Browsing by Author "Suzuki, Takeki"
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Item 3 Leadless Pacemaker Implantations in an 81-Year-Old Woman With a History of Transvenous Pacemaker Infection(Elsevier, 2024-11-20) Yagasaki, Hiroto; Suzuki, Takeki; Warita, Shunichiro; Noda, Toshiyuki; Medicine, School of MedicineLeadless pacemakers (LPMs) offer an alternative for patients with challenging venous access or device infection history. Management of LPM battery depletion in frail patients presents unique challenges. We present the case of an 81-year-old frail woman with obstructive hypertrophic cardiomyopathy and complete heart block, previously treated with percutaneous transseptal myocardial ablation and a transvenous pacemaker, who received an LPM after device extraction for infection. On battery depletion, a second LPM was implanted but dislodged, thus necessitating extraction attempts. Given the high extraction risks, a third LPM was successfully implanted. This case highlights the feasibility of multiple LPM implantations in complex cardiac patients and demonstrates that a third LPM can be a viable option when extraction risks are high. This approach expands management options for frail patients with complex cardiac histories who are unsuitable candidates for traditional pacing systems.Item Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The ARIC Study(American Heart Association, 2024) Suzuki, Takeki; Zhu, Xiaoqian; Adabag, Selcuk; Matsushita, Kunihiro; Butler, Kenneth R.; Griswold, Michael E.; Alonso, Alvaro; Rosamond, Wayne; Sotoodehnia, Nona; Mosley, Thomas H.; Medicine, School of MedicineBackground: Sudden cardiac death (SCD) is a significant global public health problem accounting for 15% to 20% of all deaths. A great majority of SCD is associated with coronary heart disease, which may first be detected at autopsy. The ankle-brachial index (ABI) is a simple, noninvasive measure of subclinical atherosclerosis. The purpose of this study was to examine the relationship between ABI and SCD in a middle-aged biracial general population. Methods and results: Participants of the ARIC (Atherosclerosis Risk in Communities) study with an ABI measurement between 1987 and 1989 were included. ABI was categorized as low (≤0.90), borderline (0.90-1.00), normal (1.00-1.40), and noncompressible (>1.40). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual and was adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Cox proportional hazards models were used to evaluate the associations between baseline ABI and incident SCD. Of the 15 081 participants followed for a median of 23.5 years, 556 (3.7%) developed SCD (1.96 cases per 1000 person-years). Low and borderline ABIs were associated with an increased risk of SCD (demographically adjusted hazard ratios [ HRs ], 2.27 [ 95% CI, 1.64-3.14 ] and 1.52 [ 95% CI, 1.17-1.96 ], respectively) compared with normal ABI. The association between low ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors (HR, 1.63 [ 95% CI, 1.15-2.32 ]). Conclusions: Low ABI is independently associated with an increased risk of SCD in a middle-aged biracial general population. ABI could be incorporated into future SCD risk prediction models.Item Carotid Intima‐Media Thickness and the Risk of Sudden Cardiac Death: The ARIC Study and the CHS(American Heart Association, 2020-10-20) Suzuki, Takeki; Wang, Wanmei; Wilsdon, Anthony; Butler, Kenneth R.; Adabag, Selcuk; Griswold, Michael E.; Nambi, Vijay; Rosamond, Wayne; Sotoodehnia, Nona; Mosley, Thomas H.; Medicine, School of MedicineBackground: Sudden cardiac death (SCD) is associated with severe coronary heart disease in the great majority of cases. Whether carotid intima-media thickness (C-IMT), a known surrogate marker of subclinical atherosclerosis, is associated with risk of SCD in a general population remains unknown. The objective of this study was to investigate the association between C-IMT and risk of SCD. Methods and Results We examined a total of 20 862 participants: 15 307 participants of the ARIC (Atherosclerosis Risk in Communities) study and 5555 participants of the CHS (Cardiovascular Health Study). C-IMT and common carotid artery intima-media thickness was measured at baseline by ultrasound. Presence of plaque was judged by trained readers. Over a median of 23.5 years of follow-up, 569 participants had SCD (1.81 cases per 1000 person-years) in the ARIC study. Mean C-IMT and common carotid artery intima-media thickness were associated with risk of SCD after adjustment for traditional risk factors and time-varying adjustors: hazard ratios (HRs) with 95% CIs for fourth versus first quartile were 1.64 (1.15-2.63) and 1.49 (1.05-2.11), respectively. In CHS, 302 participants developed SCD (4.64 cases per 1000 person-years) over 13.1 years. Maximum C-IMT was associated with risk of SCD after adjustment: HR (95% CI) for fourth versus first quartile was 1.75 (1.22-2.51). Presence of plaque was associated with 35% increased risk of SCD: HR (95% CI) of 1.37 (1.13-1.67) in the ARIC study and 1.32 (1.04-1.68) in CHS. Conclusions C-IMT was associated with risk of SCD in 2 biracial community-based cohorts. C-IMT may be used as a marker of SCD risk and potentially to initiate early therapeutic interventions to mitigate the risk.Item Cigarette Smoking, Smoking Cessation, and Heart Failure Subtypes: Insights From the Jackson Heart Study(American Heart Association, 2024) Kamimura, Daisuke; Yimer, Wondwosen K.; Mentz, Robert J.; Shah, Amil M.; White, Wendy B.; Blaha, Michael J.; Oshunbade, Adebamike; Hamid, Arsalan; Suzuki, Takeki; Clark, Donald; Fox, Ervin R.; Correa, Adolfo; Butler, Javed; Hall, Michael E.; Medicine, School of MedicineBackground: Cigarette smoking has been associated with incident heart failure (HF). However, the association between cigarette smoking and smoking cessation with HF subtypes has not been well elucidated, particularly among Black people. Methods and results: We investigated 4189 (never smoker n=2934, former smoker n=761, current smoker n=464) Black participants (mean age 54 years, 64% women) without a history of HF or coronary heart disease at baseline in the Jackson Heart Study. We examined the association of cigarette smoking with incident HF hospitalization and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection fraction). After adjustment for confounding factors, current smoking was associated with incident HF (both subtypes) compared with never smoking. Smoking intensity among those who identified as currently smoking and smoking burden among those who ever smoked were associated with higher incidence of HF with preserved ejection fraction compared with never smoking. Lung function evaluated by spirometry at baseline did not significantly influence these associations. The risk of developing HF decreased with more years after smoking cessation, and more than 20 years of smoking cessation were required to reach a risk comparable to that of never smoking. Conclusions: Smoking cigarettes was associated with developing both subtypes of HF and it was independent from the influences on baseline lung function. Long-term smoking cessation is necessary to prevent the onset of HF in people who smoke cigarettes.Item Effect of Shared Decision-Making for Stroke Prevention on Treatment Adherence and Safety Outcomes in Patients With Atrial Fibrillation: A Randomized Clinical Trial(American Heart Association, 2022) Noseworthy, Peter A.; Branda, Megan E.; Kunneman, Marleen; Hargraves, Ian G.; Sivly, Angela L.; Brito, Juan P.; Burnett, Bruce; Zeballos-Palacios, Claudia; Linzer, Mark; Suzuki, Takeki; Lee, Alexander T.; Gorr, Haeshik; Jackson, Elizabeth A.; Hess, Erik; Brand-McCarthy, Sarah R.; Shah, Nilay D.; Montori, Victor M.; SDM4AFib (Shared Decision-Making for Atrial Fibrillation) Trial Investigators; Medicine, School of MedicineBackground: Guidelines promote shared decision‐making (SDM) for anticoagulation in patients with atrial fibrillation. We recently showed that adding a within‐encounter SDM tool to usual care (UC) increases patient involvement in decision‐making and clinician satisfaction, without affecting encounter length. We aimed to estimate the extent to which use of an SDM tool changed adherence to the decided care plan and clinical safety end points. Methods and Results: We conducted a multicenter, encounter‐level, randomized trial assessing the efficacy of UC with versus without an SDM conversation tool for use during the clinical encounter (Anticoagulation Choice) in patients with nonvalvular atrial fibrillation considering starting or reviewing anticoagulation treatment. We conducted a chart and pharmacy review, blinded to randomization status, at 10 months after enrollment to assess primary adherence (proportion of patients who were prescribed an anticoagulant who filled their first prescription) and secondary adherence (estimated using the proportion of days for which treatment was supplied and filled for direct oral anticoagulant, and as time in therapeutic range for warfarin). We also noted any strokes, transient ischemic attacks, major bleeding, or deaths as safety end points. We enrolled 922 evaluable patient encounters (Anticoagulation Choice=463, and UC=459), of which 814 (88%) had pharmacy and clinical follow‐up. We found no differences between arms in either primary adherence (78% of patients in the SDM arm filled their first prescription versus 81% in UC arm) or secondary adherence to anticoagulation (percentage days covered of the direct oral anticoagulant was 74.1% in SDM versus 71.6% in UC; time in therapeutic range for warfarin was 66.6% in SDM versus 64.4% in UC). Safety outcomes, mostly bleeds, occurred in 13% of participants in the SDM arm and 14% in the UC arm. Conclusions: In this large, randomized trial comparing UC with a tool to promote SDM against UC alone, we found no significant differences between arms in primary or secondary adherence to anticoagulation or in clinical safety outcomes.Item Enrolling people of color to evaluate a practice intervention: lessons from the shared decision-making for atrial fibrillation (SDM4AFib) trial(BMC, 2022-08-12) Sivly, Angela; Gorr, Haeshik S.; Gravholt, Derek; Branda, Megan E.; Linzer, Mark; Noseworthy, Peter; Hargraves, Ian; Kunneman, Marleen; Doubeni, Chyke A.; Suzuki, Takeki; Brito, Juan P.; Jackson, Elizabeth A.; Burnett, Bruce; Wambua, Mike; Montori, Victor M.; Shared Decision-Making for Atrial Fibrillation (SDM4AFib) Trial Investigators; Medicine, School of MedicineBackground: Trial recruitment of Black, indigenous, and people of color (BIPOC) is key for interventions that interact with socioeconomic factors and cultural norms, preferences, and values. We report on our experience enrolling BIPOC participants into a multicenter trial of a shared decision-making intervention about anticoagulation to prevent strokes, in patients with atrial fibrillation (AF). Methods: We enrolled patients with AF and their clinicians in 5 healthcare systems (three academic medical centers, an urban/suburban community medical center, and a safety-net inner-city medical center) located in three states (Minnesota, Alabama, and Mississippi) in the United States. Clinical encounters were randomized to usual care with or without a shared decision-making tool about anticoagulation. Analysis: We analyzed BIPOC patient enrollment by site, categorized reasons for non-enrollment, and examined how enrollment of BIPOC patients was promoted across sites. Results: Of 2247 patients assessed, 922 were enrolled of which 147 (16%) were BIPOC patients. Eligible Black participants were significantly less likely (p < .001) to enroll (102, 11%) than trial-eligible White participants (185, 15%). The enrollment rate of BIPOC patients varied by site. The inclusion and prioritization of clinical practices that care for more BIPOC patients contributed to a higher enrollment rate into the trial. Specific efforts to reach BIPOC clinic attendees and prioritize their enrollment had lower yield. Conclusions: Best practices to optimize the enrollment of BIPOC participants into trials that examined complex and culturally sensitive interventions remain to be developed. This study suggests a high yield from enrolling BIPOC patients from practices that prioritize their care.Item Insulin resistance and reduced cardiac autonomic function in older adults: the Atherosclerosis Risk in Communities study(BMC, 2020-05-11) Poon, Anna K.; Whitsel, Eric A.; Heiss, Gerardo; Soliman, Elsayed Z.; Wagenknecht, Lynne E.; Suzuki, Takeki; Loehr, Laura; Medicine, School of MedicineBackground: Prior studies have shown insulin resistance is associated with reduced cardiac autonomic function measured at rest, but few studies have determined whether insulin resistance is associated with reduced cardiac autonomic function measured during daily activities. Methods: We examined older adults without diabetes with 48-h ambulatory electrocardiography (n = 759) in an ancillary study of the Atherosclerosis Risk in Communities Study. Insulin resistance, the exposure, was defined by quartiles for three indexes: 1) the homeostatic model assessment of insulin resistance (HOMA-IR), 2) the triglyceride and glucose index (TyG), and 3) the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C). Low heart rate variability, the outcome, was defined by <25th percentile for four measures: 1) standard deviation of normal-to-normal R-R intervals (SDNN), a measure of total variability; 2) root mean square of successive differences in normal-to-normal R-R intervals (RMSSD), a measure of vagal activity; 3) low frequency spectral component (LF), a measure of sympathetic and vagal activity; and 4) high frequency spectral component (HF), a measure of vagal activity. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals weighted for sampling/non-response, adjusted for age at ancillary visit, sex, and race/study-site. Insulin resistance quartiles 4, 3, and 2 were compared to quartile 1; high indexes refer to quartile 4 versus quartile 1. Results: The average age was 78 years, 66% (n = 497) were women, and 58% (n = 438) were African American. Estimates of association were not robust at all levels of HOMA-IR, TyG, and TG/HDL-C, but suggest that high indexes were associated consistently with indicators of vagal activity. High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low RMSSD (OR: 1.68 (1.00, 2.81), OR: 2.03 (1.21, 3.39), and OR: 1.73 (1.01, 2.91), respectively). High HOMA-IR, high TyG, and high TG/HDL-C were consistently associated with low HF (OR: 1.90 (1.14, 3.18), OR: 1.98 (1.21, 3.25), and OR: 1.76 (1.07, 2.90), respectively). Conclusions: In older adults without diabetes, insulin resistance was associated with reduced cardiac autonomic function - specifically and consistently for indicators of vagal activity - measured during daily activities. Primary prevention of insulin resistance may reduce the related risk of cardiac autonomic dysfunction.Item Long-Term Efficacy of Mitral Valve Transcatheter Edge-to-Edge Repair (M-TEER) for Exercise-Induced Mitral Regurgitation in a Cardiac Resynchronization Therapy (CRT) Non-responder: A Three-Year Follow-Up(Springer Nature, 2024-10-18) Yagasaki, Hiroto; Suzuki, Takeki; Watanabe, Keitaro; Oshima, Yoshitake; Noda, Toshiyuki; Medicine, School of MedicineMitral valve transcatheter edge-to-edge repair (M-TEER), a minimally invasive procedure that uses a clip to join the mitral valve leaflets, has emerged as an established treatment for severe mitral regurgitation (MR) in drug-refractory heart failure (HF). This case report presents an 80-year-old cardiac resynchronization therapy (CRT) non-responder with a complex cardiac history who underwent successful M-TEER. Despite optimal therapy, including CRT, she experienced recurrent HF symptoms. While resting echocardiography showed mild MR, exercise stress echocardiography (ESE) revealed severe MR. The M-TEER procedure resulted in trivial residual MR and significant symptom improvement. The patient's New York Heart Association (NYHA) functional class improved from III to I, with sustained benefits for three years post procedure. This case highlights the importance of comprehensive MR assessment, including ESE, in complex scenarios. It also underscores the potential long-term benefits of M-TEER in carefully selected CRT non-responders, even with borderline right ventricular function, when supported by thorough multidisciplinary evaluation.Item Management of coexisting patent foramen ovale and pulmonary arteriovenous malformation: a case report of sequential closure(Oxford University Press, 2025-01-29) Yagasaki, Hiroto; Suzuki, Takeki; Watanabe, Keitaro; Watanabe, Ryota; Noda, Toshiyuki; Medicine, School of MedicineBackground: Concurrent patent foramen ovale (PFO) and pulmonary arteriovenous malformation (PAVM) are rare but can cause paradoxical embolism and platypnoea-orthodeoxia syndrome (POS). Case summary: A 72-year-old female with embolic stroke history developed positional dyspnoea. Evaluation revealed right-to-left shunting through PFO and PAVM in the right middle lobe. Orthodeoxia was confirmed by 6% SpO2 decrease upon position change. A staged approach was adopted: PFO closure with Amplatzer™ Occluder, followed by PAVM embolization 1 month later. Symptoms improved significantly post-procedure. No residual shunting or symptoms have been observed during the 2-year follow-up. Discussion: This case emphasizes thorough evaluation in patients with cryptogenic stroke and POS, especially when symptoms persist. It demonstrates the effectiveness of staged treatment for concurrent PFO and PAVM, highlighting the importance of individualized strategies and long-term follow-up.Item Physical Activity, Inflammation, Coronary Artery Calcification, and Incident Coronary Heart Disease in African Americans: Insights From the Jackson Heart Study(Elsevier, 2021) Kamimura, Daisuke; Cain-Shields, Loretta R.; Clark, Donald, III.; Oshunbade, Adebamike A.; Ashley, Kellan E.; Guild, Cameron S.; Loprinzi, Paul D.; Newton, Robert; Blaha, Michael J.; Suzuki, Takeki; Butler, Javed; Hall, John E.; Correa, Adolfo; Hall, Michael E.; Medicine, School of MedicineObjective: To examine associations between physical activity, inflammation, coronary artery calcification and incident coronary heart disease in African Americans. Methods: Among Jackson Heart Study participants without prevalent coronary heart disease at baseline (n=4295), we examined the relationships between physical activity and high-sensitivity CRP, the presence of coronary artery calcification (Agatston score≥100), and incident coronary heart disease. Based on the American Heart Association’s Life’s Simple 7 metrics, participants were classified as having poor, intermediate or ideal physical activity. Results: After adjusting for possible confounding factors, ideal physical activity was associated with lower high-sensitivity CRP levels (β: −0.15, 95%CI −0.15, −0.002) and a lower prevalence of coronary artery calcification (odds ratio: 0.70, 95%CI 0.51, 0.96) compared with poor physical activity. Over a median of 12.8 years follow up, there were 164 incident coronary heart disease events (3.3/1000 person-years). Ideal physical activity was associated with a lower rate of incident coronary heart disease compared with poor physical activity (hazard ratio 0.55, 95% CI 0.31, 0.98). Conclusions: In a large community-based African American cohort, ideal physical activity was associated with lower inflammation levels, a lower prevalence of coronary artery calcification, and a lower rate of incident coronary heart disease. These findings suggest that promotion of ideal physical activity may be an important way to reduce the risk of subclinical and future clinical coronary heart disease in African Americans.