with high LVOT flow velocity than in those without (0.16 ± 0.25 vs - 0.07 ± 0.10 cm2, P < 0.001). In contrast, the difference between EOAPISA and GOA was consistent regardless of the LVOT flow velocity (- 0.07 ± 0.12 vs - 0.07 ± 0.15 cm2, P = 0.936). The PISA method was applied to estimate EOA in patients with AS. EOAPISA could be an alternative parameter for AS severity grading in patients with high LVOT flow velocity in whom EOACont would potentially overestimate the orifice area.
• Association of high serum soluble interleukin 2 receptor levels with risk of adverse events in cardiac sarcoidosis.

  Yuta Kobayashi, Takuma Sato, Toshiyuki Nagai, Kenji Hirata, Satonori Tsuneta, Yoshiya Kato, Hirokazu Komoriyama, Kiwamu Kamiya, Takao Konishi, Kazunori Omote, Hiroshi Ohira, Kohsuke Kudo, Satoshi Konno, Toshihisa Anzai

  ESC heart failure 8 (6) 5282 - 5292 2021/09/12 

  AIMS: Although soluble interleukin 2 receptor (sIL-2R) is a potentially useful biomarker in the diagnosis and evaluation of disease severity in patients with sarcoidosis, its prognostic implication in patients with cardiac sarcoidosis (CS) is unclear. We sought to investigate whether sIL-2R was associated with clinical outcomes and to clarify the relationship between sIL-2R levels and disease activity in patients with CS. METHODS AND RESULTS: We examined 83 consecutive patients with CS in our hospital who had available serum sIL-2R data between May 2003 and February 2020. The primary outcome was a composite of advanced atrioventricular block, ventricular tachycardia or ventricular fibrillation, heart failure hospitalization, and all-cause death. Inflammatory activity in the myocardium and lymph nodes was assessed by 18 F-fluorideoxyglucose positron emission tomography/computed tomography. During a median follow-up period of 2.96 (IQR 2.24-4.27) years, the primary outcome occurred in 24 patients (29%). Higher serum sIL-2R levels (>538 U/mL, the median) were significantly related to increased incidence of primary outcome (P = 0.037). Multivariable Cox regression analysis showed that a higher sIL-2R was independently associated with an increased subsequent risk of adverse events (HR 3.71, 95% CI 1.63-8.44, P = 0.002), even after adjustment for significant covariates. sIL-2R levels were significantly correlated to inflammatory activity in lymph nodes (r = 0.346, P = 0.003) but not the myocardium (r = 0.131, P = 0.27). CONCLUSIONS: Increased sIL-2R is associated with worse long-term clinical outcomes accompanied by increased systemic inflammatory activity in CS patients.
• 心臓サルコイドーシス患者における血清可溶性インターロイキン2レセプター高値は長期予後と関連する

  小林 雄太, 永井 利幸, 加藤 喜哉, 小森山 弘和, 神谷 究, 小西 崇夫, 佐藤 琢真, 安斉 俊久

  日本心臓病学会学術集会抄録 (一社)日本心臓病学会 69回 O - 282 2021/09
• 慢性心不全における右室cardiac power outputの意義

  千葉 泰之, 岩野 弘幸, 本居 昂, 石坂 傑, 辻永 真吾, 村山 迪史, 横山 しのぶ, 中鉢 雅大, 西野 久雄, 岡田 一範, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久

  日本心臓病学会学術集会抄録 (一社)日本心臓病学会 69回 O - 029 2021/09
• 器質的心疾患患者における繰り返す心室頻拍後の心臓死規定因子の検討

  小泉 拓也, 鎌田 塁, 夏井 宏征, 門坂 崇秀, 中尾 元基, 甲谷 太郎, 萩原 光, 渡邉 昌也, 横式 尚司, 安斉 俊久

  日本心臓病学会学術集会抄録 (一社)日本心臓病学会 69回 O - 232 2021/09
• Relevance of early-diastolic mitral regurgitation in dilated heart.

  Asuka Tanemura, Michito Murayama, Hiroyuki Iwano, Yasuyuki Chiba, Mutsumi Nishida, Takanori Teshima, Toshihisa Anzai

  Journal of echocardiography 21 (1) 50 - 52 2021/08/30
• 心筋梗塞後偽性仮性左室瘤に収縮性心膜炎の合併が考えられた1例

  甲谷 太郎, 安斉 俊久

  循環器専門医 (一社)日本循環器学会 30 118 - 123 0918-9599 2021/08 

  50歳男性。歩行時のふらつきに対する精査目的で当科へ入院となった。軽胸壁心エコー検査および造影CT、心臓MRI、冠動脈造影検査より発症時期不明の陳旧性心筋梗塞後左室仮性瘤に収縮性心膜炎を合併したと考えられた。本症例は組織癒着・心嚢液貯留によって心タンポナーデ様の血行動態を呈しており、左室瘤破裂も懸念されたため、治療は準緊急で冠動脈バイパス術・左室形成術、心膜切除術が行われた。その結果、術中所見と病理組織所見より確定診断が得られた。
• Long-Term Prognostic Significance of Ventricular Repolarization Dispersion in Patients with Cardiac Sarcoidosis.

  Yuta Kobayashi, Toshiyuki Nagai, Sakae Takenaka, Yoshiya Kato, Hirokazu Komoriyama, Nobutaka Nagano, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Kazunori Omote, Shingo Tsujinaga, Hiroyuki Iwano, Kengo Kusano, Satoshi Yasuda, Hisao Ogawa, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  The American journal of cardiology 152 125 - 131 2021/08/01 

  Cardiac sarcoidosis (CS) is frequently complicated by fatal ventricular arrhythmias. T-peak to T-end interval to QT interval ratio (TpTe/QT) on electrocardiograms (ECG) was proposed as a marker of ventricular repolarization dispersion. Although this ratio could be associated with the incidence of ventricular arrhythmias in cardiovascular diseases, its prognostic implication in patients with CS is unclear. We sought to investigate whether TpTe/QT was associated with long-term clinical outcomes in patients with CS. Ninety consecutive patients with CS in 2 tertiary hospitals who had ECG data before initiation of immunosuppressive therapy between November 1995 and March 2019 were examined. The primary outcome was a composite of advanced atrioventricular block, ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalization, and all-cause death. During a median follow-up period of 4.70 (interquartile range 2.06-7.23) years, the primary outcome occurred in 21 patients (23.3%). Survival analyses revealed that the primary outcome (p < 0.001), especially VT/VF or sudden cardiac death (p = 0.002), occurred more frequently in patients with higher TpTe/QT (≥ 0.242, the median) than in those with lower TpTe/QT. Multivariable Cox regression analysis showed that a higher TpTe/QT was independently associated with increased subsequent risk of adverse events (hazard ratio1.11, 95% confidence interval 1.03-1.20, p = 0.008) even after adjustment for the significant covariates. In conclusion, a higher TpTe/QT was associated with worse long-term clinical outcomes, especially fatal ventricular arrhythmic events, in patients with cardiac sarcoidosis, suggesting the importance of assessing TpTe/QT as a surrogate for risk stratification in these patients.
• Fulminant cardiac and renal sarcoidosis revealed by electron microscope: challenging aspect of diagnosis

  Seiichiro Naito, Shingo Tsujinaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  European Heart Journal - Case Reports 5 (11) ytab298  2021/07/28
• Hybrid epicardial ventricular tachycardia ablation with lateral thoracotomy in a patient with a history of left ventricular reconstruction surgery

  Taro Koya, Masaya Watanabe, Rui Kamada, Hikaru Hagiwara, Motoki Nakao, Takahide Kadosaka, Takuya Koizumi, Toshihisa Anzai

  Journal of Cardiology Cases 25 (1) 37 - 41 1878-5409 2021/07 

  Although a hybrid procedure involving surgical access may be feasible for epicardial catheter ablation in individuals with prior cardiac surgery, surgical approaches in thoracotomy are important in patients with advanced adhesions. We performed an epicardial ventricular tachycardia (VT) ablation in a patient with dilated phase hypertrophic cardiomyopathy after left ventricular reconstruction. We gained surgical epicardial access via lateral thoracotomy based on the anticipated VT circuit in the apical anteroseptal area, which was estimated using prior endocardial mapping. The remaining epicardial myocardium around the surgical incision was involved in the central isthmus, and the VT was eliminated by radiofrequency catheter ablation. .
• Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure.

  Michito Murayama, Hiroyuki Iwano, Hisao Nishino, Shingo Tsujinaga, Masahiro Nakabachi, Shinobu Yokoyama, Miho Aiba, Kazunori Okada, Sanae Kaga, Miwa Sarashina, Yasuyuki Chiba, Suguru Ishizaka, Ko Motoi, Mutsumi Nishida, Hitoshi Shibuya, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 34 (7) 723 - 734 2021/07 

  BACKGROUND: When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure. METHODS: One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) ≥ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography. RESULTS: In the derivation cohort, PAWP was elevated with higher VMT scores (score 0, 10 ± 5; score 1, 12 ± 4; score 2, 22 ± 8; score 3, 28 ± 4 mm Hg; P < .001, analysis of variance). VMT score ≥ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guideline-recommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score ≥ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores ≥ 2 were at higher risk for cardiac events than those with VMT scores ≤ 1 (P < .001). CONCLUSIONS: VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure.
• Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement.

  Hirokazu Komoriyama, Kiwamu Kamiya, Toshiyuki Nagai, Noriko Oyama-Manabe, Satonori Tsuneta, Yuta Kobayashi, Yoshiya Kato, Miwa Sarashina, Kazunori Omote, Takao Konishi, Takuma Sato, Shingo Tsujinaga, Hiroyuki Iwano, Yasushige Shingu, Satoru Wakasa, Toshihisa Anzai

  Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 23 (1) 81 - 81 2021/06/28 

  BACKGROUND: Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR. METHODS: We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR. RESULTS: After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034). CONCLUSIONS: In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
• Takotsubo Syndrome After Transcatheter Mitral Valve Repair.

  Takahide Kadosaka, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (7) 1100 - 1100 2021/06/25
• Applicability of the AHA/ACC/HRS Guideline for Implantable Cardioverter Defibrillator Implantation in Japanese Patients With Cardiac Sarcoidosis.

  Sakae Takenaka, Yuta Kobayashi, Toshiyuki Nagai, Yoshiya Kato, Hirokazu Komoriyama, Nobutaka Nagano, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Kazunori Omote, Yoshifumi Mizuguchi, Atsushi Tada, Tomoya Sato, Hiroyuki Iwano, Kengo Kusano, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  JACC. Clinical electrophysiology 7 (11) 1410 - 1418 2021/06/22 

  OBJECTIVES: This study aimed to assess, among Japanese patients with cardiac sarcoidosis (CS), the implantable cardioverter-defibrillator (ICD) recommendations from the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death (SCD). BACKGROUND: Although ICDs are used to prevent SCD from ventricular tachycardia or ventricular fibrillation (VT/VF) in patients with CS, the generalizability of the AHA/ACC/HRS guidelines for Japanese patients with CS remains unclear. METHODS: This study examined 188 consecutive patients with CS in 2 tertiary hospitals between 1979 and 2020. Patients were followed for a primary outcome of VT/VF or SCD. RESULTS: During a median follow-up of 5.68 years, the primary outcome occurred in 44 patients (23%). Patients with a class I recommendation for ICD implantation showed the highest incidence of the primary outcome among patients in whom the guideline recommendations for ICD implantation were used (log-rank test; p = 0.03). However, compared with patients with left ventricular ejection fractions (LVEFs) ≤35%, there was no significant difference in the incidence of the primary outcome among patients with LVEFs >35% and those who required a permanent pacemaker (p = 0.31); similar results were observed in those with LVEFs >35% and late gadolinium enhancement during cardiovascular magnetic resonance imaging (p = 0.22). CONCLUSIONS: The American guideline recommendations for ICD implantation might be applicable to Japanese patients with CS. Implantation of an ICD may need to be considered in these patients if they require a permanent pacemaker or have late gadolinium enhancement, regardless of LVEF.
• Improved Mitochondria! Function by Luseogliflozin Prevents Pancreatic Beta-Cell Damage

  Yuki Yamauchi, Akinobu Nakamura, Takashi Yokota, Kiyohiko Takahashi, Shinichiro Kawata, Kazuhisa Tsuchida, Kazuno Omori, Hiroshi Nomoto, Hiraku Kameda, Kyuyong Cho, Toshihisa Anzai, Shinya Tanaka, Yasuo Terauchi, Hideaki Miyoshi, Tatsuya Atsumi

  DIABETES 70 0012-1797 2021/06
• Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias.

  Yoshifumi Mizuguchi, Takao Konishi, Toshiyuki Nagai, Tomoya Sato, Sakae Takenaka, Atsushi Tada, Yuta Kobayashi, Hirokazu Komoriyama, Yoshiya Kato, Kazunori Omote, Takuma Sato, Kiwamu Kamiya, Shingo Tsujinaga, Hiroyuki Iwano, Kenjiro Kikuchi, Shinya Tanaka, Toshihisa Anzai

  The American journal of emergency medicine 44 100 - 105 2021/06 

  OBJECTIVES: Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients. METHODS: We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death. RESULTS: Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p < 0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p = 0.005) or extracorporeal membrane oxygenation (p < 0.001), tracheal intubation (p < 0.001) and persistent vegetative state (p = 0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level. CONCLUSIONS: In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.
• Anemia has an impact on prognosis in heart failure with preserved ejection fraction with mild chronic kidney disease.

  Keisuke Okuno, Yoshiro Naito, Masanori Asakura, Masataka Sugahara, Tetsuo Horimatsu, Seiki Yasumura, Saki Tahara, Toshiyuki Nagai, Yoshihiko Saito, Tsutomu Yoshikawa, Tohru Masuyama, Masaharu Ishihara, Toshihisa Anzai

  International journal of cardiology. Heart & vasculature 34 100796 - 100796 2021/06 

  Background: Anemia and chronic kidney disease (CKD) are common in patients with heart failure with preserved left ventricular fraction (HFpEF). However, it is entirely unknown about the impact of anemia on prognosis in HFpEF patients with CKD. In this study, we investigated the impact of anemia on prognosis and the optimal hemoglobin (Hb) levels to predict prognosis in HFpEF patients with CKD. Methods and Results: We prospectively examined 523 consecutive HFpEF patients enrolled in Japanese heart failure syndrome with preserved ejection fraction registry. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL /min/1.73 m2. The prevalence rate of anemia was 78% in HFpEF patients with CKD by using the World Health Organization criteria. Kaplan-Meier analysis for all-cause mortality and heart failure rehospitalization demonstrated that anemic patients had poor prognosis compared with non-anemic patients in HFpEF patients with CKD, but not those without CKD. According to the degree of CKD, anemia affected prognosis in HFpEF patients with mild CKD (45 ≤ eGFR < 60), but not those with moderate to severe CKD (15 ≤ eGFR < 45). Additionally, multivariate analysis revealed that anemia and Hb levels were independent predictors of composite outcomes in HFpEF patients with mild CKD, but not those with moderate to severe CKD. Finally, survival classification and regression tree analysis showed that the optimal Hb levels to predict composite outcomes were 10.7 g/dL in those with mild CKD. Conclusions: Anemia has an impact on prognosis in HFpEF patients, especially among those with mild CKD.
• 4-Dimensional Flow Cardiovascular Magnetic Resonance Imaging of Changes in Blood Flow Dynamics After Surgery for Discrete Subaortic Stenosis.

  Hirokazu Komoriyama, Kiwamu Kamiya, Yuta Kobayashi, Satonori Tsuneta, Takao Konishi, Takuma Sato, Hiroyuki Iwano, Toshiyuki Nagai, Satoru Wakasa, Kohsuke Kudo, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (6) 954 - 954 2021/05/25
• Intramural Tissueの二つの遅延伝導領域を交互に伝播することで維持されるリエントリーを機序とする交代性QRS波形を呈するVTを認めた非虚血性心筋症の1例

  鎌田 塁, 渡邉 昌也, 天満 太郎, 萩原 光, 甲谷 太郎, 中尾 元基, 安斉 俊久, 横式 尚司, 四倉 昭彦, 南部 忠詞, 吉田 泉, 櫻井 正之

  臨床心臓電気生理 臨床心臓電気生理研究会 44 183 - 191 0285-1652 2021/05 

  症例は50代男性。非虚血性心筋症による心室頻拍(VT)に対し心内膜より心筋焼灼術を施行。二つの波形を交互に繰り返すVTが頻発した。心臓MRIでは左室基部側壁と中隔の深部のみに遅延造影を認め、心内膜電位マッピングでも電位波高は保たれていた。基部側壁では右心室からのペーシング中にlate potential(LP)を認め、VT中は各々の波形で連結期が異なる拡張期電位(dp)を認め、連続するdp間隔が各々の波形のRR間隔を規定していた。収縮電位に対する早期性マッピングでは波形aは比較的広範囲に早期性を認めた。波形bでは限局的であった。dpを認める領域への焼灼中にVTは停止し、その後一定の連結期を有する波形aの心室期外収縮(PVC)が出現し、さらなる焼灼によりPVCは消失した。しかしながら半年後に波形aに類似したVT、PVCの再発を認め、心外膜アプローチを含めた再治療を行った。dp、収縮期電位は心外膜で先行し、両側からの焼灼で治療し得た。Intramural tissueに二つの遅延伝導領域が存在する回路が想定された。(著者抄録)
• Epsilon wave disappearance by catheter ablation for ventricular arrhythmia from the left ventricular outflow tract.

  Hikaru Hagiwara, Masaya Watanabe, Rui Kamada, Taro Koya, Motoki Nakao, Toshihisa Anzai

  HeartRhythm case reports 7 (5) 343 - 346 2021/05
• Risk Stratification Towards Precision Medicine in Heart Failure - Current Progress and Future Perspectives.

  Toshiyuki Nagai, Motoki Nakao, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (5) 576 - 583 2021/04/23 

  Clinical risk stratification is a key strategy used to identify low- and high-risk subjects to optimize the management, ranging from pharmacological treatment to palliative care, of patients with heart failure (HF). Using statistical modeling techniques, many HF risk prediction models that combine predictors to assess the risk of specific endpoints, including death or worsening HF, have been developed. However, most risk prediction models have not been well-integrated into the clinical setting because of their inadequacy and diverse predictive performance. To improve the performance of such models, several factors, including optimal sampling and biomarkers, need to be considered when deriving the models; however, given the large heterogeneity of HF, the currently advocated one-size-fits-all approach is not appropriate for every patient. Recent advances in techniques to analyze biological "omics" information could allow for the development of a personalized medicine platform, and there is growing awareness that an integrated approach based on the concept of system biology may be an excessively naïve view of the multiple contributors and complexity of an individual's HF phenotype. This review article describes the progress in risk stratification strategies and perspectives of emerging precision medicine in the field of HF management.
• JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases.

  Toshihisa Anzai, Takuma Sato, Yoshihiro Fukumoto, Chisato Izumi, Yoshiyuki Kizawa, Masatoshi Koga, Katsuji Nishimura, Mitsuru Ohishi, Akihiro Sakashita, Yasushi Sakata, Tsuyoshi Shiga, Yasuchika Takeishi, Satoshi Yasuda, Kazuhiro Yamamoto, Takahiro Abe, Rie Akaho, Yasuhiro Hamatani, Hayato Hosoda, Naoki Ishimori, Mika Kato, Yoshiharu Kinugasa, Takuro Kubozono, Toshiyuki Nagai, Shogo Oishi, Katsuki Okada, Tatsuhiro Shibata, Atsushi Suzuki, Tsuyoshi Suzuki, Masahito Takagi, Yasuko Takada, Kenkichi Tsuruga, Akiomi Yoshihisa, Dai Yumino, Keiichi Fukuda, Yasuki Kihara, Yoshihiko Saito, Yoshiki Sawa, Hiroyuki Tsutsui, Takeshi Kimura

  Circulation journal : official journal of the Japanese Circulation Society 85 (5) 695 - 757 2021/04/23
• Announcement of the 2021 JCS Meeting Activities (2).

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (5) 573 - 575 2021/04/23
• Association of Low Body Weight with Clinical Outcomes in Elderly Atrial Fibrillation Patients Receiving Apixaban-J-ELD AF Registry Subanalysis.

  Takahide Kadosaka, Toshiyuki Nagai, Shinya Suzuki, Ichiro Sakuma, Masaharu Akao, Takeshi Yamashita, Toshihisa Anzai, Ken Okumura

  Cardiovascular drugs and therapy 36 (4) 691 - 703 2021/04/08 

  PURPOSE: Although direct oral anticoagulants are effective and safe in preventing stroke in atrial fibrillation (AF) patients with low body weight, data remain limited in AF patients with extremely low body weight (<50 kg). We aimed to investigate the association of this body weight category with clinical outcomes in elderly AF patients receiving apixaban. METHODS: The J-ELD AF Registry is a large-scale, multicenter prospective observational study of Japanese non-valvular AF patients aged ≥ 75 years taking on-label doses of apixaban. The entire cohort (3025 patients from 110 institutions) was divided into three body weight subgroups: >60 kg (n = 1019, 33.7%), 50-60 kg (n = 1126, 37.2%), and <50 kg (n = 880, 29.1%). RESULTS: The event incidence rates (/100 person years) were 1.69, 1.82, and 1.23 for stroke or systemic embolism (P = 0.60); 1.37, 1.73, and 2.73 for bleeding requiring hospitalization (P = 0.154); 2.02, 2.67, and 4.92 for total death (P = 0.003); and 0.73, 0.95, and 1.23 for cardiovascular death (P = 0.57), respectively. After adjusting for confounders by Cox regression analysis, body weight <50 kg was not an independent risk for stroke or systemic embolism, bleeding requiring hospitalization, total death, or cardiovascular death. CONCLUSIONS: The incidence of events in each body weight group was comparable for stroke or systemic embolism and bleeding requiring hospitalization, and body weight <50 kg might not be an independent risk for death in Japanese non-valvular AF patients aged ≥ 75 years taking on-label doses of apixaban.
• 拡張機能学再考:beyond E/E' 時相解析に基づく新たな左室充満圧推定指標 僧帽弁輪石灰化例、心房細動例への適用

  岩野 弘幸, 村山 迪史, 辻永 真吾, 千葉 泰之, 石坂 傑, 本居 昂, 中鉢 雅大, 加賀 早苗, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 48 (Suppl.) S205 - S205 1346-1176 2021/04
• SK channel blockade prevents hypoxia-induced ventricular arrhythmias through inhibition of Ca2+/voltage uncoupling in hypertrophied hearts.

  Masayuki Takahashi, Hisashi Yokoshiki, Hirofumi Mitsuyama, Masaya Watanabe, Taro Temma, Rui Kamada, Hikaru Hagiwara, Yumi Takahashi, Toshihisa Anzai

  American journal of physiology. Heart and circulatory physiology 320 (4) H1456-H1469  2021/04/01 

  Ventricular arrhythmia (VA) is the major cause of death in patients with left ventricular (LV) hypertrophy and/or acute ischemia. We hypothesized that apamin, a blocker of small-conductance Ca2+-activated K+ (SK) channels, alters Ca2+ handling and exhibits anti-arrhythmic effects in ventricular myocardium. Spontaneous hypertensive rats were used as a model of LV hypertrophy. A dual optical mapping of membrane potential (Vm) and intracellular calcium (Cai) was performed during global hypoxia (GH) on the Langendorff perfusion system. The majority of pacing-induced VAs during GH were initiated by triggered activities. Pretreatment of apamin (100 nmol/L) significantly inhibited the VA inducibility. Compared with SK channel blockers (apamin and NS8593), non-SK channel blockers (glibenclamide and 4-AP) did not exhibit anti-arrhythmic effects. Apamin prevented not only action potential duration (APD80) shortening (-18.7 [95% confidence interval, -35.2 to -6.05] ms vs. -2.75 [95% CI, -10.45 to 12.65] ms, P = 0.04) but also calcium transient duration (CaTD80) prolongation (14.52 [95% CI, 8.8-20.35] ms vs. 3.85 [95% CI, -3.3 to 12.1] ms, P < 0.01), thereby reducing CaTD80 - APD80, which denotes "Cai/Vm uncoupling" (33.22 [95% CI, 22-48.4] ms vs. 6.6 [95% CI, 0-14.85] ms, P < 0.01). The reduction of Cai/Vm uncoupling was attributable to less prolonged Ca2+ decay constant and suppression of diastolic Cai increase by apamin. The inhibition of VA inducibility and changes in APs/CaTs parameters caused by apamin was negated by the addition of ouabain, an inhibitor of Na+/K+ pump. Apamin attenuates APD shortening, Ca2+ handling abnormalities, and Cai/Vm uncoupling, leading to inhibition of VA occurrence in hypoxic hypertrophied hearts.NEW & NOTEWORTHY We demonstrated that hypoxia-induced ventricular arrhythmias were mainly initiated by Ca2+-loaded triggered activities in hypertrophied hearts. The blockades of small-conductance Ca2+-activated K+ channels, especially "apamin," showed anti-arrhythmic effects by alleviation of not only action potential duration shortening but also Ca2+ handling abnormalities, most notably the "Ca2+/voltage uncoupling."
• Rapid Publication and Announcement of the 2021 JCS Meeting Activities.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (4) 331 - 332 2021/03/25
• 循環器疾患患者のこころの問題にどう向き合うか?(緩和ケアも含めて) 当院における心不全緩和ケアチームの立ち上げと現状

  阿部 隆宏, 佐藤 琢真, 加藤 美香, 笠谷 美鈴, 成田 尚, 福澤 宏之, 片山 真育, 池田 陽子, 小島 尚子, 杉本 由佳, 永井 利幸, 安斉 俊久

  日本循環器学会学術集会抄録集 (一社)日本循環器学会 85回 CS5 - 3 2021/03
• Circulation Journal Awards for the Year 2020.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (3) 225 - 234 2021/02/25
• Takotsubo syndrome in association with acute myocardial infarction: diagnostic caveats and clinical implications. Authors' reply.

  Takao Konishi, Naohiro Funayama, Tadashi Yamamoto, Daisuke Hotta, Shinya Tanaka, Toshihisa Anzai

  Kardiologia polska 79 (1) 96 - 96 2021/01/25
• Editorial Statistics and Best Reviewers Award for 2020.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (2) 127 - 129 2021/01/25
• Current practice and effects of intravenous anticoagulant therapy in hospitalized acute heart failure patients with sinus rhythm.

  Hiroki Nakano, Yasuhiro Hamatani, Toshiyuki Nagai, Michikazu Nakai, Kunihiro Nishimura, Yoko Sumita, Hisao Ogawa, Toshihisa Anzai

  Scientific reports 11 (1) 1202 - 1202 2021/01/13 

  Although the risk of thromboembolism is increased in heart failure (HF) patients irrespective of atrial fibrillation (AF), especially during the acute decompensated phase, the effects of intravenous anticoagulants for these patients remain unclear. We sought to investigate the current practice and effects of intravenous anticoagulant therapy in acute HF (AHF) patients with sinus rhythm. We analyzed a nationwide prospective cohort from April 2012 to March 2016. We extracted 309,015 AHF adult patients. After application of the exclusion criteria, we divided the 92,573 study population into non-heparin [n = 70,621 (76.3%)] and heparin [n = 21,952 (23.7%)] groups according to the use of intravenous heparin for the first 2 consecutive days after admission. Multivariable logistic regression analyses demonstrated that heparin administration was not associated with in-hospital mortality (OR 0.97, 95% CI 0.91-1.03) and intracranial hemorrhage (OR 1.18, 95% CI 0.78-1.77), while heparin administration was significantly associated with increased incidence of ischemic stroke (OR 1.49, 95% CI 1.29-1.72) and venous thromboembolism (OR 1.62, 95% CI 1.14-2.30). In conclusion, intravenous heparin administration was not associated with favorable in-hospital outcomes in AHF patients with sinus rhythm. Routine additive use of intravenous heparin to initial treatment might not be recommended in AHF patients.
• High-Density Lipoprotein Cholesterol and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Statins: An Observation from the REAL-CAD Study.

  Kazunori Omote, Isao Yokota, Toshiyuki Nagai, Ichiro Sakuma, Yoshihisa Nakagawa, Kiwamu Kamiya, Hiroshi Iwata, Katsumi Miyauchi, Yukio Ozaki, Kiyoshi Hibi, Takafumi Hiro, Yoshihiro Fukumoto, Hiroyoshi Mori, Seiji Hokimoto, Yasuo Ohashi, Hiroshi Ohtsu, Hisao Ogawa, Hiroyuki Daida, Satoshi Iimuro, Hiroaki Shimokawa, Yasushi Saito, Takeshi Kimura, Masunori Matsuzaki, Ryozo Nagai, Toshihisa Anzai

  Journal of atherosclerosis and thrombosis 29 (1) 50 - 68 2021/01/09 

  AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients. METHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively. RESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months. CONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.
• CORRIGENDUM: Announcement of the 2021 JCS Meeting Activities (2).

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 86 (1) 171 - 171 2021
• 右房圧の推定に用いられる超音波指標の精度比較

  小野田 愛梨, 村山 迪史, 加賀 早苗, 岡田 一範, 相庭 美穂, 藤澤 亮介, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 西田 睦, 岩野 弘幸, 安斉 俊久

  超音波検査技術抄録集 一般社団法人 日本超音波検査学会 46 S197 - S197 2021
• Influence of advanced pulmonary vascular remodeling on accuracy of echocardiographic parameters of left ventricular filling pressure

  Yasuyuki Chiba, Hiroyuki Iwano, Sanae Kaga, Mio Shinkawa, Michito Murayama, Hiroshi Ohira, Suguru Ishizaka, Miwa Sarashina, Shingo Tsujinaga, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Kazunori Okada, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Pulmonary Circulation 11 (1) 204589402098372 - 204589402098372 2045-8940 2021/01 

  Evaluation of left ventricular filling pressure plays an important role in the clinical management of pulmonary hypertension. However, the accuracy of echocardiographic parameters for the determination of left ventricular filling pressure in the presence of pulmonary vascular lesions has not been fully addressed. We retrospectively investigated 124 patients with pulmonary hypertension due to pulmonary vascular lesions (noncardiac pulmonary hypertension group) and 113 patients with ischemic heart disease (control group) who underwent right heart catheterization and echocardiography. The noncardiac pulmonary hypertension group was subdivided into less-advanced and advanced groups according to median pulmonary vascular resistance. Pulmonary artery wedge pressure was determined as left ventricular filling pressure. As echocardiographic parameters of left ventricular filling pressure, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e′), and left atrial volume index were measured. In the less-advanced noncardiac pulmonary hypertension and control groups, positive correlations were observed between pulmonary artery wedge pressure and late-diastolic transmitral flow velocity ( R = 0.41, P = 0.002 and R = 0.71, P < 0.001, respectively) and left atrial volume index ( R = 0.53, P < 0.001 and R = 0.41, P < 0.001), whereas in the advanced noncardiac pulmonary hypertension group, pulmonary artery wedge pressure was only correlated with left atrial volume index ( R = 0.27, P = 0.032). In the controls, only pulmonary artery wedge pressure determined E (β = 0.48, P < 0.001), whereas both pulmonary artery wedge pressure and pulmonary vascular resistance were independent determinants of E (β = 0.29, P < 0.001 and β = –0.28, P = 0.001, respectively) in the noncardiac pulmonary hypertension group. In conclusion, in the presence of advanced pulmonary vascular lesions, conventional echocardiographic parameters may not accurately reflect left ventricular filling pressure. Elevated pulmonary vascular resistance would lower the E, even when pulmonary artery wedge pressure is elevated, resulting in blunting of echocardiographic parameters for the detection of elevated left ventricular filling pressure.
• Acute Myocardial Infarction of the Left Main Coronary Artery Presenting with Cardiogenic Shock and Pulmonary Edema during Noncardiac Surgery.

  Sakae Takenaka, Takao Konishi, Tomoya Sato, Atsushi Tada, Takuya Koizumi, Yoshifumi Mizuguchi, Takahide Kadosaka, Ko Motoi, Yuta Kobayashi, Hirokazu Komoriyama, Yoshiya Kato, Miwa Sarashina, Kazunori Omote, Shingo Tsujinaga, Takuma Sato, Rui Kamada, Kiwamu Kamiya, Hiroyuki Iwano, Toshiyuki Nagai, Tatsuya Orimo, Hirofumi Kamachi, Akinobu Taketomi, Toshihisa Anzai

  Case reports in cardiology 2021 5460816 - 5460816 2021 

  Acute myocardial infarction (AMI) caused by severe stenosis of left main coronary artery (LMCA) presenting with cardiogenic shock and pulmonary edema during noncardiac surgery is uncommon, but a catastrophic event. A 77-year-old male with cholangiocarcinoma underwent hepatectomy. During the surgery, he presented with cardiogenic shock, which did not respond to infusion administration or vasopressor. A transesophageal echocardiogram revealed anterior, septal, and lateral severe hypokinesia and impaired left ventricular function. Emergent coronary angiogram showed severe stenosis of LMCA. The patient underwent primary percutaneous coronary intervention (PCI) under the support of intra-aortic balloon pump, followed by extracorporeal membrane oxygenation. The chest roentgenogram showed pulmonary edema. Two days after PCI, he successfully underwent hepatectomy and bile duct resection. Early identification of the cause of hemodynamic instability during noncardiac surgery and invasive strategy are important for minimizing the myocardial injury and improving clinical outcomes in AMI of LMCA.
• The effectiveness of drug-coated balloons for two dissimilar calcific lesions assessed by near-infrared spectroscopy intravascular ultrasound and optical coherence tomography.

  Takao Konishi, Kohei Saiin, Youji Tamaki, Hiroyuki Natsui, Tomoya Sato, Sakae Takenaka, Atsushi Tada, Yoshifumi Mizuguchi, Yuta Kobayashi, Hirokazu Komoriyama, Yoshiya Kato, Takuma Sato, Rui Kamada, Kiwamu Kamiya, Toshiyuki Nagai, Shinya Tanaka, Toshihisa Anzai

  Cardiology journal 28 (5) 794 - 795 2021
• Presence and relevance of mid-systolic notching on right ventricular outflow tract flow velocity envelopes in pulmonary hypertension due to heart failure.

  Yasuyuki Chiba, Hiroyuki Iwano, Michito Murayama, Sanae Kaga, Ko Motoi, Suguru Ishizaka, Shingo Tsujinaga, Asuka Tanemura, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Kazunori Okada, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 34 (6) 690 - 692 2020/12/28
• Message From the Editor-in-Chief.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 85 (1) 1 - 1 2020/12/25
• Lower left ventricular ejection fraction and higher serum angiotensin-converting enzyme activity are associated with histopathological diagnosis by endomyocardial biopsy in patients with cardiac sarcoidosis.

  Hirokazu Komoriyama, Kazunori Omote, Toshiyuki Nagai, Yoshiya Kato, Nobutaka Nagano, Kazuhiro Koyanagawa, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Yuta Kobayashi, Shingo Tsujinaga, Hiroyuki Iwano, Kengo Kusano, Satoshi Yasuda, Hisao Ogawa, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  International journal of cardiology 321 113 - 117 2020/12/15 [Refereed][Not invited]
   

  BACKGROUND: The histopathological diagnosis of cardiac sarcoidosis (CS) is challenging because of sampling error in endomyocardial biopsy (EMB) and the determinants of positive EMB are unclear. Reduced left ventricular ejection fraction (LVEF) is a simple parameter of the extent of myocardial damage, and higher serum angiotensin-converting enzyme (ACE) activity would indicate the spread of disease activity in CS patients. Thus, we sought to examine whether these parameters are related to the histopathological diagnosis of CS by EMB. METHODS: A total of 94 consecutive clinically diagnosed CS patients between August 1986 and March 2019 who were admitted to two academic hospitals were examined. We determined EMB as positive if non-caseating epithelioid granulomas were confirmed in the myocardial tissue. Patients were divided into two groups according to positive (n = 37) and negative (n = 57) EMB. We assessed the relationship between LVEF, serum ACE activity and positive EMB. RESULTS: Multivariable analysis revealed that both LVEF and serum ACE were independently associated with positive EMB (OR 0.83, 95% CI 0.70-0.99; OR 1.39, 95% CI 1.02-1.90, respectively). Moreover, patients with both lower LVEF (<37%, median) and higher ACE activity (≥13.5 IU/L, median) had the highest frequency of positive EMB (p = .003). The combination of lower LVEF and higher serum ACE showed better specificity (91.2%) and positive predictive value (73.7%) than either LVEF or serum ACE alone for positive EMB. CONCLUSIONS: Lower LVEF and higher serum ACE activity were associated with positive EMB, suggesting that these parameters might be useful for predicting positive EMB in CS patients.
• A propensity score matching analysis for cardio metabolic risk of antipsychotics in patients with schizophrenia using Japanese claims data.

  Ichiro Kusumi, Sachie Inoue, Kenji Baba, Tadashi Nosaka, Toshihisa Anzai

  BMC psychiatry 20 (1) 584 - 584 2020/12/09 

  BACKGROUND: The aim of this study was to evaluate the cardio-metabolic risk in schizophrenia patients treated by atypical antipsychotic drugs compared with that in those treated without atypical antipsychotic drugs using a nationwide insurance claims database and medical examination database in Japan. METHODS: Eligible patients were defined as those meeting the following two criteria: (i) A diagnosis of schizophrenia (ICD-10 code: F20) was made between 1 January 2005 and 31 December 2017, with data available for at least 6 months before the diagnosis was made (index month), and (ii) health check-up data were available within ±3 months of the index month. The primary endpoint was changes in cardio-metabolic risk based on the Suita score at 1 year, and the secondary endpoints were changes in medical examination data related to cardio-metabolic risk (total cholesterol [TC], triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, body mass index [BMI], and hemoglobin A1c) at 1 year. The primary endpoint was evaluated by multivariate analysis, with the cumulative chlorpromazine equivalent amount and the baseline Suita score added as covariates. RESULTS: One-hundred eighty five pairs of propensity score (PS)-matched patients were evaluated. Patients receiving atypical antipsychotic drugs exhibited a greater change in the Suita score and a risk of coronary heart disease based on the Suita score of 0.530 and 0.098%, respectively, than patients not receiving atypical antipsychotic drugs, but there was no significant difference (p = 0.412 and 0.610). The significant changes in TC and BMI were determined as 6.525 mg/dL and 0.380 kg/m2 greater, respectively, in patients treated with atypical antipsychotic drugs (p = 0.037 and 0.011). CONCLUSIONS: There were no significant increases in changes in the Suita score at 1 year by treatment with atypical antipsychotic drugs compared with treatment without atypical antipsychotic drugs. However, the TC and BMI were significantly higher in patients treated with atypical antipsychotic drugs.
• Refractory Ventricular Tachycardia in a Patient With a Left Ventricular Assist Device Successfully Treated With Stellate Ganglion Phototherapy.

  Tomoya Sato, Rui Kamada, Takuya Koizumi, Sakae Takenaka, Atsushi Tada, Shingo Tsujinaga, Takao Konishi, Takuma Sato, Masaya Watanabe, Toshiyuki Nagai, Toshihisa Anzai

  The Canadian journal of cardiology 36 (12) 1977.e1-1977.e3  2020/12 [Refereed][Not invited]
   

  Neuraxial modulation therapies, such as stellate ganglion block, thoracic epidural anaesthesia, and cardiac sympathetic denervation, are effective for ventricular arrhythmias. However, these treatments can increase the risk of bleeding and infection. In this case report, stellate ganglion phototherapy was safely and effectively performed for refractory ventricular tachycardias in a patient with a history of left ventricular assist device implantation. Stellate ganglion phototherapy may have the potential to treat refractory ventricular arrhythmias as an additive therapy or bridge therapy.
• Study protocol for prospect trial to elucidate the utility of echocardiography-based cardiac output in acute heart failure (PREDICT).

  Hiroyuki Iwano, Kentaro Shibayama, Takeshi Kitai, Kenya Kusunose, Tetsuari Onishi, Hidekazu Tanaka, Toshihisa Anzai

  Journal of echocardiography 18 (4) 235 - 239 2020/12 [Refereed][Not invited]
   

  BACKGROUND: Early worsening heart failure (WHF), defined as worsening of symptoms and signs of heart failure requiring intensification of medical or mechanical therapy during an admission for acute decompensated heart failure (ADHF), has recently been recognized as a risk of morbidity or mortality after the discharge. Although echocardiographic parameters of left ventricular (LV) output has been shown to be associated with long-term outcome in heart failure patients, its predictive value for early WHF has not been elucidated. METHODS: Prospect trial to Elucidate the utility of EchocarDiography-based Cardiac output in acute heart failure (PREDICT) is a multicenter, nonrandomized, prospective observational study to test the predictive value of echocardiographic LV output parameters for early WHF in ADHF patients. We will enroll patients admitted to 16 participating hospitals due to ADHF who did not receive positive inotropic agents as an initial therapy. Primary outcome will be set at early WHF defined as need for initiation of positive inotropic agents within 7 days after the admission. Predictive accuracy will be compared between Doppler echocardiographic LV output (stroke distance, stroke volume index, and cardiac index) and low perfusion findings assessed by physical examination. RESULTS: N/A. CONCLUSIONS: The PREDICT is expected to provide large data set to test the predictive value of echocardiographic LV output for early WHF in ADHF patients.
• Activation of invariant natural killer T cells by alpha-galactosylceramide ameliorates doxorubicin-induced cardiotoxicity in mice.

  Yoshikuni Obata, Naoki Ishimori, Akimichi Saito, Shintaro Kinugawa, Takashi Yokota, Shingo Takada, Ippei Nakano, Naoya Kakutani, Katsuma Yamanashi, Toshihisa Anzai

  European journal of preventive cardiology 27 (19) 2358 - 2361 2020/12 [Refereed][Not invited]
  
• 18F-FDG uptake of the right ventricle is an important predictor of histopathologic diagnosis by endomyocardial biopsy in patients with cardiac sarcoidosis.

  Kazunori Omote, Masanao Naya, Kazuhiro Koyanagawa, Tadao Aikawa, Osamu Manabe, Toshiyuki Nagai, Kiwamu Kamiya, Yoshiya Kato, Hirokazu Komoriyama, Masato Kuzume, Nagara Tamaki, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 27 (6) 2135 - 2143 1071-3581 2020/12 [Refereed][Not invited]
   

  BACKGROUND: The aim of this study was to determine whether right ventricle (RV) 18F-fluorodeoxyglucose (FDG) uptake can predict positive findings of endomyocardial biopsy (EMB) in patients with cardiac sarcoidosis (CS). METHODS: 70 consecutive patients with clinically diagnosed CS who had undergone FDG PET were registered in the present study. Patients without EMB (n = 42) were excluded. Ultimately, 28 patients were studied. EMB samples were obtained from the RV septum. We evaluated the FDG uptake on six segments (RV, left ventricle anterior, septal, lateral, inferior, and apex). RESULTS: Positive EMB was found in six patients (21%). Patients were divided into two groups according to positive (n = 12 [43%]) or negative (n = 16 [57%]) RV FDG uptake. Patients with positive RV FDG uptake had a significantly higher frequency of positive EMB than those without (42% vs. 6%, P = 0.024). On the other hand, there was no EMB-predictive value for the FDG uptakes in the other five segments, the cardiac metabolic volume, total lesion glycolysis, left ventricular ejection fraction, or any electrocardiogram findings. CONCLUSIONS: FDG uptake of the RV but no other heart segment was associated with positive EMB in CS patients. The presence of RV FDG uptake could improve the rate of positive EMB up to 42% in patients with CS.
• Higher Pulmonary Arterial Pressure Was Related to Non-Pulmonary Vein Atrial Tachyarrhythmia.

  Wei-Chieh Lee, Masaya Watanabe, Hisashi Yokoshiki, Taro Temma, Rui Kamada, Hikaru Hagiwara, Yumi Takahashi, Taro Koya, Motoki Nakao, Toshihisa Anzai

  International heart journal 61 (6) 1150 - 1156 2020/11/28 

  Recurrence of atrial tachyarrhythmias (ATA) following catheter ablation for atrial fibrillation (AF) is often associated with the recovery of conduction into previously isolated pulmonary veins (PVs). Little evidence concerning repeat PV isolation (PVI) and non-PV ATA ablation has been reported. This study aimed to explore the clinical outcome of recurrent ATA ablation after PVI and the difference between patients with and without non-PV ATA.A total of 49 patients without structural heart diseases who received catheter ablation for recurrent AF between January 2014 and December 2018 were recruited (prior ablation with PVI only 71.4% and PVI with cavotricuspid isthmus line ablation 28.6%). Patients were divided into two groups according to the presence or absence of non-PV ATA.Most patients (53.1%) experienced very late recurrence with a median duration of 15 months. A total of 15 patients had non-PV ATA and received non-PV ATA ablation whereas 34 patients received only repeat PVI for reconnected PVs. A higher pulmonary arterial systolic pressure (PASP) was associated with non-PV ATA (odds ratio: 1.161; 95% confidence interval: 1.021-1.321; P = 0.023). During 4.7 ± 1 months, 4/15 (26.7%) and 1/34 (2.9%) patients with and without non-PV ATA, respectively, had ATA recurrence (P = 0.011). The cumulative incidence of ATA recurrence after repeat ablation was significantly lower in patients without non-PV ATA (P = 0.013).In our study, a high PASP was associated with non-PV ATA in patients with recurrent AF. Repeat PVI had a high rate of maintenance of sinus rhythm in patients without non-PV ATA.
• Message From the Editor-in-Chief.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 84 (12) 2127 - 2128 2020/11/25
• Burden of Heart Failure on Patient Daily Life and Patient-Physician Discordance in Disease Management - Results From a Cross-Sectional Survey in Japan.

  Tomoko Hayashi, Yohei Morita, Hironobu Mitani, Hiroki Murayama, Toshihisa Anzai, Rachel Studer, Sarah Cotton, James Jackson, Hollie Bailey, Hiroshi Kitagawa, Naotsugu Oyama

  Circulation reports 2 (12) 722 - 729 2020/11/17 

  Background: We investigated the impact of heart failure (HF) on daily life and satisfaction with current HF medication from the patient perspective in a real-world study in Japan. Methods and Results: A cross-sectional survey of 154 HF patients treated by 58 cardiologists was conducted in Japan using patient self-completed questionnaires about their daily life and satisfaction with HF medication, as well as patient record forms completed by their physicians capturing corresponding data. The mean age of patients was 72.7 years. The proportion of patients within New York Heart Association Class I, II, III, and IV was 39%, 44%, 16%, and 1%, respectively. Symptoms reported by patients included dyspnea when active (46%), nocturia (43%), anxiety (18%), and depression (6%). There was a discordance between physician- and patient-reported symptoms, especially for nocturia and inability to sleep. The most frequent lifestyle recommendation from physicians was 'reduce salt/sodium intake', but only 51% of patients receiving this recommendation followed the advice. In all, 44% of patients reported dissatisfaction with their current medication; according to the patients, 27% reported no discussion with their physicians about their prescribed medication, while physicians reported the opposite. Conclusions: HF negatively impacts patient daily life. There is discordance between patients and physicians in symptom reporting, lifestyle modification advice and adherence, and reported medication decision making. Gaps in patient-physician communication exist.
• Independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation severity in heart failure with preserved ejection fraction.

  Tomonari Harada, Masaru Obokata, Kazunori Omote, Hiroyuki Iwano, Takahiro Ikoma, Kenya Okada, Kuniko Yoshida, Toshimitsu Kato, Koji Kurosawa, Toshiyuki Nagai, Kazuaki Negishi, Toshihisa Anzai, Masahiko Kurabayashi

  European heart journal cardiovascular Imaging 2020/11/07 

  AIMS: This study sought to determine the independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation (TR) severity over right heart remodelling and pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Echocardiography was performed on 311 HFpEF patients. TR severity was defined by the semiquantitative measures [i.e. vena contracta width (VCW) and jet area] and by the guideline-based integrated qualitative approach (absent, mild, moderate, or severe). All-cause mortality or heart failure hospitalization occurred in 101 patients over a 2.1-year median follow-up. There was a continuous association between TR severity and the composite outcome with a hazard ratio (HR) of 1.17 per 1 mm increase of VCW [95% confidence interval (CI) 1.08-1.26, P < 0.0001]. Compared with patients with the lowest VCW category (≤1 mm), RV-adjusted HRs for the outcome were 1.99 (95% CI 1.05-3.77), 2.63 (95% CI 1.16-5.95), and 5.00 (95% CI 1.60-15.7) for 1-3, 3-7, and ≥7 mm VCW categories, respectively. TR severity as defined by the guideline-based approach showed a similarly graded association, but it was no longer significant in models including PH. In contrast, VCW remained independently and incrementally associated with the outcome after adjusting for established prognostic factors, as well as RV diameter and PH (fully adjusted HR 1.14 per 1 mm, 95% CI 1.02-1.27, P = 0.02; χ2 58.8 vs. 51.5, P = 0.03). CONCLUSION: The current data highlight the potential value of the semiquantitative measures of TR severity for the risk stratification in patients with HFpEF.
• 肺静脈血流速度波形を用いたリザーバ期の左房硬さの非侵襲的評価法の検討

  阿部 剛大, 岡田 一範, 加賀 早苗, 政氏 伸夫, 三神 大世, 村山 迪史, 中鉢 雅大, 辻永 真吾, 岩野 弘幸, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 47 (Suppl.) S246 - S246 1346-1176 2020/11
• 房室弁開放時相差の視覚的評価に基づいたスコアリングによる左室充満圧推定と予後予測

  村山 迪史, 岩野 弘幸, 辻永 真吾, 西野 久雄, 中鉢 雅大, 横山 しのぶ, 西田 睦, 渋谷 斉, 加賀 早苗, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 47 (Suppl.) S165 - S165 1346-1176 2020/11
• 収縮期の右房容量負荷が三尖弁輪収縮期移動距離と右室駆出率との関係に及ぼす影響

  村山 迪史, 加賀 早苗, 岡田 一範, 三神 大世, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 西田 睦, 岩野 弘幸, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 47 (Suppl.) S222 - S222 1346-1176 2020/11
• 経カテーテル的大動脈弁置換術による左室機能の変化と左室外的仕事量との関連

  辻永 真吾, 岩野 弘幸, 石坂 傑, 千葉 泰之, 更科 美羽, 中鉢 雅大, 神谷 究, 永井 利幸, 安斉 俊久

  超音波医学 (公社)日本超音波医学会 47 (Suppl.) S208 - S208 1346-1176 2020/11
• Placebo-Controlled, Double-Blind Study of Empagliflozin (EMPA) and Implantable Cardioverter-Defibrillator (EMPA-ICD) in Patients with Type 2 Diabetes (T2DM): Rationale and Design.

  Shinya Fujiki, Kenichi Iijima, Masaaki Okabe, Shinichi Niwano, Kenichi Tsujita, Shigeto Naito, Kenji Ando, Kengo Kusano, Ritsushi Kato, Junichi Nitta, Tetsuji Miura, Takeshi Mitsuhashi, Kazuomi Kario, Yusuke Kondo, Masaki Ieda, Nobuhisa Hagiwara, Toyoaki Murohara, Kazuyoshi Takahashi, Hirofumi Tomita, Yasuchika Takeishi, Toshihisa Anzai, Wataru Shimizu, Masafumi Watanabe, Yoshihiro Morino, Takeshi Kato, Hiroshi Tada, Yoshihisa Nakagawa, Masafumi Yano, Koji Maemura, Takeshi Kimura, Hisako Yoshida, Keiko Ota, Takahiro Tanaka, Nobutaka Kitamura, Koichi Node, Yoshifusa Aizawa, Ippei Shimizu, Daisuke Izumi, Kazuyuki Ozaki, Tohru Minamino

  Diabetes therapy : research, treatment and education of diabetes and related disorders 11 (11) 2739 - 2755 2020/11 

  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 ).
• Functional significance of intra-left ventricular vortices on energy efficiency in normal, dilated, and hypertrophied hearts.

  Miwa Sarashina-Motoi, Hiroyuki Iwano, Ko Motoi, Suguru Ishizaka, Yasuyuki Chiba, Shingo Tsujinaga, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Toshihisa Anzai

  Journal of clinical ultrasound : JCU 49 (4) 358 - 367 2020/10/24 

  PURPOSE: To investigate the influence of changes in vortices within the left ventricle (LV) on energy efficiency (EE) in normal and diseased hearts. METHODS: We performed vector flow mapping echocardiography in 36 normal participants (N), 36 patients with dilated cardiomyopathy (D), and 36 patients with LV hypertrophy (H). The circulation of the main anterior vortex was measured as a parameter of vortex strength. Energy loss (EL) was measured for one cardiac cycle, and EE was calculated as EL divided by stroke work (SW), which represents the loss of kinetic energy per unit of LV external work. RESULTS: Circulation increased in the order of N, H, and D (N: 15 ± 4, D: 19 ± 8, H: 17 ± 6 × 10-3 m2 /s; analysis of variance [ANOVA] P < .01). Conversely, EE increased in the order of N, D, and H (N: 0.22 ± 0.07, D: 0.26 ± 0.16, H: 0.30 ± 0.16 10-5 J/mm Hg mL m s; ANOVA P = .04), suggesting worst EE in group H. We found a positive correlation between circulation and SW only in group N, and positive correlation between circulation and EE only in diseased groups (D: R = 0.55, P < .01; H: R = 0.44, P < .01). Multivariable analyses revealed that circulation was the independent determinant of EE in groups D and H. CONCLUSIONS: Enhanced vortices could be associated with effective increase in LV external work in normal hearts. Conversely, they were associated with loss of EE without an optimal increase in external work in failing hearts, regardless of the LV morphology.
• Greetings From the New Editor-in-Chief.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 84 (11) 1889 - 1889 2020/10/23
• Mechanism of Early-Diastolic Mitral Regurgitation.

  Michito Murayama, Hiroyuki Iwano, Miwa Sarashina, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 84 (11) 2036 - 2036 2020/10/23
• Message From the Editor-in-Chief.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 84 (11) 1890 - 1894 2020/10/23
• Derivation and Validation of Clinical Prediction Models for Rapid Risk Stratification for Time-Sensitive Management for Acute Heart Failure.

  Yasuyuki Shiraishi, Shun Kohsaka, Takayuki Abe, Toshiyuki Nagai, Ayumi Goda, Yosuke Nishihata, Yuji Nagatomo, Mike Saji, Yuichi Toyosaki, Makoto Takei, Takeshi Kitai, Takashi Kohno, Keiichi Fukuda, Yuya Matsue, Toshihisa Anzai, Tsutomu Yoshikawa

  Journal of clinical medicine 9 (11) 2020/10/23 

  Early and rapid risk stratification of patients with acute heart failure (AHF) is crucial for appropriate patient triage and outcome improvements. We aimed to develop an easy-to-use, in-hospital mortality risk prediction tool based on data collected from AHF patients at their initial presentation. Consecutive patients' data pertaining to 2006-2017 were extracted from the West Tokyo Heart Failure (WET-HF) and National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure (NaDEF) registries (n = 4351). Risk model development involved stepwise logistic regression analysis and prospective validation using data pertaining to 2014-2015 in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure Syndrome (REALITY-AHF) (n = 1682). The final model included data describing six in-hospital mortality risk predictors, namely, age, systolic blood pressure, blood urea nitrogen, serum sodium, albumin, and natriuretic peptide (SOB-ASAP score), available at the time of initial triage. The model showed excellent discrimination (c-statistic = 0.82) and good agreement between predicted and observed mortality rates. The model enabled the stratification of the mortality rates across sixths (from 14.5% to <1%). When assigned a point for each associated factor, the integer score's discrimination was similar (c-statistic = 0.82) with good calibration across the patients with various risk profiles. The models' performance was retained in the independent validation dataset. Promptly determining in-hospital mortality risks is achievable in the first few hours of presentation; they correlate strongly with mortality among AHF patients, potentially facilitating clinical decision-making.
• Acute anterior myocardial infarction complicated by takotsubo syndrome: the value of multimodality imaging.

  Takao Konishi, Naohiro Funayama, Tadashi Yamamoto, Daisuke Hotta, Shinya Tanaka, Toshihisa Anzai

  Kardiologia polska 78 (10) 1055 - 1056 2020/10/23 [Refereed][Not invited]
  
• A Rare Combination: Cardiac Myxoma and Aortic Stenosis.

  Takao Konishi, Daisuke Hotta, Shinya Tanaka, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 60 (6) 961 - 962 2020/10/14
• Abnormal FDG uptake predicting the instability of thoracic aortic aneurysms.

  Yasuyuki Chiba, Kiwamu Kamiya, Tadao Aikawa, Hiroyuki Iwano, Toshiyuki Nagai, Takahiro Ishigaki, Yasushige Shingu, Ai Shimizu, Yoshiro Matsui, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 27 (5) 1841 - 1843 1071-3581 2020/10 [Refereed][Not invited]
  
• 心臓サルコイドーシス患者でfragmented QRSは、心事故、慢性期致死性不整脈と関連する

  萩原 光, 渡邉 昌也, 中尾 元基, 甲谷 太郎, 小林 雄太, 加藤 喜哉, 小森山 弘和, 鎌田 塁, 永井 利幸, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 40 (サプリメント号) 56 - 56 1883-1273 2020/10
• 【循環器疾患のPrecision Medicine】臨床 心不全個別化医療

  永井 利幸, 安斉 俊久

  Cardiac Practice (株)メディカルレビュー社 31 (1) 32 - 36 0915-874X 2020/10
• Rapid-rate nonsustained ventricular tachycardias in high-risk dilated cardiomyopathy patients.

  Wei-Chieh Lee, Masaya Watanabe, Hisashi Yokoshiki, Taro Temma, Rui Kamada, Masayuki Takahashi, Hikaru Hagiwara, Yumi Takahashi, Toshihisa Anzai

  Pacing and clinical electrophysiology : PACE 43 (10) 1086 - 1095 2020/10 [Refereed][Not invited]
   

  AIMS: Nonsustained ventricular tachycardia (NSVT) occurs frequently in patients with dilated cardiomyopathy (DCM), especially in high-risk patients. The role of rapid-rate NSVT (RR-NSVT) documented by an implantable cardioverter-defibrillator (ICD) in DCM patients has not been fully explored. This study aimed to determine the relationship between RR-NSVT and the occurrence of ventricular tachyarrhythmias (VTAs) in DCM patients with ICD. METHODS: From December 2000 to December 2017, 136 DCM patients received ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation for primary or secondary prevention of VTAs. Based on the occurrence of documented RR-NSVT, patients were classified into RR-NSVT (-) or RR-NSVT (+) groups. RESULT: During the median follow-up of 4.5 years, 50.0% (68/136) patients experienced ≥1 episode, and 25.0% (34/136) patients experienced ≥3 episodes of RR-NSVT. Event-free survival for VTAs was significantly higher in the RR-NSVT (-) group, whereas those for heart failure admission and cardiovascular mortality were comparable between groups. In the multivariate Cox regression analysis, any RR-NSVT showed a positive association with the occurrence of VTAs (hazard ratio: 5.087; 95% confidence interval: 2.374-10.900; P < .001). In RR-NSVT (+) patients, a cluster (≥3 times/6 months) and frequent pattern (≥3 runs/day) of RR-NSVT were observed in 42.6% (29/68) and 30.9% (21/68) patients, respectively, who showed further increased incidence of VTAs. CONCLUSION: In DCM patients with ICD/CRT-D, 50.0% patients experienced at least one episode of RR-NSVT. RR-NSVT documentation showed a positive association with subsequent occurrence of VTAs, suggesting the importance of constructive arrhythmia management for patients with RR-NSVT.
• Type 2 diabetes is an independent predictor of lowered peak aerobic capacity in heart failure patients with non-reduced or reduced left ventricular ejection fraction.

  Takahiro Abe, Takashi Yokota, Arata Fukushima, Naoya Kakutani, Takashi Katayama, Ryosuke Shirakawa, Satoshi Maekawa, Hideo Nambu, Yoshikuni Obata, Katsuma Yamanashi, Ippei Nakano, Shingo Takada, Isao Yokota, Koichi Okita, Shintaro Kinugawa, Toshihisa Anzai

  Cardiovascular diabetology 19 (1) 142 - 142 2020/09/19 

  BACKGROUND: Although type 2 diabetes mellitus (T2DM) is one of the most frequent comorbidities in patients with chronic heart failure (CHF), the effects of T2DM on the exercise capacity of CHF patients are fully unknown. Here, we tested the hypothesis that the coexistence of T2DM lowers CHF patients' peak aerobic capacity. METHODS: We retrospectively analyzed the cases of 275 Japanese CHF patients with non-reduced ejection fraction (left ventricular ejection fraction [LVEF] ≥ 40%) or reduced EF (LVEF < 40%) who underwent cardiopulmonary exercise testing. We divided them into diabetic and nondiabetic groups in each CHF cohort. RESULTS: The mean peak oxygen uptake (VO2) value was 16.87 mL/kg/min in the non-reduced LVEF cohort and 15.52 mL/kg/min in the reduced LVEF cohort. The peak VO2 was lower in the diabetics versus the nondiabetics in the non-reduced LVEF cohort with the mean difference (95% confidence interval [95% CI]) of - 0.93 (- 1.82 to - 0.04) mL/kg/min and in the reduced LVEF cohort with the mean difference of - 1.05 (- 1.96 to - 0.15) mL/kg/min, after adjustment for age-squared, gender, anemia, renal function, LVEF, and log B-type natriuretic peptide (BNP). The adjusted VO2 at anaerobic threshold (AT), a submaximal aerobic capacity, was also decreased in the diabetic patients with both non-reduced and reduced LVEFs. Intriguingly, the diabetic patients had a lower adjusted peak O2 pulse than the nondiabetic patients in the reduced LVEF cohort, but not in the non-reduced LVEF cohort. A multivariate analysis showed that the presence of T2DM was an independent predictor of lowered peak VO2 in CHF patients with non-reduced LVEF and those with reduced LVEF. CONCLUSIONS: T2DM was associated with lowered peak VO2 in CHF patients with non-reduced or reduced LVEF. The presence of T2DM has a negative impact on CHF patients' exercise capacity, and the degree of impact is partly dependent on their LV systolic function.
• Acute Gastric Dilation after Catheter Ablation.

  Tomoya Sato, Takao Konishi, Rui Kamada, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 59 (18) 2341 - 2341 2020/09/15 [Refereed][Not invited]
  
• Cardiac involvement with anti-mitochondrial antibody-positive myositis mimicking cardiac sarcoidosis.

  Takahide Kadosaka, Shingo Tsujinaga, Hiroyuki Iwano, Kiwamu Kamiya, Azusa Nagai, Yoshifumi Mizuguchi, Ko Motoi, Kazunori Omote, Toshiyuki Nagai, Ichiro Yabe, Toshihisa Anzai

  ESC heart failure 2020/09/11 

  Anti-mitochondrial antibody (AMA)-positive myositis is an atypical inflammatory myopathy characterized by chronic progressive respiratory muscle weakness, muscular atrophy, and cardiac involvement. Arrhythmias, cardiomyopathy, and myocarditis have been reported as cardiac manifestations. Herein, we present the first report of a patient diagnosed with having AMA-positive myositis with cardiac involvement mimicking cardiac sarcoidosis.
• Myocardial T1-mapping and Extracellular Volume Quantification in Patients and Putative Carriers of Muscular Dystrophy: Early Experience.

  Kazuhiro Koyanagawa, Yuta Kobayashi, Tadao Aikawa, Atsuhito Takeda, Hideaki Shiraishi, Satonori Tsuneta, Noriko Oyama-Manabe, Hiroyuki Iwano, Toshiyuki Nagai, Toshihisa Anzai

  Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine 20 (3) 320 - 324 2020/09/07 

  To assess myocardial fibrosis associated with muscular dystrophy, T1-mapping and extracellular volume fraction (ECV) quantification was prospectively performed using cardiovascular MR (CMR) imaging in 6 male patients with muscular dystrophy and 5 female putative carriers of Duchenne or Becker muscular dystrophy. Five patients and all putative carriers had an elevated ECV (>29.5% for men and >35.2% for women), suggesting that ECV has a potential to detect diffuse fibrotic changes in patients and putative carriers of muscular dystrophy.
• Usefulness of Liver Magnetic Resonance Elastography for Estimating Right-Atrial Pressure in Heart Failure Patients.

  Yoshiya Kato, Toshiyuki Nagai, Noriko Oyama-Manabe, Satonori Tsuneta, Michikazu Nakai, Yuta Kobayashi, Hirokazu Komoriyama, Kazunori Omote, Shingo Tsujinaga, Takuma Sato, Takao Konishi, Kiwamu Kamiya, Hiroyuki Iwano, Toshihisa Anzai

  JACC. Cardiovascular imaging 13 (9) 2050 - 2052 2020/09 [Refereed][Not invited]
  
• Reversible Cancer Therapeutics-related Cardiac Dysfunction Complicating Intra-cardiac Thrombi.

  Shingo Tsujinaga, Hiroyuki Iwano, Tomohiro Oshino, Takahide Kadosaka, Yoshifumi Mizuguchi, Ko Motoi, Yasuyuki Chiba, Taro Koya, Taro Temma, Kiwamu Kamiya, Arata Fukushima, Takuya Koizumi, Tomoya Sato, Sakae Takenaka, Atsushi Tada, Suguru Ishizaka, Miwa Sarashina, Kazunori Omote, Rui Kamada, Takao Konishi, Takuma Sato, Toshiyuki Nagai, Hiroko Yamashita, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 59 (17) 2155 - 2160 2020/09/01 [Refereed][Not invited]
   

  Epirubicin-based chemotherapy carries a risk of inducing heart failure, although the frequency is rare. Bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, has recently been widely used in patients with recurrent breast cancer as a first-line chemotherapeutic agent. Heart failure or arterial thromboembolism has been reported as a rare cardiovascular complication of bevacizumab. We herein report a breast cancer patient with reversible cancer therapeutics-related cardiac dysfunction associated with bevacizumab and epirubicin complicating intracardiac thrombi in the left atrium and left ventricle. This case underscores the importance of tailored medical planning according to the individual status in patients receiving anti-cancer therapies.
• Outer Retinal Abnormalities in a Patient with Danon Disease.

  Ayaka Hasegawa, Kousuke Noda, Akio Fujiya, Kiriko Hirooka, Toshihisa Anzai, Susumu Ishida

  Retinal cases & brief reports 2020/08/31 

  PURPOSE: To report outer retinal abnormalities evaluated using high-resolution imaging modalities in a patient with Danon disease. METHODS: Case report. RESULTS: A 26-year-old woman, diagnosed with Danon disease based on genetic testing, was referred to our department for further evaluation of ocular findings. Her best-corrected visual acuity was 20/20, and color vision was normal. Fundus examination revealed pigmentary changes consisting of mottled depigmentation and pigmentation in the peripheral retina of both eyes. Spectral-domain optical coherence tomography (SD-OCT) revealed disruptions of the ellipsoid and interdigitation zones, irregularity of the retinal pigment epithelium (RPE), and hyperreflectivity of the outer nuclear layer. In addition, an adaptive optics retinal camera demonstrated the ambiguous macular cone mosaic pattern. CONCLUSION: Danon disease is caused by a primary deficiency in lysosomal associated membrane protein 2 (LAMP-2), an important constituent of the lysosomal membrane that plays a crucial role in the process of autophagy. It is possible that the findings of SD-OCT and adaptive optics retinal camera are early changes associated with the accumulation of autophagosomes and/or phagosomes due to LAMP-2 dysfunction in the photoreceptors, eventually followed by outer retinal degeneration, such as thinning of both the photoreceptor and RPE layers at the fovea.
• JCS 2020 Guideline on Diagnosis and Treatment of Cardiac Amyloidosis.

  Hiroaki Kitaoka, Chisato Izumi, Yasuhiro Izumiya, Takayuki Inomata, Mitsuharu Ueda, Toru Kubo, Jun Koyama, Motoaki Sano, Yoshiki Sekijima, Nobuhiro Tahara, Nobuhiro Tsukada, Kenichi Tsujita, Hiroyuki Tsutsui, Takeshi Tomita, Masashi Amano, Jin Endo, Atsushi Okada, Seitaro Oda, Seiji Takashio, Yuichi Baba, Yohei Misumi, Masahide Yazaki, Toshihisa Anzai, Yukio Ando, Mitsuaki Isobe, Takeshi Kimura, Keiichi Fukuda

  Circulation journal : official journal of the Japanese Circulation Society 84 (9) 1610 - 1671 2020/08/25 [Refereed][Not invited]
  
• Enhanced Echo Intensity of Skeletal Muscle Is Associated With Exercise Intolerance in Patients With Heart Failure.

  Ippei Nakano, Hiroaki Hori, Arata Fukushima, Takashi Yokota, Shintaro Kinugawa, Shingo Takada, Katsuma Yamanashi, Yoshikuni Obata, Yasuyuki Kitaura, Naoya Kakutani, Takahiro Abe, Toshihisa Anzai

  Journal of cardiac failure 26 (8) 685 - 693 1071-9164 2020/08 [Refereed][Not invited]
   

  BACKGROUND: Skeletal muscle is quantitatively and qualitatively impaired in patients with heart failure (HF), which is closely linked to lowered exercise capacity. Ultrasonography (US) for skeletal muscle has emerged as a useful, noninvasive tool to evaluate muscle quality and quantity. Here we investigated whether muscle quality based on US-derived echo intensity (EI) is associated with exercise capacity in patients with HF. METHODS AND RESULTS: Fifty-eight patients with HF (61 ± 12 years) and 28 control subjects (58 ± 14 years) were studied. The quadriceps femoris echo intensity (QEI) was significantly higher and the quadriceps femoris muscle thickness (QMT) was significantly lower in the patients with HF than the controls (88.3 ± 13.4 vs 81.1 ± 7.5, P= .010; 5.21 ± 1.10 vs 6.54 ±1.34 cm, P< .001, respectively). By univariate analysis, QEI was significantly correlated with age, peak oxygen uptake (VO2), and New York Heart Association class in the HF group. A multivariable analysis revealed that the QEI was independently associated with peak VO2 after adjustment for age, gender, body mass index, and QMT: β-coefficient = -11.80, 95%CI (-20.73, -2.86), P= .011. CONCLUSION: Enhanced EI in skeletal muscle was independently associated with lowered exercise capacity in HF. The measurement of EI is low-cost, easily accessible, and suitable for assessment of HF-related alterations in skeletal muscle quality.
• Prognostic impact of moderate mitral regurgitation on hospitalized heart failure patients with preserved ejection fraction: A report from the JASPER registry.

  Masayoshi Oikawa, Akiomi Yoshihisa, Yu Sato, Toshiyuki Nagai, Tsutomu Yoshikawa, Yoshihiko Saito, Kazuhiro Yamamoto, Yasuchika Takeishi, Toshihisa Anzai

  Heart and vessels 35 (8) 1087 - 1094 2020/08 [Refereed][Not invited]
   

  A growing body of evidence suggests that mitral regurgitation (MR) is associated with higher mortality in heart failure patients with reduced ejection fraction. However, prognostic impact of MR on heart failure patients with preserved ejection fraction (HFpEF) has not been fully examined. The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese hospitalized HFpEF patients with LVEF ≥ 50%. Severe valvular heart disease was excluded from this cohort. We divided the consecutive 341 patients into two groups based on the severity of MR at discharge: no or mild MR group (n = 317) and moderate MR group (n = 24). Compared with no or mild MR group, moderate MR group showed larger left ventricular end-diastolic diameter (52 [48-59] vs. 46 [42-50] mm, P < 0.001), left ventricular systolic diameter (35 [30-37] vs. 29 [26-34] mm, P = 0.006), left atrial diameter (49 [46-56] vs. 45 [40-50] mm, P < 0.001), and higher tricuspid regurgitation peak gradient (33 [25-40] vs. 27 [21-33] mmHg, P = 0.012). In contrast, levels of plasma B-type natriuretic peptide and left ventricular ejection fraction were comparable between the two groups. In the follow-up period (median 738 days), there were 57 all-cause deaths. In the Kaplan-Meier analysis, all-cause mortality was higher in moderate MR group than in no or mild MR group (log-rank P = 0.023). In the Cox proportional hazard analysis, moderate MR at discharge was a predictor of all-cause mortality (hazard ratio 2.256, 95% confidence interval 1.035-4.917, P = 0.041). Moderate MR at discharge is associated with adverse prognosis in hospitalized patients with HFpEF.
• Significance and prognostic impact of v wave on pulmonary artery pressure in patients with heart failure: beyond the wedge pressure.

  Hiroyuki Iwano, Shinobu Yokoyama, Kiwamu Kamiya, Toshiyuki Nagai, Shingo Tsujinaga, Miwa Sarashina, Suguru Ishizaka, Yasuyuki Chiba, Masahiro Nakabachi, Hisao Nishino, Michito Murayama, Kazunori Okada, Sanae Kaga, Toshihisa Anzai

  Heart and vessels 35 (8) 1079 - 1086 2020/08 [Refereed][Not invited]
   

  BACKGROUND: A v wave on pulmonary artery wedge (PAW) pressure sometimes augments and appears on pulmonary artery (PA) pressure wave in patients with heart failure (HF). However, the significance of PA v wave in HF remains to be elucidated. METHODS: We retrospectively analyzed pressure waveforms in 61 HF patients (left ventricular ejection fraction 35 ± 15%). On the PAW and PA pressure waveforms, mean pressure as well as peak and amplitude of v waves (ampPAWv and ampPAv, respectively) were measured. Occurrence of worsening HF and cardiac death was recorded for 2 years after the catheterization. RESULTS: The ampPAWv did not correlate with ampPAv. When the patients were divided into 4 groups: I (high-ampPAWv/high-ampPAv), II (high-ampPAWv/low-ampPAv), III (low-ampPAWv/high-ampPAv), and IV (low-ampPAWv/low-ampPAv), the prevalence of group III was low (I: 13, II: 17, III: 4, IV: 27). Mean pressures of PAW and PA were similarly elevated in groups I and II. Cardiac index was lowest (I: 2.0 ± 0.4, II: 2.8 ± 0.6, III: 2.2 ± 0.2, IV: 2.4 ± 0.6 L/min/m2, ANOVA P < 0.01, P < 0.01 for I vs II) and tricuspid annular plane systolic excursion / systolic PA pressure was impaired (I: 0.27 ± 0.07, II: 0.48 ± 0.22, III: 0.59 ± 0.35, IV: 0.68 ± 0.35 mm/mmHg, ANOVA P < 0.01) in group I. During the follow-up, 13 events were observed. Kaplan-Meier analysis showed that patients in group I were at highest risk of cardiac events. CONCLUSIONS: PA v was observed mainly in patients with augmented PAW v wave and decreased cardiac index, suggesting an advanced stage of HF. Moreover, augmented PAv was associated with worse outcome in HF patients.
• Prognostic value of base excess as indicator of acid-base balance in acute heart failure.

  Hiroki Nakano, Toshiyuki Nagai, Yasuyuki Honda, Satoshi Honda, Naotsugu Iwakami, Chisa Matsumoto, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Hisao Ogawa, Satoshi Yasuda, Taishiro Chikamori, Toshihisa Anzai

  European heart journal. Acute cardiovascular care 9 (5) 399 - 405 2020/08 [Refereed][Not invited]
   

  BACKGROUND: Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified. METHODS: We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH <7.38, >7.42 and -2 to 2 mEq/L, respectively. The primary outcome was all-cause death. RESULTS: During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia (p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08-3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47-1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others. CONCLUSIONS: High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure.
• Elevated admission urinary N-acetyl-β-D-glucosamidase level is associated with worse long-term clinical outcomes in patients with acute heart failure.

  Sayaka Funabashi, Kazunori Omote, Toshiyuki Nagai, Yasuyuki Honda, Hiroki Nakano, Satoshi Honda, Naotsugu Iwakami, Yasuhiro Hamatani, Michikazu Nakai, Kunihiro Nishimura, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  European heart journal. Acute cardiovascular care 9 (5) 429 - 436 2020/08 [Refereed][Not invited]
   

  BACKGROUND: The prognostic significance of urinary N-acetyl-β-D-glucosamidase in acute heart failure has not been fully elucidated. Accordingly, this study investigated whether urinary N-acetyl-β-D-glucosamidase could be associated with subsequent adverse events in acute heart failure patients. METHODS: We studied 708 consecutive acute heart failure patients who had accessible N-acetyl-β-D-glucosamidase data on admission from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry. We assessed the relationship between the admission N-acetyl-β-D-glucosamidase level and the combined endpoint of all-cause death and worsening heart failure. Worsening heart failure was defined as worsening symptoms and signs of heart failure requiring intensification of intravenous therapy such as diuretics, vasodilators and inotropes or initiation of mechanical support after stabilisation with initial treatment during hospitalisation, or readmission due to heart failure after discharge. RESULTS: During a median follow-up period of 763 (interquartile range 431-1028) days, higher urinary N-acetyl-β-D-glucosamidase was significantly related to increased events of all-cause death and worsening heart failure. In addition, patients with higher urinary N-acetyl-β-D-glucosamidase and lower estimated glomerular filtration rate on admission had the worst clinical outcomes. In multivariable Cox regression, urinary N-acetyl-β-D-glucosamidase on admission was independently associated with adverse events (hazard ratio 1.19, 95% confidence interval 1.04-1.35) even after adjustment by covariates including the baseline estimated glomerular filtration rate. CONCLUSIONS: Higher urinary N-acetyl-β-D-glucosamidase level on admission was independently associated with worse clinical outcomes. Our findings indicate the potential value of assessing urinary N-acetyl-β-D-glucosamidase on admission for further risk stratification in patients with acute heart failure.
• Quality indicators of palliative care for acute cardiovascular diseases.

  Atsushi Mizuno, Mitsunori Miyashita, Takashi Kohno, Yasuharu Tokuda, Shuhei Fujimoto, Masato Nakamura, Morimasa Takayama, Koichiro Niwa, Terunobu Fukuda, Shinichi Ishimatsu, Satomi Kinoshita, Shogo Oishi, Hiroki Mochizuki, Akemi Utsunomiya, Yasuko Takada, Ryota Ochiai, Toshiaki Mochizuki, Ken Nagao, Saran Yoshida, Akitoshi Hayashi, Ryuichi Sekine, Toshihisa Anzai

  Journal of cardiology 76 (2) 177 - 183 2020/08 [Refereed][Not invited]
   

  BACKGROUND: Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS: We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS: Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION: In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.
• Phosphoglyceride crystal deposition disease as a rare tumour after cardiac surgery.

  Tomoya Sato, Takao Konishi, Satoru Wakasa, Noriko Oyama-Manabe, Toshihisa Anzai

  European heart journal 41 (27) 2596 - 2596 2020/07/14 [Refereed][Not invited]
  
• Prevalence, Determinants, and Prognostic Significance of Hospital Acquired Pneumonia in Patients with Acute Heart Failure.

  Atsushi Tada, Kazunori Omote, Toshiyuki Nagai, Yasuyuki Honda, Hiroki Nakano, Satoshi Honda, Naotsugu Iwakami, Yasuhiro Hamatani, Michikazu Nakai, Kunihiro Nishimura, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Journal of clinical medicine 9 (7) 2020/07/13 [Refereed][Not invited]
   

  The prognostic impact of hospital-acquired pneumonia (HAP) in acute heart failure (AHF) patients have not been fully elucidated. We evaluated 776 consecutive hospitalized AHF patients. The primary in-hospital outcomes were all-cause death and worsening heart failure (WHF), while the outcome following discharge was all-cause death. The clinical diagnosis of HAP was based on clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Patients with HAP had a significantly higher incidence of in-hospital death (12% vs. 1%, p < 0.001), WHF during the hospitalization (28% vs. 7%, p < 0.001), and longer length of hospital stay (p = 0.003) than those without. Among patients who survived at discharge, during a median follow-up period of 741 (interquartile range 422-1000) days, the incidence of all-cause death was significantly higher in patients with HAP than in those without (p < 0.001). In the multivariable Cox regression, HAP development was independently associated with all-cause death after discharge (HR [hazard ratio] 1.86, 95%CI [confidence interval] 1.08-3.19). Furthermore, older age (OR [odds ratio] 1.04, 95%CI 1.01-1.08), male sex (OR 2.21, 95%CI 1.14-4.28), and higher serum white blood cell count (OR 1.18, 95%CI 1.09-1.29) and serum C-reactive protein (OR 1.08, 95%CI 1.01-1.06) were independently associated with HAP development. In hospitalized patients with AHF, HAP development was associated with worse clinical outcomes, suggesting the importance of prevention and early screening for HAP.
• Successful epicardial ablation for ventricular tachycardia originating from the true apex of apical aneurysm associated with hypertrophic cardiomyopathy

  Motoki Nakao, Masaya Watanabe, Rui Kamada, Hikaru Hagiwara, Yumi Takahashi, Taro Koya, Takahide Kadosaka, Takuya Koizumi, Masanori Hirose, Toshihisa Anzai

  Journal of Electrocardiology 61 170 - 174 0022-0736 2020/07
• Radiofrequency catheter ablation of a sporadically occurring ventricular arrhythmia originating from the right ventricular outflow tract: A novel arrhythmia induction strategy involving atrial fibrillation provocation.

  Taro Koya, Taro Temma, Masaya Watanabe, Rui Kamada, Toshiyuki Nagai, Toshihisa Anzai

  HeartRhythm case reports 6 (7) 411 - 414 2020/07 [Refereed][Not invited]
  
• Invasive Cardiac Lipoma Complicating Visceral Inversion

  Takahide Kadosaka, Shingo Tsujinaga, Hiroyuki Iwano, Noriko Oyama-Manabe, Toshihisa Anzai

  JACC: Case Reports 2 (10) 1570 - 1571 2666-0849 2020/07 [Refereed][Not invited]
   

  We report a case of cardiac lipoma with intramyocardial invasion complicated by visceral inversion, which, to the best of our knowledge, has not been reported before. Multimodality imaging played an important role in differential diagnosis and determination of the management strategy. (Level of Difficulty: Advanced.).
• Detailed visualization of the right and left ventricular, left atrial, and epicardial involvement of cardiac sarcoidosis with novel semiconductor PET/CT.

  Osamu Manabe, Noriko Oyama-Manabe, Toshiyuki Nagai, Sho Furuya, Toshihisa Anzai

  European journal of nuclear medicine and molecular imaging 47 (7) 1773 - 1774 2020/07 [Refereed][Not invited]
  
• Experience of morphine therapy for refractory dyspnea as palliative care in advanced heart failure patients.

  Juri Kawaguchi, Yasuhiro Hamatani, Atsushi Hirayama, Kunihiro Nishimura, Eri Nakai, Emi Nakamura, Michi Miyata, Yukie Kawano, Yasuko Takada, Yuta Anchi, Sayaka Funabashi, Kensuke Kuroda, Michiyo Azechi, Hiroyuki Takahama, Toshihisa Anzai, Satoshi Yasuda, Hiroaki Kitaoka, Chisato Izumi

  Journal of cardiology 75 (6) 682 - 688 2020/06 [Refereed][Not invited]
   

  BACKGROUND: In the field of palliative care, morphine is known to be effective for alleviating dyspnea in cancer patients. However, little is known regarding the safety and efficacy of morphine therapy for refractory dyspnea as palliative care in advanced heart failure (HF) patients. METHODS: We retrospectively reviewed consecutive advanced HF patients who were referred to the Palliative Care Team at our institution and administered morphine for refractory dyspnea during hospitalization between September 2013 and December 2018. We investigated the details of morphine usage, vital signs, an 11-point quantitative symptom scale, and adverse events at baseline, 24 h, and 72 h after the start of treatment. RESULTS: Morphine was administered for refractory dyspnea in 43 advanced HF patients [mean age: 73.5 years, male: 28 (65%), New York Heart Association functional class IV: 43 (100%), median left ventricular ejection fraction: 25%, median B-type natriuretic peptide level: 927 pg/ml, concurrent intravenous inotrope: 33 (77%)]. Median initial dose of morphine was 5 mg/day in both oral and intravenous administration and median duration of administration was 5 days. Significant decreases in an 11-point quantitative symptom scale [7 (5, 9) vs. 2 (1, 6); p <  0.01, (data available in 8 patients)] and respiratory rate (22.2 ± 6.1 vs. 19.7 ± 5.2 breaths per minute; p < 0.01) were observed 24 h after the start of morphine administration. Meanwhile, oxygen saturation, blood pressure, and heart rate were not significantly altered after treatment (NS). Common adverse events were delirium (18%) and constipation (8%); however, no lethal adverse event definitely related to morphine therapy occurred during treatment. CONCLUSIONS: This single-center retrospective study revealed the clinical practice of morphine therapy and suggested that morphine therapy might be feasible for refractory dyspnea as palliative care in advanced HF patients.
• What is this image? 2020: Image 6 result : A case of ventricular apical aneurysm with suspected IgG4-related arteritis on steroid therapy.

  Kazuhiro Koyanagawa, Masanao Naya, Osamu Manabe, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 27 (3) 719 - 722 2020/06 [Refereed][Not invited]
  
• Branched-chain amino acid supplementation ameliorates angiotensin II-induced skeletal muscle atrophy.

  Katsuma Yamanashi, Shintaro Kinugawa, Arata Fukushima, Naoya Kakutani, Shingo Takada, Yoshikuni Obata, Ippei Nakano, Takashi Yokota, Yasuyuki Kitaura, Yoshiharu Shimomura, Toshihisa Anzai

  Life sciences 250 117593 - 117593 2020/06/01 [Refereed][Not invited]
   

  AIMS: Sarcopenia is characterized by muscle mass and strength loss and reduced physical activity. Branched-chain amino acids (BCAAs) were recently described as an activator of protein synthesis via mammalian target of rapamycin (mTOR) signaling for muscle atrophy. In cardiovascular diseases, excessive activation of the renin-angiotensin system may induce an imbalance of protein synthesis and degradation, and this plays a crucial role in muscle atrophy. We investigated the effects of BCAAs on angiotensin II (Ang II)-induced muscle atrophy in mice. MATERIALS AND METHODS: We administered Ang II (1000 ng/kg/min) or vehicle to 10-12-week-old male C57BL/6J mice via subcutaneous osmotic minipumps for 4 weeks with or without BCAA supplementation (3% BCAA in tap water). KEY FINDINGS: The skeletal muscle weight/tibial length and cross-sectional area were smaller in the Ang II mice than the vehicle mice; these changes were induced by an imbalance of protein synthesis and degradation signaling such as Akt/mTOR and MuRF-1/Atrogin-1. Compared to the Ang II mice, the mTOR signaling was significantly activated and Ang II-induced muscle atrophy was ameliorated in the Ang II + BCAA mice, and this attenuated the reduction of exercise capacity. Notably, the decrease of muscle weight/tibial length in the fast-twitch dominant muscles (e.g., the extensor digitorum longus) was significantly ameliorated compared to that in the slow-twitch dominant muscles (e.g., soleus). Histologically, the effect of BCAA was larger in fast-twitch than slow-twitch fibers, which may be related to the difference in BCAA catabolism. SIGNIFICANCE: BCAA supplementation could contribute to the prevention of skeletal muscle atrophy induced by Ang II.
• Sex differences in Japanese patients with ruptured aortic aneurysms.

  Tetsuo Yamaguchi, Michikazu Nakai, Yoko Sumita, Kunihiro Nishimura, Toshihiro Nozato, Takashi Ashikaga, Toshiyuki Nagai, Toshihisa Anzai, Yasushi Sakata, Hitoshi Ogino

  Journal of vascular surgery 71 (6) 1907 - 1912 0741-5214 2020/06 [Refereed][Not invited]
   

  OBJECTIVE: This study aimed to assess the sex differences in clinical presentation and outcomes of Japanese patients with ruptured aortic aneurysm (rAA) using a large nationwide claims-based database in Japan. METHODS: We identified patients hospitalized in certified teaching hospitals in Japan with rAA between April 1, 2012, and March 31, 2015. Patients' characteristics and in-hospital outcomes were compared between men and women. The Barthel index was used for evaluating functional status at discharge by examining the ability to perform basic daily activities. RESULTS: Of 7086 eligible patients, 32.3% (2291/7086) were women. Women were older than men (81.9 years vs 76.1 years; P < .001), had higher prevalence of coma at admission (33.2% vs 25.2%; P < .001), and were less likely to undergo emergency operation including endovascular aneurysm repair (35.7% vs 51.1%; P < .001). The unadjusted mortality rate (62.5% vs 52.0%; P < .001) and Barthel index at discharge (78.7 vs 86.1; P < .001) were significantly worse in women than in men. However, multilevel mixed-effect logistic regression analyses showed that female sex itself was not an independent predictor for in-hospital death (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.78-1.04; P = .17). Older age, coma at admission, and vasopressor use were detected as independent predictors for in-hospital death. The same results were confirmed for each rupture site. Stratified analyses showed that older women (threshold, 80 years; OR, 0.81; 95% CI, 0.66-0.98; P = .028) and those who underwent emergency operation (OR, 0.75; 95% CI, 0.61-0.93; P = .009) showed significantly better outcomes than men. CONCLUSIONS: In a univariate analysis, female patients with rAA showed worse mortality than men because of their older age, more severe clinical presentation, and low emergency operation rate. However, after adjustment for covariates, female sex itself was not associated with increased mortality.
• Cardiac sarcoidosis mimicking myocardial infarction: a comprehensive evaluation using computed tomography and positron emission tomography.

  Tadao Aikawa, Kazuhiro Koyanagawa, Noriko Oyama-Manabe, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 27 (3) 1066 - 1067 1071-3581 2020/06 [Refereed][Not invited]
  
• Refractory Right Ventricular Failure in a Patient with Emery-Dreifuss Muscular Dystrophy.

  Yasuyuki Chiba, Arata Fukushima, Motoki Nakao, Yuta Kobayashi, Takahiro Ishigaki, Taro Tenma, Kiwamu Kamiya, Yasushige Shingu, Tomonori Ooka, Yoshiro Matsui, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 59 (10) 1277 - 1281 2020/05/15 [Refereed][Not invited]
   

  A 23-year-old man had progressive muscle weakness and Emery-Dreifuss muscular dystrophy (EDMD) due to a LMNA (lamin A/C) mutation. Congestive heart failure diagnosed at 19 years of age. Maximal drug treatment/cardiac resynchronization failed to improve the cardiac function. He was therefore hospitalized due to heart failure. Despite extracorporeal membrane oxygenation, he developed severe right heart dysfunction and died (multiple organ failure). A cardiac lesion's presence determines the prognosis of EDMD. While there are many arrhythmia reports, few reports on heart failure (particularly severe heart failure requiring cardiac transplantation) have been published. Right heart function monitoring and early ventricular-assist device use plus right heart support considering heart transplantation are important.
• Inhibition of xanthine oxidase in the acute phase of myocardial infarction prevents skeletal muscle abnormalities and exercise intolerance.

  Hideo Nambu, Shingo Takada, Satoshi Maekawa, Junichi Matsumoto, Naoya Kakutani, Takaaki Furihata, Ryosuke Shirakawa, Takashi Katayama, Takayuki Nakajima, Katsuma Yamanashi, Yoshikuni Obata, Ippei Nakano, Masaya Tsuda, Akimichi Saito, Arata Fukushima, Takashi Yokota, Junko Nio-Kobayashi, Hironobu Yasui, Kei Higashikawa, Yuji Kuge, Toshihisa Anzai, Hisataka Sabe, Shintaro Kinugawa

  Cardiovascular research 117 (3) 805 - 819 2020/05/13 [Refereed][Not invited]
   

  AIMS: Exercise intolerance in patients with heart failure (HF) is partly attributed to skeletal muscle abnormalities. We have shown that reactive oxygen species (ROS) play a crucial role in skeletal muscle abnormalities, but the pathogenic mechanism remains unclear. Xanthine oxidase (XO) is reported to be an important mediator of ROS overproduction in ischemic tissue. Here we tested the hypothesis that skeletal muscle abnormalities in HF are initially caused by XO-derived ROS and are prevented by the inhibition of their production. METHODS AND RESULTS: Myocardial infarction (MI) was induced in male C57BL/6J mice, which eventually led to HF, and a sham operation was performed in control mice. The time course of XO-derived ROS production in mouse skeletal muscle post-MI was first analyzed. XO-derived ROS production was significantly increased in MI mice from days 1 to 3 postsurgery (acute phase), whereas it did not differ between the MI and sham groups from 7 to 28 days (chronic phase). Second, mice were divided into three groups: sham+vehicle (Sham+Veh), MI+vehicle (MI+Veh), and MI+febuxostat (an XO inhibitor, 5 mg/kg body weight/day; MI+Feb). Febuxostat or vehicle was administered at 1 hr and 24 hr before surgery, and once-daily on days 1-7 postsurgery. On day 28 postsurgery, exercise capacity and mitochondrial respiration in skeletal muscle fibers were significantly decreased in MI+Veh compared with Sham+Veh mice. An increase in damaged mitochondria in MI+Veh compared with Sham+Veh mice was also observed. The wet weight and cross-sectional area of slow muscle fibers (higher XO-derived ROS) was reduced via the downregulation of protein synthesis-associated mTOR-p70S6K signaling in MI+Veh compared with Sham+Veh mice. These impairments were ameliorated in MI+Feb mice, in association with a reduction of XO-derived ROS production, without affecting cardiac function. CONCLUSIONS: XO inhibition during the acute phase post-MI can prevent skeletal muscle abnormalities and exercise intolerance in mice with HF. A TRANSLATIONAL PERSPECTIVE: We clearly demonstrated that febuxostat, an inhibitor of xanthine oxidase (XO), prevents exercise intolerance and skeletal muscle abnormalities (mitochondrial dysfunction and atrophy) via the suppression of XO-derived reactive oxygen species increase during hypoxia (e.g., myocardial infarction [MI]) in skeletal muscle during the early phase of heart failure (HF) model mouse. Our results shed light on the pathogenic mechanism of skeletal muscle abnormalities in HF after MI. The use of XO inhibitors requires consideration of the time course of XO activity. Our results indicate that the timing of administration is very important to achieve maximum beneficial effects when using XO inhibitors.
• Heart Failure With Preserved Ejection Fraction vs. Reduced Ejection Fraction ― Mechanisms of Ventilatory Inefficiency During Exercise in Heart Failure ―

  Shingo Tsujinaga, Hiroyuki Iwano, Yasuyuki Chiba, Suguru Ishizaka, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Kazunori Okada, Sanae Kaga, Toshihisa Anzai

  Circulation Reports 2 (5) 271 - 279 2020/05/08 [Refereed][Not invited]
   

  Background: Ventilatory inefficiency during exercise assessed using the lowest minute ventilation/carbon dioxide production (V̇E/V̇CO2) ratio was recently proven to be a strong prognostic marker of heart failure (HF) regardless of left ventricular ejection fraction (LVEF). Its physiological background, however, has not been elucidated. Methods and Results: Fifty-seven HF patients underwent cardiopulmonary exercise testing and exercise-stress echocardiography. The lowest V̇E/V̇CO2 ratio was assessed on respiratory gas analysis. Echocardiography was obtained at rest and at peak exercise. LVEF was measured using the method of disks. Cardiac output (CO) and the ratio of transmitral early filling velocity (E) to early diastolic tissue velocity (e') were calculated using the Doppler method. HF patients were divided into preserved EF (HFpEF) and reduced EF (HFrEF) using the LVEF cut-off 40% at rest. Twenty-four patients were classified as HFpEF and 33 as HFrEF. In HFpEF, age (r=0.58), CO (r=-0.44), e' (r=-0.48) and E/e' (r=0.45) during exercise correlated with the lowest V̇E/V̇CO2 ratio (P<0.05 for all). In contrast, in HFrEF, age (r=0.47) and CO (r=-0.54) during exercise, but not e' and E/e', correlated with the lowest V̇E/V̇CO2 ratio. Conclusions: Loss of CO augmentation was associated with ventilatory inefficiency in HF regardless of LVEF, although lung congestion determined ventilatory efficiency only in HFpEF.
• Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease-Report From the National Clinical Data (J-PCI Registry).

  Tadao Aikawa, Kyohei Yamaji, Toshiyuki Nagai, Shun Kohsaka, Kiwamu Kamiya, Kazunori Omote, Taku Inohara, Yohei Numasawa, Kenichi Tsujita, Tetsuya Amano, Yuji Ikari, Toshihisa Anzai

  Journal of the American Heart Association 9 (9) e015404  2020/05/05 [Refereed][Not invited]
   

  Background There is a limited evidence base to support the volume-outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume and in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. Methods and Results We analyzed characteristics and clinical outcomes of 24 320 patients undergoing PCI for unprotected left main coronary artery disease at 1102 hospitals by 7244 operators using data from the Japanese nationwide J-PCI Registry (National PCI Data Registry) between January 2014 and December 2017. We classified institutions and operators into quartiles based on the mean annual volume of PCI. A generalized linear mixed-effects model was used to evaluate the association between institutional and operator PCI volume and in-hospital outcomes. Among the 24 320 patients, 4027 (16.6%), 6147 (25.3%), and 14 146 (58.2%) presented with ST-segment-elevation myocardial infarction, non-ST-segment-elevation acute coronary syndrome, and stable ischemic heart disease; their crude in-hospital mortality was 15%, 3.1%, and 0.3%, respectively. Compared with patients in the lowest quartile of institutional volume (1-216 PCIs/y), the adjusted odds ratio of in-hospital death in patients in the second (217-323 PCIs/y), third (324-487 PCIs/y), and fourth (488-3015 PCIs/y) quartile of institutional volume was 0.75 (95% CI, 0.51-1.10; P=0.14), 0.87 (95% CI, 0.57-1.34; P=0.54), and 0.51 (95% CI, 0.30-0.86; P=0.01), respectively. These findings were consistent in rates of in-hospital death or any complication. Conversely, operator PCI volume was not significantly associated with in-hospital outcomes. Conclusions Institutional rather than operator-based PCI volume was associated with better in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease.
• Optimal sampling in derivation studies was associated with improved discrimination in external validation for heart failure prognostic models.

  Naotsugu Iwakami, Toshiyuki Nagai, Toshiaki A Furukawa, Aran Tajika, Akira Onishi, Kunihiro Nishimura, Soshiro Ogata, Michikazu Nakai, Misa Takegami, Hiroki Nakano, Yohei Kawasaki, Ana Carolina Alba, Gordon Henry Guyatt, Yasuyuki Shiraishi, Shun Kohsaka, Takashi Kohno, Ayumi Goda, Atsushi Mizuno, Tsutomu Yoshikawa, Toshihisa Anzai

  Journal of clinical epidemiology 121 71 - 80 2020/05 [Refereed][Not invited]
   

  OBJECTIVES: The objective of the study was to identify determinants of external validity of prognostic models. STUDY DESIGN AND SETTING: We systematically searched for studies reporting prognostic models of heart failure (HF) and examined their performance for predicting 30-day death in a cohort of consecutive 3,452 acute HF patients. We applied published critical appraisal tools and examined whether bias or other characteristics of original derivation studies determined model performance. RESULTS: We identified 224 models from 6,354 eligible studies. The mean c-statistic in the cohort was 0.64 (standard deviation, 0.07). In univariable analyses, only optimal sampling assessed by an adequate and valid description of the sampling frame and recruitment details to collect the population of interest (total score range: 0-2, higher scores indicating lower risk of bias) was associated with high performance (standardized β = 0.25, 95% CI: 0.12 to 0.38, P < 0.001). It was still significant after adjustment for relevant study characteristics, such as data source, scale of study, stage of illness, and study year (standardized β = 0.24, 95% CI: 0.07 to 0.40, P = 0.01). CONCLUSION: Optimal sampling representing the gap between the population of interest and the studied population in derivation studies was a key determinant of external validity of HF prognostic models.
• Impact of Hospital Practice Factors on Mortality in Patients Hospitalized for Heart Failure in Japan - An Analysis of a Large Number of Health Records From a Nationwide Claims-Based Database, the JROAD-DPC.

  Hidetaka Kaku, Kouta Funakoshi, Tomomi Ide, Takeo Fujino, Shouji Matsushima, Kisho Ohtani, Taiki Higo, Michikazu Nakai, Yoko Sumita, Kunihiro Nishimura, Yoshihiro Miyamoto, Toshihisa Anzai, Hiroyuki Tsutsui

  Circulation journal : official journal of the Japanese Circulation Society 84 (5) 742 - 753 2020/04/24 [Refereed][Not invited]
   

  BACKGROUND: An inverse relationship exists between hospital case volume and mortality in patients with heart failure (HF). However, hospital performance factors associated with mortality in HF patients have not been examined. We aimed to identify these using exploratory factor analysis and assess the relationship between these factors and 7-day, 30-day, and in-hospital mortality among HF patients in Japan.Methods and Results:We analyzed the records of 198,861 patients admitted to 683 certified hospitals of the Japanese Circulation Society between 2012 and 2014. Records were obtained from the nationwide database of the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). Using exploratory factor analysis, 90 hospital survey items were grouped into 5 factors, according to their collinearity: "Interventional cardiology", "Cardiovascular surgery", "Pediatric cardiology", "Electrophysiology" and "Cardiac rehabilitation". Multivariable logistic regression analysis was performed to determine the association between these factors and mortality. The 30-day mortality was 8.0%. Multivariable logistic regression analysis showed the "Pediatric cardiology" (odds ratio (OR) 0.677, 95% confidence interval [CI]: 0.628-0.729, P<0.0001), "Electrophysiology" (OR 0.876, 95% CI: 0.832-0.923, P<0.0001), and "Cardiac rehabilitation" (OR 0.832, 95% CI: 0.792-0.873, P<0.0001) factors were associated with lower mortality. In contrast, "Interventional cardiology" (OR 1.167, 95% CI: 1.070-1.272, P<0.0001) was associated with higher mortality. CONCLUSIONS: Hospital factors, including various cardiovascular therapeutic practices, may be associated with the early death of HF patients.
• Difference in the prevalence of subclinical left ventricular impairment among left ventricular geometric pattern in a community-based population.

  Takuya Hasegawa, Masanori Asakura, Hiroshi Asanuma, Makoto Amaki, Hiroyuki Takahama, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Toshihisa Anzai, Chisato Izumi, Masafumi Kitakaze

  Journal of cardiology 75 (4) 439 - 446 2020/04 [Refereed][Not invited]
   

  BACKGROUND: Left ventricular (LV) hypertrophy is reported to cause LV diastolic dysfunction. This study aimed to examine the prevalence of LV diastolic dysfunction in each group categorized by the geometric pattern of LV hypertrophy in a community-based population. METHODS: We studied 1260 community-dwelling subjects who experienced no symptoms of obvious heart disease (461 men, 799 women) and who participated in annual health check-ups in a rural Japanese community. The subjects were divided into 4 groups according to LV mass index and relative wall thickness: normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. We investigated the prevalence of LV diastolic dysfunction in the overall and stratified population by LV geometric pattern. LV diastolic function was determined by 3 echocardiographic parameters of LV diastolic function: early diastolic myocardial velocity, the ratio of early diastolic mitral inflow velocity and myocardial velocity, and indexed left atrial dimension. LV diastolic dysfunction was defined as the presence of abnormal values in more than 2 of 3 echocardiographic parameters. RESULTS: The prevalence of LV diastolic dysfunction was higher in the categories with more severe LV hypertrophy. However, LV mass index, rather than relative wall thickness, was a significant determinant of LV diastolic dysfunction, after adjustment for comorbidities. In addition, 71 (10%) out of 740 subjects with normal LV geometric pattern had LV diastolic dysfunction even without obvious LV geometric change. CONCLUSIONS: The prevalence of LV diastolic dysfunction was higher in the subjects with more severe LV hypertrophy in a community-based population. Subclinical LV diastolic dysfunction without obvious LV geometric change should be noted and its clinical impact should be elucidated.
• Prognostic Value of 18F-FDG PET Using Texture Analysis in Cardiac Sarcoidosis.

  Osamu Manabe, Kazuhiro Koyanagawa, Kenji Hirata, Noriko Oyama-Manabe, Hiroshi Ohira, Tadao Aikawa, Sho Furuya, Masanao Naya, Ichizo Tsujino, Yuuki Tomiyama, Yuka Otaki, Toshihisa Anzai, Nagara Tamaki

  JACC. Cardiovascular imaging 13 (4) 1096 - 1097 2020/04 [Refereed][Not invited]
  
• Development and Practical Test of Quality Indicators for Palliative Care in Patients With Chronic Heart Failure.

  Yasuhiro Hamatani, Yasuko Takada, Yoshihiro Miyamoto, Yukie Kawano, Yuta Anchi, Tatsuhiro Shibata, Atsushi Suzuki, Mitsunori Nishikawa, Hiroto Ito, Masashi Kato, Tsuyoshi Shiga, Yoshihiro Fukumoto, Chisato Izumi, Satoshi Yasuda, Hisao Ogawa, Yasuo Sugano, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 84 (4) 584 - 591 2020/03/25 [Refereed][Not invited]
   

  BACKGROUND: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.Methods and Results:We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". CONCLUSIONS: The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.
• Measurements of liver stiffness in patients with left ventricular assist device support.

  Kazunori Omote, Takuma Sato, Toshiyuki Nagai, Toshihisa Anzai

  Heart and vessels 35 (3) 442 - 442 0910-8327 2020/03 [Refereed][Not invited]
  
• Prognostic Value of Serum Uric Acid in Hospitalized Heart Failure Patients With Preserved Ejection Fraction (from the Japanese Nationwide Multicenter Registry).

  Yuta Kobayashi, Kazunori Omote, Toshiyuki Nagai, Kiwamu Kamiya, Takao Konishi, Takuma Sato, Yoshiya Kato, Hirokazu Komoriyama, Shingo Tsujinaga, Hiroyuki Iwano, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai

  The American journal of cardiology 125 (5) 772 - 776 2020/03/01 [Refereed][Not invited]
   

  Elevated serum uric acid (UA) is associated with an increased risk of cardiovascular disease and worse clinical outcome in patients with cardiovascular disease. Nevertheless, the prognostic value of serum UA level in hospitalized heart failure patients with preserved ejection fraction (HFpEF) has not been fully elucidated. The aim of this study was to investigate whether serum UA level on admission could be associated with subsequent mortality in hospitalized patients with HFpEF. We examined 516 consecutive hospitalized HFpEF (left ventricular ejection fraction ≥50%) patients with decompensated heart failure from our HFpEF-specific multicenter registry who had serum UA data on admission. The primary outcome of interest was all-cause death. During a median follow-up period of 749 (interquartile range 540 to 831) days, 90 (17%) patients died. Higher serum UA level was significantly related to increased incidence of all-cause death (p = 0.016). In addition, patients with higher serum UA (≥6.6 mg/dl, median) and plasma B-type natriuretic peptide (≥401.2 pg/ml, median) levels had the highest incidence of all-cause death in the groups (p = 0.002). In multivariable Cox regression analysis, serum UA was an independent determinant of mortality (hazards ratio 1.23, 95% confidence interval 1.10 to 1.39) even after adjustment for prespecified confounders, renal function and the use of diuretics before admission. In conclusions, higher admission serum UA was an independent determinant of mortality in hospitalized HFpEF patients. Our findings indicate the importance of assessing admission serum UA level for further risk stratification in hospitalized patients with HFpEF.
• Differential Prognostic Impact of Atrial Fibrillation in Hospitalized Heart Failure Patients With Preserved Ejection Fraction According to Coronary Artery Disease Status - Report From the Japanese Nationwide Multicenter Registry.

  Taro Temma, Toshiyuki Nagai, Masaya Watanabe, Rui Kamada, Yumi Takahashi, Hikaru Hagiwara, Taro Koya, Motoki Nakao, Kazunori Omote, Kiwamu Kamiya, Hiroyuki Iwano, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 84 (3) 397 - 403 2020/02/25 [Refereed][Not invited]
   

  BACKGROUND: Atrial fibrillation (AF) is an important prognostic determinant in heart failure (HF) with preserved ejection fraction (HFpEF). However, it is unclear which HFpEF phenotypes are affected by AF in terms of long-term clinical outcomes because HFpEF is a heterogeneous syndrome with comorbidities such as coronary artery disease (CAD). In this study we determined the differential prognostic significance of AF in HFpEF patients according to CAD status.Methods and Results:Data for 408 hospitalized HFpEF patients enrolled in the Japanese Heart Failure Syndrome with Preserved Ejection Fraction Nationwide Multicenter Registry were analyzed. Patients were divided into 4 groups according to the presence of AF and CAD. The primary outcome was the composite of all-cause death and HF rehospitalization. The incidence of adverse events was higher in the AF-non-CAD than non-AF-non-CAD group (P=0.004). On multivariable Cox regression analysis with prespecified confounders, AF-non-CAD was significantly associated with an increased risk of adverse events than non-AF-non-CAD (adjusted HR, 1.91; 95% CI: 1.02-3.92) regardless of the type of AF. In contrast, risk was comparable between the AF-CAD and non-AF-CAD groups (adjusted HR, 1.24; 95% CI: 0.64-2.47). CONCLUSIONS: In HFpEF patients without CAD, AF was independently related to adverse events, indicating that intensive management of AF would have more beneficial effects particularly in HFpEF patients without CAD.
• Impact of Endovascular Repair on the Outcomes of Octogenarians with Ruptured Abdominal Aortic Aneurysms: A Nationwide Japanese Study.

  Tetsuo Yamaguchi, Michikazu Nakai, Yoko Sumita, Kunihiro Nishimura, Toshiyuki Nagai, Toshihisa Anzai, Yasushi Sakata, Hitoshi Ogino

  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 59 (2) 219 - 225 1078-5884 2020/02 [Refereed][Not invited]
   

  OBJECTIVE: This study aimed to clarify the impact of endovascular aneurysm repair (EVAR) on clinical outcomes in Japanese patients of advanced age with ruptured abdominal aortic aneurysm (rAAA). METHODS: This was a national registry based retrospective comparative study, using data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC), a nationwide claim based database from more than 600 hospitals. Patients admitted with rAAA between April 1, 2012, and March 31, 2015 were included in the study. Patient characteristics, management, and outcomes were compared between the elderly (aged ≥ 80 y) and the less old. The primary endpoint was in hospital mortality; the secondary endpoint was the functional status at discharge. RESULTS: Of 3 969 eligible patients, 49.9% were categorised as elderly. Elderly patients had a higher prevalence of female gender (41.8% vs. 17.0%, p < .001) and disturbance of consciousness on admission (28.6% vs. 20.7%, p < .001). They were less likely to undergo open surgical repair (31.6% vs. 56.7%, p < .001), although EVAR was performed similarly in both groups (13.7% vs. 14.8%, p = .33). The unadjusted mortality rate (61.8% vs. 37.6%, p < .001) and mean Barthel index at discharge (73.0 vs. 91.8, p < .001) were statistically significantly worse in the elderly. Multilevel mixed effect logistic regression analyses showed that old age was detected as an independent predictor of in hospital death (odds ratio 2.75; 95% confidence interval, 2.39-3.17; p < .001). However, for patients who received EVAR, old age was not statistically significant (odds ratio 1.13; 95% confidence interval, 0.77-1.66; p = .53). CONCLUSION: Elderly patients with rAAA were less likely to be offered open surgical repair, and the mortality among those who received surgery was high. However, for the small subgroup of elderly patients currently selected for EVAR there was a favourable outcome. The further implementation of EVAR for rAAA in Japan, especially for elderly patients with suitable anatomy, may be justified.
• Left ventricular outflow tract velocity time integral in hospitalized heart failure with preserved ejection fraction.

  Kazunori Omote, Toshiyuki Nagai, Hiroyuki Iwano, Shingo Tsujinaga, Kiwamu Kamiya, Tadao Aikawa, Takao Konishi, Takuma Sato, Yoshiya Kato, Hirokazu Komoriyama, Yuta Kobayashi, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai

  ESC heart failure 7 (1) 167 - 175 2020/02 [Refereed][Not invited]
   

  AIMS: The prognostic implication of left ventricular outflow tract velocity time integral (LVOT-VTI) on admission in hospitalized heart failure with preserved ejection fraction (HFpEF) patients has not been determined. We sought to investigate whether LVOT-VTI on admission is associated with worse clinical outcomes in hospitalized patients with HFpEF. METHODS AND RESULTS: We studied consecutive 214 hospitalized HFpEF patients who had accessible LVOT-VTI data on admission, from a prospective HFpEF-specific multicentre registry. The primary outcome of interest was the composite of all-cause death and readmission due to heart failure. During a median follow-up period of 688 (interquartile range 162-810) days, the primary outcome occurred in 83 patients (39%). The optimal cut-off value of LVOT-VTI for the primary outcome estimated by receiver operating characteristic analysis was 15.8 cm. Lower LVOT-VTI was significantly associated with the primary outcome compared with higher LVOT-VTI (P = 0.005). Multivariable Cox regression analyses revealed that lower LVOT-VTI was an independent determinant of the primary outcome (hazard ratio 0.94, 95% confidence interval 0.91-0.98). In multivariable linear regression, haemoglobin level was the strongest independent determinant of LVOT-VTI among clinical parameters (β coefficient = -0.61, P = 0.007). Furthermore, patients with lower LVOT-VTI and anaemia had the worst clinical outcomes among the groups (P < 0.001). CONCLUSIONS: Lower admission LVOT-VTI was an independent determinant of worse clinical outcomes in hospitalized HFpEF patients, indicating that LVOT-VTI on admission might be useful for categorizing a low-flow HFpEF phenotype and risk stratification in hospitalized HFpEF patients.
• Viability assessment by 18F-FDG PET in a patient with a large left ventricular aneurysm and obstructive coronary artery disease.

  Eigo Kurebayashi, Osamu Manabe, Masanao Naya, Shiro Miura, Takehiro Yamashita, Yoshihiro Imai, Akira Ando, Chihoko Miyazaki, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 27 (1) 326 - 329 1071-3581 2020/02 [Refereed][Not invited]
  
• Serum Brain-Derived Neurotrophic Factor Levels Are Associated with Skeletal Muscle Function but Not with Muscle Mass in Patients with Heart Failure.

  Ippei Nakano, Shintaro Kinugawa, Hiroaki Hori, Arata Fukushima, Takashi Yokota, Shingo Takada, Naoya Kakutani, Yoshikuni Obata, Katsuma Yamanashi, Toshihisa Anzai

  International heart journal 61 (1) 96 - 102 2020/01/31 [Refereed][Not invited]
   

  Heart failure (HF) is associated with aberrant skeletal muscle impairments, which are closely linked to the severity of HF. A low level of brain-derived neurotrophic factor (BDNF), a myokine produced in the skeletal muscle, is known to be involved in reduced exercise capacity and poor prognosis in HF. However, little is known about the factors or conditions of skeletal muscle associated with BDNF levels. We investigated the association between serum BDNF levels and the skeletal muscle mass and function in HF patients (n = 60, 63 ± 13 years) and age-matched controls (n = 29, 61 ± 16 years). The serum BDNF level was significantly lower in the HF patients compared to the controls (24.9 ± 0.9 versus 28.6 ± 1.3, P = 0.021). In a univariate analysis, BDNF was significantly correlated with the peak oxygen uptake, estimated glomerular filtration rate, 10-m gait speed, and muscle strength, but not with the body mass index or lean mass in the HF group. A multiple linear regression analysis revealed that BDNF was independently associated with muscle strength (β-coefficient = 2.80, 95%CI: 1.89-11.8, P = 0.008). Serum BDNF levels were associated with exercise capacity and skeletal muscle function, but not with muscle mass. These novel findings may suggest that BDNF production is controlled by muscle function and activity and consequently regulates exercise capacity, highlighting the importance of adequate training regarding skeletal muscle in HF patients.
• Improved regional myocardial blood flow and flow reserve after coronary revascularization as assessed by serial 15O-water positron emission tomography/computed tomography.

  Tadao Aikawa, Masanao Naya, Kazuhiro Koyanagawa, Osamu Manabe, Masahiko Obara, Keiichi Magota, Noriko Oyama-Manabe, Nagara Tamaki, Toshihisa Anzai

  European heart journal cardiovascular Imaging 21 (1) 36 - 46 2047-2404 2020/01/01 [Refereed][Not invited]
   

  AIMS: Myocardial perfusion imaging without and with quantitative myocardial blood flow (MBF) and myocardial flow reserve (MFR) plays an important role in the diagnosis and risk stratification of patients with stable coronary artery disease (CAD). We aimed to quantify the effects of coronary revascularization on regional stress MBF and MFR and to determine whether the presence of subendocardial infarction was associated with these changes. METHODS AND RESULTS: Forty-seven patients with stable CAD were prospectively enrolled. They underwent 15O-water positron emission tomography at baseline and 6 months after optimal medical therapy alone (n = 16), percutaneous coronary intervention (PCI) (n = 18), or coronary artery bypass grafting (CABG) (n = 13). Stenosis of ≥50% diameter was detected in 98/141 vessels (70%). The regional MFR was significantly increased from baseline to follow-up [1.84 (interquartile range, IQR 1.28-2.17) vs. 2.12 (IQR 1.69-2.63), P < 0.001] in vessel territories following PCI or CABG due to an increase in the stress MBF [1.33 (IQR 0.97-1.67) mL/g/min vs. 1.64 (IQR 1.38-2.17) mL/g/min, P < 0.001], whereas there was no significant change in the regional stress MBF or MFR in vessel territories without revascularization. A multilevel mixed-effects models adjusted for baseline characteristics, subendocardial infarction assessed by cardiovascular magnetic resonance imaging, and intra-patient correlation showed that the degree of angiographic improvement after coronary revascularization was significantly associated with increased regional stress MBF and MFR (P < 0.05 for all). CONCLUSION: Coronary revascularization improved the regional stress MBF and MFR in patients with stable CAD. The magnitude of these changes was associated with the extent of revascularization independent of subendocardial infarction.
• Dual Gate Doppler法による左房収縮時の血流時相解析

  岡田 一範, 岡田 由佳, 加賀 早苗, 村山 迪史, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 三神 大世, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久

  超音波検査技術抄録集 一般社団法人 日本超音波検査学会 45 S110 - S110 2020
• Diagnosis, prevention, and treatment of cardiovascular diseases in people with type 2 diabetes and prediabetes: a consensus statement jointly from the Japanese Circulation Society and the Japan Diabetes Society

  Eiichi Araki, Atsushi Tanaka, Nobuya Inagaki, Hiroshi Ito, Kohjiro Ueki, Toyoaki Murohara, Kenjiro Imai, Masataka Sata, Takehiro Sugiyama, Hideki Ishii, Shunsuke Yamane, Takashi Kadowaki, Issei Komuro, Koichi Node, Tetsuya Amano, Toshihisa Anzai, Tetsuya Babazono, Masanori Emoto, Keiichi Fukuda, Nobuhisa Hagiwara, Ken ichi Hirata, Yuji Ikari, Takanori Ikeda, Chisato Izumi, Masahiro Jinzaki, Hideaki Kaneto, Hideki Katagiri, Takeshi Kimura, Yoshio Kobayashi, Koji Maemura, Satoaki Matoba, Tetsuo Minamino, Yoshihide Mitani, Shin ichiro Miura, Yoshihio Morino, Jiro Nakamura, Yoshihiko Nishio, Wataru Ogawa, Mitsuru Ohishi, Hiroyuki Okura, Minoru Ono, Yasushi Sakata, Asako Sato, Akira Shimada, Wataru Shimizu, Iichiro Shimomura, Ichiro Shiojima, Masayuki Takamura, Yasutomo Takeishi, Kazuo Tanemoto, Yukio Tanizawa, Yasuo Terauchi, Kazuyuki Tobe, Yayoi Tetsuou, Hirotaka Watada, Toshimasa Yamauchi, Masafumi Yano, Narihito Yoshioka

  Diabetology International 2190-1678 2020
• Emery-Dreifuss muscular dystrophy as a possible cause of coronary embolism.

  Atsushi Tada, Takao Konishi, Takuma Sato, Tomoya Sato, Takuya Koizumi, Sakae Takenaka, Yoshifumi Mizuguchi, Takahide Kadosaka, Ko Motoi, Yuta Kobayashi, Hirokazu Komoriyama, Yoshiya Kato, Kazunori Omote, Shingo Tsujinaga, Rui Kamada, Kiwamu Kamiya, Hiroyuki Iwano, Toshiyuki Nagai, Nanase Okazaki, Yoshihiro Matsuno, Toshihisa Anzai

  Cardiology journal 27 (4) 443 - 444 2020
• 心エコー法とMRIによる肺動脈弁逆流重症度に乖離を認めた総動脈幹症の術後症例

  岩野 弘幸, 村山 迪史, 山澤 弘州, 武田 充人, 真鍋 徳子, 石森 直樹, 千葉 泰之, 石坂 傑, 更科 美羽, 辻永 真吾, 中鉢 雅大, 加賀 早苗, 安斉 俊久

  日本成人先天性心疾患学会雑誌 日本成人先天性心疾患学会 9 (1) 288 - 288 2020/01 [Refereed][Not invited]
  
• 心エコー法とMRIによる肺動脈弁逆流重症度に乖離を認めた総動脈幹症の術後症例

  岩野 弘幸, 村山 迪史, 山澤 弘州, 武田 充人, 真鍋 徳子, 石森 直樹, 千葉 泰之, 石坂 傑, 更科 美羽, 辻永 真吾, 中鉢 雅大, 加賀 早苗, 安斉 俊久

  日本成人先天性心疾患学会雑誌 日本成人先天性心疾患学会 9 (1) 288 - 288 2020/01 [Refereed][Not invited]
  
• Histopathologically confirmed very late stent thrombosis associated with stent fracture after implantation of first-generation drug eluting stent.

  Takao Konishi, Naohiro Funayama, Tadashi Yamamoto, Daisuke Hotta, Yuta Kobayashi, Hirokazu Komoriyama, Yoshiya Kato, Kazunori Omote, Takuma Sato, Kiwamu Kamiya, Toshiyuki Nagai, Shinya Tanaka, Toshihisa Anzai

  Cardiology journal 27 (2) 204 - 205 2020 [Refereed][Not invited]
  
• 18F-FMISO PET/CT detects hypoxic lesions of cardiac and extra-cardiac involvement in patients with sarcoidosis.

  Sho Furuya, Masanao Naya, Osamu Manabe, Kenji Hirata, Hiroshi Ohira, Tadao Aikawa, Kazuhiro Koyanagawa, Keiichi Magota, Ichizo Tsujino, Toshihisa Anzai, Yuji Kuge, Noriko Oyama-Manabe, Kohsuke Kudo, Tohru Shiga, Nagara Tamaki

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 28 (5) 2141 - 2148 2019/12/09 [Refereed][Not invited]
   

  BACKGROUND: 18F-fluoromisonidazole (FMISO) is a hypoxia positron emission tomography (PET) tracer. Here, we evaluated cardiac and extra-cardiac sarcoidosis using both FMISO and 18F-fluorodeoxyglucose (FDG) PET/CT in a prospective cohort of patients with sarcoidosis. METHODS: Ten consecutive sarcoidosis patients with suspected cardiac involvement were prospectively enrolled. Each patient fasted overnight (for ≥ 18 hours) preceded by a low-carbohydrate diet before FDG PET/CT but not given special dietary instructions before the FMISO PET/CT scan. We visually and semiquantitatively assessed the uptakes of FMISO and FDG using the maximal standardized uptake value (SUVmax). The metabolic volume (MV) of FDG was calculated as the volume within the boundary determined by the threshold (mean SUV of blood pool × 1.5). RESULTS: Nine patients showed focal FDG uptake in the myocardium and were diagnosed with cardiac sarcoidosis. Among the patients with extra-cardiac lesions, FDG uptake was seen in 8 lymph nodes and 3 lung lesions. FMISO uptake was seen in the 7 cardiac (77.8%) and 6 extra-cardiac (54.5%) lesions. None of the patients showed physiological FMISO uptake in the myocardium. The SUVmax values of the lesions with FMISO uptake were higher than those of the lesions without FMISO uptake in both the cardiac (SUVmax: 9.9, IQR: 8.4-10.0 vs 7.3, IQR: 6.3-8.2) and non-cardiac lesions (SUVmax: 17.6, IQR: 14.5-19.3 vs 6.1, IQR: 5.9-6.2; P = 0.006). The MV values of the lesions with FMISO uptake were significantly higher than those of the lesions without FMISO uptake (111.3, IQR: 78.3-135.7 vs 6.4, IQR: 1.9-23.3; P = 0.0009). CONCLUSIONS: FMISO showed no physiological myocardial uptake and did not require special preparation. FMISO PET has the potential to detect hypoxic lesions in patients with sarcoidosis.
• Evidence-Based Utilization of Prognostic Prediction Models in Cardiovascular Medicine.

  Naotsugu Iwakami, Toshiyuki Nagai, Toshiaki A Furukawa, Kunihiro Nishimura, Toshihisa Anzai

  Circulation reports 2 (1) 10 - 16 2019/12/05 

  Prediction models are combinations of predictors to assess the risks of specific endpoints such as the presence or prognosis of a disease. Many novel predictors have been developed, modelling techniques have been evolving, and prediction models are currently abundant in the medical literature, especially in cardiovascular medicine, but evidence is still lacking regarding how to use them. Recent methodological advances in systematic reviews and meta-analysis have enabled systematic evaluation of prediction model studies and quantitative analysis to identify determinants of model performance. Knowing what is critical to model performance, under what circumstances model performance remains adequate, and when a model might require further adjustment and improvement will facilitate effective utilization of prediction models and will enhance diagnostic and prognostic accuracy in clinical practice. In this review article, we provide a current methodological overview of the attempts to implement evidence-based utilization of prognostic prediction models for all potential model users, including patients and their families, health-care providers, administrators, researchers, guideline developers and policy makers.
• Long-term Prognostic Significance of Admission Tricuspid Regurgitation Pressure Gradient in Hospitalized Patients With Heart Failure With Preserved Ejection Fraction: A Report From the Japanese Real-World Multicenter Registry.

  Kazunori Omote, Toshiyuki Nagai, Kiwamu Kamiya, Tadao Aikawa, Shingo Tsujinaga, Yoshiya Kato, Hirokazu Komoriyama, Hiroyuki Iwano, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai

  Journal of cardiac failure 25 (12) 978 - 985 1071-9164 2019/12 [Refereed][Not invited]
   

  BACKGROUND: Doppler-estimated peak systolic tricuspid regurgitation pressure gradient (TRPG) is a representative noninvasive parameter for evaluating pulmonary artery systolic pressure, which can be a determinant of adverse outcomes in chronic heart failure with preserved ejection fraction (HFpEF). However, the prognostic implications of TRPG at admission for hospitalized patients with HFpEF are undetermined. METHODS AND RESULTS: We examined 469 consecutive hospitalized patients with decompensated HFpEF (left ventricular ejection fraction ≥ 50%) who underwent TRPG measurement at admission in our HFpEF multicenter registry. The primary outcome of interest was all-cause death. Admission TRPG was significantly correlated with estimated pulmonary capillary wedge pressure and left atrial dimension (r = 0.24, P < 0.001 and r = 0.21, P < 0.001, respectively). During a median follow-up period of 748 (IQR 540-820) days, 83 patients died. Higher TRPG was significantly associated with higher mortality compared to lower TRPG (log-rank; P = 0.007). Multivariable analysis revealed that elevated TRPG was an independent determinant of mortality (HR 1.02, 95% CI 1.01-1.04, P = 0.008) after adjustment for prespecified confounders and renal function. CONCLUSIONS: Elevated TRPG at admission was an independent determinant of mortality in hospitalized patients with HFpEF, indicating that TRPG at admission could be a useful marker for risk stratification in these patients.
• 収縮機能維持の心不全入院患者における入院時の三尖弁逆流圧較差の長期予後的意義 多施設レジストリーからの報告 TRPGとHFpEFにおける長期転帰(Long-term prognostic significance of admission tricuspid regurgitation pressure gradient in hospitalized heart failure patients with preserved ejection fraction: a report from the Japanese real-world multicenter registry: TRPG and long-term outcomes in HFpEF)

  Omote Kazunori, Nagai Toshiyuki, Kamiya Kiwamu, Aikawa Tadao, Tsujinaga Shingo, Kato Yoshiya, Komoriyama Hirokazu, Iwano Hiroyuki, Yamamoto Kazuhiro, Yoshikawa Tsutomu, Saito Yoshihiko, Anzai Toshihisa

  福田記念医療技術振興財団情報 (32) 41 - 54 2019/12 

  収縮機能維持心不全(HFpEF)多施設レジストリーにて、入院時に三尖弁逆流圧較差(TRPG)を測定した非代償性HFpEF患者(左室駆出分画≧50%)469名(女232名、平均78.3歳)を対象として、入院TRPGの予後的意義を検討した。主要評価項目は総死亡率とした。その結果、入院時TRPGは推定肺毛細血管楔入圧(PCWP)および左房径(LAD)と有意に相関した。追跡期間中央値の748日までに患者83名が死亡した。TRPG高値患者はTRPG低値患者に比べて有意に死亡率が高かった。多変量解析では、TRPG上昇が事前指定の交絡因子と腎機能による調整後の死亡率の独立決定因子であった。以上より、入院TRPG上昇はHFpEF入院患者の死亡率の独立決定因子であり、入院時のTRPGは有用なリスク分類の指標になると考えられた。
• A mitochondrial delivery system using liposome-based nanocarriers that target myoblast cells.

  Takashi Katayama, Shintaro Kinugawa, Shingo Takada, Takaaki Furihata, Arata Fukushima, Takashi Yokota, Toshihisa Anzai, Mitsue Hibino, Hideyoshi Harashima, Yuma Yamada

  Mitochondrion 49 66 - 72 1567-7249 2019/11 [Refereed][Not invited]
   

  Mitochondrial function is reduced in skeletal muscles of many patients with systemic diseases and it is difficult to deliver medicinal substances to mitochondria in such tissue. In this study, we report on attempts to develop liposome-based carriers for mitochondrial delivery using mouse myoblasts (C2C12) by varying the lipid composition of the carriers. We found that a liposome that contains an optimal lipid modified with the KALA peptide (a cellular uptake and mitochondrial targeting device) was the most effective nanocarrier for achieving mitochondrial delivery in C2C12 cells. We also report on successful mitochondrial transgene expression using the carriers encapsulating a mitochondrial DNA vector as we previously reported.
• Impact of Left Ventricular Suction During Exercise on Clinical Outcomes in Patients With Heart Failure

  Shingo Tsujinaga, Hiroyuki Iwano, Suguru Ishizaka, Yasuyuki Chiba, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Takuma Sato, Toshihisa Anzai

  CIRCULATION 140 0009-7322 2019/11 [Refereed][Not invited]
   

  0
• JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version.

  Fumio Terasaki, Arata Azuma, Toshihisa Anzai, Nobukazu Ishizaka, Yoshio Ishida, Mitsuaki Isobe, Takayuki Inomata, Hatsue Ishibashi-Ueda, Yoshinobu Eishi, Masafumi Kitakaze, Kengo Kusano, Yasushi Sakata, Noriharu Shijubo, Akihito Tsuchida, Hiroyuki Tsutsui, Takatomo Nakajima, Satoshi Nakatani, Taiko Horii, Yoshikazu Yazaki, Etsuro Yamaguchi, Tetsuo Yamaguchi, Tomomi Ide, Hideo Okamura, Yasuchika Kato, Masahiko Goya, Mamoru Sakakibara, Kyoko Soejima, Toshiyuki Nagai, Hiroshi Nakamura, Takashi Noda, Takuya Hasegawa, Hideaki Morita, Tohru Ohe, Yasuki Kihara, Yoshihiko Saito, Yukihiko Sugiyama, Shin-Ichiro Morimoto, Akira Yamashina

  Circulation journal : official journal of the Japanese Circulation Society 83 (11) 2329 - 2388 1346-9843 2019/10/25 [Refereed][Not invited]
  
• Mitochondrial reactive oxygen species generation in blood cells is associated with disease severity and exercise intolerance in heart failure patients.

  Ryosuke Shirakawa, Takashi Yokota, Takayuki Nakajima, Shingo Takada, Miwako Yamane, Takaaki Furihata, Satoshi Maekawa, Hideo Nambu, Takashi Katayama, Arata Fukushima, Akimichi Saito, Naoki Ishimori, Flemming Dela, Shintaro Kinugawa, Toshihisa Anzai

  Scientific reports 9 (1) 14709 - 14709 2019/10/11 [Refereed][Not invited]
   

  Systemic oxidative stress plays a key role in the development of chronic heart failure (CHF). We tested the hypothesis that mitochondrial reactive oxygen species (ROS) generation in circulating peripheral blood mononuclear cells (PBMCs) contributes to CHF progression. A total of 31 patients who had a history of hospital admission due to worsening HF were enrolled and grouped as having either mild CHF defined as New York Heart Association (NYHA) functional class I-II or moderate-to-severe CHF defined as NYHA functional class III. ROS levels in PBMC mitochondria were significantly increased in CHF patients with NYHA functional class III compared to those with NYHA functional class I-II, accompanied by impaired mitochondrial respiratory capacity in PBMCs. ROS generation in PBMC mitochondria was positively correlated with urinary 8-hydroxydeoxyguanosine, a systemic oxidative stress marker, in CHF patients. Importantly, mitochondrial ROS generation in PBMCs was directly correlated with plasma levels of B-type natriuretic peptide, a biomarker for severity of HF, and inversely correlated with peak oxygen uptake, a parameter of exercise capacity, in CHF patients. The study showed that ROS generation in PBMC mitochondria was higher in patients with advanced CHF, and it was associated with disease severity and exercise intolerance in CHF patients.
• The rate of myocardial perfusion recovery after steroid therapy and its implication for cardiac events in cardiac sarcoidosis and primarily preserved left ventricular ejection fraction.

  Kazuhiro Koyanagawa, Masanao Naya, Tadao Aikawa, Osamu Manabe, Sho Furuya, Masato Kuzume, Noriko Oyama-Manabe, Hiroshi Ohira, Ichizo Tsujino, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 28 (4) 1745 - 1756 1071-3581 2019/10/11 [Refereed][Not invited]
   

  BACKGROUND: Sarcoidosis is a multisystemic disorder of unknown cause characterized by immune granuloma formation in the involved organs. Few studies have reported on the myocardial perfusion changes by immunosuppression therapy in cardiac sarcoidosis (CS). Additionally, the relationship between myocardial perfusion changes and prognosis is unknown. Therefore, this study aimed to clarify myocardial perfusion recovery after steroid therapy and its prognostic value for major adverse cardiac events (MACE) in patients with CS. METHODS AND RESULTS: Thirty-eight consecutive patients with CS {median age, 63 [interquartile range (IQR) 51-68] years; 10 men} underwent both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and electrocardiography-gated single-photon emission CT (SPECT) pre- and post-steroid therapy. Patients with improved or preserved myocardial perfusion after post-therapy were defined as the recovery group and those with worsened myocardial perfusion as the non-recovery group. Twenty-six patients (68%) were categorized as the recovery group. MACE occurred in eight patients. The Kaplan-Meier curves revealed a significantly higher rate of MACE in the non-recovery group (17.4%/y vs 2.9%/y, P = 0.007). CONCLUSIONS: Myocardial perfusion was recovered by steroid therapy in 61% and preserved in 8% of patients. Myocardial perfusion recovery after steroid therapy was significantly associated with a low incidence of MACE.
• Development and validation of support tools for advance care planning in patients with chronic heart failure.

  Yasuko Takada, Yasuhiro Hamatani, Yukie Kawano, Yuta Anchi, Michikazu Nakai, Chisato Izumi, Satoshi Yasuda, Hisao Ogawa, Yasuo Sugano, Toshihisa Anzai, Tatsuhiro Shibata, Atsushi Suzuki, Mitsunori Nishikawa, Hiroto Ito, Masashi Kato, Tsuyoshi Shiga, Yoshihiro Fukumoto

  International journal of palliative nursing 25 (10) 494 - 502 2019/10/02 [Refereed][Not invited]
   

  BACKGROUND: Advance care planning (ACP) is recommended as part of the management of patients with heart failure (HF). AIMS: To develop and validate ACP support tools for patients with HF. METHODS: An ACP support tool was developed based on a systematic literature review. A multi-center, prospective before and after study was conducted to evaluate the usefulness of the support tool. This study included 21 patients with HF, 11 patients formed the control group and 10 patients were part of the intervention group who received ACP from medical staff using the ACP support tools developed for this study. Participants of the study were surveyed about their experience of ACP using a 6-point Likert scale. FINDINGS: All of the healthcare professionals (n=9) involved in the study found the ACP tool useful and about 90% of patients considered the support tool useful. The score for 'the patient did not feel anxious about the future after receiving ACP discussion' was significantly higher (3.5 [3.0, 4.0] vs 2.0 [1.0, 3.0]; P=0.04) in the intervention group that used the ACP tool. CONCLUSION: ACP support tools are useful to manage patients with HF and could enable effective ACP without increasing patient anxiety.
• 心臓サルコイドーシス診療におけるFDG-PETによる活動性評価をガイドとした免疫抑制療法戦略の限界

  永井 利幸, 相川 忠夫, 安斉 俊久

  日本サルコイドーシス/肉芽腫性疾患学会雑誌 日本サルコイドーシス 39 (1-2) 73 - 76 1883-1273 2019/10 [Refereed][Not invited]
   

  18F-fluorodeoxyglucose-positron emission tomography(FDG-PET)は,心臓サルコイドーシス(心サ症)の診断および病態評価に有用と考えられるが,FDG-PETにより評価された活動性炎症所見と臨床経過の乖離がしばしば経験される.今回我々はFDG-PET所見に増悪所見を認めた一方で臨床経過は改善を認めた症例,およびFDG-PET所見に改善所見を認めた一方で臨床経過は増悪を認めた症例を経験した.また,心サ症確診症例111例のうち,長期経過観察中にFDG-PET所見の増悪を認めた13例を検討した結果,同時に有害事象を伴う症例は6例であり,そのうち増悪時免疫抑制療法が中止されていた症例は3例であった.全例免疫抑制療法を強化したものの,その後2例に再度有害事象が発生した.一方,FDG-PET所見の増悪に有害事象を伴わない症例は7例であり,そのうち5例で免疫抑制療法を強化したものの,2例に再度有害事象が発生した.免疫抑制療法中のFDG-PET所見の変化が持つ臨床的意義には未だ不明な点が多く,今後の症例蓄積と前向き多施設研究が必要である.(著者抄録)
• 心筋サルコイドーシスにおける心筋血流の改善から予想される心イベントの減少化(Improvement in myocardial perfusion predicts fewer cardiac events in cardiac sarcoidosis)

  小梁川 和宏, 納谷 昌直, 相川 忠夫, 真鍋 治, 古家 翔, 葛目 将人, 真鍋 徳子, 大平 洋, 辻野 一三, 安斉 俊久

  核医学 56 (Suppl.) S137 - S137 0022-7854 2019/10 [Refereed][Not invited]
  
• Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry.

  Yu Sato, Akiomi Yoshihisa, Masayoshi Oikawa, Toshiyuki Nagai, Tsutomu Yoshikawa, Yoshihiko Saito, Kazuhiro Yamamoto, Yasuchika Takeishi, Toshihisa Anzai

  European heart journal. Acute cardiovascular care 8 (7) 623 - 633 2048-8726 2019/10 [Refereed][Not invited]
   

  INTRODUCTION: Hyponatremia predicts adverse prognosis in patients with heart failure in particular with reduced ejection fraction. In contrast, it has recently been reported that hyponatremia on admission is not a predictor of post-discharge mortality in patients with heart failure with preserved ejection fraction. We investigated the prognostic impact of hyponatremia at discharge in patients with heart failure with preserved ejection fraction and its clinical characteristics. METHODS AND RESULTS: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese patients hospitalised with heart failure with preserved ejection fraction and left ventricular ejection fraction of 50% or greater. Five hundred consecutive patients were enrolled in this analysis. We divided the patients into two groups based on their sodium serum levels at discharge: hyponatremia group (sodium <135 mEq/L, n=50, 10.0%) and control group (sodium ⩾135 mEq/L, n=450, 90.0%). This present analysis had two primary endpoints: all-cause death and all-cause death or rehospitalisation for heart failure. At discharge, the hyponatremia group had lower systolic blood pressure (110.0 mmHg vs. 114.5 mmHg, P=0.014) and higher levels of urea nitrogen (31.9 mg/dL vs. 24.2 mg/dL, P=0.032). In the Kaplan-Meier analysis, more patients in the hyponatremia group reached the primary endpoints than those in the control group (log rank <0.01, respectively). In the Cox proportional hazard analysis, hyponatremia at discharge was a predictor of the two endpoints (all-cause death, hazard ratio 2.708, 95% confidence interval 1.557-4.708, P<0.001; all-cause death or rehospitalisation for heart failure, hazard ratio 1.829, 95% confidence interval 1.203-2.780, P=0.005). CONCLUSIONS: Hyponatremia at discharge is associated with adverse prognosis in hospitalised patients with heart failure with preserved ejection fraction.
• Simple and noninvasive method to estimate right ventricular operating stiffness based on echocardiographic pulmonary regurgitant velocity and tricuspid annular plane movement measurements during atrial contraction.

  Michito Murayama, Kazunori Okada, Sanae Kaga, Hiroyuki Iwano, Shingo Tsujinaga, Miwa Sarashina, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Mutsumi Nishida, Hitoshi Shibuya, Nobuo Masauzi, Toshihisa Anzai, Taisei Mikami

  The international journal of cardiovascular imaging 35 (10) 1871 - 1880 1569-5794 2019/10 [Refereed][Not invited]
   

  It was recently shown that invasively determined right ventricular (RV) stiffness was more closely related to the prognosis of patients with pulmonary hypertension than RV systolic function. So far, a completely noninvasive method to access RV stiffness has not been reported. We aimed to clarify the clinical usefulness of our new echocardiographic index of RV operating stiffness using atrial-systolic descent of the pulmonary artery-RV pressure gradient derived from pulmonary regurgitant velocity (PRPGDAC) and tricuspid annular plane movement during atrial contraction (TAPMAC). We studied 81 consecutive patients with various cardiac diseases who underwent echocardiography and cardiac catheterization. We measured PRPGDAC and TAPMAC using continuous-wave Doppler and M-mode echocardiography, respectively, and calculated PRPGDAC/TAPMAC. RV end-diastolic pressure (RVEDP) and RV pressure increase during atrial contraction (ΔRVPAC) were invasively measured, and RV volume change during atrial contraction (ΔVAC) was calculated from echocardiographic late-diastolic transtricuspid flow time-velocity integral and tricuspid annular area; thus ΔRVPAC/ΔVAC was used as the standard index for RV operating stiffness. PRPGDAC/TAPMAC well correlated with ΔRVPAC/ΔVAC (r = 0.84, p < 0.001) and RVEDP (r = 0.80, p < 0.001), and the area under the receiver operating characteristic curve to discriminate RVEDP > 12 mmHg was 0.94. Multivariate regression analysis revealed that PRPGDAC/TAPMAC was the single independent determinant of ΔRVPAC/ΔVAC (β = 0.86, p < 0.001). PRPGDAC/TAPMAC is useful to estimate RV operating stiffness and a good practical indicator of RVEDP.
• Long-Term Tolvaptan Treatment in Refractory Heart Failure.

  Teruhiko Imamura, Shintaro Kinugawa, Toshihiro Muramatsu, Tsuyoshi Shiga, Akiyoshi Ogimoto, Toshihisa Anzai, Nobuhisa Hagiwara, Hiroyuki Tsutsui, Issei Komuro, Koichiro Kinugawa

  Circulation reports 1 (10) 431 - 437 2019/09/26 

  Background: The vasopressin type-2 receptor antagonist tolvaptan is an essential tool in the management of decompensated heart failure (HF) in the inpatient setting for short-term use with careful monitoring. There is conflicting evidence, however, for its long-term use. Methods and Results: In this prospective, multi-center, open-labeled, randomized control trial, Assessment of QUAlity of life during long-term treatment of ToLVaptan in refractory HF (AQUA-TLV study), patients with congestive HF refractory to furosemide ≥60 mg/day were randomly assigned to a control group or tolvaptan add-on group and followed for 6 months, after confirmation of baseline urine osmolality ≥350 mOsm/L. Twenty-nine patients (median age, 60 years; 22 male) were enrolled and assigned to a control group (n=16) or a tolvaptan group (n=13). Minnesota Living with Heart Failure Questionnaire score improved significantly in the tolvaptan group (from 58 to 10, P=0.030). In the tolvaptan group, diuretics dose reduced (P=0.001), serum creatinine decreased (P=0.040), and hyponatremia tended to improve (P=0.12). The tolvaptan group had a lower HF readmission rate compared with the control group (0.213 vs. 1.242 events/year, P=0.13). Conclusions: Six-month tolvaptan therapy improved quality of life and renal function and reduced HF readmissions, when given to the estimated responders (UMIN Clinical Trial Registry Number: UMIN 000009604).
• JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure - Digest Version.

  Hiroyuki Tsutsui, Mitsuaki Isobe, Hiroshi Ito, Hiroshi Ito, Ken Okumura, Minoru Ono, Masafumi Kitakaze, Koichiro Kinugawa, Yasuki Kihara, Yoichi Goto, Issei Komuro, Yoshikatsu Saiki, Yoshihiko Saito, Yasushi Sakata, Naoki Sato, Yoshiki Sawa, Akira Shiose, Wataru Shimizu, Hiroaki Shimokawa, Yoshihiko Seino, Koichi Node, Taiki Higo, Atsushi Hirayama, Miyuki Makaya, Tohru Masuyama, Toyoaki Murohara, Shin-Ichi Momomura, Masafumi Yano, Kenji Yamazaki, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Michihiro Yoshimura, Masatoshi Akiyama, Toshihisa Anzai, Shiro Ishihara, Takayuki Inomata, Teruhiko Imamura, Yu-Ki Iwasaki, Tomohito Ohtani, Katsuya Onishi, Takatoshi Kasai, Mahoto Kato, Makoto Kawai, Yoshiharu Kinugasa, Shintaro Kinugawa, Toru Kuratani, Shigeki Kobayashi, Yasuhiko Sakata, Atsushi Tanaka, Koichi Toda, Takashi Noda, Kotaro Nochioka, Masaru Hatano, Takayuki Hidaka, Takeo Fujino, Shigeru Makita, Osamu Yamaguchi, Uichi Ikeda, Takeshi Kimura, Shun Kohsaka, Masami Kosuge, Masakazu Yamagishi, Akira Yamashina

  Circulation journal : official journal of the Japanese Circulation Society 83 (10) 2084 - 2184 1346-9843 2019/09/25 [Refereed][Not invited]
  
• Change in the NT-proBNP/Mature BNP Molar Ratio Precedes Worsening Renal Function in Patients With Acute Heart Failure: A Novel Predictor Candidate for Cardiorenal Syndrome.

  Hiroyuki Takahama, Toshio Nishikimi, Seiji Takashio, Tomohiro Hayashi, Chiaki Nagai-Okatani, Takashi Asada, Akihiro Fujiwara, Yasuaki Nakagawa, Masashi Amano, Yasuhiro Hamatani, Atsushi Okada, Makoto Amaki, Takuya Hasegawa, Hideaki Kanzaki, Kunihiro Nishimura, Satoshi Yasuda, Kenji Kangawa, Toshihisa Anzai, Naoto Minamino, Chisato Izumi

  Journal of the American Heart Association 8 (17) e011468  2019/09/03 [Refereed][Not invited]
   

  Background Early detection for worsening renal function (WRF) is indispensable in patients with acute decompensated heart failure (HF). We tested the hypothesis that the difference in the circulating levels of each B-type or brain natriuretic peptide (BNP) molecular form is associated with the occurrence of WRF. Methods and Results Circulating levels of proBNP, the NT-proBNP (N-terminal proBNP), and total BNP (proBNP+mature BNP) were prospectively measured in patients with acute decompensated HF using specific and sensitive enzyme immunochemiluminescent assays. An estimated mature BNP (emBNP) concentration was calculated by subtracting proBNP levels from total BNP levels. WRF was defined as a >20% decrease in the estimated glomerular filtration rate during the hospitalization. One-way repeated-measures ANOVA was used to compare the changes of variables between the patients with and without WRF. In patients with acute decompensated HF (New York Heart Association class III-IV; 96%) hospitalized for HF, NT-proBNP levels did not differ during the hospitalization between patients with and without WRF (n=42 and 140, respectively). By contrast, emBNP levels were lower in patients with WRF than in those without WRF on day 3 after admission. NT-proBNP/emBNP molar ratios were elevated on day 3 after admission in the patients with WRF, before estimated glomerular filtration rate declined, but were unchanged in patients without WRF. On day 3 after hospital admission, NT-proBNP/emBNP ratios were strongly associated with percentage decreases in estimated glomerular filtration rate. Conclusions These findings suggest that elevation of NT-proBNP/emBNP ratio precedes WRF in patients with acute HF and can be a potentially useful biomarker for risk stratification of cardiorenal syndrome.
• Combined heart and kidney transplantation-Is there a protective effect against cardiac allograft vasculopathy using intravascular ultrasound?

  Takuma Sato, Richard Cheng, Babak Azarbal, Michelle Kittleson, Jignesh Patel, Lawrence Czer, Ryan Levine, Sadia Dimbil, Michael Olymbios, Toshihisa Anzai, Evan Kransdorf, David H Chang, Michele A Hamilton, Fardad Esmailian, Jon Kobashigawa

  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 38 (9) 956 - 962 1053-2498 2019/09 [Refereed][Not invited]
   

  BACKGROUND: Because cardiac and renal disease are physiologically related and often coexist, the prevalence of combined heart and kidney transplantation (HKTx) has significantly increased over the last few years. It has been suggested that combined organ allografts modulate the immune system favorably for one or both allografts resulting in successful clinical outcomes. However, whether the addition of kidney transplantation has a protective immune effect against developing cardiac allograft vasculopathy (CAV) has not been fully investigated. METHODS: From March 2010 to September 2018, 30 HKTx recipients who had baseline (4-6 weeks) and 1-year intravascular ultrasound (IVUS) were matched with 60 isolated heart transplant (HTx-alone) recipients using propensity scores. First-year changes in maximal intimal thickness (MIT), maximal intimal area (MIA), maximal percent stenosis (MPS), percent atheroma volume (PAV), and incidence of rapid plaque progression were compared between the groups. RESULTS: First-year coronary plaque progression was significantly decreased in HKTx recipients compared with HTx-alone recipients by change in the MIT (0.11 ± 0.14 mm vs 0.40 ± 0.32 mm, p < 0.001), MIA (0.52 ± 1.52 mm2 vs 1.86 ± 2.68 mm2, p = 0.002), MPS (2.10% ± 5.64 percentage points vs 7.22% ± 8.59 percentage points, p = 0.001), and PAV (1.62% ± 3.07 percentage points vs 5.90% ± 5.92 percentage points, p < 0.001). Rapid plaque progression occurred in 2 of 30 in HKTx (6.7%) and in 22 of 60 HTx alone (36.7%), p = 0.002. CONCLUSIONS: Combined heart and kidney transplantation is associated with a decrease in CAV by coronary plaque progression on IVUS. These results suggest that HKTx may have an immune modulating benefit over HTx alone.
• Tricuspid regurgitation occurring in the early-diastolic phase in a case of heart failure: Insights from echocardiographic and invasive hemodynamic findings.

  Michito Murayama, Hiroyuki Iwano, Shingo Tsujinaga, Miwa Sarashina, Suguru Ishizaka, Yasuyuki Chiba, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Hitoshi Shibuya, Mutsumi Nishida, Toshihisa Anzai

  Echocardiography (Mount Kisco, N.Y.) 36 (9) 1771 - 1775 0742-2822 2019/09 [Refereed][Not invited]
   

  Although the presence and physiological significance of late-diastolic tricuspid regurgitation (TR) have been reported, those in TR occurring in early diastole have not been well known. We herein first presented a case of heart failure due to dilated cardiomyopathy showing functional TR occurring in the early-diastolic phase in whom the mechanism for its genesis could be precisely assessed from echocardiographic findings and intra-cardiac pressure recordings.
• Rapidly Progressive Heart Failure in a Female Carrier of Becker Muscular Dystrophy with No Skeletal Muscle Symptoms.

  Hirokazu Komoriyama, Arata Fukushima, Yumi Takahashi, Shintaro Kinugawa, Fusako Sera, Tomohito Ohtani, Akinori Nakamura, Yasushi Sakata, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 58 (17) 2545 - 2549 0918-2918 2019/09/01 [Refereed][Not invited]
   

  Becker muscular dystrophy (BMD) carriers are at risk to developing cardiac dysfunction. The prevalence of female BMD carriers remains underestimated, and the disease progression varies. We herein report the case of a young female BMD carrier who developed dilated cardiomyopathy (DCM) and heart failure without any skeletal muscle signs. Her cardiac dysfunction progressed over a mere two months, resulting in the need for left ventricular assist device implantation. Her case demonstrates that progressive cardiomyopathy can be the only clinical manifestation in some BMD carriers, suggesting the need for a more aggressive implementation of genetic testing in female DCM patients.
• POEMS Syndrome Showing Left Ventricular Dysfunction and Extracellular Edema Assessed by Cardiac Magnetic Resonance Imaging.

  Yumi Takahashi, Hiroyuki Iwano, Ippei Nakano, Arata Fukushima, Masanao Naya, Ai Shimizu, Yoshihiro Matsuno, Noriko Oyama-Manabe, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 58 (17) 2539 - 2543 0918-2918 2019/09/01 [Refereed][Not invited]
   

  Although cardiac involvement is rare in polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, the clinical course becomes considerably worse on complication with cardiac lesions. The increased release of various cytokines has been observed in the pathogenesis of POEMS syndrome, and serum vascular endothelial growth factor (VEGF) levels are known to be associated with the disease activity. We herein report a patient with POEMS syndrome who showed left ventricular systolic dysfunction and was treated with lenalidmide therapy. Of note, the reduction in extracellular edema in the left ventricular wall was clearly visualized by changes in the native T1 values and extracellular volumes on cardiac magnetic resonance imaging.
• Clinical significance of end-diastolic opening of pulmonary valve in a case complicating left ventricular systolic dysfunction.

  Hisao Nishino, Hiroyuki Iwano, Sanae Kaga, Mutsumi Nishida, Koji Akizawa, Takanori Teshima, Toshihisa Anzai

  Journal of echocardiography 19 (1) 53 - 55 1349-0222 2019/08/03 [Refereed][Not invited]
  
• Rationale and Design of the CANONICAL Study - Randomized, Open-Label Study to Evaluate the Efficacy and Safety of Canagliflozin for Heart Failure With Preserved Ejection Fraction With Type 2 Diabetes Mellitus.

  Shu Kasama, Tohru Masuyama, Shiro Uemura, Yukihito Sato, Shinya Hiramitsu, Izuru Masuda, Kazuhiro Yamamoto, Sei Komatsu, Toshihisa Anzai, Kunihiro Nishimura, Tomoya Ueda, Masato Kasahara, Hiroyuki Tanaka, Yutaka Susuta, Yoshihiko Saito

  Circulation reports 1 (8) 347 - 351 2019/08/03 

  Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2-I) have beneficial cardiovascular effects, including reduction in hospitalization for heart failure (HF). The aim of this study is to explore the efficacy and safety of canagliflozin compared with standard diabetes treatment in elderly patients with type 2 diabetes (T2DM) and HF with preserved ejection fraction (HFpEF). Methods and Results: This is a multicenter, randomized, open-label, parallel-group comparison study designed to evaluate the effects of canagliflozin on fluid retention and cardiac function in T2DM patients with HFpEF. Eligible participants are patients aged ≥65 years with insufficient glycemic control. Qualified patients will be randomly assigned to treatment with 100 mg of canagliflozin or standard diabetic treatment other than SGLT2-I; both groups will be treated for 24 weeks. The primary endpoints are changes in body weight as an indicator of fluid retention and plasma brain natriuretic peptide as an indicator of cardiac function. The secondary endpoints include cardiovascular event rates, changes in the dose of loop diuretics, echocardiographic left ventricular function, and nutritional status. Conclusions: This study is expected to provide valuable findings regarding the mechanisms of canagliflozin on cardiac function and a potential new therapeutic approach for HFpEF. (UMIN000028668 and jRCTs051180030).
• Does ex vivo perfusion lead to more or less intimal thickening in the first-year post-heart transplantation?

  Takuma Sato, Babak Azarbal, Richard Cheng, Fardad Esmailian, Jignesh Patel, Michelle Kittleson, Lawrence Czer, Maria Thottam, Ryan Levine, Sadia Dimbil, Michael Olymbios, Toshihisa Anzai, Michele A Hamilton, Tamer Khayal, Jon A Kobashigawa

  Clinical transplantation 33 (8) e13648  0902-0063 2019/08 [Refereed][Not invited]
   

  BACKGROUND: The Organ Care System (OCS), an ex vivo heart perfusion platform, represents an alternative to the current standard of cold organ storage that sustains the donor heart in a near-physiologic state. Previous reports showed that this system had significantly shortened the cold ischemic time from standard cold storage (CS). However, the effect of reduced ischemic injury against the coronary vascular bed has not been examined by intravascular ultrasound (IVUS). METHODS: Between August 2011 and February 2013, heart transplant (HTx) candidates enrolled in the PROCEED 2 trial were randomized to either CS or OCS. IVUS was performed at 4-6 weeks (baseline) and repeated 1 year after transplantation. The change in maximal intimal thickness (MIT) and other clinical outcomes were examined. RESULTS: Thirty-nine patients were randomized and underwent HTx by OCS (n=16) or CS (n=18). Of these, 18 patients (OCS: n=5, CS: n=13) with paired IVUS were examined. There were no significant differences in the change of MIT and other clinical outcomes between the groups. CONCLUSION: The incidence of cardiac allograft vasculopathy in donor hearts preserved with the OCS versus CS was similar. These results suggest that this ex vivo allograft perfusion system is a promising and valid platform for donor heart transportation.
• Relation of Systolic Blood Pressure on the Following Day with Post-Discharge Mortality in Hospitalized Heart Failure Patients with Preserved Ejection Fraction.

  Yu Sato, Akiomi Yoshihisa, Masayoshi Oikawa, Toshiyuki Nagai, Tsutomu Yoshikawa, Yoshihiko Saito, Kazuhiro Yamamoto, Yasuchika Takeishi, Toshihisa Anzai

  International heart journal 60 (4) 876 - 885 1349-2365 2019/07/27 [Refereed][Not invited]
   

  The clinical scenario, which is based on systolic blood pressure (SBP) upon admission, is useful for classifying and determining initial treatment for acute heart failure (HF). However, the prognostic significance of SBP following the initial treatment is unclear.The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, and prospective registration of consecutive Japanese patients hospitalized with HF with preserved ejection fraction (HFpEF) and left ventricular ejection fraction ≥ 50%. We divided 525 patients into three groups based on their SBP on the day following hospitalization: high (SBP > 140 mmHg, n = 72, 13.7%); normal (100 ≤ SBP ≤ 140 mmHg, n = 379, 72.2%); and low (SBP < 100 mmHg, n = 74, 14.1%) groups. This analysis had two primary endpoints: (1) all-cause death and (2) all-cause death or rehospitalization for HF. In the Kaplan-Meier analysis, both of the endpoints were the highest in the low group (Log-Rank < 0.05, respectively). Compared to the normal and high groups, the low group demonstrated a higher prevalence of atrial fibrillation (67.1%, 63.9%, and 47.8%, P = 0.026) and the lowest left ventricular outflow tract velocity time integral determined by echocardiography (16.4 cm, 19.4 cm, and 23.3 cm, P = 0.001). In the multivariable Cox proportional hazard analysis, low SBP on the day following hospitalization was an independent predictor of all-cause death (hazard ratio 1.868, 95% confidence interval 1.024-3.407, P = 0.042) and the composite endpoint (hazard ratio 1.660, 95% confidence interval 1.103-2.500, P = 0.015).Classification based on SBP on the day following initial treatment predicts post-discharge prognosis in hospitalized patients with HFpEF.
• Serum potassium and glucose levels, and mortality in acute myocardial infarction; fact or myth?

  Tadao Aikawa, Toshiyuki Nagai, Toshihisa Anzai

  International journal of cardiology 287 50 - 52 0167-5273 2019/07/15 [Refereed][Not invited]
  
• Validation and Recalibration of Seattle Heart Failure Model in Japanese Acute Heart Failure Patients.

  Yasuyuki Shiraishi, Shun Kohsaka, Toshiyuki Nagai, Ayumi Goda, Atsushi Mizuno, Yuji Nagatomo, Yasumori Sujino, Ryoma Fukuoka, Mitsuaki Sawano, Takashi Kohno, Keiichi Fukuda, Toshihisa Anzai, Ramin Shadman, Todd Dardas, Wayne C Levy, Tsutomu Yoshikawa

  Journal of cardiac failure 25 (7) 561 - 567 1071-9164 2019/07 [Refereed][Not invited]
   

  BACKGROUND: Precise risk stratification in heart failure (HF) patients enables clinicians to tailor the intensity of their management. The Seattle Heart Failure Model (SHFM), which uses conventional clinical variables for its prediction, is widely used. We aimed to externally validate SHFM in Japanese HF patients with a recent episode of acute decompensation requiring hospital admission. METHODS AND RESULTS: SHFM was applied to 2470 HF patients registered in the West Tokyo Heart Failure and National Cerebral And Cardiovascular Center Acute Decompensated Heart Failure databases from 2006 to 2016. Discrimination and calibration were assessed with the use of the c-statistic and calibration plots, respectively, in HF patients with reduced ejection fraction (HFrEF; <40%) and preserved ejection fraction (HFpEF; ≥40%). In a perfectly calibrated model, the slope and intercept would be 1.0 and 0.0, respectively. The method of intercept recalibration was used to update the model. The registered patients (mean age 74 ± 13 y) were predominantly men (62%). Overall, 572 patients (23.2%) died during a mean follow-up of 2.1 years. Among HFrEF patients, SHFM showed good discrimination (c-statistic = 0.75) but miscalibration, tending to overestimate 1-year survival (slope = 0.78; intercept = -0.22). Among HFpEF patients, SHFM showed modest discrimination (c-statistic = 0.69) and calibration, tending to underestimate 1-year survival (slope = 1.18; intercept = 0.16). Intercept recalibration (replacing the baseline survival function) successfully updated the model for HFrEF (slope = 1.03; intercept = -0.04) but not for HFpEF patients. CONCLUSIONS: In Japanese acute HF patients, SHFM showed adequate performance after recalibration among HFrEF patients. Using prediction models to tailor the care for HF patients may improve the allocation of medical resources.
• Effective blood hemoglobin level to predict prognosis in heart failure with preserved left ventricular ejection fraction: results of the Japanese heart failure syndrome with preserved ejection fraction registry.

  Keisuke Okuno, Yoshiro Naito, Masanori Asakura, Masataka Sugahara, Tomotaka Ando, Seiki Yasumura, Toshiyuki Nagai, Yoshihiko Saito, Tsutomu Yoshikawa, Tohru Masuyama, Toshihisa Anzai

  Heart and vessels 34 (7) 1168 - 1177 0910-8327 2019/07 [Refereed][Not invited]
   

  High prevalence of anemia in heart failure with preserved left ventricular ejection fraction (HFpEF) has been reported. However, little is known about the association of anemia and gender with prognosis in HFpEF patients. In addition, effective blood hemoglobin (Hb) level for prognosis in HFpEF patients remains largely unknown. In this study, we investigated the association between anemia, gender, and prognosis in 535 HFpEF patients enrolled in Japanese heart failure syndrome with preserved ejection fraction registry. Furthermore, we assessed effective blood Hb level to predict prognosis in HFpEF patients. According to the World Health Organization criteria, the prevalence rate of anemia on admission was about 70% in both male and female HFpEF patients. Kaplan-Meier analysis for all-cause mortality demonstrated that anemic patients had poor prognosis compared with non-anemic patients in both male and female HFpEF patients. Interestingly, multivariate analysis revealed that blood Hb level at discharge was an independent predictor of all-cause mortality in both male and female HFpEF patients. According to survival classification and regression tree analysis, blood Hb level at discharge of 9.4 g/dL for male and 12.3 g/dL for female was more accurate cutoff value to predict all-cause mortality in HFpEF patients. Anemia was implicated in poor prognosis in both male and female HFpEF patients. In particular, blood Hb level at discharge was an independent predictor of all-cause mortality in both male and female HFpEF patients. Effective cutoff value of blood Hb level at discharge to predict all-cause mortality was lower in male than in female HFpEF patients.
• Long-Term Results of Intracardiac Mesenchymal Stem Cell Transplantation in Patients With Cardiomyopathy.

  Takeshi Yagyu, Satoshi Yasuda, Noritoshi Nagaya, Kaori Doi, Takeshi Nakatani, Kazuhiro Satomi, Wataru Shimizu, Kengo Kusano, Toshihisa Anzai, Teruo Noguchi, Hajime Ohgushi, Soichiro Kitamura, Kenji Kangawa, Hisao Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 83 (7) 1590 - 1599 1346-9843 2019/06/25 [Refereed][Not invited]
   

  BACKGROUND: Mesenchymal stem cells (MSCs), which have the potential to differentiate into cardiomyocytes or vascular endothelial cells, have been used clinically as therapy for cardiomyopathy. In this study, we aimed to evaluate the long-term follow-up results.Methods and Results:We studied 8 patients with symptomatic heart failure (HF) on guideline-directed therapy (ischemic cardiomyopathy, n=3; nonischemic cardiomyopathy, n=5) who underwent intracardiac MSC transplantation using a catheter-based injection method between May 2004 and April 2006. Major adverse events and hospitalizations were investigated up to 10 years afterward. Compared with baseline, there were no significant differences in B-type natriuretic peptide (BNP) (from 211 to 173 pg/mL), left ventricular ejection fraction (LVEF) (from 24% to 26%), and peak oxygen uptake (from 16.5 to 19.2 mL/min/kg) at 2 months. During the follow-up period, no patients experienced serious adverse events such as arrhythmias. Three patients died of pneumonia in the 1st year, liver cancer in the 6th year, and HF in the 7th year. Of the remaining 5 patients, 3 patients were hospitalized for exacerbated HF, 1 of whom required heart transplantation in the 2nd year; 2 patients survived for 10 years without worsening HF. CONCLUSIONS: The results of this exploratory study of intracardiac MSCs administration suggest further research regarding the feasibility and efficacy is warranted.
• Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patients - A Single-Center Experience of 5-Year Follow-up.

  Yasuhiro Hamatani, Eri Nakai, Emi Nakamura, Michi Miyata, Yukie Kawano, Yasuko Takada, Yuta Anchi, Sayaka Funabashi, Atsushi Hirayama, Kensuke Kuroda, Masashi Amano, Yasuo Sugano, Toshihisa Anzai, Chisato Izumi

  Circulation journal : official journal of the Japanese Circulation Society 83 (7) 1607 - 1611 1346-9843 2019/06/25 [Refereed][Not invited]
   

  BACKGROUND: Little is known about palliative sedation in terminally ill heart failure (HF) patients.Methods and Results:We retrospectively reviewed terminally ill HF patients who received palliative sedation from September 2013 to August 2018. Among 95 terminally ill HF patients, 25 were prescribed dexmedetomidine and 12 were prescribed midazolam at the end of life. Richmond Agitation-Sedation Scale was significantly reduced (P<0.01), but blood pressure and heart rate were unaltered after treatment in both the dexmedetomidine and midazolam groups. CONCLUSIONS: Prescription of dexmedetomidine and/or midazolam might be feasible in selected terminally ill HF patients.
• 冠血行再建治療後の局所心筋血流量と心筋血流予備能の改善メカニズム 15O標識水PETと心臓MRIを用いた検討

  相川 忠夫, 納谷 昌直, 小梁川 和宏, 真鍋 治, 真鍋 徳子, 玉木 長良, 安斉 俊久

  日本心臓核医学会ニュースレター 日本心臓核医学会 21 (2) 96 - 96 1346-2733 2019/06 [Refereed][Not invited]
  
• Impact of admission liver stiffness on long-term clinical outcomes in patients with acute decompensated heart failure.

  Kazunori Omote, Toshiyuki Nagai, Naoya Asakawa, Kiwamu Kamiya, Yusuke Tokuda, Tadao Aikawa, Arata Fukushima, Keiji Noguchi, Yoshiya Kato, Hirokazu Komoriyama, Mutsumi Nishida, Yusuke Kudo, Hiroyuki Iwano, Takashi Yokota, Toshihisa Anzai

  Heart and vessels 34 (6) 984 - 991 0910-8327 2019/06 [Refereed][Not invited]
   

  Liver stiffness (LS) has been reported to be a marker of liver congestion caused by elevated central venous pressure in heart failure (HF) patients. Recent studies demonstrated that LS could be non-invasively measured by virtual touch quantification (VTQ). However, its prognostic implication in patients with acute decompensated heart failure (ADHF) is unclear. This study sought to determine whether LS measured by VTQ could be a determinant of subsequent adverse events in ADHF patients. We prospectively recruited 70 ADHF patients who underwent LS measurement by VTQ on admission in our university hospital between June 2016 and April 2018. The primary outcome of interest was the composite of all-cause mortality and worsening HF. During a median follow-up period of 272 (interquartile range 122-578) days, there were 26 (37%) events, including 5 (7%) deaths and 21 (30%) cases of worsening HF. The c-index of LS for predicting the composite of adverse events was 0.77 (95% CI 0.66-0.88), and the optimal cut-off value of LS was 1.50 m/s. Adverse events were more frequently observed in patients with high LS (≥ 1.50 m/s) compared to those with low LS (< 1.50 m/s). Multivariable Cox regression analyzes revealed that higher LS was independently associated with increased subsequent risk of adverse events after adjustment for confounders. In conclusion, high admission LS was an independent determinant of worse clinical outcomes in patients with ADHF. This finding suggests that LS on admission is useful for risk stratification of patients with ADHF.
• Prognostic impact of chronic obstructive pulmonary disease on adverse prognosis in hospitalized heart failure patients with preserved ejection fraction - A report from the JASPER registry.

  Yu Sato, Akiomi Yoshihisa, Masayoshi Oikawa, Toshiyuki Nagai, Tsutomu Yoshikawa, Yoshihiko Saito, Kazuhiro Yamamoto, Yasuchika Takeishi, Toshihisa Anzai

  Journal of cardiology 73 (6) 459 - 465 0914-5087 2019/06 [Refereed][Not invited]
   

  BACKGROUND: The prognostic impact of chronic obstructive pulmonary disease (COPD) on heart failure (HF) with preserved ejection fraction (HFpEF) patients and its clinical characteristics have not yet been fully examined. METHODS: The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese hospitalized HFpEF patients with left ventricular ejection fraction (LVEF) of ≥50%. Among 535 patients enrolled in the registry, 10 lacking COPD data, and seven who died during the first hospitalization, were excluded. Finally, 518 patients were enrolled in this analysis. We divided these patients into two groups: the COPD group (n=40, 7.7%) and the non-COPD group (n=478, 92.3%). This analysis had two primary endpoints: (1) all-cause death and (2) all-cause death or rehospitalization for HF. RESULTS: The COPD group showed a higher prevalence of male sex (70.0% vs. 48.1%, p=0.008), history of prior hospitalization for HF (63.2% vs. 35.1%, p=0.001), smoking history (71.8% vs. 43.3%, p=0.001), and a higher usage of loop diuretics (70.0% vs. 50.0%, p=0.015). In the follow-up period after discharge (median 733 days), there were 82 all-cause deaths and 127 rehospitalizations for HF. In the Kaplan-Meier analysis, the COPD group showed higher all-cause death and reached the composite endpoint more often than in the non-COPD group (all-cause death, log-rank 0.035; all-cause death or rehospitalization for HF, log-rank 0.025). In the Cox proportional hazard analysis, COPD was a predictor of all-cause death (hazard ratio 1.957, 95% confidence interval 1.037-3.694, p=0.038) and the composite endpoint (hazard ratio 1.694, 95% confidence interval 1.064-2.697, p=0.026). CONCLUSIONS: COPD is associated with adverse prognosis in hospitalized patients with HFpEF.
• Atrial Fibrillation Does Not Matter in Japanese Ventricular Assist Device Patients? - Half-Way Up the Hill.

  Toshiyuki Nagai, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 83 (6) 1202 - 1203 1346-9843 2019/05/24 [Refereed][Not invited]
  
• Clinical Usefulness of an Echo-Doppler Model in Predicting Elevated Pulmonary Capillary Wedge Pressure in Patients With Heart Failure.

  Daigo Chinen, Toshiyuki Nagai, Kazunori Uemura, Yukio Aikawa, Tetsufumi Motokawa, Yasuhide Asaumi, Takeshi Ogo, Hideaki Kanzaki, Teruo Noguchi, Toshihisa Anzai, Wataru Shimizu, Hisao Ogawa, Masaru Sugimachi, Satoshi Yasuda

  The American journal of cardiology 123 (9) 1464 - 1469 0002-9149 2019/05/01 [Refereed][Not invited]
   

  Although several tissue-Doppler imaging (TDI) models for pulmonary capillary wedge pressure (PCWP) estimation have been reported, their reliability remains uncertain. Our previous theoretical and experimental analyses suggest that right atrial pressure (RAP) corrected by tissue-Doppler imaging tricuspid/mitral annular peak systolic velocities (ST/SM) (RAP × ST/SM) reliably predicts elevated PCWP. We sought to investigate its clinical usefulness for predicting elevated PCWP in heart failure (HF) patients. Ninety-eight patients admitted with HF who underwent right heart catheterization were prospectively studied. RAP and PCWP were measured by right heart catheterization. Simultaneously, ST/SM, early diastolic transmitral flow velocity to mitral annular velocity ratio (E/Ea), and diameter of inferior vena cava at inspiration (IVCDi), a noninvasive surrogate for RAP, were measured by echocardiography. RAP correlated with IVCDi (R2 = 0.57). A significantly stronger correlation was observed between IVCDi corrected by ST/SM (IVCDi × ST/SM) and PCWP than between E/Ea and PCWP (R2 = 0.47 vs 0.18). Receiver-operating characteristic analyses indicated that IVCDi × ST/SM >16 mm predicted PCWP >18 mm Hg with 90% sensitivity and 77% specificity, and the area under the curve was 0.86, which was significantly larger than that of E/Ea (area under the curve=0.72). In conclusions, IVCDi × ST/SM is a new useful noninvasive model to predict elevated PCWP in HF patients.
• Prescription Rates of Guideline-Directed Medications Are Associated With In-Hospital Mortality Among Japanese Patients With Acute Myocardial Infarction: A Report From JROAD - DPC Study.

  Kazuhiro Nakao, Satoshi Yasuda, Kunihiro Nishimura, Teruo Noguchi, Michikazu Nakai, Yoshihiro Miyamoto, Yoko Sumita, Toshiaki Shishido, Toshihisa Anzai, Hiroshi Ito, Hiroyuki Tsutsui, Yoshihiko Saito, Issei Komuro, Hisao Ogawa

  Journal of the American Heart Association 8 (7) e009692  2019/04/02 [Refereed][Not invited]
   

  Background The JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) is a nationwide claims database comprised of the Japanese DPC /Per Diem Payment System. This study aimed to investigate the relationship between prescription rates of guideline-directed medications in each hospital and in-hospital mortality among patients with acute myocardial infarction. Methods and Results A total of 61 838 Japanese patients from 741 hospitals with acute myocardial infarction between 2012 and 2013 were enrolled. The relationship between prescription rates of 4 guideline-directed medications for acute myocardial infarction and in-hospital mortality was analyzed. There were variations in the prescription ratio of β-blockers on admission (median prescription rate 23% [interquartile range 11% to 38%]) and at discharge (51% [36% to 63%]), and of angiotensin converting enzyme/receptor blocker (60% [47% to 70%]). The highest prescription rate quartile of each medication was associated with a significantly lower mortality compared with the lowest prescription rate quartile (aspirin on admission, incidence rate ratio 0.67 [95% CI 0.61-0.74], P<0.001; aspirin at discharge, incidence rate ratio 0.50 [95% CI 0.46-0.55], P<0.001; β-blocker on admission, 0.83 [0.76-0.92], P<0.001; β-blocker at discharge, 0.78 [0.71-0.85], P<0.001; angiotensin converting enzyme/receptor blocker, 0.68 [0.62-0.75], P<0.001; statin, 0.63 [0.57-0.70], P<0.001). The composite prescription score was inversely associated with in-hospital mortality (β coefficient=-0.48, P<0.001) and was closer to the plateau in the high-score range (median mortality for composite prescription scores of 6, 15, and 24 were 10.6%, 6.8%, and 4.6%, respectively). Conclusions The prescription rates of guideline-directed medications for treatment of Japanese acute myocardial infarction patients were inversely associated with in-hospital mortality.
• Prolonged QRS duration as a predictor of right ventricular dysfunction after balloon pulmonary angioplasty.

  Ryotaro Asano, Takeshi Ogo, Keiko Ohta-Ogo, Shigefumi Fukui, Akihiro Tsuji, Jin Ueda, Nao Konagai, Tetsuya Fukuda, Yoshiaki Morita, Teruo Noguchi, Kengo Kusano, Toshihisa Anzai, Hatsue Ishibashi-Ueda, Satoshi Yasuda

  International journal of cardiology 280 176 - 181 0167-5273 2019/04/01 [Refereed][Not invited]
   

  BACKGROUND: Balloon pulmonary angioplasty (BPA) has shown beneficial effects for chronic thromboembolic pulmonary hypertension (CTEPH). However, previous studies have shown less cardiac output improvement and symptoms remaining after BPA, implying poor right ventricular (RV) function recovery. Therefore, we investigated the residual RV dysfunction after BPA to reveal risk factors, clinical effects, and possible underlying histopathological mechanisms. METHODS AND RESULTS: We investigated 61 consecutive CTEPH patients who underwent cardiovascular magnetic resonance before and 3 and 12 months after BPA series. Residual dysfunction (RD) of RV was defined as RV end-diastolic volume index >100 ml/m2 or RV ejection fraction (EF) <45% at 12-month follow-up. Patients were divided into RD (44%) and normalized dysfunction (ND) (56%) groups. Compared with the ND group, the RD group had significantly worse World Health Organization (WHO) functional class at follow-up. No significant hemodynamic differences were observed between the groups. On multivariable logistic regression analysis, male sex (odds ratio [OR] 12.5, p = 0.004) and prolonged QRS duration (OR 1.08, p = 0.029) were independently associated with residual RV dysfunction. Additionally, RV histopathology in 11 CTEPH autopsy cases showed that QRS duration was correlated with RV fibrosis area. CONCLUSIONS: Relatively high percentage (44%) of residual RV dysfunction with worse WHO functional class was observed in CTEPH patients even after BPA. Prolonged QRS duration may predict poor recovery in RV function after BPA.
• Effect of intravenous carperitide versus nitrates as first-line vasodilators on in-hospital outcomes in hospitalized patients with acute heart failure: Insight from a nationwide claim-based database.

  Toshiyuki Nagai, Naotsugu Iwakami, Michikazu Nakai, Kunihiro Nishimura, Yoko Sumita, Atsushi Mizuno, Hiroyuki Tsutsui, Hisao Ogawa, Toshihisa Anzai

  International journal of cardiology 280 104 - 109 0167-5273 2019/04/01 [Refereed][Not invited]
   

  BACKGROUNDS: Carperitide is a recombinantly produced intravenous formulation of human atrial natriuretic peptide. Despite of negative impacts of nesiritide on clinical outcomes for acute heart failure (AHF), carperitide has been used for around a half of Japanese AHF patients as a vasodilator based on limited evidences. We sought to determine the effect of carperitide compared to nitrates in the early care for AHF patients treated with vasodilators. METHODS AND RESULTS: We conducted a cohort study of patients admitted with AHF to 808 hospitals from April 2012 to March 2014. Patients were extracted from 1,422,703 hospitalizations according to ICD-10 heart failure codes. Patients who had sepsis or mechanical supports during hospitalization were excluded. Outcomes were in-hospital death, length of hospitalization and cost of hospitalization. Among 76,924 patients, 45,595 were in patients treated with either carperitide or nitrates during the first 2 days (carperitide; 33,386, nitrates; 12,209). After application of inverse probability of treatment weighting with variables including demographics, comorbidities and treatments, there was perfect balance in both groups. Patients who were treated with carperitide had substantially higher covariate adjusted in-hospital mortality (HR 1.49 95%CI 1.35-1.64), longer length of hospitalization (Coefficients 0.062 95%CI 0.048 to 0.076) and greater cost of hospitalization (Coefficients 0.024 95%CI 0.010 to 0.037) compared to those treated with nitrates. CONCLUSIONS: In Japanese AHF patients during their early inpatient care, carperitide use was significantly associated with worse outcomes when compared to nitrates use, suggesting the routine use of carperitide might not be recommended as a first-line vasodilator for AHF.
• Diastolic Intra-Left Ventricular Pressure Difference During Exercise: Strong Determinant and Predictor of Exercise Capacity in Patients With Heart Failure.

  Shingo Tsujinaga, Hiroyuki Iwano, Miwa Sarashina, Taichi Hayashi, Michito Murayama, Ayako Ichikawa, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Arata Fukushima, Takashi Yokota, Kazunori Okada, Sanae Kaga, Pavlos P Vlachos, Toshihisa Anzai

  Journal of cardiac failure 25 (4) 268 - 277 1071-9164 2019/04 [Refereed][Not invited]
   

  BACKGROUND: Although the enhancement of early-diastolic intra-left ventricular pressure difference (IVPD) during exercise is considered to maintain exercise capacity, little is known about their relationship in heart failure (HF). METHODS AND RESULTS: Cardiopulmonary exercise testing and exercise-stress echocardiography were performed in 50 HF patients (left ventricular [LV] ejection fraction 39 ± 15%). Echocardiographic images were obtained at rest and submaximal and peak exercise. Color M-mode Doppler images of LV inflow were used to determine IVPD. Thirty-five patients had preserved exercise capacity (peak oxygen consumption [VO2] ≥14 mL·kg-1·min-1; group 1) and 15 patients had reduced exercise capacity (group 2). During exercise, IVPD increased only in group 1 (group 1: 1.9 ± 0.9 mm Hg at rest, 4.1 ± 2.0 mm Hg at submaximum, 4.7 ± 2.1 mm Hg at peak; group 2: 1.9 ± 0.8 mm Hg at rest, 2.1 ± 0.9 mm Hg at submaximum, 2.1 ± 0.9 mm Hg at peak). Submaximal IVPD (r = 0.54) and peak IVPD (r = 0.69) were significantly correlated with peak VO2. Peak IVPD determined peak VO2 independently of LV ejection fraction. Moreover, submaximal IVPD could well predict the reduced exercise capacity. CONCLUSION: Early-diastolic IVPD during exercise was closely associated with exercise capacity in HF. In addition, submaximal IVPD could be a useful predictor of exercise capacity without peak exercise in HF patients.
• Endomyocardial fibrosis presenting as apical calcification and infective endocarditis.

  Tadao Aikawa, Kiwamu Kamiya, Tomoko Mitsuhashi, Toshihisa Anzai

  European heart journal 40 (12) 1016 - 1016 0195-668X 2019/03/21 [Refereed][Not invited]
  
• Independent Prognostic Value of Pulmonary Diffusing Capacity in Nonsmoking Patients with Chronic Heart Failure.

  Kenji Nakamura, Hideaki Kanzaki, Atsushi Okada, Makoto Amaki, Hiroyuki Takahama, Takuya Hasegawa, Yasuo Sugano, Satoshi Yasuda, Toshihisa Anzai

  International heart journal 60 (2) 366 - 373 1349-2365 2019/03/20 [Refereed][Not invited]
   

  The diffusing capacity of the lung for carbon monoxide (DLCO) is indicative of the alveolar-capillary membrane function. A reduced DLCO is associated with poor prognosis in chronic heart failure (HF). However, the significance of DLCO as an independent prognostic predictor has not been established. Here, we aimed to determine the prognostic value of DLCO in patients with chronic HF.We enrolled 214 patients (139 females, mean age: 63 ± 16 years, left ventricular ejection fraction [LVEF]: 45 ± 21%) with stable chronic HF who underwent pulmonary function tests. Only never smokers were included in the analysis because smoking can decrease DLCO.During a median follow-up period of 2.1 years, 52 patients (24.3%) experienced cardiac events, including unplanned HF admissions, left ventricular assist device (LVAD) implantations, all-cause deaths, and cardiopulmonary arrests (CPAs). The median percent predicted DLCO (%DLCO) was 87.3%. In a Cox regression analysis, a %DLCO of ≤87.3% was independently associated with the cardiac events, even after adjusting for age, sex, systolic blood pressure (SBP), LVEF, anemia, brain natriuretic peptide, estimated glomerular filtration rate (eGFR), and prior HF admission (hazard ratio [HR]: 1.87, 95% confidence interval: 1.03-3.53, P = 0.030).A reduced DLCO is an independent predictor of poor prognosis in nonsmoking patients with chronic HF.
• 心血管疾患の非侵襲評価および定量的評価における現在の試み 心血管画像診断のためのハートチームのアプローチ(Our Current Efforts on Noninvasive and Quantitative Assessment of Cardiovascular Disease: A Heart Team Approach for Cardiovascular Imaging)

  相川 忠夫, Naya Masanao, Oyama-Manabe Noriko, Koyanagawa Kazuhiro, Manabe Osamu, Anzai Toshihisa

  日本循環器学会学術集会抄録集 83回 RT4 - 2 2019/03 [Refereed][Not invited]
  
• 冠血行再建術がPET CTで評価する局所心筋血流予備能に与える影響(The Impact of Coronary Revascularization on Regional Myocardial Flow Reserve Assessed by Positron Emission Tomography)

  相川 忠夫, 納谷 昌直, 小梁川 和宏, 真鍋 治, 真鍋 徳子, 安斉 俊久

  日本循環器学会学術集会抄録集 83回 PJ103 - 2 2019/03 [Refereed][Not invited]
  
• 心不全患者におけるMRエラストグラフィで評価した肝硬度の増加は右心房圧の上昇を予測する(Increased Liver Stiffness Assessed by Magnetic Resonance Elastography Predicts Elevated Right Atrial Pressure in Patients with Heart Failure)

  加藤 喜哉, 永井 利幸, 小森山 弘和, 表 和徳, 相川 忠夫, 神谷 究, 常田 慧徳, 真鍋 徳子[大山], 安斉 俊久

  日本循環器学会学術集会抄録集 83回 PJ096 - 6 2019/03 [Refereed][Not invited]
  
• 心筋生検のリンパ管増殖所見は心サルコイドーシスの診断の助けとなる可能性がある(Lymph Vessel Proliferation on Cardiac Biopsy may Help for the Diagnosis of Cardiac Sarcoidosis)

  大江 由紀子, 植田 初江, 松山 高明, 永井 利幸, 池田 善彦, 大郷 恵子, 野口 暉夫, 安斉 俊久

  日本循環器学会学術集会抄録集 83回 (2) PJ073 - 6 2019/03 [Refereed][Not invited]
   

  Background The diagnosis of cardiac sarcoidosis ( CS ) is challenging because endomyocardial biopsy has only a 20% to 30% sensitivity rate for diagnosis and it presents with similar clinical features of idiopathic dilated cardiomyopathy ( DCM ). Lymphatic vessel proliferation in pulmonary sarcoidosis has been previously demonstrated. In this study, we compared endomyocardial biopsy samples obtained from patients with CS and DCM to determine whether lymph vessel counts using D2-40 immunostaining can be utilized as a complementary tool to distinguish CS from DCM . Methods and Results Endomyocardial biopsy tissues were obtained from 62 patients with CS (30 patients with a diagnosis made histologically, 32 patients with a diagnosis made clinically), and hematoxylin/eosin, Masson trichrome, and D2-40 immunostaining were performed. Their results were compared with those from 53 patients with DCM. The histological CS group showed significantly increased lymphatic vessels (12.0 [4.0-40.0] versus 2.6 [1.9-3.4], P<0.0001) and more severe mosaic fibrosis ( P<0.0001) compared with the DCM group. The optimal threshold was 7.5 lymphatic vessels, and this resulted in a sensitivity of 0.67 and specificity of 0.96. The clinical CS group diagnosed according to Japanese Circulation Society 2016 criteria showed increased lymphatic vessels (4.0 [3.3-9.0] versus 2.6 [1.9-3.4], P<0.0001), more severe mosaic fibrosis ( P<0.0001), more inflammatory cell infiltration (53% versus 0%, P<0.0001), and fatty infiltration within fibroblasts (50% versus 17%, P=0.0012) compared with the DCM group. The optimal threshold of lymphatic vessels was 3.5, which resulted in a sensitivity of 0.75 and specificity of 0.68. Conclusions Lymphatic vessel counts using D2-40 immunostaining may help to distinguish clinical CS without granuloma from DCM .
• 駆出率が保持されている心不全患者における腎機能悪化の予後的影響 JASPERレジストリからの報告(Prognostic Impact of Worsening Renal Function in Heart Failure Patients with Preserved Ejection Fraction: A Report from the JASPER Registry)

  佐藤 悠, 義久 精臣, 及川 雅啓, 永井 利幸, 吉川 勉, 斎藤 能彦, 山本 一博, 竹石 恭知, 安斉 俊久

  日本循環器学会学術集会抄録集 83回 (8) PJ073 - 3 1071-9164 2019/03 [Refereed][Not invited]
   

  BACKGROUND: The characteristics and prognostic impact of persistent worsening renal function (WRF; defined as an increase in serum creatinine of >0.3 mg/dL during hospitalization) on heart failure with preserved ejection fraction have not yet been fully examined. METHODS AND RESULTS: This was a post hoc analysis of the Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry. We divided 523 patients with heart failure with preserved ejection fraction: the WRF group (n = 92 [17.6%]) and the non-WRF group (n = 431 [82.4%]). The WRF group showed a higher systolic blood pressure on admission and a higher prevalence of atherosclerotic diseases, respectively. Logistic regression analysis revealed that systolic blood pressure and loop diuretics were associated with WRF development (P < .05). The Kaplan-Meier analysis (median, 732 days) showed a higher all-cause death in the WRF group, as well as a higher composite end point of all-cause death or rehospitalization for HF (log-rank P < .001). The Cox proportional hazard analysis revealed WRF to be a predictor of both all-cause death (hazard ratio, 2.725; 95% confidence interval, 1.709-4.344; P < .001) and the composite end point (hazard ratio, 2.083; 95% confidence interval, 1.488-2.914; P < .001). CONCLUSIONS: Persistent WRF was associated with systolic blood pressure, atherosclerotic diseases, diuretics, and poor postdischarge prognosis in patients with heart failure with preserved ejection fraction.
• Prognostic value of phase analysis on gated single photon emission computed tomography in patients with cardiac sarcoidosis.

  Kazuhiro Koyanagawa, Masanao Naya, Tadao Aikawa, Osamu Manabe, Masato Kuzume, Hiroshi Ohira, Ichizo Tsujino, Nagara Tamaki, Toshihisa Anzai

  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 28 (1) 128 - 136 1071-3581 2019/02/27 [Refereed][Not invited]
   

  BACKGROUND: We aimed to determine the correlation between phase analysis, reflecting the heterogeneity of perfusion defects, and the dyssynchrony of the left ventricle wall motion, and adverse cardiac events in cardiac sarcoidosis (CS) patients. METHODS: Fifty-seven consecutive patients with diagnosed CS (64 [IQR 55-71] years old, 14 males), who underwent 18F-FDG PET/CT and ECG-gated SPECT, were studied. FDG PET was analysed to measure cardiac metabolic volume (CMV), and total lesion glycolysis (TLG). The SPECT findings, such as LVEF, Summed Rest Score (SRS), bandwidth (BW) were evaluated. RESULTS: The median of BW was 56° (IQR 40-95). BW showed a strong inverse correlation with LVEF (r = - 0.60, P < 0.0001), and positive correlation with SRS (r = 0.82, P < 0.0001). However, there were no significant correlations between BW and CMV or TLG. The Kaplan-Meier curves revealed a significantly higher rate of MACE in the high BW group (BW > 56°) than the low BW group (BW ≤ 56°) (15.1%/years vs. 4.4%/years, P = 0.025). In multivariable analysis, BW was a significant independent predictor of MACE (P = 0.015). CONCLUSION: Phase analysis on gated SPECT was a significant and independent predictor of MACE in patients with CS.
• Comparison of Mortality Prediction Models on Long-Term Mortality in Hospitalized Patients With Acute Heart Failure - The Importance of Accounting for Nutritional Status.

  Hiroki Nakano, Kazunori Omote, Toshiyuki Nagai, Michikazu Nakai, Kunihiro Nishimura, Yasuyuki Honda, Satoshi Honda, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Satoshi Yasuda, Hisao Ogawa, Taishiro Chikamori, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 83 (3) 614 - 621 1346-9843 2019/02/25 [Refereed][Not invited]
   

  BACKGROUND: The ideal mortality prediction model (MPM) for acute heart failure (AHF) patients would have sufficient and stable predictive ability for long-term as well as short-term mortality. However, published MPMs for AHF predominantly predict short-term mortality up to 90 days, and their prognostic performance for long-term mortality remains unclear. Methods and Results: We analyzed 609 AHF patients in a prospective registry from January 2013 to May 2016. We compared the prognostic performance for long-term mortality among 8 systematically identified MPMs for AHF that predict short-term mortality up to 90 days from admission. The PROTECT 7-day model showed the highest c-index for long-term as well as short-term mortality among the studied MPMs. Sensitivity analyses revealed serum albumin and total cholesterol to be the most important variables, as dropping these variables resulted in a significant decline in c-index, when compared with other variables specific to the PROTECT 7-day model. Furthermore, significant improvements in c-index and net reclassification were observed when serum albumin or serum albumin plus total cholesterol was added to the studied MPMs, other than the PROTECT 7-day model. CONCLUSIONS: The PROTECT 7-day model demonstrated the highest predictive performance for long-term as well as short-term mortality in AHF patients among the published MPMs. Our findings indicate the importance of accounting for nutritional status such as serum albumin and total cholesterol in AHF patients when developing a MPM.
• Progressive Mobilization Program for Patients With Acute Heart Failure Reduces Hospital Stay and Improves Clinical Outcome.

  Naoya Kakutani, Arata Fukushima, Shintaro Kinugawa, Takashi Yokota, Tatsuya Oikawa, Mikito Nishikawa, Risako Nakamura, Takanori Tsukada, Shigeki Mori, Ichiro Yoshida, Toshihisa Anzai

  Circulation reports 1 (3) 123 - 130 2019/02/19 

  Background: Early ambulation has been shown to be associated with shorter hospital stay and better clinical outcomes in patients with acute heart failure (HF). Early mobilization program in combination with structured exercise training is recommended, but has yet to be developed and implemented in HF. Methods and Results: We developed a progressive mobilization program for HF patients that classifies the mobilization process into 7 stages based on disease condition and physical function. We retrospectively analyzed 136 patients with acute HF (80±11 years), who were assigned either to the mobilization program (intervention group, n=75) or to usual care (control group, n=61). The program was safely implemented without any adverse events. Hospital stay was significantly reduced in the intervention group compared with the control group (33±25 vs. 51±36 days, P<0.01). The intervention group had higher activities of daily living (ADL) score at discharge evaluated using the Barthel index (64±38 vs. 49±36, P<0.05). The intervention group also had a higher percentage of discharge to home (71% vs. 52%, P<0.05) and a lower rate of HF-related readmission (16% vs. 36%, P<0.05) compared with the control group. Conclusions: The progressive mobilization program for acute HF was feasible and was associated with better ADL and reduced hospital stay, leading to improvement of clinical outcome.
• Arrhythmogenic β-adrenergic signaling in cardiac hypertrophy: The role of small-conductance calcium-activated potassium channels via activation of CaMKII.

  Rui Kamada, Hisashi Yokoshiki, Hirofumi Mitsuyama, Masaya Watanabe, Kazuya Mizukami, Taro Tenma, Masayuki Takahashi, Shingo Takada, Toshihisa Anzai

  European journal of pharmacology 844 110 - 117 0014-2999 2019/02/05 [Refereed][Not invited]
   

  Sustained ventricular arrhythmias (SVAs) lead to sudden cardiac death, for which β- adrenoreceptor blockers are effective. We hypothesized that electrophysiological changes and arrhythmias by β- adrenoreceptor stimulation are crucially related to activation of small-conductance calcium-activated potassium (SK) channels via the increase in Ca2+/calmodulin-dependent protein kinase II (CaMKII) activity. We used normotensive Wistar-Kyoto (WKY) rats and spontaneous hypertensive rats (SHRs). The latter served as a model of left ventricular hypertrophy. We performed dual optical mapping of action potentials and Ca2+ transients, and the effects of isoproterenol and apamin, an SK channel blocker, were evaluated in the Langendorff-perfused hearts. Action potential duration was abbreviated by isoproterenol (100 nM) in both WKY rats and SHRs. In contrast, the CaMKII activity was increased by isoproterenol only in SHRs. In the presence of isoproterenol, apamin prolonged the action potential duration only in SHRs (n = 10, from 116.6 ± 5.05 ms to 125.4 ± 3.80 ms, P = 0.011), which was prevented by KN-93, a CaMKII inhibitor. Increase in Ca2+ transients and shortening of Ca2+ transient duration by isoproterenol were similarly observed in both animals, which was not affected by apamin. Apamin reduced the isoproterenol-induced SVAs and maximal slope of action potential duration restitution curve specifically in SHRs. In conclusion, β- adrenoreceptor stimulation creates arrhythmogenic substrates via the CaMKII-dependent activation of SK channels in cardiac hypertrophy.
• Progressive left ventricular dysfunction and myocardial fibrosis in Duchenne and Becker muscular dystrophy: a longitudinal cardiovascular magnetic resonance study.

  Tadao Aikawa, Atsuhito Takeda, Noriko Oyama-Manabe, Masanao Naya, Hirokuni Yamazawa, Kazuhiro Koyanagawa, Yoichi M Ito, Toshihisa Anzai

  Pediatric cardiology 40 (2) 384 - 392 0172-0643 2019/02 [Refereed][Not invited]
   

  This study examined the progression of left ventricular dysfunction and myocardial fibrosis in patients with Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy (BMD) to evaluate the effects of angiotensin-converting enzyme inhibitor (ACEI). Ninety-eight cardiovascular magnetic resonance (CMR) studies in 34 consecutive patients with DMD (n = 21) or BMD (n = 13) were retrospectively reviewed. Left ventricular ejection fraction (LVEF) and the extent of myocardial late gadolinium enhancement (LGE) were semiautomatically quantified. During the study period, five patients had already been treated with ACEI at the first CMR; five were started on ACEI at LVEF ≥ 55% and 10 at LVEF < 55%. All patients had hyperenhanced myocardium on LGE images at the first CMR (median extent, 3.3%; interquartile range 0.1-14.3%). A mixed-effects model for longitudinal data of each patient, adjusted for age, type of muscular dystrophy, steroid use, and ACEI use showed that higher age (β = - 1.1%/year; 95% confidence interval [CI], - 1.8% to - 0.4%; p = 0.005) and no use of ACEI (β = - 3.1%; 95% CI, - 5.4% to - 0.8%; p = 0.009) were significantly associated with a lower LVEF. When ACEI use was stratified by time of initiation (LVEF ≥ 55% vs. < 55%), only ACEI initiation at LVEF < 55% had a beneficial effect on LVEF at each imaging examination (β = 3.7%; 95% CI, 0.9-6.4%; p = 0.010). ACEI use or the time of initiation of ACEI did not significantly affect age-related increase in LGE. ACEI attenuated the age-related decline in LVEF only in patients with DMD or BMD and reduced LVEF, suggesting that further investigation on prophylactic use of cardioprotective therapy in these patients is warranted.
• Effect of Statins on Mortality in Heart Failure With Preserved Ejection Fraction Without Coronary Artery Disease - Report From the JASPER Study.

  Kyohei Marume, Seiji Takashio, Toshiyuki Nagai, Kenichi Tsujita, Yoshihiko Saito, Tsutomu Yoshikawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 83 (2) 357 - 367 1346-9843 2019/01/25 [Refereed][Not invited]
   

  BACKGROUND: Statins might be associated with improved survival in patients with heart failure with preserved ejection fraction (HFpEF). The effect of statins in HFpEF without coronary artery disease (CAD), however, remains unclear. Methods and Results: From the JASPER registry, a multicenter, observational, prospective cohort with Japanese patients aged ≥20 years requiring hospitalization with acute HF and LVEF ≥50%, 414 patients without CAD were selected for outcome analysis. Based on prescription of statins at admission, we divided patients into the statin group (n=81) or no statin group (n=333). We followed them for 25 months. The association between statin use and primary (all-cause mortality) and secondary (non-cardiac death, cardiac death, or rehospitalization for HF) endpoints was assessed in the entire cohort and in a propensity score-matched cohort. In the propensity score-matched cohort, 3-year mortality was lower in the statin group (HR, 0.21; 95% CI: 0.06-0.72; P=0.014). The statin group had a significantly lower incidence of non-cardiac death (P=0.028) and rehospitalization for HF (P<0.001), but not cardiac death (P=0.593). The beneficial effect of statins on mortality did not have any significant interaction with cholesterol level or HF severity. CONCLUSIONS: Statin use has a beneficial effect on mortality in HFpEF without CAD. The present findings should be tested in an adequately powered randomized clinical trial.
• Superiority of proatrial natriuretic peptide in the prognostic power in patients with acute decompensated heart failure on hospital admission: comparison with B-type natriuretic peptide and other natriuretic peptide forms.

  Seiji Takashio, Hiroyuki Takahama, Toshio Nishikimi, Tomohiro Hayashi, Chiaki Nagai-Okatani, Ayaka Matsuo, Yasuaki Nakagawa, Masashi Amano, Yasuhiro Hamatani, Atsushi Okada, Makoto Amaki, Takuya Hasegawa, Hideaki Kanzaki, Satoshi Yasuda, Kenji Kangawa, Toshihisa Anzai, Naoto Minamino, Chisato Izumi

  Open heart 6 (2) e001072  2019 [Refereed][Not invited]
   

  Aims: There are significant differences in how atrial (A-type) and B-type natriuretic peptide (ANP and BNP) are secreted and metabolised, but there is little information available about the relative clinical significance of the two peptides. The aim of the present study was to investigate: (1) the association between the circulating level of each ANP molecular form and patient clinical background and (2) their prognostic power for patients with acute decompensated heart failure (ADHF). Methods: We used specific chemiluminescence enzyme immunoassays to prospectively evaluate the levels of six bioactive molecular forms of ANP (pro-ANP, β-ANP and total ANP) and BNP (pro-BNP, N-terminal pro-BNP (NT-pro-BNP) and total BNP) in plasma samples collected from 173 patients with ADHF on their hospital admission. Results: We found that pro-ANP levels were strongly associated with left ventricular (LV) size and ejection fraction (p<0.001), but were not associated with left atrial size. Percent pro-ANP ([pro-ANP/total ANP]x100) was also associated with LV size and function. During the follow-up term (median: 469 days), composite adverse events (all causes of death or rehospitalisation for HF) occurred in 67 patients (38.7 %). Pro-ANP was significantly associated with composite adverse events even after adjusting by estimated glomerular filtration rate (eGFR) (p<0.05). In contrast, NT-pro-BNP was not independent of eGFR in the multivariate analysis. Conclusion: Circulating levels of pro-ANP are strongly associated with LV function and clinical outcomes of patients with ADHF. These findings suggest that during the acute phases of HF, pro-ANP has a prognostic power comparable with NT-pro-BNP independently of renal function.
• CORRIGENDUM: Survey of Palliative Sedation at End of Life in Terminally Ill Heart Failure Patients - A Single-Center Experience of 5-Year Follow-up.

  Yasuhiro Hamatani, Eri Nakai, Emi Nakamura, Michi Miyata, Yukie Kawano, Yasuko Takada, Yuta Anchi, Sayaka Funabashi, Atsushi Hirayama, Kensuke Kuroda, Masashi Amano, Yasuo Sugano, Toshihisa Anzai, Chisato Izumi

  Circulation journal : official journal of the Japanese Circulation Society 83 (11) 2389 - 2389 1346-9843 2019 [Refereed][Not invited]
  
• Reduced Myocardial Flow Reserve Is Associated with Subendocardial Infarction and Coronary Stenosis in Patients with Coronary Artery Disease: A Perfusion MRI Study

  Osamu Manabe, Noriko Oyama-Manabe, Masanao Naya, Masahiko Obara, Yasuka Kikuchi, Tadao Aikawa, Yuuki Tomiyama, Hiroyuki Sugimori, Chietsugu Katoh, Nagara Tamaki, Toshihisa Anzai

  Cardiovascular Imaging Asia 3 (1) 8 - 8 2508-707X 2019
• Clinical impacts and associated factors of delayed ambulation in patients with acute heart failure

  Ishikawa K, Fukushima A, Yokota T, Takada S, Furihata T, Kakutani N, Yamanashi K, Obata Y, Nakano I, Abe T, Kinugawa S, Anzai T

  Circ Rep 1 (4) 179 - 186 2019 [Refereed][Not invited]
   

  Background: In heart failure (HF) management, early ambulation is recommended to prevent physical deconditioning. The effects of delayed ambulation on later clinical outcomes and the factors linked to delayed ambulation in hospitalized HF patients, however, remain unestablished. Methods and Results: We retrospectively investigated 101 patients (mean age, 66±17 years) who were hospitalized for acute decompensated HF. During the mean follow-up of 244±15 days after hospital discharge, 34 patients had cardiovascular events leading to death or unplanned readmission. Patients with cardiovascular events had longer median days to acquire ambulation than those without cardiovascular events (11 days, IQR, 8-20 days vs. 7 days, IQR, 5-15 days, P<0.001). The optimal cut-off period until initiation of ambulation to discriminate cardiovascular events was 8 days, indicating that longer days (≥8 days) to acquire ambulation was associated with higher rates of cardiovascular events, even after adjustment of multiple confounders. On multivariate analysis, age >65 years (odds ratio [OR], 2.49; 95% confidence interval [CI]: 1.04-6.09) and increase in blood urea nitrogen (BUN; OR, 1.04; 95% CI: 1.01-1.08) were independent predictors of delayed ambulation. Conclusions: Delayed ambulation is associated with older age and increased BUN in patients with acute HF. Time to ambulation in the recovery phase of acute HF is important, and delayed ambulation may increase the rate of cardiovascular events after hospital discharge.
• Evaluation of the pulmonary artery potential using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography.

  Masayuki Takahashi, Hisashi Yokoshiki, Hirofumi Mitsuyama, Taro Tenma, Masaya Watanabe, Rui Kamada, Ryo Sasaki, Yuki Chiba, Motoki Maeno, Toshihisa Anzai

  Heart and vessels 34 (1) 74 - 83 0910-8327 2019/01 [Refereed][Not invited]
   

  Prolongation of the pulmonary artery potentials (PAPs) in response to short coupling intervals was related to polymorphic QRS configurations during the ventricular tachycardia originating above the pulmonary valve (PA-VT). This prospective study was aimed to investigate the mechanisms of polymorphic changes during the PA-VT. We performed the mapping above the pulmonary valve using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography in 9 consecutive patients with outflow tract arrhythmias undergoing catheter ablation (UMIN ID: UMIN000021682). The location of successful ablation was right ventricular outflow tract (RVOT) in 6 patients, above the pulmonary valve in 1 patient, left coronary cusp in 1 patient, and unknown in 1 patient. The PAP was detected in six (67%) patients with bipolar voltage of 0.56 ± 0.27 mV. Pacing from bipolar electrodes of the circumferential catheter located above the pulmonary valve captured the PA myocardium only in 1 patient who had the PA-VT (100% in PA-VT vs 0% in non-PA-VT, P = 0.0046), and slight changes of the QRS morphology was observed in accordance with the conduction delay from the stimulus to activation of the RVOT myocardium. The selective PAP capture with conduction delays evoked by bipolar stimulations through a 20-polar circumferential catheter may be a characteristic property of patients with the PA-VT. Conduction delays within the PA and PA-RVOT junction appears to contribute polymorphic QRS changes during the PA-VT.
• Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease.

  Tadao Aikawa, Masanao Naya, Masahiko Obara, Osamu Manabe, Keiichi Magota, Kazuhiro Koyanagawa, Naoya Asakawa, Yoichi M Ito, Tohru Shiga, Chietsugu Katoh, Toshihisa Anzai, Hiroyuki Tsutsui, Venkatesh L Murthy, Nagara Tamaki

  Cardiovascular research 115 (1) 119 - 129 0008-6363 2019/01/01 [Refereed][Not invited]
   

  Aims: Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results: In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8-24.5], 5.5 (IQR: 2.5-12.5), and 1.94 (IQR: 1.67-2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = -0.40, P < 0.001) and Leaman scores (ρ = -0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14-1.96) vs. 1.98 (IQR: 1.60-2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42-1.79) vs. 2.21 (IQR: 1.78-2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13-1.80) vs. 1.86 (IQR: 1.57-2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion: Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.
• Severely Impaired Leaflet Mobility of the Tricuspid Valve in an Elderly Woman.

  Tatsuro Hitsumoto, Takuya Hasegawa, Yasuhiro Hamatani, Atsushi Okada, Makoto Amaki, Hiroyuki Takahama, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Toshihisa Anzai, Chisato Izumi

  Circulation reports 1 (1) 42 - 42 2018/12/15
• A Case of Severe Aortic Regurgitation Caused by Takayasu's Arteritis Showing End-Diastolic Opening of Aortic Valve.

  Michito Murayama, Hiroyuki Iwano, Yusuke Kudo, Mutsumi Nishida, Koji Akizawa, Hitoshi Shibuya, Toshihisa Anzai

  CASE (Philadelphia, Pa.) 2 (6) 248 - 253 2018/12 [Refereed][Not invited]
  
• Left ventricular noncompaction with intractable heart failure responsive to empagliflozin.

  Yasuyuki Chiba, Kazuya Yonezawa, Masahumi Himeno, Midori Yukino, Kyo Shimazu, Shogo Imagawa, Kaoru Komuro, Noriko Kimura, Teisuke Anzai, Toshihisa Anzai

  Journal of cardiology cases 18 (6) 192 - 196 2018/12 [Refereed][Not invited]
   

  Despite several reports on the mechanism of the effect of empagliflozin, which has the potential for improved prognosis in heart failure, it is still not fully understood. We experienced a case of left ventricular noncompaction that caused fluid retention in a patient who showed resistance to existing diuretics. By using empagliflozin, we successfully treated this case of acute heart failure and observed stabilized symptoms with no renal dysfunction and deterioration of patient condition. Although the potential for improved prognosis with this drug in a high-risk group for cardiovascular events has been reported, based on EMPA-REG OUTCOME trial results, there are few reports on its effect of treatment and mechanism in treating acute heart failure. The effect of this drug in treating heart failure from the acute phase to the chronic phase can be expected. .
• Refractory cardiac myocarditis associated with drug rash with eosinophilia and systemic symptoms syndrome due to anti-bipolar disorder drugs: a case report.

  Hikaru Hagiwara, Arata Fukushima, Hiroyuki Iwano, Toshihisa Anzai

  European heart journal. Case reports 2 (4) yty100  2018/12 [Refereed][Not invited]
   

  Background: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug reaction accompanied by multiple organ dysfunction. Myocarditis is a manifestation, and once acute necrotizing eosinophilic myocarditis (ANEM) develops, the mortality rate is high. Case summary: We report the case of a 37-year-old man who developed myocarditis associated with DRESS syndrome after starting treatment with lithium and quetiapine for bipolar disorder. At that time, he presented with fever, morbilliform eruption, lymphadenopathy, eosinophilia with atypical lymphocytes, and liver dysfunction; bipolar drugs were discontinued and oral prednisolone begun. Four months later, he was admitted to our institution with worsening skin rash and dyspnoea. Transthoracic echocardiography revealed reduced systolic function in both ventricles, and endocardial biopsy indicated hypersensitivity myocarditis. Cardiac function was temporarily normalized by high-dose prednisolone. However, the inflammation was persistent as shown by a re-elevation of troponin T and fall of left ventricular ejection fraction several months later; in addition, 18F-fluoro-deoxyglucose positron emission tomography with chest computed tomography (FDG-PET/CT) showed focal FDG uptake in the left ventricle. Despite additional treatment with mycophenolate mofetil, the cardiac function deteriorated further, and the patient eventually manifested refractory heart failure classified as New York Heart Association (NYHA) Class III. Myocardial biopsy showed myocyte necrosis associated with ANEM. Discussion: This is the first case report of DRESS-associated myocarditis due to treatment for bipolar disorder. Although the pathophysiology remains incompletely understood, lithium and/or quetiapine can induce refractory myocarditis in DRESS syndrome. Regular measurements of troponin T and FDG-PET/CT are useful for assessing disease progression in DRESS-associated myocarditis.
• Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis Complicated by Sigmoid Septum.

  Kizuku Yamashita, Tomoyuki Fujita, Satsuki Fukushima, Yusuke Shimahara, Yuta Kume, Yorihiko Matsumoto, Naonori Kawamoto, Kimito Minami, Daijiro Kabata, Hideaki Kanzaki, Chisato Izumi, Toshihisa Anzai, Junjiro Kobayashi

  Circulation journal : official journal of the Japanese Circulation Society 82 (12) 3090 - 3099 1346-9843 2018/11/24 [Refereed][Not invited]
   

  BACKGROUND: In patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), a sigmoid septum, characterized by subaortic interventricular hypertrophy, often results in the need for new pacemaker implantation (PMI). In this study, we reviewed the feasibility and treatment efficacy of TAVR for AS in patients with a sigmoid septum. Methods and Results: Between 2011 and 2016, 48 patients (25.4%; mean age 84.9±5.4 years; 9 males) with a sigmoid septum and 141 (74.6%; mean age 82.9±5.5 years; 61 males) without underwent TAVR. Their operative outcomes, echocardiographic and electrocardiographic findings, and long-term outcomes were retrospectively compared. Second TAVR because of valve malposition was performed in 3 patients with a sigmoid septum (6.3%) and in 2 patients without a sigmoid septum (1.4%), with no significant difference between the 2 groups. Although there was no significant difference in valve hemodynamics between the 2 groups, sigmoid septum and deep implantation (implantation depth ≥10 mm) were independent predictors of new PMI following TAVR. CONCLUSIONS: Although a sigmoid septum did not preclude the feasibility, safety, or efficacy of TAVR for severe AS, its presence was associated with new PMI. Our approach to TAVR in patients with a sigmoid septum may contribute to clinical outcomes comparable to those of patients without this pathology.
• Peripartum Serial Echocardiographic Findings in a Patient with Life-threatening Peripartum Cardiomyopathy.

  Daisetsu Aoyama, Yasuhiro Hamatani, Chizuko Kamiya, Keiko Ohta-Ogo, Makoto Amaki, Shoji Kawakami, Atsushi Okada, Hiroyuki Takahama, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 57 (21) 3105 - 3109 0918-2918 2018/11/01 [Refereed][Not invited]
   

  A 35-year-old woman was referred to our hospital for the management of acutely decompensated heart failure due to peripartum cardiomyopathy (PPCM). Generally, cardiac examinations are performed after the manifestation of heart failure in patients with PPCM. Thus, reports of serial cardiac examinations before the onset of PPCM are scarce. In this case, we were able to document the serial echocardiographic findings before the onset of life-threatening PPCM. We found that the left ventricular systolic function was preserved at 35 weeks of gestation but declined acutely after delivery at 38 weeks. Although speculative, these findings suggest that left ventricular dilation might precede the onset of PPCM.
• A case of medical management of tricuspid regurgitation related to atrial fibrillation with constrictive pericarditis-like hemodynamics.

  Yoshiya Kato, Arata Fukushima, Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai

  Journal of cardiology cases 18 (5) 175 - 179 2018/11 [Refereed][Not invited]
   

  Severe tricuspid regurgitation (TR) is reported to represent a hemodynamic pattern similar to that of constrictive pericarditis (CP), which should be clearly differentiated for appropriate management. We report the case of a patient with severe TR due to atrial fibrillation (AF) in whom hemodynamic monitoring played a role in the selection of the management strategy. An 81-year-old Japanese man with chronic AF was admitted due to worsening heart failure. Echocardiography showed the dilation of bilateral atria and a right ventricle with severe TR. The right heart catheterization demonstrated the elevation and equalization of diastolic pressures of four cardiac chambers with impaired diastolic filling pattern, which are hallmarks of pericardial constriction due to CP. Of note, the CP-like hemodynamics were completely normalized by 10 days of medical therapies including diuretics and carperitide. After his discharge and over a 1-year follow-up, he has never experienced worsening heart failure and remained NYHA class II with moderate TR. Medical management targeted at volume reduction and vasodilation can be a therapeutic option for CP-like hemodynamics in isolated severe TR related to AF. Repeated hemodynamic assessment is an appropriate tool to help our understanding of the CP-like physiology caused by severe TR based on chronic AF. .
• Brain-Derived Neurotrophic Factor Improves Limited Exercise Capacity in Mice With Heart Failure.

  Junichi Matsumoto, Shingo Takada, Shintaro Kinugawa, Takaaki Furihata, Hideo Nambu, Naoya Kakutani, Masaya Tsuda, Arata Fukushima, Takashi Yokota, Shinya Tanaka, Hidehisa Takahashi, Masashi Watanabe, Shigetsugu Hatakeyama, Masaki Matsumoto, Keiichi I Nakayama, Yutaro Otsuka, Hisataka Sabe, Hiroyuki Tsutsui, Toshihisa Anzai

  Circulation 138 (18) 2064 - 2066 0009-7322 2018/10/30 [Refereed][Not invited]
  
• Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure.

  Naoya Kakutani, Arata Fukushima, Takashi Yokota, Takashi Katayama, Hideo Nambu, Ryosuke Shirakawa, Satoshi Maekawa, Takahiro Abe, Shingo Takada, Takaaki Furihata, Kota Ono, Koichi Okita, Shintaro Kinugawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 82 (11) 2753 - 2760 1346-9843 2018/10/25 [Refereed][Not invited]
   

  BACKGROUND: Oxygen uptake (V̇O2) at peak workload and anaerobic threshold (AT) workload are often used for grading heart failure (HF) severity and predicting all-cause mortality. The clinical relevance of respiratory exchange ratio (RER) during exercise, however, is unknown. Methods and Results: We retrospectively studied 295 HF patients (57±15 years, NYHA class I-III) who underwent cardiopulmonary exercise testing. RER was measured at rest; at AT workload; and at peak workload. Peak V̇O2 had an inverse correlation with RER at AT workload (r=-0.256), but not at rest (r=-0.084) or at peak workload (r=0.090). Using median RER at AT workload, we divided the patients into high RER (≥0.97) and low RER (<0.97) groups. Patients with high RER at AT workload were characterized by older age, lower body mass index, anemia, and advanced NYHA class. After propensity score matching, peak V̇O2 tended to be lower in the high-RER than in the low-RER group (14.9±4.5 vs. 16.1±5.0 mL/kg/min, P=0.06). On Kaplan-Meier analysis, HF patients with a high RER at AT workload had significantly worse clinical outcomes, including all-cause mortality and rate of readmission due to HF worsening over 3 years (29% vs. 15%, P=0.01). CONCLUSIONS: High RER during submaximal exercise, particularly at AT workload, is associated with poor clinical outcome in HF patients.
• Which is the proper reference tissue for measuring the change in FDG PET metabolic volume of cardiac sarcoidosis before and after steroid therapy?

  Sho Furuya, Osamu Manabe, Hiroshi Ohira, Kenji Hirata, Tadao Aikawa, Masanao Naya, Ichizo Tsujino, Kazuhiro Koyanagawa, Toshihisa Anzai, Noriko Oyama-Manabe, Tohru Shiga

  EJNMMI research 8 (1) 94 - 94 2018/10/05 [Refereed][Not invited]
   

  BACKGROUND: Cardiac sarcoidosis (CS) is a rare but potentially life-threatening disease that causes conduction disturbance, systolic dysfunction, and, most notably, sudden cardiac death. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) plays important roles not only in diagnosing CS but also in evaluating the effects of anti-inflammatory therapy. A volume-based analysis of parameters measured by FDG PET, so-called cardiac metabolic volume (CMV), has emerged as a new assessment tool. CMV is measured as the volume within the boundary determined by a reference tissue such as the liver and the blood pool uptake. However, there is a possibility that oral steroid therapy could lead to variations of the liver and the blood pool uptake. Here, we attempted to evaluate the steroid effects on the liver and the blood pool uptake. A total of 38 CS patients who underwent FDG PET/CT before and during steroid therapy were retrospectively enrolled. Volumes of interest (VOIs) were placed in the right lobe of the liver and descending aorta (DA). The maximum standardized uptake value (SUVmax), SUVmean, and SUVpeak of the liver and DA were compared between time points before and during steroid therapy. RESULTS: The SUVmax, SUVmean, and SUVpeak of the liver during steroid therapy significantly increased from the time point before the therapy (SUVmax 3.5 ± 0.4 vs. 3.8 ± 0.6, p = 0.014; SUVmean 2.7 ± 0.3 vs. 3.0 ± 0.5, p = 0.0065; SUVpeak 3.0 ± 0.4 vs. 3.4 ± 0.6, p = 0.006). However, the SUVmax, SUVmean, and SUVpeak in the DA did not significantly change (SUVmax 2.2 ± 0.3 vs. 2.2 ± 0.4, p = 0.46; SUVmean 1.9 ± 0.3 vs. 2.0 ± 0.4, p = 0.56; SUVpeak 2.0 ± 0.3 vs. 2.0 ± 0.3, p = 0.70). CONCLUSIONS: We measured FDG uptake in the liver and blood pool before and during steroid therapy. Steroid therapy increased the liver uptake but not the blood pool uptake. Our findings suggested that the DA uptake is a more suitable threshold than liver uptake to evaluate therapeutic effects using volume-based analysis of cardiac FDG PET.
• Protein acetylation in skeletal muscle mitochondria is involved in impaired fatty acid oxidation and exercise intolerance in heart failure.

  Masaya Tsuda, Arata Fukushima, Junichi Matsumoto, Shingo Takada, Naoya Kakutani, Hideo Nambu, Katsuma Yamanashi, Takaaki Furihata, Takashi Yokota, Koichi Okita, Shintaro Kinugawa, Toshihisa Anzai

  Journal of cachexia, sarcopenia and muscle 9 (5) 844 - 859 2190-5991 2018/10 [Refereed][Not invited]
   

  BACKGROUND: Exercise intolerance is a common clinical feature and is linked to poor prognosis in patients with heart failure (HF). Skeletal muscle dysfunction, including impaired energy metabolism in the skeletal muscle, is suspected to play a central role in this intolerance, but the underlying mechanisms remain elusive. Lysine acetylation, a recently identified post-translational modification, has emerged as a major contributor to the derangement of mitochondrial metabolism. We thus investigated whether mitochondrial protein acetylation is associated with impaired skeletal muscle metabolism and lowered exercise capacity in both basic and clinical settings of HF. METHODS: We first conducted a global metabolomic analysis to determine whether plasma acetyl-lysine is a determinant factor for peak oxygen uptake (peak VO2 ) in HF patients. We then created a murine model of HF (n = 11) or sham-operated (n = 11) mice with or without limited exercise capacity by ligating a coronary artery, and we tested the gastrocnemius tissues by using mass spectrometry-based acetylomics. A causative relationship between acetylation and the activity of a metabolic enzyme was confirmed in in vitro studies. RESULTS: The metabolomic analysis verified that acetyl-lysine was the most relevant metabolite that was negatively correlated with peak VO2 (r = -0.81, P < 0.01). At 4 weeks post-myocardial infarction HF, a treadmill test showed lowered work (distance × body weight) and peak VO2 in the HF mice compared with the sham-operated mice (11 ± 1 vs. 23 ± 1 J, P < 0.01; 143 ± 5 vs. 159 ± 3 mL/kg/min, P = 0.01; respectively). As noted, the protein acetylation of gastrocnemius mitochondria was 48% greater in the HF mice than the sham-operated mice (P = 0.047). Acetylproteomics identified the mitochondrial enzymes involved in fatty acid β-oxidation (FAO), the tricarboxylic acid cycle, and the electron transport chain as targets of acetylation. In parallel, the FAO enzyme (β-hydroxyacyl CoA dehydrogenase) activity and fatty acid-driven mitochondrial respiration were reduced in the HF mice. This alteration was associated with a decreased expression of mitochondrial deacetylase, Sirtuin 3, because silencing of Sirtuin 3 in cultured skeletal muscle cells resulted in increased mitochondrial acetylation and reduced β-hydroxyacyl CoA dehydrogenase activity. CONCLUSIONS: Enhanced mitochondrial protein acetylation is associated with impaired FAO in skeletal muscle and reduced exercise capacity in HF. Our results indicate that lysine acetylation is a crucial mechanism underlying deranged skeletal muscle metabolism, suggesting that its modulation is a potential approach for exercise intolerance in HF.
• Japanese Antibacterial Drug Management for Cardiac Sarcoidosis (J-ACNES): A multicenter, open-label, randomized, controlled study.

  Kohei Ishibashi, Yoshinobu Eishi, Nobuhiro Tahara, Masanori Asakura, Naka Sakamoto, Kazufumi Nakamura, Yoichi Takaya, Tomohisa Nakamura, Yoshikazu Yazaki, Tetsuo Yamaguchi, Koko Asakura, Toshihisa Anzai, Teruo Noguchi, Satoshi Yasuda, Fumio Terasaki, Toshimitsu Hamasaki, Kengo Kusano

  Journal of arrhythmia 34 (5) 520 - 526 1880-4276 2018/10 [Refereed][Not invited]
   

  Background: Cardiac sarcoidosis (CS) is a noncaseating granulomatous disease of unknown etiology. Lifelong immunosuppressive therapy, most frequently using corticosteroids, is a standard therapy to control hypersensitivity of immune reactions and prevent inflammation. However, it sometimes causes various systemic adverse effects and requires dose escalation. Thus, additional therapy may be required for the treatment of this disease. Recently, Propionibacterium acnes (P. acnes) was reported as one of the etiologic agents of CS, indicating that antibacterial drugs (ABD) may be effective for the treatment of CS. The objective of this study was to investigate the effect of ABD treatment, in addition to standard corticosteroid therapy, in patients with CS. Methods: The Japanese Antibacterial Drug Management for Cardiac Sarcoidosis (J-ACNES) trial was designed as a prospective, multicenter, randomized, open-label, controlled clinical trial. The patients will be randomized to receive either standard corticosteroid therapy plus ABD therapy (ABD group) or standard corticosteroid therapy (standard group). The primary endpoint is change in the total standardized uptake value at 6 months vs baseline using fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography. Secondary endpoints include efficacy, prognosis, and safety. Results: The results of this study are currently under investigation. Conclusion: The J-ACNES trial will be the first prospective study assessing the clinical benefit and safety of ABD therapy, in addition to corticosteroid treatment, in patients with CS. Our findings may improve treatment of patients with CS, as additional ABD therapy reduces recurrence of inflammation and elucidates the mechanism of sarcoidosis.
• Long-term reliability of the defibrillator lead inserted by the extrathoracic subclavian puncture.

  Masaya Watanabe, Hisashi Yokoshiki, Hirofumi Mitsuyama, Kazuya Mizukami, Taro Tenma, Rui Kamada, Masayuki Takahashi, Yoshiro Matsui, Toshihisa Anzai

  Journal of arrhythmia 34 (5) 541 - 547 1880-4276 2018/10 [Refereed][Not invited]
   

  Background: As the transvenous defibrillator lead is fragile and its failure may cause a life-threatening event, reliable insertion techniques are required. While the extrathoracic puncture has been introduced to avoid subclavian crush syndrome, the reports on the long-term defibrillator lead survival using this approach, especially the comparison with the cephalic cutdown (CD), remain scarce. We aimed to evaluate the long-term survival of the transvenous defibrillator lead inserted by the extrathoracic subclavian puncture (ESCP) compared with CD. Methods: Between 1998 and 2011, 324 consecutive patients who underwent an implantable cardioverter-defibrillator (ICD) implantation in Hokkaido University Hospital were included. ICD leads were inserted by CD from 1998 to 2003 and by contrast venography-guided ESCP thereafter. Lead failure was defined as a nonphysiologic high-rate oversensing with abnormal lead impedance or highly elevated sensing and pacing threshold. Results: Of 324 patients, CD was used in 37 (11%) and ESCP in 287 patients (89%). During the median follow-up of 6.2 years (IQR:3.2-8.3), 7 leads (2 in CD and 5 leads in ESCP group) failed. All patients with lead failure in ESCP group were implanted with either SJM Riata (n = 1) or Medtronic Fidelis lead (n = 4). Five-year lead survival was 93.8% (CI95%:77.3-98.4%) in CD compared with 99.1% (CI95%:96.6-99.8%) in ESCP group (P = 0.903). Univariate Cox regression analysis showed that the use of Fidelis or Riata lead was the strong predictor of the ICD lead failure (HR 13.8, CI95%:2.9-96.5; P = 0.001). Conclusions: Contrast venography-guided extrathoracic puncture ensures the reliable long-term survival in the transvenous defibrillator leads.
• The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF)

  Norihiko Kotooka, Masafumi Kitakaze, Kengo Nagashima, Machiko Asaka, Yoshiharu Kinugasa, Kotaro Nochioka, Atsushi Mizuno, Daisuke Nagatomo, Daigo Mine, Yoko Yamada, Akiko Kuratomi, Norihiro Okada, Daisuke Fujimatsu, So Kuwahata, Shigeru Toyoda, Shin ichi Hirotani, Takahiro Komori, Kazuo Eguchi, Kazuomi Kario, Takayuki Inomata, Kaoru Sugi, Kazuhiro Yamamoto, Hiroyuki Tsutsui, Tohru Masuyama, Hiroaki Shimokawa, Shin ichi Momomura, Yoshihiko Seino, Yasunori Sato, Teruo Inoue, Koichi Node, Mika Nakamizo, Chika Nishiyama, Kikumi Morita, Yuko Horiuchi, Michiko Hanawa, Takako Kanai, Hideki Hanaoka, Tohru Izumi, Yoshihiko Saito, Yukihito Sato, A. Haruyama, S. Inami, Y. Nishi, A. Amano, T. Arikawa, M. Kikuchi, Y. Eto, K. Ishii, K. Fukuda, S. Soejima, R. Hisano, D. Goto, S. Kinugawa, Y. Naito, A. Goda, T. Iwasaku, A. Eguchi, Y. Okuhara, R. Taniguchi, Y. Takatsu, K. Washida, T. Miyamoto, M. Toma, K. Yoshitani, R. Fukuhara, H. Fujiwara, K. Matsunaga, T. Iwata, Y. Nishimura, S. Hoshide, M. Shinpo, K. Kario, T. Katsuya, S. Katsuya, T. Naruke, M. Kiryu, S. Kurokawa, T. Sato, T. Koitabashi, M. Kajiwara, Y. Hiramatsu, Y. Sedutsu, T. Hashimoto, U. Yamamoto, K. Miyata, M. Mohri, H. Yamamoto, H. Origuchi, T. Hasegawa, A. Funada, H. Takahama, T. Ohara, H. Kanzaki, M. Asakura, T. Noguchi, Y. Goto, T. Anzai, C. Ibuki, T. Oba, M. Takano

  Heart and Vessels 33 (8) 866 - 876 0910-8327 2018/08/01 [Refereed][Not invited]
   

  © 2018, Springer Japan KK, part of Springer Nature. Home telemonitoring is becoming more important to home medical care for patients with heart failure. Since there are no data on home telemonitoring for Japanese patients with heart failure, we investigated its effect on cardiovascular outcomes. The HOMES-HF study was the first multicenter, open-label, randomized, controlled trial (RCT) to elucidate the effectiveness of home telemonitoring of physiological data, such as body weight, blood pressure, and pulse rate, for Japanese patients with heart failure (UMIN Clinical Trials Registry 000006839). The primary end-point was a composite of all-cause death or rehospitalization due to worsening heart failure. We analyzed 181 recently hospitalized patients with heart failure who were randomly assigned to a telemonitoring group (n = 90) or a usual care group (n = 91). The mean follow-up period was 15 (range 0–31) months. There was no statistically significant difference in the primary end-point between groups [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.548–1.648; p = 0.572]. Home telemonitoring for Japanese patients with heart failure was feasible; however, beneficial effects in addition to those of usual care were not demonstrated. Further investigation of more patients with severe heart failure, participation of home medical care providers, and use of a more integrated home telemonitoring system emphasizing communication as well as monitoring of symptoms and physiological data are required.
• Clinical determinants of successful weaning from extracorporeal membrane oxygenation in patients with fulminant myocarditis.

  Manabu Matsumoto, Yasuhide Asaumi, Yuichi Nakamura, Takeshi Nakatani, Toshiyuki Nagai, Tomoaki Kanaya, Shoji Kawakami, Satoshi Honda, Yu Kataoka, Seiko Nakajima, Osamu Seguchi, Masanobu Yanase, Kunihiro Nishimura, Yoshihiro Miyamoto, Kengo Kusano, Toshihisa Anzai, Teruo Noguchi, Tomoyuki Fujita, Junjiro Kobayashi, Hatsue Ishibashi-Ueda, Hiroaki Shimokawa, Satoshi Yasuda

  ESC heart failure 5 (4) 675 - 684 2018/08 [Refereed][Not invited]
   

  AIMS: Patients with fulminant myocarditis (FM) often present with cardiogenic shock and require mechanical circulatory support, including extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD) implantation. This study sought to clarify the determinants of successful weaning from ECMO in FM patients. METHODS AND RESULTS: We studied 37 consecutive FM patients supported by ECMO as the initial form of mechanical circulatory support between January 1995 and December 2014 in our hospital. Twenty-two (59%) patients were successfully weaned from ECMO, while 15 (41%) were not. There were significant differences in levels of peak creatine kinase and those of its MB isoform (CK-MB), left ventricular posterior wall thickness (LVPWT), and prevalence of cardiac rhythm disturbances. Receiver operating characteristic curve analysis revealed that a peak CK-MB level of 185 IU/L and LVPWT of 11 mm were the optimal cut-off values for predicting successful weaning from ECMO (areas under the curve, 0.89 and 0.85, respectively). During the follow-up [median 48 (interquartile range 8-147) months], 83% of FM patients who were weaned from ECMO survived, with preserved fractional shortening based on echocardiography. Of the 15 FM patients who were not weaned from ECMO, nine bridged to VAD, and only two were successfully weaned from VAD and survived. CONCLUSIONS: These results indicate that myocardial injury, as evidenced by CK-MB and LVPWT, and prolonged presence of cardiac rhythm disturbances are important clinical determinants of successful weaning from ECMO.
• Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan.

  Toshiyuki Nagai, Varun Sundaram, Ahmad Shoaib, Yasuyuki Shiraishi, Shun Kohsaka, Kieran J Rothnie, Susan Piper, Theresa A McDonagh, Suzanna M C Hardman, Ayumi Goda, Atsushi Mizuno, Mitsuaki Sawano, Alan S Rigby, Jennifer K Quint, Tsutomu Yoshikawa, Andrew L Clark, Toshihisa Anzai, John G F Cleland

  European journal of heart failure 20 (8) 1179 - 1190 1388-9842 2018/08 [Refereed][Not invited]
   

  AIMS: Prognostic models for hospitalized heart failure (HHF) were developed predominantly for patients of European origin in the United States of America; it is unclear whether they perform similarly in other health care systems or for different ethnicities. We sought to validate published prediction models for HHF in the United Kingdom (UK) and Japan. METHODS AND RESULTS: Patients in the UK (n =894) and Japan (n =3158) were prospectively enrolled and were similar in terms of sex (∼60% men) and median age (∼77 years). Models predicted that British patients would have a higher mortality than Japanese, which was indeed true both for in-hospital (4.8% vs. 2.5%) and 180-day (20.7% vs. 9.5%) mortality. The model c-statistics for the published/derivation (range 0.70-0.76) and Japanese (range 0.75-0.77) cohorts were similar and higher than for the UK (0.62-0.75) but models consistently overestimated mortality in Japan. For in-hospital mortality, the OPTIMIZE-HF model performed best, providing similar discrimination in published/derivation, UK and Japanese cohorts [c-indices: 0.75 (0.74-0.77); 0.75 (0.68-0.81); and 0.77 (0.70-0.83), respectively], and least overestimated mortality in Japan. For 180-day mortality, the c-statistics for the ASCEND-HF model were similar in published/derivation (0.70) and UK [0.69 (0.64-0.74)] cohorts but higher in Japan [0.75 (0.71-0.79)]; calibration was good in the UK but again overestimated mortality in Japan. CONCLUSION: Calibration of published prediction models appears moderately accurate and unbiased when applied to British patients but consistently overestimates mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest.
• Rationale and Design of the Multicenter Trial on Japan Working Group on the Effects of Angiotensin Receptor Blockers Selection (Azilsartan vs. Candesartan) on Diastolic Function in the Patients Suffering from Heart Failure with Preserved Ejection Fraction: J-TASTE Trial.

  Hiroyuki Takahama, Masanori Asakura, Yukio Abe, Masayoshi Ajioka, Kazutaka Aonuma, Toshihisa Anzai, Takaharu Hayashi, Shinya Hiramitsu, Hiroya Kawai, Hidetaka Kioka, Kazuo Kimura, Young-Jae Lim, Ken Matsuoka, Hirohiko Motoki, Yoji Nagata, Sunao Nakamura, Nobuyuki Ohte, Yukio Ozaki, Taishi Sasaoka, Shunsuke Tamaki, Toshimitsu Hamasaki, Masafumi Kitakaze

  Cardiovascular drugs and therapy 32 (4) 381 - 388 0920-3206 2018/08 [Refereed][Not invited]
   

  BACKGROUND: Previous studies suggest that the pathophysiology of heart failure with preserved ejection fraction (HFpEF) is characterized not only by high ventricular stiffness, but also by vascular stiffness. Azilsartan has higher vascular affinity compared with other angiotensin II receptor blockers (ARBs), which were proven to have no beneficial effects on clinical outcomes in patients with HFpEF in earlier clinical trials. We aimed to test the hypothesis that azilsartan may improve left ventricular diastolic function in HFpEF patients with hypertension in this trial. METHODS: The Effects of Angiotensin Receptor Blockers on Diastolic Function in Patients Suffering from Heart Failure with Preserved Ejection Fraction: J-TASTE trial is a multicenter, randomized, open-labeled, and assessor(s)-blinded, active controlled using candesartan, parallel-group clinical trial, to compare changes in left ventricular (LV) diastolic dysfunction between HFpEF patients with hypertension who have received candesartan or azilsartan for 48 weeks. The primary endpoint is the change in early diastolic wave height/early diastolic mitral annulus velocity (E/e') assessed by echocardiography from the baseline to the end of the study (48 weeks). A total of 190 patients will be recruited into the study. CONCLUSIONS: The design of the J-TASTE trial will provide data on whether differences between the effects of the two tested drugs on LV diastolic function exist in HFpEF patients with hypertension and will improve understanding of the pathophysiological role of vascular stiffness on diastolic function.
• Mitral Regurgitation and Heart Failure as the First Presentation in a Patient with Features of Two Connective Tissue Disorders: A Rare Combination of Mucopolysaccharidosis and Osteogenesis Imperfecta?

  Yasuhiro Hamatani, Junko Nakashima, Keiko Ohta-Ogo, Makoto Amaki, Masashi Koga, Daisetsu Aoyama, Kyohei Marume, Kenichiro Sawada, Yasuteru Nakashima, Atsushi Shibata, Atsushi Okada, Hiroyuki Takahama, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Yoshihiko Ikeda, Satoshi Yasuda, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 57 (15) 2209 - 2215 0918-2918 2018/08/01 [Refereed][Not invited]
   

  Connective tissue disorders sometimes involve cardiovascular systems. This report describes the case of a middle-aged man with mitral regurgitation and heart failure. He had distinctive features of mucopolysaccharidosis type (MPS) III, but no gene mutations that were known to be associated with MPS. Meanwhile, he had a COL1A2 gene mutation that is associated with osteogenesis imperfecta (OI), and had some features that were compatible with OI. The patient might have had a rare connective tissue disorder with the characteristics of MPS III and OI, which was initially detected as a result of the cardiovascular manifestations.
• Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides.

  Mitsuaki Sawano, Yasuyuki Shiraishi, Shun Kohsaka, Toshiyuki Nagai, Ayumi Goda, Atsushi Mizuno, Yasumori Sujino, Yuji Nagatomo, Takashi Kohno, Toshihisa Anzai, Keiichi Fukuda, Tsutomu Yoshikawa

  ESC heart failure 5 (4) 610 - 619 2018/08 [Refereed][Not invited]
   

  AIMS: Predictive models for heart failure patients are widely used in the clinical practice to stratify patients' mortality and enable clinicians to tailor and intensify their approach. However, such models have not been validated internationally. In addition, biomarkers are now frequently measured to obtain prognostic information, and the implications of this practice are not known. In this study, we aimed to validate the model performance of the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score in a Japanese acute heart failure registry and further explore the incremental prognostic value of discharge B-type natriuretic peptide (BNP) level. METHODS AND RESULTS: In this study, we evaluated the registered data of 2215 consecutive acute HF patients (with 694 119 person-years follow-up) from a prospective multicentre registry (the West Tokyo Heart Failure) conducted in Japan from April 2006 to August 2016. The mean age was 73.0 ± 13.0, and 61.2% were male. The MAGGIC score demonstrated modest discrimination (c-index = 0.71, 95% confidence interval 0.67-0.74) and good calibration (R2 value = 0.97); there was constant overestimation for 1 year mortality. However, when the BNP level was added to the original MAGGIC variables, the model demonstrated good discrimination (c-index = 0.74, 95% confidence interval 0.70-0.78) with adequate calibration (R2 value = 0.91). The modified MAGGIC BNP score was externally validated in a separate Japanese registry (NaDEF) and demonstrated moderate discrimination (c-index = 0.69, 95% confidence interval 0.65-0.73) and calibration (R2 value = 0.85). CONCLUSION: The original MAGGIC score performed modestly in Japanese patients, but the addition of discharge BNP level enhanced model performance. The addition of objective biomarkers may result in effective modification of preexisting internationally recognized risk models and aid in multinational comparisons of heart failure patients' outcomes.
• Left ventricular myxoma with Carney complex.

  Naoto Kuyama, Yasuhiro Hamatani, Satsuki Fukushima, Yoshihiko Ikeda, Eri Nakai, Atsushi Okada, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Tomoyuki Fujita, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Toshihisa Anzai, Junjiro Kobayashi

  ESC heart failure 5 (4) 713 - 715 2018/08 [Refereed][Not invited]
   

  The left ventricle is a less frequent location of cardiac myxomas overall. Meanwhile, cardiac myxomas related to Carney complex (CNC), which is a multiple neoplasia syndrome involving cardiac, endocrine, neural, and cutaneous tumours, more frequently occur in the left ventricle compared with sporadic cardiac myxomas. Herein, we report a case of a 20-year-old woman with CNC who underwent complete surgical excision of a large and mobile left ventricular myxoma. In our case, echocardiography performed 4 years earlier was normal. This case highlights the importance of annual follow-up by echocardiography in patients with CNC, because early diagnosis of cardiac myxomas might improve their prognosis. Besides, we should bear in mind the possibility of CNC if the patients have cardiac myxoma in a cardiac chamber other than the left atrium at a younger age.
• Elevated Plasma D-Dimer Level Is Associated With Short-Term Risk of Ischemic Stroke in Patients With Acute Heart Failure.

  Yasuhiro Hamatani, Toshiyuki Nagai, Michikazu Nakai, Kunihiro Nishimura, Yasuyuki Honda, Hiroki Nakano, Satoshi Honda, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Kazunori Toyoda, Satoshi Yasuda, Hiroyuki Yokoyama, Hisao Ogawa, Toshihisa Anzai

  Stroke 49 (7) 1737 - 1740 0039-2499 2018/07 [Refereed][Not invited]
   

  BACKGROUND AND PURPOSE: The incidence of heart failure increases the subsequent risk of ischemic stroke, and its risk could be higher in the short-term period after an acute heart failure (AHF) event. However, its determinants remain to be clarified. Plasma D-dimer level reflects fibrin turnover and exhibits unique properties as a biomarker of thrombosis. The aim of this study is to investigate whether D-dimer level is a determinant of short-term incidence of ischemic stroke in patients with AHF. METHODS: We examined 721 consecutive hospitalized AHF patients with plasma D-dimer level on admission from our prospective registry between January 2013 and May 2016. The study end points were incidence of ischemic stroke during hospitalization and at 30 days after admission. RESULTS: Of the total participants (mean age, 76 years; male, 60%; atrial fibrillation, 54%; mean left ventricular ejection fraction, 38%), in-hospital ischemic stroke occurred in 18 patients (2.5%) during a median hospitalization period of 21 days, and 30-day ischemic stroke occurred in 16 patients (2.2%). Higher D-dimer level on admission was an independent determinant of subsequent risk of in-hospital ischemic stroke even after adjustment by CHA2DS2-VASc score (odds ratio, 2.29; 95% confidence interval, 1.46-3.60; P<0.001) or major confounders, including age, atrial fibrillation, and antithrombotic therapy (odds ratio, 2.31; 95% confidence interval, 1.43-3.74; P<0.001). Subgroup analyses showed consistent findings in patients without atrial fibrillation (odds ratio, 2.46; 95% confidence interval, 1.39-4.54; P=0.002) and those without antithrombotic therapy (odds ratio, 2.79; 95% confidence interval, 1.53-5.57; P<0.001). Similar results were obtained for 30-day ischemic stroke as an alternative outcome. CONCLUSIONS: Elevated plasma D-dimer level on admission was significantly associated with increased incidence of ischemic stroke shortly after admission for AHF, suggesting a predictive role of D-dimer for short-term ischemic stroke events in patients with AHF. CLINICAL TRIAL REGISTRATION: URL: https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000017024.
• Impact of iron deficiency on long-term clinical outcomes of hospitalized patients with heart failure.

  Hiroki Nakano, Toshiyuki Nagai, Varun Sundaram, Michikazu Nakai, Kunihiro Nishimura, Yasuyuki Honda, Satoshi Honda, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Hisao Ogawa, Satoshi Yasuda, Taishiro Chikamori, Toshihisa Anzai

  International journal of cardiology 261 114 - 118 0167-5273 2018/06/15 [Refereed][Not invited]
   

  BACKGROUND: Iron deficiency (ID) is commonly observed in chronic heart failure (HF) patients and is associated with worse clinical outcomes. While ID is frequent finding in hospitalized heart failure (HHF), its impact on long-term outcome in HHF patients remains unclear. METHODS: We evaluated iron status at discharge in 578 HHF patients. Absolute ID was defined as serum ferritin <100 μg/L, and functional ID (FID) was defined as serum ferritin of 100-299 μg/L with transferrin saturation <20%. The primary outcome of interest was the composite of all-cause mortality and HF admission at one year. RESULTS: Among the study population, 185 had absolute ID, 88 had FID and 305 had no evidence of ID. At one-year post-discharge, 64 patients had died and 112 had been readmitted with HF. Patients with absolute ID had more adverse events than those with FID or no ID (p = 0.021). In multivariate Cox regression analyses, absolute ID was significantly associated with increased risk of adverse events at one year (HR 1.50, 95% CI 1.02-2.21, p = 0.040) compared with the remaining patients. Sensitivity analysis revealed that its prognostic effect did not differ across anemic status, or between HF with reduced and preserved ejection fraction (p for interaction = 0.17, 0.68, respectively). CONCLUSION: Absolute ID, but not FID, at discharge was associated with increased risk of one-year mortality or HF admission in patients with HHF. Further studies are required to evaluate the role of repleting iron stores and its impact on clinical outcomes in patients with HHF.
• Clinical Utility of Echocardiographic Hemodynamic Monitoring during Manual Compression of Arteriovenous Shunt in a Patient with High-Output Heart Failure.

  Hiroyuki Iwano, Shingo Tsujinaga, Daiki Iwami, Naoya Asakawa, Satoshi Yamada, Toshihisa Anzai

  CASE (Philadelphia, Pa.) 2 (3) 103 - 108 2018/06 [Refereed][Not invited]
  
• Clinical Characteristics, Management, and Outcomes of Japanese Patients Hospitalized for Heart Failure With Preserved Ejection Fraction - A Report From the Japanese Heart Failure Syndrome With Preserved Ejection Fraction (JASPER) Registry.

  Toshiyuki Nagai, Tsutomu Yoshikawa, Yoshihiko Saito, Yasuchika Takeishi, Kazuhiro Yamamoto, Hisao Ogawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 82 (6) 1534 - 1545 1346-9843 2018/05/25 [Refereed][Not invited]
   

  BACKGROUND: Despite the specific characteristics of heart failure with preserved ejection fraction (HFpEF) having been demonstrated predominantly from registries in Western countries, important international differences exist in terms of patient characteristics, management and medical infrastructure between Western and Asian countries.Methods and Results:We performed nationwide registration of consecutive Japanese hospitalized HFpEF patients with left ventricular EF ≥50% from 15 sites between November 2012 and March 2015. Follow-up data were obtained up to 2 years post-discharge. A total of 535 patients were registered. The median age was 80 years and 50% were female. The most common comorbid conditions were hypertension (77%) and atrial fibrillation (AF: 62%), but body mass index was relatively low. In-hospital mortality rate was 1.3% and the median length of hospitalization was 16 days. By 2 years post-discharge, 40.8% of patients had all-cause death or HF hospitalization. Approximately one-half of deaths had a cardiac cause. Lower serum albumin on admission was one of the strongest independent determinants of worse clinical outcome. CONCLUSIONS: Japanese HFpEF patients were less obese, but had a substantially higher prevalence of AF and lower incidence of subsequent events compared with previous reports. Our findings indicated that specific preventative and therapeutic strategies focusing on AF and nutritional status might need to be considered for Japanese hospitalized patients with HFpEF.
• Subacute Left Atrial Thrombus Formation After Percutaneous Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation.

  Makoto Amaki, Yu Kataoka, Hideaki Kanzaki, Koji Miyamoto, Atsushi Okada, Yasuhiro Hamatani, Masashi Fujino, Hiroyuki Takahama, Takuya Hasegawa, Yasuo Sugano, Kengo Kusano, Yoshihiko Ohnishi, Tomoyuki Fujita, Junjiro Kobayashi, Toshihisa Anzai, Satoshi Yasuda

  Circulation journal : official journal of the Japanese Circulation Society 82 (6) 1712 - 1713 1346-9843 2018/05/25 [Refereed][Not invited]
  
• Relation between total shock energy and mortality in patients with implantable cardioverter-defibrillator.

  Taro Tenma, Hisashi Yokoshiki, Hirofumi Mitsuyama, Masaya Watanabe, Kazuya Mizukami, Rui Kamada, Masayuki Takahashi, Ryo Sasaki, Motoki Maeno, Kaori Okamoto, Yuki Chiba, Toshihisa Anzai

  International journal of cardiology 259 94 - 99 0167-5273 2018/05/15 [Refereed][Not invited]
   

  BACKGROUND: Implantable Cardioverter-Defibrillator (ICD) shocks have been associated with mortality. However, no study has examined the relation between total shock energy and mortality. The aim of this study is to assess the association of total shock energy with mortality, and to determine the patients who are at risk of this association. METHODS: Data from 316 consecutive patients who underwent initial ICD implantation in our hospital between 2000 and 2011 were retrospectively studied. We collected shock energy for 3 years from the ICD implantation, and determined the relation of shock energy on mortality after adjusting confounding factors. RESULTS: Eighty-seven ICD recipients experienced shock(s) within 3 years from ICD implantation and 43 patients had died during the follow-up. The amount of shock energy was significantly associated with all-cause death [adjusted hazard ratio (HR) 1.26 (per 100 joule increase), p < 0.01] and tended to be associated with cardiac death (adjusted HR 1.30, p = 0.08). The survival rate of patients with high shock energy accumulation (≥182 joule) was lower (p < 0.05), as compared to low shock energy accumulation (<182 joule), likewise to no shock. Besides, the relation between high shock energy accumulation and all-cause death was remarkable in the patients with low left ventricular ejection fraction (LVEF ≤40%) or atrial fibrillation (AF). CONCLUSIONS: Increase of shock energy was related to mortality in ICD recipients. This relation was evident in patients with low LVEF or AF.
• Ratio of pro-B-type natriuretic peptide (BNP) to total BNP is decreased in mild, but not severe, acute decompensated heart failure patients: A novel compensatory mechanism for acute heart failure.

  Hiroyuki Takahama, Seiji Takashio, Toshio Nishikimi, Tomohiro Hayashi, Chiaki Nagai-Okatani, Yasuaki Nakagawa, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Kenji Kangawa, Naoto Minamino, Toshihisa Anzai

  International journal of cardiology 258 165 - 171 0167-5273 2018/05/01 [Refereed][Not invited]
   

  BACKGROUND: A recent study showed that both glycosylation of pro-B-type natriuretic peptide (BNP) and the proBNP/total BNP ratio are decreased in acute decompensated heart failure (ADHF). However, the following points regarding the proBNP/total BNP ratio have not been determined in patients with ADHF: 1) the relationship with the severity of ADHF, 2) the changes in the ratio during treatment, and 3) the relationship with cyclic guanosine monophosphate (cGMP)-generating activity. METHODS: Plasma proBNP and total BNP (proBNP+mature BNP) were measured in patients with ADHF (n=154). Measurement was performed on admission, 3 and 7days after admission, and before discharge using recently developed sandwich chemiluminescence enzyme immunoassays. The percent proBNP was calculated as: (proBNP/total BNP)×100. RESULTS: On admission, %proBNP was higher in patients with severe ADHF than in patients with mild ADHF (median: 61.7% vs. 56.2%, respectively; p<0.01), while the plasma cGMP/total BNP ratio, an index of the biological activity of BNP, was lower (p<0.001). In patients with severe ADHF, the higher %proBNP and lower cGMP/total BNP ratio were unchanged during hospitalization, whereas %proBNP increased gradually in patients with mild ADHF and the cGMP/total BNP ratio also increased at 3days after admission. CONCLUSION: These findings suggest that in patients with mild ADHF, compensation for heart failure occurs via increased proBNP processing, leading to increase of mature BNP and activation of the BNP/cGMP cascade. In contrast, this compensatory mechanism may be impaired in patients with severe ADHF and a vicious cycle can potentially occur.
• Successful Treatment of Mitral Regurgitation after Transapical Transcatheter Aortic Valve Implantation by Percutaneous Edge-to-edge Mitral Valve Repair (MitraClip®) -The First Combination Therapy Performed in Japan.

  Atsushi Okada, Hideaki Kanzaki, Makoto Amaki, Yu Kataoka, Koji Miyamoto, Yasuhiro Hamatani, Masashi Fujino, Hiroyuki Takahama, Takuya Hasegawa, Yusuke Shimahara, Yoshiaki Morita, Yasuo Sugano, Kengo Kusano, Yoshihiko Ohnishi, Tomoyuki Fujita, Junjiro Kobayashi, Toshihisa Anzai, Satoshi Yasuda

  Internal medicine (Tokyo, Japan) 57 (8) 1105 - 1109 0918-2918 2018/04/15 [Refereed][Not invited]
   

  A 75-year old man with a history of inferior myocardial infarction was admitted with symptoms of progressive heart failure 3 months after undergoing transapical transcatheter aortic valve implantation (TAVI). Echocardiography revealed severe mitral regurgitation (MR) caused by posterior leaflet tethering, without traumatic injury of the mitral valve or chordae. The patient was successfully treated by percutaneous edge-to-edge mitral valve repair (MitraClip®). This case highlights the role of MitraClip® in high-risk patients suffering from MR, and suggests that apical contractile loss or adhesion caused by apical puncture and suturing in transapical TAVI may be one of the mechanisms of worsening MR.
• Assessment of renal perfusion impairment in a rat model of acute renal congestion using contrast-enhanced ultrasonography

  Kaoru Komuro, Yoshihiro Seo, Masayoshi Yamamoto, Seika Sai, Tomoko Ishizu, Kyo Shimazu, Yumi Takahashi, Shogo Imagawa, Teisuke Anzai, Kazuya Yonezawa, Kazutaka Aonuma

  Heart and Vessels 33 (4) 434 - 440 1615-2573 2018/04/01 [Refereed][Not invited]
   

  Renal congestion is caused by elevated central venous pressure (CVP), and decreases glomerular filtration in patients with congestive heart failure. Since real-time contrast-enhanced ultrasonography (CEUS) using microbubble-based contrast agents can visualize the perfused microvascular bed, we sought to evaluate the impairment of renal perfusion during acute renal congestion with CEUS. In Wister rats, CEUS of kidney was performed with the direct monitoring of CVP and intra-renal pressure (IRP). When CVP was elevated to 10 and 15 mmHg after the bolus injection of normal saline via the femoral vein, peak intensity (PI, dB) and time to PI (TTP) in the renal cortex and medulla were compared with control rats. There was a strong correlation between IRP and CVP (r = 0.95, p <  0.0001). In the congestion model, more time was required for enhancement of the parenchyma, especially in the medulla compared to control TTP of the medulla and cortex at 15 mmHg CVP (CVP15) was significantly prolonged compared with controls (medulla, 4351 ± 98 vs. 1415 ± 267 ms, p = 0.003 cortex, 3219 ± 106 vs. 1335 ± 264 ms, p = 0.005). In addition, medullary PI at CVP15 decreased, but not significantly, compared to those of controls and at 10 mmHg CVP (20.1 ± 0.9, 22.8 ± 1.6, 21.6 ± 0.2 dB). In contrast, cortical PIs at CVP15 were significantly lower than that of control (24.6 ± 1.0 vs. 31.4 ± 1.0 dB, p = 0.007). CEUS revealed that impaired renal parenchymal flow in an acute congestion model is accompanied with increased renal interstitial pressure.
• Increased serum Wisteria floribunda agglutinin positive Mac-2 binding protein (Mac-2 binding protein glycosylation isomer) in chronic heart failure: a pilot study.

  Atsushi Okada, Hideaki Kanzaki, Yasuhiro Hamatani, Seiji Takashio, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Satoshi Yasuda, Toshihisa Anzai

  Heart and vessels 33 (4) 385 - 392 0910-8327 2018/04 [Refereed][Not invited]
   

  BACKGROUND: Serum Wisteria floribunda agglutinin positive Mac-2 binding protein (WFA+-M2BP) or Mac-2 Binding Protein Glycosylation Isomer (M2BPGi) is a novel biomarker currently applied for evaluating hepatic fibrosis. The aim of this study was to evaluate the utility of serum WFA+-M2BP level as a biomarker in chronic heart failure (HF) patients with abnormal liver function. METHODS AND RESULTS: Fifty chronic HF patients who underwent measurement of serum WFA+-M2BP were evaluated. The median value of serum WFA+-M2BP was 0.88 (interquartile range 0.48-1.29) cut-off index, and positive WFA+-M2BP (≥ 1.00 cut-off index) was observed in 22 (44%). Elevated WFA + -M2BP was associated with longer HF history, older age, female sex, valvular heart disease, decreased estimated glomerular filtration rate (eGFR), albumin, and cholinesterase. Stepwise multiple regression analysis showed that HF history, eGFR, and albumin were independent determinants of serum WFA+-M2BP values. Repeated measurements of serum WFA+-M2BP suggested association between the decrease of WFA+-M2BP and improvement of New York Heart Association (NYHA) functional class. CONCLUSIONS: Elevation of serum WFA+-M2BP showed a high prevalence in chronic HF patients with abnormal liver function with relation to HF history, decreased hepatic protein synthesis, and renal dysfunction. Our results suggest that serum WFA+-M2BP may be a novel biomarker of chronic HF.
• Response to letter regarding article by Formiga et al., "Utility of the Controlling Nutritional Status (CONUT) score in patients admitted due to acute heart failure".

  Naotsugu Iwakami, Toshiyuki Nagai, Toshiaki A Furukawa, Toshihisa Anzai

  International journal of cardiology 256 25 - 25 0167-5273 2018/04/01 [Refereed][Not invited]
  
• An Exploratory Study of Dapagliflozin for the Attenuation of Albuminuria in Patients with Heart Failure and Type 2 Diabetes Mellitus (DAPPER).

  Fumiki Yoshihara, Miki Imazu, Toshimitsu Hamasaki, Toshihisa Anzai, Satoshi Yasuda, Shin Ito, Haruko Yamamoto, Kazuhiko Hashimura, Yoshio Yasumura, Kiyoshi Mori, Masataka Watanabe, Masanori Asakura, Masafumi Kitakaze

  Cardiovascular drugs and therapy 32 (2) 183 - 190 0920-3206 2018/04 [Refereed][Not invited]
   

  BACKGROUND AND AIMS: Sodium-dependent glucose transporter-2 (SGLT-2) inhibitors, which are anti-diabetic drugs, reportedly decrease the incidence of cardiovascular events in high-risk patients with cardiovascular diseases, and thus chronic heart failure (CHF). SGLT-2 inhibitors also decrease albuminuria in patients with type 2 diabetes mellitus (T2D). Since albuminuria is a biomarker of not only chronic kidney disease but also cardiovascular events, we hypothesized that, among T2D patients with CHF, SGLT-2 inhibitors will decrease the extent of albuminuria and also improve CHF concomitantly. METHODS: DAPPER (UMIN000025102) is a multicenter, randomized, open-labeled, parallel-group, standard treatment-controlled study, which is designed to evaluate whether dapagliflozin, one of the SGLT-2 inhibitors, decreases albuminuria in T2D patients with CHF and exerts cardioprotective effects on the failing heart. The patients are randomized to either of the dapagliflozin (5 or 10 mg, once daily orally) or control group (administration of anti-diabetic drugs administered other than SGLT 2 inhibitors). The estimated number of patients that need to be enrolled is 446 in total (223 in each group). The primary objective is the changes in the urinary albumin-to-creatinine ratio from the baseline after 2-year treatment. The key secondary objectives are (1) the safety of dapagliflozin and (2) the cardiovascular and renal efficacies of dapagliflozin. CONCLUSION AND PERSPECTIVES: DAPPER study investigates whether dapagliflozin decreases albuminuria and exerts beneficial effects on the failing heart in T2D patients. (UMIN000025102).
• Mortality and Sudden Cardiac Death Risk Stratification Using the Noninvasive Combination of Wide QRS Duration and Late Gadolinium Enhancement in Idiopathic Dilated Cardiomyopathy.

  Kyohei Marume, Teruo Noguchi, Emi Tateishi, Yoshiaki Morita, Tsukasa Kamakura, Kohei Ishibashi, Takashi Noda, Hiroyuki Miura, Kunihiro Nishimura, Michikazu Nakai, Naoaki Yamada, Kenichi Tsujita, Toshihisa Anzai, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda

  Circulation. Arrhythmia and electrophysiology 11 (4) e006233  1941-3149 2018/04 [Refereed][Not invited]
   

  BACKGROUND: The aim of this study was to investigate whether the combination of QRS duration ≥120 ms (wide QRS duration [wQRS]) and late gadolinium enhancement (LGE) is a precise prognostic indicator for dilated cardiomyopathy. METHODS AND RESULTS: We investigated the association between the combination of LGE plus wQRS and the primary end point (all-cause death) and a composite of sudden cardiac death (SCD) or aborted SCD in 531 patients with dilated cardiomyopathy. We also analyzed the association between the combination of LGE and wQRS and these end points among patients with a class I indication for implantable cardioverter defibrillator implantation. We divided study patients into 3 groups according to LGE status and QRS duration: 2 negative indices (LGE negative and narrow QRS), 1 positive index (LGE positive or wQRS), or 2 positive indices (LGE positive and wQRS), and followed them for 3.8 years. Multivariable Cox regression analysis identified 2 positive indices as a significant predictor of all-cause death (hazard ratio, 4.29 [1.19-15.47]; P=0.026). Among 317 patients with a class I indication for implantable cardioverter defibrillator, the 5-year event rate of SCD or aborted SCD was the lowest in the 2 negative indices group (1.4%). With propensity score-matching cohorts, the 2 negative indices group had a significantly lower event rate of SCD or aborted SCD than the other 2 groups (hazard ratio, 0.12 [0.01-0.97]; P=0.046). CONCLUSIONS: The combination of LGE and wQRS provides additional prognostic stratification compared with LGE status alone and might improve the appropriate use of implantable cardioverter defibrillator therapy in patients with dilated cardiomyopathy.
• Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions.

  Yasuhiro Hamatani, Toshiyuki Nagai, Yasuyuki Shiraishi, Shun Kohsaka, Michikazu Nakai, Kunihiro Nishimura, Takashi Kohno, Yuji Nagatomo, Yasuhide Asaumi, Ayumi Goda, Atsushi Mizuno, Satoshi Yasuda, Hisao Ogawa, Tsutomu Yoshikawa, Toshihisa Anzai

  The American journal of cardiology 121 (6) 731 - 738 0002-9149 2018/03/15 [Refereed][Not invited]
   

  Plasma B-type natriuretic peptide (BNP) is an important prognostic marker in patients with acute heart failure (AHF). However, it is unclear which BNP parameter, on admission, at discharge, or change during hospitalization, has the highest predictive performance for long-term adverse outcomes, and whether its prognostic impact differs according to the new European heart failure (HF) phenotype classification by left ventricular ejection fraction: heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). We examined 1,792 patients with AHF consisting of 860 (48%) HFrEFs, 318 (18%) HFmrEFs, and 614 (34%) HFpEFs. Prognostic performance of each BNP parameter was assessed by the Harrell c-index. During a median follow-up of 664 days, 344 (19%) patients died. Discharge BNP had the highest c-index (0.69) for mortality among all BNP parameters (p <0.001). In multivariate Cox proportional hazard modeling, discharge BNP was associated with mortality in HFrEF, HFmrEF, and HFpEF patients with significant interaction (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.57 to 2.41; HR 1.76, 95% CI 1.10 to 2.82; HR 1.46, 95% CI 1.12 to 1.91, respectively; p = 0.011 for interaction). Moreover, the c-index of discharge BNP for mortality in HFrEF patients (0.72) was higher than that in HFmrEF patients (0.68) and HFpEF patients (0.65). Similar results were obtained for mortality or HF rehospitalization as alternative outcomes, except there was no statistically significant interaction among HF phenotypes. In conclusion, discharge BNP is a more reliable marker than other BNP parameters on long-term outcome prediction in patients with AHF, but its prognostic impact may be weakened in HFmrEF and HFpEF compared with HFrEF.
• LONG-TERM EFFECTS OF ANGIOTENSIN CONVERTING ENZYME INHIBITOR ON LEFT VENTRICULAR EJECTION FRACTION IN DUCHENNE AND BECKER MUSCULAR DYSTROPHY: A LONGITUDINAL CARDIAC MAGNETIC RESONANCE IMAGING STUDY

  Tadao Aikawa, Atsuhito Takeda, Noriko Oyama-Manabe, Masanao Naya, Hirokuni Yamazawa, Kazuhiro Koyanagawa, Yoichi M. Ito, Yuka Ishikawa, Yukitoshi Ishikawa, Toshihisa Anzai

  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 71 (11) 1565 - 1565 0735-1097 2018/03 [Refereed][Not invited]
  
• Long-term prognostic significance of urinary sodium concentration in patients with acute heart failure.

  Satoshi Honda, Toshiyuki Nagai, Kunihiro Nishimura, Michikazu Nakai, Yasuyuki Honda, Hiroki Nakano, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  International journal of cardiology 254 189 - 194 0167-5273 2018/03/01 [Refereed][Not invited]
   

  BACKGROUND: Lower urinary sodium concentration (UNa) may reflect impaired renal perfusion, higher neurohormonal activity and diuretic resistance. However, the prognostic impact of UNa in patients with acute heart failure (AHF) has not been fully elucidated. METHODS: We investigate the association between UNa and clinical outcomes in 669 patients admitted with AHF in our prospective registry. Patients were stratified into tertiles based on UNa in a spot urine sample on admission. RESULTS: Patients with lower UNa were more likely to have a history of prior heart failure admission, β-blockers and diuretics use, and had lower blood pressure and serum sodium level, and higher blood urea nitrogen, estimated glomerular filtration rate, blood glucose and troponin T levels on admission than those with higher UNa. Plasma renin activity, aldosterone, cortisol and dopamine levels were also significantly higher in patients with lower UNa (all p<0.001). Furthermore, patients with lower UNa had significantly less weight loss, lower net fluid loss/furosemide equivalent dose and higher incidence of worsening renal function during hospitalization than those with higher UNa (all p<0.01). During a median follow-up period of 560days, lower UNa was significantly associated with the composite of all-cause death and worsening heart failure (p<0.001). In multivariable Cox-proportional hazards model, UNa remained an independent determinant of long-term adverse events (HR, 1.24, 95% CI, 1.06-1.45, p=0.006). CONCLUSIONS: Lower UNa was associated with worse long-term clinical outcomes along with increased neurohormonal activities, impaired response to diuretics and higher incidence of worsening renal function in patients with AHF.
• Inflammatory Mechanisms of Cardiovascular Remodeling.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 82 (3) 629 - 635 1346-9843 2018/02/23 [Refereed][Not invited]
   

  Inflammation and fibrosis play an important role in the development and progression of cardiovascular diseases. Acute coronary syndrome (ACS) is caused by rupture of inflamed atherosclerotic plaque and subsequent atherothrombosis. Recent studies have shown that inflammatory markers such as C-reactive protein (CRP) can predict ACS development and have demonstrated the effectiveness of new therapeutic approaches targeting inflammation. Studies have also shown that an enhanced inflammatory response after myocardial infarction (MI) is associated with cardiac rupture, ventricular aneurysm formation, and exacerbation of left ventricular (LV) remodeling. Inflammation is a physiological reaction in which fibrosis is induced to facilitate the healing of tissue damage. However, when an excessive inflammatory response consisting mainly of monocytes/macrophages is induced by various factors, impaired reparative fibrosis and resulting pathological remodeling processes may occur. A similar phenomenon is observed in abdominal aortic aneurysm (AAA) expansion. In contrast, myocardial diseases such as inflammatory dilated cardiomyopathy (DCMI) and valvular diseases such as aortic valve stenosis (AS) are characterized by chronic inflammation mediated mainly by T lymphocytes and the associated enhancement of reactive fibrosis. Thus, inflammation can take 2 paths (the inhibition or promotion of fibrosis), depending on the phase of inflammation, inducing pathological cardiovascular remodeling. Elucidation of the regulatory mechanisms of inflammation and fibrosis will contribute to the development of new therapeutic approaches for cardiovascular diseases.
• Diagnostic utility of cardiac troponin T level in patients with cardiac amyloidosis.

  Seiji Takashio, Megumi Yamamuro, Yasuhiro Izumiya, Kyoko Hirakawa, Kyohei Marume, Masahiro Yamamoto, Mitsuharu Ueda, Taro Yamashita, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Hisao Ogawa, Yukio Ando, Toshihisa Anzai, Kenichi Tsujita

  ESC heart failure 5 (1) 27 - 35 2018/02 [Refereed][Not invited]
   

  AIM: The aim of this study was to evaluate the diagnostic utility of high-sensitivity cardiac troponin T (hs-cTnT) levels in discriminating cardiac amyloidosis from patients with cardiac hypertrophy caused by aetiologies other than cardiac amyloidosis. METHODS AND RESULTS: Serum hs-cTnT levels were measured in 96 patients with cardiac amyloidosis (light chain: 23, wild-type transthyretin amyloidosis: 40, and mutated transthyretin amyloidosis: 33), and 91 patients with other causes of cardiac hypertrophy who were confirmed to have no cardiac amyloidosis by endomyocardial biopsy (control group). The diagnostic utility and cut-off value of hs-cTnT were evaluated by receiver operating characteristic analysis. The median hs-cTnT levels were higher in cardiac amyloidosis than the control group [0.048 (0.029-0.073) vs. 0.016 (0.010-0.031) ng/mL; P < 0.001]. High levels of hs-cTnT were suggestive of cardiac amyloidosis (cut-off value: 0.0312 ng/mL, sensitivity: 0.74, specificity: 0.76, area under the curve: 0.788; 95% confidence interval: 0.723-0.854, P < 0.001), compared with brain natriuretic peptide and E/e' ratio. The hs-cTnT levels were also useful in differentiating each type of amyloidosis from the control group. Multivariate analysis identified log hs-cTnT as an independent diagnostic factor for cardiac amyloidosis (odds ratio: 2.22; 95% confidence interval: 1.30-3.80; P = 0.004). CONCLUSIONS: High serum levels of hs-cTnT are highly suggestive of cardiac amyloidosis, allowing its differentiation from cardiac hypertrophy of other aetiologies. Further refined diagnostic approaches that include imaging modalities and histopathological examination are needed for these patients to avoid underdiagnosis of cardiac amyloidosis.
• Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction.

  Naoki Maniwa, Masashi Fujino, Michikazu Nakai, Kunihiro Nishimura, Yoshihiro Miyamoto, Yu Kataoka, Yasuhide Asaumi, Yoshio Tahara, Michio Nakanishi, Toshihisa Anzai, Kengo Kusano, Takashi Akasaka, Yoichi Goto, Teruo Noguchi, Satoshi Yasuda

  European heart journal 39 (3) 201 - 208 0195-668X 2018/01/14 [Refereed][Not invited]
   

  Aims: There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). Methods and results: Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1-9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan-Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P < 0.001). Multivariate analysis showed that LVT was an independent predictor of SE. Among the LVT patients treated with vitamin K antagonists (n = 84), we compared the patients with therapeutic range (TTR) ≥50% (n = 34) and those with TTR <50% (n = 50). Only one embolic event developed in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036). There was no difference in major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89). Conclusion: Appropriate anticoagulation therapy may decrease the incidence of embolic events without increasing the incidence of bleeding events in patients with first AMI complicated by LV thrombus.
• Mortality after admission for heart failure in the UK compared with Japan.

  Toshiyuki Nagai, Varun Sundaram, Kieran Rothnie, Jennifer Kathleen Quint, Ahmad Shoaib, Yasuyuki Shiraishi, Shun Kohsaka, Susan Piper, Theresa A McDonagh, Suzanna Marie C Hardman, Ayumi Goda, Atsushi Mizuno, Takashi Kohno, Alan S Rigby, Tsutomu Yoshikawa, Andrew L Clark, Toshihisa Anzai, John G F Cleland

  Open heart 5 (2) e000811  2018 [Refereed][Not invited]
   

  Objective: Mortality amongst patients hospitalised for heart failure (HHF) in Western and Asian countries may differ, but this has not been investigated using individual patient-level data (IPLD). We sought to remedy this through rigorous statistical analysis of HHF registries and variable selection from a systematic literature review. Methods and results: IPLD from registries of HHF in Japan (n=3781) and the UK (n=894) were obtained. A systematic literature review identified 23 models for predicting outcome of HHF. Five variables appearing in 10 or more reports were strongly related to prognosis (systolic blood pressure, serum sodium concentration, age, blood urea nitrogen and creatinine). To compare mortality in the UK and Japan, variables were imputed in a propensity model using inverse probability of treatment weighting (IPTW) and IPTW with logistic regression (doubly robust IPTW). Overall, patients in the UK were sicker and in-patient and post-discharge mortalities were greater, suggesting that the threshold for hospital admission was higher. Covariate-adjusted in-hospital mortality was similar in the UK and Japan (IPTW OR: 1.14, 95% CI 0.70 to 1.86), but 180-day postdischarge mortality was substantially higher in the UK (doubly robust IPTW OR: 2.33, 95% CI 1.58 to 3.43). Conclusions: Despite robust methods to adjust for differences in patient characteristics and disease severity, HHF patients in the UK have roughly twice the mortality at 180 days compared with those in Japan. Similar analyses should be done using other data sets and in other countries to determine the consistency of these findings and identify factors that might inform healthcare policy and improve outcomes.
• Decrease in exhaled hydrogen as marker of congestive heart failure.

  Atsushi Shibata, Yasuo Sugano, Akito Shimouchi, Tetsuro Yokokawa, Naoya Jinno, Hideaki Kanzaki, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hideshi Okada, Takeshi Aiba, Kengo Kusano, Mikiyasu Shirai, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Open heart 5 (2) e000814  2018 [Refereed][Not invited]
   

  Objective: Hydrogen excretion is thought to be related to systemic antioxidation activity. H2 selectively reduces the hydroxyl radical of free hydrogen (·OH), a highly cytotoxic form of reactive oxygen species, in cultured cells. Methods: We investigated whether exhaled H2 decreased during night sleep, reflected ·OH production and was associated with heart failure severity. We enrolled 108 patients with chronic heart failure (CHF) and 15 control participants without CHF. H2 concentration was measured by gas chromatography in exhaled breath collected before sleep and in the morning after overnight fasting. Overnight change in H2 concentration (ΔH2) was calculated. Mitochondrial morphology evaluated by transmission electron microscopy in endomyocardial biopsies collected from 18 patients with dilated cardiomyopathy. Results: ΔH2 was significantly lower in patients with CHF compared with controls (-4.3±1.0 vs 2.0±2.1 ppm, p=0.030) and was positively correlated with cardiac index (CI; r = -0.285, p=0.003). Patients with a ΔH2<0 ppm had a significantly lower CI compared with those who had a ΔH2>0 ppm (2.85±0.61 vs 3.24±0.65 L/min/m2, p=0.005). ΔH2 was negatively correlated with both the percentage of vacuole-containing mitochondria and indices of cristae remodelling (r = -0.61, p=0.007). Conclusions: Decrease in exhaled H2 during night sleep was associated with CHF severity. ΔH2 warrants investigation as marker of CHF severity.
• Presence of increased inflammatory infiltrates accompanied by activated dendritic cells in the left atrium in rheumatic heart disease.

  Mikio Shiba, Yasuo Sugano, Yoshihiko Ikeda, Hideshi Okada, Toshiyuki Nagai, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  PloS one 13 (9) e0203756  2018 [Refereed][Not invited]
   

  AIMS: Left atrial (LA) structural remodelling develops in rheumatic heart disease (RHD) according to the disease severity of the mitral valve and the presence of atrial fibrillation. Sustained active inflammation has been previously reported in the LA of patients with RHD, suggesting a direct role of cell-mediated immunity in the pathogenesis of LA remodelling. Dendritic cells (DCs) have a major antigen-presenting role, and are known as crucial modulators of innate and adaptive immunity. We investigated whether DCs are involved in the pathogenesis of LA remodelling in RHD. METHODS AND RESULTS: Immunohistochemical analyses were performed using antibodies to CD11c, CD209 and CD80 as markers of myeloid DCs, migratory-active DCs, mature DCs and infiltrated inflammatory cells including T lymphocytes (CD3) and M1 (CD68; pro-inflammatory profile) and M2 (CD163; pro-resolution profile) macrophages. Furthermore, tenascin-C, an extracellular matrix (ECM) protein that appears during ECM remodelling and inflammatory response, was examined. Infiltrated myeloid DCs, migratory-active DCs, mature DCs and other inflammatory infiltrates including T lymphocytes and M1 and M2 macrophages, were significantly higher in the RHD group than the non-RHD group. The positive area fraction for tenascin-C was significantly higher in the RHD group than in the non-RHD group. CONCLUSION: Our histological findings suggest that inflammation may persist long after a bout of rheumatic fever, ultimately leading to ECM remodelling. We identified and quantitatively assessed several subsets of DCs and other immunocompetent cells, and our results indicated that activation of DCs has some role in persistence of LA inflammation in patients with chronic RHD.
• Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation.

  Hyemoon Chung, Makoto Amaki, Seiji Takashio, Hiroyuki Takahama, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Tomoyuki Fujita, Junjiro Kobayashi, Masanori Asakura, Hideaki Kanzaki, Toshihisa Anzai, Masafumi Kitakaze

  Circulation journal : official journal of the Japanese Circulation Society 82 (1) 131 - 140 1346-9843 2017/12/25 [Refereed][Not invited]
   

  BACKGROUND: Surgical treatment of functional mitral regurgitation (FMR) improves ventricular remodeling in patients with dilated cardiomyopathy (DCM). However, it is unclear whether surgical treatment improves long-term outcomes. We investigated the effects of mitral valve (MV) surgery in patients with DCM and FMR.Methods and Results:Of 525 patients with DCM hospitalized due to heart failure between January 1996 and September 2014, 70 who had severe FMR despite receiving optimal medical therapy were enrolled in the study. Of these patients, 16 underwent surgery for FMR (surgery group; repair=14, replacement=2); the remaining 54 who refused or decided not to undergo surgery were classified as the medication group. There were no differences in age, sex, medication, or echocardiographic parameters between the 2 groups (P>0.05). During the mean follow-up period of 53.6±43.6 months, the occurrence of clinical outcomes (i.e., all-cause death or left ventricular assist device implantation) was 54.3%; the occurrence of clinical outcomes was lower in the surgery group (P=0.008, log-rank test). Multivariate Cox regression analysis using clinical data revealed that MV surgery (hazard ratio [HR] 0.257, 95% confidence interval [CI] 0.103-0.640; P=0.004) and diabetes mellitus (HR 2.924, 95% CI 1.243-6.876; P=0.014) were independent predictors of clinical outcomes after adjusting for age and sex. CONCLUSIONS: Surgery for severe FMR provides better long-term outcomes in patients with DCM.
• Transcatheter Aortic Valve Implantation for Degenerated 19-mm Aortic Bioprosthetic Valve.

  Kizuku Yamashita, Tomoyuki Fujita, Satsuki Fukushima, Yusuke Shimahara, Yuta Kume, Yorihiko Matsumoto, Naonori Kawamoto, Tatsuro Hitsumoto, Nobuyasu Ito, Yasuhiro Hamatani, Atsushi Okada, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Toshihisa Anzai, Satoshi Yasuda, Junjiro Kobayashi

  Circulation journal : official journal of the Japanese Circulation Society 82 (1) 289 - 292 1346-9843 2017/12/25 [Refereed][Not invited]
   

  BACKGROUND: The valve-in-valve procedure, in which a transcatheter heart valve (THV) is implanted over a prosthetic valve, has been shown to be safe and therapeutically effective, depending on the size of the replacement valve.Methods and Results:We report 3 cases of successful valve-in-valve procedure to replace a degenerated 19-mm stented prosthetic aortic valve. Balloon-expanding THVs were implanted: 20-mm in the 1st case and 23-mm in the next 2. Aortic stenosis was almost completely resolved in all patients, who recovered promptly and without cardiac adverse events. CONCLUSIONS: Using the valve-in-valve procedure for a 19-mm degenerated bioprosthesis was feasible and safe.
• Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction.

  Takahito Doi, Yu Kataoka, Teruo Noguchi, Tatsuhiro Shibata, Takahiro Nakashima, Shoji Kawakami, Kazuhiro Nakao, Masashi Fujino, Toshiyuki Nagai, Tomoaki Kanaya, Yoshio Tahara, Yasuhide Asaumi, Etsuko Tsuda, Michikazu Nakai, Kunihiro Nishimura, Toshihisa Anzai, Kengo Kusano, Hiroaki Shimokawa, Yoichi Goto, Satoshi Yasuda

  Arteriosclerosis, thrombosis, and vascular biology 37 (12) 2350 - 2355 1079-5642 2017/12 [Refereed][Not invited]
   

  OBJECTIVE: Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown. APPROACH AND RESULTS: We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88-5.66; P<0.001), cardiac death (95% CI, 1.37-5.37; P=0.004), and nonfatal MI (95% CI, 2.20-11.0; P<0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36-10.4; P<0.001) and in a propensity score-matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14-71.0; P=0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE (P=0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy). CONCLUSIONS: The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.
• Rationale and Design of Low-dose Administration of Carperitide for Acute Heart Failure (LASCAR-AHF).

  Toshiyuki Nagai, Yasuyuki Honda, Hiroki Nakano, Satoshi Honda, Naotsugu Iwakami, Atsushi Mizuno, Nobuyuki Komiyama, Takafumi Yamane, Yutaka Furukawa, Tadayoshi Miyagi, Syuzo Nishihara, Nobuhiro Tanaka, Taichi Adachi, Toshimitsu Hamasaki, Yasuhide Asaumi, Yoshio Tahara, Takeshi Aiba, Yasuo Sugano, Hideaki Kanzaki, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Cardiovascular drugs and therapy 31 (5-6) 551 - 557 0920-3206 2017/12 [Refereed][Not invited]
   

  BACKGROUNDS: Despite current therapies, acute heart failure (AHF) remains a major public health burden with high rates of in-hospital and post-discharge morbidity and mortality. Carperitide is a recombinantly produced intravenous formulation of human atrial natriuretic peptide that promotes vasodilation with increased salt and water excretion, which leads to reduction of cardiac filling pressures. A previous open-label randomized controlled study showed that carperitide improved long-term cardiovascular mortality and heart failure (HF) hospitalization for patients with AHF, when adding to standard therapy. However, the study was underpowered to detect a difference in mortality because of the small sample size. METHODS: Low-dose Administration of Carperitide for Acute Heart Failure (LASCAR-AHF) is a multicenter, randomized, open-label, controlled study designed to evaluate the efficacy of intravenous carperitide in hospitalized patients with AHF. Patients hospitalized for AHF will be randomly assigned to receive either intravenous carperitide (0.02 μg/kg/min) in addition to standard treatment or matching standard treatment for 72 h. The primary end point is death or rehospitalization for HF within 2 years. A total of 260 patients will be enrolled between 2013 and 2018. CONCLUSION: The design of LASCAR-AHF will provide data of whether carperitide reduces the risk of mortality and rehospitalization for HF in selected patients with AHF.
• Cardiac Rehabilitation Increases Plasma Brain-Derived Neurotrophic Factor Levels in Patients With Heart Failure

  Takashio Seiji, Goto Yoichi, Anzai Toshihisa, Tsujita Kenichi

  CIRCULATION 136 0009-7322 2017/11/14 [Refereed][Not invited]
  
• Diagnostic Utility of Cardiac Troponin T Levels in Patients With Infiltrative Cardiomyopathy

  Takashio Seiji, Izumiya Yasuhiro, Hirakawa Kyoko, Marume Kyohei, Yamamoto Masahiro, Ueda Mitsuharu, Yamashita Taro, Ishibashi-Ueda Hatsue, Yasuda Satoshi, Ando Yukio, Anzai Toshihisa, Tsujita Kenichi

  CIRCULATION 136 0009-7322 2017/11/14 [Refereed][Not invited]
  
• Multimodality assessment of left ventricular dysfunction in Takayasu arteritis and familial hypercholesterolaemia.

  Atsushi Okada, Hiroyuki Takahama, Masatsune Ogura, Yoshiaki Morita, Junichi Konma, Shuzo Yoshida, Shigeki Makino, Seiji Takashio, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Mariko Harada-Shiba, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Toshiaki Hanafusa, Toshihisa Anzai

  ESC heart failure 4 (4) 655 - 659 2017/11 [Refereed][Not invited]
   

  Although left ventricular (LV) systolic dysfunction in patients suffering from Takayasu arteritis (TA) has been reported, little is known regarding the development of heart failure in these patients. We report a novel finding of active TA and familial hypercholesterolaemia presenting with severe LV dysfunction through multimodality assessments of LV systolic dysfunction.
• Contrast-enhanced computed tomography with myocardial three-dimensional printing can guide treatment in symptomatic hypertrophic obstructive cardiomyopathy.

  Yasuhiro Hamatani, Makoto Amaki, Hideaki Kanzaki, Kizuku Yamashita, Yasuteru Nakashima, Atsushi Shibata, Atsushi Okada, Hiroyuki Takahama, Takuya Hasegawa, Yusuke Shimahara, Yasuo Sugano, Tomoyuki Fujita, Isao Shiraishi, Satoshi Yasuda, Junjiro Kobayashi, Toshihisa Anzai

  ESC heart failure 4 (4) 665 - 669 2017/11 [Refereed][Not invited]
   

  Both surgical myectomy and percutaneous transluminal septal myocardial ablation are effective treatments for drug-refractory symptomatic hypertrophic obstructive cardiomyopathy (HOCM). However, in some cases, it is not easy to elucidate the abnormal structure of left ventricular outflow obstruction to adopt these treatments. Here, we presented a young female patient with drug-refractory symptomatic HOCM. In this case, contrast-enhanced computed tomography enabled us to assess the suitability of percutaneous transluminal septal myocardial ablation. By creating three-dimensional printed models using computed tomography data, we could also visualize intracardiac structure and simulate the surgical procedure. A multimodality assessment strategy is useful for evaluating patients complicated with drug-refractory symptomatic HOCM.
• What Should Be Generalized Diagnostic Markers for Peripartum Cardiomyopathy?

  Ichiro Sakuma, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 81 (11) 1578 - 1579 1346-9843 2017/10/25 [Refereed][Not invited]
  
• Potential palliative care quality indicators in heart disease patients: A review of the literature.

  Atsushi Mizuno, Mitsunori Miyashita, Akitoshi Hayashi, Fujimi Kawai, Koichiro Niwa, Akemi Utsunomiya, Shun Kohsaka, Takashi Kohno, Takeshi Yamamoto, Morimasa Takayama, Toshihisa Anzai

  Journal of cardiology 70 (4) 335 - 341 0914-5087 2017/10 [Refereed][Not invited]
   

  In spite of the increasing interest in palliative care for heart disease, data on the detailed methods of palliative care and its efficacy specifically in heart disease are still lacking. A structured PubMed literature review revealed no quality indicators of palliative care in heart disease. Therefore, we performed a narrative overview of the potential quality indicators in heart disease by reviewing previous literature concerning quality indicators in cancer patients. We summarize seven potential categories of quality indicators in heart disease: (1) presence and availability of a palliative care unit, palliative care team, and outpatient palliative care; (2) human resources such as number of skilled staff; (3) infrastructure; (4) presence and frequency of documentation or family survey; (5) patient-reported outcome measure (PROM) data and disease-specific patient quality of life such as The Kansas City Cardiomyopathy Questionnaire (KCCQ); (6) questionnaires and interviews about the quality of palliative care after death, including bereaved family surveys; and (7) admission-related outcomes such as place of death and intensive care unit length of stay. Although detailed measurements of palliative care quality have not been validated in heart disease, many indicators developed in cancer patients might also be applicable to heart disease. This new categorization might be useful to determine quality indicators in heart disease patients.
• Does the pathophysiology of heart failure prime the incidence of cancer?

  Mari Sakamoto, Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Hiroyuki Takahama, Makoto Amaki, Naoki Mochizuki, Toshihisa Anzai, Toshimitsu Hamasaki, Masafumi Kitakaze

  Hypertension research : official journal of the Japanese Society of Hypertension 40 (9) 831 - 836 0916-9636 2017/09 [Refereed][Not invited]
   

  Both chronic heart failure (CHF) and cancer are among the most frequent causes of death in developed countries. Given that CHF activates neurohumoral factors, such as cytokines, the pathophysiology of CHF could prime the onset or progression of cancer. We consecutively enrolled 5238 patients with CHF who had been hospitalized in the Department of Cardiovascular Medicine in our institute between 2001 and 2013. We followed these patients until April 2015. We examined the cohort of patients from our hospital and compared it with a control cohort derived from the 2008 cancer database 'Monitoring of Cancer Incidence in Japan' from the National Cancer Center, Japan. The incidence of cancer in CHF patients (198 cases out of the 5238 patients) was approximately four times higher than that in control patients (2.27% vs 0.59%, P<0.0001; 95% confidence interval, 1.89-2.71). When we omitted the patients whose cancer diagnosis occurred prior to their diagnosis of CHF, we still observed a significantly higher incidence of cancer in patients with CHF than in controls. Based on our results, we suggest that there is a strong correlation between the pathophysiology of CHF and cancer. Given that CHF could prime the onset of cancers, we recommend that clinicians should be vigilant regarding cancer comorbidity in patients with CHF.
• Earlier Right Ventricular Pacing in Cardiac Resynchronization Therapy for a Patient with Right Axis Deviation.

  Yusuke Hattori, Kohei Ishibashi, Takashi Noda, Hideo Okamura, Hideaki Kanzaki, Toshihisa Anzai, Satoshi Yasuda, Kengo Kusano

  Internal medicine (Tokyo, Japan) 56 (17) 2285 - 2288 0918-2918 2017/09/01 [Refereed][Not invited]
   

  We describe the case of a 37-year-old woman who presented with complete right bundle branch block and right axis deviation. She was admitted to our hospital due to severe heart failure and was dependent on inotropic agents. Cardiac resynchronization therapy was initiated but did not improve her condition. After the optimization of the pacing timing, we performed earlier right ventricular pacing, which led to an improvement of her heart failure. Earlier right ventricular pacing should be considered in patients with complete right bundle branch block and right axis deviation when cardiac resynchronization therapy is not effective.
• Efficacy and Safety of an Orally Administered Selective Prostacyclin Receptor Agonist, Selexipag, in Japanese Patients With Pulmonary Arterial Hypertension.

  Nobuhiro Tanabe, Satoshi Ikeda, Nobuhiro Tahara, Keiichi Fukuda, Masaru Hatano, Hiroshi Ito, Tomotaka Nakayama, Toshihisa Anzai, Akiyoshi Hashimoto, Teruo Inoue, Kouji Kajinami, Yasuki Kihara, Hideyuki Kinoshita, Koichiro Kuwahara, Toyoaki Murohara, Osamu Okazaki, Satoshi Sakai, Toru Satoh, Yutaka Takeda, Yasuchika Takeishi, Mitsugu Taniguchi, Hiroshi Watanabe, Takeshi Yamamoto, Keiko Yamauchi-Takihara, Koichiro Yoshioka, Shigetake Sasayama

  Circulation journal : official journal of the Japanese Circulation Society 81 (9) 1360 - 1367 1346-9843 2017/08/25 [Refereed][Not invited]
   

  BACKGROUND: Selexipag is an orally available prostacyclin receptor (IP receptor) agonist with a non-prostanoid structure. In this open-label Phase II trial, the efficacy and safety of selexipag in Japanese patients with pulmonary arterial hypertension (PAH) is examined.Methods and Results:Selexipag was administered at 200 μg twice daily and titrated up to 1,600 μg by increments of 200 μg in 37 subjects to reach the individual maximum tolerated dose. At 16 weeks, in 33 patients comprising the per-protocol set, the pulmonary vascular resistance (PVR; primary endpoint) decreased from 683.2±237.3 to 560.3±238.7 dyn·s/cm5(P<0.0001). For the secondary endpoint, the 6-min walk distance (6MWD) increased from 445.0±102.2 to 459.1±112.8 m (P=0.0324); World Health Organization functional class improved in 4 patients (12.1%), and was maintained in 29 patients (87.9%). A decrease in PVR was also shown in patients treated with selexipag, on top of a phosphodiesterase inhibitor and endothelin receptor antagonist. Most of the commonly reported adverse events were consistent with those reported for other PGI2formulations. Thirty-four patients attained the individual maximum tolerated dose (maintenance dose). CONCLUSIONS: The efficacy and tolerability of selexipag in Japanese PAH patients was confirmed by improvement in pulmonary hemodynamics, exercise capacity, symptoms. Selexipag is an efficacious treatment option for Japanese PAH patients. (Trial registration: JAPIC Clinical Trials Information [JapicCTI-111532].).
• Heart failure in patients with arrhythmogenic right ventricular cardiomyopathy: What are the risk factors?

  Yoshitaka Kimura, Takashi Noda, Taka-Aki Matsuyama, Yosuke Otsuka, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Hideo Okamura, Satoshi Nagase, Takeshi Aiba, Shiro Kamakura, Teruo Noguchi, Toshihisa Anzai, Kazuhiro Satomi, Yuko Wada, Seiko Ohno, Minoru Horie, Wataru Shimizu, Satoshi Yasuda, Hiroaki Shimokawa, Kengo Kusano

  International journal of cardiology 241 288 - 294 0167-5273 2017/08/15 [Refereed][Not invited]
   

  BACKGROUND: We previously demonstrated that heart failure (HF) was one of the major causes of death in arrhythmogenic right ventricular cardiomyopathy (ARVC). The purpose of this study was to elucidate the clinical impact and risk factors of HF in patients with ARVC. METHODS AND RESULTS: We evaluated cardiac adverse outcomes including HF in 113 consecutive patients with ARVC (85 men, mean age: 44±15years). During a median follow-up of 10.0years (interquartile range: 5.2 to 15.7years), 29 patients (26%) were hospitalized for progressive HF. The patients with one or more episodes of HF hospitalization had about a 10-fold increased incidence of cardiac death (14/29 [48%] vs. 4/84 [4.7%], p<0.0001). Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were significantly lower in the patients with HF hospitalization compared to the patients without HF hospitalization (LVEF, 45±15 vs. 54±13%, p=0.001; RVEF, 26±10 vs. 33±11%, p=0.003, respectively). Regarding the ECG findings, the prevalence of first-degree atrioventricular block (AVB, PR interval >200ms) and epsilon waves were significantly higher in patients with HF hospitalization than those without HF hospitalization (first-degree AVB, 14/29 [48%] vs. 11/84 [13%], p<0.0001; epsilon waves, 10/29 [34%] vs. 12/84 [14%], p=0.02). In multivariate analysis, first-degree AVB at baseline was the strongest independent risk factor for HF hospitalization in patients with ARVC (hazard ratio 4.24, 95% confidence interval 1.79-10.47, p=0.0011). CONCLUSION: HF hospitalization has a significant relation with malignant clinical course in ARVC patients. First-degree AVB was an independent determinant for increased risk of HF hospitalization.
• Impact of decreased serum albumin levels on acute kidney injury in patients with acute decompensated heart failure: a potential association of atrial natriuretic peptide.

  Yoichi Takaya, Fumiki Yoshihara, Hiroyuki Yokoyama, Hideaki Kanzaki, Masafumi Kitakaze, Yoichi Goto, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Yuhei Kawano, Kenji Kangawa

  Heart and vessels 32 (8) 932 - 943 0910-8327 2017/08 [Refereed][Not invited]
   

  Although hypoalbuminemia at admission is a risk for acute kidney injury (AKI) and mortality in patients with acute decompensated heart failure (ADHF), the clinical significance of decreased serum albumin levels (DAL) during ADHF therapy has not been elucidated. This study aimed to evaluate whether DAL was associated with AKI, and whether intravenous atrial natriuretic peptide (ANP) administration, which provides an effective treatment for ADHF but promotes albumin extravasation, was associated with DAL and AKI. A total of 231 consecutive patients with ADHF were enrolled. AKI was defined as ≥0.3 mg/dl absolute or 1.5-fold increase in serum creatinine levels within 48 h. AKI occurred in 73 (32%) of the 231 patients during ADHF therapy. The median value of decreases in serum albumin levels was 0.3 g/dl at 7 days after admission. When DAL was defined as ≥0.3 g/dl decrease in serum albumin levels, DAL occurred in 113 patients, and was independently associated with AKI. Of the 231 patients, 73 (32%) were treated with intravenous ANP. DAL occurred more frequently in patients receiving ANP than in those not receiving ANP (77 vs. 36%, p < 0.001), and ANP was independently associated with DAL. The incidence of AKI was higher in patients receiving ANP than in those not receiving ANP (48 vs. 24%, p < 0.001). ANP was independently associated with AKI. In conclusion, DAL is associated with AKI. Intravenous ANP administration may be one of the promoting factors of DAL, which leads to AKI, indicating a possible novel mechanism of AKI.
• "Window Sliding" analysis combined with high-density and rapid electroanatomical mapping: its efficacy and the outcome of catheter ablation of atrial tachycardia.

  Kosuke Nakasuka, Koji Miyamoto, Takashi Noda, Tsukasa Kamakura, Mitsuru Wada, Ikutaro Nakajima, Kohei Ishibashi, Yuko Inoue, Hideo Okamura, Satoshi Nagase, Takeshi Aiba, Shiro Kamakura, Wataru Shimizu, Teruo Noguchi, Toshihisa Anzai, Satoshi Yasuda, Nobuyuki Ohte, Kengo Kusano

  Heart and vessels 32 (8) 984 - 996 0910-8327 2017/08 [Refereed][Not invited]
   

  Atrial tachycardia (AT) is a clinically challenging arrhythmia that can occur based on atrial substrates. Nowadays, a rapid construction of three-dimensional electroanatomical maps, which has an analysis function for complex arrhythmias, named 'Window Sliding' (WS) is available. However, little data has revealed the efficacy of this mapping strategy. The aim of this study was to investigate the efficacy of the WS analysis for AT treatments. All patients underwent electrophysiological studies during ATs and the characteristics of the ATs were analyzed using rapid high-density mapping followed by the WS analysis. RFA was then performed. Fifty-five ATs were identified in 34 patients (63 ± 17 year-old) and in 51 activation maps (cycle length, 322 ± 120 milliseconds) were successfully constructed with 644 ± 433 points per map during 5.3 ± 2.5 min. The types of detected ATs were macro-reentries around the mitral (8) and, tricuspid (12) valves, roof-dependent reentry (5), others (13), and focal patterns (13). Of those that underwent RFA, 46 (98%) were treated successfully. Two ATs were abandoned since their critical sites were close to the His bundle and sinoatrial node. During a mean follow-up period of 179 ± 176 days, 7 patients had documented recurrences of AT. This high-density mapping using the WS analysis was useful for creating the entire picture of the ATs in a short time, resulting in favorable RFA outcomes.
• Prognostic impact of chronic total coronary occlusion on long-term outcomes in implantable cardioverter-defibrillator recipients with ischaemic heart disease.

  Tatsuya Nishikawa, Masashi Fujino, Ikutaro Nakajima, Yasuhide Asaumi, Yu Kataoka, Toshihisa Anzai, Kengo Kusano, Teruo Noguchi, Yoichi Goto, Kunihiro Nishimura, Yoshihiro Miyamoto, Keisuke Kiso, Satoshi Yasuda

  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 19 (7) 1153 - 1162 1099-5129 2017/07/01 [Refereed][Not invited]
   

  Aims: The prognostic impact of chronic total coronary occlusion (CTO) on implantable cardioverter-defibrillator (ICD) recipients remains unclear. Methods and results: Eighty-four consecutive patients with ischaemic heart disease who received ICD therapy for primary or secondary prevention were analysed. We investigated all-cause mortality and major adverse cardiac events (MACEs) including cardiac death, appropriate device therapy, hospitalization for heart failure, and ventricular assist device implantation. Of the study patients (mean age 70 ± 8 years; 86% men), 34 (40%) had CTO. There were no significant differences in age, left ventricular ejection fraction (LVEF), New York Heart Association functional class III or IV status, and proportion who underwent secondary prevention between patients with CTO (CTO group) and without CTO (non-CTO group). During a median follow-up of 3.8 years (interquartile range 2.7-5.4 years), the CTO group tended to have a higher MACE rate (log-rank P = 0.054) than the non-CTO group. Within the CTO group, there was no difference in the MACE rate between patients with and without viable myocardium. In patients with ICD for secondary prevention (n = 47), 16 patients (34%) with CTO had a higher MACE rate than patients without CTO (log-rank P < 0.01). Cox proportional hazards regression analysis showed that the presence of CTO, but not LVEF, was associated with a higher MACE rate. Multivariate analysis showed that the presence of CTO was a predictor of MACE (P < 0.05). Conclusion: In patients with ischaemic heart disease receiving ICD implantation, the presence of CTO has an adverse impact on long-term prognosis, especially as secondary prevention.
• Usefulness of the Direct and/or Total Bilirubin to Predict Adverse Outcomes in Patients With Acute Decompensated Heart Failure.

  Atsushi Okada, Yasuo Sugano, Toshiyuki Nagai, Yasuyuki Honda, Naotsugu Iwakami, Hiroki Nakano, Seiji Takashio, Satoshi Honda, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Toshihisa Anzai

  The American journal of cardiology 119 (12) 2035 - 2041 0002-9149 2017/06/15 [Refereed][Not invited]
   

  Abnormal liver function test results are often observed in acute decompensated heart failure (ADHF). However, the prognostic value of bilirubin fractionation has not been elucidated. The prognostic value of direct bilirubin (DB), in comparison with total bilirubin (TB), was examined in 556 consecutive patients with ADHF. Patients with elevated DB showed mostly similar patient characteristics including signs of elevated right-sided pressure (frequent hepatomegaly, jugular venous distention, dilated inferior vena cava, and elevated gamma-glutamyltransferase) and decreased cardiac output (cold extremities, decreased pulse pressure, and lower blood pressure) and other parameters of heart failure (HF) severity (increased plasma renin activity, decreased sodium, total cholesterol, and ejection fraction) to elevated TB; however, only patients with elevated DB showed a significant difference in the frequency of HF history and alkaline phosphatase value. Kaplan-Meier analysis showed that patients with elevated DB had a significantly higher rate of the composite end point of all-cause mortality or HF readmission (p = 0.021) compared with those with normal DB, whereas patients with elevated TB did not show a statistically significant difference compared with those with normal TB (NS). A multivariate Cox hazards model showed that DB was an independent predictor of adverse events (adjusted hazard ratio 1.052, 95% confidence interval 1.001 to 1.099, p = 0.034), whereas TB was not (adjusted hazard ratio 1.017, 95% confidence interval 0.985 to 1.046, p = 0.27). Adding DB to existing prognostic variables resulted in higher C-statistics than adding TB (C-statistics: 0.670 to 0.675, 0.670 to 0.674, respectively). In conclusion, elevated DB in ADHF was an independent prognostic predictor that was superior to TB. DB may be useful for further risk stratification in ADHF.
• A Pathophysiological Role of Plasma Indoxyl Sulfate in Patients with Heart Failure

  Miki Imazu, Hiroyuki Takahama, Kazuhiro Shindo, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai, Hiroshi Asanuma, Toshisuke Morita, Masanori Asakura, Masafumi Kitakaze

  INTERNATIONAL JOURNAL OF GERONTOLOGY 11 (2) 62 - 66 1873-9598 2017/06 [Refereed][Not invited]
   

  Background: One of uremic toxins, indoxyl sulfate (IS), is associated with cardiovascular events. This study aimed to measure the plasma IS levels in patients with and without chronic heart failure (CHF). Methods: We measured plasma IS levels in 49 patients with CHF and an estimated glomerular filtration rate (eGFR) of 40-60 ml/min/1.73 m(2) from our institute. These were compared with 31 healthy subjects without CHF (a control), but with comparable eGFR levels, from our resident cohort study. We also test the effect of AST-120 (the oral adsorbent) in 16 CHF patients. Results: The plasma IS levels in 49 CHF patients increased (1.38 +/- 0.84 (SD) vs 0.12 +/- 0.07 mu g/ml (a control), p < 0.001), and fractional shortening (FS) levels were correlated with the plasma IS levels in these subjects. Second, in our database of the hospitalized CHF patients, we retrospectively reviewed the data for eight CHF patients with stage 3-5 chronic kidney disease (CKD) who received treatment with AST-120, before and one year after treatment, and compared these patients with eight sex-matched CHF patients with stage 3-5 CKD without AST-120. AST-120 decreased plasma IS levels and improved cardiac function. Conclusions: Plasma IS levels increased in patients with CHF along with cardiac systolic dysfunction compared with those in healthy subjects, and AST-120 improved cardiac dysfunction in patients with CHF. Oral adsorbents may represent a novel treatment for CHF. Copyright (C) 2017, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC.
• Clinical impact of the presence of macrophages in endomyocardial biopsies of patients with dilated cardiomyopathy.

  Takafumi Nakayama, Yasuo Sugano, Tetsuro Yokokawa, Toshiyuki Nagai, Taka-Aki Matsuyama, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Takeshi Nakatani, Nobuyuki Ohte, Satoshi Yasuda, Toshihisa Anzai

  European journal of heart failure 19 (4) 490 - 498 1388-9842 2017/04 [Refereed][Not invited]
   

  BACKGROUND: Dilated cardiomyopathy (DCM) is the most common cardiomyopathy and causes left ventricular enlargement and contractile dysfunction, with a poor prognosis. The mechanisms underlying the disease process have not been precisely identified, but recent evidence has suggested that the activation of myocardial inflammation is involved in the deterioration associated with the condition. METHODS AND RESULTS: Biopsy samples from 182 consecutive DCM patients were immunohistochemically stained with antibodies specific to CD3 (T lymphocytes), CD68 (whole macrophages), and CD163 (M2 macrophages), and each type of infiltrating cell was counted. Masson's trichrome staining was used to determine the collagen area fraction (CAF) in each sample. Patients were followed up for 6.9 ± 2.4 years, and their clinical data were obtained for analysis. Median (interquartile range) numbers of myocardial CD3, CD68, and CD163-cell infiltrates were 8.1 (4.0-14.2)/mm2 , 22.3 (12.1-36.0)/mm2 , and 6.5 (2.0-14.0)/mm2 , respectively. Patients with higher counts of infiltrating CD3-, CD68-, and CD163-positive cells had significantly poorer outcomes (P = 0.007, P = 0.011, and P = 0.022, respectively). A high CD163-positive infiltrate count was independently associated with worse outcome in multivariate Cox regression analysis (hazard ratio 1.77, P = 0.004), and multivariate linear regression analysis revealed that the CD163 cell count was an independent determinant of CAF (P < 0.001). CONCLUSIONS: It was found that DCM with increased myocardial immune activation was associated with poor long-term outcome. The association between M2 macrophages and collagen formation suggests the phenotypic polarization of macrophages toward M2 may be associated with ventricular remodelling in DCM.
• 低体重は駆出率が保持された心不全における転帰の独立予測因子である JASPER試験からの報告(Underweight is an Independent Predictor of Outcomes in Heart Failure with Preserved Ejection Fraction: A Report from JASPER Study)

  Matsumoto Junichi, Kinugawa Shintaro, Fukushima Arata, Yokota Takashi, Yoshikawa Tsutomu, Saito Yoshihiko, Nagai Toshiyuki, Anzai Toshihisa

  日本循環器学会学術集会抄録集 81回 LBCS3 - 6 2017/03
• Prognostic value of malnutrition assessed by Controlling Nutritional Status score for long-term mortality in patients with acute heart failure.

  Naotsugu Iwakami, Toshiyuki Nagai, Toshiaki A Furukawa, Yasuo Sugano, Satoshi Honda, Atsushi Okada, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  International journal of cardiology 230 529 - 536 0167-5273 2017/03/01 [Refereed][Not invited]
   

  BACKGROUND: The prognostic value of nutritional status is poorly understood and evidence-based nutritional assessment indices are required in acute heart failure (AHF). We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT) score (range 0-12, higher=worse, consisting of serum albumin, cholesterol and lymphocytes) in AHF patients. METHODS: The CONUT score was measured on admission in 635 consecutive AHF patients. The primary outcome was all-cause death. RESULTS: Median CONUT score was 3 (interquartile range 2 to 5). During the median follow-up of 324days, CONUT score was independently associated with death (HR 1.26, 95% CI 1.11-1.42, P<0.001) after adjustment for confounders in a multivariate Cox model. The CONUT score demonstrated the best C-statistic for predicting death (0.71) among other common nutritional markers in HF. Furthermore, addition of the CONUT score to an established risk prediction model from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure study significantly increased the C-statistic from 0.75 to 0.77 (P=0.02). The net reclassification improvement afforded by CONUT score was 21% for all-cause death, 27% for survival and 49% overall (P<0.001). CONCLUSION: Malnutrition assessed by the CONUT score on admission was an independent determinant of long-term death in AHF, and its prognostic value outweighed that of other nutritional indices. Moreover, addition of the score to the existing risk prediction model significantly increased the predictive ability for death, indicating beneficial clinical application of the CONUT score in AHF patients.
• Impact of Elevated End-Diastolic Pulmonary Regurgitation Gradient on Worse Clinical Outcomes in Hospitalized Patients With Heart Failure.

  Yasuyuki Honda, Toshiyuki Nagai, Yasuo Sugano, Satoshi Honda, Atsushi Okada, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  The American journal of cardiology 119 (4) 604 - 610 0002-9149 2017/02/15 [Refereed][Not invited]
   

  The echo Doppler end-diastolic pulmonary regurgitation (EDPR) gradient correlates well with catheter-derived pulmonary artery diastolic pressure. An elevated EDPR gradient is associated with worse clinical outcomes in patients with stable coronary artery disease. However, the prognostic significance of EDPR gradient in patients with heart failure (HF) is unclear. The aim of the present study was to investigate the prognostic impact of EDPR gradient in HF. We retrospectively examined 751 consecutive hospitalized patients with acute HF. Those with acute coronary syndrome or in-hospital death and those without accessible EDPR gradient data at discharge were excluded. Finally, 265 patients were examined and divided into 2 groups according to EDPR gradient (cutoff 9 mm Hg). Adverse events were defined as worsening HF and death. Patients with elevated EDPR gradient had higher B-type natriuretic peptide, lower age, and lower left ventricular ejection fraction at discharge than those with nonelevated EDPR gradient. During a median follow-up of 429 days, elevated EDPR gradient was independently associated with adverse events (hazard ratio 2.34, 95% CI 1.44 to 3.78, p <0.001) after adjustment for confounders. In conclusion, echo Doppler EDPR gradient might be a noninvasive predictor of clinical outcomes in hospitalized patients with HF.
• Reply to "delirium in heart failure".

  Satoshi Honda, Toshiyuki Nagai, Toshihisa Anzai

  International journal of cardiology 229 133 - 133 0167-5273 2017/02/15 [Refereed][Not invited]
  
• Use of serum fibroblast growth factor 23 vs. plasma B-type natriuretic peptide levels in assessing the pathophysiology of patients with heart failure.

  Miki Imazu, Hiroyuki Takahama, Makoto Amaki, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai, Naoki Mochizuki, Hiroshi Asanuma, Masanori Asakura, Masafumi Kitakaze

  Hypertension research : official journal of the Japanese Society of Hypertension 40 (2) 181 - 188 0916-9636 2017/02 [Refereed][Not invited]
   

  Recently, fibroblast growth factor 23 (FGF23), a phosphate-regulating hormone, has been linked to the pathophysiology of heart failure (HF), thus encouraging us to examine which hemodynamic abnormalities of HF are linked to either serum FGF23 or plasma B-type natriuretic peptide (BNP) levels. We measured both the serum FGF23 and plasma BNP levels in 154 consecutive prospectively enrolled hospitalized HF patients, with an estimated glomerular filtration rate >40 ml min-1 1.73 m-2, who underwent heart catheterizations and an echocardiogram. The serum FGF23 levels correlated with the diameter of the inferior vena cava and its respiratory changes, whereas the plasma BNP levels did not. Both the plasma BNP and serum FGF23 levels were moderately correlated with the mean pulmonary artery (PA) pressure and pulmonary capillary wedge (PCW) pressure. Interestingly, in patients with an above-median right-atrial (RA) pressure (4 mm Hg), FGF23 levels were correlated with both PA and PCW pressures, but the levels were not correlated in patients with a below-median RA pressure. In contrast, the plasma BNP levels were correlated with both PA and PCW pressures. Finally, serum FGF23 levels, compared with the plasma BNP levels, were more strongly associated with the clinical outcomes in patients with above-median RA pressure. These findings suggested that serum FGF23 levels are predominantly correlated with clinical outcomes, may serve as a biomarker for HF in patients with higher RA pressure, may provide beneficial information for patients with right-sided HF and may represent different clinical information than that provided only by plasma BNP levels.
• Early development of acute kidney injury is an independent predictor of in-hospital mortality in patients with acute myocardial infarction.

  Noriaki Moriyama, Masaharu Ishihara, Teruo Noguchi, Michio Nakanishi, Tetsuo Arakawa, Yasuhide Asaumi, Leon Kumasaka, Tomoaki Kanaya, Toshiyuki Nagai, Masashi Fujino, Satoshi Honda, Reiko Fujiwara, Toshihisa Anzai, Kengo Kusano, Yoichi Goto, Satoshi Yasuda, Shigeru Saito, Hisao Ogawa

  Journal of cardiology 69 (1) 79 - 83 0914-5087 2017/01 [Refereed][Not invited]
   

  BACKGROUND: Acute kidney injury (AKI) often occurs in patients with acute myocardial infarction (AMI), and is associated with adverse outcomes. However, it remains unclear how timing of AKI affects it. This study assessed impact of timing of AKI on prognosis after AMI. METHODS: This study consisted of 760 patients with AMI who were admitted within 48h after symptom onset. AKI was diagnosed as increase in creatinine ≥0.3mg/dl or ≥50% within any 48h after admission. Patients were classified into 3 groups according to the occurrence and timing of AKI: no-AKI, early-AKI (within 48h after admission) and late-AKI (>48h). Early-AKI was classified into transient early-AKI, defined as creatinine returning to the level below the criteria of AKI, and persistent early-AKI. RESULTS: Early-AKI occurred in 64 patients (9%) and late-AKI in 32 patients (4%). Patients with early-AKI had significantly higher mortality (35%) than those with late-AKI (7%, p<0.001) and no-AKI (3%, p<0.001). Multivariate analysis showed early-AKI was an independent predictor of in-hospital mortality (OR: 3.38, 95% CI: 1.30-8.76, p=0.013), but late-AKI was not. Among patients with early-AKI, mortality was significantly higher even if AKI was transient (23%, p<0.001). Patients with persistent early-AKI had the highest mortality (66%, p<0.001). CONCLUSIONS: Early-AKI was associated with worse outcome. Even if renal function once returned to baseline level, patients with early-AKI tended to be at high risk of mortality.
• Persistent increase in cardiac troponin T at hospital discharge predicts repeat hospitalization in patients with acute decompensated heart failure.

  Seiji Takashio, Toshiyuki Nagai, Yasuo Sugano, Satoshi Honda, Atsushi Okada, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo F Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  PloS one 12 (4) e0173336  1932-6203 2017 [Refereed][Not invited]
   

  BACKGROUND: High-sensitive cardiac troponin T (hsTnT) is a sensitive biomarker of myocardial damage and predictor of acute decompensated heart failure (ADHF). However, there is little information on changes over time in hsTnT level during ADHF management. The aim of this prospective study was to evaluate changes in hsTnT levels between admission and at discharge in patients with ADHF, and identify factors that determine such levels and their prognostic significance. METHODS AND RESULTS: We evaluated 404 ADHF patients with abnormal hsTnT levels (≥0.0135 ng/ml) on admission. The median (interquartile ranges) hsTnT levels on admission, at discharge, and percent changes in hsTnT levels were 0.038 (0.026 to 0.065), 0.032 (0.021 to 0.049) ng/ml, and -12.0 (-39.8 to 7.4) % respectively. The numbers of patients with falling (hsTnT decrease > -15%), stable (hsTnT change between -15 and +15%) and rising (hsTnT increase > +15%) hsTnT level at discharge were 190, 146, and 68, respectively. The percent change in B-type natriuretic peptide (BNP) levels was greater in the falling group, compared to the stable (p<0.001) and rising groups (p<0.001). Changes in hsTnT levels correlated significantly with changes in BNP levels (ρ = 0.22, p<0.001). Multivariate Cox regression analysis identified rising or stable hsTnT at discharge as a significant predictor of heart failure-related rehospitalization (hazard ratio: 1.69; 95% confidence interval: 1.06 to 2.70; p = 0.03). CONCLUSIONS: Persistent increase in hsTnT levels at discharge correlated with inadequate decrease of BNP levels, and was a predictor of poor clinical outcome, with repeat heart failure hospitalizations.
• Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients.

  Naoya Asakawa, Keisuke Uchida, Mamoru Sakakibara, Kazunori Omote, Keiji Noguchi, Yusuke Tokuda, Kiwamu Kamiya, Kanako C Hatanaka, Yoshihiro Matsuno, Shiro Yamada, Kyoko Asakawa, Yuichiro Fukasawa, Toshiyuki Nagai, Toshihisa Anzai, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Masanori Hirota, Makoto Orii, Takashi Akasaka, Kenta Uto, Yasushige Shingu, Yoshiro Matsui, Shin-Ichiro Morimoto, Hiroyuki Tsutsui, Yoshinobu Eishi

  PloS one 12 (7) e0179980  1932-6203 2017 [Refereed][Not invited]
   

  BACKGROUND: Although rare, cardiac sarcoidosis (CS) is potentially fatal. Early diagnosis and intervention are essential, but histopathologic diagnosis is limited. We aimed to detect Propionibacterium acnes, a commonly implicated etiologic agent of sarcoidosis, in myocardial tissues obtained from CS patients. METHODS AND RESULTS: We examined formalin-fixed paraffin-embedded myocardial tissues obtained by surgery or autopsy and endomyocardial biopsy from patients with CS (n = 26; CS-group), myocarditis (n = 15; M-group), or other cardiomyopathies (n = 39; CM-group) using immunohistochemistry (IHC) with a P. acnes-specific monoclonal antibody. We found granulomas in 16 (62%) CS-group samples. Massive (≥14 inflammatory cells) and minimal (<14 inflammatory cells) inflammatory foci, respectively, were detected in 16 (62%) and 11 (42%) of the CS-group samples, 10 (67%) and 10 (67%) of the M-group samples, and 1 (3%) and 18 (46%) of the CM-group samples. P. acnes-positive reactivity in granulomas, massive inflammatory foci, and minimal inflammatory foci were detected in 10 (63%), 10 (63%), and 8 (73%) of the CS-group samples, respectively, and in none of the M-group and CM-group samples. CONCLUSIONS: Frequent identification of P. acnes in sarcoid granulomas of originally aseptic myocardial tissues suggests that this indigenous bacterium causes granuloma in many CS patients. IHC detection of P. acnes in massive or minimal inflammatory foci of myocardial biopsy samples without granulomas may be useful for differentiating sarcoidosis from myocarditis or other cardiomyopathies.
• Risk factors for amiodarone-induced thyroid dysfunction in Japan.

  Sayoko Kinoshita, Tomohiro Hayashi, Kyoichi Wada, Mikie Yamato, Takeshi Kuwahara, Toshihisa Anzai, Mai Fujimoto, Kouichi Hosomi, Mitsutaka Takada

  Journal of arrhythmia 32 (6) 474 - 480 1880-4276 2016/12 [Refereed][Not invited]
   

  BACKGROUND: Amiodarone is associated with a number of significant adverse effects, including elevated transaminase levels, pulmonary fibrosis, arrhythmia, and thyroid dysfunction. Although thyroid dysfunction is considered to be a common and potentially serious adverse effect of amiodarone therapy, the exact pathogenesis remains unknown because of its complex manifestations. Therefore, the prevalence of, and risk factors for, amiodarone-induced thyroid dysfunction in Japanese patients were investigated in the present study. METHODS: A retrospective analysis of patients treated with amiodarone between January 2012 and December 2013 was performed. A total of 317 patients with euthyroidism, or subclinical hyperthyroidism or hypothyroidism, were enrolled in this study. RESULTS: After being treated with amiodarone, 30 (9.5%) and 60 patients (18.9%) developed amiodarone-induced hyperthyroidism and amiodarone-induced hypothyroidism, respectively. Ten (33.3%) patients with amiodarone-induced hyperthyroidism and 40 (66.6%) with amiodarone-induced hypothyroidism were diagnosed within two years of the initiation of amiodarone therapy. Dilated cardiomyopathy (DCM) [Adjusted odds ratio (OR) 3.30 (95% confidence interval (CI): 1.26-8.90)], and cardiac sarcoidosis [Adjusted OR 6.47 (95% CI: 1.60-25.77)] were identified as predictors of amiodarone-induced hyperthyroidism. The baseline free thyroxine (T4) level [Adjusted OR 0.13 (95% CI: 0.03-0.68)], and thyroid-stimulating hormone (TSH) level [Adjusted OR1.47 (95% CI: 1.26-1.74)] were identified as predictors of amiodarone-induced hypothyroidism. CONCLUSION: DCM and cardiac sarcoidosis were identified as risk factors for amiodarone-induced hyperthyroidism. Risk factors for amiodarone-induced hypothyroidism included higher baseline TSH level and lower baseline free T4 level, suggesting that subclinical hypothyroidism may be a potential risk factor for the development of amiodarone-induced hypothyroidism.
• Myocardial Immunocompetent Cells and Macrophage Phenotypes as Histopathological Surrogates for Diagnosis of Cardiac Sarcoidosis in Japanese.

  Yasuyuki Honda, Toshiyuki Nagai, Yoshihiko Ikeda, Mamoru Sakakibara, Naoya Asakawa, Nobutaka Nagano, Michikazu Nakai, Kunihiro Nishimura, Yasuo Sugano, Keiko Ohta-Ogo, Yasuhide Asaumi, Takeshi Aiba, Hideaki Kanzaki, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda, Hiroyuki Tsutsui, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  Journal of the American Heart Association 5 (11) 2047-9980 2016/11/17 [Refereed][Not invited]
   

  BACKGROUND: The histological diagnosis of cardiac sarcoidosis (CS) is based on the presence of myocardial granulomas; however, the sensitivity of endomyocardial biopsy is relatively low. We investigated whether immunocompetent cells including dendritic cells (DC) and macrophages in nongranuloma sections of endomyocardial biopsy samples could be histopathological surrogates for CS diagnosis. METHODS AND RESULTS: The numbers of DC and macrophages were investigated in 95 consecutive CS patients and 50 patients with nonischemic cardiomyopathy as controls. All patients underwent endomyocardial biopsy, and immunohistochemical staining was performed on all samples. We examined these immunocompetent cells in nongranuloma sections in CS patients diagnosed by the presence of myocardial granulomas (n=26) and in CS patients without myocardial granulomas diagnosed by the Japanese Ministry of Health Welfare 2007 criteria (n=65) or the Heart Rhythm Society 2014 criteria (n=26). In CS patients with and without myocardial granulomas, CD209+ DC and CD68+ macrophages were more frequently observed (P<0.01) and CD163+M2 macrophages were less frequently observed (P<0.01) in nongranuloma sections compared to controls. Furthermore, the combination of decreased CD163+M2/CD68+ macrophage ratio and increased number of CD209+ DC in nongranuloma sections of CS patients demonstrated high specificity (100%, 95% CI 92.7-100) for CS diagnosis with each diagnostic criteria and the presence of myocardial granulomas. CONCLUSIONS: Increased number of DC and decreased M2 among all macrophages in nongranuloma sections of myocardium showed high specificity for CS diagnosis, suggesting DC and macrophage phenotypes as histopathological surrogates for the diagnosis of CS.
• Non-linear Equation using Plasma Brain Natriuretic Peptide Levels to Predict Cardiovascular Outcomes in Patients with Heart Failure.

  Hiroki Fukuda, Hideaki Suwa, Atsushi Nakano, Mari Sakamoto, Miki Imazu, Takuya Hasegawa, Hiroyuki Takahama, Makoto Amaki, Hideaki Kanzaki, Toshihisa Anzai, Naoki Mochizuki, Akira Ishii, Hiroshi Asanuma, Masanori Asakura, Takashi Washio, Masafumi Kitakaze

  Scientific reports 6 37073 - 37073 2045-2322 2016/11/15 [Refereed][Not invited]
   

  Brain natriuretic peptide (BNP) is the most effective predictor of outcomes in chronic heart failure (CHF). This study sought to determine the qualitative relationship between the BNP levels at discharge and on the day of cardiovascular events in CHF patients. We devised a mathematical probabilistic model between the BNP levels at discharge (y) and on the day (t) of cardiovascular events after discharge for 113 CHF patients (Protocol I). We then prospectively evaluated this model on another set of 60 CHF patients who were readmitted (Protocol II). P(t|y) was the probability of cardiovascular events occurring after >t, the probability on t was given as p(t|y) = -dP(t|y)/dt, and p(t|y) = pP(t|y) = αyβP(t|y), along with p = αyβ (α and β were constant); the solution was p(t|y) = αyβ exp(-αyβt). We fitted this equation to the data set of Protocol I using the maximum likelihood principle, and we obtained the model p(t|y) = 0.000485y0.24788 exp(-0.000485y0.24788t). The cardiovascular event-free rate was computed as P(t) = 1/60Σi=1,…,60 exp(-0.000485yi0.24788t), based on this model and the BNP levels yi in a data set of Protocol II. We confirmed no difference between this model-based result and the actual event-free rate. In conclusion, the BNP levels showed a non-linear relationship with the day of occurrence of cardiovascular events in CHF patients.
• Prevalence, determinants, and prognostic significance of delirium in patients with acute heart failure.

  Satoshi Honda, Toshiyuki Nagai, Yasuo Sugano, Atsushi Okada, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  International journal of cardiology 222 521 - 527 0167-5273 2016/11/01 [Refereed][Not invited]
   

  BACKGROUND: Delirium is a serious syndrome in critically ill patients. However, the prognostic impact of delirium and its determinants in acute heart failure (AHF) patients have not been fully elucidated. METHODS: We examined 611 AHF patients who were admitted to our institution. Delirium was diagnosed based on the Intensive Care Delirium Screening Checklist (ICDSC). RESULTS: Delirium developed in 139 patients (23%) during hospitalization. Patients with delirium had higher incidence of non-cardiovascular death (p=0.046) and worsening heart failure (p<0.001) during hospitalization. Among patients who survived at discharge, the incidence of all-cause death, cardiovascular death and non-cardiovascular death after discharge were significantly higher in patients with delirium than those without (log-rank; p<0.001, p=0.001, p<0.001, respectively) during a median follow-up period of 335days. In multivariable model, the development of delirium was an independent determinant of worsening heart failure during hospitalization (OR: 2.44, 95% CI: 1.27-4.63) and all-cause death after discharge (HR: 2.38, 95% CI: 1.30-4.35). Furthermore, multivariate analysis indicated that history of cerebrovascular disease (OR: 2.13, 95% CI: 1.36-3.35), age (OR: 1.43, 95% CI: 1.15-1.80), log BNP (OR: 1.39, 95% CI: 1.09-1.79), serum albumin (OR: 0.84, 95% CI: 0.76-0.93) and blood glucose levels (OR: 1.03, 95% CI: 1.00-1.06) were independent determinants of delirium. CONCLUSION: In patients with AHF, the development of delirium was associated with poor clinical outcomes, suggesting the importance of early screening and careful monitoring of delirium in such patients.
• Risk stratification based on nutritional screening on admission: Three-year clinical outcomes in hospitalized patients with acute heart failure syndrome.

  Masashi Fujino, Hiroyuki Takahama, Toshimitsu Hamasaki, Kenichi Sekiguchi, Kengo Kusano, Toshihisa Anzai, Teruo Noguchi, Yoichi Goto, Masafumi Kitakaze, Hiroyuki Yokoyama, Hisao Ogawa, Satoshi Yasuda

  Journal of cardiology 68 (5) 392 - 398 0914-5087 2016/11 [Refereed][Not invited]
   

  BACKGROUND: Several blood tests are commonly used to assess nutritional status, including serum albumin levels (SAL) and lymphocyte counts (LC). The aim of this study is to investigate whether nutritional screening on admission can be used to determine risk levels for adverse clinical events in acute heart failure syndrome (AHFS) patients. METHODS: In 432 consecutive AHFS patients, we measured SAL and LC and prospectively followed the patients for their combined clinical events (all-cause death and re-hospitalization for heart failure) for three years from admission. The classification and regression tree (CART) tool identified the cut-off criteria for SAL and LC to differentiate among patients with different risks of clinical events as 3.5g/dl and 963/mm3, respectively. RESULTS: The CART tool classified 15.5% patients as high risk, 15.7% as intermediate risk, and 68.8% as low risk. The CART for nutritional status (CART-NS) values were strongly correlated with combined clinical events [hazard ratio of 2.13 (low vs high risk), 95% confidence interval of 1.42-3.16, p<0.001], even after adjusting for plasma brain natriuretic peptide levels. The CART-NS analysis improved the specificity (89.5%) of predictions of clinical outcomes with the comparable sensitivity (36.3%) compared with the use of a single criterion (SAL <3.5g/dl: 70.2, 42.4% or LC <963/mm3: 73.4, 41.7%, respectively). CONCLUSION: A substantial proportion of AHFS patients are at risk of malnutrition, and this risk is associated with poor clinical outcomes. We demonstrate that this algorithm for nutritional screening, even in emergency clinical settings, can determine risk levels for further adverse events in AHFS patients.
• The Current Status of Cardiovascular Medicine in Japan - Analysis of a Large Number of Health Records From a Nationwide Claim-Based Database, JROAD-DPC.

  Satoshi Yasuda, Kazuhiro Nakao, Kunihiro Nishimura, Yoshihiro Miyamoto, Yoko Sumita, Toshiaki Shishido, Toshihisa Anzai, Hiroyuki Tsutsui, Hiroshi Ito, Issei Komuro, Yoshihiko Saito, Hisao Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 80 (11) 2327 - 2335 1346-9843 2016/10/25 [Refereed][Not invited]
   

  BACKGROUND: Since cardiovascular disease accounts for one-quarter of deaths in the Japanese population, we developed a nationwide database using the administrative case-mix Diagnostic Procedure Combination (DPC) system (ie, theJapaneseRegistryOfAll cardiac and vascularDiseases (JROAD)-DPC) to reveal the current status of cardiovascular medicine in Japan.Methods and Results:The JROAD-DPC database included 704,593 health records' data of 2012 from 610 certificated hospitals of the Japanese Circulation Society. The 35,824 patients with acute myocardial infarction (AMI) and 108,665 patients with heart failure (HF) were admitted to hospitals. Increased hospital case volume was associated with reduced in-hospital mortality rates for both AMI and HF (P for trend <0.001). Although there was little variation among AMI patients in terms of aspirin use at discharge (median prescription rate, 83.0%; interquartile range [IQR], 76.9-88.0%), there were wide variations in the proportions of patients prescribed β-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB) at discharge (BB, 41.4%, IQR 27.6-55.7%; ACEI/ARB, 52.0%, IQR 40.3-62.3%). In patients with HF, there were between-hospital variations in medications at discharge (BB, 38.1%, IQR, 27.8-47.6%; ACEI/ARB, 41.0%, IQR 31.7-49.1%). CONCLUSIONS: A nationwide administrative database of patients with cardiovascular diseases (JROAD-DPC) provided useful information that will contribute to improved quality of medical care, especially in the aging society of Japan, where HF has become an important health problem. (Circ J 2016; 80: 2327-2335).
• Potentially Lethal Ventricular Arrhythmias and Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy: What Are the Differences Between Men and Women?

  Yoshitaka Kimura, Takashi Noda, Yosuke Otsuka, Mitsuru Wada, Ikutaro Nakajima, Kohei Ishibashi, Koji Miyamoto, Hideo Okamura, Takeshi Aiba, Shiro Kamakura, Teruo Noguchi, Toshihisa Anzai, Kazuhiro Satomi, Hisao Ogawa, Satoshi Yasuda, Kengo F Kusano

  JACC. Clinical electrophysiology 2 (5) 546 - 555 2405-500X 2016/10 [Refereed][Not invited]
   

  OBJECTIVES: The aim of this study was to assess sex-related differences in sporadic cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). BACKGROUND: Previous studies have suggested male predominance in ARVC. However, the impact of sex on the heterogeneous clinical profile and prognosis of ARVC were not fully recognized. METHODS: The study population included 110 patients with ARVC who fulfilled the revised Task Force criteria (median age 48 years [interquartile range (IQR): 36 to 57 years]). All patients were sporadic cases without family history of ARVC. Male patients had a 3:1 predominance (75%). Ninety-seven patients (88%) were considered to have "definite" ARVC based on revised Task Force criteria. RESULTS: At the initial evaluation, there were no significant sex-related differences in age, 12-lead electrocardiogram findings, late potentials by signal-averaged electrocardiogram, left ventricular ejection fraction, or right ventricular ejection fraction. During a median follow-up of 10.0 years (IQR: 5.2 to 15.6 years), 18 patients died from cardiac causes. Kaplan-Meier analysis, considering patients' lives since birth, revealed that male patients had a significantly higher risk of ventricular tachycardia/ventricular fibrillation than did female patients (56% vs. 90%, p = 0.02), whereas female patients had a significantly higher risk of heart failure (HF) death or heart transplantation (22% vs. 5%, p = 0.002). On multivariate Cox regression analysis, female sex was an independent risk factor for HF death or heart transplantation due to HF (hazard ratio: 6.29, 95% confidence interval: 1.29 to 40.2; p = 0.02). CONCLUSIONS: Among patients with sporadic ARVC, men had a significantly higher risk of ventricular tachycardia/ventricular fibrillation, whereas women had a significantly higher risk of HF death or heart transplantation due to HF.
• Diagnostic Value of Right Ventricular Dysfunction in Tachycardia-Induced Cardiomyopathy Using Cardiac Magnetic Resonance Imaging.

  Atsushi Okada, Ikutaro Nakajima, Yoshiaki Morita, Yuko Y Inoue, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Koji Miyamoto, Hideo Okamura, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Shiro Kamakura, Toshihisa Anzai, Teruo Noguchi, Satoshi Yasuda, Kengo Kusano

  Circulation journal : official journal of the Japanese Circulation Society 80 (10) 2141 - 8 1346-9843 2016/09/23 [Refereed][Not invited]
   

  BACKGROUND: Predicting tachycardia-induced cardiomyopathy (TIC) in patients presenting with left ventricular (LV) dysfunction and tachyarrhythmias remains challenging. We assessed the diagnostic value of early right ventricular (RV) dysfunction to predict TIC using cardiac magnetic resonance (CMR) imaging. METHODS AND RESULTS: A total of 102 consecutive patients with newly diagnosed LV dysfunction and atrial tachyarrhythmias were examined. Patients whose LV ejection fraction (EF) improved to ≥50% during a 1-year follow-up were diagnosed with TIC, and with dilated cardiomyopathy (DCM) in those whose did not improve. CMR was performed at a median of 23 days after admission, and the TIC and DCM patients exhibited different distributions of EF and end-diastolic volume (EDV) between the LV and RV (both P<0.001, ANCOVA). TIC patients had significantly lower RVEF/LVEF ratio (1.01±0.23 vs. 1.36±0.31, P<0.001) and higher RVEDV/LVEDV ratio (0.96±0.21 vs. 0.73±0.19, P<0.001) compared with DCM patients, suggesting that RV systolic dysfunction and RV dilatation were observed in TIC. In the multivariate analysis, age, RVEF/LVEF ratio, and RVEDV/LVEDV ratio were significant predictors of TIC, and RVEF/LVEF ratio of <1.05 most highly predicted TIC with a sensitivity of 69.1% and specificity of 91.5% (area under the curve 0.860). CONCLUSIONS: Among patients with newly diagnosed LV dysfunction and atrial tachyarrhythmias, age and coexistence of RV dysfunction was a strong predictor of TIC. (Circ J 2016; 80: 2141-2148).
• Validation of the Coronary Artery Bypass Graft SYNTAX Score (Synergy Between Percutaneous Coronary Intervention With Taxus) as a Prognostic Marker for Patients With Previous Coronary Artery Bypass Graft Surgery After Percutaneous Coronary Intervention.

  Tadayoshi Miyagi, Yasuhide Asaumi, Kunihiro Nishimura, Takahiro Nakashima, Hiroki Sakamoto, Kazuhiro Nakao, Tomoaki Kanaya, Toshiyuki Nagai, Yuji Shimabukuro, Yoshihiro Miyamoto, Tomoyuki Fujita, Kengo Kusano, Toshihisa Anzai, Junjirou Kobayashi, Teruo Noguchi, Hisao Ogawa, Satoshi Yasuda

  Circulation. Cardiovascular interventions 9 (9) 1941-7640 2016/09 [Refereed][Not invited]
   

  BACKGROUND: The efficacy and prognosis of percutaneous coronary intervention (PCI) as secondary revascularization in patients with previous coronary artery bypass graft surgery remain uncertain. METHODS AND RESULTS: We retrospectively evaluated 434 consecutive patients with previous coronary artery bypass graft surgery hospitalized for PCI between 2004 and 2011 (men 84%, age 71 (interquartile range, 66-76) years) and calculated the coronary artery bypass graft Synergy Between Percutaneous Coronary Intervention With Taxus score (CSS) before (baseline CSS) and after PCI (post-PCI CSS). Patients were divided into 2 groups based on median post-PCI CSS: low-score (≤23; n=217) and high-score groups (>23; n=217). Major adverse cardiovascular events (MACE) were defined as the composite of cardiovascular death, myocardial infarction, and unplanned repeat revascularization for myocardial ischemia. The median baseline and post-PCI CSS were 30 (interquartile range, 21-40) and 23 (interquartile range, 14.5-33.5), respectively. During a median follow-up of 69 months, the prevalence of MACE and cardiac death differed significantly between the 2 post-PCI CSS groups (MACE: low, 13.8%; high, 28.6%; P<0.001; cardiac death: low, 6.2%; high, 16.7%; P=0.002). In multivariable analysis, the high post-PCI CSS divided by the median was associated with substantially greater cumulative MACE (hazard ratio, 2.09; 95% confidence interval, 1.31-3.34; P=0.002) and cardiac death (hazard ratio, 2.02; 95% confidence interval, 1.03-3.98; P=0.042) compared with the low post-PCI CSS. Net reclassification improvement analysis revealed that post-PCI CSS resulted in significantly improved prediction of MACE and cardiac death compared with baseline CSS. CONCLUSIONS: In this external validation study, the CSS was a potential prognostic factor after subsequent PCI, even for previous coronary artery bypass graft surgery patients.
• Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure.

  Tomohiro Hayashi, Takuya Hasegawa, Hideaki Kanzaki, Akira Funada, Makoto Amaki, Hiroyuki Takahama, Takahiro Ohara, Yasuo Sugano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  ESC heart failure 3 (3) 168 - 176 2055-5822 2016/09 [Refereed][Not invited]
   

  AIMS: Altered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so-called low-T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (T4), causes left ventricular dysfunction. Our objective was to identify the prevalence and prognostic impact of low-T3 syndrome and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS: We examined 274 ADHF patients who were not receiving thyroid medication or amiodarone on admission (70 ± 15 years, 156 male), who underwent thyroid function tests. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L; and subclinical hyperthyroidism as TSH < 0.45 mIU/L, with normal free T4 level for the last two. Additionally, low-T3 syndrome was defined as free T3 < 4.0 pmol/L among euthyroidism subjects. On admission, 188 patients (69%) showed euthyroidism, 58 (21%) subclinical hypothyroidism, 5 (2%) subclinical hyperthyroidism, and 95 (35%) low-T3 syndrome. Cox proportional hazards models revealed that higher TSH, but not free T3 and free T4, was independently associated with composite cardiovascular events, including cardiac death and re-hospitalization for heart failure. Indeed, subclinical hypothyroidism was an independent predictor (hazard ratio: 2.31; 95% confidence interval: 1.44 to 3.67; P < 0.001), whereas low-T3 syndrome and subclinical hyperthyroidism were not. CONCLUSIONS: Subclinical hypothyroidism on admission was an independent predictor of adverse cardiovascular outcomes in ADHF patients, suggesting a possible interaction between thyroid dysfunction and the pathophysiology of ADHF.
• Usefulness of Geriatric Nutritional Risk Index for Assessing Nutritional Status and Its Prognostic Impact in Patients Aged ≥65 Years With Acute Heart Failure.

  Yasuyuki Honda, Toshiyuki Nagai, Naotsugu Iwakami, Yasuo Sugano, Satoshi Honda, Atsushi Okada, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  The American journal of cardiology 118 (4) 550 - 5 0002-9149 2016/08/15 [Refereed][Not invited]
   

  Malnutrition is becoming one of the most important determinants of worse clinical outcomes in patients with acute heart failure (AHF). However, appropriate tools for evaluating the nutritional status in patients aged ≥65 years with AHF remain unclear. We examined 490 consecutive patients aged ≥65 years with AHF. They were divided into 2 groups according to Geriatric Nutritional Risk Index (GNRI; cut-off value = 92). During a median period of 189 days, the mortality rate was significantly higher in the lower GNRI group than the higher GNRI group (p <0.001). In multivariate analyses, lower GNRI was an independent determinant of adverse events (HR 0.92, 95% CI 0.88 to 0.95, p <0.001). The GNRI showed the best prognostic value (C-statistic: 0.70) among other nutritional indexes. Adding GNRI to an existing outcome prediction model for mortality in AHF significantly increased the C-statistic from 0.68 to 0.74 (p = 0.017). The net reclassification improvement afforded by GNRI was 60% overall, 27% for events, and 33% for nonevents (p <0.001). In conclusion, lower GNRI on admission was independently associated with worse clinical outcomes in patients aged ≥65 years with AHF, and it was superior to other nutritional parameters. Furthermore, the assessment of nutritional status using GNRI is very helpful for risk stratification.
• Impact of B-type natriuretic peptide (BNP) on development of atrial fibrillation in people with Type 2 diabetes

  I. Kishimoto, H. Makino, Y. Ohata, T. Tamanaha, M. Tochiya, K. Kusano, T. Anzai, K. Toyoda, S. Yasuda, K. Minematsu, H. Ogawa

  Diabetic Medicine 33 (8) 1118 - 1124 0742-3071 2016/08/01 

  Aims: To examine if a simple biomarker can identify people with diabetes who are at high risk of atrial fibrillation. Methods: A retrospective cohort study was conducted at a single centre in people with Type 2 diabetes referred to our department between January 2000 and December 2007. In 517 consecutive people without any history, signs or symptoms of atrial fibrillation at baseline, the association between baseline B-type natriuretic peptide level and future atrial fibrillation incidence was examined, with adjustments for other potentially confounding factors. Results: A total of 28 people were diagnosed with new-onset atrial fibrillation during a median 6-year follow-up. When people were categorized into three groups according to B-type natriuretic peptide clinical thresholds (20 and 100 pg/ml), hazard ratios for the development of atrial fibrillation in the middle and highest B-type natriuretic peptide groups were 2.8 and 9.4, respectively, compared with the lowest B-type natriuretic peptide group. Time-dependent receiver-operating curve analysis identified a threshold for B-type natriuretic peptide to detect atrial fibrillation development of 52.8 pg/ml (sensitivity 75.2%, specificity 68.8%). The B-type natriuretic peptide predictive value was independent of and similar to that of left atrial size and ventricular dimension. Conclusion: In people with Type 2 diabetes, high baseline B-type natriuretic peptide levels were significantly associated with future atrial fibrillation development.
• [NYHA functional classification and AHA/ACC Stages for heart failure management].

  Nagai T, Anzai T

  Nihon Rinsho Men'eki Gakkai kaishi = Japanese journal of clinical immunology 74 Suppl 6 340 - 344 0911-4300 2016/08 [Refereed][Not invited]
  
• [NYHA functional classification and AHA/ACC Stages for heart failure management].

  Toshiyuki Nagai, Toshihisa Anzai

  Nihon rinsho. Japanese journal of clinical medicine 74 Suppl 6 340 - 4 0047-1852 2016/08 [Refereed][Not invited]
  
• Larger low voltage zone in endocardial unipolar map compared with that in epicardial bipolar map indicates difficulty in eliminating ventricular tachycardia by catheter ablation.

  Koji Miyamoto, Takashi Noda, Kazuhiro Satomi, Mitsuru Wada, Ikutaro Nakajima, Kohei Ishibashi, Hideo Okamura, Teruo Noguchi, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Wataru Shimizu, Takeshi Aiba, Shiro Kamakura, Kengo Kusano

  Heart and vessels 31 (8) 1337 - 46 0910-8327 2016/08 [Refereed][Not invited]
   

  Patients with ischemic and non-ischemic cardiomyopathy often have substrate for ventricular tachycardia (VT) in the endocardium (ENDO), epicardium (EPI), and/or intramural. Although it has been reported that the ENDO unipolar (UNI) voltage map is useful in detecting EPI substrate, its feasibility to detect intramural scarring and its usefulness in radiofrequency catheter ablation (RFCA) remain unclear. To assess the relationship between the left ventricle (LV) ENDO UNI voltage map and the LV EPI bipolar (BIP) voltage map, and to determine the usefulness of the ENDO UNI voltage map to guide RFCA for VT in patients with cardiomyopathy undergoing combined ENDO- and EPI RFCA. Eleven patients with VT undergoing detailed ENDO and EPI electroanatomical mapping of the LV were included (mean age 59 ± 11 years, 9 men). We assessed the value of the LV ENDO UNI voltage map in identifying EPI and/or intramural substrate in these 11 patients with non-ischemic or ischemic cardiomyopathy. The underlying heart disease was dilated cardiomyopathy in 4 patients, cardiac sarcoidosis in 3, hypertrophic cardiomyopathy in 2, and ischemic heart disease in 2 patients. The mean LV ejection fraction was 24 ± 7 %. The low voltage zone (LVZ) was defined as <1.5 mV for LV ENDO BIP electrograms (EGMs), <8.3 mV for LV ENDO UNI EGMs, and <1.0 mV for LV EPI BIP EGMs. The surface area of each LVZ was measured. We also measured the LVZ of the spatial overlap between ENDO UNI and EPI BIP voltage maps using the transparency mode on CARTO software. We performed RFCA at the ENDO and EPI based on activation and/or substrate maps, targeting the LVZ and/or abnormal EGMs. The LVZ was present in the LV ENDO BIP voltage map in 10 of 11 patients (42 ± 33 cm(2)), and in the LV ENDO UNI voltage map in 10 of 11 patients (72 ± 45 cm(2)). The LVZ was present in the EPI BIP voltage map in 9 of 11 patients (70 ± 61 cm(2)), and the LVZ in the ENDO UNI voltage map was also seen in all 9 patients. The location of the LVZ in the EPI BIP map matched that in 45 ± 28 % of ENDO UNI voltage maps. The LVZ in the ENDO UNI voltage map was larger than that in the EPI BIP voltage map in 6 of 11 patients, and RFCA failed in 5 of these 6 patients. In the remaining 5 patients with a smaller LVZ in the ENDO UNI voltage map compared with the EPI BIP voltage map or no LVZ both at ENDO UNI and EPI BIP voltage map, VT was successfully eliminated in 4 of 5 patients. The LV ENDO UNI voltage map is useful in detecting EPI substrate in patients with cardiomyopathy. A larger LVZ in the ENDO UNI voltage map compared to that in the EPI BIP voltage map may indicate the presence of intramural substrate, which leads to difficulty in eliminating VT, even with combined ENDO- and EPI RFCA.
• Impact of renal function deterioration on adverse events during anticoagulation therapy using non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.

  Koji Miyamoto, Takeshi Aiba, Shoji Arihiro, Makoto Watanabe, Yoshihiro Kokubo, Kohei Ishibashi, Sayako Hirose, Mitsuru Wada, Ikutaro Nakajima, Hideo Okamura, Takashi Noda, Kazuyuki Nagatsuka, Teruo Noguchi, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu, Yoshihiro Miyamoto, Kazunori Toyoda, Kengo Kusano

  Heart and vessels 31 (8) 1327 - 36 0910-8327 2016/08 [Refereed][Not invited]
   

  Renal function is crucial for patients with non-valvular atrial fibrillation (NVAF) using non-vitamin K antagonist oral anticoagulants (NOAC). The incidence of renal function deterioration during anticoagulation therapy and its impact of adverse events are unknown. In 807 consecutive NVAF patients treated with NOAC and with estimated creatinine clearance (eCCr) ≥ 50 ml/min (mean age 68 ± 11 years, mean CHADS2 score = 1.8 ± 1.4, CHA2DS2-VASc score = 2.8 ± 1.8, HAS-BLED score = 1.7 ± 1.1), we analyzed the time course of renal function and clinical outcomes, and compared these with the data of general Japanese inhabitants from the Suita Study (n = 2140). Of the 807 patients, 751 (93 %) maintained eCCr ≥ 50 ml/min (group A) whereas the remaining 56 (7 %) fell into the eCCr < 50 ml/min (group B) during the 382 ± 288 days of follow-up. Multivariate logistic regression analysis revealed that advanced age, lower body weight, and congestive heart failure were independent predictors for renal function deterioration in patients with eCCr ≥ 50 ml/min at baseline. Major and/or minor bleedings were more commonly observed in group B than in group A (21 vs. 8 %; P = 0.0004). The CHADS2, CHA2DS2-VASc, and HAS-BLED scores were also significant predictors of renal function deterioration (P < 0.0001). The incidences of renal function deterioration were 1.4, 3.4, 10.5 and 11.7 % in patients with CHADS2 score of 0, 1, 2 and ≥3, respectively. As to CHA2DS2-VASc score, renal function deterioration occurred in 0, 1.7, 9.8 and 15.0 % with a score of 0, 1-2, 3-4 and ≥5, respectively. In the Suita Study of the general population, on the other hand, 122 of 2140 participants with eCCr ≥ 50 ml/min at baseline (5.7 %) fell into the eCCr < 50 ml/min during about 2 years. The incidence of renal function deterioration increased with the CHADS2 score in the general population as well as in our patients. Renal function deterioration was not uncommon and was associated with more frequent adverse events including major bleeding in NVAF patients with anticoagulation therapy. CHADS2, CHA2DS2-VASc, and HAS-BLED scores may be useful as an index of predicting renal function deterioration.
• Inflammatory dilated cardiomyopathy

  Yasuo Sugano, Toshihisa Anzai

  Respiration and Circulation 64 (7) 655 - 661 0452-3458 2016/07/01
• Novel chemiluminescent enzyme immunoassays for individual quantification of three endogenous molecular forms of atrial natriuretic peptide in human plasma.

  Nagai-Okatani C, Kangawa K, Takashio S, Takahama H, Hayashi T, Anzai T, Minamino N

  The Journal of Applied Laboratory Medicine 1 (1) 47 - 59 2016/07 [Refereed][Not invited]
   

  BACKGROUND: Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are cardiac peptide hormones with pivotal roles in maintaining cardiovascular homeostasis. BNP and its precursor fragment are accepted as gold standard markers for heart failure (HF). Human ANP is present in the atria of the heart and plasma as 3 endogenous molecular forms designated α-ANP, β-ANP, and proANP. A previous study indicated that the ratios of these 3 ANP forms are altered in the plasma of HF patients. The purpose of our study was to establish immunoassays for quantifying the individual ANP forms to collect clinical information. METHODS: We developed 3 plate-based chemiluminescent enzyme immunoassays (CLEIAs) for measuring total ANP (i.e., sum of α-ANP, β-ANP, and proANP), β-ANP, and proANP levels. To minimize background signals, we added single-step PEGylation targeting the immobilized antibody in the conventional plate-based sandwich CLEIA procedure. RESULTS: CLEIAs with PEGylation showed sensitivity, specificity, reproducibility, and accuracy satisfying clinical requirements. Two of the CLEIAs enabled direct measurement in plasma samples. During treatments, acute decompensated HF patients exhibited marked decreases in plasma β-ANP levels but moderate decreases in plasma proANP level. The plasma ratios of α-ANP/total ANP and proANP/total ANP in acute decompensated HF patients were maintained, whereas the β-ANP/total ANP ratio was significantly decreased at discharge. CONCLUSIONS: The combination of the 3 CLEIAs enabled accurate quantification of α-ANP, β-ANP, and proANP, even in plasma samples, and indicated the potential of β-ANP and proANP as circulating biomarkers for HF, with different characteristics from that of BNP.
• Renovascular heart failure: heart failure in patients with atherosclerotic renal artery disease.

  Osami Kawarada, Satoshi Yasuda, Teruo Noguchi, Toshihisa Anzai, Hisao Ogawa

  Cardiovascular intervention and therapeutics 31 (3) 171 - 82 1868-4300 2016/07 [Refereed][Not invited]
   

  Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.
• Prognostic significance of endogenous erythropoietin in long-term outcome of patients with acute decompensated heart failure.

  Toshiyuki Nagai, Kunihiro Nishimura, Takehiro Honma, Aya Higashiyama, Yasuo Sugano, Michikazu Nakai, Satoshi Honda, Naotsugu Iwakami, Atsushi Okada, Shoji Kawakami, Tomoaki Kanaya, Yasuhide Asaumi, Takeshi Aiba, Yoko Nishida, Yoshimi Kubota, Daisuke Sugiyama, Tomonori Okamura, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  European journal of heart failure 18 (7) 803 - 13 1388-9842 2016/07 [Refereed][Not invited]
   

  AIMS: Although previous reports suggest that an elevated endogenous erythropoietin (EPO) level is associated with worse clinical outcomes in chronic heart failure (HF) patients, the prognostic implication of EPO in patients with acute decompensated HF (ADHF) and underlying mechanisms of the high EPO level in severe HF patients who have a poor prognosis remain unclear. METHODS AND RESULTS: We examined 539 consecutive ADHF patients with EPO measurement on admission from our registry. During a median follow-up period of 329 days, a higher EPO level on admission was independently associated with worse clinical outcomes [hazard ratio (HR) 1.25, 95% confidence interval (CI) 1.06-1.48, P = 0.008], and haemoglobin level was the strongest determinant of EPO level (P < 0.001), whereas estimated glomerular filtration rate (eGFR) was not significant in multivariate regression analysis. In the anaemic subgroup of 318 patients, a higher EPO level than expected on the basis of their haemoglobin level was related to increased adverse events (HR 1.63, 95% CI 1.05-2.49, P = 0.028). Moreover, estimated plasma volume excess rate was positively associated with EPO level (P = 0.003), and anaemic patients with a higher than expected EPO level tended to have a higher estimated plasma volume excess rate and plasma lactate level, and lower systemic oxygen saturation level with the preservation of the reticulocyte production index than those with a lower than expected EPO level. CONCLUSION: A high EPO level predicts long-term worse clinical outcomes in ADHF patients, independent of anaemia and impaired renal function. Anaemia and hypoxia due to severe congestion may synergistically contribute to a high EPO level in high-risk HF patients.
• The predictability of renin-angiotensin-aldosterone system factors for clinical outcome in patients with acute decompensated heart failure.

  Yasuki Nakada, Hiroyuki Takahama, Hideaki Kanzaki, Yasuo Sugano, Takuya Hasegawa, Takahiro Ohara, Makoto Amaki, Akira Funada, Akemi Yoshida, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Heart and vessels 31 (6) 925 - 31 0910-8327 2016/06 [Refereed][Not invited]
   

  Although counter-regulation between B-type natriuretic peptide (BNP) levels and renin-angiotensin-aldosterone system (RAAS) activation in heart failure (HF) has been suggested, whether the regulation is preserved in acute decompensated heart failure (ADHF) patients remains unclear. This study aimed to determine: (1) the relationship between RAAS activation and clinical outcomes in ADHF patients, and (2) the relationships between plasma BNP levels and degrees of activation in RAAS factors. This study included ADHF patients (n = 103, NYHA3-4, plasma BNP > 200 pg/ml). We studied the predictability of RAAS factors for cardiovascular events and the relationships between plasma BNP levels and the degrees of activation in RAAS factors, which were evaluated by plasma renin activity (PRA) and aldosterone concentration (PAC). PRA was a strong predictor of cardiovascular (CV) events over 1 year, even after accounting for plasma BNP levels (hazard ratio (HR): 1.04, CI [1.02-1.06], p < 0.01) and medication such as RAAS blockers (HR: 1.03, CI [1.01-1.05], p < 0.01), whereas PAC was borderline-significant (univariate analysis, p = 0.06). Cut-off value of PRA (5.3 ng/ml/h) was determined by AUC curve. Of the enrolled patients, higher PRA was found in 40 % of them. Although no correlation between the plasma BNP levels and PRA was found (p = 0.36), after adjusting for hemodynamic parameters, eGFR and medication, a correlation was found between them (p = 0.01). Elevated RAAS factors were found in a substantial number of ADHF patients with high plasma BNP levels in the association with hemodynamic state, which predicts poor clinical outcomes. The measurements of RAAS factors help to stratify ADHF patients at risk for further CV events.
• Prognostic significance of late gadolinium enhancement quantification in cardiac magnetic resonance imaging of hypertrophic cardiomyopathy with systolic dysfunction.

  Akira Funada, Hideaki Kanzaki, Teruo Noguchi, Yoshiaki Morita, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hiromi Hashimura, Hatsue Ishibashi-Ueda, Masafumi Kitakaze, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Heart and vessels 31 (5) 758 - 70 0910-8327 2016/05 [Refereed][Not invited]
   

  Hypertrophic cardiomyopathy (HCM) with systolic dysfunction carries a poor prognosis. Although late gadolinium enhancement (LGE) on cardiac magnetic resonance is associated with adverse cardiac events in HCM and is inversely related to left ventricular ejection fraction (LVEF), it is unknown whether LGE or LVEF more accurately predicts adverse cardiac events in HCM with systolic dysfunction. We retrospectively assessed the extent of LGE with a threshold of 6 standard deviations in 46 consecutive HCM patients with systolic dysfunction defined as LVEF <50 % (average 35 ± 12 %) who underwent cardiac magnetic resonance (35 males, mean age 59 ± 14 years). They were followed up over 1755 ± 594 days. The composite adverse cardiac events end point included cardiovascular death, lethal arrhythmia, cardioembolic stroke, and unplanned heart failure hospitalization. LGE was detected in all patients, and the mean extent was 30 ± 15 %. Twenty-nine patients developed adverse cardiac events. Multivariate Cox proportional hazard analysis revealed the extent of LGE as a good independent predictor of adverse cardiac events. Risk increased with the extent of LGE (hazard ratio = 1.62/10 % increase in LGE, 95 % confidence interval = 1.23-2.15, p < 0.001). LVEF was inversely related to the extent of LGE (r = -0.44; p = 0.002) and was also an independent predictor of adverse cardiac events. Risk decreased with LVEF (hazard ratio = 0.68/10 % increase in LVEF, 95 % confidence interval = 0.51-0.91, p = 0.010). The Akaike information criterion evaluating the fit of a model demonstrated that the extent of LGE was a better independent predictor of MACE than LVEF (Akaike information criterion = 172.20 and 178.09, respectively).The extent of LGE was a good independent predictor of adverse cardiac events and reflected mortality and morbidity more precisely than LVEF in HCM with systolic dysfunction.
• Erratum to: Prognostic significance of late gadolinium enhancement quantification in cardiac magnetic resonance imaging of hypertrophic cardiomyopathy with systolic dysfunction.

  Akira Funada, Hideaki Kanzaki, Teruo Noguchi, Yoshiaki Morita, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hiromi Hashimura, Hatsue Ishibashi-Ueda, Masafumi Kitakaze, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Heart and vessels 31 (5) 771 - 772 0910-8327 2016/05 [Refereed][Not invited]
  
• Exhaled Acetone Concentration Is Related to Hemodynamic Severity in Patients With Non-Ischemic Chronic Heart Failure.

  Tetsuro Yokokawa, Yasuo Sugano, Akito Shimouchi, Atsushi Shibata, Naoya Jinno, Toshiyuki Nagai, Hideaki Kanzaki, Takeshi Aiba, Kengo Kusano, Mikiyasu Shirai, Yasuchika Takeishi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 80 (5) 1178 - 86 1346-9843 2016/04/25 [Refereed][Not invited]
   

  BACKGROUND: We hypothesized that exhaled acetone concentration (EAC), reflecting altered blood ketone body metabolism and increased acetone exhaust because of pulmonary congestion in heart failure (HF), would correlate with hemodynamic parameters in patients with non-ischemic chronic HF. METHODS AND RESULTS: We prospectively enrolled 102 non-ischemic HF patients with New York Heart Association (NYHA) class I-III. Exhaled breath was collected after an overnight fast. Echocardiography and cardiac catheterization were performed in all patients. We also enrolled 17 control patients without HF. EAC in the HF patients was significantly higher than that in the control patients (median EAC; 0.53 vs. 0.38 ppm, P=0.012). EAC positively correlated with blood total ketone bodies (r=0.454, P<0.001), NYHA class (r=0.489, P<0.001), and plasma B-type natriuretic peptide (r=0.316, P=0.001). Right heart catheterization revealed that EAC significantly correlated with pulmonary capillary wedge pressure (PCWP, r=0.377, P<0.001). Receiver-operating characteristic analysis revealed that EAC >1.05 ppm was associated with PCWP ≥18 mmHg (area under the curve [AUC] 0.726, sensitivity 50%, specificity 89%). EAC was shown to be a comparable diagnostic biomarker for HF to BNP (AUC 0.760, sensitivity 80%, specificity 70%). CONCLUSIONS: EAC may be a novel noninvasive biomarker that correlates hemodynamic severity in non-ischemic chronic HF. (Circ J 2016; 80: 1178-1186).
• Rationale and design of a randomized trial to test the safety and non-inferiority of canagliflozin in patients with diabetes with chronic heart failure: the CANDLE trial.

  Atsushi Tanaka, Teruo Inoue, Masafumi Kitakaze, Jun-Ichi Oyama, Masataka Sata, Isao Taguchi, Wataru Shimizu, Hirotaka Watada, Hirofumi Tomiyama, Junya Ako, Yasushi Sakata, Toshihisa Anzai, Masaaki Uematsu, Makoto Suzuki, Kazuo Eguchi, Akira Yamashina, Yoshihiko Saito, Yasunori Sato, Shinichiro Ueda, Toyoaki Murohara, Koichi Node

  Cardiovascular diabetology 15 57 - 57 1475-2840 2016/04/04 [Refereed][Not invited]
   

  BACKGROUND: Because type 2 diabetes mellitus is associated strongly with an increased risk of cardiovascular diseases, the number of patients with diabetes with chronic heart failure is increasing steadily. However, clinical evidence of therapeutic strategies in such patients is still lacking. A recent randomized, placebo-controlled trial in patients with type 2 diabetes with high cardiovascular risk demonstrated that the SGLT2 inhibitor, empagliflozin, reduced the incidence of hospitalization for heart failure. Because SGLT2 inhibitors cause a reduction in body weight and blood pressure in addition to improving glycemic control, they have the potential to exert beneficial effects on the clinical pathophysiology of heart failure. The aim of the ongoing CANDLE trial is to test the safety and non-inferiority of canagliflozin, another SGLT2 inhibitor, compared with glimepiride, a sulfonylurea agent, in patients with type 2 diabetes mellitus and chronic heart failure. METHODS: A total of 250 patients with type 2 diabetes who are drug-naïve or taking any anti-diabetic agents and suffering from chronic heart failure with a New York Heart Association classification I to III will be randomized centrally into either canagliflozin or glimepiride groups (1: 1) using the dynamic allocation method stratified by age (<65, ≥65 year), HbA1c level (<6.5, ≥6.5 %), and left ventricular ejection fraction (<40, ≥40 %). After randomization, all the participants will be given the add-on study drug for 24 weeks in addition to their background therapy. The primary endpoint is the percentage change from baseline in NT-proBNP after 24 weeks of treatment. The key secondary endpoints after 24 weeks of treatment are the change from baseline in glycemic control, blood pressure, body weight, lipid profile, quality of life score related to heart failure, and cardiac and renal function. DISCUSSION: The CANDLE trial is the first to assess the safety and non-inferiority of canagliflozin in comparison with glimepiride in patients with type 2 diabetes with chronic heart failure. This trial has the potential to evaluate the clinical safety and efficacy of canagliflozin on heart failure. Trial registration Unique trial Number, UMIN000017669.
• Significance of myocardial tenascin-C expression in left ventricular remodelling and long-term outcome in patients with dilated cardiomyopathy.

  Tetsuro Yokokawa, Yasuo Sugano, Takafumi Nakayama, Toshiyuki Nagai, Taka-Aki Matsuyama, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Takeshi Nakatani, Satoshi Yasuda, Yasuchika Takeishi, Hisao Ogawa, Toshihisa Anzai

  European journal of heart failure 18 (4) 375 - 85 1388-9842 2016/04 [Refereed][Not invited]
   

  AIM: Dilated cardiomyopathy (DCM) has a variety of causes, and no useful approach to predict left ventricular (LV) remodelling and long-term outcome has yet been established. Myocardial tenascin-C (TNC) is known to appear under pathological conditions, possibly to regulate cardiac remodelling. The aim of this study was to clarify the significance of myocardial TNC expression in LV remodelling and the long-term outcome in DCM. METHODS AND RESULTS: One hundred and twenty-three consecutive DCM patients who underwent endomyocardial biopsy for initial diagnosis were studied. Expression of TNC in biopsy sections was analysed immunohistochemically to quantify the ratio of the TNC-positive area to the whole myocardial tissue area (TNC area). Clinical parameters associated with TNC area were investigated. The patients were divided into two groups based on receiver operating characteristic analysis of TNC area to predict death: high TNC group with TNC area ≥2.3% (22 patients) and low TNC group with TNC area <2.3% (101 patients). High TNC was associated with diabetes mellitus. Comparing echocardiographic findings between before and 9 months after endomyocardial biopsy, the low TNC group was associated with decreased LV end-diastolic diameter and increased LV ejection fraction, whereas the high TNC group was not. Survival analysis revealed a worse outcome in the high TNC group than in the low TNC group (P < 0.001). Multivariable Cox regression analysis revealed that TNC area was independently associated with poor outcome (HR = 1.347, P = 0.032). CONCLUSIONS: Increased myocardial TNC expression was associated with worse LV remodeling and long-term outcome in DCM.
• Practical applicability of landiolol, an ultra-short-acting β1-selective blocker, for rapid atrial and ventricular tachyarrhythmias with left ventricular dysfunction.

  Yuko Wada, Takeshi Aiba, Yasuyuki Tsujita, Hideki Itoh, Mitsuru Wada, Ikutaro Nakajima, Kohei Ishibashi, Hideo Okamura, Koji Miyamoto, Takashi Noda, Yasuo Sugano, Hideaki Kanzaki, Toshihisa Anzai, Kengo Kusano, Satoshi Yasuda, Minoru Horie, Hisao Ogawa

  Journal of arrhythmia 32 (2) 82 - 8 1880-4276 2016/04 [Refereed][Not invited]
   

  BACKGROUND: Landiolol effectively controls rapid heart rate in atrial fibrillation or flutter (AF/AFL) patients with left ventricular (LV) dysfunction. However, predicting landiolol Responders and Non-Responders and patients who will experience adverse effects remains a challenge. The aim of this study was to clarify the potential applicability of landiolol for rapid AF/AFL and refractory ventricular tachyarrhythmias (VTs) in patients with heart failure. METHODS: A total of 39 patients with AF/AFL with ventricular response ≥120 bpm and 12 VTs were retrospectively enrolled. Landiolol Responders for rapid AF/AFL were defined as patients whose ventricular response was suppressed to less than 110 bpm or decreased by ≥20% from the initial heart rate after administration of landiolol. Responders for VTs were defined as patients with no recurrent VTs during the 24 h after the initiation of landiolol. RESULTS: For AF/AFL, 29 patients (74%) were Responders. In nine patients (31%), AF was spontaneously terminated after starting landiolol. Eight Non-Responders (80%) needed to have AF terminated by cardioversion. Left ventricular ejection fraction (LVEF) at baseline was significantly associated with landiolol efficacy. For VTs, seven patients (58%) were Responders, and smaller LV diastolic and systolic diameters were associated with landiolol efficacy. Hypotension after landiolol treatment occurred in 5 of 51 patients, and lower LV systolic function was associated with the development of adverse events. CONCLUSIONS: Landiolol is effective in patients with heart failure not only due to rapid AF/AFL but also due to VTs. However, preserved LVEF is important for efficacy and safety in landiolol treatment.
• Effect of Discontinuation of Prednisolone Therapy on Risk of Cardiac Mortality Associated With Worsening Left Ventricular Dysfunction in Cardiac Sarcoidosis.

  Toshiyuki Nagai, Nobutaka Nagano, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Hideaki Kanzaki, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  The American journal of cardiology 117 (6) 966 - 71 0002-9149 2016/03/15 [Refereed][Not invited]
   

  Prednisolone (PSL) therapy is the gold standard treatment in patients with cardiac sarcoidosis (CS). However, clinicians often have difficulty in deciding whether to discontinue PSL therapy in long-term management. Sixty-one consecutive patients with CS were divided into 2 groups based on the discontinuation of PSL during the median follow-up period of 9.9 years. PSL was discontinued in 12 patients because of improvement of clinical findings. There were no significant differences between the 2 groups in age, gender, left ventricular ejection fraction (LVEF), findings of imaging techniques, incidence of fatal arrhythmias and heart failure, and dose of PSL. After discontinuation of PSL, 5 patients had cardiac death, and discontinuation of PSL was significantly associated with higher cardiac mortality compared with continuation (p = 0.035). Although patients with discontinuation had improvement of LVEF after PSL treatment, LVEF decreased after discontinuation of PSL. Furthermore, discontinuation of PSL was associated with greater percent decrease in LVEF compared with continuation (p = 0.037) during the follow-up period. In conclusion, in the long-term management of patients with CS, discontinuation of PSL was associated with poor clinical outcomes and decreased LVEF, suggesting the importance of PSL maintenance therapy.
• Intracardiac echocardiography to diagnose pannus formation after aortic valve replacement.

  Yoshiya Yamamoto, Takahiro Ohara, Akira Funada, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Toshihisa Anzai

  Journal of echocardiography 14 (1) 39 - 41 1349-0222 2016/03 [Refereed][Not invited]
   

  A 66-year-old female, under regular follow-up for 20 years after aortic valve replacement (19-mm Carbomedics), presented dyspnea on effort and hypotension during hemodialysis. A transthoracic echocardiogram showed elevation of transvalvular velocity up to 4 m/s, but the structure around the aortic prosthesis was difficult to observe due to artifacts. Fluoroscopy revealed normal motion of the leaflets of the mechanical valve. Intracardiac echocardiography (ICE) revealed a pannus-like structure in the left ventricular outflow tract. Transesophageal echocardiogram also revealed this structure. ICE can visualize structural abnormalities around a prosthetic valve after cardiac surgery even in patients in whom conventional imaging modalities failed.
• [Valvular Heart Disease: Current Treatment and Future Perspectives. Editorial: Paradigm shift and future aspect of the treatment of valvular heart disease].

  Toshihisa Anzai

  Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 105 (2) 181 - 3 0021-5384 2016/02/10 [Refereed][Not invited]
  
• Response to Letter Regarding Article, "Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism".

  Teruo Noguchi, Satoshi Yasuda, Tatsuhiro Shibata, Shoji Kawakami, Tomotaka Tanaka, Yasuhide Asaumi, Tomoaki Kanaya, Toshiyuki Nagai, Kazuhiro Nakao, Masashi Fujino, Kazuyuki Nagatsuka, Hatsue Ishibashi-Ueda, Kunihiro Nishimura, Yoshihiro Miyamoto, Kengo Kusano, Toshihisa Anzai, Yoichi Goto, Hisao Ogawa

  Circulation 133 (5) e379 - E379 0009-7322 2016/02/02 [Refereed][Not invited]
  
• A case of acute decompensated heart failure evaluated by series of exhaled acetone concentrations as noninvasive biomarker of heart failure severity.

  Tetsuro Yokokawa, Yasuo Sugano, Akito Shimouchi, Atsushi Shibata, Takafumi Nakayama, Takahiro Ohara, Naoya Jinno, Hideaki Kanzaki, Toshihisa Anzai

  International journal of cardiology 204 112 - 3 0167-5273 2016/02/01 [Refereed][Not invited]
  
• Impact of onset time of acute kidney injury on outcomes in patients with acute decompensated heart failure.

  Yoichi Takaya, Fumiki Yoshihara, Hiroyuki Yokoyama, Hideaki Kanzaki, Masafumi Kitakaze, Yoichi Goto, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Yuhei Kawano

  Heart and vessels 31 (1) 60 - 5 0910-8327 2016/01 [Refereed][Not invited]
   

  Since acute kidney injury (AKI) is not always related to mortality in patients with acute decompensated heart failure (ADHF), the aim of this study was to focus on onset time of AKI and its clinical importance. A total of 371 ADHF patients were included. The impact of AKI (≥ 0.3 mg/dl or 1.5-fold increase in serum creatinine level within 48 h) with early onset (≤ 4 days from admission) or late onset (≥ 5 days from admission) was assessed. AKI occurred in 99 patients, who were divided into two groups according to the median onset time of AKI: 50 with early onset of AKI and 49 with late onset of AKI. The maximum increase in serum creatinine level from admission was greater in patients with late onset of AKI than in patients with early onset of AKI (p = 0.012). Patients with late onset of AKI had a higher 12-month mortality rate than that in patients with early onset of AKI (log-rank test, p = 0.014). Late onset of AKI was an independent predictor of mortality (hazard ratio: 3.39, 95 % confidence interval: 1.84-6.18, p < 0.001). Late onset of AKI was associated with high blood urea nitrogen level at admission and intravenous administration of dobutamine. In conclusion, late onset of AKI related to high blood urea nitrogen level and intravenous administration of dobutamine, but not early onset of AKI, is linked to high mortality rate. Onset time of AKI may be useful for risk stratification of mortality in ADHF patients developing AKI.
• Prognostic Impact of Functional Mitral Regurgitation in Patients Admitted With Acute Decompensated Heart Failure.

  Yuko Wada, Takahiro Ohara, Akira Funada, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Hiroyuki Yokoyama, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 80 (1) 139 - 47 1346-9843 2016 [Refereed][Not invited]
   

  BACKGROUND: Functional mitral regurgitation (FMR) is a common complication of heart failure (HF) and worsens in acute decompensation. It is unclear whether FMR on admission or discharge determines the outcome. This study aimed to elucidate the prognostic significance of FMR on admission or discharge in patients admitted with acute decompensated HF. METHODS AND RESULTS: From 2006 to 2009, 349 patients admitted with acute decompensated HF were enrolled. They were followed with the composite endpoint of all-cause death and hospitalization for HF; 74 (21%) died and 113 (32%) developed the composite endpoint during 2.1±1.3 years. Moderate/severe FMR at discharge was associated with the composite endpoint (P=0.001), whereas that on admission was not. Multivariate Cox proportional hazard analysis showed that moderate/severe FMR (hazard ratio [95% confidence interval] =1.70 [1.03-2.73] P=0.04), logBNP, and NYHA class III/IV at discharge were independent determinants of the outcome. Moderate/severe FMR at discharge with BNP ≥200 pg/ml was prognostic, but BNP <200 pg/ml was no longer prognostic. CONCLUSIONS: Residual moderate/severe FMR after medical therapy for acute decompensated HF was associated with poor outcome, suggesting a potential target for further treatment of HF.
• Pronounced Shortening of QT Interval With Mexiletine Infusion Test in Patients With Type 3 Congenital Long QT Syndrome.

  Moritoshi Funasako, Takeshi Aiba, Kohei Ishibashi, Ikutaro Nakajima, Koji Miyamoto, Yuko Inoue, Hideo Okamura, Takashi Noda, Shiro Kamakura, Toshihisa Anzai, Teruo Noguchi, Satoshi Yasuda, Yoshihiro Miyamoto, Kengo Fukushima Kusano, Hisao Ogawa, Wataru Shimizu

  Circulation journal : official journal of the Japanese Circulation Society 80 (2) 340 - 5 1346-9843 2016 [Refereed][Not invited]
   

  BACKGROUND: Mexiletine is often used for medical therapy in LQT3 patients, however, the usefulness of mexiletine infusion test for LQT3 patients has not been reported. The aim of this study was to evaluate the usefulness of mexiletine infusion test for detecting LQT3 patients. METHODS AND RESULTS: We analyzed response in 12-lead electrocardiogram parameters measured in II or V5 to i.v. mexiletine infusion (2 mg/kg) during sinus rhythm among 31 genotype-positive LQT patients (29 ± 18 years, 12 male). Change in QTc interval after mexiletine was compared between LQT3 (n=15, 24 ± 21 years, 9 male) and other LQT patients (4 LQT1 and 12 LQT2; 34 ± 14 years, 3 male). Baseline RR, QT, and QTc interval were not different between the 2 groups (981 ± 182 vs. 1,023 ± 192 ms; 550 ± 94 vs. 524 ± 75 ms; 556 ± 66 vs. 520 ± 62 ms, respectively). While QTc interval was shortened with mexiletine in both groups (P<0.0001 vs. baseline), degree of QTc shortening (∆QTc) was significantly larger in LQT3 than in LQT1/LQT2 patients (99 ± 39 vs. 48 ± 32 ms; P=0.0004). The sensitivity, specificity and predictive accuracy of mexiletine infusion test for differentiating LQT3 from LQT1/LQT2 were 86.7%, 81.3% and 81.3%, respectively, and the optimal cut-off for ∆QTc was 69 ms on receiver operating characteristic analysis. No pro-arrhythmic event was observed. CONCLUSIONS: Pronounced shortening of QT interval with mexiletine may facilitate genetic testing in patients with LQT3 syndrome.
• First Case Report of the Antemortem Diagnosis of Nonbacterial Thrombotic Endocarditis of a Mechanical Prosthetic Valve.

  Hideki Yasutake, Yasuo Sugano, Yoshihiko Ikeda, Takahiro Ohara, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 55 (3) 255 - 7 0918-2918 2016 [Refereed][Not invited]
   

  A 67-year-old man with a history of aortic mechanical valve replacement exhibited an abnormal mass on the sewing ring of the prosthesis on echocardiography. Despite receiving strong anticoagulation, he developed acute cerebral infarction due to the formation of emboli resulting from the thrombus and underwent urgent re-aortic valve replacement. Based on the microscopic findings of the resected mass, he was finally diagnosed as having nonbacterial thrombotic endocarditis (NBTE) of the mechanical prosthetic valve, which was thought to be associated with colorectal cancer. We herein report the first known case of an antemortem diagnosis of NBTE on a mechanical heart valve.
• Prognostic Value of Prothrombin Time International Normalized Ratio in Acute Decompensated Heart Failure - A Combined Marker of Hepatic Insufficiency and Hemostatic Abnormality.

  Atsushi Okada, Yasuo Sugano, Toshiyuki Nagai, Seiji Takashio, Satoshi Honda, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo F Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 80 (4) 913 - 23 1346-9843 2016 [Refereed][Not invited]
   

  BACKGROUND: There are limited studies regarding the prognostic value of coagulation abnormalities in heart failure patients. The clinical significance of prothrombin time international normalized ratio (INR), a widely accepted marker assessing coagulation abnormalities, in acute decompensated heart failure (ADHF) remains unclear. METHODS AND RESULTS: Among 561 consecutive patients admitted for ADHF, INR was assessed in 294 patients without prior anticoagulation therapy, acute coronary syndrome, liver disease, or overt disseminated intravascular coagulation. Increased INR on admission was positively associated with increased levels of thrombin-antithrombin complex, C-reactive protein, total bilirubin, γ-glutamyl transpeptidase, inferior vena cava diameter, tricuspid regurgitation severity, markers of neurohormonal activation, and also negatively associated with decreased albumin, cholinesterase, and total cholesterol. In contrast, there was no significant association with left ventricular ejection fraction, serum sodium or blood urea nitrogen. Multivariate analysis showed that increased INR was independently associated with increased all-cause mortality (hazard ratio 1.89 per 0.1 increase, 95% confidence interval 1.14-3.13, P=0.013) during the median follow up of 284 days. Increased INR also had a higher prognostic value compared to risk score models including the Model for End-Stage Liver Disease (MELD) score or the MELD excluding INR (MELD-XI) score. CONCLUSIONS: Increased INR is an independent predictor of all-cause mortality in ADHF patients without anticoagulation, reflecting coagulation abnormalities and hepatic insufficiency, possibly through systemic inflammation, neurohormonal activation and venous congestion.
• Prosthetic Valve Dysfunction 35 Years after Mitral Valve Replacement with a Starr-Edwards Caged-disc Valve.

  Tetsuro Yokokawa, Takahiro Ohara, Seiji Takashio, Mari Sakamoto, Yuko Wada, Kenji Nakamura, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Hisao Ogawa, Tomoyuki Fujita, Junjiro Kobayashi, Yoko Okamoto, Taka-Aki Matsuyama, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 55 (5) 479 - 83 0918-2918 2016 [Refereed][Not invited]
   

  A 49-year-old man was admitted to our hospital with a chief complaint of dyspnea. He had a history of mitral valve replacement (MVR) with a Starr-Edwards (SE) caged-disc valve at the age of 14. Echocardiography revealed elevated trans-valvular pressure gradient of the mitral prosthetic valve with neither disk motion abnormality nor abnormal structure. Catheterization confirmed an elevation of the mean diastolic gradient of the mitral valve to 12.3 mmHg. Re-MVR was performed, and abnormal tissue attached to the cage of the valve and proliferating beneath the valve was observed. Histologic examination revealed them as fibrinous tissue and mild pannus proliferation, respectively. This rare case report focuses on long-term follow-up and the complication of a SE caged-disc valve. A SE caged-disc valve may become stenotic, only detected with a trans-valvular pressure gradient without any disk motion abnormality or abnormal structure during a prolonged follow-up period.
• Pathohistological Evidence of Smoldering Inflammation in Rheumatic Heart Disease with Massive Left Atrial Calcification.

  Mikio Shiba, Yasuo Sugano, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Takahiro Ohara, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 55 (7) 751 - 4 0918-2918 2016 [Refereed][Not invited]
   

  A 74-year-old man, who had a history of a mitral valve replacement for rheumatic heart disease (RHD) 30 years previously, was admitted with progressive heart failure. Massive calcification was observed around the left atrium on multidetector CT, in addition to a late gadolinium enhancement (LGE)-positive layer adjacently outside of the calcification on MRI. He underwent a second mitral valve replacement for the prosthetic valve failure. Pathohistological analyses of a tissue section of the left atrial wall from a surgical specimen revealed lymphocyte and macrophage infiltration that coincided with the LGE-positive layer on MRI, suggesting the existence of sustained active inflammation even after the long period of RHD.
• Pathological Investigation of Congenital Bicuspid Aortic Valve Stenosis, Compared with Atherosclerotic Tricuspid Aortic Valve Stenosis and Congenital Bicuspid Aortic Valve Regurgitation.

  Yasuhiro Hamatani, Hatsue Ishibashi-Ueda, Toshiyuki Nagai, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Tomoyuki Fujita, Junjiro Kobayashi, Toshihisa Anzai

  PloS one 11 (8) e0160208  1932-6203 2016 [Refereed][Not invited]
   

  BACKGROUND: Congenital bicuspid aortic valve (CBAV) is the main cause of aortic stenosis (AS) in young adults. However, the histopathological features of AS in patients with CBAV have not been fully investigated. METHODS AND RESULTS: We examined specimens of aortic valve leaflets obtained from patients who had undergone aortic valve re/placement at our institution for severe AS with CBAV (n = 24, CBAV-AS group), severe AS with tricuspid aortic valve (n = 24, TAV-AS group), and severe aortic regurgitation (AR) with CBAV (n = 24, CBAV-AR group). We compared the histopathological features among the three groups. Pathological features were classified using semi-quantitative methods (graded on a scale 0 to 3) by experienced pathologists without knowledge of the patients' backgrounds. The severity of inflammation, neovascularization, and calcium and cholesterol deposition did not differ between the CBAV-AS and TAV-AS groups, and these four parameters were less marked in the CBAV-AR group than in the CBAV-AS (all p<0.01). Meanwhile, the grade of valvular fibrosis was greater in the CBAV-AS group, compared with the TAV-AS and CBAV-AR groups (both p<0.01). In AS patients, thickness of fibrotic lesions was greater on the aortic side than on the ventricular side (both p<0.01). Meanwhile, thickness of fibrotic lesions was comparable between the aortic and ventricular sides in CBAV-AR patients (p = 0.35). CONCLUSIONS: Valvular fibrosis, especially on the aortic side, was greater in patients with CBAV-AS than in those without, suggesting a difference in the pathogenesis of AS between CBAV and TAV.
• Circulating Omega-6, But Not Omega-3 Polyunsaturated Fatty Acids, Are Associated with Clinical Outcomes in Patients with Acute Decompensated Heart Failure.

  Toshiyuki Nagai, Yasuyuki Honda, Yasuo Sugano, Kunihiro Nishimura, Michikazu Nakai, Satoshi Honda, Naotsugu Iwakami, Atsushi Okada, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai

  PloS one 11 (11) e0165841  1932-6203 2016 [Refereed][Not invited]
   

  BACKGROUND: Circulating polyunsaturated fatty acid (PUFA) levels are associated with clinical outcomes in cardiovascular diseases including coronary artery disease and chronic heart failure (HF). However, their clinical implications in acute decompensated HF (ADHF) remain unclear. The aim of this study was to investigate the clinical roles of circulating PUFAs in patients with ADHF. METHODS: Circulating levels of PUFAs, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA) and dihomo-gamma linoleic acid (DGLA), were measured on admission in 685 consecutive ADHF patients. Adverse events were defined as all-cause death and worsening HF. RESULTS: During a median follow-up period of 560 days, 262 (38.2%) patients had adverse events. Although patients with adverse events had lower n-6 PUFA (AA + DGLA) level than those without, n-3 PUFA (EPA + DHA) level was comparable between the groups. Kaplan-Meier analyses showed that lower n-6 PUFA level on admission was significantly associated with the composite of all-cause death and worsening HF, all-cause death, cardiovascular death and worsening HF (p < 0.001, p = 0.005, p = 0.021, p = 0.019, respectively). In a multivariate Cox model, lower n-6 PUFA level was independently associated with increased risk of adverse events (HR 0.996, 95% CI: 0.993-0.999, p = 0.027). CONCLUSIONS: Lower n-6 but not n-3 PUFA level on admission was significantly related to worse clinical outcomes in ADHF patients. Measurement of circulating n-6 PUFA levels on admission might provide information for identifying high risk ADHF patients.
• Azilsartan, but not Candesartan Improves Left Ventricular Diastolic Function in Patients with Hypertension and Heart Failure

  Mari Sakamoto, Masanori Asakura, Atsushi Nakano, Hideaki Kanzaki, Yasuo Sugano, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Toshihisa Anzai, Masafumi Kitakaze

  INTERNATIONAL JOURNAL OF GERONTOLOGY 9 (4) 201 - 205 1873-9598 2015/12 [Refereed][Not invited]
   

  Background: Diastolic dysfunction is a major cause of heart failure (HF) with a preserved ejection fraction (HFpEF); however, there is no clear strategy for treating diastolic dysfunction. Myocardial and vascular abnormalities may cause HFpEF, which indicates that correcting both abnormalities may specifically improve the severity of diastolic dysfunction. Candesartan primarily affects the myocardium, but azilsartan affects the myocardium and the aortic vasculature. This study was undertaken to test the hypothesis that azilsartan, but not candesartan, improves left ventricular (LV) diastolic dysfunction in patients with hypertension and HFpEF. Methods: Among patients with HF in our database, the patients who received azilsartan or candesartan were retrospectively screened. Fifteen patients treated with azilsartan were identified, and sex-matched patients who received candesartan were blindly selected. Results: At baseline, there were no significant differences between the two groups in clinical findings, echocardiographic parameters, and plasma brain natriuretic peptide levels. At 3-6 months, blood pressure decreased to similar levels in both groups. However, the early LV filling velocity/early diastolic velocity (E/e') ratio decreased in the azilsartan group (13.0 +/- 4.2 vs. 10.9 +/- 3.2, p = 0.03), but remained unchanged in the candesartan group (12.0 +/- 3.6 vs. 12.5 +/- 5.0, p = 0.58; for interaction, p = 0.04). Other echocardiographic parameters were unaltered by azilsartan or candesartan. Conclusion: Azilsartan improves diastolic function in HF patients with hypertension, and it may be the preferred option over other angiotensin II receptor blockers in patients with HFpEF. Copyright (C) 2015, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.
• Improvement of left ventricular filling and pulmonary artery pressure following unilateral renal artery total occlusion stenting in a patient with recurrent congestive heart failure complicated by renovascular hypertension and renal failure.

  Osami Kawarada, Ryota Kitajima, Yasuo Sugano, Teruo Noguchi, Toshihisa Anzai, Hisao Ogawa, Satoshi Yasuda

  ESC heart failure 2 (4) 160 - 163 2055-5822 2015/12 [Refereed][Not invited]
   

  Recurrent congestive heart failure related to renal artery disease is an important clinical entity that is typically observed in bilateral renal artery stenosis or solitary functioning kidney. However, the relationship between heart failure and unilateral renal artery disease, especially that with total occlusion, remains unclear. We report a successful management by unilateral renal artery total occlusion stenting with an evidence of improvement of left ventricular filling and pulmonary artery pressure in case of a patient suffering from medical therapy resistant recurrent congestive heart failure with preserved ejection fraction.
• Active cardiac sarcoidosis in a patient with adult-onset Kawasaki disease.

  Noriaki Moriyama, Takahiro Ohara, Hideaki Kanzaki, Etsuko Tsuda, Masaharu Ishihara, Toshihisa Anzai

  Journal of cardiology cases 12 (3) 68 - 71 2015/09 [Refereed][Not invited]
   

  Adult-onset Kawasaki disease is a rare condition. Cardiac sarcoidosis is an uncommon cardiomyopathy which is characterized by progressive cardiac dysfunction, and abnormality on electrocardiography and morphological aberration of the heart. We report a first case of a combination of these rare conditions. The patient was initially diagnosed with Kawasaki disease based on the coronary artery aneurysms and a past medical history at the age of 20 years which was typical of Kawasaki disease. Decades later, he developed progressive cardiac dysfunction and a sudden-onset atrioventricular block. Laboratory and imaging results revealed severe myocardial damage and inflammation which were unexplainable by coronary artery ischemia. We diagnosed him with cardiac sarcoidosis based on a Japanese guideline to diagnose cardiac sarcoidosis. A cardiac resynchronization therapy defibrillator was implanted and he received oral steroid therapy. This rare combination of adult-onset Kawasaki disease and cardiac sarcoidosis may suggest the causative association of these conditions. .
• Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Artery Embolism.

  Tatsuhiro Shibata, Shoji Kawakami, Teruo Noguchi, Tomotaka Tanaka, Yasuhide Asaumi, Tomoaki Kanaya, Toshiyuki Nagai, Kazuhiro Nakao, Masashi Fujino, Kazuyuki Nagatsuka, Hatsue Ishibashi-Ueda, Kunihiro Nishimura, Yoshihiro Miyamoto, Kengo Kusano, Toshihisa Anzai, Yoichi Goto, Hisao Ogawa, Satoshi Yasuda

  Circulation 132 (4) 241 - 50 0009-7322 2015/07/28 [Refereed][Not invited]
   

  BACKGROUND: Coronary artery embolism (CE) is recognized as an important nonatherosclerotic cause of acute myocardial infarction. Its prevalence, clinical features, and prognosis remain insufficiently characterized. METHODS AND RESULTS: We screened 1776 consecutive patients who presented with de novo acute myocardial infarction between 2001 and 2013. CE was diagnosed based on criteria encompassing histological, angiographic, and other diagnostic imaging findings. The prevalence, clinical characteristics, treatment strategies, in-hospital outcomes, and long-term risk of CE recurrence or major adverse cardiac and cerebrovascular events (cardiac death, fatal arrhythmia, or recurrent thromboembolism) were evaluated. The prevalence of CE was 2.9% (n=52), including 8 (15%) patients with multivessel CE. Atrial fibrillation was the most common cause (n=38, 73%). Only 39% of patients with CE were treated with vitamin K antagonists, and the median international normalized ratio was 1.42 (range, 0.95-1.80). Eighteen of the 30 CE patients with nonvalvular atrial fibrillation had a CHADS2 score of 0 or 1. When those patients were reevaluated using CHA2DS2-VASc, 61% were reassigned to a higher risk category. During a median follow-up of 49 months, CE and thromboembolism recurred in 5 atrial fibrillation patients. The 5-year rate of major adverse cardiac and cerebrovascular events was 27.1%. In the propensity score-matched cohorts (n=45 each), Kaplan-Meier analysis showed a significantly higher incidence of cardiac death in the CE group than in the non-CE group (hazard ratio, 9.29; 95% confidence interval, 1.13-76.5; P<0.001). CONCLUSIONS: Atrial fibrillation is the most frequent cause of CE. Patients with CE represent a high-risk subgroup of patients with acute myocardial infarction and require close follow-up.
• Significance of low plasma levels of brain-derived neurotrophic factor in patients with heart failure.

  Seiji Takashio, Seigo Sugiyama, Megumi Yamamuro, Hiroyuki Takahama, Tomohiro Hayashi, Yasuo Sugano, Yasuhiro Izumiya, Seiji Hokimoto, Naoto Minamino, Satoshi Yasuda, Toshihisa Anzai, Hisao Ogawa

  The American journal of cardiology 116 (2) 243 - 9 0002-9149 2015/07/15 [Refereed][Not invited]
   

  Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, which regulates neuronal differentiation and functions. Low levels of BDNF are because of psychological stress and potentially play a role in the pathogenesis of depression and cognition disorders. Because psychological stress and depression are associated with increased risk of heart failure (HF), the pathogenic link between HF and psychological status has attracted clinical attention. We hypothesized that plasma BDNF levels might be decreased in patients with HF and that BDNF could be a key factor associated with HF. We evaluated plasma BDNF levels in 242 patients with HF and 80 subjects without HF who are age and gender matched. Plasma BDNF levels were significantly lower in patients with HF (3,712 pg/ml [2,124 to 6,180]) than those without HF (7,247 pg/ml [5,388 to 9,255], p <0.001) and lower in patients with HF with the New York Heart Association functional class III than class I (p = 0.01) and class II (p <0.001). Log BDNF levels correlated negatively with log B-type natriuretic peptide (r = -0.203, p = 0.03) in patients with HF. Of 61 acute decompensated patients with HF, plasma BDNF levels were significantly higher at discharge (4,194 pg/ml [2,356 to 6,916]) compared with those at admission (2,749 pg/ml [1,380 to 4,161], p = 0.003). Multivariate logistic regression analysis identified log BDNF level as a significant correlate with the presence of HF (odds ratio 0.82; 95% confidence interval 0.76 to 0.91, p <0.001). In conclusion, plasma BDNF levels were decreased in patients with HF and associated with HF severity. BDNF could be a potentially clinically useful biomarker of HF reflecting possible cardio-neuronal linkage.
• Late aneurysm formation of Valsalva sinus after aortic valve replacement due to Takayasu's arteritis.

  Akira Funada, Hideaki Kanzaki, Nobutaka Nagano, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hatsue Ishibashi-Ueda, Masafumi Kitakaze, Toshihisa Anzai

  Heart and vessels 30 (4) 558 - 62 0910-8327 2015/07 [Refereed][Not invited]
   

  Takayasu's arteritis (TA) is an inflammatory disease of unknown etiology involving the aorta and its branches, and also causes aortic regurgitation (AR). One of the most serious but rare complications after aortic valve replacement (AVR) in TA is aneurysm formation of the sinus of Valsalva. A 64-year-old woman had undergone AVR with a prosthetic valve for AR due to TA 4 years earlier and had received an implanted permanent pacemaker for complete atrioventricular block (AVB) 2 years later. Aortography 4 years postoperatively demonstrated aneurysm formation (47 mm in diameter) at the sinus of Valsalva although preoperative aortography showed severe AR without dilatation of the sinus of Valsalva. We recommended reoperation for the aneurysm but the patient refused. The perioperative histopathological examination revealed extensive destruction of the medial elastic fibers. Both the fragility of the sinus of Valsalva and the residual inflammation could have caused the patient's aneurysm formation. Moreover, extension of TA into the ventricular septum or mechanical compression of the aneurysm against the conduction system might have caused her progressive AVB. Close and lifelong follow-up for patients with TA regarding development of aneurysm after surgical treatment is indispensable when fragility of the aortic root had been confirmed.
• Prognostic impact of blood pressure response plus gadolinium enhancement in dilated cardiomyopathy.

  Emi Tateishi, Teruo Noguchi, Yoichi Goto, Yoshiaki Morita, Hatsue Ishibashi-Ueda, Naoaki Yamada, Hideaki Kanzaki, Kunihiro Nishimura, Yoshihiro Miyamoto, Toshihisa Anzai, Hisao Ogawa, Satoshi Yasuda

  Heart (British Cardiac Society) 101 (10) 774 - 80 1355-6037 2015/05/15 [Refereed][Not invited]
   

  OBJECTIVE: Late gadolinium enhancement (LGE) is not necessarily ideal for detecting diffuse myocardial fibrosis in idiopathic dilated cardiomyopathy (DCM). Since systolic blood pressure response (SBPR) during exercise has been proposed to reflect cardiac pump reserve in patients with heart failure, we wished to determine whether LGE plus SBPR is a better prognostic factor in patients with DCM. METHODS: LGE and cardiopulmonary exercise testing results in consecutive 207 patients with DCM were examined. Patients were divided into four groups according to the presence or absence of LGE and the SBPR cut-off value of +40 mm Hg according to receiver operating characteristic curve analysis: LGE-positive+SBPR <40 mm Hg (n=65), LGE-positive+SBPR ≥40 mm Hg (n=40), LGE-negative+SBPR <40 mm Hg (n=33) and LGE-negative+SBPR ≥40 mm Hg (n=69). The composite end point was cardiac death, cardiac transplantation, LV assist device implantation, life-threatening arrhythmia or heart failure. RESULTS: Forty-two (20%) patients developed the composite end point, with rates of 35%, 20%, 21% and 6% in patients with LGE-positive+SBPR <40 mm Hg, LGE-positive+SBPR ≥40 mm Hg, LGE-negative+SBPR <40 mm Hg and LGE-negative+SBPR ≥40 mm Hg status, respectively. Multivariable Cox regression analysis identified LGE-positive and SBPR <40 mm Hg as a significant independent predictor of cardiac events (HR 2.08, 95% CI 1.06 to 4.11, p=0.034). Of note, there was no significant difference in the cardiac event-free survival rate between the LGE-positive+SBPR ≥40 mm Hg and LGE-negative+SBPR <40 mm Hg groups (p=0.736). CONCLUSIONS: The combination of LGE and SBPR provides more clinically relevant information for assessing the risk of cardiac events in patients with DCM than LGE status alone.
• Efficacy and safety of flecainide for ventricular arrhythmias in patients with Andersen-Tawil syndrome with KCNJ2 mutations.

  Koji Miyamoto, Takeshi Aiba, Hiromi Kimura, Hideki Hayashi, Seiko Ohno, Chie Yasuoka, Yoshihito Tanioka, Takeshi Tsuchiya, Yoko Yoshida, Hiroshi Hayashi, Ippei Tsuboi, Ikutaro Nakajima, Kohei Ishibashi, Hideo Okamura, Takashi Noda, Masaharu Ishihara, Toshihisa Anzai, Satoshi Yasuda, Yoshihiro Miyamoto, Shiro Kamakura, Kengo Kusano, Hisao Ogawa, Minoru Horie, Wataru Shimizu

  Heart rhythm 12 (3) 596 - 603 1547-5271 2015/03 [Refereed][Not invited]
   

  BACKGROUND: Andersen-Tawil syndrome (ATS) is an autosomal dominant genetic or sporadic disorder characterized by ventricular arrhythmias (VAs), periodic paralyses, and dysmorphic features. The optimal pharmacological treatment of VAs in patients with ATS remains unknown. OBJECTIVE: We evaluated the efficacy and safety of flecainide for VAs in patients with ATS with KCNJ2 mutations. METHODS: Ten ATS probands (7 females; mean age 27 ± 11 years) were enrolled from 6 institutions. All of them had bidirectional VAs in spite of treatment with β-blockers (n = 6), but none of them had either aborted cardiac arrest or family history of sudden cardiac death. Twenty-four-hour Holter recording and treadmill exercise test (TMT) were performed before (baseline) and after oral flecainide therapy (150 ± 46 mg/d). RESULTS: Twenty-four-hour Holter recordings demonstrated that oral flecainide treatment significantly reduced the total number of VAs (from 38,407 ± 19,956 to 11,196 ± 14,773 per day; P = .003) and the number of the longest ventricular salvos (23 ± 19 to 5 ± 5; P = .01). At baseline, TMT induced nonsustained ventricular tachycardia (n = 7) or couplets of premature ventricular complex (n = 2); treatment with flecainide completely (n = 7) or partially (n = 2) suppressed these exercise-induced VAs (P = .008). In contrast, the QRS duration, QT interval, and U-wave amplitude of the electrocardiogram were not altered by flecainide therapy. During a mean follow-up of 23 ± 11 months, no patients developed syncope or cardiac arrest after oral flecainide treatment. CONCLUSION: This multicenter study suggests that oral flecainide therapy is an effective and safe means of suppressing VAs in patients with ATS with KCNJ2 mutations, though the U-wave amplitude remained unchanged by flecainide.
• Role of non-electrocardiogram-gated contrast-enhanced computed tomography in the diagnosis of acute coronary syndrome.

  Yoshinori Mano, Toshihisa Anzai, Akihiro Yoshizawa, Yuji Itabashi, Takahiro Ohki

  Heart and vessels 30 (1) 1 - 8 0910-8327 2015/01 [Refereed][Not invited]
   

  Non-electrocardiogram-gated contrast-enhanced computed tomography (non-ECG-gated CT) is available in most hospitals where patients with chest and/or back pain are admitted to the emergency department. Although it has been established as the initial diagnostic imaging modality for acute aortic dissection (AAD) and pulmonary thromboembolism (PE), its diagnostic ability for acute coronary syndrome (ACS) in the emergency department has not been elucidated. We retrospectively investigated 154 consecutive patients who required non-ECG-gated CT to differentiate AAD and PE in the emergency department, but had no evidence of them on CT. Furthermore, a subanalysis was performed in the patients who were subsequently suspected of ACS and underwent emergent invasive coronary angiography followed by CT. We evaluated left ventricular enhancement to detect myocardial perfusion deficit by calculating Hounsfield units, and the results were compared with ultimate diagnoses and angiography findings. A perfusion deficit was detected in 43 patients, among whom 26 were ultimately diagnosed with acute myocardial infarction (AMI); 24 patients required emergent revascularization. The subanalysis indicated that perfusion abnormalities corresponded with the territory of the culprit artery in all except one patient. In the remaining 111 patients without perfusion deficit, only two required emergent revascularization, and their levels of creatine kinase MB were not elevated. The sensitivity, specificity, and positive and negative predictive values of non-ECG-gated CT in predicting AMI/emergent revascularization were 93 %, 87 %, 61 %, and 98 %/92 %, 85 %, 56 %, and 98 %, respectively. Non-ECG-gated CT facilitates the diagnosis of ACS and the decision on emergent catheterization, providing information on the ischemic myocardial area by detection of a localized decrease in left ventricular enhancement.
• Non-contrast T1-weighted magnetic resonance imaging at 3.0 Tesla in a patient undergoing elective percutaneous coronary intervention – clinical and pathological significance of high-intensity plaque.

  Yasuhide Asaumi, Teruo Noguchi, Yoshiaki Morita, Taka-Aki Matsuyama, Fumiyuki Otsuka, Reiko Fujiwara, Tomoaki Kanaya, Toshiyuki Nagai, Masahiro Higashi, Kengo Kusano, Toshihisa Anzai, Hatsue Ishibashi-Ueda, Hisao Ogawa, Satoshi Yasuda

  Circulation journal : official journal of the Japanese Circulation Society 79 (1) 218 - 20 1346-9843 2015 [Refereed][Not invited]
  
• Does major noncardiac surgery accelerate the progression of aortic stenosis? - Role of inflammation.

  Makoto Amaki, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 79 (4) 766 - 7 1346-9843 2015 [Refereed][Not invited]
  
• Risk Stratification of Acute Kidney Injury Using the Blood Urea Nitrogen/Creatinine Ratio in Patients With Acute Decompensated Heart Failure.

  Yoichi Takaya, Fumiki Yoshihara, Hiroyuki Yokoyama, Hideaki Kanzaki, Masafumi Kitakaze, Yoichi Goto, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Yuhei Kawano

  Circulation journal : official journal of the Japanese Circulation Society 79 (7) 1520 - 5 1346-9843 2015 [Refereed][Not invited]
   

  BACKGROUND: Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality. METHODS AND RESULTS: In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox's proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine. CONCLUSIONS: The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI.
• Effect of Corticosteroid Therapy on Long-Term Clinical Outcome and Left Ventricular Function in Patients With Cardiac Sarcoidosis.

  Toshiyuki Nagai, Nobutaka Nagano, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Hideaki Kanzaki, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 79 (7) 1593 - 600 1346-9843 2015 [Refereed][Not invited]
   

  BACKGROUND: Cardiac involvement is the worst prognostic determinant in patients with sarcoidosis, but the long-term prognostic significance of corticosteroid therapy for cardiac sarcoidosis (CS) remains unclear. METHODS AND RESULTS: We examined 83 consecutive patients diagnosed with CS. Patients were divided into 2 groups based on the presence or absence of corticosteroid therapy at diagnosis. Patients with corticosteroid therapy had lower age and higher rate of positive findings in the myocardium on gallium scintigraphy (Ga) at diagnosis than those without. LVEF, biomarkers, and use of cardiovascular medication were similar between the 2 groups. During the follow-up (7.6±4.4 years), corticosteroid therapy was associated with fewer long-term adverse events (overall, P=0.005; cardiac death, P=0.92; symptomatic arrhythmias, P=0.89; heart failure admission, P<0.0001) and a greater % increase in LVEF than those without (7.9±36.3% vs. -16.7±34.8%, P=0.03). On Cox proportional hazards modeling, corticosteroid therapy (HR, 0.41; 95% CI: 0.20-0.89) was an independent determinant of long-term adverse event-free survival, but age, sex, LVEF, and Ga findings were not. CONCLUSIONS: Corticosteroid therapy might have a beneficial effect on long-term clinical outcome in CS patients, particularly by reduction of heart failure admission and retarding the progression of LV systolic dysfunction.
• Association Between Basal Thinning of Interventricular Septum and Adverse Long-Term Clinical Outcomes in Patients With Cardiac Sarcoidosis.

  Nobutaka Nagano, Toshiyuki Nagai, Yasuo Sugano, Yoshiaki Morita, Yasuhide Asaumi, Takeshi Aiba, Hideaki Kanzaki, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 79 (7) 1601 - 8 1346-9843 2015 [Refereed][Not invited]
   

  BACKGROUND: Basal thinning of the interventricular septum (IVS) is an important diagnostic feature of cardiac sarcoidosis (CS), but its long-term prognostic significance remains unclear. METHODS AND RESULTS: We examined 74 consecutive patients who were diagnosed with CS. Basal IVS thickness at a point located 10 mm from the aortic annulus was measured. IVS thickness at the left ventricular minor axis level (IVS) was also measured according to the recommended procedure of the American Society of Echocardiography. Patients were divided into 2 groups based on the presence or absence of basal IVS thinning, which was defined as basal IVS ≤4 mm and/or basal IVS/IVS ratio ≤0.6. Basal IVS thinning was observed in 21 patients and was associated with greater long-term adverse events during follow-up (5.1±2.5 years), although the baseline characteristics were comparable between groups (overall, P<0.01; all-cause death, P=0.53; symptomatic arrhythmias, P<0.01; heart failure admission, P=0.027). Multivariate analysis showed basal IVS thinning was an independent determinant of long-term adverse events (hazard ratio 2.86, 95% confidence interval 1.31-6.14) even after adjustment for existing prognostic variables. CONCLUSIONS: The presence of basal IVS thinning at the time of CS diagnosis was associated with poor long-term clinical outcomes, suggesting its prognostic significance in patients with CS.
• Clinical and Pathological Impact of Tissue Fibrosis on Lethal Arrhythmic Events in Hypertrophic Cardiomyopathy Patients With Impaired Systolic Function.

  Yuko Wada, Takeshi Aiba, Taka-aki Matsuyama, Ikutaro Nakajima, Kohei Ishibashi, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Yoshiaki Morita, Hideaki Kanzaki, Kengo Kusano, Toshihisa Anzai, Shiro Kamakura, Hatsue Ishibashi-Ueda, Wataru Shimizu, Minoru Horie, Satoshi Yasuda, Hisao Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 79 (8) 1733 - 41 1346-9843 2015 [Refereed][Not invited]
   

  BACKGROUND: The natural history of hypertrophic cardiomyopathy (HCM) varies from an asymptomatic benign course to a poor prognosis. Myocardial fibrosis may play a critical role in ventricular tachyarrhythmias (VT/VF); however, the clinical significance of tissue fibrosis by right ventricular (RV) biopsy in the long-term prognosis of HCM patients remains unclear. METHODS AND RESULTS: We enrolled 185 HCM patients (mean age, 57±14 years). The amount of fibrosis (%area) was quantified using a digital microscope. Hemodynamic, echocardiographic, and electrophysiologic parameters were also evaluated. Patients with severe fibrosis had longer QRS duration and positive late potential (LP) on signal-averaged ECG, resulting in a higher incidence of VT/VF. At the 5±4 year follow-up, VT/VF occurred in 31 (17%) patients. Multivariate Cox regression analysis revealed that tissue fibrosis (hazard ratio (HR): 1.65; P=0.003 per 10% increase), lower left ventricular ejection fraction (HR: 0.64; P=0.001 per 10% increase), and positive SAECG (HR: 3.14; P=0.04) led to a greater risk of VT/VF. The combination of tissue fibrosis severity and lower left ventricular ejection fraction could be used to stratify the risk of lethal arrhythmic events in HCM patients. CONCLUSIONS: Myocardial fibrosis in RV biopsy samples may contribute to abnormal conduction delay and spontaneous VT/VF, leading to a poor prognosis in HCM patients.
• Time-Course Changes of Cardiac-Specific Inflammation in a Patient With Left Ventricular Calcified Amorphous Tumor.

  Hiroki Yasui, Hiroyuki Takahama, Hideaki Kanzaki, Hatsue Ishibashi-Ueda, Naomi Morita, Yasuo Sugano, Takuya Hasegawa, Takahiro Ohara, Makoto Amaki, Akira Funada, Yasushi Yoshikawa, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 79 (9) 2069 - 71 1346-9843 2015 [Refereed][Not invited]
  
• Isolated Septal Branch Myocardial Infarction Due to Coronary Spasm Mimicking Non-Ischemic Late Gadolinium Enhancement Pattern on Cardiac Magnetic Resonance Imaging.

  Naotsugu Iwakami, Teruo Noguchi, Yoshihiko Ikeda, Emi Tateishi, Yoshiaki Morita, Hideaki Kanzaki, Mitsuhiko Takewa, Toshihisa Anzai, Hisao Ogawa, Satoshi Yasuda

  Circulation journal : official journal of the Japanese Circulation Society 79 (10) 2280 - 2 1346-9843 2015 [Refereed][Not invited]
  
• Intensity of statin therapy and new hospitalizations for heart failure in patients with type 2 diabetes.

  Ichiro Kishimoto, Hisashi Makino, Yoko Ohata, Tamiko Tamanaha, Mayu Tochiya, Toshihisa Anzai, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda, Hisao Ogawa

  BMJ open diabetes research & care 3 (1) e000137  2015 [Refereed][Not invited]
   

  OBJECTIVE: To examine a relationship between statin intensity and heart failure (HF) incidence in diabetes. RESEARCH DESIGN AND METHODS: We performed a retrospective cohort study of patients with type 2 diabetes (n=600; age, 66.3 years; men, 68%). Patients were categorized into three groups by baseline statin treatments-moderate-intensity, low-intensity, or no statin-and the independent association between the statin category and HF hospitalization during follow-up was examined. RESULTS: Over the course of the median 6-year follow-up, 17.7% of the patients were hospitalized for HF. Cox regression analysis revealed a significant association between the baseline statin category and HF incidence (p=0.002), independently of age, sex, hypertension, B-type natriuretic peptide, glycated hemoglobin, estimated glomerular filtration rate, and low-density lipoprotein (LDL) cholesterol levels. The moderate-intensity statin group had a significantly lower risk for HF than the low-intensity statin group with an adjusted HR of 0.31 (95% CI 0.13 to 0.65, p=0.0014). Interestingly, among patients with prevalent coronary artery diseases (CAD) and with baseline LDL controlled to less than 100 mg/dL, the frequency of HF was still significantly lower in the moderate-intensity group than in the low-intensity group or the no statin group. The effect of baseline statin category on HF was independent of incident CAD events during follow-up. CONCLUSIONS: In type 2 diabetes, moderate-intensity statins, in comparison to low-intensity or no statin, were associated with lower HF incidence independently of LDL levels or of CAD events.
• Impact of acute and chronic hyperglycemia on in-hospital outcomes of patients with acute myocardial infarction.

  Masashi Fujino, Masaharu Ishihara, Satoshi Honda, Shoji Kawakami, Takafumi Yamane, Toshiyuki Nagai, Kazuhiro Nakao, Tomoaki Kanaya, Leon Kumasaka, Yasuhide Asaumi, Tetsuo Arakawa, Yoshio Tahara, Michio Nakanishi, Teruo Noguchi, Kengo Kusano, Toshihisa Anzai, Yoichi Goto, Satoshi Yasuda, Hisao Ogawa

  The American journal of cardiology 114 (12) 1789 - 93 0002-9149 2014/12/15 [Refereed][Not invited]
   

  This study was undertaken to assess the impact of acute hyperglycemia (acute-HG) and chronic hyperglycemia (chronic-HG) on short-term outcomes in patients with acute myocardial infarction (AMI). This study consisted of 696 patients with AMI. Acute-HG was defined as admission plasma glucose ≥200 mg/dl and chronic-HG as hemoglobin A1c ≥6.5%. Acute-HG was associated with higher peak serum creatine kinase (4,094 ± 4,594 vs 2,526 ± 2,227 IU/L, p <0.001) and in-hospital mortality (9.8% vs 1.6%, p <0.001). On the contrary, there was no significant difference in peak creatine kinase (2,803 ± 2,661 vs 2,940 ± 3,181 IU/L, p = 0.59) and mortality (3.3 vs 3.7%, p = 0.79) between patients with chronic-HG and those without. Multivariate analysis showed that admission plasma glucose was an independent predictor of in-hospital mortality (odds ratio 1.15, 95% confidence interval 1.05 to 1.27, p <0.001), but hemoglobin A1c was not. When only patients with acute-HG were analyzed, chronic-HG was associated with a significantly smaller infarct size (3,221 ± 3,001 vs 5,904 ± 6,473 IU/L, p <0.001) and lower in-hospital mortality (5.5 vs 18.9%, p = 0.01). In conclusion, these results suggested that acute-HG, but not chronic-HG, was associated with adverse short-term outcomes after AMI. Paradoxically, in patients with acute-HG, chronic-HG might abate the adverse effects of acute-HG.
• Pathophysiological impact of serum fibroblast growth factor 23 in patients with nonischemic cardiac disease and early chronic kidney disease.

  Miki Imazu, Hiroyuki Takahama, Hiroshi Asanuma, Akira Funada, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Toshihisa Anzai, Masafumi Kitakaze

  American journal of physiology. Heart and circulatory physiology 307 (10) H1504-11 - H1511 0363-6135 2014/11/15 [Refereed][Not invited]
   

  Although the important role of fibroblast growth factor (FGF)23 on cardiac remodeling has been suggested in advanced chronic kidney disease (CKD), little is known about serum (s)FGF23 levels in patients with heart failure (HF) due to nonischemic cardiac disease (NICD) and early CKD. The present study aimed to investigate sFGF23 levels in NICD patients and identify the responsible factors for the elevation of sFGF23 levels. We prospectively measured sFGF23 levels in consecutive hospitalized NICD patients with early CKD (estimated glomerular filtration rate ≥ 40 ml·min(-1)·1.73 m(-2)) and analyzed the data of both echocardiography and right heart catheterization. Of the 156 NICD patients (estimated glomerular filtration rate range: 41-128 ml·min(-1)·1.73 m(-2)), the most severe HF symptom (New York Heart Association class III-IV, 53% vs. 33%, P = 0.015) was found in the above median sFGF23 (39.1 pg/ml) group compared with the below median sFGF23 group. sFGF23 levels were higher in patients with HF hospitalization history compared with those without HF [median: 46.8 (interquartile range: 38.8-62.7) vs. 34.7 (interquartile range: 29.6-42.4) pg/ml, P < 0.0001]. In the multivariate analysis, HF hospitalization was independently related to elevated sFGF23 levels (P = 0.022). Both systolic dysfunction and high plasma aldosterone concentration were identified as predictors of high sFGF23 levels (P < 0.05). Among the neurohormonal parameters, elevated sFGF23 levels were the only factor to predict a declining left ventricular ejection fraction (P = 0.001). These findings suggest that the progression of HF per se contributes to the elevation of sFGF23 levels even in the early stages of CKD, which leads to further myocardial dysfunction, potentially creating a vicious cycle.
• Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years.

  Satoshi Honda, Yasuhide Asaumi, Takafumi Yamane, Toshiyuki Nagai, Tadayoshi Miyagi, Teruo Noguchi, Toshihisa Anzai, Yoichi Goto, Masaharu Ishihara, Kunihiro Nishimura, Hisao Ogawa, Hatsue Ishibashi-Ueda, Satoshi Yasuda

  Journal of the American Heart Association 3 (5) e000984  2047-9980 2014/10/20 [Refereed][Not invited]
   

  BACKGROUND: There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years. METHODS AND RESULTS: The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977-1989, 1990-2000, and 2001-2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977-1989, 3.3%; 1990-2000, 2.8%; 2001-2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977-1989, 90%; 1990-2000, 56%; 2001-2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001). CONCLUSIONS: With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion-induced myocardial hemorrhage is emerging in the current PPCI era.
• Incidence and prognostic significance of myocardial late gadolinium enhancement in patients with sarcoidosis without cardiac manifestation.

  Toshiyuki Nagai, Shun Kohsaka, Shigeo Okuda, Toshihisa Anzai, Koichiro Asano, Keiichi Fukuda

  Chest 146 (4) 1064 - 1072 0012-3692 2014/10 [Refereed][Not invited]
   

  BACKGROUND: Cardiac death is the leading cause of mortality associated with sarcoidosis in Japan. However, the involvement of sarcoidosis infiltration often remains undetected. Recently, late gadolinium enhancement with cardiovascular MRI (LGE-CMR) imaging has been introduced for the detection of myocardial infiltrative disease, as it enables the detection of even minor myocardial damage. We investigated the incidence and prognostic value of LGE-CMR in patients with extracardiac sarcoidosis without cardiac manifestations. METHODS: Sixty-one consecutive patients who met the histologic and clinical criteria for sarcoidosis, and who did not have signs or symptoms of cardiovascular involvement, were prospectively recruited. LGE-CMR was performed at the time of enrollment, and patients were classified into positive or negative late gadolinium enhancement groups based on the findings. The study end point was a composite of all-cause death, symptomatic arrhythmia, and heart failure necessitating admission. RESULTS: Patients were predominantly middle aged (57 ± 15 years) and female (66%), and most had stable disease activity that did not require treatment with immunosuppressants. LGE-CMR detected cardiac involvement in eight patients (13%). Interventricular septal thinning detected by echocardiography was an independent predictor of LGE-CMR-detected cardiac involvement. During the follow-up period of 50 ± 12 months, no significant difference in adverse events was noted between patients in the LGE-CMR-positive and LGE-CMR-negative groups. CONCLUSIONS: LGE-CMR detected cardiac involvement in 13% of patients with sarcoidosis without cardiac manifestation, but both patients with and without LGE had relatively low event rates. TRIAL REGISTRY: Japan Primary Registries Network; No.: UMIN000001549; URL: www.umin.ac.jp.
• Development of a web system to support the management of chronic heart failure patients for use in disaster-stricken areas

  Shoko Tani, Yoshihiro Miyamoto, Toshihisa Anzai, Shigeki Kuwata, Takeshi Kuwahara, Yasuo Sugano, Toshinari Nakao, Kiyokazu Kawakami, Naoko Ueno, Hiroshi Inada, Kazuo Nakazawa

  Transactions of Japanese Society for Medical and Biological Engineering 52 259 - O-260 1347-443X 2014/08/17 [Refereed][Not invited]
   

  The authors aim to address self-management support of chronic heart failure (CHF) patients who are treated in the temporary housings of disaster-stricken areas. We develop a web management system to collect lifestyle information from patients with mild to moderately-severe CHF. Patients can enter information on their lifestyle and medication. They send their information to the web server of the medical institution using a tablet PC. We present the basic health conditions that are essential for patient management of CHF. We then examine the functions required to implement this system. Based on the results of these investigations, we designed an input interface and created a program that the patients can use to manage their prescription medicine, their weight and other items. Our system is expected to increase the ease of information collection, which is an important part of managing patients with CHF. We plan to validate this system in a clinical.
• Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis.

  Takayuki Ise, Takuya Hasegawa, Yoshiaki Morita, Naoaki Yamada, Akira Funada, Hiroyuki Takahama, Makoto Amaki, Hideaki Kanzaki, Hideo Okamura, Shiro Kamakura, Wataru Shimizu, Toshihisa Anzai, Masafumi Kitakaze

  Heart (British Cardiac Society) 100 (15) 1165 - 72 1355-6037 2014/08 [Refereed][Not invited]
   

  BACKGROUND: Gadolinium-enhanced cardiovascular magnetic resonance is an emerging tool for the diagnosis of cardiac sarcoidosis (CS); however, the correlations between extent of late gadolinium enhancement (LGE) and efficacy of steroid therapy and adverse outcomes in patients with CS remain unclear. OBJECTIVE: We aimed to clarify the prognostic impact of extent of LGE in patients with CS. METHODS: Before the start of steroid therapy, 43 consecutive LGE-positive patients with CS were divided into two groups based on the extent of LGE by a median value: small-extent LGE (LGE mass <20% of LV mass; n=21) and large-extent LGE (LGE mass ≥20% of LV mass; n=22). We examined the correlations between extent of LGE and outcomes after steroid therapy. RESULTS: Among the 6 patients who died from heart disorders, 11 patients who were hospitalised because of heart failure and 6 patients who suffered life-threatening arrhythmia during the follow-up period, large-extent LGE predicted higher incidences of cardiac mortality and hospitalisation for heart failure. Multivariate Cox regression analysis showed that large-extent LGE was independently associated with combined adverse outcomes including cardiac death, hospitalisation for heart failure, and life-threatening arrhythmias. In the small-extent LGE group, LV end-diastolic volume index significantly decreased and LVEF significantly increased after steroid therapy, whereas in the large-extent LGE group, neither LV volume nor LVEF changed substantially. CONCLUSIONS: Large-extent LGE correlates with absence of LV functional improvement and high incidence of adverse outcomes in patients with CS after steroid therapy.
• Decreased myocardial dendritic cells is associated with impaired reparative fibrosis and development of cardiac rupture after myocardial infarction in humans.

  Toshiyuki Nagai, Satoshi Honda, Yasuo Sugano, Taka-aki Matsuyama, Keiko Ohta-Ogo, Yasuhide Asaumi, Yoshihiko Ikeda, Kengo Kusano, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Hatsue Ishibashi-Ueda, Toshihisa Anzai

  Journal of the American Heart Association 3 (3) e000839  2047-9980 2014/06/03 [Refereed][Not invited]
   

  BACKGROUND: Dendritic cells (DC) play pivotal roles in regulating the immune system and inflammatory response. We previously reported DC infiltration in the infarcted heart and its immunoprotective roles in the post-infarction healing process after experimental myocardial infarction (MI). However, its clinical significance has not been determined. METHODS AND RESULTS: The degree of DC infiltration and its correlation with the post-infarction healing process in the human infarcted heart were investigated in 24 autopsy subjects after ST-elevation MI. Patients were divided into two groups according to the presence (n=13) or absence (n=11) of cardiac rupture. The numbers of infiltrated DC and macrophages and the extent of fibrosis in the infarcted area were examined. In the rupture group, CD68(+) macrophage infiltration was increased and CD209(+) DC, and CD11c(+) DC infiltration and the extent of reparative fibrosis were decreased compared with the non-rupture group, under matched baseline characteristics including the time from onset to death and use of revascularization. Furthermore, there was a significant positive correlation between the number of infiltrating CD209(+) DC, and CD11c(+) DC and the extent of reparative fibrosis. CONCLUSIONS: Decreased number of DC in human-infarcted myocardial tissue was associated with increased macrophage infiltration, impaired reparative fibrosis, and the development of cardiac rupture after MI. These findings suggest a protective role of DC in post-MI inflammation and the subsequent healing process.
• Hemoglobin A1c predicts heart failure hospitalization independent of baseline cardiac function or B-type natriuretic peptide level.

  Ichiro Kishimoto, Hisashi Makino, Yoko Ohata, Tamiko Tamanaha, Mayu Tochiya, Akiko Kada, Masaharu Ishihara, Toshihisa Anzai, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa

  Diabetes research and clinical practice 104 (2) 257 - 65 0168-8227 2014/05 [Refereed][Not invited]
   

  AIMS: Diabetes is a major risk factor for heart failure (HF). We examined whether baseline HbA1c level predicts HF incidence independent of other HF risk factors, including baseline cardiac structural and functional abnormalities. METHODS: In patients with type 2 diabetes, multivariable Cox regression models were constructed to examine the independent association between baseline HbA1c and future HF hospitalization. RESULTS: In 608 subjects (mean age, 66.5 years; men, 68%; mean HbA1c, 9.1% (76 mmol/mol)), 92 were hospitalized for HF during a median follow-up of 6 years. For a 1% (11 mmol/mol) increase in baseline HbA1c, the hazard ratio for HF was 1.23 (95% confidence interval, 1.1-1.7, p<0.001) with adjustment for age, sex, body mass index, blood pressure and plasma B-type natriuretic peptide (BNP) level. The effect of HbA1c on HF was independent of baseline left ventricular (LV) ejection fraction, the ratio of peak early to late diastolic filling velocity, and prevalent/incident coronary heart disease (CHD), and was more evident in patients with enlarged LV, decreased systolic function, prevalent CHD, or prevalent HF. CONCLUSION: In patients with type 2 diabetes, HbA1c significantly predicts future HF hospitalization independent of baseline BNP level or echocardiographic parameters.
• Electrocardiographic predictors of response to cardiac resynchronization therapy in patients with intraventricular conduction delay.

  Yoichi Takaya, Takashi Noda, Ikutaro Nakajima, Yuko Yamada, Koji Miyamoto, Hideo Okamura, Kazuhiro Satomi, Takeshi Aiba, Kengo F Kusano, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu

  Circulation journal : official journal of the Japanese Circulation Society 78 (1) 71 - 7 1346-9843 2014 [Refereed][Not invited]
   

  BACKGROUND: Little is known about predictors of response to cardiac resynchronization therapy (CRT) in patients with intraventricular conduction delay (IVCD). The purpose of this study was to investigate the benefits of CRT and significant variables on surface electrocardiogram (ECG) to predict response to CRT in those patients. METHODS AND RESULTS: Among the cohort of 152 CRT patients, 40 patients with IVCD were evaluated. Sixteen patients (40%) were responders. At baseline, responders had a wider QRS duration (158±18 vs. 144±18ms, P=0.02) and a higher frequency of left axis deviation (LADEV; 75% vs. 29%, P=0.004) compared with non-responders. After CRT, greater shortening of QRS duration (ΔQRS; 26±24 vs. 7±24ms, P=0.02), axis shift from LADEV to right axis deviation (RADEV; 69% vs. 13%, P<0.001), and both rightward forces in lead I and anterior forces in V1 (56% vs. 13%, P=0.003) were found more frequently in responders. Multivariable logistic regression analysis showed that LADEV at baseline, or ΔQRS and axis shift from LADEV to RADEV after CRT were independent predictors of response to CRT. CONCLUSIONS: Patients with IVCD may not respond to CRT, but LADEV at baseline and reversal of ventricular activation after CRT on surface ECG could be important to predict response to CRT.
• Admission hyperglycemia is an independent predictor of acute kidney injury in patients with acute myocardial infarction.

  Noriaki Moriyama, Masaharu Ishihara, Teruo Noguchi, Michio Nakanishi, Tetsuo Arakawa, Yasuhide Asaumi, Leon Kumasaka, Tomoaki Kanaya, Tadayoshi Miyagi, Toshiyuki Nagai, Takafumi Yamane, Masashi Fujino, Satoshi Honda, Reiko Fujiwara, Toshihisa Anzai, Kengo Kusano, Yoichi Goto, Satoshi Yasuda, Hisao Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 78 (6) 1475 - 80 1346-9843 2014 [Refereed][Not invited]
   

  BACKGROUND: Acute kidney injury (AKI) and acute hyperglycemia are associated with unfavorable outcomes. The impact of acute hyperglycemia on the development of AKI after acute myocardial infarction (AMI), however, remains unclear. This study was undertaken to assess the relationship between admission glucose and incidence of AKI after AMI. METHODS AND RESULTS: This study consisted of 760 patients with AMI admitted to the National Cerebral and Cardiovascular Center within 48h after symptom onset. Blood sample was obtained on admission and repeated sampling was done at least every 1 or 2 days during the first week. AKI was diagnosed as increase in serum creatinine ≥0.3mg/dl or ≥50% within any 48h. Ninety-six patients (13%) had AKI during hospitalization for AMI, and these patients had higher in-hospital mortality than those without AKI (25% vs. 3%, P<0.001). Patients with AKI had higher plasma glucose (PG) on admission than those without (222±105mg/dl vs. 166±69mg/dl, P<0.001). The incidence of AKI increased as admission PG rose: 7% with PG <120mg/dl; 9% with PG 120-160mg/dl; 11% with PG 160-200mg/dl; and 28% with PG >200mg/dl (P<0.01). On multivariate analysis admission PG was an independent predictor of AKI (odds ratio, 1.10; 95% confidence interval: 1.03-1.18, P=0.02). CONCLUSIONS: Admission hyperglycemia might have contributed to the development of AKI in patients with AMI.
• Massive mobile thrombus in the left ventricle due to Löffler endocarditis complicated with dilated cardiomyopathy.

  Takahiro Nakashima, Akira Funada, Hideaki Kanzaki, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hatsue Ishibashi-Ueda, Masafumi Kitakaze, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 78 (8) 1992 - 4 1346-9843 2014 [Refereed][Not invited]
  
• Electrocardiographic predictors of response to cardiac resynchronization therapy in patients with intraventricular conduction delay.

  Yoichi Takaya, Takashi Noda, Ikutaro Nakajima, Yuko Yamada, Koji Miyamoto, Hideo Okamura, Kazuhiro Satomi, Takeshi Aiba, Kengo F Kusano, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu

  Circulation journal : official journal of the Japanese Circulation Society 78 (1) 71 - 7 1346-9843 2014 [Refereed][Not invited]
   

  BACKGROUND: Little is known about predictors of response to cardiac resynchronization therapy (CRT) in patients with intraventricular conduction delay (IVCD). The purpose of this study was to investigate the benefits of CRT and significant variables on surface electrocardiogram (ECG) to predict response to CRT in those patients. METHODS AND RESULTS: Among the cohort of 152 CRT patients, 40 patients with IVCD were evaluated. Sixteen patients (40%) were responders. At baseline, responders had a wider QRS duration (158±18 vs. 144±18ms, P=0.02) and a higher frequency of left axis deviation (LADEV; 75% vs. 29%, P=0.004) compared with non-responders. After CRT, greater shortening of QRS duration (ΔQRS; 26±24 vs. 7±24ms, P=0.02), axis shift from LADEV to right axis deviation (RADEV; 69% vs. 13%, P<0.001), and both rightward forces in lead I and anterior forces in V1 (56% vs. 13%, P=0.003) were found more frequently in responders. Multivariable logistic regression analysis showed that LADEV at baseline, or ΔQRS and axis shift from LADEV to RADEV after CRT were independent predictors of response to CRT. CONCLUSIONS: Patients with IVCD may not respond to CRT, but LADEV at baseline and reversal of ventricular activation after CRT on surface ECG could be important to predict response to CRT.
• Significance of AT1 receptor independent activation of mineralocorticoid receptor in murine diabetic cardiomyopathy.

  Yuji Nagatomo, Tomomi Meguro, Hiroyuki Ito, Kimi Koide, Toshihisa Anzai, Keiichi Fukuda, Satoshi Ogawa, Tsutomu Yoshikawa

  PloS one 9 (3) e93145  1932-6203 2014 [Refereed][Not invited]
   

  BACKGROUND: Diabetes mellitus (DM) has deleterious influence on cardiac performance independent of coronary artery disease and hypertension. The objective of the present study was to investigate the role of the renin-angiotensin-aldosterone system, especially angiotensin II type 1a receptor (AT1aR) and mineralocorticoid receptor (MR) signaling, in left ventricular (LV) dysfunction induced by diabetes mellitus (DM). METHODS AND RESULTS: DM was induced by intraperitoneal injection of streptozotocin (200 mg/kg BW) in wild-type (WT) or AT1aR knockout (KO) male mice, and they were bred during 6 or 12 weeks. Some KO mice were administered the MR antagonist eplerenone (100 mg/kg body weight). At 6 weeks, LV diastolic function was impaired in WT-DM, but preserved in KO-DM. At that time point MR mRNA expression was upregulated, NADPH oxidase subunit (p47phox) and glutathione peroxidase (GPx1) mRNA expression were upregulated, the staining intensities of LV tissue for 4-hydroxy-2-nonenal was stronger in immunohistochemistry, the number of terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) positive cells was increased, Bcl-2 protein expression was significantly downregulated, and the expression of SERCA2a and phosphorylated phospholamban was depressed in WT-DM, while these changes were not seen in KO-DM. At 12 weeks, however, these changes were also noted in KO-DM. Eplerenone arrested those changes. The plasma aldosterone concentration was elevated in WT-DM but not in KO-DM at 6 weeks. It showed 3.7-fold elevation at 12 weeks even in KO-DM, which suggests "aldosterone breakthrough" phenomenon. However, the aldosterone content in LV tissue was unchanged in KO-DM. CONCLUSIONS: DM induced diastolic dysfunction was observed even in KO at 12 weeks, which was ameliorated by minelarocorticoid receptor antagonist, eplerenone. AT1-independent MR activation in the LV might be responsible for the pathogenesis of diabetic cardiomyopathy.
• Admission hyperglycemia is an independent predictor of acute kidney injury in patients with acute myocardial infarction.

  Noriaki Moriyama, Masaharu Ishihara, Teruo Noguchi, Michio Nakanishi, Tetsuo Arakawa, Yasuhide Asaumi, Leon Kumasaka, Tomoaki Kanaya, Tadayoshi Miyagi, Toshiyuki Nagai, Takafumi Yamane, Masashi Fujino, Satoshi Honda, Reiko Fujiwara, Toshihisa Anzai, Kengo Kusano, Yoichi Goto, Satoshi Yasuda, Hisao Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 78 (6) 1475 - 80 1346-9843 2014 [Refereed][Not invited]
   

  BACKGROUND: Acute kidney injury (AKI) and acute hyperglycemia are associated with unfavorable outcomes. The impact of acute hyperglycemia on the development of AKI after acute myocardial infarction (AMI), however, remains unclear. This study was undertaken to assess the relationship between admission glucose and incidence of AKI after AMI. METHODS AND RESULTS: This study consisted of 760 patients with AMI admitted to the National Cerebral and Cardiovascular Center within 48h after symptom onset. Blood sample was obtained on admission and repeated sampling was done at least every 1 or 2 days during the first week. AKI was diagnosed as increase in serum creatinine ≥0.3mg/dl or ≥50% within any 48h. Ninety-six patients (13%) had AKI during hospitalization for AMI, and these patients had higher in-hospital mortality than those without AKI (25% vs. 3%, P<0.001). Patients with AKI had higher plasma glucose (PG) on admission than those without (222±105mg/dl vs. 166±69mg/dl, P<0.001). The incidence of AKI increased as admission PG rose: 7% with PG <120mg/dl; 9% with PG 120-160mg/dl; 11% with PG 160-200mg/dl; and 28% with PG >200mg/dl (P<0.01). On multivariate analysis admission PG was an independent predictor of AKI (odds ratio, 1.10; 95% confidence interval: 1.03-1.18, P=0.02). CONCLUSIONS: Admission hyperglycemia might have contributed to the development of AKI in patients with AMI.
• Massive mobile thrombus in the left ventricle due to Löffler endocarditis complicated with dilated cardiomyopathy.

  Takahiro Nakashima, Akira Funada, Hideaki Kanzaki, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hatsue Ishibashi-Ueda, Masafumi Kitakaze, Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 78 (8) 1992 - 4 1346-9843 2014 [Refereed][Not invited]
  
• Left circumflex coronary artery is protected against no-reflow phenomenon following percutaneous coronary intervention for coronary artery disease.

  Toshiyuki Nagai, Takuro Hirano, Mayumi Tsunoda, Haruhiko Hosaka, Yoshikazu Kishino, Takaharu Katayama, Keisuke Matsumura, Takashi Miyagawa, Shun Kohsaka, Toshihisa Anzai, Keiichi Fukuda, Masahiro Suzuki

  Heart and vessels 28 (5) 559 - 65 0910-8327 2013/09 [Refereed][Not invited]
   

  Despite the positive impact of percutaneous coronary intervention (PCI) on reducing mortality, a small percentage of patients experience poor myocardial reperfusion following PCI. However, factors associated with no-reflow remain unclear. We investigated clinical factors associated with no-reflow following PCI for coronary artery disease (CAD). We retrospectively analyzed 1622 consecutive CAD patients who underwent PCI over a 5-year period at our institution. Patients were divided into two groups according to the presence (n = 31) or absence (n = 1591) of no-reflow, defined as Thrombolysis in Myocardial Infarction flow grade <3 after PCI. No significant differences in patient characteristics or PCI strategy were seen between the no-reflow and normal flow groups. The incidence of no-reflow was significantly lower in the left circumflex artery (LCx) than in the left anterior descending artery (LAD) (P = 0.0015), with no differences in characteristics or PCI strategy between these two target vessels. Multivariate analysis revealed that involvement of the LCx was an independent protective factor against no-reflow (odds ratio 0.14, 95 % confidence interval 0.02-0.98, P = 0.044). In conclusion, LCx as the target vessel was protective against no-reflow compared with LAD following PCI for CAD. Our results suggest that embolic protection devices may be unnecessary in CAD patients with involvement of LCx.
• Eicosapentaenoic acid suppresses adverse effects of C-reactive protein overexpression on pressure overload-induced cardiac remodeling.

  Toshiyuki Nagai, Toshihisa Anzai, Yoshinori Mano, Hidehiro Kaneko, Atsushi Anzai, Yasuo Sugano, Yuichiro Maekawa, Toshiyuki Takahashi, Tsutomu Yoshikawa, Keiichi Fukuda

  Heart and vessels 28 (3) 404 - 11 0910-8327 2013/05 [Refereed][Not invited]
   

  Serum C-reactive protein (CRP) elevation is associated with poor clinical outcome in patients with heart failure (HF). We previously reported that CRP exacerbates the development of pressure overload-induced cardiac remodeling through an enhanced inflammatory response and oxidative stress. In the present study, we examined the effect of eicosapentaenoic acid (EPA), a suppressor of inflammatory response and oxidative stress, on pressure overload-induced cardiac remodeling. Transverse aortic constriction (TAC) was performed on transgenic mice overexpressing CRP (CRPtg) and nontransgenic littermates (TAC/CON). CRPtg with TAC operation were randomly assigned to be fed a standard diet (TAC/CRPtg) or an EPA-enriched diet (7 % of total energy) (TAC/CRPtg/EPA). Myocardial mRNA level of transforming growth factor-β1, proinflammatory cytokines, and oxidative stress markers were increased in TAC/CRPtg in comparison with TAC/CON 1 and 4 weeks after the operation. These parameters were significantly suppressed in TAC/CRPtg/EPA compared with TAC/CRPtg. In addition, after 4 weeks of EPA treatment, as compared with TAC/CRPtg, TAC/CRPtg/EPA mice demonstrated reduced heart and lung weights, increased left ventricular fractional shortening, and decreased left ventricular end-diastolic pressure, together with decreased cardiac hypertrophy, fibrosis, and improved cardiac function. In conclusion, the anti-inflammatory and antioxidative properties of EPA may make it an effective therapeutic strategy for adverse cardiac remodeling associated with CRP overexpression.
• Post-infarction inflammation and left ventricular remodeling: a double-edged sword.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 77 (3) 580 - 7 1346-9843 2013 [Refereed][Not invited]
   

  After myocardial infarction (MI), inflammatory cells such as neutrophils, followed by monocytes and macrophages, infiltrate and phagocytose the necrotic tissues, as well as secreting a variety of inflammatory cytokines. The vulnerable myocardium, which consists of necrotic tissue and inflammatory cells, is susceptible to wall stress, resulting in infarct expansion. Subacute cardiac rupture is an extreme form of infarct expansion, whereas ventricular aneurysm is its chronic form and a trigger for subsequent left ventricular (LV) remodeling. Although post-infarction inflammation is essential for the healing process, excessive inflammation could play an important role in the development of LV remodeling. Increase in the C-reactive protein level, which reflects myocardial inflammation, is reported to be a useful predictive marker for cardiac rupture, ventricular aneurysm and LV remodeling. In addition, an increase in peripheral monocyte count is associated with a poor outcome after MI, and an animal study has demonstrated that granulocyte/macrophage-colony stimulating factor induction causes excessive macrophage infiltration in the infarcted area and worsening of LV remodeling. Recently, it was also found that dendritic cells play an important role in controlling excessive inflammation caused by monocytes/macrophages. Thus, inflammation that develops after MI is a double-edged sword, and how to control inflammation to suppress pathological remodeling is an important issue to be considered in developing new treatment for heart failure.
• Extent of heart rate reduction during hospitalization using beta-blockers, not the achieved heart rate itself at discharge, predicts the clinical outcome in patients with acute heart failure syndromes.

  Hiroyuki Takahama, Hiroyuki Yokoyama, Akiko Kada, Kenichi Sekiguchi, Masashi Fujino, Akira Funada, Makoto Amaki, Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Toshihisa Anzai, Masafumi Kitakaze

  Journal of cardiology 61 (1) 58 - 64 0914-5087 2013/01 [Refereed][Not invited]
   

  AIM: It has been uncertain whether patients with acute heart failure syndromes (AHFSs) benefit from a lower heart rate (HR) itself or from treatment for heart failure (HF) that reduces sympathetic tone with consequent HR reduction (HRR). The present study investigated the influence of HRR during hospitalization on the prognosis of AHFS patients. METHODS AND RESULTS: In 421 AHFS patients, we analyzed the relationship between HRR during hospitalization and the prognosis after discharge. During a mean follow-up period of 1.9 years, 76 and 55 patients died or were re-hospitalized for HF, respectively. Although HR at discharge did not influence cardiac events (hazard ratio [HR]: 1.00 [95% CI; 0.99-1.02], p=0.22), the extent of HRR was a predictor of cardiac events (HR: 0.89 [0.84-0.96], p<0.001). Kaplan-Meier analysis revealed that the cardiac event rate of the HRR-positive group (≥ 27 bpm reduction of HR from 114 ± 24 at admission to 65 ± 11 bpm at discharge) was significantly lower than that of the HRR-negative group (≤ 26 bpm (=median value) reduction of HR from 74 ± 14 to 71 ± 14 bpm). In the HRR-positive group, the cardiac event rate was significantly lower in patients receiving beta-blockers. Furthermore, the extent of HR change was an important predictor of cardiac events among other markers, compared with the change in systolic blood pressure or B-type natriuretic peptide. CONCLUSION: The HR itself at discharge was not associated with the prognosis, but the extent of HRR achieved by treatment of HF with beta-blockers was a strong predictor for the clinical outcome in AHFS patients.
• Post-infarction inflammation and left ventricular remodeling: a double-edged sword.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 77 (3) 580 - 7 1346-9843 2013 [Refereed][Not invited]
   

  After myocardial infarction (MI), inflammatory cells such as neutrophils, followed by monocytes and macrophages, infiltrate and phagocytose the necrotic tissues, as well as secreting a variety of inflammatory cytokines. The vulnerable myocardium, which consists of necrotic tissue and inflammatory cells, is susceptible to wall stress, resulting in infarct expansion. Subacute cardiac rupture is an extreme form of infarct expansion, whereas ventricular aneurysm is its chronic form and a trigger for subsequent left ventricular (LV) remodeling. Although post-infarction inflammation is essential for the healing process, excessive inflammation could play an important role in the development of LV remodeling. Increase in the C-reactive protein level, which reflects myocardial inflammation, is reported to be a useful predictive marker for cardiac rupture, ventricular aneurysm and LV remodeling. In addition, an increase in peripheral monocyte count is associated with a poor outcome after MI, and an animal study has demonstrated that granulocyte/macrophage-colony stimulating factor induction causes excessive macrophage infiltration in the infarcted area and worsening of LV remodeling. Recently, it was also found that dendritic cells play an important role in controlling excessive inflammation caused by monocytes/macrophages. Thus, inflammation that develops after MI is a double-edged sword, and how to control inflammation to suppress pathological remodeling is an important issue to be considered in developing new treatment for heart failure.
• Titration of β-blockers for patients with heart failure.

  Toshihisa Anzai

  Circulation journal : official journal of the Japanese Circulation Society 77 (4) 902 - 3 1346-9843 2013 [Refereed][Not invited]
  
• A successful case of percutaneous transluminal septal myocardial ablation for mitral regurgitation that emerged following mitral valve repair surgery.

  Tomohiro Hayashi, Makoto Amaki, Hideaki Kanzaki, Akira Funada, Yasuo Sugano, Takahiro Ohara, Hiroyuki Takahama, Takuya Hasegawa, Masafumi Kitakaze, Toshihisa Anzai

  Internal medicine (Tokyo, Japan) 52 (24) 2765 - 9 0918-2918 2013 [Refereed][Not invited]
   

  A 70-year-old man complaining of exertional dyspnea was referred to our hospital for recurrence of mitral regurgitation (MR) after mitral valve repair. Echocardiography revealed the presence of a bulging subaortic septum with flow acceleration in the left ventricular outflow tract (LVOT) and systolic anterior motion of the mitral valve with moderate MR, consistent with LVOT obstruction. Since medical therapy was not sufficiently effective, we performed percutaneous transluminal septal myocardial ablation (PTSMA). After the procedure, the MR resolved, with a reduced LVOT pressure gradient. The patient's symptoms improved. PTSMA was effective for the treatment of MR that emerged after mitral valve repair.
• Eosinophilia associated with dobutamine allergy causes eosinophilic endomyocarditis confirmed by serial endomyocardial biopsies.

  Moritoshi Funasako, Akira Funada, Hideaki Kanzaki, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Toshihisa Anzai, Masafumi Kitakaze

  Journal of cardiology cases 6 (6) e179-e182 - e182 2012/12 [Refereed][Not invited]
   

  We report a case of eosinophilic endomyocarditis caused by eosinophilia due to dobutamine allergy and successfully treated by a short-term and medium-dose steroid administration. Serial endomyocardial biopsies were useful for early diagnosis and evaluation of the effect of the treatment. Eosinophilic endomyocarditis due to dobutamine allergy is a rare entity; however, because of the high utilization rate of dobutamine in patients with low output heart failure, it is important to recognize that additional deterioration of cardiac function caused by eosinophilic endomyocarditis makes prognosis poor and early intervention is necessary. .
• High-mobility group box 1 protein blockade suppresses development of abdominal aortic aneurysm.

  Takashi Kohno, Toshihisa Anzai, Hidehiro Kaneko, Yasuo Sugano, Hideyuki Shimizu, Masayuki Shimoda, Taku Miyasho, Minoru Okamoto, Hiroshi Yokota, Shingo Yamada, Tsutomu Yoshikawa, Yasunori Okada, Ryohei Yozu, Satoshi Ogawa, Keiichi Fukuda

  Journal of cardiology 59 (3) 299 - 306 0914-5087 2012/05 [Refereed][Not invited]
   

  BACKGROUND: Abdominal aortic aneurysm (AAA) expansion is characterized by chronic inflammatory cell infiltration and extracellular matrix degradation. High-mobility group box 1 protein (HMGB1) is one of the damage-associated molecular pattern molecules derived from injured/necrotic and activated inflammatory cells. We investigated the expression of HMGB1 in human AAA and mouse experimental AAA. Then, we evaluated the effect of HMGB1 blockade on AAA formation in the mouse model. METHODS AND RESULTS: Human AAA samples showed increased HMGB1 expression compared with normal aortic wall. In a mouse CaCl(2)-induced AAA model, the expression of HMGB1 was increased compared with that in sham, and was positively correlated with matrix metalloproteinase (MMP)-2 and MMP-9 activity. We administered neutralizing anti-HMGB1 antibody (AAA/anti-H) or control antibody (AAA/C) to AAA mice subcutaneously every 3 days for 6 weeks. Treatment with neutralizing anti-HMGB1 antibody suppressed AAA formation, and attenuated elastin fragmentation. HMGB1 blockade markedly reduced the number of macrophages and MMP-2 and MMP-9 activity in aneurysmal tissue. The mRNA level of tumor necrosis factor-α and CD68 in the aorta was reduced in AAA/anti-H compared with AAA/C. CONCLUSIONS: Elevation of HMGB1 level in aneurysmal tissue was observed in human AAA and mouse experimental AAA. HMGB1 blockade in a mouse AAA model reduced AAA progression, in association with reduced infiltration of macrophages and MMPs activity. These findings suggest a significant role for HMGB1 in the pathogenesis of AAA.
• Effect of preoperative evaluation by multidetector computed tomography in percutaneous coronary interventions of chronic total occlusions.

  Koji Ueno, Akio Kawamura, Takeshi Onizuka, Takashi Kawakami, Yuji Nagatomo, Kentaro Hayashida, Shinsuke Yuasa, Yuichiro Maekawa, Toshihisa Anzai, Masahiro Jinzaki, Sachio Kuribayashi, Satoshi Ogawa

  International journal of cardiology 156 (1) 76 - 9 0167-5273 2012/04/05 [Refereed][Not invited]
   

  BACKGROUND: The prevalence of success of percutaneous coronary interventions (PCIs) of chronic total occlusions (CTOs) remains relatively low. We determined the effect of preoperative multidetector computed tomography coronary angiography (CTCA) in PCIs of CTOs. METHODS: The study population was 100 consecutive patients who underwent PCIs of CTOs from January 2005 to December 2007 at Keio University School of Medicine. They were divided into two groups according to the absence (non-CT group, n=60) or presence (CT group, n=40) of preoperative CTCA. The effect of preoperative CTCA was assessed in the prevalence of success of the procedure, prevalence of complications, irradiation time, and the dose of contrast agents. RESULTS: The prevalence of procedural success was similar in both groups (non-CT group vs CT group 80.0% vs 77.5%, p=0.76). Irradiation time and the dose of contrast agents were also similar between these groups. The prevalence of complications was significantly reduced in the CT group (23.3% vs 7.5%, p=0.039), especially coronary perforations, which required treatment only in the non-CT group (10.0% vs 0.0%, p=0.039). Multiple logistic regression analysis revealed that use of a rotablator (odds ratio [OR]: 4.40, 95% confidence interval [CI]: 1.19-16.27, p=0.027) and absence of preoperative CTCA (OR: 4.26, 95% CI: 1.04-17.49, p=0.044) were independent determinants of complications. CONCLUSION: Preoperative CTCA does not affect the prevalence of procedural success, irradiation time and the dose of contrast agents, but may be useful to reduce the prevalence of complications during PCIs of CTOs.
• Regulatory role of dendritic cells in postinfarction healing and left ventricular remodeling.

  Atsushi Anzai, Toshihisa Anzai, Shigenori Nagai, Yuichiro Maekawa, Kotaro Naito, Hidehiro Kaneko, Yasuo Sugano, Toshiyuki Takahashi, Hitoshi Abe, Satsuki Mochizuki, Motoaki Sano, Tsutomu Yoshikawa, Yasunori Okada, Shigeo Koyasu, Satoshi Ogawa, Keiichi Fukuda

  Circulation 125 (10) 1234 - 45 0009-7322 2012/03/13 [Refereed][Not invited]
   

  BACKGROUND: Inflammation and immune responses are integral components in the healing process after myocardial infarction. We previously reported dendritic cell (DC) infiltration in the infarcted heart; however, the precise contribution of DC in postinfarction healing is unclear. METHODS AND RESULTS: Bone marrow cells from CD11c-diphtheria toxin receptor/green fluorescent protein transgenic mice were transplanted into lethally irradiated wild-type recipient mice. After reconstitution of bone marrow-derived cells, the recipient mice were treated with either diphtheria toxin (DC ablation) or vehicle (control), and myocardial infarction was created by left coronary ligation. CD11c(+) green fluorescent protein-positive DCs expressing CD11b and major histocompatibility complex class II were recruited into the heart, peaking on day 7 after myocardial infarction in the control group. Mice with DC ablation for 7 days showed deteriorated left ventricular function and remodeling. The DC-ablated group demonstrated enhanced and sustained expression of inflammatory cytokines such as interleukin-1β, interleukin-18, and tumor necrosis factor-α, prolonged extracellular matrix degradation associated with a high level of matrix metalloproteinase-9 activity, and diminished expression level of interleukin-10 and endothelial cell proliferation after myocardial infarction compared with the control group. In vivo analyses revealed that DC-ablated infarcts had enhanced monocyte/macrophage recruitment. Among these cells, marked infiltration of proinflammatory Ly6C(high) monocytes and F4/80(+) CD206(-) M1 macrophages and, conversely, impaired recruitment of anti-inflammatory Ly6C(low) monocytes and F4/80(+) CD206(+) M2 macrophages in the infarcted myocardium were identified in the DC-ablated group compared with the control group. CONCLUSIONS: These results suggest that the DC is a potent immunoprotective regulator during the postinfarction healing process via its control of monocyte/macrophage homeostasis.
• Low incidence of catheter-related complications in patients with advanced pulmonary arterial hypertension undergoing continuous epoprostenol infusion.

  Toshiyuki Nagai, Shun Kohsaka, Toshihisa Anzai, Tsutomu Yoshikawa, Keiichi Fukuda, Toru Sato

  Chest 141 (1) 272 - 273 0012-3692 2012/01 [Refereed][Not invited]
  
• Significance of electrocardiographic right ventricular hypertrophy in patients with pulmonary hypertension with or without right ventricular systolic dysfunction.

  Toshiyuki Nagai, Shun Kohsaka, Mitsushige Murata, Shigeo Okuda, Toshihisa Anzai, Keiichi Fukuda, Toru Satoh

  Internal medicine (Tokyo, Japan) 51 (17) 2277 - 83 0918-2918 2012 [Refereed][Not invited]
   

  OBJECTIVE: We sought to determine the value of electrocardiographic right ventricular hypertrophy (ECG-RVH) in pulmonary hypertension (PH) patients with right ventricular systolic dysfunction defined by cardiac magnetic resonance (CMR-RVSD). PATIENTS: A total of 31 consecutive patients with PH with a mean pulmonary arterial pressure of >25 mmHg underwent both ECG and CMR studies. Patients were divided into 2 groups according to the presence of RVSD, defined as a RV ejection fraction <35%. Logistic regression modeling was performed to define the association between ECG-RVH and CMR-RVSD. RESULTS: About half of the patients had RVSD (n=15 ; 48%). The R to S wave ratio (p=0.01) or incidence of qR pattern (p=0.002) in lead V(1) was significantly greater in patients with PH complicated by RVSD than in those without RVSD. These 2 patterns were significant predictors of RVSD [odds ratio (OR), 19.3 for qR; OR, 14.0 for R/S>1] and when each of these ECG findings was assigned with a point proportional to OR (score of 2 for qR in lead V(1) and score of 1 for R/S>1 in lead V(1)), the incidence of RVSD increased by the total ECG score. CONCLUSION: The combination of ECG-RVH findings, especially in lead V(1), predicts the presence of RVSD defined by CMR. ECG might be a useful tool for estimating the presence of RVSD in patients with PH.
• Dendritic Cell is an Immunoprotective Regulator in Post-Infarction Healing and Left Ventricular Remodeling

  Atsushi Anzai, Toshihisa Anzai, Shigenori Nagai, Yuichiro Maekawa, Motoaki Sano, Tsutomu Yoshikawa, Shigeo Koyasu, Satoshi Ogawa, Keiichi Fukuda

  CIRCULATION 124 (21) 0009-7322 2011/11 [Refereed][Not invited]
  
• [Ivabradine (pure heart-rate-lowering agent)].

  Toshihisa Anzai

  Nihon rinsho. Japanese journal of clinical medicine 69 Suppl 9 412 - 6 0047-1852 2011/11 [Refereed][Not invited]
  
• Tumor necrosis factor-α converting enzyme is a key mediator of abdominal aortic aneurysm development.

  Hidehiro Kaneko, Toshihisa Anzai, Keisuke Horiuchi, Takashi Kohno, Toshiyuki Nagai, Atsushi Anzai, Toshiyuki Takahashi, Aya Sasaki, Masayuki Shimoda, Yuichiro Maekawa, Hideyuki Shimizu, Tsutomu Yoshikawa, Yasunori Okada, Ryohei Yozu, Keiichi Fukuda

  Atherosclerosis 218 (2) 470 - 8 0021-9150 2011/10 [Refereed][Not invited]
   

  OBJECTIVE: Tumor necrosis factor (TNF)-α is known to be elevated in plasma and the aorta in abdominal aortic aneurysm (AAA) patients. We sought to clarify the role of TNF-α converting enzyme (Tace), which cleaves the transmembrane precursor of TNF-α, in AAA development. METHODS: We obtained aortic sample of AAA during surgical operation to assess the histological features and protein expression of human AAA. AAA was induced in mice with temporal systemic deletion of Tace by the inducible Mx-1 Cre transgene (TaceMx1) and in wild-type littermates (CON) by periaortic application of CaCl(2) (AAA/TaceMx1, AAA/CON). RESULTS: Tace expression was increased in human AAA samples as compared with normal aorta. Six weeks postoperatively, aortic diameter in AAA/TaceMx1 was decreased than in AAA/CON in association with attenuated TNF-α expression and extracellular matrix disruption. Increased activities of matrix metalloproteinase (MMP)-9 and MMP-2, numbers of Mac-2-positive macrophages, CD3-positive T lymphocytes and CD31-positive vessels in periaortic tissues, mRNA expression of CD68, monocyte chemotactic protein-1, TNF-α, vascular endothelial growth factor-A, p47 and glutathione peroxidases, and protein expression of phospho-c-Jun N-terminal kinase in AAA were all attenuated by Tace deletion. Protein expression of transforming growth factor (TGF)-β1 was upregulated by Tace deletion in sham-operated mice. TGF-β1 expression was further increased in AAA/TaceMx1. CONCLUSIONS: Tace was overexpressed in the aortic wall in human and experimental AAA. Temporal systemic deletion of Tace prevented AAA development in association with attenuating inflammation, oxidative stress, neoangiogenesis and extracellular matrix disruption, suggesting a crucial role of Tace in AAA development.
• [Beta-blocker].

  Toshihisa Anzai

  Nihon rinsho. Japanese journal of clinical medicine 69 Suppl 7 445 - 9 0047-1852 2011/09 [Refereed][Not invited]
  
• Human C-reactive protein exacerbates metabolic disorders in association with adipose tissue remodelling.

  Hidehiro Kaneko, Toshihisa Anzai, Toshiyuki Nagai, Atsushi Anzai, Toshiyuki Takahashi, Yoshinori Mano, Kohkichi Morimoto, Yuichiro Maekawa, Hiroshi Itoh, Tsutomu Yoshikawa, Satoshi Ogawa, Keiichi Fukuda

  Cardiovascular research 91 (3) 546 - 55 0008-6363 2011/08/01 [Refereed][Not invited]
   

  AIMS: C-reactive protein (CRP) expression is increased with metabolic alterations. We sought to clarify the effect of CRP on the development of obesity-induced metabolic disorders using human CRP-overexpressing transgenic mice (CRPTG). METHODS AND RESULTS: CRPTG and their non-transgenic littermates (CON) were fed a standard diet (STD) or a high-fat diet (HFD) from 6 weeks of age. Oral glucose tolerance and intraperitoneal insulin tolerance tests 12 weeks after starting the diets showed deterioration of glucose tolerance and insulin sensitivity in HFD/CRPTG compared with HFD/CON. Hepatocellular ballooning, oil droplets, and peri-sinusoidal fibrosis were more prominent in HFD/CRPTG than in HFD/CON. In HFD/CRPTG, hepatic triglyceride content was higher and serum adiponectin levels lower than in HFD/CON. Epididymal adipose tissue mRNA expression of mucin-like, hormone receptor-like 1, monocyte chemotactic protein-1, and tumour necrosis factor-α in HFD/CRPTG was up-regulated compared with that in HFD/CON. Immunohistochemical staining of epididymal adipose tissue showed that the number of Mac-3(+) macrophages was higher in HFD/CRPTG than in HFD/CON. CONCLUSION: Human CRP overexpression facilitated the development of insulin resistance and hepatosteatosis with HFD in association with adiponectin down-regulation and enhancement of macrophage infiltration and expression of pro-inflammatory cytokines in epididymal adipose tissue, suggesting its pathogenic role in the development of obesity-induced metabolic disorders.
• Resveratrol prevents the development of abdominal aortic aneurysm through attenuation of inflammation, oxidative stress, and neovascularization.

  Hidehiro Kaneko, Toshihisa Anzai, Maho Morisawa, Takashi Kohno, Toshiyuki Nagai, Atsushi Anzai, Toshiyuki Takahashi, Masayuki Shimoda, Aya Sasaki, Yuichiro Maekawa, Koichi Yoshimura, Hiroki Aoki, Kazuo Tsubota, Tsutomu Yoshikawa, Yasunori Okada, Satoshi Ogawa, Keiichi Fukuda

  Atherosclerosis 217 (2) 350 - 7 0021-9150 2011/08 [Refereed][Not invited]
   

  OBJECTIVE: We sought to examine the effect of resveratrol (3,4',5-trihydroxy-trans-stilbene), a plant-derived polyphenolic compound, on the development of abdominal aortic aneurysm (AAA). METHODS: AAA was induced in mice by periaortic application of CaCl(2). NaCl (0.9%)-applied mice were used as a sham group. Mice were treated with intraperitoneal injection of PBS (Sham/CON, AAA/CON, n=30 for each) or resveratrol (100 mg/kg/day) (AAA/RSVT, n=30). Six weeks after the operation, aortic tissue was excised for further examinations. RESULTS: Aortic diameter was enlarged in AAA/CON compared with Sham/CON. Resveratrol treatment reduced the aneurysm size and inflammatory cell infiltration in the aortic wall compared with AAA/CON. Elastica Van Gieson staining showed destruction of the wavy morphology of the elastic lamellae in AAA/CON, while it was preserved in AAA/RSVT. The increased mRNA expression of monocyte chemotactic protein-1, tumor necrosis factor-α, intercellular adhesion molecule-1, CD68, vascular endothelial growth factor-A, p47, glutathione peroxidase (GPX)1 and GPX3 were attenuated by resveratrol treatment (all p<0.05). Administration of resveratrol decreased protein expression of phospho-p65 in AAA. The increased 8-hydroxy-2'-deoxyguanosine-positive cell count and 4-hydroxy-2-nonenal-positive cell count in AAA were also reduced by resveratrol treatment. Zymographic activity of matrix metalloproteinase (MMP)-9 and MMP-2 was lower in AAA/RSVT compared with AAA/CON (both p<0.05). Compared with AAA/CON, Mac-2(+) macrophages and CD31(+) vessels in the aortic wall were decreased in AAA/RSVT (both p<0.05). CONCLUSION: Treatment with resveratrol in mice prevented the development of CaCl(2)-induced AAA, in association with reduced inflammation, oxidative stress, neoangiogenesis, and extracellular matrix disruption. These findings suggest therapeutic potential of resveratrol for AAA.
• Role of vascular endothelial growth factor-A in development of abdominal aortic aneurysm.

  Hidehiro Kaneko, Toshihisa Anzai, Toshiyuki Takahashi, Takashi Kohno, Masayuki Shimoda, Aya Sasaki, Hideyuki Shimizu, Toshiyuki Nagai, Yuichiro Maekawa, Koichi Yoshimura, Hiroki Aoki, Tsutomu Yoshikawa, Yasunori Okada, Ryohei Yozu, Satoshi Ogawa, Keiichi Fukuda

  Cardiovascular research 91 (2) 358 - 67 0008-6363 2011/07/15 [Refereed][Not invited]
   

  AIMS: Increased angiogenesis, chronic inflammation, and extracellular matrix degradation are the major pathological features of abdominal aortic aneurysm (AAA). We sought to elucidate the role of vascular endothelial growth factor (VEGF)-A, a potent angiogenic and proinflammatory factor, in the development of AAA. METHODS AND RESULTS: Human AAA samples showed increased VEGF-A expression, neovascularization, and macrophage infiltration compared with normal aortic walls. AAA was induced in mice by periaortic application of CaCl(2). AAA mice were treated with soluble VEGF-A receptor (sFlt)-1 or phosphate-buffered saline and sacrificed 6 weeks after the operation. Treatment with sFlt-1 resulted in reduced aneurysm size, restored wavy structure of the elastic lamellae, reduced Mac-2(+) monocytes/macrophages, CD3(+) T-lymphocytes, and CD31(+) vessels, and attenuated matrix metalloproteinase (MMP)-2 and 9 activity in periaortic tissue of AAA. Increased aortic mRNA expression of monocyte chemotactic protein-1, tumour necrosis factor-α, and intercellular adhesion molecule-1 in AAA was attenuated by sFlt-1 treatment. CONCLUSION: VEGF-A was overexpressed in the aortic wall of human and experimental AAA. Treatment with sFlt-1 inhibited AAA development in mice, in association with reduced neoangiogenesis, infiltration of inflammatory cells, MMP activity, and extracellular matrix degradation. These findings suggest a crucial role of VEGF-A in the development of AAA.
• Impact of serum high-mobility group box 1 protein elevation on oxygenation impairment after thoracic aortic aneurysm repair.

  Takashi Kohno, Toshihisa Anzai, Hideyuki Shimizu, Hidehiro Kaneko, Yasuo Sugano, Shingo Yamada, Tsutomu Yoshikawa, Akitoshi Ishizaka, Ryohei Yozu, Satoshi Ogawa

  Heart and vessels 26 (3) 306 - 12 0910-8327 2011/05 [Refereed][Not invited]
   

  High-mobility group box 1 protein (HMGB1) is a late mediator of inflammatory responses that can cause acute lung injury. We examined the significance of serum HMGB1 elevation in the development of systemic inflammatory response syndrome (SIRS) and lung oxygenation impairment (LOI) after thoracic aortic aneurysm (TAA) repair. Serial measurements of the serum HMGB1 level and SIRS score for 7 days after surgery were determined in 20 patients with TAA who underwent surgical repair. Arterial oxygen tension was measured serially for at least 4 days after surgery, and LOI was defined as the lowest PaO(2)/FiO(2) ratio ≤ 200 mmHg. The serum HMGB1 level was markedly increased after surgery, peaking on day 2, and remained significantly elevated on day 7. Peak HMGB1 level positively correlated with SIRS duration and the cumulative SIRS score during postoperative days 1-7 (P = 0.0013 and P = 0.0004, respectively). Peak HMGB1 level and cumulative SIRS score were higher in patients with LOI than in those without (P = 0.01 and P = 0.044, respectively). Peak HMGB1 level was negatively correlated with the lowest PaO(2)/FiO(2) ratio (P = 0.0077) and positively correlated with postoperative length of hospitalization (P = 0.042). A greater serum HMGB1 elevation after TAA repair was associated with more severe SIRS and a higher incidence of LOI. HMGB1 might play a key role in the pathogenesis of SIRS and LOI after surgical TAA repair.
• Can intravascular ultrasound guidance modify the efficacy of drug-eluting stent over bare-metal stent in an aorto-ostial lesion?

  Teruo Okabe, Akio Kawamura, Yuichiro Maekawa, Toshihisa Anzai, Shiro Iwanaga, Tsutomu Yoshikawa, Satoshi Ogawa

  Cardiovascular Revascularization Medicine 12 (2) 105 - 110 1553-8389 2011/03 [Refereed][Not invited]
   

  Purpose: We compared the efficacy of drug-eluting stents (DESs) versus bare-metal stents (BMSs) in de novo and native aorto-ostial lesions (AOLs) guided by intravascular ultrasound (IVUS). Method: Thirty-eight patients underwent DES implantation for 38 AOLs 35 with sirolimus-eluting stents, and three with paclitaxel-eluting stents (DES group). The control group was composed of 40 AOLs treated by BMS. The incidence of the primary composite end point of all-cause mortality, Q-wave myocardial infarction and target vessel revascularization (TVR) as TVR-major adverse cardiac event (TVR-MACE) was evaluated during a 1-year follow-up. Clinical and IVUS parameters were compared between the DES and BMS groups, and Cox hazards model was used to calculate hazard ratios of several factors for the 1-year TVR-MACE. Results: Although the vessel, plaque, and stent volumes were significantly larger after the procedures in the DES group owing to longer lesions (18.3±5.1 vs. 13.2±5.9 mm, P< 001), the stent volume index (10.8±2.6 vs. 12.4±3.3, P=024) was much smaller than that in the BMS group. During the 1-year follow-up, there were 13 TVR-MACEs in all patients (13% in DES vs. 20% in BMS, P=4 by Kaplan-Meier analysis). The Cox hazards model did not indicate any specific unfavorable factor for the 1-year TVR-MACE. Conclusions: The present study showed equality between DES and BMS on de novo and native AOLs about the 1-year TVR-MACE rate, even though a DES was used in longer and bulkier lesions as compared to BMS. © 2011 Elsevier Inc.
• C-reactive protein overexpression exacerbates pressure overload-induced cardiac remodeling through enhanced inflammatory response.

  Toshiyuki Nagai, Toshihisa Anzai, Hidehiro Kaneko, Yoshinori Mano, Atsushi Anzai, Yuichiro Maekawa, Toshiyuki Takahashi, Tomomi Meguro, Tsutomu Yoshikawa, Keiichi Fukuda

  Hypertension (Dallas, Tex. : 1979) 57 (2) 208 - 15 0194-911X 2011/02 [Refereed][Not invited]
   

  Serum C-reactive protein (CRP) elevation predicts the development of heart failure in patients with hypertension. CRP activates macrophages and enhances oxidative stress. We hypothesize that CRP itself has a pathogenic role in the development of pressure overload-induced cardiac remodeling. Transgenic mice with human CRP overexpression (CRPtg) and nontransgenic littermates (CON) were subjected to transverse aortic constriction (TAC/CRPtg and TAC/CON) or sham operation (Sham/CRPtg and Sham/CON). One week after operation, in TAC/CRPtg, myocardial mRNA levels of interleukin (IL)-6, CD68, glutathione peroxidase-3 (GPx3), 47-kDa α-subunit of nicotinamide adenine dinucleotide phosphate oxidase (p47(phox)), and collagen-I, the number of infiltrating Mac-2-positive macrophages, nuclear localization of phosphorylated NF-κB/p65 (p-p65) in cardiomyocytes, nuclear NF-κB-DNA-binding activity, and reactive oxygen species (ROS) content were increased compared to those in TAC/CON. Cardiac fibrosis was more prominent in TAC/CRPtg compared to TAC/CON. Four weeks after operation, heart and lung weights, cardiomyocyte cross-sectional area, and the extent of cardiac fibrosis were greater in TAC/CON than in Sham/CON, and these differences were further augmented in TAC/CRPtg compared to TAC/CON. Left ventricular (LV) fractional shortening was less and LV end-diastolic pressure was higher in TAC/CRPtg than in TAC/CON. Myocardial mRNA levels of angiotensin type 1 receptor, atrial natriuretic factor, IL-6, GPx3, p47(phox), collagen-I, and transforming growth factor (TGF)-β1, the protein level of TGF-β1, and the numbers of Mac-2-positive macrophages and p-p65-positive cells were higher in TAC/CRPtg than in TAC/CON. In conclusion, CRP itself may have a pathogenic role in the development of pressure overload-induced cardiac remodeling, possibly through enhanced inflammation and oxidative stress.
• Overexpression of human C-reactive protein exacerbates left ventricular remodeling in diabetic cardiomyopathy.

  Yoshinori Mano, Toshihisa Anzai, Hidehiro Kaneko, Yuji Nagatomo, Toshiyuki Nagai, Atsushi Anzai, Yuichiro Maekawa, Toshiyuki Takahashi, Tomomi Meguro, Tsutomu Yoshikawa, Keiichi Fukuda

  Circulation journal : official journal of the Japanese Circulation Society 75 (7) 1717 - 27 1346-9843 2011 [Refereed][Not invited]
   

  BACKGROUND: C-reactive protein (CRP) is known to be a pathogenic agent in the cardiovascular system. However, the effect of CRP on heart failure has not been elucidated. The effect of human CRP on cardiac dysfunction induced by diabetes mellitus (DM) using human CRP-overexpressing transgenic mice (CRP-Tg) was examined. METHODS AND RESULTS: DM was induced in male wild-type mice (Wt/DM) and CRP-Tg (CRP/DM) by an injection of streptozotocin. Non-diabetic wild-type mice (Wt/Con) and CRP-Tg (CRP/Con) served as controls. Echocardiography and hemodynamic measurements 6 weeks after injection showed lower fractional shortening and left ventricular (LV) dP/dt max in CRP/DM compared with Wt/DM. Myocardial mRNA levels of interleukin-6, tumor necrosis factor-α, plasminogen activator inhibitor-1, angiotensin type 1 receptor, angiotensinogen, NADPH oxidase subunits (p47(phox), gp91(phox)), glutathione peroxidase-3. and connective tissue growth factor were increased in CRP/DM compared with Wt/DM. Nuclear staining of 8-hydroxydeoxyguanosine was also increased in CRP/DM compared with Wt/DM. CRP/DM was associated with increased terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling positive cells and a higher ratio of Bax/Bcl-2 proteins compared with Wt/DM. The extent of cardiac fibrosis assessed by Sirius red staining and immunohistochemical staining for collagen type 1 was significantly increased in CRP/DM compared with Wt/DM. CONCLUSIONS: Overexpression of human CRP exacerbates LV dysfunction and remodeling in diabetic cardiomyopathy, possibly through enhancement of the inflammation, renin-angiotensin system, and oxidative stress.
• Tumor necrosis factor-α converting enzyme inactivation ameliorates high-fat diet-induced insulin resistance and altered energy homeostasis.

  Hidehiro Kaneko, Toshihisa Anzai, Keisuke Horiuchi, Kokichi Morimoto, Atsushi Anzai, Toshiyuki Nagai, Yasuo Sugano, Yuichiro Maekawa, Hiroshi Itoh, Tsutomu Yoshikawa, Yasunori Okada, Satoshi Ogawa, Keiichi Fukuda

  Circulation journal : official journal of the Japanese Circulation Society 75 (10) 2482 - 90 1346-9843 2011 [Refereed][Not invited]
   

  BACKGROUND: Tumor necrosis factor (TNF)-α, which is released as a soluble form by ectodomain shedding of TNF-α converting enzyme (Tace), is known to play a pivotal role in obesity-induced insulin resistance. The role of Tace in obesity-induced metabolic disorders was to be clarified in this study. METHODS AND RESULTS: Transgenic mice with temporal systemic Tace deletion (TaceMx1) and their non-transgenic littermates (CON) were fed a standard diet or a high-fat diet (HFD) from 6 weeks of age. The increased body, liver and epididymal adipose tissue (EAT) weights, systolic blood pressure, and fasting glucose and lipid levels and decreased serum adiponectin level 12 weeks after starting a HFD were suppressed by Tace inactivation. A HFD/TaceMx1 showed ameliorated glucose tolerance and insulin sensitivity compared with HFD/CON. Indirect calorimetry showed that energy expenditure and oxidation of both fat and carbohydrate were higher in HFD/TaceMx1 than HFD/CON. Marked hepatosteatosis, increased triglyceride content and TNF-α expression in liver, and increased adipocyte size, macrophage infiltration and TNF-α and monocyte chemoattractant protein-1 expression in EAT induced by a HFD were attenuated in HFD/TaceMx1. CONCLUSIONS: Inactivation of Tace suppressed HFD-induced obesity, insulin resistance, hepatosteatosis and adipose tissue remodeling in association with increased energy expenditure, suggesting an important role of Tace in the development of obesity-induced metabolic disorders.
• Overexpression of human C-reactive protein exacerbates left ventricular remodeling in diabetic cardiomyopathy.

  Yoshinori Mano, Toshihisa Anzai, Hidehiro Kaneko, Yuji Nagatomo, Toshiyuki Nagai, Atsushi Anzai, Yuichiro Maekawa, Toshiyuki Takahashi, Tomomi Meguro, Tsutomu Yoshikawa, Keiichi Fukuda

  Circulation journal : official journal of the Japanese Circulation Society 75 (7) 1717 - 27 1346-9843 2011 [Refereed][Not invited]
   

  BACKGROUND: C-reactive protein (CRP) is known to be a pathogenic agent in the cardiovascular system. However, the effect of CRP on heart failure has not been elucidated. The effect of human CRP on cardiac dysfunction induced by diabetes mellitus (DM) using human CRP-overexpressing transgenic mice (CRP-Tg) was examined. METHODS AND RESULTS: DM was induced in male wild-type mice (Wt/DM) and CRP-Tg (CRP/DM) by an injection of streptozotocin. Non-diabetic wild-type mice (Wt/Con) and CRP-Tg (CRP/Con) served as controls. Echocardiography and hemodynamic measurements 6 weeks after injection showed lower fractional shortening and left ventricular (LV) dP/dt max in CRP/DM compared with Wt/DM. Myocardial mRNA levels of interleukin-6, tumor necrosis factor-α, plasminogen activator inhibitor-1, angiotensin type 1 receptor, angiotensinogen, NADPH oxidase subunits (p47(phox), gp91(phox)), glutathione peroxidase-3. and connective tissue growth factor were increased in CRP/DM compared with Wt/DM. Nuclear staining of 8-hydroxydeoxyguanosine was also increased in CRP/DM compared with Wt/DM. CRP/DM was associated with increased terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling positive cells and a higher ratio of Bax/Bcl-2 proteins compared with Wt/DM. The extent of cardiac fibrosis assessed by Sirius red staining and immunohistochemical staining for collagen type 1 was significantly increased in CRP/DM compared with Wt/DM. CONCLUSIONS: Overexpression of human CRP exacerbates LV dysfunction and remodeling in diabetic cardiomyopathy, possibly through enhancement of the inflammation, renin-angiotensin system, and oxidative stress.
• Tumor necrosis factor-α converting enzyme inactivation ameliorates high-fat diet-induced insulin resistance and altered energy homeostasis.

  Hidehiro Kaneko, Toshihisa Anzai, Keisuke Horiuchi, Kokichi Morimoto, Atsushi Anzai, Toshiyuki Nagai, Yasuo Sugano, Yuichiro Maekawa, Hiroshi Itoh, Tsutomu Yoshikawa, Yasunori Okada, Satoshi Ogawa, Keiichi Fukuda

  Circulation journal : official journal of the Japanese Circulation Society 75 (10) 2482 - 90 1346-9843 2011 [Refereed][Not invited]
   

  BACKGROUND: Tumor necrosis factor (TNF)-α, which is released as a soluble form by ectodomain shedding of TNF-α converting enzyme (Tace), is known to play a pivotal role in obesity-induced insulin resistance. The role of Tace in obesity-induced metabolic disorders was to be clarified in this study. METHODS AND RESULTS: Transgenic mice with temporal systemic Tace deletion (TaceMx1) and their non-transgenic littermates (CON) were fed a standard diet or a high-fat diet (HFD) from 6 weeks of age. The increased body, liver and epididymal adipose tissue (EAT) weights, systolic blood pressure, and fasting glucose and lipid levels and decreased serum adiponectin level 12 weeks after starting a HFD were suppressed by Tace inactivation. A HFD/TaceMx1 showed ameliorated glucose tolerance and insulin sensitivity compared with HFD/CON. Indirect calorimetry showed that energy expenditure and oxidation of both fat and carbohydrate were higher in HFD/TaceMx1 than HFD/CON. Marked hepatosteatosis, increased triglyceride content and TNF-α expression in liver, and increased adipocyte size, macrophage infiltration and TNF-α and monocyte chemoattractant protein-1 expression in EAT induced by a HFD were attenuated in HFD/TaceMx1. CONCLUSIONS: Inactivation of Tace suppressed HFD-induced obesity, insulin resistance, hepatosteatosis and adipose tissue remodeling in association with increased energy expenditure, suggesting an important role of Tace in the development of obesity-induced metabolic disorders.
• Increased C-reactive protein expression exacerbates left ventricular dysfunction and remodeling after myocardial infarction.

  Toshiyuki Takahashi, Toshihisa Anzai, Hidehiro Kaneko, Yoshinori Mano, Atsushi Anzai, Toshiyuki Nagai, Takashi Kohno, Yuichiro Maekawa, Tsutomu Yoshikawa, Keiichi Fukuda, Satoshi Ogawa

  American journal of physiology. Heart and circulatory physiology 299 (6) H1795-804 - H1804 0363-6135 2010/12 [Refereed][Not invited]
   

  We previously reported serum C-reactive protein (CRP) elevation after acute myocardial infarction (MI) to be associated with adverse outcomes including cardiac rupture, left ventricular (LV) remodeling, and cardiac death. Experimental studies have indicated that CRP per se has various biological actions including proinflammatory and proapoptotic effects, suggesting a pathogenic role of CRP in the post-MI remodeling process. We tested the hypothesis that increased CRP expression would exacerbate adverse LV remodeling after MI via deleterious effects of CRP. Transgenic mice with human CRP expression (CRP-Tg) and their transgene-negative littermates (control) underwent left coronary artery ligation. There was no apparent difference in phenotypic features between CRP-Tg and control mice before MI. Although mortality and infarct size were similar in the two groups, CRP-Tg mice showed more LV dilation and worse LV function with more prominent cardiomyocyte hypertrophy and fibrosis in the noninfarcted regions after MI than controls. Histological evaluation conducted 1 wk post-MI revealed a higher rate of apoptosis and more macrophage infiltration in the border zones of infarcted hearts from CRP-Tg mice in relation to increased monocyte chemotactic protein (MCP)-1 expression and matrix metalloproteinase (MMP)-9 activity. Increased CRP expression exacerbates LV dysfunction and promotes adverse LV remodeling after MI in mice. The deleterious effect of CRP on post-MI LV remodeling may be associated with increased apoptotic rates, macrophage infiltration, MCP-1 expression, and MMP-9 activity in the border zone.
• Re-elevation of D-dimer as a predictor of re-dissection and venous thromboembolism after Stanford type B acute aortic dissection.

  Yusuke Jo, Toshihisa Anzai, Koji Ueno, Hidehiro Kaneko, Takashi Kohno, Yasuo Sugano, Yuichiro Maekawa, Tsutomu Yoshikawa, Hideyuki Shimizu, Ryohei Yozu, Satoshi Ogawa

  Heart and vessels 25 (6) 509 - 14 0910-8327 2010/11 [Refereed][Not invited]
   

  D-dimer measurement is a useful complementary initial diagnostic marker in patients with acute aortic dissection (AAD). However, it has not been clarified whether serial measurements of D-dimer are useful during in-hospital management of Stanford type B AAD. We studied 30 patients who were admitted with diagnosis of Stanford type B AAD and treated conservatively. D-dimer was serially measured on admission and then every 5 days during hospitalization. Patients were divided into two groups according to the presence or absence of re-elevation of D-dimer during hospitalization, in which D-dimer transition were biphasic and latter peak >10.0 μg/ml. Re-elevation of D-dimer was observed in 17 patients. There were no differences in atherosclerotic risk factors, blood pressure on admission, D-dimer level on admission, extent of AAD, and false lumen patency. Patients with re-elevation of D-dimer showed higher incidence of re-dissection and/or venous thromboembolism (VTE). Peak D-dimer level in patients with re-dissection and/or VTE was significantly higher than that without these complications (p = 0.005). In conclusion, serial measurements of D-dimer are useful for early detection of re-dissection or VTE in patients with Stanford type B AAD, which may contribute to the prevention of disastrous consequences such as pulmonary embolism and extension of AAD.
• Impact of systemic acidosis on the development of malignant ventricular arrhythmias after reperfusion therapy for ST-elevation myocardial infarction.

  Toshiyuki Nagai, Toshihisa Anzai, Hidehiro Kaneko, Atsushi Anzai, Yoshinori Mano, Yuji Nagatomo, Shun Kohsaka, Yuichiro Maekawa, Akio Kawamura, Tsutomu Yoshikawa, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 74 (9) 1808 - 14 1346-9843 2010/09 [Refereed][Not invited]
   

  BACKGROUND: The aim of the present study was to examine the effect of systemic acidosis on the development of malignant ventricular arrhythmias, including sustained ventricular tachycardia and ventricular fibrillation (VT/VF), after reperfused ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 157 consecutive patients with a reperfused STEMI were examined. Patients were divided into 2 groups according to the presence or absence of systemic acidosis, defined as arterial blood pH <7.40 on admission. Serum creatine kinase and C-reactive protein (CRP) levels were serially measured. Systemic acidosis was observed in 53 patients (34%). There was no significant difference in coronary risk factors and arrival time from onset between the 2 groups. Estimated glomerular filtration rate (eGFR) on admission was lower in patients with acidosis than in those without (P=0.001). Patients with acidosis had a higher incidence of VT/VF (26% vs 4%, P<0.0001), especially within 48 h after STEMI (23% vs 3%, P=0.0002), than those without. The peripheral white blood cell count on admission was higher in patients with than in those without acidosis. Multivariate analysis showed that systemic acidosis was a strong independent predictor of VT/VF (relative risk =8.79, P=0.002) among variables including prior MI and eGFR <60 ml . min(-1) . 1.73 m(-2). CONCLUSIONS: Systemic acidosis was a significant determinant of VT/VF after reperfused STEMI and was associated with elevated serum CRP level. Systemic acidosis and subsequent inflammation after ischemia reperfusion may play an important role in the development of VT/VF.
• Impact of systemic acidosis on the development of malignant ventricular arrhythmias after reperfusion therapy for ST-elevation myocardial infarction.

  Toshiyuki Nagai, Toshihisa Anzai, Hidehiro Kaneko, Atsushi Anzai, Yoshinori Mano, Yuji Nagatomo, Shun Kohsaka, Yuichiro Maekawa, Akio Kawamura, Tsutomu Yoshikawa, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 74 (9) 1808 - 14 1346-9843 2010/09 [Refereed][Not invited]
   

  BACKGROUND: The aim of the present study was to examine the effect of systemic acidosis on the development of malignant ventricular arrhythmias, including sustained ventricular tachycardia and ventricular fibrillation (VT/VF), after reperfused ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: A total of 157 consecutive patients with a reperfused STEMI were examined. Patients were divided into 2 groups according to the presence or absence of systemic acidosis, defined as arterial blood pH <7.40 on admission. Serum creatine kinase and C-reactive protein (CRP) levels were serially measured. Systemic acidosis was observed in 53 patients (34%). There was no significant difference in coronary risk factors and arrival time from onset between the 2 groups. Estimated glomerular filtration rate (eGFR) on admission was lower in patients with acidosis than in those without (P=0.001). Patients with acidosis had a higher incidence of VT/VF (26% vs 4%, P<0.0001), especially within 48 h after STEMI (23% vs 3%, P=0.0002), than those without. The peripheral white blood cell count on admission was higher in patients with than in those without acidosis. Multivariate analysis showed that systemic acidosis was a strong independent predictor of VT/VF (relative risk =8.79, P=0.002) among variables including prior MI and eGFR <60 ml . min(-1) . 1.73 m(-2). CONCLUSIONS: Systemic acidosis was a significant determinant of VT/VF after reperfused STEMI and was associated with elevated serum CRP level. Systemic acidosis and subsequent inflammation after ischemia reperfusion may play an important role in the development of VT/VF.
• Differential effects of carvedilol and metoprolol on renal function in patients with heart failure.

  Hiroyuki Ito, Yuji Nagatomo, Takashi Kohno, Toshihisa Anzai, Tomomi Meguro, Satoshi Ogawa, Tsutomu Yoshikawa

  Circulation journal : official journal of the Japanese Circulation Society 74 (8) 1578 - 83 1346-9843 2010/08 [Refereed][Not invited]
   

  BACKGROUND: The aim of the present study was to verify the effects of beta-blockers on renal function in patients with heart failure (HF). METHODS AND RESULTS: A total of 40 patients with HF (New York Heart Association class, II-III) were enrolled, who had beta-blocker therapy initiated with carvedilol (n=23) or metoprolol (n=17). The changes in renal and cardiac function were retrospectively analyzed over 16 weeks. The study population was divided into 2 groups according to the median baseline (65.9 ml/min) of estimated glomerular filtration rate (eGFR) calculated by the Modification of Diet in Renal Disease formula. eGFR significantly decreased in the higher eGFR group (P=0.04), but did not in the lower eGFR group. Left ventricular ejection fraction significantly increased in both groups with lower eGFR (P=0.01) and higher eGFR (P<0.01). There was an interaction between plasma norepinephrine concentration and eGFR in terms of beta-blocker treatment (P=0.02, ANOVA). eGFR significantly decreased in patients who received metoprolol (from 75.7+/-33.5 to 59.5+/-20.0 mlxmin(-1).1.73 m(-2), P<0.01), but did not change in those who received carvedilol (from 67.1+/-27.7 mlxmin(-1).1.73 m(-2) to 65.6+/-23.2 mlxmin(-1).1.73 m(-2)). CONCLUSIONS: Beta-blockers preserved renal function in HF patients with lower baseline eGFR, but not in those with higher baseline eGFR. Carvedilol may be preferable to metoprolol to prevent the development of chronic kidney disease during beta-blocker therapy for HF.
• Differential effects of carvedilol and metoprolol on renal function in patients with heart failure.

  Hiroyuki Ito, Yuji Nagatomo, Takashi Kohno, Toshihisa Anzai, Tomomi Meguro, Satoshi Ogawa, Tsutomu Yoshikawa

  Circulation journal : official journal of the Japanese Circulation Society 74 (8) 1578 - 83 1346-9843 2010/08 [Refereed][Not invited]
   

  BACKGROUND: The aim of the present study was to verify the effects of beta-blockers on renal function in patients with heart failure (HF). METHODS AND RESULTS: A total of 40 patients with HF (New York Heart Association class, II-III) were enrolled, who had beta-blocker therapy initiated with carvedilol (n=23) or metoprolol (n=17). The changes in renal and cardiac function were retrospectively analyzed over 16 weeks. The study population was divided into 2 groups according to the median baseline (65.9 ml/min) of estimated glomerular filtration rate (eGFR) calculated by the Modification of Diet in Renal Disease formula. eGFR significantly decreased in the higher eGFR group (P=0.04), but did not in the lower eGFR group. Left ventricular ejection fraction significantly increased in both groups with lower eGFR (P=0.01) and higher eGFR (P<0.01). There was an interaction between plasma norepinephrine concentration and eGFR in terms of beta-blocker treatment (P=0.02, ANOVA). eGFR significantly decreased in patients who received metoprolol (from 75.7+/-33.5 to 59.5+/-20.0 mlxmin(-1).1.73 m(-2), P<0.01), but did not change in those who received carvedilol (from 67.1+/-27.7 mlxmin(-1).1.73 m(-2) to 65.6+/-23.2 mlxmin(-1).1.73 m(-2)). CONCLUSIONS: Beta-blockers preserved renal function in HF patients with lower baseline eGFR, but not in those with higher baseline eGFR. Carvedilol may be preferable to metoprolol to prevent the development of chronic kidney disease during beta-blocker therapy for HF.
• Prognostic significance of acute kidney injury after reperfused ST-elevation myocardial infarction: synergistic acceleration of renal dysfunction and left ventricular remodeling.

  Atsushi Anzai, Toshihisa Anzai, Kotaro Naito, Hidehiro Kaneko, Yoshinori Mano, Yusuke Jo, Yuji Nagatomo, Yuichiro Maekawa, Akio Kawamura, Tsutomu Yoshikawa, Satoshi Ogawa

  Journal of cardiac failure 16 (5) 381 - 9 1071-9164 2010/05 [Refereed][Not invited]
   

  BACKGROUND: Acute kidney injury (AKI) after myocardial infarction is associated with poor clinical outcome. However, mechanisms of the adverse effect of AKI on clinical outcome after reperfused ST-elevation myocardial infarction (STEMI) have not been fully elucidated. METHODS AND RESULTS: We examined 141 consecutive patients with reperfused first anterior STEMI. AKI was defined as an increase in serum creatinine of >or=0.3mg/dL within 48hours after admission. Patients with AKI had higher incidence of in-hospital cardiac death (P=.0004) and major adverse cardiac events (MACE, P=.020) during a mean of 39+/-40 (range, 1 to 96) months than those without, in association with adverse left ventricular (LV) remodeling. White blood cell count on admission and peak C-reactive protein were higher in patients with than those without AKI. Plasma norepinephrine on admission, interleukin-6, brain natriuretic peptide, and malondialdehyde-modified low-density lipoprotein 2 weeks after STEMI were higher in patients with AKI than those without AKI. Cox proportional hazards model analysis revealed AKI was an independent predictor of MACE (hazard ratio=2.38, P=.019). CONCLUSIONS: AKI was a strong predictor of MACE in association with adverse LV remodeling. Enhanced inflammatory response, oxidative stress, and neurohormonal activation may synergistically accelerate renal dysfunction and LV remodeling after STEMI.
• Elevated troponin T on discharge predicts poor outcome of decompensated heart failure.

  Kimi Koide, Tsutomu Yoshikawa, Yuji Nagatomo, Shun Kohsaka, Toshihisa Anzai, Tomomi Meguro, Satoshi Ogawa

  Heart and vessels 25 (3) 217 - 22 0910-8327 2010/05 [Refereed][Not invited]
   

  Persistent elevation of cardiac troponin T (cTnT) predicts an adverse clinical outcome in patients with chronic heart failure (HF), but the underlying mechanisms remain to be determined. We investigated the association between predischarge cTnT elevation and coexistent pathophysiology in patients with decompensated HF. Plasma cTnT levels were determined before discharge in 170 patients with decompensated HF. We divided the patients into a group that was positive for cTnT [cTnT(+) group, n = 40] and a group that was negative for cTnT [cTnT(-) group, n = 130]. Multivariate analysis showed that use of beta-blocker therapy (odds ratio [OR] = 0.236, P = 0.003), an elevated high-sensitivity C-reactive protein (hsCRP) level (OR = 3.731, P = 0.006), a high brain natriuretic peptide (BNP) level (OR = 3.570, P = 0.007), diabetes (OR = 3.090, P = 0.018), and anemia (OR = 2.330, P = 0.047) were independently associated with cTnT positivity. During a mean follow-up period of 441 days after discharge, total mortality (P < 0.001), cardiac death (P < 0.001), and exacerbation of HF requiring hospitalization (P = 0.007) were all more common in the cTnT(+) group than in the cTnT(-) group. Cox proportional hazards analysis showed that cTnT positivity was an independent predictor of total mortality (hazard ratio = 5.008, P = 0.004) in an age- and gender-matched model. Elevation of cTnT during convalescence was associated with lack of beta-blocker therapy, a high hsCRP level at discharge, a high BNP level at discharge, diabetes, and anemia, and a worse clinical outcome in patients with decompensated HF.
• Impact of high-density lipoprotein cholesterol level in patients with variant angina pectoris.

  Yasuo Sugano, Toshihisa Anzai, Takashi Yagi, Shigetaka Noma

  International journal of cardiology 140 (2) 175 - 81 0167-5273 2010/04/15 [Refereed][Not invited]
   

  BACKGROUND: It is generally considered that patients with variant angina pectoris (VAP) have a potential disturbance in the coronary endothelium. High-density lipoprotein (HDL) has been shown to mediate vasodilation as a result of its endothelium-enhancing property; however, the significance of low HDL in patients with VAP has not been clarified. We sought to determine the association between a low level of high-density lipoprotein cholesterol (HDL-C) and VAP. METHODS: We examined a total of 174 consecutive patients who were suspected of having VAP and underwent spasm provocation test by direct injection of acetylcholine into the coronary arteries. One hundred and three patients (59%) were consequently diagnosed as having VAP. Serum HDL-C, fasting plasma glucose (FPG), and glycohemoglobin levels were measured in all patients. RESULTS: HDL-C in quartiles showed a significant negative correlation with the presence of VAP. Multivariate analysis revealed that the lowest HDL-C quartile (<43 mg/dl), as well as cigarette smoking and impaired fasting glucose/diabetes mellitus, was an independent determinant of VAP (odds ratio=3.39, P=0.010). Patients in the highest FPG quartile (> or =106 mg/dl) or with cigarette smoking habit in combination with the lowest HDL-C quartile showed an increased risk for VAP (relative risk=2.01 and 1.88, respectively). CONCLUSIONS: A low level of HDL-C is an independent determinant for VAP. Endothelial dysfunction caused by a low HDL state may play a role in the development of VAP.
• Persistent Angiotensin II Independent Activation of Mineralocorticoid Receptor Signaling is Associated With the Deterioration of Cardiac Function Induced by Chronic Diabetes Mellitus

  Yuji Nagatomo, Tomomi Meguro, Hiroyuki Ito, Kimi Koide, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa

  CIRCULATION 120 (18) S782 - S782 0009-7322 2009/11 [Refereed][Not invited]
  
• Role of ischemic preconditioning and inflammatory response in the development of malignant ventricular arrhythmias after reperfused ST-elevation myocardial infarction.

  Hidehiro Kaneko, Toshihisa Anzai, Kotaro Naito, Takashi Kohno, Yuichiro Maekawa, Toshiyuki Takahashi, Akio Kawamura, Tsutomu Yoshikawa, Satoshi Ogawa

  Journal of cardiac failure 15 (9) 775 - 81 1071-9164 2009/11 [Refereed][Not invited]
   

  BACKGROUND: Sustained ventricular tachycardia and ventricular fibrillation (VT/VF) are major complications of ST-elevation myocardial infarction (STEMI), even in the era of reperfusion therapy. We sought to clarify the determinants of VT/VF after reperfused STEMI. METHODS AND RESULTS: Consecutive STEMI patients treated with primary percutaneous coronary intervention (n=457) were divided into 2 groups by the presence or absence of VT/VF during hospitalization. Serum C-reactive protein (CRP) level and peripheral white blood cell (WBC) count were serially measured. VT/VF was observed in 54 patients (12%). Prior infarction was more common and preinfarction angina was less in patients with VT/VF than those without. Peak CRP level (P < .0001), WBC count on admission (P=.008), and maximum WBC count (P=.0014) were higher in patients with VT/VF than those without. VT/VF, especially VT/VF later than 48 hours after onset, was associated with greater left ventricular (LV) dimension during convalescence. Kaplan-Meier curves and log-rank test revealed VT/VF to be a significant determinant of long-term major adverse cardiac events. Multivariate analysis revealed that prior infarction, absence of preinfarction angina, and peak CRP >or=10mg/dL were independent determinants of VT/VF. CONCLUSIONS: Lack of ischemic preconditioning, enhanced inflammatory response, and subsequent LV dysfunction are related to the development of VT/VF after STEMI.
• Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions.

  Koji Ueno, Toshihisa Anzai, Masahiro Jinzaki, Minoru Yamada, Yusuke Jo, Yuichiro Maekawa, Akio Kawamura, Tsutomu Yoshikawa, Yutaka Tanami, Kozo Sato, Sachio Kuribayashi, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 73 (10) 1927 - 33 1346-9843 2009/10 [Refereed][Not invited]
   

  BACKGROUND: The relationship between the epicardial fat volume measured by 64-slice multidetector computed tomography (MDCT) and the extension and severity of coronary atherosclerosis was investigated. METHODS AND RESULTS: Both MDCT and conventional coronary angiography (CAG) were performed in 71 consecutive patients who presented with effort angina. The volume of epicardial adipose tissue (EAT) was measured by MDCT. The severity of coronary atherosclerosis was assessed by evaluating the extension of coronary plaques in 790 segments using MDCT data, and the percentage diameter stenosis in 995 segments using CAG data. The estimated volume of EAT indexed by body surface area was defined as VEAT. Increased VEAT was associated with advanced age, male sex, degree of metabolic alterations, a history of acute coronary syndrome (ACS) and the presence of total occlusions, and showed positive correlation with the stenosis score (r=0.28, P=0.02) and the atheromatosis score (r=0.67, P<0.0001) of the coronary arteries. Multiple logistic regression analysis revealed an increased VEAT (>or=50 cm(3)/m(2)) to be the strongest independent determinant of the presence of total occlusions (odds ratio 4.64, P=0.02). CONCLUSIONS: VEAT correlates with the degree of metabolic alterations and coronary atheromatosis. Excessive accumulation of EAT might contribute to the development of ACS and coronary total occlusions.
• Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions.

  Koji Ueno, Toshihisa Anzai, Masahiro Jinzaki, Minoru Yamada, Yusuke Jo, Yuichiro Maekawa, Akio Kawamura, Tsutomu Yoshikawa, Yutaka Tanami, Kozo Sato, Sachio Kuribayashi, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 73 (10) 1927 - 33 1346-9843 2009/10 [Refereed][Not invited]
   

  BACKGROUND: The relationship between the epicardial fat volume measured by 64-slice multidetector computed tomography (MDCT) and the extension and severity of coronary atherosclerosis was investigated. METHODS AND RESULTS: Both MDCT and conventional coronary angiography (CAG) were performed in 71 consecutive patients who presented with effort angina. The volume of epicardial adipose tissue (EAT) was measured by MDCT. The severity of coronary atherosclerosis was assessed by evaluating the extension of coronary plaques in 790 segments using MDCT data, and the percentage diameter stenosis in 995 segments using CAG data. The estimated volume of EAT indexed by body surface area was defined as VEAT. Increased VEAT was associated with advanced age, male sex, degree of metabolic alterations, a history of acute coronary syndrome (ACS) and the presence of total occlusions, and showed positive correlation with the stenosis score (r=0.28, P=0.02) and the atheromatosis score (r=0.67, P<0.0001) of the coronary arteries. Multiple logistic regression analysis revealed an increased VEAT (>or=50 cm(3)/m(2)) to be the strongest independent determinant of the presence of total occlusions (odds ratio 4.64, P=0.02). CONCLUSIONS: VEAT correlates with the degree of metabolic alterations and coronary atheromatosis. Excessive accumulation of EAT might contribute to the development of ACS and coronary total occlusions.
• Differential Effects of Carvedilol and Metoprolol on Renal Function in Patients With Heart Failure

  Hiroyuki Ito, Yuji Nagatomo, Takashi Kohno, Toshihisa Anzai, Tomomi Meguro, Satoshi Ogawa, Tsutomu Yoshikawa

  JOURNAL OF CARDIAC FAILURE 15 (7) S160 - S160 1071-9164 2009/09 [Refereed][Not invited]
  
• Persistent Angiotensin II-independent Activation of Mineralocorticoid Receptor Signaling is Associated With the Cardiac Dysfunction Induced by Long-term Diabetes Mellitus

  Yuji Nagatomo, Tomomi Meguro, Hiroyuki Ito, Kimi Koide, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa

  JOURNAL OF CARDIAC FAILURE 15 (7) S168 - S169 1071-9164 2009/09 [Refereed][Not invited]
  
• Diagnostic Accuracy of Angiographic View Image for the Detection of Coronary Artery Stenoses by 64-Detector Row CT - A Pilot Study Comparison With Conventional Post-Processing Methods and Axial Images Alone

  Masahiro Jinzaki, Kozo Sato, Yutaka Tanami, Minoru Yamada, Toshihisa Anzai, Akio Kawamura, Koji Ueno, Sachio Kuribayashi

  CIRCULATION JOURNAL 73 (4) 691 - 698 1346-9843 2009/04 [Refereed][Not invited]
   

  Background: The angiographic view (AGV) image is a new post-processing method that is similar to conventional coronary angiography (CAG). The purpose of this study was to evaluate its accuracy for coronary stenosis detection by 64-detector row computed tomography (CT). Methods and Results: CT evaluation results of 17 patients were compared with the results of invasive CAG on a coronary segment basis concerning the presence of stenoses >50% diameter reduction. All images of the 3 viewing methods (combination of conventional methods, AGV image alone, and axial images alone) were evaluated in consensus by 3 cardiovascular radiologists. Among 196 assessable segments, invasive CAG showed significant coronary artery stenoses in 44 segments. 43 of 44 lesions were detected with the AGV image, and absence of significant stenosis was correctly identified in 135 of 152 segments (sensitivity 98%; specificity 89%; accuracy 91%; positive predictive value 72%, negative predictive value 99%). The sensitivity of the AGV image was the same as that of conventional methods (98%). There was no significant difference in accuracy between the AGV image (91%) and conventional methods (94%). The accuracy of the AGV image was significantly higher than the axial images alone (78%). Conclusions: AGV image shows promise as a post-processing method for identifying coronary artery stenosis with high accuracy. (Circ J 2009;73:691-698)
• Diagnostic accuracy of angiographic view image for the detection of coronary artery stenoses by 64-detector row CT: a pilot study comparison with conventional post-processing methods and axial images alone.

  Masahiro Jinzaki, Kozo Sato, Yutaka Tanami, Minoru Yamada, Toshihisa Anzai, Akio Kawamura, Koji Ueno, Sachio Kuribayashi

  Circulation journal : official journal of the Japanese Circulation Society 73 (4) 691 - 8 1346-9843 2009/04 [Refereed][Not invited]
   

  BACKGROUND: The angiographic view (AGV) image is a new post-processing method that is similar to conventional coronary angiography (CAG). The purpose of this study was to evaluate its accuracy for coronary stenosis detection by 64-detector row computed tomography (CT). METHODS AND RESULTS: CT evaluation results of 17 patients were compared with the results of invasive CAG on a coronary segment basis concerning the presence of stenoses>50% diameter reduction. All images of the 3 viewing methods (combination of conventional methods, AGV image alone, and axial images alone) were evaluated in consensus by 3 cardiovascular radiologists. Among 196 assessable segments, invasive CAG showed significant coronary artery stenoses in 44 segments. 43 of 44 lesions were detected with the AGV image, and absence of significant stenosis was correctly identified in 135 of 152 segments (sensitivity 98%; specificity 89%; accuracy 91%; positive predictive value 72%, negative predictive value 99%). The sensitivity of the AGV image was the same as that of conventional methods (98%). There was no significant difference in accuracy between the AGV image (91%) and conventional methods (94%). The accuracy of the AGV image was significantly higher than the axial images alone (78%). CONCLUSIONS: AGV image shows promise as a post-processing method for identifying coronary artery stenosis with high accuracy.
• A pilot study on the role of autoantibody targeting the beta1-adrenergic receptor in the response to beta-blocker therapy for congestive heart failure.

  Yuji Nagatomo, Tsutomu Yoshikawa, Takashi Kohno, Akihiro Yoshizawa, Akiyasu Baba, Toshihisa Anzai, Tomomi Meguro, Toru Satoh, Satoshi Ogawa

  Journal of cardiac failure 15 (3) 224 - 32 1071-9164 2009/04 [Refereed][Not invited]
   

  BACKGROUND: Autoantibodies directed against the beta1-adrenergic receptor exert agonist-like actions by inducing receptor uncoupling and cause myocardial damage as well as fatal ventricular arrhythmias. Previous studies have shown that beta-blockers can modulate these actions of the autoantibodies. We investigated the influence of such autoantibodies in patients with congestive heart failure (CHF) receiving beta-blocker therapy. METHODS AND RESULTS: Eighty-two CHF patients were randomly assigned to treatment with metoprolol or carvedilol for 16 weeks. Autoantibodies were detected in 20 patients (24%) by enzyme-linked immunosorbent assay. Left ventricular function in response to beta-blocker therapy did not differ significantly by the presence of the autoantibody in global analysis. However, changes of the left ventricular end-diastolic dimension (P = .04), end-systolic dimension (P < .01), and ejection fraction on radionuclide ventriculography (P = .02) were significantly larger in autoantibody-positive patients than antibody-negative patients. Changes in the plasma level of brain natriuretic peptide tended to be larger in autoantibody-positive patients (P = .09). The increase of heart rate normalized by the increase of plasma norepinephrine during exercise (an index of adrenergic responsiveness) showed a greater decrease in autoantibody-positive patients than autoantibody-negative patients (P = .035). CONCLUSION: Our data suggest that beta-blocker therapy might be more effective in CHF patients with autoantibodies targeting the beta1-adrenergic receptor.
• Role of high-mobility group box 1 protein in post-infarction healing process and left ventricular remodelling.

  Takashi Kohno, Toshihisa Anzai, Kotaro Naito, Taku Miyasho, Minoru Okamoto, Hiroshi Yokota, Shingo Yamada, Yuichiro Maekawa, Toshiyuki Takahashi, Tsutomu Yoshikawa, Akitoshi Ishizaka, Satoshi Ogawa

  Cardiovascular research 81 (3) 565 - 73 0008-6363 2009/02/15 [Refereed][Not invited]
   

  AIMS: High-mobility group box 1 protein (HMGB1) is one of the recently defined damage-associated molecular pattern molecules derived from necrotic cells and activated macrophages. We investigated clinical implications of serum HMGB1 elevation in patients with acute myocardial infarction (MI). Then, we evaluated the effect of HMGB1 blockade on post-MI left ventricular (LV) remodelling in a rat MI model. METHODS AND RESULTS: Serum HMGB1 levels were examined in patients with ST-elevation MI (n = 35). A higher peak serum HMGB1 level was associated with pump failure, cardiac rupture, and in-hospital cardiac death. Then, an experimental MI model was induced in male Wistar rats. The mRNA and protein expression of HMGB1 were increased in the infarcted area compared with those values observed in sham-operated rats. We administered neutralizing anti-HMGB1 antibody (MI/anti-H) or control antibody (MI/C) to MI rats subcutaneously for 7 days. The mRNA levels of tumour necrosis factor-alpha and interleukin-1beta and the number of macrophages in the infarcted area were reduced on day 3 in MI/anti-H rats compared with MI/C rats. Interestingly, HMGB1 blockade resulted in thinning and expansion of the infarct scar and marked hypertrophy of the non-infarcted area on day 14. CONCLUSION: Elevated serum HMGB1 levels were associated with adverse clinical outcomes in patients with MI. However, HMGB1 blockade in a rat MI model aggravated LV remodelling, possibly through impairment of the infarct-healing process. HMGB1, a novel predictor of adverse clinical outcomes after MI, may have an essential role in the appropriate healing process after MI.
• Diagnostic capacity of 64-slice multidetector computed tomography for acute coronary syndrome in patients presenting with acute chest pain.

  Koji Ueno, Toshihisa Anzai, Masahiro Jinzaki, Minoru Yamada, Takashi Kohno, Akio Kawamura, Tsutomu Yoshikawa, Sachio Kuribayashi, Satoshi Ogawa

  Cardiology 112 (3) 211 - 8 0008-6312 2009 [Refereed][Not invited]
   

  BACKGROUND/AIMS: Early evaluations of patients presenting with acute chest pain remain difficult. We examined the diagnostic capacity of multidetector computed tomography (MDCT) for acute coronary syndrome (ACS) in patients presenting with acute chest pain. METHODS/RESULTS: We examined 36 consecutive patients presenting with acute chest pain with neither diagnostic ECG changes nor elevated biomarkers. 64-slice MDCT was performed, and we evaluated the presenceof significant coronaryartery stenosis (>50% reduction in lumen diameter). Significant stenosis was detected in 15 patients by MDCT. Among them, 11 patients were diagnosed as having ACS based on the findings of coronary angiography or myocardial perfusion single photon emission computed tomography (positive predictive value 73%). All 21 patients without significant stenosis by MDCT, except only one, were regarded as not having ACS (negative predictive value 95%). Sensitivity and specificity were 92 and 83%, respectively. In patients without a history of coronary artery disease (CAD), both the specificity and positive predictive value improved to 100% (sensitivity 90%; negative predictive value 95%). In patients with neither a history of CAD nor coronary calcification, the diagnostic accuracy of MDCT was 100%. CONCLUSIONS: MDCT has high diagnostic capacity for the early evaluation of ACS, especially in patients without a history of CAD or coronary calcification.
• Extrinsic compression of the left main coronary artery by atrial septal defect.

  Yusuke Jo, Akio Kawamura, Masahiro Jinzaki, Takashi Kohno, Toshihisa Anzai, Shiro Iwanaga, Kiyokazu Kokaji, Tsutomu Yoshikawa, Ryohei Yozu, Sachio Kuribayashi, Satoshi Ogawa

  The Annals of thoracic surgery 86 (6) 1987 - 9 0003-4975 2008/12 [Refereed][Not invited]
   

  On rare occasions, extrinsic compression of the coronary artery can cause significant stenosis. We report a 42-year-old woman who was referred to our hospital for surgical repair of atrial septal defect. Cardiac 64-slice multi-detector computed tomography before the operation revealed the extrinsic compression of the proximal left main coronary artery by the marked dilatation of pulmonary trunk. The patient eventually underwent atrial septal defect closure and coronary artery bypass simultaneously. Four months after the operation, multi-detector computed tomographic scan revealed reduction of pulmonary trunk diameter and resolution of left main coronary artery narrowing.
• Impact of chronic kidney disease on postinfarction inflammation, oxidative stress, and left ventricular remodeling.

  Kotaro Naito, Toshihisa Anzai, Tsutomu Yoshikawa, Atsushi Anzai, Hidehiro Kaneko, Takashi Kohno, Toshiyuki Takahashi, Akio Kawamura, Satoshi Ogawa

  Journal of cardiac failure 14 (10) 831 - 8 1071-9164 2008/12 [Refereed][Not invited]
   

  BACKGROUND: Patients with chronic kidney disease (CKD) have poor clinical outcomes after myocardial infarction (MI). However, the precise mechanisms are unclear. We sought to determine the prognostic significance of CKD in patients with MI in relation to left ventricular (LV) remodeling. METHODS AND RESULTS: We examined 120 consecutive patients with a reperfused first anterior ST-elevation MI. Patients were divided into 2 groups according to the presence or absence of CKD, defined as estimated glomerular filtration rates <60 mL x min x 1.73 m2. Patients with CKD had a higher incidence of in-hospital cardiac death and readmission for heart failure during follow-up, in association with a greater LV volume and lower LV ejection fraction 2 weeks after MI compared with those without CKD. Cox proportional hazards model analysis revealed that CKD was an independent predictor of major adverse cardiac events (hazard ratio=3.13, P=.001). Plasma interleukin-6 on admission, and peak serum C-reactive protein, and malondialdehyde-modified low-density lipoprotein levels during convalescence, were higher in patients with CKD than in those without. CONCLUSIONS: Patients with CKD had poorer clinical outcomes and accelerated infarct expansion in association with enhanced inflammation and oxidative stress, as compared with non-CKD patients, suggesting a major impact of CKD in the development of LV remodeling after MI.
• Differential effects of GM-CSF and G-CSF on infiltration of dendritic cells during early left ventricular remodeling after myocardial infarction.

  Kotaro Naito, Toshihisa Anzai, Yasuo Sugano, Yuichiro Maekawa, Takashi Kohno, Tsutomu Yoshikawa, Kenjiro Matsuno, Satoshi Ogawa

  Journal of immunology (Baltimore, Md. : 1950) 181 (8) 5691 - 701 0022-1767 2008/10/15 [Refereed][Not invited]
   

  Several lines of evidence suggest that the immune activation after myocardial infarction (MI) induces secondary myocardial injury. Although dendritic cells (DC) are potent regulators of immunity, their role in MI is still undetermined. We investigated the effect of DC modulation by CSF on left ventricular (LV) remodeling after MI. MI was induced by ligation of the left coronary artery in male Wistar rats. G-CSF (20 microg/kg/day, MI-G, n = 33), a GM-CSF inducer (romurtide, 200 microg/kg/day, MI-GM, n = 28), or saline (MI-C, n = 55) was administered for 7 days. On day 14, MI-G animals had higher LV max dP/dt and smaller LV dimensions, whereas MI-GM animals had lower LV max dP/dt and larger LV dimensions than did MI-C animals, despite similar infarct size. In MI-C, OX62(+) DC infiltrated the infarcted and border areas, peaking on day 7. Bromodeoxyuridine-positive DC were observed in the border area during convalescence. Infiltration by DC was decreased in MI-G animals and increased in MI-GM animals compared with MI-C (p < 0.05). In the infarcted area, the heat shock protein 70, TLR2 and TLR4, and IFN-gamma expression were reduced in MI-G, but increased in MI-GM in comparison with those in MI-C animals. IL-10 expression was higher in MI-G and lower in MI-GM than in MI-C animals. In conclusion, G-CSF improves and GM-CSF exacerbates early postinfarction LV remodeling in association with modulation of DC infiltration. Suppression of DC-mediated immunity could be a new strategy for the treatment of LV remodeling after MI.
• Angiotensin-receptor blockade reduces border zone myocardial monocyte chemoattractant protein-1 expression and macrophage infiltration in post-infarction ventricular remodeling.

  Takashi Kohno, Toshihisa Anzai, Kotaro Naito, Yasuo Sugano, Yuichiro Maekawa, Toshiyuki Takahashi, Tsutomu Yoshikawa, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 72 (10) 1685 - 92 1346-9843 2008/10 [Refereed][Not invited]
   

  BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1) is a key mediator of left ventricular (LV) remodeling during the early phase of myocardial infarction (MI). The hypothesis tested was that myocardial MCP-1 expression would increase during the chronic phase of MI and an angiotensin-II type 1 receptor blocker (ARB) would attenuate macrophage infiltration through decreased myocardial MCP-1 expression. METHODS AND RESULTS: MI was produced by ligation of the left coronary artery in Wistar rats, which were then randomized to treatment with vehicle (MI/C), candesartan (10 mg.kg(-1).day(-1)) for 6 weeks (MI/ARB0-6W), or candesartan for 2 weeks, starting 4 weeks after MI (MI/ARB4-6W). LV systolic and end-diastolic pressures 6 weeks after MI were decreased in MI/ARB0-6W compared with MI/C or MI/ARB4-6W, however, there were no differences in other hemodynamic or echocardiographic parameters among infarcted rat groups. Both long- and short-term treatments with ARB similarly reduced mRNA expressions of MCP-1, transforming growth factor-beta1, and procollagen type I and III, macrophage infiltration, and myocardial fibrosis in the border zone. CONCLUSIONS: In post-MI heart failure, ARB attenuated MCP-1 expression and macrophage infiltration in the border zone, resulting in less myocardial fibrosis. ARB may exert its beneficial effect, at least in part, by inhibiting myocardial macrophage-related inflammation.
• Angiotensin-receptor blockade reduces border zone myocardial monocyte chemoattractant protein-1 expression and macrophage infiltration in post-infarction ventricular remodeling

  Takashi Kohno, Toshihisa Anzai, Kotaro Naito, Yasuo Sugano, Yuichiro Maekawa, Toshiyuki Takahashi, Tsutomu Yoshikawa, Satoshi Ogawa

  CIRCULATION JOURNAL 72 (10) 1685 - 1692 1346-9843 2008/10 [Refereed][Not invited]
   

  Background Monocyte chernoattractant protein-1 (MCP-1) is a key mediator of left ventricular (LV) remodeling during the early phase of myocardial infarction (MI). The hypothesis tested was that myocardial MCP-1 expression would increase during the chronic phase of MI and in angiotensin-II type 1 receptor blocker (ARB) would attenuate macrophage infiltration through decreased myocardial MCP-1 expression. Methods and Results MI was produced by ligation of the left coronary artery in Wistar rats, which were then randomized to treatment with vehicle (MI/C), candesartan (10 mg.kg(-1).day(-1)) for 6 weeks (MI/ARB0-6W), or candesartan for 2 weeks, starting 4 weeks after MI (MI/ARB4-6W). LV systolic and end-diastolic pressures 6 weeks after MI were decreased in MI/ARB0-6W compared with MI/C or MI/ARB4-6W, however, there were no differences in other hemodynamic or echocardiographic parameters among infarcted rat groups. Both long- and short-term treatments with ARB similarly reduced mRNA expressions of MCP-1, transforming growth factor-31. and procollagen type I and III, macrophage infiltration, and myocardial fibrosis in the border zone. Conclusions In post-MI heart failure, ARB attenuated MCP-1 expression and macrophage infiltration in the border zone. resulting in less myocardial macrophage-related inflammation.
• Angiotensin II independent mineralocorticoid receptor activation in heart failure models

  Tomomi Meguro, Yuji Nagato, Kimi Koide, Hiroyuki Ito, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa

  JOURNAL OF CARDIAC FAILURE 14 (7) S147 - S147 1071-9164 2008/09 [Refereed][Not invited]
  
• Effect of human C-reactive protein on cardiac function and angiotensin 2 signaling in diabetic cardiomyopathy

  Yoshinori Mano, Toshihisa Anzai, Toshiyuki Takahashi, Yuji Nagatomo, Kimi Koide, Hidehiro Kaneko, Tomomi Meguro, Tsutomu Yoshikawa, Satoshi Ogawa

  JOURNAL OF CARDIAC FAILURE 14 (7) S170 - S170 1071-9164 2008/09 [Refereed][Not invited]
  
• Persistent elevation in troponin T level during convalescence is associated with inflammatory response in patients with decompensated heart failure

  Kimi Koide, Tsutomu Yoshikawa, Yuji Nagatomo, Toshihisa Anzai, Tomomi Meguro, Satoshi Ogawa

  JOURNAL OF CARDIAC FAILURE 14 (7) S171 - S171 1071-9164 2008/09 [Refereed][Not invited]
  
• Use of renin-angiotensin inhibitors at discharge in patients hospitalized for heart failure is associated with improved survival

  Yusuke Yoshimatsu, Shun Kohsaka, Kimi Koide, Yuji Nagatomo, Hiroyuki Ito, Tomomi Meguro, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa

  JOURNAL OF CARDIAC FAILURE 14 (7) S173 - S173 1071-9164 2008/09 [Refereed][Not invited]
  
• Impact of optimal medical therapy at discharge in patients with heart failure: Characteristics and long-term outcome

  Shuhei Ito, Shun Kohsaka, Kipvii Koide, Yuji Nagatomo, Hiroyuki Ito, Tomomi Meguro, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikaa

  JOURNAL OF CARDIAC FAILURE 14 (7) S173 - S173 1071-9164 2008/09 [Refereed][Not invited]
  
• Differential effects of carvedilol and metoprolol on renal function in patients with heart failure

  Hiroyuki Ito, Yuji Nagatomo, Takashi Kohno, Toshihisa Anzai, Tomomi Meguro, Satoshi Ogawa, Tsutomu Ycshikawa

  JOURNAL OF CARDIAC FAILURE 14 (7) S174 - S174 1071-9164 2008/09 [Refereed][Not invited]
  
• Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection.

  Yusuke Jo, Toshihisa Anzai, Yasuo Sugano, Kotaro Naito, Koji Ueno, Takashi Kohno, Tsutomu Yoshikawa, Satoshi Ogawa

  Heart and vessels 23 (5) 334 - 40 0910-8327 2008/09 [Refereed][Not invited]
   

  We have reported that serum C-reactive protein (CRP) elevation is an independent predictor of lung oxygenation impairment (LOI) after distal type acute aortic dissection (AAD). Systemic activation of the inflammatory system after aortic injury may play a role in the development of LOI. The aim of this study is to clarify the effect of beta-blockers on systemic inflammation and the development of LOI after distal type AAD. A total of 49 patients, who were admitted with distal type AAD and treated conservatively, were examined. White blood cell (WBC) count, serum CRP level, and arterial blood gases were measured serially. Forty patients received beta-blocker treatment within 24 h of the onset, while 9 patients received no beta-blocker treatment. Maximum WBC count, maximum CRP level, lowest PaO(2)/FiO(2) (P/F) ratio, and patient background were compared between the two groups. There was no difference between the groups according to age, sex, coronary risk factors, blood pressure, serum level of CRP, WBC count, and oxygenation index on admission. Beta-blocker treatment was associated with lower maximum WBC count (P = 0.0028) and lower maximum serum CRP level (P = 0.0004). The minimum P/F ratio was higher in patients with beta-blocker treatment than in those without (P = 0.0076). Multivariate analysis revealed that administration of a beta-blocker was an independent negative determinant of LOI (P/F ratio < or = 200 mmHg). In conclusion, early use of beta-blockers prevented excessive inflammation and LOI after distal type AAD, suggesting a pleiotropic effect of beta-blockers on the inflammatory response after AAD.
• Overview image of the lumen and vessel wall in coronary CT angiography.

  Masahiro Jinzaki, Minoru Yamada, Kozo Sato, Yutaka Tanami, Toshihisa Anzai, Kosuke Sasaki, Sachio Kuribayashi

  Circulation journal : official journal of the Japanese Circulation Society 72 (4) 671 - 3 1346-9843 2008/04 [Refereed][Not invited]
   

  BACKGROUND: There is no post-processing technique that can display an overview image of the lumen and vessel wall of a whole heart in one image. A merging coronary lumen view (Angiographic View) with a plaque image can provide a single, comprehensive image of plaque distribution. METHODS AND RESULTS: A color-coded plaque image is assigned to different computed tomography attenuation ranges in the coronary artery to visualize plaques. This plaque image is re-formatted into a maximum intensity projection image and loaded onto the Angiographic View image. CONCLUSIONS: The integrated image of the coronary lumen and vessel wall of a whole heart is feasible. This image (Plaque-loaded Angiographic View) will give effective information in explaining the distribution of coronary lesions in patients as well as providing opportunities to discuss treatment strategies.
• Comparison of the effects of carvedilol and metoprolol on exercise ventilatory efficiency in patients with congestive heart failure.

  Masaharu Kataoka, Toru Satoh, Tsutomu Yoshikawa, Iwao Nakamura, Takashi Kohno, Akihiro Yoshizawa, Toshihisa Anzai, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 72 (3) 358 - 63 1346-9843 2008/03 [Refereed][Not invited]
   

  BACKGROUND: The slope of the relationship between ventilation and carbon dioxide production (VE/VCO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the VE/VCO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of beta-blockers, carvedilol or metoprolol, and the VE/VCO2 slope during exercise in patients with CHF. METHODS AND RESULTS: Fifty-seven patients with New York Heart Association functional class II or III with a radionuclide left ventricular ejection fraction (LVEF) of less than 40% received carvedilol or metoprolol in a randomized fashion. The VE/VCO2 slope, LVEF and plasma brain natriuretic peptide (BNP) concentration were determined before and after 16 weeks of treatment. LVEF improved (p<0.01), but the VE/VCO2 slope and BNP did not. A significant improvement in the VE/VCO2 slope was observed in patients with LVEF <29% or BNP >63 pg/ml (respective baseline median values) (p<0.05, p<0.05). In patients with BNP >63 pg/ml, the improvement effect on the VE/VCO2 slope with carvedilol was significantly greater than that with metoprolol (p<0.05) and a significant improvement in the VE/VCO2 slope was observed only in those who took carvedilol (p<0.01). CONCLUSIONS: The VE/VCO2 slope was not improved after beta-blocker therapy in any of the patients. However, it did improve in patients with a lower LVEF or higher BNP level at baseline, and carvedilol was more effective than metoprolol in improving the VE/VCO2 slope in patients with higher BNP levels at baseline.
• Erratum: A 19-year-old man with myocardial infarction and sitosterolemia (Internal Medicine (2003) vol. 42 (7) (591))

  Takaharu Katayama, Toru Satoh, Takashi Yagi, Nobuyoshi Hirose, Yasuo Kuita, Toshihisa Anzai, Yasushi Asakura, Tsutomu Yoshikawa, Hideo Mitamura, Satoshi Ogawa

  Internal Medicine 47 (3) 191  0918-2918 2008/02/01 [Refereed][Not invited]
  
• Genetic ablation of angiotersin II type 1a receptor has a beneficial effect on diabetes-induced cardiomyopathy by expressing heat shock proteins and by inhibiting apoptosis

  Yuji Nagatomo, Tomomi Meguro, Kimi Koide, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa

  CIRCULATION 116 (16) 310 - 310 0009-7322 2007/10 [Refereed][Not invited]
  
• Effects of beta-blocker therapy on high sensitivity c-reactive protein, oxidative stress, and cardiac function in patients with congestive heart failure.

  Yuji Nagatomo, Tsutomu Yoshikawa, Takashi Kohno, Akihiro Yoshizawa, Toshihisa Anzai, Tomomi Meguro, Toru Satoh, Satoshi Ogawa

  Journal of cardiac failure 13 (5) 365 - 71 1071-9164 2007/06 [Refereed][Not invited]
   

  BACKGROUND: It is uncertain whether beta-blocker therapy affects serum C-reactive protein (CRP) level in patients with congestive heart failure (CHF). We attempted to determine if beta-blocker therapy decreases serum CRP production and to correlate the production with biomarkers and cardiac function in such patients. METHODS AND RESULTS: Fifty-two patients with mild to moderate CHF with a left ventricular ejection fraction (EF) <40% were enrolled. They were randomly assigned to metoprolol or carvedilol treatment groups. The CRP concentration decreased significantly in patients with higher baseline CRP concentration, but not in those with lower baseline CRP concentrations. There was an inverse correlation between DeltaCRP and DeltaEF 16 weeks after the start of beta-blocker therapy for patients with higher baseline CRP concentrations. In patients with higher baseline concentrations, CRP decreased in patients who received carvedilol, but not in those who received metoprolol. Plasma lipid peroxide (LPO) concentration significantly decreased, and there was an inverse correlation between DeltaCRP and DeltaLPO 16 weeks after the start of therapy. CONCLUSIONS: Administration of beta-blockers is associated with attenuation of inflammatory marker in certain patients with CHF. The antioxidant effects of beta-blockers, especially carvedilol, may play a role in mediating the phenomenon.
• Increased body temperature after reperfused acute myocardial infarction is associated with adverse left ventricular remodeling.

  Kotaro Naito, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Yasuo Sugano, Takashi Kohno, Keitaro Mahara, Teruo Okabe, Yasushi Asakura, Satoshi Ogawa

  Journal of cardiac failure 13 (1) 25 - 33 1071-9164 2007/02 [Refereed][Not invited]
   

  BACKGROUND: Fever is frequently observed in patients with acute myocardial infarction (AMI); however, its prognostic significance remains to be determined. We sought to determine the prognostic significance of increased body temperature (BT) after AMI. METHODS AND RESULTS: We examined 156 consecutive patients with reperfused first anterior AMI. Axillary BT was serially measured every 6 hours for a week. Patients were divided into quartiles by peak BT from the lowest to highest levels. Peak BT within the first week showed a significant positive correlation with peak C-reactive protein level (P < .0001), but not with peak creatine kinase level. There were positive correlations of peak BT with the incidence of pump failure (P = .022), left ventricular (LV) aneurysm (P = .029), and readmission for heart failure (P = .006). Higher peak BT was associated with greater LV end-diastolic volume (P = .031), greater end-systolic volume (P = .008), and lower LV ejection fraction (P = .014) 2 weeks after AMI. Multiple logistic regression analyses revealed that peak BT quartile was an independent predictor of in-hospital cardiac events (odds ratio = 1.61/quartile, P = .008). Furthermore, peak BT quartile was a significant predictor of readmission for heart failure by Cox proportional hazard model analysis (P = .048). CONCLUSIONS: Increased BT after AMI was associated with a worse clinical outcome and infarct expansion, suggesting a relationship between systemic inflammatory response and LV remodeling.
• Impact of serum C-reactive protein elevation on the left ventricular spherical change and the development of mitral regurgitation after anterior acute myocardial infarction.

  Takashi Kohno, Toshihisa Anzai, Kotaro Naito, Yohei Ohno, Hidehiro Kaneko, Hui-Chong Li, Yasuo Sugano, Yuichiro Maekawa, Shiro Iwanaga, Yasushi Asakura, Tsutomu Yoshikawa, Satoshi Ogawa

  Cardiology 107 (4) 386 - 94 0008-6312 2007 [Refereed][Not invited]
   

  BACKGROUND/AIMS: Mitral regurgitation (MR) is frequently observed in patients with acute myocardial infarction (AMI), and is known to convey an adverse prognosis. We sought to clarify the relationship between MR and left ventricular (LV) remodeling, in association with serum C-reactive protein (CRP) elevation. METHODS/RESULTS: A total of 181 patients with first anterior ST-elevation AMI were examined. MR was detected in 68 patients by color Doppler echocardiography 2 weeks after AMI, and the patients with MR were associated with higher incidence of readmission for heart failure. Serum CRP was serially measured, and the peak serum CRP level was markedly increased in patients with MR compared with those without MR. Multiple logistic regression analysis showed that peak CRP tertile was an independent determinant of MR after AMI (p < 0.0001). In the substudy, the increases in LV end-diastolic volume and sphericity index were higher in patients with MR than in those without MR. CONCLUSIONS: MR during the early phase of anterior AMI was associated with LV spherical change and late-phase heart failure, in association with increased serum CRP level. These findings suggest an important role of the inflammatory response in the development of ischemic MR and LV remodeling.
• Novel method of displaying coronary CT angiography: Angiographic view.

  Masahiro Jinzaki, Kozo Sato, Yutaka Tanami, Minoru Yamada, Sachio Kuribayashi, Toshihisa Anzai, Yasushi Asakura, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 70 (12) 1661 - 2 1346-9843 2006/12 [Refereed][Not invited]
   

  Background A method of displaying coronary computed tomography (CT) angiography, which enables evaluation of coronary artery disease (CAD) with fewer images and is understandable to the third person, is preferable. Methods and Results A maximum intensity projection image was created in which contrast media in the ventricles is eliminated, enabling an overview of CAD in a single 3-dimensional (D) image that can be rotated to be viewed at various angles and is easily understood by a third person. Conclusions A novel method of displaying coronary CT angiography in a single 3-D image has been developed and we believe it should become available for many workstations.
• Genetic ablation of angiotensin II type1a receptor ameliorates cardiac diastolic dysfunction induced by diabetes mellitus through the improvement of calcium handling

  Yuji Nagatomo, Tomomi Meguro, Hitomi Saito, Jun Katada, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yosikawa

  CIRCULATION 114 (18) 151 - 151 0009-7322 2006/10 [Refereed][Not invited]
  
• Presence of autoantibody directed against ss-adrenergic receptors is associated with amelioration of cardiac dysfunction during ss-blocker therapy for congestive heart failure

  Yuji Nagatomo, Tsutomu Yosikawa, Takashi Kohno, Akihiro Yoshizawa, Akiyasu Baba, Toshihisa Anzai, Tomomi Meguro, Toru Sato, Satoshi Ogawa

  CIRCULATION 114 (18) 667 - 667 0009-7322 2006/10 [Refereed][Not invited]
  
• Presence of autoantibody against b1-adrenergic receptors is associated with amelioration of cardiac function during b-blocker therapy for congestive heart failure

  Yuji Nagatomo, Tsutomu Yoshikawa, Takashi Kohno, Akihiro Yoshizawa, Akiyasu Baba, Toshihisa Anzai, Tomomi Meguro, Toru Sato, Satoshi Ogawa

  JOURNAL OF CARDIAC FAILURE 12 (8) S172 - S172 1071-9164 2006/10 [Refereed][Not invited]
  
• Mineralocorticoid receptor blockade arrests pressure overload-induced left ventricular hypertrophy and preserves cardiac function in angiotensin II type 1a receptor knockout mice

  Tomomi Meguro, Tsutomu Yoshikawa, Jun Katada, Hitomi Saito, Toshihisa Anzai, Yuji Nagatomo, Satoshi Ogawa

  CIRCULATION 114 (18) 150 - 150 0009-7322 2006/10 [Refereed][Not invited]
  
• Antigen-specific effects of autoantibodies against sarcolemmal Na-K-ATPase pump in immunized cardiomyopathic rabbits.

  Akiyasu Baba, Tsutomu Yoshikawa, Michikado Iwata, Toshihisa Anzai, Iwao Nakamura, Yumiko Wainai, Satoshi Ogawa, Michael Fu

  International journal of cardiology 112 (1) 15 - 20 0167-5273 2006/09/10 [Refereed][Not invited]
   

  OBJECTIVES: We examine antigen-specific actions of autoantibodies directed against sarcolemmal Na-K-ATPase. BACKGROUND: Autoantibodies against some receptors or pumps were detected in patients with dilated cardiomyopathy. Although immunoglobulin adsorption therapy improved cardiac function in such patients, direct pathogenic effects of autoantibodies remain to be proven. METHODS: Japanese white rabbits were immunized once a month with purified Na-K-ATPase (NKA rabbits, n=10) or a synthetic peptide corresponding to the second extracellular loop of beta1-adrenergic receptors (beta rabbits, n=10), respectively. Control rabbits (n=10) received vehicle in the same manner. RESULTS: At 6 months, cardiac hypertrophy along with increased left ventricular end-diastolic pressure was observed in both NKA and beta rabbits, and inhibitory G protein level increased in both NKA and beta rabbits. Histological findings showed similar myocyte hypertrophy and interstitial fibrosis in both rabbits. Enzymatic activities of Na-K-ATPase were lower in NKA rabbits than in other groups. Immunoblotting showed that alpha3-isoform of Na-K-ATPase was selectively reduced in myocardium from NKA rabbits. CONCLUSIONS: Our present findings suggested that isoform-specific alterations of myocardial Na-K-ATPase activity were induced by immunizing rabbits. This was not secondary change due to cardiac hypertrophy. Thus, autoantibodies against sarcolemmal Na-K-ATPase have antigen-specific effect on the heart in vivo.
• 心筋症の診断と治療 up to date 液性免疫異常からみた心筋症の診断と治療

  馬場 彰泰, 吉川 勉, 長友 祐司, 栗田 康生, 内藤 広太郎, 吉澤 彰宏, 家田 真樹, 安斎 俊久, 島田 恵, 松原 隆, 赤石 誠, 朝倉 靖, 岩永 史郎, 熊谷 裕生, 小川 聡

  Journal of Cardiology (一社)日本心臓病学会 48 (Suppl.I) 154 - 154 0914-5087 2006/09 [Refereed][Not invited]
  
• Aging adversely affects postinfarction inflammatory response and early left ventricular remodeling after reperfused acute anterior myocardial infarction.

  Keitaro Mahara, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Teruo Okabe, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Masahiro Suzuki, Akira Murayama, Satoshi Ogawa

  Cardiology 105 (2) 67 - 74 0008-6312 2006 [Refereed][Not invited]
   

  BACKGROUND AND AIMS: We have demonstrated that an increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of left ventricular (LV) remodeling. We sought to clarify the effect of aging on the postinfarction inflammatory response and LV remodeling. METHODS: We studied 102 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Serum CRP levels, plasma neurohormones and interleukin-6 (IL-6) levels, and LV volume by left ventriculography were serially measured. Patients were divided into two groups according to their age (>or=70 years, n=33; <70 years, n=69). RESULTS: There was no difference in use of cardiovascular drugs and coronary angiographic findings. Older patients had a greater increase in LV end-diastolic volume during 2 weeks after AMI (p=0.0007) and a higher peak CRP level (12.4+/-7.3 vs. 5.5+/-4.2 mg/dl, p<0.0001), although peak CK level was comparable between the two groups. Plasma atrial natriuretic peptide, brain natriuretic peptide and IL-6 levels were higher in older patients at 2 weeks and 6 months after AMI. CONCLUSIONS: Augmented and prolonged activation of the inflammatory system after AMI was observed in older patients, in association with exaggerated LV remodeling. Aging may adversely affect LV remodeling through modification of the inflammatory response after AMI.
• Carvedilol exerts more potent antiadrenergic effect than metoprolol in heart failure.

  Takashi Kohno, Tsutomu Yoshikawa, Akihiro Yoshizawa, Iwao Nakamura, Toshihisa Anzai, Toru Satoh, Satoshi Ogawa

  Cardiovascular drugs and therapy 19 (5) 347 - 55 0920-3206 2005/10 [Refereed][Not invited]
   

  BACKGROUND: It is still uncertain whether or not there is a difference between metoprolol and carvedilol for the treatment of congestive heart failure. We attempted to determine the difference between the two beta-blockers in terms of their antiadrenergic effect during exercise in patients with heart failure and their efficacy based on the baseline plasma brain natriuretic peptide concentration. METHODS: Fifty-three patients with mild to moderate heart failure with a radionuclide left ventricular ejection fraction <40% received open label metoprolol or carvedilol in a randomized fashion. The increase in the heart rate normalized to the increase in the plasma norepinephrine concentration during exercise, was calculated as an index of adrenergic responsiveness during exercise. RESULTS: The increase in heart rate normalized by the increase in plasma norepinephrine concentration, decreased after the initiation of beta-blockers in the carvedilol group, but not in the metoprolol group. The change in cardiac function was more favorable for carvedilol than metoprolol in patients who exhibited a higher baseline brain natriuretic peptide concentration. CONCLUSIONS: Carvedilol exerts a more potent antiadrenergic effect than metoprolol during stress in patients with mild to moderate heart failure. Carvedilol appears to be more efficacious than metoprolol in patients who exhibit higher baseline brain natriuretic peptide concentrations. These differences should be kept in mind when selecting appropriate pharmacologic agents in the treatment of heart failure.
• Serum C-reactive protein elevation predicts poor clinical outcome in patients with distal type acute aortic dissection: association with the occurrence of oxygenation impairment.

  Yasuo Sugano, Toshihisa Anzai, Tsutomu Yoshikawa, Toru Satoh, Shiro Iwanaga, Takeharu Hayashi, Yuichiro Maekawa, Hideyuki Shimizu, Ryohei Yozu, Satoshi Ogawa

  International journal of cardiology 102 (1) 39 - 45 0167-5273 2005/06/22 [Refereed][Not invited]
   

  BACKGROUND: Acute aortic dissection (AAD) is sometimes complicated by respiratory failure due to severe lung oxygenation impairment. Systemic activation of inflammatory system after aortic injury may play some roles in the development of this complication. The aim of this study was to determine the significance of serum C-reactive protein (CRP) elevation in the development of oxygenation impairment and clinical outcome with distal type AAD. METHODS AND RESULTS: A total of 61 patients, who were admitted with distal type AAD within 24 h from the onset, were examined. Serum CRP levels, white blood cell (WBC) counts and body temperature were measured serially for at least 4 days. Oxygenation impairment, defined as the lowest PaO2/FIO2 ratio < or = 200 mmHg, was noted in 31 patients (51%). In patients with oxygenation impairment, peak CRP levels (20.7+/-7.9 vs. 12.7+/-3.8 mg/dl, P < 0.001), peak WBC counts (14,600+/-3600 vs. 11,800+/-4300/mm3, P = 0.008) and body temperature (38.4+/-0.5 vs. 38.0+/-0.6 degrees C, P = 0.004) were significantly higher than those without. Peak CRP level was inversely correlated with the lowest PaO2/FIO2 (P < 0.001). Patients who underwent urgent surgical treatment and/or died in the hospital had higher peak CRP levels (25.1+/-12.3 vs. 16.1+/-7.4 mg/dl, P = 0.010) than those who did not. Multivariate analysis revealed that a peak CRP level > or = 15 mg/dl (relative risk = 12.6, P < 0.001) was an independent determinant of the development of oxygenation impairment. CONCLUSION: The greater serum CRP elevation after distal type AAD was associated with a higher incidence of oxygenation impairment and poor clinical outcome. Systemic activation of the inflammatory system after aortic injury may play an important role in the development of oxygenation impairment.
• Persistent cardiac aldosterone synthesis in angiotensin II type 1A receptor-knockout mice after myocardial infarction.

  Jun Katada, Tomomi Meguro, Hitomi Saito, Akira Ohashi, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa

  Circulation 111 (17) 2157 - 64 0009-7322 2005/05/03 [Refereed][Not invited]
   

  BACKGROUND: The renin-angiotensin-aldosterone system is implicated in the pathogenesis of heart failure. Pharmacological blockade of angiotensin II (Ang II)-dependent signaling is clinically effective in reducing cardiovascular events after myocardial infarction (MI) but still fails to completely prevent remodeling. The molecular basis underlying this Ang II-independent remodeling is unclear. METHODS AND RESULTS: Acute MI was induced by coronary ligation in wild-type (WT) and angiotensin II type IA receptor-knockout (AT1A-KO) mice. Left ventricular (LV) geometry, hemodynamics, and cardiac gene expression were evaluated on day 28. Severe LV remodeling and resultant cardiac dysfunction were observed in WT mice, whereas less marked, but still significant, LV remodeling and cardiac dysfunction were induced in AT1A-KO mice. Gene expression levels of aldosterone synthase and the cardiac aldosterone content were both elevated in the MI hearts, even in AT1A-KO mice. In AT1A-KO mice treated with spironolactone (20 mg/kg per day), LV remodeling, cardiac dysfunction, and cardiac gene expression of collagens and natriuretic peptides were almost normalized. CONCLUSIONS: Our results indicate that genetic blockade of AT1A signaling fails to arrest aldosterone production in cardiac tissues and that cardiac aldosterone plays a critical role in post-MI LV remodeling. The results suggest that spironolactone could be potentially effective in patients with MI, when used in combination with renin-angiotensin system blockade, by blocking the actions of aldosterone produced by Ang II-independent mechanisms.
• Oral sildenafil improves primary pulmonary hypertension refractory to epoprostenol.

  Masaharu Kataoka, Toru Satoh, Tomohiro Manabe, Toshihisa Anzai, Tsutomu Yoshikawa, Hideo Mitamura, Satoshi Ogawa

  Circulation journal : official journal of the Japanese Circulation Society 69 (4) 461 - 5 1346-9843 2005/04 [Refereed][Not invited]
   

  BACKGROUND: Epoprostenol (prostaglandin I(2)) has become recognized as a therapeutic breakthrough that can improve hemodynamics and survival in patients with primary pulmonary hypertension (PPH). However, a significant number of patients have PPH that is refractory to epoprostenol, and lung transplantation has been the only remaining treatment option. METHODS AND RESULTS: The study subjects included 20 consecutive patients with PPH (mean pulmonary arterial pressure: 65+/-15 mmHg) who had received epoprostenol for more than 12 months. The patients were divided into 2 groups; responders and non-responders. In the non-responders, New York Heart Association (NYHA) functional class did not improve and mean right atrial pressure (mRA) increased to 8 mmHg or more, and additional sildenafil, a phosphodiesterase-5 inhibitor, was started. Six patients were included in the non-responders, whose mRA was 9+/-5 mmHg before and significantly increased to 13+/-3 mmHg after epoprostenol administration (p < 0.05). One patient died and the other 5 patients received oral sildenafil. The mRA of 12+/-4 mmHg (value before sildenafil) improved to 8+/-5 mmHg after sildenafil administration. Three patients were classified in the NYHA functional class 4 and improved to class 3, and 2 patients were in class 3 and remained in the same class after the addition of sildenafil. CONCLUSIONS: In patients with severe PPH refractory to epoprostenol treatment, additional oral sildenafil can improve pulmonary hemodynamics and symptoms. The combination therapy of epoprostenol and sildenafil is a new medical treatment to attempt before progressing to lung transplantation for patients with PPH refractory to epoprostenol.
• Granulocyte colony-stimulating factor attenuates early ventricular expansion after experimental myocardial infarction.

  Yasuo Sugano, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Takashi Kohno, Keitaro Mahara, Kotaro Naito, Satoshi Ogawa

  Cardiovascular research 65 (2) 446 - 56 0008-6363 2005/02/01 [Refereed][Not invited]
   

  OBJECTIVE: In the early phase after transmural myocardial infarction (MI), the infarcted myocardium undergoes replacement by scar tissue, which is essential for preserving the structural integrity of the infarcted tissue. Transforming growth factor (TGF)-beta1, which is known as a fibrotic cytokine, plays a pivotal role in the reparative fibrosis after MI. It is reported that granulocyte colony-stimulating factor (G-CSF) can accelerate wound healing. The aim of our study was to investigate the effect of G-CSF on early ventricular expansion after MI. METHODS: MI was induced by ligation of the left coronary artery in male Wistar rats. G-CSF (20 microg/kg/day, MI-GCSF) or saline (MI-saline) was injected subcutaneously 3 h after MI and every 24 h thereafter for 7 days. Hemodynamic and echocardiographic studies were performed at 14 days. Expression of TGF-beta1 and procollagen type I and type III mRNA in both the infarcted and noninfarcted areas was studied by quantitative RT-PCR at 1, 3, 7, and 14 days after MI. Histological studies were performed at 7 days. RESULTS: MI-GCSF had higher LV max dP/dt, lower LV end-diastolic pressure, and smaller LV end-diastolic and end-systolic dimensions compared to MI-saline. Infarct size was not different between MI-GCSF and MI-saline. Expression of TGF-beta1 mRNA in the infarcted area at 3 days was significantly higher in MI-GCSF than in MI-saline. Expression of procollagen type I and type III mRNA in the infarcted area at 3 days was higher in MI-GCSF compared to MI-saline, and the peak mRNA levels were earlier in MI-GCSF. In the noninfarcted area, there was no difference in TGF-beta1 mRNA expression between MI-GCSF and MI-saline. Histologically, collagen accumulation in the infarcted area at 7 days was more prominent in MI-GCSF than in MI-saline. CONCLUSION: G-CSF treatment improves early post-infarct ventricular expansion through promotion of reparative collagen synthesis in the infarcted area, suggesting some beneficial effect of G-CSF on the infarct healing process.
• Relation of stent overexpansion to the angiographic no-reflow phenomenon in intravascular ultrasound-guided stent implantation for acute myocardial infarction.

  Yuichiro Maekawa, Yasushi Asakura, Toshihisa Anzai, Shiro Ishikawa, Teruo Okabe, Tsutomu Yoshikawa, Satoshi Ogawa

  Heart and vessels 20 (1) 13 - 8 0910-8327 2005/02 [Refereed][Not invited]
   

  The angiographic no-reflow phenomenon is observed in some patients during stent implantation for acute myocardial infarction (AMI). We attempted to clarify the influence of stent overexpansion and plaque morphology on the angiographic no-reflow phenomenon in AMI patients who underwent intravascular ultrasound (IVUS)-guided stent implantation. We assessed the thrombolysis in myocardial infarction (TIMI) flow grade in the coronary angiographic findings, and quantitative and qualitative IVUS findings, in a total of 90 patients who underwent IVUS-guided stenting for AMI. The patients were divided into two groups according to the stent-to-artery ratio: overexpansion group (ratio > or =1.2) and non-overexpansion group (ratio <1.2). Angiographic no-reflow (defined as TIMI flow grade <3) in stent implantation was observed in 15 patients (17%). Angiographic no-reflow was more frequently observed in the overexpansion group than in the non-overexpansion group (32% vs 11%, P = 0.0312). Patients with no-reflow had more lipid pool-like images or fissure/dissection than those without. In the overexpansion group, a lipid pool-like image and fissure/dissection were more frequently observed in patients with no-reflow. The rate of target lesion revascularization (TLR) in the overexpansion group was significantly lower than that in the non-overexpansion group during the follow-up period (10% vs 18%, P = 0.0476), but the incidence of pump failure in the overexpansion group was higher than that in the non-overexpansion group during the hospital course (28% vs 14%, P = 0.0358). Stent overexpansion in AMI patients is related to a higher incidence of angiographic no-reflow, especially if the lesion has a lipid pool-like image or fissure/dissection, although there is a tendency for lower TLR.
• Effect of granulocyte-macrophage colony-stimulating factor inducer on left ventricular remodeling after acute myocardial infarction.

  Yuichiro Maekawa, Toshihisa Anzai, Tsutomu Yoshikawa, Yasuo Sugano, Keitaro Mahara, Takashi Kohno, Toshiyuki Takahashi, Satoshi Ogawa

  Journal of the American College of Cardiology 44 (7) 1510 - 20 0735-1097 2004/10/06 [Refereed][Not invited]
   

  OBJECTIVES: We sought to determine the influence of granulocyte-macrophage colony-stimulating factor (GM-CSF) induction on post-myocardial infarction (MI) remodeling, especially in relation to the inflammatory response and myocardial fibrosis. BACKGROUND: Granulocyte-macrophage colony-stimulating factor modifies wound healing by promoting monocytopoiesis and infiltration of monocytes and macrophages into injured tissue; however, the effect of GM-CSF induction on the infarct healing process and myocardial fibrosis is unclear. METHODS: A model of MI was produced in Wistar rats by ligation of the left coronary artery. The MI animals were randomized to receive GM-CSF inducer (romurtide 200 microg/kg/day for 7 consecutive days) (MI/Ro) or saline (MI/C). RESULTS: Echocardiographic and hemodynamic studies on day 14 revealed increased left ventricular (LV) end-diastolic dimension, decreased fractional shortening, elevated LV end-diastolic pressure, and decreased LV maximum rate of isovolumic pressure development in MI/Ro compared with MI/C. Immunoblotting showed that expression of transforming growth factor (TGF)-beta1 in the infarcted site on day 3 after MI was decreased in MI/Ro compared with MI/C. In the infarcted site, TGF-beta1, collagen type I and type III messenger ribonucleic acid (mRNA) expression on day 3, and collagen content on day 7 were reduced in MI/Ro compared with MI/C, in association with marked infarct expansion. In MI/Ro, monocyte chemoattractant protein-1 mRNA level and the degree of infiltration of monocyte-derived macrophages (ED-1-positive)were greater in the infarcted site on day 7 than those in MI/C. CONCLUSIONS: The GM-CSF induction by romurtide facilitated infarct expansion in association with the promotion of monocyte recruitment and inappropriate collagen synthesis in the infarcted region during the early phase of MI.
• Marked improvement with sildenafil in a patient with primary pulmonary hypertension unresponsive to epoprostenol.

  Masaharu Kataoka, Toru Satoh, Tomohiro Manabe, Toshihisa Anzai, Tsutomu Yoshikawa, Hideo Mitamura, Satoshi Ogawa

  Internal medicine (Tokyo, Japan) 43 (10) 945 - 50 0918-2918 2004/10 [Refereed][Not invited]
   

  We report a 48-year-old woman with right heart failure due to primary pulmonary hypertension. Continuous infusion of epoprostenol (prostaglandin I2) for 1.5 years failed to control her condition, but she was later successfully treated with additional sildenafil for a few months. Her mean pulmonary artery pressure was originally 57 mmHg, increased to 62 mmHg with epoprostenol, and decreased to 45 mmHg with sildenafil. Additional sildenafil may be an effective and life-saving agent in patients with primary pulmonary hypertension who show a poor response to epoprostenol, which is considered to be very powerful medical treatment for the disease.
• Angiotensin receptor blockade improves myocardial beta-adrenergic receptor signaling in postinfarction left ventricular remodeling: a possible link between beta-adrenergic receptor kinase-1 and protein kinase C epsilon isoform.

  Toshiyuki Takahashi, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Keitaro Mahara, Michikado Iwata, H Kirk Hammond, Satoshi Ogawa

  Journal of the American College of Cardiology 43 (1) 125 - 32 0735-1097 2004/01/07 [Refereed][Not invited]
   

  OBJECTIVES: We tested the hypothesis that angiotensin II type 1 receptor blocker (ARB) may improve beta-adrenergic receptor (AR) coupling in heart failure (HF) after myocardial infarction (MI). BACKGROUND: Beta-AR desensitization is one of the mechanisms underlying the transition from compensated to decompensated HF. Beta-adrenergic receptor kinase-1 (ARK1), which can be induced by protein kinase C (PKC) in vitro, is activated in the failing myocardium, resulting in beta-AR uncoupling. METHODS: Models of MI in rats were produced by ligation of left coronary artery. Four weeks after surgery, they were randomized to vehicle (MI/control [C]) or candesartan (10 mg/kg/day) treatment (MI/ARB). Sham-operated rats, or shams, served as controls. RESULTS: After two weeks of treatment, echocardiography and hemodynamics showed that the left ventricular (LV) dimension increased and that the percent of fractional shortening and maximum rate of rise in left ventricular pressure (dP/dt) decreased in MI rats compared with shams. There were no differences in these indexes between MI/C and MI/ARB. An increase in maximum dP/dt under isoproterenol (ISO) stimulation was attenuated in MI/C but improved in MI/ARB. Reductions in the percentage of high-affinity sites of beta-AR and ISO-stimulated cyclic adenosine monophosphate production in noninfarcted myocardium were also improved by ARB treatment. Up-regulation of beta-ARK1 and PKC-epsilon isoform protein levels and activation of PKC in noninfarcted myocardium from MI/C were both inhibited by ARB treatment. CONCLUSIONS: Treatment with ARB during the chronic phase of MI improved beta-AR coupling in noninfarcted myocardium without affecting basal LV function. Cross-talk between beta-AR and angiotensin signaling through beta-ARK1 and PKC-epsilon may be responsible for the phenomenon.
• Serum C-reactive protein elevation in left ventricular remodeling after acute myocardial infarction--role of neurohormones and cytokines.

  Toshiyuki Takahashi, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Satoshi Ogawa

  International journal of cardiology 88 (2-3) 257 - 65 0167-5273 2003/04 [Refereed][Not invited]
   

  BACKGROUND: We previously reported that increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of cardiac rupture and long-term outcome. The aim of this study was to clarify the role of serum CRP elevation as a possible marker of left ventricular (LV) remodeling after AMI. METHODS: We prospectively studied 31 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Peak serum CRP level was determined by serial measurements after admission. LV volume and the plasma levels of various neurohormones and cytokines were measured on admission, and 2 weeks and 6 months after AMI. RESULTS: Patients with higher peak CRP levels (above the median) had a greater increase in LV end-diastolic volume during 2 weeks after AMI (+21+/-14 vs. +5+/-6 ml/m(2), P=0.001) and a lower ejection fraction (45+/-11 vs. 53+/-7%, P=0.02) than those with lower CRP levels, associated with a higher incidence of pump failure, atrial fibrillation, and LV aneurysm. Plasma levels of norepinephrine, brain natriuretic peptide, and interleukin-6 2 weeks after AMI were higher in the high CRP group than in the low CRP group. CONCLUSIONS: Increased peak serum CRP level was associated with a greater increase in LV volume after anterior AMI. Plasma norepinephrine and interleukin-6 levels were increased in patients with higher CRP levels, suggesting a possible role of sympathetic activation and enhanced immune response in the development of LV remodeling after AMI.
• Serum C-reactive protein elevation in left ventricular remodeling after acute myocardial infarction--role of neurohormones and cytokines.

  Toshiyuki Takahashi, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Satoshi Ogawa

  International journal of cardiology 88 (2-3) 257 - 65 0167-5273 2003/04 [Refereed][Not invited]
   

  BACKGROUND: We previously reported that increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of cardiac rupture and long-term outcome. The aim of this study was to clarify the role of serum CRP elevation as a possible marker of left ventricular (LV) remodeling after AMI. METHODS: We prospectively studied 31 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Peak serum CRP level was determined by serial measurements after admission. LV volume and the plasma levels of various neurohormones and cytokines were measured on admission, and 2 weeks and 6 months after AMI. RESULTS: Patients with higher peak CRP levels (above the median) had a greater increase in LV end-diastolic volume during 2 weeks after AMI (+21+/-14 vs. +5+/-6 ml/m(2), P=0.001) and a lower ejection fraction (45+/-11 vs. 53+/-7%, P=0.02) than those with lower CRP levels, associated with a higher incidence of pump failure, atrial fibrillation, and LV aneurysm. Plasma levels of norepinephrine, brain natriuretic peptide, and interleukin-6 2 weeks after AMI were higher in the high CRP group than in the low CRP group. CONCLUSIONS: Increased peak serum CRP level was associated with a greater increase in LV volume after anterior AMI. Plasma norepinephrine and interleukin-6 levels were increased in patients with higher CRP levels, suggesting a possible role of sympathetic activation and enhanced immune response in the development of LV remodeling after AMI.
• New horizons of congestive heart failure for the 21 ^st century : Immunological approach

  Tsutomu Yoshikawa, Akiyasu Baba, Toshihisa Anzai

  Respiration and Circulation (株)医学書院 50 (10) 999 - 1006 0452-3458 2002/10 [Refereed][Not invited]
  
• Effect of preinfarction angina pectoris on ST-segment resolution after primary coronary angioplasty for acute myocardial infarction.

  Toshiyuki Takahashi, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Satoshi Ogawa

  The American journal of cardiology 90 (5) 465 - 9 0002-9149 2002/09/01 [Refereed][Not invited]
   

  The presence of preinfarction angina has been shown to exert a favorable effect on left ventricular function after acute myocardial infarction (AMI). Whether or not preinfarction angina is beneficial for myocardial tissue reperfusion, however, remains to be determined. We sought to evaluate the influence of preinfarction angina on resolution of ST-segment elevation, which could be affected by microcirculatory damage after recanalization therapy. We studied 96 patients with a first AMI in whom Thrombolysis In Myocardial Infarction (TIMI)-3 flow in the infarct-related artery was established by primary angioplasty. Percent reduction in the sum of ST elevation from baseline to 1 hour after angioplasty (percent delta summation operator ST) was examined. Poor ST resolution, defined as percent delta summation operator ST <50%, was observed in 25 patients, who had a worse clinical outcome, larger infarct size, and poorer left ventricular function. On multivariate analysis, the absence of preinfarction angina, as well as anterior wall infarction, were major independent predictors of poor ST resolution, whereas age, sex, coronary risk factors, ischemic time, Killip class on admission, multivessel disease, initial TIMI flow grade, and extent of collaterals were not significant. Patients with preinfarction angina had a greater degree of ST-segment resolution than those without angina (71 +/- 21% vs 49 +/- 43%, p = 0.02). Additional ST elevation after reperfusion was noted exclusively in patients without preinfarction angina (p = 0.02). Preinfarction angina is associated with a greater degree of ST-segment resolution in patients with TIMI-3 flow after primary angioplasty, suggesting a protective effect of preinfarction angina against microcirculatory damage after reperfusion.
• 右房内血栓,回盲部潰瘍を伴ったBehcet病の一例

  吉澤 彰宏, 松下 健一, 佐藤 徹, 栗田 康生, 安斎 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡, 四津 良平

  Circulation Journal (一社)日本循環器学会 66 (Suppl.II) 890 - 890 1346-9843 2002/04
• 梅毒性大動脈炎による重症大動脈弁逆流(AR)の一例

  菊池 真大, 杵渕 修, 佐藤 徹, 前川 裕一郎, 栗田 康生, 安斎 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡

  Circulation Journal (一社)日本循環器学会 66 (Suppl.II) 906 - 906 1346-9843 2002/04
• Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction:a possible role for left ventricular remodeling.

  Yuichiro Maekawa, Toshihisa Anzai, Tsutomu Yoshikawa, Yasushi Asakura, Toshiyuki Takahashi, Shiro Ishikawa, Hideo Mitamura, Satoshi Ogawa

  Journal of the American College of Cardiology 39 (2) 241 - 6 0735-1097 2002/01/16 [Refereed][Not invited]
   

  OBJECTIVES: The aim of this study was to determine the significance of peripheral monocytosis in clinical outcome after reperfused acute myocardial infarction (AMI), especially relating to post-infarct left ventricular (LV) remodeling. BACKGROUND: Peripheral monocytosis occurs two to three days after AMI, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. However, the prognostic significance of peripheral monocytosis after AMI remains to be determined. METHODS: A total of 149 patients with first Q-wave AMI were studied. White blood cell (WBC) count, percentage of monocytes and serum C-reactive protein level were measured every 24 h for four days after the onset of AMI. We assessed association between peripheral monocytosis and prognosis including pump failure, LV aneurysm and long-term outcome after AMI. RESULTS: Patients with pump failure (p < 0.0001) or LV aneurysm (p = 0.005) had higher peak monocyte counts than those without these complications. Predischarge left ventriculography revealed that peak monocyte count was positively correlated with LV end-diastolic volume (p = 0.024) and negatively correlated with ejection fraction (p = 0.023). Multivariate analyses showed that peak monocyte count > or = 900/mm(3) was an independent determinant of pump failure (relative risk [RR] 9.83, p < 0.0001), LV aneurysm (RR 4.78, p = 0.046) and cardiac events (RR 6.30, p < 0.0001), including readmission for heart failure, recurrent myocardial infarction and cardiac deaths, including sudden deaths. CONCLUSIONS: Peripheral monocytosis is associated with LV dysfunction and LV aneurysm, suggesting a possible role of monocytes in the development of LV remodeling after reperfused AMI.
• 急性心筋梗塞(AMI)におけるstentingとno reflowとの関連

  前川 裕一郎, 朝倉 靖, 石川 士郎, 河村 朗夫, 高橋 暁行, 山根 明子, 安斎 俊久, 吉川 勉, 小川 聡

  Journal of Cardiology (一社)日本心臓病学会 36 (Suppl.I) 126 - 126 0914-5087 2000/08
• 心不全の病態診断 情報を如何に臨床応用するか βアドレナリン受容体自己抗体を用いた拡張型心筋症患者の突然死の予測

  吉川 勉, 岩田 道圭, 馬場 彰泰, 安斎 俊久, 小川 聡

  Journal of Cardiology (一社)日本心臓病学会 36 (Suppl.I) 96 - 96 0914-5087 2000/08 [Refereed][Not invited]
  
• 心不全急性増悪期における強心薬としては何が適当か? カテコラミンとフォスフォジエステラーゼ阻害薬の比較試験

  河村 朗夫, 吉川 勉, 林 丈晴, 高橋 寿由樹, 中村 岩男, 馬場 彰泰, 安斎 俊久, 高橋 栄一, 佐藤 徹, 小川 聡

  Japanese Circulation Journal (一社)日本循環器学会 64 (Suppl.I) 339 - 339 0047-1828 2000/03 [Refereed][Not invited]
  
• Adenylylcyclase increases responsiveness to catecholamine stimulation in transgenic mice.

  M H Gao, N C Lai, D M Roth, J Zhou, J Zhu, T Anzai, N Dalton, H K Hammond

  Circulation 99 (12) 1618 - 22 0009-7322 1999/03/30 

  BACKGROUND: The cellular content of cAMP generated by activation of adenylylcyclase (AC) through the beta-adrenergic receptor (betaAR) is a key determinant of a cell's response to catecholamine stimulation. We tested the hypothesis that increased AC content, independently of betaAR number, increases responsiveness to catecholamine stimulation in vivo. METHODS AND RESULTS: Transgenic mice with cardiac-directed expression of ACVI showed increased transgene AC expression but no change in myocardial betaAR number or G-protein content. When stimulated through the betaAR, cardiac function was increased, and cardiac myocytes showed increased cAMP production. In contrast, basal cAMP and cardiac function were normal, and long-term transgene expression was not associated with abnormal histological findings or deleterious changes in cardiac function. CONCLUSIONS: The amount of AC sets a limit on cardiac beta-adrenergic signaling in vivo, and increased AC, independent of betaAR number and G-protein content, provides a means to regulate cardiac responsiveness to betaAR stimulation. Overexpressing an effector (AC) does not alter transmembrane signaling except when receptors are activated, in contrast to receptor/G-protein overexpression, which yields continuous activation and has detrimental consequences. Our findings establish the importance of AC content in modulating beta-adrenergic signaling in the heart, suggesting a new target for safely increasing cardiac responsiveness to betaAR stimulation.
• Baroreceptor sensitivity during the compensatory phase of left ventricular overloading

  H Nishimura, T Yoshikawa, T Anzai, A Baba, N Kobayashi, Y Wainai, S Ogawa

  JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION 62 (10) 773 - 778 0047-1828 1998/10 [Refereed][Not invited]
   

  This study focused on the role of the baroreceptor-mediated control during the compensatory process after acute left ventricular overloading induced by aortic regurgitation (AR). Baroreceptor-heart rate sensitivity was measured using a phenylephrine-induced increase in blood pressure according to the steady state method before, 1 day, 1 week and 4 weeks after production of AR in 7 rabbits, and compared with 6 other rabbits that underwent a sham operation. Blood pressure was monitored noninvasively using Finapres in the unanesthetized state. Four weeks after the procedure, the left ventricular diameters of both end-diastole and end-systole were larger in the rabbits with AR than in the sham-operated rabbits. There was no difference in the left ventricular end-diastolic pressure or cardiac output. Left ventricular weight was higher in the rabbits with AR than in the sham-operated rabbits. Myocardial beta-adrenergic receptor density and norepinephrine content were comparable between the two groups. Baroreceptor-heart rate sensitivity significantly decreased 1 week after production of AR, and this alteration in sensitivity was partially restored 4 weeks after production of AR. These findings suggested that the altered baroreceptor-heart rate sensitivity was reversible, relating to the compensatory process after acute left ventricular overloading, and that these changes had some role in its pathophysiology.
• Dissociation between regional dysfunction and beta-adrenergic receptor signaling in heart failure

  T Anzai, NC Lai, MH Gao, HK Hammond

  AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY 275 (4) H1267 - H1273 0363-6135 1998/10 [Refereed][Not invited]
   

  We have previously shown that left ventricular (LV) pacing-induced heart failure is associated with preserved wall thickening in the interventricular septum (TVS) compared with the posterolateral wall (PLW). The current study focuses on the relationship between regional myocardial function and altered beta-adrenergic receptor (beta-AR) signaling. We studied 15 pigs: 6 controls and 9 paced from the left ventricle (225 beats/min, 26 +/- 3 days). Heart failure was documented by decreased LV fractional shortening (P < 0.0001) and increased left atrial pressure (P < 0.0001). In heart failure, despite marked differences in basal regional function (percent wall thickening: IVS, 33 +/- 10% vs. PLW, 13 +/- 7%; P = 0.0003), there were no differences between the two regions in P-AR responsiveness, measured by regional wall thickening in response to dobutamine infusion and any measurement of adrenergic signaling. Adenylyl cyclase activity, beta-AR number, and beta-AR/G(s) coupling were markedly reduced in failing LV without regional differences. In animals with heart failure, LV G protein receptor kinase (GRK) isoform 2 content was unchanged and GRK5, the other major GRK isoform, was increased more than threefold (IVS, 0.51 +/- 0.20 vs. 0.12 +/- 0.12 arbitrary densitometric units, P = 0.01; PLW, 0.47 +/- 0.15 vs. 0.13 +/- 0.09 arbitrary densitometric units, P = 0.03), but again, there were no regional differences. These data indicate that systemic rather than regional factors govern LV adrenergic signaling and that regional adrenergic signaling abnormalities poorly predict wall thickening in the same regions.
• Serum C-reactive Protein Elevation in Acute Myocardial Infarction: A possible prognostic determinant of postinfarction ventricular remodeling

  Tsutomu Yoshikawa, Toshihisa Anzai

  Respiration and Circulation 46 (5) 477 - 482 0452-3458 1998
• Adenylyl cyclase and G protein receptor kinase expression during development of heart failure

  PP Ping, T Anzai, MH Gao, HK Hammond

  AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY 273 (2) H707 - H717 0363-6135 1997/08 [Refereed][Not invited]
   

  We examined alterations in left ventricular (LV) G protein receptor kinase (GRK) and adenylyl cyclase (AC) isoform expression during the development of pacing-induced congestive heart failure (CHF). AC isoform and GRK expression were assessed 4 (mild CHF) and 28 (severe CHF) days after initiation of pacing. LV beta-adrenergic receptor (beta-AR) number and G protein content were unchanged by mild CHF. LV AC isoform mRNA content was unaltered by mild CHF, but there were increases in total GRK activity (P < 0.01), total GRK5 protein content (P < 0.04), and GRK5 mRNA (P = 0.003); total GRK2 protein content and GRK2 mRNA were unchanged. Mild CHF was associated with decreased beta-AR coupling (P < 0.01) and reduced beta-AR stimulation of AC (P < 0.05). Severe CHF was associated with LV beta-AR downregulation (P = 0.0001) and uncoupling (P < 0.001) and marked generalized reduction of AC activity (mean P = 0.01). LV AC(VI) isoform mRNA content was reduced (P = 0.002), but AC(II) and AC(V) isoform mRNA contents were unaffected. Persistent elevations in LV total GRK activity (P < 0.01), total GRK5 protein content (P < 0.001), and GRK5 mRNA(P = 0.01) were found; in contrast, total GRK2 protein content was unchanged and GRK2 mRNA was reduced (P = 0.02). These studies indicate that increased GRK activity is an early change in heart failure that predates alterations in AC isoform expression. Impaired hormonal stimulation of AC, associated with beta-AR uncoupling, may result from increased GRK5 expression. AC downregulation is isoform specific and accompanies severe but not mild CHF.
• EFFECT ON SHORT-TERM PROGNOSIS AND LEFT-VENTRICULAR FUNCTION OF ANGINA-PECTORIS PRIOR TO FIRST Q-WAVE ANTERIOR WALL ACUTE MYOCARDIAL-INFARCTION

  T ANZAI, T YOSHIKAWA, Y ASAKURA, S ABE, T MEGURO, M AKAISHI, H MITAMURA, S HANDA, S OGAWA

  AMERICAN JOURNAL OF CARDIOLOGY 74 (8) 755 - 759 0002-9149 1994/10 [Refereed][Not invited]
   

  The prognostic significance of angina pectoris before the development of first Q-wave anterior wall acute myocardial infarction (AMI) was assessed in 153 patients. A total of 100 patients in this study had angina before Q-wave AMI, whereas 53 patients had no antecedent symptoms of angina. The presence of angina before AMI was associated with a lower incidence of complications including sustained ventricular tachycardia or fibrillation (7% vs 25%, p = 0.0022), pump failure (24% vs 47%, p = 0.0035), cardiac rupture (1% vs 17%, p = 0.0001), and a lower in-hospital mortality rate (11% vs 28%, p = 0.0067). The peak creatine phosphokinase activity was lower in patients with than without antecedent angina (1,727 +/- 1,238 vs 2,675 +/- 2,569 IU/liter, respectively, p = 0.023). There was no difference in the prevalence of multivessel coronary artery disease or the presence of collateral circulation between the 2 groups. Left ventriculography revealed a higher left ventricular ejection fraction (54 +/- 13% vs 46 +/- 11%, p = 0.034) and smaller left ventricular end-diastolic volumes (75 +/- 15 vs 86 +/- 18 ml/m(2), p = 0.017) in patients with than without antecedent angina. These findings suggest that the presence of angina before AMI may be associated with a protective effect on left ventricular function during anterior wall AMI. Although the precise mechanisms underlying the beneficial effects are unknown, they may be related to the development of collateral channels or ischemic preconditioning.
• Myelodysplastic syndrome associated with immunoblastic lymphadenopathy-like T-cell lymphoma: Simultaneous clinical improvement with chemotherapy

  Toshihisa Anzai, Wataru Hirose, Haruyuki Nakane, Mitsuhiro Kawagoe, Toshiaki Kawai, Kiyoaki Watanabe

  Japanese Journal of Clinical Oncology 24 (2) 106 - 110 1465-3621 1994 [Refereed][Not invited]
   

  A 75-year-old woman presented with anemia, lymphadenopathy, hepatomegaly and lingual tumor, but no constitutional symptoms. The laboratory data showed pancytopenia and polyclonal hypergammaglobulinemia. A bone marrow aspirate represented an apparent myelodysplastic syndrome (MDS) feature, specifically, refractory anemia with excess of blasts. A lymph-node biopsy revealed the disappearance of normal architecture, small arborizing blood vessels, large lymphoid cells with prominent cytoplasm (so-called pale cells) and a clonal proliferation of T-lymphocytes. The patient was diagnosed as having MDS associatd with immunoblastic lymphadenopathy (IBL)-like T-cell lymphoma. She was subsequently treated with cyclophosphamide, adriamycin, vincristine and prednisolone for lymphoma which successfully induced a remission of not only the T-cell lymphoma but also the MDS. The case suggested that MDS might be a paraneoplastic complication of IBL-like T-cell lymphoma. © 1994 Oxford University Press.
• Guillain-Barré Syndrome with Bilateral Tonic Pupils

  Toshihisa Anzai, Kazushi Takahashi, Tetsuji Katayama

  Internal Medicine 33 (4) 248 - 251 1349-7235 1994 [Refereed][Not invited]
   

  A 53-year-old patient with Guillain-Barre syndrome preceded by herpes simplex virus infection developed bilateral tonic pupils with light-near dissociation. Pharmacological tests for pupils suggested postganglionic involvement of the parasympathetic and sympathetic nerves. A demyelinating process of peripheral autonomic nerves was suspected to be the cause of the tonic pupils and autonomic dysfunction. © 1994, The Japanese Society of Internal Medicine. All rights reserved.

MISC

• 除細動閾値テストの必要性を考えさせられた皮下植込み型除細動器の1例

  佐々木亮, 天満太郎, 平子竜大, 千葉裕基, 前野幹, 齋藤翔太, 立田大志郎, 甲谷次郎, 西野広太郎, 夏井宏征, 門坂崇秀, 中尾元基, 太田稔, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• リードレスペースメーカ植込みを実施した左心補助人工心臓植込み患者において心室頻拍の遠隔管理に難渋した1例

  中尾元基, 天満太郎, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 齋藤翔太, 甲谷次郎, 西野広太郎, 立田大志郎, 夏井宏征, 門坂崇秀, 渡邉昌也, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 心房細動を合併する非虚血性心疾患患者における植込み型除細動器適切作動の検討

  西野広太郎, 天満太郎, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 齋藤翔太, 甲谷次郎, 立田大志郎, 夏井宏征, 門坂崇秀, 中尾元基, 渡邉昌也, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 植込み型左室補助装置による電磁干渉を回避しえた皮下植込み型除細動器の症例

  門坂崇秀, 天満太郎, 渡邉昌也, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 齋藤翔太, 西野広太郎, 甲谷次郎, 立田大志郎, 夏井宏征, 中尾元基, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 植込み型除細動器の頻拍検出設定においてエキスパートコンセンサスの盲信により適切な頻拍検出がなされなかった1例

  立田大志郎, 天満太郎, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 齋藤翔太, 甲谷次郎, 西野広太郎, 夏井宏征, 門坂崇秀, 中尾元基, 渡邉昌也, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 導線露出を伴うRiata ICDリードに対して,経静脈および外科的アプローチによるハイブリッド治療が有効であったデバイス感染の1例

  夏井宏征, 天満太郎, 渡邉昌也, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 齋藤翔太, 甲谷次郎, 立田大志郎, 西野広太郎, 門坂崇秀, 中尾元基, 南田大朗, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 高齢者における心臓突然死予防目的の植込み型心臓デバイスの有効性

  天満太郎, 齋藤翔太, 甲谷次郎, 西野広太郎, 立田大志郎, 夏井宏征, 門坂崇秀, 中尾元基, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 渡邉昌也, 渡邉昌也, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 日本人における2019HRS/EHRA/APHRS/LAHRS Expert Consensusに基づいた植込み型除細動器治療設定の有効性

  甲谷次郎, 天満太郎, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 齋藤翔太, 立田大志郎, 西野広太郎, 夏井宏征, 門坂崇秀, 中尾元基, 渡邉昌也, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• 体重増加とともにlead位置が大きく変動し,不適切作動に至った皮下植込み型除細動器の1例

  齋藤翔太, 天満太郎, 西野広太郎, 甲谷次郎, 立田大志郎, 夏井宏征, 門坂崇秀, 平子竜大, 中尾元基, 千葉裕基, 前野幹, 佐々木亮, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  16th-  2024
• Biopsy-proven cardiac sarcoidosis mimicking apical hypertrophic cardiomyopathy

  Kei Kawakami, Kazunori Omote, Satonori Tsuneta, Toshiyuki Nagai, Toshihisa Anzai  European Heart Journal Cardiovascular Imaging  25-  (1)  E57  2024/01/01
• Focal myocarditis associated with immune checkpoint inhibitor therapy

  Mizuki Hayashizaki, Kazunori Omote, Satonori Tsuneta, Toshiyuki Nagai, Toshihisa Anzai  European Heart Journal Cardiovascular Imaging  24-  (12)  E308  2023/12/01
• 高出力ペーシングによるQRS波形変化がヒス束伝導路の推定に有効であった前中隔副伝導路を有するWPW症候群の1例

  立田大志郎, 天満太郎, 齋藤翔太, 甲谷次郎, 西野広太郎, 夏井宏征, 門坂崇秀, 中尾元基, 小野太祐, 渡邉昌也, 安斉俊久  日本不整脈心電学会カテーテルアブレーション関連大会(Web)  2023-  2023
• Epicardial connectionが疑われ大動脈無冠尖から有効通電が得られたPeri-mitral atrial flutterの1例

  門坂崇秀, 天満太郎, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 斎藤翔太, 西野広太郎, 甲谷次郎, 立田大志郎, 夏井宏征, 中尾元基, 渡邉昌也, 安斉俊久  日本不整脈心電学会カテーテルアブレーション関連大会(Web)  2023-  2023
• Application of an Echocardiographic Scoring System of Left Ventricular Filling Pressure for Patients with Aortic Stenosis

  青柳裕之, 岩野弘幸, 後藤真奈, 鈴木ゆき乃, 村山迪史, 横山しのぶ, 西野久雄, 中鉢雅大, 中村公亮, 玉置陽生, 本居昂, 石坂傑, 加賀早苗, 神谷究, 永井利幸, 安斉俊久  日本循環器学会学術集会(Web)  87th-  2023
• Head-to-head comparison between hepatic vein flow and superior vena cava flow patterns analysis for predicting elevated right atrial pressure

  村山迪史, 村山迪史, 加賀早苗, 加賀早苗, 境田ひな, 小野田愛梨, 中鉢雅大, 西野久雄, 横山しのぶ, 石坂傑, 岩野弘幸, 岩野弘幸, 安斉俊久  超音波医学 Supplement  50-  2023
• 心不全患者における複数の超音波指標を組み合わせたうっ血肝診断モデルの確立

  小野田愛梨, 村山迪史, 加賀早苗, 中鉢雅大, 横山しのぶ, 西野久雄, 石坂傑, 本居昴, 青柳裕之, 玉置陽生, 中村公亮, 岩野弘幸, 安斉俊久  日本循環器学会学術集会(Web)  87th-  2023
• 超音波法を用いたスコアリングによるうっ血肝診断と予後予測

  小野田愛梨, 村山迪史, 村山迪史, 加賀早苗, 加賀早苗, 工藤悠輔, 岩井孝仁, 中鉢雅大, 横山しのぶ, 西野久雄, 西田睦, 石坂傑, 岩野弘幸, 岩野弘幸, 安斉俊久  日本超音波検査学会学術集会講演抄録集(Web)  48th-  2023
• 抗ミトコンドリアM2抗体陽性筋炎17例の臨床的特徴

  長井 梓, 永井 利幸, 矢口 裕章, 藤井 信太朗, 上床 尚, 白井 慎一, 岩田 育子, 松島 理明, 堀内 一宏, 浦 茂久, 安斉 俊久, 矢部 一郎  神経治療学  39-  (6)  S263  -S263  2022/10
• 【循環器薬の使い方-使い分け,モニタリング,導入・中止のタイミング】心不全 RAS阻害薬からARNIまで

  小林 雄太, 安斉 俊久  循環器ジャーナル  70-  (2)  218  -224  2022/04  

  ＜文献概要＞Point ・心不全患者においてACE阻害薬は予後を改善させると報告されている.・ARBはACE阻害薬に対する優位性は証明されておらず,ACE阻害薬の忍容性がない場合に処方を検討する.・ARNIはACE阻害薬と比較して優位性を示し,現在急速に普及している薬剤である.・RAS阻害薬導入にあたっては,低血圧による臓器灌流障害,腎機能障害,電解質異常などに注意する.
• SGLT2阻害薬はミトコンドリア機能の改善を介し膵β細胞量・機能を保護する

  山内 裕貴, 中村 昭伸, 横田 卓, 高橋 清彦, 川田 晋一朗, 土田 和久, 大森 一乃, 野本 博司, 亀田 啓, 曹 圭龍, 安斉 俊久, 田中 伸哉, 寺内 康夫, 三好 秀明, 渥美 達也  日本内分泌学会雑誌  98-  (1)  361  -361  2022/04
• 【お薬立ちBOOK2022 解剖生理・病態生理から薬学管理へ】病態生理を踏まえた薬物治療・薬学管理へ 循環器疾患 急性心不全、慢性心不全、うっ血性心不全

  天木 誠, 安斉 俊久  薬局  73-  (4)  957  -965  2022/03
• Suppression of Mitochondrial Oxidative Stress and Atrial Fibrillation Inducibility by SGLT2 Inhibitors in Diabetic Rats(和訳中)

  小泉 拓也, 渡邉 昌也, 横田 卓, 夏井 宏征, 門坂 崇秀, 甲谷 太郎, 中尾 元基, 萩原 光, 鎌田 塁, 天満 太郎, 安斉 俊久  日本循環器学会学術集会抄録集  86回-  MPJ14  -4  2022/03
• 【慢性心不全の薬物治療】総論 フォーカスアップデートの心不全治療アルゴリズムを読む 左室駆出率の保たれた心不全

  安斉 俊久  日本内科学会雑誌  111-  (2)  213  -220  2022/02
• Intrinsic anti-tachycardia pacingにより植込み型除細動器のショック治療を回避することができた1例

  萩原光, 渡邉昌也, 平子竜大, 千葉裕基, 前野幹, 佐々木亮, 甲谷次郎, 立田大志郎, 西野広太郎, 夏井宏征, 門坂崇秀, 小泉拓也, 中尾元基, 甲谷太郎, 小西崇夫, 佐藤琢真, 鎌田塁, 安斉俊久  植込みデバイス関連冬季大会プログラム・抄録集(Web)  14th-  2022
• 難治性VTを合併した重症心不全患者に対し,LVAD装着時に心外膜側アブレーションを施行した1例

  西野広太郎, 渡邉昌也, 青柳裕之, 甲谷次郎, 立田大志郎, 夏井宏征, 門坂崇秀, 小泉拓也, 甲谷太郎, 中尾元基, 天満太郎, 安斉俊久  日本不整脈心電学会カテーテルアブレーション関連大会(Web)  2022-  2022
• ガイドラインに基づく右房圧推定における副次的指標の再考

  村山迪史, 村山迪史, 加賀早苗, 岡田一範, 小野田愛梨, 種村明日香, 中鉢雅大, 横山しのぶ, 西野久雄, 西田睦, 辻永真吾, 岩野弘幸, 岩野弘幸, 安斉俊久  日本超音波検査学会学術集会講演抄録集(Web)  47th-  2022
• Influencing factors for the overestimation of severity of pulmonary regurgitation by Doppler echocardiography

  本居昂, 岩野弘幸, 岩野弘幸, 常田慧徳, 村山迪史, 加賀早苗, 青柳裕之, 玉置陽生, 石坂傑, 千葉泰之, 辻永真吾, 種村明日香, 横山しのぶ, 中鉢雅大, 西野久雄, 岡田一範, 武田充人, 安斉俊久  日本成人先天性心疾患学会雑誌(Web)  11-  (1)  2022
• J-CLEAR通信 心不全の薬物治療 収縮機能障害HFrEFを中心として

  中尾 元基, 安斉 俊久  日本医事新報  (5096)  36  -40  2021/12
• 注目の新薬 ベリキューボ(ベルイシグアト)

  安斉 俊久  診断と治療  109-  (10)  1447  -1452  2021/10
• 【予防・治療・緩和ケアの最重要ポイントを押さえる心不全治療アップデート】心不全の悪化予防 心不全チーム

  佐藤 琢真, 永井 利幸, 安斉 俊久  薬事  63-  (12)  2479  -2436  2021/09  

  ＜Points＞▼心不全では原因疾患に応じた治療戦略を構築することが重要であるが、疾患そのものに対する治療だけでなく、患者の価値観や生活背景を考慮した包括的な支援が必要とされる。▼運動・食事・生活習慣の管理や、適切な薬物治療に関する理解は、重症度や原因疾患にかかわらずすべての心不全患者における治療の基盤となる最重要事項である。▼多職種介入のもとで、心不全患者の生活のなかに潜む心不全増悪要因を把握し、それにあわせた適切かつ患者・家族の価値観や思いに沿った心不全セルフケア支援を進め、再入院の予防に努めることは、心不全診療における重要な柱である。(著者抄録)
• MitraClipを用いた経皮的僧帽弁接合修復術により強心薬を離脱できた重症心不全の一例

  高橋 昌寛, 辻永 真吾, 高橋 勇樹, 佐藤 琢真, 内藤 正一郎, 青柳 裕之, 小林 雄太, 神谷 究, 岩野 弘幸, 永井 利幸, 安斉 俊久  日本心臓病学会学術集会抄録  69回-  O  -267  2021/09
• 【心不全/糖尿病パンデミック的現状とICU】心不全薬物治療の新展開

  多田 篤司, 安斉 俊久  ICUとCCU  45-  (8)  463  -470  2021/08  

  社会の高齢化進行とともに心不全患者は増加の一途をたどっており、心不全パンデミックとして重要な社会問題となっている。現在、心不全治療において、主にアンジオテンシン変換酵素阻害薬、アンジオテンシンII受容体拮抗薬、β遮断薬、ミネラルコルチコイド受容体拮抗薬が心予後改善のエビデンスに基づいて使用されている。しかし、心不全予後は依然として良好とは言い難く、従来治療の効果を上回る治療薬の開発が進められてきた。最近になり新規治療薬として、アンジオテンシン受容体/ネプリライシン阻害薬やHCNチャネル阻害薬やSGLT-2阻害薬が使用可能となった。さらに、可溶性グアニル酸シクラーゼ刺激薬や心筋ミオシン活性化薬なども臨床研究で結果が得られており、近い将来使用可能になるであろう。これらの心不全薬物治療の新展開により、心不全診療は今後もますます発展すると考えられる。(著者抄録)
• 【循環器病の対策推進計画とトピックス】心不全診療と推進基本計画

  安斉 俊久  循環器内科  90-  (1)  22  -27  2021/07
• 【二次性心筋症-Present and Future】収縮不全を主徴とする二次性心筋症 がん治療関連心機能障害(CTRCD)

  辻永 真吾, 安斉 俊久  医学のあゆみ  277-  (5)  400  -405  2021/05  

  高齢化社会とがん治療の進歩により、循環器疾患を合併するがん患者やがんサバイバーが急激に増加している。がん化学療法に伴う心機能障害により、化学療法の継続が困難になったり、循環器疾患の合併ががん治療の妨げになるがん患者の増加が顕著なため、腫瘍循環器学(Onco-Cardiology)の必要性が叫ばれるようになった。そのなかでも、がん治療関連心機能障害(CTRCD)はがん患者やがんサバイバーの予後に影響するため、重要な疾患概念である。2014年に米国心エコー図学会(ASE)と欧州心血管イメージング学会(EACVI)が合同で、また2016年に欧州心臓病学会(ESC)からもこれまでのエビデンスをまとめたposition paperが発表され、CTRCDが定義され、がん治療を適切かつ安全に進めるうえで、循環器系合併症のモニタリングや治療介入の必要性が強調された。本稿では、腫瘍循環器学診療におけるCTRCDについて解説する。(著者抄録)
• 【合併症とそのマネージメント】腎障害と対処法

  山下 武廣, 安斉 俊久  Coronary Intervention  17-  (3)  76  -81  2021/05
• SGLT2阻害薬はミトコンドリア機能の改善を介し膵β細胞を保護する

  山内 裕貴, 中村 昭伸, 横田 卓, 高橋 清彦, 川田 晋一朗, 土田 和久, 大森 一乃, 野本 博司, 亀田 啓, 曹 圭龍, 安斉 俊久, 田中 伸哉, 寺内 康夫, 三好 秀明, 渥美 達也  糖尿病  64-  (Suppl.1)  III  -6  2021/05
• 【循環器疾患 緩和ケアの現状を識る】識る 循環器緩和ケアチームのあり方

  佐藤 琢真, 永井 利幸, 安斉 俊久  Heart View  25-  (4)  332  -337  2021/04  

  ＜文献概要＞Point 1 身体的,社会的,精神・心理的,スピリチュアルな苦痛といった全人的苦痛に対応するには,多職種による連携を促進する必要がある。そのため,互いの役割や専門性を理解したうえで,協働することが可能な体制を整備する必要がある。2 循環器疾患における緩和ケアでは,疾患そのものに対する適切な治療が症状ならびにQOL改善のために必要であり,多職種が連携して行う循環器疾患患者の管理全体の流れのなかで提供されることが望ましい。3 治療抵抗性の症状管理や困難な意思決定支援やコミュニケーションなど,複雑な問題への対応には緩和ケア医の経験が必要となるため,専門的緩和ケアチームとの十分な連携が重要である。
• 【新規心不全治療薬の使い方】ベルイシグアト

  安斉 俊久  医学のあゆみ  277-  (4)  285  -290  2021/04  

  心不全患者においては、血管内皮機能障害に伴い一酸化窒素(NO)の生物学的利用能が低下しており、NOの細胞内受容体である可溶型グアニリル酸シクラーゼ(sGC)の活性低下に伴い、環状グアノシン3'、5'-1リン酸(cGMP)の産生が低下し、心不全の病態を悪化させる。sGC刺激薬は、細胞質内cGMP濃度を上昇させることでプロテインキナーゼG(PKG)を活性化させ、血管平滑筋細胞においては血管拡張作用をもたらすほか、心筋細胞においては心筋肥大・線維化を抑制する作用を発揮する。左室駆出率(LVEF)の低下した心不全(HFrEF)を対象とした第III相臨床試験では、心不全に対する標準治療にベルイシグアトを追加投与することで、心血管死ならびに心不全入院からなる複合エンドポイントを10%有意に減少させることが明らかになった。心不全悪化を伴うHFrEFに対して、今後は標準治療の一部になるものと期待される。(著者抄録)
• 新規の慢性心不全治療薬ベルイシグアト

  安斉 俊久  循環器内科  89-  (4)  470  -476  2021/04
• 負荷心エコー図検査の現状と未来 負荷心エコー図検査を活かす 検査導入後5年間の取り組み

  辻永 真吾, 岩野 弘幸, 青柳 裕之, 玉置 陽生, 本居 昂, 石坂 傑, 千葉 泰之, 永井 利幸, 安斉 俊久  超音波医学  48-  (Suppl.)  S212  -S212  2021/04
• 【二次性心筋疾患を見逃すな!】心筋炎の診断と治療 急性期、慢性期の治療は?

  辻永 真吾, 安斉 俊久  循環器内科  89-  (3)  308  -315  2021/03
• 【病気とくすり2021 基礎と実践Expert's Guide】循環器系の病気とくすり 循環器系疾患 心不全

  天木 誠, 安斉 俊久, 和田 恭一  薬局  72-  (4)  932  -951  2021/03
• 循環器疾患における緩和ケアについてのJCS 2021/JHFS 2021 statement(JCS 2021/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases)

  安斉 俊久  日本循環器学会学術集会抄録集  85回-  RT14  -1  2021/03
• 心内血流パラメータと心臓形態の関連(Relationships between Intra-cardiac Flow Parameters and Cardiac Morphology)

  岩野 弘幸, 安斉 俊久  日本循環器学会学術集会抄録集  85回-  TP02  -2  2021/03
• 心不全の重症化予防の取り組み

  安斉 俊久  日本循環器学会学術集会抄録集  85回-  LS26  -LS26  2021/03
• 循環器疾患患者のこころの問題にどう向き合うか?(緩和ケアも含めて) 当院における心不全緩和ケアチームの立ち上げと現状

  阿部 隆宏, 佐藤 琢真, 加藤 美香, 笠谷 美鈴, 成田 尚, 福澤 宏之, 片山 真育, 池田 陽子, 小島 尚子, 杉本 由佳, 永井 利幸, 安斉 俊久  日本循環器学会学術集会抄録集  85回-  CS5  -3  2021/03
• 心不全療養指導士を取得した理学療法士としての活動

  阿部隆宏, 永井利幸, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  25th-  2021
• 心不全緩和ケアチームによる介入

  阿部隆宏, 佐藤琢真, 永井利幸, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  25th-  2021
• 臨床高血圧125周年 論点の整理と将来展望 高血圧心としてのHFpEFの病態と適正治療のあり方

  安斉 俊久  Therapeutic Research  42-  (1)  15  -20  2021/01
• 心臓サルコイドーシス患者における血清可溶性インターロイキン2レセプター高値は長期予後と関連する

  小林雄太, 永井利幸, 平田健司, 常田慧徳, 加藤喜哉, 小森山弘和, 神谷究, 小西崇夫, 佐藤琢真, 表和徳, 工藤與亮, 今野哲, 安斉俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  41-  (サプリメント号)  62  -62  2021
• Importance of Atrial Fibrillation and Right Atrial Remodeling in Functional Tricuspid Regurgitation in Heart Failure with Preserved Ejection Fraction

  原田智成, 小保方優, 表和徳, 岩野弘幸, 吉田くに子, 加藤寿光, 永井利幸, 安斉俊久, 倉林正彦  日本循環器学会学術集会(Web)  85th-  OJ88  -6  2021
• 慢性心不全における右室cardiac power outputの意義

  千葉泰之, 岩野弘幸, 岩野弘幸, 本居昂, 石坂傑, 辻永真吾, 村山迪史, 横山しのぶ, 中鉢雅大, 西野久雄, 岡田一範, 加賀早苗, 神谷究, 永井利幸, 安斉俊久  日本心臓病学会学術集会(Web)  69th-  2021
• 心エコー法による新たな左房圧指標を用いたHFpEFの予後予測に関する検討

  村山迪史, 岩野弘幸, 岩野弘幸, 岩野弘幸, 表和徳, 原田智成, 小保方優, 加藤寿光, 中鉢雅弘, 西野久雄, 横山しのぶ, 辻永真吾, 千葉泰之, 石坂傑, 本居昂, 西田睦, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  25th-  2021
• A case of ventricular tachycardia in a patient with non ischemic cardiomyopathy; tachycardia showing an alternating QRS morphology with a reentry mechanism maintained by alternating the different slow conduction zones of the intramural tissue

  鎌田塁, 渡邉昌也, 天満太郎, 萩原光, 甲谷太郎, 中尾元基, 安斉俊久, 横式尚司, 四倉昭彦, 南部忠詞, 吉田泉, 櫻井正之  臨床心臓電気生理  44-  2021
• 器質的心疾患患者における繰り返す心室頻拍後の心臓死規定因子の検討

  小泉拓也, 鎌田塁, 夏井宏征, 門坂崇秀, 中尾元基, 甲谷太郎, 萩原光, 渡邉昌也, 横式尚司, 安斉俊久  日本心臓病学会学術集会(Web)  69th-  2021
• MRIのT1mappingによる心筋細胞外容積分画は筋ジストロフィーによるびまん性心筋障害の検出に有用である

  相川忠夫, 小梁川和宏, 小林雄太, 武田充人, 白石秀明, 常田慧徳, 岩野弘幸, 永井利幸, 安斉俊久, 真鍋徳子  日本心血管画像動態学会プログラム・抄録集  31st (CD-ROM)-  2021
• Clinical utility of stress echocardiography: summary of 5 years’ experience

  辻永真吾, 岩野弘幸, 青柳裕之, 玉置陽生, 本居昂, 石坂傑, 千葉泰之, 永井利幸, 安斉俊久  超音波医学 Supplement  48-  2021
• 三次元スペックルトラッキング法による右室機能解析に関する初期検討

  岡田 一範, 加賀 早苗, 上田 龍一郎, 柳 裕介, 相庭 美穂, 政氏 伸夫, 三神 大世, 中鉢 雅大, 岩野 弘幸, 安斉 俊久  超音波医学  47-  (Suppl.)  S221  -S221  2020/11
• Influence of Advanced Pulmonary Vascular Remodeling on Accuracy of Echocardiographic Parameters of Left Ventricular Filling Pressure

  Yasuyuki Chiba, Hiroyuki Iwano, Sanae Kaga, Mio Shinkawa, Michito Murayama, Hiroshi Ohira, Ko Motoi, Suguru Ishizaka, Shingo Tsujinaga, Shinobu Yokoyama, Masahiro Nakabachi, Hisao Nishino, Kazunori Okada, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai  CIRCULATION  142-  2020/11  

  0
• Left Ventricular External Work as a Marker of Cardiac Functional Recovery and Outcome After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis

  Shingo Tsujinaga, Hiroyuki Iwano, Ko Motoi, Yasuyuki Chiba, Suguru Ishizaka, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Kazunori Okada, Sanae Kaga, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai  CIRCULATION  142-  2020/11  

  0
• 心臓サルコイドーシス患者における左室駆出率低値と血清ACE活性高値は組織診断陽性と関連する

  小森山 弘和, 表 和徳, 永井 利幸, 加藤 喜哉, 永野 伸卓, 神谷 究, 小西 崇夫, 草野 研吾, 植田 初江, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  40-  (サプリメント号)  52  -52  2020/10
• 心臓サルコイドーシス患者におけるステロイド開始前心室再分極過程のばらつきは長期心事故発生と関連する

  小林 雄太, 永井 利幸, 神谷 究, 小西 崇夫, 佐藤 琢真, 加藤 喜哉, 小森山 弘和, 草野 研吾, 植田 初江, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  40-  (サプリメント号)  56  -56  2020/10
• 【循環器疾患バイオマーカー 有用性と可能性】診る 欧米のエビデンスに基づいた心不全ガイドラインは日本人に当てはまるか? バイオマーカーを中心に

  永井 利幸, 安斉 俊久  Heart View  24-  (10)  937  -943  2020/10  

  ＜文献概要＞Point 1 心不全ガイドラインでは,数多くのバイオマーカーのうち,診断,予後予測を目的とした脳性ナトリウム利尿ペプチドおよび予後予測を目的とした心筋トロポニンの2 種類を測定することが推奨されている。2 ガイドラインの適用にあたっては,欧米と比較したわが国の心不全患者の臨床的特徴(併存症の違いなど)を考慮する必要がある。3 脳性ナトリウムペプチドなどバイオマーカーを予後モデルに応用することにより,欧米の予後モデルをより正確にわが国の心不全患者に当てはめられる可能性がある。
• 【循環器疾患のPrecision Medicine】臨床 心不全個別化医療

  永井 利幸, 安斉 俊久  Cardiac Practice  31-  (1)  32  -36  2020/10
• 心臓サルコイドーシス患者における左室駆出率低値と血清ACE活性高値は組織診断陽性と関連する

  小森山 弘和, 表 和徳, 永井 利幸, 加藤 喜哉, 永野 伸卓, 神谷 究, 小西 崇夫, 草野 研吾, 植田 初江, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  40-  (サプリメント号)  52  -52  2020/10
• 心臓サルコイドーシス患者でfragmented QRSは、心事故、慢性期致死性不整脈と関連する

  萩原 光, 渡邉 昌也, 中尾 元基, 甲谷 太郎, 小林 雄太, 加藤 喜哉, 小森山 弘和, 鎌田 塁, 永井 利幸, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  40-  (サプリメント号)  56  -56  2020/10
• 心臓サルコイドーシス患者におけるステロイド開始前心室再分極過程のばらつきは長期心事故発生と関連する

  小林 雄太, 永井 利幸, 神谷 究, 小西 崇夫, 佐藤 琢真, 加藤 喜哉, 小森山 弘和, 草野 研吾, 植田 初江, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  40-  (サプリメント号)  56  -56  2020/10
• 【腎臓と他臓器連関を考える-CKDにおける包括的治療戦略を目指して】臓器連関の実態 心腎連関 心臓の観点から

  小林 雄太, 安斉 俊久  内科  126-  (2)  181  -183  2020/08  

  ＜文献概要＞▼腎臓と心臓は相互に影響を及ぼし合い,腎障害の重症度に比して心血管疾患(CVD)のリスクが高まることが知られている.▼慢性腎臓病(CKD)は動脈硬化性の冠動脈疾患のみならず心筋疾患や弁膜症,さらには不整脈といったCVDの発症リスクである.▼CVD患者でのCKD合併は予後不良との関連が報告されている.▼これらの関連は心腎連関といわれ,CKDの管理にあたってはより早期にCVDのリスクを捉え,的確に双方の相互作用を意識した多角的アプローチが必要とされる.
• 心不全と栄養 心不全患者の栄養状態評価と集学的アプローチの重要性(The Importance of Assessing Nutritional Status and Multidisciplinary Approach for Malnutrition in Patients with Heart Failure)

  永井 利幸, 安斉 俊久  日本循環器学会学術集会抄録集  84回-  シンポジウム19  -1  2020/07
• すべての心疾患患者のためのAdvance Care Planning 循環器診療に関わる医療従事者の緩和ケアに対する意識調査 死にゆく患者に対する医療者のケア態度尺度を用いた検討

  阿部 隆宏, 石森 直樹, 加藤 美香, 中村 倫子, 安斉 俊久  日本循環器学会学術集会抄録集  84回-  チーム医療シンポジウム1  -3  2020/07
• 【循環器疾患とビッグデータ・AI】Precision Medicineの現状

  永井 利幸, 安斉 俊久  循環器内科  88-  (1)  9  -17  2020/07
• 心不全と栄養(The Importance of Assessing Nutritional Status and Multidisciplinary Approach for Malnutrition in Patients with Heart Failure)

  永井 利幸, 安斉 俊久  日本循環器学会学術集会抄録集  84回-  シンポジウム19  -1  2020/07
• すべての心疾患患者のためのAdvance Care Planning 循環器診療に関わる医療従事者の緩和ケアに対する意識調査 死にゆく患者に対する医療者のケア態度尺度を用いた検討

  阿部 隆宏, 石森 直樹, 加藤 美香, 中村 倫子, 安斉 俊久  日本循環器学会学術集会抄録集  84回-  チーム医療シンポジウム1  -3  2020/07
• 【心不全パンデミック】心不全の緩和医療・終末期医療

  安斉 俊久  日本医師会雑誌  149-  (3)  529  -533  2020/06
• 急性・慢性心不全診療ガイドライン 各分野のガイドラインを紐解く

  安斉 俊久  北海道外科雑誌  65-  (1)  18  -22  2020/06  

  心不全とは、ポンプとしての心臓の機能が低下し、体が要求する血液を十分に送り出せなくなることによって起こる労作時息切れや呼吸困難などの一連の症状をさす症候群である。一度発症すると、治療により一時的には安定化するものの、やがては急性増悪を繰り返すようになり、一般的には良性疾患と考えられているものの予後はがんと同様に不良である。先進国においては、心不全患者が増加の一途をたどっており、急性増悪による入退院をいかに防ぐかが喫緊の課題となっている。急性心不全の多くは慢性心不全の急性増悪であることから、2018年に改訂されたガイドラインでは、これまで二つに分かれていた急性心不全と慢性心不全のガイドラインが、急性・慢性心不全診療ガイドラインとして統合され、左室駆出率(LVEF)による分類に基づき、これまでのエビデンスに添った診断・治療法について詳細に記載された。(著者抄録)
• 【心臓疾患の治療-最新のトピックス-】心不全の緩和ケア療法

  安斉 俊久  現代医学  67-  (1)  28  -33  2020/06
• 各分野のガイドラインを紐解く 急性・慢性心不全診療ガイドライン(2018年版)

  安斉 俊久  日本外科学会雑誌  121-  (3)  380  -382  2020/05
• 【高齢者の緩和ケアと積極的治療】緩和ケア 循環器疾患と緩和ケア

  安斉 俊久  老年内科  1-  (5)  539  -549  2020/05
• 【心不全パンデミックへの挑戦】心不全のステージ、左室駆出率による分類とHFmrEFの病態について

  安斉 俊久  循環器内科  87-  (4)  397  -402  2020/04
• 収縮期の右房容量負荷が三尖弁輪収縮期移動距離に及ぼす影響

  村山 迪史, 加賀 早苗, 岡田 一範, 三神 大世, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 西田 睦, 澁谷 斉, 辻永 真吾, 岩野 弘幸, 安斉 俊久  超音波検査技術  45-  (2)  217  -217  2020/04
• VISUALIZATION OF PERIPROCEDUAL BLOOD FLOW DYNAMICS WITH FOUR-DIMENSIONAL FLOW MAGNETIC RESONANCE IMAGING IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

  Hirokazu Komoriyama, Kiwamu Kamiya, Toshiyuki Nagai, Noriko Oyama-Manabe, Satonori Tsuneta, Yuta Kobayashi, Yoshiya Kato, Kazunori Omote, Takao Konishi, Takuma Sato, Shingo Tsujinaga, Hiroyuki Iwano, Yasushige Shingu, Satoru Wakasa, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  75-  (11)  1639  -1639  2020/03
• 【病気とくすり2020 基礎と実践Expert's Guide】循環器系・泌尿器系・生殖器系の病気とくすり 循環器系疾患 心不全

  天木 誠, 安斉 俊久, 和田 恭一  薬局  71-  (4)  950  -967  2020/03
• 急性心不全におけるproANP測定の意義 測定系の構築と急性期における優れた予後予測能力

  南野 直人, 高潮 征爾, 高濱 博幸, 錦見 俊雄, 永井 千晶[岡谷], 神崎 秀明, 安田 聡, 寒川 賢治, 安斉 俊久, 泉 知里  日本内分泌学会雑誌  95-  (4)  1615  -1615  2020/02
• Simple Echocardiographic Scoring System to Estimate Left Ventricular Filling Pressure Based on Visual Assessment of Time-Difference Between Mitral and Tricuspid Valve Opening

  村山迪史, 村山迪史, 岩野弘幸, 辻永真吾, 西野久雄, 中鉢雅大, 横山しのぶ, 西田睦, 渋谷斉, 加賀早苗, 安斉俊久  超音波医学 Supplement  47-  2020
• Right Atrial Volume Overload during Ventricular Systole Alters the Relationship between Tricuspid Annular Plane Systolic Excursion and Right Ventricular Ejection Fraction: A Three-Dimensional Echocardiographic Study

  村山迪史, 村山迪史, 加賀早苗, 岡田一範, 三神大世, 中鉢雅大, 横山しのぶ, 西野久雄, 西田睦, 岩野弘幸, 安斉俊久  超音波医学 Supplement  47-  2020
• Novel non-invasive method to assess left atrial stiffness during reservoir phase using pulmonary venous flow

  阿部剛大, 岡田一範, 加賀早苗, 政氏伸夫, 三神大世, 村山迪史, 中鉢雅大, 辻永真吾, 岩野弘幸, 安斉俊久  超音波医学 Supplement  47-  2020
• Influence of Left Ventricular External Work Assessed by Echocardiography on Changes in Cardiac Function after Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis

  辻永真吾, 岩野弘幸, 石坂傑, 千葉泰之, 更科美羽, 中鉢雅大, 神谷究, 永井利幸, 安斉俊久  超音波医学 Supplement  47-  2020
• Prognostic Value of Admission Serum Uric Acid in Hospitalized Heart Failure Patients With Preserved Ejection Fraction: A Report From the Japanese Real-world Multicenter Registry

  Yuta Kobayashi, Kazunori Omote, Toshiyuki Nagai, Kiwamu Kamiya, Tadao Aikawa, Takao Konishi, Takuma Sato, Hiroyuki Iwano, Shingo Tsujinaga, Yoshiya Kato, Hirokazu Komoriyama, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai  CIRCULATION  140-  2019/11  

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• Reduced Left Ventricular Ejection Fraction and Higher Angiotensin-Converting Enzyme Levels as Key Determinants of Histopathologic Diagnosis by Endomyocardial Biopsy in Patients With Cardiac Sarcoidosis

  Hirokazu Komoriyama, Kazunori Omote, Toshiyuki Nagai, Yuta Kobayashi, Yoshiya Kato, Takuma Sato, Takao Konishi, Tadao Aikawa, Kiwamu Kamiya, Kazuhiro Koyanagawa, Shingo Tsujinaga, Hiroyuki Iwano, Hatsue Ueda, Toshihisa Anzai  CIRCULATION  140-  2019/11  

  0
• 【悩み多き子羊たちへの救いの一手 これが私の診断・治療法!】心不全・心筋症 HFmrEF(heart failure with mid-range EF)はどのような心不全なのでしょうか?そしてどのような治療が推奨されているのでしょうか?

  安斉 俊久  Heart View  23-  (12)  84  -88  2019/11
• 【循環器症候群(第3版)-その他の循環器疾患を含めて-】冠動脈・静脈疾患・走行異常 心筋梗塞後リモデリング

  安斉 俊久  日本臨床  別冊-  (循環器症候群II)  46  -50  2019/10
• 心不全緩和ケアにおける診療の質評価指標(Quality indicator)の策定

  濱谷 康弘, 高田 弥寿子, 宮本 恵宏, 河野 由枝, 庵地 雄太, 柴田 龍宏, 鈴木 敦, 西川 満則, 伊藤 弘人, 加藤 雅志, 志賀 剛, 福本 義弘, 泉 知里, 安田 聡, 菅野 康夫, 安斉 俊久  日本医療・病院管理学会誌  56-  (Suppl.)  166  -166  2019/10
• 心臓サルコイドーシス診療におけるFDG-PETによる活動性評価をガイドとした免疫抑制療法戦略の限界

  永井 利幸, 相川 忠夫, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  39-  (1-2)  73  -76  2019/10  [Not refereed][Not invited]
   

  18F-fluorodeoxyglucose-positron emission tomography(FDG-PET)は,心臓サルコイドーシス(心サ症)の診断および病態評価に有用と考えられるが,FDG-PETにより評価された活動性炎症所見と臨床経過の乖離がしばしば経験される.今回我々はFDG-PET所見に増悪所見を認めた一方で臨床経過は改善を認めた症例,およびFDG-PET所見に改善所見を認めた一方で臨床経過は増悪を認めた症例を経験した.また,心サ症確診症例111例のうち,長期経過観察中にFDG-PET所見の増悪を認めた13例を検討した結果,同時に有害事象を伴う症例は6例であり,そのうち増悪時免疫抑制療法が中止されていた症例は3例であった.全例免疫抑制療法を強化したものの,その後2例に再度有害事象が発生した.一方,FDG-PET所見の増悪に有害事象を伴わない症例は7例であり,そのうち5例で免疫抑制療法を強化したものの,2例に再度有害事象が発生した.免疫抑制療法中のFDG-PET所見の変化が持つ臨床的意義には未だ不明な点が多く,今後の症例蓄積と前向き多施設研究が必要である.(著者抄録)
• 【ガイドラインに基づいた心不全診療のスタンダード】注目される緩和ケア ACPとチームビルディング

  安斉 俊久  Cardiac Practice  30-  (2)  134  -138  2019/09
• これからの超音波検査を牽引する人材の育成を目指す大学院教育

  岡田 一範, 加賀 早苗, 政氏 伸夫, 三神 大世, 中鉢 雅大, 村山 迪史, 横山 しのぶ, 西野 久雄, 西田 睦, 澁谷 斉, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久  臨床検査学教育  11-  (2)  219  -226  2019/09  

  かつては医師が担ってきた超音波(エコー)検査は、現在、そのほとんどを臨床検査技師を中心とする技師(ソノグラファー)が担うようになってきた。ソノグラファーは、検査装置の管理・調整、検査手技、計測・画像法に習熟することはもちろん、検査対象となる疾患や病態についての十分な知識に基づき、個々例の所見や病態に応じて検査を自ら組み立てる必要がある。このため、超音波検査の検者依存性は、他の検査に比べてたいへん大きい。本学院・研究院の心血管エコー研究室では、超音波検査の実技に精通したうえで、その研究者としても活躍できる指導的な人材の育成を目的とし、北海道大学病院検査・輸血部、超音波センターならびに医学研究院循環病態内科学教室の協力を得つつ、教育・研究活動を行っている。本稿では、その取り組みの一端を紹介する。(著者抄録)
• CKDと心不全についての最近の知見を踏まえて CKD合併心不全患者の血中ヘモグロビン値を考える

  内藤 由朗, 奥野 圭佑, 朝倉 正紀, 永井 利幸, 斎藤 能彦, 吉川 勉, 石原 正治, 増山 理, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  S13  -3  2019/09
• 循環器疾患の終末期と緩和医療 末期心不全と緩和ケア

  安斉 俊久  日本心臓病学会学術集会抄録  67回-  S17  -1  2019/09
• 循環器疾患の終末期と緩和医療 心不全緩和ケアにおける診療の質評価指標(Quality indicator)の策定と実践

  濱谷 康弘, 高田 弥寿子, 宮本 恵宏, 河野 由枝, 柴田 龍宏, 鈴木 敦, 西川 満則, 伊藤 弘人, 加藤 雅志, 志賀 剛, 福本 義弘, 泉 知里, 安田 聡, 菅野 康夫, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  S17  -3  2019/09
• 循環器疾患における末期医療に関する提言の改訂について

  安斉 俊久  日本心臓病学会学術集会抄録  67回-  JS6  -2  2019/09
• 心不全における肺動脈圧波形上のv波出現の意義に関する検討

  岩野 弘幸, 横山 しのぶ, 石坂 傑, 千葉 泰之, 更科 美羽, 辻永 真吾, 中鉢 雅大, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  O  -281  2019/09
• 心筋梗塞後偽性仮性左室瘤に収縮性心膜炎の合併が考えられた1例

  甲谷 太郎, 神谷 究, 千葉 泰之, 岩野 弘幸, 納谷 昌直, 永井 利幸, 松居 喜郎, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  P  -180  2019/09
• 【循環器症候群(第3版)-その他の循環器疾患を含めて-】心不全 末期心不全(心不全終末期)

  安斉 俊久  日本臨床  別冊-  (循環器症候群I)  28  -31  2019/09
• エイコサペンタエン酸治療と冠動脈プラーク安定性の関連性についての検討 光干渉断層診断法を用いた検討

  小西 崇夫, 小林 雄太, 小森山 弘和, 加藤 喜哉, 表 和徳, 相川 忠夫, 佐藤 琢真, 神谷 究, 永井 利幸, 須永 大介, 舟山 直宏, 山本 匡, 堀田 大介, 安斉 俊久  日本心血管インターベンション治療学会抄録集  28回-  [MO6  -001]  2019/09
• 心電図同期SPECTが虚血領域評価に有用であった冠動脈バイパス術後の1例

  小林 雄太, 相川 忠夫, 永井 利幸, 神谷 究, 小西 崇夫, 佐藤 琢真, 表 和徳, 加藤 喜哉, 小森山 弘和, 安斉 俊久  日本心血管インターベンション治療学会抄録集  28回-  [MP15  -003]  2019/09
• 心不全患者におけるMagnetic Resonance Elastographyを用いた肝硬度測定による右房圧推定の有用性

  加藤 喜哉, 永井 利幸, 小林 雄太, 小森山 弘和, 表 和徳, 相川 忠夫, 佐藤 琢真, 小西 崇夫, 神谷 究, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  O  -315  2019/09  [Not refereed][Not invited]
  
• エイコサペンタエン酸治療と冠動脈プラーク安定性の関連性についての検討 光干渉断層診断法を用いた検討

  小西 崇夫, 小林 雄太, 小森山 弘和, 加藤 喜哉, 表 和徳, 相川 忠夫, 佐藤 琢真, 神谷 究, 永井 利幸, 須永 大介, 舟山 直宏, 山本 匡, 堀田 大介, 安斉 俊久  日本心血管インターベンション治療学会抄録集  28回-  [MO6  -001]  2019/09  [Not refereed][Not invited]
  
• 心電図同期SPECTが虚血領域評価に有用であった冠動脈バイパス術後の1例

  小林 雄太, 相川 忠夫, 永井 利幸, 神谷 究, 小西 崇夫, 佐藤 琢真, 表 和徳, 加藤 喜哉, 小森山 弘和, 安斉 俊久  日本心血管インターベンション治療学会抄録集  28回-  [MP15  -003]  2019/09  [Not refereed][Not invited]
  
• 【ガイドラインに基づいた心不全診療のスタンダード】注目される緩和ケア ACPとチームビルディング

  安斉 俊久  Cardiac Practice  30-  (2)  134  -138  2019/09  [Not refereed][Not invited]
  
• CKDと心不全についての最近の知見を踏まえて CKD合併心不全患者の血中ヘモグロビン値を考える

  内藤 由朗, 奥野 圭佑, 朝倉 正紀, 永井 利幸, 斎藤 能彦, 吉川 勉, 石原 正治, 増山 理, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  S13  -3  2019/09  [Not refereed][Not invited]
  
• 循環器疾患の終末期と緩和医療 末期心不全と緩和ケア

  安斉 俊久  日本心臓病学会学術集会抄録  67回-  S17  -1  2019/09  [Not refereed][Not invited]
  
• 循環器疾患の終末期と緩和医療 心不全緩和ケアにおける診療の質評価指標(Quality indicator)の策定と実践

  濱谷 康弘, 高田 弥寿子, 宮本 恵宏, 河野 由枝, 柴田 龍宏, 鈴木 敦, 西川 満則, 伊藤 弘人, 加藤 雅志, 志賀 剛, 福本 義弘, 泉 知里, 安田 聡, 菅野 康夫, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  S17  -3  2019/09  [Not refereed][Not invited]
  
• 循環器疾患における末期医療に関する提言の改訂について

  安斉 俊久  日本心臓病学会学術集会抄録  67回-  JS6  -2  2019/09  [Not refereed][Not invited]
  
• 心不全における肺動脈圧波形上のv波出現の意義に関する検討

  岩野 弘幸, 横山 しのぶ, 石坂 傑, 千葉 泰之, 更科 美羽, 辻永 真吾, 中鉢 雅大, 加賀 早苗, 神谷 究, 永井 利幸, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  O  -281  2019/09  [Not refereed][Not invited]
  
• 心不全患者におけるMagnetic Resonance Elastographyを用いた肝硬度測定による右房圧推定の有用性

  加藤 喜哉, 永井 利幸, 小林 雄太, 小森山 弘和, 表 和徳, 相川 忠夫, 佐藤 琢真, 小西 崇夫, 神谷 究, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  O  -315  2019/09  [Not refereed][Not invited]
  
• 心筋梗塞後偽性仮性左室瘤に収縮性心膜炎の合併が考えられた1例

  甲谷 太郎, 神谷 究, 千葉 泰之, 岩野 弘幸, 納谷 昌直, 永井 利幸, 松居 喜郎, 安斉 俊久  日本心臓病学会学術集会抄録  67回-  P  -180  2019/09  [Not refereed][Not invited]
  
• これからの超音波検査を牽引する人材の育成を目指す大学院教育

  岡田 一範, 加賀 早苗, 政氏 伸夫, 三神 大世, 中鉢 雅大, 村山 迪史, 横山 しのぶ, 西野 久雄, 西田 睦, 澁谷 斉, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久  臨床検査学教育  11-  (2)  219  -226  2019/09  [Not refereed][Not invited]
   

  かつては医師が担ってきた超音波(エコー)検査は、現在、そのほとんどを臨床検査技師を中心とする技師(ソノグラファー)が担うようになってきた。ソノグラファーは、検査装置の管理・調整、検査手技、計測・画像法に習熟することはもちろん、検査対象となる疾患や病態についての十分な知識に基づき、個々例の所見や病態に応じて検査を自ら組み立てる必要がある。このため、超音波検査の検者依存性は、他の検査に比べてたいへん大きい。本学院・研究院の心血管エコー研究室では、超音波検査の実技に精通したうえで、その研究者としても活躍できる指導的な人材の育成を目的とし、北海道大学病院検査・輸血部、超音波センターならびに医学研究院循環病態内科学教室の協力を得つつ、教育・研究活動を行っている。本稿では、その取り組みの一端を紹介する。(著者抄録)
• 【循環器疾患とアルドステロン】心不全と心筋梗塞におけるミネラルコルチコイド受容体拮抗薬のエビデンス

  安斉 俊久  循環器内科  86-  (2)  140  -146  2019/08  [Not refereed][Not invited]
  
• 治療法の再整理とアップデートのために 専門家による私の治療 僧帽弁閉鎖不全症

  安斉 俊久  日本医事新報  (4970)  38  -38  2019/07  [Not refereed][Not invited]
  
• 【心不全診療の最前線】まもなく使用可能な心不全薬 イバブラジン、ARNI

  安斉 俊久  循環器内科  86-  (1)  58  -63  2019/07  [Not refereed][Not invited]
  
• 統合失調症治療薬による心血管系イベント発症リスクの検証 医療情報データベースを用いたコホート研究

  久住 一郎, 井上 幸恵, 馬塲 健次, 野坂 忠史, 安斉 俊久  精神神経学雑誌  (2019特別号)  S444  -S444  2019/06
• 冠血行再建治療後の局所心筋血流量と心筋血流予備能の改善メカニズム 15O標識水PETと心臓MRIを用いた検討

  相川 忠夫, 納谷 昌直, 小梁川 和宏, 真鍋 治, 真鍋 徳子, 玉木 長良, 安斉 俊久  日本心臓核医学会ニュースレター  21-  (2)  96  -96  2019/06  [Not refereed][Not invited]
  
• 統合失調症治療薬による心血管系イベント発症リスクの検証 医療情報データベースを用いたコホート研究

  久住 一郎, 井上 幸恵, 馬塲 健次, 野坂 忠史, 安斉 俊久  精神神経学雑誌  (2019特別号)  S444  -S444  2019/06  [Not refereed][Not invited]
  
• 肺動脈内伝導遅延に応じて多形性を呈した肺動脈弁上起源心室頻拍の1例

  天満 太郎, 渡邉 昌也, 鎌田 塁, 高橋 雅之, 安斉 俊久, 横式 尚司, 三山 博史, 四倉 昭彦, 吉田 泉, 櫻井 正之  臨床心臓電気生理  42-  81  -89  2019/05  [Not refereed][Not invited]
   

  症例は57歳男性。失神を伴う心室頻拍(VT)に対して他院でICD植込み術を施行した。VTによる頻回作動を認め当院紹介となった。頻拍は右室流出路(RVOT)起源と推定され、頻拍波形の多形性を認めた。肺動脈内のリング電極から洞調律時に心室電位より遅れた肺動脈電位を認めた。頻拍時の肺動脈電位は心室電位に先行し、肺動脈-RVOT時間変化に応じたQRS波の多形性を認めた。肺動脈内からの刺激は頻拍波形を再現したが、3種類の肺動脈内伝導遅延を伴う肺動脈局所捕捉を認め、刺激-RVOT時間も同様の変化を伴い、それに応じたQRS変化も認めた。洞調律下に肺動脈電位を通電後はVT誘発不能となり再発を認めていない。肺動脈内からのトリガーが肺動脈-RVOT間(肺動脈内+肺動脈-RVOT接合部)での伝導遅延によってQRS波に多形性をもたらしたと考察された。(著者抄録)
• 【緩和ケア、エンドオブライフケアにおける食のケアの可能性】(Part 3)緩和ケア、エンドオブライフケアにおける最近の話題 心不全患者に対する緩和ケア

  安斉 俊久  臨床栄養  134-  (6)  828  -834  2019/05  [Not refereed][Not invited]
  
• 日常的な左室充満圧上昇判定における肺動脈弁逆流速度計測の意義

  村山 迪史, 加賀 早苗, 岡田 一範, 三神 大世, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 辻永 真吾, 西田 睦, 澁谷 斉, 岩野 弘幸, 安斉 俊久  超音波検査技術  44-  (Suppl.)  S139  -S139  2019/04  [Not refereed][Not invited]
  
• 心エコーで冠動脈瘻との鑑別に苦慮した左冠動脈肺動脈起始の1例

  西野 久雄, 佐々木 理, 岩野 弘幸, 武田 充人, 横山 しのぶ, 中鉢 雅大, 村山 迪史, 西田 睦, 秋沢 宏次, 杉田 純一, 豊嶋 崇徳, 安斉 俊久  超音波検査技術  44-  (Suppl.)  S163  -S163  2019/04  [Not refereed][Not invited]
  
• 【ビッグデータとICUにおけるプレシジョン・メディシン】循環器疾患におけるPrecision Medicineの現状

  永井 利幸, 安斉 俊久  ICUとCCU  43-  (4)  199  -209  2019/04  [Not refereed][Not invited]
   

  Precision Medicineは個別化医療をさらに深化させた概念であり、大規模臨床データのみならず、最先端の基礎研究を応用した莫大な生体情報(遺伝情報、オミックスデータなど)を統合して、正確なデータ分析に基づく患者個人レベルごとの最適な治療方法選択を可能にするものである。動脈硬化・虚血性心疾患では、脂質関連遺伝子を含む約70の遺伝子領域が関連遺伝子として同定され、脂質代謝異常との密接な関連が示唆されることから、これら遺伝子異常を持つ症例に対する先制医療の可能性が期待されている。また、近年造血器腫瘍の発症に関連する特定の遺伝子に高頻度にみられる体細胞変異による、未確定の潜在能をもつクローン性造血が動脈硬化・虚血性心疾患発症リスクと関連していることを示唆する報告が相次いでいる。心不全領域においても大規模臨床データを用いた予後予測モデルのみならず、遺伝子やプロテオミクス解析を駆使した個別化医療基盤の確立を目指した大規模臨床研究が進行している。(著者抄録)
• 左室拡張機能の評価は臨床で役に立っているのか? 肺動脈性肺高血圧症における左室充満圧推定の問題点

  岩野 弘幸, 辻野 一三, 安斉 俊久  超音波医学  46-  (Suppl.)  S262  -S262  2019/04  [Not refereed][Not invited]
  
• 三尖弁輪収縮期移動距離と三尖弁輪収縮期運動速度の計測に最も適する断面はどれか?

  加賀 早苗, 村山 迪史, 岡田 一範, 三神 大世, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 辻永 真吾, 岩野 弘幸, 安斉 俊久  超音波医学  46-  (Suppl.)  S616  -S616  2019/04  [Not refereed][Not invited]
  
• 【新人スタッフもぐんぐん学べる!まるごと心臓の解剖と疾患えほん】 心筋疾患 心筋症は心臓のどんな病気?肥大型心筋症と拡張型心筋症はどう違うの?

  安斉 俊久  ハートナーシング  32-  (4)  358  -361  2019/04  [Not refereed][Not invited]
  
• 日常的な左室充満圧上昇判定における肺動脈弁逆流速度計測の意義

  村山 迪史, 加賀 早苗, 岡田 一範, 三神 大世, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 辻永 真吾, 西田 睦, 澁谷 斉, 岩野 弘幸, 安斉 俊久  超音波検査技術  44-  (Suppl.)  S139  -S139  2019/04  [Not refereed][Not invited]
  
• 心エコーで冠動脈瘻との鑑別に苦慮した左冠動脈肺動脈起始の1例

  西野 久雄, 佐々木 理, 岩野 弘幸, 武田 充人, 横山 しのぶ, 中鉢 雅大, 村山 迪史, 西田 睦, 秋沢 宏次, 杉田 純一, 豊嶋 崇徳, 安斉 俊久  超音波検査技術  44-  (Suppl.)  S163  -S163  2019/04  [Not refereed][Not invited]
  
• LONG-TERM PROGNOSTIC SIGNIFICANCE OF ADMISSION TRICUSPID REGURGITANT PRESSURE GRADIENT IN HOSPITALIZED HEART FAILURE PATIENTS WITH PRESERVED EJECTION FRACTION: A REPORT FROM JAPANESE REAL-WORLD MULTICENTER REGISTRY

  Kazunori Omote, Toshiyuki Nagai, Kiwamu Kamiya, Tadao Aikawa, Yoshiya Kato, Hirokazu Komoriyama, Hiroyuki Iwano, Kazuhiro Yamamoto, Tsutomu Yoshikawa, Yoshihiko Saito, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  73-  (9)  807  -807  2019/03
• 重複障害を有する超高齢心疾患患者に対するリハビリテーションの工夫 難渋重症例をどのように対応するか? 後期高齢心不全患者に対する急性期離床プログラムの開発と運用

  角谷 尚哉, 吉田 一郎, 福島 新, 中村 梨沙子, 塚田 貴紀, 絹川 真太郎, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  CS4  -1  2019/03
• 心房細動を有するまたは有しない左室駆出率の保たれた心不全(HFpEF)患者において貧血は長期転帰に異なった影響を及ぼす(Anemia Differentially Impacts Long-Term Outcomes in HFpEF Patients with and without Atrial Fibrillation)

  奥野 圭佑, 内藤 由朗, 朝倉 正紀, 菅原 政貴, 安藤 友孝, 永井 利幸, 斎藤 能彦, 吉川 勉, 増山 理, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ03  -4  2019/03
• 駆出率の保たれた心不全寛解後の心内膜心筋生検におけるマクロファージの持続的蓄積(Prolonged Accumulation of Macrophages in Endomyocardial Biopsies after Remission of Heart Failure with Preserved Ejection Fraction)

  高濱 博幸, 菅野 康夫, 大郷 恵子, 門田 宗之, 天野 雅史, 濱谷 康弘, 岡田 厚, 天木 誠, 長谷川 拓也, 神崎 秀明, 安斉 俊久, 安田 聡, 植田 初江, 泉 知里  日本循環器学会学術集会抄録集  83回-  OJ04  -7  2019/03
• Catecholamine作動性多形性心室性頻拍に関連するRyR2変異の基礎的原因であるリアノジン受容体からのCa2+過剰放出(Excessive Ca2+ Release from Ryanodine Receptors Underlying a RyR2 Mutation Associated with Catecholaminergic Polymorphic Ventricular Tachycardia)

  伊藤 英樹, 村山 尚, 呉林 なごみ, 大野 聖子, 藤居 祐介, 加藤 浩一, 福山 恵, 高山 幸一郎, 渡邉 昌也, 安斉 俊久, 堀江 稔  日本循環器学会学術集会抄録集  83回-  OJ05  -4  2019/03
• 心不全患者における運動中の換気効率のメカニズム 駆出率の保たれた心不全と駆出率が低下した心不全の比較(Mechanisms of Ventilatory Efficiency during Exercise in Heart Failure: Comparison between Heart Failure with Preserved Ejection Fraction and Reduced Ejection Fraction)

  辻永 真吾, 岩野 弘幸, 更科 美羽, 村山 迪史, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 岡田 一範, 加賀 早苗, 福島 新, 横田 卓, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ08  -2  2019/03
• 心不全患者における左室動作時スティフネスに関する新規心エコー指標の予後に対する価値(Prognostic Value of Novel Echocardiographic Index of Left Ventricular Operating Stiffness in Patients with Heart Failure)

  岡田 一範, 藤澤 亮介, 加賀 早苗, 政氏 伸夫, 三神 大世, 村山 迪史, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ08  -7  2019/03
• 末期心不全患者における緩和鎮静の調査 国立循環器病研究センターにおける5年間の経験(Survey of Palliative Sedation in End-stage Heart Failure Patients: A Five Year Experience in National Cardiovascular Center)

  濱谷 康弘, 仲井 えり, 宮田 美知, 中村 絵美, 河野 由枝, 高田 弥寿子, 庵地 雄太, 舟橋 紗耶華, 平山 敦士, 黒田 健輔, 天野 雅史, 菅野 康夫, 安斉 俊久, 泉 知里  日本循環器学会学術集会抄録集  83回-  OJ12  -7  2019/03
• 三尖弁逆流を伴う急性非代償性心不全患者において急性腎障害が死亡率に及ぼす影響(Impact of Acute Kidney Injury on Mortality in Patients with Acute Decompensated Heart Failure Complicated with Tricuspid Regurgitation)

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安田 聡, 小川 久雄, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ27  -6  2019/03
• 急性非代償性心不全患者において利尿反応が死亡リスクのある急性腎障害の識別に及ぼす影響(Impact of Diuretic Response on Differentiation of Acute Kidney Injury at Risk of Mortality in Acute Decompensated Heart Failure Patients)

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安田 聡, 小川 久雄, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ27  -7  2019/03
• 虚血性心筋症と拡張型心筋症間の植込み型除細動器の利点はICDの適応によって異なる(Benefit of Implantable Cardioverter-Defibrillator between Ischemic Cardiomyopathy and Dilated Cardiomyopathy was Different by ICD Indication)

  天満 太郎, 渡邉 昌也, 鎌田 塁, 高橋 雅之, 高橋 佑美, 萩原 光, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ011  -2  2019/03
• 急性心不全患者において入院時のproANP値は臨床転帰の予測能が優れている proBNPとBNPとの比較(Superior Predictability of proANP Level on Admission for Clinical Outcomes in Acute Heart Failure Patients: Comparison with proBNP and BNP)

  高濱 博幸, 高潮 征爾, 錦見 俊雄, 林 友鴻, 中川 靖章, 天野 雅史, 濱谷 康弘, 岡田 厚, 天木 誠, 長谷川 拓也, 神崎 秀明, 安田 聡, 安斉 俊久, 南野 直人, 泉 知里  日本循環器学会学術集会抄録集  83回-  PJ034  -6  2019/03
• 駆出率が保持されている心不全患者において慢性閉塞性肺疾患が予後不良に及ぼす予後的影響 JASPERレジストリ(Prognostic Impact of Chronic Obstructive Pulmonary Disease on Adverse Prognosis in Heart Failure Patients with Preserved Ejection Fraction: The JASPER Registry)

  佐藤 悠, 義久 精臣, 及川 雅啓, 永井 利幸, 吉川 勉, 斎藤 能彦, 山本 一博, 竹石 恭知, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ073  -2  2019/03
• 重複障害を有する超高齢心疾患患者に対するリハビリテーションの工夫 難渋重症例をどのように対応するか? 後期高齢心不全患者に対する急性期離床プログラムの開発と運用

  角谷 尚哉, 吉田 一郎, 福島 新, 中村 梨沙子, 塚田 貴紀, 絹川 真太郎, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  CS4  -1  2019/03  [Not refereed][Not invited]
  
• Anemia Differentially Impacts Long-Term Outcomes in HFpEF Patients with and without Atrial Fibrillation(和訳中)

  奥野 圭佑, 内藤 由朗, 朝倉 正紀, 菅原 政貴, 安藤 友孝, 永井 利幸, 斎藤 能彦, 吉川 勉, 増山 理, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ03  -4  2019/03  [Not refereed][Not invited]
  
• Prolonged Accumulation of Macrophages in Endomyocardial Biopsies after Remission of Heart Failure with Preserved Ejection Fraction(和訳中)

  高濱 博幸, 菅野 康夫, 大郷 恵子, 門田 宗之, 天野 雅史, 濱谷 康弘, 岡田 厚, 天木 誠, 長谷川 拓也, 神崎 秀明, 安斉 俊久, 安田 聡, 植田 初江, 泉 知里  日本循環器学会学術集会抄録集  83回-  OJ04  -7  2019/03  [Not refereed][Not invited]
  
• Excessive Ca2+ Release from Ryanodine Receptors Underlying a RyR2 Mutation Associated with Catecholaminergic Polymorphic Ventricular Tachycardia(和訳中)

  伊藤 英樹, 村山 尚, 呉林 なごみ, 大野 聖子, 藤居 祐介, 加藤 浩一, 福山 恵, 高山 幸一郎, 渡邉 昌也, 安斉 俊久, 堀江 稔  日本循環器学会学術集会抄録集  83回-  OJ05  -4  2019/03  [Not refereed][Not invited]
  
• Mechanisms of Ventilatory Efficiency during Exercise in Heart Failure: Comparison between Heart Failure with Preserved Ejection Fraction and Reduced Ejection Fraction(和訳中)

  辻永 真吾, 岩野 弘幸, 更科 美羽, 村山 迪史, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 岡田 一範, 加賀 早苗, 福島 新, 横田 卓, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ08  -2  2019/03  [Not refereed][Not invited]
  
• Prognostic Value of Novel Echocardiographic Index of Left Ventricular Operating Stiffness in Patients with Heart Failure(和訳中)

  岡田 一範, 藤澤 亮介, 加賀 早苗, 政氏 伸夫, 三神 大世, 村山 迪史, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 更科 美羽, 辻永 真吾, 岩野 弘幸, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ08  -7  2019/03  [Not refereed][Not invited]
  
• Survey of Palliative Sedation in End-stage Heart Failure Patients: A Five Year Experience in National Cardiovascular Center(和訳中)

  濱谷 康弘, 仲井 えり, 宮田 美知, 中村 絵美, 河野 由枝, 高田 弥寿子, 庵地 雄太, 舟橋 紗耶華, 平山 敦士, 黒田 健輔, 天野 雅史, 菅野 康夫, 安斉 俊久, 泉 知里  日本循環器学会学術集会抄録集  83回-  OJ12  -7  2019/03  [Not refereed][Not invited]
  
• Impact of Acute Kidney Injury on Mortality in Patients with Acute Decompensated Heart Failure Complicated with Tricuspid Regurgitation(和訳中)

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安田 聡, 小川 久雄, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ27  -6  2019/03  [Not refereed][Not invited]
  
• Impact of Diuretic Response on Differentiation of Acute Kidney Injury at Risk of Mortality in Acute Decompensated Heart Failure Patients(和訳中)

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安田 聡, 小川 久雄, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  OJ27  -7  2019/03  [Not refereed][Not invited]
  
• Benefit of Implantable Cardioverter-Defibrillator between Ischemic Cardiomyopathy and Dilated Cardiomyopathy was Different by ICD Indication(和訳中)

  天満 太郎, 渡邉 昌也, 鎌田 塁, 高橋 雅之, 高橋 佑美, 萩原 光, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ011  -2  2019/03  [Not refereed][Not invited]
  
• Superior Predictability of proANP Level on Admission for Clinical Outcomes in Acute Heart Failure Patients: Comparison with proBNP and BNP(和訳中)

  高濱 博幸, 高潮 征爾, 錦見 俊雄, 林 友鴻, 中川 靖章, 天野 雅史, 濱谷 康弘, 岡田 厚, 天木 誠, 長谷川 拓也, 神崎 秀明, 安田 聡, 安斉 俊久, 南野 直人, 泉 知里  日本循環器学会学術集会抄録集  83回-  PJ034  -6  2019/03  [Not refereed][Not invited]
  
• Prognostic Impact of Chronic Obstructive Pulmonary Disease on Adverse Prognosis in Heart Failure Patients with Preserved Ejection Fraction: The JASPER Registry(和訳中)

  佐藤 悠, 義久 精臣, 及川 雅啓, 永井 利幸, 吉川 勉, 斎藤 能彦, 山本 一博, 竹石 恭知, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ073  -2  2019/03  [Not refereed][Not invited]
  
• Prognostic Impact of Worsening Renal Function in Heart Failure Patients with Preserved Ejection Fraction: A Report from the JASPER Registry(和訳中)

  佐藤 悠, 義久 精臣, 及川 雅啓, 永井 利幸, 吉川 勉, 斎藤 能彦, 山本 一博, 竹石 恭知, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ073  -3  2019/03  [Not refereed][Not invited]
  
• Lymph Vessel Proliferation on Cardiac Biopsy may Help for the Diagnosis of Cardiac Sarcoidosis(和訳中)

  大江 由紀子, 植田 初江, 松山 高明, 永井 利幸, 池田 善彦, 大郷 恵子, 野口 暉夫, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ073  -6  2019/03  [Not refereed][Not invited]
  
• Increased Liver Stiffness Assessed by Magnetic Resonance Elastography Predicts Elevated Right Atrial Pressure in Patients with Heart Failure(和訳中)

  加藤 喜哉, 永井 利幸, 小森山 弘和, 表 和徳, 相川 忠夫, 神谷 究, 常田 慧徳, 真鍋(大山) 徳子, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ096  -6  2019/03  [Not refereed][Not invited]
  
• The Impact of Coronary Revascularization on Regional Myocardial Flow Reserve Assessed by Positron Emission Tomography(和訳中)

  相川 忠夫, 納谷 昌直, 小梁川 和宏, 真鍋 治, 真鍋 徳子, 安斉 俊久  日本循環器学会学術集会抄録集  83回-  PJ103  -2  2019/03  [Not refereed][Not invited]
  
• 緩和ケア

  安斉 俊久  循環器内科  85-  (2)  280  -286  2019/02  [Not refereed][Not invited]
  
• 大動脈無冠尖起源の心房頻拍の1例

  鎌田塁, 渡邉昌也, 天満太郎, 萩原光, 高橋佑美, 甲谷太郎, 中尾元基, 横式尚司, 三山博史, 高橋雅之, 佐々木亮, 千葉裕基, 平子竜大, 前野幹, 安斉俊久  日本不整脈心電学会カテーテルアブレーション委員会公開研究会プログラム・抄録集  2019-  2019
• Improvement in myocardial perfusion predicts fewer cardiac events in cardiac sarcoidosis

  小梁川和宏, 納谷昌直, 相川忠夫, 真鍋治, 古家翔, 葛目将人, 真鍋徳子, 大平洋, 辻野一三, 安斉俊久  核医学(Web)  56-  (Supplement)  2019
• 急性心不全患者において鉄欠乏が長期予後に与える影響(The impact of Iron Deficiency for Long-term Prognosis in Patients with Acute Heart Failure)

  中野 宏己, 近森 大志郎, 永井 利幸, 本田 泰之, 本田 怜, 岩上 直嗣, 菅野 康夫, 浅海 泰栄, 相庭 武司, 野口 暉夫, 草野 研吾, 小川 久雄, 安田 聡, 安斉 俊久, 中井 陸運, 西村 邦宏  東京医科大学雑誌  77-  (1)  71  -71  2019/01  [Not refereed][Not invited]
  
• 冠血行再建治療が局所心筋血流予備能に与える影響:¹⁵O標識水PETと心臓MRIを用いた検討

  相川忠夫, 納谷昌直, 小梁川和宏, 真鍋治, 真鍋徳子, 安斉俊久  日本心血管画像動態学会プログラム・抄録集  29th-  148  2019  [Not refereed][Not invited]
  
• The impact of Iron Deficiency for Long-term Prognosis in Patients with Acute Heart Failure(和訳中)

  中野 宏己, 近森 大志郎, 永井 利幸, 本田 泰之, 本田 怜, 岩上 直嗣, 菅野 康夫, 浅海 泰栄, 相庭 武司, 野口 暉夫, 草野 研吾, 小川 久雄, 安田 聡, 安斉 俊久, 中井 陸運, 西村 邦宏  東京医科大学雑誌  77-  (1)  71  -71  2019/01  [Not refereed][Not invited]
  
• 【心不全診療の現状と展望】 HFmrEF 新しい心不全層別化指標となり得るか

  安斉 俊久  Pharma Medica  36-  (12)  13  -17  2018/12  [Not refereed][Not invited]
  
• 【心不全(第2版)上-最新の基礎・臨床研究の進歩-】 鑑別診断 鑑別診断のポイント

  安斉 俊久  日本臨床  76-  (増刊9 心不全(上))  715  -720  2018/12  [Not refereed][Not invited]
  
• 心移植・VAD治療におけるAdvance Care Planning実践の検討

  加藤 美香, 櫛引 勝年, 山本 真由美, 中野 政子, 成田 尚, 福島 新, 加藤 裕貴, 大岡 智学, 安斉 俊久, 松居 喜郎  移植  53-  (4-5)  314  -314  2018/12  [Not refereed][Not invited]
  
• Prognostic Value of Acid Base Balance in Acute Heart Failure

  Hiroki Nakano, Toshiyuki Nagai, Yasuyuki Honda, Satoshi Honda, Yasuhiro Hamatani, Naotsugu Iwakami, Chisa Matsumoto, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Hisao Ogawa, Satoshi Yasuda, Taishiro Chikamori, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• Diastolic Intra-Left Ventricular Pressure Difference During Exercise: Strong Determinant and Predictor of Exercise Capacity in Patients With Heart Failure

  Hiroyuki Iwano, Shingo Tsujinaga, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Arata Fukushima, Takashi Yokota, Pavlos P. Vlachos, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• Simple and Completely Noninvasive Method to Estimate Right Ventricular Operating Stiffness Based on Pulmonary Regurgitant Velocity and Tricuspid Annular Plane Movement Measurements During Atrial Contraction

  Michito Murayama, Sanae Kaga, Kazunori Okada, Hisao Nishino, Shinobu Yokoyama, Masahiro Nakabachi, Miwa Sarashina, Shingo Tsujinaga, Mutsumi Nishida, Hitoshi Shibuya, Toshiyuki Nagai, Hiroyuki Iwano, Toshihisa Anzai, Taisei Mikami  CIRCULATION  138-  2018/11  

  0
• The Outer Mitochondrial Membrane Protein, mitoNEET, Sustains Structure of Mitochondrial Cristae

  Takaaki Furihata, Shintaro Kinugawa, Shingo Takada, Satoshi Maekawa, Takashi Katayama, Ryosuke Shirakawa, Hideo Nambu, Yoshikuni Obata, Katsuma Yamanashi, Naoya Kakutani, Akimichi Saito, Arata Fukushima, Takashi Yokota, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• Inhibition of Xanthine Oxidase in the Acute Phase Preserves Mitochondrial Function in Skeletal Muscle and Exercise Capacity in Heart Failure After Myocardial Infarction

  Hideo Nambu, Shingo Takada, Satoshi Maekawa, Junichi Matsumoto, Naoya Kakutani, Ryosuke Shirakawa, Takashi Katayama, Katsuma Yamanashi, Yoshikuni Obata, Takaaki Furihata, Akimichi Saito, Takashi Yokota, Shintaro Kinugawa, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• Excessive Mitochondrial Reactive Oxygen Species Emission From Circulating Blood Cells is Associated With Systemic Oxidative Stress, Severity of Heart Failure, and Exercise Intolerance

  Ryosuke Shirakawa, Takashi Yokota, Takayuki Nakajima, Shingo Takada, Miwako Yamane, Akimichi Saito, Satoshi Maekawa, Naoya Kakutani, Takaaki Furihata, Junichi Matsumoto, Masaya Tsuda, Takashi Katayama, Hideo Nambu, Katsuma Yamanashi, Yoshikuni Obata, Ippei Nakano, Arata Fukushima, Shintaro Kinugawa, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• Serum Troponin T as a Determinant of Drug-Induced Heart Failure Development in Patients Treated With Cyclophosphamide

  Kiwamu Kamiya, Toshiyuki Nagai, Hirokazu Komoriyama, Yoshiya Kato, Kazunori Omote, Tadao Aikawa, Keiji Noguchi, Yusuke Tokuda, Hiroyuki Iwano, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• 18F-FDG Uptake of the Right Ventricle is an Important Predictor of Histopathologic Diagnosis by Endomyocardial Biopsy in Patients With Cardiac Sarcoidosis.

  Kazunori Omote, Masanao Naya, Kazuhiro Koyanagawa, Tadao Aikawa, Osamu Manabe, Toshiyuki Nagai, Kiwamu Kamiya, Yoshiya Kato, Hirokazu Komoriyama, Masato Kuzume, Nagara Tamaki, Toshihisa Anzai  CIRCULATION  138-  2018/11  

  0
• Determinants of Ventilatory Efficiency in Patients With Heart Failure: Incites From Left Ventricular Suction During Exercise

  Shingo Tsujinaga, Hiroyuki Iwano, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Arata Fukushima, Takashi Yokota, Pavlos P. Vlachos, Toshihisa Anzai  CIRCULATION  138-  2018/11  [Not refereed][Not invited]
   

  0
• HFmrEFとは?

  安斉 俊久  Medical Technology  46-  (11)  1055  -1056  2018/11  [Not refereed][Not invited]
  
• 心臓サルコイドーシス患者における心電図同期心筋血流イメージングを用いた位相解析による予後評価

  小梁川 和宏, 納谷 昌直, 葛目 将人, 相川 忠夫, 真鍋 治, 大平 洋, 辻野 一三, 真鍋 徳子, 志賀 晢, 安斉 俊久  核医学  55-  (Suppl.)  S175  -S175  2018/11  [Not refereed][Not invited]
  
• 15O標識水PETを用いた冠血行再建治療前後における局所冠血流予備能の定量評価

  相川 忠夫, 納谷 昌直, 真鍋 治, 孫田 恵一, 小梁川 和宏, 浅川 直也, 真鍋 徳子, 志賀 哲, 加藤 千恵次, 玉木 長良, 安斉 俊久  核医学  55-  (Suppl.)  S191  -S191  2018/11  [Not refereed][Not invited]
  
• 冠動脈疾患患者において血清TBARSは冠微小循環障害の予測因子である

  納谷 昌直, 相川 忠夫, 小原 雅彦, 真鍋 治, 小梁川 和宏, 浅川 直也, 加藤 知恵次, 鈴木 えり子, 筒井 裕之, 玉木 長良, 安斉 俊久  核医学  55-  (Suppl.)  S191  -S191  2018/11  [Not refereed][Not invited]
  
• サルコイドーシスの患者が5年の経過で心臓主体の病変へと進展した症例

  葛目 将人, 納谷 昌直, 小梁川 和宏, 相川 忠夫, 古家 翔, 真鍋 治, 志賀 哲, 安斉 俊久  核医学  55-  (Suppl.)  S192  -S192  2018/11  [Not refereed][Not invited]
  
• 重症/難治性(治療抵抗性)心臓サルコイドーシス 不整脈・心不全の臨床像

  草野 研吾, 石橋 耕平, 中須賀 公亮, 高谷 陽一, 永井 利幸, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  38-  (1-2)  17  -21  2018/10  [Not refereed][Not invited]
  
• 心臓サルコイドーシス診療におけるFDG-PETの有用性と限界 心臓サルコイドーシス診療におけるFDG-PETによる活動性評価をガイドとした免疫抑制療法戦略の限界

  永井 利幸, 相川 忠夫, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  38-  (サプリメント号)  35  -35  2018/10  [Not refereed][Not invited]
  
• 心臓サルコイドーシス患者において心筋血流イメージング位相解析は心事故を予測する

  小梁川 和宏, 納谷 昌直, 葛目 将人, 相川 忠夫, 古家 翔, 真鍋 治, 大平 洋, 辻野 一三, 真鍋 徳子, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  38-  (サプリメント号)  64  -64  2018/10  [Not refereed][Not invited]
  
• 心臓サルコイドーシスにおける18F-FDG PETでの右室自由壁集積は心内膜下心筋生検陽性率と関連する

  表 和徳, 納谷 昌直, 小梁川 和宏, 相川 忠夫, 真鍋 治, 永井 利幸, 神谷 究, 加藤 喜哉, 小森山 弘和, 葛目 将人, 玉木 長良, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  38-  (サプリメント号)  68  -68  2018/10  [Not refereed][Not invited]
  
• 心不全患者に対する適切な緩和ケアとは

  安斉 俊久  臨床麻酔  42-  (10)  1321  -1326  2018/10  [Not refereed][Not invited]
   

  緩和ケアは、終末期心不全だけでなく、より早期から介入することで患者セルフケアの向上とQOLの改善をもたらすことができる。アドバンス・ケア・プランニング(ACP)とは、意思決定能力が低下する前に、患者の価値観、人生観、死生観を家族と医療従事者で共有しながら、終末期に希望する医療に関して意思決定支援を行うプロセス全体を指す。心不全患者に対するACPのタイミング、末期心不全に認められる呼吸困難・全身倦怠感・疼痛などの症状緩和、終末期における医療機器の停止やDNARについて概説した。緩和ケアチームによる意思決定支援の重要性はますます高まっている。
• 重症/難治性(治療抵抗性)心臓サルコイドーシス 不整脈・心不全の臨床像

  草野 研吾, 石橋 耕平, 中須賀 公亮, 高谷 陽一, 永井 利幸, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  38-  (1-2)  17  -21  2018/10  [Not refereed][Not invited]
   

  サルコイドーシス患者の予後を決定する重要な因子として心臓サルコイドーシスがある。特に重症と考えられるものは、1)高度房室ブロック例、2)持続性心室頻拍/心室細動例、3)低心機能の3つであり、一方、難治性(治療抵抗性)心臓サルコイドーシスと考えられるものは、免疫抑制療法を含む適切な治療を行っても、1)致死的不整脈(持続性心室頻拍や心室細動)が再発する、2)心機能が低下してくる、3)心不全を繰り返す、4)FDG-PETやGaシンチで捕らえられる活動性心病変が持続する例と考えられる。ここでは、これらの因子について概説し、特に進歩が著しい非薬物治療の現状について述べる。(著者抄録)
• 心臓サルコイドーシスに対する抗菌薬治療 J-ACNES研究

  草野 研吾, 田原 宣広, 石橋 耕平, 朝倉 正紀, 中村 一文, 高谷 陽一, 坂本 央, 中村 知久, 野口 暉夫, 安田 聡, 矢崎 善一, 安斉 俊久, 山口 哲生, 朝倉 こう子, 濱崎 俊光, 寺崎 文生, 江石 義信  日本サルコイドーシス/肉芽腫性疾患学会雑誌  38-  (1-2)  34  -39  2018/10  [Not refereed][Not invited]
   

  心臓サルコイドーシスでは、副腎皮質ステロイドなどの免疫抑制薬を終生内服することが必要とされている。しかし長期のステロイド内服による副作用の懸念、経過中にステロイド増量が必要であった例が約2割に上ることも報告され、根本的な治療が望まれている。サルコイドーシスの原因としてアクネ菌の関与が報告されており、抗菌薬(クラリスロマイシンとドキシサイクリン併用)を用いた前向き探索研究(J-ACNES研究)を開始した。(著者抄録)
• 連続流型LVAD装着後遠隔期に心不全増悪を来すまで大動脈弁逆流の経時的変化を観察しえた1例

  辻永 真吾, 岩野 弘幸, 大岡 智学, 更科 美羽, 林 大知, 永井 利幸, 福島 新, 村山 迪史, 市川 絢子, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 松居 喜郎, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  np2  -np2  2018/09  [Not refereed][Not invited]
  
• 心サルコイドーシスの診断と治療における最新の知見 非肉芽腫組織における免疫応答に着目した新規心臓サルコイドーシス組織診断法に関する検討

  永井 利幸, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  S7  -5  2018/09  [Not refereed][Not invited]
  
• 右冠動脈へのPCI中に生じた逆行性冠動脈大動脈解離に対してBail out stentingを行った一例

  加藤 喜哉, 永井 利幸, 小森山 弘和, 表 和徳, 相川 忠夫, 神谷 究, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  EP  -069  2018/09  [Not refereed][Not invited]
  
• HFpEF患者における血中ヘモグロビン値の変化と予後に関する検討

  奥野 圭佑, 内藤 由朗, 朝倉 正紀, 菅原 政貴, 安藤 友孝, 康村 誠希, 永井 利幸, 斉藤 能彦, 吉川 勉, 増山 理, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  O  -095  2018/09  [Not refereed][Not invited]
  
• 【心不全のすべて-分子生物学から緩和ケアまで:beyondガイドライン】望まれる心不全診療-これからの心不全診療に求められるもの 終末期医療と緩和ケア 心不全患者に対する緩和ケアの現状と課題

  安斉 俊久  医学のあゆみ  266-  (13)  1208  -1212  2018/09  [Not refereed][Not invited]
   

  緩和ケアは、生命を脅かすすべての疾患に対して考慮すべきであると世界保健機関(WHO)で提唱されており、緩和ケアが必要とされる疾患のなかでも心不全の占める割合は大きい。心不全患者はしばしば全人的苦痛を抱えているため、患者・家族のquality of life(QOL)改善のためには、終末期に至る前からの多職種チームによるサポートが重要である。しかし、心不全は急性増悪による入退院を繰り返しながらも最期は急速に悪化するため、終末期の判断が困難であり、比較的早期の段階から、患者や家族と望む治療と生き方について医療者と共有し、事前に対話しながら計画するアドバンスケアプランニング(ACP)の普及が望まれる。また、心不全はがんとは異なり、症状緩和のために最期まで原疾患に対する治療が必要であり、多職種チームにより患者の身体的・心理的・精神的な要求を頻回にアセスメントしながら、QOL改善のための緩和ケアを行うことが推奨される。(著者抄録)
• 心不全緩和ケアの現状と課題

  安斉 俊久  Cardiovascular Anesthesia  22-  (Suppl.)  91  -91  2018/09  [Not refereed][Not invited]
  
• 連続流型LVAD装着後遠隔期に心不全増悪を来すまで大動脈弁逆流の経時的変化を観察しえた1例

  辻永 真吾, 岩野 弘幸, 大岡 智学, 更科 美羽, 林 大知, 永井 利幸, 福島 新, 村山 迪史, 市川 絢子, 中鉢 雅大, 西野 久雄, 横山 しのぶ, 松居 喜郎, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  np2  -np2  2018/09  [Not refereed][Not invited]
  
• 心サルコイドーシスの診断と治療における最新の知見 非肉芽腫組織における免疫応答に着目した新規心臓サルコイドーシス組織診断法に関する検討

  永井 利幸, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  S7  -5  2018/09  [Not refereed][Not invited]
  
• 右冠動脈へのPCI中に生じた逆行性冠動脈大動脈解離に対してBail out stentingを行った一例

  加藤 喜哉, 永井 利幸, 小森山 弘和, 表 和徳, 相川 忠夫, 神谷 究, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  EP  -069  2018/09  [Not refereed][Not invited]
  
• HFpEF患者における血中ヘモグロビン値の変化と予後に関する検討

  奥野 圭佑, 内藤 由朗, 朝倉 正紀, 菅原 政貴, 安藤 友孝, 康村 誠希, 永井 利幸, 斉藤 能彦, 吉川 勉, 増山 理, 安斉 俊久  日本心臓病学会学術集会抄録  66回-  O  -095  2018/09  [Not refereed][Not invited]
  
• 地域医療における心血管インターベンションのあるべき姿とは 北海道地域における経皮的冠動脈インターベンション施設の現状と取り組み

  神谷 究, 永井 利幸, 表 和徳, 加藤 喜哉, 小森山 弘和, 安斉 俊久  日本心血管インターベンション治療学会抄録集  27回-  SY6  -2  2018/08  [Not refereed][Not invited]
  
• 地域医療における心血管インターベンションのあるべき姿とは 北海道地域における経皮的冠動脈インターベンション施設の現状と取り組み

  神谷 究, 永井 利幸, 表 和徳, 加藤 喜哉, 小森山 弘和, 安斉 俊久  日本心血管インターベンション治療学会抄録集  27回-  SY6  -2  2018/08  [Not refereed][Not invited]
  
• 僧帽弁閉鎖不全症の包括的診療 機能性僧帽弁閉鎖術患者におけるMitraClip治療前v波および治療前後のv波変化は、治療後心係数増加と関連する

  天木 誠, 片岡 有, 神崎 秀明, 宮本 康二, 岡田 厚, 濱谷 康弘, 藤野 雅史, 高濱 博幸, 長谷川 拓也, 草野 研吾, 泉 知里, 大西 佳彦, 藤田 知之, 小林 順二郎, 安斉 俊久, 安田 聡  日本心血管インターベンション治療学会抄録集  27回-  SY9  -5  2018/08  [Not refereed][Not invited]
  
• 構造的心疾患インターベンションのための画像診断を究める 閉塞性肥大型心筋症に対する非薬物治療前評価における、造影CTと3Dプリンターの役割

  濱谷 康弘, 天木 誠, 神崎 秀明, 西井 達矢, 河野 淳, 岡田 厚, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 島原 佑介, 藤田 知之, 福田 哲也, 白石 公, 安斉 俊久, 安田 聡, 小林 順二郎, 泉 知里  日本心血管インターベンション治療学会抄録集  27回-  SY14  -3  2018/08  [Not refereed][Not invited]
  
• 【心不全診療における高血圧】 HFpEFの概念、疫学と高血圧の関与

  永井 利幸, 安斉 俊久  血圧  25-  (7)  496  -502  2018/07  [Not refereed][Not invited]
   

  高齢化社会の進行に並行して、心不全患者数は激増している。心不全患者の約半数を占める左室駆出率の保たれた心不全(heart failure with preserved ejection fraction:HFpEF)が近年注目されているが、有効な予防・治療法が確立していないため、30年来予後を改善させるに至っていない。最近、HFpEFの病態理解が進み、従来主病因と考えられてきた高血圧による左室拡張障害に加えて、糖尿病、肥満、腎機能障害、心房細動などの併存疾患による慢性血管内皮炎症からもたらされる病的左室リモデリングの重要性が報告された。特に日本人においては、心房細動や血圧のコントロールがHFpEFの予防・心不全増悪予防により重要であることを示唆する報告もあり、患者個別の適切な併存疾患管理がHFpEF診療のカギとなると考えられる。(著者抄録)
• 心不全パンデミックを見据えた高血圧治療

  安斉 俊久  Progress in Medicine  38-  (6)  611  -614  2018/06  [Not refereed][Not invited]
  
• 心不全緩和ケアのこれから 循環器緩和ケアにおける診療の質評価指標とACPプログラムの開発

  安斉 俊久, 高田 弥寿子, 河野 由枝, 菅野 康夫  Palliative Care Research  13-  (Suppl.)  S169  -S169  2018/06  [Not refereed][Not invited]
  
• 高齢心不全患者のマネジメントと緩和ケア 高齢心不全患者の緩和ケア 高齢慢性心不全患者のACPの意義と推進に向けての取り組み

  高田 弥寿子, 菅野 康夫, 河野 由枝, 濱谷 康弘, 安斉 俊久  日本在宅医学会大会  20回-  121  -121  2018/04  [Not refereed][Not invited]
  
• 混合性肺高血圧患者の左房心筋機能障害

  加賀 早苗, 岡田 一範, 三神 大世, 川村 希実, 政氏 伸夫, 村山 迪史, 横山 しのぶ, 岩野 弘幸, 山田 聡, 安斉 俊久  超音波医学  45-  (Suppl.)  S604  -S604  2018/04  [Not refereed][Not invited]
  
• 治療方針選択に苦慮し、外科治療を施行した高齢Ebstein病の1例

  横山 しのぶ, 山田 聡, 辻永 真吾, 岩野 弘幸, 西田 睦, 秋沢 宏次, 澁谷 斉, 早瀬 英子, 清水 力, 安斉 俊久  超音波医学  45-  (Suppl.)  S608  -S608  2018/04  [Not refereed][Not invited]
  
• 孤立性高度三尖弁逆流の実態調査

  岩野 弘幸, 山田 聡, 新宮 康栄, 更科 美羽, 辻永 真吾, 林 大知, 松居 喜郎, 安斉 俊久  超音波医学  45-  (Suppl.)  S616  -S616  2018/04  [Not refereed][Not invited]
  
• 三次元心エコー法による肥大型心筋症のリザーバ期左房心筋伸展障害の実態と機序の検討

  柳 裕介, 岡田 一範, 加賀 早苗, 三神 大世, 政氏 伸夫, 西野 久雄, 横山 しのぶ, 岩野 弘幸, 山田 聡, 安斉 俊久  超音波医学  45-  (Suppl.)  S618  -S618  2018/04  [Not refereed][Not invited]
  
• カテーテル大動脈弁置換術後発症する心不全の病態 左室心筋ストレイン解析の有用性

  天木 誠, 岡田 厚, 島原 佑介, 神崎 秀明, 藤田 知之, 小林 順二郎, 安田 聡, 安斉 俊久  超音波医学  45-  (Suppl.)  S637  -S637  2018/04  [Not refereed][Not invited]
  
• 高度三尖弁逆流による収縮性心膜炎様の血行動態を呈した両心不全の2例

  林 大知, 岩野 弘幸, 市川 絢子, 横山 しのぶ, 西野 久雄, 更科 美羽, 辻永 真吾, 山田 聡, 安斉 俊久  超音波医学  45-  (Suppl.)  S649  -S649  2018/04  [Not refereed][Not invited]
  
• バイオマーカーを理解する 炎症性マーカー

  安斉 俊久  Cardio-Coagulation  5-  (1)  46  -50  2018/03  [Not refereed][Not invited]
  
• バイオマーカーを理解する 炎症性マーカー

  安斉 俊久  Cardio-Coagulation  5-  (1)  46  -50  2018/03  [Not refereed][Not invited]
  
• 【病気とくすり2018 基礎と実践Expert's Guide】循環器の病気とくすり 心不全

  天木 誠, 安斉 俊久, 和田 恭一  薬局  69-  (4)  964  -981  2018/03  [Not refereed][Not invited]
  
• CKD/透析患者の心血管合併症とその対策

  原田 和昌, 阿部 雅紀, 安斉 俊久, 長谷部 直幸  臨床医のための循環器診療  (28)  3  -18  2018/03  [Not refereed][Not invited]
  
• 駆出率が保たれた心不全の日本人患者における心不全による入院の予防戦略 JASPER全国レジストリからの見識(Prevention Strategies for Heart Failure Hospitalization in Japanese Patients with Heart Failure with Preserved Ejection Fraction: Insights from JASPER Nationwide-registry)

  安斉 俊久, 永井 利幸, 吉川 勉, 斎藤 能彦, 竹石 恭知, 山本 一博, 小川 久雄  日本循環器学会学術集会抄録集  82回-  PL8  -2  2018/03  [Not refereed][Not invited]
  
• 心不全と不整脈の管理〜薬物治療からデバイス治療まで〜 左室機能障害患者の心房性不整脈に対するカテーテルアブレーションの臨床的影響(Clinical Impact of Catheter Ablation for Atrial Arrhythmias in Patients with Impaired Left Ventricular Function)

  野田 崇, 岡田 厚, 中島 育太郎, 鎌倉 令, 和田 暢, 山形 研一郎, 石橋 耕平, 井上 優子, 宮本 康二, 岡村 英夫, 永瀬 聡, 相庭 武司, 野口 暉夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  82回-  SY02  -3  2018/03  [Not refereed][Not invited]
  
• 心臓突然死の病態解明と予知・予防 早期再分極症候群の患者における冠攣縮誘発試験の重要性(The Significance of Spasm Provocation Test in Patients with Early Repolarization Syndrome)

  鎌倉 令, 和田 暢, 山形 研一郎, 石橋 耕平, 井上 優子, 宮本 康二, 岡村 英夫, 永瀬 聡, 野田 崇, 相庭 武司, 野口 暉夫, 安斉 俊久, 安田 聡, 清水 渉, 鎌倉 史郎, 草野 研吾  日本循環器学会学術集会抄録集  82回-  SY05  -2  2018/03  [Not refereed][Not invited]
  
• わが国の循環器医療提供体制の課題と展望 本邦における循環器医療の現状 JROADおよびJROAD-DPCデータベースからの知見(The Current Status of Cardiovascular Medicine in Japan: Insights from JROAD and JROAD-DPC Database)

  安田 聡, 中尾 一泰, 西村 邦宏, 宮本 恵宏, 住田 陽子, 宍戸 稔聡, 安斉 俊久, 斎藤 能彦, 小室 一成, 小川 久雄  日本循環器学会学術集会抄録集  82回-  SY11  -5  2018/03  [Not refereed][Not invited]
  
• 心不全パンデミックを見据えた高血圧治療

  安斉 俊久  日本循環器学会学術集会抄録集  82回-  LS30  -LS30  2018/03  [Not refereed][Not invited]
  
• 駆出機能が温存された心不全のため入院した日本人患者の臨床的特徴、管理、転帰 JASPER全国レジストリ(Clinical Characteristics, Managements, and Outcomes of Japanese Patients Hospitalized for Heart Failure with Preserved Ejection Function: The JASPER Nationwide Registry)

  安斉 俊久, 永井 利幸, 吉川 勉, 斎藤 能彦, 竹石 恭知, 山本 一博, 小川 久雄  日本循環器学会学術集会抄録集  82回-  LBCS2  -1  2018/03  [Not refereed][Not invited]
  
• ProBNP対総BNP比は駆出率低下を伴う急性心不全患者における将来の心臓逆リモデリングを予測する(ProBNP Ratio to Total BNP Predicts Future Cardiac Reverse Remodeling in Acute Heart Failure Patients with Reduced Ejection Fraction)

  高濱 博幸, 高潮 征爾, 錦見 俊雄, 林 友鴻, 岡谷 千晶, 中川 靖章, 濱谷 康弘, 岡田 厚, 天木 誠, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 安田 聡, 寒川 賢治, 南野 直人, 安斉 俊久  日本循環器学会学術集会抄録集  82回-  OJ20  -2  2018/03  [Not refereed][Not invited]
  
• 経カテーテル大動脈弁置換術後の新規左脚ブロックまたは右室ペーシングの有害作用(Adverse Effects of New Left Bundle Branch Block or Right Ventricular Pacing after Transcatheter Aortic Valve Implantation)

  神崎 秀明, 天木 誠, 岡田 厚, 濱谷 康弘, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 安田 聡, 安斉 俊久, 小林 順二郎  日本循環器学会学術集会抄録集  82回-  OJ25  -2  2018/03  [Not refereed][Not invited]
  
• 連続波ドップラーを用いた心房収縮前肺動脈-右室圧較差による肺動脈楔入圧の正確な推定(Accurate Estimation of Pulmonary Artery Wedge Pressure by Pre-Atrial Contraction Pulmonary Arterial-Right Ventricular Pressure Gradient Using Continuous-Wave Doppler)

  村山 迪史, 加賀 早苗, 岡田 一範, 市川 絢子, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 更科 美羽, 辻永 真吾, 林 大知, 岩野 弘幸, 西田 睦, 澁谷 斉, 山田 聡, 三神 大世, 安斉 俊久  日本循環器学会学術集会抄録集  82回-  OJ25  -8  2018/03  [Not refereed][Not invited]
  
• 正常心および拡張心における左心室内拡張早期の渦の特性と重要性(Property and Significance of Intra-Left Ventricular Early-Diastolic Vortex in Normal and Dilated Heart)

  更科 美羽, 山田 聡, 岩野 弘幸, 岡田 一範, 辻永 真吾, 林 大知, 村山 迪史, 市川 絢子, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 加賀 早苗, 安斉 俊久  日本循環器学会学術集会抄録集  82回-  PJ001  -5  2018/03  [Not refereed][Not invited]
  
• 心肥大における不整脈原性ベータアドレナリン作動性シグナル伝達 CaMKIIの興奮を介した小コンダクタンスカルシウム活性化カリウムチャネルの役割(Arrhythmogenic Beta-adrenergic Signaling in Cardiac Hypertrophy: The Role of Small Conductance Calcium Activated Potassium Channels via Activation of CaMKII)

  鎌田 塁, 横式 尚司, 三山 博史, 渡邉 昌也, 水上 和也, 天満 太郎, 高橋 雅之, 高田 真吾, 安斉 俊久  日本循環器学会学術集会抄録集  82回-  PJ016  -7  2018/03  [Not refereed][Not invited]
  
• 可溶性neprilysinの血漿中濃度は心因子と無関係に非代償性心不全の急性期に変動しない(Plasma Levels of Soluble Neprilysin Do not Fluctuate in the Acute Phase of Decompensated Heart Failure Independent of Cardiac Factors)

  高濱 博幸, 伊藤 慎, 濱谷 康弘, 岡田 厚, 天木 誠, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 北風 政史, 安田 聡, 寒川 賢治, 南野 直人, 安斉 俊久  日本循環器学会学術集会抄録集  82回-  PJ037  -6  2018/03  [Not refereed][Not invited]
  
• proBNPの総BNPに対する比率と心不全重症度との関連性 急性心不全の新たな代償機構(Association of Ratio of proBNP to Total BNP with Heart Failure Severity: A Novel Compensatory Mechanism for Acute Heart Failure)

  高濱 博幸, 高潮 征爾, 錦見 俊雄, 林 友鴻, 岡谷 千晶, 中川 靖章, 天木 誠, 大原 貴裕, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 安田 聡, 寒川 賢治, 南野 直人, 安斉 俊久  日本循環器学会学術集会抄録集  82回-  PJ042  -1  2018/03  [Not refereed][Not invited]
  
• 【心臓と血管の慢性炎症(生活習慣病)】 心筋梗塞後リモデリングと炎症

  安斉 俊久  別冊Bio Clinica: 慢性炎症と疾患  7-  (1)  14  -18  2018/02  [Not refereed][Not invited]
   

  急性心筋梗塞後には、単球、マクロファージを中心とした炎症細胞が浸潤し、膠原線維によって置換されるまでの脆弱な心筋は、壁応力によって容易に伸展を受け、いわゆる梗塞部伸展、左室リモデリングが生じる。梗塞後の炎症は、本来、治癒過程に必須のものであるが、何らかの修飾因子によって炎症が過剰に生じると、梗塞部伸展が助長される。単球・マクロファージによる過剰な炎症を制御する機構としては、樹状細胞が重要な役割を果たしていることが明らかになり、炎症を標的とした新規治療法の開発にもつながることが期待されている。(著者抄録)
• 【知っておきたい心不全治療薬の目的と使い方】 [静注薬編] 血管拡張薬

  濱谷 康弘, 安斉 俊久  循環器ナーシング  8-  (2)  15  -23  2018/02  [Not refereed][Not invited]
   

  ＜point＞●急性心不全は早期治療が大切!クリニカルシナリオ分類も参考にしよう!●血管拡張薬には、動脈系の血管に作用するものと、静脈系の血管に作用するものが存在する!●急性心不全に対して主に使われる血管拡張薬は、硝酸薬・Na利尿ペプチド・Ca拮抗薬の3種類!それぞれの特徴を理解しよう!(著者抄録)
• 【知っておきたい心不全治療薬の目的と使い方】 [静注薬編] 血管拡張薬

  濱谷 康弘, 安斉 俊久  循環器ナーシング  8-  (2)  15  -23  2018/02  [Not refereed][Not invited]
   

  ＜point＞●急性心不全は早期治療が大切!クリニカルシナリオ分類も参考にしよう!●血管拡張薬には、動脈系の血管に作用するものと、静脈系の血管に作用するものが存在する!●急性心不全に対して主に使われる血管拡張薬は、硝酸薬・Na利尿ペプチド・Ca拮抗薬の3種類!それぞれの特徴を理解しよう!(著者抄録)
• 慢性心不全におけるACP支援ツールの有効性の検討

  高田弥寿子, 濱谷康弘, 河野由枝, 庵地雄太, 中井陸運, 柴田龍宏, 鈴木敦, 志賀剛, 福本義弘, 泉知里, 菅野康夫, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  22nd-  2018
• 急性心不全入院時のD-dimer高値は短期虚血性脳卒中発症と関連する

  濱谷康弘, 永井利幸, 西村邦宏, 本田泰之, 中野宏己, 本田怜史, 岩上直嗣, 菅野康夫, 浅海泰栄, 相庭武司, 野口輝夫, 草野研吾, 豊田一則, 横山広行, 安田聡, 小川久雄, 安斉俊久  日本循環器学会近畿地方会(Web)  125th-  2018
• Clinical Impact of Catheter Ablation for Atrial Arrhythmias in Patients with Impaired Left Ventricular Function

  野田崇, 岡田厚, 中島育太郎, 鎌倉令, 和田暢, 山形研一郎, 石橋耕平, 井上優子, 宮本康二, 岡村英夫, 永瀬聡, 相庭武司, 野口暉夫, 安斉俊久, 安田聡, 草野研吾  日本循環器学会学術集会(Web)  82nd-  2018
• ¹⁵O標識水PETを用いた冠血行再建治療前後における局所冠血流予備能の定量評価

  相川忠夫, 納谷昌直, 真鍋治, 孫田恵一, 小梁川和宏, 浅川直也, 真鍋徳子, 志賀哲, 加藤千恵次, 玉木長良, 安斉俊久  核医学(Web)  55-  (Supplement)  2018
• 冠動脈疾患患者において血清TBARSは冠微小循環障害の予測因子である

  納谷昌直, 相川忠夫, 小原雅彦, 真鍋治, 小梁川和宏, 浅川直也, 加藤知恵次, 鈴木えり子, 筒井裕之, 玉木長良, 安斉俊久  核医学(Web)  55-  (Supplement)  2018
• サルコイドーシスの患者が5年の経過で心臓主体の病変へと進展した症例

  葛目将人, 納谷昌直, 小梁川和宏, 相川忠夫, 古家翔, 真鍋治, 志賀哲, 安斉俊久  核医学(Web)  55-  (Supplement)  2018
• 心臓サルコイドーシス患者における心電図同期心筋血流イメージングを用いた位相解析による予後評価

  小梁川和宏, 納谷昌直, 葛目将人, 相川忠夫, 真鍋治, 大平洋, 辻野一三, 真鍋徳子, 志賀哲, 安斉俊久  核医学(Web)  55-  (Supplement)  2018
• 多職種カンファレンスで明らかとなった緩和ケアあるいは植込み型補助人工心臓を要する重症心不全の患者像

  阿部隆宏, 阿部隆宏, 福島新, 横田卓, 古山勇気, 長崎大亮, 池田陽子, 大塚広貴, 絹川真太郎, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  22nd-  379  2018  [Not refereed][Not invited]
  
• 高齢者心不全のトータルマネージメント

  原田 和昌, 安斉 俊久, 今井 靖, 絹川 弘一郎  Therapeutic Research  39-  (1)  9  -16  2018/01  [Not refereed][Not invited]
  
• 高齢者心不全のトータルマネージメント

  原田 和昌, 安斉 俊久, 今井 靖, 絹川 弘一郎  Therapeutic Research  39-  (1)  9  -16  2018/01  [Not refereed][Not invited]
  
• 低酸素血症を呈した高齢Ebstein病の1例

  辻永 真吾, 山田 聡, 岩野 弘幸, 更科 美羽, 林 大知, 村山 迪史, 市川 絢子, 中鉢 雅大, 横山 しのぶ, 西野 久雄, 安斉 俊久  日本成人先天性心疾患学会雑誌  7-  (1)  169  -169  2018/01  [Not refereed][Not invited]
  
• Structural heart diseaseの進歩と課題 僧帽弁閉鎖不全症に対するカテーテル治療

  天木 誠, 片岡 有, 神崎 秀明, 長谷川 拓也, 岡田 厚, 宮本 康二, 大西 佳彦, 藤田 知之, 小林 順二郎, 安斉 俊久, 安田 聡  日本冠疾患学会雑誌  (Suppl.)  89  -89  2017/12  [Not refereed][Not invited]
  
• Structural heart diseaseの進歩と課題 僧帽弁閉鎖不全症に対するカテーテル治療

  天木 誠, 片岡 有, 神崎 秀明, 長谷川 拓也, 岡田 厚, 宮本 康二, 大西 佳彦, 藤田 知之, 小林 順二郎, 安斉 俊久, 安田 聡  日本冠疾患学会雑誌  (Suppl.)  89  -89  2017/12  [Not refereed][Not invited]
  
• Do Poor Responders to Cardiac Resynchronization Therapy also Poorly Respond to Exercise Therapy in Heart Failure Patients With Reduced Ejection Fraction?

  Kayo Misumi, Tetsuo Arakawa, Michio Nakanishi, Kazuhiro Nakao, Takuya Hasegawa, Shigefumi Fukui, Masanobu Yanase, Teruo Noguchi, Toshihisa Anzai, Kengo Kusano, Satoshi Yasuda, Yoichi Goto  CIRCULATION  136-  2017/11  

  0
• Comparison of Short-term Mortality Prediction Models on Long-term Mortality in Hospitalized Patients With Acute Heart Failure

  Hiroki Nakano, Toshiyuki Nagai, Michikazu Nakai, Kunihiro Nishimura, Yasuyuki Honda, Satoshi Honda, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  136-  2017/11  

  0
• Iron Deficiency and Risk of One-year Adverse Events Following a Hospitalization for Acute Heart Failure

  Hiroki Nakano, Toshiyuki Nagai, Michikazu Nakai, Kunihiro Nishimura, Varun Sundaram, Yasuyuki Honda, Satoshi Honda, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  136-  2017/11  

  0
• Irregularity in Size of Mitochondria in Cardiac Myocytes Associates With Prognosis in Patients With Dilated Cardiomyopathy

  Atsushi Shibata, Yasuo Sugano, Hideaki Kanzaki, Keiko Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  136-  2017/11  

  0
• Differential Impact of Plasma Brain Natriuretic Peptide Level on Long-term Clinical Outcomes in Acute Heart Failure Patients With Reduced, Mid-range and Preserved Ejection Fraction

  Yasuhiro Hamatani, Toshiyuki Nagai, Yasuyuki Shiraishi, Shun Kohsaka, Michikazu Nakai, Kunihiro Nishimura, Takashi Kohno, Yuji Nagatomo, Yasuhide Asaumi, Ayumi Goda, Atsushi Mizuno, Satoshi Yasuda, Hisao Ogawa, Tsutomu Yoshikawa, Toshihisa Anzai  CIRCULATION  136-  2017/11  

  0
• Simultaneous Validation of Mortality Prediction Models for Hospitalized Patients With Acute Heart Failure in the United Kingdom and Japan

  Toshiyuki Nagai, Varun Sundaram, Ahmad Shoaib, Yasuyuki Shiraishi, Shun Kohsaka, Ayumi Goda, Atsushi Mizuno, Jeniffer K. Quint, Tsutomu Yoshikawa, Toshihisa Anzai, John G. Cleland  CIRCULATION  136-  2017/11  

  0
• AutoSV現況と、今後の展開 急性心不全に対するNPPVの効果

  中野 宏己, 永井 利幸, 安斉 俊久  心臓  49-  (10)  1094  -1094  2017/10  [Not refereed][Not invited]
  
• 心臓再同期療法(CRT)を再評価する 心機能、運動耐容能、QOL 心臓再同期療法における自動最適化アルゴリズムの有用性

  神崎 秀明, 野田 崇, 濱谷 康弘, 岡田 厚, 天木 誠, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 草野 研吾, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  S8  -1  2017/09  [Not refereed][Not invited]
  
• 家族性拡張型心筋症の心臓MRIの所見を含めた医学的特徴と予後の検討

  丸目 恭平, 野口 暉夫, 立石 恵実, 高潮 征爾, 鎌倉 令, 森田 佳明, 安斉 俊久, 草野 研吾, 安田 聡, 小川 久雄, 辻田 賢一  日本心臓病学会学術集会抄録  65回-  O  -010  2017/09  [Not refereed][Not invited]
  
• CRT植込み後の運動療法における運動耐容能レスポンダーはCRT後左室駆出率レスポンダーか?

  三角 香世, 荒川 鉄雄, 中西 道郎, 中尾 一泰, 長谷川 拓也, 福井 重文, 簗瀬 正伸, 野口 暉夫, 安斉 俊久, 草野 研吾, 安田 聡, 後藤 葉一  日本心臓病学会学術集会抄録  65回-  O  -029  2017/09  [Not refereed][Not invited]
  
• カテーテルによる僧帽弁形成術 運動負荷心エコーでの術後僧帽弁狭窄症評価

  天木 誠, 片岡 有, 濱谷 康弘, 岡田 厚, 宮本 康二, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 大西 佳彦, 藤田 知之, 小林 順二郎, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  O  -070  2017/09  [Not refereed][Not invited]
  
• 経過中に自然軽快したと考えられたループス心筋炎の1例

  中川 頌子, 岡田 厚, 濱谷 康弘, 高濱 博幸, 天木 誠, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 松本 学, 植田 初江, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  O  -230  2017/09  [Not refereed][Not invited]
  
• 貧血がHFpEF患者の予後に及ぼす影響 性差の相違

  奥野 圭佑, 内藤 由朗, 朝倉 正紀, 菅原 政貴, 安藤 友孝, 康村 誠希, 永井 利幸, 斎藤 能彦, 吉川 勉, 増山 理, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  P  -038  2017/09  [Not refereed][Not invited]
  
• 僧帽弁閉鎖不全症と心不全を初発症状とした結合組織病の一例

  濱谷 康弘, 中嶋 絢子, 大郷 恵子, 天木 誠, 岡田 厚, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 池田 善彦, 安田 聡, 植田 初江, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  P  -073  2017/09  [Not refereed][Not invited]
  
• 著明な僧帽弁輪石灰化の存在を契機にMarfan症候群と診断し得た若年女性の一例

  伊藤 之康, 菅野 康夫, 濱谷 康弘, 岡田 厚, 高濱 博幸, 天木 誠, 長谷川 拓也, 神崎 秀明, 柳生 剛, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  P  -248  2017/09  [Not refereed][Not invited]
  
• 高齢者、女性は心機能、腎機能とは独立した体液貯留のリスク因子である

  長谷川 拓也, 朝倉 正紀, 坂本 真里, 浅沼 博司, 濱谷 康弘, 岡田 厚, 天木 誠, 高濱 博幸, 菅野 康夫, 神崎 秀明, 安田 聡, 安斉 俊久, 北風 政史  日本心臓病学会学術集会抄録  65回-  P  -389  2017/09  [Not refereed][Not invited]
  
• 心臓再同期療法(CRT)を再評価する 心機能、運動耐容能、QOL 心臓再同期療法における自動最適化アルゴリズムの有用性

  神崎 秀明, 野田 崇, 濱谷 康弘, 岡田 厚, 天木 誠, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 草野 研吾, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  S8  -1  2017/09  [Not refereed][Not invited]
  
• 家族性拡張型心筋症の心臓MRIの所見を含めた医学的特徴と予後の検討

  丸目 恭平, 野口 暉夫, 立石 恵実, 高潮 征爾, 鎌倉 令, 森田 佳明, 安斉 俊久, 草野 研吾, 安田 聡, 小川 久雄, 辻田 賢一  日本心臓病学会学術集会抄録  65回-  O  -010  2017/09  [Not refereed][Not invited]
  
• CRT植込み後の運動療法における運動耐容能レスポンダーはCRT後左室駆出率レスポンダーか?

  三角 香世, 荒川 鉄雄, 中西 道郎, 中尾 一泰, 長谷川 拓也, 福井 重文, 簗瀬 正伸, 野口 暉夫, 安斉 俊久, 草野 研吾, 安田 聡, 後藤 葉一  日本心臓病学会学術集会抄録  65回-  O  -029  2017/09  [Not refereed][Not invited]
  
• カテーテルによる僧帽弁形成術 運動負荷心エコーでの術後僧帽弁狭窄症評価

  天木 誠, 片岡 有, 濱谷 康弘, 岡田 厚, 宮本 康二, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 大西 佳彦, 藤田 知之, 小林 順二郎, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  O  -070  2017/09  [Not refereed][Not invited]
  
• 経過中に自然軽快したと考えられたループス心筋炎の1例

  中川 頌子, 岡田 厚, 濱谷 康弘, 高濱 博幸, 天木 誠, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 松本 学, 植田 初江, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  O  -230  2017/09  [Not refereed][Not invited]
  
• 貧血がHFpEF患者の予後に及ぼす影響 性差の相違

  奥野 圭佑, 内藤 由朗, 朝倉 正紀, 菅原 政貴, 安藤 友孝, 康村 誠希, 永井 利幸, 斎藤 能彦, 吉川 勉, 増山 理, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  P  -038  2017/09  [Not refereed][Not invited]
  
• 僧帽弁閉鎖不全症と心不全を初発症状とした結合組織病の一例

  濱谷 康弘, 中嶋 絢子, 大郷 恵子, 天木 誠, 岡田 厚, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 池田 善彦, 安田 聡, 植田 初江, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  P  -073  2017/09  [Not refereed][Not invited]
  
• 著明な僧帽弁輪石灰化の存在を契機にMarfan症候群と診断し得た若年女性の一例

  伊藤 之康, 菅野 康夫, 濱谷 康弘, 岡田 厚, 高濱 博幸, 天木 誠, 長谷川 拓也, 神崎 秀明, 柳生 剛, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  65回-  P  -248  2017/09  [Not refereed][Not invited]
  
• 高齢者、女性は心機能、腎機能とは独立した体液貯留のリスク因子である

  長谷川 拓也, 朝倉 正紀, 坂本 真里, 浅沼 博司, 濱谷 康弘, 岡田 厚, 天木 誠, 高濱 博幸, 菅野 康夫, 神崎 秀明, 安田 聡, 安斉 俊久, 北風 政史  日本心臓病学会学術集会抄録  65回-  P  -389  2017/09  [Not refereed][Not invited]
  
• 構造的心疾患診療における最適画像診断 低侵襲治療を見据えた展開 人工弁周囲逆流に対する経カテーテル的治療における画像検査

  長谷川 拓也, 小林 順二郎, 安斉 俊久  循環器専門医  25-  (2)  180  -186  2017/08  [Not refereed][Not invited]
  
• 心不全の緩和ケア 慢性心不全における意思決定支援の現状と課題

  高田 弥寿子, 菅野 康夫, 河野 由枝, 安斉 俊久  Palliative Care Research  12-  (Suppl.)  S200  -S200  2017/06  [Not refereed][Not invited]
  
• 【循環器疾患患者さんのメンタルケア:8つの具体例から学ぶ】 (総論3)緩和ケアにおけるメンタルケア

  菅野 康夫, 安斉 俊久  循環器ナーシング  7-  (6)  19  -25  2017/06  [Not refereed][Not invited]
   

  ＜point＞●循環器疾患患者さんは、うつ病などのメンタルヘルスの変調をきたすことが多い!メンタルヘルス障害はQOLを低下させ、予後を悪化させる!●循環器疾患患者さんにおけるメンタルケアは、医学的問題だけでなく、身体機能の低下や社会的問題など多面的な要素がかかわる!●緩和ケアの観点から、多職種で包括的に管理する必要がある!(著者抄録)
• 心不全診療における高血圧治療 HFpEFの概念、疫学と高血圧の関与

  安斉 俊久  日本高血圧学会臨床高血圧フォーラムプログラム・抄録集  6回-  121  -121  2017/05  [Not refereed][Not invited]
  
• 【超高齢社会における循環器疾患】 デスティネーション治療(DT)としての補助人工心臓

  安斉 俊久  Cardiac Practice  28-  (2)  141  -144  2017/05  [Not refereed][Not invited]
  
• 身体疾患患者へのメンタルケアモデル開発ナショナルプロジェクトにおける兵庫サイコカーディオロジー研究会の活動(第1報)

  庵地 雄太, 水谷 和郎, 上羽 康之, 安井 博規, 安斉 俊久, 伊藤 弘人  心身医学  57-  (5)  474  -474  2017/05  [Not refereed][Not invited]
  
• 心不全診療における高血圧治療 HFpEFの概念、疫学と高血圧の関与

  安斉 俊久  日本高血圧学会臨床高血圧フォーラムプログラム・抄録集  6回-  121  -121  2017/05  [Not refereed][Not invited]
  
• 心エコー技術のcutting edge Integrated imaging時代における心エコー 人工弁周囲逆流に対するカテーテル治療における心エコー図の役割

  長谷川 拓也, 神崎 秀明, 天木 誠, 高濱 博幸, 菅野 康夫, 藤田 知之, 安田 聡, 小林 順二郎, 安斉 俊久  超音波医学  44-  (Suppl.)  S214  -S214  2017/04  [Not refereed][Not invited]
  
• 【心臓ビギナー集まれ!治療もケアもしっかりわかる 循環器の病気ずかん】 (第5章)心臓の筋肉も病気になるんです!心筋疾患 急性心筋炎

  安斉 俊久  ハートナーシング  (2017春季増刊)  128  -131  2017/04  [Not refereed][Not invited]
  
• 心エコー技術のcutting edge Integrated imaging時代における心エコー 人工弁周囲逆流に対するカテーテル治療における心エコー図の役割

  長谷川 拓也, 神崎 秀明, 天木 誠, 高濱 博幸, 菅野 康夫, 藤田 知之, 安田 聡, 小林 順二郎, 安斉 俊久  超音波医学  44-  (Suppl.)  S214  -S214  2017/04  [Not refereed][Not invited]
  
• 日本の循環器医療の現状 全国請求データベースJROAD-DPCからの大量保険記録の分析(The Current Status of Cardiovascular Medicine in Japan: Large Number of Health Record Analysis from a Nationwide Claim-Based Database, JROAD-DPC)

  安田 聡, 中尾 一泰, 西村 邦宏, 宮本 恵宏, 住田 陽子, 宍戸 稔聡, 安斉 俊久, 伊藤 浩, 小室 一成, 斎藤 能彦  日本循環器学会学術集会抄録集  81回-  (11)  PL08  -6  2017/03  [Not refereed][Not invited]
   

  Background: Since cardiovascular disease accounts for one-quarter of deaths in the Japanese population, we developed a nationwide database using the administrative case-mix Diagnostic Procedure Combination (DPC) system (ie, the Japanese Registry Of All cardiac and vascular Diseases (JROAD)-DPC) to reveal the current status of cardiovascular medicine in Japan. Methods and Results: The JROAD-DPC database included 704,593 health records’ data of 2012 from 610 certificated hospitals of the Japanese Circulation Society. The 35,824 patients with acute myocardial infarction (AMI) and 108,665 patients with heart failure (HF) were admitted to hospitals. Increased hospital case volume was associated with reduced in-hospital mortality rates for both AMI and HF (P for trend < 0.001). Although there was little variation among AMI patients in terms of aspirin use at discharge (median prescription rate, 83.0% interquartile range [IQR], 76.9–88.0%), there were wide variations in the proportions of patients prescribed β-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB) at discharge (BB, 41.4%, IQR 27.6–55.7% ACEI/ARB, 52.0%, IQR 40.3–62.3%). In patients with HF, there were between-hospital variations in medications at discharge (BB, 38.1%, IQR, 27.8–47.6% ACEI/ARB, 41.0%, IQR 31.7–49.1%). Conclusions: A nationwide administrative database of patients with cardiovascular diseases (JROAD-DPC) provided useful information that will contribute to improved quality of medical care, especially in the aging society of Japan, where HF has become an important health problem.
• 器質的心疾患に伴う持続性心室頻拍に対するカテーテルアブレーションの最前線 心サルコイドーシスにおける心室頻拍の管理 強化薬物療法併用下での高周波カテーテルアブレーションの有効性(Management of Ventricular Tachycardia in Cardiac Sarcoidosis: Efficacy of Radiofrequency Catheter Ablation Combined with an Intensive Pharmacologic Therapy)

  宮本 康二, 岡松 秀治, 野田 崇, 松山 高明, 鎌倉 令, 和田 暢, 石橋 耕平, 井上 優子, 岡村 英夫, 永瀬 聡, 相庭 武司, 野口 輝夫, 安斉 俊久, 里見 和浩, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  SY11  -4  2017/03  [Not refereed][Not invited]
  
• 患者のニーズからみた慢性心不全におけるACPの実践と課題

  高田 弥寿子, 菅野 康夫, 柴田 龍宏, 河野 由枝, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  CE2  -2  2017/03  [Not refereed][Not invited]
  
• 急性心不全患者における循環中BNP分子形態のモル比と腎機能との関連性はあるか(Is There a Relationship in Molar Ratio of Circulating BNP Molecular Forms with Renal Function in Acute Heart Failure Patients?)

  高濱 博幸, 高潮 征爾, 林 友鴻, 岡谷 千晶, 錦見 俊雄, 中川 靖章, 天木 誠, 大原 貴裕, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 安田 聡, 寒川 賢治, 南野 直人, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  OJ  -013  2017/03  [Not refereed][Not invited]
  
• 心アミロイドーシス患者における心トロポニンT値の診断的有用性(Diagnostic Utility of Cardiac Troponin T Level in Patients with Cardiac Amyloidosis)

  高潮 征爾, 山室 惠, 平川 今日子, 泉家 康宏, 丸目 恭平, 山本 正啓, 植田 初江, 安田 聡, 小川 久雄, 安斉 俊久, 辻田 賢一  日本循環器学会学術集会抄録集  81回-  OJ  -052  2017/03  [Not refereed][Not invited]
  
• 糖尿病関連の駆出率が保持された心不全における左室形質の特徴(Characteristics of Left Ventricular Trait in Diabetes Mellitus Related Heart Failure with Preserved Ejection Fraction)

  高濱 博幸, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  OJ  -062  2017/03  [Not refereed][Not invited]
  
• 2015年日本人質問票調査からの心サルコイドーシスにおける不整脈イベント(Arrhythmic Events in Cardiac Sarcoidosis from Japanese Questionnaire Survey in 2015)

  長山 友美, 石橋 耕平, 服部 雄介, 森 一樹, 中島 健三郎, 中須賀 公亮, 鎌倉 令, 和田 暢, 井上 優子, 宮本 康二, 岡村 英夫, 永瀬 聡, 野田 崇, 相庭 武司, 磯部 光章, 寺崎 文生, 野口 輝夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  OJ  -128  2017/03  [Not refereed][Not invited]
  
• ブルガダ症候群と不整脈原性右室心筋症における再分極異常および脱分極異常の心電図解析(Electrocardiographic Analysis of Repolarization and Depolarization Abnormalities in Brugada Syndrome and Arrhythmogenic Right Ventricular Cardiomyopathy)

  片岡 直也, 永瀬 聡, 鎌倉 令, 和田 暢, 石橋 耕平, 井上 優子, 宮本 康二, 岡村 英夫, 野田 崇, 相庭 武司, 野口 輝夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  PJ  -030  2017/03  [Not refereed][Not invited]
  
• 大動脈弁逆流症指数に左室拡張機能が与える影響(The Impact of Left Ventricular Diastolic Function on Aortic Regurgitation Index)

  神崎 秀明, 天木 誠, 岡田 厚, 濱谷 康弘, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 安田 聡, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  PJ  -183  2017/03  [Not refereed][Not invited]
  
• ICD/CRT-D植込み患者における早期心臓リハビリテーションおよび心肺運動負荷試験の至適時期と安全性(Appropriate Timing and Safety of Early Cardiac Rehabilitation and Cardiopulmonary Exercise Test in Patients after ICD/CRT-D Implantation)

  熊坂 礼音, 渡慶次 竜生, 伊達 歩, 三浦 弘之, 荒川 鉄雄, 中尾 一泰, 西平 賢作, 中西 道郎, 福井 重文, 長谷川 拓也, 簗瀬 正伸, 草野 研吾, 安斉 俊久, 野口 輝夫, 安田 聡, 後藤 葉一  日本循環器学会学術集会抄録集  81回-  PJ  -266  2017/03  [Not refereed][Not invited]
  
• 急性非代償性心不全における高感度心筋troponin T濃度の経時的変化(Changes over Time of High Sensitivity Cardiac Troponin T Levels in Acute Decompensated Heart Failure)

  高潮 征爾, 高濱 博幸, 安斉 俊久, 辻田 賢一  日本循環器学会学術集会抄録集  81回-  PJ  -269  2017/03  [Not refereed][Not invited]
  
• 先天性心疾患に対する外科修復後の成人患者における心房頻拍に対する高周波カテーテルアブレーションの長期有効性(Long-term Efficacy of Radiofrequency Catheter Ablation for Atrial Tachycardias in Adult Patients after Surgical Repair of Congenital Heart Disease)

  野田 崇, 宮崎 文, 宮本 康二, 鎌倉 令, 和田 暢, 石橋 耕平, 井上 優子, 岡村 英夫, 永瀬 聡, 相庭 武司, 野口 輝夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  PJ  -398  2017/03  [Not refereed][Not invited]
  
• 急性非代償性心不全患者における利尿反応による急性腎障害のリスク層別化(Risk Stratification of Acute Kidney Injury for Diuretic Response in Patients with Acute Decompensated Heart Failure)

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安斉 俊久, 安田 聡, 小川 久雄  日本循環器学会学術集会抄録集  81回-  PJ  -689  2017/03  [Not refereed][Not invited]
  
• 臨床研究における電子カルテシステムの効率的利用に関する取り組み 院内急性心不全症例登録研究を経験して

  住田 陽子, 永井 利幸, 中村 文明, 安田 聡, 安斉 俊久, 宮本 恵宏  日本循環器学会学術集会抄録集  81回-  CP  -196  2017/03  [Not refereed][Not invited]
  
• 【病気とくすり2017 基礎と実践Expert's Guide】循環器系・泌尿器系・生殖器系の病気とくすり 循環器系疾患 心不全

  天木 誠, 安斉 俊久, 和田 恭一  薬局  68-  (4)  966  -983  2017/03  [Not refereed][Not invited]
  
• 器質的心疾患に伴う持続性心室頻拍に対するカテーテルアブレーションの最前線 心サルコイドーシスにおける心室頻拍の管理 強化薬物療法併用下での高周波カテーテルアブレーションの有効性(Management of Ventricular Tachycardia in Cardiac Sarcoidosis: Efficacy of Radiofrequency Catheter Ablation Combined with an Intensive Pharmacologic Therapy)

  宮本 康二, 岡松 秀治, 野田 崇, 松山 高明, 鎌倉 令, 和田 暢, 石橋 耕平, 井上 優子, 岡村 英夫, 永瀬 聡, 相庭 武司, 野口 輝夫, 安斉 俊久, 里見 和浩, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  SY11  -4  2017/03  [Not refereed][Not invited]
  
• 患者のニーズからみた慢性心不全におけるACPの実践と課題

  高田 弥寿子, 菅野 康夫, 柴田 龍宏, 河野 由枝, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  CE2  -2  2017/03  [Not refereed][Not invited]
  
• 急性心不全患者における循環中BNP分子形態のモル比と腎機能との関連性はあるか(Is There a Relationship in Molar Ratio of Circulating BNP Molecular Forms with Renal Function in Acute Heart Failure Patients?)

  高濱 博幸, 高潮 征爾, 林 友鴻, 岡谷 千晶, 錦見 俊雄, 中川 靖章, 天木 誠, 大原 貴裕, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 安田 聡, 寒川 賢治, 南野 直人, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  OJ  -013  2017/03  [Not refereed][Not invited]
  
• 心アミロイドーシス患者における心トロポニンT値の診断的有用性(Diagnostic Utility of Cardiac Troponin T Level in Patients with Cardiac Amyloidosis)

  高潮 征爾, 山室 惠, 平川 今日子, 泉家 康宏, 丸目 恭平, 山本 正啓, 植田 初江, 安田 聡, 小川 久雄, 安斉 俊久, 辻田 賢一  日本循環器学会学術集会抄録集  81回-  OJ  -052  2017/03  [Not refereed][Not invited]
  
• 糖尿病関連の駆出率が保持された心不全における左室形質の特徴(Characteristics of Left Ventricular Trait in Diabetes Mellitus Related Heart Failure with Preserved Ejection Fraction)

  高濱 博幸, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  OJ  -062  2017/03  [Not refereed][Not invited]
  
• 2015年日本人質問票調査からの心サルコイドーシスにおける不整脈イベント(Arrhythmic Events in Cardiac Sarcoidosis from Japanese Questionnaire Survey in 2015)

  長山 友美, 石橋 耕平, 服部 雄介, 森 一樹, 中島 健三郎, 中須賀 公亮, 鎌倉 令, 和田 暢, 井上 優子, 宮本 康二, 岡村 英夫, 永瀬 聡, 野田 崇, 相庭 武司, 磯部 光章, 寺崎 文生, 野口 輝夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  OJ  -128  2017/03  [Not refereed][Not invited]
  
• ブルガダ症候群と不整脈原性右室心筋症における再分極異常および脱分極異常の心電図解析(Electrocardiographic Analysis of Repolarization and Depolarization Abnormalities in Brugada Syndrome and Arrhythmogenic Right Ventricular Cardiomyopathy)

  片岡 直也, 永瀬 聡, 鎌倉 令, 和田 暢, 石橋 耕平, 井上 優子, 宮本 康二, 岡村 英夫, 野田 崇, 相庭 武司, 野口 輝夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  PJ  -030  2017/03  [Not refereed][Not invited]
  
• 大動脈弁逆流症指数に左室拡張機能が与える影響(The Impact of Left Ventricular Diastolic Function on Aortic Regurgitation Index)

  神崎 秀明, 天木 誠, 岡田 厚, 濱谷 康弘, 高濱 博幸, 長谷川 拓也, 菅野 康夫, 安田 聡, 安斉 俊久  日本循環器学会学術集会抄録集  81回-  PJ  -183  2017/03  [Not refereed][Not invited]
  
• ICD/CRT-D植込み患者における早期心臓リハビリテーションおよび心肺運動負荷試験の至適時期と安全性(Appropriate Timing and Safety of Early Cardiac Rehabilitation and Cardiopulmonary Exercise Test in Patients after ICD/CRT-D Implantation)

  熊坂 礼音, 渡慶次 竜生, 伊達 歩, 三浦 弘之, 荒川 鉄雄, 中尾 一泰, 西平 賢作, 中西 道郎, 福井 重文, 長谷川 拓也, 簗瀬 正伸, 草野 研吾, 安斉 俊久, 野口 輝夫, 安田 聡, 後藤 葉一  日本循環器学会学術集会抄録集  81回-  PJ  -266  2017/03  [Not refereed][Not invited]
  
• 急性非代償性心不全における高感度心筋troponin T濃度の経時的変化(Changes over Time of High Sensitivity Cardiac Troponin T Levels in Acute Decompensated Heart Failure)

  高潮 征爾, 高濱 博幸, 安斉 俊久, 辻田 賢一  日本循環器学会学術集会抄録集  81回-  PJ  -269  2017/03  [Not refereed][Not invited]
  
• 先天性心疾患に対する外科修復後の成人患者における心房頻拍に対する高周波カテーテルアブレーションの長期有効性(Long-term Efficacy of Radiofrequency Catheter Ablation for Atrial Tachycardias in Adult Patients after Surgical Repair of Congenital Heart Disease)

  野田 崇, 宮崎 文, 宮本 康二, 鎌倉 令, 和田 暢, 石橋 耕平, 井上 優子, 岡村 英夫, 永瀬 聡, 相庭 武司, 野口 輝夫, 安斉 俊久, 安田 聡, 草野 研吾  日本循環器学会学術集会抄録集  81回-  PJ  -398  2017/03  [Not refereed][Not invited]
  
• 急性非代償性心不全患者における利尿反応による急性腎障害のリスク層別化(Risk Stratification of Acute Kidney Injury for Diuretic Response in Patients with Acute Decompensated Heart Failure)

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安斉 俊久, 安田 聡, 小川 久雄  日本循環器学会学術集会抄録集  81回-  PJ  -689  2017/03  [Not refereed][Not invited]
  
• 臨床研究における電子カルテシステムの効率的利用に関する取り組み 院内急性心不全症例登録研究を経験して

  住田 陽子, 永井 利幸, 中村 文明, 安田 聡, 安斉 俊久, 宮本 恵宏  日本循環器学会学術集会抄録集  81回-  CP  -196  2017/03  [Not refereed][Not invited]
  
• 2016年版心臓サルコイドーシスの診療ガイドライン

  寺崎 文生, 吾妻 安良太, 安斉 俊久, 石坂 信和, 石田 良雄, 磯部 光章, 猪又 孝元, 植田 初江, 江石 義信, 北風 政史, 草野 研吾, 坂田 泰史, 四十坊 典晴, 土田 哲人, 筒井 裕之, 中島 崇智, 中谷 敏, 堀井 泰浩, 矢崎 善一, 山口 悦郎, 山口 哲生, 井手 友美, 岡村 英夫, 加藤 靖周, 合屋 雅彦, 榊原 守, 副島 京子, 永井 利幸, 中村 浩士, 野田 崇, 長谷川 拓也, 森田 英晃, 大江 透, 木原 康樹, 斎藤 能彦, 杉山 幸比古, 森本 紳一郎, 山科 章, 日本循環器学会, 日本心臓病学会, 日本心不全学会, 日本サルコイドーシス, 肉芽腫性疾患学会, 日本心臓核医学会, 日本不整脈心電学会, 厚生労働省難治性疾患政策研究事業, 特発性心筋症に関する調査研究, 班  循環器病ガイドシリーズ  2016-  (心臓サルコイドーシスの診療ガイドライン)  1  -75  2017/02  [Not refereed][Not invited]
  
• ダイジェスト版 2016年版心臓サルコイドーシスの診療ガイドライン

  寺崎 文生, 吾妻 安良太, 安斉 俊久, 石坂 信和, 石田 良雄, 磯部 光章, 猪又 孝元, 植田 初江, 江石 義信, 北風 政史, 草野 研吾, 坂田 泰史, 四十坊 典晴, 土田 哲人, 筒井 裕之, 中島 崇智, 中谷 敏, 堀井 泰浩, 矢崎 善一, 山口 悦郎, 山口 哲生, 井手 友美, 岡村 英夫, 加藤 靖周, 合屋 雅彦, 榊原 守, 副島 京子, 永井 利幸, 中村 浩士, 野田 崇, 長谷川 拓也, 森田 英晃, 大江 透, 木原 康樹, 斎藤 能彦, 杉山 幸比古, 森本 紳一郎, 山科 章, 日本循環器学会, 日本心臓病学会, 日本心不全学会, 日本サルコイドーシス, 肉芽腫性疾患学会, 日本心臓核医学会, 日本不整脈心電学会, 厚生労働省難治性疾患政策研究事業, 特発性心筋症に関する調査研究, 班  循環器病ガイドシリーズ  2016-  (心臓サルコイドーシスの診療ガイドライン)  76  -137  2017/02  [Not refereed][Not invited]
  
• 集中治療と臓器連関 全身病として捉えるCOPD

  安斉 俊久  日本集中治療医学会雑誌  24-  (Suppl.)  SS5  -2  2017/02  [Not refereed][Not invited]
  
• 房室ブロックに心房中隔欠損症を合併し,治療の優先性に関する検討が必要であった一例

  中川頌子, 鎌倉令, 和田暢, 石橋耕平, 井上優子, 岡村英夫, 永瀬聡, 野田崇, 相庭武司, 福井重文, 野口輝夫, 安斉俊久, 安田聡, 草野研吾  日本循環器学会近畿地方会(Web)  123rd-  2017
• 筋強直性筋ジストロフィーを合併したBrugada症候群の心房細動に対してアブレーションを行った一例

  柏麻美, 鎌倉令, 和田暢, 石橋耕平, 井上優子, 岡村英夫, 宮本康二, 永瀬聡, 野田崇, 相庭武司, 野口暉夫, 安斉俊久, 安田聡, 草野研吾  日本循環器学会近畿地方会(Web)  123rd-  2017
• MitraClipによる僧帽弁修復術が長期的な血行動態に及ぼす効果

  岡田厚, 神崎秀明, 天木誠, 片岡有, 宮本康二, 濱谷康弘, 藤野雅史, 高濱博幸, 長谷川拓也, 菅野康夫, 草野研吾, 大西佳彦, 藤田知之, 小林順二郎, 安斉俊久, 安田聡  日本循環器学会近畿地方会(Web)  124th-  2017
• Management of Ventricular Tachycardia in Cardiac Sarcoidosis: Efficacy of Radiofrequency Catheter Ablation Combined with an Intensive Pharmacologic Therapy

  宮本康二, 岡松秀治, 野田崇, 松山高明, 鎌倉令, 和田暢, 石橋耕平, 井上優子, 岡村英夫, 永瀬聡, 相庭武司, 野口輝夫, 安斉俊久, 里見和浩, 安田聡, 草野研吾  日本循環器学会学術集会(Web)  81st-  2017
• Underweight is an Independent Predictor of Outcomes in Heart Failure with Preserved Ejection Fraction: A Report from JASPER Study

  MATSUMOTO Junichi, KINUGAWA Shintaro, FUKUSHIMA Arata, YOKOTA Takashi, YOSHIKAWA Tsutomu, SAITO Yoshihiko, NAGAI Toshiyuki, ANZAI Toshihisa  日本循環器学会学術集会(Web)  81st-  2017
• 左室流出路狭窄を伴う有症候性の高度大動脈弁狭窄症に対してTAVIを施行した1例

  加藤喜哉, 浅川直也, 表和徳, 徳田裕輔, 岩野弘幸, 山田聡, 森敏洋, 新宮康栄, 久保田卓, 松居喜郎, 安斉俊久  日本循環器学会北海道地方会(Web)  118th-  2017
• 心不全における栄養障害の評価と意義

  安斉俊久, 永井利幸  日本心不全学会学術集会プログラム・抄録集  21st-  199  2017  [Not refereed][Not invited]
  
• 心房性ナトリウム利尿ペプチドの3種の内在分子型の測定意義

  南野 直人, 永井 千晶, 谷, 高潮 征爾, 高濱 博幸, 林 友鴻, 安斉 俊久, 寒川 賢治  日本内分泌学会雑誌  92-  (3)  894  -894  2017/01  [Not refereed][Not invited]
  
• 【新薬展望2017】(第III部)治療における最近の新薬の位置付け<薬効別> 新薬の広場 抗凝固薬・抗血小板薬

  岡田 厚, 安斉 俊久  医薬ジャーナル  53-  (増刊)  403  -409  2017/01  [Not refereed][Not invited]
   

  非弁膜症性心房細動に対する抗凝固療法として,直接経口抗凝固薬(DOAC)が急速に普及している。一方で,重篤な出血に対する中和剤がないことや,現時点での適応は非弁膜症性心房細動に限定されることから,まだDOACに関する課題も多数残されている。国内における最近の話題として,静脈血栓塞栓症への適応拡大,中和剤の登場などを紹介する。また抗血小板領域においても,新規抗血小板薬チカグレロルが製造販売承認を取得し,今後更なる使用指針が示されることが期待される。(著者抄録)
• 【心不全 実地医家のための診断と治療のエッセンス】 セミナー 最新の実地診療のポイントの整理と活用 心不全患者のマネジメントの実際 重症化をどう予防するか

  安斉 俊久  Medical Practice  34-  (1)  59  -63  2017/01  [Not refereed][Not invited]
  
• 心房性ナトリウム利尿ペプチドの3種の内在分子型の測定意義

  南野 直人, 永井 千晶, 谷, 高潮 征爾, 高濱 博幸, 林 友鴻, 安斉 俊久, 寒川 賢治  日本内分泌学会雑誌  92-  (3)  894  -894  2017/01  [Not refereed][Not invited]
  
• Pericellular Amyloid Infiltration in Biopsy-proven Cardiac Amyloidosis

  Tetsuro Yokokawa, Yasuo Sugano, Taka-aki Matsuyama, Kanzaki Hideaki, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Yasuchika Takeishi, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Left Ventricular Strain Rate Can Predict Rehospitalizations With Congestive Heart Failure After Transcatheter Aortic Valve Replacement

  Makoto Amaki, Atushi Okada, Yusuke Shimahara, Hideaki Kanzaki, Yasuhiro Hamatani, Hiroyuki Takahama, Takuya Hasegawa, Yasuo Sugano, Tomoyuki Fujita, Junjiro Kobayashi, Yasuda Satoshi, Toshihisa Anzai  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Pericellular Amyloid Infiltration in Biopsy-proven Cardiac Amyloidosis

  Tetsuro Yokokawa, Yasuo Sugano, Taka-aki Matsuyama, Kanzaki Hideaki, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Yasuchika Takeishi, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Fluid Retention in Elderly Women, Independent of Cardiac and Renal Function in the Community-Based Population

  Takuya Hasegawa, Masanori Asakura, Mari Sakamoto, Hiroshi Asanuma, Makoto Amaki, Hiroyuki Takahama, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Determining Factors and Prognostic Value of Plasma gamma- Atrial Natriuretic Peptide Ratio in Patients With Heart Failure

  Seiji Takashio, Hiroyuki Takahama, Tomohiro Hayashi, Chiaki Nagai-Okatani, Toshio Nishikimi, Yasuaki Nakagawa, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Kenji Kangawa, Naoto Minamino, Toshihisa Anzai  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Current Era Survival and Prevalence of Pulmonary Hypertension-Specific Therapy in Adult Patients With Eisenmenger Syndrome

  Hideo Matama, Shigefumi Fukui, Takeshi Ogo, Jin Ueda, Akihiro Tsuji, Teruo Noguchi, Kengo Kusano, Toshihisa Anzai, Satoshi Yasuda  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Fibrosis Area Measured With Endomyocardial Biopsy Specimens Predicts Poor Long-Term Outcome of End-Stage Hypertrophic Cardiomyopathy

  Yasuteru Nakashima, Yasuo Sugano, Toshiyuki Nagai, Hideki Kanzaki, Keiko Ogo, Yoshihiko Ikeda, Hastsue Ueda, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  134-  2016/11  [Not refereed][Not invited]
  
• Determining Factors and Prognostic Value of Plasma gamma-Atrial Natriuretic Peptide Ratio in Patients With Heart Failure

  Seiji Takashio, Hiroyuki Takahama, Tomohiro Hayashi, Chiaki Nagai-Okatani, Toshio Nishikimi, Yasuaki Nakagawa, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Satoshi Yasuda, Kenji Kangawa, Naoto Minamino, Toshihisa Anzai  CIRCULATION  134-  2016/11  [Refereed][Not invited]
  
• 【循環器疾患治療薬:薬の使い方、どこまで理解していますか?】 心不全を治す 急性心不全での使い方

  永井 利幸, 安斉 俊久  Heart View  20-  (12)  94  -103  2016/11  [Not refereed][Not invited]
  
• 病気の概念 循環器領域における緩和ケア

  菅野 康夫, 安斉 俊久  循環器病研究の進歩  XXXVII-  (1)  33  -38  2016/11  [Not refereed][Not invited]
  
• 【心血管集中治療pros・cons】 Remote ischemic preconditioningは無効?

  安斉 俊久  ICUとCCU  40-  (10)  673  -680  2016/10  [Not refereed][Not invited]
   

  虚血耐性獲得(ischemic preconditioning:PC)は、心筋に対し、短時間の繰り返す虚血を行うとその後の長時間虚血に際して、梗塞サイズの縮小効果が得られる現象であるが、心臓以外の遠隔臓器における虚血前処置も心筋に対してPC効果を及ぼすことが動物実験で明らかにされ、Remote ischemic PC(RIPC)として知られている。臨床におけるRIPCの効果については、賛否両論がなされていたが、最近、RIPCの効果に関する大規模臨床試験が相次いで報告され、少なくとも冠動脈バイパス術前における上腕の虚血前処置は、予後改善効果を示さないことが明らかにされた。ただし、術後の心筋梗塞を抑制し、長期的な運動耐容能を改善する可能性はあり、経皮的冠動脈インターベンション(PCI)などの前処置における有用性の検証は今後の課題と考えられる。(著者抄録)
• Fibrosis Area Semiquantitatively Measured with Endomyocardial Biopsy Specimen Predicts Poor Long-Term Outcome of Dilated Phase Hypertrophic Cardiomyopathy

  Yasuteru Nakashima, Yasuo Sugano, Hideaki Kanzaki, Junko Nakashima, Keiko Ogo, Yoshihiko Ikeda, Hastsue Ueda, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  22-  (9)  S202  -S202  2016/09  [Not refereed][Not invited]
  
• Changes in the Ratio of Plasma B-Type Natriuretic Peptide Molecular Forms in Patients Hospitalized with Acute Decompensated Heart Failure

  Hiroyuki Takahama, Seiji Takashio, Tomohiro Hayashi, Naoto Minamino, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  22-  (9)  S181  -S181  2016/09  [Not refereed][Not invited]
  
• Serial Measurements of High Sensitivity Cardiac Troponin T Levels in Acute Decompensated Heart Failure

  Seiji Takashio, Hiroyuki Takahama, Tomohiro Hayashi, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  22-  (9)  S175  -S176  2016/09  [Not refereed][Not invited]
  
• Relationships of B-Type Natriuretic Peptides (BNP) Measured by Conventional Assay with proBNP(1-108) and N-Terminal proBNP(1-76) in Heart Failure Patients

  Hiroyuki Takahama, Seiji Takashio, Tomohiro Hayashi, Chiaki Okatani Nagai, Toshio Nishikimi, Yasuaki Nakagawa, Yasuo Sugano, Hideaki Kanzaki, Naoto Minamino, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  22-  (9)  S181  -S181  2016/09  [Not refereed][Not invited]
  
• Usefulness of Dendritic Cells and Macrophage Phenotypes Infiltrated Into Myocardium for Diagnosis of Cardiac Sarcoidosis

  Toshiyuki Nagai, Yasuyuki Honda, Yoshihiko Ikeda, Mamoru Sakakibara, Naoya Asakawa, Nobutaka Nagano, Satoshi Yasuda, Hiroyuki Tsutsui, Hatsue Ueda, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  22-  (9)  S164  -S164  2016/09  [Not refereed][Not invited]
  
• 二次性心筋症の診断の進歩 イメージングとバイオマーカー 心アミロイドーシスにおける心筋トロポニンT測定の有効性

  高潮 征爾, 菅野 康夫, 天木 誠, 高濱 博幸, 長谷川 拓也, 大原 貴裕, 神崎 秀明, 池田 善彦, 植田 初江, 山室 恵, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  64回-  S13  -5  2016/09  [Not refereed][Not invited]
  
• 心不全の薬物治療の最前線

  安斉 俊久  日本心臓病学会学術集会抄録  64回-  SP2  -2  2016/09  [Not refereed][Not invited]
  
• サルコイドーシスに伴う心不全に関する多角的アプローチ 心臓サルコイドーシスにおけるステロイド療法の現状と今後の課題

  永井 利幸, 永野 伸卓, 菅野 康夫, 浅海 泰栄, 草野 研吾, 野口 暉夫, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  64回-  JS1  -3  2016/09  [Not refereed][Not invited]
  
• ストレスチェックと心臓病 ストレスと心臓病

  安斉 俊久  日本心臓病学会学術集会抄録  64回-  JS4  -4  2016/09  [Not refereed][Not invited]
  
• Increase in activated dendritic cells infiltrating into endocardium in the left atrium of rheumatic heart disease

  M. Shiba, Y. Sugano, Y. Ikeda, T. Nagai, H. Ishibashi-Ueda, S. Yasuda, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  37-  947  -948  2016/08  [Not refereed][Not invited]
  
• Poor outcome in diabetic patients with dilated cardiomyopathy through increased myocardial tenascin-C expression

  Y. Nakashima, Y. Sugano, T. Nakayama, T. Yokokawa, T. Nagai, H. Kanzaki, K. Ohta-Ogo, Y. Ikeda, H. Ishibashi-Ueda, S. Yasuda, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  37-  1322  -1322  2016/08  [Not refereed][Not invited]
  
• Hydrogen consumption is a newly oxidative stress marker predicting the severity in patients with chronic heart failure

  A. Shibata, Y. Sugano, A. Shimouchi, T. Yokokawa, N. Jinno, H. Kanzaki, T. Aiba, K. Kusano, M. Shirai, S. Yasuda, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  37-  725  -725  2016/08  [Not refereed][Not invited]
  
• Tight linkage between increases in left atrium volume and augmented right ventricular function of the cohort subjects without overt heart failure in Japan

  M. Sakamoto, T. Hasegawa, M. Asakura, S. Takashio, M. Amaki, H. Takahama, T. Ohara, Y. Sugano, H. Kanzaki, T. Anzai, M. Kitakaze  EUROPEAN HEART JOURNAL  37-  719  -719  2016/08  [Not refereed][Not invited]
  
• Pathological investigation of congenital bicuspid aortic valve stenosis, comparing with atherosclerotic tricuspid aortic valve stenosis and congenital bicuspid aortic valve regurgitation

  Y. Hamatani, H. Ishibashi-Ueda, T. Nagai, Y. Sugano, H. Kanzaki, T. Fujita, J. Kobayashi, T. Anzai  EUROPEAN HEART JOURNAL  37-  745  -746  2016/08  [Not refereed][Not invited]
  
• 【最新冠動脈疾患学(下)-冠動脈疾患の最新治療戦略-】 心不全の臨床 NYHA分類とAHA/ACC Stage分類からみた心不全

  永井 利幸, 安斉 俊久  日本臨床  74-  (増刊6 最新冠動脈疾患学(下))  340  -344  2016/08  [Not refereed][Not invited]
  
• HFpEFとHFrEFについて考える 4 疫学からみたHFpEFとHFrEFの違い

  永井利幸, 安斉俊久  Heart View  20-  (7)  618‐625  2016/07/09  [Not refereed][Not invited]
  
• 【HFpEFとHFrEFについて考える】 識る 疫学からみたHFpEFとHFrEFの違い

  永井 利幸, 安斉 俊久  Heart View  20-  (7)  618  -625  2016/07  [Not refereed][Not invited]
  
• 【二次性心筋症の見分け方と治療】 炎症性心筋症

  菅野 康夫, 安斉 俊久  呼吸と循環  64-  (7)  655  -661  2016/07  [Not refereed][Not invited]
  
• 心不全による呼吸困難に対するモルヒネ使用の有効性について

  渡慶次 竜生, 菅野 康夫, 庵地 雄太, 濱谷 康弘, 久松 恵理子, 高田 弥寿子, 河野 由枝, 小田 亮介, 山本 幸夫, 佐藤 友紀, 安斉 俊久  Palliative Care Research  11-  (Suppl.)  S295  -S295  2016/06  [Not refereed][Not invited]
  
• 循環器疾患患者を対象とした「多職種緩和ケアチーム」による精神症状への包括的介入

  菅野 康夫, 庵地 雄太, 久松 恵理子, 高田 弥寿子, 河野 由枝, 小田 亮介, 山本 幸夫, 佐藤 友紀, 長松 耕平, 榎本 佳代子, 安斉 俊久  Palliative Care Research  11-  (Suppl.)  S297  -S297  2016/06  [Not refereed][Not invited]
  
• Impact of endogenous erythropoietin level on long-term clinical outcomes in patients with acute decompensated heart failure

  T. Nagai, K. Nishimura, T. Honma, Y. Sugano, Y. Asaumi, T. Noguchi, K. Kengo, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN JOURNAL OF HEART FAILURE  18-  105  -106  2016/05  [Not refereed][Not invited]
  
• ROLE OF LEFT VENTRICULAR CIRCUMFERENTIAL STRAIN IN THE PREDICTION OF CLINICAL OUTCOME IN PATIENTS WITH END-STAGE PHASE OF HYPERTROPHIC CARDIOMYOPATHY

  Makoto Amaki, Hideaki Kanzaki, Seiji Takashio, Hiroyuki Takahama, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  67-  (13)  1794  -1794  2016/04  [Not refereed][Not invited]
  
• 僧帽弁閉鎖不全症に対するカテーテル治療

  天木 誠, 安斉 俊久  循環器内科  79-  (4)  349  -354  2016/04  [Not refereed][Not invited]
  
• 兄弟間で異なる臓器病変を呈したミトコンドリア脳筋症の1家系

  津川 有理, 井端 剛, 横田 依莉子, 成田 登紀, 新田 洋介, 飯田 さよみ, 中野 智仁, 横江 勝, 曽我 文久, 中道 伊津子, 岡田 厚, 高濱 博幸, 安斉 俊久, 大郷 恵子, 植田 初江, 藤村 晴俊, 小室 竜太郎  糖尿病  59-  (Suppl.1)  S  -343  2016/04  [Not refereed][Not invited]
  
• Clinical Significance of Measurement of Three Endogenous Forms of Human Atrial Natriuretic Peptide in Patients with Acute Decompensated Heart Failure.

  Minamino N, Nagai-Okatani C, Takashio S, Takahama H, Hayashi T, Anzai T, Kangawa K  Peptide Science  2015-  257  -258  2016/03  [Not refereed][Not invited]
  
• 急性非代償性心不全患者における血中B-type natriuretic peptide分子型の割合の経時変化(Time Course Changes in Ratio of Molecular Forms of Circulating B-type Natriuretic Peptides in Patients with Acute Decompensated Heart Failure)

  Takahama Hiroyuki, Takashio Seiji, Minamino Naoto, Okatani-Nagai Chiaki, Hayashi Tomohiro, Nishikimi Toshio, Nakagawa Yasuaki, Amaki Makoto, Ohhara Takahiro, Hasegawa Takuya, Sugano Yasuo, Kanzaki Hideaki, Yasuda Satoshi, Ogawa Hisao, Kangawa Kenji, Anzai Toshihisa  Circulation Journal  80-  (Suppl.I)  1404  -1404  2016/03  [Not refereed][Not invited]
  
• 左室駆出率が維持された、あるいは低下した心不全患者におけるB-type natriuretic peptide分子形態比の比較(Comparison of Ratio of B-type Natriuretic Peptide Molecular Forms in Patients with Heart Failure with Preserved and Reduced Ejection Fraction)

  Takahama Hiroyuki, Takashio Seiji, Minamino Naoto, Okatani-Nagai Chiaki, Hayashi Tomohiro, Nishikimi Toshio, Nakagawa Yasuaki, Amaki Makoto, Ohhara Takahiro, Hasegawa Takuya, Sugano Yasuo, Kanzaki Hideaki, Yasuda Satoshi, Ogawa Hisao, Kangawa Kenji, Anzai Toshihisa  Circulation Journal  80-  (Suppl.I)  1585  -1585  2016/03  [Not refereed][Not invited]
  
• 【病気とくすり2016 基礎と実践Expert's Guide】 循環器系・泌尿器系・生殖器系の病気とくすり 循環器系疾患 心不全

  天木 誠, 安斉 俊久, 和田 恭一  薬局  67-  (4)  846  -862  2016/03  [Not refereed][Not invited]
  
• 【体うっ血の評価】 バイオマーカーによるうっ血の評価

  永井 利幸, 安斉 俊久  Fluid Management Renaissance  6-  (1)  54  -61  2016/02  [Not refereed][Not invited]
   

  テクノロジーの進歩により、2000年以降多くの心不全関連バイオマーカーが報告された。心不全によるうっ血は主に心臓、肺、腎臓、そして肝臓など全身の主要臓器に影響を与え、本稿ではそれらに関連したマーカーを整理した。心室由来の脳性Na利尿ペプチド(BNP)はneprilysin(NEP)阻害薬の登場によりその意義が再認識され、腎臓由来のマーカーは尿細管マーカーを含めて心腎連関の側面からうっ血を捉えることができる。さらに、肝臓由来の一部のマーカーはうっ血を鋭敏に反映することが示されており、腎臓由来マーカーとのマルチバイオマーカーアプローチにより心不全症例の将来リスク予測の精度も向上してきた。(著者抄録)
• 構造的心疾患に対する低侵襲治療 Transcatheter Aortic Valve Implantation(TAVI)における患者スクリーニングおよび選択の重要性

  天木 誠, 安斉 俊久  循環器専門医  24-  (1)  60  -66  2016/02  [Not refereed][Not invited]
  
• 【うつ病と心臓リハビリテーション 予防と治療の可能性】 心臓リハビリテーションを基礎とした心臓病患者へのメンタルケアモデル開発

  庵地 雄太, 水谷 和郎, 荒木 祥子, 上羽 康之, 大石 醒悟, 竹原 歩, 辻井 由紀, 北井 愛, 熊尾 良子, 山根 崇史, 松石 邦隆, 村井 亮介, 北井 豪, 仲村 直子, 堂本 康治, 山根 光量, 民田 浩一, 高橋 恭子, 安井 博規, 見野 耕一, 井上 信孝, 平田 健一, 小林 清香, 安斉 俊久, 伊藤 弘人  心臓リハビリテーション  21-  (1・2・3)  15  -20  2016/02  [Not refereed][Not invited]
  
• 超高齢者に対する不整脈デバイス抜去の予後の検討

  柏麻美, 和田暢, 岡村英夫, 鎌倉令, 井上優子, 石橋耕平, 宮本康二, 永瀬聡, 野田崇, 相庭武司, 野口暉夫, 安斉俊久, 安田聡, 草野研吾  日本循環器学会近畿地方会(Web)  122nd-  2016
• 運動中に皮下植込み型除細動器の不適切作動をきたしたBrugada症候群の1例

  佐藤泰貴, 鎌倉令, 和田暢, 石橋耕平, 井上優子, 宮本康二, 岡村英夫, 永瀬聡, 野田崇, 相庭武司, 安斉俊久, 野口輝夫, 安田聡, 草野研吾  日本循環器学会近畿地方会(Web)  122nd-  2016
• QRS幅が比較的狭い虚血性心筋症で右室同期左室ペーシングが有効であった一例

  上田暢彦, 石橋耕平, 野田崇, 鎌倉令, 和田暢, 井上優子, 宮本康二, 岡村英夫, 永瀬聡, 相庭武司, 野口輝夫, 安斉俊久, 安田聡, 草野研吾  日本循環器学会近畿地方会(Web)  122nd-  2016
• 長期個室管理と心拍反応著明亢進のため運動様式に難渋した巨細胞性劇症型心筋炎の一例

  山本壱弥, 福井教之, 鈴木裕二, 北垣和史, 柳英利, 柴田敦, 中尾一泰, 熊坂礼音, 荒川鉄雄, 福井重文, 中西道郎, 中西道郎, 簗瀬正伸, 神崎秀明, 安斉俊久, 後藤葉一, 後藤葉一  日本臨床運動療法学会雑誌  18-  (1)  2016
• 心房性ナトリウム利尿ペプチドの3種の内在分子型の測定意義

  南野直人, 永井(岡谷)千晶, 高潮征爾, 高濱博幸, 林友鴻, 安斉俊久, 寒川賢治  日本心血管内分泌代謝学会学術総会プログラム及び抄録集  20th-  83  2016  [Not refereed][Not invited]
  
• 僧帽弁置換術後の弁周囲逆流に対して経カテーテル的逆流孔閉鎖術を施行した1例

  中山貴文, 長谷川拓也, 中嶋安曜, 柴田敦, 濱谷康弘, 岡田厚, 高潮征爾, 高濱博幸, 大原貴裕, 天木誠, 菅野康夫, 神崎秀明, 久米悠太, 島原佑介, 秦広樹, 藤田知之, 安斉俊久, 小川久雄, 小林順二郎  日本循環器学会近畿地方会(Web)  121st-  KINKI121,E33 (WEB ONLY)  2016  [Not refereed][Not invited]
  
• 組織ドップラー法による左右房室弁輪最大収縮速度比を用いた左右心機能の相対強度による心不全症例のリスク層別化

  相川幸生, 永井利幸, 知念大悟, 上村和則, 本川哲文, 菅野康夫, 浅海泰栄, 大郷剛, 神崎秀明, 野口暉夫, 安斉俊久, 小川久雄, 杉町勝, 安田聡  日本心エコー図学会学術集会プログラム・抄録集(Web)  27th-  118 (WEB ONLY)  2016  [Not refereed][Not invited]
  
• 血漿BNPによるHFpEF症例の予後リスク層別化と治療戦略への応用

  永井利幸, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  20th-  223  2016  [Not refereed][Not invited]
  
• 肺動脈弁逆流拡張末期圧格差の上昇は心不全症例の強力な予後規定因子となる

  本田泰之, 永井利幸, 菅野康夫, 本田怜史, 岡田厚, 浅海泰栄, 相庭武司, 野口暉夫, 草野研吾, 小川久雄, 安田聡, 安斉俊久  日本心エコー図学会学術集会プログラム・抄録集(Web)  27th-  152 (WEB ONLY)  2016  [Not refereed][Not invited]
  
• 心不全の心腎貧血連関における内因性エリスロポエチンの予後的意義

  永井利幸, 西村邦宏, 菅野康夫, 浅海泰栄, 草野研吾, 野口暉夫, 安田聡, 安斉俊久  日本心不全学会学術集会プログラム・抄録集  20th-  215  2016  [Not refereed][Not invited]
  
• The current status of cardiovascular medicine in Japan – Analysis of a large number of health records from a nationwide claim-based database, JROAD-DPC

  Satoshi Yasuda, Kazuhiro Nakao, Kunihiro Nishimura, Yoshihiro Miyamoto, Yoko Sumita, Toshiaki Shishido, Toshihisa Anzai, Hiroyuki Tsutsui, Hiroshi Ito, Issei Komuro, Yoshihiko Saito, Hisao Ogawa, JROAD Investigators  Circulation Journal  80-  (11)  2327  -2335  2016  [Not refereed][Not invited]
   

  Background: Since cardiovascular disease accounts for one-quarter of deaths in the Japanese population, we developed a nationwide database using the administrative case-mix Diagnostic Procedure Combination (DPC) system (ie, the Japanese Registry Of All cardiac and vascular Diseases (JROAD)-DPC) to reveal the current status of cardiovascular medicine in Japan. Methods and Results: The JROAD-DPC database included 704,593 health records’ data of 2012 from 610 certificated hospitals of the Japanese Circulation Society. The 35,824 patients with acute myocardial infarction (AMI) and 108,665 patients with heart failure (HF) were admitted to hospitals. Increased hospital case volume was associated with reduced in-hospital mortality rates for both AMI and HF (P for trend < 0.001). Although there was little variation among AMI patients in terms of aspirin use at discharge (median prescription rate, 83.0% interquartile range [IQR], 76.9–88.0%), there were wide variations in the proportions of patients prescribed β-blockers (BB) and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB) at discharge (BB, 41.4%, IQR 27.6–55.7% ACEI/ARB, 52.0%, IQR 40.3–62.3%). In patients with HF, there were between-hospital variations in medications at discharge (BB, 38.1%, IQR, 27.8–47.6% ACEI/ARB, 41.0%, IQR 31.7–49.1%). Conclusions: A nationwide administrative database of patients with cardiovascular diseases (JROAD-DPC) provided useful information that will contribute to improved quality of medical care, especially in the aging society of Japan, where HF has become an important health problem.
• Subclinical Impairment of Left Ventricular Function in Stage A Subjects in a Community-based Population

  Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Hiroshi Asanuma, Seiji Takashio, Makoto Amaki, Hiroyuki Takahama, Takahiro Ohara, Yasuo Sugano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  132-  2015/11  [Not refereed][Not invited]
  
• Prothrombin Time is a Novel Marker for Congestion in Acute Decompensated Heart Failure Patients Without Anticoagulants

  Atsushi Okada, Yasuo Sugano, Toshiyuki Nagai, Satoshi Honda, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo F. Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  132-  2015/11  [Not refereed][Not invited]
  
• Paradox of Right Ventricular Function: Lower the Better? - Right Ventricular Dysfunction May Predict the Diagnosis of Tachycardia Induced Cardiomyopathy

  Atsushi Okada, Ikutaro Nakajima, Yoshiaki Morita, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Koji Miyamoto, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Shiro Kamakura, Toshihisa Anzai, Teruo Noguchi, Satoshi Yasuda, Hisao Ogawa, Kengo F. Kusano  CIRCULATION  132-  2015/11  [Not refereed][Not invited]
  
• 循環器疾患診療実態調査(JROAD) 大規模データベース構築へ向けて

  安田 聡, 西村 邦宏, 住田 陽子, 安斉 俊久, 宍戸 稔聡, 宮本 恵宏, 小川 久雄  循環器病研究の進歩  XXXVI-  (1)  35  -41  2015/11  [Not refereed][Not invited]
  
• 冠動脈疾患と心不全管理 急性心不全における虚血性心筋症の予測因子と長期予後規定因子に関する検討 非虚血性心筋症との比較から

  永井 利幸, 菅野 康夫, 高潮 征爾, 本田 怜史, 岡田 厚, 浅海 泰栄, 相庭 武司, 野口 輝夫, 草野 研吾, 小川 久雄, 安田 聡, 安斉 俊久  日本冠疾患学会雑誌  (Suppl.)  103  -103  2015/11  [Not refereed][Not invited]
  
• 循環器緩和ケアチームにおける薬剤師の役割

  岩澤 真紀子, 小田 亮介, 高田 弥寿子, 菅野 康夫, 安斉 俊久  Therapeutic Research  36-  (11)  1048  -1050  2015/11  [Not refereed][Not invited]
  
• Prothrombin Time as a Novel Marker for Congestion in Patients with Acute Decompensated Heart Failure Not Taking Anticoagulants

  Atsushi Okada, Yasuo Sugano, Toshiyuki Nagai, Satoshi Honda, Yasuhide Asaumi, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  21-  (10)  S172  -S173  2015/10  [Not refereed][Not invited]
  
• Discontinuation of Corticosteroid Therapy Increases the Risk of Cardiac Mortality Associated with Progression of Left Ventricular Dysfunction in Cardiac Sarcoidosis

  Toshiyuki Nagai, Nobutaka Nagano, Yasuo Sugano, Takeshi Aiba, Hideaki Kanzaki, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  21-  (10)  S146  -S146  2015/10  [Not refereed][Not invited]
  
• 【これは便利-情報システム新潮流】 利便性を追求したシステム開発 在宅セルフケアを目的とした慢性心不全患者Web管理システム

  谷 昇子, 宮本 恵宏, 安斉 俊久, 桑原 健, 菅野 康夫, 中沢 一雄  新医療  42-  (10)  112  -115  2015/10  [Not refereed][Not invited]
   

  慢性心不全の特徴として、高齢患者が多く、再入院率が高いことが挙げられる。心不全の状態が悪化したことによる入院は、日常での不十分な自己管理(セルフケア)による患者が多くを占める。そこで、退院後の在宅における慢性心不全患者のセルフケア支援を目的として、Web管理システムの構築を進めてきた。本稿では、その概要と今後の展望について述べる。(著者抄録)
• 心房性ナトリウム利尿ペプチドの3種内在分子型の測定法の開発とβ型分子の測定意義

  南野 直人, 岡谷 千晶, 高潮 征爾, 高濱 博幸, 林 友鴻, 安斉 俊久, 寒川 賢治  日本内分泌学会雑誌  91-  (2)  639  -639  2015/09  [Not refereed][Not invited]
  
• 急性非代償性心不全患者の血漿proBNP比率の測定意義

  高潮 征爾, 高濱 博幸, 永井 千晶, 林 友鴻, 錦見 俊雄, 中川 靖章, 神崎 秀明, 菅野 康夫, 長谷川 拓也, 大原 貴裕, 天木 誠, 安田 聡, 小川 久雄, 寒川 賢治, 安斉 俊久, 南野 直人  日本内分泌学会雑誌  91-  (2)  644  -644  2015/09  [Not refereed][Not invited]
  
• 拡張型心筋症における心筋線維化の進展は心筋トロポニンTと相関する

  高潮 征爾, 天木 誠, 高濱 博幸, 大原 貴裕, 長谷川 拓也, 中山 貴文, 菅野 康夫, 神崎 秀明, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  63回-  196  -196  2015/09  [Not refereed][Not invited]
  
• 心臓の同期性を診る 電気的な同期不全の評価と最適化の現状と展望

  野田 崇, 中島 育太郎, 鎌倉 史郎, 神崎 秀明, 安斉 俊久, 野口 輝夫, 安田 聡, 小川 久雄, 草野 研吾  日本心臓病学会学術集会抄録  63回-  368  -368  2015/09  [Not refereed][Not invited]
  
• 循環器緩和ケアチームにおける薬剤師の役割

  岩澤 真紀子, 小田 亮介, 高田 弥寿子, 菅野 康夫, 安斉 俊久  日本心臓病学会学術集会抄録  63回-  495  -495  2015/09  [Not refereed][Not invited]
  
• 拡張型心筋症患者での最大酸素摂取量と心筋ストレインの関連 マルチ・モダリティ・イメージング時代における役割

  北島 龍太, 天木 誠, 神崎 秀明, 山本 明日香, 高潮 征爾, 高濱 博幸, 大原 貴裕, 長谷川 拓也, 菅野 康夫, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  63回-  786  -786  2015/09  [Not refereed][Not invited]
  
• 循環器疾患患者へのメンタルヘルスケア確立への取り組み 兵庫サイコカーディオロジー研究会

  庵地 雄太, 水谷 和郎, 荒木 祥子, 大石 醒悟, 竹原 歩, 堂本 康治, 村井 亮介, 松石 邦隆, 見野 耕一, 山根 光量, 民田 浩一, 安井 博規, 井上 信孝, 平田 健一, 安斉 俊久, 伊藤 弘人  日本心臓病学会学術集会抄録  63回-  1023  -1023  2015/09  [Not refereed][Not invited]
  
• 左室機能障害を伴う高速AFとVTに対する超短期作用型β1選択的遮断薬であるlandiololの臨床利用可能性(Practical Applicability of Landiolol, an Ultra-short-acting β 1-selective Blocker, for Rapid AF and VT with Left Ventricular Dysfunction)

  和田 悠子, 相庭 武司, 辻田 靖之, 伊藤 英樹, 和田 暢, 中島 育太郎, 石橋 耕平, 宮本 康二, 野田 崇, 菅野 康夫, 神崎 秀明, 安斉 俊久, 草野 研吾, 安田 聡, 堀江 稔, 小川 久雄  日本心臓病学会学術集会抄録  63回-  1357  -1357  2015/09  [Not refereed][Not invited]
  
• 頻脈誘発性心筋症と拡張型心筋症は、右室機能不全によって鑑別可能である

  岡田 厚, 中島 育太郎, 森田 佳明, 鎌倉 令, 和田 暢, 石橋 耕平, 宮本 康二, 岡村 英夫, 野田 崇, 相庭 武司, 鎌倉 史郎, 安斉 俊久, 野口 暉夫, 安田 聡, 小川 久雄, 草野 研吾  日本心臓病学会学術集会抄録  63回-  1430  -1430  2015/09  [Not refereed][Not invited]
  
• Exhaled acetone concentration is a novel noninvasive biomarker related with disease severity in patients with congestive heart failure

  T. Yokokawa, Y. Sugano, A. Shimouchi, N. Jinno, M. Shirai, Y. Satoshi, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  36-  155  -155  2015/08  [Not refereed][Not invited]
  
• Prognostic impact of plasma phospholipid fatty acid composition and dihomo-gamma-linoleic acid level in patients with acute heart failure

  T. Nagai, N. Iwakami, Y. Sugano, T. Shibata, Y. Asaumi, T. Noguchi, K. F. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  841  -841  2015/08  [Not refereed][Not invited]
  
• Carperitide versus nitroglycerin as a first-line therapy in patients with acute heart failure: a propensity-matched comparison

  N. Iwakami, T. Nagai, Y. Sugano, T. Shibata, Y. Asaumi, T. Noguchi, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  546  -546  2015/08  [Not refereed][Not invited]
  
• The impact of decompensated heart failure requiring hospitalization on pulmonary diffusing capacity of carbon monoxide

  K. Moriuchi, K. Nakamura, H. Kanzaki, K. Kusano, T. Noguchi, S. Yasuda, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  36-  495  -495  2015/08  [Not refereed][Not invited]
  
• Determinants and prognostic significance of delirium in patients with acute heart failure

  S. Honda, T. Nagai, Y. Sugano, T. Shibata, Y. Asaumi, T. Noguchi, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  1172  -1172  2015/08  [Not refereed][Not invited]
  
• Impact of elevated end-diastolic pulmonary regurgitation gradient on worse clinical outcome in patients with acute heart failure

  Y. Honda, T. Nagai, Y. Sugano, T. Shibata, Y. Asaumi, T. Noguchi, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  841  -841  2015/08  [Not refereed][Not invited]
  
• A useful risk assessment tool of malnutrition and its prognostic impact in patients with acute heart failure

  N. Iwakami, T. Nagai, Y. Sugano, T. Shibata, Y. Asaumi, T. Noguchi, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  1171  -1171  2015/08  [Not refereed][Not invited]
  
• Model for end-stage liver disease score excluding INR (MELD-XI) modified by serum direct bilirubin level is useful for risk stratification in patients with acute heart failure

  M. Yamamoto, T. Nagai, A. Okada, Y. Sugano, Y. Asaumi, T. Noguchi, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  154  -154  2015/08  [Not refereed][Not invited]
  
• Usefulness of geriatric nutritional risk index for assessing the nutritional status and its prognostic impact in elderly patients with acute heart failure

  Y. Honda, T. Nagai, Y. Sugano, T. Shibata, Y. Asaumi, T. Noguchi, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  36-  1169  -1170  2015/08  [Not refereed][Not invited]
  
• Prognostic impact of chronic total coronary occlusion on implantable cardioverter-defibrillator recipients with ischemic heart diseases

  T. Nishikawa, M. Fujino, I. Nakajima, K. Kusano, T. Anzai, Y. Goto, T. Noguchi, H. Ogawa, S. Yasuda  EUROPEAN HEART JOURNAL  36-  922  -922  2015/08  [Not refereed][Not invited]
  
• 【循環器疾患を持つ高齢者のメンタルヘルスケア-不眠、せん妄、認知症-】 循環器疾患患者のメンタルヘルスケア 施設を超えた取り組み

  庵地 雄太, 水谷 和郎, 安斉 俊久, 伊藤 弘人  循環器ナーシング  5-  (8)  66  -79  2015/08  [Not refereed][Not invited]
   

  ＜point＞●循環器疾患患者へのメンタルヘルスケア充実の近道は「連携」!●ナショナルプロジェクトの活動指針は「研修」「地域連携モデル」「研究基盤整備」の開発と実施!●兵庫サイコカーディオロジー研究会の活動目的は「地域連携会議の構築」「連携コーディネーターの養成」「地域連携ツールの開発」「啓蒙・啓発」!●最終目標は、患者一人一人における心身の治療を最適化して、地域全体でフォローすること!(著者抄録)
• 運動誘発性肺高血圧の診断に運動負荷心エコーが有用であった一例

  森川 渚, 大原 貴裕, 大場 豊治, 田原 宣広, 神崎 秀明, 安斉 俊久, 福本 義弘  呼吸と循環  63-  (8)  S54  -S55  2015/08  [Not refereed][Not invited]
  
• アセタゾラミド(ダイアモックス注射用)適正使用指針 2015年4月

  高橋 淳, 長谷川 泰弘, 峰松 一夫, 木内 博之, 寳金 清博, 西山 和利, 佐賀 恒夫, 下瀬川 恵久, 安斉 俊久, 小笠原 邦昭, 木村 弘, 巽 浩一郎, 陳 和夫, 中川原 譲二, 畑澤 順, 宮本 享, 日本脳卒中学会, 日本脳神経外科学会, 日本神経学会, 日本核医学会, 学会合同アセタゾラミド適正使用指針作成委員会  脳卒中  37-  (4)  281  -297  2015/07  [Not refereed][Not invited]
  
• 【心不全クロニクル-患者の人生に寄り添いながら診る】 入院管理 速やかに血行動態を改善する 退院前:再発予防のために 心不全治療としての栄養介入の可能性と教育指導

  永井 利幸, 岩上 直嗣, 安斉 俊久  Medicina  52-  (7)  1094  -1097  2015/06  [Not refereed][Not invited]
   

  ＜ポイント＞心不全が進行すると,腸管浮腫による吸収障害や食思不振などから栄養障害が合併する.心不全症例における栄養障害の評価法には主なもので4種類報告されているが,いまだ十分なエビデンスがあるとは言えない.栄養障害は心不全症例の独立した予後規定因子であり,特にCONUTスコアによる予後予測が今後期待される.早期に栄養障害を評価し,ハイリスク例に介入の可能性を検討することが今後の課題である.(著者抄録)
• 国立循環器病研究センターにおける、本邦初の循環器緩和ケアチーム活動の実際と浮かび上がってきた問題点

  柴田 龍宏, 菅野 康夫, 河野 由枝, 高田 弥寿子, 久松 恵理子, 岩澤 真紀子, 小田 良介, 庵地 雄太, 小川 久雄, 安田 聡, 安斉 俊久  日本緩和医療学会学術大会プログラム・抄録集  20回-  292  -292  2015/06  [Not refereed][Not invited]
  
• 人生の最期をどう迎えたいか? 心不全患者を対象にしたアンケート調査の報告

  菅野 康夫, 古川 あけみ, 柴田 龍宏, 久松 恵理子, 高田 弥寿子, 河野 由枝, 安斉 俊久  日本緩和医療学会学術大会プログラム・抄録集  20回-  292  -292  2015/06  [Not refereed][Not invited]
  
• 視覚的・パターン評価と定量的評価、どっちが役立つ? 左室の拡張能評価どの指標を用いるか? 各指標の数値が重要? パターンが大事?

  大原 貴裕, 神崎 秀明, 安斉 俊久  超音波医学  42-  (Suppl.)  S255  -S255  2015/04  [Not refereed][Not invited]
  
• 心房細動と心不全を合併した患者に対する抗凝固療法

  筒井 裕之, 清水 渉, 山本 一博, 安斉 俊久  Cardio-Coagulation  2-  (1)  81  -88  2015/04  [Not refereed][Not invited]
  
• ヒト心臓及び血中に存在する3種のナトリウム利尿ペプチド内在分子型の測定法の開発とその意義

  南野 直人, 永井 千晶, 高濱 博幸, 高潮 征爾, 林 友鴻, 安斉 俊久, 寒川 賢治  日本内分泌学会雑誌  91-  (1)  333  -333  2015/04  [Not refereed][Not invited]
  
• Multicenter Investigation for Diabetes Mellitus in Atherosclerosis(MIDAS)研究における心血管病変

  吉田 都美, 西村 邦宏, 藤野 雅史, 草野 研吾, 安斉 俊久, 安田 聡, 横田 千晶, 石原 正治, 斎藤 能彦, 吉村 道博, 宮崎 俊一, 野口 暉夫, 宮本 恵宏, 小川 久雄  糖尿病  58-  (Suppl.1)  S  -375  2015/04  [Not refereed][Not invited]
  
• PREVENTION OF ISCHEMIC EMBOLISM IN HCM PATIENTS WITHOUT PRE-DOCUMENTED ATRIAL FIBRILLATION

  Yuko Wada, Takeshi Aiba, Taka-aki Matsuyama, Koji Miyamoto, Takashi Noda, Yasuo Sugano, Hideaki Kanzaki, Yoshiaki Morita, Hatsue Ishibashi-Ueda, Kengo Kusano, Toshihisa Anzai, Kazunori Toyoda, Satoshi Yasuda, Hisao Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A936  -A936  2015/03  [Not refereed][Not invited]
  
• INCIDENCE OF CANCER INCREASED IN PATIENTS WITH CHRONIC HEART FAILURE

  Mari Sakamoto, Masanori Asakura, Akira Funada, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Toshimitsu HAmasaki, Toshihisa Anzai, Masafumi Kitakaze  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A828  -A828  2015/03  [Not refereed][Not invited]
  
• PARADOXICAL LOW-FLOW, LOW-GRADIENT SEVERE AORTIC STENOSIS DESPITE PRESERVED EJECTION FRACTION IS ASSOCIATED WITH LOWER AORTIC VALVE RESISTANCE

  Koichiro Takayama, Takahiro Ohara, Akira Funada, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A1974  -A1974  2015/03  [Not refereed][Not invited]
  
• MORE IMPAIRED DIASTOLIC FUNCTION OF LIGHT CHAIN AMYLOIDOSIS CONTRIBUTE TO POOR PROGNOSIS COMPARED WITH TRANSTHYRETIN AMYLOIDOSIS: RESULT FROM LONGITUDINAL STUDY OF BIOPSY -PROVEN CARDIAC AMYLOIDOSIS

  Mari Sakamoto, Akira Funada, Makoto Amaki, Takahiro Ohara, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Masafumi Kitakaze, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A935  -A935  2015/03  [Not refereed][Not invited]
  
• SIGNIFICANCE OF MYOCARDIAL TENASCIN-C EXPRESSION IN ASSOCIATION WITH INFILTRATIVE INFLAMMATORY CELLS IN PATIENTS WITH DILATED CARDIOMYOPATHY

  Yasuo Sugano, Takafumi Nakayama, Tetsuro Yokokawa, Toshiyuki Nagai, Hideaki Kanzaki, Taka-aki Matsuyama, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Tshibashi-Ueda, Takeshi Nakatani, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A995  -A995  2015/03  [Not refereed][Not invited]
  
• IMPACT OF ACUTE KIDNEY INJURY DURING INITIAL TREATMENT ON WORSE CLINICAL OUTCOME IN PATIENTS WITH ACUTE HEART FAILURE

  Yoshiya Yamamoto, Toshiyuki Nagai, Yasuo Sugano, Tatsuhiro Shibata, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A831  -A831  2015/03  [Not refereed][Not invited]
  
• PROGNOSTIC IMPACT OF URINARY SODIUM CONCENTRATION IN PATIENTS WITH ACUTE HEART FAILURE

  Satoshi Honda, Toshiyuki Nagai, Yasuo Sugano, Tatsuhiro Shibata, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  65-  (10)  A1057  -A1057  2015/03  [Not refereed][Not invited]
  
• アミオダロン誘発性甲状腺機能異常の発症率と患者背景に関する検討

  林 友鴻, 木下 佐昌子, 大和 幹枝, 和田 恭一, 桑原 健, 安田 聡, 安斉 俊久  Progress in Medicine  35-  (Suppl.1)  358  -361  2015/03  [Not refereed][Not invited]
   

  アミオダロン誘発性甲状腺機能異常の発症率と患者背景について検討した。アミオダロン内服処方歴のある621例を後ろ向きに調査した。アミオダロン内服開始後3ヵ月以上経過した時点の甲状腺機能データを得られた453例中、アミオダロン開始時に甲状腺治療薬を内服していた39例は除外した。甲状腺機能正常148例、アミオダロン誘発性甲状腺機能低下症(AIH)35例、アミオダロン誘発性甲状腺中毒症(AIT)26例、潜在性甲状腺機能低下症176例、潜在性甲状腺機能亢進症14例であった。高齢になるほどAIH発症率が高くなった。85歳以上では、65歳未満と比較して8.24倍のリスク増大がみられた。AIH発症の危険因子について多変量解析を行い、TSH高値はAIH発症の独立した危険因子であった。AITについても同様に、多変量解析を行ったところ、若年例でAIT発症のリスクが高かった。
• 治療抵抗性の致死的不整脈に対するアミオダロンとソタロール併用療法の有効性

  廣瀬 紗也子, 野田 崇, 木村 義隆, 丸山 将広, 三嶋 剛, 金山 純二, 上島 彩子, 鎌倉 令, 和田 暢, 中島 育太郎, 石橋 耕平, 宮本 康二, 岡村 英夫, 相庭 武司, 安斉 俊久, 田原 良雄, 鎌倉 史郎, 草野 研吾  Progress in Medicine  35-  (Suppl.1)  396  -399  2015/03  [Not refereed][Not invited]
   

  治療抵抗性の致死的不整脈に対するアミオダロンとソタロール併用療法の有効性について検討した。III群抗不整脈薬を投与したにもかかわらず植込み型心臓刺激デバイス(ICSD)の作動が複数回確認され、アミオダロン+ソタロール併用療法を開始した29例を対象とした。心エコー、血液データは併用前後で有意差はなく、心電図はQTc時間で有意な延長を認めた。併用療法開始後のICSD作動は、抗頻脈作動4例、ショック作動10例であった。ショック作動のうち9例は適切作動、1例は不適切作動であった。イベント発生はES再発3例、心不全入院11例、死亡3例であった。2例は薬剤の副作用を疑い、併用療法を中止した。併用療法開始から5年後までの追跡調査で、ICSD適切作動回避率は最初の1年で約9割、ES再発率は最初の1年で約8割であった。生存率は最初の1年で約8割強、心不全増悪による入院の回避率は最初の1年で8〜9割であった。
• 虚血性心疾患に基づく急性非代償性心不全の臨床特徴と予後規定因子に関する検討

  黒澤 毅文, 中田 康紀, 横山 広行, 安斉 俊久, 石原 正治, 安田 聡, 小川 久雄  日本冠疾患学会雑誌  21-  (1)  6  -13  2015/03  [Not refereed][Not invited]
   

  【目的】急性非代償性心不全(ADHF)の予後規定因子を虚血性心疾患(IHD)と他の心疾患で検討。【対象】2006年7月〜2010年6月に当院に入院した連続757例をIHD、非虚血性弁膜症性心疾患(VHD)、非虚血性非弁膜症性心疾患(NIVHD)に分け予後規定因子を検討。【結果】IHD(234例)、VHD(179例)、NIVHD(344例)の院内死亡率3.4%、4.5%、5.8%。IHDは高齢、男性、高血圧、高脂血症、糖尿病、慢性腎不全合併が高く、心房細動合併は低率。生存退院721例の長期予後(811±496日)は3群間で差を認めなかった。多変量解析でIHDは高齢、退院時血清Na低値、退院時BNP高値、VHDは高齢、退院時血清Na低値、NIVHDは入院時BMI上昇、退院時血清Na低値、入院時収縮期血圧低値が長期の予後規定因子であった。【結語】ADHFでは基礎疾患により予後規定因子が異なった。(著者抄録)
• 炎症と組織修復から考える心臓病理 心筋梗塞後治癒過程における樹状細胞の役割

  安斉 俊久, 永井 利幸, 菅野 康夫, 池田 善彦, 植田 初江  日本病理学会会誌  104-  (1)  193  -193  2015/03  [Not refereed][Not invited]
  
• カルベジロールからピソプロロールへの変更が有効であった、低左心機能例に合併した神経調節性失神の1例

  執行 秀彌, 大原 貴裕, 岩山 忠輝, 舟田 晃, 長谷川 拓也, 神崎 秀明, 安斉 俊久  心臓  47-  (2)  187  -190  2015/02  [Not refereed][Not invited]
   

  症例は70歳、女性。主訴は意識消失。大動脈弁閉鎖不全症、感染性心内膜炎に対してBentall手術(Prima Plus 21mm、Intergrad 20mm)、右室形成術を施行した。術後完全房室ブロックと低心機能を認め心臓再同期療法ペースメーカー(Medtronic Consulta CRT-P C3TR01)を留置した。3ヵ月に及ぶ長期入院を要した。退院後、立位にて調理中に突然の意識消失をきたし、精査のために入院。心電図では失神をきたすような不整脈を認めず、心筋逸脱酵素上昇等異常所見を認めなかった。経胸壁心エコー図では、局所壁運動異常や大動脈弁置換弁の異常所見を認めなかった。頭部単純CT、脳波検査でも異常所見は認めなかった。神経調節性失神を疑いヘッドアップチルト試験を施行。ニトロール負荷にて急激な血圧低下、失神症状を認めた。カルベジロールのα遮断作用が失神の誘因となった可能性を考慮し、カルベジロールからビソプロロールへ変更した。変更後ヘッドアップチルト試験を再施行したが、血圧低下、失神症状を認めなかった。以降症状再発なく経過している。低心機能例に対してβ遮断薬を投与する際には神経調節性失神の副作用も考慮に入れて薬剤選択する必要があると考えられた。(著者抄録)
• 心房細動患者に対する新規抗凝固薬の安全な使用方法~国循データベースの腎機能からみた検討~

  相庭武司, 宮本康二, 有廣昇司, 石橋耕平, 渡邊至, 小久保喜弘, 和田暢, 野田崇, 鎌倉史郎, 野口輝夫, 安斉俊久, 安田聡, 宮本恵宏, 小川久雄, 豊田一則, 草野研吾  日本循環薬理学会口演要旨集  25th-  2015
• 拡張相肥大型心筋症の心室頻拍に対する心外膜・心内膜両アプローチのカテーテルアブレーションの病理的考察

  中島健三郎, 宮本康二, 松山高明, 鎌倉令, 和田暢, 中島育太郎, 石橋耕平, 野田崇, 相庭武司, 鎌倉史郎, 安斉俊久, 野口輝夫, 安田聡, 小川久雄, 植田初江, 草野研吾  日本循環器学会近畿地方会(Web)  119th-  2015
• 急性非代償性心不全患者の入院回復期における血漿BNP分子多型の時間的変化についての検討

  高濱博幸, 高潮征爾, 南野直人, 林友鴻, 永井千晶, 錦見俊男, 中川靖章, 天木誠, 大原貴裕, 長谷川拓也, 菅野康夫, 神崎秀明, 安田聡, 小川久雄, 寒川賢治, 安斉俊久  日本血管生物医学会学術集会プログラム・抄録集  23rd-  149  2015  [Not refereed][Not invited]
  
• ICD移植後の虚血性心疾患患者の予後規定因子に関する検討;慢性冠動脈完全閉塞の重要性

  西川達哉, 藤野雅史, 中島育太郎, 本田怜史, 川上将司, 永井利幸, 中尾一泰, 熊坂礼音, 荒川鉄雄, 片岡有, 中西道郎, 浅海泰栄, 田原良雄, 草野研吾, 安斉俊久, 後藤葉一, 野口輝夫, 安田聡, 小川久雄  日本循環器学会近畿地方会(Web)  119th-  KINKI119,A20 (WEB ONLY)  2015  [Not refereed][Not invited]
  
• 組織ドップラー法による左右房室弁輪最大収縮速度比を用いた左右心機能の相対強度による心不全症例のリスク層別化

  相川幸生, 永井利幸, 知念大悟, 上村和紀, 本川哲史, 菅野康夫, 浅海泰栄, 大郷剛, 神崎秀明, 野口暉夫, 安斉俊久, 小川久雄, 杉町勝, 安田聡  日本心エコー図学会学術集会抄録集  26th-  123  2015  [Not refereed][Not invited]
  
• 心不全症例における組織ドップラー法による左右房室弁輪最大収縮速度比と下大静脈径を用いた新しい低侵襲左室充満圧推定法

  永井利幸, 知念大悟, 上村和紀, 相川幸生, 本川哲史, 菅野康夫, 浅海泰栄, 大郷剛, 神崎秀明, 野口暉夫, 安斉俊久, 清水渉, 小川久雄, 杉町勝, 安田聡  日本心エコー図学会学術集会抄録集  26th-  144  2015  [Not refereed][Not invited]
  
• 心臓サルコイドーシスにおけるステロイド治療の途中中止は左室機能障害の進行と関連して心臓死を増加させる

  永井利幸, 永野伸卓, 菅野康夫, 相庭武司, 神崎秀明, 草野研吾, 野口輝夫, 安田聡, 小川久雄, 安斉俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  35-  (1)  50  -1-50-1  2015  [Not refereed][Not invited]
   

  心臓サルコイドーシスにおいて、ステロイド治療は標準的治療として確立しているが、ステロイド治療の途中中止あるいは適切な中止時期に関して検討した報告は皆無である。今回我々は過去 30 年間に当院で心臓サルコイドーシスと確定診断(日本サルコイド ーシス/肉芽腫性疾患学会 2006 年診断基準)され、ステロイド 治療を導入された連続 70 例を後ろ向きに解析した。 観察期間内(9.8 ± 5.7 年)の検討で、12 例が臨床的あるいは画像 的活動性の改善を理由にステロイド治療が途中中止され、途中中 止群のステロイド治療期間は 3.4 ± 3.6 年であった。途中中止群、 継続群の 2 群間で年齢、性別、左室駆出率、ガリウムシンチ所見、 FDG-PET 所見、心不全既往、心室性不整脈既往、そしてステロ イド用量に関しても有意差を認めなかった。途中中止群のうち、5 例が心臓死の転帰をとり、継続群と比較して死亡率は有意に高値 であった(42% vs. 16%, P=0.047)。さらに、途中中止群は継続 群 と 比 較 し て 観 察 期 間 内 に 著 し く 左 室 駆 出 率 が 低 下 し た (-23.1 ± 31.5 % vs. 8.4 ± 31.8 % , P=0.019)。 結論として、心臓サルコイドーシスの⻑期管理において、臨床的 あるいは画像的に一時的な改善が認められたとしても、ステロイ ド治療の途中中止には慎重を期すべきである。
• 医師主導治験の実施支援並びに我が国の治験推進に関する研究 治験の実施に関する研究「エプレレノン」

  安田聡, 安斉俊久, 永井利幸, 神崎秀明, 長谷川拓也, 舟田晃, 大原貴裕, 菅野康夫, 山根崇史  医師主導治験の実施支援並びに我が国の治験推進に関する研究 平成26年度 総括研究報告書集  38  2015  [Not refereed][Not invited]
  
• 22-5-O30-19 アミオダロン誘発性甲状腺機能異常とアミオダロン及びアミオダロン代謝物血中濃度に関する検討(有害事象・副作用,口頭発表,一般演題,医療薬学の進歩と未来-次の四半世紀に向けて-)

  大和 幹枝, 和田 恭一, 粉川 俊則, 早川 直樹, 安斉 俊久, 藤本 麻依, 細見 光一, 高田 充隆, 桑原 健  日本医療薬学会年会講演要旨集  25-  (0)  225  -225  2015  [Not refereed][Not invited]
  
• 【循環器薬up to date 2015】 併存症と循環器薬 慢性腎臓病(CKD)

  安斉 俊久  Medicina  52-  (1)  114  -117  2015/01  [Not refereed][Not invited]
   

  ＜ポイント＞CKDにおいてはレニン・アンジオテンシン系(RAS)の賦活化が病態を悪化させる.RAS,交感神経系,炎症,酸化ストレスによる悪循環が心腎連関の病態を形成する.推定糸球体濾過量(eGFR)の低下と蛋白尿・アルブミン尿の増加は独立して心血管疾患(CVD)発症と関連する.RAS阻害薬は,特に蛋白尿を認める症例に対して腎保護作用をもたらすと同時に心血管イベントを軽減する.RAS阻害薬は,両側性腎動脈狭窄,妊婦,授乳婦には禁忌である.腎障害高度例,高齢者では少量より投与する.(著者抄録)
• 【心不全における体液管理】 心不全における腎機能と体液過剰

  安斉 俊久  Fluid Management Renaissance  5-  (1)  23  -29  2015/01  [Not refereed][Not invited]
   

  心不全においては、循環血液量を保とうとするための代償反応としてレニン-アンジオテンシン-アルドステロン(RAA)系・交感神経系の賦活化、バソプレシンの分泌亢進が生じる。しかし、心機能が低下した状態における神経体液性因子の賦活化の遷延は心拍出量低下に対する代償機構の破綻をもたらし、体液過剰とともに炎症、酸化ストレスなどによって心血管障害を引き起こす。また、心不全における腎機能の悪化はさらなる体液貯留と心腎連関の悪循環を形成し、治療は難渋するうえに予後はきわめて不良になる。体液過剰に対して用いられるループ利尿薬は強力な利尿作用を有する反面、神経体液性因子を賦活化させ腎機能をさらに悪化させてしまう可能性がある。そのため抗アルドステロン薬やバソプレシンV2受容体拮抗薬などを適切に併用し、体液量をコントロールするとともに悪循環からの離脱に向けた薬物療法が重要となる。(著者抄録)
• 循環器病の診断と治療に関するガイドライン(2010年度合同研究班報告) 【ダイジェスト版】急性心不全治療ガイドライン(2011年改訂版)

  和泉 徹, 磯部 光章, 伊藤 浩, 北風 政史, 澤 芳樹, 清野 精彦, 筒井 裕之, 平山 篤志, 百村 伸一, 山崎 健二, 吉川 勉, 青山 直善, 安達 仁, 安斉 俊久, 猪又 孝元, 大西 勝也, 小澤 竹俊, 加藤 真帆人, 加藤 倫子, 絹川 真太郎, 後藤 葉一, 坂田 泰史, 佐藤 直樹, 佐藤 幸人, 中村 一文, 西垣 和彦, 庭野 慎一, 橋村 一彦, 眞茅 みゆき, 安村 良男, 山本 一博, 横山 広行, 今泉 勉, 朔 啓二郎, 中谷 武嗣, 堀 正二, 吉村 道博, 日本循環器学会, 日本胸部外科学会, 日本高血圧学会, 日本小児循環器学会, 日本心臓血管外科学会, 日本心臓病学会, 日本心臓リハビリテーション学会, 日本心電学会, 日本心不全学会, 日本超音波学会, 日本不整脈学会  日本心臓血管外科学会雑誌  44-  (1)  (1)  -(41)  2015/01  [Not refereed][Not invited]
  
• 心脈管作動物質としての凝固因子と新規経口抗凝固薬 実臨床からみた新規経口抗凝固薬(NOAC)の安全な使い方とは? 国循データベースからの検討

  相庭 武司, 宮本 康二, 有廣 昇司, 渡邉 至, 小久保 喜弘, 石橋 耕平, 廣瀬 沙弥子, 和田 暢, 中島 育太郎, 岡村 英夫, 野田 崇, 長束 一行, 野口 輝夫, 安斉 俊久, 安田 聡, 小川 久雄, 鎌倉 史郎, 清水 渉, 宮本 恵宏, 豊田 一則, 草野 研吾  血管  38-  (1)  22  -22  2015/01  [Not refereed][Not invited]
  
• 心不全治療機器としてのオートセットCS(NPPV)の可能性

  安斉 俊久  日本心臓血管外科学会雑誌  44-  (Suppl.)  203  -203  2015/01  [Not refereed][Not invited]
  
• 急性非代償性心不全患者における体液コントロールの問題点とその対策 うっ血除去と臓器血流維持のジレンマ 急性非代償性心不全患者における急性腎傷害の臨床的意義

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安斉 俊久, 安田 聡, 小川 久雄, 河野 雄平  日本集中治療医学会雑誌  22-  (Suppl.)  [DRTi1  -1]  2015/01  [Not refereed][Not invited]
  
• Usefulness of Novel Tissue Doppler Imaging Technique for Noninvasive and Reliable Estimation of Left-Sided Filling Pressure in Patients With Heart Failure

  Daigo Chinen, Toshiyuki Nagai, Kazunori Uemura, Yukio Aikawa, Tetsufumi Motokawa, Yasuo Sugano, Yasuhide Asaumi, Takeshi Ogo, Hideaki Kanzaki, Wataru Shimizu, Kengo Kusano, Masaharu Ishihara, Toshihisa Anzai, Hisao Ogawa, Satoshi Yasuda  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Effect of Myocardial Infiltration of Dendritic Cells, Macrophages and T Lymphocytes on Long-term Prognosis in Patients With Dilated Cardiomyopathy

  Takafumi Nakayama, Yasuo Sugano, Masao Takigami, Tetsuo Yokokawa, Toshiyuki Nagai, Hideaki Kanzaki, Keiko Ogo, Taka-Aki Matsuyama, Yoshihiko Ikeda, Hatsue I. Ueda, Takeshi Nakatani, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Long-Term Follow-Up of Patients with Acute Myocardial Infarction with Chronic Total Occlusion in the Non-Infarct Related Artery

  Masashi Fujino, Masaharu Ishihara, Satoshi Honda, Shoji Kawakami, Takafumi Yamane, Toshiyuki Nagai, Kazuhiro Nakao, Tomoaki Kanaya, Leon Kumasaka, Yasuhide Asaumi, Tetsuo Arakawa, Michio Nakanishi, Teruo Noguchi, Kengo Kusano, Toshihisa Anzai, Yoichi Goto, Satoshi Yasuda, Hisao Ogawa  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Prognostic Value of Direct Bilirubin in Acute Decompensated Heart Failure

  Atsushi Okada, Yasuo Sugano, Toshiyuki Nagai, Takafumi Yamane, Tatsuhiro Shibata, Kenji Nakamura, Naotsugu Iwakami, Daigo Chinen, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Masaharu Ishihara, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Lower Plasma Omega-6 Polyunsaturated Fatty Acid Level and Malnutrition in Acute Heart Failure Patients and Its Association With Worse Clinical Outcome

  Toshiyuki Nagai, Yoshiya Yamamoto, Yasuo Sugano, Takafumi Yamane, Tatsuhiro Shibata, Kenji Nakamura, Naotsugu Iwakami, Daigo Chinen, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Masaharu Ishihara, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Low Occurrence of Left Ventricular Reverse Remodeling and Poor Long-term Prognosis in Dilated Cardiomyopathy with Higher Immunohistological Expression of Myocardial Tenascin-C

  Tetsuro Yokokawa, Yasuo Sugano, Takafumi Nakayama, Masao Takigami, Toshiyuki Nagai, Hideaki Kanzaki, Taka-aki Matsuyama, Keiko Ohta-Ogo, Yoshihiko Ikeda, Hatsue Ishibashi-Ueda, Takeshi Nakatani, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Effects of the Oral Adsorbent of AST-120 in Patients with both Chronic Heart Failure and Chronic Kidney Disease

  Miki Imazu, Masanori Asakura, Takuya Hasegawa, Hiroshi Asanuma, Shin Ito, Atsushi Nakano, Akira Funada, Yasuo Sugano, Takahiro Ohara, Hideaki Kanzaki, Hiroyuki Takahama, Toshisuke Morita, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Higher Plasma Osmolality as an Independent Determinant of In-hospital Worsening Renal Function in Acute Decompensated Heart Failure

  Tetsufumi Motokawa, Toshiyuki Nagai, Yasuo Sugano, Takafumi Yamane, Tatsuhiro Shibata, Kenji Nakamura, Naotsugu Iwakami, Daigo Chinen, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Masaharu Ishihara, Kengo Kusano, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Increased Level of Cardiac Troponin T is a Clue of Cardiac Amyloidosis in Patients With Myocardial Hypertrophy

  Seiji Takashio, Megumi Yamamuro, Toshihisa Anzai, Hisao Ogawa  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Impact of Malnutrition Score Index on Short-term Clinical Outcome in Patients with Acute Decompensated Heart Failure

  Naotsugu Iwakami, Toshiyuki Nagai, Yasuo Sugano, Takafumi Yamane, Tatsuhiro Shibata, Kenji Nakamura, Daigo Chinen, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Masaharu Ishihara, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• "Forgotten" Cluster with Moderately impaired LV Diastolic Function Determined by Doppler Echocardiography

  Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Hiroshi Asanuma, Akira Funada, Takahiro Ohara, Yasuo Sugano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Relationship of Serum Erythropoietin Level to Clinical Outcome in Acute Heart Failure Patients without Anemia

  Takehiro Homma, Toshiyuki Nagai, Yasuo Sugano, Takafumi Yamane, Tatsuhiro Shibata, Kenji Nakamura, Naotsugu Iwakami, Daigo Chinen, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Masaharu Ishihara, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Subclinical Thyroid Dysfunction, Rather than Low-T3 Syndrome, is an Independent Predictor of Adverse Cardiac Events in Patients with Acute Decompensated Heart Failure

  Tomohiro Hayashi, Takuya Hasegawa, Hideaki Kanzaki, Akira Funada, Makoto Amaki, Takahiro Ohara, Yasuo Sugano, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• Safety and Efficacy of Continuous Anticoagulant and Antiplatelet Combination Therapy during Implantation of Cardiac Rhythm Devices

  Kohei Ishibashi, Koji Miyamoto, Mitsuru Wada, Ikutaro Nakajima, Hideo Okamura, Takashi Noda, Takeshi Aiba, Hiroshi Takaki, Shiro Kamakura, Masaharu Ishihara, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Kengo Kusano  CIRCULATION  130-  2014/11  [Not refereed][Not invited]
  
• 在宅におけるセルフケアを中心とした慢性心不全患者Web管理システムの開発

  谷 昇子, 宮本 恵宏, 安斉 俊久, 桑田 成規, 桑原 健, 菅野 康夫, 中尾 寿成, 川上 清和, 上野 直子, 稲田 紘, 中沢 一雄  医療情報学連合大会論文集  34回-  612  -613  2014/11  [Not refereed][Not invited]
  
• Neurohormonal Balance between B-type Natriuretic Peptide Levels and Renin-angiotensin-aldosterone System Factors Predicts Clinical Outcome in Acute Decompensated Heart Failure Patients

  Hiroyuki Takahama, Yasuki Nakada, Akira Funada, Takahiro Ohara, Yasuo Sugano, Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Masafumi Kitakaze, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  20-  (10)  S169  -S169  2014/10  [Not refereed][Not invited]
  
• Azilsartan Improves Diastolic Function in Patients with Chronic Heart Failure

  Mari Sakamoto, Takahiro Ohara, Akira Funada, Makoto Amaki, Takuya Hasegawa, Yasuo Sugano, Hideaki Kanzaki, Masanori Asakura, Toshihisa Anzai, Masafumi Kitakaze  JOURNAL OF CARDIAC FAILURE  20-  (10)  S194  -S194  2014/10  [Not refereed][Not invited]
  
• Dynamic Study of Myocardial Contrast-enhancement in Takotsubo-cardiomyopathy: Reversible Myocardial Injury Detected by Early Gadolinium Enhancement

  Yukio Aikawa, Teruo Noguchi, Yoshiaki Morita, Naoaki Yamada, Kengo Kusano, Toshihisa Anzai, Youichi Goto, Masaharu Ishihara, Hisao Ogawa, Satoshi Yasuda  JOURNAL OF CARDIAC FAILURE  20-  (10)  S176  -S176  2014/10  [Not refereed][Not invited]
  
• A Case of Syncope and Cardiac Tamponade After Silent Acute Myocardial Infarction Successfully Diagnosed by Multiple Imaging Modalities

  Ryota Kitajima, Masashi Fujino, Takafumi Yamane, Teruo Noguchi, Kengo Kusano, Toshihisa Anzai, Yoichi Goto, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa  JOURNAL OF CARDIAC FAILURE  20-  (10)  S175  -S175  2014/10  [Not refereed][Not invited]
  
• Relationship between Indoxyl Sulfate and Fibroblast Growth Factor 23 in Heart Failure Patients with Preserved Renal Function

  Miki Imazu, Masanori Asakura, Hiroyuki Takahama, Hiroshi Asanuma, Akira Funada, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai, Masafumi Kitakaze  JOURNAL OF CARDIAC FAILURE  20-  (10)  S207  -S207  2014/10  [Not refereed][Not invited]
  
• Chronic Kidney Disease in Hospitalized Patients with Heart Failure

  Satoko Nakamura, Toshihisa Anzai, Yuhei Kawano  JOURNAL OF CARDIAC FAILURE  20-  (10)  S193  -S193  2014/10  [Not refereed][Not invited]
  
• The Impact of the Plasma BNP Levels for the Prediction of Re-hospitalization in the Management of Patients with Heart Failure

  Hideaki Suwa, Atsushi Nakano, Akira Hunada, Takahiro Ohara, Yasuo Sugano, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai, Takashi Washio, Masafumi Kitakaze  JOURNAL OF CARDIAC FAILURE  20-  (10)  S163  -S163  2014/10  [Not refereed][Not invited]
  
• Clinical Impact of Cardiac Resynchronization Therapy in Patients with Atrial Fibrillation

  Takashi Noda, Kengo Kusano, Ikutaro Nakajima, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Masafumi Kitakaze, Hisao Ogawa  JOURNAL OF CARDIAC FAILURE  20-  (10)  S140  -S140  2014/10  [Not refereed][Not invited]
  
• Late Gadolinium Enhancement in Cardiac Magnetic Resonance Predicts Unplanned Heart Failure Hospitalization in Hypertrophic Cardiomyopathy with Systolic Dysfunction

  Akira Funada, Hideaki Kanzaki, Takahiro Ohara, Takuya Hasegawa, Makoto Amaki, Yasuo Sugano, Masafumi Kitakaze, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  20-  (10)  S176  -S176  2014/10  [Not refereed][Not invited]
  
• Nationwide Registry of Heart Failure with Preserved Ejection Fraction-JASPER Study

  Toshihisa Anzai, Toshiyuki Nagai, Yasuo Sugano, Takahiro Ohara, Hideaki Kanzaki, Yasuhide Asaumi, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Hisao Ogawa  JOURNAL OF CARDIAC FAILURE  20-  (10)  S141  -S141  2014/10  [Not refereed][Not invited]
  
• 循環器疾患入院患者での治療抵抗性高血圧の特徴について

  中村 敏子, 石塚 梓, 楠 博, 大田 祐子, 岸田 真嗣, 林 真一郎, 岩嶋 義雄, 吉原 史樹, 石原 正治, 安斎 俊久, 長束 一行, 小林 順次郎, 高橋 淳, 飯原 弘二, 河野 雄平  日本高血圧学会総会プログラム・抄録集  37回-  412  -412  2014/10  [Not refereed][Not invited]
  
• 心臓所見の乏しいサルコイドーシス症例における遅延造影心臓MRIの臨床的意義 症例追加と長期予後検討後の最終報告

  永井 利幸, 香坂 俊, 奥田 茂男, 安斉 俊久, 浅野 浩一郎, 福田 恵一  日本サルコイドーシス/肉芽腫性疾患学会雑誌  34-  (サプリメント号)  48  -48  2014/10  [Not refereed][Not invited]
  
• Impact of infiltrated immune-mediated cells in myocardium on long-term prognosis in patients with dilated cardiomyopathy

  T. Nakayama, Y. Sugano, M. Takigami, K. O. Ogo, Y. Ikeda, H. I. Ueda, T. Nakatani, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  1008  -1008  2014/09  [Not refereed][Not invited]
  
• Prothrombin activity is a novel and powerful prognostic marker in patients not taking oral anticoagulants with acutely decompensated heart failure

  A. Okada, Y. Sugano, T. Nagai, T. Shibata, K. Nakamura, K. F. Kusano, M. Ishihara, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  676  -677  2014/09  [Not refereed][Not invited]
  
• Long-term prognostic impact of basal thinning of the interventricular septum in patients with cardiac sarcoidosis

  N. Nagano, T. Nagai, Y. Sugano, Y. Morita, T. Aiba, K. Kusano, M. Ishihara, S. Yasuda, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  35-  1129  -1130  2014/09  [Not refereed][Not invited]
  
• Relationship of serum erythropoietin level to short-term clinical outcome in patients with acute decompensated heart failure

  T. Homma, T. Nagai, Y. Sugano, T. Shibata, K. Nakamura, K. Kusano, M. Ishihara, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  509  -509  2014/09  [Not refereed][Not invited]
  
• Endomyocardial infiltration of macrophages, but not T lymphocytes, is associated with poor long-term prognosis in patients with dilated cardiomyopathy without severe cardiac fibrosis

  Y. Sugano, T. Nakayama, M. Takigami, T. Nagai, O. K. Ogo, Y. Ikeda, I. H. Ueda, T. Nakatani, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  329  -329  2014/09  [Not refereed][Not invited]
  
• Reduced myocardial infiltration of dendritic cells is associated with impaired reparative fibrosis and development of cardiac rupture

  T. Nagai, S. Honda, Y. Sugano, Y. Ikeda, K. Kusano, M. Ishihara, H. Ogawa, S. Yasuda, H. Ishibashi-Ueda, T. Anzai  EUROPEAN HEART JOURNAL  35-  526  -526  2014/09  [Not refereed][Not invited]
  
• Albuminuria as an independent predictor for in-hospital worsening renal function in acute decompensated heart failure

  T. Shibata, Y. Sugano, T. Nagai, T. Yamane, K. Nakamura, M. Ishihara, K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  515  -515  2014/09  [Not refereed][Not invited]
  
• Lower plasma omega-6 polyunsaturated fatty acid level as a novel determinant for short-term adverse events after acute decompensated heart failure

  T. Nagai, Y. Sugano, T. Shibata, K. Nakamura, T. Yamane, K. Kusano, M. Ishihara, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  841  -841  2014/09  [Not refereed][Not invited]
  
• Lower activation of renin-aldosterone and sympathetic nervous systems in overweight patients with acute heart failure and its association with favorable short-term prognosis

  Y. Sugano, T. Nagai, T. Shibata, K. Nakamura, M. Ishihara, F. K. Kusano, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  203  -204  2014/09  [Not refereed][Not invited]
  
• Adaptive servo-ventilation beneficially effects on cardiac remodeling in patients with severe dilated cardiomyopathy

  Y. Sugano, K. Nakamura, A. Funada, T. Ohara, T. Hasegawa, H. Kanzaki, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  842  -842  2014/09  [Not refereed][Not invited]
  
• Different response to adaptive servo-ventilation therapy according to the etiology of cardiomyopathy in patients with chronic heart failure

  Y. Sugano, K. Nakamura, A. Funada, T. Ohara, T. Hasegawa, H. Kanzaki, H. Ogawa, S. Yasuda, T. Anzai  EUROPEAN HEART JOURNAL  35-  1093  -1093  2014/09  [Not refereed][Not invited]
  
• More impaired diastolic function of light chain amyloidosis contribute to poor prognosis compared with transthyretin amyloidosis: result from longitudinal study of biopsy-proven cardiac amyloidosis

  M. Sakamoto, A. Funada, A. Amaki, T. Ohara, Y. Sugano, T. Hasegawa, H. Kanzaki, T. Matsuyama, H. Ueda, T. Anzai  EUROPEAN HEART JOURNAL  35-  1088  -1088  2014/09  [Not refereed][Not invited]
  
• The prognostic impact of the residual CABG SYNTAX score to predict long-term outcomes after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery

  T. Miyagi, Y. Asaumi, H. Sakamoto, T. Fujita, K. Kusano, T. Anzai, M. Ishihara, J. Kobayashi, H. Ogawa, S. Yasuda  EUROPEAN HEART JOURNAL  35-  471  -472  2014/09  [Not refereed][Not invited]
  
• Prognostic impact of quantification of late gadolinium enhancement in cardiac magnetic resonance on mortality and morbidity in hypertrophic cardiomyopathy with systolic dysfunction

  A. Funada, H. Kanzaki, T. Noguchi, M. Kitakaze, T. Anzai  EUROPEAN HEART JOURNAL  35-  209  -210  2014/09  [Not refereed][Not invited]
  
• Long-term effect of corticosteroid therapy in patients with cardiac sarcoidosis

  T. Nagai, N. Nagano, Y. Sugano, T. Aiba, H. Kanzaki, K. Kusano, M. Ishihara, S. Yasuda, H. Ogawa, T. Anzai  EUROPEAN HEART JOURNAL  35-  929  -929  2014/09  [Not refereed][Not invited]
  
• 【心・肺・腎連関 再考察:病態と対策】 COPDにおける心肺連関 病態と対策

  安斉 俊久  ICUとCCU  38-  (9)  607  -616  2014/09  [Not refereed][Not invited]
   

  慢性閉塞性肺疾患(COPD)は、喫煙とは独立した心血管疾患のリスクファクターとして近年着目されている。実際にCOPD患者の死因の1/4以上は心血管死であることが知られ、COPDの合併は、虚血性心疾患、不整脈、心不全いずれの心血管疾患においても予後を不良にする要因であることが知られている。COPDと心血管疾患は、低酸素、アシドーシス、感染など共通の増悪因子を有する上に、どちらも炎症、酸化ストレス、神経体液性因子の賦活化、細胞外マトリックスの破壊、血管内皮機能障害といった組織障害をもたらす共通の悪循環を活性化することで、心肺連関の病態を形成していると考えられる。COPD患者の心血管イベントを防止するには、これらの因子を複数の側面から抑制する積極的な薬物治療が肝要となる。(著者抄録)
• 内皮機能・虚血シグナル・炎症と心血管病 梗塞後心破裂と左室リモデリングにおける樹状細胞の役割

  安斉 俊久  日本内分泌学会雑誌  90-  (2)  736  -736  2014/09  [Not refereed][Not invited]
  
• 冠動脈ステント治療の慢性期の問題点 再血行再建例における臨床経過の経過

  金谷 智明, 浅海 泰栄, 草野 研吾, 安斉 俊久, 後藤 葉一, 石原 正治, 小川 久雄, 安田 聡  日本心臓病学会学術集会抄録  62回-  S2  -2  2014/09  [Not refereed][Not invited]
  
• 心不全患者に対する多面的アプローチ 末期心不全における多職種協働緩和ケアチームの役割

  菅野 康夫, 柴田 龍宏, 久松 恵理子, 三宅 絵里, 高田 弥寿子, 河野 由枝, 舟田 晃, 大原 貴裕, 長谷川 拓也, 神崎 秀明, 草野 研吾, 石原 正治, 小川 久雄, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  S12  -6  2014/09  [Not refereed][Not invited]
  
• 心室性不整脈に対するアブレーション治療の進歩 心サルコイドーシスに合併する心室頻拍への内科的アプローチ

  草野 研吾, 里見 和浩, 野田 崇, 中島 育太郎, 岡村 英夫, 石橋 耕平, 宮本 康二, 相庭 武司, 安斉 俊久, 石原 正治, 安田 聡, 鎌倉 史郎, 小川 久雄  日本心臓病学会学術集会抄録  62回-  S15  -5  2014/09  [Not refereed][Not invited]
  
• 慢性疾患・生活習慣病を合併した心疾患患者の管理 循環器疾患入院患者の内服管理と腎機能悪化に関連する因子

  中村 敏子, 吉原 史樹, 石原 正治, 安斉 俊久, 小林 順二郎, 河野 雄平  日本心臓病学会学術集会抄録  62回-  S17  -3  2014/09  [Not refereed][Not invited]
  
• 慢性期の予後を見据えた救急医療 長期予後を見据えた急性非代償性心不全症例に対する早期栄養介入の必要性

  永井 利幸, 菅野 康夫, 山根 崇史, 柴田 龍宏, 岡田 厚, 知念 大悟, 岩上 直嗣, 本田 怜史, 中村 憲史, 草野 研吾, 石原 正治, 小川 久雄, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  S18  -6  2014/09  [Not refereed][Not invited]
  
• 心臓の拡張機能を診る 心エコードプラ法を用いた左室拡張機能障害評価の問題点 分類不能例の存在とその重症度評価について

  長谷川 拓也, 神崎 秀明, 朝倉 正紀, 浅沼 博司, 舟田 晃, 大原 貴裕, 菅野 康夫, 安田 聡, 小川 久雄, 安斉 俊久, 北風 政史  日本心臓病学会学術集会抄録  62回-  VW5  -1  2014/09  [Not refereed][Not invited]
  
• HFpEFは独立した疾患概念か? HFrEFの病前状態か? HFpEFは独立した疾患概念である

  安斉 俊久  日本心臓病学会学術集会抄録  62回-  C5  -1  2014/09  [Not refereed][Not invited]
  
• 心不全における多職種協働緩和ケアチームの必要性と活動の実際

  菅野 康夫, 高田 弥寿子, 河野 由枝, 三宅 絵里, 柴田 龍宏, 久松 恵理子, 松村 なるみ, 岩澤 真紀子, 小田 亮介, 上ノ町 かおり, 山本 幸夫, 長松 耕平, 小川 久雄, 安田 聡, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  MS5  -1  2014/09  [Not refereed][Not invited]
  
• 非冠動脈疾患の心血管イメージング 非冠動脈心疾患の診断と病態評価におけるPETの有用性

  木曽 啓祐, 森田 奈緒美, 西村 圭弘, 藤崎 宏, 寺川 裕介, 安斉 俊久, 安田 聡, 内藤 博昭  日本心臓病学会学術集会抄録  62回-  JS5  -3  2014/09  [Not refereed][Not invited]
  
• 心臓専門医と精神科専門医の連携モデル 連携機関としての兵庫サイコカーディオロジー研究会の役割

  水谷 和郎, 伊藤 弘人, 堂本 康治, 民田 浩一, 北井 豪, 大石 醒悟, 安井 博規, 山根 光量, 荒木 祥子, 見野 耕一, 松石 邦隆, 竹原 歩, 庵地 雄太, 安斉 俊久, 平田 健一  日本心臓病学会学術集会抄録  62回-  JS9  -3  2014/09  [Not refereed][Not invited]
  
• 心房細動に対する新規経口抗凝固薬のオーダーメイド治療の確立に関する前向きおよび後ろ向き探索的臨床研究

  宮本 康二, 相庭 武司, 有廣 昇司, 小久保 喜弘, 渡邉 至, 中島 育太郎, 石橋 耕平, 山田 優子, 岡村 英夫, 野田 崇, 里見 和浩, 長束 一行, 豊田 一則, 宮本 恵宏, 石原 正治, 安斉 俊久, 安田 聡, 小川 久雄, 鎌倉 史郎, 清水 渉, 草野 研吾  日本心臓病学会学術集会抄録  62回-  研究課題4  -研究課題4  2014/09  [Not refereed][Not invited]
  
• 心不全患者における急性非代償期の潜在性甲状腺機能低下症は有害心イベントの独立した予測因子である

  林 友鴻, 長谷川 拓也, 神崎 秀明, 舟田 晃, 大原 貴裕, 菅野 康夫, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  O  -034  2014/09  [Not refereed][Not invited]
  
• KillipIのST上昇型急性心筋梗塞に対するTRIによるPrimary PCIの有用性

  相川 幸生, 藤野 雅史, 石原 正治, 浅海 泰栄, 中西 道朗, 野口 暉夫, 後藤 葉一, 草野 研吾, 安斉 俊久, 安田 聡, 小川 久雄  日本心臓病学会学術集会抄録  62回-  P  -019  2014/09  [Not refereed][Not invited]
  
• 心不全を伴う頻脈性不整脈に対するLandiololの使用経験

  和田 悠子, 相庭 武司, 神崎 秀明, 菅野 康夫, 野田 崇, 石原 正治, 安斉 俊久, 鎌倉 史郎, 草野 研吾, 安田 聡, 小川 久雄  日本心臓病学会学術集会抄録  62回-  P  -050  2014/09  [Not refereed][Not invited]
  
• 右室容量負荷軽減により、右心機能の改善と重症機能性三尖弁逆流波形の特異な経過を示した右心不全優位の拡張相肥大型心筋症の1例

  坂本 真里, 大原 貴裕, 舟田 晃, 長谷川 拓也, 菅野 康夫, 神崎 秀明, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  P  -061  2014/09  [Not refereed][Not invited]
  
• 循環器疾患入院患者での栄養状態・慢性炎症と腎機能の関連について

  中村 敏子, 吉原 史樹, 石原 正治, 安斉 俊久, 小林 順二郎  日本心臓病学会学術集会抄録  62回-  P  -181  2014/09  [Not refereed][Not invited]
  
• 当施設における成人心房中隔欠損症例に対するAmplatzer Septal Occluderによる閉鎖術の経験

  大原 貴裕, 長谷川 拓也, 福井 重文, 草野 研吾, 石原 正治, 安田 聡, 白石 公, 小川 久雄, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  O  -194  2014/09  [Not refereed][Not invited]
  
• 急性心筋梗塞における慢性腎臓病と急性腎障害の予後に及ぼす影響についての検討

  高山 幸一郎, 石原 正治, 中尾 一泰, 藤野 雅史, 金谷 智明, 熊坂 礼音, 荒川 鉄雄, 田原 良雄, 浅海 泰栄, 中西 道郎, 野口 暉夫, 草野 研吾, 安斉 俊久, 後藤 葉一, 安田 聡, 小川 久雄  日本心臓病学会学術集会抄録  62回-  O  -299  2014/09  [Not refereed][Not invited]
  
• 急性心筋梗塞における急性腎障害の院内予後に与える影響

  小永井 奈緒, 藤野 雅史, 石原 正治, 浅海 泰栄, 中西 道朗, 野口 輝夫, 草野 研吾, 安斉 俊久, 後藤 葉一, 安田 聡, 小川 久雄  日本心臓病学会学術集会抄録  62回-  P  -243  2014/09  [Not refereed][Not invited]
  
• 著明な体液貯留/右心不全を認めたが大量の除水により左室補助人工心臓装着に至った拡張型心筋症の一例

  執行 秀彌, 大原 貴裕, 角南 春樹, 瀬口 理, 舟田 晃, 菅野 康夫, 長谷川 拓也, 神崎 秀明, 簗瀬 正伸, 中谷 武嗣, 安斉 俊久  日本心臓病学会学術集会抄録  62回-  P  -644  2014/09  [Not refereed][Not invited]
  
• Primary PCI時代のSTEMIにおけるSimple Risk Indexの有用性の検討

  西川 達哉, 藤野 雅史, 石原 正治, 浅海 泰栄, 中西 道郎, 野口 輝夫, 草野 研吾, 安斉 俊久, 後藤 葉一, 安田 聡, 小川 久雄  日本心臓病学会学術集会抄録  62回-  O  -554  2014/09  [Not refereed][Not invited]
  
• 心Fabry病が原因で心原性脳塞栓症を発症した男性例

  西村 寿貴, 上原 敏志, 安斉 俊久, 豊田 一則  臨床神経学  54-  (7)  594  -594  2014/07  [Not refereed][Not invited]
  
• 循環器病に特化した高度先進医療センターにおいて、新たに結成した多職種協働緩和ケアチームの活動

  菅野 康夫, 高田 弥寿子, 河野 由枝, 柴田 龍宏, 久松 恵理子, 三宅 絵理, 松村 なるみ, 山本 幸夫, 上ノ町 かおり, 長松 耕平, 安斉 俊久  日本緩和医療学会学術大会プログラム・抄録集  19回-  442  -442  2014/06  [Not refereed][Not invited]
  
• 国立環器病研究センターでの医師アンケート結果から見えてきた、循環器緩和ケアの現状と取り組むべき問題点

  柴田 龍宏, 菅野 康夫, 河野 由枝, 高田 弥寿子, 久松 恵理子, 三宅 絵里, 小川 久雄, 安田 聡, 安斉 俊久  日本緩和医療学会学術大会プログラム・抄録集  19回-  494  -494  2014/06  [Not refereed][Not invited]
  
• 退院後、心肺停止により終末期に陥った慢性心不全患者の家族に対するグリーフケア 心不全の病みの軌跡から観たグリーフケアのあり方を考える

  高田 弥寿子, 河野 由枝, 菅野 康夫, 三宅 絵里, 柴田 龍宏, 安斉 俊久, 伊藤 文代  日本緩和医療学会学術大会プログラム・抄録集  19回-  497  -497  2014/06  [Not refereed][Not invited]
  
• 炎症と再生の抗加齢医学研究 心筋梗塞後心不全における樹状細胞の役割

  福田 恵一, 安西 敦, 佐野 元昭, 安斉 俊久  日本抗加齢医学会総会プログラム・抄録集  14回-  176  -176  2014/06  [Not refereed][Not invited]
  
• FIBROBLAST GROWTH FACTOR 23 IS A NOVEL BIOMARKER FOR CARDIAC FUNCTION IN HEART FAILURE PATIENTS

  Miki Imazu, Masanori Asakura, Hiroyuki Takahama, Atsushi Nakano, Akira Funada, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Hideaki Kanzaki, Toshihisa Anzai, Hiroshi Asanuma, Masafumi Kitakaze  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  63-  (12)  A795  -A795  2014/04  [Not refereed][Not invited]
  
• DECREASED MYOCARDIAL DENDRITIC CELLS IS ASOCIATED WITH IMPAIRED REPARATIVE FIBROSIS AND DEVELOPMENT OF CARDIAC RUPTURE AFTER MYOCARDIAL INFARCTION IN HUMANS

  Toshiyuki Nagai, Satoshi Honda, Yasuo Sugano, Taka-aki Matsuyama, Keiko Ohta-Ogo, Yasuhide Asaumi, Yoshihiko Ikeda, Kengo Kusano, Masaharu Ishihara, Hisao Ogawa, Satoshi Yasuda, Hatsue Ishibashi-Ueda, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  63-  (12)  A259  -A259  2014/04  [Not refereed][Not invited]
  
• SUBCLINICAL HYPOTHYROIDISM IN THE ACUTE DECOMPENSATED PHASE IS A NOVEL PREDICTOR FOR ADVERSE CARDIAC EVENTS IN PATIENTS WITH HEART FAILURE

  Tomohiro Hayashi, Takuya Hasegawa, Hideaki Kanzaki, Akira Funada, Yasuo Sugano, Takahiro Ohara, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  63-  (12)  A770  -A770  2014/04  [Not refereed][Not invited]
  
• ANTIARRHYTHMIC EFFECT OF INVASIVE TREATMENT IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY: SIGNIFICANCE OF SUBSTRATE MODIFICATION DETECTED BY CARDIAC MRI

  Tomohisa Nakamura, Yuko Inoue, Hideaki Kanzaki, Yoshiaki Morita, Ikutaro Nakajima, Kohei Ishibashi, Koji Miyamoto, Hideo Okamura, Takashi Noda, Takeshi Aiba, Shiro Kamakura, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Kengo Kusano  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  63-  (12)  A816  -A816  2014/04  [Not refereed][Not invited]
  
• TWO-STAGED CLASSIFICATION BY LEFT VENTRICULAR EJECTION FRACTION FOLLOWED BY EXTENT OF LATE GADOLINIUM ENHANCEMENT IN CARDIAC MAGNETIC RESONANCE IS USEFUL FOR RISK STRATIFICATION IN HYPERTROPHIC CARDIOMYOPATHY

  Akira Funada, Hideaki Kanzaki, Yasuo Sugano, Takahiro Ohara, Takuya Hasegawa, Masafumi Kitakaze, Toshihisa Anzai  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  63-  (12)  A841  -A841  2014/04  [Not refereed][Not invited]
  
• 心疾患と炎症応答 心筋梗塞後創傷治癒過程における樹状細胞の役割

  安西 淳, 安斉 俊久, 佐野 元昭, 福田 恵一  日本薬学会年会要旨集  134年会-  (1)  128  -128  2014/03  [Not refereed][Not invited]
  
• 重症心不全(NYHA Ⅲ~Ⅳ, ACC/AHA Stage C~D)での有効性 (特集 心臓性浮腫とトルバプタン : 長期の体液管理における役割)

  菅野 康夫, 安斉 俊久  医薬ジャーナル  50-  (2)  181  -187  2014/02
• 【あなたも名医! ゼッタイ答えがみつかる心不全 一人でGo!チームでGo!】 (1章)押さえておこう!治療に直結する心不全の病態と概念 ナトリウム利尿ペプチド系はレニン・アンジオテンシン系、交感神経系に拮抗する

  安斉 俊久  jmed mook  (30)  24  -29  2014/02  [Not refereed][Not invited]
  
• 【心臓性浮腫とトルバプタン〜長期の体液管理における役割〜】 重症心不全(NYHAIII〜IV、ACC/AHA Stage C〜D)での有効性

  菅野 康夫, 安斉 俊久  医薬ジャーナル  50-  (2)  787  -793  2014/02  [Not refereed][Not invited]
   

  従来の利尿薬と全く異なる作用機序を持つ新しい利尿薬、トルバプタンが登場した。トルバプタンは腎臓におけるバソプレシンV2受容体に拮抗し、水の再吸収を抑制する水利尿薬である。入退院を繰り返す低心機能の重症心不全患者では利尿薬抵抗性をきたしている場合が多く、ナトリウム(Na)利尿薬のみで心性浮腫を十分に抑制するのは容易ではない。そればかりでなく、利尿薬増量による腎機能悪化や、予後への影響が危惧される。トルバプタンは、こうしたNa利尿薬抵抗性の心不全における体液貯留に対して効果的な薬剤である。重症心不全では、急性増悪期のみならず、慢性期にも長期的なトルバプタン投与が必要な症例が少なからず存在し、これからの重症心不全の管理に新たな選択肢の一つとなる薬剤として期待される。(著者抄録)
• 心筋生検における組織線維化は肥大型心筋症患者の予後予測に有用である

  和田悠子, 相庭武司, 松山高明, 中島育太郎, 石橋耕平, 宮本康二, 岡村英夫, 野田崇, 森田佳明, 神崎秀明, 草野研吾, 安斉俊久, 石原正治, 安田聡, 鎌倉史郎, 植田初江, 清水渉, 小川久雄  日本循環器学会近畿地方会(Web)  117th-  2014
• 短期間で再発するたこつぼ型心筋症様の経過を呈した冠攣縮性狭心症の1症例

  本川哲史, 浅海泰栄, 本田怜史, 川上将司, 山根崇史, 永井利幸, 宮城唯良, 草野研吾, 安斉俊久, 石原正治, 小川久雄, 安田聡  日本循環器学会近畿地方会(Web)  117th-  KINKI117,B36 (WEB ONLY)  2014  [Not refereed][Not invited]
  
• 繰り返す心不全の経過中に心サルコイドーシス併発を認めた陳旧性心筋梗塞の一例

  小永井奈緒, 藤野雅史, 本田怜史, 川上将司, 山根崇史, 中尾一泰, 熊坂礼音, 永井利幸, 金谷智明, 荒川鉄雄, 浅海泰栄, 中西道郎, 野口輝夫, 草野研吾, 安斉俊久, 後藤葉一, 石原正治, 安田聡, 小川久雄  日本循環器学会近畿地方会(Web)  117th-  KINKI117,C17 (WEB ONLY)  2014  [Not refereed][Not invited]
  
• 急性心筋梗塞による心原性ショックを呈した重症大動脈弁狭窄症に対し経皮的大動脈弁形成術が奏功した一例

  中島健三郎, 浅海泰栄, 川上将司, 山根崇史, 宮城唯良, 永井利幸, 安斉俊久, 草野研吾, 石原正治, 小川久雄, 安田聡  日本循環器学会近畿地方会(Web)  117th-  KINKI117,E07 (WEB ONLY)  2014  [Not refereed][Not invited]
  
• 急性心不全院内症例登録における電子カルテ情報の効果的二次利用について―院内症例登録システムの構築―

  住田陽子, 永井利幸, 安斉俊久, 安田聡, 小川久雄  日本循環器学会近畿地方会(Web)  118th-  KINKI118,F26 (WEB ONLY)  2014  [Not refereed][Not invited]
  
• Efficacy and safety of novel anticoagulant dabigatran in clinical practice for Japanese patients with non-valvular atrial fibrillation

  Koji Miyamoto, Takeshi Aiba, Ikutaro Nakajima, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Masaharu Ishihara, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu  Journal of Arrhythmia  30-  (1)  58  -64  2014  [Not refereed][Not invited]
   

  Background: There is little evidence of the efficacy and safety of dabigatran in Japanese patients with non-valvular atrial fibrillation (NVAF). Methods and Results: We evaluated 300 consecutive patients with NVAF (68711 years old, 209 men, 180 paroxysmal) who received 220 mg/day (203 patients) or 300 mg/day dabigatran (97 patients) at our hospital. Most patients (84%) had lower CHADS2 (congestive heart failure, hypertension, age > 75 years, diabetes, stroke/transient ischemic attack) scores of 0 (n=60), 1 (n=114), or 2 (n=78) and lower HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition) scores of 0 (n=39), 1 (n=114), or 2 (n=103). The estimated creatinine clearance was 77±24 mL/min, which was inversely correlated to age (r2±0.48, p< 0.0001). Activated partial thromboplastin time was 42±9 s but was not dependent on sampling time. During follow-up of 263±160 days, an ischemic stroke occurred in 1 patient (0.3%), but no systemic embolism was observed. Some adverse events were reported for 70 (23%) patients, such as dyspepsia (n=42, 14%) or minor bleeding complications (n=11, 4%) resulting in discontinuation of dabigatran for 39 patients. However, no major complications were observed, and no patient died from adverse events or because of cardiovascular or stroke events. Conclusions: Dabigatran is safe and useful for the prevention of ischemic strokes in Japanese NVAF patients, but additional care should be taken for elderly patients. © 2013 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.
• 【メンタルケアを取り入れたディジーズマネジメント 包括的なうつ病管理の実践】 (Part.3)ディジーズマネジメント 循環器疾患 うつ病の診断と治療

  安井 博規, 安斉 俊久  看護技術  60-  (1)  28  -30  2014/01  [Not refereed][Not invited]
  
• 【循環器疾患と心拍数】 慢性心不全と心拍数

  安斉 俊久  Cardiac Practice  25-  (1)  41  -45  2014/01  [Not refereed][Not invited]
  
• 【心サルコイドーシスをいかに診断するか】 心サルコイドーシス診断における67Gaシンチグラフィーの有用性と診断能向上への取り組み

  木曽 啓祐, 森田 奈緒美, 西村 圭弘, 藤崎 弘, 徳 俊成, 安斉 俊久, 安田 聡  日本心臓核医学会ニュースレター  16-  (1)  5  -6  2014/01  [Not refereed][Not invited]
  
• Acute Hyperglycemia, but not Hemoglobin A1c, is Associated With Poor Outcome in Patients With Acute Myocardial Infarction

  Masashi Fujino, Masaharu Ishihara, Takafumi Yamane, Toshihisa Nagai, Tadayoshi Miyagi, Tomoaki Kanaya, Leon Kumasaka, Yasuhide Asaumi, Tetsuo Arakawa, Michio Nakanishi, Hiroki Sakamoto, Teruo Noguchi, Kengo Kusano, Toshihisa Anzai, Yoichi Goto, Satoshi Yasuda, Hisao Ogawa  CIRCULATION  128-  (22)  2013/11
• Over 35 Years Trend in the Clinical and Pathological Characteristics of Cardiac Rupture in Patients With Acute Myocardial Infarction

  Satoshi Honda, Yasuhide Asaumi, Takafumi Yamane, Toshiyuki Nagai, Tadayoshi Miyagi, Hiroki Sakamoto, Toshihisa Anzai, Kengo Kusano, Kengo Kusano, Masaharu Ishihara, Hisao Ogawa, Satoshi Yasuda  CIRCULATION  128-  (22)  2013/11
• Clinical Aspects and Prognosis of Elderly Patients with Brugada Syndrome

  Tsukasa Kamakura, Kohei Ishibashi, Ikutaro Nakajima, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Takeshi Aiba, Wataru Shimizu, Hiroshi Takaki, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Kengo Kusano  CIRCULATION  128-  (22)  2013/11
• Noninvasive Risk Stratification of Lethal Ventricular Arrhythmias using 64-channel Magnetocardiography in Patients with Dilated Cardiomyopathy

  Yosuke Otsuka, Takeshi Aiba, Hiroshi Takaki, Ikutarou Nakajima, Kohei Ishibashi, Kouji Myamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisan Ogawa, Kengo Kusano, Wataru Shimizu, Shiro Kamakura, Masaru Sugimachi  CIRCULATION  128-  (22)  2013/11
• Extremely Poor Prognosis after Cardiac Resynchronization Therapy is Predictable by Heterogeneous Multi-directional Left Ventricular Activation Sequence on Magnetocardiography

  Takahiro Nakashima, Hiroshi Takaki, Shogo Oishi, Shunsuke Usami, Kohei Ishibashi, Ikutaro Nakajima, Yuko Yamada, Koji Miyamoto, Hideo Okamura, Takashi Noda, Takeshi Aiba, Shiro Kamakura, Hideaki Kanzaki, Wataru Shimizu, Toshihisa Anzai, Satoshi Yasuda, Kengo Kusano, Masaru Sugimachi  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• B-Type Natriuretic Peptide is a Screening Tool to Rule Out Subclinical Left Ventricular Geometry and Diastolic Dysfunction in a Community-Based Population

  Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Jiyoong Kim, Hiroshi Asanuma, Akira Funada, Yasuo Sugano, Takahiro Ohara, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Electrocardiographic Analysis of Arrhythmogenic Right Ventricular Cardiomyopathy: Cardiovascular Events and the Epsilon Wave

  Yosuke Otsuka, Kazuhiro Satomi, Ikutarou Nakajima, Kohei Ishibashi, Kouji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Takeshi Aiba, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Kengo Kusano  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Tissue Fibrosis of Myocardial Biopsy as a Novel Predictor for Adverse Cardiac Events in Patients With Hypertrophic Cardiomyopathy

  Yuko Wada, Takeshi Aiba, Taka-aki Matsuyama, Ikutaro Nakajima, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Kengo F. Kusano, Satoshi Yasuda, Shiro Kamakura, Hatsue Ishibashi-Ueda, Wataru Shimizu, Hisao Ogawa  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Atrial Fibrillation Increases Adverse Cardiac Events in Hypertrophic Cardiomyopathy With Moderate Tissue Fibrosis

  Yuko Wada, Takeshi Aiba, Taka-aki Matsuyama, Kohei Ishibashi, Ikutaro Nakajima, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Yoshiaki Morita, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Kengo F. Kusano, Satoshi Yasuda, Shiro Kamakura, Hatsue Ishibashi-Ueda, Wataru Shimizu, Hisao Ogawa  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Effect of Corticosteroid Therapy on Long-Term Prognosis in Patients With Cardiac Sarcoidosis

  Toshiyuki Nagai, Nobutaka Nagano, Yasuo Sugano, Yasuhide Asaumi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Electrocardiographic Analysis on the Progression of Arrhythmogenic Right Ventricular Cardiomyopathy

  Yosuke Otsuka, Kazuhiro Satomi, Ikutarou Nakajima, Kohei Ishibashi, Kouji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Takeshi Aiba, Teruo Noguchi, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Kengo Kusano  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Prognostic Significance of Functional Mitral Regurgitation in Patients Admitted With Acute Decompensated Heart Failure

  Yuko Wada, Takahiro Ohara, Toshihisa Anzai, Yasuo Sugano, Akira Funada, Takuya Hasegawa, Hideaki Kanzaki, Masharu Ishihara, Hiroyuki Yokoyama, Satoshi Yasuda, Hisao Ogawa  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Impact of Basal Thinning of the Interventricular Septum on Long-term Prognosis in Patients With Cardiac Sarcoidosis

  Nobutaka Nagano, Toshiyuki Nagai, Yasuo Sugano, Yasuhide Asaumi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• Fragmented QRS as a Novel Non-Invasive Predictor for Lethal Arrhythmic Events in Hypertrophic Cardiomyopathy

  Yuko Wada, Takeshi Aiba, Taka-aki Matsuyama, Kohei Ishibashi, Ikutaro Nakajima, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Yoshiaki Morita, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Kengo F. Kusano, Satoshi Yasuda, Shiro Kamakura, Hatsue Ishibashi-Ueda, Wataru Shimizu, Hisao Ogawa  CIRCULATION  128-  (22)  2013/11  [Not refereed][Not invited]
  
• 【循環器疾患患者のメンタルケア〜ココロに寄り添い、支える看護〜】 (Step 2)エビデンスからみるメンタルケア 心不全とメンタルケアの関連

  菅野 康夫, 安斉 俊久  Heart  3-  (11)  45  -52  2013/11  [Not refereed][Not invited]
   

  ＜POINT＞心不全患者では、うつ病などのメンタルヘルスの変調をきたすことが多い!メンタルヘルス障害をきたした患者のQOLは低下し、自己ケアの劣化につながり予後を悪化させる!スクリーニング検査による早期発見、早期からの介入が重要!抗うつ薬としてセロトニン再取り込み阻害薬(SSRI)が有効な可能性がある!また、心理療法や運動療法が効果的な場合がある!(著者抄録)
• 病気の概念 左室駆出率の保持された心不全

  安斉 俊久  循環器病研究の進歩  XXXIV-  (1)  37  -44  2013/11  [Not refereed][Not invited]
  
• 在宅における慢性心不全患者の病態に即したWeb管理システムの開発

  谷 昇子, 宮本 恵宏, 安斉 俊久, 桑田 成規, 桑原 健, 菅野 康夫, 中尾 寿成, 川上 清和, 上野 直子, 稲田 紘, 中沢 一雄  医療情報学連合大会論文集  33回-  526  -527  2013/11  [Not refereed][Not invited]
  
• Long-term Clinical Outcome and Significance of Corticosteroid Therapy in Patients with Suspected Cardiac Sarcoidosis: Comparison with Definite Cases

  Nobutaka Nagano, Toshiyuki Nagai, Yasuo Sugano, Yasuhide Asaumi, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  19-  (10)  S148  -S148  2013/10  [Not refereed][Not invited]
  
• 心臓サルコイドーシスにおいて心臓MRIガドリニウム遅延造影の定量評価はステロイド治療の予後予測に有用である

  伊勢 孝之, 長谷川 拓也, 森田 佳明, 山田 直明, 舟田 晃, 高濱 博幸, 天木 誠, 神崎 秀明, 岡村 英夫, 鎌倉 史郎, 清水 渉, 安斉 俊久, 北風 政史  日本サルコイドーシス/肉芽腫性疾患学会雑誌  33-  (サプリメント号)  49  -49  2013/10  [Not refereed][Not invited]
  
• 心臓孤発サルコイドーシス疑診例の長期予後に関する検討 確診例との比較検討

  永野 伸卓, 永井 利幸, 菅野 康夫, 浅海 泰栄, 安田 聡, 小川 久雄, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  33-  (サプリメント号)  49  -49  2013/10  [Not refereed][Not invited]
  
• 心臓サルコイドーシスの長期予後におけるステロイド治療の意義

  永井 利幸, 永野 伸卓, 菅野 康夫, 浅海 泰栄, 安田 聡, 小川 久雄, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  33-  (サプリメント号)  54  -54  2013/10  [Not refereed][Not invited]
  
• 心臓サルコイドーシスの長期予後における心室中隔基部菲薄化の意義

  永野 伸卓, 永井 利幸, 菅野 康夫, 浅海 泰栄, 安田 聡, 小川 久雄, 安斉 俊久  日本サルコイドーシス/肉芽腫性疾患学会雑誌  33-  (サプリメント号)  55  -55  2013/10  [Not refereed][Not invited]
  
• 【循環器薬 使い方プラクティス】 疾患別循環器薬の使い方 《心不全》 利尿薬

  安斉 俊久  内科  112-  (3)  497  -501  2013/09  [Not refereed][Not invited]
   

  体液貯留は心不全患者の多くで認められる徴候であり,利尿薬は基本的治療薬として重要である.ループ利尿薬は強力な利尿作用を有するが,低血圧,低Na血症,低アルブミン血症などを合併している場合,反応が不良となる.フロセミドは神経体液性因子を賦活化させ,心不全の病態を悪化させる可能性もあり,投与量は必要最小限とすることが望ましい.抗アルドステロン薬は,ループ利尿薬による低K血症の副作用抑制,神経体液性因子賦活化の軽減に有効である.ループ利尿薬抵抗性に対して,サイアザイド系利尿薬,抗アルドステロン薬などの併用がしばしば有効である.(著者抄録)
• 安定冠動脈疾患に対する治療戦略 冠動脈バイパス術後患者に対する待機的PCI症例の長期予後の検討 固有冠動脈および静脈グラフトの比較

  宮城 唯良, 坂本 裕樹, 藤田 知之, 安斉 俊久, 清水 渉, 石原 正治, 小林 順二郎, 小川 久雄, 安田 聡  日本心臓病学会誌  8-  (Suppl.I)  145  -145  2013/09  [Not refereed][Not invited]
  
• 糖尿病患者の心疾患治療のevidence 急性心筋梗塞における急性期高血糖、HbA1cが短期予後に与える影響

  藤野 雅史, 石原 正治, 浅海 泰栄, 熊坂 礼音, 荒川 鉄雄, 中西 道郎, 小谷 順一, 坂本 裕樹, 野口 輝夫, 清水 渉, 安斉 俊久, 後藤 葉一, 安田 聡, 小川 久雄  日本心臓病学会誌  8-  (Suppl.I)  146  -146  2013/09  [Not refereed][Not invited]
  
• 末梢血管疾患治療の最前線 組織の損失を伴う重症の下肢虚血に対する現代の血管内療法の長期転帰(Long-term Outcomes of Contemporary Endovascular Therapy for Critical Limb Ischemia with Tissue Loss)

  河原田 修身, 横井 良明, 安斉 俊久, 清水 渉, 石原 正治, 安田 聡, 小川 久雄  日本心臓病学会誌  8-  (Suppl.I)  174  -174  2013/09  [Not refereed][Not invited]
  
• 心筋疾患の鑑別診断 心臓サルコイドーシス診断時のImaging modalityによる活動性の評価はステロイド開始の基準となりうるか 確診例77例の長期予後検討から

  永井 利幸, 永野 伸卓, 菅野 康夫, 相庭 武司, 植田 初江, 石原 正治, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会誌  8-  (Suppl.I)  187  -187  2013/09  [Not refereed][Not invited]
  
• 心不全患者における代理マーカーとしての血清線維芽細胞増殖因子23(Serum Fibroblast Growth Factor 23 as a Surrogate Marker in Patients with Heart Failure)

  高濱 博幸, 今津 美樹, 浅沼 博司, 舟田 晃, 菅野 康夫, 大原 貴裕, 長谷川 拓也, 朝倉 正紀, 神崎 秀明, 安斉 俊久, 北風 政史  日本心臓病学会誌  8-  (Suppl.I)  242  -242  2013/09  [Not refereed][Not invited]
  
• 急性非代償性心不全で入院した患者における機能的僧帽弁逆流の予後の影響(The Prognostic Impact of Functional Mitral Regurgitation in Patients Admitted with Acute Decompensated Heart Failure)

  和田 悠子, 大原 貴裕, 安斉 俊久, 菅野 康夫, 舟田 晃, 長谷川 拓也, 神崎 秀明, 石原 正治, 横山 広行, 安田 聡, 小川 久雄  日本心臓病学会誌  8-  (Suppl.I)  272  -272  2013/09  [Not refereed][Not invited]
  
• 急性心不全患者における早期、後期に発生する急性腎障害の臨床的意義

  高谷 陽一, 吉原 史樹, 横山 広行, 神崎 秀明, 北風 政史, 後藤 葉一, 安斉 俊久, 安田 聡, 小川 久雄, 河野 雄平  日本心臓病学会誌  8-  (Suppl.I)  272  -272  2013/09  [Not refereed][Not invited]
  
• 肥大型心筋症患者における致死性不整脈イベントに対するfragmented QRSの予後の影響(Prognostic Impact of Fragmented QRS for Lethal Arrhythmic Events in Hypertrophic Cardiomyopathy)

  和田 悠子, 相庭 武司, 松山 高明, 神崎 秀明, 安斉 俊久, 石原 正治, 安田 聡, 小川 久雄, 鎌倉 史郎, 植田 初江, 清水 渉  日本心臓病学会誌  8-  (Suppl.I)  282  -282  2013/09  [Not refereed][Not invited]
  
• 心臓孤発サルコイドーシス疑診例の長期予後に関する検討 確診例との比較

  永野 伸卓, 永井 利幸, 菅野 康夫, 相庭 武司, 植田 初江, 石原 正治, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会誌  8-  (Suppl.I)  369  -369  2013/09  [Not refereed][Not invited]
  
• クリニカルシナリオ分類による心不全患者の臨床的特徴

  林 友鴻, 長谷川 拓也, 神崎 秀明, 舟田 晃, 菅野 康夫, 大原 貴裕, 石原 正治, 清水 渉, 安田 聡, 小川 久雄, 北風 政史, 安斉 俊久  日本心臓病学会誌  8-  (Suppl.I)  555  -555  2013/09  [Not refereed][Not invited]
  
• 左室拡張期untwistingは左室拡張早期心尖部suctionを規定する

  大原 貴裕, 菅野 康夫, 舟田 晃, 長谷川 拓也, 神崎 秀明, 安田 聡, 小川 久雄, 安斉 俊久, Vlachos Pavlos, Little William  日本心臓病学会誌  8-  (Suppl.I)  559  -559  2013/09  [Not refereed][Not invited]
  
• BNPは冠動脈疾患発症リスクの代用マーカーとなりうるか

  長谷川 拓也, 朝倉 正紀, 江口 和男, 浅沼 博司, 天木 誠, 高濱 博幸, 舟田 晃, 菅野 康夫, 大原 貴裕, 神崎 秀明, 橋村 一彦, 友池 仁暢, 金 智隆, 安斉 俊久, 北風 政史  日本心臓病学会誌  8-  (Suppl.I)  566  -566  2013/09  [Not refereed][Not invited]
  
• 大動脈弁置換術後遠隔期にValsalva洞吻合部瘤をきたした大動脈炎症候群の一例

  舟田 晃, 神崎 秀明, 菅野 康夫, 大原 貴裕, 長谷川 拓也, 北風 政史, 安斉 俊久  日本心臓病学会誌  8-  (Suppl.I)  696  -696  2013/09  [Not refereed][Not invited]
  
• 高齢者急性非代償心不全における急性期左室収縮能改善と長期予後との関連

  志波 幹夫, 菅野 康夫, 中村 憲史, 永井 利幸, 横山 広行, 大原 貴裕, 舟田 晃, 長谷川 拓也, 神崎 秀明, 石原 正治, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会誌  8-  (Suppl.I)  707  -707  2013/09  [Not refereed][Not invited]
  
• 機序の異なる2種類の心外膜起源心室頻拍を認めた心臓サルコイドーシスの1例

  執行 秀彌, 川上 大志, 中島 育太郎, 里見 和浩, 石橋 耕平, 宮本 康二, 山田 優子, 岡村 英夫, 野田 崇, 相庭 武司, 安斉 俊久, 石原 正治, 安田 聡, 小川 久雄, 鎌倉 史郎  日本心臓病学会誌  8-  (Suppl.I)  714  -714  2013/09  [Not refereed][Not invited]
  
• Guidelines for Treatment of Acute Heart Failure (JCS 2011) - Digest Version

  Tohru Izumi, Atsushi Hirayama, Mitsuaki Isobe, Hiroshi Ito, Masafumi Kitakaze, Shin-ichi Momomura, Yoshiki Sawa, Yoshihiko Seino, Hiroyuki Tsutsui, Kenji Yamazaki, Tsutomu Yoshikawa, Hitoshi Adachi, Toshihisa Anzai, Naoyoshi Aoyama, Yoichi Goto, Kazuhiko Hashimura, Takayuki Inomata, Mahoto Kato, Shintaro Kinugawa, Kazufumi Nakamura, Kazuhiko Nishigaki, Shinichi Niwano, Katsuya Onishi, Taketoshi Ozawa, Yasushi Sakata, Naoki Sato, Yukihito Sato, Tomoko Sugiyama Kato, Miyuki Tsuchihashi-Makaya, Kazuhiro Yamamoto, Yoshio Yasumura, Hiroyuki Yokoyama, Masatsugu Hori, Tsutomu Imaizumi, Takeshi Nakatani, Keijiro Saku, Michihiro Yoshimura  CIRCULATION JOURNAL  77-  (8)  2157  -2201  2013/08  [Not refereed][Not invited]
  
• Association between plasma indoxyl sulfate levels and cardiac hypertrophy in patients with heart failure

  M. Imazu, H. Takahama, H. Asanuma, A. Funada, T. Ohara, T. Hasegawa, M. Asakura, H. Kanzaki, T. Anzai, M. Kitakaze  EUROPEAN HEART JOURNAL  34-  777  -777  2013/08  [Not refereed][Not invited]
  
• Impact of left ventricular systolic diameter on the in-hospital improvement of systolic function in acute decompensated heart failure with high blood pressure presentation

  T. Nagai, T. Anzai, H. Yokoyama, Y. Sugano, H. Sakamoto, T. Noguchi, M. Ishihara, W. Shimizu, S. Yasuda, H. Ogawa  EUROPEAN HEART JOURNAL  34-  325  -325  2013/08  [Not refereed][Not invited]
  
• Left ventricular outflow tract velocity time integral correlates with low cardiac output syndrome in patients with acute decompensated heart failure

  D. Chinen, M. Fujino, T. Anzai, M. Kitakaze, Y. Goto, M. Ishihara, W. Shimizu, H. Yokoyama, S. Yasuda, H. Ogawa  EUROPEAN HEART JOURNAL  34-  783  -783  2013/08  [Not refereed][Not invited]
  
• Clinical significance of serum fibroblast growth factor 23 as a surrogate marker of the cardiorenal hemodynamic state in patients with heart failure

  M. Imazu, H. Takahama, H. Asanuma, A. Funada, T. Ohara, T. Hasegawa, M. Asakura, H. Kanzaki, T. Anzai, M. Kitakaze  EUROPEAN HEART JOURNAL  34-  781  -782  2013/08  [Not refereed][Not invited]
  
• High value of right ventricular to left ventricular interlead electrical delay during right ventricular pacing predict favorable response in patients with cardiac resynchronization therapy

  I. Nakajima, T. Noda, H. Okamura, T. Aiba, T. Anzai, M. Ishihara, S. Yasuda, H. Ogawa, S. Kamakura, W. Shimizu  EUROPEAN HEART JOURNAL  34-  580  -580  2013/08  [Not refereed][Not invited]
  
• Prognostic significance of tricuspid valve regurgitation in patients with autely decompensated heart failure

  Y. Sugano, T. Anzai, H. Yokoyama, T. Nagai, H. Kanzaki, M. Ishihara, W. Shimizu, S. Yasuda, H. Ogawa  EUROPEAN HEART JOURNAL  34-  325  -325  2013/08  [Not refereed][Not invited]
  
• 【虚血性心疾患 エビデンスをふまえた長期予後とQOL改善を目的とした最新の実地診療】 セミナー 実地診療で用いられる診断法と治療法 腎機能低下例における虚血性心疾患の二次予防のすすめかた

  安斉 俊久  Medical Practice  30-  (6)  1020  -1024  2013/06  [Not refereed][Not invited]
  
• OVER 20-YEAR TREND OF IN-HOSPITAL MORTALITY IN PATIENTS WITH CARDIOGENIC SHOCK USING PERCUTANEOUS EXTRACORPOREAL MEMBRANE OXYGENATION: COMPARISON BETWEEN ACS AND NON-ACS PATIENTS

  Manabu Matsumoto, Satoshi Yasuda, Takafumi Yamane, Taichi Adachi, Tadayoshi Miyagi, Toshiyuki Nagai, Masashi Fujino, Yasuhide Asaumi, Reon Kumasaka, Tetsuo Arakawa, Jun-ichi Kotani, Hiroki Sakamoto, Teruo Noguchi, Yoichi Goto, Hiroyuki Yokoyama, Toshihisa Anzai, Wataru Shimizu, Masaharu Ishihara, Takeshi Nakatani, Junjiro Kobayashi, Hisao Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  61-  (10)  E18  -E18  2013/03  [Not refereed][Not invited]
  
• ADMISSION HYPERGLYCEMIA IS AN INDEPENDENT PREDICTOR OF ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

  Noriaki Moriyama, Masaharu Ishihara, Teruo Noguchi, Hiroki Sakamoto, Michio Nakanishi, Jun-Ichi Kotani, Tetsuo Arakawa, Yasuhide Asaumi, Leon Kumasaka, Taichi Adachi, Takafumi Yamane, Tadayoshi Miyagi, Toshiyuki Nagai, Masashi Fujino, Manabu Matsumoto, Satoshi Honda, Takeshi Yagyu, Reiko Fujiwara, Akiko Fujino, Toshihisa Anzai, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  61-  (10)  E170  -E170  2013/03  [Not refereed][Not invited]
  
• 【慢性心不全の薬物治療-それぞれのステージでの長期予後を見据えた早期介入-】 1次予防と薬物療法(心イベント前での薬物療法) 予兆患者の発症予防 先制介入としての薬物療法

  安斉 俊久  Circulation  3-  (3)  30  -37  2013/03  [Not refereed][Not invited]
  
• 【循環器病学における臨床研究-いかに確実に臨床に還元するか】 循環器臨床研究の展望 心不全におけるあらたな治療法の開発状況 医薬品・医療機器

  安斉 俊久  医学のあゆみ  244-  (13)  1339  -1342  2013/03  [Not refereed][Not invited]
   

  心不全の予後を悪化させる心腎連関の病態を克服するため、腎保護作用に力点をおいた心不全治療薬の開発が進んでいる。しかし、大規模臨床試験により腎保護作用が明らかになったものは、現時点で報告されていない。強心薬に関しては、心筋酸素消費量を増加させない、あるいは神経体液性因子の賦活化を引き起こさない薬剤の開発が進んでいる。また、心拍数低下をターゲットとした心不全治療薬は、その有効性が大規模臨床試験でも報告されており、今後、わが国にも導入されることが期待されている。一方、非薬物療法においては、経皮的に僧帽弁閉鎖不全に対する治療が可能なデバイスや小型化された植込み型補助人工心臓などの開発が進み、難治性心不全に対する有効性が明らかになりつつあるが、費用対効果に関する検討も今後は必要と考えられる。(著者抄録)
• 在宅心不全患者Web管理システムの開発 被災地での利用をめざして

  谷 昇子, 稲田 紘, 安斉 俊久, 中尾 寿成, 川上 清和, 上野 直子, 桑田 成規, 中沢 一雄, 宮本 恵宏  電子情報通信学会技術研究報告(MEとバイオサイバネティックス)  112-  (479)  13  -17  2013/03  [Not refereed][Not invited]
   

  本研究では、軽度から中等度の在宅心不全患者を対象としたWeb管理システムの開発を行った。患者は在宅にて、タブレット端末より、生体、食事、運動、服薬などの患者管理に要する情報を入力し、医療機関側のWebサーバに送信する。患者から送信された情報はすべて、専用のデータベースに蓄積する。臨床上必要となる機能を実装するため、心不全患者の管理に必須となる条件を基本から整理した。入力端末として10.1型のAndroid搭載タブレット端末を選定し、選定端末画面での操作を想定した入力インタフェースの開発を行った。開発システムは、被災地の仮設住宅などにおいても活用できることが期待される。(著者抄録)
• 【急性冠症候群の病態・診断・治療】 病態 炎症の関与

  安斉 俊久  月刊レジデント  6-  (2)  24  -33  2013/02  [Not refereed][Not invited]
  
• 急性心筋梗塞における急性期高血糖,慢性高血糖が短期予後に与える影響

  藤野雅史, 石原正治, 中西道郎, 坂本裕樹, 野口暉夫, 草野研吾, 安斉俊久, 後藤葉一, 安田聡, 小川久雄  日本血管生物医学会学術集会プログラム・抄録集  21st-  2013
• 房室ブロックにペースメーカー植込みするも急激な心機能低下を呈し,生検で診断に至った好酸球心筋炎の一例

  知念大悟, 宮城唯良, 山根崇史, 永井利幸, 浅海泰栄, 坂本裕樹, 安斉俊久, 石原正治, 清水渉, 小川久雄, 安田聡  日本循環器学会近畿地方会(Web)  115th-  KINKI115,D03 (WEB ONLY)  2013  [Not refereed][Not invited]
  
• 複数の検査による虚血評価を施行するも責任病変の同定に難渋した労作性狭心症の一例

  森山典晃, 山根崇史, 坂本裕樹, 野口輝夫, 小谷順一, 中西道郎, 宮城唯良, 足立太一, 永井利幸, 荒川鉄雄, 熊坂礼音, 浅海泰栄, 藤野雅史, 横山広行, 後藤葉一, 安斉俊久, 清水渉, 石原正治, 安田聡, 小川久雄  日本循環器学会近畿地方会(Web)  115th-  KINKI115,B46 (WEB ONLY)  2013  [Not refereed][Not invited]
  
• Effects of cardiac resynchronization therapy in patients with inotrope-dependent class IV end-stage heart failure

  Ikutaro Nakajima, Takashi Noda, Hideaki Kanzaki, Kohei Ishibashi, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Kazuhiro Satomi, Takeshi Aiba, Shiro Kamakura, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Wataru Shimizu  Journal of Arrhythmia  29-  (6)  342  -346  2013  [Not refereed][Not invited]
   

  Background: Cardiac resynchronization therapy (CRT) has been widely used for the treatment of refractory heart failure (HF). However, the efficacy of CRT is not well established in class IV HF patients on inotropic support. Methods: Twenty-six patients (age 55718 years, 73% men) with inotrope-dependent HF were reviewed to evaluate the effectiveness of CRT in class IV HF patients on inotropic support. Results: Intravenous inotropic therapy was administered for 72756 days before CRT and consisted of dobutamine (n=24 3.071. 2 μg kg -1 min-1), dopamine (n=2 4.572.1 μg kg -1 min-1), and/or milrinone (n=16 0.12 70.09 μg kg-1 min-1). CRT did not produce significant reverse remodeling in eligible patients (left ventricular ejection fraction 2377% to 2579% p=0.23, left ventricular end-diastolic diameter 7079 mm to 6879 mm p=0.14). After CRT device implantation, 13 (50%) patients experienced 1 or more episodes of ventricular tachyarrhythmia or sudden cardiac death. Twenty (77%) patients survived to hospital discharge with weaning from inotropic support (70770 days after CRT implantation). The 1-year survival rate was 81%. However, data from long-term follow-up showed that 68% of the study patients who attained survival discharge had an HF hospitalization event within the follow-up period. Conclusion: CRT did not result in significant reverse remodeling in patients with inotrope-dependent class IV end-stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short-term period in some patients. © 2013 Japanese Heart Rhythm Society.
• 【急性冠症候群】 ACSという概念がもたらしたもの

  安斉 俊久  Intensivist  5-  (1)  167  -172  2013/01  [Not refereed][Not invited]
   

  1992年に,Fusterらによって急性冠症候群acute coronary syndrome(ACS)という概念が提唱され,急性心筋梗塞,不安定狭心症,心臓突然死は,いずれも冠動脈硬化粥腫の不安定化に伴う急激な冠動脈内腔の閉塞または狭窄により生じる,1つの症候群として考えられるようになった。また,病理学的な検討によって,急性心筋梗塞の多くは,軽度の冠動脈狭窄から発症することも明らかとなった。病態が明らかになるにつれ,予防または治療の戦略も確立され,現代では抗血小板薬,スタチンをはじめとした薬物療法,急性期冠動脈血行再建術に加え,二次予防のための薬物療法が確立されるに至った。そうした意味では,ACSという概念が,日常の循環器臨床にもたらしたものは多大である。本稿では,冠動脈疾患が狭心症と心筋梗塞のみに分類されていた時代まで遡って,ACSという概念が生まれた背景と治療戦略の変化まで含めて述べることとする。(著者抄録)
• COPDを合併した心不全患者への適切な治療法とは?

  安斉 俊久  CORE Journal 循環器  (2)  62  -69  2012/12  [Not refereed][Not invited]
  
• 心血管リモデリングにおける炎症と心腎関連

  安斉 俊久  千里丘山田臨床医学談話会会報  30-  (12)  122  -131  2012/12  [Not refereed][Not invited]
  
• The Plasma Renin Activity in Acute Phases in Patients with Acute Heart Failure Syndromes Predicts the Long-term Clinical Outcome

  Yasuki Nakada, Hiroyuki Takahama, Akemi Yoshida, Akira Funada, Takahiro Ohara, Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Masaharu Ishihara, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Limited Efficacy of Rotational Atherectomy to Calcified Coronary Artery Lesion in Patients with Kawasaki Disease; Relatively High Rate of Restenosis and Adverse Cardiac Events

  Takeshi Yagyu, Hiroki Sakamoto, Fujino Masashi, Leon Kumasaka, Takafumi Yamane, Taichi Adachi, Tetsuo Arakawa, Yasuhide Asaumi, Tadayoshi Miyagi, Jun-ichi Kotani, Teruo Noguchi, Etsuko Tsuda, Osamu Yamada, Toshihisa Anzai, Masaharu Ishihara, Wataru Shimizu, Isao Shiraishi, Hisao Ogawa, Satoshi Yasuda  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Assessment of Myocardial and Microvascular Injury of Takotsubo cardiomyopathy and ST-elevation Myocardial Infarction by Cardiac Magnetic Resonance Imaging

  Akiko Fujino, Teruo Noguchi, Masaharu Ishihara, Hiroki Sakamoto, Michio Nakanishi, Jun-ichi Kotani, Yasuhide Asaumi, Tadayoshi Miyagi, Tetsuo Arakawa, Taichi Adachi, Reon Kumasaka, Masafumi Yamane, Masashi Fujino, Yoichi Goto, Toshihisa Anzai, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Comparison of Tissue Fibrosis and Active Inflammation as Arrhythmogenic Substrate in Patients with Cardiac Sarcoidosis and Monomorphic Ventricular Tachycardia

  Hideharu Okamatsu, Kazuhiro Satomi, Ikutarou Nakajima, Kouji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Takeshi Aiba, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shirou Kamakura, Wataru Shimizu  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Gender Differences in the Early Mortality of Octogenarian Patients with Acute Myocardial Infarction From a Registry Database in Japan

  Takafumi Yamane, Junichi Kotani, Hiroki Sakamoto, Masaharu Ishihara, Toshihisa Anzai, Wataru Shimizu, Satoshi Yasuda, Hideo Kusuoka, Hiroyuki Yokoyama  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Different Response to Exercise Testing between Andersen-Tawil Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia

  Yuko Yamada, Tomoko Sakaguchi, Ikutaro Nakajima, Koij Miyamoto, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Takeshi Aiba, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Minoru Horie, Wataru Shimizu  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Additional Dipyridamole Effect in Adenosine-Induced Transient Reconnection after Pulmonary Vein Isolation

  Kohei Iguchi, Kazuhiro Satomi, Ikutaro Nakajima, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Takeshi Aiba, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• The Diagnosis of Cardiomyopathy Using both Late Gadolinium Enhancement and Left Ventricular Mass Index

  Akemi Yoshida, Naoaki Yamada, Hatsue Ishibashi-Ueda, Hideaki Kanzaki, Takuya Hasegawa, Hiroyuki Takahama, Makoto Amaki, Akira Funada, Masanori Asakura, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Clinical Implication of Tissue Fibrosis and Physiological Parameters for Adverse Cardiac Events in Hypertrophic Cardiomyopathy

  Yuko Wada, Takeshi Aiba, Takaaki Matsuyama, Ikutaro Nakajima, Koji Miyamoto, Yuko Yamada, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Hideaki Kanzaki, Toshihisa Anzai, Masaharu Ishihara, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Wataru Shimizu  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Prevalence and Relation of Left Ventricular Diastolic Dysfunction and Hypertrophy in a Community-Based Population

  Takuya Hasegawa, Masanori Asakura, Hideaki Kanzaki, Jiyoong Kim, Hiroshi Asanuma, Shoji Sanada, Akira Funada, Makoto Amaki, Hiroyuki Takahama, Takahiro Ohara, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Molecular Imaging Using Bubble Immune-Liposomes and Echocardiography to Detect Thrombus in Left Atrial Appendage in Canine Hearts

  Hiroyuki Takahama, Hiroshi Asanuma, Ryo Suzuki, Yusuke Oda, Kazuo Maruyama, Tetsuo Minamino, Masanori Asakura, Hideaki Kanzaki, Masaharu Ishihara, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa, Toshihisa Anzai, Masafumi Kitakaze  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Prognostic Importance of Late Gadolinium Enhancement Cardiac Magnetic Resonance as a Potential Novel Risk Factor in Patients with Dilated Cardiomyopathy

  Emi Tateishi, Teruo Nogurhi, Yoshiaki Morita, Naoaki Yamada, Toshihisa Anzai, Masaharu Ishihara, Wataru Shimizu, Yochi Goto, Hisao Ogawa, Satoshi Yasuda  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Late Gadolinium Enhancement Cardiac Magnetic Resonance in Detection of Cardiac Involvement and its Prognostic Implication in Patients with Extracardiac Sarcoidosis

  Toshiyuki Nagai, Shun Kohsaka, Shigeo Okuda, Toshihisa Anzai, Koichiro Asano, Keiichi Fukuda  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• Nutrition Impairment in Patients Hospitalized With Acute Decompensated Heart Failure Relates to Poor Prognosis Even Without Left Ventricular Systolic Dysfunction

  Masashi Fujino, Hiroyuki Yokoyama, Jun-ichi Kotani, Hiroki Sakamoto, Wataru Shimizu, Toshihisa Anzai, Masafumi Kitakaze, Masaharu Ishihara, Yoichi Goto, Satoshi Yasuda  CIRCULATION  126-  (21)  2012/11  [Not refereed][Not invited]
  
• How does the Beta-blocker Provide the Best Practice of Heart Failure?

  Masafumi Kitakaze, Masanori Asakura, Hiroyuki Takahama, Hideaki Kanzaki, Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  18-  (10)  S139  -S140  2012/10  [Not refereed][Not invited]
  
• Prognostic Implication of Extent of Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance after Steroid Therapy in Patients with Cardiac Sarcoidosis

  Takayuki Ise, Takuya Hasegawa, Yoshiaki Morita, Naoaki Yamada, Akira Funada, Hideaki Kanzaki, Hideo Okamura, Shiro Kamakura, Toshihisa Anzai, Masafumi Kitakaze  JOURNAL OF CARDIAC FAILURE  18-  (10)  S164  -S165  2012/10  [Not refereed][Not invited]
  
• Nutrition Impairment in Patients Hospitalized with Acute Decompensated Heart Failure Relates to Poor Prognosis Even Without Left Ventricular Systolic Dysfunction

  Masashi Fujino, Hiroyuki Yokoyama, Jun-Ichi Kotani, Hiroki Sakamoto, Wataru Shimizu, Toshihisa Anzai, Masafumi Kitakaze, Masaharu Ishihara, Yoichi Goto, Satoshi Yasuda  JOURNAL OF CARDIAC FAILURE  18-  (10)  S155  -S155  2012/10  [Not refereed][Not invited]
  
• Incidence, background, treatment strategies and the prognosis in very elderly patients with acute myocardial infarction - from Japanese multicenter database

  Takafumi Yamane, Junichi Kotani, Hiroki Sakamoto, Masaharu Ishihara, Toshihisa Anzai, Wataru Shimizu, Satoshi Yasuda, Hideo Kusuoka, Hiroyuki Yokoyama  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  60-  (17)  B103  -B103  2012/10  [Not refereed][Not invited]
  
• Diastolic Function at Rest Determines the Prognosis of Myocardial Infarction

  Takahiro Ohara, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Robert Applegate, William Little  JOURNAL OF CARDIAC FAILURE  18-  (10)  S190  -S190  2012/10  [Not refereed][Not invited]
  
• CKDと虚血性心疾患

  安斉 俊久  心臓  44-  (10)  1329  -1332  2012/10  [Not refereed][Not invited]
  
• 完全房室ブロック発症9年後に多形性心室頻拍による失神を契機として心サルコイドーシスの診断に至った1例

  永井 利幸, 安斉 俊久, 福田 恵一  日本サルコイドーシス/肉芽腫性疾患学会雑誌  32-  (サプリメント号)  43  -43  2012/09  [Not refereed][Not invited]
  
• 男性冠動脈疾患患者において血中エストラジオール濃度は心外膜脂肪量に関連する

  岩山 忠輝, 宮本 恵宏, 屋代 祥典, 渡邉 哲, 野口 輝夫, 東 将浩, 安斉 俊久, 北風 政史, 内藤 博昭, 久保田 功  日本内分泌学会雑誌  88-  (2)  823  -823  2012/09  [Not refereed][Not invited]
  
• 心臓外サルコイドーシス症例の心臓病変早期検出における心臓MRIの有用性

  永井 利幸, 香坂 俊, 奥田 茂男, 浅野 浩一郎, 安斉 俊久, 福田 恵一  日本サルコイドーシス/肉芽腫性疾患学会雑誌  32-  (1)  93  -100  2012/09  [Not refereed][Not invited]
   

  サルコイドーシスにおいて,心病変の存在は最大の予後規定因子であるとされている.近年画像診断の進歩により,心臓MRI遅延造影(Late gadlinium enhancement-cardiac magnetic resonance:LGE-CMR)を用いた心病変の早期検出と予後への寄与を算出できる可能性が見出された.今回我々は,心臓外病変で組織学的あるいは臨床的にサルコイドーシスと確定診断され,特に胸部症状を認めず,左室駆出率も保たれた連続した57例を登録し,LGE-CMRを施行した後に約2年間前向きに観察した.結果,8例がLGE-CMR陽性であり,様々な造影パターンを認めた.LGE-CMR陽性群は陰性群と比較して血清ACE値が低値であった他は罹患臓器数,罹患期間,ステロイド使用の有無に差を認めなかった.観察期間内の評価では,死亡例は肺病変によるLGE-CMR陰性群の1例のみであり,全死亡,心臓死,症候性不整脈,心不全発症に関して,両群で有意な差を認めなかったが,LGE-CMR陽性群のうち,1例で高度房室ブロックにより,ペースメーカー植え込み術が施行され,1例でステロイド治療の開始により半年後のLGE-CMR所見の改善を認めた.結論として,無症候の段階でのLGE-CMRによる心病変の早期検出および,早期介入の可能性は期待できるが,こうした潜在例では中期的な予後は比較的良好と考えられた.(著者抄録)
• Late gadolinium enhancement quantification using a threshold of 6 SD in cardiac magnetic resonance imaging predicts mortality and morbidity more than that of 2 SD in hypertrophic cardiomyopathy

  A. Funada, H. Kanzaki, T. Noguchi, Y. Morita, H. Takahama, M. Amaki, T. Hasegawa, N. Yamada, T. Anzai, M. Kitakaze  EUROPEAN HEART JOURNAL  33-  1024  -1024  2012/08  [Not refereed][Not invited]
  
• Late gadolinium enhancement cardiac magnetic resonance in detection of cardiac involvement and its prognostic implication in patients with extracardiac sarcoidosis

  T. Nagai, S. Kohsaka, S. Okuda, T. Anzai, K. Asano, K. Fukuda  EUROPEAN HEART JOURNAL  33-  1024  -1024  2012/08  [Not refereed][Not invited]
  
• Impact of dendritic cell-derived interleukin-10 in the post-infarction inflammation and left ventricular remodeling

  A. Anzai, T. Anzai, S. Nagai, Y. Maekawa, Y. Sugano, M. Sano, S. Koyasu, K. Fukuda  EUROPEAN HEART JOURNAL  33-  327  -327  2012/08  [Not refereed][Not invited]
  
• Dendritic Cell Regulates Monocyte/Macrophage Polarization and Inflammatory Response After Myocardial Infarction in Mice

  Atsushi Anzai, Toshihisa Anzai, Keiichi Fukuda  CIRCULATION RESEARCH  111-  (4)  2012/08  [Not refereed][Not invited]
  
• Circadian variation of the occurrence of acute heart failure syndromes contributes to long-term prognosis in patients with non-ischemic cardiomyopathy

  H. Yasui, T. Hiroyuki, A. Funada, M. Amaki, T. Ohara, T. Hasegawa, M. Asakura, H. Kanzaki, T. Anzai, M. Kitakaze  EUROPEAN HEART JOURNAL  33-  936  -936  2012/08  [Not refereed][Not invited]
  
• 心血管疾患とCKD 梗塞後左室リモデリングにおける炎症と心腎連関

  安斉 俊久, 高濱 博幸, 天木 誠, 大原 貴裕, 長谷川 拓也, 神崎 秀明, 清水 渉, 安田 聡, 小川 久雄  日本心臓病学会誌  7-  (Suppl.I)  175  -175  2012/08  [Not refereed][Not invited]
  
• 心エコー図の最前線 カラーMモード法の空間的・時間的分析 拡張障害例では拡張早期左室Suctionの交感神経刺激に対する反応性が低下している

  大原 貴裕, 高濱 博幸, 天木 誠, 長谷川 拓也, 神崎 秀明, 北風 政史, 安田 聡, 小川 久雄, 安斉 俊久  日本心臓病学会誌  7-  (Suppl.I)  182  -182  2012/08  [Not refereed][Not invited]
  
• 循環器疾患とMRI 心臓外サルコイドーシス症例の心臓病変早期検出における心臓MRIの有用性

  永井 利幸, 香坂 俊, 奥田 茂男, 安斉 俊久, 浅野 浩一郎, 福田 恵一  日本心臓病学会誌  7-  (Suppl.I)  192  -192  2012/08  [Not refereed][Not invited]
  
• たこつぼ心筋障害を考える たこつぼ心筋障害の概念

  石原 正治, 安斉 俊久, 清水 渉, 安田 聡, 小川 久雄  日本心臓病学会誌  7-  (Suppl.I)  212  -212  2012/08  [Not refereed][Not invited]
  
• Physical Examinationを学ぶ 心筋心膜疾患の身体所見

  大原 貴裕, 安斉 俊久  日本心臓病学会誌  7-  (Suppl.I)  244  -244  2012/08  [Not refereed][Not invited]
  
• 急性心不全症例における入院時HbA1c値と腎機能との予後への関連

  柳生 剛, 藤野 雅史, 山根 崇史, 足立 太一, 宮城 唯良, 小谷 順一, 坂本 裕樹, 石原 正治, 安斉 俊久, 北風 政史, 後藤 葉一, 安田 聡, 小川 久雄, 横山 広行  日本心臓病学会誌  7-  (Suppl.I)  299  -299  2012/08  [Not refereed][Not invited]
  
• 心室性不整脈を合併した閉塞性肥大型心筋症における侵襲的圧較差軽減治療の有用性の検討

  中村 知久, 山田 優子, 神崎 秀明, 天木 誠, 宮本 康二, 岡村 英夫, 野田 崇, 里見 和浩, 相庭 武司, 鎌倉 史郎, 安斉 俊久, 石原 正治, 安田 聡, 小川 久雄, 清水 渉  日本心臓病学会誌  7-  (Suppl.I)  468  -468  2012/08  [Not refereed][Not invited]
  
• 重症心不全末期における緩和ケアの状況および今後の課題

  安井 博規, 高濱 博幸, 安斉 俊久, 北風 政史  日本心臓病学会誌  7-  (Suppl.I)  525  -525  2012/08  [Not refereed][Not invited]
  
• 【ACSの診療】 ACSの病態における炎症の関与

  安斉 俊久  Circulation  2-  (7)  55  -65  2012/07  [Not refereed][Not invited]
  
• 食事、飲酒により左室流出路圧較差の増悪を認めた閉塞性肥大型心筋症の1例

  岡松 秀治, 長谷川 拓也, 神崎 秀明, 宇佐美 俊輔, 舟田 晃, 天木 誠, 高濱 博幸, 植田 初江, 安斉 俊久, 北風 政史  日本心臓病学会誌  7-  (2)  102  -107  2012/06  [Not refereed][Not invited]
   

  64歳男。失神と労作時前胸部絞扼感を主訴とした。食事、飲酒後の歩行中に前胸部絞扼感が出現し、約2分間にわたる失神が出現した。経胸壁心臓超音波検査で左室壁の非対称性肥大、僧帽弁前尖収縮期前方運動、大動脈弁収縮中期半閉鎖、左室流出路に加速血流と高度な圧較差を認めた。閉塞性肥大型心筋症と診断し、確定診断のため心臓カテーテル検査を行ったが、左室流出路に圧較差を認めなかった。心臓カテーテル検査時と同じ条件、で心臓超音波検査を再度行ったところ、左室流出路の圧較差は軽度で、心臓カテーテル検査の所見と一致した。また、食事の影響を検討するため、食後に心臓超音波検査を行ったところ、食前に比べ左室流出路の圧較差が増加し、労作時の自覚症状も悪化した。シベンゾリンの内服によって食後の左室流出路圧較差や自覚症状は改善したが、食事に飲酒を加えると左室流出路の圧較差が増加し、自覚症状も増悪した。
• 重症心不全終末期における緩和ケアの現状と課題

  安井 博規, 高濱 博幸, 安斉 俊久, 梅野 貴子, 金井 恵美, 畑 朝子, 高田 弥寿子, 和田 恭一  日本緩和医療学会学術大会プログラム・抄録集  17回-  483  -483  2012/06  [Not refereed][Not invited]
  
• 重症心不全における緩和ケアの問題点および今後の課題

  安井 博規, 高濱 博幸, 安斉 俊久, 安野 史彦, 梅野 貴子, 金井 恵美, 畑 朝子, 高田 弥寿子, 和田 恭一, 平山 真秀, 上ノ町 かおり  日本緩和医療学会学術大会プログラム・抄録集  17回-  512  -512  2012/06  [Not refereed][Not invited]
  
• 心拍数と心不全

  安斉 俊久  呼吸と循環  60-  (5)  533  -538  2012/05  [Not refereed][Not invited]
  
• 遺伝性不整脈の臨床from bench to bedside 先天性QT延長症候群における遺伝子変異領域と予後・治療の選択

  相庭 武司, 牧元 久樹, 山形 研一郎, 中島 育太郎, 宮本 康二, 山田 優子, 岡村 英夫, 野田 崇, 里見 和浩, 石原 正治, 安斉 俊久, 安田 聡, 小川 久雄, 鎌倉 史郎, 宮本 恵宏, 清水 渉, 堀江 稔, 小川 聡, 相澤 義房, 大江 透, 草野 研吾, 山岸 正和, 蒔田 直昌, 田中 敏博, 牧山 武, 吉永 正夫, 萩原 誠久, 住友 直方, 先天性QT延長症候群多施設登録研究  Journal of Arrhythmia  28-  (Suppl.)  178  -178  2012/05  [Not refereed][Not invited]
  
• CHANGES IN TRICUSPID ANNULAR PLANE SYSTOLIC EXCURSION PROVOKED BY EXERCISE DETERMINE THE EXERCISE CAPACITY IN PATIENTS WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION

  Makoto Amaki, Hideaki Kanzaki, Akira Funada, Hiroyuki Takahama, Takuya Hasegawa, Toshihisa Anzai, Masafumi Kitakaze  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  59-  (13)  E1281  -E1281  2012/03  [Not refereed][Not invited]
  
• CLINICAL SCENARIO OF ACUTE HEART FAILURE SYNDROME BEFORE CARDIAC RESYNCHRONIZATION THERAPY PREDICTS LONG-TERM PROGNOSIS

  Mika Maeda, Hideaki Kanzaki, Makoto Amaki, Takuya Hasegawa, Akira Funada, Hiroyuki Takahama, Toshihisa Anzai, Masafumi Kitakaze  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  59-  (13)  E973  -E973  2012/03  [Not refereed][Not invited]
  
• 経皮的冠動脈インターベンションにおけるNo-reflow現象の標的冠動脈による相違

  永井 利幸, 穂坂 春彦, 岸野 喜一, 松村 圭祐, 片山 隆晴, 宮川 貴史, 香坂 俊, 安斉 俊久, 福田 恵一, 鈴木 雅裕  日本内科学会雑誌  101-  (Suppl.)  227  -227  2012/02  [Not refereed][Not invited]
  
• 12誘導心電図におけるV1誘導は肺高血圧症例の右室収縮不全の存在を予測する

  永井 利幸, 香坂 俊, 村田 光繁, 奥田 茂男, 安斉 俊久, 福田 恵一, 佐藤 徹  日本内科学会雑誌  101-  (Suppl.)  228  -228  2012/02  [Not refereed][Not invited]
  
• 両側経皮的腎動脈形成術により持続的血液濾過透析と静注降圧薬を離脱できた急性心不全の一例

  知念大悟, 足立太一, 山根崇史, 永井利幸, 宮城唯良, 浅海泰栄, 小谷順一, 坂本裕樹, 中西道郎, 野口輝夫, 三田祥寛, 森田佳明, 福田哲也, 谷山明, 吉原史樹, 安斉俊久, 清水渉, 安田聡, 後藤葉一, 石原正治  日本循環器学会近畿地方会(Web)  114th-  KINKI114,C41 (WEB ONLY)  2012  [Not refereed][Not invited]
  
• 繰り返す心室細動で発症した高齢者,急性好酸球性心筋炎の一例

  木村義隆, 宮城唯良, 永井利幸, 山根崇史, 足立太一, 小谷順一, 坂本裕樹, 安斉俊久, 清水渉, 石原正治, 安田聡  日本循環器学会近畿地方会(Web)  114th-  KINKI114,D51 (WEB ONLY)  2012  [Not refereed][Not invited]
  
• 【外してならない循環器薬の使い方 2012】 身につけるべき基本的な循環器薬の使い方 ACE阻害薬/ARB 心不全

  安斉 俊久  Medicina  49-  (1)  110  -114  2012/01  [Not refereed][Not invited]
   

  ＜ポイント＞★ACE阻害薬/ARBは,慢性心不全患者の左室機能ならびに生命予後を改善する.★虚血性心不全にはACE阻害薬を第一選択とし,忍容性がなければARBを考慮する.★ACE阻害薬とARBの併用は,腎障害,高カリウム血症を避けるため原則控える.★両側性腎動脈狭窄,妊婦,授乳婦には禁忌である.腎障害例では少量より投与する.★ACE阻害薬は腎排泄,ARBは胆汁排泄が多く,透析患者では原則ARBを使用する.(著者抄録)
• Increased High-Mobility Group Box1 Expression at Ruptured Plaque Was Associated with Microvascular Damage after Reperfusion in Patients with Myocardial Infarction

  Takashi Kohno, Toshihisa Anzai, Takahiro Ohki, Yuji Itabashi, Akihiro Yoshizawa, Tsutomu Yoshikawa, Keiichi Fukuda  CIRCULATION  124-  (21)  2011/11  [Not refereed][Not invited]
  
• 【冠動脈疾患(下)-診断と治療の進歩-】 虚血性心筋症の臨床 虚血性心筋症の治療戦略 虚血性心筋症に対する薬物治療 イバブラジン(選択的心拍数低下薬)

  安斉 俊久  日本臨床  69-  (増刊9 冠動脈疾患(下))  412  -416  2011/11  [Not refereed][Not invited]
  
• サルコイドーシス症例の心臓病変早期検出における心臓MRIの有用性

  永井 利幸, 香坂 俊, 奥田 茂男, 安斉 俊久, 浅野 浩一郎, 福田 恵一  日本サルコイドーシス/肉芽腫性疾患学会雑誌  31-  (サプリメント号)  36  -36  2011/10  [Not refereed][Not invited]
  
• 臓器から心不全を診る 心不全と腎臓

  安斉 俊久  日本臨床生理学会雑誌  41-  (5)  43  -43  2011/10  [Not refereed][Not invited]
  
• 心不全予防のための高血圧治療 心腎連関、心肺連関を考慮した予後改善のためのβ遮断薬療法

  安斉 俊久  日本高血圧学会総会プログラム・抄録集  34回-  302  -302  2011/10  [Not refereed][Not invited]
  
• 【冠動脈疾患(上)-診断と治療の進歩-】 冠動脈疾患における治療学の進歩 薬物治療 冠動脈疾患治療薬 βブロッカー

  安斉 俊久  日本臨床  69-  (増刊7 冠動脈疾患(上))  445  -449  2011/09  [Not refereed][Not invited]
  
• Eicosapentaenoic acid suppresses adverse effects of C-Reactive protein overexpression on pressure overload-induced cardiac remodeling

  T. Nagai, T. Anzai, Y. Mano, H. Kaneko, A. Anzai, Y. Sugano, Y. Maekawa, T. Takahashi, T. Yoshikawa, K. Fukuda  EUROPEAN HEART JOURNAL  32-  757  -757  2011/08  [Not refereed][Not invited]
  
• Significance of electrocardiographic right ventricular hypertrophy in patients with pulmonary hypertension with or without right ventricular dysfunction

  T. Nagai, S. Kohsaka, M. Murata, S. Okuda, T. Anzai, T. Sato, K. Fukuda  EUROPEAN HEART JOURNAL  32-  443  -444  2011/08  [Not refereed][Not invited]
  
• C-Reactive Protein overexpression exacerbates pressure overload-induced cardiac remodeling through enhanced inflammatory response

  T. Nagai, T. Anzai, H. Kaneko, Y. Mano, A. Anzai, Y. Maekawa, T. Takahashi, T. Meguro, T. Yoshikawa, K. Fukuda  EUROPEAN HEART JOURNAL  32-  1071  -1071  2011/08  [Not refereed][Not invited]
  
• 【新人ナースはここからスタート!循環器疾患・症状の病態生理】 急性心筋梗塞(PCI実施例)

  安斉 俊久  ハートナーシング  24-  (5)  460  -465  2011/05  [Not refereed][Not invited]
  
• SIGNIFICANCE OF ELECTROCARDIOGRAPHIC RIGHT VENTRICULAR HYPERTROPHY IN PATIENTS WITH PULMONARY HYPERTENSION WITH OR WITHOUT RIGHT VENTRICULAR DYSFUNCTION

  Toshiyuki Nagai, Shun Kohsaka, Mitsushige Murata, Shigeo Okuda, Toshihisa Anzai, Toru Sato, Keiichi Fukuda  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  57-  (14)  E149  -E149  2011/04  [Not refereed][Not invited]
  
• EICOSAPENTAENOIC ACID SUPPRESSES THE ADVERSE EFFECTS OF C-REACTIVE PROTEIN OVEREXPRESSION ON PRESSURE OVERLOAD-INDUCED CARDIAC REMODELING VIA ATTENUATING INFLAMMATORY RESPONSE AND OXIDATIVE STRESS

  Toshiyuki Nagai, Toshihisa Anzai, Hidehiro Kaneko, Yoshinori Mano, Atsushi Anzai, Yuichiro Maekawa, Toshiyuki Takahashi, Tsutomu Yoshikawa, Keiichi Fukuda  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  57-  (14)  E213  -E213  2011/04  [Not refereed][Not invited]
  
• C-REACTIVE PROTEIN OVEREXPRESSION EXACERBATES PRESSURE OVERLOAD-INDUCED CARDIAC REMODELING THROUGH ENHANCED INFLAMMATORY RESPONSE AND OXIDATIVE STRESS

  Toshiyuki Nagai, Toshihisa Anzai, Hidehiro Kaneko, Yoshinori Mano, Atsushi Anzai, Yuichiro Maekawa, Tsutomu Yoshikawa, Keiichi Fukuda  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  57-  (14)  E534  -E534  2011/04  [Not refereed][Not invited]
  
• 乳癌へのtrastuzumab投与により急激な心機能障害を認めた1例

  赤池 智子, 栗田 康生, 菅野 康夫, 大橋 成孝, 岡部 輝雄, 古川 佳子, 安斉 俊久, 小川 聡  日本内科学会関東地方会  579回-  40  -40  2011/03  [Not refereed][Not invited]
  
• 冠動脈疾患治療をめぐる最近の話題 ACE阻害薬・Ca拮抗薬が果たす役割

  清野 精彦, Bertra, d Michel E, 安斉 俊久, 横井 宏佳  Pharma Medica  29-  (2)  82  -87  2011/02  [Not refereed][Not invited]
  
• ST上昇型急性心筋梗塞後の血清HMGB1値上昇と急性腎障害発症との関連

  菅野 康夫, 安斉 俊久, 大橋 成孝, 栗田 康生, 岡部 輝雄, 古川 佳子, 小川 聰  日本内科学会雑誌  100-  (Suppl.)  130  -130  2011/02  [Not refereed][Not invited]
  
• Eicosapentaenoic acid suppresses adverse effects of C-Reactive protein overexpression on pressure overload-induced cardiac remodeling

  T. Nagai, T. Anzai, Y. Mano, H. Kaneko, A. Anzai, Y. Sugano, Y. Maekawa, T. Takahashi, T. Yoshikawa, K. Fukuda  AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE  183-  757  -757  2011  [Not refereed][Not invited]
  
• Temporal Systemic Deletion of Tumor Necrosis Factor-alpha Converting Enzyme Prevents Development of High-Fat Diet-induced Insulin Resistance, Hepatosteatosis, Adipose Tissue Remodeling with Ameliorating Energy Expenditure

  Hidehiro Kaneko, Toshihisa Anzai, Keisuke Horiuchi, Kokichi Morimoto, Hiroshi Itoh, Yasunori Okada, Tsutomu Yoshikawa, Satoshi Ogawa, Keiichi Fukuda  CIRCULATION  122-  (21)  2010/11  [Not refereed][Not invited]
  
• Temporal Systemic Deletion of Tumor Necrosis Factor-alpha Converting Enzyme Inhibits Development of Abdominal Aortic Aneurysm

  Hidehiro Kaneko, Toshihisa Anzai, Keisuke Horiuchi, Takashi Kohno, Masayuki Shimoda, Yuichiro Maekawa, Hideyuki Shimizu, Tsutomu Yoshikawa, Ryohei Yozu, Yasunori Okada, Satoshi Ogawa, Keiichi Fukuda  CIRCULATION  122-  (21)  2010/11  [Not refereed][Not invited]
  
• 【循環器薬の使い方-コツと落とし穴】 病態に応じた循環器薬の使い方とコツ β遮断薬 虚血性心疾患における使い方

  安斉 俊久  Heart View  14-  (12)  68  -71  2010/11  [Not refereed][Not invited]
  
• 【拡張期心不全の治療におけるEBM 現状と今後の展望】 拡張期心不全において心筋の拡張不全を示すエビデンス

  永井 利幸, 安斉 俊久  CIRCULATION Up-to-Date  5-  (5)  467  -473  2010/10  [Not refereed][Not invited]
  
• Human C-reactive protein exacerbates obesity induced insulin resistance and hepatosteatosis associated with adipose tissue remodeling

  H. Kaneko, T. Anzai, T. Takahashi, K. Morimoto, Y. Maekawa, H. Itoh, T. Yoshikawa, S. Ogawa  EUROPEAN HEART JOURNAL  31-  248  -249  2010/09  [Not refereed][Not invited]
  
• Ivabradine (Pure Heart-Rate-Lowering Agent)

  Toshihisa Anzai  JOURNAL OF CARDIAC FAILURE  16-  (9)  S135  -S136  2010/09  [Not refereed][Not invited]
  
• Role of vascular endothelial growth factor-A in the development of mice CaCl2 induced abdominal aortic aneurysm

  H. Kaneko, T. Anzai, T. Takahashi, M. Shimoda, K. Yoshimura, H. Aoki, H. Shimizu, Y. Okada, R. Yozu, T. Yoshikawa  EUROPEAN HEART JOURNAL  31-  1028  -1029  2010/09  [Not refereed][Not invited]
  
• CKDを合併する循環器疾患に対する治療アプローチを探る 狭心症から心不全まで

  石綿 清雄, 梶本 克也, 藤本 陽, 安斉 俊久  血圧  17-  (9)  153  -159  2010/09  [Not refereed][Not invited]
  
• Systemic Acidosis Predicts Malignant Ventricular Arrhythmias after Reperfusion Therapy for ST-Elevation Myocardial Infarction

  Toshiyuki Nagai, Toshihisa Anzai, Hidehiro Kaneko, Atsushi Anzai, Yoshinori Mano, Yuji Nagatomo, Shun Kohsaka, Yuichiro Maekawa, Tsutomu Yoshikawa, Satoshi Ogawa, Kenchi Fukuda  JOURNAL OF CARDIAC FAILURE  16-  (8)  S103  -S104  2010/08  [Not refereed][Not invited]
  
• Overexpression of C-Reactive Protein Exacerbates Pressure Overload-Induced Left Ventricular Hypertrophy. and Fibrosis in Association with Enhanced Inflammatory Response

  Toshiyuki Nagar, Toshihisa Anzai, Yoshinori Mano, Hidehiro Kaneko, Atsushi Anzai, Yuichiro Maekawa, Tsutomu Yoshikawa, Kenchi Fukuda  JOURNAL OF CARDIAC FAILURE  16-  (8)  S36  -S37  2010/08  [Not refereed][Not invited]
  
• 【循環器薬の使いかた 心・腎を守る実地診療の重要性と薬剤の選択】 治療/主な循環器疾患の最新の薬物療法の実際 心不全の薬物療法 慢性心不全の治療 日本人におけるβ遮断薬の使いかたと問題点

  安斉 俊久  Medical Practice  27-  (5)  843  -850  2010/05  [Not refereed][Not invited]
  
• 【なぜ今、Ca拮抗薬とACE阻害薬なのか?】 ACE阻害薬に関する話題 心不全とACE阻害薬(EBMを含めて)

  安斉 俊久  Modern Physician  30-  (3)  395  -399  2010/03  [Not refereed][Not invited]
   

  慢性心不全の背景には、レニン-アンジオテンシン(RA)系賦活化による悪循環が存在しており、ACE阻害薬は、その悪循環から離脱させることによって有効に作用する。ACE阻害薬は、左室機能、運動耐容能を改善させるとともに、症状を軽減させ、長期予後を良好にする。ACE阻害薬は虚血イベント抑制に関するエビデンスも豊富であり、虚血性心不全において積極的に用いるべきである。心腎連関の病態においては、ACE阻害薬の恩恵がより大であり、腎機能障害例でも投与を考慮すべきである。(著者抄録)
• 抗凝固薬内服患者への抗血小板薬追加投与による出血リスクと長期予後

  村木 浩司, 香坂 俊, 高橋 賢至, 永井 利幸, 宗形 昌儒, 前川 裕一郎, 河村 朗夫, 安斉 俊久, 小川 聡, 吉川 勉  日本内科学会雑誌  99-  (Suppl.)  126  -126  2010/02  [Not refereed][Not invited]
  
• 【心臓血管の発生、疾患に関与する新しい注目すべき分子】 HMGB1の梗塞後左室リモデリングにおける役割

  安斉 俊久, 河野 隆志  循環器内科  67-  (2)  163  -170  2010/02  [Not refereed][Not invited]
  
• 【急性冠症候群患者におけるPCI】 STEMIにおけるβ遮断薬の役割

  安斉 俊久  Coronary Intervention  6-  (1)  68  -77  2010/01  [Not refereed][Not invited]
  
• Prehospital Transport of Patients With Acute Heart Failure: Prognostic Significance of Delay in Hospital Arrival

  Masashi Takahashi, Shun Kohsaka, Hiroaki Miyata, Tetsuo Sakai, Yuichiro Maekawa, Atsutoshi Takagi, Toshihisa Anzai, Kazumasa Harada, Masaru Suzuki, Takamichi Miyamoto, Shingo Hori, Ken Nagao, Naoki Satoh, Tsutomu Yoshikawa, Morimasa Takayama  CIRCULATION  120-  (18)  S1459  -S1459  2009/11  [Not refereed][Not invited]
  
• Role of Human C-Reactive Protein in the Development of Adipose Tissue Remodeling and Insulin Resistance

  Hidehiro Kaneko, Toshihisa Anzai, Toshiyuki Takahashi, Kohkichi Morimoto, Yuichiro Maekawa, Hiroshi Itoh, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  120-  (18)  S527  -S527  2009/11  [Not refereed][Not invited]
  
• Role of Vascular Endothelial Growth Factor-A in the Development of Mice CaCl2 Induced Abdominal Aortic Aneurysm

  Hidehiro Kaneko, Toshihisa Anzai, Toshiyuki Takahashi, Yuichiro Maekawa, Masayuki Shimoda, Koichi Yoshimura, Hiroki Aoki, Hideyuki Shimizu, Yasunori Okada, Ryohei Yozu, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  120-  (18)  S1081  -S1082  2009/11  [Not refereed][Not invited]
  
• High Mobility Group Box 1 Protein Expression is Associated With Expansion and Rupture of Human Abdominal Aortic Aneurysm

  Takashi Kohno, Toshihisa Anzai, Hidehiro Kaneko, Hideyuki Shimizu, Masayuki Shimoda, Taku Miyasho, Minoru Okamoto, Hiroshi Yokota, Shingo Yamada, Tsutomu Yoshikawa, Yasunori Okada, Akitoshi Ishizaka, Ryohei Yozu, Satoshi Ogawa  CIRCULATION  120-  (18)  S1031  -S1032  2009/11  [Not refereed][Not invited]
  
• Interaction Between Acute Kidney Injury and Left Ventricular Remodeling After Myocardial Infarction: Possible Role of Inflammation, Oxidative Stress and Neurohormonal Activation

  Atsushi Anzai, Toshihisa Anzai, Kotaro Naito, Toshiyuki Nagai, Hidehiro Kaneko, Yoshinori Mano, Yuji Nagatomo, Yuichiro Maekawa, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  120-  (18)  S1156  -S1156  2009/11  [Not refereed][Not invited]
  
• 痙攣重積発作を契機として発症した、たこつぼ心筋障害(mid ventricular ballooning)の1例

  永井 利幸, 唐澤 隆明, 真鍋 知宏, 影山 智己, 香坂 俊, 河村 朗夫, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  心臓  41-  (11)  1246  -1251  2009/11  [Not refereed][Not invited]
   

  症例は70歳、男性。既往に脳動静脈奇形があり、痙攣発作を繰り返していた。仕事中に痙攣発作があり、救急搬送された。痙攣はジアゼパムの投与で改善したが、心電図変化から(I,aVL,V1〜5のST上昇)急性心筋梗塞を疑われ、緊急カテーテル検査を施行されるも、冠動脈は正常であった。しかし、左室造影で心室中部の無収縮と心室基部および心尖部の過収縮を認め(左室駆出率40.4%)、mid ventricular ballooningが疑われた。経時的に左室壁運動の改善傾向を認め、第9病日に軽快退院となった。ストレスなどを契機として発症するたこつぼ心筋障害の亜型としてmid ventricular ballooningが報告されているが、現在までに数例程度しかなく、特に痙攣を契機としたものはほとんど報告がなく、臨床的に重要であると考えられたので報告した。(著者抄録)
• 【血栓症と臨床検査】 <血栓症の画像診断> 急性冠症候群の画像診断

  安斉 俊久  臨床検査  53-  (10)  1153  -1157  2009/10  [Not refereed][Not invited]
   

  急性冠症候群(ACS)の画像診断は,責任冠動脈病変を同定し,経皮的冠動脈インターベンションを施行する際のストラテジーを立てるうえで極めて重要である.冠動脈造影や血管内超音波に加え,最近ではmultidetector-row computed tomographyによって,ACSを診断し,リスクを層別化するのみならず,将来ACSをきたす可能性のある不安定粥腫を検出する試みもなされている.これらの画像診断の進歩は,ACSの病態解明にも寄与するものと考えられる.(著者抄録)
• Ovarian sex hormones are involved in the protection against diabetes-induced left ventricular dysfunction in female mice

  K. Koide, T. Meguro, Y. Nagatomo, T. Anzai, S. Ogawa, T. Yoshikawa  EUROPEAN HEART JOURNAL  30-  1022  -1022  2009/09  [Not refereed][Not invited]
  
• Immune Response During Post-infarction Left Ventricular Remodeling: Role of HMGB1 Protein and Dendritic Cells

  Toshihisa Anzai, Kotaro Naito, Takashi Kohno, Yuichiro Maekawa, Atsushi Anzai, Hidehiro Kaneko, Yoshinori Mano, Yuji Nagatomo, Tsutomu Yoshikawa, Satoshi Ogawa  JOURNAL OF CARDIAC FAILURE  15-  (7)  S143  -S143  2009/09  [Not refereed][Not invited]
  
• Impact of preoperative multidetector computed tomography in percutaneous coronary intervention of chronic total occlusion

  K. Ueno, A. Kawamura, Y. Jo, K. Hayashida, S. Yuasa, Y. Maekawa, T. Anzai, M. Jinzaki, S. Kuribayashi, S. Ogawa  EUROPEAN HEART JOURNAL  30-  526  -526  2009/09  [Not refereed][Not invited]
  
• Intravenous administration of immunoglobulin attenuates myocardial reperfusion injury and improves left ventricular remodeling

  K. Ueno, T. Anzai, Y. Jo, K. Naito, T. Kohno, Y. Maekawa, T. Takahashi, T. Yoshikawa, S. Ogawa  EUROPEAN HEART JOURNAL  30-  891  -891  2009/09  [Not refereed][Not invited]
  
• The effect of erythromycin on myocardial ischaemia-reperfusion injury in rats during acute and chronic phase

  Y. Jo, T. Anzai, K. Ueno, T. Kohno, K. Naito, Y. Nagatomo, Y. Maekawa, T. Yoshikawa, S. Ogawa  EUROPEAN HEART JOURNAL  30-  732  -733  2009/09  [Not refereed][Not invited]
  
• Serum high mobility group box 1 protein elevation is associated with acute respiratory distress syndrome following thoracic aortic aneurysm repair

  T. Kohno, T. Anzai, H. Shimizu, H. Kaneko, Y. Jo, S. Yamada, T. Yoshikawa, A. Ishizaka, R. Yozu, S. Ogawa  EUROPEAN HEART JOURNAL  30-  976  -977  2009/09  [Not refereed][Not invited]
  
• Prognostic significance of acute kidney injury after reperfused ST-elevation myocardial infarction: synergistic acceleration of renal dysfunction and left ventricular remodeling

  A. Anzai, T. Anzai, K. Naito, H. Kaneko, Y. Jo, Y. Nagatomo, Y. Maekawa, A. Kawamura, T. Yoshikawa, S. Ogawa  EUROPEAN HEART JOURNAL  30-  470  -471  2009/09  [Not refereed][Not invited]
  
• 【ガイドラインを基盤とした心不全の個別診療】 心不全の治療 【慢性心不全の内科的治療】 慢性心不全の治療ストラテジー 一般療法の注意点

  安斉 俊久  Medicina  46-  (8)  1277  -1279  2009/08  [Not refereed][Not invited]
   

  ＜ポイント＞●慢性心不全の背景には,交感神経系,レニン・アンジオテンシン系(RAS)など神経体液性因子の賦活化による悪循環が存在している.●食塩制限は,血圧低下に加え神経体液性因子を抑制し,慢性心不全あるいは心腎連関の病態に対して良好な効果をもたらす.●身体的・精神的ストレスの解除は一般管理として重要であるが,適度な運動は運動耐容能を増加させ,神経体液性因子を抑制するとともに長期予後を改善し,精神面にも良好な影響をもたらす.●長期予後改善のためにも禁煙は必須であり,飲酒も原則として禁止する.(著者抄録)
• 慢性心不全の治療ガイドラインを検証する 慢性心不全患者におけるβ遮断薬有効性の個体差 βアドレナリン受容体抗体を指標とした解析

  吉川 勉, 長友 祐司, 河野 隆志, 吉澤 彰宏, 馬場 彰泰, 安斉 俊久, 目黒 知己, 佐藤 徹, 小川 聡  日本心臓病学会誌  4-  (Suppl.I)  122  -122  2009/08  [Not refereed][Not invited]
  
• 拡張型心筋症における慢性腎臓病および貧血の予後への寄与

  遠藤 泰, 香坂 俊, 小出 希実, 長友 祐司, 高橋 賢至, 大島 和輝, 目黒 知己, 安斉 俊久, 小川 聡, 吉川 勉  日本心臓病学会誌  4-  (Suppl.I)  207  -207  2009/08  [Not refereed][Not invited]
  
• RAS系阻害薬、β遮断薬のリアルワールドにおける使用とその長期予後への影響

  大島 和輝, 香坂 俊, 小出 希実, 長友 祐司, 高橋 賢至, 遠藤 泰, 目黒 知己, 安斉 俊久, 小川 聡, 吉川 勉  日本心臓病学会誌  4-  (Suppl.I)  208  -208  2009/08  [Not refereed][Not invited]
  
• 胸部大動脈瘤置換術後の血清HMGB1値の上昇は肺酸素化障害と関連する

  河野 隆志, 安斉 俊久, 志水 秀行, 山田 晋吾, 吉川 勉, 石坂 彰利, 四津 良平, 小川 聡  日本心臓病学会誌  4-  (Suppl.I)  281  -281  2009/08  [Not refereed][Not invited]
  
• 我が国における心不全急性増悪後の利尿薬の至適用量とその長期予後に対する解析

  大島 和輝, 香坂 俊, 小出 希実, 長友 祐司, 高橋 賢至, 遠藤 泰, 目黒 知己, 安斉 俊久, 小川 聡, 吉川 勉  日本心臓病学会誌  4-  (Suppl.I)  324  -324  2009/08  [Not refereed][Not invited]
  
• ST上昇型急性心筋梗塞における急性腎障害の診断意義

  安西 淳, 安斉 俊久, 内藤 広太郎, 金子 英弘, 城 祐輔, 長友 祐司, 前川 裕一郎, 吉川 勉, 小川 聡  日本心臓病学会誌  4-  (Suppl.I)  455  -455  2009/08  [Not refereed][Not invited]
  
• 慢性心不全例における各種バイオマーカーの寄与慢性腎臓病の有無による層別化

  遠藤 泰, 香坂 俊, 小出 希実, 長友 祐司, 高橋 賢至, 大島 和輝, 目黒 知己, 安斉 俊久, 小川 聡, 吉川 勉  日本心臓病学会誌  4-  (Suppl.I)  472  -472  2009/08  [Not refereed][Not invited]
  
• 急性心不全 診断・治療の最前線と未来予測 急性心不全治療と長期予後 心腎保護とそのメカニズム

  安斉 俊久  心臓  41-  (4)  484  -487  2009/04  [Not refereed][Not invited]
   

  慢性心不全では交感神経系やレニン・アンジオテンシン・アルドステロン(RAA)系に代表される神経体液性因子の亢進を抑制することにより長期予後が改善するが、最近、急性期においても神経体液性因子や炎症、酸化ストレスが病態の増悪と長期予後に関与することが明らかになってきた。また、これらの因子は特に腎障害を合併した急性心不全において悪影響を及ぼすことから、心腎連関を考慮した治療が長期予後の改善に必要とされる。本稿では、心不全治療における神経体液性因子抑制の意義と方法、心腎連関のメカニズム、心腎連関と長期予後を考慮した心不全治療におけるカルペリチドの役割について述べる。(著者抄録)
• Iamin遺伝子変異を認めた若年発症の重症冠動脈疾患の1例

  伊藤 博之, 高橋 寿由樹, 河村 朗夫, 河野 隆志, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  Circulation Journal  73-  (Suppl.II)  909  -909  2009/04  [Not refereed][Not invited]
  
• 痙攣重積発作を契機として発症した逆たこつぼ型心筋障害の1例

  永井 利幸, 真鍋 知宏, 唐澤 隆明, 影山 智己, 香坂 俊, 河村 朗夫, 岩永 史郎, 安斉 俊久, 吉川 勉, 小川 聡  Circulation Journal  73-  (Suppl.II)  984  -984  2009/04  [Not refereed][Not invited]
  
• PE-168 Overexpression of Human C-Reactive Protein Deteriorates Diabetic Cardiomyopathy through the Activation of Renin-Angiotensin System(PE028,Heart Failure, Basic (M),Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

  Mano Yoshinori, Anzai Toshihisa, Takahashi Toshiyuki, Maekawa Yuichiro, Nagatomo Yuji, Koide Kimi, Jo Yusuke, Kaneko Hidehiro, Anzai Atsushi, Meguro Tomomi, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  73-  441  -441  2009/03/01
• PE-433 Erythromycin Attenuates Myocardial Ischemia-Reperfusion Injury in Rats via Inhibition of Microcirculatory Disturbance and Inflammatory Response(PE073,Myocardial Ischemia-reperfusion (Basic) (IHD),Poster Session (English),The 73rd Annual Scientific Meeting of the Japanese Circulation Society)

  Jo Yusuke, Anzai Toshihisa, Ueno Koji, Kohno Takashi, Naitoh Kotaro, Nagatomo Yuji, Maekawa Yuichiro, Takahashi Toshiyuki, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  73-  508  -509  2009/03/01
• DPE-010 Increased C-reactive Protein Expression Exacerbates Left Ventricular Dysfunction and Remodeling after Myocardial Infarction in Mice(DPE02,Heart Failure, Basic (M),Digital Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

  Takahashi Toshiyuki, Anzai Toshihisa, Kaneko Hidehiro, Anzai Atsushi, Mano Yoshinori, Maekawa Yuichiro, Ogawa Satoshi, Yoshikawa Tsutomu  Circulation journal : official journal of the Japanese Circulation Society  73-  358  -358  2009/03/01
• 3 Impact of Chronic Kidney Disease on Left Ventricular Remodeling after Myocardial Infarction(New Risk Stratification for Cardiac Events after Acute Myocardial Infarction,Topic 1 (TP-1) (IHD),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

  Anzai Toshihisa, Naito Kotaro, Anzai Atsushi, Kaneko Hidehiro, Mano Yoshinori, Jo Yusuke, Maekawa Yuichiro, Kawamura Akio, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  73-  82  -82  2009/03/01
• 3 Epoprostenol Therapy for Patients with PAH(The Drug of Choice for Idiopathic Pulmonary Arterial Hypertension,Roundtable Discussion 5 (RT-5) (H),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)

  Satoh Toru, Kataoka Masaharu, Kawakami Takashi, Tamura Yuichi, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  73-  107  -107  2009/03/01
• Erythromycin Attenuates Myocardial Ischemia Reperfusion Injury in Rats via Inhibition of Microcirculatory Disturbance and Inflammatory Response

  Yusuke Jo, Toshihisa Anzai, Koji Ueno, Takashi Kohno, Kotaro Naito, Yuji Nagatomo, Yuichiro Maekawa, Toshiyuki Takahashi, Tsutomu Yoshikawa, Satoshi Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  53-  (10)  A306  -A306  2009/03  [Not refereed][Not invited]
  
• ARB大規模臨床試験からのメッセージ 循環器専門医からの提案

  山下 武志, 前村 浩二, 安斉 俊久, 佐藤 直樹  血圧  16-  (3)  269  -276  2009/03  [Not refereed][Not invited]
  
• 冠攣縮にともなう突然死や失神の臨床的特徴とその二次予防

  冨樫 郁子, 佐藤 俊明, 河村 朗夫, 村田 光繁, 高月 誠司, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  日本内科学会雑誌  98-  (Suppl.)  129  -129  2009/02  [Not refereed][Not invited]
  
• 急性心不全治療と長期予後―心腎保護とそのメカニズム―

  安斉 俊久  心臓  41-  (4)  484  -487  2009  [Not refereed][Not invited]
  
• 急性冠症候群におけるCKDの意義

  安斉 俊久  東京都医師会雑誌  61-  (10)  1472  -1476  2008/12  [Not refereed][Not invited]
  
• Increased C-Reactive Protein Expression Exacerbates Left Ventricular Dysfunction and Remodeling after Myocardial Infarction

  Tashiyuki Takahashi, Toshihisa Anzai, Hidehiro Kaneko, Atsushi Anzai, Yoshinori Mano, Yuichiro Maekawa, Satoshi Ogawa, Tsutomu Yoshikawa  CIRCULATION  118-  (18)  S541  -S541  2008/10  [Not refereed][Not invited]
  
• 肺動脈圧排により呼吸困難を来たした上行大動脈仮性動脈瘤の1例

  佐藤 誠治, 大野 洋平, 河野 隆志, 高橋 寿由樹, 伯野 大彦, 三好 俊一郎, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡, 志水 秀行, 四津 良平  Circulation Journal  72-  (Suppl.III)  1018  -1018  2008/10  [Not refereed][Not invited]
  
• 原発性悪性心膜中皮腫の1例

  山川 裕之, 高橋 寿由樹, 河野 隆志, 三好 俊一郎, 佐藤 俊明, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  Circulation Journal  72-  (Suppl.III)  1065  -1065  2008/10  [Not refereed][Not invited]
  
• 膠原病患者における肺高血圧症の診断と治療の問題点 膠原病患者における肺高血圧症の診断と治療の問題点

  片岡 雅晴, 川上 崇史, 安斉 俊久, 吉川 勉, 小川 聡, 佐藤 徹  Therapeutic Research  29-  (10)  1765  -1766  2008/10  [Not refereed][Not invited]
   

  著者らは膠原病性肺高血圧症(PAH)の治療効果や予後について最近の知見とともに報告した。1)1999〜2006年に肺動脈性と診断され、右心カテーテル検査を施行した症例は130例で、そのうち特発性肺動脈高血圧症は(IPAH)64例、膠原病性PAHは 32例であった。2)治療においてエポプロステノールは、膠原病性PAHとIPAHともに有意な治療効果がみられた。3)シルデナフィルはIPAHには有用性が示されたが、膠原病性PAHでは平均すると肺血管抵抗が改善せず、治療効果に有意差が認められた。4)ボセンタンではIPAHと膠原病性PAHでの治療効果に有意差は認めなかったが、対象例が少なく、今後のデータ集積が望まれた。5)予後の検討では統計学的有意差はなかったが、膠原病性PAHのほうがIPAHに比べて予後不良の傾向にあった。
• 肺高血圧症に対する経口治療薬の位置づけと最新の知見 肺高血圧症に対する経口治療薬の原因疾患による使い分け

  川上 崇史, 片岡 雅晴, 安斉 俊久, 吉川 勉, 小川 聡, 佐藤 徹  Therapeutic Research  29-  (10)  1779  -1779  2008/10  [Not refereed][Not invited]
  
• AT1 signaling blockade has beneficial effects on diabetes-induced cardimyopathy through upregulation or heat shock proteins and attenuation of apoptosis

  Yuji Nagatonio, Tomomi Megur, Hiroyuki To, Kimi Koide, Toshihisa Anzai, Satoshi Oganva, Tsutoniu Yoshikawa  JOURNAL OF CARDIAC FAILURE  14-  (7)  S174  -S174  2008/09  [Not refereed][Not invited]
  
• Increased expression of human C-reactive protein aggravates left ventricular remodeling after myocardial infarction in mice

  T. Takahashi, T. Anzai, H. Kaneko, A. Anzai, Y. Mano, Y. Maekawa, S. Ogawa, T. Yoshikawa  EUROPEAN HEART JOURNAL  29-  131  -132  2008/09  [Not refereed][Not invited]
  
• Usefulness of biomarkers in predicting functional class recovery in patients admitted with heart failure

  Takuto Nozaki, Shun Kohsaka, Kim Koide, Yuji Nagatomo, Hiroyuki Ito, Tomomi Megur, Toshihisa Anzai, Satoshi Ogawa, Tsutomu Yoshikawa  JOURNAL OF CARDIAC FAILURE  14-  (7)  S172  -S173  2008/09  [Not refereed][Not invited]
  
• Effect of increased C-reactive protein expression on left ventricular function and remodeling after myocardial infarction in mice

  Toshiyuki Takahashi, Toshihisa Anzai, Hidehiro Kaneko, Atsushi Anzai, Yoshinori Mano, Yuichiro Maekawa, Satoshi Ogawa, Tsutomu Yoshikawa  JOURNAL OF CARDIAC FAILURE  14-  (7)  S170  -S171  2008/09  [Not refereed][Not invited]
  
• Re-elevation of d-dimer as a predictor of re-dissection or venous thromboembolism during management of stanford type b acute aortic dissection

  Y. Jo, T. Anzai, K. Ueno, T. Kohno, Y. Sugano, Y. Maekawa, T. Takahashi, T. Yoshikawa, S. Ogawa  EUROPEAN HEART JOURNAL  29-  90  -90  2008/09  [Not refereed][Not invited]
  
• 心不全の薬物療法Update 慢性心不全におけるβ遮断薬治療が炎症と酸化ストレスに及ぼす影響

  長友 祐司, 吉川 勉, 河野 隆志, 吉澤 彰宏, 安斉 俊久, 目黒 知己, 佐藤 徹, 小川 聡  日本心臓病学会誌  2-  (Suppl.I)  130  -130  2008/08  [Not refereed][Not invited]
  
• 腎機能障害と心血管病 現状と対策 心筋梗塞後左室リモデリングに及ぼすCKDの影響

  安斉 俊久, 内藤 広太郎, 河野 隆志, 前川 裕一郎, 高橋 寿由樹, 河村 朗夫, 吉川 勉, 小川 聡  日本心臓病学会誌  2-  (Suppl.I)  149  -149  2008/08  [Not refereed][Not invited]
  
• 【急性心筋梗塞のPoor risk群 その診断・予防・治療】 慢性腎臓病(CKD)の合併

  安斉 俊久  ICUとCCU  32-  (7)  565  -572  2008/07  [Not refereed][Not invited]
   

  慢性腎臓病(CKD)は、心血管疾患のリスクファクターとして近年着目されている。CKDを合併した心筋梗塞は、急性期死亡も多い上に、左室リモデリングが助長され、遠隔期心機能も不良となる。また、心筋梗塞再発などの心血管イベントも多く、短期および長期予後は不良と言われている。CKDにおいては、レニンアンジオテンシン(RA)系、交感神経系、炎症、酸化ストレスといった神経体液性因子の賦活化により悪循環が形成され、血管内皮機能障害、心肥大、心臓リモデリング等が促進されている可能性が考えられる。CKDを合併した心筋梗塞の予後を改善するためには、これらの因子を複数の側面から抑制する積極的な薬物治療が肝要となる。(著者抄録)
• QT延長症候群、心肺停止蘇生後、低体温療法施行中にTorsades de pointesを発生した1例

  松橋 智弘, 高橋 寿由樹, 河野 隆志, 佐藤 俊明, 三好 俊一郎, 安斉 俊久, 吉川 勉, 小川 聡, 鈴木 昌, 堀 進悟  日本内科学会関東地方会  553回-  27  -27  2008/05  [Not refereed][Not invited]
  
• 抗凝固療法中に巨大右房内血栓を認めた収縮性心膜炎の1例

  西牟田 早希子, 新村 大輔, 伯野 大彦, 河村 朗夫, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡, 古梶 清和, 四津 良平  Circulation Journal  72-  (Suppl.II)  900  -900  2008/04  [Not refereed][Not invited]
  
• 奇異性塞栓が原因と考えられた急性心筋梗塞の1例

  大野 洋平, 上野 耕嗣, 伯野 大彦, 河村 朗夫, 安斉 俊久, 岩永 史郎, 佐藤 徹, 吉川 勉, 小川 聡  Circulation Journal  72-  (Suppl.II)  939  -939  2008/04  [Not refereed][Not invited]
  
• 高齢者に対する胃癌手術周術期合併症とその対策

  吉川 貴久, 須田 康一, 竹内 裕也, 入野 誠之, 平岩 訓彦, 安藤 崇史, 和田 則仁, 才川 義朗, 安斉 俊久, 森崎 浩, 武田 純三, 石坂 彰敏, 北川 雄光  日本外科学会雑誌  109-  (臨増2)  298  -298  2008/04  [Not refereed][Not invited]
  
• PJ-004 High Mobility Group Box 1 Protein is associated with Post-Infarction Healing Process and Left Ventricular Remodeling(Acute myocardial infarction, basic(02)(IHD),Poster Session(Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Kohno Takashi, Anzai Toshihisa, Anzai Atsushi, Kaneko Hidehiro, Naitoh Kotaro, Jo Yusuke, Ueno Koji, Miyasho Taku, Okamoto Minoru, Yamada Shingo, Yoshikawa Tsutomu, Ishizaka Akitoshi, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  510  -511  2008/03/01
• PE-221 Intravenous Administration of Immunoglobulin Attenuates Myocardial Reperfusion Injury and Improves Left Ventricular Remodeling(Myocardial ischemia/reperfusion, basic/clinical(03)(IHD),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Ueno Koji, Anzai Toshihisa, Jo Yusuke, Naitoh Kotaro, Kohno Takashi, Takahashi Toshiyuki, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  415  -415  2008/03/01
• PE-466 Re-elevation of D-dimers as a Predictor of Re-dissection or Venous Thromboembolism During Management of Stanford Type B Acute Aortic Dissection(Peripheral circulation/Vascular disease(05)(H),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Jo Yusuke, Anzai Toshihisa, Anzai Atsushi, Kaneko Hidehiro, Mano Yoshinori, Naito Kotaro, Ueno Koji, Kohno Takashi, Sugano Yasuo, Takahashi Toshiyuki, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  476  -476  2008/03/01
• PJ-746 Effectiveness of Sildenafil Pre-administration before Epoprostenol Therapy in Pulmonary Arterial Hypertension with Right Heart Failure(Pulmonary circulation(04)(H),Poster Session(Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Kawakami Takashi, Satoh Toru, Kataoka Masaharu, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  699  -699  2008/03/01
• OE-324 Impact of Chronic Kidney Disease on Inflammatory Response, Oxidative Stress and Left Ventricular Remodeling after Reperfused Anterior Myocardial Infarction(Acute myocardial infarction, clinical(pathophysiology)(01)(IHD),Oral Presentation(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Naitoh Kotaro, Anzai Toshihisa, Yoshikawa Tsutomu, Anzai Atsushi, Kaneko Hidehiro, Jo Yusuke, Ueno Koji, Kohno Takashi, Takahashi Toshiyuki, Kawamura Akio, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  262  -262  2008/03/01
• PE-096 Persistent elevation in troponin T during convalescence is associated with anemia and inflammatory response in patients with decompensated heart failure(Heart failure, clinical(07)(M),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Koide Kimi, Yoshikawa Tsutomu, Nagatomo Yuji, Anzai Toshihisa, Meguro Tomomi, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  384  -384  2008/03/01
• PE-196 Differences in central sleep apnea in right and left heart disorders(Heart failure, clinical(08)(M),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Suzuki Yuta, Satoh Toru, Koide Kimi, Kawakami Takashi, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  409  -409  2008/03/01
• OE-228 Improvement of prognosis in patients with idiopathic pulmonary hypertension with sildenafil for the last 4 years(Pulmonary circulation(01)(H),Oral Presentation(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)

  Satoh Toru, Kawakami Takashi, Kataoka Masaharu, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  72-  237  -237  2008/03/01
• 再発性心室細動を合併した冠攣縮性狭心症の1例

  遠藤 仁, 高橋 寿由樹, 伯野 大彦, 佐藤 俊明, 副島 京子, 安斉 俊久, 末吉 浩一郎, 吉川 勉, 秋月 哲史, 小川 聡  日本内科学会関東地方会  552回-  28  -28  2008/03  [Not refereed][Not invited]
  
• 【カラーで診る 臨床現場で役立つ 病棟必携!心不全診療マニュアル】 急性心不全 診断 心不全の基礎疾患の検索

  安斉 俊久  CIRCULATION Up-to-Date  3-  (増刊)  100  -109  2008/02  [Not refereed][Not invited]
  
• A 19-year-old man with myocardial infarction and sitosterolemia (vol 42, pg 591, 2003)

  Takaharu Katayama, Toru Satoh, Takashi Yagi, Nobuyoshi Hirose, Yasuo Kurita, Toshihisa Anzai, Yasushi Asakura, Tsutomu Yoshikawa, Hideo Mitamura, Satoshi Ogawa  INTERNAL MEDICINE  47-  (3)  191  -191  2008  [Not refereed][Not invited]
  
• 慢性腎臓病（ＣＫＤ）の合併

  安斉 俊久  ICUとCCU  32-  565  -572  2008  [Not refereed][Not invited]
  
• 循環器専門医から見たＣＫＤと血圧管理

  安斉 俊久  循環plus  8-  2  -6  2008  [Not refereed][Not invited]
  
• 【CKDと降圧治療】 循環器専門医から見たCKDと血圧管理

  安斉 俊久  循環plus  8-  (4)  2  -6  2008/01  [Not refereed][Not invited]
  
• 心臓突然死に瀕した冠攣縮に対し硝酸イソソルビドと塩酸ベニジピンの併用が著効した2例

  安斉 俊久, 伯野 大彦, 河村 朗夫, 吉川 勉, 小川 聡  呼吸と循環  55-  (12)  1381  -1385  2007/12  [Not refereed][Not invited]
   

  冠攣縮は急性心筋梗塞や致死性の不整脈などを誘発し,心臓突然死に至ることがある.今回われわれは,これまで冠攣縮の既往がないにもかかわらず,冠攣縮が原因と考えられる急性心筋梗塞あるいは心室細動を発症した2例を経験した.2例ともに硝酸イソソルビドとCa拮抗薬ベニジピンの併用により攣縮発作をコントロールすることが可能であった.特に1例はCa拮抗薬アムロジピンで治療中であったにもかかわらず冠攣縮による心筋梗塞を発症しており,心臓突然死の予防という観点からCa拮抗薬の選択において抗攣縮作用を考慮すべきと考えられたので報告する.(著者抄録)
• Presence of chronic kidney disease is associated with enhanced inflammatory response, oxidative stress and adverse left ventricular remodeling after reperfused acute myocardial infarction

  Kotaro Naito, Toshihisa Anzai, Tsutomu Yoshikawa, Hidehiro Kaneko, Yusuke Jo, Koji Ueno, Takashi Kohno, Toshiyuki Takahashi, Akio Kawamura, Satoshi Ogawa  CIRCULATION  116-  (16)  316  -316  2007/10  [Not refereed][Not invited]
  
• Intravenous administration of immunoglobulin attenuates myocardial reperfusion injury and improves left ventricular remodeling

  Koji Ueno, Toshihisa Anzai, Yusuke Jo, Kotaro Naito, Takashi Kohno, Toshiyuki Takahashi, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  116-  (16)  99  -99  2007/10  [Not refereed][Not invited]
  
• Early use of beta-blockers attenuates systemic inflammatory response and lung oxygenation impairment after distal type acute aortic dissection

  Yusuke Jo, Toshihisa Anzai, Yasuo Sugano, Hidehiro Kaneko, Kotaro Naito, Koji Ueno, Takashi Kohno, Toshiyuki Takahashi, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  116-  (16)  745  -745  2007/10  [Not refereed][Not invited]
  
• Role of ischemic preconditioning and inflammatory response in the development of malignant ventricular arrhythmias after reperfused acute myocardial infarction

  Hidehiro Kaneko, Toshihisa Anzai, Kotaro Naito, Koji Ueno, Yusuke Jo, Toshiyuki Takahashi, Akio Kawamura, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  116-  (16)  721  -721  2007/10  [Not refereed][Not invited]
  
• Role of high mobility group box 1 protein in post-infarction healing process and left ventricular remodeling

  Takashi Kohno, Toshihisa Anzai, Tsutomu Yoshikawa, Kotaro Naito, Koji Ueno, Taku Miyasho, Minoru Okamoto, Shingo Yamada, Akitoshi Ishizaka, Satoshi Ogawa  CIRCULATION  116-  (16)  286  -286  2007/10  [Not refereed][Not invited]
  
• ファロー四徴症根治術後の右室流出路狭窄・心室頻拍に対し外科的再建術および右室心筋焼灼術が奏効した1例

  池村 辰之介, 上野 耕嗣, 伯野 大彦, 副島 京子, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡, 饗庭 了  Circulation Journal  71-  (Suppl.III)  940  -940  2007/10  [Not refereed][Not invited]
  
• 左室内巨大血栓、末梢神経障害を認めたLoeffler型心内膜炎の1例

  寺井 秀樹, 大野 洋平, 上野 耕嗣, 伯野 大彦, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  Circulation Journal  71-  (Suppl.III)  950  -950  2007/10  [Not refereed][Not invited]
  
• 重症右心不全合併肺高血圧症におけるエポプロステノール治療のシルデナフィル前投与

  川上 崇史, 佐藤 徹, 伯野 大彦, 安斉 俊久, 吉川 勉, 小川 聡  Therapeutic Research  28-  (10)  1996  -1996  2007/10  [Not refereed][Not invited]
  
• 外傷性大動脈弁閉鎖不全症の1例

  小野 友佳子, 荒井 隆秀, 村田 光繁, 伯野 大彦, 高橋 寿由樹, 河村 朗夫, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  日本内科学会関東地方会  547回-  28  -28  2007/09  [Not refereed][Not invited]
  
• 【ER必携胸痛の画像診断】 急性冠症候群

  安斉 俊久, 上野 耕嗣, 陣崎 雅弘, 栗林 幸夫  画像診断  27-  (9)  1051  -1061  2007/08  [Not refereed][Not invited]
  
• 胸痛患者の診療におけるMDCTの位置づけ 不安定狭心症のトリアージにおけるMDCTの意義

  安斉 俊久, 上野 耕嗣, 城 祐輔, 河野 隆志, 河村 朗夫, 吉川 勉, 小川 聡, 山田 稔, 田波 穣, 佐藤 浩三, 陣崎 雅弘, 栗林 幸夫  Journal of Cardiology  50-  (Suppl.I)  166  -166  2007/08  [Not refereed][Not invited]
  
• 退院時BNP高値は心不全患者に合併する貧血と腎機能低下と関連する

  小出 希実, 吉川 勉, 長友 祐司, 安斉 俊久, 目黒 知己, 佐藤 徹, 小川 聡  Journal of Cardiology  50-  (Suppl.I)  395  -395  2007/08  [Not refereed][Not invited]
  
• プライマリ・ケアのための呼吸・循環器診療 胸部X線写真 縦隔陰影の見方

  安斉 俊久  呼吸と循環  55-  (7)  783  -788  2007/07  [Not refereed][Not invited]
  
• 多発性筋炎に左室心筋障害を合併した1例

  川上 崇史, 矢田 浩崇, 伯野 大彦, 副島 京子, 安斉 俊久, 吉川 勉, 小川 聡, 高田 哲也, 桑名 正隆  日本内科学会関東地方会  546回-  32  -32  2007/07  [Not refereed][Not invited]
  
• プライマリ・ケアのための呼吸・循環器診療 胸部X線写真 肺うっ血の見方

  安斉 俊久  呼吸と循環  55-  (6)  675  -679  2007/06  [Not refereed][Not invited]
  
• 【心臓突然死防止へのアプローチ】 なぜβ遮断薬が有効なのか

  安斉 俊久  循環制御  28-  (2)  96  -102  2007/06  [Not refereed][Not invited]
  
• 化学療法にcilostazolを併用したペースメーカー植え込みを回避した、洞不全症候群を合併した悪性リンパ腫の1例

  佐藤 誠治, 冨樫 郁子, 佐藤 俊明, 副島 京子, 安斉 俊久, 吉川 勉, 上田 智基, 淡谷 典弘, 岡本 真一郎, 小川 聡  日本内科学会関東地方会  544回-  18  -18  2007/05  [Not refereed][Not invited]
  
• ミトコンドリアDNA G8363A変異を遺伝子診断にて診断し、ミトコンドリア心筋症と診断された一例

  藤原 宏, 影山 智己, 岩永 史郎, 安斉 俊久, 吉川 勉, 小川 聡  Circulation Journal  71-  (Suppl.II)  813  -813  2007/04  [Not refereed][Not invited]
  
• 心臓再同期療法により心機能改善を認めたNarrow QRSを伴う左室緻密化障害の一例

  福永 朝子, 鈴木 淳司, 佐藤 俊明, 家田 真樹, 安斉 俊久, 副島 京子, 岩永 史郎, 吉川 勉, 小川 聡, 石川 士郎  Circulation Journal  71-  (Suppl.II)  875  -875  2007/04  [Not refereed][Not invited]
  
• PE-434 The Beneficial Effect of Angiotensin II Type 1 a Receptor Ablation on Diabetes-induced Cardiomyopathy may be Elicited with the Improvement of Hsp110 Expression(Heart failure, basic-4, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Nagatomo Yuji, Meguro Tomomi, Koide Kimi, Takahashi Hitomi, Anzai Toshihisa, Ogawa Satoshi, Yoshikawa Tsutomu  Circulation journal : official journal of the Japanese Circulation Society  71-  433  -433  2007/03/01
• OE-055 Differential Effects of GM-CSF and G-CSF on Infiltration of Dendritic Cells during Early Left Ventricular Remodeling after Myocardial Infarction(Acute myocardial infarction, basic-1, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Naitoh Kotaro, Anzai Toshihisa, Maekawa Yuichiro, Sugano Yasuo, Takahashi Toshiyuki, Kohno Takashi, Ueno Koji, Jo Yusuke, Kaneko Hidehiro, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  71-  165  -165  2007/03/01
• OJ-145 Stroke Complicating PCI(Coronary revascularization, PCI-07, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Kawamura Akio, Anzai Toshihisa, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  71-  290  -290  2007/03/01
• PJ-471 Epicardial Fat Volume Assessed by 64-Slice MDCT is Related to the Presence of Metabolic Syndrome and Ischemic Heart Disease(CT/DSA-10, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Ueno Koji, Anzai Toshihisa, Naitoh Kotaro, Jo Yusuke, Kohno Takashi, Kawamura Akio, Yoshikawa Tsutomu, Ogawa Satoshi, Yamada Minoru, Tanami Yutaka, Sato Kozo, Jinzaki Masahiro, Kuribayashi Sachio  Circulation journal : official journal of the Japanese Circulation Society  71-  589  -589  2007/03/01
• PJ-517 Low Level of High-density Lipoprotein Cholesterol is Associated with Coronary Vasospasitc Angina(Lipid disorders-3, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Sugano Yasuo, Yagi Takashi, Ohta Ken-ichi, Teramoto Hiroyuki, Anzai Toshihisa, Noma Shigetaka  Circulation journal : official journal of the Japanese Circulation Society  71-  601  -601  2007/03/01
• 2 Utility of Sildenafil in Pulmonary Hypertension(Diagnosis and Treatment of Pulmonary Hypertension, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Satoh Toru, Kataoka Masaharu, Kawakami Takashi, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  71-  33  -33  2007/03/01
• FRS-027 Presence of Autoantibody against β-adrenergic Receptors is Associated with Amelioration of Cardiac Function during β-blocker Therapy for Congestive Heart Failure(Clinical Heart Failure-Pathophysiology and Treatment, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Nagatomo Yuji, Yoshikawa Tsutomu, Kohno Takashi, Yoshizawa Akihiro, Baba Akiyasu, Anzai Toshihisa, Meguro Tomomi, Satoh Toru, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  71-  122  -122  2007/03/01
• PE-106 Absence of Preinfarction Angina and Elevation of Inflammatory Markers are Predictors of Malignant Ventricular Arrhythmias after Reperfused Acute Myocardial Infarction(Acute myocardial infarction, clinical (pathophysiology)-3, The 71st Annual Scientific Meeting of the Japanese Circulation Society)

  Kaneko Hidehiro, Anzai Toshihisa, Naito Kotaro, Kohono Takashi, Ueno Koji, Jo Yusuke, Takahashi Toshiyuki, Kawamura Akio, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  71-  351  -351  2007/03/01
• 心肺蘇生後に左冠動脈主幹部を含む三枝病変に対して緊急冠動脈形成術を行い救命しえた急性心筋梗塞の1例

  金子 英弘, 内藤 広太郎, 李 慧崇, 家田 真樹, 伯野 大彦, 河村 朗夫, 安斉 俊久, 朝倉 靖, 吉川 勉, 小川 聰  日本内科学会関東地方会  542回-  19  -19  2007/02  [Not refereed][Not invited]
  
• 人工弁・人工血管例の感染性心内膜炎の臨床像

  岩永 史郎, 村田 光繁, 松本 幸子, 三好 俊一郎, 副島 京子, 安斉 俊久, 吉川 勉, 四津 良平, 小川 聰  日本内科学会雑誌  96-  (Suppl.)  127  -127  2007/02  [Not refereed][Not invited]
  
• 胸痛の画像診断：急性冠症候群

  安斉 俊久  画像診断  27-  1051  -1061  2007  [Not refereed][Not invited]
  
• 心臓突然死防止へのアプローチ．なぜβ遮断薬は有効なのか

  安斉 俊久  循環制御  28-  96  -102  2007  [Not refereed][Not invited]
  
• 胸部Ｘ線写真ー縦隔陰影の見方

  安斉 俊久  呼吸と循環  55-  783  -788  2007  [Not refereed][Not invited]
  
• 胸部Ｘ線写真ー肺うっ血の見方

  安斉 俊久  呼吸と循環  55-  675  -679  2007  [Not refereed][Not invited]
  
• Blockade of angiotensin receptor reduces myocardial MCP-1 expression and macrophage infiltration in post-infarction ventricular remodeling

  Takashi Kohno, Toshihisa Anzai, Tsutomu Yoshikawa, Toshiyuki Takahashi, Satoshi Ogawa  JOURNAL OF CARDIAC FAILURE  12-  (8)  S165  -S165  2006/10  [Not refereed][Not invited]
  
• Differential effects of GM-CSF and G-CSF on infiltration of dendritic cells during early left ventricular remodeling after myocardial infarction

  Kotaro Naito, Toshihisa Anzai, Yuichiro Maekawa, Yasuo Sugano, Takashi Kohno, Tsutomu Yoshikawa, Satoshi Ogawa  CIRCULATION  114-  (18)  100  -100  2006/10  [Not refereed][Not invited]
  
• 【心不全診療の現状と未来】 虚血性心筋症の成立過程とその対策 梗塞治癒機転を中心に

  安斉 俊久  進歩する心臓研究  XXVI-  (2)  17  -25  2006/10  [Not refereed][Not invited]
  
• 心筋抑制性自己抗体に対する免疫吸着療法を施行した拡張型心筋症の一例

  福永 朝子, 内藤 広太郎, 長友 祐司, 家田 真樹, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡, 熊谷 裕生, 馬場 彰泰, 栗田 康生  Circulation Journal  70-  (Suppl.III)  1193  -1193  2006/10  [Not refereed][Not invited]
  
• 冠攣縮性狭心症とメタボリック症候群の関連 アセチルコリン負荷冠攣縮誘発テストによる検討

  菅野 康夫, 八木 崇, 太田 賢一, 寺本 洋之, 安斉 俊久, 野間 重孝  Journal of Cardiology  48-  (Suppl.I)  581  -581  2006/09  [Not refereed][Not invited]
  
• 遠位型急性大動脈解離における肺酸素化障害に及ぼすβ遮断薬の効果

  城 祐輔, 安斉 俊久, 菅野 康夫, 内藤 広太郎, 上野 耕嗣, 河野 隆志, 吉川 勉, 小川 聡  Journal of Cardiology  48-  (Suppl.I)  689  -689  2006/09  [Not refereed][Not invited]
  
• ACSトリアージにおける64列MDCTの有用性

  上野 耕嗣, 安斉 俊久, 城 祐輔, 内藤 広太郎, 河野 隆志, 李 慧崇, 岡部 輝雄, 朝倉 靖, 小川 聡, 山田 稔, 田波 穣, 陣崎 雅弘, 栗林 幸夫  Journal of Cardiology  48-  (Suppl.I)  734  -734  2006/09  [Not refereed][Not invited]
  
• 奥村論文に対するEditorial Comment 再発性化膿性心膜炎と収縮性心膜炎

  安斉 俊久  心臓  38-  (8)  836  -836  2006/08  [Not refereed][Not invited]
  
• 急性B型大動脈解離の治療中に肺血栓塞栓症を合併し治療に難渋した1例

  梅田 瑠美子, 城 祐輔, 家田 真樹, 安斉 俊久, 吉川 勉, 小川 聡, 中塚 誠之  日本内科学会関東地方会  535回-  29  -29  2006/05  [Not refereed][Not invited]
  
• 筋強直性ジストロフィーに合併した心筋症に対してカルベジロールが奏功した一例

  小倉 裕美, 佐藤 秀樹, 冨樫 郁子, 菅野 康夫, 吉川 勉, 安斉 俊久, 佐藤 徹, 家田 真樹, 川上 途行, 岩永 史郎, 朝倉 靖, 小川 聡, 石原 傳幸  Circulation Journal  70-  (Suppl.II)  1020  -1020  2006/04  [Not refereed][Not invited]
  
• 同種非血縁者間骨髄移植後に発症した滲出性収縮性心膜炎に対し心膜切除術で改善を認めた1例

  林 正憲, 鈴木 淳司, 中溝 ひかる, 河野 隆志, 家田 真樹, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡, 山崎 真敬, 古梶 清和, 四津 良平, 上田 智基, 岡本 真一郎  Circulation Journal  70-  (Suppl.II)  1099  -1099  2006/04  [Not refereed][Not invited]
  
• PE-386 Blockade of Angiotensinll Type 1a Receptor Ameliorates Cardiac Dysfunction Induced by Diabetes Mellitus(Heart failure, basic-4 (M) PE65,Poster Session (English),The 70th Anniversary Annual Scientific Meeting of the Japanese Circulation Society)

  Nagatomo Yuji, Meguro Tomomi, Saito Hitomi, Anzai Toshihisa, Ogawa Satoshi, Yoshikawa Tsutomu  Circulation journal : official journal of the Japanese Circulation Society  70-  430  -430  2006/03/01
• PE-116 Effect of G-CSF on Infiltration of Dendritic Cells and MHC Class II Positive Cells during Early Post-infarction Left Ventricular Remodeling(Acute myocardial infarction, basic-3 (IHD) PE20,Poster Session (English),The 70th Anniversary Annual Scientific Meeting of the Japanese Circulation Society)

  Naito Kotaro, Anzai Toshihisa, Sugano Yasuo, Maekawa Yuichiro, Kohno Takashi, Mahara Keitaro, Ueno Koji, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  70-  364  -364  2006/03/01
• PE-196 Angiotensin Receptor Blockade Reduces Myocardial MCP-1 Expression and Macrophage Infiltration in Post-infarction Ventricular Remodeling(Chronic coronary heart disease/Remodeling-3 (IHD) PE33,Poster Session (English),The 70th Anniversary Annual Scientific Meeting of the Japanese Circulation Society)

  Kohno Takashi, Anzai Toshihisa, Yoshikawa Tsutomu, Naitoh Kotaro, Mahara Keitaro, Sugano Yasuo, Maekawa Yuichiro, Ueno Koji, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  70-  383  -383  2006/03/01
• 3 Long-term Follow-up of Five Patients with Pulmonary Hypertension Who Take Bosentan(Which drug is useful for the treatment of pulmonary hypertension?,Topic 4 (TP4) (M),The 70th Anniversary Annual Scientific Meeting of the Japanese Circulation Society)

  Satoh Toru, Kataoka Masaharu, Kawakami Takashi, Kono Takashi, Ieda Masaki, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  70-  64  -64  2006/03/01
• FRS-073 Mineralocorticoid Receptor Blockade Arrests Pressure-overload Induced Left Ventriclar Hypertrophy and Preserves Cardiac Function in Angiotensin II Type1a Receptor Knockout Mice(Heart Failure Research (M) FRS15,Featured Research Session,The 70th Anniversary Annual Scientific Meeting of the Japanese Circulation Society)

  Meguro Tomomi, Yoshikawa Tsutomu, Katada Jun, Saito Hitomi, Nagatomo Yuji, Anzai Toshihisa, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  70-  130  -130  2006/03/01
• 虚血性心筋症の成立過程とその対策ー梗塞治癒機転を中心にー

  安斉 俊久  進歩する心臓研究  26-  17  -25  2006  [Not refereed][Not invited]
  
• 再発性化膿性心膜炎と収縮性心膜炎

  安斉 俊久  心臓  38-  836  2006  [Not refereed][Not invited]
  
• G-CSF modulates post-infarct healing process by promoting reparative collagen synthesis

  Y Sugano, T Anzai, T Yoshikawa, S Ogawa  JOURNAL OF CARDIAC FAILURE  11-  (9)  S280  -S280  2005/12  [Not refereed][Not invited]
  
• 【急性冠症候群へのアプローチ】 急性冠症候群の理解 左室リモデリングとは何か?

  安斉 俊久  Medicina  42-  (13)  2089  -2091  2005/12  [Not refereed][Not invited]
  
• Increased body temperature following acute myocardial infarction is associated with early left ventricular remodeling

  K Naito, T Anzai, T Yoshikawa, K Mahara, T Kohno, Y Sugano, Y Maekawa, T Okabe, Y Asakura, S Ogawa  CIRCULATION  112-  (17)  U757  -U757  2005/10  [Not refereed][Not invited]
  
• No-reflow phenomenon adversely affects post-infarction left ventricular remodeling in association with enhanced inflammatory response and increased plasma renin activity

  K Naito, T Anzai, T Yoshikawa, K Mahara, T Kohno, Y Sugano, Y Maekawa, T Okabe, Y Asakura, M Suzuki, S Ogawa  CIRCULATION  112-  (17)  U757  -U757  2005/10  [Not refereed][Not invited]
  
• G-CSF improves post-infarction ventricular remodeling in association with attenuated infiltration of dendritic cells and MHC class II positive cells during healing process

  K Naito, T Anzai, Y Sugano, Y Maekawa, T Kohno, K Mahara, T Yoshikawa, S Ogawa  CIRCULATION  112-  (17)  U140  -U140  2005/10  [Not refereed][Not invited]
  
• 総肺静脈還流異常症術後の心房粗動に対し,CARTOを用いたカテーテルアブレーションが有用であった一例

  宗形 昌儒, 福本 耕太郎, 副島 京子, 田中 知子, 萩原 陽子, 谷本 耕司郎, 福田 有希子, 家田 真樹, 佐藤 俊明, 三好 俊一郎, 神吉 秀明, 高月 誠司, 南雲 美也子, 安斉 俊久, 吉川 勉, 小川 聡  Circulation Journal  69-  (Suppl.III)  920  -920  2005/10  [Not refereed][Not invited]
  
• Carvedilol exerts a more potent antiadrenergic effect than metoprolol during exercise in patients with congestive heart failure

  T. Kohno, T. Yoshikawa, K. Moritani, T. Anzai, M. Suzuki, T. Satoh, H. Yokozuka, S. Ogawa  EUROPEAN HEART JOURNAL  26-  75  -75  2005/09  [Not refereed][Not invited]
  
• Absence of preinfarction angina and serum C-reactive protein elevation are predictors of malignant ventricular arrhythmias after acute myocardial infarction

  T. Anzai, T. Yoshikawa, Y. Maekawa, Y. Sugano, T. Kohno, K. Mahara, K. Naito, S. Ogawa  EUROPEAN HEART JOURNAL  26-  572  -572  2005/09  [Not refereed][Not invited]
  
• 間質性肺炎・肺高血圧症の急性増悪に対しステロイド大量,エポプロステノール,一酸化窒素,シルデナフィルにて改善を認めた1例

  西山 奈緒子, 影山 智己, 佐藤 徹, 河野 隆志, 家田 真樹, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡, 国枝 武義  日本内科学会関東地方会  529回-  31  -31  2005/09  [Not refereed][Not invited]
  
• 心不全進展のメカニズムを考慮した分子レベルからの新たな心不全治療戦略 心筋梗塞後修復性線維化に対するコロニー刺激因子の影響

  安斉 俊久, 吉川 勉, 前川 裕一郎, 菅野 康夫, 河野 隆志, 馬原 啓太郎, 内藤 広太郎, 小川 聡  Journal of Cardiology  46-  (Suppl.I)  140  -140  2005/08  [Not refereed][Not invited]
  
• 心不全におけるβ遮断薬治療が炎症マーカーに及ぼす影響 高感度CRPを指標として

  長友 祐司, 吉川 勉, 河野 隆志, 吉澤 彰宏, 安斉 俊久, 目黒 知己, 佐藤 徹, 小川 聡  Journal of Cardiology  46-  (Suppl.I)  405  -405  2005/08  [Not refereed][Not invited]
  
• 奇異性塞栓症により脳梗塞,心筋梗塞を起こした慢性肺血栓塞栓症,深部静脈血栓症の1例

  花岡 洋成, 矢田 浩崇, 佐藤 徹, 神吉 秀明, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  Therapeutic Research  26-  (6)  1130  -1130  2005/06  [Not refereed][Not invited]
  
• 大量免疫グロブリン療法が奏功した急性ウイルス性心筋炎の一例

  岩上 祐子, 金澤 英明, 佐藤 徹, 神吉 秀明, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Circulation Journal  69-  (Suppl.II)  782  -782  2005/04  [Not refereed][Not invited]
  
• Which Patients with Left Ventricular Dysfunction Show Improved VE-VCO_2 Slope after β-blocker Therapy?(Exercise Test/Cardiac Rehabilitation 1 (IHD), The 69th Annual Scientific Meeting of the Japanese Circulation Society)

  Kataoka Masaharu, Satoh Toru, Nakamura Iwao, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  69-  186  -186  2005/03/01
• Persistent Cardiac Aldosterone Synthesis in Angiotensin II Type 1A Receptor Knockout Mice after Myocardial Infarction(Acute Myocardial Infarction, Basic 2 (IHD), The 69th Annual Scientific Meeting of the Japanese Circulation Society)

  Katada Jun, Meguro Tomomi, Takahashi Hitomi, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  69-  372  -372  2005/03/01
• Studies on Mechanisms Underlying Cardiac Aldosterone Synthesis in Angiotensin II Type 1A Receptor Knockout Mice after Myocardial Infarction(Acute Myocardial Infarction, Basic 2 (IHD), The 69th Annual Scientific Meeting of the Japanese Circulation Society)

  Katada Jun, Meguro Tomomi, Takahashi Hitomi, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  69-  372  -373  2005/03/01
• Prognostic Significance of Serum C-reactive Protein Elevation in Patients with Distal Type Acute Aortic Dissection(Peripheral Circulation/Vascular Disease 1 (H), The 69th Annual Scientific Meeting of the Japanese Circulation Society)

  Sugano Yasuo, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Kohno Takashi, Mahara Keitaro, Naitoh Kotaro, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  69-  475  -475  2005/03/01
• Comparison between Sirolimus-Eluting Stents Implantation and Directional Coronary Atherectomy for Patients with Ostial Lesions (Coronary Revascularization, PTCA/Stent/DCA/Rotablator/New Device 12 (IHD), The 69th Annual Scientific Meeting of the Japanese Circulation Society)

  Maekawa Yuichiro, Asakura Yasushi, Okabe Teruo, Li Hui-chong, Anzai Toshihisa, Yoshikawa Tsutomu, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  69-  596  -596  2005/03/01
• 冠動脈慢性完全閉塞病変における側副血行路の分布様式と病変特徴の関連性

  岡部 輝雄, 朝倉 靖, 安斉 俊久, 佐藤 徹, 岩永 史郎, 吉川 勉, 小川 聰  日本内科学会雑誌  94-  (Suppl.)  127  -127  2005/02  [Not refereed][Not invited]
  
• Long-term intravenous epoprostenol is more effective in patients with collagen pulmonary hypertension than in primary pulmonary hypertension

  SATOH T, Kataoka Masaharu, Sato Toshiaki, Kanki Hideaki, Anzai Toshihisa, Yoshikawa Tutomu, Ogawa Satoshi  Proceedings of the 69^ Japanese Circulation Society Scientific Meeting. Yokohama, 2005-03  174  -174  2005
• 左室リモデリングとは何か？

  安斉 俊久  Medicina  42-  2089  -2091  2005  [Not refereed][Not invited]
  
• 循環器疾患とＲＡ系―ＡＴ１受容体とβ受容体の連関

  安斉 俊久  Cardiac Practice  16-  29  -36  2005  [Not refereed][Not invited]
  
• 【循環器疾患とRA系】 基礎 AT1受容体とβアドレナリン受容体の連関

  安斉 俊久, 吉川 勉  Cardiac Practice  16-  (1)  29  -36  2005/01  [Not refereed][Not invited]
  
• 原発性肺高血圧症における,エポプロステノール不応例に対するシルデナフィルの効果

  佐藤 徹, 真鍋 知宏, 安斉 俊久, 吉川 勉, 小川 聡  Progress in Medicine  25-  (1)  316  -320  2005/01  [Not refereed][Not invited]
   

  エポプロステノール不応6例にシルデナフィルを併用し,3例で改善が得られた.改善例ではシルデナフィル投与によって平均右房圧が低下したのに対し無効例では低下していなかった.平均肺動脈圧と肺血管抵抗はエポプロステノール投与でも低下していたが,シルデナフィル投与によってさらに低下した
• Enhanced inflammatory response after acute myocardial infarction is a predictor of infarcted wall thinning and left ventricular remodeling

  T Anzai, T Yoshikawa, K Naito, K Mahara, T Kohno, Y Sugano, Y Maekawa, T Okabe, S Iwanaga, Y Asakura, T Satoh, S Ogawa  CIRCULATION  110-  (17)  338  -338  2004/10  [Not refereed][Not invited]
  
• Hyperthermia following reperfused acute myocardial infarction is associated with early left ventricular remodeling

  K Naito, T Anzai, T Yoshikawa, K Mahara, T Kohno, Y Sugano, Y Maekawa, T Okabe, Y Asakura, S Ogawa  CIRCULATION  110-  (17)  337  -337  2004/10  [Not refereed][Not invited]
  
• 植込み型除細動器移植術後,心嚢気腫を発症した一例

  八木 崇, 高月 誠司, 福田 有希子, 真鍋 知宏, 大橋 成孝, 家田 真樹, 三好 俊一郎, 神吉 秀明, 安斉 俊久, 佐藤 徹, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Circulation Journal  68-  (Suppl.III)  891  -891  2004/10  [Not refereed][Not invited]
  
• 奇異性塞栓症により脳梗塞,心筋梗塞を起こした慢性肺血栓塞栓症,深部静脈血栓症の1例

  花岡 洋成, 矢田 浩崇, 佐藤 徹, 神吉 秀明, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  日本内科学会関東地方会  520回-  27  -27  2004/09  [Not refereed][Not invited]
  
• 今だからこそ循環器Physical Examination 症例提示-冠動脈バイパス術後グラフト閉塞を来した68歳女性

  佐藤 徹, 安斉 俊久, 岩永 史郎, 吉川 勉, 小川 聡  Journal of Cardiology  44-  (Suppl.I)  200  -200  2004/08  [Not refereed][Not invited]
  
• 左室機能障害疾患に対するβ遮断薬投与によりVE-VCO2 slopeが改善するのはどのような患者か?

  片岡 雅晴, 佐藤 徹, 吉川 勉, 中村 岩男, 真鍋 知宏, 安斉 俊久, 三田村 秀雄, 小川 聡  心臓  36-  (Suppl.2)  20  -23  2004/06  [Not refereed][Not invited]
   

  左室駆出率(LVEF)が45%以下の左室機能障害疾患患者44症例(男性40例・女性4例,年齢38〜80歳)を対象にβ遮断薬投与によるVE-VCO2 slopeの改善について検討した.β遮断薬はCarvedilol(24例)とMetoprolol(20例)を無作為選択して投与した結果,4ヵ月後にLVEFは有意に増加したが,脳性ナトリウム利尿ペプチド(BNP)とVE-VCO2 slopeの有意な改善は認めなかった.β遮断薬投与前のLVEF中間値28%およびBNP中間値62pg/mlにより心機能状態を分類してVE-VCO2 slopeの改善度を比較した結果,LVEFが低い患者およびBNPが高い患者においてVE-VCO2 slopeは有意に改善していた.β遮断薬の種類による比較では,MetoprololよりCarvedilolの方がVE-VCO2 slopeの改善効果が高かった.以上より,これらの臨床条件を満たす患者ではβ遮断薬投与により臨床的改善効果が期待できるものと考えられた
• 瀰漫性低収縮を認めたisolated left ventricular non-compactionの一例

  伊澤 良兼, 李 慧崇, 安斉 俊久, 岩永 史郎, 朝倉 靖, 佐藤 徹, 吉川 勉, 三田村 秀雄, 小川 聡  Circulation Journal  68-  (Suppl.II)  759  -759  2004/04  [Not refereed][Not invited]
  
• FRS-083 Comparison of Therapeutic Effect of Sildenafil and Prostacyclin in Patients with Pulmonary Hypertension(NO and Cardiovascular System (H) : FRS10)(Featured Research Session (English))

  Kataoka Masaharu, Satoh Toru, Manabe Tomohiro, Anzai Toshihisa, Yoshikawa Tsutomu, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  68-  111  -111  2004/03/01
• PE-081 Hyperthermia following Reperfused Acute Myocardial Infarction is Associated with Early Left Ventricular Remodeling(Acute Myocardial Infarction, Clinical (Pathophysiology) 4 (IHD) : PE14)(Poster Session (English))

  Naitoh Kotaro, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Sugano Yasuo, Kohno Takashi, Mahara Keitaro, Okabe Teruo, Asakura Yasushi, Iwanaga Shiro, Satoh Toru, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  68-  382  -382  2004/03/01
• PE-065 G-CSF Improves Cardiac Function after Myocardial Infarction via Acceleration of Reparative Collagen Synthesis(Acute Myocardial Infarction, Basic 3 (IHD) : PE12)(Poster Session (English))

  Sugano Yasuo, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Kohno Takashi, Mahara Keitaro, Naitoh Kotaro, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  68-  378  -378  2004/03/01
• PE-434 Improvement in Prognosis of Primary Pulmonary Hypertension with Continuous Intravenous Prostacyclin Infusion(Pulmonary Circulation 3 (H) : PE74)(Poster Session (English))

  Kataoka Masaharu, Satoh Toru, Manabe Tomohiro, Anzai Toshihisa, Yoshikawa Tsutomu, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  68-  468  -468  2004/03/01
• PJ-538 Limitation of Prostacyclin Therapy in Patients with Pulmonary Hypertension(Pulmonary Circulation 2 (H) : PJ90)(Poster Session (Japanese))

  Kataoka Masaharu, Satoh Toru, Manabe Tomohiro, Anzai Toshihisa, Yoshikawa Tsutomu, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  68-  611  -611  2004/03/01
• OJ-486 Granulocyte-Macrophage Colony-Stimulating Factor Inducer Adversely Affects Post-Infarction Left Ventricular Remodeling through Inappropriate Collagen Synthesis and Impaired Infarct Healing(Old Myocardial Infarction/Remodeling 1 (IHD) : OJ59)(Oral Presentation (Japanese))

  Maekawa Yuichiro, Anzai Toshihisa, Yoshikawa Tsutomu, Mahara Keitaro, Sugano Yasuo, Kohno Takashi, Naitoh Kotaro, Takahashi Toshiyuki, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  68-  348  -348  2004/03/01
• Association between serum C-reactive protein elevation and left ventricular thrombus formation after first anterior myocardial lnfarction

  T Anzai, R Yoshikawa, H Kaneko, Y Maekawa, S Iwanaga, Y Asakura, S Ogawa  CHEST  125-  (2)  384  -389  2004/02  [Not refereed][Not invited]
   

  Study objectives: Most left ventricular (LV) thrombi that occur after acute myocardial infarction (AMI) are formed within 2 weeks, when inflammatory cells have infiltrated into the necrotic myocardium. Inflammatory changes on the endocardial surface may induce platelet deposition and fibrin net formation through interaction with proinflammatory cytokines. We sought to determine the significance of the inflammatory response reflected by serum C-reactive protein (CRP) elevation in LV thrombus formation after AMI. Design: We examined 160 patients with first anterior AMI. Peak serum creatine kinase (CK) and CRP levels were determined by serial measurements. Echocardiography was performed 10 to 14 days after the onset. We assessed the association between the elevation of serum CRP levels and LV thrombus formation after AMI. Results: LV thrombus was observed in 13 patients (8%). There was no difference in age, sex, coronary risk factors, preinfarction angina, use of revascularization therapy and anticoagulant therapy, platelet count, and fibrinogen level on hospital admission between the two groups. The mean (+/- SD) peak serum CRP level was markedly increased in patients with LV thrombus compared to those without (18.0 +/- 12.6 vs 9.4 +/- 8.1 mg/dL; p = 0.001), despite their having similar peak CK levels. Multivariate analysis showed that a peak CRP level of greater than or equal to 20 mg/dL was an independent predictor of thrombus formation (relative risk, 4.82; p = 0.037) among variables including older age (greater than or equal to 60 years old), peak CK level (greater than or equal to 3,000 IU/L), and peak WBC count (greater than or equal to 12,000 cells/muL). Conclusion: A greater elevation of serum CRP level was associated with a higher incidence of LV thrombus after AMI, suggesting an important role of the inflammatory response in mural thrombus formation.
• Association between serum C-reactive protein elevation and left ventricular thrombus formation after first anterior myocardial infarction.

  Toshihisa Anzai, Tsutomu Yoshikawa, Hidehiro Kaneko, Yuichiro Maekawa, Shiro Iwanaga, Yasushi Asakura, Satoshi Ogawa  Chest  125-  (2)  384  -9  2004/02  [Refereed][Not invited]
   

  STUDY OBJECTIVES: Most left ventricular (LV) thrombi that occur after acute myocardial infarction (AMI) are formed within 2 weeks, when inflammatory cells have infiltrated into the necrotic myocardium. Inflammatory changes on the endocardial surface may induce platelet deposition and fibrin net formation through interaction with proinflammatory cytokines. We sought to determine the significance of the inflammatory response reflected by serum C-reactive protein (CRP) elevation in LV thrombus formation after AMI. DESIGN: We examined 160 patients with first anterior AMI. Peak serum creatine kinase (CK) and CRP levels were determined by serial measurements. Echocardiography was performed 10 to 14 days after the onset. We assessed the association between the elevation of serum CRP levels and LV thrombus formation after AMI. RESULTS: LV thrombus was observed in 13 patients (8%). There was no difference in age, sex, coronary risk factors, preinfarction angina, use of revascularization therapy and anticoagulant therapy, platelet count, and fibrinogen level on hospital admission between the two groups. The mean (+/- SD) peak serum CRP level was markedly increased in patients with LV thrombus compared to those without (18.0 +/- 12.6 vs 9.4 +/- 8.1 mg/dL; p = 0.001), despite their having similar peak CK levels. Multivariate analysis showed that a peak CRP level of > or =20 mg/dL was an independent predictor of thrombus formation (relative risk, 4.82; p = 0.037) among variables including older age (> or =60 years old), peak CK level (> or =3,000 IU/L), and peak WBC count (> or =12,000 cells/ microL). CONCLUSION: A greater elevation of serum CRP level was associated with a higher incidence of LV thrombus after AMI, suggesting an important role of the inflammatory response in mural thrombus formation.
• 原発性肺高血圧症に遺伝性出血性毛細血管拡張症(Osler-Weber-Rendu病)を合併した1例

  山川 裕之, 河野 隆志, 佐藤 徹, 安斉 俊久, 吉川 勉, 岩永 史郎, 三田村 秀雄, 小川 聰, 櫻庭 篤, 東 俊文  日本内科学会関東地方会  515回-  20  -20  2004/02  [Not refereed][Not invited]
  
• 急性心筋梗塞後左室リモデリングにおける炎症の関与

  安斉 俊久, 吉川 勉, 前川 裕一郎, 高橋 寿由樹, 馬原 啓太郎, 岡部 輝雄, 朝倉 靖, 佐藤 徹, 三田村 秀雄, 小川 聡  日本内科学会雑誌  93-  (Suppl.)  214  -214  2004/02  [Not refereed][Not invited]
  
• Angiotensin receptor blockade improves myocardial beta-adrenergic receptor signaling in postinfarction left ventricular remodeling: a possible link between beta-adrenergic receptor kinase-1 and protein kinase C epsilon isoform.

  Toshiyuki Takahashi, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Keitaro Mahara, Michikado Iwata, H Kirk Hammond, Satoshi Ogawa  Journal of the American College of Cardiology  43-  (1)  125  -32  2004/01/07  [Not refereed][Not invited]
   

  OBJECTIVES: We tested the hypothesis that angiotensin II type 1 receptor blocker (ARB) may improve beta-adrenergic receptor (AR) coupling in heart failure (HF) after myocardial infarction (MI). BACKGROUND: Beta-AR desensitization is one of the mechanisms underlying the transition from compensated to decompensated HF. Beta-adrenergic receptor kinase-1 (ARK1), which can be induced by protein kinase C (PKC) in vitro, is activated in the failing myocardium, resulting in beta-AR uncoupling. METHODS: Models of MI in rats were produced by ligation of left coronary artery. Four weeks after surgery, they were randomized to vehicle (MI/control [C]) or candesartan (10 mg/kg/day) treatment (MI/ARB). Sham-operated rats, or shams, served as controls. RESULTS: After two weeks of treatment, echocardiography and hemodynamics showed that the left ventricular (LV) dimension increased and that the percent of fractional shortening and maximum rate of rise in left ventricular pressure (dP/dt) decreased in MI rats compared with shams. There were no differences in these indexes between MI/C and MI/ARB. An increase in maximum dP/dt under isoproterenol (ISO) stimulation was attenuated in MI/C but improved in MI/ARB. Reductions in the percentage of high-affinity sites of beta-AR and ISO-stimulated cyclic adenosine monophosphate production in noninfarcted myocardium were also improved by ARB treatment. Up-regulation of beta-ARK1 and PKC-epsilon isoform protein levels and activation of PKC in noninfarcted myocardium from MI/C were both inhibited by ARB treatment. CONCLUSIONS: Treatment with ARB during the chronic phase of MI improved beta-AR coupling in noninfarcted myocardium without affecting basal LV function. Cross-talk between beta-AR and angiotensin signaling through beta-ARK1 and PKC-epsilon may be responsible for the phenomenon.
• Angiotensin receptor blockade improves myocardial beta-adrenergic receptor signaling in postinfarction left ventricular remodeling - A possible link between beta-adrenergic receptor kinase-1 and protein kinase C epsilon isoform

  T Takahashi, T Anzai, T Yoshikawa, Y Maekawa, K Mahara, M Iwata, HK Hammond, S Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  43-  (1)  125  -132  2004/01  [Not refereed][Not invited]
   

  Objectives We tested the hypothesis that angiotensin II type 1 receptor blocker (ARB) may improve beta-adrenergic receptor (AR) coupling in heart failure (HF) after myocardial infarction (MI). Background Beta-AR desensitization is one of the mechanisms underlying the transition from compensated to decompensated HF. Beta-adrenergic receptor kinase-1 (ARK1), which can be induced by protein kinase C (PKC) in vitro, is activated in the failing myocardium, resulting in beta-AR uncoupling. Methods Models of MI in rats were produced by ligation of left coronary artery. Four weeks after surgery, they were randomized to vehicle (MI/control [C]) or candesartan (10 mg/kg/day) treatment (MI/ARB). Sham-operated rats, or shams, served as controls. Results After two weeks of treatment, echocardiography and hemodynamics showed that the left ventricular (LV) dimension increased and that the percent of fractional shortening and maximum rate of rise in left ventricular pressure (dP/dt) decreased in MI rats compared with shams. There were no differences in these indexes between MI/C and MI/ARB. An increase in maximum dP/dt under isoproterenol (ISO) stimulation was attenuated in MI/C but improved in MI/ARB. Reductions in the percentage of high-affinity sites of beta-AR and ISO-stimulated cyclic adenosine monophosphate production in noninfarcted myocardium were also improved by ARB treatment. Up-regulation of beta-ARK1 and PKC-epsilon isoform protein levels and activation of PKC in noninfarcted myocardium from MI/C were both inhibited by ARB treatment. Conclusions Treatment with ARB during the chronic phase of MI improved beta-AR coupling in noninfarcted myocardium without affecting basal LV function. Cross-talk between beta-AR and angiotensin signaling through beta-ARK1 and PKC-epsilon may be responsible for the phenomenon.
• 梗塞後左室リモデリングにおける心筋β受容体脱感作をアンジオテンシン受容体拮抗薬は改善する

  安斉 俊久  Angiotensin Research  1-  93  -99  2004  [Not refereed][Not invited]
  
• 不整脈治療戦略. 慢性心不全の病態と治療戦略

  安斉 俊久  Current Therapy  22-  51  -57  2004  [Not refereed][Not invited]
  
• ＡＭＩの予後を改善するために. Remodeling予防はどうすればよいのか？

  安斉 俊久  救急・集中治療  16-  87  -94  2004  [Not refereed][Not invited]
  
• 【慢性心不全の病態と治療戦略】 心不全の薬物療法 不整脈治療戦略

  安斉 俊久, 小川 聡  カレントテラピー  22-  (2)  155  -161  2004/01  [Not refereed][Not invited]
   

  近年,大規模臨床試験により心室性不整脈或いは心臓突然死に対してアミオダロンの有効性が示されているが,虚血性心不全に対する有効性は未だに確立されておらず,重篤な副作用を有する点には十分注意すべきである.一方,植込み型除細動器(ICD)が日常臨床においても使用可能となった現状では,ICDとのコンビネーションセラピーとしてのアミオダロンの有用性が期待される.また心房細動は,慢性心不全において高頻度に認められるが,血行動態が不安定な症例においてはIII群抗不整脈薬による洞調律の積極的な維持が予後を改善する可能性も考えられる
• フローランによる原発性肺高血圧症の予後の改善

  片岡 雅晴, 佐藤 徹, 真鍋 知宏, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡  Progress in Medicine  24-  (1)  317  -319  2004/01  [Not refereed][Not invited]
   

  1999年11月〜2003年7月にフローランを導入した25例の生存率をKaplan-Meier法で計算した.男性13例,女性12例,年齢は33±15歳,観察期間は49±36ヵ月であった.3年生存率は87%,5年生存率67%であった
• 死亡例からみたフローランの開始適応

  佐藤 徹, 片岡 雅晴, 真鍋 知宏, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡  Progress in Medicine  24-  (1)  342  -345  2004/01  [Not refereed][Not invited]
   

  フローラン導入後の死亡例8例とフローラン不応により治療変更に至った5例について解析した.導入後1ヵ月未満で死亡した3例はいずれも肺血管抵抗が高値であった.導入後15ヵ月で死亡した16歳女性例は右房圧が急激に上昇し,右心不全が進行して亡くなった.フローランの導入にさいしては急速進行例に注意する必要があり,又,1/3程度の患者は不応例であることに留意すべきと考えられた
• 【ハート・アタック a state of the art】 AMIの予後を改善するために Remodeling予防はどうすればよいのか?

  安斉 俊久, 吉川 勉  救急・集中治療  16-  (1)  87  -94  2003/12  [Not refereed][Not invited]
  
• 炎症と心血管疾患 急性心筋梗塞と炎症 梗塞後治癒機転への関与

  安斉 俊久, 吉川 勉, 前川 裕一郎, 内藤 広太郎, 馬原 啓太郎, 河野 隆志, 菅野 康夫, 岡部 輝男, 朝倉 靖, 村山 晃, 鈴木 雅裕, 小川 聡  日本冠疾患学会雑誌  9-  (4)  198  -198  2003/11  [Not refereed][Not invited]
  
• Granulocyle-macrophage colony-stimulating factor adversely affects post-infarction left ventricular remodeling through inappropriate collagen synthesis and impaired infarct healing

  Y Maekawa, T Anzai, K Mahara, T Kohno, Y Sugano, T Yoshikawa  CIRCULATION  108-  (17)  272  -272  2003/10  [Not refereed][Not invited]
  
• Impact of plasma interleukin-6 and serum C-reactive protein elevation on left ventricular thrombus formation after first anterior myocardial infarction

  T Anzai, H Kaneko, K Naito, K Mahara, T Kohno, Y Sugano, Y Maekawa, T Okabe, S Iwanaga, Y Asakura  CIRCULATION  108-  (17)  315  -315  2003/10  [Not refereed][Not invited]
  
• Granulocyte colony-stimulating factor improves cardiac function after myocardial infarction via acceleration of reparative collagen synthesis

  Y Sugano, T Anzai, Y Maekawa, T Kohno, K Mahara, T Yoshikawa  CIRCULATION  108-  (17)  140  -140  2003/10  [Not refereed][Not invited]
  
• 左室機能障害,肺高血圧症を合併したMCTDの一例

  里見 良輔, 金澤 英明, 佐藤 徹, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡, 小笠原 孝, 亀山 香織  日本内科学会関東地方会  512回-  26  -26  2003/10  [Not refereed][Not invited]
  
• プロスタサイクリンで改善不良性にシルデナフィルが著効した原発性肺高血圧症の1例

  片岡 雅晴, 佐藤 徹, 真鍋 知宏, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Circulation Journal  67-  (Suppl.III)  926  -926  2003/10  [Not refereed][Not invited]
  
• 自己免疫機序を介したβ遮断薬の新しい作用機序

  吉川 勉, 岩田 道圭, 馬場 彰泰, 安斉 俊久, 小川 聡  Journal of Cardiology  42-  (Suppl.I)  96  -96  2003/08  [Not refereed][Not invited]
  
• 梗塞前狭心症の臨床的意義

  安斉 俊久  Journal of Cardiology  42-  (Suppl.I)  162  -162  2003/08  [Not refereed][Not invited]
  
• プロスタサイクリンで改善不良の肺高血圧症に対するシルデナフィルの効果

  片岡 雅晴, 佐藤 徹, 真鍋 知宏, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡  Journal of Cardiology  42-  (Suppl.I)  225  -225  2003/08  [Not refereed][Not invited]
  
• 急性心筋梗塞に対する経皮的冠動脈形成術後の好中球増多と微小循環障害との関連

  高橋 寿由樹, 安斉 俊久, 吉川 勉, 岡部 輝雄, 朝倉 靖, 小山田 和弘, 永見 圭一, 服部 成彦, 小川 聡  Journal of Cardiology  42-  (Suppl.I)  358  -358  2003/08  [Not refereed][Not invited]
  
• 左室心筋疾患に対するβ遮断薬治療により,VE/VCO2 slopeは改善するか?

  片岡 雅晴, 佐藤 徹, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡, 中村 岩男  Journal of Cardiology  42-  (Suppl.I)  421  -421  2003/08  [Not refereed][Not invited]
  
• A 19-year-old man with myocardial infarction and sitosterolemia.

  Takaharu Katayama, Toru Satoh, Takashi Yagi, Nobuyoshi Hirose, Yasuo Kurita, Toshihisa Anzai, Yasushi Asakura, Tsutomu Yoshikawa, Hideo Mitamura, Satoshi Ogawa  Internal medicine (Tokyo, Japan)  42-  (7)  591  -4  2003/07  [Refereed][Not invited]
   

  This is a case report of a 19-year-old man who presented with acute myocardial infarction with obstruction of one coronary artery and rapid progression to three vessels in 8 months. He was proved to have sitosterolemia, a rare hereditary disease with plant sterol storing, resulting in juvenile coronary artery disease. Atherosclerotic complications can be preventable by administration of bile acid-binding resin, after the correct diagnosis is made. We introduce this disease with a review of the literature.
• 【急性心筋梗塞症における最近のトピックス】 急性心筋梗塞における炎症 梗塞治癒機転への関与

  安斉 俊久, 吉川 勉  循環器科  54-  (1)  24  -30  2003/07  [Not refereed][Not invited]
  
• 梗塞後リモデリングと炎症

  安斉 俊久  呼吸と循環  51-  (6)  587  -594  2003/06  [Not refereed][Not invited]
  
• Serum C-reactive protein elevation in left ventricular remodeling after acute myocardial infarction-role of neurohormones and cytokines

  T Takahashi, T Anzai, T Yoshikawa, Y Maekawa, Y Asakura, T Satoh, H Mitamura, S Ogawa  INTERNATIONAL JOURNAL OF CARDIOLOGY  88-  (2-3)  257  -265  2003/04  [Not refereed][Not invited]
   

  Background: We previously reported that increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of cardiac rupture and long-term outcome. The aim of this study was to clarify the role of serum CRP elevation as a possible marker of left ventricular (LV) remodeling after AMI. Methods: We prospectively studied 31 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Peak serum CRP level was determined by serial measurements after admission. LV volume and the plasma levels of various neurohormones and cytokines were measured on admission, and 2 weeks and 6 months after AMI. Results: Patients with higher peak CRP levels (above the median) had a greater increase in LV end-diastolic volume during 2 weeks after AMI (+21 +/- 14 vs. +5 +/- 6 ml/m(2), P = 0.001) and a lower ejection fraction (45 +/- 11 vs. 53 +/- 7%, P = 0.02) than those with lower CRP levels, associated with a higher incidence of pump failure, atrial fibrillation, and LV aneurysm. Plasma levels of norepinephrine, brain natriuretic peptide, and interleukin-6 2 weeks after AMI were higher in the high CRP group than in the low CRP group. Conclusions: Increased peak serum CRP level was associated with a greater increase in LV volume after anterior AMI. Plasma norepinephrine and interleukin-6 levels were increased in patients with higher CRP levels, suggesting a possible role of sympathetic activation and enhanced immune response in the development of LV remodeling after AMI. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.
• 洞調律下,遅伝導路の伝導時に胸部不快感を伴った房室二重伝導路の一例

  加登 有紀, 福田 有希子, 高月 誠司, 三田村 秀雄, 谷本 耕司郎, 安斉 俊久, 佐藤 徹, 吉川 勉, 小川 聡  Circulation Journal  67-  (Suppl.II)  768  -768  2003/04  [Not refereed][Not invited]
  
• 生体肺移植を施行し2年を経過した原発性肺高血圧症の1例

  西山 信大, 佐藤 徹, 松下 健一, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡, 伊藤 洋至  Circulation Journal  67-  (Suppl.II)  782  -782  2003/04  [Not refereed][Not invited]
  
• 【心血管疾患と炎症】 急性心筋梗塞における再灌流障害と炎症

  安斉 俊久  循環器科  53-  (4)  270  -277  2003/04  [Not refereed][Not invited]
  
• Association between Peripheral Eosinophilia and No-Reflow Phenomenon after Percutaneous Coronary Intervention for Acute Myocardial Infarction

  Maekawa Yuichiro, Anzai Toshihisa, Yoshikawa Tsutomu, Asakura Yasushi, Mahara Keitaro, Kohno Takashi, Sugano Yasuo, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  498  -499  2003/03/01
• Mutations within the BMPR-II Gene in Japanese Patients with Primary Pulmonary Hypertension

  Satoh Toru, Asano Koichiro, Matsushita Kenichi, Anzai Toshihisa, Yoshikawa Tsutomu, Yamaguchi Kazuhiro, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  244  -245  2003/03/01
• Aging Adversely Affects Post-Infarct Inflammatory Response and Left Ventricular Remodeling

  Mahara Keitaro, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Sugano Yasuo, Kohno Takashi, Takahashi Toshiyuki, Okabe Teruo, Asakura Yasushi, Satoh Toru, Mitamura Hideo, Murayama Akira, Suzuki Masahiro, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  202  -202  2003/03/01
• Prognostic Significance of Increased Serum Oxidized LDL after Reperfused Acute Myocardial Infarction

  Mahara Keitaro, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Sugano Yasuo, Kohno Takashi, Okabe Teruo, Asakura Yasushi, Satoh Toru, Mitamura Hideo, Murayama Akira, Suzuki Masahiro, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  201  -201  2003/03/01
• Serum C-Reactive Protein as a Predictor of Mitral Regurgitation and Left Ventricular Remodeling after First Q-Wave Anterior Acute Myocardial Infarction

  Kohno Takashi, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Mahara Keitaro, Sugano Yasuo, Okabe Teruo, Asakura Yasushi, Iwanaga Shiro, Satoh Toru, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  168  -168  2003/03/01
• Carvedilol Is More Effective Than Metoprolol in Patients Who Exhibit Higher Brain Natriuretic Peptide Level

  Kohno Takashi, Yoshikawa Tsutomu, Moritani Kazunori, Anzai Toshihisa, Meguro Tomomi, Iwanaga Shiro, Suzuki Masahiro, Satoh Toru, Yokozuka Hitoshi, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  174  -174  2003/03/01
• Association between Relative Overactivation of Inflammatory Response and Pump Failure after Reperfused First Q-Wave Acute Myocardial Infarction

  Kohno Takashi, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Sugano Yasuo, Mahara Keitaro, Okabe Teruo, Asakura Yasushi, Iwanaga Shiro, Satoh Toru, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  67-  128  -128  2003/03/01
• Early use of beta-blockers is associated with attenuation of serum C-reactive protein elevation and favorable short-term prognosis after acute myocardial infarction.

  Toshihisa Anzai, Tsutomu Yoshikawa, Toshiyuki Takahashi, Yuichiro Maekawa, Teruo Okabe, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Satoshi Ogawa  Cardiology  99-  (1)  47  -53  2003  [Refereed][Not invited]
   

  BACKGROUND: We have reported that a marked elevation in serum C-reactive protein (CRP) level is a predictor for infarct expansion and cardiac rupture after AMI. Although beta-blockers prevent cardiac rupture after AMI, their effect on serum CRP elevation has not been determined. METHODS: We studied a total of 154 patients with first Q-wave AMI. Patients complicated by pump failure were excluded from this study. Eighty-two patients received beta-blocker treatment within 24 h of the onset of AMI, while 72 patients received no beta-blocker treatment. Peak serum creatine kinase (CK) and CRP levels were determined by serial measurements. RESULTS: There was no difference between the groups according to age, sex, coronary risk factors, pre-infarction angina, infarct site, prior use of cardiovascular drugs, use of revascularization therapy, and prevalence of multivessel disease. Beta-blocker treatment was associated with a lower peak CRP level (6.9 +/- 6.1 vs.10.8 +/- 9.3 mg/dl, p = 0.002), a shorter duration from the onset to the peak CRP level (2 +/- 1 vs. 3 +/- 2 days, p < 0.0001), a lower incidence of cardiac rupture (p = 0.03) and lower in-hospital cardiac mortality (p = 0.02), despite similar peak CK levels. CONCLUSION: The early use of beta-blockers is associated with decreased serum CRP level and a favorable clinical outcome after first Q-wave AMI, suggesting some beneficial effects of beta-blockers on infarct healing after AMI.
• Early use of beta-blockers is associated with attenuation of serum C-reactive protein elevation and favorable short-term prognosis after acute myocardial infarction

  T Anzai, T Yoshikawa, T Takahashi, Y Maekawa, T Okabe, Y Asakura, T Satoh, H Mitamura, S Ogawa  CARDIOLOGY  99-  (1)  47  -53  2003  [Not refereed][Not invited]
   

  Background: We have reported that a marked elevation in serum C-reactive protein (CRP) level is a predictor for infarct expansion and cardiac rupture after AMI. Although beta-blockers prevent cardiac rupture after AMI, their effect on serum CRP elevation has not been determined. Methods: We studied a total of 154 patients with first Q-wave AMI. Patients complicated by pump failure were excluded from this study. Eighty-two patients received P-blocker treatment within 24 h of the onset of AMI, while 72 patients received no P-blocker treatment. Peak serum creatine kinase (CK) and CRP levels were determined by serial measurements. Results: There was no difference between the groups according to age, sex, coronary risk factors, pre-infarction angina, infarct site, prior use of cardiovascular drugs, use of revascularization therapy, and prevalence of multivessel disease. beta-Blocker treatment was associated with a lower peak CRP level (6.9+/-6.1 vs. 10.8+/-9.3 mg/dl, p=0.002), a shorter duration from the onset to the peak CRP level (2+/-1 vs. 3+/-2 days, p<0.0001), a lower incidence of cardiac rupture (p=0.03) and lower in-hospital cardiac mortality (p=0.02), despite similar peak CK levels. Conclusion: The early use of beta-blockers is associated with decreased serum CRP level and a favorable clinical outcome after first Q-wave AMI, suggesting some beneficial effects of beta-blockers on infarct healing after AMI.
• 急性心筋梗塞における炎症―梗塞治癒機転への関与―

  安斉 俊久  循環器科  54-  24  -30  2003  [Not refereed][Not invited]
  
• 急性心筋梗塞における再灌流障害と炎症

  安斉 俊久  循環器科  53-  270  -277  2003  [Not refereed][Not invited]
  
• Early use of beta-blockers is associated with attenuation of serum C-reactive protein elevation and favorable short-term prognosis after acute myocardial infarction.

  Toshihisa Anzai, Tsutomu Yoshikawa, Toshiyuki Takahashi, Yuichiro Maekawa, Teruo Okabe, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Satoshi Ogawa  Cardiology  99-  (1)  47  -53  2003  [Not refereed][Not invited]
   

  BACKGROUND: We have reported that a marked elevation in serum C-reactive protein (CRP) level is a predictor for infarct expansion and cardiac rupture after AMI. Although beta-blockers prevent cardiac rupture after AMI, their effect on serum CRP elevation has not been determined. METHODS: We studied a total of 154 patients with first Q-wave AMI. Patients complicated by pump failure were excluded from this study. Eighty-two patients received beta-blocker treatment within 24 h of the onset of AMI, while 72 patients received no beta-blocker treatment. Peak serum creatine kinase (CK) and CRP levels were determined by serial measurements. RESULTS: There was no difference between the groups according to age, sex, coronary risk factors, pre-infarction angina, infarct site, prior use of cardiovascular drugs, use of revascularization therapy, and prevalence of multivessel disease. Beta-blocker treatment was associated with a lower peak CRP level (6.9 +/- 6.1 vs.10.8 +/- 9.3 mg/dl, p = 0.002), a shorter duration from the onset to the peak CRP level (2 +/- 1 vs. 3 +/- 2 days, p < 0.0001), a lower incidence of cardiac rupture (p = 0.03) and lower in-hospital cardiac mortality (p = 0.02), despite similar peak CK levels. CONCLUSION: The early use of beta-blockers is associated with decreased serum CRP level and a favorable clinical outcome after first Q-wave AMI, suggesting some beneficial effects of beta-blockers on infarct healing after AMI.
• Early use of beta-blockers is associated with attenuation of serum C-reactive protein elevation and favorable short-term prognosis after acute myocardial infarction

  u, ANZAI TOSHIHISA  Cardiology  99-  (1)  47  -53  2003  [Not refereed][Not invited]
  
• Serum C-reactive protein elevation in left ventricular remodeling after acute myocardial infarction - Role of neurohormones and cytokines

  Toshiyuki Takahashi, Toshihisa Anzai, Tsutomu Yoshikawa, Yuichiro Maekawa, Yasushi Asakura, Toru Satoh, Hideo Mitamura, Satoshi Ogawa  International Journal of Cardiology  88-  (2-3)  257  -265  2003  [Not refereed][Not invited]
   

  Background: We previously reported that increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of cardiac rupture and long-term outcome. The aim of this study was to clarify the role of serum CRP elevation as a possible marker of left ventricular (LV) remodeling after AMI. Methods: We prospectively studied 31 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Peak serum CRP level was determined by serial measurements after admission. LV volume and the plasma levels of various neurohormones and cytokines were measured on admission, and 2 weeks and 6 months after AMI. Results: Patients with higher peak CRP levels (above the median) had a greater increase in LV end-diastolic volume during 2 weeks after AMI (+21±14 vs. +5±6 ml/m2, P=0.001) and a lower ejection fraction (45±11 vs. 53±7%, P=0.02) than those with lower CRP levels, associated with a higher incidence of pump failure, atrial fibrillation, and LV aneurysm. Plasma levels of norepinephrine, brain natriuretic peptide, and interleukin-6 2 weeks after AMI were higher in the high CRP group than in the low CRP group. Conclusions: Increased peak serum CRP level was associated with a greater increase in LV volume after anterior AMI. Plasma norepinephrine and interleukin-6 levels were increased in patients with higher CRP levels, suggesting a possible role of sympathetic activation and enhanced immune response in the development of LV remodeling after AMI. © 2002 Elsevier Science Ireland Ltd. All rights reserved.
• A 19-year-old man with myocardial infarction and sitosterolemia

  u, ANZAI TOSHIHISA  Int Med  42-  (7)  591  -594  2003  [Not refereed][Not invited]
  
• フローラン投与による右室拡大の進行

  佐藤 徹, 松下 健一, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡  Progress in Medicine  23-  (1)  384  -389  2003/01  [Not refereed][Not invited]
   

  フローラン導入後1年以上在宅にてPGI2持続静注療法を継続し,かつカテーテル検査を前後で施行した原発性肺高血圧症(PPH)の12例を対象に検討した.右室拡大が進行した3例の血行動態の平均は,平均肺動脈圧(mLPAP)66±17mmHg,肺血管抵抗(PVR)26±9単位,mRA 11mmHg,BNP 941±1575pg/mL,CTR 59±8%で,右房圧が高く,いずれも重症であった.当施設ではPGI2持続静注療法を開始すると患者のQOLが悪化することから,以前はかなり重症になってからPGI2持続静注を開始する傾向にあったが,最近ではPGI2の開始が遅れると改善が不良の症例があることから早期に開始するようにしている.カテーテル検査はPGI2持続静注の投与前,開始後6ヵ月,1年の時点で施行した.CTRが増加した3例を心拡大群,不変か減少した9例を改善群として2群の臨床像を比較した.PGI2持続静注の増量は原則として,PVR 10単位前後までの改善を目標として一定のプログラムに従って増量した
• Aging adversely affects post-infarct inflammatory response and left ventricular remodeling

  T Anzai, T Yoshikawa, Y Maekawa, T Takahashi, T Okabe, Y Asakura, T Satoh, M Suzuki, A Murayama  CIRCULATION  106-  (19)  529  -529  2002/11  [Not refereed][Not invited]
  
• 長期観察症例の検討 急性肺塞栓症が疑われ,抗凝固療法にも拘わらず肺高血圧症が急速に進行した1例の1年後

  佐藤 徹, 大橋 成孝, 塩見 哲也, 安斉 俊久, 小山田 吉孝, 吉川 勉, 山口 佳寿博, 三田村 秀雄, 小川 聡  Therapeutic Research  23-  (11)  2182  -2183  2002/11  [Not refereed][Not invited]
   

  17歳(性別記載なし).肺血栓塞栓症と診断されワーファリンを開始されたが,徐々に増悪傾向であった.重症肺高血圧症,重症右心不全で,ドブタミン,利尿薬,PGI2の投与を開始したところ,肺高血圧症は改善を示したが,三尖弁閉鎖不全による逆流はPGI2開始前よりsevereでその後も減少せず,PGI2増量により右室の後負荷が軽減したにも拘わらず右室機能は悪化した.利尿薬により右室の容積を減少させても右室は小さくならず,三尖弁逆流も改善を認めない.本症例の発症の仕方は,1ヵ月間に平均肺動脈圧が2倍,肺動脈血管抵抗が3倍となる急激なもので,非常に特異なものである.肺動脈の全枝の亜区域枝付近に狭窄,閉塞を認めるが,慢性肺血栓塞栓症の造影所見とは異なり,病因に関しても既知の疾患にあてはまるものはなく,不明のままである
• 【21世紀の心不全治療の展望】 免疫学的アプローチによる心不全治療

  吉川 勉, 馬場 彰泰, 安斉 俊久  呼吸と循環  50-  (10)  999  -1006  2002/10  [Not refereed][Not invited]
  
• Effect of preinfarction angina pectoris on ST-segment resolution after primary coronary angioplasty for acute myocardial infarction

  T Takahashi, T Anzai, T Yoshikawa, Y Maekawa, Y Asakura, T Satoh, H Mitamura, S Ogawa  AMERICAN JOURNAL OF CARDIOLOGY  90-  (5)  465  -469  2002/09  [Not refereed][Not invited]
   

  The presence of preinfarction angina has been shown to exert a favorable effect on left ventricular function after acute myocardial infarction (AMI). Whether or not preinfarction angina is beneficial for myocardial tissue reperfusion, however, remains to be determined. We sought to evaluate the influence of preinfarction angina on resolution of ST-segment elevation, which could be affected by microcirculatory damage after reconalization therapy. We studied 96 patients with a first AMI in whom Thrombolysis In Myocardial Infarction (TIMI)-3 flow in the infarct-related artery was established by primary angioplasty. Percent reduction in the sum of ST elevation from baseline to 1 hour after angioplasty (percent DeltaSigmaST) was examined. Poor ST resolution, defined as percent DeltaSigmaST <50%, was observed in 25 patients, who had a worse clinical outcome, larger infarct size, and poorer left ventricular function. On multivariate analysis, the absence of preinfarction angina, as well as anterior wall infarction, were major independent predictors of poor ST resolution, whereas age, sex, coronary risk factors, ischemic time, Killip class on admission, multivessel disease, initial TIMI flow grade, and extent of collaterals were not significant. Patients with preinfarction angina had a greater degree of ST-segment resolution than those without angina (71 +/- 21% vs 49 +/- 43%, p = 0.02). Additional ST elevation after reperfusion was noted exclusively in patients without preinfarction angina (p = 0.02). Preinfarction angina is associated with a greater degree of ST-segment resolution in patients with TIMI-3 flow after primary angioplasty, suggesting a protective effect of preinfarction angina against microcirculatory damage after reperfusion. (C) 2002 by Excerpta Medica, Inc.
• Effect of preinfarction angina pectoris on ST-segment resolution after primary coronary angioplasty for acute myocardial infarction

  T Takahashi, T Anzai, T Yoshikawa, Y Maekawa, Y Asakura, T Satoh, H Mitamura, S Ogawa  AMERICAN JOURNAL OF CARDIOLOGY  90-  (5)  465  -469  2002/09  [Not refereed][Not invited]
   

  The presence of preinfarction angina has been shown to exert a favorable effect on left ventricular function after acute myocardial infarction (AMI). Whether or not preinfarction angina is beneficial for myocardial tissue reperfusion, however, remains to be determined. We sought to evaluate the influence of preinfarction angina on resolution of ST-segment elevation, which could be affected by microcirculatory damage after reconalization therapy. We studied 96 patients with a first AMI in whom Thrombolysis In Myocardial Infarction (TIMI)-3 flow in the infarct-related artery was established by primary angioplasty. Percent reduction in the sum of ST elevation from baseline to 1 hour after angioplasty (percent DeltaSigmaST) was examined. Poor ST resolution, defined as percent DeltaSigmaST <50%, was observed in 25 patients, who had a worse clinical outcome, larger infarct size, and poorer left ventricular function. On multivariate analysis, the absence of preinfarction angina, as well as anterior wall infarction, were major independent predictors of poor ST resolution, whereas age, sex, coronary risk factors, ischemic time, Killip class on admission, multivessel disease, initial TIMI flow grade, and extent of collaterals were not significant. Patients with preinfarction angina had a greater degree of ST-segment resolution than those without angina (71 +/- 21% vs 49 +/- 43%, p = 0.02). Additional ST elevation after reperfusion was noted exclusively in patients without preinfarction angina (p = 0.02). Preinfarction angina is associated with a greater degree of ST-segment resolution in patients with TIMI-3 flow after primary angioplasty, suggesting a protective effect of preinfarction angina against microcirculatory damage after reperfusion. (C) 2002 by Excerpta Medica, Inc.
• 心血管疾患と炎症 心筋梗塞後リモデリング過程における炎症・免疫応答の役割

  安斉 俊久, 吉川 勉, 前川 裕一郎, 高橋 寿由樹, 菅野 康夫, 小川 聡  Journal of Cardiology  40-  (Suppl.1)  89  -89  2002/08  [Not refereed][Not invited]
  
• III型急性大動脈解離後の肺酸素化障害と血清CRP値の関連

  菅野 康夫, 安斉 俊久, 林 丈晴, 岩永 史郎, 前川 裕一郎, 佐藤 徹, 吉川 勉, 三田村 秀雄, 小川 聡  Journal of Cardiology  40-  (Suppl.1)  284  -284  2002/08  [Not refereed][Not invited]
  
• 非典型的症状を主訴とする急性心筋梗塞の割合と救急医療体制

  中村 岩男, 堀 進悟, 鈴木 昌, 宮武 諭, 相川 直樹, 吉川 勉, 安斉 俊久, 朝倉 靖, 小川 聡  Journal of Cardiology  40-  (Suppl.1)  304  -304  2002/08  [Not refereed][Not invited]
  
• AMIに対するintravascular ultrasound(IVUS)ガイド下一次ステンティングにおけるステント留置及び血管造影上no-reflow現象間の関連

  前川 裕一郎, 朝倉 靖, 岡部 輝雄, 安斉 俊久, 河村 朗夫, 菅野 康夫, 吉川 勉, 三田村 秀雄, 小川 聡  Journal of Cardiology  40-  (Suppl.1)  327  -327  2002/08  [Not refereed][Not invited]
  
• VDDペースメーカー挿入3年後,右房内血栓,急性肺塞栓症,リード線断裂を併発した1例

  高林 恭子, 八木 崇, 佐藤 徹, 安斉 俊久, 吉川 勉, 岩永 史郎, 三田村 秀雄, 小川 聡, 申 範圭, 四津 良平  日本内科学会関東地方会  501回-  24  -24  2002/07  [Not refereed][Not invited]
  
• 顕微鏡的多発血管炎による心不全の一剖検例

  伊藤 圭介, 大橋 成孝, 佐藤 徹, 森本 彩, 栗田 康生, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡, 松岡 健太郎  日本内科学会関東地方会  499回-  28  -28  2002/05  [Not refereed][Not invited]
  
• Significance of inflammatory response in left ventricular wall thinning and remodeling after acute myocardial infarction

  Anzai Toshihisa, Kaneko Hidehiro, Maekawa Yuichiro, Okabe Teruo, Iwanaga Shiro, Asakura Yasushi, Satoh Toru, Yoshikawa Tsutomu, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  66-  475  -475  2002/03/31
• VE-VCO2 slope is determined by right ventricular end-diastolic pressure in pulmonary hypertension

  Satoh Toru, Kurita Yasuo, Anzai Toshihisa, Iwanaga Shiro, Yoshikawa Tsutomu, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  66-  309  -309  2002/03/31
• Different effects of carvedilol and metoprolol on the left ventricular remodeling after reperf used anterior myocardial infarction

  Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Takahashi Toshiyuki, Okabe Teruo, Asakura Yasushi, Satoh Toru, Mitamura Hideo, Ogawa Satoshi, Nakagawa Susumu, Murayama Akira, Suzuki Masahiro  Circulation journal : official journal of the Japanese Circulation Society  66-  333  -333  2002/03/31
• Effect of granulocyte-macrophage colony stimulating factor on left ventricular remodeling after acute myocardial infarction

  Maekawa Yuichiro, Anzai Toshihisa, Yoshikawa Tsutomu, Takahashi Toshiyuki, Sugano Yasuo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  66-  835  -835  2002/03/31
• Serum C-reactive protein elevation as a predictor of mural thrombus formation after first anterior myocardial infarction

  Kaneko Hidehiro, Anzai Toshihisa, Yoshikawa Tsutomu, Iwanaga Shiro, Maekawa Yuichiro, Okabe Teruo, Asakura Yasushi, Satoh Toru, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  66-  806  -806  2002/03/31
• Significance of neutrophilia and serum C-reactive protein elevation in reperfusion injury after anterior myocardial infarction

  Takahashi Toshiyuki, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Okabe Teruo, Asakura Yasushi, Satoh Toru, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  66-  613  -613  2002/03/31
• Association between peripheral monocytosis and plasma brain natriuretic peptide elevation after reperfused first anterior myocardial infarction

  Maekawa Yuichiro, Anzai Toshihisa, Yoshikawa Tsutomu, Takahashi Toshiyuki, Sugano Yasuo, Okabe Teruo, Asakura Yasushi, Satoh Toru, Mitamura Hideo, Ogawa Satoshi  Circulation journal : official journal of the Japanese Circulation Society  66-  743  -743  2002/03/31
• 19歳で心筋梗塞を発症したβシトステロール血症の一例

  片山 隆春, 八木 崇, 佐藤 徹, 栗田 康生, 安斉 俊久, 朝倉 靖, 吉川 勉, 三田村 秀雄, 小川 聡, 広瀬 信義  日本内科学会関東地方会  497回-  34  -34  2002/02  [Not refereed][Not invited]
  
• 原発性肺高血圧症におけるプロスタサイクリン在宅静注療法導入の適応基準 非観血的指標

  佐藤 徹, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会雑誌  91-  (臨増)  196  -196  2002/02  [Not refereed][Not invited]
  
• 梅毒性大動脈炎による重症大動脈弁逆流(AR)の一例

  菊池真大, 杵淵修, 佐藤徹, 前川裕一郎, 栗田康生, 安斎俊久, 小川聡, 四津良平, 林丈晴  Circulation Journal  66-  2002
• Key points and pitfalls in electrocardiographic diagnosis of acute myocardial infarction

  Anzai Toshihisa, Ogawa Satoshi  Journal of Medical Association Japan  45-  (1)  1  -8  2002  [Not refereed][Not invited]
  
• Prognostic significance of preipheral monocytosis after reperfused myocardial infarction : a possible role for left ventricular remodeling

  MAEKAWA Y  J Am Coll Cardiol  39-  (2)  241  -246  2002  [Not refereed][Not invited]
  
• Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction: A possible role for left ventricular remodeling

  Y Maekawa, T Anzai, T Yoshikawa, Y Asakura, T Takahashi, S Ishikawa, H Mitamura, S Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  39-  (2)  241  -246  2002/01  [Not refereed][Not invited]
   

  OBJECTIVES The aim of this study was to determine the significance of peripheral monocytosis in clinical outcome after reperfused acute myocardial infarction (AMI), especially relating to post-infarct left ventricular (LV) remodeling. BACKGROUND Peripheral monocytosis occurs two to three days after AMI, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. However, the prognostic significance of peripheral monocytosis after AMI remains to be determined. METHODS A total of 149 patients with first Q-wave AMI were studied. White blood cell (WBC) count, percentage of monocytes and serum C-reactive protein level were measured every 24 h for four days after the onset of AMI. We assessed association between peripheral monocytosis and prognosis including pump failure, LV aneurysm and long-term outcome after AMI. RESULTS Patients with pump failure (p < 0.0001) or LV aneurysm (p = 0.005) had higher peak monocyte counts than those without these complications. Predischarge left ventriculography revealed that peak monocyte count was positively correlated with LV end-diastolic volume (p = 0.024) and negatively correlated with ejection fraction (p = 0,023). Multivariate analyses showed that peak monocyte count greater than or equal to900/mm(3) was an independent determinant of pump failure (relative risk [RR] 9.83, p < 0.0001), LV aneurysm (RR 4.78, p = 0.046) and cardiac events (RR 6.30, p < 0.0001), including readmission for heart failure, recurrent myocardial infarction and cardiac deaths, including sudden deaths. CONCLUSIONS Peripheral monocytosis is associated with LV dysfunction and LV aneurysm, suggesting a possible role of monocytes in the development of LV remodeling after reperfused AMI. (C) 2002 by the American College of Cardiology.
• Effect of preinfarction angina on ST-segment resolution after primary angioplasty for acute myocardial infarction

  Takahashi Toshiyuki, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Asakura Yasushi, Ishikawa Shiro, Mitamura Hideo, Ogawa Satoshi  American Jounal of Cardiology  90-  (5)  465  -469  2002  [Not refereed][Not invited]
  
• 急性肺塞栓症が疑われ，抗凝固療法にもかかわらず肺高血圧症が急速に進行した1例の1年後

  佐藤徹, 大橋成孝, 塩見哲也, 安斉俊久, 小山田吉孝, 吉川勉, 山口佳寿博, 三田村秀雄, 小川聡  Therapeutic research  11-  2182  -2183  2002  [Not refereed][Not invited]
  
• 免疫学的アプローチによる心不全治療

  吉川勉, 馬場彰泰, 安斉俊久  呼吸と循環  50-  999  -1006  2002  [Not refereed][Not invited]
  
• Key points and pitfalls in electrocardiographic diagnosis of acute myocardial infarction

  Anzai T, Ogawa S  Japan Medical Association journal  45-  (1)  1  -8  2002  [Not refereed][Not invited]
  
• Key points and pitfalls in electrocardiographic diagnosis of acute myocardial infarction

  Anzai Toshihisa, Ogawa Satoshi  Journal of Medical Association Japan  45-  (1)  1  -8  2002  [Not refereed][Not invited]
  
• Prognostic Significance of Peripheral Monocytosis After Reperfused Acute Myocardial Infarction : A Possible Role for Left Ventricular Remodeling

  Maekawa Y, Anzai T, Yoshikawa T, Asakura Y, Takahashi T, Ishikawa S, Mitamura H, Ogawa S  Journal of the American College of Cardiology  39-  (2)  241  -246  2002  [Not refereed][Not invited]
  
• Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction: a possible role for left ventricular remodeling

  Maekawa Yuichiro, Anzai Toshihisa, Yoshikawa Tsutomu, Asakura Yasushi, Takahashi Toshiyuki, Ishikawa Shiro, Mitamura Hideo, Ogawa Satoshi  Journal of American College of Cardiology  39-  (2)  241  -246  2002  [Not refereed][Not invited]
  
• Effect of preinfarction angina on ST-segment resolution after primary angioplasty for acute myocardial infarction

  Takahashi Toshiyuki, Anzai Toshihisa, Yoshikawa Tsutomu, Maekawa Yuichiro, Asakura Yasushi, Ishikawa Shiro, Mitamura Hideo, Ogawa Satoshi  American Jounal of Cardiology  90-  (5)  465  -469  2002  [Not refereed][Not invited]
  
• Key points and pitfalls in electrocardiographic diagnosis of acute myocardial infarction

  Anzai T, Ogawa S  Japan Medical Association journal  45-  (1)  1  -8  2002  [Not refereed][Not invited]
  
• 冠静脈洞憩室に合併したWPW症候群の一例

  菊池 真大, 前川 裕一郎, 栗田 康生, 高月 誠司, 安斉 俊久, 佐藤 徹, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  496回-  20  -20  2001/12  [Not refereed][Not invited]
  
• 静脈洞型心房中隔欠損,部分肺静脈還流異常によるアイゼンメンジャー症候群の1例

  馬原 啓太郎, 家田 真樹, 佐藤 徹, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  495回-  19  -19  2001/11  [Not refereed][Not invited]
  
• Prognostic significance of peripheral monocytosis after acute myocardial infarction: A possible role for left ventricular remodeling

  Y Maekawa, T Anzai, T Yoshikawa, T Takahashi, S Ishikawa, Y Asakura, T Sato, S Ogawa  CIRCULATION  104-  (17)  488  -488  2001/10  [Not refereed][Not invited]
  
• Angiotensin receptor blockade improves beta-adrenergic receptor desensitization in postinfarction left ventricular remodeling

  T Takahashi, T Anzai, Y Maekawa, M Iwata, T Yoshikawa  CIRCULATION  104-  (17)  279  -280  2001/10  [Not refereed][Not invited]
  
• Effect of preinfarction angina on ST-segment resolution after primary angioplasty for acute myocardial infarction

  T Takahashi, T Anzai, T Yoshikawa, Y Maekawa, Y Asakura, S Ogawa  CIRCULATION  104-  (17)  728  -728  2001/10  [Not refereed][Not invited]
  
• Association between persistent elevation of plasma interleukin-6 level and left ventricular remodeling after acute myocardial infarction

  T Anzai, T Yoshikawa, Y Asakura, Y Maekawa, T Takahashi, T Okabe, H Mitamura, S Ogawa, S Nakagawa, M Suzuki  CIRCULATION  104-  (17)  488  -488  2001/10  [Not refereed][Not invited]
  
• Randomized two of phosphodiesterase inhibitors versus catecholamines in patients with acutely decompensated heart failure

  A Kawamura, T Yoshikawa, T Takahashi, T Hayashi, E Takahashi, T Anzai, T Sato, S Ogawa  JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION  65-  (10)  858  -862  2001/10  [Not refereed][Not invited]
   

  Increased neurohormone and cytokine concentrations are associated with adverse outcome in patients with congestive heart failure, so minimizing these increases may improve outcome, even in the acute phase of decompensated heart failure, The present study was designed to test the hypothesis that phosphodiesterase inhibitors, but not catecholamines, could favorably affect neurohormone and cytokine profiles in patients with acutely decompensated heart failure. Twenty-nine patients underwent monitoring using a Swan-Ganz catheter and were randomly allocated to receive phosphodiesterase inhibitors (PDEI group, n=19) or catecholamines (CA group, n=10). Pulmonary capillary wedge pressure decreased significantly in both groups and cardiac output showed a slight, but not statistically significant increase, in both groups. There was a significant decrease in plasma brain natriuretic peptide concentration in the PDEI group, but not in the CA group, whereas plasma interleukin-6 concentration increased in the CA group, but not in the PDEI group. Phosphodiesterase inhibitors favorably affect neurohormone and cytokine concentrations in patients with acutely decompensated heart failure.
• フローラン在宅療法における合併症の検討

  佐藤 徹, 福田 有希子, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Therapeutic Research  22-  (9)  2077  -2079  2001/09  [Not refereed][Not invited]
   

  平成11年4月〜平成13年5月迄にフローラン在宅療法を開始した11例を対象に,フローラン在宅療法の合併症とされる項目を検索対象とし,患者への質問と診療録の記載を参考に検討した.合併症は発生頻度の高い順に,顎の痛み10/11,足底痛7/11,発疹7/11,下痢5/11,吐き気4/11,頭痛4/11,カテーテル刺入部感染4/11,めまい3/11,カテーテル抜去3/11,携帯型輸液ポンプトラブル3/11,カテーテル感染1/11,好酸球性肺炎1/11であった.フローランによる副作用は大多数が入院も不要で認容可能であり,フローラン投与が長期になると軽減していった.一方,カテーテルに関連した合併症は致命的となる可能性もあり,入院加療を必要とした.好酸球性肺炎を合併した症例は,元来アレルギーの強い患者であったが,誘因なく発症し,副腎皮質ステロイドホルモンの投与で改善した
• フローラン在宅療法における増量速度の検討

  佐藤 徹, 福田 有希子, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Therapeutic Research  22-  (9)  2075  -2076  2001/09  [Not refereed][Not invited]
   

  平成11年4月〜平成13年5月迄にフローラン在宅療法を施行し,6ヵ月以上の経過観察を行った6例を対象とし,3ヵ月毎に右心カテーテル検査を施行し,フローラン投与量を決定した.フローラン投与量と,肺血管抵抗(PVR)およびBNPの関係を検討した.フローラン開始後6ヵ月でPVR,BNPは減少した.フローラン増量を規定している要因を検索する為,フローラン投与前のPVRおよび6ヵ月後のPVR変化度と,6ヵ月後のフローラン濃度の関係を検討した.変化度が小さい方がフローラン濃度はより高く,投与開始後3ヵ月目の血行動態および臨床的な改善度をみながら,改善不良であるとフローラン濃度を急速に増量していることを反映していた.BNPは右心不全の改善をみる指標としては有用であるが,BNPが正常化してからもPVRは低下を続け,運動耐容能が改善するものと考えられた
• 原発性肺高血圧症11例におけるフローラン在宅療法導入の適応基準

  佐藤 徹, 福田 有希子, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Therapeutic Research  22-  (9)  2073  -2074  2001/09  [Not refereed][Not invited]
   

  平成11年4月から平成13年5月迄にフローラン在宅療法を開始した11例を対象に,フローラン導入前の平均右房圧(mRA)と,平均肺動脈圧(mPA),心拍出量(CO),肺動脈血管抵抗(PVR),動脈血酸素分圧(PaO2),総ビリルビン値(TB),尿酸値(UA),BNP値(BNP),6分歩行距離,右室駆出率(RVEF),心胸郭比(CTR)との相関を算出した.mRAが22mmHgの症例は持続性の心房粗動を合併した症例で肺高血圧の程度以上に右房圧の高い症例であり,この症例を除外するとBNPおよびPVRがmRAと直線相関係数が高く,両者が右房圧を推定するのに最も有用であった.BNPとPVRがフローラン開始を考慮する上で,mRAと共に有用な指標であり,BNP 300pg/mL,PVR 20単位付近が適応基準値と考えられた.又,心プールシンチのRVEF 20%,CTR 55%,6分間歩行距離400mも,各指標がmRAとの間に弱い相関関係を認め,右心不全の検出に有用な所見と思われた
• 原発性肺高血圧症11例におけるプロスタグランジンI2在宅療法導入の適応基準

  福本 耕太郎, 佐藤 徹, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  493回-  20  -20  2001/09  [Not refereed][Not invited]
  
• 【急性心筋梗塞治療の新展開 心筋保護の観点から】 心臓リモデリングは抑制できるか 臨床的観点から

  吉川 勉, 安斉 俊久, 高橋 寿由樹, 前川 裕一郎  呼吸と循環  49-  (9)  867  -874  2001/09  [Not refereed][Not invited]
  
• 急性肺塞栓症が疑われ,抗凝固療法にも拘わらず肺高血圧症が急速に進行し,PGI2を開始した1例

  福本 耕太郎, 佐藤 徹, 福田 有希子, 栗田 康生, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  Therapeutic Research  22-  (9)  2061  -2063  2001/09  [Not refereed][Not invited]
   

  17歳男.多発性肺血栓塞栓症および肺高血圧症である.抗凝固療法を強化し,肺血流シンチおよび肺動脈造影上は肺塞栓症の増悪は認めなかったが,肺高血圧症は著明に増悪した.PGI2投与により肺高血圧症は改善を認めた.肺動脈造影では殆どの亜区域枝動脈付近に血栓によると思われる閉塞像を認めた.慢性肺血栓塞栓症に特徴的な,器質化血栓によるび漫性の肺動脈の変形像は認められず,殆どの肺動脈枝が閉塞しており,急性肺塞栓症としても典型的ではなかった.肺血流シンチ,肺動脈造影上は肺血栓塞栓症が疑われたが,抗凝固薬による治療が無効で,急速な進行を呈した
• 心筋症を解明する 診断と治療の最前線 特発性心筋症における自己免疫機序 β1アドレナリン受容体第二細胞外ループの役割

  吉川 勉, 岩田 道圭, 馬場 彰泰, 安斉 俊久, 小川 聡  Journal of Cardiology  38-  (Suppl.I)  94  -94  2001/08  [Not refereed][Not invited]
  
• 診断に苦慮した肺塞栓症 腫瘍塞栓症と思われた4例

  佐藤 徹, 高月 誠司, 小山田 吉孝, 安斉 俊久, 岩永 史郎, 吉川 勉, 山口 佳寿博, 三田村 秀雄, 小川 聡  Therapeutic Research  22-  (7)  1471  -1473  2001/07  [Not refereed][Not invited]
   

  1999年度に18例の急性肺塞栓症を経験し,4例は微小腫瘍塞栓症と考えられた.18例の急性肺塞栓症の発症の誘因は手術後39%,腫瘍塞栓22%,入院臥床中17%等であった.腫瘍性肺塞栓症と考えられる4症例はいずれも転移を認める進行癌患者に,急速に進行する呼吸困難として発症し,肺高血圧症,低酸素血症,DICを認め,血栓性肺塞栓に対する治療は無効であった.症例1では肺動脈血の吸引細胞診より腫瘍細胞が検出されて確定診断がされ,化学療法が著効して約6ヵ月間の延命が可能であった.他の症例は最終的な確定診断はしえなかった
• 敗血症性ショックにより急激な右左シャントをきたした卵円孔開存を伴う右室梗塞の一例

  服部 英典, 栗田 康生, 佐藤 徹, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡, 申 範圭  日本内科学会関東地方会  492回-  33  -33  2001/07  [Not refereed][Not invited]
  
• 左心不全を呈した壮年発症のlong RP頻拍の一例

  小林 由紀子, 田原 聡子, 杵渕 修, 栗田 康生, 高月 誠司, 安斉 俊久, 佐藤 徹, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  490回-  29  -29  2001/05  [Not refereed][Not invited]
  
• 【再灌流療法をめぐって】 心筋梗塞後リモデリング現象

  吉川 勉, 安斉 俊久, 高橋 寿由樹, 前川 裕一郎  進歩する心臓研究  XXI-  (1)  30  -37  2001/05  [Not refereed][Not invited]
  
• 循環器疾患のPrimary Care 急性心筋梗塞の心電図診断とpit-fall

  安斉 俊久, 小川 聡  心臓  33-  (4)  277  -283  2001/04  [Not refereed][Not invited]
  
• 家族性拘束型心筋症の一例

  馬原 啓太郎, 藤田 淳, 佐藤 徹, 高月 誠司, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡, 徳村 光昭  Japanese Circulation Journal  65-  (Suppl.II)  605  -605  2001/04  [Not refereed][Not invited]
  
• Autoimmunity against the second extracellular loop of beta(1)-adrenergic receptors induces beta-adrenergic receptor desensitization and myocardial hypertrophy in vivo

  M Iwata, T Yoshikawa, A Baba, T Anzai, Nakamura, I, Y Wainai, T Takahashi, S Ogawa  CIRCULATION RESEARCH  88-  (6)  578  -586  2001/03  [Not refereed][Not invited]
   

  Although immunoapheresis removing autoantibodies against the second extracellular domain of beta (1)-adrenergic receptors (ARs) improves cardiac function in patients with cardiomyopathy, the underlying mechanisms have not been defined. We examined the role of autoimmunity against the domain in the development of cardiac dysfunction in vivo. Japanese white rabbits were immunized with a synthetic peptide corresponding to the second extracellular loop of beta (1)-AR once a month with (beta +biso rabbits, n=10) or without (beta rabbits, n=13) bisoprolol treatment (2 mg/kg per day). Control rabbits received vehicle without bisoprolol treatment (n=13). Autoantibodies of IgG isotype against the domain were persistently detected in beta and beta +biso rabbits. Purified IgG from sera of beta and beta +biso rabbits increased cAMP production in a rabbit cardiac membrane preparation, which was blocked by bisoprolol. At 3 months, beta -AR uncoupling with increased G protein-coupled receptor kinase 5 (GRK5) expression was found in beta rabbits. At 6 months, left ventricular hypertrophy was noted with hemodynamic derangements in beta rabbits. This was accompanied by decreased beta (1)-AR density and increased inhibitory G protein and GRK5 expression, which were related to marked decrease in membrane cAMP production. These changes in beta rabbits at 6 months were prevented in beta +biso rabbits. There was no difference in the plasma norepinephrine concentration in the 3 groups over the observation period. Thus, autoimmunity against the second extracellular loop of beta (1)-ARs induced profound beta -AR desensitization and myocardial hypertrophy in vivo, associated with cardiac dysfunction. Sustained sympathomimetic-like actions of autoantibodies against the domain may be partly responsible for these changes.
• Autoimmunity against the second extracellular loop of beta(1)-adrenergic receptors induces beta-adrenergic receptor desensitization and myocardial hypertrophy in vivo

  M Iwata, T Yoshikawa, A Baba, T Anzai, Nakamura, I, Y Wainai, T Takahashi, S Ogawa  CIRCULATION RESEARCH  88-  (6)  578  -586  2001/03  [Not refereed][Not invited]
   

  Although immunoapheresis removing autoantibodies against the second extracellular domain of beta (1)-adrenergic receptors (ARs) improves cardiac function in patients with cardiomyopathy, the underlying mechanisms have not been defined. We examined the role of autoimmunity against the domain in the development of cardiac dysfunction in vivo. Japanese white rabbits were immunized with a synthetic peptide corresponding to the second extracellular loop of beta (1)-AR once a month with (beta +biso rabbits, n=10) or without (beta rabbits, n=13) bisoprolol treatment (2 mg/kg per day). Control rabbits received vehicle without bisoprolol treatment (n=13). Autoantibodies of IgG isotype against the domain were persistently detected in beta and beta +biso rabbits. Purified IgG from sera of beta and beta +biso rabbits increased cAMP production in a rabbit cardiac membrane preparation, which was blocked by bisoprolol. At 3 months, beta -AR uncoupling with increased G protein-coupled receptor kinase 5 (GRK5) expression was found in beta rabbits. At 6 months, left ventricular hypertrophy was noted with hemodynamic derangements in beta rabbits. This was accompanied by decreased beta (1)-AR density and increased inhibitory G protein and GRK5 expression, which were related to marked decrease in membrane cAMP production. These changes in beta rabbits at 6 months were prevented in beta +biso rabbits. There was no difference in the plasma norepinephrine concentration in the 3 groups over the observation period. Thus, autoimmunity against the second extracellular loop of beta (1)-ARs induced profound beta -AR desensitization and myocardial hypertrophy in vivo, associated with cardiac dysfunction. Sustained sympathomimetic-like actions of autoantibodies against the domain may be partly responsible for these changes.
• 【急性心筋梗塞 プレホスピタルケアからCCU搬送まで】 心電図診断のポイントとpit-fall

  安斉 俊久, 小川 聡  日本医師会雑誌  125-  (5)  665  -670  2001/03  [Not refereed][Not invited]
  
• 腫瘍性肺塞栓症と思われた4例

  鈴木 雄介, 佐藤 徹, 栗田 康生, 小山田 吉孝, 安斉 俊久, 岩永 史郎, 吉川 勉, 山口 佳寿博, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  489回-  19  -19  2001/03  [Not refereed][Not invited]
  
• Early use of beta-blockers is associated with an attenuation of serum C-reactive protein elevation and a favorable short-term prognosis after acute myocardial infarction

  T Anzai, T Yoshikawa, T Takahashi, Y Maekawa, Y Asakura, S Ishikawa, H Mitamura, S Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  37-  (2)  317S  -317S  2001/02  [Not refereed][Not invited]
  
• Autoantibodies against the second extracellular loop of beta(1)-adrenergic receptors predict ventricular tachycardia and sudden death in patients with idiopathic dilated cardiomyopathy

  M Iwata, T Yoshikawa, A Baba, T Anzai, H Mitamura, S Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  37-  (2)  418  -424  2001/02  [Not refereed][Not invited]
   

  Objectives We sought to define the clinical and long-term prognostic implications of autoantibodies that act against the second extracellular loop of beta(1)-adrenergic receptors (ARs) in patients with idiopathic dilated cardiomyopathy (IDC). Background Although autoantibodies directed against various domains of beta-ARs are found in patients with IDC, only a subgroup against the second extracellular domain of beta(1)-ARs exerts intrinsic sympathomimetic-like actions on human beta-ARs. It is suggested that the autoantibodies take part in the pathophysiology of LDC and may affect long-term prognosis of patients with this disorder. Methods Sera from 104 patients with IDC were screened for autoantibodies that act against the second extracellular loop of beta(1)-ARs by enzyme-linked immunosorbent assay, using a synthetic peptide corresponding to the domain. Relations of the autoantibodies to clinical variables and long-term prognosis were assessed by multivariate analysis. Results Autoantibodies were detected in 40 patients (38%). Multifocal ventricular premature contractions (p < 0.01) and ventricular tachycardia (VT; p < 0.01) were more common in autoantibody-positive than in antibody-negative patients, although no differences in cardiac function or neurohormonal levels were demonstrated. The presence of autoantibodies (p = 0.001) and a low left ventricular ejection fraction (LVEF <30%; p = 0.02) were independent predictors of VT. Sudden death was independently predicted by the presence of autoantibodies (p = 0.03), as well as by LVEF <30% (p = 0.01), whereas total mortality was predicted only by LVEF <300% (p = 0.001). Conclusions Autoantibodies directed against the second extracellular loop of beta(1)-ARs were closely related to serious ventricular arrhythmias in patients with LDC, and the presence of autoantibodies independent predicted sudden death. These autoantibodies may contribute to electrical instability in patients with IDC. (C) 2001 by the American College of Cardiology.
• 心筋梗塞後リモデリング現象

  吉川勉, 安斉俊久, 高橋寿由樹, 前川裕一郎  進歩する心臓研究  21-  30  -37  2001  [Not refereed][Not invited]
  
• 心臓リモデリングは抑制できるか―臨床的観点から

  吉川勉, 安斉俊久, 高橋寿由樹, 前川裕一郎  呼吸と循環  49-  (9)  867  -874  2001  [Not refereed][Not invited]
  
• シンポジウム我が国のPGI2ポンプ治療の現況 2保険適応の問題点と現況

  佐藤徹, 福田有希子, 栗田康生, 安斉俊久, 岩永史郎, 吉川勉, 三田村秀雄, 小川聡  Therapeutic Research  22-  (9)  44  -45  2001  [Not refereed][Not invited]
  
• 急性肺塞栓症が疑われ、抗凝固療法にもかかわらず肺高血圧症が急速に進行し、PGI2を開始した1例

  福元耕太郎, 佐藤徹, 福田有希子, 栗田康生, 安斉俊久, 岩永史郎, 吉川勉, 三田村秀雄, 小川聡  Therapeutic Research  22-  (9)  19  -21  2001  [Not refereed][Not invited]
  
• シンポジウム我が国のPGI2ポンプ治療の現況 2保険適応の問題点と現況

  佐藤徹, 福田有希子, 栗田康生, 安斉俊久, 岩永史郎, 吉川勉, 三田村秀雄, 小川聡  Therapeutic Research  22-  (9)  44  -45  2001  [Not refereed][Not invited]
  
• 急性肺塞栓症が疑われ，抗凝固療法にもかかわらず肺高血圧症が急速に進行し，PGI2を開始した1例

  福本耕太郎, 佐藤徹, 福田有希子, 栗田康生, 安斉俊久, 岩永史郎, 吉川勉, 三田村秀雄, 小川聡  Therapeutic Research  19  -21  2001  [Not refereed][Not invited]
  
• 急性心筋梗塞の心電図診断とpit-fall

  安斉俊久, 小川聡  心臓  33-  277  -283  2001  [Not refereed][Not invited]
  
• Autoantibodies against the second extracellular loop of b1-adrenergic receptors predict ventricular tachycardia and sudden death in patients with idiopathic dilated cardiomyopathy

  Iwata Michikado, Yoshikawa Tsutomu, Baba Akiyasu, Anzai Toshihisa, Mitamura Hideo, Ogawa Satoshi  The Journal of American College of Cardiology  37-  (2)  418  -424  2001  [Not refereed][Not invited]
   

  OBJECTIVES: We sought to define the clinical and long-term prognostic implications of autoantibodies that act against the second extracellular loop of beta1-adrenergic receptors (ARs) in patients with idiopathic dilated cardiomyopathy (IDC). BACKGROUND: Although autoantibodies directed against various domains of beta-ARs are found in patients with IDC, only a subgroup against the second extracellular domain of beta1-ARs exerts intrinsic sympathomimetic-like actions on human beta-ARs. It is suggested that the autoantibodies take part in the pathophysiology of IDC and may affect long-term prognosis of patients with this disorder. METHODS: Sera from 104 patients with IDC were screened for autoantibodies that act against the second extracellular loop of beta1-ARs by enzyme-linked immunosorbent assay, using a synthetic peptide corresponding to the domain. Relations of the autoantibodies to clinical variables and long-term prognosis were assessed by multivariate analysis. RESULTS: Autoantibodies were detected in 40 patients (38%). Multifocal ventricular premature contractions (p < 0.01) and ventricular tachycardia (VT; p < 0.01) were more common in autoantibody-positive than in autoantibody-negative patients, although no differences in cardiac function or neurohormonal levels were demonstrated. The presence of autoantibodies (p = 0.001) and a low left ventricular ejection fraction (LVEF <30%; p = 0.02) were independent predictors of VT. Sudden death was independently predicted by the presence of autoantibodies (p = 0.03), as well as by LVEF <30% (p = 0.01), whereas total mortality was predicted only by LVEF <30% (p = 0.001). CONCLUSIONS: Autoantibodies directed against the second extracellular loop of beta1-ARs were closely related to serious ventricular arrhythmias in patients with IDC, and the presence of autoantibodies independently predicted sudden death. These autoantibodies may contribute to electrical instability in patients with IDC.
• Autoimmunity against the second extracellular loop of β1-adrenergic receptors induces β-adrenergic receptor desensitization and myocardial hypertrophy in vivo

  Iwata Michikado, Yoshikawa Tsutomu, Baba Akiyasu, Anzai Toshihisa, Nakamura Iwao, Wainai Yumiko, Takahashi Toshiyuki, Ogawa Satoshi  Circulation Research  88-  (6)  578  -586  2001  [Not refereed][Not invited]
   

  Although immunoapheresis removing autoantibodies against the second extracellular domain of beta(1)-adrenergic receptors (ARs) improves cardiac function in patients with cardiomyopathy, the underlying mechanisms have not been defined. We examined the role of autoimmunity against the domain in the development of cardiac dysfunction in vivo. Japanese white rabbits were immunized with a synthetic peptide corresponding to the second extracellular loop of beta(1)-AR once a month with (beta+biso rabbits, n=10) or without (beta rabbits, n=13) bisoprolol treatment (2 mg/kg per day). Control rabbits received vehicle without bisoprolol treatment (n=13). Autoantibodies of IgG isotype against the domain were persistently detected in beta and beta+biso rabbits. Purified IgG from sera of beta and beta+biso rabbits increased cAMP production in a rabbit cardiac membrane preparation, which was blocked by bisoprolol. At 3 months, beta-AR uncoupling with increased G protein-coupled receptor kinase 5 (GRK5) expression was found in beta rabbits. At 6 months, left ventricular hypertrophy was noted with hemodynamic derangements in beta rabbits. This was accompanied by decreased beta(1)-AR density and increased inhibitory G protein and GRK5 expression, which were related to marked decrease in membrane cAMP production. These changes in beta rabbits at 6 months were prevented in beta+biso rabbits. There was no difference in the plasma norepinephrine concentration in the 3 groups over the observation period. Thus, autoimmunity against the second extracellular loop of beta(1)-ARs induced profound beta-AR desensitization and myocardial hypertrophy in vivo, associated with cardiac dysfunction. Sustained sympathomimetic-like actions of autoantibodies against the domain may be partly responsible for these changes.
• Autoimmunity against the second extracellular loop of β(1)-adrenergic receptors induces β-adrenergic receptor desensitization and myocardial hypertrophy in vivo

  Iwata Michikado, Yoshikawa Tsutomu, Baba Akiyasu, Anzai Toshihisa, Nakamura Iwao, Wainai Yumiko, Takahashi Toshiyuki, Ogawa Satoshi  Circulation Research  88-  (6)  578  -586  2001  [Not refereed][Not invited]
  
• Randomized trial of phosphodiesterase inhibitors versus catecholamines in patients with acutely decompensated heart failure

  A. Kawamura, T. Yoshikawa, T. Takahashi, T. Hayashi, E. Takahashi, T. Anzai, T. Sato, S. Ogawa  Japanese Circulation Journal  65-  (10)  858  -862  2001  [Not refereed][Not invited]
   

  Increased neurohormone and cytokine concentrations are associated with adverse outcome in patients with congestive heart failure, so minimizing these increases may improve outcome, even in the acute phase of decompensated heart failure. The present study was designed to test the hypothesis that phosphodiesterase inhibitors, but not catecholamines, could favorably affect neurohormone and cytokine profiles in patients with acutely decompensated heart failure. Twenty-nine patients underwent monitoring using a Swan-Ganz catheter and were randomly allocated to receive phosphodiesterase inhibitors (PDEI group, n=19) or catecholamines (CA group, n=10). Pulmonary capillary wedge pressure decreased significantly in both groups and cardiac output showed a slight, but not statistically significant increase, in both groups. There was a significant decrease in plasma brain natriuretic peptide concentration in the PDEI group, but not in the CA group, whereas plasma interleukin-6 concentration increased in the CA group, but not in the PDEI group. Phosphodiesterase inhibitors favorably affect neurohormone and cytokine concentrations in patients with acutely decompensated heart failure.
• Presynaptic modulation of the norepinephrine-induced beta-adrenergic receptor desensitization phenomenon in vivo

  Nakamura, I, T Yoshikawa, T Anzai, A Baba, M Iwata, Y Wainai, M Suzuki, S Ogawa  JOURNAL OF CARDIAC FAILURE  6-  (4)  350  -358  2000/12  [Not refereed][Not invited]
   

  Background: In vivo administration of norepinephrine fails to cause beta -adrenergic receptor desensitization. However, short-term exposure of cultured cells to norepinephrine induces the phenomenon in vitro. We sought to identify the local regulatory mechanisms responsible for in vivo beta -adrenergic receptor desensitization in congestive heart failure. Methods and Results: Control rabbits received norepinephrine (n = 7) or saline (n = 7) for 1 week, and rabbits with chemical denervation induced by 6-hydroxydopamine also received norepinephrine (n = 7) or saline (n = 7). Myocardial norepinephrine content decreased 80% in both groups of denervated rabbits. beta (1)-Adrenergic receptor density in denervated rabbits receiving norepinephrine was lower than in those receiving saline but not in control rabbits: receiving norepinephrine. Isoproterenol-competition assay revealed that there was a lower number of high-affinity binding sites with loss of guanosine triphosphate shift in denervated rabbits receiving norepinephrine. Isoproterenol-stimulated adenylyl cyclase activity in control rabbits receiving norepinephrine was lower than in those receiving saline. In denervated rabbits receiving norepinephrine, forskolin-stimulated adenylyl cyclase activity was also reduced. Immunoreactive G-protein coupled receptor kinase-2 level was increased in denervated rabbits receiving norepinephrine, Conclusion: There are profound alterations in beta -adrenergic receptor signaling after exposure to norepinephrine in the denervated heart. Defects in neuronal uptake may play a pivotal role in beta -adrenergic receptor desensitization in vivo.
• Presynaptic modulation of the norepinephrine-induced beta-adrenergic receptor desensitization phenomenon in vivo

  Nakamura, I, T Yoshikawa, T Anzai, A Baba, M Iwata, Y Wainai, M Suzuki, S Ogawa  JOURNAL OF CARDIAC FAILURE  6-  (4)  350  -358  2000/12  [Not refereed][Not invited]
   

  Background: In vivo administration of norepinephrine fails to cause beta -adrenergic receptor desensitization. However, short-term exposure of cultured cells to norepinephrine induces the phenomenon in vitro. We sought to identify the local regulatory mechanisms responsible for in vivo beta -adrenergic receptor desensitization in congestive heart failure. Methods and Results: Control rabbits received norepinephrine (n = 7) or saline (n = 7) for 1 week, and rabbits with chemical denervation induced by 6-hydroxydopamine also received norepinephrine (n = 7) or saline (n = 7). Myocardial norepinephrine content decreased 80% in both groups of denervated rabbits. beta (1)-Adrenergic receptor density in denervated rabbits receiving norepinephrine was lower than in those receiving saline but not in control rabbits: receiving norepinephrine. Isoproterenol-competition assay revealed that there was a lower number of high-affinity binding sites with loss of guanosine triphosphate shift in denervated rabbits receiving norepinephrine. Isoproterenol-stimulated adenylyl cyclase activity in control rabbits receiving norepinephrine was lower than in those receiving saline. In denervated rabbits receiving norepinephrine, forskolin-stimulated adenylyl cyclase activity was also reduced. Immunoreactive G-protein coupled receptor kinase-2 level was increased in denervated rabbits receiving norepinephrine, Conclusion: There are profound alterations in beta -adrenergic receptor signaling after exposure to norepinephrine in the denervated heart. Defects in neuronal uptake may play a pivotal role in beta -adrenergic receptor desensitization in vivo.
• 房室回帰性頻拍と呼吸性に出現する心房頻拍が誘因と考えられた神経因性失神の一例

  西澤 俊宏, 栗田 康生, 高月 誠司, 福田 有希子, 家田 真樹, 安斉 俊久, 佐藤 徹, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  486回-  26  -26  2000/11  [Not refereed][Not invited]
  
• Autoantibodies against the second extracellular loop of beta 1-adrenergic receptors predict ventricular tachycardia and sudden death in patients with idiopathic dilated cardiomyopathy

  M Iwata, T Yoshikawa, A Baba, T Anzai  CIRCULATION  102-  (18)  447  -448  2000/10  [Not refereed][Not invited]
  
• 心室細動(Vf)にて発症し,MOFを合併しながらもPCPS,ステロイドパルス療法により救命し得た劇症型心筋炎の1例

  高田 理絵, 家田 真樹, 安斉 俊久, 佐藤 徹, 高橋 栄一, 岩永 史郎, 石川 士郎, 朝倉 靖, 吉川 勉, 三田村 秀雄  Japanese Circulation Journal  64-  (Suppl.III)  874  -874  2000/10  [Not refereed][Not invited]
  
• プロスタサイクリン在宅持続点滴療法により改善を示した原発性肺高血圧症の4例

  長田 高志, 福田 有希子, 佐藤 徹, 高月 誠司, 安斉 俊久, 岩永 史郎, 吉川 勉, 三田村 秀雄, 小川 聡  日本内科学会関東地方会  485回-  19  -19  2000/10  [Not refereed][Not invited]
  
• Absence of preinfarction angina is associated with a risk of no-reflow phenomenon after primary coronary angioplasty for a first anterior wall acute myocardial infarction

  T Takahashi, T Anzai, T Yoshikawa, Y Asakura, S Ishikawa, H Mitamura, S Ogawa  INTERNATIONAL JOURNAL OF CARDIOLOGY  75-  (2-3)  253  -260  2000/09  [Not refereed][Not invited]
   

  Background: No-reflow phenomenon after primary coronary angioplasty is associated with poorer left ventricular (LV) function and prognosis after acute myocardial infarction (AMI). The purpose of this study was to determine the clinical significance of preinfarction angina in the no-reflow phenomenon. Methods and results: A total of 40 patients with first anterior AMI were examined. All patients underwent primary balloon angioplasty or stenting within 12 h of the onset of AMI. No-reflow, defined as TIMI grade 2 flow or less without residual stenosis after angioplasty, was observed in 15 patients. Patients with no-reflow were older (67 +/- 9 vs. 58 +/- 10 years, P = 0.006) and had a lower incidence of preinfarction angina (7% vs. 48%, P = 0.01) than those without no-reflow. Patients with no-reflow had poorer LV function at predischarge and a higher incidence of pump failure, LV aneurysm, malignant ventricular arrhythmias or cardiac death during the hospital course in association with higher peak serum C-reactive protein levels (12.7 +/- 8.0 vs. 7.1 +/- 5.5 mg/dl, P = 0.02). Multivariate analysis showed that the absence of preinfarction angina was a major independent determinant of no-reflow (RR = 17.1, P = 0.02). Conclusions: The absence of preinfarction angina is more frequently observed in patients with no-reflow. The beneficial effect of preinfarction angina on LV function may be explained, at least in part, by prevention of no-reflow after reperfusion. (C) 2000 Elsevier Science ireland Ltd. All rights reserved.
• Absence of preinfarction angina is associated with a risk of no-reflow phenomenon after primary coronary angioplasty for a first anterior wall acute myocardial infarction

  T Takahashi, T Anzai, T Yoshikawa, Y Asakura, S Ishikawa, H Mitamura, S Ogawa  INTERNATIONAL JOURNAL OF CARDIOLOGY  75-  (2-3)  253  -260  2000/09  [Not refereed][Not invited]
   

  Background: No-reflow phenomenon after primary coronary angioplasty is associated with poorer left ventricular (LV) function and prognosis after acute myocardial infarction (AMI). The purpose of this study was to determine the clinical significance of preinfarction angina in the no-reflow phenomenon. Methods and results: A total of 40 patients with first anterior AMI were examined. All patients underwent primary balloon angioplasty or stenting within 12 h of the onset of AMI. No-reflow, defined as TIMI grade 2 flow or less without residual stenosis after angioplasty, was observed in 15 patients. Patients with no-reflow were older (67 +/- 9 vs. 58 +/- 10 years, P = 0.006) and had a lower incidence of preinfarction angina (7% vs. 48%, P = 0.01) than those without no-reflow. Patients with no-reflow had poorer LV function at predischarge and a higher incidence of pump failure, LV aneurysm, malignant ventricular arrhythmias or cardiac death during the hospital course in association with higher peak serum C-reactive protein levels (12.7 +/- 8.0 vs. 7.1 +/- 5.5 mg/dl, P = 0.02). Multivariate analysis showed that the absence of preinfarction angina was a major independent determinant of no-reflow (RR = 17.1, P = 0.02). Conclusions: The absence of preinfarction angina is more frequently observed in patients with no-reflow. The beneficial effect of preinfarction angina on LV function may be explained, at least in part, by prevention of no-reflow after reperfusion. (C) 2000 Elsevier Science ireland Ltd. All rights reserved.
• 循環器救急医療における問題点と対策 循環器救急医療における救急部門の役割と機能評価

  中村 岩男, 堀 進悟, 鈴木 昌, 相川 直樹, 高月 誠司, 安斉 俊久, 吉川 勉, 朝倉 靖, 石川 士郎, 三田村 秀雄  Journal of Cardiology  36-  (Suppl.I)  100  -100  2000/08  [Not refereed][Not invited]
  
• 心不全の治療 アンジオテンシン受容体拮抗薬とアンジオテンシン変換酵素阻害薬の相違

  安斉 俊久  呼吸と循環  48-  (6)  613  -618  2000/06  [Not refereed][Not invited]
  
• 血栓内膜摘除術により著明な改善を認めた慢性肺血栓塞栓症の1例

  藤倉 加奈, 佐藤 徹, 富田 雄一, 高橋 栄一, 安斉 俊久, 吉川 勉, 三田村 秀雄, 小川 聡, 坂巻 文雄, 安藤 太三  日本内科学会関東地方会  481回-  35  -35  2000/05  [Not refereed][Not invited]
  
• Microvascular angina様の臨床経過を示し,急激な虚血性心筋障害をきたした心アミロイドーシスの1例

  吉崎 崇仁, 山根 明子, 安斉 俊久, 佐野 元昭, 石井 士郎, 朝倉 靖, 吉川 勉, 三田村 秀雄, 小川 聡  Japanese Circulation Journal  64-  (Suppl.II)  747  -747  2000/04  [Not refereed][Not invited]
  
• 主肺動脈拡張により左冠動脈主幹部(LMT)狭窄をきたした,肺高血圧症合併心房中隔欠損症の1例

  泉谷 幹子, 家田 真樹, 佐藤 徹, 杵渕 修, 高橋 栄一, 安斉 俊久, 岩永 史郎, 石川 士郎, 朝倉 靖, 吉川 勉  Japanese Circulation Journal  64-  (Suppl.II)  756  -756  2000/04  [Not refereed][Not invited]
  
• コロキウムVII-6 梗塞後リモデリング現象 : 臨床の立場から

  吉川 勉, 安斎 俊久, 高橋 寿由樹, 小川 聡  Japanese circulation journal  64-  96  -96  2000/03/01
• 急性心筋梗塞に対するdirect PTCA後No-Reflow現象に及ぼす梗塞前狭心症の影響

  高橋 寿由樹, 安斉 俊久, 吉川 勉, 朝倉 靖, 石川 士郎, 小川 聡  Japanese Circulation Journal  64-  (Suppl.I)  385  -385  2000/03
• 0615 心不全急性増悪期における強心薬としては何が適当か? : カテコラミンとフォスフォジエステラーゼ阻害薬の比較試験

  河村 朗夫, 吉川 勉, 林 丈晴, 高橋 寿由樹, 中村 岩男, 馬場 彰泰, 安齋 俊久, 高橋 栄一, 佐藤 徹, 小川 聡  Japanese circulation journal  64-  (0)  339  -339  2000/03/01  [Not refereed][Not invited]
  
• 急性心筋梗塞後の梗塞部伸展における血清CRP値の意義

  高橋 寿由樹, 安斉 俊久, 吉川 勉, 朝倉 靖, 石川 士郎, 前川 裕一郎, 小川 聡, 鈴木 雅裕  Japanese Circulation Journal  64-  (Suppl.I)  242  -242  2000/03  [Not refereed][Not invited]
  
• 心筋梗塞後左室リモデリングにおける心筋β受容体反応性低下の機序 G蛋白共役受容体燐酸化酵素(GRK)及びプロテインキナーゼC(PKC)の発現

  高橋 寿由樹, 安斉 俊久, 吉川 勉, 岩田 道圭, 前川 裕一郎, 小川 聡  Japanese Circulation Journal  64-  (Suppl.I)  506  -506  2000/03  [Not refereed][Not invited]
  
• 拡張型心筋症における抗β1アドレナリン受容体自己抗体の臨床的意義

  岩田 道圭, 吉川 勉, 馬場 彰泰, 中村 岩男, 安斉 俊久, 林 丈晴, 高橋 寿由樹, 小川 聡  Japanese Circulation Journal  64-  (Suppl.I)  366  -366  2000/03  [Not refereed][Not invited]
  
• Presynaptic modulation of the norepinephrine-induced β-adrenergic receptor desensitization phenomenon in vivo

  Nakamura Iwao, Yoshikawa Tsutomu, Anzai Toshihisa, Baba Akiyasu, Iwata Michikado, Wainai Yumiko, Suzuki Masahiro, Ogawa Satoshi  Journal of Cardiac Failure  6-  (4)  350  -358  2000  [Not refereed][Not invited]
  
• Presynaptic modulation of the norepinephrine-induced beta-adrenergic receptor desensitization phenomenon in vivo

  Nakamura Iwao, Yoshikawa Tsutomu, Anzai Toshihisa, Baba Akiyasu, Iwata Michikado, Wainai Yumiko, Suzuki Masahiro, Ogawa Satoshi  Journal of Cardiac Failure  6-  (4)  350  -358  2000  [Not refereed][Not invited]
   

  BACKGROUND: In vivo administration of norepinephrine fails to cause beta-adrenergic receptor desensitization. However, short-term exposure of cultured cells to norepinephrine induces the phenomenon in vitro. We sought to identify the local regulatory mechanisms responsible for in vivo beta-adrenergic receptor desensitization in congestive heart failure. METHODS AND RESULTS: Control rabbits received norepinephrine (n = 7) or saline (n = 7) for 1 week, and rabbits with chemical denervation induced by 6-hydroxydopamine also received norepinephrine (n = 7) or saline (n = 7). Myocardial norepinephrine content decreased 80% in both groups of denervated rabbits. beta1-Adrenergic receptor density in denervated rabbits receiving norepinephrine was lower than in those receiving saline but not in control rabbits receiving norepinephrine. Isoproterenol-competition assay revealed that there was a lower number of high-affinity binding sites with loss of guanosine triphosphate shift in denervated rabbits receiving norepinephrine. Isoproterenol-stimulated adenylyl cyclase activity in control rabbits receiving norepinephrine was lower than in those receiving saline. In denervated rabbits receiving norepinephrine, forskolin-stimulated adenylyl cyclase activity was also reduced. Immunoreactive G-protein coupled receptor kinase-2 level was increased in denervated rabbits receiving norepinephrine. CONCLUSION: There are profound alterations in beta-adrenergic receptor signaling after exposure to norepinephrine in the denervated heart. Defects in neuronal uptake may play a pivotal role in beta-adrenergic receptor desensitization in vivo.
• Autoantibody against Na-K-ATPase predicts electrical instability in patients with idiopathic dilated cardiomyopathy

  T Hayashi, T Yoshikawa, A Baba, M Iwata, TK Takahashi, Nakamura, I, T Anzai  CIRCULATION  100-  (18)  862  -862  1999/11  [Not refereed][Not invited]
  
• 78)興味ある心エコー所見を呈した血栓形成期のLoeffler心内膜炎の一例

  太田 賢一, 高橋 暁行, 岩永 史郎, 〓〓 貴博, 安斎 俊久, 石川 士郎, 朝倉 靖, 吉川 勉, 三田村 秀雄, 小川 聡  Japanese circulation journal  63-  (3)  844  -844  1999/10/20
• 実験室から ベッドサイドへ CRPとventricular rupture

  安斉 俊久  Cardiologist  4-  (4)  279  -283  1999/04  [Not refereed][Not invited]
  
• 拡張型心筋症患者におけるNa-K-ATPase自己抗体の臨床的意義

  林 丈晴, 吉川 勉, 馬場 彰泰, 岩田 道圭, 高橋 寿由樹, 中村 岩男, 安斉 俊久, 小川 聡  Japanese Circulation Journal  63-  (Suppl.I)  290  -290  1999/03  [Not refereed][Not invited]
  
• β遮断薬の梗塞後心破裂及び梗塞部伸展に及ぼす影響 血清CRP値を指標として

  安斉 俊久, 吉川 勉, 高橋 寿由樹, 朝倉 靖, 石川 士郎, 岩永 史郎, 三田村 秀雄, 小川 聡  Japanese Circulation Journal  63-  (Suppl.I)  341  -341  1999/03  [Not refereed][Not invited]
  
• 特発性心筋症の成因における自己免疫機序 β1アドレナリン受容体第2細胞外ループの役割

  岩田 道圭, 吉川 勉, 馬場 彰泰, 中村 岩男, 安斉 俊久, 林 丈晴, 高橋 寿由樹, 和井内 由充子, 小川 聡  Japanese Circulation Journal  63-  (Suppl.I)  461  -461  1999/03  [Not refereed][Not invited]
  
• 交感神経の除神経はノルエピネフリンによる心筋βアドレナリン受容体の脱感作現象を促進する

  中村 岩男, 吉川 勉, 岩田 道圭, 安斉 俊久, 馬場 彰泰, 和井内 由充子, 小川 聡  Japanese Circulation Journal  63-  (Suppl.I)  477  -477  1999/03  [Not refereed][Not invited]
  
• CRPとventricular rupture

  安斎俊久  Cardiologist  4-  (4)  279  -283  1999  [Not refereed][Not invited]
  
• 【心血管系とサイトカイン】 心肥大とサイトカイン

  安斉 俊久, 小川 聡  循環器科  44-  (6)  511  -514  1998/12  [Not refereed][Not invited]
  
• 急性心筋梗塞症における血清C-reactive protein増加の臨床的意義 梗塞後リモデリングの予測因子としての新たなる可能性

  吉川 勉, 安斉 俊久  呼吸と循環  46-  (5)  477  -482  1998/05  [Not refereed][Not invited]
  
• Association between preinfarction angina and a lower risk of right ventricular infarction

  Hiroto Shiraki, Tsutomu Yoshikawa, Toshihisa Anzai, Koji Negishi, Tetsuo Takahashi, Yasushi Asakura, Makoto Akaishi, Hideo Mitamura, Satoshi Ogawa  New England Journal of Medicine  338-  (14)  941  -947  1998/04/02  [Not refereed][Not invited]
   

  Background: Right ventricular infarction occurs in conjunction with inferior myocardial infarction caused by proximal occlusion of the right coronary artery. However, right ventricular infarction occurs infrequently, and the reasons for this are uncertain. Methods: We retrospectively assessed the association between preinfarction angina and right ventricular infarction, as well as the short-term outcome, in 113 patients with a first acute inferior myocardial infarction caused by right-coronary-artery occlusion. The association between the timing of angina during the week before infarction and the clinical outcome was also assessed. Results: The absence of preinfarction angina predicted the development of right ventricular infarction (odds ratio, 6.3 95 percent confidence interval, 2.7 to 15.1 P< 0.001), complete atrioventricular block (odds ratio, 3.6 95 percent confidence interval, 1.4 to 10.3 P = 0.01), and combined hypotension and shock (odds ratio, 12.4 95 percent confidence interval, 4.5 to 40.6 P< 0.001). Angina 24 to 72 hours before infarction was most strongly associated with reductions in the rates of right ventricular infarction (adjusted odds ratio, 0.2 95 percent confidence interval, 0 to 0.8 P = 0.02) and combined hypotension and shock (adjusted odds ratio, 0.1 95 percent confidence interval, 0 to 0.5 P = 0.02). Conclusions: Preinfarction angina was an independent predictor of the absence of right ventricular infarction in patients with acute inferior myocardial infarction. The patients with preinfarction angina also had better short-term outcomes than those without preinfarction angina.
• Association between preinfarction angina and a lower risk of right ventricular infarction

  H Shiraki, T Yoshikawa, T Anzai, K Negishi, T Takahashi, Y Asakura, M Akaishi, H Mitamura, S Ogawa  NEW ENGLAND JOURNAL OF MEDICINE  338-  (14)  941  -947  1998/04  [Not refereed][Not invited]
   

  Background Right ventricular infarction occurs in conjunction with inferior myocardial infarction caused by proximal occlusion of the right coronary artery. However, right ventricular infarction occurs infrequently, and the reasons for this are uncertain. Methods We retrospectively assessed the association between preinfarction angina and right ventricular infarction, as well as the short-term outcome, in 113 patients with a first acute inferior myocardial infarction caused by right-coronary-artery occlusion. The association between the timing of angina during the week before infarction and the clinical outcome was also assessed. Results The absence of preinfarction angina predicted the development of right ventricular infarction (odds ratio, 6.3; 95 percent confidence interval, 2.7 to 15.1; P<0.001), complete atrioventricular block (odds ratio, 3.6; 95 percent confidence interval, 1.4 to 10.3; P=0.01), and combined hypotension and shock (odds ratio, 12.4; 95 percent confidence interval, 4.5 to 40.6; P<0.001). Angina 24 to 72 hours before infarction was most strongly associated with reductions in the rates of right ventricular infarction (adjusted odds ratio, 0.2; 95 percent confidence interval, 0 to 0.8; P=0.02) and combined hypotension and shock (adjusted odds ratio, 0.1; 95 percent confidence interval, 0 to 0.5; P=0.02). Conclusions Preinfarction angina was an independent predictor of the absence of right ventricular infarction in patients with acute inferior myocardial infarction. The patients with preinfarction angina also had better short-term outcomes than those without preinfarction angina. (C) 1998, Massachusetts Medical Society.
• Angiotensin converting enzyme inhibition increases cardiac adenylycyclase expression in congestive heart failure

  T Anzai, M Gao, NC Lai, HK Hammond  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  31-  (2)  428A  -429A  1998/02  [Not refereed][Not invited]
  
• C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction

  T Anzai, T Yoshikawa, H Shiraki, Y Asakura, M Akaishi, H Mitamura, S Ogawa  CIRCULATION  96-  (3)  778  -784  1997/08  [Not refereed][Not invited]
   

  Background Pump failure after acute myocardial infarction (AMI) can be predicted by several indices that estimate infarct size. However, there are few indices that predict infarct expansion and cardiac rupture. We focused on the prognostic significance of serum C-reactive protein (CRP) after AMI. Methods and Results Serum CRP levels were measured every 24 hours in 220 patients with a first Q-wave AMI. In-hospital complications, predischarge left ventriculographic findings, and long-term prognosis were assessed in relation to peak CRP levels. Peak levels of both CRP and creatine kinase (CK) were higher in patients with pump failure than in those without pump failure. In patients with cardiac rupture, peak CRP levels were higher than in those without rupture (P=.001); peak CK levels were not predictive. Higher CRP levels were found in patients with left ventricular aneurysm (P=.001 versus those without), aggravated heart failure (P=.03 versus those without), and cardiac death (P<.0001 versus survivors) during the first year after AMI. Multivariate analysis confirmed that an elevation of the peak CRP level greater than or equal to 20 mg/dL was an independent predictor of cardiac rupture (relative risk, 4.72; P=.004), left ventricular aneurysmal formation (relative risk, 2.11; P=.03), and 1-year cardiac death (relative risk, 3.44; P<.0001). Conclusions Cardiac rupture, left ventricular aneurysmal formation, and 1-year cardiac death were associated with an elevation of serum CRP early after AMI, suggesting that elevation of CRP levels after AMI may predict infarct expansion.
• P232 ALTERATIONS IN THE β-ADRENERGIC SIGNAL TRANSDUCTION IN DENERVATED RABBIT MYOCARDIUM

  Nakamura Iwao, Yoshikawa Tsutomu, Anzai Toshihisa, Shiraki Hiroto, Baba Akiyasu, Nagami Keiichi, Nishimura Hiroshi, Suzuki Masahiro, Wainai Yumiko, Ogawa Satoshi  Japanese circulation journal  61-  (7)  604  -604  1997/06/20
• 0242 LOCAL ALTERATION IN β-ADRENERGIC RECEPTOR SIGNALING IN HEART FAILURE : EFFECT OF SYMPATHETIC DENERVATION

  Yoshikawa Tsutomu, Anzai Toshihisa, Baba Akiyasu, Shiraki Hiroto, Nishimura Hiroshi, Nagami Keiichi, Suzuki Masahiro, Wainai Yumiko, Ogawa Satoshi  Japanese circulation journal  61-  (7)  552  -552  1997/06/20
• 0242 不全心におけるβ受容体シグナル伝達系の局所的変化 : 除神経前処置の影響

  吉川 勉, 安斉 俊久, 馬場 彰泰, 白木 裕人, 西村 洋, 永見 圭一, 鈴木 雅裕, 和井内 由充子, 小川 聡  Japanese circulation journal  61-  (0)  171  -171  1997/03/05  [Not refereed][Not invited]
  
• P232 Denervation supersensitivityにおけるβ受容体シグナル伝達系の変化

  中村 岩男, 吉川 勉, 安斉 俊久, 馬場 彰泰, 永見 圭一, 西村 洋, 鈴木 雅裕, 和井内 由充子, 小川 聡  Japanese circulation journal  61-  (0)  443  -443  1997/03/05  [Not refereed][Not invited]
  
• Abnormal beta-adrenergic transmembrane signaling in rabbits with adriamycin-induced cardiomyopathy

  K Nagami, T Yoshikawa, M Suzuki, Y Wainai, T Anzai, S Handa  JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION  61-  (3)  249  -255  1997/03  [Not refereed][Not invited]
   

  We investigated alterations in the beta-adrenergic receptor-adenylate cyclase system in rabbits with congestive heart failure induced by adriamycin cardiotoxicity. A dose of 24 mg/kg adriamycin was administered over 16 weeks in 16 rabbits. Five of them died and 4 of them could not tolerate the full dose of adriamycin. Complete data were obtained in the remaining 7 rabbits. Another 7 rabbits received physiological saline for the same period and served as controls. Plasma norepinephrine concentration increased in adriamycin-treated rabbits, but not in the control rabbits. Cardiac output was lower in the adriamycin-treated group than in the control group. Both the left and right ventricular end-diastolic pressure were higher in the adriamycin-treated group. The density of myocardial beta-adrenergic receptors and the norepinephrine content were reduced in both ventricles in the adriamycin-treated group. Basal and isoproterenol-, sodium fluoride- and forskolin-stimulated adenylate cyclase activities were lower in the adriamycin-treated group, Thus, alterations in beta-adrenergic signaling occurred in both ventricles in animals with chronic biventricular failure induced by adriamycin. These may be the result of post-receptor abnormalities, including abnormalities of guanine nucleotide-binding proteins or of the catalytic unit of adenylate cyclase.
• C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q wave acute myocardial infarction

  T Anzai, T Yoshikawa, H Shiraki, Y Asakura, M Akaishi, H Mitamura, S Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  29-  (2)  92630  -92630  1997/02  [Not refereed][Not invited]
  
• Effects of methylprednisolone on hemodynamics and beta-adrenergic receptor signaling in rabbits with acute left ventricular failure

  H Nishimura, T Yoshikawa, N Kobayashi, T Anzai, K Nagami, S Handa, S Ogawa  HEART AND VESSELS  12-  (2)  84  -91  1997  [Not refereed][Not invited]
   

  Studies suggest that corticosteroids may restore the responsiveness to catecholamines in hypotensive patients. Since the significance of this promising intervention in congestive heart failure remains to be explored, we determined the effects of methylprednisolone, a potent activator of beta-adrenergic receptor signaling, on hemodynamics and beta-adrenergic receptor regulation in an animal model of heart failure. Acute left ventricular overloading was produced by aortic regurgitation (AR) in 22 Japanese white rabbits. Eleven animals received an intravenous administration of methylprednisolone (AR+PSL), while 11 received saline (AR+C) for 1 week. A sham operation was performed on 10 other rabbits (S). There was no difference between the AR+C and AR+PSL groups in the decrease in aortic diastolic pressure immediately after the production of AR. The aortic diastolic pressure and regurgitant fractions were also similar in the two groups. The left ventricular end-diastolic and end-systolic dimensions were both larger, and the left ventricular end-diastolic pressure was higher in AR+C or AR+PSL than in S rabbits. Between the AR+C and AR+PSL, there were no differences in any of these variables. Cardiac output was lower in AR+C, but not in AR+PSL, than in S. Cardiac output in AR+PSL was significantly higher than in AR+C. The myocardial concentration of norepinephrine and the number of beta-adrenergic receptors were both lower in the AR+C and AR+PSL than in the S groups. The number of receptors in AR+PSL was higher than in AR+C. Maximal isoproterenol-stimulated adenylyl cyclase activity was similar in the ARI-C and AR+PSL groups. Results suggest methylprednisolone yielded some benefits, including an increase in cardiac output and in total beta-adrenergic receptor number, in this animal model of heart failure.
• Abnormal β-adrenergic transmembrane signaling in rabbits with adriamycin-induced cardiomyopathy

  Keiichi Nagami, Tsutomu Yoshikawa, Masahiro Suzuki, Yumiko Wainai, Toshihisa Anzai, Shunnosuke Handa  Japanese Circulation Journal  61-  (3)  249  -255  1997  [Not refereed][Not invited]
   

  We investigated alterations in the β-adrenergic receptor-adenylate cyclase system in rabbits with congestive heart failure induced by adriamycin cardiotoxicity. A dose of 24 mg/kg adriamycin was administered over 16 weeks in 16 rabbits. Five of them died and 4 of them could not tolerate the full dose of adriamycin. Complete data were obtained in the remaining 7 rabbits. Another 7 rabbits received physiological saline for the same period and served as controls. Plasma norepinephrine concentration increased in adriamycin-treated rabbits, but not in the control rabbits. Cardiac output was lower in the adriamycin-treated group than in the control group. Both the left and right ventricular end-diastolic pressure were higher in the adriamycin-treated group. The density of myocardial β-adrenergic receptors and the norepinephrine content were reduced in both ventricles in the adriamycin-treated group. Basal and isoproterenol-, sodium fluoride- and forskolin-stimulated adenylate cyclase activities were lower in the adriamycin-treated group. Thus, alterations in β-adrenergic signaling occurred in both ventricles in animals with chronic biventricular failure induced by adriamycin. These may be the result of post-receptor abnormalities, including abnormalities of guanine nucleotide-binding proteins or of the catalytic unit of adenylate cyclase.
• Effects of methylprednisolone on hemodynamics and beta-adrenergic receptor signaling in rabbits with acute left ventricular failure

  H Nishimura, T Yoshikawa, N Kobayashi, T Anzai, K Nagami, S Handa, S Ogawa  HEART AND VESSELS  12-  (2)  84  -91  1997  [Not refereed][Not invited]
   

  Studies suggest that corticosteroids may restore the responsiveness to catecholamines in hypotensive patients. Since the significance of this promising intervention in congestive heart failure remains to be explored, we determined the effects of methylprednisolone, a potent activator of beta-adrenergic receptor signaling, on hemodynamics and beta-adrenergic receptor regulation in an animal model of heart failure. Acute left ventricular overloading was produced by aortic regurgitation (AR) in 22 Japanese white rabbits. Eleven animals received an intravenous administration of methylprednisolone (AR+PSL), while 11 received saline (AR+C) for 1 week. A sham operation was performed on 10 other rabbits (S). There was no difference between the AR+C and AR+PSL groups in the decrease in aortic diastolic pressure immediately after the production of AR. The aortic diastolic pressure and regurgitant fractions were also similar in the two groups. The left ventricular end-diastolic and end-systolic dimensions were both larger, and the left ventricular end-diastolic pressure was higher in AR+C or AR+PSL than in S rabbits. Between the AR+C and AR+PSL, there were no differences in any of these variables. Cardiac output was lower in AR+C, but not in AR+PSL, than in S. Cardiac output in AR+PSL was significantly higher than in AR+C. The myocardial concentration of norepinephrine and the number of beta-adrenergic receptors were both lower in the AR+C and AR+PSL than in the S groups. The number of receptors in AR+PSL was higher than in AR+C. Maximal isoproterenol-stimulated adenylyl cyclase activity was similar in the ARI-C and AR+PSL groups. Results suggest methylprednisolone yielded some benefits, including an increase in cardiac output and in total beta-adrenergic receptor number, in this animal model of heart failure.
• C-Reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction

  Anzai Toshihisa, Yoshikawa Tsutomu, Shiraki Hiroto, Asakura Yasushi, Akaishi Makoto, Mitamura Hideo, Ogawa Satoshi  Circulation  96-  (8)  778  -784  1997  [Not refereed][Not invited]
  
• Myocardial sympathetic denervation prevents chamber-specific alteration of beta-adrenergic transmembrane signaling in rabbits with heart failure

  T Anzai, T Yoshikawa, A Baba, H Nishimura, H Shiraki, K Nagami, M Suzuki, Y Wainai, S Ogawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  28-  (5)  1314  -1322  1996/11  [Not refereed][Not invited]
   

  Objectives. The purpose of this study was to assess the effect of myocardial sympathetic denervation on the chamber-specific alteration of beta-adrenergic signaling in left ventricular failure in rabbits. Background. Local abnormalities in sympathetic nerve terminals, including the neuronal reuptake of norepinephrine, are thought to be responsible far the chamber-specific regulation of beta-adrenergic signaling in heart failure. Methods. Sixteen rabbits were given 6-hydroxydopamine, 25 mg/kg body weight intravenously on days 1 and 2 and 50 mg/kg intravenously on days 7 and 8. Another 16 rabbits received vehicle. Aortic regurgitation was induced in eight of the 6-hydroxydopamine-treated and eight of the vehicle-treated rabbits on day 14. Another eight of the 6-hydroxydopamine-treated and eight of the vehicle-treated rabbits underwent a sham operation. The hearts were excised for biochemical analysis on day 21. Results. Hemodynamic characteristics on day 21 showed left ventricular failure in both the aortic regurgitation groups, The plasma norepinephrine concentration on day 21 was higher in both the aortic regurgitation groups than in the sham groups, The beta adrenoceptor densities and isoproterenol plus 5'-guanylylimidodiphosphate-, 5'-guanylyimidodiphosphate- and sodium fluoride-stimulated adenylyl cyclase activities were decreased only in the failing left ventricle of the vehicle-pretreated aortic regurgitation group, but in both ventricles of the 6-hydroxydopamine-pretreated aortic regurgitation group, The basal and forskolin-stimulated adenylyl cyclase activities were similar in both the aortic regurgitation groups and in the sham groups. Conclusions. Sympathetic denervation prevented chamber-specific alterations in beta-adrenergic signaling in acute left ventricular failure, Local loss of sympathetic nerve endings, and especially the defective neuronal norepinephrine reuptake, are likely to be responsible far the chamber-specific alteration of the beta-adrenoceptor-G protein-adenylyl cyclase system in heart failure in rabbits.
• Reduced myocardial G-protein receptor kinase in pacing-induced heart failure after angiotensin converting enzyme inhibition

  T Anzai, MH Gao, PP Ping, HK Hammond  CIRCULATION  94-  (8)  3759  -3759  1996/10  [Not refereed][Not invited]
  
• The protective effect of preinfarction angina against the development of right ventricular infarction

  H Shiraki, T Yoshikawa, S Iwanaga, T Anzai, Y Asakura, M Shimada, T Adachi, M Akaishi, S Ogawa  CIRCULATION  94-  (8)  3580  -3580  1996/10  [Not refereed][Not invited]
  
• The clinical significance of apical wall motion for the development of mitral regurgitation in acute inferior myocardial infarction

  SHIRAKI Hiroto, NEGISHI Koji, AKAISHI Makoto, ANZAI Toshihisa, ASANAGI Mika, IWANAGA Shiro, WAINAI Yumiko, TAKAHASHI Tetsuo, ONISHI Shohei, YOSHIKAWA Tsutomu, MITAMURA Hideo, OGAWA Satoshi  Japanese circulation journal  60-  (7)  412  -413  1996/06/20
• Assessing the significance of preinfarction angina - Reply

  T Anzai, T Yoshikawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  27-  (6)  1551  -1551  1996/05  [Not refereed][Not invited]
  
• Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction - Reply

  T Anzai, T Yoshikawa  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  27-  (4)  955  -956  1996/03  [Not refereed][Not invited]
  
• Early reduction of neurohumoral factors plays a key role in mediating the efficacy of beta-blocker therapy for congestive heart failure

  T Yoshikawa, S Handa, T Anzai, H Nishimura, A Baba, M Akaishi, H Mitamura, S Ogawa  AMERICAN HEART JOURNAL  131-  (2)  329  -336  1996/02  [Not refereed][Not invited]
   

  This study examined the role played by neurohumoral factors in mediating the effects of beta-blocker therapy for congestive heart failure. Fifteen patients with congestive heart failure underwent beta-blocker therapy. Plasma norepinephrine and alpha-atrial natriuretic peptide concentrations decreased 2 weeks after initiation of beta-blocker therapy. Decrease in plasma norepinephrine level persisted for 6 months. Lymphocyte beta-adrenoceptor density increased 2 weeks after therapy but was not increased 6 months later. Left ventricular ejection fraction was unchanged 2 weeks after therapy, but it increased 6 months after introduction of beta-blockers. Plasma norepinephrine level decreased 2 weeks after the therapy in the responders (increase in ejection fraction >0.10) but not in the nonresponders. Thus early reduction of neurohumoral factor levels preceded the late improvement of left ventricular contractile function and may therefore be partly responsible for the efficacy of beta-blocker therapy for congestive heart failure.
• Early reduction of neurohumoral factors plays a key role in mediating the efficacy of beta-blocker therapy for congestive heart failure

  T Yoshikawa, S Handa, T Anzai, H Nishimura, A Baba, M Akaishi, H Mitamura, S Ogawa  AMERICAN HEART JOURNAL  131-  (2)  329  -336  1996/02  [Not refereed][Not invited]
   

  This study examined the role played by neurohumoral factors in mediating the effects of beta-blocker therapy for congestive heart failure. Fifteen patients with congestive heart failure underwent beta-blocker therapy. Plasma norepinephrine and alpha-atrial natriuretic peptide concentrations decreased 2 weeks after initiation of beta-blocker therapy. Decrease in plasma norepinephrine level persisted for 6 months. Lymphocyte beta-adrenoceptor density increased 2 weeks after therapy but was not increased 6 months later. Left ventricular ejection fraction was unchanged 2 weeks after therapy, but it increased 6 months after introduction of beta-blockers. Plasma norepinephrine level decreased 2 weeks after the therapy in the responders (increase in ejection fraction >0.10) but not in the nonresponders. Thus early reduction of neurohumoral factor levels preceded the late improvement of left ventricular contractile function and may therefore be partly responsible for the efficacy of beta-blocker therapy for congestive heart failure.
• Myocardial sympathetic denervation prevents chamber-specific alteration of β-adrenergic transmembrane signaling in rabbits with heart failure

  Anzai Toshihisa, Yoshikawa Tsutomu, Baba Akiyasu, Nishimura Hiroshi, Shiraki Hiroto, Nagami Keiichi, Suzuki Masahiro, Wainai Yukiko, Ogawa Satoshi  J Am Coll Cardiol  28-  (11)  1314  -1322  1996  [Not refereed][Not invited]
  
• PREINFARCTION ANGINA AS A MAJOR PREDICTOR OF LEFT-VENTRICULAR FUNCTION AND LONG-TERM PROGNOSIS AFTER A FIRST Q-WAVE MYOCARDIAL-INFARCTION

  T ANZAI, T YOSHIKAWA, Y ASAKURA, S ABE, M AKAISHI, H MITAMURA, S HANDA, S OGAWA  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  26-  (2)  319  -327  1995/08  [Not refereed][Not invited]
   

  Objectives. The purpose of this study was to assess the prognostic significance of preinfarction angina after a first Q wave myocardial infarction. Patients with anterior or inferior myocardial infarction were compared. Background. The effect of preinfarction angina on prognosis after anterior and inferior myocardial infarction remains unclear. Methods. A total of 291 patients,vith a first Q wave anterior (n = 171) or inferior (n = 120) myocardial infarction were examined to assess the effect of preinfarction angina on short- and long term prognosis. The relation between predischarge left ventriculographic findings and preinfarction angina was also examined. Results. The presence of preinfarction angina was associated with lower peak creatine kinase activity, a lower in-hospital incidence of sustained ventricular tachycardia and fibrillation and a lower incidence of pump failure and cardiac mortality in patients with either anterior or inferior infarction. Among patients with anterior infarction, preinfarction angina was associated with a lower incidence of cardiac rupture and less need for readmission for heart failure, within 1 year after the onset of infarction. In this subgroup it was also associated with a higher ejection fraction, a smaller end-diastolic volume and a lower incidence of aneurysm formation noted on ventriculography during convalescence. In patients with inferior infarction, these variables did not differ significantly in the presence or absence of preinfarction angina. Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of development of ventricular aneurysm, late phase heart failure and 1-year cardiac mortality. Conclusions. The presence of preinfarction angina has a favorable effect on infarct expansion and late phase left ventricular function, especially in patients with anterior myocardial infarction. The mechanisms responsible for this phenomenon are not known but may be secondary to limitations of infarct size through unidentified mechanisms other than collateralization (e.g., ischemic preconditioning).
• 重症冠動脈疾患に合併した難治性不整脈の一例

  安斉 俊久, 小川 聡  臨床医  21-  (8)  1995  -1999  1995/08  [Not refereed][Not invited]
  
• Effect of Angina Pectoris prior to First Q-wave Myocardial Infarction(MI)on Infarct Expansion and Longterm Prognosis:Comparison between Anterior and Inferior MI

  ANZAI Toshihisa, YOSHIKAWA Tsutomu, ASAKURA Yasushi, HIROTO Shiraki, ABE Sumihisa, AKAISHI Makoto, MITAMURA Hideo, HANDA Shunnosuke, OGAWA Satoshi  Japanese circulation journal  59-  (7)  425  -425  1995/06/20
• Chamber-specific Abnormalities in Sympathetic Signal Transduction Pathway in Acute Left Ventricular Failure

  ANZAI Toshihisa, YOSHIKAWA Tsutomu, NISHIMURA Hiroshi, SHIRAKI Hiroto, BABA Akiyasu, NAGAMI Keiichi, SUZUKI Masahiro, WAINAI Yumiko, OGAWA Satoshi  Japanese circulation journal  59-  (7)  497  -497  1995/06/20
• 0724 梗塞前狭心症の梗塞部伸展および長期予後への影響 : 前壁梗塞と下壁梗塞の比較検討

  安斉 俊久, 吉川 勉, 朝倉 靖, 白木 裕人, 阿部 純久, 赤石 誠, 三田村 秀雄, 小川 聡, 半田 俊之介  Japanese circulation journal  59-  225  -225  1995/03/01
• P257 心不全における交感神経シグナル伝達系の変化 : 急性左心不全における不全心筋特異的変化

  安斉 俊久, 吉川 勉, 西村 洋, 白木 裕人, 馬場 彰泰, 氷見 圭一, 鈴木 雅裕, 和井内 由充子, 小川 聡  Japanese circulation journal  59-  (0)  465  -465  1995/03/01  [Not refereed][Not invited]
  
• P355 慢性心不全患者の病因, 症状と自律神経活動 : 心臓死の指標

  馬場 彰泰, 吉川 勉, 三田村 秀雄, 西村 洋, 安斉 俊久, 高橋 哲夫, 根岸 耕二, 村山 晃, 横塚 仁, 永見 圭一, 山田 隆康, 鈴木 雅裕, 三谷 和彦, 赤石 誠, 小川 聡, 半田 俊之介  Japanese circulation journal  59-  (0)  490  -490  1995/03/01  [Not refereed][Not invited]
  
• Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction.

  T Anzai, T Yoshikawa, Y Asakura, S Abe, M Akaishi, H Mitamura, S Handa, S Ogawa  Journal of the American College of Cardiology  26-  (2)  319  -327  1995  [Not refereed][Not invited]
   

  OBJECTIVES: The purpose of this study was to assess the prognostic significance of preinfarction angina after a first Q wave myocardial infarction. Patients with anterior or inferior myocardial infarction were compared. BACKGROUND: The effect of preinfarction angina on prognosis after anterior and inferior myocardial infarction remains unclear. METHODS: A total of 291 patients with a first Q wave anterior (n = 171) or inferior (n = 120) myocardial infarction were examined to assess the effect of preinfarction angina on short- and long-term prognosis. The relation between predischarge left ventriculographic findings and preinfarction angina was also examined. RESULTS: The presence of preinfarction angina was associated with lower peak creatine kinase activity, a lower in-hospital incidence of sustained ventricular tachycardia and fibrillation and a lower incidence of pump failure and cardiac mortality in patients with either anterior or inferior infarction. Among patients with anterior infarction, preinfarction angina was associated with a lower incidence of cardiac rupture and less need for readmission for heart failure within 1 year after the onset of infarction. In this subgroup it was also associated with a higher ejection fraction, a smaller end-diastolic volume and a lower incidence of aneurysm formation noted on ventriculography during convalescence. In patients with inferior infarction, these variables did not differ significantly in the presence or absence of preinfarction angina. Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of development of ventricular aneurysm, late phase heart failure and 1-year cardiac mortality. CONCLUSIONS: The presence of preinfarction angina has a favorable effect on infarct expansion and late phase left ventricular function, especially in patients with anterior myocardial infarction. The mechanisms responsible for this phenomenon are not known but may be secondary to limitations of infarct size through unidentified mechanisms other than collateralization (e.g., ischemic preconditioning).
• Preinfarction angina as a major predictor of left ventricular funciton and long-term prognosis after a first Q wave myocardial infarction

  Anzai T, Yoshikawa T, Asakura Y, Abe S, Akaishi M, Mitamura H, Handa S, Ogawa S  J Am Coll Cardiol  26-  (2)  319  -327  1995  [Not refereed][Not invited]
  
• Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction

  Toshihisa Anzai, Tsutomu Yoshikawa, Yasushi Asakura, Sumihisa Abe, Makoto Akaishi, Hideo Mitamura, Shunnosuke Handa, Satoshi Ogawa  Journal of the American College of Cardiology  26-  (2)  319  -327  1995  [Not refereed][Not invited]
   

  Objectives. The purpose of this study was to assess the prognostic significance of preinfarction angina after a first Q wave myocardial infarction. Patients with anterior or inferior myocardial infarction were compared. Background. The effect of preinfarction angina on prognosis after anterior and inferior myocardial infarction remains unclear. Methods. A total of 291 patients with a first Q wave anterior (n = 171) or inferior (n = 120) myocardial infarction were examined to assess the effect of preinfarction angina on short- and long-term prognosis. The relation between predischarge left ventriculographic findings and preinfarction angina was also examined. Results. The presence of preinfarction angina was associated with lower peak creatine kinase activity, a lower in-hospital incidence of sustained ventricular tachycardia and fibrillation and a lower incidence of pump failure and cardiac mortality in patients with either anterior or inferior infarction. Among patients with anterior infarction, preinfarction angina was associated with a lower incidence of cardiac rupture and less need for readmission for heart failure within 1 year after the onset of infarction. In this subgroup it was also associated with a higher ejection fraction, a smaller end-diastolic volume and a lower incidence of aneurysm formation noted on ventriculography during convalescence. In patients with inferior infarction, these variables did not differ significantly in the presence or absence of preinfarction angina. Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of development of ventricular aneurysm, late phase heart failure and 1-year cardiac mortality. Conclusions. The presence of preinfarction angina has a favorable effect on infarct expansion and late phase left ventricular function, especially in patients with anterior myocardial infarction. The mechanisms responsible for this phenomenon are not known but may be secondary to limitations of infarct size through unidentified mechanisms other than collateralization (e.g., ischemic preconditioning). © 1995.
• SIGNIFICANCE OF ANGINA-PECTORIS PRIOR TO 1ST Q-WAVE ACUTE MYOCARDIAL-INFARCTION - DIFFERENCE WITH THE LOCATIONS OF MYOCARDIAL-INFARCTION

  T ANZAI, T YOSHIKAWA, T MEGURO, Y ASAKURA, S ABE, M AKAISHI, H MITAMURA, S HANDA, S OGAWA  CIRCULATION  90-  (4)  502  -502  1994/10  [Not refereed][Not invited]
  
• Significance of angina pectoris prior to first Q-wave myocardial infarction (MI) : Comparison between anterior and inferior MI.

  Anzai Toshihisa, Yoshikawa Tsutomu, Meguro Tomomi, Asakura Yasushi, Abe Sumihisa, Akaishi Makoto, Mitamura Hideo, Handa Shunnosuke, Ogawa Satoshi  Japanese circulation journal  58-  (7)  496  -497  1994/06/20
• 急性左室容量負荷の代償過程における圧受容体反射の役割 : 第58回日本循環器学会学術集会

  西村 洋, 吉川 勉, 半田 俊之介, 安斎 俊久, 小林 夏木, 鈴木 雅裕, 永見 圭一, 和井内 由充子, 小川 聡  Japanese circulation journal  58-  441  -441  1994/03/01
• 急性心筋梗塞症における梗塞前狭心症の意義 : 前壁梗塞と下壁梗塞の比較検討 : 第58回日本循環器学会学術集会

  吉川 勉, 安斎 俊久, 目黒 知己, 朝倉 靖, 阿部 純久, 赤石 誠, 三田村 秀雄, 半田 俊之介, 小川 聡  Japanese circulation journal  58-  (0)  150  -150  1994/03/01  [Not refereed][Not invited]
  
• RAPID GROWTH OF LEFT-VENTRICULAR THROMBUS LEADING TO FATAL HEART-FAILURE IN 6 HOURS

  T ANZAI, Y ASAKURA, H YOKOZUKA, M HOSOKAWA, A MURAYAMA, T ISHII, Y NAKAMURA  CARDIOLOGY  83-  (5-6)  419  -422  1993/11  [Not refereed][Not invited]
   

  A left ventricular (LV) thrombus grew rapidly over chronic endocarditis 2 months after anterior myocardial infarction. Echocardiograms demonstrated a rapidly growing LV thrombus an eventual obstruction. Despite anticoagulant/thrombolytic therapy, the patient died of acute LV failure. Histopathologically, a fresh thrombus overlay thickened endocardium with massive T lymphocyte infiltration over healed infarction.
• 左室壁在血栓が急成長し, 心不全を呈した心筋梗塞症の1例 : 日本循環器学会第143回関東甲信越地方会

  安斎 俊久, 朝倉 靖, 横塚 仁, 細川 美千代, 村山 晃  Japanese circulation journal  57-  874  -874  1993/08/20