Second mRNA Vaccination of COVID-19 in a Patient Who Developed Pericarditis after the First Vaccination.

The coronavirus infection 2019 (COVID-19) pandemic has led to the development of mRNA vaccines with proven efficacy. However, it remains unclear whether patients who developed pericarditis after the first COVID-19 mRNA would be fit to receive the second vaccination. Herein, we present the case of a 64-year-old man who visited our emergency department with substernal chest discomfort that began 4 days after his first mRNA COVID-19 vaccination. Acute pericarditis was diagnosed based on symptoms and ST-segment elevation on an electrocardiogram. Chest pain improved 2 days after treatment.Since there are no guidelines on whether to administer an additional vaccination to a patient who developed pericarditis after the initial vaccination, we considered whether or not to administer the additional vaccination. We informed the patient about the risks and benefits and decided to administer the second dose. He did not experience any major adverse reactions. The indications for the second vaccination need to be thoroughly considered.

Penetration rate of the placement of a drug-eluting stent for the treatment of superficial femoral artery lesions in Japan.

Stent placement for treating superficial femoral artery (SFA) lesions has been approved. The Zilver PTX stent, a drug-eluting stent (DES) for treating SFA lesions, has been available in Japan since 2012. However, the penetration rate of this DES has not yet been reported. This prospective multicenter registry study enrolled 314 patients (354 limbs) to be treated by stent placement in 2014 (UMIN000011551). The primary endpoint was the measurement of the penetration rate of the DES. The secondary endpoints were measuring the freedom from restenosis, freedom from target lesion revascularization (TLR), freedom from major adverse limb event (MALE), and the survival rate at 12 months postoperatively. Female patients comprised 28% participants. The mean age was 73.1 ± 9.2 years. A total of 56% patients had diabetes mellitus (DM), 36% patients were receiving hemodialysis, and 30% used cilostazol at baseline. The mean lesion length was 156 ± 101 mm, and the percentage of TASC II C/D lesions was 58%. Critical limb ischemia (CLI) was observed in 32% limbs. The penetration rates of the Zilver PTX stent were only 8%. The primary patency rate was similar between DES and bare-metal stents (BMS) at 12 months postoperatively (77 vs. 84%, p = 0.52). In this study, the rates of freedom from restenosis, freedom from TLR, freedom from MALE, and the survival rate at 12 months postoperatively were 83, 86, 85, and 89%, respectively. The penetration rate of a first-generation DES placement for treating SFA lesions is low in Japan. On the other hand, BMS is well utilized and its primary patency is acceptable.

Effects of liraglutide, a glucagon-like peptide-1 analog, on left ventricular remodeling assessed by cardiac magnetic resonance imaging in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

The clinical efficacy of glucagon-like peptide-1 (GLP-1) analogs in patients with acute myocardial infarction (AMI) is uncertain. The purpose of the present study was to evaluate the effects of the GLP-1 analog liraglutide on left ventricular (LV) remodeling in patients with AMI. We retrospectively evaluated the effects of liraglutide on LV remodeling assessed by cardiac magnetic resonance imaging (CMRI) in 15 patients with type 2 diabetes who were successfully treated with primary percutaneous coronary intervention (PCI) for AMI. Patients were divided into two groups based on their hypoglycemic medication: liraglutide use (group L; n = 6) or standard therapy (group S; n = 9). The CMRI findings in the early phase and at the 6-month follow-up were compared. At the 6-month follow-up, group S showed increases in LV end-diastolic (from 64 to 74 mL/m(2), p = 0.08) and end-systolic (from 38 to 45 mL/m(2), p = 0.13) volume indexes, whereas no such increase was observed in group L. The LV mass index (LVMI) was significantly smaller in group L than in group S at baseline (64 vs. 75 g/m(2), p = 0.05) and at follow-up (56 vs. 78 g/m(2), p = 0.009). Multivariate regression analysis showed that liraglutide use was an independent negative predictor of LVMI (ß = -0.720, p = 0.003). In conclusion, liraglutide may be able to prevent the progression of LV remodeling and is associated with a lower LV mass in diabetic patients with AMI undergoing primary PCI.

Frequency and predictors of bleeding complications associated with anti-coagulant therapy using dabigatran in Japanese patients with atrial fibrillation.

BACKGROUND: Few data exist regarding frequency and predictors of bleeding complications associated with anticoagulant therapy using dabigatran in Japanese patients with atrial fibrillation (AF). METHODS AND RESULTS: We retrospectively studied 184 patients with AF who were administered dabigatran from April 2011 to August 2012 in our institution. Twenty-eight patients (15%) developed some type of bleeding complication. In the Bleeding group, age, CHADS2 and HAS-BLED score were higher (75 vs. 71 years, p=0.067, 2.7 vs. 1.9, p=0.006 and 2.3 vs. 1.8, p=0.01, respectively), hemoglobin concentration was lower (13.1 vs. 13.7 g/dL, p=0.04), casual activated partial thromboplastin time (APTT) was longer (60.2 vs. 47.4 sec., p<0.0001) and frequency of aspirin use was higher (29 vs. 15%, p=0.09) than those in the Non-bleeding group. Multivariate regression analysis showed that casual APTT was an independent significant predictor of any type of bleeding complications (ß=0.431, p<0.0001). Moreover, casual APTT (ß=0.359, p=0.049), pre-existing anemia (ß=0.457, p=0.02) and aspirin use (ß=0.597, p=0.02) were significant predictors of major bleeding. ROC analysis showed that casual APTT exhibited 83.3% sensitivity and 72.5% specificity as predictors of major bleeding and its cut-off value was 54.7 sec. CONCLUSION: Casual APTT level can serve as a predictor of bleeding complications, while pre-existing anemia and aspirin use may be associated with major bleeding in patients with AF treated with dabigatran.

Elevation of urinary liver-type fatty acid-binding protein as predicting factor for occurrence of contrast-induced acute kidney injury and its reduction by hemodiafiltration with blood suction from right atrium.

Although contrast-induced acute kidney injury (CI-AKI) has a great impact on patients' prognosis, few data exist regarding predictors of CI-AKI in patients with severe renal dysfunction who have undergone contrast angiography. Therefore, we prospectively studied 25 patients with renal dysfunction, which was defined as the estimated glomerular filtration rate (eGFR) level <45 ml/min/1.73 m(2), undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). We performed hemodiafiltration with blood suction from the right atrium (RA-HDF). The mean level of urinary liver-type fatty acid-binding protein (L-FABP) at baseline was significantly higher in the CI-AKI group than in the non-CI-AKI group (59.8 ± 45.6 vs 13.4 ± 11.9 µg/gCr, P = 0.0003). Multivariate regression analysis demonstrated that baseline urinary L-FABP was an independent significant predictor of CI-AKI (ß = 0.741, P = 0.013). Receiver-operating characteristic analysis showed that baseline urinary L-FABP exhibited 100 % sensitivity and 81.8 % specificity for predicting CI-AKI when the cutoff value was defined as 19.0 µg/gCr. Interestingly, the incidence of CI-AKI after CAG or PCI was reduced in the RA-HDF group in a comparison with 41 control patients (12 % vs 27 %) with eGFR level <45 ml/min/1.73 m(2) who underwent PCI before the introduction of RA-HDF. In conclusion, baseline L-FABP levels can be a predictor for occurrence of CI-AKI. We suggest that RA-HDF may prevent the development of CI-AKI in patients with severe renal dysfunction undergoing coronary procedures, although further large-scale prospective study is necessary to confirm our conclusions.

Pulmonary embolism caused by intimal sarcoma of the pulmonary artery.

We herein report the case of a 39-year-old woman with a pulmonary embolism caused by intimal sarcoma of the pulmonary artery. She presented with shortness of breath and leg edema. Computed tomography showed a low density area that extended from the main pulmonary artery to the bilateral pulmonary arteries. We diagnosed her to have a pulmonary thromboembolism. The thrombosis did not decrease after the administration of anti-coagulant therapy, and she underwent resection of the thrombotic tissue. Histopathologically, the surgical specimen was not found to be thrombotic tissue but rather an intimal sarcoma of the pulmonary artery. After undergoing surgery, she received radiation therapy and chemotherapy; however, she died 31 months after being diagnosed.

Impact of SYNTAX score on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention for unprotected left main coronary artery.

SYNTAX score is an angiographic scoring system that was developed to quantify the number, complexity, and location of lesions in patients undergoing coronary revascularization. Up to now, the impact of SYNTAX score on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) lesions has not been fully examined. Therefore, we evaluate the usefulness of the SYNTAX score and identify the cutoff value of this score to predict 1-year clinical outcomes in patients undergoing PCI for unprotected LMCA lesions. This was a single-center retrospective study that included 49 consecutive patients undergoing elective PCI for unprotected LMCA lesions. We calculated the SYNTAX score and examined the correlations between this score and 1-year clinical outcomes. Major adverse cardiac events (MACE) occurred in 12 patients (24%): target lesion revascularization in 9 patients (18%), myocardial infarction in 2 (4%), and cardiac death in 1 (2%). The frequency of MACE was significantly higher in the intermediate (47%) or high score group (50%) than in the low score group (4%). Furthermore, the SYNTAX score was significantly higher in the MACE group than in the non-MACE group (31 vs. 22, p = 0.008). Receiver-operating characteristic curve showed that the SYNTAX score exhibited 83% sensitivity and 76% specificity for predicting the development of MACE at a cutoff value 26. These results demonstrate that the SYNTAX score could be a useful tool to predict 1-year clinical outcomes in patients undergoing elective PCI for unprotected LMCA lesions.

Contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy developing after elective percutaneous coronary intervention.

BACKGROUND: Contrast-induced nephropathy (CIN) has been recognized as a serious complication of diagnostic coronary angiography and percutaneous coronary intervention (PCI), and has been associated with prolonged hospitalization and adverse clinical outcomes. A key step to minimize the risk for developing CIN is to identify patients at risk for CIN. METHODS AND RESULTS: We retrospectively investigated clinical factors associated with the development of CIN in 60 stable angina patients who had undergone elective PCI. The frequency of CIN was 13% (8/60). There were neither any significant differences in age, gender, baseline serum creatinine or hemoglobin levels, nor in the rate of diabetes mellitus between the CIN and the non-CIN group. However, the estimated glomerular filtration rate (eGFR) was significantly lower (40.4+/-11.4 mL/min/1.73 m(2) vs. 57.4+/-22.6 mL/min/1.73 m(2), p=0.044), and number of treated vessels (1.5+/-0.8 vs. 1.2+/-0.4, p=0.039) and stents used (2.1+/-0.6 vs. 1.4+/-0.6, p=0.007) were significantly higher in the CIN group. In addition, the amount of contrast medium was significantly larger (272+/-37 mL vs. 201+/-62 mL, p=0.003) and the contrast medium volume (CMV) to eGFR ratio (CMV/eGFR) was significantly greater (7.4+/-2.9 vs. 4.0+/-2.0, p=0.0001) in the CIN group. Stepwise regression analysis showed that the CMV/eGFR ratio was a significant independent predictor of CIN (p=0.035). At a cut-off point of >5.1, the CMV/eGFR ratio exhibited 87.5% sensitivity and 74.5% specificity for detecting CIN. CONCLUSION: The CMV/eGFR ratio could be a useful predictor of CIN developing after elective PCI.

Small dense low-density lipoprotein cholesterol is a useful marker of metabolic syndrome in patients with coronary artery disease.

AIM: An evaluation of the relation between small dense low-density lipoprotein cholesterol (sd-LDL-C) levels measured by the heparin-magnesium precipitation method and metabolic syndrome (MetS). METHODS: We have prospectively measured sd-LDL-C levels by the heparin-magnesium precipitation method in 112 Japanese patients (male/female=80/32) with coronary artery disease (CAD) who received percutaneous coronary intervention (PCI). Patients were diagnosed with MetS according to modified Japanese criteria. RESULTS: A total of 36 patients (32%) met the criteria for MetS. Sd-LDL-C levels were significantly higher in the MetS group than non-MetS group (20.7 +/- 1.5 mg/dL vs. 17.1 +/- 1.0 mg/dL, p=0.042), especially among patients without lipid-lowering therapy (26.4 +/- 2.6 mg/dL vs. 17.5 +/- 1.5 mg/dL, p= 0.0034). Sd-LDL-C levels gradually increased with the number of components used to define MetS (0; 14.5 +/- 1.8 mg/dL, 1; 16.5 +/- 1.8 mg/dL, 2; 16.7 +/- 1.3 mg/dL, 3; 19.3 +/- 1.7 mg/dL, 4; 23.1 +/- 2.1 mg/dL, 5; 40.0 mg/dL, p=0.0071). High-sensitivity C-reactive protein (hs-CRP) levels were significantly higher in the patients with MetS (1.09 +/- 0.17 mg/L vs. 0.67 +/- 0.09 mg/L, p=0.0204). CONCLUSION: The sd-LDL-C level measured by the heparin-magnesium precipitation method is a useful marker of MetS in Japanese patients with CAD.

T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion.

BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) associated with a deletion of lysine 183 (K183del) in the cardiac troponin I (cTnI) gene suffer sudden cardiac death at all ages. However, the correlation between QT variables and sudden cardiac death in these patients remains uncertain. HYPOTHESIS: We evaluated the correlation between QT variables and sudden cardiac death and/or ventricular tachyarrhythmia (SCD/VT) in patients with HCM associated with the cTnI mutation. METHODS: We analyzed 10 probands with HCM associated with the cTnI gene K183del and their family members. The subjects were divided into three groups: Group A (n = 7), mutation carriers with SCD/VT; Group B (n = 16), mutation carriers without SCD/VT; Group C (n = 24), no mutation carriers. QT intervals were corrected using Bazett's formula. RESULTS: Maximum QTc and corrected QT dispersion were significantly longer in Groups A and B than in Group C. However, there were no differences in either parameter between Groups A and B. On the contrary, the peak-to-end interval of T wave/QT interval in V5 (Tpe) in Group A was significantly longer than that in Groups B and C. Logistic regression analysis revealed that Tpe was a good clinical predictor for SCD/VT in patients with HCM in this study. CONCLUSIONS: These results suggest that Tpe rather than QT dispersion may be one of the best predictors for SCD/VT in patients with HCM associated with the K183del mutation in the cTnI gene.

Septal wall thinning and systolic dysfunction in patients with hypertrophic cardiomyopathy caused by a cardiac troponin I gene mutation.

BACKGROUND: Lysine 183 deletion in the cardiac troponin I gene is 1 of the mutations that causes hypertrophic cardiomyopathy (HCM). However, the clinical course and determinants of poor prognosis in patients with this mutation have not been well established. METHODS AND RESULTS: We analyzed 10 probands with HCM caused by this mutation and their family members. Forty-six of these 79 subjects were found to be carriers, and 33 were non-carriers. All non-carriers had a percent fractional shortening (%FS) of >25% at all ages. By contrast, 7 of 24 carriers >40 years of age had a %FS of <25%, and no carriers <40 years of age had a %FS of <25%. The change in interventricular septal thickness and the change in %FS were significantly correlated (R = 0.758; P =.0017). CONCLUSION: These results suggest that about 30% of patients with HCM caused by a lysine 183 deletion mutation in the cardiac troponin I gene have systolic dysfunction develop after 40 years of age, and that patients with this mutation whose interventricular septal thickness shows a serial decrease should be followed-up closely for development of systolic dysfunction.