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Tatsuya Maruhashi,
Junko Soga,
Noritaka Fujimura,
Naomi Idei,
Shinsuke Mikami,
Yumiko Iwamoto,
Masato Kajikawa,
Takeshi Matsumoto,
Takayuki Hidaka,
Yasuki Kihara,
Kazuaki Chayama,
Kensuke Noma,
Ayumu Nakashima,
Chikara Goto,
Yukihito Higashi
[show abstract]
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ABSTRACT: OBJECTIVE: Nitroglycerine-induced vasodilation has been used as a control test for flow-mediated vasodilation (FMD) to differentiate endothelium-dependent from endothelium-independent response when evaluating endothelial function in humans. Recently, nitroglycerine-induced vasodilation has also been reported to be impaired in patients with atherosclerosis. The purpose of this study was to determine the relationships between nitroglycerine-induced vasodilation and cardiovascular risk factors.Approach and Results-We measured nitroglycerine-induced vasodilation and FMD in 436 subjects who underwent health examinations (mean age, 53±19 years; age range, 19-86 years), including patients with cardiovascular diseases. There was a significant relationship between nitroglycerine-induced vasodilation and FMD (r=0.42; P<0.001). Univariate regression analysis revealed that nitroglycerine-induced vasodilation correlated with age (r=-0.34; P<0.001), systolic blood pressure (r=-0.32; P<0.001), diastolic blood pressure (r=-0.24; P<0.001), heart rate (r=-0.21; P<0.001), glucose (r=-0.23; P<0.001), and smoking pack-year (r=-0.12; P=0.01), as well as Framingham risk score (r=-0.30; P<0.001). Nitroglycerine-induced vasodilation was significantly smaller in patients with cardiovascular disease than in both subjects with and without cardiovascular risk factors (10.5±5.6% versus 13.7±5.4% and 15.3±4.3%; P<0.001, respectively), whereas there was no significant difference in nitroglycerine-induced vasodilation between subjects with and without cardiovascular risk factors. Multivariate analysis revealed that male sex, body mass index, hypertension, diabetes mellitus, baseline brachial artery diameter, and FMD were independent predictors of nitroglycerine-induced vasodilation. CONCLUSIONS: These findings suggest that nitroglycerine-induced vasodilation may be a marker of the grade of atherosclerosis. FMD should be interpreted as an index of vascular function reflecting both endothelium-dependent vasodilation and endothelium-independent vasodilation in subjects with impaired nitroglycerine-induced vasodilation.
Arteriosclerosis Thrombosis and Vascular Biology 03/2013; · 6.37 Impact Factor
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Yuichi Fujii,
Hiroki Teragawa,
Junko Soga,
Naomi Idei,
Noritaka Fujimura, Tatsuya Maruhashi,
Shinsuke Mikami,
Yumiko Iwamoto,
Takayuki Hidaka,
Yasuki Kihara,
Kazuaki Chayama,
Kensuke Noma,
Ayumu Nakashima,
Chikara Goto,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Background: The purpose of this study was to evaluate the effect of anatomical variation of the brachial artery on flow-mediated vasodilation (FMD) in healthy subjects and patients with cardiovascular disease (CVD). Methods and Results: There was no significant difference in the prevalence of double brachial artery between healthy subjects (6.1%) and patients with CVD (6.5%). In healthy subjects, FMD was larger in a single brachial artery than in large and small vessels of a double brachial artery (7.2±3.4% vs. 4.7±3.3% and 4.5±2.5%, P<0.01, respectively). In patients with CVD, there were no significant differences in FMD among a single brachial artery, large vessel of a double brachial artery and small vessel of a double brachial artery (3.3±1.4%, 3.1±2.3% and 3.6±2.1%). FMD in a single brachial artery was smaller in patients with CVD than in healthy subjects. There were no significant differences in FMD in the large vessel of a double brachial artery between the 2 groups or in the small vessel of a double brachial artery between the 2 groups. Nitroglycerine-induced vasodilation was similar in all arteries in healthy subjects and patients with CVD. Conclusions: When measuring FMD, the existence of a double brachial artery should be checked. FMD measured in a double brachial artery may be underestimated in healthy subjects.
Circulation Journal 12/2012; · 3.77 Impact Factor
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Tatsuya Maruhashi,
Junko Soga,
Noritaka Fujimura,
Naomi Idei,
Shinsuke Mikami,
Yumiko Iwamoto,
Masato Kajikawa,
Takeshi Matsumoto,
Yasuki Kihara,
Kazuaki Chayama,
Kensuke Noma,
Ayumu Nakashima,
Hirofumi Tomiyama,
Bonpei Takase,
Akira Yamashina,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Patients with Gilbert syndrome have mild unconjugated hyperbilirubinemia. It has been shown that bilirubin is an endogenous antioxidant. We evaluated the role of oxidative stress in endothelial function in patients with Gilbert syndrome under normal conditions without cardiovascular risk factors.
A total of 108 young men with Gilbert syndrome without cardiovascular risk factors and 108 age-matched healthy men (normal controls) were enrolled in this study. Serum concentrations of bilirubin were higher in patients with Gilbert syndrome than in control subjects (29.2±11.6 versus 9.4±2.7 μmol/L; P<0.001). Serum concentrations of malondialdehyde-modified low-density lipoprotein and urinary excretion of 8-hydroxy-2'-deoxyguanosine (8-OHdG), as indices of oxidative stress, were lower in patients with Gilbert syndrome than in control subjects (61.8±24.5 versus 72.5±21.8 U/L, P=0.034; 7.8±2.4 versus 10.4±3.2 ng/mg creatinine, P=0.001, respectively). Flow-mediated vasodilation was greater in patients with Gilbert syndrome than in normal control subjects (7.2±2.2% versus 5.9±1.7%; P<0.001). Vascular responses to nitroglycerine were not significantly different between the 2 groups. Flow-mediated vasodilation correlated with serum concentration of bilirubin (r=0.44, P<0.001), malondialdehyde-modified low-density lipoprotein (r=-0.25, P=0.01), and urinary excretion of 8-OHdG (r=-0.27, P=0.004) in patients with Gilbert syndrome but not in control subjects. In addition, serum concentration of bilirubin correlated with malondialdehyde-modified low-density lipoprotein (r=-0.20, P=0.04) and 8-OHdG (r=-0.21, P=0.02) in patients with Gilbert syndrome but not in control subjects.
Patients with Gilbert syndrome had low levels of oxidative stress associated with hyperbilirubinemia and enhancement of endothelium-dependent vasodilation.
URL: http://www.umin.ac.jp. Unique identifier: UMIN000003409.
Circulation 07/2012; 126(5):598-603. · 14.74 Impact Factor
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ABSTRACT: To investigate the clinical factors, including intravascular ultrasound (IVUS) findings, associated with percutaneous coronary intervention (PCI)-related periprocedural myonecrosis (PM) in patients with stable coronary artery disease (CAD).
The study included 46 patients (mean age 65±2 y, 37 men) with stable CAD who underwent elective PCI using IVUS and a Doppler flow guidewire. In addition to routine IVUS measurements, the presence of deep echo attenuation (DEA) without calcification was assessed. The sum of all high-intensity transient signals (HITS) after a balloon deflation procedure was calculated using a Doppler flow guidewire. PM was defined as an elevation in troponin T to >0.03 ng/mL 24-hour after PCI. Patients were divided into 2 groups on the basis of the presence or absence of PM.
PM was identified in 17 patients (37%). Estimated glomerular filtration ratio was lower in the PM group (p=0.021). Target vessel distribution was different between the groups (p=0.004). Positive remodeling and DEA, as observed on IVUS, were more common in the PM group (p=0.03 and p<0.0001, respectively). The total number of HITS was higher in the PM group (p=0.003). Logistic regression analysis demonstrated that the presence of DEA (p=0.003) was the sole factor associated with the occurrence of PM.
These results demonstrated that DEA is an important factor associated with PM in patients who underwent an elective PCI. Therefore, IVUS to determine the presence of DEA should be performed before PCI.
Internal Medicine 01/2012; 51(7):691-8. · 0.94 Impact Factor
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Noritaka Fujimura,
Daisuke Jitsuiki, Tatsuya Maruhashi,
Shinsuke Mikami,
Yumiko Iwamoto,
Masato Kajikawa,
Kazuaki Chayama,
Yasuki Kihara,
Kensuke Noma,
Chikara Goto,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Geranylgeranylacetone (GGA) induces expression of heat shock protein 90 (Hsp90), an adaptor molecule for assembly of endothelial nitric oxide synthase (eNOS) phosphorylation complex. The purpose of this study was to determine whether GGA enhances Hsp90 expression and augments endothelium-dependent vasodilation via upregulation of eNOS in humans.
We evaluated the effects of GGA on human umbilical vein endothelial cells (HUVECs) and on forearm blood flow (FBF) responses to acetylcholine and sodium nitroprusside in 40 healthy young men. Hsp90, eNOS, AMP-activated protein kinase (AMPK), and Akt expression in HUVECs and peripheral blood mononuclear cells was detected by Western blot analysis. GGA increased Hsp90 expression and phosphorylation of eNOS and AMPK but not Akt in HUVECs and increased Hsp90 expression in peripheral blood mononuclear cells. Oral administration of GGA (600 mg) augmented the FBF response to acetylcholine. Infusion of N(G)-monomethyl-l-arginine, an NO synthase inhibitor, completely abolished GGA-induced augmentation of the FBF response to acetylcholine. GGA also augmented the acetylcholine-stimulated NO release in smokers.
These findings suggest that GGA-induced activation of Hsp90/AMPK significantly increased NO-mediated vasodilation in healthy subjects, as well as in smokers. The use of GGA may be a new therapeutic approach for improving endothelial dysfunction.
Arteriosclerosis Thrombosis and Vascular Biology 01/2012; 32(1):153-60. · 6.37 Impact Factor
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ABSTRACT: A healthy endothelium maintains vascular tone and structure. The purpose of this study was to evaluate endothelial function in corkscrew collateral arteries in Buerger disease.
We measured flow-mediated vasodilation (FMD) in corkscrew arteries in 26 patients with Buerger disease, in control arteries in 26 healthy subjects, and in native arteries in 16 patients with Buerger disease.
Hyperemic flow was lower in corkscrew arteries than in native arteries in patients with Buerger disease and in control arteries in healthy subjects. There was no significant difference between hyperemic flow in patients with Buerger disease in whom measurements were performed in native arteries and that in healthy subjects. FMD was lower in corkscrew arteries and native arteries in patients with Buerger disease than in control arteries in healthy subjects. There was no significant difference between FMD in corkscrew arteries in patients with Buerger disease and in that in native arteries. The ratio of FMD to hyperemic flow was significantly smaller in native arteries in patients with Buerger disease than in corkscrew arteries and in control arteries in healthy subjects (5.5 ± 6.2 vs 8.8 ± 8.9 and 9.6 ± 7.6 mL/min, P < .001, respectively). There was no significant difference in the ratio of FMD to hyperemic flow between corkscrew arteries in Buerger disease and control arteries in healthy subjects. Nitroglycerin-induced vasodilation was similar in all leg arteries.
Endothelial function of a corkscrew collateral artery in patients with Buerger disease is maintained, while endothelial function is impaired in a native artery in Buerger disease.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 09/2011; 54(6):1689-97. · 3.52 Impact Factor
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Junko Soga,
Kensuke Noma,
Takaki Hata,
Takayuki Hidaka,
Yuichi Fujii,
Naomi Idei,
Noritaka Fujimura,
Shinsuke Mikami, Tatsuya Maruhashi,
Yasuki Kihara,
Kazuaki Chayama,
Hitoshi Kato,
James K Liao,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular diseases are associated with chronic activation of Rho-associated kinases (ROCKs) and endothelial dysfunction. Both increased ROCK activity and endothelial dysfunction are thought to be closely associated with conventional cardiovascular risk factors. The purpose of this study was to determine the relationships between ROCK activity, endothelial function, and cardiovascular risk factors.
We evaluated ROCK activity in peripheral leukocytes by Western blot analysis and flow-mediated vasodilation by ultrasonography in 242 men who had no cardiovascular or cerebrovascular diseases (mean age, 40±10 years; range, 20 to 73 years). ROCK activity was defined as the ratio of phospho myosin-binding subunit on myosin light chain phosphatase to total myosin-binding subunit. Univariate regression analysis revealed that leukocyte ROCK activity significantly correlated with body mass index (r=0.29, P=0.003); systolic blood pressure (r=0.25, P=0.01); low-density lipoprotein cholesterol level (r=0.21, P=0.04); and Framingham risk factor score, a cumulative cardiovascular risk index for heart attack (r=0.31, P<0.001), and that flow-mediated vasodilation significantly correlated with age (r=-0.23, P=0.02), body mass index (r=0.19, P=0.05), systolic blood pressure (r=-0.22, P=0.03), total cholesterol level (r=-0.21, P=0.04), low-density lipoprotein cholesterol level (r=-0.22, P=0.04), glucose level (r=-0.20, P=0.04), and Framingham risk factor score (r=-0.37, P<0.001). There was a significant correlation between leukocyte ROCK activity and flow-mediated vasodilation (r=-0.41, P<0.001). Multivariate analysis revealed that flow-mediated vasodilation was an independent predictor of leukocyte ROCK activity.
These findings suggest that cumulative cardiovascular risk may enhance ROCK activity and endothelial dysfunction, leading to progression of cardiovascular diseases and outcomes.
Arteriosclerosis Thrombosis and Vascular Biology 07/2011; 31(10):2353-9. · 6.37 Impact Factor
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Yuichi Fujii,
Junko Soga,
Takayuki Hidaka,
Takaki Hata,
Naomi Idei,
Noritaka Fujimura,
Shinsuke Mikami, Tatsuya Maruhashi,
Yasuki Kihara,
Kensuke Noma,
Yukihito Higashi
Journal of the American College of Cardiology 06/2011; 57(25):2539. · 14.16 Impact Factor
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Naomi Idei,
Junko Soga,
Takaki Hata,
Yuichi Fujii,
Noritaka Fujimura,
Shinsuke Mikami, Tatsuya Maruhashi,
Kenji Nishioka,
Takayuki Hidaka,
Yasuki Kihara,
Moniruddin Chowdhury,
Kensuke Noma,
Akira Taguchi,
Kazuaki Chayama,
Taijiro Sueda,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Bone-marrow mononuclear cell (BM-MNC) implantation improves ischemic symptoms in patients with critical limb ischemia (CLI). The purpose of this study was to evaluate long-term clinical outcomes after autologous BM-MNC implantation in patients with CLI.
We assessed long-term clinical outcomes after BM-MNC implantation in 51 patients with CLI, including 25 patients with peripheral arterial disease (PAD) and 26 patients with Buerger disease. Forty-six CLI patients who had no BM-MNC implantation served as control subjects. Median follow-up period was 4.8 years. The 4-year amputation-free rates after BM-MNC implantation were 48% in PAD patients and 95% in Buerger disease, and they were 0% in control PAD patients and 6% in control Buerger disease. The 4-year overall survival rates after BM-MNC implantation were 76% in PAD patients and 100% in Buerger disease, and they were 67% in control PAD patients and 100% in control Buerger disease. Multivariable Cox proportional hazards analysis revealed that BM-MNC implantation correlated with prevention of major amputation and that hemodialysis and diabetes mellitus correlated with major amputation. In Buerger disease, ankle brachial pressure index and transcutaneous oxygen pressure were significantly increased after 1 month and remained high during 3-year follow-up. However, in patients with PAD, ankle brachial pressure index and transcutaneous oxygen pressure significantly increased after 1 month and gradually decreased during 3-year follow-up and returned to baseline levels.
These findings suggest that BM-MNC implantation is safe and effective in patients with CLI, especially in patients with Buerger disease. Clinical Trial Registration- URL: http://home.hiroshima-u.ac.jp/angio/. Unique identifier: 001769.
Circulation Cardiovascular Interventions 02/2011; 4(1):15-25. · 6.06 Impact Factor
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Naomi Idei,
Kenji Nishioka,
Junko Soga,
Takayuki Hidaka,
Takaki Hata,
Yuichi Fujii,
Noritaka Fujimura, Tatsuya Maruhashi,
Shinsuke Mikami,
Hiroki Teragawa,
Yasuki Kihara,
Kensuke Noma,
Kazuaki Chayama,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Thromboangitis obliterans (TAO; Buerger's disease) and atherosclerosis obliterans (ASO) are associated with endothelial dysfunction. The purpose of this study was to evaluate the role of circulating progenitor cells (CPCs) in endothelial function in patients with TAO and ASO. We measured flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation, and circulating CPCs in 30 patients with TAO and 30 age- and sex-matched healthy subjects and in 40 patients with ASO. FMD was smaller in both the TAO group and ASO group than in the control group (6.6 ± 2.7%, 5.7 ± 3.3% versus 9.5 ± 3.1%, P<0.0001, respectively). There was no significant difference in FMD between the TAO group and ASO group. Nitroglycerine-induced vasodilation was similar in the 3 groups. The number of and migration of circulating CPCs were similar in the TAO group and control group, whereas the number of and migration of circulating CPCs were significantly lower in the ASO group than in other groups (ASO 553 ± 297/mL versus TAO 963 ± 543/mL; control 1063 ± 426/mL and ASO 36 ± 18/hpf versus TAO 62 ± 23/hpf; control 68 ± 18/hpf, P<0.0001, respectively). There was a significant relationship between the number of and migration of CPCs and FMD (r = 0.43 and r = 0.40, P<0.0001, respectively). FMD was impaired in patients with TAO as well as in patients with ASO compared to that in normal control subjects, and the number of and function of circulating CPCs were not decreased in patients with TAO. These findings may partially explain why there are differences in cardiovascular morbidity and mortality rates between patients with TAO and patients with ASO.
Hypertension 01/2011; 57(1):70-8. · 6.21 Impact Factor
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Takaki Hata,
Junko Soga,
Takayuki Hidaka,
Naomi Idei,
Yuichi Fujii,
Noritaka Fujimura,
Shinsuke Mikami, Tatsuya Maruhashi,
Yasuki Kihara,
Kazuaki Chayama,
Hitoshi Kato,
Kensuke Noma,
James K Liao,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Rho-associated kinases (ROCKs) play an important role in Ca sensitization and vascular resistance. Activation of ROCKs is associated with hypertension. The purpose of this study was to evaluate the effect of the calcium channel blocker amlodipine on ROCKs activity in patients with hypertension.
We evaluated ROCK activity in peripheral leukocytes by Western blot analysis in 651 patients with hypertension treated with antihypertensive agents, 28 untreated hypertensive patients and 28 healthy individuals, and the effects of treatment with amlodipine or losartan for 12 weeks on ROCK activity in 28 untreated hypertensive patients who were randomly divided into an amlodipine group (n = 14) and a losartan group (n = 14). ROCK activity was defined as the ratio of phospho myosin-binding subunit (MBS) on myosin light-chain phosphatase to total MBS.
Leukocyte ROCK activity was greater in untreated patients with essential hypertension than in the healthy individuals (0.84 ± 0.24 vs. 0.61 ± 0.18, P = 0.03). In 651 patients with hypertension treated with antihypertensive agents, ROCK activity was significantly lower in the calcium channel blocker-treated group than in the groups treated with renin-angiotensin system inhibitors, diuretics, and β-blockers (0.70 ± 0.24 vs. 0.85 ± 0.29, 0.83 ± 0.24, and 0.86 ± 0.31, P < 0.05, respectively). ROCK activity after 4 and 12 weeks of treatment was significantly decreased in the amlodipine group (0 weeks: 0.85 ± 0.25, 4 weeks: 0.66 ± 0.16, 12 weeks: 0.64 ± 0.15, P < 0.05, respectively) but not in the losartan group, whereas the antihypertensive effects were similar in the two groups.
These findings suggest that calcium channel blocker amlodipine inhibits ROCK activity in patients with hypertension.
Journal of hypertension 10/2010; 29(2):373-9. · 4.02 Impact Factor
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Takaki Hata,
Chikara Goto,
Junko Soga,
Takayuki Hidaka,
Yuichi Fujii,
Naomi Idei,
Noritaka Fujimura, Tatsuya Maruhashi,
Shinsuke Mikami,
Yasuki Kihara,
Kazuaki Chayama,
Kensuke Noma,
James K Liao,
Yukihito Higashi
[show abstract]
[hide abstract]
ABSTRACT: Rho-associated kinases (ROCKs) have been shown to be involved in the pathogenesis of atherosclerosis. It is clinically important to estimate the degree of ROCK activity in humans. The purpose of this study was to confirm the validity of a leukocyte ROCK parameter as an index of ROCK activity in comparison with vascular response to a ROCK inhibitor.
We evaluated the ratio of phospho myosin-binding subunit (p-MBS) on myosin light-chain phosphatase to total MBS in peripheral leukocytes by Western blot analysis and forearm blood flow (FBF) response to the ROCK inhibitor fasudil using strain-gauge plethysmography in 36 healthy subjects and 39 patients with cardiovascular diseases. Fasudil (3, 10, 30μg/min) was infused intra-arterially for 5min at each dose. Leukocyte p-MBS/total-MBS was higher in cardiovascular diseases than in healthy subjects (0.97±0.37 vs. 0.51±0.14; P=0.002). Fasudil increased FBF from 4.9±1.2 to 14.5±5.7mL/min/100mL tissue (P<0.0001) in patients with cardiovascular diseases, while fasudil did not alter FBF in healthy subjects. There was a significant relationship between leukocyte p-MBS/total-MBS and maximal FBF response to fasudil in all subjects (r=0.72, P<0.0001). There was also a significant correlation between p-MBS/total-MBS and maximal FBF response to fasudil in patients with cardiovascular diseases (r=0.59, P<0.0001). In healthy subjects, there was no significant correlation between the two parameters.
These findings suggest that assessment of leukocyte ROCK activity is minimally invasive and does not require pharmacologic intervention using ROCK inhibitors. Leukocyte p-MBS/total-MBS may be useful for evaluating ROCK activity in a clinical setting.
Atherosclerosis 10/2010; 214(1):117-21. · 3.79 Impact Factor
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Tatsuya Maruhashi,
Masaharu Ishihara,
Ichirou Inoue,
Takuji Kawagoe,
Yuji Shimatani,
Satoshi Kurisu,
Yasuharu Nakama,
Eisuke Kagawa,
Kazuoki Dai,
Junichi Matsushita,
Hiroki Ikenaga
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ABSTRACT: Prodromal angina pectoris (AP) has a cardioprotective effect by the mechanism of ischemic preconditioning, and the QRS score on the admission electrocardiogram (ECG) reflects myocardial damage at presentation. This study was undertaken to investigate the effect of prodromal AP on infarct progression after the onset of acute myocardial infarction (AMI).
The study group comprised 291 patients with a first ST-elevation AMI who underwent coronary angiography within 24 h of symptom onset. QRS score was calculated from the admission ECG. Patients were divided into 3 groups according to elapsed time from onset of AMI to angiography: early group (<2 h), intermediate group (2-6 h) and late group (6-24 h). Prodromal AP was defined as angina occurring 24 h before the onset of AMI. Patients with prodromal AP (n=101; 35%) had a significantly lower QRS score than those without (2.4+/-2.4 vs 3.2+/-3.0, P=0.02). In patients without prodromal AP, the QRS score linearly increased as elapsed time increased: 2.6+/-2.8, 3.0+/-3.0 and 5.5+/-2.9 in the early, intermediate and late groups, respectively. In patients with prodromal AP, the QRS score remained low until 6 h after onset and then increased: 2.0+/-1.8, 2.0+/-2.1, and 4.1+/-3.3, respectively.
The findings suggested that prodromal AP might delay infarct progression during the early hours after the onset of AMI and extend the window of time for reperfusion therapy.
Circulation Journal 08/2010; 74(8):1651-7. · 3.77 Impact Factor
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Kazuoki Dai,
Masaharu Ishihara,
Ichiro Inoue,
Takuji Kawagoe,
Yuji Shimatani,
Satoshi Kurisu,
Yasuharu Nakama, Tatsuya Maruhashi,
Eisuke Kagawa,
Toshiyuki Aokage,
Junichi Matsushita,
Hiroki Ikenaga
[show abstract]
[hide abstract]
ABSTRACT: Conflicting data exist about the safety of the sirolimus-eluting stent (SES) for patients with ST-elevation myocardial infarction (STEMI). Previous studies have reported delayed neointimal proliferation over SES with high incidence of adhering thrombus. This study was undertaken to assess the neointimal coverage and thrombus formation after SES implantation between patients with STEMI and those with stable angina pectoris (SAP).
We studied 23 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with SES and 18 patients with SAP who were treated with SES. Coronary angioscopic examination was performed 8.1+/-2.4 months after PCI. Neointimal coverage of the stent was classified into four grades (grade 0 to 3). Uncovered stent strut was defined as grade 0 or 1. All the patients with STEMI and 94% of patients with SAP had uncovered stent struts. There was no significant difference in minimum, maximum, and dominant neointimal coverage grade between STEMI and SAP. 96% of patients with STEMI and all the patients with SAP showed heterogeneous neointimal coverage. Thrombus adhering to uncovered stent struts was observed in eight patients after STEMI and in four patients after SAP (35% vs. 22%, p=0.38). There was no significant difference in the maximum colour grade of the plaques between STEMI and SAP (2.1+/-0.8 vs. 1.8+/-0.9, p=0.33). Most thrombus was observed at the site of yellow plaques (83%).
There was no significant difference in the neointimal coverage and thrombus formation between STEMI and SAP.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 06/2010; 6(2):251-6. · 3.29 Impact Factor
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Satoshi Kurisu,
Ichiro Inoue,
Takuji Kawagoe,
Masaharu Ishihara,
Yuji Shimatani,
Yasuharu Nakama, Tatsuya Maruhashi,
Eisuke Kagawa,
Kazuoki Dai,
Junichi Matsushita,
Hiroki Ikenaga
[show abstract]
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ABSTRACT: This report describes a case of atrioventricular crosstalk during a stimulation threshold test. This phenomenon was likely due to the accidental connection between the atrial and ventricular stylets. Electrocardiologists should recognize atrioventricular crosstalk during a stimulation threshold test to avoid repositioning the atrial lead unnecessarily or inducing ventricular arrhythmia.
Journal of Cardiovascular Medicine 10/2009; 11(3):190-2. · 1.51 Impact Factor
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Satoshi Kurisu,
Ichiro Inoue,
Takuji Kawagoe,
Masaharu Ishihara,
Yuji Shimatani,
Yasuharu Nakama, Tatsuya Maruhashi,
Eisuke Kagawa,
Kazuoki Dai,
Junichi Matsushita,
Hiroki Ikenaga
[show abstract]
[hide abstract]
ABSTRACT: A 59-year-old man had a witnessed collapse while driving a car. Approximately 10 min after the call to emergency services, paramedics arrived and initiated cardiopulmonary resuscitation. The first electrocardiogram (ECG) obtained by paramedics showed pulseless electrical activity. Review of his prehospital records documented that he experienced approximately 13 min of no flow or low flow before return of spontaneous circulation. On admission, he was still comatose with midrange dilated pupils. Electrocardiogram showed sinus rhythm, ST segment elevation in lead aVR, and ST segment depression in leads I, II, and V4-6. Coronary angiography showed 99% narrowing of the left main coronary artery (LMCA), but did not show any disease in the right coronary artery. A bare-metal stent was placed in the LMCA, and postdilated at 20 atmospheres. Immediately after return to the coronary care unit, therapeutic hypothermia was initiated. Hypothermia with a target temperature of 33.0 degrees C was maintained for 30 h. During this period, no significant hemodynamic instability occurred under intra-aortic balloon pumping (IABP) and intravenous catecholamines. Subsequently, he was slowly rewarmed at a rate of 0.3 degrees C/h up to 36.0 degrees C. Next day, the neurological condition improved and IABP was stopped. Creatine kinase increased to 2182 IU/l. Stent thrombosis did not occur despite the ad hoc loading of antiplatelet drugs. Follow-up echocardiography 9 days later showed mild hypokinesia of the anterior wall with an ejection fraction of 77%. He was discharged with no neurologic complications 18 days later.
Heart and Vessels 09/2009; 24(5):376-9. · 2.05 Impact Factor
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Eisuke Kagawa,
Ichiro Inoue,
Takuji Kawagoe,
Masaharu Ishihara,
Yuji Shimatani,
Satoshi Kurisu,
Yasuharu Nakama, Tatsuya Maruhashi,
Kazuoki Dai,
Junichi Matsushita,
Hiroki Ikenaga
[show abstract]
[hide abstract]
ABSTRACT: To investigate the impact of a history of diabetes mellitus on the neurologic outcome in comatose survivors of cardiac arrest of cardiac origin treated with mild hypothermia.
A prospective observational study was performed between September 2003 and July 2008. Eighty comatose survivors of cardiac arrest of cardiac origin were treated with mild hypothermia. Neurologic outcome at the time of hospital discharge, 30-day survival, and complications were assessed.
Twenty-four of the 80 patients (30%) had a history of diabetes. The rate of favorable neurologic outcome was significantly lower in diabetic (17%) than in nondiabetic patients (46%) (p=0.01). The rate of 30-day survival was lower in diabetic (33%) than in nondiabetic patients (54%), but the difference was not significant (p=0.10). Multivariate analysis suggested that a history of diabetes was an independent predictor of unfavorable neurologic outcome (odds ratio 7.00, 95% confidence interval 1.42-46.19, p=0.03), but not for 30-day survival. There was no significant difference in the prevalence of complications.
A history of diabetes is associated with poor neurologic outcome in comatose survivors of cardiac arrest treated with mild hypothermia.
Resuscitation 07/2009; 80(8):881-7. · 3.60 Impact Factor
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Satoshi Kurisu,
Ichiro Inoue,
Takuji Kawagoe,
Masaharu Ishihara,
Yuji Shimatani,
Yasuharu Nakama, Tatsuya Maruhashi,
Eisuke Kagawa,
Kazuoki Dai,
Junichi Matsushita,
Hiroki Ikenaga
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ABSTRACT: Earlier studies have often required the absence of obstructive coronary artery disease (CAD) as the criteria. However, it is probable that patients with tako-tsubo cardiomyopathy have an incidental CAD because most patients are elderly. We assessed the prevalence of incidental CAD.
We reviewed coronary angiograms of 97 Japanese patients with tako-tsubo cardiomyopathy. A wrapped left anterior descending artery (LAD) was defined as a LAD that perfused at least one-quarter of the inferior wall of the left ventricle in the 30 degrees right anterior oblique projection.
Ten patients (10%) had definitively incidental CAD defined as greater than 75% reduction in the luminal diameter of the major epicardial coronary artery. All patients had ST-segment elevation, and five patients had T-wave inversion on admission. Nine patients had single vessel disease, and one patient had double vessel disease. Six patients had CAD in the nonwrapped LAD, and they were judged to be definitively incidental. Three patients had CAD in the left circumflex artery, and two patients had CAD in the right coronary artery.
This study showed that incidental CAD was found in 10% of Japanese patients with tako-tsubo cardiomyopathy. In patients with CAD in the LAD, it should be carefully judged whether the CAD causes left ventricular apical ballooning to avoid performing coronary revascularization unnecessarily.
Coronary artery disease 04/2009; 20(3):214-8. · 1.56 Impact Factor
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Satoshi Kurisu,
Ichiro Inoue,
Takuji Kawagoe,
Masaharu Ishihara,
Yuji Shimatani,
Yasuharu Nakama, Tatsuya Maruhashi,
Eisuke Kagawa,
Kazuoki Dai,
Junichi Matsushita,
Hiroki Ikenaga
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ABSTRACT: The purpose of this study was to evaluate the effect of aortic valve replacement on electrocardiogram (ECG) in patients with aortic valve stenosis.
Serial 12-lead ECGs were obtained in 15 patients with aortic valve stenosis who underwent aortic valve replacement. Three ECG indexes for left ventricular hypertrophy were manually measured in each ECG: Sokolow-Lyon index (sum of S wave in V(1) and R wave in V(5)), Cornell voltage index (sum of R wave in aVL and S wave in V(3)), and Gubner index (sum of R wave in I and S wave in III).
After aortic valve replacement, Sokolow-Lyon index gradually decreased during 2 years (51.1 +/- 17.9 to 34.8 +/- 12.5 mm, P < .01). Cornell voltage index (25.6 +/- 7.0 to 15.0 +/- 4.8 mm, P < .01) and Gubner index (15.8 +/- 7.6 to 10.3 +/- 5.5 mm, P < .01) also gradually decreased during 2 years. ST depression in V(6) was found in 14 patients (93%) before aortic valve replacement. It resolved in 9 of 14 patients during 2 years.
Electrocardiographic evidence of left ventricular hypertrophy gradually resolved after aortic valve replacement in patients with aortic valve stenosis.
Journal of electrocardiology 04/2009; 42(5):410-3. · 1.08 Impact Factor
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ABSTRACT: Among 95 patients with Tako-tsubo cardiomyopathy, left ventricular (LV) apical thrombus was documented in 5 (5.3%) patients. The thrombus was mural in 2 (40%), and protruding in 3 (60%) patients. In 4 patients, LV apical thrombus disappeared after anticoagulant therapy. In one patient with protruding thrombus, brain infarction occurred. LV dysfunction was resolved during follow-up in all patients.
International journal of cardiology 03/2009; 146(3):e58-60. · 7.08 Impact Factor
