Papers - KAIKITA Koichi
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Antithrombotic therapy for atrial fibrillation with stable coronary disease Reviewed
Yasuda S., Kaikita K., Akao M., Ako J., Matoba T., Nakamura M., Miyauchi K., Hagiwara N., Kimura K., Hirayama A., Matsui K., Ogawa H.
New England Journal of Medicine 381 ( 12 ) 1103 - 1113 2019.9
Language：English Publishing type：Research paper (scientific journal) Publisher：New England Journal of Medicine
BACKGROUND There are limited data from randomized trials evaluating the use of antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease. METHODS In a multicenter, open-label trial conducted in Japan, we randomly assigned 2236 patients with atrial fibrillation who had undergone percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1 year earlier or who had angiographically confirmed coronary artery disease not requiring revascularization to receive monotherapy with rivaroxaban (a non-vitamin K antagonist oral anticoagulant) or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause; this end point was analyzed for noninferiority with a noninferiority margin of 1.46. The primary safety end point was major bleeding, according to the criteria of the International Society on Thrombosis and Hemostasis; this end point was analyzed for superiority. RESULTS The trial was stopped early because of increased mortality in the combination-therapy group. Rivaroxaban monotherapy was noninferior to combination therapy for the primary efficacy end point, with event rates of 4.14% and 5.75% per patient-year, respectively (hazard ratio, 0.72; 95% confidence interval [CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy was superior to combination therapy for the primary safety end point, with event rates of 1.62% and 2.76% per patient-year, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01 for superiority). CONCLUSIONS As antithrombotic therapy, rivaroxaban monotherapy was noninferior to combination therapy for efficacy and superior for safety in patients with atrial fibrillation and stable coronary artery disease.
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Sato K., Takahashi J., Odaka Y., Suda A., Sueda S., Teragawa H., Ishii K., Kiyooka T., Hirayama A., Sumiyoshi T., Tanabe Y., Kimura K., Kaikita K., Ong P., Sechtem U., Camici P.G., Kaski J.C., Crea F., Beltrame J.F., Shimokawa H.
International Journal of Cardiology 291 13 - 18 2019.9
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background: Possible ethnic differences in clinical characteristics and long-term prognosis of contemporary patients with vasospastic angina (VSA) remain to be elucidated. Methods and results: The Japanese Coronary Spasm Association (JCSA) conducted an international, prospective, and multicenter registry study for VSA patients. A total of 1457 VSA patients (Japanese/Caucasians, 1339/118) were enrolled based on the same diagnostic criteria. Compared with Caucasian patients, Japanese patients were characterized by higher proportions of males (68 vs. 51%) and smoking history (60 vs. 49%). Japanese patients more often had angina especially during the night and early morning hours, compared with Caucasians. Ninety-five percent of Japanese and 84% of Caucasian patients underwent pharmacological provocation test. Importantly, no significant differences in the patterns of coronary spasm were apparent, with diffuse spasm most frequently noted in both ethnicities. The prescription rate of calcium-channel blockers was higher in Japanese (96 vs. 86%), whereas the uses of nitrates (46 vs. 59%), statins (43 vs. 65%), renin-angiotensin-system inhibitors (27 vs. 51%), and β-blockers (10 vs. 24%) were more common in Caucasian patients. Survival rate free from major adverse cardiac events (MACE) was slightly but significantly higher in Japanese than in Caucasians (86.7 vs. 76.6% at 5 years, P < 0.001). Notably, multivariable analysis revealed that the JCSA risk score correlated with MACE rates not only in Japanese but also in Caucasian patients. Conclusion: These results indicate that there are ethnic differences in clinical profiles and long-term prognosis of contemporary VSA patients.
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Nishihara T., Yamamoto E., Sueta D., Fujisue K., Usuku H., Oike F., Takae M., Arima Y., Araki S., Takashio S., Nakamura T., Suzuki S., Sakamoto K., Soejima H., Kawano H., Kaikita K., Tsujita K., Roever L.
Medicine (United States) 98 ( 38 ) e17069 2019.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Medicine (United States)
Although serum magnesium (Mg) levels are closely associated with the prognosis of heart failure (HF) patients, the clinical significance of sMg levels on the cardiovascular outcomes of HF with preserved ejection fraction (HFpEF) patients is not fully understood. This study was a retrospective, single-center, observational study. We enrolled 452 consecutive HFpEF patients admitted to Kumamoto University Hospital. We defined lower sMg as <2.0mg/dl (=0.8mmol/L) based on recent clinical evidence and compared their clinical characteristics and prognosis. There were no significant differences between groups in the use of all medications (loop diuretics, mineralocorticoid receptor antagonists, renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, beta blockers, statins, and Mg preparations). The lower sMg group showed a significantly higher prevalence of diabetes mellitus (DM), uric acid levels, and BNP levels compared with the higher sMg group. Kaplan-Meier curve revealed a significantly higher probability of HF-related events in the lower sMg group compared with the higher sMg group (log-rank test, P=.012). Multivariate Cox-proportional-hazard analysis revealed that the lower sMg group had significantly and independently higher probabilities of HF-related events compared with the higher sMg group (hazard ratio=2.37, 95% confidence intervals = 1.27-4.41, P=.007). We reclassified the risk of HF-related events after adding the lower sMg to the other prognostic factors (age, previous hospitalization for HF, DM, Ln-BNP); the continuous net reclassification improvement was 29.0% (P=.041). sMg levels might provide important prognostic information in regard to HFpEF.
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New definition of pulmonary hypertension in patients with heart failure with preserved ejection fraction Reviewed
Nishihara T, Yamamoto E＊, Tokitsu T, Sueta D, Fujisue K, Usuku H, Takashio S, Sakamoto K, Kaikita K, Tsujita K
American Journal of Respiratory and Critical Care Medicine 200 ( 3 ) 386 - 388 2019.8
Language：English Publishing type：Research paper (scientific journal)
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Fujisue K., Tokitsu T., Yamamoto E., Sueta D., Takae M., Nishihara T., Oike F., Usuku H., Ito M., Motozato K., Kanazawa H., Araki S., Arima Y., Takashio S., Izumiya Y., Suzuki S., Sakamoto K., Kaikita K., Tsujita K.
Medicine (United States) 98 ( 28 ) e15959 2019.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Medicine (United States)
The prognostic significance of systemic atherothrombosis in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the relation between the presence of polyvascular disease (PVD) and cardiovascular outcomes in HFpEF patients.A total of 510 consecutive HFpEF patients were prospectively observed for up to 1500 days or until occurrence of cardiovascular events. PVD was defined as ≥2 coexistence of coronary artery disease, peripheral arterial disease, and cerebrovascular disease.Overall, 124 cardiovascular events were observed during follow-up (median: 1430 days). Kaplan-Meier curve showed HFpEF with PVD (n=84) experienced more cardiovascular events than did those without PVD patients (44.0% vs 20.4%, log-rank: P<.001). Multivariable Cox proportional hazards analysis with significant factors from univariate analysis showed the presence of PVD (hazard ratio [HR]: 2.875, 95% [CI]: 1.894-4.365, P<.001), previous HF hospitalization (HR: 1.578, 95% CI: 1.031-2.414, P=.036), hemoglobin (HR: 0.889, 95% CI: 0.805-0.983, P=.021), serum sodium (HR: 0.946, 95% CI 0.896-1.000, P=.048), ln-BNP (per 1.0, HR: 1.255, 95% CI: 1.055-1.494, P=.010), and E/e' (HR: 1.047, 95% CI: 1.020-1.075, P<.001) significantly predicted future cardiovascular events. Multivariable Cox hazard analysis with 4 established factors (age, BNP, diabetes mellitus, and previous HF hospitalization) from the I-PRESERVE (Irbesartan in HFpEF) study showed PVD was independently associated with cardiovascular events in HFpEF patients (HR: 2.562, 95% CI: 1.715-3.827, P<.001).The presence of PVD is significantly associated with cardiovascular events in HFpEF, suggesting the importance of screening PVD in HFpEF.
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Takae M., Yamamoto E., Tokitsu T., Oike F., Nishihara T., Fujisue K., Sueta D., Usuku H., Motozato K., Ito M., Kanazawa H., Araki S., Nakamura T., Arima Y., Takashio S., Suzuki S., Sakamoto K., Soejima H., Yamabe H., Kaikita K., Tsujita K.
American Journal of Hypertension 32 ( 7 ) 657 - 667 2019.6
Language：English Publishing type：Research paper (scientific journal) Publisher：American Journal of Hypertension
BACKGROUND: Although pulse wave velocity (PWV) is recognized to be a risk predictor for various cardiovascular diseases, the association of brachial-ankle PWV (baPWV) with cardiovascular outcomes in heart failure (HF) with reduced ejection fraction (HFrEF) patients remains uncertain. METHODS: We measured ankle-brachial pressure index (ABI) and baPWV values at stable condition after optimal therapy for HF in 201 consecutive HFrEF patients admitted to Kumamoto University Hospital from 2007 to 2015 who were enrolled and followed until the occurrence of cardiovascular events. We defined peripheral artery disease (PAD) as ABI value ≤ 0.9. RESULTS: Kaplan-Meier analysis revealed that HFrEF patients with peripheral artery disease PAD had a significant higher risk of total cardiovascular and HF-related events than those without PAD (P = 0.03 and P = 0.01, respectively). Next, we divided HFrEF patients without PAD into 3 groups according to baPWV values. In the Kaplan-Meier analysis, total cardiovascular and HF-related events in the highest baPWV group (1,800 cm/second ≤ baPWV) had a significantly higher frequency than those in the mid-level baPWV group (1,400 cm/second ≤ baPWV < 1,800 cm/second) (P = 0.007 and P = 0.004, respectively). The hazard ratio between HFrEF patients in the mid-level baPWV group and those with other baPWV groups was compared after adjustment for other cofounders. The probabilities of HF-related events were significantly higher in the lowest and highest baPWV group. CONCLUSION: Identifying complications of PAD and measuring baPWV values in HFrEF patients were useful for predicting their prognosis. Trial Registration: UMIN000034358.
DOI： 10.1093/ajh/hpz048
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Ishii M., Kaikita K., Mitsuse T., Nakanishi N., Oimatsu Y., Yamashita T., Nagamatsu S., Tabata N., Fujisue K., Sueta D., Takashio S., Arima Y., Sakamoto K., Yamamoto E., Tsujita K.
IJC Heart and Vasculature 23 100346 2019.6
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：IJC Heart and Vasculature
Introduction: Bleeding complications after transcatheter aortic valve implantation (TAVI) is a major problem in clinical practice. However, there is few information on thrombogenicity after TAVI. The aim of this study was to establish a monitoring of total thrombogenicity in perioperative TAVI using the Total Thrombus-formation Analysis System (T-TAS), a microchip-based flow chamber system for analysis of thrombus formation under flow condition. Methods: Twenty-three patients with severe aortic stenosis who underwent TAVI between August 2017 and March 2018 at Kumamoto university hospital were enrolled. After exclusion, data of 21 patients were analyzed. Blood samples were obtained before, 2, 7, and 30 days after TAVI. Thrombogenicity were assessed by the T-TAS to compute the area under the curve (AUC) (AR -AUC ) in the AR chip. We also measured platelet count, high-molecular-weight von Willebrand factor (HMW-vWF) multimers, and plasma thrombopoietin. Computational fluid dynamics (CFD) analysis was performed to calculate the wall shear stress (WSS). Results: The AR -AUC levels and platelet counts were significantly lower at 2 days post-TAVI, and then increased gradually. HMW-vWF multimers, and plasma thrombopoietin, were significantly higher at 2 days post-TAVI, compared with before TAVI. CFD analysis showed that WSS of the aortic valve and posterior ascending aortic wall were significantly lower after TAVI than before-TAVI. Multivariate analysis identified max velocity measured by echocardiography, platelet count, and D-dimer as significant determinants of AR -AUC , representing total thrombogenicity. Conclusions: Although HMW-vWF multimers improved earlier after TAVI, total thrombogenic activity evaluated by T-TAS remained relatively low followed by improvement in thrombogenic activity at 30 days after TAVI. Clinical Trial Registration: https://clinicaltrials.gov. Unique identifiers: NCT03248232. 10 30 10 30 10 30
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Basal septal perforator vein mimicking the “late iodine enhancement” in delayed phase cardiac CT for myocardial scar assessment Reviewed
Kidoh M＊, Oda S, Utsunomiya D, Emoto R.T, Nakaura T, Nagayama Y, Yamamoto M, Sakamoto K, Yamamoto E, Kaikita K, Tsujita K, Yamashita Y
Radiology Case Reports 14 ( 5 ) 588 - 590 2019.5
Language：English Publishing type：Research paper (scientific journal)
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A retrospective study of arterial stiffness and subsequent clinical outcomes in cancer patients undergoing percutaneous coronary intervention. Reviewed
Tabata N, Sueta D, Yamamoto E, Takashio S, Arima Y, Araki S, Yamanaga K, Ishii M, Sakamoto K, Kanazawa H, Fujisue K, Hanatani S, Soejima H, Hokimoto S, Izumiya Y, Kojima S, Yamabe H, Kaikita K, Matsui K, Tsujita K
Journal of hypertension 37 ( 4 ) 754 - 764 2019.4
Language：English Publishing type：Research paper (scientific journal)
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Misumi I., Motozato K., Yamabe H., Ohmori K., Usuku H., Kaikita K., Tsujita K.
Echocardiography 36 ( 3 ) 605 - 608 2019.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Echocardiography
A 16-year-old healthy boy visited our department because of a heart murmur. A 12-lead electrocardiogram showed left QRS axis deviation and repolarization abnormalities. Transthoracic echocardiography and a computed tomographic scan revealed a hypertrophied papillary muscle and a discrete ridge arising from the septal wall, causing mid-ventricular obstruction. Doppler echocardiography revealed that the pressure gradient at the obstruction was mild. The patient will be followed up annually, without medication or physical restriction.
DOI： 10.1111/echo.14259
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Takae M., Yamamoto E., Fujisue K., Oike F., Nishihara T., Sueta D., Usuku H., Motozato K., Ito M., Hanatani S., Kanazawa H., Arima Y., Takashio S., Nakamura T., Suzuki S., Sakamoto K., Izumiya Y., Soejima H., Kojima S., Yamabe H., Kaikita K., Tsujita K.
International Journal of Cardiology 277 3 - 7 2019.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Cardiology
Background: Thrombus formation is one of the main pathogeneses of acute coronary syndrome with atherosclerotic rupture. Previous studies have reported that atherosclerosis increases platelet aggregability and that vascular endothelial dysfunction reflects early change of atherosclerosis. However, the relationship between coronary endothelial dysfunction and platelet reactivity remains unclear. Therefore, in this study, we investigated the relationship between them in non-obstructive ischemic heart disease (IHD) patients. Methods: Three hundred sixty-eight consecutive stable patients with suspected angina presenting non-obstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test and measured adenosine triphosphate-induced coronary flow reserve. Finally, 25 non-obstructive IHD patients who had no anti-platelet agents were assessed for the relationship between coronary blood flow volume (CBFV) change and platelet aggregability as P2Y12 reaction unit (PRU) by VerifyNow P2Y12 assay system. Results: CBFV change by intracoronary 20 μg/kg per minute acetylcholine provocation showed a significant negative correlation with platelet aggregability as PRU (r = 0.44, P = 0.03). Conversely, there was no significant correlation between PRU and endothelial function as coronary flow reserve. Furthermore, multivariable linear regression analysis indicated that an incremental CBFV change was independently associated with PRU (β = 0.63, P < 0.001) in non-obstructive IHD patients. Conclusions: In patients with non-obstructive IHD, CBFV change was significantly associated with platelet aggregability, indicating that coronary endothelial dysfunction might mediate higher platelet aggregability.
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Comprehensive assessment of takotsubo cardiomyopathy by cardiac computed tomography Reviewed
Sueta D., Oda S., Izumiya Y., Kaikita K., Kidoh M., Utsunomiya D., Yamashita Y., Tsujita K.
Emergency Radiology 26 ( 1 ) 109 - 112 2019.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Emergency Radiology
Cardiac computed tomography (CT) now plays an important role in emergency settings because of its accessibility and fast acquisition time, which cardiac magnetic resonance imaging (CMR) cannot match. Although cardiac CT was originally conceived for the assessment of the coronary artery tree, it has evolved to embrace several non-coronary applications. These include myocardial assessment, resulting in myocardial characterization comparable with that of CMR and cardiac CT for late enhancement imaging. In this report, we describe a patient with takotsubo cardiomyopathy who underwent a comprehensive assessment using cardiac CT. This technique enabled to identify the condition of the coronary arteries and to evaluate the four-dimensional left ventricular function and myocardial late iodine enhancement immediately. The information obtained was similar to that provided by CMR; however, cardiac CT is more practical than CMR in emergency settings. Comprehensive assessment by cardiac CT can be beneficial for a noninvasive evaluation of patients with suspected takotsubo cardiomyopathy.
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Hirakawa K., Takashio S., Marume K., Yamamoto M., Hanatani S., Yamamoto E., Sakamoto K., Izumiya Y., Kaikita K., Oda S., Utsunomiya D., Shiraishi S., Ueda M., Yamashita T., Yamashita Y., Ando Y., Tsujita K.
ESC Heart Failure 6 ( 1 ) 122 - 130 2019.2
Language：English Publishing type：Research paper (scientific journal) Publisher：ESC Heart Failure
Aims: Mutant transthyretin (ATTRm) amyloidosis is a systemic disease caused by the deposition of amyloid fibrils derived from mutated transthyretin. Although cardiac involvement impacts the prognosis of patients with ATTRm amyloidosis, the incidence of cardiac events, such as bradyarrhythmia, ventricular tachycardia, and heart failure, has not been fully elucidated. The aim of this study was to evaluate the prognosis and predictors of clinical outcomes, including cardiac events, in patients with ATTRm amyloidosis in Japan. Methods and results: We evaluated 90 consecutive patients with ATTRm amyloidosis at Kumamoto University. ATTRm amyloidosis was diagnosed by the observation of both amyloid fibril deposition on tissue biopsy and a transthyretin mutation on sequential analysis. Sympathetic nerve activity was evaluated in 59 patients using 123-iodine metaiodobenzylguanidine ( I-MIBG) imaging. The endpoint was a composite of all-cause death, hospitalization for heart failure, and implantation of a pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy defibrillator. Sixty-seven patients had the Val30Met mutation (74%). The composite endpoint occurred in 23 patients (26%): all-cause death (n = 6), hospitalization for worsening heart failure (n = 1), and implantation of an implantable cardioverter defibrillator (n = 6), cardiac resynchronization therapy defibrillator (n = 3), or pacemaker (n = 7). The 5-year incident rate for clinical outcomes was 19%. In a multivariate Cox hazard analysis, age [hazard ratio (HR): 1.07, 95% confidence interval (95% CI): 1.01–1.12, P = 0.015], PQ interval (HR: 1.01, 95% CI: 1.00–1.02, P = 0.042), interventricular septum thickness in diastole (HR: 1.25, 95% CI: 1.09–1.42, P = 0.001), and non-Val30Met mutation (HR: 4.31, 95% CI: 1.53–12.16, P = 0.006) were independent predictive factors of clinical outcomes. Kaplan–Meier analysis demonstrated a significantly higher probability of the composite endpoint in the non-Val30Met group than in the Val30Met group (log-rank test: P = 0.002) and in patients with left ventricular hypertrophy than in patients without left ventricular hypertrophy (log-rank test: P < 0.001). In patients who underwent I-MIBG imaging, a delayed heart-to-mediastinum (HM) ratio <1.6 was a significant predictive factor of the composite endpoint (HR: 4.98, 95% CI: 1.73–14.37, P = 0.003) in the univariate Cox hazard analyses. Kaplan–Meier curve analysis showed that a delayed HM ratio <1.6 was associated with a poor prognosis (log-rank test: P = 0.001). Conclusions: Non-Val30Met mutation, septal hypertrophy, and a delayed HM ratio are useful predictors of clinical outcomes in patients with ATTRm amyloidosis in Japan. These results suggest that it is important to evaluate cardiac involvement in terms of morphological (left ventricular hypertrophy) and functional (cardiac denervation) perspectives using echocardiography and I-MIBG imaging, respectively. 123 123 123
DOI： 10.1002/ehf2.12361
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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 ( 1 ) 141 - 150 2019.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Heart and Vessels
The EXPAND Study examined the real-world efficacy and safety of rivaroxaban for the prevention of stroke and systemic embolism (SE) in Japanese patients with non-valvular atrial fibrillation (NVAF). In this sub-analysis, we compared the differences in efficacy and safety between patients with and those without history of stroke or transient ischemic attack (TIA). This multicenter, prospective, non-interventional, observational, cohort study was conducted at 684 medical centers in Japan. A total of 7141 NVAF patients aged ≥ 20 years [mean age 71.6 ± 9.4 (SD) years] who were being or planned to be treated with rivaroxaban (10 mg/day, 43.5%; 15 mg/day, 56.5%) were followed for a mean period of 897.1 ± 206.8 days with a high follow-up rate (99.7%). The primary prevention group comprised patients without history of ischemic stroke or TIA (n = 5546, 77.7%), and the secondary prevention group comprised those with history of ischemic stroke or TIA (n = 1595, 22.3%). In the primary and secondary prevention groups, the incidence rate of stroke or SE (primary efficacy endpoint) was 0.7 and 2.2%/year, respectively (P < 0.001), and the incidence rate of major bleeding (primary safety endpoint) was 1.2 and 1.5%/year, respectively (P = 0.132). For major bleeding events, the incidence rate of intracranial bleeding was 0.4 and 0.8%/year (P = 0.002) in the primary and secondary prevention groups, respectively. This sub-analysis of the EXPAND Study showed that the Japan-specific dosages of rivaroxaban were effective and safe in Japanese NVAF patients with and those without ischemic stroke or TIA in routine clinical practice.
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Myocardial ischemia suppresses ketone body utilization Reviewed
Arima Y＊, Izumiya Y, Ishida T, Takashio S, Ishii M, Sueta D, Sakamoto K, Fujisue K, Kaikita K, Tsujita K
J Am Coll Cardiol 73 ( 2 ) 246 - 247 2019.1
Language：English Publishing type：Research paper (scientific journal)
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Marume K., Takashio S., Nishi M., Hirakawa K., Yamamoto M., Hanatani S., Oda S., Utsunomiya D., Shiraishi S., Ueda M., Yamashita T., Sakamoto K., Yamamoto E., Kaikita K., Izumiya Y., Yamashita Y., Ando Y., Tsujita K.
Circulation Journal 83 ( 8 ) 1698 - 1708 2019
Language：English Publishing type：Research paper (scientific journal) Publisher：Circulation Journal
Background: A recent study revealed a high prevalence of transthyretin (TTR) cardiac amyloidosis (CA) in elderly patients. 99 Tc-labeled pyrophosphate ( Tc-PYP) scintigraphy is a remarkably sensitive and specific modality for TTR-CA, but is only available in specialist centres; thus, it is important to raise the pretest probability. The aim of this study was to evaluate the characteristics of patients with Tc-PYP positivity and make recommendations about patient selection for Tc-PYP scintigraphy. Methods and Results: We examined 181 consecutive patients aged ≥70 years who underwent Tc-PYP scintigraphy at Kumamoto University Hospital between January 2012 and December 2018. Logistic regression analyses showed that high-sensitivity cardiac troponin T (hs-cTnT) ≥0.0308 ng/mL, left ventricular posterior wall thickness ≥13.6 mm, and wide QRS (QRS ≥120 ms) were strongly associated with Tc-PYP positivity. We developed a new index for predicting Tc-PYP positivity by adding 1 point for each of the 3 factors. The Tc-PYP positive rate increased by a factor of 4.57 for each 1-point increase (P<0.001). Zero points corresponded to a negative predictive value of 87% and 3 points corresponded to a positive predictive value of 96% for Tc-PYP positivity. Conclusions: The combination of biochemical (hs-cTnT), physiological (wide QRS), and structural (left ventricular posterior wall thickness) findings can raise the pretest probability for Tc-PYP scintigraphy. It can assist clinicians in determining management strategies for elderly patients with suspected CA. m 99 m 99 m 99 m 99 m 99 m 99 m 99 m 99 m 99 m
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Takotsubo Cardiomyopathy mimicking acute coronary syndrome - extracellular volume quantification using cardiac computed tomography Reviewed
Sueta D＊, Oda S, Yamamoto E, Nishi M, Kaikita K, Kidoh M, Utunomiya D, Nakaura T, Yamashita Y, Tsujita K
Circulation Journal 83 ( 7 ) 1613 2019
Language：English Publishing type：Research paper (scientific journal)
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Isolated right ventricular apical hypoplasia without atrial septal defect Reviewed
Otsuka Y, Sato K, Sueta D＊, Suzuki S, Matsuo O, Usuku H, Imamura K, Takashio S, Oda S, Arima Y, Sakamoto K, Yamamoto E, Nakamura S, Kawano H, Kaikita K, Tsujita K
Circulation Journal 83 ( 7 ) 1615 2019
Language：English Publishing type：Research paper (scientific journal)
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Ito M., Yamabe H., Koyama J., Kanazawa H., Kaneko S., Kanemaru Y., Kiyama T., Arima Y., Takashio S., Yamamoto E., Izumiya Y., Kojima S., Kaikita K., Shono T., Utsunomiya D., Sasaki Y., Yamashita Y., Tsujita K.
Journal of Cardiology 72 ( 6 ) 480 - 487 2018.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Cardiology
Background: Esophageal injury (EI) is a serious complication that occurs after catheter ablation of atrial fibrillation (AF), however predictable factor of EI is unclear. Methods: Among 308 patients who underwent AF ablation, upper gastrointestinal tract endoscopy was performed the next day after ablation to examine for EI. To define the primary factor that predicts EI, patients’ characteristics, number and amount of radiofrequency energy applied to the posterior wall, ablation procedure, and the shortest distance between esophagus and posterior left atrium measured on contrast computed tomography (SD-CT) were analyzed. Results: EI was found in 27 patients (8.8%). There were no significant differences in the patient characteristics, number and amount of radiofrequency energy applied to posterior wall or ablation procedure between patients with (Injury Group) and without EI (Non-Injury Group). However, SD-CT in the Injury Group was significantly shorter than that in Non-Injury Group (2.3 ± 0.6 mm vs 4.1 ± 0.9 mm, p < 0.001). The area under a receiver operating characteristic curve using SD-CT as a predictive marker in EI patients was 0.988 (p < 0.001). When the cut-off value of SD-CT was set at 2.9 mm, the sensitivity and specificity for EI diagnosis were 92.3% and 96.8%, and the positive predictive value and negative predictive value were 0.75 and 0.99, respectively. Conclusions: EI observed after catheter ablation of AF was closely associated with the SD-CT. Patients with SD-CT below 2.9 mm have a potential risk of EI and thus must be strictly followed.
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冠攣縮と急性冠症候群
海北幸一, 辻田賢一.
日本臨牀 76 ( 12 ) 2109 - 2114 2018.12
Authorship：Lead author Publishing type：Research paper (scientific journal)