Tetsuya Sumiyoshi

Sakakibara Heart Institute, Фучу, Tōkyō, Japan

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Publications (197)644.09 Total impact

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    ABSTRACT: To address the critical issue that there are fewer survival benefits of mechanical circulatory support with percutaneous coronary intervention (PCI) in the treatment of a cardiogenic shock complicating acute myocardial infarction (AMI); the present study was undertaken to evaluate our hypothesis that mechanical circulatory support using intra-aortic balloon counterpulsation and/or percutaneous cardio-pulmonary bypass may provide clinical benefits if successfully treated with PCI in those with a cardiogenic shock complicating AMI. We assessed demographic and clinical data as well as information about emergency medical services, and the use of therapeutic interventions in a total of 376 consecutive patients (274 male, 69±12 years) with a cardiogenic shock complicating AMI who achieved post-PCI procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 enrolled in the Tokyo CCU Network registered cohort between January 2005 and December 2010. Overall in-hospital mortality was 29%, whereas mortality was much higher in 245 patients with mechanical circulatory support than in 131 without (36% vs. 14%, p=0.001). High prevalence of an anterior AMI (61% vs. 43%, p=0.001), a large number of males (77% vs. 65%, p=0.011), and a low systolic blood pressure (105±33mmHg vs. 123±34mmHg, p=0.003) were observed in those with mechanical circulatory support. When focused on an anterior AMI because of strongly impacting on adverse clinical outcomes in those with mechanical circulatory support, pre-PCI procedural TIMI flow grade 0 was mostly associated with in-hospital mortality (odds ratio, 3.036, 95% CI 1.399-6.590, p=0.005). Mechanical circulatory support may face some critical limitations to provide clinical benefits even in patients successfully treated with PCI for a cardiogenic shock complicating AMI. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Jun 2015 · Journal of Cardiology
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    ABSTRACT: Background: We retrospectively investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural therapeutic hypothermia may have clinical advantages in patients with a profound cardiogenic shock complicating anterior ST-segment elevation myocardial infarction (STEMI). Methods: Of 483 consecutive patients treated with PCI for a first anterior STEMI including 31 patients with aborted sudden cardiac arrest between 2009 and 2013, a total of 37 consecutive patients with an anterior STEMI complicated with profound cardiogenic shock defined as the presence of hyperlactic acidemia (serum levels of lactate >. 4. mmol/L) with mechanical circulatory support were identified. An impaired myocardial tissue-level reperfusion (angiographic myocardial blush grade 0 or 1) and in-hospital mortality were evaluated in accordance with the presence or absence of pre-PCI procedural therapeutic hypothermia. Results: Thirteen patients were treated with pre-PCI procedural therapeutic hypothermia and 24 were not inducted with therapeutic hypothermia. Five patients with and 18 without pre-PCI procedural therapeutic hypothermia impaired myocardial tissue-level reperfusion (38% vs. 75%, p. =. 0.037). A total of 26 patients with in-hospital death (overall in-hospital mortality 70%) were composed of 6 with and 20 without therapeutic hypothermia (in-hospital mortality 46% vs. 83%, p. =. 0.028). A multivariate analysis demonstrated a significant association of pre-PCI procedural therapeutic hypothermia (p. =. 0.021) with in-hospital survival benefit. Adverse events associated with therapeutic hypothermia were not found in 12 patients who completed this treatment. Conclusions: The present study may imply a crucial possibility of clinical benefits of pre-PCI procedural therapeutic hypothermia in patients with a cardiogenic shock complicating anterior STEMI.
    Full-text · Article · Jun 2015
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    ABSTRACT: Acute kidney injury (AKI) is relatively common after cardiothoracic surgery for type A acute aortic dissection (TA-AAD) and increases mortality. We investigated the incidence and risk factors for AKI in patients with TA-AAD and its impact on their outcomes. The records of 375 consecutive patients who underwent surgical treatment for TA-AAD from October 2007 to March 2013 were analyzed retrospectively. We defined AKI using the Kidney Disease Improving Global Outcomes criteria, which are based on serum creatinine concentration or glomerular filtration rate. We used Kaplan-Meier methods and multivariate Cox proportional hazards regression to assess the impact of AKI on both mortality and major adverse cardiovascular and cerebrovascular events. We also examined the association between risk factors and AKI using logistic regression modeling. Postoperative AKI was observed in 165 patients (44.0%). The overall 30-day and mid- to long-term mortality was 1.6% and 8.8%, respectively. Mortality and major adverse cardiovascular and cerebrovascular events correlated significantly with the severity of AKI, and multivariate analysis showed that AKI stage 3 (the most sever stage) was an independent risk factor for mortality (hazard ratio 6.83, 95% confidence interval 2.52 to 18.52) after adjustment for important confounding factors. Extracorporeal circulation time, body mass index, perioperative peak serum C-reactive protein concentration, renal malperfusion, and perioperative sepsis were found to be risk factors for AKI. In conclusion, AKI was common in patients who underwent surgery for type A acute aortic dissection. The severity of AKI strongly influences patient outcomes, so it should be recognized promptly and treated aggressively when possible. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · May 2015 · The American Journal of Cardiology
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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.
    No preview · Article · Mar 2015 · The American journal of cardiology
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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.
    No preview · Article · Mar 2015 · Cardiovascular Intervention and Therapeutics

  • No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    ABSTRACT: Objective : Coronary artery disease ( CAD ) frequently coexists with aortic stenosis ( AS ). During surgical aortic valve replacement, concomitant coronary artery bypass grafting is recommended in patients with significant CAD. However, the management of CAD in patients undergoing transcatheter aortic valve implantation ( TAVI ) is undetermined. Materials and Methods : We analyzed 120 consecutive patients who underwent TAVI between April 2010 and February 2015 in our hospital. Significant CAD was defined as unrevascularized significant coronary artery stenosis. Results : Of 120 patients, 34 ( 28% ) had significant CAD. Thirty-day outcomes were similar between patients with CAD and those without CAD. Among 34 patients with CAD, 15 ( 44% ) underwent percutaneous coronary intervention ( PCI ). PCI was performed safely, except one case of coronary dissection necessitating additional coronary stenting. The clinical outcomes at 30 day were the same in TAVI+PCI group and isolated TAVI group. Ischemic burden evaluated by SYNYAX score ( SS ) and Duke Myocardial Jeopardy Score ( DMJS ) were significantly alleviated by PCI ( SS : 7.2 ± 2.9 vs 0.5 ± 1.1, p < 0.01. DMJS : 5.3 ± 2.8 vs 0.4 ± 0.8, p
    Full-text · Article · Jan 2015
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    ABSTRACT: Sarcoidosis is a granulomatous disorder characterized by multi-organ involvement. Ventricular aneurysm is one of the features characterizing cardiac sarcoidosis. We investigated the clinical course in patients with cardiac sarcoidosis who were complicated by ventricular aneurysm. Consecutive 50 patients (age 64±13 years, male 24, female 26) who were diagnosed or suspected of cardiac sarcoidosis from May, 1986 to June, 2012, were examined. Twenty patients (40%) had ventricular aneurysm (aneurysm group), and the remaining 30 patients did not have aneurysm (non-aneurysm group). There was no difference in baseline characteristics such as age, cardiovascular medications between the 2 groups including beta-blocker, corticosteroids, anti-arrhythmic agent, angiotensin-converting enzyme inhibitor/receptor blocker, or diuretics), device implantation (pacemaker/implantable cardioverter-fibrillator/cardiac resynchronization therapy), or N-terminal pro-brain natriuretic peptide level, except for female gender which was more common in aneurysm group than non-aneurysm group (p=0.038). Patients were followed for a mean of 59 months for major adverse events. Composite endpoints defined as all cause death, advanced atrioventricular block, sustained ventricular tachycardia or fibrillation, hospitalization for congestive heart failure were significantly higher in aneurysm group than non-aneurysm group (60% vs. 30%, p=0.035). Kaplan-Meier curves showed that major adverse cardiac event-free survival during 10 years was significantly worse in aneurysm group than non-aneurysm group (p=0.006 by log-rank test). In addition, all-cause death and sustained ventricular tachycardia or fibrillation-free survival was also worse in aneurysm group than non-aneurysm group (p=0.024 by log-rank test). Conclusion: Cardiac sarcoidosis presenting ventricular aneurysm is associated with poor clinical outcomes. Aggressive and early interventions including use of corticosteroids and device implantation are required to prevent such fatal sequelae.
    Full-text · Article · Dec 2014 · European Heart Journal

  • No preview · Article · Oct 2014 · Journal of Cardiac Failure
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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.
    No preview · Article · Sep 2014 · Journal of Cardiology
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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.
    No preview · Article · Sep 2014 · Heart and Vessels
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    ABSTRACT: Aims: 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. Methods and results: A total of 1429 VSA patients (median 66 years; male/female, 1090/339) were enrolled. The primary endpoint was defined as major adverse cardiac events (MACE). The propensity score matching and multivariable Cox proportional hazard model were used to adjust for selection bias for treatment and potential confounding factors. Among the study patients, 695 (49%) were treated with nitrates, including conventional nitrates [e.g. nitroglycerin (GTN), isosorbide mono- and dinitrate] in 551 and nicorandil in 306. Calcium channel blockers were used in >90% of patients. During the median follow-up period of 32 months, 85 patients (5.9%) reached the primary endpoint. Propensity score-matched analysis demonstrated that the cumulative incidence of MACE was comparable between the patients with and those without nitrates [11 vs. 8% at 5 years; hazard ratio (HR): 1.28; 95% confidence interval (CI): 0.72-2.28, P = 0.40]. Although nicorandil itself had a neutral prognostic effect on VSA (HR: 0.80; 95% CI: 0.28-2.27, P = 0.67), multivariable Cox model revealed the potential harm of concomitant use of conventional nitrates and nicorandil (HR: 2.14; 95% CI: 1.02-4.47; P = 0.044), particularly when GTN and nicorandil were simultaneously administered. Conclusions: Chronic nitrate therapy did not improve the long-term prognosis of VSA patients when combined with CCBs. Furthermore, the VSA patients with multiple nitrates would have increased risk for cardiac events.
    No preview · Article · Sep 2014 · European Heart Journal
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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 123I-BMIPP/201TlCl 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 123I-BMIPP defect score and 201TlCI defect score. The uptake of 201TlCl and 123I-BMIPP was analyzed quantitatively using the Heart Score View software. Results: The 201TlCI 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 201TlCl 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.
    No preview · Article · Aug 2014 · International Journal of Cardiology
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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.
    Full-text · Article · May 2014 · Journal of Cardiology
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    ABSTRACT: A 78-year-old woman complained of experiencing dyspnea (New York Heart Association II) and faintness. Echocardiography revealed she had asymmetric left ventricular hypertrophy, and a dynamic left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion of the mitral valve. It also revealed calcification of the noncoronary cusp and a high-flow velocity in the LVOT (6.3m/s). The planimetry measurement with transesophageal echocardiography was 0.89cm2 (aortic valve area/body surface area: 0.69cm2/m2). Later, she was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) and aortic stenosis (AS). However, during the catheterization, the transvalvular pressure gradient (PG) was only 25mmHg. In order to solve this, we performed a percutaneous transluminal septal myocardial ablation. As a result, the PG of the LVOT decreased from 152mmHg to 25mmHg.We first thought that the LVOT obstruction had reduced the flow passing through the aortic valve, and restricted the motion of the aortic valve leaflets. We also considered the possibility that the aortic valve area had been underestimated. The hemodynamic study played an important role in the decision for the treatment plan. The present case was a combination of HOCM and "mild" AS.<. Learning objective: We know that we can distinguish between a left ventricular outflow tract obstruction and aortic stenosis using continuous-wave Doppler according to the phase of the peak gradient. However, if both are present, it is uncertain whether we can distinguish between them. It is necessary to measure the subaortic pressure and flow passing through the aortic valve accurately by catheterization in order to know which is the chief pathology.>.
    No preview · Article · Apr 2014 · Journal of Cardiology Cases
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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.
    No preview · Article · Mar 2014 · Heart and Vessels
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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.
    No preview · Article · Feb 2014 · Circulation Journal
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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.
    No preview · Article · Dec 2013 · General Thoracic and Cardiovascular Surgery
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    Full-text · Article · Dec 2013 · JACC. Cardiovascular imaging
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    ABSTRACT: Purpose: Many clinical trials have reported that right ventricular apical (RVA) pacing increases the risk of heart failure and atrial fibrillation, but the mechanism remains unknown. Using thallium 201 (Tl)/iodine 123-labeled beta-methyl iodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT), we assessed the hypothesis that RVA pacing has a direct undesirable effect on myocardial metabolism. Methods: We reviewed the Tl/BMIPP SPECT studies that were performed more than one month after implantation of permanent pacemaker or implantable cardioverter defibrillator in our hospital. The ventricular pacing lead was located in right ventricular apex. Patients with ischemic heart disease, congenital heart disease and specific cardiomyopathy were excluded. All images were analyzed qualitatively in a blind manner. A positive finding was defined as reduced uptake on the BMIPP image compared with the Tl perfusion image. In quantitative analysis, a polar map was divided into 17 segments. Each segment was graded on a 5-point scale and mismatch score was calculated from the %uptake differences between the Tl and BMIPP. Results: Seventy one patients were included (mean age 65 years). Indications for device implantation were atrioventricular block (AVB) (n=31), sinus node dysfunction (SND) (n=22), both AVB and SND (n=1), ventricular tachyarrhythmia (n=10) and brady atrial fibrillation (n=2). Mean duration of pacing was 3369 days. Myocardial fatty acid metabolic dysfunction defined as a mismatch between Tl uptake and BMIPP uptake were detected in 39 patients mainly in inferior and apical segments. On multivariate analysis, percent ventricular beats that were paced (%VP) was identified as only independent factor for Tl/BMIPP mismatch, however, duration of pacing and pacing threshold were not. Cutoff value of %VP was determined (40%) by ROC analysis. Conclusions: RVA pacing leads to regional myocardial metabolic dysfunction, which may be the main cause of unfavorable clinical outcomes associated with RVA pacing.
    No preview · Article · Aug 2013 · European Heart Journal

Publication Stats

2k Citations
644.09 Total Impact Points

Institutions

  • 2001-2015
    • Sakakibara Heart Institute
      Фучу, Tōkyō, Japan
  • 2004-2007
    • Kyoto University
      • Department of Cardiovascular Medicine
      Kyoto, Kyoto-fu, Japan
  • 1984-2003
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
  • 1996
    • Tokyo Junshin Women's College
      • Department of Cardiovascular Surgery
      Edo, Tōkyō, Japan
    • Osaka City General Hospital
      Ōsaka, Ōsaka, Japan