Hiroshi Ito

Okayama University, Okayama, Okayama, Japan

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Publications (319)1113.06 Total impact

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    ABSTRACT: Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFRcath) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFRCT). The purpose of this study is to determine the potential impact of non-invasive FFRCT on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFRcath guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFRCT guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFRCT of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFRCT strategy and the CAG-FFRcath guided PCI strategy. Use of the cCTA-FFRCT strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFRCT to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.
    Cardiovascular Intervention and Therapeutics 07/2014;
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    ABSTRACT: Residual risk of cardiovascular disease from increased small dense low-density lipoprotein (sdLDL)-cholesterol levels and low n-3 polyunsaturated fatty acid (PUFA) levels is a considerable therapeutic issue. The purpose of this study was to evaluate the effect of ezetimibe as an add-on to statins and supplemental eicosapentaenoic acid (EPA) on sdLDL cholesterol and absorption of EPA in patients with coronary artery disease.
    American journal of cardiovascular drugs : drugs, devices, and other interventions. 06/2014;
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    ABSTRACT: No study has investigated whether pioglitazone (an agonist of peroxisome proliferator-activated receptor gamma) protects against ischemia and reperfusion (IR)-induced endothelial dysfunction in humans.
    Journal of cardiovascular pharmacology. 05/2014;
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    ABSTRACT: A 73-year-old man with atrial fibrillation and previous left pneumonectomy was admitted with pleural effusion. Anticoagulant therapy was discontinued because of chest tube drainage. Six days later, the patient experienced chest discomfort. Echocardiography showed a pedunculated thrombus with swaying motion in the left pulmonary artery (PA) stump. Contrast-enhanced computed tomography of the chest revealed filling defects in not only the left PA stump but also the right PA, implying contralateral pulmonary embolism. Anticoagulants were resumed, and thrombolysis was successful 3 days later. Patients undergoing pneumonectomy in whom anticoagulant therapy is discontinued should be recognized as being at high risk for PA stump thrombosis and subsequent contralateral pulmonary embolism.
    The Annals of thoracic surgery 05/2014; 97(5):1797-8. · 3.45 Impact Factor
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    ABSTRACT: Multi-detector coronary CT angiography (CCTA) can detect coronary stenosis, but it has a limited ability to evaluate myocardial perfusion. We evaluated the usefulness of first-pass CT-myocardial perfusion imaging (MPI) in combination with CCTA for diagnosing coronary artery disease (CAD). A total of 145 patients with suspected CAD were enrolled. We used 64-row multi-detector CT (Definition Flash, Siemens). The same coronary CCTA data were used for first-pass CT-MPI without drug loading. Images were reconstructed by examining the signal densities at diastole as colour maps. Diagnostic accuracy was assessed by comparison with invasive coronary angiography. First-pass CT-MPI in combination with CCTA significantly improved diagnostic performance compared with CCTA alone. With per-vessel analysis, the sensitivity, specificity, positive predictive value and negative predictive value increased from 81% to 85%, 87% to 94%, 63% to 79% and 95% to 96%, respectively. The area under the receiver operating characteristic curve for detecting CAD also increased from 0.84 to 0.89 (p=0.02). First-pass CT-MPI was particularly useful for assessing segments that could not be directly evaluated due to severe calcification and motion artefacts. First-pass CT-MPI has an additional diagnostic value for detecting coronary stenosis, in particular in patients with severe calcification.
    Heart (British Cardiac Society) 04/2014; · 5.01 Impact Factor
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    ABSTRACT: Background: Several lines of evidence suggest that atrial fibrillation (AF) may be a consequence of vascular disease. We investigated the relationship between cardio-ankle vascular index (CAVI), a new index of arterial stiffness, and the presence of paroxysmal AF (PAF). Methods and results: 181 outpatients (91 patients with PAF and 90 age- and gender-matched subjects without PAF) were analysed for their sinus rhythm. The CAVI was significantly higher in patients with PAF than in subjects without PAF (9.0±1.0 vs 8.7±0.8, p<0.01). In all subjects, the CAVI was significantly correlated with the left ventricular mass index (r=0.30, p<0.01), left atrial diameter (r=0.22, p<0.01), and augmentation index, a parameter of wave reflection (r=0.32, p<0.01), in addition to age, systolic blood pressure and pulse pressure. Logistic analysis demonstrated that the CAVI was independently associated with PAF even after adjustment for confounding factors. The adjusted OR of PAF was 1.8 for each unit increase in the CAVI (p=0.01). Conclusions: Our finding suggests that increased arterial stiffness may be involved in the maintenance of AF.
    Heart Asia. 04/2014; 6(1):59-63.
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    ABSTRACT: Rationale: Epoprostenol is a first-line therapy for pulmonary arterial hypertension (PAH) patients in WHO Functional Class IV, who often have low cardiac output and hypotension. Initiation of epoprostenol could cause hemodynamic collapse. Inotropic agent support could prevent the hemodynamic instability caused by initiation of epoprostenol, though a protocol has not been established. Objective: To assess the reliability and prognostic effects of dobutamine (DOB) and dopamine (DOA) support at the initiation of epoprostenol therapy in PAH patients. Methods: We initiated epoprostenol therapy in 71 PAH patients. Hemodynamics at the initiation of epoprostenol was measured by right heart catheterization. We initiated DOB when the patients' mixed venous oxygen saturation was <60% or cardiac index was <2.0 l/min/m2 or when right ventricular failure was clinically suspected. We initiated DOA when the patients' systolic blood pressure was <90 mmHg or urine volume was <20 ml/h. Measurements and Main Results: At the initiation of epoprostenol, DOB and/or DOA were required in 46 patients. Neither DOB nor DOA was an independent factor of poor short-term survival (DOB: HR 1.63 (95%CI: 0.33-8.11) and DOA: HR 0.22 (95%CI: 0.03-1.70)). Sixty-two patients were discharged for home infusion of epoprostenol. Transplant-free survival rates at five years were 80.0% for patients with non DOB and DOA support at the start of epoprostenol and 76.6% for patients with DOB plus/or DOA support (P=0.45). Conclusions: Temporary use of DOB and DOA is safe as support at the initiation of epoprostenol therapy in PAH patients with low cardiac output and hypotension.
    Annals of the American Thoracic Society. 04/2014;
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    ABSTRACT: Postprandial elevation of triglyceride-rich lipoproteins impairs endothelial function, which can initiate atherosclerosis. We investigated the effects of bezafibrate on postprandial endothelial dysfunction and lipid profiles in patients with metabolic syndrome. Ten patients with metabolic syndrome were treated with 400 mg/day bezafibrate or untreated for 4 weeks in a randomized crossover study. Brachial artery flow-mediated dilation (FMD) and lipid profiles were assessed during fasting and after consumption of a standardized snack. Serum triglyceride and cholesterol contents of lipoprotein fractions were analyzed by high-performance liquid chromatography. Postprandial FMD decreased significantly and reached its lowest value 4 h after the cookie test in both the bezafibrate and control groups, but the relative change in FMD from baseline to minimum in the bezafibrate group was significantly smaller than that in the control group (-29.0 +/- 5.9 vs. -42.9 +/- 6.2 %, p = 0.04). Bezafibrate significantly suppressed postprandial elevation of triglyceride (incremental area under the curve (AUC): 544 +/- 65 vs. 1158 +/- 283 mg h/dl, p = 0.02) and remnant lipoprotein cholesterol (incremental AUC: 27.9 +/- 3.5 vs. 72.3 +/- 14.1 mg h/dl, p < 0.01). High-performance liquid chromatography analysis revealed that postprandial triglyceride content of the chylomicron and very low-density lipoprotein fractions was significantly lower in the bezafibrate group than in the control group (p < 0.05). Bezafibrate significantly decreased postprandial endothelial dysfunction, and elevations of both exogenous and endogenous triglycerides in patients with metabolic syndrome, suggesting that bezafibrate may have vascular protective effects in these patients.Clinical trial registration: Unique Identifiers: UMIN000012557.
    Cardiovascular Diabetology 04/2014; 13(1):71. · 4.21 Impact Factor
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    ABSTRACT: Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 2014;
    Journal of Clinical Ultrasound 04/2014; · 0.70 Impact Factor
  • Folia Pharmacologica Japonica 04/2014; 143(4):173-7.
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    ABSTRACT: This study aimed to determine the usefulness of the combination of several electrocardiographic (ECG) markers on risk assessment of ventricular fibrillation (VF) in patients with Brugada syndrome (BrS). Detection of high/low-risk BrS patients using a noninvasive method is an important issue in the clinical setting. Several ECG markers related to depolarization and repolarization abnormalities have been reported, but the relationship and usefulness of these parameters in VF events are unclear. Baseline characteristics of 246 consecutive patients (236 males; mean age, 47.6±13.6 years) with Brugada type ECG, including 13 patients with a history of VF and 40 patients with a history of syncopal episodes, were retrospectively analyzed. During the mean follow-up period of 45.1 months, VF in 23 patients and sudden cardiac death (SCD) in one patient were observed. Clinical/genetic and electrocardiographic parameters were compared with VF/SCD events. By univariate analysis, history of VF, history of syncopal episodes, paroxysmal atrial fibrillation , spontaneous type 1 pattern in the precordial leads, ECG markers of depolarization abnormalities (PQ >200 ms, QRS duration ≥120 ms, and fragmented QRS [f-QRS]), and those of repolarization abnormalities (infero-lateral early repolarization [ER] pattern and QT prolongation) were associated with later cardiac events. By multivariable analysis, history of VF, history of syncopal episodes, infero-lateral ER pattern, f-QRS were independent predictors of documented VF and SCD (odds ratio, 19.61, 28.57, 2.87, and 5.21, respectively, P<0.05). Kaplan-Meier curves showed that the presence/absence of infero-lateral ER and f-QRS provided a worse/better prognosis (log-rank test, P<0.01). The combination of depolarization and repolarization abnormalities in BrS is associated with later VF events. The combination of these abnormalities is useful for detecting high- and low-risk BrS patients.
    Journal of the American College of Cardiology 03/2014; · 14.09 Impact Factor
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    ABSTRACT: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood. We retrospectively evaluated 456 patients (60% male, age 64 +/- 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification). Patients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08-9.31, p = 0.04), but not in patients with DM. The VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.
    Cardiovascular Diabetology 03/2014; 13(1):61. · 4.21 Impact Factor
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    ABSTRACT: Heart failure with left ventricular (LV) hypertrophy is often associated with insulin resistance and inflammation. Recent studies have shown that dipeptidyl peptidase 4 (DPP4) inhibitors improve glucose metabolism and inflammatory status. We therefore evaluated whether vildagliptin, a DPP4 inhibitor, prevents LV hypertrophy and improves diastolic function in isoproterenol-treated rats. Male Wistar rats received vehicle (n = 20), subcutaneous isoproterenol (2.4 mg/kg/day, n = 20) (ISO), subcutaneous isoproterenol (2.4 mg/kg/day + oral vildagliptin (30 mg/kg/day, n = 20) (ISO-VL), or vehicle + oral vildagliptin (30 mg/kg/day, n = 20) (vehicle-VL) for 7 days. Blood pressure was similar among the four groups, whereas LV hypertrophy was significantly decreased in the ISO-VL group compared with the ISO group (heart weight/body weight, vehicle: 3.2 +/- 0.40, ISO: 4.43 +/- 0.39, ISO-VL: 4.14 +/- 0.29, vehicle-VL: 3.16 +/- 0.16, p < 0.05). Cardiac catheterization revealed that vildagliptin lowered the elevated LV end-diastolic pressure observed in the ISO group, but other parameters regarding LV diastolic function such as the decreased minimum dp/dt were not ameliorated in the ISO-VL group. Histological analysis showed that vildagliptin attenuated the increased cardiomyocyte hypertrophy and perivascular fibrosis, but it did not affect angiogenesis in cardiac tissue. In the ISO-VL group, quantitative PCR showed attenuation of increased mRNA expression of tumor necrosis factor-alpha, interleukin-6, insulin-like growth factor-l, and restoration of decreased mRNA expression of glucose transporter type 4. Vildagliptin may prevent LV hypertrophy caused by continuous exposure to isoproterenol in rats.
    Cardiovascular Diabetology 02/2014; 13(1):43. · 4.21 Impact Factor
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    ABSTRACT: Platypnea-orthodeoxia is a rare condition characterized by dyspnea and oxygen desaturation induced by the upright position and relieved by recumbency. The most common cause of this syndrome is right-to-left shunt through interatrial communications such as patent foramen ovale (PFO) or atrial septal defect (ASD). In addition, this syndrome can be caused by other extracardiac components, including pulmonary emphysema, pericardial disease, and prominent Eustachian valve. We experienced 3 cases of this syndrome, including 1 patient with PFO and 2 patients with ASD. Computer tomography imaging revealed aortic elongation and compression of the right atrium by ascending aorta in all of 3 patients. Transcatheter closure of PFO or ASD was successfully performed in all patients, including immediate improvements of symptoms and oxygen saturation without any complications.
    Cardiovascular intervention and therapeutics. 01/2014;
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    ABSTRACT: The aim of this study was to develop a limited sampling strategy (LSS) to estimate the area under the concentration-time curve (AUC) of gefitinib using data from 18 patients with non-small-cell lung cancer. On day 14 after beginning daily therapy with 250 mg of gefitinib, plasma samples were collected just before (C0h, 24 hours after the 13th administration) and 1, 2, 4, 6, 8, 12, and 24 hours (Cnh) after gefitinib administration and were analyzed by high-performance liquid chromatography. The predicted AUC from 0 to 24 hours (AUC0-24) from the single time point of C12h showed the highest correlation with the measured AUC0-24 of gefitinib (AUC0-24 = 20.0 × C12h + 1348.0; r = 0.9623; P < 0.0001). The 95% confidence intervals of the slopes and intercepts of the formulae obtained by bootstrap analysis indicated acceptable accuracy and robustness in the prediction of AUC0-24 using C0h, C1h, C12h, and C1h + C12h. The median AUC0-24 and C0h of gefitinib in patients with diarrhea (n = 8) were higher than those without diarrhea (n = 10) (15,043 versus 8918 ng·h·mL, respectively, P = 0.0164 and 542 versus 261 ng/mL, respectively, P = 0.0263). The area under the receiver operator curve was 0.813, giving the best sensitivity (75%) and specificity (90%) at a C0h threshold of 398 ng/mL. Use of the C12h single time point is recommended for the gefitinib AUC0-24 predictive equation; however, total estimation of the AUC0-24 of gefitinib at the single point of C0h was also precise. C0h monitoring of gefitinib might be beneficial during gefitinib therapy, because of a high variability in gefitinib exposure among patients taking 250 mg. Further examination of the correlation between clinical evaluation and the gefitinib exposure is necessary.
    Therapeutic drug monitoring 01/2014; · 2.43 Impact Factor
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    ABSTRACT: Idiopathic pulmonary arterial hypertension (IPAH) is characterized by pulmonary vascular remodeling. We have reported that high-dose prostaglandin I2 (PGI2) therapy markedly improved hemodynamics in IPAH patients and that PGI2 induced apoptosis of pulmonary artery smooth muscle cells obtained from IPAH patients. PGI2 is thought to have reverse remodeling effects, although it has not been histologically confirmed. In a case series, we examined the reverse pulmonary vascular remodeling effects of PGI2 in lung tissues obtained from an IPAH patient treated with high-dose PGI2 and an IPAH patient not treated with PGI2. Apoptotic cells were detected in small pulmonary arteries of the IPAH patient treated with high-dose PGI2 but not in those from the IPAH patient not treated with PGI2. Media of peripheral pulmonary arteries were thick in the IPAH patient not treated with PGI2. On the other hand, media of peripheral pulmonary arteries were thin in the IPAH patient treated with high-dose PGI2. The single case report suggested that high-dose PGI2 therapy has the potential for reverse pulmonary vascular remodeling by induction of apoptosis and reduction of medial hypertrophy. Accumulation of cases is needed for the application to generalized effect of high-dose PGI2. <Learning objective: Reverse pulmonary vascular remodeling would provide further improvement in patients with IPAH. High-dose PGI2 therapy has the potential for reverse pulmonary vascular remodeling in patients with IPAH.
    Journal of Cardiology Cases 01/2014;
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    ABSTRACT: Objective Secreted frizzled-related protein 5 (SFRP5) is an anti-inflammatory adipokine that is associated with insulin resistance in animals. To extend these observations to humans, we investigated the association of serum SFRP5 levels in subjects with and without coronary artery disease (CAD). Methods Subjects (n = 185, 68 ± 11 years, 79% male) suspected of having CAD were enrolled in the study and were divided into two groups, CAD and non-CAD subjects, according to the results of their coronary angiographies. Serum SFRP5 levels of the subjects were measured by an enzyme-linked immunosorbent assay. Results The serum SFRP5 levels in the subjects with CAD were significantly lower than those in the non-CAD subjects (median [interquartile range]: 47.7 [26.6] vs. 52.4 [29.6] ng/mL, respectively; p = 0.02). The serum SFRP5 levels significantly correlated with body mass index, the homeostasis model of assessment of insulin resistance, adiponectin levels, and CAD severity. Multivariate logistic regression analysis revealed that a decreased serum SFRP5 level (log transformed) was independently associated with CAD for all subjects (adjusted odds ratio, 0.36; 95% confidence interval, 0.14–0.94; p = 0.03). Conclusion Serum SFRP5 levels are significantly associated with CAD in humans, suggesting that low SFRP5 levels may contribute to CAD.
    Atherosclerosis 01/2014; 233(2):454–459. · 3.71 Impact Factor
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    ABSTRACT: Objectives To determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). Background Fractional flow reserve (FFR) measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFRCT to non-invasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. Methods This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed prior to ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent Core Laboratory. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory. Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤0.80. Results The area under the receiver operating characteristic curve (95% CI) for FFRCT was 0.90 (0.87-0.94) versus 0.81 (0.76-0.87) for coronary CTA (p=0.0008). Per-patient sensitivity and specificity to identify myocardial ischemia were 86% (95% CI: 77%-92%) and 79% (72%-84%) for FFRCT versus 94% (86%-97%) and 34% (27%-41%) for coronary CTA, and 65% (53%-74%) and 83% (77%-83%) for ICA, respectively. In patients (n=235) with intermediate stenosis (30%-70%) the diagnostic accuracy of FFRCT remained high. Conclusions FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared to anatomic testing by coronary CTA, FFRCT leads to a marked increase in specificity. Clinical trial info NCT01757678
    Journal of the American College of Cardiology 01/2014; · 14.09 Impact Factor
  • Journal of Cardiology Cases. 01/2014;
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    ABSTRACT: Objectives This study aimed to determine the usefulness of the combination of several electrocardiographic (ECG) markers on risk assessment of ventricular fibrillation (VF) in patients with Brugada syndrome (BrS). Background Detection of high/low-risk BrS patients using a noninvasive method is an important issue in the clinical setting. Several ECG markers related to depolarization and repolarization abnormalities have been reported, but the relationship and usefulness of these parameters in VF events are unclear. Methods Baseline characteristics of 246 consecutive patients (236 males; mean age, 47.6±13.6 years) with Brugada type ECG, including 13 patients with a history of VF and 40 patients with a history of syncopal episodes, were retrospectively analyzed. During the mean follow-up period of 45.1 months, VF in 23 patients and sudden cardiac death (SCD) in one patient were observed. Clinical/genetic and electrocardiographic parameters were compared with VF/SCD events. Results By univariate analysis, history of VF, history of syncopal episodes, paroxysmal atrial fibrillation , spontaneous type 1 pattern in the precordial leads, ECG markers of depolarization abnormalities (PQ >200 ms, QRS duration ≥120 ms, and fragmented QRS [f-QRS]), and those of repolarization abnormalities (infero-lateral early repolarization [ER] pattern and QT prolongation) were associated with later cardiac events. By multivariable analysis, history of VF, history of syncopal episodes, infero-lateral ER pattern, f-QRS were independent predictors of documented VF and SCD (odds ratio, 19.61, 28.57, 2.87, and 5.21, respectively, P<0.05). Kaplan-Meier curves showed that the presence/absence of infero-lateral ER and f-QRS provided a worse/better prognosis (log-rank test, P<0.01). Conclusions The combination of depolarization and repolarization abnormalities in BrS is associated with later VF events. The combination of these abnormalities is useful for detecting high- and low-risk BrS patients.
    Journal of the American College of Cardiology 01/2014; · 14.09 Impact Factor

Publication Stats

3k Citations
1,113.06 Total Impact Points

Institutions

  • 2009–2014
    • Okayama University
      • Department of Cardiovascular Medicine
      Okayama, Okayama, Japan
    • Akita Red Cross Hospital
      Akita, Akita, Japan
  • 2005–2014
    • Akita University
      • • Department of Cardiovascular and Respiratory Medicine
      • • Faculty of Medicine
      Akita, Akita, Japan
  • 2013
    • Hiroshima City Hospital
      Hirosima, Hiroshima, Japan
  • 2011–2013
    • Kagawa Prefectural Central Hospital
      Takamatu, Kagawa, Japan
    • Fukaya Red Cross Hospital
      Fukaya, Saitama, Japan
    • Sakakibara Heart Institute
      Фучу, Tōkyō, Japan
    • Chibaken Saiseikai Narashino Hospital
      Tiba, Chiba, Japan
  • 2004–2013
    • Osaka City University
      • • Graduate School of Medicine
      • • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
  • 2012
    • Nagai Internal Medicine Clinic
      Okayama, Okayama, Japan
    • Hyogo College of Medicine
      • Department of Internal Medicine
      Nishinomiya, Hyogo-ken, Japan
  • 2005–2012
    • Akita University Hospital
      Akita, Akita, Japan
  • 2003–2012
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan
    • Musashino Red Cross Hospital
      Edo, Tōkyō, Japan
  • 2002–2012
    • Sakurabashi Watanabe Hospital
      Ōsaka, Ōsaka, Japan
  • 2008–2011
    • Juntendo University
      Edo, Tōkyō, Japan
  • 1995–2011
    • Tokyo Medical and Dental University
      • • Department of Cardiovascular Medicine
      • • Department of Internal Medicine
      Tokyo, Tokyo-to, Japan
  • 2010
    • Minami Okayama Medical Center
      Okayama, Okayama, Japan
  • 1998–2008
    • Chiba University
      • Graduate School of Medicine
      Chiba-shi, Chiba-ken, Japan
  • 2000–2006
    • Massachusetts General Hospital
      • Transplantation Biology Research Center
      Boston, MA, United States
    • Chiba University Hospital
      Tiba, Chiba, Japan
  • 1995–2006
    • Yamaguchi University
      • Graduate School of Medicine
      Yamaguti, Yamaguchi, Japan
  • 1997
    • Queen's University Belfast
      Béal Feirste, N Ireland, United Kingdom