Yoshitaka Muraoka

Association of seasonal variation in the prevalence of metabolic syndrome with insulin resistance

The aim of this study was to examine the hypothesis that seasonal variation in the prevalence of metabolic syndrome (MetS) is associated with increased insulin resistance. Among 840 Japanese male workers who were evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR) in June (summer) 2010, we prospectively studied a total of 758 subjects (40–65 years of age) who underwent an assessment in December (winter) 2010. MetS was defined according to the criteria proposed by the International Diabetes Federation (IDF) and the Japanese Society of Internal Medicine (JSIM). The median level of HOMA-IR in the study subjects was 0.84 (interquartile range: 0.60–1.19). The prevalence rates of IDF- and JSIM-MetS significantly increased from 12.4 and 9.6% in the summer to 16.6 and 13.3% in the winter, respectively (each P<0.05). Our data suggest that these increases are mainly due to increases in blood pressure (BP) and glucose during the winter assessment. The prevalence rates of IDF-MetS in the first, second, third and fourth quartiles of HOMA-IR were 1.1, 5.8, 14.3 and 29.1% in the summer and 3.1, 10.6, 21.9, and 31.3% in the winter, respectively. Similar results were obtained when using the JSIM criteria. In the third quartile, the frequency of elevated BP increased from 42.4% in the summer to 61.2% in the winter (P<0.05), and these values were mainly correlated with significant variations in IDF- and JSIM-MetS prevalence rates. This study demonstrates that seasonal variation in MetS prevalence is associated with mildly to moderately increased insulin resistance in middle-aged Japanese men.

Contribution of Poststent Irregular Protrusion to Subsequent In-Stent Neoatherosclerosis after the Second-Generation Drug-Eluting Stent Implantation: Optical Coherence Tomography Study

Previous optical coherence tomography (OCT) study reported that irregular protrusion (IP) post drug-eluting stent (DES) implantation was an independent predictor of clinical outcome; however, the relationship between IP and the presence of subsequent in-stent neoatherosclerosis remains unclear. This study aimed to assess the relationship between IP and in-stent neoatheroscrerosis formation using OCT. We evaluated 83 patients (101 lesions) who underwent second-generation DES implantation and 8-month follow-up (8M-FU) using OCT. Lesions were divided into two groups in presence of IP (IP: n = 43, non-IP: n = 58). At prepercutaneous coronary intervention (pre-PCI), lipid-rich plaque, lesions with positive remodeling, and in-stent thrombus formation were more frequent in IP than in non-IP. On multivariate analysis, the thrombus at pre-PCI and the lesions with positive remodeling were independent predictors of IP. At 8M-FU, heterogeneous neointima, microvessel, lipid-laden neointima, and thin-cap fibro-atheroma like neointima were more frequent in IP than in non-IP (respectively, P < 0.05). On multivariate analysis, IP was associated with heterogeneous neointima. Binary restenosis was more frequent and late lumen loss tended to be larger in IP than in non-IP (19% versus 5%, P = 0.04; 1.25 ± 1.24 mm versus 0.91 ± 0.63 mm, P = 0.09); however, the target lesion revascularization rate was similar in both groups at 8M-FU. In conclusion, our study suggested that poststent IP was associated with subsequent neoatherosclerosis formation at 8M-FU after the second-generation DES implantation.

CORONARY ARTERIAL REMODELING AND PERISTENT PLAQUE CHANGE AFTER DRUG-ELUTING STENT IMPLANTATION – COMPARISON BETWEEN ZOTAROLIMUS-ELUTING STENTS AND PACLITAXEL-ELUTING STENTS -

BACKGROUND Out-stent plaque characteristics and eosinophilic inflammatory response, which correlates with positive remodeling after first-generation drug-eluting stent implantation, may be associated with late restenosis and very late stent thrombosis. The differences of out-stent plaque characteristics were compared between paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES), using integrated backscatter-intravascular ultrasound (IB-IVUS). METHODS AND RESULTS Of 78 patients enrolled, 25 receiving PES and 25 receiving ZES had adequate IVUS assessment. Volumetric IVUS analysis was performed after stenting and at 8-month follow-up. Out-stent plaque change in the stented segment was compared on IB-IVUS. The relationship between systemic inflammatory response and out-stent plaque change was evaluated. In PES, vessel volume significantly increased (365-389 mm(3), P<0.0001), whereas it did not change in ZES (315-314 mm(3), P=0.81). In culprit lesions at baseline in PES, fibrous plaque tended to increase (3.1-3.6mm(2), P=0.051) and lipid plaque significantly increased (4.3-5.1mm(2), P=0.02), whereas in ZES the fibrous plaque significantly increased (2.9-4.0mm(2), P<0.0001) but lipid plaque significantly decreased (5.1-3.6mm(2), P<0.0001). Systemic eosinophil increase was significantly correlated with positive remodeling and out-stent lipid plaque increase. CONCLUSIONS Chronic out-stent plaque change in ZES consisted of less positive remodeling and more favorable effects on out-stent plaque characteristics than PES. Systemic eosinophil change might be a marker of out-stent lipid plaque change.

LONG-TERM PROGNOSIS OF PATIENTS WITH IRREGULAR PROTRUSION AFTER SECOND-GENERATION DRUG-ELUTING STENT IMPLANTATION: OPTICAL COHERENCE TOMOGRAPHY STUDY

Previous optical coherence tomography (OCT) study reported that irregular protrusion (IP) post drug-eluting stent (DES) implantation associated with adverse clinical outcome. However, the relationship between IP, neointimal characteristics at follow-up, and future prognosis is still unknown. We

TCT-561 Long-Term Vascular Response to Permanent Polymer Everolimus-Eluting Stent vs. Biodegradable Polymer Biolimus-Eluting Stent: Five-year Follow-up Optical Coherence Tomography Study

TCT-559 Optical coherence tomography (OCT) guided percutaneous coronary intervention : clinical impact of acute abnormal findings after drug-eluting stent implantation detected only by OCT Seung Hun Lee, Jae Young Cho, Hyung Joon Joo, Jae Hyoung Park, Soonjun Hong, Cheol Woong Yu, Do Sun Lim Anam Hospital, Korea University Medical Center., Seoul, Korea, Republic of; Korea University Cardiovascular center, Seoul, Korea, Republic of; Korea University Anam Hospital, Seoul, Korea, Republic of; Korea University Anam Hospital, Seoul, Korea, Republic of; Korea University College fo Medicine, Seoul, Korea, Republic of; Korean University Anam Hospital, Seoul, Korea, Republic of; Korea University Anam Hospital, Seoul, Korea, Republic of

TCT-565 Fate of irregular protrusion after second-generation drug-eluting stent implantation: Serial optical coherence tomography study.

Previous optical coherence tomography (OCT) study reported that irregular protrusion (IP), defined as protrusion of material with an irregular surface into lumen between stent struts, and small minimal stent area (MSA) at post drug-eluting stent (DES) implantation were independent predictors of 1-

The Correlation between Post-Procedural Plasma Fractalkine and Lipid Plaque Volume in Target Lesion after Coronary Stent Implantation

Several reports suggest that fractalkine (FKN) and its cognate receptor, CX3CR1, play a role in atherogenesis. Recent data showed that plasma FKN is elevated in patients with unstable angina pectoris and is more elevated with patients with plaque rapture. We assessed the hypothesis that plasma FKN might be elevated after stentimplantation and related to the plaque-characteristics. First of all we tested the time course of plasma FKN level 30-min., 3-hour, 6-hour and 12-hour after coronary stenting. Their levels are elevated at 30 min. after percutaneous coronary intervention (PCI) and maintained the level until 12-hour after PCI. Then we examined the plasma levels of FKN, IL-8 and IL-6 in fifty consecutive patients before and 12-hour after coronary stenting following in integrated backscatterintravascular ultrasound (IB-IVUS) analysis. The plasma IL-8 did not change 12-hour after stenting. Those of FKN and IL-6, however, were significantly elevated 12-hour after stenting (FKN: from 656 ± 122 pg/mL to 811 ± 177 pg/ mL, p<0.0001, IL-6: from 3.15 ± 3.42 pg/mL to 16.0 ± 15.0 pg/mL, p<0.0001). In IB-IVUS analysis the lipid volume and volume fraction were correlated with post-procedural FKN level (R2=0.29, p<0.0001; R2=0.22, p<0.0001), while they were not related with post-procedural IL-6 level. In conclusion, a local release of FKN and IL-6 occurs shortly after PCI, which is possibly related to plaque rapture and/or endothelial traumatism following stent-implantation. We have further shown that local release of FKN is evoked proportionally to the volume of the lipid-rich plaques which are prone to be ruptured. These suggested that anti-FKN treatment could be of benefit to decrease the amount of lipid-rich plaque.

Successful coronary intervention for spontaneous coronary dissection in a patient with fibromuscular dysplasia

Spontaneous coronary artery dissection (SCAD) is a reported rare cause of acute coronary syndrome (ACS) and sudden death among middle-aged women. Some institutes have recently reported fibromuscular dysplasia (FMD) concomitant with SCAD. Therefore, a survey of the presence of comorbid FMD in SCAD patients is important to obtain a definitive diagnosis and for the prediction of possible SCAD recurrence. The optimal treatment of ACS due to SCAD remains undetermined, and technical failures are frequently encountered in primary percutaneous coronary intervention (PCI) owing to the unusual non-atherosclerotic cause of the disease. We report a case of SCAD successfully treated with cutting balloon PCI under intravascular ultrasound guidance without stent implantation, in which FMD was detected in the right external iliac artery through screening by noncoronary angiography, not duplex ultrasound. <Learning objective: SCAD is a rare cause of ACS. Intravascular ultrasound is helpful to avoid the technical failures associated with primary percutaneous coronary intervention in the treatment of ACS due to SCAD. FMD has been recently reported to be concomitant with SCAD. Therefore, this report aimed to survey the presence of comorbid FMD in SCAD patients given its important role in obtaining a definitive diagnosis and predicting the possible recurrence of SCAD.>.

A rare case of myocardial infarction related to diagnostic intravascular ultrasound

A 71-year-old man underwent intracoronary stent implantation for acute inferior myocardial infarction (MI). Immediately after diagnostic intravascular ultrasound (IVUS) at 8 months’ follow-up, an acute occlusion of the sinus node (SN) artery appeared, which developed sinus arrest with junctional escape rhythm. The serum level of high-sensitivity troponin T (TpT) was markedly elevated on the day after the procedure (2.1–32.5 ng/l), which was indicative of MI related to IVUS. Under continuous intravenous infusion of unfractionated heparin, the escape rhythm changed to lower atrial rhythm on the 4th day, and recovered to sinus rhythm on the 14th day. Coronary angiography (CAG) on 15th day showed a recanalization of the SN artery, but optical coherence tomography identified that disrupted plaque and white thrombus still existed in the ostium of the SN artery. The patient was discharged on maintenance anticoagulation therapy. We hypothesized from this case that IVUS-related myocardial injury may exist without clinical problems. Our retrospective investigation showed that the median levels of high-sensitivity TpT in 20 patients who underwent CAG and subsequent diagnostic IVUS significantly increased from 0.6 (interquartile range 0.3–1.1) to 1.6 (0.7–3.6) ng/l (P < 0.05), suggesting that IVUS may induce very low levels of myocardial injury. In conclusion, we experienced a rare case of IVUS-related MI caused by an acute occlusion of the SN artery. This case reaffirms that we should pay more attention to manipulation of IVUS catheters.