論文 - 海北 幸一
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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：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年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Circulation Journal
Background: 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年
担当区分：責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of 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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of 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 査読あり
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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of 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：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：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 査読あり
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：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年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Background: 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.
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Antithrombotic therapy for atrial fibrillation with stable coronary disease 査読あり
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年9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：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年9月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Background: 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年9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：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 査読あり
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年8月
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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：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 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年6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：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 査読あり
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年5月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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A retrospective study of arterial stiffness and subsequent clinical outcomes in cancer patients undergoing percutaneous coronary intervention. 査読あり
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年4月
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Misumi I., Motozato K., Yamabe H., Ohmori K., Usuku H., Kaikita K., Tsujita K.
Echocardiography 36 ( 3 ) 605 - 608 2019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：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