Ryo Suzuki

Background/Objectives: Epidemiological and clinical studies have linked both hypothyroidism and hyperthyroidism to adverse cardiac outcomes, including heart failure and myocardial fibrosis. Triiodothyronine (T3), a biologically active thyroid hormone, is important for cardiovascular homeostasis. While the effects of physiological and non-physiological T3 levels on cardiomyocytes have been extensively investigated, the impact of hypothyroidism and hyperthyroidism on cardiac stromal cells (CSCs), which constitute the majority of the cells in the heart, remains understudied. Given CSCs’ essential role in extracellular matrix (ECM) remodeling and paracrine signaling, understanding their response to altered T3 states is necessary to fully elucidate the thyroid hormone-induced cardiac responses. Methods: Cardiac stromal cells were isolated from human atrial appendages and cultured under hypothyroid (0 nM T3), euthyroid (2.5 nM T3), and hyperthyroid (25 nM T3) conditions for 24 (short term) and 120 h (long term). The cells were harvested after 24 h of treatment using trypsin and automatically counted, and their ECM-related gene and growth factor expression levels were assessed using quantitative RT-PCR. Cardiac glucose uptake in hypothyroid, euthyroid, and hyperthyroid mice was monitored using [18F]-FDG PET/CT at acute (7 days) and chronic (42 days) time points. Results: Both hypo- and hyperthyroidism significantly increased the number of CSCs harvested after 24 h. There were acute alterations in the expression of the ECM-related genes COL1A1, COL3A1, TIMP3 (p < 0.05), and TIMP1 (p < 0.01). Similarly, growth factors such as PDGF-A (p < 0.001), TGF-b, and IGF1 (p < 0.05) were transiently upregulated under non-physiological T3 conditions, especially hypothyroidism. Most of these alterations were attenuated or reversed at the 120 h time point. In vivo PET imaging revealed significant increases in cardiac glucose uptake under acute hypothyroidism (p < 0.05) and decreases under acute hyperthyroidism (p < 0.05). However, these metabolic shifts normalized with chronic exposure, paralleling the transient nature of the gene expression changes observed in vitro. Conclusions: Non-physiological T3 concentrations induce proliferation and changes in ECM-related and growth factor gene expression in CSCs. Most of these changes are acute and return to normal levels after chronic exposure. These transient cellular responses correlate closely with the cardiac metabolic response patterns to acute and chronic hypothyroidism and hyperthyroidism.

Background: The advent of transcatheter aortic valve implantation (TAVI) has increased the rate of aortic valve treatment in frail older adults. Factors contributing to frailty include sarcopenia (characterized by reduced muscle mass), osteopenia (characterized by decreased bone mineral density), and the newly termed osteosarcopenia, which is characterized by a simultaneous decline in muscle mass and bone mineral density. In this study, we aimed to investigate the impacts of sarcopenia, osteopenia, and osteosarcopenia on the clinical outcomes of TAVI.Methods and Results: We retrospectively analyzed 490 patients who underwent TAVI for aortic stenosis at Yamaguchi University Hospital between April 2014 and March 2025. Osteopenia, sarcopenia, and osteosarcopenia were diagnosed by preprocedural computed tomography. Patients were classified into normal (N), sarcopenia alone (S), osteopenia alone (O), and osteosarcopenia (OS) groups. Early clinical outcomes and 1-year survival rates exhibited no significant differences among the groups. However, the 5-year survival rates were 94.1%, 77.6%, 60.4%, and 46.5% in the N, S, O, and OS groups, respectively (P<0.05). The Cox proportional hazards model revealed osteosarcopenia as a significant risk factor for late death (hazard ratio, 2.09; P=0.0002).Conclusions: Preoperative evaluation of muscle mass and bone density aids in stratifying TAVI risk.

Background/Objectives: Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis, especially in older adults and high-risk patients. However, many TAVI candidates have osteopenia or osteoporosis, indicated by low bone mineral density (BMD), which is linked to frailty and adverse outcomes. Although prior research suggests an association with poor clinical outcomes, data remain limited. We investigated the impact of osteopenia on TAVI outcomes, hypothesizing that a lower BMD is associated with poor perioperative outcomes and decreased long-term survival. Methods: In this single-center retrospective study, we analyzed data from 411 patients who underwent TAVI at Yamaguchi University Hospital from 2014 to 2024. Clinical and survival data were collected, and Cox regression analysis was used to identify independent predictors of mortality. Preoperative BMD was measured using computed tomography, defining osteopenia as p = 0.04) and higher late cardiac mortality (p < 0.001). Six-year survival was 36.2% and 88.1% in patients with and without osteopenia, respectively (p < 0.0001). Cox regression analysis revealed osteopenia as a mortality risk factor (hazard ratio: 6.75, 95% confidence interval: 2.96–15.38, p < 0.0001). Severe osteopenia was associated with the poorest outcomes. Conclusions: Osteopenia is an independent predictor of poor long-term survival after TAVI. These findings underscore the importance of comprehensive risk assessment, suggesting that targeted interventions may improve outcomes.

Takahiro Mizoguchi, Takasuke Harada, Yuriko Takeuchi, Makoto Samura, Hiroshi Kurazumi, Ryo Suzuki, Kotaro Suehiro, and Kimikazu Hamano. Vasc Specialist Int 2025;41:. https://doi.org/10.5758/vsi.250027

OBJECTIVES: Stratifying patients with aortic stenosis is crucial for improving their lifetime management. Several studies analysed computed tomography (CT)-defined sarcopenia in patients undergoing transcatheter aortic valve implantation (TAVI). However, the criteria for CT-defined sarcopenia are heterogeneous among these studies. Mostly, they primarily evaluated short-term outcomes; research focusing on long-term outcomes, related to lifetime management in patients with aortic stenosis, is rare. We assessed the effects of CT-defined sarcopenia on the short- and long-term outcomes in patients undergoing TAVI using three different sarcopenia criteria, including two traditional criteria and a novel criterion. METHODS: In this retrospective study, we enrolled 360 patients. Three different sarcopenia criteria (skeletal muscle index [SMI], psoas muscle area [PMA] and psoas muscle volume index [PVI]) were applied to assess safety and early and long-term clinical outcomes. RESULTS: SMI-, PMA- and PVI-sarcopenia were diagnosed in 244 (67.7%), 246 (68.3%) and 161 (44.7%) patients, respectively. However, PMA-sarcopenia was associated with poor long-term survival after TAVI. Furthermore, PVI-sarcopenia was associated with lower safety at 30 days and poor long-term survival. Using Cox regression hazard models, PVI-sarcopenia tended to be a risk factor for overall survival (hazards ratio: 1.49, P = 0.052). CONCLUSIONS: In patients undergoing TAVI, CT-defined sarcopenia using PVI-based criteria was a reliable predictor of poor outcomes. This finding might facilitate stratification of patients undergoing TAVI.

Purpose: We aimed to compare the midterm outcomes of the no-touch saphenous vein graft (NT-SVG) as a second conduit with those of other graft types.Methods: We retrospectively reviewed 549 consecutive patients who underwent multivessel isolated coronary artery bypass grafting (CABG) with ≥2 distal anastomoses between 2002 and 2024. Five conduit groups for non-LAD grafting were analyzed: in situ internal thoracic artery (ITA), free ITA, conventional saphenous vein graft (cSVG), NT-SVG, and right gastroepiploic artery (rGEA). We analyzed conduit-specific patency and propensity score–matched patency between cSVG and NT-SVG.Results: The mean age was 68.6 ± 9.5 years, and 74% were men. Off-pump CABG was performed in 60.5% of cases, with a mean of 3.3 ± 0.9 distal anastomoses. Hospital mortality was 1.5%. Notably, the 5- and 10-year survival rates were 85.9% and 74.1%, respectively. Among 794 non-LAD grafts, the NT-SVG demonstrated a 5-year patency of 96.4%, which was significantly higher than that of cSVG (89.5%, p = 0.05) and rGEA (87.2%, p = 0.04), and equivalent to in situ ITA (94.4%) and free ITA (95.0%). The propensity score–matched analysis further demonstrated superior graft patency with the NT-SVG.Conclusions: The NT-SVG achieves a 5-year patency comparable to that of ITA grafts and superior to that of cSVG and rGEA, suggesting its potential as a promising option for non-LAD revascularization, pending further validation.

Objectives: We aimed to investigate whether the no‐touch (NT) harvesting technique for the great saphenous vein graft (SVG) affects graft flow velocity during coronary artery bypass grafting. Methods: The study included 132 and 138 conduits that underwent NT and conventional (CV) harvesting techniques, respectively (NT and CV groups, respectively). Transit‐time flow measurements and contrast‐enhanced computed tomography (CT) were performed to assess graft flow velocity and patency. Results: Intraoperative graft flows, assessed using a transit‐time flowmeter, were 40 ± 19 and 48 ± 27 mL/min/anastomosis in the NT and CV groups, respectively. Preoperative SVG diameters, assessed via vascular ultrasound, were 2.8 ± 0.7 and 2.8 ± 0.8 mm in the NT and CV groups, respectively. However, postoperative SVG diameters, measured using contrast‐enhanced CT, were 2.7 ± 0.5 and 3.5 ± 0.6 mm in the NT and CV groups, respectively, indicating a significant reduction in the NT group ( p < 0.01). Graft flow velocities, calculated from graft flow and vascular diameter, were 7.3 ± 4.2 and 5.4 ± 3.2 cm/s/anastomosis in the NT and CV groups, respectively, being significantly higher in the NT group ( p < 0.01). The incidence of postoperative occlusion was significantly lower in the NT group (two conduits, 1.5%) than in the CV group (10 conduits, 7.3%) ( p = 0.02). Significant differences were found in the 5‐year patency rates between the two groups (NT group, 98.4%; CV group, 92.9%; p = 0.04). Conclusions: The NT SVG harvesting technique prevents postoperative graft diameter expansion and significantly increases graft flow velocity and patency. Further randomized studies are needed to determine whether differences in blood flow velocity are essential for graft patency over an extended observation period.

Background: Immunoglobulin G4-related disease (IgG4RD) is a systemic autoimmune disease characterized by a dense lymphoplasmacytic infiltrate containing IgG4-positive plasma cells that can cause aneurysms in various organs and tissues. There have been many reports of IgG4RD aneurysms; however, the surgical procedures adopted remain controversial. Herein, we report a case in which surgical treatment for IgG4-related aneurysms was successful. Case presentation: An 83-year-old woman with IgG4-related disease developed multiple aneurysms, including thoracic aortic aneurysm (TAA), right coronary artery aneurysm (CAA), abdominal aortic aneurysm, and common iliac artery aneurysm. Enhanced computed tomography (CT) revealed progressive enlargement of the TAA, while positron emission tomography-CT revealed intense ¹⁸F-fluorodeoxyglucose uptake around the TAA and CAA, suggesting the presence of adhesive tissue caused by adventitial inflammation around the aneurysms. Open aortic arch replacement with frozen elephant trunk procedure and coronary artery bypass grafting with ligation of the coronary artery were performed to treat the TAA and CAA. No surgical complications occurred. The postoperative CT scan showed no endoleak around the open stent graft and the coronary artery was patent. The patient is being followed up on an outpatient basis after discontinuing steroid therapy. Conclusions: We report the successful surgical treatment of IgG4-related multiple aneurysms. Our findings reveal that the main site of inflammation in aneurysms of IgG4RD is the adventitia and the frozen elephant trunk procedure is useful for avoiding complications.