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Kurume, Japan

Michikawa T.,Japan National Institute of Environmental Studies | Ueda K.,Japan National Institute of Environmental Studies | Nitta H.,Japan National Institute of Environmental Studies | Kawasaki T.,Shin Koga Hospital | And 2 more authors.
Circulation: Cardiovascular Quality and Outcomes | Year: 2014

Background-Recently, there has been increasing concern about adverse health effects of exposure to desert dust events. However, the association between dust and the incidence of ischemic heart diseases is unknown. The aim of the present study was to elucidate whether Asian dust (AD), a windblown sand dust originating from mineral soil in China and Mongolia, is associated with the incidence of acute myocardial infarction (AMI). Methods and Results-We investigated the data regarding hospitalization because of AMI among 3068 consecutive patients from 4 AMI centers in Fukuoka, Japan, and data for AD from April 2003 to December 2010. We applied a time-stratified case-crossover design to examine the association between AD and the incidence of AMI. Using a conditional logistic regression analysis, we estimated the odds ratios of AMI associated with AD after controlling for ambient temperature and relative humidity. The occurrence of AD events 0 to 4 days before the day of admission was significantly associated with the incidence of AMI. In particular, the occurrence of AD 4 days before admission was significantly associated with the onset of AMI. Conclusions-These data suggest that exposure to AD a few days before symptom onset is associated with the incidence of AMI. © 2014 American Heart Association, Inc.

Fukuyama T.,Shin Koga Hospital
Japanese Journal of Clinical Radiology | Year: 2012

Nuclear cardiology began in the 1960s in Japan and in US. Clinical application of myocardium perfusion imaging (MPI) by 201T1-CL was started in late 1970s and it developed rapidly around a university hospital. We started to make experimental model of myocardial blood flow distribution using 86Rb-Cl in Kyushu University medical school from 1960s and found that the myocardial extraction of Rb is reduced in ischemic myocardium more than that from expected coronary flow. Clinical usefulness of MPI for diagnosing ischemic heart disease was established during 1980s: however ischemic imaging was not always clear for cardiologist who was not an expert of nuclear medicine. In 2007, fusion imaging of multi detector CT and MPI was introduced by Kaufmann et al and we applied this technique for detecting ischemic myocardial change due to culprit coronary lesion with 3D cardiac imaging. Thus easily visible ischemic myocardium with coronary lesion is now extremely useful for deciding revascularization of coronary artery.

Aihara H.,Kokura Memorial Hospital | Soga Y.,Kokura Memorial Hospital | Iida O.,Cardiovascular Center | Suzuki K.,Sendai Kosei Hospital | And 3 more authors.
Journal of Endovascular Therapy | Year: 2014

Purpose: To report long-term outcomes of endovascular therapy (EVT) for aortoiliac bifurcation lesions. Methods: Patients enrolled in the multicenter REtrospective AnaLysis of Aorto-Iliac stenting (REAL-AI) registry in Japan were pooled. Of 2096 patients who underwent EVT for de novo aortoiliac disease between January 2005 and December 2009, 190 patients (148 men; mean age 70±9 years) had aortoiliac bifurcation lesions that were treated with stents, whose configuration (single, V, or kissing) and type (balloon-expandable or self-expanding) were subjected to regression analysis to determine any impact on primary patency along with other demographic, clinical, and lesion characteristics, including Trans-Atlantic Inter-Society Consensus II C/D classification. The primary endpoints were restenosis and target lesion revascularization (TLR). Secondary endpoints were all-cause death, major cardiovascular events, and major cardiovascular + limb events. Results: The overall complication rate was 6.3%, and 1- and 5-year primary patency rates were 87% and 73%, respectively. Over a mean follow-up of 31±15 months, there were 36 (19.0%) restenoses, 22 (11.6%) TLRs, and 4 (2.1%) reocclusions; stent fracture (2, 1.1%) and major amputation (2, 1.1%) were rare. Only female gender [adjusted hazard ratio (AHR) 4.26, 95% CI 1.89 to 9.71, p<0.001] and residual diameter stenosis (AHR 1.04, 96% CI 1.01 to 1.06, p=0.01) were independent predictors of primary patency. Conclusion: Stenting for aortoiliac bifurcation lesions was found to be safe and effective. Neither stent configuration nor type appeared to affect vessel patency in true bifurcation lesions. © 2014 by the International Society of Endovascular Specialists.

Stone P.H.,Harvard University | Saito S.,Shonan Kamakura General Hospital | Takahashi S.,Harvard University | Makita Y.,Hakodate Municipal Hospital | And 19 more authors.
Circulation | Year: 2012

BACKGROUND: Atherosclerotic plaques progress in a highly individual manner. The purposes of the Prediction of Progression of Coronary Artery Disease and Clinical Outcome Using Vascular Profiling of Shear Stress and Wall Morphology (PREDICTION) Study were to determine the role of local hemodynamic and vascular characteristics in coronary plaque progression and to relate plaque changes to clinical events. METHODS AND RESULTS: Vascular profiling, using coronary angiography and intravascular ultrasound, was used to reconstruct each artery and calculate endothelial shear stress and plaque/remodeling characteristics in vivo. Three-vessel vascular profiling (2.7 arteries per patient) was performed at baseline in 506 patients with an acute coronary syndrome treated with a percutaneous coronary intervention and in a subset of 374 (74%) consecutive patients 6 to 10 months later to assess plaque natural history. Each reconstructed artery was divided into sequential 3-mm segments for serial analysis. One-year clinical follow-up was completed in 99.2%. Symptomatic clinical events were infrequent: only 1 (0.2%) cardiac death; 4 (0.8%) patients with new acute coronary syndrome in nonstented segments; and 15 (3.0%) patients hospitalized for stable angina. Increase in plaque area (primary end point) was predicted by baseline large plaque burden; decrease in lumen area (secondary end point) was independently predicted by baseline large plaque burden and low endothelial shear stress. Large plaque size and low endothelial shear stress independently predicted the exploratory end points of increased plaque burden and worsening of clinically relevant luminal obstructions treated with a percutaneous coronary intervention at follow-up. The combination of independent baseline predictors had a 41% positive and 92% negative predictive value to predict progression of an obstruction treated with a percutaneous coronary intervention. CONCLUSIONS: Large plaque burden and low local endothelial shear stress provide independent and additive prediction to identify plaques that develop progressive enlargement and lumen narrowing. CLINICAL TRIAL REGISTRATION: URL: http:www.//clinicaltrials.gov. Unique Identifier: NCT01316159. © 2012 American Heart Association, Inc.

Iida O.,Cardiovascular Center | Takahara M.,Osaka University | Soga Y.,Kokura Memorial Hospital | Suzuki K.,Sendai Kosei Hospital | And 7 more authors.
JACC: Cardiovascular Interventions | Year: 2014

Objectives This study sought to investigate factors associated with restenosis after endovascular therapy comparing TASC (Trans-Atlantic Inter-Society Consensus) II classes A to C with class D femoropopliteal (FP) lesions. Background It is unclear whether the determinants of restenosis for TASC II class D lesions are the same as those for TASC II classes A to C FP lesions. Methods We studied 2,400 limbs from 1,889 consecutive patients (73 ± 17 years of age; 31% women; 30% critical limb ischemia) who underwent successful endovascular therapy for de novo FP lesions. Predictors for restenosis in TASC II classes A to C and class D lesions were assessed using a Cox proportional hazards model. Results The 5-year primary patency rate was 50% in TASC II classes A to C and 34% in TASC II class D lesions, respectively (p < 0.001). Overall, restenosis had a significant interaction with sex and renal failure (both p < 0.01). Female sex was a significant risk factor for restenosis in TASC II class D lesions (adjusted hazard ratio [HR]: 1.80, p < 0.001) but not TASC II classes A to C lesions (adjusted HR: 1.10, p = 0.352). Conversely, renal insufficiency was a significant risk factor for restenosis in TASC II classes A to C lesions (adjusted HR: 1.43, p < 0.001) but not TASC II class D lesions (adjusted HR: 0.79, p = 0.129). Diabetes mellitus, no stent use, chronic total occlusion, and poor below-the-knee runoff were shared risk factors for restenosis between TASC II classes A to C and class D lesions (all p < 0.05). Conclusions For de novo FP lesions, diabetes, no stent use, chronic total occlusion, and poor below-the-knee runoff were shared restenosis predictors for TASC II classes A to C and class D lesions, whereas renal failure was a predictor for TASC II classes A to C lesions and female sex for TASC II class D lesions. © 2014 by the American College of Cardiology Foundation.

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