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KAWAMORI HiroyukiUniversity Hospital / Cardiovascular MedicineAssociate Professor
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■ Paper- AIMS: Optical coherence tomography (OCT) can identify high-risk plaques indicative of worsening prognosis in patients with acute coronary syndrome (ACS). However, manual OCT analysis has several limitations. In this study, we aim to construct a deep-learning model capable of automatically predicting ACS prognosis from patient OCT images following percutaneous coronary intervention (PCI). METHODS AND RESULTS: Post-PCI OCT images from 418 patients with ACS were input into a deep-learning model comprising a convolutional neural network (CNN) and transformer. The primary endpoint was target vessel failure (TVF). Model performances were evaluated using Harrell's C-index and compared against conventional models based on human observation of quantitative (minimum lumen area, minimum stent area, average reference lumen area, stent expansion ratio, and lesion length) and qualitative (irregular protrusion, stent thrombus, malapposition, major stent edge dissection, and thin-cap fibroatheroma) factors. GradCAM activation maps were created after extracting attention layers by using the transformer architecture. A total of 60 patients experienced TVF during follow-up (median 961 days). The C-index for predicting TVF was 0.796 in the deep-learning model, which was significantly higher than that of the conventional model comprising only quantitative factors (C-index: 0.640) and comparable to that of the conventional model, including both quantitative and qualitative factors (C-index: 0.789). GradCAM heat maps revealed high activation corresponding to well-known high-risk OCT features. CONCLUSION: The CNN and transformer-based deep-learning model enabled fully automatic prognostic prediction in patients with ACS, with a predictive ability comparable to a conventional survival model using manual human analysis. CLINICAL TRIAL REGISTRATION: The study was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN000049237).Nov. 2024, European heart journal. Digital health, 5(6) (6), 692 - 701, English, International magazineScientific journal
- BACKGROUND: Combining morphological and physiological evaluations might improve the risk stratification of patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) culprit lesions. AIMS: We aimed to investigate the clinical utility of morphofunctional evaluation after PCI for identifying ACS patients with increased risk of subsequent clinical events. METHODS: We retrospectively studied 298 consecutive ACS patients who had undergone optical coherence tomography (OCT)-guided PCI. We performed OCT-based morphological analysis and quantitative flow ratio (QFR)-based physiological assessment immediately after PCI. The non-culprit segment (NCS) was defined as the most stenotic untreated segment in the culprit vessel. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, and ischaemia-driven target vessel revascularisation. RESULTS: During a median follow-up period of 990 days, 42 patients experienced TVF. Cox regression analysis revealed that the presence of thin-cap fibroatheroma (TCFA) in the NCS and a low post-PCI QFR, or the presence of TCFA in the NCS and a high ΔQFR in the NCS (QFRNCS), were independently associated with TVF. The subgroup with TCFA in the NCS and a low post-PCI QFR had a significantly higher incidence of TVF (75%) than the other subgroups, and those with TCFA in the NCS and a high ΔQFRNCS had a significantly higher incidence of TVF (86%) than the other subgroups. The integration of TCFA in NCS, post-PCI QFR, and ΔQFRNCS with traditional risk factors significantly enhanced the identification of subsequent TVF cases. CONCLUSIONS: Combining post-PCI OCT and QFR evaluation may enhance risk stratification for ACS patients after successful PCI, particularly in predicting subsequent TVF.Aug. 2024, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 20(15) (15), e927-e936, English, International magazineScientific journal
- BACKGROUND: Fractional flow reserve-computed tomography (FFRCT) has not been validated in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) for coronary artery disease due to theoretical difficulties in using nitroglycerin for such patients.Methods and Results: In this single-center study, we prospectively enrolled 21 patients (34 vessels) and performed pre-TAVR FFRCTwithout nitroglycerin, pre-TAVR invasive instantaneous wave-free ratio (iFR) measurements, and post-TAVR FFR measurements using a pressure wire. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of pre-TAVR FFRCT≤0.80 to predict post-TAVR invasive FFR ≤0.80 were 82%, 83%, 82%, 71%, and 90%, respectively. A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.78 for pre-TAVR FFRCTto indicate post-TAVR FFR ≤0.80, with an area under the curve (AUC) of 0.84, and the counterpart cutoff of pre-TAVR iFR was 0.89 with an AUC of 0.86. CONCLUSIONS: FFRCTwithout nitroglycerin could be a useful non-invasive imaging modality for assessing the severity of coronary artery lesions in patients with severe AS.Mar. 2024, Circulation journal : official journal of the Japanese Circulation Society, 88(4) (4), 501 - 509, English, Domestic magazineScientific journal
- BACKGROUND: Murray law-based quantitative flow ratio (μQFR) is a novel computational method that enables accurate estimation of fractional flow reserve (FFR) using a single angiographic projection. However, its diagnostic value in patients with severe aortic stenosis (AS) remains unclear. METHOD: We included 25 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS with intermediate or greater (30-90%) coronary artery disease (CAD). Pre- and post-TAVR μQFR, QFR, instantaneous flow reserve (iFR), and post-TAVR invasive FFR values were measured. We evaluated the diagnostic performance of pre-TAVR μQFR, QFR, and iFR using post-TAVR FFR ≤ 0.80 as a reference standard of ischemia. RESULT: Pre-TAVR μQFR was significantly correlated with post-TAVR FFR (r = 0.73, p < 0.0001). The area under the curve of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 was 0.91 (95% confidence interval [CI] 0.77-0.98), comparable to that of pre-TAVR iFR (0.86 [95% CI 0.71-0.98], p = 0.97). The accuracy, sensitivity, specificity, and positive and negative predictive values of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 were 84.2% (95% CI 68.7-93.4), 61.6% (95% CI 31.6-86.1), 96.0% (95% CI 79.6-99.9), 88.9% (95% CI 52.9-98.3), and 82.8% (95% CI 70.6-90.6), respectively. For pre-TAVR iFR, these values were 76.5% (95% CI 58.8-89.3), 90.9% (95% CI 58.7-99.8), 69.6% (95% CI 47.1-86.8), 58.8% (95% CI 42.8-73.1), and 94.1% (95% CI 70.8-99.1), respectively. CONCLUSION: μQFR could be useful for the physiological evaluation of patients with severe AS with concomitant CAD.Mar. 2024, Heart and vessels, English, Domestic magazineScientific journal
- (一社)日本循環器学会, Mar. 2024, 日本循環器学会学術集会抄録集, 88回, OJ15 - 4, EnglishPrognostic Significance of Nodular Calcification Derived from Non-contrast Coronary Computed Tomography in Percutaneous Coronary Intervention(タイトル和訳中)
- (一社)日本循環器学会, Mar. 2024, 日本循環器学会学術集会抄録集, 88回, OJ15 - 6, EnglishImpact of Pericoronary Adipose Tissue Attenuation on Clinical Outcome after Percutaneous Coronary Intervention with Second-Generation Drug-Eluting Stent(タイトル和訳中)
- BACKGROUND: Perivascular inflammation contributes to the development of atherosclerosis and microcirculatory dysfunction. Pericoronary adipose tissue (PCAT) attenuation, measured by coronary computed tomography angiography, is a potential indicator of coronary inflammation. However, the relationship between PCAT attenuation, microcirculatory dysfunction, and periprocedural myocardial injury (PMI) remains unclear. METHODS AND RESULTS: Patients with chronic coronary syndrome who underwent coronary computed tomography angiography before percutaneous coronary intervention were retrospectively identified. PCAT attenuation and adverse plaque characteristics were assessed using coronary computed tomography angiography. The extent of microcirculatory dysfunction was evaluated using the angio-based index of microcirculatory resistance before and after percutaneous coronary intervention. Overall, 125 consecutive patients were included, with 50 experiencing PMI (PMI group) and 75 without PMI (non-PMI group). Multivariable analysis showed that older age, higher angio-based index of microcirculatory resistance, presence of adverse plaque characteristics, and higher lesion-based PCAT attenuation were independently associated with PMI occurrence (odds ratio [OR], 1.07 [95% CI, 1.01-1.13]; P=0.02; OR, 1.06 [95% CI, 1.00-1.12]; P=0.04; OR, 6.62 [95% CI, 2.13-20.6]; P=0.001; and OR, 2.89 [95% CI, 1.63-5.11]; P<0.001, respectively). High PCAT attenuation was correlated with microcirculatory dysfunction before and after percutaneous coronary intervention and its exacerbation during percutaneous coronary intervention. Adding lesion-based PCAT attenuation to the presence of adverse plaque characteristics improved the discriminatory and reclassification ability in predicting PMI. CONCLUSIONS: Adding PCAT attenuation at the culprit lesion level to coronary computed tomography angiography-derived adverse plaque characteristics may provide incremental benefit in identifying patients at risk of PMI. Our results highlight the importance of microcirculatory dysfunction in PMI development, particularly in the presence of lesions with high PCAT attenuation. REGISTRATION: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057722; Unique identifier: UMIN000050662.Feb. 2024, Journal of the American Heart Association, 13(3) (3), e031209, English, International magazineScientific journal
- BACKGROUND: Drug-coated balloon (DCB) became a potential treatment option for patients with acute coronary syndrome (ACS); however, factors associated with target lesion failure (TLF) remain uncertain. METHODS: This retrospective, multicentre, observational study included consecutive ACS patients who underwent optical coherence tomography (OCT)-guided DCB treatment. Patients were divided into two groups according to the occurrence of TLF, a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target lesion revascularisation. RESULTS: We enrolled 127 patients in this study. During the median follow-up period of 562 (IQR: 342-1164) days, 24 patients (18.9%) experienced TLF, and 103 patients (81.1%) did not. The cumulative 3-year incidence of TLF was 22.0%. The cumulative 3-year incidence of TLF was the lowest in patients with plaque erosion (PE) (7.5%), followed by those with rupture (PR) (26.1%) and calcified nodule (CN) (43.5%). Multivariable Cox regression analysis revealed that plaque morphology was independently associated with TLF on pre-PCI (percutaneous coronary intervention) OCT, and residual thrombus burden (TB) was positively associated with TLF on post-PCI OCT. Further stratification by post-PCI TB revealed a comparable incidence of TLF in patients with PR (4.2%) to that of PE if the culprit lesion had a smaller post-PCI TB than the cut-off value (8.4%). TLF incidence was high in patients with CN, regardless of TB size on post-PCI OCT. CONCLUSIONS: Plaque morphology was strongly associated with TLF for ACS patients after DCB treatment. Residual TB post-PCI might be a key determinant for TLF, especially in patients with PR.Sep. 2023, International journal of cardiology, 387, 131149 - 131149, English, International magazineScientific journal
- (一社)日本心血管インターベンション治療学会, Aug. 2023, 日本心血管インターベンション治療学会抄録集, 31回, MO26 - 1, English経カテーテル大動脈弁置換術施行患者における冠動脈造影検査に基づく定量的冠血流比の有効性
- (一社)日本心血管インターベンション治療学会, Aug. 2023, 日本心血管インターベンション治療学会抄録集, 31回, MP22 - 8, EnglishOFDIを用いたロータブレータの切削効果予測の検討
- This study determined the predictive accuracy of optical frequency domain imaging (OFDI) on debulking effects of rotational atherectomy (RA) and compared the predictive accuracy of OFDI catheter-based with Rota wire-based prediction methods. This prospective, single-center, observational study included 55 consecutive patients who underwent OFDI-guided RA. On pre-RA OFDI images, a circle, identical to the Rota burr was drawn at the center of the OFDI catheter (OFDI catheter-based prediction method) or wire (wire-based prediction method). The area overlapping the vessel wall was defined as the predicted ablation area (P-area). The actual ablated area (A-area) was measured by superimposing the OFDI images before and after RA. The overlapping P-area and A-area were defined as overlapped ablation area (O-area), and the predictive accuracy was evaluated by %Correct area (O-area/P-area) and %Error area (A-area - O-area/A-area). The median %Correct and %Error areas were 47.8% and 41.6%, respectively. Irrelevant ablation (low %Correct-/high % Error areas) and over ablation (high %Correct-/high % Error areas) were related to deep vessel injury and intimal flap outside the P-area. The predictive accuracy was better in the OFDI catheter-based prediction method than the wire-based prediction method in the cross sections where the OFDI catheter and wire came in contact. However, it was better in the latter than the former where the OFDI catheter and wire were not in contact. OFDI-based simulation of the RA effect is feasible though accuracy may be affected by the OFDI catheter and wire position. OFDI-based simulation of RA effect might reduce peri-procedural complications during RA.Jul. 2023, Cardiovascular intervention and therapeutics, 38(3) (3), 316 - 326, English, Domestic magazineScientific journal
- Elsevier BV, Jun. 2023, Atherosclerosis, 375, 1 - 8Scientific journal
- May 2023, Cardiovascular intervention and therapeutics, English, Domestic magazineScientific journal
- BACKGROUND: Although cardiac involvement is relatively common in mixed connective tissue disease (MCTD), few reports on MCTD-associated fulminant myocarditis are available. CASE SUMMARY: A 22-year-old woman diagnosed with MCTD was admitted to our institution for cold-like symptoms and chest pain. Echocardiography revealed that the left ventricular ejection fraction (LVEF) had rapidly decreased from 50 to 20%. Because endomyocardial biopsy revealed no significant lymphocytic infiltration, immunosuppressant drugs were not started initially; however, steroid pulse therapy (methylprednisolone, one1000 mg/day) was initiated due to prolonged symptoms and unimproved haemodynamics. Despite strong immunosuppressant therapy, the LVEF did not improve, and severe mitral regurgitation appeared. Three days after steroid pulse therapy initiation, she experienced a sudden cardiac arrest; thus, venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumping (IABP) were initiated. Subsequent immunosuppressant therapy was continued with prednisolone (100 mg/day) and intravenous cyclophosphamide (1000 mg). Six days after steroid therapy initiation, the LVEF improved to 40% and then recovered to near-normal levels. After successful weaning off of VA-ECMO and IABP, she was discharged. Thereafter, a detailed histopathological examination revealed multi-focal signs of ischaemic micro-circulatory injury and diffuse HLA-DR in the vascular endothelium, suggesting an autoimmune inflammatory response. DISCUSSION: We report a rare case of fulminant myocarditis in a patient with MCTD who recovered with immunosuppressive treatment. Despite the absence of significant lymphocytic infiltration findings on histopathological examination, patients with MCTD may experience a dramatic clinical course. Although it is unclear whether myocarditis is triggered by viral infections, certain autoimmune mechanisms may lead to its development.Apr. 2023, European heart journal. Case reports, 7(4) (4), ytad174, English, International magazine
- BACKGROUND: Evidence of prognostic factors for stent failure after drug-eluting stent implantation for calcified nodules (CNs) is limited. AIMS: We aimed to clarify the prognostic risk factors associated with stent failure among patients who underwent drug-eluting stent implantation for CN lesions using optical coherence tomography (OCT). METHODS: This retrospective, multicentre, observational study included 108 consecutive patients with CNs who underwent OCT-guided percutaneous coronary intervention (PCI). To evaluate the quality of CNs, we measured their signal intensity and analysed the degree of signal attenuation. All CN lesions were divided into dark or bright CNs according to the half width of signal attenuation, greater or lower than 332, respectively. RESULTS: During the median follow-up period of 523 days, 25 patients (23.1%) experienced target lesion revascularisation (TLR). The 5-year cumulative incidence of TLR was 32.6%. Multivariable Cox regression analysis revealed that younger age, haemodialysis, eruptive CNs, dark CNs assessed by pre-PCI OCT, disrupted fibrous tissue protrusions, and irregular protrusions assessed by post-PCI OCT were independently associated with TLR. The prevalence of in-stent CNs (IS-CNs) observed at follow-up OCT was significantly higher in the TLR group than in the non-TLR group. CONCLUSIONS: Factors such as younger age, haemodialysis, eruptive CNs, dark CNs, disrupted fibrous tissue, or irregular protrusions were independently related to TLR in patients with CNs. The high prevalence of IS-CNs might indicate that the main cause of stent failure implanted in CN lesions could be the recurrence of CN progression in the stented segment.Mar. 2023, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, English, International magazineScientific journal
- (一社)日本循環器学会, Mar. 2023, 日本循環器学会学術集会抄録集, 87回, PJ094 - 4, EnglishDiagnostic Accuracy of Nitroglycerin-free FFRCT-based Physiological Assessment in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement(タイトル和訳中)
- Springer Science and Business Media LLC, Jan. 2023, Heart and Vessels, 38(5) (5), 634 - 644Scientific journal
- BACKGROUND: Optical coherence tomography-derived fractional flow reserve (OCT-FFR) correlates strongly with wire-based FFR; however, its clinical significance remains uncertain. OBJECTIVES: This study sought to investigate the relationship between post-percutaneous coronary intervention (PCI) OCT-FFR and long-term clinical outcomes in acute coronary syndrome (ACS). METHODS: This retrospective, multicenter, observational cohort study included consecutive patients with ACS who underwent OCT-guided emergency PCI. We analyzed post-PCI OCT images and calculated OCT-FFR to identify independent factors associated with target vessel failure (TVF) after PCI. RESULTS: Among 364 enrolled patients, 54 experienced TVF during a median follow-up of 36 (IQR: 26-48) months. Vessel-level OCT-FFR was significantly lower in the TVF group than in the non-TVF group (0.87 vs 0.94; P < 0.001). In the multivariable Cox regression analysis, low vessel-level OCT-FFR (HR per 0.1 increase: 0.38; 95% CI: 0.29-0.49; P < 0.001) and thin-cap fibroatheroma in the nonculprit lesion were independently associated with TVF. The TVF rate of vessels with both low vessel-level OCT-FFR (<0.90) and thin-cap fibroatheroma in the nonculprit lesion was 8.1 times higher than that of all other vessels (69.3% vs 12.4%; HR: 8.13; 95% CI: 4.33-15.25; log-rank P < 0.001). Furthermore, adding vessel-level OCT-FFR to baseline characteristics and post-PCI OCT findings improved discriminatory and reclassification ability in identifying patients with subsequent TVF. CONCLUSIONS: Vessel-level OCT-FFR was an independent factor associated with TVF after PCI in patients with ACS. Adding the OCT-FFR measurement to post-PCI OCT findings may enable better discrimination of patients with subsequent TVF after PCI for ACS. (Relationship between Intracoronary Optical Coherence Tomography Derived Virtual Fractional Flow Reserve and cardiovascular outcome on Acute coronary syndrome; UMIN000043858).Oct. 2022, JACC. Cardiovascular interventions, 15(20) (20), 2035 - 2048, English, International magazineScientific journal
- Percutaneous transluminal septal myocardial ablation (PTSMA) is a well-established interventional therapy for drug-refractory hypertrophic obstructive cardiomyopathy (HOCM) as an alternative to surgical myectomy. Although guidelines recommend that PTSMA should be performed in institutions with extensive experience, it is not centralized to such high-volume centers in real-world clinical practice. Thus, this study aimed to assess the feasibility of PTSMA in non-high-volume centers. We retrospectively examined patients with HOCM who underwent PTSMA between August 2012 and May 2020 at four institutions that experienced fewer than 20 cases of PTSMA procedures. The primary clinical endpoint was a composite of safety (all-cause death, electrical defibrillation for ventricular tachycardia or fibrillation, cardiac tamponade, permanent pacemaker implantation, and repeated interventions) and efficacy endpoints (repeated interventions [PTSMA or surgical myectomy]). Fifty-eight consecutive patients were enrolled. During the 30-day follow-up, no major clinical adverse events were noted except three patients (5.2%) requiring permanent pacemaker implantation for complete atrioventricular block. The percentage of patients with New York Heart Association functional class 1 or 2 significantly increased from 8.6 to 100% (p < 0.001). In the Cox proportional hazard model, left ventricular outflow tract pressure gradient at rest ≥ 30 mmHg (hazard ratio [HR] 6.56; 95% confidence interval [CI] 1.44-29.90; p = 0.015) and mitral regurgitation grade ≥ 3 (HR 10.75; 95% CI 1.81-63.79; p = 0.009) at the 30-day follow-up were associated with a composite of major clinical adverse events. The current study demonstrated that 58 patients who underwent PTSMA in non-high-volume centers had favorable 30-day clinical outcomes, with a primary composite endpoint rate of 5.2%. A prospective study with a larger sample size and longer follow-up is warranted to verify the safety and efficacy of PTSMA in non-high-volume centers.May 2022, Heart and vessels, English, Domestic magazineScientific journal
- 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.Jan. 2022, Heart and vessels, 37(1) (1), 1 - 11, English, Domestic magazineScientific journal
- 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.Dec. 2021, International journal of cardiology, 344, 60 - 65, English, International magazineScientific journal
- 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.Sep. 2021, Journal of the American Heart Association, 10(18) (18), e020655, English, International magazineScientific journal
- 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.Sep. 2021, Circulation reports, 3(9) (9), 540 - 549, English, Domestic magazineScientific journal
- Background Although patients with a cancer history have a 2 to 3 times higher risk for acute coronary syndrome (ACS), the morphological characteristics of ACS culprit plaque in those patients and their relations with clinical outcomes remain unknown. Methods and Results This retrospective, multicenter, observational cohort study included consecutive patients with ACS who underwent optical coherence tomography-guided emergent percutaneous coronary intervention. Patients were categorized into those without a cancer history, those with a cancer history, and those currently receiving cancer treatment. ACS culprit lesions were classified as plaque rupture, plaque erosion, or calcified nodule using optical coherence tomography. Plaque erosion frequency was significantly higher in culprit lesions of patients with current cancer and patients with cancer history than in those of patients without cancer history (56.3% versus 61.7% versus 36.5%). Calcified nodule incidence was significantly higher in patients without cancer history than in patients with current cancer and patients without cancer history (patients with current cancer: 12.4% versus patients without cancer history: 25.5% versus patients without cancer history: 12.6%, P<0.001). Cancer history was independently associated with nonplaque rupture (plaque erosion or calcified nodule) in ACS culprit lesions (odds ratio, 4.00; P<0.001). Cancer history was independently associated with major adverse cardiovascular events (hazard ratio [HR], 1.98; P=0.002). Nonplaque rupture in ACS culprit lesions was independently associated with major adverse cardiovascular events (HR, 1.60; P=0.011). Conclusions Patients with a cancer history had significantly worse clinical outcomes after ACS than those without a cancer history. Those with a cancer history had significantly higher plaque erosion and calcified nodule incidences in the ACS culprit lesions, which might partly explain their worse clinical outcomes. Registration URL: www.umin.ac.jp/ctr/index.htm. Unique Identifier: UMIN000038442.Aug. 2021, Journal of the American Heart Association, 10(15) (15), e020243, English, International magazineScientific journal
- Jun. 2021, Cardiovascular intervention and therapeutics, English, Domestic magazineScientific journal
- 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.May 2021, The international journal of cardiovascular imaging, English, International magazineScientific journal
- 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.Apr. 2021, Heart and vessels, English, Domestic magazineScientific journal
- (一社)日本循環器学会, Mar. 2021, 日本循環器学会学術集会抄録集, 85回, CS3 - 4, JapanesePCIのための心筋虚血評価-冠血流予備能の測定に迫る- 心臓CT検査およびFFRCTに対する当院の取り組みについて
- Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions.Springer Science and Business Media LLC, Feb. 2021, Heart and Vessels, 36(8) (8), 1234 - 1245, English, Domestic magazine[Refereed]Scientific journal
- Optical frequency domain imaging (OFDI) is a high-resolution intracoronary imaging modality with fast automated longitudinal pullback. We aimed to evaluate the ability of performing OFDI from the superficial femoral artery (SFA) to the below-knee (BK) artery. This clinical trial was a multi-center, single-arm, open-label study. The primary endpoint was to obtain a clear image of the intra-vascular lumen from the SFA to the BK artery, specifically > 270 degrees visualization of the blood vessel lumen with > 16/21 cross sections. The proportion of the clear image (>= 85%) was regarded as confirmatory of the ability of OFDI to visualize the vessel lumen. Overall, 20 patients were enrolled. The proportion of the primary endpoint was 90% (18/20), and the pre-specified criterion was successfully attained. The proportion of the clear image assessed by the operator was 100% (20/20), and an additional statistical analysis for the proportion of the visualization, > 270 degrees, of the blood vessel lumen revealed a significantly higher cut-off value than that for the pre-specified criterion, 85% (p = 0.0315). There were three adverse events not related to OFDI. OFDI achieved acceptable visualization of the vessel lumen without any adverse event related to it. After regulatory approval based on the present study, OFDI will be available as a new option of endovascular imaging for peripheral artery diseases in daily practiceLead, Springer Science and Business Media LLC, Jan. 2021, Heart and Vessels, English[Refereed]Scientific journal
- BACKGROUND: The impact of antiplatelet drug effects on mid-term local arterial responses following percutaneous coronary intervention (PCI) remains uncertain. We evaluated the impact of the platelet reactivity of prasugrel on mid-term vascular healing between acute coronary syndrome (ACS) and stable coronary artery disease (CAD).Methods and Results:We conducted a prospective, 12-center study in 125 patients with ACS and 126 patients with stable CAD who underwent PCI with an everolimus-eluting stent (EES) and received dual antiplatelet therapy (DAPT) with prasugrel and aspirin. Serial optical coherence tomography (OCT) was performed immediately after PCI and at the 9-month follow-up to assess the association of P2Y12reaction units (PRU) with the frequency of malapposed or uncovered struts and intrastent thrombi (IST). The incidence of abnormal mid-term OCT findings did not different between the ACS and CAD arms, regardless of clinical presentation, except that uncovered struts were more frequent in the ACS than CAD arm. PRU at PCI was significantly associated with the frequency of IST at follow-up, but not with uncovered and malapposed struts. PRU at PCI was the only independent predictor of IST detected at follow-up (odds ratio 1.009). CONCLUSIONS: In patients undergoing EES implantation and receiving prasugrel, achieving an adequate antiplatelet effect at the time of stent implantation may regulate thrombus formation throughout the follow-up period.Japanese Circulation Society, Jan. 2021, Circulation Journal, 85(6) (6), 808 - 816, English, Domestic magazine[Refereed]Scientific journal
- Elsevier BV, Jan. 2021, JACC: Cardiovascular Imaging, 14(1) (1), 315 - 317, English, International magazine[Refereed]Scientific journal
- AIMS/INTRODUCTION: Glucose fluctuation (GF) is a residual risk factor for coronary artery disease (CAD). We investigated whether GF influenced clinical outcomes and progression of coronary stenosis in stable CAD patients. MATERIALS AND METHODS: In this prospective study, 101 consecutive lipid-controlled stable CAD patients underwent percutaneous coronary intervention were enrolled, and GF was expressed as the mean amplitude of glycemic excursion (MAGE) obtained by continuous glucose monitoring before the procedure was evaluated. At 9 months after enrollment, culprit and non-culprit (mild-to-moderate stenosis without ischemia) lesions were serially assessed by angiography. Cardiovascular events (CVE) consisting of cardiovascular death, non-fatal myocardial infarction or ischemia-driven revascularization during 2-year follow up, rapid progression in non-culprit lesions (defined as ≥10% luminal narrowing progression in lesions with stenosis ≥50%, ≥30% luminal narrowing progression in non-culprit lesions with stenosis <50% or normal segment, or progression to total occlusion) were evaluated. RESULTS: CVE occurred in 25 patients, and MAGE was significantly higher in the CVE group (76.1 ± 24.8 mg/dL vs 59.3 ± 23.7 mg/dL; P = 0.003). Multivariate analysis showed that MAGE was an independent predictor of CVE (odds ratio 1.027, 95% confidence interval 1.008-1.047; P = 0.005). The optimal MAGE value to predict CVE was 70.7 mg/dL (area under the curve 0.687, 95% confidence interval 0.572-0.802; P = 0.005). Furthermore, MAGE was independently associated with rapid progression, and with the luminal narrowing progression in all non-culprit lesions (r = 0.400, P < 0.05). CONCLUSIONS: Daily GF might influence future CVE in lipid-controlled stable CAD patients.Wiley, Dec. 2020, Journal of Diabetes Investigation, 12(6) (6), 1015 - 1024, English, Domestic magazine[Refereed]Scientific journal
- 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.Springer Science and Business Media LLC, Nov. 2020, The International Journal of Cardiovascular Imaging, 37(4) (4), 1445 - 1453, English, International magazine[Refereed]Scientific journal
- 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.Wiley, Nov. 2020, Clinical Anatomy, 33(8) (8), 1240 - 1248, English, International magazine[Refereed]Scientific journal
- Intravascular optical coherence tomography is a high-resolution intracoronary imaging modality, providing a microscopic image of intravascular features. However, it has lower penetration depth than intravascular ultrasound. Recently, a second-generation optical frequency-domain imaging (OFDI) technique has been developed to provide greater penetration depth and faster pullback speed. However, there is little evidence supporting the efficacy of OFDI in patients with peripheral artery disease (PAD) undergoing endovascular treatment (EVT). We aimed to evaluate the ability of OFDI to visualize vessel walls from the superficial femoral artery (SFA) to the below-knee (BK) arteries, as well as the coronary arteries. This clinical trial is a single-center, single-arm, open-label study to be conducted in Japan. A total of 20 patients will be enrolled in this study. The primary endpoint is to obtain a clear image of the intravascular features of the SFA and BK arteries, specifically the visualization of ≥ 270° of the vessel lumen in ≥ 16 out of 21 cross sections. Obtaining clear images in ≥ 85% of cases will be regarded as confirmation of the ability of OFDI to visualize vessel walls from the SFA to the BK arteries. This is the first clinical trial to be conducted accordance with good clinical practice to expand the indications of OFDI for PAD patients undergoing EVT in Japan. The result of this study will help provide another imaging option during EVT in daily practice.Springer Japan, Oct. 2020, Cardiovascular Intervention and Therapeutics, 35(4) (4), 385 - 391, EnglishScientific journal
- In the original publication of the article, the author group was published without full names and one of the co-authors' name was published incorrectly. The full names of author group and correct co-authors' name are given in this Correction.Springer Science and Business Media LLC, Oct. 2020, Cardiovascular Intervention and Therapeutics, 35(4) (4), 385 - 391, English, Domestic magazine[Refereed]Scientific journal
- 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.Japanese Circulation Society, Sep. 2020, Circulation Journal, 84(10) (10), 1826 - 1836, English, Domestic magazine[Refereed]Scientific journal
- Objectives: Balloon angioplasty for in-stent restenosis (ISR) in the superficial femoral artery (SFA) has a high recurrent restenosis rate; however, its mechanism has not been fully and precisely evaluated using high-resolution intravascular imaging. Thus, we aimed to evaluate the relationship between vascular features obtained by optical frequency domain imaging (OFDI) and recurrent restenosis at 6 months. Methods: This was a prospective multicenter single-arm study. OFDI was performed before and after balloon angioplasty, and vascular features were assessed. A multi-layered ISR pattern detected by OFDI was defined as several signal-poor appearances with a high-signal band adjacent to the luminal surface. The primary outcome was defined as recurrent restenosis 6 months after balloon angioplasty. Results: Given that this study was terminated early, only 18 patients completed the 6-month follow-up; of these, 8 developed restenosis. Recurrent restenosis at 6 months tended to be related to a multi-layered ISR pattern (odds ratio (OR), 6.67; 95% confidence interval (CI), 0.81-54.96; p=0.078) and the minimum lumen area (MLA) after balloon angioplasty (OR, 0.71; 95%CI, 0.48-1.04; p=0.077). Conclusion: A multi-layered ISR pattern and MLA after balloon angioplasty detected by OFDI might be risk factors for recurrent ISR in the SFA.The Editorial Committee of Annals of Vascular Diseases, Sep. 2020, Annals of Vascular Diseases, 13(3) (3), 291 - 299, English, Domestic magazine[Refereed]Scientific journal
- Although balloon angioplasty for femoropopliteal artery lesions has been associated with restenosis rates of up to 60% at 12 months, the mechanism of restenosis has not been fully evaluated. The aim of this study was to evaluate the relationship between the vascular features observed on optical frequency domain imaging (OFDI) before and after balloon angioplasty of femoropopliteal artery lesions, and restenosis at 6 months. This study was a prospective multicenter single arm study. OFDI was performed before and after balloon angioplasty and plaque characteristics and vascular features, along with de novo lesions, were assessed. The primary outcome was the presence or absence of restenosis 6 months after balloon angioplasty. Residual platelet reactivity was assessed according to VerifyNow platelet reactivity units (PRUs). The number of patients completing 6 months of follow-up was 47, of which 14 had developed restenosis. Maximum thickness of the dissection flap (odds ratio (OR) 2.71; 95% confidence interval [0.9-8.0]; p = 0.071) and lesion length were identified as risk factors for restenosis (OR 1.015; 95% confidence interval [0.001-0.029]; p = 0.039). The mean PRU at the time of treatment in patients with restenosis was significantly higher than in those without restenosis (286.3 ± 82.6 vs. 208.5 ± 03.6, p = 0.026). Long lesions and major dissection on OFDI after balloon angioplasty for femoropopliteal artery lesions increase restenosis at 6 months. In addition, high residual platelet reactivity at the time of EVT may also be a risk factor for restenosis.Clinical Trial Registration Number UMIN000021120.Jun. 2020, Cardiovascular intervention and therapeutics, 36(3) (3), 321 - 329, English, Domestic magazine[Refereed]Scientific journal
- Elsevier BV, Jun. 2020, JACC: Cardiovascular Imaging, 13(6) (6), 1452 - 1454, English, International magazine[Refereed]Scientific journal
- Investigation of Computed-Tomography Based Predictors of Acute Stroke Related to Transcatheter Aortic Valve Replacement: Aortic Wall Plaque Thickness Might be a Predictive Parameter of StrokeOBJECTIVES: Little information is available on computed tomography (CT)-based predictors of stroke related to transcatheter aortic valve replacement (TAVR). The objective of this study was to determine whether anatomical features of the aortic valve and aorta visualized by CT are predictive parameters of stroke. METHODS: The study included 1270 patients who underwent preprocedural contrast-enhanced CT assessment and TAVR for severe aortic valve stenosis. Twenty-six patients (2.5%) who developed acute strokes that occurred within 48 hours after TAVR and 104 matched patients without strokes were identified, using 1:4 propensity-score matching. The degree of hypoattenuation in the aortic valve leaflets, calcium volume of the aortic valve, and plaque thickness in the aortic wall (the ascending aorta, aortic arch, and descending thoracic aorta) were assessed. RESULTS: There were no differences between the two groups in the degree of hypoattenuation in the aortic valve leaflets and calcium volume of the aortic valve. The plaque thickness of the aortic arch and descending aorta were greater in the stroke group than in the non-stroke group: aortic arch, 2.4 mm (IQR, 1.3-2.8 mm) vs 1.8 mm (IQR, 1.4-2.2 mm), respectively (P<.01); and descending aorta, 2.9 mm (IQR, 2.1-4.2 mm) vs 2.8 mm (IQR, 2.1-3.6 mm); respectively (P=.049). CONCLUSION: Aortic wall plaque thickness measured by contrast-enhanced CT might be a predictive parameter of strokes that occur within 48 hours after TAVR.Feb. 2020, J Invasive Cardiol, 32(2) (2), E18-E26, English, International magazine[Refereed]Scientific journal
- 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.Ovid Technologies (Wolters Kluwer Health), May 2019, Journal of the American Heart Association, 8(9) (9), e011975, English, International magazine[Refereed]Scientific journal
- (一社)日本透析医学会, May 2019, 日本透析医学会雑誌, 52(Suppl.1) (Suppl.1), 353 - 353, Japanese症例から末期腎臓病患者の大動脈弁狭窄症の治療戦略を考察する 経カテーテル大動脈弁留置術(TAVI)を施行した末期腎臓病患者の一例
- (公社)日本超音波医学会, Apr. 2019, 超音波医学, 46(Suppl.) (Suppl.), S622 - S622, Japaneseアルコール性心筋症が疑われた一例[Refereed]
- (一社)日本循環器学会, Mar. 2019, 日本循環器学会学術集会抄録集, 83回, SY12 - 2, EnglishJDS-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)
- 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.Mar. 2019, J Cardiol, 73(3) (3), 228 - 232, English, International magazine[Refereed]Scientific journal
- Japanese Circulation Society, Feb. 2019, Circulation Reports, 1(2) (2), 107 - 111, English[Refereed]Scientific journal
- Prognostic Impact of Permanent Pacemaker Implantation in Patients With Low Left Ventricular Ejection Fraction Following Transcatheter Aortic Valve ReplacementBACKGROUND: Data are limited regarding the clinical impact of permanent pacemaker implantation (PPI) in patients with low left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR). The aim of this study was to determine the impact of new PPI in patients with baseline low LVEF at 2-year follow-up after TAVR. METHODS: A total of 659 patients undergoing TAVR between January 2013 and December 2015 were included in the study. Patients were divided into two groups according to the need for PPI after TAVR. These patients were further divided by their baseline LVEF: low LVEF (≤50%) and preserved LVEF (>50%). RESULTS: A total of 104 patients (15.8%) needed PPI following TAVR. After a median follow-up of 19.1 months (interquartile range, 11.4-24.4 months), overall and cardiovascular survival showed no significant differences between new PPI and no PPI (overall, log-rank P=.94; cardiovascular, log-rank P=.51). Nonetheless, patients requiring PPI who had low LVEF had higher cardiovascular mortality compared to patients with low LVEF who didn't need PPI (log-rank P<.001). Multivariable Cox hazard model demonstrated that patients with new PPI and low LVEF had higher 2-year cardiovascular mortality after TAVR (hazard ratio, 5.76; P<.001). CONCLUSION: New PPI following TAVR was not associated with overall survival or cardiovascular survival difference at 2 years. However, receiving a new PPI in the setting of low LVEF adversely impacts mid-term cardiovascular survival.Feb. 2019, J Invasive Cardiol, 31(2) (2), E15 - E22, English, International magazine[Refereed]Scientific journal
- BACKGROUND: Patients with severe aortic stenosis (AS) and an extra-large annulus (ELA) area (>683 mm2) can rarely be treated by transcatheter aortic valve replacement (TAVR) because of the size limitation of the transcatheter heart valves. This study aimed to evaluate the feasibility of TAVR using a 29-mm SAPIEN3 (S3) valve in patients with ELA and S3-dimensions by post-procedural computed tomography (post-CT). Methods and Results: We included 261 patients undergoing TAVR using a 29-mm S3: 30 patients with ELA and 231 with non-ELA were identified. S3-dimensions were evaluated at the S3 inflow and annulus level by post-CT in 129 patients. The ELA group had a greater aortic annulus area measured by pre-procedural CT (737.3±54.7 vs. 578.4±41.9 mm2, P<0.0001), higher balloon inflation volume (36 vs. 33 mL, P<0.0001), a larger S3 area at inflow by post-CT (729.6±42.2 vs. 682.2±35.0 mm2, P<0.001), and a correlation between the inflation volume and S3 area (r=0.71, P=0.0005). No differences were observed between groups in paravalvular aortic regurgitation (PAR) ≥mild (43.3% vs. 27.6%, P=0.09), PAR ≥moderate (3.3% vs. 1.3%, P=0.39) or 1-year mortality (10.0% vs. 9.1%, P=0.87). CONCLUSIONS: TAVR using a 29-mm S3 with extra inflation of the delivery balloon can be considered as a treatment option for patients with severe AS and ELA.Feb. 2019, Circ J, 83(3) (3), 672 - 680, English, Domestic magazine[Refereed]Scientific journal
- 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.Jan. 2019, Heart Vessels, 34(6) (6), 936 - 947, English, Domestic magazine[Refereed]Scientific journal
- Early Clinical Outcomes of Transcatheter Aortic Valve Replacement in Left Ventricular Outflow Tract Calcification: New-Generation Device vs Early-Generation DeviceBACKGROUND: Transcatheter aortic valve replacement (TAVR) in cases with left ventricular outflow tract calcification (LVOT-CA) remains a challenging procedure. The aim of this study was to compare the early outcomes of patients undergoing TAVR in LVOT-CA with new-generation devices vs early-generation devices. METHODS: Between January 2014 and December 2016, a total of 433 patients with severe aortic stenosis who had a preprocedural multidetector computed tomography underwent TAVR in a LVOT-CA. After propensity matching, data from 119 patients in each group were analyzed. TAVR endpoints and adverse events were defined according to the Valve Academic Research Consortium-2. RESULTS: Compared with early-generation devices (Edwards Sapien/Sapien XT/CoreValve), new-generation devices (Sapien 3/Evolut R) had significantly lower incidence of mild-moderate paravalvular leak (PVL) (1.7% new vs 7.6% early; P=.03), tended to have lower incidence of moderate or severe PVL (5.0% new vs 11.8% early; P=.06), had no significant difference in device success (89.1% new vs 83.2% early; P=.19), and had a significantly higher early safety rate at 30 days (93.3% new vs 84.9% early; P=.04). For cardiac conduction disturbances, new-generation and early-generation devices had similarly high rates of new permanent pacemaker implantation (16.8% new vs 15.1% early; P=.72), whereas the number of patients who developed new-onset left bundle-branch block (LBBB) were significantly higher in those with new-generation devices (16.0% new vs 6.7% early; P=.03). CONCLUSION: In the setting of LVOT-CA, patients with new-generation devices compared to those with early-generation devices had acceptable clinical outcomes except for cardiac conduction disturbances, especially in new-onset LBBB.Nov. 2018, J Invasive Cardiol, 30(11) (11), 421 - 427, English, International magazine[Refereed]Scientific journal
- An 86-year-old man was admitted our hospital because of sudden onset of dyspnea after blunt chest trauma. Because his oxygen saturation deteriorated from 92% in the supine position to 86% in the sitting position, platypnea-orthodeoxia syndrome was suspected. Transesophageal echocardiography showed severe tricuspid regurgitation (TR) caused by anterior papillary muscle rupture. Furthermore, right-to-left shunt with TR through a patent foramen ovale (PFO) was observed. The diagnosis was therefore platypnea-orthodeoxia syndrome with right-to-left shunt through PFO with shunting exacerbated by acute severe TR after blunt chest trauma. The patient underwent urgent tricuspid valve repair and PFO closure and has remained asymptomatic postoperatively.Aug. 2018, The Canadian journal of cardiology, 34(8) (8), 1088.e11-1088.e13, English, International magazine[Refereed]Scientific journal
- Jul. 2018, Heart Vessels., EnglishImpact of the angiographic burden on the incidence of out-of-hospital ventricular fibrillation in patients with acute myocardial infarction.[Refereed]Scientific journal
- Bicuspid aortic valve is the most common congenital cardiac malformation. Aortic valve replacement is often required in older patients but the surgical risk is often extremely high. As Transcatheter aortic valve implantation (TAVI) is an established therapy for intermediate and high surgical risk patients with symptomatic severe aortic valve stenosis (AS). Advances in technology and knowledge have led to TAVI being used for other pathologies and populations such as bicuspid AS. Recently, the diagnosis and classification of bicuspid aortic valve based on multidetector computed tomography (MDCT) assessment has been proposed, which may have an impact of outcomes after TAVI. This review article describes the advancements in diagnosis and outcomes of bicuspid AS.May 2018, INTERV CARDIOL, 13(2) (2), 62 - 65, English, International magazine[Refereed]Scientific journal
- Aims: We assessed the geometry of transcatheter heart valve (THV) and valve function associated with SAPIEN 3 implantation in patients with bicuspid aortic valve (BAV) stenosis. Methods and results: We included 280 consecutive patients who had a contrast computed tomography (CT) before and after transcatheter aortic valve implantation (TAVI) in our institution. Each THV was assessed by CT at five cross-sectional levels: inflow, annulus, mid, sinus, and outflow. The geometry of THV was assessed for eccentricity (1 - minimum diameter/maximum diameter) and expansion (CT derived external valve area/nominal external valve area). CT measurements and transthoracic echocardiogram data were compared between BAV and tricuspid aortic valve (TAV). Among 280 patients, 41 patients were diagnosed as BAV. Compared to TAV, BAV was associated with lower expansion at mid-level, sinus-level, and outflow-level (mid 94.1 ± 6.8% vs. 98.1 ± 7.8%; P = 0.002, sinus 95.9 ± 7.2% vs. 101.6 ± 8.5%; P < 0.001, outflow 107.6 ± 6.2% vs. 109.9 ± 6.6%; P = 0.043), and higher eccentricity at all levels [inflow 3.5% (1.9-5.3) vs. 6.0% (3.2-7.5); P < 0.001, annulus 3.1% (1.6-5.2) vs. 5.4% (3.1-7.8); P = 0.002, mid 3.0% (1.4-4.9) vs. 6.0% (3.3-10.4); P < 0.001, sinus 3.0% (1.7-5.1) vs. 7.6% (4.0-11.4); P < 0.001, and outflow 2.5% (1.3-4.3) vs. 4.9% (2.2-7.5); P < 0.001]. There were no differences in frequency of paravalvular leak ≥ moderate and mean post-procedural gradient between BAV and TAV. Conclusion: BAV patients have greater THV eccentricity at all levels and lower THV expansion at mid, sinus, and outflow levels than the TAV patients. There were no differences in parameters of valve function between BAV and TAV patients. Despite the observed geometrical differences, TAVI with SAPIEN 3 in BAV patients allows for feasible valve function.Lead, Jan. 2018, Eur Heart J Cardiovasc Imaging, 19(12) (12), 1408 - 1418, English, International magazine[Refereed]Scientific journal
- Left ventricular outflow tract (LVOT) calcium is known to be associated with adverse procedural outcomes after transcatheter aortic valve implantation (TAVI), yet its effect on midterm outcomes has not been previously investigated. The aim of this study was to determine the influence of LVOT calcium on 2-year mortality after TAVI. A total of 537 consecutive patients underwent TAVI and 2 groups were established, stratified based on the severity of the LVOT calcium. The primary outcome was 2-year overall survival rate. The >= moderate LVOT calcium group included 107 patients (19.9%) and the remaining 430 patients (80.1%) were included in the <= mild LVOT calcium group. After a median followup of 717 days (interquartile range 484 to 828), the Kaplan-Meier analysis revealed that the 2-year overall survival probability was significantly lower in the >= moderate LVOT calcium group than in the <= mild LVOT calcium group (log-rank p = 0.001). On a Cox hazard model, >= moderate LVOT calcium was associated with increased all-cause mortality after TAVI (hazard ratio 1.74, p = 0.009). In the subgroup analysis, based on valve designs, SAPIEN 3-TAVI done in the setting of >= moderate LVOT calcium had a relatively similar survival probability as those of <= mild LVOT calcium (log-rank p = 0.18), which is in contrast with older generation valves (log-rank p = 0.001). In conclusion, patients with >= moderate LVOT calcium were shown to have a lower survival probability in the midterm follow-up after TAVI, compared with those with <= mild LVOT calcium. Patients with high-grade LVOT calcium should be monitored with longer-term follow-ups after TAVI. (C) 2017 Elsevier Inc. All rights reserved.EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Dec. 2017, AMERICAN JOURNAL OF CARDIOLOGY, 120(11) (11), 2017 - 2024, English[Refereed]Scientific journal
- Aims: Only a few studies have examined the respective impact of low flow (LF), low gradient (LG) and low ejection fraction (LEF) on outcomes following transcatheter aortic valve replacement (TAVR). The purpose of this study was to assess the impact of preprocedural stroke volume index, aortic valve gradient, left ventricular ejection fraction (LVEF) and different flow/gradient/LVEF patterns on the clinical outcomes of patients with severe aortic stenosis (AS) who undergo TAVR. Methods and results: We analysed the clinical, echocardiographic, and outcome data collected in 770 patients with AS who underwent TAVR. Overall, 357 patients had normal flow (NF) AS and 413 had LF AS. Patients with NF had similar one-year mortality (12.0% vs. 15.0%, p=0.23) compared with those in the LF group. Overall, patients with NF and/or HG had lower one-year mortality rates (11.7 to 13%) compared to those with paradoxical LF-LG with NEF (19%) and those with classical LF-LG with LEF (27.3%). Low mean gradient was an independent predictor of all-cause mortality (hazard ratio: 1.14, per 10 mmHg decrease, p=0.02). Despite significant association in univariable analyses, LF and LEF were not found to be predictors of outcomes in multivariable analyses. Conclusions: Patients with HG and those with NF-LG have low one-year mortality rates following TAVR, whereas those with classical LF-LG and LEF and those with paradoxical LF-LG and NEF have high and intermediate risk of mortality, respectively. In contradiction to previous reports, LG but not LF or LEF is an independent predictor of late mortality in high-risk patients with severe AS undergoing TAVR.EUROPA EDITION, Dec. 2017, EUROINTERVENTION, 13(12) (12), E1428 - E1435, English[Refereed]Scientific journal
- This report concerns an 83-year-old woman with aortic stenosis (AS) who had a history of repetitive hospitalization due to decompensated heart failure. Although her clinical history was compatible with significant AS, findings for aortic valve area, hemodynamics, and valvular calcium burden were discrepant. Multiplanar reconstruction images revealed the membranous structures attached to a subcommissural lesion, which resulted in severe stenosis. The patient had a favorable clinical course after transcatheter aortic valve replacement. This is the first reported case of severe AS due to the subcommissural adhesions, which were successfully visualized by means of echocardiography and computed tomography.WILEY, Nov. 2017, ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, 34(11) (11), 1717 - 1720, English[Refereed]Scientific journal
- Aims: Self-expanding (SE) valves are characterized with long stent frame design and the radial force of the device exists both in the inflow and outflow level. Therefore, we hypothesized that device success of SE-valves may be influenced by ascending aortic dimensions (AAD). The aim of this study was to determine the influence of AAD on acute device success rates following SE transcatheter aortic valve replacement (TAVR). Methods & Results: In 4 centers in the United States and Asia, 214 consecutive patients underwent SE-TAVR. Out-comes were assessed in line with Valve Academic Research Consortium criteria. AAD was defined as the sum of the short and long axis aortic diameter divided by 2. Overall, device success rate was 85.0%. Multivariate analysis revealed that increased AAD (Odds ratio 1.27) and % oversizing (Odds ratio 0.88) were found to be independent predictors of unsuccessful device implantation. The c-statistic of the model for device success was area under the curve 0.79, sensitivity 81.3% and specificity 44.0%. Co-existence of several risk factors was associated with an exponential fall to 64.2% in device success rate. For a large AAD, however, optimally oversized SE-valves (threshold 16.2%) resulted with high device success rates compared to suboptimal oversizing (88.6% vs. 64.2%, p = 0.005). Conclusions: Larger AAD and smaller degrees of oversizing were confirmed to be the most relevant predictors of unsuccessful device implantation following SE-valve implantations. Optimal oversizing of great significance was noted, particularly that with a large AAD. (C) 2017 Elsevier B.V. All rights reserved.ELSEVIER IRELAND LTD, Oct. 2017, INTERNATIONAL JOURNAL OF CARDIOLOGY, 244, 100 - 105, English[Refereed]Scientific journal
- OBJECTIVES This study sought to develop a robust and definitive risk model for new permanent pacemaker implantation (PPMI) after SAPIEN 3 (third generation balloon expandable valve) (Edwards Lifesciences, Irvine, California) transcatheter aortic valve replacement (third generation balloon expandable valve TAVR), including calcification in the aortic-valvular complex (AVC). BACKGROUND The association between calcium in the AVC and need for PPMI is poorly delineated after third generation balloon expandable valve TAVR. METHODS At Cedars-Sinai Heart Institute in Los Angeles, California, a total of 240 patients with severe aortic stenosis underwent third generation balloon expandable valve TAVR and had contrast computed tomography. AVC was characterized precisely by leaflet sector and region. RESULTS The total new PPMI rate was 14.6%. On multivariate analysis for predictors of PPMI, pre-procedure third generation balloon expandable valve TAVR, right bundle branch block (RBBB), shorter membranous septum (MS) length, and noncoronary cusp device-landing zone calcium volume (NCC-DLZ CA) were included. Predictive probabilities were generated using this logistic regression model. If 3 pre-procedural risk factors were present, the c-statistic of the model for PPMI was area under the curve of 0.88, sensitivity of 77.1%, and specificity of 87.1%; this risk model had high negative predictive value (95.7%). The addition of the procedural factor of device depth to the model, with the parameter of difference between implantation depth and MS length, combined with RBBB and NCC-DLZ CA increased the c-statistic to 0.92, sensitivity to 94.3%, specificity to 83.8%, and negative predictive value to 98.8% CONCLUSIONS By using a precise characterization of distribution of calcification in the AVC in a single-center, retrospective study, NCC-DLZ CA was found to be an independent predictor of new PPMI post-third generation balloon expandable valve TAVR. The findings also reinforce the importance of short MS length, pre-existing RBBB, and ventricular implantation depth as important synergistic PPMI risk factors. This risk model will need validation by future prospective multicenter studies. (C) 2017 Published by Elsevier on behalf of the American College of Cardiology Foundation.ELSEVIER SCIENCE INC, Oct. 2017, JACC-CARDIOVASCULAR IMAGING, 10(10) (10), 1139 - 1147, English[Refereed]Scientific journal
- BACKGROUND: The purpose of this study was to evaluate the outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). METHODS: From April 2012 and December 2016, 108 patients with bicuspid AS underwent TAVR using the Sapien XT (34 patients) and Sapien 3 (74 patients) valves. Procedural and clinical outcomes were assessed according to VARC-2 criteria and compared between the two devices. RESULTS: In the overall cohort, the majority of patients were male (71.3%) with an intermediate surgical risk and a mean Society of Thoracic Surgeons (STS) score of 5.2%. Compared to the Sapien XT group, the Sapien 3 group had a significantly lower STS score (3.3%±2.0% vs. 6.7%±3.6%; P=0.001). Compared to the Sapien XT group, the Sapien 3 group had a significantly lower rate of moderate or severe paravalvular leak (2.7% vs. 14.7%; P=0.03) and higher device success (97.3% vs. 82.4%; P=0.006). There were no significant differences between the two groups in terms of 30-day all-cause mortality, stroke, life-threatening bleeding, major vascular complication and acute kidney injury (stage 2 or 3). Cumulative all-cause mortality at 1-year follow-up was 6.9%. There were no significant differences in cumulative event rates for all-cause mortality at 1-year follow-up between the two groups (9.4% vs. 4.6%; log-rank P=0.47). By univariate analysis, major vascular complication was significantly associated with overall all-cause mortality [hazard ratios (HR): 7.57; 95% confidence interval (CI): 1.51-37.86; P=0.014]. CONCLUSIONS: TAVR using the balloon-expandable valves provided acceptable procedural and clinical outcomes in patients with bicuspid AS. The new-generation Sapien 3 valves showed improved procedural outcomes compared to the early-generation Sapien XT valves.Sep. 2017, Ann Cardiothorac Surg, 6(5) (5), 463 - 472, English, International magazine[Refereed]Scientific journal
- Aims Four-dimensional volume-rendered computed tomography (4DCT) has demonstrated instances of hypo-attenuating leaflet thickening (HALT) with or without hypo-attenuation affecting motion (HAM) after transcatheter and surgical aortic valve implantation (TAVI, SAVR). The temporal pattern of evolution of these phenomena is uncertain. Methods and results The SAVORY registry enrolled patients treated by TAVI (n=75) or SAVR (n=30) with two 4DCT scans fully interpretable for HALT and HAM as well as unchanged anti-thrombotic medication between the scans. Logistic regression analysis was performed to examine the evolution of HALT and HAM while accounting for demographic and baseline variables, timing of both CT scans, valve type and antithrombotic therapy. The analysis population consisted of 84 patients, in whom first and second CT scans were performed at 140 +/- 152 days and 298 +/- 141 days after valve implantation, respectively. Hypo-attenuating leaflet thickening was noted in 32 patients (38.1%), with HAM in 17 (20.2%). Both findings were dynamic, showing progression in 13 (15.5%) and regression and 9 (10.7%) patients. Compared with antiplatelet therapy, progression was less likely among patients on oral anticoagulation with vitamin-K antagonists or non-VKA oral anticoagulants (odds ratio: 0.014, P=0.036). Maintenance on chronic oral anticoagulation was not a significant predictor of regression. These findings were similar for both transcatheter and surgical bioprosthetic aortic valves. No patients developed symptoms of valve dysfunction and leaflet thickening was not clearly associated with any clinical events. Conclusions Subclinical leaflet thrombosis is a common finding after TAVI and SAVR, and may progress from normal leaflet over HALT to the more severe HAM. The phenomenon can develop and regress at variable intervals after valve implantation. Anticoagulants may have a protective effect against the development of HALT, but HALT can also regress without anticoagulation therapy.OXFORD UNIV PRESS, Jul. 2017, EUROPEAN HEART JOURNAL, 38(28) (28), 2201 - 2207, English[Refereed]Scientific journal
- BACKGROUND: The aim of this study was to determine the influence of an elliptic annulus on acute device success rates following self-expanding (SE) transcatheter aortic valve replacement (TAVR) vs. balloon-expandable (BE) TAVR.Methods and Results:Outcomes were assessed using Valve Academic Research Consortium-2 definitions. Aortic annulus ratio (AAR) was measured as short axis diameter/long axis diameter. Mean AAR was 0.81±0.06. Patients were therefore divided into 2 groups: AAR <0.82 and AAR ≥0.82. For circular annuli (AAR ≥0.82; 363 patients), high device success rates were achieved in both valve groups (SE valve, 90.5% vs. BE valve, 95.0%, P=0.14). Conversely, for AAR <0.82 (374 patients), SE valves had lower device success rates than BE valves (82.5% vs. 95.3%, P=0.002). For elliptic annuli, SE-TAVR was an independent predictor of unsuccessful device implantation (OR, 6.34, P<0.001). Nonetheless, increased oversizing of SE valves for elliptic annuli was associated with an exponential rise in device success (threshold ≥17.5%; area under the curve, 0.83) but not for BE-TAVR. Furthermore, optimally oversized SE valves and BE valves had a similarly high device success for elliptic annuli (SE valve, 96.2% vs. BE valve, 95.3%). CONCLUSIONS: For circular annuli, similarly high device success was achieved for the 2 valve types. Conversely, for elliptic annuli, SE valves had a lower device success than BE valves. Device success following optimal oversizing of SE valves, however, was similar to that for BE valves.Jun. 2017, Circ J, 81(7) (7), 1036 - 1042, English, Domestic magazine[Refereed]Scientific journal
- Aims High aortic valve calcification (AVC) assessed with CT may be used to differentiate between severe and nonsevere aortic stenosis (AS). Nonetheless, in some cases patients with low calcification are diagnosed with haemodynamically severe AS. The prevalence, mechanism of valve stenosis and implications for transcatheter aortic valve implantation (TAVI) of low AVC severe AS remain unclear. We assessed the clinical and haemodynamic characteristics and the outcome of patients with severe AS and low AVC that undergo TAVI Methods and results Ninety-three patients that had low CT aortic valve calcification score (AVCS) were compared to 470 patients with high AVCS. High gradient severe AS was found among 53.8% (50/93) of the patients with low AVCS vs. 86% (404/470) of the patients with high AVCS (P < 0.001). Device success rate was similar between both groups. There were significantly lower rates of postprocedural paravalvular regurgitation (PVR) in the low AVCS group (>= mild PVR: 12.9% vs. 23.6%; P = 0.03). Overall, there were only two cases (0.4%) of valve embolization in patients with high AVCS and 1 (1.1%) in patients with low AVCS (P = 0.42). Thirty-day mortality and major complications were similar between groups Conclusion Balloon-expandable TAVI in patients with a mildly calcified aortic valve was not associated with increased risk of valve embolization or mortality. We demonstrated high device success and lower rates of PVR for these patients. These findings suggest that in patients with evidence of haemodynamically severe AS at echocardiography, the presence of low ACVS at CT should not preclude the consideration of TAVI.OXFORD UNIV PRESS, Jun. 2017, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 18(6) (6), 639 - 647, English[Refereed]Scientific journal
- BACKGROUND Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS). OBJECTIVES This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry. METHODS Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria. RESULTS Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28). CONCLUSIONS Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices. (J Am Coll Cardiol 2017;69: 2579-89) (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).ELSEVIER SCIENCE INC, May 2017, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 69(21) (21), 2579 - 2589, English[Refereed]Scientific journal
- Subclinical leaflet thrombosis was recently described in a randomized trial of transcatheter aortic valve replacement. It was subsequently demonstrated in a series of registries that this was a commonly observed imaging finding seen in all transcatheter and surgical bioprostheses. The phenomenon has aroused considerable interest due to the as-yet undefined risk for later clinical events and the possibility of pharmacological intervention with anticoagulation. Subclinical leaflet thrombosis is easily detected noninvasively by technically suitable computed tomography (CT) with a high degree of concordance to transesophageal echocardiography findings. The CT hallmarks were noted to be hypoattenuated leaflet thickening (HALT) associated with reduced leaflet motion (RELM). The combination of HALT and RELM signified hypoattenuation affecting motion, the standardized imaging endpoint used. This paper describes the systematic CT evaluation methodology that was devised during the Portico trial investigation and U.S. Food and Drug Administration submission; it also highlights the need for an ongoing discussion among experts to enable, with the help of the Valve Academic Research Consortium, standardization of reporting of this imaging finding to cater to the present and future needs of clinical trials. (C) 2017 by the American College of Cardiology Foundation.ELSEVIER SCIENCE INC, Apr. 2017, JACC-CARDIOVASCULAR IMAGING, 10(4) (4), 461 - 470, English[Refereed]Scientific journal
- Optimal sizing for SAPIEN 3 transcatheter aortic valve replacement in patients with or without left ventricular outflow tract calcificationAims: The impact of left ventricular outflow tract calcification (LVOT-CA) on SAPIEN 3 transcatheter aortic valve replacement (S3-TAVR) is not well understood. The aims of the present study were to determine optimal device sizing for S3-TAVR in patients with or without LVOT-CA and to evaluate the influence of residual paravalvular leak (PVL) on survival after S3-TAVR in these patients. Methods and results: This study analysed 280 patients (LVOT-CA=144, no LVOT-CA=136) undergoing S3-TAVR. Optimal annular area sizing was defined as % annular area sizing related to lower rates of >= mild PVL. Annular area sizing was determined as follows: (prosthesis area/CT annulus area-1)x100. Overall, >= mild PVL was present in 25.7%. Receiver operating characteristic curve analysis for prediction of >= mild PVL in patients with LVOT-CA showed that 7.2% annular area sizing was identified as the optimal threshold (area under the curve [AUC] 0.71). Conversely, annular area sizing for no LVOT-CA appeared unrelated to PVL (AUC 0.58). Aortic annular injury was seen in four patients (average 15.5% annular area oversizing), three of whom had LVOT-CA. Although there was no difference in one-year survival between patients with >= mild PVL and without PVT. (log-rank 1 p=0.91), subgroup analysis demonstrated that patients with >= moderate LVOT-CA who had >= mild PVL had lower survival compared to patients with mild PVL and none or mild LVOT-CA (log-rank p=0.010). Conclusions: In the setting of LVOT-CA, an optimally sized S3 valve is required to reduce PVL and to increase survival following TAVR.EUROPA EDITION, Apr. 2017, EUROINTERVENTION, 12(18) (18), E2177 - E2185, English[Refereed]Scientific journal
- Aims Calcified aortic stenosis (AS) and mitral annular calcification (MAC) have certain similar etiology and pathophysiological mechanisms. MAC is frequently encountered in pre-procedural computed tomography (CT) imaging of patients that undergo transcatheter aortic valve replacement (TAVR), but its prognostic implications for these patients have not been thoroughly investigated. This study sought to evaluate the prevalence of MAC among patients with severe AS and to assess the clinical implications of MAC on these patients during and following TAVR. Methods and results Consecutive patients that underwent TAVR were compared according to the existence of MAC and its severity in pre-TAVR CT scans. From the entire cohort of 761 patients, 49.3% had MAC, and 50.7% did not have MAC. Mild MAC was present in 231 patients (30.4%), moderate MAC in 72 patients (9.5%), and severe MAC in 72 patients (9.5%). Thirty-day mortality and major complications were similar between patients with and without MAC. In a multivariable survival analysis, severe MAC was found to be an independent strong predictor of overall mortality following TAVR (all-cause mortality: hazards ratio [HR] 1.95, 95% confidence interval [CI] 1.24-3.07, P = 0.004; cardiovascular mortality: HR 2.35, 95% CI 1.19-4.66; P = 0.01). Severe MAC was also found to be an independent strong predictor of new permanent pacemaker implantation (PPI) after TAVR (OR 2.83, 95% CI 1.08-7.47; P = 0.03). Conclusion Half of the patients with severe AS evaluated for TAVR were found to have MAC. Severe MAC is associated with increased all-cause and cardiovascular mortality and with conduction abnormalities following TAVR and should be included in future risk stratification models for TAVR.OXFORD UNIV PRESS, Apr. 2017, EUROPEAN HEART JOURNAL, 38(16) (16), 1194 - +, English[Refereed]Scientific journal
- Feb. 2017, Int Heart J, 58(1) (1), 56 - 62, EnglishTranscatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification[Refereed]Scientific journal
- Elsevier BV, Oct. 2016, JACC: Cardiovascular Imaging, 9(10) (10), 1145 - 1158, EnglishScientific journal
- Sapien 3 Transcatheter Aortic Valve Implantation With Moderate or Without PredilationObjectives. Aortic valve preparation with balloon aortic valvuloplasty (BAV) has been previously considered mandatory during transcatheter aortic valve implantation (TAVI) procedures. BAV-inherent risks including stroke, conduction abnormalities, and reduced device profile size established the rationale for safe valve deployment without the need for aggressive valve preparation. We investigate the feasibility and safety of performing Sapien 3 (S3; Edwards Lifesciences) balloon-expandable TAVI with moderate or without predilation (PD). Methods. We examined consecutive patients with severe aortic stenosis who underwent S3-TAVI at our institution. Overall, 119 patients underwent TAVI without PD and 126 with moderate PD (mean valvuloplasty balloon diameter, 15.3 +/- 2.1 mm). TAVI endpoints and adverse events were considered according to the Valve Academic Research Consortium (VARC)-2 definitions. Results. Device success for the entire cohort was 98.8%. PD rates were similar between groups. Total fluoroscopy time and amount of contrast used were lower in the no PD group (13 min vs 16.2 min [P<.001] and 71.3 mL vs 81 mL [P=.03], respectively). All-cause mortality up to 30 days was 0% (0/119) in the no PD group vs 1.6% (2/126) in the moderate PD group (P=.49). VARC-2 defined complication rates at 30 days including cerebrovascular accident were similar between groups. Overall, there was no significant difference in survival rate between both groups (hazard ratio, 3.6; 95% confidence interval, 0.80-16.2; P=.09). Conclusions. Balloon-expandable TAVI using the S3 device with moderate or without balloon PD is feasible and safe. Omission of PD in appropriate cases was associated with reduced fluoroscopy time and total contrast used without affecting procedural success.H M P COMMUNICATIONS, Oct. 2016, JOURNAL OF INVASIVE CARDIOLOGY, 28(10) (10), 421 - 426, English[Refereed]Scientific journal
- Aims Stent-frame morphology of the newer-generation, balloon-expandable transcatheter heart valve (THV), the SAPIEN 3 (S3), after transcatheter aortic valve implantation (TAVI) is unknown. We evaluated the THV stent-frame morphology post TAVI of the S3 using multi-slice computed tomography (MSCT) compared with the prior-generation THV, SAPIEN XT (S-XT). Methods and results A total of 94 consecutive participants of RESOLVE registry (NCT02318342) had MSCT after balloon-expandable TAVI (S3 = 39 and S-XT = 55). The morphology of the THV stent-frame was evaluated for expansion area and eccentricity at the THV-inflow, native annulus, mid-THV and THV-outflow levels. Mean %-expansion area for the S3 and the S-XT was 100.9 +/- 5.7 and 96.1 +/- 5.5%, respectively (P < 0.001). In the S3 group, the THV-inflow level had the largest value of %-expansion area, which decreased from THV-inflow to mid-THV level (105.2 +/- 6.4 to 96.5 +/- 5.9%, P < 0.001). However, in the S-XT group, %-expansion area increased from THV-inflow level to mid-THV level (93.2 +/- 6.2 to 95.1 +/- 6.1%, P = 0.0058). On nominal delivery balloon volume, the S3 in 88.5% of cases had overexpansion at the THV-inflow level. The observed degree of THV oversizing of the S3 was significantly lower than the S-XT (6.3 +/- 8.6 vs. 11.8 +/- 8.5%, P = 0.0027). Nonetheless, the incidence of post-procedural paravalvular aortic regurgitation (PVR) = mild following the S3 TAVI was also significantly lower than the S-XT TAVI (17.9 vs. 43.6%, P = 0.014). Conclusion The newer-generation, balloon-expandable device, the S3, has a flared inflow morphology, whereas the prior-generation device, the S-XT, has relatively constrained inflow morphology post TAVI. This may contribute to a lesser degree of PVR with the S3.OXFORD UNIV PRESS, Sep. 2016, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 17(9) (9), 1054 - 1062, English[Refereed]Scientific journal
- Elsevier BV, Aug. 2016, JACC: Cardiovascular Imaging, 9(8) (8), 964 - 972Scientific journal
- Several clinical variables have been identified as predictors of clinical outcome after trans catheter aortic valve implantation (TAVI). Nonetheless, there is limited and contradictive data on the impact of diabetes mellitus (DM) on the prognosis of patients who undergo TAVI. We aimed to investigate the clinical characteristics and the early and midterm outcomes after TAVI according to DM status. From 802 consecutive patients who underwent TAVI, we compared 548 patients with no DM to 254 patients with diabetes (177 orally treated and 77 insulin treated). Patients with DM were younger had higher body mass index and incidence of coronary artery disease and lower incidence of frailty. Device success, 30-day mortality and major complications rates were similar between groups. One-year mortality was 12.1% for patient with DM and 12.2% for patients without DM (p = 0.91). In a multivariable regression analysis including age, body mass index, coronary artery disease and frailty, DM was associated with decreased overall survival. This was driven by increased overall mortality of the insulin-treated DM subgroup (hazard ratio 2.40, 95% CI 1.32 to 4.37; p <0.01). In conclusion, DM does not affect short-term mortality or rates of complications after TAVI. Insulin-treated DM, but not orally treated DM, is independently associated with death at midterm follow-up and therefore aggressive cardiovascular risk factor modification as well as intense glycemic control should be considered for patients with insulin-treated DM with severe aortic stenosis who undergo TAVI. (C) 2016 Elsevier Inc. All rights reserved.EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, May 2016, AMERICAN JOURNAL OF CARDIOLOGY, 117(10) (10), 1636 - 1642, English[Refereed]Scientific journal
- Background: This study directly compared optical coherence tomography (OCT) and histopathology for the assessment of vascular response to first-and second-generation drug-eluting stents. Methods and Results: Sirolimus-, everolimus-, and biolimus-eluting stents (SES, EES, and BES, respectively) were randomly implanted into the coronary arteries of 12 porcine. OCT was conducted after implantation: at 1, 3, and 6 months; histopathology was assessed at 3 and 6 months. At 1-month OCT, EES had the highest neointimal area (NA) and lowest neointimal unevenness score (NUS). At 6 months, NA and NUS were equivalent among the stent types. Delta NA from 1 to 6 months was lowest for EES, and Delta NA correlated with the histopathological inflammation score at 6 months, which was highest for SES (P<0.001). The mean signal intensity (MSI) and the attenuation were different for the stent types at 3 months, and were associated with inflammation score. Moderate diagnostic efficiency for measuring MSI was found, with an optimal cut-off of 6.88 predicting a high (>= grade 3) inflammation score. Conclusions: EES had the greatest uniformity and the least neointimal proliferation and were associated with less persistent inflammation. OCT provides accurate morphometric data; furthermore, quantitative measurement of the optical properties may help assess histological inflammation, which was more predominantly associated with SES than with EES and BES.JAPANESE CIRCULATION SOC, Nov. 2014, CIRCULATION JOURNAL, 78(11) (11), 2665 - 2673, English[Refereed]Scientific journal
- Aims We performed this study to clarify natural consequences of abnormal structures (stent malapposition, thrombus, tissue prolapse, and stent edge dissection) after percutaneous coronary intervention (PCI). Methods and results Thirty-five patients treated with 40 drug-eluting stents underwent serial optical coherence tomography (OCT) imaging immediately after PCI and at the 8-month follow-up. Among a total of 73 929 struts in every frame, 431 struts (26 stents) showed malapposition immediately after PCI. Among these, 49 remained malapposed at the follow-up examination. The mean distance between the strut and vessel wall (S-V distance) of persistent malapposed struts on post-stenting OCT images was significantly longer than that of resolved malapposed struts (342 +/- 99 vs. 210 +/- 49 mu m; P < 0.01). Based on receiver-operating characteristic curve analysis, an S-V distance <= 260 mu m on post-stenting OCT images was the corresponding cut-off point for resolved malapposed struts (sensitivity: 89.3%, specificity: 83.7%, area under the curve = 0.884). Additionally, 108 newly appearing malapposed struts were observed on follow-up OCT, probably due to thrombus dissolution or plaque regression. Thrombus was observed in 15 stents post-PCI. Serial OCT analysis revealed persistent thrombus in 1 stent, resolved thrombus in 14 stents, and late-acquired thrombus in 8 stents. Tissue prolapse observed in 38 stents had disappeared at the follow-up. All eight stent edge dissections were repaired at the follow-up. Conclusion Most cases of stent malapposition with a short S-V distance, thrombus, tissue prolapse, or minor stent edge dissection improved during the follow-up. These OCT-detected minor abnormalities may not require additional treatment.Lead, OXFORD UNIV PRESS, Sep. 2013, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 14(9) (9), 865 - 875, English[Refereed]Scientific journal
- Background: The iMAP™ is a novel intravascular ultrasound (IVUS)-based technology to classify coronary plaque into 4 components. The aim of this study was to evaluate the feasibility of iMAP™ technology by comparing plaque characteristics in patients with and without acute coronary syndrome (ACS and non-ACS). Materials and methods: A total of 93 culprit lesions from 87 patients were analyzed using the iMAP™. Each plaque was classified into 4 components with a newly introduced parameter, confidence level (CL). Results: iMAP™ analysis of the minimal lumen cross-sectional area (MLA) revealed that ACS lesions had significantly larger lipidic and necrotic areas than non-ACS lesions. Multivariate analysis revealed that the lipidic area at the MLA was an iMAP™ factor independently associated with ACS lesions (odds ratio - 1.5, p = 0.04). Based on receiver operating characteristic analysis with 4 different CL ranges, the lipidic area at the MLA with 25%-100% CL had the largest area under the curve (0.756), suggesting that 25%-100% is the best CL range for identifying ACS culprit lesions. Conclusions: The feasibility of the novel iMAP™ IVUS system was shown in discriminating culprit lesions in patients with and without ACS. Analyzing with a CL of 25%-100% may be the best option for discriminating lesions. © 2012 Elsevier Ireland Ltd.Aug. 2013, International Journal of Cardiology, 167(4) (4), 1591 - 1596, English[Refereed]Scientific journal
- Background: We hypothesized that the tissue components of in-stent restenosis (ISR) might differ between drugeluting stents (DES) and bare-metal stents (BMS) and that these differences could be distinguished by qualitative and quantitative optical coherence tomography (OCT) analyses. Methods and Results: One-hundred and twenty-two initial ISR lesions (sirolimus-eluting stents: n=28 paclitaxeleluting stents: n=51 BMS: n=43) were evaluated with OCT. Based on their OCT appearance, the lesions were classified as homogeneous, layered or heterogeneous. The optical properties of backscatter, attenuation and signal intensity of the neointimal tissue (NIT) were quantified. To evaluate the vascular response after balloon angioplasty (BA), the rate of reduction of the NIT area (NITA) was calculated (NITA before - after BA/NITA before BA at the minimum lumen cross-sectional area). Among the morphologic OCT patterns, the layered type was predominant with DES, whereas lesions were homogeneous with BMS (P< 0.001). Backscatter and signal intensity were significantly higher with BMS (P< 0.05 and P< 0.001 respectively). The NITA reduction rate was significantly greater in the layered and heterogeneous groups than in the homogeneous group (P< 0.01). Conclusions: The morphologic OCT patterns of the NIT in ISR differed significantly between DES and BMS, probably reflecting pathologic differences. Layered and heterogeneous tissues might respond better than homogeneous tissue to simple balloon dilatation, suggesting a possible direction for OCT-based ISR treatment strategies.2013, Circulation Journal, 77(3) (3), 652 - 660, English[Refereed]Scientific journal
- Background: The Taxus Express (TM) paclitaxel-eluting stent (Express-PES) and Taxus Liberte (TM) PES (Liberte-PES) have identical drugs, drug doses, and polymers, but different stent platforms. The Liberte-PES platform has thinner struts, specifically designed for more uniform drug elution. Methods and Results: Fifty-four patients who underwent 6-month follow-up optical coherence tomography (OCT) after Express-PES (n=27) or Liberte-PES (n=27) implantation were enrolled. Longitudinal and circumferential uniformity of neointimal distribution was evaluated in 3-D by computing mean neointimal thickness (NIT) within 360 equally spaced radial sectors for every 1-mm cross-section. After stenting, intravascular ultrasound showed that Liberte-PES had a significantly smaller maximum angle between adjacent struts, with a tendency toward a lower incidence of % length of the segment with maximum angle >90 degrees than Express-PES. Liberte-PES had a significantly thinner mean NIT than the Express-PES with comparable frequency of uncovered struts. Longitudinal and circumferential absolute variation of NIT expressed by standard deviation of NIT from each sector was significantly smaller for Liberte-PES than for Express-PES. Liberte-PES had a tendency toward a decreased incidence of thrombus and pen-strut low-intensity areas (findings suggestive of delayed arterial healing), compared to Express-PES. Conclusions: Stent design and thickness appeared to affect neointima suppression of PES. The stent platform of the Liberte-PES may offer greater and more homogeneous reduction of neointimal proliferation spatially across the full length of the PES. (Circ J 2012; 76: 1880-1888)JAPANESE CIRCULATION SOC, Aug. 2012, CIRCULATION JOURNAL, 76(8) (8), 1880 - 1888, English[Refereed]Scientific journal
- Objective The aim of this study was to evaluate detailed vessel response after everolimus-eluting stents (EES) implantation in human de novo coronary lesions by optical coherence tomography (OCT). Design, setting and patients Between November 2008 and October 2009, 25 patients (14 men, 65.5 +/- 8.6 years) with de novo native coronary artery lesions were implanted with 30 EES, and OCT was performed at 8 months post-implantation. Main outcome measures Neointimal thickness (NIT) on each strut, strut apposition to the vessel wall, the frequency of struts surrounded by low intensity area and the incidence of intra-stent thrombus were analysed. To evaluate the radial unevenness of NIT, the difference between the maximum and minimum NIT (dNT) was calculated for each cross-section. Results At 236 +/- 39 days after implantation, there were no major adverse cardiac events, nor target vessel revascularisation. A total of 5931 struts was evaluated by OCT. The median NIT was 80 mm (25th and 75th percentile 50 mm and 140 mm) and average NIT was 100 +/- 74 mu m. The number of neointima-covered struts was 5834 (98.4%), and 31 (0.52%) struts showed malapposition without neointimal coverage. The number of struts surrounded by low intensity area was 452 (7.62%). Eleven EES (37%) showed full neointimal coverage. No intra-stent thrombus was detected. The average dNT was 108 +/- 77 mu m. Conclusions Most EES struts were covered with uniform and thin neointima. The frequency of low-intensity neointima was very low, which may be a result of promoted vessel healing. These results may support improved clinical outcomes with EES in clinical trials.B M J PUBLISHING GROUP, Sep. 2011, HEART, 97(17) (17), 1379 - 1384, English[Refereed]Scientific journal
- Most dialysis patients have coronary artery disease at the initiation of dialysis therapy and these patients also have marked vascular calcification. Virtual histology-intravascular ultrasound (VH-IVUS) provides coronary tissue maps that are color coded by four major plaque components and facilitate the characterization of coronary plaque composition in vivo. The aim of this study was to identify coronary plaque characteristics in dialysis patients using VH-IVUS. Twenty-three patients with coronary artery disease were included in this study. Of these, 12 patients had normal renal function or mild renal insufficiency (control group) and 11 patients were receiving maintenance dialysis therapy (hemodialysis group). We performed coronary angiography and VH-IVUS analysis on culprit lesions of all patients in the study. The result of VH-IVUS analysis showed that the hemodialysis group had a greater plaque volume, lower percentage of fibrous plaque, and higher percentage of dense calcium plaque compared with the control group. In addition, the serum phosphate levels were significantly associated with the percentage of necrotic core and dense calcium plaque in all study patients. Our findings suggest that the amount of necrotic core and dense calcium plaques increase significantly in hemodialysis patients, and that disordered mineral metabolism may be associated with coronary plaque morphology.WILEY-BLACKWELL PUBLISHING, INC, Feb. 2011, THERAPEUTIC APHERESIS AND DIALYSIS, 15(1) (1), 44 - 50, English[Refereed]Scientific journal
- Background: The cytochrome P450 (CYP) 2C19*2 polymorphism is associated with reduced responsiveness to clopidogrel and poor clinical outcome after stent implantation. Despite the high frequency of this polymorphism in Japanese patients, its contribution to cardiac events and stent thrombi after drug-eluting stent (DES) implantation is not clear in this population. Methods and Results: One hundred Japanese patients received clopidogrel and underwent follow-up optical coherence tomography (OCT) after DES implantation. The patients were divided into 2 groups: those with at least one CYP2C19*2 allele (*2 carriers) and non-carriers. The incidence of stent thrombosis and major adverse cardiac events (MACE; ie, death, myocardial infarction, and target vessel revascularization) was compared between the 2 groups. In addition, OCT was used to evaluate the incidence of intra-stent thrombus, defined as a mass protruding into the lumen with significant attenuation. Of the 100 patients, 42 were *2 carriers. No remarkable differences in the baseline characteristics were noted. Although MACE did not differ significantly between the 2 groups, a subclinical intra-stent thrombus was detected more frequently in *2 carriers than in non-carriers (52.3% vs. 15.5%, P=0.0002). Multivariate logistic regression analysis showed that the presence of the CYP2C19*2 polymorphism was the only independent predictive factor for intra-stent thrombus (P=0.00006). Conclusions: From these results it is suggested that CYP2C19*2 polymorphism is associated with subclinical thrombus formation among Japanese patients receiving clopidogrel. (Circ J 2011; 75: 99-105)JAPANESE CIRCULATION SOC, Jan. 2011, CIRCULATION JOURNAL, 75(1) (1), 99 - 105, English[Refereed]Scientific journal
- The Ability of Optical Coherence Tomography to Monitor Percutaneous Coronary Intervention: Detailed Comparison with Intravascular UltrasoundBackground We investigated the usefulness of optical coherence tomography (OCT) to evaluate vessel response after stent implantation by comparing with that of intravascular ultrasound (IVUS) Methods and Results Eighteen cases undergoing percutaneous coronary intervention (PCI) who provided consent for both IVUS and OCT usage pre- and post PCI procedure were enrolled The lumen area at the distal site of the culprit lesion was smaller on OCT images than on IVUS images due to proximal vessel occlusion whereas the lumen area at the proximal site of the lesion did not differ between OCI and IVUS images (distal site 4 6 +/- 2 0 vs 5 0 +/- 1 8 mm(2) p = 0 0004 proximal site 5 5 +/- 2 3 vs 5 6 +/- 2 3 mm(2) p = 0 8160) Stent malapposition was more frequently observed by OCT (30%) than by IVUS (5%, p = 0 0381) Stent edge dissection was not detected by IVUS but was detected in 10% by OCT Tissue pro lapse was identified in all stents by OCT and in 5% by IVUS Thrombus was observed in 15% by OCT and in 5% by IVUS Conclusions Proximal coronary occlusion during OCT imaging was possibly related to underestimation of vessel sizing at distal reference Our data suggested that OCT might provide more detailed information on the presence of tissue prolapse thrombus formation and edge dissection than IVUS Further study is warranted to assess its clinical utilityLead, H M P COMMUNICATIONS, Nov. 2010, JOURNAL OF INVASIVE CARDIOLOGY, 22(11) (11), 541 - 545, English[Refereed]Scientific journal
- Background: Previous studies demonstrated the inverse association of adiponectin with coronary artery disease (CAD) especially in men with acute coronary syndrome, however their association with in vivo plaque vulnerability in stable CAD, which may be reflected by the thin-cap fibroatheroma (TCFA) prevalence, remains unknown. Methods: In 50 men with stable CAD, we identified TCFA with multi-vessel examination of combined use of virtual histology intravascular ultrasound (VH-IVUS) and optical coherence tomography (OCT). The definition of TCFA was described as follows; necrotic-core rich lesion (% necrotic-core >10%) without evidence of an overlying fibrous component and % plaque-volume >40% in at least 3 consecutive frames by VH-IVUS, and the thinnest fibrous-cap thickness <65 mu m by OCT. The patients were divided into two groups, patients with TCFA and without TCFA, and plasma adiponectin level was compared between the groups. Results: Among 50 patients, we could observe 116 vessels (2.32 +/- 0.47 vessel/patient). At least one TCFA was identified in 20 patients. Patients with TCFA had significantly lower plasma adiponectin levels than patients without TCFA (P<0.0001). Furthermore, the plasma adiponectin levels in patients with multi-vessel TCFA were significantly lower than those in patients with single-vessel TCFA (P=0.049). Multivariate logistic regression analysis revealed that plasma adiponectin was the strongest predictive factor of the presence of TCFA (P=0.0007). Conclusions: Low plasma adiponectin was associated with the presence of TCFA in men with stable CAD. This finding suggests that, in these subjects, it may be a biomarker that can be used to stratify "vulnerable patients" into risk categories. (C) 2009 Published by Elsevier Ireland Ltd.ELSEVIER IRELAND LTD, Jul. 2010, INTERNATIONAL JOURNAL OF CARDIOLOGY, 142(3) (3), 250 - 256, English[Refereed]Scientific journal
- Background: Differences between paclitaxel-eluting stents (PES) and sirolimus-eluting stent (SES) in neointimal proliferation under strictly matched conditions remain to be clarified by optical coherence tomography (OCT). Methods and Results: Between May and December 2007, 27 patients were implanted with a PES and a SES, randomized to either the proximal or distal site in a single coronary artery, and underwent follow-up angiography and OCT examination at 6 months. The frequency of vessel wall apposition with neointima was greater for PES than for SES (92.6% vs 85.8%, P<0.01). The median (25th, 75th percentiles) neointimal thickness (NIT) in PES was significantly greater than that in SES (90 mu m [25th: 40 mu m; 75th: 200 mu m] vs 50 mu m [25th: 20 mu m; 75th: 140 mu m]; P<0.01). Both the average difference between the maximum and minimum NIT in each cross-section and the average difference between the maximum and minimum NIT in the longitudinal axis were larger in PES than in SES (206 +/- 88 vs 131 +/- 57 mu m; P<0.001, 607 +/- 243 vs 400 +/- 185 mu m; P<0.001). Low-density spots were significantly more frequently observed in PES than in SES (30.9% vs 17.0%, P=0.001). Conclusions: Compared with SES, PES had a non-uniform and larger neointimal thickness with fewer uncovered struts, and more pen-strut low-density areas. (Circ J 2010; 74: 903-908)JAPANESE CIRCULATION SOC, May 2010, CIRCULATION JOURNAL, 74(5) (5), 903 - 908, English[Refereed]Scientific journal
- Factors That Influence Measurements and Accurate Evaluation of Stent Apposition by Optical Coherence Tomography - Assessment Using a Phantom ModelBackground: Factors influencing measurements and accurate evaluation of stent apposition by optical coherence tomography (OCT) are not established. Methods and Results: Phantom models of known luminal sizes and lengths were evaluated by OCT under various conditions and measurements were compared with actual values. Stents implanted into phantom models were examined by OCT to validate the measurement point on the stent strut surface for accurate evaluation of stent apposition. Strut thickness was measured at 3 points (midpoint, inner and outer surfaces of the stent shadow). The precision of OCT measurements Of lumen diameter and area was satisfactory when the image wire was positioned in the center, but the error and deviation were unsatisfactory when the image wire was positioned eccentrically using a low frame acquisition rate. Longitudinal OCT measurements were close to actual values under all conditions examined. Measurements from the midpoint of the stent shadow to the adjacent vessel wall surface coincided with actual stent thickness. Conclusions: Significant measurement error can occur if the image wire is positioned eccentrically with a lower frame acquisition rate than specified by the manufacturer To accurately evaluate stent apposition, the stent surface should be measured from the center of the stent reflection. (Circ J 2009; 73: 1841-1847)JAPANESE CIRCULATION SOC, Oct. 2009, CIRCULATION JOURNAL, 73(10) (10), 1841 - 1847, English[Refereed]Scientific journal
- Whole Body Bioimpedance Monitoring for Outpatient Chronic Heart Failure Follow upBackground: Although cardiac output index (CI), stroke volume index (SVI), and total systemic vascular resistance (TSVR) are important hemodynamic parameters for the prognosis of chronic heart failure (CHF), they are difficult to measure in an outpatient setting. Whole body bioimpedance monitoring using a Non-Invasive Cardiac System (NICaS) allows for easy, non-invasive estimation of these parameters. Here, whether NICaS-derived hemodynamic parameters are clinically significant was investigated by relating them to other conventional cardiovascular functional indices, and by evaluating their predictive accuracy for CHF readmission. Methods and Results: Study subjects of 68 patients with CHF were enrolled in the study immediately upon discharge from the hospital. NICaS-derived CI, -SVI, and -TSVR values obtained at an outpatient clinic were significantly related with left ventricular ejection fraction (LVEF) measured by echocardiography, serum B-type natriuretic peptide (BNP), and exercise tolerance. During the 100 98 days follow-up, 15 patients were readmitted to our hospital for CHF recurrence. Multivariate analysis indicated that LVEF, NICaS-derived CI, NICaS-derived SVI, and plasma BNP were significant indicators (receiver operating characteristic curve cut-off point, LVEF: 37%, NICaS-derived CI: 2.49L.min(-1).m(-2), NICaS-derived SVI: 27.2 ml/m(2), plasma BNP: 344 pg/ml) for readmission. Conclusions: Hemodynamic parameters derived by NICaS are applicable for the non-invasive assessment of cardiac function in outpatient CHF follow up. (Circ J 2009; 73: 1074-1079)JAPANESE CIRCULATION SOC, Jun. 2009, CIRCULATION JOURNAL, 73(6) (6), 1074 - 1079, English[Refereed]Scientific journal
- Delayed Neointimalization on Sirolimus-Eluting Stents-6-Month and 12-Month Follow up by Optical Coherence TomographyBackground: Sirolimus-eluting stents (SES) have incomplete neointimal coverage at 6-month follow up as determined with optical coherence tomography (OCT). The long-term detailed changes of neointima in SES remains to be clarified. Methods and Results: Serial changes in neointimal coverage of SES from 6 months to 12 months using OCT were examined. Of 21 SES in 13 patients, OCT was used to visualize 2,321 stent struts at 6 months and 2,285 stent struts at 12 months. The frequency of struts without neointimal coverage decreased from 6 months to 12 months (from 10.4 to 5.7%). The frequency of malapposed struts decreased from 6 months to 12 months (from 1.7 to 0.2%). The average thickness of the neointima increased (from 112 +/- 123 to 120 +/- 130 mu m). The frequency of struts located at the side branch orifice without neointima decreased (from 4 out of 17 (24%) to 0 out of 17 (0%)). Complete coverage with neointima was observed in 14% (3 of 21 SES) at 6 months, and 24% (5 of 21 SES) at 12 months. Conclusions: Additional neointimal coverage was observed between 6 and 12 months, with a small increase in the neointimal thickness. The incidence of complete coverage, however, was still low at 12 months. These findings suggest delayed neointimalization on SES. (Circ J 2009; 73: 1033-1037)JAPANESE CIRCULATION SOC, Jun. 2009, CIRCULATION JOURNAL, 73(6) (6), 1033 - 1037, English[Refereed]Scientific journal
- Pioglitazone Reduces the Necrotic-Core Component in Coronary Plaque in Association With Enhanced Plasma Adiponectin in Patients With Type 2 Diabetes MellitusBackground Pioglitazone has a preventive effect on cardiovascular disease, but its ability to stabilize coronary plaque is unknown. Methods and Results A prospective, randomized trial was conducted in 54 patients with type 2 diabetes and stable angina pectoris, randomly assigned to either a pioglitazone group or control group. Non-culprit, angiographically mild-to-moderate obstructive lesions were examined with virtual histology intravascular ultrasound (VH-IVUS) at coronary intervention and 6 months later. In total, 42 lesions of 22 patients in the pioglitazone group and 44 lesions of 24 patients in the control group were analyzed. After 6 months, patients in the pioglitazone group had significantly improved blood sugar, high-sensitivity C-reactive protein, and plasma adiponectin levels. VH-IVUS analysis revealed that, although the total plaque-to-vessel volume was not changed in either group, the necrotic-core area had significantly decreased in the pioglitazone group (-4.6 +/- 5.9% vs 1.1 +/- 9.3%, P=0.001). There was a significant inverse correlation between the change in plasma adiponectin levels and the change in necrotic-core area (r=-0.46, P < 0.0001). Conclusions Pioglitazone may stabilize coronary plaque by reducing the necrotic-core component, in association with enhanced plasma adiponectin levels. (Circ J 2009; 73: 343-351)JAPANESE CIRCULATION SOC, Feb. 2009, CIRCULATION JOURNAL, 73(2) (2), 343 - 351, English[Refereed]Scientific journal
- A 54 years old man underwent directional coronary atherectomy in segment 7 with a partial deep-cut injury. A sirolimus-eluting stent (SES) was implanted at the restenosed post-atherectomy lesion. Six months after SES implantation, intravascular ultrasound (IVUS) examination revealed slight vessel enlargement although there were no malapposed struts. Optical coherence tomography (OCT) revealed partial stent malapposition. Ticlopidine was discontinued 3 months after SES implantation, but aspirin was continued. Twenty-nine months after SES implantation, after discontinuing aspirin for 7 days for colon polypectomy, the patient suffered an acute myocardial infarction at the SES implantation site. IVUS revealed further positive vessel remodeling and slight stent malapposition and OCT revealed extension of the previous stent malapposition and ulcer-like appearance around the stent struts. This case demonstrates that even a small partial SES malapposition that can be detected only by OCT has the potential to enlarge over time and the late malapposition may result in late thrombosis when anti-platelet therapy is discontinued. (C) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.ELSEVIER IRELAND LTD, Dec. 2008, JOURNAL OF CARDIOLOGY, 52(3) (3), 290 - 295, English[Refereed]Scientific journal
- Aims To evaluate the feasibility of the combined use of virtual histology (VH)-intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for detecting in vivo thin-cap fibroatheroma (TCFA). Methods and results In 56 patients with angina, 126 plaques identified by IVUS findings were analysed using both VH-IVUS and OCT. IVUS-derived TCFA was defined as an abundant necrotic core (> 10% of the cross-sectional area) in contact with the lumen (NCCL) and %plaque-volume > 40%. OCT-derived TCFA was defined as a fibrous cap thickness of < 65 mu m overlying a low-intensity area with an unclear border. Plaque meeting both TCFA criteria was defined as definite-TCFA. Sixty-one plaques were diagnosed as IVUS-derived TCFA and 36 plaques as OCT-derived TCFA. Twenty-eight plaques were diagnosed as definite-TCFA; the remaining 33 IVUS-derived TCFA had a non-thin-cap and eight OCT-derived TCFA had a non-NCCL (in discord with NCCL visualized by VH-IVUS, mainly due to misreading caused by dense calcium). Based on IVUS findings, definite-TCFA showed a larger plaque and vessel volume, %plaque-volume, higher vessel remodelling index, and greater angle occupied by the NCCL in the lumen circumference than non-thin-cap IVUS-derived TCFA. Conclusion Neither modality alone is sufficient for detecting TCFA. The combined use of OCT and VH-IVUS might be a feasible approach for evaluating TCFA.OXFORD UNIV PRESS, May 2008, EUROPEAN HEART JOURNAL, 29(9) (9), 1136 - 1146, English[Refereed]Scientific journal
- Elsevier BV, Apr. 1999, Chemico-Biological Interactions, 118(3) (3), 201 - 215Scientific journal
- 2023, 日本成人先天性心疾患学会雑誌(Web), 12(1) (1)Successful transcatheter stent implantation for late thrombotic occlusion after BT shunt surgery
- 2023, 日本循環器学会学術集会(Web), 87thDiagnostic Accuracy of Nitroglycerin-free FFRCT-based Physiological Assessment in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
- 2023, 日本腫瘍循環器学会学術集会抄録集(Web), 6thがんの既往と第2世代ステント血栓症との関連~REAL-STレジストリ研究より~
- (一社)日本透析医学会, May 2019, 日本透析医学会雑誌, 52(Suppl.1) (Suppl.1), 353 - 353, Japanese症例から末期腎臓病患者の大動脈弁狭窄症の治療戦略を考察する 経カテーテル大動脈弁留置術(TAVI)を施行した末期腎臓病患者の一例
- ELSEVIER SCIENCE INC, Oct. 2017, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 70(18) (18), B331 - B331, EnglishThe clinical impact of daily glucose fluctuation on cardiovascular events in patients with stable angina pectoris pretreated with lipid-lowering therapySummary international conference
- ELSEVIER SCIENCE INC, Oct. 2017, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 70(18) (18), B186 - B186, EnglishHigh Wall Shear Stress was Strongly Associated with Plaque Vulnerability in Computational Fluid Dynamics with Combined Optical Coherence Tomography and Heartflow FFRCT SimulationSummary international conference
- ELSEVIER SCIENCE INC, Oct. 2017, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 70(18) (18), B220 - B220, EnglishThe combination of rosuvastatin (10mg) and eicosapentaenoic acid (1800mg) improved native coronary plaques > 5.7 years after stent implantationSummary international conference
- ELSEVIER SCIENCE INC, Oct. 2017, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 70(18) (18), B175 - B175, EnglishCT predictor of periprocedural stroke related to transcatheter aortic valve replacement.Summary international conference
- ELSEVIER SCIENCE INC, Apr. 2016, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 67(13) (13), 118 - 118, EnglishFEASIBILITY AND SAFETY OF SAPIEN 3 TRANSCATHETER AORTIC VALVE IMPLANTATION WITH MODERATE OR NO PREDILATATIONSummary international conference
- LIPPINCOTT WILLIAMS & WILKINS, Nov. 2015, CIRCULATION, 132, EnglishThe Clinical Impact of Diabetes Mellitus on Outcome After Transcatheter Aortic Valve ReplacementSummary international conference
- LIPPINCOTT WILLIAMS & WILKINS, Nov. 2015, CIRCULATION, 132, EnglishImpact of Small Body Surface Area on Para-valvular Leak After Balloon-expandable Transcatheter Aortic Valve ReplacementSummary international conference
- ELSEVIER SCIENCE INC, Oct. 2015, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 66(15) (15), B257 - B257, EnglishBalloon-Expandable Transcatheter Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Mild Aortic Valve CalcificationSummary international conference
- ELSEVIER SCIENCE INC, Oct. 2015, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 66(15) (15), B133 - B134, EnglishImpact of Ultra-Low Contrast Computed Tomography Compared to Three-Dimensional Transesopageal Echocardiography for Transcatheter Aortic Valve Replacement planningSummary international conference
- ELSEVIER SCIENCE INC, Mar. 2015, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 65(10) (10), A252 - A252, EnglishSummary international conference
- OXFORD UNIV PRESS, Aug. 2011, EUROPEAN HEART JOURNAL, 32, 853 - 854, EnglishNatural consequence of stent malapposition tissue prolapse, thrombus and stent edge dissection assessed by optical coherence tomographySummary international conference
- ELSEVIER SCIENCE INC, Apr. 2011, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 57(14) (14), E1860 - E1860, EnglishA NOVEL RADIOFREQUENCY SIGNAL ANALYSIS FOR CORONARY PLAQUE CHARACTERIZATION AT CULPRIT LESION USING IMAPTM: HOW CAN WE USE THE NEW PARAMETER: CONFIDENCE LEVEL?Summary international conference
- ELSEVIER SCIENCE INC, Apr. 2011, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 57(14) (14), E1744 - E1744, EnglishNATURAL CONSEQUENCE OF STENT MALAPOSITION ASSESSED BY OPTICAL COHERENCE TOMOGRAPHYSummary international conference
- ELSEVIER SCIENCE INC, Apr. 2011, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 57(14) (14), E1299 - E1299, EnglishIMPACT OF CYTOCHROME P450 2C19*2 POLYMORPHISM ON THE TARGET LESION OUTCOME AFTER DRUG-ELUTING STENT IMPLANTATION IN JAPANESE PATIENTS RECEIVING CLOPIDOGREL.Summary international conference
- ELSEVIER SCIENCE INC, Apr. 2011, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 57(14) (14), E1210 - E1210, EnglishINFLUENCE OF PROTON PUMP INHIBITORS (PPIS) ON THE FORMATION OF INTRA-STENT THROMBUS IN JAPANESE PATIENTS RECEIVING CLOPIDOGREL WITH OR WITHOUT CYTOCHROME P450 2C19*2 POLYMORPHISMSummary international conference
- ELSEVIER SCIENCE INC, Apr. 2011, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 57(14) (14), E1723 - E1723, EnglishPOTENTIAL BENEFIT OF FINAL KISSING INFLATION AFTER SINGLE STENTING TO BIFURCATION LESIONS: DIFFERENCE OF OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN SIROLIMUS AND PACLITAXEL-ELUTING STENTSSummary international conference
- ELSEVIER SCIENCE INC, Apr. 2011, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 57(14) (14), E1731 - E1731, EnglishASSESSMENT OF YELLOW NEOINTIMA AND MURAL THROMBI AFTER 1ST GENERATION SIROLIMUS-ELUTING STENTS USING ANGIOSCOPE AND OPTICAL COHERENCE TOMOGRAPHYSummary international conference
- LIPPINCOTT WILLIAMS & WILKINS, Nov. 2010, CIRCULATION, 122(21) (21), EnglishDelayed Arterial Healing After Sirolimus Eluting Stents Implantation Into the Dominant Necrotic Core Lesions in Patients With Stable Coronary Artery DiseaseSummary international conference
- LIPPINCOTT WILLIAMS & WILKINS, Nov. 2010, CIRCULATION, 122(21) (21), EnglishDifference of Optical Properties of Neointimal Tissue Between Restenosis After Drug-Eluting and Bare Metal Coronary StentSummary international conference
- OXFORD UNIV PRESS, Sep. 2010, EUROPEAN HEART JOURNAL, 31, 150 - 150, EnglishPotential benefit of final-kissing inflation after single stenting for the treatment of bifurcation lesions: Insight from OCT observationsSummary international conference
- OXFORD UNIV PRESS, Sep. 2010, EUROPEAN HEART JOURNAL, 31, 969 - 969, EnglishImpact of cytochrome P450 2C19*2 polymorphism on subclinical thrombus after silorimus-eluting stent implantation in Japanese patients on dual anti-platelet therapy with clopidogrel and aspirinSummary international conference
- OXFORD UNIV PRESS, Sep. 2010, EUROPEAN HEART JOURNAL, 31, 370 - 370, EnglishFactor analysis of neointimal coverage after sirolimus-eluting stents implantation in patients with stable coronary artery diseaseSummary international conference
- ELSEVIER SCIENCE INC, Sep. 2010, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 56(13) (13), B58 - B58, EnglishAssessment Of Yellow Neointiam And Mural Thrombi After 1St Generation Sirolimuseluting Stents Using Angioscope And Optical Coherence TomographySummary international conference
- OXFORD UNIV PRESS, Sep. 2009, EUROPEAN HEART JOURNAL, 30, 244 - 245, EnglishFactors that influence measurements and accurate evaluation of stent apposition by optical coherence tomography; Assessment using a phantom modelSummary international conference
- OXFORD UNIV PRESS, Sep. 2009, EUROPEAN HEART JOURNAL, 30, 593 - 593, EnglishComparison of paclitaxel-eluting stent with sirolimus-eluting stent by optical coherence tomography: implanting two different types of drug-eluting stent in a single coronary arterySummary international conference
- EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Sep. 2009, AMERICAN JOURNAL OF CARDIOLOGY, 104(6A) (6A), 64D - 64D, EnglishOptical Coherence Tomography Analysis Of Target Vessel Failure After Drug Eluting And Bare Metal Coronary StentSummary international conference
- 10 Jun. 2009, Japanese Journal of Interventional Cardiology, 24(3) (3), 262 - 265, JapaneseFactorial Analysis for Contrast Induced Nephropathy after Percutaneous Coronary Intervention
- 一時的下大静脈フィルターが血栓閉塞し抜去に苦慮した先天性凝固異常合併、妊娠初期深部静脈血栓症の2例症例1(31歳初産婦)。妊娠12週より左下肢の浮腫と疼痛が出現し近医を受診、加療されるも改善せず、妊娠14週に著者らの施設へ救急搬送となった。症例2(30歳初産婦)。妊娠9週より左鼠径部の疼痛が出現し、その後、疼痛は左下肢に広がり、腫脹を認めたため、精査加療目的に著者らの施設へ救急搬送となった。精査の結果、両症例とも深部静脈血栓症と診断され、症例2では先天性凝固異常の合併を認めた。いずれも肺塞栓症(PE)予防のため、一時的下静脈フィルター(T-IVCF)を留置し、ヘパリンによる抗凝固療法を開始したところ、APTTを80〜100 secにコントロールにしたにもかかわらず、フィルター内に血栓が形成された。そこで、T-IVCFの直上に症例1は同一のT-IVCF、症例2は回収可能型のGunther Tulipフィルターを留置し、既存のT-IVCFを抜去した。以後、抗凝固療法を強化したところ、フィルター内には血栓を認めず、入院31〜43日目には下肢血栓の器質化が確認され、それぞれT-IVCF、Gunther Tulipフィルターを抜去することができた。尚、抗凝固療法をカプロシンに切り替えるも、PEを発症することなく、それぞれ妊娠39週、38週に正常分娩となった。ライフサイエンス出版(株), May 2009, Therapeutic Research, 30(5) (5), 712 - 714, Japanese
- Japanese Circulation Society, 01 Mar. 2009, Circulation journal : official journal of the Japanese Circulation Society, 73, 752 - 752, EnglishPJ-819 Tissue Characterization of Optical Coherence Tomography Derived Thin Cap Fibroatehroma(PJ137,Intravascular Imagings 1 (I),Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2009, Circulation journal : official journal of the Japanese Circulation Society, 73, 387 - 387, EnglishDPJ-046 Heterogeneity of Neointimal Distribution of Drug Eluting Stent Examined by Optical Coherence Tomography : Comparison with Cypher^
and Taxus^ (DPJ08,Intravascular Imagings (I),Digital Poster Session (Japanese),The 73rd Annual Scientific Meeting of The Japanese Circulation Society) - Japanese Circulation Society, 01 Mar. 2009, Circulation journal : official journal of the Japanese Circulation Society, 73, 418 - 419, EnglishPE-080 Coronary Plaque Progression may Associate Changes of Coronary Plaque Components with Serum Biomarker Abnormalities : Binary Intravascular Ultrasound Virtual Histology Study(PE014,Intravascular Imagings (I),Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2009, Circulation journal : official journal of the Japanese Circulation Society, 73, 481 - 481, EnglishPE-325 Comparison of Paclitaxel-eluting Stents with Sirolimus-eluting Stents by Optical Coherence Tomography(PE055,Intravascular Imagings (I),Poster Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2009, Circulation journal : official journal of the Japanese Circulation Society, 73, 162 - 162, EnglishFRS-095 Evaluation of Bioabsorbable Polymer Coated Paclitaxel-Eluting Stent by Optical Coherence Tomography : STELLIUM First-in-Man Study(FRS20,Clinical Evidence of DES Era (2) (IHD),Featured Research Session (English),The 73rd Annual Scientific Meeting of The Japanese Circulation Society)
- ELSEVIER SCIENCE INC, Mar. 2009, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 53(10) (10), A42 - A42, EnglishEvaluation of Bioabsorbable Polymer Coated Paclitaxel-Eluting Stent by Optical Coherence Tomography; STELLIUM First-in-Man StudySummary international conference
- LIPPINCOTT WILLIAMS & WILKINS, Oct. 2008, CIRCULATION, 118(18) (18), S629 - S629, EnglishLow Plasma Adiponectin Level and High Oxidative Stress are Associated with In Vivo Thin-Cap Fibroatheloma Prevalence in Patients with Stable Coronary Artery DiseaseSummary international conference
- OXFORD UNIV PRESS, Sep. 2008, EUROPEAN HEART JOURNAL, 29, 844 - 844, EnglishDifference of sirolimus-eluting stents and paclitaxel-eluting stents in cases of hybrid implantation, six-month follow-up with optical coherence tomographySummary international conference
- 日本心臓病学会, 15 May 2008, 日本心臓病学会誌 =Journal of cardiology. Japanese edition, 1(3) (3), 169 - 173, JapaneseA Case of Aortic Regurgitation Associated with Hypereosinophilic Syndrome
- 社団法人日本循環器学会, 20 Apr. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 1003 - 1003, Japanese179) 部分肺静脈還流異常症の一例(第104回日本循環器学会近畿地方会)
- Japanese Circulation Society, 01 Mar. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 546 - 546, EnglishPJ-141 Delayed Neointimalization on Sirolimus-eluting Stents Located at a Major Side Branch Orfice Evaluation by Optical Coherence Tomography(Intravascular endoscopy/Intravascular ultrasound(05)(I),Poster Session(Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 85 - 85, English4 Drug-eluting Stent Follow-up by Optical Coherence Tomography(Progress in coronary artery imaging by OCT,Topic 1 (TP-1) (I),Special Program,The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 428 - 428, EnglishPE-271 Necrotic-core coronary plaque components may decrease in relation to improvement in lipid metabolism and insulin sensitivity with increase of adiponectin(Atherosclerosis, clinical(06)(IHD),Poster Session(English),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 540 - 540, EnglishPJ-117 Noninvasive Prediction of Readmission in Patients with Chronic Heart Failure, Combined Use of Plasma BNP and Bioimpedance Derived Cardiac Index(Heart failure, clinical(13)(M),Poster Session(Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 333 - 333, EnglishOJ-177 Clinical Features of Plaque Progression in patients with Stable Angina : Binary Intravascular Ultrasound Virtual Histology Study(Intravascular endoscopy / Intravascular ultrasound(02)(I),Oral Presentation (Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2008, Circulation journal : official journal of the Japanese Circulation Society, 72, 332 - 333, EnglishOJ-176 Can Virtual Histology Intravascular Ultrasound Predict Thin Fibrous Cap In Vivo?(Intravascular endoscopy / Intravascular ultrasound(02)(I),Oral Presentation (Japanese),The 72nd Annual Scientific Meeting of the Japanese Circulation Society)
- ELSEVIER SCIENCE INC, Mar. 2008, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 51(10) (10), A285 - A285, EnglishCan we speculate thin fibrous cap only by virtual histology intravascular ultrasound in vivo?Summary international conference
- 社団法人日本循環器学会, 20 Oct. 2007, Circulation journal : official journal of the Japanese Circulation Society, 71, 1005 - 1005, Japanese143)肺動脈血栓内膜摘除術が奏功した若年発症の慢性肺動脈血栓塞栓症の一例(第103回日本循環器学会近畿地方会)
- ELSEVIER SCIENCE INC, Mar. 2007, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 49(9) (9), 382A - 382A, EnglishLower plasma adiponectin levels and higher oxidative stress are associated with in vivo thin-cap fibroatheroma in patients wth sable agina pctorisSummary international conference
- Japanese Circulation Society, 01 Mar. 2007, Circulation journal : official journal of the Japanese Circulation Society, 71, 343 - 344, EnglishPE-076 Delayed Neointimalization on Sirolimus-eluting Stents Observed by Optical Coherence Tomography(Restenosis basic/clinical-2, The 71st Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2007, Circulation journal : official journal of the Japanese Circulation Society, 71, 130 - 130, EnglishFRS-111 Low Plasma Adiponectin and High Oxidative Stress are Important Factors for the Presence of Thin-cap Fibroatheloma(IVUS, OCT and Angioscopy (clinical), The 71st Annual Scientific Meeting of the Japanese Circulation Society)
- Japanese Circulation Society, 01 Mar. 2007, Circulation journal : official journal of the Japanese Circulation Society, 71, 411 - 411, EnglishPE-347 Determinants of Plaque Progression in Patients with Stable Angina : Serial Intravascular Ultrasound Virtual Histology Study(Intravascular endoscopy/Intravascular ultrasound-4, The 71st Annual Scientific Meeting of the Japanese Circulation Society)
- Contributor, 閉塞性動脈硬化症, 医学書院, Jan. 2021今日の治療指針 2021年度版
- Others, メディアルファ, May 2018, JapanesePCIにおけるIVUS/OCTの活かし方2018後編 / ACSにおけるIVUS/OCTの使い方Others
- Others, OCTにより冠動脈インターベンションをどう評価するか, メジカルビュー社, Jun. 2011冠動脈病変の可視化と治療
- The 84th Annual Scientific Meeting of the Japanese Circulation Society, EnglishThe Necessity to Confirm Strut Design in Front of Coronary Ostium before Coronary Angiogram in Patients with SAPIEN 3Oral presentation
- 第83回日本循環器学会学術集会, Mar. 2019, Japanese, 日本循環器学会, 横浜, Domestic conferenceThe morphological characteristics and insufficient lipid control might promote intimal thickening of saphenous vein graft after coronary artery bypass graftingOral presentation
- 第83回日本循環器学会学術集会, Mar. 2019, Japanese, 日本循環器学会, 横浜, Domestic conferenceThe impact of glucose fluctuation on cardiovascular outcome in patients with stable coronary artery diseasePublic symposium
- 第83回日本循環器学会学術集会, Mar. 2019, English, 日本循環器学会, 横浜, Domestic conferenceThe concomitant use of statin and eicosapentaenoic acid prevented atherosclerotic progression in both in-stent neoatherosclerosis and native coronary plaques.Oral presentation
- 第83回日本循環器学会学術集会, Mar. 2019, English, 日本循環器学会, 横浜, Domestic conferencePlaque progression from normal vessel wall to fibroatheroma: lessons from over 5-year follow-up optical coherence tomography studyOral presentation
- 第83回日本循環器学会学術集会, Mar. 2019, Japanese, 日本循環器学会, 横浜, Domestic conferenceNovel Approach for In-vivo Detection of Vulnerable Plaques: Computational Fluid Dynamics in Optical Coherence Tomography and Computed Tomography Merged ModelPublic symposium
- 第83回日本循環器学会学術集会, Mar. 2019, English, 日本循環器学会, 横浜, Domestic conferenceClinical characteristics and morphological culprit plaque features in patients with acute coronary syndromeOral presentation
- 第83回日本循環器学会学術集会, Mar. 2019, English, 日本循環器学会, 横浜, Domestic conferenceA possible link between asymmetric expansion of SAPIEN 3 transcatheter heart valve and hypo-attenuated leaflet thickeningPoster presentation
- カテーテルアブレーション関連秋季大会2018, Nov. 2018, Japanese, 日本不整脈心電学会, 沖縄, Domestic conference下大静脈-三尖弁輪峡部通電により右冠動脈の血腫圧排，閉塞をきたした1 例 ～血管内超音波と3次元CTからの考察～Oral presentation
- Transcatheter Cardiovascular Therapeutics (TCT 2018), Sep. 2018, English, 心血管研究財団, サンディエゴ, International conferenceThe concomitant use of statin and eicosapentaenoic acid prevented atherosclerotic progression in both in-stent neoatherosclerosis and native coronary plaques.Poster presentation
- Transcatheter Cardiovascular Therapeutics (TCT2018), Sep. 2018, English, 心血管研究財団, サンディエゴ, International conferencePrediction of debulking effect of rotational atherectomy by optical frequency domain imagingPoster presentation
- Transcatheter Cardiovascular Therapeutics (TCT 2018), Sep. 2018, English, 心血管研究財団, サンディエゴ, International conferenceImpact of dual antiplatelet therapy with low-dose prasugrel on mid-term vascular response after everolimus-eluting stent implantation in elective percutaneous coronary interventionPoster presentation
- 第27回日本心血管インターベンション治療学会, Aug. 2018, Japanese, 日本心血管インターベンション治療学会, 神戸, Domestic conference慢性血栓塞栓性肺高血圧に対する肺動脈内膜血栓摘除術及びバルーン肺動脈形成術の特性を活かしたハイブリッド療法Public symposium
- 第27回日本心血管インターベンション治療学会学術集会, Aug. 2018, Japanese, 日本心血管インターベンション治療学会, 神戸, Domestic conference慢性血栓塞栓性肺高血圧に対する肺動脈内膜血栓摘除術及びバルーン肺動脈形成術の特性を活かしたハイブリッド療法Public symposium
- 第27回日本心血管インターベンション治療学会, Aug. 2018, Japanese, 日本心血管インターベンション治療学会, 神戸, Domestic conferenceTAVR後、人口弁への血栓形成を認めた血小板低下患者の一例Oral presentation
- EUROPEAN SOCIETY OFCARDIOLOGYCONGRESS 2018(ESC 2018), Aug. 2018, English, European Society of Cardiology, ミュンヘン, International conferenceComparison between pulmonary endarterectomy and balloon pulmonary angioplasty focusing on RC time constant and pulmonary artery compliance in chronic thromboembolic pulmonary hypertension.Poster presentation
- ESC Congress 2018, Aug. 2018, English, European Society of Cardiology, ミュンヘン, International conferenceComparison between pulmonary endarterectomy and balloon pulmonary angioplasty focusing on RC time constant and pulmonary artery compliance in chronic thromboembolic pulmonary hypertension.Poster presentation
- 第3回 日本肺高血圧・肺循環学会学術集会, Jun. 2018, Japanese, 日本肺高血圧・肺循環学会, 大阪, Domestic conferenceCTEPHに対する治療効果及びRC timeの臨床的意義についてOral presentation
- 第3回日本肺高血圧・肺循環学会学術集会, Jun. 2018, Japanese, 日本肺高血圧学会日本肺循環学会共催, 大阪, Domestic conferenceCTEPH に対する治療効果の比較及びRC time の臨床的意義についてOral presentation
- 第124回日本循環器学会近畿地方会, Nov. 2017, Japanese, 日本循環器学会, 大阪, Domestic conference慢性血栓塞栓性肺高血圧症に対するバルーン拡張術におけるpressure wireを用いた病変別急性効果の検討Oral presentation
- The 124th Kinki Regional Office of the Japanese Circulation Society, Nov. 2017, Japanese, The Japanese Circulation Society, 大阪, 症例は83歳女性。以前より大動脈弁狭窄症を指摘されていたが、一年前より合計3度の心不全入院を繰り返すようになり、精査加療目的で当院紹介となった。過去の心不全入院歴は高度大動脈弁狭窄症の経過として矛盾しないものの、大動脈弁位での圧較差に比して心エコー図での大動脈弁弁口面積および大動脈弁石灰化の程度は軽度であり、重症度に不一致を認めた。心臓CTによる任意多断面再構成（MPR）画像では、各交連部下に膜様組織の増生を認め、弁口部よりも左室流出路側に最狭窄部が存在していることが判明した。患者の全身状態から経カテーテル的大動脈弁置換術を施行し、その後心不全入院は消失した。弁交連部下の膜様組織による大動脈弁狭窄の様子を、心エコー図、心臓CT-MPR法にて同定しえたため画像とともに供覧する。, Domestic conference重症度の判別に苦慮した大動脈弁狭窄症の一例Oral presentation