Machiko Kanzaki

Usefulness of transient elastography for noninvasive and reliable estimation of right-sided filling pressure in heart failure.

Accurate noninvasive assessment of right atrial pressure (RAP) is important for volume management in patients with heart failure (HF). Transient elastography is a noninvasive and reliable method to assess liver stiffness (LS). We investigated the value of LS for evaluation of RAP in patients with HF without structural liver disease. We measured LS using transient elastography (Fibroscan) in 31 patients undergoing right-sided cardiac catheterization (test group). The relation between LS and RAP found in the test group was used to derive the best-fit model to predict RAP. The applicability of the model was then tested in a validation group of 49 additional patients. There was an excellent correlation between LS and RAP in the test group (r = 0.95, p <0.0001; RAP = -5.8 + 6.7 × ln [LS]). Natural log transformation (ln) of LS provided the regression equation to predict RAP. When the equation model derived from the test group was applied to the validation group, predicted RAP correlated excellently with actual RAP (r = 0.90, p <0.0001). The receiver operating characteristic curve analyses in the test group showed that LS favorably compared with echocardiography for detecting RAP >10 mm Hg (area under the curve 0.958 vs 0.800, respectively, p = 0.047). In the validation group, LS with a cut-off value of 10.6 kPa for identifying RAP >10 mm Hg had a higher sensitivity and accuracy (p = 0.046 and p = 0.049, respectively) than echocardiography. In conclusion, LS may offer an accurate noninvasive diagnostic method to assess RAP in patients with HF.

Comprehensive metagenomic approach for detecting causative microorganisms in culture-negative infective endocarditis

Comprehensive metagenomic approach for detecting causative microorganisms in culture-negative infective endocarditis Atsuko Imai , Kazuyoshi Gotoh , Yoshihiro Asano ⁎, Noriaki Yamada , Daisuke Motooka , Masaki Fukushima , Machiko Kanzaki , Tomohito Ohtani , Yasushi Sakata , Hiroyuki Nishi , Koichi Toda , Yoshiki Sawa , Issei Komuro , Toshihiro Horii , Tetsuya Iida , Shota Nakamura , Seiji Takashima a,d

A Development of Nucleic Chromatin Measurements as a New Prognostic Marker for Severe Chronic Heart Failure.

Background Accurate prediction of both mortality and morbidity is of significant importance, but it is challenging in patients with severe heart failure. It is especially difficult to detect the optimal time for implanting mechanical circulatory support devices in such patients. We aimed to analyze the morphometric ultrastructure of nuclear chromatin in cardiomyocytes by developing an original clinical histopathological method. Using this method, we developed a biomarker to predict poor outcome in patients with dilated cardiomyopathy (DCM). Methods and Results As a part of their diagnostic evaluation, 171 patients underwent endomyocardial biopsy (EMB). Of these, 63 patients diagnosed with DCM were included in this study. We used electron microscopic imaging of cardiomyocyte nuclei and an automated image analysis software program to assess whether it was possible to detect discontinuity of the nuclear periphery. Twelve months after EMB, all patients with a discontinuous nuclear periphery (Group A, n = 11) died from heart failure or underwent left ventricular assist device (VAD) implantation. In contrast, in patients with a continuous nuclear periphery (Group N, n = 52) only 7 patients (13%) underwent VAD implantation and there were no deaths (p<0.01). We then evaluated chromatin particle density (Nuc-CS) and chromatin thickness in the nuclear periphery (Per-CS) in Group N patients; these new parameters were able to identify patients with poor prognosis. Conclusions We developed novel morphometric methods based on cardiomyocyte nuclear chromatin that may provide pivotal information for early prediction of poor prognosis in patients with DCM.

Switching from carvedilol to bisoprolol ameliorates adverse effects in heart failure patients with dizziness or hypotension

BACKGROUND Treatment with carvedilol is an established primary therapy for patients with heart failure (HF). However, its most common adverse effects, dizziness and hypotension, often discourage continuation or dosage increase. The aim of this study was to examine whether switching to bisoprolol from carvedilol would help to avoid adverse symptoms and signs related to carvedilol administration. METHODS AND SUBJECTS Data were retrospectively collected from 23 patients with HF [age 57±18 years, left ventricular ejection fraction (LVEF) 33±15%] who could not increase the dosage of carvedilol because of dizziness or hypotension, defined as systolic blood pressure<90 mmHg. Before and immediately after, and 6 months after switching to bisoprolol, we examined symptoms, vital signs, laboratory data, and New York Heart Association functional class. Furthermore, left ventricular (LV) dimension and ejection fraction (EF) were evaluated in 19 patients using echocardiography. RESULTS All 13 patients with dizziness (100%) and 9 of 16 with hypotension (56%) were relieved of adverse symptoms or signs. The mean dose of carvedilol before switching was 5.60±3.43 mg. Immediately after the switch, the mean dose of bisoprolol was 1.84±1.08 mg and then increased to 3.13±1.74 mg after 6 months (p<0.01). At 6-month follow-up examinations, LV function determined by LVEF was significantly improved, which was accompanied by increased exercise tolerance. CONCLUSION Switching from carvedilol to bisoprolol may help with continuation of β-blocker treatment as well as dosage increase in HF patients with adverse symptoms or signs, allowing them to reach the target dose.

EFFECTS OF SWITCHING FROM CARVEDILOL TO BISOPROLOL IN PATIENTS WITH CHRONIC HEART FAILURE

Asrac Caegor: 13. Hear ailure: Therareseaio Numer: 1214-102Auhors: Tatsunori Taniguchi, Yasuhiro Ichibori, Machiko Matsui Kanzaki, Hitoshi Minamiguchi, Isamu Mizote, Tomohito Ohtani, Yoshihiro Asano, Yasushi Sakata, Issei Komuro, Osaka University Graduate School of Medicine, Osaka, JapanBackground: Treame ih careilol has ee esalishe as a rimar hera i aies ih hear failure. Hoeer, aerse smoms or sigs ofe iscourages coiuaio or icreases i osage of his meicaio. We seculae ha sichig o isorolol oul hel aoi aerse smoms a sigs relae o careilol amiisraio.Methods: Daa ere reroseciel collece from 23 aies ih hear failure (age 57±18 ears, NHA 2.±0.7, lef ericular ejecio fracio (LVE) 33±15%) ho coul o icrease heir osage of careilol (5.0±3.43 mg) ecause of aerse smoms (iiess, scoe) or sigs (hoesio: ssolic loo ressure (SB) <90 mmHg). Six mohs afer sichig o isorolol, e chece smoms, ial sigs, laoraor aa a cliical saus (NHA class). urhermore, lef ericular (LV) imesio a coracio ere ealuae i 17 of 23 aies usig echocariograh.Results: All of 13 smomaic aies (100%) a 5 of 10 asmomaic aies (50%) ere reliee of aerse smoms or sigs. The ose of isorolol as icrease from 1.84±1.08 o 3.13±1.74 mg (<0.01). A -moh follo-u examiaios, LV fucio measure LVE as sigiical imroe, accomaie imroeme of exercise olerace.Conclusions: Sichig from careilol o isorolol ma hel ih coiuaio of ʼ-locer reame as ell as osage icrease i aies ih aerse smoms or sigs, alloig hem o reach he arge ose.arameers Baselie mohs alueSB, mmHg 94.1±44.1 109.4±55.1 <0.05HR, m 77.1±38.2 74.±37.2 NSNHA class 2.±1.2 2.4±1.1 <0.05H, mg/l 11.±5.9 12.0±.2 NSCre, mg/l 1.08±0. 1.25±0.78 <0.01BN, g/ml 340.8±417.2 374.9±529.5 NSLVD, mm 59.8±31.5 58.0±31.5 NSLVDs, mm 51.4±27.9 4.2±25.7 <0.01LVE, % 30.3±18.1 39.4±21.8 <0.001