Shuichiro Kaji

Kobe City Medical Center General Hospital, Kōbe, Hyōgo, Japan

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Publications (74)429.09 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Current guidelines recommended surgery for patients with severe degenerative mitral regurgitation (MR) when specific left ventricular (LV) dimensions or ejection fraction (EF) are reached, based on previous postoperative survival studies. The aim of this study was to evaluate the incidence and predictors of long-term postoperative LV dysfunction, and investigate the preoperative parameters necessary to maintain or recover long-term LV function in the era of mitral valve (MV) repair. We retrospectively reviewed 473 consecutive patients undergoing MV repair for severe degenerative MR for whom both preoperative and 3-year postoperative echocardiographic data were available in our institution. Preoperative and 3-year postoperative echocardiographic data and clinical outcomes were evaluated. Receiver operating characteristic analysis identified preoperative LVEF 63% or less (area under curve [AUC], 0.725; P < .001) and LV end-systolic dimension (ESD) 39 mm or greater (AUC, 0.724; P < .001) as cut-off values for predicting LVEF less than 50% 3 years after surgery. On multivariate analysis, both preoperative LVEF and LVESD were not significant predictors of 3-year postoperative LV dysfunction among patients with preoperative LVEF greater than 63% and LVESD less 39 mm, whereas preoperative LVESD (odds ratio [OR], 2.22; P = .004), higher age (OR, 1.03; P = .04), and atrial fibrillation (OR, 2.68; P = .01) were independent predictors among patients with preoperative LVEF 63% or less or LVESD 39 mm or greater. Early MV repair with LVEF greater than 63% and LVESD less than 39 mm preserved long-term postoperative LV function well, and smaller preoperative LVESD was associated with long-term LV function recovery, even in patients with preoperative LV dysfunction.
    The Journal of thoracic and cardiovascular surgery 02/2014; · 3.41 Impact Factor
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    ABSTRACT: Surgical papillary muscle (PM) imbrication has been reported to be effective to relieve leaflet tethering in patients with functional mitral regurgitation (FMR). However, the mechanism that contributes to improvement of FMR by shortening the interpapillary muscle distance (IPMD) has not been well investigated. The purpose of the present study was to investigate whether IPMD can affect MR severity independently of PM tethering distance in patients with left ventricular dysfunction (LVD) using multislice computed tomography. We analyzed volumetric multislice computed tomography images of mitral apparatus in 83 patients with LVD (ejection fraction <50%): 37 patients with FMR and 46 patients without FMR. By using the original software, we assessed the 3-dimensional geometry of mitral apparatus including IPMD, tethering distances, and mitral tenting volume at end-systole. The severity of FMR was assessed using vena contracta (VC) width by 2-dimensional echocardiography. Posterior and anterior tethering distance and IPMD were increased significantly in patients with FMR than in those without FMR. Patients with IPMD in the highest tertile had a significantly higher degrees of MR (mean ± standard error VC width, 4.5 ± 0.3 mm) compared with patients in the lowest and the middle tertiles, adjusting for PM tethering distance (mean ± standard error VC width, 3.0 ± 0.4 and 2.9 ± 0.3 mm; P < .001, respectively). Multivariate analysis showed that anteroposterior annular diameter and IPMD were the strongest determinants of FMR severity and mitral tenting volume. IPMD, which affects leaflet tethering independently of PM tethering distance, was the major determinant of mitral tenting volume and FMR severity in patients with LVD.
    The Journal of thoracic and cardiovascular surgery 11/2013; · 3.41 Impact Factor
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    ABSTRACT: Background: Limited data are available for sex-based differences in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods and Results: The study patients comprised 1,197 women and 3,182 men who underwent primary PCI for AMI in 2005-2007. Compared with the men, the women were significantly older, and had significantly longer onset-to-balloon time and lower rate of follow-up coronary angiography. In-hospital mortality was higher among women than men (8.7% vs. 4.9%, P<0.001). Although the cumulative incidence of all-cause death at 3 years was also higher for women (17.7% vs. 10.7%, P<0.001), the adjusted risk for all-cause death was comparable [hazard ratio (HR, women vs. men)=0.94, 95% confidence interval (CI): 0.71-1.24, P=0.66]. The incidence (12.1% vs. 12.4%, P=0.77) and the adjusted risk (HR=0.99, 95% CI 0.78-1.24, P=0.92) for any clinically-driven coronary revascularization were both comparable. However, regarding any non-clinically-driven coronary revascularization, the incidence (19.6% vs. 27.8%, P<0.001) and the adjusted risk (HR=0.79, 95% CI 0.65-0.95, P=0.012) were both lower in women relative to men. Conclusions: In current Japanese clinical practice for AMI, onset-to-balloon time was significantly longer in women than in men. Female sex was associated with lower follow-up coronary angiography rate and lower incidence of any non-clinically-driven coronary revascularization, whereas the incidence of any clinically-driven coronary revascularization was comparable between the sexes.
    Circulation Journal 03/2013; · 3.58 Impact Factor
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    ABSTRACT: Background: It is controversial whether angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) provide significant survival benefits in patients with coronary artery disease (CAD) but without myocardial infarction (MI). This study investigated whether the association of ACEI/ARB therapy with clinical outcome in patients undergoing percutaneous coronary intervention (PCI) was affected by history of MI. Methods and Results: A total of 11,590 patients undergoing first PCI were divided into 2 groups: those with MI and those without MI. All-cause and cardiovascular mortality were compared between the patients with and without ACEI/ARB at discharge in each group. In patients with MI, significantly lower 3-year all-cause/cardiovascular mortality for patients with ACEI/ARB relative to those without ACEI/ARB was noted in the total patients (all-cause: 6.6% vs. 11.7%, P<0.0001; cardiovascular: 3.8% vs. 6.9%, P<0.0001) and in the 1,007 propensity score-matched pairs (all-cause: 8.2% vs. 11.3%, P=0.018; cardiovascular: 3.7% vs. 5.7%, P=0.014). In patients without MI, however, all-cause (5.2% vs. 5.6%, P=0.56) and cardiovascular (3.2% vs. 3.0%, P=0.23) mortality were similar regardless of whether ACEI/ARB were used or not; and similarly in the 2,061 propensity score-matched pairs (all-cause: 4.1% vs. 5.4%, P=0.33; cardiovascular: 1.4% vs. 2.1%, P=0.30). Conclusions: Use of ACEI/ARB at hospital discharge was associated with lower all-cause/cardiovascular mortality in revascularized CAD patients with MI, but not in those without MI.
    Circulation Journal 12/2012; · 3.58 Impact Factor
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    ABSTRACT: OBJECTIVES: The appropriate management of aortic intramural hematoma is still controversial, because a variety of aortic events can arise during follow-up in some patients. However, simplified identification of these patients remains challenging. The present study aimed to determine the prognostic significance of serial C-reactive protein measurements for the prediction of adverse events in patients with acute aortic intramural hematoma. METHODS: A total of 180 patients with aortic intramural hematoma were retrospectively reviewed. The C-reactive protein data were obtained at admission and 2 days, 1 week, and 2 weeks from the onset, and the maximum value was obtained during the acute phase. Adverse aorta-related events were defined by a composite of aortic rupture, aortic aneurysm, and surgical or endovascular aortic repair. RESULTS: The C-reactive protein value was 3.0 ± 4.6, 8.7 ± 5.9, 9.0 ± 5.5, and 5.7 ± 4.5 mg/dL on admission and 2 days, 1 week, and 2 weeks from the onset, respectively. The maximal value of C-reactive protein was 12.4 ± 6.3 mg/dL at a mean of 4 days from the onset. Patients with elevated C-reactive protein levels (≥7.2 mg/dL) at 2 weeks had significantly greater rates of aorta-related events (P < .001). On multivariate analysis, an elevated C-reactive protein level at 2 weeks (hazard ratio, 3.16; P < .001) and the development of an ulcer-like projection (hazard ratio, 2.68; P = .002) were independent predictors of adverse aorta-related events. In addition, an elevated C-reactive protein level at 2 weeks had incremental value compared with the development of an ulcer-like projection (chi-square, 16.94 for ulcer-like projection only vs 34.32 with the addition of C-reactive protein at 2 weeks, P < .001). CONCLUSIONS: C-reactive protein was a simple and useful marker providing incremental prognostic information compared with the development of an ulcer-like projection in patients with aortic intramural hematoma.
    The Journal of thoracic and cardiovascular surgery 12/2012; · 3.41 Impact Factor
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    ABSTRACT: A 39-year-old woman with Marfan syndrome presented to our hospital with chest oppression on effort. She underwent aortic root remodeling combined with aortic valve replacement 14 years ago and Bentall operation for enlargement of remaining native Valsalva sinus 3 years ago. A coronary computed tomography and a coronary angiography showed left main coronary artery stenosis, which was subsequently treated with percutaneous coronary intervention using a bare-metal stent. Follow-up coronary angiography performed 1 year after stenting revealed no restenosis.
    Cardiovascular intervention and therapeutics. 11/2012;
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    ABSTRACT: Many patients with aortic stenosis (AS) have coexisting aortic regurgitation (AR). However, few data exist regarding its clinical significance and prognostic value. The aim of this study was to examine the effect of concomitant significant AR on clinical outcomes in patients with non-surgically treated severe AS. A single centre, retrospective cohort study. We retrospectively reviewed 306 consecutive patients (age, 72±11 years) with severe AS in whom non-surgical management was primarily planned at our institution between January 1999 and December 2011. There were 74 patients with moderate or severe AR (ASR) and 232 patients without significant AR (isolated AS). Clinical outcomes were compared between the two groups. All-cause mortality and valve-related events, were defined by a composite of cardiac death and hospitalisation because of heart failure. The mean follow-up period was 4.5±3.3 years. Although the overall survival was comparable between the groups (p=0.07), the event-free survival, defined as survival without cardiac death or hospitalisation because of heart failure, was significantly worse in ASR than in isolated AS (p=0.02). Concomitant AR was an independent predictor of adverse events in patients with severe AS (HR, 2.10; p=0.003). Among patients who did not eventually undergo aortic valve replacement, ASR was associated with significantly worse survival and event-free survival than isolated AS (p=0.002 and p=0.03, respectively). Concomitant AR might worsen the prognosis of severe AS. Greater consideration of surgery might be beneficial in patients with ASR.
    Heart (British Cardiac Society) 08/2012; 98(21):1591-4. · 5.01 Impact Factor
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    ABSTRACT: Recent studies have demonstrated that newly diagnosed glucose intolerance is common among patients with acute myocardial infarction (AMI). The purpose of this study was to assess the long-term clinical cardiovascular outcomes in participants with AMI with abnormal fasting glucose compared with normal fasting glucose and an abnormal oral glucose tolerance test (OGTT) compared with a normal OGTT. A prospective study was performed in 275 consecutive patients with AMI, 85 of whom had pre-diagnosed diabetes mellitus (DM). Those without DM were divided into two groups based on the 75 g OGTT at the time of discharge. Abnormal glucose tolerance (AGT) was defined as 2 h glucose ≥140 mg/dl; 78 patients had normal glucose tolerance (NGT) and 112 had AGT. The same patients were also reclassified into the normal fasting glucose group (NFG; n=168) or the impaired fasting glucose group (IFG; n=22). The association between the glucometabolic status and long-term major adverse cardiovascular event rates was evaluated. Kaplan-Meier survival curves showed that the AGT group had a worse prognosis than the NGT group and an equivalent prognosis to the DM group (p<0.0005). Cox proportional hazard model analysis showed that the HR of AGT to NGT for major adverse cardiovascular event rates was 2.65 (95% CI 1.37 to 5.15, p=0.004) while the HR of DM to NGT was 3.27 (1.68 to 6.38, p=0.0005). However, Cox HR of IFG to NFG for major adverse cardiovascular event rates was 1.83 (0.86 to 3.87), which was not significant. In patients with AMI, an abnormal OGTT is a better risk factor for future adverse cardiovascular events than impaired fasting blood glucose.
    Heart (British Cardiac Society) 06/2012; 98(11):848-54. · 5.01 Impact Factor
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    JACC. Cardiovascular imaging 02/2012; 5(2):230-2. · 14.29 Impact Factor
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    ABSTRACT: To prospectively evaluate the relationship between left atrial volume (LAV) and the risk of clinical events in patients with hypertrophic cardiomyopathy (HCM). We enrolled a total of 141 HCM patients with sinus rhythm and normal pump function, and 102 patients (73 men; mean age, 61±13 years) who met inclusion criteria were followed for 30.8±10.0 months. The patients were divided into two groups with or without major adverse cardiac and cerebrovascular events (MACCE), a composite of stroke, sudden death, and congestive heart failure. Detailed clinical and echocardiographic data were obtained. MACCE occurred in 24 patients (18 strokes, 4 congestive heart failure and 2 sudden deaths). Maximum LAV, minimum LAV, and LAV index (LAVI) corrected for body surface area (BSA) were significantly greater in patients with MACCE than those without MACCE (maximum LAV: 64.3±25.0 vs. 51.9±16.0 ml, p=0.005; minimum LAV: 33.9±15.1 vs. 26.2±10.9 ml, p=0.008; LAVI: 40.1±15.4 vs. 31.5±8.7 ml/mm2, p=0.0009), while there were no differences in the other echocardiographic parameters.LAV/BSA of ≥40.4 ml/m2 to identify patients with cardiovascular complications with a sensitivity of 73% and a specificity of 88%. LAVI may be an effective marker for detecting the risk of MACCE in patients with HCM and normal pump function.
    Cardiovascular Ultrasound 11/2011; 9:34. · 1.32 Impact Factor
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    ABSTRACT: The management of asymptomatic severe and very severe aortic stenosis (AS) remains unestablished. This study aimed to investigate the clinical outcomes of severe versus very severe AS patients. A single centre, retrospective cohort study. The study retrospectively reviewed 108 conservatively treated patients with severe AS (a maximal jet velocity ≥ 4.0 m/s, or mean aortic pressure gradient (MPG) ≥ 40 mm Hg, or an aortic valve area (AVA) <1.0 cm(2)) and 58 patients with very severe AS (a maximal jet velocity ≥ 5.0 m/s, or MPG ≥ 50 mm Hg or an AVA <0.6 cm(2)). Clinical outcomes were compared between the two groups, considering the existence of symptoms. All-cause mortality and valve-related event, defined by a composite of cardiac death and hospitalisation because of heart failure. Mean follow-up was 5.5 ± 3.1 years. Fifty-six patients (52%) with severe AS and 20 patients (34%) with very severe AS were asymptomatic. Very severe AS had poorer survival and valve-related event-free survival than severe AS at 3 years (77% vs 88%, p < 0.01; 75% vs 88%, p < 0.001, respectively). In addition, the 3-year survival and valve-related event-free survival of asymptomatic very severe AS were comparable with symptomatic severe AS, but they were significantly worse than asymptomatic severe AS (p < 0.01 and p < 0.001, respectively). Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes.
    Heart (British Cardiac Society) 09/2011; 97(24):2029-32. · 5.01 Impact Factor
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    ABSTRACT: Previous pathological and clinical studies demonstrated an intimal defect in patients with acute aortic intramural hematoma (IMH). The purpose of this study was to investigate the prevalence and clinical outcome of intimal defect detected by multidetector computed tomography (MDCT) in patients with IMH. We retrospectively analyzed 38 consecutive patients with IMH in whom 64-row MDCT was performed during the acute phase (median, 5 days from the onset). Intimal defect was defined as continuity disruption of the inner layer of thrombosed false lumen, which could be detected by 1-mm axial and longitudinal interactive multiplanar reformation images. Clinical outcome of intimal defect was assessed in patients with type B IMH (n=32). A total of 48 lesions in 27 (71%) patients were recognized as intimal defects. The incidence of intimal defect was not affected by the timing of MDCT examination (1 to 3 days, 79%; 4 to 7 days, 58%; 8 to 14 days, 75%; P=0.56). In type B IMH, 16 (76%) of 21 patients with intimal defect showed progression (enlargement or progression to aortic aneurysm) in the chronic phase. In contrast, all 11 patients without intimal defect had complete resorption of hematoma. In lesion-based analysis, a depth of intimal defect of ≥ 5 mm predicted progression with sensitivity, specificity, and positive and negative predictive values of 84%, 95%, 94%, and 86%, respectively. A considerable portion of patients with IMH showed intimal defect detected by MDCT even in the very early stage, and defects frequently enlarged. Patients with intimal defect should be carefully followed up with serial imaging.
    Circulation 09/2011; 124(11 Suppl):S174-8. · 15.20 Impact Factor
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    ABSTRACT: Limited data are available for gender-based differences in patients undergoing coronary revascularization. This study aimed to identify gender-based differences in risk factor profiles and outcomes among Japanese patients undergoing coronary revascularization. The subjects consisted of 2,845 women and 6,843 men who underwent first percutaneous coronary intervention or coronary artery bypass grafting in 2000-2002. The outcome measures were all-cause death, major adverse cardiovascular events (MACE) as the composite of cardiovascular death, myocardial infarction and stroke, and any coronary revascularization. The females were older than the males and more frequently had histories of heart failure, diabetes, hypertension, chronic kidney disease, anemia, and dyslipidemia. Unadjusted survival analysis revealed a significantly lower incidence of any revascularization in women (at 3 years: 28.2% vs. 31.2%, P = 0.0037), although no significant gender-based differences were shown in the incidence of all-cause death (at 3 years: 8.8% vs. 8.5%, P = 0.37) or MACE (at 3 years: 12.0% vs. 11.5%, P = 0.61). Multivariate analysis revealed that female gender was associated with significantly lower risks of any revascularization (relative risk = 0.93, 95% confidence interval [CI] = 0.88-0.99, P = 0.014) and all-cause death (relative risk = 0.86, 95%CI = 0.77-0.96, P = 0.005). In Japanese patients undergoing first coronary revascularization, the coronary risk factor burden appeared greater in women than in men. Despite the greater modifiable risk factor accumulation, female gender was associated with a lower incidence of repeated revascularization relative to male gender.
    Circulation Journal 05/2011; 75(6):1358-67. · 3.58 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the influence of thrombus aspiration during primary percutaneous coronary intervention (PCI) on myocardial viability in patients with ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance imaging (MRI). We performed cardiac MRI in 62 patients who underwent primary PCI for STEMI with manual thrombus aspiration. We divided the patients into two groups: those who had thrombus aspiration during primary PCI, which resulted in a successful procedure (n=47 patients; TA group) and those who had thrombus aspiration and an unsuccessful procedure (n=15 patients; non-TA group). Thrombus aspiration was defined as successful or unsuccessful, based on the histological evidence of atherothrombotic material in the aspirate samples. The infarct volume was quantified using delayed-contrast enhancement on cardiac MRI. The reference volume was defined as transmural myocardial volume at the infarcted segment. Myocardial viability was assessed by a transmurality index defined as the ratio of the infarct volume to the reference volume. Although baseline characteristics and the reference volume were comparable between the two groups (24.5 ± 12.5 ml for TA group versus 29.0 ± 9.6 ml for non-TA group; p = 0.21), the infarct size was significantly smaller in the TA group than in the non-TA group (12.2 ± 7.1 ml versus 17.4 ± 7.1 ml, respectively; p = 0.01). The transmurality index was also significantly lower in the TA group (49.3 ± 10.6% versus 60.9 ± 13.9%, respectively; p = 0.001). Patients with successful TA showed more reduced infarct size and preserved myocardial viability than patients without TA. These effects of TA may lead to preserved left ventricular systolic function and better clinical outcomes.
    The Journal of invasive cardiology 05/2011; 23(5):172-6. · 1.57 Impact Factor
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    ABSTRACT: We sought to evaluate the impact of early surgery in the active phase on long-term outcomes in patients with left-sided native valve infective endocarditis. Clinical data were retrospectively reviewed in 212 consecutive patients with left-sided native valve infective endocarditis from 1990 to 2009. Early surgery in the active phase (within 2 weeks after the initial diagnosis) was performed in 73 patients, and the conventional treatment strategy was applied in 139 patients. In the conventional treatment group, 99 patients underwent late surgical intervention. To minimize selection bias, propensity score was used to match patients in the early operation and conventional treatment groups. Major adverse cardiac event was defined as a composite of infective endocarditis-related death, repeat surgery, and recurrence of infective endocarditis during follow-up. The mean follow-up period was 5.5 years. In-hospital mortality was lower in the early operation group than in the conventional treatment group (5% vs 13%, P = .08). For 57 propensity score-matched pairs, the estimated actuarial 7-year survivals free from infective endocarditis-related death and major adverse cardiac events were significantly higher in the early operation group than in the conventional treatment group (infective endocarditis-related death: 94% ± 5% vs 82% ± 5%, P = .011, major adverse cardiac events: 88% ± 5% vs 69% ± 7%, P = .006, respectively). Compared with conventional treatment, early surgery in the active phase was associated with better long-term outcomes in patients with left-sided native valve infective endocarditis. Further prospective randomized studies with large study populations are necessary to evaluate more precisely the optimal timing of surgery in patients with native valve infective endocarditis.
    The Journal of thoracic and cardiovascular surgery 03/2011; 142(4):836-842.e1. · 3.41 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the clinical importance of newly developed ulcer-like projection (ULP) in patients with type B aortic dissection with closed and thrombosed false lumen (AD with CTFL), which is better known as aortic intramural hematoma. A total of 170 patients with acute type B AD with CTFL were admitted to our institution from 1986 to 2008 and treated initially with medical therapy. There were 31 late deaths, including 9 cases of aortic rupture. The actuarial survival rates of all patients were 99%, 89%, 83% at 1, 5, and 10 years, respectively. A total of 62 (36%) patients showed new ULP development within 30 days from the onset. Patients who had ULP showed significantly poorer survival rates than patients who did not have ULP (P=0.037). Development of ULP was also associated with a significant increase in adverse aorta-related events (P<0.001). In addition, patients with ULP in the proximal descending thoracic aorta (PD) showed significantly higher aorta-related event rates than patients without ULP in the PD (P<0.001). Initial aortic diameter (hazard ratio, 3.55; P<0.001) and development of ULP in PD (hazard ratio, 3.79; P=0.003) were the strongest predictors of adverse aorta-related events. Initial aortic diameter and development of ULP in the PD are both strong predictors of adverse aorta-related events in patients with type B AD with CTFL. Patients with newly developed ULP should be more carefully followed up with close surveillance imaging than those without ULP.
    Circulation 09/2010; 122(11 Suppl):S74-80. · 15.20 Impact Factor
  • Journal of the American College of Cardiology 03/2010; 55(10). · 14.09 Impact Factor
  • Journal of the American College of Cardiology 03/2010; 55(10). · 14.09 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2010; 55(10).
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2010; 55(10).

Publication Stats

792 Citations
429.09 Total Impact Points

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Institutions

  • 2009–2013
    • Kobe City Medical Center General Hospital
      Kōbe, Hyōgo, Japan
  • 2007
    • Okayama University
      Okayama, Okayama, Japan
    • Osaka City University
      • Graduate School of Medicine
      Ōsaka-shi, Osaka-fu, Japan
  • 2002–2006
    • Kawasaki Medical University
      • • Department of Cardiology
      • • Department of Cardiovascular Surgery
      Kurasiki, Okayama, Japan
  • 2005
    • Shakaihoken Kobe Central Hospital
      Kōbe, Hyōgo, Japan