Osaka Ekisaikai Hospital

Ōsaka, Japan

Osaka Ekisaikai Hospital

Ōsaka, Japan
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Fukuda S.,Osaka Ekisaikai Hospital | Watanabe H.,Heart Center | Iwakura K.,Sakurabashi Watanabe Hospital | Daimon M.,University of Tokyo | And 2 more authors.
Circulation Journal | Year: 2015

Background: Physical examination as an initial screening tool to diagnose abdominal aortic aneurysm (AAA) has lost favor over the past 20 years. This multicenter cohort study aimed to determine the prevalence of AAA in elderly Japanese patients with hypertension (HT) and to clarify the diagnostic accuracy of physical examination using a pocket-sized ultrasound imaging device (the “pocket-echo”). Methods and Results: A total of 1,731 patients with HT aged >60 years from 20 collaborating institutions were enrolled in this study. Abdominal palpation was performed on physical examination, and the pocket-echo was used to confirm the diagnosis of AAA. The abdominal aorta was well visualized in 1,692 patients (98%). AAA was discovered in 69 patients (4.1%), with advanced age and male sex identified as independent risk factors. The prevalence of AAA increased according to age regardless of sex, and reached 9.2% and 5.7%, respectively, in males and females ≥80 years. Overall, 33 cases of AAA were missed on abdominal palpation (sensitivity, 52%), whereas for AAAs >40 mm, the sensitivity was 75%. Conclusions: We assessed the utility of the pocket-echo and physical examination for diagnosing AAA in Japanese patients with HT aged over 60 years. Our findings highlight the importance of AAA screening programs in high-risk Japanese populations, and confirm the ability of physical examination to detect large, but not small, AAAs. © 2015, Japanese Circulation Society. All rights reserved.

Takagi T.,Takagi Cardiology Clinic | Yoshikawa J.,Osaka Ekisaikai Hospital
Journal of Echocardiography | Year: 2011

Purpose: This study attempted to evaluate the prevalence and features of elderly patients with elevated post-exercise left ventricular (LV) filling pressure in Japan. Background: Previous studies have validated that LV filling pressure during exercise can be estimated non-invasively by the Doppler index of diastolic filling (E/E′), and diastolic stress echocardiography has been promoted. There is limited information about diastolic stress echocardiography in Japan. Methods: Three hundred ten elderly patients aged ≥60 years who underwent treadmill stress echocardiography were studied. Patients with ischemic response were excluded. Doppler measurements were made before and immediately after the treadmill stress, and patients were divided into two groups regarding post-exercise E/E′ with cutoff values of 15. Clinical and echocardiographic characteristics were compared between the two groups. Results: One-third (33.9%) of the patients presented elevated post-exercise LV filling pressure indicated by E/E′ ≥15. Patients with an elevated post-exercise E/E′ were older (p = 0.0052), had a greater mean body mass index (p = 0.0459), were more likely to have an abnormal glucose tolerance (p = 0.0059), had a greater LV mass index (p = 0.0383), a greater left atrial volume index (p = 0.0042), and a higher E/E′ value at rest (p < 0.0001). Conclusion: One-third of the Japanese elderly patients who were referred for treadmill stress echocardiography and not limited by ischemia presented elevated post-exercise LV filling pressure indicated by E/E′ ≥15. These patients are likely to have clinical and echocardiographic characteristics of heart failure with preserved ejection fraction. © 2010 Japanese Society of Echocardiography.

Kono Y.,Osaka Ekisaikai Hospital | Fukuda S.,Osaka Ekisaikai Hospital | Hanatani A.,Osaka City University | Nakanishi K.,Osaka City University | And 3 more authors.
Drug Design, Development and Therapy | Year: 2014

Background: Remote ischemic conditioning (RIC) is a treatment modality that suppresses inflammation and improves endothelial function, which are factors involved in the pathogenesis of heart failure (HF) with reduced left ventricular ejection fraction. Coronary flow reserve (CFR) is a physiological index of coronary microcirculation and is noninvasively measured by transthoracic Doppler echocardiography (TTDE). This study aimed to investigate the effects of RIC on CFR in healthy subjects and patients with HF, through the assessment by TTDE. Methods: Ten patients with HF with left ventricular ejection fraction of less than 40%, and ten healthy volunteers were enrolled in this study. RIC treatment was performed twice a day for 1 week. Our custom-made RIC device was programmed to automatically conduct 4 cycles of 5 minutes inflation and 5 minutes deflation of a blood pressure cuff to create intermittent arm ischemia. CFR measurements and laboratory tests were examined before, and after 1 week of RIC treatment. Results: One week of RIC treatment was well tolerated in both groups. RIC treatment increased CFR from 4.0±0.9 to 4.6±1.3 (mean ± standard deviation) in healthy subjects (P=0.02), and from 1.9±0.4 to 2.3±0.7 in patients with HF (P=0.03), respectively. Systolic blood pressure in healthy subjects, and heart rate in HF patients decreased after RIC treatment (both P<0.01). Conclusion: This study demonstrated that a 1 week course of RIC treatment improved coronary microcirculation in healthy subjects and patients with HF associated with reduced left ventricular ejection fraction. © 2014 Kono et al.

Otsuka K.,Osaka City University | Fukuda S.,Osaka Ekisaikai Hospital | Shimada K.,Osaka City University | Suzuki K.,Japan Health Promotion Foundation | And 3 more authors.
Hypertension research : official journal of the Japanese Society of Hypertension | Year: 2014

Arterial stiffness is a significant predictor of cardiovascular disease (CVD), the risk of which is modified by medications for atherosclerotic risk factors and life-style changes. Cardio-ankle vascular index (CAVI) provides noninvasive, objective information on arterial stiffness, independent of blood pressure. This study aimed to investigate changes in CAVI after management of atherosclerotic risk factors, and the impact of these changes on future CVD outcomes in patients with coronary artery disease (CAD). The study consisted of 211 CAD patients (65 ± 10 years, 118 men) with impaired CAVI. CAVI examination was repeated 6 months later. Impaired CAVI was defined as greater than the mean plus 1 s.d. of the age- and gender-specific normal CAVI values, according to results obtained in 5188 healthy subjects. All patients were followed for > 1 year or until the occurrence of a CVD event. Of the 211 patients, CAVI improved in 106 (50%) patients after 6 months, but remained high in 105 (50%) patients. During follow-up (2.9 ± 1.0 years), CVD events occurred in 28 (13%) patients. Persistently impaired CAVI was an independent predictor of future CVD events (P = 0.01), independent of baseline CAVI. CVD outcomes were worse in patients with persistently impaired CAVI than in those with improved CAVI (P < 0.001). Among patients with a normalized CAVI after treatment (n = 22) only one suffered a CVD event. This study was the first to demonstrate that persistent impairment of arterial stiffness was an independent risk factor of future CVD events. Serial measurements of CAVI provide important prognostic information regarding patients with CAD in clinical practice.

Otsuka K.,Osaka City University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Social Insurance Kinan Hospital | Nakanishi K.,Osaka City University | And 4 more authors.
JACC: Cardiovascular Imaging | Year: 2013

Objectives: The aim of this study was to determine the predictive value of the napkin-ring sign on coronary computed tomography angiography (CTA) for future acute coronary syndrome (ACS) events in patients with coronary artery disease. Background: Recent studies have reported a close association between the napkin-ring sign on coronary CTA and thin-cap fibroatheroma. Methods: The subjects of this prospective study were 895 consecutive patients who underwent coronary CTA examination and were followed for >1 year. The primary endpoint was an ACS event (cardiac death, nonfatal myocardial infarction, or unstable angina pectoris). The coronary CTA analysis included the presence of obstructive plaque, positive remodeling (PR), low-attenuation plaque (LAP), and the napkin-ring sign. The napkin-ring sign was defined by the following criteria: 1) the presence of a ring of high attenuation around certain coronary artery plaques; and 2) attenuation of the ring presenting higher than those of the adjacent plaque and no >130 Hounsfield units. Results: Of the 12,727 segments, 1,174 plaques were observed, including plaques with PR in 130 segments (1.0%), LAP in 107 segments (0.8%), and napkin-ring signs in 45 segments (0.4%). Thirty-six of the 45 plaques with napkin-ring signs (80%) overlapped with those showing either PR or LAP. During the follow-up period (2.3 ± 0.8 years), 24 patients (2.6%) experienced ACS events, and plaques developed in 41% with a napkin-ring sign. Segment-based Cox proportional hazards models analysis showed that PR (p < 0.001), LAP (p = 0.007), and the napkin-ring sign (p < 0.0001) were independent predictive factors for future ACS events. Kaplan-Meier analysis demonstrated that plaques with napkin-ring signs showed a higher risk of ACS events compared with those without a napkin-ring sign. Conclusions: The present study demonstrated for the first time that the napkin-ring sign demonstrated on coronary CTA was strongly associated with future ACS events, independent of other high-risk coronary CTA features. Detection of the napkin-ring sign could help identify coronary artery disease patients at high risk of future ACS events. © 2013 American College of Cardiology Foundation.

Nakamura K.,Okayama University of Science | Oe H.,Okayama University of Science | Kihara H.,Kihara Cardiovascular Clinic | Shimada K.,Osaka City University | And 8 more authors.
Cardiovascular Diabetology | Year: 2014

Background: Alpha glucosidase inhibitor (GI) attenuates postprandial hyperglycemia (PPH) and reduces the risk of cardiovascular events in patients with impaired glucose tolerance or type 2 diabetes. Dipeptidyl peptidase 4 (DPP-4) inhibitors also attenuate PPH. PPH is one of the factors leading to endothelial dysfunction which is an early event in the pathogenesis of atherosclerosis. Furthermore, DPP-4 inhibitors protect endothelial function through a GLP-1-dependent mechanism. However, the impact of these two types of drugs on endothelial dysfunction in patients with type 2 diabetes has not been fully elucidated. We compared the effects of sitagliptin, a DPP-4 inhibitor, and voglibose, an alpha GI, on endothelial function in patients with diabetes.Methods: We conducted a randomized prospective multicenter study in 66 patients with type 2 diabetes who did not achieve the treatment goal with sulfonylurea, metformin or pioglitazone treatment; 31 patients received sitagliptin treatment and 35 patients, voglibose treatment. The flow-mediated dilatation (FMD) of the brachial artery was measured in the fasting state at baseline and after 12 weeks of treatment. The primary endpoint was a change in FMD (ΔFMD) from the baseline to the end of follow-up. The effects of sitagliptin and voglibose on FMD were assessed by ANCOVA after adjustment for the baseline FMD, age, sex, current smoking, diabetes duration and body mass index. Secondary efficacy measures included changes in HbA1c, GIP, GLP-1, C-peptide, CD34, lipid profile, oxidative stress markers, inflammatory markers and eGFR and any adverse events.Results: ΔFMD was significantly improved after 12 weeks of treatment in both groups, and there was no significant difference in ΔFMD between the two groups. There were no significant differences in changes in HbA1c, GIP, GLP-1, C-peptide, lipid profile, oxidative stress marker, inflammatory marker and eGFR between the two groups. Compared with voglibose, sitagliptin significantly increased the circulating CD34, a marker of endothelial progenitor cells. Adverse events were observed in 5 patients in only the voglibose group (diarrhea 1, nausea 1, edema 2 and abdominal fullness 1).Conclusions: Sitagliptin improved endothelial dysfunction just as well as voglibose in patients with type 2 diabetes. Sitagliptin had protective effects on endothelial function without adverse events. © 2014 Nakamura et al.; licensee BioMed Central Ltd.

Takagi T.,Takagi Cardiology Clinic | Takagi A.,Tokyo Women's Medical University | Yoshikawa J.,Osaka Ekisaikai Hospital
Journal of Cardiology | Year: 2010

Background: Prolongation of the time to peak strain (TPS) is a sensitive marker of myocardial ischemia. The purpose of this study was to evaluate whether delayed strain imaging obtained at 5 min after the termination of exercise stress can detect patients with significant coronary artery disease (CAD). Methods: A total of 45 patients who underwent treadmill stress echocardiography and coronary angiography were studied. Patients with abnormal wall motion at rest were excluded. Digital echocardiographic images were recorded at baseline and immediately after the termination of treadmill stress. Exercise-induced wall motion abnormality was considered as a marker of myocardial ischemia. Tissue velocity images were also recorded at baseline and 5 min after the termination of treadmill stress, and TPS was measured. TPS ratio was calculated as the ratio between TPS at delayed post-exercise and TPS at baseline. Results: Coronary angiography revealed that 30 of the 45 patients had significant CAD ≥50% diameter stenosis. The receiver operating characteristics curve demonstrated that cut-off value of TPS ratio 1.10 provides best diagnostic accuracy for vessel-based detection of significant CAD. The sensitivity, specificity, and diagnostic accuracy of the conventional exercise stress echocardiography for detecting patients with CAD were 87%, 80%, and 84%, respectively. The sensitivity, specificity, and accuracy of delayed strain imaging for identifying patients with CAD were 93%, 73%, and 87%, respectively. Conclusion: Delayed strain imaging obtained at 5 min after the termination of exercise stress can accurately detect patients with significant CAD. © 2009 Japanese College of Cardiology.

Nakanishi K.,Osaka City University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Social Insualance Kinan Hospital | Otsuka K.,Osaka City University | And 4 more authors.
Atherosclerosis | Year: 2014

Objective. Epicardial adipose tissue (EAT) is recognized as a novel risk factor for coronary artery disease (CAD), and its contribution is thought to be stronger in non-obese patients than in obese patients. However, the prognostic impact of the progression of EAT accumulation after comprehensive management for atherosclerotic risk factors remains unclear. This study aimed to investigate whether an increase of the EAT volume during follow-up predicts future acute coronary syndrome (ACS) events in non-obese CAD patients. Methods. This study consisted of 517 non-obese CAD patients (368 men; age, 66±10 years) who underwent serial multidetector computed tomography (MDCT) examinations to evaluate coronary atherosclerosis progression. The MDCT examination was used to assess the severity of stenosis, plaque characteristics, and EAT volume. All patients received comprehensive management to reduce CAD risk factors after the first MDCT examination. The MDCT examination was repeated at 6-24 months, and patients were followed-up for more than 1 year or until the occurrence of ACS events. Results. Of 517 patients, 159 (31%) patients were classified into increase of EAT volume during follow-up, 91 (18%) into decrease of EAT volume during follow-up, and 267 (51%) patients into constant of EAT volume during follow-up. The prevalence of obstructive plaques and MDCT-derived vulnerable features of coronary plaques were significantly elevated in patients with increase of EAT volume during follow-up. In contrast, no significant changes were observed in the other 2 groups. During the follow-up period of 4.1±1.8 years (median 4.4 years) after the second MDCT examination, ACS occurred in 43 (8.3%) patients. Multivariate Cox regression analysis showed that the presence of low-attenuation plaque (hazard ratio [HR]; 1.78, p=0.04) and napkin-ring sign (HR; 3.74, p<0.001) at second MDCT examination, and changes of EAT volume per 10ml (HR; 1.34, p=0.004) were associated with future ACS events. Conclusion. Patients with increase of EAT volume during follow-up despite comprehensive management for CAD risks had an increased prevalence of obstructive plaques and plaques with high-risk features, which could be associated with unfavorable ACS outcomes in non-obese CAD patients. © 2014 Elsevier Ireland Ltd.

Nakanishi K.,Osaka City University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Nishinomiya Watanabe Cardiovascular Center | Otsuka K.,Osaka City University | And 5 more authors.
Circulation Journal | Year: 2012

Background: Atrial fibrillation (AF) is associated with considerable morbidity and mortality in patients with coronary artery disease (CAD). Epicardial adipose tissue (EAT) is recognized as an important inflammatory tissue that may exert deleterious effects on the adjacent left atrial (LA) wall. Multidetector computed tomography (MDCT) can accurately assess EAT's volume and distribution. This study used MDCT to investigate the effect of peri-atrial EAT on new-onset nonvalvular AF. Methods and Results: The study group consisted of 279 patients (176 men; age, 65±10 years) with no history of AF who underwent MDCT examination for evaluation of CAD. EAT was automatically identified on the basis of threshold attenuation values of -30 to -250 Hounsfield units. EAT volume was calculated as the sum of EAT area and subsequently divided into peri-atrial and peri-ventricular EAT. During follow-up of 3.3±1.0 years, AF occurred in 17 (6.1%) patients. Cox proportional hazards regression analysis indicated that male sex, and the LA and periatrial EAT volumes (P=0.03, P<0.001, and P<0.001, respectively) were independent predictors for future AF. The sensitivity and specificity for the prediction of AF using a peri-atrial EAT volume index of ≥27ml/m2 were 88% and 92%, respectively. Conclusions: This is the first study demonstrating that peri-atrial EAT volume estimated by MDCT excellently predicted the development of new-onset AF in patients with CAD, independent of LA enlargement.

Otsuka K.,Osaka University | Fukuda S.,Osaka Ekisaikai Hospital | Tanaka A.,Social Insurance Kinan Hospital | Nakanishi K.,Osaka University | And 4 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2014

AimsIncreasing clinical evidence has emphasized the importance of coronary plaque characteristics, rather than the severity of luminal narrowing on acute coronary syndrome (ACS) outcome. Computed tomographic coronary angiography (CTCA) is a unique, non-invasive approach for assessing plaque characteristics. This study was prospectively designed to investigate the prognostic value of physiologically non-obstructive but a vulnerable coronary plaque on CTCA for predicting future ACS events.Methods and resultsThis study consisted of 543 patients who had undergone CTCA and had normal findings on exercise-stress myocardial perfusion single-photon emission computed tomography. CTCA analysis included the presence of >50% luminal stenosis and vulnerable features including positive remodelling (PR), low-Attenuation plaque, and ring-like sign. The primary endpoint was ACS events including cardiac death, non-fatal myocardial infarction, and unstable angina. The mean follow-up period was 3.4 ± 0.8 years. The 3-year cumulative event rate was 1.2% per year, and 87% of ACS events occurred in plaques with at least one of vulnerable features. In patient-based multivariate analysis, the presence of plaque with vulnerable features on CTCA was a significant predictor for future ACS events (P = 0.001). Patients with vulnerable plaque had worse ACS outcomes compared with those without vulnerable plaques (3-year cumulative event rate; 3.2 per year vs. 0.8%, P < 0.001).ConclusionThis study demonstrated that physiologically non-obstructive but vulnerable coronary plaques were associated with future ACS events. We should pay more attention to currently non-obstructive plaque but showing vulnerable morphologies on CTCA. © The Author 2013.

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