Natsuko Tahara

Impact of CD14 ++ CD16 + monocytes on coronary plaque vulnerability assessed by optical coherence tomography in coronary artery disease patients with well-regulated lipid levels

BACKGROUND AND AIMS This study examined the impact of CD14++CD16+ monocytes on coronary plaque vulnerability, as assessed by optical coherence tomography (OCT), and investigated their association with daily glucose fluctuation. Although increased CD14++CD16+ monocyte levels have been reported to increase cardiovascular events, their impact on coronary plaque vulnerability in coronary artery disease (CAD) patients with or without diabetes mellitus (DM) remains unclear. METHODS This prospective observational study included 50 consecutive patients with CAD, receiving lipid-lowering therapy and undergoing coronary angiography and OCT. Patients were divided into 3 tertiles according to the CD14++CD16+ monocyte percentages assessed by flow cytometry. Standard OCT parameters were assessed for 97 angiographically intermediate lesions (diameter stenosis: 30-70%). Daily glucose fluctuation was analyzed by measuring the mean amplitude of glycemic excursion (MAGE). RESULTS CD14++CD16+ monocytes negatively correlated with fibrous cap thickness (r = -0.508, p < 0.01). The presence of thin-cap fibroatheroma (TCFA) was increased stepwise according to the tertile of CD14++CD16+ monocytes (0 [tertile 1] vs. 5 [tertile 2] vs. 10 [tertile 3], p < 0.01). CD14++CD16+ monocytes were a significant determinant of TCFA (OR 1.279, p = 0.001). In non-DM patients, a significant relationship was found between CD14++CD16+ monocytes and MAGE (r = 0.477, p = 0.018). CONCLUSIONS CD14++CD16+ monocytes were associated with coronary plaque vulnerability in CAD patients with well-regulated lipid levels both in DM and non-DM patients. Cross-talk between glucose fluctuation and CD14++CD16+ monocytes may enhance plaque vulnerability, particularly in non-DM patients. CD14++CD16+ monocytes could be a possible therapeutic target for coronary plaque stabilization.

The differences between bisecting and off‐center cuts of the aortic root: The three‐dimensional anatomy of the aortic root reconstructed from the living heart

It is axiomatic that the diameter of the virtual basal ring of the aortic root, which is elliptical rather than circular, will differ when assessed using between bisecting as opposed to off‐center cuts. Such differences, however, which pertain directly to echocardiographic assessments of the so‐called valvar annulus, have yet to be systematically explored.

Diversity and Determinants of the Three-dimensional Anatomical Axis of the Heart as Revealed Using Multidetector-row Computed Tomography

The location of the heart within the thorax varies significantly between individuals. The resultant diversity of the anatomical cardiac long axis, however, and its determinants, have yet to be systematically investigated. We enrolled 100 consecutive patients undergoing coronary arterial computed tomographic angiography, decomposing the vector of the anatomical cardiac long axis by projecting it to horizontal, frontal, and sagittal planes. The projected vectors on each plane were then converted into three rotation angles using coordinate transformation. We then measured the extent of aortic wedging, using the vertical distance between the inferior margins of the non‐adjacent aortic sinus and the epicardium. We took the aortic root rotation angle to be zero when an “en face” view of the right coronary aortic sinus was obtained in the frontal view, defining leftward rotation to be positive. The mean horizontal, frontal, and sagittal rotation angles were 48.7° ± 9.5°, 52.3° ± 12.0°, and 34.0° ± 11.2°, respectively. The mean extent of aortic wedging, and the aortic root rotation angle, were 42.7 ± 9.8 mm, and 5.3° ± 16.4°. Horizontal rotation of the anatomical axis was associated with leftward and ventral rotation, and vice versa. Multivariate analysis showed aortic root rotation to be associated with horizontal cardiac rotation, while aortic wedging is associated with frontal and sagittal cardiac rotation. We have quantified the marked individual variation observed in the anatomical axis of the living heart, identifying the different mechanisms involved in producing the marked three‐dimensional diversity of the living heart. Anat Rec, 300:1083–1092, 2017.

Data on impact of monocytes and glucose fluctuation on plaque vulnerability in patients with coronary artery disease

Data presented in this article are supplementary material to our research article entitled “Impact of CD14++CD16+ monocytes on coronary plaque vulnerability assessed by optical coherence tomography in coronary artery disease patients” [1]. This article contains the data of study population, diagnostic ability of CD14++CD16+ monocytes to identify thin-cap fibroatheromas, and association between laboratory variables and plaque properties.

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve: Variation in the Membranous Septum in TAVI

Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI. Using multiplanar reconstructions, we measured the height and width of the membranous septum, and the distances of its superior and inferior margins from the virtual basal ring plane. We also assessed the extent of wedging of the aortic root between the mitral valve and the ventricular septum. Mean heights and widths of the membranous septum were 6.6 ± 2.0, and 10.2 ± 3.1 mm, respectively, with its size significantly associated with that of the aortic root (P < 0.05). Its superior and inferior margins were 4.5 ± 2.3 and 2.1 ± 2.1 mm, respectively, from the plane of the basal ring. The inferior distance, the surrogate for the adjacency of the atrioventricular conduction axis, was ≤ 5mm in 91% of the patients. Deeper wedging of the aortic root was independently correlated with a shorter inferior distance (β = 0.0569, P = 0.0258). The membranous septum is appreciably closer to the virtual basal ring than previously appreciated. These findings impact on estimations of the risk of damage to the atrioventricular conduction axis during TAVI. Clin. Anat. 31:525–534, 2018.

TCT-90 Efficacy and safety of sequential hybrid therapy with pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.

nos: 89 92 TCT-89 Balloon pulmonary angioplasty for chronic thromboembolic hypertension: report of a two-year experience in a surgical center Philippe Brenot, Carlos Garcia Alonso, Benoit Gerardin, Ryad Bourkaib, Xavier Jais, Gerald Simonneau, Elie Fadel Minneapolis Heart Institute Foundation; Hôpital Marie Lannelongue, Le Plessis Robinson, France; Hôpital Marie Lannelongue; Evecquemont, Evcequemont, France; Hôpital Bicêtre; Hôpital Bicêtre; Hôpital Marie Lannelongue BACKGROUND Balloon pulmonary angioplasty (BPA) has emerged as a new therapy (beside surgery and medical treatment) for patients suffering of chronic thromboembolic pulmonary hypertension (CTEPH). We describe herein our single-center experience in our first 113 patients. METHODS Patients were selected for BPA at weekly multidisciplinary meetings in collaboration with the national reference center for pulmonary hypertension. Patients underwent functional evaluation (NYHA class and 6 minutes walking test), as well as right heart catheterization and pulmonary artery imaging before BPA and systematically 3 months after the last session. BPA was performed via femoral vein under local anesthesia. Balloon diameter ranged from 1.5 to 9 mm. Several sessions were required to reach our goal of mean PAP < 30 mmHg. RESULTS From February 2014 to May 2016, 113 patients (64 males, 57%), mean age 62 15, underwent BPA. Reasons to perform BPA were: non-surgical distal disease in 82, comorbidities in 22, persistent high pulmonary artery pressure (PAP) after surgery in 7 and refusal to surgery in 2. The mean number of sessions was 5.5 (range 1 to 10). After 620 sessions we deplore 29 hemoptysis (4.5% of procedures), none of which was life threatening, 11 pulmonary artery dissections (1.7%), 5 of which were treated by stent implantation, and 46 reperfusion pulmonary injuries (7,4%), 2 of which required mechanical ventilation. 3 patients died (2.7%), 2 because of reperfusion injury and 1 of an infectious complication. Follow up has been completed for the first 79 patients (mean FU of 8 months, range 3 to 20). 3 patients died (1 sudden death, 1 recurrence of pulmonary embolism and 1 road accident). NYHA status improved from 2.91 to 1.77 (p<0.01). Mean PAP improved from 44.5 to 31.2 mmHg (p<0.01). Cardiac output increased from 2.59 L/min/m2 to 2.95 (p<0.01). Pulmonary vascular resistance (PVR) went down from 7.77 UW to 3.92 UW (p<0.01). CONCLUSION Our short term BPA results confirm the usefulness of this technique to improve hemodynamics and more importantly quality of life in well selected patients. Future analysis should help us select responsive patients while diminishing procedure related complications. To our knowledge this series is one of the largest currently available. CATEGORIES STRUCTURAL: Heart Failure TCT-90 Efficacy and safety of sequential hybrid therapy with pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension Kenichi Yanaka, Kazuhiko Nakayama, Toshiro Shinke, Hiromasa Otake, Takayoshi Toba, Hachidai Takahashi, Daisuke Terashita, Yuto Shinkura, Koji Kuroda, Kenzo Uzu, Natsuko Tahara, Yoshinori Nagasawa, Yuichiro Nagano, Naoki Tamada, yoshiro tsukiyama, Hiroyuki Yamamoto, Noriaki Emoto, Ken-ichi Hirata University of Michigan Health System, Kobe city, Japan; CVPath Institute, Inc; Kobe University Hospital, Kobe, Japan; National Institute of Cardiovascular Diseases, Dhaka, Bangladesh; Himeji Cardiovascular Center, Himeji, Japan; Kobe University, Himeji, Japan; Kobe University Hospital; City Clinic, Kobe, Japan; Kobe University J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 8 , N O . 1 8 , S U P P L B , 2 0 1 6 B37 Hospital, kobe city, Japan; Kobe University, Kobe, Japan; Wakayama Medical University; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Aichi Medical University, Kobe-shi, Japan; Federal University of São Paulo; Morehouse College; American Heart of Poland; Tufts Medical Center, Kobe, Japan; Center for Cardiovascular Research and Development, American Heart of Poland Inc BACKGROUND Pulmonary endarterectomy (PEA) is a gold standard therapy that can dramatically reduce pulmonary artery pressure (PAP) and improve the prognosis on chronic thromboembolic pulmonary hypertension (CTEPH). However, residual pulmonary hypertension or persistent symptoms even after PEA are still the clinical issues to be solved. We investigated whether additional balloon pulmonary angioplasty (BPA) after PEA was effective. METHODS Since August 2009 until June 2016, 23 patients underwent PEA at Kobe University Hospital. Seven patients with residual pulmonary hypertension or symptom underwent additional BPA. RESULTS The period from PEA to additional BPA was 8.3 8.3 months and the number of BPA sessions was 2.4 0.9. In 7 patients who underwent additional BPA after PEA, mean PAP and pulmonary vascular resistance (PVR) had significantly improved by PEA (39.3 6.0 to 27.9 10.1 mmHg p<0.01, 996 447 to 473 255 dyne・sec・cm5 p1⁄40.02), and improved further (to 19.9 7.9 mmHg p1⁄40.01 ,to 183 96 dyne・sec・cm-5 p1⁄40.01) by additional BPA. Before PEA, 2 patients were NYHA/WHO functional class II and 5 patients were class III. Hybrid therapy improved NYHA/WHO functional class (3 patients classI, 3 patients classII, 1 patients classIII p1⁄40.05)(Figure). No patient died and had severe complication needed mechanical ventilator and extracorporeal membrane oxygenation during whole study period. CONCLUSION Although PEA for CTEPH had improved pulmonary hemodynamic profiles, additional BPA could improve them further. Additional BPA is an effective and safe treatment for residual pulmonary hypertension or persistent symptom. CATEGORIES ENDOVASCULAR: Peripheral Vascular Disease and Intervention TCT-91 Efficacy of aggressive balloon pulmonary angioplasty on chronic thromboembolic pulmonary hypertension beyond normalized mean pulmonary arterial pressure Yuto Shinkura, Kazuhiko Nakayama, Takayoshi Toba, Hachidai Takahashi, Daisuke Terashita, Kenzo Uzu, Koji Kuroda, Natsuko Tahara, Yoshinori Nagasawa, Yuichiro Nagano, Hiroyuki Yamamoto, yoshiro tsukiyama, Kenichi Yanaka, Naoki Tamada, Hiromasa Otake, Toshiro Shinke, Noriaki Emoto, Ken-ichi Hirata City Clinic, Kobe, Japan; CVPath Institute, Inc.; Himeji Cardiovascular Center, Himeji, Japan; Kobe University, Himeji, Japan; Kobe University Hospital; Kobe University, Kobe, Japan; Kobe University Hospital, kobe city, Japan; Wakayama Medical University; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Aichi Medical University, Kobe-shi, Japan; American Heart of Poland; Osaka Saiseikai Nakatsu Hospital, Kobe, Japan; University of Michigan Health System, Kobe city, Japan; Federal University of São Paulo; National Institute of Cardiovascular Diseases, Dhaka, Bangladesh; Kobe University Hospital, Kobe, Japan; Tufts Medical Center, Kobe, Japan; Center for Cardiovascular Research and Development, American Heart of Poland Inc BACKGROUND Balloon pulmonary angioplasty (BPA) attracts attention as an alternative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). Previous studies reported that despite of normalization of resting mean pulmonary artery pressure (mPAP), some patients with CTEPH still suffer from exertional dyspnea. Whether or not additional BPA therapy for these patients might improve the symptoms, however, has not been clarified. METHODS Among 102 patients with CTEPH who treated in Kobe university hospital, a total of 37 patients who achieved normalization of mPAP but still had persistent symptoms (WHO-Fc>II) after BPA with or without pulmonary endarterectomy (PEA). We formerly set normalization of resting mPAP (<25mmHg) as an endpoint of BPA sessions (conventional BPA). Since Sep, 2014 we initiated to perform additional BPA for the patients who still had persistent symptoms (WHO-Fc>II) even after normalization of resting mPAP (aggressive BPA). We analyzed the changes in hemodynamics, exercise capacity, and WHO-Fc between two groups. RESULTS Among 37 patients with normalized mPAP, 15 patients were aggressive BPA group and 22 patients were conventional BPA group. The frequency of PEA procedure before BPA and median follow-up duration since achievement of normalization mPAP were not different between the groups. The 6-minute walking distance (6MWD) and hemodynamics were significantly improved in aggressive BPA group compared with conventional BPA group(D6MWD; 51.2 14.1 vs -5.0 12.5 m ; p1⁄40.01 / DmPAP ; -2.9 0.7 vs 2.1 0.9 mmHg ; p<0.01 / DPulmonary vascular resistance ; -105.9 35.5 vs 10.4 16.6 dyne・sec/ cm-5; p < 0.01). Percentage of the patients who improved WHO-Fc was significantly higher in aggressive BPA group (73.3% vs 32.1%.; p1⁄40.01).

TCT-329 Impaired HDL uptake capacity which measure HDL functionality may associate with target lesion revascularization through provoking neoatherosclerosis formation after stent implantation

The importance of HDL functionality on coronary artery disease has been repeatedly demonstrated in recent studies. However, the association between HDL functionality and stent failure has yet to be clarified. Recently, we established a cell-free assay system to evaluate the capacity of HDL to accept

INVESTIGATION OF HEMODYNAMIC CHANGES DURING BALLOON OCCLUSION TEST FOR PERCUTANEOUS ATRIAL SEPTAL DEFECT CLOSURE

Left ventricular systolic or diastolic dysfunction may lead to elevation in pulmonary capillary wedge pressure (PCWP) during pre-balloon testing at atrial septal defect (ASD) closure, through abrupt closure of left to right shunt. However, the association between acute hemodynamic changes and

TCT-91 Efficacy of aggressive balloon pulmonary angioplasty on chronic thromboembolic pulmonary hypertension beyond normalized mean pulmonary arterial pressure.

Hospital, kobe city, Japan; Kobe University, Kobe, Japan; Wakayama Medical University; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; Aichi Medical University, Kobe-shi, Japan; Federal University of São Paulo; Morehouse College; American Heart of Poland; Tufts Medical Center, Kobe, Japan; Center for Cardiovascular Research and Development, American Heart of Poland Inc

INTRA-STENT THROMBUS FORMATION FOLLOWING BIOLIMUS A-9 ELUTING STENT IMPLANTATION IN PATIENTS WITH SHORTER AND PROLONGED DUAL ANTI-PLATELET THERAPY: OPTICAL COHERENCE TOMOGRAPHY SUB-STUDY OF NIPPON TRIAL

Dual antiplatelet therapy (DAPT) with thienopyridine and aspirin is a standard of care for prevention of stent thrombosis. However, the impact of DAPT duration on local thrombus formation was unknown. NIPPON is an open label, randomized multicenter trial designed to demonstrate non-inferiority of