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Tahara T, Usui E, Hada M, Ueno H, Kakuta T. Multimodality Imaging of Fabry Disease Cardiomyopathy Complicated With Coronary Vasospasm. JACC Case Rep 2024; 29:102257. [PMID: 38645294 PMCID: PMC11031653 DOI: 10.1016/j.jaccas.2024.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/29/2023] [Accepted: 01/23/2024] [Indexed: 04/23/2024]
Abstract
A 41-year-old man with resting angina was diagnosed with a coronary vasospasm and subsequently with Fabry disease exhibiting low serum α-galactosidase A activity. High computed tomography (CT)-derived extracellular volume was detected in the apical inferior wall of the left ventricle suggesting myocardial fibrosis, potentially from vasospasm-related ischemia and/or microvascular dysfunction.
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Affiliation(s)
- Tomohiro Tahara
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tokyo, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tokyo, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tokyo, Japan
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tokyo, Japan
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2
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Kinoshita D, Suzuki K, Usui E, Hada M, Yuki H, Niida T, Minami Y, Lee H, McNulty I, Ako J, Ferencik M, Kakuta T, Jang IK. High-Risk Plaques on Coronary Computed Tomography Angiography: Correlation With Optical Coherence Tomography. JACC Cardiovasc Imaging 2024; 17:382-391. [PMID: 37715773 DOI: 10.1016/j.jcmg.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Although patients with high-risk plaque (HRP) on coronary computed tomography angiography (CTA) are reportedly at increased risk for future cardiovascular events, individual HRP features have not been systematically validated against high-resolution intravascular imaging. OBJECTIVES The aim of this study was to correlate HRP features on CTA with plaque characteristics on optical coherence tomography (OCT). METHODS Patients who underwent both CTA and OCT before coronary intervention were enrolled. Plaques in culprit vessels identified by CTA were evaluated with the use of OCT at the corresponding sites. HRP was defined as a plaque with at least 2 of the following 4 features: positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC). Patients were followed for up to 3 years. RESULTS The study included 448 patients, with a median age of 67 years and of whom 357 (79.7%) were male, and 203 (45.3%) presented with acute coronary syndromes. A total of 1,075 lesions were analyzed. All 4 HRP features were associated with thin-cap fibroatheroma. PR was associated with all OCT features of plaque vulnerability, LAP was associated with lipid-rich plaque, macrophage, and cholesterol crystals, NRS was associated with cholesterol crystals, and SC was associated with microvessels. The cumulative incidence of the composite endpoint (target vessel nontarget lesion revascularization and cardiac death) was significantly higher in patients with HRP than in those without HRP (4.7% vs 0.5%; P = 0.010). CONCLUSIONS All 4 HRP features on CTA were associated with features of vulnerability on OCT. (Massachusetts General Hospital and Tsuchiura Kyodo General Hospital Coronary Imaging Collaboration; NCT04523194).
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Affiliation(s)
- Daisuke Kinoshita
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Keishi Suzuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Takayuki Niida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea.
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Hanyu Y, Hoshino M, Usui E, Sugiyama T, Kanaji Y, Hada M, Nagamine T, Nogami K, Ueno H, Sakamoto T, Yonetsu T, Sasano T, Kakuta T. Combined Assessment of Fractional Flow Reserve and Coronary Flow Velocity Reserve after Drug-Eluting Stent Implantation. J Am Soc Echocardiogr 2024; 37:428-438. [PMID: 38122836 DOI: 10.1016/j.echo.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Coronary flow velocity reserve (CFVR) can be measured noninvasively using stress transthoracic Doppler echocardiography (S-TDE). The prognostic significance of S-TDE-derived CFVR after percutaneous coronary intervention (PCI) remains unknown. The aim of this study was to investigate the prognostic value of post-PCI CFVR and its additional efficacy to fractional flow reserve (FFR) in patients undergoing elective PCI. METHODS A retrospective study was conducted involving 187 consecutive patients with chronic coronary syndrome who underwent elective PCI guided by FFR for the left anterior descending coronary artery. Pre- and post-PCI wire-based FFR and CFVR assessments of the left anterior descending coronary artery using S-TDE were performed in all patients. The association between post-PCI clinical and physiologic parameters and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure, and unplanned remote target vessel revascularization, was evaluated. RESULTS Three-quarters of patients exhibited CFVR increase after PCI, while all patients showed FFR improvement. During a median follow-up period of 1.5 years, MACE occurred in 21 patients (11.2%). Among clinical demographics, patients with MACE had higher levels of N-terminal pro-brain natriuretic peptide compared with those without MACE (median, 615 pg/mL [interquartile range, 245-1,500 pg/mL] vs 180 pg/mL [interquartile range, 70-559 pg/mL]; P = .010). Post-PCI S-TDE-derived CFVR was lower in patients with MACE, while post-PCI FFR showed a nonsignificant tendency to be lower in patients with MACE. In a multivariable analysis, higher NT-proBNP (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.74; P = .038), post-PCI CFVR ≤ 2.0 (adjusted hazard ratio, 2.93; 95% CI, 1.16-7.40; P = .023), and post-PCI FFR ≤ 0.82 (adjusted hazard ratio, 3.93; 95% CI, 1.52-10.18; P = .005) were independently associated with MACE. CONCLUSIONS In patients with chronic coronary syndrome who underwent successful elective PCI for left anterior descending coronary artery, the combined assessment of S-TDE-derived post-PCI CFVR and post-PCI FFR provided a significant association with the occurrence of MACE.
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Affiliation(s)
- Yoshihiro Hanyu
- Division of Cardiovascular Medicine, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tomoyo Sugiyama
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tatsuya Sakamoto
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Taishi Yonetsu
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
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Matsuda K, Hoshino M, Usui E, Hanyu Y, Sugiyama T, Kanaji Y, Hada M, Nagamine T, Nogami K, Ueno H, Sayama K, Sakamoto T, Yonetsu T, Sasano T, Kakuta T. Noninvasive transthoracic doppler flow velocity and invasive thermodilution to assess coronary flow reserve. Quant Imaging Med Surg 2024; 14:421-431. [PMID: 38223097 PMCID: PMC10784095 DOI: 10.21037/qims-23-416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/14/2023] [Indexed: 01/16/2024]
Abstract
Background Coronary flow reserve (CFR) provides prognostication and coronary physiological information, including epicardial coronary stenosis and microvascular function. The relationship between stress transthoracic Doppler echocardiography (TDE)-derived coronary flow velocity reserve (CFRS-TDE) and thermodilution-derived coronary flow reserve (CFRthermo) before and after elective percutaneous coronary intervention (PCI) remains unclear. Methods This single-center prospective registry study evaluated patients who underwent fractional flow reserve (FFR)-guided elective PCI for left anterior descending artery (LAD) lesions with wire-based invasive physiological measurements and pre- and post-PCI stress TDE examinations. Results A total of 174 LAD lesions from 174 patients were included in the final analysis. A modest correlation was detected between the pre-PCI CFRS-TDE and the pre-PCI CFRthermo (r=0.383, P<0.001). The frequently used CFRS-TDE threshold of 2.0 corresponded to a pre-PCI CFRthermo of 2.18. Pre-PCI CFRS-TDE underestimated pre-PCI CFRthermo [1.89 (1.44-2.31) vs. 2.05 (1.38-2.93), P<0.001]. Both CFRS-TDE and CFRthermo increased significantly post-PCI [pre-PCI CFRS-TDE 1.89 vs. post-PCI CFRS-TDE 2.33, P<0.001; pre-PCI CFRthermo 2.05 (1.38-2.93) vs. post-PCI CFRthermo 2.59 (1.63-3.55), P<0.001]. In contrast, there was no significant relationship between changes in CFRS-TDE and changes in CFRthermo after PCI (r=0.008, P=0.915) or between post-PCI CFRS-TDE and post-PCI CFRthermo (r=0.054, P=0.482). Conclusions Pre-PCI CFRS-TDE and CFRthermo are modestly correlated, but post-PCI CFRS-TDE and CFRthermo have no correlation. CFRS-TDE and CFRthermo are not interchangeable, particularly post-PCI, suggesting that the two metrics represent different coronary physiologies after PCI.
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Affiliation(s)
- Kazuki Matsuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihiro Hanyu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kodai Sayama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuya Sakamoto
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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Hada M, Hoshino M, Sugiyama T, Kanaji Y, Usui E, Hanyu Y, Nagamine T, Nogami K, Ueno H, Matsuda K, Sakamoto T, Yonetsu T, Sasano T, Kakuta T. Diagnostic value of computed tomography myocardial perfusion imaging to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary artery disease. Quant Imaging Med Surg 2023; 13:8423-8434. [PMID: 38106253 PMCID: PMC10722031 DOI: 10.21037/qims-23-618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/07/2023] [Indexed: 12/19/2023]
Abstract
Background Computed tomography myocardial perfusion (CT-MP) has reported usefulness in assessing hemodynamically significant epicardial coronary artery lesions. However, the diagnostic ability of the absolute coronary flow using CT-MP to detect coronary microvascular dysfunction (CMD) remains elusive. This prospective cohort study aimed to assess the diagnostic value of CT-MP in evaluating coexisting CMD in patients with functionally significant epicardial coronary stenosis and to analyze the predictive factors of lesions with CMD. Methods Sixty-eight patients with chronic coronary syndrome (CCS) and de novo single functionally significant stenosis [fractional flow reserve (FFR) ≤0.80] were studied. CMD was defined as an index of microcirculatory resistance ≥25. We compare clinical background and CT-MP findings between patients with and without CMD (CMD, n=29; non-CMD, n=39). CT-MP, and quantitative and qualitative plaque assessments were included in computed tomography angiography assessment. Logistic regression analysis was performed to predict CMD. Results FFR, invasive wire-derived coronary flow reserve (CFRwire) and index of microcirculatory resistance were 0.68 [interquartile range (IQR), 0.59-0.74], 1.71 (IQR, 1.24-2.88), and 22.6 (IQR, 15.1-34.5), respectively. The rest and hyperemic-myocardial blood flow (MBF) and CT-MP-derived CFR (CFRCT-MP) were 0.83 (0.64-1.03) mL/min/g, 2.14 (1.30-2.92) mL/min/g, and 2.19 (1.44-3.37), respectively. In the territories with CMD, hyperemic-MBF was significantly lower than in those without [1.68 (IQR, 0.84-2.44) vs. 2.31 (IQR, 1.67-3.34) mL/min/g, P=0.015] and the prevalence of CFRCT-MP <2.0 was higher in the lesions with CMD than in those without (62.1% vs. 28.2%, P=0.011), while FFR values were similar. Fibrofatty and necrotic core component volume was greater in the vessels with CMD than in those without [31.8 (IQR, 19.0-48.9) vs. 25.1 (IQR, 17.2-32.1) mm3, P=0.045]. Multivariable logistic regression analysis showed that hyperemic-MBF and fibrofatty and necrotic core component volume were independent predictors of CMD territories [odds ratio (OR) =0.583; 95% confidence interval (CI): 0.355-0.958; P=0.033 and OR =1.040; 95% CI: 1.010-1.070; P=0.011]. Conclusions Quantitative assessment of absolute coronary flow using pre-percutaneous coronary intervention (PCI) CT-MP, and comprehensive plaque analysis using computed tomography angiography may help detect coexisting subtended microvascular dysfunction in territories with functionally significant epicardial coronary lesions. Further studies are required to elucidate the clinical significance of coexisting CMD in patients with CCS undergoing PCI.
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Affiliation(s)
- Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Yoshihiro Hanyu
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Kazuki Matsuda
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Tatsuya Sakamoto
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki Prefecture, Japan
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Kanno Y, Yonetsu T, Aoyama N, Shiheido-Watanabe Y, Yoshikawa H, Ohmori M, Tashiro A, Niida T, Matsuda Y, Araki M, Usui E, Hada H, Umemoto T, Maejima Y, Isobe M, Iwata T, Sasano T. Erratum to "Association between periodontal disease and pericardial adipose tissue in patients with cardiovascular disease" [American Heart Journal Plus: Cardiol. Res. and Pract. Volume 30, 2023, 100,298]. Am Heart J Plus 2023; 35:100325. [PMID: 38511177 PMCID: PMC10945971 DOI: 10.1016/j.ahjo.2023.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
[This corrects the article DOI: 10.1016/j.ahjo.2023.100298.].
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Affiliation(s)
- Yoshinori Kanno
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Aoyama
- Department of Periodontology, Kanagawa Dental University, Kanagawa, Japan
| | - Yuka Shiheido-Watanabe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Yoshikawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mari Ohmori
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Tashiro
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Niida
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Matsuda
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroto Hada
- Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Ueno H, Hoshino M, Usui E, Sugiyama T, Kanaji Y, Hada M, Misawa T, Nagamine T, Hanyu Y, Nogami K, Sayama K, Matsuda K, Sakamoto T, Yonetsu T, Sasano T, Kakuta T. Prognostic Implications of Fractional Flow Reserve and Coronary Flow Reserve After Drug-Eluting Stent Implantation. Circ J 2023:CJ-23-0293. [PMID: 37853607 DOI: 10.1253/circj.cj-23-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) provides prognostic information, but limited data are available regarding prognostication using post-PCI coronary flow reserve (CFR). In this study we aimed to assess the prognostic value of post-procedural FFR and CFR for target vessel failure (TVF) after PCI.Methods and Results: This lesion-based post-hoc pooled analysis of previously published registry data involved 466 patients with chronic coronary syndrome with single-vessel disease who underwent pre- and post-PCI FFR and CFR measurements, and were followed-up to determine the predictors of TVF. The prognostic value of post-PCI CFR and FFR was compared with that of FFR or CFR alone. Post-PCI FFR/CFR discordant results were observed in 42.5%, and 10.3% of patients had documented TVF. Receiver-operating characteristic curve analysis revealed that the optimal cutoff values of post-PCI FFR and CFR to predict the occurrence of TVF were 0.85 and 2.26, respectively. Significant differences in TVF were detected according to post-PCI FFR (≤0.85 vs. >0.85, P=0.007) and post-PCI CFR (<2.26 vs. ≥2.26, P<0.001). Post-PCI FFR ≤0.85 and post-PCI CFR <2.26 were independent prognostic predictors. CONCLUSIONS After PCI completion, discordant results between FFR and CFR were not uncommon. Post-PCI CFR categorization showed incremental prognostic value for predicting TVF independent of post-PCI FFR risk stratification.
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Affiliation(s)
- Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | - Yoshihiro Hanyu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kodai Sayama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kazuki Matsuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tatsuya Sakamoto
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
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Hada M, Usui E, Wakasa N, Sasano T, Kakuta T. Impact of Impella on Coronary Flow Assessed by Transthoracic Doppler Echocardiography. Cureus 2023; 15:e46604. [PMID: 37933363 PMCID: PMC10625873 DOI: 10.7759/cureus.46604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/08/2023] Open
Abstract
A 66-year-old male patient presented with anterior ST-elevated myocardial infarction and cardiogenic shock. After placement of the Impella device (Abiomed, Danvers, Massachusetts), the patient successfully underwent percutaneous coronary intervention for lesions in the left anterior descending artery (LAD) and left circumflex artery. Coronary flow in the LAD according to the support setting was evaluated using transthoracic Doppler echocardiography during Impella weaning.
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Affiliation(s)
- Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JPN
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JPN
| | - Nobutaka Wakasa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JPN
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, JPN
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, JPN
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9
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Yonetsu T, Wakabayashi K, Mizukami T, Yamamoto MH, Yasuhara S, Kondo S, Oishi Y, Okabe T, Sugiyama T, Araki M, Takano M, Kobayashi N, Kimura S, Yamakami Y, Suwa S, Nakamura S, Mitomo S, Kakuta T, Usui E, Higuma T, Ako J, Minami Y, Iwasaki M, Shite J, Kozuki A, Saito S, Shishido K, Okura H, Naruse G, Uemura S, Kume T, Nanasato M, Dohi T, Ashikaga T, Otake H, Mori H, Sekimoto T, Sugizaki Y, Shinke T. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Rationale and Design of the ATLAS-OCT Study. Am J Cardiol 2023; 203:466-472. [PMID: 37562073 DOI: 10.1016/j.amjcard.2023.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023]
Abstract
Even after successful revascularization with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), subsequent adverse events still occur. Previous studies have suggested potential benefits of intravascular imaging, including optical coherence tomography (OCT). However, the feasibility of OCT-guided primary PCI has not been systematically examined in these patients. The ATLAS-OCT (ST-elevation Acute myocardial infarcTion and cLinicAl outcomeS treated by Optical Coherence Tomography-guided percutaneous coronary intervention) trial was designed to investigate the feasibility of OCT guidance during primary PCI for STEMI in experienced centers with expertise on OCT-guided PCI as a prospective, multicenter registry of consecutive patients with STEMI who underwent a primary PCI. The sites' inclusion criteria are as follows: (1) acute care hospitals providing 24/7 emergency care for STEMI, and (2) institutions where OCT-guided PCI is the first choice for primary PCI in STEMI. All patients with STEMI who underwent primary PCI at participating sites will be consecutively enrolled, irrespective of OCT use during PCI. The primary end point will be the rate of successful OCT imaging during the primary PCI. As an ancillary imaging modality to angiography, OCT provides morphologic information during PCI for the assessment of plaque phenotypes, vessel sizing, and PCI optimization. Major adverse cardiac events, defined as a composite of all-cause death, myocardial infarction, and target vessel revascularization at 1 year, will also be recorded. The ATLAS-OCT study will clarify the feasibility of OCT-guided primary PCI for patients with STEMI and further identify a suitable patient group for OCT-guided primary PCI.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takuya Mizukami
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Myong Hwa Yamamoto
- Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University, Tokyo, Japan
| | - Sakiko Yasuhara
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshitaka Okabe
- Division of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masamichi Takano
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Yosuke Yamakami
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Hyogo, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Genki Naruse
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Okayama, Japan
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Okayama, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yoichiro Sugizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
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10
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Hanyu Y, Hoshino M, Usui E, Sugiyama T, Kanaji Y, Hada M, Nagamine T, Nogami K, Ueno H, Sayama K, Matsuda K, Sakamoto T, Yonetsu T, Sasano T, Kakuta T. LTE: Scientific basis for retraction of article "microvascular resistance reserve in the presence of functionally significant epicardial stenosis and changes after revascularization". Physiol Rep 2023; 11:e15807. [PMID: 37753670 PMCID: PMC10523257 DOI: 10.14814/phy2.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 09/28/2023] Open
Affiliation(s)
- Yoshihiro Hanyu
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Masahiro Hoshino
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Eisuke Usui
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Tomoyo Sugiyama
- Department of Interventional CardiologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yoshihisa Kanaji
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Masahiro Hada
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Kai Nogami
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Hiroki Ueno
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Kodai Sayama
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Kazuki Matsuda
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Tatsuya Sakamoto
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Taishi Yonetsu
- Department of Interventional CardiologyTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
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11
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Kanaji Y, Hoshino M, Hada M, Ozcan I, Sugiyama T, Matsuda K, Sayama K, Nogami K, Nagamine T, Teng Y, Misawa T, Araki M, Usui E, Murai T, Yonetsu T, Sasano T, Kakuta T. Prognostic implications of unrecognized myocardial infarction and periprocedural myocardial injury on cardiac magnetic resonance imaging in patients with chronic coronary syndrome. Sci Rep 2023; 13:13567. [PMID: 37604987 PMCID: PMC10442331 DOI: 10.1038/s41598-023-40883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
This study sought to evaluate the prognostic implications of the presence of preprocedural unrecognized myocardial infarction (UMI) and periprocedural myocardial injury (PMI) evaluated by delayed gadolinium enhancement cardiac magnetic resonance (DE-CMR) in patients with chronic coronary syndrome (CCS) undergoing elective percutaneous coronary intervention (PCI). We enrolled 250 CCS patients scheduled for elective PCI. UMI was defined as the presence of late gadolinium enhancement (LGE) detected by pre-PCI CMR in the region without medical history of revascularization and/or MI. Periprocedural new occurrence or increased volume of LGE in the target territory detected by post-PCI CMR (PPL) were used to assess PMI. In the final analysis of 235 patients, UMI and PPL were detected in 43 patients (18.3%) and 45 patients (19.1%), respectively. During follow-up for a median of 2.2 years, major adverse cardiac events (MACE) occurred in 31 (13.2%) patients. On multivariable analysis, UMI and PPL remained as significant predictors of MACE after adjusting confounding factors (HR 4.62, 95% CI 2.24-9.54, P < 0.001, HR 2.33, 95% CI 1.11-4.91, P = 0.026). In patients with CCS who underwent elective PCI, UMI and PPL were independent predictors of worse outcomes. UMI and PPL on DE-CMR might provide additional potential insight for the risk stratification of patients undergoing elective PCI.
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Affiliation(s)
- Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Ilke Ozcan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kazuki Matsuda
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kodai Sayama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yun Teng
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
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12
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Kanno Y, Yonetsu T, Aoyama N, Shiheido-Watanabe Y, Yoshikawa H, Ohmori M, Tashiro A, Niida T, Matsuda Y, Araki M, Usui E, Hada H, Umemoto T, Maejima Y, Isobe M, Iwata T, Sasano T. Association between periodontal disease and pericardial adipose tissue in patients with cardiovascular disease. Am Heart J Plus 2023; 30:100298. [PMID: 38510923 PMCID: PMC10945929 DOI: 10.1016/j.ahjo.2023.100298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 03/22/2024]
Abstract
Background Periodontal disease (PD) is associated with an increased risk of cardiovascular disease (CVD). Pericardial adipose tissue (PAT) is known as a marker of progressive CVD. This study sought to assess the association between PD and PAT in patients with CVD. Methods We retrospectively investigated 135 patients admitted for CVD who underwent computed tomography coronary angiography (CTCA) and periodontal examinations. Periodontal assessment using the community periodontal index (CPI) was based on the probing pocket depth around teeth. Patients with CPI ≥3 were categorized as having PD. PAT volume was measured with a quantitative semi-automated procedure using CTCA images. Patients were divided into tertiles according to PAT volume. Baseline characteristics and PD findings were compared among the tertiles. Results Eighty-six patients were diagnosed with PD (63.7 %). Mean PAT volume was 181.4 ml, and patients were categorized as small-PAT (PAT <148.9 ml), intermediate-PAT (148.9 ml ≤ PAT ≤204.6 ml), and large-PAT (PAT >204.6 ml). The prevalence of PD was significantly higher in large-PAT (38/46, 82.6 %) than in small-PAT (18/45, 40.0 %) and intermediate-PAT (30/44, 68.2 %) patients. Multivariate logistic regression analysis showed that body weight, history of hypertension, and the presence of PD were independent predictors for large-PAT (odds ratio [OR]: 1.12, P < 0.001, OR: 3.97, P = 0.017, and OR: 4.18, P = 0.0078, respectively). Conclusion The presence and severity of PD were significantly correlated with PAT volume, which has been associated with progressive CVD. Further prospective studies are warranted to assess the impact of PD on the onset and outcomes of CVD.
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Affiliation(s)
- Yoshinori Kanno
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Aoyama
- Department of Periodontology, Kanagawa Dental University, Kanagawa, Japan
| | - Yuka Shiheido-Watanabe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Yoshikawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mari Ohmori
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Tashiro
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Niida
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Matsuda
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroto Hada
- Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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13
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Sugiyama T, Kanaji Y, Hoshino M, Hada M, Misawa T, Nagamine T, Teng Y, Nogami K, Ueno H, Matsuda K, Sayama K, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Relationship of OCT-defined plaque characteristics with CCTA-derived coronary inflammation and CMR-derived global coronary flow reserve in patients with acute coronary syndrome. PLoS One 2023; 18:e0286196. [PMID: 37228044 DOI: 10.1371/journal.pone.0286196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The relationship of layered plaque detected by optical coherence tomography (OCT) with coronary inflammation and coronary flow reserve (CFR) remains elusive. We aimed to investigate the association of OCT-defined layered plaque with pericoronary adipose tissue (PCAT) inflammation assessed by coronary computed tomography angiography (CCTA) and global (G)-CFR assessed by cardiac magnetic resonance imaging (CMR) in patients with acute coronary syndrome (ACS). METHODS We retrospectively investigated 88 patients with first ACS who underwent preprocedural CCTA, OCT imaging of the culprit lesion prior to primary/urgent percutaneous coronary intervention (PCI), and postprocedural CMR. All patients were divided into two groups according to the presence and absence of OCT-defined layered plaque at the culprit lesion. Coronary inflammation was assessed by the mean value of PCAT attenuation (-190 to -30 HU) of the three major coronary vessels. G-CFR was obtained by quantifying absolute coronary sinus flow at rest and during maximum hyperemia. CCTA and CMR findings were compared between the groups. RESULTS In a total of 88 patients, layered plaque was detected in 51 patients (58.0%). The patients with layered plaque had higher three-vessel-PCAT attenuation value (-68.58 ± 6.41 vs. -71.60 ± 5.21 HU, P = 0.021) and culprit vessel-PCAT attenuation value (-67.69 ± 7.76 vs. -72.07 ± 6.57 HU, P = 0.007) than those with non-layered plaque. The patients with layered plaque had lower G-CFR value (median, 2.26 [interquartile range, 1.78, 2.89] vs. 3.06 [2.41, 3.90], P = 0.003) than those with non-layered plaque. CONCLUSIONS The presence of OCT-defined layered plaque at the culprit lesion was associated with high PCAT attenuation and low G-CFR after primary/urgent PCI in patients with ACS. OCT assessment of culprit plaque morphology and detection of layered plaque may help identify increased pericoronary inflammation and impaired CFR, potentially providing the risk stratification in patients with ACS and residual microvascular dysfunction after PCI.
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Affiliation(s)
- Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yun Teng
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuki Matsuda
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kodai Sayama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tetsumin Lee
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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14
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Nagamine T, Hoshino M, Yonetsu T, Sugiyama T, Kanaji Y, Matsuda K, Sayama K, Ueno H, Nogami K, Hanyu Y, Misawa T, Hada M, Usui E, Sasano T, Kakuta T. Identification of Optical Coherence Tomography-Defined Coronary Plaque Erosion by Preprocedural Computed Tomography Angiography. J Am Heart Assoc 2023; 12:e029239. [PMID: 37183866 DOI: 10.1161/jaha.122.029239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background A previous coronary computed tomography (CT) angiographic study failed to discriminate optical coherence tomography-defined intact fibrous cap culprit lesions (IFC group) from those with ruptured fibrous caps (RFC group) in patients with coronary artery disease. This study aimed to evaluate the diagnostic efficacy of preprocedural coronary CT imaging in identifying subsequently performed optical coherence tomography-defined plaque rupture or erosion at culprit lesions in patients with non-ST-segment-elevation acute myocardial infarction. Methods and Results This study used data from 2 recently published studies that tested the hypothesis that coronary CT angiography (CCTA) before percutaneous coronary intervention may provide diagnostic information on the high-risk atherosclerotic burden in patients with non-ST-segment-elevation acute myocardial infarction. In the analysis of 186 patients, optical coherence tomography identified 106 RFC plaques and 80 IFC plaques as the culprit lesions. On CT, the prevalence of low-attenuation plaque, positive remodeling, napkin-ring sign, and spotty calcification were all significantly lower in the IFC group. The culprit vessel pericoronary adipose tissue inflammation and coronary artery calcium scores were significantly lower in the IFC group than in the RFC group. The absence of low-attenuation plaque, napkin-ring sign, zero coronary artery calcium, and low pericoronary adipose tissue inflammation were independent predictors of IFC. When stratified into 5 subgroups according to the number of these 4 CT factors, the prevalence of IFC was 8.3%, 20.8%, 44.6%, 75.6%, and 100% (P<0.001), respectively. Conclusions Preprocedural comprehensive coronary CT imaging, including coronary artery calcium and pericoronary adipose tissue inflammation assessment, can accurately and noninvasively identify optical coherence tomography-defined IFC or RFC culprit lesions.
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Affiliation(s)
- Tatsuhiro Nagamine
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Kazuki Matsuda
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Kodai Sayama
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yoshihiro Hanyu
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
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15
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Hanyu Y, Hoshino M, Usui E, Sugiyama T, Kanaji Y, Hada M, Nagamine T, Nogami K, Ueno H, Sayama K, Matsuda K, Sakamoto T, Yonetsu T, Sasano T, Kakuta T. Microvascular resistance reserve in the presence of functionally significant epicardial stenosis and changes after revascularization. Physiol Rep 2023; 11:e15627. [PMID: 36905154 PMCID: PMC10006606 DOI: 10.14814/phy2.15627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
In the presence of functionally significant epicardial lesions, microvascular resistance reserve (MRR) calculation needs incorporation of collateral flow. Coronary fractional flow reserve (FFRcor ) requiring coronary wedge pressure (Pw ), which is an essential part of the true MRR calculation, is reportedly estimated by myocardial FFR (FFRmyo ) not requiring Pw measurement. We sought to find an equation to calculate MRR without the need for Pw . Furthermore, we assessed changes in MRR after percutaneous coronary intervention (PCI). An equation to estimate FFRcor was developed from a cohort of 230 patients who underwent physiological measurements and PCI. Corrected MRR was calculated using this equation and compared with true MRR in 115 patients of the different set of the validation cohort. True MRR was calculated using FFRcor . FFRcor and FFRmyo showed a strong linear relationship (r2 = 0.86) and an equation was FFRcor = 1.36 × FFRmyo - 0.34. This equation provided no significant difference between corrected MRR and true MRR in the validation cohort. Pre-PCI lower coronary flow reserve and higher index of microcirculatory resistance were independent predictors of pre-PCI decreased true MRR. True MRR significantly decreased after PCI. In conclusion, MRR can be accurately corrected using an equation for FFRcor estimation without Pw .
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Affiliation(s)
- Yoshihiro Hanyu
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Masahiro Hoshino
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Eisuke Usui
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Tomoyo Sugiyama
- Department of Interventional CardiologyTokyo Medical and Dental UniversityTokyoJapan
| | - Yoshihisa Kanaji
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Masahiro Hada
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Kai Nogami
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Hiroki Ueno
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Kodai Sayama
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Kazuki Matsuda
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Tatsuya Sakamoto
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Taishi Yonetsu
- Department of Interventional CardiologyTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
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16
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Usui E, Nagaoka E, Ikeda H, Ohmori M, Tao S, Yonetsu T, Maejima Y, Arai H, Amemiya K, Ikeda Y, Sasano T. Fulminant myocarditis with COVID‐19 infection having normal C‐reactive protein and serial magnetic resonance follow‐up. ESC Heart Fail 2022; 10:1426-1430. [PMID: 36401586 PMCID: PMC10053182 DOI: 10.1002/ehf2.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022] Open
Abstract
A 44-year-old woman who was quarantined for 5 days after the diagnosis of coronavirus disease of 2019 (COVID-19) was transferred to our hospital with the complaint of chest pain. The patient was unvaccinated. Electrocardiography revealed ST elevation in the lateral leads. Echocardiographic biventricular dysfunction with oedematous wall thickening was identified. Cardiac enzyme levels were elevated; however, C-reactive protein (CRP) levels, and the coronary angiogram were normal. The patient required mechanical circulatory support to stabilize haemodynamics and was treated with remdesivir, baricitinib, and intravenous methylprednisolone. She recovered after 13 days of mechanical support. Serial cardiac magnetic resonance imaging revealed acute myocardial oedema and subsequent fibrosis. An endomyocardial biopsy on admission showed mild interstitial inflammatory infiltrates with endomyocardial fibrous thickening and mild interstitial fibrosis of the myocardium. Normal CRP levels suggested minor involvement of interleukin (IL)-6, supporting the efficacy of baricitinib.
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Affiliation(s)
- Eisuke Usui
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Hiroshi Ikeda
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
| | - Mari Ohmori
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery Tokyo Medical and Dental University Tokyo Japan
| | - Kisaki Amemiya
- Department of Pathology National Cerebral and Cardiovascular Center Osaka Japan
| | - Yoshihiko Ikeda
- Department of Pathology National Cerebral and Cardiovascular Center Osaka Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University 1‐5‐45, Yushima Bunkyo Tokyo Japan
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17
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Usui E, Kanno Y, Yonetsu T, Kinowaki Y, Akashi T, Sasano T. Multimodality Imaging of Possible Healed Plaque Erosion Pathologically Validated by Directional Coronary Atherectomy Specimens. JACC Cardiovasc Interv 2022; 15:2225-2227. [DOI: 10.1016/j.jcin.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
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18
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Noguchi M, Gkargkoulas F, Matsumura M, Kotinkaduwa LN, Hu X, Usui E, Fujimura T, Seike F, Salem H, Jin G, Li C, Yamamoto K, Sato T, Redfors B, Fall KN, Nazif TM, Ali ZA, Karmpaliotis D, Parikh SA, Weisz G, Collins MB, Privitera LT, Rabbani LE, Leon MB, Moses JW, Stone GW, Kirtane AJ, Mintz GS, Maehara A. Impact of Non-obstructive Left Main Coronary Artery Atherosclerosis on Long-Term Mortality. JACC Cardiovasc Interv 2022; 15:2206-2217. [DOI: 10.1016/j.jcin.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
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19
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Usui E, Matsumura M, Smilowitz NR, Mintz GS, Saw J, Kwong RY, Hada M, Mahmud E, Giesler C, Shah B, Bangalore S, Razzouk L, Hoshino M, Marzo K, Ali ZA, Merz CNB, Sugiyama T, Har B, Kakuta T, Hochman JS, Reynolds HR, Maehara A. Coronary Morphological Features in Women With Non-ST-Segment Elevation MINOCA and MI-CAD as Assessed by OCT. European Heart Journal Open 2022; 2:oeac058. [PMID: 36225342 PMCID: PMC9549740 DOI: 10.1093/ehjopen/oeac058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/01/2022] [Indexed: 12/02/2022]
Abstract
Aims We aimed to use optical coherence tomography (OCT) to identify differences in atherosclerotic culprit lesion morphology in women with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) compared with MI with obstructive coronary artery disease (MI-CAD). Methods and results Women with an OCT-determined atherosclerotic aetiology of non-ST segment elevation (NSTE)-MINOCA (angiographic diameter stenosis <50%) who were enrolled in the multicentre Women’s Heart Attack Research Program (HARP) study were compared with a consecutive series of women with NSTE-MI-CAD who underwent OCT prior to coronary intervention at a single institution. Atherosclerotic pathologies identified by OCT included plaque rupture, plaque erosion, intraplaque haemorrhage (IPH, a region of low signal intensity with minimum attenuation adjacent to a lipidic plaque without fibrous cap disruption), layered plaque (superficial layer with clear demarcation from the underlying plaque indicating early thrombus healing), or eruptive calcified nodule. We analysed 58 women with NSTE-MINOCA and 52 women with NSTE-MI-CAD. Optical coherence tomography features of underlying vulnerable plaque (thin-cap fibroatheroma) were less common in MINOCA (3 vs. 35%) than in MI-CAD. Intraplaque haemorrhage (47 vs. 2%) and layered plaque (31 vs. 12%) were more common in MINOCA than MI-CAD, whereas plaque rupture (14 vs. 67%), plaque erosion (8 vs. 14%), and calcified nodule (0 vs. 6%) were less common in MINOCA. The angle of ruptured cavity was smaller and thrombus burden was lower in MINOCA. Conclusion The prevalence of atherothrombotic culprit lesion subtype varied substantially between MINOCA and MI-CAD. A majority of culprit lesions in MINOCA had the appearance of IPH or layered plaque. Clinical Trial Registration Information Clinical Trial Name: Heart Attack Research Program- Imaging Study (HARP); ClinicalTrial.gov Identifier: NCT02905357; URL: https://clinicaltrials.gov/ct2/show/NCT02905357
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Affiliation(s)
- Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation , New York, NY
- New York-Presbyterian Hospital/Columbia University Irving Medical Center , New York, NY
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation , New York, NY
| | - Nathaniel R Smilowitz
- Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine , New York, NY
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation , New York, NY
| | | | | | - Masahiro Hada
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | | | | | - Binita Shah
- Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine , New York, NY
| | - Sripal Bangalore
- Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine , New York, NY
| | - Louai Razzouk
- Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine , New York, NY
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Kevin Marzo
- NYU Winthrop Hospital, NYU Long Island School of Medicine , Mineola, NY
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation , New York, NY
- St. Francis Hospital , Roslyn, NY
| | - C Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center , Los Angeles, CA
| | - Tomoyo Sugiyama
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Bryan Har
- University of Calgary , Calgary, AB , Canada
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Judith S Hochman
- Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine , New York, NY
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine , New York, NY
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation , New York, NY
- New York-Presbyterian Hospital/Columbia University Irving Medical Center , New York, NY
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20
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Matsuda J, Yonetsu T, Kato S, Nitta G, Hada Y, Negi K, Kanno Y, Nakao T, Niida T, Matsuda Y, Usui E, Hirasawa K, Umemoto T, Morita H, Inaba O, Matsumura Y, Sasano T. The impact of lesion complexity on predicting mortality of coronary artery disease patients after out-of-hospital cardiac arrest. Intern Emerg Med 2022; 17:1669-1678. [PMID: 35486329 DOI: 10.1007/s11739-022-02986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Coronary artery disease (CAD) is the most frequent cause of out-of-hospital cardiac arrest (OHCA). Nevertheless, there have been limited studies focusing on the impact of lesion complexity on resuscitated CAD patients. The purpose of the present study was to investigate the association between coronary lesion complexity and the mortality of CAD patients after OHCA. METHODS From pooled database of two centers, which comprised 706 successfully resuscitated OHCA patients, 172 patients undergoing coronary angiography were retrospectively investigated. A total of 148 patients exhibited coronary stenosis on angiogram and were included in the final analysis. Baseline characteristics, pre-and post-hospital care, general status after resuscitation and angiographical findings were compared between the patients who deceased within 30 days and those who survived and the predictors of 30-day mortality were determined. RESULTS Ninety-four patients (63.5%) survived at 30 days. Bystander cardiopulmonary resuscitation (CPR) (Odds ratio (OR) 0.36; 95% confidence interval (CI) 0.14-0.96; P = 0.041), revascularization of coronary stenosis (OR 0.15; 95% CI 0.19-0.86; P < 0.001), GRACE risk score (OR 1.04; 95% CI 1.02-1.05; P < 0.001) and SYNTAX score (OR 1.07; 95% CI 1.01-1.13; P = 0.025) were independent predictors of 30-day mortality. As multiple predictors such as bystander CPR, GRACE score and SYNTAX score were combined, the 30-day mortality gradually deteriorated. CONCLUSIONS In addition to bystander CPR, GRACE score and revascularization, SYNTAX score independently predicted 30-day mortality of CAD patients after OHCA.
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Affiliation(s)
- Junji Matsuda
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan.
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Shunichi Kato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yasuaki Hada
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Ken Negi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yoshinori Kanno
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Toshihiko Nakao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Takayuki Niida
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Yuji Matsuda
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Kensuke Hirasawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Hideki Morita
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yutaka Matsumura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
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21
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Chen Z, Matsumura M, Mintz GS, Noguchi M, Fujimura T, Usui E, Seike F, Hu X, Jin G, Li C, Salem H, Fall KN, Shlofmitz E, Kirtane AJ, Cao JJ, Moses JW, Ali ZA, Jeremias A, Shlofmitz RA, Maehara A. Prevalence and Impact of Neoatherosclerosis on Clinical Outcomes After Percutaneous Treatment of Second-Generation Drug-Eluting Stent Restenosis. Circ Cardiovasc Interv 2022; 15:e011693. [PMID: 36126137 DOI: 10.1161/circinterventions.121.011693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical and morphological factors associated with lipidic versus calcified neoatherosclerosis within second-generation drug-eluting stents and the impact of lipidic versus calcified neoatherosclerosis on long-term outcomes after repeat intervention have not been well studied. METHODS A total of 512 patients undergoing optical coherence tomography before percutaneous coronary intervention for second-generation drug-eluting stents in-stent restenosis were included. Neoatherosclerosis was defined as lipidic or calcified neointimal hyperplasia in ≥3 consecutive frames or ruptured lipidic neointimal hyperplasia. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, or clinically driven target lesion revascularization). RESULTS The overall prevalence of neoatherosclerosis was 28.5% (146/512): 56.8% lipidic, 30.8% calcified, and 12.3% both lipidic and calcific. The prevalence increased as a function of time from stent implantation: 20% at 1 to 3 years, 30% at 3 to 7 years, and 75% >7 years. Renal insufficiency, poor lipid profile, and time from stent implantation were associated with lipidic neoatherosclerosis, whereas severe renal insufficiency, female sex, and time from stent implantation were associated with calcified neoatherosclerosis. Multivariable Cox regression revealed that female sex and lipidic neoatherosclerosis were associated with more target lesion failure, whereas stent age and final minimum lumen diameter after reintervention were related to lower target lesion failure. Calcified neoatherosclerosis was not related to adverse events after reintervention for in-stent restenosis given a large enough minimum lumen diameter was achieved. CONCLUSIONS Lipidic but not calcified neoatherosclerosis was associated with poor subsequent outcomes after repeat revascularization if optimal stent expansion was achieved in lesions with calcified neoatherosclerosis.
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Affiliation(s)
- Zhaoyang Chen
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.).,Department of Cardiology, Union Hospital, Fujian Medical University, China (Z.C.)
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Masahiko Noguchi
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Tatsuhiro Fujimura
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Eisuke Usui
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Fumiyasu Seike
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Xun Hu
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Ge Jin
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Chenguang Li
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Hanan Salem
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Khady N Fall
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Evan Shlofmitz
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.)
| | - Ajay J Kirtane
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - J Jane Cao
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.)
| | - Jeffrey W Moses
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Richard A Shlofmitz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
| | - Akiko Maehara
- St. Francis Hospital, Roslyn, NY (Z.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., E.S., J.J.C.' J.W.M., Z.A.A., A.J., A.M.).,Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center (X.C., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., A.J.K., J.W.M., Z.A.A., A.M.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (Z.C., M.M., G.S.M., M.N., T.F., E.U., F.S., X.H., G.J., C.L., H.S., K.N.F., A.J.K., J.W.M., Z.A.A., A.J., R.A.S., A.M.)
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22
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Sugiyama T, Kanaji Y, Hoshino M, Hada M, Misawa T, Nagamine T, Teng Y, Matsuda K, Sayama K, Araki M, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Relationship Between Unrecognized Myocardial Infarction and Underlying Coronary Plaque Characteristics on Optical Coherence Tomography. JACC Cardiovasc Imaging 2022; 15:1830-1832. [DOI: 10.1016/j.jcmg.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
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23
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Salem H, Mintz GS, Matsumura M, Zhang M, Usui E, Seike F, Fujimura T, Noguchi M, Hu X, Jin G, Li C, Fall KN, Ali ZA, Kirtane AJ, Collins MB, Kodali SK, Nazif TM, Leon MB, Moses JW, Karmpaliotis D, Maehara A. Reasons for lesion uncrossability as assessed by intravascular ultrasound. Catheter Cardiovasc Interv 2022; 99:2028-2037. [PMID: 35419936 DOI: 10.1002/ccd.30202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/03/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions. BACKGROUND Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified. METHODS A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°. RESULTS Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270° 3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto-ostial lesion location and small vessels. CONCLUSIONS Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.
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Affiliation(s)
- Hanan Salem
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Medicine Department, Tanta University Hospitals, Faculty of Medicine - Tanta University, Tanta, Egypt
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mingyou Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Fumiyasu Seike
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Tatsuhiro Fujimura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Masahiko Noguchi
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Xun Hu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Ge Jin
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Chenguang Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Khady N Fall
- Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael B Collins
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Susheel K Kodali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Tamim M Nazif
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiovascular Medicine, New York-Presbyterian Hospita, Columbia University Irving Medical Center, New York, New York, USA
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24
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Zhang W, Mintz GS, Cao Y, Matsumura M, Lee T, Hoshino M, Usui E, Kanaji Y, Murai T, Yonetsu T, Kakuta T, Maehara A. Clinical determinants of coronary artery disease burden and vulnerability using optical coherence tomography co-registered with intravascular ultrasound. Coron Artery Dis 2022; 33:114-124. [PMID: 34411011 DOI: 10.1097/mca.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated clinical determinants of disease burden and vulnerability using optical coherence tomography (OCT) co-registered with intravascular ultrasound (IVUS) in a large cohort of patients. METHODS A total of 704 patients [44.5% with acute coronary syndromes (ACS)] underwent coronary intervention. IVUS plaque burden and OCT lipid, macrophage and calcium indices and the presence of thrombus, plaque rupture and thin-cap fibroatheroma (TCFA) were analyzed. RESULTS Median patient age was 66 years with 81.8% men, 34.4% with diabetes mellitus and 15.5% with preadmission statins. Median lesion length was 25.7 mm, and 33.0% had a TCFA. Adjusted models indicated (1) older patient age was related to more calcium, but fewer macrophages; (2) men were related to more thrombus with plaque rupture while women had more thrombus without plaque rupture; (3) ACS presentation was related to morphological acute thrombotic events (more thrombus with/without rupture) and plaque vulnerability (more TCFA, more lipid and macrophages and larger plaque burden); (4) diabetes mellitus was related to a greater atherosclerotic disease burden (more lipid and calcium and larger plaque burden) and more thrombus without rupture; (5) hypertension was related to more macrophages; (6) current smoking was related to less calcium; and (7) renal insufficiency and preadmission statin therapy were not independently associated with IVUS or OCT plaque morphology. CONCLUSION Patient characteristics, especially diabetes mellitus and aging, affect underlying atherosclerotic burden, among which a greater lipidic burden along with sex differences influence local thrombotic morphology that affects clinical presentation.
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Affiliation(s)
- Wenbin Zhang
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation
| | - Yang Cao
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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25
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Usui E, Yonetsu T, Ohmori M, Kanno Y, Nakao M, Niida T, Matsuda Y, Matsuda J, Umemoto T, Misawa T, Hada M, Hoshino M, Kanaji Y, Sugiyama T, Kakuta T, Sasano T. Predictors of Near-Infrared Spectroscopy-Detected Lipid-Rich Plaques by Optical Coherence Tomography-Defined Morphological Features in Patients With Acute Coronary Syndrome. Front Cardiovasc Med 2022; 9:842914. [PMID: 35265688 PMCID: PMC8899395 DOI: 10.3389/fcvm.2022.842914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNear-infrared spectroscopy (NIRS) provides the localization of lipid-rich components in coronary plaques. However, morphological features in NIRS-detected lipid-rich plaques (LRP) are unclear.MethodsA total of 140 de novo culprit lesions in 140 patients with the acute coronary syndrome (ACS) who underwent NIRS and optical coherence tomography (OCT) examinations for the culprit lesions at the time of percutaneous coronary interventions were investigated. We defined a NIRS-LRP as a lesion with a maximum lipid core burden index of 4 mm [LCBI4mm] > 500 in the culprit plaque. Clinical demographics, angiographic, and OCT findings were compared between the patients with NIRS-LRP (n = 54) vs. those without NIRS-LRP (n = 86). Uni- and multivariable logistic regression analyses were performed to examine the independent OCT morphological predictors for NIRS-LRP.ResultsClinical demographics showed no significant differences between the two groups. The angiographic minimum lumen diameter was smaller in the NIRS-LRP group than in the non- NIRS-LRP group. In OCT analysis, the minimum flow area was smaller; lipid angle, lipid length, the prevalence of thin-cap fibroatheroma, and cholesterol crystals were greater in the NIRS-LRP group than in the non-NIRS-LRP group. Plaque rupture and thrombi were more frequent in the NIRS-LRP group, albeit not significant. In a multivariable logistic regression analysis, presence of thin-cap fibroatheroma [odds ratio (OR): 2.56; 95% CI: 1.12 to 5.84; p = 0.03] and cholesterol crystals (OR: 2.90; 95% CI: 1.20 to 6.99; p = 0.02) were independently predictive of NIRS-LRP.ConclusionsIn ACS culprit lesions, OCT-detected thin-cap fibroatheroma and cholesterol crystals rather than plaque rupture and thrombi were closely associated with a great lipid-core burden.
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Affiliation(s)
- Eisuke Usui
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Taishi Yonetsu
| | - Mari Ohmori
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Kanno
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Nakao
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takayuki Niida
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Matsuda
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junji Matsuda
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Umemoto
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Misawa
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tetsuo Sasano
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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26
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Kanaji Y, Sugiyama T, Hoshino M, Yasui Y, Nogami K, Ueno H, Yun T, Nagamine T, Misawa T, Hada M, Yamaguchi M, Hamaya R, Usui E, Murai T, Yonetsu T, Sasano T, Kakuta T. Prognostic Value of Coronary Sinus Flow Quantification by Cardiac Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e023519. [PMID: 35179042 PMCID: PMC9075062 DOI: 10.1161/jaha.121.023519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study aimed to evaluate the prognostic value of hyperemic coronary sinus flow (h-CSF) and global coronary flow reserve (g-CFR) obtained by phase-contrast cine-magnetic resonance imaging in patients with acute myocardial infarction (MI). Methods and Results This retrospective study analyzed patients with acute MI (n=523) who underwent primary (ST-segment-elevation MI) or urgent (non-ST-segment-elevation MI) percutaneous coronary intervention. Absolute coronary sinus blood flow (CSF) at rest and during vasodilator stress hyperemia was quantified at 30 days (24-36 days) after the index infarct-related lesion percutaneous coronary intervention and revascularization of functionally significant non-infarct-related lesions. We used Cox proportional hazards regression modeling to examine the association between h-CSF, g-CFR, and major adverse cardiac events defined as all-cause death, nonfatal MI, hospitalization for congestive heart failure, and stroke. Finally, 325 patients with ST-segment-elevation MI (62.1%) and 198 patients with non-ST-segment-elevation MI (37.9%) were studied over a median follow-up of 2.5 years. The rest CSF, h-CSF, and g-CFR were 0.94 (0.68-1.26) mL/min per g, 2.05 (1.42-2.73) mL/min per g, and 2.17 (1.54-3.03), respectively. Major adverse cardiac events occurred in 62 patients, and Cox proportional hazards analysis showed that h-CSF and g-CFR were independent predictors of major adverse cardiac events (h-CSF: hazard ratio [HR], 0.64; 95% CI, 0.47-0.88; P=0.005; g-CFR: HR, 0.62; 95% CI, 0.47-0.82; P=0.001). When stratified by h-CSF and g-CFR, cardiac event-free survival was the worst in patients with concordantly impaired h-CSF (<1.6 mL/min per g) and g-CFR (<1.7) (P<0.001). Conclusions Global coronary sinus flow quantification using phase-contrast cine-magnetic resonance imaging provided significant prognostic information independent of infarction size and conventional risk factors in patients with acute MI undergoing revascularization.
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Affiliation(s)
- Yoshihisa Kanaji
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yumi Yasui
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Teng Yun
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tatsuhiro Nagamine
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masao Yamaguchi
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
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27
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Yamaguchi M, Hoshino M, Sugiyama T, Kanaji Y, Nogami K, Nagamine T, Misawa T, Hada M, Araki M, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Preprocedural transthoracic Doppler echocardiography to identify stenosis associated with increased coronary flow after revascularisation. Sci Rep 2022; 12:1667. [PMID: 35102261 PMCID: PMC8803832 DOI: 10.1038/s41598-022-05683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe benefit of percutaneous coronary intervention (PCI) has been reported to be associated with functional stenosis severity defined by fractional flow reserve (FFR). This study aimed to investigate the predictive ability of preprocedural transthoracic Doppler echocardiography (TDE) for increased coronary flow. A total of 50 left anterior descending arteries (LAD) that underwent TDE examinations were analysed. Hyperaemic LAD diastolic peak velocity (hDPV) was used as a surrogate of volumetric coronary flow. The increase in coronary flow was evaluated by the metric of % hDPV-increase defined by 100× (post-PCI hDPV-pre-PCI hDPV)/pre-PCI hDPV. The two groups divided by the median value of % hDPV-increase were compared, and the determinants of a significant coronary flow increase defined as more than the median % hDPV-increase were explored. After PCI, FFR values improved in all cases. hDPV significantly increased from 53.0 to 76.0 mm/s (P < 0.01) and the median % hDPV-increase was 45%, while hDPV decreased in 10 patients. On multivariable analysis, pre-PCI FFR and hDPV were independent predictors of a significant coronary flow increase. Preprocedural TDE-derived hDPV provided significant improvement of identification of lesions that benefit from revascularisation with respect to significant coronary flow increase.
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28
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Yamaguchi M, Hoshino M, Sugiyama T, Kanaji Y, Nagamine T, Misawa T, Hada M, Araki M, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Association of near-infrared spectroscopy-defined lipid rich plaque with lesion morphology and peri-coronary inflammation on computed tomography angiography. Atherosclerosis 2022; 346:109-116. [DOI: 10.1016/j.atherosclerosis.2022.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/24/2021] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
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29
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Zhang M, Matsumura M, Usui E, Noguchi M, Fujimura T, Fall KN, Zhang Z, Nazif TM, Parikh SA, Rabbani LE, Kirtane AJ, Collins MB, Leon MB, Moses JW, Karmpaliotis D, Ali ZA, Mintz GS, Maehara A. Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions. Circ Cardiovasc Interv 2021; 14:e010296. [PMID: 34665658 DOI: 10.1161/circinterventions.120.010296] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Mingyou Zhang
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, The First Hospital of Jilin Univeristy, Changchun, Jilin, China (M.Z.)
| | - Mitsuaki Matsumura
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Eisuke Usui
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Masahiko Noguchi
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Tatsuhiro Fujimura
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Khady N Fall
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Zixuan Zhang
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Tamim M Nazif
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Sahil A Parikh
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - LeRoy E Rabbani
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Ajay J Kirtane
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Michael B Collins
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Martin B Leon
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Jeffrey W Moses
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,DeMatteis Cardiovascular Institute, St. Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | - Dimitri Karmpaliotis
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Ziad A Ali
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,DeMatteis Cardiovascular Institute, St. Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | - Gary S Mintz
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
| | - Akiko Maehara
- Clinical Trial Center, Cardiovascular Research Foundation, New York, NY (M.Z., M.M., E.U., M.N., T.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.).,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.Z., E.U., M.N., T.F., KN.F., Z.Z., T.M.N., S.A.P., L.E.R., A.J.K., M.B.C., M.B.L., J.W.M., D.K., Z.A.A., G.S.M., A.M.)
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30
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Noguchi M, Dohi T, Okazaki S, Matsumura M, Takeuchi M, Endo H, Kato Y, Okai I, Nishiyama H, Doi S, Iwata H, Isoda K, Usui E, Fujimura T, Seike F, Mintz GS, Miyauchi K, Daida H, Minamino T, Maehara A. Comparison of 6-month vascular healing response after bioresorbable polymer versus durable polymer drug-eluting stent implantation in patients with acute coronary syndromes: A randomized serial optical coherence tomography study. Catheter Cardiovasc Interv 2021; 98:E677-E686. [PMID: 34357673 PMCID: PMC9292175 DOI: 10.1002/ccd.29892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
Objectives This study was conducted to use optical coherence tomography (OCT) to compare vascular healing between bioresorbable polymer (BP) and durable polymer (DP) everolimus‐eluting stents (EES) in patients with acute coronary syndromes (ACS). Background Whether BP‐EES induce better vascular healing compared to contemporary DP‐EES remains controversial, especially for ACS. Methods In this prospective, randomized, non‐inferiority trial, we used OCT to compare 6‐month vascular healing in patients with ACS randomized to BP versus DP‐EES: percent strut coverage (primary endpoint, non‐inferiority margin of 2.0%) and neointimal thickness and percent neointimal hyperplasia (NIH) volume. As an exploratory analysis, morphological factors related to the endpoints and the effect of underlying lipidic plaque on stent healing were evaluated. Results A total of 104 patients with ACS were randomly assigned to BP‐EES (n = 52) versus DP‐EES (n = 52). Of these, 86 patients (40 BP‐EES and 46 DP‐EES) were included in the final OCT analyses. Six‐month percent strut coverage of BP‐EES (83.6 ± 11.4%) was not non‐inferior compared to those of DP‐EES (81.6 ± 13.9%), difference 2.0% (lower 95% confidence interval‐2.6%), pnon‐inferiority = 0.07. There were no differences in neointimal thickness 70.0 ± 33.9 μm versus 67.2 ± 33.9 μm, p = 0.71; and percent NIH volume 7.5 ± 4.7% versus 7.3 ± 5.3%, p = 0.85. By multivariable linear regression analysis, stent type was not associated with percent strut coverage or percent NIH volume; however, percent baseline embedded struts or stent expansion was positively associated with percent NIH volume. Greater NIH volume was observed in lipidic compared with non‐lipidic segments (8.7 ± 5.6% vs. 6.1 ± 5.2%, p = 0.005). Conclusions Six‐month strut coverage of BP‐EES was not non‐inferior compared to those of DP‐EES in ACS patients. Good stent apposition and expansion were independently associated with better vascular healing.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Nishiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Tatsuhiro Fujimura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Fumiyasu Seike
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Division of Cardiology, Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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31
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Usui E, Matsumura M, Mintz GS, Zhou Z, Hada M, Yamaguchi M, Hoshino M, Kanaji Y, Sugiyama T, Murai T, Lee T, Yonetsu T, Kakuta T, Kunio M, Tearney GJ, Maehara A. Clinical outcomes of low-intensity area without attenuation and cholesterol crystals in non-culprit lesions assessed by optical coherence tomography. Atherosclerosis 2021; 332:41-47. [PMID: 34384955 DOI: 10.1016/j.atherosclerosis.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Pathologists have shown that intraplaque hemorrhage contributes to plaque destabilization and is frequently co-located with cholesterol crystals (CC). Optical coherence tomography (OCT)-detected low-intensity area without attenuation (LIA) may represent intraplaque hemorrhage. We aimed to examine the prevalence and impact of OCT-detected LIA + CC in untreated non-culprit lesions (NCLs) on subsequent major adverse cardiac events (MACE). METHODS OCT imaged NCLs in the culprit vessel in the patients who underwent OCT-guided percutaneous coronary intervention were included. An NCL was a lesion with >90° of diseased arc (≥0.5 mm intimal thickness), length ≥2 mm, and >5 mm away from stent edge. CC was defined as a thin linear region of high intensity. NCL-related MACE includes cardiac death, myocardial infarction, or ischemia-driven revascularization attributed to NCLs. RESULTS We included 735 NCLs in 566 patients with 2.5 ± 0.7 years follow-up. The prevalence of concomitant LIA with CC (LIA + CC) was 15.5% (114/735). Three-year NCL-related MACE rate was 2.9% (20 events) at a lesion level and 15.6% (78 events) at a patient level. Untreated NCLs with LIA + CC had an increased risk for NCL-MACE (adjusted hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.27-7.50, p = 0.01) along with thin-cap fibroatheroma (adjusted HR 4.38, 95% CI 1.44-13.30, p < 0.01) and minimum lumen area <3.5 mm2 (adjusted HR 5.33, 95% CI 1.94-14.62, p < 0.01). Patients having ≥1 untreated NCL with LIA + CC had an increased risk for NCL-MACE (adjusted HR 1.95, 95% CI 1.19-3.19, p < 0.01). CONCLUSIONS An OCT-detected LIA + CC in an NCL was associated with subsequent NCL-MACE.
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Affiliation(s)
- Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Masahiro Hada
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masao Yamaguchi
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tetsumin Lee
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Mie Kunio
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Canon U.S.A., Inc., Cambridge, MA, USA
| | - Guillermo J Tearney
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, USA.
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32
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Noguchi M, Gkargkoulas F, Matsumura M, Kotinkaduwa L, Hu X, Usui E, Fujimura T, Seike F, Redfors B, Fall KN, Kirtane A, Kodali S, Nazif TM, Ali ZA, Karmpaliotis D, Parikh S, Collins M, Privitera L, Rabbani LE, Stone G, Leon M, Moses J, Mintz GS, Maehara A. INTRAVASCULAR ULTRASOUND-DERIVED LEFT MAIN MINIMUM LUMEN AREA AND PLAQUE BURDEN PREDICT 12-YEAR CARDIAC MORTALITY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02417-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Seike F, Usui E, Matsumura M, Jeremias A, Shlofmitz E, Ali Z, Nguyen J, Porter C, Cao J, Pappas T, Petrossian G, Moses J, Yasuda K, Mintz G, Shlofmitz R, Maehara A. INTRACORONARY OPTICAL COHERENCE TOMOGRAPHY-DERIVED VIRTUAL FRACTIONAL FLOW RESERVE TO PREDICT POST-PCI OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01533-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Yamaguchi M, Yonetsu T, Hoshino M, Sugiyama T, Kanaji Y, Yasui Y, Nogami K, Ueno H, Nagamine T, Misawa T, Hada M, Sumino Y, Hamaya R, Usui E, Murai T, Lee T, Sasano T, Kakuta T. Clinical Significance of Increased Computed Tomography Attenuation of Periaortic Adipose Tissue in Patients With Abdominal Aortic Aneurysms. Circ J 2021; 85:2172-2180. [PMID: 33896902 DOI: 10.1253/circj.cj-20-1014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent imaging studies reported an association between vascular inflammation and progression of abdominal aortic aneurysm (AAA). This study investigated the clinical significance of periaortic adipose tissue inflammation derived from multidetector computed tomography angiography (MDCTA).Methods and Results:Patients with asymptomatic AAA (n=77) who underwent an index and >6 months follow-up MDCTA examinations were retrospectively investigated. MDCTA analysis included AAA diameter and the periaortic adipose tissue attenuation index (PAAI). The PAAI was defined as the mean CT attenuation value within a predefined range from -190 to -30 Hounsfield units of adipose tissue surrounding the AAA. The growth rate of the AAA was calculated as the change in diameter. AAA progression (AP) was defined as an AAA growth rate ≥5 mm/year. Univariate and multivariate logistic regression analysis were performed to determine the predictors of AP. AP was observed in 19 patients (24.7%), the median baseline AAA diameter was 38.9 mm (interquartile range [IQR] 32.7-42.9 mm), and the median growth rate was 3.1 mm/year (IQR 1.5-4.9 mm/year). Baseline AAA diameter (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.05-1.28; P=0.001) and PAAI (OR 1.12; 95% CI 1.05-1.20; P=0.004) were independent predictors of AP. CONCLUSIONS PAAI was an independent and significant predictor of AP, supporting the notion that local adipose tissue inflammation may contribute to aortic remodeling.
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Affiliation(s)
- Masao Yamaguchi
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Yumi Yasui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Hiroki Ueno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Yohei Sumino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
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Misawa T, Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Nagamine T, Nogami K, Yasui Y, Terada N, Kuramochi T, Usui E, Lee T, Yonetsu T, Sasano T, Kakuta T. Effect of contrast medium versus low-molecular-weight dextran for intracoronary optical coherence tomography in renal insufficiency. Int J Cardiovasc Imaging 2021; 37:2603-2615. [PMID: 33880712 DOI: 10.1007/s10554-021-02245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Low-molecular-weight dextran (LMWD) is considered a safe alternative to contrast media to displace blood during optical coherence tomography (OCT) imaging, but concerns remain. The purpose of this study was to investigate whether using LMWD for OCT protects against kidney injury in patients with renal insufficiency compared with contrast media. We retrospectively identified 474 patients with renal insufficiency (estimated glomerular filtration rate < 60 ml/min/1.73 m2) who underwent OCT during coronary angiography or percutaneous coronary intervention; 110 patients with LMWD plus contrast medium (LMWD group) and 364 patients with contrast medium exclusively (Contrast group). We evaluated differences between the two groups and performed propensity score-matched subgroup comparisons. Compared with the Contrast group, the LMWD group had worse baseline renal function, higher prevalence of diabetes mellitus and percutaneous coronary intervention history, higher C-reactive protein and N-terminal pro B-type natriuretic peptide levels, lower hemoglobin levels, and lower left ventricular ejection fraction. The median total volume of contrast medium in the Contrast group was 230.0 ml vs. 61.8 ml of LMWD in addition to 164.0 ml of contrast medium in the LMWD group. Renal function was consistently impaired in the LMWD group within 5 days, at 1-month, and 1-year follow-up (P < 0.001). Two propensity score-matched analyses adjusted for either total volume used or contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up. No protective benefit for renal function from using LMWD instead of contrast media for OCT was observed in patients with renal insufficiency.
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Affiliation(s)
- Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yumi Yasui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Noriko Terada
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tatsuhiko Kuramochi
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
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36
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Hada M, Yonetsu T, Sugiyama T, Kanaji Y, Hoshino M, Usui E, Araki M, Yamaguchi M, Misawa T, Nagamine T, Nogami K, Yasui Y, Hishikari K, Hikita H, Takahashi A, Sasano T, Kakuta T. Vascular Responses to First-Generation Sirolimus-Eluting Stents and Bare-Metal Stents Beyond 10 Years. Circ Rep 2021; 3:201-210. [PMID: 33842725 PMCID: PMC8024020 DOI: 10.1253/circrep.cr-21-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background:
There are limited data regarding differences in vascular responses between first-generation sirolimus-eluting stents (1G-SES) and bare-metal stents (BMS) >10 years after implantation. Methods and Results:
We retrospectively investigated 223 stents (105 1G-SES, 118 BMS) from 131 patients examined by optical coherence tomography (OCT) >10 years after implantation. OCT analysis included determining the presence or absence of a lipid-laden neointima, calcified neointima, macrophage accumulation, malapposition, and strut coverage. Neoatherosclerosis was defined as having lipid-laden neointima. OCT findings were compared between the 1G-SES and BMS groups, and the predictors of neoatherosclerosis were determined. The median stent age at the time of OCT examinations was 12.3 years (interquartile range 11.0–13.2 years). There were no significant differences in patient characteristics between the 1G-SES and BMS groups. On OCT analysis, there was no difference in the prevalence of neoatherosclerosis and calcification between 1G-SES and BMS. Multivariable logistic regression analysis revealed that stent size, stent length, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use were significant predictors of neoatherosclerosis. In addition, uncovered and malapposed struts were more prevalent with 1G-SES than BMS. Conclusions:
After >10 years since implantation, the prevalence of neoatherosclerosis was no different between 1G-SES and BMS, whereas uncovered struts and malapposition were significantly more frequent with 1G-SESs.
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Affiliation(s)
- Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Tokyo Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Yumi Yasui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
| | - Keiichi Hishikari
- Department of Cardiovascular Medicine, Yokosuka Kyosai Hospital Yokosuka Japan
| | - Hiroyuki Hikita
- Department of Cardiovascular Medicine, Yokosuka Kyosai Hospital Yokosuka Japan
| | - Atsushi Takahashi
- Department of Cardiovascular Medicine, Yokosuka Kyosai Hospital Yokosuka Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital Tsuchiura Japan
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37
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Misawa T, Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Nagamine T, Nogami K, Yasui Y, Usui E, Lee T, Yonetsu T, Sasano T, Kakuta T. Low-molecular-weight dextran for optical coherence tomography may not be protective against kidney injury in patients with renal insufficiency. World J Nephrol 2021; 10:8-20. [PMID: 33816153 PMCID: PMC8008983 DOI: 10.5527/wjn.v10.i2.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low-molecular-weight dextran (LMWD) is considered a safe alternative to contrast media for blood displacement during optical coherence tomography (OCT) imaging.
AIM To investigate whether the use of LMWD for OCT is protective against kidney injury in patients with advanced renal insufficiency.
METHODS In this retrospective cohort study, we identified 421 patients with advanced renal insufficiency (estimated glomerular filtration rate < 45 mL/min/1.73 m2) who underwent coronary angiography or percutaneous coronary intervention; 79 patients who used additional LMWD for OCT imaging (LMWD group) and 342 patients who used contrast medium exclusively (control group). We evaluated the differences between these two groups and performed a propensity score-matched subgroup comparison.
RESULTS The median total volume of contrast medium was 133.0 mL in the control group vs 140.0 mL in the LMWD group. Although baseline renal function was not statistically different between these two groups, the LMWD group demonstrated a strong trend toward the progression of renal insufficiency as indicated by the greater change in serum creatinine level during the 1-year follow-up compared with the control group. Patients in the LMWD group experienced worsening renal function more frequently than patients in the control group. Propensity score matching adjusted for total contrast media volume consistently indicated a trend toward worsening renal function in the LMWD group at the 1-year follow-up. Delta serum creatinine at 1-year follow-up was significantly greater in the LMWD group than that in the control group [0.06 (-0.06, 0.29) vs -0.04 (-0.23, 0.08) mg/dL, P = 0.001], despite using similar contrast volume.
CONCLUSION OCT using LMWD may not be protective against worsening renal function in patients with advanced renal insufficiency.
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Affiliation(s)
- Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Masao Yamaguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Yumi Yasui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki 300-0028, Japan
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38
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Hoshino M, Zhang J, Sugiyama T, Yang S, Kanaji Y, Hamaya R, Yamaguchi M, Hada M, Misawa T, Usui E, Murai T, Yonetsu T, Lee JM, Koo BK, Sasano T, Kakuta T. Prognostic value of pericoronary inflammation and unsupervised machine-learning-defined phenotypic clustering of CT angiographic findings. Int J Cardiol 2021; 333:226-232. [PMID: 33741428 DOI: 10.1016/j.ijcard.2021.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pericoronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects pericoronary inflammation and is associated with cardiac mortality. OBJECTIVE The aim of this study was to define the sub-phenotypes of coronary CCTA-defined plaque and whole vessel quantification by unsupervised machine learning (ML) and its prognostic impact when combined with pericoronary inflammation. METHODS A total of 220 left anterior descending arteries (LAD) with intermediate stenosis who underwent fractional flow reserve (FFR) measurement and CCTA were studied. After removal of outcome and FAI data, the phenotype heterogeneity of CCTA-defined plaque and whole vessel quantification was investigated by unsupervised hierarchical clustering analysis based on Ward's method. Detailed features of CCTA findings were assessed according to the clusters (CS1 and CS2). Major adverse cardiac events (MACE)-free survivals were assessed according to the stratifications by FAI and the clusters. RESULTS Compared with CS2 (n = 119), CS1 (n = 101) were characterized by greater vessel size, increased plaque volume, and high-risk plaque features. FAI was significantly higher in CS1. ROC analyses revealed that best cut-off value of FAI to predict MACE was -73.1. Kaplan-Meier analysis revealed that lesions with FAI ≥ -73.1 had a significantly higher risk of MACE. Multivariate Cox proportional hazards regression analysis revealed that age, FAI ≥ -73.1, and the clusters were independent predictors of MACE. CONCLUSION Unsupervised hierarchical clustering analysis revealed two distinct CCTA-defined subgroups and discriminated by high-risk plaque features and increased FAI. The risk of MACE differs significantly according to the increased FAI and ML-defined clusters.
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Affiliation(s)
- Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Jinlong Zhang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masao Yamaguchi
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
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Hoshino M, Kanaji Y, Hamaya R, Kanno Y, Hada M, Yamaguchi M, Sumino Y, Usui E, Murai T, Lee T, Yonetsu T, Kakuta T. Prognostic significance of thermodilution-derived coronary flow capacity in patients with deferred revascularisation. EUROINTERVENTION 2021; 16:1195-1203. [PMID: 31186227 PMCID: PMC9724992 DOI: 10.4244/eij-d-19-00029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate the prognostic value of thermodilution-derived coronary flow capacity (T-CFC) in patients with stable coronary artery disease and deferred revascularisation. METHODS AND RESULTS We evaluated 308 lesions in 308 patients with deferred revascularisation, stratifying the cohort according to T-CFC. Ischaemic T-CFC was defined as a composite of mildly, moderately, and severely reduced T-CFC. Clinical outcomes were assessed by vessel-oriented composite endpoints (VOCE) and major adverse cardiac events (MACE). VOCE and MACE occurred in 19 and 28 patients, respectively. Ischaemic T-CFC was found in 88 lesions (28.6%). Kaplan-Meier analysis revealed that lesions with ischaemic T-CFC had a significantly higher risk of both VOCE and MACE. The net reclassification index and integrated discrimination improvement index were both significantly improved when ischaemic T-CFC was added to the clinical risk model (age, sex, prior stent implantation, and lesion length) for predicting VOCE and MACE. Furthermore, ischaemic T-CFC showed significant incremental predictive ability for VOCE and MACE when compared with the clinical risk model + fractional flow reserve ≤0.8, or with the clinical model + coronary flow reserve ≤2.0. CONCLUSIONS T-CFC categorisation improved the risk stratification for both VOCE and MACE and showed incremental prognostic value in patients with deferred revascularisation.
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Affiliation(s)
- Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshinori Kanno
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masao Yamaguchi
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yohei Sumino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-4-1 Otsuno, Tsuchiura City, Ibaraki 300-0028, Japan
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40
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Hoshino M, Yang S, Sugiyama T, Zhang J, Kanaji Y, Yamaguchi M, Hada M, Sumino Y, Horie T, Nogami K, Ueno H, Misawa T, Usui E, Murai T, Lee T, Yonetsu T, Kakuta T. Peri-coronary inflammation is associated with findings on coronary computed tomography angiography and fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 14:483-489. [DOI: 10.1016/j.jcct.2020.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 01/11/2023]
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41
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Affiliation(s)
- Jeffrey W. Moses
- Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- Cardiology, St. Francis Hospital, Roslyn, New York
| | - Eisuke Usui
- Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Akiko Maehara
- Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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42
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Gkargkoulas F, Noguchi M, Matsumura M, Fall K, Hu X, Usui E, Seike F, Salem H, Fujimura T, Jin G, Kirtane A, Ali Z, Karmpaliotis D, Leon M, Moses J, Mintz G, Maehara A. TCT CONNECT-311 Left Main Lesion Assessment: A Comparison of Angiographic and IVUS Findings. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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43
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Usui E, Mintz GS, Lee T, Matsumura M, Zhang Y, Hada M, Yamaguchi M, Hoshino M, Kanaji Y, Sugiyama T, Murai T, Yonetsu T, Kakuta T, Maehara A. Prognostic impact of healed coronary plaque in non-culprit lesions assessed by optical coherence tomography. Atherosclerosis 2020; 309:1-7. [DOI: 10.1016/j.atherosclerosis.2020.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/27/2020] [Accepted: 07/10/2020] [Indexed: 12/20/2022]
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Kanaji Y, Hirano H, Sugiyama T, Hoshino M, Horie T, Misawa T, Nogami K, Ueno H, Hada M, Yamaguchi M, Sumino Y, Hamaya R, Usui E, Yonetsu T, Sasano T, Kakuta T. Pre-percutaneous Coronary Intervention Pericoronary Adipose Tissue Attenuation Evaluated by Computed Tomography Predicts Global Coronary Flow Reserve After Urgent Revascularization in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome. J Am Heart Assoc 2020; 9:e016504. [PMID: 32856503 PMCID: PMC7660767 DOI: 10.1161/jaha.120.016504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Impaired global coronary flow reserve (g‐CFR) is related to worse outcomes. Inflammation has been postulated to play a role in atherosclerosis. This study aimed to evaluate the relationship between pre‐procedural pericoronary adipose tissue inflammation and g‐CFR after the urgent percutaneous coronary intervention in patients with first non–ST‐segment–elevation acute coronary syndrome. Methods and Results Phase‐contrast cine‐magnetic resonance imaging was performed to obtain g‐CFR by quantifying coronary sinus flow at 1 month after percutaneous coronary intervention in a total of 116 first non–ST‐segment–elevation acute coronary syndrome patients who underwent pre‐percutaneous coronary intervention computed tomography angiography. On proximal 40‐mm segments of 3 major coronary vessels on computed tomography angiography, pericoronary adipose tissue attenuation was assessed by the crude analysis of mean computed tomography attenuation value. The patients were divided into 2 groups with and without impaired g‐CFR divided by the g‐CFR value of 1.8. There were significant differences in age, culprit lesion location, N‐terminal pro‐B‐type natriuretic peptide levels, high‐sensitivity C‐reactive protein (hs‐CRP) levels, mean pericoronary adipose tissue attenuation between patients with impaired g‐CFR and those without (g‐CFR, 1.47 [1.16, 1.68] versus 2.66 [2.22, 3.28]; P<0.001). Multivariable logistic regression analysis revealed that age (odds ratio [OR], 1.060; 95% CI, 1.012–1.111, P=0.015) and mean pericoronary adipose tissue attenuation (OR, 1.108; 95% CI, 1.026–1.197, P=0.009) were independent predictors of impaired g‐CFR (g‐CFR <1.8). Conclusions Mean pericoronary adipose tissue attenuation, a marker of perivascular inflammation, obtained by computed tomography angiography performed before urgent percutaneous coronary intervention, but not hs‐CRP, a marker of systemic inflammation was significantly associated with g‐CFR at 1‐month after revascularization. Our results may suggest the pathophysiological mechanisms linking perivascular inflammation and g‐CFR in patients with non–ST‐segment–elevation acute coronary syndrome.
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Affiliation(s)
- Yoshihisa Kanaji
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hidenori Hirano
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tomoki Horie
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masao Yamaguchi
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yohei Sumino
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
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Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Ohya H, Sumino Y, Hirano H, Kanno Y, Horie T, Misawa T, Nogami K, Ueno H, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Determinants of Pericoronary Adipose Tissue Attenuation on Computed Tomography Angiography in Coronary Artery Disease. J Am Heart Assoc 2020; 9:e016202. [PMID: 32750306 PMCID: PMC7792233 DOI: 10.1161/jaha.120.016202] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/07/2020] [Indexed: 12/29/2022]
Abstract
Background Recent studies have reported the association between pericoronary inflammation assessed by pericoronary adipose tissue attenuation (PCATA) on computed tomography angiography and worse outcomes in patients with coronary artery disease. We investigated the determinants predicting increased PCATA in patients with known or suspected coronary artery disease. Methods and Results A total of 540 patients who underwent computed tomography angiography and invasive coronary angiography were studied. Mean computed tomography attenuation values of PCAT (-190 to -30 Hounsfield units) (PCATA) were assessed at the proximal 40-mm segments of all 3 major coronary arteries by crude analysis. Univariable and multivariable analyses were performed to determine the predictors of increased PCATA surrounding the proximal right coronary artery. Mean right coronary artery-PCATA was -72.22±8.47 Hounsfield units and the average of 3-vessel PCATA was -70.24±6.60 Hounsfield units. Multivariable linear regression analysis revealed that the independent determinants of right coronary artery-PCATA were male (β coefficient=4.965, P<0.001), left ventricular mass index (β coefficient=0.040, P=0.025), and angiographically significant stenosis (diameter stenosis >50%) (β coefficient=2.418, P=0.008). Sex-related determinants were NT-proBNP level (N-terminal pro-B-type natriuretic peptide; β coefficient <0.001, P=0.026), Agatston score (β coefficient=-0.002, P=0.010), left ventricular mass index (β coefficient=0.041, P=0.028), and significant stenosis (β coefficient=4.006, P<0.001) in male patients and left ventricular ejection fraction (β coefficient=-0.217, P=0.010) and significant stenosis (β coefficient=3.835, P=0.023) in female patients. Conclusions Right coronary artery-PCATA was associated with multiple clinical characteristics, established risk factors, and the presence of significant stenosis. Our results suggest that clinically significant factors such as sex, left ventricular hypertrophy, ejection fraction, calcification, and epicardial stenosis should be taken into account in the assessment of pericoronary inflammation using computed tomography angiography.
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Affiliation(s)
- Tomoyo Sugiyama
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Yoshihisa Kanaji
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Masahiro Hoshino
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Masao Yamaguchi
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Masahiro Hada
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Hiroaki Ohya
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Yohei Sumino
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Hidenori Hirano
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Yoshinori Kanno
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Tomoki Horie
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Toru Misawa
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Kai Nogami
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Hiroki Ueno
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Rikuta Hamaya
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Eisuke Usui
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Tadashi Murai
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Tetsumin Lee
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Taishi Yonetsu
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tsunekazu Kakuta
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
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Hoshino M, Yonetsu T, Usui E, Kanaji Y, Ohya H, Sumino Y, Yamaguchi M, Hada M, Hamaya R, Kanno Y, Murai T, Lee T, Kakuta T. Clinical Significance of the Presence or Absence of Lipid-Rich Plaque Underneath Intact Fibrous Cap Plaque in Acute Coronary Syndrome. J Am Heart Assoc 2020; 8:e011820. [PMID: 31057022 PMCID: PMC6512119 DOI: 10.1161/jaha.118.011820] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although most coronary thromboses occur on the surface of lipid-rich plaque ( LRP ) with plaque rupture ( PR ), previous pathological and optical coherence tomography studies demonstrated diversity in the morphological characteristics of culprit plaque underlying the thrombus, including lesions with intact fibrous cap ( IFC ). We investigated the clinical significance of IFC in relation to the presence or absence of LRP observed via optical coherence tomography in culprit lesions of acute coronary syndrome. Methods and Results We investigated 510 patients with acute coronary syndrome who underwent optical coherence tomography for the culprit lesion. Optical coherence tomography analysis included the presence or absence of PR , which were categorized into the PR group and the IFC group, respectively. The IFC group was further categorized on the basis of the presence of LRP . Incidence of major adverse cardiac events ( MACEs ), including cardiac death, myocardial infarction, and clinically driven remote revascularizations, was compared. Culprit lesions were categorized into 328 PR s and 182 IFC s. MACEs occurred in 85 patients (16.7%) during the median follow-up duration of 621 days. LRP was detected in 325 lesions (99%) with PR , whereas 60 (33.0%) of the lesions with IFC did not show LRP . Kaplan-Meier analysis revealed significantly lower MACEs in the IFC group compared with the PR group. Furthermore, the IFC group without LRP showed significantly lower MACEs compared with the IFC group with LRP . Multivariate Cox proportional hazards analysis demonstrated that IFC without LRP was an independent predictor of better prognosis. Conclusions Exclusion of LRP underneath IFC culprit lesions in acute coronary syndrome may predict a lower risk of future MACEs .
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Affiliation(s)
- Masahiro Hoshino
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Taishi Yonetsu
- 2 Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Eisuke Usui
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yoshihisa Kanaji
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hiroaki Ohya
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yohei Sumino
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masao Yamaguchi
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hada
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Rikuta Hamaya
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yoshinori Kanno
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tadashi Murai
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tetsumin Lee
- 2 Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- 1 Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
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Usui E, Yonetsu T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Fukuda T, Ohya H, Sumino Y, Hamaya R, Kanno Y, Murai T, Lee T, Kakuta T. Corrigendum to ‘Relationship between optical coherence tomography-derived morphological criteria and functional relevance as determined by fractional flow reserve’ [J. Cardiol. 71 (2018) 359–366/4]. J Cardiol 2020; 76:226-227. [DOI: 10.1016/j.jjcc.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hirano H, Kanaji Y, Sugiyama T, Hoshino M, Horie T, Misawa T, Nogami K, Ueno H, Hada M, Yamaguchi M, Sumino Y, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Kakuta T. Impact of pericoronary adipose tissue inflammation on left ventricular hypertrophy and regional physiological indices in stable coronary artery disease patients with preserved systolic function. Heart Vessels 2020; 36:24-37. [PMID: 32638076 DOI: 10.1007/s00380-020-01658-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
Systemic low-grade inflammation has been shown to be associated with left ventricular hypertrophy (LVH). However, the relationship between pericoronary adipose tissue attenuation (PCATA) and both LVH and regional physiological indices remains unknown. This study aimed to evaluate the association of PCATA with LVH and regional physiological indices in stable coronary artery disease (CAD) patients with preserved systolic function. A total of 114 CAD patients who underwent coronary CT angiography (CTA) and invasive physiological tests showing ischemia due to a single de novo lesion were included in the study. On proximal 40-mm segments of all three major coronary vessels on CTA, PCATA was assessed by the crude analysis of the mean CT attenuation value [- 190 to - 30 Hounsfield units [HU)] and the culprit vessel PCATA was used for the analysis. Regional physiological indices were invasively obtained by pressure-temperature sensor-tipped wire. The patients were divided into three groups by culprit vessel PCATA tertiles, and clinical, CTA-derived, and physiological indices were compared. Univariable and multivariable analyses were further performed to determine the predictors of LVH. Angiographic stenosis severity, culprit lesion locations, culprit vessel fractional flow reserve, coronary flow reserve, index of microcirculatory resistance, total and target vessel coronary calcium score, and biomarkers including high-sensitivity C-reactive protein were not different among the groups. The left ventricular (LV) mass, LV mass index (LVMI), and LV mass at risk were all significantly different in the three groups with the greatest values in the highest tertile group (all, P < 0.05). On multivariable analysis, male gender, NT-proBNP, and PCATA were independent predictors of LVMI. Culprit vessel PCATA was significantly associated with LVMI, but not with regional physiology in CAD patients with functionally significant lesions and preserved systolic function. Our results may offer insight into the pathophysiological mechanisms linking pericoronary inflammation and LVH to worse prognosis.
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Affiliation(s)
- Hidenori Hirano
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tomoki Horie
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Toru Misawa
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kai Nogami
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Hiroki Ueno
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masao Yamaguchi
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yohei Sumino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Rikuta Hamaya
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Eisuke Usui
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
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Usui E, Maehara A, Ali ZA, Moses JW. A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 32617476 PMCID: PMC7319821 DOI: 10.1093/ehjcr/ytaa099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/29/2020] [Accepted: 04/01/2020] [Indexed: 12/03/2022]
Abstract
Background A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery tunnels through the myocardial band. Although MBs have been reported to cause ischaemia, physiological assessment of an MB has not been fully established. Case summary We encountered a case with exertional chest pain who underwent coronary angiography showing an MB at the mid-left anterior descending artery with systolic compression. Optical coherence tomography showed an MB defined as a homogeneous intermediate intensity surrounding the epicardial artery. The full-cycle ratio, defined as the lowest ratio of distal coronary pressure (Pd) to aortic pressure (Pa) during the entire cardiac cycle, measured 0.89 at rest and 0.73 with intravenous dobutamine of 20 µg/kg/min with a distinctive waveform pattern (early diastolic Pd drop) during a dobutamine challenge. Metoprolol succinate dosage was increased. The patient has been free from chest pain for 7 months after the discharge. Discussion Optical coherence tomography may contribute to anatomical detections of MBs. Because a systolic compression of the MB and release of the vascular lumen during early diastole leads to an early steep pressure loss, early diastolic Pd drop should be one of the specific haemodynamic characteristics of MBs. On the other hand, in a severe atherosclerotic stenosis, Pd drop is typically observed in late diastole, which could be differentiated from that of MBs. Because full-cycle ratio reflects the whole cardiac cycle including early diastole, this might be more useful than other physiological indices for detection of MB-related ischaemia induced by a dobutamine challenge.
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Affiliation(s)
- Eisuke Usui
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Akiko Maehara
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Ziad A Ali
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
| | - Jeffrey W Moses
- Division of Cardiology, Department of Medicine, New York-Presbyterian Hospital/Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.,Department of Cardiology, St. Francis Hospital, 100 Port Washington Blvd., Roslyn, NY 11576, USA
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50
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Hoshino M, Yonetsu T, Sugiyama T, Kanaji Y, Hamaya R, Kanno Y, Hada M, Yamaguchi M, Sumino Y, Usui E, Hirano H, Horie T, Nogami K, Ueno H, Misawa T, Murai T, Lee T, Kakuta T. All Resting Physiological Indices May Not Be Equivalent - Comparison Between the Diastolic Pressure Ratio and Resting Full-Cycle Ratio. Circ J 2020; 84:1147-1154. [PMID: 32493861 DOI: 10.1253/circj.cj-19-1110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Differences between resting full-cycle ratio (RFR) and diastolic pressure ratio (dPR) have not been sufficiently discussed. This study aimed to investigate if there is a difference in diagnostic performance between RFR and dPR for the functional lesion assessment and to assess if there are specific characteristics for discordant revascularization decision-makings between RFR and dPR.Methods and Results:A total of 936 intermediate lesions in 776 patients who underwent measurements of fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR) were retrospectively studied. Physiological indices were measured from anonymized pressure recordings at an independent core laboratory. Both RFR and dPR measures were highly correlated (r=0.997, P<0.001), with equivalent diagnostic performance relative to FFR-based decision-makings measured by using a dichotomous threshold of 0.80 (accuracy, 79.7% vs. 80.1%, respectively, P=0.960). The rate of diagnostic discordance was 4.7% (44/936), with no RFR-/dPR+ lesions observed. An overall significant difference in FFR and CFR values were detected among RFR/dPR-based classifications. The prevalence of positive studies was significantly higher for RFR than dPR (54.3% vs. 49.6%, respectively, P=0.047) when using the cut-off value of 0.89. CONCLUSIONS Both RFR and dPR were highly correlated, but the prevalence of positive studies was significantly different. The revascularization rate may differ significantly according to the resting index used.
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Affiliation(s)
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Rikuta Hamaya
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | | | - Masahiro Hada
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | | | - Yohei Sumino
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | | | - Tomoki Horie
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | - Hiroki Ueno
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | - Toru Misawa
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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