DOI： 10.7759/cureus.32234

PubMed

DOI： 10.1007/s00330-022-08752-0

PubMed

International / domestic magazine：Domestic journal  

We describe a case of a 59-year-old woman with hypertrophic cardiomyopathy who remained with right ventricular outflow tract obstruction after the pressure gradient in the left midventricle was resolved by a drug with a negative inotropic effect. The patient was diagnosed with hypertrophic cardiomyopathy 30 years previously and was only on low-dose beta-blocker therapy. She presented at our hospital with suspected exacerbation of heart failure because of the development and exacerbation of dyspnea and chest tightness. Transthoracic echocardiography showed an accelerated blood flow of 3 m/s in the middle of the left ventricle; thus, she was started on cibenzoline, a drug with a negative inotropic effect. After admission, intracardiac pressure measurement showed no pressure gradient in the left chamber. However, there was a pressure gradient of 18 mmHg between the apex of the right ventricle and the right ventricular outflow tract, and right ventricular outflow tract obstruction was confirmed on cardiac magnetic resonance imaging. We decided to reinforce the negative inotropic effect by adding bisoprolol, and the subjective symptoms and auscultatory systolic murmur were eliminated 2 months later. Learning objective: Hypertrophy of the right ventricular myocardium can occur in patients with hypertrophic cardiomyopathy (HCM). However, right ventricular outflow tract obstruction remains a rare finding in patients with HCM, despite the presence of morphological abnormalities such as right ventricular hypertrophy. In patients with HCM, obstruction of the right ventricle should be considered if the symptoms and auscultatory findings do not match the left ventricular imaging findings.

DOI： 10.1016/j.jccase.2022.02.010

PubMed

症例は59歳女性で、労作時呼吸困難を主訴に来院した。30年前に心筋生検により肥大型心筋症と診断され、β遮断薬を服用していた。受診時の血圧は131/85mmHg、心拍数は75bpmであった。胸骨左縁第2肋間を最強点とするIII/VIの収縮期駆出性(収縮中期性)雑音を聴取した。胸部X線で心拡大を認めたが、肺うっ血の所見はなかった。心電図は左軸偏位を呈し、V5〜V6誘導で深いS波を認めた。心臓MRIで左室前壁、下壁、中隔部に非均等型左室壁肥厚および左室中部閉塞を認めた。さらに前壁から下壁にかけてガドリニウム遅延造影を認めた。冠動脈造影で有意な狭窄病変は見られなかった。心臓カテーテルで心内圧を測定した。その結果、左室心尖部圧は148/21mmHg、左室流出路圧は138/20mmHgで左室内圧較差は見られなかったが、右室心尖部圧は43/20mmHg、右室流出路圧は25/6mmHgで圧較差は18mmHgであった。18mmHgの右室内圧較差に対して、陰性変力作用を有するシベンゾリンとビソプロロールを投与した。2ヵ月後に症状は改善し、収縮期雑音は消失した。血圧は124/70mmHgに改善した。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: In some patients with non-ischemic cardiomyopathy, left ventricular (LV) contraction is improved by optimal medical therapy, leading to LV reverse remodeling (RR). Patients with heart failure with improved ejection fraction and LVRR have a good prognosis, but the factors that predict RR are not fully understood. The relationship between body composition and cardiovascular disease has been reported. The present study aimed to assess the clinical predictors of LVRR in association with body composition. METHODS: We recruited patients who were diagnosed with non-ischemic cardiomyopathy between September 2017 and January 2020. Finally, 89 patients with a reduced LV ejection fraction were enrolled in this prospective study. Body composition, including ectopic fat, was measured in all patients using computed tomography. Echocardiography was performed 6 months after enrollment to evaluate LVRR. RESULTS: LVRR was observed in 39 patients (43.8%) after 6 months. In terms of the demographic findings, epicardial adipose tissue volume was greater in the LVRR group than in the non-LVRR group (135.2 cm3 [SD 128.4 cm3] vs. 88.9 cm3 [SD 54.6 cm3]; p = 0.040). The Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly less frequent in the LVRR group than in the non-LVRR group (log-rank test, p = 0.013). The multivariate logistic regression analysis identified epicardial adipose tissue volume as an independent predictor of LVRR (odds ratio [OR]: 1.010, 95% confidence interval [CI]: 1.001-1.01; p = 0.036). CONCLUSION: Epicardial adipose tissue volume is an independent predictor of LVRR in patients with non-ischemic cardiomyopathy.

DOI： 10.1016/j.ijcard.2022.03.051

PubMed

DOI： 10.1002/joa3.12712

PubMed

ペーシング誘発性心筋症(PICM)の予測因子を後方視的観察研究で調べた。2008年1月〜2018年1月にペースメーカー植込み目的で紹介された連続患者604名のうち、適格とした172名(男性88名、平均76±11歳)を組み入れた。リードの位置は右室心尖部(RVA)または右室中隔中部(mid-RVS)とし、mid-RVSの場合はその設置位置をCTで確認した。PICMの定義は、経過観察時の経胸壁心エコー法による評価で左室駆出率が40%未満とした。PICMを発症していた患者は18名(10.5%)(男性14名、平均76±14歳)存在した。RVA群66名とmid-RVS群106名を比較した場合、ペーシング時のQRS幅はmid-RVS群の方が有意に短かったものの、PICM発症率には有意差は認められなかった。多変量解析の結果、PICMの独立予測因子として、術前の左室収縮末期径(HR 1.12、95%CI 1.03〜1.22)とペーシング時のQRS幅(HR 1.03、95%CI 1.004〜1.06)が同定された。結論として、RVAかmid-RVSかというリードの設置位置の違いは、PICMの予測因子とはなっていなかった。術前の左室収縮末期径とペーシング時のQRS幅は、PICM予測に有用な指標となる可能性が示された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also ectopic fat has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with nonischemic cardiomyopathy. We investigated whether ectopic fat in the thigh affects the prognosis of nonischemic cardiomyopathy. This prospective study recruited 145 patients diagnosed with nonischemic cardiomyopathy between September 2017 and January 2020. Finally, 93 patients with a reduced ejection fraction were enrolled. The clinical end points were cardiovascular death or unexpected rehospitalization because of a cardiac event. Using computed tomography, the percentage of intramuscular fat (%IMF) in the thigh was measured in all patients. Patients were divided into 2 groups based on the median %IMF. The results of Spearman's correlation coefficient analysis revealed a correlation among %IMF and peak oxygen uptake (Spearman r = -0.221, p = 0.036). Kaplan-Meier analysis results showed significantly higher risk of adverse events in the high %IMF group (log-rank p = 0.013). Multivariate Cox regression analysis results revealed the %IMF as an independent factor for adverse events (hazard ratio 1.361; 95% confidence interval 1.043 to 1.745; p = 0.018). In conclusion, %IMF may have adverse consequences such as increased cardiac events in patients with nonischemic cardiomyopathy with a reduced ejection fraction.

DOI： 10.1016/j.amjcard.2021.12.059

PubMed

Publishing type：Research paper (scientific journal)  

Abstract

Aims

We aimed to develop models to detect aortic stenosis (AS) from chest radiographs—one of the most basic imaging tests—with artificial intelligence.

Methods and results

We used 10 433 retrospectively collected digital chest radiographs from 5638 patients to train, validate, and test three deep learning models. Chest radiographs were collected from patients who had also undergone echocardiography at a single institution between July 2016 and May 2019. These were labelled from the corresponding echocardiography assessments as AS-positive or AS-negative. The radiographs were separated on a patient basis into training [8327 images from 4512 patients, mean age 65 ±  (standard deviation) 15 years], validation (1041 images from 563 patients, mean age 65 ± 14 years), and test (1065 images from 563 patients, mean age 65 ± 14 years) datasets. The soft voting-based ensemble of the three developed models had the best overall performance for predicting AS with an area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 0.83 (95% confidence interval 0.77–0.88), 0.78 (0.67–0.86), 0.71 (0.68–0.73), 0.71 (0.68–0.74), 0.18 (0.14–0.23), and 0.97 (0.96–0.98), respectively, in the validation dataset and 0.83 (0.78–0.88), 0.83 (0.74–0.90), 0.69 (0.66–0.72), 0.71 (0.68–0.73), 0.23 (0.19–0.28), and 0.97 (0.96–0.98), respectively, in the test dataset.

Conclusion

Deep learning models using chest radiographs have the potential to differentiate between radiographs of patients with and without AS.

Lay Summary

We created artificial intelligence (AI) models using deep learning to identify aortic stenosis (AS) from chest radiographs. Three AI models were developed and evaluated with 10 433 retrospectively collected radiographs and labelled from echocardiography reports. The ensemble AI model could detect AS in a test dataset with an area under the receiver operating characteristic curve of 0.83 (95% confidence interval 0.78–0.88). Since chest radiography is a cost-effective and widely available imaging test, our model can provide an additive resource for the detection of AS.

DOI： 10.1093/ehjdh/ztab102

PubMed

Other URL： https://academic.oup.com/ehjdh/article-pdf/3/1/20/42981879/ztab102.pdf

DOI： 10.1148/ryai.210221

PubMed

DOI： 10.1093/ejcts/ezab409

PubMed

大動脈弁狭窄症(AS)に対し経カテーテル大動脈弁置換術(TAVI)を行う患者において、フレイルの存在が3年後の予後に及ぼす影響を評価する前向き観察研究を施行した。当院でTAVIを行う重症ASの患者連続280名(女性率68.9%、年齢中央値84歳)を組み入れた。TAVI手技の前に、患者に基本チェックリスト(KCL)へ回答してもらうことでフレイルの評価を行った。KCLは「はい/いいえ」で回答する簡単な質問文25個で構成され、0〜25点の範囲でスコア評価されるものであった。主要評価項目はTAVIから3年後の全死因死亡率とした。KCLの他に3種の尺度も用いてフレイル評価を行ったが、フレイル状態に関する受信者動作特性(ROC)曲線解析において、KCLスコアが示すROC曲線と、他の各尺度によるROC曲線の間には有意な差は認められなかった。KCLスコアで本集団がほぼ3等分になるよう層別化した時の三分位数は、8点と12点であった。多変量Cox回帰分析の結果、3年全死因死亡の有意な独立関連因子として、KCLスコア(ハザード比[HR]1.10、95%CI 1.03〜1.18)、糖尿病(HR 2.0)、肝疾患(HR 3.0)、が同定された。TAVIを行う患者でフレイルを評価し3年全死因死亡を予測する上で、KCLは簡便で有用なツールになると結論された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Frailty is a major risk factor for death and disability following transcatheter aortic valve implantation (TAVI). The Kihon checklist (KCL) is a simple self-reporting yes/no survey consisting of 25 questions and is used as a screening tool to identify frailty in the primary care setting. No clinical studies have focused on frailty calculated by the KCL in the TAVI cohort. We investigated the 3-year prognostic impact of frailty evaluated by the KCL in patients who underwent TAVI. METHODS: This single-center prospective observational study included 280 consecutive patients with symptomatic severe aortic stenosis who underwent TAVI and evaluated pre-procedural physical performance focused on frailty at our institution. We assessed all patients' frailty by the KCL before TAVI, as described previously. We set the primary endpoint as the 3-year all-cause mortality after TAVI. RESULTS: The median patient age was 84 years (interquartile range, 81-87 years), and 31.1% were men. In the receiver operating characteristics curve, there were no significant differences between the KCL and Cardiovascular Health Study frailty index [area under the curve (AUC) 0.625 versus 0.628; p=0.93), KCL and Rockwood Clinical Frailty Scale (AUC 0.625 versus 0.542; p=0.15), and KCL and Short Physical Performance Battery (AUC 0.625 versus 0.612; p=0.91). The first and second tertiles of the total KCL score were 8 and 12, respectively. The multivariate Cox regression model indicated that the total KCL score [hazard ratio (HR), 1.104; 95% confidence interval (CI), 1.034-1.179; p=0.003], presence of diabetes mellitus (HR, 1.993; CI, 1.055-3.766; p=0.03), and presence of liver disease (HR, 3.007; CI, 1.067-8.477; p=0.04) were independently associated with 3-year all-cause mortality. CONCLUSIONS: The KCL is a simple and useful tool for evaluating frailty status and predicting 3-year all-cause mortality in patients undergoing TAVI.

DOI： 10.1016/j.jjcc.2021.09.014

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To determine the correlation between upstream atherosclerosis in the femoropopliteal arteries, assessed using angioscopy, and impaired infrapopliteal runoff. MATERIALS AND METHODS: Thirty-one patients with peripheral arterial disease who underwent endovascular therapy and angioscopy were prospectively included. Yellow plaque color scores were semiquantitatively determined as 0, 1, 2, or 3. Irregular plaques with rough surfaces, similar to gastric ulcers, were defined as ulcerated plaques (UPs). Angioscopic data were correlated with angiographic runoff scores (ARS). RESULTS: UPs were detected in 74.2% of enrolled diseased legs using angioscopy. Mural thrombi were more commonly observed in the femoropopliteal artery in patients with UPs than in those without UPs (91.3% vs 37.5%, respectively; P = .006) and were frequently found on the UPs (21/23 patients with UPs). Univariate and multivariate linear regression analyses revealed that the presence of UPs was positively and independently associated with a poor ARS and that oral anticoagulant use was independently associated with a preferable ARS (standardized β = 0.462, P = .004 and standardized β = -0.411, P = .009, respectively, in the multivariate analysis). CONCLUSIONS: UPs, associated with mural thrombi and diagnosed by angioscopic examination, were demonstrated to be one of the factors associated with poor infrapopliteal runoff.

DOI： 10.1016/j.jvir.2021.10.013

PubMed

DOI： 10.11477/mf.1438200557

Publishing type：Research paper (scientific journal)  

DOI： 10.1093/ehjci/jeab123

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIMS: Oxidative stress plays an important role in the development and progression of heart failure (HF). Although exercise and oxidative stress are closely related, the effect of acute exercise on reactive oxygen species production and the fluctuation on prognosis are unclear. METHODS AND RESULTS: We enrolled 94 patients who were hospitalized for worsening HF (mean age 68.0 ± 14.5 years old, 63.8% male). The changes in diacron-reactive oxygen metabolites (d-ROM) values, a marker of oxidative stress, before and after a cardiopulmonary exercise test were considered as Δd-ROM. The mean follow-up period was 24 ± 13 months, during which 15 patients had all-cause death or left ventricular assist system implantation. Kaplan-Meier analysis demonstrated that all-cause death or left ventricular assist system implantation was significantly higher in the Δd-ROM-positive group than in the Δd-ROM-negative group (log-rank P = 0.047). Elevated Δd-ROM levels were associated with increased mortality risk. Multivariate analysis adjusted for body mass index and peak oxygen uptake revealed that Δd-ROM was an independent prognostic factor of adverse events (Tertile 3 vs. 1; hazard ratio: 4.57; 95% confidence interval: 1.21-29.77; P = 0.022). CONCLUSIONS: Patients with HF who underwent a cardiopulmonary exercise test and had an increased oxidative stress marker level had a poor prognosis. The appropriate exercise intensity could be determined by evaluating the changes in oxidative stress status in response to acute exercise in patients with HF.

DOI： 10.1002/ehf2.13538

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ahjo.2021.100047

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p>A 48-year-old woman without any medical history visited an outpatient clinic with a chief complaint of cough persisting for more than 1 year and was diagnosed with organizing pneumonia. Computed tomography showed wall thickening with luminal stenosis of the main branch vessels of the aorta, and a detailed examination including fluorodeoxyglucose-positron emission tomography revealed Takayasu arteritis. There have been some reports of combined organizing pneumonia in similar vasculitis cases, but Takayasu arteritis and organizing pneumonia have not been reported to be associated. This case can be referred to when considering the association of lung lesions with Takayasu arteritis. </p>

DOI： 10.2169/internalmedicine.6316-20

PubMed

CiNii Article

症例は48歳女性で、1年以上前から咳嗽が徐々に悪化し、他院で器質化肺炎が疑われていた。受診時の検査では、感染症、膠原病、抗好中球細胞質抗体関連血管炎、腫瘍、肺高血圧を示唆する所見はなかった。胸部CTでは、左下葉背側に結節性浸潤影を伴うすりガラス陰影、大動脈弓・腕頭動脈・左総頸動脈・鎖骨下動脈の壁肥厚が認められた。3次元マルチスライスヘリカルCT血管造影では、単純CTで認められた壁肥厚に一致した狭窄と閉塞が判明し、左下葉肺動脈の壁肥厚と狭窄病変も明らかとなった。頸動脈超音波検査では「マカロニサイン」が認められ、FDG-PET検査では、造影CTで認められた壁肥厚と狭窄部位の血管壁に高度蓄積が示された。左下葉肺動脈と左下葉外周でも造影トレーサー取り込みが認められたことから、高安動脈炎と確定診断した。感染性疾患の除外のために行った経気管支肺生検では、器質化肺炎の徴候が認められた。メチルプレドニゾロン治療を開始すると、臨床的改善が得られた。1年後の胸部CTで肺炎は著明に改善していたが、血管病変には明らかな改善は認められなかった。

循環血管ファントムをMRIのT1強調画像(T1MI)で撮像し、flow disturbanceが高信号域などのアーチファクトを引き起こすかどうかを調べ、さらにヒト血栓の連続観察を行った。ポリプロピレン製Y型チューブジョイントを用いて、1)血栓による完全閉塞、2)レジンによる完全閉塞、3)レジンによる重度狭窄、4)狭窄なし、の四つの血管分岐部モデルを作製した。循環血管ファントムシステムでT1WIの評価を行った。その結果、T1WIでは、レジンで狭窄・閉塞を引き起こした血管分岐部の周辺には高信号域が見られなかったが、血栓による閉塞部位にはHISが認められた。血栓の信号強度は、ベースラインと比較して、1ヵ月目と3ヵ月目に増加し、その後4ヵ月目に減少し、5ヵ月目には消失した。以上の結果から、ヒト血栓は血流の影響を受けることなくT1WI上に高信号域を発生させ、その信号の存在は5ヵ月未満の有限時間幅に限られることが示された。

カテーテルアブレーション(CA)治療を施行した持続性心房細動患者53例(男性41例、女性12例、平均65.6±8.7歳)を対象に、CA後のQOLおよび運動耐容能の改善に関連する臨床的因子について検討した。ペースメーカー植込み、重症弁膜疾患、虚血性心疾患、透析患者は除外した。QOLは独自に作成した質問票を用いて評価し、運動耐容能検査はCA治療前と治療後3ヵ月に実施した。CA治療によりQOLは有意に改善した(P=0.01)。また運動耐容能も有意に改善し、無酸素性作業閾値は13.3±3.0ml/kg/minから15.2±3.3ml/kg/minへ、最高酸素摂取量は19.1±4.6ml/kg/minから22.5±5.0ml/kg/minへ、分時換気量/二酸化炭素排出量の勾配は28.3±6.1から25.7±3.8へ改善した(いずれもP<0.001)。多変量解析の結果、左室駆出率の低値(OR:0.884、P=0.015)、左心耳血流速度の高値(OR:1.101、P=0.012)、CHADS2スコアの高値(OR:3.722、P=0.010)が運動耐容能の改善を予測する独立因子であった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

Soluble urokinase-type plasminogen activator receptor (suPAR) is a membrane-binding protein that is released into the blood stream by immune activation. Recent reports suggest that circulating suPAR levels are associated with adverse cardiovascular outcomes. Exercise tolerance is an independent predictor of prognosis in patients with heart failure (HF); however, the relationship between serum suPAR level and exercise tolerance is unclear. We prospectively enrolled 94 patients who were hospitalized for worsening of HF. All patients underwent a symptom-limited cardiopulmonary exercise test to evaluate exercise tolerance. The median value of serum suPAR was 4848 pg/ml. During follow up, 44 patients (47%) were admitted for all-cause mortality and re-hospitalization for HF. Median serum suPAR was significantly higher in the patients with cardiac events than in the patients with non-event group. Patients were divided into two groups according to circulating suPAR levels. Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly higher in the high suPAR group (log-rank p = 0.023). Multivariate analysis revealed that suPAR was independently correlated with the parameters of exercise tolerance such as anaerobic threshold (p = 0.007) and peak oxygen uptake (p = 0.005). suPAR levels predicted adverse cardiac events and independently correlated with the parameters of exercise tolerance. suPAR could be a useful surrogate biomarker of exercise tolerance in patients with HF.

DOI： 10.1007/s00380-019-01538-3

PubMed

心不全患者の血清可溶性ウロキナーゼ型プラスミノーゲン活性化因子受容体(suPAR)を測定し、運動能、疾患重症度、予後の評価における重要性を評価した。2013年7月〜2015年3月に心不全悪化のため入院した患者94例(男性60例、女性34例、平均68.0±14.5歳)を経過観察期間中(中央値796日)の総死亡率と心不全悪化による予期しない入院の複合を評価した。全例が退院前に症候限界性心肺運動負荷試験を実施していた。血液検体を採取して標準的臨床検査を実施した。血清suPAR中央値は4848.5pg/mlであった。心イベント群のsuPAR中央値は5530.5pg/mlで、非心イベント群の4590.0pg/mlよりも有意に高かった。受信者動作特性曲線に基づいて、死亡、再入院の検出に対するsuPAR値の最適カットオフ値を4170pg/mlと判定し、低suPAR群39例と高suPAR群55例に分けた。Kaplan-Meier解析では、高suPAR群は死亡率または再入院率が有意に高かった。多変量解析の結果、suPARは最大酸素摂取量や無酸素性作業閾値といった運動耐容能パラメータと独立して関連していることが明らかになった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jjcc.2019.10.002

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVES: In this study, we sought to investigate the association between revolution speed of rotational atherectomy (RA) and debulking area assessed by frequency domain-optical coherence tomography (FD-OCT). BACKGROUND: The number of patients with severe calcified coronary artery disease requiring treatment with calcium ablation, such as RA, is increasing. However, there is little evidence available regarding the association between debulking area and revolution speed during RA. METHODS: We retrospectively investigated 30 consecutive severely calcified coronary lesions in 29 patients who underwent RA under FD-OCT guidance. The association between preset revolution speed of RA and burr size-corrected debulking area of the calcified lesion was evaluated using a multivariable regression model with nonlinear restricted-cubic-spline, which can help assess nonlinear associations between variables. RESULTS: The median age of study participants was 73 years (quartile 65-78); 82.8% were male. The median burr size was 1.5 mm (1.5-1.75); median total duration of ablation was 120 s (100-180). FD-OCT revealed that the post-procedural minimum lumen area increased significantly from 1.64 mm2 (1.40-2.09) to 2.45 mm2 (2.11-2.98) (p < .001). In addition, the burr size-corrected debulking area increased significantly as the preset revolution speed decreased (p = .018), especially when the revolution speed was less than 150,000 rpm. This result implies that additional lumen gain will be obtained by decreasing rpm when the burr speed is set at <150,000 rpm. CONCLUSIONS: FD-OCT demonstrated that RA with lower revolution speed, below 150,000 rpm, has the potential to achieve greater calcium debulking effect in patients with severe calcified coronary lesions.

DOI： 10.1002/ccd.28212

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.11397/jsqsh.15.387

CiNii Article

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.15106/j_naika123_703

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1093/ehjci/jey158

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

拡張型心筋症患者65例(男性52例、女性13例、平均56±14歳)に心臓MRI検査を実施し、ガドリニウムによる遅延造影の判定に関して観察者間で不一致が生じた症例の転帰について検討した。冠動脈疾患、弁膜性疾患、浸潤性心筋症、遅延造影検査で梗塞心筋を認めた虚血性心筋症患者は除外した。遅延造影の判定は2名の観察者が行い、観察者全員が陽性と判定した陽性群20例、陰性群29例、観察者間で判定が一致しなかった不一致群16例の3群に患者を分類した。観察者間の診断の一致度(κ係数)は0.78であった。左室逆リモデリングは左室駆出率の10%以上の改善および左室収縮末期径の10%以上の減少と定義した。1年後に左室逆リモデリング効果を認めた各群の割合は、陰性群が59%、不一致群が31%、陽性群が15%であった(P=0.0068)。心血管死、持続性心室頻拍、心不全増悪による再入院を合わせた複合イベント発生率は陽性群と陰性群の間に有意差を認めたが、不一致群で群間差はなかった。以上より、LGE判定で観察者が一致しない症例における左室逆リモデリング効果は陽性と陰性の中間であることが示唆された。

Publishing type：Research paper (scientific journal)  

A drawback of visual assessment for late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is the subjectivity and reproducibility of the results. The aim of this study was to investigate the relationship between left ventricular (LV) reverse remodeling in response to optimal pharmacotherapies and the definite or discrepant mid-wall LGE with visual assessment in patients with dilated cardiomyopathy (DCM). A total of 65 patients who had been hospitalized with newly diagnosed DCM and had undergone CMR, were enrolled. When the visual assessment of the presence or absence of mid-wall LGE was confirmed by the two observers, patients were classified into either the positive- (n = 20) or negative-LGE (n = 29) groups. If there was discordance between the diagnoses of the two observers, patients were classified into the discrepant-LGE (n = 16) group. LV reverse remodeling was defined as an increase in LV ejection fraction by at least 10% concomitant with a decrease in the LV end-diastolic dimension by at least 10%. Among the three groups, the frequency of early LV reverse remodeling within a 1-year follow-up was significantly different (p = 0.0068). The frequency of LV reverse remodeling within a 1-year follow-up was 59, 31, and 15%, and over 2 years was 83, 62, and 40%, in patients with negative-, discrepant-LGE, and positive-LGE, respectively. The survival rate for composite end-points of cardiovascular mortality, sustained ventricular tachycardia, appropriate cardioverter-defibrillator discharge, or rehospitalization for decompensated heart failure was lower in positive-LGEs than in negative-LGEs (p =0.0011), whereas, there were no significant differences between both negative- and discrepant-LGEs, and discrepant- and positive-LGEs. This study showed that the discordance for LGE visual assessment occupied an intermediate position between positive and negative for LGE in LV reverse remodeling in patients with DCM.

DOI： 10.1007/s00380-018-1196-3

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

入院時にトルバプタンを投与した急性非代償性心不全(ADHF)患者105例(男性65例、女性40例、平均80±9歳)を対象に、退院後のトルバプタン用量が心臓死に及ぼす影響を検討した。全患者で入院中に最低3日間トルバプタンを投与した。患者を退院後にトルバプタンを外来で継続投与しなかった非投与群36例、継続投与した患者のうち用量が3.75mg/日の低用量群27例、7.5または15mg/日の高用量群42例の3群に分類した。ADHFの重症度および退院時のループ利尿剤の使用に有意な群間差はなかった。平均追跡期間は295日で、心臓死は34例(32%)で発生した。非投与群は7例(19%)、低用量群は1例(4%)、高用量群は26例(62%)であった。Kaplan-Meier法による生存曲線解析の結果、低用量群は高用量群および非投与群に比べて生存率が有意に高かった(P=0.0001)。また心不全の急性増悪による再入院と全死因死亡を合わせた複合イベントの発生率は他群に比べて低用量群で有意に低かった(P=0.0010)。

Publishing type：Research paper (scientific journal)  

Tolvaptan (TLV) is a newly developed oral vasopressin-2 receptor antagonist that is mostly used for patients with acute decompensated heart failure (ADHF) refractory to conventional diuretic therapy. The aim of this study was to investigate the effects of outpatient TLV dose on cardiac mortality in patients discharged after hospitalization for ADHF. One hundred and five patients with ADHF who had been treated with TLV for the first time during hospitalization were retrospectively divided into three groups based on outpatient TLV use and dose. The non-TLV group comprised patients who were not treated with TLV after discharge (n = 36). Patients who continued TLV after discharge were further classified into two groups: low-dose (LD)-TLV (3.75 mg/day, n = 27) and high-dose (HD)-TLV (7.5 or 15 mg/day, n = 42). The primary endpoint was cardiac mortality. Secondary endpoint included the composite of all-cause mortality or re-hospitalization due to worsening of ADHF. There were no significant differences in demographic variables other than body mass index (p = 0.0026), echocardiographic data, laboratory data other than serum chloride before TLV administration (p = 0.041), serum sodium (p = 0.040) and potassium (p = 0.027) at discharge, and concomitant medications among the three groups. The Kaplan–Meier curve showed that the survival rate was lower in HD-TLV than in non-TLV, whereas LD-TLV showed the highest survival rate among the three groups (p = 0.0001). Multivariable Cox regression analysis of the clinical characteristics used for predicting cardiac mortality revealed that LD-TLV (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.01–0.93, p = 0.040) and HD-TLV (HR 2.43, 95% CI 1.06–6.26, p = 0.035) were significant predictors after adjustment for predictive covariates. In conclusion, the judgement of the continuation of LD-TLV according to patient hemodynamics and severity of congestion may not cause worsened prognosis.

DOI： 10.1007/s00380-018-1177-6

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1016/j.jcmg.2017.11.033

PubMed

DOI： 10.15106/j_naika120_1273

CiNii Article

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

To evaluate the association between duration of the coronary occlusion and high-intensity signal (HIS) on noncontrast T1-weighted imaging using a 1.5-T magnetic resonance imager among patients with angiographic coronary total occlusion.
The signal intensity of the coronary target area divided by the signal intensity of the left ventricular muscle near the target area at each site (TMR) was measured. Areas with a TMR &gt; 1.0 were defined as HIS. Thirty five lesions from 33 patients were divided into the following three groups: subacute occlusion (up to 3 months; n = 7), short-duration chronic total occlusion (SD-CTO: 3-6 months; n = 9) and long-duration CTO (LD-CTO: &gt;= 6 months; n = 19).
All subacute occlusion lesions showed a HIS within the occlusion site. Among patients with CTO, the frequency of a HIS within the occlusion site was significantly higher in SD-CTO than in LD-CTO lesions (p = 0.013). In multivariate analyses, only an occlusion duration of less than 6 months was an independent factor associated with the presence of HIS (odds ratio 7.6, 95% CI 1.1-54.5; p = 0.044).
The presence of a HIS in the occlusion site was associated more with SD-CTO than with LD-CTO among patients with CTO.

DOI： 10.1007/s00330-016-4672-0

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

症例は65歳男性で、2年前に不安定性狭心症に対してシロリムス溶出ステント(SES)を用いる経皮的冠動脈インターベンション(PCI)を施行されていた。今回、再発性の急性胸痛が出現するため当院を受診した。緊急冠動脈造影でSES内に血栓性閉塞が認められた。吸引血栓除去後、多病巣性のperi-stent contrast staining(PSS)が観察された。光干渉断層撮影(OFDI)で冠動脈内血栓、incomplete stent apposition(ISA)、multiple inter-strut hollowが明らかになった。血管内超音波(IVUS)画像ではpositive vessel remodelingが認められた。SES内にベアメタルステント(BMS)を留置した後、ステント血栓症予防のためアスピリン、クロピドグレル、サルポグレラートを投与した。患者は徒歩で退院し、BMS留置から8ヵ月後のフォローアップ血管造影はステント内再狭窄またはPSSは認められなかった。OFDIでは、ISAのない均一な新生内膜を有する良好に被覆されたステント表面が明らかになった。

Publishing type：Research paper (scientific journal)  

A 65-year-old man who underwent percutaneous coronary intervention with sirolimus-eluting stents (SESs) 2 years ago was admitted with recurrent acute chest pain. Coronary angiography showed thrombotic occlusion within the SESs. After aspiration thrombectomy, multi-focal peri-stent contrast staining (PSS) was observed. Optical frequency domain imaging (OFDI) showed intracoronary thrombus, incomplete stent apposition (ISA), and multiple inter-strut hollows. Intravascular ultrasound (IVUS) images showed positive vessel remodeling. We deployed bare-metal stents in the SESs. Follow-up angiography showed no in-stent restenosis or PSS. OFDI showed well-covered stent surface with homogeneous neointima, without ISA. Additionally, IVUS images showed that the vessel remodeling had not worsened.

DOI： 10.1007/s12928-016-0384-2

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background: In the magnetic resonance T1-weighted imaging, some investigators have shown that coronary artery high-intensity signals (HISs) are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although previous studies used different PMR (the ratio between the signal intensities of coronary plaque and cardiac muscle) cutoff values to detect HIS, the association between PMR itself and plaque morphology has not been fully investigated.
Methods and Results: We prospectively investigated the association between PMR values and plaque morphology detected by optical coherence tomography in consecutive 106 patients with angina pectoris. The lesions with almost all of the vulnerable features such as lipid-rich, thin-cap fibroatheroma, plaque rupture, thrombus, macrophage infiltrations, intimal vasculature, and absence of calcification had significantly higher PMR; the only exception was the presence of cholesterol crystals. PMR increases linearly with the number of vulnerable features (p &lt; 0.0001, Rho = 0.504). Stepwise multiple linear regression analysis revealed that the absence of calcification (p = 0.0027), and the presence of thrombus (p = 0.0071) and intimal vasculature (p = 0.019) were independently associated with higher log-transformed PMR. There was a stepwise increase in PMR of the culprit lesions in proportion to the accumulation of the number of adverse plaque characteristics defined as non-calcified plaque, thrombus, and/or intimal vasculature.
Conclusion: These results suggest that not only the presence of HIS, but also the elevated PMR itself may be used as a quantitative marker of plaque vulnerability in clinical evaluation. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.

DOI： 10.1016/j.ijcard.2016.12.028

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

非ST上昇型心筋梗塞(NSTEMI)患者19例(男性11例、女性8例、平均71.1±9.8歳)と不安定狭心症(UAP)患者65例を対象に、光干渉断層法により冠動脈プラークの動態を観察し、臨床像を比較検討した。UAP患者はBraunwald分類に基づきI型42例(男性29例、女性13例、平均66.4±10.8歳)とII+III型23例(男性17例、女性6例、平均66.6±9.6歳)の2群に分類した。粥腫崩壊の頻度はNSTEMI患者(68%)の方がUAP患者(II+III型30%、I型19%)より高く、血栓形成の頻度もNSTEMI患者(73%)の方がUAP患者(II+III型22%、I型14%)より高かった。NSTEMIでは63%の患者で粥腫崩壊と血栓形成の両方を認めたが、UAP患者ではI型とII+III型でそれぞれ12%と13%であった。多重ロジスティック回帰分析で粥腫崩壊と血栓形成はNSTEMIに関係する独立因子であった。

Publishing type：Research paper (scientific journal)  

Recently, unstable angina pectoris (UAP) and non-ST-segment-elevation myocardial infarction (NSTEMI) have been considered together because they exhibit indistinguishable clinical and electrocardiogram features, and constitute non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). However, no optical coherence tomography (OCT) studies have reported the association between vulnerable plaque morphology and clinical characteristics in NSTE-ACS patients based on assessment of clinical symptoms and myocardial necrosis. The aim of this study was to investigate the differences in clinical characteristics and plaque morphology assessed by OCT between patients with UAP and NSTEMI. Preinterventional OCT images of 84 NSTE-ACS patients were studied, 19 with NSTEMI and 65 with UAP, according to levels of high-sensitivity troponin T. The frequency of plaque rupture and thrombus in patients with NSTEMI was higher than in UAP patients with either class I or II + III (rupture: NSTEMI, 68 %; UAP classes II + III, 30 %; UAP class I, 19 %, thrombus: NSTEMI, 73 %; UAP classes II + III, 22 %; UAP class I, 14 %). In NSTEMI patients, the frequency of occurrence of both thrombus and rupture was the highest. Conversely, patients with UAP class I or those with UAP classes II + III most frequently had no thrombus and rupture, and the frequencies of the presence of thrombus were only 14 and 22 %, respectively. Multivariate analysis revealed that thrombus and plaque rupture were independently associated with NSTEMI. This study demonstrates that the morphological features of culprit lesions could be related to clinical severity in NSTE-ACS patients.

DOI： 10.1007/s00380-016-0862-6

PubMed

経皮的冠動脈インターベンションに先行して新規責任病変を光コヒーレンストモグラフィー(OCT)で評価した急性冠症候群または安定狭心症患者173例のコレステロール結晶(CC)、その他プラーク形態と臨床的特徴の関連性を調べた。OCT画像を解析して、CC、プラーク破裂、脂質の多いプラーク、薄被膜線維性粥腫、マクロファージ蓄積、内膜血管系、冠内血栓、石灰化を評価した。患者を責任病変区域内にCCのある66例(男性83%、平均69±10歳)とない107例(男性80%、平均67±10歳)に分けた。CCに関連する独立因子を同定するために、多変量ロジスティック回帰分析を実施した。高密度リポ蛋白コレステロール<35mg/dL、糖尿病、プラーク破裂、内膜血管系、血栓がCCに関連する独立因子であった。CCの頻度は不安定プラーク特性数の蓄積と比例して増加した。CCのある患者のうち、管腔側からのCCの最小深度は血栓なしの患者よりも血栓ありの患者の方が有意に小さかった。臨床的代謝疾患と責任病変の不安定形態特性が安定および不安定冠動脈症候群患者におけるCCの存在に関連することを示した。

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background: Previous pathohistological studies demonstrated that cholesterol crystals (CCs) are frequently observed in atherosclerotic plaques, and are usually present abundantly in vulnerable plaques. However, the role of CCs in plaque destabilization, as well as their origin and composition, is unknown. Optical coherence tomography (OCT) imaging system is a high-resolution imaging device, which allows the in vivo identification of CCs accumulating within atherosclerotic plaques. The aim of this study was to investigate the relationship between the presence of CCs, other plaque morphologies assessed by OCT, and patients' clinical characteristics including acute coronary syndrome (ACS).
Methods and results: Preinterventional OCT images of 173 patients with either ACS or stable angina pectoris were studied. Of 173 lesions in the patients, 66 (38%) had CCs within the culprit lesion segment and 107 (62%) had non-CC lesions. Multivariate analysis revealed that low high-density lipoprotein cholesterol levels, diabetes mellitus, the presence of plaque rupture, intimal vasculature, and thrombus were independent factors associated with CCs. Moreover, the frequency of CCs increased in proportion to the accumulation of the number of components of their vulnerable plaque features within the culprit lesion segment. Compared with the plaques without thrombus, CCs were present at shallower locations in those with thrombus.
Conclusions: This study demonstrates the potential correlation between the clinical metabolic disorder and vulnerable morphological features of culprit lesions to the presence of CCs in patients with stable and unstable coronary syndromes. These observations of CCs by using in vivo plaque imaging could provide incremental value to OCT evaluation of atherosclerotic plaques. (C) 2016 Japanese College of Cardiology. Published by Elsevier Itd. All rights reserved.

DOI： 10.1016/j.jjcc.2016.04.003

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

光干渉断層撮影(OCT)を用いて、プラーク破裂の有無で急性冠症候群(ACS)患者における点状石灰化の特徴を調査し、点状石灰化とプラーク破裂の位置関係を判定した。ACS患者をプラーク破裂ありの38例(男性71.1%、平均73.5±9.2歳)となしの60例(男性66.7%、平均67.0±8.8歳)に分けた。OCT画像を解析し、石灰化の定量的評価と分布を調べた。点状石灰化の頻度、薄被膜線維性粥腫、マクロファージ浸潤、患者当たりの点状石灰化数は非破綻群よりも破綻群で有意に高かった。全点状石灰化の解析では、管腔表面からの平均最小深度は非破綻群よりも破綻群で有意に小さかった。最小内腔面積(MLA)に直近の点状石灰化では、管腔表面からの最小深度とMLAと点状石灰化の間における距離の絶対値は非破綻群よりも破綻群で有意に小さかった。破綻群ではMLA域の近位部で点状石灰化を最も観察したが、非破綻群では近位部から遠位部に均一に見られる傾向にあった。多変量解析では点状石灰化の存在と年齢がプラーク破裂の独立予測因子であった。

Publishing type：Research paper (scientific journal)  

動脈硬化の指標であるCardio-ankle Vascular Indexはプラーク組織性状ではなく、プラーク量と相関することを報告した。

Publishing type：Research paper (scientific journal)  

Although recent optical coherence tomography (OCT) studies have focused on spotty calcification, whether there were any characteristics in the concomitant existence of calcification and plaque rupture remains unknown. The aim of the present study was to investigate the characteristics of spotty calcification in acute coronary syndrome (ACS) patients with or without plaque rupture, using OCT. This study enrolled 98 consecutive patients with ACS. OCT image acquisitions were performed in the culprit lesions, and patients were divided into the plaque rupture group (n = 38) and the non-rupture group (n = 60). The frequency of spotty calcification (p = 0.006), thin-capped fibroatheroma (p = 0.012), macrophage infiltration (p = 0.022), and the number of spotty calcification per patient (p &lt; 0.001) were significantly higher and the largest arc and the minimum depth of spotty calcification from the luminal surface were significantly smaller in the rupture group. Moreover, in the rupture group, most of the spotty calcifications in the site nearest to the minimum lumen area were observed in the proximal portion of that site, and tended to be located near the plaque rupture. Multivariate analysis revealed that the presence of spotty calcification (OR 3.19, 95 % CI 1.12-9.76, p = 0.030) and age (OR 1.08, 95 % CI 1.02-1.14, p = 0.008) were independent predictive factors for plaque rupture. This study demonstrates the characteristics of spotty calcification in ACS patients with plaque rupture and the positional relationship between spotty calcification and plaque rupture. These detailed observations could impact on treatment strategies for the prevention of ACS.

DOI： 10.1007/s00380-016-0820-3

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction or prevention of acute cardiovascular events. Recently, magnetic resonance (MR) imaging technology has reached a sufficient level of spatial resolution, which allowed the plaque visualization of large and static arteries such as the carotids and aorta. However, coronary wall imaging by MR is still challenging due to the small size of coronary arteries, cardiac and respiratory motion, and the low contrast-to-noise ratio between the coronary artery wall and the surrounding structures. Following the introduction of carotid plaque imaging with noncontrast T1-weighted imaging (T1WI), some investigators have reported that coronary artery high-intensity signals on T1WI are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although there are several limitations and issues that need to be resolved, this novel MR technique for coronary plaque imaging could influence treatment strategies for atherothrombotic disease and may be useful for understanding the pathophysiological mechanisms of atherothrombotic plaque formation.

DOI： 10.3390/ijms17071187

PubMed

狭心症患者において、T1強調(T1WI)非造影MRIにおける冠動脈の高信号プラーク(HIP)、光干渉断層撮影(OCT)で評価したプラーク組成、血清中バイオマーカーといった複数の方法を用いて、経皮的冠動脈インターベンション(PCI)中のfilter no-reflow(FNR)現象の予測因子を検討した。狭心症を有する患者50例における50病変について検討した。全患者で侵襲的冠動脈造影実施前の24時間以内にT1WIを撮影し、PCI前に原発性のアテローム硬化性責任病変のOCTを実施した。冠動脈プラークと心筋のシグナル強度比(PMR)を、MRIシステムの標準コンソール上で計算した。50病変のうち20病変でPCI中にFNRが認められ、30病変では認められなかった。FNR病変を特定する上で、PMRカットオフ値1.85超は、感度65%、特異度93%、陽性的中率87%、陰性的中率80%であった。多変量分析にて、PMRが1.85超のHIPのみが、PCI中のFNR現象の独立予測因子であることが明らかになった。

【背景】医学科4年生の採血系実習は、各科が独自で行うため、指導法と学生の手技修得に差が生じていた。【目的】共通の知識と技術の修得を目指し、採血系実習の標準化を試み、その効果を明らかにする。【方法】2012年度より実習形式を「テーマ毎に3名の指導医で分担」、「同一指導医が同テーマを担当」、「全実習をSSCで実施」に変更した。実習後のアンケートから標準化の効果を検討した。【結果】90%超の学生が「理解できた」、「臨床実習で『採血させてください』と言える」と回答した。インストラクターを務めた研修医は80%が標準化を肯定した。【結語】今回の採血系実習の標準化は学生と指導者の双方にとって有用であった。(著者抄録)

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background: Although the occurrence of no-reflow during percutaneous coronary intervention (PCI) has been shown to be associated with worse short- and long-term clinical outcomes, the clinical relevance of preventing flow deterioration by using the filter-based distal protection devices (DPDs) is controversial. We investigated predictors of the filter no-reflow (FNR) phenomenon during PCI by using multimodality, such as hyperintense plaques (HIPs) in the coronary artery on Tl-weighted imaging (T1WI) non-contrast magnetic resonance, plaque composition by using optical coherence tomography (OCT), and serum biomarkers, in patients with angina pectoris.
Methods and results: Fifty lesions from 50 patients with angina were examined. All patients underwent T1WI within 24 h before invasive coronary angiography was performed, and preinterventional OCT was performed on a native atherosclerotic culprit lesion. The signal intensity of coronary plaque to cardiac muscle ratio (PMR) was calculated on a standard console of the magnetic resonance system. Of the 50 lesions, 20 lesions showed FNR during PCI, while non-FNR was observed in 30 lesions. A cut-off value &gt;1.85 of PMR had a sensitivity of 65%, a specificity of 93%, a positive predictive value of 87%, and a negative predictive value of 80% for identifying lesions with FNR. Multivariate analysis revealed that the presence of HIPs with PMR &gt;1.85 (p = 0.008) was the only independent predictor of the FNR phenomenon during PCI.
Conclusions: This study shows that the presence of HIPs with PMR &gt;1.85 on T1WI was a novel independent predictor of the FNR phenomenon during PCI in angina patients. This result may help in identifying high-risk lesions for no-reflow to deploy filter-based DPDs. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2015.06.015

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Many investigators have reported that the total amount of coronary calcium correlates with the overall magnitude of atherosclerotic plaque burden in the entire coronary tree and is a powerful predictor of future cardiovascular events. However, the development and spatial distribution of coronary calcifications remain unclear. We investigated the spatial distribution of calcifications throughout the coronary tree during coronary artery evaluation using coronary computed tomography angiography (CTA). A further aim was to assess the progression of existing calcifications and the development of new deposits in a follow-up study. The study population consisted of 287 patients for the cross-sectional study using CTA to evaluate the spatial distribution of calcifications by parent coronary arteries. Next, we analyzed a CTA dataset of 57 patients who had undergone two CTA examinations. In this group, the two CTA images were used for assessing the progression of existing calcifications and the development of new deposits. The coronary calcifications tended to be clustered within the proximal and middle portions. Moreover, in the proximal left anterior descending coronary artery (LAD), small calcifications were located more toward the inner pericardial side. Finally, new calcium deposits developed within the proximal and middle portions of the LAD and left circumflex coronary artery, but those in the right coronary artery were likely to appear evenly from the proximal to the distal portion. This study shows the characteristic patterns of the longitudinal and circumferential distribution of calcifications by parent coronary arteries.

DOI： 10.1007/s00380-015-0652-6

PubMed

冠動脈疾患疑いまたは冠動脈リスク因子を有する連続患者287例(男性71%、年齢33〜88歳)を対象に、CT血管造影(CTA)による冠動脈評価時の冠動脈枝の石灰化の空間的分布を検討した。次に、57例を対象としたフォローアップ研究において、既存の石灰化の進行と新しい沈着の発生を評価した。冠動脈石灰化は、冠動脈の分布内の>130HUのCT数を有する2連続ピクセル量として定義した。総カルシウム石灰化スコア(TCS)は各病変のスコアの合計として定義した。287例のうち101例(35%)はTCSがゼロであった。残りの186例(65%)のうち82例は軽度TCS、53例は中等度TCS、51例は重度TCSであった。全体として2777セグメントの804(29%)がカルシウム沈着を有した。動脈石灰化は近位部および中間部以内に集まる傾向にあった。さらに、左下行冠動脈(LAD)近位部において小石灰化が内側心膜側に向かってより多く局在した。新しいカルシウム沈着はLADおよび左回旋冠動脈の近位部および中間部以内に発生したが、右冠動脈においては近位部から遠位部に均一にみられるようであった。本試験により、親冠動脈による石灰化の長軸方向および円周分布の特徴的パターンが示された。

症例は47歳男性で、乗用車での走行中に中央分離帯に正面衝突し、救急医療部に搬送された。搬送時のグラスゴーコーマスケールはE1V2M3であった。経胸壁心エコー検査で大量の心嚢液貯留を認めた。心タンポナーデを疑い、心嚢穿刺術を施行した。収縮期血圧は70mmHg(搬送時)から120mmHgに上昇した。臨床検査で心筋トロポニンTは0.28ng/μL(正常範囲:0.00〜0.03ng/μL)、CK-MBは64IU/L(0〜25IU/L)を呈した。搬送20分後の心電図は完全右脚ブロックであったが、1時間後に胸部誘導で早期再分極に変化した。経食道および経胸壁心エコー検査で心室の収縮機能および壁運動に異常は見られなかった。冠動脈CT検査も正常であった。入院12日目の冠動脈MRAのblack bloodT2強調画像で心室中隔に高信号域を認めた。その後ガドリニウム造影剤を注入したが、同域でガドリニウム遅延造影を認めなかった。以上の所見より前壁中隔の心挫傷と診断した。

DOI： 10.1002/ams2.122

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

OBJECTIVES This study sought to investigate the relationship between Localization of high-intensity signals (HISs) on T1-weighted imaging (T1WI) with the noncontrast magnetic resonance technique and plaque morphology detected on optical coherence tomography, and the clinical severity of angina pectoris.
BACKGROUND Since the introduction of the T1WI noncontrast magnetic resonance technique for plaque imaging, some groups have reported that HISs in the coronary artery on T1WI are associated with a vulnerable morphology and future cardiac events. However, the association between the localization of HISs, such as coronary intrawall or intraluminal, and plaque morphology has not been investigated.
METHODS One hundred Lesions with either stable or unstable angina were included and divided into 3 groups according to the following criteria using T1WI. First, the plaques with the ratio between the signal intensities of coronary plaque and cardiac muscle &lt;= 1.0 were classified as non-HISs (n = 39). Then, HISs with the ratio between the signal intensities of coronary plaque and cardiac muscle &gt;1.0 were classified into 2 types by using cross-sectional T1WI. Those Localized within the coronary wall when the Lumen was identified were defined as intrawall HISs (n = 37), whereas those occupying the lumen when the Lumen was not, or even if only partly, identified, were defined as intraluminal HISs (n = 24).
RESULTS Multivariate analysis revealed that intrawall HISs were associated with macrophage accumulation and the absence of calcification assessed by using optical coherence tomography. In contrast, thrombus and intimal vasculature were independent factors associated with intraluminal HISS. Furthermore, 50% of patients with intraluminal HISs experienced rest angina, such as Braunwald class II or III.
CONCLUSIONS This study shows that intrawall and intraluminal HISs on T1WI in patients with angina are related to the different types of vulnerable plaque morphology and the clinical severity. (C) 2015 by the American College of Cardiology Foundation.

DOI： 10.1016/j.jcmg.2015.06.013

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: The presence of cardiac involvement in sarcoidosis, a multisystem granulomatous disease of unknown etiology, is associated with very poor prognosis. Therefore, early detection of cardiac sarcoidosis (C-sar) is very important for effective treatment. Recently, the value of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR), which allows visualization of even minute amounts of myocardial damage, has been emphasized in diagnosing C-sar. Although the presence of LGE has been added as a minor criterion for diagnosing C-sar in the most recent Japan Ministry of Health and Welfare (JMHW) guidelines, its clinical utility remains unknown. METHODS: A total of 17 patients with biopsy-proven extracardiac sarcoidosis, who underwent CMR and examinations using a sufficient number of modalities to diagnose or exclude C-sar in accordance with the JMHW diagnostic criteria, were retrospectively enrolled in this study. Among these 17 patients, 7 patients were diagnosed with C-sar and 10 with non-C-sar. We investigated the clinical performance of LGE in the detection of cardiac involvement, compared the distribution of LGE with perfusion defects of iodine-123-labeled 15-(p-iodophenyl)-3R,S-methyl pentadecanoic acid (BMIPP) or thallium-201 (201Tl) scintigraphy, and evaluated the prognostic value of LGE on CMR in identifying adverse clinical events. RESULTS: All patients diagnosed with C-sar were positive for LGE and all diagnosed with non-C-sar patients were negative. Evaluation of LGE revealed a broader range of abnormalities than the evaluation of the defects shown by either BMIPP or 201Tl scintigraphy. All adverse events occurred in the C-sar patients with LGE. CONCLUSIONS: This study showed that LGE is useful for the detection of cardiac involvement, and it might be a promising tool for determining the prognosis of patients with biopsy-proven extracardiac sarcoidosis.

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

DOI： 10.1093/ehjci/jeu119

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

多断面CT画像で左室重量を評価した患者93例を対象とした研究を行った。左室肥大をSokolow-Lyonの基準で判断すると感度57%、特異度67%、陽性適中度37%、陰性適中度82%であったが、ストレイン型の基準で判断すると感度65%、特異度87%、陽性適中度63%、陰性的中度88%であった。多変量解析によるとストレイン型は左室肥大と関連があったがSokolow-Lyon基準は関連がなかった。

Publishing type：Research paper (scientific journal)  

Although obesity and chest-wall thickness influence the Sokolow-Lyon electrocardiographic (ECG) voltage criteria and strain pattern, these factors have not been taken into account in previous studies that evaluate the relationship between the ECG criteria and anatomic left ventricular hypertrophy (LVH). The introduction of multislice computed tomography (MSCT) has enabled assessment of not only coronary artery stenoses but also left ventricular volume and mass, left atrial volume, and chest-wall thickness. We hypothesized that evaluating the relation between the ECG voltage criteria or strain pattern and the aforementioned factors using MSCT would be highly valuable. The study population consisted of 93 patients who required MSCT angiography. The Sokolow-Lyon voltage and strain patterns were determined to detect anatomic LVH, which was defined as increased left ventricular mass. The Sokolow-Lyon voltage criteria, as an indicator of anatomic LVH, had a sensitivity of 57 %, specificity of 67 %, positive predictive value of 36 %, and negative predictive value of 82 %. By contrast, the strain pattern had a sensitivity of 65 %, specificity of 87 %, positive predictive value of 63 %, and negative predictive value of 88 %. Multivariate analysis revealed that the strain pattern was associated with the presence of anatomic LVH, whereas the Sokolow-Lyon voltage was not. This MSCT study demonstrated that even after removing the effects of various factors, the strain pattern remained associated with the presence of anatomic LVH, in contrast to the Sokolow-Lyon voltage.

DOI： 10.1007/s00380-013-0408-0

PubMed

Publishing type：Research paper (scientific journal)  

A low ratio of eicosapentaenoic acid to arachidonic acid (EPA/AA) has been demonstrated to be associated with a higher risk of cardiovascular events. Optical coherence tomography (OCT) is useful for the assessment of coronary plaque vulnerability. The purpose of this study was to evaluate the association between EPA/AA ratio and coronary plaque vulnerability. This study involved 58 patients with stable angina pectoris undergoing percutaneous coronary intervention. OCT image acquisition was performed before the procedure in the culprit lesions. We assessed lipid-rich plaque length and arc, fibrous cap thickness, frequency of thin-cap fibroatheroma (TCFA), thrombus, ruptured plaque, macrophage infiltration, and microvessels using OCT. Patients were divided into two groups according to the median value of serum EPA/AA ratio: a low-EPA/AA group (n = 29, EPA/AA ratio &lt; 0.36) and a high-EPA/AA group (n = 29, EPA/AA ratio a parts per thousand yen0.36). In qualitative analyses, TCFA (35.4 vs 6.9 %, P = 0.0095), macrophage infiltration (48.3 vs 13.8 %, P = 0.0045), and microvessels (44.8 vs 10.3 %, P = 0.0033) were more frequently observed in the low-EPA/AA group. In quantitative analyses, the low-EPA/AA group had wider maximum lipid arc (114.0 +/- 94.8A degrees vs 56.4 +/- 66.0A degrees, P = 0.0097), longer lipid length (4.8 +/- 4.5 vs 1.6 +/- 2.6 mm, P = 0.0037), and thinner fibrous cap (69.3 +/- 28.3 vs 113.3 +/- 46.6 mu m, P = 0.005) compared with the high-EPA/AA group. EPA/AA ratio was positively correlated with fibrous cap thickness (r = 0.46, P = 0.007). In a multivariate model, an EPA/AA ratio &lt; 0.36 was associated with the presence of TCFA (odds ratio 6.41, 95 % confidence interval 1.11-61.91, P = 0.0371). In our detailed OCT analysis, lower EPA/AA ratio was associated with higher vulnerability of coronary plaques to rupture.

DOI： 10.1007/s00380-013-0404-4

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Previous studies have reported that insulin resistance plays an important role in the progression of atherosclerosis. However, the relationship between insulin resistance and coronary plaque instability is not well established. The purpose of this study was to assess the relationship between insulin resistance and coronary plaque characteristics identified by optical coherence tomography (OCT).
This study enrolled 155 consecutive patients undergoing percutaneous coronary intervention. OCT image acquisitions were performed in the culprit lesions. Insulin resistance was identified using the homeostasis model assessment of insulin resistance (HOMA-IR). Subjects were divided into three tertiles according to the HOMA-IR values. Patients in the higher HOMA tertile had more frequent prevalence of lipid-rich plaques than those in the middle and lower tertiles (83 vs. 62 vs. 57; P 0.01). The thin-cap fibroatheroma (TCFA) prevalence rates among the higher (2.5), middle (1.42.5), and lower HOMA-IR (1.4) tertiles were 50, 29, and 26 (P 0.02). The microvessel prevalence rates of the three tertiles were 54, 39, and 28 (P 0.02). Furthermore, in the higher HOMA-IR group, the fibrous cap was significantly thinner compared with the other two tertiles (vs. lower HOMA-IR, P 0.009; vs. middle HOMA-IR, P 0.008). On multivariate analysis, acute coronary syndrome [odds ratio (OR): 17.98; 95 confidence interval (CI): 7.1252.02; P 0.0001] and HOMA-IR 2.50 (OR: 3.57; 95 CI: 1.429.55; P 0.007) were independent predictors for the presence of TCFA.
This study suggests that insulin resistance might be associated with coronary plaque vulnerability.

DOI： 10.1093/ehjci/jet158

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

PubMed

PubMed

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

3T MRIを使用して、鬱血性心不全(CHF)患者の心房性ナトリウム利尿ペプチド(ANP)とニトログリセリン(NTG)の静脈内注入による、心外膜冠動脈のサイズと血液の流速の変化を測定した。CHF患者8名と健常被験者6名を無作為にANP群とNTG群に分け、ベースライン、注入時、注入後に同じ面で横断面MR血管造影、位相差流速測定を行った。両群の薬物注入開始15分後に冠動脈横断面で有意な増加が認められたが、注入停止15分後にはANP群にのみ遅れたピークが認められた。両群の流速に有意差は観察されなかった。さらにNTGでは心拍数が増加したが、ANP群では増加しなかった。冠動脈の拡張と流速は、3T MRIによって同時に測定できた。この方法で冠動脈拡張と流速に対するANPの効果はNTGに劣らず、心拍数の有意な変化も伴わないことを示すことができた。

Publishing type：Research paper (scientific journal)  

Although atrial natriuretic peptide (ANP) is widely used in patients with congestive heart failure (CHF), little is known about its effect on epicardial coronary arteries. Magnetic resonance imaging (MRI) enables precise measurement of coronary vasodilation and flow velocity. In this study, we examined the changes in epicardial coronary artery size and flow velocity in response to intravenous infusion of ANP or nitroglycerin (NTG) by using 3 T MRI in patients with CHF. The study cohort contained a total of 14 subjects: 8 patients with CHF and 6 healthy volunteers as controls, randomly divided into two groups: the ANP group (0.03 mu g/kg/min) and the NTG group (0.3 mu g/kg/min). Cross-sectional MR angiography and phase-contrast flow velocity of the right coronary artery in the same in-plane slice were obtained at the baseline, during drug infusion, and at two subsequent time points after stopping drug infusion. A significant increase was observed in the coronary cross-sectional area at 15 min after drug infusion in both groups compared with that at baseline; however, a late peak was observed at 15 min after stopping infusion in the ANP group. No significant differences were detected in the flow velocity in both groups. Furthermore, although NTG increased the heart rate, this change was not found in the ANP group. Coronary vasodilation and flow velocity can be measured simultaneously using 3 T MRI. Using this method, we showed that the effects of ANP on the coronary artery vasodilation and flow velocity were not inferior to those of NTG, with no significant alteration in heart rate.

DOI： 10.1007/s00380-012-0292-z

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Many investigators have speculated that hyperintense plaques (HIPs) of the carotid artery on noncontrast T1-weighted imaging (T1WI) in cardiovascular magnetic resonance indicate the presence of mural or intraplaque hemorrhage containing methemoglobin. However, coronary plaque imaging with T1WI is challenging, and the clinical significance of coronary HIPs on T1WI remains unknown. Incidentally, it is very rare to find an intracoronary thrombus at the culprit lesion site in patients in stable condition. This article reports the case of a lesion containing an intracoronary thrombus, detected as HIP on T1WI associated with the filter no-reflow phenomenon in a patient with silent myocardial ischemia.

DOI： 10.1186/1532-429X-15-50

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

拡張型心筋症(DCM)13例、左室求心性肥大(LVCH)18例、対照者69例を対象とし、64-マルチスライスCT画像により冠動脈容積と左室重量を評価した。LVCH患者とDCM患者の冠動脈の長さと容積の絶対値は対照群より大であったが、左室重量で調整した冠動脈容積は、DCM患者はLVCH及び対照群患者より小であり、LVCH患者と対照群との間には有意差はなかった(左室容積はDCM4.1±0.9、LVCH5.4±1.4、対照群5.5±2.3ml/100g、P<0.005)。LVCHでは左室重量増加に応じて冠動脈容積が増加にするが、DCMでは左室重量増加に比べて冠動脈容積が小さかった。

Publishing type：Research paper (scientific journal)  

Background: Myocardial fractional flow reserve (FFR) is useful in the evaluation of coronary lesion ischemia. However, the impact of lesion length on FFR has not been adequately assessed. Hypothesis: We hypothesized that lesion length would influence functional significance in intermediate coronary lesions. Methods: FFR measurements were assessed in 136 patients (163 lesions) with stable angina who had &gt
40% stenotic coronary lesion by quantitative coronary angiography (QCA). One hundred sixty-three lesions were classified as intermediate (40%-70% stenosis
n=107
group I) or significant (≥70%
n=56
group S) by QCA. We assessed the relationships between lesion length, coronary stenosis, and FFR in these 163 lesions. Results: Regression analysis revealed an inverse correlation between the percentage of diameter stenosis (%DS) and FFR in group S (r = -0.83, P &lt
0.0001). In group I, no significant correlation was found between %DS and FFR (r = -0.06, P = 0.55), whereas lesion length was significantly inversely correlated with FFR (r = -0.79, P &lt
0.0001). Receiver operating characteristic curve analysis demonstrated that the best cutoff value for predicting an FFR value &lt
0.80 was a lesion length &gt
16.1 mm in group I (sensitivity, 86%
specificity, 94%). Conclusions: These study findings suggest that lesion length has a physiologically significant impact on intermediate-grade coronary lesions. Clin. Cardiol. 2011 DOI: 10.1002/clc.22076 The authors have no funding, financial relationships, or conflicts of interest to disclose. © 2012 Wiley Periodicals, Inc.

DOI： 10.1002/clc.22076

PubMed

Publishing type：Research paper (scientific journal)  

Several coronary angiographic studies have reported that enlarged and tortuous epicardial coronary arteries are characteristic of patients with left ventricular concentric hypertrophy (LVCH). Recently, we showed that small volumes opacified by contrast medium can be accurately measured by 64-multislice computed tomography (MSCT) and that there is a direct relationship between the coronary artery volume and left ventricular (LV) mass. However, the relationship of coronary artery volume with LV mass in patients with dilated cardiomyopathy (DCM) is unknown. The present study was designed to investigate this issue. Thirteen patients with DCM and 18 patients with LVCH who underwent MSCT angiography were included in this analysis. The coronary arteries were segmented on a workstation, and the appropriate window settings obtained from the results of the phantom experiments were applied to the volume-rendered images to calculate the total coronary artery volume (right and left coronary arteries). The absolute coronary lengths and volumes in patients with LVCH and DCM were greater than those in controls. The coronary artery volumes adjusted for LV mass in patients with DCM were found to be smaller than those in patients with LVCH or in controls, and these values did not differ between patients with LVCH and controls (DCM 4.1 +/- 0.9, LVCH 5.4 +/- 1.4, controls 5.5 +/- 2.3 ml/100 g of LV mass, P &lt; 0.005; DCM vs LVCH, P &lt; 0.01; and DCM vs control, P &lt; 0.0005). This study showed that the increase in the coronary artery volume in patients with LVCH matched the increase in LV mass, but a decreased coronary volume with regard to LV mass was characteristic of patients with DCM.

DOI： 10.1007/s00380-011-0230-5

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background/Aim: The aim of the present study was to quantitatively examine factors associated with aortic calcification in non-dialysis CKD patients. Methods: We quantitatively investigated aortic calcification from the renal artery to the bifurcation in 149 non-dialysis CKD patients (58 +/- 16 years; 96 males and 53 females, 48 diabetics; eGFR 40.3 +/- 29.3 ml/min), and measured Agatston scores using multi-slice computed tomography. Result: Of 149 patients, aortic calcification was present in 117. In patients with aortic calcification, age (p &lt; 0.001), C-reactive protein (p &lt; 0.001), and intact-PTH (p &lt; 0.001) were significantly higher, estimated glomerular filtration rate (eGFR) was significantly lower (p &lt; 0.001), and diabetes was observed more often (p &lt; 0.05). In regards to the degree of aortic calcification, the Agatston scores correlated significantly and positively with age (rho = 0.438, p &lt; 0.001) and serum phosphate (rho = 0.208, p = 0.024), and correlated significantly but negatively with e-GFR (rho = -0.353, p &lt; 0.001). In multiple regression analysis, eGFR was associated significantly and independently with the log [Agatston score] (beta = -0.346, p &lt; 0.01), after adjustment for several confounders including serum phosphate and the presence of diabetes. Conclusions: Hyperphospatemia, chronic inflammation, diabetes, and decreased GFR are associated significantly with the presence of aortic calcification in non-dialysis CKD patients. Decreased eGFR was associated significantly and independently with the quantitative degree of aortic calcification. Copyright (C) 2014 S. Karger AG, Basel

DOI： 10.1159/000355768

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Recently, an aortic valve area (AVA) index (AVAI) &lt;0.6 cm(2)/m(2) was proposed as an indicator of severe aortic stenosis. The purpose of the present study was to clarify the prognostic value of the AVAI. We identified 103 consecutive asymptomatic patients (mean age 72 +/- 11 years) with severe aortic stenosis, defined by an AVA of &lt;1.0 cm(2), who had not undergone aortic valve replacement on initial evaluation. During follow-up (median 36 +/- 27 months), 31 aortic valve replacements and 20 cardiac deaths occurred. Multivariate analysis revealed that an AVAI &lt;0.6 cm(2)/m(2) (hazard ratio 2.6, 95% confidence interval 1.1 to 6.3; p = 0.03) and peak aortic jet velocity (Vp) &gt;4.0 m/s (hazard ratio 2.6, 95% confidence interval 1.2 to 5.8; p = 0.02) were associated with cardiac events but that an AVA &lt;0.75 cm(2) was not. The event-free survival of patients with an AVAI of &gt;= 0.6 cm(2)/m(2) was better than that for those with an AVAI &lt;0.6 cm(2)/m(2) (86% vs 41% at 3 years, p&lt;0.01). Furthermore, patients with an AVAI of &gt;= 0.6 cm(2)/m(2) and Vp of &lt;= 4.0 m/s showed an excellent prognosis, but those without these findings had poorer outcomes. In conclusion, AVAI is a powerful predictor of adverse events in asymptomatic patients with severe aortic stenosis. Furthermore, the combination of AVAI and Vp provides additional prognostic information. Watchful observations are required for timely aortic valve replacement in patients with an AVAI of &lt;0.6 cm(2)/m(2) or a Vp &gt;4.0 m/s. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:93-97)

DOI： 10.1016/j.amjcard.2012.02.056

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

PubMed

CiNii Article

PubMed

組織病理学的観察、血管内超音波(IUVS)および光コヒーレンストモグラフィー(OCT)の所見に基づき、ステント留置後の動脈治癒像について検討した。ミニブタ6頭の血管(冠動脈、回旋動脈、腸骨動脈、大腿動脈)にベアメタルステントを挿入し、ステント留置1および4週間後に、組織病理学的観察、IUVS、OCT撮像を行った。新生内膜被覆スコアは0〜3で判定した。IVUSおよびOCTでは、平均新生内膜厚は1〜4週間で増加した。OCTはIUVSよりも高スコアを示した。OCT分析は、組織病理学的検査と同様に心内膜被覆を評価できた。OCTにより、ステント留置後の動脈治癒過程を正確に連続して分析できる。

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Aims Many investigators have speculated that hyperintense plaques (HIPs) of the carotid artery on non-contrast T1-weighted imaging (T1WI) in magnetic resonance indicate the presence of mural or intraplaque haemorrhage containing methemoglobin. Coronary plaque imaging with T1WI is challenging, and the clinical significance of coronary HIP on T1WI remains unknown. The aim of this study was to compare HIPs on T1WI with coronary plaque morphology assessed by optical coherence tomography (OCT), which allows us to identify not only plaque rupture, but also fibrous cap thickness and intracoronary thrombus in vivo, in patients with angina pectoris.
Methods and results Twenty-six lesions from 26 patients with either stable or unstable angina pectoris were examined in this study. All patients underwent T1WI within 24 h before the day on which invasive coronary angiography was performed, and pre-interventional OCT was performed on a native atherosclerotic lesion, considered to be the culprit lesion. Of the 26 lesions studied, 16 (62%) were HIPs and 10 (38%) were non-HIPs. The signal intensity of the coronary plaque to cardiac muscle ratio in HIPs was significantly higher than that in non-HIPs. There were no significant differences in the frequency of lipid-rich plaque, thin-cap fibroatheroma, plaque rupture, and calcification between HIPs and non-HIPs. In contrast, the frequency of thrombus was significantly higher in HIPs than in non-HIPs (P = 0.004).
Conclusion This study shows that the HIPs on T1WI in angina patients relate to the presence of intracoronary thrombus as detected by OCT imaging.

DOI： 10.1093/ehjci/jer305

PubMed

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

多検出器CT(MDCT)は非侵襲的に冠動脈内腔狭窄と冠動脈粥状硬化の特性を評価することができる。本研究では高血圧患者134例(平均年齢70±11歳、男93例)の冠動脈をMDCTで評価し、急性冠症候群発症(ACS)の予知因子を検討した。平均39±10ヵ月の追跡期間中にACSを発症した患者が10例(心筋梗塞3例、不安定狭心症7例)あった。多変量解析によりACS発生の独立予知因子として同定されたのは低密度冠動脈プラークの総数であった(P<0.001)。

Publishing type：Research paper (scientific journal)  

Background: Arterial hypertension is an established risk factor for acute coronary syndrome (ACS). Multidetector computed tomography (MDCT) is an accurate and less invasive technique for assessment of the degree of coronary artery luminal narrowing and characterization of coronary atherosclerosis. We therefore aimed to investigate the predictive power of MDCT for future ACS events and compared with traditional parameters in patients with hypertension.
Methods: One hundred and thirty-four patients (93 men, mean age 70 +/- 11 years) with hypertension underwent MDCT for evaluation of coronary artery disease. MDCT analysis focused on the presence of plaques, the degree of stenosis, and the plaque characteristics. Traditional parameters included Framingham risk score, carotid intima-media thickness, and left ventricular mass index.
Results: During a mean follow-up of 39 +/- 10 months, ACS events occurred in 10 patients, including myocardial infarction (n=3) and unstable angina (n=7). Multivariate analysis identified total number of low attenuation plaques as an independent predictor of ACS events (p&lt;0.001).
Conclusion: We demonstrated that non-obstructive low attenuation coronary plaques on MDCT predicted more accurately future ACS events in patients with hypertension than traditional parameters. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2011.11.010

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Purpose: Inflammation plays a critical role in atherosclerosis and is associated with upregulation of inducible nitric oxide synthase (iNOS). We studied bioluminescence imaging (BLI) to track iNOS gene expression in a murine model of vascular inflammation.
Procedures: Macrophage-rich vascular lesions were induced by carotid ligation plus high-fat diet and streptozotocin-induced diabetes in 18 iNOS-luc reporter mice. In vivo iNOS expression was imaged serially by BLI over 14 days, followed by in situ BLI and histology.
Results: BLI signal from ligated carotids increased over 14 days (9.7 +/- 4.4 x 10(3) vs. 4.4 +/- 1.7 x 10(3) photons/s/cm(2)/sr at baseline, p &lt; 0.001 vs. baseline, p &lt; 0.05 vs. sham controls). Histology confirmed substantial macrophage infiltration, with iNOS and luciferase expression, only in ligated left carotid arteries and not controls.
Conclusions: BLI allows in vivo detection of iNOS expression in murine carotid lesions and may provide a valuable approach for monitoring vascular gene expression and inflammation in small animal models.

DOI： 10.1007/s11307-010-0451-5

PubMed

DOI： 10.1016/j.jccase.2011.08.001

PubMed

最近、薬物溶出ステント留置後のステント外への造影剤染み出し(PSS)、即ち、ステント圧着不良(ISA)の拡張が報告されている。症例は58歳男性で、三血管疾患に対し冠動脈バイパス術が施行された。しかし、左回旋動脈への静脈グラフトの不全が認められたため、シロリムス溶出ステントを留置した。1年後の血管造影でPSSが認められ、3年後の血管造影では遅発性ISAの拡張と遅発性ステント再狭窄がみられた。この再狭窄部位を血管内超音波(IVUS)と光コヒーレンストモグラフィー(OCT)で評価した。IVUSでは狭窄部位のステント内に不規則な構造が認められたが、OCTでは通常はみられないベル型の遅発性ステント再狭窄像が検出され、ISAの拡張を伴っていた。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Drug-eluting stents reduce restenosis due to neointimal growth suppression. Considering long-term outcomes, it is both difficult and important to predict drug-eluting stent restenosis. Thus, this study was designed to examine the utility of myocardial fractional flow reserve (FFR) as a predictor of sirolimus-eluting stent (SES) restenosis. Thirty-three patients (35 lesions) were enrolled. Upon completion of SES implantation, FFR was obtained under hyperemia. At 8 months of follow-up, coronary angiography revealed that five lesions had restenosis. Percent diameter stenosis (restenosis 68.7 +/- A 12.8% vs. non-restenosis 68.7 +/- A 12.4%, p = 0.78) and lesion length (restenosis 15.8 +/- A 9.4 mm vs. non-restenosis 14.4 +/- A 9.2 mm, p = 0.60) were similar. At post-intervention, percent diameter stenosis (restenosis 16.4 +/- A 6.1% vs. non-restenosis 14.0 +/- A 7.4%, p = 0.48) and minimum stent area (restenosis 6.01 +/- A 1.08 mm(2) vs. non-restenosis 6.27 +/- A 1.85 mm(2), p = 0.92) were also equivalent. However, proximal edge lumen area was smaller (restenosis 4.24 +/- A 1.40 mm(2) vs. non-restenosis 7.73 +/- A 2.64 mm(2), p = 0.004) and FFR was lower in the restenosis group (restenosis 0.81 +/- A 0.12 vs. non-restenosis 0.92 +/- A 0.06, p = 0.029). SES patients with restenosis had a lower FFR post stent deployment, suggesting the decreased FFR may be a useful predictor for SES restenosis.

DOI： 10.1007/s00380-010-0105-1

PubMed

薬剤溶出ステントは、新内膜増殖の抑制により再狭窄を減少させるが、長期成績をみると、再狭窄は依然として存在する。したがって、再狭窄の予測が重要であるが、困難でもある。シロリムス溶出ステント(SES)を留置した患者33名(35病変)を対象に、標記について検討した。SES留置完了後に、心筋血流予備量比(FFR)を充血時に測定した。ステント留置8ヵ月後、冠動脈血管造影により5病変の再狭窄が明らかになった。再狭窄病変と非再狭窄病変の間で、インターベンション前の血管径狭窄率および病変長は類似していた。インターベンション後の両病変において、血管径狭窄率および最小ステント面積も同等であった。しかし、再狭窄病変において、近位端管腔面積が有意に小さく(4.24±1.40mm2対7.73±2.64mm2)、FFRが有意に低かった(0.81±0.12対0.92±0.06)。以上より、FFRの低下がSES再狭窄の有用な予測因子である可能性がある。

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

重大な冠動脈疾患(CAD)の欠如を示唆する冠動脈石灰化(CAC)スコアゼロ(CAC-0)の同定および介入は、臨床設定に有意義と思われる。CAD疑いの患者309名を対象に、CAC-0に関連する因子を同定し、本スコアと求心性左室(LV)肥大との関係について検討した。各病変のスコアを合計した総CACスコアにより、ゼロ、軽度(0〜100)、中程度(100〜400)、高度(>400)に分類した結果、LV求心性肥大の頻度はそれぞれ、6%、17%、26%、19%で、ゼロ群における頻度が極端に低かった。多変量解析の結果、年齢、高コレステロール血症、糖尿病、LV求心性肥大、LV重量係数がCAC-0に関連する独立した因子であったが、高血圧は関連していなかった。LV求心性肥大がCAC-0の必須条件であること、つまり、LV求心性肥大の存在がCACの存在に関与することが示された。

Publishing type：Research paper (scientific journal)  

The identification and intervention of factors associated with a coronary artery calcification (CAC) score of zero, suggesting the absence of significant coronary artery disease (CAD) with high probability, would be meaningful in the clinical setting. Thus far, the relationship between CAC and left ventricular (LV) hypertrophy has not been documented. We identified factors associated with a CAC score of zero and evaluated the relationship between this score and LV concentric hypertrophy in 309 consecutive patients with suspected CAD who were clinically indicated to undergo multislice computed tomography angiography for coronary artery evaluation. The quantitative CAC score was calculated according to Agatston&apos;s method. The total coronary calcium score (TCS) was defined as the sum of the scores for each lesion. Four absolute TCS categories were considered: zero, mild (0-100), moderate (100-400), and severe (&gt; 400). LV hypertrophy was classified into concentric (LV mass index &gt; 104 g/m(2) in women or &gt; 116 g/m(2) in men; LV end-diastolic volume index &lt;= 109.2 mL/m(2)) and eccentric (LV end-diastolic volume index &gt; 109.2 mL/m(2)) patterns. In the zero-TCS group, the frequency of LV concentric hypertrophy was extremely low (zero 6%, mild 17%, moderate 26%, severe 19%). Multivariate analysis revealed that age, hypercholesterolemia, diabetes mellitus, LV concentric hypertrophy, and LV mass index, but not hypertension, were the independent factors associated with a CAC score of zero. The present study demonstrated that the absence of LV concentric hypertrophy was a prerequisite for a CAC score of zero. That is, the presence of LV concentric hypertrophy, which indicated more severe underlying hypertension, long duration, or poor control of blood pressure, implicates the presence of CAC.

DOI： 10.1007/s00380-010-0082-4

PubMed

PubMed

マルチスライスCT血管造影が必要と判定された患者151名を対象として、心尖拍動を仰臥位で触診した。また、左室肥大(LVH)検出のためSokolow-Lyon電圧とCornell電圧を測定した。その結果、持続性心尖拍動(SAI)または二重心尖拍動(DAI)のパターンとCornell電圧はSokolow-Lyon電圧に比べてLVHの指標としての特異度が高かった。内側の胸壁までの距離は左室拡張末期容積および質量と負の相関を示したが、胸部表面までの距離は体格指数と相関していた。多変量解析では、SAIまたはDAIのパターンは胸部表面までの距離よりも内側の胸壁までの距離と強い関連を示したが、Sokolow-Lyon電圧は胸部表面までの距離と関連していた。LVHを伴う患者を除外するためのスクリーニング検査の中では、体の大きさにあまり依存しておらず、特異度の高いCornell電圧または心尖拍動がSokolow-Lyon電圧よりも優れていると考えられた。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

シロリムス溶出性ステントの不完全ステント圧着のために晩期再狭窄を呈した冠動脈病変が特徴的なベル型光干渉断層像を示した症例を報告した。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background: Coronary wall cardiovascular magnetic resonance (CMR) is a promising noninvasive approach to assess subclinical atherosclerosis, but data are limited in subjects over 60 years old, who are at increased risk. The purpose of the study was to evaluate coronary wall CMR in an asymptomatic older cohort.
Results: Cross-sectional images of the proximal right coronary artery (RCA) were acquired using spiral black-blood coronary CMR (0.7 mm resolution) in 223 older, community-based patients without a history of cardiovascular disease (age 60-72 years old, 38% female). Coronary measurements (total vessel area, lumen area, wall area, and wall thickness) had small intra-and inter-observer variabilities (r = 0.93 similar to 0.99, all p &lt; 0.0001), though one-third of these older subjects had suboptimal image quality. Increased coronary wall thickness correlated with increased coronary vessel area (p &lt; 0.0001), consistent with positive remodeling. On multivariate analysis, type 2 diabetes was the only risk factor associated with increased coronary wall area and thickness (p = 0.03 and p = 0.007, respectively). Coronary wall CMR measures were also associated with coronary calcification (p = 0.01-0.03).
Conclusions: Right coronary wall CMR in asymptomatic older subjects showed increased coronary atherosclerosis in subjects with type 2 diabetes as well as coronary calcification. Coronary wall CMR may contribute to the noninvasive assessment of subclinical coronary atherosclerosis in older, at-risk patient groups.

DOI： 10.1186/1532-429X-12-75

PubMed

PubMed

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

An 80-year-old Japanese man was admitted with orthopnea and pitting edema of both lower legs. We diagnosed congestive heart failure (CHF) on the basis of a chest X-ray and an echocardiogram. An electrocardiogram showed a heart rate of 120 beats/min with atrial fibrillation rhythm (Af). The patient developed aortic valve failure and destruction of the base of right coronary artery (RCA) due to infectious endocarditis at 71 years of age. The patient underwent aortic valve replacement and coronary artery bypass grafting with an interposed graft with polyester vascular graft to RCA. The patient recovered from CHF after the 6 days of treatment with diuretics and verapamil. We confirmed the patency of coronary arteries and bypass grafts using a 64-slice cardiac computed tomography scan (CT) and diagnosed CHF due to Af. Here we describe the estimation of the prosthetic coronary artery graft patency with the interposition procedure using 64-slice cardiac CT. © the author(s), publisher and licensee Libertas Academica Ltd.

DOI： 10.4137/CMC.S5806

PubMed

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

冠動脈評価のために64例CT検査を施行した患者連続200例を対象として研究を行った。左側臥位で心尖拍動を触診し、CT画像所見から触診所見を評価した。多変量解析によると、心尖拍動の存在を独立に関連する因子は、左室重量係数(P<0.01)、胸壁との距離(P<0.005)、男性であること(P<0.005)であった。左室重量係数は心尖拍動の位置とも関連があり、さらに持続性または二重心尖拍動と独立に関連した。持続性または二重心尖拍動は左室肥大の標識として感度57%、特異度90%、陽性反応的中度68%、陰性反応的中度85%であった。以上、心尖拍動触診は、左室重量増加患者を除外するためには高感度の診断手法であった。

Publishing type：Research paper (scientific journal)  

Objectives: Although physicians frequently perform palpation of the apex beat to evaluate left ventricular (LV) size and hypertrophy, the clinical significance of apex beat palpation is still unclear. The introduction of multislice computed tomography (MSCT) has enabled assessment not only of coronary stenoses but also LV volume, mass, and distance from heart to chest wall. The aim of this study was to evaluate the relationships among presence, location, and sustained or double apical impulse of apex beat and LV function, volume, mass, and distance from heart to chest wall determined by MSCT.
Methods and results: The study population consisted of 200 consecutive patients clinically indicated for MSCT angiography for coronary artery evaluation. Apex palpation was performed with the patients in the supine and left lateral decubitus positions. Multivariate analysis revealed that LV mass index (p&lt;0.01), distance (p&lt;0.005), and being male (p&lt;0.005) remained independent factors associated with presence of apex beat in the supine position, and that LV mass index was also associated with location of apex beat. Furthermore, in patients with a palpable apex beat, LV mass index was an independent factor associated with patterns of sustained or double apical impulse. In the group of all patients, patterns of sustained or double apical impulse in the supine position had a sensitivity of 57%, specificity of 90%, positive predictive value of 68%, and negative predictive value of 85% as an indicator of LV hypertrophy.
Conclusion: Palpation of the apex beat is a sensitive diagnostic maneuver for excluding patients with increased LV mass. We believe that our observations have important implications for bedside clinical examination. (C) 2009 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2009.11.008

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Objective: Neopterin is an activation marker for monocytes/macrophages, and circulating levels of neopterin are elevated in patients with coronary complex lesions in unstable angina pectoris. We investigated the possible association between neopterin and complex carotid plaques which may be associated with the risk of ischemic stroke in patients with stable angina pectoris (SAP).
Methods: We measured plasma levels of neopterin in 102 patients with SAP and carotid ultrasound was performed for evaluation of the presence of carotid plaques and plaque surface characteristics categorized as complex or noncomplex. In addition, endarterectomy specimens of extracranial high-grade carotid stenosis with complex plaques from five patients with SAP were immunohistochemically examined with antibodies to smooth muscle cells, endothelial cells, platelets, macrophages, and T cells.
Results: Plasma neopterin levels were significantly higher in patients with complex carotid plaques than in those with noncomplex plaques (median [interquartile range]: 24.2 [19.2-39.3] nmol/L vs. 19.4 [11.9-25.1] nmol/L; P = 0.01) or without any plaques (18.8 [14.9-23.6] nmol/L; P = 0.001). On multivariate logistic analyses after adjustment for traditional atherosclerotic risk factors, multi-vessel coronary disease and high sensitivity C-reactive protein, neopterin levels were independently associated with the presence of complex carotid plaques (adjusted OR 2.21 per SD increase, 95% CI 1.13-4.33, P = 0.02). Immunohistochemical staining revealed abundant neopterin-positive macrophages in carotid complex lesions.
Conclusion: These findings demonstrate that carotid plaques with complex morphology have increased circulating neopterin levels and immunohistochemical localization of neopterin in patients with SAP. Neopterin can be considered an important biomarker of plaque destabilization in carotid artery atherosclerotic lesions in this population. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.atherosclerosis.2009.07.054

PubMed

症例は60歳女性で、主訴は3週間前から続く呼吸困難であった。経胸壁心エコーで心外膜液と心タンポナーデの兆候が認められたが、腫瘍はいずれの視野においても検出されなかった。マルチ検出器CT(MDCT)では腫瘍が右心房に突出しており、心臓の外側に浸潤していた。経食道心エコー(TEE)でも右心房に可動性の腫瘍が認められた。本報告は、心臓腫瘍の検出においてはMDCTとTEEが補完的方法として必要であることを証明していると思われた。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

心臓CTにて診断された右心房内腫瘤の一例を報告した。

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Effective clearance of extracellular haemoglobin (Hb) is thought to limit systemic oxidative heme toxicity, which is presumed to contribute to the pathogenesis of plaque instability. We immunohistochemically examined the relationship between intraplaque haemorrhage, 4-HNE (4-hydroxy-2-nonenal), an index of lipid peroxidation, and the Hb scavenger receptor (CD163), using coronary atherectomy specimens from 74 patients with stable angina pectoris (SAP, n = 39) or unstable angina pectoris (UAP, n = 35).
Atherectomy samples were stained with antibodies against glycophorin A (a protein specific to erythrocyte membranes), CD31, 4-HNE, and CD163. Quantitative analysis demonstrated that glycophorin A-positive areas, 4-HNE-positive macrophage score, and CD163-positive macrophage score in UAP patients were significantly higher (glycophorin A, P &lt; 0.0001; 4-HNE-positive macrophage score, P &lt; 0.0001; CD163-positive macrophage score, P &lt; 0.0005) than in SAP patients. The percentage of the glycophorin A-positive area showed a significant positive correlation with the number of CD31-positive microvessels and the 4-HNE-positive macrophage score (microvessels, R = 0.59, P &lt; 0.0001; 4-HNE, R = 0.59, P &lt; 0.0001). Moreover, the CD163-positive macrophage score was positively correlated with glycophorin A-positive area and the 4-HNE-positive macrophage score (glycophorin A, R = 0.58, P &lt; 0.0001; 4-HNE, R = 0.53, P &lt; 0.0001).
These findings suggest a positive association among intraplaque haemorrhage, enhanced expression of Hb scavenger receptor, and lipid peroxidation in human unstable plaques.

DOI： 10.1093/eurheartj/ehp257

PubMed

Publishing type：Research paper (scientific journal)  

<b><i>Background:</i></b> Previous studies have shown a correlation between coronary artery cross-sectional diameter and left ventricular (LV) mass. However, no studies have examined the correlation between actual coronary artery volume (CAV) and LV mass. In the present study, measurements of CAV by 64-multislice computed tomography (MSCT) were validated and the relationship between CAV and LV mass was investigated. <b><i>Methods and Results:</i></b> First, coronary artery phantoms consisting of syringes filled with solutions of contrast medium moving at simulated heart rates were scanned by 64-MSCT. Display window settings permitting accurate calculation of small volumes were optimized by evaluating volume-rendered images of the segmented contrast medium at different window settings. Next, 61 patients without significant coronary artery stenosis were scanned by 64-MSCT with the same protocol as for the phantoms. Coronary arteries were segmented on a workstation and the same window settings were applied to the volume-rendered images to calculate total CAV. Significant correlations between total CAV and LV mass (r=0.660, P<0.0001) were found, whereas an inverse relation was present between total CAV per 100 g of LV mass and LV mass. <b><i>Conclusions:</i></b> The novel concept of "CAV" for the characterization of coronary arteries may prove useful for future research, particularly on the causes of LV hypertrophy. (<i>Circ J</i> 2009; <b>73:</b> 1448 - 1453)<br>

DOI： 10.1253/circj.cj-08-1126

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

PubMed

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CiNii Article

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Objectives: There is increasing evidence that left atrial (LA) size is an important predictor of adverse cardiovascular outcomes such as atrial fibrillation, stroke, and congestive heart failure. The aim of this study was to determine whether there is a difference in results of quantification of LA volume by the area-length and Simpson&apos;s methods using multislice computed tomography (MSCT).
Methods and results: The study population consisted of 51 patients with sinus rhythm (sinus group) and 20 patients with atrial. fibrillation (af group) clinically indicated for MSCT angiography for evaluation of coronary arteries. Maximum LA volume, obtained at end-systole from the phase immediately preceding mitral valve opening, was measured using the area-length and Simpson&apos;s methods. In the sinus group, the mean LA volumes, indexed to body surface area, were 48.4 +/- 17.9 ml/m(2) with the area-length method and 48.3 +/- 17.0 ml/m(2) with the Simpson&apos;s method. In the af group, the mean indexed LA volumes with the area-length method and the Simposon&apos;s method were 91.5 +/- 47.5 ml/m(2) and 90.3 +/- 45.9 ml/m(2), respectively. LA volumes calculated by the area-length method exhibited a strong linear relationship and agreement with those calculated using Simpson&apos;s method in both the groups (sinus group: r=0.99, P&lt;0.0001, af group: r=0.99, P&lt;0.0001).
Conclusions: The area-length method is a simple and reproducible means of assessment of LA volume. Standardization of LA volume assessment using MSCT is important for serial follow-up and meaningful communication of results of testing among institutions and physicians. (C) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2008.11.012

PubMed

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background. The modified Bentall technique, which was reported by Svensson in 1992, is an aortic root composite valve graft replacement involving reimplantation of the left coronary ostium with a long interposed graft wrapping behind the composite graft. The technique is technically advantageous, particularly for complicated or redo aortic roots. To justify the technique, the midterm outcome needs to be evaluated.
Methods. Since 1992, 40 patients (4 with Marfan syndrome) underwent the modified Bentall technique (Svensson&apos;s modification). The mean age was 54.7 +/- 13.6 years, and 32 patients (80.0%) were male. All hospital survivors have been consecutively followed with annual echocardiographic evaluations. Furthermore, in 2007, multislice computed tomography was performed at 4.7 +/- 3.5 years (maximum, 14.9 years) postoperatively in 30 patients who had preserved renal function.
Results. No patients have experienced any complications regarding the technique at the follow-up of 5.7 +/- 4.0 years (maximum, 14.9 years), although there were 2 hospital deaths of emergency cases and 5 late deaths owing to noncardiac causes. In 35 patients (92.1% of hospital survivors), no structural complications were detected by multislice computed tomographies of the 30 patients or coronary angiograms of the remaining 5 patients. The consecutive echocardiographic follow-ups showed well-preserved left ventricular function with the most recent ejection fraction being 0.581 +/- 0.078.
Conclusions. This Svensson&apos;s modification technique was associated with favorable midterm outcomes by multislice computed tomography and consecutive echocardiographic evaluations, indicating long-lasting advantages as well as technical benefits. Thus, the technique can be considered as a helpful and justifiable alternative method.

DOI： 10.1016/j.athoracsur.2008.10.008

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

<b>Background</b> With multislice computed tomography (MSCT) it is possible to visualize the coronary arteries, as well as the aorta, in a single computed tomography scan. Using MSCT, atherosis and sclerosis of the descending thoracic aorta (DTA) were quantified and differences between patients with and without coronary artery disease (CAD) were analyzed. <b>Methods and Results</b> The population comprised 89 patients who underwent ECG-gated MSCT: 40 patients with suspected CAD by MSCT underwent invasive coronary angiography, and had documented significant stenoses (CAD group), 49 patients did not have significant stenoses (control group). Twenty cross-sectional images of DTA were reconstructed every 5% (0-95%) of the RR interval, and the largest and smallest luminal areas were traced. Atheromatous score and stiffness β of DTA were quantified; both were significantly higher in the CAD group than in the controls. Multivariate analysis revealed that the average atheromatous score was an independent factor associated with CAD (p<0.005). <b>Conclusion</b> This study demonstrates that atherosis and sclerosis of DTA are associated with CAD. In cases with image quality that is unsatisfactory for interpretation of coronary stenoses, additional assessment of atherosclerosis of the DTA will be useful for identifying patients with CAD. (<i>Circ J</i> 2008; <b>72:</b> 2021 - 2027)<br>

DOI： 10.1253/circj.cj-08-0396

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

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Background and Purpose - The atherosclerotic process is associated with both morphological and functional changes in the carotid artery. We evaluated the relationship between these parameters of the carotid artery and the extent of coronary artery disease (CAD) in patients with preserved left ventricular function.
Methods - The study population consisted of 104 stable patients with CAD who had preserved left ventricular function (left ventricular ejection fraction &gt;= 45%). All patients underwent carotid ultrasound for evaluation of carotid artery plaque score defined by the sum of plaque thickness, maximum percent area stenosis, and carotid arterial stiffness index beta calculated by a combination of changes in carotid arterial diameter and blood pressure.
Results - Plaque score and percent area stenosis correlated with the extent of CAD defined as the number of diseased coronary vessels (P &lt; 0.001 and 0.002, respectively), but arterial stiffness beta did not (P = 0.39). Using logistic regression analyses adjusting for confounding coronary risk factors and arterial stiffness beta, plaque score and percent area stenosis were independently correlated with multivessel CAD (P &lt; 0.001 and 0.004, respectively).
Conclusions - Carotid artery plaque burden, but not arterial stiffness, is associated with the extent of CAD, suggesting morphological rather than functional changes in the carotid artery may be a more accurate predictor of the extent of CAD and multivessel CAD independent of left ventricular function.

DOI： 10.1161/STROKEAHA.107.502732

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Aim: Predictions of the onset of acute myocardial infarction (AMI) in high risk individuals are of great clinical importance. Among various risk factors, elevated levels of oxidized low density lipopro-tein (ox-LDL) in plasma have been shown to reflect unstable coronary plaques. Coronary calcifica-tion is a common finding in the elderly, however, its clinical implications as a risk factor for plaque rupture are controversial. This study was designed to investigate the clinical implications of plasma ox-LDL levels and coronary calcification detected by electron-beam computed tomography (EBCT), by comparing patients with AMI with those with stable angina pectoris (SAP).<BR>Methods: We measured plasma ox-LDL levels in AMI (n=34) and SAP (n=49) patients. In addition, a coronary calcium score was quantified with the Agatston system. The total coronary calcium score (TCS) was defined as the sum of the scores for each lesion.<BR>Results: TCS and total calcium area were significantly smaller in patients with AMI than in those with SAP. On the other hand, plasma ox-LDL levels were significantly higher in AMI patients than in SAP patients (p<0.0005).<BR>Conclusion: These results suggest that a combined assessment of coronary calcium and plasma ox-LDL levels may be useful for screening patients with unstable coronary plaques.

DOI： 10.5551/jat.e523

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Recent epidemiologic, pathologic, and intravascular ultrasound (IVUS) studies have shown that there are differences in coronary risk factors or plaque morphology between younger and older patients with acute myocardial infarctions (AMIs). This study examined clinical background and plaque morphology using IVUS in younger and older adults with AMIs in Japan. The study population consisted of 96 patients with AMIs, for whom preinterventional IVUS images were obtained. Patients were classified into 3 groups: a young group (aged :555 years), a middle-aged group (aged 56 to 69 years), and an old group (aged :70 years). The remodeling index was defined as the ratio of the external elastic membrane area at the culprit lesion to the external elastic membrane area at the proximal reference site. Expansive remodeling was defined as a remodeling index &gt; 1.05 and constrictive remodeling as a remodeling index &lt; 0.95. The frequency of hypercholesterolemia was significantly different among the 3 age groups. Total cholesterol (p &lt; 0.001), low-density lipoprotein cholesterol (p &lt; 0.005), and triglyceride (p &lt; 0.05) levels and body mass index (p &lt; 0.001) in the young group were significantly higher than in the old group. On IVUS images, constrictive remodeling was most common in the young group,whereas expansive remodeling occurred most commonly in the middle-aged and old groups. In conclusion, this study demonstrated that. patients with AMIs in the young group had higher levels of hypercholesterolemia, obesity, and constrictive remodeling compared with those in the old group. The differences in arterial remodeling of the culprit lesions between younger and older patients with AMIs may reflect different biologic mechanisms of plaque activation and destabilization. (C) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2007.07.021

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background: Previous studies have shown that recent activation of the inflammatory response in coronary atherosclerotic lesions contributes to rapid progressive plaque destabilisation. Neopterin, a by- product of the guanosine triphosphate pathway, is produced by activated macrophages and serves as an activation marker for monocytes/ macrophages.
Objective: To elucidate the role of neopterin in coronary plaque destabilisation by immunohistochemical study of the presence of neopterin in coronary atherectomy specimens obtained from patients with stable angina pectoris ( SAP) and unstable angina pectoris ( UAP).
Patients and methods: All patients underwent atherectomy of the primary atherosclerotic lesions responsible for SAP ( n = 25) and UAP ( n = 25). Frozen samples were studied with antibodies against smooth muscle cells, macrophages, T cells, neutrophils and neopterin.
Results: In 22/ 25 patients with UAP, abundant neopterin- positive macrophages were found at the sites of coronary culprit lesions. However, in 25 lesions from patients with SAP, only 11 lesions showed neopterin positivity. Quantitatively, the neopterin- positive macrophage score was significantly higher ( p&lt; 0.001) in patients with UAP than in patients with SAP. Moreover, the neopterin- positive macrophage score showed a significant positive correlation with the number of neutrophils or T cells, respectively ( neutrophils, r = 0.55, p&lt; 0.001; T cells, r = 0.70, p&lt; 0.001).
Conclusions: Neopterin can be considered as one of the significant factors in the process of plaque inflammation and destabilisation in human coronary atherosclerotic lesions. Its exact role in the process needs to be investigated further.

DOI： 10.1136/hrt.2006.109736

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background beta-Blocker therapy reverses left ventricular (LV) remodeling in patients with idiopathic dilated cardiornyopathy (IDC). Improvement in coronary circulation by p-blocker could play a role in these circumstances. This study investigated the relationship between change in coronary flow reserve (CFR), as a marker of coronary circulation, and Subsequent improvement in LV ejection fraction (LVEF) at follow-up during carvedilol therapy in patients with IDC.
Methods Eighteen patients with IDC underwent CFR measurements by transthoracic Doppler echocardiography at baselineand after 1 month of treatment with carvedilol. A follow-up echocardiographic assessment of LVEF was done at 12 6 months of treatment. The patients were classified by the degree of improvement in LVEF in the follow-up study, as group A (LVEF change &gt;= 10%) and group B (LVEF change &lt;:10%).
Results Although there was no significant difference in CFR between the 2 groups at baseline, CFR was significantly higher in group A than in group B at 1 month of therapy (3.7 +/- 0.5 vs 2.5 +/- 0.9; P &lt;.01). Coronary flow reserve change after 1 month was significantly greater in group A than in group B (1.3 +/- 0.6 vs 0.4 +/-: 0.5; P &lt;.01). Logistic regression analysis revealed that CFR change predicted a significant improvement in LVEF at follow-up (P &lt; .05). Furthermore, a significant correlation was found between the change in CFR after I month and that in LVEF on follow-up (r =.65, P &lt;.01).
Conclusions This study demonstrated that early change in CFR is associated with subsequent improvement in LVEF, suggesting the potential predictive value of coronary circulation for subsequent LV reverse remodeling after beta-blocker therapy in patients with IDC.

DOI： 10.1016/j.ahj.2007.03.014

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

<b>Background</b> Increased levels of oxidized low-density lipoprotein (ox-LDL) are related to plaque instability, so the aim of the present study was to investigate whether there is a relationship between angiographic coronary plaque morphology in patients with unstable angina pectoris (UAP) and the level of ox-LDL. <b>Methods and Results</b> Plasma ox-LDL levels were measured in 149 patients with UAP and in 88 control subjects, using a highly sensitive enzyme-linked immunosorbent assay method. Angiographic morphology of the culprit lesion was classified as either simple or complex based on the Ambrose classification. Plasma ox-LDL levels in patients with Braunwald class III were significantly higher than in patients with class I (p<0.0001) or in control subjects (p<0.0001). In each of the 3 Braunwald classes, plasma ox-LDL levels in patients with a complex lesion were significantly higher than in patients with a simple lesion. Multivariate logistic regression analysis revealed that ox-LDL level and Braunwald class III were independent factors associated with angiographically detected complex lesions. <b>Conclusion</b> In each Braunwald class of UAP, elevated plasma levels of ox-LDL closely relate to the presence of angiographically detected complex and thrombotic lesion morphology. (<i>Circ J</i> 2007; <b>71:</b> 681 - 687)<br>

DOI： 10.1253/circj.71.681

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<b>Background</b> Previous intravascular ultrasound (IVUS) studies have shown that calcification can be quantified by the determination of the arc on one cross-section. However, because calcium levels change along the length of lesions, it is important to assess the length of calcium using serial cross-sectional images. The correlation between the largest arc and length of each calcium deposit in patients with coronary artery disease (CAD) has not been determined. The present study was performed to determine this correlation. <b>Methods and Results</b> Preinterventional IVUS images of 194 patients with CAD were studied. The largest arc and length of all calcium within the 10-mm-long culprit lesion segment were quantified using serial cross-sectional images. One hundred and ninety-four patients had 277 calcium deposits. In all patients, the length of each calcium exhibited a strong correlation with the largest arc of calcium (R=0.750, p<0.0001). <b>Conclusions</b> Our findings revealed the quantitative characteristics of each calcium within the culprit lesion segment. They will be useful in interpreting results of previous and future IVUS studies, which deal only with the arc of calcium, as well as studies using new modalities such as computed tomography that assess calcium mainly along the long axis of the coronary artery. (<i>Circ J</i> 2007; <b>71:</b> 530 - 535)<br>

DOI： 10.1253/circj.71.530

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Objectives: To investigate the relation between aortic stiffness and coronary flow reserve (CFR) in patients with coronary artery disease ( CAD).
Design: Observational study.
Setting: Coronary care unit of a primary care hospital.
Patients: 192 consecutive patients who underwent coronary angiography.
Main outcome measure: Brachial-ankle pulse wave velocity (ba-PWV), CFR, and severity of CAD.
Results: According to the angiographic findings, patients were divided into four subgroups: patients without significant stenosis (normal coronary artery (NCA) group, n = 28) and those with one vessel disease (1VD group, n = 92), two vessel disease (2VD group, n = 50), or three vessel disease (3VD group, n = 22). ba-PWV increased with the number of diseased vessels and was significantly correlated with the number of diseased vessels ( NCA group v 1VD group v 2VD group v 3VD group: 1481 ( 252) v 1505 (278) v 1577 (266) v 1727 (347) cm/s, p &lt; 0.001). CFR had a significant negative correlation with ba-PWV (r = -0.45, p &lt; 0.0001). The diastolic to systolic velocity ratio obtained in 45 patients also was significantly correlated with ba-PWV (r = 20.35, p &lt; 0.05). Multiple regression analysis showed that ba-PWV was an independent determinant of CFR (p &lt; 0.01). \
Conclusions: Coronary flow is altered with aortic stiffening in patients with CAD. These results suggest one possible mechanism for recent reports that aortic stiffness is a key cardiovascular risk factor.

DOI： 10.1136/hrt.2005.067934

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Objective The repair process at the site of injury after percutaneous coronary intervention (PCI) is dominated by neointimal formation composed mainly of smooth muscle cells (SMC). Endothelin-1 (ET-1) is a powerful vasoconstrictor and SMC mitogen. Endothelin-converting enzyme (ECE) is the final key enzyme of endothelin processing. The effects of ET-1 are mediated by binding to endothelin type A (ETA) and endothelin type B (ETB) receptors. The ligand/receptor/ligand-producing system (ET system) could be involved in the pathogenesis of neointimal formation in humans.
Methods Fifteen post-PCI sites obtained at autopsy and eight atherectomy specimens obtained from restenotic sites were investigated using immunohistochemical single and double staining techniques. Frozen sections were stained with antibodies against ECE, ET-1, ETA and ETB receptors, SMC, macrophages and endothelial cells.
Results At the early stage, less than 3 months after PCI, neointimal SMC were positive for ECE, ET-1, ETA and ETB receptors. The expression of ECE, ET-1, ETA and ETB receptors in these neointimal SMC decreased markedly from 6 months onwards. The ECE, ET-1, ETA and ETB receptor-positive cell areas were significantly (P &lt; 0.005) greater in the first 3 months after PCI compared with 6 months or more after PCI. Atherectomy specimens also showed similar positivity.
Conclusions These observations strongly suggest that the expression of ECE, ET-1, ETA and ETB receptors is enhanced in neointimal SMC at early stages after PCI injury in human coronary arteries. The increased expression of the ET system may contribute to SMC proliferation/migration and vasoconstriction in human post-PCI coronary lesions.

DOI： 10.1097/01.hjh.0000217854.97369.8c

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Objective-Recently, elevated levels of plasma oxidized low-density lipoprotein (LDL) have been shown to relate to plaque instability in human atherosclerotic lesions. We investigated prospectively patients admitted with acute myocardial infarction (AMI) who underwent primary coronary stenting to evaluate whether the 6-month outcome could be predicted by measuring plasma oxidized LDL (ox-LDL) levels at the time of hospital discharge.
Methods and Results-Plasma ox-LDL levels were measured in 102 patients with AMI undergoing primary coronary stenting using a highly sensitive ELISA method. Measurements were taken on admission and at discharge, and the findings related to the clinical outcome. At 6-month follow-up, angiographic stent restenosis occurred in 25 (25%) of the 102 AMI patients. Plasma ox-LDL levels at discharge were significantly (P = 0.0074) higher in the restenosis group than those in the no-restenosis group (1.03 +/- 0.65 versus 0.61 +/- 0.34 ng/5 mu g LDL protein). Multiple regression analysis showed that only plasma ox-LDL levels at discharge were a statistically significant independent predictor for late lumen loss after stenting (beta = 0.645; P &lt; 0.0001).
Conclusions-This prospective study demonstrates that persistence of an increased level of plasma ox-LDL at discharge is a strong independent predictor of stent restenosis at 6-month follow-up in AMI patients.

DOI： 10.1161/01.ATV.0000209886.31510.7f

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Nonalcoholic steatohepatitis/nonalcoholic fatty liver disease is considered to be a hepatic manifestation of various metabolic disorders. However, its precise pathogenic mechanism is obscure. Oxidative stress and consequent lipid peroxidation seem to play a pivotal role in disease progression. In this study, we analyzed the localization of oxidized phosphatidylcholine (oxPC), a lipid peroxide that serves as a ligand for scavenger receptors, in livers of patients with this steatotic disorder. Specimens of nonalcoholic fatty liver disease (15 autopsy livers with simple steatosis and 32 biopsy livers with steatohepatitis) were examined via immunohistochemistry and immunoelectron microscopy using a specific antibody against oxPC. In addition, scavenger receptor expression, hepatocyte apoptosis, iron deposition, and inflammatory cell infiltration in the diseased livers were also assessed. Oxidized phosphatidylcholine was mainly localized to steatotic hepatocytes and some macrophages/Kupffer cells. A few degenerative or apoptotic hepatocytes were also positive for oxPC. Immunoelectron microscopy showed oxPC localized to cytoplasmic/intracytoplasmic membranes including lipid droplets. Steatotic livers showed enhanced expression of scavenger receptors. The number of oxPC cells was correlated with disease severity and the number of myeloperoxidase-positive neutrophils, but not with the degree of iron deposition. In conclusion, distinct localization of oxPC in liver tissues suggest that neutrophil myeloperoxidase-derived oxidative stress may be crucial in the formation of oxPC and the progression of steatotic liver disease.

DOI： 10.1002/hep.21070

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)  

Background According to recent intravascular ultrasound (IVUS) studies; expansive remodeling (ER) at the culprit lesion has been observed in almost 50% of patients with acute coronary syndrome and constrictive remodeling (CR) in 30%. The purpose of this study is to investigate the difference between ER and CR at the culprit lesion in patients with acute myocardial infarction (AMI).
Methods and Results Preinterventional IVUS images of 73 patients with AMI were identified. The remodeling index (RI) was defined as the ratio of the external elastic membrane (EEM) areas at the culprit lesion to the EEM areas at the proximal reference site. Expansive remodeling was defined as an RI &gt; 1.05; CR, as an RI &lt; 0.95. In patients with AM], 40 patients (55%) showed ER on IVUS, whereas CR was observed in 18 patients (25%). Patients with ER were significantly older than those with CR (P &lt; .005). The frequency of the presence of calcifications was higher in patients with ER than in those with CR (P &lt; .0005). In patients with AMI with ER, soft plaque with small calcium was the most frequent (58%). Multivariate analysis revealed that age and the presence of calcifications remained as independent predictors of ER.
Conclusions These findings suggest that ER relates to old age and calcification, and CR may contribute to early plaque progression than ER in patients with AMI.

DOI： 10.1016/j.ahj.2005.03.041

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Calcification is a common finding in human coronary arteries. However, there is conflicting evidence for a link between calcification and plaque instability. Current intravascular ultrasound (IVUS) technology allows a definitive detection of the calcification and measurement of the vessel wall. Using preinterventional IVUS images, we clarified that in patients with acute myocardial infarction, small “spotty” calcifications prevailed, associated with a fibrofatty plaque and positive remodeling. Conversely, in patients with stable angina pectoris, extensive calcification was frequent. IVUS allows the detection of vulnerable plaques in coronary arteries, by identifying not only a large lipid core and positive remodeling, but also a spotty pattern of calcification.

DOI： 10.5551/jat.13.31

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Matrix metalloproteinases (MMPs) are important for resorption of extracellular matrixes and may degrade the fibrous cap of an atherosclerotic plaque, thus contributing to coronary plaque rupture. Histologic studies have shown MMP expression in lesions of acute coronary syndrome. In this study, we evaluated the relation between plaque morphology as obtained by intravascular ultrasound before percutaneous coronary intervention and serum MMP levels in patients who had coronary artery disease. We enrolled consecutive 47 patients who had acute myocardial infarction (AMI), 23 who had unstable angina pectoris (UAP), and 19 who had stable effort angina pectoris and underwent intravascular ultrasound before percutaneous coronary intervention followed by successful primary percutaneous coronary intervention. Peripheral blood was obtained from all patients before angiography and serum levels of MMP-1,-2, and -9 were analyzed. Serum levels of MMP-9 in the AMI and UAP groups were significantly higher than that in the stable effort angina pectoris group (p = 0.007 and 0.04, respectively). From the intravascular ultrasound findings before percutaneous coronary intervention, plaque rupture was detected in 26 patients (55%) in the AMI group and in 11 patients (48%) in the UAP group. In these 2 groups, patients with plaque rupture had significantly higher levels of MMP-9 than patients who did not have plaque rupture (p = 0.03 and 0.01, respectively). Multiple logistic regression analysis showed that MMP-9 was the only independent predictor of plaque rupture (p = 0.004). In conclusion, high levels of MMP-9 in patients who have AMI and UAP are related to the presence of plaque rupture in the culprit lesion. (C) 2006 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2005.08.020

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

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Understanding restenosis after percutaneous coronary intervention (PCI) remains a challenge. Neointimal proliferation is the main cause of restenosis. C-Type natriuretic peptide (CNP) plays a role in relaxation and growth inhibition of vascular smooth muscle cells (SMCs); the effects depend on the presence of specific natriuretic peptide receptors (NPRs) consisting of NPR-A, NPR-B, and NPR-C. To test the hypothesis that CNP and NPRs may be involved in restenosis, we immunohistochemically studied the expression of CNP and NPRs during the post-PCI healing process; 10 sites after PCI obtained at autopsy and 14 atherectomy specimens obtained from restenotic sites were investigated. Frozen sections were stained with antibodies against CNP, NPRs, SMCs, macrophages, and endothelial cells. Within 2 months after PCI. most neointimal SMCs expressed CNP and NPR-A. The expression of CNP and NPR-A in these neointimal SMCs decreased from 6 months onward. In contrast, NPR-C was strongly expressed in neointimal SMCs from I to 9 months after PCI. In atherectomy specimens, most neointimal SMCs showed weak positivity for CNP and NPR-A, but NPR-C was strongly expressed in the neointimal SMCs. These findings strongly suggest that a paracrine and autocrine system of CNP and NPRs may be important in controlling neointimal growth after PCI in humans. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.atherosclerosis.2005.01.023

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Publishing type：Research paper (scientific journal)  

Angiotensin II (ANG-II) and its receptor (ATI) have been potential targets of therapy for liver cirrhosis. However, AT1 expression in human cirrhotic livers has not been clarified. We studied ATI and ANG-II generating enzymes in human autopsy (20 cirrhotics and 20 normal controls) and biopsy (10 cirrhotics) livers. ATI immunoreactivity in tissue sections was quantified by computer-aided morphometry. ATI protein and mRNA levels were assessed by Western blotting and real-time polymerase chain reaction. Concerning ANG-II generating system, angiotensin-converting enzyme (ACE) and mast cell chymase were examined. AT] expression was seen not only in vascular smooth muscle cells, but also in activated stellate cells/myofibroblasts and liver parenchymal cells. ATI-positive vessels and myofibroblasts were significantly increased in fibrous septa of cirrhosis, although overall hepatic AT1 expression was reduced in the cirrhotic livers compared with the controls. Augmentation of AT1-positive vessels was related to severity of portal hypertension. Expressions of ACE and chymase were enhanced in the cirrhotic livers. These results suggest that hepatic ATI expression is shifted to and concentrated in vessels and myofibroblasts in cirrhotic settings, and increased ANG-II generation by ACE and chymase contributes to portal hypertension and liver fibrosis via binding to ATI expressed on vessels and myofibroblasts. (c) 2005 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.hepres.2005.01.017

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

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蟹づめ状の形態を示した感染性冠動脈瘤の一例を報告した。

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Platelet aggregation at the site of plaque rupture or erosion is a dominant feature in the pathophysiology of plaque destabilization. To elucidate the role of glycoprotein (GP) IIb/IIIa in coronary plaque destabilization, we immunohistochemically studied the presence of GP IIb/IIIa in coronary atherectomy specimens obtained from patients with stable angina (SAP) and unstable angina pectoris (UAP). Moreover, we immunohistochemically investigated the presence of P-selectin, which is known to be a marker of platelet activation, in these specimens. All these patients underwent atherectomy at primary atherosclerotic lesions responsible for SAP (n=25) and UAP (n=23). Frozen samples were studied with antibodies against smooth muscle cells, macrophages, neutrophils, endothelial cells, GP IIb/IIIa and P-selectin. Immunoreactive positive areas for GP IIb/IIIa, P-selectin, and macrophages, respectively, were calculated using computer-aided planimetry, and numbers of neutrophils were also counted. In the culprit lesions of UAP patients, 17 of the 23 lesions (74%) contained GP IIb/IIIa positive platelet thrombi, and all these platelet thrombi were positive for P-selectin. In contrast, in the lesions of SAP patients, 3 of the 25 lesions (12%) showed staining positivity for GP IIb/IIIa and P-selectin. Quantitatively, the percentage of GP IIb/IIIa- and P-selectin-positive area was significantly higher (GP IIb/IIIa, P &lt; 0.0005; P-selectin, P &lt; 0.0001) in patients with UAP than in patients with SAP. The number of neutrophils was significantly higher (P &lt; 0.0005) in patients with UAP than in patients with SAP. Moreover, the percentage of GP IIb/IIIa-positive area showed a significant positive correlation with the number of neutrophils (r=0.66, p &lt; 0.0001). These findings strongly suggest that platelet activation and aggregation, leading to formation of platelet thrombi, and the interaction between activated platelets and neutrophils play a pivotal role in the pathogenesis of plaque destabilization in human coronary atherosclerotic lesions.

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Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：Domestic journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Publishing type：Research paper (scientific journal)   Kind of work：Joint Work   International / domestic magazine：International journal  

Responsible for pages：p.40-46   Book type：Scholarly book Participation form：Corresponding Author

Responsible for pages：p.281-289   Book type：Scholarly book Participation form：Corresponding Author

Total pages：414   Responsible for pages：p.151-160   Book type：Scholarly book Participation form：First Author

Total pages：667   Responsible for pages：p.113-116   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.320-329   Book type：Scholarly book

Responsible for pages：p.133-142   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.80(800)-87(807)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.75-80   Book type：Scholarly book

Responsible for pages：p.1686-1692   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.75-80   Book type：Scholarly book

Responsible for pages：p.80(800)-87(807)   Book type：Scholarly book

Responsible for pages：p.133-142   Book type：Scholarly book

Responsible for pages：p.320-329   Book type：Scholarly book

Responsible for pages：p.1686-1692   Book type：Scholarly book

Responsible for pages：p.66-71   Book type：Scholarly book Participation form：First Author

Total pages：286   Responsible for pages：p.66-69   Book type：Scholarly book Participation form：First Author

Total pages：322   Responsible for pages：p.138-142   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.27(241)-32(246)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.66-71   Book type：Scholarly book

Responsible for pages：p.27(241)-32(246)   Book type：Scholarly book

Total pages：286   Responsible for pages：p.66-69   Book type：Scholarly book

Total pages：322   Responsible for pages：p.138-142   Book type：Scholarly book

Responsible for pages：p.19(231)-24(236)   Book type：Scholarly book Participation form：First Author

Total pages：328   Responsible for pages：p.7-13   Book type：Scholarly book Participation form：First Author

Total pages：307   Responsible for pages：p.118-127   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.23-27   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.204-210   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.380-384   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.372-377   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.2585-2594   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.19(231)-24(236)   Book type：Scholarly book

Responsible for pages：p.204-210   Book type：Scholarly book

Responsible for pages：p.380-384   Book type：Scholarly book

Responsible for pages：p.23-27   Book type：Scholarly book

Total pages：307   Responsible for pages：p.118-127   Book type：Scholarly book

Total pages：328   Responsible for pages：p.7-13   Book type：Scholarly book

Responsible for pages：p.372-377   Book type：Scholarly book

Responsible for pages：p.2585-2594   Book type：Scholarly book

Responsible for pages：p.76(1212)-80(1216)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.17(325)-23(331)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.1172-1176   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.2182-2187   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.84(1024)-88(1028)   Book type：Scholarly book Participation form：Second Author

Responsible for pages：p.2182-2187   Book type：Scholarly book

Responsible for pages：p.1172-1176   Book type：Scholarly book

Responsible for pages：p.17(325)-23(331)   Book type：Scholarly book

Responsible for pages：p.84(1024)-88(1028)   Book type：Scholarly book

Responsible for pages：p.76(1212)-80(1216)   Book type：Scholarly book

Responsible for pages：p.90-91   Book type：Scholarly book Participation form：First Author

Total pages：706   Responsible for pages：p.140-154/p.184-188   Book type：Scholarly book Participation form：First Author

Total pages：706   Responsible for pages：p.140-154/p.184-188   Book type：Scholarly book

Responsible for pages：p.90-91   Book type：Scholarly book

Responsible for pages：p.22-28   Book type：Scholarly book Participation form：First Author

Total pages：278   Responsible for pages：p.79-95/p.127-135   Book type：Scholarly book Participation form：First Author

Total pages：417   Responsible for pages：p.175-177   Book type：Scholarly book Participation form：Second Author

Total pages：331   Responsible for pages：p.214-217   Book type：Scholarly book Participation form：First Author

Total pages：331   Responsible for pages：p.214-217   Book type：Scholarly book

Total pages：278   Responsible for pages：p.79-95/p.127-135   Book type：Scholarly book

Responsible for pages：p.22-28   Book type：Scholarly book

Total pages：417   Responsible for pages：p.175-177   Book type：Scholarly book

Responsible for pages：p.215-220   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.87(1387)-91(1391)   Book type：Scholarly book Participation form：First Author

Total pages：331   Responsible for pages：p.80-81   Book type：Scholarly book Participation form：Last Author

Responsible for pages：p.119-122   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.1181-1184   Book type：Scholarly book Participation form：First Author

Total pages：282   Responsible for pages：p.69-74   Book type：Scholarly book Participation form：First Author

Total pages：222   Responsible for pages：p.112-116   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.20(368)-25(373)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.27(343)-30(346)   Book type：Scholarly book Participation form：Last Author

Responsible for pages：p.1133   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.25(129)-27(131)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.63(195)-67(199)   Book type：Scholarly book Participation form：Last Author

Responsible for pages：p.7(123)-12(128)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.875-880   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.10-13   Book type：Scholarly book Participation form：First Author

Total pages：160   Responsible for pages：p.106-111   Book type：Scholarly book Participation form：First Author

Total pages：178   Responsible for pages：p.7-11   Book type：Scholarly book Participation form：Second Author

Responsible for pages：p.56(56)-59(59)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.818-823   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.27(1095)-31(1099)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.28(1264)-33(1269)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.820-824   Book type：Scholarly book Participation form：Second Author

Responsible for pages：p.109(1281)-116(1288)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.37(301)-42(306)   Book type：Scholarly book Participation form：First Author

Responsible for pages：p.2401-2403   Book type：Scholarly book Participation form：First Author

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

2012年の欧米のガイドライン以降,心筋壊死マーカーが上昇する心筋梗塞と正常範囲におさまる狭心症が明確に分類された.心筋梗塞は,心電図上ST上昇を伴うST上昇型急性心筋梗塞(STEMI)とST上昇を伴わない非ST上昇型急性心筋梗塞(NSTEMI)に細分されたが,不安定狭心症(UAP)と安定狭心症(SAP)の鑑別には注意深い病歴の聴取が最も重要であり,診断の大略はこれにより決まるといっても過言ではない.NSTEMIとUAPは初診時では鑑別困難なため非ST上昇型急性冠症候群としてまとめて扱われることが多い.(著者抄録)

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

2012年の欧米のガイドライン以降,心筋壊死マーカーが上昇する心筋梗塞と正常範囲におさまる狭心症が明確に分類された.心筋梗塞は,心電図上ST上昇を伴うST上昇型急性心筋梗塞(STEMI)とST上昇を伴わない非ST上昇型急性心筋梗塞(NSTEMI)に細分されたが,不安定狭心症(UAP)と安定狭心症(SAP)の鑑別には注意深い病歴の聴取が最も重要であり,診断の大略はこれにより決まるといっても過言ではない.NSTEMIとUAPは初診時では鑑別困難なため非ST上昇型急性冠症候群としてまとめて扱われることが多い.(著者抄録)

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

DOI： 10.1016/j.cardfail.2012.08.165

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

J-GLOBAL

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Kind of work：Single Work  

PubMed

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)