掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jjcc.2023.06.006

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circj.cj-23-0096

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Preventing loss of life in patients with type A acute aortic dissection (AAD) who present with cardiopulmonary arrest (CPA) can be extremely difficult. Thus, we investigated the early outcomes in these patients. METHODS: Patients with type A AAD who were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with CPA and also investigated the differences in outcomes between patients with out-of-hospital and in-hospital CPA. RESULTS: A total of 3307 patients with type A AAD were transported, 434 (13.1%) of whom presented with CPA. The overall mortality of patients presenting with CPA was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital CPA and 79.4% (143/180) experienced in-hospital CPA (P < 0.001). Multivariable analysis revealed that aortic surgery [odds ratio (OR), 0.022; 95% confidence interval (CI), 0.008-0.060; P < 0.001] and patient age over 80 years (OR, 2.946; 95% CI, 1.012-8.572; P = 0.047) were related with mortality in patients with type A AAD and CPA. Between in-hospital and out-of-hospital CPA, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065-5.054; P = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056-0.629; P = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045-0.271; P = 0.001), age (OR, 0.969; 95% CI, 0.940-0.998; P = 0.039) and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025-1.228; P = 0.012) were significantly different. CONCLUSIONS: Patients with type A AAD presenting with CPA exhibited extremely high rates of death. Patient outcomes following in-hospital CPA tended to be better than those following out-of-hospital CPA; however, this difference was not significantly different. To prevent deaths, aortic surgery, when possible, should be considered in patients with type A AAD who sustained CPA.

DOI： 10.1093/ejcts/ezad056

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients with acute myocardial infarction (AMI) commonly have multiple comorbidities, and some die in hospitals due to causes other than cardiac complications. However, limited information is available on noncardiac death in patients hospitalised for AMI. Therefore, the present study was performed to determine the incidence, annual trend, clinical characteristics, and predictors of in-hospital non-cardiac death in patients with AMI using the Tokyo Cardiovascular Care Unit (CCU) network registry. METHODS: The registry included 38,589 consecutive patients with AMI who were admitted to the CCU between 2010 and 2019. The primary endpoint was in-hospital noncardiac death. Further, predictors of cardiac and non-cardiac death were identified. RESULTS: The incidence of all-cause in-hospital mortality was 7.0% (n = 2700), and the proportion of mortality was 15.6% (n = 420) and 84.4% (n = 2280) for noncardiac and cardiac causes, respectively. The proportion of noncardiac deaths did not change annually over the last decade (p = 0.66). After adjusting for all variables, age, Killip classification grade, peak creatine kinase, hemoglobin, serum creatinine, and C-reactive protein were common predictors of cardiac and non-cardiac deaths. Indicators of malnutrition, such as lower body mass index (kg/m2) [odds 0.94, 95%CI (0.90-0.97), p < 0.001] and serum low-density lipoprotein cholesterol level (per 10 mg/dl) [odds 0.92, 95%CI (0.89-0.96), p < 0.001] were the specific predictors for non-cardiac deaths. CONCLUSIONS: The incidence of in-hospital noncardiac death was significant in patients with AMI, accounting for 15.6% of all in-hospital mortalities. Thus, prevention and management of non-cardiac complications are vital to improve acute-phase outcomes, especially those with predictors of non-cardiac death.

DOI： 10.1016/j.ijcard.2023.02.022

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Takotsubo syndrome (TTS) is an acute cardiovascular disease with clinical manifestations similar to those of acute myocardial infarction (AMI), and TTS sometimes occurs just after catastrophes. Large-scale studies of TTS in Japan are scarce, so we examined data over 9 years from Tokyo metropolitan acute cardiovascular care hospital network registry. METHODS: A total of 1626 patients were diagnosed with TTS between 2010 and 2018 at Tokyo Cardiovascular Care Unit Network facilities, and data from all these patients were analyzed. We investigated annual and monthly captured incidence of TTS, temporal trend of the captured incidence proportion of TTS versus AMI, the occurrence of TTS on the day of the great earthquake, and we elucidated the prognostic factors for in-hospital death. RESULTS: The annual incidence proportion of TTS versus AMI increased from 2.3 % to 4.5 % (p < 0.001) over 9 years. The mean TTS patient age was 74.4 years: the peak incidence of TTS was at 80 to 84 years of age for both male and female; females accounted for 78.5 % of patients. The monthly variation of the incidence of TTS was found (p = 0.009). In 2011, a total of 137 cases of TTS occurred, with as many as 6 occurring on March 11, the day of the Great East Japan Earthquake. There was a definable trigger for TTS in 64 % (physical: 36 %; emotional: 27 %; others: 2 %). All-cause in-hospital mortality was 5.3 % and was higher in males than in females (10.3 % vs 3.9 %; p < 0.001). Non-cardiac causes accounted for 62 % of in-hospital mortality. Factors at presentation that were associated with in-hospital all-cause mortality were male sex, low body mass index, and a high C-reactive protein level. CONCLUSIONS: This study elucidated the clinical features, in-hospital outcomes, and their attributed factors in patients with TTS in real-world clinical practice in Japan.

DOI： 10.1016/j.jjcc.2022.12.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circrep.CR-22-0097

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 77-year-old female presented with loss of consciousness, blood pressure of 90/60 mmHg, and heart rate of 47 bpm. At admission, highly sensitive Trop-T and lactate were elevated, and an electrocardiogram revealed an infero-posterior ST elevation myocardial infarction. Echocardiography revealed a depressed left ventricular ejection fraction with abnormal wall motion in the infero-posterior region and hyperkinetic apical movement along with severe mitral regurgitation (MR). Coronary angiography showed a hypoplastic right coronary artery, 100% thrombotic occlusion of the dominant left circumflex (LCx) artery, and 75% stenosis in the left anterior descending (LAD) artery. Substantial hemodynamic improvement with the reduction of acute ischemic MR was achieved by the initiation of an Impella 2.5, which is a transvalvular axial flow pump, and successful percutaneous coronary intervention (PCI) was conducted with stents to the LCx. The patient was weaned off the Impella 2.5 in 5 days, received staged PCI to LAD, and was later discharged after completion of the staged PCI to LAD.

DOI： 10.1536/ihj.22-572

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with acute myocardial infarction (AMI) triaged as life-threatening are transferred to our emergency medical care center (EMCC). However, data on these patients remain limited. We aimed to compare the characteristics and AMI prognosis of patients transferred to our EMCC with those transferred to our cardiovascular intensive care unit (CICU) using whole and propensity-matched cohorts.We analyzed the data of 256 consecutive AMI patients transferred from the scene to our hospital by ambulance between 2014 and 2017. The EMCC and CICU groups comprised 77 and 179 patients, respectively. There were no significant between-group age or sex differences. Patients in the EMCC group had more disease severity score and had the left main trunk identified as the culprit more frequently (12% versus 0.6%, P < 0.001) than those in the CICU group; however, the number of patients with multiple culprit vessels did not differ. The EMCC group had a longer door-to-reperfusion time (75 [60, 109] minutes versus 60 [40, 86] minutes, P< 0.001) and a higher in-hospital mortality (19% versus 4.5%, P < 0.001), especially from non-cardiac causes (10% versus 0.6%, P < 0.001), than the CICU group. However, peak myocardial creatine phosphokinase did not significantly differ between the groups. The EMCC group had a significantly higher 1-year post-discharge mortality than the CICU group (log-rank, P = 0.032); this trend was maintained after propensity score matching, although the difference was not statistically significant (log-rank, P = 0.094).AMI patients transferred to the EMCC exhibited more severe disease and worse overall in-hospital and non-cardiac mortality than those transferred to the CICU.

DOI： 10.1536/ihj.22-654

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although the primary percutaneous coronary intervention (PCI) is an established treatment for acute ST-elevation myocardial infarction (STEMI), relevant guidelines do not recommend it for recent-STEMI cases with a totally occluded infarcted related artery (IRA). However, PCI is allowed in Japan for recent-STEMI cases, but little is known regarding its outcomes. We aimed to examine the details and outcomes of PCI procedures in recent-STEMI cases with a totally occluded IRA and compared the findings with those in acute-STEMI cases.Among the 903 consecutive patients admitted with acute coronary syndrome, 250 were treated with PCI for type I STEMI with a totally occluded IRA. According to the time between symptom onset and diagnosis, patients were divided into the recent-STEMI (n = 32) and acute-STEMI (n = 218) groups. The background, procedure details, and short-term outcomes were analyzed. No significant differences between the groups were noted regarding patient demographics, acute myocardial infarction severity, or IRA distribution. Although the stent number and type were similar, significant differences were observed among PCI procedures, including the number of guidewires used, rate of microcatheter or double-lumen catheter use, and application rate of thrombus aspiration. The thrombolysis rate in the myocardial infarction flow 3-grade post-PCI did not differ significantly between the groups. Both groups had a low frequency of procedure-related complications. The in-hospital mortality rates were 0% and 4.6% in the recent-STEMI and acute-STEMI groups, respectively (P > 0.05).Although recent-STEMI cases required complicated PCI techniques, their safety, success rate, and in-hospital mortality were comparable to those of acute-STEMI cases.

DOI： 10.1536/ihj.22-656

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jacasi.2022.06.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: In the management of patients with ST-elevation myocardial infarction (STEMI), system delays for reperfusion therapy are still a matter of concern. We investigated the impact of prehospital activation of the catheterization laboratory in the management of STEMI patients. Methods and Results: This is a systematic review of observational studies. A search was conducted of the PubMed database from inception to July 2020 to identify articles for inclusion in the study. The critical outcomes were short- and long-term mortality. The important outcome was door-to-balloon time. The GRADE approach was used to assess the certainty of the evidence. Seven studies assessed short-term mortality; 1,541 were assigned to the prehospital activation (PH) group and 1,191 were assigned to the emergency department activation (ED) group. There were 26 fewer deaths per 1,000 patients in the PH group. Three studies assessed long-term mortality; 713 patients were assigned to the PH group and 1,026 were assigned to the ED group. There were 54 fewer deaths per 1,000 patients among the PH group. Five studies assessed door-to-balloon time; 959 were assigned to the PH group and 631 to the ED group. Door-to-balloon time was 33.1 min shorter in the PH group. Conclusions: Prehospital activation of the catheterization laboratory resulted in lower mortality and shorter door-to-balloon time for patients with suspected STEMI outside of a hospital.

DOI： 10.1253/circrep.CR-22-0034

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chronic total occlusion (CTO) is a high-risk factor for stent thrombosis, but little is known about the difference in neointimal healing between CTO and non-CTO lesions regarding implanted stents. We investigated factors affecting neointimal healing after stent implantation for CTO and non-CTO lesions using angioscopy. METHODS: We retrospectively evaluated 106 stents in 85 consecutive patients between March 2016 and July 2020. Their average age was 68 ± 11 years, and participants (73 male and 12 female) underwent follow-up angiography and angioscopy 1 year after percutaneous coronary intervention (PCI). The stents (n = 106) were divided into three groups according to the lesion status at the previous PCI: CTO (n = 17), acute coronary syndrome (ACS) (n = 35), and stable coronary artery disease without CTO or non-CTO (n = 54). RESULTS: The neointimal stent coverage grade was significantly lower in the CTO and ACS groups than in the non-CTO group (0.4 ± 0.5, 0.9 ± 0.8, and 1.4 ± 0.8, respectively, p < 0.001). Thrombi were significantly more frequent in CTO and ACS than in non-CTO (71 %, 51 %, and 15 %, respectively, p < 0.001). The yellow grade in CTO was comparable to that in ACS but significantly higher in CTO than in non-CTO (CTO vs. ACS vs. non-CTO 1.5 ± 0.7, 1.4 ± 0.6, and 0.9 ± 0.7, respectively, p = 0.007). CONCLUSIONS: Delayed healing occurs in stents implanted for CTO lesions. Longer dual-antithrombotic therapy may be beneficial.

DOI： 10.1016/j.jjcc.2022.08.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: In Japan, oxygen is commonly administered during the acute phase of myocardial infarction (MI) to patients without oxygen saturation monitoring. In this study we assessed the effects of supplemental oxygen therapy, compared with ambient air, on mortality and cardiac events by synthesizing evidence from randomized controlled trials (RCTs) of patients with suspected or confirmed acute MI. Methods and Results: PubMed was systematically searched for full-text RCTs published in English before June 21, 2020. Two reviewers independently screened the search results and appraised the risk of bias. The estimates for each outcome were pooled using a random-effects model. In all, 2,086 studies retrieved from PubMed were screened. Finally, 7,322 patients from 9 studies derived from 4 RCTs were analyzed. In-hospital mortality in the oxygen and ambient air groups was 1.8% and 1.6%, respectively (risk ratio [RR] 0.90; 95% confidence interval [CI] 0.38-2.10]); 0.8% and 0.5% of patients, respectively, experienced recurrent MI (RR 0.44; 95% CI 0.12-1.54), 1.5% and 1.6% of patients, respectively, experienced cardiac shock (RR 1.10; 95% CI 0.77-1.59]), and 2.4% and 2.0% of patients, respectively, experienced cardiac arrest (RR 0.91; 95% CI 0.43-1.94). Conclusions: Routine supplemental oxygen administration may not be beneficial or harmful, and high-flow oxygen may be unnecessary in normoxic patients in the acute phase of MI.

DOI： 10.1253/circrep.CR-22-0031

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Circulation Society  

DOI： 10.1253/circrep.cr-22-0060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The aim of this study was to assess and discuss the diagnostic accuracy of prehospital ECG interpretation through systematic review and meta-analyses. Methods and Results: Relevant literature published up to July 2020 was identified using PubMed. All human studies of prehospital adult patients suspected of ST-segment elevation myocardial infarction in which prehospital electrocardiogram (ECG) interpretation by paramedics or computers was evaluated and reporting all 4 (true-positive, false-positive, false-negative, and true-negative) values were included. Meta-analyses were conducted separately for the diagnostic accuracy of prehospital ECG interpretation by paramedics (Clinical Question [CQ] 1) and computers (CQ2). After screening, 4 studies for CQ1 and 6 studies for CQ2 were finally included in the meta-analysis. Regarding CQ1, the pooled sensitivity and specificity were 95.5% (95% confidence interval [CI] 82.5-99.0%) and 95.8% (95% CI 82.3-99.1%), respectively. Regarding CQ2, the pooled sensitivity and specificity were 85.4% (95% CI 74.1-92.3%) and 95.4% (95% CI 87.3-98.4%), respectively. Conclusions: This meta-analysis suggests that the diagnostic accuracy of paramedic prehospital ECG interpretations is favorable, with high pooled sensitivity and specificity, with an acceptable estimated number of false positives and false negatives. Computer-assisted ECG interpretation showed high pooled specificity with an acceptable estimated number of false positives, whereas the pooled sensitivity was relatively low.

DOI： 10.1253/circrep.CR-22-0002

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/ehf2.14010

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ehf2.14010

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: This study assessed the diagnostic performance of the 0-hour/1-hour (0/1-h) algorithm to rule in and rule out acute myocardial infarction (MI) in patients presenting to the emergency department (ED) for suspected acute coronary syndrome without ST-segment elevation, as recommended in the 2015 European Society of Cardiology (ESC) guideline. Methods and Results: Following the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy (PRISMA-DTA) guidelines, a systematic review was conducted using the PubMed database from inception to March 31, 2020. We included any article published in English investigating the diagnostic performance of the ESC 0/1-h algorithm for diagnosing MI in patients with chest pain visiting the ED. Of 651 studies identified as potentially available for the study, 7 studies including 16 databases were analyzed. A meta-analysis of the diagnostic accuracy of the 0/1-h algorithm using high-sensitivity cardiac troponin I (hs-cTn) with 6 observational databases showed a pooled sensitivity of 99.3% (95% confidence interval [CI] 98.5-99.7%) and a pooled specificity of 90.1% (95% CI 80.7-95.2%). A meta-analysis of the diagnostic accuracy of 10 observational databases of the ESC 0/1-h algorithm using hs-cTn revealed a pooled sensitivity of 99.3% (95% CI 96.9-99.9%) and a pooled specificity of 91.7% (95% CI 83.5-96.1%). Conclusions: Our results demonstrate that the ESC 0/1-h algorithm can effectively rule in and rule out patients with non-ST-segment elevation MI.

DOI： 10.1253/circrep.CR-22-0001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In acute aortic dissection, weekend admissions are reported to be associated with increased mortality compared with weekday admissions. OBJECTIVE: This study aimed to determine whether patients with acute type A aortic dissection (ATAAD) admitted on weekends had higher in-hospital mortality than those admitted on weekdays in the Tokyo metropolitan area, where we developed a patient-transfer system for aortic dissection. METHODS: Data were collected during the first year after our transfer system began (cohort I) and in the subsequent years from 2013 to 2015 (cohort II). RESULTS: We studied 2,339 patients (500 in cohort I; 1,839 in cohort II) with ATAAD. Patients with weekend admissions had higher in-hospital mortality than those with weekday admissions in cohort I. In association with increased interfacility transfer during weekends and reduced mortality at non-high-volume centers, the in-hospital mortality in the weekend group improved from 37.2% in cohort I to 22.2% in cohort II (P < 0.001). After inverse probability weighting adjustment, weekend admission was associated with higher in-hospital mortality in cohort I (odds ratio: 2.28; 95% confidence interval: 1.48 to 3.52; P < 0.001), but not in cohort II (odds ratio: 0.96; 95% confidence interval: 0.75 to 1.22; P = 0.731). On multivariable analyses, weekend admission was associated with higher in-hospital mortality in combined cohort I+II; the associations between weekend admission and mortality were not significant in cohort II. CONCLUSIONS: We found a significant reduction in in-hospital mortality in patients with weekend admissions for ATAAD. No mortality difference between weekend and weekday admissions was observed in the later years of the study.

DOI： 10.1016/j.jacasi.2021.11.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: To achieve early reperfusion therapy for ST-elevation myocardial infarction (STEMI), proper and prompt patient transportation and activation of the catheterization laboratory are required. We investigated the efficacy of prehospital 12-lead electrocardiogram (ECG) acquisition and destination hospital notification in patients with STEMI. Methods and Results: This is a systematic review of observational studies. We searched the PubMed database from inception to March 2020. Two reviewers independently performed literature selection. The critical outcome was short-term mortality. The important outcome was door-to-balloon (D2B) time. We used the GRADE approach to assess the certainty of the evidence. For the critical outcome, 14 studies with 29,365 patients were included in the meta-analysis. Short-term mortality was significantly lower in the group with prehospital 12-lead ECG acquisition and destination hospital notification than in the control group (odds ratio 0.72; 95% confidence interval [CI] 0.61-0.85; P<0.0001). For the important outcome, 10 studies with 2,947 patients were included in the meta-analysis. D2B time was significantly shorter in the group with prehospital 12-lead ECG acquisition and destination hospital notification than in the control group (mean difference -26.24; 95% CI -33.46, -19.02; P<0.0001). Conclusions: Prehospital 12-lead ECG acquisition and destination hospital notification is associated with lower short-term mortality and shorter D2B time than no ECG acquisition or no notification among patients with suspected STEMI outside of a hospital.

DOI： 10.1253/circrep.CR-22-0003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background The association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex-related differences in clinical features and in-hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated. Methods and Results We studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super-Network Registry. There were fewer and older women than men (median age [interquartile range]: 76 years [66-84 years], n=695 versus 68 years [57-77 years], n=1677; P<0.001). Women presented to the aortic centers later than men. Women had a higher proportion of intramural hematoma (63.7% versus 53.7%, P<0.001), were medically managed more frequently (90.9% versus 86.3%, P=0.002), and had less end-organ malperfusion (2.4% versus 5.7%, P<0.001) and higher in-hospital mortality (5.3% versus 2.7%, P=0.002) than men. In multivariable analysis, age (per year, odds ratio [OR], 1.06 [95% CI, 1.03-1.08]; P<0.001), hyperlipidemia (OR, 2.09 [95% CI, 1.13-3.88]; P=0.019), painlessness (OR, 2.59 [95% CI, 1.14-5.89]; P=0.023), shock/hypotension (OR, 2.93 [95% CI, 1.21-7.11]; P=0.017), non-intramural hematoma (OR, 2.31 [95% CI, 1.32-4.05]; P=0.004), aortic rupture (OR, 26.6 [95% CI, 14.1-50.0]; P<0.001), and end-organ malperfusion (OR, 4.61 [95% CI, 2.11-10.1]; P<0.001) were associated with higher in-hospital mortality, but was not female sex (OR, 1.67 [95% CI, 0.96-2.91]; P=0.072). Conclusions Women affected with type B acute aortic dissection were older and had more intramural hematoma, a lower incidence of end-organ malperfusion, and higher in-hospital mortality than men. However, female sex was not associated with in-hospital mortality after multivariable adjustment.

DOI： 10.1161/JAHA.121.024149

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and safety of a subxiphoid anterior approach using fluoroscopy aided by a sagittal axis chest computed tomography (CT) view in comparison with an ultrasound-guided apical approach in patients with chronic pericardial effusion. METHODS: Among 72 consecutive patients (68.8 ± 14.4 years old, 52 males) with hemodynamically stable chronic pericardial effusions, a total of 85 procedures were retrospectively analyzed. We divided them into two groups according to the site of the approach for the pericardiocentesis. RESULTS: A subxiphoid anterior approach (n = 53) was performed guided by fluoroscopy. The sagittal axis view of the chest CT was constructed to determine the puncture angle and direction for the subxiphoid anterior approach. An apical approach (n = 32) was performed by ultrasound guidance. The success rates of the anterior and apical approaches were 98.1% and 93.8%, respectively. There were two cases with cardiac perforations in the apical approach group, while no cases developed perforations in the subxiphoid anterior approach group. CONCLUSION: The subxiphoid anterior approach for pericardiocentesis was feasible and safe for managing chronic pericardial effusions. A reconstruction of the sagittal axis view of the chest CT imaging was helpful to identify the direction and depth to access the pericardial space from the subxiphoid puncture site before the pericardiocentesis using the lateral fluoroscopic view.

DOI： 10.1002/clc.23810

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is now widely accepted. Recent guidelines have focused on total ischemic time, because shorter total ischemic time is associated with a more favorable prognosis. The door-in to door-out (DIDO) time, defined as time from arrival at a non-PCI-capable hospital to leaving for a PCI-capable hospital, may affect STEMI patient prognosis. However, a relevant meta-analysis is lacking. Methods and Results: We searched PubMed for clinical studies comparing short-term (30-day and in-hospital) mortality rates of STEMI patients undergoing primary PCI with DIDO times of ≤30 vs. >30 min. Two investigators independently screened the search results and extracted the data. Random effects estimators with weights calculated by the inverse variance method were used to determine pooled risk ratios. The search retrieved 1,260 studies; of these, 2 retrospective cohort studies (15,596 patients) were analyzed. In the DIDO time ≤30 and >30 min groups, the primary endpoint (i.e., in-hospital or 30-day mortality) occurred for 51 of 1,794 (2.8%) and 831 of 13,802 (6.0%) patients, respectively. The incidence of the primary endpoint was significantly lower in the DIDO time ≤30 min group (odds ratio 0.45; 95% confidence interval 0.34-0.60). Conclusions: Our findings suggest that a DIDO time ≤30 min is associated with a lower short-term mortality rate. However, further larger systematic reviews and meta-analyses are needed to validate our findings.

DOI： 10.1253/circrep.CR-21-0160

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. METHODS: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). RESULTS: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). CONCLUSIONS: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.

DOI： 10.3390/jcm11010262

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.cardfail.2021.07.022

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.8220-21

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

【背景】急性心筋梗塞(AMI)の臨床的特徴や至適治療戦略は明らかとなっているが、亜急性心筋梗塞(RMI)については十分に評価されていない。本研究の目的は東京都CCUネットワークデータベースを用いて実臨床におけるRMI患者の臨床的特徴、治療戦略、院内転帰を明らかにすることである。【方法と結果】2013年から2016年の間に東京都CCUネットワークデータベースに登録された1,853人のRMI患者と12,494人のAMI患者を比較した。心筋梗塞患者のうち、発症から2〜28日をRMI群、24時間以内をAMI群と定義した。AMI群と比較し、RMI群では平均年齢が高く(70.4±12.9対68.0±13.4歳、p<0.001)、女性が多く(27.6%対23.6%、p<0.001)、胸痛を主訴とする患者の割合が低く(75.2%対83.6%、p<0.001)、高血圧症(63.4%対60.5%、p=0.015)と糖尿病(35.9%対31.0%、p<0.001)の有病率が高く、機械的合併症の発生率が高かった(3.0%対1.5%、p<0.001)。30日死亡率は同等であったが(5.3%対5.8%、p=0.360)、死因の内訳はAMI群では心原性ショックが最多であり、RMI群では機械的合併症が最多と両群間で異なった。AMI群の機械的合併症による死亡(発症時期ではない)は、入院後約1週間で停滞状態になったが、RMI群では増加し続けた。【結論】RMI患者には特徴的な臨床的特徴、続発症、死因を認めた。RMI患者の治療はガイドラインに準拠していたが不十分であり、入院加療を行っていても機械的合併症による死亡が増加し続けた。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection. METHODS: Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair. RESULTS: The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063-2.624, P = 0.026], use of percutaneous circulatory assist devices (n = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867-8.228, P < 0.001), shock (n = 162, 10.8%) (OR 3.06, 95% CI 1.741-5.387, P < 0.001), cardiopulmonary arrest (n = 41, 2.7%) (OR 7.534, 95% CI 3.407-16.661, P < 0.001), coronary ischaemia (n = 36, 2.3%) (OR 2.583, 95% CI 1.042-6.404, P = 0.041) and cerebral ischaemia (n = 59, 3.9%) (OR 2.904, 95% CI 1.347-6.261, P = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n = 34, 2.3%) (OR 10.282, 95% CI 4.640-22.785, P < 0.001), cerebral ischaemia (n = 80, 5.3%) (OR 2.409, 95% CI 1.179-4.923, P = 0.016) and mesenteric ischaemia (n = 15, 1.0%) (OR 44.763, 95% CI 13.027-153.808, P < 0.001) were independent postoperative risk factors. CONCLUSIONS: Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair.

DOI： 10.1093/ejcts/ezab146

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We investigated whether intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) was associated with favourable neurological outcomes for patients after the return of spontaneous circulation (ROSC). Moreover, we evaluated the aetiology of cardiac arrest on the effectiveness of this therapy in a sub-study. BACKGROUND: There is insufficient research on the optimal combination of machines for patients after ROSC is not established. METHODS: This is a large-scale, multicentre, 30-day cohort study. Among 80,716 patients who delivered to the emergency room, 935 patients treated with VA-ECMO after ROSC were included using the data from the Tokyo Cardiovascular Care Unit Network Registry between 2010 and 2017. The study patients were stratified according to the use of IABP [the ECMO + IABP group (n = 762) vs. the ECMO-alone group (n = 173)]. We also evaluated the cause of cardiac arrest [acute coronary syndrome (ACS) and non-ACS] in the sub-study. To adjust the patients' backgrounds, we used the propensity score matching for additional analyses. The endpoint was 30-day favourable neurological outcome. RESULTS: The ECMO + IABP group showed significantly better neurological outcomes than the ECMO-alone group (crude; 35% vs. 25%; log-lank P < 0.001). In the ACS subgroup, the ECMO + IABP group showed significantly better neurological outcome (crude; 34% vs. 18%; log-lank P < 0.001), but not in the non-ACS subgroup (crude; 38% vs. 32%; log-lank P = 0.11). These results are similar after adjustments to their backgrounds using propensity matching. CONCLUSIONS: Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is associated with better neurological outcomes after ROSC, especially in complicated ACS.

DOI： 10.1016/j.resuscitation.2021.07.019

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An ideal urban network system for improving regional acute myocardial infarction (AMI) outcomes should be geographically balanced and uniform according to regional population in performance of participating hospitals. The objective of our study is to evaluate whether there is a major difference in risk-adjusted in-hospital mortality between the Tokyo Cardiovascular Care Unit (CCU) network hospitals, which cover the whole population of large cities. METHODS: The study subjects were all AMI patients without cardiac arrest on arrival admitted to the Tokyo CCU network hospitals from 2009 to 2017. Risk-adjusted in-hospital mortality rates (RAMRs) were compared between the categories of each hospital-level factor. A hospital-level multivariable linear regression was modeled to analyze the association between RAMRs and hospital-level factors. A funnel plot was constructed by plotting RAMRs against hospital volumes. RESULTS: From 2009 to 2017, there were 42,123 hospitalizations for AMI in Tokyo CCU network hospitals (n=72, as of December, 2017). There were no significant differences in RAMRs in the comparison of hospital backgrounds. Each hospital background was not significantly associated with the RAMR. Considering the 99% CI in funnel plots, only five hospitals (7.2%) were located outside the control limits. CONCLUSIONS: There was no major difference in the RAMRs between the participating hospitals within the Tokyo CCU network, despite the different hospital backgrounds.

DOI： 10.1016/j.jjcc.2021.04.002

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Alcohol septal ablation (ASA) is a treatment option in patients with drug-refractory symptomatic hypertrophic obstructive cardiomyopathy (HOCM). In many patients, right bundle branch block (RBBB) develops during ASA because septal branches supply the right bundle branch. However, the clinical significance of procedural RBBB is uncertain.Methods and Results:We retrospectively reviewed 184 consecutive patients with HOCM who underwent ASA. We excluded 40 patients with pre-existing RBBB (n=10), prior pacemaker implantation (n=15), mid-ventricular obstruction type (n=10), and those lost to follow-up (n=5), leaving 144 patients for analysis. Patients were divided into 2 groups according to the development (n=95) or not (n=49) of procedural RBBB. ASA conferred significant decreases in the left ventricular pressure gradient (LVPG) in both the RBBB and no-RBBB group (from 74±48 to 27±27 mmHg [P<0.001] and from 75±45 to 31±33 mmHg [P<0.001], respectively). None of the RBBB patients developed further conduction system disturbances. The percentage reduction in LVPG at 1 year after the procedure was significantly greater in the RBBB than no-RBBB group (66±24% vs. 49±45%; P=0.035). Procedural RBBB was not associated with pacemaker implantation after ASA, but was associated with reduction in repeat ASA (odds ratio 0.34; 95% confidence interval 0.13-0.92; P=0.045). CONCLUSIONS: Although RBBB frequently occurs during the ASA procedure, it does not adversely affect clinical outcomes.

DOI： 10.1253/circj.CJ-20-1191

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report a case of mitochondrial disease with heart and intestinal tract involvement resulting in hemodynamic collapse. A 66-year-old woman was transferred to our hospital because of cardiogenic shock. Vasopressors were administered, and a circulatory support device was deployed. However, her hemodynamics did not improve sufficiently, and we detected abdominal compartment syndrome caused by the aggravation of chronic intestinal pseudo-obstruction as a complication. Insertion of a colorectal tube immediately decreased the intra-abdominal pressure, improving the hemodynamics. Finally, we diagnosed her with mitochondrial disease, concluding that the resulting combination of acute heart failure and abdominal compartment syndrome had aggravated the hemodynamics.

DOI： 10.2169/internalmedicine.7729-21

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Plasma volume status (PVS), a parameter of the discrepancy between actual plasma volume (PV) and ideal PV, has been recently evaluated as a prognostic marker in patients with heart failure. This subgroup analysis of the EMBODY trial was designed to determine whether a sodium-glucose cotransporter 2 (SGLT2) inhibitor affects the alleviation of heart failure and improvement of PVS in patients after acute myocardial infarction (AMI) with congestive heart failure (CHF). METHODS: The EMBODY trial was a prospective, multicenter, randomized, double-blind, placebo-controlled trial to identify the effect of an SGLT2 inhibitor on cardiac sympathetic hyperactivity in patients with AMI and type 2 diabetes mellitus (T2DM) in Japan. In total, 105 patients were randomized (1:1) to receive 10 mg empagliflozin or a placebo (once daily), 2 weeks after the onset of AMI. In this subanalysis, we investigated the time-course of PVS at baseline and weeks 4, 12, and 24. RESULTS: Overall, 96 patients were included in the subgroup analysis set (age 64.3 ± 10.9 years, 80.2% men; 46 in the empagliflozin group and 50 in the placebo group). Body weight and PVS decreased in the empagliflozin group compared with the placebo group at 24 weeks (- 2.2 vs. + 0.1 kg, P < 0.001, and - 5.1 vs. - 0.3%, P < 0.001, respectively). Decreased PVS, defined as a change in PVS of < - 4.5%, was associated with the administration of empagliflozin (odds ratio 2.61, 95% confidence interval 1.11-6.15, P = 0.028). N-terminal pro b-type natriuretic peptide levels decreased in both the empagliflozin and placebo groups (1028.7-370.3 pg/mL, P < 0.001, and 1270.6-673.7 pg/mL, P < 0.01, respectively). CONCLUSION: Empagliflozin reduced the body weight and PVS. Early SGLT2 inhibitor administration in patients with AMI, CHF, and T2DM can therefore be effective in reducing the body weight and PVS. TRIAL REGISTRATION: UMIN 000030158.

DOI： 10.1007/s13300-021-01103-0

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Although the reno-protective effects of sodium-glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The prospective, multicentre, randomized, double-blind, placebo-controlled EMBODY trial investigated patients with AMI and T2DM in Japan. The eligible patients included adults aged 20 years or older, diagnosed with AMI and T2DM, and who could be discharged within 2-12 weeks after the onset of AMI. One hundred and five patients were randomized (1:1) to receive once daily 10 mg empagliflozin or placebo within 2 weeks of AMI onset. In this sub-analysis, we investigated the time course of renal functional parameters such as serum creatinine levels and estimated glomerular filtration rate (eGFR) from baseline to Weeks 4, 12, and 24. Ninety-six patients (64 ± 11 years, 78 male) were included in the full analysis (n = 46 and 50 in the empagliflozin and placebo groups, respectively). We used serum creatinine and eGFR as indicators of renal function. In the placebo group, eGFR decreased from 66.14 mL/min/1.73 m2 at baseline to 62.77 mL/min/1.73 m2 by Week 24 (P = 0.023) but remained unchanged in the empagliflozin group (from 64.60 to 64.36 mL/min/1.73 m2 , P = 0.843). In the latter group, uric acid improved from 5.8 mg/dL at baseline to 4.9 mg/dL at Week 24 (P < 0.001). In the earlier analysis of 56 patients with eGFR ≥ 60 mL/min/1.73 m2 , the eGFR decreased and the serum creatinine increased from baseline to 24 weeks in the placebo group, significantly different to the empagliflozin group (-6.61 vs. +0.22 mL/min/1.73 m2 , P = 0.008 and +0.063 vs. -0.001 mg/dL, P = 0.030, respectively). The changes in serum creatinine and eGFR from baseline to Week 24 were significantly correlated with those in uric acid in the placebo group (r = 0.664, P < 0.001 and r = -0.675, P < 0.001, respectively) but not in the empagliflozin group. CONCLUSIONS: Empagliflozin prevented the kidney functional decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2 . Early administration of sodium-glucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection.

DOI： 10.1002/ehf2.13509

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In the modern US cardiovascular intensive care unit (CICU), the incidence of non-cardiovascular disorders has increased and non-cardiovascular disorders are associated with an increase in morbidity and mortality. In Japan, however, data regarding the association between non-cardiovascular disorders and outcomes in the CICU are limited. METHODS: This study examined 490 consecutive admissions to a closed CICU at the Nippon Medical School Hospital from January to December 2017. Characteristics, diagnoses, treatments, and outcomes of admitted patients were identified. RESULTS: The most common primary diagnosis was acute coronary syndrome (50.4%), followed by acute heart failure (20.0%), arrhythmia (6.7%), and non-cardiovascular diseases (3.7%). The mortality rate and median length of stay (LOS) in the CICU were 4.7% and 4 (interquartile range, 2-8) days, respectively. Of all patients, 42.2% (n = 207) developed non-cardiovascular complications such as acute respiratory failure, acute kidney injury, or sepsis during CICU stay. Multivariate logistic regression analysis revealed that acute respiratory failure and sepsis were significantly associated with mortality in the CICU (odds ratio, 11.014 and 25.678, respectively; both p<0.05). The multiple linear regression analysis showed that acute kidney injury was significantly associated with LOS in the CICU (β=0.144, p = 0.002). CONCLUSIONS: Approximately half of patients admitted to the CICU had non-cardiovascular disorders including non-cardiovascular disease and non-cardiovascular complications, which were significantly associated with mortality and LOS in the CICU.

DOI： 10.1016/j.jjcc.2021.03.002

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but which arm shows lower blood pressure (BP) and the mechanism of IADBP has not been fully elucidatedMethods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to non-AAD group. Characteristics included in these comparisons were patients' backgrounds and IADBP-related factors such as systolic BP (SBP) in the right arm (R) and left arm (L), R-L or L-R as the IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients having IADBP. RESULTS: In the TAAD group, the prevalence of R<130mmHg (38%-vs.-19%, p=0.009), L-R>15mmHg (19%-vs.-8%, p=0.047), L-R>20mmHg (14%-vs.-4%, p=0.029) was higher than in the non-AAD group. Multivariate analysis showed L-R>15mmHg with R<130mmHg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R>20mmHg were all TAAD, and all aortic dissection extended to BCA just before the right common carotid artery on CT. CONCLUSIONS: IADBP was characterized by R<L with low R in TAAD, but was not associated with TBAD.

DOI： 10.1272/jnms.JNMS.2021_88-605

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Because acute coronary syndrome (ACS) development worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals in recurrent ACS patients are achieved is unknown. METHODS: Consecutive 214 ACS patients were divided into two groups; First ACS (n=182) and Recurrent ACS (n=32), and compared clinical characteristics between the groups. Fifteen patients developed death or cardiovascular (CV) events during hospitalization, and remained 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events. RESULTS: Patients in the Recurrent ACS group were older (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003) than those in the First ACS group. The attainment rate of low-density lipoprotein cholesterol (LDL-C) < 70mg/dl in the Recurrent ACS group was only 28.1%, despite 68.8% of these patients receiving statin. HbA1c < 7.0% was achieved in 66.7% of recurrent ACS patients who had been diagnosed with DM. Overall, 12.5% of recurrent ACS patients had received optimal treatment for secondary prevention. CV events after hospital discharge were identified in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068). CONCLUSION: Optimal treatment for secondary prevention in recurrent ACS patients was insufficient. Attainment of the guideline-recommended LDL-C goal for secondary prevention was especially low in recurrent ACS patients.

DOI： 10.1272/jnms.JNMS.2021_88-601

PubMed

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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掲載種別：研究論文（学術雑誌）  

Gastrointestinal (GI) bleeding worsens the outcomes of critically ill patients in the intensive care unit (ICU). Owing to a lack of corresponding data, we aimed to investigate whether GI bleeding during cardiovascular-ICU (C-ICU) admission in acute cardiovascular (CV) disease patients is a risk factor for subsequent CV events. Totally, 492 consecutive C-ICU patients (40.9% acute coronary syndrome, 22.8% heart failure) were grouped into GI bleeding (n = 27; 12 upper GI and 15 lower GI) and non-GI bleeding (n = 465) groups. Thirty-nine patients died or developed CV events during hospitalization, and 453 were followed up from the date of C-ICU discharge to evaluate subsequent major adverse CV events. The GI bleeding group had a higher Acute Physiology and Chronic Health Evaluation II score (20.2 ± 8.2 vs. 15.1 ± 6.8, p < 0.001), higher frequency of mechanical ventilator use (29.6% vs. 13.1%, p = 0.039), and longer C-ICU admission duration (8 [5–16] days vs. 5 [3–8] days, p < 0.001) than the non-GI bleeding group. The in-hospital mortality rate did not differ between the groups. Of those who were followed-up, CV events after C-ICU discharge were identified in 34.6% and 14.3% of patients in the GI and non-GI bleeding groups, respectively, during a median follow-up period of 228 days (log rank, p < 0.001). GI bleeding was an independent risk factor for subsequent CV events (adjusted hazard ratio: 2.23, 95% confidence interval: 1.06–4.71; p = 0.035). GI bleeding during C-ICU admission was independently associated with subsequent CV events in such settings.

DOI： 10.1007/s00380-021-01822-1

Scopus

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00001&link_issn=&doc_id=20210322470010&doc_link_id=%2Faa6icutc%2F2020%2F0044s1%2F011%2F5034-5036%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2020%2F0044s1%2F011%2F5034-5036%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00001&link_issn=&doc_id=20210322470038&doc_link_id=%2Faa6icutc%2F2020%2F0044s1%2F039%2F5114-5116%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2020%2F0044s1%2F039%2F5114-5116%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:日本は超高齢社会へと突入し、高齢者と超高齢者を中心に心不全の増加が顕著である。多くの疫学データや臨床データは比較的若年者の心不全を対象としており、高齢者および超高齢者の心不全におけるデータは限られている。目的:超高齢者の急性心不全の特徴を明らかにする。方法:2016年1月から12月までの1年間に急性心不全で東京都CCUネットワーク登録施設に登録された5,045例の患者を対象とした。これらを90歳以上の超高齢者、75歳から89歳までの高齢者、65歳から74歳までの準高齢者、65歳未満の4群に分類し、それらの臨床データを比較検討した。結果:超高齢者の心不全は左室駆出率が保たれたHFpEFが多く、これらは弁膜症による心不全が多いことに起因するものと考えられた。ACE阻害薬およびARB、β遮断薬の処方率は超高齢者ではいずれも50%を下回っており、超高齢者の心不全における薬物療法の難しさが見て取れた。超高齢者の心不全は、若年心不全の延長ではなかった。超高齢者は院内死亡率が高く、他の年齢区分と比較しても予後不良であった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00001&link_issn=&doc_id=20210322470037&doc_link_id=%2Faa6icutc%2F2020%2F0044s1%2F038%2F5110-5113%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2020%2F0044s1%2F038%2F5110-5113%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Portopulmonary hypertension (PoPH) is a well-known complication of liver cirrhosis. The aim of this study was to clarify the pulmonary hemodynamics and the prevalence and characteristics of PoPH in patients with portal hypertension. METHODS: The subjects were 335 patients with portal hypertension diagnosed by hepatic vein pressure gradient (HVPG). Among them, 186 patients received measurements of pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR). PoPH was diagnosed by PAP >20 mmHg, PVR ≥3 Wood units (WU) and PAWP ≤15 mmHg. RESULTS: The Child-Pugh classification was class A in 53, B in 92 and C in 41 patients. Median (range) values of HVPG, PAP, PVR and PAWP were 18.4 (5.5-39.0) mmHg, 12.9 (6.6-40.8) mmHg, 0.8 (0.1-4.5) WU and 7.5 (2.2-15.4) mmHg, respectively. Of six patients with PAP >20 mmHg, four had autoimmune hepatitis or primary biliary cholangitis, with the prevalence being significantly higher than that in patients with PAP ≤20 mmHg. Meanwhile, no significant difference was noted in the hepatic functional reserve or HVPG between patients with PAP >20 mmHg and ≤20 mmHg. Only two patients met the diagnostic criteria of PoPH and both patients were Child-Pugh B. The Child-Pugh score and HVPG were not associated with PoPH. CONCLUSIONS: Our study demonstrated that only two patients were complicated by PoPH. High PAP values were noted in patients with primary biliary cholangitis or autoimmune hepatitis. However, the presence of PoPH and high PAP were not associated with the degree of hepatic functional reserve or HVPG.

DOI： 10.1111/hepr.13560

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本人工臓器学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Takotsubo syndrome occasionally occurs in patients with fever due to underlying diseases. However, the impact of body temperature on inhospital prognosis of patients with takotsubo syndrome remains unknown. METHODS: Using the patient cohort in the Tokyo Cardiovascular Care Unit Network Registry from 2013 to 2015, we identified 421 eligible patients whose data on body temperature at admission were available and classified them into three groups: high body temperature group (≥37.5°C; n=27), normal body temperature group (36.0-37.4°C; n=319), and low body temperature group (≤35.9°C; n=75). We compared the patient characteristics and inhospital outcomes among the three groups. RESULTS: On admission, the high body temperature group showed a higher proportion of men and preceding physical triggers, higher heart and respiratory rates, and higher C-reactive protein level than the other groups. Inhospital all-cause mortality was significantly higher in the high body temperature group than in the normal or low body temperature group (18.5% vs. 2.2% vs. 4.0%, respectively, P<0.001). Both cardiac mortality (11.1% vs. 1.3% vs. 1.3%, P=0.001) and non-cardiac mortality (7.4% vs. 0.9% vs. 2.7%, P=0.031) were also significantly higher in the high body temperature group. Multivariable logistic regression analysis showed that high body temperature (reference: normal body temperature) was significantly associated with higher inhospital mortality (adjusted odds ratio 4.22; 95% confidence interval 1.15-15.51; P=0.030). CONCLUSIONS: Our findings suggest that high body temperature at admission is a strong predictor of inhospital mortality in patients with takotsubo syndrome. Febrile takotsubo syndrome patients may need to be managed with recognition of life-threatening conditions from the time of diagnosis, no matter what the causes of fever are.

DOI： 10.1177/2048872619886313

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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掲載種別：研究論文（学術雑誌）  

© 2020 The Author(s). Background: Protection from lethal ventricular arrhythmias leading to sudden cardiac death (SCD) is a crucial challenge after acute myocardial infarction (AMI). Cardiac sympathetic and parasympathetic activity can be noninvasively assessed using heart rate variability (HRV) and heart rate turbulence (HRT). The EMBODY trial was designed to determine whether the Sodium-glucose cotransporter 2 (SGLT2) inhibitor improves cardiac nerve activity. Methods: This prospective, multicenter, randomized, double-blind, placebo-controlled trial included patients with AMI and type 2 diabetes mellitus (T2DM) in Japan; 105 patients were randomized (1:1) to receive once-daily 10-mg empagliflozin or placebo. The primary endpoints were changes in HRV, e.g., the standard deviation of all 5-min mean normal RR intervals (SDANN) and the low-frequency-to-high-frequency (LF/HF) ratio from baseline to 24 weeks. Secondary endpoints were changes in other sudden cardiac death (SCD) surrogate markers such as HRT. Results: Overall, 96 patients were included (46, empagliflozin group; 50, placebo group). The changes in SDANN were + 11.6 and + 9.1 ms in the empagliflozin (P = 0.02) and placebo groups (P = 0.06), respectively. Change in LF/HF ratio was - 0.57 and - 0.17 in the empagliflozin (P = 0.01) and placebo groups (P = 0.43), respectively. Significant improvement was noted in HRT only in the empagliflozin group (P = 0.01). Whereas intergroup comparison on HRV and HRT showed no significant difference between the empagliflozin and placebo groups. Compared with the placebo group, the empagliflozin group showed significant decreases in body weight, systolic blood pressure, and uric acid. In the empagliflozin group, no adverse events were observed. Conclusions: This is the first randomized clinical data to evaluate the effect of empagliflozin on cardiac sympathetic and parasympathetic activity in patients with T2DM and AMI. Early SGLT2 inhibitor administration in AMI patients with T2DM might be effective in improving cardiac nerve activity without any adverse events. Trial Registration: The EMBODY trial was registered by the UMIN in November 2017 (ID: 000030158). UMIN000030158; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034442.

DOI： 10.1186/s12933-020-01127-z

Scopus

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Characteristics and treatment outcomes of acute myocardial infarction (AMI) patients have been studied; however, those of recent myocardial infarction (RMI) patients remain unclear. This study aimed to clarify characteristics, treatment strategy, and in-hospital outcomes of RMI patients in the Tokyo CCU network database.Methods and Results:In total, 1,853 RMI and 12,494 AMI patients from the Tokyo CCU network database during 2013-2016 were compared. Both RMI and AMI were redefined by onset times of 2-28 days and ≤24 h, respectively. The RMI group had a higher average age (70.4±12.9 vs. 68.0±13.4 years, P<0.001), more women (27.6% vs. 23.6%, P<0.001), lower proportion of patients with chest pain as the chief complaint (75.2% vs. 83.6%, P<0.001), higher prevalence of diabetes mellitus (35.9% vs. 31.0%, P<0.001), and higher mechanical complication incidence (3.0% vs. 1.5%, P<0.001) than did the AMI group. Thirty-day mortality was comparable (5.3% vs. 5.8%, P=0.360); major causes of death were cardiogenic shock and mechanical complications in the AMI and RMI groups, respectively. Death from mechanical complications (not onset time) in the AMI group plateaued almost 1 week after hospitalization, whereas it continued to increase in the RMI group. CONCLUSIONS: Both RMI and AMI patients have distinctive clinical features, sequelae, and causes of death. Although treatment of RMI patients adhered to guidelines, it was insufficient, and death from mechanical complications continues to increase.

DOI： 10.1253/circj.CJ-20-0333

PubMed

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The absence of high quality, large-scale data that indicates definitive mortality benefits does not allow for firm conclusions on the role of intravenous vasodilators in acute heart failure. We aimed to investigate the associations between intravenous vasodilators and clinical outcomes in acute heart failure patients, with a specific focus on patient profiles and type of vasodilators. METHODS: Data of 26,212 consecutive patients urgently hospitalised for a primary diagnosis of acute heart failure between 2009 and 2015 were extracted from a government-funded multicentre data registration system. Propensity scores were calculated with multiple imputations and 1:1 matching performed between patients with and without vasodilator use. The primary endpoint was inhospital mortality. RESULTS: On direct comparison of the vasodilator and non-vasodilator groups after propensity score matching, there were no significant differences in the inhospital mortality rates (7.5% vs. 8.8%, respectively; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. CONCLUSIONS: In acute heart failure patients, vasodilator use was not universally associated with improved inhospital outcomes; rather, its effect depended on individual clinical presentation: patients with higher systolic blood pressure and no atrial fibrillation seemed to benefit maximally from vasodilators. TRIAL REGISTRATION: UMIN-CTR identifier, UMIN000013128.

DOI： 10.1177/2048872619891075

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Many patients with emergent heart failure (HF) readmission have a delay between symptom onset and hospitalization. The present study aimed to characterize the interval between symptom onset and hospitalization in patients being readmitted for HF and to compare the clinical phenotypes of patients with delay before emergent readmission with those who presented to the hospital earlier. Methods: Data for a total of 2073 consecutive patients was collected from the Tokyo CCU Network database; the patients were divided into delayed (those who sought medical help > 2 days after symptom onset; n = 271) and early groups (remaining patients; n = 1802), and their clinical characteristics and mode of presentation were compared. Results: Age, sex, and laboratory findings including brain natriuretic peptide and serum creatinine levels were not significantly different between the two groups. Patients in the delayed group had greater chronic fluid retention and symptoms not associated with respiratory failure, whereas those in the early group were more likely to have acute respiratory distress, faster heart and respiration rates, and higher systolic blood pressure. Conclusions: More than one in ten patients with HF readmission delay seeking treatment > 2 days after symptom onset. Patients who delayed seeking treatment showed the phenotype of chronic fluid retention, whereas those who presented to the hospital earlier had the phenotype of acute respiratory failure.

DOI： 10.1186/s40560-020-00482-z

PubMed

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記述言語：英語  

DOI： 10.1111/jgs.16301

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:たこつぼ症候群(TTS)の大多数は高齢者に発症するが、高齢者はしばしば低栄養となるリスクにさらされている。総コレステロール(T-Chol)値は栄養状態に関連している。T-Chol値とTTSの予後との関連を調査した先行研究はない。方法と結果:2013年から2015年の東京都CCUネットワークレジストリを用いて、入院時T-Chol値のデータがある329名のTTS患者を同定し、T-Chol値の三分位で3群に分けた:Low-T-Chol(≦164mg/dL)111名、Medium-T-Chol(165〜202mg/dL)110名、高T-Chol(≧203mg/dL)108名。Low-T-Chol群では、Medium-T-Chol群とHigh-T-Chol群に比べ、より高齢で(75.8±11.0歳vs70.8±11.2歳vs73.0±10.4歳;p=0.003)、男性が多く(31.5% vs 20.9% vs 9.3%;p<0.001)、身体的ストレスの割合が高かった(46.8% vs 23.6% vs 19.4%;p<0.001)。入院前のスタチン使用割合に有意な群間差はなかった。複合アウトカム(死亡、持続性心室頻拍・心室細動、Mobitz 2型・完全房室ブロック、もしくは機械的循環サポートの使用と定義)が他の2群に比べLow-T-Chol群で高値であった(18.9% vs 3.6% vs 2.8%;p<0.001)。多変量ロジスティック回帰分析でLow-T-Chol群は高い複合アウトカム発症率と有意に関連していた(Medium-T-Chol群を対照として、調節後オッズ比8.57;95%信頼区間2.32〜31.67;p=0.001)。結論:Low-T-Chol値はTTSの院内予後不良を予測するかもしれない。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00001&link_issn=&doc_id=20200325320033&doc_link_id=%2Faa6icutc%2F2019%2F0043s1%2F042%2F5102-5107%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2019%2F0043s1%2F042%2F5102-5107%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12872-019-01274-6

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:急性心筋梗塞の患者背景については明らかになっているが、亜急性心筋梗塞においては十分ではない。目的と方法:亜急性心筋梗塞の臨床的特徴を明らかにするために、2015年の東京都CCUネットワークデータベースから607名の亜急性心筋梗塞患者と3,001名の急性心筋梗塞患者を比較した。発症から2〜28日を亜急性心筋梗塞群、発症から24時間以内を急性心筋梗塞群とした。結果:急性心筋梗塞群と比較し、亜急性心筋梗塞群ではより高齢で、糖尿病の罹患率が高く、典型的な胸部症状を有する患者が少なく、緊急経皮的冠動脈インターベンションの施行率が低く、冠動脈バイパス術の施行率が高かった。30日死亡率は2群間で差がなかったが、亜急性心筋梗塞群では心破裂などの機械的合併症の発症率が高く、不整脈死も多かった。結語:非典型的な症候による診断の遅れは、機械的合併症や不整脈合併症を引き起こす可能性がある。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00001&link_issn=&doc_id=20200325320031&doc_link_id=%2Faa6icutc%2F2019%2F0043s1%2F040%2F5095-5099%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2019%2F0043s1%2F040%2F5095-5099%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The relationship between outcome and trigger in takotsubo syndrome (TTS) has been recently discussed, but the data are still limited. Methods and Results: We enrolled 745 consecutive patients with TTS from the Tokyo Cardiovascular Care Unit Network registry. The patients were divided into 4 groups based on trigger: (1) medical illness, 202 (27%); (2) physical activity, trauma and injury, 54 (7%); (3) emotional trigger, 199 (27%); and (4) unidentifiable trigger, 290 (39%). Compared with other groups, the medical illness group had the lowest percentage of female patients (68%, 85%, 89%, and 79%, respectively; P<0.001) and the highest mean patient age (75±11 years, 72±11, 73±12, and 75±11 years, respectively; P=0.02). In-hospital all-cause mortality was higher (11%) in this group (0%, 2%, and 2%, respectively; P<0.001). On multivariate logistic regression analysis, the medical illness group independently predicted all-cause death (OR, 4.73; 95% CI: 1.33-16.87); although there was no significant difference in cardiac deaths between the 4 groups. Conclusions: TTS has a wide spectrum of outcome depending on the trigger. The medical illness trigger was a powerful predictor of outcome but the main cause of death is not cardiac complication.

DOI： 10.1253/circrep.CR-19-0045

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00380-019-01525-8

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00679&link_issn=&doc_id=20190719190020&doc_link_id=%2Fah2sinzd%2F2019%2Fs05107%2F003%2F0753-0753%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2019%2Fs05107%2F003%2F0753-0753%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/jgs.16050

PubMed

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jgs.16050

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00380-019-01350-z

PubMed

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記述言語：日本語   出版者・発行元：日本循環制御医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00380-019-01419-9

Web of Science

PubMed

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DOI： 10.1253/circj.CJ-19-0187

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00380-018-1278-2

PubMed

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/CIRCEP.118.006969

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/HJH.0000000000001932

PubMed

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/2048872618762638

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-18-0785

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:肥満患者で予後が良いという「肥満パラドックス」が急性心筋梗塞で報告されているが、たこつぼ心筋症(TC)患者ではbody mass index(BMI)と予後の関連性は調査されていない。方法と結果:2010〜2014年の東京都CCUネットワークデータベースを用いて入院時BMIのデータがある563名のTC患者を同定し、痩せ(<18.5kg/m2)157名、正常体重(18.5〜24.9kg/m2)325名、過体重(≧25kg/m2)81名の3群に分けた。痩せ群は、より高齢で、先行の身体ストレスの割合が高く、来院時の収縮期血圧が低かった。性別、バルーンタイプ、心電図異常に有意な差はなかった。院内死亡率は、痩せ群と正常体重群(5.5〜5.7%)に比べ、過体重群(1.2%)で低かったが、3群間で有意な差はなかった(P=0.246)。多変量ロジスティック回帰解析では、BMIと院内死亡率に有意な関連を認めなかった(調節オッズ比0.94;95%信頼区間0.84〜1.05)。結論:TCで有意な「肥満パラドックス」を認めなかったが、過体重・肥満患者で院内予後が良好である可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00001&link_issn=&doc_id=20190118480027&doc_link_id=%2Faa6icutc%2F2018%2F0042s1%2F032%2F5084-5088%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2018%2F0042s1%2F032%2F5084-5088%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00001&link_issn=&doc_id=20190118480029&doc_link_id=%2Faa6icutc%2F2018%2F0042s1%2F034%2F5091-5093%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2018%2F0042s1%2F034%2F5091-5093%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00001&link_issn=&doc_id=20190118480025&doc_link_id=%2Faa6icutc%2F2018%2F0042s1%2F030%2F5079-5081%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2018%2F0042s1%2F030%2F5079-5081%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00001&link_issn=&doc_id=20190118480030&doc_link_id=%2Faa6icutc%2F2018%2F0042s1%2F035%2F5094-5096%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2018%2F0042s1%2F035%2F5094-5096%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.amjcard.2018.07.042

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Protection from lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important problems after myocardial infarction. Cardiac sympathetic hyperactivity is related to poor prognosis and fatal arrhythmias and can be non-invasively assessed with heart rate variability, heart rate turbulence, T-wave alternans, late potentials, and 123I-meta-iodobenzylguanide (123I-MIBG) scintigraphy. Sodium glucose cotransporter 2 (SGLT2) inhibitors potentially reduce sympathetic nervous system activity that is augmented in part due to the stimulatory effect of hyperglycemia. The EMBODY trial is designed to determine whether the suppression of cardiac sympathetic activity induced by the SGLT2 inhibitor is accompanied by protection against adverse cardiovascular outcomes. METHODS: The EMBODY trial is a prospective, multicenter, randomized, double-blind, placebo-controlled trial in patients with acute MI and type 2 diabetes in Japan. A total of 98 patients will be randomized (1:1) to receive once-daily placebo or empagliflozin, an SGLT2 inhibitor, 10 mg. The primary end point is the change from baseline to 24 weeks in heart rate variability. Secondary end points include the change from baseline for other sudden cardiac death surrogate-markers such as heart rate turbulence, T-wave alternans, late potentials, and 123I-MIBG scintigraphy imaging. Adverse effects will be evaluated throughout the trial period. PLANNED OUTCOMES: The EMBODY trial will evaluate the potential cardioprotective effect of empagliflozin and will provide additional important new data regarding its preventative effects on sudden cardiac death. TRIAL REGISTRATION: Unique Trial Number, UMIN000030158 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000034442 ). FUNDING: Nippon Boehringer Ingelheim and Eli Lilly and Company.

DOI： 10.1007/s13300-018-0480-7

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.amjcard.2018.05.042

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehx812

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Recent randomized clinical trials have questioned the clinical benefits of thrombus aspiration (TA) in ST-segment elevation myocardial infarction (STEMI). Real-world data on TA and the efficacy of TA for various culprit lesions have not been sufficiently evaluated. This study mainly aimed to evaluate whether the clinical impact of TA depends on culprit lesions in the setting of STEMI. We surveyed the Tokyo Coronary Care Unit Network Registry, a prospective cohort study, between 2010 and 2014, which included 10,232 patients with STEMI. In-hospital deaths occurred in 538 patients (5.3%). Improved Thrombolysis in Myocardial Infarction flow was more frequently observed in patients who underwent TA than in those who did not (87 vs. 80%
p &lt
0.001). Univariate logistic regression analysis revealed that TA was associated with a lower in-hospital mortality rate [odds ratio (OR), 0.80
95% confidential interval (CI), 0.66–0.96
p = 0.016]. However, the difference was not significant after multivariate logistic regression analysis (OR 0.95
95% CI 0.71–1.17
p = 0.355). Only TA for the left circumflex (LCx) lesions was associated with a better prognosis (OR 0.38
95% CI 0.21–0.72
p = 0.003). The effect persisted after adjustment (OR 0.50
95% CI 0.25–0.99
p = 0.049) but was attenuated after analysis using inverse probability weighting (OR 0.97
95% CI 0.93–0.99
p = 0.048). On the basis of the findings in a large Japanese cohort, a prognostic benefit of TA on in-hospital mortality was not observed. The effect of TA on the LCx lesions was marginally significant and limited. Therefore, TA is not recommended in Japanese patients with STEMI.

DOI： 10.1007/s00380-018-1171-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

The relationship between glycemic control and outcome in patients with heart failure (HF) remains contentious. A recent study showed that patients with HF with mid-range ejection fraction (HFmrEF) more frequently had comorbid diabetes relative to other patients. Herein, we examined the association between glycosylated hemoglobin (HbA1c) and in-hospital mortality in acute HF patients with reduced, mid-range, and preserved EF. A multicenter retrospective study was conducted on 5205 consecutive patients with acute HF. Potential risk factors for in-hospital mortality were selected by univariate analyses
then, multivariate Cox regression analysis with backward stepwise selection was performed to identify significant factors. Kaplan–Meier survival curves and log-rank testing were used to compare in-hospital mortality between groups. Across the study cohort, 44% (2288 patients) had reduced EF, 20% had mid-range EF, and 36% had preserved EF. The overall in-hospital mortality rate was 4.6%, with no significant differences among the HF patients with reduced, mid-range, and preserved EF groups. For patients with HFmrEF, higher HbA1c level was a significant risk factor for in-hospital mortality (hazard ratio 1.387
95% confidence interval 1.014–1.899
P = 0.041). In contrast, HbA1c was not an independent risk factor for in-hospital mortality in HF patients with preserved or reduced EF. In conclusion, HbA1c is an independent risk factor for in-hospital mortality in acute HF patients with mid-range EF, but not in those with preserved or reduced EF. Elucidation of the pathophysiological mechanisms behind these findings could facilitate the development of more effective individualized therapies for acute HF.

DOI： 10.1007/s00380-018-1152-2

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記述言語：英語   出版者・発行元：BioMed Central Ltd.  

High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Most deaths in patients with shock occur within the first few hours after presentation, and rapid diagnosis and treatment is therefore essential to save patients' lives. The main manifestations of major PE are acute right ventricular (RV) failure and hypoxia. RV pressure overload is predominantly related to the interaction between the mechanical pulmonary vascular obstruction and the underlying cardiopulmonary status. Computed tomography angiography allows not only adequate visualization of the pulmonary thromboemboli down to at least the segmental level but also RV enlargement as an indicator of RV dysfunction. Bedside echocardiography is an acceptable alternative under such circumstances. Although it does not usually provide a definitive diagnosis or exclude pulmonary embolism, echocardiography can confirm or exclude severe RV pressure overload and dysfunction. Extracorporeal membrane oxygenation support can be an effective procedure in patients with PE-induced circulatory collapse. Thrombolysis is generally accepted in unstable patients with high-risk PE
however, thrombolytic agents cannot be fully administered to patients with a high risk of bleeding. Conversely, catheter-directed treatment is an optimal treatment strategy for patients with high-risk PE who have contraindications for thrombolysis and is a minimally invasive alternative to surgical embolectomy. It can be performed with a minimum dose of thrombolytic agents or without, and it can be combined with various procedures including catheter fragmentation or embolectomy in accordance with the extent of the thrombus on a pulmonary angiogram. Hybrid catheter-directed treatment can reduce a rapid heart rate and high pulmonary artery pressure and can improve the gas exchange indices and outcomes. Surgical embolectomy is also performed in patients with contraindications for or an inadequate response to thrombolysis. Large hospitals having an intensive care unit should preemptively establish diagnostic and therapeutic protocols and rehearse multidisciplinary management for patients with high-risk PE. Coordination with a skilled team comprising intensivists, cardiologists, cardiac surgeons, radiologists, and other specialists is crucial to maximize success.

DOI： 10.1186/s40560-018-0286-8

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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DOI： 10.1016/j.jjcc.2017.09.006

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.amjmed.2017.09.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Association for Coronary Artery Surgery  

A 64-year-old man was admitted for evaluation of back pain. He did not have a Marfan syndrome (MFS)-like appearance, and had a history of a type B aortic dissection and total arch replacement. A connective tissue disorder had been suspected because of the histologic findings of the resected aortic wall. On admission, a computed tomography (CT) scan demonstrated a three-channeled aortic dissection (3ch-AD) measuring 63 mm in diameter. We planned to perform elective surgery during his hospitalization. On the fourth hospital day, he complained of severe back pain, and enhanced CT scan revealed an aortic rupture. The patients with 3ch-AD often have MFS. However, even if they do not have an MFS-like appearance, clinicians should consider fragility of the aortic wall in patients with 3ch-AD. If the aortic diameter is enlarged, early surgery is recommended. In particular, if a connective tissue disorder is obvious or suspected, emergent surgery is warranted.

DOI： 10.5761/atcs.cr.17-00066

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:心尖部型たこつぼ心筋症(apical TC)患者と急性前壁心筋梗塞(anterior AMI)患者の特徴の違いは明らかではない。方法と結果:2013年の東京都CCUネットワークデータベースのapical TC患者112名とanterior AMI患者1,327名から、1:4の比で年齢と性別をマッチさせたapical TC患者101名とanterior AMI患者404名を対象とした(平均年齢76.1歳;女性85.1%)。Apical TC患者は、anterior AMI患者に比べ、来院時のbody mass indexは低く、収縮期圧は低く心拍数は高かった。ST上昇やトロポニン陽性、BNP値には2群間で有意な差はなかった。院内死亡率はapical TC患者2.0%、anterior AMI患者5.0%で有意差はなかった(p=0.277)。全死亡、心室細動・頻拍、心破裂、機械循環補助装置使用の複合イベント率は、anterior AMI患者(17.8%)に比べapical TC患者(8.9%)で有意に低かった(p=0.014)。多変量ロジスティック回帰解析でanterior AMIに比較してapical TCは低い複合イベント率と有意に関連していた(調節オッズ比、0.35:95%信頼区間、0.14〜0.87)。結論:本研究によりapical TCとanterior AMIに臨床所見に有意な差を認め、両者の鑑別が重要であると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:収縮期血圧は心不全の強力な予後因子の1つであるが、急性期の血圧変動と予後との関連について検討した研究はない。方法:多施設コホートレジストリである東京都CCUネットワークデータベースは、東京消防庁の協力のもと病院前患者情報を収集している。2010〜2012年まで、合計5,669人の救急車で搬送された急性心不全患者が解析対象となった。救急隊が現場で測定した血圧(on-site SBP)と、搬送後の救急外来で測定した血圧(ER-SBP)を基に、SBP>100mmHg、SBP100〜160mmHg、SBP>160mmHgの3群にそれぞれ分けて背景因子を比較し、また院内死亡へ対する影響を検討した。結果:院内死亡率とはon-site SBP、ER-SBPの両者とも負の相関を認め、多変量解析後も統計学的な有意差をもったままであった。とくにER-SBP100〜160mmHgの患者においては、on-site SBP>160mmHgの患者に比較して、on-site SBP<100mmHg(オッズ比:7.39;95%信頼区間:4.00〜13.60;P<0.001)、on-site SBP100〜160mmHg(オッズ比:2.73;95%信頼区間:1.83〜4.08;P<0.001)の患者は院内予後が不良であった。結論:急性心不全診療では、急性期の血圧変化を考慮することで、より正確な急性期リスク層別化が可能である。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Prasugrel is often replaced with clopidogrel after a certain period of time following coronary stenting. However, the time course of platelet aggregation during this replacement is unknown. We performed a prospective, single-arm study to monitor platelet reactivity before and after the replacement. Forty-five patients (mean age 62.6 +/- 13 years, 40 male) who received coronary stenting for acute coronary syndrome were initially treated with the loading dose (20 mg) of prasugrel followed by the maintenance dose (3.75 mg/day) for 7 days, then switched to 75 mg/day of clopidogrel. The P2Y12 reaction unit (PRU) level was measured at baseline and selected time points. Prasugrel effectively suppressed PRU from 248 +/- 59 at baseline to 145 +/- 65 on day 1 (P &lt; 0.001). The PRU value on the final day of prasugrel treatment (day 7) was 156 +/- 68 (P &lt; 0.001 vs. baseline). After switching to clopidogrel, PRU was consistently suppressed [146 +/- 60, 139 +/- 54, and 135 +/- 60 on days 9, 11, and 13, respectively (P &lt; 0.001, each point vs. baseline)]. Switching from the initial prasugrel therapy to clopidogrel using the maintenance dose does not cause a drug efficacy gap and stays effective for preventing stent thrombosis.

DOI： 10.1007/s00380-017-1016-1

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00001&link_issn=&doc_id=20180226480008&doc_link_id=%2Faa6icutc%2F2017%2F0041s1%2F010%2F5028-5030%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2017%2F0041s1%2F010%2F5028-5030%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：日本心臓血管内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

Both the obesity paradox and blood pressure (BP) paradox remain ill defined. Because both obesity and hypertension are well-known predictors of coronary artery disease (CAD) and acute heart failure (HF), in the present study, we compared the obesity paradox and the BP paradox between patients with acute HF with and without a history of CAD. A multi-center retrospective study was conducted on 3,204 consecutive patients with acute HF. Potential risk factors for in-hospital mortality were selected by univariate analyses; multivariate Cox regression analysis with backward stepwise selection was then used to identify significant factors. Kaplan-Meier survival curves and log-rank testing were used to compare in hospital mortality between groups. Across the study cohort, 27% of patients had a history of CAD, and the all-cause in-hospital mortality rate was 5%. In-hospital mortality was significantly lower for patients with obesity than in those without obesity (log-rank, p = 0.033). However, this obesity paradox disappeared in the group with HF and CAD (log-rank, p = 0.740). In contrast, in-hospital mortality was significantly lower for patients with high BP at admission, regardless of the presence of a history of CAD (log-rank, p &lt;0.001 for both groups). In conclusion, a history of CAD canceled the obesity paradox in patients with acute HF, whereas the BP paradox persisted regardless of a history of CAD. (C) 2017 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2017.07.054

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE BV  

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. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2017.02.010

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Prognosis of acute myocarditis is generally benign, but fulminant cases exist which require advanced life support devices, such as percutaneous cardio-pulmonary support (PCPS) and ventricular assist devices (VAD), and lead to fatal outcomes. The purpose of this study was to identify predictors and their values at admission which might foreshadow a fulminant course of myocarditis. Data from 138 patients (mean age 42.0 years, 79 males) with a diagnosis of acute myocarditis in the Tokyo CCU Network database from 2007 to 2009 were analyzed retrospectively. Patients were divided into fulminant (in-hospital death, or PCPS or VAD requirement, N = 42) and non-fulminant groups (N = 96). Clinical data at admission were compared between them. Overall in-hospital mortality was 14.5%. On multivariate analysis, low systolic blood pressure (BPsys, odds ratio (OR)/mmHg 0.97; 95% confidence interval (CI) 0.93-1.00, p = 0.032) and electrocardiographic QRS complex prolongation (OR/10 ms 1.28; 95% CI 1.10-1.59, p = 0.0034) at admission were independent factors associated with a fulminant course. By receiver operator characteristic curve analysis, the area under the curve predicting a fulminant course was 0.769 for low BPsys and 0.821 for prolongation of QRS duration. The optimal cut-off value was 101 mmHg for BPsys (sensitivity 79.5%, specificity 68.0%), and 120 ms for QRS duration (sensitivity 72.2%, specificity 88.0%). Systolic hypotension and prolonged QRS on admission are predictors of a fulminant course of myocarditis.

DOI： 10.1007/s00380-017-0960-0

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00679&link_issn=&doc_id=20170720210029&doc_link_id=10.11281%2Fshinzo.49.754&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo.49.754&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Cardiac tamponade is an important and potentially lethal complication of acute pericarditis. However, recurrence of cardiac tamponade is rare when it is treated appropriately. We present a 49-year-old man with bacterial pericarditis and recurrent cardiac tamponade, which was caused by the rupture of an upper part of the left atrium (LA). According to the autopsy findings, bacteremia from Staphylococcus aureus developed on a substrate of poorly controlled diabetes mellitus and spread to the pericardium via the blood. Subsequently, tissue necrosis developed from the pulmonary trunk and aorta to the LA, leading to recurrence of cardiac rupture and cardiac tamponade.

DOI： 10.1272/jnms.84.133

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記述言語：日本語   出版者・発行元：日本静脈学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC).
Methods and Results: Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5 +/- 11.7 years; 21.4% male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS &gt;= 120 ms; n=34) and those with normal QRS duration (&lt;120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5% vs. 3.8%, P&lt;0.001). Similarly, prevalence of ventilator use (38.2% vs. 11.4%, P&lt;0.001), ventricular tachycardia or fibrillation (14.7% vs. 1.5%, P&lt;0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2% vs. 14.0%, P&lt;0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95% CI: 1.79-14.30, P=0.002) and cardiac death (OR, 7.34; 95% CI: 1.33-40.51, P=0.02).
Conclusions: TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.

DOI： 10.1253/circj.CJ-16-0912

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:受診時心電図におけるQRS幅の延長は心筋炎・心筋梗塞・心不全において強い予後予測因子であることが知られている。たこつぼ心筋症において、受診時心電図におけるQRS幅延長の予後に与える影響はいまだ明らかではない。方法:2010年から2012年の3年間に東京都CCUネットワークデータベースに登録されたたこつぼ心筋症患者のうち、入院時心電図でQRS幅が評価できた349名(平均年齢73.5歳、男性22%)を対象とした。受診時心電図でQRS幅が120ms以上に延長している群(n=40)と、正常群(n=309)で院内予後を比較検討した。結果:院内死亡率はQRS幅延長群で有意に高く(22.5% vs 4.2%、p<0.001)、同様に心不全(50.0% vs 24.6%、p=0.001)、房室ブロック(15.0% vs 3.2%、p=0.001)、心室性不整脈(15.0% vs 1.9%、p<0.001)のいずれもQRS幅延長群で有意に高かった。多変量解析にて、QRS幅の延長は院内死亡の独立した予後規定因子であった(オッズ比:5.06;95%信頼区間:1.79〜14.3、p=0.002)。結論:たこつぼ心筋症患者において、受診時QRS幅は強い予後予測因子である。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Systolic blood pressure (SBP) is an important prognostic indicator for patients with acute heart failure (AHF). However, its changes and the effects in the different phases of the acute management process are not well known.
Methods and Results: The Tokyo CCU Network prospectively collects on-site information about AHF from emergency medical services (EMS) and the emergency room (ER). The association between in-hospital death and SBP at 2 different time points (on-site SBP [measured by EMS] and in-hospital SBP [measured at the ER; ER-SBP]) was analyzed. From 2010 to 2012, a total of 5,669 patients were registered and stratified into groups according to both their on-site SBP and ER-SBP: &gt;160 mmHg; 100-160 mmHg; and &lt;100 mmHg. In-hospital mortality rates increased when both on-site SBP and ER-SBP were low. After multivariate adjustment, both SBPs were inversely associated with in-hospital death. Notably, the risk for patients with ER-SBP of 100-160 mmHg (intermediate risk) differed according to their on-site SBP; those with on-site SBP &lt;100 or 100-160 mmHg were at higher risk (OR, 7.39; 95% CI, 4.00-13.6 and OR, 2.73; 95% CI, 1.83-4.08, respectively [P&lt;0.001 for both]) than patients with on-site SBP &gt;160 mmHg.
Conclusions: Monitoring changes in SBP assisted risk stratification of AHF patients, particularly patients with intermediate ER-SBP measurements.

DOI： 10.1253/circj.CJ-16-0837

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Aims: To determine the association of daily and day-to-day glucose variability with oxidative stress.
Methods: This was a cross-sectional analysis of 68 patients with type 2 diabetes mellitus (T2DM) over 72 h of continuous glucose monitoring. Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) were measured before breakfast on day 1. Glucose variability, mean glucose level (MGL), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD) in glucose levels and area under the postprandial plasma glucose curve (AUC(PP)) were measured on days 2 and 3. Plasma oxidant capacity against N,N-diethylpara phenylenediamine was measured with the diacron-reactive oxygen metabolites (d-ROMs) test on day 1.
Results: Overall, 66.2% males with the mean age of 63.2 +/- 12.6 years, diabetes duration of 12.9 +/- 10.4 years, and HbA1c level of 8.1 +/- 1.6% (65 +/- 17 mmol/mol) were included. MGL (r = 0.330), HbA1c (r = 0.326), MAGE (r = 0.565), MODD (r = 0.488), and AUCPP (r = 0.254) exhibited significant correlations with d-ROMs and not FPG; these correlations remained significant after adjustment for clinical factors (sex, age, duration of diabetes, smoking habit, insulin use, statin use, angiotensin II receptor blocker use, BMI, LDL-C, HDL-C, TG, eGFR, and systolic blood pressure) (R-2 = 0.268, R-2 = 0.268, R-2 = 0.417, R-2 = 0.314, and R-2 = 0.347, respectively). MAGE was significantly correlated with MODD (r = 0.708) and MAGE and MODD were independently correlated with d-ROMs by multivariate analysis.
Conclusions: Therefore, oxidative stress is associated with daily and day-to-day glucose variability in patients with T2DM. (C) 2016 The Author(s). Published by Elsevier Ireland Ltd.

DOI： 10.1016/j.diabres.2016.09.025

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Limited data exists on ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) managed by a well-organized cardiac care network in a metropolitan area. We analyzed the Tokyo CCU network database in 2009-2010. Of 4329 acute myocardial infarction (AMI) patients including STEMI (n = 3202) and NSTEMI (n = 1127), percutaneous coronary intervention (PCI) was performed in 88.8 % of STEMI and 70.4 % of NSTEMI patients. Mean onset-to-door and door-to-balloon times in STEMI patients were shorter than those in NSTEMI patients (167 vs 233 and 60 vs 145 min, respectively, p &lt; 0.001). Coronary artery bypass graft surgery was performed in 4.2 % of STEMI and 11.4 % of NSTEMI patients. In-hospital mortality was significantly higher in STEMI patients than NSTEMI patients (7.7 vs 5.1 %, p &lt; 0.007). Independent correlates of in-hospital mortality were advanced age, low blood pressure, and high Killip classification, statin-treated dyslipidemia and PCI within 24 h were favorable predictors for STEMI. High Killip classification, high heart rate, and hemodialysis were significant predictors of in-hospital mortality, whereas statin-treated dyslipidemia was the only favorable predictor for NSTEMI. In conclusion, patients with MI received PCI frequently (83.5 %) and promptly (door-to-balloon time; 66 min), and had favorable in-hospital prognosis (in-hospital mortality; 7.0 %). In addition to traditional predictors of in-hospital death, statin-treated dyslipidemia was a favorable predictor of in-hospital mortality for STEMI and NSTEMI patients, whereas hemodialysis was the strongest predictor for NSTEMI patients.

DOI： 10.1007/s00380-015-0791-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.amjcard.2016.07.052

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記述言語：日本語   出版者・発行元：日本心臓血管内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00679&link_issn=&doc_id=20160727210038&doc_link_id=%2Fah2sinzd%2F2016%2F004807%2F040%2F0844-0844%26dl%3D2&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2016%2F004807%2F040%2F0844-0844%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

記述言語：日本語   出版者・発行元：日本静脈学会  

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DOI： 10.1016/S0735-1097(16)30581-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Previous trials have found that low low-density lipoprotein-cholesterol (LDL-C) on admission was associated with increased mortality in patients with acute myocardial infarction (AMI). There are few reports, however, on the effect of low LDL-C with or without in-hospital statin treatment on short-term prognosis in AMI patients.
Methods and Results: A total of 9,032 AMI patients underwent primary PCI in 68 centers in the Tokyo CCU Network Registry during 2009-2012, in whom LDL-C was measured in 6,486. We divided them into 4 groups: statintreated/LDL-C &lt;100 mg/dl (n=1,236), statin-treated/LDL-C &gt;= 100 mg/dl (n=3,671), statin-naive/LDL-C &lt;100 mg/dl (n=662), and statin-naive/LDL-C &gt;= 100 mg/dl (n=917). We assessed hospital mortality within 30 days. In-hospital all-cause mortality was significantly lower in the statin-treated/LDL-C &gt;= 100-mg/dl group (3.2%, P&lt;0.001). On multivariate Cox regression analysis, adjusted for age, gender, hypertension, diabetes mellitus, dyslipidemia and other clinical factors, the combination of statin treatment and LDL-C &gt;= 100 mg/dl was an independent predictor of lower in-hospital mortality (adjusted HR, 0.211; 95% CI: 0.096-0.462; P&lt;0.001). In the LDL-C &lt;100-mg/dl patients, statin treatment also independently reduced in-hospital mortality (adjusted HR, 0.467; 95% CI: 0.223-0.976; P=0.043). Spontaneously low LDL-C was associated with increased short-term mortality.
Conclusions: Statin treatment was associated with better short-term outcome in patients with AMI, even in patients with low LDL-C.

DOI： 10.1253/circj.CJ-15-0889

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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DOI： 10.18888/J01565.2016139080

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記述言語：日本語   出版者・発行元：一般社団法人 日本集中治療医学会  

DOI： 10.3918/jsicm.23.621

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記述言語：英語   出版者・発行元：一般社団法人 日本内科学会  

<p>Objective A fever is observed in approximately one-third of cases of acute aortic dissection (AAD); however, the causes remain unclear. We investigated the mechanism of a fever in AAD by measuring the serum concentrations of inflammatory markers, mediators of coagulation and fibrinolysis, and procalcitonin, a marker of bacterial infection. </p><p>Methods We retrospectively studied 43 patients with medically treated AAD without apparent infection. Patients were divided into those with (Group A; n=19) and without (Group B; n=24) a maximum body temperature >38°C. We established which patients fulfilled the criteria for systemic inflammatory response syndrome (SIRS), and its relationship with a fever was examined. Mediators of inflammation, coagulation and fibrinolysis were compared by a univariate analysis. Factors independently associated with a fever were established by a multivariate analysis. </p><p>Results The criteria for SIRS were fulfilled in a greater proportion of patients in Group A (79%) than in Group B (42%, p=0.001). There was no difference in the procalcitonin concentration between Groups A and B (0.15±0.17 ng/mL vs. 0.11±0.12 ng/mL, respectively; p=0.572). Serum procalcitonin concentrations lay within the normal range in all patients in whom it was measured, which showed that the fever was caused by endogenous mediators. On the multivariate analysis, there was a borderline significant relationship between a fever and the prothrombin time-International Normalized Ratio (p=0.065), likely reflecting the extrinsic pathway activity initiated by tissue factor. </p><p>Conclusion Our findings suggest that a fever in AAD could be caused by SIRS, provoked by endogenous mediators that influence the extrinsic coagulation pathway without elevating the serum procalcitonin concentration. </p>

DOI： 10.2169/internalmedicine.55.5924

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Although several studies have shown the relation between temperature/atmospheric pressure and pulmonary embolism (PE), their results are inconsistent. Furthermore, diurnal temperature range (DTR) and diurnal pressure range (DPR) were not fully evaluated for their associations with hospital admissions for PE. Study subjects comprised cases of 1,148 PE treated at institutions belonging to the Tokyo Cardiovascular Care Unit Network from January 2005 to December 2012. Patient data were combined with a variety of daily local climate parameters obtained from the Japan Meteorological Agency. Every 1 degrees C increase in the DTR at lag0 corresponded to an increased relative risk of hospital admission for PE (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.003 to 1.070). In the cooler season (November to April), an increase of 1 hPa (barometric pressure) in the DPR at lag4 and lag5 was associated with an increased relative risk of hospital admission for PE (OR 1.042, 95% CI 1.007 to 1.077 and OR 0.952, 95% CI 0.914 to 0.992, respectively). An increase in the PE hospitalization rate was seen only in the cool season. Using a metropolitan database, we showed that DTR and DPR have differ

DOI： 10.1016/j.amjcard.2015.09.035

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

Although several studies have shown the relation between temperature/atmospheric pressure and pulmonary embolism (PE), their results are inconsistent. Furthermore, diurnal temperature range (DTR) and diurnal pressure range (DPR) were not fully evaluated for their associations with hospital admissions for PE. Study subjects comprised cases of 1,148 PE treated at institutions belonging to the Tokyo Cardiovascular Care Unit Network from January 2005 to December 2012. Patient data were combined with a variety of daily local climate parameters obtained from the Japan Meteorological Agency. Every 1 degrees C increase in the DTR at lag0 corresponded to an increased relative risk of hospital admission for PE (odds ratio [OR] 1.036,95% confidence interval [CI] 1.003 to 1.070). In the cooler season (November to April), an increase of 1 hPa (barometric pressure) in the DPR at lag4 and lag5 was associated with an increased relative risk of hospital admission for PE (OR 1.042,95% CI 1.007 to 1.077 and OR 0.952,95% CI 0.914 to 0.992, respectively). An increase in the PE hospitalization rate was seen only in the cool season. Using a metropolitan database, we showed that DTR and DPR have different impacts on hospital admissions for PE. In conclusion, we found that an increase in the DTR increases the PE hospitalization rate, especially during the cooler season. The impact of DTR and DPR on PE incidence and related hospitalizations needs to be further evaluated. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2015.09.035

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:たこつぼ心筋症のうち、典型的な心尖部型とその亜型である心室中部あるいは心基部型のたこつぼ心筋症の心電図変化の違いはいまだ明らかではない。方法と結果:2010年から2012年の3年間に東京都CCUネットワークデータベースに登録されたたこつぼ心筋症患者368名のうち、入院時12誘導心電図が評価可能であった310名(心尖部型、n=290;心室中部型、n=13、心基部型、n=7)を対象として心電図所見を比較した。V1誘導のST上昇とV3〜4誘導の陰性T波は心基部型で最も多く認め、一方、I誘導の陰性T波は心室中部型で最も多く認めた。ST上昇を示す誘導数の平均は心尖部型で3.3誘導、心室中部型で2.4誘導、心基部型で1.7誘導であり3病型間で異なっていたが、陰性T波を示す誘導数の平均は3病型とも同等であった。結論:たこつぼ心筋症患者において、心電図のST-T変化はそのバルーン型と関連していることが示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20160315310025&doc_link_id=%2Faa6icutc%2F2015%2F0039s1%2F027%2F5073-5076%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F0039s1%2F027%2F5073-5076%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

【目的】たこつぼ型心筋症は、心身的ストレスにより誘発され可逆性の心室壁運動低下を認める疾患であり、一般的に予後は良好である。しかし、急性期に心不全、ショックなど重篤な血行動態障害を合併する例や一過性左室流出路障害を合併する症例もある。今回、急性期の心エコー所見を用いて、たこつぼ型心筋症の心機能障害の特徴について検討した。【方法】症例は2010年1月から2012年12月までに東京都CCUネットワークに登録された368例(平均年齢74±12歳)である。たこつぼ型心筋症の急性期の心機能障害の特徴を入院時に施行された心エコーを用いて検討した。【結果】急性期に心不全を合併したのは368例中124例(Group HF;34%)であり、院内死亡は23例(6.3%)であった。Group HFでは、左室駆出率(LVEF)が心不全非合併例(Group N)と比較して有意に低値であった(45.6±13.3 vs 53.5±13.3;P<0.001)。しかし、LVEF≧50%の症例でも170例中37例(21.8%)に心不全の合併を認めた。Group HFでは、E/e'が有意に高値(16.5±10.8 vs 11.5±4.2;P=0.0029)で左房径が有意に拡大し(36.5±7.2mm vs 33.1±7.3mm;P=0.0013)、より高度の拡張機能障害の存在が認められた。また、急性期に一過性の左室流出路狭窄が30例(8.2%)に出現し、これらの症例ではショックの合併が有意に高率であった(20.0% vs 5.6%;P=0.009)。【結論】たこつぼ型心筋症の急性期に心エコーを用いて左室収縮能低下、左室拡張能障害や左室流出路障害の合併を検討することは有用である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20160315310024&doc_link_id=%2Faa6icutc%2F2015%2F0039s1%2F026%2F5069-5072%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F0039s1%2F026%2F5069-5072%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:たこつぼ型心筋症は女性に多い疾患であるため、男性の臨床的特徴は明らかになっていないのが現状である。方法:2010年1月から2012年12月に都内71施設で構成されている東京都CCUネットワーク・データベースに登録された368例(男性84例、女性284例)のたこつぼ型心筋症において、入院中の臨床的特徴の比較検討を行った。結果:心尖部型、心機能、心室性不整脈を認めた症例、心臓死において男女差の違いは認められなかった。男性は女性より若く(中央値:72歳vs76歳、P=0.040)、先行する身体的ストレスは男性で多く(50.0% vs 31.3%、P=0.002)、感情的ストレスは女性で多かった(19.0% vs 31.0%、P=0.039)。Killip III以上の重症心不全(20.2% vs 10.6%、P=0.020)は男性で多かった。多変量解析にて院内心合併症(心臓死、重症心不全、心室性不整脈)の予測因子として、男性(odds ratio=4.32、CI=1.41〜13.6、P=0.011)が規定因子であった。結論:男性は女性に比べ院内心合併症が多く、積極的な治療介入が必要である可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20160315310021&doc_link_id=%2Faa6icutc%2F2015%2F0039s1%2F023%2F5061-5064%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F0039s1%2F023%2F5061-5064%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Several studies from Western countries have reported associations between cardiac troponin and B-type natriuretic peptide (BNP) levels and acute pulmonary embolism prognosis; however, the number of such reports from Asian countries, including Japan, is limited. Thus, we evaluated the relationship between blood biochemical findings and acute-phase pulmonary embolism prognosis in Japanese patients.
Methods: The subjects included 441 patients with acute pulmonary embolism (191 men, 250 women; average age, 65.8 +/- 16.0 years) treated at Tokyo CCU Network Institutions from 2009 to 2011 and registered via survey forms. The association between blood biochemical findings at admission and 30-day mortality was investigated.
Results: The median BNP value was 186.5 pg/mL (25th to 75th interguartile range: 49.8-500 pg/mL) of 210 cases. No deaths were recorded among those with BNP levels &lt;90 pg/mL (n = 70), whereas significantly higher mortality (10 deaths/140 cases, 7.1%; p = 0.033) was observed among those with BNP levels &gt;= 90 pg/mL. A qualitative cardiac troponin test was positive in 58 of the 204 cases (28.4%), with a significantly higher mortality incidence (p = 0.017) among the troponin-positive cases [6(10.3%) versus 3 (2.1%) deaths among the 146 troponin-negative cases]. The overall mean blood glucose level at admission of 331 cases was 152.0 +/- 74.0 mg/dL, and 30-day mortality significantly increased with blood glucose values (p = 0.048).
Conclusions: Troponin, BNP, and blood glucose levels are useful prognostic biomarkers for acute pulmonary embolism in Japanese patients. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2015.03.002

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Background
The clinical features of gender differences in takotsubo cardiomyopathy (TC) remain to be determined. The aim of this study was to evaluate the differences in clinical characteristics of male and female patients with TC.
Methods
We obtained the clinical information of 368 patients diagnosed with TC (84 male, 284 female) from the Tokyo CCU Network database collected from 1 January 2010 to 31 December 2012; the Network is comprised of 71 cardiovascular centers in the Tokyo (Japan) metropolitan area. We attempted to characterize clinical differences during hospitalization, comparing male and female patients with TC.
Results
There were no significant differences in apical ballooning type, median echocardiography ejection fraction, serious ventricular arrhythmias (such as ventricular tachycardia or fibrillation), or cardiovascular death between male and female patients. Male patients were younger than female patients (median age at hospitalization for male patients was 72 years vs. 76 years for female patients; p = 0.040). Prior physical stress was more common in male than female patients (50.0% vs. 31.3%; p = 0.002), while emotional stress was more common in female patients (19.0% vs. 31.0%; p = 0.039). Severe pump failure (defined as Killip Class &gt;= III) (20.2% vs. 10.6%; p = 0.020) and cardiopulmonary supportive therapies (28.6% vs. 12.7%, p &lt; 0.001) were more common in male than female patients. Multivariate analysis revealed that male gender (odds ratio = 4.32, 95% CI = 1.41-13.6, p = 0.011) was an independent predictor of adverse composite cardiac events, including cardiovascular death, severe pump failure, and serious ventricular arrhythmia.
Conclusions
Cardiac complications in our dataset appeared to be more common in male than female patients with TC during their hospitalization. Further investigation is required to clarify the underlying mechanisms responsible for the observed gender differences.

DOI： 10.1371/journal.pone.0136655

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記述言語：日本語   出版者・発行元：(株)総合医学社  

＜point＞心筋梗塞後においてモニター心電図でのST変化は病態変化の察知に有用である。モニター心電図で判断に迷う場合は12誘導心電図を記録し、胸部症状や心エコー所見などから総合的に判断する。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Scientific Council from January 2009 to December 2011, a total of 180 consecutive patients (144 men, 68 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction flow grade 0 (absent initial coronary flow) were recruited. Achievements of post-PCI procedural Thrombolysis in Myocardial Infarction flow grade 3 (optimal coronary reflow) and also in-hospital mortality were evaluated in those in accordance with and without coronary thrombectomy. Coronary thrombectomy was performed in 128 patients with Shock-STEM! (71% of all). Overall in-hospital mortality was 41% and that in anterior Shock-STEMI with a necessity of mechanical circulatory support increased by 59% (i.e., profound shock). Coronary thrombectomy did not affect any improvements in the achievement of optimal coronary reflow (65% vs 58%, p = 0.368) and in-hospital mortality (42% vs 37%, p = 0.484) in these patients. Even when focused on 76 patients with profound shock, neither an achievement of optimal coronary reflow (56% vs 47%, p = 0.518) nor in-hospital mortality (58% vs 65%, p = 0.601) were different between with and without coronary thrombectomy. Multivariate logistic analysis did not demonstrate any association of coronary thrombectomy (p = 0.798), left main Shock-STEM! (p = 0.258), and use of mechanical circulatory support (p = 0.119) except a concentration of hemoglobin (for each 1 g/dl increase, odds ratio 1.247, 95% confidence interval 1.035 to 1.531, p = 0.019) with optimal coronary reflow. In conclusion, pre-PCI procedural coronary thrombectomy may have serious limitations on attempting optimal coronary reflow that indicates a necessity of promising strategies for this critical illness. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2015.03.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) have not been fully evaluated in Japan, so the present study aimed to evaluate these risk stratification models in the prediction of mortality of affected patients in Japan.
Methods and Results: We retrospectively analysed 302 PE patients (63.9 +/- 17.2 years of age; 42.4% male) from January 2011 to December 2012 using data from the Tokyo CCU Network. The areas under the receiver-operating characteristic curves were 0.92 (95% confidence interval (CI): 0.88-0.97) for the PESI and 0.88 (95% CI: 0.77-0.98) for the sPESI.
Conclusions: Both scores can be used to predict PE mortality in Japan.

DOI： 10.1253/circj.CJ-14-1433

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: In practice, patients with acute aortic dissection (AAD) are generally divided into 2 groups according to the status of the false lumen: non-communicating or communicating. The similarities and differences between the 2 groups, however, have not been fully determined in a large population.
Methods and Results: We studied 502 patients with Stanford type B AAD. Clinical background at symptom onset was compared, and similarities and differences characterized, for patients with non-communicating (NC group, n=288) vs. communicating (C group, n=214) false lumens. Time of day (00.00-06.00 hours, 06.00-12.00 hours, 12.00-18.00 hours, and 18.00-24.00 hours) and extent of physical activity (extreme exertion, slight exertion, at rest, and sleeping) at symptom onset were similar between groups. Patients in the NC group were older (mean age, 71 +/- 11 years vs. 64 +/- 14 years, P&lt;0.01) and had lower prevalence of distally extended aortic dissection (26% vs. 8%, P&lt;0.01) and deaths in hospital (2% vs. 7%, P=0.011) than those in the C group.
Conclusions: At symptom onset, clinical circumstances and physical activity were similar between the groups, and old age and a background of DeBakey IIIa aortic dissection may be associated with determination of false lumen status. The outcome in the NC group was better than in the C group.

DOI： 10.1253/circj.CJ-14-0828

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   出版者・発行元：The Japanese Circulation Society  

Background:Few reports are available on the characteristics of electrical storms of ventricular tachycardia (VT storm) refractory to intravenous (IV) amiodarone.Methods and Results:IV-amiodarone was administered to 60 patients with ventricular tachyarrhythmia between 2007 and 2012. VT storms, defined as 3 or more episodes of VT within 24 h, occurred in 30 patients (68±12 years, 7 female), with 12 having ischemic and 18 non-ischemic heart disease. We compared the clinical and electrocardiographic characteristics of the patients with VT storms suppressed by IV-amiodarone (Effective group) to those of patients not affected by the treatment (Refractory group). IV-amiodarone could not control recurrence of VT in 9 patients (30%). The Refractory group comprised 5 patients with acute myocardial infarctions. Although there was no difference in the VT cycle length, the QRS duration of both the VT and premature ventricular contractions (PVCs) followed by VT was narrower in the Refractory group than in the Effective group (140±30 vs. 178±25 ms, P<0.01; 121±14 vs. 179±22 ms, P<0.01). In the Refractory group, additional administration of IV-mexiletine and/or Purkinje potential-guided catheter ablation was effective.Conclusions:IV-amiodarone-refractory VT exhibited a relatively narrow QRS tachycardia. The narrow triggering PVCs, suggesting a Purkinje fiber origin, may be treated by additional IV-mexiletine and endocardial catheter ablation.

DOI： 10.1253/circj.CJ-15-0213

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記述言語：日本語   出版者・発行元：The Japanese Coronary Association  

DOI： 10.7793/jcoron.21.015

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その他リンク： http://search.jamas.or.jp/link/ui/2015370800

記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:たこつぼ心筋症(TC)における心電図変化と心臓合併症の関連はいまだ明らかではない。方法:2010年と2011年に東京都CCUネットワークデータベースに登録され入院時12誘導心電図を入手できたTC患者204名(平均年齢73歳、女性78%)を対象として心電図所見を解析した。結果:入院時心電図は以下の5タイプに分類された。ST上昇(+)かつ陰性T波(-)、40%;ST上昇(+)かつ陰性T波(+)、18%;ST上昇(-)かつ陰性T波(+)、28%;正常心電図、6%;分類不能、7%。ST上昇と陰性T波の総誘導数はおのおの、平均3.3誘導、3.5誘導であった。ST上昇は、V1誘導(18%)や肢誘導(4〜18%)に比べ、V2〜6誘導(30〜53%)で多く認めた。心臓合併症があった群は、なかった群に比べ、心拍数が高値で(97/分vs82/分、p<0.001)、V1誘導の陰性T波を示す割合が低かった(16%vs30%、p=0.017)。V1誘導でST上昇(+)かつ陰性T波(-)の場合に心臓合併症を来す割合が高かった(61%)。結論:TCの入院時心電図は多様な所見を示した。V1誘導のST-T変化と心臓合併症が関連する可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00001&link_issn=&doc_id=20150217290017&doc_link_id=%2Faa6icutc%2F2014%2F0038s1%2F020%2F5058-5064%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2014%2F0038s1%2F020%2F5058-5064%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00001&link_issn=&doc_id=20150217290016&doc_link_id=%2Faa6icutc%2F2014%2F0038s1%2F019%2F5055-5057%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2014%2F0038s1%2F019%2F5055-5057%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.amjcard.2014.06.027

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Objective: To elucidate the current status of use of inferior vena cava filters (IVCFs) in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network.
Methods: We conducted a retrospective investigation of 832 consecutive cases of pulmonary embolism reported on survey forms to the Tokyo CCU Network between 2005 and 2010.
Results: Of 832 cases of pulmonary embolism, IVCFs were used in 338(40.6%) and not used in 415(49.9%). Their use was unclear in 79(9.5%) cases. The use rate gradually increased each year from 2005 until 2008 but decreased from 2009 onward. Moreover, 68.9% of the IVCFs used in cases were non-permanent types. In terms of pulmonary embolism severity, the rate of use was 37.2% in non-massive cases, 49.4% in sub-massive cases, 46.9% in massive cases, and 31.9% in collapse cases. Thirty-day mortality in cases of collapse in which IVCFs were not used was extremely high at 75.8%, suggesting that in many cases, rapid deterioration may occur with insufficient time for IVCF insertion. The differences in IVCF usage rate among institutions were large in the range of 12.5-90% from 2005 to 2008, which slightly declined to the range of 25.0-72.2% from 2009 to 2010.
Conclusions: We elucidated the current IVCF use status in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network. Since the status of use differed among institutions, future studies of effective methods of use are required. (c) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2013.10.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Background: Takotsubo cardiomyopathy (TC) is an acute cardiac syndrome characterized by transient left ventricular dysfunction and relatively good prognosis after discharge. However, cardiac complications during hospitalization remain to be fully determined. We attempted to determine features characterizing patients with adverse clinical outcome by comparing those with cardiac complication and without cardiac complication during hospitalization.
Methods and results: We investigated 107 patients with TC from the Tokyo CCU Network database, comprising 67 cardiovascular centers in the metropolitan area during January 1 to December 31, 2010. Cardiac complications were defined as cardiac death, pump failure (Killip grade &gt;= II), sustained ventricular tachycardia or fibrillation (SVT/VF), and advanced atrioventricular block (AVB). Cardiac complications were observed in 41 patients (37 pump failure complicated by 3 cardiac deaths and 2 SVT/VF and 2 AVB without pump failure), and there was no cardiac complication in the remaining 66 patients. There was no difference in age, peak creatinine kinase level, C-reactive protein level and ST elevation on electrocardiogram. Multiple logistic regression analysis showed that white blood cell count (p = 0.039) and brain natriuretic peptide (p = 0.001) were independent predictors of in-hospital adverse cardiac complications.
Conclusions: Cardiac complications are relatively high in patients with TC during hospitalization. High white blood cell count and brain natriuretic peptide level are associated with poor clinical outcome in patients with TC. (c) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2013.09.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5761/atcs.cr.13-00218

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記述言語：日本語   出版者・発行元：Japan Heart Foundation  

DOI： 10.11281/shinzo.46.1033

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その他リンク： http://search.jamas.or.jp/link/ui/2014333842

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

【目的】たこつぼ型心筋症は、心身的ストレスにより誘発され可逆性の心室壁運動低下を認める疾患であり、一般的に予後は良好である。しかし、急性期に心不全、ショックなど重篤な血行動態障害を合併する例や一過性左室流出路障害を合併する症例もある。今回、急性期の心エコー所見を用いて、たこつぼ型心筋症の心機能的特徴について検討した。【方法】症例は2010年1月から12月までに東京都CCUネットワークに登録された107例(平均年齢74±11歳)である。入院時と退院時に心エコーを施行し、心機能評価および左室流出路狭窄出現の有無を検討した。【結果】107例中急性期にcardiac event合併43例(心不全40例(37%)、ショック8例(7%)、院内死亡9例(8%))をGroup CE、それ以外をGroup Nとした。Group Nと比較してGroup CEでは、左室駆出率(LVEF)は有意に低値(49.0±12.6%vs55.6±14.6%:p=0.0294)、E/e'は、有意に高値(16.5±5.1vs9.7±3.9:p=0.0013)で、E/Aは、高値の傾向(1.1±0.9vs0.7±0.3)であった。また、急性期に左室流出路狭窄(LVOT-O)を合併したのは10(9%)であった。Group CEでテコラミン製剤(DOB、DOA)を使用した11例中LVOT-Oを合併したのは4例(36%)であった。ノルアドレナリン、IABP/PCPSにより治療された症例にはLVOT-Oを合併した症例は認めなかった。【結論】たこつぼ型心筋症の急性期に、左室収縮能および左室拡張末期圧や左心房圧上昇、左室流出路狭窄の有無を評価し、重症例の検出や治療法の選択に心エコーは有用である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00001&link_issn=&doc_id=20140123580010&doc_link_id=%2Faa6icutc%2F2013%2F0037s1%2F011%2F5035-5041%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2013%2F0037s1%2F011%2F5035-5041%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

背景:たこつぼ心筋症症例の多くは閉経後の平均65〜75歳の女性とされる。しかし、60歳以下の症例の臨床予後に関するデータは少ない。方法:対象は、2010年1月から2010年12月までに東京都CCU連絡協議会に加盟している67施設に入院したたこつぼ心筋症症例。60歳以下(若年者群)および60歳より高齢(高齢者群)の2群に分け、臨床予後につき比較検討した。結果:対象となったたこつぼ心筋症症例は84症例であった。84症例の内、8症例が60歳以下であった(若年者群)。若年者群の内、75%の症例が女性で、高齢者群の内79%が女性であった。先行する精神的および身体的ストレスが同定された症例は若年者群で50%、高齢者群で72%であった。入院時のKillipクラスがIII以上である重症症例の割合は若年者群で低い傾向にあった。入院中の致死的不整脈の発生頻度は若年群で高く、院内死亡率および入院中に心原性ショックを呈する割合は高齢者群で高い傾向にあった。結論:60歳以下のたこつぼ心筋症症例は入院時のKillipクラスが低く、入院中の院内死亡率および心原性ショックを呈する割合が低い傾向にあった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00001&link_issn=&doc_id=20140123580024&doc_link_id=%2Faa6icutc%2F2013%2F0037s1%2F025%2F5081-5084%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2013%2F0037s1%2F025%2F5081-5084%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

たこつぼ型心筋症は多施設共同研究が少なく、対象人数が少ないのが現状である。今回、東京都CCUネットワークdatabaseを用い、院内での臨床的特徴を明らかにすることを目的とした。2010年1月から12月までに登録された107例のたこつぼ型心筋症を解析した。82例が女性であり、平均年齢74±11歳であり、胸痛、呼吸困難を主訴に来院される方が89%であった。また68%で精神的、身体的ストレスが先行、心尖部型は92%で認められた。入院中に20%の症例で循環補助を要し、18%の症例で呼吸器補助を要した。入院中の心血管死を4例で認め、2例は心原性ショック、1例は心不全、1例は心原性脳塞栓の内訳であった。心臓合併症が決してまれでないことが示された。(著者抄録)

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記述言語：英語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00679&link_issn=&doc_id=20130718330056&doc_link_id=10.11281%2Fshinzo.45.907&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo.45.907&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jacc.2013.01.097

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記述言語：英語   出版者・発行元：JAPANESE CIRCULATION SOC  

DOI： 10.1253/circj.CJ-13-0241

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記述言語：英語   出版者・発行元：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.ijcard.2012.08.037

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.52.0708

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DOI： 10.4022/jafib.570

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は77歳女性で、左大腿骨頸部骨折で人工骨頭置換術を受け、退院7日後に呼吸困難および胸痛が出現した。胸部造影CTで両側肺動脈主幹部、下肢静脈エコーで左大腿静脈に血栓が認められた。心エコーでは右房内に索状の巨大浮遊血栓(42mm×35mm)を認め、推定収縮期肺動脈圧は58.1mmHgと肺高血圧を示した。右房内血栓を伴っていたが亜広範型の急性肺塞栓症であり、出血リスクは低いと考え血栓溶解療法を選択した。肺塞栓および循環不全に備えて経皮的心肺補助装置導入用のシースを右大腿動静脈に挿入後、モンテプラーゼ160万単位を全身投与した。投与2時間後の心エコーで右房内血栓に変化はなく、右心負荷所見の改善が認められた。軽度の穿刺部出血で輸血を要したが、未分画ヘパリン静注による抗凝固療法は継続した。第5病日の造影CTで両側肺動脈内の血栓は残存していたが末梢では縮小を認め、右房内血栓は第9病日に消失した。その後、順調に経過し第35病日に退院した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00679&link_issn=&doc_id=20120723250062&doc_link_id=%2Fah2sinzd%2F2012%2F004407%2F064%2F0937-0938%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2012%2F004407%2F064%2F0937-0938%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語  

DOI： 10.1016/j.ijcard.2011.10.039

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記述言語：日本語   出版者・発行元：日本静脈学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 61-year-old man without a Marfan-like phenotype was admitted to the hospital because of acute Stanford type A aortic dissection. The patient underwent surgical repair with total arch replacement. Histological examination of the excised aorta showed a connective tissue abnormality, which could have contributed to the development of aortic dissection. The cause of the connective tissue abnormality could not be determined through physical examination. Recently, however, many novel gene mutations have been found to be related to aortic diseases that do not always produce physical signs and symptoms. In this case, unknown causes of connective tissue abnormalities might be existed. (J Nippon Med Sch 2012: 79: 159-162)

DOI： 10.1272/jnms.79.159

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   出版者・発行元：The Japanese Circulation Society  

Background: Because it remains unclear whether noninvasive ventilation (NIV) is an effective therapy for cardiogenic pulmonary edema secondary to acute myocardial infarction (AMI), we retrospectively evaluated our experience with NIV in the treatment of pulmonary edema secondary to AMI and other cardiac conditions. Methods and Results: The study group included 206 patients with cardiogenic pulmonary edema, divided into an AMI group (53 patients) and a non-AMI group (153 patients). The weaning rate from NIV was similar in the AMI and non-AMI groups (90.6% vs. 90.8%, P=0.950). Heart rate, blood pressure, and respiratory rate decreased significantly 1h after initiation of NIV in both groups, and were maintained until weaning from NIV. The frequency of endotracheal intubation after weaning from NIV was higher in the AMI group than in the non-AMI group (7.5% vs. 0.7%, P=0.016), although the overall frequency of intubation was similar in both groups. The in-hospital mortality rate was similar in the AMI and non-AMI groups (13.1% vs. 9.8%, P=0.489). Conclusions: NIV effectively improved vital signs and oxygenation and lowered the intubation rate in patients with cardiogenic pulmonary edema of all etiologies, including AMI. The outcome in patients with AMI treated with NIV depends primarily on the severity of the course of AMI and not on the severity of acute respiratory failure.  (Circ J 2012; 76: 2586–2591)<br>

DOI： 10.1253/circj.CJ-12-0517

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

When pulmonary embolism (PE) develops, circulatory collapse and hypoxia are caused at the same time. The rapid and proper use of extracorporeal life support (ECLS) can improve the mortality rate of patients with collapsed massive PE. No study has examined the influence of treatment that involved adding catheter based-intervention to ECLS with massive collapsed PE. Thirty-five patients with massive PE were examined, and 10 of these patients were placed on ECLS. Eight of the 10 patients placed on ECLS for massive PE were female, and the median age was 61 years. Seven patients had in-hospital onset PE and 3 patients out-of-hospital onset PE. Their underlying conditions were a cerebral infarction (3 patients), coronary artery disease (5 patients), collagen disease (one patient), postoperative state (3 patients), and lung disease (2 patients). Pulmonary angiographic findings showed that a filling defect or complete occlusion was observed in all 10 patients in the proximal lobular arteries, 6 of which had large thrombi stretching to the main pulmonary arteries. All patients underwent thrombolysis. Percutaneous catheter embolus fragmentation and/or thrombectomy were undertaken in 7 patients. All patients required red blood cell transfusion for cannulation site bleeding. The mean duration of ECLS bypass was 48 ± 44 hours. The 30 day mortality rate was 30%. The current study clarified the characteristics of patients with massive PE requiring ECLS. These patients have extensive pulmonary thromboemboli, thus, the aggressive use of catheter-based intervention appears to have beneficial effects for massive PE requiring ECLS.

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記述言語：英語   出版者・発行元：The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery  

Stanford type B acute aortic dissection is sometimes complicated with compressed true lumen of the descending aorta (Dynamic obstruction) and stenosis of a major aortic branch (Static obstruction), which cause organ malperfusion. In such a case, medical therapy alone is usually not effective and endovascular treatments are required including stent implantation and balloon fenestration. However, it is difficult to determine which strategy should be selected, that is, only stent implantation at dissected branch or simultaneous fenestration with stent implantation. We report a case of a 54-year-old man with lower leg ischemia due to type B aortic dissection, who was successfully treated with stent implantation plus balloon fenestration. This case suggests that balloon fenestration plus stent implantation should be considered when static obstruction in the aortic branches is accompanied by dynamic obstruction in the descending aorta.

DOI： 10.5761/atcs.cr.11.01712

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その他リンク： http://search.jamas.or.jp/link/ui/2013106695

記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(株)総合医学社  

＜point＞●動脈穿刺は、解剖や合併症を理解したうえで施行すれば安全に施行できることから、救急・集中治療においては習得すべき手技である。●動脈ラインは、持続的な血圧や血液ガスを測定できるため、重症患者の治療や管理において必要不可欠なツールである。●動脈ラインを使用した、より低侵襲な血行動態モニターとしてAPCOやPiCCOなどが開発されており、術中や救急・集中治療の場で使用されている。●動脈ラインは、簡便でありながら重要な血行動態の情報が得られることから、救急・集中治療においては積極的に導入すべきと考えられる。(著者抄録)

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記述言語：日本語   出版者・発行元：ライフサイエンス出版(株)  

虚血性急性心不全が疑われた19例(男13例・女6例・平均67歳)を対象に、ニコランジル単回静注負荷MIBI心筋シンチグラムにより病態評価を行った。ニコランジル単回静注前後において、収縮期血圧は有意に低下し、心拍数は有意に増加したが、拡張期血圧は有意な変化がなかった。虚血性急性心不全と確定診断された14例において、SPECT像の集積低下度を5段階で評価するtotal defect score(TDS)は、安静時平均17.9からニコランジル投与時14.2と有意に改善した。一方非虚血性心不全5例のTDSは安静時7.4からニコランジル投与時6.2と有意な変化がなかった。虚血性心不全14例全238区域のうち、有意狭窄灌流区域は130区域、非有意狭窄灌流区域は108区域で、両区域ともニコランジル投与により有意な虚血の改善を示した。心エコーによる左室駆出率が30%未満の群も両区域で有意な改善を示したが、30%以上群では主に有意狭窄灌流区域にのみ改善を認めた。

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：Japan Heart Foundation  

DOI： 10.11281/shinzo.43.978

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記述言語：日本語   出版者・発行元：Japan Heart Foundation  

DOI： 10.11281/shinzo.43.935

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We present a case of a 69-year-old male who was hospitalized for the treatment of thyroid storm due to Grave&apos;s disease, who presented with unexpected ventricular fibrillation (VF). The possible etiology was early repolarization (ER), characterized by J-point elevation in inferior and posterolateral leads, unmasked by the attenuation of beta-adrenergic effect with normalization of thyroid hormones and following the administration of a beta-blocker. Our case focuses attention on the occurrence of VF in a patient with ER during the treatment of hyperthyroidism, which to our knowledge is the first such report.

DOI： 10.1007/s10840-010-9507-3

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J00679&link_issn=&doc_id=20100726380050&doc_link_id=%2Fah2sinzd%2F2010%2F004207%2F056%2F0985-0985%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2010%2F004207%2F056%2F0985-0985%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本インターベンショナルラジオロジー学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J02793&link_issn=&doc_id=20100521470004&doc_link_id=10.11407%2Fivr.25.156&url=https%3A%2F%2Fdoi.org%2F10.11407%2Fivr.25.156&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Major pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. The clinical characteristics and outcomes in major PE managed by a well-organized cardiac care regional urban network and hospitals have not been clarified and were examined in the present study.
Methods and Results: Data from the Tokyo CCU Network registered cohort in 2005-2006 were analyzed. Among 193 patients with major PE and known severities and outcomes, 42 patients had massive PE, defined as cardiogenic shock or cardiac arrest. The median time from symptom onset to CCU admission was 16.3h. The in-hospital mortality of the 124 patients who received reperfusion therapy was lower than that of the 69 patients that did not receive reperfusion therapy (11.3% vs 18.8%; P=0.15). In multiple logistic regression analyses after adjusting for advanced age and sex, reperfusion therapy was selected as a significant predictor for in-hospital death (adjusted odds ratio, 0.34; 95%CI, 0.12-0.95; P=0.039), in addition to massive type (adjusted odds ratio, 14.02; 95%CI, 4.71-41.76; P&lt;0.0001).
Conclusions: Early transport and specific reperfusion therapy for major PE were effectively performed by the Tokyo CCU Network, suggesting the efficacy of a specialty management system for major PE. (Circ J 2010; 74: 289-293)

DOI： 10.1253/circj.CJ-09-0623

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-08-0660

PubMed

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

Background Contrast-induced nephropathy (CIN) frequently complicates cardiac catheterization, so the objectives of present study were to investigate the usefulness of cystatin C before catheterization and establish a cut-off level for CIN, and to examine the changes in cystatin C and several other markers in patients with and without CIN. Methods and Results Prospective study of consecutive 87 patients who underwent elective catheterization: moderate renal disease defined as glomerular filtration rate 30-59 ml · min^-1 ·1.73 mm^-2; cystatin C and creatinine (Cr), urinary liver-type fatty acid-binding protein (L-FABP), α₁, β₂ microglobulins, N-acetyl-β-D-glucosaminidase, and microalbumin were measured immediately before, and 1, 2, and 3 days after catheterization. CIN occurred in 18 patients and receiver-operating characteristic analysis showed a higher area-under-the-curve for cystatin C compared with serum Cr (0.933 vs 0.832 p=0.012). At a cut-off level of >1.2 mg/L, cystatin C before catheterization exhibited 94.7% (95% confidence interval: 0.851-1.015) sensitivity and 84.8% specificity for detecting CIN. Cystatin C levels were higher in CIN patients than in those without CIN, even before catheterization (cystatin C: 1.08±0.22 vs 1.36±0.28 mg/L, p=0.007). Urinary L-FABP was increased on days 1 and 2 in patients with moderate renal disease. Conclusion Cystatin C was useful for predicting the occurrence of CIN. Urinary L-FABP was the only marker of transient renotubular damage. (Circ J 2008; 72: 1499 - 1505)<br>

DOI： 10.1253/circj.CJ-07-1006

PubMed

CiNii Books

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DOI： 10.1253/circj.72.679

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Background: Nifekalant is a class III antiarrhythmic drug, which is usually used for suppression of ventricular tachycardia (VT) and fibrillation. We studied the efficacy of nifekalant for acute conversion of atrial flutter (AFL) in a prospective, open label study in the intensive care unit (ICU) of cardiovascular medicine.
Methods: This study consisted of 31 patients. Twenty-six patients (84%) suffered from structural heart diseases. AFL was developed in 15 patients (48%) while on antiarrhythmic therapy with class IA or IC drugs (I-AFL group) for suppressing atrial fibrillation (AF) and in the remaining patients without such drugs (S-AFL group). Patients with prolonged QT interval, hypokalemia were excluded. All patients received one dose of 0.3 mg/kg of nifekalant over 10 minutes under continuous ambulatory monitoring. Four patients with common AFL in each group received nifekalant during electrophysiologic (EP) study.
Results: Nifekalant had an overall AFL conversion efficacy of 77.4% within 60 minutes. Eleven patients in S-AFL group (68.8%) and 13 patients in I-AFL group (86.7%) could be converted with mean conversion times of 10.8 +/- 6.2 and 15.0 +/- 8.0 minutes, respectively (n.s.). Conversion rate was significantly higher in patients with a short duration of arrhythmia. The two modes of AFL termination were mainly demonstrated and the preferential mode significantly differed between the two groups. One patient in each group with excessive QT prolongation (6.5%) developed torsade de pointes (TdP), requiring electrical shock in one patient (3.3%).
Conclusions: Nifekalant can be used for conversion of AFL with a potent efficacy even in patients with structural heart diseases. However, caution should be required for developing TdP.

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記述言語：日本語   出版者・発行元：(NPO)日本高血圧学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

We report a case of a 51- year-old man with transient mid-ventricular ballooning cardiomyopathy. Left ventriculography demonstrated mid- ventricular ballooning and akinesis with hypercontractile apical and basal segments. Iodine- 123- beta-methyl-p-iodophenyl-pentadecanoic acid myocardial scintigraphy showed decreased uptake in the mid-ventricle, corresponding to the mid-ventricular akinetic region. This is the first report of a transient mid-ventricular ballooning cardiomyopathy observed by not only left ventriculography but myocardial scintigraphy. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.ijcard.2007.01.076

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1536/ihj.48.1

PubMed

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記述言語：英語   出版者・発行元：The Japanese Society of Internal Medicine  

Infective endocarditis, a serious infection most commonly affecting rheumatic or prosthetic valves, generally occurs after bacteremia. Atopic dermatitis, a very common disease, carries a high prevalence of skin infections, particularly with Staphylococcus aureus. While cutaneous colonization by S. aureus represents an important source of bacteremia, few cases of infective endocarditis arising from the skin lesions of atopic dermatitis have been reported. We describe a patient with recurrent S. aureus prosthetic valve endocarditis developing in this manner.<br>

DOI： 10.2169/internalmedicine.46.6207

PubMed

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その他リンク： http://search.jamas.or.jp/link/ui/2007315600

記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は53歳,女性.左下肢腫脹,疼痛を主訴に当院に入院した.臨床症状と画像診断より深部静脈血栓症(DVT)および肺動脈血栓塞栓症(PTE)の所見を得た.また血中アンチトロンビン(AT)活性ならびに抗原量も低値であり,先天性AT欠損症と診断した.血栓溶解療法,抗凝固療法を施行し,PTEに対し経カテーテル的血栓吸引破砕術,永久型下大静脈(IVC)フィルター挿入術を施行した.約1週間後より右下肢の腫脹,疼痛,熱感が出現したため骨盤造影CTおよび下肢静脈造影施行したところ,IVCフィルター直下に大量血栓が付着し完全閉塞が認められた.ウロキナーゼの全身投与は奏効せず,頻回のカテーテル手技により再開通した.その後抗凝固療法を継続し退院した.退院後の経過も良好である.本症例のごとく血栓溶解療法,抗凝固療法にもかかわらずIVCフィルター直下に大量血栓が付着したというAT欠損症の報告例は稀有であるが,われわれはこれに対し積極的なカテーテル治療手技を行い著効を示したためここに報告する(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00679&link_issn=&doc_id=20060818280007&doc_link_id=10.11281%2Fshinzo1969.38.8_796&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo1969.38.8_796&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

DOI： 10.1016/j.ijcard.2005.07.010

PubMed