Hiroki Niikura

In-hospital mortality analysis of Japanese patients with acute coronary syndrome using the Tokyo CCU Network database: Applicability of the GRACE risk score

BACKGROUND The GRACE risk score was developed to predict in-hospital mortality for acute coronary syndrome (ACS) using multinational registries, but did not include Japanese data. Therefore, GRACE risk scores are not extensively used in Japan. The present study aimed to evaluate the relationship between the GRACE risk score and in-hospital mortality among Japanese patients with ACS using the Tokyo CCU (cardiovascular care unit) Network Database. METHODS AND RESULTS A total of 9460 patients with ACS hospitalized at 67 Tokyo CCUs between January 2011 and December 2013 were retrospectively reviewed and GRACE risk scores were calculated. Patients in the Tokyo CCU Network database had more severe conditions compared to those of the original GRACE study. There was a strong correlation between the GRACE risk score and in-hospital mortality for patients with ST-segment elevation myocardial infarction (STEMI) or non ST-segment elevation myocardial infarction (NSTEMI) (r=0.99, p<0.001); however, the correlation was not significant for patients with unstable angina (r=0.35, p=0.126). For STEMI+NSTEMI patients, the discrimination ability of the GRACE risk score was excellent, with a c statistic of 0.87 (95% confidence interval, 0.86-0.89). CONCLUSIONS The GRACE risk score is a good predictor of in-hospital mortality for Japanese patients with STEMI or NSTEMI, and can help clinicians stratify patients by risk for optimal patient triage and early treatment management.

TCT-667 Causes and Clinical Outcomes of Patients with Mitral Regurgitation Who are ineligible for Transcatheter Mitral Valve Replacement

Despite the increasing availability of transcatheter mitral valve replacement (TMVR) under research investigation, patients with mitral regurgitation (MR) frequently are not eligible for such therapy. The characteristics of these patients who fail qualification and their clinical outcomes are

Congenital Absence of Left Atrial Appendage Diagnosed by Multimodality Imaging

A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected. An absence of the LAA was confirmed using cardiac computed tomography (CT), which included 3D reconstruction. Additionally, the LAA was not visualized with left atrium (LA) angiography. During the ablation procedure, 3D voltage mapping in LA was created and no low voltage area or abnormal potential was recorded around the usual root location of the LAA. Successful electrical pulmonary vein isolation was achieved with no major complications. After six months of follow-up, the patient remained in sinus rhythm without any antiarrhythmic drugs and showed no related clinical symptoms. He stopped his anticoagulation therapy due to lack of evidence of AF recurrence and an absence of LAA. Multimodality imaging allowed us to identify the congenital absence of LAA.

BODY FAT PERCENTAGE EVALUATED BY A BIOELECTRICAL IMPEDANCE ANALYSIS PROVIDES PROGNOSTIC VALUE IN ACUTE HEART FAILURE, BEYOND ON THE “OBESITY PARADOX”

Background: Obesity is associated with incident heart failure, but it is paradoxically associated with better prognosis during acute heart failure(AHF). Currently, obesity is usually identified by body mass index(BMI). Bioelectrical impedance analysis is a noninvasive modality for evaluating the

EVALUATION OF HEMOCONCENTRATION BASED BIOELECTRICAL VECTORIAL IMPEDANCE ANALYSIS IS USEFUL RISK STRATIFICATION IN ACUTE DECOMPENSATED HEART FAILURE

Background: Anemia is associated with poor outcomes in patients with acute decompensated heart failure (ADHF). Whereas pseudoanemia with hemodilution due to fluid retention is also observed in ADHF patients. Thus, we investigated the association between hematocrit (Hct) and volume-overload with

The Successful Removal of Two Retrievable Inferior Vena Cava (IVC) Filters after 67 Days in a Patient with a Double IVC

We herein present a case in which two retrievable inferior vena cava (IVC) filters, which were implanted to treat deep-vein thrombosis caused by the compression of a double IVC, were successfully removed on the 67th day after placement. The filters were individually placed in both the left and right IVCs. With a prevalence of only 0.2%, a double IVC is an extremely rare anatomical variation. The long-term effects of IVC filters are unknown, and the placement of a filter potentially introduces the risk of complications. Thus, if the patient’s clinical condition allows, the endovascular retrieval of the filter should be considered within a few months after implantation.

Clinical utility of early use of tolvaptan in very elderly patients with acute decompensated heart failure

Objective: The establishment of an optimal strategy for elderly patients with acute decompensated heart failure (ADHF) is currently an important issue. Particularly in very elderly (VE) patients, ADHF is associated with a poor prognosis. We therefore aimed to evaluate the efficacy and safety of the early use of tolvaptan (TLV) in VE patients. Methods: Of 245 patients with ADHF admitted between March 2013 and July 2014, we prospectively enrolled 111 patients with TLV first administered within 24 h of hospitalization. These were divided into two groups according to the age: VE (≥85 years, n=45) and not very elderly (NVE, <85 years, n=66). The endpoints were the incidence of worsening renal function, death by any cause, or the length of hospital stay. Results: There were no significant differences between the two groups in the incidence of worsening renal function (26.7% in VE vs. 25.8% in not VE, p=0.92), dose of TLV after hospitalization (7.4±0.7 vs. 7.5±1.3 mg/day, p=0.63), mean duration of the use of TLV (4.3±3.5 vs. 5.4±4.8 days, p=0.17), or mean length of hospital stay (16.5±7.8 vs. 15.7±8.0 days, p=0.64). Conclusion: TLV shows similar efficacy and safety in both VE and NVE groups. Even for VE patients with ADHF, initiation of TLV with standard diuretic treatment may have the potential not to increase the incidence of worsening renal function.