2022/11/02 更新

写真a

ナカノ ヨシヒサ
中野 嘉久
NAKANO Yoshihisa
所属
大学院医学系研究科 附属医学教育研究支援センター 先端領域支援部門 特任助教
職名
特任助教
連絡先
メールアドレス
外部リンク

学位 1

  1. 大学院医学系研究科博士(医学) ( 2018年10月   名古屋大学 ) 

研究キーワード 3

  1. 肺高血圧症

  2. 肺血栓塞栓症

  3. 疫学研究(心血管疾患)

研究分野 3

  1. ライフサイエンス / 循環器内科学  / 肺高血圧症

  2. ライフサイエンス / 循環器内科学  / 肺血栓塞栓症

  3. ライフサイエンス / 衛生学、公衆衛生学分野:実験系を含まない  / 疫学研究(心血管疾患)

現在の研究課題とSDGs 2

  1. 肺高血圧症

  2. 肺塞栓症

経歴 2

  1. 名古屋大学   肺高血圧先端治療学寄付講座   寄附講座助教

    2019年4月 - 2021年3月

  2. 名古屋大学   大学院医学系研究科 附属医学教育研究支援センター 先端領域支援部門   特任助教

    2022年1月 - 現在

 

論文 28

  1. Right ventricular pressure overload related to residual thrombotic burden in patients 1 year after acute pulmonary embolism: From the Nagoya PE study

    Nakano Yoshihisa, Adachi Shiro, Nishiyama Itsumure, Yasuda Kenichiro, Yoshida Masahiro, Iwano Shingo, Kondo Takahisa, Murohara Toyoaki

    THROMBOSIS RESEARCH   216 巻   頁: 113 - 119   2022年8月

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    記述言語:日本語   出版者・発行元:Thrombosis Research  

    Introduction: Residual pulmonary thrombus is an important factor affecting long-term prognosis after acute pulmonary embolism (PE). In this sub-analysis of the Nagoya PE study, we aimed to evaluate the relationship between residual thrombi detected by our refined computed tomography (CT) imaging protocol and the results of a multifaceted assessment of patients 1 year after acute PE. Materials and methods: The Nagoya PE study was a prospective observational study of patients diagnosed with acute PE. At 1 year, patients were evaluated multifacetedly, including by enhanced CT using our refined protocol. Results and conclusion: Forty-three patients completed full testing at 1 year. Patients were divided into three groups according to the modified CT obstruction index (mCTOI): no pulmonary thrombus, low mCTOI, and high mCTOI. At baseline, left ventricular end-diastolic dimension and tricuspid regurgitation (TR) pressure gradient differed significantly across the three groups. At 1 year, patients with TR velocity > 2.8 m/s were found only in the high mCTOI group (P =.022). No difference was observed in symptoms, exercise tolerance, and quality of life score. Multivariate regression analysis revealed that TR velocity > 2.8 m/s (P =.001) and change in oxygen saturation during a 6-min walking test (P =.043) at 1 year were significantly related to mCTOI at 1 year. High thrombotic burden might be detected in patients with right ventricular pressure overload at diagnosis of acute PE or after 1 year. These patients should be carefully and multifacetedly assessed for potential chronic thromboembolic pulmonary disease or chronic thromboembolic pulmonary hypertension.

    DOI: 10.1016/j.thromres.2022.06.010

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  2. Right Ventricular Dyssynchrony Casts New Light on the Risk Stratification and Prediction of Prognosis in Patients With Pulmonary Hypertension

    Adachi Shiro, Nakano Yoshihisa, Furusawa Kenji

    CIRCULATION JOURNAL   86 巻 ( 6 ) 頁: 945 - 946   2022年6月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    DOI: 10.1253/circj.CJ-22-0145

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  3. Implications of Pulmonary Artery Wave Reflection in Patients With Pulmonary Hypertension

    Nakano Yoshihisa, Adachi Shiro

    CIRCULATION JOURNAL   86 巻 ( 6 ) 頁: 956 - 957   2022年6月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    DOI: 10.1253/circj.CJ-21-0981

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  4. End-Systolic Eccentricity Index Obtained by Enhanced Computed Tomography Is a Predictor of Pulmonary Vascular Resistance in Patients with Chronic Thromboembolic Pulmonary Hypertension

    Tsutsumi Yoshinori, Adachi Shiro, Nakano Yoshihisa, Iwano Shingo, Abe Shinji, Kato Katsuhiko, Naganawa Shinji

    LIFE-BASEL   12 巻 ( 4 )   2022年4月

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    記述言語:日本語   出版者・発行元:Life  

    The usefulness of the parameters of biventricular function simultaneously measured using enhanced multi-detector computed tomography (MDCT) pulmonary angiography in patients with chronic thromboembolic pulmonary hypertension (CTEPH) has not been clarified. This study aimed to verify the correlation between left and right ventricular (RV) parameters and pulmonary vascular resistance (PVR). Patients who underwent enhanced MDCT before diagnostic right heart catheterization at Nagoya University Hospital between October 2014 and April 2021 were enrolled. The correlation of biventricular function and volume parameters with PVR was assessed. Eighty patients were retrospectively analyzed. Patients’ mean age was 65 ± 13 years, mean PVR was 9.1 (range, 6.1–11.3) Wood units, and mean end-systolic eccentricity index (esEI) was 1.76 ± 0.50. RV end-systolic volume (ESV) (p = 0.007), RV cardiac output (CO) (p < 0.001), RV ejection fraction (p < 0.001), LV end-diastolic volume (EDV) (p < 0.001), left ventricular (LV) ESV (p = 0.006), LVCO (p < 0.001), end-diastolic EI (p < 0.001), and esEI (p < 0.001) were significantly correlated with PVR. The LVEDV (p = 0.001) and esEI (p < 0.009) were independent predictors of PVR. Systolic pulmonary arterial pressure (PAP) (p < 0.001), diastolic PAP (p < 0.001), mean PAP (p < 0.001), right atrial pressure (p < 0.023), and PVR (p < 0.001) were significantly higher in the high esEI group than in the low esEI group. The esEI was a simple predictor of CTEPH severity.

    DOI: 10.3390/life12040593

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  5. Inhaled iloprost induces long-term beneficial hemodynamic changes in patients with pulmonary arterial hypertension receiving combination therapy

    Yasuda Kenichiro, Adachi Shiro, Nishiyama Itsumure, Yoshida Masahiro, Nakano Yoshihisa, Murohara Toyoaki

    PULMONARY CIRCULATION   12 巻 ( 2 ) 頁: e12074   2022年4月

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    記述言語:日本語   出版者・発行元:Pulmonary Circulation  

    Inhaled iloprost is an established treatment for pulmonary arterial hypertension (PAH). However, the long-term hemodynamic changes that inhaled iloprost induces are unclear. Here, we retrospectively enrolled 18 patients with PAH who received inhaled iloprost as add-on to oral combination therapy from December 2016 to January 2021 at our institute in Japan. We then examined the changes in hemodynamic parameters induced by iloprost in these patients during right heart catheterization (RHC). To examine the long-term effects of iloprost, we repeated the RHC examination at follow-up (median time to follow-up, 8.5 months). During both catheterization procedures, iloprost was administered by using an I-neb AAD system (Philips NV). In a comparison of pre-inhalation values at the first and follow-up RHCs, inhaled iloprost significantly improved mean pulmonary artery pressure (mPAP; 39.9 ± 7.8 to 32.5 ± 7.2 mmHg, p = 0.016) and pulmonary vascular resistance (PVR; 588.5 ± 191.7 to 464.4 ± 188.5 dyn s cm−5, p = 0.047). During the follow-up RHC, in a comparison of the pre-inhalation and best recorded values out to 30 min after the end of iloprost inhalation, iloprost significantly decreased mPAP (32.5 ± 7.2 to 30.0 ± 6.6 mmHg, p = 0.007) and PVR (457.8 ± 181.4 to 386.2 ± 142.8 dyn s cm−5, p = 0.025) and significantly increased cardiac output (4.19 ± 0.91 to 4.64 ± 1.01 L/min, p = 0.035). Iloprost may have not only acute vasodilation effects but also long-term hemodynamic benefits in PAH patients receiving combination therapy.

    DOI: 10.1002/pul2.12074

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  6. Usefulness of a refined computed tomography imaging method to assess the prevalence of residual pulmonary thrombi in patients 1 year after acute pulmonary embolism: The Nagoya PE study

    Nakano Yoshihisa, Adachi Shiro, Nishiyama Itsumure, Yasuda Kenichiro, Imai Ryo, Yoshida Masahiro, Iwano Shingo, Kondo Takahisa, Murohara Toyoaki

    JOURNAL OF THROMBOSIS AND HAEMOSTASIS   20 巻 ( 4 ) 頁: 888 - 898   2022年4月

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    記述言語:日本語   出版者・発行元:Journal of Thrombosis and Haemostasis  

    Background: Post-pulmonary embolism (PE) syndrome is an important clinical condition that can affect the long-term prognosis after acute PE. Objective: We aimed to evaluate the prevalence of residual pulmonary thrombi and the thrombotic burden 1 year after acute PE, by using our refined computed tomography (CT) imaging method. Patients/Methods: In this prospective study, patients diagnosed with acute PE were recruited and examinations were conducted at 1 month, 6 months, and 1 year. Especially at 1 year, patients were evaluated multifacetedly, including by laboratory tests, quality-of-life, 6-min walking test, and enhanced CT. Results: Fifty-two patients were enrolled. Two patients (3.8%) developed chronic thromboembolic pulmonary hypertension. A total of 43 patients completed evaluation at 1 year, among whom (74%) had residual thrombi, with a median modified CT obstruction index (mCTOI) of 10.7%. In multivariate analysis, residual thrombi at 1 month was the only factor significantly related to residual thrombi at 1 year (odds ratio, 103.4; 95% confidence interval, 4.2–2542.1). The tricuspid regurgitation pressure gradient ≥60 mmHg and left ventricular end-diastolic dimension at diagnosis were significantly related to mCTOI at 1 year (β = 0.367, P =.003; and β = –0.435, P =.001, respectively). Conclusions: Using our improved CT imaging protocol, we found a high prevalence of residual thrombi 1 year after acute PE. Furthermore, right ventricular overload was related to the thrombotic burden. The long-term treatment strategy of acute PE could be modified to include precise CT imaging.

    DOI: 10.1111/jth.15636

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  7. Pulmonary tumor thrombotic microangiopathy with thrombus in pulmonary artery caused by diffuse sclerosing variant of thyroid papillary adenocarcinoma: A case report

    Yoshida Masahiro, Adachi Shiro, Nishiyama Itsumure, Yasuda Kenichiro, Imai Ryo, Nakano Yoshihisa, Tsuyuki Yuta, Kim Deoksu, Kondo Takahisa, Murohara Toyoaki

    PULMONARY CIRCULATION   12 巻 ( 1 ) 頁: e12027   2022年1月

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    記述言語:日本語   出版者・発行元:Pulmonary Circulation  

    Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease associated with malignant tumors that progresses to pulmonary hypertension. Gastric cancer is the most common cause, followed by breast cancer and lung cancer, whereas PTTM due to thyroid cancer has not been reported. In addition to pulmonary obstruction by tumor embolism, tumor cells stimulate endothelial cells to release angiogenetic factors, which induce remodeling of pulmonary arteries and veins and lead to lymphatic obstruction. There is limited information on the relationship between thrombus and PTTM. We herein report an autopsy case with PTTM which was caused by diffuse sclerosing variant of thyroid papillary adenocarcinoma, in which differential diagnosis included the acute phase of chronic thromboembolic pulmonary hypertension.

    DOI: 10.1002/pul2.12027

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  8. Mortality, Recurrent Thromboembolism and Major Bleeding in Cancer-Associated and Non-Cancer Pulmonary Embolism Patients Treated With Direct Oral Anticoagulants.

    Nakano Y, Adachi S, Imai R, Yoshida M, Shimokata S, Murohara T, Kondo T

    Circulation journal : official journal of the Japanese Circulation Society   advpub 巻 ( 0 )   2021年4月

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    記述言語:英語   出版者・発行元:一般社団法人 日本循環器学会  

    DOI: 10.1253/circj.CJ-20-1247

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  9. Endostatin and Vascular Endothelial Growth Factor-A<sub>165</sub>b May Contribute to Classification of Pulmonary Hypertension.

    Adachi S, Kikuchi R, Shimokata S, Suzuki A, Yoshida M, Imai R, Nakano Y, Kondo T, Murohara T

    Circulation reports   3 巻 ( 3 ) 頁: 161 - 169   2021年2月

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    記述言語:英語   出版者・発行元:一般社団法人 日本循環器学会  

    DOI: 10.1253/circrep.CR-20-0096

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  10. Impact of higher detection rate of residual pulmonary thromboemboli one-year after acute pulmonary embolism: modified CT scan imaging method with modified CT obstruction index

    Nakano Y., Okumura N., Imai R., Yoshida M., Shimokata S., Adachi S., Murohara T., Kondo T.

    EUROPEAN HEART JOURNAL   41 巻   頁: 2242 - 2242   2020年11月

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  11. Clinical course of pulmonary embolism patients treated with DOACs: comparing prognosis, recurrent thromboembolism, and major bleeding between patients with and without cancer

    Nakano Y., Imai R., Yoshida M., Shimokata S., Adachi S., Murohara T., Kondo T.

    EUROPEAN HEART JOURNAL   41 巻   頁: 2279 - 2279   2020年11月

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  12. Potential of Selexipag in Chronic Thromboembolic Pulmonary Hypertension Medical Therapy

    Kondo Takahisa, Nakano Yoshihisa, Adachi Shiro

    CIRCULATION JOURNAL   84 巻 ( 10 ) 頁: 1691 - 1692   2020年10月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    DOI: 10.1253/circj.CJ-20-0879

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  13. Single-center prognostic validation of the risk assessment of the 2015 ESC/ERS guidelines in patients with pulmonary arterial hypertension in Japan.

    Imai R, Adachi S, Yoshida M, Shimokata S, Nakano Y, Okumura N, Murohara T, Kondo T

    Canadian journal of physiology and pharmacology   98 巻 ( 9 ) 頁: 653 - 658   2020年9月

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    記述言語:英語   出版者・発行元:Canadian journal of physiology and pharmacology  

    The 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension include a multidimensional risk assessment for patients with pulmonary arterial hypertension (PAH). However, prognostic validations of this risk assessment are limited, especially outside Europe. Here, we validated the risk assessment strategy in PAH patients in our institution in Japan. Eighty consecutive PAH patients who underwent right heart catheterization between November 2006 and December 2018 were analyzed. Patients were classified as low, intermediate, or high risk by using a simplified version of the risk assessment that included seven variables: World Health Organization functional class, 6-min walking distance, peak oxygen consumption, brain natriuretic peptide, right atrial pressure, mixed venous oxygen saturation, and cardiac index. The high-risk group showed significantly higher mortality than the low- or intermediate-risk group at baseline (P < 0.001 for both comparisons), and the mortalities in the intermediate- and low-risk groups were both low (P = 0.989). At follow-up, patients who improved to or maintained a low-risk status showed better survival than those who did not (P = 0.041). Our data suggest that this risk assessment can predict higher mortality risk and long-term survival in PAH patients in Japan.

    DOI: 10.1139/cjpp-2019-0640

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  14. Single-center prognostic validation of the risk assessment of the 2015 ESC/ERS guidelines in patients with pulmonary arterial hypertension in Japan

    Imai Ryo, Adachi Shiro, Yoshida Masahiro, Shimokata Shigetake, Nakano Yoshihisa, Okumura Naoki, Murohara Toyoaki, Kondo Takahisa

    CANADIAN JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY   98 巻 ( 9 ) 頁: 653 - 658   2020年9月

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  15. Risk of Pulmonary Arterial Hypertension During Qing-Dai Use for the Treatment of Ulcerative Colitis

    Adachi Shiro, Nakano Yoshihisa, Kondo Takahisa

    CIRCULATION JOURNAL   84 巻 ( 8 ) 頁: 1235 - 1236   2020年8月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    DOI: 10.1253/circj.CJ-20-0621

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  16. Option of Using Peripherally Inserted Central Catheters in Elderly Patients With Dementia: An Observational Study

    Nakano Yoshihisa, Kondo Takahisa, Murohara Toyoaki, Yamauchi Kazunobu

    GERONTOLOGY AND GERIATRIC MEDICINE   6 巻   頁: 2333721420906922   2020年2月

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  17. Addition of a bilateral access form of peripheral extracorporeal membrane oxygenation rescued a patient with idiopathic pulmonary arterial hypertension who developed circulatory collapse immediately after childbirth

    Adachi Shiro, Shimokata Shigetake, Yoshida Masahiro, Imai Ryo, Nakano Yoshihisa, Okumura Naoki, Suzuki Susumu, Murohara Toyoaki, Kondo Takahisa

    PULMONARY CIRCULATION   10 巻 ( 1 )   2020年1月

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    出版者・発行元:Pulmonary Circulation  

    DOI: 10.1177/2045894020910140

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  18. Effects of Tobacco Smoking on Cardiovascular Disease

    Kondo Takahisa, Nakano Yoshihisa, Adachi Shiro, Murohara Toyoaki

    CIRCULATION JOURNAL   83 巻 ( 10 ) 頁: 1980 - 1985   2019年10月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    Tobacco smoking continues to be a major risk factor for cardiovascular disease (CVD) and the leading avoidable cause of death worldwide. Tobacco smoking has declined in high-income countries, but the average smoking rate in Japan remains high: 29.4% for men and 7.2% for women in 2017. Of note, the average smoking rate among middle-aged men remains approximately 40%, indicating that a high incidence of smoking-related CVD will continue for a couple of decades in Japan. The adverse effects of tobacco smoking on CVD are more extensive than previously thought. Physicians should be particularly alert to the development and progression of heart failure, atrial fibrillation, and venous thromboembolism, as well as ischemic CVD among tobacco smokers. Increasing use of heat-not-burn tobacco as cigarette alternatives is an emerging issue. Harmful effects do not disappear just by changing the delivery system of tobacco.

    DOI: 10.1253/circj.CJ-19-0323

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  19. Medium-term health-related quality of life in patients with pulmonary arterial hypertension treated with goal-oriented sequential combination therapy based on exercise capacity

    Hirashiki Akihiro, Adachi Shiro, Okumura Naoki, Nakano Yoshihisa, Shimokata Shigetake, Shimizu Atsuya, Arai Hidenori, Toba Kenji, Murohara Toyoaki, Kondo Takahisa

    HEALTH AND QUALITY OF LIFE OUTCOMES   17 巻 ( 1 ) 頁: 103   2019年6月

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    記述言語:日本語   出版者・発行元:Health and Quality of Life Outcomes  

    Background: Pulmonary arterial hypertension (PAH) remains a life-threatening condition, despite modern therapies. We prospectively investigated the therapeutic health-related quality of life (HRQOL) effects of goal-oriented sequential combination therapy based on exercise capacity in patients newly diagnosed with PAH. Methods: To examine the changes in HRQOL in PAH patients, we treated 30 patients newly diagnosed with PAH with goal-oriented sequential combination therapy based on exercise capacity. We monitored exercise capacity by cardiopulmonary exercise testing and observed the benefit of using a peak VO2 cut-off of 15 mL/kg/min to guide combination therapy. First-line treatment was an endothelin receptor antagonist (ERA); second-line treatment was the addition of a phosphodiesterase-5 inhibitor (PDE-5I). At baseline and at 3, 6, and 12 months, HRQOL was evaluated by using the eight-item Medical Outcomes Survey Short Form Health Survey. Results: At 12 months, 100% of PAH patients were receiving an ERA, and 82% an ERA + PDE-5I. The mean physical component summary (PCS) score was 33.5 at baseline, 41.2 at 3 months, 40.8 at 6 months, and 42.0 at 12 months, and the mean mental component summary (MCS) scores were 45.6, 47.0, 50.0, and 50.1, respectively. PCS score was significantly greater at 3 months than at baseline (P = 0.035). MCS score was comparable at 3 months and at baseline, but was significantly greater at 6 and 12 months than at baseline (P = 0.033, P = 0.028, respectively). Thus, PCS score improved soon after initiation of therapy, and MCS score improved later. Conclusions: Together, these results suggest that goal-oriented sequential combination therapy based on exercise capacity improves HRQOL in patients with PAH.

    DOI: 10.1186/s12955-019-1178-x

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  20. Goal-Oriented Sequential Combination Therapy Evaluated Using Cardiopulmonary Exercise Parameters for the Treatment of Newly Diagnosed Pulmonary Arterial Hypertension - Goal-Oriented Therapy Evaluated by Cardiopulmonary Exercise Testing for Pulmonary Arterial Hypertension (GOOD EYE).

    Hirashiki A, Kondo T, Adachi S, Nakano Y, Kamimura Y, Shimokata S, Okumura N, Shimizu A, Washimi Y, Arai H, Murohara T, GOOD EYE Investigators.

    Circulation reports   1 巻 ( 7 ) 頁: 303 - 311   2019年6月

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    記述言語:英語   出版者・発行元:一般社団法人 日本循環器学会  

    DOI: 10.1253/circrep.CR-19-0047

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  21. Renin Activity as a Key Predictor of Major Adverse Cardiac Events

    Kondo Takahisa, Nakano Yoshihisa, Adachi Shiro, Murohara Toyoaki

    CIRCULATION JOURNAL   83 巻 ( 6 ) 頁: 1204 - 1205   2019年6月

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    記述言語:日本語   出版者・発行元:Circulation Journal  

    DOI: 10.1253/circj.CJ-19-0337

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  22. Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension

    Kamimura Yoshihiro, Okumura Naoki, Adachi Shiro, Shimokata Shigetake, Tajima Fumitaka, Nakano Yoshihisa, Hirashiki Akihiro, Murohara Toyoaki, Kondo Takahisa

    HEART AND VESSELS   33 巻 ( 10 ) 頁: 1220 - 1228   2018年10月

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    記述言語:日本語   出版者・発行元:Heart and Vessels  

    Right ventricular (RV) function is associated with prognosis in chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to establish an RV dysfunction score using RV echocardiographic parameters to clarify the clinical characteristics in patients with CTEPH and to compare RV dysfunction score with parameters such as World Health Organization (WHO) functional class, hemodynamics, exercise capacity, and plasma BNP level. We enrolled 35 inpatients with CTEPH (mean age, 62 ± 15 years, 15 males). We constructed ‘an RV dysfunction score’ calculated as the summation of each point awarded for the presence of four parameters: tricuspid annular plane systolic excursion (TAPSE) < 16 mm, 1 point; tissue Doppler-derived tricuspid lateral annular systolic velocity (S′) < 10 cm/s, 1 point; right ventricular fractional area change (RVFAC) < 35%, 1 point; and right ventricular myocardial performance index (RV-MPI) > 0.4, 1 point. TAPSE, S′, RVFAC, and RV-MPI was 18.7 ± 4.8 mm, 11.9 ± 3.1 cm/s, 33.5 ± 13.9%, and 0.39 ± 0.2, respectively. The RV dysfunction score was associated with symptom [WHO functional class (p = 0.026)], hemodynamics [mean PAP (p = 0.01), cardiac index (p = 0.009), pulmonary vascular resistance (p = 0.001), and SvO2 (p = 0.039)], exercise capacity [6-min walk distance (p = 0.046), peakVO2 (p = 0.016), and VE/VCO2 slope (p = 0.031)], and plasma BNP level (p = 0.005). This RV dysfunction score using the four RV echocardiographic parameters could be a simple and useful scoring system to evaluate prognostic factors in patients with CTEPH.

    DOI: 10.1007/s00380-018-1168-7

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  23. Left ventricular end-diastolic dimension and septal e' are predictors of cardiac index at rest, while tricuspid annular plane systolic excursion is a predictor of peak oxygen uptake in patients with pulmonary hypertension

    Nakano Yoshihisa, Okumura Naoki, Adachi Shiro, Shimokata Shigetake, Tajima Fumitaka, Kamimura Yoshihiro, Murohara Toyoaki, Kondo Takahisa

    HEART AND VESSELS   33 巻 ( 5 ) 頁: 521 - 528   2018年5月

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    記述言語:日本語   出版者・発行元:Heart and Vessels  

    Little is known regarding a correlation of hemodynamics at rest or exercise capacity with echocardiographic parameters in patients with pulmonary hypertension (PH). To clarify these potential correlations, we performed transthoracic echocardiography, right heart catheterization, and cardiopulmonary exercise testing in 53 patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Left ventricular end-diastolic dimension (LVDd), early diastolic velocity of the septal mitral annulus (septal e′), tricuspid regurgitation peak gradient (TRPG), and tricuspid annular plane systolic excursion (TAPSE) were significantly correlated with cardiac index (LVDd; r = 0.477, P < 0.001, septal e′; r = 0.463, P = 0.001, TRPG; r = − 0.455, P = 0.001 and TAPSE; r = 0.406, P = 0.003, respectively). Multiple regression analysis revealed that LVDd and septal e′ were significantly associated with cardiac index (CI) and stroke volume index at rest. Among the exercise capacity markers evaluated, TAPSE, TRPG, and LVDd were significantly correlated with peak oxygen uptake (TAPSE; r = 0.534, P < 0.001, TRPG; r = − 0.466, P = 0.001 and LVDd; r = 0.411, P = 0.002, respectively). Multiple regression analysis showed that TAPSE was significantly associated with peak oxygen uptake (VO2). In PAH and CTEPH patients, LVDd and septal e′ were significantly associated with CI at rest, whereas TAPSE was significantly associated with peak VO2. Echocardiographic parameters may predict the prognostic factors of PAH and CTEPH patients.

    DOI: 10.1007/s00380-017-1086-0

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  24. Effects of balloon pulmonary angioplasty were modest in patients with inoperable central-type chronic thromboembolic pulmonary hypertension

    Adachi S., Okumura N., Tajima F., Shimokata S., Kamimura Y., Nakano Y., Murohara T., Kondo T.

    EUROPEAN HEART JOURNAL   38 巻   頁: 1079 - 1080   2017年8月

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  25. Right ventricular myocardial performance index is a useful parameter for evaluating right ventricular ejection fraction using by computed tomography in patients with CTEPH

    Okumura N., Tajima F., Nakano Y., Shimokata S., Kamimura Y., Adachi S., Kondo T., Murohara T.

    EUROPEAN HEART JOURNAL   38 巻   頁: 287 - 287   2017年8月

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  26. Left ventricular end-diastolic dimension, septal e prime and tricuspid annular plane systolic excursion are useful for evaluating conditions of patients with pulmonary hypertension

    Nakano Y., Okumura N., Adachi S., Shimokata S., Kamimura Y., Tajima F., Murohara T., Kondo T.

    EUROPEAN HEART JOURNAL   38 巻   頁: 1151 - 1151   2017年8月

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  27. Circulatory power and ventilatory power over time under goal-oriented sequential combination therapy for pulmonary arterial hypertension

    Hirashiki Akihiro, Adachi Shiro, Nakano Yoshihisa, Kamimura Yoshihiro, Shimokata Shigetake, Takeshita Kyosuke, Shimizu Atsuya, Toba Kenji, Murohara Toyoaki, Kondo Takahisa

    PULMONARY CIRCULATION   7 巻 ( 2 ) 頁: 448 - 454   2017年

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    記述言語:日本語   出版者・発行元:Pulmonary Circulation  

    Many therapeutic options are available for patients with pulmonary arterial hypertension (PAH). However, little is known about the effects of sequential combination therapy on exercise capacity. Here we monitored exercise capacity by cardiopulmonary exercise testing (CPX) and observed the benefit of using a peak VO2 cutoff of 15 mL/kg/min to guide combination therapy. Thirty patients newly diagnosed with PAH were treated with goal-oriented sequential combination therapy. Endothelin receptor antagonists (ERA) were the first-line treatment, with phosphodiesterase type 5 inhibitors (PDE-5i) as the preferred combination partner. The patients underwent cardiac catheterization at baseline and after 12 months and CPX at baseline and after three, six, and 12 months. Circulatory power (CP) was defined as the product of peak O2 uptake and peak systolic blood pressure (SBP); ventilatory power (VP) was defined as peak SBP divided by the minute ventilation–CO2 production slope. After 12 months, ERA had been administered to 100% of the study patients and PDE-5i to 82%. Mean CP at baseline and after three, six, and 12 months was 1807, 2063, 2248, and 2245 mmHg·min/mL/kg, respectively, and mean VP was 2.93, 3.53, 4.16, and 3.68 mmHg, respectively. CP was greater after 6 months than at baseline (P=0.047); VP was greater after three months than at baseline (P=0.019) and further improved at six months compared with three months (P=0.040). Therefore, repeated CPX assessment, including measurement of CP and VP, can provide useful information regarding the efficacy of goal-oriented treatment for PAH.

    DOI: 10.1177/2045893217703954

    Web of Science

    Scopus

    PubMed

  28. Left main coronary artery compression by a dilated main pulmonary artery and left coronary sinus of Valsalva aneurysm in a patient with heritable pulmonary arterial hypertension and FLNA mutation

    Hirashiki Akihiro, Adachi Shiro, Nakano Yoshihisa, Kamimura Yoshihiro, Ogo Takeshi, Nakanishi Norifumi, Morisaki Takayuki, Morisaki Hiroko, Shimizu Atsuya, Toba Kenji, Murohara Toyoaki, Kondo Takahisa

    PULMONARY CIRCULATION   7 巻 ( 3 ) 頁: 734 - 740   2017年

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    記述言語:日本語   出版者・発行元:Pulmonary Circulation  

    Left main coronary artery (LMCA) disease due to external compression by a dilated main pulmonary artery (MPA) is an uncommon clinical entity. Here, we describe a 52-year-old woman with pulmonary arterial hypertension (PAH) and anteroseptal old myocardial infarction (OMI). The cause of the OMI was external compression of the LMCA by the dilated MPA and aneurysm of the left coronary sinus of Valsalva. The patient’s sister (aged 56 years) had also been diagnosed with PAH and both women had a novel heterozygous splicing mutation, IVS2-2A>G (c.374-2A>G in NM_001456), in the filamin A (FLNA) gene. To our knowledge, this is the first report of HPAH which is likely to be due to FLNA mutation and compression of the LMCA between a dilated MPA and aneurysm of the left coronary sinus of Valsalva.

    DOI: 10.1177/2045893217716107

    Web of Science

    Scopus

    PubMed

▼全件表示

書籍等出版物 1

  1. ER・ICUでの薬の使い方・考え方2021-'22 (救急・集中治療32巻3号)

    中野嘉久( 担当: 分担執筆 ,  範囲: 肺高血圧症)

    総合医学社  2020年11月 

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    記述言語:日本語

MISC 1

  1. Safe and successful transition from oral selexipag to subcutaneous treprostinil in a patient with idiopathic pulmonary arterial hypertension treated with triple combination therapy.

    Adachi S, Nishiyama I, Yasuda K, Yoshida M, Nakano Y, Kondo T, Murohara T  

    Journal of cardiology cases26 巻 ( 1 ) 頁: 42 - 45   2022年7月

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

    Some patients with pulmonary arterial hypertension (PAH) might undergo transition to parenteral prostacyclin analogs due to inadequate response to oral combination therapy. However, there is no consensus on how transition from oral selexipag to subcutaneous treprostinil should be performed. Herein, we report a 56-year-old woman diagnosed with idiopathic PAH that was treated with initial combination therapy (10 mg of macitentan, 40 mg of tadalafil, and 3.2 mg of selexipag daily). Mean pulmonary arterial pressure (PAP) improved from 63 to 39 mm Hg. Transition to parenteral prostacyclin analog was required because cardiac index was below 2.5 L/min/m2. The selexipag was tapered off while subcutaneous treprostinil was titrated up to 30 ng/kg/min over 19 days. Hemodynamic parameters were slightly better than those before the transition. The mean PAP improved to 32 mm Hg by further gradual increases of subcutaneous treprostinil up to 60 ng/kg/min. Therefore, the patient having idiopathic PAH with inadequate response to oral triple combination therapy experienced successful transition from selexipag to subcutaneous treprostinil. Hemodynamic parameters were slightly more improved at a dose of 30 ng/kg/min of subcutaneous treprostinil than at a dose of 3200 μg daily of selexipag in the midst of disease progression. Learning objectives: There is limited evidence for transition of pulmonary vasodilators, especially from oral selexipag to subcutaneous treprostinil. Detailed change in hemodynamic parameters before and after transition and the way of performing transition in patients with idiopathic pulmonary arterial hypertension with exacerbations despite treatment with oral triple combination therapy may provide useful information for better management in the clinical setting.

    DOI: 10.1016/j.jccase.2022.02.003

    Scopus

    PubMed

科研費 2

  1. コロナ禍での持病悪化要因と持病有無が就労関連要因の心血管発症リスクに及ぼす影響

    研究課題/研究課題番号:22H03349  2022年4月 - 2027年3月

    科学研究費助成事業  基盤研究(B)

    八谷 寛, 平川 仁尚, 大塚 礼, 李 媛英, 江 啓発, 玉腰 浩司, 太田 充彦, 山田 宏哉, 松永 眞章, 中野 嘉久

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    担当区分:研究分担者 

    本研究は申請者らが長期間追跡調査を実施している愛知職域コホート研究において、糖尿病や高血圧等の持病の有無により、就労に関わる要因と心血管疾患等発症リスクの関連がどの程度異なるのかを明らかにすること、また追跡調査と生活習慣等の追加調査を同コホート研究で実施し、新型コロナウイルス感染拡大下に、持病を有する労働者の健康状態の悪化が、特にコロナ禍前より把握している職場ストレスなどの就労関連要因により異なるかを検討すること、さらにこれらの目的に即したデータ統合型研究を計画するとともに既存のデータベースを用いた統計解析を行おうとするものである。

  2. 肺高血圧症の病態における血管新生因子(VEGF)の役割の解明研究

    研究課題/研究課題番号:17K15997  2017年4月 - 2019年3月

    足立 史郎

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    担当区分:その他 

    肺高血圧症は肺動脈が狭窄していき心不全から死に至る疾患である。この狭窄の過程に血管新生因子(VEGF)が関連していると考えられ、VEGF165とVEGF165bの役割の解明を目的とした。33例の肺高血圧患者を登録した。コントロール群と比較しVEGF-A, 165b共に肺高血圧症群で有意に上昇していた。さらに原因疾患毎に解析した結果、VEGF-A, 165b共に慢性血栓塞栓性肺高血圧症の膠原病に伴う肺高血圧症で有意な上昇が見られた。以上よりVEGF-Aおよび165bは肺高血圧症の原因を分類するにあたって有用である可能性があることが結論付けられた。
    肺高血圧症は多岐にわたる原因がある。その原因により治療方針は大きく変わるため、背景疾患の正確な診断は予後の改善に極めて重要である。本研究結果では血管新生因子は肺血管の変性に関与していることが判明した。さらに1群の中で解析をした結果、VEGFAは膠原病、慢性血栓塞栓性肺高血圧症において有意に上昇していた。1群を除いた肺高血圧症の解析では3群(肺疾患関連)において有意な上昇をみた。これらより肺疾患に関連する肺高血圧症、膠原病、慢性血栓塞栓性肺高血圧症において上昇するマーカーと考えられる。肺高血圧治療における背景疾患の診断に有用な情報であり、今後さらなるバイオマーカー研究に拍車をかけるであろう。