小林 欣夫

BACKGROUND: The HELT-E2S2score, a novel risk stratification system, was developed to determine the incidence of ischemic stroke in Japanese patients with non-valvular atrial fibrillation (NVAF). It has been suggested that the HELT-E2S2score is more useful than the CHADS2and CHA2DS2-VASc scores for Japanese patients with NVAF. This study determined the incidence of ischemic stroke in patients with NVAF and cardiac implantable electronic devices (CIEDs) and assessed the validity of the HELT-E2S2score in this population. METHODS AND RESULTS: We retrospectively analyzed the database of the CIED clinic of Chiba University Hospital and investigated the incidence of ischemic stroke according to the HELT-E2S2score. Of the 730 consecutive patients who were followed-up at the CIED clinic, those without NVAF were excluded, leaving 362 patients in this study (mean [±SD] follow-up period, 64±48 months; mean age, 73±16 years; 65% male). The mean CHADS2and CHA2DS2-VASc scores were 1.8±1.2 and 2.8±1.6 points, respectively. During follow-up, 31 (8.6%) patients experienced ischemic stroke. The c-statistic for the HELT-E2S2score was 0.719 (95% confidence interval [CI] 0.657-0.795), which was higher than the c-statistics for the CHADS2(0.704; 95% CI 0.647-0.768; P=0.025) and CHA2DS2-VASc (0.700; 95% CI:0.621-0.747; P=0.0097) scores. CONCLUSIONS: Risk stratification for ischemic stroke using the HELT-E2S2score is valid in Japanese patients with NVAF and CIEDs.

Takotsubo syndrome (TTS) is a complex cardiovascular condition characterized by transient left and/or right ventricular dysfunction in the absence of a coronary artery culprit lesion. The InterTAK registry, a large international collaborative registry, has significantly advanced our understanding of TTS. This review summarizes key findings from the InterTAK registry, including epidemiology, clinical presentation, comorbidities, outcomes, and treatment. The registry has revealed the diverse clinical spectrum of TTS, including atypical presentations, and identified various risk factors associated with adverse outcomes. The InterTAK registry has been instrumental in shaping the current understanding of TTS and will continue to guide future research and clinical practice.