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Niu C, Lv W, Zhu X, Dong Z, Yuan K, Jin Q, Zhang P, Li P, Mao M, Dong T, Chen Z, Luo J, Hou L, Zhang C, Hao K, Chen S, Huang Z. Intestinal Translocation of Live Porphyromonas gingivalis Drives Insulin Resistance. J Dent Res 2024; 103:197-207. [PMID: 38185909 DOI: 10.1177/00220345231214195] [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] [Indexed: 01/09/2024] Open
Abstract
Periodontitis has been emphasized as a risk factor of insulin resistance-related systemic diseases. Accumulating evidence has suggested a possible "oral-gut axis" linking oral infection and extraoral diseases, but it remains unclear whether periodontal pathogens can survive the barriers of the digestive tract and how they play their pathogenic roles. The present study established a periodontitis mouse model through oral ligature plus Porphyromonas gingivalis inoculation and demonstrated that periodontitis aggravated diet-induced obesity and insulin resistance, while also causing P. gingivalis enrichment in the intestine. Metabolic labeling strategy validated that P. gingivalis could translocate to the gastrointestinal tract in a viable state. Oral administration of living P. gingivalis elicited insulin resistance, while administration of pasteurized P. gingivalis had no such effect. Combination analysis of metagenome sequencing and nontargeted metabolomics suggested that the tryptophan metabolism pathway, specifically indole and its derivatives, was involved in the pathogenesis of insulin resistance caused by oral administration of living P. gingivalis. Moreover, liquid chromatography-high-resolution mass spectrometry analysis confirmed that the aryl hydrocarbon receptor (AhR) ligands, mainly indole acetic acid, tryptamine, and indole-3-aldehyde, were reduced in diet-induced obese mice with periodontitis, leading to inactivation of AhR signaling. Supplementation with Ficz (6-formylindolo (3,2-b) carbazole), an AhR agonist, alleviated periodontitis-associated insulin resistance, in which the restoration of gut barrier function might play an important role. Collectively, these findings reveal that the oral-gut translocation of viable P. gingivalis works as a fuel linking periodontitis and insulin resistance, in which reduction of AhR ligands and inactivation of AhR signaling are involved. This study provides novel insight into the role of the oral-gut axis in the pathogenesis of periodontitis-associated comorbidities.
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Affiliation(s)
- C Niu
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - W Lv
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, P. R. China
| | - X Zhu
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - Z Dong
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - K Yuan
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - Q Jin
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - P Zhang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - P Li
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - M Mao
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - T Dong
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - Z Chen
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - J Luo
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
| | - L Hou
- Department of Nursing, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - C Zhang
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - K Hao
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - S Chen
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, P. R. China
- Department of Oral Implantology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, P. R. China
| | - Z Huang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Clinical Research Center for Oral Diseases, National Center for Stomatology, Shanghai, P. R. China
- Shanghai Key Laboratory of Stomatology, Shanghai, P. R. China
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Takahashi J, Onuma S, Hao K, Godo S, Shiroto T, Yasuda S. Pathophysiology and diagnostic pathway of myocardial infarction with non-obstructive coronary arteries. J Cardiol 2024; 83:17-24. [PMID: 37524299 DOI: 10.1016/j.jjcc.2023.07.014] [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: 04/27/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous and diverse disease entity, which accounts for about 6 % of all acute myocardial infarction (AMI) cases. In patients with chest pain and acute myocardial injury detected by a highly sensitive troponin assay, the absence of epicardial coronary stenosis of 50 % or greater on angiography leads to the working diagnosis of MINOCA. The updated JCS/CVIT/JCC 2023 Guideline described MINOCA as a new disease concept and recommended a multimodality approach to uncovering the underlying causes of MINOCA. Cardiac magnetic resonance (CMR) is useful in not only making a definite diagnosis of MINOCA, but also excluding non-ischemic causes that mimic AMI such as takotsubo cardiomyopathy and myocarditis. Meanwhile, intracoronary imaging, particularly optical coherence tomography (OCT), enables us to evaluate precisely intracoronary morphological alterations including plaque disruption and spontaneous coronary artery dissection which are not revealed by angiographic findings alone. Recent studies have shown that an initial workup with the combination of CMR and OCT could provide a definite diagnosis in a significant percentage of patients suspected of MINOCA. Consecutively, patients with inconclusive results of a series of CMR and OCT implementation are eligible for assessing the potential for coronary functional abnormalities or blood coagulopathy as another factor involved in the development of MINOCA. Although uncovering the pathogenesis of MINOCA might be essential for establishing an individualized treatment approach, significant knowledge gaps in terms of secondary prevention strategies for MINOCA focusing on the improvement of long-term prognosis remain to be overcome. In this review, we summarize our current understanding of MINOCA and highlight contemporary diagnostic approaches for patients with suspected MINOCA.
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Affiliation(s)
- Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Sho Onuma
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Liu X, Hao K, Wang RG, Chen LF, Shen WB. [The application of a new type of sterile elastic exsanguination tourniquet in aspiration surgery for upper limb lymphedema]. Zhonghua Yi Xue Za Zhi 2023; 103:2330-2334. [PMID: 37574831 DOI: 10.3760/cma.j.cn112137-20230306-00337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Objective: To evaluate the effect of a new type of sterile elastic exsanguination tourniquet (SEET) in aspiration surgery for upper limb lymphedema. Methods: The clinical data of 159 patients who underwent aspiration surgery for upper limb lymphedema from January 2017 to June 2022 in the Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. Among them, 54 patients were treated with SEET (SEET group), while 105 patients were not treated with SEET (No-SEET group). The propensity score matching method was used, and the surgical indicators and complications were compared between the two groups. The factors affecting intraoperative bleeding volume were analyzed through multiple linear regression analysis. Results: A total of 49 pairs of patients were successfully matched by the propensity score method. The age of patients in the SEET and No-SEET groups was (57.7±8.9) years and (56.8±9.1) years, respectively. Compared with the Non-SEET group, the SEET group had less bleeding volume [(311±164) ml vs (437±173) ml, P<0.001]. The results of multiple linear regression analysis showed that the factors affecting intraoperative bleeding volume included age (β=-0.142, P=0.041), using the SEET (β=-0.249, P=0.002), surgical time (β=0.195, P=0.010) and the amount of fat mixture sucked out (β=0.464, P<0.001). Conclusions: The clinical application of the SEET in aspiration surgery for upper limb lymphedema is safe, and can significantly reduce the bleeding volume and alleviate blood shortage.
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Affiliation(s)
- X Liu
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - K Hao
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - R G Wang
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - L F Chen
- Department of Blood Transfusion, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - W B Shen
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Hao K, Yasuda S. Calcium-Channel Blockers: An Alternative Therapy to Beta-Blockers for Myocardial Infarction? JACC Asia 2023; 3:455-456. [PMID: 37396429 PMCID: PMC10308093 DOI: 10.1016/j.jacasi.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
| | - Satoshi Yasuda
- Address for correspondence: Dr Satoshi Yasuda, Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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Fukui K, Takahashi J, Hao K, Honda S, Nishihira K, Kojima S, Takegami M, Sakata Y, Itoh T, Watanabe T, Takayama M, Sumiyoshi T, Kimura K, Yasuda S. Disparity of Performance Measure by Door-to-Balloon Time Between a Rural and Urban Area for Management of Patients With ST-Segment Elevation Myocardial Infarction ― Insights From the Nationwide Japan Acute Myocardial Infarction Registry ―. Circ J 2022; 87:648-656. [PMID: 36464277 DOI: 10.1253/circj.cj-22-0454] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Although a door-to-balloon (D2B) time ≤90 min is recognized as a key indicator of timely reperfusion for patients with ST-segment elevation myocardial infarction (STEMI), it is unclear whether regional disparities in the prognostic value of D2B remain in contemporary Japan.Methods and Results: We retrospectively analyzed 17,167 STEMI patients (mean [±SD] age 68±13 years, 77.6% male) undergoing primary percutaneous coronary intervention. With reference to the Japanese median population density of 1,147 people/km2, patients were divided into 2 groups: rural (n=6,908) and urban (n=10,259). Compared with the urban group, median D2B time was longer (70 vs. 62 min; P<0.001) and the rate of achieving a D2B time ≤90 min was lower (70.7% vs. 75.4%; P<0.001) in the rural group. In-hospital mortality was lower for patients with a D2B time ≤90 min than >90 min, regardless of residential area, whereas multivariable analysis identified prolonged D2B time as a predictor of in-hospital death only in the rural group (adjusted odds ratio 1.57; 95% confidence interval 1.18-2.09; P=0.002). Importantly, the rural-urban disparity in in-hospital mortality emerged most distinctively among patients with Killip Class IV and a D2B time >90 min. CONCLUSIONS These data suggest that there is a substantial rural-urban gap in the prognostic significance of D2B time among STEMI patients, especially those with cardiogenic shock and a prolonged D2B time.
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Affiliation(s)
- Kento Fukui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Sunao Kojima
- Department of Cardiovascular Medicine, Kawasaki Medical School
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | | | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Takeuchi M, Suzuki H, Matsumoto Y, Kikuchi Y, Takanami K, Wagatsuma T, Sugisawa J, Tsuchiya S, Nishimiya K, Hao K, Godo S, Shindo T, Shiroto T, Takahashi J, Kumagai K, Kohzuki M, Takase K, Saiki Y, Yasuda S, Shimokawa H. Prediction of the development of delirium after transcatheter aortic valve implantation using preoperative brain perfusion SPECT. PLoS One 2022; 17:e0276447. [PMID: 36327325 PMCID: PMC9632803 DOI: 10.1371/journal.pone.0276447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Delirium is an important prognostic factor in postoperative patients undergoing cardiovascular surgery and intervention, including transcatheter aortic valve implantation (TAVI). However, delirium after transcatheter aortic valve implantation (DAT) is difficult to predict and its pathophysiology is still unclear. We aimed to investigate whether preoperative cerebral blood flow (CBF) is associated with DAT and, if so, whether CBF measurement is useful for predicting DAT. Methods We evaluated CBF in 50 consecutive patients before TAVI (84.7±4.5 yrs., 36 females) using 99mTc ethyl cysteinate dimer single-photon emission computed tomography. Preoperative CBF of the DAT group (N = 12) was compared with that of the non-DAT group (N = 38) using whole brain voxel-wise analysis with SPM12 and region of interest-based analysis with the easy-Z score imaging system. Multivariable logistic regression analysis with the presence of DAT was used to create its prediction model. Results The whole brain analysis showed that preoperative CBF in the insula was lower in the DAT than in the non-DAT group (P<0.05, family-wise error correction). Decrease extent ratio in the insula of the DAT group (17.6±11.5%) was also greater relative to that of the non-DAT group (7.0±11.3%) in the region of interest-based analysis (P = 0.007). A model that included preoperative CBF in the insula and conventional indicators (frailty index, short physical performance battery and mini-mental state examination) showed the best predictive power for DAT (AUC 0.882). Conclusions These results suggest that preoperative CBF in the insula is associated with DAT and may be useful for its prediction.
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Affiliation(s)
- Masashi Takeuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Rehabilitation Medicine, Tohoku University Hospital, Sendai, Japan
| | - Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshihiro Wagatsuma
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiichiro Kumagai
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Rehabilitation Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- National Cerebral and Cardiovascular Center, Suita, Japan
- * E-mail:
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
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Hao K, Takahashi J, Sato K, Suda A, Sindo T, Godo S, Nishimiya K, Kikuchi Y, Shiroto T, Yasuda S. The influence of COVID-19 pandemic on management of acute myocardial infarction in Japan; Insight from the Miyagi AMI Registry Study. IJC Heart & Vasculature 2022; 43:101116. [PMID: 36127895 PMCID: PMC9477968 DOI: 10.1016/j.ijcha.2022.101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022]
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Haddadi N, Mande P, Brodeur T, Hao K, Ryan G, Moses S, Subramanian S, Picari X, Afshari K, Marshak-Rothstein A, Richmond J. LB868 Th2 skewing promotes the expression of skin-homing molecules on T cells and is required for the induction of skin lesions in lupus-prone mice. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.883] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hao K, Xin JF, Sun YG, Li B, Zhang L, Shen WB. [Lower extremity lymphedema as the initial symptom of malignant disease]. Zhonghua Yi Xue Za Zhi 2022; 102:584-587. [PMID: 35196781 DOI: 10.3760/cma.j.cn112137-20211209-02746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To investigate the diagnosis of malignancy with lower extremity lymphedema as the initial manifestation. We performed a retrospective study of 33 patients with malignant lymphedema treated at the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from May 22, 2007 to December 31, 2018. A total of 33 cases of lower extremity lymphedema caused or aggravated by malignant tumors were found. The age range of 33 patients with malignant lymphedema was 21 to 84 years. Twenty-two patients were male, and 11 patients were female, with a mean age of (57.5±15.0) years. The time from the occurrence of lymphedema to the diagnosis of malignant tumors ranged from a month to 2 years. The proportion of patients with abnormal tumor markers was 88.9% (24/27), the prevalence of anemia among patients with malignant lymphedema was 42.4% (14/33), and the positive rates of ultrasonography, CT, MRI, and radionuclide imaging were 100.0% (17/17), 100.0% (25/25), 100.0% (4/4) and 60.0% (12/20), respectively. Twenty-seven cases with malignant tumors were confirmed by pathological diagnosis. To avoid delays in the diagnosis and therapy of malignant lymphedema, physicians should actively look for signs or symptoms of lymphedema during the follow-up period and promptly manage patients developing problems.
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Affiliation(s)
- K Hao
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038,China
| | - J F Xin
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038,China
| | - Y G Sun
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038,China
| | - B Li
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038,China
| | - L Zhang
- Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - W B Shen
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038,China
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Yang Y, Memon F, Hao K, Jiang M, Guo L, Liu T, Lv F, Zhang W, Zhang Y, Si H. The combined use of Bacillus subtilis-based probiotic and anticoccidial herb had a better anti-Eimeria tenella efficiency. J APPL POULTRY RES 2021. [DOI: 10.1016/j.japr.2021.100181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Hao K, Takahashi J, Kikuchi Y, Suda A, Sato K, Sugisawa J, Tsuchiya S, Shindo T, Nishimiya K, Ikeda S, Tsuburaya R, Shiroto T, Matsumoto Y, Miyata S, Sakata Y, Yasuda S, Shimokawa H. Prognostic Impacts of Comorbid Significant Coronary Stenosis and Coronary Artery Spasm in Patients With Stable Coronary Artery Disease. J Am Heart Assoc 2021; 10:e017831. [PMID: 33455423 PMCID: PMC7955295 DOI: 10.1161/jaha.120.017831] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Stable coronary artery disease is caused by a variable combination of organic coronary stenosis and functional coronary abnormalities, such as coronary artery spasm. Thus, we examined the clinical importance of comorbid significant coronary stenosis and coronary spasm. METHODS AND RESULTS We enrolled 236 consecutive patients with suspected angina who underwent acetylcholine provocation testing for coronary spasm and fractional flow reserve (FFR) measurement. Among them, 175 patients were diagnosed as having vasospastic angina (VSA), whereas the remaining 61 had no VSA (non-VSA group). The patients with VSA were further divided into the following 3 groups based on angiography and FFR: no organic stenosis (≤50% luminal stenosis; VSA-alone group, n=110), insignificant stenosis of FFR>0.80 (high-FFR group, n=36), and significant stenosis of FFR≤0.80 (low-FFR group, n=29). The incidence of major adverse cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, urgent percutaneous coronary intervention, and hospitalization attributed to unstable angina was evaluated. All patients with VSA received calcium channel blockers, and 28 patients (95%) in the low-FFR group underwent a planned percutaneous coronary intervention. During a median follow-up period of 656 days, although the incidence of major adverse cardiovascular events was low and comparable among non-VSA, VSA-alone, and high-FFR groups, the low-FFR group had an extremely poor prognosis (non-VSA group, 1.6%; VSA-alone group, 3.6%; high-FFR group, 5.6%; low-FFR group, 27.6%) (P<0.001). Importantly, all 8 patients with major adverse cardiovascular events in the low-FFR group were appropriately treated with percutaneous coronary intervention and calcium channel blockers. CONCLUSIONS These results indicate that patients with VSA with significant coronary stenosis represent a high-risk population despite current guideline-recommended therapies, suggesting the importance of routine coronary functional testing in this population.
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Affiliation(s)
- Kiyotaka Hao
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Jun Takahashi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yoku Kikuchi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Akira Suda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Koichi Sato
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Jun Sugisawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Tsuchiya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Tomohiko Shindo
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Kensuke Nishimiya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Shohei Ikeda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Ryuji Tsuburaya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Takashi Shiroto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuharu Matsumoto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Miyata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuhiko Sakata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Yasuda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroaki Shimokawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
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12
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Sugisawa J, Matsumoto Y, Takeuchi M, Suda A, Tsuchiya S, Ohyama K, Nishimiya K, Akizuki M, Sato K, Ohura S, Ota H, Ikeda S, Shindo T, Kikuchi Y, Hao K, Shiroto T, Takahashi J, Miyata S, Sakata Y, Takase K, Kohzuki M, Shimokawa H. Beneficial effects of exercise training on physical performance in patients with vasospastic angina. Int J Cardiol 2020; 328:14-21. [PMID: 33309635 DOI: 10.1016/j.ijcard.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/23/2020] [Revised: 11/04/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022]
Abstract
AIMS In vasospastic angina (VSA), coronary vasomotion abnormalities could develop not only in epicardial coronary arteries but also in coronary microvessels, where calcium channel blockers (CCBs) have limited efficacy. However, efficacy of exercise training for VSA remains to be elucidated. We thus aimed to examine whether vasodilator capacity of coronary microvessels is impaired in VSA patients, and if so, whether exercise exerts beneficial effects on the top of CCBs. METHODS We performed 2 clinical protocols. In the protocol 1, we measured myocardial blood flow (MBF) using adenosine-stress dynamic computed tomography perfusion (CTP) in 38 consecutive VSA patients and 17 non-VSA controls. In the protocol 2, we conducted randomized controlled trial, where 20 VSA patients were randomly assigned to either 3-month exercise training group (Exercise group) or Non-Exercise group (n= 10 each). RESULTS In the protocol 1, MBF on CTP was significantly decreased in the VSA group compared with the Non-VSA group (138 ± 6 vs 166 ± 10 ml/100 g/min, P = 0.02). In the protocol 2, exercise capacity was significantly increased in the Exercise group than in the Non-Exercise group (11.5 ± 0.5 to 15.4 ± 1.8 vs 12.6 ± 0.7 to 14.0 ± 0.8 ml/min/kg, P < 0.01). MBF was also significantly improved after 3 months only in the Exercise group (Exercise group, 145 ± 12 to 172 ± 8 ml/100 g/min, P < 0.04; Non-Exercise group, 143 ± 14 to 167 ± 8 ml/100 g/min, P = 0.11), although there were no significant between-group differences. CONCLUSIONS These results provide the first evidence that, in VSA patients, exercise training on the top of CCBs treatment may be useful to improve physical performance, although its effect on MBF may be minimal.
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Affiliation(s)
- Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Takeuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mina Akizuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shoko Ohura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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13
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Nishimiya K, Suda A, Hao K, Takahashi J, Matsumoto Y, Satoh K, Sugisawa J, Shindo T, Godo S, Kikuchi Y, Shiroto T, Shimokawa H. Clinical implications of coronary artery morphology of patients with ischemia and non-obstructive coronary artery disease (INOCA) -An intracoronary OCT study-. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ischemia and non-obstructive coronary artery disease (INOCA), including microvascular spasm (MVS) and epicardial spasm, has recently attracted much attention, for which in vivo imaging evaluation for coronary artery morphology is warranted for better understanding of this disorder. Besides the improved diagnostic accuracy of optical coherence tomography (OCT) for coronary plaques, we have recently demonstrated its capability for in vivo visualization of coronary adventitial vasa vasorum (VV) and the enhanced VV formation in patients with epicardial spasm.
Purpose
We aimed to examine OCT-delineated morphological characteristics in patients with INOCA in vivo.
Methods
A total of 335 consecutive INOCA patients, who underwent pharmacological spasm provocation tests, lactate sampling, and OCT imaging over the entire length of the left anterior descending (LAD) coronary arteries, were enrolled at our institute over 68 months from April 2013. They were classified into 4 groups; control with non-cardiac chest pain, MVS, diffuse spasm (DS), or focal spasm (FS) (Fig. 1A). MVS was diagnosed when negative lactate extraction ratio (coronary orifice < coronary sinus) was detected despite the absence of epicardial spasm during the spasm provocation test. DS was defined as epicardial spasm induced in more than 2 coronary segments in LAD, and FS as epicardial spasm in one segment. Quantitative analyses for adventitial inflammation and atherosclerotic changes were performed by calculating VV density and %area stenosis (AS) on OCT (Fig. 1B, E). Furthermore, index of microcirculatory resistance (IMR), a marker of microvascular disorder with a cut-off value of ≥25, was measured during intravenous infusion of adenosine, which was then correlated with VV densities in the MVS and DS groups. Coronary plaque with a necrotic core was classified as fibroatheroma (FA), and the number of OCT frames with internal VV (IVV) in the atheroma was counted.
Results
VV density was significantly higher in MVS as compared with the controls (Fig. 1B). DS was most prevalent in INOCA (Fig. 1A) with highest VV density (Fig. 1B). Patients with IMR≥25 were predominantly distributed with a gradual increase in the MVS, DS, and FS groups, but none in the controls (Fig. 1C). Importantly, there was a significant positive correlation between VV densities and IMR in the MVS and DS groups (Fig. 1D). In addition, FS had the largest plaque size and showed the highest prevalence of FA and IVV (Fig. 1E–G).
Conclusions
These results indicate that MVS and DS are characterized by vasomotion abnormalities associated with adventitial inflammation and microvascular disorder, while FS by vulnerable atherosclerotic phenotype, suggesting that OCT may be useful for screening high-risk populations in INOCA.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Nishimiya
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Satoh
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Godo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shiroto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
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14
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Suda A, Takahashi J, Hao K, Kikuchi Y, Shindo T, Ikeda S, Sato K, Sugisawa J, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. Coronary Functional Abnormalities in Patients With Angina and Nonobstructive Coronary Artery Disease. J Am Coll Cardiol 2020; 74:2350-2360. [PMID: 31699275 DOI: 10.1016/j.jacc.2019.08.1056] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [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: 04/15/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary stenosis, in whom coronary functional abnormalities could be involved. OBJECTIVES This study examined the significance of coronary functional abnormalities in a comprehensive manner for both epicardial and microvascular coronary arteries in patients with angina and nonobstructive coronary artery disease (CAD). METHODS This study prospectively enrolled 187 consecutive patients (male/female 113/74, 63.2 ± 12.3 years), who underwent acetylcholine provocation test for coronary spasm and measurement of index of microcirculatory resistance (IMR) to evaluate coronary microvascular function, and followed them for a median of 893 days. RESULTS Of all subjects, acetylcholine test identified 128 patients with vasospastic angina (VSA) (68%), and cardiac events occurred in 10 patients (5.3%) during the follow-up. Multivariable analysis revealed that IMR correlated with the incidence of cardiac events (hazard ratio: 1.05; 95% confidence interval: 1.02 to 1.09; p = 0.002) and receiver-operating characteristics (ROC) curve analysis identified IMR of 18.0 as the optimal cut-off value. Among the 4 groups based on the cut-off value of IMR and the presence of VSA, the Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with high IMR (≥18.0) and VSA compared with other groups (log rank, p = 0.002). Importantly, intracoronary administration of fasudil, a Rho-kinase inhibitor, significantly ameliorated IMR in the VSA patients with increased IMR (p < 0.0001). CONCLUSIONS These results indicate that in patients with angina and nonobstructive CAD, coexistence of epicardial coronary spasm and increased microvascular resistance is associated with worse prognosis, for which Rho-kinase activation may be involved.
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Affiliation(s)
- Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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15
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Ohura-Kajitani S, Shiroto T, Godo S, Ikumi Y, Ito A, Tanaka S, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Hao K, Kikuchi Y, Nochioka K, Matsumoto Y, Takahashi J, Miyata S, Shimokawa H. Marked Impairment of Endothelium-Dependent Digital Vasodilatations in Patients With Microvascular Angina. Arterioscler Thromb Vasc Biol 2020; 40:1400-1412. [DOI: 10.1161/atvbaha.119.313704] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective:
It remains to be elucidated whether and how endothelial functions are impaired in peripheral circulation of patients with coronary functional disorders, such as vasospastic angina (VSA) and microvascular angina (MVA). We simultaneously examined endothelial functions of peripheral conduit and resistance arteries in patients with coronary functional disorders, with a special reference to NO and endothelium-dependent hyperpolarization factors.
Approach and Results:
Based on the results of invasive coronary acetylcholine testing and coronary physiological measurements, we divided 43 patients into 3 groups; VSA, MVA, and VSA+MVA. Endothelium-dependent vasodilatations of the brachial artery and fingertip arterioles to intra-arterial infusion of bradykinin were simultaneously evaluated by ultrasonography and peripheral arterial tonometry, respectively. To assess NO and endothelium-dependent hyperpolarization factors, measurements were repeated after oral aspirin and intra-arterial infusion of N
G
-monomethyl-L-arginine. Additionally, endothelium-independent vasodilatations to sublingual nitroglycerin and plasma levels of biomarkers for endothelial functions were measured. Surprisingly, digital vasodilatations to bradykinin were almost absent in patients with MVA alone and those with VSA+MVA compared with those with VSA alone. Mechanistically, both NO- and endothelium-dependent hyperpolarization–mediated digital vasodilatations were markedly impaired in patients with MVA alone. In contrast, endothelium-independent vasodilatations to nitroglycerin were comparable among the 3 groups. Plasma levels of soluble VCAM (vascular cell adhesion molecule)-1 were significantly higher in patients with MVA alone compared with those with VSA alone.
Conclusions:
These results provide the first evidence that both NO- and endothelium-dependent hyperpolarization–mediated digital vasodilatations are markedly impaired in MVA patients, suggesting that MVA is a cardiac manifestation of the systemic small artery disease.
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Affiliation(s)
- Shoko Ohura-Kajitani
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Godo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Ikumi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiyo Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuhei Tanaka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Nihei T, Takahashi J, Hao K, Kikuchi Y, Odaka Y, Tsuburaya R, Nishimiya K, Matsumoto Y, Ito K, Miyata S, Sakata Y, Shimokawa H. Prognostic impacts of Rho-kinase activity in circulating leucocytes in patients with vasospastic angina. Eur Heart J 2019; 39:952-959. [PMID: 29165549 DOI: 10.1093/eurheartj/ehx657] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Received: 04/03/2017] [Accepted: 10/24/2017] [Indexed: 12/15/2022] Open
Abstract
Aims Rho-kinase activity in circulating leucocytes is a useful biomarker for diagnosis and disease activity assessment of vasospastic angina (VSA). The present study aimed to examine the long-term prognostic impact of Rho-kinase activity in circulating leucocytes in VSA patients. Methods and results We prospectively enrolled 174 consecutive patients with VSA and 50 non-VSA patients, in whom we measured Rho-kinase activity in circulating leucocytes, and they were followed for a median of 16 months. The primary endpoint was cardiac events including cardiac death, non-fatal myocardial infarction, and hospitalization for unstable angina. During the follow-up period, cardiac events occurred in 10 VSA patients (5.7%) but in none of the non-VSA patients. When we divided VSA patients into two groups by a median value of their Rho-kinase activity, the Kaplan-Meier survival analysis showed a significantly worse prognosis in VSA patients with high Rho-kinase activity compared with those with low activity or non-VSA patients (log-rank; P < 0.05, respectively). Receiver-operating characteristic curve analysis showed that Rho-kinase activity value of 1.24 was the best cut-off level to predict cardiac events in VSA patients, and multivariable analysis showed that a value above the cut-off point had the largest hazard ratio to predict poor outcome in VSA patients [hazard ratio (95% confidence interval) 11.19 (1.41-88.95); P = 0.022]. Importantly, combination of the Japanese Coronary Spasm Association risk score and Rho-kinase activity significantly improved the prognostic impact in VSA patients as compared with either alone. Conclusion Rho-kinase activity in circulating leucocytes is useful for prognostic stratification of VSA patients.
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Affiliation(s)
- Taro Nihei
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yuji Odaka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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17
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Kikuchi Y, Takahashi J, Hao K, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Shiroto T, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. Usefulness of intracoronary administration of fasudil, a selective Rho-kinase inhibitor, for PCI-related refractory myocardial ischemia. Int J Cardiol 2019; 297:8-13. [PMID: 31611086 DOI: 10.1016/j.ijcard.2019.09.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/23/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intra-procedural myocardial ischemia as an iatrogenic complication still remains a critical issue in contemporary interventional cardiology. The aim of this study was to examine the usefulness of fasudil, a selective Rho-kinase inhibitor, for percutaneous coronary intervention (PCI)-related myocardial ischemia. METHODS Among 448 PCI sessions performed between October 2015 and December 2017, we retrospectively examined 36 patients (69.0 ± 9.1 [SD] yrs., M/F 26/10) who underwent intracoronary administration of fasudil during a procedure to resolve myocardial ischemia that was resistant to intracoronary nitrate administration. RESULTS The refractory myocardial ischemia was caused by distal embolization (69%), enhanced vasoconstriction at distal site of chronic total occlusion (11%), coronary spasm (11%), and coronary dissection (8%), most of which occurred immediately after balloon or stent dilatation. Intracoronary fasudil significantly improved corrected TIMI frame count (from 37 [30-56] to 24 [12-36]) and TIMI flow grade (from 2 [1-2.5] to 3 [2-3]) (both P < 0.001). Finally, 86% of all subjects successfully obtained TIMI flow grade 3 at the end of the procedure. Intracoronary fasudil tended to be more effective in patients with an attenuated plaque detected by intravascular ultrasound. Importantly, among the 19 elective cases, fasudil successfully prevented 17 patients from developing post-procedure myocardial infarction. Although fasudil-induced transient hypotension requiring a vasopressor was noted in 22% of the subjects, no other adverse effects were noted. CONCLUSIONS These results indicate that fasudil is a useful and safe therapeutic option for PCI-related myocardial ischemia refractory intracoronary nitrate.
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Affiliation(s)
- Yoku Kikuchi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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18
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Tsuchiya S, Matsumoto Y, Suzuki H, Kikuchi Y, Sugisawa J, Shindo T, Hao K, Takeuchi M, Takahashi J, Kumagai K, Wagatsuma T, Saiki Y, Shimokawa H. 92Transcatheter aortic valve implantation improves cerebral blood flow and cognitive function in elderly patients with aortic stenosis - Brain perfusion SPECT imaging study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Abstract
Abstract
Background
Cognitive impairment and depression are commonly noted in elderly frail patients with severe aortic stenosis (AS). However, their mechanisms and reversibility after treatment remain remain to be examined.
Purpose
In this study, we examined whether transcatheter aortic valve implantation (TAVI) increases cerebral blood flow (CBF) in cognitive/emotional brain areas, such as the hippocampus, in the elderly patients with severe AS.
Methods
We examined consecutive 15 right-handed patients with severe AS who were eligible for TAVI (median age 83.2 years, 12 (80%) women). We evaluated the following assessments both at baseline and 3 months after TAVI. Frailty was evaluated based on Fried scale, which consists of 5 items, including gait speed, cognitive function, weight loss, exhaustion, and inactivity. Frail and pre-frail were defined as greater than 3 and 1∼2 in the scale, respectively. Cognitive and emotional status were evaluated with Logical Memory (LM) II, Mini Mental State Examination (MMSE), and geriatric depression scale (GDS). Lower LM II (less than 4 points) and MMSE (less than 24 points) and higher GDS (more than 6 points) indicate worse memory, general cognitive function, and depressive symptoms, respectively. CBF images were recorded with 99mTc single-photon emission computed tomography and were analyzed using SPM12. Briefly, CBF images were firstly normalized to the standard Montreal Neurological Institute space. Then, a voxel-wise parametric analysis was conducted between normalized CBF images at baseline and those after TAVI (P<0.005 at each voxel). Continuous variables were presented as mean ± standard error (SE). Normality was assessed using the Shapiro-Wilk test. Continuous variables were compared with the use of paired t test. Linear mixed-model analysis was performed to evaluate changes in neuropsychological tests and CBF over time.
Results
In the present study, all patients were not robust but pre-frail (47.3%) or frail (53.7%). LM II score was significantly improved at 3 months after TAVI compared with baseline (baseline, 8.7 vs. 3 months, 13.8, P<0.01) (Figure A), whereas no significant changes in MMSE or GDS scores were noted (baseline, 24.6 vs. 3 months, 25.2 for MMSE; baseline, 4.3 vs. 3 months, 4.2 for GDS). Importantly, although no patients showed clinical symptoms or signs for transient ischemic attack or stroke after TAVI, CBF in the local regions, including the right hippocampus, was significantly increased after TAVI compared with baseline (P<0.005 at each voxel) (green arrowheads) (Figure B). Furthermore, CBF in the right hippocampus were positively correlated with LM II scores (P=0.017) (Figure C).
Figure 1
Conclusions
These results provide the first evidence that TAVI improves cerebral perfusion (especially that in the hippocampus) and cognitive functions in elderly patients with severe AS.
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Affiliation(s)
- S Tsuchiya
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - H Suzuki
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - M Takeuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - K Kumagai
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - T Wagatsuma
- Tohoku University Graduate School of Medicine, Anesthesiology and Perioperative Medicine, Sendai, Japan
| | - Y Saiki
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
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19
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Hao K, Takahashi J, Suda A, Sato K, Sugisawa J, Tsuchiya S, Shindo T, Ikeda S, Kikuchi Y, Shiroto T, Matsumoto Y, Sakata Y, Shimokawa H. P3575Clinical importance of fractional flow reserve in patients with organic coronary stenosis and vasospastic angina. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Abstract
Abstract
Background
Vasospastic angina (VSA), which is one of the important functional cardiac disorders, may also play a role in the pathogenesis of atherosclerosis. Conversely, organic coronary stenosis is also known as an independent predictor for poor clinical outcomes in VSA patients. Although VSA patients have a variable degree of organic coronary stenosis in clinical setting, the functional importance of organic stenosis in those patients remains to be elucidated.
Purpose
The aim of this study was to examine the clinical importance and prognostic impact of fractional flow reserve (FFR) in patients with VSA and organic coronary stenosis.
Methods
We enrolled 236 consecutive patients with suspected vasospastic angina who underwent acetylcholine provocation test for coronary spasm (M/F 148/88, 63.6±12.0 [SD] yrs.). Among them, 175 patients (74.1%) were diagnosed as having VSA, while the remaining non-VSA patients were regarded as controls (Group-C, n=61). We divided the VSA patients into 3 groups based on angiographical findings and FFR values; VSA with no organic stenosis (>50% luminal stenosis) (Group-N, n=110), organic stenosis and high FFR (≥0.80) (Group-H, FFR 0.87±0.05, n=36), and organic stenosis and low FFR (<0.80) (Group-L, FFR 0.71±0.07, n=29). We evaluated the incidence of major adverse cardiovascular events (MACE), including cardiovascular death (CVD), non-fatal myocardial infarction (MI), urgent percutaneous coronary intervention (PCI), and hospitalization due to unstable angina pectoris (UAP) during the median follow-up period of 656 days.
Results
The groups with organic stenosis (Groups H and L) were characterized by higher prevalence of diabetes mellitus (Group-C/N/H/L, 23.0/20.9/44.4/34.5%, P=0.03) and dyslipidemia (Group-C/N/H/L, 37.7/39.1/50.0/65.5%, P=0.03) as compared with Group-C. After provocation test, all VSA patients received calcium channel blockers (CCBs). In addition, 20 days (median) after provocation test, 26 patients (92.9%) in Group-L underwent elective PCI with coronary stents, while no patient underwent PCI in Groups N or H. The incidence of MACE during follow-up was significantly higher in Group-L (Group-C/N/H/L; 1.6/3.6/5.6/27.6%, log-rank P<0.001), whereas clinical outcomes were comparable among the remaining 3 groups (Figure). Importantly, all 8 patients with MACE in Group-L had poor outcomes (CVD/MI/urgent PCI/UAP; 2/1/3/2) despite complete revascularization and the prevention of coronary spasm with CCBs, indicating that they might be resistant to standard contemporary therapies. They were characterized by less frequent use of angiotensin convert enzyme inhibitor (0 vs. 47.6%, P=0.02) and higher prevalence of multi-vessel organic lesions (37.5 vs. 4.8%, P=0.052) compared with those without MACE.
Figure 1
Conclusions
These results provide the first evidence that evaluation of coronary functional abnormalities with FFR is useful for making therapeutic strategies in VSA patients with organic coronary stenosis.
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Affiliation(s)
- K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shiroto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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20
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Kajitani S, Shiroto T, Godo S, Ito A, Ikumi Y, Sugisawa J, Suda A, Shindo T, Ikeda S, Hao K, Kikuchi Y, Nochioka K, Matsumoto Y, Takahashi J, Shimokawa H. P4158Marked impairment of endothelium-dependent digital vasodilatations in patients with microvascular angina compared with those with vasospastic angina. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Nitric oxide (NO) and endothelium-dependent hyperpolarization (EDH) factor are the major endothelium-derived relaxing factors. NO plays an important role in conduit arteries, while the importance of EDH factor increases as the vessel size decrease in patients with microvascular angina (MVA) compared with those with vasospastic angina (VSA) remains to be fully elucidated.
Purpose
We evaluated the roles of NO and EDH factor in conduit (brachial) arteries and resistance (digital) arteries of the patients with MVA, VSA and comorbid MVA+VSA patients.
Methods
We enrolled 39 patients who underwent diagnostic cardiac catheterization and divided them into 3 groups based on acetylcholine (ACh) provocation test, index of microcirculation resistance (IMR), and coronary flow reserve (CFR); MVA (N=9, mean age 59.9±3.5 years), VSA (N=12, mean age 61.3±1.8 years), and comorbid MVA+VSA (N=18, mean age 64.0±2.2 years). Endothelium-dependent brachial and digital vasodilatations in response to intra-arterial infusion of bradykinin (BK, 25, 50, and 100 ng/min for 2 min) were simultaneously measured by ultrasonography and peripheral arterial tonometry, respectively. Measurements were repeated after oral administration of aspirin (486 mg) and intra-arterial infusion of NG-monomethyl-L-arginine (L-NMMA, 8μmol/min for 5 min) in order to inhibit the effects of vasodilator prostaglandins and NO, respectively. Finally, endothelium-independent brachial and digital vasodilatations in response to sublingual nitroglycerin (NTG, 0.3 mg) were measured in the same manner.
Results
In the brachial artery, dose-dependent vasodilatations to BK were comparable among the 3 groups, and L-NMMA equally attenuated the responses to BK (Figure 1). Endothelium-independent brachial vasodilatation in response to NTG was also comparable among the 3 groups. Surprisingly, dose-dependent digital vasodilatations to BK were almost absent in MVA patients compared with VSA or comorbid MVA+VSA group (Figure 2). Furthermore, the digital vasodilatations were unaffected by L-NMMA in VSA group, but were significantly reduced in comorbid MVA+VSA group (VSA, 16.8±15.1% vs. MVA+VSA, −0.23±6.2%, P<0.05), suggesting reduced EDH and compensatory role of NO in the latter group. In contrast, endothelium-independent digital vasodilatation in response to NTG was comparable among the 3 groups.
The main results of this study
Conclusions
These results provide the first evidence that endothelium-dependent digital vasodilatations (both NO and EDH factor) are markedly impaired in MVA patients compared with VSA or comorbid MVA+VSA patients, whereas the responses are comparable in the brachial artery among the 3 groups, suggesting the involvement of severe endothelial dysfunction in the pathogenesis of MVA.
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Affiliation(s)
- S Kajitani
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shiroto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Godo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Ito
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Ikumi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Nochioka
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
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21
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Watanabe T, Matsumoto Y, Amamizu H, Morosawa S, Ohyama K, Nishimiya K, Shindo T, Suda A, Ikeda S, Kikuchi Y, Hao K, Shiroto T, Takahashi J, Shimokawa H. 2381Low-intensity pulsed ultrasound ameliorates DES-induced coronary adventitial inflammation and hyperconstricting responses in pigs in vivo - A novel non-invasive therapy for coronary inflammation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Abstract
Abstract
Background
We previously demonstrated that coronary adventitial inflammation plays important roles in the pathogenesis of coronary artery spasm, including drug-eluting stent (DES)-induced coronary hyperconstricting responses, in pigs and humans. Indeed, the coronary adventitia has recently attracted much attention as the important site for vascular inflammation. However, a direct therapeutic approach to the coronary adventitia remains to be developed. We have developed a non-invasive low-intensity pulsed ultrasound (LIPUS) therapy for angina, which exerts anti-inflammatory effects through improved coronary microcirculation.
Purpose
In this study, we aimed to examine whether our LIPUS therapy ameliorates DES-induced coronary hyperconstricting responses in pigs in vivo, and if so, what mechanisms are involved.
Methods
An everolimus-eluting stent (EES) was implanted into the left anterior descending (LAD) coronary artery in normal male pigs. They were randomly assigned to the LIPUS or the sham therapy groups. After EES implantation, in the LIPUS group, LIPUS (32 cycles, 193 mW/cm2) was applied to the heart at 3 different levels (proximal and distal stent edges and middle portion of the stent) through X-ray for 20 min at each level for every other day for 2 weeks (6 days in total) (Figs. 1A, 1B). The sham therapy group was treated in the same manner but without LIPUS. At 4 weeks after the procedure, we performed coronary angiography to examine coronary vasoconstricting responses to intracoronary serotonin in vivo. Finally, stented coronary vessels were harvested for immunohistochemistry of vasa vasorum, lymphatic vessels (LYVE-1), sympathetic nerve fibers (SNF), vascular inflammation (macrophages and IL-1β expression), Rho-kinase expression and activity as evaluated by phosphorylated myosin phosphatase target subunit-1 (pMYPT-1).
Results
Coronary vasoconstricting responses to intracoronary serotonin were significantly enhanced in the sham therapy group but were significantly suppressed in the LIPUS group at the DES edges in the LAD, whereas those responses were comparable at the non-DES implanted segments in the left circumflex (LCx) coronary arteries between the 2 groups. (Figs. 1C, 1D). Furthermore, in vivo lymph transport speed was significantly faster in the LIPUS group than in sham group (Figs. 1E–1G). Histological analysis showed that except vasa vasorum formation, the number of lymphatic vessels, adventitial inflammatory cells infiltration, Rho-kinase expression and activity were all significantly enhanced in the sham therapy group and were significantly suppressed in the LIPUS group (Figs. 1G–1K).
Figure 1
Conclusion
We were able to develop a non-invasive LIPUS therapy for coronary functional abnormalities caused by chronic adventitial inflammation in pigs in vivo, for which multiple beneficial effects appear to be involved (Fig. 1L).
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Affiliation(s)
- T Watanabe
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Amamizu
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Morosawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Nishimiya
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shiroto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
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22
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Sugisawa J, Matsumoto Y, Suda A, Ota H, Tsuchiya S, Ohyama K, Takeuchi M, Shindo T, Ikeda S, Hao K, Kikuchi Y, Takahashi J, Takase K, Kohzuki M, Shimokawa H. 3332Exercise training ameliorates vasodilator capacity of coronary microvessels in patients with vasospastic angina - A new therapeutic approach for the coronary functional disorder. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
We have recently demonstrated that coronary vasospasm could develop in both epicardial coronary arteries and intramuscular coronary microvessels in patients with vasospastic angina (VSA). However, it remains to be examined whether vasodilator capacity of coronary microvessels is impaired in VSA patients and if so, whether exercise training could ameliorate vasodilator capacity of coronary microvessels on the top of calcium channel blockers. The effectiveness of exercise training is established for organic coronary artery disease but remained to be examined for VSA.
Purpose
We thus examined whether vasodilator capacity of coronary microvessels is impaired in VSA patients without organic coronary stenosis using an adenosine-stress dynamic computed tomography perfusion (CTP) that can measure absolute value of myocardial blood flow (MBF). We also examined whether exercise training ameliorates not only vasodilator capacity of coronary microvessels but also exercise capacity and frequency of angina attack.
Methods
In the first protocol, we measured MBF using CTP in consecutive 32 VSA patients with acetylcholine-induced diffuse coronary spasm in the left anterior descending coronary arteries (LAD) and 12 non-VSA controls. In the second protocol, we conducted a randomized controlled trial (RCT; Exercise VSA trial, UMIN: ehz745.008423996), where 20 VSA patients were randomly assigned to either exercise group (Ex group: supervised exercise training session for 30-min using bicycle ergometer, once/week at the hospital and more than 3 times/week at home) or non-exercise group (Non-Ex group) (n=10 each) (Figure A). Before and 3 months after exercise training, we measured MBF with adenosine-stress dynamic CTP and peak VO2 by cardiopulmonary exercise tests, and also assessed angina attack with Seattle Angina Questionnaire (SAQ).
Results
In the first protocol, CTP showed that adenosine-stress MBF was significantly decreased in the VSA group compared with the non-VSA group (VSA, 137.2±6.6 vs. Non-VSA, 174.4±10.7 ml/100g/min, P<0.01) (Figure B), although patient characteristics were comparable between the 2 groups. In the second protocol, exercise training was performed safely in all patients, and RCT showed that MBF was significantly increased in the Ex group compared with the non-Ex group (Figures C, D), although patient characteristics were also comparable between the 2 groups. Furthermore, peak VO2 was significantly increased in the Ex group compared with the non-Ex group (Figure E), and frequency of angina was significantly decreased in the Ex group compared with the non-Ex group (Figure F). Finally, there was a significant positive correlation between the extents of the changes in peak VO2 and the SAQ score for angina frequency in the Ex group (P<0.01, R=0.67).
Figures
Conclusions
These results provide the first evidence that vasodilator capacity of coronary microvessels is impaired in VSA patients, which can be ameliorated by exercise training.
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Affiliation(s)
- J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Ota
- Tohoku University Graduate School of Medicine, Department of Radiology, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - M Takeuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Takase
- Tohoku University Graduate School of Medicine, Department of Radiology, Sendai, Japan
| | - M Kohzuki
- Tohoku University Graduate School of Medicine, Department of Internal Medicine & Rehabilitation Science, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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23
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Suda A, Takahashi J, Hao K, Kikuchi Y, Shindo T, Ikeda S, Sato K, Sugisawa J, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. P4156Coexistence and prognostic impacts of epicardial and microvascular coronary dysfunctions in patients with chest pain and unobstructive coronary artery disease - Involvement of Rho-kinase activation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0728] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although the importance of coronary functional abnormalities has been emerging, including epicardial coronary spasm (vasospastic angina, VSA) and coronary microvascular dysfunction (CMD), comprehensive evaluation of the abnormalities in the same population remains to be examined.
Purpose
We examined the significance of coronary functional abnormalities in a comprehensive manner for both epicardial and microvascular coronary arteries in patients with chest pain and unobstructive coronary artery disease (CAD) as well as their prognostic impacts.
Methods and results
We prospectively enrolled 187 consecutive patients with suspected angina and unobstructive coronary arteries (M/F 113/74, 63.2±12.3 [SD] yrs.). We performed acetylcholine (ACh) provocation tests for coronary spasm, followed by functional tests for coronary microvascular function, including coronary flow reserve (CFR) and index of microcirculation resistance (IMR) during hyperemic state induced by intravenous adenosine. Among the 187 patients, ACh test identified 128 patients with VSA (68%). There was no significant difference in age, sex, or prevalence of traditional coronary risk factors between the non-VSA and the VSA groups. The median IMR value was significantly higher in the VSA group than in the non-VSA group [17.5 (12.0, 25.3) vs. 14.7 (10.7, 17.8), P=0.02], whereas CFR values were comparable between the 2 groups [2.51 (1.72, 3.35) vs. 2.66 (1.85, 3.64), P=0.34]. During the median follow-up period of 893 days, major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, and hospitalization due to unstable angina pectoris, occurred in 10 patients (5.3%). Multivariable analysis revealed that IMR correlated with the incidence of MACE [hazard ratio (HR) (95% confidence interval), 1.05 (1.02–1.09), P=0.002] and receiver-operating characteristics curve analysis identified IMR of 18.0 as the optimal cut-off value for the incidence of cardiac events. When we divided the patients into the following 4 groups according to the cut-off value of IMR (>18) and the presence or absence of VSA; G1, IMR <18 without VSA (n=45); G2, IMR ≥18 without VSA (n=14); G3, IMR <18 with VSA (n=67); and G4, IMR ≥18 with VSA (n=61), the Kaplan-Meier survival analysis showed a significantly worse prognosis in G4 compared with other 3 groups (HR [95% CI] 6.23 [1.21–118.46], P=0.002) (Figure 1). Importantly, intracoronary administration of fasudil, a Rho-kinase inhibitor, significantly ameliorated IMR in G4 (P<0.0001) (Figure 2A), and %changes in IMR in response to intracoronary fasudil were more evident in G4 compared with other 3 groups (P<0.0001) (Figure 2B).
Conclusions
These results provide the first evidence that in patients with chest pain and unobstructive CAD, epicardial coronary spasm and increased microvascular resistance are frequently coexisted with worse long-term prognosis, for which Rho-kinase activationmay be involved.
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Affiliation(s)
- A Suda
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - S Miyata
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
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24
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Tsuchiya S, Matsumoto Y, Doman T, Fujiya T, Sugisawa J, Suda A, Sato K, Ikeda S, Shindo T, Kikuchi Y, Hao K, Takahashi J, Hatta W, Koike T, Masamune A, Saiki Y, Horiuchi H, Shimokawa H. Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature. J Atheroscler Thromb 2019; 27:271-277. [PMID: 31378751 PMCID: PMC7113142 DOI: 10.5551/jat.49239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
An 83-year-old woman with severe aortic stenosis was admitted to our hospital due to heart failure with refractory anemia requiring blood transfusions. She had repetitive bleeding episodes from endoscopically proven angiodysplasia in the stomach. Moreover, she repeatedly underwent endoscopic argon plasma coagulation for hemostasis. Importantly, she had a deficiency of the high-molecular-weight (HMW) multimers of von Willebrand factor (VWF), and she was diagnosed with Heyde's syndrome.After she underwent transcatheter aortic valve implantation (TAVI), aortic valve area and mean left ventricular aorta pressure gradient improved. Notably, endoscopy showed cessation of bleeding at 10 days after TAVI and the disappearance of angiodysplasia at 4 months after TAVI. Even at 2 years after TAVI, follow-up endoscopy showed remaining free of angiodysplasia in the stomach. She experienced no episodes of anemia since TAVI procedure. Additionally, analysis of HMW multimers demonstrated immediate and lasting recovery after TAVI.Recovery of HMW multimers of VWF with cessation of gastrointestinal bleeding following aortic valve replacement has been previously reported in a patient diagnosed with Heyde's syndrome. To the best our knowledge, this is the first case to demonstrate that angiodysplasia disappears after TAVI for a long term with endoscopic images in a patient with Heyde's syndrome. Here, we summarized case reports of patients with Heyde's syndrome that required aortic valve intervention. Cessation of gastrointestinal bleeding and anemia after aortic valve intervention for severe aortic stenosis may be attributed not only to recovery of HMW multimers of VWF but also to the disappearance of angiodysplasia.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tsuyoshi Doman
- Department of Molecular and Cellular Biology, Institute of Development, Aging, and Cancer, Tohoku University
| | - Taku Fujiya
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shohei Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Waku Hatta
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tomoyuki Koike
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Atsushi Masamune
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate school of Medicine
| | - Hisanori Horiuchi
- Department of Molecular and Cellular Biology, Institute of Development, Aging, and Cancer, Tohoku University
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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25
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Ohyama K, Matsumoto Y, Takanami K, Ota H, Nishimiya K, Sugisawa J, Tsuchiya S, Amamizu H, Uzuka H, Suda A, Shindo T, Kikuchi Y, Hao K, Tsuburaya R, Takahashi J, Miyata S, Sakata Y, Takase K, Shimokawa H. Coronary Adventitial and Perivascular Adipose Tissue Inflammation in Patients With Vasospastic Angina. J Am Coll Cardiol 2019; 71:414-425. [PMID: 29389358 DOI: 10.1016/j.jacc.2017.11.046] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [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: 07/19/2017] [Revised: 10/22/2017] [Accepted: 11/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies suggested that perivascular components, such as perivascular adipose tissue (PVAT) and adventitial vasa vasorum (VV), play an important role as a source of various inflammatory mediators in cardiovascular disease. OBJECTIVES The authors tested their hypothesis that coronary artery spasm is associated with perivascular inflammation in patients with vasospastic angina (VSA) using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). METHODS This study prospectively examined 27 consecutive VSA patients with acetylcholine-induced diffuse spasm in the left anterior descending artery (LAD) and 13 subjects with suspected angina but without organic coronary lesions or coronary spasm. Using CT coronary angiography and electrocardiogram-gated 18F-FDG PET/CT, coronary PVAT volume and coronary perivascular FDG uptake in the LAD were examined. In addition, adventitial VV formation in the LAD was examined with optical coherence tomography, and Rho-kinase activity was measured in circulating leukocytes. RESULTS Patient characteristics were comparable between the 2 groups. CT coronary angiography and ECG-gated 18F-FDG PET/CT showed that coronary PVAT volume and coronary perivascular FDG uptake significantly increased in the VSA group compared with the non-VSA group. Furthermore, optical coherence tomography showed that adventitial VV formation significantly increased in the VSA group compared with the non-VSA group, as did Rho-kinase activity. Importantly, during the follow-up period with medical treatment, both coronary perivascular FDG uptake and Rho-kinase activity significantly decreased in the VSA group. CONCLUSIONS These results provide the first evidence that coronary spasm is associated with inflammation of coronary adventitia and PVAT, where 18F-FDG PET/CT could be useful for disease activity assessment. (Morphological and Functional Change of Coronary Perivascular Adipose Tissue in Vasospastic Angina [ADIPO-VSA Trial]; UMIN000016675).
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Affiliation(s)
- Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirokazu Amamizu
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironori Uzuka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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26
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Hao K, Takahashi J, Sakata Y, Miyata S, Shiroto T, Nochioka K, Miura M, Oikawa T, Abe R, Sato M, Kasahara S, Aoyanagi H, Shimokawa H. Prognostic impact of residual stenosis after percutaneous coronary intervention in patients with ischemic heart failure - A report from the CHART-2 study. Int J Cardiol 2019; 278:22-27. [PMID: 30366856 DOI: 10.1016/j.ijcard.2018.10.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/23/2018] [Revised: 09/09/2018] [Accepted: 10/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Complete revascularization with PCI is not always achieved in patients with ischemic HF. Therefore, this study aimed to elucidate the prognostic impact of residual coronary stenosis (RS) after percutaneous coronary intervention (PCI) in patients with ischemic heart failure (HF). METHODS We analyzed a total of 1307 patients with symptomatic HF and a history of PCI registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study. RS that was defined as the presence of ≥70% luminal stenosis in major coronary arteries at the last coronary angiography. RESULTS Among the study population, 851 patients (65.1%) had RS. During a median follow-up period of 3.2 years, patients with RS had higher all-cause mortality than those without it even after propensity score matching (21.9 vs. 11.6%, log-rank P = 0.027). Multivariable Cox hazard analysis also showed the negative impact of RS on all-cause death in ischemic HF patients [hazard ratio (HR):1.62, 95% confidence interval (CI): 1.07-2.46, P = 0.024]. Importantly, when divided all subjects into three subgroups by left ventricular ejection fraction (LVEF) [LVEF < 40% (HFrEF), LVEF 40-49% (HFmrEF), and LVEF ≥ 50% (HFpEF)], inverse probability of treatment weighted method provided a similar result that RS after PCI was an independent risk factor for death in the HFpEF [HR(95%CI); 1.94(1.22-3.09), P < 0.01] and HFmrEF [4.47(1.13-14.98), P < 0.01] groups, but not in the HFrEF group [1.20(0.59-2.43), P = 0.62]. CONCLUSIONS These results indicate that RS after PCI could aggravate long-term prognosis of ischemic HF patients with moderate- to well-preserved EF, but not those with reduced EF.
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Affiliation(s)
- Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Oikawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ruri Abe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Aoyanagi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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27
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Sato K, Takahashi J, Hao K, Sakata Y, Shimokawa H. P4618Temporal trends in emergency care and outcomes of geriatric patients with acute myocardial infarction in Japan - report from the miyagi AMI registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Sato
- Tohoku University Graduate School of Medicine, Department of cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of cardiovascular Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Department of cardiovascular Medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Department of cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of cardiovascular Medicine, Sendai, Japan
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28
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Tsuchiya S, Matsumoto Y, Kikuchi Y, Sugisawa J, Hao K, Takeuchi M, Takahashi J, Kawamoto S, Kumagai K, Wagatsuma T, Saiki Y, Shimokawa H. P6315Evidence for improved cognitive function following transcatheter aortic valve implantation in elderly patients with severe aortic stenosis - Brain perfusion SPECT imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Tsuchiya
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - M Takeuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - S Kawamoto
- Tohoku Pharmaceutical University Hospital, Cardiovascular Surgery, Sendai, Japan
| | - K Kumagai
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - T Wagatsuma
- Tohoku University Graduate School of Medicine, Anesthesiology and Perioperative Medicine, Sendai, Japan
| | - Y Saiki
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
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29
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Hao K, Takahashi J, Suda A, Sato K, Sugisawa J, Tsuchiya S, Sindo T, Ikeda S, Kikuchi Y, Matsumoto Y, Sakata Y, Shimokawa H. P4628Clinical significance of fractional flow reserve in patients with vasospastic angina and organic coronary stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Sindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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30
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Suda A, Takahashi J, Hao K, Kikuchi Y, Shindo T, Sato K, Sugisawa J, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. 1345Prognostic impacts of impaired coronary vasodilatation and enhanced coronary vasoconstricting responses in patients with angina and unobstructive coronary arteries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Suda
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - S Miyata
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Cardiovascular medicine, Sendai, Japan
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31
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Kikuchi Y, Takahashi J, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Hao K, Shiroto T, Matsumoto Y, Sakata Y, Shimokawa H. P793Usefulness and safety of fasudil, a selective Rho-kinase inhibitor, for PCI-related myocardial ischemia in interventional cardiology. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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32
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Sugisawa J, Matsumoto Y, Suda A, Ota H, Tsuchiya S, Ohyama K, Sato K, Shindo T, Ikeda S, Hao K, Kikuchi Y, Takahashi J, Shimokawa H. 1343Evidence for impaired vasodilator capacity of coronary microvessels in patients with vasospatic angina - Myocardial CT perfusion imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Ota
- Tohoku University Graduate School of Medicine, Department of Radiology, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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33
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Kikuchi Y, Ito K, Shindo T, Hao K, Shiroto T, Matsumoto Y, Takahashi J, Matsubara T, Yamada A, Ozaki Y, Hiroe M, Misumi K, Ota H, Takanami K, Hiraide T, Takase K, Tanji F, Tomata Y, Tsuji I, Shimokawa H. A multicenter trial of extracorporeal cardiac shock wave therapy for refractory angina pectoris: report of the highly advanced medical treatment in Japan. Heart Vessels 2018; 34:104-113. [PMID: 29942978 DOI: 10.1007/s00380-018-1215-4] [Citation(s) in RCA: 12] [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] [Received: 03/16/2018] [Accepted: 06/22/2018] [Indexed: 01/09/2023]
Abstract
We have previously demonstrated that cardiac shock wave therapy (CSWT) effectively improves myocardial ischemia through coronary neovascularization both in a porcine model of chronic myocardial ischemia and in patients with refractory angina pectoris (AP). In this study, we further addressed the efficacy and safety of CSWT in a single-arm multicenter study approved as a highly advanced medical treatment by the Japanese Ministry of Health, Labour and Welfare. Fifty patients with refractory AP [mean age 70.9 ± 12.6 (SD) years, M/F 38/12] without the indications of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were enrolled in 4 institutes in Japan. Ischemic myocardial regions in the left ventricle (LV) were identified by drug-induced stress myocardial perfusion imaging (MPI). Shock waves (200 shots/spot at 0.09 mJ/mm2) were applied to 40-60 spots in the ischemic myocardium 3 times in the first week. The patients were followed up for 3 months thereafter. Forty-one patients underwent CSWT and completed the follow-up at 3 months. CSWT markedly improved weekly nitroglycerin use [from 3.5 (IQR 2 to 6) to 0 (IQR 0 to 1)] and the symptoms [Canadian Cardiovascular Society functional class score, from 2 (IQR 2 to 3) to 1 (IQR 1 to 2)] (both P < 0.001). CSWT also significantly improved 6-min walking distance (from 384 ± 91 to 435 ± 122 m, P < 0.05). There were no significant changes in LV ejection fraction evaluated by echocardiography and LV stroke volume evaluated by cardiac magnetic resonance imaging (from 56.3 ± 14.7 to 58.8 ± 12.8%, P = 0.10, and from 52.3 ± 17.4 to 55.6 ± 15.7 mL, P = 0.15, respectively). Percent myocardium ischemia assessed by drug-induced stress MPI tended to be improved only in the treated segments (from 16.0 ± 11.1 to 12.1 ± 16.2%, P = 0.06), although no change was noted in the whole LV. No procedural complications or adverse effects related to the CSWT were noted. These results of the multicenter trial further indicate that CSWT is a useful and safe non-invasive strategy for patients with refractory AP with no options of PCI or CABG.
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Affiliation(s)
- Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takao Matsubara
- Department of Cardiovascular Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Akira Yamada
- Department of Cardiovascular Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Yukio Ozaki
- Department of Cardiovascular Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Michiaki Hiroe
- Department of Cardiovascular Medicine, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Kazuo Misumi
- Department of Cardiovascular Medicine, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Hideki Ota
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomomichi Hiraide
- Department of Radiology, Miyagi Cardiovascular and Respiratory Center, Kurihara, Japan
| | - Kei Takase
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumiya Tanji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Yasutake Tomata
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Vonk JM, Nieuwenhuis MAE, Dijk FN, Boudier A, Siroux V, Bouzigon E, Probst-Hensch N, Imboden M, Keidel D, Sin D, Bossé Y, Hao K, van den Berge M, Faiz A, Koppelman GH, Postma DS. Novel genes and insights in complete asthma remission: A genome-wide association study on clinical and complete asthma remission. Clin Exp Allergy 2018; 48:1286-1296. [PMID: 29786918 DOI: 10.1111/cea.13181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asthma is a chronic respiratory disease without a cure, although there exists spontaneous remission. Genome-wide association (GWA) studies have pinpointed genes associated with asthma development, but did not investigate asthma remission. OBJECTIVE We performed a GWA study to develop insights in asthma remission. METHODS Clinical remission (ClinR) was defined by the absence of asthma treatment and wheezing in the last year and asthma attacks in the last 3 years and complete remission (ComR) similarly but additionally with normal lung function and absence of bronchial hyperresponsiveness (BHR). A GWA study on both ClinR and ComR was performed in 790 asthmatics with initial doctor diagnosis of asthma and BHR and long-term follow-up. We assessed replication of the 25 top single nucleotide polymorphisms (SNPs) in 2 independent cohorts (total n = 456), followed by expression quantitative loci (eQTL) analyses of the 4 replicated SNPs in lung tissue and epithelium. RESULTS Of the 790 asthmatics, 178 (23%) had ClinR and 55 ComR (7%) after median follow-up of 15.5 (range 3.3-47.8) years. In ClinR, 1 of the 25 SNPs, rs2740102, replicated in a meta-analysis of the replication cohorts, which was an eQTL for POLI in lung tissue. In ComR, 3 SNPs replicated in a meta-analysis of the replication cohorts. The top-hit, rs6581895, almost reached genome-wide significance (P-value 4.68 × 10-7 ) and was an eQTL for FRS2 and CCT in lung tissue. Rs1420101 was a cis-eQTL in lung tissue for IL1RL1 and IL18R1 and a trans-eQTL for IL13. CONCLUSIONS AND CLINICAL RELEVANCE By defining a strict remission phenotype, we identified 3 SNPs to be associated with complete asthma remission, where 2 SNPs have plausible biological relevance in FRS2, CCT, IL1RL1, IL18R1 and IL13.
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Affiliation(s)
- J M Vonk
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - M A E Nieuwenhuis
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, The Netherlands
| | - F N Dijk
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, The Netherlands
| | - A Boudier
- INSERM, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, IAB, Grenoble, France
| | - V Siroux
- INSERM, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, IAB, Grenoble, France.,Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, IAB, Univ. Grenoble Alpes, Grenoble, France.,CHU de Grenoble, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, IAB, Grenoble, France
| | - E Bouzigon
- UMR-946, Inserm, Paris, France.,Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, France
| | - N Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - M Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - D Keidel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - D Sin
- St Paul's Hospital, The University of British Columbia James Hogg Research Laboratory, Vancouver, BC, Canada.,Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Y Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Molecular Medicine, Laval University, Québec, QC, Canada
| | - K Hao
- Merck Research Laboratories, Boston, MA, USA
| | - M van den Berge
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, The Netherlands
| | - A Faiz
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, The Netherlands
| | - G H Koppelman
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, The Netherlands
| | - D S Postma
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, The Netherlands
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Satoh K, Takahashi J, Matsumoto Y, Tatebe S, Aoki T, Kikuchi Y, Hao K, Ohyama K, Nogi M, Suda A, Kasahara S, Sato K, Ichijo S, Shimokawa H. European Society of Cardiology (ESC) Annual Congress Report From Barcelona 2017. Circ J 2017; 81:1758-1763. [PMID: 29093432 DOI: 10.1253/circj.cj-17-1103] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
From August 26th to 30th, the 2017 Annual Congress of the European Society of Cardiology (ESC 2017) was held in Barcelona, Spain. Despite the terrorism tradegy just before the ESC congress, the congress attracted many medical professionals from all over the world to discuss the recent topics in cardiovascular medicine in more than 500 sessions, including COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS Trial), CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study), and ORION (which assessed the effect of a novel siRNA inhibitor to PCSK9 on reductions in low-density lipoprotein cholesterol). Japanese cardiologists and the Japanese Circulation Society greatly contributed to the congress. This report briefly introduces some late-breaking registry results, late-breaking clinical trials, and ESC Guidelines from the ESC 2017 Congress.
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Affiliation(s)
- Kimio Satoh
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tatsuo Aoki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masamichi Nogi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Sadamitsu Ichijo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Nishimiya K, Matsumoto Y, Wang H, Piao Z, Ohyama K, Uzuka H, Hao K, Tsuburaya R, Takahashi J, Ito K, Shimokawa H. Absence of adventitial vasa vasorum formation at the coronary segment with myocardial bridge - An optical coherence tomography study. Int J Cardiol 2017; 250:275-277. [PMID: 28993001 DOI: 10.1016/j.ijcard.2017.09.211] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Myocardial bridge (MB) is a myocardial bundle through which coronary segment tunnels and could compress coronary arteries causing myocardial ischemia. However, the characteristic structural findings of MB remain to be fully elucidated. Recently, we demonstrated that optical coherence tomography (OCT) enables us to visualize adventitial vasa vasorum (VV) formation in humans. In this study, we examined adventitial VV formation at the coronary segment with MB in humans using OCT. METHODS We examined 15 consecutive patients with suspected angina pectoris and MB in the left anterior descending (LAD) coronary arteries but no angiographic coronary stenosis. MB was detected on coronary angiography as a segment with milking effect. We performed intracoronary OCT imaging along the entire LAD. Morphometric analysis was performed at MB and proximal/distal segments at every 1mm. RESULTS OCT examination showed the absence of adventitial VV formation at MB in the LAD, while VV was clearly noted at both the proximal and distal reference segments. Adventitial VV area was significantly less at MB compared with the proximal or distal references. CONCLUSIONS These results with OCT imaging indicate that coronary segments with MB lack adventitial VV formation in humans, suggesting that MB could influence morphological and functional changes of the coronary artery.
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Affiliation(s)
- Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hongxin Wang
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Zhonglie Piao
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hironori Uzuka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
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Sato K, Takahashi J, Cui Y, Hao K, Miyata S, Sakata Y, Shimokawa H. Temporal Trends in Prevalence and Outcomes of Geriatric Patients with Acute Myocardial Infarction Complicated with Heart Failure -Miyagi AMI Registry-. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.072] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kerns S, Hao K, Stahl E, Rosenstein B, CaamaNo AG, Carballo A, Peleteiro P, Fachal L, Vega A, Dunning A, Sydes M, Hall E, Dearnaley D, West C, Ostrer H. Contribution of Common SNPs to Variability in Late Radiation Therapy Toxicity in Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2047] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Uzuka H, Matsumoto Y, Nishimiya K, Ohyama K, Suzuki H, Amamizu H, Morosawa S, Hirano M, Shindo T, Kikuchi Y, Hao K, Shiroto T, Ito K, Takahashi J, Fukuda K, Miyata S, Funaki Y, Ishibashi-Ueda H, Yasuda S, Shimokawa H. Renal Denervation Suppresses Coronary Hyperconstricting Responses After Drug-Eluting Stent Implantation in Pigs In Vivo Through the Kidney-Brain-Heart Axis. Arterioscler Thromb Vasc Biol 2017; 37:1869-1880. [PMID: 28818859 DOI: 10.1161/atvbaha.117.309777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Drug-eluting stent-induced coronary hyperconstricting responses remain an important issue. The adventitia harbors a variety of components that potently modulate vascular tone, including sympathetic nerve fibers (SNF) and vasa vasorum. Catheter-based renal denervation (RDN) inhibits sympathetic nerve activity. We, thus, examined whether RDN suppresses drug-eluting stent-induced coronary hyperconstricting responses, and if so, what mechanisms are involved. APPROACH AND RESULTS Protocol 1: pigs implanted with everolimus-eluting stents into the left coronary arteries underwent coronary angiography at 1 month after implantation for assessment of coronary vasomotion and adventitial SNF formation. Drug-eluting stent-induced coronary hyperconstricting responses were significantly enhanced associated with enhanced coronary adventitial SNF and vasa vasorum formation. Protocol 2: pigs implanted with everolimus-eluting stents were randomly assigned to the RDN or sham group. The RDN group underwent renal ablation. At 1 month, RDN significantly caused marked damage of the SNF at the renal arteries without any stenosis, thrombus, or dissections. Notably, RDN significantly upregulated the expression of α2-adrenergic receptor-binding sites in the nucleus tractus solitarius, attenuated muscle sympathetic nerve activity, and decreased systolic blood pressure and plasma renin activity. In addition, RDN attenuated coronary hyperconstricting responses to intracoronary serotonin at the proximal and distal stent edges associated with decreases in SNF and vasa vasorum formation, inflammatory cell infiltration, and Rho-kinase expression/activation. Furthermore, there were significant positive correlations between SNF and vasa vasorum and between SNF and coronary vasoconstricting responses. CONCLUSIONS These results provide the first evidence that RDN ameliorates drug-eluting stent-induced coronary hyperconstricting responses in pigs in vivo through the kidney-brain-heart axis.
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Affiliation(s)
- Hironori Uzuka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kensuke Nishimiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuma Ohyama
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Suzuki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hirokazu Amamizu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Susumu Morosawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Michinori Hirano
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomohiko Shindo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoku Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kiyotaka Hao
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenta Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Fukuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihito Funaki
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hatsue Ishibashi-Ueda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (H.U., Y.M., K.N., K.O., H. Suzuki, H.A., S.M., M.H., T.S., Y.K., K.H., T.S., K.I., J.T., K.F., S.M., H. Shimokawa); Wellman Center for Photomedicine, Massachusetts General Hospital, Boston (K.N.); Division of Brain Sciences, Department of Medicine, Imperial College London, United Kingdom (H. Suzuki); Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan (Y.F.); and Department of Pathology (H.I.-U.) and Department of Cardiovascular Medicine (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.
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Kikuchi Y, Ito K, Shindo T, Hao K, Shiroto T, Matsumoto Y, Takahashi J, Matsubara T, Yamada A, Ozaki Y, Hiroe M, Misumi K, Tomata Y, Tsuji I, Shimokawa H. P4023A multicenter trial of extracorporeal cardiac shock wave therapy for refractory angina pectoris - Results from the highly advanced medical treatment in Japan. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4023] [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: 11/14/2022] Open
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41
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Suda A, Takahashi J, Hao K, Kikuchi Y, Shindo T, Komatsu M, Odaka Y, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. 1057Important prognostic impact of comorbid coronary microvascular dysfunction in patients with vasospastic angina. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hao K, Takahashi J, Sakata Y, Miyata S, Shiroto T, Nochioka K, Shimokawa H. 3868Different prognostic impacts of residual coronary stenosis after percutaneous coronary intervention by left ventricular systolic function in patients with ischemic heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K. Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J. Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y. Sakata
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S. Miyata
- Tohoku University Graduate School of Medicine, Department of Evidenced-based Cardiovascular Medicine, Sendai, Japan
| | - T. Shiroto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K. Nochioka
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H. Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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Ong P, Odaka Y, Athanasiadis A, Suda A, Komatsu M, Nishimiya K, Hao K, Tsuburaya R, Ito K, Mahrholdt H, Schaeufele T, Hill S, Takahashi J, Sechtem U, Shimokawa H. P882Comparison of epicardial coronary artery spasm during intracoronary acetylcholine testing between German and Japanese patients with unobstructed coronaries. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p882] [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: 11/13/2022] Open
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Ohyama K, Matsumoto Y, Takanami K, Ota H, Nishimiya K, Sugisawa J, Amamizu H, Uzuka H, Suda A, Shindo T, Kikuchi Y, Hao K, Takahashi J, Sakata Y, Shimokawa H. 1059Evidence for enhanced inflammation of coronary adventitia and perivascular adipose tissue in patients with vasospastic angina - a multi-modality imaging study-. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1059] [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: 11/14/2022] Open
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45
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Cui Y, Hao K, Takahashi J, Miyata S, Shindo T, Nishimiya K, Kikuchi Y, Tsuburaya R, Matsumoto Y, Ito K, Sakata Y, Shimokawa H. Age-Specific Trends in the Incidence and In-Hospital Mortality of Acute Myocardial Infarction Over 30 Years in Japan — Report From the Miyagi AMI Registry Study —. Circ J 2017; 81:520-528. [DOI: 10.1253/circj.cj-16-0799] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuanji Cui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Satoshi Miyata
- Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
- Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
- Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Kozu K, Suzuki H, Nishiyama S, Yaoita N, Yamamoto S, Tatebe S, Miura M, Aoki T, Hao K, Matsumoto Y, Sugimura K, Aoki M, Shimokawa H. Multiple sclerosis lesion in the medulla oblongata in a patient with takotsubo cardiomyopathy. Int J Cardiol 2016; 222:980-981. [DOI: 10.1016/j.ijcard.2016.08.128] [Citation(s) in RCA: 8] [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: 06/15/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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Odaka Y, Takahashi J, Tsuburaya R, Nishimiya K, Hao K, Matsumoto Y, Ito K, Sakata Y, Miyata S, Manita D, Hirowatari Y, Shimokawa H. Plasma concentration of serotonin is a novel biomarker for coronary microvascular dysfunction in patients with suspected angina and unobstructive coronary arteries. Eur Heart J 2016; 38:489-496. [DOI: 10.1093/eurheartj/ehw448] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 08/26/2016] [Indexed: 11/14/2022] Open
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Komatsu M, Takahashi J, Fukuda K, Takagi Y, Shiroto T, Nakano M, Kondo M, Tsuburaya R, Hao K, Nishimiya K, Nihei T, Matsumoto Y, Ito K, Sakata Y, Miyata S, Shimokawa H. Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003798. [DOI: 10.1161/circep.115.003798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Received: 11/02/2015] [Accepted: 08/04/2016] [Indexed: 11/16/2022]
Abstract
Background—
Optimal therapy for patients resuscitated from out-of-hospital cardiac arrest (OHCA) who are not found to have structural heart disease remains to be established, especially regarding the use of implantable cardioverter-defibrillators. Coronary artery spasm (CAS) and lethal ventricular arrhythmias are important causes of OHCA.
Methods and Results—
In 47 consecutive OHCA survivors without structural heart disease who had fully recovered (M/F 44/3, 43±13 years.), we performed dual induction tests, including acetylcholine provocation test first followed by programmed ventricular stimulation after 1 to 2 weeks. Patients with CAS were treated with calcium channel blocker–based antianginal medications; implantable cardioverter-defibrillators were implanted in all patients. The results of the dual induction tests defined 4 groups: CAS alone (n=7), inducible ventricular arrhythmias alone (n=13), both positive (n=24), and both negative (n=3). During a median follow-up period of 38 months, ventricular fibrillation recurred in all groups except the both-negative group. Of the 16 patients with a type I Brugada ECG, 2 had CAS alone, 8 had ventricular arrhythmias alone, and 6 had both positive. No ventricular fibrillation episodes were observed in the CAS-alone patients who did not also have Brugada syndrome. Kaplan–Meier analysis showed that the CAS-alone group was at lower risk for OHCA recurrence as compared with the Brugada syndrome group (log-rank test;
P
=0.036).
Conclusions—
Among OHCA survivors without structural heart disease, provokable CAS and ventricular arrhythmias are common and can be seen in Brugada syndrome. CAS alone without Brugada syndrome who are treated for CAS may be a lower-risk group.
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Affiliation(s)
- Masayasu Komatsu
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Fukuda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Takagi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Nakano
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masateru Kondo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuji Tsuburaya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taro Nihei
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenta Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Hao K, Takahashi J, Miyata S, Sakata Y, Shimokawa H. Prognostic Impact of Residual Coronary Stenosis in Patients With Ischemic Heart Failure After Percutaneous Coronary Intervention. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Takahashi J, Satoh K, Fukuda K, Sugimura K, Matsumoto Y, Nakano M, Tsuburaya R, Aoki T, Hao K, Nishimiya K, Ito K, Sakata Y, Shimokawa H. Overview of the 80(th) Annual Scientific Meeting of the Japanese Circulation Society - The Past, Present and Future of Cardiovascular Medicine in Japan - - The 5(th) Anniversary of the Great East Japan Earthquake. Circ J 2016; 80:1689-94. [PMID: 27385500 DOI: 10.1253/circj.cj-16-0644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/09/2022]
Abstract
The 80(th)Annual Scientific Meeting of the Japanese Circulation Society was held in Sendai, Japan, on March 18-20, 2016, which coincided with the 5(th)anniversary of the Great East Japan Earthquake that hit the Tohoku area on March 11, 2011. Thus, the main themes for this meeting were "The Past, Present and Future of Cardiovascular Medicine in Japan" and "The 5(th)Anniversary of the Great East Japan Earthquake". Despite the provincial location, approximately 15,000 people attended during the 3-day meeting, and there were in-depth discussions in each of the various sessions on these themes. Especially, to our great pleasure, the Japanese Royals, Emperor Akihito and Empress Michiko, kindly visited the panel exhibition of the Great East Japan Earthquake and spoke words of appreciation to us. The meeting successfully completed and we sincerely appreciate the great cooperation and support from all affiliates. (Circ J 2016; 80: 1689-1694).
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Affiliation(s)
- Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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