論文 - 楠瀬　賢也

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年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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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年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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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年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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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年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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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年12月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

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急激な弁破壊を認めたメチシリン感受性表皮ブドウ球菌による感染性心内膜炎の一例

瀬野 弘光, 山崎 宙, 八木 秀介, 楠瀬 賢也, 伊勢 孝之, 山口 浩二, 山田 博嗣, 添木 武, 若槻 哲三, 佐田 政隆, 黒部 裕嗣, 高森 信行

四国医学雑誌 ( 徳島医学会 )  71 ( 5-6 ) 170 - 170   2015年12月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

: 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年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

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年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

Atrial Late Potentials and Atrial Substrate Remodeling in Patients With Atrial Fibrillation

Bando Sachiko, Soeki Takeshi, Matsuura Tomomi, Tobiume Takeshi, Ise Takayuki, Kusunose Kenya, Yamaguchi Koji, Yagi Shusuke, Yamada Hirotsugu, Wakatsuki Tetsuzo, Sata Masataka

CIRCULATION   132   2015年11月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

3D Transthoracic Echocardiography Provides Accurate Cross-Sectional Area of the RV Outflow Tract

Naoko Sawada, Hirotsugu Yamada, Kenya Kusunose, Shuji Hayashi, Takashi Lwase, Masataka Sata

JACC-CARDIOVASCULAR IMAGING ( ELSEVIER SCIENCE INC )  8 ( 11 ) 1343 - 1345   2015年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Characteristics and Outcomes of Patients With Severe Bioprosthetic Aortic Valve Stenosis Undergoing Redo Surgical Aortic Valve Replacement

Peyman Naji, Brian P. Griffin, Joseph F. Sabik, Kenya Kusunose, Fadi Asfahan, Zoran B. Popovic, L. Leonardo Rodriguez, Bruce W. Lytle, Richard A. Grimm, Lars G. Svensson, Milind Y. Desai

CIRCULATION ( LIPPINCOTT WILLIAMS & WILKINS )  132 ( 21 ) 1953 - 1960   2015年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background With improved event-free survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. We sought to (1) identify of the characteristics of patients with severe bioprosthetic PAS undergoing redo AVR, and (2) assess the outcomes of these patients, along with factors associated with adverse outcomes. Methods and Results We studied 276 patients with severe bioprosthetic PAS (6416 years, 58% men) who underwent redo-AVR between 2000 and 2012 (excluding mechanical PAS, severe other valve disease, and transcatheter AVR). Society of Thoracic Surgeons score was calculated. Severe PAS was defined as AV area <0.8 cm(2), mean AV gradient 40 mmHg, or dimensionless index <0.25. A composite outcome of death and congestive heart failure admission was recorded. Mean Society of Thoracic Surgeons score and mean AV gradients were 8 +/- 8 and 53 +/- 17 mmHg, whereas 28% had >II+ aortic regurgitation. Only 39% had an isolated redo AVR, the rest were combination surgeries (coronary bypass and/or aortic surgeries). At 4.2 +/- 3 years, 64 (23%) patients met the composite end point (48 deaths and 19 congestive heart failure admissions, 2.5% 30-day deaths). On multivariable Cox survival analysis, higher Society of Thoracic Surgeons score (hazard ratio, 1.35), higher grades of aortic regurgitation (hazard ratio, 1.29), and higher right ventricular systolic pressure (hazard ratio, 1.3) were associated with worse longer-term outcomes (all P<0.01). Conclusions At an experienced center, in patients with severe bioprosthetic PAS undergoing redo AVR, the majority undergo combination surgeries but have excellent outcomes.

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Clinical Utility of Measuring Epicardial Adipose Tissue Thickness with Echocardiography Using a High-Frequency Linear Probe in Patients with Coronary Artery Disease

Yukina Hirata, Hirotsugu Yamada, Kenya Kusunose, Takashi Iwase, Susumu Nishio, Shuji Hayashi, Mika Bando, Rie Amano, Koji Yamaguchi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY ( MOSBY-ELSEVIER )  28 ( 10 ) 1240 - +   2015年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: The relationship between epicardial adipose tissue (EAT) and coronary artery disease (CAD) has recently attracted a great deal of attention in the medical community. The objective of this study was to determine whether measuring EAT thickness in the anterior interventricular groove (AIG) using echocardiography is feasible and whether this index can be a marker of CAD. Methods: A total of 311 patients (mean age, 676 11 years; 208 men) who underwent coronary angiography between December 2011 and December 2013 were prospectively enrolled. EAT-AIG thickness and EAT thickness on the free wall of the right ventricle (RV) were measured in systole using a high-frequency linear probe. Seventy-one patients who underwent multidetector-row computed tomography were enrolled to validate the method for measuring EAT thickness using echocardiography. Subjects were divided into two groups, those with and without significant coronary stenosis, on the basis of findings on coronary angiography (>= 75% luminal narrowing). Results: EAT-AIG thickness measured using echocardiography was validated by computed tomography. EAT-AIG thickness was strongly correlated with EAT volume (r = 0.714, P < .001). The CAD group had thicker EAT-AIG than the non-CAD group (8.3 +/- 3.0 vs 6.3 +/- 2.5 mm, P < .001). EAT-RV thickness was greater in the CAD group than in the non-CAD group (5.0 +/- 2.1 vs 4.4 +/- 2.3 mm, P = .009) as well. The area under the curve on receiver operating characteristic curve analysis of EAT-AIG thickness for predicting CAD was 0.704, which was higher than the EAT-RV thickness. Conclusions: Measuring EAT thickness using echocardiography with a high-frequency linear probe was validated with computed tomography. EAT-AIG was thicker in the CAD group than in the non-CAD group, as was EAT-RV thickness. This noninvasive index may have potential as a diagnostic marker for predicting coronary atherosclerosis.

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Successful Surgical Repair of Aged Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connection: A Case Report

Kadota Muneyuki, Ise Takayuki, Yagi Shusuke, Kusunose Kenya, Kinoshita Hajime, Kurobe Hirotsugu, Yamada Hirotsugu, Soeki Takeshi, Wakatsuki Tetsuzo, Sata Masataka

JOURNAL OF CARDIAC FAILURE   21 ( 10 ) S185   2015年10月 [ 査読有り ]

掲載種別: 研究論文（その他学術会議資料等）

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Reduced ratio of eicosapentaenoic acid and docosahexaenoic acid to arachidonic acid is associated with early onset of acute coronary syndrome

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 ( No.1 ) 111 - 111   2015年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: The hospitalization rate for acute coronary syndrome (ACS) for people aged <= 50 has remained stable over the past decade. Increased serum levels of n-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are associated with a decreased incidence of cardiovascular events and mortality in older patients; however, it is currently unknown whether reduced serum levels of n-3 PUFAs is also a risk factor for ACS in patients aged <= 50 years. Methods and results: We retrospectively reviewed 102 (male/female 73/29) Japanese ACS patients whose serum levels of EPA/arachidonic acid (AA) and DHA/AA were evaluated on admission. The EPA/AA ratio was the lowest in patients aged <= 50 compared to patients aged 51-74 and >= 75. Pearson correlation analysis showed that early ACS onset was associated with low EPA/AA and DHA/AA ratios, and multiple regression analysis determined that decreased ratios of EPA/AA and DHA/AA, and male sex, current smoker status, increased body mass index and triglyceride levels, independently correlated with early ACS onset. Conversely, low-density and high-density lipoproteins, glycated hemoglobin, and hypertension did not correlate with early ACS onset. Subgroup analyses of male patients revealed that decreased ratios of EPA/AA and DHA/AA independently correlated with early ACS onset. Conclusion: Decreased EPA/AA and DHA/AA ratios may be risk factors for early onset of ACS, suggesting that reduced EPA/AA and DHA/AA may represent targets for preventing ACS in Japanese young people.

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Echocardiographic screening for congenital heart disease in 8819 children: A report from local community events for children's healthcare

Susumu Nishio, Kenya Kusunose, Hirotsugu Yamada, Masami Yamao, Yukina Hirata, Kazuhiro Mori, Suguru Matsuoka, Masataka Sata

JOURNAL OF CARDIOLOGY ( ELSEVIER SCIENCE BV )  66 ( 3-4 ) 315 - 319   2015年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: We had the opportunity to perform echocardiographic screening of children at local community events for children's healthcare sponsored by the prefectural government. The aim of this study was to assess the utility of echocardiographic screening by measuring the prevalence of congenital heart disease (CHD) and abnormal findings in children without history of diagnosed CHD. Methods: Subjects consisted of 8819 infants and preschool children (1 month to 6 years) who underwent echocardiographic examination at public events from 2001 to 2013. Children with known CHD were excluded. Results: We performed echocardiographic screening on 752 (range: 464-993) children at each event. At a total of 12 events, subjects consisted of 3175 infants less than one year (36%), 2292 one-year-olds (26%), 1058 two-year-olds (12%), 794 three-year-olds (9%), and other children up to age six years. We identified echocardiographic abnormalities in 137 children (15.5/1000 subjects), and 89 children (10.1/1000 subjects) were diagnosed with CHD. The prevalence of an echocardiographic abnormality did not change over the 12-year period (Kendall's tau = -0.272, p = 0.19). Conclusions: CHD which could not be identified by prenatal echocardiography and neonatal auscultation could be detected in a substantial number of young children by echocardiographic screening. Echocardiographic screening may be useful for early diagnosis of CHD. However, our study is based on cross-sectional data without follow-up. Larger prospective studies are needed to verify the utility of echocardiographic screening with follow-up data in this cohort. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension

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

KOREAN CIRCULATION JOURNAL ( KOREAN SOC CARDIOLOGY )  45 ( 5 ) 398 - 407   2015年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background and Objectives: Right ventricular longitudinal strain (RVLS) is a new parameter of RV function. We evaluated the relationship of RVLS by speckle-tracking echocardiography with functional and invasive parameters in pulmonary arterial hypertension (PAH) patients. Subjects and Methods: Thirty four patients with World Health Organization group 1 PAH (29 females, mean age 45 +/- 13 years old). RVLS were analyzed with velocity vector imaging. Results: Patients with advanced symptoms {New York Heart Association (NYHA) functional class III/IV} had impaired RVLS in global RV (RVLSglobal, -17 +/- 5 vs. -12 +/- 3%, p<0.01) and RV free wall (RVLSFW, -19 +/- 5 vs. -14 +/- 4%, p<0.01 to NYHA class I/II). Baseline RVLSglobal and RVLSFW showed significant correlation with 6-minute walking distance (r=-0.54 and r=-0.57, p<0.01 respectively) and logarithmic transformation of brain natriuretic peptide concentration (r=0.65 and r=0.65, p<.01, respectively). These revealed significant correlations with cardiac index (r=-0.50 and r=-0.47, p<0.01, respectively) and pulmonary vascular resistance (PVR, r=0.45 and r=0.45, p=0.01, respectively). During a median follow-up of 33 months, 25 patients (74%) had follow-up examinations. Mean pulmonary arterial pressure (mPAP, 54 +/- 13 to 46 +/- 16 mmHg, p=0.03) and PVR (11 +/- 5 to 6 +/- 2 wood units, p<0.01) were significantly decreased with pulmonary vasodilator treatment. RVLSglobal (-12 +/- 5 to -16 +/- 5%, p<0.01) and RVLSFW (-14 +/- 5 to -18 +/- 5%, p<0.01) were significantly improved. The decrease of mPAP was significantly correlated with improvement of RVLSglobal (r=0.45, p<0.01) and RVLSFW (r=0.43, p<0.01). The PVR change demonstrated significant correlation with improvement of RVLSglobal (r=0.40, p<0.01). Conclusion: RVLS correlates with functional and invasive hemodynamic parameters in PAH patients. Decrease of mPAP and PVR as a result of treatment was associated with improvement of RVLS.

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Impact of Indoxyl Sulfate, a Uremic Toxin, on Non-Culprit Coronary Plaque Composition Assessed on Integrated Backscatter Intravascular Ultrasound

Hiromu Yamazaki, Koji Yamaguchi, Takeshi Soeki, Tetsuzo Wakatsuki, Toshiyuki Niki, Yoshio Taketani, Atsunori Kitaoka, Kenya Kusunose, Takayuki Ise, Takeshi Tobiume, Shusuke Yagi, Takashi Iwase, Hirotsugu Yamada, Masataka Sata

CIRCULATION JOURNAL ( JAPANESE CIRCULATION SOC )  79 ( 8 ) 1773 - 1779   2015年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: Uremic toxin has emerged as an important determinant of cardiovascular risk. The aim of this study was to examine the relationship between serum uremic toxin and coronary plaque composition on integrated backscatter intravascular ultrasound (IB-IVUS). Methods and Results: IB-IVUS was performed in 47 patients with planned treatment for angina pectoris. Non-culprit intermediate plaque analyzed in this study had to be >5mm apart from the intervention site. 3-D IB-IVUS analysis was performed to determine percent lipid volume (LV) and fibrous volume (FV). We also measured serum uremic toxins (indoxyl sulfate [IS], asymmetric dimethylarginine [ADMA], and p-cresol [PC]). Glomerular filtration rate correlated with IS (r=-0.329, P=0.04), but did not correlate with ADMA or PC. Percent LV correlated with IS ( r=0.365, P=0.02), but did not correlate with ADMA or PC. Percent FV also correlated with IS (r=-0.356, P=0.03), but did not correlate with ADMA or PC. On multivariate regression, only IS was associated with percent LV (r=0.359, P=0.04) and percent FV (r=-0.305, P=0.04) independently of potentially confounding coronary risk factors. Conclusions: Among the uremic toxins, serum IS might be a novel useful biomarker to detect and monitor lipid-rich coronary plaque on IB imaging.

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Comparison of carotid plaque tissue characteristics in patients with acute coronary syndrome or stable angina pectoris: assessment by iPlaque, transcutaneous carotid ultrasonography with integrated backscatter analysis

Mika Bando, Hirotsugu Yamada, Kenya Kusunose, Daiju Fukuda, Rie Amano, Rina Tamai, Yuta Torii, Yukina Hirata, Susumu Nishio, Koji Yamaguchi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata

CARDIOVASCULAR ULTRASOUND ( BIOMED CENTRAL LTD )  13 ( No.1 ) 34 - 34   2015年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Background: The association of the tissue characteristics of carotid plaques with coronary artery disease has attracted interest. The present study compared the tissue characteristics of carotid plaques in patients with acute coronary syndrome (ACS) with those in patients with stable angina pectoris (SAP) using the iPlaque system, which is based on ultrasound integrated backscatter. Methods and results: Carotid ultrasound examinations were performed in 26 patients with ACS, and 38 age- and gender-matched patients with SAP. Neither plaque area nor maximal intima-media thickness differed significantly between the two groups. However, the average integrated backscatter value within the plaque was greater in the ACS patients than in the SAP patients. iPlaque analysis revealed that the percentage blue area (lipid pool) was greater in the ACS patients than in the SAP patients (43.4 +/- 11.2 vs 18.3 +/- 10.3 %, p < 0.0001), and that the percentage green area (fibrosis) was lower in the ACS than in the SAP patients (7.5 +/- 7.5 % vs 20.7 +/- 11.7 %, p < 0.0001). Conclusions: The lipid component of carotid plaques is greater in ACS patients than in SAP patients. Our iPlaque system provides a useful and feasible method for the tissue characterization of carotid plaques in the clinical setting.

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Prediction of Future Overt Pulmonary Hypertension by 6-Min Walk Stress Echocardiography in Patients With Connective Tissue Disease

Kenya Kusunose, Hirotsugu Yamada, Junko Hotchi, Mika Bando, Susumu Nishio, Yukina Hirata, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Jun Kishi, Masataka Sata

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY ( ELSEVIER SCIENCE INC )  66 ( 4 ) 376 - 384   2015年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND Early detection of pulmonary hypertension (PH) in connective tissue disease (CTD) is crucial to ensuring that patients receive timely treatment for this progressive disease. Exercise stress tests have been used to screen patients in an attempt to identify early-stage PH. Recent studies have described abnormal mean pulmonary artery pressure (mPAP)-cardiac output (Q) responses as having the potential to assess the disease state. OBJECTIVES This study hypothesized that pulmonary circulation pressure-flow relationships obtained by 6-min walk (6MW) stress echocardiography would better delineate differential progression of PH and predict development of PH during follow-up. METHODS We prospectively performed 6MW stress echocardiographic studies in 78 CTD patients (age 58 +/- 12 years; 9% male) at baseline and follow-up. All patients underwent yearly echocardiographic follow-up studies for up to 5 years. RESULTS During a median period of 32 months (range: 15 to 62 months), 16 patients reached the clinical endpoint of development of PH and none died during follow-up. PH was confirmed by right heart catheterization in all 16 patients (mPAP >= 25 mm Hg and pulmonary capillary wedge pressure <= 15 mm Hg). In a Cox proportional-hazards survival model, 6MW distance (hazard ratio [HR]: 0.99; p = 0.010), early diastolic tricuspid annulus motion velocity (HR: 0.79; p = 0.025), and Delta mPAP/Delta Q by 6MW stress (HR: 1.10; p = 0.005) were associated with development of PH. In sequential Cox models, a model on the basis of 6MW distance (chi-square, 6.6) was improved by Delta mPAP/Delta Q (chi-square: 14.4; p = 0.019). Using a receiver-operating characteristic curve, we found that the best cutoff value of Delta mPAP/Delta Q for predicting development of pulmonary hypertension was > 3.3 mm Hg/l/min. CONCLUSIONS The 6MW stress echocardiography noninvasively provides an incremental prognostic value of PH development in CTD. This is a single-center prospective cohort study. Larger multicenter studies are warranted to confirm this result. (C) 2015 by the American College of Cardiology Foundation.

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[Case Report; Successful treatment with methotrexate and low-dose corticosteroids for recurrent cardiac sarcoidosis].

Ise T, Takagi E, Iwase T, Kusunose K, Yamaguchi K, Yagi S, Yamada H, Soeki T, Wakatsuki T, Sata M

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine   104 ( 6 ) 1175 - 1179   2015年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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