研究者詳細 - 田中　哲人

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Impact of Albuminuria on the Prognosis After Transcatheter Aortic Valve Implantation 査読有り国際誌

Tobe A., Tanaka A., Tokuda Y., Shirai Y., Miyazaki T., Yuhara S., Akita S., Furusawa K., Ishii H., Mutsuga M., Murohara T.

American Journal of Cardiology 186 巻頁： 156 - 162 2023年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：American Journal of Cardiology

The impact of preoperative albuminuria on the prognosis after transcatheter aortic valve implantation (TAVI) has not been studied. A total of 228 patients who underwent TAVI for severe aortic stenosis (AS) and for whom preoperative urinary data was available were retrospectively investigated. Patients were divided into two groups according to the urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). The urinary total protein-to-creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was the composite outcome of all-cause death and readmission for heart failure. In total, 117 patients had a high ACR and 111 patients had a low ACR. During the median follow-up period of 467 days, patients with a high ACR had a higher incidence of the primary outcome than those with a low ACR (p<0.001). Patients with a high PCR or positive dipstick proteinuria were also at a higher risk for the primary outcome (p<0.001 and p=0.008, respectively). Multivariable Cox proportional hazards analysis showed a high ACR was independently associated with a primary outcome (hazard ratio, 4.98; 95% confidence interval, 1.84–13.49; p=0.002). In conclusion, preoperative albuminuria is an independent predictor of cardiac events in patients with severe AS undergoing TAVI.

DOI： 10.1016/j.amjcard.2022.09.020

Impact of C-Reactive Protein on Long-Term Cardiac Events in Stable Coronary Artery Disease Patients with Chronic Kidney Disease 査読有り

Tokuda Kotaro, Tanaka Akihito, Tobe Akihiro, Shirai Yoshinori, Kurobe Masanari, Kubota Yoshiaki, Kunieda Takeshige, Miyazaki Tatsuya, Mizutani Koji, Furusawa Kenji, Ishii Hideki, Murohara Toyoaki

Ｊｏｕｒｎａｌ　ｏｆ　Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ　ａｎｄ　Ｔｈｒｏｍｂｏｓｉｓ advpub 巻 ( 0 ) 2023年

Comparative study of fractional flow reserve and diastolic pressure ratio using a guidewire with a sensor for measuring intravascular pressure 査読有り国際誌

Kojima Hiroki, Ishii Hideki, Tanaka Akihito, Funakubo Hiroshi, Kato Toshiaki, Shimbo Yusaku, Kawamiya Toshiki, Kuwatsuka Yachiyo, Ando Masahiko, Murohara Toyoaki

MEDICINE 101 巻 ( 52 ) 頁： e32578 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Medicine (United States)

Purpose: This study aimed to evaluate the correlation and diagnostic agreement between diastolic pressure ratio (dPR) and fractional flow reserve (FFR) in a Japanese real-world setting. Design: Prospective multicenter observational study Methods: This study included 100 patients with intermediate coronary artery stenosis at 4 Japanese hospitals. For these lesions, FFR and dPR were measured using a guidewire with a sensor and a monitor to measure intravascular pressure. The correlation and diagnostic agreement between FFR and dPR were assessed. When both FFR and dPR were negative or positive, the results were considered to be concordant. When one was positive and the other was negative, the result was regarded as discordant (positive discordance, FFR > 0.80 and dPR ≤ 0.89; negative discordance, FFR ≤ 0.80 and dPR > 0.89). Results: Overall, the FFR and dPR were well-correlated (R = 0.841). FFR and dPR were concordant in 89% of cases (concordant normal, 43%; concordant abnormal, 46%) and discordant in 11% (positive discordance, 7%; negative discordance, 4%). No significant difference was observed in the rate of concordant results between patients with and without diabetes mellitus. The diagnostic concordance rate was significantly different among the 3 coronary arteries (right coronary artery, 93.3%; left anterior descending artery, 93.2%; and left circumflex artery, 58.3%; P = .001). Additionally, the rate of concordant results tended to be higher when using intravenous administration of adenosine than when using intracoronary bolus injection of nicorandil (adenosine, 95.1%; nicorandil, 84.7%; P = .103). Conclusion: We found that dPR was highly correlated with FFR, and diagnostic discordance was observed in 11% of the lesions. Several factors, including lesion location and medication for hyperemia, may cause the diagnostic discordance between dPR and FFR.

DOI： 10.1097/MD.0000000000032578

The ridge line of left pulmonary vein isolation from left atrial appendage can subsequently increase the completion rate of the mitral isthmus block line 査読有り

Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome　― A Systematic Review ― 査読有り

Nakayama Naoki, Yamamoto Takeshi, Kikuchi Migaku, Hanada Hiroyuki, Mano Toshiaki, Nakashima Takahiro, Hashiba Katsutaka, Tanaka Akihito, Matsuo Kunihiro, Nomura Osamu, Kojima Sunao, Yamaguchi Junichi, Matoba Tetsuya, Tahara Yoshio, Nonogi Hiroshi, 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 4 巻 ( 10 ) 頁： 449 - 457 2022年10月

記述言語：英語出版者・発行元：The Japanese Circulation Society

Background: Recent guidelines for acute coronary syndrome (ACS) recommend prehospital administration of aspirin and nitroglycerin for ACS patients. However, there is no clear evidence to support this. We investigated the benefits and harms of prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals in patients with suspected ACS.Methods and Results: We searched the PubMed database and used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Three retrospective studies for aspirin and 1 for nitroglycerin administered in the prehospital setting to patients with acute myocardial infarction were included. Prehospital aspirin administration was associated with significantly lower 30-day and 1-year mortality compared with aspirin administration after arrival at hospital, with odds ratios (OR) of 0.59 (95% confidence interval [CI] 0.35–0.99) and 0.47 (95% CI 0.36–0.62), respectively. Prehospital nitroglycerin administration was also associated with significantly lower 30-day and 1-year mortality compared with no prehospital administration (OR 0.34 [95% CI 0.24–0.50] and 0.38 [95% CI 0.29–0.50], respectively). The certainty of evidence was very low in both systematic reviews.Conclusions: Our systematic reviews suggest that prehospital administration of aspirin and nitroglycerin by non-physician healthcare professionals is beneficial for patients with suspected ACS, although the certainty of evidence is very low. Further investigation is needed to determine the benefit of the prehospital administration of these agents.

DOI： 10.1253/circrep.cr-22-0060

CiNii Research

Hori Hitomi, Kaneko Shinji, Fujita Masaya, Nagai Shin, Ito Ryota, Shirai Yoshinori, Adachi Kentaro, Suzuki Noriyuki, Suzuki Junya, Kondo Kiyota, Yamauchi Ryota, Haga Tomoaki, Tatami Yosuke, Ohashi Taiki, Kubota Ryuji, Shinoda Masanori, Tanaka Akihito, Inden Yasuya, Murohara Toyoaki

JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY 2022年10月

記述言語：英語出版者・発行元：Journal of Interventional Cardiac Electrophysiology

Background and objectives: Mitral isthmus (MI) ablation for mitral flutter is technically difficult, and incomplete block line is not uncommon. The objective of this study is to investigate the effect of the ridge line of left pulmonary vein isolation (LPVI) from left atrial appendage (LAA) on completion rate of mitral isthmus (MI) block line and recurrence rate of atrial tachycardia (AT) or atrial flutter (AFL) after the first MI ablation. Methods: We identified 611 patients who underwent first MI ablation for mitral flutter during the study period. Finally, 559 patients were enrolled and divided into two groups according to the method of ridge line ablation of LPVI (LAA group, n = 467, conventional group, n = 92). Outcome measures were the completion of MI block line by first MI ablation, the recurrence of AT/AFL, and repeat MI ablation after the first MI ablation. Results: The first MI block line completion rate was significantly higher in the LAA group than the conventional group (95% vs. 85%, p < 0.001). The recurrence rate of AT/AFL after 3 months from first MI ablation was significantly lower in the LAA group. The requirement of additional MI ablation tended to be lower in the LAA group. Conclusions: Our novel approach of ablating LPV-LAA ridge from the LAA side during PVI can increase the success rate of MI block line completion, and reduce the recurrence rate of AT/AFL and the need for additional MI block line ablation. [Figure not available: see fulltext.].

DOI： 10.1007/s10840-022-01382-y

Prehospital Activation of the Catheterization Laboratory Among Patients With Suspected ST-Elevation Myocardial Infarction Outside of a Hospital　- Systematic Review and Meta-Analysis. 査読有り

Hashiba K, Nakashima T, Kikuchi M, Kojima S, Hanada H, Mano T, Yamamoto T, Tanaka A, Yamaguchi J, Matsuo K, Nakayama N, Nomura O, Matoba T, Tahara Y, Nonogi H, 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 4 巻 ( 9 ) 頁： 393 - 398 2022年9月

Incidence and predictors of frailty progression among octogenarians with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention 査読有り国際誌

Tashiro H., Tanaka A., Takagi K., Uemura Y., Inoue Y., Umemoto N., Negishi Y., Shibata N., Yoshioka N., Shimizu K., Morishima I., Watarai M., Asano H., Ishii H., Murohara T.

Archives of Gerontology and Geriatrics 102 巻頁： 104737 2022年9月

担当区分：責任著者記述言語：英語出版者・発行元：Archives of Gerontology and Geriatrics

Background: Frailty is one of the most serious health problems in older individuals with cardiovascular disease. Moreover, frailty progression is associated with subsequent adverse outcomes; therefore, the prevention of frailty progression is an important clinical issue. However, the incidence and predictors of frailty progression following acute myocardial infarction have not yet been fully elucidated. Methods: The present study is a sub-analysis of an observational multicenter registry retrospectively evaluating clinical outcomes of 288 octogenarians who underwent primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 2014 and December 2016 at five hospitals. We identified 244 patients who survived until discharge and evaluated frailty at baseline and discharge using the Clinical Frailty Scale (CFS). We defined frailty progression as an increase of at least one level in the CFS score at discharge from baseline and assessed the predictors of frailty progression. Results: Frailty progression was observed in 29.5% of patients. Patients with frailty progression were older, had more severe conditions with a higher prevalence of Killip 4 status and mechanical circulatory support use, more frequently experienced in-hospital events such as stroke (4/72, 6% vs. 0/172, 0%, p = 0.007), and had longer hospital stays than those without frailty progression [19 (11–35) vs. 13 (9–19) days, p<0.01]. Multivariate analysis showed that age (odds ratio 1.08, 95% confidence interval 1.00–1.17, p = 0.046) and Killip 4 status at baseline (odds ratio 3.34, 95% confidence interval 1.26–8.85, p = 0.01) were significant predictors of frailty progression. Conclusions: In-hospital frailty progression was commonly observed in octogenarians with STEMI who underwent primary PCI and survived until discharge, and was associated with more severe clinical conditions.

DOI： 10.1016/j.archger.2022.104737

Long-term outcomes of percutaneous revascularization for internal mammary artery-left anterior descending artery bypass failure 査読有り国際誌

Yamaguchi Shogo, Uemura Yusuke, Tanaka Akihito, Takagi Kensuke, Ohashi Taiki, Tanaka Miho, Umemoto Norio, Yoshida Ruka, Negishi Yosuke, Iwama Makoto, Takemoto Kenji, Watarai Masato, Kudo Nobutaka, Morishima Itsuro, Tatami Yosuke, Takada Yasunobu, Shimizu Kiyokazu, Yoshida Yukihiko, Tanaka Toshikazu, Noda Toshiyuki, Ishii Hideki, Murohara Toyoaki

HEART AND VESSELS 2022年8月

記述言語：英語出版者・発行元：Heart and Vessels

Despite the excellent long-term results of internal mammary artery (IMA)–left anterior descending (LAD) bypass, percutaneous revascularization of IMA is sometimes required for IMA-LAD bypass failure. However, its clinical outcomes have not been fully elucidated. The aim of this study was to investigate the long-term clinical outcomes, including target lesion revascularization (TLR) following contemporary percutaneous revascularization of failed IMA bypass graft. We examined data of 59 patients who had undergone percutaneous revascularization of IMA due to IMA-LAD bypass failure at nine hospitals. Patients with IMA graft used for Y-composite graft or sequential bypass graft were excluded. The incidence of TLR was primarily examined, whereas other clinical outcomes including cardiac death, myocardial infarction, and target vessel revascularization were also evaluated. Mean age of the enrolled patients was 67.4 ± 11.3 years, and 74.6% were men. Forty patients (67.8%) had anastomotic lesions, and 17 (28.8%) underwent revascularization within three months after bypass surgery. Procedural success was achieved in 55 (93.2%) patients. Stent implantation was performed in 13 patients (22.0%). During a median follow-up of 1401 days (interquartile range, 282–2521 days), TLR was required in six patients (8.5% at 1, 3, and 5 years). Patients who underwent percutaneous revascularization within 3 months after surgery tended to have a higher incidence of TLR. Clinical outcomes of IMA revascularization for IMA-LAD bypass failure were acceptable.

DOI： 10.1007/s00380-022-02150-8

Supplemental Oxygen and Acute Myocardial Infarction　- A Systematic Review and Meta-Analysis. 査読有り

Kojima S, Yamamoto T, Kikuchi M, Hanada H, Mano T, Nakashima T, Hashiba K, Tanaka A, Yamaguchi J, Matsuo K, Nakayama N, Nomura O, Matoba T, Tahara Y, Nonogi H, 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 4 巻 ( 8 ) 頁： 335 - 344 2022年8月

Systematic Review and Meta-Analysis of Diagnostic Accuracy to Identify ST-Segment Elevation Myocardial Infarction on Interpretations of Prehospital Electrocardiograms.

Tanaka A, Matsuo K, Kikuchi M, Kojima S, Hanada H, Mano T, Nakashima T, Hashiba K, Yamamoto T, Yamaguchi J, Nakayama N, Nomura O, Matoba T, Tahara Y, Nonogi H, 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 4 巻 ( 7 ) 頁： 289 - 297 2022年7月

Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement 査読有り国際誌

Shirai Yoshinori, Tanaka Akihito, Tokuda Yoshiyuki, Tobe Akihiro, Furusawa Kenji, Usui Akihiko, Murohara Toyoaki

JOURNAL OF CARDIAC SURGERY 37 巻 ( 7 ) 頁： 2103 - 2104 2022年7月

担当区分：責任著者記述言語：英語出版者・発行元：Journal of Cardiac Surgery

An interventricular membranous septal aneurysm, though rare, can coexist with aortic valve stenosis. In this report, we present an unsuitable anatomy for transcatheter aortic valve replacement (TAVR) due to large interventricular membranous septal aneurysm. This case suggests that the feasibility of TAVR would depend on the location and size of the aneurysm and its relationship with the aortic root.

DOI： 10.1111/jocs.16504

Percutaneous Treatment for Venous Stenosis Caused by a Vascular Closure Device 査読有り

Tachi M., Tanaka A., Riku S., Furuta T., Tobe A., Hayashi K., Murohara T.

Cardiovascular Revascularization Medicine 40 巻頁： 157 - 158 2022年7月

担当区分：責任著者記述言語：英語出版者・発行元：Cardiovascular Revascularization Medicine

Vascular closure devices (VCDs) are widely used as an alternative to manual compression of femoral puncture sites. In this report, we present a 73-year-old man who developed symptomatic venous stenosis related to VCD after pulmonary vein isolation. We performed percutaneous treatment with balloon angioplasty. This case suggests that balloon angioplasty with proper safety measures can be an option for treating venous stenosis related to VCDs.

DOI： 10.1016/j.carrev.2022.02.008

Very long-term clinical outcomes after percutaneous coronary intervention for complex vs non-complex lesions: 10-year outcomes following sirolimus-eluting stent implantation 査読有り

Performance of the 0-Hour/1-Hour Algorithm for Diagnosing Myocardial Infarction in Patients With Chest Pain in the Emergency Department　- A Systematic Review and Meta-Analysis. 査読有り

Nomura O, Hashiba K, Kikuchi M, Kojima S, Hanada H, Mano T, Yamamoto T, Nakashima T, Tanaka A, Nakayama N, Yamaguchi J, Matsuo K, Matoba T, Tahara Y, Nonogi H, 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 4 巻 ( 6 ) 頁： 241 - 247 2022年6月

Impact of Prehospital 12-Lead Electrocardiography and Destination Hospital Notification on Mortality in Patients With Chest Pain　- A Systematic Review. 査読有り

Nakashima T, Hashiba K, Kikuchi M, Yamaguchi J, Kojima S, Hanada H, Mano T, Yamamoto T, Tanaka A, Matsuo K, Nakayama N, Nomura O, Matoba T, Tahara Y, Nonogi H, 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 4 巻 ( 5 ) 頁： 187 - 193 2022年5月

Albuminuria predicts worsening renal function after transcatheter aortic valve replacement 査読有り国際誌

Tobe Akihiro, Tanaka Akihito, Tokuda Yoshiyuki, Fujii Taro, Furusawa Kenji, Ishii Hideki, Usui Akihiko, Murohara Toyoaki

JOURNAL OF CARDIOLOGY 79 巻 ( 5 ) 頁： 648 - 654 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: The impact of albuminuria on worsening renal function (WRF) and clinical outcomes after transcatheter aortic valve replacement (TAVR) is unknown. Methods: Overall, 142 patients who underwent TAVR for severe aortic stenosis were divided into two groups based on the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥30 mg/g) and low (ACR <30 mg/g). The incidence of WRF (an absolute increase in serum creatinine level of ≥0.3 mg/dL or ≥1.5-fold from baseline or dialysis initiation) at 6 months after TAVR and the incidence of all-cause death and heart failure readmission during follow-up were investigated. Results: Half of the examined patients [n=71/142 (50.0%)] had a high ACR. Patients with a high ACR more frequently had WRF at 6 months than those with a low ACR (17.6% vs. 2.9%, p=0.004). Multivariate analysis showed a high ACR was independently associated with WRF (odds ratio, 7.76; 95% confidence interval, 1.62–37.30; p=0.01), whereas baseline estimated glomerular filtration rate <60 mL/min/1.73m² was not (odds ratio, 0.34; 95% confidence interval, 0.08–1.50; p=0.15). Patients with a high ACR had a higher risk of composite outcomes of all-cause death and heart failure readmission (p=0.002). Conclusions: Preoperative albuminuria (ACR ≥30 mg/g) was independently associated with WRF at 6 months after TAVR. Furthermore, patients with an ACR ≥30 mg/g had higher risks of all-cause death and heart failure readmission than those with an ACR <30 mg/g.

DOI： 10.1016/j.jjcc.2021.11.014

Riku Shuro, Suzuki Susumu, Yokoi Tsuyoshi, Sakaguchi Teruhiro, Yamamoto Toshihiko, Jinno Yasushi, Tanaka Akihito, Ishii Hideki, Inden Yasuya, Murohara Toyoaki

NAGOYA JOURNAL OF MEDICAL SCIENCE 84 巻 ( 2 ) 頁： 352 - 365 2022年5月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

Few studies have reported the long-term outcomes (>10 years) following first-generation drug-eluting stent implantation. In this single-center retrospective study, we investigated the very long-term clinical outcomes after first-generation sirolimus-eluting stent (SES) implantation in patients with complex lesions. The study included 383 consecutive patients who underwent initial SES implantation between July 2004 and January 2006; 84 and 299 of these patients reported a history of percutaneous coronary intervention (PCI) for complex and noncomplex lesions, respectively. Complex PCI was defined as having at least one of the following features: left main trunk PCI, implantation of ≥3 stents, bifurcation lesions with implantation of 2 stents, total stent length >60 mm, or chronic total occlusion. The target lesion revascularization (TLR) rate was significantly higher in the complex PCI than in the noncomplex PCI group (29.4% vs 13.0%, P=0.001), and we observed a significant intergroup difference in the late TLR (>1 year) rates (21.6% vs 9.5%, P=0.008). Late TLR continued over 10 years at a rate of 2.4%/year in the complex PCI and 1.1%/year in the noncomplex PCI group. Cox regression analysis revealed that complex PCI was related to TLR both over 10 years (hazard ratio 2.29, P=0.003) and beyond 1 year (hazard ratio 2.32, P=0.01). Cardiac death was more common in the complex PCI than in the noncomplex PCI group, particularly 4 years after PCI (15.8% vs 7.5%, P=0.031). Sudden death was the major cause of cardiac death beyond 4 years in the complex PCI group. These data indicate that long-term careful follow-up is essential for patients implanted with SES, especially those treated for complex lesions.

DOI： 10.18999/nagjms.84.2.352