Publications by authors named "Hiroyuki Iwano"

Article Synopsis
  • A 59-year-old female with multiple myeloma developed symptoms of edema and dyspnea after starting treatment with carfilzomib, a cancer drug, which raised concerns about potential drug-related cardiac complications.
  • Diagnostic tests revealed signs of pre-capillary pulmonary hypertension (PH) and confirmed it through right heart catheterization, leading to the conclusion that carfilzomib was causing the condition.
  • After stopping the drug and starting pulmonary vasodilator therapy, the patient experienced symptom improvement and heart changes, suggesting the need for careful monitoring for PH in patients receiving carfilzomib.
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  • Accurate assessment of left ventricular filling pressure in patients with atrial fibrillation is challenging, but a new scoring system called VMT score can visually assess valve opening timings to evaluate this pressure.
  • In a study with 119 patients, the VMT score showed a strong correlation with elevated pulmonary arterial wedge pressure and had a diagnostic accuracy of 87%, outperforming traditional Doppler methods.
  • The findings were validated in a separate group of 189 patients, confirming that a VMT score of 2 or higher indicates significant left ventricular filling pressure elevation, making it a potentially valuable tool in clinical settings.
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Background: In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).

Methods And Results: A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.

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  • * The research highlights how these nanosheets can form unique superstructured mesophases through tunable interactions, overcoming challenges posed by size variability in previous materials.
  • * Various microscopy techniques were used to demonstrate the reversible nature of these mesophases, which can be controlled by factors like counter cations, nanosheet concentration, solvent choice, and temperature.
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  • - The study aimed to assess which Doppler profile (hepatic vein systolic filling fraction or SVC peak systolic/diastolic ratio) better indicated elevated right atrial pressure (RAP) in patients with cardiovascular diseases.
  • - It involved 193 patients, measuring Doppler profiles alongside cardiac catheterization, revealing that both profiles inversely correlated with RAP; however, SVC-S/D provided significantly better diagnostic accuracy than HV-SFF.
  • - Findings indicate that SVC-S/D is a more reliable measure for diagnosing elevated RAP compared to HV-SFF, with SVC-S/D showing additional diagnostic value beyond estimated RAP from inferior vena cava morphology.
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In recent years, bedside ultrasound examinations have been used in many clinical departments and are called point-of-care ultrasound (POCUS). Regarding POCUS in the cardiac field, a protocol called focus (focused) cardiac ultrasound (FoCUS) has been developed in Europe and the United States, is being used clinically, and an educational syllabus has been created. According to them, FoCUS is defined as a point-of-care cardiac ultrasound examination using standardized limited sections and protocols.

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Background: The assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently-proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score.

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Infective endocarditis (IE) is a life-threatening disease that affects the endocardial surface of the heart. Although heart valves are commonly involved in IE, in rare cases, vegetation is attached to the cardiac walls without valvular endocardial involvement, which is referred to as mural IE. In this case, a 60-year-old female presented with a seven-day history of fever associated with worsening pain in the right shoulder and left hip.

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Article Synopsis
  • Infective endocarditis (IE) is a severe condition with high mortality rates if not diagnosed and treated quickly, but studies on in-hospital death rates related to lab findings and causative organisms are limited.
  • A study analyzed 162 patients from 2009 to 2021, confirming IE with transesophageal echocardiography and focusing on factors associated with in-hospital death.
  • Significant findings indicated that lower hemoglobin levels, higher white blood cell counts, lower eGFR, and the presence of Staphylococcus as the causative agent were key predictors of higher in-hospital mortality risk in IE patients.
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Right ventricular (RV) diastolic stiffness is an independent predictor of survival and is strongly associated with disease severity in patients with precapillary pulmonary hypertension (PH). Therefore, a fully validated echocardiographic method for assessing RV diastolic stiffness needs to be established. This study aimed to compare echocardiography-derived RV diastolic stiffness and invasively measured pressure-volume loop-derived RV diastolic stiffness in patients with precapillary PH.

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The Forrester classification plays a crucial role in comprehending the underlying pathophysiology of heart failure (HF) and is employed to categorize the severity and predict the outcomes of patients with acute HF. Our objective was to assess the predictive value of the Forrester classification, based on noninvasive hemodynamic measurements obtained through Doppler echocardiography at admission, in forecasting the short-term prognosis posthospitalization of patients with acute HF. Patients were recruited for the Prospect trial to elucidate the utility of EchocarDIography-based Cardiac ouTput in acute heart failure (PREDICT) study, a multicenter, prospective study conducted in Japan.

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  • The study examines the clinical outcomes and left ventricular (LV) function recovery after transcatheter aortic valve implantation (TAVI) in patients with low-gradient (LG) aortic stenosis (AS), highlighting ongoing controversies in the prognostic implications of TAVI in these patients.
  • It involved a retrospective analysis of 1,742 patients, finding that LG AS was linked to worse outcomes and lower improvements in LV function compared to high-gradient (HG) AS, with 13% having reduced ejection fraction.
  • The research suggests that careful assessment of AS severity is crucial for optimal timing and management of TAVI in patients with LG AS, as they experienced higher rates of cardiovascular death and rehospitalization.
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Background: Although global longitudinal strain (GLS) is recognized as a sensitive marker of intrinsic left ventricular (LV) dysfunction, its afterload dependency has also been pointed. We hypothesized that decrease in GLS during handgrip exercise could be more sensitive marker of intrinsic myocardial dysfunction.

Methods: Handgrip exercise-stress echocardiography was performed in 90 cardiovascular disease patients with preserved LV ejection fraction.

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Background: Dyspnea is a common symptom in acute heart failure (AHF) patients. Although an accurate and rapid diagnosis of AHF is essential to improve prognosis, estimation of left ventricular (LV) filling pressure (FP) remains challenging, especially for noncardiologists. We evaluated the usefulness of a recently-proposed parameter of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, to detect AHF in patients complaining of dyspnea.

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We herein report the first case of constrictive pericarditis (CP) induced by long-term pergolide treatment for Parkinson's disease that was assessed using multimodal imaging in a 72-year-old patient with leg edema and dyspnea. The patient was correctly diagnosed with CP using multimodal imaging and successfully treated with pericardiectomy. The treatment history of Parkinson's disease and pathological findings of the removed pericardium suggested that long-term pergolide was the cause of CP.

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Background: Accurate detection of significant pulmonary regurgitation (PR) is critical in management of patients after right ventricular (RV) outflow reconstruction in Tetralogy of Fallot (TOF) patients, because of its influence on adverse outcomes. Although pressure half time (PHT) of PR velocity is one of the widely used echocardiographic markers of the severity, shortened PHT is suggested to be seen in conditions with increased RV stiffness with mild PR. However, little has been reported about the exact characteristics of patients showing discrepancy between PHT and PR volume in this population.

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Purpose: This study investigated the novel non-invasive left atrial (LA) stiffness parameter using pulmonary venous (PV) flow measurements and the clinical usefulness of the novel LA stiffness parameter.

Methods: We retrospectively analyzed 237 patients who underwent right heart catheterization and echocardiography less than one week apart. From the pulmonary artery wedge pressure waveform, the difference between x-descent and v-wave (ΔP) was measured.

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Background: Although left ventricular (LV) cardiac power output (CPO) is a powerful prognostic indicator in heart failure (HF), the significance of right ventricular (RV) CPO is unknown. In contrast, RV pulsatile load is a key prognostic marker in HF. We investigated the impact of RV-CPO and pulsatile load on cardiac outcome and the prognostic performance of the combined systemic and pulmonary circulation parameters in HF.

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  • * The patient presented with elevated plasma D-dimer levels and mobile masses on the TV, leading to moderate to severe regurgitation; initial treatment with heparin improved her condition.
  • * The interruption of heparin supply due to COVID-19 resulted in a worsening of her condition, but resuming heparin therapy led to significant improvement, highlighting the need for awareness of NBTE in cancer patients.
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