Researchers Database

Fujita Hideo

    ComprehensiveMedicine1 Professor
Last Updated :2021/12/04

Researcher Information

J-Global ID

Research Interests

  • 循環器内科学   

Research Areas

  • Life sciences / Cardiology

Published Papers

  • Hisataka Maki, Tadao Aikawa, Tatsuro Ibe, Noriko Oyama-Manabe, Hideo Fujita
    European heart journal. Cardiovascular Imaging 2021/10
  • Masashi Hatori, Kenichi Sakakura, Yousuke Taniguchi, Hiroyuki Jinnouchi, Takunori Tsukui, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
    International heart journal 62 (4) 756 - 763 2021/07 
    The clinical outcomes in acute myocardial infarction (AMI) patients with Killip class 3 are often inconsistent with those in the literature, and the factors associated with poor outcomes have not been sufficiently investigated. The purpose of this study was to identify factors associated with in-hospital death in AMI patients with Killip class 3. We included 205 AMI patients with Killip class 3, and divided them into a survived group (n = 189) and in-hospital death group (n = 16). The primary objective was to identify factors associated with in-hospital death using multivariate analysis. Age was significantly younger in the survived group than in the in-hospital death group (73.1 ± 11.2 versus 83.2 ± 6.2 years, P < 0.001). Systolic blood pressure (SBP) was significantly higher in the survived group than in the in-hospital death group (150.0 ± 31.2 versus 124.8 ± 25.3 mmHg, P = 0.002). The prevalence of TIMI thrombus grade ≥ 2 was significantly greater in the in-hospital death group than in the survived group (56.3 versus 22.2%, P = 0.005). In multivariate logistic regression analysis, in-hospital death was significantly associated with age [odds ratio (OR) 1.168, 95% confidence interval (CI) 1.061-1.287, P = 0.002] and TIMI thrombus grade ≥ 2 (versus ≤ 1: OR 5.743, 95% CI 1.717-19.214, P = 0.005), and inversely associated with SBP on admission (per 10 mmHg increase: OR 0.764, 95% CI 0.613-0.953, P = 0.017). In conclusion, in-hospital death was associated with age and coronary thrombus burden, and was inversely associated with SBP on admission in patients with Killip class 3. It may be important to recognize these high risk features to improve the clinical outcomes of patients with Killip class 3.
  • Soichiro Ban, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Takunori Tsukui, Yusuke Watanabe, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
    Journal of atherosclerosis and thrombosis 2021/07 
    AIMS: Peripheral arterial disease (PAD) is the well-known risk factor for cardiovascular events. Although low ankle-brachial index (ABI) is recognized as a risk factor in general population, low ABI without any symptoms of PAD has not been established as a prognostic marker in patients with acute myocardial infarction (AMI) yet. The purpose of this retrospective study was to examine whether asymptomatic low ABI was associated with long-term clinical outcomes in AMI patients without treatment history of PAD. METHODS: We included 850 AMI patients without a history of PAD and divided them into the preserved ABI (ABI ≥ 0.9) group (n=760) and the reduced ABI (ABI <0.9) group (n=90) on the basis of the ABI measurement during the hospitalization. The primary endpoint was the major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction, and hospitalization for heart failure. RESULTS: During the median follow-up duration of 497 days (Q1: 219 days to Q3: 929 days), a total of 152 MACE were observed. The Kaplan-Meier curves showed that MACE were more frequently observed in the reduced ABI group than in the preserved ABI group (p<0.001). The multivariate COX hazard analysis revealed that reduced ABI was significantly associated with MACE (hazard ratio 2.046, 95% confidence interval 1.344-3.144, p=0.001) after controlling confounding factors. CONCLUSIONS: Reduced ABI was significantly associated with long-term adverse events in AMI patients without a history of PAD. Our results suggest the usefulness of ABI as a prognostic marker in AMI patients irrespective of symptomatic PAD.
  • Masataka Narita, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    Postepy w kardiologii interwencyjnej = Advances in interventional cardiology 17 (2) 163 - 169 2021/06 
    Introduction: In percutaneous coronary intervention (PCI) to atherosclerotic lesions in the right coronary artery (RCA), coronary artery dissection in the ostium of the RCA is a rare but fatal complication. Stent implantation to the ostium of RCA may be selected for the prevention of aorto-ostial dissection. Aim: To find factors associated with aorto-ostial stent coverage to mild to moderate ostial stenosis during the treatment of severely narrowed non-ostial RCA lesions. Material and methods: The primary interest was to find factors associated with ostial stent coverage using multivariate regression analysis. We included 236 patients who underwent intravascular ultrasound (IVUS)-guided PCI to severely narrowed RCA lesions with mild to moderate ostial stenosis, and divided those into the ostial-coverage group (n = 52) and the non-coverage group (n = 184). Results: The prevalence of continuous ostial plaque detected by intravascular ultrasound (IVUS) was significantly greater in the ostial-coverage group (84.6%) than in the non-coverage group (52.9%) (p < 0.001). Multivariate logistic regression analysis revealed that continuous ostial plaque detected by IVUS (OR = 5.398, 95% CI: 2.322-12.553, p < 0.001) was significantly associated with ostial stent coverage after controlling confounding factors. Ischaemia-driven target vessel revascularization was less frequently observed in the ostial-coverage group than in the non-coverage group, without reaching statistical significance (p = 0.069). Conclusions: Continuous ostial plaque detected by IVUS was significantly associated with ostial stent coverage to the mild to moderate stenosis when PCI to non-ostial, severely narrowed RCA lesions was performed. The use of IVUS may enhance the safety but may increase the total stent length in PCI to RCA.
  • Kaho Shibata, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    International heart journal 62 (3) 479 - 486 2021/05 
    The rapid introduction of dual antiplatelet therapy (DAPT) is important for patients with acute myocardial infarction (AMI). The risks and benefits of reduced-dose prasugrel (20 mg loading and 3.75 mg maintenance) over clopidogrel have not been fully discussed. The purpose of this study was to compare the 90-days clinical outcomes of AMI between prasugrel-based DAPT and clopidogrel-based DAPT. We included 534 AMI patients and divided them into the clopidogrel group (n = 330) and the prasugrel group (n = 204). The primary endpoint was the total ischemic events and total bleeding events. In all, 52 ischemic events and 35 bleeding events were observed during the study period. The total ischemic events were similar between the clopidogrel and the prasugrel groups (P = 0.385). The total bleeding events were similar between the clopidogrel and the prasugrel groups (P = 0.125). The multivariate Cox hazard analysis showed that prasugrel was not associated with the total ischemic events (hazard ratio (HR) 0.955, 95% confidence interval (CI) 0.499-1.829, P = 0.890) and was not associated with the total bleeding events after controlling confounding factors (HR 0.972, 95% CI 0.528-1.790, P = 0.927). In conclusion, as compared to clopidogrel, the reduced dose of prasugrel was not associated with the excess risk of bleeding or the excess risk of ischemic events. Our real-world data support the current regimen of prasugrel for AMI patients who underwent primary percutaneous coronary intervention.
  • Yusuke Mizuno, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Takunori Tsukui, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
    Scientific reports 11 (1) 11140 - 11140 2021/05 
    Complications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA). However, it remains unclear whether the high incidence of slow flow results in the high incidence of periprocedural myocardial infarction (PMI), reflecting real myocardial damage. The aim of this study was to compare the incidence of PMI between PCI with versus without RA using propensity score-matching. We included 1350 elective PCI cases, which were divided into the RA group (n = 203) and the non-RA group (n = 1147). After propensity score matching, the matched RA group (n = 190) and the matched non-RA group (n = 190) were generated. The primary interest was to compare the incidence of PMI between the matched RA and non-RA groups. Before propensity score matching, the incidence of slow flow and PMI was greater in the RA group than in the non-RA group. After matching, the incidence of slow flow was still greater in the matched RA group than in the matched non-RA group (16.8% vs. 9.5%, p = 0.048). However, the incidence of PMI was similar between the matched RA and matched non-RA group (7.4% vs. 5.3%, p = 0.528, standardized difference: 0.086). In conclusion, although use of RA was associated with greater risk of slow flow, use of RA was not associated with PMI after a propensity score-matched analysis. The fact that RA did not increase the risk of myocardial damage in complex lesions would have an impact on revascularization strategy for severely calcified coronary lesions.
  • Tsukasa Murakami, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    Cardiovascular intervention and therapeutics 2021/04 
    Percutaneous coronary intervention (PCI) is a standard strategy for non-ST-segment elevation myocardial infarction (NSTEMI) as well as for ST-segment elevation myocardial infarction (STEMI). The device cost for PCI may be more expensive in NSTEMI, because the culprit lesion morphology may be more complex in NSTEMI. This study aimed to compare the total device cost of PCI between STEMI and NSTEMI. We included 504 patients with acute myocardial infraction (AMI) who underwent PCI, and divided those into a STEMI group (n = 286) and a NSTEMI group (n = 218). We compared the total device cost, the number of used devices, and procedure cost between the 2 groups. The total device cost was significantly higher in the NSTEMI group [\371,300 (\320,700-503,350)] than in the STEMI group [\341,200 (\314,200-410,475)] (p = 0.001), whereas the procedure cost was significantly higher in the STEMI group [\343,800 (\243,800-343,800)] than in the NSTEMI group [\220,000 (\216,800-243,800)] (p < 0.001). Drug eluting stent (85.3% vs. 76.1%, p = 0.029) and aspiration catheter (16.8% vs. 2.3%, p < 0.001) were more frequently used in the STEMI group, whereas rotablator (0.7% vs. 8.3%, p < 0.001) were more frequently used in the NSTEMI group. The multivariate logistic regression analysis revealed that NSTEMI was significantly associated with the high device cost (odds ratio 1.899, 95% confidence interval 1.166-3.093, p = 0.01). In conclusion, the total device cost for PCI was significantly higher in the culprit lesions of NSTEMI than in those of STEMI, whereas the procedure cost was significantly higher in the culprit lesions of STEMI than in those of NSTEMI.
  • Kunihiro Kani, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 62 (2) 256 - 263 2021/03 
    Radial access is recommended for primary percutaneous coronary intervention (PCI), because it has fewer bleeding complications than trans-femoral PCI. However, even if trans-radial PCI is chosen, patients with ST-elevation myocardial infarction (STEMI) presenting with anemia on admission might have poor clinical outcomes. The aim of this retrospective study was to investigate whether anemia on admission was associated with mid-term clinical outcomes in patients who underwent trans-radial primary PCI. The primary endpoint was a composite of all-cause death, recurrent acute myocardial infarction, and readmission for heart failure. A total of 288 consecutive patients with STEMI who underwent trans-radial primary PCI were divided into an anemia group (n = 79) and a non-anemia group (n = 209). The median follow-up duration was 301 days. The anemia group was significantly older than the non-anemia group (77.3 ± 11.9 versus 64.4 ± 12.7 years, respectively; P < 0.001). There were significantly more females in the anemia group than in the non-anemia group (36.7% versus 14.4%, respectively; P < 0.001). Kaplan-Meier analysis revealed that the composite outcome-free survival was significantly worse in the anemia group than in the non-anemia group (P < 0.001). Multivariate Cox hazard model analysis revealed that hemoglobin levels on admission were significantly associated with the composite outcome (per 1 g/dL increase: hazard ratio 0.76, 95% confidence interval 0.66-0.88, P < 0.001) after controlling for confounding factors. In conclusion, baseline anemia was significantly associated with poor clinical outcomes. Patients with STEMI presenting with anemia should be managed carefully, even if trans-radial primary PCI is chosen.
  • Shun Ishibashi, Kenichi Sakakura, Satoshi Asada, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    International heart journal 62 (2) 282 - 289 2021/03 
    The clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) were comparable or even worse than those with ST-segment elevation myocardial infarction (STEMI). Although successful percutaneous coronary intervention (PCI) to the culprit lesions of NSTEMI would improve the clinical outcomes, some PCI require long fluoroscopy time, reflecting the difficulty of PCI. This study aims to find clinical factors associated with long fluoroscopy time in PCI to the culprit lesion of NSTEMI. We included 374 patients and divided those into the conventional fluoroscopy time (n = 302) and long fluoroscopy time (n = 72) groups according to the quintiles of fluoroscopy time. Clinical and angiographic parameters were compared between the two groups. Calcification and tortuosity were significantly more severe in the long fluoroscopy time group than in the conventional fluoroscopy time group. The prevalence of previous coronary artery bypass grafting (CABG) and bifurcation lesions was significantly greater in the long fluoroscopy time group than in the conventional fluoroscopy time group. In the multivariate stepwise logistic regression analysis, previous CABG (odds ratio [OR], 3.368; 95% confidence interval [CI], 1.407-8.064; P = 0.006), bifurcation lesion (OR, 2.407; 95% CI, 1.285-4.506; P = 0.006), excessive tortuosity (versus mild to moderate tortuosity; OR, 4.095; 95% CI, 1.159-14.476; P = 0.029), and moderate to severe calcification (versus none to mild; OR, 5.792; 95% CI, 3.254-10.310; P < 0.001) were significantly associated with long fluoroscopy time. In conclusion, previous CABG, bifurcation, excessive tortuosity, and moderate to severe calcification were associated with long fluoroscopy time. Our study provided a reference for PCI operators to identify the difficulties in PCI to the culprit lesion of NSTEMI.
  • Kei Yamamoto, Kenichi Sakakura, Shun Ishibashi, Kaho Shibata, Takunori Tsukui, Yousuke Taniguchi, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    International heart journal 62 (2) 422 - 426 2021/03 
    A method to manage ST-segment elevated myocardial infarction (STEMI) caused by very late stent thrombosis (VLST) has yet to be established. In this case series, we present several cases of STEMI caused by VLST, which were successfully revascularized using a perfusion balloon. Since the perfusion balloon (Ryusei: Kaneka Medix Corporation, Osaka, Japan) has the unique advantage of maintaining blood flow during balloon inflation, we can keep dilating the target lesion for more than several minutes. Extended inflation might work to prevent acute recoil, and to achieve optimal expansion without an additional stent. Our case series may provide a reasonable option for the treatment of VLST.
  • Yousuke Taniguchi, Kenichi Sakakura, Takunori Tsukui, Kei Yamamoto, Hiroyuki Jinnouchi, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Internal medicine (Tokyo, Japan) 2021/03 
    Objective Since patients with thoracic aortic aneurysm (TAA)/abdominal aortic aneurysm (AAA) are often complicated with coronary artery disease, it is common for those patients to undergo percutaneous coronary intervention (PCI). The ankle brachial index (ABI) is usually measured in patients with TAA/AAA to screen the presence of peripheral arterial disease. The present study investigated the association between the ABI and clinical outcomes following PCI in patients with TAA/AAA. Methods and Material We divided 200 TAA/AAA patients who underwent PCI into a normal ABI group (n=137) and an abnormal ABI group (n=63) according to the ABI cut-off level of 1.00. The primary endpoint was one-year major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fetal myocardial infarction, stroke, target vessel revascularization, and hospitalization for heart failure. Results Mean ABIs in the normal and abnormal ABI groups were 1.12±0.09 and 0.86±0.11, respectively (p<0.01). Kaplan-Meier curves showed MACE were more frequent in the abnormal ABI group than in the normal ABI group (p=0.01). A multivariate Cox hazard analysis revealed that an abnormal ABI was significantly associated with 1-year MACE (vs. ABI ≥1.0: HR 3.02, 95% confidence interval 1.00-9.08, p=0.049). Conclusion Among patients with TAA/AAA who underwent PCI, abnormal ABI was significantly associated with 1-year MACE, suggesting the utility of the ABI measurement in this high-risk population.
  • Naoyuki Akashi, Takunori Tsukui, Kei Yamamoto, Masaru Seguchi, Yousuke Taniguchi, Kenichi Sakakura, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Heart and vessels 2021/03 
    Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is generally thought to be an adaptive but compromising phenomenon particularly in patients with diabetes mellitus (DM). However, whether the extent of LVR is associated with poor prognostic outcome with or without DM after STEMI in the modern era of reperfusion therapy has not been elucidated. This was a single-center retrospective observational study. Altogether, 243 patients who were diagnosed as having STEMI between January 2016 and March 2019, and examined with echocardiography at baseline (at the time of index admission) and mid-term (from 6 to 11 months after index admission) follow-up were included and divided into the DM (n = 98) and non-DM groups (n = 145). The primary outcome was major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, heart failure (HF) hospitalization, and non-fatal myocardial infarction. The median follow-up duration was 621 days (interquartile range: 304-963 days). The DM group was significantly increased the rate of MACEs (P = 0.020) and HF hospitalization (P = 0.037) compared with the non-DM group, despite of less LVR. Multivariate Cox regression analyses revealed that the patients with DM after STEMI were significantly associated with MACEs (Hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.20-6.47, P = 0.017) and HF hospitalization (HR 3.62, 95% CI 1.19-11.02, P = 0.023) after controlling known clinical risk factors. LVR were also significantly associated with MACEs (HR 2.44, 95% CI 1.03-5.78, P = 0.044) and HF hospitalization (HR 3.76, 95% CI 1.15-12.32, P = 0.029). The patients with both DM and LVR had worse clinical outcomes including MACEs and HF hospitalization, suggesting that it is particularly critical to minimize LVR after STEMI in patients with DM.
  • Yusuke Adachi, Arihiro Kiyosue, Jiro Ando, Takuya Kawahara, Satoshi Kodera, Shun Minatsuki, Hironobu Kikuchi, Toshiro Inaba, Hiroyuki Kiriyama, Kazutoshi Hirose, Hiroki Shinohara, Akihito Saito, Takayuki Fujiwara, Hironori Hara, Kazutaka Ueda, Kenichi Sakakura, Masaru Hatano, Mutsuo Harada, Eiki Takimoto, Hiroshi Akazawa, Hiroyuki Morita, Shin-Ichi Momomura, Hideo Fujita, Issei Komuro
    Scientific reports 11 (1) 239 - 239 2021/01 
    Percutaneous coronary intervention (PCI) is sometimes considered as an alternative therapeutic strategy to surgical revascularization in patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). However, the types or conditions of patients that receive the clinical benefit of left ventricular reverse remodelling (LVRR) remain unknown. The purpose of this study was to investigate the determinants of LVRR following PCI in CAD patients with reduced LVEF. From 4394 consecutive patients who underwent PCI, a total of 286 patients with reduced LV systolic function (LVEF < 50% at initial left ventriculography) were included in the analysis. LVRR was defined as LV end-systolic volume reduction ≥ 15% and improvement of LVEF ≥ 10% at 6 months follow-up left ventriculography. Patients were divided into LVRR (n = 63) and non-LVRR (n = 223) groups. Multivariate logistic regression analysis revealed that unprotected left main coronary artery (LMCA) intervention was significantly associated with LVRR (P = 0.007, odds ratios [OR] 4.70, 95% confidence interval [CI] 1.54-14.38), while prior PCI (P = 0.001, OR 0.35, 95% CI 0.19-0.66), presence of in-stent restenosis (P = 0.016, OR 0.32, 95% CI 0.12-0.81), and presence of de-novo stenosis (P = 0.038, OR 0.36, 95% CI 0.14-0.95) were negatively associated with LVRR. These data suggest the potential prognostic benefit of unprotected LMCA intervention for LVRR and importance of angiographic follow-up in patients with CAD and LV systolic dysfunction.
  • Tatsuro Ibe, Hiroshi Wada, Kenichi Sakakura, Yusuke Ugata, Hisataka Maki, Kei Yamamoto, Masaru Seguchi, Yousuke Taniguchi, Hiroyuki Jinnouchi, Hideo Fujita
    PloS one 16 (6) e0252833  2021 
    BACKGROUND: The role of cardiac index (CI) and right atrial pressure (RAP) for predicting long-term outcomes of heart failure has not been well established. The aim of this study was to investigate long-term cardiac outcomes in patients with heart failure having various combinations of CI and RAP. METHODS: A total of 787 heart failure patients who underwent right-heart catheterization were retrospectively categorized into the following four groups: Preserved CI (≥2.5 L/min/m2) and Low RAP (<8 mmHg) (PRE-CI/L-RAP; n = 285); Preserved CI (≥2.5 L/min/m2) and High RAP (≥8 mmHg) (PRE-CI/H-RAP; n = 242); Reduced CI (<2.5 L/min/m2) and Low RAP (<8 mmHg) (RED-CI/L-RAP; n = 123); and Reduced CI (<2.5 L/min/m2) and High RAP (≥8 mmHg) (RED-CI/H-RAP; n = 137). Survival analysis was applied to investigate which groups were associated with major adverse cardiovascular events (MACE). RESULTS: The RED-CI/L-RAP and RED-CI/H-RAP groups were significantly associated with MACE as compared with the PRE-CI/L-RAP and PRE-CI/H-RAP groups after adjustment for confounding factors (RED-CI/L-RAP vs. PRE-CI/L-RAP: HR 2.11 [95% CI 1.33-3.37], p = 0.002; RED-CI/H-RAP vs. PRE-CI/L-RAP: HR 2.18 [95% CI 1.37-3.49], p = 0.001; RED-CI/L-RAP vs. PRE-CI/H-RAP: HR 1.86 [95% CI 1.16-3.00], p = 0.01; RED-CI/H-RAP vs. PRE-CI/H-RAP: HR 1.92 [95% CI 1.26-2.92], p = 0.002), whereas the difference between the RED-CI/H-RAP and RED-CI/L-RAP groups was not significant (HR 1.03 [95% CI 0.64-1.66], p = 0.89). CONCLUSIONS: The hemodynamic severity categorized by CI and RAP levels provided clear risk stratification in patients with symptomatic heart failure. Low CI was an independent predictor of long-term cardiac outcomes.
  • Yousuke Taniguchi, Kenichi Sakakura, Yohei Nomura, Masashi Hatori, Kaho Shibata, Yusuke Tamanaha, Taku Kasahara, Takunori Tsukui, Tatsuro Ibe, Kei Yamamoto, Hiroyuki Jinnouchi, Hiroshi Wada, Atsushi Yamaguchi, Hideo Fujita
    PloS one 16 (2) e0247588  2021 
    Careful auscultation is the first step to diagnose aortic stenosis (AS). The aim of this study was to compare clinical outcomes following transcatheter aortic valve implantation (TAVI) between the patients primarily diagnosed by heart murmur and those diagnosed by other reasons. We retrospectively included 258 patients who underwent TAVI in our medical center, and divided those into the murmur group (n = 81) and the other-reason group (n = 177) according to the primary reason for AS diagnosis. The primary endpoint was the major adverse cardiovascular and cerebrovascular events (MACCE), which was defined as the composite of cardiovascular death, hospitalization due to acute decompensated heart failure, and disabling stroke. The murmur group included younger patients than the other-reason group (82.8 year-old vs. 84.0 year-old, P = 0.02). History of AF was more frequently observed in the other-reason group than in the murmur group (21.5% vs. 7.4%, P <0.01). STS score and logistic EuroSCORE were lower in the murmur group than in the other-reason group (STS: 4.7% vs. 7.2%, P <0.01, logistic EuroSCORE: 8.3% vs. 11.2%, P <0.01). The median follow-up period was 562 days. MACCE was more frequently observed in the other-reason group than in the murmur group (27.7% vs. 9.9%, Log Rank P <0.01). The multivariate COX hazard analysis revealed that the AS patients primarily diagnosed by heart murmur was inversely associated with MACCE (HR 0.38, 95%CI 0.17-0.86, P = 0.020). Among AS patients who underwent TAVI, the patients primarily diagnosed by heart murmur were significantly associated with favorable long-term clinical outcomes.
  • Tatsuro Ibe, Hiroshi Wada, Kenichi Sakakura, Yusuke Ugata, Hisataka Maki, Kei Yamamoto, Masaru Seguchi, Yousuke Taniguchi, Hiroyuki Jinnouchi, Shin-Ichi Momomura, Hideo Fujita
    PloS one 16 (3) e0247987  2021 
    BACKGROUND: The prognostic implications of combined pre- and post-capillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension due to left heart disease (PH-LHD) remain controversial. The aim of this retrospective study was to evaluate the new PH-LHD criteria, recommended by the 6th World Symposium on Pulmonary Hypertension and to determine the prognostic value of Cpc-PH. METHODS: A total of 701 patients with symptomatic heart failure who had undergone right-heart catheterization were divided into the following four groups: (i) Isolated post-capillary PH (Ipc-PH) group; mean pulmonary artery pressure (mPAP) >20 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and pulmonary vascular resistance (PVR) <3 Wood units (WU) (ii) Cpc-PH group; mPAP >20 mmHg, PAWP >15 mmHg, and PVR ≥3 WU (iii) borderline-PH group; mPAP >20 mmHg and PAWP ≤15 mmHg (iv) non-PH group; mPAP ≤20 mmHg. Multivariate Cox hazard analysis was used to investigate whether Cpc-PH was associated with cardiac outcomes. RESULTS: The study subjects were allocated into the Ipc-PH (n = 268), Cpc-PH (n = 54), borderline-PH (n = 112), or non-PH (n = 267) groups. The Cpc-PH group was associated significantly with adverse cardiac events even after adjustment for clinically relevant confounding factors for heart failure prognosis (vs. non-PH group: HR 2.98 [95% CI 1.81-4.90], P <0.001; vs. Ipc-PH group: HR: 1.92 [95% CI 1.19-3.08], P = 0.007). CONCLUSIONS: The new definitions of PH-LHD stratified patients into 4 categories. Long-term clinical outcomes were significantly different between the four categories, with Cpc-PH having the worst cardiac outcomes.
  • Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Hiroyuki Jinnouchi, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
    PloS one 16 (4) e0250757  2021 
    BACKGROUND: Although several groups reported the risk factors for slow flow during rotational atherectomy (RA), they did not clearly distinguish modifiable factors, such as burr-to-artery ratio from unmodifiable ones, such as lesion length. The aim of this retrospective study was to investigate the modifiable and unmodifiable factors that were associated with slow flow. METHODS: We included 513 lesions treated with RA, which were classified into a slow flow group (n = 97) and a non-slow flow group (n = 416) according to the presence or absence of slow flow just after RA. The multivariate logistic regression analysis was performed to find factors associated with slow flow. RESULTS: Slow flow was inversely associated with reference diameter [Odds ratio (OR) 0.351, 95% confidence interval (CI) 0.205-0.600, p<0.001], primary RA strategy (OR 0.224, 95% CI 0.097-0.513, p<0.001), short single run (≤15 seconds) (OR 0.458, 95% CI 0.271-0.776, p = 0.004), and systolic blood pressure (BP) ≥ 140 mmHg (OR 0.501, 95% CI 0.297-0.843, p = 0.009). Lesion length (every 5 mm increase: OR 1.193, 95% CI 1.093-1.301, p<0.001), angulation (OR 2.054, 95% CI 1.171-3.601, p = 0.012), halfway RA (OR 2.027, 95% CI 1.130-3.635, p = 0.018), initial burr-to-artery ratio (OR 1.451, 95% CI 1.212-1.737, p<0.001), and use of beta blockers (OR 1.894, 95% CI 1.004-3.573, p = 0.049) were significantly associated with slow flow. CONCLUSIONS: Slow flow was positively associated with several unmodifiable factors including lesion length and angulation, and inversely associated with reference diameter. In addition, slow flow was positively associated with several modifiable factors including initial burr-to-artery ratio and use of beta blockers, and inversely associated with primary RA strategy, short single run, and systolic blood pressure just before RA. Application of this information could help to improve RA procedures.
  • Tomonobu Yanase, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
    PloS one 16 (5) e0251124  2021 
    BACKGROUND: High-degree atrioventricular block (HAVB) is a prognostic factor for survival in patients with inferior ST-segment elevation myocardial infarction (STEMI). However, there is little information about factors associated with temporary pacing (TP). The aim of this study was to find factors associated with TP in patients with inferior STEMI. METHODS: We included 232 inferior STEMI patients, and divided those into the TP group (n = 46) and the non-TP group (n = 186). Factors associated with TP were retrospectively investigated using multivariate logistic regression model. RESULTS: The incidence of right ventricular (RV) infarction was significantly higher in the TP group (19.6%) than in the non-TP group (7.5%) (p = 0.024), but the incidence of in-hospital death was similar between the 2 groups (4.3% vs. 4.8%, p = 1.000). Long-term major adverse cardiovascular events (MACE), which were defined as a composite of all-cause death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and readmission for heart failure, were not different between the 2 groups (p = 0.100). In the multivariate logistic regression analysis, statin at admission [odds ratio (OR) 0.230, 95% confidence interval (CI) 0.062-0.860, p = 0.029], HAVB at admission (OR 9.950, 95% CI 4.099-24.152, p<0.001), and TIMI-thrombus grade ≥3 (OR 10.762, 95% CI 1.385-83.635, p = 0.023) were significantly associated with TP. CONCLUSION: Statin at admission, HAVB at admission, and TIMI-thrombus grade ≥3 were associated with TP in patients with inferior STEMI. Although the patients with TP had the higher incidence of RV infarction, the incidence of in-hospital death and long-term MACE was not different between patients with TP and those without.
  • Tomonobu Yanase, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 62 (1) 33 - 41 2021 
    Although the incidence of acute myocardial infarction (AMI) has been decreasing in the elderly, it has been increasing in the young, especially in Japan. A social impact of AMI would be greater in the young, because loss of the young directly influences social activities such as business, child-raising, and tax payment. The aim of this study was to identify the specific characteristics of young AMI patients. We retrospectively included 408 consecutive AMI patients < 70 years of age, divided into a young group (< 55 years: n = 136) and an older group (55 to < 70 years: n = 272). The prevalence of overweight was greater in the young group (58.5%) than in the older group (40.7%) (P = 0.001). The frequency of current smokers was higher in the young group (67.6%) than in the older group (44.9%) (P < 0.001). Although the prevalence of hypertension was lower in the young group (66.7%) than in the older group (77.2%) (P = 0.017), that of untreated hypertension was greater in the young group (40.4%) than in the older group (27.2%) (P = 0.007). Furthermore, the prevalence of untreated dyslipidemia was greater in the young group (45.0%) than in the older group (26.6%) (P < 0.001). In conclusion, the young AMI patients had more modifiable risk factors such as obesity, smoking, untreated hypertension, and untreated dyslipidemia than the older patients. There is an unmet medical need for the prevention of AMI in the young generation.
  • Yusuke Mizuno, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 61 (6) 1121 - 1128 2020/11 
    Periprocedural myocardial infarction (PMI) is closely associated with long-term cardiovascular events. The factors associated with PMI are not fully understood. The purpose of this study was to investigate the determinants of PMI in contemporary elective percutaneous coronary intervention (PCI). Overall, 731 elective PCI was divided into the PMI (n = 27) and non-PMI (n = 704) groups. Univariate and multivariate logistic regression analysis was used to find factors associated with PMI. In the univariate analysis, PMI was associated with complex lesion characteristics, such as the lesion length, lesion angle, calcification, and Medina classification. In the multivariate logistic regression analysis, the lesion length (per 10-mm increase: odds ratio (OR), 1.477; 95% confidence interval (CI), 1.161‒1.879; P = 0.002), lesion angle ≥ 45° (versus lesion angle < 45°: OR, 4.244; 95% CI, 1.187‒15.171; P = 0.026), and Medina classification (0,1,1) / (1,1,1) (versus other lesions: OR, 14.843; 95% CI, 6.235‒35.334; P < 0.001) were significantly associated with PMI. Of the 24 lesions with lesion angle ≥ 45° in the PMI group, 14 had final TIMI flow grade ≤ 2 in side branches and 9 had transient slow flow in main branches/transient ST elevation during PCI. Of the 87 lesions with Medina classification (1,1,1) / (0,1,1), 19 had final TIMI grade ≤ 2 in side branches. In conclusion, the lesion length, lesion angle ≥ 45°, and Medina classification (0,1,1) / (1,1,1) were significantly associated with PMI in contemporary elective PCI. Preventing flow limitation in both side branches and main vessels in elective PCI for the diffuse long, angulated, or true bifurcation lesions is important.
  • Shinnosuke Sawano, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    The American journal of cardiology 135 24 - 31 2020/11 
    Acute myocardial infarction (AMI) would sometimes raise severe in-hospital complications such as cardiopulmonary arrest, shock, stroke, atrioventricular block, and respiratory failure. The purpose of this retrospective study was to compare the clinical outcomes of AMI patients who recovered from severe in-hospital complications with those who did not have in-hospital complications. We included 494 AMI patients, and divided those into the in-hospital complications group (n = 166) and noncomplications group (n = 328). The primary end point was the major adverse cardiovascular events (MACE) defined as the composite of all cause death, nonfatal myocardial infarction (MI), and readmission for heart failure within 1 year after the hospital discharge. A total of 50 postdischarge MACE were observed during the study period. MACE was more frequently observed in the in-hospital complications group (14.5%) than in the noncomplications group (7.9%) (p = 0.023). The presence of in-hospital complications was significantly associated with the MACE (Odds Ratio 1.889, 95% Confidence Interval 1.077 to 3.313, p = 0.026) after controlling age, gender, ST-elevation MI, and culprit of AMI. In conclusion, the MACE was significantly frequent in AMI patients who recovered from severe in-hospital complications and discharged to home, as compared with those who did not have in-hospital complications. AMI patients who recovered from complications could be recognized as a high risk group, and should be carefully managed after discharge to prevent cardiovascular events.
  • Kei Yamamoto, Kenichi Sakakura, Takunori Tsukui, Masaru Seguchi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Cardiovascular intervention and therapeutics 2020/10 
    Since slow flow can be a fatal complication in left main coronary artery (LMCA)-acute coronary syndrome (ACS) patients, it should be important to anticipate and prepare slow flow during primary PCI for LMCA-ACS. We hypothesized that intravascular ultrasound (IVUS) findings would be useful to predict slow flow for LMCA-ACS patients without cardiogenic shock (CS). The purpose of this study was to investigate clinical factors associated with slow flow in LMCA-ACS patients without CS. We included 60 LMCA-ACS patients without CS, and divided into the slow flow group (n = 18) and the non-slow flow group (n = 42). Slow flow was defined as either transient or persistent TIMI flow grade ≤ 2. The prevalence of ST-segment elevation myocardial infarction (STEMI) was significantly higher in the slow flow group (55.6%) than in the non-slow flow group (11.9%) (p = 0.002). In the IVUS analysis, remodeling index was significantly greater in the slow flow group (1.15 ± 0.17) than in the non-slow flow group (0.99 ± 0.11) (p = 0.001). The multivariate logistic regression analyses in the IVUS factors revealed that remodeling index was significantly associated with slow flow (0.1 increase: OR 2.238, 95% CI 1.144-4.379, p = 0.019). In conclusion, remodeling index was significantly associated with slow flow. Our results suggest that the remodeling index determined by IVUS would be useful to find high-risk features of slow flow in LMCA-ACS patients without CS.
  • Masayuki Kubota, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 61 (5) 865 - 871 2020/09 
    Bleeding complication has been considered as a serious problem in current percutaneous coronary interventions (PCI). Fortunately, several groups have already reported the effectiveness of protamine use just after PCI to immediately remove any arterial sheath. However, there is a concern that protamine reversal may increase non-occlusive thrombus and, in turn, lead to mid-term cardiovascular events such as target vessel revascularization (TVR) or stent thrombosis. Thus, the purpose of this study was to evaluate whether protamine use following elective PCI was associated with mid-term clinical outcomes. In total, 472 patients were included in this study; subsequently, they were divided into protamine group (n = 142) and non-protamine group (n = 330). The primary endpoint was the composite of ischemia-driven TVR and stent thrombosis. The median follow-up period was determined to be at 562 days. In total, 32 primary endpoints were observed during the study period, and the incidence of primary endpoints tended to be greater in the protamine group than in the non-protamine group (P = 0.056). However, the lesion length, the degree of calcification, and the prevalence of hemodialysis were significantly determined greater in the protamine group than in the non-protamine group. In the multivariate Cox proportional hazards model, the use of protamine (versus non-protamine: hazard ratio 0.542 and 95% confidence interval 0.217-1.355, P = 0.191) was deemed not to be associated with the primary endpoint after controlling legion length, calcification, and hemodialysis. In conclusion, immediate protamine use following elective PCI did not increase mid-term ischemia-driven TVR or stent thrombosis. However, immediate protamine use after PCI should be discussed further for the safety of the patient.
  • Masaru Seguchi, Kenichi Sakakura, Takunori Tsukui, Kei Yamamoto, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 61 (5) 879 - 887 2020/09 
    Since the number of elderly patients suffering from acute myocardial infarction (AMI) has been increasing in developed countries, primary percutaneous coronary intervention (PCI) for the very elderly aged ≥80 years old is already common. The study aimed to examine the determinants of in-hospital death among the very elderly with AMI in current PCI era. We included 412 consecutive AMI patients aged ≥ 80 years old who received PCI to the culprit lesion; however, 42 patients (10.2%) died during the index hospitalization. Thus, univariate and multivariate logistic regression analyses were performed to identify the determinants of in-hospital death. Of note, the modified KATZ index, which is a seven-point scale ranging from 0 to 6 (0 point indicating no dependence and six points indicating full dependence), was calculated to evaluate pre-admission activity of daily living (ADL). In multivariate analysis, cardiac arrest (OR 4.642, 95% CI 1.177-18.305, P = 0.028), Killip class IV (versus Killip class I: OR 5.732, 95% CI 1.076-16.630, P = 0.001), modified KATZ index (OR 1.212, 95% CI 1.001-1.469, P = 0.049), hemoglobin levels (OR 0.803, 95% CI 0.656-0.983, P = 0.033), use of temporary pacemaker (OR 2.603, 95% CI 1.010-6.709, P = 0.048), final Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (versus TIMI ≤ 2: OR 0.240, 95% CI 0.093-0.618, P = 0.003), and mechanical circulatory support (OR 4.264, 95% CI 1.818-10.005, P = 0.001) were found to be significantly associated with in-hospital death. In conclusion, in-hospital outcomes of the very elderly with AMI were still poor in the current PCI era. Poor pre-admission ADL as well as cardiogenic shock and anemia were determined to be strongly associated with in-hospital death.
  • Hiroki Yoshida, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Takashi Moriya, Hideo Fujita
    Cardiovascular intervention and therapeutics 2020/08 
    In most areas in Japan, patients with ST-elevation myocardial infarction (STEMI) would be transferred to the secondary hospitals or tertiary hospitals according to the judgement of emergency medical service (EMS) staff members. We hypothesized that in-hospital outcomes would be worse in STEMI patients judged as tertiary emergency than in those judged as secondary emergency, which may support the judgement of the current EMS systems. The purpose of this study was to compare in-hospital outcomes of STEMI between patients judged as secondary emergency and those judged as tertiary emergency. We included 238 STEMI patients who were transferred to our institution using EMS hotline, and divided those into the secondary emergency group (n = 106) and the tertiary emergency group (n = 132). The primary endpoint was in-hospital death. The prevalence of shock was significantly higher in the tertiary emergency group than in the secondary emergency group (32.6% vs. 10.4%, p < 0.001). The GRACE score was significantly higher in the tertiary emergency group than the secondary emergency group [146 (118-188) vs. 134 (101-155), p < 0.001]. The incidence of in-hospital death was significantly higher in the tertiary emergency group than in the secondary emergency group (8.0% vs. 2.1%, p = 0.014). The multivariate logistic regression analysis revealed that the tertiary emergency was significantly associated with in-hospital death (OR 3.52, 95% CI 1.24-10.02, p = 0.018) after controlling age and gender. In conclusion, the tertiary emergency was significantly associated with in-hospital death. Our results might validate the judgement of levels of emergency by local EMS staff members.
  • Naoyuki Kimura, Yohei Nomura, Akinori Aomatsu, Akio Matsuda, Yusuke Imamura, Yosuke Taniguchi, Daijiro Hori, Yoshiyuki Morishita, Hideo Fujita, Koichi Yuri, Kenji Matsumoto, Atsushi Yamaguchi
    The American Journal of Cardiology 128 35 - 44 0002-9149 2020/08
  • Kei Yamamoto, Kenichi Sakakura, Kohei Hamamoto, Hiroko Hasegawa, Takunori Tsukui, Masaru Seguchi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Journal of cardiology 76 (2) 217 - 223 2020/08 [Refereed][Not invited]
     
    BACKGROUND: Peak skin dose (PSD) is closely associated with skin radiation injuries such as skin ulcers in percutaneous coronary intervention (PCI). Although PSD is greater in PCI for chronic total occlusion (CTO) lesions as compared with non-CTO lesions, the determinants of PSD in CTO-PCI are not fully understood. The purpose of this study was to investigate the clinical factors associated with excess PSD in PCI for CTO. METHODS: The study population included a total of 220 CTO-PCI cases that were divided into a standard PSD group (<2 Gy, n = 187) and an excess PSD group (≥2 Gy, n = 33). Clinical, lesion, and procedural characters were compared between the 2 groups. Multivariate logistic regression was performed to investigate the clinical factors associated with excess PSD. RESULTS: Body surface area (BSA) was significantly higher in the excess PSD group (1.85 ± 0.24 m2) than the standard PSD group (1.71 ± 0.18 m2) (p = 0.001). The J-CTO score was significantly higher in the excess PSD group (2.51 ± 1.28) than the standard PSD group (1.60 ± 1.13) (p < 0.001). Multivariate logistic regression analysis revealed that BSA (0.1 mm increase: OR 1.663, 95% CI 1.300-2.128, p < 0.001) and J-CTO score (1-point increase: OR 2.015, 95% CI 1.322-3.071, p = 0.001) were significantly associated with excess PSD. CONCLUSIONS: A large BSA and high J-CTO score were significantly associated with excess PSD. It is important to pay special attention to CTO patients who have a large BSA and/or high J-CTO score to reduce patient's PSD.
  • Jumpei Ohashi, Kenichi Sakakura, Wataru Sasaki, Yousuke Taniguchi, Kunihiro Kani, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Heart and vessels 2020/07 [Refereed][Not invited]
     
    The current Japanese guideline for ST-segment elevation myocardial infarction (STEMI) recommends 500-m walk electrocardiogram (ECG) test for patients with STEMI during hospitalization. However, little is known regarding the association between acute phase 500-m walk ECG test and clinical outcomes. The purpose of this study was to investigate the association between 500-m walk ECG test and mid-term clinical outcomes in patients with STEMI. A total of 313 STEMI patients who underwent primary percutaneous coronary interventions were included, and were divided into the successful 500-m group (n = 263) and the unsuccessful 500-m group (n = 50). The primary endpoint was the major adverse cardiovascular events (MACE), which were defined as the composite of all cause death, acute myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization (TVR). During the follow-up period (median 223 days), a total of 55 MACE were observed. The log-rank test revealed that MACE, all cause death, readmission for heart failure, and ischemia-driven TVR were more frequently observed in the unsuccessful 500-m group than the successful 500-m group. In the multivariate Cox proportional hazard model, the unsuccessful 500-m walk ECG test was significantly associated with MACE (OR 5.62, 95% CI 3.08-10.08, P < 0.01) after controlling confounding factors such as age, and serum creatinine levels. In conclusion, the unsuccessful 500-m walk ECG test was significantly associated with poor mid-term outcomes in patients with STEMI. Our results suggest the usefulness of 500-m walk ECG test to stratify the high-risk group from patients with STEMI.
  • Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Scientific reports 10 (1) 11362 - 11362 2020/07 [Refereed][Not invited]
     
    Although the usefulness of intravascular ultrasound (IVUS) in rotational atherectomy (RA) has been widely recognized, an IVUS catheter may not cross the target lesion because of severe calcification. The aim of this study was to compare the incidence of slow flow following RA between IVUS-crossable versus IVUS-uncrossable calcified lesions. We included 284 RA lesions, and divided into an IVUS-crossable group (n = 150) and an IVUS-uncrossable group (n = 134). The primary endpoint was slow flow just after RA. The incidence of slow flow (TIMI flow grade ≤ 2) was significantly greater in the IVUS-uncrossable group than in the IVUS-crossable group (26.1% vs. 10.7%, p = 0.001). The incidence of severe slow flow (TIMI grade ≤ 1) was also greater in the IVUS-uncrossable group than in the IVUS-crossable group (9.7% vs. 2.7%, p = 0.022). The multivariate logistic regression model showed a significant association between slow flow and pre-IVUS uncrossed lesions (vs. crossed lesions: odds ratio 2.103, 95% confidence interval 1.047-4.225, p = 0.037). In conclusion, the incidence of slow flow/severe slow flow just after RA was significantly greater in the IVUS-uncrossable lesions than in the IVUS-crossable lesions. Our study suggests the possibility that the IVUS-crossability can be used as a risk stratification of severe calcified lesions.
  • 電子カルテから多モダリティ循環器診療情報を収集するCLIDASデータベースシステム
    的場 哲哉, 興梠 貴英, 藤田 英雄, 苅尾 七臣, 中山 雅晴, 清末 有宏, 宮本 恵宏, 辻田 賢一, 中島 直樹, 筒井 裕之, 永井 良三
    日本動脈硬化学会総会プログラム・抄録集 (一社)日本動脈硬化学会 52回 257 - 257 1347-7099 2020/07
  • Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Cardiovascular intervention and therapeutics 35 (3) 227 - 233 1868-4300 2020/07 [Refereed][Not invited]
     
    Since intravascular imaging such as intravascular ultrasound (IVUS) can provide useful information for rotational atherectomy (RA), intravascular imaging should be attempted before RA. However, some calcified lesions do not allow imaging catheters to cross before RA. Although small burrs (1.25 mm or 1.5 mm) should be selected for such tight lesions, it is unknown whether a 1.25-mm burr or 1.5-mm burr is safer as the initial burr. The aim of this study was to compare the incidence of complications with a 1.25-mm versus a 1.5-mm burr as the initial burr for IVUS-uncrossable lesions. This was a retrospective, single-center study. A total of 109 IVUS-uncrossable lesions were included, and were divided into a 1.25-mm group (n =52) and a 1.5-mm group (n =57). The incidence of slow flow just after RA was not different between the 2 groups (1.25-mm group: 25%, 1.5-mm group: 31.6%, P =0.45). The incidence of peri-procedural MI with slow flow was not different and equally low in the 2 groups (1.25-mm group: 1.9%, 1.5-mm group: 3.5%, P =0.61). The use of the 1.5-mm burr as the initial burr was not significantly associated with slow flow after controlling for chronic renal failure on hemodialysis and reference diameter (vs. 1.25-mm: OR 2.34, 95% CI 0.89-6.19, P =0.09). In conclusion, the incidence of complications following RA was comparable between the 1.25-mm and the 1.5-mm burrs as the initial burr for IVUS-uncrossable lesions. The present study provides insights into the selection of an appropriate burr for IVUS-uncrossable lesions.
  • Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Hiroyuki Jinnouchi, Hideo Fujita
    The American journal of cardiology 132 172 - 173 2020/06 [Refereed][Not invited]
  • Shinnosuke Sawano, Kenichi Sakakura, Yoshimasa Tsurumaki, Hideo Fujita
    Cardiovascular intervention and therapeutics 2020/06 [Refereed][Not invited]
  • Yumiko Haraguchi, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Internal medicine (Tokyo, Japan) 59 (12) 1489 - 1495 2020/06 [Refereed][Not invited]
     
    Objective Although the importance of evidence-based optimal medical therapy (OMT) after acute myocardial infarction (AMI) has been recognized, the prescription rate of OMT is not sufficiently high in real-word clinical settings. The purpose of this study was to identify the clinical characteristics of AMI patients who did not receive OMT. Methods The present study was a retrospective study. OMT was defined as the combination of antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), beta-blockers, and statins at the time of hospital discharge. Non-OMT was defined as the lack of either antiplatelet therapy, ACE inhibitors/ARBs, beta-blockers, or statins. Results A total of 457 AMI patients were included as the final study population, and 98 patients (22.4%) lacked at least 1 OMT medication. The prescription rates of antiplatelet therapy, ACE inhibitors/ARBs, beta-blockers, and statins were 98.7%, 87.5%, 90.4%, and 96.7%, respectively. In the multivariate logistic regression analysis, age [per 1-year increase: odds ratio (OR) 1.033, 95% confidence interval (CI) 1.007-1.059, p=0.014], hemodialysis (vs. no hemodialysis: OR 2.707, 95% CI 1.082-6.774, p=0.033), estimated glomerular filtration rate <30 mL/min/1.73 m2 without hemodialysis (OR 4.585, 95% CI 1.975-10.644, p<0.001), AMI caused by vasospastic angina (VSA) (vs. no VSA: OR 13.198, 95% CI 1.809-96.260, p=0.011), and asthma (vs. no asthma: OR 7.241, 95% CI 1.716-30.559, p=0.007) were significantly associated with non-OMT, whereas heart rate on admission (per 1-bpm increase: 0.987, 95% CI 0.975-0.999, p=0.033), any PCI (vs. no PCI: OR 0.156, 95% CI 0.066-0.373, p<0.001), and ST-elevation myocardial infarction (STEMI) (vs. NSTEMI: OR 0.384, 95% CI 0.218-0.675, p=0.001) were inversely associated with non-OMT. Conclusion An advanced age, VSA, bradycardia, asthma, impaired renal function, non-PCI revascularization, and non-ST-elevation myocardial infarction were significantly associated with non-OMT.
  • Hiroko Hasegawa, Yousuke Taniguchi, Kenichi Sakakura, Atsushi Yamaguchi, Hideo Fujita
    Cardiovascular intervention and therapeutics 2020/06 [Refereed][Not invited]
  • Satoshi Asada, Kenichi Sakakura, Kei Yamamoto, Shinichi Momomura, Hideo Fujita
    Postepy w kardiologii interwencyjnej = Advances in interventional cardiology 16 (2) 219 - 220 2020/06 [Refereed][Not invited]
  • Shinnosuke Sawano, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 61 (3) 463 - 469 2020/05 [Refereed][Not invited]
     
    Recently, we developed a novel acute myocardial infarction (AMI) risk stratification system (nARS), which stratifies AMI patients into low- (L), intermediate- (I), and high- (H) risk groups. We have shown that the nARS shortened the length of intensive care unit (ICU) stay as well as that of hospitalization. However, the incidence of AMI-related adverse outcomes has not been fully investigated. The purpose of this study was to investigate the incidence of severe complications requiring ICU care among the 3 risk groups stratified by nARS. We retrospectively reviewed AMI patients between October 2016 and December 2018. A total of 592 patients were divided into the L- (n = 285), I- (n = 124), and H- (n = 183) risk groups. The primary endpoint was in-hospital complications requiring ICU care defined as death/cardiopulmonary arrest, shock, stroke, atrioventricular block, and respiratory failure. Among 592 patients, 239 (40.4%) developed at least 1 complication requiring ICU care, but only 28 (11.7%) developed complications in general wards. Complications requiring ICU care were most frequently observed in the H-risk group (68.9%), followed by the I-risk group (50.8%), and least in the L-risk group (17.5%) (P < 0.001). Complications requiring ICU care that occurred in the general wards were more frequently observed in the H-risk group (8.7%) compared to the I-risk (3.2%) and L-risk (2.8%) groups (P = 0.009). In conclusion, complications requiring ICU care rarely happened in the general wards, and were less in the I- and L-risk groups than in the H-risk group. These results validated the nARS, and might support the widespread use of nARS.
  • Taku Kasahara, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 61 (2) 209 - 214 2020/03 [Refereed][Not invited]
     
    Recent guidelines do not recommend the routine use of intra-aortic balloon pumping (IABP) for patients with cardiogenic shock. However, IABP support is still selected for acute myocardial infarction (AMI) in clinical practice because an Impella device did not show superiority over IABP and the mortality of AMI with cardiogenic shock is still high. This study aimed to find factors associated with in-hospital mortality in patients with AMI who required IABP support. Overall, 104 patients with AMI who required IABP support were included as the study population. Of 104 patients, in-hospital death was observed in 19 (18.3%). Multivariate stepwise logistic regression analysis was performed to investigate the determinants of in-hospital death. Shock, resuscitation, estimated glomerular filtration rate (eGFR), pre-systolic blood pressure of IABP insertion, multi-vessel disease, fluoroscopy time, initial lactic acid dehydrogenase levels, and timing of IABP support were included as independent variables. Shock (OR 25.27, 95% CI 3.26-196.11, P = 0.002) was significantly associated with in-hospital death after controlling other covariates, whereas eGFR (every 10 mL/minute/1.73 m2 increase: OR 0.65, 95% CI 0.51-0.82, P < 0.001) and pre-percutaneous coronary intervention (pre-PCI) insertion of IABP (versus on-PCI insertion of IABP: OR 0.06, 95% CI 0.008-0.485, P = 0.008) were inversely associated with in-hospital death. In conclusion, shock was significantly associated with in-hospital death, whereas eGFR and pre-PCI insertion of IABP were inversely associated with in-hospital death in patients with AMI who received IABP support. Pre-PCI insertion of an IABP catheter might be associated with better survival in AMI patients who potentially require IABP support.
  • 山本 慶, 坂倉 建一, 明石 直之, 津久井 卓伯, 瀬口 優, 谷口 陽介, 和田 浩, 百村 伸一, 藤田 英雄
    循環器内科 (有)科学評論社 87 (2) 219 - 224 1884-2909 2020/02 [Refereed][Not invited]
  • Yasuhiro Mukai, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Heart and vessels 35 (2) 143 - 152 0910-8327 2020/02 [Refereed][Not invited]
     
    Since the amount of contrast media during percutaneous coronary intervention (PCI) is closely related to the exacerbation of renal function, it should be important to reduce the dose of contrast media during PCI. The purpose of this retrospective study was to evaluate the association of less-contrast media with clinical factors in elective PCI. A total of 709 patients were divided into the less-contrast media group (n = 142) and the conventional-contrast media group (n = 567) according to the quintile of total contrast volume. Univariate and multivariate logistic regression analyses were performed to find associations between the clinical variables and the less-contrast media group. The intravascular ultrasound (IVUS) use rate in the study population was considerably high (94.9%). In multivariable logistic regression analysis, an eGFR < 30 mL/min/1.73 m2 without hemodialysis was significantly associated with the less-contrast media group [odds ratio (OR) 43.73, 95% confidence interval (CI) 14.05-136.09, P < 0.001]. Left main-left anterior descending artery lesion (OR 0.28, 95% CI 0.17-0.48, P < 0.001), bifurcation lesion (OR 0.39, 95% CI 0.16-0.92, P = 0.03), chronic total occlusion (OR 0.22, 95% CI 0.06-0.90, P = 0.03) were inversely associated with the less-contrast media group. In conclusion, complex lesion characteristics were inversely associated with the less-contrast media in elective PCI. Since operators could access patients' renal function before elective procedure, an eGFR < 30 mL/min/1.73 m2 was most significantly associated with the less-contrast media. Our results suggest the possibility that the amount of contrast media is controllable in current PCI under IVUS-guidance.
  • Masaru Seguchi, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 61 (1) 7 - 14 2020/01 [Refereed][Not invited]
     
    Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Although there are earlier studies regarding AMI in octogenarians, clinical evidences of AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital outcomes of AMI between octogenarians and nonagenarians. We included consecutive 415 very elderly (≥ 80 years) with AMI and divided them into the nonagenarian group (n = 38) and the octogenarian group (n = 377). Clinical characteristics and in-hospital outcomes were compared between the two groups. Furthermore, we used propensity score matching to find the matched octogenarian group (n = 38). Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups. The incidence of in-hospital death in the nonagenarian group (10.5%) was similar to that in the octogenarian group (12.5%) (P = 0.487). After using the propensity score matching, the incidence of in-hospital death was less in the nonagenarian group (10.5%) than in the matched octogenarian group (18.4%) without reaching statistical significance (P = 0.328). The length of hospitalization was significantly shorter in the nonagenarian group [7.0 (4.0-9.0)] than in the matched octogenarian group [10.0 (6.5-15.0)] (P = 0.01). In conclusion, the in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed.
  • Takunori Tsukui, Kenichi Sakakura, Shin-Ichi Momomura, Hideo Fujita
    Cardiovascular intervention and therapeutics 35 (4) 405 - 406 2020/01 [Refereed][Not invited]
  • Yusuke Watanabe, Kenichi Sakakura, Hideo Fujita, Masanobu Ohya, Kazunori Horie, Futoshi Yamanaka, Gaku Nakazawa, Hiromasa Otake, Hiroki Shiomi, Masahiro Natsuaki, Kenji Ando, Kazushige Kadota, Shigeru Saito, Takeshi Kimura, Shoichi Kuramitsu
    Circulation journal : official journal of the Japanese Circulation Society 84 (2) 169 - 177 2020/01 [Refereed][Not invited]
     
    BACKGROUND: Stent thrombosis (ST) remains a severe complication following stent implantation. We previously reported the risk factors for ST after 2nd-generation drug-eluting stent (DES) in the REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation DES Implantation) registry.Methods and Results:In this subanalysis, we aimed to reveal the difference in ST between right coronary (RCA) and left (LCA) coronary arteries. A total of 307 patients with ST were divided into the RCA-ST group (n=93) and the LCA-ST group (n=214). Multivariate analysis revealed younger age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99, P=0.01), ostial lesion at the time of index percutaneous coronary intervention (OR 4.37, 95% CI 1.43-13.33, P=0.01), bifurcation lesion at the time of index PCI (OR 0.05, 95% CI 0.02-0.12, P<0.01), chronic total occlusion (CTO) lesion at the time of index PCI indication (OR 4.19, 95% CI 1.05-16.71, P=0.04), and use of prasugrel at the time of ST (OR 7.30, 95% CI 1.44-36.97, P=0.02) were significantly associated with RCA-ST. CONCLUSIONS: Younger age, ostial or CTO lesion, and use of prasugrel at the time of ST were prominent factors in RCA-ST, whereas bifurcation lesion was associated with LCA-ST. We should pay attention to the differences between RCA-ST and LCA-ST to prevent ST.
  • Yumiko Haraguchi, Kenichi Sakakura, Hideo Fujita
    Internal medicine (Tokyo, Japan) 59 (17) 2207 - 2207 2020
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    PloS one 15 (10) e0241251  2020 
    BACKGROUND: Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the door-to-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes. METHODS: This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of all-cause death, acute myocardial infarction, and acute heart failure requiring hospitalization. RESULT: The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m2) (vs. >20 kg/m2: HR 2.80, 95% CI 1.39-5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06-5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30-4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79-5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71-5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32-0.92, p = 0.02) was inversely associated with MACE. CONCLUSION: Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas radial-access was inversely associated with MACE. It is important to avoid flow worsening during primary PCI even when appropriate DTBT was achieved.
  • Yusuke Watanabe, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Masaru Seguchi, Takunori Tsukui, Hiroyuki Jinnouchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    PloS one 15 (11) e0241836  2020 
    OBJECTIVES: This study aimed to compare the mid-term clinical outcomes of intravascular ultrasound (IVUS)-calcified nodules between percutaneous coronary intervention (PCI) with and without rotational atherectomy (RA). BACKGROUND: There has been a debate whether to use RA for the revascularization of calcified nodule. Although RA can ablate the calcified structure within calcified nodule and may facilitate adequate stent expansion, RA may provoke severe coronary perforation, because calcified nodule typically shows eccentric calcification. METHODS: We included 204 lesions with IVUS-calcified nodule, and divided into 73 lesions treated with RA (RA group) and 131 lesions without RA (non-RA group). After propensity-score matching, 42 lesions with RA (matched RA group) and 42 lesions without RA (matched non-RA group) were selected. We compared the clinical characteristics and outcomes between the 2 groups before and after propensity-score matching. The primary endpoint was ischemia-driven target vessel revascularization (TVR) within 1 year. RESULTS: Acute lumen area gain on IVUS was comparable between the matched RA group and matched non-RA group (3.9 ± 2.1 mm2 vs. 3.4 ± 1.6 mm2, p = 0.18). The stent malapposition at calcified nodules was frequently observed in both groups. The ischemia-driven TVR was not different between the 2 groups before (p = 0.82) and after propensity score-matching (p = 0.87). CONCLUSIONS: The use of RA could not reduce the incidence of ischemia-driven TVR in lesions with IVUS-calcified nodule. Our results do not support the routine use of RA for lesions with IVUS-calcified nodule.
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Internal medicine (Tokyo, Japan) 59 (13) 1597 - 1603 2020 [Refereed][Not invited]
     
    Objective In primary percutaneous coronary intervention (PCI), the door-to-balloon time (DTBT) is known to be associated with in-hospital death in patients with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding the association between the DTBT and the mid-term clinical outcomes in patients with STEMI. The purpose of this study was to investigate the association between the DTBT and mid-term all-cause death. Methods The study population included 309 STEMI patients, who were divided into the short DTBT (DTBT<60 minutes, n=103), intermediate DTBT (DTBT 60-120 minutes, n=174) and long DTBT (DTBT >120 minutes, n=32) groups. The median follow-up period was 287 days (interquartile range: 182-624 days). Results The incidence of all-cause death in the long DTBT group was significantly higher in comparison to the other groups (p<0.001). In the multivariate Cox regression analysis, although a short DTBT [vs. intermediate DTBT: hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.39-2.55, p=0.99] was not associated with all-cause death, a long DTBT (vs. intermediate DTBT: HR 2.80, 95% CI 1.26-6.17, p=0.011) was significantly associated with all-cause death, after controlling for confounding factors such as Killip class 4, an impaired renal function, and the number of diseased vessels. Conclusion The DTBT was significantly associated with the incidence of mid-term all-cause death. Our results support the strong adherence to the DTBT in patients with STEMI.
  • Satoshi Asada, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    PloS one 15 (8) e0237362  2020 [Refereed][Not invited]
     
    BACKGROUND: Since the long fluoroscopy time in primary PCI for ST-segment elevation myocardial infarction (STEMI) could be an indicator of delayed reperfusion, it should be important to recognize which types of lesions require longer fluoroscopy-time in primary PCI. The purpose of this study was to investigate the association of the long fluoroscopy-time with clinical factors in primary percutaneous coronary interventions (PCI). METHODS: A total of 539 patients who underwent primary PCI were divided into the conventional fluoroscopy-time group (Q1-Q4: n = 434) and the long fluoroscopy-time group (Q5: n = 105) according to the quintile of the total fluoroscopy time in primary PCI. Univariate and multivariate logistic regression analyses were performed to find associations between clinical variables and the long fluoroscopy-time. RESULTS: In univariate logistic regression analysis, prevalence of diabetes mellitus, hemodialysis, and previous CABG were significantly associated with the long fluoroscopy-time. In addition, complex lesion characteristics such as lesion length, lesion angle, tortuosity, and calcification were associated with the long fluoroscopy-time. In multivariable logistic regression analysis, lesion length [per 10 mm incremental: odds ratio (OR) 1.751, 95% confidence interval (CI) 1.397-2.195, P<0.001], moderate-excessive tortuosity (vs. mild tortuosity: OR 4.006, 95% CI 1.498-10.715, P = 0.006), and moderate to severe calcification (vs. none-mild calcification: OR 1.865, 95% CI 1.107-3.140, P = 0.019) were significantly associated with the long fluoroscopy-time. CONCLUSIONS: In primary PCI for STEMI, diffuse long lesion, tortuosity, and moderate-severe calcification were associated with the long fluoroscopy-time. These complex features require special attention to reduce reperfusion time in primary PCI.
  • Hiroko Hasegawa, Kenichi Sakakura, Kohei Hamamoto, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Cardiovascular revascularization medicine : including molecular interventions 21 (1) 6 - 11 2020/01 [Refereed][Not invited]
     
    BACKGROUND: Skin radiation injuries, especially radiation ulcers, are serious side effects caused by ionizing radiation during percutaneous coronary interventions (PCI). Because skin radiation injuries are closely associated with the peak skin dose, it is important to minimize the peak skin dose. The aim of the present study was to investigate the determinants of greater peak skin dose in current PCI. METHODS: We included 707 consecutive coronary artery lesions, and divided them into an excess radiation group (n = 26; defined as peak skin dose ≥2 Gy) and a standard radiation group (n = 681; defined as peak skin dose <2 Gy). Clinical, lesion, and procedural characteristics were compared between the 2 groups. Univariate and multivariate logistic regression analyses were performed to identify determinants of the excess radiation group. RESULTS: A multivariate logistic regression analysis revealed that body surface area (BSA) [0.1 m2 increase: odds ratio (OR) 1.39, 95% confidence interval (CI) 1.13-1.71, P < 0.01], PCI to a right coronary artery (RCA) (OR 3.11, 95% CI 1.35-7.17, P < 0.01), and PCI to a chronic total occlusion (CTO) (OR 6.69, 95% CI 2.65-16.87, P < 0.01) were significantly associated with the excess radiation group. CONCLUSIONS: Greater BSA, PCI to RCA lesions, and PCI to CTO lesions were significantly associated with excess radiation dose. The first step in the prevention of radiation injuries in current PCI will be to recognize these risk factors.
  • Taku Kasahara, Kenichi Sakakura, Shin-Ichi Momomura, Hideo Fujita
    Journal of cardiology cases 21 (1) 32 - 34 2020/01 [Refereed][Not invited]
     
    A reverse guidewire technique along with double lumen catheter has become a standard technique for extremely angulated bifurcation lesions. A-72-year-old male underwent coronary angiography, which revealed a severe stenosis of the left anterior descending artery with an extremely angulated diagonal branch. We introduced the Crusade (Kaneka, Osaka, Japan) accompanied with the reversed guidewire to the lesion, but the Crusade with the reversed guidewire could not cross the lesion. We kept the Crusade at the just proximal to the stenosis, and advanced the only reversed guidewire to the lesion. The reversed guidewire successfully crossed the lesion, and then we pulled back the reversed guidewire to lead the reversed guidewire's tip into the diagonal branch retrogradely. In this modified reverse guidewire technique, the Crusade does not need to cross the lesion, but needs to bring the reversed guidewire at the just proximal of the lesion. Because the profile of the reversed guidewire alone is smaller than that of the Crusade accompanied with the reversed guidewire, the reversed guidewire alone has greater chance to cross the severe stenosis. Our modification may increase the success rate of the reverse guidewire technique, and expand the indication of this technique. .
  • Wataru Sasaki, Hiroshi Wada, Kenichi Sakakura, Jun Matsuda, Tatsuro Ibe, Takekuni Hayashi, Hirohito Ueba, Shin-Ichi Momomura, Hideo Fujita
    Clinical case reports 8 (1) 190 - 193 2020/01 [Refereed][Not invited]
     
    Vascular toxicity is one of serious complications following cisplatin-based chemotherapy. This case suggests that cisplatin has a potential risk of delayed occurrence of vasospastic angina. It is important to perform careful history taking including discontinued drugs for differential diagnosis of chest pain.
  • Kei Yamamoto, Kenichi Sakakura, Takunori Tsukui, Masaru Seguchi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    PloS one 15 (4) e0232158  2020 [Refereed][Not invited]
     
    BACKGROUND: Recently, the importance of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) has been emphasized with greater success rates. In the antegrade wire based approach, it is generally considered that the guidewire would not advance from the subintimal space to the intimal space without dissection re-entry device. However, it is sometimes observed by intravascular ultrasound (IVUS) that the guidewire within the subintimal space advanced into the distal true lumen. The purpose of this study was to investigate specific conditions or characteristics which were associated with "antegrade true-sub-true" phenomenon in CTO-PCI. METHODS: We retrospectively reviewed consecutive 320 CTO lesions that underwent CTO-PCI in our institution. Among them, 16 lesions in which the IVUS confirmed the "antegrade true-sub-true" phenomenon were categorized as the true-sub-true group, whereas 27 lesions that resulted in unsuccessful CTO-PCI were categorized as the unsuccessful group. We compared the clinical, lesion, and procedural characteristics between the true-sub-true group and the unsuccessful group. RESULTS: The prevalence of bifurcation with abrupt type in CTO exit-sites was significantly higher in the true-sub-true group in comparison to the unsuccessful group (75.0% vs. 25.9%, p = 0.002). The multivariate logistic regression analysis revealed that bifurcation with abrupt type in CTO exit-site (OR 8.017; 95%CI: 1.484-43.304; p = 0.016) was independent predictor of the antegrade true-sub-true phenomenon. CONCLUSIONS: In CTO-PCI, the antegrade true-sub-true phenomenon is rare, but can be a last chance for successful PCI. Bifurcation with abrupt type in CTO exit-site was significantly associated with the antegrade true-sub-true phenomenon.
  • Jumpei Ohashi, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hitomi Nanba-Sato, Kaho Shibata, Wataru Sasaki, Tomoya Ikeda, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 60 (6) 1245 - 1252 2019/11 [Refereed][Not invited]
     
    Persistent severe left ventricular (LV) systolic dysfunction after acute myocardial infarction (AMI) is associated with increased morbidity and mortality, whereas mid-term recovery of LV systolic function after AMI is associated with better long-term outcomes. The purpose of this study was to investigate the determinants of mid-term improvement of LV ejection fraction (EF) in AMI patients. We included 210 AMI patients who had modified Simpson EF both at the index admission and mid-term follow up. The difference of EF between the index admission and mid-term follow-up was calculated in all study patients. The EF improvement group was defined as mid-term ≥ 10% EF increase compared with the index admission EF. Of 210 AMI patients, 46 (21.9%) were allocated to the EF improvement group and 164 (78.1%) to the non-EF improvement group. Brain natriuretic peptide (BNP) at the timing of admission was significantly greater in the EF improvement group (735.8 ± 1077.6 pg/mL) than in the non-EF improvement group (239.0 ± 419.8 pg/mL) (P < 0.001). Multivariate logistic regression analysis revealed that log10 BNP at the timing of admission (OR 3.36, 95% CI 1.69-6.66, P < 0.001) and left main trunk-left anterior descending artery (LM-LAD) as the infarct-related artery (OR 3.34, 95% CI 1.59-7.02, P = 0.001) were significantly associated with EF improvement. In conclusion, elevated BNP at the timing of admission and LM-LAD as the infarct-related artery were significantly associated with mid-term LVEF recovery. Our results support aggressive acute treatment for those severe AMI, because the possibility of mid-term LVEF recovery is greater compared with other AMI.
  • Yousuke Taniguchi, Kenichi Sakakura, Koichi Yuri, Yohei Nomura, Yusuke Tamanaha, Naoyuki Akashi, Takunori Tsukui, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Atsushi Yamaguchi, Hideo Fujita
    International heart journal 60 (6) 1350 - 1357 2019/11 [Refereed][Not invited]
     
    Transcatheter aortic valve implantation (TAVI) has been recognized as a standard therapy for severe aortic valve stenosis. However, since some patients who receive TAVI have poor outcomes, the predictors of clinical outcomes after TAVI are important. The aim of this study was to investigate the association between appetite and long-term clinical outcomes.We screened consecutive cases who received TAVI at our medical center between July 2014 and October 2018. A total of 139 patients who received transfemoral TAVI were included as the final study population. They were divided into a good appetite group (n = 105) and a less appetite group (n = 34) according to their dietary intake rate (> 90%: good appetite group, ≤ 90%: less appetite group). We defined the intake rate as the average for breakfast, lunch, and dinner on the day just before discharge. We defined two-year major adverse cardiovascular and cerebrovascular events (MACCE) as a composite of cardiovascular death, myocardial infarction, any coronary revascularization, history of hospitalization due to heart failure, and disabling acute cerebral infarction. Kaplan-Meier analyses and multivariate Cox regression analysis were performed.The median duration of the follow-up period was 372 (189-720) days. Kaplan-Meier curves showed that the less appetite group got MACCE more frequently (event free rate of the less appetite group: 76.5% versus the good appetite group: 94.3%, Log Rank P = 0.01). In multivariate Cox regression analysis, having less appetite was a significant predictor of two-year MACCE (HR 5.26, 95%CI 1.66-16.71, P < 0.01).In conclusion, among the patients who received transfemoral TAVI, appetite status just before discharge was significantly associated with long-term outcome.
  • 多モダリティ循環器診療情報を収集するCLIDASデータベース
    的場 哲哉, 興梠 貴英, 藤田 英雄, 苅尾 七臣, 中山 雅晴, 清末 有宏, 辻田 賢一, 宮本 恵宏, 中島 直樹, 筒井 裕之, 永井 良三
    医療情報学連合大会論文集 (一社)日本医療情報学会 39回 155 - 155 1347-8508 2019/11
  • 山本 慶, 坂倉 建一, 津久井 卓伯, 瀬口 優, 谷口 陽介, 和田 浩, 百村 伸一, 藤田 英雄
    日本臨床生理学会雑誌 日本臨床生理学会 49 (4) 89 - 89 0286-7052 2019/10 [Refereed][Not invited]
  • Yusuke Tamanaha, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 60 (5) 1030 - 1036 1349-2365 2019/09 [Refereed][Not invited]
     
    Postcatheterization pseudoaneurysm is a serious complication following diagnostic or therapeutic catheterization. Because radial access is unsuitable in some situations, there is still a need to use femoral or brachial access for arterial catheterization. The aim of this study was to compare the incidence and clinical characteristics of pseudoaneurysm between brachial and femoral access. We identified patients who underwent arterial catheterization from our cardiac catheter records. A total of 5,990 cardiac catheter records and discharge summaries were reviewed, and 23 pseudoaneurysm cases were identified. Those pseudoaneurysm cases were divided into a brachial pseudoaneurysm group (n = 9) and a femoral pseudoaneurysm group (n = 14). The incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access (odds ratio: 4.16, 95% confidence interval: 1.80-9.65; P < 0.001). Successful manual compression was frequently achieved in both the brachial (77.8%) and the femoral (92.9%) pseudoaneurysm groups (P = 0.295). Surgical intervention was more frequently performed in the brachial pseudoaneurysm group (22.2%) than in the femoral pseudoaneurysm group (0%) without reaching statistical significance (P = 0.07). Moreover, neurological disorders were observed only in the brachial pseudoaneurysm group (22.2%). In conclusion, the incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access, indicating the potential risk of brachial access. Successful manual compression was frequently achieved in both groups, but neurological disorders were observed only in brachial access, suggesting the greater risk of brachial pseudoaneurysms.
  • 慢性期の分岐部再狭窄に対してProximal optimization techniqueが有効であった1例
    石橋 峻, 津久井 卓伯, 坂倉 建一, 谷口 陽介, 山本 慶, 瀬口 優, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 28回 [MP3 - 005] 2019/09 [Refereed][Not invited]
  • 新たな急性心筋梗塞のリスク分類の有用性
    山本 慶, 坂倉 建一, 津久井 卓伯, 瀬口 優, 和田 浩, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 28回 [MO79 - 001] 2019/09 [Refereed][Not invited]
  • 経カテーテル大動脈弁植込み術後の遅発性房室ブロックの一例
    津久井 卓伯, 谷口 陽介, 長谷川 宏子, 成田 昌隆, 玉那覇 雄介, 笠原 卓, 山本 慶, 宇賀田 裕介, 瀬口 優, 坂倉 建一, 和田 浩, 百村 伸一, 藤田 英雄, 今村 有佑, 野村 陽平, 由利 康一, 山口 敦司
    日本心血管インターベンション治療学会抄録集 28回 [MO103 - 001] 2019/09 [Refereed][Not invited]
  • TAVIによる生体弁留置直後、右房内に巨大血栓を形成した一例
    長谷川 宏子, 谷口 陽介, 玉那覇 雄介, 笠原 卓, 津久井 卓伯, 山本 慶, 瀬口 優, 坂倉 建一, 和田 浩, 百村 伸一, 藤田 英雄, 今村 有佑, 野村 陽平, 由利 康一, 山口 敦司, 岩崎 夢大, 大塚 祐史
    日本心血管インターベンション治療学会抄録集 28回 [MO103 - 002] 2019/09 [Refereed][Not invited]
  • Masamitsu Noguchi, Kenichi Sakakura, Naoyuki Akashi, Yusuke Adachi, Yusuke Watanabe, Yousuke Taniguchi, Tatsuro Ibe, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 60 (3) 560 - 568 1349-2365 2019/05 [Refereed][Not invited]
     
    Right ventricular infarction (RVI) is a complication following inferior ST-elevation myocardial infarction (STEMI). The aim of the present study was to investigate the clinical outcomes of RVI in the contemporary primary percutaneous coronary intervention (PCI) era. The primary endpoint was in-hospital death, and the secondary endpoint was major adverse cardiac events (MACE), defined as the composite of cardiovascular death, re-hospitalization for heart failure, and non-fatal acute myocardial infarction (AMI). Event-free survival curves for MACE were constructed using the Kaplan-Meier method, and statistical differences between curves were assessed using the log-lank test. A total of 1354 patients with AMI were screened from January 2010 to December 2016. The final study population involved 315 patients with STEMI whose infarct related artery (IRA) was the right coronary artery (RCA). We categorized these 315 patients into the RVI group (n = 85) and the non-RVI group (n = 230). Median follow-up duration was 358 (IQR: 208-987) days. In-hospital deaths were more frequently observed in the RVI group (9.4%) than in the non-RVI group (3.0%) (P = 0.018). However, the incidence of MACE was not different between the groups (P = 0.537). In conclusion, in-hospital clinical outcomes were poorer in the RVI group than in the non-RVI group. However, mid-term MACE was not different between the two groups, suggesting the importance of aggressive acute treatment for STEMI patients with RVI.
  • Hiroshi Itoh, Issei Komuro, Masahiro Takeuchi, Takashi Akasaka, Hiroyuki Daida, Yoshiki Egashira, Hideo Fujita, Jitsuo Higaki, Ken ichi Hirata, Shun Ishibashi, Takaaki Isshiki, Sadayoshi Ito, Atsunori Kashiwagi, Satoshi Kato, Kazuo Kitagawa, Masafumi Kitakaze, Takanari Kitazono, Masahiko Kurabayashi, Katsumi Miyauchi, Tomoaki Murakami, Toyoaki Murohara, Koichi Node, Susumu Ogawa, Yoshihiko Saito, Yoshihiko Seino, Takashi Shigeeda, Shunya Shindo, Masahiro Sugawara, Seigo Sugiyama, Yasuo Terauchi, Hiroyuki Tsutsui, Kenji Ueshima, Kazunori Utsunomiya, Masakazu Yamagishi, Tsutomu Yamazaki, Shoei Yo, Koutaro Yokote, Kiyoshi Yoshida, Michihiro Yoshimura, Nagahisa Yoshimura, Kazuwa Nakao, Ryozo Nagai
    Diabetes, Obesity and Metabolism 21 (4) 791 - 800 1462-8902 2019/04 
    © 2018 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. Aims: To assess the benefits of intensive statin therapy on reducing cardiovascular (CV) events in patients with type 2 diabetes complicated with hyperlipidaemia and retinopathy in a primary prevention setting in Japan. In the intension-to-treat population, intensive therapy [targeting LDL cholesterol <1.81 mmol/L (<70 mg/dL)] was no more effective than standard therapy [LDL cholesterol ≥2.59 to <3.10 mmol/L (≥100 to <120 mg/dL)]; however, after 3 years, the intergroup difference in LDL cholesterol was only 0.72 mmol/L (27.7 mg/dL), and targeted levels were achieved in <50% of patients. We hypothesized that the intergroup difference in CV events would have been statistically significant if more patients had been successfully treated to target. Materials and Methods: This exploratory post hoc analysis focused on intergroup data from patients who achieved their target LDL cholesterol levels. The primary endpoint was the composite incidence of CV events. A Cox proportional hazards model was used to estimate hazard ratios (HRs) for incidence of the primary endpoint in patients who achieved target LDL cholesterol levels in each group. Results: Data were analysed from 1909 patients (intensive: 703; standard: 1206) who achieved target LDL cholesterol levels. LDL cholesterol at 36 months was 1.54 ± 0.30 mmol/L (59.7 ± 11.6 mg/dL) in the intensive group and 2.77 ± 0.46 mmol/L (107.1 ± 17.8 mg/dL) in the standard group (P < 0.05). After adjusting for baseline prognostic factors, the composite incidence of CV events or deaths associated with CV events was significantly lower in the intensive than the standard group (HR 0.48; 95% confidence interval 0.28-0.82; P = 0.007). Conclusions: This post hoc analysis suggests that achieving LDL cholesterol target levels <1.81 mmol/L may more effectively reduce CV events than achieving target levels ≥2.59 to <3.10 mmol/L in patients with hypercholesterolaemia and diabetic retinopathy.
  • Hiroshi Itoh, Issei Komuro, Masahiro Takeuchi, Takashi Akasaka, Hiroyuki Daida, Yoshiki Egashira, Hideo Fujita, Jitsuo Higaki, Ken-ichi Hirata, Shun Ishibashi, Takaaki Isshiki, Sadayoshi Ito, Atsunori Kashiwagi, Satoshi Kato, Kazuo Kitagawa, Masafumi Kitakaze, Takanari Kitazono, Masahiko Kurabayashi, Katsumi Miyauchi, Tomoaki Murakami, Toyoaki Murohara, Koichi Node, Susumu Ogawa, Yoshihiko Saito, Yoshihiko Seino, Takashi Shigeeda, Shunya Shindo, Masahiro Sugawara, Seigo Sugiyama, Yasuo Terauchi, Hiroyuki Tsutsui, Kenji Ueshima, Kazunori Utsunomiya, Masakazu Yamagishi, Tsutomu Yamazaki, Shoei Yo, Koutaro Yokote, Kiyoshi Yoshida, Michihiro Yoshimura, Nagahisa Yoshimura, Kazuwa Nakao, Ryozo Nagai
    DIABETES OBESITY & METABOLISM 21 (4) 791 - 800 1462-8902 2019/04 
    Aims To assess the benefits of intensive statin therapy on reducing cardiovascular (CV) events in patients with type 2 diabetes complicated with hyperlipidaemia and retinopathy in a primary prevention setting in Japan. In the intension-to-treat population, intensive therapy [targeting LDL cholesterol <1.81 mmol/L (<70 mg/dL)] was no more effective than standard therapy [LDL cholesterol >= 2.59 to <3.10 mmol/L (>= 100 to <120 mg/dL)]; however, after 3 years, the intergroup difference in LDL cholesterol was only 0.72 mmol/L (27.7 mg/dL), and targeted levels were achieved in Materials and Methods This exploratory post hoc analysis focused on intergroup data from patients who achieved their target LDL cholesterol levels. The primary endpoint was the composite incidence of CV events. A Cox proportional hazards model was used to estimate hazard ratios (HRs) for incidence of the primary endpoint in patients who achieved target LDL cholesterol levels in each group. Results Data were analysed from 1909 patients (intensive: 703; standard: 1206) who achieved target LDL cholesterol levels. LDL cholesterol at 36 months was 1.54 +/- 0.30 mmol/L (59.7 +/- 11.6 mg/dL) in the intensive group and 2.77 +/- 0.46 mmol/L (107.1 +/- 17.8 mg/dL) in the standard group (P < 0.05). After adjusting for baseline prognostic factors, the composite incidence of CV events or deaths associated with CV events was significantly lower in the intensive than the standard group (HR 0.48; 95% confidence interval 0.28-0.82; P = 0.007). Conclusions This post hoc analysis suggests that achieving LDL cholesterol target levels <1.81 mmol/L may more effectively reduce CV events than achieving target levels >= 2.59 to <3.10 mmol/L in patients with hypercholesterolaemia and diabetic retinopathy.
  • Yusuke Adachi, Takekuni Hayashi, Takeshi Mitsuhashi, Kenichi Sakakura, Yoko Yamada, Yuko Wada, Minoru Horie, Shin-Ichi Momomura, Hideo Fujita
    BMC cardiovascular disorders 19 (1) 41 - 41 2019/02 [Refereed][Not invited]
     
    BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited myocardial disease characterized by fibrofatty replacement and ventricular arrhythmias. ARVC is believed to be a disease of the young, with most cases being diagnosed before the age of 40 years. We report here a case of newly diagnosed ARVC in an octogenarian associated with a pathogenic variant in the plakophilin 2 gene (PKP2). CASE PRESENTATION: An 80-year-old Japanese man was referred for sustained ventricular tachycardia. His baseline electrocardiogram showed negative T waves in V1-V4. Right ventriculography showed right ventricular aneurysm. Because this case met three major criteria, ARVC was diagnosed. He was successfully treated with radiofrequency ablation and oral amiodarone. Genetic analysis identified an insertion mutation in exon 8 of PKP2 (1725_1728dupGATG), which caused a frameshift and premature termination of translation (R577DfsX5). CONCLUSIONS: To the best of our knowledge, this is the first report of newly diagnosed ARVC in an octogenarian associated with a loss-of-function PKP2 pathogenic variant. Although the late clinical presentation of ARVC is rare, it should be included in the differential diagnosis when treating older patients with ventricular tachyarrhythmias.
  • Yousuke Taniguchi, Kenichi Sakakura, Koichi Yuri, Yusuke Imamura, Takunori Tsukui, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Atsushi Yamaguchi, Hideo Fujita
    Postepy w kardiologii interwencyjnej = Advances in interventional cardiology 15 (4) 431 - 438 2019 [Refereed][Not invited]
     
    Introduction: Transcatheter aortic valve implantation (TAVI) has grown to be an alternative treatment for severe symptomatic aortic valve stenosis (AS) in elderly patients. Although TAVI is a less invasive surgery than surgical aortic valve replacement, some patients may require prolonged hospitalization. Aim: To find the determinants of prolonged hospitalization in patients who underwent trans-femoral TAVI. Material and methods: A total of 94 AS patients who underwent trans-femoral TAVI were included as the final study population, and divided into the conventional hospitalization group (≤ 21 days) (n = 74) and prolonged hospitalization group (> 21 days) (n = 20). We compared clinical characteristics between the two groups, and multivariate logistic regression analysis was performed to find the determinants of prolonged hospitalization. Results: In multivariate logistic regression analysis, moderate or severe mitral regurgitation (OR = 4.49, 95% CI: 1.16-17.47, p = 0.03), taking statins or angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) on admission (statins: OR = 0.13, 95% CI: 0.02-0.71, p = 0.02, ACE inhibitors/ARB: OR = 0.25, 95% CI: 0.06-0.96, p = 0.04), estimated glomerular filtration rate (eGFR) (per 15 ml/min/1.73 m2 incremental) (OR = 0.49, 95% CI: 0.26-0.90, p = 0.02) and current chopsticks user (OR = 0.05, 95% CI: 0.01-0.41, p < 0.01) were significantly associated with prolonged hospitalization. Conclusions: Moderate or severe mitral regurgitation was significantly associated with prolonged hospitalization, while current chopsticks user, eGFR (per 15 ml/min/1.73 m2 incremental), taking ACE inhibitors/ARB or statins before the procedure were inversely associated with prolonged hospitalization in patients who underwent trans-femoral TAVI.
  • ドクターカーでのモバイル12誘導心電図伝送システムにより、迅速かつ確実に診断しえた特発性冠動脈解離の1例
    田村 洋行, 柏浦 正広, 松井 崇頼, 笠井 史也, 喜久山 和貴, 天笠 俊介, 鈴木 涼平, 下山 哲, 海老原 貴之, 藤田 英雄, 守谷 俊
    日本救急医学会雑誌 (一社)日本救急医学会 29 (10) 599 - 599 0915-924X 2018/10
  • Yousuke Taniguchi, Kenichi Sakakura, Yusuke Adachi, Naoyuki Akashi, Yusuke Watanabe, Masamitsu Noguchi, Kei Yamamoto, Yusuke Ugata, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Cardiovascular intervention and therapeutics 33 (4) 338 - 344 1868-4300 2018/10 [Refereed][Not invited]
     
    In-hospital outcomes of acute myocardial infarction (AMI) with cardiogenic shock (CS) were still not satisfactory even in the primary percutaneous coronary intervention (PCI) era. The aim of this study was to compare in-hospital outcomes of AMI with CS caused by right coronary artery (RCA) occlusion vs. left coronary artery (LCA) occlusion. Consecutive 894 AMI patients from January 2010 to March 2015 were screened for inclusion. A total of 114 AMI patients with CS were included as the final study population, and were divided into the RCA group (n = 56) and LCA group (n = 58). The patient characteristics were compared between the two groups. Multivariate logistic regression analysis was performed to show whether the RCA group was associated with better outcomes even after controlling confounding factors. In-hospital mortality was significantly lower in the RCA group (8.9%) than in the LCA group (46.6%) (P < 0.001). The RCA group (vs. the LCA group) was inversely associated with in-hospital death (OR 0.08, 95% CI 0.02-0.21, P < 0.001) after controlling covariates. Aspartate transaminase value (per 50 U/L incremental: OR 1.22, 95% CI 1.03-1.45, P = 0.02), aging (per 10-year-old incremental: OR 2.14, 95% CI 1.26-3.63, P = 0.01) and using VA-ECMO (OR 22.13, 95% CI 5.22-93.90, P < 0.001) were also significantly associated with in-hospital death. In conclusion, among AMI patients with CS, IRA of RCA was significantly associated with the better in-hospital outcome.
  • 経カテーテル的大動脈弁留置術後に生じた右冠動脈狭窄に対し、GUIDEPLUSを用いることで狭窄解除に成功した一例
    谷口 陽介, 由利 康一, 今村 有佑, 伊藤 みゆき, 玉那覇 雄介, 津久井 卓伯, 和田 浩, 坂倉 建一, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 27回 MO084 - MO084 2018/08 [Refereed][Not invited]
  • 従来のガイドカテーテルエクステンションと新しい柔軟なものの有用性についての比較
    津久井 卓伯, 坂倉 建一, 谷口 陽介, 山本 慶, 和田 浩, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 27回 MO217 - MO217 2018/08 [Refereed][Not invited]
  • ステント留置後の血腫や解離に対する新たなオプション
    山本 慶, 坂倉 建一, 津久井 卓伯, 谷口 陽介, 和田 浩, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 27回 MP165 - MP165 2018/08 [Refereed][Not invited]
  • Yasushi Wakabayashi, Takekuni Hayashi, Takeshi Mitsuhashi, Hideo Fujita
    Heart Rhythm 15 (7) 1116  1556-3871 2018/07 [Refereed][Not invited]
  • Naoyuki Akashi, Kenichi Sakakura, Yusuke Watanabe, Masamitsu Noguchi, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Heart and Vessels 33 (7) 713 - 721 1615-2573 2018/07 [Refereed][Not invited]
     
    Acute myocardial infarction (AMI) is more frequently observed in patients with chronic kidney disease (CKD) than in patients without CKD. Initial treatment strategy for AMI includes primary percutaneous coronary intervention (PCI), which requires substantial amount of contrast media. We hypothesized that the clinical outcomes are comparable or worse in patients with AMI and advanced CKD off chronic hemodialysis as compared to patients with AMI and advanced CKD on chronic hemodialysis. The purpose of this study was to compare the clinical outcomes of patients with AMI and advanced CKD on hemodialysis versus off hemodialysis. A total of 148 patients with estimated glomerular filtration rate & lt  30 ml/min/1.73 m2 on admission were included and were divided into the HD group (n = 68) and non-HD group (n = 80). The length of hospitalization was significantly less in the HD group (15.7 ± 14.8 days) than in the non-HD group (22.4 ± 21.3 days) (P = 0.01). In-hospital death was significantly less in the HD group (10.3%) than in the non-HD group (25.0%) (P = 0.02). While the non-HD group was not significantly associated with in-hospital death after controlling clinical covariates, the non-HD group (odd ratio 2.89, 95% confidence interval 1.03–8.12, P = 0.04) was significantly associated with long hospitalization even after controlling clinical covariates. In conclusion, as compared to advanced CKD on chronic hemodialysis, advanced CKD off hemodialysis had higher morbidity and mortality in patients with AMI. Advanced CKD off hemodialysis was closely associated with long hospitalization even after controlling clinical factors.
  • Yasushi Wakabayashi, Takeshi Mitsuhashi, Naoyuki Akashi, Takekuni Hayashi, Tomio Umemoto, Yoshitaka Sugawara, Hideo Fujita, Shin-ichi Momomura
    Heart and Vessels 1 - 10 1615-2573 2018/06 [Refereed][Not invited]
     
    Previous studies suggested that right ventricular pacing was associated with pacing-induced cardiac dysfunction (PICD). The purpose of this study was to investigate the clinical characteristics including the incidence of undiagnosed cardiac sarcoidosis (CS) in patients with atrioventricular block (AVB) who manifest PICD. We retrospectively investigated consecutive patients with permanent pacemaker (PPM) undergoing a first-generator replacement surgery with a new PPM or an upgrade procedure to a cardiac resynchronization therapy (CRT) device between December 1, 2011 and June 30, 2017. Patients with AVB showing normal echocardiographic findings before PPM implantation were included and divided into 2 groups: patients with post-PPM left ventricular ejection fraction (LVEF) < 40% and/or undergoing an upgrade procedure to CRT (PICD group) and patients with post-PPM LVEF ≥ 40% who underwent replacement surgery with a new PPM (no-PICD group). There were 15 and 41 patients in the PICD and no-PICD groups, respectively. A wider-paced QRS duration just after the PPM implantation and/or lower pre-PPM LVEF was observed in the PICD group. Furthermore, 46.7% of the PICD patients (7/15) satisfied the diagnostic criteria for CS according to the guideline of the Japanese Circulation Society, although no patients fulfilled these criteria before PPM implantation. In conclusion, a high incidence of CS was observed in patients with AVB who had PICD. However, none of these patients was diagnosed with CS before PPM implantation.
  • Hiroshi Itoh, Issei Komuro, Masahiro Takeuchi, Takashi Akasaka, Hiroyuki Daida, Yoshiki Egashira, Hideo Fujita, Jitsuo Higaki, Ken Ichi Hirata, Shun Ishibashi, Takaaki Isshiki, Sadayoshi Ito, Atsunori Kashiwagi, Satoshi Kato, Kazuo Kitagawa, Masafumi Kitakaze, Takanari Kitazono, Masahiko Kurabayashi, Katsumi Miyauchi, Tomoaki Murakami, Toyoaki Murohara, Koichi Node, Susumu Ogawa, Yoshihiko Saito, Yoshihiko Seino, Takashi Shigeeda, Shunya Shindo, Masahiro Sugawara, Seigo Sugiyama, Yasuo Terauchi, Hiroyuki Tsutsui, Kenji Ueshima, Kazunori Utsunomiya, Masakazu Yamagishi, Tsutomu Yamazaki, Shoei Yo, Koutaro Yokote, Kiyoshi Yoshida, Michihiro Yoshimura, Nagahisa Yoshimura, Kazuwa Nakao, Ryozo Nagai
    Diabetes Care 41 (6) 1275 - 1284 0149-5992 2018/06 
    © 2018 by the American Diabetes Association. OBJECTIVE Diabetes is associated with high risk of cardiovascular (CV) events, particularly in patients with dyslipidemia and diabetic complications. We investigated the incidence of CV events with intensive or standard lipid-lowering therapy in patients with hypercholesterolemia, diabetic retinopathy, and no history of coronary artery disease (treat-to-target approach). RESEARCH DESIGN AND METHODS In this multicenter, prospective, randomized, open-label, blinded end point study, eligible patients were randomly assigned (1:1) to intensive statin therapy targeting LDL cholesterol (LDL-C) <70 mg/dL (n = 2,518) or standard statin therapy targeting LDL-C 100-120 mg/dL (n = 2,524). RESULTS Mean follow-up was 37± 13months. LDL-C at 36 months was 76.5± 21.6mg/dL in the intensive group and 104.1 ± 22.1 mg/dL in the standard group (P < 0.001). The primary end point events occurred in 129 intensive group patients and 153 standard group patients (hazard ratio [HR] 0.84 [95% CI 0.67-1.07]; P = 0.15). The relationship between the LDL-C difference in the two groups and the event reduction rate was consistent with primary prevention studies in patients with diabetes. Exploratory findings showed significantly fewer cerebral events in the intensive group (HR 0.52 [95% CI 0.31-0.88]; P = 0.01). Safety did not differ significantly between the two groups. CONCLUSIONS We found no significant decrease in CV events or CV-associated deaths with intensive therapy, possibly because our between-group difference of LDL-C was lower than expected (27.7 mg/dL at 36 months of treatment). The potential benefit of achieving LDL-C <70 mg/dL in a treat-to-target strategy in high-risk patients deserves further investigation.
  • Hiroshi Itoh, Issei Komuro, Masahiro Takeuchi, Takashi Akasaka, Hiroyuki Daida, Yoshiki Egashira, Hideo Fujita, Jitsuo Higaki, Ken-ichi Hirata, Shun Ishibashi, Takaaki Isshiki, Sadayoshi Ito, Atsunori Kashiwagi, Satoshi Kato, Kazuo Kitagawa, Masafumi Kitakaze, Takanari Kitazono, Masahiko Kurabayashi, Katsumi Miyauchi, Tomoaki Murakami, Toyoaki Murohara, Koichi Node, Susumu Ogawa, Yoshihiko Saito, Yoshihiko Seino, Takashi Shigeeda, Shunya Shindo, Masahiro Sugawara, Seigo Sugiyama, Yasuo Terauchi, Hiroyuki Tsutsui, Kenji Ueshima, Kazunori Utsunomiya, Masakazu Yamagishi, Tsutomu Yamazaki, Shoei Yo, Koutaro Yokote, Kiyoshi Yoshida, Michihiro Yoshimura, Nagahisa Yoshimura, Kazuwa Nakao, Ryozo Nagai
    DIABETES CARE 41 (6) 1275 - 1284 0149-5992 2018/06 
    OBJECTIVEDiabetes is associated with high risk of cardiovascular (CV) events, particularly in patients with dyslipidemia and diabetic complications. We investigated the incidence of CV events with intensive or standard lipid-lowering therapy in patients with hypercholesterolemia, diabetic retinopathy, and no history of coronary artery disease (treat-to-target approach).RESEARCH DESIGN AND METHODSIn this multicenter, prospective, randomized, open-label, blinded end point study, eligible patients were randomly assigned (1:1) to intensive statin therapy targeting LDL cholesterol (LDL-C) <70 mg/dL (n = 2,518) or standard statin therapy targeting LDL-C 100-120 mg/dL (n = 2,524).RESULTSMean follow-up was 376 +/- 13 months. LDL-C at 36 months was 76.56 +/- 21.6 mg/dL in the intensive group and 104.1 +/- 22.1 mg/dL in the standard group (P < 0.001). The primary end point events occurred in 129 intensive group patients and 153 standard group patients (hazard ratio [HR] 0.84 [95% CI 0.67-1.07]; P = 0.15). The relationship between the LDL-C difference in the two groups and the event reduction rate was consistent with primary prevention studies in patients with diabetes. Exploratory findings showed significantly fewer cerebral events in the intensive group (HR 0.52 [95% CI 0.31-0.88]; P = 0.01). Safety did not differ significantly between the two groups.CONCLUSIONSWe found no significant decrease in CV events or CV-associated deaths with intensive therapy, possibly because our between-group difference of LDL-C was lower than expected (27.7 mg/dL at 36 months of treatment). The potential benefit of achieving LDL-C < 70 mg/dL in a treat-to-target strategy in high-risk patients deserves further investigation.
  • Yasushi Wakabayashi, Takekuni Hayashi, Yoshitaka Sugawara, Takeshi Mitsuhashi, Hideo Fujita, Shin-ichi Momomura
    Journal of Cardiovascular Electrophysiology 29 (6) 929 - 931 1540-8167 2018/06 [Refereed][Not invited]
  • Shingo Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International Heart Journal 59 (3) 482 - 488 1349-3299 2018/05 [Refereed][Not invited]
     
    Bleeding complications following percutaneous coronary interventions (PCI) have been closely associated with morbidity and mortality. Although radial arteries have been widely used in current PCI, including primary PCI, transfemoral PCI remains necessary for complex PCI. The purpose of this study was to compare the incidence of complications following elective transfemoral PCI between manual compression with and without protamine. We identified 249 consecutive patients who underwent elective transfemoral PCI from hospital records, and divided them into two groups: patients who used protamine for manual compression (the protamine group n = 205) and patients who did not (the non-protamine group, n = 44). Complications including acute thrombosis, bleeding requiring blood transfusion, transient hypotension, skin rash, and death within 30 days were compared between groups. The baseline clinical and procedural characteristics were comparable between the protamine and non-protamine groups. The incidences of all complications were not different between the protamine (5.9%) and the non-protamine groups (9.1%) (P = 0.43). While more than 90% of the patients received drug-eluting stent implantation, there was no acute thrombus in either group. The incidence of bleeding requiring blood transfusion was significantly lower in the protamine group (0.5%) than in the non-protamine group (6.8%) (P = 0.002). Multivariate logistic regression analysis revealed the inverse association between protamine use and bleeding requiring blood transfusion (odds ratio 0.08, 95% confidence interval 0.01-0.84, P = 0.04). In conclusion, the use of protamine for manual compression following elective transfemoral PCI was safe and was associated with less bleeding complications.
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Heart and Vessels 33 (5) 498 - 506 1615-2573 2018/05 [Refereed][Not invited]
     
    Primary percutaneous coronary interventions (PCI) have been developed to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). In primary PCI, the door-to-balloon time (DTBT) is closely associated with mortality and morbidity. The purpose of this study was to find determinants of short and long DTBT. From our hospital record, we included 214 STEMI patients, and divided into the short DTBT group (DTBT <  60 min, n = 60), the intermediate DTBT group (60 min ≤ DTBT ≤ 120 min, n = 121) and the long DTBT group (DTBT >  120 min, n = 33). In-hospital mortality was highest in the long DTBT group (24.2%), followed by the intermediate DTBT group (5.8%), and lowest in the short DTBT group (0%) (<  0.001). Transfers from local clinics or hospitals (OR 3.43, 95% CI 1.72–6.83, P <  0.001) were significantly associated with short DTBT, whereas Killip class 3 or 4 (vs. Killip class 1 or 2: OR 0.20, 95% CI 0.06–0.64, P = 0.007) was inversely associated with short DTBT in multivariate analysis. In conclusion, transfer from local clinics/hospitals was associated with short DTBT. Our results may suggest the current limitation of ambulance system, which does not include pre-hospital ECG system, in Japan. The development of pre-hospital ECG system would be needed for better management in STEMI.
  • Yusuke Watanabe, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Hideo Fujita, Shin-ichi Momomura
    Heart and Vessels 33 (3) 226 - 238 1615-2573 2018/03 [Refereed][Not invited]
     
    Slow flow is a serious complication in primary percutaneous coronary intervention (PCI) and is associated with poor clinical outcomes. Intravascular ultrasound (IVUS)-guided PCI may improve clinical outcomes after drug-eluting stent implantation. The purpose of this study was to seek the factors of slow flow following stent implantation, including factors related to IVUS-guided primary PCI. The study population consisted of 339 ST-elevation myocardial infarction patients, who underwent stent deployment with IVUS. During PCI, 56 patients (16.5%) had transient or permanent slow flow. Multivariate logistic regression analysis showed age (OR 1.04, 95% CI 1.01–1.07, P = 0.01), low attenuation plaque on IVUS (OR 3.38, 95% CI 1.70–6.72, P = 0.001), initial Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 (vs. TIMI 0: OR 0.44, 95% CI 0.20–0.99, P = 0.046), and the ratio of stent diameter to vessel diameter (per 0.1 increase: OR 2.63, 95% CI 1.84–3.77, P <  0.001) were significantly associated with slow flow. A ratio of stent diameter to vessel diameter of 0.71 had an 80.4% sensitivity and 56.9% specificity to predict slow flow. There was no significant difference in ischemic-driven target vessel revascularization between the modest stent expansion (ratio of stent diameter to vessel diameter < 0.71) and aggressive stent expansion (ratio of stent diameter to vessel diameter ≥0.71) strategies. Unlike other variables, the ratio of stent diameter to vessel diameter was the only modifiable factor. The modest stent expansion strategy should be considered to prevent slow flow following stent implantation in IVUS-guided primary PCI.
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 1878-0938 2018 [Refereed][Not invited]
     
    Background: The guide extension catheter is frequently used in current percutaneous coronary intervention, and the GuideLiner (Vascular Solutions Inc., Minneapolis, MN) has been the standard guide extension catheter. Recently, the Guideplus (Nipro, Osaka, Japan) has emerged as a new guide extension catheter. The aim of the present study was to compare device performance between the Guideplus and GuideLiner. Methods: We compared the purpose of guide extension catheter and the device unsuccessful rate between the Guideplus and GuideLiner. We classified the purpose of guide extension catheter into 4 categories: (1) to advance devices into the target lesion, (2) to engage guide catheter into the ostium, (3) to support the small profile balloon crossing the CTO or 99% stenosis that the microcatheter could not cross, and (4) others. Results: Ninety-two lesions were classified as the Guideplus group, whereas 103 lesions were classified as the GuideLiner group. The purpose of guide extension catheter was significantly different between the 2 groups (P < 0.001). The Guideplus was frequently used to support the small profile balloon crossing the CTO or 99% stenosis (20.7%), whereas the GuideLiner was not used (0%). The device unsuccessful rate was significantly less in the Guideplus (8.7%) than in the GuideLiner (20.4%) (P = 0.022). Conclusions: The purpose of guide extension catheter was significantly different between the Guideplus and GuideLiner. The Guideplus was more frequently used to support the small profile balloon crossing the CTO or 99% stenosis. The device unsuccessful rate was less in the Guideplus, which may suggest the better performance as the guide extension catheter.
  • Kei Yamamoto, Kenichi Sakakura, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 1878-0938 2018 [Refereed][Not invited]
     
    Severe dissection and hematoma following stent implantation can cause acute vessel closure, which requires an immediate bailout procedure. However, bailout from such a situation may not be easy, especially when the hematoma extends to the distal segment of a coronary artery. We present a case of 73-year-old woman with effort angina who underwent PCI to the right coronary artery (RCA). Following stent implantation, there was a massive hematoma from the distal edge of the stent. We tried to create re-entry at the distal part of the hematoma, but were not successful. We managed her conservatively without additional stent placement or creating re-entry. Follow-up coronary angiography on day 68 showed excellent coronary flow. Intravascular ultrasound demonstrated complete healing of the hematoma. A hematoma caused by edge dissection is a challenging complication. Additional stent implantation to cover the entire length of the hematoma and/or cutting balloon dilatation to create re-entry are options however, these procedures may worsen the situation. Our case clearly showed healing of dissection and hematoma without creating re-entry or additional stent implantation. Conservative management should be considered an option for severe edge dissection and hematoma following stent implantation.
  • Yumiko Haraguchi, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Ikue Nakashima, Hiroshi Wada, Masamitsu Sanui, Shin-Ichi Momomura, Hideo Fujita
    International Heart Journal 59 (2) 407 - 412 1349-3299 2018 [Refereed][Not invited]
     
    Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.
  • Kei Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Yoshimasa Tsurumaki, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International Heart Journal 59 (2) 399 - 402 1349-3299 2018 [Refereed][Not invited]
     
    Because rotational atherectomy (RA) has several unique complications, such as burr entrapment, vessel perforation, and slow flow, it is important for interventional cardiologists to be familiar with bailout procedures for such complications. The principal part of bailout procedures is to keep a guidewire in the target coronary artery during the procedure. However, it is not easy to keep a guidewire in the same position during the removal of a burr because the length of the RA guidewires is 300 cm, and the removal of a burr requires collaboration between the primary operator and an assistant. We describe the case of an 83-year-old male with stable angina. We performed RA to the left anterior descending artery, and removed the burr using a KUSABI (Kaneka Medix Corporation, OSAKA, Japan) trapping balloon technique without activating the dynaglide mode. This simple technique would help RA operators remove a burr more reliably than the conventional removal technique.
  • Yusuke Ugata, Hiroshi Wada, Kenichi Sakakura, Tatsuro Ibe, Miyuki Ito, Nahoko Ikeda, Hideo Fujita, Shin-Ichi Momomura
    International Heart Journal 59 (1) 216 - 219 1349-3299 2018 [Refereed][Not invited]
     
    Aerobic training based on anaerobic threshold (AT) is well-known to improve cardiac function, exercise capacity, and long-term outcomes of patients with heart failure. Recent reports suggested that high-intensity interval training (HIIT) for patients with cardiovascular disease may improve cardiopulmonary exercise capacity. We present a 61-year-old male patient of severe left ventricular dysfunction with left ventricular assisted device (LVAD). Following HIIT for 8 weeks, exercise capacity and muscle strength have improved without worsening left ventricular function. Our case showed the possibility that HIIT was feasible and effective even in patients with LVAD.
  • Kei Yamamoto, Kenichi Sakakura, Naoyuki Akashi, Yusuke Watanabe, Masamitsu Noguchi, Yousuke Taniguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Heart and Vessels 33 (1) 33 - 40 1615-2573 2018/01 [Refereed][Not invited]
     
    Percutaneous coronary interventions to ostial left anterior descending artery (LAD)-acute myocardial infarction (AMI) were challenging, especially in crossover stenting from left main trunk (LMT) to LAD. The clinical outcomes of ostial LAD-AMI that needed crossover stenting were not well investigated. The objective of this study was to compare the clinical outcomes of LMT crossover stenting with those of ostial LAD just proximal (jp) stenting. Between January 2009 and March 2016, 1499 patients were diagnosed as AMI in our institution. Among them, 76 ostial LAD-AMIs were included in this study, and divided into 30 LMT crossover stenting (the crossover group) and 46 jp stenting (the jp stenting group). The primary endpoint was major cardiovascular events (MACE) defined as the composite of cardiac death, acute myocardial infarction (AMI), stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). The frequency of MACE was comparable between the 2 groups (16.7% in the crossover group and 21.7% in the jp stenting group, P = 0.587). Similarly, the frequency of cardiac death was comparable between the 2 groups (6.7% in the crossover group and 13.0% in the jp stenting group, P = 0.376). The frequencies of TLR (6.7% in the crossover group and 6.5% in the jp stenting group, P = 0.980) and TVR (10.0% in the crossover group and 8.7% in the jp stenting group, P = 0.848) were not significantly different between the 2 groups. In conclusion, the clinical outcomes of the crossover stenting were comparable to the jp stenting in the stenting strategy for ostial LAD-AMI. LMT-LAD crossover stenting would be the acceptable strategy for ostial LAD-AMI.
  • Keisuke Yonezu, Kenichi Sakakura, Yusuke Watanabe, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Heart and Vessels 33 (1) 25 - 32 1615-2573 2018/01 [Refereed][Not invited]
     
    Overall mortality and neurologic outcome of patients treated by veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was still not satisfactory. The aim of this study was to clarify the determinants of survival and favorable neurologic outcomes in patients with ischemic heart disease (IHD) treated by V-A ECMO. We identified IHD patients who received V-A ECMO, and divided those patients into the survived and the in-hospital death group. Multivariate logistic regression analysis was performed to identify the determinants of survival and favorable neurologic outcomes. Fifty-eight patients were divided into the in-hospital death group (n = 35) and the survived group (n = 23). Cardiogenic arrest for the reason for V-A ECMO introduction (vs. non-cardiac arrest: OR 0.34, 95% CI 0.002–0.65, P = 0.03) and final thrombolysis in myocardial infarction (TIMI-3) flow grade (vs. TIMI ≤2 flow grade: OR 17.44, 95% CI 1.65–184.04, P = 0.02) were determinants of in-hospital survival. Time from collapse to initiation of V-A ECMO was inversely associated with favorable neurologic function (10 min increase OR 0.49, 95% CI 0.28–0.89, P = 0.02), while final TIMI-3 flow grade was not associated with favorable neurologic function. In conclusion, the rapid establishment of V-A ECMO system as well as obtaining TIMI-3 flow grade should be sought for better survival with maintaining neurological function in IHD patients who requires V-A ECMO.
  • Yasushi Wakabayashi, Takekuni Hayashi, Yoshitaka Sugawara, Takeshi Mitsuhashi, Hideo Fujita, Shin-ichi Momomura
    Journal of Arrhythmia 33 (6) 633 - 636 1883-2148 2017/12 [Refereed][Not invited]
     
    A 74-year-old woman who developed atrial tachycardia following the Cox-Maze IV procedure underwent catheter ablation. The reentrant circuit included the coronary sinus (CS), Marshall bundle (MB), distal MB-left atrial (LA) connection, and anterolateral mitral annulus. The distal MB-LA connection was the last barrier in the conduction pathway between the CS and the left atrium.
  • Yasushi Wakabayashi, Yoshitaka Sugawara, Kanna Fujita, Takekuni Hayashi, Nahoko Ikeda, Tomio Umemoto, Hiroshi Wada, Kenichi Sakakura, Hiroshi Funayama, Takeshi Mitsuhashi, Hideo Fujita, Shin-ichi Momomura
    HEART AND VESSELS 32 (11) 1382 - 1389 0910-8327 2017/11 [Refereed][Not invited]
     
    Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and carries an increased risk of cardiogenic embolism. Oral anticoagulants (OACs) including warfarin and/or non-vitamin K antagonists can prevent the majority of these events. The Saitama AF Registry was a community-based survey of patients with AF in Saitama City, which represents an urban community in Japan. A total of 75 institutions participated in the registry and attempted to enroll consecutive patients with AF from September 2014 to August 2015. The aim of the present study was to examine the clinical characteristics of patients with AF using data of the Saitama AF Registry. In addition, we investigated the difference in clinical characteristics of the patients between small-sized hospitals and large-sized hospitals. A total of 3591 patients were enrolled; 57.7% of all patients were enrolled from small-sized hospitals, whereas 42.3% were from large-sized hospitals. The patients from small-sized hospitals had higher CHADS(2) score than those from large-sized hospitals. Approximately, 80% of all patients were treated with OACs, and the prescription rate was higher in patients with CHADS(2) score ae<yen> 2 from both small-sized hospitals and large-sized hospitals. In conclusion, the present study demonstrated an appropriate use of OACs for high-risk patients with CHADS(2) score ae<yen>2 in Saitama City regardless of hospital size.
  • Yusuke Watanabe, Kenichi Sakakura, Naoyuki Akashi, Mami Ishikawa, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Hideo Fujita, Shin-ichi Momomura
    International Heart Journal 58 (5) 831 - 834 1349-3299 2017/09 [Refereed][Not invited]
     
    While most of pulmonary thromboembolism (PE) cases can be managed by thrombolytic and anticoagulation therapy, massive PE remains a life-threatening disease. Although surgical embolectomy can be a curative therapy for massive PE, peri-operative mortality for hemodynamically collapsed PE is extremely high. We present a case of hemodynamically collapsed massive PE. We avoided either thrombolytic therapy or surgical embolectomy, because the patient had recent cerebral contusion. Therefore, we managed the patient with the combination of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and conventional anticoagulation, which dramatically improved the patient’s hemodynamics. In conclusion, the combination of V-A ECMO and conventional anticoagulation may be the preferred first line therapy for the patients with cardiogenic shock following massive PE.
  • Kei Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 18 (6) 52 - 53 1878-0938 2017/09 [Refereed][Not invited]
     
    A 79-year-old male who had a history of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) received coronary angiography (CAG), because of angina pectoris. CAG showed in-stent restenosis of the paclitaxel-eluting stent (PES). Since the devices could not pass the lesion, we performed rotational atherectomy. Although we could not identify the calcified lesion by the optical frequency domain imaging (OFDI) findings because of strong attenuation, the intravascular ultrasound (IVUS) image showed the superficial calcification. On the other hand, strong attenuation in OFDI suggested the presence of foamy macrophage, which was essential for the diagnosis of neoatherosclerosis. We could obtain a favorable result by deploying another drug-eluting stent. While an earlier report showed the calcified neoatherosclerosis following bare-metal stent implantation, we clearly showed the calcified neoatherosclerosis following PES implantation.
  • Tomio Umemoto, Takanori Yasu, Kenshiro Arao, Nahoko Ikeda, Yasuto Horie, Hiroyuki Sugimura, Masanobu Kawakami, Hideo Fujita, Shin-ichi Momomura
    HEART AND VESSELS 32 (9) 1051 - 1061 0910-8327 2017/09 [Refereed][Not invited]
     
    Postprandial hypertriglyceridemia and hyperglycemia may promote endothelial and hemorheological dysfunction. The present study investigated the effects of pravastatin on endothelial function and hemorheology in patients with stable angina pectoris (AP) before and after eating a test meal. We recruited 26 patients with stable AP who had impaired glucose tolerance and mild dyslipidemia and six healthy men as controls to assess endothelial function and hemorheological behavior. In each group, we measured forearm blood flow (FBF) during post-ischemic reactive hyperemia and obtained blood samples before and 2 h after the test meal. Pravastatin 20 mg/day was then commenced in the 26 AP patients. The above tests were repeated after 2 days and 6 months. Maximum FBF during hyperemia in the baseline fasting phase was significantly lower in the AP patients than in the controls (p < 0.05). Fasting and postprandial FBF during reactive hyperemia time-dependently improved after pravastatin treatment (p < 0.05 vs. baseline data for each phase). Pravastatin treatment for 6 months, but not for 2 days, inhibited leukocyte activation and improved hemorheological parameters. In conclusion, pravastatin treatment for 6 months improved fasting and postprandial endothelial and hemorheological dysfunction in AP patients.
  • 経カテーテル的大動脈弁留置術後にシースが長軸方向に裂けてしまった一例
    谷口 陽介, 由利 康一, 津久井 卓伯, 今村 有佑, 伊藤 みゆき, 明石 直之, 伊部 達郎, 和田 浩, 坂倉 建一, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 26回 MO029 - MO029 2017/07 [Refereed][Not invited]
  • 左冠動脈前下行枝へ薬剤溶出性ステント留置3日後に早期ステント血栓症を発症し心肺停止となった一例
    津久井 卓伯, 坂倉 建一, 佐々木 渉, 向井 康治, 間瀬 卓顕, 渡邉 裕介, 鶴巻 良允, 山本 慶, 谷口 陽介, 和田 浩, 百村 伸一, 藤田 英雄
    日本心血管インターベンション治療学会抄録集 26回 MP161 - MP161 2017/07 [Refereed][Not invited]
  • Kei Yamamoto, Kenichi Sakakura, Yusuke Adachi, Yousuke Taniguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    JOURNAL OF CARDIOLOGY 69 (5-6) 823 - 829 0914-5087 2017/05 [Refereed][Not invited]
     
    Background: The optimal strategy for diffuse right coronary artery (RCA) stenosis remains unclear. Objective: The objective of this study was to compare the mid-term outcomes of "complete full-metal jacket (c-FMJ) stenting strategy" with "incomplete full-metal jacket (i-FMJ) stenting strategy" for the diffuse long RCA lesion using drug-eluting stents (DES). Methods: Between July 2007 and October 2015, 121 patients underwent percutaneous coronary intervention (PCI) for diffuse RCA lesions using DES. Fifty-three patients underwent c-FMJ PCI, whereas 68 patients underwent i-FMJ. Thirty patients received angiographical follow-up in the c-FMJ group, while 34 patients received angiographical follow-up in the i-FMJ group. The primary endpoint was major adverse cardiac events (MACE): cardiac death, stent thrombosis (ST), target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: The incidence of MACE was significantly lower in the c-FMJ group (13.3%) as compared to the iFMJ group (41.2%) (p = 0.013). There was no cardiac death in either group. The incidence of ST was comparable between the i-FMJ group (2.9%) and c-FMJ group (3.3%) (p = 1.00), while TLR was significantly less in the c-FMJ group (6.7%) compared to the i-FMJ group (32.4%) (p = 0.011). Conclusions: The mid-term MACE was significantly less in the c-FMJ group than in the i-FMJ group, indicating that c-FMJ stenting was a favorable strategy for the diffuse long RCA lesion. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Takayuki Mori, Kenichi Sakakura, Hiroshi Wada, Yousuke Taniguchi, Kei Yamamoto, Yusuke Adachi, Hiroshi Funayama, Shin-ichi Momomura, Hideo Fujita
    HEART AND VESSELS 32 (5) 514 - 519 0910-8327 2017/05 [Refereed][Not invited]
     
    While rotational atherectomy (RA) is used for complex lesions in percutaneous coronary intervention, there are several contraindications such as unprotected left main stenosis or left ventricular dysfunction. We previously reported that the incidence of in-hospital complications was significantly greater in off-label as compared to on-label use RA. However, the mid-term clinical outcomes between off-label and on-label RA have not been investigated. The purpose of this study was to compare the mid-term clinical outcomes between off-label (n = 156) and on-label RA (n = 94). The primary endpoint was the incidence of major adverse cardiovascular events (MACE) defined as the composite of ischemia-driven target vessel revascularization (TVR), non-fatal MI, and all-cause death. We also identified 154 patients who underwent RA and follow-up angiography within 1 year, and compared quantitative coronary analysis between the off-label group (n = 96) and on-label group (n = 58). There was no significant difference in late luminal loss between the groups (0.03 +/- 0.53 mm in the off-label and -0.05 +/- 0.44 mm in the on-label groups, P = 0.57). However, the incidence of MACE was less in the on-label group (3.2 %) as compared to the off-label group (9.0 %) without reaching statistical significance (P = 0.08). In conclusion, mid-term clinical outcomes tended to be worse in the off-label group than in the on-label group. We may have to follow-up the patient who underwent off-label RA more carefully than the patient who underwent on-label RA.
  • Aki Hayashi, Satoko Yamaguchi, Kayo Waki, Katsuhito Fujiu, Norio Hanafusa, Takahiro Nishi, Hyoe Tomita, Haruka Kobayashi, Hideo Fujita, Takashi Kadowaki, Masaomi Nangaku, Kazuhiko Ohe
    JMIR research protocols 6 (4) e63  2017/04 
    BACKGROUND: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. OBJECTIVE: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. METHODS: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D's usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. RESULTS: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89% (SD 23), 95% (SD 7), and 78% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86%) reported that using SMART-D helped improve their lifestyle and self-management. CONCLUSIONS: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life.
  • Yusuke Adachi, Kenichi Sakakura, Tatsuro Ibe, Nanae Yoshida, Hiroshi Wada, Hideo Fujita, Shin-Ichi Momomura
    International heart journal 58 (2) 286 - 289 1349-2365 2017/04 [Refereed][Not invited]
     
    Coronary spasm is abnormal contraction of an epicardial coronary artery resulting in myocardial ischemia. Coronary spasm induces not only depressed myocardial contractility, but also incomplete myocardial relaxation, which leads to elevated ventricular filling pressure. We herein report the case of a 55-year-old woman who had repeated acute heart failure caused by coronary spasm. Acetylcholine provocation test with simultaneous right heart catheterization was useful for the diagnosis of elevated ventricular filling pressure as well as coronary artery spasm. We should add coronary spasm to a differential diagnosis for repeated acute heart failure.
  • Kenichi Sakakura, Hiroshi Funayama, Yousuke Taniguchi, Yoshimasa Tsurumaki, Kei Yamamoto, Mitsunari Matsumoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS 89 (5) 832 - 840 1522-1946 2017/04 [Refereed][Not invited]
     
    Objectives: The purpose of this randomized trial was to compare the incidence of slow flow between low-speed and high-speed rotational atherectomy (RA) of calcified coronary lesions. Background: Preclinical studies suggest that slow flow is less frequently observed with low-speed than high-speed RA because of less platelet aggregation with low-speed RA. Methods: This was a prospective, randomized, single center study. A total of 100 patients with calcified coronary lesions were enrolled and randomly assigned in a 1:1 ratio to low-speed (140,000 rpm) or high-speed (190,000 rpm) RA. The primary endpoint was the occurrence of slow flow following RA. Slow flow was defined as slow or absent distal runoff (Thrombolysis in Myocardial Infarction [TIMI] flow grade2). Results: The incidence of slow flow in the low-speed group (24%) was the same as that in the high-speed group (24%) (P=1.00; odds ratio, 1.00; 95% confidence interval, 0.40-2.50). The frequencies of TIMI 3, TIMI 2, TIMI 1, and TIMI 0 flow grades were similar between the low-speed (TIMI 3, 76%; TIMI 2, 14%; TIMI 1, 8%; TIMI 0, 2%) and high-speed (TIMI 3, 76%; TIMI 2, 14%; TIMI 1, 10%; TIMI 0, 0%) groups (P=0.77 for trend). The incidence of periprocedural myocardial infarction was the same between the low-speed (6%) and high-speed (6%) groups (P=1.00). Conclusions: This randomized trial did not show a reduction in the incidence of slow flow following low-speed RA as compared with high-speed RA (UMIN ID: UMIN000015702). (c) 2016 Wiley Periodicals, Inc.
  • Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNATIONAL HEART JOURNAL 58 (2) 279 - 282 1349-2365 2017/03 [Refereed][Not invited]
     
    hi rotational atherectomy (RA), several burr sizes are available, such as 1.25 mm, 1.5 mm, 1.75 mm, or >= 2.0 mm. It is important to select an appropriate bun size for each lesion because rotational atherectomy has several unique complications regarding burrs such as entrapment or perforation. When a burr cannot penetrate the lesion, downsizing of the burr is generally recommended. Also, if the smallest burr (1.25 mm) cannot penetrate the lesion, a change to a more supportive or larger French guiding catheter has been recommended. We describe the case of a 68 year-old female who was referred to our department for percutaneous coronary intervention to the calcified stenosis in the middle of the left anterior descending coronary artery. We used the smallest burr (1.25 mm) and a supportive 7 Fr guiding catheter to penetrate the lesion. However, the smallest burr could not pass the lesion even after 14 sessions (total ablation time: 339 seconds). We intentionally increased the burr size from 1.25 mm to 1.5 mm. The 1.5 mm burr successfully passed the lesion without any perforation or burr entrapment. In this manuscript, we discuss why increasing the burr size was successful for this severely calcified lesion that was not penetrated by the smallest burr.
  • 胸骨骨折に伴った外傷性右冠動脈損傷の一例
    中嶋 いくえ, 原口 裕美子, 青松 昭徳, 川岸 利臣, 飯塚 悠祐, 牧野 淳, 坂倉 健一, 藤田 英雄, 百村 伸一, 讃井 將満
    日本集中治療医学会雑誌 (一社)日本集中治療医学会 24 (Suppl.) O60 - 3 1340-7988 2017/02
  • Watanabe Yusuke, Ono Kohei, Sakakura Kenichi, Fujita Hideo
    Journal of Rural Medicine 一般社団法人 日本農村医学会 12 (2) 149 - 152 2017 

    Acute symptomatic deep vein thrombosis (DVT) is usually managed by intravenous heparin and oral warfarin. Recently, direct oral anticoagulants (DOAC) have been introduced for the treatment of acute DVT. DOAC may be useful for very elderly patients who live in rural areas, where medical resources are limited. An 83-year-old woman presented to our clinic with left leg edema. Contrast enhanced computed tomography showed massive deep vein thrombosis in her left internal iliac vein. We diagnosed her with acute deep vein thrombosis. Since she refused to be hospitalized, we treated her with rivaroxaban as an outpatient. She had a good clinical course without hospitalization or an adverse event. DOAC may be useful for very elderly patients in rural areas.

  • Tomomi Shibuta, Kayo Waki, Nobuko Tomizawa, Ayumi Igarashi, Noriko Yamamoto-Mitani, Satoko Yamaguchi, Hideo Fujita, Shigeko Kimura, Katsuhito Fujiu, Hironori Waki, Yoshihiko Izumida, Takayoshi Sasako, Masatoshi Kobayashi, Ryo Suzuki, Toshimasa Yamauchi, Takashi Kadowaki, Kazuhiko Ohe
    BMJ open diabetes research & care 5 (1) e000322  2017 
    OBJECTIVES: To examine the prevalence of the willingness of patients with diabetes to use a self-management tool based on information and communication technology (ICT) such as personal computers, smartphones, and mobile phones; and to examine the patient characteristics associated with that willingness. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional interview survey of 312 adults with diabetes at a university hospital in an urban area in Japan. Participants were classified into 2 groups: those who were willing to use an ICT-based self-management tool and those who were unwilling. Multiple logistic regression analysis was used to identify factors associated with the willingness, including clinical and social factors, current use of ICT, self-management practices, self-efficacy, and diabetes-related emotional distress. RESULTS: The mean age of the 312 participants was 66.3 years (SD=11.5) and 198 (63%) were male. Most of the participants (93%) had type 2 diabetes. Although only 51 (16%) currently used ICT-based self-management tools, a total of 157 (50%) expressed the willingness to use such a tool. Factors associated with the willingness included: not having nephropathy (OR=2.02, 95% CI 1.14 to 3.58); outpatient visits once a month or more (vs less than once a month, OR=2.13, 95% CI 1.13 to 3.99); current use of personal computers and/or smartphones (OR=4.91, 95% CI 2.69 to 8.98); and having greater diabetes-related emotional distress (OR=1.10, 95% CI 1.01 to 1.20). CONCLUSIONS: Approximately half of the patients showed interest in using an ICT-based self-management tool. Willing patients may expect ICT-based self-management tools to complement outpatient visits and to make self-management easier. Starting with patients who display the willingness factors might optimize programs based on such tools.
  • Yusuke Watanabe, Hiroshi Wada, Kenichi Sakakura, Hideo Fujita, Shin-ichi Momomura
    INTERNAL MEDICINE 56 (2) 157 - 161 0918-2918 2017 [Refereed][Not invited]
     
    Eosinophilic myocarditis is a rare form of myocardial inflammation that is characterized by the infiltration of eosinophilic cells into the myocardium. The clinical symptoms of eosinophilic myocarditis are similar to those of acute coronary syndrome, and eosinophilic myocarditis sometimes occurs in combination with bronchial asthma. We herein present a case of eosinophilic myocarditis in which additional time was required to make a definitive diagnosis because the patient received steroid therapy. The diagnosis of eosinophilic myocarditis is challenging, especially when a patient has other inflammatory diseases, such as bronchial asthma. We should pay attention to the possibility that steroid therapy may mask the presentation of eosinophilic myocarditis.
  • Yusuke Watanabe, Kenichi Sakakura, Yousuke Taniguchi, Yusuke Adachi, Masamitsu Noguchi, Naoyuki Akashi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International heart journal 57 (6) 697 - 704 1349-2365 2016/12 [Refereed][Not invited]
     
    Compared to acute myocardial infarction (AMI) with single vessel disease (SVD) or double vessel disease (DVD), AMI with triple vessel disease (TVD) is associated with higher mortality. The aim of this study was to identify the determinants of in-hospital death in AMI with TVD. We identified AMI patients with TVD in our tertiary medical center between January 2009 and December 2014. Baseline patient characteristics including laboratory data, echocardiograms, and coronary angiograms were collected from our hospital records. We divided our study population into a survivor group and non-survivor group. Multivariate stepwise logistic regression analysis was performed to identify the determinants of in-hospital death. A total of 138 AMI patients with TVD were identified and included as the final study population. Fifteen patients died during the hospitalization (mortality rate, 10.9%). Mean systolic blood pressure (134 ± 27 mmHg) was significantly greater in the survivor group compared with the non-survivor group (114 ± 31 mmHg) (P = 0.02). The prevalence of shock on admission was significantly less in the survivor group (15.4%) than in the non-survivor group (66.7%) (P < 0.001). Multivariate stepwise logistic regression analysis revealed that shock status on admission (OR 11.50, 95% CI 3.21-41.14, P < 0.001), the left anterior descending artery (LAD) as the infarct related artery (IRA) (OR 3.83, 95% CI 1.04-14.09, P = 0.04), and serum albumin on admission (OR 0.26, 95% CI 0.08-0.84, P = 0.02) were significantly associated with in-hospital death. In conclusion, shock status on admission, the LAD as the IRA, and a low serum albumin level were the determinants of in-hospital death in AMI patients with TVD.
  • Kenichi Sakakura, Taku Inohara, Shun Kohsaka, Tetsuya Amano, Shiro Uemura, Hideki Ishii, Kazushige Kadota, Masato Nakamura, Hiroshi Funayama, Hideo Fujita, Shin-Ichi Momomura
    Circulation. Cardiovascular interventions 9 (11) 2016/11 [Refereed][Not invited]
     
    BACKGROUND: The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI). METHODS AND RESULTS: The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02-1.05), impaired kidney function (OR 1.59, 95% CI 1.15-2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21-2.35), emergent PCI (OR 4.02, 95% CI 1.66-8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43-3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36-0.89). CONCLUSIONS: The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).
  • Shigeko Kato, Kayo Waki, Sadako Nakamura, Sanae Osada, Haruka Kobayashi, Hideo Fujita, Takashi Kadowaki, Kazuhiko Ohe
    Diabetology International 7 (3) 244 - 251 2190-1686 2016/09 [Refereed][Not invited]
     
    Background: The accuracy of estimating nutritional intake and balance from photos of meals has not been well documented. However, DialBetics (DB)—our diabetes self-management support system, which is based on information and communication technologies—relies on the photos that type 2 diabetes patients take of their meals with smartphones. Therefore, we designed a study to evaluate this accuracy. Methods: We prepared 61 dishes whose actual amount/value of total energy and each nutrient were known: protein, fat, carbohydrates, dietary fiber and salt. Their balance—the protein-fat-carbohydrate ratio—was also known, constituting the weighed food record (WFR). Smartphone photos of those dishes were taken, and three registered dietitians evaluated each dish from those photos, naming the dish and estimating the amount of each nutrient in it, plus the dish’s balance. These estimated DB and WFR values were compared using the Wilcoxon matched-pairs rank-sum test intraclass correlation coefficients (ICCs) were calculated. Agreement between the two values for each dish was assessed by Bland-Altman analysis. Results: There were significant ICCs—0.84 for fat (95 % confidence interval 0.75–0.90) and 0.93 for carbohydrates (0.88, 0.96)—but no statistically significant differences between DB and WRF for other nutrients or balance. Bland-Altman analysis showed that differences between the two values were random and not biased against nutrient intake 95 % limits of agreement were acceptable although wide (energy −198 to 210 kcal/dish carbohydrates −22.7 to 25.8 g/dish). Conclusion: DB’s diet evaluation by photos is reliable with apparent potential for assessing diets.
  • Yusuke Adachi, Kenichi Sakakura, Hiroshi Wada, Hiroshi Funayama, Tomio Umemoto, Hideo Fujita, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 57 (5) 565 - 572 1349-2365 2016/09 [Refereed][Not invited]
     
    Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) - (LVEF during acute phase)] >= 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non -improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG.
  • 3枝疾患を伴った急性心筋梗塞の院内死亡の決定因子について
    渡邉 裕介, 坂倉 建一, 安達 裕助, 明石 直之, 野口 正満, 宇賀田 裕介, 谷口 陽介, 和田 浩, 梅本 富士, 船山 大, 藤田 英雄, 百村 伸一
    日本心血管インターベンション治療学会抄録集 25回 MO274 - MO274 2016/07 [Refereed][Not invited]
  • Yusuke Adachi, Kenichi Sakakura, Hiroshi Wada, Hiroshi Funayama, Tomio Umemoto, Shin-ichi Momomura, Hideo Fujita
    JOURNAL OF CARDIOLOGY 68 (1-2) 37 - 42 0914-5087 2016/07 [Refereed][Not invited]
     
    Background: Prolonged fluoroscopy time during coronary angiography is a major concern for interventional cardiologists as well as for patients. It is unknown which factors affect the prolonged fluoroscopy time. Methods: A total of 458 patients who underwent diagnostic coronary angiography were included. The patients who had the highest decile of fluoroscopy time were assigned to the prolonged fluoroscopy group (fluoroscopy time >= 15.7 min), while the other patients were assigned to the non -prolonged fluoroscopy group (fluoroscopy time <15.7 min). We performed univariate and multivariate logistic regression analysis to identify the predictors of prolonged fluoroscopy time. Results: Mean fluoroscopy time in 458 patients was 8.5 +/- 5.8 min. Median and ranges of fluoroscopy time were 19.0 [15.7-47.0] min in the prolonged fluoroscopy group and 6.0 [2.0-15.3] min in the non -prolonged fluoroscopy group, respectively. The multivariate logistic regression analysis showed that significant predictors of prolonged fluoroscopy time were prior surgery of ascending aorta replacement [odds ratios (OR) 11.46, 95% confidence intervals (CI) 1.53-85.74, p = 0.02] and the prevalence of moderate to severe aortic regurgitation (OR 2.83, 95% CI 1.20-6.66, p = 0.02). Conclusions: The prior surgery of ascending aorta replacement and moderate to severe aortic regurgitation were significant predictors of the prolonged fluoroscopy time. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Kenichi Sakakura, Yousuke Taniguchi, Mitsunari Matsumoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNATIONAL HEART JOURNAL 57 (3) 376 - 379 1349-2365 2016/05 [Refereed][Not invited]
     
    Rotational atherectomy to an angulated calcified lesion is always challenging. The risk of catastrophic complications such as a burr becoming stuck or vessel perforation is greater when the calcified lesion is angulated. We describe the case of an 83-year-old female suffering from unstable angina. Diagnostic coronary angiography revealed an angulated calcified lesion in the proximal segment of the right coronary artery. We performed rotational atherectomy to the lesion, but intentionally did not advance the rotational atherectomy burr beyond the top of the angulation. We controlled the rotational atherectomy burr and stopped it just before the top of the angulation to avoid complications. Following rotational atherectomy, balloon dilatation with a non-compliant balloon was performed, and drug-eluting stents were successfully deployed. In this manuscript, we provide a review of the literature on this topic, and discuss how rotational atherectomy to an angulated calcified lesion should be performed.
  • Tatsuro Ibe, Hiroshi Wada, Kenichi Sakakura, Nahoko Ikeda, Yoko Yamada, Yoshitaka Sugawara, Takeshi Mitsuhashi, Junya Ako, Hideo Fujita, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 67 (5-6) 555 - 559 0914-5087 2016/05 [Refereed][Not invited]
     
    Background: Compared to transpulmonary pressure gradient (TPPG), diastolic pulmonary vascular pressure gradient (DPG) may be a more sensitive and specific indicator for pulmonary hypertension (PH) due to left heart disease (LHD) with significant pulmonary vascular disease (PVD). The aim of this study was to investigate the incidence and clinical features of PH-LHD with PVD classified by DPG and TPPG. Methods: We analyzed 410 patients admitted for symptomatic heart failure (HF) (New York Heart Association >= 2) and who underwent right heart catheterization (RHC) at compensated stage between 2007 and 2012. Patients with PH-LHD were divided into 3 groups according to the value of DPG and TPPG (Non-PVD group: DPG <7 mmHg and TPPG <= 12 mmHg; TPPG-PVD group: DPG <7 mmHg and TPPG >12 mmHg; DPG-PVD group: DPG >= 7 mmHg). Multivariate Cox regression analysis was applied to investigate whether each PH-LHD category predicts death or HF readmission after adjusting for other variables. Results: PH-LHD was observed in 164 patients (40%) with symptomatic HF. Thirteen patients (3%) were allocated into DPG-PVD group, while 24 patients were allocated into TPPG-PVD group (6%). DPG-PVD group was significantly associated with death or HF readmission compared to non-PVD group (hazard ratio: 3.57; 95% CI: 1.33 to 9.55, p = 0.01), while the association between TPPG-PVD group and non-PVD group did not reach statistical significance (hazard ratio: 1.89; 95% CI: 0.77 to 4.64, p = 0.17). Conclusions: PH-LHD with PVD classified by DPG was significantly associated with poor long-term clinical outcomes, whereas the association between PH-LHD with PVD classified by TPPG and clinical outcomes did not reach statistical significance. However, further studies are needed, because there was no substantial difference in clinical outcomes between PH-LHD with PVD classified by DPG and PH-LHD with PVD classified by TPPG. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • 虚血性心不全における冠動脈血行再建術後の左室駆出率改善の決定因子(Determinants of Left Ventricular Ejection Fraction Improvement Following Coronary Artery Revascularization in Ischemic Heart Failure)
    Adachi Yusuke, Sakakura Kenichi, Wada Hiroshi, Funayama Hiroshi, Umemoto Tomio, Fujita Hideo, Momomura Shin-ichi
    Circulation Journal 80 (Suppl.I) 2346 - 2346 1346-9843 2016/03 [Refereed][Not invited]
  • Takekuni Hayashi, Seiji Fukamizu, Takeshi Mitsuhashi, Takeshi Kitamura, Yuya Aoyama, Rintaro Hojo, Yoshitaka Sugawara, Harumizu Sakurada, Masayasu Hiraoka, Hideo Fujita, Shin-Ichi Momomura
    JACC: Clinical Electrophysiology 2 (1) 27 - 35 2405-500X 2016/02 [Refereed][Not invited]
     
    Objectives The aim of this study was to determine whether re-entrant circuits were associated with the ligament of Marshall (LOM). Background Peri-mitral atrial tachycardias (PMATs) following pulmonary vein isolation (PVI) or mitral valve surgery are common. Methods Six PMATs involving epicardial circuits were identified from 38 patients. Of these, 4 PMATs involved the LOM (PMAT-LOM, mean cycle length 308 ± 53 ms), as confirmed by the insertion of a 2-F electrode in the vein of Marshall (VOM). All patients underwent PVI and mitral isthmus ablation. The PMAT-LOMs were diagnosed based on left atrium (LA) activation maps that covered < 90% of tachycardia cycle length (TCL), and a difference between the post-pacing interval and TCL that was: 1) ≤20 ms at the VOM, the ridge between the left pulmonary vein and appendage, the anterior wall of the LA, and along the 6 to 11 o'clock direction of the mitral annulus and 2) > 20 ms at the distal coronary sinus (CS), the posterior wall of the LA, and the mitral isthmus ablation line (or noncapture). Catheter ablation was performed at the ridge for all PMAT-LOMs. Results Three tachycardias were successfully terminated at the ridge, which showed continuous fractionated potential lasting > 100 ms, confirming the bidirectional block of Marshall bundle (MB)-LA connections. The remaining tachycardia required ablation for the CS-MB connections, confirming bidirectional block of CS-MB connections. Conclusions PMAT-LOMs following PVI or valve surgery accounted for up to 11% of PMATs. The bidirectional block of either MB-LA or CS-MB connections is required to eliminate PMAT-LOMs.
  • Yusuke Adachi, Kenichi Sakakura, Naoyuki Akashi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNAL MEDICINE 55 (24) 3603 - 3606 0918-2918 2016 [Refereed][Not invited]
     
    A 60-year-old man was prescribed oral desmopressin (1-deamino-8-D-arginine vasopressin acetate trihydrate; DDAVP) for nocturnal polyuria. One week after starting to take desmopressin, he frequently felt chest pain while resting. Coronary angiography revealed no organic stenosis; however, an acetylcholine provocation test showed severe coronary spasm with ST elevation. He was diagnosed with coronary spastic angina, and we stopped the oral desmopressin and added diltiazem. While DDAVP should dilate the coronary vessels in healthy subjects, it may provoke coronary vasospasm in patients with endothelial dysfunction. We should be careful to avoid triggering coronary spasm when administering DDAVP to patients that may have potential endothelial dysfunction.
  • Yusuke Adachi, Nahoko Ikeda, Kenichi Sakakura, Sachiho Netsu, Tatsuro Ibe, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNAL MEDICINE 55 (18) 2639 - 2642 0918-2918 2016 [Refereed][Not invited]
     
    A 44-year-old woman, who had been previously diagnosed with coronary spastic angina and treated with standard medical therapy including calcium channel blockers, was admitted to our hospital due to chest pain at rest. Her chest pain attacks were concentrated just before and during menstruation. Despite the administration of an intravenous infusion of nitroglycerin and nicorandil, strong heart attacks with ST elevation occurred frequently after this admission. However, following continuous combined estrogen-progestin hormonal contraception use (estradiol plus dienogest), her attacks disappeared completely. Reduced estrogen levels before and during menstruation were speculated to be associated with her angina attacks.
  • Takekuni Hayashi, Takeshi Mitsuhashi, Hideo Fujita, Shin-Ichi Momomura
    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 26 (11) 1279 - 1281 1045-3873 2015/11 [Refereed][Not invited]
  • Shingo Yamamoto, Kenichi Sakakura, Hiroshi Funayama, Hiroshi Wada, Hideo Fujita, Shin-ichi Momomura
    JACC-CARDIOVASCULAR INTERVENTIONS 8 (10) 1396 - 1398 1936-8798 2015/08 [Refereed][Not invited]
  • Kayo Waki, Kiyoharu Aizawa, Shigeko Kato, Hideo Fujita, Hanae Lee, Haruka Kobayashi, Makoto Ogawa, Keisuke Mouri, Takashi Kadowaki, Kazuhiko Ohe
    Journal of Diabetes Science and Technology 9 (3) 534 - 540 1932-2968 2015/05 [Refereed][Not invited]
     
    Background: Diabetes self-management education is an essential element of diabetes care. Systems based on information and communication technology (ICT) for supporting lifestyle modification and self-management of diabetes are promising tools for helping patients better cope with diabetes. An earlier study had determined that diet improved and HbA1c declined for the patients who had used DialBetics during a 3-month randomized clinical trial. The objective of the current study was to test a more patient-friendly version of DialBetics, whose development was based on the original participants' feedback about the previous version of DialBetics. Method: DialBetics comprises 4 modules: data transmission, evaluation, exercise input, and food recording and dietary evaluation. Food recording uses a multimedia food record, FoodLog. A 1-week pilot study was designed to determine if usability and compliance improved over the previous version, especially with the new meal-input function. Results: In the earlier 3-month, diet-evaluation study, HbA1c had declined a significant 0.4% among those who used DialBetics compared with the control group. In the current 1-week study, input of meal photos was higher than with the previous version (84.8 ± 13.2% vs 77.1% ± 35.1% in the first 2 weeks of the 3-month trial). Interviews after the 1-week study showed that 4 of the 5 participants thought the meal-input function improved the fifth found input easier, but did not consider the result an improvement. Conclusions: DialBetics with FoodLog was shown to be an effective and convenient tool, its new meal-photo input function helping provide patients with real-time support for diet modification.
  • Daishi Fujita, Masao Takahashi, Kent Doi, Mitsuru Abe, Junichi Tazaki, Arihiro Kiyosue, Masahiro Myojo, Jiro Ando, Hideo Fujita, Eisei Noiri, Takeshi Sugaya, Yasunobu Hirata, Issei Komuro
    HEART AND VESSELS 30 (3) 296 - 303 0910-8327 2015/05 [Refereed][Not invited]
     
    Urinary liver-type fatty acid-binding proteins (uL-FABP) have recently been recognized as a useful biomarker for predicting contrast-induced nephropathy. Although accumulating studies have evaluated short-term outcomes, its prognostic value for long-term renal prognosis in patients undergoing coronary angiography (CAG) has not been fully examined. This study aimed to evaluate the predictive value of uL-FABP for long-term renal outcome in patients with ischemic heart disease (IHD). Consecutive 24 patients with impaired renal function (serum creatinine >1.2 mg/dL) who underwent CAG were enrolled. uL-FABP was measured before CAG, 24 and 48 h after CAG. The changes in estimated glomerular filtration rate (eGFR) throughout CAG and at 1 year later were compared with the uL-FABP levels. The patients with a greater decrease in eGFR 1 year later had higher uL-FABP levels at all points, but only the value at 48 h after CAG reached statistical significance (lower vs. higher decreased eGFR group, 4.61 +/- 3.87 vs. 17.71 +/- 12.96; P < 0.01). Measurement of uL-FABP at 48 h after CAG (48h-uL-FABP) showed better correlation with the change in eGFR (pre-CAG uL-FABP vs. 48h-uL-FABP: R = 0.27, P = 0.20 vs. R = 0.65, P < 0.01). Moreover, the high-pre and high-48h-uL-FABP group showed a significantly larger decrease in eGFR compared with the high-pre and low-48h-uL-FABP group (change in eGFR; 8.12 +/- 4.06 vs. 1.25 +/- 2.23 mL/min/1.73 m(2), P < 0.01), although the baseline eGFR levels were similar between these two groups. In this pilot study, measurement of uL-FABP levels at 48 h after CAG may be useful in detecting renal damage, and in predicting 1-year renal outcome in IHD patients undergoing CAG.
  • Masahiro Myojo, Masao Takahashi, Tomofumi Tanaka, Yasutomi Higashikuni, Arihiro Kiyosue, Jiro Ando, Hideo Fujita, Issei Komuro, Yasunobu Hirata
    CLINICAL CARDIOLOGY 38 (4) 216 - 221 0160-9289 2015/04 [Refereed][Not invited]
     
    BackgroundA clear indication and strategy for placement of retrievable inferior vena cava filters (IVCFs) have not been established. This study was designed to evaluate the efficacy and disadvantages of the retrievable IVCF use particularly in venous thromboembolism (VTE) patients with malignancy. HypothesisRetrievable IVCFs might be safe and useful in VTE patients with malignancy. MethodsThe study population consisted of 56 consecutive patients undergoing IVCF placement at our institution from January 1, 2008 to December 31, 2011. Prognostic data were retrospectively reviewed in April 2013. ResultsMean follow-up period was 584.6 (range, 1-1857) days. Twenty-six of the 56 patients had a malignancy. In 16 of the 30 patients without malignancy, the filter was retrieved, whereas the other 14 patients eventually received permanent implantation. There was no significant difference in the survival rate between the retrieval group and the nonretrieval group in the nonmalignancy patients (1-year survival rates, 94% vs 85%). In patients with malignancy, the nonretrieval group showed a significantly lower survival rate (P < 0.01). The 1-year and 2-year survival rates were 100% vs 46% and 100% vs 18%, respectively. There was no medical record of pulmonary thromboembolism occurrence or recurrence. All deaths in the patients with malignancy were malignancy related. In 4 of 5 malignancy patients who could undergo tumor resection surgery, adequate thrombus regression enabled us to retrieve the IVCF after surgery. ConclusionsPermanent use of a retrievable IVCF is relatively safe in short- or midterm follow-up regardless of malignancy status. Retrievable filter use might be reasonable in malignancy patients.
  • Ichiro Takeuchi, Hideo Fujita, Tomoyoshi Yanagisawa, Nobuhiro Sato, Tomohiro Mizutani, Jun Hattori, Sadataka Asakuma, Tatsuhiro Yamaya, Taito Inagaki, Yuichi Kataoka, Kazuhiko Ohe, Junya Ako, Yasushi Asari
    INTERNATIONAL HEART JOURNAL 56 (2) 170 - 173 1349-2365 2015/03 [Refereed][Not invited]
     
    Early reperfusion by percutaneous coronary intervention (PCI) is the current standard therapy for ST-elevation myocardial infarction (STEMI). To achieve better prognoses for these patients, reducing the door-to-balloon time is essential. As we reported previously, the Kitasato University Hospital Doctor Car (DC), an ambulance with a physician on board, is equipped with a novel mobile cloud 12-lead ECG system. Between September 2011 and August 2013, there were 260 emergency dispatches of our Doctor Car, of which 55 were for suspected acute myocardial infarction with chest pain and cold sweat. Among these 55 calls, 32 patients received emergent PCI due to STEMI (DC Group). We compared their data with those of 76 STEMI patients who were transported directly to our hospital by ambulance around the same period (Non-DC Group). There were no differences in patient age, gender, underlying diseases, or Killip classification between the two groups. The door-to-balloon time in the DC group was 56.1 +/- 13.7 minutes and 74.0 +/- 14.1 minutes in the Non-DC Group (P < 0.0001). Maximum levels of CPK were 2899 +/- 308 and 2876 +/- 269 IU/L (P = 0.703), and those of CK-MB were 292 +/- 360 and 295 +/- 284 ng/mL (P = 0.423), respectively, in the 2 groups. The Doctor Car system with the Mobile Cloud ECG was useful for reducing the door-to-balloon time.
  • Masao Takahashi, Susumu Miyazaki, Masahiro Myojo, Daigo Sawaki, Hiroshi Iwata, Arihiro Kiyosue, Yasutomi Higashikuni, Tomofumi Tanaka, Daishi Fujita, Jiro Ando, Hideo Fujita, Yasunobu Hirata, Issei Komuro
    PLOS ONE 10 (3) 1932-6203 2015/03 [Refereed][Not invited]
     
    Objectives This study aimed to assess the relation between stent edge restenosis (SER) and the distance from the stent edge to the residual plaque using quantitative intravascular ultrasound. Background Although percutaneous coronary intervention with drug-eluting stents has improved SER rates, determining an appropriate stent edge landing zone can be challenging in cases of diffuse plaque lesions. It is known that edge vascular response can occur within 2 mm from the edge of a bare metal stent, but the distance to the adjacent plaque has not been evaluated for drug-eluting stents. Methods A total of 97 proximal residual plaque lesions (plaque burden [PB] > 40%) treated with ever-olimus- eluting stents were retrospectively evaluated to determine the distance from the stent edge to the residual plaque. Results The SER group had significantly higher PB (59.1 +/- 6.1% vs. 51.9 +/- 9.1% for non-SER; P = 0.04). Higher PB was associated with SER, with the cutoff value of 54.74% determined using receiver operating characteristic (ROC) curve analysis. At this cutoff value of PB, the distance from the stent edge to the lesion was significantly associated with SER (odds ratio = 2.05, P = 0.035). The corresponding area under the ROC curve was 0.725, and the cutoff distance value for predicting SER was 1.0 mm. Conclusion An interval less than 1 mm from the proximal stent edge to the nearest point with the determined PB cutoff value of 54.74% was significantly associated with SER in patients with residual plaque lesions.
  • Kayo Waki, Hideo Fujita, Yuji Uchimura, Koji Omae, Eiji Aramaki, Shigeko Kato, Hanae Lee, Haruka Kobayashi, Takashi Kadowaki, Kazuhiko Ohe
    Journal of Diabetes Science and Technology 8 (2) 209 - 215 1932-2968 2014 [Refereed][Not invited]
     
    Numerous diabetes-management systems and programs for improving glycemic control to meet guideline targets have been proposed, using IT technology. But all of them allow only limited - or no - real-time interaction between patients and the system in terms of system response to patient input few studies have effectively assessed the systems' usability and feasibility to determine how well patients understand and can adopt the technology involved. DialBetics is composed of 4 modules: (1) data transmission module, (2) evaluation module, (3) communication module, and (4) dietary evaluation module. A 3-month randomized study was designed to assess the safety and usability of a remote health-data monitoring system, and especially its impact on modifying patient lifestyles to improve diabetes self-management and, thus, clinical outcomes. Fifty-four type 2 diabetes patients were randomly divided into 2 groups, 27 in the DialBetics group and 27 in the non-DialBetics control group. HbA1c and fasting blood sugar (FBS) values declined significantly in the DialBetics group: HbA1c decreased an average of 0.4% (from 7.1 ± 1.0% to 6.7 ± 0.7%) compared with an average increase of 0.1% in the non-DialBetics group (from 7.0 ± 0.9% to 7.1 ± 1.1%) (P = .015) The DialBetics group FBS decreased an average of 5.5 mg/dl compared with a non-DialBetics group average increase of 16.9 mg/dl (P = .019). BMI improvement - although not statistically significant because of the small sample size - was greater in the DialBetics group. DialBetics was shown to be a feasible and an effective tool for improving HbA1c by providing patients with real-time support based on their measurements and inputs. © 2014 Diabetes Technology Society.
  • 桐山 皓行, 原 弘典, 細谷 弓子, 田中 庸介, 石渡 淳平, 高澤 郁夫, 江口 智也, 山口 敏弘, 李 政哲, 中山 敦子, 田中 悌史, 清末 有宏, 安東 治郎, 藤田 英雄, 飯島 勝矢, 山下 尋史, 平田 恭信, 小室 一成
    ICUとCCU 医学図書出版(株) 37 (別冊) S106 - S106 0389-1194 2013/11
  • Hirotaka Fujimoto, Toru Suzuki, Kenichi Aizawa, Daigo Sawaki, Junichi Ishida, Jiro Ando, Hideo Fujita, Issei Komuro, Ryozo Nagai
    Clinical Chemistry 59 (9) 1330 - 1337 0009-9147 2013/09 [Refereed][Not invited]
     
    BACKGROUND: Restenosis, a condition in which the lesion vessel renarrows after a coronary intervention procedure, remains a limitation in management.Asurrogate biomarker for risk stratification of restenosis would be welcome. B-type natriuretic peptide (BNP) is secreted in response to pathologic stress from the heart. Its use as a biomarker of heart failure is well known however, its diagnostic potential in ischemic heart disease is less explored. Recently, it has been reported that processed forms of BNP exist in the circulation. We hypothesized that circulating processed forms of BNP might be a biomarker of ischemic heart disease. METHODS: We characterized processed forms of BNP by a newly developed mass spectrometry- based detection method combined with immunocapture using commercial anti-BNP antibodies. RESULTS: Measurements of processed forms of BNP by this assay were found to be strongly associated with presence of restenosis. Reduced concentrations of the aminoterminal processed peptide BNP(5-32) relative to BNP(3-32) [as the index parameter BNP(5-32)/BNP(3- 32) ratio] were seen in patients with restenosis [median (interquartile range) 1.19 (1.11-1.34), n=22] vs without restenosis [1.43 (1.22-1.61),n=83 P< 0.001] in a crosssectional study of 105 patients undergoing follow-up coronary angiography. A sensitivity of 100% to rule out the presence of restenosis was attained at a ratio of 1.52. CONCLUSIONS: Processed forms of BNP may serve as viable potential biomarkers to rule out restenosis. © 2013 American Association for Clinical Chemistry.
  • Eriko Hasumi, Hiroshi Iwata, Takahide Kohro, Ichiro Manabe, Koichiro Kinugawa, Naho Morisaki, Jiro Ando, Daigo Sawaki, Masao Takahashi, Hideo Fujita, Hiroshi Yamashita, Junya Ako, Yasunobu Hirata, Issei Komuro, Ryozo Nagai
    INTERNATIONAL JOURNAL OF CARDIOLOGY 168 (2) 1429 - 1434 0167-5273 2013/09 [Refereed][Not invited]
     
    Background: Restenosis after percutaneous coronary intervention (PCI) is still a great concern even in the recent drug-eluting stent (DES) era. As less invasive and sensitive parameter to detect restenosis is needed, this study was aimed to assess whether the clinical implication of temporal change in plasma BNP levels might be a useful indicator of restenosis after DES implantation. Methods and results: 847 consecutive patients who underwent elective PCI using silorimus-eluting sent (SES) between 2005 and 2009 were analyzed. Primary endpoint was subsequent target-lesion revascularization (TLR) after PCI. There was no significant difference in either baseline (TLR + vs. TLR-: 107.2 +/- 172.2 vs. 96.2 +/- 175.5 pg/mL, P=0.53) or follow-up plasma B-type natriuretic peptide (BNP) levels (TLR + vs. TLR-: 88.6 +/- 111.6 vs. 68.5 +/- 226.0 pg/mL, P=0.35) between patients with and without subsequent TLR. Conversely, ratio of follow-up to baseline BNP was significantly higher in patients with TLR (TLR + vs. TLR-: 1.55 +/- 1.58 vs. 1.07 +/- 1.04, P<0.001). Multivariate analysis using logistic regression showed log transformed BNP-ratio was an independent predictor of TLR (adjusted odds ratio (aOR): 1.94, 95%CI: 1.42-2.66, P<0.001). A closer relationship between BNP elevation greater than 2-fold and subsequent TLR was found (aOR: 2.69, 95%CI: 1.27-5.69, P<0.009). Furthermore, propensity score matching analysis showed that the incidence of subsequent TLR was significantly higher in patients with BNP elevation (P<0.001). Conclusion: Serial measurement of plasma BNP levels and its change might be a useful approach to predict restenosis in patients without typical chest symptoms receiving SES. (c) 2012 Elsevier Ireland Ltd. All rights reserved.
  • Atsuko Nakayama, Hiroyuki Morita, Jiro Ando, Hideo Fujita, Hiroshi Ohtsu, Ryozo Nagai
    Heart and Vessels 28 (3) 292 - 300 0910-8327 2013/05 [Refereed][Not invited]
     
    Recent clinical studies reported the drug interaction between proton-pump inhibitors (PPI) and clopidogrel, which remains controversial. The aim of this study was to determine whether the concurrent use of PPI with clopidogrel or ticlopidine is associated with increased risk for adverse cardiovascular outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). In this retrospective cohort study, we assessed the cardiovascular outcomes associated with the concurrent use of PPI and clopidogrel or ticlopidine in the well-characterized 1286 patients with CAD undergoing PCI in the University of Tokyo Hospital. In the Japanese patients with CAD undergoing PCI, the concurrent use of PPI was significantly associated with increased risk for major adverse cardiovascular events in the ticlopidine users (hazard ratio 2.63 95 % confidence interval 1.65-4.18 P < 0.001), but not in the clopidogrel users. In the clopidogrel users as well as the ticlopidine users, PPI use did not affect the occurrence of target lesion revascularization, but significantly increased the risk for new lesion formation in the coronary arteries, which required subsequent revascularization. The adverse cardiovascular effects of the concurrent use of PPI and ticlopidine were identified in the patients with CAD undergoing PCI. Also, new lesion formation in the coronary arteries was shown to be increased when PPI was coprescribed for the thienopyridine users. © 2012 Springer.
  • Ichiro Takeuchi, Hideo Fujita, Kazuhiko Ohe, Ryuta Imaki, Nobuhiro Sato, Kazui Soma, Shinichi Niwano, Tohru Izumi
    International Heart Journal 54 (1) 45 - 47 1349-2365 2013/02 [Refereed][Not invited]
     
    It is important for myocardial infarction patients to undergo immediate reperfusion of the affected coronary artery. In order to improve the prognosis, efforts to shorten the door to balloon time to within 90 minutes have been made. However, conventional methods such as faxing electrocardiograms (ECG) have not become widespread due to their high cost and lack of sharpness of the ECG. The "Doctor Car" (rapid response car system) of Kitasato University Hospital is now equipped with a Mobile Cloud ECG system. With this system, 12-lead ECG data obtained in the field are transmitted to the cloud server via a standard mobile telephone network. Since it uses an existing phone network, the cost of this system is low and it is fairly reliable. Cardiologists at the hospital read the ECG waveforms on the cloud server and decide whether emergency cardiac catheterization is necessary. In our first case using this Mobile Cloud ECG system, the door to balloon time could be shortened.
  • Hideo Fujita, Yuji Uchimura, Kayo Waki, Koji Omae, Ichiro Takeuchi, Kazuhiko Ohe
    Studies in Health Technology and Informatics 192 (1-2) 1077  0926-9630 2013 [Refereed][Not invited]
     
    To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system 'Cloud Cardiology®' based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome. © 2013 IMIA and IOS Press.
  • Izumi Yamaguchi, Hideo Fujita, Kazuhiko Ohe
    Studies in Health Technology and Informatics 192 (1-2) 1043  0926-9630 2013 [Refereed][Not invited]
     
    To prevent unexpected sudden cardiac patient death due to drug-induced Long QT syndrome (LQTS), we seek to build a computerized early detection and warning system of QTc interval increase tendency. We built an ECG database system that holds the digital waveform data and related information of the ECGs performed in out hospital, and developed an experimental detection system of QTc increase tendency. Despite the several problems about the accuracy of detection, we succeeded in extracting a patient who seemed to be drug-induced LQTS. A combination of such a detection system with more accuracy and drug prescription database would contribute to the early detection of drug-induced LQTS. © 2013 IMIA and IOS Press.
  • 大川 庭煕, 森 啓純, 沼田 玄理, 加藤 愛巳, 森岡 まさき, 加藤 賢, 山田 友春, 川上 拓也, 今村 輝彦, 安部 元, 多田 祐子, 田中 悌史, 荷見 映理子, 清末 有宏, 内野 悠一, 細谷 弓子, 高橋 政夫, 岩田 洋, 安東 治郎, 藤田 英雄, 山下 尋史, 平田 恭信, 永井 良三
    ICUとCCU 医学図書出版(株) 36 (10) 807 - 807 0389-1194 2012/10
  • Atsuko Nakayama, Hiroyuki Morita, Tetsuro Miyata, Jiro Ando, Hideo Fujita, Hiroshi Ohtsu, Takafumi Akai, Katsuyuki Hoshina, Masatoshi Nagayama, Shuichiro Takanashi, Tetsuya Sumiyoshi, Ryozo Nagai
    ATHEROSCLEROSIS 222 (1) 278 - 283 0021-9150 2012/05 [Refereed][Not invited]
     
    Objectives: A strong degree of co-existence between coronary artery disease (CAD) and abdominal aortic aneurysm (AAA) is widely acknowledged, however, it remains to be elucidated whether the existence of CAD is associated with an accelerated expansion rate of AAA. Also, the relationship between preoperative CAD and postoperative major adverse cardiovascular events (MACE) has not been examined in Japanese patients. The aim of this study was to investigate the deleterious effects of CAD on the progression of AAA and the onset of postoperative MACE after elective AAA repair. Methods and results: A retrospective cohort study of 665 consecutive Japanese patients who underwent elective surgical repair for infrarenal AAA at 2 high-volume Tokyo hospitals from 2003 through 2010 was performed. Preoperative CAD was shown to be a significant determinant of postoperative MACE (HR 2.29; 95% CI, 1.12-4.66; p = 0.02). In the analysis of 510 patients for whom there were at least 2 follow-up CT scans of the size of their AAA before repair, the existence of CAD was shown to be inversely associated with the accelerated expansion rate of AAA. Conclusion: This study on the patients undergone elective repair for infrarenal AAA identified an inverse association between the existence of CAD and progression of AAA as well as the significant impact of preoperative CAD on the occurrence of postoperative MACE after elective AAA repair. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
  • Koichi Kimura, Katsu Takenaka, Aya Ebihara, Tomoko Okano, Kansei Uno, Nobuaki Fukuda, Jiro Ando, Hideo Fujita, Hiroyuki Morita, Yutaka Yatomi, Ryozo Nagai
    ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES 29 (4) 404 - 410 0742-2822 2012/04 [Refereed][Not invited]
     
    Background: The ratio of early diastolic transmitral flow velocity (E) to tissue Doppler (TD) mitral annular early diastolic velocity (E/E'VEL-TD) has been widely used for the noninvasive assessment of LV diastolic filling pressures. However, it has been reported that E/E'VEL-TD is not accurate particularly when being applied to patients with advanced heart failure. Methods: Fifty-six ICU patients with decompensated heart failure underwent simultaneous echocardiography and PCWP measurements. Patients with elevated PCWP (n = 41) were compared with patients normal PCWP (n = 15) as well as age-matched healthy controls (n = 32). In the apical 4-chamber view, the ratio of E to speckle tracking (ST) mitral annular velocity (E/E'VEL-ST) and early diastolic global LV longitudinal strain rate (E/E'SR-ST) were evaluated as new surrogate markers of elevated PCWP. Results: Correlations with PCWP were observed for speckle tracking derived E/E'VEL-ST (r = 0.40,P = 0.002) and E/E'SR-ST (r = 0.56, P < 0.001), although the traditional E/E'VEL-TD did not show a significant correlation (r = 0.23, P = 0.082). Compared with controls, patients with elevated PCWP had significant increases in all variables. The best cutoff values and diagnostic accuracies for identifying elevated PCWP were E/E'VEL-TD>12 (Sensitivity/Specificity/area under the ROC curve: 0.58/0.90/0.78), E/E'VEL-ST > 14 (0.60/0.85/0.80), and E/E'SR-ST > 93 (0.80/0.88/0.89). Conclusion: Speckle tracking derived E/E'SR-ST may be a robust surrogate marker of elevated LV filling pressure. In ICU patients, E/E'SR-ST showed better correlation with PCWP and higher diagnostic accuracy than the tissue Doppler approach. (Echocardiography 2012;29:404-410)
  • Masahiro Myojo, Hiroshi Iwata, Takahide Kohro, Hiroki Sato, Arihiro Kiyosue, Jiro Ando, Daigo Sawaki, Masao Takahashi, Hideo Fujita, Yasunobu Hirata, Ryozo Nagai
    ATHEROSCLEROSIS 221 (1) 148 - 153 0021-9150 2012/03 [Refereed][Not invited]
     
    Background: Macrocytosis, as a qualitative abnormality of erythrocytes, has not drawn attention as a prognostic indicator after PCI, while anemia, as a quantitative abnormality of erythrocytes, has been recognized as a predictor of adverse outcomes. The aim of this study was to perform prognostic risk stratification of patients after PCI based on the presence or absence of macrocytosis. Methods: The clinical records of 941 consecutive patients who underwent PCI at a single institution were retrospectively reviewed. The prognostic implication of macrocytosis was evaluated by univariate and multivariate Cox's proportional hazard regression analysis. Results: There were 130 (13.8%) patients with macrocytosis. A significantly higher all-cause and cardiac mortality, as well as incidence of composite adverse events were observed in the Macrocytic group. Kaplan-Meier analysis also showed a significantly poorer overall survival in patients with macrocytosis. Even after exclusion of anemic patients, this tendency was still observed. Furthermore, macrocytosis was significantly and independently associated with adverse outcomes after PCI (aHR of cardiac death: 3.45, 95%CI: 1.22-9.80, P = 0.019). Interestingly, fewer patients with macrocytosis were prescribed statins compared with those without it (33.8% vs. 47.1%, P = 0.005). Conclusions: The results of the study indicate that measuring mean corpuscular volume (MCV) as a qualitative index of erythrocytes might be helpful for a prognostic risk stratification of patients subjected to PCI. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
  • Eiji Aramaki, Mai Miyabe, Kayo Waki, Hideo Fujita, Yuji Uchimura, Koji Omae, Masayo Hayakawa, Takashi Kadowaki, Kazuhiko Ohe
    AAAI Spring Symposium - Technical Report SS-12-05 2 - 4 2012 
    This paper proposes a novel telemedicine system for type 2 diabetes patients. The proposed system supports the patient self-management via a set of telemedicine devices, consisting of health sensors and a smart phone. The proposed system covers not only the sensor data but also the diet (food) and exercise data. To capture the food information, we also developed the voice recognition module focusing on the food names. The basic feasibility of the system is practically demonstrated in the preliminary experiment. Copyright © 2012, Association for the Advancement of Artificial Intelligence. All rights reserved.
  • Takahide Kohro, Hiroshi Iwata, Katsuhito Fujiu, Ichiro Manabe, Hideo Fujita, Go Haraguchi, Yoshihiro Morino, Atsushi Oguri, Hiroshi Ikenouchi, Masahiko Kurabayashi, Yuji Ikari, Mitsuaki Isobe, Kazuhiko Ohe, Ryozo Nagai
    INTERNATIONAL HEART JOURNAL 53 (1) 35 - 42 1349-2365 2012/01 [Refereed][Not invited]
     
    The 'evidence' in evidence-based medicine (EBM) is often limited to knowledge obtained from randomized controlled clinical trials (RCT). Most RCTs, however, have strict enrollment criteria which make patient background characteristics and clinical histories significantly different from those encountered in actual practice. Thus it is important to accumulate and analyze data obtained in daily practice to gain insight into a larger clinical picture. Recent developments in information technology and its lowered cost have enabled us to record clinical activity in much greater detail at a lower cost. These factors prompted us to design and develop a coronary angiography and intervention reporting system (CAIRS) to collect data and analyze outcomes of coronary intervention. The resulting advanced CAIRS can record detailed data on coronary angiographic and interventional procedures. To date, data on 10,025 cases of coronary angiography, of which 3,574 were interventional, have been collected over a 5.5 year period. There were 4,343 unique patients, 3,115 (71.7%) of which were male. The overall mean age was 67.0 +/- 11.5. The mean age of males was 66.3 +/- 11.4 and that of females was 69.0 +/- 11.4. About one-third of the patients never underwent a PCI procedure at our institution. For patients that underwent at least one PCI procedure at our institution, the prescription rate of stain increased from 50.8% in 2005 to 80.3% in 2011, while those of nitrate and ticlopidine decreased from 36.7% and 90.8% in 2005 to 21.3% and 0.8% in 2011, respectively. We have also implemented the same system at another institution and compared the data on stem usage between the two institutions, which revealed vastly different stent usage profiles. In conclusion, we have successfully developed and implemented an advanced coronary angiography and intervention reporting system which we call CAIRS. Implementing the same system at multiple institutions and analyzing data collected from several institutions will provide detailed and timely insight into the 'real world' of coronary angiography and interventional procedures and their outcome. (Int Heart J 2012; 53: 35-42)
  • Eriko Hasumi, Hiroshi Iwata, Kan Saito, Katsuhito Fujiu, Jiro Ando, Yasushi Imai, Hideo Fujita, Yasunobu Hirata, Ryozo Nagai
    INTERNATIONAL HEART JOURNAL 52 (4) 240 - 242 1349-2365 2011/07 [Refereed][Not invited]
     
    Procedure-related coronary dissection is associated with an increased risk of major adverse cardiovascular events after percutaneous coronary intervention (PCI). In most patients with such an iatrogenic complication, further PCI or bypass surgery aimed at complete revascularization is performed. Moreover, conventional coronary angiography has been used as a standard modality in the follow-up of such patients. The present report describes a 70 year old female patient who was complicated by catheter-related extensive coronary dissection in the right coronary artery (RCA) when treated for an acute myocardial infarction. Although RCA flow was insufficient, we decided against revascularization and followed her medically without additional revascularization procedures. Her clinical course had been uneventful for 4 years. However, symptoms of effort angina developed and re-examinations were performed at approximately 5 years after the myocardial infarction. Although conventional coronary angiography failed to show the culprit lesion responsible for the angina symptoms, the superior spatial resolution of the coronary CT angiography clearly identified significant progression of the stenotic lesion in the true lumen of the dissected RCA. Thus, coronary CT angiography might be considered as a possible first-line follow-up modality in patients with procedure-related coronary dissection. (Int Heart J 2011; 52: 240-242)
  • Dai Kawashima, Takayuki Ohno, Osamu Kinoshita, Noboru Motomura, Arihiro Kiyosue, Hideo Fujita, Jiro Ando, Kazuyoshi Ohtomo, Takashi Shigeeda, Satoshi Kato, Takashi Kadowaki, Ryozo Nagai, Shinichi Takamoto, Minoru Ono
    CIRCULATION JOURNAL 75 (2) 329 - 335 1346-9843 2011/02 [Refereed][Not invited]
     
    Background: In patients with diabetic retinopathy (DR), vitreous hemorrhage (VH) is a common complication that threatens visual acuity and hence, quality of life. A considerable number of DR patients at risk of VH require coronary revascularization, but little is known about the prevalence of VH after coronary revascularization. Methods and Results: This study investigated 151 patients with DR who were followed up by ophthalmologists between April 2004 and September 2008, and underwent coronary revascularization (coronary artery bypass surgery n=36 or drug-eluting stent implantation n=115). At the time of coronary revascularization 56 had non-proliferative DR (NPDR) and 95 had proliferative DR (PDR). During an average follow-up of 531 days after revascularization, VH occurred in 24 (15.9%) patients, 18 (11.9%) of whom experienced VH within 6 months of the procedure. In VH patients, PDR rather than NPDR predominated as the background to VH (21 vs. 3, respectively). The 1-year prevalence of VH was higher in patients with PDR than in those with NPDR (22.0% vs. 1.9%, P=0.0055). Conclusions: VH is not a rare complication following coronary revascularization among patients with DR, especially in those with PDR. Thus, in terms of maintaining quality of life, VH after coronary revascularization needs further attention in these patients. (Circ J 2011; 75: 329-335)
  • Arihiro Kiyosue, Yasunobu Hirata, Jiro Ando, Hideo Fujita, Toshihiro Morita, Masao Takahashi, Daisuke Nagata, Takahide Kohro, Yasushi Imai, Ryozo Nagai
    CIRCULATION JOURNAL 74 (11) 2441 - 2447 1346-9843 2010/11 [Refereed][Not invited]
     
    Background: This study examines whether the serum concentration of cystatin C (Cys C) correlates with the severity of coronary artery disease (CAD) and whether it provides additional information on the risk for CAD in patients without chronic kidney disease (CKD) estimated by the creatinine-based glomerular filtration rate (GFR). Methods and Results: The relationship between serum Cys C and the severity of CAD in 526 patients was investigated. Based on GFR, patients were divided into those with and without CKD. The relationship of serum Cys C with the severity of CAD was examined. Serum Cys C was closely correlated with GFR in all cases and in CKD patients, but not in non-CKD patients. The average number of stenotic coronary arteries was significantly higher in the quartiles of higher concentration of Cys C as well as in those of GFR. In 348 patients (66%) the GFR was >= 60ml.min(-1).1.73 m(-2). Those patients with increased Cys C (>0.90 mg/L, 143 patients) had a significantly larger number of stenotic coronary arteries than those patients with normal Cys C. Conclusions: Among patients considered to be at low risk based on the estimated GFR using serum creatinine, those with high concentrations of Cys C could have severe CAD. Besides CKD, Cys C might serve as a marker of CAD severity. (Circ J 2010; 74: 2441-2447)
  • 腹部大動脈瘤破裂と冠動脈疾患との関連についての検討
    中山 敦子, 森田 啓行, 安東 治郎, 藤田 英雄, 重松 邦宏, 宮田 哲郎, 平田 恭信, 永井 良三
    日本心臓病学会誌 (一社)日本心臓病学会 5 (Suppl.I) 386 - 386 1882-4501 2010/08
  • Hiroshi Iwata, Masataka Sata, Jiro Ando, Hideo Fujita, Toshihiro Morita, Daigo Sawaki, Masao Takahashi, Yoichiro Hirata, Shuichiro Takanashi, Minoru Tabata, Yasunobu Hirata, Ryozo Nagai
    HEART 96 (10) 748 - 755 1355-6037 2010/05 [Refereed][Not invited]
     
    Background Clinical evidence suggests that intracoronary thrombus formation is associated with a high incidence of late restenosis after successful coronary intervention in patients with myocardial infarction (MI). However, little is known about the mechanism by which intracoronary thrombi play pathological roles. Methods and Results We analysed the cellular constituents of 108 thrombi aspirated from coronary lesions with a thrombectomy device in 62 patients who underwent emergent coronary intervention for the treatment of acute (<24 h) or recent (24-72 h) ST-segment elevation MI (44 men, 18 women, aged 68.0619.3 years). Immunohistological analysis of aspirated thrombotic materials revealed that the content of platelets, as determined by immunostaining for CD42a, had a negative correlation with the time after the onset of chest pain (correlation coefficient -0.683, p<0.01). Immunofluorescent staining for CD34 and breast cancer-resistant protein-1 (bcrp-1) detected primitive cells in intracoronary thrombi. Furthermore, the ratio of CD34-positive cells in intracoronary thrombi had a significant positive correlation with restenosis at follow-up coronary angiography (correlation coefficient 0.76, p=0.01). Conclusions The findings of this study indicate that the early accumulation of primitive cells in platelet aggregates may play a role in neointimal growth after successful coronary intervention in patients with acute coronary syndrome.
  • Arihiro Kiyosue, Yasunobu Hirata, Jiro Ando, Hideo Fujita, Toshihiro Morita, Masao Takahashi, Daisuke Nagata, Takahide Kohro, Yasushi Imai, Ryozo Nagai
    CIRCULATION JOURNAL 74 (4) 786 - 791 1346-9843 2010/04 [Refereed][Not invited]
     
    Background: The relationship between renal dysfunction and the severity of coronary artery disease (CAD) was examined. Methods and Results: The severity of CAD in 572 patients was graded according to the number of stenotic coronary arteries, and the estimated glomerular filtration rate (eGFR) was monitored for 3 years. Patients were stratified into 3 eGFR groups: normal (>75 ml.min(-1).1.73 m(-2)), mild reduction (60-75) and chronic kidney disease (CKD: <60). There were 161 patients in the CKD group. The average number of stenotic coronary arteries was larger in the CKD group than in the other groups (normal vs mild reduction vs CKD =1.35 +/- 0.07 (SE) vs 1.22 +/- 0.08 vs 1.69 +/- 0.08 vessel disease (VD), P<0.001). During the 3-year follow-up, the renal function of 13.8% of the patients worsened. Those who showed more deterioration of eGFR had more severe CAD than those who did not (1.20 +/- 0.06 vs 1.61 +/- 0.06 VD, P<0.001). Multivariate analysis revealed that the severity of CAD was independently and significantly associated with the deterioration of eGFR. Conclusions: Patients with CKD had more severe CAD, which may explain the high rate of cardiovascular events in these patients. Moreover, the prognosis of renal function was poor in patients with severe CAD, and CAD was found to be an independent risk factor for worsening of renal dysfunction. (Circ J 2010; 74: 786-791)
  • PCI施行患者の新病変形成に対する危険因子の検証(Identification of the Risk Factors for New Lesion Formation in the Patients Undergoing PCI)
    Yamaguchi Atsuko, Morita Hitoyuki, Iwata Hiroshi, Kohro Takahide, Andoh Jiro, Fujita Hideo, Imai Yasushi, Yamazaki Tsutomu, Nagai Ryozo
    Circulation Journal 74 (Suppl.I) 567 - 567 1346-9843 2010/03
  • Tsuyoshi Shimizu, Takayuki Ohno, Jiro Ando, Hideo Fujita, Ryozo Nagai, Noboru Motomura, Minoru Ono, Shunei Kyo, Shinichi Takamoto
    Circulation Journal 74 (3) 449 - 455 1346-9843 2010/03 [Refereed][Not invited]
     
    Background: The optimal revascularization strategy for unprotected left main coronary artery (ULMCA) disease in the era of drug-eluting stents (DES) has become more controversial between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Methods and Results: Since April 2004, 89 patients underwent CABG, including 82 (92.1%) off-pump procedures and 63 patients underwent PCI with DES for ULMCA disease. Major adverse cardiac and cerebrovascular events (MACCE: death, acute myocardial infarction, stroke and repeat revascularization) and hospitalization costs were compared. Patients in the CABG group were likely to have multivessel disease and higher euroSCORE. The mean follow-up was 2.2±1.1 years in the CABG group and 1.6±0.8 years in the DES group (P< 0.001). The overall survival rate did not differ (P=0.288) between the groups (CABG: 93.4% and DES: 91.9% at 2 years). The MACCE-free survival rate was better (P=0.033) in the CABG group (CABG: 82.2% and DES: 62.6% at 2 years). Total hospitalization costs were lower (P=0.013) in the CABG group (median: 3,225 thousand yen) than in the DES group (median: 4,192 thousand yen). Conclusions: CABG might be associated with cost-effectiveness and could be still the first revascularization strategy for ULMCA disease.
  • Fujita Fusako, Sahara Makoto, Sugiyama Hiroaki, Ando Jiro, Fujita Hideo, Morita Toshihiro, Hirata Yasunobu, Nagai Ryozo
    Shinzo 公益財団法人 日本心臓財団 42 (1) 49 - 59 2010 
    今回われわれは, 両側腎動脈狭窄症 (RAS) による再発性の心不全と急性腎不全, あるいは治療抵抗性高血圧をきたした2症例を経験した.
    症例1: 72歳, 女性. 僧帽弁置換術後の低左心機能症例で心不全入院を繰り返していた. 今回心不全加療中に急性腎前性腎不全を発症して血液透析導入となり, その後両側RASの存在が判明した. 両腎とも8.5cm大と軽度萎縮していたが, 透析から離脱困難だったこともあり腎機能と血行動態の改善を目指してステント留置による経皮的腎動脈形成術 (PTRA) を施行した. 術直後より著明な腎機能の改善が得られ, 透析から離脱できるとともに慢性期の心不全の管理も容易となった.
    症例2: 63歳, 女性. 冠動脈3枝病変に対するバイパス術直前に, 両側RASによる難治性高血圧が顕在化した. 腎動脈エコー上, 腎硬化症の指標である腎抵抗係数は両側とも1.0と著明高値であったが, 薬物治療抵抗性の高血圧であったため両側RASに対してPTRA (ステント留置によるPTRA) を施行した. 術後血圧は著明に改善して降圧薬の減量が可能となり, その後冠動脈バイパス術が無事に施行された. 以上の2症例はいずれも症候性RASに対してPTRAが有効であった. 特異的な臨床徴候に乏しく見逃されることの多いRASとその病態, および適応をめぐっていまだ議論の多いPTRAを考えるうえで示唆に富む2症例であり, ここに報告する.
  • Takayuki Ohno, Osamu Kinoshita, Hideo Fujita, Satoshi Kato, Akira Hirose, Takashi Sigeeda, Kazuyoshi Otomo, Jiro Ando, Takashi Kadowaki, Makoto Araie, Ryozo Nagai, Shinichi Takamoto
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 139 (1) 92 - 97 0022-5223 2010/01 [Refereed][Not invited]
     
    Objectives: We hypothesized that a large number of patients with diabetic retinopathy who could benefit greatly from early coronary artery bypass grafting would not be identified. Methods: Patients with diabetic retinopathy receiving ophthalmologic care as outpatients in our hospital in whom coronary artery disease was not previously suspected were referred randomly to the diabetic retinocoronary clinic and were asked to participate in diagnostic tests, including an exercise treadmill test and exercise thallium scintigraphy or coronary computed tomography. Patients who had type 1 diabetes mellitus, required hemodialysis, or both were excluded from this study. A definitive diagnosis of coronary artery disease was confirmed by means of coronary angiography. Results: Of 214 patients with diabetic retinopathy, 55 (25.7%) were confirmed as having significant stenotic coronary artery disease. Patients with angiographically confirmed coronary disease were older than those with negative results on diagnostic tests (62.2 +/- 9.8 vs 57.9 +/- 10.3 years, P = .01). Fifteen had 1-vessel disease, 17 had 2-vessel disease, 14 had 3-vessel disease, 1 had left main trunk plus 1-vessel disease, 2 had left main trunk plus 2-vessel disease, and 5 had left main trunk plus 3-vessel disease. Eight patients had left main trunk disease, and 18 patients with non-left main trunk disease had proximal left anterior descending coronary artery (LAD) disease. Forty-two patients showed indications of coronary revascularization (coronary artery bypass grafting in 17 and percutaneous coronary intervention in 25). During the entire follow-up (287.6 +/- 183.2 days) of 39 patients undergoing coronary revascularization, all were alive without myocardial infarction, but 8 experienced vitreous hemorrhage. Conclusions: Approximately 25% of patients with diabetic retinopathy receiving ophthalmologic care as outpatients have a significant stenotic coronary artery disease. Of the total diabetic population, a large number of patients with diabetic retinopathy who show strong indications for early coronary artery bypass grafting might well go unrecognized. (J Thorac Cardiovasc Surg 2010; 139: 92-7)
  • 糖尿病網膜症患者におけるCABG・DES留置後の硝子体出血頻度 DES留置は禁忌?
    川島 大, 大野 貴之, 木下 修, 益澤 明広, 本村 昇, 高本 眞一, 大友 一義, 重枝 崇志, 廣瀬 晶, 加藤 聡, 新家 眞, 藤田 英雄, 安東 治郎, 永井 良三
    日本心臓血管外科学会雑誌 (NPO)日本心臓血管外科学会 38 (Suppl.) 263 - 263 0285-1474 2009/03
  • Akihiro Masuzawaa, Takayuki Ohno, Shinichi Takamoto, Noboru Motomura, Minoru Ono, Hideo Fujita, Jiro Ando, Toshihiro Morita, Yasunobu Hirata, Ryozo Nagai, Akira Hirose, Takashi Shigeeda, Satoshi Kato, Makoto Araie
    JOURNAL OF CARDIOLOGY 53 (1) 86 - 93 0914-5087 2009/02 [Refereed][Not invited]
     
    Background: Patients with diabetic retinopathy (DR) have an increased risk of death from coronary heart disease and myocardial infarction. The purpose of this study was to compare the outcomes of revascularization strategies (sirolimus-eluting stent [SES] and coronary artery bypass surgery [CABG]) in patients with DR according to the stage of retinopathy: non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR). Methods: From April 2004 until February 2007, 627 patients including 51 NPDR and 62 PDR patients underwent SES implantation. For each retinopathy group, a historical comparison group at the same stages of retinopathy undergoing CABG was selected. Cardiac events were defined as a composite of cardiac death, myocardial infarction, and repeat revascularization. Results: The average follow-up from the time of the initial revascularization was 27.7 +/- 8.5 months for NPDR-SES patients, 69.6 +/- 36.6 months for NPDR-CABG patients, 26.4 +/- 9.7 months for PDR-SES patients, and 68.3 +/- 44.2 months for PDR-CABG patients; and Kaplan-Meier estimates of the percentages of events at 24 months were 47.0%, 22.8%, 28.5%, and 26.0%. Kaplan-Meier curves for cardiac events differed significantly between the SES group and the CABG group in NPDR patients (p = 0.04), whereas the curves did not differ significantly between the two groups of PDR patients. The adjusted hazard ratio of SES implantation for cardiac events in the entire group of DR patients was 1.75 (95% confidence interval [CI] 1.02-3.00, p = 0.04). Conclusions: SES implantation is not a suitable method of revascularization in DR patients, especially in NPDR patients. CABG may become the first-choice revascularization technique for these patients. (c) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
  • 糖尿病患者の血行再建術 糖尿病網膜症患者に対する冠動脈血行再建術選択
    益澤 明広, 大野 貴之, 木下 修, 小野 稔, 本村 昇, 高本 眞一, 藤田 英雄, 安東 治郎, 森田 敏弘, 永井 良三
    日本心臓病学会誌 (一社)日本心臓病学会 2 (Suppl.I) 153 - 153 1882-4501 2008/08
  • 糖尿病患者の血行再建術 糖尿病網膜症患者に対する早期冠動脈血行再建
    木下 修, 大野 貴之, 益澤 明広, 高本 眞一, 藤田 英雄, 安東 治郎, 永井 良三
    日本心臓病学会誌 (一社)日本心臓病学会 2 (Suppl.I) 153 - 153 1882-4501 2008/08
  • 東大病院における糖尿病網膜症患者を対象とした冠動脈専門外来 糖尿病網膜症患者には無症状の重症冠動脈疾患が多数潜んでいる
    木下 修, 大野 貴之, 益澤 明広, 高本 眞一, 藤田 英雄, 安東 治郎, 平田 恭信, 永井 良三, 大友 一義, 重枝 崇志, 廣瀬 晶, 加藤 聡, 新家 眞, 迫田 秀之, 塚本 和久, 植木 浩二郎, 門脇 孝
    糖尿病 (一社)日本糖尿病学会 51 (Suppl.1) S - 255 0021-437X 2008/04
  • 糖尿病網膜症を伴う虚血性心疾患 薬剤溶出ステントと冠状動脈バイパスとの比較
    益澤 明広, 大野 貴之, 木下 修, 小野 稔, 本村 昇, 高本 眞一, 藤田 英雄, 安東 治郎, 森田 敏宏, 永井 良三
    日本心臓血管外科学会雑誌 (NPO)日本心臓血管外科学会 37 (Suppl.) 361 - 361 0285-1474 2008/01
  • Takayuki Ohno, Shinichi Takamoto, Noboru Motomura, Minoru Ono, Jiro Ando, Toshihiro Morita, Hideo Fujita, Yasunobu Hirata, Ryozo Nagai, Takashi Shigeeda, Akira Hirose
    ANNALS OF THORACIC SURGERY 84 (5) 1474 - 1478 0003-4975 2007/11 [Refereed][Not invited]
     
    Background. We compared the 1-year outcome of coronary revascularization with sirolimus-eluting stents (SESs) or coronary artery bypass grafting (CABG) for coronary artery disease involving the left anterior descending artery (LAD) in diabetic patients according to their retinal status: no diabetic retinopathy (NDR) and diabetic retinopathy (DR). Methods. Between April 2004 and October 2005, 220 consecutive patients with coronary artery disease involving the LAD underwent implantation of SESs; of these, 25 patients had NDR and 54 had DR. For each group, we included a comparison group of diabetic patients who had undergone CABG and had the same retinal status. Results. During 1 year after revascularization, five cardiac events (cardiac death, myocardial infarction, and repeat revascularization) were noted in NDR-SES patients, four in NDR-CABG, 24 in DR-SES, and eight in DR-CABG patients. Most cardiac events were repeat revascularizations. Kaplan-Meier estimates of the incidence of cardiac events at 1 year were 21.1%, 11.4%, 44.0%, and 14.0%, respectively. Kaplan-Meier curves for cardiac events in SES patients were different from those of CABG patients for the DR group (p = 0.003), but not NDR groups. After adjustments for the potential confounders, the hazard ratio of cardiac events in DR-SES patients was 2.8 (95% confidence interval, 1.1 to 6.9; p = 0.02). Conclusions. Compared with SES implantation, CABG is more suitable for revascularization in patients with coronary artery disease involving the LAD and DR.
  • Satoshi Nishimura, Ichiro Manabe, Mika Nagasaki, Yumiko Hosoya, Hiroshi Yamashita, Hideo Fujita, Mitsuru Ohsugi, Kazuyuki Tobe, Takashi Kadowaki, Ryozo Nagai, Seiryo Sugiura
    Diabetes 56 (6) 1517 - 1526 0012-1797 2007/06 [Refereed][Not invited]
     
    OBJECTIVE - The expansion of adipose tissue mass seen in obesity involves both hyperplasia and hypertrophy of adipocytes. However, little is known about how adipocytes, adipocyte precursors, blood vessels, and stromal cells interact with one another to achieve adipogenesis. RESEARCH DESIGN AND METHODS - We have developed a confocal microscopy-based method of three-dimensional visualization of intact living adipose tissue that enabled us to simultaneously evaluate angiogenesis and adipogenesis in db/db mice. RESULTS - We found that adipocyte differentiation takes place within cell clusters (which we designated adipogenic/angiogenic cell clusters) that contain multiple cell types, including endothelial cells and stromal cells that express CD34 and CD68 and bind lectin. There were close spatial and temporal interrelationships between blood vessel formation and adipogenesis, and the sprouting of new blood vessels from preexisting vasculature was coupled to adipocyte differentiation. CD34 + CD68+ lectin-binding cells could clearly be distinguished from CD34- CD68+ macrophages, which were scattered in the stroma and did not bind lectin. Adipogenic/angiogenic cell clusters can morphologically and immunohistochemically be distinguished from crownlike structures frequently seen in the late stages of adipose tissue obesity. Administration of anti-vascular endothelial growth factor (VEGF) antibodies inhibited not only angiogenesis but also the formation of adipogenic/angiogenic cell clusters, indicating that the coupling of adipogenesis and angiogenesis is essential for differentiation of adipocytes in obesity and that VEGF is a key mediator of that process. CONCLUSIONS - Living tissue imaging techniques provide novel evidence of the dynamic interactions between differentiating adipocytes, stromal cells, and angiogenesis in living obese adipose tissue. © 2007 by the American Diabetes Association.
  • Takayuki Ohno, Shinichi Takamoto, Jiro Ando, Toshihiro Morita, Hideo Fujita, Yasunobu Hirata, Takashi Shigeeda, Akira Hirose, Ryozo Nagai
    Journal of Interventional Cardiology 20 (2) 122 - 131 0896-4327 2007/04 [Refereed][Not invited]
     
    Introduction: The prognostic value of identifying the retinal status of diabetic patients undergoing coronary implantation of drug-eluting stents is unknown. Methods: We evaluated the outcomes of 318 consecutive patients undergoing implantation of sirolimus-eluting stents for coronary artery disease. Patients were divided into 5 groups according to the diabetic and retinal status: diabetic patients without retinopathy (43 patients) diabetic patients with nonproliferative retinopathy (34) diabetic patients with proliferative retinopathy (37) diabetic patients with unknown retinal status (30) and nondiabetic patients (174). Results: During a mean follow-up of 385 days, 64 patients had target-vessel failure (defined as a composite of death from cardiac causes, myocardial infarction, and target-vessel revascularization). At 1 year, Kaplan-Meier estimates of the rate of target-vessel failure were 15.3% for diabetic patients without retinopathy, 56.6% for those with nonproliferative retinopathy, 17.3% for those with proliferative retinopathy, 19.0% for those with unknown retinal status, and 16.0% for nondiabetic patients. After adjustment for the potential confounders and differences between groups, the relation of nonproliferative retinopathy to target-vessel failure remained significant. In an analysis in which diabetic patients without retinopathy were used as the reference group, the hazard ratios for target-vessel failure were 3.9 for those with nonproliferative retinopathy, 1.3 for those with proliferative retinopathy, 1.1 for those with unknown retinal status, and 1.4 for nondiabetic patients (P for trend = 0.015). Conclusions: As compared with diabetic patients without retinopathy, those with nonproliferative retinopathy have an increased risk for target-vessel failure after coronary implantation of sirolimus-eluting stents. © 2007, the Authors.
  • Satoshi Nishimura, Yasuo Kawai, Toshiaki Nakajima, Yumiko Hosoya, Hideo Fujita, Masayoshi Katoh, Hiroshi Yamashita, Ryozo Nagai, Seiryo Sugiura
    Cardiovascular Research 72 (3) 403 - 411 0008-6363 2006/12 [Refereed][Not invited]
     
    Objective: To elucidate the interdependence between the mechanical state of the myocardium and its electrical activity, previous studies have been performed at the cellular level. However, the information to date has been limited by the technical difficulties associated with stretching single myocytes. Methods: We solved this problem by combining two techniques, namely a carbon fiber technique for stretching rat myocytes with wide ranges of amplitude and speed, and ratiometric measurement of a fluorescent indicator (di8-ANEPPS) for evaluating the membrane potential in the non-contact mode. Results: During systole, stretching caused depolarization that prolonged the action potential duration without affecting the peak amplitude, but the effect was only significant in the late phase. Application of a stretch to quiescent myocytes depolarized the membrane potential in amplitude- and speed-dependent manners, but the response was suppressed by cytochalasin D treatment, suggesting participation of the cytoskeleton in the mechanotransduction mechanism. Finally, ion replacement experiments revealed that although Na+ was the dominant charge carrier for large amplitude stretches, Ca2 + permeation was involved in small amplitude stretches, suggesting amplitude-dependent ion selectivity. Conclusions: Application of axial stretching to rat ventricular myocytes changed the membrane potential in phase-, amplitude- and speed-dependent manners. Amplitude may also modulate the ion selectivity of stretch-activated channels. © 2006 European Society of Cardiology.
  • Doubun Hayashi, Yasushi Imai, Hiroyuki Morita, Hideo Fujita, Koshiro Monzen, Tomohiro Harada, Takefumi Nojiri, Tadashi Yamazaki, Tsutomu Yamazaki, Ryozo Nagai
    Japanese Heart Journal 45 (2) 315 - 324 0021-4868 2004 [Refereed][Not invited]
     
    Nowadays, evidence-based medicine has entered the mainstream of clinical judgement and the human genome has been completely decoded. Even the concept of individually designed medicine, that is, tailor-made medicine, is now being discussed. Due to their complexity, however, management methods for clinical information have yet to be established. We have conducted a study on a universal technique which enables one to select or produce by employing information processing technology clinical findings from various clinical information generated in vast quantity in day-to-day clinical practice, and to share such information and/or the results of analysis between two or more institutions. In this study, clinically useful findings have been successfully obtained by systematizing actual clinical information and genomic information obtained by an appropriate collecting and management method of information with due consideration to ethical issues. We report here these medical achievements as well as technological ones which will play a role in propagating such medical achievements. Copyright © 2004 by the Japanese Heart Journal.
  • Hiroshi Yamashita, Seiryo Sugiura, Hideo Fujita, So-Ichiro Yasuda, Ryozo Nagai, Yasutake Saeki, Kenji Sunagawa, Haruo Sugi
    Cardiovascular Research 60 (3) 580 - 588 0008-6363 2003/12 [Refereed][Not invited]
     
    Objective: To investigate the functional role of myosin light chain (MLC) isoforms in cardiac muscles, we examined the motor function of two different myosins the structure of which differed only in the MLC. Methods: We purified myosin from atria (A-myosin) and ventricles (V-myosin) of young rats, which contained atrial-type and ventricular-type MLCs, respectively, but having identical α-heavy chain isoform. Actin filament velocity (Vel) was determined in the in vitro motility assay. Average force of myosin molecules (F) was estimated and single events of actin-myosin interaction were recorded with the laser trap technique. Results: Vel was slightly higher in A-myosin than in V-myosin, while actin-activated ATPase activity was not different. F, determined from force versus actin filament length relation, was ∼60% higher in V-myosin (3.3 vs. 2.1 pN/μm). The mean duration of isometric force events was longer in V-myosin than in A-myosin (323±13 vs. 294±30 ms, p< 0.05), while the amplitudes of unitary displacement and force of a single myosin molecule did not differ between them. Conclusion: The MLC isoform can be a determinant of force-generating ability of cardiac myosin by modulating crossbridge kinetics without affecting the catalytic activity. © 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
  • 冠動脈疾患患者におけるmalondialdehyde修飾(MDA)-LDLの濃度が上昇することが明らかになった(Elevated levels of malondialdehyde modified (MDA)-LDL levels in patients with coronary artery disease)
    Hayashi Doubun, Miyama Genta, Yamazaki Tsutomu, Fujita Hideo, Morita Hiroyuki, Suzuki Toru, Nakamura Fumitaka, Imai Yasushi, Fukino Keiko, Amaki Toshihiro
    Japanese Circulation Journal 65 (Suppl.I-A) 251 - 251 0047-1828 2001/03
  • ANPとBNPの濃度は,左心系性能にかかわりなく,明らかにCHDの重症度に関連する(The levels of ANP and BNP are positively correlated with the severity of CHD irrespective of left ventricular function)
    Hayashi Doubun, Miyama Genta, Yamazaki Tsutomu, Fujita Hideo, Morita Hiroyuki, Nakamura Fumitaka, Imai Yasushi, Fukino Keiko, Asakawa Masako, Ikeda Yuichi
    Japanese Circulation Journal 65 (Suppl.I-A) 251 - 251 0047-1828 2001/03
  • So-Ichiro Yasuda, Seiryo Sugiura, Naoshi Kobayakawa, Hideo Fujita, Hiroshi Yamashita, Kaoru Katoh, Yasutake Saeki, Hiroko Kaneko, Yoshihisa Suda, Ryozo Nagai, Haruo Sugi
    American Journal of Physiology - Heart and Circulatory Physiology 281 (3) H1442 - H1446 0363-6135 2001 [Refereed][Not invited]
     
    To facilitate cardiac muscle research, we developed a novel method by which the force and length of a single ventricular myocyte can be recorded with a pair of carbon graphite fibers attached firmly to both ends. One fiber was stiff, whereas the other fiber was compliant to allow the recording of force and shortening during twitch contractions. The image of the compliant carbon fiber was projected onto a pair of photodiodes, and their output was fed to a piezoelectric transducer after variable amplifications to alter the effective compliance of the carbon fiber. Thus contraction of the myocyte was induced under virtually isometric conditions as well as under auxotonic conditions. We obtained a bell-shaped relation between the compliance under an auxotonic load and the work output of the myocyte, which was directly related to myocyte performance in the heart. Because it is easy to attach myocytes to the experimental apparatus, the present method would allow us to study cardiac muscle mechanics at the cellular and molecular levels.
  • ロータブレーター手技中の,ニコランジルの冠動脈内頻回投与によるslow flow予防効果
    森田 敏宏, 中村 文隆, 藤田 英雄, 杉浦 清了, 池田 祐一, 武藤 真祐, 平田 恭信, 中島 敏明, 永井 良三
    Journal of Cardiology (一社)日本心臓病学会 36 (Suppl.I) 360 - 360 0914-5087 2000/08
  • 藤田 英雄, 中村 文隆, 永井 良三
    Pharma Medica (株)メディカルレビュー社 17 (11) 107 - 111 0289-5803 1999/11
  • Akihiro Matsumoto, Shin-Ichi Momomura, Seiryo Sugiura, Hideo Fujita, Teruhiko Aoyagi, Masataka Sata, Masao Omata, Yasunobu Hirata
    Annals of Internal Medicine 130 (1) 40 - 44 0003-4819 1999/01 [Refereed][Not invited]
     
    Background: Conventional vasodilators increase ventilation-perfusion mismatch and do not improve gas exchange even though they reduce pulmonary hypertension. However, the effects of nitric oxide inhalation on ventilatory and gas exchange values in patients with congestive heart failure are not known. Objective: To investigate the effect of nitric oxide inhalation on gas exchange in patients with congestive heart failure, Design: Randomized, controlled trial. Setting: University hospital. Patients: 16 patients with congestive heart failure (New York Heart Association class II or III). Interventions: Patients inhaled nitric oxide gas at graded concentrations (n = 8) or were given intravenous isosorbide dinitrate, 2.5 mg (n = 8). Measurements: Hemodynamic and ventilatory variables and blood gases were measured 5 minutes after inhalation of different doses of nitric oxide and 10 minutes after administration of isosorbide dinitrate. Results: Nitric oxide inhalation reduced the mean pulmonary arterial pressure in a dose-dependent manner without altering the mean arterial pressure or cardiac output. At a dose of 40 parts per million, nitric oxide inhalation increased PaO2 (change from baseline, 12.0 mm Hg [95% Cl, 2.3 to 21.7 mm Hg] P = 0.014) and decreased the alveolar-arterial difference in partial pressure of oxygen (change, -8.6 mm Hg [Cl, -16.8 to -0.4 mm Hg] P = 0.038) and the ventilatory equivalent for carbon dioxide output (change, -6.7 [Cl, -10.3 to -3.1] P < 0.001). Although isosorbide dinitrate similarly decreased pulmonary arterial pressure, it did not alter gas exchange or ventilatory variables. Conclusions: Because nitric oxide inhalation improved gas exchange, it may be used as a supportive therapy when other conventional vasodilators worsen gas exchange.
  • Seiryo Sugiura, Naoshi Kobayakawa, Hideo Fujita, Hiroshi Yamashita, Shin-Ichi Momomura, Shigeru Chaen, Masao Omata, Haruo Sugi
    Circulation Research 82 (10) 1029 - 1034 0009-7330 1998/06 [Refereed][Not invited]
     
    To provide information on the mechanism of cardiac adaptation at the molecular level, we compared the unitary displacements and forces between the 2 rat cardiac myosin isoforms, V1 and V3. A fluorescently labeled actin filament, with a polystyrene bead attached, was caught by an optical trap and brought close to a glass surface sparsely coated with either of the 2 isoforms, so that the actin-myosin interaction took place in the presence of a low concentration of ATP (0.5 μmol/L). Discrete displacement events were recorded with a low trap stiffness (0.03 to 0.06 pN/nm). Frequency distribution of the amplitude of the displacements consisted of 2 gaussian curves with peaks at 9 to 10 and 18 to 20 nm for both V1 and V3, suggesting that 9 to 10 nm is the unitary displacement for both isoforms. The duration of the displacement events was longer for V3 than for V1. On the other hand, discrete force transients were recorded with a high trap stiffness (2.1 pN/nm), and their amplitude showed a broad distribution with mean values between 1 and 2 pN for V1 and V3. The durations of the force transients were also longer for V3 than for V1. These results indicate that both the unitary displacements and forces are similar in amplitude but different in duration between the 2 cardiac myosin isoforms, being consistent with the reports that the tension cost is higher in muscles consisting mainly of V1 than those consisting mainly of V3.
  • Seiryo Sugiura, Naoshi Kobayakawa, Hideo Fujita, Shin-Ichi Momomura, Shigeru Chaen, Haruo Sugi
    Advances in Experimental Medicine and Biology 453 125 - 130 0065-2598 1998 [Refereed][Not invited]
     
    To clarify the physiological significance of myosin isoform redistribution in cardiac adaptation process, we compared the kinetic property of the two cardiac myosin isoforms using in vitro motility assay techniques. Cardiac myosin isoforms V1 and V3 were obtained from ventricular muscle of young rats and hypothyroid rats respectively. On each of these myosin isoforms fixed on a glass coverslip, fluorescently labeled actin filaments were made to slide in the presence of ATP. To measure the force generated by actomyosin interaction, a small latex bead was attached to the barbed end of an actin filament and the bead was captured by the laser optical trap installed in a microscope. The force was determined from the distance between the bead and the trap positions under either auxotonic or isometric conditions. The time-averaged force generated by multiple cross- bridges did not differ significantly between the two isoforms. On the other hand, the unitary force measurement revealed the same level of amplitude but a longer duration for V3 isoform. The same level of time-averaged force is in agreement with not only our previous finding but the results of maximum force measurement in muscle preparations. The difference in kinetic characteristics of the two isoforms could account for the difference in economy of force development and the basis for cardiac adaptation mechanism.
  • Hideo Fujita, Seiryo Sugiura, Shin-Ichi Momomura, Haruo Sugi, Kazuo Sutoh
    Advances in Experimental Medicine and Biology 453 131 - 137 0065-2598 1998 [Refereed][Not invited]
     
    Familial hypertrophic cardiomyopathy (FHC) is caused by missence mutations in β-myosin heavy chain or other various sarcomeric proteins. To elucidate the functional impact of FHC mutations in myosin heavy chain, we generated Dictyostelium discoideum myosin II mutants equivalent to human FHC mutations by site-directed mutagenesis, and characterized their molecular- basis motor function. The current mutants, i.e. R397Q, F506C, G575R, A699R, K703Q and K703W are equivalent to R403Q, F513C, G584R, G716R, R719Q and R719W FHC mutants respectively. We measured the molecular-basis force and the sliding velocity generated by these myosin mutants. The measurement revealed that the A699R, K703Q and K703W myosins exhibited the lowest level of force with their preserved actin-activated MgATPase activity. F506C mutant showed the least impairment of the motile and enzymatic activities. The motor function of R397Q and G575R myosins were classified as intermediate. These results suggest that ELC binding domain might be important for force production.
  • Hideo Fujita, Seiryo Sugiura, Shin-Ichi Momomura, Masao Omata, Haruo Sugi, Kazuo Sutoh
    Journal of Clinical Investigation 99 (5) 1010 - 1015 0021-9738 1997/03 [Refereed][Not invited]
     
    Recent studies have revealed that familial hypertrophic cardiomyopathy (FHC) is caused by missence mutations in myosin heavy chain or other sarcomeric proteins. To investigate the functional impact of FHC mutations in myosin heavy chain, mutants of Dictyostelium discoideum myosin II equivalent to human FHC mutations were generated by site-directed mutagenesis, and their motor function was characterized at the molecular level. These mutants, i.e., R397Q, F506C, G575R, A699R, K703Q, and K703W are respectively equivalent to R403Q, F513C, G584R, G716R, R719Q, and R719W FHC mutants. We measured the force generated by these myosin mutants as well as the sliding velocity and the actin-activated ATPase activity. These measurements showed that the A699R, K703Q, and K703W myosins exhibited unexpectedly weak affinity with actin and the lowest level of force, though their ATPase activity remained rather high. F506C mutant which has been reported to have benign prognosis exhibited the least impairment of the motile and enzymatic activities. The motor functions of R397Q and G575R myosins were classified as intermediate. These results suggest that the force level of mutant myosin molecule may be one of the key factors for pathogenesis which affect the prognosis of human FHC.
  • Seiryo Sugiura, Naoshi Kobayakawa, Hideo Fujita, Shin-Ichi Momomura, Masao Omata
    Heart and Vessels 12 (12) 97 - 99 0910-8327 1997 [Refereed][Not invited]
     
    Distinct crossbridge kinetics among cardiac myosin isoforms have been proposed as the basis of differences in energetic characteristics. However, direct evidence for this hypothesis is lacking because of experimental difficulty. As a preliminary approach to this problem, we applied an in-vitro force measurement technique to directly observe force impulse generated by a single cardiac myosin molecule. The force measurement system was constructed with an inverted microscope coupled with a laser optical trap. With the feedback of the position signal to the driving circuit for a galvanomirror that steers the laser beam, trap stiffness was increased thus, isometric force measurement was made possible. We measured the force generated by the cardiac myosin V3 isoform purified from hypothyroid rat ventricular muscle. With very low myosin density and low adenosine triphosphate (ATP) concentration of the assay buffer, we successfully observed a single force impulse similar in shape to that of skeletal muscle myosin. With this approach, we will be able to gain a clear view of the molecular basis of cardiac mechanoenergetics.
  • Masataka Sata, Seiryo Sugiura, Hiroshi Yamashita, Hideo Fujita, Shin-Ichi Momomura, Takashi Serizawa
    Circulation Research 76 (4) 626 - 633 0009-7330 1995 [Refereed][Not invited]
     
    MCI-154 (6-[4-(4′-pyridylamino)phenyl]-4,5-dihydro-3(2H)pyridazinone hydrochloride trihydrate) is a potent novel cardiotonic agent whose positive inotropism is shown to be mainly based on an increase in Ca2+ sensitivity of the contractile apparatus. To elucidate the exact mechanism through which this drug acts, we investigated the movement of the reconstituted thin filament on a myosin layer in vitro. Cardiac thin filaments were reconstituted from actin and tropomyosin-troponin complex purified from rat cardiac acetone powder separately. Double staining of the filament showed that tropomyosin-troponin complex was integrated along actin filament homogeneously. Thin filaments thus prepared were fluorescently labeled and made to slide on rat cardiac myosin fixed on a glass coverslip while varying the [Ca2+] of the medium (control, pH 7.2 at 25°C). When [Ca2+] was low, the filaments showed only brownian motion. However, above a certain level of [Ca2+] (the threshold [Ca2+]), the filaments started to slide, and the velocity increased, reaching the maximum velocity within a very narrow range of [Ca2+]. The regulation was completely abolished by using simple actin filaments without tropomyosin-troponin complex, demonstrating that the regulatory proteins are responsible for this Ca2+ regulation of the movement of the reconstituted thin filament. Under the control condition, addition of MCI-154 shifted the threshold [Ca2+] to a lower level (sensitization) in a concentration-related manner. And 10-4 mol/L of MCI-154 reversed the desensitization effect induced by either acidosis (pH 6.8), low temperature (15°C), or the addition of inorganic phosphate (10 mmol/L). However, the maximum sliding velocity was not affected by the drug under any condition. In conclusion, MCI-154 directly sensitized the contractile apparatus under not only physiological but also pathophysiological conditions. This in vitro motility assay technique using reconstituted thin filaments is a useful tool for studying the mechanism of action of Ca2+ sensitizers.
  • Masataka Sata, Hiroshi Yamashita, Seiryo Sugiura, Hideo Fujita, Shin-ichi Momomura, Takashi Serizawa
    Pflügers Archiv European Journal of Physiology 429 (3) 443 - 445 0031-6768 1995/01 [Refereed][Not invited]
     
    We attempted to introduce calcium regulation into in vitro motility assay. Cardiac thin filament was reconstituted from actin and tropomyosin-troponin complex purified from rat myocardium separately. Double staining of the filaments showed tropomyosin-troponin complex was integrated along actin filaments homogeneously. The reconstituted thin filaments were made to slide on cardiac myosin fixed on a glass coverslip in the presence of MgATP while varying free Ca2+ concentration of the medium ([Ca2+]). Filaments showed only Brownian motion when [Ca2+] was below 10-6.4 M. However, filaments slid at a constant velocity when [Ca2+] exceeded 10-6.4 M, showing that the sliding was regulated in an on-off manner. The threshold [Ca2+] increased to 10-5.0 M under acidic conditions, indicating a decrease in Ca2+ sensitivity of the contractile proteins. Simple actin filaments slid at a constant velocity independently of [Ca2+], demonstrating that the regulatory proteins were responsible for this on-off manner regulation. This new assay technique may be a powerful tool to directly evaluate the Ca2+ sensitivity of the contractile apparatus and to investigate how cardiac contraction is regulated by Ca2+. © 1995 Springer-Verlag.

MISC

  • Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Yoshimasa Tsurumaki, Shin-ichi Momomura, Hideo Fujita  Cardiovascular Revascularization Medicine  19-  (3)  286  -291  2018/04  [Not refereed][Not invited]
     
    Intravascular ultrasound (IVUS) is mainly used in PCI to treat complex lesions, such as left main bifurcation, chronic total occlusion and calcified lesions. Although IVUS yields useful information such as the presence of napkin-ring calcification, the role of IVUS in rotational atherectomy (RA) is not fully appreciated. Recently, since the deliverability and crossability of IVUS catheters have improved, IVUS should be attempted before RA. Even if the IVUS catheter cannot cross the lesion, IVUS provides information just proximal to the target lesion, which would be useful in the selection of the appropriate guidewire and burr size. IVUS can be repeated following RA, which may influence the decision to continue RA with larger burrs. Circumferential calcification is a good indication for RA, since RA can create a calcium crack that facilitates balloon dilatation. However, if the distribution of calcification is not circumferential, the indication for RA can more safely be determined based on IVUS images than angiographic information alone. Because RA burrs usually follow the route taken by the IVUS catheter, the positional relationship between the IVUS imaging core and calcification would be similar to that between the RA burrs and calcification. The relationship between the RA burrs and distribution of calcification is discussed in this review.
  • Yusuke Adachi, Kenichi Sakakura, Tomohisa Okochi, Takaaki Mase, Mitsunari Matsumoto, Hiroshi Wada, Hideo Fujita, Shin-Ichi Momomura  International heart journal  59-  (2)  451  -454  2018/03  [Not refereed][Not invited]
     
    A 32-year-old man with a history of bronchial asthma was referred for low back pain and bilateral femur pain. Vascular sonography revealed bilateral deep vein thrombosis (DVT) from the femoral veins to the popliteal veins. Computed tomography revealed hypoplasia of the inferior vena cava (IVC) and dilated lumbar veins, ascending lumbar veins, and azygos vein as collaterals. There was no evidence of malignant neoplasm. The results of the thrombophilia tests were within normal limits. Hypoplasia of the IVC is a rare cause of DVT. This anomaly should be considered as a cause of bilateral and proximal DVT, in particular, in young patients without major risk factors.
  • Kenichi Sakakura, Yousuke Taniguchi, Takunori Tsukui, Kei Yamamoto, Shin-ichi Momomura, Hideo Fujita  JACC-CARDIOVASCULAR INTERVENTIONS  10-  (24)  E227  -E229  2017/12  [Not refereed][Not invited]
  • Yohei Numasawa, Kenichi Sakakura, Kei Yamamoto, Shingo Yamamoto, Yousuke Taniguchi, Hideo Fujita, Shin-ichi Momomura  Cardiovascular Revascularization Medicine  18-  (4)  295  -298  2017/06  [Not refereed][Not invited]
     
    Side branch occlusion, which was one of the common complications in percutaneous coronary interventions, was closely associated with cardiac death and myocardial infarction. Clinical guidelines also support the importance of preservation of physiologic blood flow in SB during PCI to bifurcation lesions. In order to avoid side branch occlusion during stent implantation, we often performed the jailed wire technique, in which a conventional guide wire was inserted to the side branch before stent implantation to the main vessel. However, the jailed wire technique could not always prevent side branch occlusion. In this case report, we described a case of 72-year-old male suffering from angina pectoris. Coronary angiography revealed the diffuse calcified stenosis in the proximal and middle of left anterior descending coronary artery, and the large diagonal branch originated from the middle of the stenosis. To prevent side branch occlusion, we performed a novel side branch protection technique by using the Corsair microcatheter (Asahi Intecc, Nagoya, Japan). In this case report, we illustrated this “Jailed Corsair technique”, and discussed the advantage compared to other side branch protection techniques such as the jailed balloon technique.
  • Tatsuro Ibe, Hiroshi Wada, Kenichi Sakakura, Yusuke Ugata, Kanna Fujita, Tomio Umemoto, Hideo Fujita, Shin-Ichi Momomura  JOURNAL OF CARDIAC FAILURE  22-  (9)  S225  -S225  2016/09  [Not refereed][Not invited]
  • Hideo Fujita  CIRCULATION JOURNAL  80-  (8)  1700  -1701  2016/08  [Not refereed][Not invited]
  • Kazuyoshi Ohtomo, Takashi Shigeeda, Akira Hirose, Takayuki Ohno, Osamu Kinoshita, Hideo Fujita, Jiro Ando, Ryozo Nagai, Shinichi Takamoto, Takashi Kadowaki, Satoshi Kato  DIABETES RESEARCH AND CLINICAL PRACTICE  118-  154  -155  2016/08  [Not refereed][Not invited]
  • Yasushi Wakabayashi, Takekuni Hayashi, Shingo Yamamoto, Yoshitaka Sugawara, Takeshi Mitsuhashi, Hideo Fujita, Shin-ichi Momomura  JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY  27-  (7)  881  -883  2016/07  [Not refereed][Not invited]
  • Takekuni Hayashi, Takeshi Mitsuhashi, Hideo Fujita, Shin-Ichi Momomura  JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY  27-  (5)  621  -622  2016/05  [Not refereed][Not invited]
  • Yasushi Wakabayashi, Takekuni Hayashi, Jun Matsuda, Yoshitaka Sugawara, Takeshi Mitsuhashi, Hideo Fujita, Shin-ichi Momomura  CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY  9-  (1)  2016/01  [Not refereed][Not invited]
  • Yu Shimizu, Yoshifumi Itoda, Yasutomi Higashikuni, Yuri Kadowaki, Aya Saito, Hideo Fujita, Hiroshi Yamashita, Masafumi Watanabe, Minoru Ono, Issei Komuro  INTERNATIONAL JOURNAL OF CARDIOLOGY  199-  38  -39  2015/11  [Not refereed][Not invited]
  • Kanna Fujita, Hiroshi Wada, Kenichi Sakakura, Hideo Fujita, Shin-Ihci Momomura  JOURNAL OF CARDIAC FAILURE  21-  (10)  S190  -S190  2015/10  [Not refereed][Not invited]
  • Kenichi Sakakura, Yusuke Adachi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita  Case reports in cardiology  2015-  407059  -407059  2015  [Not refereed][Not invited]
     
    We present a case of a patient who needed rapid switch from intra-aortic balloon pumping (IABP) to percutaneous cardiopulmonary support (PCPS)/venoarterial extracorporeal membrane oxygenation. It is difficult to switch from IABP to PCPS, because 0.035-inch guidewires cannot pass the IABP guidewire lumen (0.025-inch compatible), and the IABP sheath needs to be removed together with the IABP catheter. First, a 0.025-inch guidewire was inserted into the IABP wire lumen, and then the IABP catheter together with the 8 Fr IABP sheath was removed, leaving the 0.025-inch guidewire in place. We used the Perclose ProGlide for safe and rapid exchange of the 0.025-inch guidewire for a 0.035-inch guidewire. This allowed insertion of a PCPS cannula and the prompt initiation of PCPS.
  • Kazuyoshi Ohtomo, Takashi Shigeeda, Akira Hirose, Takayuki Ohno, Osamu Kinoshita, Hideo Fujita, Jiro Ando, Ryozo Nagai, Shinichi Takamoto, Takashi Kadowaki, Satoshi Kato  ACTA OPHTHALMOLOGICA  92-  (6)  E492  -E493  2014/09  [Not refereed][Not invited]
  • 藤田 英雄  診断と治療  101-  (1)  85  -90  2013/01
  • 高澤郁夫, 李政哲, 中山敦子, 桐山皓行, 原弘典, 細谷弓子, 田中庸介, 石渡惇平, 江口智也, 山口敏弘, 田中悌史, 清末有宏, 安東治郎, 藤田英雄, 飯島勝矢, 山下尋史, 小室一成  日本循環器学会関東甲信越地方会(Web)  228th-  2013
  • 藤田 英雄, 安東 治郎, 脇 嘉代  ICUとCCU : 集中治療医学  36-  (10)  886  -890  2012/10
  • Kayo Waki, Hideo Fujita, Yuji Uchimura, Eiji Aramaki, Koji Omae, Takashi Kadowaki, Kazuhiko Ohe  Journal of Diabetes Science and Technology  6-  (4)  983  -985  2012  [Not refereed][Not invited]
  • Yuji Uchimura, Hideo Fujita  IEEJ Transactions on Sensors and Micromachines  132-  (11)  381  -386  2012  [Not refereed][Not invited]
     
    Very recently, mobile devices as intelligent data terminals have become widely popular in the world, which are expected to contribute to medical/health information and communication technology (ICT). As it is recognized to be critical to share medical/health information between patients and healthcare providers electronically, a variety of electronic health record (EHR) and personal health record (PHR) systems have been developed. Furthermore, advances in mobile and cloud computing technologies nowadays enable us to transmit information anywhere at any time, and provide better environment for EHR/PHR. It will be of great importance to promote research and development of a novel mobile/cloud system to integrate dispersedly stored pieces of patients' healthcare information into virtually combined one. Those records include not only static previously collected medical records, but also currently occurring dynamic data of patients such as vital signs, adherence to medication, and emergency medical records. We particularly focus on better clinical outcome, as well as efficacy, safety, and security matters achieved by those innovative systems in the various medical/health fields. Through development of new sensor devices and ICT, a systematic methodology would be strongly required to establish virtual space of ubiquitous health information. © 2012 The Institute of Electrical Engineers of Japan.
  • Atsuko Nakayama, Hiroyuki Morita, Jiro Ando, Hideo Fujita, Masatoshi Nagayama, Shuichirou Takanashi, Tetsuya Sumiyoshi, Tetsurou Miyata, Ryozo Nagai  CIRCULATION  124-  (21)  2011/11  [Not refereed][Not invited]
  • Tetsuya Saito, Masafumi Watanabe, Toshiya Kojima, Takayoshi Matsumura, Hideo Fujita, Arihiro Kiyosue, Masao Takahashi, Norihiko Takeda, Koji Maemura, Hiroshi Yamashita, Yasunobu Hirata, Shuhei Komatsu, Kuni Ohtomo, Ryozo Nagai  INTERNATIONAL HEART JOURNAL  52-  (5)  327  -330  2011/09  [Not refereed][Not invited]
     
    Interrupted inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, and is frequently associated with other cardiovascular malformations and situs anomalies, such as left isomerism. These patients usually develop deep vein thrombosis (DVT), and asymptomatic patients above 60 years of age are very rare. Here we report a case of interrupted IVC which we diagnosed in a 72-year-old woman. She was admitted to our hospital suffering from heart failure and supraventricular tachycardia. Echocardiography detected secundum atrial septal defect (ASD). An abnormal paravertebral pleural line on the chest X-rays indicated the existence of venous anomaly. Anatomical images obtained by Multidetector Computed Tomography (MDCT) helped us to successfully perform right heart catheterization procedures through azygos continuation including blood sampling from pulmonary veins. Even in elderly patients, a careful examination of chest X-rays can indicate undiagnosed venous anomalies; thus, it is critically important before planning surgical or interventional procedures. (Int Heart J 2011; 52: 327-330)
  • Hideo Fujita, Ryozo Nagai  CIRCULATION JOURNAL  75-  (4)  773  -774  2011/04  [Not refereed][Not invited]
  • Koichi Kimura, Katsu Takenaka, Aya Ebihara, Kansei Uno, Tomoko Okano, Nobuaki Fukuda, Jiro Ando, Fujita Hideo, Hiroyuki Morita, Yutaka Yatomi, Ryozo Nagai  CIRCULATION  122-  (21)  2010/11  [Not refereed][Not invited]
  • Hiroshi Iwata, Masataka Sata, Jiro Ando, Hideo Fujita, Daigo Sawaki, Masao Takahashi, Yasunobu Hirata, Ryozo Nagai  CIRCULATION  122-  (21)  2010/11  [Not refereed][Not invited]
  • Eriko Hasumi, Hiroshi Iwata, Takahide Kohro, Jiro Ando, Daigo Sawaki, Masao Takahashi, Hideo Fujita, Yasunobu Hirata, Ryozo Nagai  CIRCULATION  122-  (21)  2010/11  [Not refereed][Not invited]
  • 腎機能障害と心血管病 現状と対策 腎機能障害と冠動脈疾患重症度の相互関係
    清末 有宏, 平田 恭信, 今井 靖, 興梠 貴英, 高橋 政夫, 藤田 英雄, 森田 敏宏, 安東 治郎, 永井 良三  日本心臓病学会誌  2-  (Suppl.I)  150  -150  2008/08  [Not refereed][Not invited]
  • Satoshi Nishimura, Kinya Seo, Mika Nagasaki, Yumiko Hosoya, Hiroshi Yamashita, Hideo Fujita, Ryozo Nagai, Seiryo Sugiura  PROGRESS IN BIOPHYSICS & MOLECULAR BIOLOGY  97-  (2-3)  282  -297  2008/06  [Not refereed][Not invited]
     
    Mechano-electrical feedback (MEF) has mainly been studied in isolated single cardiomyocytes using the microelectrode and micropipette techniques, but information regarding its dynamic aspects at the cellular level is limited due to the technical difficulties associated with manipulating single cells and maintaining stable attachment of these devices. To overcome such difficulties, we have combined two experimental methods, namely a carbon fiber technique to hold single myocytes and a ratiometric fluorescence measurement technique to monitor Ca2+ transients or membrane potentials. Following an overview of the experimental technique for stretching myocytes, the results for single rat ventricular myocytes under axial stretching are presented. Ca2+ transients were influenced by the loading conditions and involvement of myofilaments was suspected in regulatory mechanism. Membrane potential measurements during dynamic axial stretching revealed that the action potential duration was prolonged when the stretch was applied during the late phase of twitch contraction, and that depolarization of the resting membrane potential depended on the phase, amplitude and speed of the applied stretch. The amplitude may also modulate the ion selectivity of stretch-activated channels. This combination of the carbon fiber technique with fluorescence measurement could represent a powerful tool for clarifying MEF at the cellular level. (c) 2008 Published by Elsevier Ltd.
  • Hideo Fujita, Takayuki Ohno, Jiro Ando, Osamu Kinoshita, Satoshi Kato, Akira Hirose, Takeshi Shigeeda, Ryozo Nagai, Shinichi Takamoto  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  51-  (10)  A268  -A268  2008/03  [Not refereed][Not invited]
  • Fumihiko Hatao, Ikuo Wada, Hirokazu Yamaguchi, Sachiyo Nomura, Kazuhiko Yamada, Akemi Yoshikawa, Kazuhiko Mori, Hideo Fujita, Toshihiro Morita, Michio Kaminishi  Japanese Journal of Gastroenterological Surgery  41-  (2)  269  -274  2008  [Not refereed][Not invited]
     
    Drug-eluting coronary stents (DES) incorporating an eluting antiproliferative agent are commonly used to treat coronary heart disease. While DES reduce the rate of coronary artery restenosis, they have a higher incidence of late thrombosis compared to bare metal stents. Patients are maintained on dual antiplatelet therapy with aspirin and thienopyridine. If the patient suffers from digestive cancer after DES implantation, antiplatelet therapy is temporarily halted, and replaced by heparin administration to avoid perioperative bleeding risk. No evidence exists, to our knowledge is that this drug substitution is safe. We report two successfully treated and one unsuccessfully treated case of gastric cancer involving DES implantation. We review the literature and propose anticoagulation treatment guidelines for DES patients undergoing surgery. ©2008 The Japanese Society of Gastroenterological Surgery.
  • Takayuki Ohno, Shinichi Takamoto, Noboru Motomura, Minoru Ono, Jiro Ando, Toshihiro Morita, Hideo Fujita, Yasunobu Hirata, Takashi Shigeeda, Akira Hirose  JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY  49-  (9)  195A  -195A  2007/03  [Not refereed][Not invited]
  • 藤田 英雄  診断と治療  90-  (1)  65  -70  2002/01
  • 西川 尚子, 荒井 直人, 青柳 昭彦, 吹野 恵子, 松井 浩, 松本 晃裕, 桑田 志宏, 園田 誠, 鈴木 順一, 島本 涼一, 藤田 英雄, 佐田 政隆, 山下 尋史, 森田 敏宏, 中村 文隆, 中島 敏明, 杉浦 清子, 平田 恭信, 永井 良三  Japanese circulation journal  64-  740  -740  2000/04
  • 森田敏宏, 中村文隆, 藤田英雄, 杉浦清了, 池田祐一, 武藤真祐, 平田恭信, 中島敏明, 永井良三  Journal of Cardiology  36-  (Supplement 1)  2000
  • Akihiro Matsumoto, Yasunobu Hirata, Shin-ichi Momomura, Hideo Fujita, Atsushi Yao, Masataka Sata, Takashi Serizawa  The Lancet  343-  (8901)  849  -850  1994/04  [Not refereed][Not invited]

Research Grants & Projects

  • 冠動脈インターベンション
    共同研究


Copyright © MEDIA FUSION Co.,Ltd. All rights reserved.