論文 - 海北 幸一
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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年5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 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
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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 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
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Early diastolic overinflation in diastolic mitral regurgitation 査読あり
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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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：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.
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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：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.
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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：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.
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Significance of coronary vasospasm in the perioperative management of non-cardiac surgery 査読あり
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 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.
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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年7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：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.
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Subsequent silent plaque rupture of nonculprit lesion in a patient with acute myocardial infarction 査読あり
Takaoka N., Tsujita K., Kaikita K., Tayama S., Hokimoto S., Sugiyama S., Ogawa H.
International Journal of Cardiology 157 ( 3 ) e60 - 2 2012年6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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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年6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 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.
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冠動脈形成術後の心房細動の抗凝固療法：抗血小板薬との併用はどうするか
海北幸一
治療 94 ( 6 ) 1120 - 1124 2012年6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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Onoue Y., Izumiya Y., Takashio S., Ono T., Morihisa K., Tsujita K., Yamamoto E., Yamamuro M., Kaikita K., Tayama S., Hokimoto S., Sumida H., Sugiyama S., Ogawa H.
Internal Medicine 51 ( 10 ) 1215 - 1219 2012年5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：Internal Medicine
Shock patients with restrictive cardiomyopathy due to cardiac amyloidosis are refractory to medical treatment. Here, we report a case of early initiation of intra-aortic balloon pumping (IABP) in a patient with cardiac amyloidosis who developed postoperative shock. Continuous hemodiafiltration was also applied to control circulating fluid volume. The mechanical treatments allowed reduction of the doses of catecholamine and diuretics and resulted in full recovery. It is reasonable to initiate IABP and hemofiltration dialysis during the early stages for the appropriate control of hemodynamics and fluid in shock patients with cardiac amyloidosis. © 2012 The Japanese Society of Internal Medicine.
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Obscured meshwork structure after treatment for heart failure: A case study 査読あり
Rokutanda T., Misumi I., Hanaoka Y., Akahoshi R., Matsumoto M., Takeda N., Obayashi H., Kaikita K., Yamamuro M., Sugiyama S., Ogawa H.
Internal Medicine 51 ( 9 ) 1049 - 1053 2012年5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：Internal Medicine
An 87-year-old man with heart failure was admitted to our hospital. A transthoracic echocardiography showed diffuse mild left ventricular (LV) hypokinesis and LV noncompaction at the apex. A threedimensional transthoracic echocardiography confirmed a trabecular meshwork. After treatment for heart failure, LV end-systolic dimension decreased and trabeculae seemed to converge and became obscure in endsystole. This is a rare case suggesting mechanism of obscured LV noncompaction after treatment for heart failure. © 2012 The Japanese Society of Internal Medicine.
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Tsujita K., Miyazaki T., Kaikita K., Chitose T., Takaoka N., Soejima H., Tayama S., Hokimoto S., Sugiyama S., Ogawa H.
Cardiovascular Intervention and Therapeutics 27 ( 2 ) 121 - 126 2012年5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：Cardiovascular Intervention and Therapeutics
A 45-year-old premenopausal woman presented with acute myocardial infarction (MI). An intravascular ultrasound (IVUS) revealed that her distal right coronary artery was occluded by spontaneous coronary artery dissection (SCAD). She did not have any specific condition related to SCAD. At follow-up cardiac catheterization, an acetylcholine provocation test was applied to examine the etiology of SCAD, and definitive coronary vasospasm was induced with chest symptoms and significant electrocardiographic change. A Ca-channel blocker was administered and since then chest pain has subsequently so far been relieved. The current case suggests the significance of the IVUS in detecting etiology of MI in younger patients and the potential association between SCAD and coronary vasospasm. © 2012 Japanese Association of Cardiovascular Intervention and Therapeutics.
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Simultaneous pressure recording in mid-ventricular obstructive hypertrophic cardiomyopathy 査読あり
Hanaoka Y., Misumi I., Rokutanda T., Akahoshi R., Matsumoto M., Sakamoto T., Kaikita K., Yamamuro M., Sugiyama S., Ogawa H.
Internal Medicine 51 ( 4 ) 387 - 390 2012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：Internal Medicine
A 70-year-old man was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) with apical aneurysm and paradoxic jet flow. At cardiac catheterization, pressure study showed that there was a markedly high pressure-gradient of 90 mmHg between the apex and the base in systole. Apical pressure was 350 mmHg after premature ventricular contraction. The apical aneurysm was already dilated and spherical in late systole; the absence of active relaxation was considered to be the cause of the paradoxic jet flow. In this report, we suggest the pathogenesis of left ventricular apical aneurysm and paradoxic jet flow in MVOHCM. © 2012 The Japanese Society of Internal Medicine.
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Marked decrease in BNP levels in 2 related patients with reversible dilated cardiomyopathy 査読あり
Misumi I., Fujimoto K., Miyao Y., Matsumoto M., Rokutanda T., Hanaoka Y., Kaikita K., Yamamuro M., Sugiyama S., Ogawa H.
Journal of Cardiology Cases 5 ( 1 ) e65 - e68 2012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：Journal of Cardiology Cases
Two male patients, one in his thirties and the other in his fifties, were admitted to different hospitals for congestive heart failure (CHF). In both patients, laboratory findings indicated high plasma B-type natriuretic peptide (BNP) levels (266.0 and 902.7. pg/mL, respectively) and echocardiography showed large left ventricular diastolic dimensions (LVDd) (67 and 73. mm, respectively) and low ejection fractions (EF) (26% and 18%, respectively). Coronary arteriography revealed no organic stenosis in either patient. Following treatment, plasma BNP levels decreased to below the limit of measurement (4. pg/mL) in both patients and echocardiography revealed improved LVDd (61 and 52. mm, respectively) and EF (41% and 45%, respectively). Because these patients are related, genetic factors might have affected low plasma BNP levels. Moreover, these results suggest that marked decrease in plasma BNP during follow up may be an indicator of preserved neurohormonal and organ systems. © 2011 Japanese College of Cardiology.
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Matsubara J., Sugiyama S., Sugamura K., Nakamura T., Fujiwara Y., Akiyama E., Kurokawa H., Nozaki T., Ohba K., Konishi M., Maeda H., Izumiya Y., Kaikita K., Sumida H., Jinnouchi H., Matsui K., Kim-Mitsuyama S., Takeya M., Ogawa H.
Journal of the American College of Cardiology 59 ( 3 ) 265 - 276 2012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 the American College of Cardiology
The aim of this study was to investigate the antiatherogenic effects of the dipeptidyl peptidase-4 inhibitor, des-fluoro-sitagliptin (DFS). The new class of antitype 2 diabetes drugs, dipeptidyl peptidase-4 inhibitors, improves glucose metabolism by increasing levels of active glucagon-like peptide (GLP)-1. Endothelial function was examined by acetylcholine-induced endothelium- dependent vasorelaxation using aortic rings and atherosclerotic lesion development in the entire aorta in apolipoprotein Edeficient mice fed a high-fat diet with or without DFS, and the antiatherogenic effects of DFS were investigated in cultured human macrophages and endothelial cells. Plasma levels of active GLP-1 were measured in patients with or without coronary artery disease. DFS significantly improved endothelial dysfunction (89.9 ± 3.9% vs. 79.2 ± 4.3% relaxation at 10 mol/l acetylcholine, p < 0.05) associated with increased endothelial nitric oxide synthase phosphorylation and reduced atherosclerotic lesion area (17.7% [15.6% to 25.8%] vs. 24.6% [19.3% to 34.6%], p < 0.01) compared with vehicle treatment. In cultured human macrophages, DFS significantly increased GLP-1-induced cytosolic levels of cyclic adenosine monophosphate compared with GLP-1 alone, resulted in inhibiting phosphorylation of c-jun N-terminal kinase and extracellular signal-regulated kinase 1/2 and nuclear factor-kappa B p65 nuclear translocation through the cyclic adenosine monophosphate/protein kinase A pathway, and suppressed proinflammatory cytokines (i.e., interleukin-1-beta, interleukin-6, and tumor necrosis factor-alpha) and monocyte chemoattractant protein-1 production in response to lipopolysaccharide. DFS-enhanced GLP-1 activity sustained endothelial nitric oxide synthase phosphorylation and decreased endothelial senescence and apoptosis compared with GLP-1 alone. In the human study, fasting levels of active GLP-1 were significantly lower in patients with coronary artery disease than those without (3.10 pmol/l [2.40 to 3.62 pmol/l] vs. 4.00 pmol/l [3.10 to 5.90 pmol/l], p < 0.001). A DPP-4 inhibitor, DFS, exhibited antiatherogenic effects through augmenting GLP-1 activity in macrophages and endothelium. © 2012 American College of Cardiology Foundation. -4
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Chitose T., Hokimoto S., Oshima S., Nakao K., Fujimoto K., Miyao Y., Shimomura H., Tsunoda R., Maruyama H., Hirose T., Yamamoto K., Mizobe M., Kaikita K., Nakamura S., Ogawa H.
Circulation Journal 76 ( 1 ) 71 - 78 2012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：Circulation Journal
Background: The aim of this study was to examine the effect of proton-pump inhibitor (PPI) on clinical outcomes in Japanese patients who undergo coronary stent implantation. Methods and Results: A total of 1,270 patients (males 915, 69 years) were enrolled and dual antiplatelet therapy of aspirin and a thienopyridine derivative was prescribed (clopidogrel 630, ticlopidine 640). Patients were divided into 2 groups treated with or without PPI. PPI was administered in 331 cases (26%), and non-PPI in 939 (74%). There were no significant differences in cardiovascular death (PPI vs. non-PPI: 5 vs. 11 cases), nonfatal myocardial infarction (3 vs. 5), and stroke (3 vs. 16) between PPI and non-PPI groups, but the ratio of gastrointestinal events had a higher tendency in non-PPI group compared with PPI group (1 vs. 17, P=0.08). In subgroup analysis of patients taking clopidogrel, or patients with acute coronary syndrome, there was no significant difference in the ratio of cardiovascular events (7 vs. 16, 6 vs. 17, NS). The non-PPI group had a tendency of an increased risk of gastrointestinal events compared with the PPI group (0 vs. 9, P=0.06; 1 vs. 7, P=0.14). Conclusions: In contrast to the negative drug interaction of PPI reported elsewhere, in the present study the intake of PPI was not associated with an increased risk for adverse clinical outcomes in patients treated with stents.
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経皮的冠動脈ステント留置術を受けた透析患者において，糖尿病は臨床転帰に影響を及ぼすか 査読あり
永野雅英，掃本誠治＊，大嶋秀一，中尾浩一，藤本和輝，宮尾雄治，下村英紀，角田隆輔，丸山秀樹，廣瀬豊樹，中村夏樹，境野成次，岡秀樹，山本展誉，森上靖洋，松村敏幸，梶原一郎，小森顕一，枇杷剛，小出俊一，溝部道生，千年忠祐，山本浩一朗，海北幸一，杉山正悟，中村淳，小川久雄
日本心臓病学会誌 7 263 - 267 2012年
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Ono T., Kaikita K., Hokimoto S., Iwashita S., Yamamoto K., Miyazaki Y., Horio E., Sato K., Tsujita K., Abe T., Deguchi M., Tayama S., Sumida H., Sugiyama S., Yamabe H., Nakamura S., Nakagawa K., Ogawa H.
Thrombosis Research 128 ( 6 ) e130 - 6 2011年12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：Thrombosis Research
Introduction: Carriers of reduced-function CYP2C19 allele on antiplatelet therapy show diminished platelet inhibition and higher rate of clinical risk. The purpose of this study was to determine cut-off levels of VerifyNow P2Y12 system associated with effective inhibition of on-clopidogrel platelet aggregation to predict carriers of CYP2C19 reduced-function allele among patients undergoing percutaneous coronary intervention (PCI). Materials and Methods: We enrolled 202 consecutive patients with stable coronary artery disease (CAD) undergoing PCI and treated with clopidogrel. All patients underwent CYP2C19 genotyping and measurement of residual platelet aggregation by VerifyNow system. Results: Carriers of CYP2C19 reduced-function allele constituted 131 (65%) of 202 CAD patients. Platelet inhibition measured by P2Y12 reaction units (PRU) and %inhibition was diminished in carriers compared with noncarriers (PRU: 290.0 ± 81.2 vs 217.6 ± 82.4, p < 0.001, %inhibition: 17.9 ± 17.8 vs 35.5 ± 22.8, p < 0.001, respectively). Multiple logistic regression analysis identified PRU and %inhibition as significant predictors of carrier state [odds ratio (OR) 4.95; 95% confidence interval (95%CI): 2.49 to 9.85; p < 0.001, OR 5.55; 95%CI: 2.80 to 10.99; p < 0.001, respectively]. Receiver-operating characteristic analysis showed that PRU and %inhibition were significant predictors of carrier state [area under the curve (AUC) 0.736 (95%CI: 0.664 to 0.808; p < 0.001), AUC 0.727 (95%CI: 0.651 to 0.803; p < 0.001), respectively]. The cut-off levels of PRU and %inhibition were 256 and 26.5% for the identification of carriers. Conclusions: Our results suggested that the cut-off levels of PRU and %inhibition to discriminate carriers of CYP2C19 reduced-function allele from noncarriers are potentially useful clinically to provide optimal clopidogrel therapy in patients with stable CAD undergoing PCI. © 2011 Elsevier Ltd. All rights reserved.