Faculty Profiles - TANAKA Akihito

Computed tomography imaging using split-bolus contrast injection with volume scan of aortic root and heart for preoperative evaluation of transcatheter aortic valve implantation Reviewed

Albuminuria predicts short-term worsening renal function after transcatheter aortic valve replacement Reviewed International journal

Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Yoshinori Shirai, Satoshi Otsuka, Toshikuni Yamamoto, Masayoshi Tokoro, Kenji Furusawa, Hideki Ishii, Akihiko Usui, Toyoaki Murohara

Cardiovascular Revascularization Medicine Vol. 42 page： 178 - 181 2022.3

Assessment of appropriate body mass index cut-off points for long-term mortality among ST-elevation myocardial infarction survivors in Asian population using machine learning algorithm Reviewed International journal

Naoki Yoshioka, Kensuke Takagi, Akihito Tanaka, Yasuhiro Morita, Ruka Yoshida, Hiroaki Nagai, Yasunori Kanzaki, Naoki Watanabe, Ryota Yamauchi, Shotaro Komeyama, Hiroki Sugiyama, Kazuki Shimojo, Takuro Imaoka, Gaku Sakamoto, Takuma Ohi, Hiroki Goto, Hideki Ishii, Itsuro Morishima, Toyoaki Murohara

Heart and Vessels Vol. 37 ( 2 ) page： 219 - 228 2022.2

Koyanagi Hitomi, Tsutsumi Yoshinori, Tokuda Yoshiyuki, Tanaka Akihito, Endo Maki, Furukawa Yasushi, Abe Shinji

HEART AND VESSELS Vol. 37 ( 1 ) page： 132 - 141 2022.1

Language：English Publisher：Heart and Vessels

The purpose of this study was to investigate using split-bolus contrast injection (SPBI) with volume scanning of the heart and aortic root with helical scanning of the access route, compared to single bolus contrast injection (SI) with variable helical pitch scanning (VHP) of the heart and aortic root and access route in a preoperative evaluation before transcatheter aortic valve implantation (TAVI). Thirty-five patients who underwent preoperative CT before TAVI using SPBI (contrast media: 24.5 mgI /kg/s, injected for 12 s for heart scan and then injected for 8 s for access route) were examined. Electrocardiogram (ECG) gated scans of the heart were performed by volume scan, after a period of time, non-gated helical scans of the aorto-iliac were performed (SPBI method). For comparison, 40 patients who had a single bolus injection (26.5 mg I/kg/s, injected for period of the scan time plus 3 s) and a VHP scan (SI method) before the SPBI method was performed were included in the study. The image qualities of the coronary arteries, aortic root, and access route (aorta-iliac), as well as radiation and iodine doses, were assessed. In visual assessment, image quality of coronary artery was significantly better with the SPBI method (grade; excellent: 57.1% in SPBI vs. 24.3% in SI, p = 0.03). There was no significant difference in image quality of the aortic root by visual assessment. The signal-to-noise (SNR) and contrast-to-noise ratio (CNR) of coronary and aortic root were not significantly different between the two methods. The access route showed significantly higher SNR (45.7 ± 11.5 vs. 34.3 ± 9.8, p < 0.001) and CNR (36.0 ± 9.7 vs. 28.0 ± 8.8, p < 0.001) for the SPBI method. The SPBI method compared to SI method reduced iodine dose by 10% and radiation dose by 45%. Preoperative CT imaging before TAVI using SPBI with volume scan is useful and can reduce iodine and radiation doses.

DOI： 10.1007/s00380-021-01899-8

Transcatheter aortic valve replacement for bicuspid aortic stenosis with a severely calcified raphe using an under-sized SAPIEN 3 valve: Sizing by the circle method and deployment by the pressure-regulated method Reviewed

Clinical Significance of the Left Atrial Appendage Orifice Area Reviewed

Yusuke Miki, Yasuhiro Uchida, Akihito Tanaka, Akihiro Tobe, Keisuke Sakakibara, Takashi Kataoka, Kiyoshi Niwa, Kenji Furusawa, Hitoshi Ichimiya, Junji Watanabe, Masaaki Kanashiro, Hideki Ishii, Satoshi Ichimiya, Toyoaki Murohara

Internal Medicine Vol. 61 ( 12 ) page： 1801 - 1807 2022

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Japanese Society of Internal Medicine

Objective The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA orifice area. Methods A total of 149 patients who underwent TEE without significant valvular disease were studied. The LAA orifice area was measured using three-dimensional TEE. The patients were divided into two groups according to the LAA orifice area (large LAA orifice group, ≥median value, and small LAA orifice group). The clinical characteristics and echocardiographic findings were evaluated. Results The median LAA orifice area among all patients was 4.09 cm2 (interquartile range 2.92-5.40). The large LAA orifice group were older (67.2±10.4 vs. 62.4±15.3 years, p=0.02), more often had hypertension (66.7% vs. 44.6%, p=0.007), and atrial fibrillation (70.7% vs. 39.2%, p<0.001) than the small LAA orifice group. Regarding the TEE findings, the LAA flow velocity was significantly lower (33.7±20.0 vs. 50.2±24.3, p<0.001) and spontaneous echo contrast was more often observed (21.3% vs. 8.1%, p=0.02) in the large LAA orifice group. Multivariate models demonstrated that atrial fibrillation was an independent predictor of the LAA orifice area. In the analysis of atrial fibrillation duration, the LAA orifice area tended to be larger as patients had a longer duration of atrial fibrillation. Conclusion Our findings indicated that a larger LAA orifice area was associated with the presence of atrial fibrillation and high thromboembolic risk based on TEE findings. A continuation of the atrial fibrillation rhythm might lead to the gradual expansion of the LAA orifice.

DOI： 10.2169/internalmedicine.8301-21

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

Cardiovascular Revascularization Medicine 2022

Language：English Publisher：Cardiovascular Revascularization Medicine

Transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve stenosis is challenging, and the absence of established methods for sizing the bicuspid aortic valve (BAV) complicates TAVR. We report a case of successful TAVR for bicuspid aortic stenosis with a severely calcified raphe. We used an undersized SAPIEN 3 valve, with three safety measures based on assessment of structural characteristics, sizing by the circle method, and deployment of the valve by the pressure-regulated method.

DOI： 10.1016/j.carrev.2022.08.025

Spontaneous dissection of left internal mammary artery graft: A case report and literature review Reviewed

Riku S., Suzuki S., Tanaka A., Murohara T.

Cardiovascular Revascularization Medicine 2022

Authorship：Corresponding author Language：English Publisher：Cardiovascular Revascularization Medicine

Spontaneous left internal mammary artery (LIMA) graft dissection is a rare condition, and clinical findings remain to be elucidated. We report a case of LIMA graft dissection diagnosed by a coronary computed tomography and intravascular ultrasound. The patient was successfully treated with percutaneous intervention. We also conducted a literature review of published cases and summarized the clinical presentation, pathophysiology, diagnosis, and treatment.

DOI： 10.1016/j.carrev.2022.04.007

Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention Reviewed

Tobe Akihiro, Tanaka Akihito, Furusawa Kenji, Shirai Yoshinori, Funakubo Hiroshi, Otsuka Satoshi, Kubota Yoshiaki, Kunieda Takeshige, Yoshioka Naoki, Sato Sara, Kudo Nobutaka, Ishii Hideki, Murohara Toyoaki

Journal of Atherosclerosis and Thrombosis Vol. advpub ( 0 ) 2022

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Atherosclerosis Society

Aim: The relationship between carotid artery ultrasound findings and clinical outcomes in patients who undergo percutaneous coronary intervention (PCI) has not been completely elucidated. Methods: This single-center retrospective study investigated 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥ 1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥ 1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular (CV) death, myocardial infarction, and ischemic stroke. Results: Among 691 patients, 309 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.01–2.90; p=0.046). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE, but both were not independently associated with MACE (HR, 1.35; 95% CI, 0.69–2.64, p=0.38 and HR, 0.98; 95% CI, 0.57–1.69; p=0.95, respectively). Conclusion: The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future CV events. These patients may require more aggressive medical therapy and careful follow-up.

DOI： 10.5551/jat.63622

CiNii Research

Impact of Handgrip Strength on Clinical Outcomes after Percutaneous Coronary Intervention Reviewed

Tobe Akihiro, Tanaka Akihito, Shirai Yoshinori, Kubota Yoshiaki, Kunieda Takeshige, Sato Sara, Furusawa Kenji, Ishii Hideki, Murohara Toyoaki

Journal of Atherosclerosis and Thrombosis Vol. advpub ( 0 ) 2022

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Atherosclerosis Society

Aim: The relationship between handgrip strength (HGS) and clinical outcomes after percutaneous coronary intervention (PCI) has not yet been thoroughly investigated. Methods: This was a single-center, observational study. A total of 469 patients who underwent PCI and whose periprocedural HGS was measured were included. Patients were divided into two groups: the low HGS group (men, ＜28 kg; women, ＜18 kg) and the high HGS group (men, ≥ 28 kg; women, ≥ 18 kg). The primary outcome was the composite endpoint of all-cause death, myocardial infarction (MI), and heart failure readmission. Results: There were 151 patients in the low HGS group and 318 patients in the high HGS group. The age of patients in the low HGS group was significantly higher (median [interquartile range]: 78 [71–82] vs. 70 [61–75] years, p＜0.001), while the body mass index and serum albumin level were significantly lower (body mass index: 22.5 [20.2–24.3] vs. 24.3 [22.3–26.6] kg/m2, p＜0.001; serum albumin: 3.6 [3.1–3.9] vs. 4.0 [3.7–4.3] g/dL, p＜ 0.001)than those in the high HGS group. During the median follow-up period of 778 days, the low HGS group had a higher incidence of composite endpoint than the high HGS group (p＜0.001). The low HGS group had a higher risk of all-cause, cardiac, and non-cardiac death (p＜0.001). Multivariable Cox proportional hazards analysis showed that low handgrip strength was an independent predictor for the composite endpoint (hazard ratio 1.80, 95% confidence interval 1.04–3.12, p=0.04). Conclusions: Low HGS was independently associated with adverse outcomes after PCI.

DOI： 10.5551/jat.63854

Prevalence of acute coronary syndrome during the pandemic of COVID-19 in the Tokai Region of Japan Reviewed

CiNii Research

Kudo Nobutaka, Tanaka Akihito, Ishii Hideki, Uemura Yusuke, Takagi Kensuke, Iwama Makoto, Yoshida Ruka, Ohashi Taiki, Kawai Hideki, Negishi Yosuke, Umemoto Norio, Tanaka Miho, Watarai Masato, Yoshioka Naoki, Morishima Itsuro, Noda Toshiyuki, Yoshida Yukihiko, Tatami Yosuke, Muramatsu Takashi, Tanaka Toshikazu, Tashiro Hiroshi, Takada Yasunobu, Izawa Hideo, Watanabe Eiichi, Murohara Toyoaki

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 4 ) page： 697 - 703 2021.11

Language：English Publisher：Nagoya Journal of Medical Science

The outbreak of coronavirus disease 19 (COVID-19) has had a great impact on medical care. During the COVID-19 pandemic, the rate of hospital admissions has been lower and the rate of in-hospital mortality has been higher in patients with acute coronary syndrome (ACS) in Western countries. However, in Japan, it is unknown whether the COVID-19 pandemic has affected the incidence of ACS. In the study, eleven hospitals in the Tokai region participated. Among enrolled hospital, we compared the incidence of ACS during the COVID-19 pandemic (April and May, 2020) with that in equivalent months in the preceding year as the control. During the study period; April and May 2020, 248 patients with ACS were admitted. Compared to April and May 2019, a decline of 8.1% [95% confidence interval (CI) 5.2–12.1; P = 0.33] in admissions for ACS was observed between April and May 2020. There was no significant difference in the strategy for revascularization and in-hospital deaths between 2019 and 2020. In conclusion, the rate of admission for ACS slightly decreased during the COVID-19 pandemic, compared to the same months in the preceding year. Moreover, degeneration of therapeutic procedures for ACS did not occur.

DOI： 10.18999/nagjms.83.4.697

Clinical Outcomes Following Emergent Percutaneous Coronary Intervention for Acute Total/Subtotal Occlusion of the Left Main Coronary Artery Reviewed

Naoki Shibata, Norio Umemoto, Akihito Tanaka, Kensuke Takagi, Makoto Iwama, Yusuke Uemura, Yosuke Inoue, Yosuke Negishi, Taiki Ohashi, Miho Tanaka, Ruka Yoshida, Kiyokazu Shimizu, Hiroshi Tashiro, Naoki Yoshioka, Itsuro Morishima, Toshiyuki Noda, Masato Watarai, Hiroshi Asano, Toshikazu Tanaka, Yosuke Tatami, Yasunobu Takada, Hideki Ishii, Toyoaki Murohara

Circulation Journal Vol. 85 ( 10 ) page： 1789 - 1796 2021.9

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

Background:Data regarding the clinical features, outcomes and prognostic factors in patients presenting with acute total/subtotal occlusion of the unprotected left main coronary artery (LMCA) remain limited.Methods and Results:From a multi-center registry, 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. Emergency room (ER) status classification was defined according to the presence of cardiogenic shock and cardiopulmonary arrest (CPA) in the ER (class 1=no cardiogenic shock; class 2= cardiogenic shock but not CPA; and class 3=CPA). In-hospital mortality and cerebral performance category (CPC) as the endpoints were evaluated. One-half (67/134) of the enrolled patients presented with total occlusion of the unprotected LMCA. Regarding ER status classification, class 1, 2, and 3 were observed in 30.6%, 45.5%, and 23.9% of the patients, respectively. In-hospital mortality occurred in 73 (54.5%) patients; of the remaining patients, 52 (85.3%) could be discharged with a CPC 1 or 2. ER status classification (odds ratio 4.4 [95% confidence interval: 2.33–10.67]; P<0.001) and total occlusion of the unprotected LMCA (odds ratio 8.29 [95% confidence interval 2.93–23.46]; P<0.001) were strong predictors of in-hospital mortality.Conclusions:Acute total/subtotal occlusion involving the unprotected LMCA appeared to be associated with high in-hospital mortality. ER status classification and initial flow in the unprotected LMCA were significant predictive factors of in-hospital mortality.

DOI： 10.1253/circj.cj-20-0545

In-hospital mortality among consecutive patients with ST-Elevation myocardial infarction in modern primary percutaneous intervention era ~ Insights from 15-year data of single-center hospital-based registry ~ Reviewed International journal

Kensuke Takagi, Akihito Tanaka, Naoki Yoshioka, Yasuhiro Morita, Ruka Yoshida, Yasunori Kanzaki, Naoki Watanabe, Ryota Yamauchi, Shotaro Komeyama, Hiroki Sugiyama, Kazuki Shimojo, Takuro Imaoka, Gaku Sakamoto, Takuma Ohi, Hiroki Goto, Hideki Ishii, Itsuro Morishima, Toyoaki Murohara

PLOS ONE Vol. 16 ( 6 ) page： e0252503 - e0252503 2021.6

Language：English Publishing type：Research paper (scientific journal) Publisher：Public Library of Science (PLoS)

Objective

To clarify the association of detailed angiographic findings with in-hospital outcome after primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) in Japan.

Background

Data regarding the association of detailed angiographic findings with in-hospital outcome after STEMI are limited in the p-PCI era.

Methods

Between January-2004 and December-2018, 1735 patients with STEMI (mean age, 68.5 years; female, 24.6%) who presented to the hospital in the 24-hours after symptom onset and underwent p-PCI were evaluated using the disease registries. The registry is an ongoing, retrospective, single-center hospital-based registry.

Results

The 30-day mortality rate and in-hospital mortality rate were 7.7% and 9.2%, respectively. Independent predictors of in-hospital mortality were ejection fraction (EF) < 40% [adjusted Odds Ratio (aOR), 4.446, p < 0.001], culprit lesions in the left coronary artery (LCA) (aOR, 2.940, p < 0.001) compared with those in the right coronary artery, Killip class > II (aOR, 7.438; p < 0.001), chronic kidney disease (CKD) (aOR, 4.056; p < 0.001), final thrombolysis in myocardial infarction (TIMI) grades 0/1/2 (aOR, 1.809; p = 0.03), absence of robust collaterals (aOR, 17.309; p = 0.01) and hypertension (aOR, 0.449; p = 0.01).

Conclusions

Among the consecutive patients with STEMI, the in-hospital mortality rate after p-PCI significantly improved in the second half. Not only CKD, Killip class > II, and EF < 40%, but also the angiographic findings such as culprit lesions in the LCA, absence of very robust collaterals, and final TIMI grades <3 were associated with an increased risk of in-hospital mortality.

DOI： 10.1371/journal.pone.0252503

Clinical characteristics and treatment of Spontaneous Coronary Artery Dissection in Young Women Undergoing Percutaneous Coronary Intervention Reviewed

Yosuke Inoue, Akihito Tanaka, Hiroshi Asano, Yusuke Uemura, Kensuke Takagi, Taiki Ohashi, Miho Tanaka, Norio Umemoto, Masayoshi Ajioka, Hiroshi Tashiro, Masato Watarai, Itsuro Morishima, Yosuke Tatami, Yasunobu Takada, Kiyokazu Shimizu, Hideki Ishii, Toyoaki Murohara

Journal of Cardiovascular Medicine Vol. 22 ( 1 ) page： 14 - 19 2021.1

Association between discharge destination and mid-term mortality in octogenarian patients with ST-elevation myocardial infarction Reviewed International journal

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

Journal of Cardiology Vol. 77 ( 2 ) page： 116 - 123 2021

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement Reviewed

Nishi Toshihiko, Tokuda Yoshiyuki, Tanaka Akihito, Furusawa Kenji, Miki Yusuke, Tobe Akihiro, Murohara Toyoaki, Usui Akihiko

Circulation Reports Vol. 2 ( 11 ) page： 701 - 702 2020.11

Clinical outcomes following percutaneous coronary intervention for bifurcation lesions: kissing balloon inflation vs. sequential dilation Reviewed

Hitora, Y., Teraoka, T., Tanaka, A., Uemura, Y., Tobe, A., Sakakibara, K., Miki, Y., Kataoka, T., Niwa, K., Tashiro, H., Furusawa, K., Takemoto, K., Watarai, M., Kimura, A., Ishii, H., Murohara, T.

Cardiovascular Intervention and Therapeutics Vol. 36 ( 4 ) page： 436 - 443 2020.11

Ablation effect of additional low-speed rotational atherectomy following high-speed rotational atherectomy Reviewed International journal

Ruka Yoshida, Hideki Ishii, Itsuro Morishima, Akihito Tanaka, Takuma Tsuda, Kensuke Takagi, Yasuhiro Morita, Takashi Kataoka, Kiyoshi Niwa, Kenji Furusawa, Naoki Yoshioka, Hideyuki Tsuboi, Toyoaki Murohara

AsiaIntervention Vol. 6 ( 1 ) page： 52 - 55 2020.7

Coronary Drug-Eluting Stent Infection Complicated by Coronary Artery Aneurysm and Purulent Pericarditis: Complete Resolution Without Surgery Reviewed

Riku, S., Suzuki, S., Jinno, Y., Tanaka, A., Ishii, H., Murohara, T.

Canadian Journal of Cardiology Vol. 36 ( 6 ) page： 967.e1 - 967.e3 2020.6

Comparison of Anti-factor Xa Activity Among Three Different Factor Xa Inhibitors in Non-valvular Atrial Fibrillation Patients with Renal Impairment Reviewed

Tobe, A., Osanai, H., Tanaka, A., Sakaguchi, T., Kambara, T., Nakashima, Y., Asano, H., Ishii, H., Ajioka, M., Murohara, T.

Clinical Drug Investigation Vol. 40 ( 6 ) page： 567 - 573 2020.6

Heparin 'flush' induced thrombocytopenia triggered by total hip replacement: a case report

Yoshida Ruka, Tanaka Akihito, Yoshioka Naoki, Yokote Jun

EUROPEAN HEART JOURNAL-CASE REPORTS Vol. 4 ( 2 ) page： 1 - 5 2020.6

Language：Japanese Publisher：European Heart Journal - Case Reports

Background Heparin-induced thrombocytopenia (HIT) typically responds to heparin termination. Some types of HIT can persist after heparin discontinuation. Case summary A 95-year-old woman was referred to the cardiology from orthopaedics because of acute limb ischaemia (ALI) 1 day after surgery of a femoral neck fracture. Despite thrombectomy, ALI relapsed the next day. She had been treated with intravenous antibiotics with a diagnosis of aspiration pneumonia for 1 week until 3 days before surgery, together with heparin flush twice a day. Of note, no intra-/post-operative heparin was administered, no cell salvage device, central venous, nor arterial catheters were used before development of ALI. The patient and her family refused reattempting invasive therapies; consequently, the patient continued to worsen and died on post-operative day 3. Diagnosis of autoimmune HIT, which was prompted by surgery without re-exposure to heparin, was confirmed posthumously. Discussion This case emphasizes the significance of suspecting autoimmune HIT in any patient presenting with thrombosis, even if the heparin exposure dates back more than a few days or even without heparin exposure.

DOI： 10.1093/ehjcr/ytaa036