Background:Heart failure (HF) hospitalization is increasing in Japan's aging population. Current guidelines recommend daily biometric monitoring for patients with HF to facilitate early clinical intervention. However, promoting patient self-management remains insufficient. Therefore, we assessed the usefulness of the LAVITA telemonitoring system, which automatically obtains and stores the biometric data of patients with HF via wireless devices. Methods and Results:This prospective, single-arm, multicenter cohort study enrolled patients with HF. Patients were introduced to the LAVITA telemonitoring system and trained to measure body weight, blood pressure, pulse rate, oxygen saturation (SpO2), physical activity with activity trackers (AT), and electronic patient-reported outcomes (ePRO). The primary outcome was the measurement rate of each cetology at 9-12 weeks post-discharge. The secondary outcomes included the subgroup analyses by age, sex, and left ventricular function. Thirty patients continued to use the system at home. The measurement rates of patient data were as follows: body weight 92.4% (interquartile range [IQR] 83.3-97.8%); blood pressure 95.6% (IQR 84.8-98.5%); pulse rate 96.5% (IQR 86.5-98.8%); SpO2 93.1% (IQR 76.6-97.9%); AT 88.4% (IQR 31.3-98.5%); and ePRO 76.9% (IQR 26.4-95.9%). The subgroup analysis did not significantly differ. Conclusions:The LAVITA telemonitoring system had high measurement rates for the biometric data of patients with HF, including elderly patients. Hence, it can possibly improve patient self-management and facilitate early clinical intervention.

Background Caffeine is a widely used dietary stimulant, and cases of caffeine overdoses, sometimes leading to death, are increasing. We encountered a case of caffeine intoxication resolved with administration of the sedative agent dexmedetomidine. Case presentation We administered dexmedetomidine for sedation and to suppress sympathetic nerve stimulation in the case of an 18-year-old Japanese male who ingested a massive dose of caffeine with the intention of committing suicide. The patient was in an excited state and had hypertension, sinus tachycardia, and hypokalemia with prominent QT prolongation. After dexmedetomidine administration, the patient’s mental state, hemodynamics, and electrolyte levels were improved immediately. He was discharged without any sequelae 3 days later. Conclusion Cases of acute caffeine intoxication with agitation, sympathetic overactivity and adverse cardiac events would benefit with dexmedetomidine treatment.

心臓ペースメーカが臨床応用されてから約60年経過したが，近年になっても技術進化が著しい分野である。最近ではMRI対応ペースメーカやリードレスペースメーカ，完全皮下植込み型除細動器（subcutaneous implantable cardioverter defibrillator, S-ICD），着用型自動除細動器（wearable cardioverter defibrillator, WCD）などが登場している。MRI対応ペースメーカが普及しつつあるが，機種により撮像範囲などが異なり実施基準も定められているため，注意が必要である。リードレスペースメーカやS-ICDは感染や血腫などのポケット関連合併症，断線や静脈内血栓，三尖弁閉鎖不全などのリード関連合併症を低減，またはなくしてしまうような新しいデバイスである。既存のデバイスと比較しそれぞれ欠点もあり，症例に応じて選択する必要がある。WCDはICD植込みまでの期間に使用する，新しい発想のデバイスである。今後も心臓植込みデバイスの進化・革新が起こり，より良い治療へ繋がることを期待する。

Vascular remodeling, resulting from proliferation and migration of vascular smooth muscle cells (VSMCs), is a major cause of atherosclerosis and restenosis. The lysophospholipid mediator sphingosine-1-phosphate (S1P) regulates proliferation and migration of VSMCs via S1P-specific G protein-coupled receptors, including S1P receptor 1 (S1PR1) to S1PR3. However, the role of S1PR1 in vascular remodeling is not well understood. Therefore, in this study, we aimed to investigate the effect of S1PR1 on neointimal hyperplasia in a carotid artery ligation mouse model using transgenic C57Bl/6 mice that overexpressed S1PR1 (Tg-S1PR1) under the control of α-smooth muscle actin promoter. We found that S1PR1 expression in carotid artery was upregulated after carotid artery ligation in non-transgenic (nTg) mice. Tg-S1PR1 mice showed enhanced ligation-induced neointimal hyperplasia with increased neointimal cell proliferation, compared with control nTg mice. VSMCs isolated from Tg-S1PR1 mice showed enhanced proliferation and migration in response to S1P stimulation. VSMCs from Tg-S1PR1 mice showed greater expression of interleukin-6 (IL-6) compared with nTg mouse-derived VSMCs, and administration of IL-6-neutralizing antibody into Tg-S1PR1 mice suppressed neointimal hyperplasia. These results suggest that S1P-S1PR1 signaling plays an important role in neointimal hyperplasia after vascular injury via IL-6 production.

Background: In patients with coronary artery disease (CAD), one of the risk models available in Japan was a multivariate risk prediction model based on a Japanese multicenter database: the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPELT (J-ACCESS). The aim of this study was to clinically validate the accuracy of this risk model. Methods: We evaluated the performance of the J-ACCESS model using data derived from the Assessment of the Predicted value of PROgnosis of cArdiaC events in Hokuriku (APPROACH) registry. Variables of age, summed stress score (SSS), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and diabetes mellitus were included. The major cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure that required hospitalization. The patients were followed up for three years to compare between predicted risk and actual events. Results: We evaluated 283 patients with suspected or confirmed CAD receiving myocardial perfusion imaging using Tc-99m-tetrofosmin between March 2009 and August 2011. Mean age was 68.9 +/- 10.1 years, mean eGFR 67.4 +/- 24.3 mL/min/1.73 m(2), mean SSS 5.2 +/- 7.2, and mean LVEF 65.4 +/- 14.0%. Fourteen (4.9%) patients experienced major cardiac events including cardiac death in 4 patients (1.4%), non-fatal myocardial infarction in 1 patient (0.3%), and severe heart failure in 9 patients (3.2%), respectively. While SSS >= 8, LVEF < 50%, eGFR < 45 mL/min/1.73 m2, and event risk >= 10% were significant variables in survival analysis, multivariate proportional hazard analysis showed that only LVEF and eGFR were significant. The event rate estimated from the J-ACCESS model was comparable to the actual number of major cardiac events (9 and 6, respectively, p = 0.58 by Chi-square test). Conclusions: The predictive ability of the J-ACCESS risk model is clinically valid among patients with CAD and could be applicable in clinical practice. (C) 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Introduction: Adipose derived stem cells (ADSCs) have been tested in cardiovascular diseases (CVD). However, CVD patients often accompany adipose tissue (AT) inflammation triggered by impaired angi...

Objective Comprehensive profiling of gene expression in peripheral blood leucocytes (PBLs) in patients with acute coronary syndrome (ACS) as a prognosticator is needed. We explored the specific profile of gene expression in PBLs in ACS for long-term risk stratification. Methods 30 patients with ACS who underwent primary percutaneous coronary intervention (PCI) and 15 age-matched adults who participated in medical check-ups were enrolled from three centres. Peripheral blood samples were collected to extract RNA for microarray analyses. Results During the 5-year follow-up, 36% of this cohort developed the expected non-fatal coronary events (NFEs) of target lesion revascularisation (TLR) and PCI for a de novo lesion. Class comparison analysis (p<0.005) demonstrated that 83 genes among 7785 prefiltered genes (41 upregulated vs 42 downregulated genes) were extracted to classify the patients according to the occurrence of NFE. Pathway analysis based on gene ontology revealed that the NFEs were associated with altered gene expression regarding the T-cell receptor signalling pathway in ACS. Univariate t test showed that the expression level of death-associated protein kinase1 (DAPK1), known to regulate inflammation, was the most significantly negatively regulated gene in the event group (0.61-fold, p<0.0005). Kaplan-Meier curve analysis and multivariate analysis adjusted for baseline characteristics or clinical biomarkers demonstrated that lower DAPK1 expression in PBL emerged as an independent risk factor for the NFEs (HR: 8.73; CI 1.05 to 72.8, p=0.045). Conclusions Altered gene expression in T-cell receptor signalling in PBL in ACS could be a prognosticator for secondary coronary events. Trial registration number UMIN000001932; Results.

Contrast-induced nephropathy (CIN) requires a prolonged hospital stay and represents a powerful predictor of poor early and late outcome. The recent guidelines to prevent CIN recommend intravenous volume expansion with saline solution. However, the continuous hemofiltration (CHF) also may be an effective treatment.