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Tanabe G, Mori T, Araki M, Kataoka H, Into T. Role of LL-37 in Oral Bacterial DNA Accumulation in Dental Plaque. J Dent Res 2024; 103:177-186. [PMID: 38093556 DOI: 10.1177/00220345231210767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Dental plaque, a highly structured polymicrobial biofilm, persistently forms in the oral cavity and is a common problem affecting oral health. The role of oral defense factors in either collaborating or disrupting host-microbiome interactions remains insufficiently elucidated. This study aims to explore the role of LL-37, a critical antimicrobial peptide in the oral cavity, in dental plaque formation. Through immunostaining dental plaque specimens, we observed that LL-37 and DNA colocalized in the samples, appearing as condensed clusters. In vitro experiments revealed that LL-37 binds rapidly to oral bacterial DNA, forming high molecular weight, DNase-resistant complexes. This interaction results in LL-37 losing its inherent antibacterial activity. Further, upon the addition of LL-37, we observed a visible increase in the precipitation of bacterial DNA. We also discovered a significant correlation between the levels of the DNA-LL-37 complex and LL-37 within dental plaque specimens, demonstrating the ubiquity of the complex within the biofilm. By using immunostaining on dental plaque specimens, we could determine that the DNA-LL-37 complex was present as condensed clusters and small bacterial cell-like structures. This suggests that LL-37 immediately associates with the released bacterial DNA to form complexes that subsequently diffuse. We also demonstrated that the complexes exhibited similar Toll-like receptor 9-stimulating activities across different bacterial species, including Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, and Streptococcus salivarius. However, these complexes prompted dissimilar activities, such as the production of IL-1β in monocytic cells via both NLRP3 pathway-dependent and pathway-independent mechanisms. This study, therefore, reveals the adverse role of LL-37 in dental plaque, where it binds bacterial DNA to form complexes that may precipitate to behave like an extracellular matrix. Furthermore, the unveiled stimulating properties and species-dependent activities of the oral bacterial DNA-LL-37 complexes enrich our understanding of dental plaque pathogenicity and periodontal innate immune responses.
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Affiliation(s)
- G Tanabe
- Department of Oral Microbiology, Division of Oral Infection Health Sciences, Asahi University School of Dentistry, Mizuho, Gifu, Japan
- Department of Sports Dentistry, Meikai University School of Dentistry, Sakado, Saitama, Japan
| | - T Mori
- Department of Oral Microbiology, Division of Oral Infection Health Sciences, Asahi University School of Dentistry, Mizuho, Gifu, Japan
| | - M Araki
- Department of Oral Microbiology, Division of Oral Infection Health Sciences, Asahi University School of Dentistry, Mizuho, Gifu, Japan
- Asahi University School of Dental Hygienists, Mizuho, Gifu, Japan
| | - H Kataoka
- Department of Oral Microbiology, Division of Oral Infection Health Sciences, Asahi University School of Dentistry, Mizuho, Gifu, Japan
| | - T Into
- Department of Oral Microbiology, Division of Oral Infection Health Sciences, Asahi University School of Dentistry, Mizuho, Gifu, Japan
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2
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Maruyama Y, Sadahira T, Nagasaki N, Watanabe T, Sekito T, Iwata T, Ishii A, Watanabe M, Wada K, Araki M. Transition in antimicrobial susceptibility and impact of urease production on urinary stone formation of P. mirabilis and M. morganii isolated from urinary tract infections. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00782-0] [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: 02/12/2023]
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3
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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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4
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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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5
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Sakamoto Y, Hirano K, Mori S, Yamawaki M, Araki M, Kobayashi N, Tsutsumi M, Honda Y, Ito Y. Impact of Extravascular Ultrasound-Guided Wiring on Achieving Optimal Vessel Preparation and Patency in Endovascular Therapy for Superficial Femoral Artery Chronic Total Occlusion. J Invasive Cardiol 2022; 34:E730-E738. [PMID: 36166361] [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: 06/16/2023]
Abstract
PURPOSE The study aim was to evaluate the impact of extravascular ultrasound-guided (EVUSG) wiring on achieving optimal vessel preparation and patency in endovascular therapy (EVT) for superficial femoral artery (SFA) chronic total occlusion (CTO). METHODS Between April 2007 and January 2019, a total of 239 SFA-CTO limbs were successfully treated with EVT and bailout implantation of self-expandable nitinol stents at our hospital. The study subjects were divided into 2 groups according to the type of guidance strategy used during CTO wiring, ie, the EVUSG group and the conventional angiography guidance (AG) group. Immediately after the initial balloon angioplasty and successful passage of the wire through the SFA-CTO lesions, the EVUSG (65 limbs) and AG groups (174 limbs) were retrospectively evaluated for angiographic dissection patterns. The primary patency rate was also compared between the 2 groups. RESULTS No significant difference was observed in the balloon diameter at the initial dilation immediately after successful wire passing (3.7 ± 0.5 mm in the EVUSG group vs 3.8 ± 0.5 mm in the AG group; P=.17). The incidence of severe dissection was significantly lower (P<.001) in the EVUSG group (28/65; 43%) than in the AG group (137/174; 79%). The 3-year primary patency rates in the EVUSG and AG groups were 84.5% and 68.4%, respectively (P<.001). CONCLUSIONS EVUSG for SFA-CTO may achieve optimal vessel preparation, defined as an initial balloon angioplasty without severe dissection, and subsequent implantation of self-expandable stents may lead to a better patency rate.
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Affiliation(s)
- Yasunari Sakamoto
- Division of Cardiology, Osaki Hospital Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo, 141-0001, Japan.
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6
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Katayama S, Pradere B, Grossmann N, Potretzke A, Boorjian S, Daneshmand S, Djaladat H, Sfakianos J, Mari A, Khene Z, D’Andrea D, Kikuchi E, Fujita K, Heindenreich A, Raman J, Roumiguié M, Abdollah F, Marcus J, Breda A, Fontana M, Rouprêt M, Araki M, Nasu Y, Shariat S. Clinical significance of tumor location for ureteroscopic tumor grading in upper tract urothelial carcinoma. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00383-9] [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: 11/04/2022]
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7
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Watanabe T, Sadahira T, Edamura K, Kobayashi Y, Araki M. Evaluating renal tumors by SPARE can save the effort of making three-dimensional imaging. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01065-x] [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: 11/04/2022]
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8
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Yokoyama H, Yamanaka F, Shishido K, Ochiai T, Yokota S, Moriyama N, Watanabe Y, Shirai S, Tada N, Araki M, Yashima F, Naganuma T, Ueno H, Tabata M, Mizutani K, Takagi K, Yamamoto M, Saito S, Hayashida K. Prognostic Value of Ventricular-Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes. J Am Heart Assoc 2021; 10:e019267. [PMID: 34533038 PMCID: PMC8649497 DOI: 10.1161/jaha.120.019267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: <0.326; group 2: 0.326–0.453; group 3: 0.453–0.666; and group 4: >0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [P=0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [P<0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [P<0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [P=0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/. Unique identifier: UMIN000020423.
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Futoshi Yamanaka
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan.,Department of Cardiovascular Medicine Kokura Memorial Hospital Kitakyushu Japan
| | - Koki Shishido
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Tomoki Ochiai
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Shohei Yokota
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Noriaki Moriyama
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Yusuke Watanabe
- Department of Cardiology Teikyo University School of Medicine Tokyo Japan
| | - Shinichi Shirai
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Norio Tada
- Department of Cardiology Saiseikai Yokohama City Eastern Hospital Yokohama Japan
| | - Motoharu Araki
- Department of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya Japan
| | - Fumiaki Yashima
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Toru Naganuma
- Department of Cardiovascular Medicine Kokura Memorial Hospital Kitakyushu Japan.,Department of Cardiology New Tokyo Hospital Matsudo Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine Toyama University Hospital Toyama Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery Tokyobay Urayasu Ichikawa Medical Center Urayasu Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine Osaka City University Hospital Osaka Japan
| | - Kensuke Takagi
- Department of Cardiology Ogaki Municipal Hospital Ogaki Japan
| | - Masanori Yamamoto
- Department of Cardiology Nagoya Heart Center Nagoya Japan.,Department of Cardiology Toyohashi Heart Center Toyohashi Japan
| | - Shigeru Saito
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Kentaro Hayashida
- Department of Cardiology Keio University School of Medicine Tokyo Japan
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9
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Imamura T, Ueno H, Sobajima M, Kinugawa K, Watanabe Y, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Takagi K, Yamamoto M, Hayashida K. Creatinine Score Can Predict Persistent Renal Dysfunction Following Trans-Catheter Aortic Valve Replacement. Int Heart J 2021; 62:546-551. [PMID: 34053999 DOI: 10.1536/ihj.20-713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Severe aortic stenosis (AS) is often accompanied by renal dysfunction, which portends a poor prognosis. Trans-catheter aortic valve replacement (TAVR) is an accepted therapy for patients with severe AS, whereas the prediction of persistent renal dysfunction following TAVR remains challenging. In this study, we aimed to evaluate the pre-procedural score to assess the reversibility of renal dysfunction following TAVR. A total of 2,588 patients with severe AS who received TAVR and were enrolled in the Optimized transCathEter vAlvular iNtervention (OCEAN-TAVI) multicenter registry (UMIN000020423) were retrospectively investigated and those with serum creatinine (Cre) data at baseline and one year following TAVR were included. The Cre score was calculated using the formula: 0.2 × (age [years]) + 3.6 × (baseline serum Cre [mg/dL]). This score was evaluated to assess the risk of persistent renal dysfunction defined as serum Cre level > 1.5 mg/dL at one year following TAVR. Of the 1705 patients (84.3 ± 5.0 years old) included, 246 (14%) had persistent renal dysfunction following TAVR. The Cre score predicted the incidence of persistent renal dysfunction with an adjusted incidence rate ratio of 1.48 (95% confidence interval 1.42-1.56) with a cutoff of 21.4 (43% versus 5%, P < 0.001). The Cre score also predicted 4-year survival following TAVR (70% versus 52%, P < 0.001) with an adjusted hazard ratio of 1.75 (95% confidence interval 1.29-2.37). In conclusion, the Cre score identified those with a high risk of one-year persistent renal dysfunction following TAVR. The implication of Cre score-guided therapeutic strategy is the next concern.
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Affiliation(s)
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama
| | - Mitsuo Sobajima
- Second Department of Internal Medicine, University of Toyama
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital.,Department of Cardiology, Keio University School of Medicine
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | | | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
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10
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Yoshinaga K, Araki M, Wada K, Sekito T, Watari S, Maruyama Y, Sadahira T, Nishimura S, Sako T, Edamura K, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y. Well controlled patients with diabetes mellitus has the potential to expand the kidney donor pool. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Shishido K, Yamanaka F, Ochiai T, Moriyama N, Yokoyama H, Yokota S, Noguchi K, Yashima F, Tada N, Naganuma T, Araki M, Shirai S, Ueno H, Mizutani K, Tabata M, Takagi K, Watanabe Y, Yamamoto M, Saito S, Hayashida K. Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation. Circ J 2021; 85:979-988. [PMID: 33907051 DOI: 10.1253/circj.cj-20-1095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of sex on mortality is controversial; furthermore, sex differences in left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI) remain unknown.Methods and Results:This study included 2,588 patients (1,793 [69.3%] female) enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry between October 2013 and May 2017. We retrospectively analyzed the effect of sex on mortality, and evaluated changes in the LV mass index (LVMI) after TAVI. Female sex was significantly associated with lower all-cause and cardiovascular mortality (log-rank P<0.001 for both). Multivariate analysis showed that female sex was independently associated with lower cumulative long-term mortality (hazard ratio 0.615; 95% confidence interval 0.512-0.738; P<0.001). Regression in the LVMI was observed in both sexes, and there was no significant difference in the percentage LVMI regression from baseline to 1 year after TAVI between women and men. Women had a survival advantage compared with men among patients with LVMI regression at 1 year, but not among patients with no LVMI regression. CONCLUSIONS We found that female sex is associated with better survival outcomes after TAVI in a large Japanese registry. Although LVMI regression was observed in women and men after TAVI, post-procedural LV mass regression may be related to the sex differences in mortality.
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Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | - Tomoki Ochiai
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | | | - Shohei Yokota
- Department of Cardiology, Shonan Kamakura General Hospital
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital
| | | | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University School of Medicine
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University School of Medicine
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Canter.,Department of Cardiology, Nagoya Heart Canter
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital
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12
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Adachi Y, Yamamoto M, Shimura T, Yamaguchi R, Kagase A, Tokuda T, Tsujimoto S, Koyama Y, Otsuka T, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Late kidney injury after transcatheter aortic valve replacement. Am Heart J 2021; 234:122-130. [PMID: 33454371 DOI: 10.1016/j.ahj.2021.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Information on early to late-phase kidney damage in patients who underwent transcatheter aortic valve replacement (TAVR) is scarce. We aimed to identify the predictive factors for late kidney injury (LKI) at 1-year and patient prognosis beyond 1-year after TAVR. METHODS We retrospectively reviewed 1,705 patients' data from the Japanese TAVR multicenter registry. Acute kidney injury (AKI) and LKI, defined as an increase of at least 0.3 mg/dL in creatinine level, a relative 50% decrease in kidney function from baseline to 48 hours and 1-year, were evaluated. The patients were categorized into the 4 groups as AKI-/LKI- (n = 1.362), AKI+/LKI- (n = 95), AKI-/LKI+ (n = 199), and AKI+/LKI+ (n = 46). RESULTS The cumulative 3-year mortality rates were significantly increased across the four groups (12.5%, 15.8%, 24.6%, 25.8%, P < .001). Multivariate analysis revealed that chronic kidney disease, coronary artery disease, periprocedural AKI, and heart failure-related re-admission within 1-year were significantly associated with LKI. The Cox regression analysis revealed that AKI-/LKI+ and AKI+/LKI+ were independent predictors of increased late mortality beyond 1-year after TAVR (P = .001 and P = .01). CONCLUSIONS LKI was influenced by adverse cardio-renal events and was associated with increased risks of late mortality beyond 1-year after TAVR.
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Yamanaka M, Iwata H, Masuda K, Araki M, Okuno Y, Okamura M, Koiwa J, Tanaka T. A novel orexin antagonist from a natural plant was discovered using zebrafish behavioural analysis. Eur Rev Med Pharmacol Sci 2021; 24:5127-5139. [PMID: 32432777 DOI: 10.26355/eurrev_202005_21207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Phenotypic screening is one of the most practical approaches to the identification of mediators of behaviour, since it is difficult to model brain function in vitro, at a cellular level. We used a zebrafish (Danio rerio) behavioural assay to discover novel, natural, neuroactive compounds. MATERIALS AND METHODS A zebrafish behavioural assay was performed for seven natural compounds, obtained from plants. The behavioural profiles were compared to those of known psychoactive drugs. We characterised a natural compound exhibiting a behaviour profile similar to that of suvorexant, using in silico, in vitro and microarray expression analysis. RESULTS The behavioural analysis performed in this study classified central nervous system drugs according to their mechanism. Zebrafish treated with a natural compound, 8b-(4'-Hydroxytigloyloxy) costunolide (8b), showed behaviour profiles similar to those of zebrafish treated with suvorexant, a known orexin antagonist. This behavioural assay was validated using in silico and in vitro assays, which revealed that the new compound was a dual orexin receptor antagonist. In addition, transcriptome analysis suggested that 8b might regulate the nuclear factor-κB (NF-κB) related pathway. CONCLUSIONS We conclude that zebrafish phenotypic screening, combined with in silico assays and gene expression profiling, is a useful strategy to discover and characterize novel therapeutic compounds, including natural products.
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Affiliation(s)
- M Yamanaka
- Department of Systems Pharmacology, Mie University, Graduate School of Medicine, Tsu, Mie, Japan.
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Shibata K, Yamamoto M, Yamada S, Kobayashi T, Morita S, Kagase A, Tokuda T, Shimura T, Tsunaki T, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Clinical Outcomes of Subcutaneous and Visceral Adipose Tissue Characteristics Assessed in Patients Underwent Transcatheter Aortic Valve Replacement. CJC Open 2021; 3:142-151. [PMID: 33644728 PMCID: PMC7893200 DOI: 10.1016/j.cjco.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adipose tissue (AT) characteristics are considered to be a marker for predicting clinical outcomes. This study aimed to investigate the prognostic value of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) computed tomography (CT) assessment in patients who underwent transcatheter aortic valve replacement (TAVR). METHODS We used the Japanese multicentre registry data of 1372 patients (age: 84.5 ± 5.0 years, women: 70.6%) who underwent TAVR. The SAT and VAT were assessed according to the preprocedural CT area and density. Baseline characteristics and clinical outcomes were compared based on the differences in AT characteristics. The independent associations with all-cause mortality after TAVR were evaluated according to the CT area and density of AT. RESULTS Low-volume area of SAT and VAT was associated with worse clinical outcomes compared with high-volume area of SAT and VAT in patients who underwent TAVR (log-rank test P = 0.016 and P = 0.014). High CT density of SAT and VAT was associated with increasing mortality in comparison with low CT density of SAT and VAT (log-rank test P < 0.001 and P = 0.007). The Cox regression multivariate analysis demonstrated the independent association of increased all-cause mortality in the high SAT and VAT density (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.88, P = 0.019, and HR: 1.34, 95% CI: 1.03-1.76, P = 0.031, respectively), but not in the low SAT and VAT area (HR: 0.85, 95% CI: 0.74-1.29, P = 0.85, and HR: 0.78, 95% CI: 0.60-1.03, P = 0.085, respectively). CONCLUSIONS CT-derived AT characteristics, particularly the qualitative assessments, were useful for predicting the prognosis in patients after TAVR.
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Affiliation(s)
- Kenichi Shibata
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Satoshi Morita
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Testuro Shimura
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduates School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - OCEAN-TAVI investigators
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
- Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
- Department of Cardiovascular Medicine, Osaka City University Graduates School of Medicine, Osaka, Japan
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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15
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Saito T, Yoshijima N, Hase H, Yashima F, Tsuruta H, Shimizu H, Fukuda K, Naganuma T, Mizutani K, Araki M, Tada N, Yamanaka F, Shirai S, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Yamamoto M, Hayashida K. Impact of beta blockers on patients undergoing transcatheter aortic valve replacement: the OCEAN-TAVI registry. Open Heart 2020; 7:openhrt-2020-001269. [PMID: 32641381 PMCID: PMC7342827 DOI: 10.1136/openhrt-2020-001269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Abstract
Objective There is paucity of data on optimal medical treatment, including use of beta blockers for patients undergoing transcatheter aortic valve replacement (TAVR). The study aimed to investigate the association of beta blockers and clinical outcomes following TAVR. Methods We examined data of 2563 patients who underwent TAVR between October 2013 and May 2017 obtained from a prospective multicentre cohort registry, the optimised catheter valvular intervention-TAVI registry. We compared the 2-year cardiovascular and non-cardiovascular mortality and in-hospital outcomes between patients with and without preprocedural beta-blocker administration by propensity score matching (PSM). Results Preprocedural beta blockers were prescribed in 867 patients (33.8%). After PSM, the incidence of in-hospital congestive heart failure was significantly lower in patients with preprocedural beta blocker (p=0.046). No differences were found in 2-year cardiovascular and non-cardiovascular mortality. In the subgroup analyses, beta-blocker administration was associated with a lower cardiovascular mortality within 2 years in patients with a history of coronary artery bypass grafting (CABG; log-rank p=0.017), presence of peripheral artery disease (PAD; log-rank p=0.003) and brain natriuretic peptide (BNP) ≥400 pg/mL (log-rank p=0.003). When stratified by postprocedural left ventricular ejection fraction (post-LVEF), beta-blocker administration was associated with a lower cardiovascular mortality among patients with post-LVEF <50% (log-rank p=0.024). Conclusions Preprocedural beta-blocker administration was not associated with 2-year cardiovascular and non-cardiovascular mortality in overall, but was associated with a lower 2-year cardiovascular mortality in patients with a history of CABG, presence of PAD, BNP ≥400 pg/mL and post-LVEF <50%. The findings must be validated using randomised trials.
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Affiliation(s)
- Tetsuya Saito
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nobuhiro Yoshijima
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiromu Hase
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Fumiaki Yashima
- Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Hikaru Tsuruta
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hideyuki Shimizu
- Cardiovascular Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Keiichi Fukuda
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toru Naganuma
- Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Kazuki Mizutani
- Cardiovascular Medicine, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Motoharu Araki
- Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Norio Tada
- Cardiology, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Futoshi Yamanaka
- Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shinichi Shirai
- Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Minoru Tabata
- Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Iryo Center, Urayasu, Chiba, Japan
| | - Hiroshi Ueno
- Cardiology, Toyama University School of Medicine, Toyama, Toyama, Japan
| | - Kensuke Takagi
- Cardiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | | | - Yusuke Watanabe
- Cardiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Masanori Yamamoto
- Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan.,Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Kentaro Hayashida
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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16
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Mori S, Ito Y, Kishida T, Fukagawa T, Nakano T, Makino K, Mizusawa M, Shirai S, Honda Y, Tsutsumi M, Sakamoto Y, Kobayashi N, Araki M, Yamawaki M, Hirano K. Occurrence and clinical course of peri-stent contrast staining: comparison between second-generation drug-eluting stents and third generation drug-eluting stents. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1322] [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
Peri-stent contrast staining (PSS) has been reported to be associated with very late stent thrombosis.
The aims of this study was to compare the occurrence rate of PSS between second generation drug-eluting stents (2nd DES) and third generation drug-eluting stents (3rd DES), and to identify clinical characteristics associated with PSS.
Methods and results
This study comprised 1899 patients with 2493 de novo lesions treated with 2nd or 3rd DES from October 2015 to September 2018. Follow-up angiography was available for 1883 lesions (75.5%). There were 725 patients with 968 lesions treated with 2nd DES, and 716 patients with 915 lesions treated with 3rd DES. The occurrence of PSS, types of PSS, and VLST related to PSS were compared between 2nd and 3rd DES implantation. Mean follow-up period was 30±12 months. The occurrence rate of PSS and segmental type of PSS were similar between two groups (2nd DES vs. 3rd DES, 1.5% vs. 1.7%, p=0.73, 47% vs. 50%, p=0.85, and respectively). The VLST related to PSS occurred in only one case in 3rd DES group. (0% vs. 6.3%, p=0.33).
Conclusion
The occurrence rate of PSS and clinical course were similar between 2nd and 3rd DES.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mori
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - Y Ito
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - T Kishida
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - T Fukagawa
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - T Nakano
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - K Makino
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - M Mizusawa
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - S Shirai
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - Y Honda
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - M Tsutsumi
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - Y Sakamoto
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - N Kobayashi
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - M Araki
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - M Yamawaki
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
| | - K Hirano
- Saiseikai Yokohama City Eastern Hospital, Cardiology, Yokohama, Japan
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17
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Nakajima A, Araki M, Kurihara O, Minami Y, Soeda T, Higuma T, Kakuta T, Lee H, Malhotra R, Nakamura S, Jang I. Predictors for rapid progression of coronary calcification: an optical coherence tomography (OCT) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0316] [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 natural progression of coronary calcification has not been systematically studied. In vivo coronary calcium can be evaluated by OCT.
Purpose
To identify the incidence and predictors for rapid progression of coronary calcification.
Methods
Patients with serial OCT imaging at baseline and at 6 months were selected from our database. Changes in calcium index during 6-month follow-up and predictors for progression of calcification were studied. Calcium index was defined as the product of the mean calcium arc and calcium length. Rapid progression of calcification was defined as an increase in calcium index above the median value.
Results
Among 187 patients who had serial OCT imaging, 235 calcified plaques were identified in 108 patients (57.8%) at baseline with median calcium index of 132.0 (Interquartile range 58.5–281.2). After 6 months, the calcium index increased in 95.3% of calcified plaques from 132.0 to 178.2 (p<0.001). In multivariable analysis, diabetes mellitus (DM), chronic kidney disease (CKD), lipid-rich plaque, and macrophages were found to be independent predictors for rapid progression of coronary calcification (table). Interestingly, rapid progression of calcification was associated with a significant reduction of inflammatory features (thin-cap fibroatheroma [TCFA]; baseline 21.2% vs. follow-up 11.9%, p=0.003, macrophages; baseline 74.6% vs. follow-up 61.0%, p=0.001).
Conclusions
This study demonstrated that DM, CKD, lipid-rich plaque, and macrophages were independent predictors for rapid progression of coronary calcification. High level of vascular inflammation may stimulate rapid progression of calcification.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Nakajima
- Mass General Hopital (MGH), Boston, United States of America
| | - M Araki
- Mass General Hopital (MGH), Boston, United States of America
| | - O Kurihara
- Mass General Hopital (MGH), Boston, United States of America
| | - Y Minami
- Kitasato University School of Medicine, Kanagawa, Japan
| | - T Soeda
- Nara Medical University, Nara, Japan
| | - T Higuma
- St. Marianna University School of Medicine, Kanagawa, Japan
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - H Lee
- Mass General Hopital (MGH), Boston, United States of America
| | - R Malhotra
- Mass General Hopital (MGH), Boston, United States of America
| | | | - I.K Jang
- Mass General Hopital (MGH), Boston, United States of America
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18
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Uemura S, Kakuta T, Jang I. Predictors of rapid plaque progression: an optical coherence tomography study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2459] [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
Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former will cause stable angina when the narrowing reaches a critical threshold, while the latter may lead to acute coronary syndromes or sudden cardiac death.
Purpose
The aim of the study was to identify morphologic predictors for rapid plaque progression.
Methods
Patients who had OCT imaging during the index procedure and follow-up angiography with a minimum of 6-month interval were selected. Non-culprit lesion was defined as a plaque with a diameter stenosis ≥30% on index angiogram. Lesion progression was defined as the decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of the plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with progression, morphological changes from baseline to follow-up were assessed.
Results
Among 517 lesions, 50 lesions showed progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%), layered plaque (60.0% vs. 34.0%), macrophage accumulation (62.0% vs. 42.4%), microvessel (46.0% vs. 29.1%), plaque rupture (12.0% vs. 4.7%), and thrombus (6.0% vs. 1.1%), compared to those without progression. The multivariable analysis identified lipid-rich plaque [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.02–4.62, p=0.045], TCFA (OR 5.85, 95% CI 2.01–17.03, p=0.001), and layered plaque (OR 2.19, 95% CI 1.03–4.17, p=0.040) as predictors of subsequent lesion progression. In a subgroup with follow-up OCT, a new layer was detected in 14/41 (34.1%) plaques.
Conclusions
Lipid-rich plaque, TCFA, and layered plaque were predictors of subsequent rapid plaque progression. A new layer, a signature of rapid progression through plaque disruption and healing, was detected in 1/3 of the cases.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Araki
- Massachusetts General Hospital, Boston, United States of America
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - O Kurihara
- Massachusetts General Hospital, Boston, United States of America
| | - A Nakajima
- Massachusetts General Hospital, Boston, United States of America
| | - H Lee
- Massachusetts General Hospital, Boston, United States of America
| | - T Soeda
- Nara Medical University, Nara, Japan
| | - Y Minami
- Kitasato University School of Medicine, Sagamihara, Japan
| | - S Uemura
- Nara Medical University, Nara, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - I.K Jang
- Massachusetts General Hospital, Boston, United States of America
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Yakabe D, Aso A, Fukuyama Y, Araki M, Nakamura T. Impact of left atrial appendage morphology on the silent cerebral infarction after cryoballoon ablation for atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0424] [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
Aims
Cryoballoon ablation (CBA) is effective for atrial fibrillation (AF), however acute silent cerebral infarction (SCI) is not uncommon after CBA. This study aimed to clarify the relationship between the morphology of LAA and SCI.
Methods and results
From 2015 to 2019, 207 consecutive patients (65.1±11.4 years, 26.6% of female, 31.4% of persistent AF) who underwent CBA for AF at our hospital were enrolled. All patients were evaluated with computed tomography for LAA before CBA and divided into two groups as chicken wing (CW) group and non-CW group. SCI was evaluated with magnetic resonance imaging at the following day after CBA. As a result, 18.4% of patients have occurred SCI after CBA. Although the patients' background didn't differ between the two groups, the Hounsfield scale (LAA/Aorta ratio) was lower (non-CW vs. CW = 0.68±0.12 vs. 0.73±0.11, p=0.004), and LAA orifice size tended to be larger (16.9±4.6 vs. 15.8±4.1, p=0.053) in non-CW group. SCI significantly occurred in non-CW group (29.5% vs. 11.6%, p=0.003), especially in cauliflower shape of 45.0%. In multivariate analysis, non-CW (p=0.002, Odds ratio 3.2, 95% of CI 1.5–7.0), skipped DOAC before CBA (p=0.04, Odds ratio 6.1, 95% of CI 1.1–115.4), and touch-up ablation in left atrium (p=0.02, Odds ratio 2.8, 95% CI 1.2–6.5) were independent predictors of SCI.
Conclusions
SCI was not rare after CBA for AF. Morphology of LAA was strongly associated with SCI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Yakabe
- Kyushu Medical Center, Department of Cardiology and clinical research institute, Fukuoka, Japan
| | - A Aso
- Kyushu Medical Center, Department of Cardiology and clinical research institute, Fukuoka, Japan
| | - Y Fukuyama
- Kyushu Medical Center, Department of Cardiology and clinical research institute, Fukuoka, Japan
| | - M Araki
- Kyushu Medical Center, Department of Cardiology and clinical research institute, Fukuoka, Japan
| | - T Nakamura
- Kyushu Medical Center, Department of Cardiology and clinical research institute, Fukuoka, Japan
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Yan B, Adriaenssens T, Boeder N, Nef H, Kim C, Crea F, Kakuta T, Jang I. Circadian variations in pathogenesis of ST-segment elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2463] [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 studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated.
Purpose
We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT).
Methods
Patients presenting with STEMI were selected from an international, multi-center, longitudinal registry study, which included patients who underwent OCT imaging of the culprit lesion at 11 institutions in 6 countries. Onset of MI was estimated using the time of OCT imaging. Patients were divided into 4 groups based on the estimated time of onset (00:00–05:59, 06:00–11:59, 12:00–17:59, or 18:00–23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were compared among the 4 groups.
Results
Among 648 patients, plaque rupture was diagnosed in 386 patients (59.6%), plaque erosion in 197 patients (30.4%), and calcified plaque in 65 patients (10.0%). A marked circadian variation was detected in the incidence of plaque rupture with a peak at 9:00, whereas it was not evident in plaque erosion or calcified plaque. The probability of plaque rupture increased in the periods of 06:00–11:59 (odds ratio: 2.13, 95% confidence interval: 1.30 to 3.49, p=0.002) and 12:00–17:59 (odds ratio: 2.10, 95% confidence interval: 1.23 to 3.58, p=0.005), compared to the period of 00:00–05:59. This circadian pattern was observed only during weekdays (p=0.013) and it was not evident during the weekend (p=0.742).
Conclusions
Plaque rupture occurred most frequently in the morning and the circadian variation was evident only during the weekdays. Acute MI caused by plaque rupture may be related to catecholamine surge.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Araki
- Massachusetts General Hospital, Boston, United States of America
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - O Kurihara
- Massachusetts General Hospital, Boston, United States of America
| | - A Nakajima
- Massachusetts General Hospital, Boston, United States of America
| | - H Lee
- Massachusetts General Hospital, Boston, United States of America
| | - T Soeda
- Nara Medical University, Nara, Japan
| | - Y Minami
- Kitasato University School of Medicine, Sagamihara, Japan
| | - B.P Yan
- The Chinese University of Hong Kong, Hong Kong, China
| | | | | | - H.M Nef
- University of Giessen, Giessen, Germany
| | - C.J Kim
- Kyunghee University, Seoul, Korea (Republic of)
| | - F Crea
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - I.K Jang
- Massachusetts General Hospital, Boston, United States of America
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21
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Adachi Y, Yamamoto M, Shimura T, Yamaguchi R, Kagase A, Tokuda T, Tsujimoto S, Koyama Y, Otsuka T, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Late Adverse Cardiorenal Events of Catheter Procedure-Related Acute Kidney Injury After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 133:89-97. [PMID: 32798043 DOI: 10.1016/j.amjcard.2020.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/30/2022]
Abstract
Data regarding the longitudinal effect of catheter procedure-related acute kidney injury (AKI) on clinical outcomes are limited. This study aimed to assess the late adverse cardiorenal events of AKI following transcatheter aortic valve implantation (TAVI). A total of 2,518 patients who underwent TAVI, excluding in-hospital deaths, were enrolled from the Japanese multicenter registry. The definition of AKI was determined using the Valve Academic Research Consortium-2 criteria. The incidence, predictors, major adverse renal and cardiac events (MARCE), and all-cause mortality of AKI were evaluated. MARCE included readmission for renal and heart failure (HF), hemodialysis requirement, and cardiovascular-renal death during the follow-up period. The incidence of AKI was 9.7% in the entire cohort. The significant predictive factors of AKI were men, diabetes mellitus, hypertension, chronic kidney disease, low albumin, overdose of contrast media, nontransfemoral approach, transfusion, vascular complications, and new pacemaker implantation. The rates of HF readmission and future hemodialysis were significantly higher in patients with AKI than in those without AKI (19.7% vs 9.0%, p <0.001, 3.3% vs 0.4%, p <0.001, respectively). Cox regression multivariate analysis showed that AKI occurrence was an independent predictive factor for the incremental risk of both MARCE and late mortality up to 4 years (hazard ratio [HR] 1.59, 95% confidence interval [CI] 0.75 to 1.20, p <0.001, HR 2.18, 95% CI 1.70 to 2.79; p <0.001, respectively). In conclusion, AKI occurrence was significantly associated with late adverse cardiorenal events after TAVI. Adequate clinical management can be expected to reduce AKI-related late phase cardiorenal damage even after successful TAVI.
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Affiliation(s)
- Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
| | - Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | | | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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22
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Taramasso M, Shinichi S, Hayashi M, Kawaguchi T, Arai Y, Ando K, Naganuma T, Mizutani K, Araki M, Tada N, Yamanaka F, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K, Miura M. TCT CONNECT-466 New Pacemaker Implantation Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Mori S, Hirano K, Makino K, Honda Y, Tsutsumi M, Sakamoto Y, Kobayashi N, Araki M, Yamawaki M, Ito Y. Feasibility of Ultrasound-Guided Transoccluded Radial Access for Coronary Angiography or Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2020; 13:2088-2090. [PMID: 32912468 DOI: 10.1016/j.jcin.2020.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
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24
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Hioki H, Watanabe Y, Kozuma K, Kataoka A, Yashima F, Naganuma T, Araki M, Tada N, Shirai S, Yamanaka F, Mizutani K, Tabata M, Takagi K, Ueno H, Yamamoto M, Hayashida K. Short-term dual anti-platelet therapy decreases long-term cardiovascular mortality after transcatheter aortic valve replacement. Heart Vessels 2020; 36:252-259. [PMID: 32880683 DOI: 10.1007/s00380-020-01693-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/06/2020] [Accepted: 08/28/2020] [Indexed: 01/09/2023]
Abstract
No data are available on extended dual anti-platelet therapy (DAPT) duration which may influence long-term prognosis (later than 1 year) after transcatheter aortic valve replacement (TAVR). Therefore, this study is aimed to evaluate whether discontinuing DAPT within 1 year had an impact on adverse events after TAVR. Using data from the OCEAN-TAVI registry, we assessed 1008 patients who survived the first year after TAVR with DAPT since discharge. Patients were divided into 'DAPT group' (n = 462), comprising patients who took DAPT at both discharge and 1 year, and 'stop-DAPT group' (n = 546), comprising patients who took DAPT at discharge and single anti-platelet therapy (SAPT) at 1 year. We compared the incidence of cardiovascular (CV) death, major and minor bleeding, and ischemic stroke later than 1 year after TAVR between the two groups. A total of 28 CV deaths were observed later than 1 year after TAVR. The stop-DAPT group had a significantly lower incidence of CV death than the DAPT group (1.8% vs. 4.9%, log-rank P = 0.029). Stop DAPT was associated with lower CV death later than 1 year of TAVR in Cox regression analysis (adjusted hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.20-0.99), and in analysis with inverse probability of treatment weighting method using propensity score (adjusted HR, 0.45; 95% CI, 0.20-0.98). Our study demonstrated that switching from DAPT to SAPT within 1 year of TAVR was significantly associated with a lower CV death later than 1 year after TAVR.
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Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan.
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | | | | | - Motoharu Araki
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | - Kazuki Mizutani
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | | | | | - Masanori Yamamoto
- Toyohashi Heart Center, Aichi, Japan.,Nagoya Heart Center, Aichi, Japan
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25
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Kamoshida T, Ochi M, Ikegami T, Araki M, Yamaguchi Y, Hamano Y, Ohkawara H, Ohkawara A, Kakinoki N, Hirai S, Yanaka A. 1002P Usefulness of hand-foot skin reaction as a prognostic marker in patients with hepatocellular carcinoma treated with sorafenib: Close cooperation between pharmacists and oncologist changes prognosis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1118] [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] Open
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26
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Shimura T, Yamamoto M, Kano S, Sago M, Tsunaki T, Kagase A, Koyama Y, Tsujimoto S, Otsuka T, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Predictors and Prognostic Impact of Nutritional Changes After Transcatheter Aortic Valve Replacement. Cardiovasc Revasc Med 2020; 23:68-76. [PMID: 32900641 DOI: 10.1016/j.carrev.2020.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about changes in nutritional status as an index of frailty on clinical outcomes after transcatheter aortic valve replacement (TAVR). This study aimed to assess the clinical impact of serum albumin changes after TAVR. METHODS Changes in serum albumin levels from baseline to 1 year after TAVR were evaluated in 1524 patients who were classified as having hypoalbuminemia (<3.5 g/dl) and normoalbuminemia (≥3.5 g/dl) at each timepoint. The patients were categorized into 4 groups: NN (baseline normoalbuminemia, 1-year normoalbuminemia: n = 1119), HN (baseline hypoalbuminemia, 1-year normoalbuminemia: n = 202), NH (baseline normoalbuminemia, 1-year hypoalbuminemia: n = 121), and HH (baseline hypoalbuminemia, 1-year hypoalbuminemia: n = 82). We also defined late hypoalbuminemia as hypoalbuminemia identified at the 1-year assessment. Clinical outcomes were compared among 4 groups. Multivariable analysis was driven to assess the variables associated with late hypoalbuminemia and long-term mortality. RESULTS The cumulative 3-year mortality was significantly different among the 4 groups (NN: 11.4%, HN: 10.7%, NH: 25.4%, HH: 44.4%, p < 0.001). Multivariable Cox regression analysis revealed that the NH group had a higher mortality risk (hazard ratio [HR]; 2.80 and 3.53, 95% confidence interval [CI]; 1.71-4.57 and 2.06-6.06, p < 0.001 and p < 0.001, respectively), whereas the HN group had a similar risk (HR; 1.16, 95% CI; 0.66-2.06, p = 0.61) compared with the NN group. Baseline hypoalbuminemia, low body mass index, liver disease, peripheral artery disease, and hospital readmission within 1 year were predictors of late hypoalbuminemia (all p < 0.05). CONCLUSION Serial albumin assessment may identify poor prognostic subsets in patients with persistent and late acquired malnutrition after TAVR.
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Affiliation(s)
- Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
| | - Seiji Kano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Mitsuru Sago
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | | | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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27
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Hibino M, Tabata M, Ito J, Shibayama K, Obunai K, Watanabe H, Tada N, Naganuma T, Araki M, Yamanaka F, Ueno H, Mizutani K, Higashimori A, Takagi K, Watanabe Y, Shirai S, Yamamoto M, Hayashida K. Midterm outcomes after the rescue THV-in-THV procedure: Insights from the multicenter prospective OCEAN-TAVI registry. Catheter Cardiovasc Interv 2020; 97:701-711. [PMID: 32790158 DOI: 10.1002/ccd.29175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/05/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To confirm whether the rescue transcatheter heart valve in the transcatheter heart valve (THV-in-THV) procedure is effective and feasible, we aimed to assess the midterm outcomes following rescue THV-in-THV procedures. The trends in the usage of the rescue THV-in-THV procedure at the time of transcatheter aortic valve implantation (TAVI) have also been explored. BACKGROUND Midterm outcomes of the rescue THV-in-THV procedure have been poorly defined, though it is popular as an effective method to bail-out some complications in TAVI. METHODS We reviewed data from the Optimized transCathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry and compared the outcomes of TAVI with rescue THV-in-THV and TAVI without rescue THV-in-THV. We also examined the annual rates of rescue THV-in-THV procedures in all the TAVI procedures between 2013 and 2017. RESULTS Among 2,588 patients who underwent TAVI, 26 patients have required rescue THV-in-THV for valve malposition (n = 23) or severe transvalvular regurgitation because of stuck THV leaflets (n = 3). Three cases needed an open conversion, and two died in the hospital. The rates of new permanent pacemaker implantation, acute kidney injury, and stroke were higher in the THV-in-THV group. A two-year cumulative survival and echocardiographic outcomes succeeding rescue THV-in-THV procedure were comparable to non-THV-in-THV cases. The rate of rescue THV-in-THV procedure lessened from 2.6% in 2013 to 0.6% in 2017. CONCLUSIONS The rescue THV-in-THV procedure is an effective and feasible option for THV malpositioning and stuck valve. It has given a comparable survival and a stable valve function over midterm observation periods.
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Affiliation(s)
- Makoto Hibino
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Joji Ito
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Kentaro Shibayama
- Department of Cardiology, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Norio Tada
- Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University School of Medicine, Toyama, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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28
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Yamamoto M, Otsuka T, Shimura T, Yamaguchi R, Adachi Y, Kagase A, Tokuda T, Yashima F, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Watanabe S, Sato Y, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K. Clinical risk model for predicting 1-year mortality after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E544-E551. [PMID: 32729657 PMCID: PMC7983930 DOI: 10.1002/ccd.29130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 01/08/2023]
Abstract
Objectives Estimating 1‐year life expectancy is an essential factor when evaluating appropriate indicators for transcatheter aortic valve replacement (TAVR). Background It is clinically useful in developing a reliable risk model for predicting 1‐year mortality after TAVR. Methods We evaluated 2,588 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry from October 2013 to May 2017. The 1‐year clinical follow‐up was achieved by 99.5% of the entire population (n = 2,575). Patients were randomly divided into two cohorts: the derivation cohort (n = 1,931, 75% of the study population) and the validation cohort (n = 644). Considerable clinical variables including individual patient's comorbidities and frailty markers were used for predicting 1‐year mortality following TAVR. Results In the derivation cohort, a multivariate logistic regression analysis demonstrated that sex, body mass index, Clinical Frailty Scale, atrial fibrillation, peripheral artery disease, prior cardiac surgery, serum albumin, renal function as estimated glomerular filtration rate, and presence of pulmonary disease were independent predictors of 1‐year mortality after TAVR. Using these variables, a risk prediction model was constructed to estimate the 1‐year risk of mortality after TAVR. In the validation cohort, the risk prediction model revealed high discrimination ability and acceptable calibration with area under the curve of 0.763 (95% confidence interval, 0.728–0.795, p < .001) in the receiver operating characteristics curve analysis and a Hosmer–Lemeshow χ2 statistic of 5.96 (p = .65). Conclusions This risk prediction model for 1‐year mortality may be a reliable tool for risk stratification and identification of adequate candidates in patients undergoing TAVR.
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Affiliation(s)
- Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Syonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Shun Watanabe
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University, Minato, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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29
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Kobayashi N, Ito Y, Yamawaki M, Araki M, Obokata M, Sakamoto Y, Mori S, Tsutsumi M, Honda Y, Makino K, Shirai S, Mizusawa M, Hirano K. Optical coherence tomography-guided versus intravascular ultrasound-guided rotational atherectomy in patients with calcified coronary lesions. EUROINTERVENTION 2020; 16:e313-e321. [PMID: 31845895 DOI: 10.4244/eij-d-19-00725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to evaluate whether optical coherence tomography (OCT)-guided rotational atherectomy (RA) improves stent expansion and clinical outcomes compared to intravascular ultrasound (IVUS)-guided RA. METHODS AND RESULTS From our database, we identified 247 de novo calcified coronary lesions that underwent RA between September 2013 and December 2017. Of these, lesions with no intravascular imaging data (n=11), poor image quality (n=7), balloon angioplasty alone (n=16), and complications (two burr entrapments, two perforations) were excluded. Finally, 88 and 121 lesions that underwent OCT-guided and IVUS-guided RA, respectively, were included in the study. The primary endpoint of the present study was percent stent expansion. Burr upsizing was more frequently performed (55% vs 32%, p=0.001) and the final burr size was significantly larger (1.75 [1.50-1.75] vs 1.50 [1.50-1.75] mm, p<0.001) in the OCT-guided RA group. Percent stent expansion was significantly larger in the OCT-guided RA group (83±15% vs 72±16%, p=0.0004). Although TLR at one year was lower in the OCT-guided RA group, there was no statistical difference (6.8% vs 11.6%, p=0.25). CONCLUSIONS OCT-guided RA for calcified coronary lesions resulted in larger percent stent expansion compared to IVUS-guided RA. OCT-guided RA may be ideal for treating calcified coronary lesions.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan
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30
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Fukagawa T, Hirano K, Yamawaki M, Araki M, Kobayashi N, Mori S, Sakamoto Y, Tsutsumi M, Honda Y, Makino K, Mizusawa M, Shirai S, Ito Y. Usefulness of a Guide Extension Catheter in Endovascular Therapy of Infrapopliteal Lesions. Ann Vasc Surg 2020; 66:670.e9-670.e14. [DOI: 10.1016/j.avsg.2020.01.086] [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] [Received: 10/04/2019] [Accepted: 01/05/2020] [Indexed: 11/25/2022]
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31
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Maruyama Y, Sadahira T, Araki M, Mitsui Y, Wada K, Edamura K, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y. The second opinion pathology review improves concordance between prostate biopsy and radical prostatectomy specimens. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33634-x] [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: 10/23/2022] Open
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Sadahira T, Wada K, Ishii A, Maruyama Y, Mitsui Y, Iwata T, Araki M, Watanabe M, Watanabe T, Nasu Y. Preventive efficacy and safety of lactobacillus vaginal suppositories in women with recurrent cystitis: A phase 2 study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33968-9] [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: 10/23/2022] Open
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Kobayashi N, Yamawaki M, Hirano K, Araki M, Sakai T, Sakamoto Y, Mori S, Tsutsumi M, Nauchi M, Sahara N, Honda Y, Makino K, Shirai S, Mizusawa M, Sugizaki Y, Nakano T, Fukagawa T, Kishida T, Kozai Y, Setonaga Y, Goda S, Ito Y. Use of the orbital atherectomy system backed up with the guide-extension catheter for a severely tortuous calcified coronary lesion. SAGE Open Med Case Rep 2020; 8:2050313X20921081. [PMID: 32577280 PMCID: PMC7290249 DOI: 10.1177/2050313x20921081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/30/2020] [Indexed: 01/21/2023] Open
Abstract
A 68-year-old man was scheduled to undergo percutaneous coronary intervention for in-stent total occlusion of the severely tortuous right coronary artery. Intravascular ultrasound revealed heavy in-stent calcification. Lesion atherectomy was required; however, severe proximal vessel tortuosity was detected. We introduced a 7-Fr guide-extension catheter beyond the severely tortuous part and performed rotational atherectomy with a 1.5 mm burr. However, the balloon could not expand; therefore, we changed to an orbital atherectomy system. Subsequently, the balloon successfully expanded, and intravascular ultrasound revealed an enlarged lumen. Severe proximal vessel tortuosity limits the use of atherectomy devices; however, a guide-extension catheter delivers the atherectomy device beyond the tortuosity. The delivery of the orbital atherectomy system inside the guide-extension catheter is easy due to its low profile; the debulking effect increases with the number of passes and rotational speed. This strategy is a useful option for treating severe calcified lesions with proximal vessel tortuosity.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Tsuyoshi Sakai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yasunari Sakamoto
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinsuke Mori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masakazu Tsutsumi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masahiro Nauchi
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Naohiko Sahara
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yohsuke Honda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Kenji Makino
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shigemitsu Shirai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Masafumi Mizusawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yuta Sugizaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Takahide Nakano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Tomoya Fukagawa
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Toshihiko Kishida
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yuki Kozai
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yusuke Setonaga
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shutaro Goda
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
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Miura M, Yamaji K, Shirai S, Hayashi M, Kawaguchi T, Arai Y, Sakaguchi G, Ando K, Naganuma T, Mizutani K, Araki M, Tada N, Yamanaka F, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Yamamoto M, Hayashida K. Clinical Impact of Preprocedural Moderate or Severe Mitral Regurgitation on Outcomes After Transcatheter Aortic Valve Replacement. Can J Cardiol 2020; 36:1112-1120. [PMID: 32470334 DOI: 10.1016/j.cjca.2019.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The influence of improved mitral regurgitation (MR) on the outcomes of transcatheter aortic valve replacement (TAVR) is unknown. Our aim was to determine the impact of significant preprocedural MR and the improvement of MR after TAVR. METHODS A population of 1587 patients from the Optimized Catheter Valvular Intervention Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry were evaluated. Preprocedural MR was mild or less in 1443 patients (90.9%) and moderate or severe in 144 patients (9.1%). RESULTS Moderate or severe MR was associated with increased risk for all-cause mortality at 1 year (adjusted hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.84; P = 0.005) and 2 years (adjusted hazard ratio, 1.64; 95% CI, 1.15-2.34; P = 0.007). At 6 months after TAVR, the MR grade improved in 77.4% of the patients with moderate or severe baseline MR. Multivariate analysis showed that the absence of previous myocardial infarction (odds ratio, 8.00; 95% CI, 1.74-36.8; P = 0.008) and beta-blocker use at baseline (odds ratio, 2.71; 95% CI, 1.09-6.70; P = 0.031) were independently associated with improved MR at 6 months (vs unchanged, worsened MR, or death). Patients with improved MR had a significantly lower rate of midterm readmission for heart failure (11.6%) than those with unchanged or worsened MR (30.8%, P = 0.007). CONCLUSIONS Moderate or severe MR was associated with increased risk of all-cause mortality 2 years after TAVR. Moderate or severe baseline MR was improved in most patients at 6 months after TAVR. Patients with unchanged or worsened MR had an increased rate of readmission for heart failure.
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Affiliation(s)
- Mizuki Miura
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masaomi Hayashi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Norio Tada
- Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Urayasu, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Noguchi M, Tabata M, Obunai K, Shibayama K, Ito J, Watanabe H, Yashima F, Watanabe Y, Naganuma T, Araki M, Yamanaka F, Shirai S, Ueno H, Mizutani K, Higashimori A, Takagi K, Tada N, Yamamoto M, Hayashida K. Clinical outcomes of transcatheter aortic valve implantation (TAVI) in nonagenarians from the optimized catheter valvular intervention-TAVI registry. Catheter Cardiovasc Interv 2020; 97:E113-E120. [PMID: 32333724 DOI: 10.1002/ccd.28935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/24/2020] [Accepted: 04/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate 30-day and 2-year clinical outcomes, and predictors of 2-year mortality in nonagenarians undergoing transcatheter aortic valve implantation (TAVI). BACKGROUND TAVI has been applied to nonagenarians. However, sufficient clinical data in nonagenarians who could benefit from TAVI are limited. METHODS We evaluated the data from the optimized catheter valvular intervention-TAVI registry. Clinical outcomes were compared between patients' age ≥90 years and age <90 years. Predictive factors of 2-year mortality were assessed by multivariable Cox regression analyses. RESULTS From October 2013 to May 2017, a total of 375 nonagenarians (age ≥90 years) and 2,213 younger patients (age <90 years) were included. Although nonagenarians had a higher surgical risk score, 30-day clinical outcomes were similar between two groups. There were no significant differences in 2-year mortality (22.0% vs. 17.3%; p = .11) and stroke (5.5% vs. 3.9%; p = .31); however, 2-year heart failure readmission was higher in nonagenarians (13.3% vs. 9.0%; p = .03). After adjusting covariates, age ≥90 years was not independent predictor for 2-year outcomes. In nonagenarians, female sex (hazard ratio [HR] = 0.43; 95% confidence interval [CI] = 0.26-0.74; p = .002), chronic kidney disease grade ≥4 (HR = 2.14; 95% CI = 1.21-3.64; p = .01), and Clinical Frailty Scale ≥4 (HR = 1.82; 95% CI = 1.02-3.42; p = .04) were independently associated with 2-year mortality. CONCLUSIONS Clinical outcomes of TAVI in selected nonagenarians were favorable. Severe renal dysfunction and frailty may be important factors to predict mid-term mortality after TAVI in nonagenarians.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kentaro Shibayama
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Joji Ito
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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36
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Fujikawa H, Araki M. Hepatobiliary and Pancreatic: Abscess of the ligamentum teres hepatis. J Gastroenterol Hepatol 2020; 35:529. [PMID: 31898824 DOI: 10.1111/jgh.14921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/31/2019] [Indexed: 12/09/2022]
Affiliation(s)
- H Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan
| | - M Araki
- Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan
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Yamawaki M, Araki M, Yashima F, Suzuyama H, Nishina H, Yamasaki K, Izumo M, Nakajima Y, Ohno Y, Ueno H, Mizutani K, Tabata M, Higashimori A, Yamanaka F, Tada N, Takagi K, Naganuma T, Watanabe Y, Shirai S, Yamamoto M, Hayashida K. IMPACT OF POLYVASCULAR DISEASE ON CLINICAL OUTCOME IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mizusawa M, Ito Y, Hirano K, Yamawaki M, Araki M, Kobayashi N, Sakamoto Y, Mori S, Tsutsumi M, Honda Y, Makino K, Shirai S, Nakano T, Fukagawa T, Kishida T, Kozai Y, Setonaga Y, Goda S. EFFICACY OF HYBRID EMERGENCY ROOM FOR OUT-OF-HOSPITAL CARDIAC ARREST PATIENTS UNDERGOING EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION WITH VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yokoyama H, Yamanaka F, Shishido K, Ochiai T, Yokota S, Watanabe Y, Shirai S, Tada N, Araki M, Yashima F, Naganuma T, Ueno H, Tabata M, Mizutani K, Higashimori A, Takagi K, Yamamoto M, Saito S, Hayashida K. THE IMPACT OF VENTRICULAR-ARTERIAL COUPLING AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT ON MID-TERM CLINICAL OUTCOMES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31734-4] [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: 10/24/2022]
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Araki M. SAT-153 CORRELATION BETWEEN HBA1c LEVEL AND RENAL FUNCTION IN DIABETIC NEPHROPATHY. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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41
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Kobayashi N, Hirano K, Yamawaki M, Araki M, Sakai T, Sakamoto Y, Mori S, Tsutsumi M, Nauchi M, Sahara N, Honda Y, Makino K, Shirai S, Mizusawa M, Sugizaki Y, Nakano T, Fukagawa T, Kishida T, Kozai Y, Setonaga Y, Goda S, Ito Y. Sustained drug retention after paclitaxel-coated balloon angioplasty for superficial femoral artery disease: Follow-up intravascular imaging. SAGE Open Med Case Rep 2020; 8:2050313X20907825. [PMID: 32110413 PMCID: PMC7026811 DOI: 10.1177/2050313x20907825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/21/2020] [Indexed: 11/30/2022] Open
Abstract
A 63 year-old woman with claudication underwent endovascular therapy for diffuse stenosis of the right superficial femoral artery in our hospital. We performed paclitaxel-coated balloon angioplasty using the IN.PACT™ Admiral™ and achieved acceptable results. After 42 days, we performed follow-up optical frequency domain imaging for the right superficial femoral artery lesion treated with paclitaxel-coated balloon and observed several high-intensity regions with attenuation on the lumen surface. Sustained drug availability is a notable characteristic of paclitaxel-coated balloon. To the best of our knowledge, this is the first report on the visualization of sustained drug retention on the lumen surface using follow-up optical frequency domain imaging after paclitaxel-coated balloon angioplasty in a human patient with superficial femoral artery disease.
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Affiliation(s)
- Norihiro Kobayashi
- Norihiro Kobayashi, Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama 230-8765, Kanagawa, Japan.
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Tokuda T, Yamamoto M, Kagase A, Koyama Y, Otsuka T, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Importance of combined assessment of skeletal muscle mass and density by computed tomography in predicting clinical outcomes after transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2020; 36:929-938. [DOI: 10.1007/s10554-020-01776-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022]
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Honda Y, Araki M, Yamawaki M, Hirano K, Kobayashi N, Sakamoto Y, Mori S, Tsutsumi M, Makino K, Ito Y. The ARAHKEY technique: A novel method for the management of access site bleeding during percutaneous transfemoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 96:E355-E359. [PMID: 31815366 DOI: 10.1002/ccd.28610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/12/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This retrospective study assessed the safety and efficacy of the ARAHKEY (ARterial sealing with Additional Hemostatic device Kissing with Extravascular and suture-based device deeplY) technique during transcatheter aortic valve replacement (TAVR). BACKGROUND Access site complications are still a major issue to be solved during TAVR using a large caliber sheath. METHODS From February 2014 to June 2019, a total of 302 patients underwent TAVR in our hospital. Twenty-five patients (10.2% of patients who underwent percutaneous transfemoral TAVR [n = 246]) were treated using the ARAHKEY technique, which is the additional use of Exoseal for the common femoral artery puncture site when hemostasis was not achieved with ProGlide alone. RESULTS Complete hemostasis was achieved in all patients (100%). The mean procedural time for hemostasis was 9.8 ± 4.5 min. No complications, including recurrent bleeding, infection, and late acquired hematoma, were observed in this study cohort. CONCLUSION The ARAHKEY technique is a safe method and should be considered as a secondary option when hemostasis is not achieved with ProGlide during TAVR.
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Affiliation(s)
- Yohsuke Honda
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Motoharu Araki
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Masahiro Yamawaki
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Keisuke Hirano
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Norihiro Kobayashi
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Yasunari Sakamoto
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Shinsuke Mori
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Masakazu Tsutsumi
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Kenji Makino
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan
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Tsunaki T, Yamamoto M, Shimura T, Kagase A, Naganuma T, Higashimori A, Araki M, Yamanaka F, Mizutani K, Watanabe Y, Otsuka T, Yanagisawa R, Hayashida K. Silent Valsalva thrombus between the native Valsalva and balloon-expandable transcatheter heart valve: multicentre Japanese registry analysis. EUROINTERVENTION 2019; 15:892-899. [PMID: 31746754 DOI: 10.4244/eij-d-19-00370] [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: 11/23/2022]
Abstract
AIMS The newly formed geometry between the native Valsalva and implanted transcatheter heart valve (THV) may induce local thrombogenicity. This study aimed to assess the incidence of and the clinical outcomes associated with Valsalva thrombus formation after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS We retrospectively evaluated the multidetector computed tomography (MDCT) data of 338 patients following transcatheter aortic valve implantation (TAVI) using a balloon-expandable THV. The Valsalva and leaflet thrombi were assessed by MDCT at the left coronary cusp (LCC), right coronary cusp (RCC), and non-coronary cusp (NCC). Combined endpoints such as death, stroke, and readmission for heart failure rates in patients with and without Valsalva and/or leaflet thrombus were examined at two years. The overall incidence of Valsalva and leaflet thrombi was 8.9% and 8.3%, respectively. Significant differences in the location of the Valsalva thrombus in the LCC, RCC, and NCC were noted (5.0%, 4.2%, 8.9%, respectively, p<0.001). The independent predictor for increased risk of Valsalva thrombus was high Valsalva area to implanted THV size ratio (odds ratio 11.8, 95% confidence interval [CI]: 1.67-83.0, p=0.013). Combined endpoints were similar in patients with and without Valsalva thrombus, Valsalva/leaflet thrombus, and leaflet thrombus (p>0.05 for all). CONCLUSIONS Valsalva thrombus was detected in 8.9% of patients following balloon-expandable THV implantation and was common in the LCC, but it did not increase the risk of adverse events after TAVI.
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Affiliation(s)
- Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
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Shimura T, Yamamoto M, Kano S, Hosoba S, Sago M, Kagase A, Koyama Y, Tsujimoto S, Otsuka T, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes. J Am Heart Assoc 2019; 7:e009195. [PMID: 30371215 PMCID: PMC6222955 DOI: 10.1161/jaha.118.009195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Although transcatheter aortic valve replacement (TAVR) is the least invasive treatment for patients with symptomatic aortic stenosis, some patients hesitate to undergo the procedure. We investigated the clinical impact of treatment delay after patient refusal of TAVR. Methods and Results We used the Japanese OCEAN (Optimized Catheter valvular intervention) regsitry data of 1542 patients who underwent TAVR. Refusal was defined as at least 1 refusal of TAVR at the time of informed consent. Patients were separated into 2 groups: refusal (28/1542, 1.8%) and non‐refusal (1514/1542, 98.2%). We compared the baseline characteristics, procedural outcomes, and mortality rates between the groups. Additionally, data on reasons for refusal and those leading to eventually undergoing TAVR were collected. Age, surgical risk scores, and frailty were higher in the refusal group than in the non‐refusal group (P<0.05 for all). Periprocedural complications did not differ between groups, whereas 30‐day and cumulative 1‐year mortality were significantly higher in the refusal group than in the non‐refusal group (7.1% versus 1.3%, P=0.008 and 28.8% versus 10.3%, P=0.010, respectively). Multivariate Cox regression analysis revealed that TAVR refusal was an independent predictor of increased midterm mortality (hazard ratio: 3.37; 95% confidence interval: 1.52–7.48; P=0.003). The most common reason for refusal was fear (13/28, 46.4%), and the most common reason for changing their mind was worsening heart failure (21/28, 75.0%). All patients in the refusal group decided to undergo TAVR within 20 months (median: 5.5 months). Conclusions Refusing TAVR even once led to poorer prognosis; therefore, this fact should be clearly discussed when obtaining informed consent.
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Affiliation(s)
- Tetsuro Shimura
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Masanori Yamamoto
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan.,2 Department of Cardiology Nagoya Heart Center Aichi Japan
| | - Seiji Kano
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Soh Hosoba
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Mitsuru Sago
- 1 Department of Cardiology Toyohashi Heart Center Aichi Japan
| | - Ai Kagase
- 2 Department of Cardiology Nagoya Heart Center Aichi Japan
| | - Yutaka Koyama
- 2 Department of Cardiology Nagoya Heart Center Aichi Japan
| | | | - Toshiaki Otsuka
- 3 Department of Hygiene and Public Health Nippon Medical School Tokyo Japan.,4 Center for Clinical Research Nippon Medical School Hospital Tokyo Japan
| | - Norio Tada
- 5 Department of Cardiology Sendai Kosei Hospital Miyagi Japan
| | - Toru Naganuma
- 6 Department of Cardiology New Tokyo Hospital Chiba Japan
| | - Motoharu Araki
- 7 Department of Cardiology Saiseikai Yokohama City Eastern Hospital Kanagawa Japan
| | - Futoshi Yamanaka
- 8 Department of Cardiology Shonan Kamakura General Hospital Kanagawa Japan
| | - Shinichi Shirai
- 9 Department of Cardiology Kokura Memorial Hospital Fukuoka Japan
| | - Kazuki Mizutani
- 10 Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Minoru Tabata
- 11 Department of Cardiovascular Surgery Tokyo Bay Urayasu-Ichikawa Medical Center Chiba Japan
| | - Hiroshi Ueno
- 12 Department of Cardiology Toyama University Hospital Toyama Japan
| | - Kensuke Takagi
- 13 Department of Cardiology Ogaki Municipal Hospital Gifu Japan
| | | | - Yusuke Watanabe
- 15 Department of Cardiology Teikyo University School of Medicine Tokyo Japan
| | - Kentaro Hayashida
- 16 Department of Cardiology Keio University School of Medicine Tokyo Japan
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Matsui Y, Hiraki T, Gobara H, Iguchi T, Tomita K, Uka M, Araki M, Nasu Y, Furuya M, Kanazawa S. Percutaneous thermal ablation for renal cell carcinoma in patients with Birt–Hogg–Dubé syndrome. Diagn Interv Imaging 2019; 100:671-677. [DOI: 10.1016/j.diii.2019.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/16/2019] [Accepted: 06/20/2019] [Indexed: 01/29/2023]
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Aso A, Nakamura T, Fukuyama Y, Fukuda S, Sibao K, Araki M, Meno K, Yakebe D, Omura S, Mori T, Takenaka K, Murasato Y. P1912Incidence of silent cerebral thromboembolism in catheter ablation for atrial fibrillation under the use of DOAC: Comparison of cryoballoon versus radiofrequency ablation system. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0659] [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
Silent cerebral thromboembolism (CE) in catheter ablation for atrial fibrillation (AF) is not rare. Prior our study has reported lower incidence of silent CE in AF radiofrequency (RF) ablation using irrigated-tip catheter than conventional 4 or 8mm-tip catheter. In addition, the incidence of silent CE in AF ablation under direct oral anticoagulant (DOAC) was equivalent to continuous therapeutic warfarin. Recently pulmonary vein isolation (PVI) using cryoballoon (CB) has emerged as an alternative technique to RF ablation because some studies suggested that the efficacy for PVI by CB was equivalent to RF. However, incidence of silent CE in CB ablation under the use of DOAC is unknown.
Objective
We aimed to evaluate the incidence new silent CE in AF ablation using CB system compared with irrigated RF system under the use of DOAC.
Methods
322 consecutive patients with paroxysmal or persistent AF (155 using CB system, 167 using RF system) who underwent the first AF ablation were taking DOAC more than one month prior to the procedure. Throughout AF ablation procedure, heparin was administered to maintain activated clotting time (ACT) between 300 and 400 seconds. Head MRI was performed in all patients within 24 hours after the procedure.
Results
In 14 (9.0%) patients using CB and in 20 (12.0%) patients using RF, head MRI showed new embolic lesions without neurological symptom (P=0.469). Although the amount of heparin during the procedure in group CB was significantly less than in group RF (16134±3125 U vs. 18689±5222 U; P<0.0001), amount of heparin per hour in group CB was more than in group RF (8335±1955 U/h vs. 6143±1918 U/h; P<0.0001) because procedure time in group CB was shorter than in group RF (121.3±34.1 min vs. 189.5±47.4 min; P<0.0001). Mean ACT in both groups was maintained high level (3367±25.3 sec. vs. 338.6±23.5 sec.; P=0.479). In univariate analysis, minimum ACT during procedure, as before puncture of interatrial septum, were significantly correlated with the incidence of silent CE (P=0.027).
Conclusions
The incidence of silent CE in AF ablation using CB system was lower than RF system, although it was not a significant difference between different ablation techniques for AF. In AF ablation, the use of CB may be preferred rather than RF as ablation system in regard to risk reduction of thromboembolic complications.
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Affiliation(s)
- A Aso
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - T Nakamura
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Y Fukuyama
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - S Fukuda
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - K Sibao
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - M Araki
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - K Meno
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - D Yakebe
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - S Omura
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - T Mori
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - K Takenaka
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Y Murasato
- National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Shimizu A, Sonoda S, Setoyama K, Inoue K, Miura T, Anai R, Tsuda Y, Araki M, Otsuji Y. P6402Ischemic and bleeding events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients: a propensity score-matched analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0997] [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
Dual-antiplatelet therapy (DAPT) after second-generation drug eluting stent (2-DES) implantation reduced the risk of stent thrombosis and subsequent ischemic events, with an increase in bleeding risk. Although chronic kidney disease patients have high ischemic and bleeding risk, little is known about both risks in hemodialysis patients after 2-DES implantation during DAPT.
Method
From July 2009 to March 2017, we retrospectively analyzed post-discharge major adverse cardiac and cerebrovascular events [MACCE: cardiac death, myocardial infarction, target vessel revascularization (TVR) and cerebral infarction] and bleeding events in 644 consecutive patients during DAPT after 2-DES implantation. We divided them into 2 groups [102 hemodialysis (HD) and 518 non-hemodialysis (Non-HD) patients, mean age, 71±10 years] after excluding 24 patients (lost to follow up and peritoneal dialysis). Follow-up period was 49±24 months. Median DAPT duration was 12 months. The primary endpoint was MACCE. The secondary endpoint was bleeding events according to the Bleeding Academic Research Consortium (BARC) type 2, 3, or 5. MACCE and bleeding events were compared between HD and Non-HD by using the propensity score-matching (PSM) method.
Results
Among the 620 eligible patients, the primary and secondary events occurred in 207 (33.3%) and 76 (12.3%) patients, respectively. The rates of unadjusted MACCE [HD vs Non-HD: 53.9% vs 29.3%; Hazard ratio (HR) 2.39, p<0.01] and bleeding events (HD vs Non-HD: 21.6% vs 10.4%; HR 2.50, p<0.01) were significantly higher in HD than Non-HD.
After 1-to-1 propensity score adjustment for baseline differences (hypertension, diabetes mellitus, low ejection fraction, low albumin, anemia, and high C-reactive protein), a total of 160 patients (80 HD vs 80 Non-HD) was created. The rate of MACCE [HD vs Non-HD: 52.5% vs 31.3%; adjusted HR 2.04, p<0.01] was significantly higher in HD than Non-HD. Regarding MACCE, cardiac death (HD vs Non-HD: 18.8% vs 8.8%; adjusted HR 2.65, p=0.03) and TVR (HD vs Non-HD: 15.0% vs 6.3%; adjusted HR 2.74, p=0.046) occurred significantly higher in HD. On the other hand, bleeding events did not exhibit significant differences though HD had a numerically higher event rate (HD vs Non-HD: 25.0% vs 16.3%; adjusted HR 1.68, p=0.15), indicating that the bleeding risk in HD would be strongly dependent on the patient's background.
Conclusions
As a result of PSM, HD was shown to contribute to ischemic risk rather than bleeding risk. Even in the 2-DES era, HD was an independent risk factor of cardiac death and TVR. Therefore, further study on the current regimen of DAPT would be necessary while balancing both ischemic and bleeding risk.
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Affiliation(s)
- A Shimizu
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - S Sonoda
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - K Setoyama
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - K Inoue
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - T Miura
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - R Anai
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - Y Tsuda
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - M Araki
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
| | - Y Otsuji
- University of Occupational and Environmental Health, cardiovascular medicine, Kitakyushu, Japan
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Makino K, Hirano K, Mori S, Yamawaki M, Araki M, Kobayashi N, Sakamoto Y, Tsutsumi M, Shirai S, Honda Y. TCT-571 Glasgow Prognostic Score Predicts the Clinical Outcomes in Critical Limb Ischemia With Tissue Loss After Endovascular Treatment. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Yamamoto M, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K. Transcatheter aortic valve replacement outcomes in Japan: Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. Cardiovascular Revascularization Medicine 2019; 20:843-851. [DOI: 10.1016/j.carrev.2018.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/06/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
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