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1.
Am J Cardiol ; 2024 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-38936788

RESUMEN

BACKGROUND: Some patients with atrial fibrillation (AF), albeit less frequently, may regress from sustained to paroxysmal type. OBJECTIVES: We sought to investigate how the regression of AF is associated with outcomes. METHODS: Among the AF patients enrolled in the Fushimi AF Registry who were identified as having sustained AF at baseline, conversion of sustained to paroxysmal AF during follow-up was defined as AF regression. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death, myocardial infarction, ischemic stroke, systemic embolism, or hospitalization due to heart failure. RESULTS: Among 2,261 patients with sustained AF at baseline, AF regression was observed in 214 (9.5%) patients over a median follow-up period of 5.8 years (1.78% per patient-year). The annual incidence of MACE in patients with AF regression was significantly lower than those without (3.47% vs. 6.59% per patient-year, P < 0.001; adjusted hazard ratio [HR], 0.53, 95% confidence interval [CI], 0.38-0.72). Furthermore, AF regression was significantly associated with reduced risk of MACE during and after the regression period from sustained to paroxysmal forms (during regression period: adjusted HR, 0.45; 95% CI, 0.22-0.90; after regression period: adjusted HR, 0.43; 95% CI, 0.26-0.67). The incidence of MACE was comparable between spontaneous regression (35/178: 19.7%) and therapy-associated regression (either receiving catheter ablation or antiarrhythmic drugs before the regression) (7/36: 19.4%) (P=0.98). CONCLUSION: Regression of AF was associated with a lower incidence of adverse cardiovascular events. The risk of adverse events decreased significantly during the regression period and its reduction level persisted after regression. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000005834.

2.
Eur Heart J Open ; 4(2): oeae015, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38487366

RESUMEN

Aims: Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little is known regarding the risk stratification for incident HF in AF patients, especially with preserved left ventricular ejection fraction (LVEF). Methods and results: The Fushimi AF Registry is a community-based prospective survey of AF patients. From the registry, 3002 non-valvular AF patients with preserved LVEF and with the data of antero-posterior left atrial diameter (LAD) at enrolment were investigated. Patients were stratified by LAD (<40, 40-44, 45-49, and ≥50 mm) with backgrounds and HF hospitalization incidences compared between groups. Of 3002 patients [mean age, 73.5 ± 10.7 years; women, 1226 (41%); paroxysmal AF, 1579 (53%); and mean CHA2DS2-VASc score, 3.3 ± 1.7], the mean LAD was 43 ± 8 mm. Patients with larger LAD were older and less often paroxysmal AF, with a higher CHA2DS2-VASc score (all P < 0.001). Heart failure hospitalization occurred in 412 patients during the median follow-up period of 6.0 years. Larger LAD was independently associated with a higher HF hospitalization risk [LAD ≥ 50 mm: hazard ratio (HR), 2.36; 95% confidence interval (CI), 1.75-3.18; LAD 45-49 mm: HR, 1.84; 95% CI, 1.37-2.46; and LAD 40-44 mm: HR, 1.34; 95% CI, 1.01-1.78, compared with LAD < 40 mm) after adjustment by age, sex, AF type, and CHA2DS2-VASc score. These results were also consistent across major subgroups, showing no significant interaction. Conclusion: Left atrial diameter is significantly associated with the risk of incident HF in AF patients with preserved LVEF, suggesting the utility of LAD regarding HF risk stratification for these patients.

3.
Eur Geriatr Med ; 15(2): 371-380, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38353911

RESUMEN

PURPOSE: This study aimed to investigate the effects of a self-monitoring intervention to promote an increase in physical activity, as measured by step count, and reduce sedentary behavior in older people covered by the long-term care insurance system (LTCI) in Japan. METHODS: This was a randomized controlled trial conducted at a daycare center from October 2022 to January 2023. Fifty-two older adults with LTCI who were able to walk with or without aids were assigned to an intervention (n = 26) group and control (n = 26) group. During the 5-week follow-up period, the intervention group received education on physical activity and self-monitoring such as goal setting, self-management and feedback. The primary outcome was step count, and the secondary outcome was sedentary behavior. RESULTS: Participants who completed the study to the end of the 5-week follow-up and drop-out participants for whom outcome data were available were included in the final analysis of 57 participants, n = 24 (79.8 ± 8.8 years, male 25.5%) in the intervention group and n = 23 (82.5 ± 8.5 years, male 39.1%) in the control group. Comparisons between the two groups at baseline showed no significant differences. In the results of a two-way mixed analysis of variance (ANOVA) including 2 (group: control, intervention) × 2 (term: baseline, 5-week follow-up) factors, an interaction was observed in the number of steps, sedentary behavior, and light physical activity (p < 0.05). CONCLUSION: Self-monitoring of physical activity using an accelerometer may be effective in increasing the number of steps and light physical activity and in reducing sedentary behavior in older people with LTCI. CLINICAL TRIAL REGISTRATION: UMIN000052044, registered on 2023/08/29.


Asunto(s)
Ejercicio Físico , Seguro de Cuidados a Largo Plazo , Anciano , Humanos , Masculino , Acelerometría , Japón , Caminata , Femenino , Anciano de 80 o más Años
4.
Eur Heart J Qual Care Clin Outcomes ; 10(3): 193-202, 2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38236704

RESUMEN

AIMS: Atrial fibrillation (AF) type (paroxysmal, persistent, or permanent) is important in determining therapeutic management; however, clinical outcomes by AF type are largely unknown for hospitalized patients with heart failure (HF). METHODS AND RESULTS: The Japanese Registry Of Acute Decompensated Heart Failure is a retrospective, multicenter, and nationwide registry of patients hospitalized for acute HF in Japan. Follow-up data were collected up to 5 years after hospitalization. Patients were divided based on diagnosis and AF type into 3 groups [without AF, paroxysmal AF, and sustained AF (defined as a composite of persistent and permanent AF)], and compared the backgrounds and outcomes between the groups. Of 12 895 hospitalized HF patients [mean age: 78 ± 13 years, female: 6077 (47%), and mean left ventricular ejection fraction: 47 ± 17%], 1725 had paroxysmal AF, and 3672 had sustained AF. Compared with patients without AF, sustained AF had a higher risk of the primary composite endpoint of cardiovascular (CV) death or HF hospitalization [hazard ratio (HR): 1.09, 95% confidence interval (CI): 1.01-1.17; P = 0.03], mainly driven by HF hospitalization [HR: 1.16, 95% CI: 1.06-1.26; P < 0.001], whereas the corresponding risk for the primary endpoint in patients with paroxysmal AF was not elevated (HR: 1.03, 95% CI: 0.94-1.13; P = 0.53) after adjustment by multivariable Cox regression analysis. These results were consistent among the subgroups of patients with reduced or preserved ejection fraction (interaction P = 0.74). CONCLUSION: Among hospitalized patients with HF, sustained AF, but not paroxysmal AF, was significantly associated with a higher risk for CV death or HF hospitalization, indicating the importance of accounting for AF type in HF patients.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Hospitalización , Sistema de Registros , Humanos , Fibrilación Atrial/complicaciones , Femenino , Insuficiencia Cardíaca/fisiopatología , Masculino , Anciano , Estudios Retrospectivos , Japón/epidemiología , Estudios de Seguimiento , Factores de Tiempo , Volumen Sistólico/fisiología , Tasa de Supervivencia/tendencias , Pronóstico , Anciano de 80 o más Años
5.
Healthcare (Basel) ; 11(18)2023 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-37761755

RESUMEN

(1) Background: This study examined the differences in changes in physical function with and without falls after daycare use among frail older adults with long-term care insurance (LTCI). (2) Methods: In this retrospective cohort study, 82 of 96 consecutive daycare center users met the inclusion criteria. The participants were divided into two groups based on the presence or absence of falls 6-12 months after use. Participant characteristics in the fall and non-fall groups and physical function at baseline and six months in each group were compared. Using analysis of covariance, we analyzed physical function and its changes between the two groups, and cut-off values were calculated using receiver operating characteristic curves. (3) Results: Gait speed, timed up-and-go test, and 30 s chair stand test (CS30) improved significantly over six months in the no-fall group (n = 70) and all participants (n = 82) (p < 0.01). Gait speed in the fall group (n = 12) improved significantly over six months (p = 0.04). The fall group had significantly lower adjusted ΔCS30 scores than the no-fall group (p = 0.03), with a cutoff value of 2 (p = 0.024). (4) Conclusions: In older adults with LTCI, physical function with and without falls after daycare use differed by ΔCS30, with a cutoff value of 2.

6.
Circ J ; 87(12): 1730-1739, 2023 11 24.
Artículo en Inglés | MEDLINE | ID: mdl-37743520

RESUMEN

BACKGROUND: This study assessed the prognostic importance of B-type natriuretic peptide (BNP) concentrations for clinical events after catheter ablation for atrial fibrillation (AF).Methods and Results: We enrolled 1,750 consecutive patients undergoing initial AF ablation whose baseline BNP data were available from a large-scale multicenter observational cohort (TRANQUILIZE-AF Registry). The prognostic impact of BNP concentration on clinical outcomes, including recurrent tachyarrhythmias and a composite of heart failure (HF) hospitalization or cardiac death, was evaluated. Median baseline BNP was 94.2 pg/mL. During a median follow-up of 2.4 years, low BNP (<38.3 pg/mL) was associated with lower rates of recurrent atrial tachyarrhythmias than BNP concentrations ≥38.3 pg/mL (19.9% vs. 30.6% at 3 years; P<0.001) and HF (0.8% vs. 5.3% at 3 years; P<0.001). Multivariable Cox regression analyses revealed that low BNP was independently associated with lower risks of arrhythmia recurrence (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.47-0.82; P<0.001) and HF (HR 0.17; 95% CI 0.04-0.71; P=0.002). The favorable impact of low BNP on arrhythmia recurrence was prominent in patients with paroxysmal, but not non-paroxysmal, AF, particularly among those with long-standing AF. CONCLUSIONS: Low BNP concentrations had a favorable impact on clinical outcomes after AF ablation. The heterogeneous impact of baseline BNP concentrations on arrhythmia recurrence for the subgroups of patients divided by AF type warrants future larger studies with longer follow-up periods.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Insuficiencia Cardíaca , Humanos , Pronóstico , Fibrilación Atrial/cirugía , Péptido Natriurético Encefálico , Resultado del Tratamiento , Biomarcadores , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Insuficiencia Cardíaca/cirugía , Taquicardia , Recurrencia
7.
J Phys Ther Sci ; 35(5): 326-329, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37131354

RESUMEN

[Purpose] This study aimed to clarify whether collaborative learning could be promoted via information and communication technology education using tablets at college of physical therapy. [Participants and Methods] An online survey was conducted to evaluate collaborative learning among 81 first-year students at the Department of Physical Therapy actively using tablets in classes (six specific categories). [Results] The Friedman test had significant results, and a significant primary effect was observed between each questionnaire item. Following this, the Bonferroni test was performed for multiple comparisons, with significant differences were observed among certain items. [Conclusion] We reported employing tablets in the classroom positively impacted collaborative learning. Here, among the evaluations of collaborative learning, the items with the best results corresponded mainly to communication activation between students.

8.
Eur Heart J Qual Care Clin Outcomes ; 9(8): 758-767, 2023 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-36611235

RESUMEN

AIMS: Previous studies have shown that proteinuria is independently associated with the incidence of atrial fibrillation (AF), and is also associated with the incidence of cardiovascular events such as stroke and thromboembolism in patients with AF. However, the association of proteinuria with heart failure (HF) events in patients with AF remains unclear. METHODS AND RESULTS: The Fushimi AF Registry is a community-based prospective study of patients with AF. Of the entire cohort of 4489 patients, 2164 patients had available data of proteinuria. We compared the clinical background and outcomes between patients with proteinuria (n = 606, 28.0%) and those without (n = 1558, 72.0%). Patients with proteinuria were older and had a higher prevalence of major co-morbidities. During the median follow-up of 5.0 years, the incidence rates of HF events (composite of cardiac death or HF hospitalization) were higher in patients with proteinuria than those without (4.1% vs. 2.1% person-year, P < 0.01). Multivariate analyses revealed that proteinuria was an independent risk factor of the incidence of HF events [adjusted hazard ratio (HR): 1.40, 95% confidence interval (CI): 1.13-1.74]. This association was consistent among the various subgroups, except for the age subgroup in which there was a significant interaction (P < 0.01) between younger (<75 years) (unadjusted HR: 3.03, 95% CI: 2.12-4.34) and older (≥75 years) patients (unadjusted HR: 1.59, 95% CI: 1.23-2.05). CONCLUSION: Our community-based large prospective cohort suggests that proteinuria is independently associated with the incidence of HF events in Japanese patients with AF.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Humanos , Recién Nacido , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Estudios Prospectivos , Sistema de Registros , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Proteinuria/epidemiología , Proteinuria/complicaciones
9.
J Interv Card Electrophysiol ; 66(6): 1441-1453, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36510108

RESUMEN

BACKGROUND: Atrial fibrillation (AF) plays the main role in atrial functional tricuspid regurgitation (TR). However, the effectiveness of catheter ablation (CA) for atrial functional TR together with the mechanisms of improvement of atrial functional TR have not been fully evaluated. METHODS: We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Kyoto University Hospital, Kyoto, Japan. The current study population consisted of 2331 patients with available transthoracic echocardiographic (TTE) data before CA (2110 patients without significant TR and 221 patients with significant TR). Among the 221 patients with significant TR, there were 64 patients with functional TR and follow-up TTE at 6-18 months after CA for AF, in whom we compared echocardiographic parameters from baseline to follow-up. RESULTS: Patients with significant TR were older, and more often women, and had more persistent AF than those without significant TR. Among the 64 patients with functional TR, TR severity and TR jet area significantly improved at follow-up (TR jet area: 5.8 [4.0-7.6] cm2 to 2.1 [1.1-3.1] cm2, P < 0.001). Moreover, mitral regurgitation jet area, left atrial area, mitral valve diameter, right ventricular end-diastolic area, right atrial area, and tricuspid valve diameter decreased at follow-up. CONCLUSIONS: TR severity and jet area improved after CA in patients with AF and significant TR. The improvement of TR might be associated with reverse remodeling of the right heart.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Insuficiencia de la Válvula Tricúspide , Humanos , Femenino , Insuficiencia de la Válvula Tricúspide/complicaciones , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/cirugía , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Estudios Retrospectivos , Válvula Tricúspide/cirugía
11.
PLoS One ; 17(12): e0279178, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36520956

RESUMEN

BACKGROUND: Catheter ablation for asymptomatic atrial fibrillation (AF) remains controversial. The aim of the present study was to explore the prognostic impact of catheter ablation in asymptomatic AF patients. METHODS: We performed a post-hoc analysis of 537 risk-matched pairs of AF patients receiving first-time catheter ablation or conservative management. The primary outcome measure was a composite of cardiovascular death, heart failure (HF) hospitalization, ischemic stroke, or major bleeding. The study patients were divided into asymptomatic and symptomatic patients, and were further divided according to the presence or absence of previous AF-related complications (ischemic stroke or HF hospitalization). RESULTS: Most baseline characteristics were well balanced between the catheter ablation versus conservative management groups. The median follow-up period was 5.3 years. Catheter ablation as compared to conservative management was associated with significantly lower incidence of the primary outcome measure in the asymptomatic AF patients (14.7% versus 25.4% at 8-year, log-rank P = 0.008). However, the advantage of catheter ablation was significant only in the high-risk subset of patients with the previous AF-related complications (19.2% versus 55.6% at 8-year, log-rank P = 0.006), but not in those without (13.9% and 17.3%, P = 0.08). On the other hand, among the symptomatic AF patients, catheter ablation was associated with significantly lower incidence of the primary outcome measure regardless of the previous AF-related complications. CONCLUSIONS: In the post-hoc analysis of the matched AF cohort, catheter ablation as compared with conservative management was associated with better long-term clinical outcomes among asymptomatic AF patients only when the previous AF-related complications were present.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Insuficiencia Cardíaca , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Pronóstico , Accidente Cerebrovascular/epidemiología , Factores de Riesgo , Resultado del Tratamiento , Factores de Tiempo , Ablación por Catéter/efectos adversos , Accidente Cerebrovascular Isquémico/complicaciones
12.
J Cardiol Cases ; 26(1): 32-34, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35923533

RESUMEN

Infective endocarditis (IE) is not a common disease, but it remains a serious condition. Antineutrophil cytoplasmic antibodies (ANCA) are often positive in IE, and discrimination between IE and ANCA-associated vasculitis is important because misdirected selection of therapy can lead to catastrophic consequences. We report a case of IE mimicking ANCA-associated vasculitis in which we were able to make a correct diagnosis and perform treatment. This case suggests that it is important to consider IE as a differential diagnosis in ANCA-positive patients. Learning objective: Antineutrophil cytoplasmic antibodies (ANCA) are associated with primary systemic vasculitis. However, ANCA have also been described in other conditions and infective endocarditis (IE) was considered an important cause of ANCA.Discrimination between IE and ANCA-associated vasculitis is important, although it is sometimes difficult. We report a case of IE mimicking ANCA-associated vasculitis. ANCA-positive patients with nonspecific symptoms should be suspected of having IE, checked for heart murmurs, and tested by echocardiography and blood cultures.

13.
Circ J ; 86(8): 1252-1262, 2022 07 25.
Artículo en Inglés | MEDLINE | ID: mdl-35786691

RESUMEN

BACKGROUND: Atrial fibrillation (AF) patients often have concomitant coronary artery disease (CAD); however, there are little data on clinical characteristics and outcomes of such patients in daily clinical practice in Japan.Methods and Results: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available for 4,464 patients, and the median follow up was 5.1 (interquartile range: 2.3-8.0) years. History of CAD was present in 647 patients (14%); of those patients, 267 (41%) had history of myocardial infarction (MI). Patients with CAD were older and had more comorbidities than those without CAD. The crude incidences (% per patient-year) of cardiovascular events were significantly higher in patients with CAD than those without CAD (cardiac death: 1.8 vs. 0.7, stroke or systemic embolism [SE]: 2.9 vs. 2.1, MI: 0.6 vs. 0.1, composite of those events: 5.1 vs. 2.8, respectively, all log-rank P<0.01). After multivariate adjustment, concomitant CAD was associated with incidence of cardiac events, and history of MI was associated with incidence of MI; however, neither history of CAD nor MI was associated with the incidence of stroke/SE. CONCLUSIONS: In Japanese AF patients, concomitant CAD was associated with higher prevalences of major co-morbidities and higher incidences of cardiovascular events; however, history of CAD was not associated with the incidence of stroke/SE.


Asunto(s)
Fibrilación Atrial , Enfermedad de la Arteria Coronaria , Embolia , Accidente Cerebrovascular , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/epidemiología , Embolia/epidemiología , Humanos , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Accidente Cerebrovascular/etiología
14.
Circ J ; 86(4): 726-736, 2022 03 25.
Artículo en Inglés | MEDLINE | ID: mdl-35283403

RESUMEN

BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke and death. Oral anticoagulants (OAC) are highly effective in reducing the risk of stroke, and direct oral anticoagulants (DOAC) became available worldwide in 2011.Methods and Results:The Fushimi AF Registry is an on-going prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. The study cohort consisted of 4,489 patients (mean age 73.6 years, 59.6% male, mean CHADS2score 2.03), enrolled in 2011-2017. From 2011 to 2021, antithrombotic therapy has undergone a major transition; the proportion of patients receiving OAC has increased from 53% to 70%, with a steady uptake of DOAC (from 2% to 52%), whereas the proportion of patients receiving antiplatelet agents has decreased from 32% to 14%. Over a median follow-up of 5.1 years, the incidence of stroke/systemic embolism (SE), major bleeding, and all-cause death was 2.2%, 1.9%, and 4.9% per patient-year, respectively. The incidence of stroke/SE (1.6% vs. 2.3%; P<0.01), major bleeding (1.6% vs. 2.0%; P=0.07), and death (4.2% vs. 5.0%; P<0.01) was lower among patients enrolled in 2014-2017 than in 2011-2013, despite comparable baseline characteristics (age 73.2 vs. 73.7 years, CHADS2score 2.03 vs. 2.04, and HAS-BLED score 1.67 vs. 1.77, respectively). CONCLUSIONS: Over the past 10 years, there has been a major transition in antithrombotic therapy and a decline in the incidence of adverse events in AF patients.


Asunto(s)
Fibrilación Atrial , Embolia , Accidente Cerebrovascular , Anciano , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/epidemiología , Embolia/epidemiología , Femenino , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Japón/epidemiología , Masculino , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control
15.
Heart Vessels ; 37(7): 1242-1254, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35124705

RESUMEN

It is still controversial whether catheter ablation for atrial fibrillation (AF) could improve clinical outcomes in general AF population. Among 4398 patients with diagnosis of AF in the outpatient department of Kyoto University Hospital between January 2005 and March 2015, we identified 537 pairs of patients who received first-time catheter ablation (ablation group) or conservative management (conservative group), matched for age, gender, AF duration, AF type, AF symptoms, and previous heart failure (HF). The primary outcome measure was a composite of cardiovascular death, HF hospitalization, ischemic stroke, or major bleeding. Most baseline characteristics were well balanced between the 2 groups, except for the higher prevalence of low body weight, history of malignancy, and severe chronic kidney disease in the conservative group. Median follow-up duration was 5.3 years. The cumulative 5-year incidence of the primary outcome measure was significantly lower in the ablation group than in the conservative group (5.2% versus 15.6%, log-rank P < 0.001). Even after adjusting for the imbalances in the baseline characteristics, the lower risk of the ablation group relative to the conservative group for the primary outcome measure remained highly significant (HR 0.32, 95% CI 0.21-0.47, P < 0.001). Ablation compared with conservative management was also associated with significantly lower risks for the individual components of the primary outcome. In this matched analysis in AF patients, ablation as compared with conservative management was associated with better long-term clinical outcomes, although we could not deny the possibility of selection bias and unmeasured confounding.


Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Insuficiencia Cardíaca , Accidente Cerebrovascular , Fibrilación Atrial/epidemiología , Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Tratamiento Conservador/efectos adversos , Humanos , Resultado del Tratamiento
16.
J Phys Ther Sci ; 34(1): 40-43, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35035078

RESUMEN

[Purpose] The purpose of this study is to consider the correlation between ankle plantar flexion strength and degree of body sway. [Participants and Methods] Twenty-one healthy adult males were targeted. A handheld dynamometer was used to measure ankle plantar flexion strength. The Body Pressure Measurement System was used to measure the degree of body sway. Lastly, correlation between ankle plantar flexion strength and degree of body sway was considered. [Results] A negative correlation was observed between ankle plantar flexion strength and degree of body sway. [Conclusion] Regarding ankle plantar flexion strength and degree of body sway, results of a consideration using a handheld dynamometer and Body Pressure Measurement System were the same as that of previous studies using large equipment.

17.
Intern Med ; 61(12): 1817-1822, 2022 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-34776492

RESUMEN

Objective The severity of mitral regurgitation (MR) dynamically changes during a stress test. Isometric handgrip is a readily-available stress test in daily practice; however, little is known regarding the response to isometric handgrip in MR patients during right heart catheterization. We aimed to evaluate this issue from our case-series study. Methods We retrospectively investigated consecutive MR patients using the isometric handgrip stress test during right heart catheterization at our institution between October 2019 and April 2021. After resting measurements were obtained, sustained maximum-effort hand dynamometer grasping was maintained for about 2-3 minutes. We investigated the differences in right heart catheterization data between at rest and during handgrip, and evaluated the individual response to the isometric handgrip stress test. Results We investigated a total of 15 patients (mean age: 75±6 years, moderate/severe MR: 7/8, primary/secondary MR: 8/7, mean left ventricular ejection fraction: 56±16%, exertional dyspnea: 10). During the handgrip test, the pulmonary capillary wedge pressure (PCWP) significantly increased [9 (8, 13) mmHg at rest to 20 (15, 27) mmHg during handgrip; p<0.001]. PCWP changes varied among individuals (range 2-22 mmHg) and were not correlated with patients' backgrounds including age, the natriuretic peptide levels, left ventricular ejection fraction, left atrial diameter or E/e' (all p>0.05). Patients with PCWP ≥25 mmHg during handgrip had a higher prevalence of exertional dyspnea than those without [6 (100%) vs. 4 (44%); p=0.04]. Conclusion We observed dynamic and varied hemodynamic changes during isometric handgrip in MR patients, suggesting that further research is needed to evaluate the clinical value of this maneuver.


Asunto(s)
Insuficiencia de la Válvula Mitral , Anciano , Anciano de 80 o más Años , Cateterismo Cardíaco/métodos , Disnea , Prueba de Esfuerzo/métodos , Fuerza de la Mano , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Presión Esfenoidal Pulmonar/fisiología , Estudios Retrospectivos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología
18.
Circ J ; 85(3): 323-329, 2021 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-33518695

RESUMEN

Due to the COVID-19 pandemic, the 84thAnnual Meeting of the Japanese Circulation Society (JCS) was held in a web-based format for the first time in its history as "The Week for JCS 2020" from Monday, July 27 to Sunday, August 2, 2020. All sessions, including general abstracts, were streamed live or on-demand. The main theme of the meeting was "Change Practice!" and the aim was to organize the latest findings in the field of cardiovascular medicine and discuss how to change practice. The total number of registered attendees was over 16,800, far exceeding our expectations, and many of the sessions were viewed by far more people than at conventional face-to-face scientific meetings. At this conference, the power of online information dissemination was fully demonstrated, and the evolution of online academic meetings will be a direction that cannot be reversed in the future. The meeting was completed with great success, and we express our heartfelt gratitude to all affiliates for their enormous amount of work, cooperation, and support.


Asunto(s)
Cardiología/organización & administración , Congresos como Asunto/organización & administración , Sociedades Científicas/organización & administración , Telecomunicaciones/organización & administración , Cardiología/tendencias , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/terapia , Congresos como Asunto/estadística & datos numéricos , Congresos como Asunto/tendencias , Humanos , Japón , Investigación , Encuestas y Cuestionarios , Telecomunicaciones/estadística & datos numéricos , Telecomunicaciones/tendencias
19.
Heart Vessels ; 36(4): 509-517, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33123778

RESUMEN

The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, ß-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.


Asunto(s)
Actividades Cotidianas , Ejercicio Físico/fisiología , Evaluación Geriátrica/métodos , Insuficiencia Cardíaca/fisiopatología , Alta del Paciente , Volumen Sistólico/fisiología , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estado Nutricional , Estudios Retrospectivos
20.
J Phys Ther Sci ; 32(10): 637-640, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33132522

RESUMEN

[Purpose] The purpose of this study was to examine the correlation between leg extensor torque and the degree of sway. [Participants and Methods] We recruited 31 male and 22 female healthy adults. Strength Ergo 240 was used to measure leg extensor torque. A body pressure measurement system was used to measure the degree of sway. After the measurement, the correlation between these factors was investigated according to sex. [Results] In the males, a significant negative correlation was observed between leg extensor torque and the degree of sway. [Conclusion] In cases where therapists actively performed muscle strengthening and standing-up exercises to reduce the degree of sway in the males, the possibility that such efforts could increase leg extensor torque was observed.

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