Tokushige Akihiro

写真a

Title

Instructor

Researcher Number(JSPS Kakenhi)

70780287

Current Affiliation Organization 【 display / non-display

  • Duty   University of the Ryukyus   Graduate School of Medicine   Instructor  

External Career 【 display / non-display

  • 2012.01
    -
    2015.12

    Kagoshima University  

  • 2016.01
    -
    2016.03

    Kagoshima University  

  • 2016.04
    -
    2019.03

    University of the Ryukyus  

  • 2016.04
    -
    2019.03

    University of the Ryukyus, Graduate School of Medicine, Instructor  

  • 2019.04
    -
    2021.08

    Kagoshima University  

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Research Areas 【 display / non-display

  • Life Science / Cardiology

  • Life Science / Clinical pharmacy

  • Life Science / Medical management and medical sociology

Published Papers 【 display / non-display

  • Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention.

    Shimono H, Tokushige A, Kanda D, Ohno A, Hayashi M, Fukuyado M, Akao M, Kawasoe M, Arikawa R, Otsuji H, Chaen H, Okui H, Oketani N, Ohishi M

    Heart and vessels ( Heart and Vessels )  38 ( 10 ) 1205 - 1217   2023.10 [ Peer Review Accepted ]

    Type of publication: Research paper (scientific journal)

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    There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607-1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan-Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86-9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.

  • Agile 3+and Agile 4, noninvasive tests for liver fibrosis, are excellent formulae to predict liver-related events in nonalcoholic fatty liver disease

    Miura, K; Hayashi, H; Kamada, Y; Fujii, H; Takahashi, H; Oeda, S; Iwaki, M; Kawaguchi, T; Tomita, E; Yoneda, M; Tokushige, A; Ueda, S; Aishima, S; Sumida, Y; Nakajima, A; Okanoue, T

    HEPATOLOGY RESEARCH ( Hepatology Research )  53 ( 10 ) 978 - 988   2023.10 [ Peer Review Accepted ]

    Type of publication: Research paper (scientific journal)

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    AIM: The noninvasive tests (NITs) Agile 3+ and Agile 4 effectively identify patients with nonalcoholic fatty liver disease (NAFLD) complicated with advanced fibrosis (F3-4) and cirrhosis (F4), respectively. Little information is available on associations between Agile scores and intra-/extrahepatic events. The aim of this study was to determine the predictive performance of Agile scores for intra-/extrahepatic events in Asian patients with biopsy-proven NAFLD. METHODS: We undertook a retrospective multicenter cohort study to investigate associations between intra-/extrahepatic events and two Agile scores, Agile 3+ and Agile 4. The scores were obtained by combining clinical parameters and liver stiffness measurement using transient elastography. RESULTS: Among 403 enrolled patients, 11 had liver-related events (LREs), including seven with hepatocellular carcinoma (HCC). The incidence of LREs and HCC showed a stepwise increase in the advanced fibrosis group (F3-4), Agile 3+ rule-in (F3-4, highly suspected), and Agile 4 rule-in (F4, highly suspected) groups, compared to their counterparts. Hazard ratios for LREs in the advanced fibrosis group, Agile 3+ rule-in, and Agile 4 rule-in groups were 4.05 (p = 0.03), 23.5 (p = 0.003), and 45.5 (p < 0.001), respectively. The predictive performance results for Agile 3+ and Agile 4 were 0.780 and 0.866, respectively, which were higher than for fibrosis (0.595). Unlike for LREs, Agile scores failed to identify patients with extrahepatic events, including cardiovascular events and extrahepatic cancer. CONCLUSIONS: Agile 3+ and Agile 4 scores are excellent NITs for predicting LREs in patients with NAFLD, possibly without histological assessment.

  • Secondary rotational atherectomy is associated with reduced occurrence of prolonged ST-segment elevation following ablation.

    Daisuke Kanda, Takuro Takumi, Ryo Arikawa, Kazuhiro Anzaki, Takeshi Sonoda, Kenta Ohmure, Daichi Fukumoto, Akihiro Tokushige, Mitsuru Ohishi

    Internal and emergency medicine   18 ( 7 ) 1995 - 2002   2023.10 [ Peer Review Accepted ]

    Type of publication: Research paper (scientific journal)

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    Elevation of the ST segment after percutaneous coronary intervention (PCI) using rotational atherectomy (RA) for severely calcified lesions often persists after disappearance of the slow-flow phenomenon on angiography. We investigated clinical factors relevant to prolonged ST-segment elevation following RA among 152 patients with stable angina undergoing elective PCI. PCI procedures were divided into two strategies, RA without (primary RA strategy) or with (secondary RA strategy) balloon dilatation before RA. Incidence of prolonged ST-segment elevation after disappearance of slow-flow phenomenon was higher in the 56 patients with primary RA strategy (13%) than in the 96 patients with secondary RA strategy (3%, p = 0.039). Univariate logistic regression analysis showed levels of low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.93-0.99; p = 0.013), levels of triglycerides (OR 0.97, 95%CI 0.94-0.99; p = 0.040), and secondary RA strategy (OR 0.23, 95% CI 0.05-0.85; p = 0.028) were inversely associated with occurrence of prolonged ST-segment elevation following ablation. However, hemodialysis, diabetes mellitus, left-ventricular ejection fraction, lesion length ≥ 20 mm, and burr size did not show significant associations. Multivariate logistic regression analysis modeling revealed that secondary RA strategy was significantly associated with the occurrence of prolonged ST-segment elevation (Model 1: OR 0.24, 95% CI 0.05-0.95, p = 0.042; Model 2: OR 0.17, 95% CI 0.03-0.68, p = 0.018; Model 3: OR 0.21, 95% CI 0.03-0.87, p = 0.041) even after adjusting for levels of LDL-C and triglycerides. Secondary RA strategy may be useful to reduce the occurrence of prolonged ST-segment elevation following RA.

  • Living alone predicts poor prognosis among patients with acute myocardial infarction.

    Daichi Fukumoto, Daisuke Kanda, Takuro Takumi, Yoshiyuki Ikeda, Akihiro Tokushige, Kenta Ohmure, Takeshi Sonoda, Ryo Arikawa, Kazuhiro Anzaki, Mitsuru Ohishi

    Coronary artery disease     2023.09 [ Peer Review Accepted ]

    Type of publication: Research paper (scientific journal)

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    BACKGROUND: Living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. We thus investigated the impact of living alone on mortality in acute myocardial infarction (AMI) patients. METHODS: Subjects comprised 277 AMI patients who underwent percutaneous coronary intervention (PCI). Associations between all-cause and cardiac deaths after PCI and baseline characteristics including living alone and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. RESULTS: Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of both all-cause and cardiac deaths compared with patients not living alone (18% vs. 8%, P = 0.019 and 14% vs. 4%, P = 0.004). Multivariate Cox proportional hazards regression analysis models showed living alone [hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20-5.62; P = 0.016 and HR, 4.17; 95% CI, 1.60-10.84; P = 0.003] and GRACE risk score (HR, 1.02; 95% CI, 1.01-1.03; P = 0.003 and HR, 1.03; 95% CI, 1.01-1.04; P < 0.001) correlated significantly with all-cause and cardiac deaths. Cox proportional hazards modeling revealed that patients living alone with GRACE risk score ≥162 derived from the receiver-operating characteristic curve showed a significantly greater risk of all-cause death than patients not living alone with GRACE risk score <162 (HR 16.57; 95% CI 6.67-41.21; P < 0.001). CONCLUSION: Among AMI patients, living alone represents an independent risk factor for all-cause and cardiac deaths after PCI, separate from GRACE risk score. Furthermore, AMI patients living alone with high GRACE risk scores may experience an additively increased risk of mortality after PCI.

  • A case of cardiac metastasis of neuroendocrine tumor with 2-year follow-up.

    Keisuke Shibata, Akihiro Tokushige, Yuki Hamamoto, Shiho Arima, Kazuhisa Matsumoto, Michiyo Higashi, Yoshiyuki Ikeda, Mitsuru Ohishi

    Journal of cardiology cases   28 ( 3 ) 91 - 94   2023.09 [ Peer Review Accepted ]

    Type of publication: Research paper (other science council materials etc.)

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    UNLABELLED: A 55-year-old male underwent surgery for thymus gland tumors six years previously, and for lung and pancreas tumors three years previously, which were pathologically diagnosed as neuroendocrine tumors (NETs). During routine medical checkups, a giant negative T-wave was observed on the electrocardiogram. Echocardiography revealed a tumor at the apex. A surgical biopsy was performed; the tumor was diagnosed as a cardiac metastasis of NETs, and chemotherapy was initiated. Two years later, echocardiography confirmed that the tumor had not increased in size. A 2-year follow-up of NETs cardiac metastasis is rare; we therefore report this case. LEARNING OBJECTIVE: Neuroendocrine tumors are considered slowly progressing tumors, but despite the presence of cardiac metastasis, accurate diagnosis and appropriate treatment have allowed the patient to survive the disease for more than two years.

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Other Papers 【 display / non-display

  • Risk Factors of Cardiovascular Death for 2-years after Revascularization in Elderly Critical Limb Ischemia Patients with Coronary Artery Disease(和訳中)

    安崎 和博, 神田 大輔, 有川 亮, 薗田 剛嗣, 徳重 明央, 小瀬戸 一平, 池田 義之, 大石 充

    日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  84回   PJ33 - 8   2020.07

     

  • White Blood Cell Count Predicts Cardiovascular Prognosis in Type 2 Diabetic Patients with Established Coronary Artery Disease(和訳中)

    河邉 篤彦, 安隆 則, 森本 剛, 百村 伸一, 坂倉 建一, 徳重 明央, 野出 孝一, 植田 真一郎

    日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  84回   PJ16 - 1   2020.07

     

  • 冠動脈疾患を伴う糖尿病患者における癌生存者の心血管転帰 CHDコホートから(The Cardiovascular Outcome of Cancer Survivor in Patients with Diabetes Mellitus with Coronary Artery Disease: From CHD Cohort)

    徳重 明央, 植田 真一郎, 大石 充

    日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  83回   PJ022 - 4   2019.03

     

  • 脂質異常および心血管リスクを有する2型糖尿病患者のLDL cholesterolに対するanagliptinとsitagliptinの効果 Reason試験からの結果(Effect of Anagliptin and Sitagliptin on LDL-cholesterol in Type 2 Diabetic Patients with Dyslipidemia and Cardiovascular Risk Results from Reason Trial)

    植田 真一郎, 佐久間 一郎, 作間 未織, 徳重 明央, 夏秋 政浩, 旭 朝弘, 島袋 充生, 野見山 崇, 新崎 修, 野出 孝一, 森本 剛

    日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  83回   PJ018 - 1   2019.03

     

  • 多様化する医療に向けて臨床研究の方向性を再考する 多剤併用高齢CAD患者における最適な減薬方法に関する臨床試験の提唱 患者レジストリに基づいた理論的根拠とデザイン(Proposal of Clinical Trial for Appropriate Deprescribing in Elderly Cad Patients with Polypharmacy: Rationale and Design Based on Patients Registry)

    徳重 明央, 植田 真一郎

    日本循環器学会学術集会抄録集 ( (一社)日本循環器学会 )  82回   SY09 - 4   2018.03

     

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