Tadayuki Yakushiji

Association between increased epicardial adipose tissue volume and coronary plaque composition

To assess the relationship between epicardial adipose tissue volume (EATV) and plaque vulnerability in significant coronary stenosis using a 40-MHz intravascular ultrasound (IVUS) imaging system (iMap-IVUS), we analyzed 130 consecutive patients with coronary stenosis who underwent dual-source computed tomography (CT) and cardiac catheterization. Culprit lesions were imaged by iMap-IVUS before stenting. The iMAP-IVUS system classified coronary plaque components as fibrous, lipid, necrotic, or calcified tissue, based on the radiofrequency spectrum. Epicardial adipose tissue was measured as the tissue ranging from −190 to −30 Hounsfield units. EATV, calculated as the sum of the fat areas on short-axis images, was 85.0 ± 34.0 cm3. There was a positive correlation between EATV and the percentage of necrotic plaque tissue (R2 = 0.34, P < 0.01), while there was a negative correlation between EATV and the percentage of fibrous tissue (R2 = 0.24, P < 0.01). Multivariate analysis revealed that an increased low-density lipoprotein cholesterol level (β = 0.15, P = 0.03) and EATV (β = 0.14, P = 0.02) were independently associated with the percentage of necrotic plaque tissue. An increase in EATV was associated with the development of coronary atherosclerosis and, potentially, with the most dangerous type of plaque.

Serial Intravascular Ultrasound Findings After Treatment of Chronic Total Occlusions Using Drug-Eluting Stents

Morphologic changes after chronic total occlusion (CTO) treatment with drug-eluting stents (DESs) have not been assessed in detail. Our aim was to use both baseline and follow-up intravascular ultrasound studies to evaluate the morphologic changes and, especially, the changes in distal vessel size and the effect of subintimal stenting after treatment of CTOs with DES. We analyzed serial follow-up intravascular ultrasound (baseline and follow-up at 9 ± 2 months) after DES implantation into 40 CTOs. Overall, 33 CTOs were treated by the anterograde approach; and 7 were treated by the retrograde approach. Minimum lumen cross-sectional area (CSA) trended toward a decrease from baseline to follow-up (4.8 ± 1.7 vs 4.5 ± 1.7 mm(2), p = 0.10), although the minimum stent CSA (4.8 ± 1.7 vs 4.9 ± 1.7 mm(2), p = 0.26) did not change. The distal reference, but not the proximal reference lumen CSA, increased significantly at follow-up (3.8 ± 2.0 to 5.1 ± 2.3 mm(2), p = 0.0004). Late-acquired stent malapposition was seen in 17 patients (42.5%). In 8 CTOs (20%), a part of the stent was implanted into a subintimal space; in these 8 patients, maximum percent neointimal hyperplasia and minimum lumen area was similar in the subintimal segment compared with the adjacent intraplaque segment. The frequency of late-acquired stent malapposition was similar. In conclusion, after CTO treatment with DES, distal vessel enlargement was detected. Subintimal stenting after recanalization of CTO was not inferior compared with stenting within the plaque in terms of long-term morphologic impact.

Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

A 32‐year‐old man presented with palpitation. He was diagnosed with pulmonary sarcoidosis by lung biopsy. The electrocardiogram showed first‐degree atrioventricular block and complete right bundle branch block (CRBBB). We planned to examine laboratory data, echocardiography, Holter monitoring, and gallium‐67 scintigraphy. Before he went through all these exams, he developed ventricular tachycardia. After defibrillation was performed, his electrocardiogram revealed complete atrioventricular block. We observed elevation of serum angiotensin‐converting enzyme levels. In addition, both of gallium‐67 scintigraphy and 18F‐fluorodeoxyglucose positron emission tomography showed abnormal uptake in the ventricular septum. We diagnosed the patient with cardiac sarcoidosis associated with these arrhythmias. We started treatment with methylprednisolone pulse therapy (1 g daily). After 3 days of steroid pulse therapy, we administered prednisolone 30 mg daily. On day 15, electrocardiogram changed from complete atrioventricular block to first‐degree atrioventricular block and CRBBB. He was discharged with no progression with cardiac sarcoidosis for 2 years.

Morphological assessment of chronic total occlusions by combined coronary computed tomographic angiography and intravascular ultrasound imaging

Aims The relationship between CTO morphology and vessel remodelling is unclear. We described chronic total occlusion (CTO) morphology using coronary computed tomographic angiography (CCTA) combined with intravascular ultrasound (IVUS). Methods and results Pre‐intervention CCTA and IVUS of 130 CTO lesions (128 patients) were evaluated. Based on CCTA, positive CTO lesion remodelling [PR, maximum CTO segment vessel diameter > proximal reference vessel diameter (RVD)] was seen in 44 (33.8%) lesions. In the other 86 lesions without PR, 74 (56.9%) had a minimum CTO segment vessel diameter >50% of the proximal RVD and were classified as non‐PR; 12 (9.2%) lesions had a minimum CTO segment vessel diameter ≤50% of the proximal RVD and were classified as collapse. Comparing the three groups, CTO with PR had the greatest maximum atheroma cross‐sectional area (CSA) while the collapse group had the least atheroma CSA (16.0 mm2 [12.0, 19.4] vs. 9.1 mm2 [6.0, 15.9], P < 0.001). The maximum arc of attenuated plaque was greatest in the PR group (51° [0, 167]); and the maximum arc of calcium was greatest in the non‐PR group (91° [51, 174]). In the collapse group distal to the occluded segment, there was a normal‐appearing vessel by IVUS that corresponded to the collapsed segment by CCTA; its minimum plaque burden was 33.2% [19.9, 38.1] with a smooth concave‐shaped lumen surface, implying that the CCTA collapse segment was not occluded. Conclusion Not all CTOs are the same with regard to lesion remodelling and underlying morphology. The combination of IVUS and CCTA can help to categorize CTO morphology.

Relationship between worsening renal function and long-term cardiovascular mortality in heart failure patients

BACKGROUND Recently several studies showed that worsening renal function (WRF) during hospitalization might be a strong independent predictor of poor prognosis in decompensated heart failure (HF) patients. However, these studies had a relatively short follow-up duration and their data were limited to in-hospital outcomes. Our purpose was to assess the relationship between WRF and long-term cardiovascular mortality in HF patients. METHODS We enrolled decompensated HF patients who were admitted to our hospital between April 2010 and March 2015. WRF was defined as a relative increase in serum creatinine of at least 25% or an absolute increase in serum creatinine ≥0.3mg/dL from the baseline. We assessed the cardiovascular mortality and all-cause mortality in HF patients with WRF (WRF group) and without WRF (no WRF group). RESULTS Among 301 patients enrolled, WRF developed in 118 patients (39.2%). During a median follow-up period of 537days [interquartile range, 304.3 to 1025.8days], cardiovascular mortality and all-cause mortality were significantly higher in the WRF group than in the no WRF group (23.2% vs. 6.1%, P<0.001; 30.3% vs. 14.7%, P<0.001, respectively). In the multivariate Cox proportional hazards model, age and serum B-type natriuretic peptide (BNP) level were associated with both cardiovascular death and all-cause death. However, WRF was not the independent predictor of cardiovascular death (P=0.19) nor all-cause death (P=0.57). CONCLUSIONS WRF was associated with cardiovascular death in patients with HF. Although not an independent predictor, WRF might be one of useful markers to identify patients who should be followed carefully after discharge.

Local injection of tissue-plasminogen activator using a pulse spray catheter as a treatment option for proximal deep vein thrombosis: A case report

A 24-year-old woman was admitted to our hospital with the diagnosis of pulmonary thromboembolism (PTE) and left common iliac vein thrombosis. She had used low-dose contraceptive pill for dysmenorrhea. Otherwise, her laboratory data did not show any other thrombotic risk factors. Thrombus in the common iliac vein usually requires a permanent inferior vena cava (IVC) filter. However, the use of long-term warfarin should have been avoided for her potential future pregnancy. A retrievable IVC filter was placed and catheter directed thrombolysis was performed for her deep vein thrombosis (DVT). Local injection of monteplase from a pulse spray catheter was performed for 4 days. After the catheter-based treatment, the thrombus resolved and the IVC filter was successfully removed on day 19. The patient was discharged on day 21. Warfarin therapy was discontinued 6 months after discharge. <Learning objective: Urokinase is recommended in the guideline of the Japanese Circulation Society. But the dose is much less than those stated in guidelines overseas. Several studies have shown that tissue-plasminogen activator (t-PA) might be more effective than urokinase. We report a case in which local injection of monteplase, a type of long acting t-PA, for DVT was effective in treating PTE and DVT.>.

TCT-73 Serial Three-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated of Plaque Progression in Patients With Stable Angina Pectoris

nos: 73 76 TCT-73 Serial Three-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated of Plaque Progression in Patients With Stable Angina Pectoris Myong Hwa Yamamoto, kennosuke yamashita, Mitsuaki Matsumura, Seitarou Ebara, Toshitaka Okabe, Shigeo Saito, Koichi Hoshimoto, Kisaki Amemiya, Tadayuki Yakushiji, Naoei Isomura, Hiroshi Araki, Chiaki Obara, Masahiko Ochiai, Gary Mintz, Akiko Maehara Cardiovascular Research Foundation, New York, New York, United States; Showa University Northern Yokohama Hospital, Yokohama, Japan; Cardiovascular Research Foundation, New York, New York, United States; NorthPoint Solutions, LLC; Showa University Northern Yokohama Hospital, Tokyo, Japan; Showa University Northern Yokohama Hospital, Yokohama, Japan; CRF; Showa universty yohohama northern hospital, Yokohama, Japan; Showa University Northern Yokohama Hospital, Yokohama, Japan; Showa University Northern Yokohama Hospital, Yokohama, Japan; Showa Univ. Northern Yokohama Hospital, Yokohama, Japan; Ospedale Sacco Vialba; Showa University Northern Yokohama Hospital, Kanagawa, Japan; Cardiovascular Research Foundation, Washington, District of Columbia, United States; Cardiovascular Research Foundation, New York, New York, United States BACKGROUND OCT morphologies associated with plaque progression are not well-studied. METHODS We used baseline and 8-mo follow-up 3-vessel OCT and IVUS to assess 124 non-culprit lesions (IVUS plaque burden 40%) in 45 pts with stable angina after culprit lesion percutaneous coronary intervention. Plaque progression was defined as IVUS minimum lumen area decrease >0.5mm2. Lipid plaques by OCT were defined as signal-poor regions with diffuse borders. RESULTS Overall, 24/124 plaques progressed and were characterized by OCT as plaque rupture (n1⁄44), new layer appearance (n1⁄47), thickening of fibrous cap (n1⁄47), or no OCT morphological change with negative remodeling by IVUS (n1⁄46, vessel area at baseline 12.2 [9.9, 18.7]mm2 to follow-up; 10.2 [8.0, 18.5]mm2, p1⁄40.17) (Figure). Pts with plaque progression (n1⁄416) reported less statin use (31.3% vs. 72.4%, p1⁄40.007) and higher baseline LDL-C (110.0 vs. 87.0 mg/dL, p1⁄40.007) and hs-CRP (0.097 vs. 0.051 mg/dL, p1⁄40.004). Multivariable logistic regression analysis showed that lipid plaque by OCT was an independent predictor of plaque progression (OR: 10.2, p1⁄40.001). Progression (n[24) Non-progression

THE ASSOCIATION BETWEEN EPICARDIAL FAT VOLUME AND CORONARY ARTERY PLAQUE CHARACTERIZATION

The aim of this study is to assess the relationship of EFV and plaque vulnerability using a 40MHz IVUS imaging system (iMap-IVUS) in significant coronary stenotic lesion. We analysed consecutive 130patients (94men and 36women) with suspected coronary artery disease who underwent dual-source CT (