Hideyuki Maezawa

Cardiopulmonary arrest due to persistent coronary spasm in a young woman: Are we properly diagnosing vasospastic angina?

Coronary spasm is a risk factor for acute myocardial infarction and sudden cardiac death. This is a case of a young female patient with cardiopulmonary arrest induced by coronary spasm on arrival at our hospital. There has been no case that prolonged spontaneous attack was confirmed in multi-vessels. This case demonstrates that persistent coronary spasm is lethal and an important cause of cardiopulmonary arrest even in young people. It is extremely important to detect patients with coronary spasm before the ischemic events associated with cardiopulmonary arrest occur.

Association of aging with glomerular filtration changes in cardiac rehabilitation participants with chronic kidney disease

a Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan b Cardiac Rehabilitation, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan c Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan d Showa University Research Institute for Sport and Exercise Sciences, Yokohama, Japan e Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan

LEFT ATRIAL AREA STRAIN MEASURED BY THREE DIMENSIONAL SPECKLE TRACKING ECHOCARDIOGRAPHY REPRESENTS GLOBAL AND REGIONAL LEFT ATRIAL FUNCTION AT ONCE

Measurements of left atrial volume and function has become clinically important in aging society. Feasibility and reliability of a novel automatic indexbased on internal surface area change (AS :area strain) of left atrium using three dimensional speckle tracking echocardiography (3DSTE) was

The histological characteristics and virtual histology findings of the tissues obtained by a distal protection device during endovascular therapy for peripheral artery disease

BACKGROUND Distal embolization (DE) is one of the most serious complications of endovascular therapy (EVT). The purpose of the present study was to characterize the lesions that indicate a high risk of DE in patients undergoing EVT, and to investigate the pathological characteristics of the debris. METHODS Seventy-three consecutive patients with peripheral artery disease (PAD) underwent EVT with a filter device. Image analyses using grayscale intravascular ultrasound (IVUS) and virtual histology (VH) IVUS were performed and the large debris that was trapped was subjected to histological, immunohistochemical, and immunofluorescence analyses. RESULTS Sixty-nine patients were successfully treated with a filter device (iliac artery, n=46; femoral artery, n=23). Large debris, which was defined as debris of >2mm in maximal diameter, was confirmed in 33 of 69 patients (48%) and was trapped more frequently in the iliac artery than in the femoral artery. Histological analyses were not performed in 36 of 69 patients (52%) because the debris particles were too small to investigate (<2mm in maximal diameter). The proportion of large debris was significantly higher in lesions with ulceration than in lesions without ulceration (p<0.001). The necrotic core (NC) was significantly more developed in the large debris group than in the small debris group (p<0.05). White thrombi were observed in most of the debris particles, and not only the inflammatory component, but also the stable component caused distal embolisms. Inflammatory cells, mainly CD68-positive cells that were also positive for myeloperoxidase, were observed in approximately half of the debris particles. CONCLUSIONS Distal protection during EVT would be considered when the lesion is located in the iliac artery, is an ulcerative lesion, and when VH-IVUS determines that the lesion contains NC. The plaque in PAD patients mainly corresponds to the stable phenotype; however, it may also exhibit the characteristics of the vulnerable phenotype.

Cardiac Sarcoidosis Mimicking Septal Tumor with Intermittent Complete Atrioventricular Block

A 52-year-old woman with intermittent complete atrioventricular (AV) block detected on exercise was admitted to the hospital. Echocardiography revealed lesions on the right ventricular side of the interventricular septum and free wall of the basal inferolateral area. Gadolinium-enhanced cardiovascular magnetic resonance (CMR) imaging revealed the mass and wall thickening at the same locations with late gadolinium enhancement (LGE). Focal uptake at the septal lesion was detected using 67Ga scintigraphy. Focal on diffuse intense uptake in the lesions was observed on Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging. Whole-body CT and laboratory evaluations uncovered no signs of malignant tumors in other organs. Ophthalmologic evaluation revealed ophthalmologic sarcoidosis. Although the result of endomyocardial biopsy was negative, the presence of cardiac sarcoidosis was strongly suggested on the basis of the new Japanese guidelines published in 2017. AV conduction disturbance and tracer accumulation on 67Ga scintigraphy completely disappeared after 2 weeks of steroid therapy. The size of mass, inferolateral wall thickness in echocardiography and CMR, and standardized uptake value (SUV) of the masses on 18F-FDG PET also decreased over time.

Clinical Outcomes of Oral Tolvaptan Treatment in Patients Hospitalized with Acute Decompensated Heart Failure-Retrospective Cohort Study

was no significant difference regarding age, gender, body mass index, left ventricular function and diameters, and medication for CHF. During the follow-up of 40.3 months, the composite-endpoint occurred 22.5% in patients with DCM and DM, and 6.8% in the patients with DCM alone (p50.039). DM was associated with an increased risk of the composite-endpoint (HR: 3.05; 95% CI: 1.01 to 7.99; p50.049). The coexistent of CAD was seen more in patients with DCM and DM compared to patients with DCM alone (27.5% vs. 11.2%, p50.044). However, there was no statistical relation between the composite-endpoint and the coexistent of CAD. Conclusions: DM may contribute to the prognosis of DCM regardless of CAD.