Publications by authors named "Yasushi Ino"

165 Publications

Usefulness of optical coherence tomography with angiographic coregistration in the guidance of coronary stent implantation.

Heart Vessels 2021 Jul 21. Epub 2021 Jul 21.

Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.

Optical coherence tomography (OCT)-angiography coregistration during stent implantation may be useful to avoid geographical mismatch and incomplete lesion coverage. Untreated lipid-rich plaque at stent edge is associated with subsequent stent edge restenosis. The present study sought to compare the frequency of untreated lipid-rich plaque at the stent edge between OCT-guided percutaneous coronary intervention (PCI) with and without OCT-angiography coregistration. We investigated 398 patients who underwent OCT-guided stent implantation (n = 198 in the coregistration group, and n = 200 in the no coregistration group). In OCT after PCI, untreated lipid-lich plaque was identified by the maximum lipid arc > 180˚ in the 5-mm stent edge segment. The PCI-targeted lesion characteristics and stent length were not different between the coregistration group and the no coregistration group. The frequency of untreated lipid-rich plaque in either proximal or distal stent edge segment was significantly lower in the coregistration group than in the no coregistration group (16% vs. 26%, P = 0.015). The frequency of stent-edge dissection (5% vs. 6%, P = 0.516) and untreated stenosis (2% vs. 3%, P = 0.724) was low and without significant differences between the two groups. In OCT-guided PCI, the use of OCT-angiography coregistration was associated with a reduced frequency of untreated lipid-rich plaque at stent edges. OCT-angiography coregistration has a positive impact on PCI results.
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http://dx.doi.org/10.1007/s00380-021-01911-1DOI Listing
July 2021

Near-Infrared Spectroscopy to Predict Microvascular Obstruction after Primary Percutaneous Coronary Intervention.

EuroIntervention 2021 06 8. Epub 2021 Jun 8.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Successful restoration of epicardial coronary artery patency by primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) does not always lead to adequate reperfusion at the microvascular level.

Aims: This study sought to investigate the association between lipid-rich coronary plaque identified by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) and microvascular obstruction (MVO) detected by cardiac magnetic resonance imaging (MRI) after PPCI for STEMI.

Methods: We investigated 120 patients with STEMI undergoing PPCI. NIRS-IVUS was used to measure the maximum lipid-core burden index in 4 mm (maxLCBI4mm) in the infarct-related lesions before PPCI. Delayed contrast-enhanced cardiac MRI was performed to evaluate MVO 1 week after PPCI.

Results: MVO was identified in 40 (33%) patients. MaxLCBI4mm in the infarct-related lesion was significantly larger in the MVO group compared with the no-MVO group (median [interquartile range]: 745 [522-853] vs. 515 [349-698], p<0.001). Multivariable logistic regression model showed that maxLCBI4mm was an independent predictor of MVO (odds ratio: 24.7 [95% confidence interval: 2.5-248.0], p=0.006). Receiver-operating characteristic curve analysis demonstrated that maxLCBI4mm >600 was the optimal cut-off value to predict MVO (Youden index = 0.44 and area under the curve = 0.71) with a sensitivity of 75% and a specificity of 69%.

Conclusions: Lipid content measured by NIRS in the infarct-related lesions was associated with the occurrence of MVO after PPCI in STEMI.
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http://dx.doi.org/10.4244/EIJ-D-20-01421DOI Listing
June 2021

Intimal thickening and disruption of the media occur in the arterial walls of coronary arteries not associated with coronary arterial aneurysms in patients with Kawasaki disease.

BMC Cardiovasc Disord 2021 06 5;21(1):278. Epub 2021 Jun 5.

Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.

Background: Coronary artery aneurysm (CAA) is an important complication of Kawasaki disease (KD) that is associated with arterial structure damage. However, few studies have examined structural changes in coronary arteries that are not associated with CAA.

Methods: We examined coronary arteries in KD patients with CAAs who underwent follow-up coronary angiography (CAG) and optical coherence tomography (OCT). Coronary arterial branches with no abnormal findings during the most recent CAG were classified into two groups. Arteries with an acute-phase CAA that later regressed were classified as group R; arteries with no abnormal findings on either acute or convalescent phase CAG were classified as group N. Coronary arterial wall structural changes were compared between groups using OCT.

Results: Fifty-seven coronary arterial branches in 23 patients were evaluated by OCT. Thirty-six branches showed no abnormality during the most recent CAG. Both groups R and N comprised 18 branches. Maximum intimal thicknesses in groups R and N were 475 and 355 µm, respectively (p = 0.007). The incidences of media disruption were 100% and 67%, respectively (p = 0.02). Calcification, macrophage accumulation, and thrombus were not found in either group.

Conclusions: Intimal thickening and disruption of the media occur in coronary arteries with acute phase CAAs that later regress in the convalescent phase, as well as in arteries with normal CAG findings in the acute and convalescent phases.
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http://dx.doi.org/10.1186/s12872-021-02090-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180057PMC
June 2021

Target Lesion Lipid Content Detected by Near-Infrared Spectroscopy After Stenting and the Risk of Subsequent Target Lesion Failure.

Arterioscler Thromb Vasc Biol 2021 07 13;41(7):2181-2189. Epub 2021 May 13.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan (T. Kubo, Y.I., T. Kameyama, K.T., T.A.).

[Figure: see text].
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http://dx.doi.org/10.1161/ATVBAHA.120.315617DOI Listing
July 2021

Oncolytic virotherapy with human telomerase reverse transcriptase promoter regulation enhances cytotoxic effects against gastric cancer.

Oncol Lett 2021 Jun 23;21(6):490. Epub 2021 Apr 23.

Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama 641-8510, Japan.

Currently, gastric cancer is the third most common cause of cancer-associated mortality worldwide. Oncolytic virotherapy using herpes simplex virus (HSV) has emerged as a novel therapeutic strategy against cancer. Telomerase is activated in >90of malignant tumors, including gastric cancer, and human telomerase reverse transcriptase (hTERT) is one of the major components of telomerase enzyme. Therefore, in oncolytic HSV, placing the essential genes under the regulation of the hTERT promoter may enhance its antitumor efficacy. The present study examined the antitumor effect of fourth-generation oncolytic HSVs, which contain the gene under the regulation of the hTERT promoter (T-hTERT). To examine the association between hTERT expression and prognosis in patients with gastric cancer, immunohistochemical analysis of resected tumor specimens was performed. The enhanced efficacy of T-hTERT was determined in human gastric cancer cell lines and in human gastric adenocarcinoma specimens . In experiments, enhanced cytotoxicity of T-hTERT was observed in MKN1, MKN28 and MKN45 cells compared with that of a third-generation oncolytic HSV, T-null. In particular, the cytotoxicity of T-hTERT was markedly enhanced in MKN45 cells. Furthermore, experiments demonstrated that 36.7 and 54.9% of cells were found to be lysed 48 h after infection with T-null or T-hTERT viruses at 0.01 pfu/cell, respectively. The T-hTERT-treated group exhibited considerably lower cell viability than the control [phosphate-buffered saline (-)] group. Therefore, employing oncolytic HSVs that contain the gene under the regulation of the hTERT promoter may be an effective therapeutic strategy for gastric cancer. To the best of our knowledge, the present study was the first to describe the effect of an oncolytic HSV with expression regulated by the hTERT promoter on gastric cancer cells.
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http://dx.doi.org/10.3892/ol.2021.12751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100961PMC
June 2021

Cancer-related vulnerable lesions in patients with stable coronary artery disease.

Int J Cardiol 2021 07 26;335:1-6. Epub 2021 Mar 26.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Coronary artery disease (CAD) has become a major cause of morbidity and mortality in cancer survivors. It is still unclear whether cancer history influences lesion characteristics. The purpose of this study was to investigate cancer-related lesion morphology in patients with CAD.

Methods: This study enrolled 400 patients with stable CAD. The patients were classified into a cancer survivor group (n = 69) and a noncancer group (n = 331). We investigated coronary lesion morphology by optical coherence tomography, and we assessed the prognosis in terms of both all-cause mortality and major adverse cardiovascular events (MACE).

Results: Adenocarcinoma was the most common histopathological diagnosis. Serum C-reactive protein levels were significantly higher in the cancer survivor group than in the noncancer group (cancer survivors 0.12 [0.05-0.42] mg/dL vs. noncancer 0.08 [0.04-0.17] mg/dL, p = 0.019). The cancer survivor group was more likely than the noncancer group to have thrombi (cancer survivors 30.4% vs. noncancer 15.4%, p = 0.004), and layered fibrotic plaques (LFPs; cancer survivors 18.8% vs. noncancer 3.6%, p < 0.0001). Cancer survivors had poorer outcomes than noncancer controls in terms of both all-cause mortality (p = 0.020) and MACE (p = 0.036).

Conclusions: Because of underlying inflammation, CAD patients with cancer had more high-risk lesions than those without cancer, which could result in poorer prognosis for the former. This result might inform the management of CAD in cancer patients in terms of secondary prevention.
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http://dx.doi.org/10.1016/j.ijcard.2021.03.050DOI Listing
July 2021

Impact of left ventricular ejection fraction and preoperative hemoglobin level on perioperative adverse cardiovascular events in noncardiac surgery.

Heart Vessels 2021 Sep 9;36(9):1317-1326. Epub 2021 Mar 9.

Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.

The prediction of a perioperative adverse cardiovascular event (PACE) is an important clinical issue in the medical management of patients undergoing noncardiac surgery. Although several predictors have been reported, simpler and more practical predictors of PACE have been needed. The aim of this study was to investigate the predictors of PACE in noncardiac surgery. We retrospectively analyzed 723 patients who were scheduled for elective noncardiac surgery and underwent preoperative examinations including 12-lead electrocardiography, transthoracic echocardiography, and blood test. PACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, congestive heart failure, arrhythmia attack that needs emergency treatment (rapid atrial fibrillation, ventricular tachycardia, and bradycardia), acute pulmonary embolism, asystole, pulseless electrical activity, or stroke during 30 days after surgery. PACE occurred in 54 (7.5%) of 723 patients. High-risk operation (11% vs. 3%, p = 0.003) was more often seen, left ventricular ejection fraction (LVEF) (55 ± 8% vs. 60 ± 7%, p = 0.001) and preoperative hemoglobin level (11.8 ± 2.2 g/dl vs. 12.7 ± 2.0 g/dl, p = 0.001) were lower in patients with PACE compared to those without PACE. By multivariate logistic regression analysis, high-risk operation (odds ratio (OR): 7.05, 95% confidence interval (CI) 2.16-23.00, p = 0.001), LVEF (OR 1.06, every 1% decrement, 95% CI 1.03-1.09, p = 0.001), and preoperative hemoglobin level (OR 1.22, every 1 g/dl decrement, 95% CI 1.07-1.39, p = 0.003) were identified as independent predictors of PACE. Receiver operating characteristic analysis demonstrated that LVEF of 58% (sensitivity = 80%, specificity = 61%, area under the curve (AUC) = 0.723) and preoperative hemoglobin level of 12.2 g/dl (sensitivity = 63%, specificity = 64%, AUC = 0.644) were optimal cut-off values for predicting PACE. High-risk operation, reduced LVEF, and reduced preoperative hemoglobin level were independently associated with PACE in patients undergoing noncardiac surgery.
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http://dx.doi.org/10.1007/s00380-021-01818-xDOI Listing
September 2021

Oncolytic virotherapy with SOCS3 enhances viral replicative potency and oncolysis for gastric cancer.

Oncotarget 2021 Feb 16;12(4):344-354. Epub 2021 Feb 16.

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.

Oncolytic virotherapy is an encouraging treatment using herpes simplex virus (HSV) for gastric cancer patients. To treat gastric cancer, we generated and evaluated the efficacy of an attractive type of oncolytic HSV expressing the suppressor of cytokine signaling 3 (SOCS3). We constructed a third-generation type of oncolytic HSV (T-SOCS3) arming with SOCS3 by a bacterial artificial chromosome (BAC) system. We examined the viral replicative intensification and oncolysis of T-SOCS3 for human gastric cancer cell lines . T-SOCS3 enhanced its replication and potentiated its cell-killing effect for MKN1 human gastric cancer cell lines, which are resistant to a non-armed third-generation type of oncolytic HSV (T-01) . T-SOCS3 also induced the destruction within human gastric cancer specimens. Armed oncolytic HSVs expressing SOCS3 may be an efficacious therapeutic agent for gastric cancer treatment.
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http://dx.doi.org/10.18632/oncotarget.27873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899552PMC
February 2021

Optical coherence tomography detection of vulnerable plaques at high risk of developing acute coronary syndrome.

Eur Heart J Cardiovasc Imaging 2021 Feb 23. Epub 2021 Feb 23.

Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8509, Japan.

Aims: The ability of optical coherence tomography (OCT) to detect plaques at high risk of developing acute coronary syndrome (ACS) remains unclear. The aim of this study was to evaluate the association between non-culprit plaques characterized as both lipid-rich plaque (LRP) and thin-cap fibroatheroma (TCFA) by OCT and the risk of subsequent ACS events at the lesion level.

Methods And Results: In 1378 patients who underwent OCT, 3533 non-culprit plaques were analysed for the presence of LRP (maximum lipid arc > 180°) and TCFA (minimum fibrous cap thickness < 65 μm). The median follow-up period was 6 years [interquartile range (IQR): 5-9 years]. Seventy-two ACS arose from non-culprit plaques imaged by baseline OCT. ACS was more often associated with lipidic plaques that were characterized as both LRP and TCFA vs. lipidic plaques that did not have these characteristics [33% vs. 2%, hazard ratio 19.14 (95% confidence interval: 11.74-31.20), P < 0.001]. The sensitivity and specificity of the presence of both LRP and TCFA for predicting ACS was 38% and 97%, respectively. A larger maximum lipid arc [1.01° (IQR: 1.01-1.01°)], thinner minimum fibrous cap thickness [0.99 μm (IQR: 0.98-0.99 μm)], and smaller minimum lumen area [0.78 mm2 (IQR: 0.67-0.90 mm2), P < 0.001] were independently associated with ACS.

Conclusion: Non-culprit plaques characterized by OCT as both LRP and TCFA were associated with an increased risk of subsequent ACS at the lesion level. Therefore, OCT might be able to detect vulnerable plaques.
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http://dx.doi.org/10.1093/ehjci/jeab028DOI Listing
February 2021

Global longitudinal strain evaluated by speckle-tracking echocardiography as a surrogate marker for predicting replacement fibrosis detected by magnetic resonance-late gadolinium enhancement in patients with nonischemic cardiomyopathy.

J Clin Ultrasound 2021 Jun 1;49(5):479-487. Epub 2021 Feb 1.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Purpose: This study aimed to investigate whether left ventricular (LV) global longitudinal strain (GLS) evaluated by speckle-tracking echocardiography (STE) can be used as a surrogate marker for the detection of replacement fibrosis by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with nonischemic cardiomyopathy (NICM).

Methods: This study analyzed 41 NICM patients who successfully underwent both STE and CMR, and were divided into those with (Group A, n = 18) and those without CMR-LGE (Group B, n = 23). Echocardiographic indexes, including GLS, were compared between the two groups.

Results: No significant differences were observed in LV end-diastolic and end-systolic volume indexes, LV ejection fraction, mitral E/A, deceleration time, E/e', left atrial volume index, and the systolic trans-tricuspid pressure gradient between Groups A and B. STE-GLS was significantly worse in Group A than in Group B (-7.6% ± 3.0% vs -9.9% ± 3.2%, P = .01). Receiver operating characteristic curve analysis showed that STE-GLS of -7.9% was the best cut-off value for detection of CMR-LGE (sensitivity, 78%; specificity, 74%; and area under the curve, 0.74).

Conclusions: STE-GLS may be a potential surrogate marker for the detection of CMR-LGE-derived replacement fibrosis in patients with NICM.
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http://dx.doi.org/10.1002/jcu.22983DOI Listing
June 2021

Impact of Optical Coherence Tomography Imaging on Decision-Making During Percutaneous Coronary Intervention in Patients Presented With Acute Coronary Syndromes.

Circ J 2021 Jan 20. Epub 2021 Jan 20.

Department of Cardiovascular Medicine, Wakayama Medical University.

Background: Optical coherence tomography (OCT) provides valuable information to guide percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) regarding lesion preparation, stent sizing, and optimization. The aim of the present study was to compare lumen expansion of stent-treated lesions immediately after the procedure for ACS between OCT-guided PCI and angiography-guided PCI.Methods and Results:This study investigated stent-treated lesions immediately after PCI for ACS by using quantitative coronary angiography in 390 patients; 260 patients with OCT-guided PCI and 130 patients with angiography-guided PCI. Before stenting, the frequency of pre-dilatation and thrombus aspiration were not different between the OCT-guided and angiography-guided PCI groups. Stent diameter was significantly larger as a result of OCT-guided PCI (3.11±0.44 mm vs. 2.99±0.45 mm, P=0.011). In post-dilatation, balloon pressure-up (48% vs. 31%, P=0.001) and balloon diameter-up (33% vs. 6%, P<0.001) were more frequently performed in the OCT-guided PCI group. Minimum lumen diameter (2.55±0.35 mm vs. 2.13±0.50 mm, P<0.001) and acute lumen gain (2.18±0.54 mm vs. 1.72±0.63 mm, P<0.001) were significantly larger in the OCT-guided PCI group. Percent diameter stenosis (14±4% vs. 24±10%, P<0.001) and percent area stenosis (15±5% vs. 35±17%, P<0.001) were significantly smaller in the OCT-guided PCI group.

Conclusions: OCT-guided PCI potentially results in larger lumen expansion of stent-treated lesions immediately after PCI in the treatment of ACS compared with angiography-guided PCI.
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http://dx.doi.org/10.1253/circj.CJ-20-0942DOI Listing
January 2021

Prevalence, Features, and Prognosis of Artery-to-Artery Embolic ST-Segment-Elevation Myocardial Infarction: An Optical Coherence Tomography Study.

J Am Heart Assoc 2020 12 30;9(24):e017661. Epub 2020 Nov 30.

Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan.

Background The major underlying mechanisms contributing to acute coronary syndrome are plaque rupture, plaque erosion, and calcified nodule. Artery-to-artery embolic myocardial infarction (AAEMI) was defined as ST-segment-elevation myocardial infarction caused by migrating thrombus formed at the proximal ruptured plaque. The aim of this study was to investigate the prevalence and clinical features of AAEMI by using optical coherence tomography. Methods and Results This study retrospectively enrolled 297 patients with ST-segment-elevation myocardial infarction who underwent optical coherence tomography before percutaneous coronary intervention. Patients were divided into 4 groups consisting of plaque rupture, plaque erosion, calcified nodule, and AAEMI according to optical coherence tomography findings. The prevalence of AAEMI was 3.4%. The culprit vessel in 60% of patients with AAEMI was right coronary artery. Minimum lumen area at the culprit site was larger in AAEMI compared with plaque rupture, plaque erosion, and calcified nodule (4.0 mm [interquartile range (IQR), 2.2-4.9] versus 1.0 mm [IQR, 0.8-1.3] versus 1.0 mm [IQR, 0.8-1.2] versus 1.1 mm [IQR, 0.7-1.6], <0.001). Lumen area at the rupture site was larger in patients with AAEMI compared with patients with plaque rupture (4.4 mm [IQR, 2.5-6.7] versus 1.5 mm [IQR, 1.0-2.4], <0.001). In patients with AAEMI, the median minimum lumen area at the occlusion site was 1.2 mm (IQR, 1.0-2.1), 40% of them had nonstent strategy, and the 3-year major adverse cardiac event rate was 0%. Conclusions AAEMI is a rare cause for ST-segment-elevation myocardial infarction and has unique morphological features of plaque including larger lumen area at rupture site and smaller lumen area at the occlusion site.
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http://dx.doi.org/10.1161/JAHA.120.017661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955389PMC
December 2020

NIRS-IVUS for Differentiating Coronary Plaque Rupture, Erosion, and Calcified Nodule in Acute Myocardial Infarction.

JACC Cardiovasc Imaging 2021 Jul 18;14(7):1440-1450. Epub 2020 Nov 18.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Objectives: This study sought to investigate the ability of combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) to differentiate plaque rupture (PR), plaque erosion (PE), or calcified nodule (CN) in acute myocardial infarction (AMI).

Background: Most acute coronary syndromes occur from coronary thrombosis based on PR, PE, or CN. In vivo differentiation among PR, PE, and CN is a major challenge for intravascular imaging.

Methods: The study enrolled 244 patients with AMI who had a de novo culprit lesion in a native coronary artery. The culprit lesions were assessed by both NIRS-IVUS and optical coherence tomography (OCT). Maximum lipid core burden index in 4 mm (maxLCBI) was measured by NIRS. Plaque cavity and convex calcium was detected by IVUS. The OCT diagnosis of PR (n = 175), PE (n = 44), and CN (n = 25) was used as a reference standard.

Results: In the development cohort, IVUS-detected plaque cavity showed a high specificity (100%) and intermediate sensitivity (62%) for identifying OCT-PR. IVUS-detected convex calcium showed a high sensitivity (93%) and specificity (100%) for identifying OCT-CN. NIRS-measured maxLCBI was largest in OCT-PR (705 [interquartile range (IQR): 545 to 854]), followed by OCT-CN (355 [IQR: 303 to 478]) and OCT-PE (300 [IQR: 126 to 357]) (p < 0.001). The optimal cutoff value of maxLCBI was 426 for differentiating between OCT-PR and -PE; 328 for differentiating between OCT-PE and -CN; and 579 for differentiating between OCT-PR and -CN. In the validation cohort, the NIRS-IVUS classification algorithm using plaque cavity, convex calcium, and maxLCBI showed a sensitivity and specificity of 97% and 96% for identifying OCT-PR, 93% and 99% for OCT-PE, and 100% and 99% for OCT-CN, respectively.

Conclusions: By evaluating plaque cavity, convex calcium, and maxLCBI, NIRS-IVUS can accurately differentiate PR, PE, and CN.
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http://dx.doi.org/10.1016/j.jcmg.2020.08.030DOI Listing
July 2021

Supporting evidence for ST-segment elevation myocardial infarction from optical coherence tomography.

EuroIntervention 2021 Aug;17(6):506-507

Department of Cardiovascular Medicine, Shingu Municipal Medical Center, Shingu, Japan.

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http://dx.doi.org/10.4244/EIJ-D-20-00985DOI Listing
August 2021

Expression of Cyclophilin A in Coronary Artery Plaque with Intraplaque Hemorrhage Is More Frequent in Deceased Patients Who Had Impaired Kidney Function.

Int Heart J 2020 Nov 13;61(6):1129-1134. Epub 2020 Nov 13.

Department of Cardiovascular Medicine, Wakayama Medical University.

Patients with impaired kidney function have a high frequency of intraplaque hemorrhage (IPH) in their coronary arteries. Levels of cyclophilin A (CyPA), an indirect matrix metalloproteinase inducer, are increased in deceased patients who had impaired kidney function. In this study, we have examined the relationship between IPH and CyPA.We examined 47 samples of coronary plaque from 27 cadavers with coronary stenosis. These sections, all with > 50% coronary stenosis, were stained with an antibody against CyPA and the expression of CyPA was semi-quantified. Cadavers and plaques were classified into one of two groups depending on the presence or absence of IPH. IPH was defined as the presence of red blood cells stained with hematoxylin and eosin (HE) indicative of overt acute hemorrhage.In an individual analysis, estimation of glomerular filtration rate (eGFR) in the IPH group was significantly lower than that in the non-IPH group (P = 0.002). In a histological analysis, the percentage of stained area of CyPA in the IPH group was significantly higher than that in the non-IPH group (P < 0.0001).IPH was associated with a significantly higher expression of CyPA in this study. In addition, patients with IPH in their coronary arteries had significantly impaired kidney function.
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http://dx.doi.org/10.1536/ihj.20-283DOI Listing
November 2020

Assessment of myocardial damage after acute myocardial infarction by diastolic deceleration time of coronary flow velocity using echocardiography and contrast-enhanced magnetic resonance imaging.

Echocardiography 2020 12 3;37(12):1981-1988. Epub 2020 Nov 3.

Department of Cariology, Wakayama Medical University, Wakayama, Japan.

Background: There are limited data available regarding the use of diastolic deceleration time (DDT) of three major arteries measured by transthoracic echocardiography (TTE) for assessing coronary microvascular damage after acute myocardial infarction (AMI). Therefore, we aimed to compare the DDT of three major arteries using TTE with the transmural extent of infarction (TEI) and infarct size, which were classified using contrast-enhanced magnetic resonance imaging (CE-MRI), in patients with AMI.

Methods: The DDT of the culprit coronary artery was measured in 74 patients using TTE and CE-MRI 1 week after the onset of AMI. The TEI was graded based on the transmural extent of the hyper-enhanced tissue (grades 1-4).

Results: The assessable rate for the DDT was 95%; individual rates were 100% for the left anterior descending coronary artery, 90% for the left circumflex artery, and 93% for the right coronary artery. The DDT decreased gradually as the TEI grade progressed (P = .021). Infarct size was significantly correlated with the DDT (r = -0.51, P < .0001). Univariate analysis revealed that the left ventricular (LV) end-systolic volume, LV ejection fraction, and DDT were significantly associated with TEI grade 4. After adjustment via multiple logistic regression analysis, the DDT was independently remained. With a cutoff value of 950ms, as determined by the ROC curve, DDT could detect TEI grade 4 with 81.1% sensitivity and 80.1% specificity.

Conclusion: The DDT of three major coronary arteries measured by TTE 1 week after the onset of AMI can assess the extent of myocardial damage, which is determined by CE-MRI.
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http://dx.doi.org/10.1111/echo.14903DOI Listing
December 2020

Comparison of Optical Flow Ratio and Fractional Flow Ratio in Stent-Treated Arteries Immediately After Percutaneous Coronary Intervention.

Circ J 2020 11 29;84(12):2253-2258. Epub 2020 Oct 29.

Department of Cardiovascular Medicine, Wakayama Medical University.

Background: Optical flow ratio (OFR) is a recently developed method for functional assessment of coronary artery disease based on computational fluid dynamics of vascular anatomical data from intravascular optical coherence tomography (OCT). The purpose of this study was to investigate the relationship between OFR and fractional flow reserve (FFR) in stent-treated arteries immediately after percutaneous coronary intervention (PCI).Methods and Results:The OFR and FFR were measured in 103 coronary arteries immediately after successful PCI with a stent. An increase in the OFR and FFR values within the stent was defined as in-stent ∆OFR and ∆FFR, respectively. The values of FFR and OFR were 0.89±0.06 and 0.90±0.06, respectively. OFR was highly correlated with FFR (r=0.84, P<0.001). OFR showed a good agreement with FFR, presenting small values of mean difference and root-mean-squared deviation (FFR-OFR: -0.01±0.04). In-stent ∆OFR showed a moderate correlation (r=0.69, P<0.001) and good agreement (in-stent ∆FFR - in-stent ∆OFR: 0.00±0.02) with in-stent ∆FFR.

Conclusions: OFR showed a high correlation and good agreement with FFR in stent-treated arteries immediately after PCI.
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http://dx.doi.org/10.1253/circj.CJ-20-0661DOI Listing
November 2020

Very late-phase vascular response after everolimus-eluting stent implantation assessed by optical coherence tomography.

Int J Cardiovasc Imaging 2020 Sep 8;36(9):1627-1635. Epub 2020 May 8.

Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.

Long-term safety of second generation drug-eluting stents (DES) has not yet been evaluated. We sought to evaluate the very late phase (> 3 years) vascular response after second generation everolimus-eluting stent (EES) as compared with first generation sirolimus-eluting stent (SES) by using optical coherence tomography (OCT). We examined the vascular response in 39 patients with a total of 55 DESs [31 EESs (mean 54 months after stenting) and 24 first generation SES (mean 66 months after stenting)] by OCT. The frequency of lesions with any malapposed stent struts (19% vs. 46%, p = 0.035) and evagination (6% vs. 42%, p = 0.002) was significantly lower. Segments with malapposed stent struts were significantly shorter (0.4 ± 0.9 mm vs. 1.9 ± 3.5 mm, p = 0.024), maximal malapposition area and malapposition volume were significantly smaller (0.26 ± 0.38 mm vs. 0.95 ± 1.54 mm, p = 0.019, and 0.78 ± 1.35 mm vs. 6.22 ± 15.76 mm, p = 0.016, respectively) in EES. Compared with first generation SES, second generation EES showed more favourable vascular responses at the very late phase.
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http://dx.doi.org/10.1007/s10554-020-01877-7DOI Listing
September 2020

Optical Coherence Tomography Comparison of Percutaneous Coronary Intervention Among Plaque Rupture, Erosion, and Calcified Nodule in Acute Myocardial Infarction.

Circ J 2020 05 18;84(6):911-916. Epub 2020 Apr 18.

Department of Cardiovascular Medicine, Wakayama Medical University.

Background: Acute myocardial infarction (AMI) is caused by coronary plaque rupture (PR), plaque erosion (PE), or calcified nodule (CN). We used optical coherence tomography (OCT) to compare stent expansion immediately after primary percutaneous coronary intervention (PCI) in patients with AMI caused by PR, PE, or CN.Methods and Results:In all, 288 AMI patients were assessed by OCT before and immediately after PCI, performed with OCT guidance according to OPINION criteria for stent sizing and optimization. The frequency of OCT-identified PR (OCT-PR), OCT-PE, and OCT-CN was 172 (60%), 82 (28%), and 34 (12%), respectively. Minimum stent area was smallest in the OCT-CN group, followed by the OCT-PE and OCT-PR groups (mean [±SD] 5.20±1.77, 5.44±1.78, and 6.44±2.2 mm, respectively; P<0.001), as was the stent expansion index (76±13%, 86±14%, and 87±16%, respectively; P=0.001). The frequency of stent malapposition was highest in the OCT-CN group, followed by the OCT-PR and OCT-PE groups (71%, 38%, and 27%, respectively; P<0.001), as was the frequency of stent edge dissection in the proximal reference (44%, 23%, and 10%, respectively; P<0.001). The frequency of tissue protrusion was highest in the OCT-PR group, followed by the OCT-PE and OCT-CN groups (95%, 88%, and 85%, respectively; P=0.036).

Conclusions: Stent expansion was smallest in the OCT-CN group, followed by the OCT-PR and OCT-PE groups. Plaque morphology in AMI culprit lesions may affect stent expansion immediately after primary PCI.
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http://dx.doi.org/10.1253/circj.CJ-20-0014DOI Listing
May 2020

Extent of the difference between microcatheter and pressure wire-derived fractional flow reserve and its relation to optical coherence tomography-derived parameters.

Int J Cardiol Heart Vasc 2020 Apr 13;27:100500. Epub 2020 Mar 13.

The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Although previous studies demonstrated that microcatheter-derived fractional flow reserve (mc-FFR) tends to overestimate lesion severity compared to pressure wire-derived FFR (pw-FFR), the clinical utility of mc-FFR remains obscure. The extent of differences between the two FFR systems and its relation to a lesion-specific parameter remain unknown. In this study, we sought to compare mc-FFR with pw-FFR and determine the lower and upper mc-FFR cut-offs predicting ischemic and non-ischemic stenosis, using an and a FFR threshold of 0.75 and 0.80 as references, respectively. We further explored optical coherence tomography (OCT) parameters influencing the difference in FFR between the two systems.

Methods And Results: In this study, 44 target vessels with intermediate de novo coronary artery lesion in 36 patients with stable ischemic heart disease were evaluated with mc-FFR, pw-FFR and OCT. Bland-Altman plots for mc-FFR versus pw-FFR showed a bias of -0.04 for lower mc-FFR values compared to pw-FFR values. The mc-FFR cut-off values of 0.73 and 0.79 corresponded to the 0.75 pw-FFR and 0.80 pw-FFR thresholds with high predictive values, respectively. The differences in the two FFR measurements (pw-FFR minus mc-FFR) were negatively correlated with OCT-derived minimum lumen area (MLA) (R = -0.359, p = 0.011). The OCT-derived MLA of 1.36 mm was a cut-off value for predicting between the two FFR measurements defined as >0.03.

Conclusion: Mc-FFR is clinically useful when the specific cut-offs are applied. An OCT-derived MLA accounts for in FFR between the two systems.
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http://dx.doi.org/10.1016/j.ijcha.2020.100500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075984PMC
April 2020

[Usefulness of CT in the Lateral Decubitus Position for Preoperative Evaluation of Cranioplasty].

No Shinkei Geka 2020 Feb;48(2):117-122

Department of Neurosurgery, Teikyo University Chiba Medical Center.

Patients with massive brain swelling undergo external decompressive craniectomy to manage intracranial pressure. Following supratentorial craniectomy, and after the brain swelling is relieved, cranioplasty is performed. Although feasibility of the surgery is usually assessed by CT scanning in a supine position, it is sometimes difficult to determine whether the surgery can be performed safely. Although nine patients underwent a decompressive craniectomy during the study period, only six patients could undergo brain CT-first in a supine position and next in a lateral decubitus position with the surgical side upward-before cranioplasty. On CT images, the distance from the midline to the brain surface was measured on the image where brain bulging was maximal, and the bulging was calculated by comparing the image with the distance measured on the contralateral side. In all cases, brain bulging decreased with this change in position. The decrease ranged from 5.5-9.2mm(mean 7.1mm). Patients with brain bulging of 2.8-3.6mm in the lateral decubitus position needed no additional procedure, or only required drainage of a very small amount of cerebrospinal fluid(CSF)from the brain surface. Those with brain bulging of 5.1-12mm showed ventricular dilatation on CT images, and required ventricular puncture or spinal CSF drainage to decrease brain bulging for cranioplasty. We believe that the lateral decubitus position, with the surgical side upward, ameliorates the local brain shift induced by gravity. A lateral position during CT simulates the surgical head position for cranioplasty and can help to assess whether cranioplasty is feasible.
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http://dx.doi.org/10.11477/mf.1436204147DOI Listing
February 2020

Early and Mid-Term Vascular Responses to Optical Coherence Tomography-Guided Everolimus-Eluting Stent Implantation in Stable Coronary Artery Disease.

Can J Cardiol 2019 11 8;35(11):1513-1522. Epub 2019 Aug 8.

Yodogawa Christian Hospital, Osaka, Japan.

Background: Analysis of pooled clinical data has shown the safety of 3 months of dual antiplatelet therapy with everolimus-eluting cobalt-chromium stents (Co-Cr EESs). This study evaluated early and mid-term vascular responses to Co-Cr EESs in patients with stable coronary artery disease.

Methods: The Multicenter Comparison of Early and Late Vascular Responses to Everolimus-Eluting Cobalt-Chromium Stent and Platelet Aggregation Studies in Patients With Stable Angina Managed as Elective Case (MECHANISM-Elective) study (NCT02014818) is a multicenter optical coherence tomography (OCT) registry. Enrolled patients were evaluated by OCT immediately after everolimus-eluting stent implantation were prospectively allocated to 1 month (n = 50) or 3 months (n = 50) OCT follow-up and then received a 12-month OCT evaluation. The incidences of intrastent thrombus (IS-Th) and irregular protrusion (IRP) were also assessed.

Results: The percentage of uncovered struts was 6.4% ± 10.3% at 1 month (P < 0.001 vs. postprocedure) and 0.5% ± 0.9% at 12 months (P < 0.001 vs. 1 month). The corresponding values in the 3-month cohort were 2.0% ± 2.5% (P < 0.001 vs. postprocedure) and 0.5% ± 1.5% (P < 0.001 vs. 3 months). The incidence of IS-Th was 32.7% at 1 month, 5.4% at 3 months, and 2.0% at 12 months. IRP was observed in 21.8% of patients post-EES but had totally resolved at 1, 3, and 12 months.

Conclusion: Early and mid-term vascular reactions after Co-Cr EES implantation in stable patients with coronary artery disease in the MECHANISM-Elective included dynamic resolution of IS-Th and IRP and rapid decrease in uncovered struts. Thus, EES may allow shortening of dual antiplatelet therapy duration less than 3 months in this patient subset.
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http://dx.doi.org/10.1016/j.cjca.2019.07.633DOI Listing
November 2019

The inter-study reproducibility of instantaneous wave-free ratio and angiography coregistration.

J Cardiol 2020 05 23;75(5):507-512. Epub 2019 Oct 23.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Coregistration system of instantaneous wave-free ratio (iFR) pullback and angiography has been developed to enhance benefits of physiology oriented percutaneous coronary intervention (PCI), but its reproducibility has not yet been fully assessed.

Methods And Results: In 51 coronary arteries from 39 patients with stable coronary artery disease, iFR angio-coregistrations were repeated twice. The mean iFR values were comparable between the first and second studies (0.85 ± 0.12 vs. 0.84 ± 0.13, p = 0.97). In terms of a coronary segment with predominant iFR gradients defined by the largest segmental iFR gradients, the repeated iFR angio-coregistrations matched in 47 of 51 (92%) studies and showed good agreement (κ = 0.75) in overall vessels. When assessed only in vessels with positive iFR (≤0.89), iFR angio-coregistrations matched in 31 of 32 (97%) studies and showed an excellent agreement (κ = 0.91). The predominant iFR gradients in the repeated iFR angio-coregistrations demonstrated strong correlation (r = 0.96, p < 0.0001) and an excellent agreement: mean difference was 0.0006, and the lower and upper limits (mean difference ± 1.96 standard deviation) of agreement were -0.0312 and 0.0324.

Conclusions: iFR angio-coregistration is highly reproducible and can precisely identify a suitable target for PCI.
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http://dx.doi.org/10.1016/j.jjcc.2019.09.016DOI Listing
May 2020

QFR Versus FFR Derived From Computed Tomography for Functional Assessment of Coronary Artery Stenosis.

JACC Cardiovasc Interv 2019 10;12(20):2050-2059

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Objectives: The aim of this study was to compare diagnostic performance between quantitative flow ratio (QFR) derived from coronary angiography and fractional flow reserve derived from computed tomography (FFR) using fractional flow reserve (FFR) as the reference standard.

Background: QFR and FFR are recently developed, less invasive techniques for functional assessment of coronary artery disease.

Methods: QFR, FFR, and FFR were measured in 152 patients (233 vessels) with stable coronary artery disease.

Results: QFR was highly correlated with FFR (r = 0.78; p < 0.001), whereas FFR was moderately correlated with FFR (r = 0.63; p < 0.001). Both QFR and FFR showed moderately good agreement with FFR, presenting small values of mean difference but large values of root mean squared deviation (FFR-QFR, 0.02 ± 0.09; FFR-FFR, 0.03 ± 0.11). The sensitivity, specificity, positive predictive value, and negative predictive value of QFR ≤0.80 for predicting FFR ≤0.80 were 90%, 82%, 81%, and 90%, respectively. Those of FFR ≤0.80 for predicting FFR ≤0.80 were 82%, 70%, 70%, and 82%, respectively. The diagnostic accuracy of QFR ≤0.80 for predicting FFR ≤0.80 was 85% (95% confidence interval [CI]: 81% to 89%), whereas that of FFR ≤0.80 for predicting FFR ≤0.80 was 76% (95% CI: 70% to 80%).

Conclusions: QFR and FFR showed significant correlation with FFR. Mismatches between QFR and FFR and between FFR and FFR were frequent.
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http://dx.doi.org/10.1016/j.jcin.2019.06.043DOI Listing
October 2019

Different vascular healing process between bioabsorbable polymer-coated everolimus-eluting stents versus bioresorbable vascular scaffolds via optical coherence tomography and coronary angioscopy (the ENHANCE study: ENdothelial Healing Assessment with Novel Coronary tEchnology).

Heart Vessels 2020 Apr 5;35(4):463-473. Epub 2019 Oct 5.

Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan.

Recent clinical trials have raised concerns about the safety and efficacy of ABSORB™ bioresorbable vascular scaffolds (BVS). The difference in the vascular healing process between SYNERGY™ bioabsorbable polymer-coated everolimus-eluting stents (BP-EES) and BVS remains unclear. The aim of the ENHANCE study was to compare vascular healing on BP-EES versus BVS by optical coherence tomography (OCT) and coronary angioscopy (CAS) at 4- and 12-month follow-ups. This is a prospective, non-randomized, single center clinical trial. Thirteen eligible patients with multivessel disease were enrolled. BP-EES and BVS were simultaneously implanted in the same patients, but in different coronary vessels. Imaging follow-up with both OCT and CAS was completed in 11 patients at 12 months. Neointimal coverage rates were similar between the two groups based on OCT measurements. The neointimal thickness of BP-EES was significantly thicker at the 12th month than at the 4th month, whereas the neointimal thickness of BVS did not change between the measurements taken at the 4th and 12th month. Existence of intra-stent thrombus was significantly higher in the BVS group, compared to the BP-EES group. On the other hand, CAS revealed that red-thrombi and yellow-plaque were more frequently observed in BVS at 4 months and up to 12-month follow-ups than in BP-EES. These findings suggested that the evidence of instability remained up to 12 months in the vascular healing with BVS, compared to that with BP-EES. Vascular healing of the stented wall was recognized at the very early phase after BP-EES implantation. However, vascular healing with BVS was still incomplete after 12 months.
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http://dx.doi.org/10.1007/s00380-019-01516-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085473PMC
April 2020

Intracoronary pressure increase due to contrast injection for optical coherence tomography imaging.

J Cardiol 2020 03 7;75(3):296-301. Epub 2019 Sep 7.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Optical coherence tomography (OCT) requires intracoronary injection of contrast media to remove blood from the field of view during image acquisition. Contrast injection may cause a temporal increase in intracoronary pressure. The aim of this study was to compare the intracoronary pressure during contrast injection between OCT and coronary angiography.

Methods: We measured intracoronary pressure by using a pressure guidewire during contrast injection for OCT and angiography in 30 coronary arteries (mean fractional flow reserve = 0.90 ± 0.03). Contrast media was injected into coronary artery through the guiding catheter by using a mechanical injector pump.

Results: Intracoronary pressure before contrast injection was similar between OCT and angiography (systolic pressure: 123 ± 18 mmHg vs. 122 ± 19 mmHg, p = 0.863). Intracoronary pressure was increased due to contrast injection in both OCT (systolic pressure: 123 ± 18 mmHg to 132 ± 18 mmHg, p < 0.001) and angiography (systolic pressure: 122 ± 19 mmHg to 128 ± 19 mmHg, p < 0.001). The increase in intracoronary pressure was slightly greater in OCT compared with angiography (absolute increase of systolic pressure: 9 ± 2 mmHg vs. 6 ± 1 mmHg, p < 0.001; and relative increase of systolic pressure: 8 ± 2% vs. 5 ± 1%, p < 0.001). Intracoronary pressure during contrast injection was not significantly different between OCT and angiography (systolic pressure: 132 ± 18 mmHg vs. 128 ± 19 mmHg, p = 0.831).

Conclusions: Contrast injection for OCT induced significant but small increase in intracoronary pressure compared with that for angiography.
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http://dx.doi.org/10.1016/j.jjcc.2019.08.008DOI Listing
March 2020

Imaging assessment and accuracy in coronary artery autopsy: comparison of frequency-domain optical coherence tomography with intravascular ultrasound and histology.

Int J Cardiovasc Imaging 2019 Oct 7;35(10):1785-1790. Epub 2019 Jun 7.

Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan.

Optical coherence tomography (OCT) is a coronary artery imaging technique with high resolution. Second-generation frequency-domain OCT (FD-OCT) technology allows safer and faster clinical application compared with first-generation time-domain OCT (TD-OCT). Only limited validation studies compare FD-OCT with other modes of analysis: histology, which is the current gold standard, and intravascular ultrasound (IVUS). This study therefore aims to demonstrate the accuracy of FD-OCT images compared with IVUS and histology. FD-OCT and IVUS images were acquired from 203 segments from 31 coronary arteries obtained at autopsy from 20 cadavers. Of these, 30 randomly-selected pairs were used to create three classifications of plaque type based on morphological features in FD-OCT and IVUS compared with corresponding histopathology. The remaining 173 pairs were used to demonstrate the diagnostic accuracy for classification of coronary plaques by FD-OCT. Plaque type distributions were 27% fibroatheroma, 22% fibrocalcific plaque and 51% fibrous plaque. The diagnostic accuracies of FD-OCT for fibroatheroma, fibrocalcific plaque and fibrous plaque were 90, 95 and 93%, respectively. Those of IVUS were 81, 89 and 84%, respectively. FD-OCT achieved high diagnostic accuracy for the classification of coronary plaques comparable to TD-OCT. Physicians should consider the differences in the ability to classify plaque morphology of OCT of imaging devices when applying their use.
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http://dx.doi.org/10.1007/s10554-019-01639-0DOI Listing
October 2019

Preoperative left atrial minimum volume as a surrogate marker of postoperative symptoms in senile patients with aortic stenosis who underwent surgical aortic valve replacement.

J Cardiol 2019 Oct 7;74(4):366-371. Epub 2019 May 7.

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Previous reports have shown that postoperative symptoms despite successful surgical aortic valve replacement (AVR) are not uncommon depending on severity of myocardial fibrosis in patients with aortic stenosis (AS). Left atrial minimum volume (LAV) at end-diastole determined by direct exposure of left ventricular end-diastolic pressure may be useful as a surrogate marker of postoperative symptoms in patients with AS undergoing AVR.

Methods And Results: We studied 75 patients with AS who underwent AVR and were followed up to 600 days after AVR. We examined the postoperative symptomatic status which occurred between 60 days to 600 days after AVR. The study patients were divided into 2 groups: 19 patients (25%) with postoperative symptoms (symptomatic group) and 56 without symptoms (asymptomatic group). There were no significant differences in preoperative left ventricular volumes and ejection fraction and AS severity by echocardiography between the two groups. There were significant differences in preoperative echocardiographic LAV index (LAVI) between symptomatic group and asymptomatic group (45±15 vs. 28±11ml/m). Using receiver operating characteristic curve analysis, LAVI≥30ml/m detected postoperative symptoms with the large area under the curve (0.84) (sensitivity 94% and specificity 68%). In the multivariate analysis, preoperative LAVI was the independent predictor of the postoperative symptomatic status after AVR (odds ratio: 1.11; 95% CI: 1.04-1.18).

Conclusions: The preoperative echocardiographic LAVI measurement is useful as a surrogate marker of symptomatic status after AVR in patients with AS.
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http://dx.doi.org/10.1016/j.jjcc.2019.04.003DOI Listing
October 2019

Lesion characteristics and prognosis of acute coronary syndrome without angiographically significant coronary artery stenosis.

Eur Heart J Cardiovasc Imaging 2020 02;21(2):202-209

Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8509, Japan.

Aims: While patients with acute coronary syndrome (ACS) presenting with non-obstructive coronary artery disease (CAD) are at high risk for cardiovascular mortality and morbidity, detailed lesion characteristics are unclear. The aim of this study was to investigate the lesion characteristics and prognosis of ACS with non-obstructive CAD.

Methods And Results: This study consisted of 82 consecutive ACS patients without obstructive CAD who underwent optical coherence tomography (OCT). Based on the presence of high-risk lesions (HL) in the culprit artery, we classified the patients into two groups: HL group and non-high-risk lesions (NHL) group. A systematic clinical follow-up was performed at our outpatient clinic for up to 24 months. Our endpoint was recurrence of ACS with obstructive CAD. OCT revealed that 42 (51.2%) of 82 patients had hidden HL in the culprit artery, including ruptured plaque (15.9%), calcified nodule (11.0%), spontaneous coronary artery dissection (8.5%), lone thrombus (8.5%), thin-cap fibroatheroma (6.1%), and plaque erosion (1.2%). During angiography, 5 (11.9%) HL patients complained of chest pain without ST elevation. Patients in the HL group had poorer prognoses than those in the other groups (P = 0.040).

Conclusion: Hidden high-risk lesions accompany ACS patients without obstructive CAD, resulting in poorer outcomes. Vascular injury itself might provoke acute chest pain.
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http://dx.doi.org/10.1093/ehjci/jez079DOI Listing
February 2020
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