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SHIROTANI Manabu

    Kindai University Nara Hospital　Professor/General Manager
Last Updated :2024/04/25

Researcher Information

Degree

  • MD, PhD（1991/03 Kyoto University）

URL

Research funding number

  • 50319737

ORCID ID

J-Global ID

Research Interests

  • 虚血性心疾患   Ischemic Heart Disease   

Research Areas

  • Life sciences / Cardiology

Academic & Professional Experience

  • 2021/04 - Today  近畿大学奈良病院顧問
  • 2008/04 - Today  Kindai UniversityFaculty of Medicine診療部長 兼 教授
  • 2018/04 - 2021/03  近畿大学奈良病院病院長
  • 1999/08 - 2008/03  Kindai UniversityFaculty of Medicine准教授
  • 1997/04 - 1999/07  静岡県立総合病院循環器科総括医長
  • 1994/10 - 1997/03  静岡県立総合病院循環器科医長
  • 1992/07 - 1994/09  Austin Hospital, MelbourneCardiology departmentclinical fellow
  • 1990 - 1992  京都大学医学部附属病院第3内科 医員
  • 1990 - 1992  Kyoto University Hospital, Medical Staff

Education

  •        - 1990  Kyoto University  医学研究科  内科学
  •        - 1990  Kyoto University  Graduate School, Division of Medicine
  •        - 1983  Kyoto University  Faculty of Medicine  Department of Medical Science
  •        - 1983  Kyoto University  Faculty of Medicine

Association Memberships

  • 日本心血管カテーテル治療学会   日本冠疾患学会   日本心血管インターベンション学会   日本内科学会   日本循環器学会   

Published Papers

  • Ko Yamamoto; Takeshi Morimoto; Masahiro Natsuaki; Hiroki Shiomi; Neiko Ozasa; Hiroki Sakamoto; Yasuaki Takeji; Takenori Domei; Takeshi Tada; Ryoji Taniguchi; Takashi Uegaito; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Hiroshi Sakai; Katsuhisa Ishii; Mamoru Toyofuku; Shinji Miki; Tomoya Onodera; Yutaka Furukawa; Tsukasa Inada; Kenji Ando; Kazushige Kadota; Yoshihisa Nakagawa; Takeshi Kimura
    Circulation Journal Japanese Circulation Society 1346-9843 2023/09
  • Yasuaki Takeji; Tomohiko Taniguchi; Takeshi Morimoto; Shinichi Shirai; Takeshi Kitai; Hiroyuki Tabata; Kazuki Kitano; Nobuhisa Ohno; Ryosuke Murai; Kohei Osakada; Koichiro Murata; Masanao Nakai; Hiroshi Tsuneyoshi; Tomohisa Tada; Masashi Amano; Shin Watanabe; Hiroki Shiomi; Hirotoshi Watanabe; Yusuke Yoshikawa; Ryusuke Nishikawa; Ko Yamamoto; Yuki Obayashi; Mamoru Toyofuku; Shojiro Tatsushima; Norio Kanamori; Makoto Miyake; Hiroyuki Nakayama; Kazuya Nagao; Masayasu Izuhara; Kenji Nakatsuma; Moriaki Inoko; Takanari Fujita; Masahiro Kimura; Mitsuru Ishii; Shunsuke Usami; Kenichiro Sawada; Fumiko Nakazeki; Marie Okabayashi; Manabu Shirotani; Yasutaka Inuzuka; Kenji Ando; Tatsuhiko Komiya; Kenji Minatoya; Takeshi Kimura
    Cardiovascular intervention and therapeutics 2023/06 
    There were no data comparing the in-hospital outcomes after transcatheter aortic valve implantation (TAVI) with those after surgical aortic valve replacement (SAVR) in Japan. Among consecutive patients with severe AS between April 2018 and December 2020 in the CURRENT AS Registry-2, we identified 1714 patients who underwent aortic valve replacement (TAVI group: 1134 patients, and SAVR group: 580 patients). Patients in the TAVI group were much older (84.4 versus 73.6 years, P < 0.001) and more often had comorbidities than those in the SAVR group. In-hospital death rate was numerically lower in the TAVI group than in the SAVR group (0.6% versus 2.2%). After excluding patients with dialysis, in-hospital death rate was very low and comparable in the TAVI and SAVR groups (0.6% versus 0.8%). The rates of major bleeding and new-onset atrial fibrillation during index hospitalization were higher after SAVR than after TAVI (72% versus 20%, and 26% versus 4.6%, respectively), while the rate of pacemaker implantation was higher after TAVI than after SAVR (8.1% versus 2.4%). Regarding the echocardiographic data at discharge, the prevalence of patient-prosthesis mismatch was lower in the TAVI group than in the SAVR group (moderate: 9.0% versus 26%, and severe: 2.6% versus 4.8%). In this real-world data in Japan, TAVI compared with SAVR was chosen in much older patients with more comorbidities with severe AS. In-hospital death rate was numerically lower in the TAVI group than in the SAVR group.
  • Tomohiko Taniguchi; Takeshi Morimoto; Kyohei Yamaji; Shinichi Shirai; Kenji Ando; Hiroki Shiomi; Yasuaki Takeji; Nobuhisa Ohno; Norio Kanamori; Fumio Yamazaki; Tadaaki Koyama; Kitae Kim; Natsuhiko Ehara; Yutaka Furukawa; Tatsuhiko Komiya; Atsushi Iwakura; Manabu Shirotani; Jiro Esaki; Genichi Sakaguchi; Kosuke Fujii; Shogo Nakayama; Hiroshi Mabuchi; Hiroshi Tsuneyoshi; Hiroshi Eizawa; Kotaro Shiraga; Michiya Hanyu; Akira Nakano; Katsuhisa Ishii; Nobushige Tamura; Nobuya Higashitani; Ichiro Kouchi; Tomoyuki Yamada; Junichiro Nishizawa; Toshikazu Jinnai; Yuko Morikami; Kenji Minatoya; Takeshi Kimura
    The Annals of thoracic surgery 2023/02 
    BACKGROUND: There is a paucity of data regarding shorter life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). METHODS: Among 3815 patients with severe AS enrolled in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry, there were 1469 patients (initial AVR: n = 647; conservative strategy: n = 822) with low surgical risk, 1642 patients (initial AVR: n = 433; conservative strategy: n = 1209) with intermediate surgical risk, and 704 patients (initial AVR: n = 117; conservative strategy: n = 587) with high surgical risk. Among 1163 patients who actually underwent surgical AVR as the initial strategy, patients were divided into 4 groups according to age <65 years (n = 185), 65 to 74 (n = 394), 75 to 80 (n = 345), and >80 (n = 239). The expected survival of the general Japanese population was obtained from the Statistics Bureau of Japan. The surgical risk was estimated using The Society of Thoracic Surgery (STS) score. RESULTS: The median follow-up was 3.7 years. The cumulative incidences of all-cause death were significantly lower in the initial AVR strategy than in the initial conservative strategy across the 3 STS groups. Shorter life expectancy after surgical AVR was seen especially in younger patients. The observed mortality in low-risk patients was comparable to the expected mortality across all the age-groups, while intermediate-risk patients aged <75 years, and high-risk patients across all age-groups had higher mortality compared with the expected mortality. CONCLUSIONS: The risk stratification according to age and STS score might be useful to estimate shorter life expectancy after AVR, and these findings have implications for decision making in the choice of surgical or transcatheter AVR.
  • Yasuaki Takeji; Tomohiko Taniguchi; Takeshi Morimoto; Shinichi Shirai; Takeshi Kitai; Hiroyuki Tabata; Kazuki Kitano; Nobuhisa Ono; Ryosuke Murai; Kohei Osakada; Koichiro Murata; Masanao Nakai; Hiroshi Tsuneyoshi; Tomohisa Tada; Masashi Amano; Hiroki Shiomi; Hirotoshi Watanabe; Yusuke Yoshikawa; Ko Yamamoto; Mamoru Toyofuku; Shojiro Tatsushima; Norino Kanamori; Makoto Miyake; Hiroyuki Nakayama; Kazuya Nagao; Masayasu Izuhara; Kenji Nakatsuma; Moriaki Inoko; Takanari Fujita; Masahiro Kimura; Mitsuru Ishii; Shunsuke Usami; Kenichiro Sawada; Fumiko Nakazeki; Marie Okabayashi; Manabu Shirotani; Yasutaka Inuzuka; Tatsuhiko Komiya; Kenji Minatoya; Takeshi Kimura
    Circulation Journal Japanese Circulation Society 86 (11) 1769 - 1776 1346-9843 2022/10 [Refereed]
     
    BACKGROUND: There is scarce data evaluating the current practice pattern and clinical outcomes for patients with severe aortic stenosis (AS), including both those who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) and those who were managed conservatively in the TAVI era.Methods and Results: The Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis (CURRENT AS) Registry-2 is a prospective, physician-initiated, multicenter registry enrolling consecutive patients who were diagnosed with severe AS between April 2018 and December 2020 among 21 centers in Japan. The rationale for the prospective enrollment was to standardize the assessment of symptomatic status, echocardiographic evaluation, and other recommended diagnostic examinations such as computed tomography and measurement of B-type natriuretic peptide. Moreover, the schedule of clinical and echocardiographic follow up was prospectively defined and strongly recommended for patients who were managed conservatively. The entire study population consisted of 3,394 patients (mean age: 81.6 years and women: 60%). Etiology of AS was degenerative in 90% of patients. AS-related symptoms were present in 60% of patients; these were most often heart failure symptoms. The prevalence of high- and low-gradient AS was 58% and 42%, respectively, with classical and paradoxical low-flow low-gradient AS in 4.5% and 6.7%, respectively. CONCLUSIONS: The CURRENT AS Registry-2 might be large and meticulous enough to determine the appropriate timing of intervention for patients with severe AS in contemporary clinical practice.
  • Kyohei Yamaji; Hiroki Shiomi; Takeshi Morimoto; Yukiko Matsumura-Nakano; Natsuhiko Ehara; Hiroki Sakamoto; Yasuaki Takeji; Yusuke Yoshikawa; Ko Yamamoto; Eri T Kato; Kazuaki Imada; Takeshi Tada; Ryoji Taniguchi; Ryusuke Nishikawa; Tomohisa Tada; Takashi Uegaito; Tatsuya Ogawa; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Nobushige Tamura; Keiichi Tambara; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Junichiro Nishizawa; Masahiro Natsuaki; Hiroshi Sakai; Takashi Yamamoto; Naoki Kanemitsu; Nobuhisa Ohno; Katsuhisa Ishii; Akira Marui; Hiroshi Tsuneyoshi; Yasuhiko Terai; Shogo Nakayama; Kazuhiro Yamazaki; Mamoru Takahashi; Takashi Tamura; Jiro Esaki; Shinji Miki; Tomoya Onodera; Hiroshi Mabuchi; Yutaka Furukawa; Masaru Tanaka; Tatsuhiko Komiya; Yoshiharu Soga; Michiya Hanyu; Takenori Domei; Kenji Ando; Kazushige Kadota; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura
    JACC. Asia 2 (3) 294 - 308 2022/06 [Refereed]
     
    BACKGROUND: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization. OBJECTIVES: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions. METHODS: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry. The primary outcome measure was major adverse cardiovascular and cerebral endpoints (MACCE), which was defined as a composite of all-cause death, myocardial infarction, and stroke. RESULTS: With median follow-up of 5.6 years, diabetes was associated with significantly higher adjusted risks for MACCE. The excess adjusted risks of diabetes relative to nondiabetes for MACCE increased with younger age (≤64 years: adjusted HR: 1.30; 95% CI: 1.19-1.41; P < 0.001; 64-73 years: adjusted HR: 1.24; 95% CI: 1.16-1.33; P < 0.001; >73 years: adjusted HR: 1.17; 95% CI: 1.10-1.23; P < 0.001; P interaction < 0.001), mainly driven by greater excess adjusted mortality risk of diabetes relative to nondiabetes in younger tertile. No significant interaction was observed between adjusted risk of diabetes relative to nondiabetes for MACCE and other subgroups such as sex, mode of revascularization, and clinical presentation of acute myocardial infarction. CONCLUSIONS: The excess risk of diabetes relative to nondiabetes for MACCE was profound in the younger population. This observation suggests more aggressive interventions for secondary prevention in patients with diabetes might be particularly relevant in younger patients.
  • Masahiro Natsuaki; Takeshi Morimoto; Hiroki Shiomi; Ko Yamamoto; Kyohei Yamaji; Hirotoshi Watanabe; Takashi Uegaito; Mitsuo Matsuda; Toshihiro Tamura; Ryoji Taniguchi; Moriaki Inoko; Hiroshi Mabuchi; Teruki Takeda; Takenori Domei; Manabu Shirotani; Natsuhiko Ehara; Hiroshi Eizawa; Katsuhisa Ishii; Masaru Tanaka; Tsukasa Inada; Tomoya Onodera; Ryuzo Nawada; Eiji Shinoda; Miho Yamada; Takashi Yamamoto; Hiroshi Sakai; Mamoru Toyofuku; Takashi Tamura; Mamoru Takahashi; Tomohisa Tada; Hiroki Sakamoto; Takeshi Tada; Kazuhisa Kaneda; Shinji Miki; Takeshi Aoyama; Satoru Suwa; Yukihito Sato; Kenji Ando; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Takeshi Kimura
    Circulation Journal Japanese Circulation Society 86 (5) 748 - 759 1346-9843 2022/04 [Refereed]
     
    BACKGROUND: Optimal intensity is unclear for P2Y12receptor blocker therapy after percutaneous coronary intervention (PCI) in real-world clinical practice.Methods and Results:From the CREDO-Kyoto Registry, the current study population consisted of 25,419 patients (Cohort-2: n=12,161 and Cohort-3: n=13,258) who underwent their first PCI. P2Y12receptor blocker therapies were reduced dose of ticlopidine (200 mg/day), and global dose of clopidogrel (75 mg/day) in 87.7% and 94.8% of patients in Cohort-2 and Cohort-3, respectively. Cumulative 3-year incidence of GUSTO moderate/severe bleeding was significantly higher in Cohort-3 than in Cohort-2 (12.1% and 9.0%, P<0.0001). After adjusting 17 demographic factors and 9 management factors potentially related to the bleeding events other than the type of P2Y12receptor blocker, the higher bleeding risk in Cohort-3 relative to Cohort-2 remained significant (hazard ratio (HR): 1.52 95% confidence interval (CI) 1.37-1.68, P<0.0001). Cohort-3 compared with Cohort-2 was not associated with lower adjusted risk for myocardial infarction/ischemic stroke (HR: 0.96, 95% CI: 0.87-1.06, P=0.44). CONCLUSIONS: In this historical comparative study, Cohort-3 compared with Cohort-2 was associated with excess bleeding risk, which might be at least partly explained by the difference in P2Y12receptor blockers.
  • Ryosuke Murai; Yuichi Kawase; Tomohiko Taniguchi; Takeshi Morimoto; Kazushige Kadota; Masanobu Ohya; Takenobu Shimada; Takeshi Maruo; Yasushi Fuku; Tatsuhiko Komiya; Kenji Ando; Michiya Hanyu; Norio Kanamori; Takeshi Aoyama; Koichiro Murata; Tomoya Onodera; Fumio Yamazaki; Takeshi Kitai; Yutaka Furukawa; Tadaaki Koyama; Makoto Miyake; Chisato Izumi; Yoshihisa Nakagawa; Kazuo Yamanaka; Hirokazu Mitsuoka; Manabu Shirotani; Masashi Kato; Shinji Miki; Hiroyuki Nakajima; Yutaka Hirano; Shunichi Miyazaki; Toshihiko Saga; Sachiko Sugioka; Shintaro Matsuda; Mitsuo Matsuda; Tatsuya Ogawa; Kazuya Nagao; Tsukasa Inada; Shogo Nakayama; Hiroshi Mabuchi; Yasuyo Takeuchi; Hiroki Sakamoto; Genichi Sakaguchi; Keiichiro Yamane; Hiroshi Eizawa; Mamoru Toyofuku; Takashi Tamura; Atsushi Iwakura; Mitsuru Ishii; Masaharu Akao; Kotaro Shiraga; Eri Minamino-Muta; Takao Kato; Moriaki Inoko; Koji Ueyama; Tomoyuki Ikeda; Yoshihiro Himura; Akihiro Komasa; Katsuhisa Ishii; Kozo Hotta; Yukihito Sato; Keiichi Fujiwara; Yoshihiro Kato; Ichiro Kouchi; Yasutaka Inuzuka; Shigeru Ikeguchi; Senri Miwa; Chiyo Maeda; Eiji Shinoda; Junichiro Nishizawa; Toshikazu Jinnai; Nobuya Higashitani; Mitsuru Kitano; Yuko Morikami; Shouji Kitaguchi; Kenji Minatoya; Takeshi Kimura
    Circulation Journal Japanese Circulation Society 86 (3) 427 - 437 1346-9843 2022/02 
    BACKGROUND: The clinical significance of concomitant mitral regurgitation (MR) has not been well addressed in patients with severe aortic stenosis (AS).Methods and Results:We analyzed 3,815 patients from a retrospective multicenter registry of severe AS in Japan (CURRENT AS registry). We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategy (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death or heart failure hospitalization. At baseline, moderate/severe MR was present in 227/1,197 (19%) patients with initial AVR strategy and in 536/2,618 (20%) patients with a conservative strategy. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR, regardless of the initial treatment strategy (25.2% vs. 14.4%, P<0.001 in the initial AVR strategy, and 63.3% vs. 40.7%, P<0.001 in the conservative strategy). After adjusting confounders, moderate/severe MR was not independently associated with higher risk for the primary outcome measure in the initial AVR strategy (hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.67-1.83, P=0.69), and in the conservative strategy (HR 1.13, 95% CI 0.93-1.37, P=0.22). CONCLUSIONS: Concomitant moderate/severe MR was not independently associated with higher risk for the primary outcome measure regardless of the initial treatment strategy.
  • Ko Yamamoto; Masahiro Natsuaki; Takeshi Morimoto; Hiroki Shiomi; Yasuaki Takeji; Kyohei Yamaji; Yukiko Matsumura-Nakano; Yusuke Yoshikawa; Erika Yamamoto; Masayuki Fuki; Eri Kato; Yugo Yamashita; Hidenori Yaku; Kenji Nakatsuma; Hiroki Watanabe; Mitsuo Matsuda; Toshihiro Tamura; Moriaki Inoko; Hiroshi Mabuchi; Manabu Shirotani; Hiroshi Eizawa; Katsuhisa Ishii; Tsukasa Inada; Tomoya Onodera; Eiji Shinoda; Takashi Yamamoto; Mamoru Toyofuku; Mamoru Takahashi; Hiroki Sakamoto; Shinji Miki; Takeshi Aoyama; Satoru Suwa; Yukihito Sato; Yutaka Furukawa; Kenji Ando; Kazushige Kadota; Yoshihisa Nakagawa; Takeshi Kimura
    The American Journal of Cardiology Elsevier BV 164 34 - 43 0002-9149 2022/02 
    Recently, one observational study showed that patients with ST-segment elevation myocardial infarction (STEMI) without standard cardiovascular risk factors were associated with increased mortality compared with patients with risk factors. This unexpected result should be evaluated in other populations including those with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and chronic coronary syndrome (CCS). Among 30,098 consecutive patients undergoing first coronary revascularization in the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) registry cohort-2 and 3, we compared clinical characteristics and outcomes between patients with and without risk factors stratified by their presentation (STEMI n = 8,312, NSTE-ACS n = 3,386, and CCS n = 18,400). Patients with risk factors were defined as having at least one of the following risk factors: hypertension, dyslipidemia, diabetes, and current smoking. The proportion of patients without risk factors was low (STEMI: 369 patients [4.4%], NSTE-ACS: 110 patients [3.2%], and CCS: 462 patients [2.5%]). Patients without risk factors compared with those with risk factors more often had advanced age, low body weight, and malignancy and less often had history of atherosclerotic disease and prescription of optimal medical therapy. In patients with STEMI, patients without risk factors compared with those with risk factors were more often women and more often had atrial fibrillation, long door-to-balloon time, and severe hemodynamic compromise. During a median of 5.6 years follow-up, patients without risk factors compared with those with risk factors had higher crude incidence of all-cause death. After adjusting confounders, the mortality risk was significant in patients with CCS (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.01 to 1.49, p = 0.04) but not in patients with STEMI (HR 1.06, 95% CI 0.89 to 1.27, p = 0.52) and NSTE-ACS (HR 1.07, 95% CI, 0.74 to 1.54, p = 0.73). In conclusion, among patients undergoing coronary revascularization, patients without standard cardiovascular risk factors had higher crude incidence of all-cause death compared with those with at least one risk factor. After adjusting confounders, the mortality risk was significant in patients with CCS but not in patients with STEMI and NSTE-ACS.
  • Ko Yamamoto; Masahiro Natsuaki; Takeshi Morimoto; Hiroki Shiomi; Neiko Ozasa; Hiroki Sakamoto; Yasuaki Takeji; Kazuaki Imada; Takeshi Tada; Ryoji Taniguchi; Takashi Uegaito; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Hiroshi Sakai; Takashi Yamamoto; Katsuhisa Ishii; Mamoru Takahashi; Takashi Tamura; Shinji Miki; Tomoya Onodera; Yutaka Furukawa; Masaru Tanaka; Kenji Ando; Kazushige Kadota; Yoshihisa Nakagawa; Takeshi Kimura
    The American Journal of Cardiology Elsevier BV 159 19 - 29 0002-9149 2021/11 [Refereed]
     
    Polypharmacy was reported to be associated with increased mortality in various populations. However, there is a scarcity of data on status of polypharmacy and association with long-term mortality in patients who underwent percutaneous coronary intervention (PCI). Among 12,291 patients who underwent first PCI in the CREDO-Kyoto PCI/CABG registry Cohort-3, we evaluated the number of medications at discharge from index PCI hospitalization, and compared long-term mortality across the 3 groups divided by the tertiles of the number of medications. The median number of medications was 6 (interquartile range: 5 to 8), and 88.0% of the patients were on >=5 medications. Most of medications were those related to cardiovascular disease. Patients taking more medications were older and more often had co-morbidities and guideline-indicated medications. The cumulative 5-year incidence of all-cause death increased incrementally with increasing number of medications (Tertile 1 [<=5]: 13.1%, Tertile 2 [6 to 7]: 13.9%, and Tertile 3 [>=8]: 18.0%, log-rank p <0.001). After adjusting confounders, the mortality risks of Tertile 2 and Tertile 3 relative to Tertile 1 were no longer significant (Tertile 2: hazard ratio 0.93; 95% confidence interval 0.84 to 1.04; p = 0.23, and Tertile 3: hazard ratio 0.91; 95% confidence interval 0.81 to 1.03; p = 0.14, respectively). In conclusion, in a real-world population of patients who underwent PCI, approximately 90% of patients were on >=5 medications. Increasing medications was associated with higher crude incidence of all-cause death, whereas adjusted mortality risks were similar regardless of the number of medications. These data might suggest that achievement of optimal medical therapy would be preferred, even if it might increase the number of medications used.
  • Hiroki Shiomi; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Yusuke Yoshikawa; Kyohei Yamaji; Tomohisa Tada; Junichi Tazaki; Natsuhiko Ehara; Ryoji Taniguchi; Toshihiro Tamura; Atsushi Iwakura; Takeshi Tada; Hirotoshi Watanabe; Satoru Suwa; Mamoru Toyofuku; Tsukasa Inada; Kazuhisa Kaneda; Tatsuya Ogawa; Teruki Takeda; Hiroshi Sakai; Takashi Yamamoto; Keiichi Tambara; Jiro Esaki; Hiroshi Eizawa; Miho Yamada; Eiji Shinoda; Junichiro Nishizawa; Hiroshi Mabuchi; Nobushige Tamura; Manabu Shirotani; Shogo Nakayama; Takashi Uegaito; Mitsuo Matsuda; Mamoru Takahashi; Moriaki Inoko; Naoki Kanemitsu; Takashi Tamura; Kazuhisa Ishii; Ryuzo Nawada; Tomoya Onodera; Nobuhisa Ohno; Tadaaki Koyama; Hiroshi Tsuneyoshi; Hiroki Sakamoto; Takeshi Aoyama; Shinji Miki; Masaru Tanaka; Yukihito Sato; Fumio Yamazaki; Michiya Hanyu; Yoshiharu Soga; Tatsuhiko Komiya; Kenji Ando; Kenji Minatoya; Takeshi Kimura
    The American Journal of Cardiology Elsevier BV 153 20 - 29 0002-9149 2021/08 [Refereed]
     
    The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081). From Cohort-1 to Cohort-3, the patients got progressively older across subsequent cohorts (67.0 ± 10.0, 68.4 ± 9.9, and 69.8 ± 10.2 years, ptrend < 0.001). There was increased use of PCI over CABG (73.5%, 81.9%, and 85.2%, ptrend < 0.001) and increased prevalence of evidence-based medications use over time. The cumulative 3-year incidence of all-cause death was similar across the 3 cohorts (9.0%, 9.0%, and 9.3%, p = 0.74), while cardiovascular death decreased over time (5.7%, 5.1%, and 4.8%, p = 0.03). The adjusted risk for all-cause death and for cardiovascular death progressively decreased from Cohort-1 to Cohort-2 (HR:0.89, 95%CI:0.80 to 0.99, p = 0.03, and HR:0.80, 95%CI:0.70 to 0.92, p = 0.002, respectively), and from Cohort-2 to Cohort-3 (HR:0.86, 95%CI:0.78 to 0.95, p = 0.004, and HR:0.77, 95%CI:0.67-0.89, p < 0.001, respectively). The risks for stroke and repeated coronary revascularization also improved over time. In conclusions, we found a progressive and substantial reduction of adjusted risk for all-cause death, cardiovascular death, stroke, and repeated coronary revascularization over the past two decades in Japan.
  • Yukiko Matsumura-Nakano; Hiroki Shiomi; Takeshi Morimoto; Kyohei Yamaji; Natsuhiko Ehara; Hiroki Sakamoto; Yasuaki Takeji; Yusuke Yoshikawa; Ko Yamamoto; Kazuaki Imada; Takeshi Tada; Ryoji Taniguchi; Ryusuke Nishikawa; Tomohisa Tada; Takashi Uegaito; Tatsuya Ogawa; Miho Yamada; Teruki Takeda; Hiroshi Eizawa; Nobushige Tamura; Keiichi Tambara; Satoru Suwa; Manabu Shirotani; Toshihiro Tamura; Moriaki Inoko; Junichiro Nishizawa; Masahiro Natsuaki; Hiroshi Sakai; Takashi Yamamoto; Naoki Kanemitsu; Nobuhisa Ohno; Katsuhisa Ishii; Akira Marui; Hiroshi Tsuneyoshi; Yasuhiko Terai; Shogo Nakayama; Kazuhiro Yamazaki; Mamoru Takahashi; Takashi Tamura; Jiro Esaki; Shinji Miki; Tomoya Onodera; Hiroshi Mabuchi; Yutaka Furukawa; Masaru Tanaka; Tatsuhiko Komiya; Yoshiharu Soga; Michiya Hanyu; Kenji Ando; Kazushige Kadota; Kenji Minatoya; Yoshihisa Nakagawa; Takeshi Kimura
    The American Journal of Cardiology Elsevier BV 145 25 - 36 0002-9149 2021/04 [Refereed]
     
    There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.
  • Yasuaki Takeji; Hiroki Shiomi; Takeshi Morimoto; Yusuke Yoshikawa; Ryoji Taniguchi; Yukiko Mutsumura-Nakano; Ko Yamamoto; Kyohei Yamaji; Junichi Tazaki; Eri Toda Kato; Hirotoshi Watanabe; Erika Yamamoto; Yugo Yamashita; Masayuki Fuki; Satoru Suwa; Moriaki Inoko; Teruki Takeda; Manabu Shirotani; Natsuhiko Ehara; Katsuhisa Ishii; Tsukasa Inada; Toshihiro Tamura; Tomoya Onodera; Eiji Shinoda; Takashi Yamamoto; Hiroki Watanabe; Hidenori Yaku; Kenji Nakatsuma; Hiroki Sakamoto; Kenji Ando; Yoshiharu Soga; Yutaka Furukawa; Yukihito Sato; Yoshihisa Nakagawa; Kazushige Kadota; Tatsuhiko Komiya; Kenji Minatoya; Takeshi Kimura
    BMJ Open BMJ 11 (3) e043683 - e043683 2044-6055 2021/03 [Refereed]
     
    ObjectiveTo evaluate changes in demographics, clinical practices and long-term clinical outcomes of patients with ST segment-elevation myocardial infarction (STEMI) before and beyond 2010. DesignMulticentre retrospective cohort study. SettingThe Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI Registries Wave-1 (2005–2007, 26 centres) and Wave-2 (2011–2013, 22 centres). Participants9001 patients with STEMI who underwent coronary revascularisation (Wave-1: 4278 patients, Wave-2: 4723 patients). Primary and secondary outcome measuresThe primary outcome was all-cause death at 3 years. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, target vessel revascularisation, ischaemia-driven target vessel revascularisation, any coronary revascularisation and any ischaemia-driven coronary revascularisation. ResultsPatients in Wave-2 were older, more often had comorbidities and more often presented with cardiogenic shock than those in Wave-1. Patients in Wave-2 had shorter onset-to-balloon time and door-to-balloon time, were more frequently implanted drug-eluting stents, and received guideline-directed medication than those in Wave-1. The cumulative 3-year incidence of all-cause death was not significantly different between Wave-1 and Wave-2 (15.5% and 15.7%, p=0.77). The adjusted risk of all-cause death in Wave-2 relative to Wave-1 was not significant at 3 years (HR 0.92, 95% CI 0.83 to 1.03, p=0.14), but lower beyond 30 days (HR 0.86, 95% CI 0.75 to 0.98, p=0.03). The adjusted risks of Wave-2 relative to Wave-1 were significantly lower for definite stent thrombosis (HR 0.59, 95% CI 0.43 to 0.81, p=0.001) and for any coronary revascularisation (HR 0.75, 95% CI 0.69 to 0.81, p<0.001), but higher for major bleeding (HR 1.34, 95% CI 1.20 to 1.51, p=0.005). ConclusionsWe could not demonstrate improvement in 3-year mortality risk from Wave-1 to Wave-2, but we found reduction in mortality risk beyond 30 days. We also found risk reduction for definite stent thrombosis and any coronary revascularisation, but an increase in the risk of major bleeding from Wave-1 to Wave-2.
  • Yasuaki Takeji; Hiroki Shiomi; Takeshi Morimoto; Yusuke Yoshikawa; Ryoji Taniguchi; Yukiko Mutsumura-Nakano; Ko Yamamoto; Kyohei Yamaji; Junichi Tazaki; Satoru Suwa; Moriaki Inoko; Teruki Takeda; Manabu Shirotani; Natsuhiko Ehara; Katsuhisa Ishii; Tsukasa Inada; Tomoya Onodera; Eiji Shinoda; Takashi Yamamoto; Takashi Tamura; Kenji Nakatsuma; Hiroki Sakamoto; Kenji Ando; Yoshiharu Soga; Yutaka Furukawa; Yukihito Sato; Yoshihisa Nakagawa; Kazushige Kadota; Tatsuhiko Komiya; Kenji Minatoya; Takeshi Kimura
    BMJ Open BMJ 11 (2) e044329 - e044329 2044-6055 2021/02 [Refereed]
     
    ObjectivesTo evaluate patient characteristics and long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) in the past two decades. DesignMulticenter retrospective study. SettingThe Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) Registry Cohort-2 (2005–2007) and Cohort-3 (2011–2013). Participants3254 patients with NSTEACS who underwent first coronary revascularisation. Primary and secondary outcome measuresThe primary outcome was all-cause death. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, any coronary revascularisation and target vessel revascularisation. ResultsPatients in Cohort-3 were older and more often had heart failure at admission than those in Cohort-2. The prevalence of PCI, emergency procedure and guideline-directed medical therapy was higher in Cohort-3 than in Cohort-2. In patients who received PCI, the prevalence of transradial approach, drug-eluting stent use and intravascular ultrasound use was higher in Cohort-3 than in Cohort-2. There was no change in 3-year adjusted mortality risk from Cohort-2 to Cohort-3 (HR 1.00, 95% CI 0.83 to 1.22, p=0.97). Patients in Cohort-3 compared with those in Cohort-2 were associated with lower adjusted risks for stroke (HR 0.65, 95% CI 0.46 to 0.92, p=0.02) and any coronary revascularisation (HR 0.76, 95%CI 0.66 to 0.87, p<0.001), but with higher risk for major bleeding (HR 1.25, 95% CI 1.06 to 1.47, p=0.008). The unadjusted risk for definite stent thrombosis was lower in Cohort-3 than in Cohort 2 (HR 0.29, 95% CI 0.11 to 0.67, p=0.003). ConclusionsIn the past two decades, we did not find improvement for mortality in patients with NSTEACS. We observed a reduction in the risks for definite stent thrombosis, stroke and any coronary revascularisation, but an increase in the risk for major bleeding.
  • Masahiro Natsuaki; Takeshi Morimoto; Hiroki Shiomi; Natsuhiko Ehara; Ryoji Taniguchi; Toshihiro Tamura; Takeshi Tada; Satoru Suwa; Kazuhisa Kaneda; Hirotoshi Watanabe; Junichi Tazaki; Shin Watanabe; Erika Yamamoto; Naritatsu Saito; Masayuki Fuki; Teruki Takeda; Hiroshi Eizawa; Eiji Shinoda; Hiroshi Mabuchi; Manabu Shirotani; Takashi Uegaito; Mitsuo Matsuda; Mamoru Takahashi; Moriaki Inoko; Takashi Tamura; Kazuhisa Ishii; Tomoya Onodera; Hiroki Sakamoto; Takeshi Aoyama; Yukihito Sato; Kenji Ando; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Takeshi Kimura
    Circulation Journal Japanese Circulation Society 85 (6) 769 - 781 1346-9843 2020/12 [Refereed]
     
    BACKGROUND: The prevalence of and expected bleeding event rate in patients with the Japanese version of high bleeding risk (J-HBR) criteria are currently unknown in real-world percutaneous coronary intervention (PCI) practice.Methods and Results:We applied the J-HBR criteria in the multicenter CREDO-Kyoto registry cohort-3 that enrolled 13,258 consecutive patients who underwent first PCI. The J-HBR criteria included Japanese-specific major criteria such as heart failure, low body weight, peripheral artery disease and frailty in addition to the Academic Research Consortium (ARC)-HBR criteria. There were 8,496 patients with J-HBR, and 4,762 patients without J-HBR. The J-HBR criteria identified a greater proportion of patients with HBR than did ARC-HBR (64% and 48%, respectively). Cumulative incidence of the Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was significantly higher in the J-HBR group than in the no-HBR group (14.0% vs. 4.1% at 1 year; 23.1% vs. 8.4% at 5 years, P<0.0001). Cumulative 5-year incidence of BARC 3/5 bleeding was 25.1% in patients with ARC-HBR, and 23.1% in patients with J-HBR. Cumulative incidence of myocardial infarction or ischemic stroke was also significantly higher in the J-HBR group than in the no-HBR group (6.9% vs. 3.6% at 1 year; 13.2% vs. 7.1% at 5 years, P<0.0001). CONCLUSIONS: The J-HBR criteria successfully identified those patients with very high bleeding risk after PCI, who represented 64% of patients in this all-comers registry.
  • YOKOTA Ryoji; NISHI Yuko; SUGITANI Yuuki; TAMADA Hiroyuki; OHI Yohei; ISHIKAWA Chisato; OHE Kentarou; UEMORI Noritsugu; MITSUOKA Hirokazu; TOGI Kiyonori; SHIROTANI Manabu
    Acta Medica Kindai University 43 (1) 35 - 42 0386-6092 2018/06 [Refereed]
  • Masahiro Natsuaki; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Kenji Ando; Hiroki Shiomi; Toshiaki Toyota; Hirotoshi Watanabe; Koh Ono; Satoshi Shizuta; Takashi Tamura; Moriaki Inoko; Tsukasa Inada; Manabu Shirotani; Mitsuo Matsuda; Takeshi Aoyama; Tomoya Onodera; Satoru Suwa; Teruki Takeda; Katsumi Inoue; Takeshi Kimura
    Cardiovascular intervention and therapeutics 33 (1) 23 - 34 2018/01 [Refereed]
     
    One-month duration of dual antiplatelet therapy (DAPT) has widely been adopted after bare-metal stent (BMS) implantation in the real clinical practice. However, it has not been adequately addressed yet whether DAPT for only 1-month could provide sufficient protection from ischemic events beyond 1-month after BMS implantation. We assessed the effects of short DAPT relative to prolonged DAPT on clinical outcomes with the landmark analysis at 2 month after BMS implantation. Among 13,058 consecutive patients enrolled in the CREDO-Kyoto registry cohort-2, this study population consisted of 4905 patients treated with BMS only in whom the information on the status of antiplatelet therapy was available at 2 month after stent implantation [single-antiplatelet therapy (SAPT) group: N = 2575 (acute myocardial infarction (AMI): N = 1257, and non-AMI: N = 1318), and DAPT group: N = 2330 (AMI: N = 1304, and non-AMI: N = 1026)]. Cumulative 3-year incidence of the primary outcome measure (a composite of cardiovascular death, myocardial infarction, stroke, definite stent thrombosis, and GUSTO moderate/severe bleeding) was not significantly different between the SAPT and DAPT groups (9.8 versus 10.6 %, P = 0.34). After adjusting confounders, the risk of SAPT relative to DAPT for the primary outcome measure remained insignificant in the entire cohort (HR 0.97, 95 % CI 0.79-1.19, P = 0.77), and in both AMI and non-AMI strata without any significant interaction between clinical presentation (AMI versus non-AMI) and the effect of SAPT relative to DAPT (P interaction = 0.56). In conclusion, short DAPT <2 month after BMS implantation was as safe as prolonged DAPT ≥2-month in both AMI and non-AMI patients.
  • PCI後のプロタミンによる抗凝固能の適切な中和をめざして 止血時ACT減少に関わる影響因子の研究
    玉田 博之; 杉谷 勇季; 石川 千紗都; 大江 健太郎; 東儀 圭則; 城谷 学
    日本心血管インターベンション治療学会抄録集 (一社)日本心血管インターベンション治療学会 26回 MO162 - MO162 2017/07
  • 直接的血管形成による治療後の急性心筋梗塞において、入院時glucose値は梗塞サイズを反映し、結果として院内死亡率も示す可能性がある(Admission Glucose Levels may Reflect Infarct Size and Thereby in-hospital Mortality in Acute Myocardial Infarction Treated by Primary Angioplasty)
    杉谷 勇季; 玉田 博之; 太居 洋平; 石川 千紗都; 大江 健太郎; 三岡 仁和; 東儀 圭則; 横田 良司; 城谷 学
    日本循環器学会学術集会抄録集 (一社)日本循環器学会 81回 PJ - 201 2017/03
  • Hiroki Shiomi; Takeshi Morimoto; Shoji Kitaguchi; Yoshihisa Nakagawa; Katsuhisa Ishii; Yoshisumi Haruna; Itaru Takamisawa; Makoto Motooka; Kazuhiro Nakao; Shintaro Matsuda; Satoru Mimoto; Yutaka Aoyama; Teruki Takeda; Koichiro Murata; Masaharu Akao; Tsukasa Inada; Hiroshi Eizawa; Eiji Hyakuna; Kojiro Awano; Manabu Shirotani; Yutaka Furukawa; Kazushige Kadota; Katsumi Miyauchi; Masaru Tanaka; Yuichi Noguchi; Sunao Nakamura; Satoshi Yasuda; Shunichi Miyazaki; Hiroyuki Daida; Kazuo Kimura; Yuji Ikari; Haruo Hirayama; Tetsuya Sumiyoshi; Takeshi Kimura
    JACC-CARDIOVASCULAR INTERVENTIONS ELSEVIER SCIENCE INC 10 (2) 109 - 117 1936-8798 2017/01 [Refereed]
     
    OBJECTIVES The purpose of this study was to evaluate long-term clinical impact of routine follow-up coronary angiography (FUCAG) after percutaneous coronary intervention (PCI) in daily clinical practice in Japan. BACKGROUND The long-term clinical impact of routine FUCAG after PCI in real-world clinical practice has not been evaluated adequately. METHODS In this prospective, multicenter, open-label, randomized trial, patients who underwent successful PCI were randomly assigned to routine angiographic follow-up (AF) group, in which patients were to receive FUCAG at 8 to 12 months after PCI, or clinical follow-up alone (CF) group. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure over a minimum of 1.5 years follow-up. RESULTS Between May 2010 and July 2014, 700 patients were enrolled in the trial among 22 participating centers and were randomly assigned to the AF group (n = 349) or the CF group (n = 351). During a median of 4.6 years of follow-up (interquartile range [IQR]: 3.1 to 5.2 years), the cumulative 5-year incidence of the primary endpoint was 22.4% in the AF group and 24.7% in the CF group (hazard ratio: 0.94; 95% confidence interval: 0.67 to 1.31; p = 0.70). Any coronary revascularization within the first year was more frequently performed in AF group than in CF group (12.8% vs. 3.8%; log-rank p < 0.001), although the difference between the 2 groups attenuated over time with a similar cumulative 5-year incidence (19.6% vs. 18.1%; log-rank p = 0.92). CONCLUSIONS No clinical benefits were observed for routine FUCAG after PCI and early coronary revascularization rates were increased within routine FUCAG strategy in the current trial. (Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial [ReACT]; NCT01123291) (C) 2017 by the American College of Cardiology Foundation.
  • Uemori Noritsugu; Yokota Ryoji; Ohi Yohei; Ishikawa Chisato; Tamada Hiroyuki; Sugitani Yuuki; Ohe Kentarou; Mitsuoka Hirokazu; Togi Kiyonori; Shirotani Manabu
    Acta Medica Kinki University 近畿大学医学会 40 (2) 47 - 51 0386-6092 2015/12 
    症例は47歳女性で、6歳時にファロー四徴症に対する心内修復術の施行歴があった。今回、心悸亢進と目眩を主訴に来院した。心電図で心房周期240msの心房頻拍を認めた。心拍数は125bpmで、房室ブロックを認めた。多電極カテーテルを右房、右室、冠状静脈洞に挿入し、サンプリングレート1000/秒で心内心電図を記録した。磁気立体マッピング法の使用により高密度のactivation mapが30分間で作製できた。このactivation mapにより上大静脈と下大静脈をそれぞれ旋回するdual-loopの8の字型リエントリー回路が同定された。右房側壁の低電位領域にcritical isthmusを同定し、カテーテルアブレーションによりisthmusの先端から下大静脈に向かって焼却した。リエントリー性頻拍は根治し、右横隔神経の損傷は見られなかった。
  • Hiroki Watanabe; Hiroki Shiomi; Kenji Nakatsuma; Takeshi Morimoto; Tomohiko Taniguchi; Yutaka Furukawa; Yoshihisa Nakagawa; Minoru Horie; Takeshi Kimura; Takeshi Kimura; Ryuzo Sakata; Akira Marui; Mitsuo Matsuda; Hirokazu Mitsuoka; Masahiko Onoe; Yoshihisa Nakagawa; Kazuo Yamanaka; Hisayoshi Fujiwara; Yoshiki Takatsu; Nobuhisa Ohno; Ryuji Nohara; Tomoyuki Murakami; Teruki Takeda; Masakiyo Nobuyoshi; Masashi Iwabuchi; Michiya Hanyu; Ryozo Tatami; Tsutomu Matsushita; Manabu Shirotani; Noboru Nishiwaki; Toru Kita; Yutaka Furukawa; Yukikatsu Okada; Hiroshi Kato; Hiroshi Eizawa; Katsuhisa Is; Masaru Tanaka; Shogo Nakayama; Jong-Dae Lee; Akira Nakano; Takaaki Koshiji; Koichi Morioka; Akinori Takizawa; Mitsuomi Shimamoto; Fumio Yamazaki; Masaaki Takahashi; Junichiro Nishizawa; Minoru Horie; Hiroyuki Takashima; Takashi Tamura; Masaki Aota; Mamoru Takahashi; Takafumi Tabata; Chuwa Tei; Shuichi Hamasaki; Yutaka Imoto; Hiroyuki Yamamoto; Hirofumi Kambara; Osamu Doi; Katsuhiko Matsuda; Masafumi Nara; Kazuaki Mitsudo; Kazushige Kadota; Tatsuhiko Komiya; Shinji Miki; Tetsu Mizoguchi; Hiroyuki Nakajima; Hisao Ogawa; Seigo Sugiyama; Michio Kawasuji; Syuji Moriyama; Ryuichi Hattori; Takeshi Aoyama; Makoto Araki; Satoru Suwa; Keiichi Tanbara; Kumiko Kitagawa; Misato Yamauchi; Naoko Okamoto; Yumika Fujino; Saori Tezuka; Asuka Saeki; Miya Hanazawa; Yuki Sato; Chikako Hibi; Hitomi Sasae; Emi Takinami; Yuriko Uchida; Yuko Yamamoto; Satoko Nishida; Mai Yoshimoto; Sachiko Maeda; Izumi Miki; Saeko Minematsu; Mitsuru Abe; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Akihiro Tokushige; Masahiro Natsuaki; Tetsu Nakajima
    Journal of the American Heart Association 4 (6) e001962  2015/06 [Refereed]
     
    BACKGROUND: Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) was reported to promote better coronary and myocardial reperfusion. However, long-term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. METHODS AND RESULTS: The CREDO-Kyoto AMI Registry is a large-scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005-2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI. Clinical outcomes were compared between the 2 patient groups with or without TA. During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA (TA group). The cumulative 5-year incidence of all-cause death was significantly lower in the TA group than in the non-TA group (18.5% versus 23.9%, log-rank P<0.001). After adjusting for confounders, however, the risk for all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio: 0.90, 95% CI: 0.76 to 1.06, P=0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target-lesion revascularization were also not significantly different between the 2 groups. CONCLUSIONS: Adjunctive TA during primary PCI was not associated with better 5-year mortality in STEMI patients.
  • 橫田良司; 玉田博之; 杉谷勇季; 太居洋平; 石川千紗都; 上森宜嗣; 三岡仁和; 東儀圭則; 胡内一郎; 城谷 学
    心電図 34 (4) 382 - 389 0285-1660 2015/04 [Refereed]
  • Hirotoshi Watanabe; Takeshi Morimoto; Masahiro Natsuaki; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Kyohei Yamaji; Kenji Ando; Satoshi Shizuta; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Takashi Tamura; Manabu Shirotani; Shinji Miki; Mitsuo Matsuda; Mamoru Takahashi; Katsuhisa Ishii; Masaru Tanaka; Takeshi Aoyama; Osamu Doi; Ryuichi Hattori; Masayuki Kato; Satoru Suwa; Akinori Takizawa; Yoshiki Takatsu; Eiji Shinoda; Hiroshi Eizawa; Teruki Takeda; Jong-Dae Lee; Moriaki Inoko; Hisao Ogawa; Shuichi Hamasaki; Minoru Horie; Ryuji Nohara; Hirofumi Kambara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita; Adnan Kastrati; Takeshi Kimura
    PloS one 10 (4) e0124314  2015 [Refereed]
     
    Relation of antiplatelet therapy (APT) discontinuation with the risk of serious cardiovascular events has not been fully addressed yet. This study is aimed to evaluate the risk of ischemic event after APT discontinuation based on long-term APT status of large cohort. In the CREDO-Kyoto Registry Cohort-2 enrolling 15939 consecutive patients undergoing first coronary revascularization, 10470 patients underwent percutaneous coronary intervention either with bare-metal stents (BMS) only (N=5392) or sirolimus-eluting stents (SES) only (N=5078). Proportions of patients taking dual-APT were 67.3% versus 33.4% at 1-year, and 48.7% versus 24.3% at 5-year in the SES and BMS strata, respectively. We evaluated daily APT status (dual-, single- and no-APT) and linked the adverse events to the APT status just 1-day before the events. No-APT as compared with dual- or single-APT was associated with significantly higher risk for stent thrombosis (ST) beyond 1-month after SES implantation (cumulative incidence rates beyond 1-month: 1.23 versus 0.15/0.29, P<0.001/P<0.001), while higher risk of no-APT for ST was evident only until 6-month after BMS implantation (incidence rates between 1- and 6-month: 8.43 versus 0.71/1.20, P<0.001/P<0.001, and cumulative incidence rates beyond 6-month: 0.31 versus 0.11/0.08, P=0.16/P=0.08). No-APT as compared with dual- or single-APT was also associated with significantly higher risk for spontaneous myocardial infarction (MI) and stroke regardless of the types of stents implanted. Single-APT as compared with dual-APT was not associated with higher risk for serious adverse events, except for the marginally higher risk for ST in the SES stratum. In conclusion, discontinuation of both aspirin and thienopyridines was associated with increased risk for serious cardiovascular events including ST, spontaneous MI and stroke beyond 1-month after coronary stenting.
  • Incidence and Clinical Predictors of Stent Restenosis and Early Stent Occlusion in Patients with Acute Myocardial Infarction Treated by Bare Metal Stents: Importance of Infarct Location and Serum Creatinine Level
    Noritsugu Uemori; Yuki Sugitani; Hiroyuki Tamada; Yohei Ohi; Chisato Ishikawa; Narimasa Miho; Hirokazu Mitsuoka; Kiyonori Togi; Ichiro Kouchi; Ryoji Yokota; Manabu Shirotani
    Angiology 2 (4) 136  2014/11 [Refereed]
  • Short communication： Current Problems in the Treatment of Acute Myocardial Infarction: For Better Reperfusion and Long-Term Benefits
    Shirotani M; Togi K; Ohi Y
    Emergency Medicine 4 (6) 220  2014/09 [Refereed][Invited]
  • Koji Gott; Kentaro Nakai; Satoshi Shizuta; Takeshi Morimoto; Hiroki Shiomi; Masahiro Natsuaki; Mitsuhiko Yahata; Chihiro Ota; Koh Ono; Takeru Makiyama; Yoshihisa Nakagawa; Yutaka Furukawa; Kazushige Kadota; Yoshiki Takatsu; Takashi Tamura; Akinori Takizawa; Tsukasa Inada; Osamu Doi; Ryuji Nohara; Mitsuo Matsuda; Teruki Takeda; Masayuki Kato; Manabu Shirotani; Hiroshi Eizawa; Katsuhisa Ishii; Jong-Dae Lee; Masaaki Takahashi; Minoru Horie; Mamoru Takahashi; Shinji Miki; Takeshi Aoyama; Satoru Suwa; Shuichi Hamasaki; Hisao Ogawa; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita; Takeshi Kimura
    AMERICAN JOURNAL OF CARDIOLOGY EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC 114 (1) 70 - 78 0002-9149 2014/07 [Refereed]
     
    The prevalence, intensity, safety, and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in "real-world" patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not yet been fully evaluated. In the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2, a total of 1,057 patients with AF (8.3%) were identified among 12,716 patients undergoing first PCI. Cumulative 5-year incidence of stroke was higher in patients with AF than in no-AF patients (12.8% vs 5.8%, p <0.0001). Although most patients with AF had CHADS(2) score >= 2 (75.2%), only 506 patients (47.9%) received OAC with warfarin at hospital discharge. Cumulative 5-year incidence of stroke in the OAC group was not different from that in the no-OAC group (13.8% vs 11.8%, p = 0.49). Time in therapeutic range (TTR) was only 52.6% with an international normalized ratio of 1.6 to 2.6, and only 154 of 409 patients (37.7%) with international normalized ratio data had TTR >= 65%. Cumulative 5-year incidence of stroke in patients with TTR >= 65% was markedly lower than that in patients with TTR <65% (6.9% vs 15.1%, p = 0.01). In a 4-month landmark analysis in the OAC group, there was a trend for higher cumulative incidences of stroke and major bleeding in the on-DAPT (n = 286) than in the off-DAPT (n = 173) groups (15.1% vs 6.7%, p = 0.052 and 14.7% vs 8.7%, p = 0.10, respectively). In conclusion, OAC was underused and its intensity was mostly suboptimal in real-world patients with AF undergoing PCI, which lead to inadequate stroke prevention. Long-term DAPT in patients receiving OAC did not reduce stroke incidence. (C) 2014 The Authors. Published by Elsevier Inc. All rights reserved.
  • Masahiro Natsuaki; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Kyohei Yamaji; Kenji Ando; Satoshi Shizuta; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Takashi Tamura; Manabu Shirotani; Shinji Miki; Mitsuo Matsuda; Mamoru Takahashi; Katsuhisa Ishii; Masaru Tanaka; Takeshi Aoyama; Osamu Doi; Ryuichi Hattori; Masayuki Kato; Satoru Suwa; Akinori Takizawa; Yoshiki Takatsu; Eiji Shinoda; Hiroshi Eizawa; Teruki Takeda; Jong-Dae Lee; Moriaki Inoko; Hisao Ogawa; Shuichi Hamasaki; Minoru Horie; Ryuji Nohara; Hirofumi Kambara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita; Takeshi Kimura
    CIRCULATION-CARDIOVASCULAR INTERVENTIONS LIPPINCOTT WILLIAMS & WILKINS 7 (2) 168 - + 1941-7640 2014/04 [Refereed]
     
    Background-Late adverse events such as very late stent thrombosis (VLST) or late target-lesion revascularization (TLR) after first-generation sirolimus-eluting stents (SES) implantation have not been yet fully characterized at long term in comparison with those after bare-metal stent (BMS) implantation. Methods and Results-Among 13 058 consecutive patients undergoing first percutaneous coronary intervention in the Coronary REvascularization Demonstrating Outcome study-Kyoto registry Cohort-2, 5078 patients were treated with SES only, and 5392 patients were treated with BMS only. During 7-year follow-up, VLST and late TLR beyond 1 year after SES implantation occurred constantly and without attenuation at 0.24% per year and at 2.0% per year, respectively. Cumulative 7-year incidence of VLST was significantly higher in the SES group than that in the BMS group (1.43% versus 0.68%, P<0.0001). However, there was no excess of all-cause death beyond 1 year in the SES group as compared with that in the BMS group (20.8% versus 19.6%, P=0.91). Cumulative incidences of late TLR (both overall and clinically driven) were also significantly higher in the SES group than in the BMS group (12.0% versus 4.1%, P<0.0001 and 8.5% versus 2.6%, P<0.0001, respectively), leading to late catch-up of the SES group to the BMS group regarding TLR through the entire 7-year follow-up (18.8% versus 25.2%, and 10.6% versus 10.2%, respectively). Clinical presentation as acute coronary syndrome was more common at the time of late SES TLR compared with early SES TLR (21.2% and 10.0%). Conclusions-Late catch-up phenomenon regarding stent thrombosis and TLR was significantly more pronounced with SES than that with BMS. This limitation should remain the target for improvements of DES technology.
  • Editorial: What do we need to seek in the next step in clinical cardiology for better treatment of patients with cardiovascular diseases?
    Manabu Shirotani; Kiyonori Togi; Noritsugu Uemori
    Austin J Clin Cardiol 1 (1) 5  2014/01 [Refereed]
  • 岸谷 讓; 川崎 俊彦; 石川 千紗都; 太居 洋平; 横田 良司; 城谷 学; 太田 善夫; 笹野 公伸
    日本内分泌学会雑誌 (一社)日本内分泌学会 88 (1) 368 - 368 0029-0661 2012/04
  • Takeshi Kimura; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Masashi Iwabuchi; Satoshi Shizuta; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Takashi Tamura; Manabu Shirotani; Shinji Miki; Mitsuo Matsuda; Mamoru Takahashi; Katsuhisa Ishii; Masaru Tanaka; Takeshi Aoyama; Osamu Doi; Ryuichi Hattori; Ryozo Tatami; Satoru Suwa; Akinori Takizawa; Yoshiki Takatsu; Masaaki Takahashi; Hiroshi Kato; Teruki Takeda; Jong-Dae Lee; Ryuji Nohara; Hisao Ogawa; Chuwa Tei; Minoru Horie; Hirofumi Kambara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita
    Cardiovascular intervention and therapeutics 26 (3) 234 - 45 2011/09 
    Long-term safety and efficacy of drug-eluting stents remains controversial. The CREDO-Kyoto registry cohort-2 is a physician-initiated non-company sponsored multi-center registry enrolling consecutive patients undergoing first coronary revascularization in 26 centers in Japan. We compared 3-year outcome between patients treated with sirolimus-eluting stent (SES) only (5092 patients) and bare-metal stent (BMS) only (5405 patients). SES-use as compared with BMS-use was associated with significantly lower adjusted risk for all-cause death [hazard ratio (HR) [95% confidence interval (CI)] 0.72 (0.59-0.87), P = 0.0007], which was mainly driven by the reduction in non-cardiac death [HR (95% CI) 0.64 (0.48-0.85), P = 0.002]. The risk of cardiac death [HR (95% CI) 0.82 (0.63-1.07), P = 0.15], myocardial infarction [HR (95% CI) 0.73 (0.51-1.03), P = 0.07] and definite stent thrombosis [HR (95% CI) 0.62 (0.35-1.09), P = 0.1] was not different between the two groups. Despite longer duration of thienopyridine administration, SES-use was associated with significantly lower risk for bleeding [HR (95% CI) 0.75 (0.6-0.95), P = 0.02] and similar risk for stroke [HR (95% CI) 1.0 (0.75-1.34), P = 1.0]. The risk for target-lesion revascularization (TLR) was markedly lower in the SES group [HR (95% CI) 0.42 (0.36-0.48), P < 0.0001]. The direction and magnitude of the effect of SES relative to BMS in patients presenting acute myocardial infarction (AMI) were similar to those in patients presenting otherwise. In conclusion, SES-use as compared with BMS-use was associated with marked reduction of TLR without any increases in death, myocardial infarction, stent thrombosis, stroke and bleeding in real world clinical practice regardless of clinical presentation including AMI.
  • Takeshi Kimura; Takeshi Morimoto; Yutaka Furukawa; Yoshihisa Nakagawa; Kazushige Kadota; Masashi Iwabuchi; Satoshi Shizuta; Hiroki Shiomi; Tomohisa Tada; Junichi Tazaki; Yoshihiro Kato; Mamoru Hayano; Mitsuru Abe; Takashi Tamura; Manabu Shirotani; Shinji Miki; Mitsuo Matsuda; Mamoru Takahashi; Katsuhisa Ishii; Masaru Tanaka; Takeshi Aoyama; Osamu Doi; Ryuichi Hattori; Ryozo Tatami; Satoru Suwa; Akinori Takizawa; Yoshiki Takatsu; Masaaki Takahashi; Hiroshi Kato; Teruki Takeda; Jong-Dae Lee; Ryuji Nohara; Chuwa Tei; Minoru Horie; Hirofumi Kambara; Hisayoshi Fujiwara; Kazuaki Mitsudo; Masakiyo Nobuyoshi; Toru Kita
    Cardiovascular intervention and therapeutics 26 (3) 222 - 33 2011/09 
    Previous studies have shown inconsistent results regarding the effects of concomitant use of clopidogrel and proton pump inhibitors (PPI) on cardiovascular outcomes. We sought to evaluate the clinical impact of PPI-use in patients treated with thienopyridines after percutaneous coronary intervention (PCI) in a large Japanese observational database. Among 12446 patients discharged alive on thienopyridines (ticlopidine 90.4% and clopidogrel 9.6%), 3223 patients were treated with PPIs and 9223 patients without PPI at the time of hospital discharge. The PPI group included more patients with co-morbidities than the non-PPI group. The adjusted hazard ratio (HR) of PPI-use for a composite of cardiovascular death, myocardial infarction, and stroke was 1.26 (95% confidence interval (CI) 1.09-1.47, p = 0.002). The adjusted HR of PPI-use for bleeding was 1.26 (95% CI 1.05-1.52, p = 0.013). Cardiovascular and bleeding outcomes were not different among the three groups receiving three different types of PPI. The negative effect of PPI on cardiovascular outcome was consistently seen in both drug-eluting stent (DES) [HR 1.31 (95% CI 1.07-1.6, p = 0.0097)] and non-DES strata [HR 1.25 (95% CI: 0.99-1.57, p = 0.057)] (Interaction p = 0.79) despite the fact that the duration of thienopyridine administration was significantly longer in patients receiving DES. In conclusion, cardiovascular outcomes after PCI were significantly worse in patients with PPI than in patients without PPI in the Japanese real clinical practice. However, the observed poorer cardiovascular outcome in patients receiving PPI was most likely to be related to residual confounding and seemed not causally related to attenuation of antiplatelet effect of thienopyridine through interaction with PPI.
  • 城谷 学; 横田 良司; 胡内 一郎; 平井 拓; 上森 宜嗣; 羽場 一直; 清水 良栄; 溝部 道生; 石川 千紗都; 太居 洋平; 三保 成正; 服部 隆一
    Respiration and Circulation 医学書院 59 (6) 625 - 629 0452-3458 2011/06 
    急性心筋梗塞（AMI）患者における冠攣縮の影響は，日本人で大きいことが示されているが，個々の患者における関連の程度については不明の点が多い．今回AMI患者60例でアテノロールが冠攣縮に及ぼす影響を調べた当施設の研究の中で，エルゴノビン負荷試験の結果を再評価し，責任冠動脈（IRA）と非IRA(non-IRA)で比較検討した．負荷試験による冠動脈狭小化は11～100%と様々で，IRA，non-IRAとも同様であった．単変量解析で，IRAにおける負荷陽性因子は，IRAがどの冠動脈であるかであった．またnon-IRAにおけるそれは，冠動脈疾患の家族歴のないことと非糖尿病，発症時のIRAへの側副血行路の発達となった．多変量解析でIRAでは，右冠動脈の梗塞(p=0.001)，非糖尿病(p=0.035)が，non-IRAでは，家族歴なし(p=0.004)と側副血行路の発達(p=0.011)が関連因子となった．AMI慢性期の冠攣縮反応は症例によって広くばらつきがあり， IRAとnon-IRAでは異なる背景が関連していることが示唆された．
  • M. Shirotani; Y. Ohi; C. Ishikawa; Y. Shimizu; M. Mizobe; K. Haba; N. Uemori; N. Miho; T. Hirai; Kouchi, I; R. Yokota; R. Hattori
    CORONARY ARTERY DISEASE: 2011 UPDATE: FROM PREVENTION TO INTERVENTION MEDIMOND S R L 273 - 275 2011 [Refereed]
  • Manabu Shirotani; Ryoji Yokota; Ichiro Kouchi; Taku Hirai; Noritsugu Uemori; Kazunao Haba; Ryuichi Hattori
    INTERNATIONAL JOURNAL OF CARDIOLOGY ELSEVIER IRELAND LTD 139 (2) 181 - 186 0167-5273 2010/03 
    Background: Japanese patients with acute myocardial infarction (MI) have a greater incidence of coronary artery spasm than Caucasians. Some beta-blockers have been reported to aggravate coronary spasm. This study sought to assess the effects of beta-adrenoceptor blockade on coronary vasospasm in Japanese patients with acute MI who had been treated with primary angioplasty. Methods: In 69 patients we analyzed the effect of atenolol 50 mg/day initiated the day after emergency primary angioplasty on the results of intracoronary ergonovine provocation test performed 4 weeks after onset. Results: Among 35 patients in the atenolol group, the drug was discontinued in 9 (26%) due to hemodynamic compromise. The remaining 26 in the atenolol group and 34 in the control group underwent the spasm provocation test. Atenolol did not significantly increase the incidence of coronary vasospasm (31% vs. 15% in the atenolol and control groups, respectively, p=0.135). Multivariate analysis revealed that only the pre-provocation diameter of the distal segment of the infarct-related artery predicted coronary spasm whereas atenolol did not. Conclusions: This study showed that atenolol 50 mg/day did not increase coronary spasm in Japanese acute MI patients. It is suggested that beta-blockers can be safely used soon after coronary intervention for acute MI without the risk of increasing coronary spasm; however, attention should be paid to hemodynamic change in the acute phase. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
  • 薬剤溶出性ステント(DES)の最近の動向
    上森 宜嗣; 服部 隆一; 城谷 学; 横田 良司; 胡内 一郎; 羽場 一直; 清水 良栄; 溝部 道生
    Jpn J Cardiovasc Cathet Thrr Jpn J Cardiovasc Cathet Thrr Miwa-Shoten Ltd. 7 (4) 317 - 324 2007/12
  • R Yokota; M Shirotani; L Kouchi; T Hirai; N Uemori; Y Ohta; Y Mitsui; R Hattori
    INTERNAL MEDICINE JAPAN SOC INTERNAL MEDICINE 43 (3) 204 - 208 0918-2918 2004/03 
    We describe a rare case of Becker's muscular dystrophy (BMD) in a 28-year-old man complicated by rapidly progressing heart failure without apparent clinical signs of neuromuscular disease. He showed rhabdomyolysis, which repeatedly occurred causing acute renal failure as heart failure worsened. His serum creatine kinase (CK) level was generally below 300 IU/l. However, it exceeded more than 10,000 IU/l at the time of myoglobinuria. This suggests that the worsening of heart failure could induce rhabdomyolysis in a BMD patient. Gene analysis for BMD should be considered when the elevation of serum CK is noted in heart failure.
  • K Sakata; T Nakamura; H Tamekiyo; K Obayashi; J Ishikawa; R Nawada; H Yoshida; M Shirotani
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION BLACKWELL SCIENCE ASIA 63 (10) 806 - 808 0047-1828 1999/10 [Refereed]
     
    In patients with pseudoxanthoma elasticum, severe organic coronary artery stenosis often occurs without coronary risk factors. However, this report presents the case: of a 49-year-old woman with pseudoxanthoma elasticum who had coronary artery spasm with an angiographically normal coronary artery. In addition, coronary artery spasm was provoked with dipyridamole thallium-201 cardiac imaging.
  • 当院における経皮的冠動脈形成術(PTCA)の現状と再狭窄について 豪州との比較と冠動脈血管エコー(IVUS)による評価を含めて
    城谷 学; 吉田 裕; 坂田 和之; 縄田 隆三; 大林 和彦; 三保 成正; 東儀 圭則
    静岡県立総合病院医学雑誌 静岡県立総合病院 14 (1) 1 - 8 0911-4157 1999/08 
    1997年から2年間に施行したPTCAについて,使用したバルーンサイズの分布を,豪州留学中のそれと比較検討した.また拡張部位の再狭窄の発生における,最終拡張バルーンのサイズ,ステントの種類,冠動脈内超音波検査の測定結果との関連性についても検討した.日本人の治療対象冠動脈内径は,オーストラリア人に比べ細い.冠動脈内径が細い症例では,再狭窄の発生が高い.至適ステントによる十分な拡張は,再狭窄を予防すると考えられるが,2.5mm以下の内径ではステントの効果にも限界がある.また逆に,3.5mm以上の大きな冠動脈内径を有する部位(日本人では稀であるが)では,バルーン拡張だけでも再狭窄は起こりにくい
  • K Sakata; M Shirotani; H Yoshida; R Nawada; K Obayashi; K Togi; N Miho
    HYPERTENSION LIPPINCOTT WILLIAMS & WILKINS 33 (6) 1447 - 1452 0194-911X 1999/06 [Refereed]
     
    N-Type calcium channel antagonists may suppress sympathetic activity, The purpose of this study was to assess the effects of amlodipine and cilnidipine on the cardiac sympathetic nervous system and the neurohormonal status of essential hypertension. I-123-metaiodobenzylguanidine (MIBG) cardiac imaging was performed and blood samples were taken to determine plasma renin activity and plasma norepinephrine concentration before and 3 months after drug administration in 47 patients with mild essential hypertension. Twenty-four of the patients were treated with 5 to 10 mg/d of amlodipine; the other 23 were treated with 10 to 20 mg/d of cilnidipine. For comparison, 12 normotensive subjects were also studied. No significant differences were found in the basal characteristics between the 2 hypertensive groups. In both hypertensive groups, both the systolic and diastolic blood pressures were significantly reduced to similar levels 3 months after drug treatment. Before the drug treatment, the 2 hypertensive groups had a significantly higher washout rate and lower heart-to-mediastinum (H/M) ratio compared with the normotensive subjects. The H/M ratio significantly increased (P<0.05) in combination with a decreased washout rate (P<0.02) after drug treatment in the cilnidipine group. In the amlodipine group, a significant decrease in washout rate (P<0.04) was noted, without an increase in the H/M ratio. However, no significant changes were found in plasma renin activity and plasma norepinephrine concentration in either group. Thus, in patients with essential hypertension, cilnidipine suppressed cardiac sympathetic overactivity and amlodipine had a little suppressive effect. Cilnidipine may provide a new strategy for treatment of cardiovascular diseases with sympathetic overactivity.
  • K Sakata; M Shirotani; H Yoshida; T Urano; Y Takada; A Takada
    AMERICAN HEART JOURNAL MOSBY-ELSEVIER 137 (6) 1094 - 1099 0002-8703 1999/06 [Refereed]
     
    Background Impaired fibrinolysis is associated with thromboembolic complications in hypertensive patients. It has been reported that cardiovascular morbidity and mortality rates are high even after lowering the elevated blood pressure with antihypertensive drugs. The aim of this study was to assess the effect of clinically used dosages of enalapril and nitrendipine on the fibrinolytic system. Methods Tissue plasminogen activator antigen (tPA) and tissue plasminogen activator inhibitor-1 (PAI-1) activity were measured in 20 normotensive male subjects and 46 male patients with mild essential hypertension divided into 2 groups (22 patients treated with 5 to 10 mg enalapril once a day and 24 treated with 5 to 10 mg nitrendipine once a day) before and 3 months after drug administration. Plasma renin activity and norepinephrine concentration were also measured. Results There were no significant differences in basal characteristics between the 2 hypertensive groups. In both hypertensive groups, blood pressure was significantly reduced to a similar level after drug treatment, In the 2 hypertensive groups, plasma renin activity significantly increased after drug treatment; however, there were no significant changes in norepinephrine concentration. Before drug treatment, the 2 hypertensive groups had significantly higher IPA and higher PAI-1 activity than the normotensive subjects. In the enalapril group, there was no significant change in IPA although PAI-1 activity significantly decreased after drug treatment. In the nitrendipine group, there was no significant change in tPA although PAI-1 activity significantly increased after drug treatment. Conclusion Thus enalapril improved impaired fibrinolysis but nitrendipine further aggravated Fibrinolysis in essential hypertension. Considering the effect of antihypertensive drugs on the fibrinolytic system, more effective and beneficial treatment of hypertensives, especially at a high risk for thrombus formation might be selected.
  • 本態性高血圧進展過程における心臓交感神経の変動123I-MIBGシンチによる検討
    坂田 和之; 東儀 圭則; 三保 成正; 縄田 隆三; 大谷 誠司; 城谷 学; 吉田 裕
    Japanese Circulation Journal (一社)日本循環器学会 62 (Suppl.III) 923 - 923 0047-1828 1999/02
  • 失語・感染性脳動脈瘤を合併した感染性心内膜炎の1例
    東儀 圭則; 城谷 学; 吉田 裕; 坂田 和之; 大谷 誠司; 縄田 隆三; 三保 成正
    Japanese Circulation Journal (一社)日本循環器学会 62 (Suppl.III) 939 - 939 0047-1828 1999/02
  • K Sakata; M Shirotani; H Yoshida; C Kurata
    JOURNAL OF NUCLEAR MEDICINE SOC NUCLEAR MEDICINE INC 40 (1) 6 - 11 0161-5505 1999/01 [Refereed]
     
    Sympathetic overactivity has been noted in Various clinical stages of essential hypertension. The purpose of this study is to investigate I-123-metaiodobenzylguanidine (MIBG) uptake and washout in patients with borderline and mild hypertension. Methods: To assess cardiac sympathetic function in essential hypertension, we performed I-123-MIBG cardiac imaging and echocardiography in 25 normotensive, 25 borderline hypertensive and 24 mildly hypertensive men. Age and body mass index were similar in the three groups. Results: Regarding the echocardiographic variables, the left ventricular mass index (LVMI) was significantly higher in the mildly hypertensive group (125.6 +/- 28.6 g/m(2)) than in the normotensive (99.9 +/- 20.7 g/m(2)) and the borderline hypertensive (110.0 +/- 24.4 g/m(2)) groups (P < 0.001 and P < 0.051 respectively). Regarding the scintigraphic variables, the heart-to-mediastinum (HIM) ratio was significantly tower in the mildly hypertensive group (1.8 +/- 0.3) than in the normotensive (2.1 +/- 0.3) and the borderline hypertensive (2.1 +/- 0.2) groups. in contrast, the washout rate was significantly higher in the mildly hypertensive group (17.6% +/- 10.8%) than in the normotensive (7.0% +/- 4.9%) and the borderline (11.9% +/- 8.9%) hypertensive groups (P < 0.001 and P < 0.02, respectively). In addition, the borderline hypertensive group had a significantly higher washout rate than the normotensive group (P < 0.05). MIBG washout rate had a strong positive correlation with LVMI (r = 0.77, P < 0.0001). In contrast, the H/M ratio had a weak negative correlation with LVMI (r = -0.40, P < 0.0006). Conclusion: During the course of establishment of essential hypertension, the washout Fate becomes higher with the advance of hypertension and with the development of left ventricular hypertrophy. Thus, we suggest a strong relationship between cardiac sympathetic activity and the advance of hypertension at its early stages.
  • H Yoshida; M Shirotani; M Mochizuki; K Sakata
    JOURNAL OF NUCLEAR CARDIOLOGY MOSBY-YEAR BOOK INC 6 (1) 33 - 40 1071-3581 1999/01 [Refereed]
     
    Background, We used beta-methyl iodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) to evaluate fatty acid metabolism in patients who were candidates for permanent pacemaker implantation and in patients with atrioventricular (AV) synchronous pacing. Methods and Results, We performed BMIPP SPECT studies in 66 patients with bradyarrhythmia, of whom 11 patients were candidates for permanent pacemaker implantation, 27 patients had atrial pacing (atrial sensing, inhibited mode, simple programmable [AAI]), and 28 patients had atrial synchronous ventricular inhibited pacing (ventricular pacing, 2-chamber sensing, atrial-triggered and ventricular-inhibited, multiprogrammable [VDD]) or atrial and ventricular pacing in sequence (atrial and ventricular sensing, atrial-inhibited and atrial-triggered, ventricular-inhibited, multiprogrammable [DDD]), A qualitative assessment revealed that the BMIPP uptake at the septal, inferior, and apical regions was significantly decreased in the patients with VDD/DDD compared with both the candidates for permanent pacemaker implantation and the patients with AAI, The total extent score (ES) and severity score (SS) were significantly higher in the patients with VDD/DDD than in the other 2 groups, Significant regional differences of both ES and SS values were observed at the septal and inferior regions in the patients with VDD/DDD compared with the other groups. No differences were found between the qualitative and quantitative measures of BMIPP uptake in the candidates for permanent pacemaker implantation and those in the patients with AAI. Conclusion. Our study suggests that AV synchronous right ventricular pacing resulting in the delayed conduction and depolarization of myocardial cells may directly interfere with regional cellular free fatty acid uptake and metabolism.
  • K Sakata; M Shirotani; H Yoshida; C Kurata
    JOURNAL OF NUCLEAR MEDICINE SOC NUCLEAR MEDICINE INC 39 (10) 1667 - 1671 0161-5505 1998/10 [Refereed]
     
    it has been proposed that sympathetic nervous system pathophysiology is involved in the development of cardiovascular disorders. Since cardiac adrenergic activity has been difficult to assess in humans, physiological changes in the sympathetic nervous system in the human left ventricle remain unclear. Methods: To determine if age and gender influence the sympathetic nervous function of the left ventricle, 300 angiographically normal subjects (170 men, 130 women; age range 40-79 yr) had I-123-metaiodobenzylguanidine (MIBG) cardiac imaging. Regional quantitative analysis of MIBG uptake and washout rate was performed. Results: Men and women had prominent age-related decreases in MIBG uptake in the inferior and lateral walls (r(2) = 0.34, p <0.0001 for both). Both genders had a significant positive correlation between regional washout rate and age in each region. In contrast to men, women had strong positive correlations in all regions (r(2) = 0.54, P <0.0001 in the anterior wall, r(2) = 0.56, P <0.0001 in the lateral wall and r(2) = 0.44, p <0.0001 in the inferior wall). According to the decade-by-decade analysis of washout rate, women had a significantly lower washout than men under 50 yr in every region and a significantly higher washout in the lateral wall than men over 70 yr. Conclusion: The sympathetic nervous system in the human left ventricle showed age- and gender-related regional changes. The findings suggested that men have high sympathetic nerve activity from a younger age, and women have a progressive increase in sympathetic nerve activity with aging, These changes may contribute to the age and gender differences in the incidence and development of cardiac disorders.
  • 完全房室ブロックからQT延長をきたし,Torsades de pointesを呈した1例
    東儀 圭則; 吉田 裕; 城谷 学; 坂田 和之; 大谷 誠司; 縄田 隆三; 三保 成正
    Japanese Circulation Journal (一社)日本循環器学会 62 (Suppl.II) 710 - 710 0047-1828 1998/08
  • 金田敏夫; 青嶋 實; 石神直之; 家村順三; 城谷 学; 大谷誠司; 三保成正
    呼吸と循環 46 (8) 827 - 830 1998/08 [Refereed]
  • K Sakata; M Shirotani; H Yoshida; C Kurata
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY ELSEVIER SCIENCE INC 32 (2) 438 - 443 0735-1097 1998/08 [Refereed]
     
    Objectives. The purpose of this study was to assess the effects of enalapril and nitrendipine on the cardiac sympathetic nervous system. Background. Angiotensin-converting enzyme inhibitors and long acting calcium channel blockers have been widely used in the treatment of cardiovascular diseases, in some of which sympathetic overactivity plays a major role in the pathophysiology and prognosis. However, little information is available on the effects of these drugs on the cardiac sympathetic nervous system. Methods. (123)I.metaiodobenzylguanidine (MIBG) cardiac imaging was performed before and 3 months after drug administration in 46 patients with mild essential hypertension. Twenty-two patients were treated with 5 to 10 mg of enalapril once a day, and the other 24 with 5 to 10 mg of nitrendipine once a day For comparison, 20 normotensive subjects were also studied. Results. There were no significant differences between the basal characteristics in the 2 hypertensive groups. In both hypertensive groups, both systolic and diastolic blood pressures were significantly reduced to similar levels after the 3-month drug treatment. Before the drug treatment, the 2 hypertensive groups had a significantly higher washout rate and lower MIBG uptake than the normotensive subjects. The heart-to-mediastinum ratio significantly increased (p < 0.0001), with decreased (p < 0.002) washout rate after drug treatment in the enalapril group, but with no significant changes in the nitrendipine group. Conclusion. Enalapril could suppress cardiac sympathetic activity and nitrendipine had no effect on it. The knowledge of antihypertensive drugs on the cardiac sympathetic nervous system appears to be helpful in selecting appropriate treatment in cardiovascular diseases.
  • H Yoshida; K Sakata; M Mochiduki; M Shirotani
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION BLACKWELL SCIENCE 62 (3) 178 - 182 0047-1828 1998/03 [Refereed]
     
    Thallium-201 (Tl-201) late reinjection after stress-redistribution imaging improves the detection of viable myocardium, Recently, early reinjection of Tl-201 immediately after stress imaging was proposed as a new method for distinguishing ischemic myocardium, hibernating myocardium, and myocardial scar, However, there are no data on the influence of the timing of reinjection on "fill-in." This study was designed to assess whether the reinjection time influences "fill-in" in chronic coronary artery disease. Thirty-three patients with chronic coronary artery disease were studied. All patients underwent exercise Tl-201 tomography, immediately after stress imaging, 37 MBq of thallium was reinjected earlier than usual and early reinjection delayed image (ERDI) was acquired 3 h later. With the same protocol, all patients also underwent a second study involving late reinjection of Tl-201 within 1 week, An additional 37 MBq of thallium was reinjected jh after stress and late reinjection delayed image (LRDI) was obtained 10 min later. All images were analyzed qualitatively using a 4-point grading uptake score, Of the 72 hypoperfused segments on stress images, 66 segments showed fill-in and 6 showed persistent defects on ERDI, and of the same 72 segments 55 segments displayed fill-in and the remaining 17 showed persistent defects on LRDI (p<0.05). The delta uptake score (the uptake score of the delayed image minus that of stress image) in early reinjection was 1.60+/-0.80, which was significantly higher than that in late reinjection (1.24+/-0.94, p<0.01). A small dose of thallium reinjected immediately after stress imaging with delayed images obtained 3 h later is convenient and might provide another technique fur determining myocardial viability.
  • K Sakata; N Miho; M Shirotani; H Yoshida; Y Takada; A Takada
    ATHEROSCLEROSIS ELSEVIER IRELAND LTD 136 (2) 225 - 231 0021-9150 1998/02 [Refereed]
     
    We investigated the association of remnant-like particle cholesterol (RLP-C), with vasospastic angina (VSA). We selected 66 subjects with nearly normal coronary artery as a control group, and 74 VSA with nearly normal coronary artery, of whom 19 had prior myocardial infarction (MI). Coronary risk factors, triglyceride, lipoproteins and apolipoproteins were evaluated using stepwise discriminant analysis, smoking was the only discriminator of the control group from VSA and RLP-C was the only discriminator of VSA with MI from VSA without MI. In comparison between VSA with and without MI, using stepwise logistic regression analysis, the only significant variable was RLP-C, and odds ratio of RLP-C for MI was 1.59. Thus, RLP-C is a major discriminator of VSA with MI and appears to be a major risk factor for MI in VSA. (C) 1998 Elsevier Science Ireland Ltd.
  • 拡張先天性左室瘤の一例
    金田敏夫; 青嶋 實; 石神直之; 家村順三; 星野恒雄; 城谷 学; 松田捷彦
    胸部外科 51 (1) 74 - 77 1998/01 [Refereed]
  • K. Sakata; N. Miho; S. Ohtani; M. Shirotani; H. Yoshida; A. Takada
    Fibrinolysis and Proteolysis Churchill Livingstone 12 (3) 123 - 127 1369-0191 1998 [Refereed]
     
    The aim of the study was to examine the relationship between remnants of triglyceride-rich lipoprotein (RLP-C), other lipids, and fibrinolytic components in coronary artery disease. We studied 58 patients with coronary artery disease, at Shizuoka General Hospital. Coronary angiography was performed and lipids and fibrinolytic components were measured. There were no significant correlations between RLP-C, PAI-1 activity and the severity of coronary artery disease. RLP-C had the strongest positive correlation with serum levels of triglyceride (r = 0.76, P < 0.0001) among the lipids. RLP-C levels also correlated significantly with apolipoproteins B, C-III, and E (r = 0.54, P < 0.0001, r = 0.47, P < 0.001, r = 0.64, P < 0.0001, respectively). RLP-C had a stronger positive correlation with PAI-1 activity levels (r = 0.40, P < 0.003) than with serum triglyceride levels (r = 0.30, P < 0.02). The present study demonstrated that RLP-C could impair fibrinolysis by increasing PAI-1 activity, which was irrelevant of the severity of coronary artery disease. Association of PAI-1 activity with RLP-C appears to be important in the development of coronary thrombus formation rather than that of coronary atherosclerosis.
  • K Sakata; M Shirotani; H Yoshida; C Kurata
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY ELSEVIER SCIENCE INC 30 (2) 370 - 376 0735-1097 1997/08 [Refereed]
     
    Objectives. We assessed the ability of iodine-123 metaiodobenzylguanidine (MIBG) imaging to identify and localize coronary spasm and determined the most useful method of MIBG analysis in vasospastic angina without significant coronary narrowing. Background. Various noninvasive methods have been used to detect vasospastic angina, but they are not very sensitive in patients with sporadic attacks. MIBG imaging has recently been proposed as a useful tool for detecting vasospastic angina. Methods. Normal limits of both visual and quantitative analy sis of two dimensional polar maps (bull's-eyes) for MIBG imaging were at first established in 59 normal subjects. For optimal criteria of visual analysis, we established regional differences in abnormal MIBG defect scores. An abnormal region of the bullseye was defined as an area >2 SD below normal. An abnormal regional washout rate was defined as <0%. Using these criteria, we prospectively evaluated 104 patients with suspected vasospastic angina. Visual, bull's-eye and regional washout rate analyses were compared for overall detection of the disease and for individual vessel involvement. Results. Overall sensitivity by these methods was 30%, 42% and 76%, respectively. Washout rate analysis showed a significantly higher sensitivity than the other trio methods. Specificity was 78%, 72% and 87%, respectively. The sensitivity of detecting spasm-induced coronary artery with washout rate analysis was 82% for the left anterior descending (LAD), 76% for the right (RCA) and 69% for the circumflex (Cx) coronary arteries. The sensitivity of visual analysis was 29%, 15% and 35%, respectively; that for bull's eye analysis was 34%, 54% and 41%, respectively. Washout rate analysis showed a significantly higher sensitivity for LAD spasm than for the other two methods and a higher sensitivity for RCA and Cx spasms than for visual analysis. (C) 1997 by the American College of Cardiology. Conclusions. Regional washout rate analysis of MIBG imaging is a highly accurate technique for determining the presence and location of coronary artery spasm.
  • K Sakata; F Miura; H Sugino; T Saegusa; M Shirotani; H Yoshida; T Hoshino; C Kurata
    AMERICAN HEART JOURNAL MOSBY-ELSEVIER 133 (4) 484 - 489 0002-8703 1997/04 [Refereed]
     
    With the use of iodine 123-labeled metaiodobenzylguanidine (I-123-MIBG) scintigraphy, this study evaluated regional sympathetic nerve activity in vasospastic angina. Twenty male patients with left anterior descending coronary artery spasm and 18 male patients with normal coronary arteries as a control group were studied. All patients underwent quantitative I-123-MIBG scintigraphy and atropine stress I-123-MIBG scintigraphy. Both groups showed a similar heterogeneous I-123-MIBG uptake in the left ventricle. However, the regional washout rate in patients with coronary artery spasm was significantly reduced in all three territories compared with that in the control group. In vasospastic angina, the regional washout rate in the left anterior descending coronary artery territory was significantly reduced as compared with the other two regions. After intravenous injection of 1 mg atropine, the regional washout rate in the three regions significantly increased in both groups, but the regional differences between the two groups disappeared. The current study demonstrated that cardiac sympathetic nerve activity in vasospastic angina was suppressed, especially in the territory of the spasm-induced coronary artery, probably because of the enhanced parasympathetic nerve activity.
  • 坂田和之; 中所英樹; 三浦史晴; 城谷 学; 吉田 裕; 星野恒雄; 望月 守; 吉村正己
    呼吸と循環 45 303 - 306 1997/01 [Refereed]
  • K Sakata; F Miura; H Sugino; M Shinobe; M Shirotani; H Yoshida; N Mori; T Hoshino; A Takada
    AMERICAN HEART JOURNAL MOSBY-ELSEVIER 131 (1) 1 - 6 0002-8703 1996/01 [Refereed]
     
    This study examined the role of fibrinolytic components in the process of restenosis after percutaneous transluminal coronary angioplasty (PTCA). Seventy-two patients with single-vessel disease who underwent successful PTCA were prospectively selected. Tissue plasminogen activator (TPA), free plasminogen activator inhibitor-1 (free PAI-1), TPA/PAI-1 complex, and total PAI-1 antigen levels were measured before, at 1 week after, and at 3 months after PTCA. Six months after PTCA, the study patients were divided into two groups: 41 patients without restenosis and 31 patients with restenosis. There were no significant differences with regard to sex, age, coronary risk factors, or morphologic changes in the target lesions between the two groups. There were no significant differences in plasma TPA, TPA/PAI-1 complex, or total PAI-1 levels at each sampling period, or in the time courses between the two groups, except for total PAI-1 levels at 1 week after PTCA. Although no significant differences in free PAI-1 levels before PTCA were observed, free PAI-1 levels after PTCA in the patients with restenosis were significantly higher than those in the patients without restenosis. In addition, each group had a significant change in the time course of free PAI-1 levels. The results suggest that impaired fibrinolysis early after PTCA might affect the repair process of vascular injury, which leads to restenosis, and also that serial determination of free PAI-1 levels could help predict restenosis.
  • Restenosis after coronary angioplasty: pathogenesis of neointimal thickening initiated by endothelial loss.
    MANABU SHIROTANI; YOSHIKI YUI; CHUICHI KAWAI
    Endothelium 1 (1) 5 - 22 1993/06 [Refereed]
  • M SHIROTANI; Y YUI; R HATTORI; H MORISHITA; C KAWAI; T SUSAWA; S TAMAKI; M TAKAHASHI; K SAKAGUCHI
    AMERICAN HEART JOURNAL MOSBY-YEAR BOOK INC 125 (4) 931 - 938 0002-8703 1993/04 [Refereed]
     
    The factors responsible for early occlusion of the infarct vessel after emergency percutaneous transluminal coronary angioplasty (PTCA) were retrospectively examined in 191 patients with acute myocardial infarction. During the 24-hour period after the initial balloon inflation, 47 patients (25%) had occlusion of the vessel (occlusion group), whereas 144 did not (nonocclusion group). The former patients immediately underwent repeat PTCA, which was successful in 37. Univariate correlates of early occlusion were a shorter time interval between the onset of symptoms and PTCA (3.5 +/- 2.2 vs 4.5 +/- 2.9 hours, p = 0.025), right coronary artery involvement (53% vs 30%, p = 0.015), prior thrombolytic therapy (49% vs 32%, p = 0.035), and undersized inflation (43% vs 17%, p < 0.001). With multivariate analysis the three independent predictors were undersized inflation (p < 0.001), right coronary artery involvement (p = 0.004), and a shorter time interval until PTCA (p = 0.011). Thus patients undergoing early PTCA and having right coronary artery involvement appear to be at greater risk of having early occlusion. Thrombolytic agents and undersized inflation may also play an important role in its development.
  • K SASE; Y YUI; R HATTORI; M SHIROTANI; C KAWAI; S SASAYAMA
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION JAPAN CIRCULATION SOC 56 (12) 1229 - 1233 0047-1828 1992/12 [Refereed]
     
    HA1077 is a newly synthesized vasodilator with unique intracellular calcium antagonistic action. In this study, its effect on the growth off vascular smooth muscle cells (VSMC) stimulated by fetal calf serum was examined. Both the proliferation and [H-3]thymidine incorporation into DNA of the growth-arrested VSMC was dose-dependently inhibited by HA1077. The expression of a proto-oncogene, c-fos, which reached the maximum 30 min after addition of serum, was similarly inhibited by this agent in a dose-dependent manner. Thus. HA1077 is expected to be a useful vasodilator agent capable of suppressing the growth of VSMC which is thought to he an important underlying mechanism of atherosclerosis or restenosis after angioplasty.
  • R HATTORI; Y YUI; T AOYAMA; H MORISHITA; K SAKAGUCHI; T SUSAWA; S TAMAKI; M TAKAHASHI; M SHIROTANI; H UCHIZUMI; K SASE; H EIZAWA; K KOSUGA; K HIKI; C KAWAI
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION JAPAN CIRCULATION SOC 56 (11) 1180 - 1183 0047-1828 1992/11 [Refereed]
     
    Percutaneous transluminal coronary angioplasty (PTCA) was successful in 91% of 76 patients with unstable angina pectoris refractory to pharmacological treatment. However, the rate of acute occlusion and reocclusion was rather high (95). Restenosis developed in 56.5% of successful cases after initial PTCA, and 29 patients underwent 2nd, and nine 3rd PTCA. Most refractory unstable angina can be controlled by PTCA, which may require repeating in some patients.
  • M SHIROTANI; Y YUI; R HATTORI; C KAWAI
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION JAPAN CIRCULATION SOC 56 1421 - 1424 0047-1828 1992 [Refereed]
  • Ryuichi Hattori; Yoshiki Yui; Manabu Shirotani; Chuichi Kawai
    Cardiovascular Drug Reviews 10 (2) 233 - 242 1527-3466 1992 [Refereed]
  • Manabu Shirotani; Ryuichi Hattori; Chuichi Kawai; Shigetake Sasayama; Yoshiki Yui
    Cardiovascular Drug Reviews 10 (3) 333 - 357 1527-3466 1992 [Refereed]
  • M SHIROTANI; Y YUI; R HATTORI; C KAWAI
    JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS WILLIAMS & WILKINS 259 (2) 738 - 744 0022-3565 1991/11 [Refereed]
     
    The effects of a newly developed vasodilator agent, HA1077 [1-(5-isoquinolinesulfonyl)-homopiperazine hydrochloride], were investigated on the proliferation of cultured bovine aortic vascular smooth muscle cells (VSMC). HA1077 (10-100-mu-M) inhibited both fetal calf serum-induced proliferation and [H-3]thymidine incorporation into DNA of the growth-arrested VSMC in a dose-dependent manner. When quiescent cells were stimulated with platelet-derived growth factor followed by insulin, HA1077 (1-30-mu-M), administered together with either stimulation, showed dose-dependent inhibition of [H-3]thymidine incorporation. Further reduction of [H-3]thymidine incorporation was observed when HA1077 was present at both stimulations, suggesting that HA1077 suppresses DNA synthesis acting in both competence and progression stages. After stimulation with fetal calf serum, quiescent VSMC started and ceased DNA synthesis in 15 to 18 hr and 24 hr, respectively. HA1077 inhibited [H-3]thymidine incorporation when it was added either from 12 hr to 15 hr or from 21 hr to 24 hr after serum stimulation. In addition, when percent inhibition of [H-3]thymidine incorporation by continuous exposure to HA1077 was examined as a function of the time it was added, reductions of the value were observed at 0 to 3 hr, 12 to 18 hr and 21 to 24 hr. Thus, we concluded that HA1077 suppresses DNA synthesis of bovine VSMC acting at the G0/G1 and the G1/S phase transitions and also in the S phase of the cell cycle. It is suggested that this agent may act as a potent inhibitor of VSMC proliferation as well as a vasodilator.
  • M SHIROTANI; Y YUI; R HATTORI; C KAWAI
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION JAPAN CIRCULATION SOC 55 (6) 634 - 642 0047-1828 1991/06 [Refereed]
     
    We compared the effects on the proliferation of bovine vascular smooth muscle cells (VSMC) of serum from 36 patients without restenosis (group A), and 21 patients with restenosis (group B) after percutaneous transluminal coronary angioplasty (PTCA). Baseline characteristics were similar in both groups, except for the greater number of patients with unstable angina at the time of PTCA (52 vs 22%, p = 0.020) and the shorter interval between PTCA and repeat angiography in group B (106 +/- 30 vs 153 +/- 112 days, p = 0.022). Cultured bovine VSMC were stimulated with patient serum (5%) obtained at repeat angiography in either Ca2+-containing or Ca2+-free culture medium. DNA synthesis was assessed by [H-3]thymidine incorporation. The following indices of VSMC proliferation were used: S(+) = [H-3]thymidine uptake stimulated by 5% serum in Ca2+-containing medium/[H-3]thymidine uptake stimulated by 5% fetal calf serum (FCS) in Ca2+-containing medium, S(-) = [H-3]thymidine uptake stimulated by 5% serum in Ca2+-free medium/[H-3]thymidine uptake stimulated by 5% FCS in Ca2+-free medium, and D = S(-)-S(+). D represented the preserved DNA synthesis in Ca2+-deprived medium. S(-) was lower than S(+) in group A (1.35 +/- 0.56 vs 1.57 +/- 0.58, p < 0.0001), whereas it was higher than S(+) in group B (1.64 +/- 0.66 vs 1.50 +/- 0.58, p = 0.010). D was significantly higher in group B than in group A (0.14 +/- 0.23 vs -0.22 +/- 0.28, p < 0.0001), and was not associated with any continuous variables including serum calcium level on univariate regression analysis. However, multivariate analysis revealed unstable angina as an independent variable for D. Thus, it is suggested that serum from patients with restenosis stimulates VSMC proliferation while not requiring as much extracellular Ca2+ as serum from those without restenosis. This serum property appears to be associated with the angina pattern at PTCA. This finding concerning serum in patients with restenosis may contribute to the understanding of the pathophysiological mechanisms underlying restenosis.
  • M SHIROTANI; Y YUI; R HATTORI; C KAWAI
    PROSTAGLANDINS BUTTERWORTH-HEINEMANN 41 (2) 97 - 110 0090-6980 1991/02 [Refereed]
     
    The effects of U-61, 431F, ciprostene, a stable prostacyclin analogue, were examined on the proliferation of cultured quiescent bovine aortic endothelial cells (EC) and smooth muscle cells (SMC). After stimulation with 5% fetal calf serum, U-61, 431F suppressed both the DNA systhesis and proliferation of SMC dose-dependently at the concentration of 3 approximately 100-mu-M, but had no effect on either of them in EC at a concentration of up to 30-mu-M. The inhibitory effect on DNA synthesis was greater in SMC than in EC at 3 approximately 50-mu-M. When SMC were stimulated with platelet-derived growth factor (PDGF) for 2 hrs followed by a 22-hr incubation with insulin, U-61, 431F (1 approximately 50-mu-M) administered at the time of PDGF stimulation did not inhibit DNA synthesis. SMC initiated and terminated DNA synthesis at about 15-18 h and 24 h after stimulation with serum, respectively. Inhibition of DNA synthesis in serum-stimulated SMC as a function of the addition time of U-61, 431F reduced at 3-12 h after the stimulation. U-61, 431F raised the cyclic AMP (cAMP) content in SMC. Moreover, a phosphodiesterase inhibitor, 3-isobutyl-1-methylxanthine, and a more specific cAMP phosphodiesterase inhibitor, Ro 20-1724, augmented the inhibition of DNA synthesis in SMC concomitant with further elevation of cAMP level. These results suggest that U-61, 431F inhibits DNA synthesis of SMC acting in the progression stage rather than in the competence stage, with little antiproliferative effect on EC. cAMP may play an important role in its antiproliferative action in SMC.
  • T AOYAMA; Y YUI; Y TAKATSU; M TAKAHASHI; Y MUROHARA; M SHIROTANI; H YASUMOTO; H MORISHITA; K KADOTA; K SAKAGUCHI; C KAWAI
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION JAPAN CIRCULATION SOC 54 (9) 1139 - 1146 0047-1828 1990/09 [Refereed]
     
    This study aimed to examine the dynamic changes of the fibrinolytic system during coronary vasospasm. Tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI) and fibrinopeptide A (FPA) levels were measured in the great cardiac venous and arterial blood of 9 patients with clinically and angiographically proven vasospastic angina and 11 controls. Before ergonovine provocation, although there was no difference between the above 2 groups in t-PA levels in the aorta or the great cardiac vein, the PAI level in patients with variant angina was lower than in the controls both in the aorta (4.2 +/- 3.5 IU/ml vs 10.9 +/- 5.2 IU/ml) and in the great cardiac vein (2.3 +/- 2.9 IU/ml vs 11.9 +/- 4.9 IU/ml). During ergonovine-induced coronary vasospasm in patients with variant angina, the t-PA level in the great cardiac vein significantly increased from 3.4 +/- 0.7 ng/ml to 4.4 +/- 0.5 ng/ml (p < 0.05), but it did not change in the aorta. The maximal dose of ergonovine (0.4 mg) induced mild diffuse coronary vasoconstriction in the controls, and this diffuse coronary vasoconstriction induced a reduction of PAI levels in the great cardiac vein from 11.9 +/- 4.9 IU/ml to 9.5 +/- 4.8 IU/ml (p < 0.05). FPA levels in the great cardiac vein did not change during ergonovine-induced coronary vasospasm in either group. Thus, the coronary vasospasm induced the release of t-PA from endothelial cells of coronary vessels and resulted in the reduction in the PAI activity in the great cardiac vein. In conclusion, during coronary vasospasm, the fibrinolytic system seems to play an anti-thrombogenic role in coronary arteries.
  • C KAWAI; M SHIROTANI; Y YUI
    RECENT ADVANCES IN CALCIUM CHANNELS AND CALCIUM ANTAGONISTS PERGAMON PRESS 93 - 97 1990 [Refereed]
  • 城谷 学; 野坂秀行; 日比野均; 三岡相啓; 木村 剛; 黒沢好文; 大塚眞一; 荒川雅夫; 横井博厚; 細川博昭; 荒川雅夫; 安本 均; 紀田 貢; 森下 浩; 佐藤 信; 延吉正清
    心臓 21 (4) 395 - 403 1989/04 [Refereed]
  • T SUSAWA; Y YUI; R HATTORI; Y TAKATSU; N YUI; M TAKAHASHI; T AOYAMA; Y MUROHARA; M SHIROTANI; C KAWAI
    JAPANESE CIRCULATION JOURNAL-ENGLISH EDITION JAPAN CIRCULATION SOC 52 (1) 72 - 78 0047-1828 1988/01 [Refereed]
  • 紀田 貢; 木村 剛; 安本 均; 野坂秀行; 日比野均; 三岡相啓; 黒澤好文; 大塚眞一; 横井博厚; 細川博昭; 荒川雅夫; 城谷 学; 森下 浩; 佐藤 信; 吉長正博; 上野勝己; 延吉正清
    心臓 19 137 - 143 1987/01 [Refereed]

Books etc

  • 先端医療シリーズ50 循環器疾患の最新医療
    城谷 学 (Joint work施設資料編 奈良 近畿大学奈良病院 循環器内科)(株）寺田国際事務所／先端医療技術研究所 2019/09
  • In: Lewis BS, Flugelman MY, Halon DA, editors. CORONARY ARTERY DISEASE: 2011 UPDATE., Influence of atenolol on coronary artery spasm after acute myocardial infarction in a Japanese population
    城谷 学; 太居 洋平; 石川 千紗都; 三岡 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 三保 成正; 平井 拓; 胡内 一郎; 横田 良司; 服部 隆一 (Joint work)Bologna: MEDIMOND/Italy 2011/10
  • 日本体外循環技術研究会・教育研究会 教育セミナーテキスト, 循環器疾患と診断 検体、生理、放射線その他検査と診断
    城谷 学 (Joint work)医薬広告社 2005/06 
    主要な循環器疾患の診断について、検体検査、生理検査、放射線検査の所見を解説したもの 2005年6月に大阪市で開催された第8回1年次 日本体外循環技術研究会教育セミナーの講演内容を補足したもの
  • 臨床研修プラクティス, 連載 この心電図から何を考えるか？ 第10回症例
    城谷 学; 服部 隆一 文光堂 2005/01
  • 臨床研修プラクティス, Ⅲ． よくナースコールがある症状・症候－軽症と思っても必ず診察しよう １０ 胸が痛い
    城谷 学 文光堂 2004/05
  • 循環器研修医ノート 改訂第2版, H Emergency 11 心タンポナーデ
    城谷 学; 服部 隆一 診断と治療社 2001/06 
    心タンポナーデは、心膜腔に貯留した液体により、心膜腔内圧が上昇したために、心臓が圧迫されて心室の拡張障害と心拍出量の低下をきたした状態である。心タンポナーデの病態生理、原因疾患、症状、身体所見、検査所見、治療について概説した。
  • EDHF
    メディカル・レビュー社 2001
  • EDHF
    Vascular Biology Navigator 2001

Conference Activities & Talks

  • 右内頚静脈血栓症を発症し、経過中にヘパリン起因性血小板減少症（HIT)合併が発見された白人女性の一例  [Not invited]
    南 遙香; 鈴木智詞; 八木英次郎; 蘆田健毅; 大江健太郎; 石川千紗都; 東儀圭則; 城谷 学
    第134回日本循環器学会近畿地方会  2022/12
  • Tip detection 法を用いた OFDI ガイド DCA とその検証  [Not invited]
    鈴木 智詞; 永井 宏幸; 南 遥香; 八木 英次郎; 大江 健太郎; 石川 千紗都; 東儀 圭則; 城谷 学
    第39回日本心血管ｲﾝﾀｰﾍﾞﾝｼｮﾝ治療学会近畿地方会  2022/10
  • 左前下行枝の CTO 病変に対して IVUS ガイドの tip detection 法により wire を通過させ、治療に成功した１症例  [Not invited]
    南 遥香; 鈴木 智詞; 永井 宏幸; 八木 英次郎; 大江 健太郎; 石川 千紗都; 東儀 圭則; 城谷 学
    第39回日本心血管ｲﾝﾀｰﾍﾞﾝｼｮﾝ治療学会近畿地方会  2022/10
  • CTOインターベンションにおけるNavifocus IVUSとAnteOwl IVUSの実臨床における比較検討  [Not invited]
    鈴木智詞; 岡村篤徳; 八木英次郎; 大江健太郎; 石川千紗都; 東儀圭則; 城谷 学
    第133回日本循環器学会近畿地方会  2022/06
  • PCI術後、プロタミン使用による止血時活性化凝固時間短縮に影響する予測因子について  [Not invited]
    南 遙香; 鈴木智詞; 八木英次郎; 大江健太郎; 学石川千紗都; 東儀圭則; 城谷
    第133回日本循環器学会近畿地方会  2022/06
  • S字状中隔に伴う左室流出路狭窄、僧帽弁逆流に僧帽弁および大動脈弁の心内膜炎を合併した一例  [Not invited]
    南 遙香; 鈴木智詞; 八木英次郎; 大江健太郎; 石川千紗都; 東儀圭則; 城谷 学; 山中一朗; 石田英和
    第133回日本循環器学会近畿地方会  2022/06
  • 祖父の心臓病を契機に発症した20歳女性のたこつぼ心筋症の1例  [Not invited]
    八木英次郎; 大江健太郎; 石川千紗都; 東儀圭則; 城谷 学
    第133回日本循環器学会近畿地方会  2022/06
  • PCI後のプロタミンによる抗凝固能の適切な中和をめざして －止血時ACT減少に関わる影響因子の研究  [Not invited]
    玉田博之; 杉谷勇季; 石川千紗都; 大江健太郎; 東儀圭則; 城谷 学
    第26回日本心血管インターベンション治療学会学術集会  2017/07
  • Admission Glucose Levels may Reflect Infarct Size and Thereby in-hospital Mortality in Acute Myocadial Infarction Treated by Primary Amgioplasty.  [Not invited]
    Yuki Sugitani; Hiroyuki Tamada; Youhei Ooi; Chisato Ishikawa; Kentaro Ooe; Noritsugu Uemori; Hirokazu Mitsuoka; Kiyonori Tohgi; Ryoji Yokota; Manabu Shirotani
    第８１回日本循環器学会総会・学術集会  2017/03
  • Primary PCI and IRA occlusion; historical development of reperfusion technique  [Invited]
    SHIROTANI Manabu
    JCR2016  2016/12
  • Assessment of Left Ventricular Reverse Remodeling after Aortic Valve Replacement in Patients with Severe Aortic Stenosis by Using Strain Imaging  [Not invited]
    Chisato Ishikawa; Katsuhisa Ishii; Hiroyuki Tamada; Yuki Sugitani; Youhei Ooi; Noritsugu Uemori; Hirokazu Mitsuoka; Kiyonori Tohgi; Ryoji Yokota; Manabu Shirotani
    第79回日本循環器学会総会・学術集会  2015/04
  • 循環器領域におけるアンチエイジング ～動脈硬化と不整脈に対する新たな戦略～  [Invited]
    城谷 学
    第15回奈良抗加齢研究会  2013/12
  • 心臓マッサージ中にICDが作動した１症例  [Not invited]
    横田 良司; 石川 千紗都; 上森 宜嗣; 太居 洋平; 三保 成正; 東儀 圭則; 胡内 一郎; 城谷 学
    第13回京大関西心不全と不整脈カンファレンス  2013/02  大阪市  第13回京大関西心不全と不整脈カンファレンス
  • 下大静脈フィルター内血栓症の治療に難渋した肺塞栓症の一例  [Not invited]
    三保 成正; 城谷 学; 横田 良司; 胡内 一郎; 東儀 圭則; 上森 宜嗣; 石川 千紗都; 太居 洋平
    第20回日本心血管インターベンション治療学会近畿地方会  2013/02  大阪  第20回日本心血管インターベンション治療学会近畿地方会
  • 下大静脈フィルター内血栓症の治療に難渋した肺塞栓症の一例  [Not invited]
    三保 成正; 胡内 一郎; 城谷 学; 横田 良司; 上森 宜嗣; 石川 千紗都; 太居 洋平
    第11回 京都心血管疾患フォーラム  2013/01  京都  第11回 京都心血管疾患フォーラム
  • 急性心筋梗塞症の心電図診断と治療について  [Not invited]
    城谷 学
    生駒地区 病病連携講演会  2013/01  生駒市  生駒地区 病病連携講演会
  • 亜急性期にICD active leadが穿孔した心サルコイドーシスの一例  [Not invited]
    横田 良司; 石川 千紗都; 上森 宜嗣; 太居 洋平; 三保 成正; 東儀 圭則; 胡内 一郎; 城谷 学
    第12回京大関西心不全と不整脈カンファレンス  2012/08  大阪市  第12回京大関西心不全と不整脈カンファレンス
  • 下大静脈フィルター留置後、上臀部痛が生じた一例  [Not invited]
    三保 成正; 城谷 学; 横田 良司; 胡内 一郎; 上森 宜嗣; 石川 千紗都; 太居 洋平
    第113回日本循環器学会近畿地方会  2012/06  大阪  第113回日本循環器学会近畿地方会
  • バルーンカテーテルによる高圧を要する病変とは；VH-IVUSによる検討  [Not invited]
    太居 洋平; 羽場 一直; 石川 千紗都; 三岡 良栄; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第９回 奈良 Cardiovascular Conference  2012/05  奈良市  第９回 奈良 Cardiovascular Conference
  • バルーン拡張に高圧を要する病変とは；VH-IVUSによる検討  [Not invited]
    太居 洋平; 羽場 一直; 石川 千紗都; 三岡 良栄; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第25回日本冠疾患学会学術集会  2011/12  大阪市  第25回日本冠疾患学会学術集会
  • INFLUENCE OF ATENOLOL ON CORONARY ARTERY SPASM AFTER ACUTE MYOCARDIAL INFARCTION IN A JAPANESE POPULATION  [Not invited]
    城谷 学; 太居 洋平; 石川 千紗都; 三岡 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 三保 成正; 平井 拓; 胡内 一郎; 横田 良司; 服部 隆一
    ICCAD 2011  2011/10  ベネチア(イタリア）  ICCAD 2011
  • CIRCUMFERENTIAL STRAIN CAN BE AN EARLY-PHASE PREDICTOR FOR THE IMPROVEMENT OF LEFT VENTRICULAR FUNCTION AFTER CORONARY ARTERY BYPASS SURGERY  [Not invited]
    石川 千紗都; 太居 洋平; 三岡 良栄; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    ICCAD 2011  2011/10  ベネチア（イタリア）  ICCAD 2011
  • 冠攣縮性狭心症によると思われるAMIに心破裂を合併した1例  [Not invited]
    上森 宜嗣; 太居 洋平; 三岡 良栄; 石川 千紗都; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第6回冠攣縮研究会  2011/07  大阪市  第6回冠攣縮研究会
  • 冠攣縮によると思われる急性心筋梗塞に心破裂を合併した一例  [Not invited]
    上森 宜嗣; 城谷 学; 横田 良司; 胡内 一郎; 三保 成正; 羽場 一直; 溝部 道生; 三岡 良栄; 石川 千紗都; 太居 洋平; 西脇 登; 長阪 重雄
    第111回日本循環器学会近畿地方会  2011/06  神戸市  第111回日本循環器学会近畿地方会
  • 洞機能低下、房室伝導低下のためCRT-Pを施行し心不全が改善した左脚ブロックの一症例  [Not invited]
    太居 洋平; 横田 良司; 上森 宜嗣; 石川 千紗都; 三岡 良栄; 溝部 道生; 羽場 一直; 三保 成正; 胡内 一郎; 城谷 学
    第111回日本循環器学会近畿地方会  2011/06  神戸市  第111回日本循環器学会近畿地方会
  • 発作性上室性頻拍の一例  [Not invited]
    横田 良司; 太居 洋平; 石川 千紗都; 三岡 良栄; 三保 成正; 胡内 一郎; 城谷 学; 上森 宜嗣
    第１回奈良不整脈Expert Meeting  2011/05  奈良市  第１回奈良不整脈Expert Meeting
  • 2D スペックルトラッキング 法を用いた脚ブロック例での左室機能評価  [Not invited]
    三岡 良栄; 太居 洋平; 石川 千紗都; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第８回 奈良 Cardiovascular Conference  2011/05  奈良市  第８回 奈良 Cardiovascular Conference
  • 川崎病（KD)後のAMIに対し、緊急PCIを施行した8歳男児の一例  [Not invited]
    上森 宜嗣; 太居 洋平; 清水 良栄; 溝部 道生; 石川 千紗都; 羽場 一直; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学; 石原 温子; 吉林 宗夫
    第1６回日本心血管ｲﾝﾀｰﾍﾞﾝｼｮﾝ治療学会近畿地方会  2011/02  豊中市  第1６回日本心血管ｲﾝﾀｰﾍﾞﾝｼｮﾝ治療学会近畿地方会
  • Section 1-6: Acute Myocardial Infarction and Myocarditis; How to Manage Acute Myocardial Infarction Complicated with Cardiogenic Shock  [Not invited]
    城谷 学
    BIT's 2nd Annual International Congress of Cardiology-2010  2010/12  中国・上海市  BIT's 2nd Annual International Congress of Cardiology-2010
  • 遷延性低血圧を来した長期維持透析の１例  [Not invited]
    三保 成正; 横田 良司; 太居 洋平; 石川 千紗都; 溝部 道生; 清水 良栄; 羽場 一直; 上森 宜嗣; 胡内 一郎; 城谷 学
    第192回日本内科学会近畿地方会  2010/09  大阪市  第192回日本内科学会近畿地方会
  • WPW症候群の一症例  [Not invited]
    横田 良司; 上森 宜嗣; 太居 洋平; 石川 千紗都; 三岡 良栄; 三保 成正; 胡内 一郎; 城谷 学
    第8回京大関西心不全と不整脈カンファレン  2010/07  大阪市  第8回京大関西心不全と不整脈カンファレン
  • 異所性心房調律の起源と心房頻拍の起源がEnSiteシステムにより同一であると考えられた一症例  [Not invited]
    太居 洋平; 横田 良司; 上森 宜嗣; 石川 千紗都; 清水 良栄; 溝部 道生; 羽場 一直; 三保 成正; 胡内 一郎; 城谷 学
    第109回日本循環器学会近畿地方会  2010/06  大阪市  第109回日本循環器学会近畿地方会
  • 2D strain 法を用いたCABG前後における左室局所機能評価  [Not invited]
    石川 千紗都; 太居 洋平; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第7回 奈良 Cardiovascular Conference  2010/05  奈良市  第7回 奈良 Cardiovascular Conference
  • 急性心筋梗塞発症後の冠動脈攣縮に及ぼすβ遮断薬の影響  [Not invited]
    城谷 学; 横田 良司; 胡内 一郎; 平井 拓; 三保 成正; 上森 宜嗣; 羽場 一直; 清水 良栄; 溝部 道生; 石川 千紗都; 太居 洋平; 服部 隆一
    第1回京都循環器内科カンファレンス  2010/05  京都市  第1回京都循環器内科カンファレンス
  • 巨大血管径を有する右冠動脈に多量の血栓を認めたAMIの一例  [Not invited]
    上森 宜嗣; 太居 洋平; 清水 良栄; 溝部 道生; 石川 千紗都; 羽場 一直; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    近畿大学医学部奈良病院  2010/02  豊中市  近畿大学医学部奈良病院
  • 後中隔Kent束のAblationに難渋した3症例  [Not invited]
    石川 千紗都; 太居 洋平; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第7回京都大学関西心不全と不整脈カンファレンス  2010/02  大阪  第7回京都大学関西心不全と不整脈カンファレンス
     
    副伝導路を介したAVRTの治療はアブレーションが第一選択であり、成功率も高い。しかし、後中隔の副伝導路には斜走、broad band、複数伝導路の合併など難渋する症例があり、経験した3症例を報告する。 症例１：51歳男性。繰り返すPSVTが原因で心不全となった。デルタ波の指摘はそれまでなく、右室ペーシングでVAは融合し、CS5,6付近が心房再早期であった。心房刺激でPSVTが誘発され、後中隔の副伝導路を介したAVRTと診断した。経大動脈アプローチで焼灼し、成功し、以後PSVTは再発していない。しかし、2年後にデルタ波が出現した。12誘導ECGはA型を示し、再発より新たな側壁の副伝導路が顕性化したと考えられた。 症例2：61歳男性。顕性WPW症候群で、心房細動となりアブレーションが施行された。経大動脈アプローチでは出力が上がらず、一過性の成功で終わった。その後、CABGを受け、心房細動、房室ブロックとなりVVIペースメーカーが植え込まれた。内服治療で安定していたが、糖
  • 人工血管バイパスにステント留置を施行した一例  [Not invited]
    石川 千紗都; 太居 洋平; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第10８回日本循環器学会近畿地方会  2009/12  和歌山  第10８回日本循環器学会近畿地方会
     
    【症例】71歳女性【併存症】糖尿病・高血圧・狭心症【現病歴】他院で大動脈炎症候群と診断され、胸部下行大動脈に約18cmの瀰漫性大動脈狭窄を認めたため、2000年1月に右腋窩-右腸骨動脈バイパス術が施行された。2009年に婦人科術前精査目的で造影CT検査を行ったところ、右腹横筋を横切る部分でバイパス内に高度狭窄を認め、PTA目的で入院となった。IVUSでは狭窄部位に局所的な全周性plaque付着を認め、8mmのバルーンで前拡張を行ったところ、シースイントロデューサーから多量の白色plaqueが吸引された。10mmのWALLSTENTを留置し、後拡張を行うと再度多量のplaqueを認めた。【結語】人工血管バイパス狭窄にシース吸引を用いたPTAが有効であった症例を経験したので報告する。
  • Crista Terminalis起源と考えられるATの症例  [Not invited]
    横田 良司; 上森 宜嗣; 石川 千紗都; 太居 洋平; 溝部 道生; 清水 良栄; 羽場 一直; 三保 成正; 胡内 一郎; 城谷 学
    第6回5病院合同循環器セミナー  2009/11  大阪市  第6回5病院合同循環器セミナー
     
    EnSiteシステムを使用してCrista Terminalis起源と診断した心房頻拍（AT)の症例を報告した。
  • 急性心筋梗塞の診断・治療とプライマリケアの役割  [Not invited]
    城谷 学
    生駒市医師会講演会  2009/09  大和郡山市  生駒市医師会講演会
  • 心房中隔にリードを挿入した症例  [Not invited]
    横田 良司; 上森 宜嗣; 石川 千紗都; 太居 洋平; 清水 良栄; 溝部 道生; 羽場 一直; 三保 成正; 胡内 一郎; 城谷 学
    第6回京大関西心不全と不整脈カンファレンス  2009/08  大阪市  第6回京大関西心不全と不整脈カンファレンス
     
    心房中隔にリードを留置した場合の手技的問題や合併症などについて報告。
  • 高齢者の進行性慢性心不全の一例  [Not invited]
    石川 千紗都; 太居 洋平; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 三保 成正; 胡内 一郎; 横田 良司; 城谷 学
    第107回日本循環器学会近畿地方会  2009/06  大阪  第107回日本循環器学会近畿地方会
     
    【症例】85歳女性 【既往歴】非定型抗酸菌症 【現病歴】2008年より労作時の息切れが出現し、他院で僧帽弁逆流症と心房細動を指摘された。2008年10月に僧帽弁縫縮術を施行。しかし本年1月に再び胸水貯留を認めたため入院となった。心エコーでは左室壁肥厚とgranular sparkling patternを呈し、心嚢液貯留・左室駆出率低下を認めたが、術後の僧帽弁異常はなく、心房細動のレートコントロールも良好であった。尿中B-J蛋白陽性・血清M蛋白（IgM-κ型）陽性であり、今回の心不全増悪にはアミロイドーシスが関与している可能性が高いと考えられた。高齢でワーファリン内服中のため、心筋生検や消化管生検は施行しなかった。【考察】高齢者の心不全では、侵襲的な検査は厳しい場合が多いが、尿検査や血液検査でもアミロイドーシス鑑別のきっかけとなると考えられた。
  • 左膝窩静脈から腎静脈合流部まで血栓を認めたため、上位に下大静脈フィルターを留置した肺塞栓の症例  [Not invited]
    太居 洋平; 清水 良栄; 溝部 道生; 石川 千紗都; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学
    第14回日本心血管インターベンション学会、第6回日本心血管カテーテル治療学会  2009/02  第14回日本心血管インターベンション学会、第6回日本心血管カテーテル治療学会
  • 左膝窩静脈から腎静脈合流部まで血栓を認めたため、下大静脈フィルターを留置した肺塞栓症の一例  [Not invited]
    太居 洋平; 清水 良栄; 溝部 道生; 石川 千紗都; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学
    京都心血管疾患フォーラム  2009/01  京都心血管疾患フォーラム
  • 治療経過中に尿細管間質性腎炎を合併した僧房弁狭窄症の1例  [Not invited]
    山本 智久; 城谷 学; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 服部 隆一
    第187回日本内科学会近畿地方会  2008/11  京都市  第187回日本内科学会近畿地方会
  • 左膝窩静脈から腎静脈合流部まで血栓を認めたため、下大静脈フィルターを留置した肺塞栓症の一例  [Not invited]
    上森 宜嗣; 太居 洋平; 清水 良栄; 溝部 道生; 石川 千紗都; 胡内 一郎; 横田 良司; 城谷 学
    第4回循環器合同症例検討会  2008/11  大阪  第4回循環器合同症例検討会
  • Brugada型心電図を呈したが失神の原因は神経調節性失神と考えられた1例  [Not invited]
    太居 洋平; 横田 良司; 上森 宜嗣; 溝部 道生; 石川 千紗都; 清水 良栄; 胡内 一郎; 羽場 一直; 城谷 学
    日本循環器学会近畿地方会  2008/11  日本循環器学会近畿地方会
  • 同時期に3弁に閉鎖不全をきたし緊急手術となった1例  [Not invited]
    羽場 一直; 太居 洋平; 石川 千紗都; 清水 良栄; 溝部 道生; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 西脇 登
    第106回日本循環器学会近畿地方会  2008/11  神戸市  第106回日本循環器学会近畿地方会
     
    症例は35歳、女性。患者は2008年4月頃より下半身の浮腫、心窩部不快感を自覚した。当院消化器内科を受診した。上部消化管内視鏡を施行されたが、特に異常を認めなかった。浮腫の精査のためにCTを施行されたところ、心拡大、両側胸水貯留を認め、心不全の疑いにて当科に紹介となった。心エコーにて高度の僧帽弁逆流、大動脈弁逆流、三尖弁逆流を認めた。3弁いずれも逸脱所見を認めた。精査目的のためにCAG等を施行後に心不全の急性増悪をきたし、緊急に僧帽弁置換術、大動脈弁置換術、三尖弁輪縫縮術を施行した。
  • 急性心筋梗塞の治療とプライマリーケアの役割－開院後9年間の診療実績から－  [Not invited]
    城谷 学
    学術講演会（ｋｓｋセミナー）  2008/11  奈良市  学術講演会（ｋｓｋセミナー）
  • 第2回 ネシリチド治験(J2)前期第Ⅱ相試験 Investigators meeting  [Not invited]
    石川 千紗都; 太居 洋平; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 平井 拓; 胡内 一郎; 横田 良司; 城谷 学
    2008/10
  • 寛解増悪を繰り返し多数の薬剤が原因と考えられた間質性肺炎の一例  [Not invited]
    溝部 道生; 横田 良司; 清水 良栄; 羽場 一直; 胡内 一郎; 城谷 学; 中島 宏和; 中島 重徳; 澤口 博千代; 上森 宜嗣
    2008/09 
    カンデサルタンやアプリンジンで間質性肺炎を発症した一例。
  • 多形性心室頻拍と複数単形性頻拍に対してカテーテルアブレーションが有効であった陳旧性心筋梗塞の一症例  [Not invited]
    横田 良司; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 胡内 一郎; 城谷 学; 服部 隆一; 平井 拓; 大林 和彦
    第18回京滋奈良ハートリズム研究会  2008/07  京都  第18回京滋奈良ハートリズム研究会
     
    症例報告
  • 心嚢水貯留をきたした全身性アミロイドーシスの一症例  [Not invited]
    清水 良栄; 太田 善夫; 溝部 道生; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    第105回日本循環器学会地方会  2008/06  大阪  第105回日本循環器学会地方会
     
    55歳の女性。心嚢水貯留精査にて入院。肺、骨髄、心筋生検よりAL型アミロイドーシスと診断。
  • 陳旧性心筋梗塞に合併した複数の持続性単形性頻拍に対してカテーテルアブレーションを施行した一症例  [Not invited]
    横田 良司; 清水 良栄; 溝部 道生; 羽場 一直; 上森 宜嗣; 胡内 一郎; 城谷 学; 服部 隆一; 平井 拓; 大林 和彦
    第105回日本循環器学会近畿地方会  2008/06  大阪  第105回日本循環器学会近畿地方会
     
    症例報告。
  • EPAの多彩な作用と期待する効果； 血管弾力性保持作用  [Not invited]
    城谷 学
    関西N-3系脂肪酸 EPAラウンドテーブル  2008/03  大阪市  関西N-3系脂肪酸 EPAラウンドテーブル
     
    EPAが動脈硬化に効果があることをシンポジストとして発表した
  • ＃13完全閉塞病変に対し、PCIを施行した一症例（ビデオライブ呈示）  [Not invited]
    上森 宜嗣; 服部 隆一; 城谷 学; 横田 良司; 胡内 一郎; 羽場 一直; 清水 良栄; 溝部 道生
    第13回日本心血管インターベンション学会、第5回日本心血管カテーテル治療学会 合同学会  2008/02  第13回日本心血管インターベンション学会、第5回日本心血管カテーテル治療学会 合同学会
  • 左前下行枝近位部に対しPCIを施行した際に冠動脈解離が左冠動脈主幹部、回旋枝にまで波及した１例  [Not invited]
    羽場 一直; 溝部 道生; 清水 良栄; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    第13回日本心血管インターベンション学会、第5回日本心血管カテーテル治療学会、近畿合同地方会  2008/02  京都市  第13回日本心血管インターベンション学会、第5回日本心血管カテーテル治療学会、近畿合同地方会
  • Stenting to the infarct lesion in AMI does not influence vasospasm of the infarct-related artery.  [Not invited]
    第8回日本心血管カテーテル治療学会学術集会  2008
  • Early Administration of Beta-blocker does not Increase Inducible Coronary Arterial Spasm in Japanese Patients with Acute Myocardial Infarction (AMI)  [Not invited]
    第72回日本循環器学会総会・学術集会  2008
  • 冠動脈瘤と冠動脈狭窄を合併したたこつぼ型心筋症の一例  [Not invited]
    溝部 道生; 横田 良司; 清水 良栄; 羽場 一直; 上森 宜嗣; 胡内 一郎; 城谷 学; 服部 隆一
    2007/12
  • A case complicated with Mallory-Weiss Syndrome after coronary stenting  [Not invited]
    羽場 一直; 清水 良栄; 溝部 道生; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    第7回日本心血管カテーテル治療学会学術集会  2007/08  名古屋市  第7回日本心血管カテーテル治療学会学術集会
  • 高血圧を伴う心不全患者に対するアンジオテンシンⅡ受容体拮抗薬の臨床効果の検討---シネMRI、３D心エコーを利用して---  [Not invited]
    城谷 学
    ARB Update  2007/07  大和郡山市  ARB Update
  • 緊急PCI中冠動脈入口部に解離を発症、退院直後にステント遠位に解離による再梗塞を起こした心筋梗塞の一例  [Not invited]
    稻葉 陽一郎; 溝部 道生; 清水 良栄; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一; 平井 拓
    近畿大学医学部奈良病院循環器内科  2006/12  大津市  近畿大学医学部奈良病院循環器内科
  • T-stenting後の分枝再閉塞病変に対するPCIに際し、ガイドワイヤーによる冠動脈穿孔を合併した一例  [Not invited]
    清水 良栄; 城谷 学; 溝部 道生; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 服部 隆一
    第３回日本心血管カテーテル治療学会近畿地方会  2006/06  和歌山市  第３回日本心血管カテーテル治療学会近畿地方会
  • 消化器症状にて発見された右房内腫瘍患者の1例  [Not invited]
    羽場 一直; 上森 宜嗣; 平井 拓; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一; 平間 大介; 西脇 登
    第101回日本循環器学会近畿地方会  2006/06  神戸市  第101回日本循環器学会近畿地方会
     
    症例は38歳、女性。患者は1999年頃より抑欝状態となり心療内科に通院したが、徐々に症状は軽減し通院を中断した。2005年1月頃より、易疲労感を自覚し再び心療内科に通院し、内服治療を受けた。同年6月頃より腹部膨満感、食思低下を自覚し、近医（内科）を受診した。腹部エコーにて腹水を指摘され、当院消化器内科に紹介となった。再度腹部エコーを施行したところ、心嚢水貯留を認め、心エコーを施行した。心エコーにて右房内腫瘍を認めた。右房内腫瘍摘出術を行い、組織診の結果、粘液腫であった。
  • 肺高血圧を合併した甲状腺機能亢進症の一例  [Not invited]
    溝部 道生; 清水 良栄; 羽場 一直; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一; 松田 尚史; 西田 卓
    2006/05
  • 心電図異常のため冠動脈造影を施行し左房内腫瘤が証明された糖尿病性腎症で透析中の一例  [Not invited]
    上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    奈良冠疾患研究会  2005/11  奈良県  奈良冠疾患研究会
  • ステント留置後のslow flowを伴うステント内血栓像がニトロプルシド局注により劇的に消失した一例  [Not invited]
    更谷 紀思; 平井 拓; 城谷 学; 横田 良司; 胡内 一郎; 上森 宜嗣; 羽場 一直; 服部 隆一
    第5回日本心血管カテーテル治療学会学術集会  2005/08  岐阜市  第5回日本心血管カテーテル治療学会学術集会
  • 自然発症冠動脈解離による不安定狭心症の一例  [Not invited]
    更谷 紀思; 胡内 一郎; 羽場 一直; 上森 宜嗣; 平井 拓; 横田 良司; 城谷 学; 服部 隆一
    第99回日本循環器学会近畿地方会  2005/06  大阪市  第99回日本循環器学会近畿地方会
  • 循環器疾患と診断 検体、生理、放射線その他検査と診断  [Not invited]
    城谷 学
    第8回1年次 日本体外循環技術研究会教育セミナー  2005/06  大阪市  第8回1年次 日本体外循環技術研究会教育セミナー
  • 出血性胃潰瘍後に血清CK上昇と心電図上ST上昇を伴う背部痛が生じたが、冠動脈に有意な狭窄のなかった一例  [Not invited]
    上森 宜嗣; 横田 良司; 羽場 一直; 平井 拓; 胡内 一郎; 城谷 学; 服部 隆一
    第2回奈良Cardiovascular Conference  2005/05  奈良県  第2回奈良Cardiovascular Conference
  • ACS患者の大動脈血と冠静脈洞血中LOX-1の比較  [Not invited]
    羽場 一直; 服部 隆一; 城谷 学; 横田 良司; 胡内 一郎; 平井 拓; 上森 宜嗣; 久米 典昭; 北
    長寿科学総合研究事業「心筋梗塞、脳梗塞の予知因子の同定と予知法の開発」に関する研究班会議  2005/01  京都府  長寿科学総合研究事業「心筋梗塞、脳梗塞の予知因子の同定と予知法の開発」に関する研究班会議
  • 補助循環装置、および血漿交換療法により救命し得た劇症型心筋炎の一例  [Not invited]
    清水 良栄; 平井 拓; 城谷 学; 横田 良司; 胡内 一郎; 上森 宜嗣; 羽場 一直; 服部 隆一
    第98回日本循環器学会近畿地方会  2004/12  京都市  第98回日本循環器学会近畿地方会
  • ステント再狭窄病変に対するバルーン拡張に際し、繰り返しショック状態に陥った一例  [Not invited]
    城谷 学; 横田 良司; 羽場 一直; 上森 宜嗣; 平井 拓; 胡内 一郎; 服部 隆一
    第4回日本心血管カテーテル治療学会学術集会  2004/09  京都市  第4回日本心血管カテーテル治療学会学術集会
  • 高Mg血症によるTorsades de pointesを来たしたペースメーカー植え込み後の透析患者  [Not invited]
    羽場 一直; 横田 良司; 城谷 学; 胡内 一郎; 平井 拓; 上森 宜嗣; 服部 隆一
    第97回日本循環器学会近畿地方会  2004/06  大阪府  第97回日本循環器学会近畿地方会
  • In-stent reocclusionに対するPCIに際し、バルーンカテーテルの通過困難を認めた慢性腎不全の一例  [Not invited]
    羽場 一直; 胡内 一郎; 城谷 学; 横田 良司; 平井 拓; 上森 宜嗣; 服部 隆一
    第17回奈良冠疾患研究会  2004/06  奈良県  第17回奈良冠疾患研究会
  • In-stent reocclusion に対するPCIに際し、バルーンカテーテルの通過困難を認めた慢性腎不全の一例  [Not invited]
    城谷 学; 胡内 一郎; 服部 隆一; 横田 良司; 平井 拓; 上森 宜嗣; 羽場 一直
    第1回 日本心血管カテーテル治療学会 近畿地方会  2004/06  京都市  第1回 日本心血管カテーテル治療学会 近畿地方会
  • Protected LMTのPCIに、distal protectionを行った一例  [Not invited]
    上嶋 運啓; 城谷 学; 横田 良司; 胡内 一郎; 平井 拓; 上森 宜嗣; 羽場 一直; 服部 隆一
    近畿大学医学部奈良病院循環器内科  2003/11  大和郡山市  近畿大学医学部奈良病院循環器内科
  • Protected LMTにstenting直後よりショックに陥った一症例  [Not invited]
    上森 宜嗣; 平井 拓; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    日本シネアンギオ研究会  2003/06  大阪府  日本シネアンギオ研究会
  • 妊娠16週で肺塞栓を合併したが血栓溶解療法で軽快し、その後正常出産した一例  [Not invited]
    横田 良司; 上森 宜嗣; 平井 拓; 胡内 一郎; 城谷 学; 服部 隆一
    第95回日本循環器学会近畿地方会  2003/06  大阪  第95回日本循環器学会近畿地方会
  • 心筋梗塞急性期に喀血を伴った一症例  [Not invited]
    上森 宜嗣; 平井 拓; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    奈良冠疾患研究会  2003/05  奈良県  奈良冠疾患研究会
  • バイパス術後、次第に心不全に陥った一症例  [Not invited]
    上森 宜嗣; 平井 拓; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    第一回京都心血管疾患フォーラム  2003/01  京都府  第一回京都心血管疾患フォーラム
  • 当院における急性肺塞栓症の初期診断について  [Not invited]
    澤本 学; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    第94回日本循環器学会近畿地方会  2002/12  大阪市  第94回日本循環器学会近畿地方会
  • tPA投与により出血を来たしたが、血栓溶解が不可能に終わった肺塞栓症の一例  [Not invited]
    澤本 学; 上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    第12回奈良循環器疾患初期治療研究会  2002/09  奈良市  第12回奈良循環器疾患初期治療研究会
  • 連続２枝閉塞を来たした急性心筋梗塞の１例  [Not invited]
    胡内 一郎; 上森 宜嗣; 横田 良司; 城谷 学; 服部 隆一
    第13回 奈良冠疾患研究会  2002/06  奈良市  第13回 奈良冠疾患研究会
  • 左冠動脈主幹部病変による狭心症を発症したChurg-Strauss症候群の一症例  [Not invited]
    上森 宜嗣; 胡内 一郎; 横田 良司; 城谷 学; 服部 隆一
    日本循環器学会近畿地方会第93回学術集会  2002/06  滋賀県  日本循環器学会近畿地方会第93回学術集会
  • 当院開院2年間の冠動脈インターベンションの成績  [Not invited]
    城谷 学; 上森 宜嗣; 胡内 一郎; 横田 良司; 服部 隆一
    第51回 近畿大学医学会学術講演会  2002/01  大阪狭山市  第51回 近畿大学医学会学術講演会
  • 心電図異常のため冠動脈造影を施行し、左心房内腫瘤が証明された糖尿病性腎症で透析中の1症例  [Not invited]
    上森 宜嗣; 服部 隆一; 城谷 学; 横田 良司; 胡内 一郎
    第12回 奈良冠疾患研究会  2001/11  第12回 奈良冠疾患研究会
  • 心不全増悪に横紋筋融解と肝障害を伴った心筋症の１症例。  [Not invited]
    横田 良司; 城谷 学; 胡内 一郎; 服部 隆一
    第91回日本循環器学会近畿地方会  2001/06  大阪  第91回日本循環器学会近畿地方会
  • Protected LMTにstenting直後よりmultiple coronary spasmにてショックに陥った１例  [Not invited]
    城谷 学; 胡内 一郎; 横田 良司; 服部 隆一
    第１１回 奈良冠疾患研究会  2001/06  奈良市  第１１回 奈良冠疾患研究会
     
    57才男性。Ao-freeLITA-LADｸﾞﾗﾌﾄで保護されたLMTのPTCA。カッティングバルーンでスムーズに拡張後、ステント留置した直後から心原性ショックに陥った。造影上LAD、Cxとも多発性に閉塞し、心電図上ST上昇を示す誘導が移動性に変化し、多発冠攣縮が示唆された。
  • 急性大動脈解離との鑑別診断が困難で、術後に右冠動脈瘤破裂が証明された症例  [Not invited]
    横田 良司; 城谷 学; 服部 隆一; 西脇 登; 城谷 均; 野島 武久; 長門 久雄; 寺井弘
    奈良冠疾患研究会  2000/11  奈良  奈良冠疾患研究会

MISC

Awards & Honors

  • 1992 日本心臓財団佐藤賞
     JPN

Research Grants & Projects

  • PTCA後再狭窄に関する研究
  • 急性心筋梗塞の治療
  • Study on Restenosis after Percutaneous Transluminal Coronary Angioplasty
  • Treatment of Acute Myocardial Infarction

Committee Membership

  • 2017/07 - Today   Case Reports in Cardiology   Editorial Board

Media Coverage

  • Case Reports in Cardiology
    Publisher, broadcasting station: Hindawi
    Paper

Other link

researchmap


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