Publications by authors named "Yoshihiro Fukumoto"

306 Publications

Multimodal imaging of quadricuspid aortic valve in elderly patient.

Eur Heart J Case Rep 2021 Sep 17;5(9):ytab344. Epub 2021 Aug 17.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.

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http://dx.doi.org/10.1093/ehjcr/ytab344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453391PMC
September 2021

Takayasu arteritis-associated pulmonary hypertension.

Eur Heart J 2021 Sep 20. Epub 2021 Sep 20.

Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University, School of Medicine, Kurume, Japan.

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http://dx.doi.org/10.1093/eurheartj/ehab688DOI Listing
September 2021

Association between the albumin-bilirubin (ALBI) score and severity of portopulmonary hypertension (PoPH): A data-mining analysis.

Hepatol Res 2021 Sep 17. Epub 2021 Sep 17.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.

Introduction: Portopulmonary hypertension (PoPH) is a severe complication of chronic liver disease. We aimed to investigate the etiology of chronic liver disease and the factors associated with the severity of PoPH.

Subjects And Methods: Echocardiography was undergone in 833 patients with chronic liver disease during 2005-2019 and 13 patients (1.6%) were diagnosed with PoPH in this observational study. At the diagnosis of PoPH, liver function was evaluated by albumin-bilirubin (ALBI) score. Severe PoPH was defined as (1) mean pulmonary arterial pressure (mPAP) ≥50 mmHg or (2) mPAP: 35-49 mmHg and pulmonary vascular resistance ≥400 dyne/s/cm . Factors associated with severe PoPH were evaluated by decision-tree analysis.

Results: In patients with PoPH, the leading etiology of chronic liver disease was hepatitis C virus (HCV) (46.2% [sustained virological response (SVR): 23.1% and non-SVR: 15.4%]). Severe PoPH was observed in 53.8% of patients and the 5-year survival rate was 48.1%. There was a significant correlation of mPAP with ALBI score (r = 0.6456, p = 0.0171). In the decision-tree and random forest analyses, the most impacted classifier for severe PoPH was the ALBI score. In patients with ALBI score ≥-1.45, all patients showed severe PoPH, while the prevalence of severe PoPH was 25.0% in patients with ALBI score <-1.45.

Conclusions: We found that HCV including SVR was the major etiology of chronic liver disease in patients with PoPH. Moreover, we revealed that the ALBI score was the most impacted factor associated with severe PoPH. Thus, ALBI score may be useful for the estimation of pulmonary vascular resistance.
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http://dx.doi.org/10.1111/hepr.13714DOI Listing
September 2021

Robotic-assisted percutaneous coronary intervention in the COVID-19 pandemic.

J Cardiol 2021 Aug 19. Epub 2021 Aug 19.

Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan.

Coronavirus disease-2019 (COVID-19) has a profound impact on the health care system worldwide. In the COVID-19 pandemic, hospitals are required to halt elective surgeries and procedures for preventing nosocomial infections and saving medical resources. In these situations, emergency procedures are required for life-threatening cardiovascular diseases such as acute coronary syndrome and cardiogenic shock. To prevent the spread of COVID-19, a social distance is essentially required. In ordinary percutaneous coronary intervention (PCI), operators manipulate the devices standing at the patient's tableside during the whole procedure, which may involve a certain risk of exposure to patients with COVID-19. A robotic-assisted PCI (R-PCI) allows operators to manipulate devices remotely, sitting at a cockpit located several meters away from the patient, and in addition, the assistant can be at the foot of the bed, much further from the access site. R-PCI can help to minimize the radiation exposure and the amount of person-to-person contact, and consequently may reduce the risk for the exposure to the virus.
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http://dx.doi.org/10.1016/j.jjcc.2021.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373664PMC
August 2021

Nutrition Status and Renal Function as Predictors in Acute Myocardial Infarction with and without Cancer: A Single Center Retrospective Study.

Nutrients 2021 Jul 30;13(8). Epub 2021 Jul 30.

Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.

Clinical characteristics of nutrition status in acute myocardial infarction (AMI) patients with cancer remains unknown. Therefore, this study aimed to clarify the differences of clinical parameters, including nutrition status, between AMI patients with and without history of cancer. This retrospective cohort study, using the database of AMI between 2014 and 2019 in Kurume University Hospital, enrolled 411 patients; AMI patients without cancer ( = 358, 87.1%) and with cancer ( = 53, 12.9%). AMI patients with cancer were significantly older with lower body weight, worse renal function, and worse nutrition status. Next, we divided the patients into 4 groups by cancer, age, and plaque area, detected by coronary image devices. The prediction model indicated that nutrition, lipid, and renal functions were significant predictors of AMI with cancer. The ordinal logistic regression model revealed that worse nutrition status, renal dysfunction, lower uric acid, and elevated blood pressure were significant predictors. Finally, we were able to calculate the probability of the presence of cancer, by combining each factor and scoring. Worse nutrition status and renal dysfunction were associated with AMI with cancer, in which nutrition status was a major different characteristic from those without cancer.
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http://dx.doi.org/10.3390/nu13082663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399317PMC
July 2021

Correlation between estimated plasma remnant-like particle cholesterol and vegetable fat intake in Uku town, Japan.

Environ Health Prev Med 2021 Aug 24;26(1):82. Epub 2021 Aug 24.

Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, 830-0011, Japan.

Background: Remnant-like particle cholesterol (RLP-C) is highly atherogenic, which is associated with atherosclerosis. However, RLP-C has not been routinely measured in the clinical practice. We estimated RLP-C levels using conventional lipid profiles and examined the association between estimated RLP-C and related factors including nutrient intake.

Methods: This study was performed in Uku town, Nagasaki prefecture, Japan in 2019. A total of 225 subjects were enrolled and directly measured RLP-C levels. Estimated RLP-C levels were defined as the following formula [total cholesterol - (LDL-cholesterol) - (HDL-cholesterol)]. Multivariate analyses were used to assess the relationship between estimated RLP-C and atherogenic factors. We calculated cut-off values on dichotomized RLP-C (< 7.5 mg/dL vs. ≥ 7.5 mg/dL) by receiver operating characteristic (ROC) curve.

Results: The mean values of directly measured RLP-C levels and estimated RLP-C were 4.0 mg/dL and 16.4 mg/dL, respectively. In the multiple stepwise linear regression analysis, directly measured and estimated RLP-C levels were independently and commonly associated with apolipoprotein E, triglycerides, and vegetable fat intake (inversely). Using ROC curves, we found the cut-off value of estimated RLP-C was 22.0 mg/dL.

Conclusion: We demonstrated that the estimated RLP-C levels using conventional lipid profiles may substitute for directly measured RLP-C and these levels were independently and inversely associated with vegetable fat intake in the community-dwelling Japanese population.
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http://dx.doi.org/10.1186/s12199-021-01005-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385972PMC
August 2021

Multidisciplinary Team-Based Palliative Care for Heart Failure and Food Intake at the End of Life.

Nutrients 2021 Jul 13;13(7). Epub 2021 Jul 13.

Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan.

Traditionally, patients with end-stage heart failure (HF) have rarely been involved in end-of-life care (EOLC) discussions in Japan. The purpose of this study was to examine the impact of HF-specific palliative care team (HF-PCT) activities on EOLC discussions with patients, HF therapy and care, and food intake at the end of life. We retrospectively analyzed 52 consecutive patients with HF (mean age, 70 ± 15 years; 42% female) who died at our hospital between May 2013 and July 2020 and divided them into two groups: before (Era 1, n = 19) and after (Era 2, n = 33) the initiation of HF-PCT activities in June 2015. Compared to Era 1, Era 2 showed a decrease in invasive procedures, an increase in opioid and non-intubating sedative use for symptom relief, improved quality of meals at the end of life, and an increase in participation in EOLC discussions. The administration of artificial nutrition in the final three days was associated with non-ischemic cardiomyopathy etiology, the number of previous hospitalizations for HF, and multidisciplinary EOLC discussion support. HF-PCT activities may provide an opportunity to discuss EOLC with patients, reduce the burden of physical and psychological symptoms, and shift the goals of end-of-life nutritional intake to ensure comfort and quality of life.
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http://dx.doi.org/10.3390/nu13072387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308898PMC
July 2021

Correction to: Localization of myocardial FDG uptake for prognostic risk stratification in corticosteroid-naïve cardiac sarcoidosis.

J Nucl Cardiol 2021 Jul 29. Epub 2021 Jul 29.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

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http://dx.doi.org/10.1007/s12350-021-02740-5DOI Listing
July 2021

SOCS3 deficiency in cardiomyocytes elevates sensitivity of ischemic preconditioning that synergistically ameliorates myocardial ischemia reperfusion injury.

PLoS One 2021 22;16(7):e0254712. Epub 2021 Jul 22.

Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.

Ischemic preconditioning (IPC) is the most powerful endogenous cardioprotective form of cellular adaptation. However, the inhibitory or augmenting mechanism underlying cardioprotection via IPC remains largely unknown. Suppressor of cytokine signaling-3 (SOCS3) is a cytokine-inducible potent negative feedback regulator of the signal transducer and activator of transcription-3 (STAT3) signaling pathway. Here, we aimed to determine whether cardiac SOCS3 deficiency and IPC would synergistically reduce infarct size after myocardial ischemia reperfusion injury. We evaluated STAT3 activation and SOCS3 induction after ischemic conditioning (IC) using western blot analysis and real-time PCR, and found that myocardial IC alone transiently activated myocardial STAT3 and correspondingly induced SOCS3 expression in wild-type mice. Compared with wild-type mice, cardiac-specific SOCS3 knockout (SOCS3-CKO) mice showed significantly greater and more sustained IC-induced STAT3 activation. Following ischemia reperfusion, IPC substantially reduced myocardial infarct size and significantly enhanced STAT3 phosphorylation in SOCS3-CKO mice compared to in wild-type mice. Real-time PCR array analysis revealed that SOCS3-CKO mice after IC exhibited significantly increased expressions of several anti-apoptotic genes and SAFE pathway-related genes. Moreover, real-time PCR analysis revealed that myocardial IC alone rapidly induced expression of the STAT3-activating cytokine erythropoietin in the kidney at 1 h post-IC. We also found that the circulating erythropoietin level was promptly increased at 1 h after myocardial IC. Myocardial SOCS3 deficiency and IPC exert synergistic effects in the prevention of myocardial injury after ischemia reperfusion. Our present results suggest that myocardial SOCS3 is a potent inhibitor of IPC-induced cardioprotection, and that myocardial SOCS3 inhibition augment IPC-mediated cardioprotection during ischemia reperfusion injury.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254712PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297769PMC
July 2021

Cardiac sarcoidosis with thickening myocardium.

J Nucl Cardiol 2021 Jul 9. Epub 2021 Jul 9.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

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http://dx.doi.org/10.1007/s12350-021-02719-2DOI Listing
July 2021

Reverse remodeling of small pulmonary arteries and right ventricle in pulmonary arterial hypertension.

J Nucl Cardiol 2021 Jul 9. Epub 2021 Jul 9.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

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http://dx.doi.org/10.1007/s12350-021-02727-2DOI Listing
July 2021

Localization of myocardial FDG uptake for prognostic risk stratification in corticosteroid-naïve cardiac sarcoidosis.

J Nucl Cardiol 2021 Jul 6. Epub 2021 Jul 6.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

Background: The localization of myocardial 18F-fluorodeoxyglucose (FDG) uptake affecting long-term clinical outcomes has not been elucidated in patients with corticosteroid-naïve cardiac sarcoidosis (CS).

Objectives: This study sought to investigate the localization of myocardial FDG uptake on positron emission tomography (PET) and myocardial perfusion abnormality to predict adverse events (AEs) for a long-term follow-up in patients with corticosteroid-naïve CS.

Methods: Consecutive 90 patients with clinical suspicion of CS who underwent FDG-PET imaging to assess for inflammation were enrolled. AEs were defined as a composite of sustained ventricular tachycardia (VT), heart transplantation, and all-cause death, which were ascertained by medical records, defibrillator interrogation, and telephone interviews.

Results: Of 90 patients, 42 patients (mean age 62.9 ± 12.0 years; 76.2% females) were confirmed active cardiac involvement. Over a median follow-up of 4.9 years, 15 patients with CS experienced AEs including 6 sustained ventricular tachycardias (VT) and 9 deaths. Cox proportional-hazards model after adjustment for left ventricular systolic dysfunction revealed that FDG uptake in the right ventricle (RV) or basal anterolateral area of the left ventricle (LV) with myocardial perfusion abnormality was predictive of AEs.

Conclusions: FDG uptake in the RV or basal anterolateral area of the LV with myocardial perfusion abnormality provides long-term prognostic risk stratification in patients with corticosteroid-naïve CS.
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http://dx.doi.org/10.1007/s12350-021-02684-wDOI Listing
July 2021

Cut-off Values for Lower Limb Muscle Thickness to Detect Low Muscle Mass for Sarcopenia in Older Adults.

Clin Interv Aging 2021 25;16:1215-1222. Epub 2021 Jun 25.

Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Purpose: Ultrasound-based prediction methods for the detection of low muscle mass for sarcopenia in older adults have been explored previously; however, the muscle that most accurately predicts it is unclear. This study aimed to clarify prediction accuracy and cut-off values for ultrasound-derived thigh and lower leg muscle thickness (MT) to detect low skeletal muscle mass index (SMI) in older adults and to estimate cut-off values based on two standard deviations (SD) below younger adult means for the corresponding muscles as an early detection tool for site-specific low muscle mass.

Methods: This study included 204 community-dwelling older (64 males, 140 females, mean age: 75.4 years) and 59 younger (31 males, 28 females, mean age: 22.3 years) adults. The MT of the rectus femoris, vastus intermedius, gastrocnemius, and soleus muscles was measured using ultrasound; SMI was measured using bioelectrical impedance analysis.

Results: The prevalence of a low SMI among older adults was 20.3% (n=13) for males and 21.4% (n=30) for females. The receiver operating characteristic analysis revealed that the total MT for the four muscles measured presented the highest area under the curve (AUC) value to predict low SMI for males (0.849) and females (0.776). The AUC value was the highest for the total MT of the gastrocnemius and soleus muscles for males and the gastrocnemius for females (0.836, 0.748; cut-off value: 5.67 cm, 1.42 cm, respectively). Muscle-specific differences between the low SMI-predicting and SD-based cut-off values were observed. The SD-based value for the rectus femoris (1.85 cm) was substantially higher than the low SMI-predicting value (1.51 cm) in males.

Conclusion: Ultrasound measurement of lower leg muscles may be a simple, robust measure to detect low muscle mass for sarcopenia. Additionally, cut-off values for site-specific muscle mass loss may not always agree with those for whole-limb muscle mass loss.
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http://dx.doi.org/10.2147/CIA.S304972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241812PMC
July 2021

Relation of renal function to mid-term prognosis of stable angina patients with high- or low-dose pitavastatin treatment: REAL-CAD substudy.

Am Heart J 2021 10 24;240:89-100. Epub 2021 Jun 24.

Jichi Medical University, Shimotsuke, Japan.

Background: It has not yet been established whether higher-dose statins have beneficial effects on cardiovascular events in patients with stable coronary artery disease (CAD) and renal dysfunction.

Methods: The REAL-CAD study is a prospective, multicenter, open-label trial. As a substudy, we categorized patients by an estimated glomerular filtration rate (eGFR) as follows: eGFR ≥60 (n = 7,768); eGFR ≥45 and <60 (n = 3,176); and eGFR <45 mL/Min/1.73 m (n = 1,164), who were randomized to pitavastatin 4mg or 1mg therapy. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina, and was assessed by the log-rank test and Cox proportional hazards model.

Results: The baseline characteristics and medications were largely well-balanced between two groups. The magnitude of low-density lipoprotein cholesterol (LDL-C) reduction at 6 months in high- and low-dose pitavastatin groups was comparable among all eGFR categories. During a median follow-up of 3.9 years, high- compared with low-dose pitavastatin significantly reduced cardiovascular events in patients with eGFR ≥60 (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.58-0.91; P = .006), and reduced but not significant for patients with eGFR ≥45 and <60 (HR 0.85; 95% CI, 0.63-1.14; P = .27) or eGFR <45 mL/Min/1.73 m (HR 0.90; 95% CI 0.62-1.33; P = .61). An interaction test of treatment by eGFR category was not significant (P value for interaction = .30).

Conclusion: Higher-dose pitavastatin therapy reduced LDL levels and cardiovascular events in stable CAD patients irrespective of eGFR level, although the effect on events appeared to be numerically lower in patients with lower eGFR.
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http://dx.doi.org/10.1016/j.ahj.2021.06.009DOI Listing
October 2021

Differential impacts of 24 hour urinary sodium excretion on cardiovascular diseases or cancer mortality in a general population.

J Cardiol 2021 Oct 24;78(4):334-340. Epub 2021 May 24.

Division of Cardio-Vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.

Background: Elevated blood pressure is a major risk factor for cardiovascular (CV) disease. But the effects of sodium intake or excretion on CV mortality are uncertain. The present study aimed to investigate the association between 24 h urinary sodium excretion, as a marker of dietary salt intake, and CV or cancer mortality in a healthy Japanese population using 24 hurine collection.

Methods: The baseline study was conducted in 1980. A total of 1291 participants aged 21 to 85 years, underwent health check-ups, which included blood chemistry measurements and the collection of 24 h urine samples. Enrolled 1291 participants were followed up for 27.5 years, in whom the final follow-up rate was 95.8%. Cox proportional hazards regression models were used to assess the association between 24 h urinary sodium excretion and CV or cancer mortality.

Results: The mean 24 h urinary sodium excretion was 5.80 ± 2.28 g/day. There were 631 deaths: 153 (27%) from cancer, 142 (26%) from CV disease. In the Cox proportional hazard regression model after adjustment for confounding factors, systolic and diastolic blood pressures, and uric acid were positively associated with CV mortality, and the 24 h urinary sodium and potassium excretions were inversely associated with CV mortality (p < 0.05). On the other hand, there were no association between 24 h urinary sodium excretions and cancer mortality. We divided the urinary sodium excretions levels into quartiles. After adjustment for confounding factors, the hazard ratio of CV mortality in the highest quartile of 24 h urinary sodium excretion versus the lowest was 0.46 (p < 0.05). The cumulative survival rate for CV death was significantly decreased in the lowest quartile compared with the other higher groups.

Conclusions: We found that impacts of 24 h sodium excretion on CV and cancer mortalities were much different in the general population.
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http://dx.doi.org/10.1016/j.jjcc.2021.04.013DOI Listing
October 2021

Enhanced echo intensity and a higher extracellular water-to-intracellular water ratio are helpful clinical signs for detecting muscle degeneration in patients with knee osteoarthritis.

Clin Rheumatol 2021 Oct 17;40(10):4207-4215. Epub 2021 May 17.

Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.

Objectives: Enhanced muscle echo intensity (EI) with ultrasound imaging and a higher extracellular water-to-intracellular water (ECW/ICW) ratio with segmental-bioelectrical impedance spectroscopy (S-BIS) represent muscle quality loss. This study aimed to clarify quadriceps muscle degeneration characteristics, focusing on muscle quality changes in patients with knee osteoarthritis (OA).

Method: Forty-one women with knee OA (mean age, 71.4±6.0 years) and 27 healthy women (mean age, 75.6±4.9 years) participated. Ultrasonography was used to evaluate the muscle thickness (MT) and the EI of each quadriceps compartment. The ECW/ICW ratio was obtained by S-BIS. MT, EI, and ECW/ICW ratio differences between the two groups were tested using univariate analysis of variance, adjusting for age and body mass index. Logistic regression analyses were performed with the group as the dependent variable, and the MT and EI of the vastus medialis (VM) and the ECW/ICW ratio as independent variables.

Results: Patients with knee OA had a significant decrease in VM MT, enhanced VM, and vastus intermedius EIs and a higher ECW/ICW ratio compared with healthy participants. Logistic regression analysis showed that the VM EI (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06-1.35) and the ECW/ICW ratio were independently associated with knee OA (OR, 1.19; 95% CI, 1.00-1.42).

Conclusions: VM EI and the ECW/ICW ratio, rather than VM MT, characterised quadriceps muscle degeneration in patients with knee OA. Therefore, enhanced EI and a higher ECW/ICW ratio are helpful clinical signs for detecting muscle degeneration in patients with knee OA. Key Points •Echo intensity (EI) of the vastus medialis and the extracellular-to-intracellular water (ECW/ICW) ratio significantly increased in patients with knee osteoarthritis OA). •Enhanced EI and a higher ECW/ICW ratio are useful clinical signs for detecting muscle degeneration in patients with knee OA.
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http://dx.doi.org/10.1007/s10067-021-05763-yDOI Listing
October 2021

Effect of home-based rehabilitation of purposeful activity-based electrical stimulation therapy for chronic stroke survivors: a crossover randomized controlled trial.

Restor Neurol Neurosci 2021 ;39(3):173-180

Graduate School of Medicine, Kyoto University, Shogoinkawaracho, Sakyou-ku, Kyoto City, Kyoto Japan.

Background: In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study.

Objective: The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial.

Methods: The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl-Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light).

Results: Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching.

Conclusions: The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.
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http://dx.doi.org/10.3233/RNN-211157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461679PMC
January 2021

Are updated diagnosis criteria for sarcopenia appropriate?

J Cardiol 2021 Aug 16;78(2):174. Epub 2021 Apr 16.

Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.

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http://dx.doi.org/10.1016/j.jjcc.2021.03.009DOI Listing
August 2021

Beta-blocker in preserved left ventricular ejection fraction with elevated serum vitamin A concentrations.

Eur J Prev Cardiol 2021 Apr 9. Epub 2021 Apr 9.

Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.

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http://dx.doi.org/10.1093/eurjpc/zwab009DOI Listing
April 2021

Carpal tunnel syndrome as an early red-flag sign of ATTRwt amyloidosis.

J Nucl Cardiol 2021 Apr 6. Epub 2021 Apr 6.

Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

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http://dx.doi.org/10.1007/s12350-021-02584-zDOI Listing
April 2021

Rationale and Design of Therapeutic Angiogenesis by Cell Transplantation Using Adipose-Derived Regenerative Cells in Patients With Critical Limb Ischemia - TACT-ADRC Multicenter Trial.

Circ Rep 2020 Aug 8;2(9):531-535. Epub 2020 Aug 8.

Department of Cardiology, Nagoya University Graduate School of Medicine Nagoya Japan.

Despite the growing knowledge regarding optimal treatments for critical limb ischemia (CLI), there are still a considerable number of patients who have to undergo major limb amputation. Intramuscular injection of autologous adipose-derived regenerative cells (ADRCs) in these patients has shown therapeutic potential in improving tissue ischemia, in both preclinical and initial pilot studies. Here, we present a clinical protocol for ADRCs use in a multicenter trial. The TACT-ADRC multicenter trial is a prospective, interventional, single-arm, open-labeled study at 8 hospitals in Japan, investigating the safety and feasibility of intramuscular injections of ADRCs and testing the hypothesis that this treatment promotes neovascularization and improves major amputation-free survival rates in patients with CLI who have no other treatment option. 40 patients with CLI will be enrolled and followed up from November 2015 to November 2020. Freshly isolated autologous ADRCs will be injected into the target ischemic limbs. Survival rate, adverse events, major limb amputation, ulcer size, 6-min walking distance, numerical rating scale, ankle-brachial pressure index, skin perfusion pressure and digital subtraction angiography will be evaluated at baseline and during 6 months' follow-up. This trial will demonstrate whether implantation of autologous ADRCs is a safe and effective method for therapeutic angiogenesis, resulting in an improvement in major amputation-free survival rates in patients with CLI.
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http://dx.doi.org/10.1253/circrep.CR-20-0055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819646PMC
August 2020

Need more attention to peripheral arterial diseases, especially in women.

Eur J Prev Cardiol 2020 Jan 22. Epub 2020 Jan 22.

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http://dx.doi.org/10.1177/2047487319898308DOI Listing
January 2020

Lower albumin levels are associated with frailty measures, trace elements, and an inflammation marker in a cross-sectional study in Tanushimaru.

Environ Health Prev Med 2021 Feb 19;26(1):25. Epub 2021 Feb 19.

Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan.

Background: There is little data on the association between the lower nutrition represented by serum albumin levels and related factors in a general population. The present study aimed to determine whether the albumin level positioned as some kind of biomarker with frailty measures, trace elements, and an inflammation marker.

Methods: In 2018, we performed an epidemiological survey in 1368 subjects who resided in Tanushimaru, Japan, in which we examined the blood chemistry including albumin, trace elements, hormone levels, and carotid ultrasonography. Albumin levels were categorized into 4 groups (G1 [3.2-3.9 mg/dL], G2 [4.0-4.3 mg/dL], G3 [4.4-4.6 mg/dL], and G4 [4.7-5.3 mg/dL]). The participants underwent measurements of handgrip strength and were tested by asking to walk 5 m. Their cognitive functions were evaluated by the mini-mental state examination (MMSE).

Results: Multiple stepwise regression analysis demonstrated that albumin levels were significantly and independently associated with age (inversely), systolic blood pressures, estimated glomerular filtration rate (eGFR), MMSE score, frailty measures (handgrip strength), an inflammation marker (high-sensitivity C-reactive protein), hormones (growth hormone (inversely) and insulin-like growth factor-1), and trace elements (calcium, magnesium, iron, and zinc), with a linear trend.

Conclusions: Lower albumin levels, even in the normal range, were found to be related factors of frailty measures, trace elements, and an inflammation marker in a general population.
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http://dx.doi.org/10.1186/s12199-021-00946-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893938PMC
February 2021

Isolated right ventricular metastasis of hepatocellular carcinoma induced by epithelial-mesenchymal transition: a case report.

Eur Heart J Case Rep 2021 Feb 16;5(2):ytaa517. Epub 2020 Dec 16.

Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.

Background: Hepatocellular carcinoma (HCC) that metastasizes to the right ventricle has rarely been reported. An important link between epithelial-mesenchymal transition (EMT) and the invasion and metastasis of cancer cells has recently been demonstrated. However, there are few reports on the relationship between HCC metastasized to the heart and EMT.

Case Summary: We here report the case of a 74-year-old woman who had type C HCC referred to our hospital with general fatigue due to a right ventricular tumour diagnosed at a general hospital. Anticoagulation therapy was done, but the mass had rapidly grown. We performed surgical resection of the mass. Histopathological examination revealed that the tumour was diagnosed as a poorly differentiated HCC metastasis induced by EMT.

Discussion: Isolated metastasis of HCC to the right ventricle is extremely rare. The HCC with EMT has a potentially high risk of metastasizing to the heart and other organs, and the prognosis is poor.
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http://dx.doi.org/10.1093/ehjcr/ytaa517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873797PMC
February 2021

Impact of combined elevations of homocysteine and asymmetric dimethylarginine on all-cause death - The Tanushimaru Study.

J Cardiol 2021 Aug 4;78(2):129-135. Epub 2021 Feb 4.

Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan.

Background: Both homocysteine (Hcy) and asymmetric dimethylarginine (ADMA) induce endothelial dysfunction. However, the impact of both elevations on all-cause death is not known. We investigated the association between elevations of Hcy or ADMA and all-cause death in a general population.

Methods: A total of 517 subjects (224 men, 293 women; mean age, 62.8 years) were recruited from a population-based survey in 1999 in Tanushimaru, and we measured fasting plasma Hcy and ADMA levels. We followed them up for over 20 years and examined the effect on mortality using Cox proportional hazard regression model.

Results: The mean follow-up years were 17.7 (1.8-20.8). In this period, 182 subjects have died (35.2%). The correlation between Hcy and ADMA was high (r=0.194; p<0.001). With Cox regression analysis after adjustments for age and sex, elevated log transformed Hcy levels were significantly associated with all-cause death (p=0.028). When Hcy and ADMA levels were divided into quintiles, the hierarchical model showed the synergistic effect of Hcy and ADMA on all-cause death.

Conclusions: This is the first report that we have measured Hcy and ADMA levels simultaneously in this community-dwelling Japanese, and we demonstrated that combined elevations of Hcy and ADMA had big impact on all-cause death in this epidemiological study.
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http://dx.doi.org/10.1016/j.jjcc.2021.01.011DOI Listing
August 2021

Successful introduction of robotic-assisted percutaneous coronary intervention system into Japanese clinical practice: a first-year survey at single center.

Heart Vessels 2021 Jul 27;36(7):955-964. Epub 2021 Jan 27.

Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

In Japan, a robotic-assisted PCI (R-PCI) system, the CorPath GRX System (Corindus Inc.), has been approved for clinical use in 2018, which is the first introduction of R-PCI into Japan. In this study, the clinical performance of the R-PCI system in the initial year at Kurume University Hospital was evaluated comparing with conventional manual PCI (M-PCI). A total of 30 R-PCI and 77 M-PCI procedures performed between April 2019 and March 2020, were retrospectively included. The primary outcome was the rate of clinical success defined as < 30% residual stenosis without in-hospital major adverse cardiovascular events (MACE). The secondary outcomes were fluoroscopy time, dose area product (DAP), amount of radiation exposure to operators and assistants, procedural time, and contrast volume. Propensity-matching technique was used to match each R-PCI lesion to the nearest M-PCI lesion without replacement. After propensity score matching, 30 R-PCI procedures in 28 patients and 37 M-PCI procedures in 35 patients were analyzed. Clinical success rate with R-PCI was favorable and comparable to M-PCI (93.3 vs. 94.6%, p = 0.97), without any in-hospital MACE. The operator radiation exposure was significantly lower in R-PCI (0 vs. 24.5 µSV, p < 0.0001). Radiation exposure to the patients was tended to be reduced by R-PCI (DAP: 77.6 vs. 100.2 Gycm, p = 0.07). There were no statistically significant differences in radiation exposure to the assistant, fluoroscopy time, procedural time and contrast volume between the two groups (radiation exposure to the assistant: 10.5 vs. 10.0 µSV, p = 0.64, fluoroscopy time: 27.5 vs. 30.1 min, p = 0.55, procedural time: 72.4 vs. 61.6 min, p = 0.23, and contrast volume: 93.2 vs. 102.0 ml, p = 0.36). R-PCI in selected patients demonstrated favorable clinical outcomes with dramatical reduction of radiation exposure to operators.
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http://dx.doi.org/10.1007/s00380-021-01782-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839282PMC
July 2021

Differences in muscle thickness and echo intensity between stroke survivors and age- and sex-matched healthy older adults.

Phys Ther Res 2020 20;23(2):188-194. Epub 2020 Aug 20.

Kobe Gakuin University.

Objective: The stroke survivors exhibit change in muscle quantity and quality compared to healthy older adults. This study aimed to compare the muscle thickness (MT) and echo intensity (EI) values of individual muscles between stroke survivors and age- and sex-matched healthy older adults.

Methods: In total, 27 stroke survivors and 34 healthy older adults participated in this study. The MT and EI values of the following muscles were assessed from transverse ultrasound images: rectus abdominis (RA), external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), gastrocnemius (Gas), and soleus (Sol). The MT and EI values of these muscles were compared between stroke survivors and healthy older adults.

Results: The MT values of the VL, VM, and RA on the non-paretic sides were significantly higher and those of the TA, Gas, and Sol on the paretic sides were significantly lower in the stroke survivors than in the healthy older adults (P < 0.05). The EI values of the VI, VL, VM, TA on the paretic sides and those of the Gas on both the paretic and non-paretic sides were significantly higher in the stroke survivors than in the healthy older adults (P < 0.05).

Conclusion: Stroke survivors seem to develop muscle hypertrophy of the non-paretic thigh muscles owing to a compensatory strategy. In addition, the lower-leg muscles on the paretic side of stroke survivors tend to show both quantitative and qualitative muscle changes.
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http://dx.doi.org/10.1298/ptr.E10018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814197PMC
August 2020

High-Density Lipoprotein Cholesterol and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Statins: An Observation from the REAL-CAD Study.

J Atheroscler Thromb 2021 Jan 9. Epub 2021 Jan 9.

Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.

Aim: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.

Methods: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) <120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.

Results: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.

Conclusions: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.
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http://dx.doi.org/10.5551/jat.59881DOI Listing
January 2021

Practical utilization of cardiac computed tomography for the success in complex coronary intervention.

Cardiovasc Interv Ther 2021 Apr 11;36(2):178-189. Epub 2021 Jan 11.

Department of Cardiology, Tokai University, Kanagawa, Japan.

Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.
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http://dx.doi.org/10.1007/s12928-020-00751-6DOI Listing
April 2021
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