Papers - KAIKITA Koichi
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Tabata N., Yamamoto E., Hokimoto S., Yamashita T., Sueta D., Takashio S., Arima Y., Izumiya Y., Kojima S., Kaikita K., Matsui K., Fujimoto K., Sakamoto K., Shimomura H., Tsunoda R., Hirose T., Nakamura N., Sakaino N., Nakamura S., Yamamoto N., Matsumura T., Kajiwara I., Koide S., Sakamoto T., Nakao K., Oshima S., Tsujita K., Hanatani S., Fujisue K., Horio E., Morihisa K., Nishijima T., Noda K., Nagano M., Fukunaga T., Taguchi E., Miyamoto S., Katayama T., Matsubara J., Matsukawa M., Miyao Y., Ogura Y., Kudo T., Yamada Y., Usuku H., Yoshimura H., Fuchigami S., Ikemoto T., Ito T., Uemura T., Kurokawa H., Maruyama H., Sato K., Yamanaga K., Nakamura S., Chitose T., Ono T., Abe K., Doi H., Miyazaki T., Miura M., Okuyama E., Kikuta K., Kusaka H., Kuroki K., Fukushima R., Tayama S., Rokutanda T., Hanaoka Y.
Journal of the American Heart Association 6 ( 8 ) 2017.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
Background--The CHADS score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS score in predicting cardiovascular/cerebrovascular events in coronary artery disease patients without atrial fibrillation. Methods and Results--This was a multicenter, observational cohort study. The subjects had been admitted to one of the participating institutions with coronary artery disease requiring percutaneous coronary intervention. We calculated the CHADS scores for 7082 patients (mean age, 69.7 years; males, 71.9%) without clinical evidence of atrial fibrillation. Subjects were subdivided into low- (0-1), intermediate- (2-3), and high-score (4-6) groups and followed for 1 year. The end point was a composite of cardiovascular/cerebrovascular death, nonfatal myocardial infarction, and ischemic stroke at 1-year follow-up. Rates of triple-vessel/left main trunk disease correlated positively with CHADS score categories. CHADS scores among single, double, and triple-vessel/left main trunk groups were 2 (1-2), 2 (1-3), and 2 (2-3), respectively (P < 0.001). A total of 194 patients (2.8%) had a cardiovascular/cerebrovascular event, and Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular/cerebrovascular events in proportion to a higher CHADS score (log-rank test, P < 0.001). Multivariate Cox hazard analysis identified CHADS score (per 1 point) as an independent predictor of cardiovascular/cerebrovascular events (hazard ratio, 1.31; 95% CI, 1.17-1.47; P < 0.001). Conclusions--This large cohort study indicated that the CHADS score is useful for the prediction of cardiovascular/cerebrovascular events in coronary artery disease patients without atrial fibrillation. 2 2 2 2 2 2 2 2
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CYP2C19 variants and epoxyeicosatrienoic acids in patients with microvascular angina Reviewed
Akasaka T., Sueta D., Arima Y., Tabata N., Takashio S., Izumiya Y., Yamamoto E., Tsujita K., Kojima S., Kaikita K., Kajiwara A., Morita K., Oniki K., Saruwatari J., Nakagawa K., Hokimoto S.
IJC Heart and Vasculature 15 15 - 20 2017.6
Language：English Publishing type：Research paper (scientific journal) Publisher：IJC Heart and Vasculature
Background Categorization as a cytochrome P450 (CYP) 2C19 poor metabolizer (PM) is reported to be an independent risk factor for cardiovascular disease. Epoxyeicosatrienoic acids (EETs) are metabolites of arachidonic acid by CYP2C19 epoxygenases and anti-inflammatory properties, especially in microvascular tissues. We examined the impact of CYP2C19 polymorphisms and EETs on the patients with microvascular angina (MVA) caused by coronary microvascular dysfunction. Methods and results We examined CYP2C19 genotypes in patients with MVA (n = 81). MVA was defined as absence of coronary artery stenosis and epicardial spasms, and the presence of inversion of lactic acid levels between intracoronary and coronary sinuses in acetylcholine-provocation test or the adenosine-triphosphate-induced coronary flow reserve ratio was below 2.5. CYP2C19 PM have two loss-of-functon alleles (*2, *3). We measured serum dihydroxyeicosatrienoic acid (DHET) as representative EET metabolite. In MVA, the patients with CYP2C19 PM were 34.6% and high sense C-reactive protein (hs-CRP) levels in CYP2C19 PM were significantly higher than that of non-PM group (0.165 ± 0.116 vs. 0.097 ± 0.113 mg/dL, P = 0.026). Moreover, DHET levels in CYP2C19 PM were significantly lower than that of non-PM (10.4 ± 4.58 vs. 15.6 ± 11.1 ng/mL, P = 0.003 (11,12-DHET); 12.1 ± 3.79 vs. 17.3 ± 6.49 ng/mL, P = 0.019 (14,15-DHET)). Conclusions The decline of EET owing to CYP2C19 variants may affects coronary microvascular dysfunction via chronic inflammation.
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Yamamura S., Izumiya Y., Ishida T., Onoue Y., Kimura Y., Hanatani S., Araki S., Fujisue K., Sueta D., Kanazawa H., Takashio S., Usuku H., Sugamura K., Sakamoto K., Yamamoto E., Yamamuro M., Yasuda H., Kojima S., Kaikita K., Hokimoto S., Ogawa H., Tsujita K.
Heart and Vessels 32 ( 6 ) 708 - 713 2017.6
Language：English Publishing type：Research paper (scientific journal) Publisher：Heart and Vessels
Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Impaired atrial function, in addition to ventricular diastolic dysfunction, is one of the hallmarks of cardiac amyloidosis. Here, we assessed the hypothesis that atrial function evaluated by A-velocity in pulse Doppler echocardiography is useful to differentiate ATTRwt in elderly patients with LVH. We analyzed 133 consecutive patients who underwent tissue biopsy to rule out infiltrative cardiomyopathy in our institute. We excluded patients younger than 50 years, without LVH (LV thickness was less than 12 mm), with other types of cardiac amyloidosis and patients with chronic atrial fibrillation, and analyzed remaining 51 patients (ATTRwt: 16, non-ATTRwt: 35). ATTRwt patients were significantly older and had advanced heart failure compared with non-ATTRwt group. In echocardiography, E/A, E/e′, and relative wall thickness was significantly higher in ATTRwt group than non-ATTRwt group. A-velocity was significantly decreased in ATTRWT group compared with non-ATTRwt group (40.8 ± 20.8 vs. 78.7 ± 28.2 cm/s, p = 0.0001). Multivariate logistic analysis using eight forced inclusion models identified trans-mitral Doppler A-wave velocity was more significant factor of cardiac amyloidosis in ATTRwt. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for A-wave velocity in discrimination between ATTRwt and non-ATTRwt were 0.86 (CI 0.76–0.96, p < 0.001). The cut-off value was 62.5 cm/s, and it yielded the best combination of sensitivity (69.7%) and specificity (87.5%) for prediction of amyloidosis. We concluded that reduced A-velocity predicts the presence of ATTRwt in elderly patients with LVH in sinus rhythm.
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Akasaka T., Sueta D., Tabata N., Takashio S., Yamamoto E., Izumiya Y., Tsujita K., Kojima S., Kaikita K., Matsui K., Hokimoto S.
Journal of the American Heart Association 6 ( 5 ) 2017.5
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
Background-Mean amplitude of glycemic excursion (MAGE) is commonly used to gauge the degree of glucose level fluctuations. MAGE plays a significant role in vascular endothelial dysfunction and cardiovascular events in patients with diabetes mellitus (DM), but its significance is not clear in non-DM patients. Thus, we examined the impact of MAGE and vascular endothelial dysfunction on clinical outcomes in non-DM patients with coronary artery disease. Methods and Results-We followed non-DM patients (n = 65) for 12 months who underwent percutaneous coronary intervention and assessed the relationship among MAGE, reactive hyperemia index (RHI) measured by reactive hyperemia peripheral arterial tonometry as endothelial function, and cardiovascular events. Cardiovascular events analyzed were cardiovascular death, myocardial infarction, unstable angina, and revascularizations. Compared with patients with MAGE < 65 mg/dL (normal glycemic excursions), the group with MAGE ≥ 65 mg/dL (high glycemic excursions) had significantly higher high-sensitivity C-reactive protein (0.10±0.11 mg/dL versus 0.18±0.13 mg/dL, P = 0.006) and lower RHI (0.64±0.21 versus 0.51±0.22, P = 0.035). The multivariable analysis identified high MAGE and low RHI ( ≤ 0.56) as risk factors associated with cardiovascular events (hazard ratio, 5.6; 95% RI, 1.72-18.4 [P = 0.004] versus hazard ratio, 4.5; 95% RI, 1.37-14.9 [P = 0.013]). When the prognosis was classified by combination with MAGE and RHI, the incidence of cardiovascular events was 46.7% (high MAGE+low RHI), 26.7% (high MAGE+high RHI), 20.0% (low MAGE+low RHI), and 6.6% (low MAGE+high RHI) in descending order (P = 0.014). Receiver operating characteristic curve analysis revealed that MAGE, RHI, and MAGE+RHI were each associated with cardiovascular events (area under the curve 0.780, 0.727, and 0.796, respectively). Conclusions-MAGE was associated with cardiovascular events in non-DM patients with coronary artery disease. Furthermore, the combination with MAGE and RHI was useful for further subdivision of the risk of cardiovascular events.
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Sueta D., Suyama K., Sueta A., Tabata N., Yamashita T., Tomiguchi M., Takeshita T., Yamamoto-Ibusuki M., Yamamoto E., Izumiya Y., Kaikita K., Yamamoto Y., Hokimoto S., Iwase H., Tsujita K.
Atherosclerosis 260 116 - 120 2017.5
Language：English Publishing type：Research paper (scientific journal) Publisher：Atherosclerosis
Background and aims Lenvatinib (Lenvima ), an oral multi-kinase inhibitor, is effective in the treatment of differentiated thyroid carcinomas (DTCs). A severe adverse effect of lenvatinib is hypertension, thus limiting its use as an anti-cancer treatment. Although the pathogenesis of hypertension is generally assumed to involve microvascular bed reduction and an increase in peripheral vascular resistance due to a decrease in nitrogen oxide (NOx) production after vascular endothelial growth factor (VEGF) inhibition, the effects of hypertension on vascular endothelial function in actual patients remain unclear. Here, we examined how lenvatinib affects vascular endothelial function. Methods Ten consecutive DTC patients who did not take any cardiovascular agents were orally administered 24 mg of lenvatinib once daily. Using an EndoPAT2000 system, we used reactive hyperemia-peripheral arterial tonometry (RH-PAT) and evaluated vascular endothelial function on the basis of the RH-PAT index (RHI). We expressed the results as %RHI, which indicates the change compared with pretreatment levels. Additionally, we measured serum NOx and plasma VEGF concentrations pre- and post-treatment. Results All of the patients treated with lenvatinib exhibited significant hypertension; the %RHI levels were significantly decreased the day after treatment with lenvatinib. Furthermore, serum NOx and plasma VEGF concentrations were significantly decreased and increased, respectively, compared with pretreatment levels. These results indicate that hypertension induced by lenvatinib may be caused by a decrease in nitric oxide production, as a result of VEGF inhibition and impaired vascular endothelial function. Conclusions We provide the first demonstration that lenvatinib causes hypertension via vascular endothelial dysfunction in human subjects. ® ®
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Oimatsu Y., Kaikita K., Ishii M., Mitsuse T., Ito M., Arima Y., Sueta D., Takahashi A., Iwashita S., Yamamoto E., Kojima S., Hokimoto S., Tsujita K.
Journal of the American Heart Association 6 ( 4 ) 2017.4
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
BACKGROUND: Periprocedural bleeding events are common after percutaneous coronary intervention. We evaluated the association of periprocedural bleeding events with thrombogenicity, which was measured quantitatively by the Total Thrombus-formation Analysis System equipped with microchips and thrombogenic surfaces (collagen, platelet chip [PL]; collagen plus tissue factor, atheroma chip [AR]).
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Tabata N., Sueta D., Yamashita T., Utsunomiya D., Arima Y., Yamamoto E., Tsujita K., Kojima S., Kaikita K., Hokimoto S.
Hypertension Research 40 ( 4 ) 392 - 398 2017.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Hypertension Research
Little is known about the significance of asymptomatic intra-cranial lesions (ICL) identified by brain MRI in coronary artery disease (CAD) patients. Silent cerebral lesions are suggested to be associated with arterial stiffness in healthy subjects. We investigated whether subclinical ICL are associated with arterial stiffness and the prognosis in CAD patients without medical history of cerebrovascular diseases. We recruited CAD patients who required percutaneous coronary intervention (PCI), did not meet exclusion criteria, and agreed with MRI before PCI. Subjects were divided into two groups according to the presence of ICL of cerebral microbleeds or lacunar infarction. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Clinical outcome was defined as a composite of cardiovascular death, non-fatal myocardial infarction, stroke, unstable angina and heart failure. In total, 149 patients underwent brain MRI. Patients with ICL (n=55) had significantly higher baPWV than those without ICL (1591-2204 vs. 1450-1956 cm per sec; P=0.009). A multivariate analysis showed that male sex (odds ratio (OR), 3.15; 95% confidence interval (CI), 1.38-7.20; P=0.006) and baPWV (OR, 1.001; 95% CI, 1.000-1.002; P=0.023) were predictors of ICL. In total, 12 patients experienced a cardiovascular event. The Kaplan-Meier analysis indicated a significantly higher incidence of cardiovascular events in patients with ICL (log-rank test: P=0.018). Multivariate Cox proportional hazards analyses indicated that ICL finding was a significant predictor of clinical outcome (hazard ratio, 3.41; 95% CI, 1.02-11.5; P=0.047). Patients with subclinical ICL had a higher baPWV and worse prognoses than those without ICL.
DOI： 10.1038/hr.2016.159
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Sueta D., Ito M., Uchiba M., Sakamoto K., Yamamoto E., Izumiya Y., Kojima S., Kaikita K., Shinriki S., Hokimoto S., Matsui H., Tsujita K.
Thrombosis Journal 15 ( 1 ) 8 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Thrombosis Journal
Background: Because the venous thromboembolisms (VTEs) due to the coagulation factor V R506Q (FV Leiden) mutation is often seen in Caucasians, the VTE onset in Japan has not been reported. Case presentation: A 34-year-old man from north Africa experiencing sudden dyspnea went to a hospital for advice. The patient had pain in his right leg and a high plasma D-dimer level. A contrast-enhanced computed tomography scan revealed a contrast deficit in the bilateral pulmonary artery and in the right lower extremity. The patient was diagnosed with VTE, and anticoagulation therapy was initiated. Our targeted gene panel sequencing revealed that the occurrence of VTE was attributed to a presence of the FV Leiden mutation. Conclusions: This is the first report demonstrating VTE caused by the FV Leiden mutation in Japan.
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Sueta D., Hokimoto S., Sakamoto K., Akasaka T., Tabata N., Kaikita K., Honda O., Naruse M., Ogawa H.
International Journal of Cardiology 230 97 - 102 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background Malnutrition-Inflammation-Atherosclerosis (MIA) factors significantly and independently affect life prognosis of hemodialysis (HD) patients. We re-evaluated Japanese data, which have progressed ahead from a community-based observational study. The present study was designed to assess the contribution of these MIA factors to the mortality rate of Japanese HD patients in a community of 1.8 million people over a 36-month follow-up period. Methods and results A total of 5813 patients at 76 facilities were on maintenance HD in the Kumamoto Prefecture. Specifically, 4807 of these patients at 58 institutions were enrolled. Patients who exhibited lower serum albumin and higher serum C-reactive protein levels were defined as “malnourished” and “inflamed”, respectively, compared with the median values. Patients who underwent invasive procedures for atherosclerotic diseases were defined as “atherosclerotic”. The 36-month all-cause mortality rate in Japanese HD patients was 12.4%. This rate directly correlated with the number of MIA factors. The odds ratio of the all-cause mortality rate markedly and significantly increased as the number of factors increased. The presence of 3 MIA factors in HD patients was a significant predictor of mortality, as evidenced by a multivariate logistic regression analysis. Conclusions This study clearly demonstrated the close association between MIA syndrome and high mortality in Japanese HD patients. Early detection and the adjustment of MIA factors are mandatory.
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Hirakawa K., Yamamuro M., Uemura T., Takashio S., Kaikita K., Utsunomiya D., Nakayama M., Yamamoto E., Yamashita Y., Hokimoto S., Tsujita K.
International Journal of Cardiology 228 881 - 885 2017.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Backgrounds The relationship between microvascular dysfunction and plasma B-type natriuretic peptide (BNP) levels remains unclear in heart failure (HF) patients with cardiac fibrosis. Methods This study evaluated 55 consecutive non-ischemic HF patients in an effort to determine the relationship between endothelial independent coronary microvascular dysfunction and plasma BNP levels, as well as whether each measure is correlated with myocardial fibrosis. We evaluated plasma BNP levels in patients with stable HF. We used cardiac catheterization to measure trans-cardiac BNP release levels, measuring from the coronary sinus and the aortic root, and coronary flow reserve (CFR). Patients also underwent cardiac magnetic resonance imaging to evaluate for the presence of late gadolinium enhancement (LGE), as an indicator of cardiac fibrosis. Results CFR in cardiac catheterization was significantly and inversely correlated with plasma BNP levels (r = 0.336, p = 0.012) and trans-cardiac BNP release levels (r = 0.347, p = 0.041). Thirty-three patients were LGE-positive. CFR was significantly correlated with plasma BNP levels in the LGE-positive group (r = 0.349, p = 0.046), but this correlation was not significant in the LGE-negative group. (r = 0.338, p = 0.125). Multivariate logistic regression analysis revealed that a plasma BNP levels > 180 pg/ml at stable HF condition was significant and independent predictor of CFR < 2.5 in all patients (p = 0.035, odds ratio: 5.2, 95% confidence interval: 1.1–29.0), and in the LGE-positive group (p = 0.040, odds ratio: 5.4, 95% confidence interval: 1.1–27.2). Conclusions In non-ischemic HF patients especially those with cardiac fibrosis, endothelial independent microvascular dysfunction is closely correlated with plasma BNP levels, and ventricular wall tension.
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Nakashima N., Sueta D., Kanemaru Y., Takashio S., Yamamoto E., Hanatani S., Kanazawa H., Izumiya Y., Kojima S., Kaikita K., Hokimoto S., Tsujita K.
Thrombosis Journal 15 ( 1 ) 4 2017.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Thrombosis Journal
Background: Although vein stenting is popular for treatment for venous thromboembolism due to mechanical compression, some cases are forced to avoid inserting align agents because of immunodeficiency. Case presentation: An 82-year-old man with left extremity redness and swelling presented to a hospital for a medical evaluation. The patient was immunodeficient because of the adverse effects of his treatment for Castleman's disease. A contrast-enhanced computed tomography scan revealed a venous thromboembolism in inferior vena cava and the left lower extremity. Magnetic resonance venography showed that the iliac artery was compressing the iliac vein. We were reluctant to place a stent in the iliac vein has because of the patient's immunodeficient status. Three months of treatment using single-dose edoxaban (30 mg daily) resulted in complete resolution of the thrombus. This is the first report demonstrating that single-dose edoxaban without acute-phase parenteral anticoagulation is effective in the treatment of iliac vein compression. Conclusions: A single-dose direct oral anti-coagulant without acute-phase parenteral anticoagulation is effective for mechanical compression
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Akasaka T., Hokimoto S., Sueta D., Tabata N., Oshima S., Nakao K., Fujimoto K., Miyao Y., Shimomura H., Tsunoda R., Hirose T., Kajiwara I., Matsumura T., Nakamura N., Yamamoto N., Koide S., Nakamura S., Morikami Y., Sakaino N., Kaikita K., Nakamura S., Matsui K., Ogawa H.
Journal of Cardiology 69 ( 1 ) 103 - 109 2017.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology
Background Based on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS). Methods and results From August 2008 to March 2011, subjects (n = 3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n = 2764) or without (n = 477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p = 0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p = 0.200]. There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p < 0.001; STEMI, 21.9% vs. 14.5%, p = 0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p = 0.547; STEMI, 11.2% vs. 7.5%, p = 0.210). Conclusions There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.
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Fujisue K., Sugamura K., Kurokawa H., Matsubara J., Ishii M., Izumiya Y., Kaikita K., Sugiyama S.
Circulation Journal 81 ( 8 ) 1174 - 1182 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background: Several studies have reported that colchicine attenuated the infarct size and inflammation in acute myocardial infarction (MI). However, the sustained benefit of colchicine administration on survival and cardiac function after MI is unknown. It was hypothesized that the short-term treatment with colchicine could improve survival and cardiac function during the recovery phase of MI. Methods and Results: MI was induced in mice by permanent ligation of the left anterior descending coronary artery. Mice were then orally administered colchicine 0.1 mg/kg/day or vehicle from 1 h to day 7 after MI. Colchicine significantly improved survival rate (colchicine, n=48: 89.6% vs. vehicle, n=51: 70.6%, P<0.01), left ventricular end-diastolic diameter (5.0±0.2 vs. 5.6±0.2 mm, P<0.05) and ejection fraction (41.5±2.1 vs. 23.8±3.1%, P<0.001), as assessed by echocardiogram compared with vehicle at 4 weeks after MI. Heart failure development as pulmonary edema assessed by wet/dry lung weight ratio (5.0±0.1 vs. 5.5±0.2, P<0.01) and B-type natriuretic peptide expression in the heart was attenuated in the colchicine group at 4 weeks after MI. Histological and gene expression analysis revealed colchicine significantly inhibited the infiltration of neutrophils and macrophages, and attenuated the mRNA expression of pro-inflammatory cytokines and NLRP3 inflammasome components in the infarcted myocardium at 24 h after MI. Conclusions: Short-term treatment with colchicine successfully attenuated pro-inflammatory cytokines and NLRP3 inflammasome, and improved cardiac function, heart failure, and survival after MI.
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Sueta D., Akahoshi R., Okamura Y., Kojima S., Ikemoto T., Yamamoto E., Izumiya Y., Tsujita K., Kaikita K., Katabuchi H., Hokimoto S.
Internal Medicine 56 ( 4 ) 409 - 412 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Internal Medicine
A 40-year-old woman experiencing sudden dyspnea went to her personal doctor for advice. She was previously diagnosed with endometriosis and prescribed oral contraceptives for treatment. During earthquakes, she spent 7 nights sleeping in a vehicle. The patient had swelling and pain in her left leg and high D-dimer concentration levels. A contrast-enhanced computed tomography scan revealed a contrast deficit in the bilateral pulmonary artery and in the left lower extremity. She was diagnosed with pulmonary thromboembolism (PTE), and anticoagulation therapy was initiated. This present case is the first report of PTE attributed to the use of oral contraceptives after earthquakes.
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Simultaneous idiopathic dissections of the coronary and superior mesenteric arteries Reviewed
Nishi M., Sueta D., Miyazaki T., Sakamoto K., Yamamoto E., Izumiya Y., Tsujita K., Kojima S., Kaikita K., Ikeda O., Yamashita Y., Hokimoto S.
Internal Medicine 56 ( 11 ) 1363 - 1367 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Internal Medicine
A 49-year-old man complained of sudden upper abdominal pain but was not given a definitive diagnosis. The day after he was discharged, he noticed left chest pain. An in-depth electrocardiogram indicated acute myocardial infarction, and emergent coronary angiography revealed 99% stenosis of his left coronary artery. An intravascular ultrasound revealed spontaneous coronary artery dissection (SCAD), and the lesion was successfully stented. In an atherosclerosis screening, superior mesenteric artery dissection (SMAD) was confirmed, after which the lesion was successfully stented. This case suggests that SCAD and SMAD might have similar pathological backgrounds.
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When Is the Optimal Timing of Surgical Intervention for Severe Functional Tricuspid Regurgitation? Reviewed
Nakanishi N, Ishii M, Kaikita K, Okamoto K, Izumiya Y, Yamamoto E, Takashio S, Hokimoto S, Fukui T, Tsujita K
Case reports in cardiology 2017 9232658 2017
Language：English Publishing type：Research paper (scientific journal)
DOI： 10.1155/2017/9232658
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Pulmonary tumor thrombotic microangiopathy - Antemortem diagnosis with pulmonary artery wedge blood cell sampling in a recurrent breast cancer patient Reviewed
Fuchigami S, Tsunoda R＊, Shimizu H, Takae M, Usuku H, Yoshimura H, Ikemoto T, Nagamine M, Ito T, Izumiya Y, Kaikita K, Hokimoto S, Tsujita K
Circulation Journal 81 ( 12 ) 1959 - 1960 2017
Language：English Publishing type：Research paper (scientific journal)
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冠動脈疾患における抗血小板療法
海北幸一, 小川久雄.
医学のあゆみ 259 ( 14 ) 1453 - 1458 2016.12
Authorship：Lead author Publishing type：Research paper (scientific journal)
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Uemura T., Yamamuro M., Kaikita K., Takashio S., Utsunomiya D., Hirakawa K., Nakayama M., Sakamoto K., Yamamoto E., Tsujita K., Kojima S., Hokimoto S., Yamashita Y., Ogawa H.
Heart and Vessels 31 ( 12 ) 1969 - 1979 2016.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Heart and Vessels
Myocardial fibrosis and microvascular dysfunction are key determinants of outcome in heart failure (HF); we examined their relationship in patients with HF. Our study included 61 consecutive patients with HF but without coronary stenosis. All underwent gadolinium-enhanced cardiac magnetic resonance to evaluate late gadolinium enhancement (LGE) and an acetylcholine (ACh) provocation test to evaluate microvascular dysfunction. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations. We quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. We detected LGE in 34 patients (LGE-positive); 27 were LGE-negative. Coronary blood flow volume increased significantly after the ACh provocation test only in LGE-negative patients (before vs. after ACh, 47.5 ± 36.8 vs. 69.2 ± 48.0 ml/min, respectively; p = 0.004). The myocardial lactate extraction ratio (LER) significantly decreased after the ACh test in both groups (LGE-negative, p = 0.001; LGE-positive, p < 0.001), significantly more so in the LGE-positive group (p = 0.017). Multivariate logistic regression analysis showed that a post-ACh LER < 0 (indicating myocardial lactate production) was a significant predictor of LGE-positivity (odds ratio 4.54; 95 % confidence interval 1.38–14.93; p = 0.013). In the LGE-positive group, an LGE volume greater than the median significantly predicted a post-ACh LER of <0 (p = 0.042; odds ratio 6.02; 95 % confidence interval 1.07–33.86). ACh-provoked coronary vasomotor abnormality is closely correlated with myocardial fibrosis in patients with HF but without organic coronary stenosis. Coronary vasomotor abnormalities in fibrotic myocardium may worsen HF.
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Yamamoto E., Sugiyama S., Hirata Y., Tokitsu T., Tabata N., Fujisue K., Sugamura K., Sakamoto K., Tsujita K., Matsumura T., Kaikita K., Hokimoto S.
Atherosclerosis 255 210 - 216 2016.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Atherosclerosis
Background and aims This study investigated the association of leukocyte subtype counts with vascular endothelial dysfunction and future cardiovascular events in patients with coronary artery disease (CAD). Methods The study included 389 consecutive CAD patients (259 male, 130 female; mean age, 70.1 ± 9.9 years). The patients underwent coronary angiography, and measurement of blood parameters, including leukocyte subtype counts. Results There were 84 cardiovascular events during a mean follow-up of 586 ± 378 days. Kaplan–Meier analysis showed a higher probability of cardiovascular events in the high-monocyte group (≥360/mm ) compared with the low-monocyte group (<360/mm ) (log-rank test, p = 0.047). Multivariate Cox hazard analysis identified a high monocyte count as an independent predictor of cardiovascular events (hazard ratio: 1.63, 95% confidence interval:1.05–2.51, p = 0.028). Peripheral endothelial function in 355 of the CAD patients was assessed by reactive hyperemia peripheral arterial tonometry index (RHI) to examine the association of ln-RHI with leukocyte subtype counts. Total leukocyte, monocyte and neutrophil counts were significantly higher in CAD patients with low ln-RHI (<0.57: the mean ln-RHI value) compared with those with high ln-RHI (≥0.57). Univariate analyses revealed that ln-RHI in CAD patients was positively correlated with ln-total leukocyte (r = −0.187, p < 0.001), ln-monocyte (r = 0.316, p < 0.001), and neutrophil (r = −0.175, p = 0.001) counts. Multiple regression analysis showed that the monocyte count was a significant and independent factor associated with ln-RHI (adjusted R = 0.126, p < 0.001). Conclusions A high monocyte count was an independent and incremental predictor of cardiovascular events in CAD patients. The monocyte count was also significantly correlated with peripheral endothelial dysfunction in CAD patients. 3 3 2