Shingo Ota

Introduction: Insufficient nutrient intake is a strong independent predictor of mortality in elderly patients with heart failure. However, it is unclear to what extent energy intake affects their prognosis. This study investigated the association between patient outcomes and actual measured energy intake in elderly patients (≥65 years) with heart failure. Methods: This study enrolled 139 elderly patients who were hospitalized with worsening heart failure at Shingu Municipal Medical Center, Shingu, Japan, between May 2017 and April 2018. Energy intake was evaluated for three days (from three days prior to the day of discharge until the day of discharge). Based on basal energy expenditure calculated using the Harris–Benedict equation, the patients were classified into a low-energy group (n = 38) and a high-energy group (n = 101). We assessed the prognosis in terms of both all-cause mortality and readmission due to worsening heart failure as a primary outcome. Results: Compared to the patients in the high-energy group, the patients in the low-energy group were predominantly female, less frequently had smoking habits and ischemic heart diseases, and had a higher left ventricular ejection fraction. The low-energy group had higher mortality than the high-energy group (p = 0.028), although the two groups showed equivalent event rates of the primary outcome (p = 0.569). Conclusion: Calculations based on the Harris–Benedict equation revealed no significant difference in the primary outcome between the two groups, with a secondary outcome that showed worse mortality in the low-energy group. Given this result, energy requirement-based assessments using the Harris–Benedict equation might help in the management of elderly heart failure patients in terms of improved life outcomes.

An 86-year-old Japanese man was referred to our hospital because of leg oedema. Electrocardiography revealed a right bundle branch block, and transthoracic echocardiography showed a left ventricular septal wall thickness of 15 mm. On cardiovascular magnetic resonance imaging (CMR), late gadolinium enhancement areas and high native T1 value areas extended in the basal region of the left ventricular lateral wall (Panels A and C), the right ventricular (RV) side of the septum, and the RV free wall (Panels B and D). Abnormal accumulation of ^99mTc-labelled pyrophosphate (^99mTc-PYP) in the myocardium was visualized in concordance with the abnormal areas on CMR (Panels E and F). The patient was diagnosed with wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) due to the histological evidence of transthyretin deposition in the myocardium and no transthyretin gene mutation. In this case, both CMR and ^99mTc-PYP scintigraphy, which are reliable imaging tools for transthyretin deposition in the myocardium, revealed RV-dominant transthyretin deposition. Based on the UK ATTR-CM staging system, this case was classified as Stage 1. Since no cases of RV-dominant transthyretin deposition have been reported in the literature, it is unclear whether RV-dominant transthyretin deposition is an early stage or a very rare clinical phenotype of wild-type ATTR-CM. Nonetheless, clinicians should be aware of an RV-dominant transthyretin deposition pattern in wild-type ATTR-CM.

Purpose: This study aimed to investigate whether left ventricular (LV) global longitudinal strain (GLS) evaluated by speckle‐tracking echocardiography (STE) can be used as a surrogate marker for the detection of replacement fibrosis by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with nonischemic cardiomyopathy (NICM).Methods: This study analyzed 41 NICM patients who successfully underwent both STE and CMR, and were divided into those with (Group A, n = 18) and those without CMR‐LGE (Group B, n = 23). Echocardiographic indexes, including GLS, were compared between the two groups.Results: No significant differences were observed in LV end‐diastolic and end‐systolic volume indexes, LV ejection fraction, mitral E/A, deceleration time, E/e′, left atrial volume index, and the systolic trans‐tricuspid pressure gradient between Groups A and B. STE‐GLS was significantly worse in Group A than in Group B (−7.6% ± 3.0% vs −9.9% ± 3.2%, P = .01). Receiver operating characteristic curve analysis showed that STE‐GLS of −7.9% was the best cut‐off value for detection of CMR‐LGE (sensitivity, 78%; specificity, 74%; and area under the curve, 0.74).Conclusions: STE‐GLS may be a potential surrogate marker for the detection of CMR‐LGE‐derived replacement fibrosis in patients with NICM.

Refractory angina is an independent predictor of adverse events in patients with vasospastic angina (VSA). The aim of this study was to investigate the relationship between coronary lumen complexity and refractory symptoms in patients with VSA. Seventeen patients with VSA underwent optical coherence tomography. The patients were divided into the refractory VSA group (n = 9) and the stable VSA group (n = 8). A shoreline development index was used to assess the coronary artery lumen complexity. Shear stress was estimated using a computational fluid dynamics model. No difference was observed in the baseline characteristics between the two groups. The refractory VSA group showed the higher shoreline development index (refractory VSA 1.042 [1.017–1.188] vs stable VSA 1.003 [1.006–1.025], p = 0.036), and higher maximum medial thickness (refractory VSA 184 ± 17 μm vs stable VSA 148 ± 31 μm, p = 0.017), and higher maximum shear stress (refractory VSA 14.5 [12.1–18.8] Pa vs stable VSA 5.6 [3.0–10.5] Pa, p = 0.003). The shoreline development index positively correlates with shear stress (R² = 0.46, P = 0.004). Increased medial thickness of the coronary arteries provokes lumen complexity and high shear stress, which might cause refractory symptoms in patients with VSA. The shoreline index could serve as a marker for irritability of the medial layer of coronary arteries and symptoms.