Papers - KAIKITA Koichi
-
冠動脈内血栓形成における冠攣縮の関与
海北幸一, 辻田賢一, 掃本誠治, 小川久雄
日本血栓止血学会誌 25 ( 3 ) 396 - 398 2014
Authorship：Lead author Publishing type：Research paper (scientific journal)
-
Tsujita K., Takaoka N., Kaikita K., Hokimoto S., Horio E., Sato K., Mizobe M., Nakayama N., Kojima S., Tayama S., Sugiyama S., Nakamura S., Ogawa H.
Catheterization and Cardiovascular Interventions 82 ( 7 ) 1068 - 1074 2013.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Catheterization and Cardiovascular Interventions
Objectives The present study used iMap IVUS system to compare neointimal tissue components between DES and bare-metal stents (BMSs). Background Drug-eluting stents (DESs) can cause impaired arterial healing, which constitutes the most important pathological substrate underlying late DES thrombosis. Intravascular ultrasound (IVUS)-based tissue characterization allows for the in vivo identification of neointimal tissue components. Methods and Results Follow-up IVUS data after coronary stenting (9.8 ± 9.4 months from index procedures) was obtained from consecutive 61 lesions (34 in DES, 27 in BMS). The iMap tissue components (fibrotic, lipidic, necrotic, and calcified) were measured in every recorded frame and expressed as percentages of mean neointimal cross-sectional area for the stented segment. Patients' characteristics were comparable between DES and BMS. When compared with BMSs, smaller (2.9 ± 0.4 mm vs. 3.2 ± 0.4 mm, P = 0.004) and longer (34 ± 18 mm vs. 26 ± 14 mm, P = 0.03) DESs were implanted. When compared with BMS group, minimum lumen area at follow-up was significantly greater in DES group (3.9 ± 1.8 mm vs. 3.1 ± 1.5 mm , P < 0.04), mainly attributable to suppression of neointimal hyperplasia (1.7 ± 0.8 mm vs. 3.1 ± 1.5 mm , P < 0.0001). The iMap analyses showed that neointima after DES placement was composed of smaller fibrotic component (67 ± 8% vs. 78 ± 7%, P < 0.0001), larger necrotic (14 ± 4% vs. 9 ± 3%, P < 0.0001) and calcified (15 ± 6% vs. 7 ± 4%, P < 0.0001) components compared with BMS. Logistic regression analysis showed that only intra-DES neointima was a significant predictor of necrotic neointima at follow-up. Conclusions DES implantation would be associated with iMap-derived necrotic and less-fibrotic neointimal formation. In vivo iMap evaluation of neointimal tissue may provide useful information in detecting impaired healing after stenting. Copyright © 2013 Wiley Periodicals, Inc. 2 2 2 2
DOI： 10.1002/ccd.24907
-
Rokutanda T., Misumi I., Usuku H., Kusuhara K., Akahoshi R., Matsumoto M., Akahoshi G., Yasuda H., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
Journal of Echocardiography 11 ( 4 ) 167 - 168 2013.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Echocardiography
-
Mid-diastolic mitral flow vectors in complete atrioventricular block Reviewed
Kusuhara K., Misumi I., Itou M., Rokutanda T., Akahoshi R., Matsumoto M., Shimoda K., Yasuda H., Kaikita K., Hokimoto S., Ogawa H.
Journal of Echocardiography 11 ( 4 ) 169 - 170 2013.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Echocardiography
-
Mid-diastolic mitral regurgitation in a patient with diastolic heart failure Reviewed
Usuku H., Misumi I., Kusuhara K., Rokutanda T., Akahoshi R., Matsumoto M., Omori K., Yasuda H., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
Journal of Echocardiography 11 ( 4 ) 161 - 163 2013.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Echocardiography
-
Tsujita K., Sakamoto K., Kojima S., Kojima S., Takaoka N., Nagayoshi Y., Sakamoto T., Tayama S., Kaikita K., Hokimoto S., Sumida H., Sugiyama S., Nakamura S., Ogawa H.
International Journal of Cardiology 168 ( 3 ) 2411 - 2415 2013.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background Coronary spasm plays an important role in the pathogenesis of ischemic heart disease. However, tissue components of coronary plaque in patients with vasospastic angina (VSA) have been unknown. This study used virtual histology (VH)-intravascular ultrasound (IVUS) to elucidate the tissue component of spastic coronary arteries and its gender differences in patients with VSA. Methods According to acetylcholine provocation tests, the study subjects (42 patients [19 men, 23 women, 61 ± 13 years]) were divided into 2 groups: the VSA group of 26 patients and the non-VSA group of 16 patients. After nitrate injection, IVUS volumetric analysis was done, and the parameters were compared between the groups. Results Although clinical demographics were almost identical between the groups, VSA group had lower plasma adiponectin level (5.9 ± 3.3 μg/ml vs. 11.2 ± 7.6 μg/ml, p = 0.007) and tended to have higher high-sensitivity C-reactive protein (0.15 ± 0.24 mg/dl vs. 0.06 ± 0.04 mg/dl, p = 0.1) than non-VSA group. VSA group had diffusely thickened intima (% plaque volume, 34 ± 11% vs. 27 ± 7%, p = 0.01) compared with non-VSA group. However, plaque components of patients with VSA were similar with that of non-VSA patients (dense calcium, 4 ± 6% vs. 3 ± 4%; necrotic core, 10 ± 9% vs. 8 ± 6%; fibrofatty, 19 ± 16% vs. 22 ± 11%; and fibrous, 67 ± 16% vs. 67 ± 9%). Although male patients with VSA had atherogenic lipid and metabolic profiles than female VSA patients, there were no significant gender differences in the volumetric IVUS parameters and plaque components. Conclusions Compared with non-VSA patients, VSA patients had diffusely thickened fibrous-dominant coronary plaque without gender difference, and that might suggest the role of vasospasm in the development of atherosclerosis. © 2013 Elsevier Ireland Ltd. All rights reserved.
-
Takashio S., Yamamuro M., Izumiya Y., Sugiyama S., Kojima S., Yamamoto E., Tsujita K., Tanaka T., Tayama S., Kaikita K., Hokimoto S., Ogawa H.
Journal of the American College of Cardiology 62 ( 7 ) 632 - 640 2013.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American College of Cardiology
Objectives This study investigated factors associated with cardiac troponin T (cTnT) release from failing myocardium. Background Persistent and modest elevation of serum cTnT is frequently observed in heart failure (HF) patients free of coronary artery disease, although the mechanisms underlying this finding remain unclear. Methods We evaluated serum cTnT levels in the aortic root (Ao) and coronary sinus (CS) using a highly sensitive assay in 90 nonischemic HF patients and 47 non-HF patients. Transcardiac cTnT and plasma B-type natriuretic peptide (BNP) release were described as the differences between CS and Ao cTnT levels [ΔcTnT (CS-Ao)] and BNP levels [ΔBNP (CS-Ao)], respectively. Coronary flow reserve (CFR) was measured in 68 HF patients using an intracoronary Doppler guidewire. Results ΔcTnT (CS-Ao) levels were available in 76 HF patients and 28 non-HF patients (84% vs. 60%; p = 0.001), and higher in HF patients than non-HF patients (p < 0.001). Among HF patients, log[ΔcTnT (CS-Ao)] correlated with log[ΔBNP (CS-Ao)] (r = 0.368, p = 0.001), pulmonary capillary wedge pressure (r = 0.253, p = 0.03) and left ventricular end-diastolic pressure (LVEDP) (r = 0.321, p = 0.005). Multivariate regression analysis identified LVEDP as an independent parameter that correlated with ΔcTnT (CS-Ao). ΔcTnT (CS-Ao) levels were available in 58 HF patients who were evaluated for CFR. Coronary microvascular dysfunction, diagnosed by CFR <2.0, was observed in 18 HF patients. ΔcTnT (CS-Ao) was higher in patients with coronary microvascular dysfunction (4.8 [2.0 to 8.1] ng/l) than those without (2.0 [1.2 to 4.6] ng/l; p = 0.04). Conclusions cTnT release from failing myocardium correlated with diastolic load and coronary microvascular dysfunction in nonischemic HF patients. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
-
Sato K., Kaikita K., Nakayama N., Horio E., Yoshimura H., Ono T., Ohba K., Tsujita K., Kojima S., Tayama S., Hokimoto S., Matsui K., Sugiyama S., Yamabe H., Ogawa H.
Journal of the American Heart Association 2 ( 4 ) e000227 2013.8
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
The aim of this study was to elucidate the correlation between angiographic coronary vasomotor responses to intracoronary acetylcholine (ACh) injection, clinical features, and long-term prognosis in patients with vasospastic angina (VSA). This is a retrospective, observational, single-center study of 1877 consecutive patients who underwent ACh-provocation test between January 1991 and December 2010. ACh-provoked coronary spasm was observed in 873 of 1637 patients included in the present analysis. ACh-positive patients were more likely to be older male smokers with dyslipidemia, to have a family history of ischemic heart disease, and to have a comorbidity of coronary epicardial stenosis than were ACh-negative patients. ACh-positive patients were divided into 2 groups: those with focal (total or subtotal obstruction, n=511) and those with diffuse (severe diffuse vasoconstriction, n=362) spasm patterns. Multivariable logistic regression analysis identified female sex and low comorbidity of coronary epicardial stenosis to correlate with the ACh-provoked diffuse spasm pattern in patients with VSA. Kaplan-Meier survival curve indicated better 5-year survival rates free from major adverse cardiovascular events in patients with diffuse spasm pattern compared with those with focal spasm pattern (P=0.019). Multivariable Cox hazard regression analysis identified diffuse spasm pattern as a negative predictor of major adverse cardiovascular events in patients with VSA. ACh-induced diffuse coronary spasm was frequently observed in female VSA patients free of severe coronary epicardial stenosis and was associated with better prognosis than focal spasm. These results suggest the need to identify the ACh-provoked coronary spasm subtypes in patients with VSA.
-
Fujisue K., Sugiyama S., Ono T., Matsuzawa Y., Akiyama E., Sugamura K., Matsubara J., Kurokawa H., Kaikita K., Iwashita S., Sumida H., Hokimoto S., Oniki K., Nakagawa K., Matsui K., Ogawa H.
Circulation: Cardiovascular Interventions 6 ( 4 ) 452 - 459 2013.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation: Cardiovascular Interventions
Background-Dual antiplatelet therapy with aspirin and clopidogrel is widely used in patients with coronary stents. High residual platelet reactivity (high RPR) after dual antiplatelet therapy is associated with increased cardiovascular events. Endothelial function could affect platelet reactivity in vivo. We hypothesized that endothelial dysfunction could be associated with high RPR after dual antiplatelet therapy in patients with stable coronary artery disease. Methods and Results-We screened patients with stable coronary artery disease for cytochrome P450 (CYP) 2C19 genotypes and enrolled 103 patients who lacked CYP2C19*2 or *3 loss-of-function allele to minimize the effect of this gene on high RPR. All patients received aspirin (100 mg/d) and clopidogrel (75 mg/d for long-term treatment or a loading dose of 300 mg) before the following tests. Platelet aggregability was assessed as P2Y12 reaction unit using the VerifyNow System. High RPR was defined as P2Y12 reaction unit =230. Peripheral endothelial function was expressed as reactive hyperemia index using reactive hyperemia peripheral arterial tonometry. Fifty-three patients exhibited high RPR. High RPR patients were significantly older, had higher levels of B-type natriuretic peptide, and were predominantly hypertensive compared with non-high RPR patients. Reactive hyperemia index was significantly lower in high RPR patients (0.46±0.15) compared with non-high RPR patients (0.61±0.18; P<0.001). Linear regression analysis demonstrated significant negative correlation between reactive hyperemia index and P2Y12 reaction unit (r=-0.32; P=0.001). Multivariable logistic regression analysis identified reactive hyperemia index as an independent and significant determinant of high RPR (odds ratio, 0.55; 95% confidence interval, 0.39-0.78; P=0.001). Conclusions-In patients with stable coronary artery disease, endothelial function was significantly impaired in high RPR patients. Endothelial dysfunction is independently correlated with high RPR after dual antiplatelet therapy. © 2013 American Heart Association, Inc.
-
ランブル様収縮期雑音を聴取した1例 Reviewed
三角郁夫＊，宇宿弘輝，楠原健一，六反田拓，赤星隆一郎，松本充博，安田久代，海北幸一，掃本誠治，杉山正悟，小川久雄
日本心臓病学会誌 8 ( 2 ) 168 - 170 2013.6
Language：Japanese Publishing type：Research paper (scientific journal)
-
Matsubara J., Sugiyama S., Akiyama E., Iwashita S., Kurokawa H., Ohba K., Maeda H., Fujisue K., Yamamoto E., Kaikita K., Hokimoto S., Jinnouchi H., Ogawa H.
Circulation Journal 77 ( 5 ) 1337 - 1344 2013.5
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background: Dipeptidyl peptidase 4 (DPP4) inhibitors are used for treatment of diabetes mellitus (DM). We hypothesized that sitagliptin, a DPP4-inhibitor, could improve endothelial dysfunction in DM patients with coronary artery disease (CAD). Methods and Results: The 40 patients with CAD and uncontrolled DM, aged 68.7±9.4 years (mean ± standard deviation) (50% males, hemoglobin A1c [HbA ] 7.4±1.0%) were assigned to either additional treatment with sitagliptin (50 mg/day, n=20) or aggressive conventional treatment (control, n=20) for 6 months. Endothelial function was assessed by the reactive hyperemia peripheral arterial tonometry index (RHI). The clinical characteristics at baseline were not different between the groups. After treatment, fasting blood glucose and insulin levels, and lipid profiles were not different between the groups. HbA levels significantly improved similarly in both groups. The percent change in RHI was greater in the sitagliptin group than in the control group (62.4±59.2% vs. 15.9±22.0%, P<0.01). Furthermore, treatment with sitagliptin resulted in a significant decrease in the high-sensitivity C-reactive protein (hsCRP) level, but no such change was noted in the control group. Linear regression analysis demonstrated a significant negative relation between changes in RHI and hsCRP, but not between RHI and HbA . Conclusions: Sitagliptin significantly improved endothelial function and inflammatory state in patients with CAD and uncontrolled DM, beyond its hypoglycemic action. These findings suggest that sitagliptin has beneficial effects on the cardiovascular system in DM patients. 1c 1c 1c
-
Yamamuro M., Yamamoto K., Kan H., Takashio S., Tayama S., Kaikita K., Hokimoto S., Sumida H., Sugiyama S., Ogawa H.
Journal of Atherosclerosis and Thrombosis 20 ( 3 ) 238 - 244 2013.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Atherosclerosis and Thrombosis
Aim: The concomitant use of angiotensin II receptor blocker (ARB) with low doses of hydrochlorothiazide (HCTZ) may provide additional antihypertensive activity. HCTZ induces hypokalemia and hyperglycemia, while ARB slightly induces hyperkalemia. Recently, it has been reported that ARB/ HCTZ did not worsen fasting blood sugar levels; however, the detailed glucose tolerance change effect with combination therapy of ARB/HCTZ compared to ARB alone therapy remains to be investigated. Methods: Treated non-diabetes mellitus (DM) hypertensive patients taking a common dose of ARB regimens, not achieving blood pressure (BP) goals, were switched to 50 mg Losartan/12.5 mg HCTZ combinations, and the 75 g oral glucose tolerance test (75 g OGTT) was performed before switching and after switching at 3 months. Results: This study included 30 patients aged 66.5±8.7 years, 67% women. Pre-switching BP 146.6± 17.0/ 88.4±10.4 mmHg decreased and was maintained at a steady state, reaching 131.4±1.0/73.8± 8.8 mmHg (p < 0.001) 3 months later. After switching, blood glucose levels on the 75 g OGTT at fasting, 30, 60 and 120 minutes were significantly decreased. Homeostasis model assessment as an index of insulin resistance and the whole body insulin sensitivity index were significantly ameliorated. Conclusions: On the 75 g OGTT, 50 mg Losartan with 12.5 mg HCTZ combinations did not worsen glucose tolerance; moreover, they improved BP, insulin resistance and sensitivity in non-DM Japanese patients with essential hypertension uncontrolled with ARBs alone.
DOI： 10.5551/jat.14464
-
Early diastolic overinflation in diastolic mitral regurgitation Reviewed
Misumi I., Usuku H., Kusuhara K., Rokutanda T., Akahoshi R., Matsumoto M., Kimura K., Yasuda H., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
Journal of Echocardiography 11 ( 1 ) 32 - 33 2013.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Echocardiography
-
Tabata N., Tsujita K., Mizobe M., Hirakawa K., Tanaka T., Yamamuro M., Yamamoto E., Kaikita K., Tayama S., Hokimoto S., Sugiyama S., Ogawa H.
Journal of Cardiology Cases 6 ( 5 ) e154 - e157 2012.11
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology Cases
Intra-aortic balloon counterpulsation (IABP) has been used in various cardiovascular conditions including cardiogenic shock. Prophylactic systemic heparinization has been commonly utilized to prevent thrombotic complications. There are a number of anticoagulants in addition to heparin; however, there is little consensus and few data to support the safety of alternative anticoagulation during IABP management. We report here on the case of a 47-year-old woman with cardiogenic shock. She had a medical history of heparin-induced thrombocytopenia (HIT) type II and soon after admission she deteriorated into cardiogenic shock of unknown etiology. This patient survived by IABP circulatory support with alternative argatroban anticoagulant therapy; and there were no signs of thrombus or thromboembolism in this patient or on the catheter itself. Our report suggests that alternative anticoagulation by argatroban may be a safe and effective therapeutic option in seriously ill patients requiring IABP support and nonheparin anticoagulation. © 2012 Japanese College of Cardiology.
-
Akiyama E., Sugiyama S., Matsuzawa Y., Konishi M., Suzuki H., Nozaki T., Ohba K., Matsubara J., Maeda H., Horibata Y., Sakamoto K., Sugamura K., Yamamuro M., Sumida H., Kaikita K., Iwashita S., Matsui K., Kimura K., Umemura S., Ogawa H.
Journal of the American College of Cardiology 60 ( 18 ) 1778 - 1786 2012.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American College of Cardiology
Objectives: The purpose of this study was to investigate whether peripheral endothelial dysfunction could predict the occurrence of cardiovascular events in patients with heart failure (HF) with normal left ventricular ejection fraction (HFNEF). Background: Endothelial dysfunction plays an important role in HF, but the relation between peripheral endothelial dysfunction and prognosis in HFNEF remains unknown. Methods: We conducted a prospective cohort study of 321 patients with HFNEF. We evaluated cardiac function by echocardiography measuring the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e'), noninvasively assessed peripheral endothelial function by reactive hyperemia-peripheral arterial tonometry (RH-PAT) as the RH-PAT index (RHI), and followed cardiovascular events. Results: A total of 59 patients had a cardiovascular event. Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in the low RHI group than in the high RHI group (mean follow-up: 20 months; log-rank test: p < 0.001). Multivariate Cox hazard analysis identified RHI (per 0.1) (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.67 to 0.94; p = 0.007), E/e' (Ln[E/e'] [per 0.1]) (HR: 1.15; 95% CI: 1.04 to 1.26; p = 0.006), and B-type natriuretic peptide (BNP) (Ln[BNP] [per picogram/milliliter]) (HR: 1.81; 95% CI: 1.44 to 2.28; p < 0.001) as independent predictors of cardiovascular events. The C-statistics for cardiovascular events substantially increased when the RHI was added to the HFNEF prognostic 5 factors (PF5) - age, diabetes, New York Heart Association classification, HF hospitalization history, and left ventricular ejection fraction - which were identified in the I-PRESERVE (Irbesartan in Heart Failure with Preserved Ejection Fraction Study) (PF5 alone: 0.671; PF5 + RHI: 0.712). The net reclassification index was significant after addition of the RHI (19.0%, p = 0.01). Conclusions: Peripheral endothelial dysfunction independently correlated with future cardiovascular events, adding incremental clinical significance for risk stratification in patients with HFNEF. (Endothelial Dysfunction Assessed by Reactive Hyperemia Peripheral Arterial Tonometry and Heart Failure with Preserved Left Ventricular Ejection Fraction; UMIN000002640) © 2012 American College of Cardiology Foundation.
-
Ohba K., Sugiyama S., Sumida H., Nozaki T., Matsubara J., Matsuzawa Y., Konishi M., Akiyama E., Kurokawa H., Maeda H., Sugamura K., Nagayoshi Y., Morihisa K., Sakamoto K., Tsujita K., Yamamoto E., Yamamuro M., Kojima S., Kaikita K., Tayama S., Hokimoto S., Matsui K., Sakamoto T., Ogawa H.
Journal of the American Heart Association 1 ( 5 ) e002485 2012.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor-borderline ischemic electrocardiogram findings at rest, limited-baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate-induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular events over 47.8±27.5 months. Microvascular CAS causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided. URL: www.umin.ac.jp/ctr. Unique identifier: UMIN000003839.
-
Significance of coronary vasospasm in the perioperative management of non-cardiac surgery Reviewed
Nagayoshi Y., Kawano H., Kojima S., Soejima H., Kaikita K., Nakayama M., Sumida H., Sugiyama S., Ogawa H.
Circulation Journal 76 ( 8 ) 1965 - 1971 2012.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background:The number of patients undergoing non-cardiac surgery has been increasing. Thus, the reduction of cardiac events is important during the perioperative period. The prevalence of Japanese patients with coronary vasospasm is higher as compared with Western countries. The present study reported the role of coronary vasospasm in the perioperative period in a Japanese university hospital. Methods and Results:A total of 77,745 consecutive patients who underwent non-cardiac surgery in Kumamoto University Hospital between April 2003 and March 2010 were retrospectively examined. Forty-two cases in which patients underwent coronary catheterization due to cardiovascular events in the perioperative period were reviewed, and data were collected on the type of surgery, urgency of surgery, cardiac risk factors, previous history and the cardiology consultation. The Revised Cardiac Risk Index (RCRI) was also calculated. A total of 18 patients were diagnosed as having definite vasospastic angina. In the definite vasospastic angina group, 9 patients had cardiovascular events intraoperatively. Six patients were in the group undergoing high-risk surgery. The RCRI score in the definite vasospastic angina group was 0.5±0.6 (mean ± SEM), and only 2 patients had a preoperative consultation with a cardiologist. Conclusions:Coronary vasospasm is not often encountered, but it can be a cause of cardiac trouble in the perioperative period. It should be taken into consideration at the time of planning of operation in Japanese patients even if they apparently have low cardiac risk.
-
Kimura Y., Ohba K., Sumida H., Tsujita K., Hirose T., Maruyama H., Hirai S., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
Internal Medicine 51 ( 14 ) 1845 - 1850 2012.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Internal Medicine
A 54-year-old man was referred to a local hospital, located about 90 km from our hospital, with cardiogenic shock due to left main coronary artery infarction (LMCA-MI). Percutaneous coronary intervention (PCI) was performed under intra-aortic balloon pumping (IABP) support, but resulted in insufficient reperfusion and his condition worsened. The helicopter emergency medical service (HEMS) rapidly transported the patient to our hospital. After percutaneous cardio-pulmonary support system (PCPS) insertion, PCI could establish the coronary flow. A series of intensive therapies saved the patient. The cooperation of medical and emergency service system following revascularization and intensive care saved the patient with LMCA-MI accompanied by cardiogenic shock. © 2012 The Japanese Society of Internal Medicine.
-
Subsequent silent plaque rupture of nonculprit lesion in a patient with acute myocardial infarction Reviewed
Takaoka N., Tsujita K., Kaikita K., Tayama S., Hokimoto S., Sugiyama S., Ogawa H.
International Journal of Cardiology 157 ( 3 ) e60 - 2 2012.6
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
-
Takashio S., Yamamuro M., Kojima S., Izumiya Y., Kaikita K., Hokimoto S., Sugiyama S., Tsunoda R., Nakao K., Ogawa H.
American Journal of Cardiology 109 ( 11 ) 1651 - 1656 2012.6
Language：English Publishing type：Research paper (scientific journal) Publisher：American Journal of Cardiology
Although the prognosis of patients with stress (takotsubo) cardiomyopathy is relatively favorable, serious complications occur in some patients. It is generally accepted that electrocardiography is an essential tool for the diagnosis of stress cardiomyopathy, with findings highly suggestive of the characteristics of myocardial damage. We tested the hypothesis that the quantitative analysis of electrocardiograhic changes can predict complications in stress cardiomyopathy. The study subjects were 85 patients with stress cardiomyopathy. A total of 34 patients developed <1 in-hospital complications (heart failure, intraventricular pressure gradient [>30 mm Hg], cardiogenic shock, ventricular tachycardia/fibrillation, and embolism). Patients with complications were likely to have a higher heart rate (96 ± 25 vs 76 ± 17 beats/min, p <0.001), larger sum of ST-segment elevation in 12 leads (median 10.5 mm; interquartile range 5.0 to 17.5 vs 3.0 mm, interquartile range 0 to 7.0; p <0.001) and extension of ST-segment elevation to limb leads (50% vs 12%, p <0.001) than those without complications. Multivariate logistic regression analysis identified heart rate (odds ratio 1.05, 95% confidence interval 1.02 to 1.07, p = 0.001) and sum of ST-segment elevation in 12 leads (odds ratio 1.24, 95% confidence interval 1.11 to 1.39, p <0.001) as significant and independent predictors of complications. Receiver operating characteristic analysis selected 5.5 mm as the best cutoff value of sum of ST-segment elevation in 12 leads for the prediction of complications, with a sensitivity and specificity of 74% and 73%, respectively, and area under the curve of 0.81 (95% confidence interval 0.72 to 0.90, p <0.001). The results suggest that the extent and magnitude of ST-segment elevation on the electrocardiogram are potentially useful predictors of in-hospital complications in patients with stress cardiomyopathy. © 2012 Elsevier Inc.