Published Papers - Kusunose Kenya

Noninvasive Vascular Function Tests - Long Journey for Predicting Cardiovascular Events

Kenya Kusunose, Hirotsugu Yamada

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  80 ( 6 ) 1321 - 1322   2016.06 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Left Ventricular Global Strain for Estimating Relaxation and Filling Pressure - A Multicenter Study -

Taichi Hayashi, Satoshi Yamada, Hiroyuki Iwano, Masahiro Nakabachi, Mamoru Sakakibara, Kazunori Okada, Daisuke Murai, Hisao Nishino, Kenya Kusunose, Kiyotaka Watanabe, Tomoko Ishizu, Kazuaki Wakami, Hirotsugu Yamada, Kaoru Dohi, Yoshihiro Seo, Nobuyuki Ohte, Taisei Mikami, Hiroyuki Tsutsui

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  80 ( 5 ) 1163 - 1170   2016.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background: Speckle-tracking echocardiography (STE)-derived parameters may have better correlation with left ventricular (LV) relaxation and filling pressure than tissue Doppler-derived parameters. However, it has not been elucidated which parameter - strain or strain rate - and which direction of myocardial deformation - longitudinal or circumferential - is the most useful marker of LV relaxation and filling pressure. Methods and Results: We conducted a prospective multicenter study and compared the correlation of tissue Doppler-and STE-derived parameters with the time constant of LV pressure decay (tau) and LV mean diastolic pressure (MDP) in 77 patients. The correlation of early-diastolic mitral annular velocity (e') with t was weak (r=-0.32, P<0.01), and that of peak longitudinal strain (LS) was the strongest (r=-0.45, P<0.001) among the STE-derived parameters. There was a modest correlation between LVMDP and the ratio of early-diastolic inflow velocity (E) to e' (E/e') (r=0.50, P<0.001). In contrast, the ratio of E to LS (E/LS) correlated strongly with LVMDP (r=0.70, P<0.001). The correlation of E/LS with LVMDP was significantly better than that for E/e' (P<0.01). Receiver-operating characteristic analysis showed that E/LS had the largest area under the curve for distinguishing elevated LVMDP (E/LS 0.86, E/e' 0.74, E/A 0.67). Conclusions: STE-derived longitudinal parameters correlated well with LV relaxation and filling pressure. In particular, E/LS could be more accurate than E/e' for estimating LV filling pressure.

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Prognostic implication of relative regional strain ratio in cardiac amyloidosis

Alpana Senapati, Brett W. Sperry, Justin L. Grodin, Kenya Kusunose, Paaladinesh Thavendiranathan, Wael Jaber, Patrick Collier, Mazen Hanna, Zoran B. Popovic, Dermot Phelan

HEART ( BMJ PUBLISHING GROUP )  102 ( 10 ) 748 - 754   2016.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Objective Cardiac amyloidosis (CA) is a rapidly progressive disease that portends poor prognosis. Our objective was to evaluate the prognostic impact of relative regional strain ratio (RRSR, a measure of the relative apical sparing of longitudinal strain (LS)) in CA. Methods This is a retrospective study evaluating 97 patients with CA from 2004 to 2013. Patients were included if they met criteria for CA based on endomyocardial biopsy or advanced imaging criteria coupled with either extracardiac biopsy or genetic analysis. Baseline clinical and imaging data were collected and compared between light-chain amyloidosis (AL) (n=59) and transthyretin amyloidosis (ATTR) (n=38) subtypes. RRSR was defined as the average apical LS divided by the sum of the average mid and basal LS values. A Cox proportional hazards model was used to assess the effects of clinical and echocardiographic characteristics, including RRSR, on the outcome of time to death or heart transplantation. Results Despite younger age, the AL subtype had a statistically significant association with the composite outcome as compared with ATTR (p=0.022). Log-transformed RRSR was independently associated with the composite outcome at 5 years (HR 2.45 (1.36 to 4.40), p=0.003). Patients with low ejection fraction and high RRSR had the worst prognosis. In multivariable analysis, RRSR remained predictive of the primary outcome (p=0.018). Addition of covariates related to systolic function (global LS and ejection fraction) to the model attenuated this effect. Conclusions High RRSR is adversely prognostic in patients with cardiac amyloid. This novel tool is both diagnostic and prognostic and may have implications in management and suitability for treatment.

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Noninvasive Quantitative Tissue Characterization of Carotid Plaques Using Color-Coded Mapping Based on Ultrasound Integrated Backscatter.

Bando M, Yamada H, Kusunose K, Fukuda D, Amano R, Tamai R, Torii Y, Hirata Y, Nishio S, Satomi J, Nagahiro S, Sata M

JACC. Cardiovascular imaging ( ELSEVIER SCIENCE INC )  9 ( 5 ) 625 - 627   2016.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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COMPARISON OF RIGHT VENTRICULAR GLOBAL LONGITUDINAL STRAIN BETWEEN VENDER-DEPENDENT AND VENDER-INDEPENDENT TWO-DIMENSIONAL SPECKLE TRACKING SOFTWARE

Seno Hiromitsu, Kusunose Kenya, Yamada Hirotsugu, Saijo Yoshihito, Nishio Susumu, Hirata Yukina, Ise Takayuki, Yamaguchi Koji, Yagi Shusuke, Soeki Takeshi, Wakatsuki Tetsuzo, Masataka Sata

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY   67 ( 13 ) 1781   2016.04 [ Peer Review Accepted ]

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

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Effects of Transthoracic Echocardiographic Simulator Training on Performance and Satisfaction in Medical Students

Kenya Kusunose, Hirotsugu Yamada, Rino Suzukawa, Yukina Hirata, Masami Yamao, Takayuki Ise, Shusuke Yagi, Masashi Akaike, Masataka Sata

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY ( MOSBY-ELSEVIER )  29 ( 4 ) 375 - 377   2016.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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m Prognostic Implications of Non-Invasive Vascular Function Tests in High-Risk Atherosclerosis Patients

Kenya Kusunose, Mitsuyo Sato, Hirotsugu Yamada, Yoshihito Saijo, Mika Bando, Yukina Hirata, Susumu Nishio, Shuji Hayashi, Masataka Sata

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  80 ( 4 ) 1034 - 1040   2016.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background: The aim of this study was to assess the role of clinically available vascular function tests as predictors of cardiovascular events and decline in kidney function. Methods and Results: One hundred and fourteen patients who had at least 2 cardiovascular risk factors were recruited for vascular function assessment including ankle-brachial blood pressure index (ABI), brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI) and flow-mediated vasodilatation (%FMD). During a median period of 51 months, 35 patients reached the primary endpoint (29 cardiovascular events and 6 cardiac deaths), and 30 patients reached the secondary endpoint (decline in kidney function: defined as a 5% per year decline of estimated glomerular filtration rate). In sequential Cox models, a model on the basis of the Framingham risk score, hemoglobin, and high-sensitivity C-reactive protein (chi-squared, 16.6) was improved by the ABI (chisquared: 21.5; P=0.047). The baPWV (hazard ratio: 1.42 per 1 SD increase; P=0.025) and the CAVI (hazard ratio: 1.52 per 1 SD increase; P=0.040) were associated with the secondary endpoint. The %FMD was only slightly associated with the primary and secondary endpoints. Conclusions: Both ABI and baPWV are significantly associated with future cardiovascular events in high-risk patients with cardiovascular disease. The predictive capabilities of these parameters are greater than that of other parameters in this cohort.

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Erratum: Relationship between right ventricular longitudinal strain, invasive hemodynamics, and functional assessment in pulmonary arterial hypertension (Korean Circulation Journal (2015) 45 (398-407) DOI: 10.4070/kcj.2015.45.5.398)

Jae-Hyeong Park, Kenya Kusunose, Deborah H. Kwon, Margaret M. Park, James D. Thomas, Richard A. Grimm, Brian P. Griffin, Thomas H. Marwick, Zoran B. Popovic

Korean Circulation Journal ( Korean Society of Circulation )  46 ( 2 ) 273   2016.03 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Rest and exercise echocardiography for early detection of pulmonary hypertension

Kenya Kusunose, Hirotsugu Yamada

Journal of Echocardiography ( Springer Tokyo )  14 ( 1 ) 2 - 12   2016.03 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Early detection of pulmonary hypertension (PH) is essential to ensure that patients receive timely and appropriate treatment for this progressive disease. Rest and exercise echocardiography has been used to screen patients in an attempt to identify early stage PH. However, current PH guidelines recommend against exercise tests because of the lack of evidence. We reviewed previous studies to discuss the current standpoint concerning rest and exercise echocardiography in PH. Around 20 exercise echocardiography studies were included to assess the cutoff value for exercise-induced pulmonary hypertension (EIPH). Approximately 40 exercise echocardiography studies were also included to evaluate the pulmonary artery pressure-flow relationship as assessed by the slope of the mean pulmonary artery pressure and cardiac output (ΔmPAP/ΔQ). There were several EIPH and ΔmPAP/ΔQ reference values in individuals with pulmonary vascular disease. We believed that assessing the ΔmPAP/ΔQ makes sense from a physiological standpoint, and the clinical value should be confirmed in future studies. Exercise echocardiography is an appealing alternative in PH. Further studies are needed to assess the prognostic value of the pulmonary artery pressure-flow relationship in high-risk subjects.

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Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension (vol 45, pg 398, 2015)

Jae-Hyeong Park, Kenya Kusunose, Deborah H. Kwon, Margaret M. Park, James D. Thomas, Richard A. Grimm, Brian P. Griffin, Thomas H. Marwick, Zoran B. Popovic

KOREAN CIRCULATION JOURNAL ( KOREAN SOC CARDIOLOGY )  46 ( 2 ) 273 - 273   2016.03 [ Peer Review Accepted ]

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

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Vegetation in the coronary sinus that concealed the presence of a coronary arteriovenous fistula in a patient with infectious endocarditis

Akira Takashima, Shusuke Yagi, Koji Yamaguchi, Eri Takagi, Tamotsu Kanbara, Hirohisa Ogawa, Takayuki Ise, Kenya Kusunose, Takeshi Tobiume, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Tetsuya Kitagawa, Masataka Sata

INTERNATIONAL JOURNAL OF CARDIOLOGY ( ELSEVIER IRELAND LTD )  207   266 - 268   2016.03 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Effects of the Addition of Eicosapentaenoic Acid to Strong Statin Therapy on Inflammatory Cytokines and Coronary Plaque Components Assessed by Integrated Backscatter Intravascular Ultrasound

Toshiyuki Niki, Tetsuzo Wakatsuki, Koji Yamaguchi, Yoshio Taketani, Hiroyasu Oeduka, Kenya Kusunose, Takayuki Ise, Takashi Iwase, Hirotsugu Yamada, Takeshi Soeki, Masataka Sata

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  80 ( 2 ) 450 - 460   2016.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background: The effects of eicosapentaenoic acid (EPA) on coronary artery disease have been previously reported; however, those of the addition of EPA to strong statins on coronary plaque components and local inflammatory cytokines are not known. Methods and Results: A total of 95 patients who had been treated with strong statin for at least 6 months were randomized into 2 groups: an EPA group (additional treatment with EPA at 1,800 mg/day, n=48) or a control group (no additional treatment, n=47), for 6 months. The tissue characteristics of target coronary plaque in each patient were analyzed using IB-IVUS before and after treatment. We also measured plasma levels of inflammatory cytokines sampled in the coronary sinus (CS) and peripheral vein. A significant reduction in lipid volume (18.5+/-1.3 to 15.0+/-1.5 mm(3), P=0.007) and a significant increase in fibrous volume (22.9+/-0.8 to 25.6+/-1.1 mm(3), P=0.01) were observed in IB-IVUS image analyses in the EPA group, but no significant changes in the plaque components in the control group. CS levels of pentraxin 3 and monocyte chemoattractant protein-1 were lower after than before treatment with EPA (3.3+/-2.1 to 2.6+/-1.2 ng/ml, 120.4+/-26.2 to 110.2+/-26.8 pg/ml, P=0.015 and P=0.008, respectively); however, there were no significant changes in those inflammatory cytokines between pre-and post-treatment in the control group. Conclusions: The addition of EPA was associated with reduced lipid volume in coronary plaques and decreased inflammatory cytokines.

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Left Ventricular Lipomatous Hamartoma Mimicking a Calcified Amorphous Tumor

Yuta Torii, Hirotsugu Yamada, Susumu Matsukuma, Susumu Nishio, Kenya Kusunose, Miho Abe, Masataka Sata

CIRCULATION ( LIPPINCOTT WILLIAMS & WILKINS )  133 ( 8 ) E408 - E410   2016.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Supplemental Digital Content is available in the text.

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Comparison of Tricuspid Annular Plane Systolic Excursion in Patients With Atrial Fibrillation Versus Sinus Rhythm

Yuta Torii, Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Yukina Hirata, Rie Amano, Masami Yamao, Mika Bando, Shuji Hayashi, Masataka Sata

AMERICAN JOURNAL OF CARDIOLOGY ( EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC )  117 ( 2 ) 226 - 232   2016.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Echocardiography now plays a central guiding role in the management of patients with atrial fibrillation (AF). However, the current guidelines mention little about the presence AF during the assessment of echocardiographic variables in the clinical setting. AF itself may impact on tricuspid annular plane systolic excursion (TAPSE) as a right ventricular systolic function compared with sinus rhythm (SR). The aim of this study was to compare and assess the echocardiographic parameters including TAPSE in patients with AF and SR. From January 1, 2013, to September 30, 2014, patients with AF without any cardiovascular disease were retrospectively evaluated using echocardiography. Age-, gender-, and left ventricular ejection fraction matched patients with SR were selected from our database on the basis of a comprehensive history, physical examination, and echocardiographic findings. During the study period, we identified 239 patients with AF (74 +/- 9 years; 65% men) and without any cardiac disease who underwent echocardiography. We also included 281 patients in the SR group (74 +/- 8 years; 67% men). In all study subjects, TAPSE in AF was smaller than in SR regardless of age (17 +/- 3 vs 20 +/- 3 mm, p <0.001). In the stepwise multiple regression model, TAPSE was strongly associated with the presence of AF (standardized beta = -0.362, p <0.001) and stroke volume index (standardized beta = 0.173, p <0.001) after adjustment for age, gender, heart rate, left ventricular ejection fraction, and tricuspid regurgitant grade. In conclusions, patients with AF had lower TAPSE than those with SR regardless of age. When we assess TAPSE in the clinical setting, we must pay attention to the presence of AF. (C) 2016 Elsevier Inc. All rights reserved.

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Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Strain in Patients With Significant Aortic Stenosis

Andrew Goodman, Kenya Kusunose, Zoran B. Popovic, Roosha Parikh, Tyler Barr, Joseph F. Sabik, L. Leonardo Rodriguez, Lars G. Svensson, Brian P. Griffin, Milind Y. Desai

JOURNAL OF THE AMERICAN HEART ASSOCIATION ( WILEY-BLACKWELL )  5 ( 1 )   2016.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background-In aortic stenosis (AS), symptoms and left ventricular (LV) dysfunction represent a later disease state, and objective parameters that identify incipient LV dysfunction are needed. We sought to determine prognostic utility of brain natriuretic peptide (BNP) and left ventricular global longitudinal strain (LV-GLS) in patients with aortic valve area < 1.3 cm(2). Methods and Results-Five-hundred and thirty-one patients between January 2007 and December 2008 with aortic valve area < 1.3 cm(2) (86% with aortic valve area <= 1.1 cm(2)) and left ventricular ejection fraction = 50% who had BNP drawn = 90 days from initial echo were included. Society of Thoracic Surgeons (STS) score and mortality were recorded. Mean STS score, glomerular filtration rate, and median BNP were 11 +/- 5, 73 +/- 35 mL/min per 1.73 m, and 141 (60-313) pg/mL, respectively; 78% were in New York Heart Association class >= II. Mean LV-stroke volume index (LV-SVI) and LV-GLS were 39 +/- 10 mL/m(2) and -13.9 +/- 3%. At 4.7 +/- 2 years, 405 patients (76%) underwent aortic valve replacement; 161 died (30%). On multivariable survival analysis, age (hazard ratio [HR] 1.46), New York Heart Association class (HR 1.27), coronary artery disease (HR 1.72), decreasing glomerular filtration rate (HR 1.15), increasing BNP (HR 1.16), worsening LV-GLS (HR 1.13) and aortic valve replacement (time dependent) (HR 0.34) predicted survival (all P< 0.01). For mortality, the c-statistic incrementally increased as follows (all P< 0.01): STS score (0.60 [0.58-0.64]), STS score+ BNP (0.67 [0.62-0.70]), and STS score+ BNP+ LV-GLS (0.74 [0.68-0.78]). Conclusions-In normal LVEF patients with significant aortic stenosis, BNP and LV-GLS provide incremental (additive not duplicative) prognostic information over established predictors, suggesting that both play a synergistic role in defining outcomes.

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Left Atrial Size and Function in a Canine Model of Chronic Atrial Fibrillation and Heart Failure

Adam Goldberg, Kenya Kusunose, Salima Qamruddin, L. Leonardo Rodriguez, Todor N. Mazgalev, Brian P. Griffin, David R. Van Wagoner, Youhua Zhang, Zoran B. Popovic

PLOS ONE ( PUBLIC LIBRARY SCIENCE )  11 ( 1 ) e0147015 - e0147015   2016.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background Our aim was to assess how atrial fibrillation (AF) induction, chronicity, and RR interval irregularity affect left atrial (LA) function and size in the setting of underlying heart failure (HF), and to determine whether AF effects can be mitigated by vagal nerve stimulation (VNS). Methods HF was induced by 4-weeks of rapid ventricular pacing in 24 dogs. Subsequently, AF was induced and maintained by atrial pacing at 600 bpm. Dogs were randomized into control (n = 9) and VNS (n = 15) groups. In the VNS group, atrioventricular node fat pad stimulation (310 mu s, 20 Hz, 3-7 mA) was delivered continuously for 6 months. LA volume and LA strain data were calculated from bi-weekly echocardiograms. Results RR intervals decreased with HF in both groups (p = 0.001), and decreased further during AF in control group (p = 0.014), with a non-significant increase in the VNS group during AF. LA size increased with HF (p<0.0001), with no additional increase during AF. LA strain decreased with HF (p = 0.025) and further decreased after induction of AF (p = 0.0001). LA strain decreased less (p = 0.001) in the VNS than in the control group. Beat-by-beat analysis showed a curvilinear increase of LA strain with longer preceding RR interval, (r = 0.45, p<0.0001) with LA strain 1.1% higher (p = 0.02) in the VNS-treated animals, independent of preceding RR interval duration. The curvilinear relationship between ratio of preceding and pre-preceding RR intervals, and subsequent LA strain was weaker, (r = 0.28, p = 0.001). However, VNS-treated animals again had higher LA strain (by 2.2%, p = 0.002) independently of the ratio of preceding and pre-preceding RR intervals. Conclusions In the underlying presence of pacing-induced HF, AF decreased LA strain, with little impact on LA size. LA strain depends on the preceding RR interval duration.

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Pulmonary embolism due to right atrial free-floating thrombus during echocardiographic examination: a case of a pulmonary saddle thrombus

Mika Bando, Hirotsugu Yamada, Kenya Kusunose, Shuji Hayashi, Yuriko Takagawa, Yoshihito Saijo, Susumu Nishio, Kozue Ogasawara, Masataka Sata

Journal of Echocardiography ( Springer Tokyo )  13 ( 4 ) 145 - 147   2015.12 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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A 69-year-old female with polymyositis was referred to our hospital with a chief complaint of dyspnea. Transthoracic echocardiography showed right ventricular overloading. In addition to two-dimensional echocardiography, observation of the abnormal free-floating string-like mass by three-dimensional echocardiography provided superior visualization of the features of the mass which protruded into the right ventricle across the tricuspid valve during diastole. These findings enabled us to confirm the diagnosis of venous thrombus. The thrombus disappeared during the echocardiographic examination. Multidetector-row computed tomography showed a string-like thrombus across the bifurcation of the main pulmonary artery. Anticoagulation therapy was initiated with heparin and warfarin, and fondaparinux was started on the fourth day. Three-dimensional echocardiography was useful in characterizing the motion and extent of the thrombus.

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Reduced ratio of eicosapentaenoic acid and docosahexaenoic acid to arachidonic acid is associated with early onset of acute coronary syndrome (vol 14, 111, 2015)

Shusuke Yagi, Ken-ichi Aihara, Daiju Fukuda, Akira Takashima, Mika Bando, Tomoya Hara, Sachiko Nishimoto, Takayuki Ise, Kenya Kusunose, Koji Yamaguchi, Takeshi Tobiume, Takashi Iwase, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Michio Shimabukuro, Masashi Akaike, Masataka Sata

NUTRITION JOURNAL ( BIOMED CENTRAL LTD )  14   121   2015.12 [ Peer Review Accepted ]

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

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: Combination of Clinical, Electrocardiographic and Echocardiographic Parameters Predict the Onset of Atrial Fibrillation

Soeki Takeshi, Bando Sachiko, Matsuura Tomomi, Tobiume Takeshi, Uematsu Etsuko, Kusunose Kenya, Ise Takayuki, Yamaguchi Koji, Yagi Shusuke, Fukuda Daiju, Yamada Hirotsugu, Wakatsuki Tetsuzo, Shimabukuro Michio, Sata Masataka

CIRCULATION   132   2015.11 [ Peer Review Accepted ]

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

Clinical Utility of Echocardiographic Epicardial Adipose Tissue Thickness Measured Using a High-frequency Linear Probe in Patients With Coronary Artery Disease

Hirata Yukia, Yamada Hirotsugu, Kusunose Kenya, Nishio Susumu, Bando Mika, Yamaguchi Koji, Iwase Takashi, Soeki Takeshi, Wakatsuki Tetsuzo, Sata Masataka

CIRCULATION   132   2015.11 [ Peer Review Accepted ]

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