Papers - KAIKITA Koichi
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Yamamoto M., Yamamoto E., Yasuda O., Yasuda H., Sakamoto K., Tsujita K., Izumiya Y., Kaikita K., Hokimoto S., Ogawa H.
Journal of Cardiology Cases 12 ( 6 ) 195 - 198 2015.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology Cases
We herein report a case of Werner's syndrome (WS) with cardiac syndrome X (CSX) and heart failure with preserved ejection fraction (HFpEF), receiving nicorandil treatment. A 58-year-old woman with chest discomfort on exercise was suspected of having effort-angina pectoris because of broad ST-depression in electrocardiogram of exercise test and reversible defect in the posterior-wall portion of left ventricle in exercise thallium myocardial scintigraphy. This patient also exhibited HFpEF, diagnosed by increased ratio of early-transmitral-flow-velocity to tissue-Doppler early-diastolic mitral annular velocity (E/e') in echocardiography and plasma B-type natriuretic peptide (BNP) levels. However, coronary angiography revealed no organic stenosis in epicardial coronary arteries, and coronary physiological measurements by PressureWire™ (St. Jude Medical, St Paul, MN, USA) demonstrated that coronary flow reserve (CFR) was greatly decreased. Because impaired CFR represents coronary microvascular dysfunction in the absence of obstructive coronary narrowing, we diagnosed CSX, and initiated the administration of nicorandil to improve coronary microcirculation. After three-month-treatment of nicorandil, the patient's symptoms were diminished, and reversible defect in exercise myocardial scintigraphy was improved. Furthermore, both E/e' and BNP were decreased, indicating the improvement of HFpEF via the restoration of microvascular dysfunction.Thus, nicorandil administration could bring beneficial effects in WS with CSX and HFpEF, accompanied by coronary microcirculation dysfunction. <. Learning objective: Contrary to previous case reports regarding Werner's syndrome (WS) with obstructive coronary artery disease (CAD), we herein report a case of WS with cardiac syndrome X (CSX) without obstructive CAD, complicated with heart failure with preserved ejection fraction (HFpEF). Because impaired coronary microcirculation is known to be associated with left ventricular hypertrophy and HFpEF, nicorandil could improve not only CSX but HFpEF via the restoration of coronary microvascular dysfunction.>. 201
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Kaikita K., Ishii M., Sato K., Nakayama M., Arima Y., Tanaka T., Sugamura K., Sakamoto K., Izumiya Y., Yamamoto E., Tsujita K., Yamamuro M., Kojima S., Soejima H., Hokimoto S., Matsui K., Ogawa H.
Journal of the American Heart Association 4 ( 12 ) 2015.12
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
Background-Myocardial lactate production in the coronary circulation during acetylcholine (ACh)-provocation test (abbreviated as lactate production) provides supporting evidence for coronary spasm-induced myocardial ischemia. The purpose of this study was to examine the clinical features, predictive factors, and prognosis of patients with coronary vasospastic angina (VSA) and lactate production. Methods and Results-We examined all 712 patients who underwent both myocardial lactate measurement during AChprovocation test in the left coronary artery and genetic screening test of a -786T/C polymorphism in the 50-flanking region of the endothelial nitric oxide synthase (eNOS) gene between January 1991 and December 2010. Lactate production was observed in 252 of the 712 patients and in 219 of 356 VSA patients diagnosed by ACh-provocation test. Compared with lactate production- negative VSA patients, the lactate production-positive counterparts were more likely to be nonsmoker female diabetics with - 786T/C eNOS polymorphism (61% vs 31%, P < 0.001, 62% vs 34%, P < 0.001, 24% vs 14%, P=0.016, and 25% vs 15%, P=0.018, respectively). Multivariable logistic regression analysis identified female sex, diabetes mellitus, and -786T/C eNOS polymorphism to correlate with lactate production (odds ratio 3.51, 95% CI 2.16 to 5.70, P < 0.001; odds ratio 2.53, 95% CI 1.38 to 4.65, P=0.003; and odds ratio 1.85, 95% CI 1.02 to 3.35, P=0.044, respectively). Kaplan-Meier survival curve showed no difference in 5-year survival rate free from major adverse cardiac events between lactate production-positive and -negative VSA patients (P=0.319). Conclusions-The results indicated that female sex, diabetes, and mutation in -786T/C eNOS gene correlate with ACh-provoked myocardial ischemia in patients with coronary spasm.
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Usefulness of excimer laser atherectomy for balloon uncrossable lesion in chronic total occlusion Reviewed
Sueta D, Hokimoto S＊, Miyazaki T, Sakamoto K, Tsujita K, Yamamoto E, Tabata N, Kojima S, Kaikita K, Ogawa H
IJC Heart &Vasculature 9 70 - 72 2015.12
Language：English Publishing type：Research paper (scientific journal)
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Nocturia in patients with sleep-disordered breathing and cardiovascular disease Reviewed
Miyazaki T., Kojima S., Yamamuro M., Sakamoto K., Izumiya Y., Tsujita K., Yamamoto E., Tanaka T., Kaikita K., Hokimoto S., Ogawa H.
Circulation Journal 79 ( 12 ) 2632 - 2640 2015.11
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background:Sleep apnea is a common condition and a cardiovascular risk factor. Continuous positive airway pressure (CPAP) reduces cardiovascular events and sleep apnea-related symptoms, especially in patients with obstructive sleep apnea (OSA), who occasionally experience nocturia, a common problem in individuals of advanced age.Methods and Results:The present study was a prospective, observational study including 1,429 consecutive patients with cardiovascular disease (CVD). A questionnaire on nocturia was administered and nocturnal pulse oximetry was performed. Patients with moderate-to-severe sleep-disordered breathing (SDB) underwent polysomnography, and patients with OSA received CPAP therapy. Nocturia was observed in 561 of 666 patients included in the analysis. A multiple logistic regression analysis revealed that nocturia was associated with oxygen desaturation defined as a 3% decrease (P=0.0335) independent of age (P<0.0001), male sex (P=0.0078), hypertension (P=0.0139), and B-type natriuretic peptide (BNP) level (P=0.0185). Nocturia was reduced in patients who continued CPAP treatment and they also showed a decrease in the apnea-hypopnea index (45.3±13.6 vs. 2.5±3.7 events/h, P<0.0001), systolic blood pressure (121.6±11.9 vs. 113.4±8.8 mmHg, P=0.0002), and BNP level (57.7 [15.0–144.4] vs. 27.4 [8.5–111.7] pg/ml, P=0.0006).Conclusions:CPAP has the potential to reduce nocturia and risk factors for SDB such as increased blood pressure and BNP level, which may be beneficial in older men with CVD and OSA.
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Fujisue K., Sugiyama S., Matsuzawa Y., Akiyama E., Sugamura K., Matsubara J., Kurokawa H., Maeda H., Hirata Y., Kusaka H., Yamamoto E., Iwashita S., Sumida H., Sakamoto K., Tsujita K., Kaikita K., Hokimoto S., Matsui K., Ogawa H.
Circulation Journal 79 ( 12 ) 2623 - 2631 2015.11
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background:Endothelial dysfunction plays a crucial role in heart failure (HF), but the association between peripheral microvascular endothelial function assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) and prognosis remains unknown in HF with reduced left ventricular (LV) ejection fraction (HFREF). We prospectively investigated the association between peripheral microvascular endothelial function and HF-related near-future cardiovascular outcomes in HFREF patients.Methods and Results:The 362 HFREF patients (LVEF <50%) were followed for HF-related events (composite of cardiovascular death and HF hospitalization) up to 3 years. A natural logarithmic-scaled RH-PAT index (Ln-RHI) was obtained for each patient. A total of 82 HF-related events were recorded. The lower-RHI group (Ln-RHI ≤0.49, median) experienced a higher rate of HF-related events compared with the higher-RHI group by Kaplan-Meier analysis (30.9% vs. 14.4%, log-rank test: P<0.001). Multivariable Cox hazard analysis identified Ln-RHI as an independent predictor for HF-related events (per 0.1, hazard ratio: 0.84, 95% confidence interval: 0.75–0.95, P=0.005). Adding Ln-RHI to the Meta-analysis Global Group in Chronic HF risk score (MAGGICs) and Seattle Heart Failure Model (SHFM), powerful prognostic predictors of HF, significantly improved the net reclassification index (MAGGICs: 20.11%, P=0.02, SHFM: 24.88%, P<0.001), and increased the C-statistics for prediction of HF-related events (MAGGICs+Ln-RHI: from 0.612 to 0.670, SHFM+Ln-RHI: from 0.662 to 0.695).Conclusions:Peripheral microvascular endothelial dysfunction assessed by RH-PAT was associated with future HF-related events in HFREF.
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Clinical significance of plasma galectin-3 in patients with coronary artery disease Reviewed
Kusaka H., Yamamoto E., Hirata Y., Fujisue K., Tokitsu T., Sugamura K., Sakamoto K., Tsujita K., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
International Journal of Cardiology 201 532 - 534 2015.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
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Yamanaga K., Tsujita K., Komura N., Kaikita K., Sakamoto K., Miyazaki T., Saito M., Ishii M., Tabata N., Akasaka T., Arima Y., Yamamoto E., Yamamuro M., Izumiya Y., Kojima S., Tayama S., Nakamura S., Hokimoto S., Ogawa H.
International Journal of Cardiology 201 535 - 537 2015.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
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Tsujita K., Sugiyama S., Sumida H., Shimomura H., Yamashita T., Yamanaga K., Komura N., Sakamoto K., Ono T., Oka H., Nakao K., Nakamura S., Ishihara M., Matsui K., Sakaino N., Nakamura N., Yamamoto N., Koide S., Matsumura T., Fujimoto K., Tsunoda R., Morikami Y., Matsuyama K., Oshima S., Kaikita K., Hokimoto S., Ogawa H.
Journal of Cardiology 66 ( 4 ) 353 - 358 2015.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology
Background: Although the positive association between achieved low-density lipoprotein cholesterol (LDL-C) level and the risk of coronary artery disease (CAD) has been confirmed by randomized studies with statins, many patients remain at high residual risk of events suggesting the necessity of novel pharmacologic strategies. The combination of ezetimibe/statin produces greater reductions in LDL-C compared to statin monotherapy. Purpose: The Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound (PRECISE-IVUS) trial was aimed at evaluating the effects of ezetimibe addition to atorvastatin, compared with atorvastatin monotherapy, on coronary plaque regression and change in lipid profile in patients with CAD. Methods: The study is a prospective, randomized, controlled, multicenter study. The eligible patients undergoing IVUS-guided percutaneous coronary intervention will be randomly assigned to receive either atorvastatin alone or atorvastatin plus ezetimibe (10. mg) daily using a web-based randomization software. The dosage of atorvastatin will be increased by titration within the usual dose range with a treatment goal of lowering LDL-C below 70. mg/dL based on consecutive measures of LDL-C at follow-up visits. IVUS will be performed at baseline and 9-12 months follow-up time point at participating cardiovascular centers. The primary endpoint will be the nominal change in percent coronary atheroma volume measured by volumetric IVUS analysis. Conclusion: PRECISE-IVUS will assess whether the efficacy of combination of ezetimibe/atorvastatin is noninferior to atorvastatin monotherapy for coronary plaque reduction, and will translate into increased clinical benefit of dual lipid-lowering strategy in a Japanese population.
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Nagano M., Hokimoto S., Nakao K., Kaikita K., Akasaka T., Ogawa H., Fujimoto K., Miyao Y., Shimomura H., Tsunoda R., Hirose T., Nakamura N., Sakaino N., Oka H., Yamamoto N., Morikami Y., Matsumura T., Kajiwara I., Koide S.
Journal of Cardiology 66 ( 4 ) 333 - 340 2015.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology
Background: Stent thrombosis (ST) has emerged as a severe complication of percutaneous coronary intervention (PCI). Since the occurrence of ST is lower in Japan than Western countries, there are few data to predict ST after drug-eluting stent (DES) implantation in Japan. We examined the independent predictors of ST incidence after DES implantation in Japanese patients, including the use of calcium channel blockers (CCBs). Methods and results: We used data from the Kumamoto Intervention Conference Study registry. There were 6286 consecutive patients enrolled from June 2008 to March 2011. Among them, we analyzed 3493 patients who underwent DES implantation. The incidence of definite/probable ST throughout a median follow-up period of 364 days was 0.57% (20 patients). There were 8 patients with early ST (within 30 days), 8 patients with late ST (between 31 and 365 days), and 4 patients with very late ST (after 1 year). The frequency of CCB use was significantly lower in ST than non-ST patients (25.0% versus 51.4%, respectively, p = 0.016). Multiple regression analysis showed that longer stent length (p = 0.034), acute coronary syndrome (p = 0.039), and the absence of CCB use (p = 0.046) were significant and independent predictors of ST within 1 year. Conclusions: These results suggest that CCB use may be associated with a decreased risk of ST after DES implantation within 1 year in Japanese patients.
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Yoshimura H., Kaikita K., Ono T., Iwashita S., Nakayama N., Sato K., Horio E., Tsujita K., Kojima S., Tayama S., Hokimoto S., Ogawa H.
Heart and Vessels 30 ( 5 ) 572 - 579 2015.9
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Heart and Vessels
Peri-procedural myocardial damage (MD) is associated with increased risk of major in-hospital complications and adverse clinical events. The aim of this study was to evaluate the effects of on-clopidogrel platelet aggregation and CYP2C19-reduced-function gene variants on elective percutaneous coronary intervention (PCI)-related MD. We measured changes in serum high-sensitive troponin T (hs-TnT) levels, CYP2C19 genotype, and on-clopidogrel platelet aggregation (PA) using VerifyNow P2Y12 system in 91 patients who received stent implantation (stent group). The control group comprised 30 patients who did not receive PCI. Blood samples were obtained before and 24 h after PCI or coronary angiography (CAG). Patients of the stent group were divided into high and low MD groups based on the median value of hs-TnT level at 24 h after PCI. Serum hs-TnT levels were significantly higher 24 h after PCI (86.8 ± 121.5 pg/ml) compared with before PCI (9.4 ± 5.3, p < 0.001), whereas the levels were identical before and 24 h after CAG in the control group. Simple logistic regression analysis demonstrated that MD correlated with age (p = 0.014), estimated GFR (p = 0.003), hemoglobin A1c (p = 0.015), baseline serum hs-TnT (p = 0.049), and stent length (p < 0.001). Multiple logistic regression analysis identified old age, high hemoglobin A1c level, and long stent, but not CYP2C19 reduced-function allele or high on-clopidogrel PA, as independent predictors of elective PCI-related MD. The present study demonstrated no significant relation between peri-procedural MD and high on-clopidgrel PA associated with CYP2C19 reduced-function allele in patients undergoing elective PCI. ®
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Ishii M., Kaikita K., Sato K., Tanaka T., Sugamura K., Sakamoto K., Izumiya Y., Yamamoto E., Tsujita K., Yamamuro M., Kojima S., Soejima H., Hokimoto S., Matsui K., Ogawa H.
Journal of the American College of Cardiology 66 ( 10 ) 1105 - 1115 2015.9
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American College of Cardiology
Background Coronary artery spasm contributes to the pathogenesis of variant angina and ischemic heart disease and may play a role in the progression of atherosclerosis. It is unclear whether the location of spasm is related to outcome. Objectives This study compared the clinical features and prognosis of patients with coronary spasm at the site of significant atherosclerotic stenosis with patients with spasm at sites without stenosis or nonsignificant stenosis. Methods This was a retrospective, observational study of 1,877 consecutive patients with typical or atypical angina-like chest pain undergoing acetylcholine (ACh)-provocation testing. A total of 1,760 patients were eligible for analysis. ACh-provoked coronary spasm and significant organic stenosis were observed in 873 and 358 patients, respectively. Results In patients with significant atherosclerotic stenosis, ACh-positive patients (n = 233) were younger and without diabetes mellitus compared with nonspasm patients (n = 125). In patients without organic stenosis, ACh-positive patients (n = 640) were older, had dyslipidemia, and were more likely to have a family history of ischemic heart disease than nonspasm patients (n = 762). Multiple logistic regression analysis identified ST-segment elevation during anginal attacks, organic stenosis of the left anterior descending artery, and multivessel spasm as correlates of spasm at sites of significant organic stenosis (n = 192). Multivariate analysis identified ACh-provoked spasm at the site of significant stenosis and use of nitrates as the 2 prognostic factors for major adverse cardiac events. Conclusions The clinical features and prognosis of patients with ACh-provoked coronary spasm were different when it occurred at the site of significant atherosclerotic stenosis compared with patients with spasm elsewhere. Both spasm at the site of significant organic stenosis and nitrate use were significant predictors of major adverse cardiac events.
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Sueta D., Yamamoto E., Tanaka T., Hirata Y., Sakamoto K., Tsujita K., Kojima S., Nishiyama K., Kaikita K., Hokimoto S., Jinnouchi H., Ogawa H.
IJC Heart and Vasculature 8 52 - 54 2015.9
Language：English Publishing type：Research paper (scientific journal) Publisher：IJC Heart and Vasculature
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Misumi I., Nishida Y., Honda T., Kurokawa H., Yasuda H., Kaikita K., Hokimoto S., Ogawa H.
Internal Medicine 54 ( 17 ) 2197 - 2200 2015.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Internal Medicine
A boy with Duchenne muscular dystrophy was admitted to our hospital due to a transient loss of consciousness. Transthoracic echocardiography revealed left ventricular (LV) dilatation and diffuse hypokinesis of the LV wall. The LV wall was thin, and both non-compaction of the LV wall and marked thinning of the posterior LV wall resulting from a lesion were observed. The plasma B-type natriuretic peptide (BNP) level ultimately increased to 7,795 pg/mL, and the patient died of cardiac arrest following ventricular tachycardia. Severe heart failure, a critical condition, and thinning of the LV wall may have contributed to the markedly high plasma BNP level in this case.
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Novel vascular indices evaluated non-invasively in end-stage renal disease patients on hemodialysis Reviewed
Sueta D, Yamamoto E＊, Hirata Y, Tokitsu T, Sakamoto K, Tsujita K, Kaikita K, Hokimoto S, Sakanashi T
Clinical Trials and Regulatory Science in Cardiology 9 1 - 3 2015.9
Language：English Publishing type：Research paper (scientific journal)
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Sueta D., Kaikita K., Okamoto N., Arima Y., Ishii M., Ito M., Oimatsu Y., Iwashita S., Takahashi A., Nakamura E., Hokimoto S., Mizuta H., Ogawa H.
International Journal of Cardiology 197 98 - 100 2015.8
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
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Tsujita K., Sugiyama S., Sumida H., Shimomura H., Yamashita T., Yamanaga K., Komura N., Sakamoto K., Oka H., Nakao K., Nakamura S., Ishihara M., Matsui K., Sakaino N., Nakamura N., Yamamoto N., Koide S., Matsumura T., Fujimoto K., Tsunoda R., Morikami Y., Matsuyama K., Oshima S., Kaikita K., Hokimoto S., Ogawa H.
Journal of the American College of Cardiology 66 ( 5 ) 495 - 507 2015.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American College of Cardiology
Background Despite standard statin therapy, a majority of patients retain a high "residual risk" of cardiovascular events. Objectives The aim of this study was to evaluate the effects of ezetimibe plus atorvastatin versus atorvastatin monotherapy on the lipid profile and coronary atherosclerosis in Japanese patients who underwent percutaneous coronary intervention (PCI). Methods This trial was a prospective, randomized, controlled, multicenter study. Eligible patients who underwent PCI were randomly assigned to atorvastatin alone or atorvastatin plus ezetimibe (10 mg) daily. Atorvastatin was uptitrated with a treatment goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dl. Serial volumetric intravascular ultrasound was performed at baseline and again at 9 to 12 months to quantify the coronary plaque response in 202 patients. Results The combination of atorvastatin/ezetimibe resulted in lower levels of LDL-C than atorvastatin monotherapy (63.2 ± 16.3 mg/dl vs. 73.3 ± 20.3 mg/dl; p < 0.001). For the absolute change in percent atheroma volume (PAV), the mean difference between the 2 groups (-1.538%; 95% confidence interval [CI]: -3.079% to 0.003%) did not exceed the pre-defined noninferiority margin of 3%, but the absolute change in PAV did show superiority for the dual lipid-lowering strategy (-1.4%; 95% CI: -3.4% to -0.1% vs. -0.3%; 95% CI: -1.9% to 0.9% with atorvastatin alone; p = 0.001). For PAV, a significantly greater percentage of patients who received atorvastatin/ezetimibe showed coronary plaque regression (78% vs. 58%; p = 0.004). Both strategies had acceptable side effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events. Conclusions Compared with standard statin monotherapy, the combination of statin plus ezetimibe showed greater coronary plaque regression, which might be attributed to cholesterol absorption inhibition-induced aggressive lipid lowering. (Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound [PRECISE-IVUS]; NCT01043380)
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Clinical significance of pulse pressure in patients with coronary artery disease Reviewed
Tokitsu T., Yamamoto E., Hirata Y., Fujisue K., Sueta D., Sugamura K., Sakamoto K., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
International Journal of Cardiology 190 ( 1 ) 299 - 301 2015.8
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
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Yamamoto E., Hirata Y., Tokitsu T., Kusaka H., Sakamoto K., Yamamuro M., Kaikita K., Watanabe H., Hokimoto S., Sugiyama S., Maruyama T., Ogawa H.
International Journal of Cardiology 190 ( 1 ) 335 - 337 2015.8
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
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Systolic flow reversal in a case of mid-ventricular obstructive hypertrophic cardiomyopathy Reviewed
Misumi I., Honda T., Kurokawa H., Kubota Y., Ishii M., Sato R., Yamabe H., Yasuda H., Kaikita K., Hokimoto S., Ogawa H.
Internal Medicine 54 ( 14 ) 1765 - 1769 2015.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Internal Medicine
A 69-year-old man presented to our hospital with chest pain. Two-dimensional transthoracic echocardiography showed hypertrophy of the left ventricle, mid-ventricular obstruction and an apical aneurysm. Color-flow imaging at the obstruction site on the apical four-chamber view demonstrated systolic flow reversal in addition to a paradoxical jet flow. The systolic flow reversal may have been caused by a decreased apical contractility and pressure during systole.
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Sueta D., Yamamoto E., Tanaka T., Hirata Y., Sakamoto K., Tsujita K., Kojima S., Nishiyama K., Kaikita K., Hokimoto S., Jinnouchi H., Ogawa H.
International Journal of Cardiology 189 ( 1 ) 244 - 246 2015.6
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology