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Tatami Y, Tanaka A, Ohashi T, Kubota R, Kaneko S, Shinoda M, Uemura Y, Takagi K, Tanaka M, Umemoto N, Tashiro H, Shibata N, Yoshioka N, Watarai M, Morishima I, Takada Y, Shimizu K, Ishii H, Murohara T. Clinical features, future cardiac events, and prognostic factors following percutaneous coronary intervention in young female patients. Heart Vessels 2024; 39:505-513. [PMID: 38411632 DOI: 10.1007/s00380-024-02369-7] [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: 09/09/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The proportion of young females among the patients who undergo percutaneous coronary intervention (PCI) is relatively small, and information on their clinical characteristics is limited. This study investigated the clinical characteristics and prognostic factors for future cardiac events in young females who underwent PCI. METHODS This multicenter observational study included 187 consecutive female patients aged < 60 years who underwent PCI in seven hospitals. The primary composite endpoint was the incidence of cardiac death, nonfatal myocardial infarction, and target vessel revascularization. RESULTS The mean patient age was 52.1 ± 6.1 years and 89 (47.6%) had diabetes, and renal dysfunction (an estimated glomerular filtration rate < 60 mL/min/1.73 m2) was observed in 38 (20.3%). During a median follow-up of 3.3 years, the primary endpoint occurred in 28 patients. The Cox proportional hazards models showed that renal dysfunction was an independent predictor for the primary endpoint (hazard ratio 3.04, 95% confidence interval 1.25-7.40, p = 0.01), as well as multivessel disease (hazard ratio 2.79, 95% confidence interval 1.12-6.93, p = 0.03). Patients with renal dysfunction had a significantly higher risk for the primary endpoint than those without renal dysfunction. CONCLUSIONS Renal dysfunction was strongly associated with future cardiac events in young females who underwent PCI.
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Affiliation(s)
- Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan.
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Ryuji Kubota
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Shinji Kaneko
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | | | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
- Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8560, Japan
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Yasaka K, Uehara S, Kato S, Watanabe Y, Tajima T, Akai H, Yoshioka N, Akahane M, Ohtomo K, Abe O, Kiryu S. Super-resolution Deep Learning Reconstruction Cervical Spine 1.5T MRI: Improved Interobserver Agreement in Evaluations of Neuroforaminal Stenosis Compared to Conventional Deep Learning Reconstruction. J Imaging Inform Med 2024:10.1007/s10278-024-01112-y. [PMID: 38671337 DOI: 10.1007/s10278-024-01112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
The aim of this study was to investigate whether super-resolution deep learning reconstruction (SR-DLR) is superior to conventional deep learning reconstruction (DLR) with respect to interobserver agreement in the evaluation of neuroforaminal stenosis using 1.5T cervical spine MRI. This retrospective study included 39 patients who underwent 1.5T cervical spine MRI. T2-weighted sagittal images were reconstructed with SR-DLR and DLR. Three blinded radiologists independently evaluated the images in terms of the degree of neuroforaminal stenosis, depictions of the vertebrae, spinal cord and neural foramina, sharpness, noise, artefacts and diagnostic acceptability. In quantitative image analyses, a fourth radiologist evaluated the signal-to-noise ratio (SNR) by placing a circular or ovoid region of interest on the spinal cord, and the edge slope based on a linear region of interest placed across the surface of the spinal cord. Interobserver agreement in the evaluations of neuroforaminal stenosis using SR-DLR and DLR was 0.422-0.571 and 0.410-0.542, respectively. The kappa values between reader 1 vs. reader 2 and reader 2 vs. reader 3 significantly differed. Two of the three readers rated depictions of the spinal cord, sharpness, and diagnostic acceptability as significantly better with SR-DLR than with DLR. Both SNR and edge slope (/mm) were also significantly better with SR-DLR (12.9 and 6031, respectively) than with DLR (11.5 and 3741, respectively) (p < 0.001 for both). In conclusion, compared to DLR, SR-DLR improved interobserver agreement in the evaluations of neuroforaminal stenosis using 1.5T cervical spine MRI.
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Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Shunichi Uehara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shimpei Kato
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yusuke Watanabe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taku Tajima
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Hiroyuki Akai
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 Ktiakanemaru, Ohtawara, Tochigi, 324-8501, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.
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Yoshioka N, Shimada T, Iwasaki Y, Yoshida H, Otsuka K, Yamazaki T, Morita Y, Nakamura S, Fukuda D, Morishima I. Utility and optimal dose of nicorandil for physiological assessment of the femoropopliteal artery. Catheter Cardiovasc Interv 2024; 103:670-677. [PMID: 38363043 DOI: 10.1002/ccd.30976] [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: 08/24/2023] [Revised: 12/10/2023] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Nicorandil is widely used as a vasodilator for the physiological assessment of coronary arteries because of its usefulness and safety; however, there are no data on its use in peripheral arteries. AIMS To identify the utility of nicorandil and its appropriate dose for the physiological assessment on the femoropopliteal artery. METHODS We retrospectively enrolled patients from three institutes in which physiological assessment was carried out with various doses of nicorandil before treatment. Twenty-four femoropopliteal artery stenotic lesions from 22 patients were included. The nicorandil doses used were 2, 4, and 6 mg. Twenty-two lesions were also assessed using 30 mg of papaverine. The pressure gradient (PG) and peripheral fractional flow reserve (pFFR) were calculated based on the mean and systolic pressure levels. We examined the correlation of each parameter with the peak systolic velocity ratio (PSVR) based on the duplex ultrasound images using Spearman's rank correlation coefficient. Systemic blood pressure was assessed for safety. RESULTS The correlations were higher for mean pressure-based parameters than for systolic pressure-based parameters. As the nicorandil dose increased, the correlations among PG, pFFR, and PSVR also increased (mean pressure-based PG: 2 mg, r = 0.360; 4 mg, r = 0.498; 6 mg, r = 0.694, mean pressure-based pFFR: 2 mg, r = -0.479; 4 mg, r = -0.469; 6 mg, r = -0.641). The blood pressure after the administration of 6 mg of nicorandil was low, and the median systemic mean pressure was 65 mmHg. CONCLUSION A 4 mg dose of nicorandil is effective and safe for the mean pressure-based physiological assessment of lesions in the femoropopliteal artery.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kenichiro Otsuka
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takanori Yamazaki
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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Horie K, Takahara M, Nakama T, Tobita K, Tanaka A, Shintani Y, Tsubakimoto Y, Yoshioka N, Hayakawa N, Sasaki S, Iwata Y, Ogata K, Takagi T, Doijiri T, Fujihara M. Multicenter Registry of Common Femoral Artery Disease Treated With Endovascular Revascularization Using Interwoven Nitinol Stents: An Observational Retrospective Study. J Endovasc Ther 2024:15266028241231472. [PMID: 38369732 DOI: 10.1177/15266028241231472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
PURPOSE Surgical thromboendarterectomy has been the gold standard treatment for common femoral artery (CFA) disease. However, endovascular therapy (EVT) is conducted in certain patients with CFA lesions because of multiple comorbidities. The interwoven nitinol stent (IWS) has been developed to prevent stent fracture. Thus, this study aimed to evaluate the feasibility of EVT using IWS for CFA lesions in clinical practice. MATERIALS AND METHODS This retrospective multicenter registry analyzed patients who had symptomatic lower-extremity artery disease due to CFA lesions and underwent EVT using IWS between 2019 and 2021. The primary endpoint was restenosis 2 years after EVT. RESULTS This study enrolled a total of 177 patients with 196 CFA lesions. The 2-year estimate of freedom from restenosis was 88.0%. The 2-year freedom rates from the target-lesion revascularization, major amputation, and all-cause death were 92.9%, 99.0%, and 75.2%, respectively. The clinical features significantly associated with restenosis risk were the reference vessel diameter (RVD, per 1.0 mm, hazard ratio [HR], 0.24 [0.08-0.70]; p=0.009), external iliac artery (EIA) involvement (HR=4.03 [1.56-10.4]; p=0.004), superficial femoral artery (SFA) involvement (HR=3.05 [1.00-9.25]; p=0.049), body mass index (BMI; per 1.0, HR=0.85 [0.73-0.99]; p=0.032), occlusion of deep femoral arteries (DFAs) at baseline (HR=7.89 [2.04-30.5]; p=0.003), and chronic limb-threatening ischemia (CLTI, HR=2.63 [1.02-6.78]; p=0.045). Their significant association was also confirmed by the random survival forest analysis. During a median follow-up of 12.0 months, guiding sheaths were inserted via CFAs implanted IWSs in 73 cases (37.2%), and no patients had cannulation-related complications, such as failed hemostasis, fracture of IWS, and stent occlusion. CONCLUSIONS Endovascular therapy using IWS in CFA lesions showed acceptable 2-year patency rates at 88.0% and might preserve the arterial access via the ipsilateral CFAs. Small RVD, involving EIA and SFA lesions, emaciation, occluded DFA, and CLTI are associated with poor 2-year patency rates following EVT, thus, IWS implantation in CFA lesions may be an option for patients unsuitable for surgical revascularization. CLINICAL IMPACT This retrospective multicenter registry enrolled 177 patients with 199 CFA lesions treated with EVT using interwoven nitinol stents, because surgical thromboendarterectomy was difficult due to their multiple comorbidities. The 2-year estimate of freedom from restenosis was acceptable at 88.0%. The 2-year freedom rate from major amputation was also high at 99.0%. Moreover, during a median follow-up of 12.0 months, guiding sheaths were inserted via CFAs implanted IWSs in 73 cases, and no patients had cannulation-related complications such as failed hemostasis, fracture of IWS, and stent occlusion.
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Affiliation(s)
- Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Kazuki Tobita
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Akiko Tanaka
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yoshiaki Shintani
- Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
| | | | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Shinya Sasaki
- Department of Cardiology, Saka General Hospital, Shiogama, Japan
| | - Yo Iwata
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Kenji Ogata
- Cardiovascular Center, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Tomonari Takagi
- Cardiovascular Center, Takatsu General Hospital, Kawasaki, Japan
| | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital, Yamato, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
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Tretyakov EV, Zayakin IA, Dmitriev AA, Fedin MV, Romanenko GV, Bogomyakov AS, Akyeva AY, Syroeshkin MA, Yoshioka N, Gritsan NP. A Nitronyl Nitroxide-Substituted Benzotriazinyl Tetraradical. Chemistry 2024; 30:e202303456. [PMID: 37988241 DOI: 10.1002/chem.202303456] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/23/2023]
Abstract
High-spin organic tetraradicals with significant intramolecular exchange interactions have high potential for advanced technological applications and fundamental research, but those synthesized to date possess limited stability and processability. In this work, we have designed a tetraradical based on the Blatter's radical and nitronyl nitroxide radical moieties and successfully synthesized it by using the palladium-catalyzed cross-coupling reaction of a triiodo-derivative of the 1,2,4-benzotriazinyl radical with gold(I) nitronyl nitroxide-2-ide complex in the presence of a newly developed efficient catalytic system. The molecular and crystal structure of the tetraradical was confirmed by X-ray diffraction analysis. The tetraradical possesses good thermal stability with decomposition onset at ∼150 °C under an inert atmosphere and exhibits reversible redox waves at -0.54 and 0.45 V versus Ag/AgCl. The magnetic properties of the tetraradical were characterized by SQUID magnetometry of polycrystalline powders and EPR spectroscopy in various matrices. The collected data, analyzed by using high-level quantum chemical calculations, confirmed that the tetraradical has a triplet ground state and a nearby excited quintet state. The unique high stability of the prepared triazinyl-nitronylnitroxide tetraradical is a new milestone in the field of creating high-spin systems.
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Affiliation(s)
- Evgeny V Tretyakov
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Ave. 47, 119991, Moscow, Russian Federation
| | - Igor A Zayakin
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Ave. 47, 119991, Moscow, Russian Federation
| | - Alexey A Dmitriev
- V.V. Voevodsky Institute of Chemical Kinetics and Combustion, Siberian Branch of Russian Academy of Sciences, Institutskaya Str. 3, 630090, Novosibirsk, Russian Federation
| | - Matvey V Fedin
- International Tomography Center, Siberian Branch of Russian Academy of Sciences, Institutskaya Str. 3a, 630090, Novosibirsk, Russian Federation
| | - Galina V Romanenko
- International Tomography Center, Siberian Branch of Russian Academy of Sciences, Institutskaya Str. 3a, 630090, Novosibirsk, Russian Federation
| | - Artem S Bogomyakov
- International Tomography Center, Siberian Branch of Russian Academy of Sciences, Institutskaya Str. 3a, 630090, Novosibirsk, Russian Federation
| | - Anna Ya Akyeva
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Ave. 47, 119991, Moscow, Russian Federation
| | - Mikhail A Syroeshkin
- N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky Ave. 47, 119991, Moscow, Russian Federation
| | - Naoki Yoshioka
- Department of Applied Chemistry Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, 223-8522 Kanagawa, Japan
| | - Nina P Gritsan
- V.V. Voevodsky Institute of Chemical Kinetics and Combustion, Siberian Branch of Russian Academy of Sciences, Institutskaya Str. 3, 630090, Novosibirsk, Russian Federation
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Yamada T, Tokuda T, Yoshioka N, Koyama A, Nishikawa R, Shimamura K, Tsuruoka T, Mitsuoka H, Aoyama T. Validation of the Usefulness of the Diameter Reduction, Spiral Shape, Flow Impairment, or Adverse Morphology Classification System in Real-World Clinical Practice. J Atheroscler Thromb 2024; 31:148-157. [PMID: 37558496 PMCID: PMC10857836 DOI: 10.5551/jat.64335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/02/2023] [Indexed: 08/11/2023] Open
Abstract
AIM The accuracy of the DISFORM (diameter reduction, spiral shape, flow impairment, or adverse morphology) classification system has not been validated. METHODS This retrospective multicenter observational study enrolled 288 consecutive patients with lower extremity artery disease who underwent endovascular therapy with drug-coated balloons for femoropopliteal lesions between January 2018 and December 2021. Patients were classified into DISFORM I-IV groups. Primary patency (PP) and freedom from clinically driven target lesion revascularization (CD-TLR) at 12 months, and recurrence predictors at 12 months were investigated. RESULTS In total, 183, 66, 11, and 28 patients were classified into DISFORM I, II, III, and IV groups, respectively. In the DISFORM I, II, III, and IV groups, the PP rates were 75.3%, 91.1%, 87.5%, and 50.0%, respectively, and freedom from CD-TLR rates were 86.0%, 91.6%, 88.9%, and 76.7%, respectively, at 12 months. In the DISFORM I-III and IV groups, the PP rates were 79.4% and 50.0%, respectively, and freedom from CD-TLR rates were 87.5% and 76.7%, respectively, at 12 months. Multivariate analysis showed that chronic limb-threatening ischemia, DISFORM IV, and Lutonix™ use were independent predictors of PP loss at 12 months. CONCLUSION DISFORM IV had a lower PP rate than DISFORM I-III in midterm phase.
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Affiliation(s)
- Takehiro Yamada
- Division of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | | | - Naoki Yoshioka
- Division of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Akio Koyama
- Division of Vascular surgery, Toyota Memorial Hospital, Aichi, Japan
| | | | | | - Takuya Tsuruoka
- Division of Vascular surgery, Ichinomiya Municipal Hospital, Aichi, Japan
| | - Hiroki Mitsuoka
- Division of Vascular surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Takuma Aoyama
- Division of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Division of molecular pathology, Shinshu University of Medicine, Nagano, Japan
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Tokuda T, Yoshioka N, Koyama A, Yamada T, Shimamura K, Nishikawa R. Chronic Limb-Threatening Ischemia is a Residual Bleeding Risk Factor among Patients with Lower Extremity Artery Disease. J Atheroscler Thromb 2024; 31:100-108. [PMID: 37532569 PMCID: PMC10776334 DOI: 10.5551/jat.64242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
AIM Lower-extremity artery disease (LEAD) is a high-risk factor for bleeding. However, the specific risk factors for bleeding in patients with LEAD remain unclear. We aimed to identify risk factors for bleeding in patients with LEAD after endovascular treatment (EVT). METHODS This multicenter, retrospective, observational study included 732 consecutive patients with LEAD who underwent EVT between January 2018 and December 2019. Patient characteristics, laboratory data, target lesions, and medications were compared between patients with and without chronic limb-threatening ischemia (CLTI). Predictive bleeding risk factors were explored using Cox regression analysis with differential models. RESULTS In model 1, a body mass index (BMI) <18.5 kg/m2, prior heart failure, high bleeding risk, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were predictive bleeding risk factors (hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.13-3.52; p<0.01; HR 2.15; 95% CI 1.28-3.55; p<0.01; HR 3.40; 95% CI 1.28-3.55; p<0.01; HR 2.05; 95% CI 1.33-5.84; p<0.01; respectively). In model 2, a BMI <18.5 kg/m2, prior heart failure, anemia (<11 g/dL), low platelet count (<10*104/µL), chronic kidney disease, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were independent risk factors for bleeding (model 2: HR 2.05; 95% CI 1.12-3.56; p=0.02; HR 2.35; 95% CI 1.39-3.90; p<0.01; HR 2.71; 95% CI 1.64-4.50; p<0.01; HR 2.66; 95% CI 1.00-5.89; p=0.05; HR 2.47; 95% CI 1.25-5.45; p<0.01; HR 2.79; 95% CI 1.24-5.63; p=0.01; respectively) Conclusions: CLTI is a residual and predictive risk factor for bleeding in patients with LEAD. We have to pay attention to the bleeding events of patients with CLTI after EVT during follow-up.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Aichi, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | | | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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8
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Funakubo H, Tanaka A, Tobe A, Kunieda T, Kubota Y, Yoshioka N, Otsuka S, Kudo N, Shirai Y, Furusawa K, Ishii H, Murohara T. Impact of proteinuria on long-term prognosis in patients with coronary artery disease. J Cardiovasc Med (Hagerstown) 2023; 24:900-905. [PMID: 37942791 DOI: 10.2459/jcm.0000000000001573] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND This study aimed to investigate the association between proteinuria and long-term prognosis in patients with coronary artery disease. METHODS This was a single-center observational study. A total of 1351 patients were identified who underwent percutaneous coronary intervention, and whose urine data were available. Patients were divided into two groups according to the presence (n = 245) or absence (n = 1106) of proteinuria. All-cause and cardiovascular deaths were primarily evaluated. RESULTS The prevalence rates of hypertension and diabetes were significantly higher, and the baseline estimated glomerular filtration rate (eGFR) was lower in patients with proteinuria than in those without proteinuria. During the median follow-up of 4.1 years (interquartile range, 1.7-6.8 years), the occurrences of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria. Multivariable Cox regression analysis indicated that the presence of proteinuria was a significant predictor of cardiovascular death as well as age, BMI, reduced eGFR, and left ventricular ejection fraction. When stratified into four groups based on eGFR category (eGFR <60 or ≥60 ml/min/1.73 m2) and absence or presence of proteinuria, the incidence rates of all-cause and cardiovascular deaths were highest in patients with proteinuria and eGFR less than 60 ml/min/1.73 m2. Furthermore, the incidence rates of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria among both diabetic and nondiabetic patients. CONCLUSION Proteinuria is associated with the long-term prognosis, and all-cause and cardiovascular deaths in patients with coronary artery disease, regardless of eGFR and the presence or absence of diabetes mellitus.
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Affiliation(s)
- Hiroshi Funakubo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Takeshige Kunieda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Yoshiaki Kubota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Satoshi Otsuka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Nobutaka Kudo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Yoshinori Shirai
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
- Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
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9
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Yamauchi R, Morishima I, Okumura K, Kanzaki Y, Morita Y, Watanabe N, Furui K, Yoshioka N, Shibata N, Miyazawa H, Shimojo K, Imaoka T, Sakamoto G, Goto H, Ohi T, Yanagisawa S, Inden Y, Murohara T. Association Between Catheter Ablation for Nonparoxysmal Atrial Fibrillation and Functional Mitral Regurgitation in Patients With Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2023; 207:192-201. [PMID: 37742539 DOI: 10.1016/j.amjcard.2023.08.154] [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: 06/07/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023]
Abstract
Functional mitral regurgitation (FMR) often coexists with atrial fibrillation (AF) and may have a causal relation with AF persistence and exacerbation of heart failure (HF). The purpose of this study was to investigate the impact of FMR on AF catheter ablation (AFCA) outcomes and improvement in FMR after AFCA in patients with HF with preserved ejection fraction (HFpEF) and nonparoxysmal AF. Excluding patients with primary valve disease or post-mitral valve repair, 280 patients with HFpEF who underwent CA for nonparoxysmal AF were retrospectively included. All patients completed 1-year follow-up and were assessed for FMR, AF recurrence and HF parameters, including echocardiography. At baseline, FMR was present in 153 (54.6%) patients (mild, n = 112; moderate, n = 40; severe, n = 1), and these were decreased to 70 (25%) significantly 1 year after AFCA (mild, n = 64; moderate, n = 6), 119 patients (78%) had improvement in MR (a decrease of ≥1 level in the severity from baseline to 1 year on echocardiography). Overall, 274 patients (97.9%) had sinus rhythm at the 1-year examination, and recurrent AF-free survival did not differ in patients with and without MR improvement (83.2% vs 82.4%, p = 0.908). However, the MR improvement group had a significantly lower cardiothoracic ratio, left atrial diameter, E/e', and B-type natriuretic peptide levels after 1 year than those in the MR nonimprovement group. In conclusion, the majority of the HFpEF patients with nonparoxysmal AF had improvement of FMR after AFCA with the high maintenance of sinus rhythm, leading to a virtuous cycle of cardiac function.
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Affiliation(s)
- Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Kenji Okumura
- Department of Cardiology, Tohno Kosei Hospital, Mizunami, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroki Goto
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takuma Ohi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Pál G, Danku Z, Batool A, Kádár V, Yoshioka N, Ito N, Ódor G, Kun F. Scaling laws of failure dynamics on complex networks. Sci Rep 2023; 13:19733. [PMID: 37957302 PMCID: PMC10643452 DOI: 10.1038/s41598-023-47152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023] Open
Abstract
The topology of the network of load transmitting connections plays an essential role in the cascading failure dynamics of complex systems driven by the redistribution of load after local breakdown events. In particular, as the network structure is gradually tuned from regular to completely random a transition occurs from the localized to mean field behavior of failure spreading. Based on finite size scaling in the fiber bundle model of failure phenomena, here we demonstrate that outside the localized regime, the load bearing capacity and damage tolerance on the macro-scale, and the statistics of clusters of failed nodes on the micro-scale obey scaling laws with exponents which depend on the topology of the load transmission network and on the degree of disorder of the strength of nodes. Most notably, we show that the spatial structure of damage governs the emergence of the localized to mean field transition: as the network gets gradually randomized failed clusters formed on locally regular patches merge through long range links generating a percolation like transition which reduces the load concentration on the network. The results may help to design network structures with an improved robustness against cascading failure.
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Affiliation(s)
- Gergő Pál
- Department of Theoretical Physics, Faculty of Science and Technology, Doctoral School of Physics, University of Debrecen, P.O.Box: 400, Debrecen, H-4002, Hungary
| | - Zsuzsa Danku
- Department of Theoretical Physics, Faculty of Science and Technology, Doctoral School of Physics, University of Debrecen, P.O.Box: 400, Debrecen, H-4002, Hungary
| | - Attia Batool
- Department of Theoretical Physics, Faculty of Science and Technology, Doctoral School of Physics, University of Debrecen, P.O.Box: 400, Debrecen, H-4002, Hungary
| | - Viktória Kádár
- Department of Theoretical Physics, Faculty of Science and Technology, Doctoral School of Physics, University of Debrecen, P.O.Box: 400, Debrecen, H-4002, Hungary
| | - Naoki Yoshioka
- RIKEN Center for Computational Science, 7-1-26 Minatojima-minami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Nobuyasu Ito
- RIKEN Center for Computational Science, 7-1-26 Minatojima-minami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Géza Ódor
- Centre for Energy Research, Institute of Technical Physics and Materials Science, P.O. Box 49, H-1525, Budapest, Hungary
| | - Ferenc Kun
- Department of Theoretical Physics, Faculty of Science and Technology, Doctoral School of Physics, University of Debrecen, P.O.Box: 400, Debrecen, H-4002, Hungary.
- Institute for Nuclear Research (Atomki), P.O. Box 51, Debrecen, H-4001, Hungary.
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11
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Yoshioka N, Tokuda T, Koyama A, Yamada T, Shimamura K, Nishikawa R, Morita Y, Morishima I. Association between High Bleeding Risk and 2-Year Mortality in Patients with Chronic Limb-Threatening Ischemia. J Atheroscler Thromb 2023; 30:1674-1686. [PMID: 36948637 PMCID: PMC10627769 DOI: 10.5551/jat.64157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023] Open
Abstract
AIM Patients with chronic limb-threatening ischemia (CLTI) have a high bleeding risk (HBR) and mortality rate. The 2-year life expectancy is an important factor in deciding the appropriate treatment strategy. This study aimed to assess the influence of HBR on the prognosis of patients with CLTI. METHODS A total of 259 patients with CLTI who underwent endovascular therapy (EVT) (mean age, 76.2 years; male, 62.9%) between January 2018 and December 2019 were evaluated. The Academic Research Consortium for HBR (ARC-HBR) criteria were applied to each patient, and the ARC-HBR scores were calculated. The cut-off score for predicting all-cause mortality within two years was derived using a survival classification and regression tree (CART) model. Causes of death and the association between ARC-HBR scores and major bleeding events within two years were also investigated. RESULTS Based on the CART model, patients were divided into three groups (low HBR score 0-1.0, 48 patients; moderate HBR score 1.5-3.0, 176 patients; and high HBR score ≥ 3.5, 35 patients). During the study period, 82 patients (39.6%) died due to cardiac (n=23) and non-cardiac causes (n=59). All-cause mortality increased significantly with increasing ARC-HBR scores. Cox multivariate analysis revealed a significant association between high ARC-HBR scores and the risk of all-cause mortality within two years. Major bleeding events increased significantly with increasing ARC-HBR scores. CONCLUSIONS The ARC-HBR score could predict 2-year mortality in patients with CLTI who underwent EVT. Thus, this score can help determine the best revascularization strategy for patients with CLTI.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Aichi, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | | | - Ryusuke Nishikawa
- Department of Cardiovascular of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
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12
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Iwawaki T, Morishima I, Kanzaki Y, Morita Y, Watanabe N, Yoshioka N, Shibata N, Miyazawa H, Shimojo K, Yanagisawa S, Inden Y, Murohara T. Elevated liver fibrosis-4 index predicts recurrence after catheter ablation for atrial fibrillation in patients with heart failure. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01661-2. [PMID: 37855993 DOI: 10.1007/s10840-023-01661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The fibrosis-4 (FIB-4) index is a noninvasive scoring system that is used to assess the progression of liver fibrosis. This study aimed to assess whether the FIB-4 index is associated with recurrent atrial fibrillation (AF) after catheter ablation in patients with and without heart failure (HF). METHODS We included 1,184 patients who underwent initial AF catheter ablation between 2016 and 2021. The patients were classified into low-risk (< 1.3), intermediate-risk (1.3-2.67), and high-risk (> 2.67) groups based on their FIB-4 indices at baseline. The patients were divided into HF (n = 552) and non-HF groups (n = 632); the HF group was further divided into paroxysmal AF (PAF) and non-PAF groups. AF recurrence after catheter ablation was then compared among the groups. RESULTS In the non-HF group, no significant differences in recurrence after ablation were observed between the low-(n = 219), intermediate-(n = 364), and high-risk (n = 49) groups. In contrast, in the HF group, the intermediate-(n = 341) and high-risk (n = 112) groups had significantly higher recurrence rates than the low-risk group (n = 99) (log-rank test, p = 0.005). This association remained significant after multivariate analysis (hazard ratio [HR]:1.374; p = 0.027). The FIB-4 index increased incrementally as the brain natriuretic peptide levels and severity of tricuspid regurgitation increased. The FIB-4 index was an independent predictor of recurrence in the non-PAF HF group (HR:1.498; p = 0.007) but not in the PAF group. CONCLUSIONS The FIB-4 index may be a useful predictor of AF recurrence after catheter ablation in patients with HF, particularly in those with non-PAF.
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Affiliation(s)
- Tomoya Iwawaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Hiroyuki Miyazawa
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-Cho, Ogaki, 503-0864, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Yoshioka N, Morita Y, Tokuda T, Yamada T, Morishima I. Removal of Migrated Vascular Closure Device Plug Material From the Popliteal Artery Using the Bi-Directional Approach "Push Balloon Into Vessel and Close Embolus From Retrograde Site (PINCER)" Technique: A Case Report. Vasc Endovascular Surg 2023; 57:795-800. [PMID: 37097033 DOI: 10.1177/15385744231173200] [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: 04/26/2023]
Abstract
Vascular closure devices (VCDs) are widely used to achieve rapid hemostasis after percutaneous intervention via the common femoral artery (CFA), with well-established efficacy and safety. Although VCD-related artery occlusion is rare, it can be critical. A 72-year-old female underwent endovascular therapy (EVT) for stent occlusion in the left superficial femoral artery through a 7-Fr guiding sheath from the right CFA. After the procedure, an acute right popliteal artery (POP-A) occlusion, associated with the EXOSEAL VCD plug, occurred. The plug material was successfully removed using a bidirectional approach. The migration plug was blocked to prevent distal vessel migration and pushed gently to close the antegrade system, using an over-the-wire balloon from the retrograde site. We named this the "Push balloon INto vessel and Close Embolus from Retrograde site" (PINCER) technique. Finally, the plug was successfully removed using biopsy forceps. Acute limb ischemia (ALI) caused by EXOSEAL is a rare condition. Removal of the emboli by EVT is clinically significant because it is minimally invasive. However, it is sometimes difficult to remove the embolus using only antegrade approach; thus, the bidirectional approach using the PINCER technique can be effective in these situations.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Minokamo, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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14
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Tajima T, Akai H, Yasaka K, Kunimatsu A, Yoshioka N, Akahane M, Ohtomo K, Abe O, Kiryu S. Comparison of 1.5 T and 3 T magnetic resonance angiography for detecting cerebral aneurysms using deep learning-based computer-assisted detection software. Neuroradiology 2023; 65:1473-1482. [PMID: 37646791 DOI: 10.1007/s00234-023-03216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To compare the diagnostic performance of 1.5 T versus 3 T magnetic resonance angiography (MRA) for detecting cerebral aneurysms with clinically available deep learning-based computer-assisted detection software (EIRL aneurysm® [EIRL_an]), which has been approved by the Japanese Pharmaceuticals and Medical Devices Agency. We also sought to analyze the causes of potential false positives. METHODS In this single-center, retrospective study, we evaluated the MRA scans of 90 patients who underwent head MRA (1.5 T and 3 T in 45 patients each) in clinical practice. Overall, 51 patients had 70 aneurysms. We used MRI from a vendor not included in the dataset used to create the EIRL_an algorithm. Two radiologists determined the ground truth, the accuracy of the candidates noted by EIRL_an, and the causes of false positives. The sensitivity, number of false positives per case (FPs/case), and the causes of false positives were compared between 1.5 T and 3 T MRA. Pearson's χ2 test, Fisher's exact test, and the Mann‒Whitney U test were used for the statistical analyses as appropriate. RESULTS The sensitivity was high for 1.5 T and 3 T MRA (0.875‒1), but the number of FPs/case was significantly higher with 3 T MRA (1.511 vs. 2.578, p < 0.001). The most common causes of false positives (descending order) were the origin/bifurcation of vessels/branches, flow-related artifacts, and atherosclerosis and were similar between 1.5 T and 3 T MRA. CONCLUSION EIRL_an detected significantly more false-positive lesions with 3 T than with 1.5 T MRA in this external validation study. Our data may help physicians with limited experience with MRA to correctly diagnose aneurysms using EIRL_an.
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Affiliation(s)
- Taku Tajima
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-Ku, Tokyo, 108-8329, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Hiroyuki Akai
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-Ku, Tokyo, 108-8639, Japan
| | - Koichiro Yasaka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Akira Kunimatsu
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-Ku, Tokyo, 108-8329, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 Kitakanamaru, Otawara, Tochigi, 324-8501, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.
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15
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Iwama M, Noda T, Takagi K, Tanaka A, Uemura Y, Umemoto N, Shibata N, Negishi Y, Ohashi T, Tanaka M, Yoshida R, Shimizu K, Tashiro H, Yoshioka N, Morishima I, Watarai M, Tanaka T, Tatami Y, Takada Y, Ishii H, Murohara T. Impact of right coronary artery dominance on the long-term mortality in the patients with acute total/subtotal occlusion of unprotected left main coronary artery. J Cardiol 2023; 82:165-171. [PMID: 37028507 DOI: 10.1016/j.jjcc.2023.04.003] [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: 12/03/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Patients with a right dominant coronary artery anatomy account for a significant proportion of acute myocardial infarction cases, and this condition is associated with a better prognosis. However, there are limited data on the impact of coronary dominance on patients with acute total/subtotal occlusion of unprotected left main coronary artery (ULMCA). METHODS This study aimed to assess the impact of right coronary artery (RCA) dominance on long-term mortality in patients with acute total/subtotal occlusion of the ULMCA. From a multicenter registry, 132 cases of consecutive patients who had undergone emergent percutaneous coronary intervention (PCI) due to acute total/subtotal occlusion of the ULMCA were reviewed. RESULTS Patients were classified into two groups according to the size of their RCA (dominant RCA group, n = 29; non-dominant RCA group, n = 103). Long-term outcomes were examined according to the presence of dominant RCA. Cardiopulmonary arrest (CPA) occurred in 52.3 % of patients before revascularization. All-cause death was significantly lower in the dominant RCA group than in the non-dominant RCA group. In the Cox regression model, dominant RCA was an independent predictor of all-cause death, as well as total occlusion of ULMCA, collateral from RCA, chronic kidney disease, and CPA. Patients were further analyzed according to the degree of stenosis of the ULMCA; patients with non-dominant RCA and total occlusive ULMCA had the worst outcome compared with the other groups. CONCLUSIONS A dominant RCA might improve long-term mortality in patients with acute total/subtotal occlusion of the ULMCA who were treated with PCI.
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Affiliation(s)
- Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Okazaki City Hospital, Okazaki, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | | | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Tobe A, Tanaka A, Furusawa K, Shirai Y, Funakubo H, Otsuka S, Kubota Y, Kunieda T, Yoshioka N, Sato S, Kudo N, Ishii H, Murohara T. Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention. J Atheroscler Thromb 2023; 30:1187-1197. [PMID: 36503894 PMCID: PMC10499458 DOI: 10.5551/jat.63622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/25/2022] [Indexed: 09/05/2023] Open
Abstract
AIM The relationship between carotid artery ultrasound findings and clinical outcomes in patients who undergo percutaneous coronary intervention (PCI) has not been completely elucidated. METHODS This single-center retrospective study investigated 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥ 1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥ 1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular (CV) death, myocardial infarction, and ischemic stroke. RESULTS Among 691 patients, 309 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.01-2.90; p=0.046). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE, but both were not independently associated with MACE (HR, 1.35; 95% CI, 0.69-2.64, p=0.38 and HR, 0.98; 95% CI, 0.57-1.69; p=0.95, respectively). CONCLUSION The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future CV events. These patients may require more aggressive medical therapy and careful follow-up.
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Affiliation(s)
- Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Shirai
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Funakubo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Otsuka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Kubota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshige Kunieda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sara Sato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobutaka Kudo
- Department of Cardiology, Handa City Hospital, Aichi, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yamada T, Tokuda T, Yoshioka N, Koyama A, Nishikawa R, Shimamura K, Aoyama T. Predictors of recurrence based on intravascular ultrasound findings after Eluvia placement in symptomatic peripheral arterial disease: A retrospective study. Health Sci Rep 2023; 6:e1481. [PMID: 37547358 PMCID: PMC10400754 DOI: 10.1002/hsr2.1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/15/2023] [Accepted: 07/23/2023] [Indexed: 08/08/2023] Open
Abstract
Background and Aims Polymer-coated drug-eluting stents (Eluvia) have shown favorable clinical outcomes in real-world registries. There are no reports on recurrent predictors after Eluvia placement based on intravascular ultrasound (IVUS) findings. Methods We analyzed clinical data from the ASIGARU PAD registry, a retrospective, multicenter, observational study that enrolled patients who underwent endovascular therapy for superficial femoral and proximal popliteal arteries lesions using Eluvia or drug-coated balloon. The primary outcome was the identification of recurrent predictors, including IVUS parameters at 12 months. The rate of target lesion recurrence was also assessed. Results IVUS images were obtained in 54 of 65 cases. Seven recurrent cases (13.0%) were observed within 12 months. The random survival forest method presented eight predictive variables of recurrence: Clinical Frailty Scale (CFS), distal stent edge area, distal plaque burden, age, sex, distal external elastic membrane (EEM) area, minimum stent area (MSA), and distal lumen area. Furthermore, the partial dependence plot showed that frailty (CFS ≥ 6), smaller distal stent edge area, higher and lower distal plaque burden, older and younger age, female sex, smaller distal EEM area, smaller MSA, and smaller and larger distal lumen area predicted recurrence after Eluvia placement within 12 months. Conclusion CFS, distal stent edge area, distal plaque burden, age, sex, distal EEM area, MSA, and distal lumen area were significant recurrent predictors after Eluvia placement.
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Affiliation(s)
- Takehiro Yamada
- Division of CardiologyCentral Japan International Medical CenterGifuJapan
| | | | - Naoki Yoshioka
- Division of CardiologyOgaki Municipal HospitalOgakiJapan
| | - Akio Koyama
- Division of Vascular surgeryToyota Memorial HospitalToyotaJapan
| | | | | | - Takuma Aoyama
- Division of CardiologyCentral Japan International Medical CenterGifuJapan
- Division of Molecular PathologyShinshu University of MedicineMatsumotoJapan
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Akai H, Yasaka K, Sugawara H, Tajima T, Akahane M, Yoshioka N, Ohtomo K, Abe O, Kiryu S. Commercially Available Deep-learning-reconstruction of MR Imaging of the Knee at 1.5T Has Higher Image Quality Than Conventionally-reconstructed Imaging at 3T: A Normal Volunteer Study. Magn Reson Med Sci 2023; 22:353-360. [PMID: 35811127 PMCID: PMC10449552 DOI: 10.2463/mrms.mp.2022-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/22/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aimed to evaluate whether the image quality of 1.5T magnetic resonance imaging (MRI) of the knee is equal to or higher than that of 3T MRI by applying deep learning reconstruction (DLR). METHODS Proton density-weighted images of the right knee of 27 healthy volunteers were obtained by 3T and 1.5T MRI scanners using similar imaging parameters (21 for high resolution image and 6 for normal resolution image). Commercially available DLR was applied to the 1.5T images to obtain 1.5T/DLR images. The 3T and 1.5T/DLR images were compared subjectively for visibility of structures, image noise, artifacts, and overall diagnostic acceptability and objectively. One-way ANOVA and Friedman tests were used for the statistical analyses. RESULTS For the high resolution images, all of the anatomical structures, except for bone, were depicted significantly better on the 1.5T/DLR compared with 3T images. Image noise scored statistically lower and overall diagnostic acceptability scored higher on the 1.5T/DLR images. The contrast between lateral meniscus and articular cartilage of the 1.5T/DLR images was significantly higher (5.89 ± 1.30 vs. 4.34 ± 0.87, P < 0.001), and also the contrast between medial meniscus and articular cartilage of the 1.5T/DLR images was significantly higher (5.12 ± 0.93 vs. 3.87 ± 0.56, P < 0.001). Similar image quality improvement by DLR was observed for the normal resolution images. CONCLUSION The 1.5T/DLR images can achieve less noise, more precise visualization of the meniscus and ligaments, and higher overall image quality compared with the 3T images acquired using a similar protocol.
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Affiliation(s)
- Hiroyuki Akai
- Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Koichiro Yasaka
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Haruto Sugawara
- Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Taku Tajima
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
- Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Kuni Ohtomo
- Department of Radiology, International University of Health and Welfare, Ohtawara, Tochigi, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
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Kiryu S, Akai H, Yasaka K, Tajima T, Kunimatsu A, Yoshioka N, Akahane M, Abe O, Ohtomo K. Clinical Impact of Deep Learning Reconstruction in MRI. Radiographics 2023; 43:e220133. [PMID: 37200221 DOI: 10.1148/rg.220133] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Deep learning has been recognized as a paradigm-shifting tool in radiology. Deep learning reconstruction (DLR) has recently emerged as a technology used in the image reconstruction process of MRI, which is an essential procedure in generating MR images. Denoising, which is the first DLR application to be realized in commercial MRI scanners, improves signal-to-noise ratio. When applied to lower magnetic field-strength scanners, the signal-to-noise ratio can be increased without extending the imaging time, and image quality is comparable to that of higher-field-strength scanners. Shorter imaging times decrease patient discomfort and reduce MRI scanner running costs. The incorporation of DLR into accelerated acquisition imaging techniques, such as parallel imaging or compressed sensing, shortens the reconstruction time. DLR is based on supervised learning using convolutional layers and is divided into the following three categories: image domain, k-space learning, and direct mapping types. Various studies have reported other derivatives of DLR, and several have shown the feasibility of DLR in clinical practice. Although DLR efficiently reduces Gaussian noise from MR images, denoising makes image artifacts more prominent, and a solution to this problem is desired. Depending on the training of the convolutional neural network, DLR may change the imaging features of lesions and obscure small lesions. Therefore, radiologists may need to adopt the habit of questioning whether any information has been lost on images that appear clean. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Shigeru Kiryu
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Hiroyuki Akai
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Koichiro Yasaka
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Taku Tajima
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Akira Kunimatsu
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Naoki Yoshioka
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Masaaki Akahane
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Osamu Abe
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
| | - Kuni Ohtomo
- From the Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita 286-0124, Japan (S.K., H.A., K.Y., T.T., A.K., N.Y., M.A.); Department of Radiology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (H.A.); Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (K.Y., O.A.); Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan (T.T., A.K.); and International University of Health and Welfare, Otawara, Japan (K.O.)
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Yoshioka N, Tokuda T, Koyama A, Yamada T, Shimamura K, Nishikawa R, Morita Y, Morishima I. Clinical Outcomes Based on High Bleeding Risk in Patients With Lower Extremity Peripheral Artery Disease Who Have Undergone Endovascular Therapy. J Endovasc Ther 2023:15266028231176953. [PMID: 37246791 DOI: 10.1177/15266028231176953] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Endovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. In this study, we investigated the prevalence and severity of HBR, as well as its association with clinical outcomes in the patients with PAD who underwent EVT. MATERIALS AND METHODS The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were applied to 732 consecutive patients with lower extremity PAD post-EVT to assess the prevalence of HBR, and its association with major bleeding events, all-cause mortality, and ischemic events. The ARC-HBR scores (1 point for each major criterion and 0.5 points for each minor criterion) were obtained and the patients were divided into four groups (score: 0-0.5; low risk, score: 1-1.5; moderate risk, score: 2-2.5; high risk, and score: ≥3; very high risk) according to the score. Major bleeding events were defined as Bleeding Academic Research Consortium type-3 or type-5 bleeding, and ischemic events were defined as the composite of myocardial infarction, ischemic stroke, and acute limb ischemia within 2 years. RESULTS High bleeding risk occurred in 78.8% of the patients. Major bleeding events, all-cause mortality, and ischemic events occurred in 9.7%, 18.7%, and 6.4% of the study cohort, respectively, within 2 years. During the follow-up period, major bleeding events significantly increased with the ARC-HBR score. The severity of the ARC-HBR score was significantly associated with an increased risk of major bleeding events (high risk: adjusted hazard ratio [HR] 5.62; 95% confidence interval [CI]: [1.28, 24.62]; p=0.022; very high risk: adjusted HR: 10.37; 95% CI: [2.32, 46.30]; p=0.002). All-cause mortality and ischemic events also significantly increased with higher ARC-HBR score. CONCLUSIONS High bleeding risk patients with lower extremity PAD can be at a high risk of bleeding events, mortality, and ischemic events after EVT. The ARC-HBR criteria and its associated scores can successfully stratify HBR patients and assess the bleeding risk in patients with lower extremity PAD who undergo EVT. CLINICAL IMPACT Endovascular therapies (EVTs) for symptomatic lower extremity peripheral artery disease (PAD) are efficient and minimally invasive. However, patients with PAD tend to have high bleeding risk (HBR), and there are limited data regarding the HBR for patients with PAD after EVT. Post EVT, most of the patients with PAD were classified as having HBR using the Academic Research Consortium for HBR (ARC-HBR) criteria and the rate of bleeding events as well as mortality and ischemic events within 2 years increased as the ARC-HBR score increased in this retrospective study of 732 participants. HBR patients with PAD can be at high risk of not only bleeding events but also mortality and ischemic events in the mid-term. The ARC-HBR criteria and its associated scores can successfully stratify HBR patients and assess the bleeding risk in patients with PAD who underwent EVT.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Minokamo, Japan
| | | | - Ryusuke Nishikawa
- Department of Cardiovascular of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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Okuda I, Abe K, Yoshioka N, Komemushi T, Jinzaki M, Ohjimi H. Objective Analysis of Age-Related Changes in the Superficial Musculoaponeurotic System in Japanese Females Using Computed Tomography. Aesthet Surg J Open Forum 2023; 5:ojad043. [PMID: 37333712 PMCID: PMC10270653 DOI: 10.1093/asjof/ojad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background The superficial musculoaponeurotic system (SMAS) is an anatomical structure involved in facial aging. Objectives This study focused on SMAS thickness and aimed to establish age-related changes in SMAS thickness. Methods A total of 100 adult Japanese female participants (aged 20-79 years) were enrolled in the study. The participants were divided into 3 age groups: Y, M, and E, comprising 20 to 39, 40 to 59, and 60 to 79 years, respectively. Anatomical structures were used as landmarks to standardize the SMAS analysis sites. The SMAS in a fixed analysis area (FAA) was quantified using multi-detector computed tomography (MDCT), and the relationship between SMAS thickness and age, as well as BMI, was analyzed. Results In 96 participants (four were excluded due to imaging artifacts), a moderate yet significant negative correlation was found between the average (A)-SMAS thickness within the FAA and age. The A-SMAS thickness in groups M and E was significantly lower than that of group Y, and the mean value of group E was significantly lower than that of group M. SMAS thickness was greater in the young population. The SMAS gradually became thinner with aging. A statistically significant correlation was not found between SMAS thickness and BMI. Conclusions Using MDCT technology, age-related changes in SMAS were successfully analyzed. This highly objective analysis method corroborated the aesthetic surgical knowledge of the SMAS features related to facial aging. In clinical applications, our findings may help elucidate the mechanisms involved in facial aging. Level of Evidence 3
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Affiliation(s)
- Itsuko Okuda
- Corresponding Author: Dr Itsuko Okuda, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan. E-mail:
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Yoshioka N, Tokuda T, Koyama A, Yamada T, Shimamura K, Nishikawa R, Morita Y, Morishima I. Two-year clinical outcomes and predictors of restenosis following the use of polymer-coated paclitaxel-eluting stents or drug-coated balloons in patients with femoropopliteal artery disease. Heart Vessels 2023; 38:429-437. [PMID: 36169709 DOI: 10.1007/s00380-022-02182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
We aimed to assess the clinical performance and risk factors for patency loss within 2 years following the use of polymer-coated paclitaxel-eluting stents (PC-PESs) and drug-coated balloons (DCBs) in patients with lower extremity artery disease. Multi-center registry data from 151 patients (65 and 86 treated with PC-PES and DCB, respectively) were retrospectively investigated. Two-year primary patency (PP) and clinically driven target lesion revascularization (CD-TLR) were evaluated using Kaplan-Meier analysis. Predictors of restenosis within 2 years of the procedures were analyzed using the random survival forest method. The consistent predictors of restenosis within 1 and 2 years were assessed and validated using Kaplan-Meier analysis. Two-year PP was 77.2 and 57.2% (log rank p = 0.047) and freedom from CD-TLR was 84.4 and 84.8% in the PC-PES and DCB groups, respectively (log rank p = 0.89). In the DCB group, most of the patients (n = 77, 89.5%) were treated with high-dose DCB. Consistent predictors of restenosis were lower vessel diameter and severity of Clinical Frailty Scale in the PC-PES group, and severity of peripheral artery calcification scoring system grade, severity of post dissection pattern, and smaller vessel diameter in the DCB group. The validation analysis revealed that patients with consistent predictors had significantly worse PP values than that of those without in the PC-PES (87.9% vs. 55.3%, log rank p = 0.003) and DCB groups (75.9% vs. 35.2%, log rank p = 0.001). The 2-year PP of DCBs was lower than that of PC-PESs. A smaller vessel diameter could predict restenosis in both devices. Vessel calcification and dissection should be considered when using DCB to ensure longer term patency.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Minokamo, Japan
| | | | - Ryusuke Nishikawa
- Department of Cardiovascular of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
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Akai H, Yasaka K, Sugawara H, Tajima T, Kamitani M, Furuta T, Akahane M, Yoshioka N, Ohtomo K, Abe O, Kiryu S. Acceleration of knee magnetic resonance imaging using a combination of compressed sensing and commercially available deep learning reconstruction: a preliminary study. BMC Med Imaging 2023; 23:5. [PMID: 36624404 PMCID: PMC9827641 DOI: 10.1186/s12880-023-00962-2] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To evaluate whether deep learning reconstruction (DLR) accelerates the acquisition of 1.5-T magnetic resonance imaging (MRI) knee data without image deterioration. MATERIALS AND METHODS Twenty-one healthy volunteers underwent MRI of the right knee on a 1.5-T MRI scanner. Proton-density-weighted images with one or four numbers of signal averages (NSAs) were obtained via compressed sensing, and DLR was applied to the images with 1 NSA to obtain 1NSA-DLR images. The 1NSA-DLR and 4NSA images were compared objectively (by deriving the signal-to-noise ratios of the lateral and the medial menisci and the contrast-to-noise ratios of the lateral and the medial menisci and articular cartilages) and subjectively (in terms of the visibility of the anterior cruciate ligament, the medial collateral ligament, the medial and lateral menisci, and bone) and in terms of image noise, artifacts, and overall diagnostic acceptability. The paired t-test and Wilcoxon signed-rank test were used for statistical analyses. RESULTS The 1NSA-DLR images were obtained within 100 s. The signal-to-noise ratios (lateral: 3.27 ± 0.30 vs. 1.90 ± 0.13, medial: 2.71 ± 0.24 vs. 1.80 ± 0.15, both p < 0.001) and contrast-to-noise ratios (lateral: 2.61 ± 0.51 vs. 2.18 ± 0.58, medial 2.19 ± 0.32 vs. 1.97 ± 0.36, both p < 0.001) were significantly higher for 1NSA-DLR than 4NSA images. Subjectively, all anatomical structures (except bone) were significantly clearer on the 1NSA-DLR than on the 4NSA images. Also, in the former images, the noise was lower, and the overall diagnostic acceptability was higher. CONCLUSION Compared with the 4NSA images, the 1NSA-DLR images exhibited less noise, higher overall image quality, and allowed more precise visualization of the menisci and ligaments.
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Affiliation(s)
- Hiroyuki Akai
- grid.26999.3d0000 0001 2151 536XDepartment of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan ,Present Address: Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124 Japan
| | - Koichiro Yasaka
- Present Address: Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124 Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Haruto Sugawara
- grid.26999.3d0000 0001 2151 536XDepartment of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan
| | - Taku Tajima
- Present Address: Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124 Japan ,grid.415958.40000 0004 1771 6769Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329 Japan
| | - Masaru Kamitani
- grid.26999.3d0000 0001 2151 536XDepartment of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan
| | - Toshihiro Furuta
- grid.26999.3d0000 0001 2151 536XDepartment of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan
| | - Masaaki Akahane
- Present Address: Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124 Japan
| | - Naoki Yoshioka
- Present Address: Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124 Japan
| | - Kuni Ohtomo
- grid.411731.10000 0004 0531 3030International University of Health and Welfare, 2600-1 Kiakanemaru, Ohtawara, Tochigi 324-8501 Japan
| | - Osamu Abe
- grid.26999.3d0000 0001 2151 536XDepartment of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Shigeru Kiryu
- Present Address: Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124 Japan
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Tobe A, Tanaka A, Furusawa K, Shirai Y, Funakubo H, Otsuka S, Kubota Y, Kunieda T, Yoshioka N, Sato S, Kudo N, Ishii H, Murohara T. Heterogeneous carotid plaque is associated with cardiovascular events after percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1140] [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
The relationship between carotid artery ultrasound findings and clinical outcomes in percutaneous coronary intervention (PCI) patients has not been fully elucidated.
Purpose
To investigate the relationship between carotid artery ultrasound findings and cardiovascular risks in PCI patients.
Methods
This was a single-center retrospective study investigating 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke.
Results
Among 691 patients, 312 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.06–3.04; p=0.03). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE but both were not independently associated with MACE (HR, 1.37; 95% CI, 0.70–2.67, p=0.36 and HR, 1.13; 95% CI, 0.66–1.93; p=0.66, respectively).
Conclusions
The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future cardiovascular events. These patients may require more aggressive medical therapy and careful follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Tobe
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - A Tanaka
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - K Furusawa
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - Y Shirai
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - H Funakubo
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - S Otsuka
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - Y Kubota
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - T Kunieda
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - N Yoshioka
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - S Sato
- Nagoya University Hospital, Cardiology , Aichi , Japan
| | - N Kudo
- Handa City Hospital, Cardiology , Handa , Japan
| | - H Ishii
- Gunma University Graduate School of Medicine, Cardiology , Maebashi , Japan
| | - T Murohara
- Nagoya University Hospital, Cardiology , Aichi , Japan
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25
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Akahane M, Yoshioka N, Kiryu S. Radiation Protection of the Eye Lens in Fluoroscopy-guided Interventional Procedures. Interventional Radiology 2022; 7:44-48. [PMID: 36196387 PMCID: PMC9527101 DOI: 10.22575/interventionalradiology.2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 11/04/2022]
Abstract
The medical staff involved in fluoroscopy-guided procedures are at potential risks of radiation-induced cataract. Therefore, proper monitoring of the lens doses is critical, and radiation protection should be provided to the maximum extent that is reasonably achievable. The collar dosimeter is necessary to avoid underestimation of the lens dose, and the third dosimeter behind the protective eyewear would be helpful for those who are likely to exceed the dose limit. The reduction of the patient doses will correspondingly reduce the staff doses. Proper placement of the ceiling-mounted shields and minimization of the face-to-glass gap are the keys to effective shielding. The optimization of procedures and devices that help maintain a distance from the irradiated area and to prevent the looking-up posture will substantially reduce the lens dose.
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Affiliation(s)
- Masaaki Akahane
- Department of Radiology, School of Medicine, International University of Health and Welfare
| | - Naoki Yoshioka
- Department of Radiology, School of Medicine, International University of Health and Welfare
| | - Shigeru Kiryu
- Department of Radiology, School of Medicine, International University of Health and Welfare
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26
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Tajima T, Akai H, Sugawara H, Furuta T, Yasaka K, Kunimatsu A, Yoshioka N, Akahane M, Abe O, Ohtomo K, Kiryu S. Feasibility of accelerated whole-body diffusion-weighted imaging using a deep learning-based noise-reduction technique in patients with prostate cancer. Magn Reson Imaging 2022; 92:169-179. [PMID: 35772583 DOI: 10.1016/j.mri.2022.06.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the possibility of reducing the image acquisition time for diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) by denoising with deep learning-based reconstruction (dDLR). METHODS Seventeen patients with prostate cancer who underwent DWIBS by 1.5 T magnetic resonance imaging with a number of excitations of 2 (NEX2) and 8 (NEX8) were prospectively enrolled. The NEX2 image data were processed by dDLR (dDLR-NEX2), and the NEX2, dDLR-NEX2, and NEX8 image data were analyzed. In qualitative analysis, two radiologists rated the perceived coarseness, conspicuity of metastatic lesions (lymph nodes and bone), and overall image quality. The contrast-to-noise ratios (CNRs), contrast ratios, and mean apparent diffusion coefficients (ADCs) of metastatic lesions were calculated in a quantitative analysis. RESULTS The image acquisition time of NEX2 was 2.8 times shorter than that of NEX8 (3 min 30 s vs 9 min 48 s). The perceived coarseness and overall image quality scores reported by both readers were significantly higher for dDLR-NEX2 than for NEX2 (P = 0.005-0.040). There was no significant difference between dDLR-NEX2 and NEX8 in the qualitative analysis. The CNR of bone metastasis was significantly greater for dDLR-NEX2 than for NEX2 and NEX8 (P = 0.012 for both comparisons). The contrast ratios and mean ADCs were not significantly different among the three image types. CONCLUSIONS dDLR improved the image quality of DWIBS with NEX2. In the context of lymph node and bone metastasis evaluation with DWIBS in patients with prostate cancer, dDLR-NEX2 has potential to be an alternative to NEX8 and reduce the image acquisition time.
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Affiliation(s)
- Taku Tajima
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Hiroyuki Akai
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan; Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Haruto Sugawara
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Toshihiro Furuta
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Koichiro Yasaka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan; Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Akira Kunimatsu
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 kitakanamaru, Otawara, Tochigi 324-8501, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan.
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27
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Honma S, Katano S, Nagaoka R, Numazawa R, Kouzu H, Ohori K, Nishikawa R, Ohwada W, Nagano N, Koyama M, Katayose M, Kobayashi C, Yoshioka N, Hashimoto A, Yano T. Novel equation for skeletal muscle mass estimation is useful for predicting mortality in patients with heart failure. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.226] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Skeletal muscle mass in heart failure (HF) patients is closely related to exercise tolerance and prognosis. Although the dual-energy X-ray absorptiometry (DEXA) method is a standard method for measuring skeletal muscle mass, it is not suitable in a daily clinical setting since it is a costly and hospital-based modality. We recently reported that an equation for appendicular skeletal muscle mass index (ASMI) estimation using anthropometric parameters predicted DEXA-measured ASMI in HF patients with reasonable accuracy. Here, we examined the prognostic impacts of ASMI predicted by the equation (predicted ASMI) in HF patients.
Methods
Data for 539 patients with HF ( 73 ± 14 years old, 43% female) who received the DEXA method and measurements of calf circumference (CC) and mid-arm circumference (MAC) between August 1, 2015, to August 31, 2020, were used for analyses. DEXA measured-appendicular skeletal muscle (ASM) was calculated as the sum of bone-free lean masses in the arms and legs, and ASMI was defined as ASM/height². Predicted ASMI was calculated as we previously reported: predicted ASMI (kg/m²) = [0.214 × weight (kg) + 0.217 × CC (cm) - 0.189 × MAC (cm) + 1.098 (male = 1, female = -1) + 0.576]/height² (m²). Low ASMI was defined as <7.0 kg/m² in males and <5.4 kg/m² in females, respectively. The primary endpoint was all-cause death. Multiple imputation using chained equations was used for the substitution of missing values.
Results
The median follow-up period was 1.75 years (interquartile range, 0.96 to 2.37 years), and 73 patients (15%) has died. Kaplan-Meier survival curves showed that patients with low DEXA measured-ASMI and patients with low predicted ASMI had significantly lower survival rates than those with high ASMI (Figure 1). In a multivariate Cox proportional hazard analyses adjusted for age, sex, logarithmic B-type natriuretic peptide, cystatin C based-estimated glomerular filtration rate, and gait speed, DEXA-measured ASMI [hazard ratio (HR), 0.982; 95% confidence interval (CI), 0.967 to 0.988; p<0.001] and predicted ASMI (HR, 0.979; 95% CI, 0.962 to 0.996; p=0.018) were independent predictors of all-cause mortality, respectively. Inclusion of predicted ASMI into the adjustment model improved the accuracy of prediction of the mortality after discharge [continuous net reclassification improvement, 0.338, p<0.01; integrated discrimination improvement, 0.020, p < 0.05] (Figure 2).
Conclusions
ASMI estimated by an equation using CC and MAC predicted the prognosis of HF patients at a similar level of accuracy to DEXA-measured ASMI, and it can be applied to the assessment of skeletal muscle mass in a daily clinical setting and in large population-based studies.
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Affiliation(s)
- S Honma
- Sapporo Cardiovascular Hospital, Department of Rehabilitation, Sapporo, Japan
| | - S Katano
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - R Nagaoka
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - R Numazawa
- Sapporo Medical University Hospital, Division of Rehabilitation, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - K Ohori
- Hokkaido Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - R Nishikawa
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - W Ohwada
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
| | - M Koyama
- Sapporo Medical University School of Medicine, Department of Public Health, Sapporo, Japan
| | - M Katayose
- Sapporo Medical University School of Medicine, Second Division of Physical Therapy, Sapporo, Japan
| | - C Kobayashi
- Sapporo Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - N Yoshioka
- Sapporo Cardiovascular Hospital, Department of Cardiology, Sapporo, Japan
| | - A Hashimoto
- Sapporo Medical University School of Medicine, Division of Health Care Administration and Management, Sapporo, Japan
| | - T Yano
- Sapporo Medical University School of Medicine, Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo, Japan
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Tashiro H, Tanaka A, Takagi K, Uemura Y, Inoue Y, Umemoto N, Negishi Y, Shibata N, Yoshioka N, Shimizu K, Morishima I, Watarai M, Asano H, Ishii H, Murohara T. Incidence and Predictors of Frailty Progression among Octogenarians with ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Arch Gerontol Geriatr 2022; 102:104737. [PMID: 35671551 DOI: 10.1016/j.archger.2022.104737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty is one of the most serious health problems in older individuals with cardiovascular disease. Moreover, frailty progression is associated with subsequent adverse outcomes; therefore, the prevention of frailty progression is an important clinical issue. However, the incidence and predictors of frailty progression following acute myocardial infarction have not yet been fully elucidated. METHODS The present study is a sub-analysis of an observational multicenter registry retrospectively evaluating clinical outcomes of 288 octogenarians who underwent primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 2014 and December 2016 at five hospitals. We identified 244 patients who survived until discharge and evaluated frailty at baseline and discharge using the Clinical Frailty Scale (CFS). We defined frailty progression as an increase of at least one level in the CFS score at discharge from baseline and assessed the predictors of frailty progression. RESULTS Frailty progression was observed in 29.5% of patients. Patients with frailty progression were older, had more severe conditions with a higher prevalence of Killip 4 status and mechanical circulatory support use, more frequently experienced in-hospital events such as stroke (4/72, 6% vs. 0/172, 0%, p = 0.007), and had longer hospital stays than those without frailty progression [19 (11-35) vs. 13 (9-19) days, p<0.01]. Multivariate analysis showed that age (odds ratio 1.08, 95% confidence interval 1.00-1.17, p = 0.046) and Killip 4 status at baseline (odds ratio 3.34, 95% confidence interval 1.26-8.85, p = 0.01) were significant predictors of frailty progression. CONCLUSIONS In-hospital frailty progression was commonly observed in octogenarians with STEMI who underwent primary PCI and survived until discharge, and was associated with more severe clinical conditions.
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Affiliation(s)
- Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Shibata
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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29
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Okuda I, Takeda M, Taira M, Kobayashi T, Inomata K, Yoshioka N. Objective analysis of the effectiveness of facial massage using breakthrough computed tomographic technology: A preliminary pilot study. Skin Res Technol 2022; 28:472-479. [PMID: 35416349 PMCID: PMC9907650 DOI: 10.1111/srt.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial massage is empirically known to be associated with morphological changes, such as improvements in facial sagging. However, quantified objective evaluations of massage-induced changes have not been performed to date. This preliminary pilot study aimed to verify the effectiveness of facial massages by using breakthrough computed tomographic technology. MATERIALS AND METHODS Five healthy adult volunteers (three women and two men; age, 29-37 years) were enrolled, and computed tomography (CT) examinations using a 320 detectors-spiral CT system known as 320-multidetector-row CT (MDCT) were performed before and after facial massages. Each participant performed a self-massage twice daily for 2 weeks. Massage-induced changes in the cheeks and the superficial musculoaponeurotic system (SMAS) were analyzed by two radiologists on a workstation with a high-accuracy imaging analysis system. RESULTS After facial massage, the malar top became thinner by -0.8% ± 0.45% and shifted cranially and horizontally over a distance of 3.9 ± 1.94 mm. The SMAS-height, defined as the highest vertical distance of the SMAS, increased by 2.6% ± 2.6%. The change rate in cheek thickness and SMAS-height showed a significant correlation (r = -0.63; P < 0.05). These changes were attributed to the lifting and tightening effects of facial massage. CONCLUSION We conducted a detailed analysis of the effects of facial massages by using the breakthrough CT technology. Our results provide useful information for beauty treatments and could contribute to the collection of objective scientific evidence for facial massages.
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Affiliation(s)
- Itsuko Okuda
- Department of Diagnostic Radiology, International University of Health and Welfare (IUHW), Mita Hospital, Tokyo, Japan.,Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Aging Imaging Laboratory Inc., Tokyo, Japan
| | | | | | | | - Ken Inomata
- Research Laboratories, KOSÉ Corporation, Tokyo, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare (IUHW), Chiba, Japan
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30
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Yoshioka N, Asano M, Kuse A, Kondo T, Takahashi M, Morichika M, Nakagawa K, Sakurada M, Ueno Y. Quantitative analysis of thiamylal and its metabolite secobarbital using liquid chromatography-tandem mass spectrometry in adipose tissue, serum, and liver. J Forensic Sci 2021; 67:1241-1249. [PMID: 34970733 DOI: 10.1111/1556-4029.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Thiamylal is an ultrashort-acting barbiturate used for intravenous administration or general anesthesia induction. However, some cases of poisoning and suicide with thiamylal administration have been reported. Additionally, there are few reports on its analysis in the organs and adipose tissue, which requires purification by column chromatography and evaporation. A rapid and sensitive method was developed for quantifying thiamylal and its metabolite, secobarbital, in the adipose tissue, serum, and liver using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Samples were prepared using modified QuEChERS extraction. For adipose tissue samples, an acetonitrile-hexane partitioning step was added to the extraction. This method was applied to investigate a suspected self-poisoning autopsy case. The quantitation accuracy for thiamylal added to porcine pericardial fat (0.18 µg/g), human serum (0.015 µg/mL), and porcine liver (0.18 µg/g) was 103%, 113%, and 95.3%, respectively. The quantitation limits calculated for porcine pericardial fat, human serum, and porcine liver at a signal-to-noise ratio of 10 were 0.06 µg/g, 0.005 µg/mL, and 0.06 µg/g, respectively. In addition, the thiamylal and secobarbital levels in the forensic autopsy case were 140 and 1.5 µg/g, respectively, in myocardial fat; 3.5-4.9 and 0.12-0.20 µg/mL, respectively, in serum; and 6.2-42 and 0.58-1.1 µg/g, respectively, in liver tissue. Thiamylal is especially distributed in the adipose tissue. The thiamylal-to-fat ratio may help estimate the time from administration to death. The developed modified QuEChERS extraction method with acetonitrile-hexane partitioning is suitable for analyzing hydrophobic compounds, such as thiamylal, in the adipose tissue.
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Affiliation(s)
- Naoki Yoshioka
- Hyogo Prefectural Institute of Public Health Science, Kakogawa, Japan.,Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Migiwa Asano
- Department of Legal Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Azumi Kuse
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Kondo
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Motonori Takahashi
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mai Morichika
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanako Nakagawa
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Sakurada
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan.,Forensic Science Laboratory, Hyogo Prefectural Police Headquarters, Kobe, Japan
| | - Yasuhiro Ueno
- Division of Legal Medicine, Department of Environmental Health and Safety, Kobe University Graduate School of Medicine, Kobe, Japan
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31
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Niwa K, Tanaka A, Funakubo H, Otsuka S, Yoshioka N, Kudo N, Tobe A, Sakakibara K, Miki Y, Kataoka T, Furusawa K, Ishii H, Murohara T. The Influence of Eicosapentaenoic Acid to Arachidonic Acid Ratio on Long-term Cardiovascular Events Following Percutaneous Coronary Intervention. Intern Med 2021; 60:3865-3871. [PMID: 34148960 PMCID: PMC8758441 DOI: 10.2169/internalmedicine.7336-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The relationship between cardiovascular disease and the serum polyunsaturated fatty acid parameters has been reported. The aim of the present study was to investigate the association between the eicosapentaenoic acid and arachidonic acid (EPA/AA) ratio and long-term cardiovascular events in patients with coronary artery disease. Methods We identified a total of 831 patients who underwent percutaneous coronary intervention and whose EPA/AA ratio was available. The patients were divided into two groups according to their serum EPA/AA ratio (median, 0.29; interquartile range 0.19-0.47): those in the lower quartile of EPA/AA ratios (Low EPA/AA group; n=231) and all other subjects (High EPA/AA group; n=600). The primary endpoints included a composite of cardiovascular death, myocardial infarction, and ischemic stroke. Results Patients in the Low EPA/AA group were significantly younger (66.0±12.6 years vs. 69.9±9.3 years, p<0.001), current smokers (33.3% vs. 22.7%, p=0.002), and had a history of myocardial infarction (20.3% vs. 12.3%, p=0.003). During the follow-up (median, 1,206 days; interquartile range, 654-1,910 days), the occurrence of the primary endpoint was significantly higher in the Low EPA/AA group than in the High EPA/AA group. Of note, the rate of cardiovascular death was significantly higher in the Low EPA/AA group, and the rates of myocardial infarction and stroke tended to be higher. Conclusion A low EPA/AA ratio was associated with long-term adverse cardiovascular events in Japanese patients with coronary artery disease.
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Affiliation(s)
- Kiyoshi Niwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Hiroshi Funakubo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Satoshi Otsuka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Nobutaka Kudo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Keisuke Sakakibara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Yusuke Miki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Takashi Kataoka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
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Yasaka K, Akai H, Sugawara H, Tajima T, Akahane M, Yoshioka N, Kabasawa H, Miyo R, Ohtomo K, Abe O, Kiryu S. Impact of deep learning reconstruction on intracranial 1.5 T magnetic resonance angiography. Jpn J Radiol 2021; 40:476-483. [PMID: 34851499 PMCID: PMC9068615 DOI: 10.1007/s11604-021-01225-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/21/2021] [Indexed: 12/22/2022]
Abstract
Purpose The purpose of this study was to evaluate whether deep learning reconstruction (DLR) improves the image quality of intracranial magnetic resonance angiography (MRA) at 1.5 T. Materials and methods In this retrospective study, MRA images of 40 patients (21 males and 19 females; mean age, 65.8 ± 13.2 years) were reconstructed with and without the DLR technique (DLR image and non-DLR image, respectively). Quantitative image analysis was performed by placing regions of interest on the basilar artery and cerebrospinal fluid in the prepontine cistern. We calculated the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for analyses of the basilar artery. Two experienced radiologists evaluated the depiction of structures (the right internal carotid artery, right ophthalmic artery, basilar artery, and right superior cerebellar artery), artifacts, subjective noise and overall image quality in a qualitative image analysis. Scores were compared in the quantitative and qualitative image analyses between the DLR and non-DLR images using Wilcoxon signed-rank tests. Results The SNR and CNR for the basilar artery were significantly higher for the DLR images than for the non-DLR images (p < 0.001). Qualitative image analysis scores (p < 0.003 and p < 0.005 for readers 1 and 2, respectively), excluding those for artifacts (p = 0.072–0.565), were also significantly higher for the DLR images than for the non-DLR images. Conclusion DLR enables the production of higher quality 1.5 T intracranial MRA images with improved visualization of arteries.
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Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba, 286-8520, Japan
| | - Hiroyuki Akai
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba, 286-8520, Japan.,Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Haruto Sugawara
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Taku Tajima
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba, 286-8520, Japan.,Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba, 286-8520, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba, 286-8520, Japan
| | - Hiroyuki Kabasawa
- Department of Radiological Sciences, School of Health Sciences at Narita, International University of Health and Welfare, 4-3 Kozunomori, Chiba, 286-8686, Japan
| | - Rintaro Miyo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 kitakanamaru, Otawara, Tochigi, 324-8501, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba, 286-8520, Japan.
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33
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Kudo N, Tanaka A, Ishii H, Uemura Y, Takagi K, Iwama M, Yoshida R, Ohashi T, Kawai H, Negishi Y, Umemoto N, Tanaka M, Watarai M, Yoshioka N, Morishima I, Noda T, Yoshida Y, Tatami Y, Muramatsu T, Tanaka T, Tashiro H, Takada Y, Izawa H, Watanabe E, Murohara T. <Editors' Choice> Prevalence of acute coronary syndrome during the pandemic of COVID-19 in the Tokai Region of Japan. Nagoya J Med Sci 2021; 83:697-703. [PMID: 34916714 PMCID: PMC8648530 DOI: 10.18999/nagjms.83.4.697] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
The outbreak of coronavirus disease 19 (COVID-19) has had a great impact on medical care. During the COVID-19 pandemic, the rate of hospital admissions has been lower and the rate of in-hospital mortality has been higher in patients with acute coronary syndrome (ACS) in Western countries. However, in Japan, it is unknown whether the COVID-19 pandemic has affected the incidence of ACS. In the study, eleven hospitals in the Tokai region participated. Among enrolled hospital, we compared the incidence of ACS during the COVID-19 pandemic (April and May, 2020) with that in equivalent months in the preceding year as the control. During the study period; April and May 2020, 248 patients with ACS were admitted. Compared to April and May 2019, a decline of 8.1% [95% confidence interval (CI) 5.2-12.1; P = 0.33] in admissions for ACS was observed between April and May 2020. There was no significant difference in the strategy for revascularization and in-hospital deaths between 2019 and 2020. In conclusion, the rate of admission for ACS slightly decreased during the COVID-19 pandemic, compared to the same months in the preceding year. Moreover, degeneration of therapeutic procedures for ACS did not occur.
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Affiliation(s)
- Nobutaka Kudo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Ruka Yoshida
- Department of Cardiology, Japanese Red Cross Society, Nagoya Daini Hospital, Nagoya, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yosuke Negishi
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | | | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Society, Nagoya Daini Hospital, Nagoya, Japan
| | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Toshikazu Tanaka
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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34
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Yoshioka N, Tokuda T, Koyama A, Yamada T, Nishikawa R, Shimamura K, Takagi K, Morita Y, Tanaka A, Ishii H, Morishima I, Murohara T. Correction to: Clinical outcomes and predictors of restenosis in patients with femoropopliteal artery disease treated using polymer-coated paclitaxel-eluting stents or drug-coated balloons. Heart Vessels 2021; 37:567. [PMID: 34668032 DOI: 10.1007/s00380-021-01962-4] [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: 10/20/2022]
Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Kizawa Memorial Hospital, Minokamo, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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35
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Miura Y, Murai K, Yamada K, Yoshioka N. 4-Arylethynyl-5-fluorobenzoyl-1-methylimidazole Exhibiting Self-Recovering Mechanofluorochromism and Forming Fluorescence Molecular Glass. BCSJ 2021. [DOI: 10.1246/bcsj.20210247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Youhei Miura
- Department of Applied Chemistry, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Yokohama, Kanagawa 223-8522, Japan
| | - Kazuki Murai
- Department of Applied Chemistry, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Yokohama, Kanagawa 223-8522, Japan
| | - Kazufumi Yamada
- Department of Applied Chemistry, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Yokohama, Kanagawa 223-8522, Japan
| | - Naoki Yoshioka
- Department of Applied Chemistry, Faculty of Science and Technology, Keio University, 3-14-1 Hiyoshi, Yokohama, Kanagawa 223-8522, Japan
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36
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Nagase C, Tanno M, Kouzu H, Miki T, Nishida J, Murakami N, Kokubu N, Nagano N, Nishikawa R, Yoshioka N, Tsuchida A, Kita H, Ohnishi H, Miura T. Is GLP-1 insufficiency a coronary risk factor? A multicenter observational study, BOREAS-CAD2. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1064] [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 and aim
Glucagon-like peptide-1 (GLP-1) regulates insulin secretion and also affords pleiotropic effects including protective effects on blood vessels. Multiple factors regulate GLP-1 secretion after meals, but a group of apparently healthy subjects showed blunted responses of GLP-1 secretion in our previous study. In this study, we examined the possibility that the reduced capacity of GLP-1 secretion is associated with increased extent of coronary artery stenosis in non-diabetic patients.
Methods and results
Non-diabetic patients who were admitted for coronary angiography without a history of coronary interventions were enrolled. Coronary artery stenosis was quantified by Gensini score (GS), and GS ≥10 was used as an outcome variable based on results of earlier studies indicating its predictive value for cardiovascular events. The patients (mean age, 66.5±8.8 years; 71% males, n=173) underwent oral 75 g-glucose tolerant tests for determination of glucose, insulin and active GLP-1 levels. The area under the curve of plasma active GLP-1 (AUC-GLP-1) was determined as an index of GLP-1 secretion capacity. AUC-GLP-1 was not correlated with fasting glucose, AUC-glucose, serum lipids, indices of insulin sensitivity or estimated glomerular filtration rate. In multivariate logistic regression analysis for GS ≥10, AUC-GLP-1 < median, age and hypertension were selected as explanatory variables, though fasting GLP-1 level was not selected.
Conclusion
The findings indicate significant association of reduced GLP-1 secretion capacity with increased extent of coronary artery stenosis in non-diabetic patients. A causal relationship between change in GLP-1 secretion capacity and coronary stenosis remains to be examined by a longitudinal study
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp./MSD K.K.
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Affiliation(s)
- C Nagase
- Sapporo Medical University, Sapporo, Japan
| | - M Tanno
- Sapporo Medical University, Sapporo, Japan
| | - H Kouzu
- Sapporo Medical University, Sapporo, Japan
| | - T Miki
- Sapporo Medical University, Sapporo, Japan
| | - J Nishida
- Sapporo Medical University, Sapporo, Japan
| | - N Murakami
- Sapporo Medical University, Sapporo, Japan
| | - N Kokubu
- Sapporo Medical University, Sapporo, Japan
| | - N Nagano
- Sapporo Medical University, Sapporo, Japan
| | | | - N Yoshioka
- Sapporo Circulation Hospital, Sapporo, Japan
| | | | - H Kita
- JCHO Hokushin Hospital, Sapporo, Japan
| | - H Ohnishi
- Sapporo Medical University, Sapporo, Japan
| | - T Miura
- Sapporo Medical University, Sapporo, Japan
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Tajima T, Akai H, Sugawara H, Yasaka K, Kunimatsu A, Yoshioka N, Akahane M, Ohtomo K, Abe O, Kiryu S. Breath-hold 3D magnetic resonance cholangiopancreatography at 1.5 T using a deep learning-based noise-reduction approach: Comparison with the conventional respiratory-triggered technique. Eur J Radiol 2021; 144:109994. [PMID: 34627106 DOI: 10.1016/j.ejrad.2021.109994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the image quality of conventional respiratory-triggered 3-dimentional (3D) magnetic resonance cholangiopancreatography (Resp-MRCP) and breath-hold 3D MRCP (BH-MRCP) with and without denoising procedure using deep learning-based reconstruction (dDLR) at 1.5 T. METHODS Forty-two patients underwent MRCP at 1.5 T MRI. The following imaging sequences were performed: Resp-MRCP and BH-MRCP. We applied the dDLR method to the BH-MRCP data (BH-dDLR-MRCP). As a qualitative analysis, two radiologists rated the visibility of the proximal common bile duct (CBD), pancreaticobiliary junction, distal main pancreatic duct, cystic duct, and right and left hepatic ducts. Artifacts and overall image quality were also rated. The signal-to-noise ratios (SNRs), contrast ratios, and contrast-to-noise ratios (CNRs) of the CBD images were calculated for quantitative analysis. RESULTS BH-MRCP was successfully performed in a single BH. The qualitative and quantitative measurements for BH-dDLR-MRCP were significantly higher than for BH-MRCP (P < 0.02 and P < 0.001, respectively), and the qualitative measurements for BH-dDLR-MRCP were equivalent to or higher than for Resp-MRCP (P = 0.048-1.000). The SNRs and CNRs for BH-dDLR-MRCP were significantly higher than for Resp-MRCP (P < 0.001 and P = 0.001, respectively). CONCLUSION dDLR is useful and clinically feasible for BH-MRCP at 1.5 T MRI, and enables rapid imaging without loss of image quality compared to conventional Resp-MRCP.
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Affiliation(s)
- Taku Tajima
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Hiroyuki Akai
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Haruto Sugawara
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Koichiro Yasaka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Akira Kunimatsu
- Department of Radiology, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Naoki Yoshioka
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan
| | - Kuni Ohtomo
- International University of Health and Welfare, 2600-1 kitakanamaru, Otawara, Tochigi 324-8501, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan.
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Yoshioka N, Takagi K, Tokuda T, Morita Y, Morishima I. External iliac artery pseudoaneurysm following treatment for arterio-ureteral fistula using a balloon-expandable stent-graft: A case report. Radiol Case Rep 2021; 16:3544-3548. [PMID: 34567330 PMCID: PMC8449077 DOI: 10.1016/j.radcr.2021.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
Sepsis and bleeding can lead to life-threatening complications, such as stent-graft infection and pseudoaneurysm, after stent-graft implantation. An 83 year-old woman was admitted to our hospital for sepsis 14 months after treatment with a balloon-expandable stent-graft for an arterio-ureteral fistula (AUF) between the right external iliac artery and the right ureter. Blood cultures were positive for methicillin-resistant Staphylococcus aureus and Candida tropicalis. A giant infectious pseudoaneurysm (44 × 70 mm) at the distal edge of the stent-graft was suspected of having caused the sepsis. Although endovascular therapy (EVT) was planned to correct the pseudoaneurysm, the right iliac artery spontaneously became occluded from the ostium of the right common iliac artery to the common femoral artery 5 days after diagnosing the pseudoaneurysm; hence, EVT was not performed. Antibiotic administration was continued, and blood culture results were negative. Although EVT using a stent graft for AUFs is effective, data on the chronic phase outcomes are limited. Therefore, patients with AUFs treated using stent-grafts should be carefully followed up.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Japan
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39
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Shibata N, Umemoto N, Tanaka A, Takagi K, Iwama M, Uemura Y, Inoue Y, Negishi Y, Ohashi T, Tanaka M, Yoshida R, Shimizu K, Tashiro H, Yoshioka N, Morishima I, Noda T, Watarai M, Asano H, Tanaka T, Tatami Y, Takada Y, Ishii H, Murohara T. Clinical Outcomes Following Emergent Percutaneous Coronary Intervention for Acute Total/Subtotal Occlusion of the Left Main Coronary Artery. Circ J 2021; 85:1789-1796. [PMID: 33746154 DOI: 10.1253/circj.cj-20-0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Data regarding the clinical features, outcomes and prognostic factors in patients presenting with acute total/subtotal occlusion of the unprotected left main coronary artery (LMCA) remain limited.Methods and Results:From a multi-center registry, 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. Emergency room (ER) status classification was defined according to the presence of cardiogenic shock and cardiopulmonary arrest (CPA) in the ER (class 1=no cardiogenic shock; class 2= cardiogenic shock but not CPA; and class 3=CPA). In-hospital mortality and cerebral performance category (CPC) as the endpoints were evaluated. One-half (67/134) of the enrolled patients presented with total occlusion of the unprotected LMCA. Regarding ER status classification, class 1, 2, and 3 were observed in 30.6%, 45.5%, and 23.9% of the patients, respectively. In-hospital mortality occurred in 73 (54.5%) patients; of the remaining patients, 52 (85.3%) could be discharged with a CPC 1 or 2. ER status classification (odds ratio 4.4 [95% confidence interval: 2.33-10.67]; P<0.001) and total occlusion of the unprotected LMCA (odds ratio 8.29 [95% confidence interval 2.93-23.46]; P<0.001) were strong predictors of in-hospital mortality. CONCLUSIONS Acute total/subtotal occlusion involving the unprotected LMCA appeared to be associated with high in-hospital mortality. ER status classification and initial flow in the unprotected LMCA were significant predictive factors of in-hospital mortality.
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Affiliation(s)
- Naoki Shibata
- Department of Cardiology, Ichinomiya Municipal Hospital.,Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center
| | | | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital
| | | | | | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital
| | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine.,Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital
| | | | - Hiroshi Tashiro
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center
| | | | | | | | | | | | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine.,Department of Cardiology, Fujita Health University Bantane Hospital
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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40
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Yoshioka N, Tokuda T, Koyama A, Yamada T, Nishikawa R, Shimamura K, Takagi K, Morita Y, Tanaka A, Ishii H, Morishima I, Murohara T. Clinical outcomes and predictors of restenosis in patients with femoropopliteal artery disease treated using polymer-coated paclitaxel-eluting stents or drug-coated balloons. Heart Vessels 2021; 37:555-566. [PMID: 34553242 DOI: 10.1007/s00380-021-01941-9] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/10/2021] [Indexed: 01/22/2023]
Abstract
Both polymer-coated paclitaxel-eluting stents (PC-PESs) and drug-coated balloons (DCBs) are used in conjunction with endovascular therapy (EVT) for the treatment of peripheral artery disease (PAD). We aimed to identify the risk factors for the loss of patency following the use of PC-PES and DCB in a real clinical setting. We assessed the multi-center registry data of 151 lesions from 151 patients who underwent EVT for symptomatic PAD in the superficial femoral and proximal popliteal arteries using PC-PES or DCB. One-year primary patency (PP) and clinically driven target lesion revascularization (CD-TLR) were evaluated using Kaplan-Meier analysis. The predictive risk factors for 1-year outcomes were analyzed using the random survival forest method. PC-PES and DCB were used in 65 (43.0%) and 86 (57.0%) cases, respectively. There were no significant differences in 1-year PP or freedom from CD-TLR between PC-PES and DCB. PP occurred in 85.4% and 80.2% of cases in the PC-PES and DCB groups, respectively (log-rank p = 0.65), while freedom from CD-TLR was noted in 92.7% and 94.1% of cases in the PC-PES and DCB groups, respectively (log-rank p = 0.73). In order of importance, a Clinical Frailty Scale score ≥ 6, female sex, lower proximal vessel diameter, lower body mass index, and younger and older age were identified as predictive risk factors of restenosis in the PC-PES group. Peripheral artery calcification scoring system grade of ≥ 2, post-dissection pattern ≥ D, lower proximal and distal vessel diameter, and lesion length ≥ 100 mm were identified as predictive risk factors of restenosis, in order of importance, in the DCB group. Both PC-PES and DCB were associated with favorable clinical outcomes within 1 year in patients with femoropopliteal artery disease. Furthermore, several factors that could predict restenosis within 1 year following the use of each device were detected.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Akio Koyama
- Department of Vascular Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Kizawa Memorial Hospital, Minokamo, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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41
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Shimojo K, Takagi K, Morita Y, Kanzaki Y, Nagai H, Watanabe N, Yoshioka N, Yamauchi R, Komeyama S, Sugiyama H, Imaoka T, Sakamoto G, Ohi T, Goto H, Tsuboi H, Morishima I. Prevalence and prognosis of isolated posterior ST-segment elevation acute myocardial infarction using synthesized-V 7-9 lead. Cardiovasc Interv Ther 2021; 37:343-353. [PMID: 34542792 DOI: 10.1007/s12928-021-00796-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Limited data exist on the prevalence and prognosis of isolated posterior ST-segment elevation acute myocardial infarction (STEMI), revealed with a posterior chest lead. Furthermore, the utility of a synthesized-V7-9 lead in the diagnosis of STEMI is unclear; therefore, we aimed to evaluate its usefulness. We enrolled 142 consecutive patients with STEMI with the culprit lesion on the left circumflex artery (STEMI-LCx) undergoing percutaneous coronary intervention (PCI) between January 2009 and December 2019. We retrospectively checked the ST-segment change of both standard 12-lead and synthesized-V7-9 lead in all patients with STEMI-LCx. Based on electrocardiogram (ECG) findings, isolated posterior STEMI that was only revealed in synthesized-V7-9 lead was classified as "STEMI-LCx-synV7-9" and the remaining as "STEMI-LCx-12ECG." The prevalence of STEMI-LCx-synV7-9 in patients with STEMI-LCx was assessed. The incidence of all-cause death, cardiac death, and mechanical complications within 30 days, 3 months, and 1 year was also assessed according to each STEMI-LCx. STEMI-LCx-synV7-9 and STEMI-LCx-12ECG occurred in 10 (7.0%) and 132 (93.0%) patients, respectively. No significant difference was found in patients' characteristics between the two groups. The patients with STEMI-LCx-synV7-9 had significantly higher incidences of cardiac death within 3 months and 1 year (30.0% vs. 6.1%, P = 0.031, 30.0% vs. 7.6%, P = 0.050, respectively) and mechanical complications in each follow-up period (20.0% vs. 1.5%, P = 0.025) than those with STEMI-LCx-12ECG. STEMI-LCx-synV7-9 was observed in 7.0% of the patients with STEMI-LCx. Our findings suggest that the synthesized-V7-9 lead helps diagnose isolated posterior STEMI and might improve prognosis in patients with STEMI-LCx.
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Affiliation(s)
- Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Shotaro Komeyama
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Hiroki Sugiyama
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Takuma Ohi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Hiroki Goto
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.
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42
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Furui K, Morishima I, Morita Y, Kanzaki Y, Takagi K, Nagai H, Watanabe N, Yoshioka N, Yamauchi R, Miyazawa H, Yanagisawa S, Inden Y, Murohara T. Impact of Preoperative Nutritional Status on the Outcome of Catheter Ablation for Atrial Fibrillation. Circ J 2021; 86:268-276. [PMID: 34373432 DOI: 10.1253/circj.cj-21-0218] [Citation(s) in RCA: 3] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationship between nutritional status and the incidence or prognosis of atrial fibrillation (AF) has been reported, but no studies have described the relationship between the outcomes of AF catheter ablation (CA) and nutritional status as assessed by various scoring tools. We aimed to verify the hypothesis that preoperative nutritional status is associated with arrhythmia recurrence after CA for AF.Methods and Results:We evaluated 913 patients (age, 67±10 years; men, 72%; paroxysmal AF, 56%) who underwent CA for AF between November 2011 and November 2017. Patients were systematically followed with an endpoint of atrial tachyarrhythmia recurrence, the predictive value of which was compared among 3 scoring tools (Controlling Nutritional Status [CONUT] score / Geriatric Nutritional Risk Index [GNRI] / Prognostic Nutritional Index [PNI]). Patients were divided into normal nutrition (CONUT <2 [n=637] / GNRI >98 [n=836] / PNI >38 [n=910]) and undernutrition (CONUT ≥2 [n=276] / GNRI ≤98 [n=77] / PNI ≤3 [n=3]) groups. AF recurred in 274 patients (mean follow-up, 2.3±0.8 years). The AF recurrence rate was higher in patients with undernutrition than in those with normal nutrition (CONUT/GNRI) status. Multivariate Cox regression analysis identified undernutrition status (GNRI ≤98) as an independent predictor of atrial tachyarrhythmia recurrence. CONCLUSIONS The AF recurrence rate after CA was higher in patients with undernutrition than in those with normal nutrition as stratified by the nutrition scoring tools.
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Affiliation(s)
- Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital.,Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | | | | | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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43
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Yoshida R, Takagi K, Ishii H, Morishima I, Tanaka A, Morita Y, Kanzaki Y, Nagai H, Watanabe N, Furui K, Shibata N, Yoshioka N, Yamauchi R, Komeyama S, Sugiyama H, Tsuboi H, Murohara T. Myocardial salvage after ST-segment-elevation myocardial infarction: comparison between prasugrel and clopidogrel in the presence or absence of high-residual platelet reactivity. J Nucl Cardiol 2021; 28:1422-1434. [PMID: 31428979 DOI: 10.1007/s12350-019-01852-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The effect of prasugrel over clopidogrel on myocardial salvage in ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI) is not fully elucidated. METHODS Among 854 consecutive STEMI patients who underwent p-PCI, 446 patients were evaluated by two-phase (7 days and 3 months) single-photo emission computed tomography (SPECT). Patients were divided into two groups based on the loading P2Y12 inhibitor. The clopidogrel group was further divided based on the result of platelet function testing. Thus, the prasugrel group included 227 patients; the clopidogrel without high-residual platelet reactivity (HRPR) group, 109 patients; and the clopidogrel with HRPR group, 107 patients. The primary endpoint was the Myocardial Salvage Index (MSI), determined by SPECT. RESULTS The incidence of final TIMI 0/1 and TIMI myocardial perfusion grade 0/1 was higher in the clopidogrel with HRPR group (0.9%, 1.8%, and 7.5%, P = .002; 19.8%, 29.4%, and 41.1%, P = .0002, in the prasugrel, clopidogrel without HRPR, and clopidogrel with HRPR groups, respectively). The MSI was significantly lower in the clopidogrel with HRPR group (48% [27-66], 44% [30-72], and 36% [15-55], P = .006, respectively). CONCLUSIONS Prasugrel in STEMI patients was associated with an increased MSI compared with clopidogrel in the presence of HRPR.
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Affiliation(s)
- Ruka Yoshida
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shotaro Komeyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroki Sugiyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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44
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Yoshioka N, Tanaka M, Ochi K, Watanabe A, Ono K, Sawada M, Ogi T, Itoh M, Ito A, Shiraki Y, Enomoto A, Ishigami M, Fujishiro M, Ogawa Y, Suganami T. The sodium-glucose cotransporter-2 inhibitor Tofogliflozin prevents the progression of nonalcoholic steatohepatitis-associated liver tumors in a novel murine model. Biomed Pharmacother 2021; 140:111738. [PMID: 34029949 DOI: 10.1016/j.biopha.2021.111738] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes and obesity contribute to the pathogenesis of nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC). However, how diabetes and obesity accelerate liver tumorigenesis remains to be fully understood. Moreover, to verify the therapeutic potential of anti-diabetic drugs, there exists a strong need for appropriate animal models that recapitulate human pathophysiology of NASH and HCC. METHODS We established a novel murine model of NASH-associated liver tumors using genetically obese melanocortin 4 receptor-deficient mice fed on Western diet in combination with a chemical procarcinogen, and verified the validity of our model in evaluating drug efficacy. FINDINGS Our model developed multiple liver tumors together with obesity, diabetes, and NASH within a relatively short period (approximately 3 months). In this model, sodium glucose cotransporter 2 inhibitor Tofogliflozin prevented the development of NASH-like liver phenotypes and the progression of liver tumors. Tofogliflozin attenuated p21 expression of hepatocytes in non-tumorous lesions in the liver. INTERPRETATION Tofogliflozin treatment attenuates cellular senescence of hepatocytes under obese and diabetic conditions. This study provides a unique animal model of NASH-associated liver tumors, which is applicable for assessing drug efficacy to prevent or treat NASH-associated HCC.
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MESH Headings
- Animals
- Benzhydryl Compounds/pharmacology
- Benzhydryl Compounds/therapeutic use
- Blood Glucose/analysis
- Cellular Senescence/drug effects
- Diabetes Mellitus, Experimental/blood
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/etiology
- Diabetes Mellitus, Experimental/pathology
- Diet, Western
- Disease Models, Animal
- Disease Progression
- Glucosides/pharmacology
- Glucosides/therapeutic use
- Hepatocytes/drug effects
- Insulin/blood
- Liver/drug effects
- Liver/pathology
- Liver Neoplasms/blood
- Liver Neoplasms/drug therapy
- Liver Neoplasms/etiology
- Liver Neoplasms/pathology
- Mice, Inbred C57BL
- Mice, Knockout
- Non-alcoholic Fatty Liver Disease/blood
- Non-alcoholic Fatty Liver Disease/complications
- Non-alcoholic Fatty Liver Disease/drug therapy
- Non-alcoholic Fatty Liver Disease/pathology
- Obesity/blood
- Obesity/complications
- Obesity/drug therapy
- Obesity/pathology
- Receptor, Melanocortin, Type 4/genetics
- Sodium-Glucose Transporter 2 Inhibitors/pharmacology
- Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
- Mice
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Affiliation(s)
- Naoki Yoshioka
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miyako Tanaka
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Immunometabolism, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kozue Ochi
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Akiko Watanabe
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Kenji Ono
- Department of Brain Function, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Molecular Pharmacokinetics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Sawada
- Department of Brain Function, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Molecular Pharmacokinetics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoo Ogi
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiko Itoh
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Kanagawa Institute of Industrial Science and Technology, Ebina, Japan
| | - Ayaka Ito
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Immunometabolism, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Shiraki
- Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Enomoto
- Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Ogawa
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayoshi Suganami
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Immunometabolism, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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45
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Watanabe N, Takagi K, Tanaka A, Yoshioka N, Morita Y, Yoshida R, Kanzaki Y, Nagai H, Yamauchi R, Komeyama S, Sugiyama H, Shimojo K, Imaoka T, Sakamoto G, Ohi T, Goto H, Okumura T, Ishii H, Morishima I, Murohara T. Ten-Year Mortality in Patients With ST-Elevation Myocardial Infarction. Am J Cardiol 2021; 149:9-15. [PMID: 33753036 DOI: 10.1016/j.amjcard.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 12/22/2022]
Abstract
Knowledge of the long-term prognosis (>10 years) and mortality predictors of ST-elevation myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (p-PCI) is scarce. Therefore, this study evaluated the long-term prognosis and determined the predictors of long-term outcomes for STEMI patients after p-PCI. Between January, 2006 and December, 2010, we collected data and analyzed 459 consecutive patients with acute STEMI who underwent p-PCI and were discharged from the hospital (mean age, 66.8 years; male, 75.2%; peak creatine phosphokinase level, 2,292.5 IU/L). The primary endpoint was 10-year all-cause mortality. The cumulative 10-year incidence of all-cause death was 23.8%. The Cox multivariate regression analysis identified age ≥ 65 years (adjusted hazard ratio [aHR], p <0.001), body mass index (aHR, 0.93, p = 0.033), presence of atrial fibrillation (aHR, 1.69, p = 0.038), mineralocorticoid receptor antagonist use (aHR, 1.95, p = 0.008), ejection fraction <40% (aHR, 2.14, p = 0.005), and albumin <3.5 g/dL (aHR, 2.01, p = 0.005) as independent predictors of all-cause mortality. In conclusion, a post-discharge 10-year survival rate of 76.2% was identified for STEMI patients who underwent p-PCI.
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46
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Yoshioka N, Takagi K, Tokuda T, Morita Y, Morishima I. Clinical performance of polymer-coated paclitaxel-eluting stent implanted for diffuse and calcified superficial femoral artery stenotic lesions: Insights from a patient on hemodialysis. SAGE Open Med Case Rep 2021; 9:2050313X211025929. [PMID: 34178357 PMCID: PMC8207276 DOI: 10.1177/2050313x211025929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
In recent years, various devices have been approved for peripheral artery disease with femoropopliteal lesions. However, treatment of long, calcified, and diffused lesions is still challenging because these lesions are associated with restenosis. This report described the case of an 82-year-old man with bilateral severely calcified and diffused long lesions in the superficial femoral artery that was treated using polymer-coated paclitaxel-eluting stent and interwoven nitinol stent. After 6 months, in-stent restenosis was observed at the implantation site of the interwoven nitinol stents. Polymer-coated paclitaxel-eluting stents were deployed at the in-stent restenosis site. After another 6 months, angiography and intravascular ultrasound imaging revealed no restenosis at the polymer-coated paclitaxel-eluting stent site. Optical coherence tomography was also performed, revealing that the stent struts were well covered by neointima, which was very thin at approximately 0.1 mm. This representative case demonstrated substantial differences in the effects of devices; in other words, the superiority of polymer-coated paclitaxel-eluting stent in treating long, diffuse, and calcified lesions indicated that its implantation is a reasonable option when the initial gain was obtained following sufficient vessel preparation.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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47
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Takagi K, Tanaka A, Yoshioka N, Morita Y, Yoshida R, Kanzaki Y, Watanabe N, Yamauchi R, Komeyama S, Sugiyama H, Shimojo K, Imaoka T, Sakamoto G, Ohi T, Goto H, Ishii H, Morishima I, Murohara T. In-hospital mortality among consecutive patients with ST-Elevation myocardial infarction in modern primary percutaneous intervention era ~ Insights from 15-year data of single-center hospital-based registry ~. PLoS One 2021; 16:e0252503. [PMID: 34115767 PMCID: PMC8195354 DOI: 10.1371/journal.pone.0252503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To clarify the association of detailed angiographic findings with in-hospital outcome after primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) in Japan. Background Data regarding the association of detailed angiographic findings with in-hospital outcome after STEMI are limited in the p-PCI era. Methods Between January-2004 and December-2018, 1735 patients with STEMI (mean age, 68.5 years; female, 24.6%) who presented to the hospital in the 24-hours after symptom onset and underwent p-PCI were evaluated using the disease registries. The registry is an ongoing, retrospective, single-center hospital-based registry. Results The 30-day mortality rate and in-hospital mortality rate were 7.7% and 9.2%, respectively. Independent predictors of in-hospital mortality were ejection fraction (EF) < 40% [adjusted Odds Ratio (aOR), 4.446, p < 0.001], culprit lesions in the left coronary artery (LCA) (aOR, 2.940, p < 0.001) compared with those in the right coronary artery, Killip class > II (aOR, 7.438; p < 0.001), chronic kidney disease (CKD) (aOR, 4.056; p < 0.001), final thrombolysis in myocardial infarction (TIMI) grades 0/1/2 (aOR, 1.809; p = 0.03), absence of robust collaterals (aOR, 17.309; p = 0.01) and hypertension (aOR, 0.449; p = 0.01). Conclusions Among the consecutive patients with STEMI, the in-hospital mortality rate after p-PCI significantly improved in the second half. Not only CKD, Killip class > II, and EF < 40%, but also the angiographic findings such as culprit lesions in the LCA, absence of very robust collaterals, and final TIMI grades <3 were associated with an increased risk of in-hospital mortality.
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Affiliation(s)
- Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shotaro Komeyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroki Sugiyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takuma Ohi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroki Goto
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
- * E-mail:
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yoshioka N, Takagi K, Tanaka A, Morita Y, Yoshida R, Kanzaki Y, Nagai H, Watanabe N, Yamauchi R, Komeyama S, Sugiyama H, Shimojo K, Imaoka T, Sakamoto G, Ohi T, Goto H, Ishii H, Morishima I, Murohara T. The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction. Intern Med 2021; 60:1665-1674. [PMID: 33390500 PMCID: PMC8222117 DOI: 10.2169/internalmedicine.6549-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The popularity of primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) has increased over the past decades. Despite improvements in in-hospital mortality rates, it is clinically important to investigate the prognoses after discharge. However, data on the mode of death and prognostic factors are limited. We analyzed these factors in a Japanese cohort in the modern p-PCI era. Methods Between January 2004 and December 2017, a total of 1,222 patients who underwent p-PCI within 24 hours from the onset of STEMI and were alive at discharge (mean age, 67.7 years old; men, 75.5%), were evaluated. The two-year mortality was analyzed using a Cox regression model, and the mode of death was evaluated. Results The rate of mortality at 2 years was 5.7%. Non-cardiac death was more frequent than cardiac death (62.6% vs. 37.4%). A Cox multivariate analysis identified the following as independent predictors of the 2-year mortality: hemoglobin (log-transformed) [adjusted hazard ratio (HR), 0.048; 95% confidence interval (CI), 0.008-0.29; p<0.001], age above 80 years old (adjusted HR, 2.26; 95% CI, 1.30-3.91; p=0.004), Killip class ≥II (adjusted HR, 1.99; 95% CI, 1.17-3.39; p=0.011), brain natriuretic peptide level (log-transformed) (adjusted HR, 1.47; 95% CI, 1.09-2.01; p=0.013), and body mass index (log-transformed) (adjusted HR, 0.16; 95% CI, 0.030-0.84; p=0.030). Conclusion This study demonstrated that the 2-year mortality was 5.7% in STEMI survivors after p-PCI. Non-cardiac death was more frequent than cardiac death. Compared to well-known clinical variables, angiographic findings did not have a significant influence on the mid-term mortality.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | | | | | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Takuma Ohi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Hiroki Goto
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
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Yamauchi R, Morishima I, Okumura K, Kanzaki Y, Morita Y, Takagi K, Nagai H, Watanabe N, Furui K, Yoshioka N, Miyazawa H, Shimojo K, Imaoka T, Sakamoto G, Murohara T. Catheter ablation for non-paroxysmal atrial fibrillation accompanied by heart failure with preserved ejection fraction: feasibility and benefits in functions and B-type natriuretic peptide. Europace 2021; 23:1252-1261. [PMID: 33693617 DOI: 10.1093/europace/euaa420] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/17/2020] [Accepted: 12/29/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed to examine the benefits of catheter ablation in patients with non-paroxysmal atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF. METHODS AND RESULTS From 1173 consecutive patients undergoing catheter ablation, 502 with non-paroxysmal AF were divided into three groups: no history of HF [plasma B-type natriuretic peptide (BNP) <100 pg/mL and no HF hospitalization; n = 125], HFpEF [left ventricular (LV) EF ≥50%; n = 293], and HF with midrange EF (HFmrEF) + HFrEF (LVEF <50%; n = 84) groups. The endpoints were AF recurrence at 1 year, changes in symptomatic and image-based functional status, and changes in BNP levels from baseline to 1 year. In the HFpEF group, AF recurred in 48 patients (16.4%) and 278 patients (94.8%) had sinus rhythm at 1 year; these values were comparable with those in the other groups. Significant improvement was observed in the left atrial diameter, LVEF, and New York Heart Association functional class in the HFpEF and HFmrEF + HFrEF groups. The BNP level significantly decreased irrespective of the index rate control status, and freedom from AF recurrence was an independent predictor of HF remission, defined as BNP <100 pg/mL at 1 year, in the HFpEF group. CONCLUSION Catheter ablation is highly feasible for restoring sinus rhythm in non-paroxysmal AF with coexisting HFpEF, thereby improving cardiac function and BNP levels. Catheter ablation for AF may be an optional management strategy.
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Affiliation(s)
- Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Kenji Okumura
- Department of Cardiology, Tohno Kosei Hospital, 76-1 Tokicho, Mizunami, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Miyazawa
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, 503-8502 Ogaki, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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50
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Yoshioka N, Takagi K, Morita Y, Kanzaki Y, Nagai H, Watanabe N, Morishima I. Bleeding events and mid-term mortality in the patients undergoing endovascular interventions for peripheral artery disease of the lower limbs based on the academic research consortium high bleeding risk criteria. Heart Vessels 2021; 36:1336-1349. [PMID: 33616719 DOI: 10.1007/s00380-021-01804-3] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
This study applied the Academic Research Consortium for HBR (ARC-HBR) criteria to peripheral artery disease (PAD) patients after Endovascular therapy (EVT) and assessed the prevalence of HBR, as well as the association between HBR and clinical outcomes. This is a single-center, non-randomized, controlled, and retrospective study. EVTs for symptomatic PAD are minimally invasive and efficient. Although bleeding can be a serious adverse event, the criteria for HBR and assessment of bleeding events in patients who underwent EVT have been limited. A total of 156 patients with PAD who underwent EVT were divided into two groups according to ARC-HBR criteria. The associations between HBR and bleeding events, which was defined as Bleeding Academic Research Consortium Type 3 or Type 5 bleeding within 1 year and all-cause mortality within 1 year, were analyzed. The percentage of patients who were categorized as having HBR was 75.0%. Bleeding events occurred in 12.6% of the patients. All bleeding events occurred in the HBR group, while no bleeding events occurred in the no-HBR group. (16.9% vs. 0.0%, respectively; p = 0.008). During the follow-up period, 11.1% of the patients had died. All-cause mortality was significantly higher in the HBR group than in the no-HBR group (14.7% vs. 0.0%, respectively; p = 0.019). Most patients with PAD were classified as having HBR as assessed by ARC-HBR criteria, and patients with HBR were at a higher risk of not only bleeding events but also mid-term mortality compared to those without HBR. ARC-HBR criteria can be a helpful parameter when treating PAD patients after EVT.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan.
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