論文 - 海北 幸一
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Hanatani S., Izumiya Y., Takashio S., Kojima S., Yamamuro M., Araki S., Rokutanda T., Tsujita K., Yamamoto E., Tanaka T., Tayama S., Kaikita K., Hokimoto S., Sugiyama S., Ogawa H.
Heart and Vessels 29 ( 2 ) 231 - 237 2014年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Heart and Vessels
To distinguish hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) based on a morphological examination is often challenging. Growth differentiation factor 15 (GDF-15) is a novel diagnostic and prognostic biomarker for several cardiovascular diseases. In patients with LVH, GDF-15 promises to be a useful biomarker to distinguish between HCM and H-LVH. We evaluated 93 patients with H-LVH, 28 with HCM, and 28 disease control individuals. Serum GDF-15 concentrations were measured with an enzyme-linked immunosorbent assay. Circulating GDF-15 levels were significantly higher in patients with H-LVH than with HCM (P = 0.003). On the other hand, values for plasma B-type natriuretic peptide (BNP) levels were significantly lower in patients with H-LVH than with HCM (P = 0.004). Serum GDF-15 and plasma BNP levels positively correlated in patients with H-LVH but not with HCM. Multivariate logistic regression analysis revealed GDF-15 (odds ratio 12.06, confidence interval 1.85-78.77, P < 0.01) as an independent predictor of H-LVH among patients with LVH. In receiver-operating characteristic analysis, GDF-15 achieved an area under the curve of 0.70 for the identification of H-LVH. We found that GDF-15 might be a useful biomarker for discriminating HCM from H-LVH. Understanding serum GDF-15 values may have clinical utility for patients with LVH because the therapeutic strategies for treating HCM and H-LVH differ. © 2013 Springer.
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Hemodynamic influence of triphasic mitral inflow velocity: A case report 査読あり
Misumi I., Ito M., Rokutanda T., Kusuhara K., Akahoshi R., Matsumoto M., Tanaka H., Yasuda H., Kaikita K., Hokimoto S., Ogawa H.
Journal of Echocardiography 12 ( 1 ) 43 - 45 2014年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Echocardiography
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Izumiya Y., Hanatani S., Kimura Y., Takashio S., Yamamoto E., Kusaka H., Tokitsu T., Rokutanda T., Araki S., Tsujita K., Tanaka T., Yamamuro M., Kojima S., Tayama S., Kaikita K., Hokimoto S., Ogawa H.
Canadian Journal of Cardiology 30 ( 3 ) 338 - 344 2014年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Canadian Journal of Cardiology
Background: Circulating growth differentiation factor 15 (GDF-15) levels correlate with heart mass and fibrosis; however, little is known about its value in predicting the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). Methods: We measured serum GDF-15 levels in 149 consecutive patients with left ventricular diastolic dysfunction (LVDD) and normal LV ejection fraction (>50%) and followed them for cardiovascular events. LVDD was defined according to the European Society of Cardiology guidelines. Results: The New York Heart Association functional class and circulating B-type natriuretic peptide (BNP) levels were significantly higher in the high-GDF-15 group (n= 75; greater than or equal to the median value [3694 pg/mL]) than in the low-GDF-15 group (n= 74). Patients were divided into HFpEF and LVDD groups according to the presence or absence of HF. Serum GDF-15 levels were significantly higher in the HFpEF group (n= 73) than in the LVDD group (n= 76) (median, 4215 [interquartile range, 3382-5287] vs 3091 [interquartile range, 2487-4217 pg/mL]; P < 0.0001). Kaplan-Meier curve analysis showed a significantly higher probability of cardiovascular events in the high-GDF-15 group than in the low-GDF-15 group for data of all patients (log-rank test P= 0.006) and data of patients in the HFpEF group only (. P= 0.014). Multivariate Cox hazard analysis identified age (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.87-0.98; P= 0.008), atrial fibrillation (HR, 7.95; 95% CI, 1.98-31.85, P= 0.003), lnBNP (HR, 3.37; 95% CI, 1.73-6.55; P < 0.0001), and GDF-15 (ln[GDF-15]) (HR, 4.74; 95% CI, 1.26-17.88, P= 0.022) as independent predictors of primary end points. Conclusions: GDF-15 is a potentially useful prognostic biomarker in patients with HFpEF. © 2014 Canadian Cardiovascular Society.
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Takaoka N., Tsujita K., Kaikita K., Hokimoto S., Mizobe M., Nagano M., Horio E., Sato K., Nakayama N., Yoshimura H., Yamanaga K., Komura N., Kojima S., Tayama S., Nakamura S., Ogawa H.
International Journal of Cardiology 171 ( 3 ) 423 - 430 2014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：International Journal of Cardiology
Background Some plaques lead to ST-segment elevation myocardial infarction (STEMI), whereas others cause non-ST-segment elevation acute coronary syndrome (NSTEACS). We used angiography and intravascular ultrasound (IVUS) to investigate the difference of culprit lesion morphologies in ACS. Methods Consecutive 158 ACS patients whose culprit lesions were imaged by preintervention IVUS were enrolled (STEMI = 81; NSTEACS = 77). IVUS and angiographic findings of the culprit lesions, and clinical characteristics were compared between the groups. Results There were no significant differences in patients' characteristics except for lower rate of statin use in patients with STEMI (20% vs 44%, p = 0.001). Although angiographic complex culprit morphology (Ambrose classification) and thrombus were more common in STEMI than in NSTEACS (84% vs 62%, p = 0.002; 51% vs 5%, p < 0.0001, respectively), SYNTAX score was lower in STEMI (8.6 ± 5.4 vs 11.5 ± 7.1, p = 0.01). In patients with STEMI, culprit echogenicity was more hypoechoic (64% vs 40%, p = 0.01), and the incidence of plaque rupture, attenuation and " microcalcification" were significantly higher (56% vs 17%, p < 0.0001; 85% vs 69%, p = 0.01; 77% vs 61%, p = 0.04, respectively). Furthermore, the maximum area of ruptured cavity, echolucent zone and arc of microcalcification were significantly greater in STEMI compared with NSTEACS (1.80 ± 0.99 mm vs 1.13 ± 0.86 mm , p = 0.006; 1.52 ± 0.74 mm vs 1.21 ± 0.81 mm , p = 0.004; 99.9 ± 54.6 vs 77.4 ± 51.2, p = 0.01, respectively). Quantitative IVUS analysis showed that vessel and plaque area were significantly larger at minimum lumen area site (16.6 ± 5.4 mm vs 14.2 ± 5.5 mm , p = 0.003; 13.9 ± 5.1 mm vs 11.6 ± 5.2 mm , p = 0.003, respectively). Conclusion Morphological feature (outward vessel remodeling, plaque buildup and IVUS vulnerability of culprit lesions) might relate to clinical presentation in patients with ACS. © 2014 Elsevier Ireland Ltd. 2 2 2 2 2 2 2 2
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Tabata N., Hokimoto S., Akasaka T., Arima Y., Kaikita K., Kumagae N., Morita K., Miyazaki H., Oniki K., Nakagawa K., Matsui K., Ogawa H.
Thrombosis Research 134 ( 5 ) 939 - 944 2014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：Thrombosis Research
Introduction: There is some controversy regarding the effect of CYP2C19 polymorphism on clinical outcome in patients with dual antiplatelet therapy. Chronic kidney disease (CKD) is associated with increased risk of cardiovascular event, but the association between the possession of CYP2C19 loss-of-function (LOF) alleles and clinical outcome according to the presence of CKD is poorly understood. The aim of this study was to investigate whether CKD status modifies the association of CYP2C19 polymorphism in predicting outcomes in a prospective cohort study. Material and Methods: We enrolled 331 patients following coronary stent implantation. Patients were divided into two groups: CKD (n = 154) and non-CKD (n = 177). Platelet reactivity and CYP2C19 polymorphism were examined. The subjects were further divided into two groups according to the possession of CYP2C19 LOF alleles: carriers and non-carriers. Patients were followed up and clinical events were evaluated according to CKD and carrier status. Results: The proportion of high platelet reactivity was significantly higher in carriers than in non-carriers in both CKD (42.4% versus 21.7%; P = 0.016) and non-CKD groups (34.3% versus 3.7%; P b 0.001). In the non-CKD group alone, the incidence of cardiovascular events was significantly higher in carriers than in non-carriers (13.7% versus 1.7%; P = 0.013). Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in carriers than in non-carriers in the non-CKD group (log-rank test: P = 0.013) and there was no significant difference in the CKD group (log-rank test: P = 0.591). Multivariate analysis identified carriers as an independent predictor of cardiovascular events only in the non-CKD group alone (hazard ratio: 8.048; 95% confidence interval: 1.066 to 60.757; P = 0.043). Conclusions: CYP2C19 polymorphism significantly correlates with clinical outcome in non-CKD patients, and CKD status modifies the association of CYP2C19 polymorphism in predicting clinical outcomes following coronary stent implantation.
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Nakayama N., Kaikita K., Fukunaga T., Matsuzawa Y., Sato K., Horio E., Yoshimura H., Mizobe M., Takashio S., Tsujita K., Kojima S., Tayama S., Hokimoto S., Sakamoto T., Nakao K., Sugiyama S., Kimura K., Ogawa H.
Journal of the American Heart Association 3 ( 3 ) e000795 2014年
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：Journal of the American Heart Association
Background: The prevalence, clinical features, and long-term outcome of patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) associated with coronary spasm are not fully investigated. Methods and Results: This observational multicenter study enrolled 1601 consecutive patients with suspected NSTE-ACS who underwent cardiac catheterization between January 2001 and December 2010. A culprit lesion was found in 1152 (72%) patients. In patients without a culprit lesion, the acetylcholine provocation test was performed in 221 patients and was positive in 175 patients. In the other patients, coronary spasm was verified in 145 patients during spontaneous attack. Spasm-induced NSTE-ACS was diagnosed in 320 (20%) patients. Multivariable analysis identified age <70 years (odds ratio [OR] 2.19, 95% CI 1.58 to 3.04), estimated glomerular filtration rate >60 mL/min per 1.73 m (OR 1.72, 95% CI 1.16 to 2.56), and lack of hypertension (OR 2.55, 95% CI 1.90 to 3.41), dyslipidemia (OR 2.76, 95% CI 2.05 to 3.73), diabetes mellitus (OR 2.49, 95% CI 1.78 to 3.48), previous myocardial infarction (OR 5.37, 95% CI 2.89 to 10.0), and elevated cardiac biomarkers (OR 2.84, 95% CI 2.11 to 3.83) as significant correlates of spasm-induced NSTE-ACS (P<0.01 for all variables). Transient ST-segment elevation during spontaneous attack (variant angina) was observed in 119 patients with spasm-induced NSTE-ACS. Variant angina was more common in nondyslipidemic men among patients with spasm-induced NSTE-ACS. Conclusions: The study showed frequent involvement of coronary spasm in the pathogenesis of NSTE-ACS. Variant angina was observed in one third of patients with spasm-induced NSTE-ACS. Coronary spasm should be considered even in patients with less coronary risk factors and nonobstructive coronary arteries. 2
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Hanatani S., Izumiya Y., Takashio S., Kimura Y., Araki S., Rokutanda T., Tsujita K., Yamamoto E., Tanaka T., Yamamuro M., Kojima S., Tayama S., Kaikita K., Hokimoto S., Ogawa H.
Circulation Journal 78 ( 4 ) 903 - 910 2014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: Thrombospondin-2 (TSP-2) is a matricellular protein found in human serum. Deletion of TSP-2 causes age-dependent dilated cardiomyopathy. We hypothesized that TSP-2 is a useful biomarker in patients with heart failure with reduced ejection fraction (HFrEF). Methods and Results: Serum TSP-2 was measured in 101 patients with HFrEF, and mortality and cardiovascular events were followed. Serum TSP-2 in the HFrEF group was significantly higher than in the non-HF group (n=17). Mean NYHA functional class was significantly higher in the high TSP-2 group (>median) than the low TSP-2 group (2.26 vs. 1.76, P=0.004). Circulating TSP-2 level was significantly associated with that of B-type natriuretic peptide (BNP; r=0.40, P<0.0001) on multivariate linear regression analysis. On Kaplan-Meier curve analysis the high TSP-2 group had a lower event-free rate than the low TSP-2 group (log-rank test, P=0.03). Multivariate Cox hazard analysis identified hemoglobin (hazard ratio [HR], 0.66; 95% confidence interval [CI]: 0.53-0.82, P<0.0001), and TSP-2 (ln[TSP-2]; HR, 3.34; 95% CI: 1.03-10.85, P=0.045) as independent predictors of adverse outcome. The area under the curve for 1-year events increased when TSP-2 was added to Framingham risk score (FRS; alone, 0.60) or BNP (alone, 0.69; FRS+TSP-2, 0.75; BNP+TSP-2, 0.76). Conclusions: TSP-2 is a potentially useful biomarker for assessment of disease severity and prognosis in HFrEF.
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Chronic thromboembolic pulmonary hypertension complicated with homocystinuria 査読あり
Ogawa S., Katayama T., Kaikita K., Tsukamoto M., Yamamoto E., Yamamuro M., Tanaka T., Tsujita K., Kojima S., Tayama S., Hokimoto S., Yamabe H., Indo Y., Endo F., Matsubara H., Ogawa H.
Internal Medicine 53 ( 22 ) 2605 - 2608 2014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 17-year-old boy with homocystinuria was found to have a systolic murmur during a routine examination. Echocardiography demonstrated pulmonary hypertension (PH), and computer tomography angiography showed pulmonary thrombi. Although 12-month anticoagulation treatment reduced the thrombotic material within the main branch, it failed to clear thrombotic materials in the left and right lobar branches. Two years later, the patient was admitted to our hospital due to a worsening of PH. Treatment with bosentan, sildenafil and beraprost, in addition to anti-coagulant therapy, did not improve his PH. Balloon pulmonary angioplasty (BPA) was performed to remove the pulmonary thrombi. BPA markedly improved the patient’s hemodynamics and exercise capacity. Close follow-up is scheduled to prevent any potential future thrombotic complications.
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Kaikita K., Ono T., Iwashita S., Nakayama N., Sato K., Horio E., Nakamura S., Tsujita K., Tayama S., Hokimoto S., Sakamoto T., Nakao K., Oshima S., Sugiyama S., Ogawa H.
Journal of Atherosclerosis and Thrombosis 21 ( 1 ) 64 - 76 2014年
担当区分：筆頭著者, 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：Journal of Atherosclerosis and Thrombosis
Aim: Carriers of the reduced-function CYP2C19 allele receiving dual antiplatelet therapy (DAPT) with aspirin and clopidogrel exhibit diminished platelet inhibition and an increased risk of events. The purpose of this study was to investigate the effects of CYP2C19 gene variants on platelet function tests and coagulation and inflammatory biomarkers in patients undergoing elective percutaneous coronary intervention (PCI). Methods: This prospective, observational, multicenter study enrolled 104 consecutive Japanese patients undergoing elective PCI. We examined the CYP2C19 genotype, platelet function tests, the levels of coagulation and inflammatory biomarkers and the serum levels of high-sensitivity troponin T (hs- TnT) before, immediately after and one, two and 28 days after PCI. Results: A total of 68 (65%) of the 104 enrolled patients were carriers of the CYP2C19 reducedfunction allele. On-clopidogrel platelet aggregation (PA), measured using light transmittance aggregometry and the VerifyNow® P2Y12 system, and the platelet reactivity index (PRI) were significantly higher at all time points in the carriers than in the noncarriers (p<0.05), whereas there were no differences in the levels of the coagulation and inflammatory biomarkers or serum hs-TnT. Simple and multiple logistic regression analyses identified on-clopidogrel PA and PRI as being significant predictors of carriers of the CYP2C19 reduced-function allele. Conclusions: The present study suggests that platelet function tests, but not coagulation, inflammatory or cardiac biomarkers, are useful for identifying carriers of CYP2C19 reduced-function gene variants and monitoring the efficacy of DAPT in patients undergoing elective PCI.
DOI： 10.5551/jat.18952
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Yamanaga K., Tsujita K., Shimomura H., Nakamura Y., Ogura Y., Onoue Y., Chazono N., Nagata T., Morisaki S., Kudo T., Yamada Y., Komura N., Miyazaki T., Akasaka T., Horio E., Sato K., Arima Y., Kojima S., Kaikita K., Tayama S., Hokimoto S., Ogawa H.
Journal of Cardiology 64 ( 4 ) 279 - 284 2014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：Journal of Cardiology
Purpose: In-stent restenosis has been decreasing through the introduction of drug-eluting stents (DES). On the other hand, adverse events such as very late stent thrombosis (VLST) and late catch-up phenomenon can occur especially with sirolimus-eluting stents (SES, first-generation DES) in long-term follow-up. However, the precise mechanisms underlying VLST have not been well investigated in vivo. Methods and results: From 2004 to 2010, 2034 SES were implanted in 1656 patients and caused eight VLST (0.48% per patient) at Fukuoka Tokushukai Medical Center. Of these, serial intravascular ultrasound (IVUS) images (post-stent implantation and at the time of VLST onset) were obtained from three patients with VLST. Comparing them with eight control patients with SES implanted, the vascular reactivity of VLST patients was analyzed. Eight VLST happened 50±15 months after stent implantation and three of the eight patients with VLST had not taken aspirin daily. There were no differences in minimum stent area, maximum external elastic membrane (EEM) area, and stent edge (distal and proximal) EEM area in post-procedural IVUS images. Compared with the control group patients, δEEM area (10.6±3.4mm<sup>2</sup> vs. 1.7±1.9mm<sup>2</sup>, p=0.01) and vessel expansion ratio (185.6±40.3% vs. 112.0±12.1%, p=0.01) were significantly greater in the VLST group based on the greater peri-stent plaque expansion (262.1±72.8% vs. 118.7±21.2%, p=0.01). Conclusion: Our serial IVUS study showed that the vascular positive remodeling after SES implantation is one of the most probable morphological mechanisms for VLST development.
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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年
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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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：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
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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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Echocardiography
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Mid-diastolic mitral flow vectors in complete atrioventricular block 査読あり
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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Echocardiography
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Mid-diastolic mitral regurgitation in a patient with diastolic heart failure 査読あり
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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Echocardiography
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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 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.
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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年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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.
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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年8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：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.
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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年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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.
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ランブル様収縮期雑音を聴取した1例 査読あり
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年6月
記述言語：日本語 掲載種別：研究論文（学術雑誌）