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Seki S, Sugiyama T, Kikuchi S, Iino Y. Risk factors for occurrence and progression of external auditory canal cholesteatoma. Auris Nasus Larynx 2024; 51:295-300. [PMID: 37925251 DOI: 10.1016/j.anl.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE External auditory canal cholesteatoma (EACC) is characterized by retained squamous debris within the external canal and variable amounts of localized bone destruction. The etiology of primary EACC remains incompletely understood. This study was conducted to analyze the clinical features and backgrounds of patients with primary EACC and to clarify the risk factors for the occurrence and progression of EACC. METHODS Sixty-nine ears of 62 patients diagnosed with primary EACC were included in this study (EACC group). Additionally, 74 ears of 60 patients with chronic otitis media (COM) with perforation who underwent tympanoplasty or myringoplasty were included as controls (COM group). We retrospectively investigated the clinical features, life history, and medical history of the patients in both groups. In addition, to investigate the risk factors for progression of EACC, we compared the clinical features and medical history of patients with stage IV (advanced) disease versus stage I + II (mild) disease. RESULTS The inferior wall of the bony canal was the main structure affected in patients with primary EACC of all stages. The following factors were significantly more common in the EACC than COM group: older age, female sex, left-sided disease, osteoporosis, renal dysfunction, anemia, and treatment with bisphosphonates. Among these, the most significant factor associated with EACC was renal dysfunction (odds ratio, 11.4; 95 % confidence interval, 2.32-55.9). The significant factors observed in patients with stage IV disease were younger age, male sex, posterior wall involvement, and otorrhea. Surgical treatment was required for more than half of the patients with stage III and IV EACC. CONCLUSION Patients with renal dysfunction are at risk of primary EACC. In particular, younger patients and relatively younger elderly patients with posterior wall involvement have a risk of progression to advanced-stage EACC. Canalplasty should be considered in patients with EACC who have these risk factors to prevent progression to advanced-stage disease.
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Affiliation(s)
- Saori Seki
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan; Department of Otolaryngology, Niigata Prefectural Central Hospital 205, Shinnan-cho, Joetsu, Niigata 943-0192, Japan.
| | - Tomonori Sugiyama
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Deafness and Middle Ear Surgicenter Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan; Department of Otolaryngology Head and Neck Surgery, Jichi Medical University Saitama Medical Center 1-847, Amanuma-cho, Omiya 330-0834, Japan
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Hoshi Y, Shirakura S, Yamada M, Sugiyama T, Koide N, Tamii S, Kamata K, Yokomura M, Osaki S, Ohno T, Yagihara K, Hara H, Beppu T. Site of distant metastasis affects the prognosis with recurrent/metastatic head and neck squamous cell carcinoma patients treated with Nivolumab. Int J Clin Oncol 2023; 28:1139-1146. [PMID: 37421478 DOI: 10.1007/s10147-023-02381-3] [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: 03/24/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Nivolumab is approved for the treatment of recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, the influence of the site of distant metastasis on the efficacy of immune checkpoint inhibitor in R/M HNSCC remains unclear. We investigated the prognosis of R/M HNSCC patients treated with nivolumab, focusing on the site of distant metastasis. METHODS We reviewed the data of R/M HNSCC patients treated with nivolumab between April 2017 and June 2020 at Saitama Prefectural Cancer Center. The differences in the prognosis were evaluated according to the site of distant metastasis. RESULTS Of the 41 patients enrolled, 26 (63.4%) had lung metastasis, 7 (17.1%) had bone metastasis, and 4 (9.8%) had liver metastasis. Ten patients (24.4%) had single-organ distant metastasis (lung metastasis in all cases). Univariate analysis identified lung metastasis alone (single-organ distant metastasis) was associated with a significantly better prognosis [HR0.37 (95% CI) 0.14-0.97 p = 0.04], while liver metastasis was associated with a significantly worse prognosis [HR3.86 (95% CI) 1.26-11.8 p = 0.02]. Multivariate analysis identified lung metastasis alone and liver metastasis as independent prognostic factors. While 7 patients (70%) with lung metastasis alone could be continued on nivolumab treatment or received subsequent chemotherapy, only 1 patient (25%) with liver metastasis received subsequent chemotherapy. CONCLUSION The site of distant metastasis affects the prognosis of R/M HNSCC patients treated with nivolumab. Lung metastasis alone appears to be associated with a better prognosis, in that it allows easier transition to subsequent chemotherapy, while liver metastasis associates with a worse prognosis.
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Affiliation(s)
- Yuta Hoshi
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan.
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Satoshi Shirakura
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masato Yamada
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tomonori Sugiyama
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
| | - Nobuaki Koide
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Satoru Tamii
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
| | - Kyohei Kamata
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 1-4-12 Kojirakawa-machi, Yamagata-shi, Yamagata, 990-8560, Japan
| | - Masaru Yokomura
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Sotaro Osaki
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takafumi Ohno
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kazuhiro Yagihara
- Department of Oral Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
| | - Takeshi Beppu
- Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806, Japan
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Kikuchi S, Yoshida S, Sugiyama T, Iino Y. Myringoplasty for Eosinophilic Otitis Media. Otol Neurotol 2023; 44:572-577. [PMID: 37231536 DOI: 10.1097/mao.0000000000003904] [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: 05/27/2023]
Abstract
OBJECTIVE Surgical intervention of eosinophilic otitis media (EOM) has been considered contraindicated because middle ear surgery is associated with a risk of deafness. Myringoplasty is believed to be less invasive. Therefore, we analyzed the surgical results of myringoplasty for perforated eardrums in patients with EOM treated by biological drugs (biologics). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Nine ears of seven patients with EOM with eardrum perforation associated with bronchial asthma were treated with add-on biologics; myringoplasty was then performed. The controls comprised 17 ears of 11 patients with EOM treated by myringoplasty without biologics. INTERVENTIONS The EOM status of each patient of both groups was assessed using severity scores, hearing acuity, and temporal bone computed tomography scores. MAIN OUTCOME MEASURES Preoperative and postoperative changes in severity scores and hearing acuity, postoperative closure of the perforation, and relapse of EOM. RESULTS Severity scores significantly decreased after the use of biologics but did not change after myringoplasty. One patient developed postoperative relapse of middle ear effusion (MEE); in the control group, however, 10 ears developed recurrence of MEE. Significant improvement of the air conduction hearing level was obtained in the biologics group. No patients showed deterioration of the bone conduction hearing level. CONCLUSIONS This is the first report to describe successful surgical interventions with add-on biologics for patients with EOM. In the era of biologics, surgical interventions such as myringoplasty will be indicated to improve hearing and to avoid recurrence of MEE in patients with EOM with perforated eardrums, with the use of biologics.
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Affiliation(s)
- Saori Kikuchi
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saeko Yoshida
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
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Seegers LM, Araki M, Nakajima A, Yuki H, Yonetsu T, Soeda T, Kurihara O, Higuma T, Minami Y, Adriaenssens T, Nef H, Lee H, Sugiyama T, Kakuta T, Jang IK. Cardiovascular risk factors and underlying pathology and prevalence of lipid plaques in women with acute coronary syndromes in different age groups. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1199] [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: 11/14/2022] Open
Abstract
Abstract
Background
An incidence of cardiovascular events increases with age in women. The relationship between cardiovascular risk factors, and the underlying pathology and the prevalence of lipid plaques has not been systematically studied in different age groups in women presented with acute coronary syndromes (ACS).
Purpose
We investigated the underlying pathology and the prevalence of lipid plaques in culprit lesions by optical coherence tomography (OCT) in women with different risk factors.
Methods
A total of 382 women who underwent pre-intervention OCT imaging were included. The underlying pathology and the prevalence of lipid plaques in the culprit lesion was compared between women with and without cardiovascular risk factors (i.e. hypertension, smoking, hyperlipidemia, diabetes mellitus, family history and chronic kidney disease) in three different age groups (<60 yr, 60–70 yr, >70 yr).
Results
The relative prevalence of plaque erosion was higher in younger women (<60 yr) and decreased with age (from 51% to 28%, p<0.001). There was no significant difference in the prevalence of lipid plaques between women with and without risk factors, except a higher prevalence of lipid plaques in current smokers compared to non-smokers (79% vs. 63%, p=0.003). In women with hyperlipidemia, the prevalence of lipid plaques was modest in young ages (<60 yr), but increased steeply with age (p<0.001). The increasing age trend for lipid plaque was also observed in women with hypertension (p=0.03) and current smokers (p=0.01). In women with diabetes mellitus and family history, the prevalence of lipid plaques was high even in young ages (<60 yr) and did not increase with age.
Conclusion
The prevalence of plaque erosion was higher in younger women (<60 yr) and decreased with age. Current smokers had significantly higher prevalence of lipid plaque. Patients with diabetes and positive family history had a higher prevalence of lipid plaque at young age. The prevalence of lipid plaques increased with age particularly in women with hyperlipidemia and hypertension.
Funding Acknowledgement
Type of funding sources: Foundation.
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Affiliation(s)
- L M Seegers
- Mass General Hopital (MGH) , Boston , United States of America
| | - M Araki
- Mass General Hopital (MGH) , Boston , United States of America
| | - A Nakajima
- Mass General Hopital (MGH) , Boston , United States of America
| | - H Yuki
- Mass General Hopital (MGH) , Boston , United States of America
| | - T Yonetsu
- Tokyo Medical and Dental University , Tokyo , Japan
| | - T Soeda
- Nara Medical University , Nara , Japan
| | - O Kurihara
- Nippon Medical School Chiba Hokusoh Hospital , Inzai , Japan
| | - T Higuma
- Toyoko Hospital, St. Marianna University School of Medicine , Kawasaki , Japan
| | - Y Minami
- Kitasato University School of Medicine , Kanagawa , Japan
| | | | - H Nef
- Justus-Liebig University of Giessen , Giessen , Germany
| | - H Lee
- Massachusetts General Hospital - Harvard Medical School, Biostatistics Center , Boston , United States of America
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - I K Jang
- Mass General Hopital (MGH) , Boston , United States of America
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Hada M, Hoshino M, Sugiyama T, Misawa T, Nagamine T, Ueno H, Matsuda K, Sayama K, Yonetsu T, Sasano T, Kakuta T. the diagnostic value of left-anterior-descending artery velocity assessed by transthoracic Doppler echocardiography for microvascular dysfunction in stenotic left-anterior-descending artery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.167] [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
Index of microcirculatory resistance (IMR) has been used as a clinical measure of microvascular function. Transthoracic Doppler echocardiography (TDE) can provide information on the functional status of coronary artery circulation. This study aims to assess the diagnostic value of left-anterior-descending artery (LAD) flow velocity by TDE for microvascular dysfunction.
Methods
Consecutive patients who were scheduled for elective percutaneous coronary intervention (PCI) for LAD lesions were prospectively enrolled in the single tertiary-care center between April 2020 and July 2021. Pre-PCI LAD diastolic peak velocity (DPV) by TDE at rest and hyperemia were measured. By invasive coronary angiography, quantitative coronary angiography and invasive wire-based physiological indices including fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) were measured.
Results
A total of 104 patients were studied. Median FFR and IMR values were 0.70 (0.60–0.74) and 20.68 (14.92–31.69), respectively. No significant relationship was observed between FFR and IMR. The prevalence of microvascular dysfunction defined as IMR≥25 was 39.4%. Basal DPV was 25 (20–33) cm/sec, and hyperemic DPV was 51 (41–67) cm/sec. In lesions with IMR≥25, reference diameter (RD) was significantly greater [2.63 (2.22–3.19) mm vs 2.39 (2.09–2.66) mm, p=0.019], basal DPV was lower [26 (18–29) cm/sec vs 29 (22–37) cm/sec, p=0.022)] and hyperemic DPV was lower [49 (19–54) cm/sec vs 56 (42–70) cm/sec, p=0.023] compared to lesions with IMR<25. ROC analysis showed basal DPV and RD are significant predictors of IMR≥25 [basal DPV: AUC 0.633 (0.525–0.742), best cutoff 29cm/sec RD: AUC 0.636 (0.523–0.750), best cutoff 2.84mm]. Multivariable logistic regression analysis showed basal DPV<29cm/sec and RD>2.84mm are independent predictors for IMR≥25 [Odds ratio: 3.08 (1.22–7.78), p=0.017; odds ratio 4.40 (1.55–12.50), p=0.005].
Conclusion
Basal DPV by non-invasive pre-PCI TDE and reference diameter can predict lesions with coexisting microvascular dysfunction in LAD territory with functionally significant lesions without the need of vasodilator-induced hyperemia and a wire-based invasive physiological measurement.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Hada
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Sasano
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
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Nogami K, Hoshino M, Kanaji Y, Sugiyama T, Misawa T, Hada M, Yamaguchi M, Nagamine T, Teng Y, Ueno H, Matsuda K, Sayama K, Kakuta T. Prognostic implications of unrecognized myocardial infarction before elective percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.292] [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
A non-negligible proportion of myocardial infarction (MI) is not clinically recognized and unrecognized myocardial infarction (UMI) is associated with adverse outcomes.
Purpose
To determine the prevalence and prognostic significance of UMI by delayed-enhancement cardiac magnetic resonance (DE-CMR) before elective percutaneous coronary intervention (PCI).
Methods
In this prospective, single-center study, 236 patients with stable coronary artery disease undergoing elective and uncomplicated PCI were studied. All patients underwent DE-CMR before PCI. The prevalence of UMI was evaluated and the association of clinical and CMR-derived variables with primary MACE, defined as cardiovascular death, nonfatal MI, hospitalization for heart failure, unplanned late revascularization, and ischemic stroke was investigated.
Results
In the final analysis of 213 patients, 63 patients (29.6%) showed UMI. Target territory UMI was observed in 38 (17.8% of total, 60.3% of patients with UMI). UMI was significantly associated with sex, diabetes mellitus, left ventricular ejection fraction, SYNTAX score and fractional flow reserve in target vessels. During follow-up periods (median, 23 months), MACE was observed in 17 (27.0%) of patients with UMI, and 17 (11.3%) without (P=0.001). In a multivariable model, UMI (hazard ratio [HR] 2.18, 95% confidential interval, 1.10–4.33, P=0.001) remained as an independent predictor of MACE. Kaplan–Meier analysis indicated that the presence of UMI was significantly associated with higher incidence of MACE.
Conclusions
The prevalence of UMI in patients undergoing elective PCI was 29.6%. UMI was independently associated with an increased risk of MACE after successful PCI. Given the non-negligible prevalence and potential clinical significance of UMI, clinical studies comparing PCI and guideline directed medical therapy (GDMT) versus GDMT only strategy might have to take the presence of UMI into consideration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Nogami
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Teng
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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9
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Sayama K, Hoshino M, Kanaji Y, Sugiyama T, Misawa T, Hada M, Nagamine T, Nogami K, Teng Y, Ueno H, Matsuda K, Yonetsu T, Kakuta T. Prognostic implication of unrecognized myocardial infarction in patients with non-ST-segment-elevation acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prognostic value of unrecognized non-infarct-related territory (non-IR) myocardial infarction (UMI) in patients with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) remains to be elucidated.
Purpose
This study sought to evaluate the prevalence of non-IR UMI and its prognostic value in patients with first NSTE-ACS presentation.
Methods
This retrospective single-center analysis was conducted in patients with NSTE-ACS without prior history of coronary artery disease, who underwent uncomplicated urgent percutaneous coronary intervention (PCI) within 48 hours of admission between August 2014 and January 2018. All patients underwent postprocedural cardiac magnetic resonance imaging (CMR) within 30 days after PCI. Non-IR UMI was defined as the presence of non-IR delayed gadolinium enhancement with an ischemic distribution pattern. We investigated the association of non-IR UMI, other CMR findings and baseline clinical characteristics with major adverse cardiac events (MACE), defined as all-cause death, non-fatal myocardial infarction, ischemic stroke, late revascularization and hospitalization for congestive heart failure.
Results
A total of 168 NSTE-ACS patients were included (124 males (73.8%); 66±11 years). Non-IR UMI was detected in 28 patients (16.7%). During a median follow-up of 32 months (15–58), MACE occurred in 10 (35.7%) patients with non-IR UMI, and 20 (14.3%) patients without (P=0.013). Patients with MACE showed higher frequency of non-IR UMI in RCA territory and multi vessel disease, higher level of NT-proBNP at admission, higher Genisini score, and greater extent of UMI. Cox's proportional hazards analysis showed that the presence of non-IR UMI was an independent predictor of MACE (HR 2.34, 95% CI 1.02–5.37, P=0.045), after adjusting confounding factors, such as multi vessel disease and serum levels of NT-proBNP at admission. The discriminant efficacy (IDI and NRI) of predicting MACE was significantly improved when the presence of non-IR UMI added to the reference clinical risk model. Kaplan-Meier analysis revealed that patients with non-IR UMI were significantly associated with poor prognosis. (Figure 1).
Conclusions
In patients with NSTE-ACS undergoing urgent PCI, the prevalence of non-IR UMI was 16.7%. Non-IR UMI provided prognostic information independent of conventional risk factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Teng
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Division of Cardiovascular Medicine , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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10
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Nagamine T, Hoshino M, Matsuda K, Misawa T, Sugiyama T, Sasano T, Sayama S, Ueno H, Hada M, Yonetsu T, Kakuta T. Identification of coronary plaque rupture or erosion by preprocedural computed tomography angiography in patients with non-st-segment elevation acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1182] [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 frequent pathological cause of acute coronary thrombosis is plaque rupture or erosion. A previous CT angiographic study failed to discriminate OCT-defined intact fibrous cap culprit lesions (IFC lesions) from those with ruptured fibrous cap (RFC group) in patients with acute coronary syndrome (ACS) and chronic coronary syndrome.
Objectives
This study aimed to evaluate the diagnostic efficacy of preprocedural coronary CT imaging to identify optical coherence tomography (OCT)-defined plaque rupture or erosion at culprit lesions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Methods
Consecutive patients with suspected NSTE-ACS who underwent preprocedural non-contrast CT and CT angiography (CCTA) were studied. Patients with at least one lesion with more than 50% stenosis at the proximal segment on CCTA were subsequently assessed by invasive coronary angiography and OCT. ALL CT and OCT examination were performed within 24 hours from presentation. The diagnosis of intact fibrous cap or ruptured fibrous cap was made by OCT for the angiographically most severely stenosed lesion. Cases of ambiguous OCT diagnosis such as massive thrombosis or calcified nodule precluding the fibrous cap assessment were excluded from the final analysis.
Results
In the final analysis of 176 patients, OCT identified 87 RFC plaques and 89 IFC plaques for the culprit lesions, respectively. In IFC group, lower prevalence of diabetes mellitus (24.7% vs. 41.4%, P=0.025) and lower peak cardiac marker elevation (CPK, 159 vs. 272 U/L, P<0.001) were observed. On CT, the prevalence of low attenuation plaque, positive remodeling, napkin ring sign, spotty calcification, calcium score (CAC), and culprit vessel pericoronary adipose tissue attenuation (FAI) were all significantly low in IFC group. Multivariate regression analysis to predict IFC at culprit lesions revealed that the absence of low attenuation plaque, the absence of napkin ring sign, zero CAC, and low FAI were independent predictors of IFC. When stratified by the number of these 4 CT factors, the presence of IFC were stratified as 0%, 23.6%, 50%, 77.8%, and 100% (P<0.001), respectively. Adding non-contrast CT factor of zero CAC to the reference model including age, sex, DM, EF, low attenuation plaque, napkin ring sign, and FAI, can increase the incremental discriminatory and reclassification performance for the prediction of IFC (C-statistic 0.828 NRI: 0.37, 95% CI: 0.095–0.646, P=0.008 and IDI: 0.042, 95% CI: 0.012–0.071, P=0.005).
Conclusions
Preprocedural comprehensive CT imaging including CAC and pericoronary adipose tissue inflammation could identify IFC or RFC culprit lesions defined by OCT. Further studies are needed to confirm our preliminary results and if CT imaging in NSTE-ACS provides prognostic information or specific therapeutic approach such as conservative therapy or non-stenting strategy before invasive angiography.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sasano
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - S Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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11
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Hada M, Hoshino M, Sugiyama T, Misawa T, Nagamine T, Ueno H, Matsuda K, Sayama K, Yonetsu T, Sasano T, Kakuta T. Diagnostic value of computed tomography myocardial perfusion to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.217] [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 usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant epicardial coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of absolute coronary flow by CTP to detect microvascular dysfunction remains unknown.
Purpose
The aim of study is to assess the diagnostic value of CTP to evaluate coronary microvascular dysfunction (CMD) in patients with significant epicardial coronary stenosis, and to analyze the predicting factors for lesions with CMD.
Methods
Sixty-eight chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR] <0.80) were investigated. CMD was defined by the index of microcirculatory resistance (IMR) ≥25. Clinical characteristics and CTP findings were compared between the two groups with and without CMD (CMD, n=29, non-CMD, n=39, respectively). The computed tomography angiography (CCTA) assessment included CTP findings and quantitative and qualitative assessment of plaques.
Results
In wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.59–0.74), 1.71 (1.24–2.88), and 22.6 (15.1–34.5), respectively.
In CTP analysis, culprit territory regional absolute myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. CTP-derived CFR (CFRCTP) was calculated as hyperemic-MBF divided by rest-MBF. Rest and hyperemic-MBF and CFRCTP were 0.83 (0.64–1.03) ml/min/g, 2.14 (1.30–2.92) ml/min/g, and 2.19 (1.44–3.37).
In the lesions with CMD, hyperemic-MBF was significantly lower than those without CMD (1.68 [0.84–2.44] vs 2.31 [1.67–3.34] ml/min/g, p=0.015) and the prevalence of CFRCTP<2.0 was higher in the lesions with CMD than those without CMD (62.1% vs 28.2%, p=0.007).
CCTA analysis showed that fibrofatty and necrotic core component (FFNC) volume was greater in the lesions with CMD than in the lesions without CMD (31.8 [19.0–48.9] vs 25.1 [17.2–32.1] mm3, p=0.045). The multivariable logistic regression analysis, hyperemic-MBF and FFNC volume were independent predictors for lesions with CMD (Odds ratio [OR] 0.583 [0.355–0.958], p=0.033 and OR 1.040 [1.010–1.070], p=0.018).
Conclusion
Quantitative assessment of absolute coronary flow by CTP and comprehensive plaque analysis by CCTA may help detect coexisting subtended microvascular dysfunction in patients with functionally significant epicardial coronary lesions. Further studies are needed to elucidate the clinical significance of coexisting CMD in CCS patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Hada
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Sasano
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine , Tsuchiura , Japan
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12
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Hoshino M, Sugiyama T, Kanaji Y, Hada M, Misawa T, Nagamine T, Ueno H, Matsuda K, Sayama K, Yonetsu T, Sasano T, Kakuta T. Multimodality coronary imaging to predict non-culprit territory unrecognized myocardial infarction assessed by cardiac magnetic resonance in non-ST-elevation acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.349] [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
Objectives
This study sought to assess the predictors of coherence tomography (OCT) and coronary computed tomography angiographic (CCTA) findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with first non-ST-elevation acute coronary syndrome (NSTE-ACS) presentation.
Background
UMI detected by cardiac magnetic resonance (CMR) is associated with adverse outcomes in patients with both acute coronary syndrome and chronic coronary syndrome. However, the association between the presence of UMI and findings of multimodality coronary imaging remains unknown.
Methods
We investigated 69 patients with a first clinical episode of NSTE-ACS, who underwent pre-PCI 320-slice CCTA, uncomplicated urgent percutaneous coronary intervention (PCI) with OCT assessment within 48 hours of admission, and post-PCI CMR. UMI was assessed on late gadolinium enhancement (LGE-CMR) by identifying regions of hyperenhancement with an ischemic distribution pattern in non-IR territories (non-IR UMI).
Results
Non-IR UMI was detected in 11 patients (15.9%). ROC analysis revealed the optimal cut-off value of PCATA in culprit vessel for predicting the presence of non-IR UMI were −71.3. Lower ejection fraction, higher Gensini score, high pericoronary inflammation (>−71.3), OCT-defined culprit lesion plaque rupture (OCT-PR), and OCT-defined culprit lesion cholesterol crystal (OCT-CC) were significantly associated with the presence of non-IR UMI (Figure 1A). OCT findings are shown in Figure 1B. Patients with non-IR UMI had a higher prevalence of OCT-PR and OCT-CC than those without. Compared with patients without non-IR UMI, the prevalence of high pericoronary inflammation was higher in patients with non-IR UMI (Figure 1C). When the total cohort was divided into four groups according to the numbers of aforementioned OCT-derived risk factors and PCATA, patients with all of these UMI risk factors showed 46.2% (6/13) prevalence of non-IR UMI, whereas none of 15 patients without these factors showed non-IR UMI (Figure 1D).
Conclusions
When culprit lesion showed OCT-PR, OCT-CC, and high PCATA, about half of these patients are likely to have non-IR UMI. The integrated CCTA and OCT assessment may help identify the presence of non-IR UMI, potentially providing prognostic information in first NSTE-ACS patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Hoshino
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University , Tokyo , Japan
| | - T Sasano
- Tokyo Medical and Dental University , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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13
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Ueno H, Hoshino M, Sugiyama T, Kanaji Y, Hada M, Misawa T, Nagamine T, Nogami K, Sayama K, Matsuda K, Yonetsu T, Sasano T, Kakuta T. Prognostic implications of fractional flow reserve and coronary flow reserve after newer-generation drug-eluting stent implantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1212] [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: 11/14/2022] Open
Abstract
Abstract
Background
FFR after percutaneous coronary intervention (PCI) has been reported to provide prognostic information. However, limited data are available regarding the prognostication by CFR in patients treated with elective PCI using newer generation DES.
Purpose
This study aimed to assess the prognostic value of post-procedural fractional flow reserve (FFR) and coronary flow reserve (CFR) after newer-generation drug-eluting stent implantation (DES).
Methods
A total of 466 stenoses in 466 patients underwent FFR-guided PCI. FFR and CFR measurements before and after PCI by a pressure-temperature sensor-tipped wire were performed. Follow-up data were studied to determine the predictors of target vessel failure (TVF), defined as death, target vessel-related nonfatal myocardial infarction, and unplanned clinically driven target vessel late revascularization. Prognostic value of post-PCI CFR was compared with that of FFR or FFR/CFR combination.
Results
After PCI completion, 13.7% showed post-PCI FFR ≤0.80 and 44.2% exhibited post-PCI CFR <2.5. Discordant results were observed in 42.5% (198/466). During 2.7 (1.8–3.3) years follow-up, 57 (12.2%) TVF were documented. The multivariable Cox proportional hazard regression analysis revealed that post-PCI FFR and post-PCI CFR were independent prognostic factors. ROC analysis revealed that the optimal cut-off values of post-PCI FFR and CFR values were 0.85 and 2.26, respectively. Significant differences in TVF were detected according to post-PCI FFR (≤0.85 vs >0.85: 17.8% vs 8.9%, P<0.05) and post-PCI CFR (≤2.26 vs >2.26: 20.5% vs 7.2%, P<0.01), although the reclassification ability for TVF was improved only with post-PCI CFR (net reclassification index 0.598; P<0.01; integrated discrimination index 0.038; P<0.01), but not with post-PCI FFR, in comparison with the clinical model. Compared with patients with FFR >0.85, those with post-PCI FFR ≤0.85 and CFR ≤2.26 showed significantly higher risk of TVF (8.9% vs 28.9%, P<0.01, HR 4.24, 95% CI 2.40–7.50, P<0.01), whereas those with post-PCI FFR <0.85 and CFR >2.26 had similar TVF risk (8.9% vs 9.2%, P=1.00, HR 1.01, 95% CI 0.47–2.16, P=0.97).
Conclusions
After PCI completion with newer-generation DES, discordant results between FFR and CFR were observed in 42.5%. Compared with post-PCI CFR, post-PCI FFR provided limited reclassification ability for TVF. Among patients with lower post-PCI FFR, only patients with lower post-PCI CFR showed significantly higher risk of TVF than those with higher post-PCI FFR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Cardiovascular Medicine , Tokyo , Japan
| | - T Sasano
- Tokyo Medical and Dental University, Cardiovascular Medicine , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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14
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Travieso A, Mejia-Renteria H, Jeronimo-Baza A, Hyun Jung J, Doh JH, Nam CW, Shin ES, Hoshino M, Sugiyama T, Kanaji Y, Gonzalo N, Lee JM, Kakuta T, Koo BK, Escaned J. Hyperaemic and non-hyperaemic pressure indices of coronary stenosis severity in patients with chronic kidney disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1124] [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
Evidence regarding the use of pressure indices for the assessment of coronary stenoses in patients with chronic kidney disease (CKD) is scarce.
Methods
We assessed the relation between eGFR, FFR and resting Pd/Pa in 1147 consecutive patients (1316 vessels) included in the International Collaboration of Comprehensive Physiologic Assessment Study. We also compared FFR and Pd/Pa against a standardized cut-off of coronary flow reserve (CFR<2.0). Finally, we examined the occurrence of vessel-oriented composite outcome (VOCO: cardiac death, vessel-specific revascularization, vessel-specific myocardial infarction) across negative/positive results of both FFR and CFR in patients with and without CKD.
Results
FFR increases as renal function worsens (beta −10.5, 95% CI −20.0 to −11.03, p=0.030), a relation that was not seen with resting Pd/Pa (beta −6.14, 95% CI −19.9 to 6.78, p=0.351). Both indices had similar diagnostic accuracies for the detection of a CFR<2.0 in the presence of CKD (AUC 0.629 for FFR vs 0.663 for resting Pd/Pa, p=0.192). However, CKD patients showed a higher proportion of vessels with negative FFR but low CFR (24.5% vs 13.4%, p=0.015).
CFR decreased linearly with deteriorating eGFR, and this was mainly driven by higher resting coronary flow in CKD patients (p=0.026), while hyperaemic coronary flow remained similar (p=0.403). IMR did not change significantly with eGFR (beta −0.02, 95% −0.09 to 0.05, p=0.557).
The incidence of VOCO was higher in patients with CKD and FFR>0.80 when compared to non-CKD patients and FFR>0.80 (12.7% vs 6.90%, p=0.062). Prognosis was worse for those with CKD, negative FFR and CFR<2.0 (20.59% vs. 8.44% in non-CKD, p=0.038).
Conclusions
The assessment of a given coronary stenosis in patients with CKD with either FFR or resting Pd/Pa is equivalent when compared to underlying coronary flow. In CKD, impaired CFR is caused by a state of increased resting flow. The assessment of CFR on top of standard pressure wire examination significantly improves prognostic stratification in CKD patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Travieso
- San Carlos Clinical Hospital , Madrid , Spain
| | | | | | - J Hyun Jung
- Sejong General Hospital , Bucheon , Korea (Republic of)
| | - J H Doh
- Ilsan Paik Hospital , Ilsan , Korea (Republic of)
| | - C W Nam
- Dongsan Medical Center. Keimyung University , Daegu , Korea (Republic of)
| | - E S Shin
- Ulsan University Hospital , Ulsan , Korea (Republic of)
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - N Gonzalo
- San Carlos Clinical Hospital , Madrid , Spain
| | - J M Lee
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - B K Koo
- Seoul National University Hospital , Seoul , Korea (Republic of)
| | - J Escaned
- Seoul National University Hospital , Seoul , Korea (Republic of)
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15
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Hamaya R, Yonetsu T, Ueno H, Hoshino M, Sugiyama T, Sasano T, Kakuta T. Robust association between changes in coronary flow capacity following PCI and vessel-oriented outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Backgrounds
While trials show a comparative effectiveness of percutaneous coronary intervention (PCI) against medical therapy with respect to patient outcomes, deferring all elective PCI might be too simplistic, given the prognostic benefit differential according to several factors. Coronary flow capacity (CFC) is a potentially useful coronary flow (CF)-related physiologic marker of ischemia for guiding PCI indication [1,2]. However, the physiological/prognostic mechanics of the CFC guidance, which could be assessed by CFC changes following PCI, have not been investigated.
Objectives
To assess the determinants and prognostic implication of the change in the CFC status following PCI.
Methods
From a single center registry, 450 patients with chronic coronary syndrome (CCS) who underwent fractional flow reserve (FFR)-guided PCI with pre-/post-PCI coronary physiological assessments by thermodilution-method were included. CFC status was defined as follows [1]; normal CFC as CFR ≥2.80 with hyperemic CF (hCF) ≥3.70; mildly reduced CFC as CFR <2.80 and ≥2.10, combined with hCF <3.70 and ≥2.56; moderately reduced CFC as CFR <2.10 and ≥1.70, and 1/Tmn <2.56 and ≤2.00; and severely reduced CFC otherwise (CFR <1.70 and hCF <2.00). Associations between PCI-related changes in thermodilution method-derived CFC categories and incident target vessel failure (TVF) during a median follow-up of 4.3 (IQR: 2.5, 6.9) years were assessed by multivariate COX proportional hazard models.
Results
The mean (SD) age was 67.1 (10.0) years and there were 75 (16.7%) women. There were no differences in survival according to pre-PCI CFC status (P for linear trends = 0.22). Compared with patients showing no change in CFC categories after PCI, patients with category worsened, +1, +2, and +3 category improved had the hazard ratio (95% CI) for incident TVF of 2.27 (0.95, 5.43), 0.85 (0.33, 2.22), 0.45 (0.12, 1.63), and 0.14 (0.016, 1.30), respectively (P for linear trends = 0.0017). The relevant Kaplan-Meier curves were illustrated in the Figure, which highlights a best survival in those with +3 categories improvement (severely reduced to normal CFC) and worst in worsened CFC. After adjustment for confounders, one additional improvement in CFC status was associated with 0.61 (0.45, 0.83) times the hazard of TVF. CFC changes ≥3 categories were largely predicted by pre-PCI CFC with area under the curve of 0.94 (95% CI: 0.93, 0.96), and 48.6% of the variability of continuous CFC changes in ranks was explained solely by pre-PCI CFC, while only 12.4% by FFR.
Conclusion
CFC improvement following PCI, which was largely determined by the pre-PCI CFC status, was associated with lower risk of incident TVF in patients with CCS who underwent PCI. Therefore, CFC changes provide a mechanistic explanation on a potential favorable effect of PCI on reducing vessel-oriented outcome in lesions with reduced CFC and low FFR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Hamaya
- Harvard T. H. Chan School of Public Health , Boston , United States of America
| | - T Yonetsu
- Tokyo Medical and Dental University, Cardiology , Tokyo , Japan
| | - H Ueno
- Tsuchiura Kyodo Hospital, cardiology , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, cardiology , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, cardiology , Tsuchiura , Japan
| | - T Sasano
- Tokyo Medical and Dental University, Cardiology , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, cardiology , Tsuchiura , Japan
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16
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Nagamine T, Masahiro H, Sayama K, Matsuda K, Ueno H, Misawa T, Hada M, Sugiyama T, Yonetsu T, Sasano T, Kakuta T. Prevalence and culprit lesion plaque characteristics on optical coherence tomography in patients with non-st-segment elevation acute coronary syndrome with zero coronary calcification on coronary CTA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1183] [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
CAC evaluated by non-contrast computed tomography is a marker of atherosclerosis. However, the characteristic features of CCTA and optical coherence tomography (OCT) of culprit lesions in patients with NSTE-ACS showing zero CAC remain unknown.
Objectives
This study aimed to assess the prevalence and characteristic features of culprit lesions on coronary CT angiography (CCTA) and optical coherence tomography (OCT) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) showing zero coronary artery calcium (CAC).
Methods
A total of 176 consecutive patients with NSTE-ACS who underwent preprocedural CCTA and OCT were studied. Patients were divided into two groups according to their CAC (zero-CAC and non-zero-CAC groups). Baseline characteristics, CCTA and OCT findings were compared between these two groups.
Results
The prevalence of patients with zero-CACS was 15.9% (28/176). Patients in zero CAC group were younger (mean age, 55 vs. 65 years, P<0.001) and had a lower prevalence of diabetes (10.7 vs 37.2%, P=0.012) than non-zero CAC group. In zero CAC group, the lower prevalence of napkin ring sign (3.5% vs. 28.4%, P=0.028), smaller LV mass index (77.7 vs. 83.9, P=0.04), lower prevalence on spotty calcification (0 vs. 83.8%, P<0.001), lower epicardial fat volume (111.3 vs. 142.6 cm3, P=0.025), and lower pericoronary adipose tissue attenuation (−71.5 vs. −70.2 HU, P=0.07) on CCTA were observed. On OCT, the frequency of plaque erosion (82.1 vs. 44.6%, P<0.001) was significantly higher in zero-CACS group. The prevalence of lipid-rich plaque (46.4 vs. 86.5%, P<0.001), thin-cap fibroatheroma (17.9 vs. 46%, P=0.006), macrophage accumulation (46.4 vs. 81.8%, P<0.001) and cholesterol crystal (7 vs. 41.9%, P<0.001) were all significantly lower in zero-CAC group.
Conclusions
Zero CAC NSTE-ACS was not rare. Zero-CAC NSTE-ACS was characterized by specific phenotypes defined by the combined assessment of CCTA and OCT. Further studies are warranted if these characteristics of NSTE-ACS on preprocedural imaging studies provide prognostic information or guidance of a specific therapeutic approach.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Masahiro
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Sasano
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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17
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Araki M, Sugiyama T, Nakajima A, Yonetsu T, Seegers LM, Dey D, Lee H, McNulty I, Yasui Y, Teng Y, Nagamine T, Kakuta T, Jang IK. Level of vascular inflammation is higher in acute coronary syndromes compared to chronic coronary disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1181] [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: 11/14/2022] Open
Abstract
Abstract
Background
Vascular inflammation has been recognized as one of the key factors in the pathogenesis of acute coronary syndromes (ACS). Peri-coronary adipose tissue (PCAT) attenuation by computed tomography angiography (CTA) has emerged as a marker specific for coronary artery inflammation. We examined the relationship between clinical presentation and coronary artery inflammation assessed by PCAT attenuation and coronary plaque characteristics.
Methods
Patients with ACS or stable angina pectoris (SAP) who underwent pre-intervention coronary CTA and optical coherence tomography (OCT) were enrolled. PCAT attenuation was measured around the culprit lesion and in the proximal 40 mm of all coronary arteries. PCAT attenuation and OCT findings were compared between patients with ACS versus SAP.
Results
Among 471 patients (ACS: 198, SAP: 273), PCAT attenuation was higher in ACS patients than in SAP patients both at the culprit plaque level (−67.5±9.6 Hounsfield unit [HU] vs. −71.5±11.0 HU, p<0.001) and the culprit vessel level (−68.3±7.7 HU vs. −71.1±7.9 HU, p<0.001). The mean PCAT attenuation of all 3 coronary arteries was also significantly higher in ACS patients than in SAP patients (−68.8±6.3 HU vs. −70.5±7.1 HU, p=0.007). After adjusting patient characteristics, not only thin-cap fibroatheroma (OR: 2.44; 95% CI: 1.63–3.65) and macrophages (OR: 2.07; 95% CI: 1.34–3.21) but also PCAT attenuation in the culprit plaque (OR: 1.04; 95% CI: 1.02–1.06) was associated with the clinical presentation of ACS.
Conclusions
PCAT attenuation at culprit plaque, culprit vessel, and pan-coronary levels was higher in ACS patients than in SAP patients. Vascular inflammation appears to play a crucial role in the development of ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Araki
- Massachusetts General Hospital , Boston , United States of America
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - A Nakajima
- Massachusetts General Hospital , Boston , United States of America
| | - T Yonetsu
- Tokyo Medical and Dental University , Tokyo , Japan
| | - L M Seegers
- Massachusetts General Hospital , Boston , United States of America
| | - D Dey
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - H Lee
- Massachusetts General Hospital , Boston , United States of America
| | - I McNulty
- Massachusetts General Hospital , Boston , United States of America
| | - Y Yasui
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Teng
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - I K Jang
- Massachusetts General Hospital , Boston , United States of America
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18
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Sugiyama T, Kanaji Y, Hoshino M, Hada M, Misawa T, Nagamine T, Ueno H, Matsuda K, Sayama K, Yonetsu T, Sasano T, Kakuta T. Relationship between OCT-derived plaque characteristics, CTA-derived coronary inflammation, and CMR-derived global coronary flow reserve in patients with acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The presence of layered plaque is suggestive of recurrent thrombotic events. However, the impact of layered plaque detected by optical coherence tomography (OCT) on coronary inflammation and coronary flow reserve remains unclear.
Purpose
We aimed to investigate the association of OCT-derived layered plaque with pericoronary adipose tissue inflammation assessed by coronary computed tomography angiography (cCTA) and global coronary flow reserve (G-CFR) assessed by cardiac magnetic resonance imaging (CMR) in patients with acute coronary syndrome (ACS).
Methods
We investigated 88 patients with first ACS who underwent preprocedural cCTA and OCT imaging of the culprit lesion, and CMR after percutaneous coronary intervention (PCI). All patients were divided into four groups according to the OCT-derived culprit plaque characteristics: layered vs. non-layered plaque; and plaque rupture vs. plaque erosion. Coronary inflammation was assessed by the mean value of pericoronary adipose tissue (PCAT) attenuation (−190 to −30 HU) of the three major coronary vessels. G-CFR was obtained by quantifying absolute coronary sinus flow at rest and during maximum hyperemia. CCTA and CMR findings were compared between the groups.
Results
In a total of 88 patients, layered plaque [L] with plaque rupture [PR] was observed in 25 patients, layered plaque with plaque erosion [PE] was observed in 26 patients, non-layered plaque [NL] with PR was observed in 23 patients, and non-layered plaque with PE was observed in 14 patients, respectively. Three-vessel-PCAT attenuation value (L-PR vs. L-PE vs. NL-PR vs. NL-PE; −68.13±6.18 vs. −69.01±6.72 vs. −69.76±4.04 vs. −74.61±5.63 HU, P=0.009) and culprit vessel PCAT attenuation value (L-PR vs. L-PE vs. NL-PR vs. NL-PE; −66.39±7.38 vs. −68.94±8.06 vs. −70.01±5.76 vs. −75.45±6.60 HU, P=0.003) showed the graded difference between the four groups. G-CFR value also showed the graded difference between the four groups (L-PR vs. L-PE vs. NL-PR vs. NL-PE; 2.26 [1.80–2.87] vs. 2.24 [1.72–3.13] vs. 2.97 [2.24–3.83] vs. 3.18 [2.67–4.08], P=0.022).
Conclusions
The presence of layered plaque at the culprit lesion was associated with high PCATA and low G-CFR in patients with ACS. Detection of layered plaque may indicate increased pericoronary inflammation and impaired coronary flow reserve, potentially providing the risk stratification in patients with ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Sugiyama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Nagamine
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Matsuda
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - K Sayama
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
| | - T Yonetsu
- Tokyo Medical and Dental University , Tokyo , Japan
| | - T Sasano
- Tokyo Medical and Dental University , Tokyo , Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Tsuchiura , Japan
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19
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Yoshida S, Seki S, Sugiyama T, Kikuchi S, Iino Y. Clinical characteristics of atelectatic eardrums and adhesive otitis media in children. Int J Pediatr Otorhinolaryngol 2022; 159:111188. [PMID: 35653949 DOI: 10.1016/j.ijporl.2022.111188] [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: 02/19/2022] [Revised: 04/26/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Atelectatic eardrum and adhesive otitis media in children are related to persistent otitis media with effusion (OME) and eustachian tube dysfunction in infancy. However, the pathogenesis of these diseases is not fully understood, and some cases even progress to pars tensa cholesteatoma. This study analyzed the clinical characteristics of children with atelectatic eardrum and adhesive otitis media to clarify associated causes of and risk factors for progression of these middle ear pathologies in children. PATIENTS AND METHODS This retroactive study included 38 ears of 31 children with atelectatic eardrums (atelectasis group), and 19 ears of 17 children with adhesive otitis media (adhesive OM group). Thirty-two contralateral non-cholesteatoma ears of 32 children with congenital cholesteatoma were also examined as a control group. Participants were aged 15 or younger. Life history (obtained via questionnaire), associated diseases, hearing acuity, aeration and development of the temporal bone were investigated. RESULTS All children in the atelectasis and adhesive OM groups had a history of recurrent acute otitis media (rAOM) and/or OME. The prevalence of perennial allergic rhinitis was 18 cases (58%) in the atelectasis group and 16 cases (94%) in the adhesive OM group. The prevalence of perennial allergic rhinitis was significantly higher in the adhesive OM group compared to the control group (P < 0.01). The development of mastoid air cells, categorized by MC classification, showed MC0 + MC1 (poor pneumatization) in 19 ears (50.0%) with atelectatic eardrums and 12 ears (63.2%) with adhesive OM. Poor pneumatized mastoid was more frequently observed in the ears of the atelectasis and adhesive OM groups compared to the control group (P < 0.01). No significant difference was found in regards to aeration of the middle ear between the two groups; however, aeration was significantly poorer in both groups compared to the control group (P < 0.01). Three characteristics were analyzed using multivariate logistic regression: perennial allergic rhinitis (odds ratio [OR] 4.319, P = 0.013), poor mastoid pneumatization (OR 8.457, P = 0.012), and pars flaccida retraction pocket (OR 20.897, P = 0.006). These characteristics were shown to be significant risk factors for atelectatic eardrums and adhesive OM. In addition, the predisposition to perennial allergic rhinitis was shown to be the most important factor in the progression from atelectatic eardrum to adhesive otitis media (OR 16.615, P = 0.012). CONCLUSION Children with perennial allergic rhinitis, poor development of mastoid air cells, poor aeration of the temporal bone, and with pars flaccida retraction pocket were at an increased risk of developing an atelectatic eardrum and adhesive OM. In particular, perennial allergic rhinitis was shown to be a significant risk factor in the progression from atelectatic eardrum to adhesive otitis media. Allergic inflammation may affect not only the nasal passages but also the eustachian tube, resulting in persistent middle ear dysfunction. Therefore, children with rAOM/OME who have these risk factors should be carefully monitored and treat over time in effort to prevent progression of pathology.
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Affiliation(s)
- Saeko Yoshida
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan.
| | - Saori Seki
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
| | - Yukiko Iino
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo, 115-0053, Japan
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20
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Yoshida S, Seki S, Sugiyama T, Kikuchi S, Yoshida N, Iino Y. Comparative study on adhesive otitis media and pars tensa cholesteatoma in children. Auris Nasus Larynx 2022; 49:790-796. [PMID: 35248415 DOI: 10.1016/j.anl.2022.02.007] [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: 12/13/2021] [Revised: 01/19/2022] [Accepted: 02/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma. METHODS Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography. RESULTS Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834-264.184), total adhesion (OR, 28.550; 95% CI, 0.962-847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022-366.589) were related to pars tensa cholesteatoma. CONCLUSION Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.
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Affiliation(s)
- Saeko Yoshida
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan.
| | - Saori Seki
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology Head and Neck Surgery, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya 330-0834, Japan
| | - Yukiko Iino
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan; Department of Otolaryngology Head and Neck Surgery, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya 330-0834, Japan
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21
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Sugiyama T, Yoshida S, Kikuchi S, Iino Y. [SUCCESSFUL TREATMENT FOR OTITIS MEDIA AND SINUSITIS ASSOCIATED WITH EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS USING ANTI-IL-5 RECEPTOR MONOCLONAL ANTIBODY BENRALIZUMAB]. Arerugi 2022; 71:242-247. [PMID: 35569946 DOI: 10.15036/arerugi.71.242] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a type of ANCA-related vasculitis. Asthma and sinusitis occur first in the course of EGPA, followed by vasculitis symptoms such as fever, weight loss, and peripheral neuropathy. Otitis media with effusion and sensorineural hearing loss occur occasionally in EGPA patients. Here we report a case of a 39-years-old female patient with asthma that developed at age 37 and sinusitis. The patient was diagnosed with EGPA and treatment was started with oral corticosteroids. During the course of treatment, otitis media with effusion and sensorineural hearing loss developed. Benralizumab was administered for severe asthma. After treatment with benralizumab, the symptoms of asthma, otitis media with effusion and sinusitis dramatically improved. This is the first reported case in which benralizumab was used for treating otitis media and sinusitis associated with EGPA. The findings suggest that benralizumab may be effective for otitis media and sinusitis associated with EGPA.
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Affiliation(s)
| | - Saeko Yoshida
- Department of Otolaryngology, Tokyo-kita Medical Center
| | - Saori Kikuchi
- Department of Otolaryngology, Tokyo-kita Medical Center
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-kita Medical Center
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22
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Kikuchi S, Yoshida S, Sugiyama T, Iino Y. A case of eosinophilic otitis media successfully treated by tympanoplasty with use of dupilumab. Otolaryngology Case Reports 2021. [DOI: 10.1016/j.xocr.2021.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Hoshino M, Yang S, Sugiyama T, Zhang J, Kanaji Y, Yamaguchi M, Hada M, Sumino Y, Nogami K, Ueno H, Misawa T, Yonetsu T, Koo B, Kakuta T. Prognostic value of peri-coronary adipose tissue attenuation and whole vessel and lesion plaque quantification on Coronary Computed Tomography Angiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0155] [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: 11/14/2022] Open
Abstract
Abstract
Background
Peri-coronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects peri-coronary inflammation and is associated with cardiac mortality. CCTA also provides two-dimensional and three-dimensional quantification of the individual component of atherosclerotic plaque and entire vessel. The atherosclerotic burden or disease extent in entire epicardial coronary arteries provides prognostic information in patients with coronary artery disease.
Purpose
This study sought to explore the prognostic significance of FAI values and whole vessel and lesion plaque quantification on CCTA in stable patients with intermediate epicardial stenosis evaluated by fractional flow reserve (FFR).
Methods
A total of 277 patients (277 lesions) with intermediate coronary stenosis who underwent FFR measurement and CCTA were studied. FAI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation) on CCTA. CT findings including whole vessel and lesion plaque quantification, and target vessel myocardial mass were investigated. Major adverse cardiovascular outcome (MACE) was defined as all cause death, cardiac death, myocardial infarction, unplanned revascularization, and heart failure requiring admission. Survivals from MACE were assessed.
Results
The mean FAI and the median FFR values were −71.6 and 0.77, respectively. FFR values were weakly albeit significantly correlated with FAI values. (r=−0.016, P=0.008.) MACE was occurred 43 (15.5%) patients during 5 years F-up. ROC analyses revealed that best cut-off value of FAI to predict MACE was −73.1. Kaplan-Meier analysis revealed that lesions with FAI ≥−73.1 had a significantly higher risk of MACE. (Chi-square 5.5, P=0.019) FFR values and the percutaneous coronary intervention were not predictive of MACE. Multivariate COX proportional hazards regression analysis revealed that age, remodeling index, and lesions with FAI ≥−73.1 were independent predictors of MACE.
Conclusion
The peri-coronary inflammation evaluated by FAI and CT remodeling index enhances cardiac risk prediction in chronic coronary syndrome patients with intermediate lesions. Non-invasive comprehensive CT assessment may help identify high risk patients of subsequent clinical events and provide enhanced patient management.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This study was supported in part by an unrestricted research grant from St. Jude Medical (Abbot Vascular, Santa Clara, CA, USA). The company had no role in study design, conduct, data analysis or manuscript preparation.
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Affiliation(s)
- M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - S Yang
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - J Zhang
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - B Koo
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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24
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Nogami K, Kanaji Y, Sugiyama T, Hoshino M, Yamaguchi M, Hada M, Sumino Y, Misawa T, Hirano H, Ueno H, Kakuta T. Prognostic value of unrecognized myocardial infarction and hyperemic coronary sinus flow in patients undergoing elective percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR) imaging is a useful instrument for the assessment of pathological and functional conditions without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Both unrecognized myocardial infarction (UMI) and impaired global myocardial blood flow (g-MBF) have been reported to be strongly associated with worse outcome in patients with cardiovascular disease. However, their combined efficacy remains undetermined.
Purpose
We sought to assess the prognostic value of the presence of UMI and pre-procedural hyperemic g-MBF evaluated by phase-contrast cine magnetic resonance imaging (PC-CMR) in patients with chronic coronary syndrome who underwent elective percutaneous coronary intervention (PCI).
Methods
A total of 177 patients with de novo functionally significant stenosis who underwent pre-PCI CMR and PCI between September, 2016 and March, 2019 were retrospectively studied. UMI was defined as a scar detected by late gadolinium enhancement (LGE) without previously diagnosed MI. g-MBF was assessed by quantifying coronary sinus flow using PC-CMR at rest and hyperemic state. The predictors of major adverse cardiac events (MACE; cardiac death, nonfatal myocardial infarction, clinically driven unplanned revascularization, or hospitalization for congestive heart failure) during follow-up were investigated.
Results
UMI was detected in 40 (27.7%) patients and rest and maximal hyperemic g-MBF evaluated by the coronary sinus flow obtained by PC-CMR were 0.95 ml/min/g and 2.26 ml/min/g, respectively. During the median follow-up of 26 months, cardiovascular death occurred in 1 patient (0.6%), nonfatal myocardial infarction occurred in 4 patients (2.3%), and clinically driven revascularization and hospitalization due to congestive heart failure occurred in 25 patients (14.1%) and 3 patients (1.7%) patients, respectively. In patients with MACE, hyperemic g-MBF was significantly lower and the prevalence of UMI were significantly higher compared with those without MACE (1.94 ml/min/g vs 2.36 ml/min/g P=0.014; 48.3% vs 23.6%, P=0.011). Cox proportional hazards model indicated that impaired hyperemic g-MBF (<2.00 ml/min/g) and the presence of UMI were significant predictors of MACE (HR 2.22, 95% CI 1.060–4.640, P=0.034; HR 2.660, 95% CI 1.290–5.470, P=0.008). During follow-up, cardiac event-free survival was significantly worse in patients with impaired hyperemic g-MBF (<2.00 ml/min/g) and UMI (log-rank χ2=11.0, P=0.010).
Conclusion
In patients with chronic coronary syndrome undergoing elective PCI, the combined assessment of UMI and hyperemic g-MBF obtained by preprocedural noninvasive CMR may provide significant prognostic information.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Nogami
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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25
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Hada M, Kanaji Y, Ueno H, Nogami K, Misawa T, Sumino Y, Yamaguchi M, Sugiyama T, Yonetsu T, Kakuta T. Diagnostic value of myocardial perfusion CT to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of regional absolute coronary flow by CTP to detect microvascular dysfunction remains unknown.
Purpose
The aim of study is to assess the diagnostic value of preprocedural CTP to detect coexisting microvascular dysfunction with functionally significant epicardial stenosis in patients with chronic coronary syndromes.
Methods and results
Thirty-three chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR]<0.80) who underwent noncomplicated PCI were investigated. In CTP analysis, regional myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. Clinical characteristics, pressure-temperature sensor-chipped wire-based information and CTP findings were compared between groups with and without microvascular dysfunction defined by the index of microcirculatory resistance (IMR) (IMR≥25, n=17, IMR<25, n=16, respectively).
The determinants of coexistence of microvascular dysfunction and functional epicardial stenosis were determined. In invasive wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.57–0.72), 1.61 (1.00–1.98), and 26.7 (19.3–39.4) respectively.
In CTP analysis, rest and hyperemic-MBF and CFR derived from CTP (CFRCTP; calculated as hyperemic-MBF/rest-MBF) were 2.00 (1.31–2.35) ml/min/g, 4.03 (2.11–5.44) ml/min/g, and 2.09 (1.49–2.09) respectively.
In the lesions with IMR>25, hyperemic-MBF was significantly lower than that in IMR<25 (3.42 [1.89–4.34] vs 4.50 [3.44–5.99], p=0.031), although there was no significant difference in regional rest-MBF and CFRCTP (1.75 [1.31–2.24] vs 2.05 [1.35–2.46], p=0.439, and 1.83 [1.21–2.11] vs 2.61 [1.91–2.91], p=0.101 respectively). Receiver operating characteristic curve analysis of hyperemic-MBF detecting IMR>25 showed area under the curve of 0.72 (0.54–0.90), sensitivity of 47% and specificity of 94%.
Conclusion
Quantitative assessment of absolute coronary flow by CTP may help detect coexisting microvascular dysfunction in patients with significant epicardial stenotic lesions.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Hada
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Department of cardiovascular medicine, Tsuchiura, Japan
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26
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Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Misawa T, Sumino Y, Nogami K, Ueno H, Kakuta T. Prognostic value of fat attenuation index of pericoronary adipose tissue surrounding left anterior descending artery on coronary computed tomography angiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies reported the association between elevated fat attenuation index (FAI) of pericoronary adipose tissue (PCAT) on coronary computed tomography angiography (CTA) and worse cardiac outcomes.
Purpose
We investigated the prognostic value of increased FAI-defined coronary inflammation status in patients with coronary artery disease.
Methods
Three-hundred fifty-eight patients (127 acute coronary syndromes [ACS], 231 stable coronary artery disease) with left anterior descending artery (LAD) as a culprit vessel who underwent coronary CTA were retrospectively studied. The FAI defined as the mean CT attenuation value of PCAT (−190 to −30 Hounsfield Unit [HU]) was measured at the proximal 40-mm segment of LAD. All subjects were divided into two groups according to the median value of FAI in the LAD. The association between the incidence of major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, target and non-target vessel revascularization were evaluated.
Results
In a total of 358 patients, median FAI values surrounding the LAD was −71.46 (interquartile range, −77.10 to −66.34) HU. Thirty-eight patients (10.6%) experienced MACE during the follow-up period (median, 818 days). Kaplan-Meier analysis revealed that high FAI-LAD (>−71.46 HU [median]) was significantly associated with the incidence of MACE (log-rank test, chi-square = 4.183, P=0.041) (Figure).
Conclusions
In patients with coronary artery disease with culprit LAD lesions, elevated FAI of PCAT surrounding the LAD was associated with worse clinical outcomes. Assessment of FAI may have a potential for potential for non-invasive risk-stratification by coronary CTA.
Kaplan-Meier analysis for MACE
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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27
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Sumino Y, Yonetsu T, Ueno H, Nogami K, Misawa T, Hada M, Yamaguchi M, Hoshino M, Kanaji Y, Sugiyama T, Kakuta T. Impact of neoatherosclerosis observed at very late phase after coronary stent implantation on subsequent adverse events. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0310] [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: 11/14/2022] Open
Abstract
Abstract
Background
Despite the reduction in late thrombotic events with newer generation coronary stents, late stent failure remains a concern following stent implantation. Neoatherosclerosis (NA) is a cause of in-stent restenosis and acute thrombotic occlusion originating from the stented segment by disruption of the in-stent atheroma. Although the clinical impact of NA at 1 year has been reported, clinical significance of NA observed at very later phase remains to be determined. We sought to investigate the association between optical coherence tomography (OCT) findings at very late phase after stenting and subsequent clinical outcomes.
Methods
A total of 195 patients with 316 stents (including 74 bare metal stents, 48 first-generation DES, and 194 second-generation DES) without stent failure who underwent OCT examination at >3 years (4.9 [3.9- 5.8] years) after stent implantation according to the prespecified protocol were investigated. OCT analysis included the presence of lipid-laden neointima, macrophage, malapposition, thrombus, and plaque rupture within the stents. NA was defined as having lipid-laden neointima. The criteria for the diagnosis of NA were signal-poor region in continuous flames, lipid length longer than 0.3 mm, and invisible stent strut at NA site. Quantitative OCT measurement included lipid length (LL), lipid arc, minimum lumen area (MLA) at the stented segment and minimum stent area (MSA). Major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, and clinically driven revascularization were assessed. MACE-free survival rate was compared between patients with stent showing NA (NA group) and those without NA (non-NA group). Furthermore, in per-stent basis analysis, stent failure including remote revascularization and stent thrombosis of the stent after follow-up OCT examination was assessed.
Results
NA was identified in 50 stents (15.8%) in 38 patients (19.5%). During the median follow-up period of 2.1 [1.0- 2.8] years after OCT examination, 15 MACEs (7.7%) were captured in the total cohort, of which stent failure was observed in 5 stents (5/316, 1.6%). In patient-based analysis, patients with NA had more frequent MACE than those without (18.0% vs 5.1%, p=0.01). Kaplan-Meier analysis revealed that significantly higher MACE rate was detected in NA group than in non-NA group (χ2=5.4, Log-rank p=0.02). In stent-based analysis, NA stents had more frequent stent failure than those without (8.0% vs 0.4%, p=0.002)
Conclusions
NA observed by OCT at >3 years after implantation were associated with subsequent worse clinical outcomes in both patient and stent-based analysis. NA at the very late phase after stenting might be the therapeutic target of secondary prevention and OCT examination at very late phase after stenting may help identify high risk patients of subsequent MACE.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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28
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Kanaji Y, Sugiyama T, Hoshino M, Ueno H, Nogami K, Hada M, Misawa T, Sumino Y, Yamaguchi M, Yonetsu T, Kakuta T. Prognostic value of coronary flow capacity assessed by coronary sinus flow obtained by phase contrast cine-magnetic resonance imaging in patients with acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1710] [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: 11/14/2022] Open
Abstract
Abstract
Background
The concept of coronary flow capacity (CFC) originated from positron emission tomography has been reported to provide prognostic information. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying global coronary sinus flow (CSF) and global coronary flow reserve (g-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization.
Purpose
We evaluated the prognostic value of postprocedural CFC by quantifying CSF using PC-CMR in patients with acute coronary syndrome (ACS) treated with primary or urgent percutaneous coronary intervention (PCI).
Methods
This study prospectively but nonconsecutively enrolled 569 ACS patients who underwent uncomplicated primary (for ST-segment elevation myocardial infarction (STEMI)) or urgent PCI within 48 hours of symptom onset (for non-ST elevation acute coronary syndrome (NSTE-ACS)). Breath-hold PC-CMR images of CS were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after culprit lesion PCI and revascularization of functionally significant non-culprit lesions. The entire cohort was stratified by the CFC according to the thresholds of hyperemic CSF and g-CFR. Impaired CFC was defined as a severely-reduced CFC in the present study. The association of CFC and baseline clinical characteristics with major adverse cardiac events (all-cause death, nonfatal myocardial infarction, hospitalization for congestive heart failure or stroke) was investigated.
Results
In the final analysis of 502 patients (Male 417 (83.1%), mean age was 67 [58, 73]) and 310 patients (82.3%) with STEMI and 192 patients (38.2%) with NSTE-ACS were studied. In a total cohort, rest and maximal hyperemic CSF and corrected G-CFR were 0.93 [0.68, 1.24] ml/min/g, 2.08 [1.44, 2.77] ml/min/g, and 2.21 [1.58, 3.05], respectively. During a median follow-up of 28 months, MACE occurred in 53 patients (all-cause death: 19, nonfatal myocardial infarction: 16, late revascularization: 59, hospitalization for congestive heart failure: 9, stroke: 9). Cox proportional hazards analysis showed that corrected G-CFR and impaired CFC were both independent predictors of MACE. (hazard ratio (HR), 0.61, 95% confidence interval (CI): 0.45–0.82, p=0.001; HR, 3.51, 95% CI: 1.79–6.86, p≤0.001, respectively). Cardiac event-free survival was significantly worse in patients with impaired CFC (log-rank χ2=22.9, P<0.001). Net reclassification index (NRI) and integrated discrimination improvement (IDI) were both significantly improved when impaired CFC was added to the clinical risk model for predicting MACE.
Conclusions
In ACS patients successfully revascularized with primary or urgent PCI, CFC categorization stratified by noninvasive PC-CMR provided significant prognostic information independent of infarction size, conventional risk factors and g-CFR.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Cardiovascular medicine, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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29
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Yamaguchi M, Hoshino M, Nogami K, Ueno H, Misawa T, Sumino Y, Hada M, Kanaji Y, Sugiyama T, Yonetsu T, Kakuta T. Association between near-infrared spectroscopy defined lipid rich plaque and pericoronary adipose tissue inflammation on computed tomography angiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0314] [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: 11/14/2022] Open
Abstract
Abstract
Background
A recent study has shown that lipid-rich plaque (LRP) detected by near-infrared spectroscopy (NIRS) is a significant predictor of future adverse events. Pericoronary adipose tissue inflammation (FAI; fat attenuation index) evaluated by computed tomography angiography (CTA) has also been reported to be linked with cardiac events. The relationship between NIRS-defined LRP and FAI remains to be determined.
Methods
A total of 82 de novo culprit lesions in 82 patients with chronic coronary syndromes (CCS) who underwent perprocedural CTA and NIRS was retrospectively studied. FAI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation) of pericoronary adipose tissue. Plaque morphology was assessed by coronary CTA and grey-scale intravascular ultrasound (IVUS). NIRS-defined LRP was defined as a maximum lipid core burden index (LCBI) in 4 mm ≥400. Relationship between NIRS-defined LRP, CTA/grey-scale IVUS findings, and FAI was assessed. Univariate and multivariate logistic regression analyses were performed to determine the predictors for NIRS-derived LRP.
Results
NIRS-defined LRP was observed in 35 (42.6%) patients. Maximum LCBI showed modest correlations both with FAI (r=0.29, p-value=0.007) and CT-derived remodeling index (r=0.51, p<0.001). Receiver operating characteristic (ROC) curve analysis revealed that the best cut-off values of FAI and CT-derived remodeling index for predicting NIRS-defined LRP were −70.7 (AUC: 0.65, 95% CI: 0.53–0.71, P<0.05) and 1.11 (AUC: 0.74, 95% CI: 0.63–0.86, P<0.01), respectively. Multivariate logistic regression analysis showed FAI ≥−70.7 (odds ratio [OR]: 4.27; 95% CI: 1.28–14.3; p-value = 0.02) and CT-derived remodeling index (OR: 10.7; 95% CI: 2.99–32.2; p-value <0.001) were independent predictors of the presence of NIRS-defined LRP, whereas there was no statistically significant and independent predictor of IVUS-derived factors for NIRS-defined LRP. When stratified according to the presence or absence of FAI ≥−70.7 and CT-derived remodeling index ≥1.11, 93% of the lesions showed NIRS-derived LRP when both factors were present, and NIRS-derived LRP was safely ruled out (88%) when both factors were absent.
Conclusions
FAI of the culprit lesion in CCS was an independent predictor of NIRS-defined LRP, supporting the notion that local pericoronary adipose tissue inflammation may correlate to the presence of LRP. Comprehensive assessment of coronary CTA including FAI evaluation may provide a highly accurate information with high sensitivity and specificity for identifying high risk lesions potentially leading to future cardiac events.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Yamaguchi
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
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30
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Yamaguchi M, Hoshino M, Nogami K, Ueno H, Misawa T, Sumino Y, Hada M, Kanaji Y, Sugiyama T, Yonetsu T, Kakuta T. Clinical significance of the periaortic adipose tissue inflammation in patients with abdominal aortic aneurysms. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2331] [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
Recent studies have reported the association between periaortic adipose tissue volumes identified by multi-detector computed tomography (MDCT) and the periaortic adipose tissue inflammation (PATI) identified by positron emission tomography, which may suggest the link between perivascular inflammation and aortic dilation. However, clinical significance of the PATI identified by MDCT remains elusive in patients with asymptomatic abdominal aortic aneurysm (AAA).
Methods
A total of 77 patients with AAA (diameter >30mm) who underwent the initial and follow-up MDCT examinations were studied retrospectively. PATI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation). The AAA progression (AP) was defined as the growth of AAA diameter >5.0mm/year from the initial to follow-up. Univariate and multivariate logistic regression analysis were performed to determine the predictors for AP.
Results
AP was observed in 19 (24.7%) patient, the median initial AAA diameter was 38.9 (32.7–42.9) mm, and the median progression of AAA diameter was 3.1 (1.5–4.9) mm/year. The initial AAA diameter (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.05–1.28; p-value=0.001) and the initial PATI (OR: 1.12; 95% CI: 1.05–1.20; p-value=0.004) were independent predictors of AP. PATI of −71.08 at initial MDCT and the initial AAA diameter of 37.7mm were the best cut-off value to predict AP. Receiver operating characteristic curve analysis revealed that the best cut-off values of PATI at initial MDCT and the initial AAA diameter for predicting AP were −71.08 (AUC: 0.68, 95% CI: 0.50–0.82) and 37.7 (AUC: 0.71, 95% CI: 0.59–0.84), respectively. Addition of the initial AAA diameter to PATI at initial MDCT significantly increased the accuracy for discriminating AP (net reclassification improvement; 95% CI: 0.67 [0.17–1.17]; p-value = 0.007, integrated discrimination improvement; 95% CI: 0.14 [0.04–0.24]; p-value =0.007).
Conclusions
PATI was an independent and significant predictor of aortic dilation, supporting the notion that local adipose tissue inflammation may contribute to aortic remodeling. Comprehensive assessment of MDCT including PATI evaluation may provide a highly accurate information for identifying high risk lesions potentially leading to future AAA rupture.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Yamaguchi
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - T Misawa
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Department of Cardiovascular Medicine, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Kakuta
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
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31
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Misawa T, Sugiyama T, Kanaji Y, Hoshino M, Yamaguchi M, Hada M, Sumino Y, Ueno H, Nogami K, Kakuta T. Impact of pericoronary inflammation assessed by coronary computed tomography angiography on the progression of aortic valve calcification. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1907] [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
Aortic valve calcification (AVC) has been known as an independent predictor for adverse cardiovascular events and all-cause mortality. Previous studies demonstrated that AVC was associated with aortic valve inflammation and atherosclerosis. However, the relationship between the progression of AVC and pericoronary inflammation remains undetermined.
Purpose
The purpose of this study was to evaluate the impact of the pericoronary inflammation on the progression of AVC.
Methods
A total of 107 patients with suspected or known chronic coronary syndromes who underwent clinically indicated serial 320-slice coronary computed tomography angiography (CTA) at Tsuchiura Kyodo General Hospital from January 2011 to June 2019 were retrospectively studied. Pericoronary inflammation was assessed by pericoronary adipose tissue attenuation (PCATA) defined as the mean CT attenuation value of PCATA (−190 to −30 Hounsfield units [HU]) on proximal 40 mm segments of coronary arteries. AVC was quantified by Agatston score on CTA. The mean aortic attenuation (HU Aorta) and the standard deviation (SD) in the region of interest at the level of the sinotubular junction was measured. AVC was defined as the threshold for calcium detection (mean HU Aorta + 2SD). AVC index was calculated as follows: (follow-up/baseline) AVC divided by follow-up period. AVC progression was defined as newly-developed AVC at follow-up or an increased AVC index during follow-up. All patients were divided into two groups according to the presence or absence of AVC progression, and clinical characteristics and CT findings were compared between these two groups.
Results
AVC progression was observed in 26 patients (24.3%) between 2 serial CT examinations (median, 34 months). There was no significant difference in age, gender and the prevalence of other cardiovascular risk factors between the 2 groups. Patients in AVC progression group were associated with higher prevalence of elevated PCATA-LAD, higher LV mass index at baseline and the initial AVC presence. Receiver-operating characteristic curve analysis revealed that the optimal cut off value of PCATA-LAD for predicting AVC progression was −68.26 HU (area under the curve 0.605; 95% confidence interval [CI], 0.465–0.745). Multivariable logistic regression analysis revealed that baseline PCATA-LAD ≥−68.26 HU (odds ratio [OR], 3.12; 95% CI, 1.04–9.35, p=0.042) and the presence of baseline positive AVC (OR, 6.84; 95% CI, 2.34–20.0, p=0.0004) were independent predictors of AVC progression.
Conclusions
The increased pericoronary inflammation and the presence of AVC may help identify patients with high risk for future AVC progression.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Misawa
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ueno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - K Nogami
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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Yoshihara K, Enomoto T, Aoki D, Watanabe Y, Kigawa J, Takeshima N, Inomata H, Hattori K, Tsuda H, Sugiyama T. The first study evaluating the distribution of gBRCA1/2 variants within the ovarian cancer cluster region in Japanese ovarian cancer patients. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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33
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Nagase Y, Matsuo K, Shimada M, Matsuzaki S, Machida H, Saito T, Kamiura S, Iwata T, Sugiyama T, Mikami M. Significance of malignant peritoneal cytology on survival of women with early-stage cervical cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Nishida S, Hayashi Y, Hirai K, Takekoshi A, Yamada Y, Kobayashi R, Shimizu S, Niwa T, Hayashi H, Shimohata T, Sugiyama T, Suzuki A. Effect of therapeutic plasma exchange on phenytoin plasma concentration in patients receiving intravenous fosphenytoin therapy. Pharmazie 2020; 75:488-490. [PMID: 33305722 DOI: 10.1691/ph.2020.0525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
We report for patients with encephalitis treated with plasma exchange (PE) and fosphenytoin. In patient 1, phenytoin levels decreased on the maintenance dose, and the phenytoin concentration was <10 μg/mL on day 12 of administration. In patient 2, the phenytoin levels was <10 μg/mL on day 4. Increasing the fosphenytoin dose pushed the phenytoin level into therapeutic range. There were no differences between the areas under the concentration-time curve of phenytoin with and without PE. We previously reported a decline in phenytoin levels after prolonged use of fosphenytoin. Therefore, dose adjustment of fosphenytoin in patients undergoing PE may be unnecessary.
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Affiliation(s)
- S Nishida
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Y Hayashi
- Departments of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - K Hirai
- Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Gifu, Japan
| | - A Takekoshi
- Departments of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Y Yamada
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - R Kobayashi
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - S Shimizu
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - T Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - H Hayashi
- Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - T Shimohata
- Departments of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - T Sugiyama
- Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan
| | - A Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan;,
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Omatsu K, Hamanishi J, Katsumata N, Nishio S, Sawada K, Takeuchi S, Aoki D, Fujiwara K, Sugiyama T, Konishi I. 807O Nivolumab versus gemcitabine or pegylated liposomal doxorubicin for patients with platinum-resistant (advanced or recurrent) ovarian cancer: Open-label, randomized trial in Japan (NINJA trial). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- T Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Centre for Urban Transitions, Swinburne University of Technology, John Street, Hawthorne, VIC 3122, Australia
| | - M J Koohsari
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - K Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Ito T, Sugiyama T, Otsuka A, Miyake H. Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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38
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Nakajima T, Nakajima N, Kikuchi S, Iwamoto A, Sugiyama T. A case of pediatric obstructive sleep apnea successfully treated with rapid maxillary expansion. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Sugiyama T, Kanno Y, Hamaya R, Hoshino M, Usui E, Kanaji Y, Yamaguchi M, Hada M, Ohya H, Sumino Y, Hirano H, Yuki H, Horie T, Yonetsu T, Kakuta T. P3578Determinants of visual-functional mismatches as assessed by coronary angiography and 3-D angiography-based quantitative flow ratio. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Quantitative flow ratio (QFR) is a novel three-dimensional quantitative coronary angiography (QCA)-based computational index that can estimate fractional flow reserve (FFR) without pharmacologically induced hyperemia or the use of a pressure wire.
Purpose
We aimed to evaluate the determinants of visual-functional mismatches between conventional two-dimensional QCA and QFR.
Methods
A total of 504 de novo intermediate-to-severe lesions from 504 patients with stable angina who underwent angiographical and physiological assessments were analyzed. All lesions were divided into four groups based on the significance of visual (QCA-diameter stenosis [DS] >50% and ≤50%) and functional (QFR <0.80 and ≥0.80) stenosis severity. Patient characteristics, angiographic findings, QFR computations, and physiological indices were compared among the four groups.
Results
Among 504 lesions, 153 lesions (30.4%) showed concordantly negative (DS ≤50% and QFR >0.80) and 170 lesions (33.7%) showed concordantly positive (DS >50% and QFR ≤0.80) visual and functional assessments. Among 181 lesions (35.9%) with discordant results, 75 lesions (14.9%) showed a mismatch (DS >50% and QFR >0.80) and 106 lesions (21.0%) showed a reverse mismatch (DS ≤50% and QFR ≤0.80), respectively. Reverse mismatch was associated with smaller reference diameter (odds ratio [OR] 0.561; P=0.036), greater DS (OR 1.039, P=0.013), lower coronary flow reserve (CFR) (OR 0.571, P<0.001, non-diabetes mellitus (OR 2.141, P=0.013) and lower ejection fraction (OR 0.961, P=0.011). Mismatch was associated with smaller DS (OR 0.914, P<0.001), shorter lesion length (OR 0.894, P=0.001), higher CFR (OR 1,633, P<0.001), and lower estimated glomerular filtration rate (OR, 0.968, P=0.001). Lesion location and the index of microcirculatory resistance was not associated with the prevalence of reverse mismatch or mismatch.
Conclusions
There was a high prevalence of visual-functional mismatches between QCA-DS and QFR, and CFR was an important functional factor of mismatches. Our results suggested the difference between predictors of reported visual-functional mismatches of QCA/FFR and those of QCA/QFR.
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Affiliation(s)
- T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - R Hamaya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - E Usui
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Yuki
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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Kanno Y, Hoshio M, Sugiyama T, Kanaji Y, Yamaguchi M, Hada M, Ohya H, Sumino Y, Hirano H, Horie T, Yuki H, Yonetsu T, Kakuta T. P2705Hybrid QFR-FFR decision making strategy for revascularization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Measurement of the fractional flow reserve (FFR) has become a standard practice for revascularization decision-making in evaluating the functional significance of angiographically intermediate epicardial coronary stenosis. The quantitative flow ratio (QFR) is a novel method for rapid computational estimation of FFR without pressure wire and vasodilator drugs.
Purpose
Nevertheless, the evidence was shown the clinical better outcome of coronary revascularization stratified by FFR, the adoption of FFR remains low. We hypothesized that combined QFR and FFR hybrid strategy could improve the physiological assessment without pressure wire and drugs.
Methods and results
We performed a post-hocanalysis of 549 vessels with angiographically intermediate stenosis in 549 patients who underwent measurement of FFR. The median FFR and QFR values were 0.81 (0.73–0.87) and 0.79 (0.74–0.87), respectively.The ischemic threshold was defined as 0.80 for both QFR and FFR measures. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the QFR for predicting an FFR of ≤0.80 were 86.2%, 71.9%, 78.9%, 74.5%, and 84.5%, respectively. The area under the receiver operating characteristic curve using the cut-off threshold of ≤0.80 for the FFR was 0.85 (95% confidence interval [CI], 0.81–0.88) for the QFR.In total, 433 (78.9%) and 116 (21.1%) lesions showed concordant and discordant FFR and QFR functional classifications, respectively. A hybrid QFR-FFR strategy was developed, by allowing deferral when QFR values providing negative predictive value greater than 90% and treat others when QFR values greater than that showing 90% positive predictive value, with adenosine being given only to patients with QFR in between those values. For the FFR cut-off (0.8), an QFR of <0.73 could be used to confirm treatment (PPV of 90.7%), while an QFR value of >0.83 could be used to defer revascularization (NPV of 90.0%). When QFR values fall between 0.73 and 0.84, adenosine is given for hyperemic induction and the FFR cut-off of 0.8 is used to guide revascularization. This hybrid QFR-FFR approach has a 95% agreement with an FFR-only decision making, and 285 lesions (51.9%) would have obviated the need of a pressure wire and adenosine.
Hybrid QFR-FFR strategy
Conclusions
A hybrid QFR-FFR strategy for coronary revascularization could reduce the need of a pressure wire and vasodilator drugs, which may increase the penetration of functional assessment of coronary lesions.
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Affiliation(s)
- Y Kanno
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - M Hoshio
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - H Yuki
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
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Hoshino M, Kanaji Y, Sugiyama T, Yamaguchi M, Ohya H, Sumino Y, Hada M, Kanno Y, Hirano H, Horie T, Yonetsu T, Kakuta T. P5619Comparison of different resting physiological indices: are diastolic pressure ratio and resting full-cycle ratio equal? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0563] [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
Previous reports showed all diastolic resting indexes tested were virtually identical to the instantaneous wave-free ratio (iFR). Although RFR has been also reported to be diagnostically equivalent to iFR, no comparisons have been reported about the prevalence and characteristics of discordance in diagnosis between diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR).
Purpose
This study sought to determine the coronary pressure characteristics of lesions classified as discordant between dPR and RFR in angiographically intermediate stenoses.
Methods
We recruited 532 patients with 668 intermediate (angiographically stenosis between 30% to 70% severity) coronary lesions undergoing FFR assessment and analyzed DICOM pressure tracings of resting state (dPR and RFR) using a fully automated off-line software algorithm in a blind fashion. Diagnostic performance of dPR and RFR was evaluated using FFR as a reference. Furthermore, we investigated similarity and difference between dPR and RFR.
Results
Median FFR was 0.81 with an interquartile range of 0.74 to 0.87. RFR was highly correlated to dPR (R2=0.94, p<0.001), with a mean bias of 0.012 (95% limits of agreement −0.008 to 0.031). The diagnostic performance of RFR versus dPR was diagnostic accuracy 95.4%, sensitivity 100.0%, specificity 91.6%, positive predictive value 90.6%, negative predictive value 100.0%). Using the binary cut-off of dPR ≤0.89 as a cut-off value, RFR showed near identical agreement according to ROC curve analysis (AUC: 0.996, 95% CI: 0.994–0.999, p<0.001). Although dPR and RFR demonstrated equivalent performance against FFR ≤0.8 (79.5% vs. 79.3% accuracy; p=0.960; area under the receiver-operating characteristic curve: 0.869 vs. 0.870; p=0.528), RFR disagreed with dPR in 4.6% (31 of 668). When all lesions (668 vessels) were divided into groups according to the concordance and discordance between dPR and RFR: RFR+/dPR+ (298 vessels, n=240), RFR+/dPR– (31 vessels, n=31 patients), RFR-/dPR- (339 vessels, n=259). There was no lesion showing RFR-/dPR+. The prevalence of ischemia was tended to be higher in lesions evaluated by RFR (49.3% vs 44.6%, P=0.100) when using FFR ≤0.80 as a reference standard. An overall significant difference in the prevalence of FFR ≤0.80 and the FFR values were detected among these 3 groups. Furthermore, pairwise comparison also revealed the prevalence of FFR >0.80 and the FFR values were significantly lower in RFR+/dPR– than in RFR-/dPR-, and significantly higher in RFR+/dPR– than in RFR+/dPR+. (P<0.001 and P<0.001, respectively)
Conclusion
Significant difference in FFR values was observed according to dPR/RFR agreement and disagreement. Revascularization decision making might defer according to the resting index used. Compared with RFR, lesions might be more frequently deferred when dPR was used to assess physiological significance.
Acknowledgement/Funding
None
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Affiliation(s)
- M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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Hirano H, Kanaji Y, Horie T, Yuki H, Kanno Y, Ohya H, Hada M, Sumino Y, Yamaguchi M, Hoshino M, Sugiyama T, Yonetsu T, Kakuta T. P2704The association between global coronary flow reserve and coronary inflammation assessed by attenuation index on computed tomography in patients with stable angina pectoris. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1021] [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: 11/14/2022] Open
Abstract
Abstract
Background
Impaired global coronary flow reserve (G-CFR) is known to predict worse outcomes in patients with coronary artery disease. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying coronary sinus flow (CSF) and G-CFR without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Although G-CFR impairment is previously reported to be linked with endothelium dysfunction and progression of atherosclerosis, the association of perivascular adipose tissue inflammation with myocardial coronary flow remains to be determined.
Purpose
We evaluated the association between G-CFR by quantifying CSF using PC-CMR and the extent of coronary inflammation evaluated by perivascular adipose tissue inflammatory status using CT to assess if coronary inflammation is linked with G-CFR in patients with stable angina pectoris (SAP) treated with elective percutaneous coronary intervention (PCI).
Methods
The study enrolled 74 SAP patients with single denovo lesion who underwent coronary CT angiography and PC-CMR within 90 days before coronary intervention. Proximal 40-mm segments of all three major epicardial coronary vessels were traced and examined. Coronary inflammation was assessed by the CT fat attenuation index of perivascular adipose tissue (FAI-PVAT) defined as the mean attenuation of the perivascular adipose tissue (−190 to −30 Hounsfield units (HU)) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel. CMR images were also acquired to assess absolute CSF at rest and during maximum hyperemia before elective PCI. The patients were divided into 4 groups according to the number of inflamed vessels as defined by showing FAI ≥−70.1 HU.
Results
In the final analysis of 69 patients (mean age 67, Male 45 (65.2%)), 18, 19, 20, 12 patients exhibited none, 1, 2, 3 inflamed vessels with FAI ≥−70.1 HU, respectively. Rest and maximal hyperemic CSF and corrected G-CFR were 1.28 [0.76,1.55] vs 1.47 [1.11, 1.81] vs 1.30 [0.94, 1.64] vs 1.27 [1.11, 2.00] ml/min/g; P=0.49, 3.50 [2.84, 5.25] vs 3.28 [2.62, 4.31] vs 3.11 [2.16, 3.63] vs 2.37 [1.40, 2.98] ml/min/g; P=0.049, 3.57 [2.17, 4.54] vs 2.25 [1.73, 3.49] vs 2.26 [1.64, 3.38] vs 1.89 [0.89, 2.32]; P=0.023, respectively. G-CFR and hyperemic CSF were both significantly lower in the group with larger number of inflamed vessels.
Conclusions
In SAP patients with significant coronary artery stenosis, G-CFR obtained by PC-CMR significantly associated with the prevalence of inflamed vessels detected by coronary CT. The extent of coronary inflammation may influence global coronary endothelium dysfunction, resulting in decreased G-CFR.
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Affiliation(s)
- H Hirano
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - H Yuki
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | | | - M Hoshino
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
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Fracassi F, Sugiyama T, Yamamoto E, Kurihara O, Kim HO, Thondapu V, Lee H, Fujimoto JG, Fuster V, Jang IK. 108Biologic significance of healed culprit plaques in stable angina versus acute coronary syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0036] [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: 11/15/2022] Open
Abstract
Abstract
Background
Healed plaques, the signature of prior subclinical plaque destabilization, are frequently found in autopsy studies and have recently been described in patients with acute coronary syndromes (ACS).
Objectives
To compare the prevalence and features of plaque vulnerability of healed culprit lesions in stable angina pectoris (SAP) versus ACS patients by using Optical Coherence Tomography (OCT).
Methods
A total of 752 patients were included: 376 patients with SAP were selected using propensity score matching, comparable to 376 patients with ACS. Healed plaques were identified using established criteria, defined as layers of different optical density on OCT. Healed plaque prevalence along with angiographic and OCT findings were compared between the two groups.
Results
Healed plaques were more frequent in SAP than in ACS patients (42.0% vs 28.7%, p<0.001). LDL-cholesterol and high sensitive C-reactive protein (hs-CRP) levels were significantly lower in SAP patients with layered plaque as compared to ACS patients with layered plaque [97.9±36.9 mg/dL vs 116.7±39.2 mg/dL, p<0.001; 0.20 (0.10–0.83) mg/L vs 4.98 (1.00–11.32) mg/L, p<0.001, respectively]. Thin-cap fibroatheroma, macrophage accumulation and microvessels were significantly less frequent in layered plaques in SAP patients as compared to those in ACS patients (12.7% vs 56.5%, p<0.001, 7.0% vs 79.6%, p<0.001, and 20.3% vs 43.5%, p<0.001, respectively). Calcifications were found more frequently among layered plaques in SAP patients than in ACS patients (51.3% vs 33.6%, p=0.006).
Conclusions
Healed plaques, detected more frequently in SAP than in ACS patients, portend different atherosclerotic backgrounds. In SAP patients, plaque destabilization frequently does not lead to occlusive thrombosis, possibly due to low level of local vulnerability and systemic inflammation. In ACS patients, the presence of high level of local vulnerability and systemic inflammation may play an important role in occlusive thrombus formation, resulting in terminating the cycles of subclinical thrombosis and healing.
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Affiliation(s)
- F Fracassi
- Harvard Medical School, Boston, United States of America
| | - T Sugiyama
- Harvard Medical School, Boston, United States of America
| | - E Yamamoto
- Harvard Medical School, Boston, United States of America
| | - O Kurihara
- Harvard Medical School, Boston, United States of America
| | - H O Kim
- Harvard Medical School, Boston, United States of America
| | - V Thondapu
- Harvard Medical School, Boston, United States of America
| | - H Lee
- Harvard Medical School, Boston, United States of America
| | - J G Fujimoto
- Harvard Medical School, Boston, United States of America
| | - V Fuster
- Harvard Medical School, Boston, United States of America
| | - I K Jang
- Harvard Medical School, Boston, United States of America
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Horie T, Hoshino M, Hirano H, Kanno Y, Ohya H, Sumino Y, Hada M, Yamaguchi M, Kanaji Y, Sugiyama T, Yonetsu T, Kakuta T. P5617Repeatability of instantaneous wave-free ratio in comparison with fractional flow reserve. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0561] [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: 11/14/2022] Open
Abstract
Abstract
Background
Instantaneous wave-free ratio (iFR) has been recently introduced as an adenosine free alternative for fractional flow reserve (FFR) to assess the functional significance of epicardial coronary stenosis. Little is known, however, regarding the repeatability and stability of iFR in comparison with FFR.
Purpose
The aim of this study was to evaluate the repeatability of iFR and compare it to that of FFR.
Methods
Patients with stable coronary artery disease who underwent physiological assessment twice within 90 days were enrolled. Repeated measurements were performed at diagnostic and therapeutic catheterization in about 70% of studied population. The remaining patients were measured twice for non-culprit lesion assessment at primary PCI and subsequent non-culprit and ischemia-documented lesion PCI. The calculation of iFRmatlab from DICOM pressure tracing data of resting state was performed using a fully automated off-line software algorithm in a blind fashion. FFR values were also measured by a fully automated algorithm in the same core laboratory by using hyperemic pressure tracing data. The repeatability of the two indices were evaluated and compared. The inter-rater agreement between iFRmatlab and FFR values of two measurements was assessed by κ coefficient. The pressure rate product during each assessment was also documented and evaluated.
Results
Ninety-three lesions from 92 patients were included in the study. The time interval between the two assessments was 38.4±19.0 days. iFRmatlab and FFR both showed significant correlation within the two assessments (iFRmatlab: r=0.75, 95% confidence interval, 0.64 to 0.83; mean difference, −0.006 [−0.18 to −0.01], FFR: r=0.86, 95% confidence interval, 0.79 to 0.90; mean difference, 0.004 [−0.07 to 0.03]). The inter-rater agreement of functional ischemia for iFRmatlab and FFR were κ=0.449 and κ=0.732, respectively. Although the prevalence of functional ischemia during the first and second assessment were consistent for both indices (iFRmatlab: 70.0%/67.7%, FFR: 86.0%/ 86.0%), significant difference was observed in the prevalence of clinical disagreement on the diagnosis of functional ischemia (FFR=0.80, iFR=0.89 used as cut-off values, respectively) between the first and second assessment among the two indices (iFRmatlab: 6.5%, FFR: 23.7%, p=0.002). iFRmatlab was significantly associated with pressure rate product during the examination compared to FFR (iFRmatlab: r= −0.25, 95% confidence interval, −0.43 to −0.04, P=0.018, FFR: r=−0.08, 95% confidence interval, −0.28 to −0.13, p=0.467).
Conclusion
Our results suggested that iFRmatlab showed lower repeatability and reliability for decision making compared to FFR. The instability of iFRmatlab potentially derives at least in part from its association with heart rate and blood pressure product.
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Affiliation(s)
- T Horie
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Cardiology, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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45
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Yamada Y, Imai H, Minemura H, Sugiyama T, Kaira K, Kanazawa K, Kasai T, Minato K, Kaburagi T. EP1.01-83 Efficacy and Safety of EGFR-TKI Rechallenge Treatment in Elderly Patients with Advanced NSCLC Harboring Sensitive EGFR Mutations. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Kanno Y, Hoshino M, Sugiyama T, Kanaji Y, Yamaguchi M, Hada M, Ohya H, Sumino Y, Hirano H, Horie T, Yonetsu T, Kakuta T. P2703Impact of subtended myocardial mass on the assessment of functional ischemia as evaluated by FFR and QFR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The fractional flow reserve (FFR) becomes a standard practice for revascularization decision-making in evaluating the functional significance of angiographically intermediate epicardial coronary stenosis. The quantitative flow ratio (QFR) is a novel method for rapid computational estimation of FFR without pressure wire and hyperemic induction. FFR has been reported to be associated with not only epicardial stenosis but also subtended myocardial mass (Vsub). In contrast, the relationship between QFR and Vsub has not been clarified.
Purpose
We sought to examine if subtended myocardial mass (Vsub) assessed by coronary computed tomography showed a significant relationship with QFR in comparison with FFR.
Methods and results
We performed a post-hoc analysis of 152 territories (LAD 116, RCA 25 and LCX 11 lesions) with angiographically intermediate-to-severe stenosis in 152 patients who underwent FFR assessment. The median FFR and QFR values were 0.76 (0.64–0.84) and 0.76 (0.72–0.83), respectively. The median diameter stenosis (%DS) and minimum lumen diameter (MLD) were 54.5 (43.9–64.2) and 1.2 (0.9–1.6), respectively. In total, 123 (80.9%) and 29 (19.1%) lesions showed concordant and discordant FFR and QFR functional classifications, respectively. The ability of Vsub/MLD2 to discriminate lesions with FFR≤0.80 and QFR≤0.80 was assessed compared with QCA data. FFR values were associated with Vsub (R=0.37, P<0.001). In contrast, a trend albeit no significant linear relationshipwas detected between QFR and Vsub (R=0.15, P=0.060). The area under the curve (AUC) of Vsub/MLD2 predicting FFR≤0.80 (0.88: 95% confidence interval [CI], 0.83–0.94)was significantly better than that of MLD (0.80: 95% [CI], 0.72–0.88) (P<0.001). On the other hand, the AUC of Vsub/MLD2 predicting QFR≤0.80 (0.82: 95% [CI], 0.75–0.90) was similar to that of MLD (0.80: 95% [CI], 0.72–0.87) (P=0.276). Multivariate analysis showed that the value of Vsub/MLD2 was an independent predictor of FFR≤0.80 (odds ratio [OR]: 1.09, 95% [CI]: 1.03–1.15, P=0.002), whereas it was not an independent predictor of QFR≤0.80.
Conclusions
Subtended cardiac mass volume derived from CT segmentation improved the diagnostic performance of angiography-derived parameters to identify ischemia-producing lesions when FFR used as a reference standard, whereas QFR showed non-significant relationship with subtended cardiac mass.
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Affiliation(s)
- Y Kanno
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Cardiology, Tsuchiura, Japan
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Hoshino M, Yonetsu T, Kanaji Y, Sugiyama T, Yamaguchi M, Hada M, Ohya H, Sumino Y, Kanno Y, Hirano H, Horie T, Murai T, Koo BK, Escaned J, Kakuta T. 6113Gender differences in long-term outcomes in patients with deferred revascularization following fractional flow reserve assessment: international collaboration registry of physiologic evaluation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0139] [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
Studies of sex differences in fractional flow reserve (FFR) measurements have shown that in comparison with men, angiographic lesions of similar visual severity are less likely to be ischemia producing in women. Gender specific differences may influence revascularization decision making and prognosis after deferred revascularization following FFR measurement.
Purpose
This study sought to investigate the gender difference in long-term prognosis of patients of deferred revascularization following FFR assessment.
Methods
A total of 879 patients (879 vessels) with deferred revascularization with FFR >0.75 who underwent FFR and CFR measurements were enrolled from 3 countries (Korea, Japan, and Spain). Long-term outcomes were assessed in 649 men and 230 women by the patient-oriented composite outcome (POCO, a composite of any death, any myocardial infarction [MI], and any revascularization). We applied inverse-probability weighting (IPW) based on propensity scores to account for differences at baseline between women and men (age, hypertension, hyperlipidemia, diabetes mellitus, lesion location, clinical status, FFR, Reference diameter, Diameter stenosis, lesion length). The median follow-up duration was 1855 days (745–1855 days).
Results
Median FFR values were 0.88 (0.83–0.93) in men and 0.89 (0.85–0.94) in women, respectively. The occurrences of POCO were significantly high in men compared with that in women (10.5% vs 4.2%, P=0.007). Kaplan–Meier analysis revealed that women had a significantly lower risk of POCO (χ2=7.2, P=0.007). Multivariate COX regression analysis revealed that age, male, diabetes mellitus, diameter stenosis, lesion length, and coronary flow reserve were independent predictors of POCO. After applying IPW, the hazard ratio of male for POCO was 2.20 (95% confidence interval: 1.12 to 4.33, P=0.023).
Conclusion
This large multinational study reveals that long-term outcome differs between women and men in favour of women after FFR-guided revascularization deferral.
Acknowledgement/Funding
None
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Affiliation(s)
- M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Murai
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - B K Koo
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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48
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Kanaji Y, Sugiyama T, Hoshino M, Hirano H, Horie T, Kanno Y, Ohya H, Sumino Y, Hada M, Yamaguchi M, Yuki H, Yonetsu T, Kakuta T. P2239The association between global coronary flow reserve and coronary inflammation assessed by fat attenuation index on computed tomography in patients with acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0717] [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
Impaired global coronary flow reserve (G-CFR) is known to predict worse outcomes in patients with coronary artery disease. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying coronary sinus flow (CSF) and global coronary flow reserve (G-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Although G-CFR impairment has been previously reported to be linked with endothelium dysfunction and subsequent atherosclerosis, the relationship between coronary inflammation and absolute coronary blood flow volume or coronary flow reserve remains elusive.
Purpose
We evaluated the association between G-CFR by quantifying CSF using PC-CMR and the extent of coronary inflammation in patients with ACS treated with emergent percutaneous coronary intervention (PCI).
Methods
The study enrolled 107 ACS patients who underwent uncomplicated emergent PCI within 48 hours of symptom onset and coronary CT angiography were performed before PCI. Proximal 40-mm segments of all three major epicardial coronary vessels were examined. Coronary inflammation was assessed by the CT fat attenuation index of perivascular adipose tissue (FAI−PVAT) defined as the mean attenuation of the perivascular adipose tissue (−190 to −30 Hounsfield units (HU)) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel, as previously reported. CMR images were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after emergent PCI and revascularization of non-culprit significant lesions. The patients were divided into 4 groups according to the number of inflamed vessels (defined as 0, 1, 2, 3 vessels with FAI ≥−70.1 HU).
Results
In the final analysis of 102 patients (mean age 64, Male 65 (63.7%)) including 77 patients with non-ST-segment elevation myocardial infarction (NSTEMI) (75.5%) and 25 patients with unstable angina pectoris (UAP), 25, 30, 26, 21 patients exhibited none, 1, 2, 3 inflamed vessels with FAI ≥−70.1 HU, respectively. Rest and maximal hyperemic CSF and corrected G-CFR were 1.17 [0.63, 1.71] vs 1.36 [1.05, 1.67] vs 1.21 [0.83, 1.94] vs 1.35 [0.96, 1.67] ml/min/g; P=0.61, 3.26 [2.62, 2.99] vs 3.50 [2.60, 4.03] vs 3.34 [1.78, 4.20] vs 2.48 [1.54, 3.43]; P=0.061, 2.95 [2.05, 4.30] vs 2.63 [1.80, 3.56] vs 2.15 [1.37, 2.91] vs 2.18 [1.46, 2.42]; P=0.018, respectively. G-CFR was significantly lower in group with increased number of inflamed vessels.
Conclusions
In ACS patients successfully revascularized within 48 hours of onset, G-CFR obtained by noninvasive PC-CMR significantly associated with the prevalence of inflamed vessels detected by coronary CT. Further large population study is warranted to test the hypothesis that the extent of coronary inflammation before coronary revascularization in patients with ACS might provide prognostic information.
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Affiliation(s)
- Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Yuki
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Cardiovascular medicine, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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Kanaji Y, Sugiyama T, Hoshino M, Hirano H, Yuki H, Horie T, Kanno Y, Ohya H, Sumino Y, Hada M, Yamaguchi M, Yonetsu T, Kakuta T. P5251Prognostic value of unrecognized myocardial infarction detected by cardiac magnetic resonance imaging in patients presenting with first acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0222] [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: 11/14/2022] Open
Abstract
Abstract
Background
Unrecognized myocardial infarction (UMI) has been reported to be strongly associated with worse outcome in patients with cardiovascular disease. Cardiac magnetic resonance (CMR) imaging is a useful instrument for the assessment of pathological and functional conditions.
Purpose
This study sought to evaluate the prognostic value of the presence of unrecognized non-infarct-related late gadolinium enhancement (non-IR LGE) evaluated by cardiac magnetic resonance imaging in patients presenting with a first acute myocardial infarction (AMI).
Methods
We studied 311 AMI patients including 213 STEMI and 98 NSTEMI patients without the history of prior MI who underwent uncomplicated primary or emergent PCI within 48 hours of symptom onset between October, 2012 and June, 2017. CMR images were acquired at 28 [21, 32] days after primary/emergent PCI. UMI was defined as having LGE separately in the different and remote area from the perfused territory by infarct-related artery. In case of multiple LGE areas of infarction, the coronary angiography findings were used to support identification of the area corresponding to the culprit artery of AMI. The association of CMR variables and other clinical characteristics with major adverse cardiac events (cardiac death, nonfatal myocardial infarction, nonfatal stroke) were investigated.
Results
Forty-six patients (14.8%) showed UMI defined by the presence of non-IR LGE (27 STEMI and 19 NSTEMI). During the follow up for 830 [385, 1309] days, cardiovascular death occurred in 7 patients (2.3%), and non-fatal MI and non-fatal stroke occurred in 10 and 1 patients, respectively (3.2%, 0.3%, respectively). There was no significant difference in the prevalence of UMI and incidence of MACE between the patients with STEMI and NSTEMI (p=0.13, p=0.11, respectively). Event-free survival was significantly worse in patients with UMI (log-rank χ2=16.3, P=0.001) in a total cohort. Cox proportional hazards analysis showed that UMI was independent predictors of adverse cardiac events during follow-up in patients with first MI (hazard ratio, 7.60, 95% confidence interval, 2.78–20.8, p=0.0001).
Conclusions
In first AMI patients, UMI defined by non-IR LGE obtained by noninvasive CMR provides significant prognostic information. Early detection of UMI by CMR may help risk stratification of patients with AMI and support adjunctive aggressive patient management such as strong statin therapy and life style intervention.
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Affiliation(s)
- Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Yuki
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Cardiovascular medicine, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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50
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Sugiyama T, Hoshino M, Kanaji Y, Horie T, Yuki H, Hirano H, Kanno Y, Hada M, Ohya H, Sumino Y, Yamaguchi M, Yonetsu T, Kakuta T. P6393Differences in coronary inflammation between the culprit and non-culprit vessels assessed by fat attenuation index on computed tomography in patients with acute coronary syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0989] [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
Inflammation is linked with progression of coronary atherosclerosis. Recent studies have reported the association between elevated perivascular fat attenuation index (FAI) on computed tomography (CT) and worse cardiac outcomes in patients with coronary artery disease.
Purpose
We aimed to investigate the differences in FAI-defined peri-coronary inflammation status between the culprit and non-culprit vessels in patients with acute coronary syndromes (ACS).
Methods
A total of 78 ACS patients with left anterior descending coronary arteries (LAD) as a culprit vessel who underwent coronary CT angiography and invasive coronary angiography were studied. Proximal 40-mm segments of the LAD and the right coronary artery (RCA) were traced. Coronary inflammation was assessed by the FAI defined as the mean CT attenuation value of perivascular adipose tissue (−190 to −30 Hounsfield units [HU]) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel. All patients were divided into two groups according to the values of FAI in the LAD: high FAI group (FAI-LAD > median; n=39) and low FAI group (FAI-LAD ≤ median; n=39). Patient characteristics, angiographic and CT findings were compared between the two groups.
Results
In a total of 78 patients, median FAI in the LAD was −70.20 (interquartile range, −74.81 to −64.58) HU. High FAI group was associated with male sex and lower left ventricular ejection fraction compared with Low FAI group. Minimal lumen diameter, reference diameter, diameter stenosis, and lesion length on quantitative coronary angiography analysis and coronary artery calcium score on CT was not different between the groups. FAI in the RCA was also higher in High FAI group than that in Low FAI group (−67.64±8.31 vs. −76.47±6.25 HU, P<0.001). Paired t-test comparison demonstrated that culprit vessel showed higher FAI than the non-culprit vessel (−69.85±7.74 vs. −72.11±8.54 HU, P=0.013).
Conclusions
In ACS patients with culprit LAD lesions, FAI-defined peri-coronary inflammation status is higher in the culprit vessel than in the non-culprit vessel.
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Affiliation(s)
- T Sugiyama
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hoshino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Horie
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Yuki
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Hirano
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Kanno
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Hada
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - H Ohya
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Y Sumino
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - M Yamaguchi
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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