論文 - 渡邉 望
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ST-Elevation Myocardial Infarction With Cardiogenic Shock and Severe Acute Ischemic Mitral Regurgitation Rescued by Primary Coronary Intervention Under Hemodynamic Support With Impella. 査読あり
Koiwaya H, Watanabe N, Nishihira K, Goriki Y, Shibata Y
Circulation reports 3 ( 5 ) 304 - 305 2021年4月
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Nishihira K., Yoshioka G., Kuriyama N., Ogata K., Kimura T., Matsuura H., Furugen M., Koiwaya H., Watanabe N., Shibata Y.
European Heart Journal - Quality of Care and Clinical Outcomes 7 ( 2 ) 189 - 197 2021年4月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：European Heart Journal - Quality of Care and Clinical Outcomes
Aims: Frailty is characterized by reduced biological reserves and weakened resistance to stressors, and is common in older adults. This study evaluated the prognostic implications of frailty at hospitalization in elderly patients with acute myocardial infarction (AMI) who undergo percutaneous coronary intervention (PCI). Methods and results: We prospectively analysed 546 AMI patients aged ≥80 years undergoing PCI from 2009 to 2017. Frailty was classified based on impairment in walking (unassisted, assisted, and wheelchair/non-Ambulatory), cognition (normal, mildly impaired, moderately to severely impaired), and basic activities of daily living. Impairment in each domain was scored as 0, 1, or 2, and patients were categorized into the following three groups based on total score: no frailty (0), mild frailty (1-2), moderate-To-severe frailty (≥3). The median follow-up period was 589 days. Of the 546 patients, 27.8% were frail (mild or moderate-To-severe), and this proportion significantly increased to 35.5% at discharge (P < 0.001). Compared to non-frail patients, frail patients were older, less likely to be male, and had a higher rate of advanced Killip class. Major bleeding (no frailty, 9.6%; mild frailty, 16.9%; moderate-To-severe frailty, 31.8%; P < 0.001) and in-hospital mortality (no frailty, 8.4%; mild frailty, 15.4%; moderate-To-severe frailty, 27.3%; P < 0.001) increased as frailty worsened. After adjusting for confounders, frailty was independently associated with higher mid-Term all-cause mortality (hazard ratio, 1.81; 95% confidence interval, 1.23-2.65; P = 0.002). Conclusion: Frailty in AMI patients aged ≥80 years undergoing PCI was associated with major bleeding, in-hospital death, and mid-Term mortality.
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Designer Exosomes: Smart Nano-Communication Tools for Translational Medicine 査読あり 国際共著
Madhyastha H, Madhyastha R, Nakajima Y, Gothandam KM, Ohe K, Shiomori K and Watanabe N
Bioengineering 2021年
担当区分：最終著者 記述言語：英語 掲載種別：研究論文（学術雑誌）
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Prognostic impact of follow-up serum albumin after acute myocardial infarction 査読あり
Yoshioka G., Tanaka A., Nishihira K., Natsuaki M., Kawaguchi A., Watanabe N., Shibata Y., Node K.
ESC Heart Failure 8 ( 6 ) 5456 - 5465 2021年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：ESC Heart Failure
Aims: Previous studies have suggested that low serum albumin (LSA) at admission for acute myocardial infarction (AMI) is associated with adverse in-hospital outcomes. The aim of this study was to investigate whether LSA in the remote phase after AMI is prognostic for long-term outcomes. Methods and results: This was a single-centre, retrospective study of consecutive patients admitted for AMI from 2008 to 2016. Serum albumin concentrations were measured serially at admission and 1 year after discharge in Japanese patients. Occurrence of a composite of hospitalization for heart failure and cardiovascular death was the primary endpoint. The prognostic impact of remote LSA, defined as a serum albumin level < 3.8 g/dL at 1 year after discharge, was investigated with a multivariate-adjusted Cox model. Among 1424 subjects analysed, 289 (20.3%) had LSA at admission, and 165 (11.6%) had LSA at 1 year after discharge. During follow-up (median: 4.1 years), the primary endpoint occurred in 31/165 (18.8%) patients with remote LSA and 42/1259 (3.3%) patients without it [adjusted hazard ratio (aHR), 2.76; 95% confidence interval (CI), 1.32 to 5.72; P = 0.007]. The all-cause death rate was 29.7% (49/165) in patients with remote LSA and 4.3% (54/1259) in patients without it (aHR, 4.02; 95% CI, 2.36 to 6.87; P < 0.001). The prognostic impact of remote LSA was consistent across albumin status in the acute phase of AMI. Conclusions: Regardless of albumin status in the acute phase of AMI, LSA in the remote phase after AMI was significantly associated with long-term adverse outcomes.
DOI： 10.1002/ehf2.13640
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Retinoic acid attenuates nuclear factor kappaB mediated induction of NLRP3 inflammasome 査読あり
Purbasari B., Madhyastha R., Madhyastha H., Nurrahmah Q.I., Maruyama M., Nakajima Y., Kataoka H., Watanabe N.
Pharmacological Reports 74 ( 1 ) 189 - 203 2021年
担当区分：最終著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Pharmacological Reports
Background: Acetylcholine (ACh), a neurotransmitter and a part of the cholinergic system, can modify immune responses. Expression of acetylcholine receptors (AChR) in immune cells, including macrophages, leads to modulation of their function. Inflammasomes are part of the innate immune system and have been linked to a variety of inflammatory diseases. The NLRP3/ASC/caspase-1/IL-1 axis has emerged as a critical signaling pathway in inflammation process initiation. The role of ACh in modulating inflammasomes in macrophages remains relatively under-explored. Methods: The effect of AChR agonist carbachol on inflammasome expression was investigated using murine and human macrophages. Cell lysates were assessed by western blot for protein analysis. Immunofluorescence studies were used to study the translocation of p65. The experiments were conducted in the presence of NF-ĸB inhibitor, AChR antagonists, and retinoic acid (RA) to study the role of NF-ĸB, ACh receptors, and RA, respectively. Results: We found that carbachol increased the expression of NLRP3 inflammasome (NLRP3, ASC, cleaved caspase-1, IL-1β, and IL-18). The treated cells also showed an increase in NF-ĸB activation. The effect of carbachol was diminished by NF-ĸB inhibitor and atropine, a mAChR antagonist. The addition of RA also significantly reduced the effect of carbachol on NLRP3 inflammasomes. Conclusions: Our current study suggests that carbachol induces NLRP3 inflammasome activation through mAChR and NF-ĸB, and that RA abolishes the inflammatory response. It reveals the potentials of co-administration of RA with cholinergic drugs to prevent inflammatory responses during cholinergic medications.
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Seo Y., Daimon M., Yamada H., Kagiyama N., Ohta M., Izumi C., Yamamoto K., Nakatani S., Sakata Y., Toide H., Akasaka K., Inoue K., Ohnishi T., Dohi K., Yoshimuta T., Watanabe N., Koitabashi T., Iino T., Komuro K., Kobayashi A., Hayashida A., Mizukami N., Hirata K., Wada Y., Kotani A., Takigiku K., Miyake M., Okaniwa H., Hirano Y., Murata M., Suzuki K.
Journal of Echocardiography 18 ( 4 ) 226 - 233 2020年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Echocardiography
Under the coronavirus disease 2019 (COVID-19) pandemic, the Japanese Society of Echocardiography (JSE) has been working to protect medical staff involved in echocardiographic examinations and to prevent secondary infections caused by the examinations since mid-March 2020. This review aims to describe the footprint of the JSE's responses, focusing on the 3 months in which the initial outbreak of COVID-19 pandemic occurred in Japan. We summarized the six parts as follows: (1) the initial actions for COVID-19 of JSE, (2) JSE’s actions for infection control-associated echocardiographic examinations, (3) statements from the American Society of Echocardiography during the COVID-19 pandemic and their Japanese translation by JSE, (4) making videos for explaining the practice of echocardiography during the COVID-19 pandemic, (5) attempts with the JSE members’ opinions by the communication platform and surveys, and (6) efforts of final statement during the initial spread of COVID-19. We look forward that this review will help daily practices associated with echocardiography under the COVID-19 pandemic and in the future event of an unknown infectious disease pandemic.
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JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease 査読あり
Izumi C., Eishi K., Ashihara K., Arita T., Otsuji Y., Kunihara T., Komiya T., Shibata T., Seo Y., Daimon M., Takanashi S., Tanaka H., Nakatani S., Ninami H., Nishi H., Hayashida K., Yaku H., Yamaguchi J., Yamamoto K., Watanabe H., Abe Y., Amaki M., Amano M., Obase K., Tabata M., Miura T., Miyake M., Murata M., Watanabe N., Akasaka T., Okita Y., Kimura T., Sawa Y., Yoshida K.
Circulation Journal 84 ( 11 ) 2037 - 2119 2020年10月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Circulation Journal
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Anatomical and physiological assessment of a symptomatic anomalous origin of the right coronary artery from the pulmonary artery by noninvasive imaging examinations. 査読あり
Nishino S, Watanabe N, Komatsu M, Yano M, Shibata Y
Journal of cardiology cases 22 ( 2 ) 72 - 76 2020年8月
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Nishihira K, Watanabe N, Kuriyama N, Shibata Y
European heart journal. Acute cardiovascular care 9 ( 5 ) 488 - 495 2020年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：European Heart Journal: Acute Cardiovascular Care
Background: With increases in life expectancy, percutaneous coronary intervention is being performed more often, even in elderly patients with acute myocardial infarction. However, the optimal management of nonagenarians with acute myocardial infarction is uncertain. This study sought to investigate clinical outcomes of nonagenarians who undergo percutaneous coronary intervention. Methods: Of 2640 consecutive patients with acute myocardial infarction hospitalised within 24 hours after symptom onset in 2009–2018, we prospectively analysed 96 nonagenarians (median age 92 years; interquartile range 91–94) who underwent percutaneous coronary intervention. Results: The median follow-up period was 375 days. Inhospital major bleeding (Bleeding Academic Research Consortium type 3 or 5) and inhospital death occurred in 15.6% and 17.7% of patients, respectively. The proportion of patients with frailty increased during hospitalisation, from 43.8% (mild frailty 37.5%; moderate to severe frailty 6.3%) at admission to 60.7% (mild frailty 46.8%; moderate to severe frailty 13.9%) at discharge (P < 0.01). The cumulative incidence of all-cause mortality was 22.2% at 180 days and 27.5% at 365 days. After adjusting for confounders, cardiogenic shock (hazard ratio (HR) 2.85; 95% confidence interval (CI) 1.07–7.64) and final thrombolysis in myocardial infarction flow grade less than 3 (HR 2.45; 95% CI 1.03–5.58) were associated with higher mid-term mortality and cardiac rehabilitation (HR 0.25; 95% CI, 0.13–0.50) was associated with lower mid-term mortality. Conclusions: The mid-term mortality of selected nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention is reasonable, but older patients have high rates of inhospital major bleeding and progression of frailty. This study provides physicians, patients and families with important information for therapeutic decision-making.
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Anomalous band in the left atrium: a rare embryologic remnant causing severe mitral regurgitation. 査読あり
Nishino S, Watanabe N, Yano M, Shibata Y
European heart journal. Case reports 4 ( 4 ) 1 - 2 2020年8月
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Lost in the Woods? Then We Need a Bird's-Eye View: Integrative Approach for the Doppler Assessment of Mitral Regurgitation. 査読あり
Watanabe N
Circulation. Cardiovascular imaging 13 ( 5 ) e010788 2020年5月
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Goriki Y., Tanaka A., Nishihira K., Kawaguchi A., Natsuaki M., Watanabe N., Ashikaga K., Kuriyama N., Shibata Y., Node K.
Journal of Clinical Medicine 9 ( 3 ) 2020年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Clinical Medicine
In emergency clinical settings, it may be beneficial to use rapidly measured objective variables for the risk assessment for patient outcome. This study sought to develop an easy-to-measure and objective risk-score prediction model for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 1027 consecutive STEMI patients were recruited and divided into derivation (n = 669) and validation (n = 358) cohorts. A risk-score model was created based on the combination of blood test parameters obtained immediately after admission. In the derivation cohort, multivariate analysis showed that the following 5 variables were significantly associated with in-hospital death: estimated glomerular filtration rate <45 mL/min/1.73 m2, platelet count <15 × 104/µL, albumin ≤3.5 g/dL, high-sensitivity troponin I >1.6 ng/mL, and blood sugar ≥200 mg/dL. The risk score was weighted for those variables according to their odds ratios. An incremental change in the scores was significantly associated with elevated in-hospital mortality (p < 0.001). Receiver operating characteristic curve analysis showed adequate discrimination between patients with and without in-hospital death (derivation cohort: area under the curve (AUC) 0.853; validation cohort: AUC 0.879), and there was no significant difference in the AUC values between the laboratory-based and Global Registry of Acute Coronary Events (GRACE) score (p = 0.721). Thus, our laboratory-based model might be helpful in objectively and accurately predicting in-hospital mortality in STEMI patients.
DOI： 10.3390/jcm9030852
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Unique mechanism of mitral valve prolapse in atrial septal defect: Three-dimensional insights into mitral complex geometry using real-time transesophageal echocardiography. 査読あり
Furugen M, Watanabe N, Nishino S, Kimura T, Ashikaga K, Kuriyama N, Shibata Y
Echocardiography (Mount Kisco, N.Y.) 37 ( 3 ) 445 - 452 2020年3月
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Nishino S., Watanabe N., Gi T., Kuriyama N., Shibata Y., Asada Y.
Circulation: Cardiovascular Imaging 13 ( 12 ) e011396 2020年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Circulation: Cardiovascular Imaging
Background: Recent animal studies have suggested that mitral valve (MV) leaflet remodeling can occur even without significant tethering force and that the postinfarct biological reaction would contribute to the histopathologic changes of the leaflet. We serially evaluated the MV remodeling in patients with anterior and inferior acute myocardial infarction (MI), by using 2-And 3-dimensional transthoracic echocardiography. Additional histopathologic examinations were performed to assess the leaflet pathology. Methods: Sixty consecutive first-onset acute MI (anterior MI, n=30; inferior MI, n=30) patients who underwent successful primary percutaneous coronary intervention were examined (1) before primary percutaneous coronary intervention, (2) at 6-month follow-up, and (3) at follow-up 1 year or later after onset. MV complex geometry including MV leaflet area and thickness was analyzed using dedicated software. Additional histopathologic study compared 18 valves harvested during surgery for ischemic mitral regurgitation (MR). Results: MV area and thickness incrementally increased during the follow-up period. MV leaflet area significantly increased (anterior MI: 5.59 [5.28-5.98] to 6.54 [6.20-7.26] cm2/m2, P<0.001; inferior MI: 5.60 [4.76-6.08] to 6.32 [5.90-6.90] cm2/m2, P<0.001), and leaflet thickness also increased (anterior MI: 1.09 [0.92-1.24] to 1.45 [1.28-1.60] mm/m2, P<0.001; inferior MI: 1.15 [1.03-1.25] to 1.44 [1.27-1.59] mm/m2, P<0.001); data represent onset versus ≥1 year. Larger annuls, larger tenting, and a reduced leaflet area/annular ratio with smaller coaptation index were observed in patients with persistent ischemic MR compared with those without significant ischemic MR. Histopathologic examinations revealed that MV thickness was significantly greater in chronic ischemic MR compared with acute ischemic MR (1432.6±490.5 versus 628.7±278.7 μm; P=0.001), with increased smooth muscle cells and fibrotic materials. Conclusions: MV leaflet remodeling progressed both in area and thickness after MI. This is the first clinical study to record the longitudinal course of MV leaflet remodeling by serial echocardiography.
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Hei S., Iwataki M., Jang J.Y., Kuwaki H., Fukuda S., Kim Y.J., Toki M., Onoue T., Hayashi A., Nishino S., Watanabe N., Hayashida A., Tsuda Y., Araki M., Nishimura Y., Song J.K., Yoshida K., Levine R.A., Otsuji Y.
International Heart Journal 61 ( 5 ) 970 - 978 2020年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Heart Journal
The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV leaflet/chorda tissue complex at superior and outer ends, annular expansion could be related to inward (superior) shift of the complex at another inferior and inner end of the papillary muscle (PM) tip and/or systolic lengthening of the tissue complex, especially MV leaflets. MV annulus systolic expansion, PMs’ systolic superior shift, and MV leaflets’ systolic lengthening were evaluated by echocardiography with a speckle tracking analysis in 25 normal subjects, 25 subjects with holo-systolic MVP and 20 subjects with late-systolic MVP. PMs’ superior shift, MV leaflets’ lengthening, MV annular area at the onset of systole and subsequent MV annulus expansion were significantly greater in late-systolic MVP than in holo-systolic MVP (4.6 ± 1.6 versus 1.5 ± 0.7 mm/m2, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m2, 6.8 ± 2.5 versus 5.7 ± 1.0 cm2/m2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm2/m2, P < 0.001, respectively). Multivariate analysis identified MV leaflets’ lengthening and PMs’ superior shift as independent factors associated with MV annular expansion. Conclusions: These results suggest that systolic MV annular expansion in MVP is related to abnormal MV leaflets’ lengthening and PMs’ superior shift.
DOI： 10.1536/ihj.20-236