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伊澤 有医学部附属病院 冠動脈疾患治療部助教
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■ 論文- 2025年10月, JACC. Clinical electrophysiology, 11(10) (10), 2273 - 2279, 英語, 国際誌研究論文（学術雑誌）
- ANATOMY: Phrenic nerves descend anterior to the pulmonary hila, sandwiched between the pericardium and parietal pleura, thus running extrinsically to the heart and lungs. PATHOLOGY: Phrenic nerve injury during catheter ablation or diaphragmatic stimulation during cardiac resynchronization therapy. IMAGING CORRELATION: Conventional approach of preprocedural identification of the phrenic nerve includes slice-by-slice detection of the pericardiophrenic bundle using axial images. However, it is time-consuming with substantial uncertainty and difficulty in precise structural tracing in each axial plane. Three-dimensional visualization using a volume rendering technique has a distinct advantage for detecting fine structures and their anatomical course. TREATMENT: Preprocedural identification of the 3-dimensional course of the phrenic nerve in relation to surrounding structures is useful in avoiding iatrogenic injury of the phrenic nerve or predicting diaphragmatic stimulation. TAKE-HOME MESSAGE: Volume rendering reconstruction offers fast and easy 3-dimensional identification of the phrenic nerve and is even feasible without a contrast material.2025年09月, JACC. Case reports, 30(27) (27), 104947 - 104947, 英語, 国際誌研究論文（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: Nodular calcification (NC) detected via intracoronary imaging is associated with adverse cardiovascular events after percutaneous coronary intervention (PCI). However, the impact of NC detected on pre-PCI non-contrast computed tomography (CT) on clinical outcomes has not been fully investigated. METHODS AND RESULTS: We retrospectively included 267 consecutive patients with chronic coronary syndrome who underwent electrocardiography-gated non-contrast CT before PCI for severely calcified lesions. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, stroke, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-eight patients had NC detected on non-contrast CT in target lesions. The MACCE-free survival rate was significantly lower in patients with than without NC (P<0.001). All-cause death, cardiac death, and TLR-free survival rates were significantly lower among patients with than without NC. Multivariate Cox regression analysis revealed that hemodialysis (hazard ratio [HR] 3.00; P=0.003), peripheral artery disease (HR 2.65; P=0.01), and the presence of NC (HR 5.25; P<0.001) were independently associated with MACCE. Adding NC to traditional cardiovascular risk factors, peripheral artery disease, and hemodialysis can provide discriminatory and reclassification abilities in predicting MACCE. CONCLUSIONS: NC detected on non-contrast CT was independently associated with MACCE. Therefore, evaluating NC using preprocedural non-contrast CT may be useful in predicting future clinical outcomes after PCI.2025年06月, Circulation journal : official journal of the Japanese Circulation Society, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Cryoballoon ablation (CBA) is useful for pulmonary vein (PV) isolation. However, some cases are challenging, requiring multiple applications and/or touch-up ablations. Although several predictors of CBA difficulty have been reported, none have assessed the spatial location and morphology of the left atrium and PVs. This study aimed to develop a three-dimensional (3D) deep learning (DL) model to predict CBA difficulty and compare its accuracy with conventional manual measurement. METHODS: A 28-mm cryoballoon (Arctic Front Advance, Medtronic) was used in all cases. CBA difficulty was defined as requiring touch-up ablation and/or more than three applications per PV. We developed a DL model that can learn polygonal meshes and predict CBA difficulty. In the conventional method, predictors included a thinner left lateral ridge, higher left superior PV (LSPV) ovality index, longer LSPV ostium-bifurcation distance, and shorter right inferior PV ostium-bifurcation distance. RESULTS: A total of 189 patients who underwent CBA for drug-resistant atrial fibrillation between January 2015 and January 2022 were included. The DL model was superior to the conventional method in accuracy (0.793 vs. 0.630, p = .042) and specificity (0.796 vs. 0.609, p = .022), with the AUC-ROC of 0.821. CONCLUSIONS: We developed a 3D DL model that can detect CBA difficulty using a polygonal mesh representation. By predicting difficult cases in advance, strategies can be developed to increase success rates.2025年04月, Journal of arrhythmia, 41(2) (2), e70078, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Calcification score by cardiac computed tomography (CT) is required for diagnosis of paradoxical low-flow/low-gradient (PLFLG) aortic stenosis (AS). According to the guideline, velocity ratio (VR) < 0.25 by echocardiography is defined as severe AS, but utility of VR in patients with PLFLG AS remains unknown. This retrospective study was therefore conducted to investigate the utility of VR for a diagnosis of severe AS based on CT in patients with PLFLG AS. METHODS: We studied 58 patients with PLFLG AS. Severity of AS was defined as calcium score derived from cardiac CT. RESULTS: Of the 58 patients, 28 (48.3%) were diagnosed with severe AS based on CT, while 23 of them (82.1%) had VR < 0.25. It was noteworthy that receiver operating characteristic curve analysis showed that the optimal VR cutoff value for a diagnosis of severe AS was 0.25, with an area under the curve of 0.870 (P < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value of VR < 0.25 for a diagnosis of severe AS were 82.1%, 86.7%, 85.2% and 83.9%, respectively. Furthermore, patients who match the value of VR and severity of AS based on CT had higher prevalence of atrial fibrillation, higher serum brain natriuretic peptide concentration, larger left ventricular end-diastolic volume, and left ventricular stroke volume index. CONCLUSION: The measurement of VR is simple, and VR < 0.25 can be used for diagnosis of patients with PLFLG AS as severe. Our findings may thus have clinical implications for routine clinical practice.2025年03月, Journal of echocardiography, 23(1) (1), 41 - 47, 英語, 国内誌研究論文（学術雑誌）
- 2025年02月, HeartRhythm case reports, 11(2) (2), 96 - 100, 英語, 国際誌研究論文（学術雑誌）
- 2025年01月, JACC. Case reports, 30(2) (2), 102753 - 102753, 英語, 国際誌研究論文（学術雑誌）
- We revisit and show comprehensive femoral access site anatomy with a combination of images obtained from detailed cadaveric dissection, fluoroscopy, computed tomography, ultrasound, and 3-dimensional printings. Part 1 focuses on the femoral triangle, femoral bifurcation, fluoroscopic and/or ultrasonographic anatomy, and branches of the femoral artery. Profound understanding of this region is fundamental to facilitate safe procedures and to avoid unnecessary complications.2024年12月, JACC. Case reports, 29(23) (23), 102807 - 102807, 英語, 国際誌研究論文（学術雑誌）
- This paper revisits and shows comprehensive femoral access site anatomy with a combination of images obtained from detailed cadaveric dissection, fluoroscopy, computed tomography, ultrasound, and 3-dimensional printings. Part 2 focuses on the fluoroscopic anatomy, pelvic cavity, and complications. In addition, a file for 3-dimensional printing is provided. Profound understanding of this region is fundamental to facilitate safe procedures and to avoid unnecessary complications.2024年12月, JACC. Case reports, 29(23) (23), 102800 - 102800, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Hemothorax caused by a right intercostal artery (ICA) injury behind the left atrium (LA) is a potentially fatal complication during pulmonary vein isolation. However, their anatomic relationship has not been fully elucidated. OBJECTIVE: This study aimed to investigate the clinical anatomy of the right ICA in relation to the LA. METHODS: This retrospective study included 100 patients (70.2 ± 10.6 years; 39.0% female) who underwent cardiac computed tomography. The patients were divided into sinus rhythm and atrial fibrillation groups. We focused on the distance between the LA and right ICAs and its predictive factors. RESULTS: On average, 3.7 ± 0.7 right ICAs were found behind the LA. Of these, the eighth ICA was the closest in 54% of the cases, followed by the seventh ICA in 29% and the ninth ICA in 14%. The average closest distance between them was 3.8 ± 3.8 mm, which was significantly shorter in the atrial fibrillation group than in the sinus rhythm group (3.0 ± 3.2 mm vs 4.7 ± 4.2 mm; P = .006). Multivariate analysis revealed that a thinner chest cavity (β = -0.512; P = .002) and LA dilation (β = -0.432; P = .001) were predictors of shorter distance. The closest points distributed along the vertebral column, generally near the inferior pulmonary vein orifices. CONCLUSION: Right ICA-LA proximity was systematically clarified. Particularly in cases with an enlarged LA or thin chest cavity, operators should be aware of the potential risk of injuring the right ICA during pulmonary vein isolation.2024年09月, Heart rhythm, 英語, 国際誌研究論文（学術雑誌）
- The 88thAnnual Scientific Meeting of the Japanese Circulation Society (JCS2024) was held from Friday, March 8thto Sunday, March 10thin Kobe, Japan. The main theme of this 3-day meeting was "The Future of Cardiology: Challenges in Overcoming Cardiovascular Disease". As COVID-19 has been finally conquered, with revision of its categorization under the Infectious Disease Control Law and relaxation of infection prevention measures, it was once again possible to have face-to-face presentations and lively discussion. JCS2024 was a major success, with 19,209 participants and attendees, thanks to the greatly appreciated cooperation and support from all affiliates.2024年08月, Circulation journal : official journal of the Japanese Circulation Society, 88(9) (9), 1502 - 1508, 英語, 国内誌研究論文（学術雑誌）
- 2024年06月, JACC. Clinical electrophysiology, 10(6) (6), 1223 - 1231, 英語, 国際誌研究論文（学術雑誌）
- RATIONALE AND OBJECTIVES: Pericardial fat (PF)-the thoracic visceral fat surrounding the heart-promotes the development of coronary artery disease by inducing inflammation of the coronary arteries. To evaluate PF, we generated pericardial fat count images (PFCIs) from chest radiographs (CXRs) using a dedicated deep-learning model. MATERIALS AND METHODS: We reviewed data of 269 consecutive patients who underwent coronary computed tomography (CT). We excluded patients with metal implants, pleural effusion, history of thoracic surgery, or malignancy. Thus, the data of 191 patients were used. We generated PFCIs from the projection of three-dimensional CT images, wherein fat accumulation was represented by a high pixel value. Three different deep-learning models, including CycleGAN were combined in the proposed method to generate PFCIs from CXRs. A single CycleGAN-based model was used to generate PFCIs from CXRs for comparison with the proposed method. To evaluate the image quality of the generated PFCIs, structural similarity index measure (SSIM), mean squared error (MSE), and mean absolute error (MAE) of (i) the PFCI generated using the proposed method and (ii) the PFCI generated using the single model were compared. RESULTS: The mean SSIM, MSE, and MAE were 8.56 × 10-1, 1.28 × 10-2, and 3.57 × 10-2, respectively, for the proposed model, and 7.62 × 10-1, 1.98 × 10-2, and 5.04 × 10-2, respectively, for the single CycleGAN-based model. CONCLUSION: PFCIs generated from CXRs with the proposed model showed better performance than those generated with the single model. The evaluation of PF without CT may be possible using the proposed method.2024年03月, Academic radiology, 31(3) (3), 822 - 829, 英語, 国際誌研究論文（学術雑誌）
- Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and critical malignancy-related disease characterized by acute progressive pulmonary hypertension (PH). In most cases of PTTM, the cancer can be diagnosed in advance. Identification of the primary cancer is valuable for PTTM diagnosis. Here, we present the case of a patient with PTTM due to early gastric carcinoma in whom the diagnosis of malignant cancer was not revealed until macroscopic autopsy findings. This case highlights the importance of recognizing causative occult early gastric cancer leading to PTTM in cases of acute progressive PH.2024年01月, Pulmonary circulation, 14(1) (1), e12359, 英語, 国際誌研究論文（学術雑誌）
- 2023年09月, JACC. Clinical electrophysiology, 9(9) (9), 2034 - 2039, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Intermuscular implantations of subcutaneous implantable cardioverter-defibrillators (S-ICD) have been recommended, but the position of the anterior border of the latissimus dorsi muscle (LDM) has not previously been evaluated in establishing an incision line to facilitate the intermuscular approach. The objective of this study is to evalua the position and trend of the anterior border of the LDM in patients who are candidates for implantable cardioverter-defibrillators. METHODS: The distance from the back to the anterior border of the LDM (A) and the anterior-posterior width of the chest wall (B) were measured on computed tomography retrospectively, and the ratio (=A/B) was used as the position of the anterior border of the LDM. In addition, the variability and factors affecting the values were evaluated. RESULTS: An analysis was performed on 78 patients, and the position of the anterior border of the LDM (=A/B) exhibited a normal distribution, with a mean value of 0.53 ± 0.062 (0.41-0.69). The position of the anterior border of the LDM tended to be more anterior in younger, taller, male, primary prevention, nonheart failure, low brain natriuretic peptide level, and nondiabetic patients. CONCLUSION: The position of the anterior border of the LDM varied from case to case with variable results. Conventional incisions on the midaxillary line may be inappropriate for intermuscular implantations, and the position of the anterior border of the LDM should be evaluated in each individual case to establish the incision line.2023年07月, Journal of cardiovascular electrophysiology, 34(7) (7), 1569 - 1576, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Lesion gaps assessed by late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) are associated with the atrial fibrillation (AF) recurrence after pulmonary vein isolation. Animal studies have demonstrated that the catheter-contact force (CF), stability, and orientation are strongly associated with lesion formation. However, the impact of those procedural factors on the lesion characteristics associated with AF recurrence has not been well discussed. METHODS: A total of 30 patients with paroxysmal AF who underwent catheter ablation were retrospectively enrolled. Radiofrequency (RF) applications were performed with 35 W for 30 s in a point-by-point fashion under esophageal temperature monitoring. The inter-lesion distance was 4 mm. The lesions were visualized by LGE-MRI 3 months postprocedure and assessed by the LGE volume (ml), gap number (GN), and average gap length (AGL [mm]). The gaps were defined as nonenhancement sites of >4 mm. The procedural factors including the catheter-CF, stability, and orientation were calculated on the NavX system. RESULTS: Six (20%) of 30 patients had AF recurrences 12 months postablation. A univariate analysis demonstrated that the AGL was associated with AF recurrence (hazard ratio [HR]: 1.20, confidence interval [CI]: 1.03-1.42, p = .02). All AF recurrence were found in patients with an AGL of >7 mm. The catheter-CF and stability were associated with an AGL of >7 mm, but not the orientation (CF-HR: 0.62, CI: 0.39-0.97, p = .038; stability-HR: 0.8, CI: 0.66-0.98, p = .027). CONCLUSIONS: RF ablation with a low CF and poor catheter stability has a potential risk of creating large lesion gaps associated with AF recurrence.2023年03月, Journal of cardiovascular electrophysiology, 34(3) (3), 527 - 535, 英語, 国際誌研究論文（学術雑誌）
- The management of heart rhythm disorders in patients with adult congenital heart disease and limited vascular access is challenging. We present the case of a 38-year-old woman with Ebstein's anomaly who underwent implantation of a combination of a leadless pacemaker and a subcutaneous implantable cardioverter-defibrillator to manage fatal arrhythmias. (Level of Difficulty: Intermediate.).2022年12月, JACC. Case reports, 4(23) (23), 101464 - 101464, 英語, 国際誌研究論文（学術雑誌）
- Background: Poor subpleural perfusion (PSP) on dual-energy computed tomography (DE-CT) suggests microvasculopathy in chronic thromboembolic pulmonary hypertension (CTEPH). However, whether the microvasculopathy findings are equivalent to those in pulmonary arterial hypertension (PAH) remains unclear. The aim of this study was to elucidate the characteristics of microvasculopathy in CTEPH compared to those of that in PAH. Methods: We retrospectively reviewed subpleural perfusion on DE-CT and the hemodynamics of 23 patients with PAH and 113 with inoperable CTEPH. Subpleural perfusion on DE-CT was classified as poor (subpleural spaces in all segments with little or no perfusion) or normal. Results: PSP was observed in 51% of patients with CTEPH and in 4% of those with PAH (p < 0.01). CTEPH patients with PSP had poorer baseline hemodynamics and lower diffusing capacity for carbon monoxide divided by the alveolar volume (DLCO/VA) than those with CTEPH with normal perfusion (pulmonary vascular resistance [PVR]: 768 ± 445 dynes-sec/cm5 vs. 463 ± 284 dynes-sec/cm5, p < 0.01; DLCO/VA, 60.4 ± 16.8% vs. 75.9 ± 15.7%, p < 0.001). Despite the existence of PSP, hemodynamics improved to nearly normal in both groups after balloon pulmonary angioplasty. Conclusions: PSP on DE-CT, which is one of the specific imaging findings in CTEPH, might suggest a different mechanism of microvasculopathy from that in PAH.2022年08月, 日本循環器学会学術集会(Web), 12(8) (8), 英語, 国際誌
- OBJECTIVE: Both myocardial perfusion scintigraphy and 18F-fluorodeoxyglucose positron emission tomography (FDG PET) are useful for the diagnosis of cardiac sarcoidosis (CS). However, the association between the washout of 99mTc-labeled tracer and FDG PET has not been established. This study aimed to evaluate the association between the washout of 99mTc-labeled tracer and FDG PET findings in patients with CS. METHODS: We retrospectively analyzed 64 patients (65.0 ± 11.2 years, 53% male) with suspected CS who underwent myocardial single-photon emission computed tomography (SPECT) with 99mTc-labeled tracer and FDG PET. The SPECT images were acquired at 15 min (early images) and 3 h (delayed images) after injection and scored visually using a 17-segment model with a 5-point scoring system. The washout score was defined as the difference between the early and delayed total defect scores. FDG positivity was considered as focal or focal on diffuse patterns on visual assessment, and FDG uptake was quantified by measuring the standardized uptake value (SUV) of each of the 17 segments. RESULTS: The washout score was significantly higher for the CS group than for the non-CS group (3.0 [-1.0-5.0] vs. 0.0 [-0.5-1.0], p = 0.010). Receiver operating characteristic analysis showed that a washout score of ≥ 2 had the best accuracy for detecting CS (88% sensitivity and 56% specificity) and FDG positivity (71% sensitivity and 89% specificity). In the segment-based analysis of 833 segments from 49 patients, excluding 15 patients with diffuse FDG uptake, the median SUVs for FDG uptake for the washout scores of ≤ 0, 1, and 2 were 2.3 (1.8-3.6), 4.2 (2.9-7.8), and 8.3 (6.5-9.4), respectively (p < 0.001). CONCLUSIONS: The washout of 99mTc-labeled tracer can be a useful marker for the evaluation of FDG PET findings in patients with CS.2022年06月, Annals of nuclear medicine, 36(6) (6), 544 - 552, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Some of atrial fibrillation (AF) drivers are found in normal/mild late-gadolinium enhancement (LGE) areas, as well as moderate ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. OBJECTIVE: The purpose of this study was to evaluate the impact of the AWT in normal/mild LGE areas on AF drivers. METHODS: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping), mild LGE areas were defined as areas with a volume ratio of the enhancement voxel of 0% to <10%. The AWT was defined as the minimum distance from the manually determined endocardium to the epicardial border on the LGE-MRI. RESULTS: NPAs were found in 20 (18.0%) of 131 normal/mild LGE areas where AWT was significantly thicker than that in the passively activated areas (PAs) (2.5 ± 0.3 vs. 2.2 ± 0.3 mm, p < .001). However, NPAs were found in 41 (26.3%) of 156 moderate LGE areas where AWT was thinner than that of PAs (2.1 ± 0.2 mm vs. 2.23 ± 0.3 mm, p = .02). An ROC curve analysis yielded an optimal cutoff value of 2.2 mm for predicting the presence of an NPA in normal/mild LGE areas. CONCLUSION: The location of AF drivers in normal/mild LGE areas might be more accurately identified by evaluating AWT.2022年04月, Journal of arrhythmia, 38(2) (2), 221 - 231, 英語, 国内誌研究論文（学術雑誌）
- Innovations in invasive cardiovascular diagnostics and therapeutics, not only limited to transcatheter approaches but also involving surgical approaches, are based on a precise appreciation of the three-dimensional living heart anatomy. Rapid advancements in three-dimensional cardiovascular imaging technologies in the 21st century have supported such innovations through the periprocedural assessment of the clinical anatomy of the living heart. However, even if high-resolution volume-rendered images are reconstructed, they cannot provide appropriate depth perception when displayed and shared on a two-dimensional display, which is widely used in clinical settings. Currently, images reconstructed from clinical datasets can visualize fine details of the cardiovascular anatomy. Therefore, this is an optimal time for cardiologists and cardiac surgeons to revisit the classic technology, stereopsis, and obtain bonus information from carefully reconstructed clinical images. Using anaglyphs or cross/uncross-fusion of paired images, striking depth perception can be readily obtained without the need for expensive equipment. This conventional technique, when applied to high-resolution volume-rendered images, may help in obtaining appropriate diagnostics, choosing optimal therapeutics, securing procedural success, and preventing complications. Furthermore, it can be used for anatomical education. In this review, we demonstrate multiple stereoscopic images reconstructed from cardiac computed tomographic datasets and discuss their clinical and educational implications.2022年03月, Tomography (Ann Arbor, Mich.), 8(2) (2), 824 - 841, 英語, 国際誌研究論文（学術雑誌）
- 2022年03月, Circulation reports, 4(3) (3), 145 - 146, 英語, 国内誌研究論文（学術雑誌）
- This case report concerns a 72-year-old-female with severe functional tricuspid stenosis due to phosphoglyceride crystal deposition disease and a history of atrial septum closure and tricuspid valvuloplasty. Phosphoglyceride crystal deposition disease is extremely rare, and percutaneous transcatheter biopsy under intracardiac echocardiographic guidance proved to be useful for its diagnosis. (Level of Difficulty: Advanced.).2022年02月, JACC. Case reports, 4(4) (4), 230 - 235, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The sigmoid septum has been generally evaluated subjectively and qualitatively, without detailed examination of its diversity, impact on the morphology of the left ventricular outflow tract (LVOT), and anatomical background. METHODS: We enrolled 100 patients without any background cardiac diseases (67.5 ± 12.8 years old; 43% women) who underwent cardiac computed tomography. Basal septal morphology was evaluated using antero-superior and medial bulging angles (bidirectional angulation of the basal septum relative to the LVOT). The eccentricity index of the LVOT, area narrowing ratio (LVOT/virtual basal ring area), aortic-to-left ventricular axial angle (angulation of the aortic root relative to the left ventricle), and wedged height (non-coronary aortic sinus to inferior epicardium distance) were also quantified. RESULTS: The antero-superior bulging, medial bulging, aortic-to-left ventricular axial angles, LVOT eccentricity index, area narrowing ratio, and wedged height were 76° ± 17°, 166° ± 27°, 127° ± 9°, 1.8 ± 0.5, 1.0 ± 0.2, and 41.2 ± 9.1 mm, respectively. Both bulging angles were correlated with each other and contributed to the narrowing and deformation of the LVOT. Angulated aortic root was not correlated with either bidirectional septal bulge or LVOT narrowing. Clockwise rotation of the aortic root rotation was an independent predictor of prominent antero-superior septal bulge. Deeper aortic wedging was a common independent predictor of bidirectional septal bulge. CONCLUSIONS: The extent of septal bulge varies in normal hearts. Along with deep aortic wedging, the bidirectional bulge of the basal septum deforms and narrows the LVOT without affecting the virtual basal ring morphology.2022年02月, Echocardiography (Mount Kisco, N.Y.), 39(2) (2), 248 - 259, 英語, 国際誌研究論文（学術雑誌）
- Eosinophilic myocarditis (EM) is an under-diagnosed inflammatory heart disease that often leads to severe left ventricular (LV) dysfunction. Meanwhile, severe secondary mitral regurgitation (MR) with valve disruption, possibly requiring mitral valve repair, is rarely concomitant with EM. We present the case of a 64-year-old female diagnosed with heart failure with severe LV dysfunction and localized asynergy. Echocardiography revealed severe secondary MR with mitral valve disruption. Cardiac magnetic resonance imaging (CMR) showed transmural late-gadolinium enhancement localized in the anterior wall and diffuse high-signal areas on T2-weighted images, suggesting non-ischemic and inflammatory heart disease. Although the peripheral eosinophil count was not elevated on admission, it gradually increased during hospitalization. These findings encouraged us to perform endomyocardial biopsy, which confirmed myocardial eosinophilic infiltration with mild fibrosis and necrosis, leading to the diagnosis of EM. Immunosuppressive treatment with oral corticosteroids improved LV dysfunction and completely resolved severe secondary MR. The current case highlighted that comprehensive assessment of laboratory, imaging, and pathological examinations including CMR is crucial to develop the appropriate therapeutic strategy for refractory heart failure. Immunosuppressive treatment should be considered as the first therapeutic option even in EM cases with severe secondary MR, possibly requiring mitral valve repair.2022年02月, Journal of cardiology cases, 25(2) (2), 95 - 98, 英語, 国内誌
. 研究論文（学術雑誌） - 2022年02月, HeartRhythm case reports, 8(2) (2), 137 - 141, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The impact of the extent of aortic atheroma on patients' prognosis after transcatheter aortic valve replacement (TAVR) has not been completely evaluated. This study aimed to evaluate the prognostic value of the aortic atheroma volume (AAV) derived from computed tomography, and the effect of its differences among the segments of the aorta, in patients undergoing TAVR. METHODS: In total, 143 patients with symptomatic severe aortic stenosis who underwent pre-procedural computed tomography before TAVR procedure indication were evaluated. AAV was calculated by measuring the aortic lumen and vessel volume using every 1-mm axial image and was further divided into thoracic (TAAV) and abdominal segments (AbAAV). RESULTS: During a median follow-up of 651 days, 24 all-cause and 14 cardiac deaths occurred. In the Kaplan-Meier analysis, the high AAV group had significantly higher all-cause and cardiac mortalities than the low AAV group (p = 0.016 and 0.023, respectively). Regarding segmental AAV, all-cause and cardiac mortalities did not have significant differences between the high and low TAAV groups. Moreover, all-cause and cardiac mortalities were significantly higher in the high AbAAV group than in the low AbAAV group (p = 0.0043 and 0.023, respectively). The multivariable analysis showed that only AbAAV was an independent predictor for all-cause mortality (hazard ratio: 1.06, p = 0.046). CONCLUSION: AAV was significantly associated with the mortality after TAVR. The current study suggests the pre-procedural assessment of AAV is valuable in predicting prognosis after TAVR. However, further investigation with a larger sample size is needed to validate our findings.2021年12月, International journal of cardiology, 344, 60 - 65, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Although the life expectancy of patients with tetralogy of Fallot (TOF) is comparable to that of the general population due to advancements in surgical intervention, if untreated, patients with TOF may die during their childhood. However, it has been anecdotally reported that a small number of patients with unrepaired TOF survived into their senescence. CASE SUMMARY: A 71-year-old man with a history of multiple heart failure admissions was referred to our institute after successful cardiopulmonary arrest resuscitation. Transthoracic echocardiography showed the overriding of the aorta on a large ventricular septal defect and right ventricular hypertrophy, along with severe pulmonary stenosis (PS), all of which indicated unrepaired TOF. Computed tomography revealed a patent Blalock-Taussig shunt, which was constructed at the age of 19 years. Coronary angiography revealed multivessel coronary stenoses. Although radical intracardiac repair was not performed due to his multiple comorbidities, his heart failure symptoms were significantly improved owing to proper medication titration. One year following discharge, the patient was well and enjoyed playing golf. DISCUSSION: Specific anatomical, functional, and haemodynamic characteristics may be required for the long-term survival of patients with TOF. Pulmonary stenosis should be initially mild to guarantee pulmonary flow during childhood and adolescence, and gradual PS exacerbation should be paralleled with systemic-to-pulmonary collateral development or an extracardiac shunt. Moreover, reduced left ventricular compliance may act as a balancing factor against a right-to-left shunt. The presence of all of these special requirements may have contributed to the unusual survival for this patient.2021年12月, European heart journal. Case reports, 5(12) (12), ytab486, 英語, 国際誌研究論文（学術雑誌）
- There is continued interest in surgical repair of both the congenitally malformed aortic valve, and the valve with acquired dysfunction. Aortic valvar repair based on a geometric approach has demonstrated improved durability and outcomes. Such an approach requires a thorough comprehension of the complex 3-dimensional anatomy of both the normal and congenitally malformed aortic root. In this review, we provide an understanding of this anatomy based on the features that can accurately be revealed by contrast-enhanced computed tomographic imaging. We highlight the complimentary role that such imaging, with multiplanar reformatting and 3-dimensional reconstructions, can play in selection of patients, and subsequent presurgical planning for valvar repair. The technique compliments other established techniques for perioperative imaging, with echocardiography maintaining its central role in assessment, and enhances direct surgical evaluation. This additive morphological and functional information holds the potential for improving selection of patients, surgical planning, subsequent surgical repair, and hopefully the subsequent outcomes.2021年11月, Circulation. Cardiovascular imaging, 14(11) (11), e013134, 英語, 国際誌研究論文（学術雑誌）
- Background Myocardial extracellular volume fraction (ECV), measured by cardiac magnetic resonance imaging, is a useful prognostic marker for patients who have undergone aortic valve replacement (AVR) for aortic stenosis. However, the prognostic significance of ECV measurements based on computed tomography (CT) is unclear. This study evaluated the association between ECV measured with dual-energy CT and clinical outcomes in patients with aortic stenosis who underwent transcatheter or surgical AVR. Methods and Results We retrospectively enrolled 95 consecutive patients (age, 84.0±5.0 years; 75% women) with severe aortic stenosis who underwent preprocedural CT for transcatheter AVR planning. ECV was measured using iodine density images obtained by delayed enhancement dual-energy CT. The primary end point was a composite outcome of all-cause death and hospitalization for heart failure after AVR. The mean ECV measured with CT was 28.1±3.8%. During a median follow-up of 2.6 years, 22 composite outcomes were observed, including 15 all-cause deaths and 11 hospitalizations for heart failure. In Kaplan-Meier analysis, the high ECV group (≥27.8% [median value]) had significantly higher rates of composite outcomes than the low ECV group (<27.8%) (log-rank test, P=0.012). ECV was the only independent predictor of adverse outcomes on multivariable Cox regression analysis (hazards ratio, 1.25; 95% CI, 1.10‒1.41; P<0.001). Conclusions Myocardial ECV measured with dual-energy CT in patients who underwent aortic valve intervention was an independent predictor of adverse outcomes after AVR.2021年09月, Journal of the American Heart Association, 10(18) (18), e020655, 英語, 国際誌研究論文（学術雑誌）
- Detailed 3-dimensional analysis of mitral annular disjunction was undertaken in 3 comparative cases of mitral valve prolapse. A case of Barlow disease showed extensive disjunction, whereas cases of fibroelastic deficiency and forme fruste demonstrated less extensive disjunction. Considering the current controversies surrounding disjunction, these observations call for detailed research in the future. (Level of Difficulty: Advanced.).2021年08月, JACC. Case reports, 3(10) (10), 1251 - 1257, 英語, 国際誌研究論文（学術雑誌）
- 2021年08月, JACC. Cardiovascular imaging, 14(8) (8), 1682 - 1684, 英語, 国際誌
- BACKGROUND: A thorough understanding of the anatomy of the aortic valve is necessary for aortic valve-sparing surgery. Normal valvar dimensions and their relationships in the living heart, however, have yet to be fully investigated in a 3-dimensional fashion. METHODS AND RESULTS: In total, 123 consecutive patients (66±12 years, Men 63%) who underwent coronary computed tomographic angiography were enrolled. Mid-diastolic morphology of the aortic roots, including height of the interleaflet triangles, geometric height, free margin length of each leaflet, effective height, and coaptation length were measured using multiplanar reconstruction images. Average height of the interleaflet triangle, geometric height, free margin length, effective height, and the coaptation length were 17.3±1.8, 14.7±1.3, 32.6±3.6, 8.6±1.4, and 3.2±0.8 mm, respectively. The right coronary aortic leaflet displayed the longest free margin length and shortest geometric height. Geometric height, free margin length, and effective height showed positive correlations with aortic root dimensions. Coaptation length, however, remained constant regardless of aortic root dimensions. CONCLUSIONS: Diversities, as well as characteristic relationships among each value involving the aortic root, were identified using living-heart datasets. The aortic leaflets demonstrated compensatory elongation along with aortic root dilatation to maintain constant coaptation length. These measurements will serve as the standard value for revealing the underlying mechanism of aortic regurgitation to plan optimal aortic valve-sparing surgery.2021年06月, Circulation journal : official journal of the Japanese Circulation Society, 85(7) (7), 1059 - 1067, 英語, 国内誌研究論文（学術雑誌）
- A 61-year-old female with 50 000 ventricular premature contractions and a reduced left ventricular ejection fraction of 35% was referred to our center. Although the origin was considered to originate from the junction between the left and right coronary cusp, a single radiofrequency application above the aortic sinus cusp could eliminate it. LGE-MRI was able to reveal the exact location of the single RF lesion.2021年06月, Clinical case reports, 9(6) (6), e04169, 英語, 国際誌研究論文（学術雑誌）
- Atrial tachycardia (AT) in the right atrium often occurs following open-heart surgery. Catheter ablation for these AT is challenging and can lead to unintended conduction block. We performed late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) prior to catheter ablation and predicted wavefront propagation during SR as well as the slow conduction zone during tachycardia. LGE-MRI may assist predicting the conduction disturbance and reducing the risk of unexpected sinus exit block.2021年06月, Clinical case reports, 9(6) (6), e04198, 英語, 国際誌研究論文（学術雑誌）
- AIMS: Mitral annular disjunction is fibrous separation between the attachment of the posterior mitral leaflet and the basal left ventricular myocardium initially described in dissected hearts. Currently, it is commonly evaluated by echocardiography, and potential relationships with mitral valve prolapse and ventricular arrhythmia have been suggested. However, controversy remains as its prevalence and extent have not been fully elucidated in normal living subjects. METHODS AND RESULTS: Systolic datasets of cardiac computed tomography obtained from 98 patients (mean age, 69.1 ± 12.6 years; 81% men) with structurally normal hearts were assessed retrospectively. Circumferential extent of both mitral leaflets and disjunction was determined by rotating orthogonal multiplanar reconstruction images around the central axis of the mitral valvar orifice. Distribution angle within the circumference of the mitral valvar attachment and maximal height of disjunction were quantified. In total, 96.0% of patients demonstrated disjunction. Average distribution angles of the anterior and posterior mitral leaflets were 91.3 ± 9.4° and 269.8 ± 9.7°, respectively. Average distribution angle of the disjunction was 105.1 ± 49.2°, corresponding to 39.0 ± 18.2% of the entire posterior mitral valvar attachment. Median value of the maximal height of disjunction was 3.0 (1.5-7.0) mm. Distribution prevalence map of the disjunction revealed characteristic double peaks, with frequent sites of the disjunction located at the anterior to antero-lateral and inferior to infero-septal regions. CONCLUSION: Mitral annular disjunction is a rather common finding in the normal adult heart with bimodal distribution predominantly observed involving the P1 and P3 scallops of the posterior mitral leaflet.2021年05月, European heart journal. Cardiovascular Imaging, 22(6) (6), 614 - 622, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Two-dimensional measurements are self-evidently limited when seeking accurately to represent the three-dimensional complexity of the aortic root. Volumetric measurement, therefore, seems an ideal alternative for a more accurate assessment. MATERIALS AND METHODS: We retrospectively analyzed 123 individuals undergoing cardiac computed tomography. We measured the dimensions of the sinuses of Valsalva using routine multiplanar short axis imaging. Three conventional two-dimensional methods were applied to measure the dimensions of the sinuses. These involved bisecting center of sinus-to-center of interleaflet triangle measures, along with center of sinus-to-center of sinus, and largest sinus-to-sinus measurements. We then quantified the volumes of the root using the volume-rendering method. RESULTS: The mean dimensions of the sinuses were significantly greater when measured using the largest sinus-to-sinus method as opposed to center of sinus-to-center of interleaflet triangle and center of sinus-to-center of sinus methods (33.6 ± 3.6 mm vs. 31.1 ± 3.1 mm and 30.9 ± 3.3 mm, p < .0001). The mean root volume of 13.6 ± 4.2 ml showed the strongest correlation with the mean dimensions of the sinuses of Valsalva measured using the bisecting method (R2 = .8401, p < .0001). CONCLUSIONS: By using two- and three-dimensional measurements, we have provided average data for the structurally normal aortic root. The differences and correlations encountered should be noted when evaluating and following changes in the diseased root.2021年04月, Clinical anatomy (New York, N.Y.), 34(3) (3), 333 - 341, 英語, 国際誌研究論文（学術雑誌）
- To investigate the feasibility of pre-procedural morphological assessment of coronary artery calcification in severely calcified lesions with electrocardiography (ECG)-gated non-contrast computed tomography (CT). Severely calcified coronary arteries in patients who underwent ECG-gated non-contrast CT prior to optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) were studied retrospectively. CT and OCT data were co-registered by marking landmark structures such as side branches and reviewed side by side with cross-sectional images. The maximum calcium angle (MCA) and presence of nodular calcification (NC) were evaluated. A total of 496 cross-sections in 16 lesions were included in this analysis. The Pearson correlation coefficient between CT- and OCT-derived MCA was 0.92 (p < 0.001). Bland-Altman plots of OCT-derived MCA in relation to CT-derived MCA showed a mean bias of 4.8 degrees with 95% limits of agreement of - 69.7 to 79.4 degrees. Sensitivity, specificity, and positive and negative predictive values of CT in identifying MCA > 270 degrees were 90.3%, 79.7%, 92.1%, and 97.4%, respectively. Sensitivity, specificity, and positive and negative predictive values of CT in identifying NC were 73.3%, 97.5%, 47.8%, and 99.2%, respectively. ECG-gated non-contrast coronary CT might be helpful to obtain detailed information of severe coronary artery calcification before PCI.2021年04月, The international journal of cardiovascular imaging, 37(4) (4), 1445 - 1453, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome. METHODS: A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden-matched pulmonary vein isolation (PVI) group. RESULTS: Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow-up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log-rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not. CONCLUSIONS: FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.2021年04月, Journal of cardiovascular electrophysiology, 32(4) (4), 1014 - 1023, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Inflammation, such as that associated with intermediate CD14++ CD16+ monocytes and atrial structural remodeling (SRM), may be important in the recurrence of atrial fibrillation (AF) after catheter ablation. However, the relationship between the intermediate CD14++ CD16+ monocytes, SRM, and AF recurrence is unclear. METHODS: Twenty-four patients with AF were enrolled. The proportion of intermediate monocytes (PIM) was assessed before ablation by flow cytometry. As a surrogate marker of SRM, the volume ratio (VR) of signal intensity greater than 1 standard deviation on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) was calculated. We investigated whether PIM correlated with SRM on LGE-MRI and determined the optimal cutoff value for predicting AF recurrence. RESULTS: Univariate analysis revealed positive correlations between PIM and BNP with SRM (PIM: r = .593, p = .002; BNP: r = .567, p = .004). Multivariable analysis revealed that PIM was independently associated with VR on LGE-MRI (β = .522; p = .033). The finding of an area under the receiver operating characteristic curve of 0.750 revealed that a VR ≥ 13.3% on LGE-MRI as the optimal cutoff value to predict AF recurrence with 80% sensitivity and 71% specificity, which was associated with PIM ≥ 10.0%. CONCLUSION: Intermediate monocytes were significantly positively correlated with SRM. PIM ≥ 10% was associated with a VR ≥ 13.3% on LGE-MRI, which predicted AF recurrence after catheter ablation.2021年04月, Journal of cardiovascular electrophysiology, 32(4) (4), 1035 - 1043, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: A computational model demonstrated that atrial fibrillation (AF) rotors could be distributed in patchy late-gadolinium enhancement (LGE) areas and play an important role in AF drivers. However, this was not validated in humans. OBJECTIVE: The purpose of this study was to evaluate the LGE properties of AF rotors in patients with persistent AF. METHODS: A total of 287 segments in 15 patients with persistent AF (long-standing persistent AF in 9 patients) that underwent AF ablation were assessed. Non-passively activated areas (NPAs), where rotational activation (AF rotor) was frequently observed, were detected by the novel real-time phase mapping (ExTRa Mapping). The properties of the LGE areas were assessed using the LGE heterogeneity and the density which was evaluated by the entropy (LGE-entropy) and the volume ratio of the enhancement voxel (LGE-volume ratio), respectively. RESULTS: NPAs were found in 61 (21%) of 287 segments and were mostly found around the pulmonary vein antrum. A receiver operating characteristic curve analysis yielded an optimal cutoff value of 5.7% and 10% for the LGE-entropy and LGE-volume ratio, respectively. The incidence of NPAs was significantly higher at segments with an LGE-entropy of >5.7 and LGE-volume ratio of >10% than at the other segments (38 [30%] of 126 vs. 23 [14%] of 161 segments; p = .001). No NPAs were found at segments with an LGE-volume ratio of >50% regardless of the LGE-entropy. Of five patients with AF recurrence, NPAs outside the PV antrum were not ablated in three patients and the remaining NPAs were ablated, but their LGE-entropy and LGE-volume ratio were low. CONCLUSION: AF rotors are mostly distributed in relatively weak and much more heterogenous LGE areas.2021年04月, Journal of cardiovascular electrophysiology, 32(4) (4), 1005 - 1013, 英語, 国際誌研究論文（学術雑誌）
- (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, OE022 - 7, 英語The Lesion Continuity after Pulmonary Vein Isolation with LSI of 5 vs 6: Late-gadolinium Enhancement Magnetic Resonance Imaging(LGE-MRI) Analysis(和訳中)
- (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, OE032 - 2, 英語The Relationship between AF Rotor Detected by ExTRa Mapping and Tissue Property Assessed by LGE-MRI in Persistent Atrial Fibrillation Patients(和訳中)
- (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, OE045 - 1, 英語Acute Response and Rhythm Outcome of the Patchy Late-gadolinium Enhancement Sites Ablation in Patients with Atrial Fibrillation: LGE-MRI Analysis(和訳中)
- BACKGROUND: Atrial inflammation plays an important role in initiating atrial fibrosis, which could perpetuate atrial fibrillation (AF). However, the method of visualization of atrial inflammation has not been established. We sought to investigate whether the intensive atrial inflammation caused by cryoballoon ablation (CBA) could be detected by positron emission tomography/ magnetic resonance imaging (PET/MRI) and whether the atrial inflammation could be associated with consequent fibrosis. METHODS: A total of 10 paroxysmal atrial fibrillation patients after CBA were enrolled. To detect and quantify intensive atrial inflammation, PET/MRI was performed to assess regional 18F-fluorodeoxyglucose (18F-FDG) uptake one day after the CBA, and the standardized uptake values (SUV) max were compared between the pulmonary vein (PV) antrum where CBA could be applied and the healthy left atrial (LA) wall where CBA could not be applied. Furthermore, the atrial inflammation one day after the procedure and atrial fibrosis areas one month after the procedure were three-dimensionally quantified by PET/MRI and late-gadolinium enhancement magnetic resonance imaging (LGE-MRI), respectively. RESULTS: The mean SUV max at the PV antrum was significantly higher than that on the healthy LA wall (2.12 ± 0.35 vs 1.73 ± 0.30, P = .00021). The volume of the atrial inflammation strongly correlated with that of the atrial fibrosis (r = .94 [.76-.99], P = .00006). CONCLUSIONS: The atrial inflammation after CBA could be detected by PET/MRI. CBA-induced atrial inflammation was strongly associated with consequent lesion maturation.2021年02月, Journal of arrhythmia, 37(1) (1), 52 - 59, 英語, 国内誌研究論文（学術雑誌）
- 2021年01月, Circulation journal : official journal of the Japanese Circulation Society, 85(2) (2), 220 - 220, 英語, 国内誌研究論文（学術雑誌）
- The existence of microvasculopathy in patients with chronic thromboembolic pulmonary hypertension has been suggested. Recently, dual-energy computed tomography has been used to produce a sensitive iodine distribution map in lung fields to indicate microvasculopathy according to poor subpleural perfusion. Our aim was to evaluate the impact of microvasculopathy on pathophysiology in chronic thromboembolic pulmonary hypertension. According to the extent of poor subpleural perfusion, ninety-three interventional treatment-naïve patients were divided into poorly perfused (n = 49) or normally perfused group (n = 44). We assessed cardiopulmonary exercise test, right heart catheterization, and dual-energy computed tomography parameters for quantitative evaluation of lung perfusion of blood volume score. Lung perfusion of blood volume score in normally perfused group was significantly inversely correlated with pulmonary vascular resistance (pulmonary vascular resistance = 6816.1 × lung perfusion of blood volume score-0.793, R2 = 0.225, p < 0.01), but lung perfusion of blood volume score in poorly perfused group was not. Poorly perfused group had higher pulmonary vascular resistance (879 ± 409 dynes-s/cm5 vs. 574 ± 279 dynes-s/cm5, p < 0.01) and lower lung perfusion of blood volume score (22.1 ± 5.4 vs. 26.4 ± 6.6, p < 0.01) and % diffusing capacity for carbon monoxide divided by the alveolar volume (59.9 ± 15.4% vs. 78.8 ± 14.2%, p < 0.01). Perfusion of blood volume score in the normally perfused group showed an inverse correlation with pulmonary vascular resistance; however, that in poorly perfused group did not. Microvasculopathy might contribute to severe hemodynamics, apart from pulmonary vascular obstruction. In our experience, more than half of treatment-naïve chronic thromboembolic pulmonary hypertension patients have microvasculopathy.2021年, Pulmonary circulation, 11(1) (1), 2045894020983162 - 2045894020983162, 英語, 国際誌研究論文（学術雑誌）
- A septuagenarian female with cardiac sarcoidosis suffered from drug refractory ventricular tachycardia (VT) requiring multiple implantable cardioverter-defibrillator shocks. The QRS complex during the VT was very similar to that during sinus rhythm although the QRS width during the VT (142 ms) was relatively wider than that during sinus rhythm (107 ms). The VT exit was located on the ventricular septum close to the His-bundle recording region. However, the critical pathway of this VT was detected on the anterior free wall of the left ventricle (LV), and a radiofrequency application at that site could terminate the VT. No Purkinje potentials were recorded there during the VT or sinus rhythm. According to the electrophysiological study, 3-D mapping, and the response to the ablation, the critical circuit of the VT was surrounded by a protected area of scar associated with cardiac sarcoidosis. As a result, the VT circuit was connected to the basal septal area close to the His-Purkinje system as an outer loop of the VT circuit. This unique trajectory of the VT might have caused a similar QRS morphology to that of sinus rhythm, and the relatively narrow QRS complex despite the critical isthmus was located on the anterior free wall of the LV.2021年, Indian pacing and electrophysiology journal, 21(5) (5), 308 - 312, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Configurational changes in the proximal aorta are relevant to the procedural difficulty of transcatheter aortic valve implantation (TAVI). Among several morphological changes involving the ascending aorta, elongation is characteristics of elderly patients with aortic stenosis and can compromise the success and safety of TAVI. However, the effect of ascending aortic elongation on the overall morphology of the proximal aorta has not been established. AIMS: Our primary purpose was to investigate the effect of ascending aortic elongation on structural changes in the proximal aorta in TAVI candidates. MATERIALS & METHODS: In total, 121 consecutive patients with severe aortic stenosis (mean age, 84.5 ± 5.3 years; 69% women) who had undergone preprocedural computed tomography before TAVI were enrolled. We examined the structural anatomy of the proximal aorta in detail, focusing on its elongation, dilatation, tilting, rotation, and wedging. RESULTS: The mean length of the ascending aorta was 68.0 ± 9.2 mm, and the length was significantly correlated with dilatation (R = .278, p = .002), rightward tilting (R = .437, p < .001), clockwise rotation (R = .228, p = .018), and deep wedging (R = -.366, p < .001) of the proximal aorta. Elongation of the ascending aorta was correlated with dilatation, rightward tilting, clockwise rotation, and deep wedging of the proximal aorta in an elderly population with severe aortic stenosis. DISCUSSION: Appreciation of the clinical anatomy around the proximal aorta is required for clinicians involved in TAVI to estimate the procedural difficulty. CONCLUSION: Elongation of the ascending aorta was associated with dilatation, rightward tilting, clockwise rotation, and deep wedging of the proximal aorta.2020年11月, Clinical anatomy (New York, N.Y.), 33(8) (8), 1240 - 1248, 英語, 国際誌研究論文（学術雑誌）
- Comprehensive appreciation of the 3-dimensional anatomy of the living heart is essential for accurate diagnosis and establishment of safe interventional treatment by clinical electrophysiologists. Three-dimensional images displayed on a 2-dimensional surface usually undergo distortion and are not considered a real 3-dimensional representation because they cannot provide accurate depth perception. Currently, the availability of 3-dimensional visualization techniques, including 3-dimensional printing, 3-dimensional projectors, 3-dimensional monitors, and virtual reality, is limited owing to their limited user-friendliness and high costs. The authors discuss an alternative conventional approach of a cross-eyed method for viewing stereoscopically displayed images for better appreciation of real 3-dimensional images based on a simple technique.2020年11月, JACC. Clinical electrophysiology, 6(12) (12), 1473 - 1477, 英語, 国際誌研究論文（学術雑誌）
- Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.2020年08月, Journal of cardiovascular development and disease, 7(3) (3), 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The left ventricular apex commonly has a paper-thin structure. However, available data about its structure are limited to variable samples, methodologies, and results. OBJECTIVE: To investigate the structural anatomy of the left ventricular apex using living heart datasets with the latest computed tomography scanner. METHODS: One hundred thirty-one consecutive patients (median age, 73 years; 58% men) who underwent cardiac computed tomography were retrospectively analyzed. Patients with severe aortic stenosis were analyzed separately. Thickness and diameters of the thinnest part of the left ventricular apex during mid-diastole were measured using orthogonal multiplanar reconstruction images. The area of thinning was estimated using the formula for the ellipse. RESULTS: In 88 patients without severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was only 0.9 mm. Among them, 74%, 99%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 5.6 mm2 . In 43 patients with severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was 1.2 mm. Among them, 51%, 93%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 3.9 mm2 . CONCLUSIONS: Localized thinning of the left ventricular apex is unexceptional, regardless of aortic stenosis with concentric left ventricular hypertrophy, thus highlighting the need for a reappreciation of this feature to avoid inadvertent catastrophic complications.2020年04月, Journal of cardiovascular electrophysiology, 31(4) (4), 915 - 920, 英語, 国際誌研究論文（学術雑誌）
- We report the case of a 63-year-old man who was admitted to our hospital due to progressive dyspnea and leg edema. Echocardiography and cardiac computed tomography revealed localized severe pericardial calcification surrounding the basal segments of both ventricles, which caused pericardial constriction. Right heart catheter examination confirmed typical hemodynamic findings of constrictive pericarditis and subsequently led to the definite diagnosis of constrictive pericarditis. We experienced a rare case of localized constrictive pericarditis caused by the thickened and calcified pericardial ring. Non-invasive and invasive multimodality evaluations should be encouraged for accurate diagnosis and better management of these cases.2019年12月, Echocardiography (Mount Kisco, N.Y.), 36(12) (12), 2265 - 2267, 英語, 国際誌研究論文（学術雑誌）
- We aimed to assess the relationship of the rotational position of the aortic root to its underlying ventricular support, and to the position of the inferior margin of the membranous septum, which serves as a surrogate of the atrioventricular conduction axis. We analyzed 40 normal heart specimens (19 children, 21 adults). The inferior margin of the membranous septum was measured relative to the virtual basal ring. The rotational position of the aortic root was determined by assessing the relationship of the aortic leaflet of the mitral valve to the interleaflet triangle between the non- and left coronary leaflets. The extent of supporting fibrous versus myocardial tissues was measured. We also performed a similar investigation of 30 adult computed tomographic data sets. The median age was 0.25 years (44% male) for children, and 64 years (33% male) for adults. The aortic root was positioned centrally in 22 specimens (55%), rotated counterclockwise in 6 (15%), and clockwise in 12 (30%). In the setting of counterclockwise rotation, 53.4% (median) of the supporting circumference was myocardial, as opposed to 41.4% (median) in those with centrally positioned roots, and 31.9% (median) in those with clockwise rotation (P < 0.0001). The position of the inferior margin of the membranous septum was not associated with the rotational position. Analysis of the 30 adult computed tomographic data sets (median age 66.5 years, 57% male) confirmed the positive relationship between clockwise rotation of the aortic root and an increase in the extent of fibrous as opposed to myocardial support. The rotational position of the aortic root correlates with variation in the extent of its fibrous as opposed to myocardial ventricular support, but not with the position of the inferior margin of the membranous septum relative to the virtual basal ring. Clin. Anat. 32:1107-1117, 2019. © 2019 Wiley Periodicals, Inc.2019年11月, Clinical anatomy (New York, N.Y.), 32(8) (8), 1107 - 1117, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Because the aortic root anatomy is too complicated to evaluate only with 2D methodology, precise appreciation of its 3D anatomy is a prerequisite for all cardiologists and cardiac surgeons. METHODS AND RESULTS: We provide comprehensive image panels reconstructed from CT datasets to understand the complexity of the aortic root by focusing on the representative longitudinal sections cut through the central zone of coaptation. CONCLUSIONS: The provided images will accelerate profound understanding of the 2D long-axis image of the aortic root commonly interrogated with 2D echocardiography, as well as correlated clinical measured values, including the geometric height, effective height, and coaptation length.2019年10月, Circulation journal : official journal of the Japanese Circulation Society, 83(11) (11), 2320 - 2323, 英語, 国内誌研究論文（学術雑誌）
- 2019年08月, Journal of cardiovascular electrophysiology, 30(8) (8), 1339 - 1340, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: This study aimed to confirm the precise course of a pericardiocentesis with the anterior approach using post-procedural computed tomography (CT). BACKGROUND: Percutaneous epicardial ventricular tachycardia (VT) ablation has been increasingly performed. Although the inferior approach has been the common method, the feasibility of the anterior approach has subsequently been reported. However, the precise course of the anterior approach has not been presented. METHODS: An epicardial ablation with the anterior approach was performed in 15 patients. At the end of the procedure, the epicardial sheath was exchanged for a drainage tube to monitor bleeding. Of those patients, in 9 procedures in 8 patients a CT scan was performed just after the procedure to confirm the course of the drainage tube and to rule out any complications. Epicardial ablation was indicated for a failed endocardial VT ablation in 7 patients and epicardial substrate modification in 1 patient with Brugada syndrome. RESULTS: Volume-rendered images reconstructed from CT demonstrated each course of the drainage tubes and their relation to the surrounding organs. These images revealed that the tube had a curved trace, and did not penetrate the diaphragm or pass through the abdominal cavity. No injury to the surrounding organs was detected in any of the cases. CONCLUSIONS: The precise course of the drainage tube placed along the trajectory of the anterior approach was able to be confirmed using post-procedural CT images. These images support the safety and feasibility of the anterior approach from the anatomic standpoint with a low incidence of abdominal viscera injury.2019年06月, JACC. Clinical electrophysiology, 5(6) (6), 730 - 741, 英語, 国際誌研究論文（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, PL04 - 3, 英語LGE-MRI技術を用いた左心房線維性基質の画像化の実施可能性(Feasibility of Imaging Fibrotic Substrates in the Left Atrium Using LGE-MRI Technology)
- (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, OE01 - 5, 英語Cryoballoonアブレーション治療および接触力センシング型カテーテルによるラジオ波焼灼療法におけるLGE-MRIにより評価した損傷特性(Lesion Characteristics Assessed by LGE-MRI between Cryo-balloon Ablation and Radiofrequency Ablation with Contact-force Sensing Catheter)
- We present a patient with non-cardiac sarcoidosis complicated with manifest ventricular preexcitation. Initially, cardiac involvement of sarcoidosis was suspected from the echocardiographic findings showing localized hypokinesia at the left ventricular basal inferior wall. We, however, considered that the hypokinesia was a preexcitation-induced mechanical dyssynchrony rather than cardiac sarcoidosis, because polarities of the delta-waves indicated a left ventricular inferior accessory pathway. Temporal administration of oral flecainide acetate eliminated the basal left ventricular motion abnormality. Accordingly, we could successfully differentiate the mechanism of hypokinesia. In this context, we could rule out cardiac sarcoidosis, and initiation of glucocorticoid therapy was reasonably withheld.2019年, Journal of electrocardiology, 57, 87 - 89, 英語, 国際誌研究論文（学術雑誌）
- Focal thinning of the basal muscular ventricular septum is a characteristic morphological finding in cases of cardiac sarcoidosis, usually detected on the parasternal long-axis image during echocardiography. Surprisingly, however, its circumferential extent has rarely been demonstrated and discussed. We present a case showing typical thinning of the basal ventricular septum. The extent of circumferential wall thinning was evaluated using both echocardiography and cardiac computed tomography. The present case highlights the importance of detailed multiplanar and three-dimensional evaluation of this characteristic abnormality, more so because its mechanism as well as the precise impact on conduction has not yet been elucidated.2018年12月, Echocardiography (Mount Kisco, N.Y.), 35(12) (12), 2095 - 2098, 英語, 国際誌研究論文（学術雑誌）
- 2018年09月, HeartRhythm case reports, 4(9) (9), 389 - 392, 英語, 国際誌研究論文（学術雑誌）
- Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI. Using multiplanar reconstructions, we measured the height and width of the membranous septum, and the distances of its superior and inferior margins from the virtual basal ring plane. We also assessed the extent of wedging of the aortic root between the mitral valve and the ventricular septum. Mean heights and widths of the membranous septum were 6.6 ± 2.0, and 10.2 ± 3.1 mm, respectively, with its size significantly associated with that of the aortic root (P < 0.05). Its superior and inferior margins were 4.5 ± 2.3 and 2.1 ± 2.1 mm, respectively, from the plane of the basal ring. The inferior distance, the surrogate for the adjacency of the atrioventricular conduction axis, was ≤ 5mm in 91% of the patients. Deeper wedging of the aortic root was independently correlated with a shorter inferior distance (β = 0.0569, P = 0.0258). The membranous septum is appreciably closer to the virtual basal ring than previously appreciated. These findings impact on estimations of the risk of damage to the atrioventricular conduction axis during TAVI. Clin. Anat. 31:525-534, 2018. © 2018 Wiley Periodicals, Inc.2018年05月, Clinical anatomy (New York, N.Y.), 31(4) (4), 525 - 534, 英語, 国際誌研究論文（学術雑誌）
- We present optimally reconstructed three-dimensional computed tomography images of left ventricular outflow obstruction, comprehensive left ventriculography, and comparable intraoperative transesophageal echocardiography, as well as serial operative pictures, to facilitate the understanding of live-heart anatomy of hypertrophic obstructive cardiomyopathy. As shown in this case, detailed morphological analysis around the left ventricular outflow tract using preoperative computed tomography would be feasible and useful. The present case highlights the importance of obtaining complete three-dimensional information present in the acquired computed tomography dataset because computed tomography is not entirely noninvasive or free of radiation exposure and contrast material.2018年04月, Echocardiography (Mount Kisco, N.Y.), 35(4) (4), 537 - 540, 英語, 国際誌研究論文（学術雑誌）
- Predominant or isolated right ventricular involvement in cardiac sarcoidosis is uncommon, but should always be considered in a case of right ventricular hypertrophy combined with ventricular arrhythmia and/or conduction disturbance. Although improvement in right ventricular hypertrophy and atrioventricular conduction disturbance following corticosteroid therapy has been reported, the detailed serial electrocardiographic responses during corticosteroid therapy, as well as temporal changes in the electrocardiographic, biochemical, and morphological responses, have not been reported. We describe the clinical course and supportive imaging findings of reversible right ventricular hypertrophy and cardiac conduction disturbance in a case of right ventricular-predominant cardiac sarcoidosis.2018年, Journal of electrocardiology, 51(4) (4), 658 - 662, 英語, 国際誌研究論文（学術雑誌）
- In cases with significant pericardial effusion, cardiac apical swinging is a characteristic finding, usually detected by echocardiography and electrocardiography. We present a case showing typical cardiac apical swinging, initially detected by routine computed tomography as a cardiac swinging artifact. The present case highlights the importance of multidisciplinary interpretation of cardiac images, specifically focusing on the difference between static images obtained by computed tomography and dynamic images visualized by echocardiography.2017年12月, Echocardiography (Mount Kisco, N.Y.), 34(12) (12), 1950 - 1952, 英語, 国際誌研究論文（学術雑誌）
- Extracardiac structures can cause distortion of cardiac anatomy particularly in patients presenting with a significantly dilated heart, and/or thoracic deformities. We present the case of a 69-year-old woman with dilated cardiomyopathy who underwent cardiac resynchronization therapy. Preoperative electrocardiography-gated contrast-enhanced computed tomography revealed the inferolateral wall of her significantly dilated and leftward-rotated heart was close to the descending aorta, and the descending aorta compressed the sandwiched inferolateral branch of the coronary vein. Retrograde coronary venography performed at the time of device implantation confirmed focal stenosis of the inferolateral branch of the coronary vein.2017年12月, Journal of arrhythmia, 33(6) (6), 646 - 648, 英語, 国内誌研究論文（学術雑誌）
- An asymptomatic 45-year-old man was referred to our hospital for detailed evaluation of a systolic ejection murmur. The intensity of the murmur increased on deep expiration and decreased on deep inspiration, showing so-called reversed Rivero-Carvallo's sign. Using cardiac magnetic resonance imaging, we demonstrated a characteristic respiratory-induced change in peak flow velocity in the right ventricular outflow tract, which was the basic mechanism of the reversed Rivero-Carvallo's sign in a case with straight back syndrome. Concomitant anatomical changes in the entire heart in relation to the thoracic cage were also clarified.2017年11月, Echocardiography (Mount Kisco, N.Y.), 34(11) (11), 1721 - 1724, 英語, 国際誌研究論文（学術雑誌）
- Preprocedural recognition of the segment of latest mechanical contraction along with the anatomy of the coronary venous system is important for successful and effective cardiac resynchronization therapy. We present a case of ischemic cardiomyopathy who underwent implantation of a cardiac resynchronization therapy device with a defibrillator, which was facilitated by preprocedural computed tomographic images reconstructed to visualize the left ventricular slab and the coronary venous system simultaneously on the cardiac contour. The present reconstruction method using computed tomography is optimal and feasible method to incorporate the echocardiographic findings into the procedure performed under fluoroscopy appropriately.2017年07月, Echocardiography (Mount Kisco, N.Y.), 34(7) (7), 1073 - 1076, 英語, 国際誌研究論文（学術雑誌）
- The location of the heart within the thorax varies significantly between individuals. The resultant diversity of the anatomical cardiac long axis, however, and its determinants, have yet to be systematically investigated. We enrolled 100 consecutive patients undergoing coronary arterial computed tomographic angiography, decomposing the vector of the anatomical cardiac long axis by projecting it to horizontal, frontal, and sagittal planes. The projected vectors on each plane were then converted into three rotation angles using coordinate transformation. We then measured the extent of aortic wedging, using the vertical distance between the inferior margins of the non-adjacent aortic sinus and the epicardium. We took the aortic root rotation angle to be zero when an "en face" view of the right coronary aortic sinus was obtained in the frontal view, defining leftward rotation to be positive. The mean horizontal, frontal, and sagittal rotation angles were 48.7° ± 9.5°, 52.3° ± 12.0°, and 34.0° ± 11.2°, respectively. The mean extent of aortic wedging, and the aortic root rotation angle, were 42.7 ± 9.8 mm, and 5.3° ± 16.4°. Horizontal rotation of the anatomical axis was associated with leftward and ventral rotation, and vice versa. Multivariate analysis showed aortic root rotation to be associated with horizontal cardiac rotation, while aortic wedging is associated with frontal and sagittal cardiac rotation. We have quantified the marked individual variation observed in the anatomical axis of the living heart, identifying the different mechanisms involved in producing the marked three-dimensional diversity of the living heart. Anat Rec, 300:1083-1092, 2017. © 2017 Wiley Periodicals, Inc.2017年06月, Anatomical record (Hoboken, N.J. : 2007), 300(6) (6), 1083 - 1092, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: It is axiomatic that the diameter of the virtual basal ring of the aortic root, which is elliptical rather than circular, will differ when assessed using between bisecting as opposed to off-center cuts. Such differences, however, which pertain directly to echocardiographic assessments of the so-called valvar annulus, have yet to be systematically explored. METHODS: We retrospectively analyzed 30 patients undergoing coronary computed tomographic angiography, measuring the virtual basal ring diameter using routine multiplanar reconstructions. We made orthogonal bisecting cuts from the nadir of the hinge of the right coronary aortic leaflet to the center of the opposite inter-leaflet fibrous triangle between the noncoronary and left coronary aortic leaflets. We compared these measurements with orthogonal off-center cuts made through the nadirs of the hinges of the adjacent leaflets. RESULTS: The measured diameter of the virtual basal ring was significantly longer when measured using the bisecting cut as opposed to all off-center cuts (mean difference: 1.35±1.34 mm, P<.0001; 0.77±0.95 mm, P=.0001, respectively). The measured diameters of the sinuses of Valsalva, in contrast, were significantly shorter when measured using the bisecting cut (mean difference: -3.24±1.38 mm, P<.0001; -2.86±1.61 mm, P<.0001). CONCLUSIONS: There are significant differences in the diameters of the aortic root, which represent the echocardiographic annulus, when measured using bisecting as opposed to off-center cuts. Account should be taken of these differences when using cross-sectional echocardiographic measurements to assess the dimensions of the aortic root.2017年03月, Echocardiography (Mount Kisco, N.Y.), 34(3) (3), 453 - 461, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Stent fracture (SF) after drug-eluting stent (DES) implantation was reported to be associated with target lesion revascularization (TLR). We have noted abnormal late acquired stent axial deformation in lesions after DES implantation, especially in SF lesions, and defined it as stent recoil (SR). We evaluated the incidence, predictive factors, and clinical impact of SR in SF lesions. METHODS: Between 2003 and 2012, 5456 patients (11,712 lesions) underwent DES implantations and follow-up angiography within one year after the index procedure. SR was defined as an axial recoil deformation less than 80% of the stent diameter and SF was defined as the separation of stent segments or stent struts. SF and SR were confirmed by follow-up angiography. The primary endpoint was defined as clinically driven TLR. RESULTS: SF was observed in 494 lesions (4.2%) and SR in 138 of SF lesions (27.9%). According to multinomial logistic regression analyses, severe calcification and ostial lesion in the right coronary artery were stronger predictive factors of SF with SR lesions. The cumulative incidences of any and clinically driven TLR at 5years were both significantly higher in the SF with SR group than in the SF without SR group (51.7% versus 35.0%, P<0.001; 22.2% versus 12.8%, P=0.019; respectively). CONCLUSIONS: SR in SF lesions after DES implantation could be related to the lesion characteristics. SF with SR was highly associated with subsequent TLR compared with SF without SR.2016年07月, International journal of cardiology, 214, 123 - 9, 英語, 国際誌研究論文（学術雑誌）
- UNLABELLED: Little is known about the long-term outcomes after first-generation sirolimus-eluting stent (SES) implantation. We aimed to investigate the clinical outcomes up to 10 years after SES implantation. METHODS: The study population comprised 342 patients (504 lesions) who underwent SES implantation between January 2002 and December 2004. The median duration of follow-up was 3816 days (interquartile range [Q1-Q3], 3,705-3,883 days). RESULTS: The cumulative event rate of definite stent thrombosis was 3.9%. The cumulative rate of target lesion revascularization (TLR) at 1, 5, and 10 years was 8.7%, 18.8%, and 31.1%, respectively, and the annual rate of TLR was 3.1%. Clinically driven TLR occurred at relatively constant rate during 10 years (2.0% per year). In a multivariate analysis, higher body mass index, hemodialysis, in-stent restenosis (ISR) target lesion, and total stent length >30 mm were independent risk factors of TLR within 5 years. An independent risk factor of TLR beyond 5 years was ISR target lesion. CONCLUSIONS: Late TLR after SES implantation is a long-term hazard, lasting up to 10 years. The ISR target lesion is a risk factor of TLR during 10 years.2016年05月, American heart journal, 175, 47 - 55, 英語, 国際誌研究論文（学術雑誌）
- AIMS: Morphological assessment of neointimal tissue using optical coherence tomography (OCT) is important for clarifying the pathophysiology of in-stent restenosis (ISR) lesions. The aim of this study was to determine the impact of OCT findings on recurrence of ISR after various types of percutaneous coronary intervention (PCI) including plain old balloon angioplasty (POBA), paclitaxel-coated balloon (PCB) dilatation, and drug-eluting stent (DES) implantation. METHODS AND RESULTS: Between June 2008 and August 2013, we performed PCI for 428 ISR lesions in 379 patients using POBA (78 lesions, POBA group), PCB dilatation (202 lesions, PCB group), and DES implantation (148 lesions, DES group). Morphological assessment of neointimal tissue at the minimum lumen area site to determine restenotic tissue structure (homogeneous, heterogeneous, or layered type) using OCT was performed. We examined the association between tissue structure and midterm results including ISR and target lesion revascularization (TLR) rates. The patients were 308 men and 71 women with a mean age of 68.9 ± 9.4 years. The mean follow-up period was 211 ± 40 days. ISR and TLR rates of lesions with a homogeneous structure were significantly higher in the POBA group than in the PCB group (ISR: 54.8 vs. 19.1%, P < 0.001; TLR: 38.7 vs. 10.6%, P < 0.001) and DES group (ISR: 54.8 vs. 19.6%, P = 0.002; TLR: 38.7 vs. 10.7%, P = 0.005), whereas there were no differences in ISR and TLR rates between the three groups in lesions with a heterogeneous structure. CONCLUSION: Morphological assessment of ISR tissue using OCT might suggest favourable types of PCI for ISR lesions.2015年10月, European heart journal. Cardiovascular Imaging, 16(10) (10), 1101 - 11, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Stent fracture (SF) after sirolimus-eluting stent implantation is reported to be associated with target lesion revascularization (TLR) and stent thrombosis. We aimed to assess the clinical impact of SF at 8 years. METHODS AND RESULTS: Between 2002 and 2005, 972 patients (1795 lesions) underwent sirolimus-eluting stent implantation and follow-up angiography within 1 year after index procedure. SF, defined as the complete separation of stent segments or stent struts at follow-up angiography, was observed in 105 lesions (5.8%). The study sample comprised 954 patients (1630 lesions), excluding 147 lesions undergoing TLR and 18 patients (18 lesions) who died or in whom stent thrombosis developed within 1 year after sirolimus-eluting stent implantation. The median follow-up duration was 9.1 years (the first and third quarters, 8.7 and 9.4 years). The primary end point was defined as any TLR. The 8-year cumulative rates of adverse events were estimated by Kaplan-Meier methods with P values from log-rank tests. Between patients with and without SF, there were no significant differences in the cumulative rates of all-cause death (23.5% versus 27.6%, P=0.35) and cardiac death (4.7% versus 9.1%, P=0.14), whereas patients with SF had significantly higher cumulative rates in myocardial infarction (10.1% versus 3.3%, P=0.001), very late stent thrombosis (6.8% versus 0.7%, P<0.001), any TLR (38.1% versus 10.8%, P<0.001), and clinically driven TLR (26.2% versus 6.6%, P<0.001). CONCLUSIONS: SF after sirolimus-eluting stent implantation was consistently associated with higher rates of adverse cardiac events during the 8-year follow-up.2015年08月, Circulation. Cardiovascular interventions, 8(8) (8), e002664, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: There are currently inadequate data on whether "late restenosis" occurs after paclitaxel-coated balloon (PCB) angioplasty for in-stent restenosis (ISR) lesions. OBJECTIVES: To evaluate the long-term safety and efficacy of PCB angioplasty, we investigated serial clinical and angiographic outcomes after PCB angioplasty for ISR lesions. METHODS: Between September 2008 and December 2012, PCB angioplasty was performed in 468 patients with 550 ISR lesions (bare-metal stent restenosis [BMS-ISR]: 114 lesions, drug-eluting stent restenosis [DES-ISR]: 436 lesions). Two serial angiographic follow-ups were routinely planned for the patients (at 6 and 18 months after the procedure). RESULTS: Early follow-up (6 months) angiography was performed for 488 lesions (89%), and recurrent restenosis occurred in 13 lesions (13.0%) in the BMS-ISR group and in 82 lesions (21.1%) in the DES-ISR group. Target lesion revascularization was performed for 7 lesions (7.0%) in the BMS-ISR group and 54 lesions (13.9%) in the DES-ISR group. Late follow-up (18 months) angiography was performed for 377 (88%) of the remaining 427 lesions (excluding target lesion revascularization lesions), and late restenosis was found in 2 lesions (2.5%) in the BMS-ISR group and 50 lesions (16.8%) in the DES-ISR group. Delayed late lumen loss was significantly larger in the DES-ISR group. Previous stent size ≤2.5 mm, percentage diameter stenosis after the procedure, and in-stent occlusion lesion were independent predictors of early restenosis. DES-ISR, percentage diameter stenosis at early follow-up, and hemodialysis were independent predictors of late restenosis. CONCLUSIONS: Late restenosis occurs after PCB angioplasty for DES-ISR lesions.2015年07月, Journal of the American College of Cardiology, 66(1) (1), 14 - 22, 英語, 国際誌研究論文（学術雑誌）
- AIMS: Morphological assessment of neointimal tissue using optical coherence tomography (OCT) is important for clarifying the pathophysiology of in-stent restenosis (ISR) lesions. The aim of this study was to determine the impact of OCT findings on recurrence of ISR after paclitaxel-coated balloon (PCB) dilatation compared with plain old balloon angioplasty (POBA). METHODS AND RESULTS: Between July 2008 and May 2012, we performed percutaneous coronary intervention for 214 ISR lesions using POBA + PCB (146 lesions, PCB group) or POBA only (68 lesions, POBA group). Morphological assessment of neointimal tissue using OCT, including assessment of restenotic tissue structure and restenotic tissue backscatter, was performed. We examined the association between lesion morphologies and mid-term (6-8 months) results including ISR and target lesion revascularization (TLR) rates. Both ISR and TLR rates of lesions with a homogeneous structure were significantly lower in the PCB group than those in the POBA group (ISR: 20.0 vs. 55.6%, P = 0.002, TLR: 12.7 vs. 37.0%, P = 0.019), but there was no difference between the two groups in ISR and TLR rates of lesions with a heterogeneous or layered structure. Both ISR and TLR rates of lesions with high backscatter were significantly lower in the PCB group than those in the POBA group (ISR: 19.8 vs. 52.5%, P < 0.001, TLR: 13.6 vs. 42.5%, P = 0.001), but there was no difference between the two groups in ISR and TLR rates of lesions with low backscatter. CONCLUSION: Morphological assessment of ISR tissue using OCT might be useful for identifying ISR lesions favourable for PCB dilatation.2014年03月, European heart journal. Cardiovascular Imaging, 15(3) (3), 307 - 15, 英語, 国際誌研究論文（学術雑誌）
- (公社)日本医学放射線学会, 2024年02月, Japanese Journal of Radiology, 42(Suppl.) (Suppl.), 37 - 37, 日本語心臓病変を認めたErdheim Chester病の1例
- 2024年, 日本循環器学会学術集会(Web), 88th経皮的冠動脈インターベンションにおいて非造影冠動脈計算機トモグラフィーから誘導された結節石灰化の予後的重要性
- 2023年, 日本内科学会雑誌, 112経カテーテル的大動脈弁置換術の術前CTから算出された細胞外液分画と患者予後との関連について
- 2023年, 日本循環器学会学術集会(Web), 87th心サルコイドーシスから心筋炎を鑑別するためのガドリニウム遅延造影と心臓磁気共鳴イメージングから求めた細胞外体積分画の評価
- 2022年, 日本成人先天性心疾患学会雑誌(Web), 11(1) (1)極めて稀な高齢未修復ファロー四徴症の一例
- 症例は76歳，女性．計3度の胸椎圧迫骨折ののち，徐々に座位時の呼吸困難感を訴えるようになった．このため，次第に日常生活活動度も低下するようになり，呼吸困難の原因精査のため当院入院となった．経胸壁心エコー図検査を施行したところ，仰臥位では明らかな短絡は認められなかったものの，座位時には超音波コントラスト剤による左心系の染影が確認された．卵円孔開存を基礎としたplatypnea-orthodeoxia syndromeが強く疑われたため，引き続き経食道心エコー図検査を施行．座位への体位変換により大きく開大する卵円孔開存の存在が確認され，同部を介した多量のコントラスト剤の左房流入を確認することができた．経皮的卵円孔閉鎖術を実施したところ，術後は呼吸困難および低酸素血症は消失した．本症例は，卵円孔開存の存在に加えて胸椎圧迫骨折を繰り返したことで亀背が進行し，その結果蛇行した大動脈が心房中隔を変形させ，右左短絡が形成されplatypnea-orthodeoxia syndromeを呈するに至ったものと考えられた．公益財団法人 日本心臓財団, 2021年10月15日, 心臓, 53(10) (10), 1118 - 1123, 日本語
- 2021年, 超音波医学 Supplement, 48ファロー四徴症心内修復後患者における高度肺動脈弁逆流症をどのようにして同定するか
- 2021年, 日本循環器学会学術集会(Web), 85thVT管理における心臓画像の有用性:CTおよびLGE-MRI評価
- 2021年, 日本循環器学会学術集会(Web), 85th心臓CT検査およびFFRCTに対する当院の取り組みについて
- 2021年, 日本循環器学会学術集会(Web), 85th皮下植込み型除細動器の埋め込みにおける広背筋の解剖学
- 2021年, 日本循環器学会学術集会(Web), 85th僧帽弁輪周囲分離の特徴的な分布パターン:心臓CTを用いた網羅的解析
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE76 - 2, 英語ラジオ波焼灼術が心房細動患者におけるpatchy遅延造影部位に及ぼす影響 LGE-MRIによる解析(The Impact of the Radiofrequency Application on the Patchy Late-gadolinium Enhancement Sites in Patients with Atrial Fibrillation: LGE-MRI Analysis)
- (一社)日本循環器学会, 2020年07月, 日本循環器学会学術集会抄録集, 84回, OE104 - 1, 英語心房細動患者におけるLGE-MRIで描出された線維化領域とExTRa Mappingで記録された非受動的興奮領域との関連(The Relationship between Fibrotic Areas Assessed by LGE-MRI and Non-Passively Activated Areas Detected by ExTRa Mapping in Atrial Fibrillation Patients)
- 2020年, 日本循環器学会学術集会(Web), 84th左心室心尖部の局所的な菲薄化:予想外に一般的な所見とその臨床的意義
- 2020年, 日本循環器学会学術集会(Web), 84th介入治療後の慢性血栓塞栓性肺高血圧症における微小血管障害の評価
- 2020年, 心臓核医学, 22(2) (2)心臓サルコイドーシスの炎症評価における99mTc製剤のWashout評価の有用性
- 2018年, 日本循環器学会近畿地方会(Web), 125th冠静脈洞瘤を合併したWPW症候群に対し,解剖学的情報がアブレーションに有用であった1例
- 2018年, 日本循環器学会近畿地方会(Web), 126th左室基部筋性中隔の菲薄化を三次元的に評価した心臓サルコイドーシスの一例
- 2018年, 日本循環器学会近畿地方会(Web), 126th二次孔欠損型心房中隔欠損に合併する下大静脈欠損の診断を契機に判明した左側相同の一例
- 2017年, 日本内科学会雑誌, 106立っている心臓・寝ている心臓とは何か:心臓解剖軸の多様性とその規定因子
- 2017年, 日本循環器学会近畿地方会(Web), 123rd逆Rivero-Carvallo徴候を心臓MRIにて証明したStraight Back Syndromeの一例
- 2017年, 日本循環器学会近畿地方会(Web), 124th可逆性の右室壁肥厚を呈した右室優位の心サルコイドーシスの一例
- 2017年, 日本循環器学会近畿地方会(Web), 124th左室リードの至適留置位置決定に有用な心臓CT三次元画像再構成法
- 2017年, 日本循環器学会近畿地方会(Web), 124th心臓CTを契機に診断に至ったスタックバルブの一例
- 2017年, 日本循環器学会学術集会(Web), 81st大動脈弁の石灰化密度は,大動脈弁の面積と独立に,大動脈弁狭窄症の血行力学的重症度を予測する
- 2017年, 日本循環器学会学術集会(Web), 81st心外膜アブレーションに使用する上腹壁動脈の解剖学的特徴
- 2015年, 倉敷中央病院年報, 77診断に苦慮した感染性心内膜炎の1例
- 2015年, 日本循環器学会中国地方会(Web), 106th乾酪様僧帽弁輪石灰化によると思われる心筋内に粗大な石灰化病変を認めた一例
- 2015年, 日本循環器学会中国地方会(Web), 106th急性心筋梗塞患者における,EPA/AA比と冠動脈病変の重症度との関連
- 2015年, 日本循環器学会中国地方会(Web), 107th散発性Mitochondrial Cardiomyopathyの一例
- 2015年, 日本循環器学会中国地方会(Web), 107thPET-CTで高集積を認めたが,ステロイド導入せず自然軽快が得られた心サルコイドーシスの一例
- 2015年, 日本循環器学会中国地方会(Web), 107th左室機能低下例にてエルゴノビン負荷試験を施行した139例における内服薬と左室駆出率の検討
- 2015年, 日本循環器学会中国地方会(Web), 107th急性冠症候群患者における出血リスクに基づいた低用量Prasugrelの使用経験
- 2015年, 日本循環器学会中国地方会(Web), 106th急性冠症候群PCI患者における出血リスクに基づいたPrasugrelの使用経験
- 2015年, 日本循環器学会中国地方会(Web), 106th薬剤溶出性ステント間での再狭窄を伴うStent Fracture病変に対する治療成績の比較検討
- 2015年, 日本循環器学会中国地方会(Web), 106thBiolimus-eluting stentとEverolimus-eluting stentの右冠動脈入口部における治療成績
- 2015年, 倉敷中央病院年報, 77心室頻拍で来院した不整脈源性右室心筋症(ARVC)の1例
- 2015年, 日本循環器学会中国地方会(Web), 107th当院におけるLMTの再狭窄への初回DCBの使用に対する短期成績の検討
- 2015年, 日本循環器学会中国地方会(Web), 107th透析患者に対する薬剤溶出性ステント(DES)留置の成績に関する検討-第1世代DESと第2世代DESとの比較-
- 2015年, 日本循環器学会中国地方会(Web), 107thステント内再狭窄病変に対するパクリタキセル被覆バルーン治療後の,遅発性の狭窄度の退縮について
- 2015年, 日本心臓病学会学術集会(Web), 63rd各種冠動脈ステント留置例において冠攣縮が与える中期予後への影響について
- 2015年, 日本心臓病学会学術集会(Web), 63rd部分再分布所見を伴う負荷心筋血流SPECT検査での冠動脈狭窄の予測因子の検討
- 2015年, 日本心臓病学会学術集会(Web), 63rd薬剤溶出性ステント間での再狭窄を伴うStent Fracture病変に対する治療成績の比較検討
- 2015年, 臨床神経学(Web), 55(4) (4)透析患者に生じたセフェピム脳症の一例
- 2014年, 日本循環器学会中国地方会(Web), 104th心臓MRIとTl+BMIPP心筋SPECTが診断に有用であった冠攣縮性狭心症の一例
- 2014年, 日本循環器学会中国地方会(Web), 105th心臓MRIが病態の把握に有用であった周産期心筋症の一例
- 2014年, 日本循環器学会中国地方会(Web), 105th当院での心サルコイドーシスにおけるPET-CTの有用性
- 2014年, 日本循環器学会中国地方会(Web), 105th当院における過去12年間の初回冠動脈造影9399例とエルゴノビン負荷冠攣縮誘発試験2454例の検討
- 2014年, 日本循環器学会中国地方会(Web), 105th当院における心サルコイドーシス評価のためのPET-CTでの心臓生理的集積の検討
- 2014年, 日本循環器学会中国地方会(Web), 105th心臓MRIの遅延造影像から心アミロイドーシスを疑い,診断にいたった原発性アミロイドーシスの一例
- 2014年, 倉敷中央病院年報, 76大腿動脈アプローチによる経カテーテル大動脈弁植え込み術の臨床成績
- 2014年, 日本循環器学会中国地方会(Web), 104thST上昇型急性心筋梗塞患者の院内死亡の危険因子の検討。
- 2014年, 日本循環器学会中国地方会(Web), 104th非左主幹部分岐部病変に対するCullote-stentingの第2世代溶出性ステントにおける中期成績
- 2014年, 日本循環器学会中国地方会(Web), 105th冠動脈拡張症に合併したST上昇型急性心筋梗塞症例の患者背景
- 2014年, 日本循環器学会中国地方会(Web), 105th急性前壁心筋梗塞後中隔枝閉塞により遅発性に完全房室ブロックとなった1症例
- 2014年, 日本心臓病学会学術集会抄録(CD-ROM), 62ndエベロリムス溶出性ステント留置後の抗血栓療法と出血性合併症に関する検討
- 2014年, 日本循環器学会中国地方会(Web), 105th薬剤溶出性ステント留置後の遅発性再狭窄の頻度,予測因子の検討
- 2014年, 日本循環器学会中国地方会(Web), 105th極小血管に対する2.25mmのPtCrおよびCoCr everolimus-eluting stentの中期成績の検討
- 2014年, 日本心臓病学会学術集会抄録(CD-ROM), 62ndST上昇型急性心筋梗塞患者の院内死亡の危険因子の検討
- 2013年, 日本循環器学会中国地方会(Web), 102nd慢性心不全におけるトルバプタンの外来使用成績
- 2013年, 日本循環器学会中国地方会(Web), 102ndBrugada症候群にRVOT-VTを合併した一例
- 2013年, 日本循環器学会中国地方会(Web), 102ndたこつぼ型心筋障害発症の集積性
- 2013年, 日本心臓病学会誌, 8(Supplement 1) (Supplement 1)Everolimus eluting Stent留置後の出血性合併症の頻度と予測因子
- 2012年, 日本循環器学会中国地方会(Web), 101stEverolimus-eluting StentとBiolimus-eluting StentにおけるStent Fracture,Stent Recoilと再狭窄の関連
- 2012年, 日本循環器学会中国地方会(Web), 101st非典型的な心外膜下血腫による冠動脈穿孔後心タンポナーデの一例
- 2011年, 日本循環器学会中国地方会(Web), 99thBMS留置後,PSSを認め,その後遅発性ステント血栓症を発症した1例