Faculty Profiles - TANAKA Akihito

Effectiveness of the Shock Team on Short-Term Outcomes in Patients With Cardiogenic Shock　― Systematic Review and Meta-Analysis ― Reviewed International journal Open Access

Arai Marina, Kondo Toru, Nakashima Takahiro, Hanada Hiroyuki, Hashiba Katsutaka, Yamamoto Takeshi, Nakayama Naoki, Kirigaya Jin, Ishizu Tomoko, Hosoya Yumiko, Katasako-Yabumoto Aya, Okazaki Yusuke, Yamamoto Masahiro, Sakamoto Kazuo, Osawa Takumi, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Mano Toshiaki, Kojima Sunao, Noguchi Teruo, Tsujimoto Yasushi, Kikuchi Migaku, Funazaki Toshikazu, Tahara Yoshio, Nonogi Hiroshi, Matoba Tetsuya, for the Japan Resuscitation Council (JRC) Emergency Cardiovascular Care (ECC) Cardiogenic Shock (CS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. 8 ( 1 ) page： 13 - 20 2026.1

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background: Recently, shock teams have been introduced to optimize cardiogenic shock (CS) care; however, their clinical benefits remain unclear. We conducted a systematic review and meta-analysis to assess whether management by a shock team improves outcomes in patients with CS.Methods and Results: This meta-analysis was conducted according to the PRISMA guidelines. Studies comparing adults with CS managed with or without a shock team were identified from the PubMed, Web of Science, and Cochrane Library databases. The primary outcome was short-term mortality (cardiac intensive care unit, in-hospital, or 30-day mortality); the secondary outcome was bleeding. Of the 7 retrospective cohort studies that met the inclusion criteria, 3 without a critical risk of bias were included in the analysis. Shock team management was significantly associated with lower short-term mortality (odds ratio [OR] 0.52; 95% confidence interval [CI] 0.32–0.85; P=0.010) and bleeding complications (OR 0.62; 95% CI 0.43–0.91; P=0.010). Sensitivity analysis using crude data also supported the mortality benefit (OR 0.68; 95% CI 0.54–0.85; P<0.010). However, no randomized trials were included, and the certainty of evidence was rated very low owing to the risk of bias and inconsistency.Conclusions: Shock team management may improve short-term outcomes in patients with CS; however, the level of evidence is very low. Further prospective studies are needed to evaluate optimal shock team composition and roles.

DOI： 10.1253/circrep.cr-25-0240

A Case of Concurrent Left Main Obstruction and Worsening Left Ventricular Outflow Tract Obstruction Following Transcatheter Aortic Valve Replacement Reviewed Open Access

Tatami Yosuke, Tanaka Akihito, Ohashi Taiki, Kobayashi Akihiro, Haga Tomoaki, Kubota Ryuji, Araki Yoshimori, Kaneko Shinji, Shinoda Masanori, Murohara Toyoaki

Journal of Transcatheter Valve Therapies Vol. 8 ( 1 ) page： 49 - 58 2026

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Transcatheter Valve Therapies

Objective: Predicting coronary obstruction (CO) and left ventricular outflow tract (LVOT) obstruction (LVOTO) after transcatheter aortic valve replacement (TAVR) remains challenging.Case Presentation: An 86-year-old female presented with chest pain. Transthoracic echocardiography revealed very severe aortic stenosis, accelerated LVOT flow (2.4 m/s), systolic anterior motion (SAM) of the mitral valve, and mild mitral regurgitation (MR). Computed tomography demonstrated a low left coronary artery height (9.5 mm) with a posteriorly located ostium adjacent to heavy commissural calcification between the left and noncoronary cusps. The patient preferred TAVR; therefore, the procedure was performed using a 23-mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA, USA) via transfemoral approach under left main (LM) protection. Immediately after valve deployment, ventricular tachycardia occurred due to LM obstruction, and required venoarterial extracorporeal membrane oxygenation (VA-ECMO). After drug-eluting stent implantation in the LM, coronary reperfusion was achieved with recovery of left ventricular function. After hemodynamic stabilization, transesophageal echocardiography demonstrated LVOTO with accelerated LVOT flow (3.0 m/s), worsening SAM, and moderate MR. Despite these findings, hemodynamics remained stable; VA-ECMO was weaned and discontinued. Three days after TAVR, LVOT flow increased (6.4 m/s) along with improved left ventricular function. Despite medical therapy alone, a dual-chamber permanent pacemaker was implanted. Although immediate improvement of LVOTO was not observed, LVOT flow decreased to 1.5 m/s, and SAM resolved at 6-month follow-up.Conclusion: We report a case of CO and LVOTO following TAVR. Prompt bail-out intervention for CO was successfully achieved, and LVOTO gradually improved over time.

DOI： 10.33290/jtvt.cr.25-0024

Clinical utility of dynamic chest radiography as an auxiliary tool for atrial fibrillation detection in heart failure: a pilot study Reviewed Open Access

Hiraiwa H., Nagai S., Ito R., Kondo K., Kazama S., Kondo T., Adachi S., Furusawa K., Tanaka A., Morimoto R., Okumura T., Murohara T.

BMC Cardiovascular Disorders Vol. 25 ( 1 ) 2025.12

Language：English Publishing type：Research paper (scientific journal) Publisher：BMC Cardiovascular Disorders

Background: Dynamic chest radiography (DCR) can estimate haemodynamic parameters in patients with heart failure (HF). Atrial fibrillation (AF) often coexists with HF; however, owing to its sometimes paroxysmal nature and minimal or absent symptoms, many patients with AF remain undiagnosed. Additional tools for AF diagnosis may be beneficial; therefore, we evaluated the ability of DCR to distinguish patients with HF in sinus rhythm (SR) from those with AF. Methods: In this small-sample pilot study, 20 patients with HF (median age, 67 years; males, 85%) underwent 12-lead electrocardiography and DCR on the same day. Aortic arch (Ao), right atrial (RA), right and left pulmonary artery (PA), and left ventricular (LV) apex pixel values (PVs) were measured. Seventeen patients were in SR and three demonstrated AF on 12-lead electrocardiography before DCR. Results: The PV and PV change rate waveforms of the Ao, RA, PAs, and LV apex were regular in SR and irregular with AF. The difference between patients in SR and those with AF was particularly clear in the LV apex PV change rate waveforms. In addition, the heart rates (HRs) of patients in SR and with AF could be calculated from the PV change rate waveforms and were similar to those calculated by 12-lead electrocardiography. Conclusions: DCR can detect AF in patients with HF and may be able to infer HR.

DOI： 10.1186/s12872-025-04820-7

Delirium in Nonagenarians with Acute Coronary Syndrome Following Percutaneous Coronary Intervention Reviewed International journal Open Access

Hayakawa Hikaru, Uemura Yusuke, Tanaka Akihito, Tokuda Kotaro, Shibata Naoki, Iwama Makoto, Sakaguchi Teruhiro, Yoshida Ruka, Negishi Yosuke, Tashiro Hiroshi, Tanaka Miho, Tatami Yosuke, Yamaguchi Shogo, Yoshioka Naoki, Umemoto Norio, Ohashi Taiki, Takada Yasunobu, Asano Hiroshi, Yoshida Yukihiko, Tanaka Toshikazu, Noda Toshiyuki, Morishima Itsuro, Takemoto Kenji, Watarai Masato, Ishii Hideki, Murohara Toyoaki

International Heart Journal Vol. 66 ( 6 ) page： 941 - 946 2025.11

Language：English Publishing type：Research paper (scientific journal) Publisher：International Heart Journal Association

The aging population has led to an increase in nonagenarians undergoing percutaneous coronary intervention (PCI). Nonagenarian patients are at risk for geriatric complications, including delirium, which can worsen clinical outcomes. However, research on delirium and its clinical implications in nonagenarians with acute coronary syndrome (ACS) following PCI is limited.This retrospective observational cohort study analyzed data from 307 nonagenarians with ACS who underwent PCI. Delirium was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Prevalence and prognostic impact of delirium during hospitalization were investigated.Delirium occurred in 85 patients (27.7%) during hospitalization. Patients with delirium had longer hospital stays and lower discharge rates to home or the same location as prior to hospitalization compared to patients without delirium. However, in-hospital mortality rates were comparable between the groups. Over a median follow-up of 480 days, no significant differences were found in all-cause mortality between the two groups.Delirium was common among nonagenarians with ACS following PCI. While delirium was associated with length of hospital stays and discharge destination, it was not linked to survival rates. Prevention, early detection, and effective management of delirium are important for optimizing care in super-aged patients following PCI.

DOI： 10.1536/ihj.25-289

PubMed

Diagnostic Accuracy of the Initial Point-of-Care Troponin Tests for Patients With Chest Pain Who Were Suspected of Acute Myocardial Infarction　― A Systematic Review and Meta-Analysis ― Reviewed

Arai Marina, Minami Yuichiro, Yamaguchi Junichi, Tanaka Akihito, Matsuo Kunihiro, Mano Toshiaki, Kojima Sunao, Hao Kiyotaka, Taniguchi Takuya, Tateishi Kazuya, Aoyama Rie, Yokose Masashi, Noguchi Teruo, Tsujimoto Yasushi, Matoba Tetsuya, Funazaki Toshikazu, Tahara Yoshio, Nonogi Hiroshi, Kikuchi Migaku, for the Japan Resuscitation Council (JRC) Emergency Cardiovascular Care (ECC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. advpub ( 0 ) 2025.9

Language：English Publisher：The Japanese Circulation Society

Background: Point-of-care (POC) cardiac troponin testing, although less sensitive than high-sensitivity cardiac troponin assays, allows for rapid bedside evaluation. This study assessed the diagnostic performance of POC troponin tests for both ruling in and ruling out acute myocardial infarction (AMI) at the time of patient presentation.Methods and Results: In accordance with PRISMA-DTA guidelines, we conducted a systematic review and meta-analysis using PubMed, Web of Science, and the Cochrane Library from inception through June 17, 2023. We included all studies evaluating the diagnostic accuracy of POC troponin assays for identifying AMI among adult patients. Among the 551 studies initially screened, 6 met the eligibility criteria for inclusion. A meta-analysis of diagnostic accuracy based on these 6 observational datasets demonstrated pooled sensitivity and specificity values of 47% (95% confidence interval (CI) 45–49%) and 90% (95% CI 89–90%), respectively, for AMI detection. In a subgroup meta-analysis of non-ST-segment elevation MI using 4 observational datasets, the pooled sensitivity and specificity were 48% (95% CI 45–50%) and 89% (95% CI 89–90%), respectively.Conclusions: These findings emphasize that the clinical application of POC troponin assays in AMI diagnosis must consider the test’s robust specificity (≈90%) alongside its limited sensitivity (<50%).

DOI： 10.1253/circrep.cr-25-0163

Impact of Risk Stratification on Clinical Outcomes in Patients With Acute Coronary Syndrome　― A Systematic Review ― Reviewed

Aoyama Rie, Tateishi Kazuya, Mano Toshiaki, Hao Kiyotaka, Taniguchi Takuya, Kojima Sunao, Arai Marina, Minami Yuichiro, Yokose Masashi, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Noguchi Teruo, Tsujimoto Yasushi, Funazaki Toshikazu, Matoba Tetsuya, Tahara Yoshio, Nonogi Hiroshi, Kikuchi Migaku, for the Japan Resuscitation Council (JRC) Emergency Cardiovascular Care (ECC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. advpub ( 0 ) 2025.9

Language：English Publisher：The Japanese Circulation Society

Background: Risk scores have been developed to determine the treatment strategies and predict the prognosis of acute coronary syndromes (ACS). It remains unclear whether risk score-guided management improves prognosis. Therefore, this systematic review aimed to evaluate whether the use of risk scores to assess the acute severity of illness affects the prognosis of adult patients with ACS.Methods and Results: We conducted a systematic review and meta-analysis to evaluate whether risk score-guided management improves clinical outcomes in patients with ACS. We searched MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to November 30, 2024, and included randomized controlled trials comparing risk score-based care with standard care. Two cluster randomized trials, using the Global Registry of Acute Coronary Events risk score (GRS), were identified, with a total of 5,368 patients. A systematic review adjusted for clustering revealed no significant differences in clinical outcomes, including in-hospital and 1-year mortality, in-hospital cardiac arrest, in-hospital recurrent ischemia, in-hospital and 1-year heart failure, and early invasive angiography.Conclusions: Risk score-guided management of patients with ACS using risk scores, particularly the GRS, did not consistently lead to improved clinical outcomes. Further research is needed to assess whether risk score-guided management can improve patient outcomes.

DOI： 10.1253/circrep.cr-25-0162

Prognostic Impact of Point-of-Care Ultrasound in Patients With Suspected Cardiogenic Shock　― A Systematic Review ―

Osawa Takumi, Nakayama Naoki, Ishizu Tomoko, Kondo Toru, Nakashima Takahiro, Yamamoto Takeshi, Hanada Hiroyuki, Hashiba Katsutaka, Kirigaya Jin, Hosoya Yumiko, Katasako-Yabumoto Aya, Okazaki Yusuke, Yamamoto Masahiro, Sakamoto Kazuo, Arai Marina, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Mano Toshiaki, Kojima Sunao, Noguchi Teruo, Tsujimoto Yasushi, Kikuchi Migaku, Funazaki Toshikazu, Tahara Yoshio, Nonogi Hiroshi, Matoba Tetsuya, Japan Resuscitation Council (JRC) Emergency Cardiovascular Care (ECC) Cardiovascular Shock (CS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. 7 ( 9 ) page： 735 - 741 2025.9

Language：English Publisher：The Japanese Circulation Society

Background: Cardiogenic shock, a life-threatening condition frequently encountered in emergency departments, requires rapid diagnosis and management. Point-of-care ultrasound (POCUS) is widely used as a bedside tool; however, its impact on prognosis in patients with suspected cardiogenic shock remains unclear. This systematic review aimed to evaluate whether POCUS improves the clinical outcomes in these patients.Methods and Results: We searched PubMed, Web of Science, and Cochrane Library up to December 31, 2023, for studies evaluating the prognostic impact of POCUS in adults with undifferentiated shock, including cardiogenic shock. From 3,759 identified records, 2 studies (1 randomized controlled trial [RCT] and 1 observational study) involving 5,711 patients with shock were included. The RCT showed no significant differences in in-hospital mortality between the POCUS and non-POCUS groups (relative risk [RR] 0.99 [95% confidence interval (CI) 0.64–1.51]). The observational study reported higher mortality in patients receiving POCUS before intervention (RR 1.25 [95% CI 1.12–1.39]). Overall, POCUS did not significantly reduce mortality in patients with suspected cardiogenic shock. Given the limited number and quality of available studies, the certainty of evidence was low (RCT) and very low (observational study).Conclusions: Although POCUS plays an essential role in diagnosis and clinical decision-making, our review suggests that it may not significantly improve prognosis in patients with suspected cardiogenic shock. Further studies are required to determine its prognostic value.

DOI： 10.1253/circrep.cr-25-0108

Early Invasive Strategy in Non-ST-Elevation Acute Coronary Syndrome With Congestive Heart Failure　― A Systematic Review and Meta-Analysis ― Reviewed

Hao Kiyotaka, Taniguchi Takuya, Kojima Sunao, Arai Marina, Aoyama Rie, Tateishi Kazuya, Minami Yuichiro, Yokose Masashi, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Mano Toshiaki, Yamamoto Takeshi, Nakayama Naoki, Hanada Hiroyuki, Hashiba Katsutaka, Nakashima Takahiro, Kondo Toru, Noguchi Teruo, Tsujimoto Yasushi, Matoba Tetsuya, Funazaki Toshikazu, Tahara Yoshio, Nonogi Hiroshi, Kikuchi Migaku, for the Japan Resuscitation Council (JRC) Emergency Cardiovascular Care (ECC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. 7 ( 9 ) page： 697 - 704 2025.9

Language：English Publisher：The Japanese Circulation Society

Background: Congestive heart failure (CHF) is associated with worse clinical outcomes in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS); however, the optimal timing of invasive intervention in NSTE-ACS with CHF remains unclear. In this study, we assessed the impact of early vs. delayed invasive strategies on mortality and cardiac events by synthesizing a systematic review of randomized controlled trials of patients with NSTE-ACS.Methods and Results: We searched MEDLINE, CENTRAL, and the Web of Science for randomized controlled trials comparing early and delayed invasive strategies in patients with NSTE-ACS and CHF, published before February 2023. Observational studies were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction at 2 years. Two eligible studies, including 310 participants, were identified. The primary endpoint occurred in 40 (24.5%) of 163 patients in the early invasive strategy group, compared with 39 (26.5%) of 147 patients in the delayed invasive strategy group, and the effect of an early invasive strategy on the primary outcome was uncertain (risk ratio 0.95 [95% confidence interval 0.66–1.37]). The certainty of the evidence was rated very low.Conclusions: The effects of an early invasive strategy in patients with NSTE-ACS and CHF remains uncertain, with no clear reduction in composite outcome of mortality and myocardial infarction at 2 years compared with delayed intervention.

DOI： 10.1253/circrep.cr-25-0104

Diagnostic Accuracy of Point-of-Care Ultrasound for Patients With Cardiogenic Shock　― A Meta-Analysis and Systematic Review ― Reviewed

Osawa Takumi, Nakayama Naoki, Ishizu Tomoko, Kondo Toru, Nakashima Takahiro, Yamamoto Takeshi, Hanada Hiroyuki, Hashiba Katsutaka, Kirigaya Jin, Hosoya Yumiko, Katasako-Yabumoto Aya, Okazaki Yusuke, Yamamoto Masahiro, Sakamoto Kazuo, Arai Marina, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Mano Toshiaki, Kojima Sunao, Noguchi Teruo, Tsujimoto Yasushi, Kikuchi Migaku, Funazaki Toshikazu, Tahara Yoshio, Nonogi Hiroshi, Matoba Tetsuya, Resuscitation Council (JRC) Emergency Cardiovascular Care (ECC) Cardiovascular Shock (CS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. 7 ( 9 ) page： 727 - 734 2025.9

Language：English Publisher：The Japanese Circulation Society

Background: Cardiogenic shock, cardiac tamponade, and pulmonary embolism are critical conditions in cardiovascular emergencies, characterized by high mortality rates. Early diagnosis and treatment are essential to improve outcomes. Point-of-care ultrasound (POCUS) has emerged as a noninvasive tool for evaluating shock. However, further assessment through the latest meta-analyses is necessary to comprehensively evaluate its diagnostic accuracy in cardiogenic emergencies. Therefore, in this study, we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of POCUS in patients with cardiogenic and obstructive shock.Methods and Results: Up to December 31, 2023, we systematically reviewed 9 studies reporting all 4 values (true positive, false positive, false negative, and true negative) published in the PubMed, Web of Science, and CENTRAL databases: 8 studies assessed cardiac shock, and 8 assessed obstructive shock separately. For cardiac shock, the pooled sensitivity was 86.1% (95% confidence interval [CI]: 71.5–93.9%), and specificity was 95.8% (95% CI: 94.0–97.2%). For obstructive shock, the pooled sensitivity was 77.5% (95% CI: 62.5–87.6%) and specificity was 97.6% (95% CI: 93.9–99.1%). The area under the curve was 0.96 (95% CI: 0.95–0.98) for cardiogenic shock and 0.94 (95% CI: 0.88–0.98) for obstructive shock.Conclusions: This meta-analysis suggested that POCUS has reasonable diagnostic accuracy for cardiogenic and obstructive shock, particularly with high pooled specificity.

DOI： 10.1253/circrep.cr-25-0105

Clinical Benefits of Coronary Computed Tomography Angiography for Evaluating Low-Risk Patients With Non-ST-Elevation Acute Coronary Syndrome in the Emergency Department　― Systematic Review and Meta-Analysis ― Reviewed

Tateishi Kazuya, Mano Toshiaki, Aoyama Rie, Hao Kiyotaka, Taniguchi Takuya, Kojima Sunao, Arai Marina, Minami Yuichiro, Yokose Masashi, Kondo Toru, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Yamamoto Takeshi, Nakayama Naoki, Hanada Hiroyuki, Hashiba Katsutaka, Nakashima Takahiro, Matoba Tetsuya, Tahara Yoshio, Nonogi Hiroshi, Noguchi Teruo, Tsujimoto Yasushi, Kikuchi Migaku, for the Japan Resuscitation Council (JRC) Acute Coronary Syndrome (ACS) Task Force and the Guideline Editorial Committee on behalf of the Japanese Circulation Society (JCS) Emergency and Critical Care Committee

Circulation Reports Vol. 7 ( 9 ) page： 705 - 714 2025.9

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background: The utility of coronary computed tomography angiography (CCTA) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), particularly among low-risk individuals presenting to the emergency department (ED), remains unclear. We conducted a systematic review to assess the clinical benefits of CCTA in low-risk patients presenting to the ED with chest pain.Methods and Results: A systematic search of MEDLINE, CENTRAL, and Web of Science was performed for randomized controlled trials (RCTs) published up to March 23, 2023, comparing CCTA performed in the ED with standard care in low-risk patients with NSTE-ACS. Low-risk status was defined as resolved symptoms at ED presentation and no troponin elevation or ischemic ECG changes. Seven RCTs were extracted from the databases. No significant differences were observed between the CCTA and standard care groups in all-cause mortality, non-fatal myocardial infarction, ED revisits, or radiation exposure. However, hospital length of stay was significantly shorter and healthcare costs were slightly lower in the CCTA group. Conversely, revascularization and invasive coronary angiography were significantly more frequent in this group.Conclusions: In low-risk patients with NSTE-ACS, CCTA performed in the ED did not reduce adverse clinical events but was associated with shorter hospital stays and marginally reduced healthcare costs. These findings suggest that CCTA may be a useful tool that supports the safe and early discharge of selected patients.

DOI： 10.1253/circrep.cr-25-0114

Drug-Eluting Stent and Drug-Coated Balloon Compared to Full-Covered Drug-Eluting Stent for Femoropopliteal Lesions: CENTAUR Study

Ogata K., Nishihira K., Tokuda T., Yoshioka N., Tanaka A., Kojima S., Yamaguchi K., Yanagiuchi T., Takei T., Nakama T., Shibata Y., Tsujita K.

Catheterization and Cardiovascular Interventions Vol. 106 ( 3 ) page： 1600 - 1609 2025.9

Publisher：Catheterization and Cardiovascular Interventions

Background: Several studies have documented positive clinical outcomes associated with drug-containing devices, such as drug-eluting stents (DES) and drug-coated balloons (DCB), for femoropopliteal artery (FPA) lesions. Endovascular therapy (EVT) using drug-containing devices is the primary strategy, even for complex FP lesions. However, little is known about the clinical outcomes of the hybrid of DES and DCB therapies. Aims: To compare the efficacy of hybrid therapy with that of a full-covered DES for FPA lesions in a real-world setting. Methods: This retrospective multi-center study enrolled 2105 consecutive patients (2173 de novo FPA lesions) who underwent EVT between 2018 and 2021. Among these, 99 FPA lesions treated with hybrid therapy and 369 FPA lesions treated with a full-covered DES were analyzed. Propensity score matching was performed to compare clinical outcomes between hybrid and full-covered DES groups, resulting in the analysis of 79 matched pairs. The primary outcome was patency at 1 year, with target lesion revascularization (TLR) also evaluated. Results: Primary patency and freedom from TLR at 1 year were comparable between the groups (hybrid vs. full-covered DES: 79.6% vs. 88.3%, p = 0.23; and 86.9% vs. 93.6%, respectively; p = 0.21). However, interaction analysis revealed that full-covered DES provided significantly higher primary patency than hybrid therapy in FPA lesions without popliteal artery involvement (interaction p = 0.049). Conclusions: Hybrid therapy achieved an acceptable clinical outcome for complex FPA lesions compared with full-covered DES in a real-world setting.

DOI： 10.1002/ccd.31727

Use of a Pulmonary Artery Catheter in Patients With Cardiogenic Shock　― A Systematic Review and Meta-Analysis ― Reviewed

Kondo Toru, Nakashima Takahiro, Yamamoto Takeshi, Nakayama Naoki, Hanada Hiroyuki, Hashiba Katsutaka, Kirigaya Jin, Ishizu Tomoko, Hosoya Yumiko, Katasako-Yabumoto Aya, Okazaki Yusuke, Yamamoto Masahiro, Sakamoto Kazuo, Arai Marina, Osawa Takumi, Tanaka Akihito, Matsuo Kunihiro, Yamaguchi Junichi, Mano Toshiaki, Kojima Sunao, Noguchi Teruo, Tsujimoto Yasushi, Kikuchi Migaku, Funazaki Toshikazu, Tahara Yoshio, Nonogi Hiroshi, Matoba Tetsuya

Circulation Reports Vol. 7 ( 8 ) page： 589 - 598 2025.8

Language：English Publisher：The Japanese Circulation Society

Background: A pulmonary artery catheter (PAC) provides detailed hemodynamic data, and managing a patient with cardiogenic shock (CS) using a PAC potentially improves patient outcomes. Therefore, in this systematic review and meta-analysis we aimed to evaluate whether a PAC is associated with better outcomes in patients with CS.Methods and Results: Studies comparing PAC and non-PAC management in patients with CS were identified from the PubMed, Web of Science, and CENTRAL databases. There were no randomized controlled trials (RCTs). Of the 19 studies that met the inclusion criteria, 12 without a critical risk of bias were analyzed. PAC use was associated with lower in-hospital mortality when evaluated as a dichotomous outcome. Similar trends were observed in the time-to-event analyses. Substantial heterogeneity was observed across the studies. Subgroup analysis revealed better outcomes with PAC in patients with CS related to heart failure, but not in those with acute coronary syndrome. Sensitivity analyses, which included studies with a critical risk of bias, showed consistent trends favoring PAC use for crude in-hospital mortality. The overall certainty of the evidence was very low because of inconsistencies and biases.Conclusions: The PAC-guided CS management was associated with better in-hospital mortality, particularly in patients with heart failure-related CS. However, RCTs that evaluated the efficacy of PAC use as a primary purpose were not included, necessitating further RCTs to confirm these findings.

DOI： 10.1253/circrep.cr-25-0088

Current Trends in Device and Size Selection for Transcatheter Atrial Septal Defect Closure in Adults　― Insights From a Japanese Nationwide Registry ― Reviewed

Tanaka Akihito, Takahara Mitsuyoshi, Kohsaka Shun, Shinke Toshiro, Furusawa Kenji, Nanasato Mamoru, Ishii Hideki, Hara Hidehiko, Amano Tetsuya, Murohara Toyoaki, Kozuma Ken

Circulation Journal Vol. 89 ( 7 ) page： 939 - 945 2025.6

Authorship：Lead author,　Corresponding author Language：English Publisher：The Japanese Circulation Society

Background: This study investigated current trends in transcatheter atrial septal defect (ASD) closure among adult patients, with an emphasis on device and size selection, as well as acute complications.Methods and Results: This study used the Japanese Structural Heart Disease (J-SHD) registry database, which is a prospective nationwide multicenter registry. In all, 1,921 patients who underwent transcatheter ASD closure between 2019 and 2022 were analyzed in this study. The specifics of the procedures, including device type, size selection, and acute complications, were assessed. The mean (±SD) age of participants was 57±18 years, with 37.6% being male. Aortic rim deficiency was observed in most patients (50.3%). The prevalence of aortic rim deficiency was 32.5% for the Amplatzer®Septal Occluder (ASO), 65.6% for the Occlutech®Figulla Flex II Septal Occluder (FSO), and 57.8% for the GORE®CARDIOFORM ASD Occluder. In patients in whom the ASO or FSO was used, device size was 2–3 and 5–6 mm larger than defect size, respectively. Device migration was observed in 8 (0.4%) patients, and occurred regardless of device oversizing or undersizing relative to defect size.Conclusions: This study reports the trends in clinical features, device and size selection, and acute complications in adult patients who underwent transcatheter ASD closure.

DOI： 10.1253/circj.cj-24-0944

PubMed

Comparing the Clinical Performance of High-Dose and Low-Dose Drug-Coated Balloons for Long Femoropopliteal Artery Disease: Results of the SATELLITE Study Reviewed Open Access

Yoshioka N., Tokuda T., Tanaka A., Kojima S., Yamaguchi K., Yanagiuchi T., Ogata K., Takei T., Morita Y., Nakama T., Morishima I.

Catheterization and Cardiovascular Interventions Vol. 105 ( 6 ) page： 1453 - 1461 2025.5

Language：English Publisher：Catheterization and Cardiovascular Interventions

Background: Previous studies have shown comparable outcomes between first-generation high-dose drug-coated balloon (HD-DCB) and second-generation low-dose drug-coated balloon (LD-DCB) for femoropopliteal artery disease. However, data about the clinical performances of these DCBs for longer lesions in real-world clinical settings are limited. Methods: In this multicenter, retrospective study, the clinical performances of the HD-DCB (IN.PACT, Medtronic, MN, USA) and the LD-DCB (Ranger, Boston, MA, USA) were assessed in cases of femoropopliteal artery disease with lesion length ≥ 150 mm. From the database, 288 lesions in 288 patients were assigned to the HD-DCB group, and 88 lesions in 88 patients were assigned to the LD-DCB group. Propensity score-matching analysis was performed to adjust for baseline patient and lesion characteristics. The primary outcome was the 2-year primary patency rate of the two types of DCBs. Results: Propensity score matching was used to extract 76 pairs with no significant intergroup differences in baseline patient and lesion characteristics. The average lesion length was 257.5 and 255.7 mm in the HD and LD-DCB groups, respectively. The 2-year primary patency rates between the HD and LD-DCB groups were comparable (68.5% vs. 60.4%; p = 0.33). There were also no significant differences in clinically driven target lesion revascularization, acute limb ischemia, major amputation, or overall survival between the two types of DCBs. Conclusion: The clinical outcomes between the HD and LD-DCBs did not significantly differ in real-world populations with severely complex lesions.

DOI： 10.1002/ccd.31485

Clinical utility of dynamic chest radiography in the oblique view to evaluate cardiac contraction: a case description Reviewed

Hiraiwa H., Nagai S., Ito R., Kondo K., Kazama S., Kondo T., Adachi S., Furusawa K., Tanaka A., Morimoto R., Okumura T., Murohara T.

Quantitative Imaging in Medicine and Surgery Vol. 15 ( 3 ) page： 2632 - 2641 2025.3

Impact of Aortic Atherosclerosis on Clinical Outcomes After Transfemoral Transcatheter Aortic Valve Replacement Reviewed

Shirai Y., Tanaka A., Tokuda Y., Kondo H., Mizutani K., Uemura T., Furusawa K., Mutsuga M., Murohara T.

Catheterization and Cardiovascular Interventions 2025

Authorship：Corresponding author Language：English Publisher：Catheterization and Cardiovascular Interventions

Background: Aortic atherothrombotic lesions can cause systemic embolization and adverse outcomes after interventional procedures. Aims: This study aimed to assess the association between the degree of aortic atherosclerosis and clinical outcomes after transfemoral transcatheter aortic valve replacement (TAVR). Methods: This single-center observational study included data from 278 patients who underwent transfemoral TAVR. The degree of aortic atherosclerosis in the ascending aorta, aortic arch, descending aorta, and abdominal aorta according to preoperative enhanced computed tomography was evaluated, and extensive intimal thickening ≥ 4 mm or mobile-looking, ulcerated or protruding atheroma were considered to be atherothrombotic lesions. Patients were classified into two groups: those with and without atherothrombotic lesions. Clinical outcomes, including all-cause death, stroke, systemic embolization, and worsening renal function, were investigated. Results: Of 278 patients, 116 (41.4%) exhibited atherothrombotic lesions. Baseline renal function was significantly worse in patients with atherothrombotic lesions. There were no significant differences in the occurrence of all-cause death (0% vs. 0.6%; p > 0.99), stroke (3.5% vs. 2.5%; p = 0.72), systemic embolism (0.9% vs. 0%; p = 0.42), and worsening renal function (increase in serum creatinine ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline; 5.4% vs. 5.2%; p = 0.93) within 1-month. During a median follow-up of 3.0 years (interquartile range 2.0–4.0 years), the occurrence of all-cause death was numerically higher in patients with atherothrombotic lesions compared to those without. Conclusions: Atherothrombotic lesions were commonly observed in patients undergoing transfemoral TAVR. No significant clinical effect of aortic atherosclerosis on short-term adverse outcomes was observed, although long-term mortality was numerically higher in patients who exhibited atherothrombotic lesions.

DOI： 10.1002/ccd.70125

Clinical implications of cerebral microbleeds in patients who undergo transcatheter aortic valve replacement Reviewed

Uemura Y., Tanaka A., Ozaki Y., Yamaguchi S., Okajima T., Mitsuda T., Ishikawa S., Takemoto K., Murohara T., Watarai M.

Cardiovascular Revascularization Medicine 2025

Language：English Publishing type：Research paper (scientific journal) Publisher：Cardiovascular Revascularization Medicine

Background: The prognostic implications of cerebral microbleeds (CMBs) in patients who undergo transcatheter aortic valve replacement (TAVR) have not been fully elucidated. Therefore, we aimed to investigate the association between the presence of CMBs and adverse outcomes post-TAVR. Methods: In this single-center retrospective study, we included 124 patients who underwent brain magnetic resonance imaging before TAVR. The outcomes of interest were the subsequent incidences of stroke and all-cause death or admission for heart failure. Results: CMBs were identified in 32.2 % of the included patients. The median follow-up duration was 954 (interquartile range, 553–1306) days. The incidence of stroke after TAVR was comparable between patients with and without CMBs. Conversely, all-cause death or admission for heart failure was significantly higher in patients with CMBs than in those without (log-rank P = 0.010). Multivariate Cox regression analysis revealed that the presence of CMBs was independently correlated with the occurrence of all-cause death or admission for heart failure after adjusting for other prognostic predictors (hazard ratio 4.016, 95 % confidence interval 1.572–10.259, P = 0.007). Conclusion: The presence of CMBs predicts the incidence of all-cause death or admission for heart failure in patients undergoing TAVR. Evaluating CMBs could provide useful information for post-TAVR management.

DOI： 10.1016/j.carrev.2024.12.013

Feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated vascular closure device Reviewed International journal

Tachi M., Tanaka A., Teraoka T., Furuta T., Matsushita E., Hayashi K., Shimojo M., Yanagisawa S., Inden Y., Murohara T.

Heart Rhythm Vol. 21 ( 10 ) page： 2028 - 2036 2024.10

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Heart Rhythm

Background: Venous vascular access complications are usually nonfatal but are the most common complications after transvenous catheter intervention. Vascular closure devices (VCDs) have recently become available for venous closure. Objective: This study aimed to evaluate the feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated VCDs in patients who underwent catheter ablation. Methods: This single-center observational study enrolled 226 consecutive patients who underwent elective catheter ablation with femoral venipuncture. For hemostasis, vessel closure by VCD was performed with real-time ultrasound guidance after 2022 (n = 123) and without ultrasound guidance in 2021 (n = 103). The occurrence of venous access site–related complications (major, minor, or other) was compared. Results: The rate of device failure was significantly lower in patients with ultrasound guidance than in those without (1.6% vs 6.3%; P = .048). The occurrence of all venous access site–related complications was significantly lower in patients with ultrasound guidance than in those without (4.9% vs 18.4%; P = .001). Time to ambulation was shorter in patients with ultrasound guidance than in those without (2.0 ± 0.1 hours vs 2.2 ± 0.6 hours; P < .001). Conclusion: Real-time ultrasound guidance can reduce device failure, access site–related complications, and time to ambulation in performing venous closure with a VCD.

DOI： 10.1016/j.hrthm.2024.04.041

Predictability of noninvasive liver fibrosis score for cardiac events in patients with nonalcoholic fatty liver disease Reviewed International journal

Shibata N., Ito T., Toyoda H., Tanaka A., Morita Y., Kanzaki Y., Watanabe N., Yoshioka N., Yasuda S., Morishima I.

Nutrition, Metabolism and Cardiovascular Diseases Vol. 34 ( 9 ) page： 2115 - 2123 2024.9

Language：English Publishing type：Research paper (scientific journal) Publisher：Nutrition, Metabolism and Cardiovascular Diseases

Background and aims: Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of cardiac events. However, although the severity of liver fibrosis is related to worsening prognosis in patients with NAFLD, it is unclear whether the noninvasive liver fibrosis score has a predictive value for cardiac events. Methods and results: We evaluated 4071 patients with NAFLD diagnosed using ultrasonography. Liver fibrosis was assessed and divided into three groups based on the Fibrosis-4 (FIB4) index and NAFLD fibrosis score (NFS). The primary outcome of this study was major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and revascularization due to coronary artery disease. The median age of the evaluated patients was 61 (52–69) years, and 2201 (54.1%) were male. During the median follow-up period of 6.6 years, 179 (4.4%) patients experienced MACE. Kaplan–Meier survival analysis demonstrated that MACE increased progressively with the FIB4 index (log-rank, p < 0.001) and NFS (log-rank, p < 0.001). Multivariable analysis showed that the higher the FIB4 index, the higher the risk for MACE (low group as reference vs. intermediate group, hazard ratio [HR]: 1.860 [95% confidence interval (CI), 1.326–2.610; p < 0.001]; vs. high group, HR:3.325 [95% CI, 2.017–5.479; p < 0.001]), as well as NFS (low NFS group as reference vs. intermediate group, HR: 1.938 [95% CI, 1.391–2.699; p < 0.001]; vs. high group, HR: 3.492 [95% CI, 1.997–6.105; p < 0.001]). Conclusions: The FIB4 index and NFS are associated with the probability of MACE in patients with NAFLD. Clinical trials: The study design was approved by the ethics review board of Ogaki Municipal Hospital (approval number: 20221124–12, registration date: November 28th, 2022). https://www.ogaki-mh.jp/chiken/kenkyu.html.

DOI： 10.1016/j.numecd.2024.03.025