研究者詳細 - 田中　哲人

論文 - 田中　哲人

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Comparison of short and long term clinical outcomes according to status of the false lumen in patients with acute type B aortic dissection

Tanaka A., Sakakibara M., Hayashida R., Jinno Y., Okumura S., Okada K., Murohara T.

EUROPEAN HEART JOURNAL 33 巻頁： 243 - 243 2012年8月

Comparison of early outcomes after primary stenting in Japanese patients with acute myocardial infarction between clopidogrel and ticlopidine in concomitant use with proton-pump inhibitor 査読有り

TANAKA Akihito, SAKAKIBARA Masaki, OKUMURA Satoshi, OKADA Koji, ISHIII Hideki, MUROHARA Toyoaki

Journal of cardiology 60 巻 ( 1 ) 頁： 7 - 11 2012年

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: Recent studies have reported that concomitant use of clopidogrel with proton-pump inhibitors (PPIs) might decrease antiplatelet effects and increase the risk of adverse outcomes after coronary stenting. However, little is known about the difference between clopidogrel and ticlopidine in concomitant use with PPIs, especially within the Asian population. Methods: We retrospectively analyzed 302 consecutive patients (248 males, mean age 66. ± 12 years) undergoing primary stenting for acute myocardial infarction from July 2006 to June 2010. PPIs were administered to 92% (278/302) of the patients. The patients were divided into two groups on the basis of clopidogrel (clopidogrel group, n= 187) or ticlopidine (ticlopidine group, n= 91) with PPI. Their characteristics, medications, and 30-day clinical outcomes were examined. Results: There were no significant differences in 30-day major adverse cardiac events (cardiac death, non-fatal myocardial infarction, and definite stent thrombosis), bleeding events, and stroke between the two groups. The discontinuation of clopidogrel due to side effects was significantly less frequent than that of ticlopidine (1.1% vs 7.7%, p= 0.003, respectively). Conclusion: Our findings suggest that concomitant use of clopidogrel with PPIs might be safer than ticlopidine with PPIs in patients undergoing primary stenting for acute myocardial infarction. © 2012 Japanese College of Cardiology.

DOI： 10.1016/j.jjcc.2012.02.003

Does N-Acetylcysteine Reduce the Incidence of Contrast-Induced Nephropathy and Clinical Events in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction? 査読有り

Tanaka Akihito, Suzuki Yoriyasu, Suzuki Noriyuki, Hirai Toshihisa, Yasuda Nobuyuki, Miki Ken, Fujita Masaya, Tanaka Toshikazu

Internal Medicine 50 巻 ( 7 ) 頁： 673 - 677 2011年

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：The Japanese Society of Internal Medicine

<b>Objectives</b> We examined oral N-acetylcysteine effects on contrast-induced nephropathy (CIN) and clinical events in patients undergoing primary angioplasty for acute myocardial infarction.<br> <b>Background</b> Recent studies have reported that N-acetylcysteine reduces CIN and improves the clinical outcome in patients undergoing primary angioplasty. However, additional investigations are warranted to further support these findings.<br> <b>Methods</b> We randomly assigned 76 patients undergoing primary angioplasty into two groups: 38 patients were assigned to N-acetylcysteine (NAC, 705 mg orally administration before and 12, 24, 36 hours after primary angioplasty), and 38 patients to placebo. CIN was defined as an increase in the serum creatinine concentration of 25 percent or more from baseline value within the 72-hour period after primary angioplasty.<br> <b>Results</b> CIN occurred in 7 patients (9.2%). In the NAC group, the incidence of CIN tended to be lower than in the placebo group (NAC; 2/38; 5.3% vs. Placebo; 5/38; 13.2%, p=0.21). The composite endpoints such as death, acute renal failure requiring temporary renal replacement therapy, or need for mechanical ventilation did not occur in either group.<br> <b>Conclusion</b> While N-acetylcysteine might have the possibility to reduce the incidence of contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction, the in-hospital mortality and morbidity were not significantly different between the two groups.<br>

DOI： 10.2169/internalmedicine.50.4226

Percutaneous coronary intervention with a virtual 2-Fr system. 査読有り

Tanaka A, Saito S

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 76 巻 ( 5 ) 頁： 684 - 6 2010年

Ability of dynamic chest radiography to identify left ventricular systolic dysfunction in heart failure 国際誌

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

International Journal of Cardiovascular Imaging 2025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：International Journal of Cardiovascular Imaging

Dynamic chest radiography (DCR) can estimate haemodynamic parameters in heart failure (HF). However, no studies have evaluated its ability to determine cardiac systolic function in HF. This experimental study investigates the correlation between left ventricular (LV) ejection fraction (LVEF) and DCR image parameters in HF. Ninety-one patients with acute HF (median age, 58 years; males, 75%) (cardiologist diagnosis using the Framingham criteria) underwent DCR and transthoracic echocardiography after treatment for the uncompensated phase of HF. The LV apex pixel value (PV) change was measured by DCR. Correlations between the PV change and LVEF, as well as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DCR, were evaluated. LVEF and LV apex PV change were correlated in all patients (R = 0.428, P < 0.001) and in patients with LVEF < 50% (n = 38; R = 0.355, P = 0.029), < 40% (n = 31; R = 0.343, P = 0.059), and < 30% (n = 23; R = 0.321, P = 0.135). There was no significant correlation for patients with LVEF ≥ 50% (n = 53; R = − 0.004, P = 0.980). The LV apex PV change rate cutoff values for identifying LVEF < 50%, < 40%, and < 30% were 9.3% (AUC: 0.761, sensitivity: 0.698, specificity: 0.789, P < 0.001), 5.5% (AUC: 0.765, sensitivity: 0.883, specificity: 0.645, P < 0.001), and 5.5% (AUC: 0.767, sensitivity: 0.838, specificity: 0.696, P < 0.001), respectively. DCR may be useful to identify LV systolic dysfunction based on LVEF in acute HF.

DOI： 10.1007/s10554-025-03332-x

The Influence of Eicosapentaenoic Acid to Arachidonic Acid Ratio on Long-term Cardiovascular Events Following Percutaneous Coronary Intervention 査読有り

Niwa Kiyoshi, Tanaka Akihito, Funakubo Hiroshi, Otsuka Satoshi, Yoshioka Naoki, Kudo Nobutaka, Tobe Akihiro, Sakakibara Keisuke, Miki Yusuke, Kataoka Takashi, Furusawa Kenji, Ishii Hideki, Murohara Toyoaki

Japanese Journal of Medicine 60 巻 ( 24 ) 頁： 3865 - 3871 2021年12月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本内科学会

Objective The relationship between cardiovascular disease and the serum polyunsaturated fatty acid parameters has been reported. The aim of the present study was to investigate the association between the eicosapentaenoic acid and arachidonic acid (EPA/AA) ratio and long-term cardiovascular events in patients with coronary artery disease. Methods We identified a total of 831 patients who underwent percutaneous coronary intervention and whose EPA/AA ratio was available. The patients were divided into two groups according to their serum EPA/ AA ratio (median, 0.29; interquartile range 0.19-0.47): those in the lower quartile of EPA/AA ratios (Low EPA/AA group; n=231) and all other subjects (High EPA/AA group; n=600). The primary endpoints included a composite of cardiovascular death, myocardial infarction, and ischemic stroke. Results Patients in the Low EPA/AA group were significantly younger (66.0±12.6 years vs. 69.9±9.3 years, p<0.001), current smokers (33.3% vs. 22.7%, p=0.002), and had a history of myocardial infarction (20.3% vs. 12.3%, p=0.003). During the follow-up (median, 1,206 days; interquartile range, 654-1,910 days), the occurrence of the primary endpoint was significantly higher in the Low EPA/AA group than in the High EPA/ AA group. Of note, the rate of cardiovascular death was significantly higher in the Low EPA/AA group, and the rates of myocardial infarction and stroke tended to be higher. Conclusion A low EPA/AA ratio was associated with long-term adverse cardiovascular events in Japanese patients with coronary artery disease.

DOI： 10.2169/internalmedicine.7336-21

Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients 査読有り

Tobe Akihiro, Tanaka Akihito, Tokuda Yoshiyuki, Miki Yusuke, Furusawa Kenji, Akita Sho, Fujii Taro, Tsutsumi Yoshinori, Ishii Hideki, Iwano Shingo, Naganawa Shinji, Usui Akihiko, Murohara Toyoaki

HEART AND VESSELS 36 巻 ( 12 ) 頁： 1911 - 1922 2021年12月

担当区分：責任著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Heart and Vessels

Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19–40) days vs. 27 (19–43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223–805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

DOI： 10.1007/s00380-021-01875-2

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review 査読有り

Tobe Akihiro, Tanaka Akihito, Yoshida Satoya, Kondo Toru, Morimoto Ryota, Furusawa Kenji, Okumura Takahiro, Bando Yasuko K., Ishii Hideki, Murohara Toyoaki

Japanese Journal of Medicine 60 巻 ( 18 ) 頁： 2979 - 2984 2021年9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：一般社団法人日本内科学会

High-output heart failure caused by a tumor-related arteriovenous fistula in adults is a rare clinical condition. We herein report a case of high-output heart failure caused by an arteriovenous fistula associated with renal cell carcinoma and a literature review of 29 published cases to date. Renal cell carcinoma seems to be the most common underlying tumor. For the diagnosis, right heart catheterization and enhanced computed tomography (CT) are considered useful. The removal of the underlying tumor and arteriovenous fistula is the best treatment for heart failure.

DOI： 10.2169/internalmedicine.6962-20

Improvement in the nutritional status after transcatheter aortic valve implantation 査読有り

Tobe Akihiro, Tanaka Akihito, Tokuda Yoshiyuki, Akita Sho, Miki Yusuke, Furusawa Kenji, Ishii Hideki, Usui Akihiko, Murohara Toyoaki

JOURNAL OF CARDIOLOGY 78 巻 ( 3 ) 頁： 250 - 254 2021年9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: A poor nutritional status of patients before transcatheter aortic valve implantation (TAVI) has been reported to be associated with poor clinical outcomes. However, changes in the nutritional status following TAVI have not been fully elucidated. Methods: In this single-center retrospective observational study, 129 patients whose nutritional status at baseline and 6 months after TAVI were available were investigated. The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) were used to assess the nutritional status of the patients at baseline and at 6 months. We further assessed changes in the nutritional status of patients in the subgroups stratified according to the baseline levels as low and high. Results: The PNI and GNRI values at 6 months were significantly better than at baseline [PNI, baseline: 44.5 (41.0–48.0), 6 months: 46.0 (41.9–48.3), p = 0.02; GNRI, baseline: 95.3 (89.0–100.3), 6 months: 97.8 (91.5–101.4), p = 0.006]. Both PNI and GNRI values at 6 months were significantly better in the patients with a low baseline nutritional status, while no significant change was observed in those with high baseline levels [PNI, low; baseline: 36.8 (36.1–39.4), 6 months: 40.8 (39.0–43.4), p = 0.002, high; baseline: 47.0 (43.0–49.5), 6 months: 46.5 (43.5–50.5), p = 0.44 and GNRI, low; baseline: 86.4 (81.7–88.7), 6 months: 88.6 (83.4–95.3), p = 0.001, high; baseline: 99.8 (95.3–102.8), 6 months: 100.7 (96.8–103.4), p = 0.34]. Conclusion: Nutritional status of patients might improve during the chronic phase after TAVI, especially in those with poor baseline levels.

DOI： 10.1016/j.jjcc.2021.04.006

Worsening renal function after transcatheter aortic valve replacement and surgical aortic valve replacement 査読有り

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

HEART AND VESSELS 36 巻 ( 7 ) 頁： 1080 - 1087 2021年7月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Heart and Vessels

Several prior reports have investigated worsening renal function around transcatheter aortic valve replacement (TAVR) procedures. However, in clinical practice, it seems more important to evaluate changes associated with TAVR-related procedures, including preoperative enhanced computed tomography (CT), as well as the TAVR procedure itself, as CT assessment is considered essential for safe TAVR. This study evaluated worsening renal function during the TAVR perioperative period, from the preoperative enhanced CT to 1 month after TAVR, and then compared the incidence with that in patients undergoing surgical aortic valve replacement (SAVR). This retrospective single-center study investigated 123 TAVR patients and 130 SAVR patients. We evaluated baseline renal function before enhanced CT in TAVR patients and before operation in SAVR patients, and again at 1 month post-operatively. We defined worsening renal function at 1 month according to three definitions: (1) an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline or initiation of dialysis, (2) a decline in eGFR at 1 month ≥ 20% from baseline or initiation of dialysis, (3) a decline in eGFR at 1 month ≥ 30% from baseline or initiation of dialysis. TAVR patients were significantly older and had higher surgical risk scores than SAVR patients. In TAVR patients, serum creatinine levels were 1.00 ± 0.32 mg/dL at baseline and 1.01 ± 0.40 mg/dL at 1 month post-operatively (p = 0.58), while in SAVR patients, these levels were 0.99 ± 0.51 mg/dL and 0.98 ± 0.49 mg/dL, respectively (p = 0.59). In TAVR patients, 7 (5.7%), 14 (11.4%), and 3 (2.4%) patients experienced worsening renal function according to the three definitions, respectively, but there were no significant differences from those in SAVR patients, for any definition. Worsening renal function after TAVR was uncommon, and the incidence rate was comparable to that in SAVR patients, even though TAVR patients had worse baseline characteristics.

DOI： 10.1007/s00380-021-01778-2

その他リンク： https://link.springer.com/article/10.1007/s00380-021-01778-2/fulltext.html

Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis

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

日本循環器學誌 85 巻 ( 7 ) 頁： 1093 - 1098 2021年6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：一般社団法人日本循環器学会

Background: The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated. Methods and Results: The study group included 64 patients who underwent TAVI for aortic stenosis. Their 12-lead ECGs before and at 2 days and 1, 6 and 12 months after TAVI were analyzed, and ECG-LVH was evaluated using various definitions. Values and prevalence of each ECG-LVH parameter significantly decreased between 1 and 6 months after TAVI. Values of ECG-LVH parameters decreased especially in patients with ECG-LVH at baseline. Conclusions: Regression of ECG-LVH was observed between 1 and 6 months after TAVI.

DOI： 10.1253/circj.cj-21-0354

The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction 査読有り

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

Japanese Journal of Medicine 60 巻 ( 11 ) 頁： 1665 - 1674 2021年6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：一般社団法人日本内科学会

Objective The popularity of primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) has increased over the past decades. Despite improvements in in-hospital mortality rates, it is clinically important to investigate the prognoses after discharge. However, data on the mode of death and prognostic factors are limited. We analyzed these factors in a Japanese cohort in the modern p-PCI era. Methods Between January 2004 and December 2017, a total of 1,222 patients who underwent p-PCI within 24 hours from the onset of STEMI and were alive at discharge (mean age, 67.7 years old; men, 75.5%), were evaluated. The two-year mortality was analyzed using a Cox regression model, and the mode of death was evaluated. Results The rate of mortality at 2 years was 5.7%. Non-cardiac death was more frequent than cardiac death (62.6% vs. 37.4%). A Cox multivariate analysis identified the following as independent predictors of the 2-year mortality: hemoglobin (log-transformed) [adjusted hazard ratio (HR), 0.048; 95% confidence interval (CI), 0.008-0.29; p<0.001], age above 80 years old (adjusted HR, 2.26; 95% CI, 1.30-3.91; p=0.004), Killip class !II (adjusted HR, 1.99; 95% CI, 1.17-3.39; p=0.011), brain natriuretic peptide level (log-transformed) (adjusted HR, 1.47; 95% CI, 1.09-2.01; p=0.013), and body mass index (log-transformed) (adjusted HR, 0.16; 95% CI, 0.030-0.84; p=0.030). Conclusion This study demonstrated that the 2-year mortality was 5.7% in STEMI survivors after p-PCI. Non-cardiac death was more frequent than cardiac death. Compared to well-known clinical variables, angiographic findings did not have a significant influence on the mid-term mortality.

DOI： 10.2169/internalmedicine.6549-20

Ten-Year Mortality in Patients With ST-Elevation Myocardial Infarction 査読有り

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

AMERICAN JOURNAL OF CARDIOLOGY 149 巻頁： 9 - 15 2021年6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

Knowledge of the long-term prognosis (>10 years) and mortality predictors of ST-elevation myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (p-PCI) is scarce. Therefore, this study evaluated the long-term prognosis and determined the predictors of long-term outcomes for STEMI patients after p-PCI. Between January, 2006 and December, 2010, we collected data and analyzed 459 consecutive patients with acute STEMI who underwent p-PCI and were discharged from the hospital (mean age, 66.8 years; male, 75.2%; peak creatine phosphokinase level, 2,292.5 IU/L). The primary endpoint was 10-year all-cause mortality. The cumulative 10-year incidence of all-cause death was 23.8%. The Cox multivariate regression analysis identified age ≥ 65 years (adjusted hazard ratio [aHR], p <0.001), body mass index (aHR, 0.93, p = 0.033), presence of atrial fibrillation (aHR, 1.69, p = 0.038), mineralocorticoid receptor antagonist use (aHR, 1.95, p = 0.008), ejection fraction <40% (aHR, 2.14, p = 0.005), and albumin <3.5 g/dL (aHR, 2.01, p = 0.005) as independent predictors of all-cause mortality. In conclusion, a post-discharge 10-year survival rate of 76.2% was identified for STEMI patients who underwent p-PCI.

DOI： 10.1016/j.amjcard.2021.03.008

待機的経カテーテル大動脈弁置換術後患者の術後在院長期化の要因;術前握力の有用性査読有り

堀将也, 小林聖典, 高木大地, 徳田順之, 田中哲人, 碓氷章彦

心臓リハビリテーション 27 巻 ( 2 ) 頁： 129 - 135 2021年6月

記述言語：日本語出版者・発行元：(NPO)日本心臓リハビリテーション学会

【目的】待機的経カテーテル大動脈弁置換術(TAVI)後患者において、術後在院長期化の要因を検討する。【方法】2016年4月以降TAVI施行例119を対象として検討した。一般リスクに加え術前後に握力、歩行速度、認知機能を評価し、可能な限り術翌日より歩行を行うプロトコールで集中的理学療法を行った。術後在院の長期化を8日以上または転院例と定義し、危険因子を検討した。【結果】在院長期化群(n=51)では非長期化群(n=68)と比し術前握力低下例が多く(オッズ比=3.62、p=0.011)、non-TFアプローチが多く(オッズ比=20.6、p=0.009)、併発症としてのペースメーカー留置(オッズ比=15.9、p=0.010)が多かった。【結語】術前握力低下はTAVI後在院期間の長期化の独立危険因子であった。簡便に測定できる握力を評価に含めた理学療法計画の策定が有用であろう。(著者抄録)

Perioperative D-dimer levels after transcatheter aortic valve replacement: Comparison of patients with and without anticoagulant therapy 査読有り

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

CARDIOLOGY JOURNAL 28 巻 ( 1 ) 頁： 170 - 172 2021年2月

Relationship between epicardial adipose tissue volume and coronary artery spasm 査読有り

Kataoka Takashi, Harada Ken, Tanaka Akihito, Onishi Tomohiro, Matsunaga Shun, Funakubo Hiroshi, Harada Kazuhiro, Nagao Tomoyuki, Shinoda Norihiro, Marui Nobuyuki, Niwa Kiyoshi, Tashiro Hiroshi, Hitora Yusuke, Furusawa Kenji, Ishii Hideki, Amano Tetsuya, Murohara Toyoaki

INTERNATIONAL JOURNAL OF CARDIOLOGY 324 巻頁： 8 - 12 2021年

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Journal of Cardiology

Background: Epicardial adipose tissue (EAT) is considered to play a critical role in vascular endothelial function. Coronary artery spasm has been postulated to be a causal factor in vascular endothelial abnormalities and atherosclerosis. This study aimed to investigate the relationship between coronary artery spasm and EAT volume, total abdominal adipose tissue (AAT) area, and abdominal visceral adipose tissue (AVAT) area. Method: Among patients undergoing coronary computed tomography (CT) to evaluate coronary artery disease, we identified 110 patients who did not have significant coronary artery stenosis and underwent a coronary spasm provocation test with cardiac catheterization. They were divided into two groups according to the results of the spasm provocation test: spasm-positive and spasm-negative. EAT volume, total AAT area, and AVAT area were evaluated using CT images. Results: Seventy-seven patients were included in the spasm-positive group and 33 patients in the spasm-negative group. There were no significant differences in baseline clinical characteristics between the two groups, except for the prevalence of current smoking (48% vs. 27%, p = 0.04). EAT volume was significantly higher in the spasm-positive group (108 ± 38 mL vs. 87 ± 34 mL, p = 0.007), while no significant difference was seen in total AAT area (280 ± 113 cm2 vs. 254 ± 128 cm2, p = 0.32) or AVAT area (112 ± 54 cm2 vs. 98 ± 55 cm2, p = 0.27). Multivariate logistic analysis indicated that EAT volume (per 10 cm3) (odds ratio, 1.198; 95% confidence interval, 1.035–1.388; p = 0.016) was a significant predictor of coronary artery spasm. Conclusion: Our results suggest that EAT has a strong association with coronary artery spasm, while AAT may not.

DOI： 10.1016/j.ijcard.2020.09.074

Serial Images of Aortic Plaque Rupture During Transfemoral Transcatheter Aortic Valve Replacement 査読有り

Tobe Akihiro, Tanaka Akihito, Tokuda Yoshiyuki, Akita Sho, Miki Yusuke, Furusawa Kenji, Ishii Hideki, Usui Akihiko, Murohara Toyoaki

JACC-CARDIOVASCULAR INTERVENTIONS 13 巻 ( 22 ) 頁： E203 - E204 2020年11月

Multimodality imaging evaluation of saphenous vein graft peri-stent contrast staining enlargement 査読有り

Shibata Naoki, Sugiura Tsuyoshi, Tanaka Akihito, Shimizu Kiyokazu

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 36 巻 ( 11 ) 頁： 2105 - 2106 2020年11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：International Journal of Cardiovascular Imaging

A patient with Takayasu arteritis who underwent CABG using a saphenous vein graft (SVG) experienced ventricular fibrillation due to total SVG occlusion. A drug-eluting stent was implanted; however, follow-up CAG demonstrated an advanced expansion of peri-stent contrast staining. Coronary computed tomography angiography revealed contrast media extending around the SVG. An intravascular ultrasound indicated a worsening stent malapposition and a significant positive remodeling.

DOI： 10.1007/s10554-020-01937-y

Impact of skeletal muscle mass on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement 査読有り

Uchida Yasuhiro, Ishii Hideki, Tanaka Akihito, Yonekawa Jun, Satake Akinori, Makino Yuichiro, Suzuki Wataru, Kurobe Masanari, Mizutani Koji, Mizutani Yoshiaki, Fujimoto Masanobu, Ichimiya Hitoshi, Teramoto Chikao, Tamenishi Akinori, Okamoto Hiroshi, Watanabe Junji, Kanashiro Masaaki, Amano Tetsuya, Matsubara Tatsuaki, Ichimiya Satoshi, Murohara Toyoaki

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 36 巻 ( 4 ) 頁： 514 - 522 2020年10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：Cardiovascular Intervention and Therapeutics

Low skeletal muscle mass is one of the components of sarcopenia. However, the prognostic impact of skeletal muscle mass on clinical outcomes in patients after transcatheter aortic valve replacement (TAVR) remains unclear. Therefore, we assessed the impact of skeletal muscle mass on future cardiovascular events in patients undergoing TAVR. We enrolled 71 consecutive patients who underwent TAVR for symptomatic severe aortic stenosis. We applied bilateral psoas muscles as an indicator of skeletal muscle mass. Psoas muscle volumes were measured from the origin of psoas at the level of the lumbar vertebrae to its insertion in the lesser trochanter on three-dimensional computed tomography datasets. Psoas muscle mass index (PMI) was calculated as psoas muscle volume/height2 (cm3/m2). According to the median value of PMIs (79.8 and 60.0 cm3/m2 for men and women), the enrolled patients were divided into two groups. During the follow-up, 11 (31.4%) patients in low PMI group and 4 (11.1%) in high PMI group experienced major adverse cardiovascular events (MACE) defined as a composite of death from any cause, myocardial infarction, heart failure hospitalization, and stroke. The proportion of MACE-free survival was significantly lower in low PMI group (log-rank P = 0.033), mainly due to the difference of hospital readmission for congestive heart failure. On multivariate Cox proportional hazard analysis, PMI remained an independent negative predictor of MACE [hazard ratio 0.95 (95% confidence interval 0.92–0.98, P = 0.002)]. In conclusion, low skeletal muscle mass independently predicted MACE in patients undergoing TAVR.

DOI： 10.1007/s12928-020-00725-8

Rotational Atherectomy for Severely Calci fi ed Lesions in Patients With Left Ventricular Systolic Dysfunction: One-Year Outcomes From a Single-Center Registry Analysis 査読有り

Yoshida Ruka, Ishii Hideki, Morishima Itsuro, Tanaka Akihito, Takagi Kensuke, Yoshioka Naoki, Morita Yasuhiro, Unno Kazumasa, Yoshida Yukihiko, Tsuboi Hideyuki, Murohara Toyoaki

CARDIOVASCULAR REVASCULARIZATION MEDICINE 21 巻 ( 10 ) 頁： 1220 - 1227 2020年10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：Cardiovascular Revascularization Medicine

Background: High-risk percutaneous coronary intervention (PCI) in patients with left ventricular (LV) systolic dysfunction has been proven to induce reverse LV remodeling. However, the impact of high-risk PCI focusing on rotational atherectomy (RA) in patients with severe LV systolic dysfunction has not been completely addressed. Methods: Among 4339 consecutive patients who underwent PCI, 178 patients with 192 lesions were treated with RA. The reduced ejection fraction (EF) group (LVEF ≤35%) included 25 patients, the mid-range EF group (LVEF 36–50%) included 44 patients, and the preserved EF group (LVEF >50%) included 109 patients. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke. Results: The cumulative 1-year incidence of the primary outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). After adjusting for confounding factors, the incidence of the primary outcome in the reduced EF group (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.43–2.37; p = 0.87) and the mid-range EF group (HR, 0.99; 95% CI, 0.47–1.94; p = 0.97) was similar to that in the preserved EF group. LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and −0.7 ± 7.8%, respectively; p < 0.0001). Conclusions: Reduced EF was not associated with increase in the primary outcome in patients undergoing RA. This seemed to result from the improved LV function after PCI. Summary for annotated table of contents: This single center analysis study investigated 1-year composite outcome of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke in patients with severe LV systolic dysfunction undergoing RA compared with that in patients with preserved LV function. The cumulative 1-year incidence of the composite outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and −0.7 ± 7.8%, respectively; p < 0.0001).

DOI： 10.1016/j.carrev.2020.03.033

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