研究者総覧

坂倉 建一 (サカクラ ケンイチ)

  • 総合医学第1講座 准教授
Last Updated :2021/09/22

研究者情報

学位

  • 医学博士(自治医科大学)

ホームページURL

科研費研究者番号

  • 20773310

Researcher ID

  • AAK-4564-2020

J-Global ID

研究キーワード

  • 腎デナベーション   冠動脈インターベンション   

研究分野

  • ライフサイエンス / 循環器内科学

学歴

  •         - 1999年03月   自治医科大学   医学部医学科

所属学協会

  • 日本心血管インターベンション治療学会(専門医)   日本循環器学会(専門医)   日本内科学会(専門医)   

研究活動情報

論文

  • 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年07月 
    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年07月 
    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.
  • Atsuhiko Kawabe, Takanori Yasu, Takeshi Morimoto, Akihiro Tokushige, Shin-Ichi Momomura, Kenichi Sakakura, Koichi Node, Taku Inoue, Shinichiro Ueda
    ESC heart failure 2021年07月 
    AIMS: White blood cell (WBC) count in healthy people is associated with the risk of coronary artery disease (CAD) and mortality. This study aimed to determine whether WBC count predicts heart failure (HF) requiring hospitalization as well as all-cause death, acute myocardial infarction (AMI) and stroke in patients with Type 2 diabetes mellitus and established CAD. METHODS: We conducted this retrospective registry study that enrolled consecutive patients with Type 2 diabetes mellitus and CAD based on coronary arteriography records and medical charts at 70 teaching hospitals in Japan from 2005 to 2015. A total of 7608 participants (28.2% women, mean age 68 ± 10 years) were eligible. In the cohort, the median (interquartile range) and mean follow-up durations were 39 (16.5-66.1 months) and 44.3 ± 32.7 months, respectively. The primary outcome was HF requiring hospitalization. The secondary outcomes were AMI, stroke, all-cause death, 3-point major adverse cardiovascular events (MACE) (AMI/stroke/death) and 4-point MACE (AMI/stroke/death/HF requiring hospitalization). Outcomes were reported as cumulative incidences (proportion of patients experiencing an event) and incidence rates (events/100 person-years). The primary and secondary outcomes were assessed using the Kaplan-Meier method and were compared using the log-rank test stratified by the baseline WBC count. The association between the WBC count at baseline and each MACE was assessed using the Cox proportional hazard model and expressed as the hazard ratio (HR) and 95% confidence interval (CI) after adjusting for other well-known risk factors for MACE. RESULTS: During the follow-up, 880 patients were hospitalized owing to HF. The WBC Quartile 4 (≥7700 cells/μL) had significantly lower HF event-free survival rate (log-rank test, P < 0.001). The HRs for HF events requiring hospitalization with each WBC quartile compared with the lowest in the first WBC quartile were 1 for Quartile 1 (WBC < 5300 cells/μL), 1.20 (95% CI, 0.96-1.5; P = 0.1) for Quartile 2 (5300 ≤ WBC < 6400), 1.34 (95% CI, 1.08-1.67; P = 0.009) for Quartile 3 (6400 ≤ WBC < 7700) and 1.62 (95% CI, 1.31-2.00; P < 0.001) for Quartile 4 after adjusting for covariates. Similar findings were observed for the risk of AMI and death; however, no significant difference was found for stroke. WBC Quartile 4 patients had a significantly lower 3- or 4-point MACE-free survival rate (log-rank test, P < 0.0001). CONCLUSIONS: A higher WBC count is a predictor of hospitalization for HF, all-cause death and AMI but not for stroke in patients with concurrent Type 2 diabetes mellitus and established CAD.
  • 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年06月 
    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年05月 
    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年05月 
    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.
  • Kenichi Sakakura
    Circulation journal : official journal of the Japanese Circulation Society 85 6 834 - 836 2021年05月
  • Tsukasa Murakami, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    Cardiovascular intervention and therapeutics 2021年04月 
    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.
  • Sho Torii, Yu Sato, Fumiyuki Otsuka, Frank D Kolodgie, Hiroyuki Jinnouchi, Atsushi Sakamoto, Joohyung Park, Kazuyuki Yahagi, Kenichi Sakakura, Anne Cornelissen, Rika Kawakami, Masayuki Mori, Kenji Kawai, Falone Amoa, Liang Guo, Matthew Kutyna, Raquel Fernandez, Maria E Romero, David Fowler, Aloke V Finn, Renu Virmani
    Journal of the American College of Cardiology 77 13 1599 - 1611 2021年04月 
    BACKGROUND: Calcified nodule (CN) has a unique plaque morphology, in which an area of nodular calcification causes disruption of the fibrous cap with overlying luminal thrombus. CN is reported to be the least frequent cause of acute coronary thrombosis, and the pathogenesis of CN has not been well studied. OBJECTIVES: The purpose of this study is to provide a comprehensive morphologic assessment of the CN in addition to providing an evolutionary perspective as to how CN causes acute coronary thrombosis in patients with acute coronary syndromes. METHODS: A total of 26 consecutive CN lesions from 25 subjects from our autopsy registry were evaluated. Detailed morphometric analysis was performed to understand the plaque characteristics of CN and nodular calcification. RESULTS: The mean age was 70 years, with a high prevalence of diabetes and chronic kidney disease. CNs were equally distributed between men and women, with 61.5% of CNs found in the right coronary artery (n = 16), mainly within its mid-portion (56%). All CNs demonstrated surface nonocclusive luminal thrombus, consisting of multiple nodular fragments of calcification, protruding and disrupting the overlying fibrous cap, with evidence of endothelial cell loss. The degree of circumferential sheet calcification was significantly less in the culprit section (89° [interquartile range: 54° to 177°]) than in the adjacent proximal (206° [interquartile range: 157° to 269°], p = 0.0034) and distal (240° [interquartile range: 178° to 333°], p = 0.0004) sections. Polarized picrosirius red staining showed the presence of necrotic core calcium at culprit sites of CNs, whereas collagen calcium was more prevalent at the proximal and distal regions of CNs. CONCLUSIONS: Our study suggests that fibrous cap disruption in CN with overlying thrombosis is initiated through the fragmentation of necrotic core calcifications, which is flanked-proximally and distally-by hard, collagen-rich calcification in coronary arteries, which are susceptible to mechanical stress.
  • 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年03月 
    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年03月 
    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年03月 
    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年03月 
    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年03月 
    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年01月 
    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年 
    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.
  • 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年 
    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年 
    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年 
    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.
  • 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年 
    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.
  • 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年 
    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年11月 
    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年11月 [査読有り][通常論文]
     
    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.
  • Kenichi Sakakura, Yoshiaki Ito, Yoshisato Shibata, Atsunori Okamura, Yoshifumi Kashima, Shigeru Nakamura, Yuji Hamazaki, Junya Ako, Hiroyoshi Yokoi, Yoshio Kobayashi, Yuji Ikari
    Cardiovascular intervention and therapeutics 2020年10月 
    Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.
  • Kei Yamamoto, Kenichi Sakakura, Takunori Tsukui, Masaru Seguchi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Cardiovascular intervention and therapeutics 2020年10月 [査読有り][通常論文]
     
    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年09月 [査読有り][通常論文]
     
    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年09月 [査読有り][通常論文]
     
    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年08月 [査読有り][通常論文]
     
    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.
  • 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年08月 [査読有り][通常論文]
     
    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年07月 [査読有り][通常論文]
     
    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年07月 [査読有り][通常論文]
     
    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.
  • 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 2020年07月 [査読有り][通常論文]
     
    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 2020年06月 [査読有り][通常論文]
  • Shinnosuke Sawano, Kenichi Sakakura, Yoshimasa Tsurumaki, Hideo Fujita
    Cardiovascular intervention and therapeutics 2020年06月 [査読有り][通常論文]
  • 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年06月 [査読有り][通常論文]
     
    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年06月 [査読有り][通常論文]
  • Keisuke Hirai, Tomohiro Kawasaki, Kenichi Sakakura, Toshiya Soejima, Kimihiro Kajiyama, Yurie Fukami, Kazuki Haraguchi, Taichi Okonogi, Ryota Fukuoka, Yoshiya Orita, Kyoko Umeji, Hisashi Koga, Hiroshige Yamabe
    Heart and vessels 2020年06月 [査読有り][通常論文]
     
    Fractional flow reserve (FFR) has become an increasingly important index for decision making concerning coronary revascularization. It is commonly accepted that significant improvement in FFR following percutaneous coronary intervention (PCI) is associated with better symptomatic relief and a lower event rate. However, in lesions with insufficient FFR improvement, PCI may not improve prognosis. Leading to the observation that the clinical and angiographic characteristics associated with insufficient FFR improvement have not been fully explored. The purpose of this study was to investigate the factors associated with insufficient improvement in FFR. Using our own PCI database, established between January 2014 and December 2018, we identified 220 stable coronary artery lesions, which had been evaluated for both pre- and post-PCI FFR values. All 220 of these lesions were included in this study. The improvement in FFR (ΔFFR) was calculated in each lesion with the lowest quartile of ΔFFR being defined as the lowest ΔFFR group, and the other quartiles being defined as the intermediate-high ΔFFR group. The mean ΔFFR in the lowest and intermediate-high ΔFFR groups was 0.07 ± 0.02 and 0.21 ± 0.11, respectively. In multivariate logistic regression analysis, a short total stent length (10 mm increase: OR 0.67, 95% CI 0.47-0.96, P = 0.030), higher pre-PCI FFR (0.1 increase: OR 4.07, 95% CI 1.83-9.06, P = 0.001), in-stent restenosis (ISR) (OR 8.02, 95% CI 1.26-51.09, P = 0.028), myocardial infarction (MI) in the target vessel (OR 6.87, 95% CI 1.19-39.69, P = 0.031) and non-use of intravascular imaging (OR 0.35, 95% CI 0.12-0.99, P = 0.048) were significantly associated with the lowest ΔFFR group. The use of short stents, higher pre-PCI FFR values, ISR, MI in the target vessel, and non-use of intravascular imaging were significantly associated with insufficient FFR improvement. It was conversely suggested that full coverage and adequate dilatation of the lesions under an intravascular imaging guidance might contribute to an improvement in FFR.
  • Satoshi Asada, Kenichi Sakakura, Kei Yamamoto, Shinichi Momomura, Hideo Fujita
    Postepy w kardiologii interwencyjnej = Advances in interventional cardiology 16 2 219 - 220 2020年06月 [査読有り][通常論文]
  • 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年05月 [査読有り][通常論文]
     
    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年03月 [査読有り][通常論文]
     
    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 87 2 219 - 224 (有)科学評論社 2020年02月 [査読有り][通常論文]
  • 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 2020年02月 [査読有り][通常論文]
     
    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年01月 [査読有り][通常論文]
     
    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 2020年01月 [査読有り][通常論文]
  • 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年01月 [査読有り][通常論文]
     
    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.
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Masaru Seguchi, Hiroyuki Jinnouchi, Hiroshi Wada, Hideo Fujita
    PloS one 15 10 e0241251  2020年 
    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年 
    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.
  • Yumiko Haraguchi, Kenichi Sakakura, Hideo Fujita
    Internal medicine (Tokyo, Japan) 59 17 2207 - 2207 2020年 [査読有り][通常論文]
  • 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年 [査読有り][通常論文]
     
    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.
  • 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年 [査読有り][通常論文]
     
    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.
  • Kei Yamamoto, Kenichi Sakakura, Takunori Tsukui, Masaru Seguchi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    PloS one 15 4 e0232158  2020年 [査読有り][通常論文]
     
    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.
  • Taku Kasahara, Kenichi Sakakura, Shin-Ichi Momomura, Hideo Fujita
    Journal of cardiology cases 21 1 32 - 34 2020年01月 [査読有り][通常論文]
     
    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年01月 [査読有り][通常論文]
     
    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.
  • 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年01月 [査読有り][通常論文]
     
    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.
  • 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年11月 [査読有り][通常論文]
     
    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年11月 [査読有り][通常論文]
     
    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.
  • 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 49 4 89 - 89 日本臨床生理学会 2019年10月 [査読有り][通常論文]
  • 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 2019年09月 [査読有り][通常論文]
     
    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年09月 [査読有り][通常論文]
  • 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年09月 [査読有り][通常論文]
  • 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年09月 [査読有り][通常論文]
  • 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年09月 [査読有り][通常論文]
  • Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H
    Heart and vessels 34 7 1096 - 1103 2019年07月 [査読有り][通常論文]
  • Ito M, Wada H, Sakakura K, Ibe T, Ugata Y, Fujita H, Momomura SI
    International heart journal 60 4 862 - 869 2019年07月 [査読有り][通常論文]
  • Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Seguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H
    Journal of cardiology 2019年07月 [査読有り][通常論文]
  • Taniguchi Y, Sakakura K, Mukai Y, Yamamoto K, Momomura SI, Fujita H
    Journal of cardiology cases 19 6 200 - 203 2019年06月 [査読有り][通常論文]
  • 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 2019年05月 [査読有り][通常論文]
     
    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.
  • Ibe T, Wada H, Sakakura K, Yoshimura S, Ito M, Ugata Y, Yamamoto K, Seguchi M, Taniguchi Y, Momomura SI, Fujita H
    Heart and vessels 2019年05月 [査読有り][通常論文]
  • Watanabe Y, Sakakura K, Kotoku H, Mashimo S, Nakata M, Nagata H, Chiba Y, Kojima M
    Journal of rural medicine : JRM 14 1 116 - 119 2019年05月 [査読有り][通常論文]
  • Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H
    Cardiovascular revascularization medicine : including molecular interventions 2019年05月 [査読有り][通常論文]
  • Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Seguchi M, Taniguchi Y, Ugata Y, Wada H, Momomura SI, Fujita H
    Circulation journal : official journal of the Japanese Circulation Society 83 5 1039 - 1046 2019年04月 [査読有り][通常論文]
  • 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年02月 [査読有り][通常論文]
     
    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.
  • Sakaoka A, Rousselle SD, Hagiwara H, Tellez A, Hubbard B, Sakakura K
    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 93 3 494 - 502 2019年02月 [査読有り][通常論文]
  • Ishibashi S, Sakakura K, Yamamoto K, Okochi T, Momomura SI, Fujita H
    Clinical case reports 7 2 391 - 393 2019年02月 [査読有り][通常論文]
  • 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年 [査読有り][通常論文]
     
    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.
  • Narita M, Sakakura K, Ohashi J, Ibe T, Yamamoto K, Wada H, Momomura SI, Fujita H
    International heart journal 60 1 215 - 219 2019年01月 [査読有り][通常論文]
  • Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H
    International heart journal 60 1 37 - 44 2019年01月 [査読有り][通常論文]
  • Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H
    International heart journal 59 6 1237 - 1245 2018年11月 [査読有り][通常論文]
  • 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 2018年10月 [査読有り][通常論文]
     
    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.
  • Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Ugata Y, Wada H, Momomura SI, Fujita H
    Journal of cardiology 72 3 227 - 233 2018年09月 [査読有り][通常論文]
  • Ibe T, Wada H, Sakakura K, Ito M, Ugata Y, Yamamoto K, Taniguchi Y, Momomura SI, Fujita H
    International heart journal 59 5 1047 - 1051 2018年09月 [査読有り][通常論文]
  • Jinnouchi H, Sakakura K, Fujita H
    Journal of thoracic disease 10 Suppl 26 S3176 - S3181 2018年09月 [査読有り][通常論文]
  • 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年08月 [査読有り][通常論文]
  • 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年08月 [査読有り][通常論文]
  • 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年08月 [査読有り][通常論文]
  • 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 2018年07月 [査読有り][通常論文]
     
    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.
  • Hirai K, Sakakura K, Watanabe Y, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H
    Cardiovascular revascularization medicine : including molecular interventions 19 5 Pt B 607 - 612 2018年07月 [査読有り][通常論文]
  • Ito M, Wada H, Sakakura K, Ibe T, Ugata Y, Fujita H, Momomura SI
    International heart journal 59 4 766 - 771 2018年07月 [査読有り][通常論文]
  • Ibe T, Wada H, Sakakura K, Ugata Y, Ito M, Umemoto T, Momomura SI, Fujita H
    International heart journal 59 4 887 - 890 2018年07月 [査読有り][通常論文]
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Heart and Vessels 33 5 498 - 506 2018年05月 [査読有り][通常論文]
     
    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.
  • Shingo Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International Heart Journal 59 3 482 - 488 2018年05月 [査読有り][通常論文]
     
    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.
  • Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Yoshimasa Tsurumaki, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 19 3 286 - 291 2018年04月 [査読有り][通常論文]
     
    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年03月 [査読有り][通常論文]
     
    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.
  • Yusuke Watanabe, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Hideo Fujita, Shin-ichi Momomura
    Heart and Vessels 33 3 226 - 238 2018年03月 [査読有り][通常論文]
     
    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.
  • Atsushi Sakaoka, Hisako Terao, Shintaro Nakamura, Hitomi Hagiwara, Toshihito Furukawa, Kiyoshi Matsumura, Kenichi Sakakura
    Circulation: Cardiovascular Interventions 11 2 e005779  2018年02月 [査読有り][通常論文]
     
    Background - Ablation lesion depth caused by radiofrequency-based renal denervation (RDN) was limited to < 4 mm in previous animal studies, suggesting that radiofrequency-RDN cannot ablate a substantial percentage of renal sympathetic nerves. We aimed to define the true lesion depth achieved with radiofrequency-RDN using a fine sectioning method and to investigate biophysical parameters that could predict lesion depth. Methods and Results - Radiofrequency was delivered to 87 sites in 14 renal arteries from 9 farm pigs at various ablation settings: 2, 4, 6, and 9 W for 60 seconds and 6 W for 120 seconds. Electric impedance and electrode temperature were recorded during ablation. At 7 days, 2470 histological sections were obtained from the treated arteries. Maximum lesion depth increased at 2 to 6 W, peaking at 6.53 (95% confidence interval, 4.27-8.78) mm under the 6 W/60 s condition. It was not augmented by greater power (9 W) or longer duration (120 seconds). There were statistically significant tendencies at 6 and 9 W, with higher injury scores in the media, nerves, arterioles, and fat. Maximum lesion depth was positively correlated with impedance reduction and peak electrode temperature (Pearson correlation coefficients were 0.59 and 0.53, respectively). Conclusions - Lesion depth was 6.5 mm for radiofrequency-RDN at 6 W/60 s. The impedance reduction and peak electrode temperature during ablation were closely associated with lesion depth. Hence, these biophysical parameters could provide prompt feedback during radiofrequency-RDN procedures in the clinical setting.
  • Keisuke Yonezu, Kenichi Sakakura, Yusuke Watanabe, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Heart and Vessels 33 1 25 - 32 2018年01月 [査読有り][通常論文]
     
    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.
  • 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 2018年01月 [査読有り][通常論文]
     
    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.
  • Hiroyuki Jinnouchi, Shoichi Kuramitsu, Tomohiro Shinozaki, Takashi Hiromasa, Yohei Kobayashi, Yasuaki Takeji, Mizuki Miura, Hisaki Masuda, Yukiko Matsumura, Yuhei Yamaji, Kenichi Sakakura, Takenori Domei, Yoshimitsu Soga, Makoto Hyodo, Shinichi Shirai, Kenji Ando
    Circulation Journal 82 4 983 - 991 2018年 [査読有り][通常論文]
     
    Background: Percutaneous coronary intervention for heavily calcified lesions requires rotational atherectomy (RA). Long-term clinical outcomes after drug-eluting stent (DES) implantation following (RA) for heavily calcified lesions remain unclear. We assessed 5-year clinical outcomes after DES implantation following RA. Methods and Results: Between March 2006 and September 2011, 219 consecutive patients with 219 lesions treated with DES following RA, were retrospectively enrolled. The cumulative 5-year incidence of target-lesion revascularization (TLR) and definite stent thrombosis (ST) were assessed. The cumulative incidence of TLR within (≤) the first year was 18.6%. Late TLR beyond (> ) 1 year continued to occur at 1.9% per year without a decrease in the rate (5-year incidence, 26.0%). The cumulative incidence of definite ST at 30 days, 1 and 5 years was 0.9%, 2.3% and 2.9%, respectively. The annual rate of definite ST beyond 1 year was 0.15%. On multivariate analysis, the significant predictor of TLR within 1 year was use of first-generation DES (hazard ratio [HR], 2.09 95% CI: 1.10–4.03, P=0.02) and that of TLR beyond 1 year was hemodialysis (HR, 3.29 95% CI: 1.06–10.55, P=0.04). Conclusions: Late TLR beyond 1 year continued to occur up to 5 years at a constant annual incidence, whereas very late ST was rare. Careful long-term clinical follow-up is continually needed in patients who have already received DES following RA for heavily calcified lesions.
  • Yusuke Ugata, Hiroshi Wada, Kenichi Sakakura, Tatsuro Ibe, Miyuki Ito, Nahoko Ikeda, Hideo Fujita, Shin-Ichi Momomura
    International Heart Journal 59 1 216 - 219 2018年 [査読有り][通常論文]
     
    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, Yousuke Taniguchi, Yoshimasa Tsurumaki, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    International Heart Journal 59 2 399 - 402 2018年 [査読有り][通常論文]
     
    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.
  • 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 2018年 [査読有り][通常論文]
     
    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, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 20 4 347 - 350 2018年 [査読有り][通常論文]
     
    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.
  • Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 20 2 113 - 119 2018年 [査読有り][通常論文]
     
    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.
  • Sakakura K, Taniguchi Y, Tsukui T, Yamamoto K, Momomura SI, Fujita H
    JACC. Cardiovascular interventions 10 24 E227 - E229 2017年12月 [査読有り][通常論文]
  • 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 2017年11月 [査読有り][通常論文]
     
    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.
  • Watanabe Y, Ono K, Sakakura K, Fujita H
    Journal of rural medicine : JRM 12 2 149 - 152 2017年11月 [査読有り][通常論文]
  • Kei Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    Cardiovascular Revascularization Medicine 18 6 52 - 53 2017年09月 [査読有り][通常論文]
     
    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.
  • 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 2017年09月 [査読有り][通常論文]
     
    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.
  • 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年07月 [査読有り][通常論文]
  • 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年07月 [査読有り][通常論文]
  • Akashi N, Sakakura K, Yamamoto K, Taniguchi Y, Wada H, Momomura SI, Fujita H
    Clinical case reports 5 6 787 - 791 2017年06月 [査読有り][通常論文]
  • Yohei Numasawa, Kenichi Sakakura, Kei Yamamoto, Shingo Yamamoto, Yousuke Taniguchi, Hideo Fujita, Shin-ichi Momomura
    Cardiovascular Revascularization Medicine 18 4 295 - 298 2017年06月 [査読有り][通常論文]
     
    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.
  • 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 2017年05月 [査読有り][通常論文]
     
    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.
  • Kei Yamamoto, Kenichi Sakakura, Yusuke Adachi, Yousuke Taniguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    JOURNAL OF CARDIOLOGY 69 5-6 823 - 829 2017年05月 [査読有り][通常論文]
     
    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.
  • Yusuke Adachi, Kenichi Sakakura, Tatsuro Ibe, Nanae Yoshida, Hiroshi Wada, Hideo Fujita, Shin-Ichi Momomura
    International heart journal 58 2 286 - 289 2017年04月 [査読有り][通常論文]
     
    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 2017年04月 [査読有り][通常論文]
     
    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 2017年 [査読有り][通常論文]
     
    In 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 burr 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. (Int Heart J 2017 58: 279-282)
  • Yusuke Watanabe, Hiroshi Wada, Kenichi Sakakura, Hideo Fujita, Shin-ichi Momomura
    INTERNAL MEDICINE 56 2 157 - 161 2017年 [査読有り][通常論文]
     
    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 2016年12月 [査読有り][通常論文]
     
    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.
  • Tobias Koppara, Kenichi Sakakura, Erica Pacheco, Qi Cheng, XiaoQing Zhao, Eduardo Acampado, Aloke V. Finn, Mark Barakat, Luc Maillard, Jane Ren, Mahesh Deshpande, Frank D. Kolodgie, Michael Joner, Renu Virmani
    INTERNATIONAL JOURNAL OF CARDIOLOGY 222 217 - 225 2016年11月 [査読有り][通常論文]
     
    Background: Treatment options for patients with coronary artery disease at high risk for bleeding complications are limited. The aim of the current preclinical study was to evaluate neointimal coverage, endothelial recovery, inflammation and thrombogenicity in a novel thin-strut (71 mu m thickness) Cobalt Chromium (CoCr) stent modified with a nano-thin Polyzene (R)-F (PzF) surface coating. Methods and results: Twenty-eight single PzF nano-coated stents and 20 bare metal control stents (BMS) were implanted in the coronary arteries of 24 pigs, with scheduled 5-(n = 5), 28-(n = 13), and 90-day (n = 6) follow-up in addition to overlapping configuration (n = 6 each), examined at 28-days. Histomorphometric analysis showed significantly lower neointimal thickness in PzF nano-coated stents than BMS controls at both 28- and 90-days (p = 0.023 and 0.005) and reduced inflammation (p = 0.06 and 0.13). Endothelial coverage over luminal surfaces at all time points was similar between nano-coated stents and BMS controls. We conducted supplementary in-vitro experiments using human monocytes and an ex-vivo swine carotidjugular arterio-venous shunt model to better understand the healing properties afforded by the PzF nanocoating. Overall, the PzF-nano-coating showed reduced monocyte adhesion and thrombus formation compared to the un-coated controls. Conclusions: Stents modified with a nano-thin PzF-coating implanted in healthy swine indicate favorable vascular healing properties shown by reduced neointimal hyperplasia and inflammation, along with resistance to thrombus formation in an ex-vivo shunt model over unmodified stents. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • 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年11月 [査読有り][通常論文]
     
    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).
  • Yusuke Adachi, Kenichi Sakakura, Hiroshi Wada, Hiroshi Funayama, Tomio Umemoto, Hideo Fujita, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 57 5 565 - 572 2016年09月 [査読有り][通常論文]
     
    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年07月 [査読有り][通常論文]
  • Yusuke Adachi, Kenichi Sakakura, Hiroshi Wada, Hiroshi Funayama, Tomio Umemoto, Shin-ichi Momomura, Hideo Fujita
    JOURNAL OF CARDIOLOGY 68 1-2 37 - 42 2016年07月 [査読有り][通常論文]
     
    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.
  • Takayuki Fujiwara, Masashi Yoshida, Naoyuki Akashi, Hodaka Yamada, Takunori Tsukui, Tomohiro Nakamura, Kenichi Sakakura, Hiroshi Wada, Kenshiro Arao, Takuji Katayama, Tomio Umemoto, Hiroshi Funayama, Yoshitaka Sugawara, Takeshi Mitsuhashi, Masafumi Kakei, Shin-ichi Momomura, Junya Ako
    HEART AND VESSELS 31 6 855 - 862 2016年06月 [査読有り][通常論文]
     
    Diabetes mellitus and impaired glucose tolerance are well-known risk factors for coronary artery disease (CAD) and adverse clinical events after percutaneous coronary intervention (PCI). Postprandial hyperglycemia is an important risk factor for CAD and serum 1,5-anhydroglucitol (1,5-AG) reflects postprandial hyperglycemia more robustly than hemoglobin (Hb)A1c. We aimed to clarify the relationship between serum 1,5-AG level and adverse clinical events after PCI. We enrolled 141 patients after PCI with follow-up coronary angiography. We evaluated associations between glycemic biomarkers including HbA1c and 1,5-AG and cardiovascular events during follow-up. Median serum 1,5-AG level was significantly lower in patients with any coronary revascularization and target lesion revascularization (TLR) [13.4 A mu g/ml (first quartile, third quartile 9.80, 18.3) vs. 18.7 (12.8, 24.2), p = 0.005; 13.4 A mu g/ml (10.2, 16.4) vs. 18.7 (12.9, 24.2), p = 0.001, respectively]. Multivariate logistic analysis showed lower 1,5-AG was independently associated with any coronary revascularization and TLR (odds ratio 0.93, 95 % confidence interval 0.86-0.99, p = 0.04; 0.90, 0.81-0.99, p = 0.044, respectively), whereas higher HbA1c was not. Postprandial hyperglycemia and lower 1,5-AG are important risk factors for adverse clinical events after PCI.
  • Kenichi Sakakura, Yousuke Taniguchi, Mitsunari Matsumoto, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNATIONAL HEART JOURNAL 57 3 376 - 379 2016年05月 [査読有り][通常論文]
     
    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 2016年05月 [査読有り][通常論文]
     
    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.
  • Yusuke Adachi, Nahoko Ikeda, Kenichi Sakakura, Sachiho Netsu, Tatsuro Ibe, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNAL MEDICINE 55 18 2639 - 2642 2016年 [査読有り][通常論文]
     
    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.
  • Yusuke Adachi, Kenichi Sakakura, Naoyuki Akashi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    INTERNAL MEDICINE 55 24 3603 - 3606 2016年 [査読有り][通常論文]
     
    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.
  • Kenichi Sakakura
    JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 23 8 903 - 904 2016年 [査読有り][通常論文]
  • Masamitsu Noguchi, Yoko Yamada, Kenichi Sakakura, Takuji Katayama, Shin-ichi Momomura, Junya Ako
    Cardiovascular Intervention and Therapeutics 31 1 75 - 78 2016年01月 [査読有り][通常論文]
     
    Thrombus aspiration is currently the standard strategy for primary PCI. Thrombus can be aspirated via aspiration catheters, restoring coronary blood flow. However, there are a limited number of reports regarding thrombus aspiration toward tumor embolized occlusion. We present a case of 90-year-old male with AMI caused by the metastatic tumor embolism. Emergent coronary angiography revealed total occlusion in three epicardial vessels. Histopathological examination of the aspirated specimen revealed the mixture of thrombus and metastatic tumor cells. Thrombus aspiration was partially effective for restoring coronary blood flow however, it was very helpful for the final diagnosis of tumor embolism.
  • Takayuki Fujiwara, Masashi Yoshida, Tomohiro Nakamura, Kenichi Sakakura, Hiroshi Wada, Kenshiro Arao, Takuji Katayama, Hiroshi Funayama, Yoshitaka Sugawara, Takeshi Mitsuhashi, Masafumi Kakei, Shin-ichi Momomura, Junya Ako
    HEART AND VESSELS 30 5 696 - 701 2015年09月 [査読有り][通常論文]
     
    Dipeptidyl peptidase-4 (DPP4) is an integral membrane glycoprotein that modulates the pathological state of diabetes mellitus (DM), and DPP4 inhibitors are a new class of anti-type-2 DM drugs. Recent preclinical studies have associated DPP4 inhibition with improved myocardial systolic and diastolic function. Based on preclinical findings, we investigated associations between the administration of DPP4 inhibitors and cardiac function after acute myocardial infarction (AMI) in a clinical setting. We enrolled 34 patients with diabetes who were treated for acute myocardial infarction at our hospital between January 2010 and December 2012. We retrospectively compared changes in cardiac parameters determined by trans-thoracic echocardiography between patients treated with (DPP4-I group; n = 13) or without (non-DPP4-I group; n = 21) a DPP4 inhibitor during follow-up. The values of E/e' and of e'/a' significantly decreased and increased, respectively, in the DPP4-I, compared with the non-DPP4-I group (-2.53 +/- A 5.53 vs. 2.58 +/- A 5.68, p = 0.038 and 0.08 +/- A 0.23 vs. -0.12 +/- A 0.21, p = 0.036, respectively). We concluded that DPP4 inhibitors could improve E/e' and e'/a' in patients with DM and AMI and thus might be effective for treating left ventricular diastolic failure.
  • Yasushi Wakabayashi, Hiroshi Wada, Kenichi Sakakura, Kei Yamamoto, Takeshi Mitsuhashi, Junya Ako, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 66 3-4 341 - 346 2015年09月 [査読有り][通常論文]
     
    Background: The optimal preoperative therapeutic strategy for patients with coronary artery disease (CAD) is an important concern in the era of drug-eluting stents and antiplatelet therapy. However, there are few studies about the impact of prior percutaneous coronary intervention (PCI) on perioperative major adverse cardiac events (MACEs) and bleeding events associated with oral antiplatelet therapy. The aim of this study was to examine the risks and benefits of performing PCI before non-cardiac surgery (NCS) in patients with CAD. Methods: We investigated 130 patients who had angiographically significant and stable CAD and underwent NCS after index coronary angiography. We divided the patients into two groups: patients undergoing PCI with coronary stenting (PCI group), and those not undergoing PCI before NCS (no-PCI group), and compared the MACEs and bleeding events within 30 days from NCS between the groups. Results: There were 53 and 77 patients in the PCI and no-PCI groups, respectively. MACEs were observed in 2 patients (3.8%) in the PCI group and 3 patients (3.9%) in the no-PCI group (p = 0.97), whereas bleeding events were observed in 10 (18.9%) and 8 patients (10.4%) in the PCI and no-PCI groups, respectively (p = 0.17). There were no significant differences between the two groups in terms of MACEs and bleeding events. Conclusions: The rate of MACEs following NCS was not significantly different between the PCI and no-PCI groups, while the rate of bleeding events was higher in the PCI group without reaching statistical significance. This study suggests that patients with stable CAD may be able to safely undergo NCS without revascularization even in the presence of significant coronary artery stenosis. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Hiroyuki Jinnouchi, Shoichi Kuramitsu, Tomohiro Shinozaki, Yohei Kobayashi, Takashi Hiromasa, Takashi Morinaga, Toru Mazaki, Kenichi Sakakura, Yoshimitsu Soga, Makoto Hyodo, Shinichi Shirai, Kenji Ando
    CIRCULATION JOURNAL 79 9 1938 - 1943 2015年09月 [査読有り][通常論文]
     
    Background: Clinical outcomes of implantation of the newer-generation drug-eluting stent (DES) following rotational atherectomy for heavily calcified lesions remain unclear in the real-world setting. Methods and Results: We enrolled 252 consecutive patients (273 lesions) treated with newer-generation DES following rotational atherectomy. The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, clinically-driven target lesion revascularization, and definite stent thrombosis. Complete clinical follow-up information at 2-year was obtained for all patients. The mean age was 73.2+/-9.0 years and 155 patients (61.5%) were male. Cumulative 2-year incidence of MACE (cardiac death, myocardial infarction, clinically-driven target lesion revascularization and definite stent thrombosis) was 20.3% (7.0%, 2.1%, 18.1% and 2.1%, respectively). Predictors of MACE were presenting with acute coronary syndrome (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.29-11.2, P= 0.02), hemodialysis (HR: 1.93, 95% CI: 1.04-3.56, P= 0.04) and previous coronary artery bypass graft (HR: 2.26, 95% CI: 1.02-5.00, P= 0.045). Conclusions: PCI for calcified lesions requiring rotational atherectomy is still challenging even in the era of newer-generation DES.
  • Otsuka F, Cheng Q, Yahagi K, Acampado E, Sheehy A, Yazdani SK, Sakakura K, Euller K, Perkins LE, Kolodgie FD, Virmani R, Joner M
    JACC. Cardiovascular interventions 8 9 1248 - 1260 2015年08月 [査読有り][通常論文]
     
    OBJECTIVES This study sought to evaluate whether the permanent fluoropolymer-coated Xience Xpedition everolimus-eluting stent (Xience-EES) exhibits lower acute thrombogenicity compared with contemporary drug-eluting stents (DES) with biodegradable polymer coatings in an acute swine shunt model. BACKGROUND Previous pre-clinical and clinical experience suggests that several factors may influence the predisposition for acute thrombus formation of polymer-coated DES, including stent design and the polymer coating technology. It remains unclear whether relevant differences exist with respect to acute thrombogenicity, particularly between current commercial stent designs using permanent polymers and those using biodegradable polymers. METHODS An ex vivo carotid to jugular arteriovenous porcine shunt model involving a test circuit of 3 in-line stents, was used to test acute thrombogenicity, where Xience-EES (n = 24) was compared with 4 CE-marked DES with biodegradable polymer coatings (BioMatrix Flex, Synergy, Nobori, and Orsiro [n = 6 each]). After 1 h of circulation, platelet aggregation in whole mount stents was evaluated by confocal microscopy with immunofluorescent staining against dual platelet markers (CD61/CD42b) along with scanning electron microscopy. RESULTS Xience-EES showed the least percentage of thrombus-occupied area as compared with the biodegradable polymer-coated DES, with a significant difference compared with BioMatrix Flex and Synergy (mean differences: [BioMatrix Flex: 15.54, 95% confidence interval [CI]: 11.34 to 19.75, p < 0.001; Synergy: 8.64, 95% CI: 4.43 to 12.84, p < 0.001; Nobori: 4.22, 95% CI: -0.06 to 8.49, p = 0.055; Orsiro: 2.95, 95% CI: -1.26 to 7.15, p = 0.286). The number of cell nuclei on strut surfaces was also the least in Xience-EES, with a significant difference relative to BioMatrix Flex, Nobori, and Orsiro (mean ratios: BioMatrix Flex: 4.73, 95% CI: 2.46 to 9.08, p < 0.001; Synergy: 1.44, 95% CI: 0.75 to 2.76, p = 0.51; Nobori: 5.97, 95% CI: 3.11 to 11.44, p < 0.001; Orsiro: 5.16, 95% CI: 2.69 to 9.91, p < 0.001). CONCLUSIONS Xience-EES's overall design confers acute thromboresistance relative to contemporary DES with biodegradable coatings, with less platelet aggregation versus BioMatrix Flex and Synergy, and less inflammatory cell attachment versus BioMatrix Flex, Nobori, and Orsiro, in an ex vivo swine shunt model, which lends support to reported clinical findings of lower early stent thrombosis. (C) 2015 by the American College of Cardiology Foundation.
  • Shingo Yamamoto, Kenichi Sakakura, Hiroshi Funayama, Hiroshi Wada, Hideo Fujita, Shin-ichi Momomura
    JACC-CARDIOVASCULAR INTERVENTIONS 8 10 1396 - 1398 2015年08月 [査読有り][通常論文]
  • Takayuki Fujiwara, Masashi Yoshida, Hodaka Yamada, Takunori Tsukui, Tomohiro Nakamura, Kenichi Sakakura, Hiroshi Wada, Kenshiro Arao, Takuji Katayama, Hiroshi Funayama, Yoshitaka Sugawara, Takeshi Mitsuhashi, Masafumi Kakei, Shin-ichi Momomura, Junya Ako
    HEART AND VESSELS 30 4 469 - 476 2015年07月 [査読有り][通常論文]
     
    Postprandial hyperglycemia is a risk factor for cardiovascular disease and mortality. Serum 1,5-anhydroglucitol (1,5-AG) level is an useful clinical marker of glucose metabolism which reflects postprandial hyperglycemia more robustly compared to hemoglobin A1c (HbA1c). Relationship between serum 1,5-AG level and cardiovascular disease has been reported; however, comparison between HbA1c and 1,5-AG as markers of cardiovascular disease was not performed. We included 227 consecutive patients who underwent coronary angiography meeting the following inclusion criteria: (1) patients who had no history of coronary artery disease (CAD); (2) patients without acute coronary syndrome; (3) patients without poorly controlled diabetes mellitus; (4) patients without anemia, liver dysfunction, acute, and chronic renal failure and malnutrition; and (5) patients without adhibition of acarbose or Chinese herbal medicine. We measured HbA1c, glycoalbumin, and 1,5-AG. Serum 1,5-AG was significantly lower in patients with CAD (16.6 +/- A 8.50 vs. 21.1 +/- A 7.97 mu g/ml, P < 0.001). Multivariable logistic regression analysis showed decrease in serum 1,5-AG was independently associated with the presence of denovo CAD (0.93, 95 % CI 0.88-0.98, P = 0.006). Serum 1,5-AG was also independently associated with the presence of denovo CAD in patients without diabetes mellitus (0.94, 95 % CI 0.88-0.99, P = 0.046). In conclusion, lower serum 1,5-AG was associated with the presence of denovo CAD. Serum 1,5-AG may identify high cardiovascular risk patients for denovo CAD in both diabetic and non-diabetic patients.
  • Masaru Seguchi, Hiroshi Wada, Kenichi Sakakura, Tom Nakagawa, Tatsuro Ibe, Nahoko Ikeda, Yoshitaka Sugawara, Junya Ako, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 56 3 324 - 328 2015年05月 [査読有り][通常論文]
     
    Acute aortic dissection (AAD) is a life-threatening cardiovascular disease with high mortality. Hypertension is a well known risk factor of AAD. There have been previous reports about the association between circadian variation of blood pressure (BP) and cardiovascular events. However, little is known about the association between the onset-time of AAD and circadian variation of BP. The purpose of this study was to clarify the characteristics of circadian variation of BP in AAD and its relation to the onset-time of this disease. This study included type B spontaneous AAD patients who were referred to our institution and treated conservatively between January 2008 and June 2013. Patients with type A AAD, secondary to trauma, and type B AAD which preceded surgical intervention were excluded. Data were retrospectively collected from the hospital medical records. Sixty-eight patients with type B AAD were enrolled. The distribution of the circadian pattern in the study patients was as follows: extreme-dipper, 0% (none); dipper, 20.6% (n = 14); non-dipper, 50% (n = 34); riser, 29.4% (n = 20). Non-dipper and riser patterns were more frequently observed compared with. other population studies reported previously. Moreover, no patient in the dipper group had night-time onset while 31.5% of the patients in the absence of nocturnal BP fall group (non-dipper and riser) did (P = 0.01). Absence of a nocturnal BP fall was frequently seen in AAD patients. Absence of a nocturnal BP fall may be a risk factor of AAD. Circadian variation of BP may also affect the onset-time of type BAAD.
  • Kenichi Sakakura
    Journal of Cardiology Cases 11 2 42 - 43 2015年02月 [査読有り][通常論文]
  • Kenichi Sakakura, Austin Roth, Elena Ladich, Kai Shen, Leslie Coleman, Michael Joner, Renu Virmani
    EuroIntervention 10 10 1230 - 1238 2015年02月 [査読有り][通常論文]
     
    Aims: The Paradise Ultrasound Renal Denervation System is a next-generation catheter-based device which was used to investigate whether the target ablation area can be controlled by changing ultrasound energy and duration to optimise nerve injury while preventing damage to the arterial wall. Methods and results: Five ultrasound doses were tested in a thermal gel model. Catheter-based ultrasound denervation was performed in 15 swine (29 renal arteries) to evaluate five different doses in vivo, and animals were euthanised at seven days for histopathologic assessment. In the gel model, the peak temperature was highest in the low power-long duration (LP-LD) dose, followed by the mid-low power-mid duration (MLP-MD) dose and the mid-high power-short duration (MHP-SD) dose, and lowest in the mid power-short duration (MP-SD) dose and the high power-ultra short duration (HP-USD) dose. In the animal study, total ablation area was significantly greater in the LP-LD group, followed by the MLP-MD group, and it was least in the HP-USD, MP-SD and MHP-SD groups (p=0.02). Maximum distance was significantly greater in the LP-LD group, followed by the MLP-MD group, the MHP-SD group, and the HP-USD group, and shortest in the MP-SD group (p=0.007). The short spare distance was not different among the five groups (p=0.38). Renal artery damage was minimal, while preserving significant nerve damage in all groups. Conclusions: The Paradise Ultrasound Renal Denervation System is a controllable system where total ablation area and depth of ablation can be optimised by changing ultrasound power and duration while sparing renal arterial tissue damage but allowing sufficient pen-arterial nerve damage.
  • Kenichi Sakakura, Stefan Tunev, Kazuyuki Yahagi, Amanda J. O'Brien, Elena Ladich, Frank D. Kolodgie, Robert J. Melder, Michael Joner, Renu Virmani
    CIRCULATION-CARDIOVASCULAR INTERVENTIONS 8 2 e001813  2015年02月 [査読有り][通常論文]
     
    Background-The pathology of radiofrequency-derived sympathetic renal denervation has not been studied over time and may provide important understanding of the mechanisms resulting in sustained blood pressure reduction. The purpose of this study was to investigate chronological changes after radiofrequency-renal denervation in the swine model. Methods and Results-A total of 49 renal arteries from 28 animals with 4 different time points (7, 30, 60, and 180 days) were examined. Semiquantitative histological assessment of arteries and associated tissue was performed to characterize the chronological progression of the radiofrequency lesions. Arterial medial circumferential injury (%) was greatest at 7 days (38 +/- 13%), followed by 30 days (31 +/- 6%) and 60 days (31 +/- 15%), and least at 180 days (21 +/- 12%) (P=0.046). Nerve injury score was significantly greater (P<0.001) at 7 days (3.9 +/- 0.4) compared with 30 days (2.5 +/- 0.5), 60 days (2.6 +/- 0.5), and 180 days (1.9 +/- 0.9). Tyrosine hydroxylase score, which assesses functional nerve damage, was significantly less after 7 (1 +/- 1) and 30 days (0.7 +/- 0.6) compared with 60 (2.7 +/- 0.6) and 180 days (2.7 +/- 0.6; P=0.01). Focal nerve regeneration at the sites of radiofrequency ablation was observed in 17% of renal arteries at 60 days and 71% of 180 days. Conclusions-Nerve injury after radiofrequency ablation was greatest at 7 days, with maximum functional nerve damage sustained <= 30 days. Focal terminal nerve regeneration was observed only at the sites of ablation as early as 60 days and continued to 180 days. Renal artery and peri-arterial soft tissue injury is greatest in the subacute phase, and least in the chronic phase, suggesting gradual recovery of the renal arterial wall and surrounding tissue.
  • Austin Roth, Leslie Coleman, Kenichi Sakakura, Elena Ladich, Renu Virmani
    ENERGY-BASED TREATMENT OF TISSUE AND ASSESSMENT VIII 9326 2015年 [査読有り][通常論文]
     
    An intra-luminal ultrasound catheter system (ReCor Medical's Paradise System) has been developed to provide circumferential denervation of the renal sympathetic nerves, while preserving the renal arterial intimal and medial layers, in order to treat hypertension. The Paradise System features a cylindrical non-focused ultrasound transducer centered within a balloon that circulates cooling fluid and that outputs a uniform circumferential energy pattern designed to ablate tissues located 1-6 mm from the arterial wall and protect tissues within 1 mm. RF power and cooling flow rate are controlled by the Paradise Generator which can energize transducers in the 8.5-9.5 MHz frequency range. Computer simulations and tissue-mimicking phantom models were used to develop the proper power, cooling flow rate and sonication duration settings to provide consistent tissue ablation for renal arteries ranging from 5-8 mm in diameter. The modulation of these three parameters allows for control over the near-field (border of lesion closest to arterial wall) and far-field (border of lesion farthest from arterial wall, consisting of the adventitial and peri-adventitial spaces) depths of the tissue lesion formed by the absorption of ultrasonic energy and conduction of heat. Porcine studies have confirmed the safety (protected intimal and medial layers) and effectiveness (ablation of 1-6 mm region) of the system and provided near-field and far-field depth data to correlate with bench and computer simulation models. The safety and effectiveness of the Paradise System, developed through computer model, bench and in vivo studies, has been demonstrated in human clinical studies.
  • Kenichi Sakakura, Yusuke Adachi, Yousuke Taniguchi, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
    Case reports in cardiology 2015 407059 - 407059 2015年 [査読有り][通常論文]
     
    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.
  • Sandeep Panikker, Renu Virmani, Kenichi Sakakura, Frank Kolodgie, Darrel P. Francis, Vias Markides, Greg Walcott, H. Tom McElderry, Tom Wong
    HEART RHYTHM 12 1 202 - 210 2015年01月 [査読有り][通常論文]
     
    BACKGROUND Left atrial appendage (LAA) electrical isolation is reported to improve atrial fibrillation ablation outcomes. However, loss of mechanical function may increase thromboembolic risk. OBJECTIVE The aim of this study was to evaluate the feasibility and safety of LAA occlusion after electrical isolation in a canine model. METHODS Nine canines underwent LAA isolation with irrigated radiofrequency ablation after pulmonary vein (PV) isolation. Entrance and exit block were confirmed with intravenous adenosine after 30 minutes. The LAA was then occluded with a Watchman device. Device position was assessed at 10 days by using transthoracic echocardiography. At 45 days, LAA isolation was assessed epicardially. Hearts were then examined macroscopically and histologically. RESULTS All 36 PVs and 8 of 9 LAAs (89%) were electrically isolated, Acute LAA reconnection occurred in 4 of 8 LAAs (50%). All were reisolated. The mean ablation time was 51 +/- 19 minutes, including 24 +/- 18 minutes for LAA isolation. LAA occlusion was successful in all cases. One animal died of a primary intracranial bleed due to anticoagulant hypersensitivity 36 hours after the procedure. Transthoracic echocardiography at 10 days confirmed satisfactory device positions and no pericardial effusion. At 45 days, 7 of 8 (88%) had persistent LAA electrical isolation. All devices were stable without evidence of erosion. Microscopy revealed complete device-tissue apposition and a mature connective tissue layer overlying the device surface in all cases. CONCLUSION LAA electrical isolation and mechanical occlusion can be performed concomitantly in this animal model, with no displacement or mechanical erosion of the appendage at 45 days. This technique can potentially improve success rates and obviate the need for chronic anticoagulation. Future studies should address efficacy, safety, and feasibility in humans.
  • Kenichi Sakakura, Elena Ladich, Kristine Fuimaono, Debby Grunewald, Patrick O'Fallon, Anna-Maria Spognardi, Peter Markham, Fumiyuki Otsuka, Kazuyuki Yahagi, Kai Shen, Frank D. Kolodgie, Michael Joner, Renu Virmani
    CIRCULATION-CARDIOVASCULAR INTERVENTIONS 8 1 2015年01月 [査読有り][通常論文]
     
    Background-The long-term efficacy of radiofrequency ablation of renal autonomic nerves has been proven in nonrandomized studies. However, long-term safety of the renal artery (RA) is of concern. The aim of our study was to determine if cooling during radiofrequency ablation preserved the RA while allowing equivalent nerve damage. Methods and Results-A total of 9 swine (18 RAs) were included, and allocated to irrigated radiofrequency (n=6 RAs, temperature setting: 50 degrees C), conventional radiofrequency (n=6 RAs, nonirrigated, temperature setting: 65 degrees C), and high-temperature radiofrequency (n=6 RAs, nonirrigated, temperature setting: 90 degrees C) groups. RAs were harvested at 10 days, serially sectioned from proximal to distal including perirenal tissues and examined after paraffin embedding, and staining with hematoxylin-eosin and Movat pentachrome. RAs and periarterial tissue including nerves were semiquantitatively assessed and scored. A total of 660 histological sections from 18 RAs were histologically examined by light microscopy. Arterial medial injury was significantly less in the irrigated radiofrequency group (depth of medial injury, circumferential involvement, and thinning) than that in the conventional radiofrequency group (P<0.001 for circumference; P=0.003 for thinning). Severe collagen damage such as denatured collagen was also significantly less in the irrigated compared with the conventional radiofrequency group (P<0.001). Nerve damage although not statistically different between the irrigated radiofrequency group and conventional radiofrequency group (P=0.36), there was a trend toward less nerve damage in the irrigated compared with conventional. Compared to conventional radiofrequency, circumferential medial damage in highest-temperature nonirrigated radiofrequency group was significantly greater (P<0.001). Conclusions-Saline irrigation significantly reduces arterial and periarterial tissue damage during radiofrequency ablation, and there is a trend toward less nerve damage.
  • Kei Yamamoto, Hiroshi Wada, Kenichi Sakakura, Nahoko Ikeda, Yoko Yamada, Takuji Katayama, Yoshitaka Sugawara, Takeshi Mitsuhashi, Junya Ako, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 64 5-6 334 - 338 2014年11月 [査読有り][通常論文]
     
    Background: The perioperative risk of non-cardiac surgery (NCS) in the patients on antiplatelet therapy after percutaneous coronary intervention (PCI) remains unclear. Methods: This study was a retrospective and single center study. Between January 2008 and December 2011,198 patients who had already received PCI underwent NCS in our hospital. Among them, 63 patients underwent surgery on dual antiplatelet therapy (DAPT group) and 88 patients on single antiplatelet therapy (SAPT group). We compared bleeding events and cardiovascular events during perioperative period between the two groups. Results: There was no stent thrombosis in either group. The bleeding events in the DAPT group were significantly higher than that in the SAPT group (9.5% vs 2.3%, p = 0.049). There was no difference in events between with or without heparin-bridge in the SAPT group. Conclusions: The frequency of bleeding events was higher in the DAPT group. Both bleeding and cardiovascular events with aspirin alone were low in our study. It may be safe to undergo NCS with SAPT after PCI. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Yahagi K, Zarpak R, Sakakura K, Otsuka F, Kutys R, Ladich E, Fowler DR, Joner M, Virmani R
    JACC. Cardiovascular imaging 7 11 1172 - 1174 2014年11月 [査読有り][通常論文]
  • Kenichi Sakakura, Elena Ladich, Elazer R. Edelman, Peter Markham, James R. L. Stanley, John Keating, Frank D. Kolodgie, Renu Virmani, Michael Joner
    JACC-CARDIOVASCULAR INTERVENTIONS 7 10 1184 - 1193 2014年10月 [査読有り][通常論文]
     
    Transcatheter ablation of renal autonomic nerves is a viable option for the treatment of resistant arterial hypertension; however, structured pre-clinical evaluation with standardization of analytical procedures remains a clear gap in this field. Here we discuss the topics relevant to the pre-clinical model for the evaluation of renal denervation (RDN) devices and report methodologies and criteria toward standardization of the safety and efficacy assessment, including histopathological evaluations of the renal artery, periarterial nerves, and associated periadventitial tissues. The pre-clinical swine renal artery model can be used effectively to assess both the safety and efficacy of RDN technologies. Assessment of the efficacy of RDN modalities primarily focuses on the determination of the depth of penetration of treatment-related injury (e.g., necrosis) of the periarterial tissues and its relationship (i.e., location and distance) and the effect on the associated renal nerves and the correlation thereof with proxy biomarkers including renal norepinephrine concentrations and nervespecific immunohistochemical stains (e.g., tyrosine hydroxylase). The safety evaluation of RDN technologies involves assessing for adverse effects on tissues local to the site of treatment (i.e., on the arterial wall) as well as tissues at a distance (e.g., soft tissue, veins, arterial branches, skeletal muscle, adrenal gland, ureters). Increasing experience will help to create a standardized means of examining all arterial beds subject to ablative energy and in doing so enable us to proceed to optimize the development and assessment of these emerging technologies. (C) 2014 by the American College of Cardiology Foundation.
  • Kenichi Sakakura, Michael Joner, Renu Virmani
    JACC-CARDIOVASCULAR IMAGING 7 8 796 - 798 2014年08月 [査読有り][通常論文]
  • Kenichi Sakakura, Elena Ladich, Qi Cheng, Fumiyuki Otsuka, Kazuyuki Yahagi, David R. Fowler, Frank D. Kolodgie, Renu Virmani, Michael Joner
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 64 7 635 - 643 2014年08月 [査読有り][通常論文]
     
    BACKGROUND Although renal sympathetic denervation therapy has shown promising results in patients with resistant hypertension, the human anatomy of peri-arterial renal nerves is poorly understood. OBJECTIVES The aim of our study was to investigate the anatomic distribution of peri-arterial sympathetic nerves around human renal arteries. METHODS Bilateral renal arteries were collected from human autopsy subjects, and peri-arterial renal nerve anatomy was examined by using morphometric software. The ratio of afferent to efferent nerve fibers was investigated by dual immunofluorescence staining using antibodies targeted for anti-tyrosine hydroxylase and anti-calcitonin gene-related peptide. RESULTS A total of 10,329 nerves were identified from 20 (12 hypertensive and 8 nonhypertensive) patients. The mean individual number of nerves in the proximal and middle segments was similar (39.6 +/- 16.7 per section and 39.9 +/- 1 3.9 per section), whereas the distal segment showed fewer nerves (33.6 +/- 13.1 per section) (p = 0.01). Mean subject-specific nerve distance to arterial lumen was greatest in proximal segments (3.40 +/- 0.78 mm), followed by middle segments (3.10 +/- 0.69 mm), and least in distal segments (2.60 +/- 0.77 mm) (p < 0.001). The mean number of nerves in the ventral region (11.0 +/- 3.5 per section) was greater compared with the dorsal region (6.2 +/- 3.0 per section) (p < 0.001). Efferent nerve fibers were predominant (tyrosine hydroxylase/calcitonin gene-related peptide ratio 25.1 +/- 33.4; p < 0.0001). Nerve anatomy in hypertensive patients was not considerably different compared with nonhypertensive patients. CONCLUSIONS The density of peri-arterial renal sympathetic nerve fibers is lower in distal segments and dorsal locations. There is a clear predominance of efferent nerve fibers, with decreasing prevalence of afferent nerves from proximal to distal peri-arterial and renal parenchyma. Understanding these anatomic patterns is important for refinement of renal denervation procedures. (C) 2014 by the American College of Cardiology Foundation.
  • Hiroyuki Jinnouchi, Kenichi Sakakura, Hiroshi Wada, Kenshiro Arao, Norifumi Kubo, Yoshitaka Sugawara, Hiroshi Funayama, Shin-ichi Momomura, Junya Ako
    HEART AND VESSELS 29 4 429 - 436 2014年07月 [査読有り][通常論文]
     
    No reflow following primary percutaneous coronary intervention (PCI) is a serious complication in the treatment of acute myocardial infarction. No reflow in some patients is reversible (transient no reflow), whereas no reflow in others persists until the end of the procedure (persistent no reflow). The aim of this study was to identify clinical features of transient no reflow following primary PCI. Consecutive patients with no reflow (n = 123) were enrolled following primary PCI. Among them, 59 patients were in the transient group and 64 in the persistent group. We compared clinical features and hospital outcomes between the two groups. Multivariate logistic regression analysis was performed to identify the determinants of transient no reflow. The transient group had a lower rate of in-hospital cardiac death than the persistent group (0 vs. 6.4 %, relatively, P = 0.018). There was a trend for a shorter length of hospital stay in the transient group. Multivariate logistic regression analysis identified initial thrombolysis in myocardial infarction (TIMI) flow grade 3 (OR 6.239, 95 % CI 1.727-22.541, P = 0.005) and a higher estimated glomerular filtration rate (OR 1.204, 95 % CI 1.006-1.440, P = 0.042) as independent predictors of transient no reflow. Transient no reflow tended to be associated with TIMI thrombus grade a parts per thousand currency sign3 (OR 2.879, 95 % CI 0.928-8.931, P = 0.067). In conclusion, initial TIMI flow grade 3 and preserved renal function were associated with recovery from no reflow. Initial angiographic finding such as TIMI flow or TIMI thrombus grade might be an important predictor of recovery from the no-reflow phenomenon.
  • Kenichi Sakakura, Masataka Nakano, Fumiyuki Otsuka, Kazuyuki Yahagi, Robert Kutys, Elena Ladich, Aloke V. Finn, Frank D. Kolodgie, Renu Virmani
    EUROPEAN HEART JOURNAL 35 25 1683 - + 2014年07月 [査読有り][通常論文]
     
    Aims The aim of our study was to investigate chronic total occlusion (CTO) in human coronary arteries to clarify the difference between CTO with prior coronary artery bypass graft (CABG) and those without prior CABG. Methods and results A total of 95 CTO lesions from 82 patients (61.6 +/- 14.0 years, male 87.8%) were divided into the following three groups: CTO with CABG (n = 34) (CTO+CABG), CTO without CABG-of long-duration (n = 49) (LD-CTO) and short-duration (n = 12) (SD-CTO). A histopathological comparison of the plaque characteristics of CTO, proximal and distal lumen morphology, and negative remodelling between groups was performed. A total of 1127 sections were evaluated. Differences in plaque characteristics were observed between groups as follows: necrotic core area was highest in SD-CTO (18.6%) (LD-CTO: 7.8%; CTO+CABG: 4.5%; P = 0.02); calcified area was greatest in CTO+CABG (29.2%) (LD-CTO: 16.8%; SD-CTO: 12.1%; P = 0.009); and negative remodelling was least in SD-CTO [remodelling index (RI) 0.86] [CTO+CABG (RI): 0.72 and LD-CTO (RI): 0.68; P < 0.001]. Approximately 50% of proximal lumens showed characteristics of abrupt closure, whereas the majority of distal lumen patterns were tapered (79%) (P < 0.0001). Conclusion These pathological differences in calcification, negative remodelling, and presence of necrotic core along with proximal and distal tapering, which has been associated with greater success, help explain the differences in success rates of percutaneous coronary intervention in CTO patients with and without CABG.
  • Renu Virmani, Michael Joner, Kenichi Sakakura
    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY 34 7 1329 - 1332 2014年07月 [査読有り][通常論文]
  • Masataka Nakano, Kazuyuki Yahagi, Fumiyuki Otsuka, Kenichi Sakakura, Aloke V. Finn, Robert Kutys, Elena Ladich, David R. Fowler, Michael Joner, Renu Virmani
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 63 23 2510 - 2520 2014年06月 [査読有り][通常論文]
     
    Objectives The study interrogated an autopsy registry to investigate the histopathologic features of early stent thrombosis (ST) in patients presenting with acute coronary syndrome (ACS). Background The occurrence of early ST following percutaneous coronary intervention (PCI) for ACS remains a clinical problem despite advances in stent technology in both bare-metal and drug-eluting stents. Methods Sixty-seven stented coronary lesions from 59 patients who presented with ACS and died within 30 days were included. Stented segments were cross sectioned at 3 to 4 mm intervals and evaluated by light microscopy, and morphometric analysis was performed. Results Early ST (< 30 days of PCI) was identified in 34 (58%) of the 59 patients. Early ST was dependent on the underlying plaque morphology and underlying thrombus burden: presence of necrotic core prolapse was more frequent in thrombosed lesions compared with patent lesions (70% vs. 43%, p = 0.045) and maximal underlying thrombus thickness was significantly greater in thrombosed versus patent lesions. All 3 patients with false lumen stenting had ST. Detailed analysis revealed that the percent of necrotic core prolapse, medial tear, or incomplete apposition was significantly greater in the early ST compared with patent group (28% vs. 11%, p < 0.001; 27% vs. 15% p = 0.004; and 34% vs. 18% p = 0.008, respectively). Multivariate analysis revealed that maximal depth of strut penetration, % strut with medial tear, and % struts with incomplete apposition were the primary indicators of early ST. Conclusions The current autopsy study highlights the impact of thrombus burden and suboptimal stent implantation in unstable lesions as a trigger of early ST, suggesting that improvement in implantation technique and refinement of stent design may improve clinical outcomes of ACS patients. (c) 2014 by the American College of Cardiology Foundation
  • Fumiyuki Otsuka, Erica Pacheco, Laura E. L. Perkins, Jennifer P. Lane, Qing Wang, Marika Kamberi, Michael Frie, Jin Wang, Kenichi Sakakura, Kazuyuki Yahagi, Elena Ladich, Richard J. Rapoza, Frank D. Kolodgie, Renu Virmani
    CIRCULATION-CARDIOVASCULAR INTERVENTIONS 7 3 330 - 342 2014年06月 [査読有り][通常論文]
     
    Background The Absorb everolimus-eluting bioresorbable vascular scaffold (Absorb) has shown promising clinical results; however, only limited preclinical data have been published. We sought to investigate detailed pathological responses to the Absorb versus XIENCE V (XV) in a porcine coronary model with duration of implant extending from 1 to 42 months. Methods and Results A total of 335 devices (263 Absorb and 72 XV) were implanted in 2 or 3 main coronary arteries of 136 nonatherosclerotic swine and examined by light microscopy, scanning electron microscopy, pharmacokinetics, and gel permeation chromatography analyses at various time points. Vascular responses to Absorb and XV were largely comparable at all time points, with struts being sequestered within the neointima. Inflammation was mild to moderate (with absence of inflammation at 1 month) for both devices, although the scores were greater in Absorb at 6 to 36 months. Percent area stenosis was significantly greater in Absorb than XV at all time points except at 3 months. The extent of fibrin deposition was similar between Absorb and XV, which peaked at 1 month and decreased rapidly thereafter. Histomorphometry showed expansile remodeling of Absorb-implanted arteries starting after 12 months, and lumen area was significantly greater in Absorb than XV at 36 and 42 months. These changes correlated with dismantling of Absorb seen after 12 months. Gel permeation chromatography analysis confirmed that degradation of Absorb was complete by 36 months. Conclusions Absorb demonstrates comparable long-term safety to XV in porcine coronary arteries with mild to moderate inflammation. Although Absorb was associated with greater percent stenosis relative to XV, expansile remodeling was observed after 12 months in Absorb with significantly greater lumen area at 36 months. Resorption is considered complete at 36 months.
  • Kenichi Sakakura, Michael Joner
    EUROINTERVENTION 10 2 178 - 180 2014年06月 [査読有り][通常論文]
  • Hiroshi Wada, Takanori Yasu, Kenichi Sakakura, Yuki Hayakawa, Takeshi Ishida, Nobuhiko Kobayashi, Norifumi Kubo, Junya Ako, Shin-ichi Momomura
    HEART AND VESSELS 29 3 308 - 312 2014年05月 [査読有り][通常論文]
     
    Although detecting left ventricular thrombus in anterior myocardial infarction is important for the prevention of embolic events, imaging of apical thrombus is often difficult using conventional echocardiography. We examined whether contrast echocardiography improves sensitivity and specificity in detecting thrombus in the left ventricle in comparison with conventional echocardiography alone in patients with anterior myocardial infarction. Participants in this single-center prospective study comprised 392 patients with anterior myocardial infarction admitted between 2000 and 2006. After conventional echocardiography, all patients underwent contrast echocardiography (left ventricular opacification and myocardial contrast echocardiography) during intravenous drip infusion of contrast media at rest. Left ventricular thrombus was diagnosed based on left ventriculography or multidetector-row computed tomography (MDCT). Mural left ventricular thrombus was confirmed by left ventriculography and/or MDCT in 32 of 393 patients (8 %). Sensitivity and specificity of conventional echocardiography alone were 88 % and 96 %, respectively, compared with 100 % each with contrast echocardiography. Among the 32 patients with left ventricular thrombus, 25 patients (78 %) showed no perfusion in the anterior wall on myocardial contrast echocardiography, even with a four-beat interval. In conclusion, contrast echocardiography offers a clinically feasible and useful method for noninvasively evaluating left ventricular thrombus in anterior myocardial infarction.
  • Oscar D Sanchez, Kenichi Sakakura, Fumiyuki Otsuka, Kazuyuki Yahagi, Renu Virmani, Michael Joner
    Expert review of cardiovascular therapy 12 5 601 - 11 2014年05月 [査読有り][通常論文]
     
    Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS) allowed the field to evaluate the principles of vascular anatomy, which is often underestimated by coronary angiography. Furthermore, IVUS image technologies were developed to obtain improved characterization of plaque composition. However, since spatial resolution of IVUS is insufficient to distinguish details of plaque morphology, a broad adoption of this technology in clinical practice was missing. Optical coherence tomography is a light-based imaging modality with higher spatial resolution compared to IVUS, which enables the assessment of vascular anatomy with great detail.
  • Fumiyuki Otsuka, Kenichi Sakakura, Kazuyuki Yahagi, Michael Joner, Renu Virmani
    ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY 34 4 724 - 736 2014年04月 [査読有り][通常論文]
     
    Coronary artery calcification is a well-established predictor of future cardiac events; however, it is not a predictor of unstable plaque. The intimal calcification of the atherosclerotic plaques may begin with smooth muscle cell apoptosis and release of matrix vesicles and is almost always seen microscopically in pathological intimal thickening, which appears as microcalcification (0.5 m, typically <15 m in diameter). Calcification increases with macrophage infiltration into the lipid pool in early fibroatheroma where they undergo apoptosis and release matrix vesicles. The confluence of calcified areas involves extracellular matrix and the necrotic core, which can be identified by radiography as speckled (2 mm) or fragmented (>2, <5 mm) calcification. The calcification in thin-cap fibroatheromas and plaque rupture is generally less than what is observed in stable plaques and is usually speckled or fragmented. Fragmented calcification spreads into the surrounding collagen-rich matrix forming calcified sheets, the hallmarks of fibrocalcific plaques. The calcified sheets may break into nodules with fibrin deposition, and when accompanied by luminal protrusion, it is associated with thrombosis. Calcification is highest in fibrocalcific plaques followed by healed plaque rupture and is the least in erosion and pathological intimal thickening. The extent of calcification is greater in men than in women especially in the premenopausal period and is also greater in whites compared with blacks. The mechanisms of intimal calcification remain poorly understood in humans. Calcification often occurs in the presence of apoptosis of smooth muscle cells and macrophages with matrix vesicles accompanied by expression of osteogenic markers within the vessel wall.
  • Hiroyuki Jinnouchi, Kenichi Sakakura, Hiroshi Wada, Kohki Ishida, Kenshiro Arao, Norifumi Kubo, Yoshitaka Sugawara, Hiroshi Funayama, Junya Ako, Shin-ichi Momomura
    AMERICAN JOURNAL OF CARDIOLOGY 113 6 924 - 929 2014年03月 [査読有り][通常論文]
     
    Early statin treatment of patients with acute coronary syndrome results in vascular changes and improved clinical outcomes. However, the influence of chronic statin treatment on the culprit vessel in acute coronary syndrome is not fully understood. The aim of this study was to investigate the morphologic features of the culprit vessel in acute myocardial infarction by comparing patients with and without chronic statin treatment. We enroled consecutive patients with AMI, who had hyperfipidemia and primary percutaneous coronary intervention guided by intravascular ultrasound within 24 hours of symptom onset. Of 155 patients, 73 patients were stratified to the chronic statin group and 82 to the nonstatin group. Intravascular ultrasound in both the groups showed that positive remodeling was significantly less frequent in the chronic statin group (46.6%) compared with the nonstatin group (70.7%; p = 0.001). Necrotic core area was significantly smaller in the chronic statin group (2.2 +/- 1.3 mm(2)) compared with the nonstatin group (3.2 +/- 2.1 mm(2); p <0.001). Multivariate logistic regression analysis revealed that chronic statin treatment was significantly associated with less positive remodeling (odds ratio 0.283, 95% confidence interval 0.111 to 0.723, p = 0.008). In conclusion, chronic statin treatment reduced positive remodeling in the culprit lesions of patients with acute myocardial infarction. (c) 2014 Elsevier Inc. All rights reserved.
  • Tom Nakagawa, Hiroshi Wada, Kenichi Sakakura, Yoko Yamada, Kohki Ishida, Tatsuro Ibe, Nahoko Ikeda, Yoshitaka Sugawara, Junya Ako, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 63 1-2 145 - 148 2014年01月 [査読有り][通常論文]
     
    Background: The circumstances surrounding infective endocarditis (IE) are under constant change due to an increase in drug-resistant organisms, a decrease in rheumatic valve disease, progress in surgical treatment, and aging society. The purpose of this study was to compare clinical features of IE between the 1990s and 2000s and to elucidate the determinants of death or clinical event. Methods: All hospital admission records between January 1990 and December 2009 were retrospectively analyzed. The definition of IE was based on modified Duke criteria. Clinical presentation, blood culture, laboratory results, and echocardiography findings were compared between the 19905 and 2000s. Results: There were 112 patients with definite or probable IE according to modified Duke criteria. The most frequent organism causing IE was Streptococcus viridians both in the 1990s and 2000s. The determinants of in-hospital death were hemodialysis and congestive heart failure. The in-hospital mortality of IE was 5.4% in the 1990s and 13.3% in the 2000s. Composite events of in-hospital death and central nervous system disorders were significantly higher in the 2000s compared with the 1990s. Conclusion: The most frequent causative organism of IE was S. viridians, both in the 1990s and 2000s. Independent predictors of in-hospital mortality in IE were hemodialysis and congestive heart failure. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Fumiyuki Otsuka, Marc Vorpahl, Masataka Nakano, Jason Foerst, John B. Newell, Kenichi Sakakura, Robert Kutys, Elena Ladich, Aloke V. Finn, Frank D. Kolodgie, Renu Virmani
    CIRCULATION 129 2 211 - 223 2014年01月 [査読有り][通常論文]
     
    Background Clinical trials have demonstrated that the second-generation cobalt-chromium everolimus-eluting stent (CoCr-EES) is superior to the first-generation paclitaxel-eluting stent (PES) and is noninferior or superior to the sirolimus-eluting stent (SES) in terms of safety and efficacy. It remains unclear whether vascular responses to CoCr-EES are different from those to SES and PES because the pathology of CoCr-EES has not been described in humans. Methods and Results A total of 204 lesions (SES=73; PES=85; CoCr-EES=46) from 149 autopsy cases with duration of implantation >30 days and 3 years were pathologically analyzed, and comparison of vascular responses was corrected for duration of implantation. The observed frequency of late and very late stent thrombosis was less in CoCr-EES (4%) versus SES (21%; P=0.029) and PES (26%; P=0.008). Neointimal thickness was comparable among the groups, whereas the percentage of uncovered struts was strikingly lower in CoCr-EES (median=2.6%) versus SES (18.0%; P<0.0005) and PES (18.7%; P<0.0005). CoCr-EES showed a lower inflammation score (with no hypersensitivity) and less fibrin deposition versus SES and PES. The observed frequency of neoatherosclerosis, however, did not differ significantly among the groups (CoCr-EES=29%; SES=35%; PES=19%). CoCr-EES had the least frequency of stent fracture (CoCr-EES=13%; SES=40%; PES=19%; P=0.007 for CoCr-EES versus SES), whereas fracture-related restenosis or thrombosis was comparable among the groups (CoCr-EES=6.5%; SES=5.5%; PES=1.2%). Conclusions CoCr-EES demonstrated greater strut coverage with less inflammation, less fibrin deposition, and less late and very late stent thrombosis compared with SES and PES in human autopsy analysis. Nevertheless, the observed frequencies of neoatherosclerosis and fracture-related adverse pathological events were comparable in these devices, indicating that careful long-term follow-up remains important even after CoCr-EES placement.
  • Mamoru Arakawa, Atsushi Yamaguchi, Kenichi Sakakura, Homare Okamura, Junya Ako, Shin-Ichi Momomura, Hideo Adachi
    General Thoracic and Cardiovascular Surgery 62 6 364 - 369 2014年 [査読有り][通常論文]
     
    Objective: Since drug-eluting stents (DESs) appeared in Japan, coronary artery bypass grafting (CABG) has been indicated for more severe lesions. To understand the implications of this trend, we compared SYNTAX scores in two groups of patients treated with CABG before and after DESs approval. Methods: Consecutive CABG patients during January 2001-July 2003 (pre-DES era patients, n = 160) and January 2008-July 2010 (DES era patients, n = 103) were included. The SYNTAX scores of both groups were compared and a cardiologist retrospectively re-evaluated coronary angiograms to determine whether CABG or percutaneous coronary intervention (PCI) would be recommended under current standards. Results: SYNTAX scores were significantly higher in DES era group compared with pre-DES era group (33.3 ± 10.6 vs. 28.1 ± 10.6, p < 0.01). Percutaneous coronary intervention would be the preferred treatment option in 66 (41 %) of pre-DES patients, whose SYNTAX scores were significantly lower than those of patients who were considered good candidates for CABG (21.9 ± 9.3 vs. 32.5 ± 9.1, p < 0.01). Conclusions: Although CABG is now being performed in intermediate-to-highly complex cases, DES era outcomes, including operative mortality and early graft failure, have not worsened in comparison to the pre-DES era. © 2013 The Japanese Association for Thoracic Surgery.
  • Fumiyuki Otsuka, Kenichi Sakakura, Renu Virmani
    EUROPEAN HEART JOURNAL 34 48 3681 - 3683 2013年12月 [査読有り][通常論文]
     
    This editorial refers to 'Mast cells in human carotid atherosclerotic plaques are associated with intraplaque microvessel density and the occurrence of future cardiovascular events'(dagger), by S. Willems et al., on page 3699-3706
  • Masayuki Mori, Kenichi Sakakura, Hiroshi Wada, Nahoko Ikeda, Hiroyuki Jinnouchi, Yoshitaka Sugawara, Norifumi Kubo, Shin-ichi Momomura, Junya Ako
    HEART AND VESSELS 28 6 677 - 683 2013年11月 [査読有り][通常論文]
     
    Left ventricular apical aneurysm (LVAA) is a serious complication of acute anterior myocardial infarction (MI). The purpose of our study was to investigate the clinical features of LVAA in the primary PCI era. A total of 161 acute anterior MI patients who had primary PCI and had an echocardiogram on chronic phase were included. The development of LVAA was reviewed on chronic phase. Univariate and multivariate logistic regression analyses were performed to identify the predictors of LVAA. Primary stenting was performed in 160 patients (99.4 %). Procedural success was obtained in all patients with a final TIMI flow grade 3 obtained in 142 patients (88.2 %). LVAA developed in the chronic phase in 29 patients (18.0 %). Multivariate logistic regression analysis revealed that peak CK (500 mU/ml increase; OR 1.24, 95 % CI 1.09-1.41, p = 0.001), heart rate at discharge (5/min increase; OR 1.39, 95 % CI 1.03-1.87, p = 0.03), final TIMI flow grade a parts per thousand currency sign2 (vs. TIMI 3; OR 6.95, 95 % CI 1.70-28.36, p = 0.01) and final myocardial brush grade (MBG) a parts per thousand currency sign2 (vs. MBG 3; OR 4.33, 95 % CI 1.06-17.66, p = 0.04) were significantly associated with the development of LVAA. The initial TIMI flow grade or the grade of collateral flow was not associated with LVAA. In conclusion, peak CK, heart rate, and final TIMI flow grade or final MBG a parts per thousand currency sign2 were significantly associated with the development of LVAA. Achieving a TIMI flow grade 3 by primary PCI may be important for preventing LVAA.
  • Masataka Nakano, Fumiyuki Otsuka, Kazuyuki Yahagi, Kenichi Sakakura, Robert Kutys, Elena R Ladich, Aloke V Finn, Frank D Kolodgie, Renu Virmani
    European heart journal 34 42 3304 - 13 2013年11月 [査読有り][通常論文]
     
    AIMS: Restenosis in drug-eluting stents (DESs) occurs infrequently, however, it remains a pervasive clinical problem. We interrogated our autopsy registry to determine the underlying mechanisms of DES restenosis, and further we investigated the neointimal characteristics of DESs and compared with bare metal stents (BMSs). METHODS AND RESULTS: Coronary lesions from patients with DES implants (n = 82) were categorized into four groups based on cross-sectional area narrowing: patent (<50%), intermediate (50-74%), restenotic (≥ 75% with residual lumen), and total occlusion (organized thrombus within the stent). Restenosis and occlusion were significantly dependent on the total stented length: restenosis (26.7 mm) and occlusion (25.7 mm) compared with patent DESs (17.3 mm). Further, restenotic and occluded lesions were located more distally in the coronary arteries and had greater vessel injury and uneven strut distribution suggesting local drug gradient. Multivariate analysis revealed that normalized maximum inter-strut distance was associated with DES restenosis (OR: 17.4, P = 0.04) while medial tear length was a predictor of DES occlusion (OR: 5.1, P = 0.03). No differences were observed between different DESs (sirolimus-, paclitaxel-, and everolimus-eluting stents) for restenosis and occlusion. Further, neointimal compositions of restenotic DESs demonstrated greater proteoglycan deposition and less smooth muscle cellularity over time, when compared with BMS with greater cell density and collagen deposition. CONCLUSIONS: Our study indicates the impacts of inadequate drug concentration due to wider inter-strut distance and vessel injury as primary mechanisms of DES restenosis and occlusion, respectively. Moreover, the differences in neointimal compositions between DESs and BMSs might serve as a potential target for the suppression of late neointima growth via inhibition of proteoglycans in DESs.
  • Fumiyuki Otsuka, Kazuyuki Yahagi, Kenichi Sakakura, Renu Virmani
    Annals of cardiothoracic surgery 2 4 519 - 26 2013年07月 [査読有り][通常論文]
     
    The internal mammary artery (IMA) grafts have been associated with long-term patency and improved survival as compared to saphenous vein grafts (SVGs). Early failure of IMA is attributed to poor surgical technique and less with thrombosis. Similarly, bypass surgery especially with the use of IMA has also been shown to be superior at 1-year as well as over five years compared to percutaneous procedures, including the use of drug-eluting stents for the treatment of coronary artery disease. The superiority of IMAs over SVGs can be attributed to its striking resistance to the development of atherosclerosis. Structurally its endothelial layer shows fewer fenestrations, lower intercellular junction permeability, greater anti-thrombotic molecules such as heparin sulfate and tissue plasminogen activator, and higher endothelial nitric oxide production, which are some of the unique ways that make the IMA impervious to the transfer of lipoproteins, which are responsible for the development of atherosclerosis. A better comprehension of the molecular resistance to the generation of adhesion molecules that are involved in the transfer of inflammatory cells into the arterial wall that also induce smooth muscle cell proliferation is needed. This basic understanding is crucial to championing the use of IMA as the first line of defense for the treatment of coronary artery disease.
  • Kenichi Sakakura, Masataka Nakano, Fumiyuki Otsuka, Elena Ladich, Frank D. Kolodgie, Renu Virmani
    HEART LUNG AND CIRCULATION 22 6 399 - 411 2013年06月 [査読有り][通常論文]
     
    Atherosclerotic plaque rupture with luminal thrombosis is the most common mechanism responsible for the majority of acute coronary syndromes and sudden coronary death. The precursor lesion of plaque rupture is thought to be a thin cap fibroatheroma (TCFA) or "vulnerable plaque". TCFA is characterised by a necrotic core with an overlying thin fibrous cap (<= 65 mu m) that is infiltrated by macrophages and T-lymphocytes. Intraplaque haemorrhage is a major contributor to the enlargement of the necrotic core. Haemorrhage is thought to occur from leaky vasa vasorum that invades the intima from the adventitia as the intima enlarges. The early atherosclerotic plaque progression from pathologic intimal thickening (PIT) to a fibroatheroma is thought to be the result of macrophage infiltration. PIT is characterised by the presence of lipid pools which consist of proteoglycan with lipid insudation. The conversion of the lipid pool to a necrotic core is poorly understood but is thought to occur as a result of macrophage infiltration which releases matrix metalloproteinase (MMPs) along with macrophage apoptosis that leads to the formation of a acellular necrotic core. The fibroatheroma has a thick fibrous cap that begins to thin over time through macrophage MMP release and apoptotic death of smooth muscle cells converting the fibroatheroma into a TCFA. Other causes of thrombosis include plaque erosion which is less frequent than plaque rupture but is a common cause of thrombosis in young individuals especially women <50 years of age. The underlying lesion morphology in plaque erosion consists of PIT or a thick cap fibroatheroma. Calcified nodule is the least frequent cause of thrombosis, which occurs in older individuals with heavily calcified and tortious arteries. (c) 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
  • Hiroyuki Jinnouchi, Kenichi Sakakura, Hiroshi Wada, Norifumi Kubo, Yoshitaka Sugawara, Hiroshi Funayama, Junya Ako, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 54 3 123 - 128 2013年05月 [査読有り][通常論文]
     
    Clinical features and outcomes of acute myocardial infarction (AMI) in the young have been poorly investigated. The aim of this study was to investigate the clinical features and hospital outcomes of AMI in young Japanese. We conducted a case-control study. A total of 53 consecutive AMI patients whose age was <= 45 years old were assigned to the young group and 106 AMI patients whose age was > 45 years old were assigned to the non-young group. We compared the clinical features and hospital outcomes between the two groups. Compared with the non-young group, the young group was associated with male sex, hyperlipidemia, current smoking, being overweight, single vessel disease, and Killip class I on admission. There were no differences in the length of hospital stay or major adverse cardiac events between the groups. However, mortality and ventricular rupture were slightly lower in the young. In conclusion, young AMI patients had clinical characteristics different to those of the non-young patients. Compared to non-young patients, modifiable risk factors such as smoking, hyperlipidemia, and being overweight were associated with young AMI patients.
  • Hiroyuki Jinnouchi, Kenichi Sakakura, Jun Matsuda, Yasushi Wakabayashi, Hiroshi Wada, Shin-ichi Momomura, Junya Ako
    INTERNATIONAL HEART JOURNAL 54 3 181 - 183 2013年05月 [査読有り][通常論文]
     
    Spontaneous coronary artery dissection (SCAD) is considered to be a rare cause of acute coronary syndrome, especially recurrent or multivessel dissection. We present here the case of 51 year-old man who had recurrent and multivessel SCAD. In the initial event, the distal segment of the right coronary artery was spontaneously dissected, which was confirmed by coronary angiography (CAG), intracoronary ultrasound (IVUS), and multidetector computed tomography (MDCT). In the second event, the left coronary artery was spontaneously dissected. The dissection was confirmed by IVUS and MDCT, although CAG did not show stenosis, occlusion, or dissection in the left coronary artery. These findings suggest the weakness of CAG and the usefulness of IVUS or MDCT for the diagnosis of SCAD.
  • Kenshiro Arao, Takayuki Fujiwara, Kenichi Sakakura, Hiroshi Wada, Yoshitaka Sugawara, Chikashi Suga, Junya Ako, San-e Ishikawa, Shin-ichi Momomura
    CIRCULATION JOURNAL 77 1 116 - 122 2013年01月 [査読有り][通常論文]
     
    Background: Various factors associated with worsening heart failure (HF) events have been investigated in HF subjects. The purpose of this study was to identify the predictive factor(s) for worsening HF events after cardiac resynchronization therapy (CRT) among baseline parameters, as well as baseline factors associated with responsiveness or non-responsiveness to CRT. Methods and Results: Seventy-seven HF patients with an indication for CRT were enrolled. Baseline parameters of blood chemistry, electrocardiogram, echocardiogram and cardiac catheterization before device implantation were measured, and subsequent clinical HF events after CRT were investigated. During the follow-up period (median 601 days), 22 of 77 (29%) recipients had HF events (unscheduled HF hospitalization: 16; use of left ventricular assist system: 1; heart transplantation: 1; cardiac death: 4). In the multivariate Cox proportional hazards model, low serum sodium concentration was associated with the occurrence of HF events after CRT (hazard ratio 0.82, 95% confidence interval 0.68-0.99, P=0.034). At baseline, serum sodium concentration negatively correlated With pulmonary capillary wedge pressure (r=-0.71, P<0.001) and with plasma arginine vasopressin level (r=-0.68, P=0.008). Conclusions: Hyponatremia is an independent predictor for worsening HF events after CRT implantation, which may be partly explained by elevated level of plasma arginine vasopressin. (Circ J 2013; 77: 116-122)
  • Kohki Ishida, Hiroshi Wada, Kenichi Sakakura, Norifumi Kubo, Nahoko Ikeda, Yoshitaka Sugawara, Junya Ako, Shin-Ichi Momomura
    Heart and Vessels 28 1 86 - 90 2013年01月 [査読有り][通常論文]
     
    Fulminant myocarditis is a rapidly progressive, life-threatening disease with severe impairment of systolic left ventricle function in the acute phase. However, the long-term prognosis of patients who survive the acute phase with percutaneous extracorporeal cardiopulmonary support (PCPS) is not established. The purpose of this study was to elucidate the long-term follow-up on chronic cardiac function and long-term outcome. Twenty consecutive patients with fulminant myocarditis in the acute phase supported by PCPS were enrolled between January 1995 and March 2010. Echocardiography was performed at least three times acute phase (within 3 days from onset), predischarge (days 3-30), and chronic phase (> 6 months, 2.67 ± 2.19 years, mean ± SD). The clinical events were queried by their medical record and questionnaires. Eight patients (40%) died in the acute phase. The time course of ejection fraction (%) by echocardiography was 22.7 ± 9.8, 53.1 ± 7.2, and 57.2 ± 9.6 in acute, predischarge, and chronic phase, respectively. Diastolic dimension (mm) was 46.8 ± 7.4, 51.3 ± 2.9, and 50.4 ± 1.8, and systolic dimension (mm) was 41.4 ± 7.7, 36.8 ± 4.0, and 35.2 ± 3.3 in acute, predischarge, and chronic phase, respectively. There was no recurrence or admission related to heart failure during the follow-up period. The cardiac function of patients with fulminant myocarditis recovers rapidly during their stay in hospital. The cardiac function of predischarge patients remains unchanged in the chronic phase. The long-term survival of fulminant myocarditis appears favorable in the chronic phase. © 2011 Springer.
  • Kenichi Sakakura, Hiroshi Wada, Yousuke Taniguchi, Masayuki Mori, Shin-ichi Momomura, Junya Ako
    Cardiovascular Intervention and Therapeutics 28 1 71 - 75 2013年 [査読有り][通常論文]
     
    Catheter-induced aortocoronary dissection is a rare, but serious complication during diagnostic coronary catheterization or percutaneous coronary intervention (PCI). Immediate coronary artery stenting of the entry point is one of therapeutic options. However, PCI itself may worsen the dissection, because contrast injection has been reported to be a risk factor for the extension of dissected aorta. We present a case of 79-year-old male suffering from inferior acute myocardial infarction due to the catheter-induced aortocoronary dissection. Multi-slice computed tomography (MSCT) revealed an intramural hematoma of the ascending aorta and an intimal tear from the proximal portion of right coronary artery (RCA) to the intramural hematoma. We attempted intravascular ultrasound (IVUS)-guided coronary stenting without contrast injection. IVUS revealed that thrombus distributed from the ostium to middle portion of RCA. A 3. 0 × 30 mm bare-metal stent was deployed to cover the distal end of thrombus, and a 3. 5 × 30 mm bare-metal stent was deployed to cover the entry point and ostium of RCA. All procedures were done without contrast injection. Follow-up MSCT confirmed the patency of stents and the disappearance of the intimal tear. As contrast injection may cause the expansion of the dissected aorta, IVUS-guided stenting of the entry point without contrast injection can be a promising solution for such lesions. © 2012 Japanese Association of Cardiovascular Intervention and Therapeutics.
  • Kenshiro Arao, Takayuki Fujiwara, Kenichi Sakakura, Hiroshi Wada, Yoshitaka Sugawara, Chikashi Suga, Junya Ako, San-e Ishikawa, Shin-ichi Momomura
    CIRCULATION JOURNAL 77 1 116 - 122 2013年01月 [査読有り][通常論文]
     
    Background: Various factors associated with worsening heart failure (HF) events have been investigated in HF subjects. The purpose of this study was to identify the predictive factor(s) for worsening HF events after cardiac resynchronization therapy (CRT) among baseline parameters, as well as baseline factors associated with responsiveness or non-responsiveness to CRT. Methods and Results: Seventy-seven HF patients with an indication for CRT were enrolled. Baseline parameters of blood chemistry, electrocardiogram, echocardiogram and cardiac catheterization before device implantation were measured, and subsequent clinical HF events after CRT were investigated. During the follow-up period (median 601 days), 22 of 77 (29%) recipients had HF events (unscheduled HF hospitalization: 16; use of left ventricular assist system: 1; heart transplantation: 1; cardiac death: 4). In the multivariate Cox proportional hazards model, low serum sodium concentration was associated with the occurrence of HF events after CRT (hazard ratio 0.82, 95% confidence interval 0.68-0.99, P=0.034). At baseline, serum sodium concentration negatively correlated With pulmonary capillary wedge pressure (r=-0.71, P<0.001) and with plasma arginine vasopressin level (r=-0.68, P=0.008). Conclusions: Hyponatremia is an independent predictor for worsening HF events after CRT implantation, which may be partly explained by elevated level of plasma arginine vasopressin. (Circ J 2013; 77: 116-122)
  • Harue Sasai, Kenichi Sakakura, Koichi Yuri, Hiroshi Wada, Kenshiro Arao, Hiroshi Funayama, Yoshitaka Sugawara, Atsushi Yamaguchi, Hideo Adachi, Shin-ichi Momomura, Junya Ako
    Cardiovascular Intervention and Therapeutics 28 2 193 - 196 2013年 [査読有り][通常論文]
     
    Fractional flow reserve (FFR) is considered as the gold standard for physiological assessment of coronary artery stenosis. However, it may be difficult to interpret FFR for the stenosis of the donor artery of chronic total occlusion (CTO), because revascularization of CTO may improve FFR of the donor artery. We present a case of 32-year-old male who had a CTO in right coronary artery (RCA), 90 % stenoses in left circumflex artery (LCx) and a mild stenosis in the middle segment of left anterior descending artery (LAD). FFR for the mild stenosis in LAD showed significant value (0. 72). However LAD was the donor artery to CTO of RCA, revascularization to RCA was expected to improve FFR for LAD. As the patient had chronic granulocytic leukemia and the difficulty in continuing dual antiplatelet therapy, we selected coronary artery bypass grafting (CABG) to RCA and LCx, and we decided not to perform anastomosis to LAD. Although each graft was patent and collateral flow from LAD to RCA disappeared after CABG, FFR for LAD was still 0. 72. Careful consideration should be given when interpreting FFR for the donor artery to a CTO lesion. When CABG is selected, it may be a practical approach to revascularize not only CTO but also FFR positive mild stenosis simultaneously, even though it appears angiographically mild stenosis. © 2012 Japanese Association of Cardiovascular Intervention and Therapeutics.
  • Yousuke Taniguchi, Kenichi Sakakura, Hiroshi Wada, Yoshitaka Sugawara, Hiroshi Funayama, Norifumi Kubo, Shin-ichi Momomura, Junya Ako
    Cardiovascular Intervention and Therapeutics 28 2 157 - 161 2013年 [査読有り][通常論文]
     
    Contrast media affects renal function, especially in the patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate the characteristics of contrast induced exacerbation of renal dysfunction in the patients with advanced CKD (estimated glomerular filtration rate < 30 ml/min/1. 73 m2). We enrolled 102 advanced CKD patients who underwent cardiac catheterization. Delta creatinine (post-catheterization creatinine minus pre-catheterization creatinine) were calculated. The patients were divided into three groups according to delta creatinine. The highest tertile of the delta creatinine was defined as the exacerbation group. Multivariate logistic regression analyses were performed to find the characteristics of the exacerbation group. Anemia (odds ratio (OR): 15. 53, 95 % Confidence Interval (95 %CI): 1. 81-133. 27, p = 0. 01) and proteinuria (OR: 5. 91, 95 %CI: 1. 64-21. 28, p < 0. 01) were significant characteristics of the exacerbation group after adjusting confounding factors. In conclusion, anemia and proteinuria were associated with contrast induced exacerbation of renal dysfunction in the advanced CKD patients. © 2012 Japanese Association of Cardiovascular Intervention and Therapeutics.
  • Fumio Liu, Hiroshi Wada, Kenichi Sakakura, Taishi Hirahara, Kenshiro Arao, Yousuke Taniguchi, Daisuke Ono, Junya Ako, Shin-ichi Momomura
    Journal of Cardiology Cases 6 6 e176 - e178 2012年12月 [査読有り][通常論文]
     
    A 68-year-old man was referred to our hospital for the evaluation and treatment of chest discomfort and syncope. He was diagnosed with variant angina by prolonged ischemic episode with ST-segment elevation in leads II, III, and aVF. His symptoms had a seasonal trend and occurred only from April to September. In other seasons, he had no symptoms even with no medication. He had a history of nasal polyps and allergic rhinitis. His symptoms increased in frequency and intensity, and the attacks were not fully controlled by multiple drug therapy. Sarpogrelate hydrochloride, however, resulted in complete resolution of his symptoms. Further examination revealed that he was allergic to mites, Dermatophagoides farina, which were prevalent mainly from April to September. The allergic mechanism was suggested to be involved in the seasonal variety in angina attacks.< . Learning objective: We present a 68-year-old male with variant angina. Seasonal variation in his frequency of the attacks suggested the involvement of allergic reactions. While medications including calcium channel blockers and nitrates failed to suppress the angina attack, adding sarpogrelate, a selective 5-HT2A antagonist, significantly prevented symptoms of recurrent coronary vasospasm. Allergic mechanism was suggested to be involved in the pathogenesis of coronary vasospasm in this case.> . © 2012 Japanese College of Cardiology.
  • Kenichi Sakakura, Junya Ako, Hiroshi Wada, Norifumi Kubo, Shin-ichi Momomura
    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS 80 3 370 - 376 2012年09月 [査読有り][通常論文]
     
    Objectives: The purpose of this study was to investigate the association between ACC/AHA type classification of coronary lesions and medical resource utilization. Background: It is not known whether the classification of coronary lesions by the ACC/AHA system reflects the consumption of medical resources in current percutaneous coronary interventions (PCI). Methods: We identified coronary artery lesions treated with PCI from our PCI database between January 1, 2009 and December 31, 2009. Lesions were classified into type A, type B1, type B2, and type C according to the ACC/AHA definition. Total PCI cost, total contrast volume, and total fluoroscopy time were compared among the groups. Results: A total of 447 lesions were analyzed. The number of type A, type B1, type B2, and type C lesion were 75 (16.8%), 98 (21.9%), 145 (32.4%), and 129 (28.9%), respectively. Total PCI cost for type A, type B1, type B2, and type C lesions were $7,262 +/- 1,397, $8,126 +/- 1,891, $9,126 +/- 3,128, and $13,243 +/- 4,678, respectively (P < 0.0001). Total contrast volume and fluoroscopy time were also stratified according to the order of type A, type B1, type B2, and type C lesions (P < 0.0001 for total contrast volume; P < 0.0001 for total fluoroscopy time). Conclusions: Total PCI cost, total contrast volume, and total fluoroscopy time were clearly stratified according to the order of type A, type B1, type B2, and type C lesions. Lesion classification by the ACC/AHA system reflects medical resource use in current PCI. (c) 2011 Wiley Periodicals, Inc.
  • Manabu Ogita, Kenichi Sakakura, Tomohiro Nakamura, Hiroshi Funayama, Hiroshi Wada, Ryo Naito, Yoshitaka Sugawara, Norifumi Kubo, Junya Ako, Shin-ichi Momomura
    HEART AND VESSELS 27 5 460 - 467 2012年09月 [査読有り][通常論文]
     
    Acute renal insufficiency after percutaneous coronary artery intervention (PCI) is a strong predictor of adverse events. However, the effect of chronic renal impairment on the long-term outcomes after PCI has not been well established. The aim of this study was to evaluate the incidence of deteriorated renal function during the chronic phase after PCI and its impact on clinical outcomes. We enrolled 282 consecutive patients who underwent PCI and had serum creatinine measured during the chronic phase (at least 3 months after PCI). We divided the study population into two groups: an advanced group that had an increase in stage of chronic kidney disease during the chronic phase, and a preserved group that included the remainder of the study population. There were 43 patients in the advanced group. We evaluated the incidence of major adverse cardiac events (MACE) that included all-cause death, nonfatal myocardial infarction, and rehospitalization with heart failure or angina pectoris. The rate of rehospitalization for heart failure and angina pectoris was significantly higher in the advanced group than in the preserved group (19.0% vs 6.8%, P < 0.01). In multivariate Cox regression analysis, the advanced group was associated with MACE (hazard ratio 3.50, 95% confidence interval 1.49-8.22, P < 0.01). Deterioration of renal function during long-term follow-up after percutaneous coronary intervention was associated with adverse cardiac events.
  • Takeshi Nishida, Kenichi Sakakura, Hiroshi Wada, Nahoko Ikeda, Yoshitaka Sugawara, Norifumi Kubo, Junya Ako, Shin-ichi Momomura
    HEART AND VESSELS 27 5 475 - 479 2012年09月 [査読有り][通常論文]
     
    Ventricular septal perforation (VSP) is a serious complication associated with acute myocardial infarction (MI). The purpose of this study was to investigate the determinants of in-hospital death in patients with postinfarction VSP. Between January 1990 and April 2010, we identified 37 patients from our hospital records. Univariate analysis and multivariate logistic regression analysis were performed to find the determinants of in-hospital death. In-hospital mortality was 35% (13/37 patients). History of hypertension (P = 0.03), percutaneous coronary intervention (P = 0.04), and preoperative percutaneous cardiopulmonary support (P = 0.04) were associated with in-hospital death, whereas history of hyperlipidemia was associated with in-hospital survival. The interval from MI to VSP in survivors was significantly longer than that in nonsurvivors (P < 0.01). In multivariate logistic regression analysis, a shorter interval from MI to VSP (odds ratio 0.57, 95% confidence interval 0.34-0.95, P = 0.03) was found to be an independent predictor of in-hospital death. In conclusion, in-hospital mortality was high in patients with postinfarction VSP. A shorter interval from MI to VSP was a significant independent predictor of in-hospital death.
  • Hiroshi Wada, Kenichi Sakakura, Norifumi Kubo, Nahoko Ikeda, Yoshitaka Sugawara, Junya Ako, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 60 3-4 306 - 309 2012年09月 [査読有り][通常論文]
     
    Background: Temporary vena cava filters have been used for protection from potentially fatal pulmonary embolism. However, recent reports suggested that they may be associated with serious adverse complications including filter-related thrombosis. The purpose of this study was to examine the clinical complications of temporary vena cava filter placement. Methods: We enrolled 40 consecutive patients from January 2006 to December 2010 who underwent percutaneous temporary vena cava filter insertion in Saitama Medical Center, Jichi Medical University. Results: Major filter complications related to temporary vena cava filters were filter thrombosis in 4 patients (10.2%), filter dislocation in 4 (10.2%), and catheter-related infection in 3 (7.7%). Massive pulmonary embolism and cardiogenic shock was observed in one case (2.5%) at the time of retraction. Conclusion: Temporary filter placement was associated with a high incidence of device-related complications. The benefit of temporary filter placement should be judiciously weighed against the risk of complications. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Kenichi Sakakura, Junya Ako, Hiroshi Wada, Ryo Naito, Hiroshi Funayama, Kenshiro Arao, Norifumi Kubo, Shin-ichi Momomura
    AMERICAN JOURNAL OF CARDIOLOGY 110 4 498 - 501 2012年08月 [査読有り][通常論文]
     
    Although rotational atherectomy (RA) is used for complex lesions in percutaneous coronary intervention, there are several contraindications and precautions. The purpose of our study was to compare complications between off-label and on-label use of RA. We identified 250 consecutive patients who underwent RA. Off-label characteristics included saphenous vein graft lesions, presence of thrombus, unprotected left main stenosis, coronary artery dissection, acute myocardial infarction (MI), left ventricular dysfunction, 3-vessel disease, long lesion (>= 25 mm), or angulated lesion (>= 45 degrees). Patients who had >= 1 off-label characteristic were assigned to the off-label group (156 patients), and patients who had no off-label characteristics were assigned to the on-label group (94 patients). Occurrence of slow flow or periprocedural MI in the off-label group was higher than that in the on-label group (slow flow 30% vs 18%, p = 0.06; MI 8.8% vs 2.1%, p = 0.04), whereas severe complications such as burr entrapment, transection of the guidewire, or perforation were rare in the 2 groups. In conclusion, compared to the on-label group, the off-label group had a higher incidence of slow flow and periprocedural MI. Severe complications such as burr entrapment, transection of the guidewire, or perforation were rare in the 2 groups. 2012 Elsevier Inc. (C) All rights reserved. (Am J Cardiol 2012;110:498 501)
  • Kenichi Sakakura, Junya Ako, Hiroshi Wada, Ryo Naito, Kenshiro Arao, Hiroshi Funayama, Norifumi Kubo, Shin-ichi Momomura
    JOURNAL OF INVASIVE CARDIOLOGY 24 8 379 - 384 2012年08月 [査読有り][通常論文]
     
    Objectives. The purpose of this study was to investigate the association between beta-blocker use and slow flow during rotational atherectomy (RA). Background. RA is often performed as part of percutaneous coronary interventions for the treatment of calcified lesions; however, the procedure can be complicated by slow flow. Previous reports suggested that the use of beta-blockers was associated with slow flow during RA. Methods. A total of 186 patients who received RA were included, and 87 patients were on beta-blockers. The occurrence of slow flow was compared between the beta-blocker group (n = 87) and the non-beta-blocker group (n = 99). Multivariate logistic regression analysis was performed to investigate whether the use of beta-blockers was associated with slow flow. Results. The occurrence of slow flow was not different between the beta-blocker group (29.9%) and the non-beta-blocker group (24.2%; P=.39). The use of beta-blockers was not significantly associated with slow flow (odds ratio, 0.75; 95% confidence interval, 0.34-1.68; P=.49) after controlling for all potential confounding factors. Conclusions. There was no definitive association between slow flow and the use of beta-blockers during RA. There is no need to discontinue beta-blockers in patients receiving RA.
  • Ryo Naito, Kenichi Sakakura, Hiroshi Wada, Hiroshi Funayama, Yoshitaka Sugawara, Norifumi Kubo, Junya Ako, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 53 4 215 - 220 2012年07月 [査読有り][通常論文]
     
    Drug-eluting stents (DES) have proven to be effective for reducing the rate of restenosis, whereas stem thrombosis (ST) after DES implantation has raised safety concerns. Everolimus-eluting stents (EES) are a new generation of DES that have demonstrated safety and efficacy compared with first-generation DES. However, the use of EES in patients presenting with acute coronary syndrome (ACS) has not been adequately investigated. We compared the clinical outcomes between the ACS and non-ACS groups treated with EES. A total of 335 consecutive patients who received EES implantation between January 2010 and January 2011 were investigated (ACS; n = 172, non-ACS; n = 163). Clinical outcome data were obtained for 94.3% of the patients. Follow-up angiography was performed in 58.5% of all patients. The median follow-up period was 8 months in both groups. Clinical outcomes were not statistically different between the groups. The rate of target lesion revascularization (TLR) was 2.5% in the ACS group and 3.8% in the non-ACS group (P = 0.37). MACE occurred in 8.2% of the ACS group and 10.2% of the non-ACS group (P = 0.54). A definite ST was identified in one patient in each group (P = 0.75). The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant difference between the groups for TLR, target vessel revascularization (TVR), all-cause death, or MACE. In conclusion, EES was safe and efficacious for patients presenting with ACS, as well as for those with non-ACS during a mid-term follow-up period. (Int Heart J 2012; 53: 215-220)
  • Ryo Naito, Kenichi Sakakura, Takatoshi Kasai, Tomotaka Dohi, Hiroshi Wada, Yoshitaka Sugawara, Norifumi Kubo, Suguru Yamashita, Koji Narui, Sugao Ishiwata, Minoru Ohno, Junya Ako, Shin-ichi Momomura
    HEART AND VESSELS 27 3 265 - 270 2012年05月 [査読有り][通常論文]
     
    Aortic dissection is a life-threatening cardiovascular disease with high in-hospital mortality. However, the risk factors of aortic dissection have not been fully elucidated. Obstructive sleep apnea (OSA) has been increasingly recognized as an independent cardiovascular risk factor. Among the underlying mechanisms to explain the association between OSA and cardiovascular morbidity, previous studies reported that intermittent hypoxia and re-oxygenation (IHR) might induce cardiovascular diseases via atherosclerosis. However, little is known about an association between aortic dissection and IHR. The aims of the study were to investigate the prevalence of nocturnal IHR among patients with aortic dissection and compared with that in subjects without aortic dissection, and to investigate whether there is an independent association between aortic dissection and IHR. We enrolled 29 patients with aortic dissection and 59 control subjects. We performed sleep studies and compared the results between the groups. Frequency of IHR is expressed as 3% oxygen desaturation index (ODI). Multivariate analysis was performed to identify determinants of aortic dissection. The percentage of either moderate-to-severe IHR or severe IHR was significantly higher in the aortic dissection group ( = 0.04 and < 0.001, respectively) than in the control group. The mean 3% ODI of patients with aortic dissection was significantly higher than that of control subjects (34.8 +/- A 23.1 and 19.0 +/- A 14.1, = 0.003). In multivariate analysis, 3% ODI was significantly associated with aortic dissection (odds ratio 1.44; 95% confidence interval 1.08-1.91; = 0.01). The present study showed the close association between aortic dissection and, IHR, a major component of OSA.
  • Ryo Naito, Kenichi Sakakura, Hiroshi Wada, Hiroshi Funayama, Yoshitaka Sugawara, Norifumi Kub, Junya Ako, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 53 3 149 - 153 2012年05月 [査読有り][通常論文]
     
    Rotational atherectomy (RA) can facilitate smooth stent delivery and stein expansion through lesion modification for a calcified coronary lesion. Several studies reported that sirolimus-eluting stent (SES) implantation following RA showed a lower rate of revascularization compared with bare-metal stents (BMS). However, there are limited data that compared the clinical outcomes between SES and paclitaxel-eluting stents (PES) after RA. We compared the long-term clinical outcomes of SES and PES following RA. Two hundred and thirty-three consecutive patients (SES n = 179, PES is = 54) who were treated with SES or PES following RA between 10th September 2004 and 13th April 2010 were investigated. Follow-up data for clinical outcomes were obtained in 91.4% of all subjects. The median follow-up period was 630 days (interquartile range, 300 to 1170 days) in the SES group, and 625 days (interquartile range, 285 to 900 days) in the PES group. Clinical outcomes including target lesion revascularization (TLR) (SES 4.9% versus PES 9.8%, P = 0.31), target vessel revascularization (TVR) (SES 6.8% versus PES 11.8%, P = 0.25), and major adverse cardiac events (MACE) (SES 14.8% versus PES 13.7%, P = 0.8) were not statistically different between the groups. The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant differences between the two groups for time to event for TLR, cardiovascular death, all-cause death, or MACE. In conclusion, there was no significant difference in the long-term clinical outcomes between SES and PES following RA. (Int Heart J 2012; 53: 149-153)
  • Takayuki Fujiwara, Kenichi Sakakura, Junya Ako, Hiroshi Wada, Kenshiro Arao, Yoshitaka Sugawara, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 53 3 165 - 169 2012年05月 [査読有り][通常論文]
     
    Peri-stent contrast staining (PSS) is an abnormal angiographic finding following drug-eluting stem implantation which suggests the presence of a space outside the stent struts. PSS has been reported to be associated with very late stent thrombosis (VLST). The aims of this study were to compare the occurrence rate of late acquired PSS between sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) implantation, and to identify clinical characteristics associated with PSS. The percutaneous coronary intervention (PCI) database of our hospital was queried to identify patients meeting the following criteria: (i) patients who received SES or EES in de nova coronary artery lesions; and (ii) patients who had angiographic follow-up between 3 and 15 months after stent implantation. There were 221 patients with 249 lesions treated with SES, and 173 patients with 212 lesions treated with EES. The occurrence of PSS was evaluated and compared between SES and EES implantation on a patient and lesion basis. The occurrence rate of late acquired PSS with EES was lower than that with SES. (On a patient basis; 1.2% versus 4.5%, P = 0.045, on a lesion basis; 0.9% versus 4.0%, P = 0.043). Among the clinical characteristics, chronic total occlusion (CTO) lesions were associated with PSS. The occurrence of late acquired PSS in EES was lower than that in SES. In conclusion, the occurrence rate of late acquired PSS with EES was lower than that with SES, however, it remains to be determined whether this difference translates to the difference in the rate of VLST. (Int Heart J 2012; 53: 165-169)
  • Hiroshi Wada, Kenichi Sakakura, Junya Ako, Shin-ichi Momomura
    INTERNATIONAL JOURNAL OF CARDIOLOGY 155 3 E47 - E48 2012年03月 [査読有り][通常論文]
  • Hajime Satomura, Hiroshi Wada, Kenichi Sakakura, Norifumi Kubo, Nahoko Ikeda, Yoshitaka Sugawara, Junya Ako, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 59 2 215 - 219 2012年03月 [査読有り][通常論文]
     
    Background: Little has been known about clinical features and prognosis of very old patients with heart failure with preserved ejection fraction (HFPEF). The aim of this study was to compare clinical features and clinical outcomes between HFPEF and heart failure with reduced ejection fraction (HFREF) in patients older than 80 years. Methods: We enrolled a total of 113 patients over 80 years old, who were admitted for heart failure between 2006 and 2009. We retrospectively analyzed the clinical features including laboratory data and echocardiography parameters. Results: In 53 patients (49%) left ventricular ejection fraction was preserved. The clinical characteristics and treatment between HFPEF and HFREF showed that anemia was one of the risk factors for HFPEF, and the long-term outcomes of HFPEF in this population were not different from that of HFREF. Conclusion: These results suggest that anemia is one of the important risk factors for HFPEF in the very elderly. (C) 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Hiroyuki Jinnouchi, Kenichi Sakakura, Hiroshi Wada, Norifumi Kubo, Yoshitaka Sugawara, Tomohiro Nakamura, Hiroshi Funayama, Junya Ako, Shin-ichi Momomura
    INTERNATIONAL HEART JOURNAL 53 2 79 - 84 2012年03月 [査読有り][通常論文]
     
    Transradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (>= 80 years old). We enrolled 116 AMI patients aged >= 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups. The duration of CCU stay in the transradial and non-transradial groups was 3.6 +/- 1.5 days and 5.0 +/- 3.2 days, respectively (P = 0.001). The duration of hospital stay in the transradial and non-transradial groups was 13.3 +/- 7.4 clays and 19.2 +/- 11.1 days, respectively (P = 0.001). In-hospital mortality was not different between the two groups (7.7% versus 2.6%, P = 0.20). The day of the monitored standing test in the transradial and non-transradial groups was 3.2 +/- 0.7 and 4.6 +/- 2.3, respectively (P < 0.0001). Multivariate logistic regression analysis identified a transradial approach as an independent predictor of short (<= 3 days) CCU stay (OR: 3.01, 95%CI: 1.16-7.83, P = 0.02). In conclusion, transradial PCI was associated with a shorter CCU stay in AMI patients >= 80 years old. Furthermore, transradial PCI facilitated early rehabilitation in this high risk population. (Int Heart J 2012; 53: 79-84)
  • Mizuho Hoshina, Hiroshi Wada, Kenichi Sakakura, Norifumi Kubo, Nahoko Ikeda, Yoshitaka Sugawara, Takanori Yasu, Junya Ako, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 59 1 78 - 83 2012年01月 [査読有り][通常論文]
     
    Background: Hemodialysis (HD) is an important risk factor for progression of aortic valve stenosis (AS). However, there are varying degrees of disease progression among patients with AS on HD. The aim of this study was to find determinants of rapid progression of AS in patients on HD. Methods: We enrolled 30 patients with AS on HD with a mean follow-up period of 4 years. The peak pressure gradient (PPG) between the initial echocardiography and the last echocardiography at least 3 months interval (Delta PPG) was adopted as the indicator of AS progression. We divided the patients into two groups according to Delta PPG per year [rapid progression (Delta PPG >4.5 mmHg/year), slow progression (Delta PPG <4.5 mmHg/year)] and compared the clinical characteristics between the two groups. Results: Overall mean Delta PPG was 4.5 mmHg/year. Systolic blood pressure (SBP), serum calcium, and calcium-phosphate product were significantly higher in rapid progression group compared with slow progression group (p < 0.05). Conclusion: High systolic blood pressure, serum calcium, and calcium-phosphate product were associated with rapid progression of AS in patients on chronic HD. (C) 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
  • Harue Sasai, Kenichi Sakakura, Hiroshi Wada, Yoshitaka Sugawara, Junya Ako, Shin-ichi Momomura
    JACC-CARDIOVASCULAR INTERVENTIONS 5 1 112 - 113 2012年01月 [査読有り][通常論文]
  • Kenichi Sakakura, Junya Ako, Hiroshi Wada, Norifumi Kubo, Shin-ichi Momomura
    JOURNAL OF INVASIVE CARDIOLOGY 23 11 454 - 459 2011年11月 [査読有り][通常論文]
     
    Objectives. The purpose of this study was to compare medical resource use, such as total device cost, total contrast volume, and total fluoroscopy time between the staged and simultaneous strategies for treating two-vessel disease (2VD) by percutaneous coronary intervention (PCI). Background. 2VD can be treated by the staged strategy or the simultaneous strategy. Compared to the staged strategy, the simultaneous strategy may reduce medical resource use. Methods. We identified a staged group (138 patients) and simultaneous group (62 patients) from our PCI database between January 1, 2008 and December 31, 2010. Total PCI device cost, total contrast volume, and total fluoroscopy time were compared between the two groups. Results. Total costs for the staged group and the simultaneous group given in United States dollars were $21,289 +/- 5633 and $ 16,571 +/- 5530, respectively (P<.0001). Total contrast volumes for the staged group and the simultaneous group were 299 +/- 79 mL and 194 +/- 62 mL, respectively (P<.0001). Total fluoroscopy times for the staged group and the simultaneous group were 60 +/- 27 minutes and 40 +/- 15 minutes, respectively (P<.0001). In multivariate analysis, the simultaneous strategy was significantly associated with low cost, small contrast volume, and short fluoroscopy time even after controlling for age, sex, acute coronary syndrome, and lesion complexity. Conclusions. Compared to the staged strategy to treat 2VD by PCI, the simultaneous strategy reduced medical resource use, i.e., total device cost, total contrast volume, and total fluoroscopy time.
  • Kenichi Sakakura, Junya Ako, Shin-ichi Momomura
    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS 78 4 567 - 570 2011年10月 [査読有り][通常論文]
     
    Burr entrapment is a rare but serious complication during rotational atherectomy (RA). Although emergent surgical removal is a reliable option for this complication, surgical removal is invasive and takes several hours. Balloon inflation just proximal to the burr was the previously-reported nonsurgical option for burr removal. However, this method needed large guide catheter lumen (>= 8 Fr). We present a case of 67-year-old male on chronic hemodialysis. During RA for severe stenosis of the right coronary artery, the RA burr was entrapped. We cut off the drive shaft, the drive shaft sheath, and the RA wire together near the advancer, and then we removed the drive shaft sheath. After removing the drive shaft sheath, the 2.5 mm balloon easily entered the 7-Fr guide catheter. We inflated that balloon to a pressure of 18 atm. The burr was easily removed immediately after balloon deflation. Removal of the drive shaft sheath following balloon dilatation is a new, nonsurgical bailout method for a burr that becomes entrapped during RA. Since removal of the drive shaft sheath following balloon dilatation can be applied to 7 Fr as well as 6 Fr guide systems, this method may be of considerable benefit when operators use 7 Fr or 6 Fr systems. (C) 2011 Wiley-Liss, Inc.
  • Masaru Seguchi, Hiroshi Wada, Kenichi Sakakura, Norifumi Kubo, Nahoko Ikeda, Yoshitaka Sugawara, Atsushi Yamaguchi, Junya Ako, Shin-ichi Momomura
    CIRCULATION 124 14 E369 - E370 2011年10月 [査読有り][通常論文]
  • Manabu Ogita, Junya Ako, Kenichi Sakakura, Tomohiro Nakamura, Hiroshi Funayama, Yoshitaka Sugawara, Norifumi Kubo, Shinichi Momomura
    INTERNATIONAL HEART JOURNAL 52 5 270 - 273 2011年09月 [査読有り][通常論文]
     
    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) increases forward blood flow, possibly resulting in an increase in lumen diameter. We investigated the determinants of luminal gain at the distal reference segment following PCI for CTO. Forty-eight consecutive patients who underwent PCI for CTO were included in this study. Clinical and angiographic data were obtained at baseline and follow-up (mean follow-up period: 251 +/- 73.6 days). Overall, the reference lumen diameter was 2.53 +/- 0.38 min at post-procedure and 2.38 +/- 0.84 mm at follow-up. The distal reference lumen diameter (segment 5 mm distal to the stent) was larger at follow-up than at post-procedure (1.64 +/- 0.64 and 1.38 +/- 0.51 mm, respectively, P < 0.05). Luminal gain (LG), in the distal reference segment, defined as an increase in lumen diameter from post-procedure to follow-up, was observed in 33 of 48 patients (69%). Univariate and multivariate logistic regression analyses were performed to identify the clinical and angiographic predictors of LG. Minimum lumen diameter and left ventricular ejection fraction at baseline were both significant predictors of LG in univariate and multivariate logistic regression analyses. Luminal gain was observed at the distal reference segment following PCI for CTO. Left ventricular ejection fraction may have an impact on the lumen diameter distal to lesions responsible for CTO. (Int Heart J 2011; 52: 270-273)
  • Kenichi Sakakura, Norifumi Kubo, Hiroshi Wada, Nahoko Ikeda, Junya Ako, Shin-Ichi Momomura
    Cardiovascular Intervention and Therapeutics 26 3 274 - 277 2011年 [査読有り][通常論文]
     
    An 88-year-old male was referred to our medical center for the treatment of severe angina pectoris. Coronary angiography revealed severely calcified tight stenosis in the left main (LM), the left circumflex (LCX) ostium, and the proximal portion of the left anterior descending (LAD) artery (Medina 1, 1, 1). We performed T-stenting with two everolimus-eluting stents. Prior to T-stenting, we performed alternating rotational atherectomy (RA) of the vessel segments from the LM to LCX and from the LM to LAD. The effectiveness of alternating RA was confirmed by a "pendulous calcification" at the carina of the LM bifurcation. © 2011 Japanese Association of Cardiovascular Intervention and Therapeutics.
  • Kenichi Sakakura, Norifumi Kubo, Junya Ako, Hiroshi Wada, Naoki Fujiwara, Hiroshi Funayama, Nahoko Ikeda, Tomohiro Nakamura, Yoshitaka Sugawara, Takanori Yasu, Masanobu Kawakami, Shin-ichi Momomura
    HYPERTENSION 55 2 422 - U330 2010年02月 [査読有り][通常論文]
     
    Acute aortic dissection (AAD) is associated with an inflammatory reaction, as evidenced by elevated inflammatory markers, including C-reactive protein (CRP). The association between the peak CRP level and long-term outcomes in type B AAD has not been systematically investigated. The purpose of this study was to investigate whether the peak CRP level during admission predicts long-term outcomes in type B AAD. We conducted a clinical follow-up study of type B AAD. We divided the study population into 4 groups according to the tertiles of peak CRP levels (T1: 0.60 to 9.37 mg/dL; T2: 9.61 to 14.87 mg/dL; T3: 14.90 to 32.60 mg/dL; and unavailable peak CRP group). Multivariate Cox regression analysis was applied to investigate whether the tertiles of peak CRP predict adverse events even after adjusting for other variables. A total of 232 type B AAD patients were included in this analysis. The median follow-up period was 50 months. CRP reached its peak on day 4.5 +/- 1.7. Mean peak CRP values in T1, T2, and T3 were 6.4 +/- 2.4, 12.0 +/- 1.5, and 19.5 +/- 4.0 mg/dL, respectively. There were 65 events (39 deaths and 26 aortic events) during the follow- up. T3 and T2 (versus T1) were strong predictors of adverse events (T3: hazard ratio: 6.02 [95% CI: 2.44 to 14.87], P=0.0001; T2: hazard ratio: 3.25 [95% CI: 1.37 to 7.71], P=0.01) after controlling for all of the confounding factors. In conclusion, peak CRP is a strong predictor for adverse long-term events in patients with type B AAD. (Hypertension. 2010;55:422-429.)
  • Tetsuhisa Hattori, Kenichi Sakakura, Norifumi Kubo, Junya Ako, Yoshitaka Sugawara, Hiroshi Funayama, Shiori Matsuzaki, Tomohiro Nakamura, Taishi Hirahara, Hiroshi Wada, Masanobu Kawakami, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 54 3 490 - 493 2009年12月 [査読有り][通常論文]
     
    It is considered that percutaneous cardiopulmonary support (PCPS)-associated thrombosis is rare on antithrombotic coated PCPS if anticoagulation therapy is appropriately performed. We experienced two cases in which the association between antithrombotic coated PCPS and venous thrombus formation was highly suspected. These cases suggest that PCPS-associated venous thrombus formation should be checked frequently during and after PCPS even if anticoagulation was appropriately performed. (C) 2009 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
  • Kenichi Sakakura, Norifumi Kubo, Junya Ako, Nahoko Ikeda, Hiroshi Funayama, Taishi Hirahara, Hiroshi Wada, Yoshitaka Sugawara, Takanori Yasu, Masanobu Kawakami, Shin-ichi Momomura
    HEART AND VESSELS 24 5 347 - 351 2009年09月 [査読有り][通常論文]
     
    Recurrence of myocardial infarction, especially when occurring early after the prior one, carries a significant morbidity and mortality rate. The aim of this study was to investigate the characteristics of patients who experienced recurrence under secondary prevention therapy. Case record review identified myocardial infarction patients who had a history of previous myocardial infarction within 5 years. Hospital chart records, initial laboratory data, medications, and type of infarction were reviewed. Patients were divided into two groups according to the interval of recurrence: an early group (recurrence within 1 year), and a late group (recurrence after more than 1 year). A total of 89 patients were included in the analysis; 40 patients in the early group, and 49 patients in the late group. Mean age in the early group and late groups was 67.3 +/- 11.9 and 59.4 +/- 8.9, respectively (P = 0.001). Mean body mass index in the early and late groups was 22.1 +/- 3.6 and 25.0 +/- 3.3, respectively (P < 0.001). There were fewer current smokers in the early group (7.5% vs 44.9%, P < 0.001) and more stent thrombosis (17.5% vs 2%, P = 0.02), as compared with the late group. The in-hospital mortality rate tended to be higher in the early group (7.5% vs 0%, P = 0.09). Multiple logistic regression revealed that smoking status (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02-0.49, P = 0.005), HDL cholesterol level (5 mg/dl increase: OR 1.34, 95% CI 1.04-1.74, P = 0.03), and stent thrombosis (OR 35.59, 95% CI 2.13-595.49, P = 0.01) had significant associations with early recurrence. Early recurrence of myocardial infarction was associated with stent thrombosis, a higher HDL cholesterol level, and a lower frequency of smoking. Early recurrence had a trend toward higher mortality than late recurrence.
  • Manabu Ogita, Hirosihi Funayama, Tomohiro Nakamura, Kenichi Sakakura, Yoshitaka Sugawara, Norifumi Kubo, Junya Ako, San-e Ishikawa, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 54 1 59 - 65 2009年08月 [査読有り][通常論文]
     
    Background: The aim of this study was to characterize coronary plaque composition of non-target lesions in diabetic patients using virtual histology intravascular ultrasound (VH-IVUS). Methods and results: In 134 stable angina pectoris patients, plaque components of non-culprit (<50% in diameter stenosis) lesions in de nova target vessels were analyzed by VH-IVUS. Plaque characterization was compared between diabetic (n = 65) and non-diabetic groups (n=69). Diabetic patients were further divided into four groups according to estimated glomerular filtration rate (eGFR, ml/min): eGFR >= 70 (n = 20), 50 <= eGFR < 70 (n = 19), GFR < 50 (n = 18), and end stage renal disease (ESRD) on hemodialysis (HD) (n = 11). There was no significant difference in plaque composition between the diabetic and the non-diabetic patients except for the percentage of dense calcium (8.9% vs. 6.2%; p < 0.05). In the diabetic patients, the percent volume of necrotic core was 9.6%, 11.4%, 14.8%, and 20.8% in the eGFR >= 70, 50 <= eGFR < 70, eGFR < 50, and the ESRD on HD groups, respectively, showing significantly higher percentage in eGFR < 50 (p < 0.05 vs. eGFR >= 70) and ESRD on HD group (p < 0.001). Conclusions: Diabetic patients have significantly larger amount of dense calcium than non-diabetic patients in non-culprit coronary artery segments, and the plaque components of non-culprit lesions in diabetes are significantly different according to the decline in renal function. (C) 2009 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.
  • Manabu Ogita, Tomohiro Nakamura, Naoki Fujiwara, Kenichi Sakakura, Hiroshi Funayama, Yoshitaka Sugawara, Norifumi Kubo, Junya Ako, Shinichi Momomura
    JOURNAL OF INTERVENTIONAL CARDIOLOGY 22 3 216 - 221 2009年06月 [査読有り][通常論文]
     
    Background and Objective: Drug-eluting stents have been shown to reduce the incidence of restenosis and target vessel revascularization (TVR) compared with bare metal stents (BMSs); however, the long-term efficacy of sirolimus-eluting stent (SES) implantation in patients with acute coronary syndrome (ACS) has not been well established. We have investigated the long-term clinical outcome of SES in patients with ACS. Methods: Consecutive 245 patients with ACS treated by primary stenting within 24 hours after onset were enrolled. There were 128 patients treated with SES and 117 patients were treated with BMS. We evaluated the incidence of major cardiac events (MACE; total death, nonfatal myocardial infarction, TVR) at 3 years, comparing with 8-month clinical outcome. Results: Eight-month clinical follow-up shows a significantly lower incidence of TVR in the SES group, 3.1% in the SES group versus 9.4% in the BMS group (P = 0.04). At 3-year clinical follow-up, there was no significant difference in the rate of TVR between the two groups, 8.4% versus 12.4% (P = 0.37). Cumulative incidence of total MACE was 9.2% in the SES group compared with 15.9% in the BMS group (P = 0.18). Only one case of stent thrombosis was observed in the SES (late thrombosis), while two cases of stent thrombosis occurred in the BMS group (late and very late thrombosis; P = 0.55). Conclusion: SES implantation in patients with ACS is associated with favorable long-term clinical outcome with no excess of late stent thrombosis. Further long-term clinical follow-up will be warranted to confirm the safety and efficacy of SES. (J Interven Cardiol 2009;22:216-221).
  • Kenichi Sakakura, Norifumi Kubo, Junya Ako, Naoki Fujiwara, Hiroshi Funayama, Nahoko Ikeda, Tomohiro Nakamura, Yoshitaka Sugawara, Takanori Yasu, Masanobu Kawakami, Shin-ichi Momomura
    AMERICAN JOURNAL OF HYPERTENSION 22 4 371 - 377 2009年04月 [査読有り][通常論文]
     
    BACKGROUND Type B acute aortic dissection (AAD) carries a high short- and midterm mortality rate; however, knowledge related to long-term outcome is largely incomplete. The objective of this study was to identify long-term predictors including anti hypertensive medications in type B AAD. METHODS We conducted a clinical follow-up study on 202 type B AAD patients. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. RESULTS There were 44 postdischarge deaths in 202 consecutive type B AAD patients with a median follow-up of 55 months. In univariate Cox-regression analysis, age (10 year incremental: hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.35-2.46, P < 0.0001), previous myocardial infarction or angina pectoris (HR 3.93, 95% Cl 1.72-8.99, P = 0.001), and impaired renal function (HR 4.90, 95% Cl 2.48-9.65, P < 0.0001) were predictors of death. Calcium channel blockers (CCBs), beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors as anti hypertensive medications at discharge were predictors of increased survival. In multivariate Cox regression analysis, CCBs were a significant predictor of increased survival (vs. no anti hypertensive medication at discharge: HR 0.38, 95% Cl 0.15-0.97, P = 0.04). Impaired renal function was a significant predictor of death (HR 3.41, 95% Cl 1.58-7.33, P = 0.002). No anti hypertensive medication at discharge group was significantly associated with increased mortality (vs. 1 class of antihypertensive medication: HR9.51, 95% Cl 1.85-48.79, P = 0.007). CONCLUSIONS Impaired renal function was a predictor for adverse outcome in patients with type B AAD. The use of CCBs as anti hypertensive medication at discharge was associated with increased survival.
  • Kenichi Sakakura, Norifumi Kubo, Shigemasa Hashimoto, Nahoko Ikeda, Hiroshi Funayama, Taishi Hirahara, Yoshitaka Sugawara, Takanori Yasu, Junya Ako, Masanobu Kawakami, Shin-ichi Momomura
    JOURNAL OF CARDIOLOGY 52 1 24 - 29 2008年08月 [査読有り][通常論文]
     
    Background: Acute myocardial infarction (AMI) due to left main coronary artery disease is associated with significantly elevated morbidity and mortality. The aim of this study was to identify the predictors of in-hospital death from left main AMI complicated by cardiogenic shock. Methods: Clinical record review identified a total of 25 cases of left main AMI with cardiogenic shock. Patients' background characteristics, Laboratory data, and angiographic findings were analyzed according to the in-hospital mortality. Results: In this patient subset, in-hospital mortality (60%) was associated with a history of hypertension (p = 0.02) and a higher heart rate (p = 0.02). Furthermore, in-hospital mortality was also associated with a complete right bundle branch block (CRBBB) pattern in the admission ECG (p = 0.01) and low HCO(3)(-) (p = 0.0004). In step-wise logistic regression analysis, a CRBBB pattern (OR 48.59, 95% CI 1.34-1768.10, p=0.03) and low HCO(3)(-) (OR 0.62, 95% CI 0.40-0.94, p=0.02) were found to be independent predictors of mortality.
  • Kenichi Sakakura, Satoshi Hoshide, Joji Ishikawa, Shin-ichi Momomura, Masanobu Kawakami, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 21 6 627 - 632 2008年06月 [査読有り][通常論文]
     
    BACKGROUND As hypertension, obesity, and leanness are reported to be associated with poor cognitive function, it is possible that obesity or leanness in hypertensive patients may also be associated strongly with poor cognitive function. METHODS We recruited 184 elderly hypertensive patients comprising 93 very elderly (aged >= 80 years) and 91 younger elderly (aged 61-79 years) subjects. A mini-mental state examination (MMSE) and 24-h ambulatory blood pressure monitoring (ABPM) were performed in all participants. Patients were classified as either lean, normal physique, or obese according to the body mass index (BMI) quartile. The prevalence of poor cognitive function, total MMSE score, and MMSE subscores were compared between the groups. RESULTS The prevalence of poor cognitive function, total MMSE score, and MMSE subscore attention/calculation were significantly different between the groups both in the total study population and in the very elderly patients. The multiple logistic regression model showed that leanness was a significant determinant of poor cognitive function in both the total study population (odds ratio (OR) 2.54, 95% confidence interval (CI) 1.13-5.73, P= 0.02) and the very elderly patients (OR 3.94,95% CI 1.31-11.82, P= 0.01). Obesity was not a significant determinant in either the total study population, very elderly, or younger elderly groups. CONCLUSION While obesity in hypertensive elderly patients was not associated with poor cognitive function, leanness in hypertensive elderly patients was, especially in the very elderly.
  • Kenichi Sakakura, Norifumi Kubo, Junya Ako, Nahoko Ikeda, Hiroshi Funayama, Taishi Hirahara, Yoshitaka Sugawara, Takanori Ydsu, Masanobu Kawakami, Shinichi Momomura
    CIRCULATION JOURNAL 71 10 1521 - 1524 2007年10月 [査読有り][通常論文]
     
    Background In Stanford B acute aortic dissection (AAD), medical treatment is the choice of therapy in the acute phase, however, a portion of patients experience complications caused by serious clinical outcomes including aortic rupture and abdominal visceral ischemia. The objective of this study was to determine the predictors of in-hospital events in an Asian cohort of Stanford type 9 AAD. Methods and Results Hospital records were queried to identify patients that met following criteria: (1) AAD presenting within 14 days of symptom onset; and (2) computed tomography (CT) confirmation of a dissected descending aorta not involving the ascending aorta. An in-hospital event was defined as death, rupture/ impending rupture, or organ malperfusion. Patient characteristics, inflammatory markers, and CT findings were obtained from clinical case records and retrospectively analyzed. Two hundred and twenty patients with Stanford B AAD were identified. In-hospital events occurred in 15 patients (there were 8 deaths, and 5 patients need to undergo emergent surgery because of impending rupture or rupture, and 4 patients experienced organ malperfusion). In univariate logistic regression analysis, the non-thrombosed type (odds ratio (OR) 3.88, 95% confidence interval (0) 1.20-12.61, p=0.02) and maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.61, 95% CI 1.20-2.15, p=0.001) were significant predictors of in-hospital events. In multiple logistic regression analysis, the only significant predictor was maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.41, 95 % CI 1.04-1.92, p=0.03). Conclusion The results identified a large maximum aortic diameter as the independent predictor of in-hospital events in Stanford type B AAD. The non-thrombosed type might also help differentiate high-risk patients.
  • Kenichi Sakakura, Joji Ishikawa, Masataka Okuno, Kazuyuki Shimada, Kazuomi Kario
    AMERICAN JOURNAL OF HYPERTENSION 20 7 720 - 727 2007年07月 [査読有り][通常論文]
     
    Background: It is reported that blood pressure (BP) variability increases with aging, and cognitive dysfunction may be related to BP variability; however, there are no data showing that exaggerated BP variability is associated with cognitive dysfunction or quality of life (QOL) in the older elderly. We investigated the relationships and the differences between ambulatory BP variability and cognitive function or QOL in younger elderly and very elderly. Methods: We recruited both 101 very elderly (aged >= 80 years) and 101 younger elderly (aged 61 to 79 years). Twenty-four-hour ambulatory blood pressure monitoring, mini-mental state examinations (MMSE), and Medical Outcome Study Short-Form 36 Items Health Survey (SF-36) were performed for all subjects. Results: The mean standard deviation (SD) of daytime systolic BP in young elderly was 17.2 +/- 4.6 mm Hg (mean SD SD of mean SD), and that in very elderly was 21.2 +/- 4.3 mm Hg. The MMSE score significantly decreased with the tertile of SD of daytime systolic BP in very elderly (P = .004) and young elderly (P = .03). In very elderly, there was no significant association between the SD of daytime systolic BP and each of eight SF-36 categories. On the other hand, in younger elderly, two of eight SF-36 categories decreased with the tertile of SID of daytime systolic BP (P = .001 for Vitality and P = .003 for Role emotion). Conclusions: Very elderly had larger BP variability than younger elderly. Exaggerated ambulatory BP variability was related to cognitive dysfunction in the elderly, especially in the very elderly, and was related to lower QOL in the younger elderly. Am J Hypertens 2007;20: 720-727 (c) 2007 American Journal of Hypertension, Ltd.
  • K Sakakura, T Yasu, Y Kobayashi, T Katayama, Y Sugawara, H Funayama, Y Takagi, N Ikeda, T Ishida, Y Tsuruya, N Kubo, M Saito
    ANGIOLOGY 57 2 155 - 160 2006年03月 [査読有り][通常論文]
     
    Noninvasive characterization of coronary plaques is challenging for cardiologists. The authors' goal was to explore the clinical feasibility of newly developed 16-slice computed tomography (CT) in tissue characterization of coronary arterial plaques in patients with acute coronary syndrome. Sixteen patients with acute coronary syndrome underwent 16-slice CT (Aquillion, Toshiba) and coronary arteriography with intravascular ultrasound (IVUS) within 7 days. Twenty-three plaques were classified by IVUS according to plaque echogenicity: 6 soft plaques, I I intermediate plaques, and 6 calcified plaques. Mean (+/- SD) CT numbers (Hounsfield units [HU]) of these 3 types of plaques were 50.6 +/- 14.8 HU, 131 +/- 21.0 HU, and 72 1 +/- 231 HU, respectively. Sixteen-slice CT facilitates noninvasive tissue characterization of coronary arterial plaques.
  • Kenichi Sakakura, Norifumi Kubo, Takuji Katayama, Tomio Umemoto, Satoshi Oosawa, Seiichiro Murata, Yoshitaka Sugawara, Hiroshi Funayama, Yousuke Takagi, Takanori Yasu, Yoshio Tsuruya, Takashi Ino, Muneyasu Saito
    Journal of Cardiology 45 6 257 - 262 2005年06月 [査読有り][通常論文]
     
    A 45-year-old woman presented with triple valve infective endocarditis and ventricular septal defect. There were vegetations on the tricuspid valve, pulmonary valve, and aortic valve. She had multiple complications such as nephrotic syndrome, severe anemia, congestive heart failure, and convulsion. Her general condition was extremely poor. Intensive medical therapy, such as blood transfusion, mechanical ventilation, and continuous venovenous hemofiltration, allowed her to tolerate surgery. Triple valve replacement and ventricular septal defect closure was successfully performed without major complication. She was ambulatory at the time of discharge.
  • Sakakura K, Kubo N, Takagi Y, Katayama T, Sugawara Y, Funayama H, Ikeda N, Ishida T, Yasu T, Tsuruya Y, Saito M
    Journal of cardiology 45 3 123 - 128 2005年03月 [査読有り][通常論文]
  • Kenichi Sakakura, Katsuyuki Tone, Hitoshi Kakimoto, Miki Koyama, Kiyotsugu Sekioka
    Journal of Cardiology 41 6 277 - 283 2003年06月 [査読有り][通常論文]
     
    Objectives. This study evaluated whether the use of Levovist™ improves endocardial border delineation during dobutamine stress echocardiography. Methods. Thirty patients (20 men and 10 women) were enrolled in this study. Dobutamine was infused intravenously using an incremental regimen of 5, 10, 20, 30, and 40 μg/kg/min, each dose for 3 min. Levovist (277 mg/ml), dissolved in 9 ml of 5% dextrose, was infused intravenously. Two ml was infused at rest, 10, and 20 μg/kg/min. Three ml was infused at peak dobutamine dosage. Echocardiograms were recorded on videotapes. A endocardial border delineation score index (EDST) was used for image analysis. The EDSI was obtained from each of 12 segments of the left ventricular wall (30 patients) in the rest and peak stress periods, before and after Levovist. Data from a total of 1,440 segments were analyzed separately. Results. The mean EDSI at rest was 2.2 ± 0.6 without contrast medium, and 2.4 ± 0.7 with contrast medium (p < 0.05). The mean EDSI during peak stress was 2.0 ± 0.7 without contrast medium, and 2.2 ± 0.6 with contrast medium (p < 0.05). The wall-by-wall EDSI revealed that the delineation of apical-septal, mid- and apical-lateral, apical-inferior, and apical-anterior segments was improved significantly with Levovist in the rest and peak stress periods. Conclusions. Delineation of the apical-septal, mid- and apical-lateral, apical-inferior, and apical-anterior segments was improved significantly with Levovist during dobutamine stress echocardiography.

書籍

MISC

受賞

  • 2021年05月 International Heart Journal Best Reviewer Awards 2020
  • 2018年 The American Journal of Cardiology Outstanding Reviewer
  • 2018年 Journal of Cardiology Outstanding Reviewer
  • 2017年 日本心臓財団・日本循環器学会 「心臓」優秀査読者賞
  • 2016年 Journal of Cardiology Cases Outstanding Reviewer
  • 2015年 日本心血管インターベンション治療学会 Research Proposal採択
  • 2014年 第63回 American College of Cardiology 総会 Young Investigator Award competition: First place winner
  • 2012年 万有生命科学振興国際交流財団 平成24年度海外留学助成
  • 2011年 自治医科大学附属さいたま医療センター センター長賞
  • 2010年 自治医科大学医学部 優秀論文賞
  • 2010年 第33回日本高血圧学会総会 Young Investigator's Award 優秀賞
  • 2009年 17th Asian Pacific Congress of Cardiology Travel grant award.
  • 2008年 地域医療振興協会 第21回 地域保健医療研究奨励賞
  • 2007年 地域医療振興協会 第20回 地域保健医療研究奨励賞
  • 2006年 American Society of Hypertension Young Investigator Travel Award

共同研究・競争的資金等の研究課題

  • 冠動脈高度石灰化病変に対する治療戦略の検討
    日本学術振興会:科学研究費助成事業 基盤研究(C)
    研究期間 : 2017年04月 -2020年03月 
    代表者 : 坂倉 建一, 百村 伸一, 藤田 英雄
     
    冠動脈高度石灰化における治療戦略の検討がテーマであり、昨年度はロータブレーターに関する3報の論文を報告している(Yamamoto K, Sakakura K, et al. Int Heart J 2018;59:399-402, Sakakura K, et al. JACC Cardiovasc Interv 2017;10:e227-e229, Sakakura K, et al. Cardiovasc Revasc Med 2018;19:286-291)ところであるが、昨年に引き続きロータブレーターを用いた治療戦略を中心に研究している。ロータブレーターのバーが通過困難な際にどのような治療戦略を取るかを示したTechnical case report(Taniguchi Y, Sakakura K, et al.J CardiolCases 2019 doi.org/10.1016/j.jccase.2019.02.005)を報告した。本報告では、直径1.5mmのバーと直径1.25mmのバーを交互に用いることで、通過困難な高度石灰化病変が有効かつ安全に治療ができる可能性を示している。ロータブレーターを行った際に過度の回転数の低下を避けることが重要と考えられているが、どのような状況で過度の回転数低下が起こるのかは明らかではない。ロータブレーター使用時において、過度の回転数低下の規定因子は何かを検討した原著論文を現在投稿中である。また、ロータブレーター中の重大合併症(血管穿孔やバーのスタック)を避けるために、どのような切削方法をとればよいのかについての治療戦略を検討した原著論文も現在投稿中である。


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