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ABSTRACT: Background: In recent years there has been a debate about the functional severity of restenosis of drug-eluting stents. The aim of the present study was to assess the functional severity of stenosis in patients with moderate angiographic restenosis after paclitaxel-eluting stents (PES) deployment. Methods and Results: Forty-two patients with moderate angiographic restenosis at the in-stent segment and/or approximately 5mm from the stent edge were enrolled. For comparison, furthermore, 42 patients with de novo stenosis lesions matched for angiographic severity were assigned to the control group. Quantitative coronary angiography and functional assessment using fractional flow reserve (FFR) were performed. Although percent diameter stenosis was not significantly different between the 2 groups (PES group, 40.6±11.2%; de novo group, 40.6±9.0%, P=0.981), the functional severity of stenosis was significantly less in the PES group than in the de novo group (FFR: PES group, 0.86±0.07; de novo group, 0.79±0.10, P=0.002). Conclusions: FFR was preserved in patients with moderate angiographic restenosis after PES deployment, and the functional severity of restenosis is often limited. Therefore, revascularization should be performed with caution for patients with moderate angiographic restenosis after PES deployment.
Circulation Journal 02/2013; · 3.77 Impact Factor
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ABSTRACT: When selecting coronary stenoses for interventional treatment, assessment of reversible ischaemia is paramount from a symptomatic as well as prognostic point of view. Fractional flow reserve (FFR) is now considered the gold standard for invasive assessment of ischaemia. By measuring FFR in the catheterization laboratory, one can accurately identify which lesions should be stented resulting in improved patient outcome in most elective clinical and angiographic conditions. Recently, in the European Society of Cardiology guidelines on coronary revascularization, FFR was upgraded to an IA classification in multivessel percutanous coronary intervention. In this review paper, the rationale for routine measurement of FFR will be reviewed and studies supporting its integration into everyday practice will be highlighted.
European Heart Journal 12/2012; · 10.48 Impact Factor
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ABSTRACT: Stent boost (SB) imaging is an enhancement of the radiologic edge of the stent by digital management of regular X-ray images. The purpose of the present study was to validate SB imaging by comparison with the anatomical standard using intravascular ultrasound (IVUS). We investigated SB and IVUS after stent implantation in 68 arteries in 60 patients. Based on those findings, we added high-pressure dilatation in four patients and another stent implantation in four patients. We defined the SB criteria for adequate stent deployment as: complete stent expansion, stent minimum diameter ≥70% of reference diameter, and stent minimum diameter ≥2.0 mm; and IVUS criteria for adequate stent deployment as: minimal stent area ≥5.0 mm(2). If the reference vessel was <2.8 mm, adequate stent deployment was defined as minimum stent area ≥4.5 mm(2). IVUS findings indicated inadequate stent deployment in 21/72 observations (29%). Seven SB images showed inadequate stent expansion. SB predicted inadequate findings of IVUS with 100% specificity, 33% sensitivity, and 81% agreement. Although the sensitivity of SB image for adequate stent deployment is low, the specificity is sufficiently high for it to be the first-line for monitoring just after stent implantation in centers where IVUS is not used routinely.
Heart and Vessels 10/2011; · 2.05 Impact Factor
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ABSTRACT: Although stress-induced myocardial stunning often develops after exercise testing, determinants of this phenomenon have not been evaluated.
Thirty-one patients with 1-vessel coronary artery disease, limited to the left anterior descending artery (LAD), were evaluated by quantitative coronary angiography (QCA) and intracoronary pressure measurements to calculate fractional flow reserve (FFR). In addition, electrocardiogram-gated technetium-99m sestamibi myocardial imaging was acquired >30 min after exercise and 4 h later to assess the development of stunning. Exercise-induced myocardial stunning was observed in 11 patients (35%). In patients with myocardial stunning, a summed stress score (17.3+/-7.1 vs. 8.1+/-6.2, p<0.001), summed difference score (10.3+/-4.1 vs. 2.7+/-1.9, p<0.0001), and wall motion difference score (4.8+/-2.8 vs. 0.9+/-1.1, p<0.0001) were greater than in those without, while diameter stenosis calculated by QCA (55.1+/-17.3% vs. 29.8+/-17.3%, p<0.0001) was greater and FFR reduced significantly (0.54+/-0.13 vs. 0.83+/-0.06, p<0.0001). Of note, 4 out of 21 patients (19%) with <50% LAD stenosis developed myocardial stunning, whereas only one patient with FFR of 0.64 or greater showed stunning. The best cut-off value was determined as 0.64 for FFR and 46% for QCA, providing 91% sensitivity and 100% specificity for FFR (chi-square=57.2), but 91% sensitivity and 80% specificity for diameter stenoses measured by QCA (chi-square=17.8).
The major determinant for exercise-induced myocardial stunning was a severe flow-limiting coronary stenosis, which was more important than anatomical evaluation based on luminal narrowing alone.
Journal of Cardiology 01/2010; 55(3):337-44. · 1.28 Impact Factor
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ABSTRACT: The effect of acute hyperglycemia (AHG) during the oral glucose tolerance test (OGTT) on coronary microvascular function was evaluated, as well as the associations among the changes in coronary microvascular function, oxidative stress, and sympathetic tone.
Transthoracic Doppler echocardiography and OGTT were performed in 24 subjects with atherosclerotic risk factors (61+/-9 years). The coronary flow velocity before and during the infusion of adenosine (CFV(hyp)), plasma levels of thiobarbituric acid-reactive substances (TBARS), and the low-frequency/high-frequency power (LF/HF) ratio yielded by power spectral analysis of heart rate variability were measured before and at 1 h during 75-g OGTT. AHG significantly decreased the CFV(hyp), and increased the TBARS and LF/HF. Multiple linear regression analysis revealed that the percent changes in the CFV(hyp) were significantly associated with the percent changes in the LF/HF ratio (beta=-0.43, p<0.05).
In subjects with atherosclerotic risk factors who may be considered likely to have atherosclerotic arterial damage, AHG seems to induce concomitant coronary microvascular dysfunction, increased oxidative stress, and sympathetic activation. Coronary microvascular dysfunction, therefore, appears to be closely related to sympathetic activation.
Circulation Journal 03/2007; 71(2):202-6. · 3.77 Impact Factor
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ABSTRACT: Since a decrease of central aortic pressure contributes to the prevention of cardiovascular events, simple measurement of not only brachial blood pressure but also central aortic pressure may be useful in the prevention and treatment of cardiovascular diseases. In this study, we simultaneously measured radial artery pulse waves non-invasively and ascending aortic pressure invasively, before and after the administration of nicorandil. We then compared changes in central aortic pressure and radial arterial blood pressure calibrated with brachial blood pressure in addition to calculating the augmentation index (AI) at the aorta and radial artery. After nicorandil administration, the reduction in maximal systolic blood pressure in the aorta (Deltaa-SBP) was -14+/-15 mmHg, significantly larger than that in early systolic pressure in the radial artery (Deltar-SBP) (-9+/-12 mmHg). The reduction in late systolic blood pressure in the radial artery (Deltar-SBP2) was -15+/-14 mmHg, significantly larger than Deltar-SBP, but not significantly different from Deltaa-SBP. There were significant relationships between Deltaa-SBP and Deltar-SBP (r=0.81, p<0.001), and between Deltaa-SBP and Deltar-SBP2 (r=0.91, p<0.001). The slope of the correlation regression line with Deltar-SBP2 (0.83) was larger and closer to 1 than that with Deltar-SBP (0.63), showing that the relationship was close to 1:1. Significant correlations were obtained between aortic AI (a-AI) and radial AI (r-AI) (before nicorandil administration: r=0.91, p<0.001; after administration: r=0.70, p<0.001). These data suggest that the measurement of radial artery pulse wave and observation of changes in the late systolic blood pressure in the radial artery (r-SBP2) in addition to the ordinary measurement of brachial blood pressure may enable a more accurate evaluation of changes in maximal systolic blood pressure in the aorta (a-SBP).
Hypertension Research 03/2007; 30(3):219-28. · 2.58 Impact Factor
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ABSTRACT: The effect of cibenzoline, a class-Ia antiarrhythmic drug, on coronary flow velocity reserve (CFVR) was examined in patients with hypertrophic cardiomyopathy using transthoracic Doppler echocardiography. Coronary flow velocity reserve was assessed in 11 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 12 patients with hypertrophic nonobstructive cardiomyopathy (HNCM), before and after the intravenous administration of cibenzoline (1 mg/kg). Coronary hyperemia was induced by an intravenous infusion of adenosine triphosphate and CFVR was calculated as the ratio of hyperemic to basal mean coronary diastolic flow velocity. At baseline, CFVR was significantly correlated with left ventricular outflow tract pressure gradient (LVPG) in patients with HOCM (r = 0.67, P < 0.03). In patients with HOCM, administration of cibenzoline significantly improved impaired CFVR (2.0 +/- 0.8 to 3.0 +/- 1.0, P < 0.001), and reduced LVPG (55 +/- 30 to 23 +/- 18 mmHg, P < 0.001), while CFVR remained unchanged in patients with HNCM (2.6 +/- 0.9 to 2.9 +/- 0.8, P not significant). Cibenzoline not only reduces LVPG but also improves CFVR in patients with HOCM. In addition left ventricular outflow obstruction plays an important role in impaired coronary circulation in patients with HOCM.
Heart and Vessels 12/2006; 21(6):350-5. · 2.05 Impact Factor
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ABSTRACT: The aim of the present study was to quantitatively assess the physiological acute recoil after percutaneous coronary intervention (PCI), and to determine the relation between it and target lesion revascularization (TLR) in the chronic phase.
This study evaluated 76 patients who underwent elective PCI between May 1997 and December 2001: plain old balloon angioplasty (POBA) in 50 patients and bare metal stent implantation in 26 patients. Fractional flow reserve (FFR) was measured immediately (FFR0m) and 15 min (FFR15m) after the final dilation, and the difference (dif-FFR) was calculated. In POBA patients with TLR, FFR15m was significantly low (0.79+/-0.05 vs 0.87 +/-0.08, p<0.001) and dif-FFR was significantly high (0.06+/-0.04 vs -0.01+/-0.04, p<0.001) compared with the patients without TLR. The patients with a larger dif-FFR value (> or =0.05) had a higher rate of TLR (92%). Dif-FFR was the strongest independent predictor of TLR.
The changes in FFR during the time course shortly after coronary intervention can be detected and a decrease in the first 15 min after PCI is associated with a higher rate of TLR.
Circulation Journal 11/2006; 70(10):1327-31. · 3.77 Impact Factor
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ABSTRACT: Although a very simple method of measuring brachial -- ankle pulse wave velocity (baPWV) has become available in a clinical setting, whether baPWV can predict future cardiovascular events remains uncertain. We examined whether baPWV is a predictor of cardiovascular events in patients with acute coronary syndrome (ACS).
baPWV measurement was performed in 215 consecutive patients with ACS. During the follow-up period (26+/-10 months), 46 patients experienced post-hospitalization cardiovascular events (18 patients experienced a major event (eg, stroke, re-admission for heart failure or cardiac death), and 28 patients experienced coronary re-intervention). A receiver operating characteristic curve demonstrated that the best cut-off point of a baPWV for predicting a post-hospitalization cardiovascular event was 17.00 m/s and that for predicting a major cardiovascular event was 18.00 m/s. After the adjustment for the conventional risk factors influencing the prognosis, a multivariate Cox proportional hazards model demonstrated that both cut-off points of baPWV had a significant hazard ratio for a post-hospitalization event: 5.47 (2.69-11.09) and for a major cardiovascular event: 9.22 (2.78-30.56).
baPWV is a simple predictor of the prognosis of patients with ACS that is independent of conventional risk factors for ACS.
Circulation Journal 08/2005; 69(7):815-22. · 3.77 Impact Factor
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ABSTRACT: The objective of this study was to examine the usefulness of fractional flow reserve (FFR) in determining the indication of target lesion revascularization (TLR) at follow-up angiography after percutaneous coronary intervention (PCI). One hundred forty-seven patients with 155 lesions that had intermediate restenosis took part in this study. FFR was measured in all patients for the evaluation of stenosis severity. Then TLR was performed when FFR was < 0.75, and TLR was deferred when FFR was > or = 0.75. Patients in whom TLR was deferred were followed up clinically (25 +/- 11 months). In 98 patients (67%) who underwent stress myocardial scintigraphy before angiography, the results of the scintigraphy were compared with FFR results. TLR was performed in 34 lesions (22%). After TLR, the Canadian Cardiovascular Society class decreased significantly (from 1.5 +/- 0.7 to 1.1 +/- 0.5; P < 0.05). In 113 patients who did not undergo TLR, only 4 patients (3.5%) had cardiac events (re-PCI in 1 patient and a positive SPECT in 3 patients). Discordance between the results of scintigraphy and FFR was observed in 30 patients (30%), but the patients who had good values of FFR > or = 0.75 showed a nil event rate (0%). FFR might be useful for the determination of the indication of TLR.
Catheterization and Cardiovascular Interventions 07/2005; 65(3):355-60. · 2.29 Impact Factor
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ABSTRACT: Measurements of changes in plaque temperature may predict plaque rupture. The present study investigated variations in temperature within the atherosclerotic coronary artery using a pressure guide wire with thermal sensor (dual sensor guide wire).
Seventy-seven patients (78 lesions), who had no significant lesion at the orifice of the culprit coronary artery, were studied. The patients had acute myocardial infarction (22 patients), unstable angina pectoris (20 patients), and stable angina pectoris (35 patients). The thermal sensor was calibrated at the orifice of the coronary artery, and then inserted into the culprit coronary artery. deltaT was defined as the difference between the intracoronary temperature at the position of the pressure gradient and at the orifice. deltaT was higher in patients with acute myocardial infarction and unstable angina pectoris than in patients with stable angina pectoris (0.09 +/- 0.07 and 0.07 +/- 0.07 vs 0.03 +/- 0.04 degrees C, p < 0.001, p = 0.02, respectively). There was no significant difference in deltaT between patients with acute myocardial infarction and unstable angina pectoris (p = 0.48). Patients with acute myocardial infarction and unstable angina pectoris showed a significant relationship between deltaT and C-reactive protein (r = 0.59, p = 0.0004).
The variations in intracoronary temperature of the culprit coronary arteries in patients with acute coronary syndrome were higher than those in patients with stable angina pectoris. These variations may be related to inflammation of vulnerable plaque.
Journal of Cardiology 05/2005; 45(5):185-91. · 1.28 Impact Factor
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ABSTRACT: Regional myocardial systolic function in hypertensive left ventricular hypertrophy was assessed using the newly developed myocardial strain imaging.
This study included 17 patients with hypertensive left ventricular hypertrophy (LVH group) and 22 normal subjects (N group). The transmural location of the strain peak value (StPP), and the strain peak value (StPV) in the end-systolic phase were measured at the posterior wall by myocardial strain imaging. Left ventricular mass index was simultaneously measured in both groups.
StPV was significantly lower in the LVH group than the N group (1.00 +/- 0.36 vs 1.38 +/- 0.42, p < 0.01) and StPP was significantly moved to the epicardium side compared with the N group (31 +/- 10% vs 11 +/- 5%, p < 0.0001). StPV decreased and StPP increased with greater left ventricular mass index (r = -0.61, p < 0.0001; r = 0.72, p < 0.0001, respectively).
Myocardial systolic impairment in hypertensive left ventricular hypertrophy may occur from the endocardium side, and the impairment may progress with increased left ventricular hypertrophy.
Journal of Cardiology 03/2005; 45(2):53-60. · 1.28 Impact Factor
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ABSTRACT: Although the development of a coronary guidewire mounted with a pressure sensor has facilitated the measurement of pressure-derived fractional flow reserve (FFR) to assess the functional severity of coronary artery stenoses, the theoretical limitations include diabetes mellitus because of the associated microvascular abnormalities.
In the present study 304 vessels and their coronary territories in 96 diabetic and 149 nondiabetic patients were evaluated by pressure-derived FFR and thallium-201 single photon emission computed tomography (SPECT) to determine the applicability of measuring FFR in diabetic subjects. The best cut-off value for FFR to detect myocardial ischemia, as demonstrated by (201)Tl SPECT, was 0.725 in the diabetic and 0.745 in the nondiabetic patients. Sensitivity and specificity were similar for the 2 groups (83% and 75% (diabetic) vs 79% and 83%). However, diabetic patients with homoglobin (Hb) A(1c) >or=7.0% showed lower specificity in comparison with those having HbA(1c) <7.0% (64 vs 88%; p=0.045); however, sensitivities were similar (83 vs 83%; p=NS).
The cut-off value of 0.75 for FFR can detect myocardial ischemia in diabetic patients, although the adequacy of glycemic control should be taken into consideration when assessing the FFR measurements.
Circulation Journal 12/2004; 68(11):993-8. · 3.77 Impact Factor
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ABSTRACT: Recently, a measurement device that can simultaneously measure the ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (PWV) has become available. The present study compares the applicability of ABI and PWV as markers for predicting the prevalence of coronary artery disease (CAD) in subjects with a high risk of atherosclerotic cardiovascular disease. The ABI and brachial-ankle PWV were measured in 472 consecutive subjects who subsequently underwent coronary angiography for diagnosis or exclusion of CAD. The prevalence of CAD in the lowest ABI quartile was higher than those in the other 3 ABI quartiles, whereas the prevalence in the lowest brachial-ankle PWV quartile was lower than those in the other 3 brachial-ankle PWV quartiles. A multivariate logistic regression analysis demonstrated that the lowest ABI quartile was a significant independent variable for the prevalence of CAD and that the lowest brachial-ankle PWV quartile was a significant independent variable for the absence of CAD in a population. Thus, a low ABI is an independent marker for an additive risk of CAD, whereas a low brachial-ankle PWV may be used as an independent marker for excluding the risk of CAD among subjects with a high risk of atherosclerotic cardiovascular disease.
The American Journal of Cardiology 11/2004; 94(7):868-72. · 3.37 Impact Factor
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ABSTRACT: This study investigated the relationship between serum homocysteine level and coronary artery disease in Japanese.
Serum homocysteine level was measured in 200 consecutive patients who underwent coronary angiography for the assessment of ischemic heart disease. Patients with acute myocardial infarction were excluded, so 197 patients were included in this study. The patients were classified into four groups based on number of diseased vessels identified by coronary angiography: no significant stenosis group (non-vessel group), one-vessel group, two-vessel group, and three-vessel group. More than 50% stenosis was defined as diseased vessels.
Serum homocysteine level in the three-vessel group (13.5 +/- 8.0 microM) was significantly higher than that in the non-vessel group (9.9 +/- 2.7 microM), one-vessel group (9.1 +/- 2.3 microM), and two-vessel group (10.4 +/- 3.3 microM). Patients were classified into quartile groups according to the serum homocysteine level. The number of diseased vessels and frequency of three-vessel disease tended to be higher with increasing serum homocysteine level. There was no significant relationship between serum homocysteine level and coronary risk factors (diabetes mellitus, hyperlipidemia, smoking habit) except hypertension. Multivariate analysis for the predictor of number of diseased vessels showed diabetes mellitus, hypertension, and serum homocysteine level were independent predictors.
Elevation of plasma homocysteine level is related to the severity of coronary artery disease in Japanese.
Journal of Cardiology 06/2004; 43(5):223-9. · 1.28 Impact Factor
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ABSTRACT: Development of the coronary pressure wire has facilitated the measurement of fractional flow reserve (FFR) to assess the functional severity of coronary artery stenoses.
This study evaluated the correlations between FFR and myocardial direct counts of technetium-99m(99mTc)-sestamibi in 20 patients (16 men, 4 women, mean age 66 +/- 8 years) who underwent 99mTc-sestamibi single-photon emission computed tomography (SPECT) with the 2-day protocol using 740 MBq of 99mTc-sestamibi each day. Visual assessment of myocardial imaging and quantitative analysis with the measurement of percent uptake and direct count of 99mTc-sestamibi were performed.
Visual assessment of myocardial imaging revealed that reversibility of 99mTc-sestamibi perfusion defects was correlated with FFR of < 0.75, which is regarded as functionally important stenosis (17/20 vs 3/20, kappa = 0.71, p < 0.002). Regional reversibility score did not correlate with FFR (r = -0.40, p = NS). Quantitative analysis revealed that the change in 99mTc-sestamibi percent uptake with pharmacologic stress using adenosine triphosphate disodium (ATP) also did not correlate with FFR (r = 0.35, p = NS). In contrast, percent increase in 99mTc direct counts with ATP was lower in patients with FFR of < 0.75 than in those with FFR of > = 0.75 (-4 +/- 16% vs 24 +/- 30%, p < 0.01). In addition, a significant correlation (r = 0.70, p < 0.001) was observed between percent increase in 99mTc direct counts with ATP and FFR.
These results suggest that quantitative analysis of 99mTc-sestamibi scintigraphy enables the assessment of the magnitude of functional significance of coronary stenosis.
Journal of Cardiology 05/2004; 43(4):155-63. · 1.28 Impact Factor
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ABSTRACT: In 167 patients with suspected coronary artery disease, 74 of whom had myocardial infarction (MI), measurement of myocardial fractional flow reserve (FFR) in previous infarction territories, using a cut-off point of 0.75, showed a sensitivity of 79% and a specificity of 79% for myocardial ischemia as demonstrated by thallium-201 myocardial imaging. This sensitivity and specificity were similar to a sensitivity of 79% and a specificity of 72% observed in territories not related to MI. In addition, a receiver-operating characteristic curve analysis revealed that the best predictability of FFR for myocardial ischemia was between 0.74 and 0.76, regardless of the presence or absence of MI.
The American Journal of Cardiology 10/2003; 92(6):699-702. · 3.37 Impact Factor
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ABSTRACT: To assess the coronary flow velocity - pressure relationship distal to a stenosis, and to evaluate the influence of microvascular abnormalities on this relationship, coronary flow velocity and coronary pressure were measured simultaneously in 38 patients (42 vessels). The instantaneous peak coronary flow velocity was plotted against the simultaneous measured distal coronary pressure, and the slope of the relation in the phase of diastolic flow decrease was calculated as the flow - pressure slope index (FPSI) and the X-intercept of the slope was calculated as zero-flow pressure (Pzf). The slope of the curve increased from 2.0+/-2.6 to 4.5+/-4.1 (p<0.001) and the X-intercept decreased from 42+/-16 to 27+/-13 mmHg (p<0.001) after papaverine injection. After successful coronary intervention, Pzf increased from 23+/-10 to 35+/-11 (p<0.01) and FPSI decreased from 6.8+/-5.1 to 3.5+/-1.8 (p<0.05). Pzf was higher in patients with an old myocardial infarction. It is feasible to assess the relationship between coronary flow and pressure distal to a stenosis in the clinical setting, and the relationship may provide additional information regarding coronary microcirculation. Microvascular abnormalities may play an important role in the coronary flow - pressure relationship distal to stenosis.
Circulation Journal 07/2003; 67(6):525-9. · 3.77 Impact Factor
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Journal of Cardiology 06/2003; 41(5):259-61. · 1.28 Impact Factor
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ABSTRACT: To evaluate the usefulness of left anterior descending coronary artery (LAD) flow measured by transthoracic Doppler echocardiography (TTDE) in patients with acute coronary syndrome.
Thirty consecutive patients with acute coronary syndrome in the LAD territory and unstable angina or non-ST-segment elevation myocardial infarction required decisions on the need for emergency coronary angiography. The diastolic peak flow velocity was measured in the distal segment of the LAD under guidance of color Doppler echocardiography in the emergency room. If LAD flow was not detected within 10 min, the coronary flow was judged as under the detection limit. The results of TTDE were compared with the Thrombolysis in Myocardial Infarction (TIMI) grade of LAD determined by coronary angiography, which was performed within 1 week (mean 2.5 +/- 1.5 days) in all patients.
Coronary flow was not detected by TTDE in six patients who had TIMI grade 1 or 0. The diastolic peak flow velocity in 19 patients with TIMI 3 was higher than that in 5 patients with TIMI 2 (20.1 +/- 4.1 vs 10.9 +/- 2.3 cm/sec, p = 0.0001). A diastolic peak flow velocity of 14 cm/sec was the optimal cut-off value for the prediction of TIMI 3, with a sensitivity of 95% and a specificity of 100%.
Coronary flow velocity measured by TTDE closely reflected the TIMI grade. Coronary flow measurement by TTDE is useful to decide the treatment strategy for patients with acute coronary syndrome in the emergency room.
Journal of Cardiology 03/2003; 41(2):63-71. · 1.28 Impact Factor
