構造的心疾患・虚血研究グループ
Structural Heart Disease and Ischemia Research Group
研究内容
虚血研究
近年、スタチンを中心とした薬剤治療や薬剤溶出性ステント・バルーンなどデバイスの進歩により虚血性心疾患治療は大きく変化してきています。我々は、経皮的冠動脈形成術 (PCI) 施行時に血管内超音波 (IVUS) や光干渉断層診断法 (OCT) 画像などによる冠動脈イメージングを活かした研究を行っています。また、心臓移植実施施設として、心臓移植症例に対する心臓同種移植血管症（cardiac allograft vasculopathy: CAV）の発症予測や危険因子の解析に取り組んでいます。札幌市の急性冠症候群 (acute coronary syndrome: ACS) ネットワークの学術担当事務局として、札幌市ACSネットワークで蓄積されたデータ解析を行い、情報発信しています。また、多施設共同の大規模臨床試験にも積極的に参加しております。2023年はピタバスタチンを用いた「REAL-CAD研究」から、スタチン治療後の残余リスクとして慢性腎臓病と糖尿病管理が重要であることを報告しました。
①安定狭心症患者におけるOCTで測定したプラーク形態による予後に関する研究
本研究は、安定狭心症患者にOCT画像評価を用いて、①冠動脈病変の不安定プラークの特徴と慢性期予後との関連性を検証、②OCT画像での不安定プラークを簡便に検出可能な新規血中バイオマーカーを探索するために研究を行いました。OCT画像から得られた高リスクの冠動脈プラークの特徴を点数化し、合計した冠動脈プラークリスクスコア(CPRS)と、標的病変再血行再建術には直接的に関連があること、炎症性バイオマーカーであるMCP-1はCPRSと有意な相関を認めることを明らかにしました。
②札幌市ACSネットワークにおける循環器救急搬送患者の実態調査
本研究では、札幌市ACSネットワーク参画施設に循環器救急疾患として搬送された全患者を対象とし、札幌市ACSネットワーク救急搬送患者の搬送・診断・治療内容・転帰に関する実態調査を行っております。北海道大学は学術担当事務局として、札幌市ACSネットワークで蓄積されたデータ解析を行っています。2023年度は、新型コロナウイルス感染症流行期における札幌市のACS治療実態について詳細に解析した結果が欧米誌に掲載されました。今後は、更なるデータベースの質向上と学術論文の執筆を目標として進める予定です。
③ 心臓移植症例に対する心臓同種移植血管症（cardiac allograft vasculopathy: CAV）の発症予測や危険因子の解析
CAVは、心臓移植後患者の死因の大きな割合を占める疾患です。冠動脈造影検査やIVUSによる評価が広く行われておりますが、発症予測や治療適応については十分検討されておりません。我々は、通常の画像評価に加え、近赤外線分光法を用いた血管内超音波検査 (near infrared spectroscopy-IVUS: NIRS-IVUS)や冠血流予備能測定など詳細な画像・血流動態評価により、心臓移植後の冠動脈病変の不安定性の評価、予後解析を行っています。道内唯一の心臓移植実施施設である当院でしか行えない研究であり、地道に症例登録をすすめています。研究で得られた成果の一部は、国際心肺移植学会（ISHLT）などで発表しております。
構造的心疾患研究
大動脈弁狭窄症（AS）に対する経皮的大動脈弁留置術（TAVI）は、外科手術リスクが高い患者の低侵襲治療としての地位を確立しており、より低リスク患者へとその適応が拡大していっております。また、2018年12月に当院が道内初症例を成功した僧帽弁閉鎖不全症(MR)に対する経皮的僧帽弁接合不全修復術（MitraClip治療）も心不全患者さんの症状・予後改善のための治療として広まってきております。また、更には非弁膜症性心房細動における塞栓症予防治療「Watchmanによる左心耳永久閉鎖術」が保険診療開始になり、左室駆出率の保たれた心不全（HFpEF）に対する心房間シャントデバイスの治験が始まるなど、構造的心疾患（SHD）の低侵襲インターベンション治療の重要性が増して来ております。我々はこのようなSHDの病態解明、治療成績向上に寄与することを目標にSHD研究プロジェクトを進めてきております。
1.TAVI関連研究
a.最新画像技術を用いた血流動態研究
経カテーテル的大動脈弁置換術(TAVI)は、外科的大動脈弁置換術実施件数を超え、大動脈狭窄症(AS)に対する標準治療として認知されております。近年では、中長期成績も報告されてきており、外科弁に劣らない成績が示されてきております。一方で、比較的早期に弁変性や心不全再入院をきたす症例も報告されてきており、留置弁や治療法の選択が必要となってきております。従来、TAVIによる血流動態評価は心エコーのみで施行されておりましたが、計測エラーなど問題点も指摘されております。我々は、血流動態の詳細な評価を可能とするTime-Resolved Three-Dimensional Phase-Contrast MRI(4D-Flow)を用いた画像研究に取り組んでまいりました。現在では登録症例が200例を超えております。
2023年は、高橋勇樹大学院生、神谷究助教を中心に自己拡張型弁とバルーン拡張型弁では有意に血流動態に違いがあることを明らかとし、主要国内外の学会で発表するとともに、心臓血管MR分野のメジャージャーナルであるJournal of Cardiovascular Magnetic Resonance誌に論文掲載されました（J Cardiovasc Magn Reson.2023;25(1):60.）。今後は、さらに研究をすすめカテーテル人工弁の世代間の血行動態評価や長期成績との関係を明らかとするために、引き続き症例登録を進めてまいります。
2023年は、高橋勇樹大学院生、神谷究助教を中心に自己拡張型弁とバルーン拡張型弁では有意に血流動態に違いがあることを明らかとし、主要国内外の学会で発表するとともに、心臓血管MR分野のメジャージャーナルであるJournal of Cardiovascular Magnetic Resonance誌に論文掲載されました（J Cardiovasc Magn Reson.2023;25(1):60.）。今後は、さらに研究をすすめカテーテル人工弁の世代間の血行動態評価や長期成績との関係を明らかとするために、引き続き症例登録を進めてまいります。
#02
2.運動負荷カテーテルを用いたSHD研究
運動時には、骨格筋などの末梢組織の酸素需要に応えるため心拍出量を増加させる必要があります。心臓は、安静時の数倍の血液を拍出する予備能を有していますが、心拍出量の増加は、弁を通過する血流を増加させ、心臓の負荷状態を変化させます。また、運動に伴う頻脈や血圧上昇により、弁逆流や心筋酸素消費量の増大を招きます。これらより安静時のみならず、運動時の心機能を評価することが非常に重要と報告されています。しかしながら、TAVIやMitraClip治療などSHD治療における運動負荷検査の意義については不明な点が多く、SHD治療における運動負荷検査の評価を行うことにより、適切な治療介入の時期、患者選択や治療後の有害事象や予後の推定を行い、SHD治療の成績の改善に寄与できると考え、積極的に研究を行っております。以前より当教室では、心エコーによる運動時血行動態の変化を評価してきましたが、それに加え臥位エルゴメーターによる運動負荷時の血行動態変化をカテーテル検査にてリアルタイムに評価を施行することで新しい知見が得られるものと考えております。
#03
運動負荷カテーテル検査
臥位エルゴメーター（＊：Lobe社製 Angio V2Ⓡ）を用いた運動負荷検査を行っている。内頚静脈から挿入したスワンガンズカテーテル（黄色矢頭）により運動負荷時の血行動態変化をリアルタイムに評価できる。
主な原著論文
2024
1.
Kamiya, Kiwamu; Takei, Makoto; Nagai, Toshiyuki; Miyoshi, Toru; Ito, Hiroshi; Fukumoto, Yoshihiro; Obara, Hitoshi; Kakuma, Tatsuyuki; Sakuma, Ichiro; Daida, Hiroyuki; Iimuro, Satoshi; Shimokawa, Hiroaki; Kimura, Takeshi; Nagai, Ryozo; Anzai, Toshihisa
In: J Atheroscler Thromb, vol. 31, no. 1, pp. 61–80, 2024, ISSN: 1880-3873.
@article{pmid37574272,
title = {Association between Non-Lipid Residual Risk Factors and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Pitavastatin: An Observation from the REAL-CAD Study},
author = {Kiwamu Kamiya and Makoto Takei and Toshiyuki Nagai and Toru Miyoshi and Hiroshi Ito and Yoshihiro Fukumoto and Hitoshi Obara and Tatsuyuki Kakuma and Ichiro Sakuma and Hiroyuki Daida and Satoshi Iimuro and Hiroaki Shimokawa and Takeshi Kimura and Ryozo Nagai and Toshihisa Anzai},
doi = {10.5551/jat.64304},
issn = {1880-3873},
year = {2024},
date = {2024-01-01},
urldate = {2024-01-01},
journal = {J Atheroscler Thromb},
volume = {31},
number = {1},
pages = {61--80},
abstract = {AIMS: We aimed to investigate the association between non-lipid residual risk factors and cardiovascular events in patients with stable coronary artery disease (CAD) who achieved low-density lipoprotein cholesterol (LDL-C) ＜100 mg/dL from the Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study.nnMETHODS: The REAL-CAD study was a prospective, multicenter, open-label trial. As a sub-study, we examined the prognostic impact of non-lipid residual risk factors, including blood pressure, glucose level, and renal function, in patients who achieved LDL-C ＜100 mg/dL at 6 months after pitavastatin therapy. Each risk factor was classified according to severity. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, and unstable angina requiring emergency hospitalization.nnRESULTS: Among 8,743 patients, the mean age was 68±8.2 years, and the mean LDL-C level was 84.4±18 mg/dL. After adjusting for the effects of confounders, an estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m showed the highest risk of the primary outcome (hazard ratio [HR] 1.92; 95% confidence interval [CI] 1.45-2.53). The combination of eGFR ≤ 60 and hemoglobin A1c (HbA1c) ≥ 6.0% also showed the highest risk of all-cause death (HR, 2.42; 95% CI, 1.72-3.41).nnCONCLUSIONS: In patients with stable CAD treated with pitavastatin and who achieved guidelines-directed levels of LDL-C, eGFR and HbA1c were independently associated with adverse events, suggesting that renal function and glycemic control could be residual non-lipid therapeutic targets after statin therapy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIMS: We aimed to investigate the association between non-lipid residual risk factors and cardiovascular events in patients with stable coronary artery disease (CAD) who achieved low-density lipoprotein cholesterol (LDL-C) ＜100 mg/dL from the Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study.nnMETHODS: The REAL-CAD study was a prospective, multicenter, open-label trial. As a sub-study, we examined the prognostic impact of non-lipid residual risk factors, including blood pressure, glucose level, and renal function, in patients who achieved LDL-C ＜100 mg/dL at 6 months after pitavastatin therapy. Each risk factor was classified according to severity. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, and unstable angina requiring emergency hospitalization.nnRESULTS: Among 8,743 patients, the mean age was 68±8.2 years, and the mean LDL-C level was 84.4±18 mg/dL. After adjusting for the effects of confounders, an estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m showed the highest risk of the primary outcome (hazard ratio [HR] 1.92; 95% confidence interval [CI] 1.45-2.53). The combination of eGFR ≤ 60 and hemoglobin A1c (HbA1c) ≥ 6.0% also showed the highest risk of all-cause death (HR, 2.42; 95% CI, 1.72-3.41).nnCONCLUSIONS: In patients with stable CAD treated with pitavastatin and who achieved guidelines-directed levels of LDL-C, eGFR and HbA1c were independently associated with adverse events, suggesting that renal function and glycemic control could be residual non-lipid therapeutic targets after statin therapy.
2.
Kobayashi, Yuta; Nagai, Toshiyuki; Kamiya, Kiwamu; Tsuneta, Satonori; Shingu, Yasushige; Wakabayashi, Kento; Kudo, Kohsuke; Matsuno, Yoshihiro; Wakasa, Satoru; Anzai, Toshihisa
Chronic Active Myocarditis After Transapical Transcatheter Aortic Valve Implantation Journal Article
In: Circulation Journal, vol. advpub, pp. CJ-23-0910, 2024.
@article{YutaKobayashi2024CJ-23-0910,
title = {Chronic Active Myocarditis After Transapical Transcatheter Aortic Valve Implantation},
author = {Yuta Kobayashi and Toshiyuki Nagai and Kiwamu Kamiya and Satonori Tsuneta and Yasushige Shingu and Kento Wakabayashi and Kohsuke Kudo and Yoshihiro Matsuno and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1253/circj.CJ-23-0910},
year = {2024},
date = {2024-01-01},
urldate = {2024-01-01},
journal = {Circulation Journal},
volume = {advpub},
pages = {CJ-23-0910},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2023
3.
Takahashi, Yuki; Kamiya, Kiwamu; Nagai, Toshiyuki; Tsuneta, Satonori; Oyama-Manabe, Noriko; Hamaya, Takeshi; Kazui, Sho; Yasui, Yutaro; Saiin, Kohei; Naito, Seiichiro; Mizuguchi, Yoshifumi; Takenaka, Sakae; Tada, Atsushi; Ishizaka, Suguru; Kobayashi, Yuta; Omote, Kazunori; Sato, Takuma; Shingu, Yasushige; Kudo, Kohsuke; Wakasa, Satoru; Anzai, Toshihisa
In: J Cardiovasc Magn Reson, vol. 25, no. 1, pp. 60, 2023, ISSN: 1532-429X.
@article{pmid37880721,
title = {Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement},
author = {Yuki Takahashi and Kiwamu Kamiya and Toshiyuki Nagai and Satonori Tsuneta and Noriko Oyama-Manabe and Takeshi Hamaya and Sho Kazui and Yutaro Yasui and Kohei Saiin and Seiichiro Naito and Yoshifumi Mizuguchi and Sakae Takenaka and Atsushi Tada and Suguru Ishizaka and Yuta Kobayashi and Kazunori Omote and Takuma Sato and Yasushige Shingu and Kohsuke Kudo and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1186/s12968-023-00970-9},
issn = {1532-429X},
year = {2023},
date = {2023-10-01},
urldate = {2023-10-01},
journal = {J Cardiovasc Magn Reson},
volume = {25},
number = {1},
pages = {60},
abstract = {BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR).nnMETHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR.nnRESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups.nnCONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR).nnMETHODS: We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients' refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4-39] days) and after (median interval, 6 [IQR 3-6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR.nnRESULTS: The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: - 0.22 ± 0.86 vs. SEV: - 0.85 ± 0.80, P < 0.001 and BEV: - 0.11 ± 0.79 vs. SEV: - 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: - 0.6 [- 2.1 to 0.5] Pa vs. SEV: - 1.8 [- 3.5 to - 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups.nnCONCLUSIONS: Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.
4.
Saiin, Kohei; Takenaka, Sakae; Nagai, Toshiyuki; Takahashi, Akinori; Mizuguchi, Yoshifumi; Konishi, Takao; Anzai, Toshihisa; Hotta, Daisuke; Kamigaki, Mitsunori; Yamazaki, Seiji; Fujita, Tsutomu; Yamashita, Takehiro; Kawahatsu, Kandoh; Suzuki, Takashi; Nozaki, Yoichi; Sakurada, Taku; Takenaka, Takashi; Igarashi, Yasumi; Makino, Takao
Impact of COVID-19 pandemic on emergency medical system and management strategies in patients with acute coronary syndrome Journal Article
In: Sci Rep, vol. 13, no. 1, pp. 5120, 2023, ISSN: 2045-2322.
@article{pmid36991026,
title = {Impact of COVID-19 pandemic on emergency medical system and management strategies in patients with acute coronary syndrome},
author = {Kohei Saiin and Sakae Takenaka and Toshiyuki Nagai and Akinori Takahashi and Yoshifumi Mizuguchi and Takao Konishi and Toshihisa Anzai and Daisuke Hotta and Mitsunori Kamigaki and Seiji Yamazaki and Tsutomu Fujita and Takehiro Yamashita and Kandoh Kawahatsu and Takashi Suzuki and Yoichi Nozaki and Taku Sakurada and Takashi Takenaka and Yasumi Igarashi and Takao Makino},
doi = {10.1038/s41598-023-32223-1},
issn = {2045-2322},
year = {2023},
date = {2023-03-01},
urldate = {2023-03-01},
journal = {Sci Rep},
volume = {13},
number = {1},
pages = {5120},
abstract = {The global coronavirus disease-2019 (COVID-19) pandemic is associated with reduced rate of percutaneous coronary intervention (PCI). However, there were a few data showing how emergency medical system (EMS) and management strategies for acute coronary syndrome (ACS) changed during the pandemic. We sought to clarify changes on characteristics, treatments, and in-hospital mortality of patients with ACS transported via EMS between pre- and post-pandemic. We examined consecutive 656 patients with ACS admitted to Sapporo City ACS Network Hospitals between June 2018 and November 2021. The patients were divided into pre- and post-pandemic groups. The number of ACS hospitalizations declined significantly during the pandemic (proportional reduction 66%, coefficient -0.34, 95% CI -0.50 to -0.18, p < 0.001). The median time from an EMS call to hospital was significantly longer in post-pandemic group than in pre-pandemic group (32 [26-39] vs. 29 [25-36] min, p = 0.008). There were no significant differences in the proportion of patients with ACS receiving PCI, and in-hospital mortality between the groups. The COVID-19 pandemic had a significant impact on EMS and management in patients with ACS. Although a significant decline was observed in ACS hospitalizations, the proportion of patients with ACS receiving emergency PCI remained during the pandemic.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The global coronavirus disease-2019 (COVID-19) pandemic is associated with reduced rate of percutaneous coronary intervention (PCI). However, there were a few data showing how emergency medical system (EMS) and management strategies for acute coronary syndrome (ACS) changed during the pandemic. We sought to clarify changes on characteristics, treatments, and in-hospital mortality of patients with ACS transported via EMS between pre- and post-pandemic. We examined consecutive 656 patients with ACS admitted to Sapporo City ACS Network Hospitals between June 2018 and November 2021. The patients were divided into pre- and post-pandemic groups. The number of ACS hospitalizations declined significantly during the pandemic (proportional reduction 66%, coefficient -0.34, 95% CI -0.50 to -0.18, p < 0.001). The median time from an EMS call to hospital was significantly longer in post-pandemic group than in pre-pandemic group (32 [26-39] vs. 29 [25-36] min, p = 0.008). There were no significant differences in the proportion of patients with ACS receiving PCI, and in-hospital mortality between the groups. The COVID-19 pandemic had a significant impact on EMS and management in patients with ACS. Although a significant decline was observed in ACS hospitalizations, the proportion of patients with ACS receiving emergency PCI remained during the pandemic.
5.
Takenaka, Sakae; Sato, Takuma; Nagai, Toshiyuki; Omote, Kazunori; Kobayashi, Yuta; Kamiya, Kiwamu; Konishi, Takao; Tada, Atsushi; Mizuguchi, Yoshifumi; Takahashi, Yuki; Naito, Seiichiro; Saiin, Kohei; Ishizaka, Suguru; Wakasa, Satoru; Anzai, Toshihisa
Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device Journal Article
In: Am J Physiol Heart Circ Physiol, vol. 324, no. 3, pp. H355–H363, 2023, ISSN: 1522-1539.
@article{pmid36705992,
title = {Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device},
author = {Sakae Takenaka and Takuma Sato and Toshiyuki Nagai and Kazunori Omote and Yuta Kobayashi and Kiwamu Kamiya and Takao Konishi and Atsushi Tada and Yoshifumi Mizuguchi and Yuki Takahashi and Seiichiro Naito and Kohei Saiin and Suguru Ishizaka and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1152/ajpheart.00626.2022},
issn = {1522-1539},
year = {2023},
date = {2023-03-01},
urldate = {2023-03-01},
journal = {Am J Physiol Heart Circ Physiol},
volume = {324},
number = {3},
pages = {H355--H363},
abstract = {Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( = 0.59, = 0.003) and peak V̇o ( = 0.56, = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( = 0.44, = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( = -0.34, = 0.88), peak V̇o ( = 0.074, = 0.74), or EQ-VAS ( = 0.127, = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Although measuring right ventricular (RV) function during exercise is more informative than assessing it at rest, the relationship between RV reserve function, exercise capacity, and health-related quality of life (HRQoL) in patients with left ventricular assist devices (LVAD) remains unresolved. We aimed to investigate whether RV reserve assessed by the change in RV stroke work index (RVSWI) during exercise is correlated with exercise capacity and HRQoL in patients with LVAD. We prospectively assessed 24 consecutive patients with LVAD who underwent invasive right heart catheterization in the supine position. Exercise capacity and HRQoL were assessed using the 6-min walk distance (6 MWD) and peak oxygen consumption (V̇o) in cardiopulmonary exercise testing, and the EuroQol visual analog scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (change from rest to peak exercise). Patients with lower ΔRVSWI had significantly lower changes in cardiac index and absolute value of RV dP/d than those with higher ΔRVSWI. The ΔRVSWI was positively correlated with 6 MWD ( = 0.59, = 0.003) and peak V̇o ( = 0.56, = 0.006). In addition, ΔRVSWI was positively correlated with the EQ-VAS ( = 0.44, = 0.030). In contrast, there was no significant correlation between RVSWI at rest and 6 MWD ( = -0.34, = 0.88), peak V̇o ( = 0.074, = 0.74), or EQ-VAS ( = 0.127, = 0.56). Our findings suggest that the assessment of RV reserve function is useful for risk stratification in patients with LVAD. The change in right ventricular stroke work index (RVSWI) during exercise, not RVSWI at rest, was associated with exercise capacity and HRQoL. Our findings suggest that the assessment of change in RVSWI during exercise as a surrogate of RV reserve function may aid in risk stratification of patients with LVAD.
6.
Saiin, Kohei; Konishi, Takao; Kazui, Sho; Yasui, Yutaro; Takahashi, Yuki; Naito, Seiichiro; Takenaka, Sakae; Mizuguchi, Yoshifumi; Tada, Atsushi; Kobayashi, Yuta; Kato, Yoshiya; Omote, Kazunori; Sato, Takuma; Kamiya, Kiwamu; Nagai, Toshiyuki; Tanaka, Shinya; Anzai, Toshihisa
Association of coronary plaque morphology with inflammatory biomarkers and target lesion revascularization in patients with chronic coronary syndrome: an optical coherence tomography study Journal Article
In: Am J Cardiovasc Dis, vol. 13, no. 5, pp. 309–319, 2023, ISSN: 2160-200X.
@article{pmid38026114,
title = {Association of coronary plaque morphology with inflammatory biomarkers and target lesion revascularization in patients with chronic coronary syndrome: an optical coherence tomography study},
author = {Kohei Saiin and Takao Konishi and Sho Kazui and Yutaro Yasui and Yuki Takahashi and Seiichiro Naito and Sakae Takenaka and Yoshifumi Mizuguchi and Atsushi Tada and Yuta Kobayashi and Yoshiya Kato and Kazunori Omote and Takuma Sato and Kiwamu Kamiya and Toshiyuki Nagai and Shinya Tanaka and Toshihisa Anzai},
issn = {2160-200X},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {Am J Cardiovasc Dis},
volume = {13},
number = {5},
pages = {309--319},
abstract = {BACKGROUND: The characteristics of high-risk coronary atherosclerosis evaluated using optical coherence tomography (OCT) can have a prognostic role. Inflammatory biomarkers may be related to the severity of coronary artery disease. This study investigated the association of high-risk morphological features of coronary plaques on OCT with circulating levels of inflammatory biomarkers and target lesion revascularization (TLR).nnMATERIALS AND METHODS: We prospectively analyzed the data of 30 consecutive patients with chronic coronary syndrome who underwent percutaneous coronary intervention (PCI) using OCT. The levels of interleukin-6, tumor necrosis factor-alpha, high-sensitivity C-reactive protein, pentraxin 3, vascular endothelial growth factor, and monocyte chemoattractant protein-1 (MCP-1) were measured in plasma samples. Coronary plaque characteristics were scored quantitatively in the form of coronary plaque risk score (CPRS). The estimated high-risk plaque characteristics for TLR were plaque rupture, plaque erosion, calcified nodule, lipid-rich plaque, thin-cap fibroatheroma, cholesterol crystals, macrophage infiltration, microchannels, calcification angle >90°, and microcalcifications. Each high-risk feature carries 1 point. Patients were defined as having a low CPRS (CPRS ≤3) or a high CPRS (CPRS ≥4).nnRESULTS: The primary outcome was TLR. TLR occurred in 6 (20%) patients within 15 months of PCI. High CPRS on OCT was directly correlated with TLR (P=0.029). In logistic regression analysis, CPRS was associated with TLR (odds ratio, 10.0; 95% confidence interval, 1.34-74.5). Serum MCP-1 level was significantly correlated with the CPRS (P=0.020).nnCONCLUSIONS: In patients with chronic coronary syndrome, CPRS may be a surrogate predictor of TLR. Serum MCP-1 may aid in the detection of high-risk coronary atherosclerosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The characteristics of high-risk coronary atherosclerosis evaluated using optical coherence tomography (OCT) can have a prognostic role. Inflammatory biomarkers may be related to the severity of coronary artery disease. This study investigated the association of high-risk morphological features of coronary plaques on OCT with circulating levels of inflammatory biomarkers and target lesion revascularization (TLR).nnMATERIALS AND METHODS: We prospectively analyzed the data of 30 consecutive patients with chronic coronary syndrome who underwent percutaneous coronary intervention (PCI) using OCT. The levels of interleukin-6, tumor necrosis factor-alpha, high-sensitivity C-reactive protein, pentraxin 3, vascular endothelial growth factor, and monocyte chemoattractant protein-1 (MCP-1) were measured in plasma samples. Coronary plaque characteristics were scored quantitatively in the form of coronary plaque risk score (CPRS). The estimated high-risk plaque characteristics for TLR were plaque rupture, plaque erosion, calcified nodule, lipid-rich plaque, thin-cap fibroatheroma, cholesterol crystals, macrophage infiltration, microchannels, calcification angle >90°, and microcalcifications. Each high-risk feature carries 1 point. Patients were defined as having a low CPRS (CPRS ≤3) or a high CPRS (CPRS ≥4).nnRESULTS: The primary outcome was TLR. TLR occurred in 6 (20%) patients within 15 months of PCI. High CPRS on OCT was directly correlated with TLR (P=0.029). In logistic regression analysis, CPRS was associated with TLR (odds ratio, 10.0; 95% confidence interval, 1.34-74.5). Serum MCP-1 level was significantly correlated with the CPRS (P=0.020).nnCONCLUSIONS: In patients with chronic coronary syndrome, CPRS may be a surrogate predictor of TLR. Serum MCP-1 may aid in the detection of high-risk coronary atherosclerosis.
2022
7.
Saiin, Kohei; Konishi, Takao; Ninagawa, Keita; Anzai, Toshihisa
Cogan Syndrome with Aortic Regurgitation and Multiple Vasculopathy Journal Article
In: Intern Med, vol. 61, no. 12, pp. 1921–1922, 2022, ISSN: 1349-7235.
@article{pmid34866099,
title = {Cogan Syndrome with Aortic Regurgitation and Multiple Vasculopathy},
author = {Kohei Saiin and Takao Konishi and Keita Ninagawa and Toshihisa Anzai},
doi = {10.2169/internalmedicine.8248-21},
issn = {1349-7235},
year = {2022},
date = {2022-06-01},
urldate = {2022-06-01},
journal = {Intern Med},
volume = {61},
number = {12},
pages = {1921--1922},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
8.
Saiin, Kohei; Konishi, Takao; Ninagawa, Keita; Anzai, Toshihisa
Cogan Syndrome with Aortic Regurgitation and Multiple Vasculopathy Journal Article
In: Intern Med, vol. 61, no. 12, pp. 1921–1922, 2022, ISSN: 1349-7235.
@article{pmid34866099b,
title = {Cogan Syndrome with Aortic Regurgitation and Multiple Vasculopathy},
author = {Kohei Saiin and Takao Konishi and Keita Ninagawa and Toshihisa Anzai},
doi = {10.2169/internalmedicine.8248-21},
issn = {1349-7235},
year = {2022},
date = {2022-06-01},
urldate = {2022-06-01},
journal = {Intern Med},
volume = {61},
number = {12},
pages = {1921--1922},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
9.
Omote, Kazunori; Yokota, Isao; Nagai, Toshiyuki; Sakuma, Ichiro; Nakagawa, Yoshihisa; Kamiya, Kiwamu; Iwata, Hiroshi; Miyauchi, Katsumi; Ozaki, Yukio; Hibi, Kiyoshi; Hiro, Takafumi; Fukumoto, Yoshihiro; Mori, Hiroyoshi; Hokimoto, Seiji; Ohashi, Yasuo; Ohtsu, Hiroshi; Ogawa, Hisao; Daida, Hiroyuki; Iimuro, Satoshi; Shimokawa, Hiroaki; Saito, Yasushi; Kimura, Takeshi; Matsuzaki, Masunori; Nagai, Ryozo; Anzai, Toshihisa
In: J Atheroscler Thromb, vol. 29, no. 1, pp. 50–68, 2022, ISSN: 1880-3873.
@article{pmid33431716,
title = {High-Density Lipoprotein Cholesterol and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Statins: An Observation from the REAL-CAD Study},
author = {Kazunori Omote and Isao Yokota and Toshiyuki Nagai and Ichiro Sakuma and Yoshihisa Nakagawa and Kiwamu Kamiya and Hiroshi Iwata and Katsumi Miyauchi and Yukio Ozaki and Kiyoshi Hibi and Takafumi Hiro and Yoshihiro Fukumoto and Hiroyoshi Mori and Seiji Hokimoto and Yasuo Ohashi and Hiroshi Ohtsu and Hisao Ogawa and Hiroyuki Daida and Satoshi Iimuro and Hiroaki Shimokawa and Yasushi Saito and Takeshi Kimura and Masunori Matsuzaki and Ryozo Nagai and Toshihisa Anzai},
doi = {10.5551/jat.59881},
issn = {1880-3873},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {J Atheroscler Thromb},
volume = {29},
number = {1},
pages = {50--68},
abstract = {AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.nnMETHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.nnRESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.nnCONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.nnMETHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.nnRESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.nnCONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.
10.
Omote, Kazunori; Yokota, Isao; Nagai, Toshiyuki; Sakuma, Ichiro; Nakagawa, Yoshihisa; Kamiya, Kiwamu; Iwata, Hiroshi; Miyauchi, Katsumi; Ozaki, Yukio; Hibi, Kiyoshi; Hiro, Takafumi; Fukumoto, Yoshihiro; Mori, Hiroyoshi; Hokimoto, Seiji; Ohashi, Yasuo; Ohtsu, Hiroshi; Ogawa, Hisao; Daida, Hiroyuki; Iimuro, Satoshi; Shimokawa, Hiroaki; Saito, Yasushi; Kimura, Takeshi; Matsuzaki, Masunori; Nagai, Ryozo; Anzai, Toshihisa
In: J Atheroscler Thromb, vol. 29, no. 1, pp. 50–68, 2022, ISSN: 1880-3873.
@article{pmid33431716c,
title = {High-Density Lipoprotein Cholesterol and Cardiovascular Events in Patients with Stable Coronary Artery Disease Treated with Statins: An Observation from the REAL-CAD Study},
author = {Kazunori Omote and Isao Yokota and Toshiyuki Nagai and Ichiro Sakuma and Yoshihisa Nakagawa and Kiwamu Kamiya and Hiroshi Iwata and Katsumi Miyauchi and Yukio Ozaki and Kiyoshi Hibi and Takafumi Hiro and Yoshihiro Fukumoto and Hiroyoshi Mori and Seiji Hokimoto and Yasuo Ohashi and Hiroshi Ohtsu and Hisao Ogawa and Hiroyuki Daida and Satoshi Iimuro and Hiroaki Shimokawa and Yasushi Saito and Takeshi Kimura and Masunori Matsuzaki and Ryozo Nagai and Toshihisa Anzai},
doi = {10.5551/jat.59881},
issn = {1880-3873},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {J Atheroscler Thromb},
volume = {29},
number = {1},
pages = {50--68},
abstract = {AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.nnMETHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.nnRESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.nnCONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AIM: The association between high-density lipoprotein cholesterol (HDL-C) level after statin therapy and cardiovascular events in patients with stable coronary artery disease (CAD) remains unclear. Thus, in this study, we sought to determine how HDL-C level after statin therapy is associated with cardiovascular events in stable CAD patients.nnMETHODS: From the REAL-CAD study which had shown the favorable prognostic effect of high-dose pitavastatin in stable CAD patients with low-density lipoprotein cholesterol (LDL-C) ＜120 mg/dL, 9,221 patients with HDL-C data at baseline and 6 months, no occurrence of primary outcome at 6 months, and reported non-adherence for pitavastatin, were examined. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission after 6 months of randomization. Absolute difference and ratio of HDL-C levels were defined as (those at 6 months-at baseline) and (absolute difference/baseline)×100, respectively.nnRESULTS: During a median follow-up period of 4.0 (IQR 3.2-4.7) years, the primary outcome occurred in 417 (4.5%) patients. The adjusted risk of all HDL-C-related variables (baseline value, 6-month value, absolute, and relative changes) for the primary outcome was not significant (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.91-1.08, HR 1.03, 95% CI 0.94-1.12, HR 1.05, 95% CI 0.98-1.12, and HR 1.08, 95% CI 0.94-1.24, respectively). Furthermore, adjusted HRs of all HDL-C-related variables remained non-significant for the primary outcome regardless of on-treatment LDL-C level at 6 months.nnCONCLUSIONS: After statin therapy with modestly controlled LDL-C, HDL-C level has little prognostic value in patients with stable CAD.
2021
11.
Mizuguchi, Yoshifumi; Konishi, Takao; Nagai, Toshiyuki; Sato, Tomoya; Takenaka, Sakae; Tada, Atsushi; Kobayashi, Yuta; Komoriyama, Hirokazu; Kato, Yoshiya; Omote, Kazunori; Sato, Takuma; Kamiya, Kiwamu; Tsujinaga, Shingo; Iwano, Hiroyuki; Kikuchi, Kenjiro; Tanaka, Shinya; Anzai, Toshihisa
Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias Journal Article
In: Am J Emerg Med, vol. 44, pp. 100–105, 2021, ISSN: 1532-8171.
@article{pmid33582610,
title = {Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias},
author = {Yoshifumi Mizuguchi and Takao Konishi and Toshiyuki Nagai and Tomoya Sato and Sakae Takenaka and Atsushi Tada and Yuta Kobayashi and Hirokazu Komoriyama and Yoshiya Kato and Kazunori Omote and Takuma Sato and Kiwamu Kamiya and Shingo Tsujinaga and Hiroyuki Iwano and Kenjiro Kikuchi and Shinya Tanaka and Toshihisa Anzai},
doi = {10.1016/j.ajem.2021.02.005},
issn = {1532-8171},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {Am J Emerg Med},
volume = {44},
pages = {100--105},
abstract = {OBJECTIVES: Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients.nnMETHODS: We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death.nnRESULTS: Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p < 0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p = 0.005) or extracorporeal membrane oxygenation (p < 0.001), tracheal intubation (p < 0.001) and persistent vegetative state (p = 0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level.nnCONCLUSIONS: In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients.nnMETHODS: We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death.nnRESULTS: Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p < 0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p = 0.005) or extracorporeal membrane oxygenation (p < 0.001), tracheal intubation (p < 0.001) and persistent vegetative state (p = 0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level.nnCONCLUSIONS: In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.
12.
Komoriyama, Hirokazu; Kamiya, Kiwamu; Nagai, Toshiyuki; Oyama-Manabe, Noriko; Tsuneta, Satonori; Kobayashi, Yuta; Kato, Yoshiya; Sarashina, Miwa; Omote, Kazunori; Konishi, Takao; Sato, Takuma; Tsujinaga, Shingo; Iwano, Hiroyuki; Shingu, Yasushige; Wakasa, Satoru; Anzai, Toshihisa
In: J Cardiovasc Magn Reson, vol. 23, no. 1, pp. 81, 2021, ISSN: 1532-429X.
@article{pmid34176516b,
title = {Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement},
author = {Hirokazu Komoriyama and Kiwamu Kamiya and Toshiyuki Nagai and Noriko Oyama-Manabe and Satonori Tsuneta and Yuta Kobayashi and Yoshiya Kato and Miwa Sarashina and Kazunori Omote and Takao Konishi and Takuma Sato and Shingo Tsujinaga and Hiroyuki Iwano and Yasushige Shingu and Satoru Wakasa and Toshihisa Anzai},
doi = {10.1186/s12968-021-00771-y},
issn = {1532-429X},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {J Cardiovasc Magn Reson},
volume = {23},
number = {1},
pages = {81},
abstract = {BACKGROUND: Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR.nnMETHODS: We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR.nnRESULTS: After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034).nnCONCLUSIONS: In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR.nnMETHODS: We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR.nnRESULTS: After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034).nnCONCLUSIONS: In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
13.
Kadosaka, Takahide; Kamiya, Kiwamu; Nagai, Toshiyuki; Anzai, Toshihisa
Takotsubo Syndrome After Transcatheter Mitral Valve Repair Journal Article
In: Circ J, vol. 85, no. 7, pp. 1100, 2021, ISSN: 1347-4820.
@article{pmid33980780,
title = {Takotsubo Syndrome After Transcatheter Mitral Valve Repair},
author = {Takahide Kadosaka and Kiwamu Kamiya and Toshiyuki Nagai and Toshihisa Anzai},
doi = {10.1253/circj.CJ-21-0107},
issn = {1347-4820},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {Circ J},
volume = {85},
number = {7},
pages = {1100},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
14.
Mizuguchi, Yoshifumi; Konishi, Takao; Nagai, Toshiyuki; Sato, Tomoya; Takenaka, Sakae; Tada, Atsushi; Kobayashi, Yuta; Komoriyama, Hirokazu; Kato, Yoshiya; Omote, Kazunori; Sato, Takuma; Kamiya, Kiwamu; Tsujinaga, Shingo; Iwano, Hiroyuki; Kikuchi, Kenjiro; Tanaka, Shinya; Anzai, Toshihisa
Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias Journal Article
In: Am J Emerg Med, vol. 44, pp. 100–105, 2021, ISSN: 1532-8171.
@article{pmid33582610b,
title = {Prognostic value of admission serum magnesium in acute myocardial infarction complicated by malignant ventricular arrhythmias},
author = {Yoshifumi Mizuguchi and Takao Konishi and Toshiyuki Nagai and Tomoya Sato and Sakae Takenaka and Atsushi Tada and Yuta Kobayashi and Hirokazu Komoriyama and Yoshiya Kato and Kazunori Omote and Takuma Sato and Kiwamu Kamiya and Shingo Tsujinaga and Hiroyuki Iwano and Kenjiro Kikuchi and Shinya Tanaka and Toshihisa Anzai},
doi = {10.1016/j.ajem.2021.02.005},
issn = {1532-8171},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {Am J Emerg Med},
volume = {44},
pages = {100--105},
abstract = {OBJECTIVES: Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients.nnMETHODS: We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death.nnRESULTS: Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p < 0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p = 0.005) or extracorporeal membrane oxygenation (p < 0.001), tracheal intubation (p < 0.001) and persistent vegetative state (p = 0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level.nnCONCLUSIONS: In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVES: Although electrolyte abnormalities are related to worse clinical outcomes in patients with acute myocardial infarction (AMI), little is known about the association between admission serum magnesium level and adverse events in AMI patients complicated by out-of-hospital cardiac arrest presenting with malignant ventricular arrhythmias (OHCA-MVA). We investigated the prognostic value of serum magnesium level on admission in these patients.nnMETHODS: We retrospectively analyzed the data of 165 consecutive reperfused AMI patients complicated with OHCA-MVA between April 2007 and February 2020 in our university hospital. Serum magnesium concentration was measured on admission. The primary outcome was in-hospital death.nnRESULTS: Fifty-four patients (33%) died during hospitalization. Higher serum magnesium level was significantly related to in-hospital death (Fine & Gray's test; p < 0.001). In multivariable logistic regression analyses, serum magnesium level on admission was independently associated with in-hospital death (hazard ratio 2.68, 95% confidence interval 1.24-5.80) even after adjustment for covariates. Furthermore, the incidences of cardiogenic shock necessitating an intra-aortic balloon pump (p = 0.005) or extracorporeal membrane oxygenation (p < 0.001), tracheal intubation (p < 0.001) and persistent vegetative state (p = 0.002) were significantly higher in patients with higher serum magnesium level than in those with lower serum magnesium level.nnCONCLUSIONS: In reperfused AMI patients complicated by OHCA-MVA, admission serum magnesium level might be a potential surrogate marker for predicting in-hospital death.
15.
Komoriyama, Hirokazu; Kamiya, Kiwamu; Kobayashi, Yuta; Tsuneta, Satonori; Konishi, Takao; Sato, Takuma; Iwano, Hiroyuki; Nagai, Toshiyuki; Wakasa, Satoru; Kudo, Kohsuke; Anzai, Toshihisa
4-Dimensional Flow Cardiovascular Magnetic Resonance Imaging of Changes in Blood Flow Dynamics After Surgery for Discrete Subaortic Stenosis Journal Article
In: Circ J, vol. 85, no. 6, pp. 954, 2021, ISSN: 1347-4820.
@article{pmid33814528,
title = {4-Dimensional Flow Cardiovascular Magnetic Resonance Imaging of Changes in Blood Flow Dynamics After Surgery for Discrete Subaortic Stenosis},
author = {Hirokazu Komoriyama and Kiwamu Kamiya and Yuta Kobayashi and Satonori Tsuneta and Takao Konishi and Takuma Sato and Hiroyuki Iwano and Toshiyuki Nagai and Satoru Wakasa and Kohsuke Kudo and Toshihisa Anzai},
doi = {10.1253/circj.CJ-20-1248},
issn = {1347-4820},
year = {2021},
date = {2021-05-01},
urldate = {2021-05-01},
journal = {Circ J},
volume = {85},
number = {6},
pages = {954},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
16.
Takenaka, Sakae; Konishi, Takao; Sato, Tomoya; Tada, Atsushi; Koizumi, Takuya; Mizuguchi, Yoshifumi; Kadosaka, Takahide; Motoi, Ko; Kobayashi, Yuta; Komoriyama, Hirokazu; Kato, Yoshiya; Sarashina, Miwa; Omote, Kazunori; Tsujinaga, Shingo; Sato, Takuma; Kamada, Rui; Kamiya, Kiwamu; Iwano, Hiroyuki; Nagai, Toshiyuki; Orimo, Tatsuya; Kamachi, Hirofumi; Taketomi, Akinobu; Anzai, Toshihisa
2021, ISSN: 2090-6404.
@misc{pmid34430055,
title = {Acute Myocardial Infarction of the Left Main Coronary Artery Presenting with Cardiogenic Shock and Pulmonary Edema during Noncardiac Surgery},
author = {Sakae Takenaka and Takao Konishi and Tomoya Sato and Atsushi Tada and Takuya Koizumi and Yoshifumi Mizuguchi and Takahide Kadosaka and Ko Motoi and Yuta Kobayashi and Hirokazu Komoriyama and Yoshiya Kato and Miwa Sarashina and Kazunori Omote and Shingo Tsujinaga and Takuma Sato and Rui Kamada and Kiwamu Kamiya and Hiroyuki Iwano and Toshiyuki Nagai and Tatsuya Orimo and Hirofumi Kamachi and Akinobu Taketomi and Toshihisa Anzai},
doi = {10.1155/2021/5460816},
issn = {2090-6404},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {Case Rep Cardiol},
volume = {2021},
pages = {5460816},
abstract = {Acute myocardial infarction (AMI) caused by severe stenosis of left main coronary artery (LMCA) presenting with cardiogenic shock and pulmonary edema during noncardiac surgery is uncommon, but a catastrophic event. A 77-year-old male with cholangiocarcinoma underwent hepatectomy. During the surgery, he presented with cardiogenic shock, which did not respond to infusion administration or vasopressor. A transesophageal echocardiogram revealed anterior, septal, and lateral severe hypokinesia and impaired left ventricular function. Emergent coronary angiogram showed severe stenosis of LMCA. The patient underwent primary percutaneous coronary intervention (PCI) under the support of intra-aortic balloon pump, followed by extracorporeal membrane oxygenation. The chest roentgenogram showed pulmonary edema. Two days after PCI, he successfully underwent hepatectomy and bile duct resection. Early identification of the cause of hemodynamic instability during noncardiac surgery and invasive strategy are important for minimizing the myocardial injury and improving clinical outcomes in AMI of LMCA.},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Acute myocardial infarction (AMI) caused by severe stenosis of left main coronary artery (LMCA) presenting with cardiogenic shock and pulmonary edema during noncardiac surgery is uncommon, but a catastrophic event. A 77-year-old male with cholangiocarcinoma underwent hepatectomy. During the surgery, he presented with cardiogenic shock, which did not respond to infusion administration or vasopressor. A transesophageal echocardiogram revealed anterior, septal, and lateral severe hypokinesia and impaired left ventricular function. Emergent coronary angiogram showed severe stenosis of LMCA. The patient underwent primary percutaneous coronary intervention (PCI) under the support of intra-aortic balloon pump, followed by extracorporeal membrane oxygenation. The chest roentgenogram showed pulmonary edema. Two days after PCI, he successfully underwent hepatectomy and bile duct resection. Early identification of the cause of hemodynamic instability during noncardiac surgery and invasive strategy are important for minimizing the myocardial injury and improving clinical outcomes in AMI of LMCA.
17.
Konishi, Takao; Saiin, Kohei; Tamaki, Youji; Natsui, Hiroyuki; Sato, Tomoya; Takenaka, Sakae; Tada, Atsushi; Mizuguchi, Yoshifumi; Kobayashi, Yuta; Komoriyama, Hirokazu; Kato, Yoshiya; Sato, Takuma; Kamada, Rui; Kamiya, Kiwamu; Nagai, Toshiyuki; Tanaka, Shinya; Anzai, Toshihisa
In: Cardiol J, vol. 28, no. 5, pp. 794–795, 2021, ISSN: 1898-018X.
@article{pmid34494252,
title = {The effectiveness of drug-coated balloons for two dissimilar calcific lesions assessed by near-infrared spectroscopy intravascular ultrasound and optical coherence tomography},
author = {Takao Konishi and Kohei Saiin and Youji Tamaki and Hiroyuki Natsui and Tomoya Sato and Sakae Takenaka and Atsushi Tada and Yoshifumi Mizuguchi and Yuta Kobayashi and Hirokazu Komoriyama and Yoshiya Kato and Takuma Sato and Rui Kamada and Kiwamu Kamiya and Toshiyuki Nagai and Shinya Tanaka and Toshihisa Anzai},
doi = {10.5603/CJ.2021.0091},
issn = {1898-018X},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {Cardiol J},
volume = {28},
number = {5},
pages = {794--795},
keywords = {},
pubstate = {published},
tppubtype = {article}
}