Toshihiro Shoji

Recommended acquisition-parameters in achieving successful evaluation of coronary lumen patency surrounded by XIENCE of diameters<3.0mm in 1st generation 320-slice CT. XIENCE Phantom Study Part 1.

Recommended acquisition-parameters in achieving successful evaluation of coronary lumen patency surrounded by XIENCE of diameters b3.0 mm in 1st generation 320-slice CT. XIENCE Phantom Study Part 1 Nobusada Funabashi ⁎, Yasuaki Namihira , Ryosuke Irie , Yoshihide Fujimoto , Toshihiro Shoji , Hiroyuki Takaoka , Hironori Kondo , Kanako Atou , Joji Ota , Yoshitada Masuda , Takashi Uno , Yoshio Kobayashi a

Optical stent-sizes in evaluating patency of coronary lumen surrounded by XIENCE of actual diameters 2.21-2.85 mm in 1st-generation 320-slice-CT using Pulsating-Phantom XIENCE phantom study part 5

Optical stent-sizes in evaluating patency of coronary lumen surrounded by XIENCE of actual diameters 2.21–2.85 mm in 1st-generation 320-slice-CT using Pulsating-Phantom XIENCE phantom study part 5 Nobusada Funabashi ⁎, Yasuaki Namihira , Ryosuke Irie , Yoshihide Fujimoto , Toshihiro Shoji , Hiroyuki Takaoka , Hironori Kondo , Kanako Atou , Joji Ota , Yoshitada Masuda , Takashi Uno , Yoshio Kobayashi a

Intracoronary Acetylcholine Provocation Testing - Omission of the 20-µg Dose Is Feasible in Patients Without Coronary Artery Spasm in the Other Coronary Artery.

BACKGROUNDnBased on the Japanese Circulation Society guideline of vasospastic angina, incremental doses of acetylcholine (ACh) are prescribed for coronary spasm provocation: 20 and 50 μg for the right coronary artery (RCA), and 20, 50 and 100 μg for the left coronary artery (LCA). However, the requirement for each dose of ACh has not been fully evaluated.nnnMETHODSANDRESULTSnA total of 249 patients who underwent ACh provocation test for both the RCA and LCA were included. The positive diagnosis of intracoronary ACh provocation test was defined as total or subtotal coronary artery narrowing accompanied by chest pain and/or ischemic ECG changes. Positive ACh provocation test was observed in 116 patients (47%). Patients without vasospasm in the LCA had a lower incidence of vasospasm in the RCA induced by 20 μg of ACh compared with those with vasospasm in LCA (0.8% vs. 27.5%, P<0.001). Similarly, vasospasm in the LCA induced by 20 μg of ACh was observed less frequently in patients without than with vasospasm in the RCA (6.1% vs. 26.7%, P<0.001). In all patients without vasospasm in the other coronary artery, intracoronary administration of 50 μg of ACh was performed without any complications.nnnCONCLUSIONSnSkipping the provocation test with 20 μg of ACh in patients without coronary artery spasm in the other coronary artery may be possible. (Circ J 2016; 80: 1820-1823).

Aortic pulsatility assessed by an oscillometric method is associated with coronary atherosclerosis in elderly people.

Abstract The aim of this study was to investigate the association of aortic pulsatility assessed by a non-invasive brachial cuff-based method with coronary atherosclerosis. In total, 139 patients undergoing coronary angiography were included in this cross-sectional study. Aortic blood pressure (BP) indices were recorded invasively by a fluid-filled catheter and non-invasively by a brachial cuff-based oscillometric device. Fractional pulse pressure (FPP) was defined as pulse pressure (PP)/mean BP and pulsatility index (PI) as PP/diastolic BP. Aortic FPP and PI in coronary artery disease (CAD) patients were significantly higher than in non-CAD patients in both invasive and non-invasive methods. Multivariate logistic regression analysis demonstrated that non-invasively measured aortic FPP and PI were associated with CAD risk in patients aged ≥70 years [aortic FPP per 0.1 odds ratio (OR)u2009=u20091.66, 95% confidence interval (CI) 1.05–2.64; aortic PI per 0.1 OR =1.39, 95% CI 1.02–1.88; all pu2009<u20090.05], but were not associated with CAD risk in patients aged <70 years. In linear regression analysis, non-invasively measured aortic FPP and PI correlated with SYNTAX and Gensini scores only in patients aged ≥70 years. Aortic FPP and PI measured non-invasively by a brachial cuff-based oscillometric device were associated with coronary atherosclerosis in elderly patients.

Paroxysmal atrial fibrillation during intracoronary acetylcholine provocation test

Intracoronary acetylcholine (ACh) provocation test is useful to diagnose vasospastic angina. However, paroxysmal atrial fibrillation (AF) often occurs during intracoronary ACh provocation test, leading to disabling symptoms. The aim of this study was to investigate the incidence and predictors of paroxysmal AF during the test. A total of 377 patients without persistent AF who underwent intracoronary ACh provocation test were included. Paroxysmal AF during ACh provocation test was defined as documented AF on electrocardiogram during the procedure. There were 31 patients (8%) with paroxysmal AF during the test. Of these, 11 (35%) required antiarrhythmic drugs, but none received electrical cardioversion. All of them recovered sinus rhythm within 48xa0h. At procedure, paroxysmal AF occurred mostly during provocation for the right coronary artery (RCA) rather than for the left coronary artery (LCA) (90 vs. 10%). Multivariate logistic regression analysis demonstrated that a history of paroxysmal AF (OR 4.38 CI 1.42–13.51, pxa0=xa00.01) and body mass index (OR 0.88 CI 0.78–0.99, pxa0=xa00.03) were independent predictors for occurrence of paroxysmal AF during intracoronary ACh provocation test. In conclusions, paroxysmal AF mostly occurs during ACh provocation test for the RCA, especially in patients with a history of paroxysmal AF and lower body mass index. It may be better to initially administer intracoronary ACh in the LCA when the provocation test is performed.

Crucial Effect of Calibration Methods on the Association Between Central Pulsatile Indices and Coronary Atherosclerosis

BACKGROUND Several studies have reported that central systolic blood pressure (SBP) estimation is affected by calibration methods. However, whether central pulsatile indices, namely pulse pressure (PP) and fractional PP (FPP) (defined as PP/mean arterial pressure (MAP)), also depend on calibration methods remains uninvestigated. This study assessed the accuracy and discriminatory ability of these indices for coronary atherosclerosis using 2 calibration methods. METHODS Post-hoc analysis of a previous cross-sectional study (n = 139) that investigated the association between central pulsatile indices and coronary atherosclerosis. A validated-oscillometric device provided PP and FPP at the brachial artery (bPP and bFPP) and central artery using 2 calibration methods: brachial SBP/diastolic BP (DBP) (cPPsd and cFPPsd) and MAP/DBP (cPPmd and cFPPmd). Accuracy was assessed against invasive measurements (cPPinv and cFPPinv). Multivariate logistic and linear regression analyses were performed to assess the association between pulsatile indices and the presence of coronary artery disease (CAD) and SYNTAX score, respectively. RESULTS cPPmd and cFPPmd were closer to invasive values than cPPsd (cPPsd: 39.6±12.6; cPPmd: 60.2±20.1; cPPinv: 71.4±22.9). cFPP exhibited similar results (cFPPsd: 0.35±0.09; cFPPmd: 0.55±0.14; cFPPinv: 0.70±0.19). In patients ≥70 years, only cFPPmd was significantly associated with CAD risk (odds ratio: 1.66 (95% confidence interval: 1.05–2.64)). SYNTAX score was significantly correlated with cPPmd, cFPPmd, and bFPP (standardized &bgr;: cPPmd 0.39, cFPPmd 0.50, bFPP 0.42, all P < 0.01). No significant association was observed in patients aged <70 years. CONCLUSIONS Central pulsatile indices calibrated with brachial MAP/DBP were more accurate and discriminatory for coronary atherosclerosis than SBP/DBP calibration.

Relation between severity of myocardial bridge and vasospasm

BACKGROUNDnMyocardial bridge (MB) has been reported to induce cardiac complications including coronary vasospasm. Although MB has some anatomical and morphological variations, the association of these variations with vasospasm is unclear. The aim of this study was to investigate the relation between morphological severity of MB and vasospasm induced by acetylcholine (ACh) provocation test.nnnMETHODSnA total of 392 patients without coronary stent in the left anterior descending artery (LAD) undergoing intracoronary ACh provocation test were included. Angiographic coronary artery vasospasm was defined as total or subtotal occlusion induced by ACh provocation. MB was identified on coronary angiography as a milking effect. Total bridged length and maximum percent systolic compression of MB in the LAD were analyzed quantitatively.nnnRESULTSnMBs in the LAD were identified in 140 patients (36%), mostly in the mid segment. Patients with MB in the LAD had greater number of provoked vasospasm in the LAD and positive ACh provocation test compared to those without. The bridged length positively correlated with percent systolic compression of MB (r=0.37, p<0.001). In the receiver operating characteristic curve analysis, both bridged length and percent systolic compression of MB significantly predicted the provoked LAD spasm (AUC 0.74, p<0.001, and AUC 0.68, p<0.001). Multivariate regression analysis demonstrated these factors as independent predictors for provoked LAD spasm.nnnCONCLUSIONnMB, especially morphologically severe MB, may induce greater coronary vasospasm.

Feasibility of omitting provocation test with 50 μg of acetylcholine in left coronary artery.

According to the Japanese Circulation Society guideline of vasospastic angina, incremental doses of acetylcholine (ACh) are prescribed for coronary spasm provocation: 20 and 50xa0μg for the right coronary artery (RCA), and 20, 50 and 100xa0μg for the left coronary artery (LCA). However, provocation by low doses of ACh in patients with low vasoreactivity may be less needed, and the requirement of 50xa0μg of ACh for the LCA in these patients has not been evaluated. In the present study, patients who underwent ACh provocation test for both the RCA and LCA were included. The positive diagnosis of intracoronary ACh provocation test was defined as total or subtotal coronary artery narrowing (i.e., angiographic coronary artery spasm) accompanied by chest pain and/or ischemic electrocardiographic changes. Coronary artery constriction was visually evaluated and defined as coronary artery diameter reduction <25 or 25–90% in patients without angiographic coronary artery spasm by 20xa0µg of ACh in the LCA. There were 33 out of 249 patients (13%) with LCA spasm by 20xa0µg of ACh. In subjects without LCA spasm by 20xa0µg of ACh, patients with coronary constriction <25% (nxa0=xa0101) by 20xa0µg of ACh in the LCA rarely showed coronary artery spasm induced by 50xa0μg of ACh in the LCA, in comparison to those with coronary constriction 25–90% (nxa0=xa0115) (2.6 vs. 32.7%, pxa0<xa00.001). None of the patients with coronary constriction <25% by 20xa0µg of ACh in the LCA had cardiac complications associated with administration of ACh. In conclusion, omission of 50xa0µg of ACh in the LCA may be possible when there is little coronary artery constriction by 20xa0µg of ACh in the LCA during provocation test, leading to less contrast and shortens overall procedure time.

Multisector-reconstruction in 1st generation 320-slice CT at high pulsation-rates achieved accurate-evaluation of coronary-lumen patency after insertion of a XIENCE stent. XIENCE Phantom Study Part 4.

Multisector-reconstruction in 1st generation 320-slice CT at high pulsation-rates achieved accurate-evaluation of coronary-lumen patency after insertion of a XIENCE stent. XIENCE Phantom Study Part 4 Nobusada Funabashi ⁎, Yasuaki Namihira , Ryosuke Irie , Yoshihide Fujimoto , Toshihiro Shoji , Hiroyuki Takaoka , Hironori Kondo , Kanako Atou , Joji Ota , Yoshitada Masuda , Takashi Uno , Yoshio Kobayashi a

Safety and usefulness of acetylcholine provocation test in patients with no culprit lesions on emergency coronary angiography

BACKGROUNDnVasospastic angina (VSA), which often causes acute coronary syndrome (ACS), can be diagnosed by intracoronary acetylcholine (ACh) provocation test. However, the safety and usefulness of ACh provocation test in ACS patients on emergency coronary angiography (CAG) compared to non-emergency settings are unclear.nnnMETHODSnA total of 529 patients undergoing ACh provocation test during emergency or non-emergency CAG were included. Patients with resuscitated cardiac arrest were excluded. The primary endpoint was adverse events defined as a composite of death, ventricular fibrillation or sustained ventricular tachycardia, myocardial infarction, cardiogenic shock, cardiac tamponade, and stroke within 24u202fh after ACh provocation test.nnnRESULTSnThere were no significant differences of the clinical characteristics between the groups of emergency (nu202f=u202f84) and non-emergency (nu202f=u202f445) ACh provocation test. The rate of positive ACh provocation test was similar between the 2 groups (50% vs. 49%, pu202f=u202f0.81). Similarly, the incidence of adverse events in patients with emergency and non-emergency ACh provocation test did not significantly differ (1.2% vs. 1.3%, pu202f=u202f1.00).nnnCONCLUSIONnACh provocation test can be safely performed in ACS patients with no obstructive culprit lesions on emergency CAG, and may be useful to diagnose VSA in those patients.