Hideyasu Kohshoh

Barthel Index as a Predictor of 1-Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life.

Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated.

Left ventricular dysfunction due to diffuse multiple vessel coronary artery spasm can be concealed in dilated cardiomyopathy

Many patients with idiopathic dilated cardiomyopathy (DCM) have been diagnosed on the basis of the exclusion of significant coronary stenosis and the presence of left ventricular (LV) dysfunction. In the present study, we investigated the possibility that coronary multispasm is one of the mechanisms leading to diffuse idiopathic DCM‐like LV dysfunction.

Patency of Saphenous Vein Grafts Using the PAS-Port System During Coronary Artery Bypass Surgery

BACKGROUND Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). METHODS From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. RESULTS Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. CONCLUSIONS The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency.

NEW STRATEGY OF MEDICAL THERAPY TO LEFT VENTRICULAR DYSFUNCTION WITHOUT SIGNIFICANT CORONARY STENOSIS BY USING ACETYLCHOLINE PROVOCATION

Results: In either patient with positive ACh-test (n=13) or with negative ACh-test (n=19), LV function was severely depressed (LVEF: 32 vs. 37%, ns; BNP: 903 vs. 580; ns). In all of patients with positive ACh-test, ACh-CAG showed multi-vessel diffuse coronary spasm with remarkable ECG changes. Among positive ACh-test group, all of three LV biopsy specimens were negative, and only one of 10 cases (10%) showed an abnormal MRI delayed enhancement (DE). On the other hand, among the negative ACh-test group, LV biopsy in 2 of 3 cases and MRI-DE findings in 5 of 10 cases showed more frequently abnormal findings compatible with cardiomyopathy than among the positive ACh-test group (60%, vs. 10%, p<0.05). Among the positive ACh-test group, depressed LV function improved after starting Ca antagonist during 3 months (LVEF: 32±12% to 49±13%, p<0.01; BNP: 903±565 to 80±40, p<0.01), however, among the negative ACh-test group, depressed LV improved under treatment of antagonist during 8 months (LVEF: 37±11% to 44±11%, p<0.01; BNP: 580±470 to 144±149, p<0.01).