Published Papers - Kusunose Kenya

Clinical, Electrocardiographic, and Echocardiographic Parameter Combination Predicts the Onset of Atrial Fibrillation.

Soeki T, Matsuura T, Tobiume T, Bando S, Matsumoto K, Nagano H, Uematsu E, Kusunose K, Ise T, Yamaguchi K, Yagi S, Fukuda D, Yamada H, Wakatsuki T, Shimabukuro M, Sata M

Circulation journal : official journal of the Japanese Circulation Society   82 ( 9 ) 2253 - 2258   2018.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: The ability to identify risk markers for new-onset atrial fibrillation (AF) is critical to the development of preventive strategies, but it remains unknown whether a combination of clinical, electrocardiographic, and echocardiographic parameters predicts the onset of AF. In the present study, we evaluated the predictive value of a combined score that includes these parameters. Methods and Results: We retrospectively studied 1,040 patients without AF who underwent both echocardiography and 24-h Holter electrocardiography between May 2005 and December 2010. During a median follow-up period of 68.4 months (IQR, 49.9-93.3 months), we investigated the incidence of new-onset AF. Of the 1,040 patients, 103 (9.9%) developed AF. Patients who developed AF were older than patients who did not. Total heart beats, premature atrial contraction (PAC) count, maximum RR interval, and frequency of sinus pause quantified on 24-h electrocardiography were associated with new-onset AF. LA diameter (LAD) on echocardiography was also associated with the development of AF. On multivariate Cox analysis, age ≥58 years, PAC count ≥80 beats/day, maximum RR interval ≥1.64 s, and LAD ≥4.5 cm were independently associated with the development of AF. The incidence rate of new-onset AF significantly increased as the combined score (i.e., the sum of the risk score determined using hazard ratios) increased. CONCLUSIONS: A combined score that includes age, PAC count, maximum RR interval, and LAD could help characterize the risk of new-onset AF.

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A clinical application of preload stress echocardiography for predicting future hemodynamic worsening in patients with early-stage heart failure.

西條 良仁, 山田 博胤, 楠瀬 賢也, 坂東 美佳, 西尾 進, 鳥居 裕太, 平田 有紀奈, 瀬野 弘光, 松浦 朋美, 伊勢 孝之, 飛梅 威, 山口 浩司, 八木 秀介, 添木 武, 若槻 哲三, 佐田 政隆

Echocardiography   35 ( 10 ) 1587 - 1595   2018.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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AIM: To improve the prognosis of patients with heart failure, risk stratification in their early stage is important. We assessed whether the change in transmitral flow (TMF) velocity pattern during preload augmentation can predict future hemodynamic worsening in early-stage heart failure patients with impaired relaxation TMF pattern. METHODS: We designed a prospective cohort study that included 155 consecutive patients with impaired relaxation (IR) pattern at rest. Preload stress echocardiography was achieved using leg-positive pressure (LPP), and changes in TMF pattern during the LPP was observed during baseline echocardiographic examination. The patients whose TMF pattern developed to pseudonormal (PN) pattern throughout the study period were classified into the change to PN group, and patients whose TMF pattern stayed in IR pattern were classified into the stay in IR group. RESULTS: The median follow-up period was 17 months. The average age was 68 ± 11 years old, and 97 patients (63%) were male. Among 155 patients, 27 were classified into the change to PN group. A Cox proportional hazard analysis confirmed that the change in the peak atrial systolic TMF velocity during the LPP (ΔA, hazard ratio = 0.58 per 1SD; 95% CI = 0.39-0.88, P = 0.010) was the powerful independent predictor of change into PN pattern. Kaplan-Meier analysis revealed that the patients with ΔA ≤ -7 cm/s had more likely to develop into PN pattern than patients with ΔA > -7 cm/s (P = 0.001). CONCLUSIONS: Evaluation of a response in TMF during the LPP might provide an incremental diagnostic value to detect future overt heart failure in patients with early-stage heart failure.

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Novel Echocardiographic Parameters in Patients With Aortic Stenosis and Preserved Left Ventricular Systolic Function Undergoing Surgical Aortic Valve Replacement.

Huded CP, Kusunose K, Shahid F, Goodman AL, Alashi A, Grimm RA, Gillinov AM, Johnston DR, Rodriguez LL, Popovic ZB, Sato, Kimi, Svensson LG, Griffin BP, Desai MY

Am J Cardiol.     2018.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

Reduced variability of visual left ventricular ejection fraction assessment with reference images: The Japanese Association of Young Echocardiography Fellows multicenter study.

Kenya Kusunose, Kentaro Shibayama, Hiroyuki Iwano, Masaki Izumo, Nobuyuki Kagiyama, Koji Kurosawa, Hirotsugu Mihara, Hiroki Oe, Tetsuari Onishi, Toshinari Onishi, Mitsuhiko Ota, Shunsuke Sasaki, Yumi Shiina, Hikaru Tsuruta, Hidekazu Tanaka

Journal of cardiology   72 ( 1 ) 74 - 80   2018.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Visual estimation of left ventricular ejection fraction (LVEF) is widely applied to confirm quantitative EF. However, visual assessment is subjective, and variability may be influenced by observer experience. We hypothesized that a learning session might reduce the misclassification rate. METHODS: Protocol 1: Visual LVEFs for 30 cases were measured by 79 readers from 13 cardiovascular tertiary care centers. Readers were divided into 3 groups by their experience: limited (1-5 years, n=28), intermediate (6-11 years, n=26), and highly experienced (12-years, n=25). Protocol 2: All readers were randomized to assess the effect of a learning session with reference images only or feedback plus reference images. After the session, 20 new cases were shown to all readers following the same methodology. To assess the concordance and accuracy pre- and post-intervention, each visual LVEF measurement was compared to overall average values as a reference. RESULTS: Experience affected the concordance in visual EF values among the readers. Groups with intermediate and high experience showed significantly better mean difference (MD), standard deviation (SD), and coefficient of variation (CV) than those with limited experience at baseline. The learning session with reference image reduced the MD, SD, and CV in readers with limited experience. The learning session with reference images plus feedback also reduced proportional bias. Importantly, the misclassification rate for mid-range EF cases was reduced regardless of experience. CONCLUSION: This large multicenter study suggested that a simple learning session with reference images can successfully reduce the misclassification rate for LVEF assessment.

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Prognostic Value of Frailty and Diastolic Dysfunction in Elderly Patients.

Kusunose K, Okushi Y, Yamada H, Nishio S, Torii Y, Hirata Y, Saijo Y, Ise T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M

Circulation journal : official journal of the Japanese Circulation Society   82 ( 8 ) 2103 - 2110   2018.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: High prevalence of frailty and of diastolic dysfunction (DD) in heart failure and high mortality in frail adults have been noted. We characterized frailty by quantifying differences on echocardiography, and assessed the added prognostic utility of frailty and DD grade in an elderly population. METHODS AND RESULTS: One hundred and ninety-one patients ≥65 years who had at least 1 cardiovascular risk factor were prospectively recruited for clinically indicated echocardiography at the present institute. Weight loss, exhaustion, and deficits in physical activity, gait speed, and handgrip strength were used to categorize patients as frail (≥3 features), intermediately frail (1 or 2 features), or non-frail (0 features). DD grade ≥2 was defined as severe. Frailty was associated with larger left atrial volume, smaller stroke volume, and worse DD grade after adjustment for age. In a period of 14 months, 29 patients (15%) had cardiovascular events. The addition of frailty score and severe DD significantly improved the prognostic power of a model containing male gender (model 1, male gender, χ2=6.4; model 2, model 1 plus frailty score, χ2=16.7, P=0.004; model 3, model 2 plus severe DD, χ2=25.5, P=0.015). CONCLUSIONS: Both frailty and DD grade were significantly associated with future cardiovascular events in an elderly population with preserved ejection fraction and ≥1 risk factor of cardiovascular disease.

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Clinical, Electrocardiographic, and Echocardiographic Parameter Combination Predicts the Onset of Atrial Fibrillation.

添木 武, 松浦 朋美, 飛梅 威, 坂東 佐知子, 松本 和久, H Nagano, E Uematsu, 楠瀬 賢也, 伊勢 孝之, 山口 浩司, 八木 秀介, 福田 大受, 山田 博胤, 若槻 哲三, 島袋 充生, 佐田 政隆

Circulation Journal   82 ( 9 ) 2253 - 2258   2018.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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The ability to identify risk markers for new-onset atrial fibrillation (AF) is critical to the development of preventive strategies, but it remains unknown whether a combination of clinical, electrocardiographic, and echocardiographic parameters predicts the onset of AF. In the present study, we evaluated the predictive value of a combined score that includes these parameters.Methods and Results:We retrospectively studied 1,040 patients without AF who underwent both echocardiography and 24-h Holter electrocardiography between May 2005 and December 2010. During a median follow-up period of 68.4 months (IQR, 49.9-93.3 months), we investigated the incidence of new-onset AF. Of the 1,040 patients, 103 (9.9%) developed AF. Patients who developed AF were older than patients who did not. Total heart beats, premature atrial contraction (PAC) count, maximum RR interval, and frequency of sinus pause quantified on 24-h electrocardiography were associated with new-onset AF. LA diameter (LAD) on echocardiography was also associated with the development of AF. On multivariate Cox analysis, age ?58 years, PAC count ?80 beats/day, maximum RR interval ?1.64 s, and LAD ?4.5 cm were independently associated with the development of AF. The incidence rate of new-onset AF significantly increased as the combined score (i.e., the sum of the risk score determined using hazard ratios) increased. A combined score that includes age, PAC count, maximum RR interval, and LAD could help characterize the risk of new-onset AF.

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Noninvasive Assessment of Preload Reserve Enhances Risk Stratification of Patients With Heart Failure With Reduced Ejection Fraction.

Kensuke Matsumoto, Akira Onishi, Hirotsugu Yamada, Kenya Kusunose, Makiko Suto, Yutaka Hatani, Hiroki Matsuzoe, Kazuhiro Tatsumi, Hidekazu Tanaka, Ken-Ichi Hirata

Circulation. Cardiovascular imaging   11 ( 5 ) e007160 - e007160   2018.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: The leg-positive pressure maneuver can safely and noninvasively apply preload stress without increase in total body fluid volume. The purpose of this study was to determine whether preload stress could be useful for risk stratification of patients with heart failure with reduced ejection fraction. METHODS AND RESULTS: For this study, 120 consecutive patients with heart failure with reduced ejection fraction were prospectively recruited. The stroke work index was estimated as product of stroke volume index and mean blood pressure, and the E/e' ratio was calculated to estimate ventricular filling pressure. The echocardiographic parameters were obtained both at rest and during leg-positive pressure stress. During the median follow-up period of 20 months, 30 patients developed adverse cardiovascular events. During preload stress, stroke work index increased significantly (from 3280±1371 to 3857±1581 mm Hg·mL/m2; P<0.001) along with minimal changes in ventricular filling pressure (E/e', from 16±10 to 17±9; P<0.05) in patients without cardiovascular events. However, patients with cardiovascular events showed impairment of Frank-Starling mechanism (stroke work index, from 2863±969 to 2903±1084 mm Hg·mL/m2; P=0.70) and a serious increase in E/e' ratio (from 19±11 to 25±14; P<0.001). Both the patients without contractile reserve and those without diastolic reserve exhibited worse event-free survival than the others (P<0.001). In a Cox proportional-hazards analysis, the changes in stroke work index (hazard ratio: 0.44 per 500 mm Hg·mL/m2 increase; P=0.001) and in E/e' (hazard ratio: 2.58 per 5-U increase; P<0.001) were predictors of cardiovascular events. CONCLUSION: Contractile reserve and diastolic reserve during leg-positive pressure stress are important determinants of cardiovascular outcomes for patients with heart failure with reduced ejection fraction.

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Prognostic Value of Frailty and Diastolic Dysfunction in Elderly Patients.

楠瀬 賢也, Y Okushi, 山田 博胤, 西尾 進, 鳥居 裕太, 平田 有紀奈, 西條 良仁, 伊勢 孝之, 山口 浩司, 八木 秀介, 添木 武, 若槻 哲三, 佐田 政隆

Circulation Journal   82 ( 8 ) 2103 - 2110   2018.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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High prevalence of frailty and of diastolic dysfunction (DD) in heart failure and high mortality in frail adults have been noted. We characterized frailty by quantifying differences on echocardiography, and assessed the added prognostic utility of frailty and DD grade in an elderly population. One hundred and ninety-one patients ?65 years who had at least 1 cardiovascular risk factor were prospectively recruited for clinically indicated echocardiography at the present institute. Weight loss, exhaustion, and deficits in physical activity, gait speed, and handgrip strength were used to categorize patients as frail (?3 features), intermediately frail (1 or 2 features), or non-frail (0 features). DD grade ?2 was defined as severe. Frailty was associated with larger left atrial volume, smaller stroke volume, and worse DD grade after adjustment for age. In a period of 14 months, 29 patients (15%) had cardiovascular events. The addition of frailty score and severe DD significantly improved the prognostic power of a model containing male gender (model 1, male gender, χ=6.4; model 2, model 1 plus frailty score, χ=16.7, P=0.004; model 3, model 2 plus severe DD, χ=25.5, P=0.015). Both frailty and DD grade were significantly associated with future cardiovascular events in an elderly population with preserved ejection fraction and ?1 risk factor of cardiovascular disease.

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Calcified Amorphous Tumorに対し腫瘍摘出術を行った一例

清水 郁子, 瀬野 弘光, Koji Yamaguchi, Kenya Kusunose, Hirotsugu Yamada, Tetsuzo Wakatsuki, Takeshi Soeki, Masataka Sata, Takashi Iwase, Hirotsugu Kurobe, Tetsuya Kitagawa

四国医学雑誌   74 ( 1-2 ) 84 - 84   2018.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

Local Thickness of Epicardial Adipose Tissue Surrounding the Left Anterior Descending Artery Is a Simple Predictor of Coronary Artery Disease - New Prediction Model in Combination With Framingham Risk Score.

Maimaituxun G, Shimabukuro M, Fukuda D, Yagi S, Hirata Y, Iwase T, Takao S, Matsuura T, Ise T, Kusunose K, Tobiume T, Yamaguchi K, Yamada H, Soeki T, Wakatsuki T, Harada M, Sata M

Circulation journal : official journal of the Japanese Circulation Society   82 ( 5 ) 1369 - 1378   2018.04 [ Peer Review Accepted ]

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

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Paclitaxel投与を併用した冠動脈形成術後の局所凝固療法への反応の差(Differential Response of Local Coagulation after Coronary Angioplasty with Paclitaxel)

山口 浩司, 若槻 哲三, 川端 豊, 伊藤 浩敬, 轟 貴史, 松浦 朋美, 伊勢 孝之, 楠瀬 賢也, 飛梅 威, 八木 秀介, 山田 博胤, 添木 武, 佐田 政隆

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   PJ022 - 1   2018.03 [ Peer Review Accepted ]

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

心血管系イベント予測のための上腕収縮期血圧左右差の至適カットオフ値の設定および検証(Development and Validation of Optimal Cut-off Value in inter-armsystolic Blood Pressure Difference for Prediction of Cardiovascular Events)

廣野 明, 楠瀬 賢也, 蔭山 徳人, 藤永 裕之, 佐田 政隆

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   PJ033 - 2   2018.03 [ Peer Review Accepted ]

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

栄養血管の増殖は新鮮遺体において冠動脈プラーク周囲の局所炎症と関連する(Growth of Vasa Vasorum is Associated with Local Inflammation around Coronary Plaque in Fresh Cadavers)

伊藤 浩敬, 若槻 哲三, 山口 浩司, 福田 大受, 川端 豊, 轟 貴史, 松浦 朋美, 伊勢 孝之, 楠瀬 賢也, 飛梅 威, 八木 秀介, 山田 博胤, 添木 武, 佐田 政隆

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   PJ007 - 3   2018.03 [ Peer Review Accepted ]

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

高血圧患者におけるL/N型カルシウム拮抗薬が蛋白尿およびangiotensin II-reninフィードバックに及ぼす効果(Effects of L-/N-type Calcium Channel Blocker on Proteinuria and Angiotensin II-renin Feedback in Hypertensive Patients)

川端 豊, 添木 武, 伊勢 孝之, 松浦 朋美, 楠瀬 賢也, 飛梅 威, 八木 秀介, 山口 浩司, 山田 博胤, 若槻 哲三, 佐田 政隆

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   PJ067 - 4   2018.03 [ Peer Review Accepted ]

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

Age-related changes in morphology of left atrial appendage in patients with atrial fibrillation.

Hirata Y, Kusunose K, Yamada H, Shimizu R, Torii Y, Nishio S, Saijo Y, Takao S, Soeki T, Sata M

The international journal of cardiovascular imaging   34 ( 2 ) 321 - 328   2018.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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The purpose of this study was to evaluate the relationship between age and frequency of left atrial appendage (LAA) morphology in patients with atrial fibrillation (AF) compared with sinus rhythm (SR). We enrolled 145 AF patients, and 199 SR patients for the control group without any cardiovascular disease. LAA volume index (LAAVi) and morphology were assessed by electrocardiogram-gated computed tomography angiography. LAA morphology was classified into "chicken wing" or "non-chicken wing" according to the previously described classification. There was no significant trend in frequency of non-chicken wing morphology among ages in the SR group (p = 0.36 for trend), whereas the frequency was negatively related to age in the AF group (p = 0.002 for trend). In multivariable logistic regression, age > 65 (odds ratio [OR] 0.42, p = 0.002) and duration of AF (OR 0.53, p = 0.010) and LAAVi (OR 0.62, p = 0.017) were independent factors of non-chicken wing LAA morphology in the AF group. LAA morphology is affected by age, especially in patients with AF. When we utilize non-chicken wing LAA morphology as a stroke risk factor in patients with AF, we should pay attention to their age.

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Provocation of clinically significant left ventricular outflow tract obstruction by postural change in patients with sigmoid septum

Yukina Hirata, Hirotsugu Yamada, Kenya Kusunose, Susumu Nishio, Yuta Torii, Yuki Horike, Masataka Sata

Journal of Echocardiography ( Springer Tokyo )  Vol.- ( No.- ) 1 - 2   2018.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events

Akira Hirono, Kenya Kusunose, Norihito Kageyama, Masayuki Sumitomo, Masahiro Abe, Hiroyuki Fujinaga, Masataka Sata

Journal of Cardiology ( Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) )  71 ( 1 ) 24 - 30   2018.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. Methods From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. Results During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, p = 0.005). The receiver operating characteristic curve revealed that 5 mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p &lt 0.001). In the validation cohort, the presence of a large IAD (IAD ≥5 mmHg) was significantly associated with the primary endpoint (p = 0.021). Conclusions IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5 mmHg.

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Predictors for the Treatment Effect of Sodium Glucose Co-transporter 2 Inhibitors in Patients with Type 2 Diabetes Mellitus

Shusuke Yagi, Ken-ichi Aihara, Takeshi Kondo, Kiyoe Kurahashi, Sumiko Yoshida, Itsuro Endo, Daiju Fukuda, Yutaka Nakaya, Kin-ichiro Suwaki, Takashi Takeji, Toshihiro Wada, Hotimah Masdan Salim, Saori Hama, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Koji Yamaguchi, Takeshi Tobiume, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Munehide Matsuhisa, Michio Shimabukuro, Masashi Akaike, Masataka Sata

Advances in Therapy ( Springer Healthcare )  35 ( 1 ) 124 - 134   2018.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Introduction: Predictors for the effect of sodium glucose co-transporter 2 (SGLT2) inhibitors at lowering hemoglobin A1c (HbA1c) levels in type 2 diabetes mellitus patients remain unclear. We therefore aimed to elucidate these predictors in type 2 diabetes patients after 3 months of SGLT2 treatment. Methods: A total of 302 consecutive type 2 diabetes patients who had been treated with SGLT2 inhibitors as monotherapy or add-on therapy to existing antidiabetic treatments were enrolled retrospectively. After excluding 27 patients whose HbA1c levels could not be evaluated 3 months after treatment, the glucose-lowering effects of SGLT2 inhibitors were assessed in 275 patients by measuring HbA1c levels before and 3 months after treatment. The predictors for changes in HbA1c levels after 3 months of treatment were evaluated. Results: SGLT2 inhibitor treatment for 3 months decreased HbA1c levels from 7.8 ± 1.2% to 7.4 ± 1.0% (p &lt  0.0001). A multiple regression analysis showed that the independent determinants for SGLT2 inhibitor treatment effect included decreased HbA1c levels after 1 month of treatment, high baseline HbA1c levels, and a high estimated glomerular filtration rate (eGFR). Conclusion: We show that type 2 diabetes patients who received the greatest glucose-lowering effect with SGLT2 inhibitor treatment were those with preserved renal function (high baseline eGFR) and high baseline HbA1c levels. Moreover, SGLT2 inhibitor treatment efficacy could be predicted by the patients’ initial response to treatment.

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Effect of the epicardial adipose tissue volume on the prevalence of paroxysmal and persistent atrial fibrillation

Kageyuki Oba, Minetaka Maeda, Gulinu Maimaituxun, Satoshi Yamaguchi, Osamu Arasaki, Daiju Fukuda, Shusuke Yagi, Yukina Hirata, Susumu Nishio, Takashi Iwase, Shoichiro Takao, Kenya Kusunose, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masafumi Harada, Hiroaki Masuzaki, Masataka Sata, Michio Shimabukuro

Circulation Journal ( Japanese Circulation Society )  82 ( 7 ) 1778 - 1787   2018 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background: Although increasing evidence suggests that epicardial adipose tissue volume (EATV) is associated with atrial fibrillation (AF), it is controversial whether there is a dose-response relationship of increasing EATV along the continuum of AF. We evaluated the effect of the EATV on the prevalence of paroxysmal AF (PAF) and persistent AF (PeAF) and the relationships with cardiac structure and functional remodeling. Methods and Results: Subjects who underwent multidetector computed tomography (MDCT) coronary angiography because of symptoms suggestive of coronary artery disease were divided into sinus rhythm (SR) (n=112), PAF (n=133), and PeAF (n=71) groups. The EATV index (EATV/body surface area, mL/m2) was strongly associated with the prevalence of PAF and PeAF on the model adjusted for known AF risk factors. The effect of the EATV index on the prevalence of PeAF, but not on that of PAF, was modified by the left atrial (LA) dimension, suggesting that extension of the LA dimension is related to EATV expansion in PeAF. The cutoff value of the EATV index for the prevalence was higher in PeAF than in PAF (64 vs. 55 mL/m2, P&lt 0.01). Conclusions: The EATV index is associated with the prevalence of PAF and PeAF, and its cutoff values are predictive for PAF and PeAF development independently of other AF risk factors.

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Local thickness of epicardial adipose tissue surrounding the left anterior descending artery is a simple predictor of coronary artery disease ― new prediction model in combination with framingham risk score ―

Gulinu Maimaituxun, Michio Shimabukuro, Daiju Fukuda, Shusuke Yagi, Yukina Hirata, Takashi Iwase, Shoichiro Takao, Tomomi Matsuura, Takayuki Ise, Kenya Kusunose, Takeshi Tobiume, Koji Yamaguchi, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Masafumi Harada, Masataka Sata

Circulation Journal ( Japanese Circulation Society )  82 ( 5 ) 1369 - 1378   2018 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background: Compared with global cardiac adiposity, the local accumulation of fat surrounding coronary arteries might have a more direct impact on coronary artery disease (CAD). Here, we compared the local epicardial adipose tissue (EAT) thickness and global cardiac adiposity volumes for predicting CAD. Methods and Results: A total of 197 consecutive subjects underwent 320-slice multi-detector computed tomography coronary angiography and were segregated into CAD (≥1 coronary artery branch stenosis ≥50%) and non-CAD groups. EAT thickness was measured at the right coronary artery (EATRCA), the left anterior descending artery (EATLAD), and the left circumflex artery (EATLCX). Although EATRCA and EATLCX were similar between the 2 groups, EATLAD was larger in the CAD group than in the non-CAD group (5.45±2.16 mm vs. 6.86±2.19 mm, P&lt 0.001). EATLAD, after correcting for confounding factors, was strongly associated with CAD (r=0.276, P&lt 0.001) and Gensini score (r=0.239, P&lt 0.001). On multiple regression analysis, Framingham risk score combined with EATLAD was a strong predictor of CAD (adjusted R2=0.121 P&lt 0.001). Conclusions: The local fat thickness surrounding the LAD is a simple and useful surrogate marker for estimating the presence, severity, and extent of CAD, independent of classical cardiovascular risk factors.

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