Atsushi Iwata

St.Mary's Hospital (Fukuoka - Japan), Hukuoka, Fukuoka, Japan

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Publications (44)81.73 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: It is well known that percutaneous coronary intervention (PCI) in hemodialysis (HD) patients is associated with higher rates of in-stent restenosis and major adverse cardiovascular events (MACE) compared to that in non-HD patients, even if the target value in cholesterol management is achieved.
    Journal of Cardiology 07/2014; · 2.30 Impact Factor
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    ABSTRACT: Objective We compared the efficacies of irbesartan and olmesartan after successful stent implantation in patients with stable angina. Methods Twenty-six patients were randomly divided into irbesartan and olmesartan groups and treated for approximately eight months (at follow-up coronary angiography). Results There were no differences in blood pressure (BP) reduction or late loss between the groups. The BP levels in both groups at follow-up were significantly reduced. The equality of variance of systolic (S)BP (i.e., the intragroup standard deviation of SBP) in the irbesartan group was significantly smaller than that observed in the olmesartan group at follow-up. In addition, log[pentraxin-3] was significantly decreased in all of the patients at follow-up, with no differences between the groups. Interestingly, the levels of log[high-sensitive C-reactive protein(hs-CRP)] measured at 0 weeks were positively associated with in-stent late loss, and among independent biochemical variables in addition to age, gender, body mass index and the kind of angiotensin receptor blockers at 0 weeks, only these levels were related to in-stent late loss, as assessed by a multivariate analysis. Conclusion The ability of irbesartan to reduce BP is comparable to that of olmesartan, and irbesartan exhibits a lower variance of systolic BP after treatment. The level of log[hs-CRP] before stent implantation is a predictor of in-stent late loss.
    Internal Medicine 01/2013; 52(7):713-9. · 0.97 Impact Factor
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    ABSTRACT: Although the use of drug-eluting stents (DES) has reduced the rate of restenosis, some problems remain regarding the usefulness of DES in small coronary arteries in addition to late thrombosis and a longer duration of dual-antiplatelet therapy. We considered 335 patients with 698 lesions who underwent DES or bare-metal stent (BMS) implantation, and randomly selected 172 DES and 124 BMS lesions that had undergone a complete data analysis and evaluation. Patients had a history of stable angina with at least 1 lesion with 50% diameter stenosis in a vessel and with a successfully minimum stent implantation (stent diameter=2.5mm). The baseline characteristics including the clinical presentation and cardiovascular risk factors were similar between the DES and BMS groups, except for the percentage of dyslipidemia (DL). Pre-procedure reference vessel diameter (RVD pre) in the DES group was significantly smaller than that in the BMS group (p<0.01), and stent length in the DES group was significantly longer (p<0.01). There was no significant difference in the cumulative incidence of major adverse cardiac events including the target lesion revascularization rate, whereas in-stent restenosis (ISR) in the DES group was significantly lower than that in the BMS group. In a multivariate analysis of ISR, diabetes mellitus, prior percutaneous coronary intervention, and DES use in clinical background were identified as independent predictors of ISR. In addition, RVD pre, stent length, and DES use in angiographical background were also identified. In conclusion, DES use is an independent predictor of ISR, although the DES group included more severely diseased small coronary arteries.
    Journal of Cardiology 11/2012; · 2.30 Impact Factor
  • Atsushi Iwata, Keijiro Saku
    Nihon Naika Gakkai Zasshi 11/2012; 101(11):3268-71.
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    ABSTRACT: Dietary habits are associated with obesity, and both are important contributing factors to lifestyle-related diseases. The STYLIST study examined the effects of dietary counseling by registered dietitians and the delivery of proper calorie-controlled meals (UMIN Registration No: 000006582). Two-hundred adult patients with hypertension and/or diabetes mellitus were randomly divided into 2 groups with/without dietary counseling and consumed an ordinary diet for 4 weeks. Each group was then subdivided into 2 groups with/without dietary counseling and received calorie-controlled lunch and dinner boxes for the next 4 weeks. The calories in the delivered meals were based on the subject's ideal body weight (BW) and physical activity level. BW, waist circumference, blood pressure, and laboratory data, including glycoalbumin, were measured at 0, 4, and 8 weeks. BW and the other parameters were significantly reduced during the study period in patients who received diet counseling in the ordinary diet period and/or delivered meal period but not in patients without dietary counseling, as assessed by linear mixed models for longitudinal data. The combination of dietary counseling by dietitians and delivery of calorie-controlled meals was effective in reducing BW, as well as blood pressure and glycoalbumin, in patients with hypertension and/or diabetes mellitus.
    Circulation Journal 05/2012; 76(6):1335-44. · 3.58 Impact Factor
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    ABSTRACT: Pentraxin 3 (PTX3) is a novel candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors and to predict adverse outcomes in patients with coronary artery disease. The purpose of this study was to investigate the association between the plasma levels of PTX3 and plaque vulnerability and the effect of the levels using statin in patients with coronary artery disease. We determined the associations among the plasma levels of PTX3 and coronary plaque vulnerability in nonculprit coronary lesions with stenosis as assessed by integrated backscatter intravascular ultrasound (study 1). One hundred and eighteen consecutive patients with stable angina who underwent a percutaneous coronary intervention were enrolled. We also enrolled 53 patients with stable angina, and they were treated either with (n=36) or without (n=17) atorvastatin (10 mg/day) (study 2). In study 1, although there was no association between the plasma levels of PTX3 and plaque vulnerability in all patients, the level of PTX3 was positively correlated with the percentage of lipid volume and negatively correlated with the percentage of fibrous volume in patients without statin treatment. There were no associations between high-sensitivity C-reactive protein levels and percentage of lipid volume and fibrous volume. Moreover, in study 2, statin therapy for 6-8 months significantly decreased the level of PTX3 in addition to high-sensitivity C-reactive protein. The plasma level of PTX3 may be a useful biomarker for predicting the tissue characteristics of coronary plaque using integrated backscatter intravascular ultrasound. Statin therapy may have a beneficial effect with regard to the reduction of PTX3 levels.
    Coronary artery disease 05/2012; 23(5):315-21. · 1.56 Impact Factor
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    ABSTRACT: Little is known about the efficacy and safety of intensive lowering of low-density lipoprotein cholesterol (LDL-C) with statin/ezetimibe therapy after coronary stent implantation in patients with stable angina. Fifty patients with stable angina were randomly divided into an atorvastatin (10 mg/day) (A) group and an atorvastatin (10 mg/day)/ezetimibe (10 mg/day) (A+E) group after stent implantation. Follow-up coronary angiography was performed at 6-9 months after stenting. The A and A+E groups showed significant reductions in LDL-C. The levels of LDL-C in the A+E group were significantly lower than those in the A group at follow-up, whereas there were no differences in major adverse cardiac events, in-stent restenosis, or in-stent % diameter stenosis (DS) between the groups. Only the A+E group showed a significant decrease in the levels of highly sensitive C-reactive protein. In a sub-analysis, %DS in the non-target vessel significantly decreased in both groups. Moreover, Δ%DS (Δ=the value at baseline minus that at follow-up) in the A+E group was more closely associated with LDL-C levels at follow-up than that in the A group. There were no significant differences in adverse effects between the A and A+E groups. In conclusion, although statin/ezetimibe therapy was effective and safe for intensive lipid-lowering in patients with stable angina after successful coronary stent implantation, improvement in clinical outcomes with the combination therapy remains unclear.
    Journal of Cardiology 04/2012; 60(2):111-8. · 2.30 Impact Factor
  • Nihon Naika Gakkai Zasshi 02/2012; 101(2):504-11.
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    ABSTRACT: Coarctation of the aorta with aortic dissection is sometimes seen in cases of Turner syndrome, and most cases are type A aortic dissection, whereas coarctation of the aorta with type B aortic dissection is unusual. Only two cases of coarctation of the aorta presenting as aortic dissection have been reported in Japan, and only a few cases have been reported worldwide. We report here a case of coarctation of the aorta with some collaterals presenting as aortic dissection (type B) detected by 64-multidetector row computed tomography (MDCT). A 36-year-old man was brought to the emergency room complaining of sudden chest pain and back pain. Since he showed highly developed collaterals, he might never have exhibited symptoms or any limits on movement. Three-dimensional image reconstruction enabled detection of the coarctation of the aorta with some collaterals and aortic dissection in the best projection, and enabled assessment of precise anatomical relationship. In the present case, MDCT gave more useful information than cardiac catheterization for planning the surgical repair of coarctation of the aorta with some collaterals presenting as aortic dissection.
    Journal of Cardiology Cases 02/2012;
  • Cardiovascular Revascularization Medicine. 01/2012; 13(2):e4–e5.
  • Cardiovascular Revascularization Medicine. 01/2012; 13(2):e9.
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    ABSTRACT: Although plasma pigment epithelium-derived factor (PEDF) levels have been shown to be significantly correlated with the levels of creatinine (Cr) in type 2 diabetes, little is known about the association between PEDF levels and renal dysfunction in patients with coronary artery disease (CAD). We enrolled 134 consecutive patients with diagnosed CAD and measured plasma levels of PEDF, serum Cr, uric acid (UA) and high-sensitive C-reactive protein (hsCRP). Plasma PEDF levels were positively correlated with serum Cr (p 〈 0.0001) and UA (p 〈 0.0001) and negatively correlated with the estimated glomerular filtration rate (eGFR) (p 〈 0.0001), whereas there was no association between plasma PEDF and age or hsCRP. When the subjects were divided into five groups (0-4) according to the number of metabolic factors (obesity, diabetes, hypertension and dyslipidemia), PEDF levels in patients with four factors were significantly higher than those in patients without factors. Next, we divided the patients into quartiles according to their plasma PEDF levels (〈 9.9 μg/mL, 9.9-12.8, 12.9- -15.7, 〉 15.7). The eGFR in the first group was significantly higher than those in the third and fourth groups. Multivariate logistic analysis indicated that eGFR (p 〈 0.0001) and age (p = 0.030) were significant independent variables that correlated with the quartile classification according to PEDF levels. This study revealed that PEDF may play a role in renal dysfunction in CAD patients.
    Cardiology journal 09/2011; 18(5):515-20. · 1.15 Impact Factor
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    ABSTRACT: Hypoadiponectinemia is an independent predictor for the progression of coronary artery disease (CAD); however, the importance of plasma adiponectin levels in the midterm clinical outcome in patients with CAD who underwent percutaneous coronary intervention (PCI) has not been fully elucidated. The purpose of this study was to investigate the association between plasma adiponectin levels and midterm clinical outcome in patients with CAD who underwent PCI. A total of 112 patients (120 lesions) with stable angina who underwent PCI under intravascular ultrasound guidance, and who underwent follow-up coronary angiography about 8 months after PCI from August 2004 to December 2009 were enrolled in this study. Plasma adiponectin levels were significantly lower in the group with restenosis (n=13) than in the group without restenosis (n=107) (4.2±1.5 vs. 6.8±4.9 μg/ml, P<0.0001). A two-graph receiver operating characteristic curve analysis indicated that the cut-off point of adiponectin was 6.0 μg/ml. Although plasma adiponectin levels were independent of well-known risk factors of CAD, a multivariate logistic regression analysis indicated that the higher adiponectin group (patients with hyperadiponectinemia) was independently associated with lower risk of restenosis (odds ratio=0.21, 95% confidence interval=0.03-0.82). Hyperadiponectinemia (plasma adiponectin levels ≥6.0 μg/ml) is independently associated with a lower risk of restenosis. Thus, the plasma adiponectin level may be useful as a marker of restenosis independent of preinterventional intravascular ultrasound variables.
    Coronary artery disease 07/2011; 22(7):451-7. · 1.56 Impact Factor
  • Atsushi Iwata, Keijiro Saku
    Nihon Naika Gakkai Zasshi 07/2011; 100(7):2006-7, 2036-8.
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    ABSTRACT: This study analyzed the antiatherogenic effects of newly developed apolipoprotein A-I (ApoA-I) mimetic peptide/phospholipid complexes (ETC-642) against the aortic plaque burden in vivo. We used human macrophage cells to analyze cholesterol efflux by ETC-642. Watanabe-heritable hyperlipidemic (WHHL) rabbits were divided into 3 groups: low- (15mg/kg) and high-dose ETC-642 (50mg/kg), and placebo. The test material was injected twice/week for 12 weeks. The aortic plaque burden was assessed by intravascular ultrasound (IVUS) at 0 and 12 weeks. Plasma lipid profiles were analyzed by capillary isotachophoresis every 4 weeks. ETC-642 had an effect on cholesterol efflux comparable to that of conventional rHDL. In WHHL rabbits, high-dose ETC-642 inhibited the progression of aortic atherosclerosis compared to placebo. There was no change in the percentage of plaque volume (%PV) in the high-dose group between before (30.9%) and after infusion (28.6%), whereas there was a significant increase in the control group from 27.8% to 37.9%. ETC-642 significantly reduced charge-modified low-density lipoprotein (LDL) by converting more negative-charged modified LDL to less negative-charged LDL, and reduced small dense (sd) LDL by converting it into large, buoyant (lb) LDL. Changes in the %PV were positively correlated with changes in negative-charged modified LDL (r=0.61, p<0.01) and sdLDL (r=0.59, p<0.01), and negatively correlated with changes in less negative-charged LDL (r=-0.43, p<0.01) and lbLDL (r=-0.57, p<0.01). In conclusion, the ETC-642-induced remodeling of sdLDL to large and lbLDL and the enhancement of cholesterol efflux may prevent progression of the aortic plaque burden. HDL-based therapy may be useful for preventing the progression of plaque volume.
    Atherosclerosis 06/2011; 218(2):300-7. · 3.71 Impact Factor
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    ABSTRACT: Atorvastatin, rosuvastatin and pitavastatin are available for intensive, aggressive low-density lipoprotein cholesterol (LDL-C)-lowering therapy in clinical practice. The objective of the Randomized Head-to-Head Comparison of Pitavastatin, Atorvastatin, and Rosuvastatin for Safety and Efficacy (Quantity and Quality of LDL) (PATROL) Trial was to compare the safety and efficacy of atorvastatin, rosuvastatin and pitavastatin head to head in patients with hypercholesterolemia. This is the first prospective randomized multi-center trial to compare these strong statins (UMIN Registration No: 000000586). Patients with risk factors for coronary artery disease and elevated LDL-C levels were randomized to receive atorvastatin (10mg/day), rosuvastatin (2.5mg/day), or pitavastatin (2mg/day) for 16 weeks. Safety was assessed in terms of adverse event rates, including abnormal clinical laboratory variables related to liver and kidney function and skeletal muscle. Efficacy was assessed by the changes in the levels and patterns of lipoproteins. Three hundred and two patients (from 51 centers) were enrolled, and these 3 strong statins equally reduced LDL-C and LDL particles, as well as fast-migrating LDL (modified LDL) by 40-45%. Newly developed pitavastatin was non-inferior to the other 2 statins in lowering LDL-C. There were no differences in the rate of adverse drug reactions among the 3 groups, but HbA(1c) was increased while uric acid was decreased in the atorvastatin and rosuvastatin groups. The safety and efficacy of these 3 strong statins are equal. It is suggested that the use of these 3 statins be completely dependent on physician discretion based on patient background.
    Circulation Journal 05/2011; 75(6):1493-505. · 3.58 Impact Factor
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    ABSTRACT: In-stent restenosis (ISR) remains the major limitation of percutaneous coronary intervention (PCI), and the mechanism of ISR is neointimal growth. Higher serum total bilirubin (TBIL) inhibits the inflammatory response and the proliferation of vascular smooth muscle cells; however, the relationship between TBIL and ISR is still unclear. This study aimed to determine whether the serum bilirubin level is associated with ISR after coronary stenting in patients with coronary artery disease. This study investigated 1076 consecutive patients who underwent coronary stenting and follow-up angiography (average period: 236 days) using the Fukuoka University Hospital Registry. We used multivariate logistic regression analysis to identify independent predictors of ISR. The baseline TBIL level was significantly lower in patients with ISR at follow-up compared to those without ISR [0.53 ± 0.26 mg/dL vs. 0.62 ± 0.69 mg/dL, p= 0.036]. When we divided the patients into 4 groups according to their baseline TBIL level ["low", "low-normal", "high-normal group" and "high" (0.18 ± 0.04, 0.50 ± 0.13, 0.93 ± 0.12 and 2.11 ± 2.68 mg/dL)], the ISR rate at follow-up was significantly correlated with the TBIL level [31.0, 32.3, 22.1, and 15.6%, respectively; p= 0.008 for trend]. A significant negative correlation between the TBIL level and ISR was revealed by multivariate analyses [odds ratio, 0.6; 95% confidence interval, 0.39-0.89, p= 0.015]. This risk reduction was comparable to those of other known ISR risk factors and covariates. To the best of our knowledge, this is the first report to demonstrate that a higher TBIL level may be a useful independent predictor of ISR risk after PCI.
    Journal of atherosclerosis and thrombosis 03/2011; 18(7):574-83. · 2.93 Impact Factor
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    ABSTRACT: Pigment epithelium-derived factor (PEDF) and pentosidine have received growing attention as sensitive biomarkers of the progression of atherosclerosis. The present study was performed to evaluate the utility of these biomarkers for assessing the effects of angiotensin II type 1 receptor blockers (ARBs). Sixty-three patients with coronary artery disease (CAD) following successful stent implantation were divided into an ARB group (n = 50), who initially received valsartan or olmesartan immediately following stent implantation, and a non-ARB group (n = 13) according to their blood pressure (BP) at baseline. Measurement of BP and blood sampling was performed prior to (at baseline) and 6-8 months following stent implantation (at follow-up). There were no significant differences in the baseline characteristics between the groups. Although there were no differences in the percentage of diameter re-stenosis between the groups, the BP level in the ARB group at follow-up showed a significant reduction and reached the target BP. The levels of plasma PEDF were significantly increased at follow-up in the ARB group, but not in the non-ARB group, while there were no differences in the levels of pentosidine between the groups. Changes in BP (ΔBP = BP at follow-up minus BP at baseline) were not associated with ΔPEDF. In conclusion, PEDF may be a useful biomarker for assessing the effects of ARBs independent of a reduction in BP.
    Journal of Renin-Angiotensin-Aldosterone System 02/2011; 12(3):320-5. · 2.29 Impact Factor
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    ABSTRACT: A 55-year-old man with severe chest pain was hospitalized for acute coronary syndrome. Coronary angiography revealed total occlusion of his left anterior descending coronary artery, which was successfully recanalized by percutaneous coronary intervention (PCI). However, the patient subsequently experienced subacute stent thrombosis, restenosis in the stent, and frequent thrombosis in PCI toward restenosis. Primary antiphospholipid syndrome should be considered as a possible cause of repeated stent thrombosis, and, if salvage by PCI is impossible, salvage by coronary artery bypass graft should be considered.
    Journal of Cardiology Cases 01/2011; 4(2).
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    ABSTRACT: Recent evidence has strongly suggested that atherosclerosis is an angiogenic disease, and PEDF may play a significant role in determining the balance of angiogenesis/antiangiogenesis during atherogenesis. Therefore, we assessed the associations among plasma levels of pigment epithelium-derived factor (PEDF), high-sensitivity C-reactive protein (hsCRP), the lipid profile and tissue characteristics of coronary plaque as assessed by integrated backscatter intravascular ultrasound (IB-IVUS). Fifty-two consecutive patients with stable coronary artery disease who underwent percutaneous coronary intervention were enrolled. Non-target coronary lesions with mild to moderate stenosis were measured by IB-IVUS. A total of 20 IB-IVUS images were recorded at an interval of 0.5 mm for a length of 10 mm in each plaque. Although the percentage of plaque volume (%PV, 100×total PV/total vessel volume), percentage of lipid volume (%LV, 100×LV/PV) and percentage of fibrous volume (%FV, 100×FV/PV) were not associated with plasma log[PEDF] levels in the overall patients, in the patients without statin treatment %LV and %FV were correlated with plasma log[PEDF] levels (r=0.525, p=0.021 and r=-0.498, p=0.030, respectively). The plasma level of PEDF may be a useful biomarker for predicting the tissue characteristics of coronary plaque using IB-IVUS.
    Internal Medicine 01/2011; 50(18):1889-94. · 0.97 Impact Factor

Publication Stats

190 Citations
81.73 Total Impact Points

Institutions

  • 2004–2014
    • St.Mary's Hospital (Fukuoka - Japan)
      Hukuoka, Fukuoka, Japan
  • 2008–2012
    • Fukuoka University
      • Department of Cardiology
      Fukuoka-shi, Fukuoka-ken, Japan