論文 - 海北 幸一
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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年2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：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年1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 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 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：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 査読あり
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：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? 査読あり
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年
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Pulmonary tumor thrombotic microangiopathy - Antemortem diagnosis with pulmonary artery wedge blood cell sampling in a recurrent breast cancer patient 査読あり
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年
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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年12月
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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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：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：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
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Ikeda T., Atarashi H., Inoue H., Uchiyama S., Kitazono T., Yamashita T., Shimizu W., Kamouchi M., Kaikita K., Fukuda K., Origasa H., Sakuma I., Saku K., Okumura Y., Nakamura Y., Morimoto H., Matsumoto N., Tsuchida A., Ako J., Sugishita N., Shimizu S., Shimokawa H.
Tohoku Journal of Experimental Medicine 240 ( 4 ) 259 - 268 2016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：Tohoku Journal of Experimental Medicine
The use of rivaroxaban, a factor Xa inhibitor, has been increasing for prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF) in Japan. We conducted the nationwide multicenter study, termed as the EXPAND Study, to address its effectiveness and safety in the real-world practice of patients with non-valvular AF in Japan. The EXPAND Study is a prospective, non-interventional, observational cohort study to evaluate the effectiveness and safety of rivaroxaban in non-valvular AF patients in a real-world clinical practice. A total of 7,178 patients with non-valvular AF were enrolled in 684 medical institutes between November 20, 2012 and June 30, 2014. As for the baseline demographic and clinical characteristics of 7,164 patients, the proportion of female patients was 32.2%, and those of patients with creatinine clearance < 50 mL/min and non-paroxysmal (persistent or permanent) AF were 21.8% and 55.1%, respectively. The proportions of patients complicated with hypertension, congestive heart failure, diabetes mellitus, and a history of ischemic stroke were 70.9%, 25.9%, 24.3%, and 20.2%, respectively. The proportions of patients with a CHADS score ≤ 1 and a CHA DS -VASc score ≤ 1 were 37.3% and 13.6%, respectively. They were followed up until March 31, 2016 for a mean follow-up period of approximately 2.5 years. The findings of the EXPAND Study will help to establish an appropriate treatment with rivaroxaban for Japanese patients with non-valvular AF. 2 2 2
DOI： 10.1620/tjem.240.259
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Association of CYP2C19 variants and epoxyeicosatrienoic acids on patients with microvascular angina 査読あり
Akasaka T., Sueta D., Arima Y., Tabata N., Takashio S., Izumiya Y., Yamamoto E., Yamamuro M., Tsujita K., Kojima S., Kaikita K., Kajiwara A., Morita K., Oniki K., Saruwatari J., Nakagawa K., Ogata Y., Matsui K., Hokimoto S.
American Journal of Physiology - Heart and Circulatory Physiology 311 ( 6 ) H1409 - H1415 2016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：American Journal of Physiology - Heart and Circulatory Physiology
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 arachi-donic acid by CYP2C19 epoxygenases and anti-inflammatory properties, especially in microvascular tissues. We examined the association of CYP2C19 polymorphisms and EETs on microvascular angina (MVA) caused by coronary microvascular dysfunction. We examined CYP2C19 genotypes in patients with MVA (« = 71) and healthy subjects as control (n = 71). MVA was defined as the 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-triphos-phate-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. MVA group showed significantly higher CYP2C19 PM incidence (35% vs. 16%; P = 0.007) and high sense C-reactive protein (hs-CRP) levels (0.127 ± 0.142 vs. 0.086 ± 0.097 mg/dl; P = 0.043) than those of controls. Moreover, in MVA group, hs-CRP levels in CYP2C19 PM were significantly higher than that of non-PM (0.180 ± 0.107 vs. 0.106 ± 0.149 mg/dl. P = 0.045). Multivariate analysis indicated that smoking, hypertension, high hs-CRP, and CYP2C19 PM are predictive factors for MVA. In MVA group, DHET levels for CYP2C19 PM were significantly lower than that of non-PM [10.9 ± 1.64 vs. 14.2 ± 5.39 ng/ml, P = 0.019 (11, 12-DHET); 15.2 ± 4.39 vs. 17.9 ± 4.73 ng/ml, P = 0.025 (14, 15-DHET)]. CYP2C19 variants are associated with MVA. The decline of EET-based defensive mechanisms owing to CYP2C19 variants may affect coronary microvascular dysfunction.
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Tsujita K., Kaikita K., Araki S., Yamada T., Nagamatsu S., Yamanaga K., Sakamoto K., Kojima S., Hokimoto S., Ogawa H.
BMC Cardiovascular Disorders 16 ( 1 ) 235 2016年11月
担当区分：責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：BMC Cardiovascular Disorders
Background: Coronary plaques in patients with coronary vasospastic angina have been characterized by diffuse intima-media thickening with homogeneous fibrous tissue, without confluent necrotic tissue. However, coronary vasospasm can trigger coronary thrombosis, and may play an important role in the pathogenesis of acute coronary syndromes, though the precise morphological mechanisms underlying this process remain unclear. Case presentation: A 43-year-old man with a history of multivessel coronary vasospastic angina had been treated with long-acting diltiazem and fluvastatin since 2004. Eleven years later, following 1 month of medication nonadherence, he experienced recurrence of rest angina and myocardial infarction, with elevated high-sensitivity troponin T. An emergency coronary angiogram demonstrated no de novo lesions, and the current episode was diagnosed as intractable sustained coronary spasm-induced anterior myocardial infarction. Optical coherence tomography imaging revealed the coronary plaque with homogeneous high-intensity signal, and a clearly visualized intraplaque neovascular microchannel (NVMC) network. Conclusions: Neovascularization within a coronary atheroma is known to accelerate coronary atherosclerosis. The current case with coronary vasospastic angina highlights the role of NVMC formation in this process.
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A rare case of long-term survival with idiopathic dilatation of the pulmonary artery 査読あり
Sueta D., Sugamura K., Shimizu H., Shiota T., Yamamuro M., Hirakawa K., Sakamoto K., Tsujita K., Hanatani S., Yamamoto E., Araki S., Kanazawa H., Kojima S., Kaikita K., Hokimoto S., Komohara Y., Ogawa H.
International Journal of Cardiology 223 337 - 339 2016年11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：International Journal of Cardiology
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Tokitsu T., Yamamoto E., Hirata Y., Kusaka H., Fujisue K., Sueta D., Sugamura K., Sakamoto K., Tsujita K., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
European Journal of Heart Failure 18 ( 11 ) 1353 - 1361 2016年11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 Journal of Heart Failure
Aims: Although pulse pressure (PP) is a recognized risk factor for various cardiovascular diseases, its association with cardiovascular outcomes in patients with heart failure with preserved ejection fraction (HFpEF) is uncertain. Methods and results: We enrolled 512 of 951 consecutive HFpEF patients admitted to the Kumamoto University Hospital between 2007 and 2013 and divided them into five groups according to PP quintiles. Blood pressure and pulse wave velocity (PWV) were measured by an ankle–brachial index device. The PP values in HFpEF were significantly and positively correlated with PWV and LV stroke volume index, and were negatively correlated with estimated glomerular filtration rate and haemoglobin levels. Furthermore, plasma B-type natriuretic peptide levels in HFpEF patients with the lowest (<45 mmHg) and highest PP (≥75 mmHg) were significantly higher than those with other PP (45–74 mmHg). The percentage of total cardiovascular and heart failure (HF)-related events by PP category resulted in U- and J-shaped curves. The higher frequency of coronary-related events was nearly linear. In the Kaplan–Meier analysis, HFpEF patients with the lowest and highest PP quintiles had a significantly higher risk of cardiovascular and HF-related events than those with other PPs (45–74 mmHg) (log-rank test, both P < 0.01). Conversely, the frequency of coronary-related events in the highest PP group, but not in the lowest PP group, was significantly higher than in other PP groups. Conclusion: Pulse pressure lower than 45 mmHg and higher than 75 mmHg was closely associated with HFpEF prognosis, indicating the clinical significance of PP for risk stratification of HFpEF.
DOI： 10.1002/ejhf.559
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Hokimoto S., Tabata N., Yamanaga K., Sueta D., Akasaka T., Tsujita K., Sakamoto K., Yamamoto E., Yamamuro M., Izumiya Y., Kaikita K., Kojima S., Matsui K., Ogawa H.
International Journal of Cardiology 222 185 - 194 2016年11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：International Journal of Cardiology
Background The aim was to examine the prevalence and characteristics of epicardial vasomotor abnormality (EVA) and coronary microvascular dysfunction (CMD) including endothelium-dependent (EDCMD) or -independent (EICMD) in patients following a second-generation drug-eluting stent (second DES) implantation without in-stent restenosis. Methods and results In 105 patients who underwent second DES implantation in the left anterior descending coronary artery (74 men; mean age, 67.9±9.6years), and in 105 suspected angina patients without stenting (65 men; mean age 66.4±9.1years), we evaluated EVA using the acetylcholine provocation test, EDCMD and EICMD by measuring the coronary flow reserve and the relationship between myocardial ischemia (intracoronary lactate production between aorta and coronary sinus and ST-T changes) or recurrent angina and vascular function. There was no difference in the incidence of EVA between DES and control (49.5% versus 55.2%; P = 0.41). Given that the prevalence of CMD was higher in DES than in control (59.0% versus 29.5%; P < 0.001), CMD may be associated with stent placement. Of the CMD patients, EDCMD alone, EICMD alone, and both CMDs were found in 40.3%, 22.6%, and 37.1%, respectively. Myocardial ischemia was detected in 42.4% of patients, and recurrent angina was more common in the presence of both EDCMD and EICMD in patients with EVA or CMD compared to patients with normal vascular function (EVA, 42.9% versus 7.7%, P = 0.015: CMD, 39.1% versus 7.7%, P = 0.007). Conclusions Myocardial ischemia and recurrent angina may be caused by the presence of both EDCMD and EICMD after a second DES implantation without ISR.
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Tabata N., Sueta D., Akasaka T., Arima Y., Sakamoto K., Yamamoto E., Izumiya Y., Yamamuro M., Tsujita K., Kojima S., Kaikita K., Morita K., Oniki K., Saruwatari J., Nakagawa K., Hokimoto S.
PLoS ONE 11 ( 11 ) e0166240 2016年11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：PLoS ONE
Background Helicobacter pylori infection and interleukin-1 polymorphisms are associated with an increased risk of gastric cancer. We examined the prevalence of Helicobacter pylori seropositivity and interleukin-1 polymorphisms between ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients. Methods We recruited consecutive acute coronary syndrome patients, and 101 non-ST-segment elevation acute coronary syndrome patients and 103 ST-segment elevation myocardial infarction patients were enrolled. Interleukin-1 polymorphism analyses were performed for single nucleotide polymorphism in interleukin-1 beta-511 and the variable number of tandem repeats polymorphism in the interleukin-1 receptor antagonist by polymerase chain reaction. Immunoglobulin G antibodies against Helicobacter pylori and high sensitivity C-reactive protein were also measured. Results The rates of the simultaneous presence of interleukin-1 polymorphisms and Helicobacter pylori-seropositivity between non-ST-segment elevation acute coronary syndrome and STsegment elevation myocardial infarction groups were 25.7% and 42.7%, respectively (P = 0.012). Helicobacter pylori-seropositive subjects with interleukin-1 polymorphisms showed significantly higher levels of high sensitivity C-reactive protein (0.04-0.12 vs. 0.02-0.05; P<0.001). Multivariate logistic regression analysis revealed that the carriage of Helicobacter pylori-seropositivity and interleukin-1 polymorphisms was significantly associated with STsegment elevation myocardial infarction (odds ratio, 2.32; 95% confidence interval, 1.23-4.37; P = 0.009). The C-statistic of conventional risk factors was 0.68 (P<0.001) and that including Helicobacter pylori-seropositivity and interleukin-1 polymorphisms was 0.70 (P<0.001); continuous net reclassification improvement was 34% (P = 0.0094) and integrated discrimination improvement was 3.0% (P = 0.014). Conclusions The coincidence of Helicobacter pylori-seropositivity and interleukin-1 polymorphisms was significantly associated with higher levels of high sensitivity C-reactive protein and the increased risk of ST-segment elevation myocardial infarction.
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Tsujita K., Yamanaga K., Komura N., Sakamoto K., Miyazaki T., Oimatsu Y., Ishii M., Tabata N., Akasaka T., Sueta D., Yamamoto E., Yamamuro M., Izumiya Y., Kojima S., Nakamura S., Kaikita K., Hokimoto S., Ogawa H.
International Journal of Cardiology 220 112 - 115 2016年10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：International Journal of Cardiology
Background Although acute coronary syndrome (ACS) mainly arises from plaque ruptures (PR), precise mechanisms underlying ACS without PR are unknown. We sought to examine clinical, angiographic and intravascular ultrasound (IVUS) characteristics of ACS without PR. Methods and results Culprit lesions of 161 ACS patients were categorized by the presence or absence of PR (PR group: n = 57, Non-PR group: n = 104). Lower abdominal circumference (86 ± 10 cm vs 90 ± 9 cm, p = 0.02), lower prevalence of myocardial infarction (53% vs 82%, p = 0.0002), and higher prevalence of definite vasospasm (15% vs 2%, p = 0.006) were found in Non-PR group. Morphologically, Non-PR group was associated with simpler Ambrose classification (36% vs 14%, p = 0.004), less hypoechoic plaque (45% vs 65%, p = 0.04) and lower incidence of IVUS-detected thrombus (21% vs 54%, p < 0.0001), compared with PR group. On quantitative IVUS, although minimum lumen area (MLA) was similar between the groups, vessel (14.2 ± 5.4 mm vs 17.5 ± 5.1 mm , p = 0.0002) and plaque (11.6 ± 5.0 mm vs 14.9 ± 4.9 mm , p < 0.0001) areas were significantly smaller at MLA site in Non-PR group than in PR group. On multivariate analysis, average plaque area was only an independent IVUS-predictor of non-rupture ACS (odds ratio: 0.85, p = 0.01). Conclusion Compared to ACS with PR, non-rupture ACS arise from more hyperechoic (allegedly “stable”) plaque with smaller vessel and plaque area, leading to lower incidence of thrombotic occlusion. Coronary vasospasm might be a possible pathogenic mechanism underlying non-rupture ACS. 2 2 2 2
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Ishii M., Kaikita K., Sato K., Yamanaga K., Miyazaki T., Akasaka T., Tabata N., Arima Y., Sueta D., Sakamoto K., Yamamoto E., Tsujita K., Yamamuro M., Kojima S., Soejima H., Hokimoto S., Matsui K., Ogawa H.
International Journal of Cardiology 220 328 - 332 2016年10月
担当区分：責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Background Coronary spasm is one of the mechanisms of myocardial infarction with nonobstructive coronary arteries (MINOCA). The aim of this study was to investigate the effects of aspirin on future cardiovascular events in patients with coronary vasospastic angina (VSA) with non-significant atherosclerotic stenosis. Methods This was the retrospective analysis of the 640 VSA patients with non-significant atherosclerotic stenosis (≤ 50% stenosis) among 1,877 consecutive patients who underwent acetylcholine (ACh)-provocation testing between January 1991 and December 2010. The patients were divided into 2 groups treated with (n = 137) or without (n = 503) low-dose aspirin (81–100 mg/day). We evaluated major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction, and unstable angina. Results In the study population, 24 patients (3.8%) experienced MACE; there were 6 cases in VSA patients with aspirin and 6 in those without aspirin. Multivariate Cox hazards analysis for correlated factors of MACE indicated that use of statin (HR: 0.11; 95% CI: 0.02 to 0.84; P = 0.033), ST-segment elevation during attack (HR: 5.28; 95% CI: 2.19–12.7; P < 0.001), but not the use of aspirin as a significant predictor of MACE. After propensity score matching (n = 112, each), Kaplan–Meier survival analysis indicated almost identical rate of 5-year survival free from MACE in those with aspirin, compared to those without aspirin in the entire and matched cohort (P = 0.640 and P = 0.541, respectively). Conclusions Low-dose aspirin might not reduce future cardiovascular events in VSA patients with non-significant stenosis.
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Changes in the risk factors for coronary spasm 査読あり
Ishii M., Kaikita K., Sato K., Yamanaga K., Miyazaki T., Akasaka T., Tabata N., Arima Y., Sueta D., Sakamoto K., Yamamoto E., Tsujita K., Yamamuro M., Kojima S., Soejima H., Hokimoto S., Matsui K., Ogawa H.
IJC Heart and Vasculature 12 85 - 87 2016年9月
担当区分：責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：IJC Heart and Vasculature