label: url

en: Treat-and-Repair Strategy for Atrial Septal Defect with Eisenmenger Syndrome due to Pulmonary Arterial Hypertension: A Case Report

en: Internal Medicine

ja: Internal Medicine


en: Impact of early in-hospital initiation of sacubitril/valsartan on left ventricular reverse remodelling in acute heart failure

en: The effect of initiating sacubitril/valsartan (Sac/Val) therapy during hospitalization for acute heart failure (AHF) on left ventricular (LV) remodelling remains unclear. This study aimed to assess the impact of Sac/Val on LV remodelling in patients in whom Sac/Val was initiated during AHF hospitalization. This study was a sub-analysis of the Program of Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study, which investigated the impact of initiating Sac/Val during hospitalization for AHF on echocardiographic parameters over an 8-week period, in comparison with the standard renin-angiotensin system inhibitor therapy (control). Among the full analysis set of the PREMIER study, this analysis included 206 patients [mean age, 73 years; 64 females (31.1%)], who had available echocardiographic data. The Sac/Val group (n = 94) showed significantly improved LV function and morphological parameters at 8 weeks. Compared with the control group (n = 112), preload-dependent parameters improved significantly, including LV end-diastolic volume index [mean, -5.1 mL/m2; 95% confidence interval (CI), -10.2 to -0.04; P = 0.048] and tricuspid regurgitation peak velocity (mean, -0.17 m/s; 95% CI, -0.31 to -0.03; P = 0.016). In a subgroup analysis stratified by LV ejection fraction (LVEF), a reverse remodelling effect was primarily observed in patients with an LVEF < 40%. Early Sac/Val initiation after hospitalization for AHF may significantly improve LV function and morphology at 8 weeks, particularly in patients with an LVEF < 40%, supporting its role in LV reverse remodelling.

en: European Heart Journal. Cardiovascular Pharmacotherapy


en: Clinical and Echocardiographic Characteristics of Left Atrial Diverticulum

en: Remarkable advancements in cardiac computed tomography (cCT) have provided new insights into previously undescribed anatomical structures, such as the left atrial diverticula (LADs). The aims of the present study were to assess the characteristics of LADs and their relationship with cardiac function. We analyzed consecutive patients who underwent preprocedural cCT and transthoracic echocardiography (TTE) for catheter ablation of paroxysmal or persistent atrial fibrillation between January 2020 and 2022. LADs were identified on cCT as smooth contoured protrusions extending from the left atrial wall. LADs were classified as cystiform (body length/orifice width ratio <2) or tubiform (body length/orifice width ratio 2), and their volume was measured. Among 201 patients (mean age: 65 ± 12 years, 66% male), 124 LADs were detected in 105 patients, with 19 patients having two LADs each. Of these, 99 (80%) were classified as cystiform, and 25 (20%) as tubiform. No statistically significant differences were observed in the clinical and echocardiographic characteristics between patients with and without LADs. Log-transformed volume of tubiform LADs showed a moderate correlation with age (R = 0.62; p = 0.001), and mild correlations with LA volume index (R = 0.40; p = 0.05), and E/e' (R = 0.44; p = 0.027). However, no such associations were observed for cystiform LADs. LADs were present in approximately half of the patients, with no significant association between LADs prevalence and clinical or echocardiographic characteristics. However, the relationship between LAD volume and cardiac function varied depending on the LAD subtypes.

en: Echocardiography

ja: Echocardiography


en: Association between cardiovascular risk factors and left ventricular strain distribution in patients without previous cardiovascular disease

en: Some cardiovascular (CV) risk factors, such as hypertension and diabetes mellitus, have been reported to reduce left ventricular (LV) longitudinal strain (LS) even in patients with preserved LV ejection fraction. We hypothesized that multiple CV risk factors might cause changes in myocardial strain. Our study aimed to assess the association between multiple CV risk factors and strain in patients without previous CV disease (CVD). We retrospectively evaluated 137 patients without CVD, who underwent echocardiography at our institution between May 2017 and February 2020. They were divided into four groups based on the number of risk factors (group 0: no risk factor, group 1: one risk factor, group 2: two risk factors, and groups 3: three or four risk factors). Risk factors were hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease. Absolute values of global LS (GLS) and relative apical LS ratio (RALSR) defined using the equation: average apical LS/(average basal LS + average mid LS) and was used as a marker of strain distribution. Out of 137 patients, group 0 had 35 patients, group 1 had 35 patients, group 2 had 32 patients, and group 3 had 35 patients. GLS was 22.4 ± 2.0%, 21.7 ± 2.1%, 21.3 ± 1.8%, 20.7 ± 2.2%, and RALSR was 0.64 ± 0.06, 0.66 ± 0.06, 0.68 ± 0.08, 0.69 ± 0.07 in groups 0-3, respectively. The one-way ANOVA detected significant differences between groups in GLS (p = 0.005) and RALSR (p = 0.037), respectively. Group 3 had a significantly lower GLS and higher RALSR than group 0 (p < 0.05). In patients without previous CVD, LS decreased especially from the basal segment as the number of cardiovascular risks increased. The segmental LS may be markers of occult LV dysfunction in patients with CV risk factors.

en: Journal of Echocardiography

ja: Journal of Echocardiography


en: Socioeconomic, Residential, and Disaster-Related Factors Associated with Household Emergency Food Stockpiling in Japan: A Nationwide Cross-Sectional Study

en: Preprints with THE LANCET

ja: Preprints with THE LANCET