Publications by authors named "Kaoru Dohi"

168 Publications

Impact of Helicopter Transport on Reperfusion Times and Long-Term Outcomes in Acute Myocardial Infarction Patients in Rural Areas: A Report From the Mie Acute Coronary Syndrome Registry.

Air Med J 2021 Sep-Oct;40(5):337-343. Epub 2021 May 30.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Objective: Helicopter emergency medical services (HEMS) are effective for time-sensitive conditions, such as stroke and trauma. However, prognostic data on helicopter transport for acute myocardial infarction (AMI) patients are insufficient.

Methods: We registered 2,681 AMI patients in the Mie Acute Coronary Syndrome Registry and enrolled 163 patients from rural areas to HEMS base hospitals with HEMS or ground emergency medical services (GEMS). They were categorized into 4 groups according to the transportation method for interhospital transfer (direct HEMS: n = 52, direct GEMS: n = 54, interhospital HEMS: n = 32, and interhospital GEMS: n = 25). The primary end point was the emergency medical services (EMS) call-to-balloon time. The secondary end point was 2-year major adverse cardiac and cerebrovascular events.

Results: The direct HEMS group was younger than the direct GEMS group (P = .029). The EMS call-to-balloon time was shorter in the direct HEMS and interhospital HEMS groups than in each GEMS group (P = .015 and P = .046). The incidence of 2-year major adverse cardiac and cerebrovascular events tended to be lower in both HEMS groups than in each GEMS group.

Conclusion: Direct HEMS for AMI in rural areas shortens the time from the EMS call to reperfusion when the transport distance is expected to exceed 30 km, which may result in a better patient prognosis. In addition, prehospital diagnostic modalities, such as 12-lead electrocardiography and echocardiography, may shorten the duration from the EMS call to reperfusion.
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http://dx.doi.org/10.1016/j.amj.2021.05.001DOI Listing
May 2021

Elderly Man With "Overalls" Edema.

Circ J 2021 Sep 15. Epub 2021 Sep 15.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.

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http://dx.doi.org/10.1253/circj.CJ-21-0700DOI Listing
September 2021

Effects of canagliflozin on NT-proBNP stratified by left ventricular diastolic function in patients with type 2 diabetes and chronic heart failure: a sub analysis of the CANDLE trial.

Cardiovasc Diabetol 2021 Sep 14;20(1):186. Epub 2021 Sep 14.

Department of Cardiovascular Medicine, Saga University, Saga, Japan.

Background: Identification of the effective subtypes of treatment for heart failure (HF) is an essential topic for optimizing treatment of the disorder. We hypothesized that the beneficial effect of SGLT2 inhibitors (SGLT2i) on the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) might depend on baseline diastolic function. To elucidate the effects of SGLT2i in type 2 diabetes mellitus (T2DM) and chronic HF we investigated, as a post-hoc sub-study of the CANDLE trial, the effects of canagliflozin on NT-proBNP levels from baseline to 24 weeks, with the data stratified by left ventricular (LV) diastolic function at baseline.

Methods: Patients (n = 233) in the CANDLE trial were assigned randomly to either an add-on canagliflozin (n = 113) or glimepiride treatment groups (n = 120). The primary endpoint was a comparison between the two groups of the changes from baseline to 24 weeks in NT-pro BNP levels, stratified according to baseline ventricular diastolic function.

Results: The change in the geometric mean of NT-proBNP level from baseline to 24 weeks was 0.98 (95% CI 0.89-1.08) in the canagliflozin group and 1.07 (95% CI 0.97-1.18) in the glimepiride group. The ratio of change with canagliflozin/glimepiride was 0.93 (95% CI 0.82-1.05). Responder analyses were used to investigate the response of an improvement in NT-proBNP levels. Although the subgroup analyses for septal annular velocity (SEP-e') showed no marked heterogeneity in treatment effect, the subgroup with an SEP-e' < 4.7 cm/s indicated there was an association with lower NT-proBNP levels in the canagliflozin group compared with that in the glimepiride group (ratio of change with canagliflozin/glimepiride (0.83, 95% CI 0.66-1.04).

Conclusions: In the subgroup with a lower LV diastolic function, canagliflozin showed a trend of reduced NT-pro BNP levels compared to that observed with glimepiride. This study suggests that the beneficial effects of canagliflozin treatment may be different in subgroups classified by the severity of LV diastolic dysfunction.
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http://dx.doi.org/10.1186/s12933-021-01380-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442416PMC
September 2021

Time Trajectory of Pulmonary Artery Involvement in Takayasu Arteritis Confirmed by Histopathology.

JACC Case Rep 2021 Aug 19;3(10):1294-1296. Epub 2021 Aug 19.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan.

The early diagnosis of Takayasu arteritis (TAK) remains challenging when TAK-related pulmonary artery involvement occurs as an isolated or initial clinical manifestation. We describe the long-term course of a patient with isolated pulmonary TAK who was initially diagnosed with pulmonary arterial hypertension with in situ thrombus but was re-diagnosed following thromboendarterectomy surgery. ().
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http://dx.doi.org/10.1016/j.jaccas.2021.04.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387802PMC
August 2021

Prognosis of acute myocardial infarction in patients on hemodialysis stratified by Killip classification in the modern interventional era (focus on the prognosis of Killip class 1).

Heart Vessels 2021 Aug 4. Epub 2021 Aug 4.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.

Cardiovascular events and death are more prevalent in hemodialysis (HD) patients than in the general population. However, a detailed prognostic risk stratification of HD patients with acute myocardial infarction (AMI) has not yet been performed in the modern interventional era. We examined 4509 AMI patients (89 AMI/HD and 4420 AMI/non-HD) from the Mie ACS registry and detailed prognostic analyses based on the Killip classification were performed (Cohort A). In addition, prognosis of Killip class1 AMI/HD was compared with those of 313 non-AMI/HD patients from the MIE-CARE HD study using propensity score-matching method (Cohort B). Primary endpoint was all-cause mortality for up to 2 years. All-cause death occurred in 13.0% of AMI/non-HD and 35.8% of AMI/HD during follow-up, and patients with Killip class 1 had lower 30-day and 2-year mortality than those with Killip class ≥ 2 in both AMI/non-HD and AMI/HD. Cox regression analyses identified that Killip class ≥ 2 was the strongest independent prognostic factor of 30-day mortality with a hazard ratio of 7.44 (p < 0.001), whereas both presence of HD and Killip class ≥ 2 were the independent prognostic factors of mortality for up to 2 years. In Cohort B, a propensity score-matching analysis revealed similar all-cause mortality rates between Killip class 1 AMI/HD and non-AMI/HD. In HD patients with Killip class 1 AMI, 30-day mortality was around 6%, and long-term mortality among 30-day survivors after AMI was comparable with the natural course of HD patients in the modern interventional era. Clinical trial registration: URL: https://www.umin.ac.jp/ctr/index-j.htm . UMIN000036020 and UMIN000008128.
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http://dx.doi.org/10.1007/s00380-021-01919-7DOI Listing
August 2021

Endovascular Treatment for Lower-extremity Arterial Thrombosis in a Patient with Congenital Afibrinogenemia and a History of Bleeding Complications.

Intern Med 2021 Jul 30. Epub 2021 Jul 30.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan.

Congenital afibrinogenemia is a rare autosomal recessive blood disorder that accompanies thrombotic complications and is associated with bleeding tendency. The management of these opposing complications remains a challenge. Endovascular treatment (EVT) for peripheral arterial thrombosis has not been described in previous studies. A 57-year-old man with congenital afibrinogenemia developed back pain and left lower leg pain. The cause of the pain was confirmed to be renal infarction and lower extremity arterial thrombosis by Doppler ultrasound and contrast-enhanced computed tomography. He was treated with EVT for the lower extremity arterial thrombosis, leading to an excellent short-term improvement without bleeding.
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http://dx.doi.org/10.2169/internalmedicine.7542-21DOI Listing
July 2021

Pathological Q-Waves With Coronary Artery Spasm.

JACC Case Rep 2021 Apr 10;3(4):555-560. Epub 2021 Feb 10.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

This case highlights the diagnostic challenge associated with myocarditis, especially when accompanied by coronary spasm. Any coronary spasm with hemodynamic instability and/or an inexplicable widespread electrocardiogram should alert the clinician to the possibility of fulminant myocarditis and the necessity of endomyocardial biopsy for treatment decisions. ().
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http://dx.doi.org/10.1016/j.jaccas.2020.11.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302779PMC
April 2021

Refractory exercise-induced severe mitral regurgitation in a patient with hypertrophic cardiomyopathy.

J Echocardiogr 2021 Jul 1. Epub 2021 Jul 1.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan.

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http://dx.doi.org/10.1007/s12574-021-00535-8DOI Listing
July 2021

Prognostic importance of acute phase extracellular volume evaluated by cardiac magnetic resonance imaging for patients with acute myocardial infarction.

Int J Cardiovasc Imaging 2021 Jun 30. Epub 2021 Jun 30.

Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan.

Myocardial extracellular volume (ECV) by cardiac magnetic resonance (CMR) in the acute phase of acute myocardial infarction (MI) more precisely predicts the functional recovery of infarct-related wall motion abnormalities and left ventricular (LV) remodeling than late gadolinium enhancement (LGE). The purpose of this study was to evaluate the prognostic importance of acute phase ECV in patients with AMI. We evaluated 61 consecutive AMI patients using 3.0 T CMR. CMR examination was performed median 10 days (7-15 days) after PCI. Primary endpoint was defined as major adverse cardiac event (MACE). The median follow-up duration was 3.1 years, and MACE occurred in 11 (18%) patients. Although LVEF and % infarct LGE volume were not associated with MACE in this study population, higher infarct ECV predicted the MACE with a hazard ratio (HR) of 4.04 (P = 0.02). High global ECV, which was a combined assessment of infarct ECV and remote ECV, also predicted MACE with a HR of 5.24 (P = 0.035). The addition of infarct ECV to remote ECV (global chi-squared score: 1.4) resulted in a significantly increased global chi-squared score (6.7; P = 0.017). Furthermore, after adjusting for the calculated propensity score for high global ECV, it remained an independent predictor of MACE with HR of 5.10 (P = 0.04). The quantification of ECV in the acute phase among AMI patients may provide an incremental prognostic value for predicting MACE beyond that of clinical, angiographic, and functional variables.
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http://dx.doi.org/10.1007/s10554-021-02321-0DOI Listing
June 2021

A Woman in Her 70s With Hypotension, Diffuse ST-Elevation, Murmurs, and an Intracardiac Mass.

JAMA Cardiol 2021 Jun 30. Epub 2021 Jun 30.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

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http://dx.doi.org/10.1001/jamacardio.2021.2012DOI Listing
June 2021

Current status and issues regarding reference values for echocardiography: a short review.

J Med Ultrason (2001) 2021 Jun 29. Epub 2021 Jun 29.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.

In general, the reference values of diagnostic test parameters are specified based on the values of 95% confidence intervals of those parameters measured in healthy subjects. As heart size varies according to sex, there are sex-related differences in the reference values of echocardiographic parameters. There have been attempts to minimize the variability in the reference values of echocardiographic parameters worldwide by correcting for age-related, sex-related, and body size-related differences. This short review describes the current status and issues regarding the reference values of echocardiographic parameters and discusses the findings of research aimed at resolving these issues.
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http://dx.doi.org/10.1007/s10396-021-01108-zDOI Listing
June 2021

Biliary peritonitis due to liver cyst rupture in autosomal dominant polycystic kidney disease.

BMC Gastroenterol 2021 Jun 24;21(1):267. Epub 2021 Jun 24.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent genetic kidney disease and polycystic liver disease is its major extrarenal manifestation, however biliary peritonitis due to a liver cyst rupture is extremely rare.

Case Presentation: The patient was a 71-year-old Japanese woman who was diagnosed with ADPKD 3 years previously and developed right abdominal pain suddenly 1 month previously. As abdominal computed tomography (CT) showed a ruptured liver cyst in the right lobe, she was admitted to our hospital. Her symptoms improved with conservative management and she was discharged from the hospital after 1 week. Although she was asymptomatic for a while, she noticed abdominal distension and general malaise at 1 month after hospital discharge. Since abdominal CT showed massive ascites, she was admitted to our hospital again. A physical examination revealed abdominal distention without tenderness. Her serum creatinine, alkaline phosphatase, γ-glutamyl transpeptidase, total bilirubin, and CA19-9 were elevated. Abdominal paracentesis revealed amber transparent ascites and the bilirubin and CA19-9 concentrations were high. She was diagnosed with biliary peritonitis due to a ruptured liver cyst. Hemodialysis treatment was initiated with drainage of the ascites. The outflow of the ascites was no tendency to decrease and drip infusion cholangiography (DIC)-CT revealed a communication between the ruptured cyst and an intrahepatic bile duct. On day 31, she was transferred to a university hospital and abdominal surgery was performed. After removing the necrotic roof of the ruptured cyst on the right liver lobe, the orifice of the bile leakage was sutured. Cholecystectomy was performed and cholangiography showed no stones in the common bile duct. Abdominal CT one month after the operation showed no recurrence of ascites and she was discharged on day 49. Hemodialysis treatment was discontinued immediately after discharge because urine volume increased and her creatinine level decreased. There has been no recurrence of ascites since then.

Conclusions: While rare, biliary peritonitis can occur in association with the rupture of a liver cyst in ADPKD patients due to communication between the cyst and the intrahepatic bile duct, and DIC-CT should be recommended when biliary cyst rupture is suspected.
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http://dx.doi.org/10.1186/s12876-021-01845-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223295PMC
June 2021

Trajectory of left ventricular geometry and diastolic dysfunction in hereditary transthyretin cardiac amyloidosis.

ESC Heart Fail 2021 Aug 19;8(4):3422-3426. Epub 2021 Jun 19.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Amyloid transthyretin (ATTR) depositions cause left ventricular (LV) hypertrophy, diastolic dysfunction, and heart failure. The time course of changes in LV geometry and diastolic dysfunction has not been fully reported in patients with ATTR cardiomyopathy. A 79-year-old woman with previous myocardial infraction presented with shortness of breath on exertion, and progressive bilateral lower extremity weakness and polyneuropathy. She was diagnosed with Val30Met hereditary ATTR cardiomyopathy by cardiac biopsy and genetic testing. During the past 5 year period, significant LV concentric remodelling with small LV cavity occurred, resulting in an increased LV stiffness and prolonged LV relaxation. This case report highlights the time course of changes in LV geometry and diastolic function and the importance of early diagnosis of ATTR cardiomyopathy.
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http://dx.doi.org/10.1002/ehf2.13454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318479PMC
August 2021

Fatal myopericarditis complicated with coronary vein perforation under the triple antithrombotic therapy: a case report.

Eur Heart J Case Rep 2021 Apr 24;5(4):ytab098. Epub 2021 Apr 24.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.

Background : Acute pericarditis generally follows a mild clinical course and is rarely fatal. Coronary vein involvement is rarely reported.

Case Summary : We report an autopsy case of cardiac tamponade from idiopathic myopericarditis due to coronary venous perforation under the triple antithrombotic therapy. A 69-year-old man was admitted to our hospital with abnormal findings on electrocardiography, bloody pericardial effusion, and mild elevation of troponin I. Oral anti-inflammatories were started and the patient followed a benign course. However, on hospital Day 5, he suddenly suffered cardiogenic shock with pulseless electric activity due to cardiac tamponade under the combination use of the dual antiplatelet drugs and an anticoagulant drug. He died despite intense medical treatment. Autopsy revealed cardiac tamponade caused by perforation in the coronary venous wall. To the best of our knowledge, this is the first description of fatal myopericarditis as a complication of coronary venous perforation.

Discussion : The aetiology and mechanism remain unknown; however, we should take care for this rare complication in patients with acute myopericarditis and bloody effusion under the triple antithrombotic therapy.
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http://dx.doi.org/10.1093/ehjcr/ytab098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188861PMC
April 2021

Membranous nephropathy associated with multicentric Castleman's disease that was successfully treated with tocilizumab: a case report and review of the literature.

BMC Nephrol 2021 Jun 9;22(1):216. Epub 2021 Jun 9.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Background: Multicentric Castleman's disease is a life-threatening disorder involving a systemic inflammatory response and multiple organ failure caused by the overproduction of interleukin-6. Although renal complications of Castleman's disease include AA amyloidosis, thrombotic microangiopathy, and membranoproliferative glomerulonephritis, membranous nephropathy is relatively rare. We experienced a case of secondary membranous nephropathy associated with Castleman's disease.

Case Presentation: The patient was a 43-year-old Japanese man who had shown a high zinc sulfate value in turbidity test, polyclonal hypergammaglobulinemia, anemia, and proteinuria. A physical examination revealed diffuse lymphadenopathy, an enlarged spleen and papulae of the body trunk. A skin biopsy of a papule on the patient's back showed plasma cells in the perivascular area and he was diagnosed with multicentric Castleman's disease, plasma cell variant. Kidney biopsy showed the appearance of bubbling in the glomerular basement membranes in Periodic acid methenamine silver stain and electron microscopy revealed electron dense deposits within and outside the glomerular basement membranes. Since immunofluorescence study showed predominant granular deposition of IgG1 and IgG2, he was diagnosed with secondary membranous nephropathy associated with Castleman's disease. He was initially treated with prednisolone alone, however his biochemical abnormalities did not improve. After intravenous tocilizumab (700 mg every 2 weeks) was started, his C-reactive protein elevation, anemia, and polyclonal gammopathy improved. Furthermore, his urinary protein level declined from 1.58 g/gCr to 0.13 g/gCr. The prednisolone dose was gradually tapered, then discontinued. He has been stable without a recurrence of proteinuria for more than 6 months.

Conclusions: Tocilizumab might be a treatment option for secondary membranous nephropathy associated with Castleman's disease.
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http://dx.doi.org/10.1186/s12882-021-02423-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191014PMC
June 2021

Management of immune checkpoint inhibitor myocarditis: a serial cardiovascular magnetic resonance T2 mapping approach.

Eur Heart J 2021 07;42(29):2869

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 5148507, Japan.

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http://dx.doi.org/10.1093/eurheartj/ehab319DOI Listing
July 2021

Mother-Son Kidney Transplantation in Patients With X-Linked Alport Syndrome.

Kidney Int Rep 2021 May 12;6(5):1454-1458. Epub 2021 Mar 12.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.

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http://dx.doi.org/10.1016/j.ekir.2021.02.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116725PMC
May 2021

Long-term prognostic value of whole-heart coronary magnetic resonance angiography.

J Cardiovasc Magn Reson 2021 05 17;23(1):56. Epub 2021 May 17.

Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.

Background: Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA.

Methods: A total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina.

Results: Obstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan-Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022).

Conclusions: In long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.
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http://dx.doi.org/10.1186/s12968-021-00749-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127259PMC
May 2021

Coronary Microvascular Dysfunction Restored After Surgery in Inflammatory Bowel Disease: A Prospective Observational Study.

J Am Heart Assoc 2021 05 26;10(9):e019125. Epub 2021 Apr 26.

Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Japan.

Background We aimed to investigate the presence and severity of coronary microvascular dysfunction (CMD) in inflammatory bowel disease (IBD) including Crohn disease and ulcerative colitis and to elucidate the influence of surgical resection of the diseased intestines on CMD by assessing coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography. Methods and Results Thirty-seven patients with IBD (aged 44±15 years; 22 patients with Crohn disease and 15 patients with ulcerative colitis) and 30 controls (aged 46±12 years) were enrolled. For CFVR measurement, coronary flow velocity was recorded at rest and during hyperemia by ADP infusion using transthoracic Doppler echocardiography, and CFVR <2.5 defined CMD. CFVR measurement was repeated before and within 1 year after surgery. CFVR was similarly and significantly lower in patients with Crohn disease and those with ulcerative colitis than controls (Crohn disease: 2.92±1.03 [<0.05 versus controls], ulcerative colitis: 2.99±0.65 [<0.05 versus controls], and controls: 3.84±0.75). Multiple linear regression analysis showed that the presence of IBD and baseline hs-CRP (high-sensitivity C-reactive protein) were independently associated with low CFVR among all study participants (β=-0.403 [=0.001] and -0.237 [=0.037], respectively). Hyperemic coronary flow velocity significantly improved after surgery only in patients with IBD who had CMD. CFVR significantly improved in patients with IBD who had both CMD and non-CMD, and the extent of CFVR improvements were greater in patients with CMD than non-CMD. Multiple linear regression analysis showed that the reduction of hs-CRP was independently associated with improvement of hyperemic coronary flow velocity and CFVR among all patients with IBD (β=-0.481 [=0.003] and β=-0.334 [=0.043], respectively). Conclusions IBD is associated with CMD, which improved after surgical resection of diseased intestines.
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http://dx.doi.org/10.1161/JAHA.120.019125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200729PMC
May 2021

Comparison of Door-to-Balloon Time and 30-Day Mortality According to Symptom Presentation in Patients With Acute Myocardial Infarction.

Circ Rep 2021 Mar 19;3(4):194-200. Epub 2021 Mar 19.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Tsu Japan.

We hypothesized that symptom presentation in patients with acute myocardial infarction (AMI) may affect their management and subsequent outcome. Using Rural AMI Registry data, 1,337 consecutive patients with AMI who underwent percutaneous coronary intervention were analyzed. Typical symptoms were defined as any symptoms of chest pain or pressure due to myocardial ischemia. We considered the specific symptoms of dyspnea, nausea, or vomiting as atypical symptoms. The primary outcome was 30-day mortality. There were 150 (11.2%) and 1,187 (88.8%) patients who presented with atypical and typical symptoms, respectively. Those who presented with atypical symptoms were significantly older (mean [±SD] age 74±12 vs. 68±13 years; P<0.001) and had a higher Killip class (46.7% vs. 21.8%; P<0.001) than patients presenting with typical symptoms. The prevalence of door-to-balloon time of ≤90 min was significantly lower in patients with atypical than typical symptoms (40.0% vs. 66.3%; P<0.001). At 30 days, there were 55 incidents of all-cause death. Multivariate Cox proportional hazards regression analysis revealed that symptom presentation was associated with 30-day mortality (hazard ratio 2.33; 95% confidence interval 1.20-4.38; P<0.05). Atypical symptoms in patients with AMI are less likely to lead to timely reperfusion and are associated with increased risk of 30-day mortality.
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http://dx.doi.org/10.1253/circrep.CR-21-0006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024011PMC
March 2021

Giant deep vein thrombus complicating endovascular cooling therapy after cardiac arrest in a boy with hypertrophic cardiomyopathy.

J Cardiol Cases 2021 Apr 19;23(4):189-191. Epub 2021 Feb 19.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.

Mild hypothermia therapy (33-36 °C) is useful in preventing anoxic brain injury occurring after return of spontaneous circulation among survivors of cardiac arrest. Adverse events generally include bleeding, pneumonia, bradycardia, and deep vein thrombosis (DVT). However, one rare complication is huge DVT. We recently encountered a boy with ventricular fibrillation due to hypertrophic cardiomyopathy complicated by huge DVT from bilateral common femoral veins close to the hepatic vein during endovascular cooling therapy via his femoral vein. We successfully managed this case without any complications after infusion of unfractionated heparin to maintain a relatively high activated partial thromboplastin time. .
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http://dx.doi.org/10.1016/j.jccase.2021.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020061PMC
April 2021

Effect of left ventricular ejection fraction on the prognostic impact of chronic total occlusion in a non-infarct-related artery in patients with acute myocardial infarction.

Int J Cardiol Heart Vasc 2021 Apr 26;33:100738. Epub 2021 Feb 26.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.

Background: Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) in patients with acute coronary syndrome (ACS) is associated with a poor prognosis. However, whether the prognostic impact of non-IRA CTO differs according to left ventricular ejection fraction (LVEF) is unclear.

Methods And Results: A total of 2060 consecutive acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) were classified into 2 groups according to their LVEF (reduced EF: LVEF < 50%, preserved EF: LVEF ≥ 50%) and further subdivided according to the presence of concomitant non-IRA CTO. In the reduced EF group, patients with CTO had a higher 1-year all-cause death rate (20.3% vs. 34.3%, P = 0.001) and major adverse cardiac event rate (MACE: 19.6% vs. 39.6%, P < 0.001) compared to those without CTO, but they were similar between patients with and without CTO in the preserved EF group. Non-IRA CTO was an independent predictor of all-cause death (HR 1.58, 95% CI 1.06-2.33, P = 0.02) and MACE (HR 1.67, 95% CI 1.14-2.46, P = 0.009) only in the reduced EF group. In addition, the outcomes of successful CTO-PCI seemed to be similar to those without CTO in the reduced EF group.

Conclusions: CTO in a non-IRA may contribute to a poor prognosis only in AMI patients with reduced LVEF.
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http://dx.doi.org/10.1016/j.ijcha.2021.100738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933260PMC
April 2021

U-Shaped Intrapericardial Chronic Expanding Hematoma Due to Blunt Chest Trauma.

Circ Cardiovasc Imaging 2021 02 1;14(2):e011176. Epub 2021 Feb 1.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (H.I., R.O., M. Ito, K.D.).

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http://dx.doi.org/10.1161/CIRCIMAGING.120.011176DOI Listing
February 2021

Autopsy study of pulmonary capillary hemangiomatosis with inflammatory cell infiltration into the myocardium.

Pulm Circ 2020 Oct-Dec;10(4):2045894020960600. Epub 2020 Nov 23.

Department of Cardiology and Nephrology, Mie University Hospital, Tsu, Japan.

Pulmonary capillary hemangiomatosis is a rare form of pulmonary artery hypertension; to date, only few descriptions of myocardial pathology in pulmonary capillary hemangiomatosis have been reported in the literature. We report the case of a Japanese female patient who was diagnosed with pulmonary capillary hemangiomatosis combined with acute myocardial inflammation on performing autopsy. She was admitted to our hospital because of acute pneumonia and subsequently suddenly developed severe hypoxemia with breathing difficulty and died 13 days after admission. At autopsy, the histology of the lung was consistent with pulmonary capillary hemangiomatosis. Additionally, a diffuse severe infiltration of inflammatory cells was associated with edema in the myocardium. Myocytolysis was limited and fibrosis was absent. To the best of our knowledge, pulmonary capillary hemangiomatosis with acute myocarditis-like histological findings has been described for the first time through our case.
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http://dx.doi.org/10.1177/2045894020960600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686619PMC
November 2020

An atypical CMR presentation of hypertrophic cardiomyopathy mimicking infiltrative diseases.

Eur Heart J Cardiovasc Imaging 2021 Jul;22(8):e127

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 5148507, Japan.

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http://dx.doi.org/10.1093/ehjci/jeaa331DOI Listing
July 2021

Prevalence and Prognosis of Familial Hypercholesterolemia in Patients With Acute Coronary Syndrome in Mie Prefecture, Japan - Report From Mie ACS Registry.

Circ J 2020 12 12;85(1):9-18. Epub 2020 Nov 12.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.

Background: Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by elevated low-density lipoprotein cholesterol concentration and premature acute coronary syndrome (ACS). However, hereditary diseases may have regional characteristics, and few data are available regarding the prevalence of FH throughout particular regions in Japan. This study investigated the prevalence and prognosis of FH in patients with ACS in Mie Prefecture, Japan.Methods and Results:This study investigated 738 ACS patients from the Mie ACS Registry in Mie Prefecture, and 706 (95.7%) with sufficient data to diagnose FH were enrolled for analysis. Eighteen patients (2.5%) were diagnosed with FH, which was similar to findings of another multidistrict registry conducted in Japan. Patients with FH were significantly younger and had a higher prevalence of premature onset of ACS than patients with non-FH (P<0.01). Incidence of major adverse cardiac and cerebrovascular events (MACCE) was not statistically different between patients with FH and non-FH in this study population, even in the propensity score-matched analysis.

Conclusions: Prevalence of FH in ACS patients from the Mie Prefecture was similar to that found in another Japanese multidistrict registry. Among ACS patients, short-term incidence of MACCE was not statistically different between patients with FH and non-FH in this study population.
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http://dx.doi.org/10.1253/circj.CJ-20-0112DOI Listing
December 2020

Monitoring of the Evolution of Immune Checkpoint Inhibitor Myocarditis With Cardiovascular Magnetic Resonance.

Circ Cardiovasc Imaging 2020 11 6;13(11):e010633. Epub 2020 Nov 6.

Department of Cardiology and Nephrology (T.S., S.N., M. Ito, K.D.), Mie University Graduate School of Medicine, Tsu, Japan.

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http://dx.doi.org/10.1161/CIRCIMAGING.120.010633DOI Listing
November 2020

Collagenofibrotic Glomerulopathy.

Intern Med 2021 Mar 14;60(6):911-915. Epub 2020 Oct 14.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan.

Collagenofibrotic glomerulopathy or LMX1B-associated nephropathy is a rare disease in which type III collagen accumulates in the glomeruli. We herein report a 64-year-old Japanese woman with an elevated serum creatinine level and persistent proteinuria for 7 years. An electron microscopic study using tannic acid showed curved and frayed collagen fibers within mesangial and subendothelial regions compatible with type III collagen depositions. The distribution of type IV collagen α1-6 chains was normal. Since no pathogenic mutations were identified in the LMX1B gene, she was diagnosed with collagenofibrotic glomerulopathy and treated with angiotensin II receptor blocker and calcium antagonist to control her blood pressure.
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http://dx.doi.org/10.2169/internalmedicine.6090-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024945PMC
March 2021

Gap junction protein beta 4 plays an important role in cardiac function in humans, rodents, and zebrafish.

PLoS One 2020 13;15(10):e0240129. Epub 2020 Oct 13.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Aims: GJB4 encodes a transmembrane connexin protein (Cx30.3) that is a component of gap junctions. This study investigated whether GJB4 plays an important role in human heart disease and function.

Methods And Results: We examined a patient and her older brother who both presented with complicated severe hypertrophic cardiomyopathy (HCM) and whose parents are healthy married cousins. The gene exome analysis showed 340 single nucleotide polymorphisms (SNPs) that caused amino acid changes for which the patient was homozygous and both parents were heterozygous. After excluding all known common (>10%) SNP gene mutations, the gene for GJB4 was the only identified gene that is possibly associated with cardiac muscle. The resultant E204A substitution exists in the 4th transmembrane domain. GJB4-E204A impaired the binding with gap junction protein A1 (GJA1) compared with GJB4-WT. The expression of GJB4 was induced in rat disease models of left and right ventricle hypertrophy and mouse disease models of adriamycin-induced cardiomyopathy and myocardial infarction, while it was not detected at all in control. An immunohistochemical study was performed for autopsied human hearts and the explanted heart of the patient. GJB4 was expressed and colocalized with GJA1 in intercalated discs in human diseased hearts, which was extensively enhanced in the explanted heart of the patient. The abnormal expression and localization of GJB4 were observed in beating spheres of patient's induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CMs). We generated knockout zebrafish of GJB4 by CRISPR/Cas9 and the endodiastolic volume and the ventricular ejection fraction were significantly lower in GJB4-deficient than in wild-type zebrafish at five days post-fertilization.

Conclusions: These results indicate both that GJB4 is defined as a new connexin in diseased hearts, of which mutation can cause a familial form of HCM, and that GJB4 may be a new target for the treatment of cardiac hypertrophy and dysfunction.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240129PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553298PMC
December 2020
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