| 1. |
- Hatano, Masaru, et al.
(author)
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Less frequent opening of the aortic valve and a continuous flow pump are risk factors for postoperative onset of aortic insufficiency in patients with a left ventricular assist device
- 2011
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 75:5, s. 1147-1155
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Journal article (peer-reviewed)abstract
- BACKGROUND:Postoperative development of aortic insufficiency (AI) after implantation of left ventricular assist devices (LVADs) has recently been recognized, but the devices in the previous reports have been limited to the HeartMate I or II. The purposes of this study were to determine whether AI develops with other types of LVADs and to elucidate the factors associated with the development of AI.METHODS AND RESULTS:Thirty-seven patients receiving LVADs without evident abnormalities in native aortic valves were enrolled (pulsatile flow LVAD [TOYOBO]: 76%, continuous flow LVAD [EVAHEART, DuraHeart, Jarvik2000, HeartMate II]: 24%). Frequency of aortic valve opening and grade of AI were evaluated by the most recent echocardiography during LVAD support. None of the patients had more than trace AI preoperatively. During LVAD support AI >- grade 2 developed in 9 patients (24%) across all 5 types of devices. More severe grade of AI correlated with higher plasma B-type natriuretic peptide concentration (r = 0.53, P < 0.01) and with less frequent of the aortic valve (r = 0.45, P < 0.01). Multivariate analysis revealed that lower preoperative left ventricular ejection fraction and a continuous flow device type were independent risk factors for higher incidence of AI.CONCLUSIONS:AI, which is hemodynamically significant, develops after implantation of various types of LVADs. Physicians need to be more alert to the development of AI particularly with continuous flow devices.
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| 2. |
- Imamura, Teruhiko, et al.
(author)
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Correction of hyponatremia by tolvaptan before left ventricular assist device implantation
- 2012
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In: International Heart Journal. - : International Heart Journal Association. - 1349-2365 .- 1349-3299. ; 53:6, s. 391-393
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Journal article (peer-reviewed)abstract
- Hypervolemic hyponatremia is often complicated with advanced heart failure together with increased excretion of sodium by diuretics. Tolvaptan, an oral vasopressin-2-receptor antagonist, has been previously reported to improve congestion and correct hyponatremia through increased excretion of free water. However, there is little evidence concerning the administration of tolvaptan in patients with stage D heart failure. We experienced 2 patients with stage D heart failure who received 3.75 mg/day of tolvaptan to correct hyponatremia before ventricular assist device implantation. It may be useful, even for patients with stage D heart failure, to administer a low dose of tolvaptan to treat hyponatremia before ventricular assist device implantation to avoid a drastic alteration in serum sodium concentration perioperatively.
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| 3. |
- Imamura, Teruhiko, et al.
(author)
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How to demonstrate the reversibility of end-organ function before implantation of left ventricular assist device in INTERMACS profile 2 patients?
- 2012
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In: Journal of Artificial Organs. - : Springer. - 1434-7229 .- 1619-0904. ; 15:4, s. 395-398
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Journal article (peer-reviewed)abstract
- For the time being, in Japan, two recently approved implantable ventricular assist devices (VADs) are indicated only when a patient has been listed for heart transplantation or approved to be eligible for heart transplantation by in-hospital committee. The reversibility of end-organ dysfunction must be expected before VAD implantation, but it is often hard to prove during worsening clinical status. We report two patients whose end-organ dysfunction had been eventually demonstrated to be reversible by invasive procedures such as transluminal liver biopsy or transient insertion of intra-aortic balloon pumping.
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| 4. |
- Imamura, Teruhiko, et al.
(author)
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Novel risk scoring system with preoperative objective parameters gives a good prediction of 1-year mortality in patients with a left ventricular assist device.
- 2012
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 76:8, s. 1895-1903
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Journal article (peer-reviewed)abstract
- BACKGROUND:As we have previously reported, the preoperative profile defined by INTERMACS is a good predictor for the prognosis after left ventricular assist device (LVAD) implantation, but is largely dependent on the physician's decision. Several other risk stratification systems including objective parameters (eg, Leitz-Miller, Columbia, Seattle Heart Failure Model, APACHE II) have been proposed to estimate patient's mortality after LVAD implantation.METHODS AND RESULTS:According to the preoperative data from 59 patients who received LVAD (10 implantable, 49 extracorporeal) since 2002 through 2010, we performed a logistic analysis and constructed a new scoring system (ie, the TODAI VAD score (TVAD score), assigning 8 points to serum albumin <3.2mg/dl (odds ratio [OR] 8.475), 7 points to serum total bilirubin >4.8mg/dl (OR 7.300), 6 points to left ventricular end-diastolic diameter <55mm (OR 5.917), 5 points to central venous pressure >11mmHg (OR 5.128)). The receiver-operating characteristic analysis showed that the area under the curve of our new scoring system (0.864) was significantly larger than any of the abovementioned 5 scoring methods (all P<0.05). With the TVAD score, low (0-8 points), intermediate (9-17 points), and high (18-26 points) risk strata had significantly different 1-year survival rates of 95%, 54%, and 14%, respectively (all P<0.001).CONCLUSIONS:The TVAD score can predict the prognosis after LVAD implantation much better than the previously known methods.
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| 5. |
- Imamura, Teruhiko, et al.
(author)
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Preoperative Levels of Bilirubin or Creatinine Adjusted by Age Can Predict Their Reversibility After Implantation of Left Ventricular Assist Device
- 2013
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 77:1, s. 96-104
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Journal article (peer-reviewed)abstract
- Background: It is often difficult to predict reversibility of liver or renal function after left ventricular assist device (LVAD) implantation in patients with stage D heart failure. Methods and Results: Data were obtained for 69 patients who had received a LVAD (18 continuous-flow, 51 pulsatile). Persistent hepatic or renal dysfunction was defined as levels of total bilirubin (TB) or creatinine (Cre) greater than1.5 mg/dl at 6 months after LVAD implantation. TB score or Cre score was calculated: 0.15 x age+ 1.1x (preoperative TB) or 0.2 x age + 3.6 x (preoperative Cre), in which coefficients were determined on the basis of odds ratios for persistent hepatic or renal dysfunction, respectively. Receiver-operating characteristics analyses showed good predictabilities for persistent end-organ dysfunction (area under curve: 0.794 for TB score and 0.839 for Cre score). High-risk strata of TB score (greater than11.0 points) or Cre score (greater than14.1 points) were associated with persistently higher levels of TB or Cre (TB, 1.32 +/- 0.51; Cre, 1.23 +/- 0.41 mg/dl; both Pless than0.001 vs. low-risk strata). Conclusions: Reversibility of end-organ function with LVAD implantation can be well predicted by our new risk scoring system that consists of the preoperative TB or Cre level adjusted by the patients age. The scoring system would be beneficial, especially in considering the indication of a bridge to candidacy.
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| 6. |
- Imamura, Teruhiko, et al.
(author)
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Successful conversion to everolimus after cytomegalovirus infection in a heart transplant recipient
- 2012
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In: International Heart Journal. - : International Heart Journal Association. - 1349-2365 .- 1349-3299. ; 53:3, s. 199-201
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Journal article (peer-reviewed)abstract
- Cytomegalovirus (CMV) infection remains a major problem in recipients with heart transplantation (HTx), because it may play a significant role in the development of cardiac allograft vasculopathy, which is one of the major causes of death after HTx. Valganciclovir (VGC) is effective for the treatment of CM V infection, but is often associated with neutropenia, especially when used with mycophenolate mophetil (MMF). We experienced an HTx recipient with positive CMV antigenemia who suffered progressive neutropenia after administration of VGC. We switched MMF to everolimus (EVL) and assay for CM V antigenemia was constantly negative even after discontinuation of VGC. In all other 14 HTx recipients who received EVL for any reason, we found that assay for CMV antigenemia remained negative throughout the period of EVL administration. Considering the prophylactic effect on CMV, EVL can not only be an alternative to rescue from comorbidity, but might also be indicated earlier especially in CMV-seronegative HTx recipients.
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| 7. |
- Irnamura, Teruhiko, et al.
(author)
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An elevated ratio of early to late diastolic filling velocity recovers after heart transplantation in a time-dependent manner
- 2012
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In: Journal of Cardiology. - : Elsevier. - 0914-5087 .- 1876-4738. ; 60:4, s. 295-300
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Journal article (peer-reviewed)abstract
- BackgroundSeveral groups have reported that an elevated ratio of early (E) to late (A) diastolic filling velocities is observed in patients after heart transplantation. However, the mechanism has not been fully analyzed.MethodsSerial echocardiography and hemodynamic study were performed in 16 patients who had received heart transplantation and had no evidence of rejection during 1 month after the operation.ResultsOn Day 1 after the surgery, E/A ratio was higher and peak velocity of A wave was lower than normal range among the patients after heart transplantation. E/A ratio and peak velocity of A wave gradually normalized during 1 moth after the surgery. Meanwhile, early mitral annular velocity and pulmonary capillary wedge pressure remained within normal range during the study period.ConclusionsLonger ischemic time during heart transplantation procedure may cause atrial stunning, but it appears to recover within 1 month. We have to be alert to misinterpretation of this “psuedo-psuedonormal” mitral inflow pattern early after transplantation.
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| 8. |
- Kato, Naoko, et al.
(author)
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Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction
- 2012
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In: Journal of Cardiology. - : Elsevier. - 0914-5087 .- 1876-4738. ; 60:1, s. 23-30
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Journal article (peer-reviewed)abstract
- BackgroundLittle is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF ≥50%). We aimed to assess the prevalence of depression, to clarify the impact of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with reduced EF (HFrEF, EF <50%) and HFpEF.Methods and resultsA total of 106 HF outpatients were enrolled. Of them, 61 (58%) had HFpEF. Most patients were male (HFrEF 80%, HFpEF 70%) and the mean of plasma B-type natriuretic peptide (BNP) level in the HFrEF group was similar to that in the HFpEF group (164.8 ± 232.8 vs. 98.7 ± 94.8 pg/mL). HFrEF patients were treated more frequently with beta-blockers compared with HFpEF patients (71% vs. 43%, p = 0.004). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The prevalence of depression (CES-D score ≥16), and CES-D score did not significantly differ between HFrEF and HFpEF (24% vs. 25%, 14.1 ± 8.3 vs. 12.1 ± 8.3, respectively). During the 2-year follow-up, depressed patients had more cardiac death or HF hospitalization in HFrEF (55% vs. 12%, p = 0.002) and HFpEF (35% vs. 11%, p = 0.031). Cox proportional hazard analysis revealed that a higher CES-D score, indicating increased depressive symptoms, predicted cardiac events independent of BNP in HFrEF [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01–1.13] and HFpEF (HR 1.09, 95%CI 1.04–1.15). Multiple regression analyses adjusted for BNP showed that independent predictors of depressive symptoms were non-usage of beta-blockers and being widowed or divorced in HFrEF. On the other hand, usage of warfarin was the only independent risk factor for depressive symptoms in HFpEF (all, p < 0.05).ConclusionsDepressive symptoms are common and independently predict adverse events in HFrEF/HFpEF patients. This study suggests that beta-blockers reduce depressive symptoms in HFrEF. In contrast, treatment for depression remains to be elucidated in HFpEF.
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| 9. |
- Kato, Naoko, et al.
(author)
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Quality of life as an independent predictor for cardiac events and death in patients with heart failure
- 2011
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 75:7, s. 1661-1669
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Journal article (peer-reviewed)abstract
- BACKGROUND:Little is known about health-related quality of life (QOL) in Japanese patients with heart failure. The purpose of this study was to identify factors related to QOL using a disease-specific QOL instrument, and to clarify whether QOL independently predicts clinical outcomes among Japanese patients with heart failure.METHODS AND RESULTS:A total of 114 outpatients with heart failure were enrolled (mean age 64.7 ± 15.8 years; 73.7% males). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) to assess patient's QOL was used. At baseline, depressive symptoms and chronic kidney disease were significantly associated with worse QOL in multiple regression analysis. During a 2-year follow up, patients with a MLHFQ score ≥ 26, indicating worse QOL, had a higher incidence of the combined endpoint of cardiac death or hospitalization for heart failure, and a higher all-cause mortality than those with a score < 26 (25.3% vs. 7.5%, P = 0.011; 18.5% vs. 6.4%, P = 0.018; respectively). Multivariate Cox proportional hazard models demonstrated that a higher MLHFQ score was significantly associated with increased risks of cardiac events (hazard ratio, 1.02, 95% confidential interval, 1.001-1.05, P = 0.038) and of all-cause death (hazard ratio, 1.04, 95% confidential interval, 1.02-1.07, P = 0.001).CONCLUSIONS:Depressive symptoms and chronic kidney disease are major determinants of impaired QOL, and the MLHFQ score is an independent predictor of both cardiac events and death among Japanese patients with heart failure.
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| 10. |
- Shiga, Taro, et al.
(author)
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Age and preoperative total bilirubin level can stratify prognosis after extracorporeal pulsatile left ventricular assist device implantation
- 2011
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 75:1, s. 121-128
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Journal article (peer-reviewed)abstract
- Background: In Japan, the TOYOBO left ventricular assist device (LVAD) has been commercially available for heart failure patients as of 2010, but clinical risk stratification before implantation has not been widely performed. Methods and Results: In the present study data from 47 patients (age 38.6 +/- 14.6 [SD] years, male 74.5%, non-ischemic 74.5%) implanted with a TOYOBO LVAD between November 2002 and February 2010 were analyzed. Kaplan-Meier survival analysis showed significantly higher mortality in the patients who had cardiogenic shock preoperatively (P=0.031). Multivariate analysis revealed that the preoperative total bilirubin level (odds ratio [OR] 1.312, Pless than0.001) and age (OR 1.076, P=0.013) were independent risk factors for death. Perioperative necessity of a right ventricular assist device was also an independent risk factor for poor prognosis. Conclusions: LVAD implantation is preferable before the patient experiences hemodynamic collapse. The preoperative total bilirubin level can be used to predict prognosis after device implantation in end-stage heart failure patients.
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| 11. |
- Shiga, Taro, et al.
(author)
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Combination evaluation of preoperative risk indices predicts requirement of biventricular assist device
- 2012
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 76:12, s. 2785-2791
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Journal article (peer-reviewed)abstract
- BACKGROUND:Patients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated.METHODS AND RESULTS:Data from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62 mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4 m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200 pg/ml) and LVDd (≤62 mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019).CONCLUSIONS:The new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.
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