Go Kawamura

Beneficial effects of rapid introduction of adaptive servo-ventilation in the emergency room in patients with acute cardiogenic pulmonary edema

BACKGROUND Adaptive servo-ventilation (ASV) at home has been used for patients with chronic heart failure. However, its effect on acute cardiogenic pulmonary edema (ACPE) is not clear. The aim of this study was to elucidate the effect of ASV use in the emergency room in patients with ACPE. METHODS We enrolled 198 consecutive patients with ACPE. Eighty patients received standard therapies, such as oxygen inhalation and vasodilators (conventional therapy group), and 118 received ASV in addition to standard therapy (ASV therapy group). ASV was initiated in the emergency room immediately after diagnosis. The procedure was switched over from ASV to endotracheal intubation (ETI) when oxygenation was insufficient. RESULTS The ETI rate in the ASV therapy group was significantly lower than that in the conventional therapy group (3% vs. 21%, p<0.01). The intensive care unit and/or high care unit length of stay in the ASV therapy group was also significantly shorter than that in the conventional therapy group (1.9±2.1 days vs. 5.3±6.8 days, p<0.01). Consequently, the hospitalization period in the ASV therapy group was shorter than that in the conventional therapy group (19.3±11.0 days vs. 26.3±16.6 days, p<0.01). CONCLUSION In patients with ACPE, rapid introduction of ASV in the emergency room reduces the need for ETI and decreases the hospitalization period.

A calcified amorphous tumor that developed on both sides of the atrioventricular valve annulus.

We report a rare case of a hemodialysis patient with a calcified amorphous tumor (CAT) on both sides of the atrioventricular valve annulus. A 70-year-old female who had received hemodialysis for 23 years because of chronic glomerulonephritis presented to our hospital with acute heart failure. Echocardiography indicated the presence of mobile cardiac masses on the mitral valve and tricuspid valve annulus. We suspected the presence of a cardiac tumor or vegetation. The patient received 3 g/day sulbactam-ampicillin and 60 mg/day gentamicin. Surgery was performed on the 14th day after hospital admission. The patient underwent mitral valve replacement, tricuspid annuloplasty, and tumor resection. Based on the pathological findings, the cardiac tumor was diagnosed as a CAT.

Clinical Usefulness of Coronary Flow Reserve Ratio for the Detection of Significant Coronary Artery Disease on 13N-Ammonia Positron Emission Tomography

BACKGROUND This study aimed to evaluate the diagnostic performance of coronary flow reserve (CFR), hyperemic myocardial blood flow (hMBF), and CFR ratio for detecting significant coronary artery disease (CAD) on 13N-ammonia positron emission tomography (PET).Methods and Results:We analyzed 63 patients (mean age, 71±9 years; 43 males) with suspected CAD who underwent both pharmacological stress/rest 13N-ammonia PET and coronary angiography. CFR and hMBF for PET were calculated automatically using quantitative PET software, and the CFR ratio was defined as the ratio of per-vessel CFR to maximum CFR in a standard 17-segment model. We compared the diagnostic performance among the 3 quantitative values. In the per-vessel analysis, 55 vessels were diagnosed as significant CAD (≥70% stenosis and/or fraction flow reserve ≤0.8). CFR, hMBF, and CFR ratio of significant CAD were significantly lower than for non-significant CAD (1.85±0.69 vs. 2.38±0.69; P<0.01, 1.67±0.54 vs. 2.19±0.52 mL·min-1·g-1; P<0.01, and 0.66±0.15 vs. 0.82±0.09; P<0.01, respectively). In the receiver-operating characteristic curve analysis, CFR, hMBF, and CFR ratio had areas under the curve of 0.71, 0.75, and 0.85 respectively, and the CFR ratio was significantly higher than CFR and hMBF (P<0.05). The sensitivity, specificity, and accuracy of the CFR ratio with an optimal cutoff value of 0.75 were 75%, 85%, and 82%, respectively. CONCLUSIONS Clinically, the CFR ratio in 13N-ammonia PET was more effective in detecting significant CAD.

FAVORABLE EFFECTS OF EARLY ADMINISTRATION OF TOLVAPTAN IN ELDERLY PATIENTS WITH REPEAT HOSPITALIZATIONS FOR ACUTE DECOMPENSATED HEART FAILURE

Tolvaptan is an oral selective vasopressin 2 receptor antagonist that acts on the distal nephrons, causing a loss of electrolyte-free water. Thus far, its early administration in elderly patients who had repeat hospitalizations for acute decompensated heart failure (ADHF) despite receiving optimal

A Case of Isolated Left Atrial Infective Mural Endocarditis

A 52-year-old man presented with a fever and malaise. Transthoracic echocardiogram was performed because of a holosystolic murmur, which showed mitral valve prolapse and a regurgitation jet toward the posterior wall of the left atrium. There was no apparent vegetation at any valves. Blood cultures were positive for Streptococcus mitis/oralis. Transesophageal echocardiogram revealed vegetation only at the posterior wall of the left atrium exposed to the mitral regurgitant jet. We diagnosed this condition as infective mural endocarditis. This case highlighted the need for a detailed observation of the valves and the atrial wall when infective endocarditis is suspected.

Radiation-Induced Cardiomyopathy Incidentally Detected on Oncology 18 F-Fluorodeoxyglucose Positron Emission Tomography

therapy (RTx) with a total dose of 60 Gy for the tumor and lymph nodes, with 40 Gy and 20 Gy using anteriorposterior and parallel-oblique fields, respectively (Figure 1A). Before RTx, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) A 54-year-old man was referred to Ehime Prefectural Central Hospital because of dysphagia. After several examinations, he was diagnosed with unresectable stage IV esophageal cancer. The patient received chemotherapy (5-fluorouracil+cisplatin) and mediastinal radio-

THE CLINICAL FEATURES AND UNDERLYING PATHOPHYSIOLOGY OF MYOCARDIAL INFARCTION WITH NO OBSTRUCTIVE CORONARY ATHEROSCLEROSIS: THE ROLE OF OPTICAL COHERENCE TOMOGRAPHY

Myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) is an important subgroup of myocardial infarction (MI) because additional evaluations are required for understanding the pathophysiology. The aim of this study was to evaluate the clinical features of MINOCA and to clarify

TCTAP C-245 Usefulness of Reverse Wire Technique for Septal Branch Selection During Percutaneous Transluminal Septal Myocardial Ablation

### Patient initials or identifier number 0020248389 ### Relevant clinical history and physical exam A 73 years-old female with bronchial asthma developed dyspnea on effort (DOE) and visted a hospital. She was diagnosed with hypertrophic obstructive cardio myopathy (HOCM) and administered