Tomohisa Nakamura

Vascular Inflammation Evaluated by [18F]-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Is Associated With Endothelial Dysfunction

Objective—Endothelial dysfunction is an initial step in atherosclerotic cardiovascular disease. However, involvement of vascular inflammation in endothelial dysfunction is not fully investigated in humans because of the lack of diagnostic modality to noninvasively evaluate vascular inflammation. We assessed the relationship between endothelial function and vascular inflammation evaluated by [18F]-fluorodeoxyglucose-positron emission tomography/computed tomographic imaging. Approach and Results—We examined endothelial function and vascular inflammation by flow-mediated dilation (FMD) of the brachial artery and [18F]-fluorodeoxyglucose-positron emission tomography/computed tomographic imaging of carotid arteries, respectively, in 145 subjects (95 men and 50 women; mean age, 61.8±9.5 years) who underwent a risk-screening test for cardiovascular disease in Kurume University Hospital. Vascular inflammation was measured by blood-normalized standardized uptake value, known as a target:background ratio (TBR). We investigated whether absolute changes from baseline of %FMD after antihypertensive treatment for 6 months (&Dgr;%FMD) were correlated with those of TBR in 33 drug-naive patients with essential hypertension. Multiple logistic regression analysis revealed that age (odds ratio, 1.767 for 10-year increase), male sex (odds ratio, 0.434), low-density lipoprotein-cholesterol (odds ratio, 1.630 for 26-mg/dL increase), and TBR values (odds ratio, 1.759 for 0.2 increase) were independently associated with %FMD in 145 patients. There was an inverse correlation between &Dgr;%FMD and &Dgr;TBR; &Dgr;TBR was a sole independent associate of &Dgr;%FMD in hypertensive patients (r=−0.558; P<0.001). Conclusions—The present study showed that vascular inflammation in the carotid arteries evaluated by [18F]-fluorodeoxyglucose-positron emission tomography/computed tomography was one of the independent correlates of decreased %FMD, thus suggesting the association of vascular inflammation with endothelial dysfunction in humans.

Successful balloon pulmonary angioplasty with gadolinium contrast media for a patient with chronic thromboembolic pulmonary hypertension and iodine allergy

A 28-year-old male was referred to our hospital with dyspnea. He was diagnosed as having chronic thromboembolic pulmonary hypertension, and a pulmonary endarterectomy (PEA) was performed. However, exertional dyspnea remained because of residual pulmonary hypertension; therefore, the patient was re-admitted to our hospital 1 year after PEA. We performed computed tomography and pulmonary angiography and found web and band lesions in the distal pulmonary artery with a high pulmonary artery pressure. Although further management was complicated because the patient had an anaphylactic shock to iodine-based contrast media, we eventually completed five sessions of balloon pulmonary angioplasty (BPA) using gadolinium contrast medium. His symptoms and hemodynamics dramatically improved after a series of BPA. After 15 months, mean pulmonary arterial pressure reduced from 67 mmHg to 20 mmHg, and subjective symptoms improved from stage Ⅳ to I as per the WHO classification system. BPA is a potential procedure for residual pulmonary hypertension after PEA and could be safely performed using gadolinium contrast medium for patients with iodine allergy.

Anagliptin, A Dipeptidyl Peptidase-4 Inhibitor Ameliorates Arterial Stiffness in Association with Reduction of Remnant-Like Particle Cholesterol and Alanine Transaminase Levels in Type 2 Diabetic Patients

BACKGROUND Inhibition of dipeptidyl peptidase-4 (DPP-4) has been proposed as a therapeutic target for type 2 diabetes (T2DM). Arterial stiffness, a predictor of future cardiovascular events and all-cause mortality, is augmented in these patients. However, effects of DPP-4 inhibitors on arterial stiffness remain unknown. In this study, we compared effects of anagliptin, an inhibitor of DPP-4 on arterial stiffness evaluated by cardio-ankle vascular index (CAVI) with those of an equipotent glucose-lowering agent, glimepiride in patients with T2DM. METHODS The study involved 50 consecutive outpatients (33 males and 17 females; mean age of 72.5±9.5 years) who visited our hospitals for a risk-screening test or treatment for T2DM. They underwent complete history and physical examination, and determination of blood chemistry and anthropometric variables, and then were randomized to receive either anagliptin (n=26) or glimepiride (n=24) for 6 months. RESULTS After 6-months treatment, fasting plasma glucose and HbA1c values were comparably reduced in both groups. Anagliptin, but not glimepiride treatment significantly decreased low-density lipoprotein cholesterol, malondialdehyde-modified LDL, remnant-like particle (RLP) cholesterol, CAVI, alanine transaminase (ALT), γ-glutamyl transferase and visceral fat volume. In multiple regression analysis, absolute changes from baseline of RLP cholesterol and ALT after anagliptin treatment for 6 months (ΔRLP cholesterol and ΔALT) were independently correlated with ΔCAVI (R2=0.445). CONCLUSION The present study suggests that anagliptin may exert a beneficial effect on arterial stiffness in patients with T2DM, which is independent of its blood glucose-lowering property. Anagliptin may ameliorate arterial stiffness partly via reduction of RLP cholesterol and improvement of liver function.

Switching Dipeptidyl Peptidase-4 Inhibitors to Tofogliflozin, a Selective Inhibitor of Sodium-Glucose Cotransporter 2 Improves Arterial Stiffness Evaluated by Cardio-Ankle Vascular Index in Patients with Type 2 Diabetes: A Pilot Study

BACKGROUND We have found that anagliptin, a dipeptidyl peptidase-4 inhibitor (DPP-4) significantly ameliorates arterial stiffness in Type 2 Diabetes Mellitus (T2DM) patients compared with an equivalent hypoglycaemic agent, glimepiride. However, it remains unclear whether switching DPP-4 inhibitors to tofogliflozin, a selective inhibitor of Sodium-Glucose Cotransporter 2 (SGLT2) improves arterial stiffness in T2DM patients. METHODS Nineteen T2DM patients who had received DPP-4 inhibitors for at least 1 year were enrolled in this study. Clinical parameters and arterial stiffness evaluated by cardio-ankle vascular index (CAVI) were measured at baseline and after 6-months treatment with tofogliflozin. RESULTS At 6 months after switching to tofogliflozin, CAVI, waist circumference, body weight, body mass index, subcutaneous and visceral fat volume, white blood cell number, fasting plasma insulin, uric acid, aspartate transaminase (AST), γ-glutamyl transferase (GTP), and advanced glycation end products (AGEs) were significantly reduced, while red blood cell number, haemoglobin, and HbA1c values were increased. When stratified by median values of change in CAVI after switching to tofogliflozin (ΔCAVI), baseline serum levels of AGEs were significantly higher in the low ΔCAVI group (high responder) than in the high one (low responder). ΔAST and ΔGTP were positively correlated with ΔCAVI. CONCLUSION The present study suggests that switching DPP-4 inhibitors to tofogliflozin ameliorates arterial stiffness in T2DM patients partly via improvement of liver function. Baseline serum levels of AGEs may identify patients who improve arterial stiffness more after treatment with tofogliflozin.

Thalidomide for Hereditary Hemorrhagic Telangiectasia With Pulmonary Arterial Hypertension

initiate thalidomide, which increases platelet-derived growth factor-B expression and downregulates vascular endothelial growth factor in endothelial cells, stimulating mural cell coverage and leading to normal vascular maturation.1,2 After the initiation of thalidomide (50 mg daily), the anemia was dramatically improved without blood transfusion (Figure H) and telangiectatic lesions in the tongue were no longer notable (Figure A-2). Although intensive therapy with pulmonary vasodilators might induce bleeding, we were able to add tadalafil 10 mg daily and increase ambrisentan to 7.5 mg daily without any bleeding side-effects. Twelve months after thalidomide treatment, right heart failure developed with deteriorating pulmonary hemodynamics (mean PAP, 90 mmHg; cardiac index, 1.88 L/min/m2; Table, January 2014). Wedged distal pulmonary angiography showed markedly decreased peripheral vessels (Figure I-2) as compared with that before thalidomide therapy (Figure I-1). After the discontinuation of thalidomide, the bleeding recurred and PAH did not improve, as reflected by serial changes in B-type natriuretic peptide and tricuspid regurgitation pressure gradient (Figure G,H). Finally, the patient died due to right heart failure. Thalidomide was beneficial against mucocutaneous bleeding,1–7 but careful consideration is required with regard to its initiation in HHT patients with PAH.

Acute heart failure caused by mechanical valve leaflet dislodgment at the mitral position.

A 46-year-old woman was transferred to the hospital by ambulance for sudden dyspnoea and frothy blood-streaked sputum with cardiogenic shock, who has taken mitral valve replacement (MVR) using a mechanical valve (Edward TEKNA, 29 mm) at the age of 34 due to severe mitral regurgitation. Chest radiography revealed marked blood congestion ( Panel A ). Because her vital sign was …

Right ventricular workload assessed by FDG-PET in a patient with residual VSD and infundibular pulmonary stenosis after repair of tetralogy of Fallot

Right ventricular workload assessed by FDG-PET in a patient with residual VSD and infundibular pulmonary stenosis after repair of tetralogy of Fallot Tomohisa Nakamura, MD, Nobuhiro Tahara, MD, PhD, Atsuko Tahara, MD, Akihiro Honda, MD, PhD, Sachiyo Igata, PhD, Munehisa Bekki, MD, Yoichi Sugiyama, MD, Jiahui Sun, MD, Eita Kumagai, MD, PhD, Seiji Kurata, MD, PhD, Kiminori Fujimoto, MD, PhD, Toshi Abe, MD, PhD, Seiya Kato, MD, PhD, Hiroyuki Tanaka, MD, PhD, and Yoshihiro Fukumoto, MD, PhD

Myocardial metabolic improvement prior to electrocardiographic or volumetric changes of the right ventricle in pulmonary arterial hypertension.

Myocardial metabolic improvement prior to electrocardiographic or volumetric changes of the right ventricle in pulmonary arterial hypertension Tomohisa Nakamura, MD, Nobuhiro Tahara, MD, PhD, Atsuko Tahara, MD, Akihiro Honda, MD, PhD, Munehisa Bekki, MD, Yoichi Sugiyama, MD, Jiahui Sun, MD, Eita Kumagai, MD, PhD, Seiji Kurata, MD, PhD, Kiminori Fujimoto, MD, PhD, Toshi Abe, MD, PhD, Sachiyo Igata, PhD, and Yoshihiro Fukumoto, MD, PhD

Diagnostic performance of FDG-PET/CTA in native mitral valve endocarditis

Diagnostic performance of FDG-PET/CTA in native mitral valve endocarditis Shoko Maeda, MD, Nobuhiro Tahara, MD, PhD, Fumitake Takase, MD, Munehisa Bekki, MD, Atsuko Tahara, MD, Akihiro Honda, MD, PhD, Sachiyo Igata, PhD, Yoichi Sugiyama, MD, Tomohisa Nakamura, MD, Jiahui Sun, MD, Seiji Kurata, MD, PhD, Kiminori Fujimoto, MD, PhD, Toshi Abe, MD, PhD, Yoshihiro Fukumoto, MD, PhD a Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, Japan b Department of Radiology, Kurume University School of Medicine, Kurume, Japan

Anti-inflammatory effect of statin in coronary aneurysms late after Kawasaki disease

Anti-inflammatory effect of statin in coronary aneurysms late after Kawasaki disease Munehisa Bekki, MD, Nobuhiro Tahara, MD, PhD, Atsuko Tahara, MD, Akihiro Honda, MD, PhD, Sachiyo Igata, PhD, Yoichi Sugiyama, MD, Tomohisa Nakamura, MD, Jiahui Sun, MD, Seiji Kurata, MD, PhD, Kiminori Fujimoto, MD, PhD, Toshi Abe, MD, PhD, Hiroyuki Tanaka, MD, PhD, Kenji Suda, MD, PhD, and Yoshihiro Fukumoto, MD, PhD