Kennosuke Yamashita

Distance between the left atrium and the vertebral body is predictive of esophageal movement in serial MR imaging

PurposeMRI or CT imaging can be used to identify the esophageal location prior to left atrial ablation, but the esophagus may move making the location unreliable when ablating to minimize esophageal injury. The aim of this study was to evaluate esophageal position and movement based on serial MRI imaging with the goal of identifying imaging and clinical characteristics that can predict the esophageal movement.MethodsFifty patients undergoing 190 MRI scans were analyzed. The relative position of the esophagus in each MRI along with clinical and imaging characteristics was quantified, including the gap between the left atrium (LA) and the vertebral body (GAP), an anatomic space in which the esophagus can move.ResultsA mean of 3.8 MRIs was analyzed per patient. Sixteen patients (32.0%) experienced significant lateral esophageal movement of more than 10xa0mm. In the significant movement group, body mass index (BMI) was higher (33.0u2009±u20096.5 vs 28.8u2009±u20095.3, pu2009=u20090.02) and the GAP was significantly larger (7.1u2009±u20092.5 vs 4.8u2009±u20095.1xa0mm, pu2009=u20090.04). Multivariate logistic regression analysis revealed that the GAP ≤u20094.5xa0mm was the only independent predictor of the esophagus not moving (odds ratiou2009=u20099.25, 95% confidence intervalu2009=u20091.72 to 49.67, pu2009=u20090.0095).ConclusionsA GAP of less than 4.5xa0mm between the LA and the vertebral body is associated with lack of esophageal movement (<u200910xa0mm). This suggests that the measurement of GAP <u20094.5xa0mm may be used to predict the esophageal location in patients undergoing atrial ablation.

Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health‐care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta‐analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF. Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed. Results Twenty‐four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta‐analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non‐POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47‐0.63), left atrial diameter (0.45: 0.15‐0.75), and left ventricular ejection fraction (0.30: 0.14‐0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31‐1.96), chronic obstructive pulmonary disease (1.36: 1.13‐1.64), hypertension (1.29: 1.12‐1.48), and myocardial infarction (1.18: 1.05‐1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00‐1.13). Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.

Serum zinc concentration in patients with acute myocardial infarction in percutaneous coronary intervention era

Introduction There were few studies that investigated the association between serum zinc concentration and acute myocardial infarction (AMI) in percutaneous coronary intervention era. Objective We assessed the relationships between serum zinc concentration, complications, and prognosis in AMI patients after primary percutaneous coronary intervention. Methods We conducted a single-center, prospective, observational study including 50 patients with AMI. We divided patients into two groups (High-zinc group and Low-zinc group) by median serum zinc concentration and compared two groups about clinical outcomes up to 1 year follow up. Results The mean age of patients was 66.2 ± 11.8 years old. Patients in the Low-zinc group had ST-segment elevation more frequently than those in the High-zinc group (96.0% vs. 72.0%, P = 0.02). All-cause mortality at 1 year was similar in both groups (P (log-rank) = 0.33). However, the lengths of hospital stay and in coronary care unit were longer in patients in the Low-zinc group than in those in the High-zinc group (15.6 ± 9.2 days vs. 11.9 ± 2.9 days, P = 0.06; 3.9 ± 2.8 days vs. 2.3 ± 0.8 days, P = 0.01). Multivariate regression analysis showed that low serum zinc concentration was associated with the use of cardiac or respiratory assist devices (adjusted odds ratio, 17.79; 95% CI 1.123 to 1216.5; P = 0.04). Conclusions Although there was no significance difference in mortality in Low-zinc and High-zinc groups, low serum zinc concentration was associated with longer stay in the coronary care unit, and was one of the independent predictors for the use of cardiac or respiratory assist devices.

The association between high-dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure: High-dose loop diuretic use

Few studies have reported the impact of high‐dose loop diuretics at discharge on prognosis in Japanese patients with heart failure (HF). Our purpose was to assess the relationship between the dose of loop diuretics at discharge and cardiovascular mortality in patients with HF.

Serial 3-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated With Lesion Progression in Patients With Stable Angina PectorisCLINICAL PERSPECTIVE

Background— Optical coherence tomographic (OCT) morphologies associated with lesion progression are not well studied. The aim of this study was to determine the morphological change for untreated lesion progression using both OCT and intravascular ultrasound (IVUS). Methods and Results— We used baseline and 8-month follow-up 3-vessel OCT and IVUS to assess 127 nonculprit lesions (IVUS plaque burden ≥40%) in 45 patients with stable angina after target lesion treatment. Lesion progression was defined as an IVUS lumen area decrease >0.5 mm2. A layered pattern was identified as a superficial layer that had a different optical intensity and a clear demarcation from underlying plaque. Lesion progression was observed in 19% (24/127) lesions, and its pattern was characterized into 3 types: type I, new superficial layered pattern at follow-up that was not present at baseline (n=9); type II, a layered pattern at baseline whose layer thickness increased at follow-up (n=7); or type III, no layered pattern at baseline or follow-up (n=8). The increase of IVUS plaque+media area was largest in type I and least in type III (1.9 mm2 [1.6–2.1], 1.1 mm2 [0.9–1.4], and 0.3 mm2 [−0.2 to 0.8], respectively; P=0.002). Type III, but not types I or II, showed negative remodeling during follow-up (IVUS vessel area; from 14.3 mm2 [11.4–17.2] to 13.5 mm2 [10.4–16.7]; P=0.02). OCT lipidic plaque was associated with lesion progression (odds ratio, 13.6; 95% confidence interval, 3.7–50.6; P<0.001). Conclusions— Lesion progression was categorized to distinct OCT morphologies that were related to changes in plaque mass or vessel remodeling.