Tetsuya Sumiyoshi

Sakakibara Heart Institute, Фучу, Tōkyō, Japan

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Publications (180)555.36 Total impact

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    ABSTRACT: Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Scientific Council from January 2009 to December 2011, a total of 180 consecutive patients (144 men, 68 ± 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction flow grade 0 (absent initial coronary flow) were recruited. Achievements of post-PCI procedural Thrombolysis in Myocardial Infarction flow grade 3 (optimal coronary reflow) and also in-hospital mortality were evaluated in those in accordance with and without coronary thrombectomy. Coronary thrombectomy was performed in 128 patients with Shock-STEMI (71% of all). Overall in-hospital mortality was 41% and that in anterior Shock-STEMI with a necessity of mechanical circulatory support increased by 59% (i.e., profound shock). Coronary thrombectomy did not affect any improvements in the achievement of optimal coronary reflow (65% vs 58%, p = 0.368) and in-hospital mortality (42% vs 37%, p = 0.484) in these patients. Even when focused on 76 patients with profound shock, neither an achievement of optimal coronary reflow (56% vs 47%, p = 0.518) nor in-hospital mortality (58% vs 65%, p = 0.601) were different between with and without coronary thrombectomy. Multivariate logistic analysis did not demonstrate any association of coronary thrombectomy (p = 0.798), left main Shock-STEMI (p = 0.258), and use of mechanical circulatory support (p = 0.119) except a concentration of hemoglobin (for each 1 g/dl increase, odds ratio 1.247, 95% confidence interval 1.035 to 1.531, p = 0.019) with optimal coronary reflow. In conclusion, pre-PCI procedural coronary thrombectomy may have serious limitations on attempting optimal coronary reflow that indicates a necessity of promising strategies for this critical illness. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American journal of cardiology 03/2015; DOI:10.1016/j.amjcard.2015.03.008 · 3.43 Impact Factor
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    ABSTRACT: So far physiological significance of multiple intraluminal channels separated by thin wall structures, so called "a lotus root appearance", in an angiographic insignificant lesion in patients with suspected angina pectoris has remained undetermined. Here we present two cases that showed a "reverse visual-functional mismatch" phenomenon of a lotus root appearance using the indexes of myocardial fractional flow reserve and/or coronary flow velocity reserve. Our findings may provide a novel physiological insight into a lotus root appearance as a high possibility of critical functional stenosis in those with stable coronary artery diseases.
    Cardiovascular Intervention and Therapeutics 03/2015; DOI:10.1007/s12928-015-0325-5
  • Journal of the American College of Cardiology 03/2015; 65(10):A2037. DOI:10.1016/S0735-1097(15)62037-X · 15.34 Impact Factor
  • European Heart Journal 12/2014; 177(2):720-2. DOI:10.1016/j.ijcard.2014.10.024 · 14.72 Impact Factor
  • Journal of Cardiac Failure 10/2014; 20(10):S209. DOI:10.1016/j.cardfail.2014.07.425 · 3.07 Impact Factor
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    ABSTRACT: Background A novel real-time three-dimensional echocardiography (RT3DE) system allows fully automated quantification of the left ventricular (LV) volume throughout a cardiac cycle. This study aimed to investigate whether an LV time–volume curve, obtained using fully automated RT3DE, is useful in the evaluation of LV diastolic function. Methods First, 15 patients underwent simultaneous standard two-dimensional echocardiography (2DE), RT3DE, and cardiac catheterization to measure the time constant of the isovolumic-pressure decline (τ). From the LV time–volume curve obtained using RT3DE, peak early filling rate (PFR) during diastole was generated and indexed for LV end-systolic volume. Next 570 patients, who were scheduled for both 2DE and RT3DE examinations, were enrolled to investigate the association between PFR index and 2DE-evidenced diastolic dysfunction and clinical characteristics. Results Of the 585 patients, RT3DE analysis was adequate in 542 patients (feasibility 93%). In the 15 patients, PFR index showed significant correlation with τ (r = −0.65, p = 0.009). In the remaining 527 patients, PFR index was related to age (r = −0.24, p < 0.001) and e′ (r = 0.41, p < 0.001). PFR index decreased in proportion to the grade of 2DE-evidenced diastolic dysfunction. All patients with normal diastolic function had a PFR index greater than 2.0. Conclusions This study demonstrated that a novel, fully automated RT3DE-derived PFR index was the diagnostic tool of choice for the assessment of LV diastolic function.
    Journal of Cardiology 09/2014; DOI:10.1016/j.jjcc.2014.08.007 · 2.57 Impact Factor
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    ABSTRACT: Simultaneous dual-isotope SPECT imaging with 201Tl and (123)I-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) is used to study the perfusion-metabolism mismatch. It predicts post-ischemic functional recovery by detecting stunned myocardium. On the other hand, (99m)Tc-MIBI is another radioisotope widely used in myocardial perfusion imaging because of its better image quality and lower radiation exposure than 201Tl. However, since the photopeak energies of (99m)Tc and (123)I are very similar, crosstalk hampers the simultaneous use of these two radioisotopes. To overcome this problem, we conducted simultaneous dual-isotope imaging study using the D-SPECT scanner (Spectrum-Dynamics, Israel) which has a novel detector design and excellent energy resolution. We first conducted a basic experiment using cardiac phantom to simulate the condition of normal perfusion and impaired fatty acid metabolism. Subsequently, we prospectively recruited 30 consecutive patients who underwent successful percutaneous coronary intervention for acute myocardial infarction, and performed (99m)Tc-MIBI/(123)I-BMIPP dual-isotope imaging within 5 days after reperfusion. Images were interpreted by two experienced cardiovascular radiologists to identify the infarcted and stunned areas based on the coronary artery territories. As a result, cardiac phantom experiment revealed no significant crosstalk between (99m)Tc and (123)I. In the subsequent clinical study, (99m)Tc-MIBI/(123)I-BMIPP dual-isotope imaging in all participant yielded excellent image quality and detected infarcted and stunned areas correctly when compared with coronary angiographic findings. Furthermore, we were able to reduce radiation exposure to significantly approximately one-eighth. In conclusion, we successfully demonstrated the practical application of simultaneous assessment of myocardial perfusion and fatty acid metabolism by (99m)Tc-MIBI and (123)I-BMIPP using a D-SPECT cardiac scanner. Compared with conventional (201)TlCl/(123)I-BMIPP dual-isotope imaging, the use of (99m)Tc-MIBI instead of (201)TlCl improves image quality as well as lowers radiation exposure.
    Heart and Vessels 09/2014; DOI:10.1007/s00380-014-0578-4 · 2.11 Impact Factor
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    ABSTRACT: Although nitrates are widely used as a concomitant therapy with calcium channel blockers (CCBs) for vasospastic angina (VSA), their prognostic contribution remains unclear. The present study aimed to examine the prognostic impact of chronic nitrate therapy in patients with VSA.
    European Heart Journal 09/2014; 36(4). DOI:10.1093/eurheartj/ehu313 · 14.72 Impact Factor
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    ABSTRACT: Background/objectives: Detecting the presence of coronary artery disease (CAD) is critically important in managing patients with heart failure of uncertain cause. The recently introduced I-123-BMIPP/(TlCl)-Tl-201 dual myocardial single-photon emission computed tomography (dual SPECT) is potentially a non-invasive diagnostic tool in detecting ischemic heart disease. The aim of our study is to evaluate the efficacy of detecting CAD by dual SPECT in patients with heart failure. Methods: We studied 501 consecutive patients (366 males, mean age 68 +/- 12 years) who were admitted because of heart failure between January 2005 and April 2009. In all patients, the dual SPECT was performed in clinically stabilized states, followed by coronary angiography within 1 week. The polar map of the SPECT image was divided into 17 segments, each scored on a scale of 0-4 based on segmental percent uptake. The mismatch score was defined as the difference between I-123-BMIPP defect score and (TlCI)-Tl-201 defect score. The uptake of (TlCl)-Tl-201 and I-123-BMIPP was analyzed quantitatively using the Heart Score View software. Results: The (TlCl)-Tl-201 defect score and mismatch score were significantly higher in CAD patients than in non-CAD patients. The receiver operating characteristic (ROC) curve revealed that the mismatch score was a significantly more effective marker in detecting the presence of CAD than (TlCl)-Tl-201 defect score (area under the curve: 0.84 versus 0.73, p < 0.05). Using the mismatch score, the sensitivity and specificity of dual SPECT in detecting CAD were 84% and 83%, respectively. Conclusion: Dual SPECT is a useful non-invasive procedure for the detection of CAD in patients with heart failure.
    International Journal of Cardiology 08/2014; 176(3). DOI:10.1016/j.ijcard.2014.08.129 · 6.18 Impact Factor
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    ABSTRACT: Elevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS. We performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm(2)] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups. Age was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e' were significantly higher in elderly than younger patients [133.0 (IQR, 73.3-329.7)pg/dl vs 92.8 (IQR, 40.6-171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e', estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e', eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index. There may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients.
    Journal of Cardiology 05/2014; DOI:10.1016/j.jjcc.2014.03.005 · 2.57 Impact Factor
  • Journal of Cardiology Cases 04/2014; 9(4). DOI:10.1016/j.jccase.2013.12.003
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    ABSTRACT: In this study, the coronary findings in 185 autopsy cases with a ruptured abdominal aortic aneurysm (AAA) from the Tokyo Medical Examiner's Office were examined and compared with those in 1,056 patients undergoing AAA repair at the University of Tokyo Hospital or Sakakibara Heart Institute (Tokyo, Japan). The number of cases with any significant coronary stenosis was significantly greater in the autopsy cases with a ruptured AAA than in the patients undergoing emergency repair of a ruptured AAA, suggesting that the low prevalence of CAD observed in patients undergoing emergency repair of a ruptured AAA was due to the survival bias before reaching hospital. In addition, we also found that significant coronary left main trunk stenosis was more frequent in CAD cases with a ruptured AAA than in those with an unruptured AAA, findings that suggest novel clinical implications. Large-scale prospective studies are warranted to confirm our findings and to clarify the pathophysiological relationship between coronary atherosclerosis and AAA status.
    Heart and Vessels 03/2014; 30(3). DOI:10.1007/s00380-014-0488-5 · 2.11 Impact Factor
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    ABSTRACT: Background: The prognostic value of late gadolinium enhancement (LGE) on contrast-enhanced cardiovascular magnetic resonance (CMR) in Japanese hypertrophic cardiomyopathy (HCM) patients in a large, single-center cohort was investigated. Methods and Results: A total of 345 HCM patients (mean age, 59±17 years; 214 male) underwent CMR with gadolinium enhancement, and were followed (mean duration, 21.8 months) for cardiovascular events. Patients were divided into event-positive and event-negative groups. The clinical and CMR characteristics were compared between the 2 groups, and predictors of cardiovascular events assessed on multivariate analysis. LGE was positive in 252 patients (73%). The annual cardiovascular events rate was significantly higher in patients with LGE than in those without (6.2%/year vs. 0.6%/year, P=0.003). On multivariate analysis, LGE (hazard ratio [HR], 7.436; 95% confidence interval [CI]: 1.001-55.228, P=0.050), increased myocardial mass index (HR, 1.013; 95% CI: 1.002-1.023, P=0.018), reduced left ventricular ejection fraction (HR, 0.965; 95% CI: 0.945-0.985, P=0.001), and atrial fibrillation (HR, 2.257; 95% CI: 1.024-4.976, P=0.043) were significantly associated with cardiovascular events. Conclusions: The presence of LGE, increased myocardial mass index, reduced left ventricular ejection fraction and atrial fibrillation were independent predictors of adverse prognosis in Japanese HCM patients.
    Circulation Journal 02/2014; 78(4). DOI:10.1253/circj.CJ-13-0979 · 3.69 Impact Factor
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    ABSTRACT: Coronary artery bypass grafting (CABG) is considered the standard treatment for patients with left main disease (LMD). However, percutaneous coronary intervention (PCI) has recently emerged as a treatment option for selected patients. We assessed early and long-term outcomes of patients with LMD who underwent either CABG or PCI in our institution. We reviewed the records of 438 patients with LMD who underwent revascularization between January 2005 and December 2010. Treatment modality, chosen by our heart team, was CABG in 409 patients and PCI in 29. Age, prevalence of women, and mean ejection fraction of patients were not significantly different between groups. Mean logistic European system for cardiac operative risk evaluation score was 7.7. Mean follow-up was 37.1 months. In CABG group, mean number of anastomoses was 4.0 and complete revascularization was achieved in 97.1 %. Bilateral internal thoracic arteries were used in 87.0 %. In PCI group, mean number of stents was 1.3 and complete revascularization was achieved in 44.8 %. Drug-eluting stent was used in 72.4 %. In-hospital mortality was 1.1 % (1.0 %, CABG group vs. 3.4 %, PCI group; p = 0.29). At 3 years, overall survival was 94.3 % (95.3 vs. 81.1 %; p < 0.01) and rate of freedom from major adverse cardiac events and cerebrovascular accidents was 88.9 % (89.8 vs. 77.3 %; p = 0.05). Our heart team's approach resulted in favorable overall results in patients with LMD. Multidisciplinary decision making in these high-risk patients can make good long-term outcomes in CABG.
    General Thoracic and Cardiovascular Surgery 12/2013; 62(5). DOI:10.1007/s11748-013-0357-7
  • JACC. Cardiovascular imaging 12/2013; 6(12):1347-1349. DOI:10.1016/j.jcmg.2013.03.011 · 6.99 Impact Factor
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    ABSTRACT: The present study aimed to develop a comprehensive clinical risk score for vasospastic angina (VSA) patients. Previous studies demonstrated various prognostic factors of future adverse events in VSA patients. However, to apply these prognostic factors in clinical practice, the assessment of their accumulation in individual patients is important. The patient database of the multicenter registry study by the Japanese Coronary Spasm Association (JCSA) (n=1,429; median 66 years; median follow-up of 32 months) was utilized for score derivation. Multivariable Cox proportional hazard model selected 7 predictors of major adverse cardiac events (MACE). The integer score was assigned to each predictors proportional to their respective adjusted hazard ratio; history of out-of-hospital cardiac arrest (4 points), smoking, angina at rest alone, organic coronary stenosis, multivessel spasm (2 points each), ST-elevation during angina and β-blocker use (1 point each). According to the total score in individual patients, 3 risk strata were defined; low (score 0-2, n=598), intermediate (score 3-5, n=639) and high (score 6 or more, n=192). The incidence of MACE in the low-, intermediate- and high-risk patients were 2.5%, 7.0% and 13.0%, respectively (P<0.001). Cox model for MACE between the 3 risk strata also showed prognostic utility of the scoring system in various clinical subgroups. The average prediction rate of the scoring system in the internal training and validation sets were 86.6% and 86.5%, respectively. We developed a novel scoring system, the JCSA risk score, which may provide the comprehensive risk assessment and prognostic stratification for VSA patients.
    Journal of the American College of Cardiology 07/2013; 62(13). DOI:10.1016/j.jacc.2013.07.018 · 15.34 Impact Factor
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    ABSTRACT: We present a case of prosthetic valve endocarditis, which was caused by a rare etiological agent, Streptococcus constellatus. In our case, transesophageal echocardiography showed a large and broad abscess formation throughout the patient's aortic prosthetic valve ring and left atrium. Despite specific intravenous antibiotic therapy, the infection was uncontrollable, and the patient underwent surgical treatment. The pathogen rarely causes endocarditis, but it is known to have a strong potential to form abscess, and therefore its infection may be more serious than other Streptococcus species. Our case seems to be the first report of surgical treatment of PVE caused by S. constellatus. As in our case, transesophageal echocardiography is useful for the detection of vegetation and abscess, and early cardiac surgery may be a more appropriate therapeutic approach for endocarditis caused by S. constellatus.
    Heart & lung: the journal of critical care 07/2013; 42(5). DOI:10.1016/j.hrtlng.2013.05.006 · 1.32 Impact Factor
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    ABSTRACT: BACKGROUND: Acute Stanford type A aortic dissection (AAD) with coronary involvement is associated with high mortality. However, coronary involvement is not always successfully visualized by computed tomography and two-dimensional (2D) transesophageal echocardiography (TEE). The aim of this study was to test the hypothesis that three-dimensional (3D) TEE can detect coronary involvement in patients with AAD. METHODS: Fifty-one consecutive patients with AAD who underwent intraoperative TEE using an iE33 system during emergency surgery were enrolled. Using computed tomographic images, conventional 2D transesophageal echocardiographic images, and a 3D transesophageal echocardiographic data set, the status of coronary ostia was evaluated and classified into four types-branching from true lumen, branching from false lumen, dissection, and unclear-and these results were compared with operative findings. RESULTS: In six patients, coronary involvement was diagnosed operatively by surgeons. They comprised dissection at three left coronary ostia and branching from false lumen at three right coronary ostia. All six cases were successfully detected by both 2D TEE and 3D TEE before instituting cardiopulmonary bypass. However, in 45 patients (90 ostia) confirmed operatively as having no coronary involvement, 69 ostia by computed tomography (36 in the left and 33 in the right coronary artery) and 16 ostia by 2D TEE (four in the left and 12 in the right coronary artery) were evaluated as unclear coronary involvement. On the other hand, 3D TEE clearly depicted no coronary involvement in all but one (right coronary ostium) of the unclear cases. CONCLUSIONS: Three-dimensional TEE reduced the number of cases evaluated as unclear coronary involvement by computed tomography and 2D TEE. In patients with AAD, 3D TEE allows evaluation of the status of coronary ostia in the operating room.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 06/2013; 26(8). DOI:10.1016/j.echo.2013.05.001 · 3.99 Impact Factor
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    ABSTRACT: Background Recently, post-exercise diastolic stunning (PES) has been reported as a new clinical marker of induced ischemia. Velocity vector imaging (VVI) has been developed to visualize regional wall motion abnormalities based on vectors detected by the tissue tracking technique, which has the potential to visualize PES. Thus, the aim of this study was to evaluate the usefulness of PES detection by VVI as an objective marker of ischemia compared to stress thallium-201 (Tl-201) single photon emission computed tomography (SPECT). Methods We studied consecutive patients who were scheduled to undergo exercise stress Tl-201 SPECT for the diagnosis of ischemic heart disease. Transthoracic echocardiography was recorded digitally before and 20 min after exercise for Tl-201 SPECT, and the data were used subsequently for VVI analysis. We defined PES regions as those with new abnormal vectors observed during isovolumic relaxation. Results After excluding 14 patients with old myocardial infarction and/or atrial fibrillation, echocardiograms suitable for VVI analysis were obtained from 62 of 65 patients (feasibility, 95 %; 44 men; mean age, 64 ± 11 years). SPECT revealed induced ischemia in 20 patients, whereas VVI identified PES in 18 patients. VVI detected inducible ischemia with 85 % sensitivity and 98 % specificity compared to SPECT. Conclusions VVI detection of PES is a new clinical tool for induced ischemia. Regional diastolic wall motion abnormalities following induced ischemia can be noninvasively detected by VVI.
    Journal of Echocardiography 06/2013; 11(2). DOI:10.1007/s12574-012-0163-8

Publication Stats

1k Citations
555.36 Total Impact Points

Institutions

  • 2000–2015
    • Sakakibara Heart Institute
      Фучу, Tōkyō, Japan
  • 2004–2009
    • Kyoto University
      • Department of Cardiovascular Medicine
      Kyoto, Kyoto-fu, Japan
  • 2007
    • Tokyo Women's Medical University
      • Department of Cardiology
      Tokyo, Tokyo-to, Japan
  • 2003–2005
    • Osaka Police Hospital
      Ōsaka, Ōsaka, Japan
  • 1986–2003
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka-shi, Osaka-fu, Japan
  • 1996
    • Tokyo Junshin Women's College
      • Department of Cardiovascular Surgery
      Edo, Tōkyō, Japan
    • Osaka City General Hospital
      Ōsaka, Ōsaka, Japan