論文 - 海北 幸一
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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年2月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Background: 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 査読あり
Sueta D., Oda S., Izumiya Y., Kaikita K., Kidoh M., Utsunomiya D., Yamashita Y., Tsujita K.
Emergency Radiology 26 ( 1 ) 109 - 112 2019年2月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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年2月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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：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 査読あり
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年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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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: 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 査読あり
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年
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Isolated right ventricular apical hypoplasia without atrial septal defect 査読あり
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年
記述言語：英語 掲載種別：研究論文（学術雑誌）
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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
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年12月
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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Fujisue K., Nagamatsu S., Shimomura H., Yamashita T., Nakao K., Nakamura S., Ishihara M., Matsui K., Yamamoto N., Koide S., Matsumura T., Fujimoto K., Tsunoda R., Morikami Y., Matsuyama K., Oshima S., Sakamoto K., Izumiya Y., Kaikita K., Hokimoto S., Ogawa H., Tsujita K.
International Journal of Cardiology 268 23 - 26 2018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: Chronic kidney disease (CKD) deteriorates the prognosis of patients undergoing percutaneous coronary intervention (PCI). Because coronary artery disease (CAD) is the major cause of death in CKD patients, cardiovascular risk reduction has been clinically important in CKD. We hypothesized intensive lipid-lowering with statin/ezetimibe attenuated coronary atherosclerotic development even in patients with CKD. Methods: In the prospective, randomized, controlled, multicenter PRECISE-IVUS trial, 246 patients undergoing intravascular ultrasound (IVUS)-guided PCI were randomly assigned to receive atorvastatin/ezetimibe combination or atorvastatin alone (the dosage of atorvastatin was up-titrated to achieve the level of low-density lipoprotein cholesterol < 70 mg/dL). Serial volumetric IVUS findings obtained at baseline and 9–12 month follow-up to quantify the coronary plaque response in 202 patients were compared stratified by the presence or absence of CKD. Results: CKD was observed in 52 patients (26%) among 202 enrolled patients. Compared with the non-CKD group, the CKD group was significantly older (71.5 ± 8.6 years vs. 64.4 ± 9.6 years, P < 0.001) with similar prevalence of comorbid coronary risk factors and lipid profiles. Similar to the non-CKD group (−1.4 [−2.8 to −0.1]% vs. −0.2 [−1.7 to 1.0]%, P = 0.002), the atorvastatin/ezetimibe combination significantly reduced ∆PAV compared with atorvastatin alone even in the CKD group (−2.6 [−5.6 to −0.4]% vs. −0.9 [−2.4 to 0.2]%, P = 0.04). Conclusions: As with non-CKD, intensive lipid-lowering therapy with atorvastatin/ezetimibe demonstrated stronger coronary plaque regression effect even in patients with CKD compared with atorvastatin monotherapy. Trial registration: NCT01043380 (ClinicalTrials.gov).
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Hanatani S., Izumiya Y., Onoue Y., Tanaka T., Yamamoto M., Ishida T., Yamamura S., Kimura Y., Araki S., Arima Y., Nakamura T., Fujisue K., Takashio S., Sueta D., Sakamoto K., Yamamoto E., Kojima S., Kaikita K., Tsujita K.
International Journal of Cardiology 268 216 - 221 2018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: Sarcopenia is frequently observed and associated with poor outcomes in patients with chronic kidney disease (CKD). A simple screening test for sarcopenia using age, grip strength, and calf circumference was recently developed. However, the clinical utility of this sarcopenia score in patients with CKD remains unclear. Methods and results: We calculated the sarcopenia score of 265 patients with CKD and followed the patients for cardiovascular events. The endpoint of this study was the composite of cardiovascular hospitalization and total mortality. We divided all participants into high (n = 166) and low (n = 99) sarcopenia score groups using a simple scoring system. Patients in the high sarcopenia score group showed significantly higher plasma B-type natriuretic peptide (BNP) levels than those in the low sarcopenia score group (median: 103.1, interquartile range: 46.3–310.0 vs. 46.7, 18.0–91.8 pg/mL; p < 0.0001). The Kaplan–Meier curve revealed that the risk of cardiovascular events was significantly greater in the high sarcopenia score group (log-rank test: p < 0.0001), even after potential confounding factors were corrected using propensity score matching. Multivariate Cox hazard analysis identified a high sarcopenia score (hazard ratio: 3.04, 95% confidence interval: 1.45–6.38, p = 0.003) as an independent predictor of the primary endpoints. Furthermore, the combination of a high sarcopenia score and high BNP level identified patients with a significantly higher probability of future events (p < 0.0001). Conclusions: This study demonstrates that this simple screening score for sarcopenia could be a useful tool for estimating the future adverse event risk in patients with CKD.
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Fujisue K., Shirakawa T., Nakamura S., Yamamoto N., Oshima S., Matsumura T., Tsunoda R., Hirai N., Tayama S., Nakamura N., Hirose T., Maruyama H., Fujimoto K., Kajiwara I., Sakamoto T., Nakao K., Sakaino N., Hokimoto S., Nagayoshi Y., Hokamaki J., Shimomura H., Sakamoto K., Yamamoto E., Izumiya Y., Kaikita K., Ogawa H., Tsujita K.
Journal of Cardiology 72 ( 4 ) 350 - 355 2018年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Cardiology
Background: Acute myocardial infarction (AMI) is mainly characterized by the rupture of lipid-rich vulnerable atherosclerotic plaque. The matrix metalloproteinases (MMPs) have been shown to play a critical role in inflammatory processes underlying plaque rupture. Some reports suggested statins inhibit the increased MMP levels after AMI. However, there are a few comparison studies between the different dosages of the same statin and circulating levels of MMPs. Purpose: This study will preliminarily investigate the potential effects of appropriate or low dose of rosuvastatin on circulating MMPs levels in AMI patients. Moreover, we will also obtain plasma from patients while undergoing diagnostic angiography to determine differences in various cardiac sites and peripheral vessels. Methods: This study is a multicenter, open-label, randomized, parallel-group study to be conducted to compare the appropriate or low dose of rosuvastatin in the effect on serum levels of inflammatory markers in AMI patients. The eligible patients undergoing percutaneous coronary intervention (PCI) will be randomly assigned to receive either appropriate or low-dose rosuvastatin daily using a web-based randomization software within 24 h after PCI. The low-dose group will be treated with rosuvastatin 2.5 mg once daily with a follow-up. The appropriate-dose group will begin treatment with rosuvastatin 5 mg once daily, and the dose of rosuvastatin will be titrated to 10 mg within 4 weeks. During administration of the study treatment, subjects will undergo laboratory testing including MMPs and be monitored for the occurrence of adverse events up to 24 weeks. The primary endpoint will be the change rate of MMPs at 24 weeks after administration. Conclusions: INVITATION will compare the appropriate or low dose of rosuvastatin in the effects on serum levels of inflammatory markers including MMPs in AMI patients. This study will provide significant information on rosuvastatin as an anti-inflammatory agent for AMI.
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Impact of current and past cancer history on the risk of cardiovascular events following percutaneous coronary intervention: a Kumamoto University Malignancy and Atherosclerosis (KUMA) study 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, Tsujita K
Eur Heart J - Qual Care Clin Outcomes 4 ( 4 ) 290 - 300 2018年10月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Nishihara T., Tokitsu T., Sueta D., Takae M., Oike F., Fujisue K., Usuku H., Takashio S., Hanatani S., Kanazawa H., Arima Y., Sakamoto K., Izumiya Y., Yamabe H., Kaikita K., Yamamoto E., Tsujita K.
American Journal of Hypertension 31 ( 10 ) 1098 - 1105 2018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：American Journal of Hypertension
BACKGROUND Although serum potassium (sK) levels are closely associated with the prognosis of chronic heart failure patients, the clinical significance of sK levels in cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF) patients is not fully understood. METHODS This study was a retrospective, single-center, observational study. We enrolled 506 consecutive HFpEF patients admitted to Kumamoto University Hospital and divided them into four groups according to the quartiles of the sK levels at discharge (Q1: sK < 4.1 mEq/l, Q2: 4.1 ≤ sK < 4.4 mEq/l, Q3: 4.4 ≤ sK < 4.7 mEq/l, and Q4: sK ≥ 4.7 mEq/l). RESULTS No significant differences were observed in the use of all drugs (loop diuretics, mineralocorticoid receptor antagonists, renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, β-blockers, and statins) among the four groups. Hemoglobin, the estimated glomerular filtration rate, and pulse wave velocity levels were lower, and the serum sodium levels were higher in the Q4 group compared with those in the Q2 group. Kaplan-Meier analysis revealed significantly higher probabilities of both cardiovascular and HF-related events in the Q1, Q3, and Q4 groups than those in the Q2 group. Multivariate Cox proportional hazard analysis revealed that the Q1, Q3, and Q4 groups had significantly and independently higher probabilities of cardiovascular events compared with those in the Q2 group, indicating a J-shaped association between sK levels and cardiovascular events. CONCLUSIONS sK levels at discharge could provide important prognostic information in regard to HFpEF. Further evaluation in a larger number of patients might be needed. Clinical Trials Registration UMIN-CTR (http://www.umin.ac.jp/ctr/). Identifier UMIN000029600. Public Access Information Opt-out materials are available at the website: http://www.kumadai-junnai.com/home/wp-content/uploads/houkatsu.pdf.
DOI： 10.1093/ajh/hpy101
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Sueta D., Utsunomiya D., Izumiya Y., Nakaura T., Oda S., Kaikita K., Yamashita Y., Tsujita K.
Journal of Cardiology Cases 18 ( 3 ) 88 - 91 2018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：Journal of Cardiology Cases
Because the prognosis of pulmonary thromboembolism (PTE) will be often poor, early diagnosis and assessing severity at the first visit is important. A 76-year-old man with suspected venous thromboembolism and a contrast deficit in the pulmonary artery (PA) was revealed by contrast-enhanced computed tomography (CT) imaging by dual-layer spectral-detector CT (IQon Spectral CT , Philips Healthcare, Best, The Netherlands). The lung perfusion image showed decreased perfusion in the culprit lesion. The dual-energy analysis of the virtual monoenergetic imaging showed clear visualization of deep vein thrombosis (DVT). In a 64-year-old man, an IQon Spectral CT revealed a small contrast deficit in the PA. However, no perfusion abnormality was detected in the lung perfusion analysis. The IQon Spectral CT enables the detection of lung perfusion abnormalities in addition to PTE. The IQon Spectral CT imaging may be useful for the “one-stop shop” evaluation of PTE and DVT. <Learning objective: The prognosis of pulmonary thromboembolism (PTE) will be often poor, so early diagnosis and assessing severity at the first visit is important. The dual-layer spectral-detector computed tomography imaging for PTE, whereby the iodine map provided information regarding lung perfusion, whereas virtual monoenergetic images enabled clear visualization of deep vein thrombosis.> ® ® ® ®
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Yasuda S., Kaikita K., Ogawa H., Akao M., Ako J., Matoba T., Nakamura M., Miyauchi K., Hagiwara N., Kimura K., Hirayama A., Matsui K.
International Journal of Cardiology 265 108 - 112 2018年8月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Background: In atrial fibrillation (AF) patients with coronary artery disease (CAD), anticoagulants are commonly used in combination with antiplatelet drugs. However, dual therapy can increase the risk of bleeding, and the potential therapeutic benefits must be weighed against this. Therefore, it is recommended that dual therapy is only used for a limited time, and that monotherapy with anticoagulants should start from 1 year after percutaneous coronary intervention (PCI). However, there is a lack of evidence on the use of monotherapy, in particular with direct oral anticoagulants, in this group of patients. Methods: The AFIRE Study is a multicenter, prospective, randomized, open-label, parallel group study conducted in patients aged ≥20 years with non-valvular AF (NVAF) and CAD. Patients who have undergone PCI or coronary artery bypass graft at least 1 year prior to enrollment, or those without significant coronary lesions requiring PCI (≥50% stenosis), will be included. Approximately 2200 participants will be randomized to receive either rivaroxaban monotherapy or rivaroxaban plus an antiplatelet drug (aspirin, clopidogrel, or prasugrel). The primary efficacy endpoints are the composite of cardiovascular events (stroke, non-central nervous system embolism, myocardial infarction, and unstable angina pectoris requiring revascularizations) and all-cause mortality. The primary safety endpoint is major bleeding as defined by the International Society on Thrombosis and Haemostasis criteria. Conclusions: This study will be the first to assess the efficacy and safety of rivaroxaban monotherapy in NVAF patients with stable CAD.
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Shimokawa H., Yamashita T., Uchiyama S., Kitazono T., Shimizu W., Ikeda T., Kamouchi M., Kaikita K., Fukuda K., Origasa H., Sakuma I., Saku K., Okumura Y., Nakamura Y., Morimoto H., Matsumoto N., Tsuchida A., Ako J., Sugishita N., Shimizu S., Atarashi H., Inoue H.
International Journal of Cardiology 258 126 - 132 2018年5月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Aims: 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). Methods and results: This multicenter, prospective, non-interventional, observational, cohort study was conducted at 684 medical centers in Japan. A total of 7141 NVAF patients ≥20 years of age (mean, 71.6 ± 9.4 years) who were being or about to be treated with rivaroxaban (10 mg/day, 43.5%; 15 mg/day, 56.5%) were followed for an average of 897.1 (±206.8) days with a high follow-up rate (99.65%). The mean CHADS score at baseline was 2.1 (1.3) (0–1, 37%; 2, 29%; ≥3, 34%). The total incidence rate of symptomatic stroke and SE (primary efficacy endpoint) was 1.0%/year, and 0.5%, 0.9%, and 1.7%/year for those with CHADS scores of 0–1, 2, and ≥3, respectively. Cumulative incidence rates for major bleeding (primary safety endpoint) and non-major bleeding (secondary safety endpoint) were 1.2%/year and 4.9%/year, respectively. Differences were noted between new and current users only for major bleeding event rate (1.7% vs. 1.1%/year, P = 0.0024). Comparisons with previous studies suggested that rivaroxaban is effective and safe for low-risk patients (0–1 CHADS ), as shown for warfarin in the XANTUS international prospective post-marketing study. Conclusions: The EXPAND study demonstrated that low dosages of rivaroxaban for Japanese NVAF patients in real-world clinical practice, including those with CHADS scores 0–1, resulted in low rates of stroke and SE, and major and non-major bleeding. 2 2 2 2
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Nakayama M., Yamamuro M., Takashio S., Uemura T., Nakayama N., Hirakawa K., Oda S., Utsunomiya D., Kaikita K., Hokimoto S., Yamashita Y., Morita Y., Kimura K., Tamura K., Tsujita K.
Heart and Vessels 33 ( 4 ) 393 - 402 2018年4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
Myocardial fibrosis and coronary endothelial dysfunction are important determinants of outcome in patients with heart failure. However, the relationship of these factors in patients with dilated cardiomyopathy (DCM) is not fully understood. This study aimed to investigate the relationship between endothelium-dependent coronary vasomotor abnormality and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with DCM. We examined 38 consecutive patients with DCM. All patients underwent CMR and the acetylcholine (ACh) provocation test using cardiac catheterization. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations, and quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. LGE was detected in 17 (44.7%) patients. The lactate extraction ratio (LER) in the ACh provocation test was significantly decreased in the LGE-positive group (before vs after ACh, 18.6 ± 13.6 vs − 13.3 ± 24.8%; p < 0.001) and in the LGE-negative group (before vs after ACh, 14.2 ± 19.5 vs 3.3 ± 16.2%; p = 0.02). The rate of patients with an LER < 0% (indicating myocardial lactate production due to myocardial ischemia) was significantly higher in the LGE-positive group than in the LGE-negative group [12 (70.6%) vs 7 (33.3%); p = 0.02]. Multivariable logistic regression analysis showed that a post-ACh LER < 0% was a significant predictor of LGE positivity (odds ratio 7.75; 95% confidence interval 1.37–43.68; p = 0.02). In conclusion, ACh-provoked coronary vasomotor abnormality is associated with myocardial fibrosis in patients with DCM. These results suggest that coronary endothelial dysfunction is involved in myocardial fibrosis and worsening heart failure concomitant with DCM.
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Arima Y., Hokimoto S., Tabata N., Nakagawa O., Oshima A., Matsumoto Y., Sato T., Mukunoki T., Otani J., Ishii M., Uchikawa M., Yamamoto E., Izumiya Y., Kaikita K., Ogawa H., Nishiyama K., Tsujita K.
Journal of the American Heart Association 7 ( 6 ) 2018年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of the American Heart Association
BACKGROUND: Collateral arteries provide an alternative blood supply and protect tissues from ischemic damage in patients with peripheral artery disease. However, the mechanism of collateral artery development is difficult to validate. METHODS AND RESULTS: Collateral arteries were visualized using micro-x-ray computed tomography. Developmental characteristics were assessed using confocal microscopy. We conducted a single-center, retrospective, observational study and assessed the dilatation of collateral arteries on ischemic sides. We quantified the vascular volume in both ischemic and nonischemic legs. A prominent increase in vascular volume was observed in the ischemic leg using a murine hind-limb ischemia model. We also performed qualitative assessment and confirmed that the inferior gluteal artery functioned as a major collateral source. Serial analysis of murine hind-limb vessel development revealed that the inferior gluteal artery was a remnant of the ischial artery, which emerged as a representative vessel on the dorsal side during hind-limb organogenesis. We retrospectively analyzed consecutive patients who were admitted for the diagnosis or treatment of peripheral artery disease. The diameter of the inferior gluteal artery on the ischemic side showed significant dilatation compared with that on the nonischemic side. CONCLUSIONS: Our findings indicate that an embryonic remnant artery can become a collateral source under ischemic conditions. Flow enhancement in the inferior gluteal artery might become a novel therapeutic approach for patients with peripheral artery disease.