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Ōsaka, Japan

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. Source

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. Source

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. Source

Takagi T.,Takagi Cardiology Clinic | Takagi A.,Tokyo Womens 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. Source

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. Source

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