Publications by authors named "Shunsuke Kuroda"

28 Publications

  • Page 1 of 1

The utility of a novel mapping algorithm utilizing vectors and global pattern of propagation for scar-related atrial tachycardias.

J Cardiovasc Electrophysiol 2021 May 5. Epub 2021 May 5.

Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Background: Activation maps of scar-related atrial tachycardias (AT) can be challenging to interpret due to difficulty in inaccurate annotation of electrograms, and an arbitrarily predefined mapping window. A novel mapping software integrating vector data and applying an algorithmic solution taking into consideration global activation pattern has been recently described (Coherent™, Biosense Webster "Investigational").

Objective: We aimed to assess the investigational algorithm to determine the mechanism of AT compared with the standard algorithm.

Methods: This study included patients who underwent ablation of scar-related AT using the Carto 3 and the standard activation algorithm. The mapping data were analyzed retrospectively using the investigational algorithm, and the mechanisms were evaluated by two independent electrophysiologists.

Results: A total of 77 scar-related AT activation maps were analyzed (89.6% left atrium, median tachycardia cycle length of 273 ms). Of those, 67 cases with a confirmed mechanism of arrhythmia were used to compare the activation software. The actual mechanism of the arrhythmia was more likely to be identified with the investigational algorithm (67.2% vs. 44.8%, p = .009). In five patients with dual-loop circuits, 3/5 (60%) were correctly identified by the investigational algorithm compared to 0/5 (0%) with the standard software. The reduced atrial voltage was prone to lead to less capable identification of mechanism (p for trend: .05). The investigational algorithm showed higher inter-reviewer agreement (Cohen's kappa .62 vs. .47).

Conclusions: In patients with scar-related ATs, activation mapping algorithms integrating vector data and "best-fit" propagation solution may help in identifying the mechanism and the successful site of termination.
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http://dx.doi.org/10.1111/jce.15074DOI Listing
May 2021

Clinical and Biomarker Profiles and Prognosis of Elderly Patients With Coronavirus Disease 2019 (COVID-19) With Cardiovascular Diseases and/or Risk Factors.

Circ J 2021 05 29;85(6):921-928. Epub 2021 Apr 29.

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.

Background: This study investigated the effects of age on the outcomes of coronavirus disease 2019 (COVID-19) and on cardiac biomarker profiles, especially in patients with cardiovascular diseases and/or risk factors (CVDRF).Methods and Results:A nationwide multicenter retrospective study included 1,518 patients with COVID-19. Of these patients, 693 with underlying CVDRF were analyzed; patients were divided into age groups (<55, 55-64, 65-79, and ≥80 years) and in-hospital mortality and age-specific clinical and cardiac biomarker profiles on admission evaluated. Overall, the mean age of patients was 68 years, 449 (64.8%) were male, and 693 (45.7%) had underlying CVDRF. Elderly (≥80 years) patients had a significantly higher risk of in-hospital mortality regardless of concomitant CVDRF than younger patients (P<0.001). Typical characteristics related to COVID-19, including symptoms and abnormal findings on baseline chest X-ray and computed tomography scans, were significantly less prevalent in the elderly group than in the younger groups. However, a significantly (P<0.001) higher proportion of elderly patients were positive for cardiac troponin (cTn), and B-type natriuretic peptide (BNP) and N-terminal pro BNP (NT-proBNP) levels on admission were significantly higher among elderly than younger patients (P<0.001 and P=0.001, respectively).

Conclusions: Elderly patients with COVID-19 had a higher risk of mortality during the hospital course, regardless of their history of CVDRF, were more likely to be cTn positive, and had significantly higher BNP/NT-proBNP levels than younger patients.
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http://dx.doi.org/10.1253/circj.CJ-21-0160DOI Listing
May 2021

Association Between Statin Use Prior to Admission and Lower Coronavirus Disease 2019 (COVID-19) Severity in Patients With Cardiovascular Disease or Risk Factors.

Circ J 2021 05 29;85(6):939-943. Epub 2021 Apr 29.

Department of Cardiovascular Medicine, Toho University Graduate School of Medicine.

Background: Cardiovascular diseases and/or risk factors (CVDRF) have been reported as risk factors for severe coronavirus disease 2019 (COVID-19).Methods and Results:In total, we selected 693 patients with CVDRF from the CLAVIS-COVID database of 1,518 cases in Japan. The mean age was 68 years (35% females). Statin use was reported by 31% patients at admission. Statin users exhibited lower incidence of extracorporeal membrane oxygenation (ECMO) insertion (1.4% vs. 4.6%, odds ratio [OR]: 0.295, P=0.037) and septic shock (1.4% vs. 6.5%, OR: 0.205, P=0.004) despite having more comorbidities such as diabetes mellitus.

Conclusions: This study suggests the potential benefits of statins use against COVID-19.
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http://dx.doi.org/10.1253/circj.CJ-21-0087DOI Listing
May 2021

Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation.

J Arrhythm 2021 Feb 5;37(1):33-42. Epub 2020 Dec 5.

Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan.

Background: Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is an established treatment, but the effect of deep sedation on PSVT inducibility remains unclear.

Aim: We sought to examine PSVT inducibility and outcomes of catheter ablation under deep sedation using adaptive servo ventilation (ASV).

Methods: We retrospectively evaluated consecutive patients who underwent catheter ablation for PSVT under deep sedation (Propofol + Dexmedetomidine) with use of ASV. Anesthetic depth was controlled with BIS™ monitoring, and phenylephrine was administered to prevent anesthesia-induced hypotension. PSVT induction was attempted in all patients using extrastimuli at baseline, and after isoproterenol (ISP) infusion when necessary.

Results: PSVT was successfully induced in 145 of 147 patients, although ISP infusion was required in the majority (89%). The PSVT was atrioventricular nodal reentrant tachycardia (AVNRT) in 77 (53%), atrioventricular reciprocating tachycardia (AVRT) in 51 (35%), and atrial tachycardia (AT) in 17 (12%). A higher ISP dose was required for AT compared to other PSVT (AVNRT: 0.06 (IQR 0.03-0.06) vs AVRT: 0.03 (0.02-0.06) vs AT: 0.06 (0.03-0.12) mg/h,  = .013). More than half (51%) of the patients developed hypotension requiring phenylephrine; these patients were older. Acute success was obtained in 99% (patients with AVNRT had endpoints with single echo on ISP in 46%). Long-term success rate was 136 of 144 (94%) (AVNRT 96%, AVRT 92%, and AT 93%). There were no complications related to deep sedation.

Conclusions: Deep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long-term outcome. PSVT remains inducible if ISP is used.
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http://dx.doi.org/10.1002/joa3.12476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896470PMC
February 2021

Radiofrequency ablation using a needle electrode combined with heated saline injection: Three different mechanisms of tissue heating.

Heart Rhythm 2021 Mar 11;18(3):453-454. Epub 2020 Dec 11.

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1016/j.hrthm.2020.12.008DOI Listing
March 2021

Procedural and Short-Term Outcomes of Percutaneous Left Atrial Appendage Closure in Patients With Cancer.

Am J Cardiol 2021 02 3;141:154-157. Epub 2020 Dec 3.

Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.12.003DOI Listing
February 2021

Clinical impact of serial change in brain natriuretic peptide before and after catheter ablation in patients with atrial fibrillation and heart failure.

J Cardiol 2021 May 26;77(5):517-524. Epub 2020 Nov 26.

Department of Cardiology, Kameda Medical Center, Chiba, Japan.

Background: Brain natriuretic peptide (BNP) predicts the prognosis in patients with atrial fibrillation (AF) and heart failure (HF); however, the level of BNP can change immediately after restoration of sinus rhythm. We aimed to investigate the clinical impact of serial change in BNP level before and after catheter ablation for AF, on the prognosis.

Methods: In this retrospective single center study, 162 consecutive patients (67±9 years, 66.7% male) with AF and concomitant HF who underwent catheter ablation were examined. We analyzed the cardiac rhythm and % change in BNP pre- and post-ablation.

Results: BNP increased by 32.7% (-4.5% to 51.3%) in patients with sinus rhythm at baseline (sinus rhythm group: N=50) and decreased by 47.6% (20.9 to 61.6%) in patients with AF rhythm at baseline. Patients with AF rhythm at baseline were categorized into two groups according to the median value of reduction in % BNP; patients with good % BNP reduction (good BNP-R group; N=56), and with poor % BNP reduction (poor BNP-R group; N=56). Although the rate of recurrence of AF after ablation was comparable between the good and poor BNP-R groups, poor BNP-R was an independent predictor of subsequent composite events including HF hospitalization, ischemic stroke, and all cause of death after ablation, even after adjusting for other confounders (hazard ratio: 6.85, 95% confidence interval: 2.16 to 21.7, p-value=0.001). In the longitudinal analysis of echocardiographic parameters, shortening of the left ventricular end-diastolic diameter with preserved ejection fraction was evident except in the poor BNP-R group.

Conclusion: In patients with AF and HF, poor % BNP reduction was an independent predictor of adverse outcome, although the rate of recurrence of AF was comparable. Serial BNP measurement might help in better identification of high-risk patients in whom sinus rhythm is restored with catheter ablation.
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http://dx.doi.org/10.1016/j.jjcc.2020.11.011DOI Listing
May 2021

Risk factors for venous bleeding complication at the femoral puncture site after catheter ablation of atrial fibrillation.

J Arrhythm 2020 Aug 1;36(4):678-684. Epub 2020 Jun 1.

Department of Cardiovascular Medicine Tokyo Medical and Dental University Bunkyo, Tokyo Japan.

Background: Venous bleeding complication is often observed after catheter ablation of atrial fibrillation (AF), but the risk factors remain unclear.

Methods: We retrospectively evaluated 570 consecutive patients who underwent catheter ablation of AF from April 2012 to March 2017. After the procedure, the sheaths were removed, and hemostasis was obtained by manual compression followed by application of rolled gauze with elastic bandage and continuous pressure to the puncture site. We evaluated the risk factors for venous bleeding complications defined as hemorrhage from the puncture site that needed recompression after removal of the elastic bandage and rolled gauze.

Results: After excluding 11 patients because of missing data, 559 patients (395 [70.7%] men, mean age: 65.6 ± 8.7 years) were included for analysis. Venous bleeding complication was observed in 213 patients (38.1%). In the multivariate logistic regression analysis, low body mass index (BMI; odds ratio [OR] 0.95, 95% CI 0.90-1.00,  = .04), short compression time (OR 0.77, 95% CI 0.68-0.88,  < .001), and antiplatelet therapy (OR 1.86, 95% CI 1.09-3.16,  = .02) were independent risk factors for venous bleeding complication.

Conclusions: Low BMI, short compression time, and antiplatelet therapy were independent risk factors for venous bleeding complication after catheter ablation of AF. Longer compression time may be needed for patients with low BMI and/or those receiving antiplatelet therapy.
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http://dx.doi.org/10.1002/joa3.12378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411236PMC
August 2020

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure.

PLoS One 2020 26;15(6):e0235493. Epub 2020 Jun 26.

Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.

Aims: The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF.

Methods And Results: Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 78±12 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine >0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction group had a worse prognosis than the other groups. In a Cox regression analysis, only the WRF/lower-BNP-reduction group had higher mortality compared to the no-WRF/higher-BNP-reduction group (hazard ratio: 3.34, p<0.001).

Conclusion: In the very acute phase of AHF, BNP reduction may aid in identifying relevant prognostic significance of WRF.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235493PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319326PMC
September 2020

Predictive value of noninducibility after catheter ablation for paroxysmal and persistent atrial fibrillation.

J Arrhythm 2020 Jun 2;36(3):439-447. Epub 2020 Mar 2.

Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan.

Background: It is unclear whether pacing maneuver at the end of catheter ablation for atrial fibrillation (AF) predicts recurrence of atrial tachyarrhythmia postintervention.

Objective: To investigate whether the predictive value of incremental pacing maneuver after catheter ablation for AF depends on the pacing cycle length and type of AF.

Methods: This study included 298 consecutive patients who underwent initial catheter ablation for nonvalvular AF (61% paroxysmal AF [PAF], 39% persistent AF [PeAF]). Rapid atrial pacing was performed at the end of the procedure. We analyzed minimum coupling interval (CI) of pacing, arrhythmia-inducibility, and atrial tachyarrhythmia recurrence in patients with PAF and PeAF.

Results: Patients were divided into the following three groups according to their response to pacing maneuver: AF-inducible (inducible group; n = 86), noninducible at CI ≥200 ms (non-CI ≥200 group; n = 100), and noninducible at CI <200 ms (non-CI <200 group; n = 112). Kaplan-Meier analysis showed that response to pacing maneuver was significantly associated with recurrence of atrial tachyarrhythmias ( = .028). Cox-regression analysis showed that non-CI <200 was an independent predictor when the inducible group was used as a reference (hazard ratio 0.60, 95% confidence interval 0.40-0.96,  = .031). However, when PAF and PeAF were analyzed separately, non-CI <200 was an independent predictor only in PeAF.

Conclusion: Noninducibility with shorter CI predicted atrial tachyarrhythmia recurrence only for PeAF. Pacing CI and type of AF could influence the predictive value of atrial tachyarrhythmia recurrence.
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http://dx.doi.org/10.1002/joa3.12320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279986PMC
June 2020

Clinical and Prognostic Values of ALBI Score in Patients With Acute Heart Failure.

Heart Lung Circ 2020 Sep 23;29(9):1328-1337. Epub 2019 Dec 23.

Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Background: Although liver dysfunction is one of the common complications in patients with acute heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. We investigated the utility of the ALBI score in patients with AHF compared to that for a preexisting liver dysfunction score, the Model of End-Stage Liver Disease Excluding prothrombin time (MELD XI) score.

Methods: We evaluated ALBI and MELD XI scores in 1,190 AHF patients enrolled in the prospective, multicentre Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure study. The associations between the two scores and the clinical profile and prognostic predictive ability for 1-year mortality were evaluated.

Results: The mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher ALBI score, but not higher MELD XI score, was associated with findings of fluid overload. After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95% CI: 1.60-2.79, p<0.001), but not the MELD XI score (HR 1.02, 95% CI: 0.99-1.06, p=0.242), was associated with 1-year mortality. Likewise, area under the receiver-operator-characteristic curves for 1-year mortality significantly increased when the ALBI score (0.71 vs. 0.74, p=0.020), but not the MELD XI score (0.71 vs. 0.72, p=0.448), was added to the pre-existing risk factors.

Conclusions: The ALBI score is potentially a suitable liver dysfunction marker that incorporates information on fluid overload and prognosis in patients with AHF. These results provide new insights into heart-liver interactions in AHF patients.
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http://dx.doi.org/10.1016/j.hlc.2019.12.003DOI Listing
September 2020

Tricuspid regurgitation pressure gradient identifies prognostically relevant worsening renal function in acute heart failure.

Eur Heart J Cardiovasc Imaging 2021 Jan;22(2):203-209

Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

Aims: Not all worsening renal function (WRF) during heart failure treatment is associated with a poor prognosis. However, a metric capable providing a prognosis of relevant WRF has not been developed. Our aim was to evaluate if a change in tricuspid regurgitation pressure gradient (TRPG) could discriminate prognostically relevant and not relevant WRF in patients with acute heart failure (AHF).

Methods And Results: We examined 809 consecutive hospitalized patients with heart failure (78 ± 12 years, 54% male). WRF was defined as an increase in creatinine >0.3 mg and ≥25% from admission to discharge. TRPG was measured at admission and before discharge using echocardiography. The primary outcome was all-cause death within 1-year after discharge. Patients were classified as follows for analysis: no WRF and no TRPG increase (n = 523); no WRF and TRPG increase (no WRF with iTRPG, n = 170); WRF and no TRPG increase (WRF without iTRPG, n = 90); and WRF and TRPG increase (WRF with iTRPG, n = 26). A change in TRPG weakly but significantly correlated to a change in haemoglobin and haematocrit, a percent decrease in brain natriuretic peptide, and body weight reduction during the index period of hospitalization. All-cause mortality within 1 year was higher in patients with WRF and iTRPG, compared to the other three groups (P = 0.026). On Cox regression analysis, only WRF with iTRPG was associated with higher mortality (hazard ratio 4.24, P = 0.001), even after adjustment for other confounders.

Conclusion: An increase in TRPG may provide a marker to identify prognostically relevant WRF in patients with AHF.
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http://dx.doi.org/10.1093/ehjci/jeaa035DOI Listing
January 2021

Inferior Vena Cava Thrombus due to Left Inferior Vena Cava and Ulcerative Colitis.

TH Open 2018 Oct 24;2(4):e369-e370. Epub 2018 Oct 24.

Department of Cardiology, Kameda Medical Center, Kamogawa City, Chiba, Japan.

A 29-year-old man with diarrhea and abdominal pain for 2 weeks presented with new-onset left back pain. Contrast-enhanced computed tomography (CT) showed a left inferior vena cava (IVC) crossing over the aorta, and thrombus in the IVC and left renal vein. Colonoscopy and biopsy for assessment of diarrhea and abdominal pain provided a diagnosis of ulcerative colitis. Stasis of blood flow due to left IVC crossing over the aorta, and hypercoagulability due to ulcerative colitis influenced thrombus formation.
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http://dx.doi.org/10.1055/s-0038-1673391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524902PMC
October 2018

Safety and Prognostic Impact of Early Treatment with Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers in Patients with Acute Heart Failure.

Am J Cardiovasc Drugs 2019 Dec;19(6):597-605

Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

Background: Although angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been recommended for patients with heart failure, their clinical and prognostic impact in the very acute phase of acute heart failure (AHF) is unclear, mainly because data on their safety and efficacy are lacking.

Methods: This study was a post hoc analysis of the REALITY-AHF trial. Patients with AHF who did not take an ACEI or ARB at admission were enrolled. Patients who received these medications within 48 h of admission were categorized as the ACEI/ARB group, and all other patients were categorized as the no ACEI/ARB group. The primary endpoint was a composite of all-cause death and heart failure readmission within 1 year of admission.

Results: Of the 1682 patients in the REALITY-AHF cohort, 900 were enrolled in this study, and 288 (32%) were included in the ACEI/ARB group. After propensity score matching, 152 pairs were evaluated, and no significant difference was found for in-hospital mortality, worsening renal function, or length of hospital stay. The ACEI/ARB group had significantly higher event-free survival (hazard ratio 0.51; 95% confidence interval 0.32-0.82; p = 0.006).

Conclusions: Early initiation of ACEIs/ARBs within 48 h of admission for hospitalized patients with AHF was not associated with adverse events and correlated with improved outcomes at 1 year from admission.
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http://dx.doi.org/10.1007/s40256-019-00355-3DOI Listing
December 2019

Left subclavian approach for ablation of persistent left superior vena cava in a patient with cardiac resynchronization therapy: a case report.

Europace 2019 Aug;21(8):1184

Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan.

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http://dx.doi.org/10.1093/europace/euz117DOI Listing
August 2019

Specialty-Related Differences in the Acute-Phase Treatment and Prognosis in Patients With Acute Heart Failure - Insights From REALITY-AHF.

Circ J 2018 12 15;83(1):174-181. Epub 2018 Nov 15.

Department of Cardiology, Nagoya University Graduate School of Medicine.

Background: The aim of this study was to assess specialty-related differences in the treatment for patients with acute heart failure (AHF) in the acute phase and subsequent prognostic differences. Methods and Results: We analyzed hospitalizations for AHF in REALITY-AHF, a multicenter prospective registry focused on very early presentation and treatment in patients with AHF. All patients were classified according to the medical specialty of the physicians responsible for contributed most to decisions regarding the initial diagnosis and treatment after the emergency department (ED) arrival. Patients initially managed by emergency physicians (n=614) or cardiologists (n=911) were analyzed. After propensity-score matching, vasodilators were used less often by emergency physicians than by cardiologists at 90 min after ED arrival (29.8% vs. 46.1%, P<0.001); this difference was also observed at 6, 24, and 48 h. Cardiologists administered furosemide earlier than emergency physicians (67 vs. 102 min, P<0.001). However, the use of inotropes, noninvasive ventilation, and endotracheal intubation were similar between groups. In-hospital mortality did not differ between patients managed by emergency physicians and those managed by cardiologists (4.1% vs. 3.8%, odds ratio 1.12; 95% confidence interval 0.58-2.14).

Conclusions: Despite differences in initial management, no prognostic difference was observed between emergency physicians and cardiologists who performed the initial management of patients with AHF.
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http://dx.doi.org/10.1253/circj.CJ-18-0724DOI Listing
December 2018

Very Early Diuretic Response After Admission for Acute Heart Failure.

J Card Fail 2019 Jan 13;25(1):12-19. Epub 2018 Sep 13.

University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands; Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address:

Background: In hospitalized heart failure patients, a poor diuretic response (DR) during the first days of hospital admission is associated with worse outcomes. However, it remains unknown whether DR in the first hours has similar prognostic value. Moreover, data on the sequential change in DR during hospital admission are lacking.

Methods And Results: DR (urine output per 40-mg furosemide-equivalent diuretics dose) was measured from 0 to 6 hours (DR6), 6 to 48 hours (DR6-48), and 0 to 48 hours (DR48) of the patient's emergency department (ED) arrival in 1551 patients with acute heart failure (AHF; mean age 78 years, 56% male, and 48% de novo patients with heart failure). Patients with a poor DR within the first 6 hours were older age, had worse renal function, and were already on diuretic treatment before admission. DR6 was only weakly correlated with DR6-48 (Spearman's rho = 0.273; P < .001). DR6, DR6-48, and DR48 were all significantly associated with 60-day mortality independent of other prognostic factors. DR6 and DR48 showed comparable prognostic ability. However, the model combining DR6 with DR6-48 significantly exceeded both DR6 (net reclassification improvement 0.249; P = .032) and DR48 (net reclassification improvement 0.287; P = 0.025) with regard to 60-day mortality prediction.

Conclusions: DR measured within the first 6 hours of ED arrival and DR measured during the first 48 hours in patients with AHF have similar prognostic value, although they were moderately correlated. Changes in DR over time provide additional prognostic information.
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http://dx.doi.org/10.1016/j.cardfail.2018.09.004DOI Listing
January 2019

Images of atrial giant cell myocarditis.

Eur Heart J Cardiovasc Imaging 2018 02;19(2):243

Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan.

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http://dx.doi.org/10.1093/ehjci/jex261DOI Listing
February 2018

Calcification of joints and arteries with novel NT5E mutations with involvement of upper extremity arteries.

Vasc Med 2017 12 19;22(6):541-543. Epub 2017 Aug 19.

1 Department of Cardiology, Kameda Medical Center, Chiba, Japan.

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http://dx.doi.org/10.1177/1358863X17724263DOI Listing
December 2017

Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure.

J Am Coll Cardiol 2017 Jun;69(25):3042-3051

Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Background: Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics.

Objectives: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome.

Methods: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time <60 min were pre-defined as the early treatment group. Primary outcome was all-cause in-hospital mortality.

Results: Among 1,291 AHF patients treated with intravenous furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006).

Conclusions: In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105).
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http://dx.doi.org/10.1016/j.jacc.2017.04.042DOI Listing
June 2017

Histological examination of the right atrial appendage after failed catheter ablation for focal atrial tachycardia complicated by cardiogenic shock in a post-partum patient.

J Arrhythm 2016 Jun 3;32(3):227-9. Epub 2016 Feb 3.

Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.

A 26-year-old woman in her first pregnancy presented with persistent atrial tachycardia (AT). AT was resistant to medications, cardioversions, and the first attempt of catheter ablation. Two months after delivery she developed severe systolic dysfunction and circulatory collapse. Emergent catheter ablation was performed with the support of percutaneous cardiopulmonary bypass and intraaortic balloon pump. The AT originated in the apex of the right atrial appendage (RAA). Repeated attempts at ablation were unsuccessful, prompting surgical RAA resection, which terminated the tachycardia and improved the cardiac function. Histological examination of resected RAA provided insights into mechanism of resistance to catheter ablation.
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http://dx.doi.org/10.1016/j.joa.2016.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913157PMC
June 2016

Moderate vasomotor response to acetylcholine provocation test as an indicator of long-term prognosis.

Heart Vessels 2016 Dec 11;31(12):1943-1949. Epub 2016 Mar 11.

Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.

The acetylcholine (ACh) provocation test (ACh-test) is used for the diagnosis of vasospastic angina (VSA). However, subjects often show a moderate spasm (MS) response for which diagnosis of VSA is not definitive, and the clinical significance of this response is unknown. We assessed moderate coronary vasomotor response to the ACh test as an indicator of long-term prognosis. A total of 298 consecutive patients who underwent the ACh test for suspected VSA were retrospectively investigated. Coronary spasm severity after intracoronary administration of isosorbide dinitrate was evaluated by measuring epicardial coronary artery diameter reduction after ACh injection. Patients were divided into three groups according to the diameter reduction during the ACh test: severe spasm (SS) showing ≥75 % diameter reduction, MS showing ≥50 % diameter reduction, and others (N). In Kaplan-Meier analysis, the major adverse cardiac event (MACE) rates with a median follow-up of 4.6 years were significantly worse in SS (11.1 %) and MS (8.5 %) than N (1.9 %), (SS vs N; P = 0.009, MS vs N; P = 0.029). Significant difference in MACE rates was not observed between SS and MS (P = 0.534). Cox regression analysis revealed that MS remained an independent predictor of MACE after adjustment for other confounders (HR: 7.18, 95 % CI 1.42-36.4, P = 0.017). Patients with MS by ACh test had a cardiac event rate comparable with that of patients with SS and significantly worse than that of patients with normal vasomotor responses.
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http://dx.doi.org/10.1007/s00380-016-0827-9DOI Listing
December 2016

Differences in catheter ablation of paroxysmal atrial fibrillation between males and females.

Int J Cardiol 2013 Oct 4;168(3):1984-91. Epub 2013 Feb 4.

Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address:

Background: Catheter ablation (CA) has become a standard treatment for patients with atrial fibrillation (AF). However, gender-related differences associated with CA of paroxysmal AF (PAF) remain unclear.

Methods: We compared 1124 consecutive patients (mean age, 61 ± 10 years; male, n=864) with PAF scheduled for CA between the genders.

Results: Females were significantly older (p<0.0001), and had a lower body-mass-index (p=0.02), smaller left atrial dimension (LAD; p=0.04), larger LAD indexed by the body-surface-area (LADI; p<0.0001) and better left ventricular ejection fraction (p<0.0001) at baseline. Ischemic heart disease (p=0.007) was more frequent in males, whereas hypertrophic cardiomyopathy (p=0.007) and mitral stenosis (p=0.001) were more frequent in females. More additional procedures were performed to eliminate non-pulmonary vein foci in females than males (p<0.05), but those locations were similar between the genders. The incidence of procedure-related complications was similar between genders (p=0.73). Sinus rhythm was similarly maintained between females and males after the first CA (56.4% vs. 59.3% at 5 years, p=0.24), but was significantly lower in females after the last CA (76.5% vs. 81.3% at 5 years, p=0.007). More females did refuse multiple CA procedures (especially a second one) than males (37.8% in females vs. 27.4% in males, p=0.02). The age (HR, 0.98/y, p=0.01), duration of AF (HR, 1.04/y, p=0.0001), number of failed anti-arrhythmic-drugs (HR, 1.10, p=0.03) and LADI (HR, 1.89 per 10mm/m(2), p=0.001) were significantly associated with AF-recurrence in males, but not in females.

Conclusions: Specific differences and similarities between the genders were observed in PAF patients undergoing CA.
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http://dx.doi.org/10.1016/j.ijcard.2012.12.101DOI Listing
October 2013

Impact of statin use before the onset of acute myocardial infarction on coronary plaque morphology of the culprit lesion.

Angiology 2013 Jul 7;64(5):375-8. Epub 2012 Jun 7.

Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan.

Statins favorably stabilize coronary plaque. We evaluated the impact of statin use before the onset of acute myocardial infarction (AMI) on culprit lesion plaque morphology. Patients (n = 127) with AMI were divided into either a statin group (n = 31) or a nonstatin group (n = 96) based on statin use before the onset of AMI. Coronary plaque morphology of the culprit lesion was evaluated using intravascular ultrasound virtual histology (IVUS-VH) with radiofrequency data analysis before coronary intervention. The IVUS-VH identified 4 types of plaque components: fibrous, fibrofatty, dense calcium, and necrotic core. The IVUS-VH showed less percentage of necrotic area, greater percentage fibrous area, and greater percentage of fibrofatty area of the culprit lesion in the statin group. In conclusion, statin use before the onset of AMI might have effects on coronary plaque morphology of the AMI culprit lesion with less necrotic core and greater fibrous and fibrofatty component.
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http://dx.doi.org/10.1177/0003319712449196DOI Listing
July 2013

Differential characteristics of inflammatory responses to stent implantation between de novo and intrastent restenosis lesion in patients with stable angina.

Angiology 2012 Feb 11;63(2):92-5. Epub 2011 May 11.

Yokosuka Kyosai Hospital, 1-16 Yonegahama-dori, Yokosuka, Kanagawa, Japan.

Mechanical plaque rupture of coronary atherosclerotic plaque during stent implantation can increase serum levels of high-sensitivity C-reactive protein (hsCRP). Patients with stable angina pectoris were divided into 2 groups: one group included 186 patients with de novo lesion who underwent stent implantation (de novo group); the other group included 40 patients with intrastent restenosis (ISR) undergoing stent implantation (ISR group). The de novo group had a significant increase in hsCRP levels post stenting, while the ISR group showed no increase in hsCRP post stenting. Intravascular ultrasound with radiofrequency data analysis showed that the de novo group had larger percentage of both necrotic core area and fibrofatty area at the target lesion than the ISR group, while the ISR group had a larger percentage of fibrous area. Differential inflammatory response to stent implantation between the de novo plaque and in ISR lesion is related to lesion morphology.
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http://dx.doi.org/10.1177/0003319711408284DOI Listing
February 2012