研究者詳細 - 古澤　健司

Relationship between epicardial adipose tissue volume and coronary artery spasm

Kataoka, T; Harada, K; Tanaka, A; Onishi, T; Matsunaga, S; Funakubo, H; Harada, K; Nagao, T; Shinoda, N; Marui, N; Niwa, K; Tashiro, H; Hitora, Y; Furusawa, K; Ishii, H; Amano, T; Murohara, T

INTERNATIONAL JOURNAL OF CARDIOLOGY 324 巻頁： 8 - 12 2021年2月

記述言語：英語出版者・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

A case of reexpansion pulmonary edema and acute pulmonary thromboembolism associated with diffuse large B-cell lymphoma treated with venovenous extracorporeal membrane oxygenation. Open Access

Kazama S, Hiraiwa H, Kimura Y, Ozaki R, Shibata N, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Kondo T, Furusawa K, Morimoto R, Okumura T, Bando YK, Sato T, Shimada K, Kiyoi H, Nakamura G, Yasuda Y, Kasugai D, Ogawa H, Higashi M, Yamamoto T, Jingushi N, Ozaki M, Numaguchi A, Goto Y, Matsuda N, Murohara T

Journal of cardiology cases 23 巻 ( 1 ) 頁： 53 - 56 2021年1月

記述言語：英語出版者・発行元：Journal of Cardiology Cases

A 37-year-old man diagnosed with diffuse large B-cell lymphoma two weeks previously, visited our emergency department with sudden dyspnea. He had a severe respiratory failure with saturated percutaneous oxygen at 80% (room air). Chest radiography showed a large amount of left pleural effusion. After 1000 mL of the effusion was urgently drained, reexpansion pulmonary edema (RPE) occurred. Despite ventilator management, oxygenation did not improve and venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated in the intensive care unit. The next day, contrast-enhanced computed tomography showed a massive thrombus in the right pulmonary artery, at this point the presence of pulmonary thromboembolism (PTE) was revealed. Fortunately, the patient's condition gradually improved with anticoagulant therapy and VV-ECMO support. VV-ECMO was successfully discontinued on day 4, and chemotherapy was initiated on day 8. We speculated the following mechanism in this case: blood flow to the right lung significantly reduced due to acute massive PTE, and blood flow to the left lung correspondingly increased, which could have caused RPE in the left lung. Therefore, our observations suggest that drainage of pleural effusion when contralateral blood flow is impaired due to acute PTE may increase the risk of RPE. <Learning objective: This is a case of reexpansion pulmonary edema (RPE) in the left lung following acute pulmonary thromboembolism (PTE) in the right lung associated with malignant lymphoma, managed by venovenous extracorporeal membrane oxygenation. Contralateral pleural drainage could increase the risk of RPE because contralateral pulmonary blood flow is assumed to increase when PTE obstructs blood flow. Pleural drainage should be performed carefully in patients with malignant tumors because PTE may be hidden.>

DOI： 10.1016/j.jccase.2020.08.013

Perioperative D-dimer levels after transcatheter aortic valve replacement: Comparison of patients with and without anticoagulant therapy Open Access

Tobe, A; Tanaka, A; Tokuda, Y; Nishi, T; Miki, Y; Furusawa, K; Ishii, H; Usui, A; Murohara, T

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

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review Open Access

Tobe, A; Tanaka, A; Yoshida, S; Kondo, T; Morimoto, R; Furusawa, K; Okumura, T; Bando, YK; Ishii, H; Murohara, T

INTERNAL MEDICINE 60 巻 ( 18 ) 頁： 2979 - 2984 2021年

記述言語：英語出版者・発行元：Internal Medicine

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

The Influence of Eicosapentaenoic Acid to Arachidonic Acid Ratio on Long-term Cardiovascular Events Following Percutaneous Coronary Intervention Open Access

Niwa, K; Tanaka, A; Funakubo, H; Otsuka, S; Yoshioka, N; Kudo, N; Tobe, A; Sakakibara, K; Miki, Y; Kataoka, T; Furusawa, K; Ishii, H; Murohara, T

INTERNAL MEDICINE 60 巻 ( 24 ) 頁： 3865 - 3871 2021年

記述言語：英語出版者・発行元：Internal Medicine

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

Serial Images of Aortic Plaque Rupture During Transfemoral Transcatheter Aortic Valve Replacement Open Access

Tobe, A; Tanaka, A; Tokuda, Y; Akita, S; Miki, Y; Furusawa, K; Ishii, H; Usui, A; Murohara, T

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

Efficacy of right ventricular dysfunction estimated by pulmonary artery pulsatility index in stable phased dilated cardiomyopathy

Kuwayama, T; Morimoto, R; Oishi, H; Kato, H; Kimura, Y; Kazama, S; Shibata, N; Arao, Y; Yamaguchi, S; Hiraiwa, H; Kondo, T; Furusawa, K; Okumura, T; Murohara, T

EUROPEAN HEART JOURNAL 41 巻頁： 902 - 902 2020年11月

Associations between spleen volume and exercise capacity in advanced heart failure patients with left ventricular assist device

Hiraiwa, H; Okumura, T; Sawamura, A; Kazama, S; Kimura, Y; Shibata, N; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Kondo, T; Furusawa, K; Morimoto, R; Murohara, T

EUROPEAN HEART JOURNAL 41 巻頁： 1094 - 1094 2020年11月

The prognostic impact of right ventricular dysfunction in patients with septic cardiomyopathy

Hiraiwa, H; Kasugai, D; Okumura, T; Kazama, S; Kimura, Y; Shibata, N; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Kondo, T; Furusawa, K; Morimoto, R; Murohara, T

EUROPEAN HEART JOURNAL 41 巻頁： 1836 - 1836 2020年11月

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement.

Nishi T, Tokuda Y, Tanaka A, Furusawa K, Miki Y, Tobe A, Murohara T, Usui A

Circulation reports 2 巻 ( 11 ) 頁： 701 - 702 2020年10月

Efficacy of Pulmonary Artery Pulsatility Index as a Measure of Right Ventricular Dysfunction in Stable Phase of Dilated Cardiomyopathy Open Access

Kuwayama, T; Morimoto, R; Oishi, H; Kato, H; Kimura, Y; Kazama, S; Shibata, N; Arao, Y; Yamaguchi, S; Hiraiwa, H; Kondo, T; Furusawa, K; Okumura, T; Murohara, T

CIRCULATION JOURNAL 84 巻 ( 9 ) 頁： 1536 - + 2020年9月

記述言語：英語出版者・発行元：Circulation Journal

Background: Right ventricular dysfunction (RVD) in the setting of left ventricular (LV) myocardial damage is a major cause of morbidity and mortality, and the pulmonary artery pulsatility index (PAPi) is a novel hemodynamic index shown to predict RVD in advanced heart failure. However, it is unknown whether PAPi can predict the long-term prognosis of dilated cardiomyopathy (DCM) even in the mild to moderate phase. This study aimed to assess the ability of PAPi to stratify DCM patients without severe symptoms. Methods and Results: Between April 2000 and March 2018, a total of 162 DCM patients with stable symptoms were evaluated, including PAPi, and followed up for a median of 4.91 years. The mean age was 50.9±12.6 years and the mean LV ejection fraction (EF) was 30.5±8.3%. When divided into 2 groups based on median value of PAPi (low, L-PAPi [<3.06] and high, H-PAPi [≥3.06]), even though there were no differences in B-type natriuretic peptide or pulmonary vascular resistance, the probability of cardiac event survival was significantly higher in the L-PAP than in the H-PAP group by Kaplan-Meier analysis (P=0.018). Furthermore, Cox’s proportional hazard regression analysis revealed that PAPi was an independent predictor of cardiac events (hazard ratio: 0.782, P=0.010). Conclusions: Even in patients identified with DCM in the mild to moderate phase, PAPi may help stratify DCM and predict cardiac events.

DOI： 10.1253/circj.CJ-20-0279

Fulminant myocarditis with myositis of ocular and respiratory muscles

Hiraiwa, H; Furusawa, K; Kazama, S; Kimura, Y; Shibata, N; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Kondo, T; Sawamura, A; Morimoto, R; Okumura, T; Murohara, T

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 3 ) 頁： 585 - 593 2020年8月

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

A 46-year-old Japanese woman visited a nearby hospital because of diplopia after flu-like symptoms. One month later, she presented with blepharoptosis and external ophthalmoplegia. Laboratory tests showed a high creatine kinase concentration (3146 U/L). She underwent intravenous immunoglobulin therapy; however, her symptoms did not improve, prompting transfer to our institute. On admission, transthoracic echocardiography revealed 30% of left ventricular ejection fraction and edema of the left ventricular wall. Coronary angiography showed no significant coronary stenosis. An endomyocardial biopsy resulted in a diagnosis of acute myocarditis. On the following day, she needed a temporary pacemaker because she had complete atrioventricular block and intra-aortic balloon pump because of cardiogenic shock. Intravenous immunoglobulin therapy was again administered and her cardiac function gradually recovered. She was successfully weaned off her temporary pacemaker and intra-aortic balloon pump on Day 5 after improvement in her complete atrioventricular block. Steroid therapy administered from Day 9 was effective in reducing her creatine kinase concentrations. However, contrast-enhanced magnetic resonance imaging revealed inflammation of the scalene, semispinalis cervicis, sternocleidomastoid, and intercostal muscles. On Day 25, her cardiac function had recovered to a left ventricular ejection fraction of 59%. Finally, she was successfully discharged on Day 45 after undergoing rehabilitation.

DOI： 10.18999/nagjms.82.3.585

Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Tashiro, H; Tanaka, A; Ishii, H; Motomura, N; Arai, K; Adachi, T; Okajima, T; Iwakawa, N; Kojima, H; Mitsuda, T; Hirayama, K; Hitora, Y; Hayashi, M; Furusawa, K; Yoshida, R; Imai, H; Ogawa, Y; Kawaguchi, K; Murohara, T

HEART AND VESSELS 35 巻 ( 8 ) 頁： 1044 - 1050 2020年8月

記述言語：英語出版者・発行元：Heart and Vessels

Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9 ± 11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed 5 days after the onset of AMI. Reduced exercise capacity was defined as peak VO2 ≤ 12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed. Among 136 patients, reduced exercise capacity (peak VO2 ≤ 12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e’ and larger left atrial dimension. Multivariate logistic analysis showed that E/e’ (OR 1.19, 95% CI 1.09–1.31, p < 0.001) was an independent predictor of reduced exercise capacity (peak VO2 ≤ 12). Median follow-up term was 12 months (IQR 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2 ≤ 12 than those with peak VO2 > 12 (p < 0.001). Reduced exercise capacity following primary PCI in AMI patients is associated with diastolic dysfunction and may lead to poorer clinical outcomes.

DOI： 10.1007/s00380-020-01576-2

Prognostic impact of recanalizing chronic total occlusion in non-infarct related arteries on long-term clinical outcomes in acute myocardial infarction patients undergoing primary percutaneous coronary intervention

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Takagi, K; Yoshioka, N; Kataoka, T; Tashiro, H; Hitora, Y; Niwa, K; Furusawa, K; Morita, Y; Tsuboi, H; Murohara, T

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 35 巻 ( 3 ) 頁： 259 - 268 2020年7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

Although chronic total occlusion (CTO) in non-infarct-related arteries (non-IRAs) negatively affects long-term mortality in patients with acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI), the prognostic impact of successful CTO-PCI has not been completely addressed. Among 1855 consecutive patients with AMI who underwent primary PCI, those who were treated for CTO with either PCI or medical therapy were included. We evaluated the association between recanalization of CTO and long-term cardiac mortality. Of the 172 included patients, 88 underwent CTO-PCI, and the procedures were successful in 65 patients. Thus, the successfully recanalized CTO (SR-CTO) group included 65 patients; and the no recanalized CTO (NR-CTO) group, 107 patients. During the follow-up, 72 patients died, and of whom 56 (77.8%) died because of cardiac causes. The cumulative 10-year, 30-day, and 30-day to 10-year incidences of cardiac mortality were lower in the SR-CTO group than in the NR-CTO group (19.0% vs. 51.9% p = 0.004; 4.6% vs. 14.0%, p = 0.05; 15.0% vs. 44.1%, p = 0.003, respectively). After adjusting for confounding factors, the benefits of SR-CTO for the 10-year cardiac mortality remained significant compared with those of NR-CTO (hazard ratio 0.37; 95% confidence interval 0.17–0.75; p = 0.004). In conclusion, patients with SR-CTO in non-IRAs after AMI was associated with reduced long-term cardiac mortality compared with those with NR-CTO.

DOI： 10.1007/s12928-019-00615-8

Spleen size improvement in advanced heart failure patients using a left ventricular assist device

Hiraiwa, H; Okumura, T; Sawamura, A; Kondo, T; Kazama, S; Kimura, Y; Shibata, N; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Furusawa, K; Morimoto, R; Murohara, T

ARTIFICIAL ORGANS 44 巻 ( 7 ) 頁： 700 - 708 2020年7月

記述言語：英語出版者・発行元：Artificial Organs

The spleen has been recognized as an important organ that holds a reserve of 20% to 30% of the total blood volume. Spleen contraction and splenic volume reduction occur in patients with hypovolemic shock. However, the change in the spleen volume and the association between spleen size and hemodynamic parameters remain unclear in patients with advanced heart failure (HF) who need left ventricular assist device (LVAD) support. This study was performed to investigate the change in spleen size and the relationship between spleen size and hemodynamic parameters before and after LVAD implantation in patients with advanced HF. We enrolled 20 patients with advanced HF on LVAD support. All patients underwent right heart catheterization and computed tomography before and after LVAD implantation. The spleen size was measured by computed tomography volumetry. We excluded patients with a mean right atrial pressure (RAP) of <5 mm Hg because of the possibility of hypovolemia and those with a cardiac index of >2.2 L/min/m2 before LVAD implantation. The splenic volume significantly increased from 160.6 ± 46.9 mL before LVAD implantation to 224.6 ± 73.5 mL after LVAD implantation (P <.001). Before LVAD implantation, there was a significant negative correlation between spleen volume and systemic vascular resistance (SVR). After LVAD implantation, however, there were significant correlations between spleen volume and the cardiac index, RAP, and pulmonary capillary wedge pressure despite the absence of a significant correlation between spleen volume and SVR. Furthermore, one patient developed reworsening HF because of LVAD failure due to pump thrombosis. In this case, the splenic volume was 212 mL before LVAD implantation and increased to 418 mL after LVAD implantation, although it decreased to 227 mL after LVAD failure. The spleen size may change depending on hemodynamics in patients with advanced HF with LVAD support, reflecting sympathetic nerve activity and the systemic volume status.

DOI： 10.1111/aor.13658

Ablation effect of additional low-speed rotational atherectomy following high-speed rotational atherectomy: Low-speed RA following high-speed RA. Open Access

Yoshida R, Ishii H, Morishima I, Tanaka A, Tsuda T, Takagi K, Morita Y, Kataoka T, Niwa K, Furusawa K, Yoshioka N, Tsuboi H, Murohara T

AsiaIntervention 6 巻 ( 1 ) 頁： 52 - 55 2020年7月

Lipid-rich large plaques in a non-culprit left main coronary artery and long-term clinical outcomes

Tashiro, H; Tanaka, A; Ishii, H; Sakakibara, K; Tobe, A; Kataoka, T; Miki, Y; Hitora, Y; Niwa, K; Furusawa, K; Murohara, T

INTERNATIONAL JOURNAL OF CARDIOLOGY 305 巻頁： 5 - 10 2020年4月

記述言語：英語出版者・発行元：International Journal of Cardiology

Background: An integrated backscatter (IB) intravascular ultrasound (IVUS) provides an information about tissue components and vulnerability of coronary plaques. The presence of vulnerable plaque in non-culprit lesion is associated with future clinical events. The purpose of this study was to assess the association between the characteristics of non-culprit left main coronary artery (LMCA) plaques evaluated by IB-IVUS and long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods: Among the patients who underwent non-LMCA PCI, we studied 366 patients with adequate LMCA IVUS images. Conventional and IB-IVUS analyses of the LMCA segment were performed. Lipid-rich large plaque was defined as the presence of both a lager plaque volume and a higher percentage of the lipid component than the obtained median values. Major adverse cardiovascular events (MACE) included cardiac death, myocardial infarction, and unplanned revascularization. Results: The mean age of the patients was 68.5 ± 10.2 years, 79.8% were men. Median follow-up period was 6.0 years (IQR: 4.2–8.1 years). The incidence of MACE was significantly higher in patients with lipid-rich large plaques (P = .006). The incidence rates of cardiac death, myocardial infarction, and unplanned revascularization were significantly higher in patients with lipid-rich large plaques (P = .02, 0.004, and 0.02, respectively). Multivariate Cox regression analysis showed that the presence of a lipid-rich large plaque was significantly associated with MACE (HR: 1.74; 95%CI: 1.17–2.58; P = .006). Conclusion: The presence of lipid-rich large plaques in a non-culprit LMCA can be associated with the long-term MACE in patients who have undergone PCI.

DOI： 10.1016/j.ijcard.2020.01.072

Pathological changes of the myocardium in reworsening of anthracycline-induced cardiomyopathy after explant of a left ventricular assist device

Hiraiwa, H; Okumura, T; Shimizu, S; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Haga, T; Yokoi, T; Kondo, T; Sugiura, Y; Kano, N; Watanabe, N; Fukaya, K; Furusawa, K; Sawamura, A; Morimoto, R; Fujimoto, K; Mutsuga, M; Usui, A; Murohara, T

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 1 ) 頁： 129 - 134 2020年2月

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

We herein report the long-term changes in cardiac function and pathological findings after successful explantation of a left ventricular assist device in a 42-year-old patient with anthracycline-induced cardiomyopathy with reworsening heart failure. Endomyocardial biopsy samples revealed that the cardiomyocyte diameter decreased and collagen volume fraction increased just after left ventricular assist device explantation. The collagen volume fraction decreased after 6 months, despite preserved systolic function. At 5 years after left ventricular assist device explantation, the systolic function markedly decreased and cardiomyocyte diameter increased. Pathological changes of the myocardium may enable the identification of cardiac dysfunction prior to echocardiographic changes in patients with reworsening heart failure after left ventricular assist device explantation.

DOI： 10.18999/nagjms.82.1.129