Abstract Background A QRS scoring system by 12-lead electrocardiography (ECG) is a quick and simple method to evaluate degree and extension of myocardial infarction. Previous studies have shown that high QRS scores (≥5) at hospitalization (before reperfusion) related to impaired myocardial reperfusion during percutaneous coronary intervention (PCI) and subsequent poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI) (Figure 1). However, the pathogenesis and associated factors with high QRS scores remain poorly defined. Therefore, this study aimed to explore clinical and lesion characteristics associated with QRS scores at hospitalization in patients with STEMI. Methods This retrospective observational study enrolled 138 broad anterior-wall STEMI patients who underwent PCI in the proximal left anterior descending artery and achieved reperfusion within 3 hours of onset. Patients were divided by QRS scores at hospitalization into low (<5: n=97) and high (≥5: n=41) QRS-scores, and clinical and lesion characteristics were compared between the 2 groups. Lesion characteristics were evaluated by intravascular ultrasound (IVUS). Results Despite early phase of STEMI, QRS scores at hospitalization varied (3 [2-5] points). Clinical characteristics, including onset-to-door time (66 [41-101] min vs. 55 [42-76] min) and onset-to-reperfusion time (112 [88-145] min vs. 106 [81-120] min), were comparable between patients with low and high QRS-scores. In contrast, significantly higher percentages of lipid plaques, plaque rupture and large thrombus were seen at the culprit lesion sites in patients with high versus low QRS scores (Figure 2). As a result, patients with high QRS scores had higher incidence of no-reflow phenomenon during PCI (36.6% vs. 12.6%, p<0.05) and larger infarct size assessed by peak CK values (5333 [3307-7443] IU/l vs. 1941 [759-3559], p<0.05) compared with those with low QRS-scores. Conclusions High QRS scores at hospitalization were associated with vulnerable lesion characteristics, as well as impaired coronary reperfusion and large infarct size. Although the exact mechanisms of the associations require future studies, QRS scores may help risk stratification before reperfusion and prognostic prediction after reperfusion.Figure 1.Figure 2.

Abstract Background Transthyretin cardiac amyloidosis (ATTR-CA) appears to be prevalent in aortic stenosis (AS). The coexistence of ATTR-CA and severe AS is associated with an increased risk of hospitalization for heart failure after transcatheter aortic valve implantation (TAVI). The identification of ATTR-CA is of great clinical importance. In this study, we investigated the diagnostic value of computed tomography-derived myocardial extracellular volume (CT-ECV) for the diagnosis of biopsy-proven ATTR-CA. Methods From December 2022 to January 2024, we enrolled patients who underwent both TAVI and myocardial biopsy. CT-ECV was measured as part of routine CT imaging before TAVI and myocardial biopsy for definitive diagnosis of CA. Results Of 131 TAVI patients, 101 patients underwent myocardial biopsy. Eight patients (7.9%) were diagnosed with ATTR-CA. There were no significant differences in electrocardiographic parameters. On echocardiography, left ventricular ejection fraction (64 ± 16% vs. 65 ± 14%, p = 0.84) was similar between the 2 groups, whereas intraventricular septum and left ventricular posterior wall in diastole were thicker in the ATTR-CA group (15 ± 3mm vs. 13 ± 2mm, p = 0.04 and 14 ± 3mm vs. 12 ± 2mm, p <0.01, respectively). Significantly higher CT-ECV values were found in the ATTR-CA group than in the non-ATTR-CA group (32.6 ± 3.7% vs. 28.1 ± 3.7%, p = 0.001). Conclusions Patients with biopsy-proven ATTR-CA had high CT-ECV values. Routine CT-ECV evaluation before TAVI may be useful for the diagnosis of ATTR-CA.

Abstract Background Patient who are hospitalized for heart failure (HF) prior to transcatheter aortic valve implantation (TAVI) are associated with poor prognosis. In this study, we aimed to assess whether myocardial fibrosis (MF) in TAVI patients is strongly involved in prior heart failure hospitalization. Methods We performed a retrospective single-center study, including 93 patients who underwent cardiac biopsies before TAVI from December 2022 to December 2023. The extent of MF was assessed on Masson’s trichrome-stained tissue specimens, using a validated software "ImageJ". Results Prior hospitalization had significant association with BNP (HF hospitalization (+): 461.9[130.4-987.7] vs. HF hospitalization (-):125.3[78.2-228.6], p=0.0014) , aortic valve area index (AVAi) (0.43±0.02 vs. 0.51±0.01, p=0.002), left ventricular ejection fraction (LVEF) (54.4±2.8 vs. 67.2±1.6, p=0.0002), E/e’ (23.4±1.9 vs. 19.1±1.0, p=0.045), left atrial volume index (LAVI)(59.0±3.5 vs. 46.1±1.6, p=0.0013), global longitudinal strain (GLS) (13.2±1.0 vs. 15.7±0.5), and percent area of myocardial fibrosis(7.0[4.8-14.2] vs. 3.3[2.2-7.3], p=0.0002) Moreover, percent area of MF was the most reliable indicator (area under the curve: AUC= 0.75, p=0.0009) of prior heart failure hospitalization (figure 1) among HF parameters which include BNP (AUC=0.73, p<0.0001), AVAi (AUC=0.69, p=0.0024), LVEF(AUC=0.68,p=0.0005), E/e’ (AUC=0.63, p=0.051), LAVI (AUC=0.72, p=0.0022), GLS (AUC=0.65, p=0.035). Furthermore, the ROC curve analyses demonstrated that the best thresholds of LVEF and percent area of MF were 64.9% (60.9% sensitivity and 68.1% specificity) and 4.1% (91.7% sensitivity and 56.5% specificity) for heart failure hospitalization, respectively. When patients were divided into 4 groups according to LVEF 65% and percent area of myocardial fibrosis 4%, a stepwise increase in the proportion of heart failure hospitalization was found in the 4 groups (figure 2). Conclusions This study illustrates that extensive myocardial fibrosis was strongly associated with prior heart failure hospitalization in TAVI patients. Patients with advanced myocardial fibrosis due to aortic stenosis may benefit from earlier treatment with TAVI to prevent further progression of myocardial fibrosis.

Abstract Background Recent studies have demonstrated that the prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) is determined by the presence of myocardial fibrosis. The aim of this study was to quantify myocardial fibrosis in tissues obtained through myocardial biopsy before TAVI and to evaluate the relationship between the extent of myocardial fibrosis and baseline cardiac parameters. Methods We performed a retrospective single-center study, including 93 patients who underwent cardiac biopsies before TAVI from December 2022 to December 2023. The extent of myocardial fibrosis was assessed on Masson’s trichrome-stained tissue specimens, using a validated software "ImageJ". Results Median percent area of myocardial fibrosis in the entire cohort was 4.7% (interquartile range: 2.5 - 7.9). A significant correlation was found between the extent of myocardial fibrosis and brain natriuretic peptide (r= 0.41 p=0.0001), left ventricular ejection fraction (r=0.34, p=0.0009), aortic valve area index (r=0.33, p=0.0017), and global longitudinal strain (r=0.52, p<0.001). Patients who experienced prior heart failure hospitalization had a significantly larger extent of myocardial fibrosis (3.3% vs. 7.0%, p=0.0002). Conclusions Extensive myocardial fibrosis was associated with various heart failure parameters in patients undergoing TAVI. Patients with a large extent of myocardial fibrosis may require early intervention and/or intensive heart failure medical therapy to prevent fibrosis progression.

Core-level photoemission spectra of Ta2NiSe5 are theoretically analyzed on the basis of numerically-exact diagonalization calculations applied for the extended attractive Hubbard model in one dimension. The attractive intersite interaction (V) mimics the effective attraction between Ta 5d electrons caused by the excitonic coupling. The asymmetric line shape of the Ta 4f photoemission spectrum clearly indicates the existence of an appreciable number of correlated Ta 5d electrons, which is consistent with the semi-metal-like band structure below the structural phase transition temperature (= 328 K). The ground state may be located close to the boundary between SDW and superconductivity in the phase diagram of the extended attractive Hubbard model. The theoretical analysis is also applied to the Ni 2p photoemission.

We discuss the Uranium 5 f electron states in UPd3 and UAl3 on the basis of the theoretical calculation of the core level photoemission with the use of the impurity Anderson model. In order to suppress the ambiguity in evaluating the relevant physical parameters involved in the model, such as the 5 f-5 f Coulomb interaction strength and the hybridization strength between the 5f and ligand valence orbitals, we adopt a Bayesian data analysis framework. As a result, we conclude the importance of the energy dependence in the hybridization strength. It suggests the importance of the nonlocal screening effects in U compounds as well as in the cuprates.

Abstract Introduction Chronic inflammation has been receiving considerable attention as an emerging risk factor for cardiovascular disease. In contrast, with the aging of the population, frailty has been also attracting a great deal of attention as the residual risk for cardiovascular disease. Although inflammation and frailty exacerbate each other and have an adverse effect on many diseases, the relationship between chronic inflammation and frailty and the impact of these combination on long-term prognosis in patients with acute coronary syndrome (ACS) are not elucidated. Purpose The aims of this study were to determine the association between chronic inflammation and frailty and its impact on long-term cardiovascular outcomes in patients with ACS. Methods A total of 482 consecutive ACS patients with obstructive coronary artery disease (age 66±12 years, male 81%) were enrolled in this observational study. We evaluated patients' gait speed as a measure of frailty before discharge. C-reactive protein (CRP) levels at 1 month after discharge were also evaluated as inflammation in the chronic phase. According to commonly used criteria of the residual inflammation (CRP>0.2 mg/dL) and the definition of the European Working Group for Sarcopenia (gait speed ≤0.8 m/sec), patients were stratified by 4 subgroups: low/high CRP with slow/normal gait speed. The primary endpoint was composite outcomes of cardiovascular death, myocardial infarction and ischemic stroke. Results While there was no significant association between CRP levels and gait speed in all patients, a significant negative association between two variables was observed in the high CRP group (Spearman's ρ = −0.31, p=0.001). During the median follow-up of 6 years, primary endpoints have occurred in 82 patients. Overall, event-free rates differed significantly among the 4 groups, demonstrating the lowest event-free rate in the patients with high CRP and slow gait speed (p<0.0001; Figure). In the multivariate analysis, high CRP (adjusted HR 1.99, 95% CI 1.14–3.46, p=0.02) and slow gait speed (adjusted HR 1.82, 95% CI 1.09–3.04, p=0.02) were independently and significantly associated with the primary endpoint. Moreover, the patients with both high CRP and slow gait speed had a 2.6-fold higher risk of cardiovascular events compared to others (adjusted HR 2.62, 95% CI 1.36–5.05, p=0.004). Conclusion In the patients with ACS, CRP levels and gait speed were negatively associated in the high CRP group. Chronic inflammation and frailty were both associated with poor prognosis in ACS and in particular, the combination of these factors was strongly associated with poor prognosis. Funding Acknowledgement Type of funding sources: None. Figure 1

Background: The optimal endpoint after balloon angioplasty remains poorly defined. This study aimed to charac-terize post-balloon angioplasty anatomical and physiological indexes by quantitative flow ratio (QFR) and to compare their prognostic impacts on long-term clinical outcomes.Methods: This retrospective study included 106 lesions from 106 patients who underwent percutaneous coronary interventions with drug-coated-balloon (n = 69) or plain-old-balloon-angioplasty (n = 37). Analyses measured minimum lumen diameter (MLD) and percent diameter stenosis (%DS) as anatomical indexes; QFR of target ves-sel (QFR-vessel) and QFR-gradient (Delta QFR between proximal and distal segments of the lesion) as physiological indexes. Primary endpoint was target lesion revascularization (TLR) after the index procedure.Results: TLR occurred in 21 (20 %) lesions. TLR group showed significantly smaller QFR-vessel (0.79 +/- 0.12 vs. 0.85 +/- 0.12, p = 0.03), as well as greater QFR-gradient (0.12 +/- 0.07 vs. 0.04 +/- 0.03, p < 0.0001) at post -procedure compared with non-TLR group. The percentage of angiographically significant dissection was also more frequently observed in TLR group compared with non-TLR group (47.6 % vs. 14.1 %, p < 0.0001 for log -rank). In the multivariate analysis, angiographically significant dissection and QFR-gradient at post-procedure was significantly associated with TLR. In the receiver-operating characteristics curve analysis, the area under the curve for predicting post-procedural TLR was significantly greater for QFR-gradient than for MLD and residual %DS (p < 0.0001 for MLD and p = 0.0003 for residual %DS at post-procedure). The best cut-off value of post -procedural QFR-gradient for predicting TLR was 0.08. Conclusions: Post-procedural QFR-gradient across the lesion was a statistically independent and stronger predic-tor of TLR, compared with anatomical indexes.(c) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Abstract Background The early transmitral flow velocity (E) divided by the early diastolic velocity of the mitral valve annulus (e') is referred to as the “E/e' ratio,” is useful even for ST elevation acute myocardial infarction (STEMI). However, the role of late diastolic velocity (a') which reveals the atrial function for STEMI is still unclear. Objectives We evaluated the clinical usefulness of tissue Doppler including atrial function for a first-time STEMI by long time follow up. Furthermore, we evaluated the meaning of each parameters by performing immediately after PCI or 2 weeks later. Methods We treated consecutive 571 first-time STEMI patients by immediate PCI within 12 hours after onset, and we examined 270 patients at immediately after PCI (GroupA, 65 years, 250 male) and 301 patients at 2 weeks after onset (GroupB, 64 years, 243 male). We examined trans mitral flow and TDI, then defined E/e' as LV filling pressure and A/a' as left atrial function. We followed them for a long time (>5 years). The primary end point (PE) was cardiac death or re-admission for heart failure (HF). Results We followed the patients in Group A for 10 years, Group B for 5 years. PE occurred in 64 patients in GroupA during 10 years, and 45 patients in GroupB during 5 years. We analyzed the univariate and multivariate Cox hazard analyses and we compared e' and a', E/e' and A/a' (Table). In GroupA, a' and A/a' were the independent predictors, on the other hand neither a' nor A/a' were the predictors in GroupB. E/e' was an independent predictor both in GroupA and B. Conclusion TDI parameters have different meanings by the timing of echocardiography after onset of a first-time STEMI. These results demonstrated that atrial dysfunction immediately after onset of STEMI suggests the poor prognosis after STEMI. Cox Hazard Proportional Analysis Funding Acknowledgement Type of funding source: None

Abstract Objectives Doppler echocardiography is a well-recognized technique for noninvasive evaluation; however, little is known about its efficacy in patients with rapid atrial fibrillation (AF) accompanied by acute decompensated heart failure (ADHF). The aim of this study was to explore the usefulness of serial echocardiographical assessment for rapid AF patients with ADHF. Patients A total of 110 ADHF patients with reduced ejection fraction (HFrEF) and rapid AF who were admitted to the CCU unit and received landiolol treatmentto decrease the heart rate (HR) to <110 bpm and change HR (ΔHR) of >20% within 24 hours were enrolled. Interventions Immediately after admission, the patients (n=110) received landiolol, and its dose was increased to the maximum; then, we repeatedly performed echocardiography. Among them, 39 patients were monitored using invasive right heart catheterization (RHC) simultaneously with echocardiography. Measurements and main results There were significant relationships between Doppler and RHC parameters through the landiolol treatment (Figure, baseline–max HR treatment). We observed for the major adverse events (MAE) during initial hospitalization, which included cardiac death, HF prolongation (required intravenous treatment at 30 days), and worsening renal function (WRF). MAE occurred in 44 patients, and logistic regression analyses showed that the mean left atrial pressure (mLAP)-Doppler (odds ratio = 1.132, 95% confidence interval [CI]: 1.05–1.23, p=0.0004) and stroke volume (SV)-Doppler (odds ratio = 0.93, 95% confidence interval [CI]: 0.89–0.97, p=0.001) at 24 hours were the significant predictors for MAE, and multivariate analysis showed that mLAP-Doppler was the strongest predictor (odds ratio = 1.16, 95% CI: 0.107–1.27, p=0.0005) (Table). Conclusions During the control of the rapid AF in HFrEF patients withADHF, echocardiography was useful to assess their hemodynamic condition, even at bedside. Doppler for rapid AF of ADHF Funding Acknowledgement Type of funding source: None

Abstract Background Although the prognostic value of non-invasive endothelial function test has been reported in several populations including heart failure patients and angina pectoris patients, it is unknown in patients with acute coronary syndrome (ACS). Furthermore, the role of endothelial dysfunction in increased risk for specific causes of death has not been investigated. Purpose To study the relation between endothelial dysfunction and the risk of death in ACS patients, both overall and with regard to the main causes of death. Method Six hundred and ninety-two patients who were hospitalized for ACS from 2010 to 2014 were enrolled. Reactive hyoeremia index (RHI) was measured to assess endothelial function non-invasively in all patients using the peripheral arterial tonometry. RHI values below 1.67 were interpreted as signs of endothelial dysfunction in accordance with the manufacturer. Patients were followed up for a median of 6.5 years. Result A mean age (standard deviation) was 66 (12) years, and 542 patients (78%) were male. The patients in this study consist of 377 ST-elevation myocardial infarction (54%), and 263 non ST-elevation myocardial infarction (38%), and 52 unstable angina (8%). Endothelial dysfunction was detected in 276 patients (40%). During the follow-up period, 84 patients (12%) died (48 from cardiovascular disease, 36 from other causes). Patients with endothelial dysfunction had an increased risk of death (hazard ratio (HR) 1.83, 95% confidence interval (95% CI): 1.19–2.83, p=0.006) compared with those without endothelial dysfunction. Analyses for specific causes of death showed that patients with endothelial dysfunction had a 2.4-fold higher increased risk of cardiovascular death (HR: 2.44, 95% CI: 1.35 ro 4.59, p=0.003) after multivariate adjustment. However there was no significant relation between endothelial dysfunction and non-cardiovascular mortality (HR: 0.69, 95% CI: 0.34 to 1.36, p=0.29). Conclusion Endothelial dysfunction is strongly associated with an increased risk of cardiovascular mortality in ACS patients. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract Introduction Muscle, fat and bone mass may play some roles to keep physical activity and favorable outcome in patients with cardiovascular diseases. However, there is a paucity of data regarding the effects on the prognosis of skeletal muscle, fat, and bone mass in patients with ST-segment elevation myocardial infarction (STEMI). Purpose Our purpose was to examine whether skeletal muscle, fat, and bone mass each affect the prognosis after STEMI. Methods A total of 354 male patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization. Results During a median follow-up of 32 months, 57 patients experienced primary composite outcome. Each of skeletal muscle, fat, and bone mass were indexed by height squared (kg/m2) and divided into two groups using the cut-off value obtained from the maximum Youden index to predict the primary composite outcome. The event rate was significantly higher in patients with low appendicular skeletal muscle mass index (ASMI) (29.2% vs 11.7%, p<0.001), low fat mass index (FMI) (22.9% vs 13.3%, p=0.030), and low bone mass index (23.8% vs 11.6%, p=0.002). After adjustment for age, renal function, diabetes mellitus, infarct size, Killip classification, and body mass index, low ASMI but not FMI (p=0.150) and bone mass index (p=0.159) was independently and significantly associated with the primary composite outcome (adjusted hazard ratio 2.12, 95%-confidence interval 1.05–4.31, p=0.035). Conclusions Index about muscle mass rather than fat and bone mass have prognostic impact in male patients with STEMI.

Abstract Introduction Sarcopenia, characterized by the loss of skeletal muscle mass and muscle strength, has been demonstrated the importance in cardiovascular diseases including ST-segment elevation myocardial infarction (STEMI). However, there is few data comparing the effects on the prognosis of skeletal muscle mass of upper and lower extremities in STEMI patients. Purpose Our purpose was to examine whether skeletal muscle mass of upper and lower extremities affect the prognosis after STEMI. Methods A total of 432 patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. Each of upper and lower extremity skeletal muscle masses was indexed by height squared (kg/m2), and divided into two groups using the first quartile value for each sex. All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization. Results During a median follow-up of 32 months, 68 patients experienced primary composite outcome. The event rate was significantly higher in patients with low-lower extremity skeletal muscle mass index (LESMI) than in those with high-LESMI (24.3% vs 12.9%, log-rank p<0.001), as well as in those with low-upper extremity muscle mass index than in those with high-upper extremity muscle mass index (UESMI) (19.6% vs 14.5%, log-rank p=0.047). However, after adjustment for age, gender, renal function, diabetes mellitus, infarct size, body mass index, and body fat percentage, only low-LESMI was independently and significantly associated with the primary composite outcome (adjusted hazard ratio for LESMI 2.11, 95%-confidence interval 1.06–4.14, p=0.034, adjusted hazard ratio for UESMI 1.04, 95%-confidence interval 0.52–2.08, p=0.906,). Conclusions Decreased muscle mass of lower extremity, rather than upper extremity, might have prognostic impact in patients with STEMI.

Core level X-ray photoelectron spectrum of the ladder vanadate NaV2O5 is calculated with an extended Hubbard model, adopting a numerically exact diagonalization method based on the Lanczos algorithm. The result shows that the d band filling dependence of the spectrum deviates considerably from the simple statistical ratio of V4+ to V5+ in NaV2O5, which indicates the importance of the delocalized nature of d electron states. It is also shown that the spectrum is significantly influenced by the intersite Coulomb interaction and lattice distortion, which are responsible for the charge ordering.

Genu recurvatum is one of the common problems in patients with hemiplegia after stroke. For its improvement, it may be important to manipulate the ankle movement in coordination with the knee during gait. However, no device is available yet that can achieve it. We are developing a new exoskeleton robot that can assist knee and ankle joints simultaneously. This study aimed to test the feasibility of the robot in healthy individuals and patients with stroke, and to investigate its effect on genu recurvatum during gait. Two healthy individuals and two patients with chronic stroke participated in this study. Healthy individuals received the robot-assisted gait training for 60 min in total. We assessed the safety of the training and muscle activities during gait with or without the robot-assistance. Patients with stroke had moderate lower-limb paralysis and genu recurvatum during gait. They received the robot-assisted gait training for 30 min in total. The robot consisted of a knee ankle foot orthosis and an actuator with pneumatic artificial muscles (Fig. 1). We adjusted the assist parameters to prevent their knee hyper-extension during the stance phase. We evaluated the range of knee joint motion, temporal and spatial parameters during over-ground gait without the robot before and after the intervention. All participants safely completed the training. The robot decreased muscle activities during gait in healthy individuals. One of the patients showed a decrease in the maximum knee extension range during the stance phase, an increase in the maximum knee flexion range during the swing phase, and improvements in the temporal and spatial asymmetries. The robot which can assist knee and ankle joints simultaneously has a potential to be a new therapeutic device for genu recurvatum in patients with hemiparetic stroke.

We use soft x-ray photoemission spectroscopy (SXPES) to investigate Ce 4f electronic states of a new BiS2 layered superconductor CeO1-xFxBiS2, for polycrystalline and single-crystal samples. The Ce 3d spectrum of the single crystal of nominal composition x = 0.7 has no f(0) component and the spectral shape closely resembles the ones observed for Ce trivalent insulating compounds, strongly implying that the CeO layer is still in an insulating state even after the F doping. The Ce 3d-4f resonant SXPES for both polycrystalline and single-crystal samples shows that the prominent peak is located around 1 eV below the Fermi level (E-F) with negligible spectral intensity at EF. The F-concentration dependence of the valence band spectra for single crystals shows the increases of the degeneracy in energy levels and of the interaction between Ce 4f and S 3p states. These results give insight into the nature of the CeO1-xFx layer and the microscopic coexistence of magnetism and superconductivity in CeO1-xFxBiS2.

The Ni 2p X-ray photoemission spectrum ( Ni 2p XPS) of the linear-chain nickelate Y2BaNiO5 is calculated by a Ni5O26 cluster model, adopting the numerically-exact diagonalization method based on the Lanczos algorithm. Particular attention is paid to how the Ni 2p core-hole charge is screened by the Ni 3d-O 2p valence electron system. The result shows that the leading d(9)L peak of the Ni 2p XPS has two components, as in the case of the Ni 2p XPS of NiO, where L denotes a ligand hole. The hole distribution analysis shows the importance of "nonlocal screening" that the Ni 3d holes apart from the core-hole site actively participate in the core-hole screening, and it also shows that the "local screening" is realized in the lowest-energy final state. The calculated spectrum of Y2BaNiO5 well reproduces that obtained experimentally.