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杉﨑 陽一郎医学部附属病院 循環器内科助教
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■ 論文- BACKGROUND: Perivascular adipose tissue (PVAT) attenuation on computed tomography angiography reflects vascular inflammation. However, its prognostic value in patients undergoing endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) remains unclear. METHODS: We retrospectively studied consecutive patients who underwent EVAR for unruptured infrarenal AAA with preprocedural computed tomography angiography. PVAT attenuation and aortic characteristics were assessed using computed tomography angiography. The primary outcome was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, stroke, and any vessel treatment. RESULTS: Among 275 patients treated with EVAR, 35.6% (98/275) experienced MACCE during a median follow-up of 3.5 years. Pre-EVAR PVAT attenuation was higher in patients who experienced MACCE than in those who did not (−69.8±10.3 HU versus −77.3±8.6 HU; P <0.001). In the Cox proportional hazards model, higher PVAT attenuation (per 10 HU; unadjusted hazard ratio, 1.88 [95% CI, 1.56–2.28]; P <0.001) was associated with MACCE after EVAR. Furthermore, higher PVAT attenuation was associated with AAA-related adverse events: a composite of AAA-related death, reintervention for AAA, embolization for endoleak, and AAA enlargement (per 10 HU; unadjusted hazard ratio, 2.16 [95% CI, 1.59–2.94]). Adding PVAT attenuation to post-EVAR prognostic factors and computed tomography angiography findings improved the predictive and reclassification abilities for MACCE after EVAR. CONCLUSIONS: In patients undergoing EVAR, higher PVAT attenuation was associated with both MACCE and AAA-related adverse events. PVAT attenuation may provide incremental prognostic value for identifying patients at higher risk of unfavorable outcomes following EVAR.Ovid Technologies (Wolters Kluwer Health), 2026年05月, Circulation: Cardiovascular Imaging, 19(5) (5)研究論文（学術雑誌）
- Elsevier BV, 2026年05月, JACC: Cardiovascular Interventions, 19(10) (10), 1274 - 1290研究論文（学術雑誌）
- BACKGROUND: Perivascular adipose tissue (PVAT) attenuation interacts with local and systemic vascular inflammation and consequently contributes to unfavorable clinical outcomes in patients with various cardiovascular diseases. METHODS: We retrospectively analyzed consecutive patients with severe aortic stenosis to investigate the association between PVAT attenuation measured before transcatheter aortic valve replacement (TAVR) and subsequent clinical outcomes. PVAT attenuation was measured using computed tomography angiography images around the aortic valve. The primary outcome was defined as major adverse cardiovascular events (MACE), a composite of all-cause death, stroke, and heart failure rehospitalization. RESULTS: MACE was observed in 23.6% of 233 patients during a median follow-up of 2.2 years. The MACE group had significantly higher PVAT attenuation than the non-MACE group (-74.0±9.8 Hounsfield unit [HU] versus -78.9±9.2 HU, P=0.001). In the Cox regression model, higher PVAT attenuation was independently associated with MACE (hazard ratio: 1.52 [95% CI: 1.13-2.04], P=0.006). Incorporating PVAT attenuation into established prognostic factors following TAVR improved the predictive and reclassification performance of MACE risk. CONCLUSIONS: Elevated PVAT attenuation around the aortic valve was associated with MACE in patients undergoing TAVR. Measuring PVAT attenuation before TAVR can help identify patients at higher risk of developing heart failure or cardiovascular death after TAVR, thereby aiding in treatment strategy decisions. REGISTRATION: URL: https://www.umin.ac.jp/ctr/; Unique Identifier: UMIN000057107.2026年03月, Journal of the American Heart Association, 15(6) (6), e046324, 英語, 国際誌研究論文（学術雑誌）
- Springer Science and Business Media LLC, 2026年01月, Heart and Vessels研究論文（学術雑誌）
- BACKGROUND: Coronary stenting alters vessel dynamics, displacing hinge movement closer to stent edges. We aimed to investigate whether calcified nodules (CNs) are more frequent at stent edges associated with calcium. METHODS: In vessels with previously implanted stents evaluated by optical coherence tomography, 4 different calcified lesions were studied: stent-edge calcified lesions with or without a CN, and unstented native calcified lesions with or without a CN. RESULTS: In 801 patients, 989 stent-edge calcified lesions and 354 unstented native calcified lesions were identified. Stent-edge calcified lesions exhibited a higher prevalence of CNs versus native calcified lesions (15.7% versus 5.1%; P<0.001) and were observed in locations (mid left anterior descending artery, mid left circumflex, or branches) where no unstented native vessel CNs were seen. Stent-edge (versus native vessel) location (odds ratio [OR], 4.58 [95% CI, 2.23-9.43]) predicted the presence of a CN. Correspondingly, greater angiographic (systole-diastole) ∆angle at the stent edge or unstented lesion (per 10°, OR, 2.27 [95% CI, 1.43-3.60]) and greater calcium burden: calcium length (per 10 mm, OR, 4.04 [95% CI, 2.36-6.92]), maximum calcium arc (per 90°, OR, 1.65 [95% CI, 1.25-2.17]), and maximum calcium thickness (per 0.1 mm, OR, 1.25 [95% CI, 1.15-1.36]) were associated with the presence of a CN. Stent-edge CNs were associated with a higher rate of stent-edge calcified lesion-related major adverse cardiac events (a composite of cardiac death, target vessel-related myocardial infarction, clinically driven target lesion revascularization, or definite/probable stent thrombosis) compared with stent edges without a CN (15.9% versus 6.5%; P=0.01), mainly driven by target lesion revascularization. CONCLUSIONS: Stent-edge calcium may predispose to the development of a CN. Stent-edge CNs were associated with a higher major adverse cardiac events rate than stent edges without a CN, whether treated or untreated.2025年07月, Circulation. Cardiovascular interventions, 18(7) (7), e015028, 英語, 国際誌研究論文（学術雑誌）
- Intravascular imaging for acute coronary syndrome is recommended in the guidelines; however, the actual rate of patients with ST-segment elevation myocardial infarction (STEMI) who successfully undergo optical coherence tomography (OCT)-guided primary percutaneous coronary intervention (PCI) is unclear. This study aimed to determine the feasibility of OCT-guided primary PCI and identify the patient population that would benefit most from OCT guidance in STEMI. The ATLAS-OCT trial was a prospective, single-arm, all-comers study conducted at 16 institutions. The primary endpoint was the feasibility of OCT guidance for primary PCI, defined as successful image acquisition (vessel's circumferential or > 270° visualization along > 70% of the lesion's length, as evaluated by an independent core laboratory). A total of 632 patients (mean age: 68.4 years; 80.2% male) were enrolled in the study. OCT-guided PCI was performed in 503 patients, whereas OCT guidance was avoided in 129 patients for patient's condition. Successful image acquisition was achieved in all but seven patients who underwent OCT. The primary endpoint was achieved in 78.5% (496/632) of patients. No procedural complications were associated with OCT. Patients with left main disease (adjusted odds ratio, 4.1; 95% confidence interval, 1.2-14.7; p = 0.024), estimated glomerular filtration rate (mL/min/1.73 m2) < 30 (3.7; 1.6-8.3; p = 0.002), and Killip IV (2.5; 1.3-4.6; p = 0.003) were significantly avoided for OCT guidance. OCT guidance was feasible in four-fifths of all-comers with STEMI. Further studies are warranted to evaluate the efficacy of OCT-guided PCI in selected patient populations based on the findings of this trial (UMIN000048590).2025年07月, Cardiovascular intervention and therapeutics, 40(3) (3), 576 - 587, 英語, 国内誌研究論文（学術雑誌）
- 2025年06月, Circulation journal : official journal of the Japanese Circulation Society, 89(7) (7), 997 - 997, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Pericoronary adipose tissue (PCAT) attenuation, measured using coronary computed tomography angiography (cCTA), is a potential marker of coronary inflammation. AIMS: We aimed to examine the association between coronary inflammation, as assessed by measuring PCAT attenuation before percutaneous coronary intervention (PCI), and clinical outcomes of PCI using current-generation drug-eluting stents (DES). METHODS: We retrospectively studied consecutive patients who underwent cCTA before PCI with current-generation DES. Adverse plaque characteristics, calcified plaque (CP) burden, and PCAT attenuation of the proximal right coronary artery (PCATRCA) were assessed using cCTA. The primary outcome was a patient-oriented composite endpoint (PoCE), including cardiovascular death, non-fatal myocardial infarction, any revascularisation, and stroke. RESULTS: During a median follow-up of 1,540 days, 77 of 490 patients experienced PoCE. Patients with PoCE had higher PCATRCA (-76.3±6.4 Hounsfield units [HU] vs -82.5±8.1 HU; p<0.001). Multivariable analysis showed that the presence of adverse plaque, greater CP burden and higher PCATRCA were independently associated with PoCE (hazard ratio [HR] 2.05, 95% confidence interval [CI]: 1.26-3.34; p=0.004; HR 1.04, 95% CI: 1.02-1.07; p=0.002; and HR 2.20, 95% CI: 1.63-2.97; p<0.001, respectively). PoCE incidence was 3.9 times higher in patients with high PCATRCA (≥-79.9 HU) than those with low PCATRCA (.2025年06月, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 21(11) (11), e605-e616, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Chronic stent recoil can vary according to both stent materials and designs. OBJECTIVES: The authors sought to use serial optical coherence tomography (OCT) to investigate the incidence of chronic stent recoil and its impact on target lesion revascularization (TLR) in second- or newer-generation drug-eluting stent implantation. METHODS: Patients undergoing clinically indicated serial OCT studies (baseline and either at TLR or after more than 6-month follow-up) were studied. Chronic stent recoil was defined as >10% stent volume reduction (over a 10-mm length centered at the maximum recoil site) without fracture or deformation or >10% reduction in cross-sectional stent area with fracture or deformation. RESULTS: Chronic stent recoil occurred in 21.5% (35/163) of lesions undergoing TLR and 7.8% (8/102) of lesions not undergoing TLR during a median of 16.1 (Q1-Q3: 10.1-29.4) months following baseline OCT. In a multivariable generalized logistic mixed model, larger maximum calcium arc (per 90°, OR: 1.64; 95% CI: 1.17-2.29), greater baseline stent expansion (per 10%, OR: 1.41; 95% CI: 1.19-1.83), and greater stent eccentricity index (per 0.1, OR: 0.61; 95% CI: 0.39-0.92) were associated with an increased risk for chronic stent recoil. Greater chronic stent recoil (per 1 mm2, OR: 3.86; 95% CI: 1.57-9.48), greater in-stent tissue growth (per 1 mm2, OR: 4.26; 95% CI: 2.83-6.41), and baseline smaller minimum stent area (1 mm2, OR: 0.38; 95% CI: 0.28-0.51) were associated with TLR. CONCLUSIONS: Chronic stent recoil after second- or new-generation drug-eluting stent implantation occurred in 1 of 5 lesions undergoing TLR and was associated with TLR.2025年05月, JACC. Cardiovascular interventions, 18(9) (9), 1133 - 1144, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Severe calcification is the morphology most strongly associated with stent underexpansion. OBJECTIVES: The aim of this study was to revise an optical coherence tomography (OCT)-derived calcium score to predict stent underexpansion in severely calcified lesions (angle >270°) using a point-based system. METHODS: A retrospective observational study was conducted in which 250 de novo lesions undergoing OCT-guided stenting, with angiographically visible calcium and optical coherence tomographic maximum superficial calcium angle >270°, not subjected to atherectomy or specialty balloon treatment before stent implantation, were randomly divided into derivation (n = 167) and validation (n = 83) cohorts. The endpoint was stent expansion (minimum stent area/average of reference luminal area) at the maximum calcium deposition site, and stent expansion <70% was considered underexpansion. RESULTS: Stent underexpansion was present in 19.6% of lesions (49 of 250). In the multivariable linear regression model, the morphologic characteristics associated with stent expansion in the derivation cohort were: 1) calcium >270° with a length longer than 3 mm (regression coefficient = -10.3; 95% CI: -17.8 to -2.8; P = 0.007); 2) calcium angle of 360° (regression coefficient = -15.5; 95% CI: -25.2 to -5.8; P = 0.002); and 3) minimum calcium thickness >0.30 mm (regression coefficient = -12.4; 95% CI: -19.1 to -5.6; P = 0.0004). In the validation cohort, the calcium score (range: 0-3) was significantly correlated with stent expansion (regression coefficient = -9.1; 95% CI: -12.6 to -6.1; P < 0.0001). CONCLUSIONS: This revised OCT-derived calcium score can serve as a reliable tool for identifying severely calcified lesions at risk for stent underexpansion.2025年03月, JACC. Cardiovascular interventions, 18(5) (5), 622 - 633, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Calcified nodules (CNs) are an increasingly important, high-risk lesion subset. AIMS: We sought to identify the emergence of new CNs and the relation between underlying plaque characteristics and new CN development. METHODS: Patients who had undergone two optical coherence tomography (OCT) studies that imaged the same untreated calcified lesion at baseline and follow-up were included. New CNs were an accumulation of small calcium fragments at follow-up that were not present at baseline. Cardiac death, myocardial infarction (MI), or clinically driven revascularisation related to OCT-imaged, but untreated, calcified lesions were then evaluated. RESULTS: Among 372 untreated calcified lesions, with a median of 1.5 (first and third quartiles: 0.7-2.9) years between baseline and follow-up OCTs, new CNs were observed in 7.0% (26/372) of lesions at follow-up. Attenuated calcium representing residual lipid (odds ratio [OR] 3.38, 95% confidence interval [CI]: 1.15-9.98; p=0.03); log10 calcium volume index (length×maximum arc×maximum thickness; OR 2.76, 95% CI: 1.10-6.95; p=0.03); angiographic Δangle between systole and diastole, per 10° (OR 2.30, 95% CI: 1.25-4.22; p=0.01); and time since baseline OCT, per year (OR 1.36, 95% CI: 1.05-1.75; p=0.02) were all associated with new CN development. Clinical events were revascularisation and/or MI and were more frequent in lesions with versus without a new CN (29.3% vs 15.3%; p=0.04). CONCLUSIONS: New CNs developed in untreated, lipid-containing, severely calcified lesions with a larger angiographic hinge motion (between systole and diastole), compared with lesions without CNs, and were associated with worse clinical outcomes.2024年11月, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 20(21) (21), e1330-e1339, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Proprotein convertase subtilisin/kexin type 9 inhibitors stabilize vulnerable plaque, reducing cardiovascular events. However, manual optical coherence tomography (OCT) analysis of drug efficacy is challenging because of signal attenuation within lipid plaques. METHODS AND RESULTS: Twenty-four patients with thin-cap fibroatheroma were prospectively enrolled and randomized to receive alirocumab (75 mg every 2 weeks) plus rosuvastatin (10 mg/day) or rosuvastatin (10 mg/day) alone. OCT images at baseline and 36 weeks were analyzed manually and with artificial intelligence (AI)-aided software. AI-aided OCT analysis showed significantly greater percentage changes in the alirocumab+rosuvastatin vs. rosuvastatin-alone group in fibrous cap thickness (FCT; median [interquartile range] 212.3% [140.5-253.5%] vs. 88.6% [63.0-119.6%]; P=0.006) and lipid volume (median [interquartile range] -30.8% [-51.8%, -16.6%] vs. -2.1% [-21.6%, 4.3%]; P=0.015). Interobserver reproducibility for changes in minimum FCT and lipid index was relatively low for manual analysis (interobserver intraclass correlation coefficient [ICC] 0.780 and 0.499, respectively), but high for AI-aided analysis (interobserver ICC 0.999 and 1.000, respectively). Agreements between manual and AI-aided OCT analyses of FCT and the lipid index were acceptable (concordance correlation coefficients 0.859 and 0.833, respectively). CONCLUSIONS: AI-aided OCT analysis objectively showed greater plaque stabilization of adding alirocumab to rosuvastatin. Our results highlight the benefits of a fully automated AI-assisted approach for assessing drug efficacy, offering greater objectivity in evaluating serial changes in plaque stability vs. conventional OCT assessment.2024年10月, Circulation journal : official journal of the Japanese Circulation Society, 88(11) (11), 1809 - 1818, 英語, 国内誌研究論文（学術雑誌）
- 2024年04月, Circulation, 149(14) (14), 1087 - 1089, 英語, 国際誌
- BACKGROUND: Intravascular ultrasound (IVUS) studies show that one-quarter of left anterior descending (LAD) arteries have a myocardial bridge. An MB may be associated with stent failure when the stent extends into the MB. OBJECTIVES: The aim of this study was to investigate: 1) the association between an MB and chronic total occlusion (CTO) in any LAD lesions; and 2) the association between an MB and subsequent clinical outcomes after percutaneous coronary intervention in LAD CTOs. METHODS: A total of 3,342 LAD lesions with IVUS-guided percutaneous coronary intervention (280 CTO and 3,062 non-CTO lesions) were included. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, and ischemic-driven target lesion revascularization). RESULTS: An MB by IVUS was significantly more prevalent in LAD CTOs than LAD non-CTOs (40.4% [113/280] vs 25.8% [789/3,062]; P < 0.0001). The discrepancy in CTO length between angiography and IVUS was greater in 113 LAD CTOs with an MB than 167 LAD CTOs without an MB (6.0 [Q1, Q3: 0.1, 12.2] mm vs 0.2 [Q1, Q3: -1.4, 8.4] mm; P < 0.0001). Overall, 48.7% (55/113) of LAD CTOs had a stent that extended into an MB after which target lesion failure was significantly higher compared to a stent that did not extend into an MB (26.3% vs 0%; P = 0.0004) or compared to an LAD CTO without an MB (26.3% vs 9.6%; P = 0.02). CONCLUSIONS: An MB was more common in LAD CTO than non-CTO LAD lesions. If present, approximately one-half of LAD CTOs had a stent extending into an MB that, in turn, was associated with worse outcomes.2024年02月, JACC. Cardiovascular interventions, 17(4) (4), 491 - 501, 英語, 国際誌研究論文（学術雑誌）
- Background The prognostic impact of optical coherence tomography-diagnosed culprit lesion morphology in acute coronary syndrome (ACS) has not been systematically examined in real-world settings. Methods and Results This investigator-initiated, prospective, multicenter, observational study was conducted at 22 Japanese hospitals to identify the prevalence of underlying ACS causes (plaque rupture [PR], plaque erosion [PE], and calcified nodules [CN]) and their impact on clinical outcomes. Patients with ACS diagnosed within 24 hours of symptom onset undergoing emergency percutaneous coronary intervention were enrolled. Optical coherence tomography-guided percutaneous coronary intervention recipients were assessed for underlying ACS causes and followed up for major adverse cardiac events (cardiovascular death, myocardial infarction, heart failure, or ischemia-driven revascularization) at 1 year. Of 1702 patients with ACS, 702 (40.7%) underwent optical coherence tomography-guided percutaneous coronary intervention for analysis. PR, PE, and CN prevalence was 59.1%, 25.6%, and 4.0%, respectively. One-year major adverse cardiac events occurred most frequently in patients with CN (32.1%), followed by PR (12.4%) and PE (6.2%) (log-rank P<0.0001), primarily driven by increased cardiovascular death (CN, 25.0%; PR, 0.7%; PE, 1.1%; log-rank P<0.0001) and heart failure trend (CN, 7.1%; PR, 6.8%; PE, 2.2%; log-rank P<0.075). On multivariate Cox regression analysis, the underlying ACS cause was associated with 1-year major adverse cardiac events (CN [hazard ratio (HR), 4.49 [95% CI, 1.35-14.89], P=0.014]; PR (HR, 2.18 [95% CI, 1.05-4.53], P=0.036]; PE as reference). Conclusions Despite being the least common, CN was a clinically significant underlying ACS cause, associated with the highest future major adverse cardiac events risk, followed by PR and PE. Future studies should evaluate the possibility of ACS underlying cause-based optical coherence tomography-guided optimization.2023年10月, Journal of the American Heart Association, 12(20) (20), e030412, 英語, 国際誌研究論文（学術雑誌）
- Even after successful revascularization with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), subsequent adverse events still occur. Previous studies have suggested potential benefits of intravascular imaging, including optical coherence tomography (OCT). However, the feasibility of OCT-guided primary PCI has not been systematically examined in these patients. The ATLAS-OCT (ST-elevation Acute myocardial infarcTion and cLinicAl outcomeS treated by Optical Coherence Tomography-guided percutaneous coronary intervention) trial was designed to investigate the feasibility of OCT guidance during primary PCI for STEMI in experienced centers with expertise on OCT-guided PCI as a prospective, multicenter registry of consecutive patients with STEMI who underwent a primary PCI. The sites' inclusion criteria are as follows: (1) acute care hospitals providing 24/7 emergency care for STEMI, and (2) institutions where OCT-guided PCI is the first choice for primary PCI in STEMI. All patients with STEMI who underwent primary PCI at participating sites will be consecutively enrolled, irrespective of OCT use during PCI. The primary end point will be the rate of successful OCT imaging during the primary PCI. As an ancillary imaging modality to angiography, OCT provides morphologic information during PCI for the assessment of plaque phenotypes, vessel sizing, and PCI optimization. Major adverse cardiac events, defined as a composite of all-cause death, myocardial infarction, and target vessel revascularization at 1 year, will also be recorded. The ATLAS-OCT study will clarify the feasibility of OCT-guided primary PCI for patients with STEMI and further identify a suitable patient group for OCT-guided primary PCI.2023年09月, The American journal of cardiology, 203, 466 - 472, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Accurate intravascular ultrasound (IVUS) measurements are important in IVUS-guided percutaneous coronary intervention optimization by choosing the appropriate device size and confirming stent expansion. OBJECTIVES: The purpose of this study was to assess the accuracy of machine learning (ML) automatic segmentation of coronary artery vessel and lumen dimensions and balloon sizing. METHODS: Using expert analysis as the gold standard, ML segmentation of 60 MHz IVUS images was developed using 8,076 IVUS cross-sectional images from 234 patients, which were randomly split into training (83%) and validation (17%) data sets. The performance of ML segmentation was then evaluated using an independent test data set (437 images from 92 patients). The endpoints were the agreement rate between ML vs experts' measurements for appropriate balloon size selection, and lumen and acute stent areas. Appropriate balloon size was determined by rounding down from the mean vessel diameter or rounding up from the mean lumen diameter to the next balloon size. The difference of lumen area ≥0.5 mm2 was considered as clinically significant. RESULTS: ML model segmentation correlated well with experts' segmentation for training data set with a correlation coefficient of 0.992 and 0.993 for lumen and vessel areas, respectively. The agreement rate in lumen and acute stent areas was 85.5% and 97.0%, respectively. The agreement rate for appropriate balloon size selection was 70.6% by vessel diameter only and 92.4% by adding lumen diameter. CONCLUSIONS: ML model IVUS segmentation measurements were well-correlated with those of experts and selected an appropriate balloon size in more than 90% of images.2023年09月, JACC. Advances, 2(7) (7), 100564 - 100564, 英語, 国際誌研究論文（学術雑誌）
- The initial process of atherosclerotic development has not been systematically evaluated. This study aimed to observe atherosclerotic progression from normal vessel wall (NVW) to atherosclerotic plaque and examine local factors associated with such progression using > 5-year long-term follow-up data obtained by serial optical coherence tomography (OCT). A total of 49 patients who underwent serial OCT for lesions with NVW over 5 years (average: 6.9 years) were enrolled. NVW was defined as a vessel wall with an OCT-detectable three-layer structure and intimal thickness ≤ 300 μm. Baseline and follow-up OCT images were matched, and OCT cross sections with NVW > 30° were enrolled. Cross sections were diagnosed as "progression" when the NVW in these cross sections was reduced by > 30° at > 5-year follow-up. Atherogenic progression from NVW to atherosclerotic plaque was observed in 40.8% of enrolled cross sections. The incidence of microchannels in an adjacent atherosclerotic plaque within the same cross section (6.7 vs. 3.3%; p = 0.046) and eccentric distribution of atherosclerotic plaque (25.0 vs. 12.6%; p < 0.001) at baseline was significantly higher in cross sections with progression than in those without. Cross sections with progression exhibited significantly higher NVW intimal thickness at baseline than cross sections without progression (200.1 ± 53.7 vs. 180.2 ± 59.6 μm; p < 0.001). Multivariate analysis revealed that the presence of microchannels in an adjacent atherosclerotic plaque, eccentric distribution of atherosclerotic plaque, and greater NVW intimal thickness at baseline were independently associated with progression at follow-up. The presence of microchannels in an adjacent atherosclerotic plaque, eccentric distribution of atherosclerotic plaque, and greater NVW intimal thickness were potentially associated with initial atherosclerotic development from NVW to atherosclerotic plaque.2022年01月, Heart and vessels, 37(1) (1), 1 - 11, 英語, 国内誌研究論文（学術雑誌）
- Objective The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare systems. Some studies have reported the negative impact of COVID-19 on ST-elevation myocardial infarction (STEMI) patients; however, the impact in Japan remains unclear. This study investigated the impact of the COVID-19 pandemic on STEMI patients admitted to an academic tertiary-care center in Tokyo, Japan. Methods In this retrospective, observational, cohort study, we included 398 consecutive patients who were admitted to our institute from January 1, 2018, to March 10, 2021, and compared the incidence of hospitalization, clinical characteristics, time course, management, and outcomes before and after March 11, 2020, the date when the World Health Organization declared COVID-19 a pandemic. Results There was a 10.7% reduction in hospitalization of STEMI patients during the COVID-19 pandemic compared with that in the previous year (117 vs. 131 cases). During the COVID-19 pandemic, the incidence of late presentation was significantly higher (26.5% vs. 12.1%, p<0.001), and the onset-to-door [241 (IQR: 70-926) vs. 128 (IQR: 66-493) minutes, p=0.028] and door-to-balloon [72 (IQR: 61-128) vs. 60 (IQR: 43-90) min, p<0.001] times were significantly longer than in the previous year. Furthermore, the in-hospital mortality was higher, but the difference was not significant (9.4% vs. 5.0%, p=0.098). Conclusion The COVID-19 pandemic significantly impacted STEMI patients in Tokyo and resulted in a slight decrease in hospitalization, a significant increase in late presentation and treatment delays, and a slight but nonsignificant increase in mortality. In the COVID-19 era, the acute management system for STEMI in Japan must be reviewed.2021年12月, Internal medicine (Tokyo, Japan), 60(23) (23), 3693 - 3700, 英語, 国内誌研究論文（学術雑誌）
- Culprit lesions of acute coronary syndrome (ACS) could be classified as plaque rupture (PR), erosion, or calcified nodule (CN). We aimed to determine the relationship among clinical characteristics, morphological plaque features, and long-term prognosis in ACS. Patients with ACS, who underwent pre-intervention optical coherence tomography between April 2013 and July 2018 were retrospectively enrolled, and classified into the three groups based on the culprit lesion morphology. In the 436 patients enrolled, incidences of PR, erosion, and CN in ACS culprit lesions were 46.1, 39.9, and 14.0%, respectively. Plaque erosion was more frequent in men aged < 60 years and CN was more frequent in older adults in both sexes (≥ 80 years) (P < 0.001). Patients with CN had a higher incidence of hemodialysis treatment (P < 0.001) and diabetes (P = 0.003). Multivariate analysis revealed that ST elevation myocardial infarction (STEMI) (P = 0.049) and presence of thin-cap fibroatheroma (TCFA) at the culprit lesion were independently associated with PR; in younger patients (< 60 year), preserved left ventricular ejection fraction and lower incidence of TCFA were correlated with plaque erosion; and older age, non-STEMI, or unstable angina pectoris, higher serum brain natriuretic peptide levels, and lower incidence of TCFA were independently associated with CN. Multivariable analysis revealed that CN (odds ratio [OR] 1.990, P = 0.005), male sex (OR 2.012, P = 0.004), and older age (OR 1.036, P < 0.001) were independently associated with future adverse events during a median follow-up of 757 days. Different patient characteristics and morphological features were associated with the type of culprit lesion in patients with ACS.2021年10月, The international journal of cardiovascular imaging, 37(10) (10), 2827 - 2837, 英語, 国際誌研究論文（学術雑誌）
- Background: The effect of intraindividual variability in lipid levels on the onset of acute coronary syndrome (ACS) remains uncertain. We evaluated the relationship between intraindividual variability in lipid levels and culprit lesion morphologies by optical coherence tomography (OCT). Methods and Results: Seventy-four consecutive patients with ACS whose cholesterol levels were assessed ≥3 times during outpatient visits before the onset of ACS were enrolled in the study; 222 patients without significant stenotic lesions were used as a control group. Based on OCT findings of culprit lesions, ACS patients were categorized into a plaque rupture ACS (PR-ACS) group (n=44) or a non-plaque rupture ACS (NPR-ACS) group (erosion or calcified nodule; n=30). Visit-to-visit variability in lipid levels was evaluated using the corrected variability independent of the mean (cVIM). Patients with ACS had significantly higher low-density lipoprotein cholesterol (LDL-C) levels and cVIM in LDL-C than the control group. The PR-ACS group had significantly higher mean LDL-C levels and greater cVIM in LDL-C than the control group. The PR-ACS group had a significantly higher cVIM than the NPR-ACS group, despite similar mean LDL-C levels. Multivariate analysis revealed that higher cVIM of LDL-C was an independent predictor of PR-ACS (odds ratio 1.06; P=0.018). Conclusions: In addition to the LDL-C level, greater visit-to-visit variability in LDL-C levels may be associated with the onset of ACS induced by plaque rupture.2021年09月, Circulation reports, 3(9) (9), 540 - 549, 英語, 国内誌研究論文（学術雑誌）
- Whether predicting the rotational atherectomy (RA) effect based on the position of optical frequency domain imaging (OFDI) is accurate remains uncertain. The aim of this study was to evaluate the predictive accuracy of OFDI in identifying RA location and area. Twenty-five patients who underwent RA with OFDI were included. On pre-RA OFDI images, a circle with the dimension of a Rota burr was drawn at the center of the OFDI catheter. The area where the circle overlapped with the vessel wall was defined as the predicted ablation area (P-area), and the actual ablated area (A-area) was measured. The predictive accuracy of OFDI was evaluated as follows: overlapped ablation area (O-area: overlapping P- and A-areas) divided by P-area = %Correct-area, and A-area - O-area divided by A-area = %Error-area. Cross-sections were separated into four categories based on the median values of %Correct- and %Error-area. Among 334 cross-sections, RA effects were confirmed in the predicted location in 87% of them. The median %Correct- and %Error-areas were 43.1% and 64.2%, respectively. Floppy wire, narrow lumen area, OFDI catheter close to the intima, and large arc of calcium were independently associated with good prediction (high %Correct-/low %Error-areas). Non-left anterior descending lesions, OFDI catheter far from the wire, and OFDI catheter and wire far from the intima were associated with irrelevant ablation (low %Correct-/ high %Error-areas). The accuracy of the OFDI-based predictions for RA effects was acceptable with regard to location, but not high with regard to area. Wire types, target vessels, and OFDI catheter and wire positions are important determinants for accurately predicting RA effect using pre-procedural OFDI.2021年09月, Heart and vessels, 36(9) (9), 1265 - 1274, 英語, 国内誌研究論文（学術雑誌）
- 2021年01月, JACC. Cardiovascular imaging, 14(1) (1), 315 - 317, 英語, 国際誌
- BACKGROUND: In-stent neoatherosclerosis (NA) is a risk for future cardiovascular events through atherosclerotic progression in non-stented lesions. Using optical coherence tomography, this study assessed the efficacy of intensive therapy with 10 mg/day rosuvastatin plus 1,800 mg/day eicosapentaenoic acid (EPA) vs. standard 2.5 mg/day rosuvastatin therapy on native coronary plaques in patients with NA. METHODS AND RESULTS: This was a subgroup analysis of the randomized LINK-IT trial, which was designed to compare changes in the lipid index in NA between intensive and standard therapy for 12 months. In all, 42 patients with native coronary plaques and NA were assessed. Compared with standard therapy, intensive therapy resulted in greater decreases in serum low-density lipoprotein cholesterol concentrations and greater increases in serum 18-hydroxyeicosapentaenoic acid concentrations, with significantly greater decreases in the lipid index and macrophage grade in both NA (-24 vs. 217 [P<0.001] and -15 vs. 24 [P<0.001], respectively) and native coronary plaques (-112 vs. 29 [P<0.001] and -17 vs. 1 [P<0.001], respectively) following intensive therapy. Although there was a greater increase in the macrophage grade in NA than in native coronary plaques in the standard therapy group, in the intensive therapy group there were comparable reductions in macrophage grade between NA and native coronary plaques. CONCLUSIONS: Compared with standard therapy, intensive therapy prevented atherosclerotic progression more effectively in native coronary plaques in patients with NA.2020年09月, Circulation journal : official journal of the Japanese Circulation Society, 84(10) (10), 1826 - 1836, 英語, 国内誌研究論文（学術雑誌）
- Elsevier BV, 2020年06月, JACC: Cardiovascular Imaging, 13(6) (6), 1452 - 1454研究論文（学術雑誌）
- Background We evaluated the importance of high-density lipoprotein (HDL) functionality for target-lesion revascularization in patients treated with coronary stents using a rapid cell-free assay system to evaluate the functional capacity of HDL to accept additional cholesterol (cholesterol-uptake capacity; CUC). Methods and Results From an optical coherence tomography (OCT) registry of patients treated with coronary stents, 207 patients were enrolled and their HDL was functionally evaluated by measuring the CUC. Follow-up OCT was performed (median duration, 24.5 months after stenting) to evaluate the presence of neoatherosclerosis. Clinical follow-up was performed to assess target-lesion revascularization for a median duration of 42.3 months after stent implantation. Neoatherosclerosis was identified in 37 patients (17.9%). Multivariate logistic regression analysis revealed that a decreased CUC was independently associated with neoatherosclerosis (odds ratio, 0.799; P<0.001). The CUC showed a significant inverse correlation with incidence of target-lesion revascularization (odds ratio, 0.887; P=0.003) and with lipid accumulation inside stents, suggesting that neoatherosclerosis contributes to the association between CUC and target-lesion revascularization. Conclusions Impaired HDL functionality, detected as decreased CUC, might lead to future stent failure by provoking atherogenic changes of the neointima within stents. Both quantitative and qualitative assessments of HDL might enable the improved prediction of clinical outcomes after stent implantation.2019年05月, Journal of the American Heart Association, 8(9) (9), e011975, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Although a recent clinical trial demonstrated that alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, significantly reduces the incidence of acute coronary events, the impact of alirocumab on plaque stabilization remains uncertain. The Efficacy of ALirocumab for Thin-cap fibroatheroma in patients with coronary Artery disease estImated by optical coherence tomogRaphy (ALTAIR) study will investigate the effect of alirocumab on thin-cap fibroatheroma (TCFA) in Japanese patients who underwent recent percutaneous coronary intervention (PCI). METHODS AND DESIGN: ALTAIR is a phase IV, open-label, randomized, parallel-group, single-center study involving blinded optical coherence tomography (OCT) image analysis in Japanese adults hospitalized for PCI and having suboptimal control of low-density lipoprotein cholesterol (LDL-C) levels (>70mg/dL) despite statin therapy. Patients will be randomized (1:1) to the alirocumab arm (alirocumab 75mg every 2 weeks added to rosuvastatin 10mg/day) or the standard-of-care arm (rosuvastatin 10mg/day, with initiation and/or dose adjustment of non-statin lipid-lowering to achieve an LDL-C target of <70mg/dL). OCT imaging will be conducted at baseline and at week 36 (post-treatment). The primary objective is to compare the alirocumab and standard-of-care arms regarding the change in TCFA fibrous-cap thickness after 9 months of treatment. CONCLUSION: The outcomes of ALTAIR (ClinicalTrials.gov identifier: NCT03552432) will provide insights into the effect of alirocumab on plaque vulnerability following PCI in patients with suboptimal LDL-C control despite stable statin therapy.2019年03月, J Cardiol, 73(3) (3), 228 - 232, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- (一社)日本循環器学会, 2019年03月, 日本循環器学会学術集会抄録集, 83回, SY12 - 2, 英語JDS-JCSジョイントシンポ(Controversy or Debate)-"Stop DM for Stop CVD"生命予後改善のための糖尿病管理とは ブドウ糖変動が安定冠動脈疾患患者の心血管転帰に与える影響(The Impact of Glucose Fluctuation on Cardiovascular Outcome in Patients with Stable Coronary Artery Disease)
- Japanese Circulation Society, 2019年02月, Circulation Reports, 1(2) (2), 107 - 111研究論文（学術雑誌）
- The impact of dual antiplatelet therapy (DAPT) with adjusted-dose (3.75 mg/day) prasugrel for Japanese patients has not been fully investigated in terms of local arterial healing following the elective percutaneous coronary intervention (PCI). The ROUTE-01 elective study was a prospective, 12-center and single-arm registry that enrolled 123 patients who underwent elective PCI with everolimus-eluting stents (EESs) under DAPT with a combination of adjusted-dose prasugrel and aspirin. Serial optical coherence tomography (OCT) was performed at the index PCI and 9-month follow-up to assess the relationship between in-stent thorombus (IST) and residual platelet reactivity measuring platelet reactivity unit (PRU). The patients were classified as extensive, intermediate, and poor metabolizers by cytochrome P450 2C19 (CYP2C19) loss-of-function polymorphisms. The prevalence of IST was 9.0% by 9-month OCT, with no difference amongst the three groups (p = 0.886). The incidences of malapposed and uncovered struts were not different among the groups. PRU was not statistically different among the groups. In multivariate logistic regression analysis, the independent predictor for IST on 9-month OCT was irregular protrusion (odds ratio = 8.952, p = 0.037) on post-PCI OCT, not CYP2C19 loss-of-function polymorphisms. An adequate anti-thrombotic effect with an acceptable incidence of IST was observed irrespective of CYP2C19 loss-of-function polymorphisms. Our data suggests that adjusted-dose prasugrel and aspirin is a feasible treatment option in Japanese patients treated with EESs in elective PCI.2019年01月, Heart Vessels, 34(6) (6), 936 - 947, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- An 82-year-old man with severe aortic stenosis and idiopathic pulmonary fibrosis (IPF) underwent transcatheter aortic valve implantation (TAVI) under general anesthesia. However, following a successful TAVI procedure, he developed progressive respiratory failure because of the exacerbation of IPF. Despite the use of immunosuppressants, the patient could not be saved and he died of respiratory failure. Although TAVI is a less invasive procedure compared to conventional surgical aortic valve replacement, it is currently selected for management of severely ill, frail, and elderly patients. This case highlights the potential risk of IPF exacerbation following a TAVI procedure performed under general anesthesia.2018年08月, J CARDIOL CASES, 18(5) (5), 171 - 174, 英語, 国内誌
. [査読有り]研究論文（学術雑誌） - 2018年07月, Heart Vessels., 英語Impact of the angiographic burden on the incidence of out-of-hospital ventricular fibrillation in patients with acute myocardial infarction.[査読有り]研究論文（学術雑誌）
- 2013年, INTERNAL MEDICINE, 52(1) (1), 71 - 74, 英語[査読有り]研究論文（学術雑誌）
- (一社)日本心臓病学会, 2021年09月, 日本心臓病学会学術集会抄録, 69回, O - 156, 日本語本邦におけるCOVID-19パンデミックがST上昇型心筋梗塞患者に与える影響
- (一社)日本循環器学会, 2021年03月, 日本循環器学会学術集会抄録集, 85回, SS13 - 4, 英語Standardized Team-based Care for Cardiogenic Shock Concomitant with Myocardial Infarction Using SCAI Shock Classification in Multidisciplinary "Shock Team"(和訳中)
- 2021年, 日本集中治療医学会学術集会(Web), 48th心原性ショック合併急性心筋梗塞に対して血行再建前のImpella導入により再灌流が得られた1例
- 2021年, 日本心臓病学会学術集会(Web), 69th左室駆出率が軽度低下した心不全(HFmrEF)患者に対する入院中の積極的な心保護薬治療の導入は左室駆出率を改善する.
- 2021年, ICUとCCU, 453枝病変を有する心原性ショックに対し,IMPELLA補助下で内科的治療を優先し,待機的に外科的完全血行再建を行い良好な経過が得られた1例
- 2021年, 日本循環器学会学術集会(Web), 85th劇症心筋炎の臨床経過における心機能改善例の予測因子
- 2021年, 日本循環器学会学術集会(Web), 85th初期の乳酸値とSOFAスコアは,急性心筋梗塞を合併する心原性ショックにおける生存を予測する
- (一社)日本脈管学会, 2020年10月, 脈管学, 60(Suppl.) (Suppl.), S128 - S129, 日本語再発した急性冠症候群患者の特徴と二次予防
- 2020年, 脈管学(Web), 60(supplement) (supplement)再発した急性冠症候群患者の特徴と二次予防
- 2020年, 日本集中治療医学会関東甲信越支部学術集会プログラム・抄録集(Web), 4th拡張型心筋症による難治性心原性ショックにImpellaを導入し管理中に,敗血症性ショック,脳出血をきたしたが,集学的治療により救命しえた一例
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