International / domestic magazine：Domestic journal  

DOI： 10.1007/s12928-023-00973-4

PubMed

DOI： 10.1093/bjs/znad282

Publishing type：Research paper (scientific journal)  

DOI： 10.1161/JAHA.123.030084

PubMed

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

Histopathological examination has revealed that stents on severely calcified plaques were associated with delayed vascular healing. Although atherectomy devices can increase the number of malapposed struts, tissue responses to implanted drug eluting stents in atherectomy patients remain largely unknown. This retrospective observational study included 30 patients who underwent atherectomy and everolimus-eluting stent (EES) deployment for severely calcified coronary lesions (biodegradable polymer EES (BP-EES), n = 15; durable polymer EES (DP-EES), n  = 15). Optical coherence tomography was carried out at baseline and follow-up, and struts with acute stent malapposition (ASM) were categorized as struts on modified calcium (mod-Ca), non-modified calcium (non-mod-Ca), or non-calcium (non-Ca). Adequate vascular healing, defined as ASM resolution with neointimal coverage, was compared between the BP-EES and DP-EES groups. Multivariate linear regression analysis using a generalized estimated equation revealed that BP-EES use was associated with significantly better adequate vascular healing compared with DP-EES (odds ratio [OR]: 3.691, 95% confidence interval [CI] 1.175-11.592, P = 0.025). adequate vascular healing was associated with the underlying plaque morphology (mod-Ca vs non-mod-Ca: OR 2.833, 95% CI 1.491-5.384, P = 0.001; non-Ca vs non-mod-Ca: OR 1.248, 95% CI 0.440-3.543, P = 0.677). This study demonstrates that drug-eluting stent selection and calcium modification are possible factors affecting vascular healing of malapposed struts in severely calcified lesions.

DOI： 10.1007/s12928-023-00965-4

PubMed

International / domestic magazine：International journal  

DOI： 10.1093/ehjcr/ytad278

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1093/ehjcr/ytac318

DOI： 10.1101/2023.03.02.23286724

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

BACKGROUND: This study aimed to investigate the association between the extent and severity of coronary atherosclerosis, epicardial adipose tissue (EAT) accumulation, and left ventricular (LV) global longitudinal strain (GLS) in patients with preserved LV ejection fraction (LVEF) and without LV regional wall motion abnormalities. METHODS: This study included 169 preserved LVEF patients without LV wall motion abnormalities who underwent coronary computed tomography (CT) angiography for the assessment of suspected coronary artery disease (CAD). The segment stenosis score (SSS) and segment involvement score (SIS) were calculated to evaluate CAD extent. The EAT volume was defined as CT attenuation values ranging from -250 to -30 HU within the pericardial sac. LVGLS was measured using echocardiography to assess subclinical LV dysfunction. RESULTS: All patients had preserved LVEF of ≥50%, and the mean LVGLS was -18.7% (-20.5% to -16.9%). Mean SSS and SIS were 2.0 (0-5) and 4.0 (0-36), respectively, while mean EAT volume was 116.1 mL (22.9-282.5 mL). Multivariate analysis using linear regression model demonstrated that LVEF (β, -17.0; 95% CI, -20.9 - -13.1), LV mass index (β, 0.03; 95% CI, 0.01-0.06), and EAT volume (β, 0.010; 95% CI, 0.0020-0.0195) were independently associated with LVGLS; however, obstructive CAD was not. The multivariate models demonstrated that SSS (Î, 0.12; 95% CI, 0.05-0.18) and SIS (Î, 0.27; 95% CI, 0.10-0.44) were correlated with deterioration of LVGLS, independent of other parameters. CONCLUSION: This study demonstrates that EAT volume and CAD extent are associated with the deterioration of LVGLS in this population.

DOI： 10.1016/j.ijcha.2023.101176

PubMed

DOI： 10.3389/fcvm.2023.1095806

PubMed

DOI： 10.2116/bunsekikagaku.72.341

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

DOI： 10.1093/eurheartj/ehac743

PubMed

冠動脈CT血管造影(CCTA)-Wide Volume Scan(WVS)により冠動脈疾患と胸部大動脈プラークを同時に評価し、心血管予後との関連について検討した。2017年4月〜2019年11月の期間にCCTA-WVS検査により冠動脈疾患の評価と大動脈弓を含む胸部大動脈の評価を行った胸痛患者455名(男性234名、女性221名、平均65±13歳)を対象とした。CCTA-WVS所見は冠動脈石灰化スコア0、0〜100、101〜400、>400がそれぞれ42.9%、26.8%、20.6%、11.2%であった。平均2.8±0.9年の追跡期間中、445例中34例(7.6%)に主要有害事象(MACE)を認めた。吹田CVDリスクスコアで調整したCox比例ハザードモデルでは、冠動脈石灰化スコア>400と胸部大動脈プラークスコア(T3)が心血管イベント発症の独立した予測因子であった。CCTA-WVSを用いた胸部大動脈プラークスコアと冠動脈疾患の包括的評価が心血管イベントリスクの層別化に貢献できると考えられた。

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

BACKGROUND: Wide-volume scanning with 320-row multidetector computed tomography coronary angiography (CTCA-WVS) enables the assessment of the aortic arch plaque (AAP) morphology and coronary arteries without requiring additional contrast volume. This study aimed to investigate the prevalence of AAPs and their association with coronary artery disease (CAD) and major adverse cardiovascular events (MACEs) in patients who underwent CTCA-WVS. METHODS: This study included 204 patients without known CAD (mean age, 65 years; 53% men) who underwent CTCA-WVS. We evaluated the presence of aortic plaques in the ascending aorta, aortic arch, and thoracic descending aorta using CTCA-WVS. Large aortic plaques were defined as plaques of at least 4 mm in thickness. A complex aortic plaque was defined as a plaque with ulceration or protrusion. MACEs were defined as composite events of cardiovascular (CV) death, nonfatal myocardial infarction, and ischemic stroke. RESULTS: AAPs and large/complex AAPs were identified in 51% ( n = 105) and 18% ( n = 36) of the study patients, respectively. The prevalence of AAPs with large/complex morphology increased with CAD severity (2.1% in no CAD, 12% in nonobstructive CAD, and 39% in obstructive CAD). The univariate Cox hazard model demonstrated that the predictors associated with MACEs were diabetes, obstructive CAD, and large/complex AAPs. Independent factors associated with large/complex AAPs were male sex [odds ratio (OR), 2.90; P = 0.025], stroke history (OR, 3.48; P = 0.026), obstructive CAD (OR, 3.35; P = 0.011), and thoracic aortic calcification (OR, 1.77; P = 0.005). CONCLUSION: CTCA-WVS provides a comprehensive assessment of coronary atherosclerosis and thoracic aortic plaques in patients with CAD, which may improve the stratification of patients at risk for CV events.

DOI： 10.1097/MCA.0000000000001171

PubMed

ST上昇型急性心筋梗塞の冠動脈インターベンション(PCI)に難渋した冠動脈拡張症(CAE)2例を呈示した。症例1は歳40代男性で、一時ペーシング挿入、血栓吸引、責任病変部に残存する巨大な血栓に対する薬剤溶出性ステント(DES)留置を行った。最終造影はTIMI 2であった。急性期に輸血を要する大出血をきたしたためDAPT(アスピリン、クロピドグレル)を休薬し、慢性期はアスピリン単剤投与とした。症例2は50歳代男性で、血栓吸引により冠血流は改善したが最終造影はTIMI 1で、大動脈内バルーンポンプ(IABP)を留置した。ワルファリンとクロピドグレル内服を開始したが、慢性期に出血合併症を認めたため、直接作用型経口抗凝固薬単剤へ変更とした。2例とも再灌流を得られ、再発や責任病変の再狭窄は認めない。

International / domestic magazine：International journal  

DOI： 10.1093/ehjcr/ytac027

PubMed

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

Supplemental Digital Content is available in the text.

DOI： 10.1161/CIRCIMAGING.121.013661

PubMed

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

BACKGROUND: Although epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), it is unclear whether EAT volume (EAV) can be used to diagnose high-risk coronary plaque burden associated with coronary events. This study aimed to investigate (1) the prognostic impact of low-attenuation non-calcified coronary plaque (LAP) burden on patient level analysis, and (2) the association of EAV with LAP volume in patients without known CAD undergoing coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: This retrospective study consisted of 376 patients (male, 57%; mean age, 65.2 ± 13 years) without known CAD undergoing CCTA. Percent LAP volume (%LAP, <30 HU) was calculated as the LAP volume divided by the vessel volume. EAT was defined as adipose tissue with a CT attenuation value ranging from -250 to -30 HU within the pericardial sac. The primary endpoint was a composite event of death, non-fatal myocardial infarction, and unstable angina and worsening symptoms requiring unplanned coronary revascularization >3 months after CCTA. The determinants of %LAP (Q4) were analyzed using a multivariable logistic regression model. RESULTS: During the follow-up period (mean, 2.2 ± 0.9 years), the primary endpoint was observed in 17 patients (4.5%). The independent predictors of the primary endpoint were %LAP (Q4) (hazard ratio [HR], 3.05; 95% confidence interval [CI], 1.09-8.54; p = 0.033] in the Cox proportional hazard model adjusted by CAD-RADS category. Cox proportional hazard ratio analysis demonstrated that %LAP (Q4) was a predictor of the primary endpoint, independnet of CAD severity, Suita score, EAV, or CACS. The independent determinants of %LAP (Q4) were CACS ≥218.3 (p < 0.0001) and EAV ≥125.3 ml (p < 0.0001). The addition of EAV to CACS significantly improved the area under the curve (AUC) to identify %LAP (Q4) than CACS alone (AUC, EAV + CACS vs. CACS alone: 0.728 vs. 0.637; p = 0.013). CONCLUSIONS: CCTA-based assessment of EAV, CACS, and LAP could help improve personalized cardiac risk management by administering patient-suited therapy.

DOI： 10.3389/fcvm.2022.824470

PubMed

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

DOI： 10.4244/EIJ-D-20-00990

PubMed

International / domestic magazine：International journal  

DOI： 10.1016/j.jacasi.2021.09.001

PubMed

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

BACKGROUND: Intravascular polarization-sensitive optical frequency domain imaging (PS-OFDI) offers a novel approach to measure tissue birefringence, which is elevated in collagen and smooth muscle cells, that in turn plays a critical role in healing coronary thrombus (HCT). This study aimed to quantitatively assess polarization properties of coronary fresh and organizing thrombus with PS-OFDI in patients with acute coronary syndrome (ACS).Methods and Results:The POLARIS-I prospective registry enrolled 32 patients with ACS. Pre-procedural PS-OFDI pullbacks using conventional imaging catheters revealed 26 thrombus-regions in 21 patients. Thrombus was manually delineated in conventional OFDI cross-sections separated by 0.5 mm and categorized into fresh thrombus caused by plaque rupture, stent thrombosis, or erosion in 18 thrombus-regions (182 frames) or into HCT for 8 thrombus-regions (141 frames). Birefringence of coronary thrombus was compared between the 2 categories. Birefringence in HCTs was significantly higher than in fresh thrombus (∆n=0.47 (0.37-0.72) vs. ∆n=0.25 (0.17-0.29), P=0.007). In a subgroup analysis, when only using thrombus-regions from culprit lesions, ischemic time was a significant predictor for birefringence (ß (∆n)=0.001 per hour, 95% CI [0.0002-0.002], P=0.023). CONCLUSIONS: Intravascular PS-OFDI offers the opportunity to quantitatively assess the polarimetric properties of fresh and organizing coronary thrombus, providing new insights into vascular healing and plaque stability.

DOI： 10.1253/circj.CJ-20-0862

PubMed

急性冠症候群(ACS)患者の冠動脈にみられる新鮮血栓または器質化血栓を対象に、血管内偏光測定による光周波数領域イメージング法(血管内PS-OFDI)を適用して、それらの血栓が示す偏光の特性を定量評価した。単一施設での前向きレジストリであるPOLARIS-Iに登録されたACS患者で、経皮的冠動脈インターベンション(PCI)施行前にPS-OFDI評価を受けた患者32名のうち、従来品のイメージングカテーテルを使用したPS-OFDIのpullback手技に成功し、冠動脈に血栓を1個以上発見された21名(男性13名、平均65.3±13.3歳)の血栓領域26ヶ所を解析対象とした。治癒しつつある冠動脈血栓(healing coronary thrombus)が示した複屈折率は、新鮮血栓の複屈折率よりも有意に高かった(P=0.007)。サブグループ解析では、責任病変に由来する血栓領域例に限定した時のみ、虚血時間が複屈折率の有意な予測因子となっていた。

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

DOI： 10.1253/circrep.CR-21-0044

PubMed

DOI： 10.1111/jre.12835

International / domestic magazine：International journal  

DOI： 10.1016/j.jcmg.2020.07.009

PubMed

本報ではPET/CTにより、成人に観察される正常肛門管への18F-FDG取込みを調べ、肛門癌患者に対する臨床的重要性を後方視的に評価した。正常肛門管を有する成人患者201例(正常群:男性119例、女性82例、平均年齢66歳、年齢30～91歳)、肛門癌患者8例(男性1例、女性7例、平均年齢71歳、年齢58～79歳)を対象とし、FDG取込みを肝臓へのSUVmax(肝SUVmax)と定量的に比較した。その結果、正常群では、平均肛門管SUVmaxは初期相で2.26(1.10～6.30)、遅延相で2.52(1.00～8.80)であり、肝SUVmaxに対する比は初期相で0.74(0.24～2.25)、遅延相では0.81(0.23～2.32)で、25例(15.4%)に初期相と遅延相でグレード3の取込みが認められた。一方、肛門癌患者においては、全例に定性的に高い肛門管FDG取込みが観察され、平均肛門管SUVmaxも初期相で11.09(5.40～17.73)、遅延相では14.23(6.70～22.85)であった。また、取込みがグレード3の正常群と肛門癌患者群では、初期相肛門管SUVmax、遅延相肛門管SUVmax平均値において有意差が認められ、肝SUVmaxに対する比も有意に異なっていた。以上の結果から、成人の正常肛門管PET/CTデータにおいても、高いFDG取込み値が認められることが確認され、肝と肛門管のFDG SUVmaxを比較することにより、正常肛門管と肛門癌の鑑別が可能となることが示唆された。

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

Cholesterol crystals (CCs) are frequently found in high-risk plaques, such as thin-capped fibroatheromas. The purpose of this study was to investigate the associations of CCs, plaque morphologies, and post-stent optical frequency domain imaging (OFDI) findings with periprocedural cardiac troponin (cTn) elevation in patients treated with percutaneous coronary intervention (PCI). This study consists of 119 patients with stable coronary artery disease (CAD) with normal cTn levels who underwent OFDI-guided PCI. Periprocedural cTn elevation was defined as an elevation of cTn ≥  × 5 times the upper reference limit after PCI. Pre- and post-stent OFDI findings, including fibrous cap thickness (FCT), presence of CCs, and parameters for lipid and calcification were analyzed. A total of 37 (31%) patients were classified into the periprocedural cTn elevation group. Compared with lesions without CCs, lesions exhibiting CCs had thinner FCT, larger lipid arc, and longer lipid length, and were more likely to have irregular protrusion and in-stent thrombus (all p < 0.05). For pre-stent OFDI features, FCT < 82 µm [odds ratio (OR) 4.11; p = 0.003] and CCs (OR 3.23; p = 0.017) were associated with periprocedural cTn elevation. For post-stent OFDI features, in-stent dissection (OR 3.08; p = 0.035) and in-stent thrombus (OR 7.98; p = 0.002) were independent predictors of cTn elevation. The combination of CCs and FCT < 82 µm showed increased risk of periprocedural cTn elevation (OR 7.22; p = 0.002). OFDI-guided PCI provides unique insight into the mechanism for periprocedural cTn elevation in CAD patients.

DOI： 10.1007/s00380-019-01512-z

PubMed

冠動脈プラークの組織所見が周術期の心筋トロポニン上昇を予測するかどうかについて検討した。血管内光干渉断層法ガイド下に経皮的冠動脈インターベンションを施行した安定冠動脈疾患患者119例(男性92例、女性27例、平均71±9歳)を対象とした。周術期における心筋トロポニンの上昇は術後24時間に基準値(0.028ng/mL)の5倍以上の増加を認めた場合と定義した。術前と術後に冠動脈プラークの線維性被膜の厚さ、コレステロール結晶の有無、脂質コア量や石灰化の程度を評価した。周術期に心筋トロポニンの上昇は37例(31%)で認めた。患者を心筋トロポニン(cTn)が上昇したcTn上昇群37例(男性78%、平均71±9歳)と非上昇群82例(男性77%、平均70±9歳)の2群に分類した。組織性状はcTn上昇群の方が線維性被膜(FCT)は薄く(P=0.005)、脂質プラークの円弧角度が大きく(P=0.006)、コレステロール結晶(CC)が有意に多かった(P=0.001)。ロジスティックス回帰分析でFCTが82μm未満(OR:4.11、P=0.003)とCCの存在(OR:3.23、P=0.017)が周術期の心筋トロポニン上昇を予測する独立因子であった。

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

OBJECTIVES: The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary plaque morphology, likely related to the propensity of plaque rupture in patients. BACKGROUND: Plaque rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element modeling (FEM), typically used to calculate tensile stress, is computationally intensive and impractical as a clinical tool for locating rupture-prone plaques. This study derived a multifactorial stress equation (MSE) that accurately computes peak stress in NCFAs by combining the influence of several morphological parameters. METHODS: Intravascular ultrasound and optical frequency domain imaging were conducted in 30 patients, and plaque morphological parameters were defined in 61 NCFAs. Multivariate regression analysis was applied to derive the MSE and compute a peak stress metric (PSM) that was based on the analysis of plaque morphological parameters. The accuracy of the MSE was determined by comparing PSM with FEM-derived peak stress values. The ability of the PSM in locating plaque rupture sites was tested in 3 additional patients. RESULTS: The following parameters were found to be independently associated with peak stress: fibrous cap thickness (p < 0.0001), necrotic core angle (p = 0.024), necrotic core thickness (p < 0.0001), lumen area (p < 0.0001), necrotic core including calcium areas (p = 0.017), and plaque area (p = 0.003). The PSM showed excellent correlation (R = 0.85; p < 0.0001) with FEM-derived peak stress, thus confirming the accuracy of the MSE. In only 56% (n = 34) of plaques, the thinnest fibrous cap thickness was a determining parameter in identifying the cross section with highest PSM. In coronary segments with plaque ruptures, the MSE precisely located the rupture site. CONCLUSIONS: The MSE shows potential to calculate the PSM in coronary lesions rapidly. However, further studies are warranted to investigate the use of biomechanical stress profiling for the prognostic evaluation of patients with atherosclerosis.

DOI： 10.1016/j.jcmg.2019.01.033

PubMed

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

OBJECTIVES: The aims of this first-in-human pilot study of intravascular polarimetry were to investigate polarization properties of coronary plaques in patients and to examine the relationship of these features with established structural characteristics available to conventional optical frequency domain imaging (OFDI) and with clinical presentation. BACKGROUND: Polarization-sensitive OFDI measures birefringence and depolarization of tissue together with conventional cross-sectional optical frequency domain images of subsurface microstructure. METHODS: Thirty patients undergoing polarization-sensitive OFDI (acute coronary syndrome, n = 12; stable angina pectoris, n = 18) participated in this study. Three hundred forty-two cross-sectional images evenly distributed along all imaged coronary arteries were classified into 1 of 7 plaque categories according to conventional OFDI. Polarization features averaged over the entire intimal area of each cross section were compared among plaque types and with structural parameters. Furthermore, the polarization properties in cross sections (n = 244) of the fibrous caps of acute coronary syndrome and stable angina pectoris culprit lesions were assessed and compared with structural features using a generalized linear model. RESULTS: The median birefringence and depolarization showed statistically significant differences among plaque types (p < 0.001 for both, one-way analysis of variance). Depolarization differed significantly among individual plaque types (p < 0.05), except between normal arteries and fibrous plaques and between fibrofatty and fibrocalcified plaques. Caps of acute coronary syndrome lesions and ruptured caps exhibited lower birefringence than caps of stable angina pectoris lesions (p < 0.01). In addition to clinical presentation, cap birefringence was also associated with macrophage accumulation as assessed using normalized SD. CONCLUSIONS: Intravascular polarimetry provides quantitative metrics that help characterize coronary arterial tissues and may offer refined insight into coronary arterial atherosclerotic lesions in patients.

DOI： 10.1016/j.jcmg.2019.06.015

PubMed

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

Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) visualize the coronary artery wall and plaque morphology in great detail. The advent of these high-resolution intracoronary imaging modalities has propelled our understanding of coronary atherosclerosis and provided enhanced guidance for percutaneous coronary intervention. Yet, the lack of contrast between distinct tissue types and plaque compositions impedes further elucidation of the complex mechanisms that contribute to acute coronary syndrome (ACS) and hinders the prospective identification of plaques susceptible to rupture. Intravascular polarimetry with polarization-sensitive OFDI measures polarization properties of the coronary arterial wall using conventional intravascular imaging catheters. The quantitative polarization metrics display notable image contrast between several relevant coronary plaque microstructures that are difficult to identify with conventional OCT and OFDI. Tissues rich in collagen and smooth muscle cells exhibit birefringence, while lipid and macrophages cause depolarization. In this review, we describe the basic principles of intravascular polarimetry, discuss the interpretation of the polarization signatures, and outline promising avenues for future research and clinical implications.

DOI： 10.3389/fcvm.2020.00146

PubMed

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

The microscopic tissue structure and organization influence the polarization of light. Intravascular polarimetry leverages this compelling intrinsic contrast mechanism by using polarization-sensitive optical frequency domain imaging to measure the polarization properties of the coronary arterial wall. Tissues rich in collagen and smooth muscle cells appear birefringent, while the presence of lipid causes depolarization, offering quantitative metrics related to the presence of important components of coronary atherosclerosis. Here, we review the basic principle, the interpretation of polarization signatures, and first clinical investigations of intravascular polarimetry and discuss how this extension of contemporary intravascular imaging may advance our knowledge and improve clinical practice in the future.

DOI： 10.1253/circrep.CR-19-0102

PubMed

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

DOI： 10.4244/EIJ-D-19-00431

PubMed

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

BACKGROUND: Although ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end-stage kidney disease (ESKD). HYPOTHESIS: We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. METHODS: This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain-natriuretic peptide, high-sensitive cardiac troponin T (hs-cTnT), and high-sensitive C-reactive protein (hs-CRP). MACE was defined as a composite event of all-cause death, acute coronary syndrome, and stroke. RESULTS: During a mean follow-up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs-cTnT (adjusted HR, 2.77; P < .05), and hs-CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs-CRP, 4.42 for abnormal ABI + hs-cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). CONCLUSION: Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.

DOI： 10.1002/clc.23188

PubMed

緊急経皮的冠動脈インターベンション(PCI)を施行した急性冠動脈症候群(ACS)患者334例(男性252例、女性82例、平均68±11歳)を対象に、腎機能障害とその経時的な変化パターンによって予後を予測できるか検討した。維持透析患者は除外した。推算糸球体濾過量(eGFR)は入院時、入院中、退院時に算出し、最も高い時期をベースラインとした。退院3ヵ月後のeGFRがベースラインに比べて20%以上低下した場合を腎機能障害と定義した。主要評価項目は全死亡、ACSの再発、心不全増悪による再入院を合わせた主要有害心血管イベント(MACE)の発生とした。慢性腎臓病(CKD)、急性腎障害(AKI)、腎機能障害(WRF)とMACEとの関連を評価した。患者をWRF群71例(男性70%、平均71±10歳)と非WRF群263例(男性77%、平均67±11歳)の2群に分類した。平均追跡期間は3.3±1.7年で、MACEは66例で発生した。多変量解析の結果、CKDとAKIはMACEの独立した予測因子であった。

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

Renal dysfunction and its change pattern are associated with short- and long-term mortality. However, it remains to be investigated whether or not worsening renal function (WRF) defined by baseline renal function identified from different time points would provide prognostic implication on outcomes in acute coronary syndrome (ACS) patients. This study consists of 334 ACS patients (mean age 68 ± 11 years, 75% male) treated with emergent percutaneous coronary intervention (PCI). Estimated glomerular filtration rate (eGFR) was evaluated on baseline, during hospitalization, at discharge, and at 3-month follow-up. WRF was defined as a relative decrease of eGFR > 20% at 3 months using baseline eGFR identified from different time points. The primary end point was a composite event of major cardiovascular events (MACE), including all-cause death, ACS, and heart failure hospitalization. The associations of chronic kidney disease (CKD), acute kidney injury (AKI), and WRF with MACE were evaluated. During a mean follow-up of 3.3 ± 1.7 years, a total of 64 MACE were observed. Multivariable analysis revealed that CKD (hazard ratio 2.16; p = 0.018) and AKI (hazard ratio 1.95; p = 0.030) were independent predictors of MACE, but WRF did not remain as an independent predictor of MACE (p = 0.208). The highest risk was observed in AKI patients with CKD when stratified by the presence or absence of CKD and AKI. In ACS patients treated with emergent PCI, this study demonstrated that CKD and AKI were independent predictors of MACE, while there was no independent relationship between WRF and MACE.

DOI： 10.1007/s00380-018-1291-5

PubMed

2016年1月～2018年8月までの期間内に、当院で18F-FDG PET/CTを受けた成人患者のうち、虫垂疾患を認めない無症候性患者303例(男性200例,女性103例、平均年齢67±12歳)を対象として、正常虫垂への18F-FDG集積を後向きに評価した。その結果、18-FDGの異常集積(SUVmax)は平均1.14±0.52(0.52～5.12)、肝臓に対する虫垂のSUVmax比は平均0.34±0.16(0.06～1.28)で、肥満指数は平均22.55±3.38、血糖値は平均6.14±3.45mmol/L、FDG集積量は平均234.65±46.46MBqであった。また、PET/CTで多く認められた悪性腫瘍は肺癌(23.2%)で、次に鼻咽頭癌(16%)、リンパ腫(10.4%)の順となり、FDG蓄積はグレード0が259例、グレード1が41例、グレード3が2例、グレード3が1例であった。なお、陽性率は0.9%で、SUVmaxが3.00以上の3例には、虫垂炎や悪性腫瘍の既往や徴候はみられず、虫垂SUVmaxと年齢、肥満指数、血糖値間においても相関性はみられなかった。以上の所見から、成人の正常虫垂に観察される18F-FDG集積は肝臓への集積に比べ低い傾向であることが示されたが、FDG高集積で正常虫垂の場合もみられるため、画像識別に困難を要することが示唆された。

ST上昇型急性心筋梗塞の冠動脈インターベンション(PCI)に難渋した冠動脈拡張症(CAE)2例を呈示した。症例1は歳40代男性で、一時ペーシング挿入、血栓吸引、責任病変部に残存する巨大な血栓に対する薬剤溶出性ステント(DES)留置を行った。最終造影はTIMI 2であった。急性期に輸血を要する大出血をきたしたためDAPT(アスピリン、クロピドグレル)を休薬し、慢性期はアスピリン単剤投与とした。症例2は50歳代男性で、血栓吸引により冠血流は改善したが最終造影はTIMI 1で、大動脈内バルーンポンプ(IABP)を留置した。ワルファリンとクロピドグレル内服を開始したが、慢性期に出血合併症を認めたため、直接作用型経口抗凝固薬単剤へ変更とした。2例とも再灌流を得られ、再発や責任病変の再狭窄は認めない。

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