ABSTRACT Background Reducing anxiety about motor vehicle driving in patients receiving implantable cardioverter defibrillators and cardiac resynchronization therapy with defibrillators is important not only for improving quality of life but also for preventing vehicle collisions owing to driver distraction. This study aimed to clarify the driving‐related anxiety of patients with these defibrillators and the factors that predict such anxiety. Methods We conducted a cross‐sectional survey using a self‐administered questionnaire of patients who had been driving a vehicle after device implantation at a general hospital between August 2018 and November 2019. Results The mean age was 60.8 ± 12.6 years. The reasons for implantation were primary prevention in 47 patients and secondary prevention in 30 patients. A total of 16 patients experienced anxiety about driving and 61 did not. Significantly more younger patients (mean age of 50.4 vs. 63.6 years, p < 0.001) and those with implantable cardioverter defibrillators had anxiety (100% vs. 73.8%, p = 0.02). Multivariable analysis indicated that age was the only independent factor that predicted driving‐related anxiety (odds ratio, 0.937; 95% confidence interval, 0.883–0.993). Conclusions Identifying and addressing driving‐related anxiety in patients (particularly young patients) with defibrillators is important in preventing motor vehicle collisions and improving quality of life.

This study aimed to evaluate the diagnostic ability of 5-(5-(2-(2-(2-18F-fluoroethoxy) ethoxy) ethoxy) benzofuran-2-yl)-N-methylpyridin-2-amine (18F-FPYBF-2) dynamic PET for patients with cardiac amyloidosis (CA). The subjects were patients diagnosed with proven amyloidosis (n = 16) including transthyretin cardiac amyloidosis (ATTR-CA) (n = 7) and light chain amyloidosis (AL amyloidosis) (n = 9), of which 4 and 5 with (AL-CA) and without (AL-nCA) cardiac involvement, and 4 control subjects suffering from some symptoms of cardiac failure without amyloidosis (CTL). Thirty minutes dynamic 18F-FPYBF-2 PET/CT was performed to evaluate the time activity curve and the retention index (mRI) as the ratio of the myocardial SUV at 15 to 5 min. The results of bone scan were also evaluated except for 2 AL-nCA cases. Diffuse 18F-FPYBF-2 distribution in the myocardium was observed within a few minutes in all cases. The accumulation was still seen at 30 min after injection in all the CA cases, while it showed rapid clearance in CTL and AL-nCA cases. The values mRI of the ATTR-CA and AL-CA were significantly higher than CTL and AL-nCA cases, and AL-CA showed higher value than ATTR-CA (p < 0.05), while the positive results of bone scan were observed in all ATTR-CA cases, and in one case of AL-CA. 18F-FPYBF-2 PET could be a useful tool to evaluate cardiac involvement of amyloidosis and can visualize AL-CA regardless of the results of bone scan.

院内心停止で自動体外式除細動器（automated external defibrillator：AED）がショック不要と判断した中に3例の心室頻拍（ventricular tachycardia：VT）が含まれていた．事後検証で解析システムには問題がないとわかった．医療関係者は，AEDによる解析の限界を認識しておく必要がある．また，心電図モニターをいち早く患者に装着し，必要に応じてマニュアル除細動器を手配することが求められる．心電図モニター付きAEDを設置している施設では，マニュアルモードに切り替えて電気ショックをする方法に習熟しておく必要がある．

Although the salt restriction is nonpharmacologic measures widely used in the treatment of acute decompensated heart failure (ADHF), the benefits of salt restriction in Japanese patients hospitalized with ADHF are unclear. We studied 114 consecutive patients hospitalized with ADHF between January 2011 and December 2011 retrospectively. Salt restriction (maximum dietary intake, 6 g/d) were carried out in 91 patients: restriction group. Twenty three patients received a standard hospital diet (10 g of dietary intake): control group. The mean age of the patients was 77 years for both groups and the rate of major cardiovascular comorbidities was not different between the groups. At the 2-year follow up, the cumulative incidence of hospitalized for heart failure was not different between the two groups (40% in restriction group v.s. 38% in control group, n.s). In patients > 80 years, the incidence of hyponatremia (Na < 135 mEq/L), was significantly higher in restriction group than control group (31% v.s. 11%, p=0.01). Salt restriction may be unnecessary for aged patients admitted for ADHF.

HomeCirculationVol. 131, No. 3Rare Case of Cardiac Hemangioma Causing Massive Pericardial Effusion Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBRare Case of Cardiac Hemangioma Causing Massive Pericardial EffusionCan a Left Atrial Tumor Produce Pericardial Effusion? Soji Nishio, MD, Kunihiko Kosuga, MD, PhD, FJCC, Senri Miwa, MD, PhD, Yasue Fujiwara, MD, Kazuhiko Katsuyama, MD, PhD, Tatsuhiko Hata, MD, PhD, Masaharu Okada, MD, PhD, Yuzo Takeuchi, MD, PhD, Shinsaku Takeda, MD, Yasutaka Inuzuka, MD, PhD, Junya Seki, MD, Eiji Takeuchi, MD, PhD, Tsuyoshi Terashima, MD and Shigeru Ikeguchi, MD, PhD Soji NishioSoji Nishio From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Kunihiko KosugaKunihiko Kosuga From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Senri MiwaSenri Miwa From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Yasue FujiwaraYasue Fujiwara From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Kazuhiko KatsuyamaKazuhiko Katsuyama From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Tatsuhiko HataTatsuhiko Hata From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Masaharu OkadaMasaharu Okada From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Yuzo TakeuchiYuzo Takeuchi From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Shinsaku TakedaShinsaku Takeda From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Yasutaka InuzukaYasutaka Inuzuka From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Junya SekiJunya Seki From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Eiji TakeuchiEiji Takeuchi From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. , Tsuyoshi TerashimaTsuyoshi Terashima From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. and Shigeru IkeguchiShigeru Ikeguchi From the Departments of Cardiology (S.N., K. Kosuga, T.H., M.O., Y.T., S.T., Y.I., J.S., S.I.), Cardiac Surgery (S.M., Y.F., K. Katsuyama), and Pathology (E.T., T.T.), Shiga Medical Center for Adults, Shiga, Japan. Originally published20 Jan 2015https://doi.org/10.1161/CIRCULATIONAHA.114.013545Circulation. 2015;131:e21–e23A 35-year-old woman presented to the emergency room with a 2-month history of general malaise and anasarca. The chest x-ray showed cardiomegaly, and transthoracic echocardiography revealed massive pericardial effusion leading to cardiac tamponade (Figure 1A and 1B). Immediately, 1400 mL pericardial effusion (yellow exudate) was removed by needle pericardiocentesis. After the procedure, transthoracic echocardiography showed an immobile, heterogeneous tumor in the left atrium (LA) (Figure 1C and Movie I in the online-only Data Supplement).Download figureDownload PowerPointFigure 1. Multimodality imaging of the left atrial (LA) tumor. Transthoracic echocardiography revealed massive pericardial effusion leading to cardiac tamponade (A and B). After removal of the pericardial effusion, the immobile, heterogeneous tumor was observed in the LA (C and Movie I in the online-only Data Supplement). Cardiac computed tomography (CT) showed a well-circumscribed tumor located in the LA wall near the origin of the left pulmonary veins (D and Movie II in the online-only Data Supplement). Reconstruction of CT images by the CARTO3 software (Biosense Webster, Diamond Bar, CA) indicated that the tumor was fed by the left circumflex (LCX) artery (E and Movie III in the online-only Data Supplement). Cardiac magnetic resonance imaging showed that the tumor was isointense on T1-weighted images (F) and hyperintense on T2-weighted images (G). Coronary angiography revealed "tumor blush" with feeding arteries from the left circumflex artery (H and Movie IV in the online-only Data Supplement). LAD indicates left anterior descending artery.Cardiac computed tomography revealed a well-circumscribed tumor located in the LA near the origin of the left pulmonary veins (Figure 1D and 1E and Movies II and III in the online-only Data Supplement). Cardiac magnetic resonance imaging showed that the tumor was isointense on T1-weighted images (Figure 1F) and hyperintense on T2-weighted images (Figure 1G). Coronary angiography revealed "tumor blush" with feeding arteries from the left circumflex artery (Figure 1H and Movie IV in the online-only Data Supplement), indicating hypervascularity.Multimodality imaging (computed tomography, cardiac magnetic resonance, and echocardiography) indicated that the tumor was an LA intracavitary mass originating from the LA wall. However, an intracavitary tumor cannot intrinsically produce pericardial effusion (the tumor must be located in the pericardial space to produce pericardial effusion). Therefore, the tumor was thought to invade the epicardium, and the differential diagnosis of hypervascular tumor included not only benign hypervascular tumor such as myxoma and hemangioma but also malignant tumor such as angiosarcoma.After these preoperative examinations, the tumor was excised, and the patient's recovery was uneventful. Initially, the tumor was considered to be myxoma because of its edematous, semitransparent appearance on macroscopic examination (Figure 2A). However, histopathology revealed that the tumor was a cardiac hemangioma (cavernous-capillary type) originating from the LA myocardium (Figure 2B–2E).Download figureDownload PowerPointFigure 2. Histology of the left atrial tumor. Macroscopic view of the tumor (A). Because of its edematous semitransparent appearance, the tumor was initially regarded as myxoma. Overview of histology of the tumor (B; hematoxylin and eosin stain) and its conceptual scheme (C). The tumor invaded the epicardium and was located in the pericardial space, resulting in massive pericardial effusion. The tumor also forced the left atrial (LA) myocardium toward the LA cavity (C), and this is why we misrecognized the extracavitary tumor as intracavitary. The tumor was composed of a myxomatous area (D) and an area with multiple vessels (E). In the myxomatous area (D), a so-called "ring structure," which is characteristic of myxoma, was not observed. In the area of multiple vessels (E), both dilated, thin-walled vessels (cavernous type) and smaller capillary channels (capillary type) were observed, indicating that the tumor was a cavernous-capillary type of cardiac hemangioma.Cardiac hemangiomas are usually asymptomatic, but depending on the location of the tumor, they have been reported to cause arrhythmia, heart failure, outflow tract obstruction, angina, and pericardial effusion in rare cases.1 In our case, the tumor was initially recognized as an intracavitary mass, and it was not clear why the intracavitary tumor produced pericardial effusion. However, histology disclosed that the tumor extended to the epicardium and was located in the pericardial space, resulting in massive pericardial effusion. The tumor also forced the LA myocardium toward the LA cavity (Figure 2B and 2C), and this is why we misrecognized the extracavitary tumor as intracavitary.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.114.013545/-/DC1.Correspondence to Kunihiko Kosuga, MD, PhD, Department of Cardiology, Shiga Medical Center for Adults, 5-4-30, Moriyama, Moriyama City, Shiga 524–8524, Japan. E-mail [email protected]References1. Burke A, Virmani R. Tumors of the heart and great vessels.In: Atlas of Tumor Pathology, 3rd Series, Fascicle 16. Washington, DC: Armed Forces Institute of Pathology; 1996:80–86.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Patil V and Khanolkar U (2018) Percutaneous intervention for cardiac haemangioma-a rare case report, IHJ Cardiovascular Case Reports (CVCR), 10.1016/j.ihjccr.2018.06.001, 2, (S36-S40), Online publication date: 1-Dec-2018. Shikata D, Nakagomi T, Yokoyama Y, Yamada Y, Nakajima M, Oyama T and Goto T (2017) Debulking surgery for venous hemangioma arising from the epicardium: report of a case, World Journal of Surgical Oncology, 10.1186/s12957-017-1152-1, 15:1, Online publication date: 1-Dec-2017. January 20, 2015Vol 131, Issue 3 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.013545PMID: 25601954 Originally publishedJanuary 20, 2015 PDF download Advertisement SubjectsComputerized Tomography (CT)

HomeCirculationVol. 129, No. 4Decade of Histological Follow-Up for a Fully Biodegradable Poly-l-lactic Acid Coronary Stent (Igaki-Tamai Stent) in Humans Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBDecade of Histological Follow-Up for a Fully Biodegradable Poly-l-lactic Acid Coronary Stent (Igaki-Tamai Stent) in HumansAre Bioresorbable Scaffolds the Answer? Soji Nishio, MD, Shinsaku Takeda, MD, Kunihiko Kosuga, MD, PhD, FJCC, Masaharu Okada, MD, PhD, Eisho Kyo, MD, Takafumi Tsuji, MD, Eiji Takeuchi, MD, PhD, Tsuyoshi Terashima, MD, Yasutaka Inuzuka, MD, PhD, Tatsuhiko Hata, MD, PhD, Yuzo Takeuchi, MD, PhD, Takeshi Harita, MD, Junya Seki, MD and Shigeru Ikeguchi, MD, PhD Soji NishioSoji Nishio From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Shinsaku TakedaShinsaku Takeda From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Kunihiko KosugaKunihiko Kosuga From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Masaharu OkadaMasaharu Okada From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Eisho KyoEisho Kyo From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Takafumi TsujiTakafumi Tsuji From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Eiji TakeuchiEiji Takeuchi From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Tsuyoshi TerashimaTsuyoshi Terashima From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Yasutaka InuzukaYasutaka Inuzuka From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Tatsuhiko HataTatsuhiko Hata From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Yuzo TakeuchiYuzo Takeuchi From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Takeshi HaritaTakeshi Harita From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author , Junya SekiJunya Seki From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author and Shigeru IkeguchiShigeru Ikeguchi From the Departments of Cardiology (S.N., S.T., K.K., M.O., Y.I., T.H., Y.T., T.H., J.S., S.I.) and Pathology (E.T., T.T.), Shiga Medical Center for Adults, and Kusatsu Heart Center (E.K., T.T.), Shiga, Japan. Search for more papers by this author Originally published28 Jan 2014https://doi.org/10.1161/CIRCULATIONAHA.113.003769Circulation. 2014;129:534–535IntroductionAn 83-year-old male with a history of angina pectoris presented with massive intracranial hemorrhage in June 2011, and he died 2 days after admission. Previously, he was included in the first in-human feasibility study of biodegradable poly-l-lactic acid (PLLA) coronary stents: the Igaki-Tamai stents (Kyoto Medical Planning Co Ltd, Kyoto, Japan).1,2 To assess the long-term behavior of PLLA coronary stents in humans, postmortem examination of his coronary arteries was performed.In November 1999, he was diagnosed with stable angina pectoris, and coronary angiography disclosed a single lesion at the middle part of left anterior descending coronary artery (Figure 1A). One Igaki-Tamai stent had been implanted with successful result (Figure 1B). He received follow-up coronary angiography at 6 months, which showed restenosis at the distal edge of the stent (Figure 1C). Because he was asymptomatic, reintervention was avoided. Additional coronary angiography at 2 and 6 years of follow-up revealed late lumen enlargement (Figure 1D and 1E).Download figureDownload PowerPointFigure 1. Coronary angiography of the left anterior descending coronary artery (LAD). The index lesion (A). One 4×12-mm Igaki-Tamai stent had been implanted (B). Follow-up angiography 6 months (C), 2 years (D), and 6 years (E) after implantation of the Igaki-Tamai stent. Although restenosis was observed at the distal edge of the stent (C), late lumen enlargement was observed at 2 and 6 years of follow-up (D and E). The yellow arrows indicate the radio-opaque gold markers at the edges of the stent. The white lines (F) indicate the sites corresponding to the histological cross-sections shown in Figure 2.The coronary arteries were examined histopathologically by hematoxylin and eosin staining and other histochemical methods. The spaces previously occupied by PLLA struts had disappeared, suggesting complete degradation of PLLA (Figure 2A, 2D, and 2G). Inflammatory cell infiltration, foreign body reaction, and thrombus were not observed. The neointima consisted of connective tissue (Figure 2B, 2E, and 2H) and smooth muscle cells (Figure 2C, 2F, and 2I), and this stable neointimal layer sealed off old preexisting atherosclerotic plaques. The phenomenon of so-called neoatherosclerosis was not observed.Download figureDownload PowerPointFigure 2. Cross-sectional histology of the left anterior descending coronary artery (LAD) at the site where an Igaki-Tamai stent had been implanted. A corresponds to the white line A in Figure 1F, and B corresponds to the white line B in Figure 1F. The spaces previously occupied by poly-l-lactic acid (PLLA) had completely disappeared (A, D). Inflammatory cell infiltration, foreign body reaction, and thrombus were not observed. The stable neointimal layer sealed off old preexisting atherosclerotic plaques. The phenomenon of so-called neoatherosclerosis was not observed. Magnified histology of the neointima (G, H, I). In the neointima, proliferation of connective tissue and smooth muscle cells are shown using Elastiva van Gieson (EVG) staining (B, E, H) and α-smooth muscle (SM) actin staining (C, F, I), respectively. H.E indicates hematoxylin and eosin.The Igaki-Tamai stent is the first in-human bioresorbable scaffold, and this is the first human histology case to show the complete biodegradation of PLLA. Although this is only a single case, the histological examination indicates the biocompatibility and the long-term safety of PLLA. This bioresorbable scaffold technology can be one of the ideal treatment choices for coronary artery disease, especially when viewed from a long-term standpoint.DisclosuresShiga Medical Center for Adults has participated in a clinical study which evaluates PLLA stent for peripheral artery disease, provided by Kyoto Medical Planning Co Ltd, Kyoto, Japan. The authors report no conflicts.FootnotesCorrespondence to Kunihiko Kosuga, MD, PhD, FJCC, Department of Cardiology, Shiga Medical Center for Adults, 5-4-30, Moriyama, Moriyama City, Shiga 524-8524, Japan. E-mail [email protected]References1. Nishio S, Kosuga K, Igaki K, Okada M, Kyo E, Tsuji T, Takeuchi E, Inuzuka Y, Takeda S, Hata T, Takeuchi Y, Kawada Y, Harita T, Seki J, Akamatsu S, Hasegawa S, Bruining N, Brugaletta S, de Winter S, Muramatsu T, Onuma Y, Serruys PW, Ikeguchi S. Long-Term (>10 Years) clinical outcomes of first-in-human biodegradable poly-l-lactic acid coronary stents: Igaki-Tamai stents.Circulation. 2012; 125:2343–2353.LinkGoogle Scholar2. Tamai H, Igaki K, Kyo E, Kosuga K, Kawashima A, Matsui S, Komori H, Tsuji T, Motohara S, Uehata H. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans.Circulation. 2000; 102:399–404.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Fang H, Qi X, Zhou S, Yang S, Hang C, Tian Y and Wang C (2021) High-Efficient Vacuum Ultraviolet-Ozone Assist-Deposited Polydopamine for Poly(lactic- co -glycolic acid)-Coated Pure Zn toward Biodegradable Cardiovascular Stent Applications , ACS Applied Materials & Interfaces, 10.1021/acsami.1c21567, 14:2, (3536-3550), Online publication date: 19-Jan-2022. Kuwabara K, Zen K, Yashige M, Ito N, Kadoya Y, Wakana N, Yanishi K and Matoba S (2020) Comparative Analysis of the Paclitaxel-Eluting Peripheral Igaki-Tamai Stent and the Drug-Free Igaki-Tamai Stent Using Optical Coherence Tomography and Histological Analysis in a Porcine Iliac Artery Model, Circulation Journal, 10.1253/circj.CJ-20-0040, 84:5, (799-805), Online publication date: 24-Apr-2020. Raphael C, El-Sabbagh A, Corban M, Hajj S and Prasad A (2020) Emerging therapies in coronary balloon angioplasty, stenting, and bioabsorbable scaffolds Emerging Technologies for Heart Diseases, 10.1016/B978-0-12-813704-8.00024-3, (527-557), . Jinnouchi H, Torii S, Sakamoto A, Kolodgie F, Virmani R and Finn A (2018) Fully bioresorbable vascular scaffolds: lessons learned and future directions, Nature Reviews Cardiology, 10.1038/s41569-018-0124-7, 16:5, (286-304), Online publication date: 1-May-2019. Lee S, Jo H, Lim K, Lim D, Lee S, Lee J, Kim W, Jeong M, Lim J, Kwon I, Jung Y, Park J and Park S (2019) Heparin coating on 3D printed poly (l-lactic acid) biodegradable cardiovascular stent via mild surface modification approach for coronary artery implantation, Chemical Engineering Journal, 10.1016/j.cej.2019.122116, 378, (122116), Online publication date: 1-Dec-2019. Nikoubashman O, Heringer S, Feher K, Brockmann M, Sellhaus B, Dreser A, Kurtenbach K, Pjontek R, Jockenhövel S, Weis J, Kießling F, Gries T and Wiesmann M (2018) Development of a Polymer-Based Biodegradable Neurovascular Stent Prototype: A Preliminary In Vitro and In Vivo Study, Macromolecular Bioscience, 10.1002/mabi.201700292, 18:7, (1700292), Online publication date: 1-Jul-2018. 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January 28, 2014Vol 129, Issue 4 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.113.003769PMID: 24470476 Originally publishedJanuary 28, 2014 PDF download Advertisement SubjectsStent

Background: To thoroughly investigate the diagnostic information obtained by pacemakers, it is important that the stored intracardiac electrograms (EGMs) are analyzed. However, in Medtronic pacemakers, only a single intracardiac recording channel is available and thus EGM channel selection is critical.Methods: The study population comprised 150 patients who under went implantation of Medtronic's dual chamber pacemakers with a single intracardiac EGM memory channel. We first set the electrogram channel to "summed,'' and the automatic EGM diagnosis during the tachycardia was compared with the manual analysis findings. When the results were not identical for the 2 methods, the a trial EGM (AEGM) and ventricular EGM channels were sequentially selected and the results of each EGM selection were compared to conclude which channel was more valuable for diagnosis of high-rate episodes. The post-ventricular a trial blanking (PVAB) period was adjusted to the shortest interval with a relevant margin to avoid any far-field R wave over-sensing.Results: A total of 130 patients were eventually enrolled. High-rate episodes were observed in 115/130 patients (88%). The results of the automated tachycardia diagnosis obtained using the "summed'' EGM differed from those obtained manually in 43/115 patients (37%). Changing the intracardiac EGM channel from "summed'' to "AEGM'' enabled a much better manual diagnosis with intracardiac EGMs because of improved a trial potential sensing, clearer manifestation of a trial electrograms with in the PVAB, and more prominent a trial electrograms fused with the ventricular potentials. The ventricular EGM channel was not as useful as the AEGM channel for tachycardia diagnosis.Conclusions: In Medtronic pacemakers with single intracardiac EGM channel recording capability, AEGM is the most useful of the 3 EGM channel settings; PVAB should also be set to a much shorter value to achieve a more accurate automatic diagnosis. (C) 2013 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.

BACKGROUND:The purpose of this study was to evaluate the long-term safety of the Igaki-Tamai stent, the first-in-human fully biodegradable coronary stent made of poly-l-lactic acid.METHODS AND RESULTS:Between September 1998 and April 2000, 50 patients with 63 lesions were treated electively with 84 Igaki-Tamai stents. Overall clinical follow-up (>10 years) of major adverse cardiac events and rates of scaffold thrombosis was analyzed together with the results of angiography and intravascular ultrasound. Major adverse cardiac events included all-cause death, nonfatal myocardial infarction, and target lesion revascularization/target vessel revascularization. During the overall clinical follow-up period (121 ± 17 months), 2 patients were lost to follow-up. There were 1 cardiac death, 6 noncardiac deaths, and 4 myocardial infarctions. Survival rates free of all-cause death, cardiac death, and major adverse cardiac events at 10 years were 87%, 98%, and 50%, respectively. The cumulative rates of target lesion revascularization (target vessel revascularization) were 16% (16%) at 1 year, 18% (22%) at 5 years, and 28% (38%) at 10 years. Two definite scaffold thromboses (1 subacute, 1 very late) were recorded. The latter case was related to a sirolimus-eluting stent, which was implanted for a lesion proximal to an Igaki-Tamai stent. From the analysis of intravascular ultrasound data, the stent struts mostly disappeared within 3 years. The external elastic membrane area and stent area did not change.CONCLUSION:Acceptable major adverse cardiac events and scaffold thrombosis rates without stent recoil and vessel remodeling suggested the long-term safety of the Igaki-Tamai stent.

Background: Complex Fractionated Atrial Electrogram (CFAE) can contribute to the substrate of atrial fibrillation (AF), and some investigators have proposed that CFAE reflects cardiac autonomic nerve system activity occurring in areas of ganglionated plexi (GP). In this study, we examined the electrophysiological charactaristics of the left atrial sites close to GP. Methods: We analyzed 17 patients refered to our institution for AF ablation. GP was sought by demonstrating parasympathetic response to high-frequency stimulation. If AF sustained, we measured the average AF cycle length at GP sites by using automated calculation systems. Furthermore in 8 cases, we conducted CFAE analysis at the whole area of the left atrium. Results: We could measure the average AF cycle length at 76 GP sites. The values were 30–176 ms (81.5±29.7 ms). At 8 of 76 (10.5%) GP sites, AF cycle length was longer than 120 ms. In 8 cases with entire left atrial CFAE analysis, the shortest AF cycle length in the left atrium was 30–54 ms (43.4±11.4 ms). We could not induce GP responses at the shortest AF cycle length sites except 2 cases. Conclusion: We could induce GP responses at the long AF cycle length sites (over 120 ms). In 6 of 8 cases with CFAE analysis, we could not find GP responses at the shortest AF cycle length sites in the left atrium. In this study, we suggest that CFAE does not always reflect the GP activity.

Complex Fractionated Atrial Electrogram (CFAE) is associated with atrial fibrillation (AF) substrate. Culprit CFAE site might be pivot point of rotor wave. However, several sites with CFAE might behave just as bystander sites showing passive fibrillatory conduction. If AF termination is not obtained, is it no use ablating CFAE sites?CFAE ablation would eliminate fibrillatory conduction and help organizing AF, changing AF to atrial tachycardia (AT). CFAE might be related to the focus of driver (AT focus) or the site with activation gradient showing local reentry in small area. Therefore CFAE ablation would restore sinus rhythm in multi factorial ways. Recently important electrophysiological roles of ganglionated plexi (GP) have been emphasized. GP site is defined as showing parasympathetic response to high frequency stimulation. The sites of GP and CFAE are reported to overlap, however, details are unknown. We performed CFAE mapping by measuring fibrillation cycle length and displayed the sites of GP on that map. The result showed wide variety of fibrillation cycle length (30–176 ms) at the GP site. Although GP site may not demonstrate shortest fibrillation cycle length, GP site ablation eliminated AF inducibility in several cases, demonstrating GP is another important marker of AF substrate ablation, apart from CFAE ablation strategy.

Recently, drug-eluting stent (DES) has been recommended as the first choice in those patients who need stent implantation in unprotected left main coronary artery (ULMCA) stenosis. However, the long-term safety and efficacy of this procedure is still controversial. The objective of this study was to evaluate the safety and efficacy of bare metal stent (BMS) implantation in ULMCA stenting in the DES era. We implanted BMS (mainly 4 mm-diameter) in large-sized ULMCA after December 2004 when DES became available. The results of BMS implantation (n = 19) were compared with those of DES implantation (n = 39). There was no significant difference between the 2 groups regarding age, gender and coronary risk factors. Emergency procedures were more frequently performed in the BMS group than in the DES group (53% vs. 26%, p = 0.08). The initial mortality was 10.5% (n = 2) in the BMS group and 2.6% (n = 1) in the DES group (p = 0.25). There was no stent thrombosis, Q-wave myocardial infarction or emergent bypass surgery in either group during their hospital stay. The restenosis rate was 0% (n = 45) in both groups, and the target vessel revascularization rate was 5.9% in the BMS group (1/17) and 2.6% (1/38) in the DES group (p = 0.53). Therefore, there were no statistically significant differences in outcomes between the two study groups. These results indicate that BMS implantation in a large-sized ULMCA may be a safe and effective treatment even in the DES era.

Objectives: Statins are widely administered to patients with acute myocardial infarction (AMI), but knowledge of the effects of early statin therapy on the long-term mortality of AMI patients after stent implantation is still limited, especially for beyond low-density lipoprotein cholesterol (LDL-C) lowering effects.Methods: Our 378 consecutive AMI patients who were discharged alive from the hospital with successful stent implantation between 1997 and 2005 were included. We retrospectively evaluated the effects of statin therapy on major adverse cardiovascular events (MACE), including all-cause death, reinfarction, coronary artery bypass grafting, heart failure requiring rehospitalization, and target lesion revascularization.Results: Statins were given to 271 patients according to the physician to achieve a LDL-C level of less than 100 mg/dL. The achieved LDL-C levels in the statin group were 100.7, 95.1, 96.7, and 102.8 mg/dL at discharge, 6 months, 1 year, and 3 years, respectively, whereas those in the non-statin group were 103.2, 107.3, 102.8, and 103.0 mg/dL. These levels were not significantly different between the groups during 3 years. Based on Kaplan-Meier estimates, statin therapy was associated with a reduction of long-term mortality (log-rank test P=0.007). Multivariate Cox regression analysis revealed that statin therapy (P=0.015, hazard ratio: 0.10; 95% confidence interval: 0.01-0.64) was a significant predictor of favorable prognosis. Multivariate analysis revealed that statin treatment had a beneficial effect against MACE over 3 years (P=0.008).Conclusions: Early statin therapy was beneficial for long-term mortality of AMI patients treated with stenting. (c) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.

A 71-year-old woman was admitted to our department because of acute myocarditis. She was ameliorated with conventional heart failure treatment, however she developed left ventricular dilatation and cardiac troponin T (cTnT) was elevated again to >1.0 ng/ml 6 month after the first admission. She was re-admitted because of recurrent decompensated heart failure in spite of conventional treatment. Right ventricular endomyocardial biopsy revealed active myocarditis. Immunosuppressive therapy with prednisolone and azathioprine improved her symptoms and left ventricular function accompanied by a striking decrease of cTnT levels. The decreased cTnT level indicated an effective response to immunosuppression early after the beginning of treatment. These findings suggested that it is possible to evaluate the response to immunosuppressive therapy by serial measurement of cardiac troponin.

BACKGROUND The cardio-ankle vascular index (CAVI) has been recently reported as a new index of aortic stiffness, which is less influenced by blood pressure than pulse wave velocity (PWV). The present study investigated the relationship between the levels of CAVI and carotid and coronary arteriosclerosis. METHODS AND RESULTS The 443 consecutive patients who underwent CAVI, carotid sonography, and coronary angiography in hospital were examined. Intima-media thickness (IMT) and carotid plaque were evaluated by ultrasonography. The severity of coronary artery disease (CAD) was evaluated by coronary angiography and the subjects were divided into 4 groups (0, no significant organic stenosis: 1, 1-vessel disease: 2, 2-vessel disease: 3, 3-vessel disease). Univariate analyses showed that both CAVI and brachial-ankle PWV (baPWV) were associated with IMT and the presence of carotid plaque. Multiple stepwise regression analyses revealed that CAVI (p=0.0427), but not baPWV, was associated with the IMT. Both CAVI (p<0.0001) and baPWV (p=0.0140) were significantly associated with the severity of CAD. Multiple logistic analyses revealed that CAVI (p=0.0342), but not baPWV (p=0.8027), was associated with the presence of multivessel disease. CONCLUSION High CAVI implies progression of carotid and coronary arteriosclerosis. CAVI may be more closely linked with arteriosclerosis than baPWV.

Background Hypoadiponectinemia has been reported to indicate an increased risk of cardiovascular disease, so the present study investigated the significance of serum adiponectin (APN) levels for predicting clinical outcomes after percutaneous coronary intervention (PCI).Methods and Results The APN levels were evaluated in 184 consecutive patients who underwent PCI. The patients were divided into Group A [the lowest quartile of APN levels (APN <= 4.5 mu g/ml), n=46] and Group B [the upper 3 quartiles of APN levels (APN > 4.5 mu g/ml), n= 138]. During a mean follow-up period of 27.3 months, the rate of major adverse cardiac and cerebrovascular events (MACCE: death from any cause, re-infarction, repeat coronary revascularization, hospitalization because of congestive heart failure, and cerebral infarction) was higher in Group A (58.7%) than in Group B (37.0%, p=0.0101). Moreover, when the APN levels were calculated by adjusting for sex, age, body mass index, and triglyceride levels, patients in the lowest quartile of residual APN levels had a higher risk of MACCE (p=0.0405). Multiple logistic analyses showed that hypoadiponectinemia (APN <= 4.5 mu g/ml) was independently correlated with MACCE. Kaplan-Meier analysis demonstrated a higher MACCE rate in Group A than in Group B (Log-rank chi(2)=7.89, p=0.0050).Conclusion The APN level maybe helpful for predicting clinical outcomes after PCI.

OBJECTIVES Adiponectin is an adipocyte-derived endocrine factor. Hypoadiponectinemia has been observed in obese patients, and plasma adiponectin levels are reported to increase during weight reduction. Moreover, hypoadiponectinemia has also been observed in patients with coronary artery diseases. The present study investigated the relationships between levels of adiponectin and carotid intimal-medial thickness, a marker of early vascular disease, and carotid artery plaque and the severity of coronary artery disease, a marker of advanced vascular disease. METHODS Four hundred thirty-one consecutive patients were enrolled from inpatients without acute coronary syndrome who underwent coronary angiography between August 2001 and August 2003. The residual adiponectin levels were calculated by adjusting for sex, age, and body mass index, and a logarithmic transformation was applied. The severity of coronary artery disease was evaluated by coronary angiography and divided into four groups (Group 0: no significant organic stenosis, Group 1: 1-vessel disease, Group 2: 2-vessel disease, Group 3: 3-vessel disease or left main coronary trunk disease). Carotid plaque was evaluated by ultrasonography and divided into two groups [Group(-) : patients without carotid plaque, Group (+): patients with carotid plaque]. The intimal-medial thickness was measured on a longitudinal scan of the common carotid artery at a point 1 cm proximal from the bifurcation bulb. RESULTS The logarithmic-transformed levels of residual adiponectin were associated with severity of coronary artery disease (Group 0: 0.18 +/- 0.59 microg/ml, Group 1: -0.02 +/- 0.56 microg/ml, Group 2: - 0.09 +/- 0.58 microg/ml, Group 3: - 0.10 +/- 0.66 microg/ml, p = 0.0013). The logarithmic-transformed levels of residual adiponectin were decreased in patients with carotid plaque [Group (-): 0.08 +/- 0.59 microg/ml, Group (+): - 0.08 +/- 0.59 microg/ml, p = 0.045]. However, the logarithmic-transformed levels of residual adiponectin were not associated with intimal-medial thickness (p = 0.6398). CONCLUSIONS Hypoadiponectinemia adjusted for sex, age, body mass index implies the progression of carotid and coronary sclerosis.