Papers - KAIKITA Koichi
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Yamamoto M., Takashio S., Nakashima N., Hanatani S., Arima Y., Sakamoto K., Yamamoto E., Kaikita K., Aoki Y., Tsujita K.
ESC Heart Failure 7 ( 2 ) 721 - 726 2020.4
Language：English Publishing type：Research paper (scientific journal) Publisher：ESC Heart Failure
We present a case of double-chambered right ventricle (DCRV) complicated by hypertrophic obstructive cardiomyopathy (HOCM) in KRAS mutation-associated Noonan syndrome. The diagnosis was incidental and made during diagnostic testing for an intradural extramedullary tumour. Spinal compression, if not surgically treated, may cause paralysis of the extremities. We decided to pursue pharmacological therapy to control biventricular obstructions and reduce the perioperative complication rate. We initiated treatment with cibenzoline and bisoprolol; the doses were titrated according to the response. After 2 weeks, the peak pressure gradient of the two RV chambers decreased from 101 to 68 mmHg, and the LV peak pressure gradient decreased from 109 to 14 mmHg. Class 1A antiarrhythmic drugs and β-blockers decreased the severe pressure gradients of biventricular obstructions caused by DCRV and HOCM. The patient was able to undergo surgery to remove the intradural extramedullary tumour, which was diagnosed as schwannoma.
DOI： 10.1002/ehf2.12650
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A Mechanism for L-Wave Generation via Color M-Mode Imaging in a Patient with Mitral Regurgitation. Reviewed
Misumi I, Motozato K, Usuku H, Sakamoto K, Kaikita K, Tsujita K, Fukui T
CASE (Philadelphia, Pa.) 4 ( 2 ) 86 - 89 2020.4
Language：English Publishing type：Research paper (scientific journal)
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Tabata N., Sueta D., Arima Y., Okamoto K., Shono T., Hanatani S., Takashio S., Oniki K., Saruwatari J., Sakamoto K., Kaikita K., Sinning J.M., Werner N., Nickenig G., Sasaki Y., Fukui T., Tsujita K.
IJC Heart and Vasculature 27 100498 2020.4
Language：English Publishing type：Research paper (scientific journal) Publisher：IJC Heart and Vasculature
Aims: Although the bacterial virulent factor of cytotoxin-associated gene-A (CagA)-seropositivity and the host genetic factors of interleukin (IL)-1 polymorphisms have been suggested to influence Helicobacter pylori (HP) -related diseases, the underlying mechanisms of the association between HP infection and acute coronary syndrome (ACS) remain unknown. Methods and results: Among 341 consecutive ACS patients, the clinical outcomes after ACS included composite cardiovascular events within the 2-year follow-up period. A significantly higher probability of primary outcomes was observed in HP positive patients than in HP negative patients. There were no significant differences in the rate of cardiovascular events between HP positive and HP negative patients in the absence of an IL-polymorphism, while there were significant differences in the presence of an IL-polymorphism. There were significant differences in the rate of cardiovascular events among CagA positive, CagA negative/ HP positive and CagA negative/HP negative patients. Moreover, via immunohistochemical staining, aortic CagA positive cells were confirmed in the vasa vasorum in CagA positive patients, whereas they could not be identified in CagA negative patients. Conclusions: The bacterial virulence factor CagA and host genetic IL-1 polymorphisms influence the incidence of adverse cardiovascular events, possibly through infection of atherosclerotic lesions. Registration: University Hospital Medical Information Network (UMIN)-CTR (http://www.umin.ac.jp/ctr/). Identifier: UMIN000035696.
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Utility of Kumamoto Criteria in Diagnosing Transthyretin Cardiac Amyloidosis in Real-World Practice - Reply. Reviewed
Takashio S, Marume K, Nishi M, Kaikita K, Tsujita K
Circulation journal : official journal of the Japanese Circulation Society 84 ( 4 ) 681 - 682 2020.3
Language：English Publishing type：Research paper (scientific journal)
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Nakanishi N, Kaikita K, Ishii M, Oimatsu Y, Mitsuse T, Ito M, Yamanaga K, Fujisue K, Kanazawa H, Sueta D, Takashio S, Arima Y, Araki S, Nakamura T, Sakamoto K, Suzuki S, Yamamoto E, Soejima H, Tsujita K
Circulation reports 2 ( 3 ) 158 - 166 2020.3
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：一般社団法人 日本循環器学会
<b><i>Background:</i></b>Direct-activated factor X (FXa) plays an important role in thrombosis and is also involved in inflammation via the protease-activated receptor (PAR)-1 and PAR-2 pathway. We hypothesized that rivaroxaban protects against cardiac remodeling after myocardial infarction (MI).<b><i>Methods and Results:</i></b>MI was induced in wild-type mice by permanent ligation of the left anterior descending coronary artery. At day 1 after MI, mice were randomly assigned to the rivaroxaban and vehicle groups. Mice in the rivaroxaban group were provided with a regular chow diet plus rivaroxaban. We evaluated cardiac function by echocardiography, pathology, expression of mRNA and protein at day 7 after MI. Rivaroxaban significantly improved cardiac systolic function, decreased infarct size and cardiac mass compared with the vehicle. Rivaroxaban also downregulated the mRNA expression levels of tumor necrosis factor-α, transforming growth factor-β, PAR-1 and PAR-2 in the infarcted area, and both A-type and B-type natriuretic peptides in the non-infarcted area compared with the vehicle. Furthermore, rivaroxaban attenuated cardiomyocyte hypertrophy and the phosphorylation of extracellular signal-regulated kinase in the non-infarcted area compared with the vehicle.<b><i>Conclusions:</i></b>Rivaroxaban protected against cardiac dysfunction in MI model mice. Reduction of PAR-1, PAR-2 and proinflammatory cytokines in the infarcted area may be involved in its cardioprotective effects.
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Sueta D., Yamamoto E., Sato M., Sato T., Fujisue K., Arima Y., Takashio S., Sakamoto K., Soejima H., Kaikita K., Shigaki N., Takasu Y., Tsujita K.
Circulation journal : official journal of the Japanese Circulation Society 84 ( 3 ) 524 - 528 2020.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation journal : official journal of the Japanese Circulation Society
BACKGROUND: Although it has been discussed which measures against atherosclerotic diseases should be started in childhood, the current situation in Japan is unclear.Methods and Results:We conducted a health management survey of all 12-year-old children in a local town for 20 years. The body mass index tended to decrease over time. Although the serum low-density lipoprotein cholesterol level did not change, the levels of serum high-density lipoprotein cholesterol and serum triglycerides significantly increased over time. CONCLUSIONS: The serum triglyceride levels in school children increased significantly, probably through lifestyle changes, and the health management system should be reviewed.
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Ishii M., Kaikita K., Sakamoto K., Seki T., Kawakami K., Nakai M., Sumita Y., Nishimura K., Miyamoto Y., Noguchi T., Yasuda S., Tsutsui H., Komuro I., Saito Y., Ogawa H., Tsujita K.
International Journal of Cardiology 301 108 - 113 2020.2
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common presentation of acute myocardial infarction (AMI) and has a better prognosis. However, there were few reports on large-scale, high aged population. The aim of this study was to determine the differences in the clinical characteristics and short-term prognosis between MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD) using a nationwide administrative database in the super-aging society, Japan. Methods: This was an observational study using data of 137,678 AMI patients who underwent angiography between April 2012 through March 2016. Using the international classification of diseases 10th revision, AMI patients were divided into two groups based on the presence or absence of revascularization and coronary atherosclerosis, identifying 123,633 MI-CAD and 14,045 working diagnosis of MINOCA patients. The true MINOCA (n = 13,022) was defined as the MINOCA excluding non-ischemic causes. We assessed in-hospital mortality within 30 days. Results: Both MINOCA groups were typically found in non-obese, non-smoker young females, with a low grade on Killip classification, and non-low ADL status. Compared to MI-CAD, chronic pulmonary diseases, peripheral vascular diseases, liver diseases, renal diseases, and cerebrovascular diseases were more common, whereas diabetes was less common in the MINOCA groups. In-hospital mortality within 30 days was higher in both MINOCA groups than in MI-CAD. Multivariate frailty model identified both MINOCA groups as an independent risk factor for in-hospital mortality. Conclusions: Our large-population study demonstrated that MINOCA was associated with a high risk of in-hospital mortality compared with MI-CAD in the super-aging society.
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Kanemaru Y., Arima Y., Kaikita K., Kiyama T., Kaneko S., Ito M., Yamabe H., Motozato K., Yamanaga K., Fujisue K., Sueta D., Takashio S., Araki S., Usuku H., Nakamura T., Fukunaga T., Suzuki S., Izumiya Y., Sakamoto K., Soejima H., Yamamoto E., Kawano H., Kanazawa H., Tsujita K.
International Journal of Cardiology 300 147 - 153 2020.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background: The impact of intra-atrial conduction delay on the recurrence of atrial tachyarrhythmia after radio frequency catheter ablation (RFCA) has not been fully elucidated. Methods: We retrospectively analyzed 155 AF patients who were sinus rhythm at the start of RFCA. The conduction time from the onset of the earliest atrial electrogram at the high right atrium (HRA) to the end of the latest electrogram at the coronary sinus (CS) during sinus rhythm was defined as HRA-CS conduction time. Pulmonary vein isolation (PVI) was performed followed by linear roof lesion and complex fractionated atrial electrogram (CFAE) ablation until AF termination. We evaluated atrial tachyarrhythmia recurrence 12 months after RFCA. Results: The follow-up data were available for 148 patients. The recurrence of atrial tachyarrhythmia was noted in 28 (18.9%) patients. Atrial tachyarrhythmia recurrence patients had longer HRA-CS conduction times (151.3 ± 22.1 ms vs 160.1 ± 32.6 ms, p =.017). The patients were divided into the long or short HRA-CS conduction time group. The Kaplan–Meier analysis revealed that the long HRA-CS conduction time group held a higher risk of atrial tachyarrhythmia recurrence (log-rank test, p =.019). The multivariable Cox hazard analysis revealed that a long HRA-CS conduction time was a significant risk factor for the recurrence of atrial tachyarrhythmia, despite a long AF duration, persistent AF, and larger left atrial diameter (LAD) were not statistically significant. Conclusions: The HRA-CS conduction time was the primary influencing factor that predicted the recurrence of atrial tachyarrhythmia after catheter ablation.
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Suzuki S., Kaikita K., Yamamoto E., Sueta D., Yamamoto M., Ishii M., Ito M., Fujisue K., Kanazawa H., Araki S., Arima Y., Takashio S., Usuku H., Nakamura T., Sakamoto K., Izumiya Y., Soejima H., Kawano H., Jinnouchi H., Matsui K., Tsujita K.
ESC Heart Failure 7 ( 1 ) 65 - 74 2020.2
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：ESC Heart Failure
Aims: The prediction of future heart failure (HF) in stable outpatients is often difficult for general practitioners and cardiologists. Recently, the H FPEF score (0–9 points) has been proposed for the discrimination of HF with preserved ejection fraction from non-cardiac causes of dyspnoea. The six clinical and echocardiographic variables that constitute the H FPEF score include the following: (i) obesity (H); (ii) the use of ≥2 antihypertensive drugs (H); (iii) atrial fibrillation (F); (iv) pulmonary hypertension (P); (v) an age > 60 years (E); and (vi) E/e' > 9 (F). We performed an external validation study that investigated whether the H FPEF score could predict future HF-related events in stable outpatients with cardiovascular risk factor(s) in Japan. Methods and results: In this prospective cohort study, after exclusion of 195 from 551 consecutive, stable Japanese outpatients with at least one cardiovascular risk factor who were enrolled between September 2010 and July 2013, the remaining 356 outpatients (171 men, 185 women, mean age 73.2 years) were eligible for the analysis. We calculated the H FPEF score (0–9 points), and followed up the patients for an average of 517 days. In all of the 356 patients, the mean H FPEF score was 3.1 ± 1.8, and 15 developed HF-related events during the follow-up period, including cardiovascular death (n = 2) and hospitalization for HF decompensation (n = 13). Multivariate Cox proportional hazards analysis showed that the H FPEF score was an independent predictor of future HF-related events (P < 0.001 for all three models). Kaplan–Meier survival curves showed a significantly higher probability of HF-related events in the outpatients with a high H FPEF score (P < 0.001). In receiver operating characteristic (ROC) curve analysis, the H FPEF score was significantly associated with the occurrence of future HF-related events (P < 0.001). In ROC curve analysis, the sensitivity, specificity, and positive likelihood ratio of a H FPEF score of 7 points to predict HF-related events were 47%, 96%, and 11.4%, respectively. Conclusions: The H FPEF score could provide useful information for future HF-related events in stable outpatients with cardiovascular risk factor(s) in Japan. 2 2 2 2 2 2 2 2 2 2
DOI： 10.1002/ehf2.12570
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Emoto T., Kidoh M., Oda S., Nakaura T., Nagayama Y., Sasao A., Funama Y., Araki S., Takashio S., Sakamoto K., Yamamoto E., Kaikita K., Tsujita K., Yamashita Y.
European Radiology 30 ( 2 ) 691 - 701 2020.2
Language：English Publishing type：Research paper (scientific journal) Publisher：European Radiology
Objectives: To compare the effects of hybrid iterative reconstruction (HIR) and model-based iterative reconstruction (MBIR) that incorporates a beam-hardening model for myocardial extracellular volume (ECV) quantification by cardiac CT using MRI as a reference standard. Methods: In this retrospective study, a total of 34 patients were evaluated using cardiac CT and MRI. Paired CT image sets were created using HIR and MBIR with a beam-hardening model. We calculated mean absolute differences and correlations between the global mid-ventricular ECV derived from CT and MRI via Pearson correlation analysis. In addition, we performed qualitative analysis of image noise and beam-hardening artifacts on postcontrast images using a four-point scale: 1 = extensive, 2 = strong, 3 = mild, and 4 = minimal. Results: The mean absolute difference between the ECV derived from CT and MRI for MBIR was significantly smaller than that for HIR (MBIR 3.74 ± 3.59%; HIR 4.95 ± 3.48%, p = 0.034). MBIR improved the correlation between the ECV derived from CT and MRI when compared with HIR (MBIR, r = 0.60, p < 0.001; HIR, r = 0.47, p = 0.006). In qualitative analysis, MBIR significantly reduced image noise and beam-hardening artifacts when compared with HIR ([image noise, MBIR 3.4 ± 0.7; HIR 2.1 ± 0.8, p < 0.001], [beam-hardening artifacts, MBIR 3.8 ± 0.4; HIR 2.6 ± 1.0, p < 0.001]). Conclusions: MBIR with a beam-hardening model effectively reduced image noise and beam-hardening artifacts and improved myocardial ECV quantification when compared with HIR using MRI as a reference standard. Key Points: • MBIR with a beam-hardening model effectively reduced image noise and beam-hardening artifacts. • The mean absolute difference between the global mid-ventricular ECV derived from CT and MRI for MBIR was significantly smaller than that for conventional HIR. • MBIR provided more accurate myocardial CT number and improved ECV quantification when compared with HIR.
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Yamamura S., Izumiya Y., Araki S., Nakamura T., Kimura Y., Hanatani S., Yamada T., Ishida T., Yamamoto M., Onoue Y., Arima Y., Yamamoto E., Sunagawa Y., Yoshizawa T., Nakagata N., Bober E., Braun T., Sakamoto K., Kaikita K., Morimoto T., Yamagata K., Tsujita K.
Hypertension (Dallas, Tex. : 1979) 75 ( 1 ) 98 - 108 2020.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Hypertension (Dallas, Tex. : 1979)
Sirt (Sirtuin) 7, the most recently identified mammalian sirtuin, has been shown to contribute to appropriate wound healing processes after acute cardiovascular insult. However, its role in the development of cardiac remodeling after pressure overload is unclear. Cardiomyocyte-specific Sirt7-knockout and control mice were subjected to pressure overload induced by transverse aortic constriction. Cardiac hypertrophy and functions were then examined in these mice. Sirt7 protein expression was increased in myocardial tissue after pressure overload. Transverse aortic constriction-induced increases in heart weight/tibial length were significantly augmented in cardiomyocyte-specific Sirt7-knockout mice compared with those of control mice. Histological analysis showed that the cardiomyocyte cross-sectional area and fibrosis area were significantly larger in cardiomyocyte-specific Sirt7-deficient mice. Cardiac contractile functions were markedly decreased in cardiomyocyte-specific Sirt7-deficient mice. Mechanistically, we found that Sirt7 interacted directly with GATA4 and that the exacerbation of phenylephrine-induced cardiac hypertrophy by Sirt7 knockdown was decreased by GATA4 knockdown. Sirt7 deacetylated GATA4 in cardiomyocytes and regulated its transcriptional activity. Interestingly, we demonstrated that treatment with nicotinamide mononucleotide, a known key NAD+ intermediate, ameliorated agonist-induced cardiac hypertrophies in a Sirt7-dependent manner in vitro. Sirt7 deficiency in cardiomyocytes promotes cardiomyocyte hypertrophy in response to pressure overload. Sirt7 exerts its antihypertrophic effect by interacting with and promoting deacetylation of GATA4.
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Saku T., Takashio S., Tsuruta Y., Otsuka Y., Takae M., Kiyama T., Yamamoto E., Kaikita K., Hotta T., Matsumoto S., Kang D., Tsujita K., Komohara Y.
Medical Molecular Morphology 54 ( 2 ) 181 - 186 2020
Language：English Publishing type：Research paper (scientific journal) Publisher：Medical Molecular Morphology
Mitochondrial cardiomyopathy can be described as a condition characterized by abnormal heart-muscle structure and/or function, secondary to mutations in nuclear or mitochondrial DNA. Its severity can range from subclinical to critical conditions. We presented three cases of mitochondrial cardiomyopathy with m.3243A > G mutation and compared the clinical manifestations with the histological findings for each of these cases. All cases showed cardiac hypertrophy, juvenile-onset diabetes mellitus, and hearing loss. Case 1 (43-year-old male) showed less cardiac involvement and shorter duration of mitochondrial disease-related symptoms than case 2 (67-year-old female) and case 3 (51-year-old male), who showed the most advanced cardiac condition and longest duration from the manifestation of heart failure. The histological findings revealed that cardiomyocytes from case 1 showed no hypertrophy and mitochondrial degeneration in electron microscopy. Alternatively, cases 2 and 3 showed hypertrophy in their cardiomyocytes, and mitochondrial degeneration (e.g. onion-like lesions, swollen cristae, and lamellar bodies) was most apparent in case 3. These results suggested that mitochondrial degeneration, as evaluated by electron microscopy, might be correlated with impaired heart function in patients with mitochondrial cardiomyopathy.
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Kurogi K., Ishii M., Sakamoto K., Komaki S., Kusaka H., Yamamoto N., Takashio S., Arima Y., Yamamoto E., Kaikita K., Tsujita K.
Circulation Journal 84 ( 6 ) 917 - 925 2020
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background: The excessive volume of contrast needed is a significant limitation of optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI). Low-molecular-weight dextran (LMWD) has been used for OCT image acquisition instead of contrast media. This study compared the effects of OCT-guided PCI using LMWD on renal function and clinical outcomes to those of intravascular ultrasound (IVUS)-guided PCI. Methods and Results: In all, 1,183 consecutive patients who underwent intracoronary imaging-guided PCI were enrolled in this single-center, retrospective, observational study. After propensity score matching, 133 pairs of patients were assigned to undergo either OCT-guided PCI using LMWD or IVUS-guided PCI. There was no significant change from baseline in the primary endpoint, serum creatinine concentrations, after the procedure in either group. There were no significant differences between the OCT and IVUS groups in the volume of contrast medium, the incidence of contrast-induced nephropathy (1.5% vs. 2.3%; P=0.65), and major adverse cardiovascular events (MACE) at 30 days (2.3% vs. 6.0%; P=0.12) and 12 months (2.3% vs. 3.0%; P=0.70) after the procedure. Kaplan-Meier analysis at the 12-month follow-up revealed no significant difference in the incidence of MACE between the 2 groups (P=0.75). Conclusions: OCT-guided PCI using LMWD did not negatively affect renal function and achieved similar short- and long-term clinical outcomes to IVUS-guided PCI.
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Mitsuse T., Kaikita K., Ishii M., Oimatsu Y., Nakanishi N., Ito M., Arima Y., Sueta D., Iwashita S., Fujisue K., Kanazawa H., Takashio S., Araki S., Usuku H., Suzuki S., Sakamoto K., Yamamoto E., Soejima H., Tsujita K.
Journal of Atherosclerosis and Thrombosis 27 ( 3 ) 215 - 225 2020
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Atherosclerosis and Thrombosis
Aims: The assessment of bleeding risk in patients with coronary artery disease (CAD) is clinically important. We recently developed the Total Thrombus-Formation Analysis System (T-TAS) for the quantitative analysis of thrombus formation using microchips with thrombogenic surfaces. Here, we assessed the utility of T-TAS parameters in predicting 1-year bleeding events in patients with CAD. Methods: The study subjects were 561 consecutive patients who underwent coronary angiography (CAG) between August 2013 and September 2016 for suspected CAD. Blood samples collected at the time of CAG were used for T-TAS to compute the area under the curve (AUC) (AR10-AUC30) in the AR chip. Patients were divided into three groups according to AR10-AUC30 (low: ≤ 1603, intermediate, and high: ＞1765, n =187 each). One-year bleeding events were defined by the Platelet Inhibition and Patient Outcomes criteria. Results: Bleeding occurred in 21 (3.7%) patients and was classified as major (8 [1.4%]) and minor (13 [2.3%]). The AR10-AUC30 levels were significantly lower in the bleeding group than the non-bleeding group (median [interquartile range] 1590 [1442–1734] vs. 1687 [1546–1797], p=0.04). Univariate Cox regression analysis demonstrated that low AR10-AUC30, high prothrombin time-international normalized ratio levels, and diabetes correlated with bleeding events. Multivariate Cox regression analysis identified low AR10-AUC30 levels as a significant determinant of bleeding events. Kaplan-Meier survival curves showed a higher rate of bleeding events in the low than the high AR10-AUC30 group (p =0.007). Conclusions: The results highlight the potential usefulness of the AR10-AUC30 levels in the prediction of 1-year bleeding events in patients with CAD treated with various antithrombotic therapies.
DOI： 10.5551/jat.49700
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Kurogi K., Ishii M., Sakamoto K., Komaki S., Marume K., Kusaka H., Yamamoto N., Arima Y., Yamamoto E., Kaikita K., Tsujita K.
Journal of the American Heart Association 8 ( 23 ) e014096 2019.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American Heart Association
Background: The long-term prognosis of patients with acute myocardial infarction who develop persistent renal dysfunction (RD) remains unclear. We investigated risk factors and prognostic implications of persistent RD after contrast-induced nephropathy (CIN) in patients with acute myocardial infarction after primary percutaneous coronary intervention. Methods and Results: We enrolled 952 consecutive patients who underwent primary percutaneous coronary intervention for acute myocardial infarction. CIN was defined as an increase in serum creatinine levels ≥0.5 mg/dL or ≥25% from baseline within 72 hours after percutaneous coronary intervention. Persistent RD was defined as residual impairment of renal function over 2 weeks, and transient RD was defined as recovery of renal function within 2 weeks, after CIN. The overall incidence of CIN was 8.8% and that of persistent CIN was 3.1%. A receiver-operator characteristic curve showed that the optimal cutoff value of the contrast volume/baseline estimated glomerular filtration rate ratio for persistent CIN was 3.45. In multivariable logistic analysis, a contrast volume/baseline estimated glomerular filtration rate >3.45 was an independent correlate of persistent RD. At 3 years, the incidence of death was significantly higher in patients with persistent RD than in those with transient RD (P=0.001) and in those without CIN (P<0.001). Cox regression analysis showed that persistent RD (hazard ratio, 4.99; 95% CI, 2.30–10.8; P<0.001) was a significant risk factor for mortality. A similar trend was observed for the combined end points, which included mortality, hemodialysis, stroke, and acute myocardial infarction. Conclusions: Persistent RD, but not transient RD, is independently associated with long-term mortality. A contrast volume/baseline estimated glomerular filtration rate >3.45 is an independent predictor of persistent RD.
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A case of repetitive acute coronary syndrome in a patient with familial hypercholesterolemia Reviewed
Motozato K., Sueta D., Sakamoto K., Nagamatsu S., Yamashita T., Sato R., Mitsuse T., Kanemaru Y., Takaoka K., Fujisue K., Takashio S., Arima Y., Yamamoto E., Kaikita K., Tsujita K.
Journal of Cardiology Cases 20 ( 6 ) 200 - 204 2019.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology Cases
The low-density lipoprotein-cholesterol (LDL-C) level of a 60-year-old woman diagnosed with acute coronary syndrome (ACS) was 212 mg/dL. She was suspected of having familial hypercholesterolemia, therefore, administration of a proprotein convertase subtilisin-kexin type 9 (PCSK9) antibody in addition to atorvastatin plus ezetimibe was initiated, reducing her LDL-C level to 42 mg/dL. Nine months after initial ACS, the PCSK9 antibody was discontinued. Six months after the iturruption, she relapsed with ACS, and neoatherosclerosis progression was confirmed via intravascular ultrasound. Then, the PCSK9 antibody was reintroduced. Disruption of a PCSK9 may be associated with the progression and destabilization of neoatherosclerosis. <Learning objective: Administration of a proprotein convertase subtilisin-kexin type 9 (PCSK9) antibody in addition to statin decreases low-density lipoprotein-cholesterol level and is effective in suppressing cardiovascular events, the effect on neoatherosclerosis after coronary artery stent deployment is not clear. We experienced an interesting reccurent ACS case with familial hypercholesterolemia, and reported the possibility that PCSK9 antibody disruption might contribute to destabilization of neoatherosclerosis after coronary stenting utilizing intravascular ultrasound.>
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Sakuma I., Uchiyama S., Atarashi H., Inoue H., Kitazono T., Yamashita T., Shimizu W., Ikeda T., Kamouchi M., Kaikita K., Fukuda K., Origasa H., Shimokawa H.
Heart and Vessels 34 ( 11 ) 1839 - 1851 2019.11
Language：English Publishing type：Research paper (scientific journal) Publisher：Heart and Vessels
For Japanese patients with non-valvular atrial fibrillation (NVAF), the risk of stroke and major bleeding events was assessed by using the CHADS CHA DS -VASc, and HAS-BLED scores. The risk factors for embolism and major bleeding under DOAC may be different from current reports. We analyzed the data set of the EXPAND Study to determine the risk factors for events among Japanese NVAF patients in the era of direct oral anticoagulant. Using the data of EXPAND Study, the validity for predictability of the CHADS , CHA DS -VASc, and HAS-BLED scores was identified using the receiver operating characteristic curve analysis. Multivariate analysis was performed with the Cox proportional hazard model to determine the independent risk factors for stroke/systemic embolism and major bleeding among NVAF patients receiving rivaroxaban. Explanatory variables were selected based on the univariate analysis. A total of 7141 patients (mean age 71.6 ± 9.4 years, women 32.3%, and rivaroxaban 15 mg per day 56.5%) were included. Incidence rates of stroke/systemic embolism and major bleeding were 1.0%/year and 1.2%/year, respectively. The multivariate analysis revealed that only history of stroke was associated with stroke/systemic embolism (hazard ratio 3.4, 95% confidence interval 2.5-4.7, p < 0.0001). By contrast, age (1.7, 1.1–2.6, p = 0.0263), creatinine clearance (CrCl) 30–49 mL/min (1.6, 1.2-2.2, p = 0.0011), liver dysfunction (1.7, 1.1–2.8, p = 0.0320), history/disposition of bleeding (1.8, 1.0–3.0, p = 0.0348), and concomitant use of antiplatelet agents (1.6, 1.2–2.3, p = 0.0030) were associated with major bleeding. This sub-analysis showed that some components of the HAS-BLED score were independently associated with major bleeding in Japanese NVAF patients receiving anticoagulation therapy by rivaroxaban. Additionally, CrCl value of 30–49 mL/min was an independent predictor of major bleeding in patients receiving rivaroxaban. 2, 2 2 2 2 2
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Sueta D, Sakamoto K, Usuku H, Fujisue K, Yamanaga K, Arima Y, Takashio S, Suzuki S, Yamamoto E, Kaikita K, Tsujita K
Circulation reports 1 ( 11 ) 531 - 533 2019.10
Language：English Publishing type：Research paper (scientific journal) Publisher：一般社団法人 日本循環器学会
<b><i>Background:</i></b>Although "disaster-related death" as a category awarded disaster-related compensation includes death not caused by the tragedy itself, the actual definition remains unclear.<b><i>Methods and Results:</i></b>In the Kumamoto earthquake 2016, compared with the Great East Japan Earthquake 2011, excessive mental and physical stress and suicide were observed significantly more as causes of disaster-related death.<b><i>Conclusions:</i></b>It is essential to give maximum consideration to refugees to support them while in shelters.
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H<inf>2</inf>FPEF Score as a Prognostic Value in HFpEF Patients Reviewed
Sueta D., Yamamoto E., Nishihara T., Tokitsu T., Fujisue K., Oike F., Takae M., Usuku H., Takashio S., Arima Y., Suzuki S., Nakamura T., Ito M., Kanazawa H., Sakamoto K., Kaikita K., Tsujita K.
American Journal of Hypertension 32 ( 11 ) 1082 - 1090 2019.10
Language：English Publishing type：Research paper (scientific journal) Publisher：American Journal of Hypertension
Background: The H FPEF score is recognized as a simple method to diagnose heart failure (HF) with preserved left ventricular ejection fraction (HFpEF). We investigated the value of the H FPEF score in predicting subsequent cardiovascular events in HFpEF patients. Methods: This study was a retrospective, single-center, observational study. We calculated the H FPEF scores for 404 consecutive HFpEF patients. Subjects were subdivided into low- (0-3), intermediate- (4-6), and high-score (7-9) groups and followed for 50 months. The primary and secondary endpoints were composite cardiovascular/cerebrovascular events (cardiovascular death, nonfatal myocardial infarction, unstable angina pectoris, hospitalization for HF decompensation, and nonfatal stroke) occurrence and HF-related events (hospitalization for HF decompensation) occurrence at 50 months, respectively. Results: Kaplan-Meier analyses demonstrated a significantly higher incidence of cardiovascular/cerebrovascular events among those with a higher H FPEF score (log-rank test, P = 0.005). The HF-related event rate was higher in proportion to the H FPEF score (log-rank test, P < 0.001). Multivariate Cox hazard analyses identified the H FPEF score (per 1 point) as an independent predictor of cardiovascular and HF-related events (hazard ratio [HR], 1.179; 95% confidence interval [CI], 1.066-1.305; P = 0.001 and HR, 1.288; 95% CI, 1.134-1.463; P = 0.001, respectively). Receiver operating characteristic analysis showed that the H FPEF significantly predicted cardiovascular events (area under the curve [AUC], 0.626; 95% CI, 0.557-0.693; P < 0.001) and HF-related events (AUC, 0.680; 95% CI, 0.600-0.759; P < 0.001). The cutoff H FPEF score was 5.5 for the identification of cardiovascular and HF-related events. Conclusion: The H FPEF score might be a potentially useful marker for the prediction of cardiovascular and HF-related events in HFpEF patients. Clinical Trails Registration: Trail Number UMIN000029600. 2 2 2 2 2 2 2 2 2
DOI： 10.1093/ajh/hpz108
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Usuku H., Yamamoto E., Arima Y., Takashio S., Araki S., Sueta D., Kanazawa H., Suzuki S., Yoshimura H., Tsunoda R., Nishigami K., Uekihara S., Sakamoto K., Kawano H., Kaikita K., Matsui H., Tsujita K.
International Journal of Cardiology 293 248 - 253 2019.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background: In patients undergoing dialysis therapy, mitral annular calcification (MAC) is a powerful predictor of cardiovascular events and all-cause mortality. However, there is little data on predictors for MAC progression in patients undergoing dialysis therapy. Methods and results: We retrospectively analyzed 98 hemodialysis-dependent patients in Japanese Red Cross Kumamoto Hospital who underwent routine transthoracic echocardiography (TTE) in 2017. Three patients with history of surgical valve replacement or severe valvular heart diseases were excluded. In the 95 enrolled patients, MAC was detected by TTE in 28 patients (29%). A multivariate logistic regression analysis revealed that duration of hemodialysis therapy was independently associated with presence of MAC (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.02–1.16; p < 0.01). Among the 95 patients, 72 patients also underwent routine TTE 5 years previously in 2012. In these patients, progression of MAC from 2012 to 2017 was observed in 11 patients (15%). A multivariate logistic regression analysis revealed that number of coronary risk factors (OR: 2.67; 95% CI: 1.24–5.76; p = 0.01), baseline MAC diameter (OR: 1.23; 95% CI: 1.05–1.45; p = 0.01), and left atrial diameter (OR: 0.81; 95% CI: 0.68–0.95; p = 0.01) were significantly associated with progression of MAC. Conclusions: Accumulation of coronary risk factors was associated with progression of MAC in patients undergoing dialysis. Management of coronary risk factors may be important for inhibition of MAC progression.