Masakazu Yasuda

Difference in statin effects on neointimal coverage after implantation of drug-eluting stents.

ObjectiveThis study was carried out to examine the difference in effects between rosuvastatin and pravastatin on neointimal formation after the placement of a drug-eluting stent (DES). Materials and methodsForty patients who underwent placement of a DES in our hospital were prospectively randomized to receive rosuvastatin (n=20) or pravastatin (n=20), and analyzed by optical coherence tomography at the chronic stage. The main outcome measure was comparison of neointimal coverage analyzed at a strut level. ResultsA significant reduction in total cholesterol, low-density lipoprotein, and white blood cell count was observed during the study in the rosuvastatin group (total cholesterol, from 4.82±0.90 to 4.43±0.77 mmol/l, P=0.038; low-density lipoprotein, from 2.85±0.76 to 2.34±0.57 mmol/l, P=0.006; white blood cell count, from 5810±1399 to 5355±1257/µl, P=0.048), but not in the pravastatin group. Although not statistically significant, C-reactive protein was lower in the rosuvastatin than in the pravastatin group at the chronic stage (1.14±1.21 vs. 7.67±13.67 mg/l, P=0.051). Malapposed and uncovered struts were significantly less frequent in the rosuvastatin group than in the pravastatin group (malapposed, 0.06 vs. 0.60%, P<0.001; uncovered, 6.49 vs. 11.29%, P<0.001). The difference in uncovered struts was maintained even when stent types were analyzed separately (everolimus-eluting stent, 4.81 vs. 6.21%, P=0.007; sirolimus-eluting stent, 14.40 vs. 20.86%, P<0.001). Comparison of neointimal thickness between the rosuvastatin and the pravastatin groups showed inconsistent results depending on the stent types analyzed. ConclusionCompared with pravastatin, the use of rosuvastatin resulted in lower frequency of uncovered and malapposed struts after the placement of a DES, which might be mediated through improved inflammatory and lipid profiles.

Risk stratification for major adverse cardiac events and ventricular tachyarrhythmias by cardiac MRI in patients with cardiac sarcoidosis

Background The presence of myocardial fibrosis by cardiac MRI has prognostic value in cardiac sarcoidosis, and localisation may be equally relevant to clinical outcomes. Objective We aimed to analyse cardiac damage and function in detail and explore the relationship with clinical outcomes in patients with cardiac sarcoidosis using cardiac MRI. Methods We included 81 consecutive patients with cardiac sarcoidosis undergoing cardiac MR. Left ventricular mass and fibrosis mass were calculated, and localisation was analysed using a 17-segment model. Participants underwent follow-up through 2015, and the development of major adverse cardiac events including ventricular tachyarrhythmias was recorded. Results Increased left ventricular fibrosis mass was associated with increased prevalence of ventricular tachyarrhythmias (p<0.001). When localisation was defined as the sum of late gadolinium enhancement in the left ventricular basal anterior and basal anteroseptal areas, or the right ventricular area, it was associated with ventricular tachyarrhythmias (p<0.001). Kaplan-Meier analysis during a median follow-up of 22.1 months showed that both the mass and localisation groupings for fibrosis were significantly associated with major adverse cardiac events or ventricular tachyarrhythmias and that when combined, the risk stratification was better than for each variable alone (p<0.001, respectively). By Cox-proportional hazard risk analysis, the localisation grouping was an independent predictor for the both. Conclusions In patients with cardiac sarcoidosis, both fibrosis mass and its localisation to the basal anterior/anteroseptal left ventricle, or right ventricle was associated with the development of major adverse cardiac events or ventricular tachyarrhythmias. Cardiac MR with late gadolinium enhancement may be useful for improving risk stratification in patients with cardiac sarcoidosis.

Climbing the hill of left main coronary artery revascularization: percutaneous coronary intervention or coronary artery bypass graft?

Unprotected left main coronary artery (ULMCA) disease can be found in 3–10% of patients undergoing coronary angiography and has an impact on prognosis (1). Surgical myocardial revascularization by means of coronary artery bypass graft (CABG) has traditionally represented the standard therapeutic procedure for ULMCA disease (2) mainly because up to 80% of left main (LM) lesions involve the bifurcation and up to 80% of patients with ULMCA disease also have multivessel coronary artery disease.

Migration of a stent from left main and its retrieval from femoral artery: A case report

Rationale: Embolization of a deployed stent is a rare complication and its mechanism remains unclear in most cases. Patient concerns: A 52-year-old man underwent coronary angiography for effort angina, revealing an 80% stenosis of the proximal left anterior descending (LAD) involving the distal left main (LM). After luminal sizing with intravascular ultrasound two drug-eluting stents were deployed (5.0 × 12 mm and 3.5 × 15 mm) to cover the LM-LAD lesion. After postdilatation, the proximal stent had disappeared from the LM. Diagnoses: The missing stent was found in the right deep femoral artery. Interventions: A new 5.0 × 15 mm stent was deployed onto the LM-LAD ostium, in overlapping with the previously implanted. Then, the stent migrated to the deep femoral artery was successfully retieved through the contralateral femoral artery. Outcomes: The patient was discharged 2 days later, after an uneventful hospital stay. Lessons: Stent deformation after postdilation is a possible causes of stent migration.

Interrelationship between the Myocardial Mass, Fibrosis, BNP, and Clinical Outcomes in Hypertrophic Cardiomyopathy

Objective Increased left ventricular mass (LVM) and LV fibrosis mass (LVFM) are characteristics of hypertrophic cardiomyopathy (HCM). Additionally, a substantial increase in the plasma B-type natriuretic peptide (BNP) level is observed. Therefore, we investigated the interrelationship and clinical significances of these parameters in a HCM cohort that underwent cardiac MRI (CMR). Methods Patients with HCM (n=109) receiving regular outpatient treatment underwent CMR and follow-up through 2015 from CMR examinations. The clinical outcome measures were all-cause mortality, admission for worsening heart failure, and ventricular tachycardia/fibrillation. Results The baseline body mass index (BMI), LV outflow tract (LVOT) obstruction, New York Heart Association (NYHA) class, and increased left atrial dimension (LAD) index were associated with the plasma BNP level. In the CMR analysis, LVM and LVFM indices significantly correlated with the BNP level (r=0.422 and 0.368, respectively), which were independent determinants according to a multivariate analysis (p=0.009 and 0.023, respectively). A Kaplan-Meier analysis during a median follow-up of 19.4 months showed that the baseline LVM or LVFM index was not associated with the clinical outcomes. However, the baseline BNP level was significantly associated with them (p<0.001). In addition, a multivariate Cox proportional hazard analysis showed that plasma BNP was an independent predictor for the clinical outcomes after adjusting for age, sex, LVM, and LVFM. Conclusion The LVM and LVFM are determinants of the BNP level independent of the BMI, LVOT obstruction, LAD, and NYHA class in patients with HCM. However, plasma BNP may be a more sensitive integrated-marker for the clinical outcomes than LVM or LVFM.