Publications by authors named "Hiroaki Kitaoka"

126 Publications

Clinical significance of new-onset atrial fibrillation in patients with hypertrophic cardiomyopathy.

ESC Heart Fail 2021 Sep 2. Epub 2021 Sep 2.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.

Aims: There is limited information about the clinical significance of atrial fibrillation (AF), particularly new-onset AF, in patients with hypertrophic cardiomyopathy (HCM) in a community-based patient cohort. This study was carried out to clarify the prevalence and prognostic impact of AF in Japanese HCM patients.

Methods And Results: In 2004, we established a cardiomyopathy registration network in Kochi Prefecture as a prospective study, and finally, 293 patients with HCM were followed. In the patients' cohort, we recently reported the clinical outcomes including mortality and HCM-related morbid events. HCM-related adverse cardiovascular events were defined in the following: (i) sudden cardiac death (SCD)-relevant events including SCD, spontaneous sustained ventricular tachycardia, and appropriate implantable cardioverter defibrillator discharge; (ii) heart failure (HF) events with the composite of HF death and hospitalization for HF; and (iii) embolic events included embolic stroke-related death and admission for embolic events. In the present study, we focused on AF and conducted a detailed investigation. At registration, the mean age of the patients was 63 ± 14 years, and 86 patients (29%) had documented AF including paroxysmal AF. Patients with AF at registration were characterized by worse clinical profiles including more advanced age, more symptomatic, more advanced left ventricular, and left atrial remodelling at registration. During a mean follow-up period of 6.1 ± 3.2 years, a total of 77 HCM-related adverse events occurred, and the presence of AF at registration was associated with an increased risk of HCM-related adverse events, particularly heart failure events. During the follow-up period, an additional 31 patients (11%) had documentation of AF for the first time, defined as new-onset AF, with an annual incidence of approximately 1.8%, and finally, a total of 117 patients (40%) showed AF. The presence of palpitation and enlarged left atrial diameter, particularly left atrial diameter ≥50 mm, at registration were significant predictors of new-onset AF. Importantly, the incidence of overall HCM-related adverse events was further higher in patients with new-onset AF observed from AF onset than in patients with AF at registration.

Conclusions: In our HCM registry in an aged Japanese community, a significant proportion developed AF. The presence of AF, particularly new-onset AF, was associated with increased incidence of HCM-related events. AF may not be just a marker of disease stage but an important trigger of adverse events.
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http://dx.doi.org/10.1002/ehf2.13563DOI Listing
September 2021

Wild-Type Transthyretin Amyloidosis in Female Patients - Consideration of Sex Differences.

Circ Rep 2021 Aug 29;3(8):465-471. Epub 2021 Jun 29.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan.

With recent advances in non-invasive diagnostic tools, some studies indicate that wild-type transthyretin amyloidosis (ATTRwt) may be more common in females than previously reported. However, the clinical characteristics of female ATTRwt patients have not been determined. Of the 78 consecutive patients with ATTRwt in our cohort, 14 (17.9 %) were female. Compared with male patients, female ATTRwt patients had smaller left ventricular (LV) wall thicknesses (ventricular septum thickness 12.9 vs. 14.2 mm [P=0.081]; posterior wall thickness 12.7 vs. 13.6 mm [P=0.035]) and a higher LV ejection fraction (EF; mean [±SD] 58.4±8.9% vs. 48.9±11.8%; P=0.006). However, the severity of heart failure (HF), as assessed by HF stage, New York Heart Association functional class and B-type natriuretic peptide concentrations, did not differ between female and male patients. Moreover, LV mass index and relative wall thickness were increased and the stroke volume index was reduced in both female and male patients. In organ biopsies, female patients had a higher sensitivity to transthyretin deposition from abdominal fat than male patients (positive abdominal fat biopsy 80.0 % vs. 26.5%; P=0.016). This study suggests that a relatively large proportion of elderly females have ATTRwt. Female ATTRwt patients had HF symptoms even at the stage of mild LV hypertrophy and preserved EF. Abdominal fat biopsy may be useful to diagnose ATTRwt, especially in female patients with HF.
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http://dx.doi.org/10.1253/circrep.CR-21-0067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8338431PMC
August 2021

Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial.

Eur J Phys Rehabil Med 2021 Jul 22. Epub 2021 Jul 22.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Background: Improvements in the Short Physical Performance Battery (SPPB) rather than exercise tolerance reportedly lead to favorable prognosis in elderly patients with acute decompensated heart failure (ADHF). However, about 50% of heart failure shows heart failure with preserved ejection fraction, safe and effective interventions to improve SPPB for these types remain unclear. In addition, although a standard cardiac rehabilitation (CR) program for heart failure is widely used in Japan, whether this is sufficient to improve SPPB in elderly patients with ADHF remains unclear.

Aim: This study was to evaluate whether the addition of multidisciplinary physical interventions to the standard CR program would prove effective for improving SPPB among elderly patients with ADHF regardless types of heart failure.

Desing: Randomized, prospective study.

Setting: Patients admitted to our hospital due to ADHF in Japan.

Population: Elderly patients with ADHF between March 2019 and March 2020 were randomized to two groups, an Intervention group and a Control group.

Methods: The Control group performed standard CR. The Intervention group received balance training and resistance training and used a cycling ergometer in addition to the standard CR program. The primary outcome was the improvement in SPPB after CR.

Results: Seventy-five patients with ADHF were divided into the two groups (Intervention group, n=36; Control group, n=39). At baseline, both groups showed low physical performance and a high prevalence of frailty. Intervention size effect was an improvement in SPPB score of +2.2 (+3.7±1.1 vs. +1.5±1.7; p<0.001). Of the 3 components of SPPB, both gait speed and timed repeated chair rise were significantly improved in the Intervention group compared to the Control group, with intervention size effect of +0.76 and +0.94, respectively (p<0.001). Subgroup analysis of heart failure with preserved ejection fraction showed significant improvement in SPPB score in the Intervention group compared to the Control group (p<0.001).No adverse events were observed during the study period.

Conclusions: A multi-faceted intervention in addition to standard CR improved physical performance among elderly patients with ADHF regardless types of heart failure.

Clinical Rehabilitation Impact: We believe that use of a cycling ergometer and loadspecific resistance training provide specific CR for patients with ADHF during acute hospitalization and highlight the need for active intervention.
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http://dx.doi.org/10.23736/S1973-9087.21.06727-7DOI Listing
July 2021

Tenosynovial and Cardiac Transthyretin Amyloidosis in Japanese Patients Undergoing Carpal Tunnel Release.

Circ Rep 2021 May 27;3(6):338-344. Epub 2021 May 27.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan.

Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is a life-threatening progressive disease. Recent studies have shown that the detection of transthyretin (TTR) amyloid in tenosynovial tissue may play an important role in the diagnosis of cardiac amyloidosis. The aim of this study was to determine the prevalence of TTR amyloid deposits in surgical tissue of patients undergoing carpal tunnel surgery and to clarify the clinical significance of concomitant cardiac examination with Tc-labeled pyrophosphate (Tc-PYP) scintigraphy in those patients with TTR deposition. We evaluated 79 consecutive patients undergoing carpal tunnel release surgery and biopsy of tenosynovial tissue. The mean (±SD) age of the patients at surgery was 71.6±12.5 years (range 30-95 years); 32 patients (41%) were male. TTR amyloid deposition in tenosynovial tissue was observed in 27 patients (34%). Sixteen of those 27 patients underwent Tc-PYP scintigraphy. Of those 16 patients, 3 (19%) had Grade 2 uptake on Tc-PYP scintigraphy. None of the 3 patients with a diagnosis of ATTRwt-CA had apparent cardiac symptoms and left ventricular wall thickness >13 mm. Concomitant cardiac examination with Tc-PYP scintigraphy in patients who had TTR amyloid deposition in tenosynovial tissue resulted in the identification of 19% of patients with a diagnosis of ATTRwt-CA. This diagnostic approach seems to be useful for the early diagnosis of the disease.
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http://dx.doi.org/10.1253/circrep.CR-21-0046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180371PMC
May 2021

The High Road or the Low Road? A Question Regarding Whether to Use Upper or Lower Pulmonary Veins in Measuring Pulmonary Vein Flow.

J Am Soc Echocardiogr 2021 Jun 5. Epub 2021 Jun 5.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

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http://dx.doi.org/10.1016/j.echo.2021.05.018DOI Listing
June 2021

Frailty in patients with acute decompensated heart failure in a super-aged regional Japanese cohort.

ESC Heart Fail 2021 Aug 3;8(4):2876-2888. Epub 2021 Jun 3.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku, Kochi, 783-8505, Japan.

Aims: The aim of this study was to investigate clinical characteristics of frail patients based on a comprehensive frailty assessment in patients hospitalized for acute decompensated heart failure (HF) (ADHF) in super-aged regional Japanese cohort.

Methods And Results: We established the Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI) study, which was a prospective multicentre community-based cohort study in six participating hospitals in Kochi Prefecture, Japan. We enrolled 1061 patients (median age, 81 years; 50.0% men) hospitalized for ADHF between June 2017 and December 2019 in this registry. Patients were classified into the three groups by the severity of frailty using the Kihon Checklist: we identified frailty in 510 patients (53.7%), prefrailty in 293 patients (30.9%), and non-frailty in 146 patients (15.4%). Compared with prefrail and non-frail patients, frail patients were older (84 years interquartile range [IQR, 77-88] vs. 79 years [IQR, 69-86] and 72 years [IQR 65-81], P < 0.001) and more often had prior HF hospitalization (29.6% vs. 21.8% and 16.4%, P < 0.05), chronic kidney disease (81.6% vs. 71.7% and 61.0%, P < 0.01), anaemia (75.3% vs. 61.4% and 50.0%, P < 0.001), cerebrovascular accident (19.0% vs. 9.9% and 4.1%, P < 0.01). The proportion of patients with three or more comorbidities was larger in the frailty group than in the other groups (78.0% vs. 67.2% and 63.0%, P < 0.01). The frequency of functional decline in all domains increased with frailty status. Approximately 70% of frail patients were identified as functional decline in physical function and socialization domains. Fifty to sixty per cent of frail patients had functional decline in instrumental activities of daily living, cognitive function, and depression domains. The percentage of worsening walking ability during hospitalization was increasing with the frailty status (frailty, 27.5%; prefrailty, 21.8%; non-frailty, 8.9%). In multivariate logistic regression analysis, frailty was associated with age [odds ratio (OR) 1.031, 95% confidence interval (CI) 1.011-1.052, P = 0.003], prior HF hospitalization (OR 1.789, 95% CI 1.165-2.764, P = 0.008), brain natriuretic peptide level at discharge (OR 1.001, 95% CI 1.000-1.001, P = 0.020) and prior cerebrovascular accident (OR 2.549, 95% CI 1.484-4.501, P < 0.001).

Conclusions: More than half of patients with ADHF were frail and had functional decline across multiple domains, not only physical function domain. The Kihon Checklist provided useful and valuable information for easily identifying frail patients and comprehensive management of HF.
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http://dx.doi.org/10.1002/ehf2.13363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318434PMC
August 2021

Importance of Paroxysmal Atrial Fibrillation and Sex Differences in the Prevention of Embolic Stroke in Hypertrophic Cardiomyopathy.

Circ Rep 2021 Apr 6;3(5):273-278. Epub 2021 Apr 6.

Department of Cardiology, Chikamori Hospital Kochi Japan.

Although atrial fibrillation (AF) is a well-known risk factor for embolic stroke in hypertrophic cardiomyopathy (HCM), there is a paucity of information derived from HCM patients who have experienced embolic stroke. From 141 consecutive HCM patients who had been hospitalized between 2000 and 2018, the clinical characteristics and management of 86 patients with AF were analyzed retrospectively. The incidence of embolic stroke was 36% (n=31 patients). The median (interquartile range) age of embolic stroke was younger in male than female HCM patients (71 [64-80] vs. 83 [77-87] years, respectively; P=0.009). The prevalence of paroxysmal AF (74%) was significantly higher than that of chronic AF (26%) in 31 patients with embolic stroke (P=0.007). The CHADS score in patients with embolic stroke was not particularly useful in predicting the occurrence of embolic stroke. One-third of HCM patients with AF developed embolic stroke, and male HCM patients were younger at the time of the embolic stroke than female HCM patients. The prevalence of paroxysmal AF was significantly higher than that of chronic AF in patients with AF and embolic stroke. Early introduction of anticoagulation therapy is recommended at the first documentation of paroxysmal AF.
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http://dx.doi.org/10.1253/circrep.CR-20-0101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099667PMC
April 2021

Added value of anxiolytic benzodiazepines in predictive models on severe delirium in patients with acute decompensated heart failure: A retrospective analysis.

PLoS One 2021 22;16(4):e0250372. Epub 2021 Apr 22.

Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan.

Background: Delirium in patients with acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. Although some medications have been reported as risk factors for delirium, their impact on patients with ADHF is still unclear. This study aimed to determine the association of specific medication use with delirium and their additive predictive value in models based on conventional risk factors.

Methods And Results: In this single-center, retrospective study, 650 patients treated for ADHF were included. Fifty-nine patients (9.1%) had delirium. In multivariate analysis, anxiolytic benzodiazepines [odds ratio (OR): 6.4, 95% confidence interval (CI): 2.8-15], mechanical ventilation or noninvasive positive pressure ventilation (OR: 6.0, 95% CI: 2.9-12), depression (OR: 3.2, 95% CI: 1.5-6.5), intensive care or high care unit admission (OR: 2.9, 95% CI: 1.5-5.6), male sex (OR: 2.0, 95% CI: 1-3.7), and age (OR: 1.1, 95% CI: 1-1.1) were independently associated with severe delirium. The predictive model that included anxiolytic benzodiazepines had a significantly better discriminatory ability for the incidence of severe delirium than the conventional model.

Conclusions: The use of anxiolytic benzodiazepines was independently correlated with severe delirium, and their use in models based on conventional risk factors had an additive value for predicting delirium in patients with ADHF.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250372PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062069PMC
April 2021

A Novel Disease Entity in Search of Its Own Identity - Takotsubo Syndrome. Is It Really "Cardiomyopathy"?

Circ Rep 2020 Jul 15;2(8):446-448. Epub 2020 Jul 15.

Department of Cardiology and Aging Science, Kochi Medical School Nankoku Japan.

The term "takotsubo cardiomyopathy" is commonly used in clinical practice. However, there is conceptual problem with the term "cardiomyopathy" in this context because "cardiomyopathy" implies a primary and chronic myocardial disease of unknown etiology. In this study we reviewed the literature related to takotsubo cardiomyopathy to investigate whether it is appropriate to use the term "cardiomyopathy" for this condition. A literature review revealed that this condition was originally described in 1990 in Japan as postischemic myocardial stunning with unique left ventricular apical ballooning and that it gradually gained global attention thereafter. Subsequently, the term "takotsubo cardiomyopathy" was introduced to describe this heart failure phenotype. However, this term has been called into question because several recent studies investigating the mechanism underlying this condition have provided evidence of myocardial ischemia possibly due to microvascular dysfunction. The term "takotsubo syndrome" was suggested to describe this microvascular acute coronary syndrome, which is in agreement with the original description of the condition as myocardial stunning following acute myocardial ischemia. Based on the accumulating evidence of acute myocardial ischemia due to microvascular dysfunction as the mechanism underlying this condition, in addition to the fact that the term "cardiomyopathy" literally implies a primary and chronic myocardial disease, it is advisable that the term "takotsubo syndrome" is used until the etiology and underlying mechanism of this condition are fully clarified.
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http://dx.doi.org/10.1253/circrep.CR-20-0057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819659PMC
July 2020

Sudden Cardiac Death-Relevant Events of Hypertrophic Cardiomyopathy in a Regional Japanese Cohort - Results From the Kochi RYOMA Study.

Circ Rep 2020 Jul 2;2(8):433-439. Epub 2020 Jul 2.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan.

Sudden cardiac death (SCD) is a most devastating complication of hypertrophic cardiomyopathy (HCM). The aim of this study was to clarify the clinical features of HCM in patients who experienced SCD-relevant events in an aged Japanese community. In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, and herein report on 293 patients with HCM who are followed as part of the registry. The mean (±SD) age at registration and diagnosis was 63±14 and 56±16 years, respectively. SCD-relevant events occurred in 19 patients during a mean follow-up period of 6.1±3.2 years (incidence rate 1.0%/year): sudden death in 9 patients, successful recovery from cardiopulmonary arrest in 4 patients, and appropriate implantable cardioverter-defibrillator discharge in 6 patients. At registration, 13 patients were in the dilated phase of HCM (D-HCM). During the follow-up period, HCM developed to D-HCM in 21 patients; thus, 34 patients in total had D-HCM. Multivariate analysis revealed that D-HCM at registration or during follow-up and detection of non-sustained ventricular tachycardia (NSVT) during follow-up were significant predictors of SCD-relevant events. In this HCM population in an aged Japanese community, the annual rate of SCD-relevant events was 1.0%. HCM developed to D-HCM in a considerable number of patients, and D-HCM and NSVT were shown to be independently associated with an increased risk of SCD-relevant events.
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http://dx.doi.org/10.1253/circrep.CR-20-0056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819656PMC
July 2020

Prediction of Medium-Term Mortality in Japanese Patients With Wild-Type Transthyretin Amyloidosis.

Circ Rep 2020 Apr 29;2(6):314-321. Epub 2020 Apr 29.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan.

The prognostic factors in Japanese patients with wild-type transthyretin amyloidosis (ATTRwt) have not been elucidated. In this study we retrospectively analyzed the clinical characteristics and outcomes of 47 patients with ATTRwt (mean (±SD) age at diagnosis 80.3±4.6 years; 41 males). Fifteen patients died within 2 years of their diagnosis. Receiver operating characteristic and Kaplan-Meier analyses revealed that the best predictors of 2-year mortality were low serum albumin (≤3.75 g/dL), elevated high-sensitivity cardiac troponin T (hs-cTnT; >0.086 ng/mL), and reduced left ventricular ejection fraction (LVEF; <50%). According to the total number of these 3 risk factors, patients were stratified into 4 subgroups: low risk (no risk factors; n=15), intermediate-low risk (1 risk factor; n=15), intermediate-high risk (2 risk factors; n=7), and high risk (3 risk factors; n=10). The estimated 2-year survival rate of patients classified as low risk, intermediate-low risk, intermediate-high risk, and high risk was 93%, 80%, 83%, and 11%, respectively (P<0.001). Low serum albumin, elevated hs-cTnT, and reduced LVEF are associated with a worse prognosis in Japanese patients with ATTRwt. The combination of these factors may be useful for predicting medium-term mortality in patients with ATTRwt.
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http://dx.doi.org/10.1253/circrep.CR-20-0031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925325PMC
April 2020

What we believed to be a right upper pulmonary vein by transthoracic echocardiography is actually a right lower pulmonary vein.

Echocardiography 2021 03 29;38(3):427-434. Epub 2021 Jan 29.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Background: Current guidelines recommend that pulmonary vein (PV) velocity should be recorded by using the right upper pulmonary vein (RUPV) during transthoracic echocardiography (TTE) evaluation of left ventricular diastolic function. However, it is uncertain whether the PV displayed during TTE is truly measuring the upper PV. This study aimed to identify the actual site of each PV that is usually detected during TTE.

Methods: We retrospectively studied 105 patients who underwent cardiac computed tomography (CT) and TTE, reconstructed images three-dimensionally, and measured the angles between each PV and the left ventricle (LV) that would correspond to the Doppler incident angle of the apical four-chamber view on TTE. We also performed TTE during catheter ablation to confirm the exact site of the PV.

Results: Apical four-chamber views on TTE revealed that one certain PV was detectable on the right side of the vertebra. CT scans revealed that the median angle of the axes between the LV and right lower pulmonary vein (RLPV) was smaller than that of RUPV {32.1˚ [interquartile range (IQR): 21.7˚-42.1˚] vs. 62.5˚ (IQR: 51.6˚-70.6˚), P < .001}. During catheter ablation for treatment of atrial fibrillation, in the most well-displayed PV on TTE, we detected the ablation catheter placed in the RLPV.

Conclusions: The most well-displayed PV in an apical four-chamber view by TTE was not the RUPV but the RLPV which showed the smallest angle of incidence toward the LV apex. The RLPV is suitable for evaluation of PV velocity to assess LV diastolic function.
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http://dx.doi.org/10.1111/echo.14986DOI Listing
March 2021

A Validation Study of the Mayo Clinic Phenotype-Based Genetic Test Prediction Score for Japanese Patients With Hypertrophic Cardiomyopathy.

Circ J 2021 Apr 23;85(5):669-674. Epub 2021 Jan 23.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University.

Background: Hypertrophic cardiomyopathy (HCM) is a primary myocardial disorder with an autosomal-dominant disorder mainly caused by mutations in sarcomere genes. Recently, a phenotype-based genetic test prediction score for patients with HCM was introduced by Mayo Clinic. The genotype score was derived on the basis of the predictive effect of 6 clinical markers, and the total score was shown to be correlated with the yield of genetic testing. However, it has not been determined whether this prediction model is useful in Japanese HCM patients.Methods and Results:The utility of the Mayo Clinic HCM genotype predictor score in 209 Japanese unrelated patients with a clinical diagnosis of HCM who had undergone genetic testing for 6 sarcomere genes was assessed. Overall, 55 patients (26%) had pathogenic or likely pathogenic variants (60% being genotype-positive in familial cases). We divided the patients into 6 groups (groups with scores of from -1 to 5) according to the prediction score. The yields of genetic testing in the groups with scores of -1, 0, 1, 2, 3, 4, and 5 were 8%, 16%, 24%, 48%, 50%, 100%, and 89%, respectively, with an incremental increase in yield between each of the score subgroups (P<0.001).

Conclusions: The Mayo Clinic HCM genotype predictor score is useful for predicting a positive genetic test result in Japanese HCM Patients.
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http://dx.doi.org/10.1253/circj.CJ-20-0826DOI Listing
April 2021

Greetings from the new Editor-in-Chief.

Authors:
Hiroaki Kitaoka

J Cardiol Cases 2021 Jan 27;23(1). Epub 2020 Nov 27.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

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http://dx.doi.org/10.1016/j.jccase.2020.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783667PMC
January 2021

Association between self-reported night sleep duration and cognitive function among older adults with intact global cognition.

Int J Geriatr Psychiatry 2021 05 3;36(5):766-774. Epub 2020 Dec 3.

Department of Medicine and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Objectives: The purpose of this study was to clarify the association between self-reported night sleep duration and cognitive functions such as word memory, story memory, attention, executive function, and processing speed of older adults with normal global cognitive function.

Methods: A total of 241 functionally independent older adults (mean age, 75.5 ± 6.4 years) participated in this study. No participants had a history of dementia diagnosis, and each had a Mini-Mental State Examination (MMSE) score ≥ 24. Participants were evaluated for self-reported sleep duration and cognitive function using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT).

Results: The longest sleep duration group (≥9 h) had lower MMSE scores (p = 0.010), Z-score of word list memory II (delayed recall; p = 0.001), and Z-score of story memory II (delayed recognition; p = 0.002) than the medium sleep duration group (7-8 h). Longest and long sleep duration (8-9 h) was significantly associated with impairment of story memory II (longest sleep duration: adjusted odds ratio [OR] = 3.58, 95% confidence interval [CI] = 1.13-11.37, long sleep duration: adjusted OR = 4.30, 95% CI = 1.34-13.82) with reference to medium sleep duration, but no impairment of MMSE according to multiple logistic regression analysis. Furthermore, short sleep duration (<7 h) was not associated with cognitive impairment.

Conclusions: This study suggests that long sleep duration is associated with cognitive impairment, especially of story memory (delayed recognition) in older adults with normal global cognitive function.
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http://dx.doi.org/10.1002/gps.5476DOI Listing
May 2021

Validation of the Kumamoto criteria for prediction of technetium pyrophosphate scintigraphy positivity as a strategy for diagnosis of transthyretin cardiac amyloidosis: A retrospective cohort study in Kochi.

J Cardiol 2021 02 22;77(2):124-130. Epub 2020 Oct 22.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Background: Early diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) is important. The aim of this study was to validate the 'Kumamoto criteria' for prediction of technetium-99m pyrophosphate (Tc-PYP) scintigraphy positivity.

Methods: One hundred fifty patients (median age: 79.4 years, 117 males) with the possibility of ATTR-CA who underwent Tc-PYP scintigraphy were assessed. We divided the patients into 4 groups (groups with score of 0-3) according to the Kumamoto criteria by total points for the following 3 factors: high-sensitivity cardiac troponin T (hs-cTnT) ≥0.0308 ng/ml, left ventricle posterior wall thickness ≥13.6 mm, and wide QRS (QRS ≥ 120 ms).

Results: Seventy patients (46.7%) were positive for Tc-PYP scintigraphy. Tc-PYP positivity rates in the groups with score of 0, 1, 2, and 3 were 4%, 39%, 69%, and 89%, respectively. Compared with the original Kumamoto cohort, our patients in the score 1 group showed a relatively high rate of Tc-PYP positivity because hs-cTnT as one of the positive factors had high ability to discriminate the disease. The sensitivity and negative predictive value of hs-cTnT ≥0.0308 ng/ml for Tc-PYP positivity were 97.1% and 93.9%.

Conclusions: In the Kochi validation cohort, the Kumamoto criteria were useful for predicting Tc-PYP positivity. However, patients in the score 1 group should be assessed cautiously for the possibility of ATTR-CA if the hs-cTnT value is high.
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http://dx.doi.org/10.1016/j.jjcc.2020.06.019DOI Listing
February 2021

Cardiac manifestations and effects of enzyme replacement therapy for over 10 years in adults with the attenuated form of mucopolysaccharidosis type I.

Mol Genet Metab Rep 2020 Dec 20;25:100662. Epub 2020 Oct 20.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Background: Mucopolysaccharidosis type I (MPS I) is a rare autosomal recessive disease caused by a deficiency of the lysosomal enzyme α-L-iduronidase. Cardiac manifestations such as valvular heart disease are associated with poor prognosis. There have been only a few reports on the effect of long-term enzyme replacement therapy (ERT) for adult patients with the attenuated form of MPS I (Scheie syndrome) and cardiac involvement.

Methods: We retrospectively reviewed four adult patients of Scheie syndrome for which ERT was performed in our hospital. We investigated the findings of electrocardiography and echocardiography for the four patients performed before and 10 years after the initiation of ERT to evaluate the efficacy for ERT in Scheie syndrome.

Results: The ages of the patients at the initiation of ERT ranged from 26 to 46 years. The mean follow-up period was 129 months (121 to 134 months). Two patients underwent valve replacement surgery before the initiation of ERT. One patient had gradual progressive aortic valve stenosis and mitral valve stenosis during the course of ERT, and double valve replacement was finally performed. The patient who had started ERT at the youngest age did not develop significant cardiovascular disease. Regarding clinical courses with ERT for a period of 10 years, all four patients survived and they showed relatively stable cardiac conditions although two patients developed sick sinus syndrome after the valvular surgery.

Conclusions: Valvular disease in patients with Scheie syndrome occur at a young age. In a limited number of the four patients, ERT might contribute the stability of cardiac condition.
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http://dx.doi.org/10.1016/j.ymgmr.2020.100662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576511PMC
December 2020

Elevation of high-sensitivity cardiac troponin T and left ventricular remodelling in hypertrophic cardiomyopathy.

ESC Heart Fail 2020 Oct 12. Epub 2020 Oct 12.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Aims: Hypertrophic cardiomyopathy (HCM) is generally associated with mild disability and normal life expectancy. On the other hand, once the end-stage phase of HCM characterized by left ventricular (LV) ejection fraction < 50% is established, patients with this subtype have a poor prognosis. This study clarifies the clinical parameters associated with progression to end-stage HCM.

Methods And Results: We retrospectively studied 157 HCM patients (age 59.9 ± 14.2 years, 104 men) with preserved LV systolic function in whom subsequent echocardiographic data were obtained for a period of >1 year. HCM progressed to end-stage HCM in 13 patients (8.3%) of the 157 patients during a mean follow-up period of 6.3 ± 2.8 years. Compared with patients who did not reach end-stage HCM at the last evaluation, patients with progression to the end-stage phase had lower ejection fraction, larger LV size, more enlarged left atrial diameter, longer follow-up period, and higher frequency of an elevated concentration of high-sensitivity cardiac troponin T (hs-cTnT; >0.014 ng/mL) at registration. Multivariate analysis revealed that elevated hs-cTnT was a significant predictor independent of lower LV ejection fraction for progression to end-stage HCM. Furthermore, in patients with elevated hs-cTnT levels, LV ejection fraction became significantly lower, LV end-diastolic diameter increased, and LV wall thickness decreased during the follow-up period, whereas those parameters did not change in the normal hs-cTnT group.

Conclusions: In patients with HCM, an elevated hs-cTnT was associated with progression of LV remodelling, and this biomarker can be useful for predicting progression to the end-stage phase.
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http://dx.doi.org/10.1002/ehf2.12852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754740PMC
October 2020

The diaphragm affects echocardiographic measurement of inferior vena cava diameter to predict right atrial pressure.

J Med Ultrason (2001) 2020 Oct 27;47(4):565-573. Epub 2020 Aug 27.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.

Purpose: It is recommended in current guidelines that the inferior vena cava (IVC) diameter should be measured at 1.0-2.0 cm from the junction with the right atrium. However, right atrial pressure (RAP) is underestimated in some patients who have a small IVC diameter (IVCD) because of a high-echo structure compressing the IVC from the back at that portion. The aim of this study was to identify the structure behind the IVC and to evaluate its influence on RAP.

Methods: We retrospectively studied 116 patients who underwent right-heart catheterization. We reviewed computed tomography (CT) scans and analyzed the relation between RAP and IVCD measured by echocardiography not only in the way recommended in the guidelines, but also in a way that avoided the structure.

Results: CT scans revealed that the diaphragm, not the vertebra, was located just behind the IVC in most patients. Sixteen patients (13.8%) had RAP ≥ 10 mmHg. In those patients, when IVCs were measured in a way that avoided the diaphragm, IVCDmax diameter was larger and IVC collapsibility index (IVCCI) tended to be smaller than those when IVCDs were measured according to the guideline methods. The sensitivity of IVCD to predict RAP ≥ 10 mmHg (IVCDmax > 21 mm, IVCCI < 50%) increased from 31.3% to 68.8% with our method.

Conclusions: The high-echo structure pushing the IVC from the back is the diaphragm in most patients. It might be better to measure IVCD using a method that avoids the diaphragm to accurately estimate RAP.
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http://dx.doi.org/10.1007/s10396-020-01047-1DOI Listing
October 2020

Lifelong Clinical Impact of the Presence of Sarcomere Gene Mutation in Japanese Patients With Hypertrophic Cardiomyopathy.

Circ J 2020 09 22;84(10):1846-1853. Epub 2020 Aug 22.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University.

Background: Hypertrophic cardiomyopathy (HCM) is mainly caused by mutations in sarcomere genes. Regarding the clinical implications of genetic information, little is known about the lifelong clinical effect of sarcomere mutations in Japanese HCM patients.Methods and Results:We studied 211 consecutive Japanese patients with HCM who had agreed to genetic testing between 2003 and 2013. Genetic analyses were performed by direct DNA sequencing in the 6 common sarcomere genes (MYH7,MYBPC3,TNNT2,TNNI3,TPM1,ACTC). Through variant filtering, 21 mutations were identified in 67 patients. After excluding 8 patients whose variants were determined as having uncertain significance, finally 203 patients (130 men, age at study entry: 61.8±14.1 years) were investigated for clinical presentation and course. At the time of study entry, patients with mutations were younger, had more frequent non-sustained ventricular tachycardia, had greater interventricular wall thickness, were more frequently in the dilated phase and less frequently had apical HCM. Through their lifetimes, a total of 98 HCM-related morbid events occurred in 72 patients. Survival analysis revealed that patients with sarcomere gene mutations experienced those morbid events significantly more frequently, and this tendency was more prominent for lethal arrhythmic events.

Conclusions: In our HCM cohort, patients with sarcomere gene mutations had poorer lifelong outcome. Genetic information is considered important for better management of HCM.
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http://dx.doi.org/10.1253/circj.CJ-20-0027DOI Listing
September 2020

Premature Onset Aortic Stenosis in Systemic Sclerosis: A Report of a Series of Cases.

Intern Med 2020 Dec 12;59(24):3177-3181. Epub 2020 Aug 12.

Department of Medicine, Chikamori Hospital, Japan.

Although cardiovascular involvement is a well-known complication correlated with a poor prognosis in patients with systemic sclerosis, there are few reports on valvular heart disease. Forty patients with systemic sclerosis were retrospectively analyzed. Valvular heart disease was found in six patients, five of whom had severe tri-leaflet aortic stenosis. Three of these 5 patients were ≤71 years old. Two frail elderly patients who underwent transcatheter aortic valve replacement died within two years. Premature-onset aortic stenosis is not uncommon in patients with systemic sclerosis. When considering mechanical intervention, the evaluation of frailty is important.
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http://dx.doi.org/10.2169/internalmedicine.5226-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807118PMC
December 2020

A single atrial septal defect masquerading as multiple defects due to a refraction artifact - A cautionary note.

J Cardiol Cases 2020 Aug 27;22(2):55-58. Epub 2020 Apr 27.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.

Echocardiography is useful for making a diagnosis of atrial septal defect (ASD) by directly visualizing the shunt flow. Herein, we present a case in which a single ostium secundum type ASD masqueraded as multiple defects on color flow imaging by transthoracic echocardiography. We confirmed by transesophageal echocardiography that this patient actually had a single ASD. An echocardiographic refraction artifact was considered to be the cause of this phenomenon. We need to be aware of the existence of this artifact to avoid misdiagnosis. 〈 Echocardiography is useful for making a diagnosis of atrial septal defect (ASD). We present the case with a single ostium secundum type ASD which masqueraded as multiple defects on color flow imaging due to a refraction artifact. Refraction artifacts can make multiple false flow signals on color imaging. This case emphasizes the importance of an understanding of the existence of this artifact in not only B mode imaging but also color Doppler imaging.〉.
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http://dx.doi.org/10.1016/j.jccase.2020.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403555PMC
August 2020

Preoperative Clinical Features and High Pulmonary Wedge Pressure with a Discordant Pattern as Prognostic Factor in Hemodialysis Patients with Severe Aortic Valve Stenosis.

Int Heart J 2020 Jul 18;61(4):720-726. Epub 2020 Jul 18.

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University.

Hemodialysis (HD) is one of the important risks for the development of cardiovascular disease, including aortic valve stenosis (AS). Although aortic valve replacement (AVR) is a beneficial treatment for AS, HD patients are known to show a high rate of mortality after AVR than non-HD patients.We retrospectively studied 109 patients who underwent AVR for severe AS, 18 of which were HD patients. Survival rate after AVR, preoperative clinical data, and surgical procedure were investigated.In preoperative clinical features, left ventricular end-diastolic diameter was larger, intraventricular septum thickness (IVST) was thicker, left ventricular mass index (LVMI) was higher, left ventricular ejection fraction was lower, E/e' was higher, and pulmonary arterial wedge pressure (PAWP) was higher in the HD group than in the non-HD group. During a follow-up period of 3.2 ± 2.3 years after AVR, patients receiving HD had a worse prognosis than those without HD treatment: the 3-year survival rate after surgery in the HD group was 36.2% and that in the non-HD group was 84.9%. With regard to prognostic factors in the whole cohort, significant differences were found in IVST, LVMI, E/e', PAWP, and HD. In patients receiving HD, abnormally high PAWP for their right atrial pressure (RAP) was observed, suggesting that PAWP and RAP were discordant, and univariate analysis revealed that high PAWP was the only predictor of mortality in HD patients after surgery.Preoperative PAWP with a discordant pattern in HD patients might be an important prognostic predictor after AVR.
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http://dx.doi.org/10.1536/ihj.19-575DOI Listing
July 2020

Hypertrophic Cardiomyopathy - A Heterogeneous and Lifelong Disease in the Real World.

Circ J 2020 07 14;84(8):1218-1226. Epub 2020 Jul 14.

Cardiomyopathy Institute, Chikamori Hospital.

Hypertrophic cardiomyopathy (HCM) is the most frequent hereditary cardiomyopathy, showing an autosomal-dominant f inheritance. A great deal of attention has been paid to genetics, left ventricular tract obstruction and the prediction and prevention of sudden cardiac death in HCM. Needless to say, these are very important, but we should recognize the heterogeneity in etiology, morphology, clinical course and management of this unique cardiomyopathy. Another important perspective is that HCM causes left ventricular remodeling over time and is a disease that requires lifelong management in the real world.
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http://dx.doi.org/10.1253/circj.CJ-20-0524DOI Listing
July 2020

Effects of Switching from Treatment with Amlodipine and Atorvastatin Using Two Pills to an Equal Dose of Single-Pill Therapy in Japanese Outpatients.

Acta Med Okayama 2020 Apr;74(2):103-108

Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi 783-8505, Japan.

This study examined whether switching from amlodipine and atorvastatin treatment using two pills to an equal dose of single-pill therapy is useful in Japanese outpatients. We retrospectively reviewed data obtained from 94 outpatients for whom treatment with two pills, namely amlodipine and atorvastatin, was switched to an equal dose of single-pill therapy in 11 hospitals. The criterion for enrollment in this study was that patients had switched their medication without changing other anti-hypertensive or anti-cholesterol drugs. Neither systolic nor diastolic blood pressure changed significantly after switching to an equal dose of single-pill therapy, whereas low-density lipoprotein (LDL) cholesterol levels significantly decreased after the medication was switched from 94±24 mg/dl to 89±17 mg/dl (p=0.015). A switch from medication with two separate pills of amlodipine and atorvastatin to an equal dose of single-pill therapy resulted in an overall decrease in LDL cholesterol. The results indicated that the switch to single-pill therapy might be a useful treatment.
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http://dx.doi.org/10.18926/AMO/58267DOI Listing
April 2020

Experience of morphine therapy for refractory dyspnea as palliative care in advanced heart failure patients.

J Cardiol 2020 06 12;75(6):682-688. Epub 2020 Feb 12.

Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address:

Background: In the field of palliative care, morphine is known to be effective for alleviating dyspnea in cancer patients. However, little is known regarding the safety and efficacy of morphine therapy for refractory dyspnea as palliative care in advanced heart failure (HF) patients.

Methods: We retrospectively reviewed consecutive advanced HF patients who were referred to the Palliative Care Team at our institution and administered morphine for refractory dyspnea during hospitalization between September 2013 and December 2018. We investigated the details of morphine usage, vital signs, an 11-point quantitative symptom scale, and adverse events at baseline, 24 h, and 72 h after the start of treatment.

Results: Morphine was administered for refractory dyspnea in 43 advanced HF patients [mean age: 73.5 years, male: 28 (65%), New York Heart Association functional class IV: 43 (100%), median left ventricular ejection fraction: 25%, median B-type natriuretic peptide level: 927 pg/ml, concurrent intravenous inotrope: 33 (77%)]. Median initial dose of morphine was 5 mg/day in both oral and intravenous administration and median duration of administration was 5 days. Significant decreases in an 11-point quantitative symptom scale [7 (5, 9) vs. 2 (1, 6); p <  0.01, (data available in 8 patients)] and respiratory rate (22.2 ± 6.1 vs. 19.7 ± 5.2 breaths per minute; p < 0.01) were observed 24 h after the start of morphine administration. Meanwhile, oxygen saturation, blood pressure, and heart rate were not significantly altered after treatment (NS). Common adverse events were delirium (18%) and constipation (8%); however, no lethal adverse event definitely related to morphine therapy occurred during treatment.

Conclusions: This single-center retrospective study revealed the clinical practice of morphine therapy and suggested that morphine therapy might be feasible for refractory dyspnea as palliative care in advanced HF patients.
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http://dx.doi.org/10.1016/j.jjcc.2019.12.015DOI Listing
June 2020
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