Faculty Profiles - NAKAGAWA Kouji

Papers - NAKAGAWA Kouji

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Gore Cardioform ASD Occluderを用いた経皮的心房中隔欠損閉鎖術の初期成績

古田めぐみ, 赤木禎治, 三木崇史, 西原大裕, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本心臓病学会学術集会抄録 70回 O - 3 2022.9

ブレイン・ハートチームで挑む脳卒中予防・治療戦略地域で築くブレイン・ハートネットワーク PFOに起因する奇異性脳塞栓患者を的確に診断し治療に導く方策は?

三木崇史, 赤木禎治, 西原大裕, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩, 木村舞

日本心臓病学会学術集会抄録 70回 S13 - 2 2022.9

Overview of the 86th Annual Scientific Meeting of the Japanese Circulation Society - Cardiology Spreading Its Wings.

Kazufumi Nakamura, Toru Miyoshi, Satoshi Akagi, Norihisa Toh, Yukihiro Saito, Yoichi Takaya, Masatoki Yoshida, Koji Nakagawa, Satoshi Kawada, Hironobu Toda, Takashi Miki, Rie Nakayama, Fumi Yokohama, Keishi Ichikawa, Masashi Yoshida, Makiko Taniyama, Nobuhiro Nishii, Teiji Akagi, Hiroshi Morita, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 86 ( 8 ) 1312 - 1318 2022.7

Language：English Publishing type：Research paper (scientific journal)

The 86thAnnual Scientific Meeting of the Japanese Circulation Society was held in a web-based format on March 11-13, 2022. In accordance with the internationalization policy of the JCS, the meeting was held with the Asian Pacific Society of Cardiology Congress 2022. The main theme was "Cardiology Spreading its Wings". The number of patients with heart failure and other cardiovascular diseases is increasing dramatically, and the fields dealt with by cardiovascular medicine are also greatly expanding. This conference was both intellectually satisfying and exciting for all participants, who numbered over 14,900. The meeting was completed with great success, and the enormous amount of cooperation and support from all involved was greatly appreciated.

DOI： 10.1253/circj.CJ-22-0349

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Amplatzer PFO Occluderを使用した経カテーテル卵円孔開存閉鎖術の初期成績

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 30回 [MO397] - [MO397] 2022.7

心臓CTによる卵円孔開存の診断能についての検討

三木崇史, 中川晃志, 市川啓之, 水野智文, 中山理絵, 川田哲史, 高谷陽一, 宮本真和, 三好亨, 赤木禎治, 伊藤浩

日本心血管インターベンション治療学会抄録集 30回 [MO267] - [MO267] 2022.7

Gore Cardioform ASD Occluderを用いた心房中隔欠損症のカテーテル閉鎖術経食道エコーによるダブル4ポイント評価法

赤木禎治, 三木崇史, 高谷陽一, 中山理絵, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 30回 [MO398] - [MO398] 2022.7

Intermittent orthodromic capture of the earliest activation site during atrial pacing in a case with reentrant atrial tachycardia originating from the atrioventricular node vicinity.

Akira Ueoka, Satoshi Nagase, Koji Nakagawa, Hiroshi Morita, Hiroshi Ito

Journal of arrhythmia 38 ( 3 ) 473 - 477 2022.6

Language：English Publishing type：Research paper (scientific journal)

Constant pacing (S1-S1: 520 ms) from the right atrial appendage (RAA) during reentrant atrial tachycardia originating from the atrioventricular node vicinity. RA-FW 1-2 was constantly captured antidromically. However, the earliest atrial activation site (EAAS = His1-2) was orthodromically (red circle) and antidromically (blue square) captured at a ratio of 3:1. The electrogram morphology at the EAAS was different between orthodromically and antidromically electrograms captured during pacing. Moreover, the interval between the S1 and orthodromically captured electrogram was gradually prolonged.

DOI： 10.1002/joa3.12702

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Ablation for unmappable ventricular tachycardia in a patient with complete transposition of the great arteries who underwent Rastelli repair.

Takashi Nishimoto, Nobuhiro Nishii, Saori Asada, Koji Nakagawa, Hiroshi Morita, Hiroshi Ito

Journal of cardiology cases 25 ( 4 ) 218 - 224 2022.4

Language：English

Catheter ablation (CA) of ventricular tachycardia (VT) after repair of congenital heart disease may be difficult because of complex anatomy and sometimes unmappable VT. Here, we report a 41-year-old woman with successful CA of unmappable VT in a patient with complete transposition of the great arteries after Rastelli repair. Clinical VT was induced by programmed electrical stimulation, when the mapping catheter was placed at the high anterior right ventricular outflow tract (RVOT). During VT, the local potential at the high anterior RVOT under the right ventricle (RV) - pulmonary artery (PA) conduit was equal to that at the timing of onset of QRS. The VT was unmappable because the hemodynamics deteriorated. Pace mapping was also tried at the aortic cusp and the left ventricular outflow tract (LVOT). Fractionated potential during sinus rhythm was observed at the noncoronary cusp, and the paced QRS morphology at this site was similar to that of the clinical VT, with a delay of 55 ms from pacing to the onset of QRS. However, mapping at the LVOT was impossible due to the difficulty of catheter manipulation. Radiofrequency energy was successfully applied at the noncoronary cusp and the high anterior RVOT under the RV-PA conduit. <Learning objective: This report is a rare case of successful catheter ablation of unmappable ventricular tachycardia (VT) in a patient with complete transposition of the great arteries after Rastelli repair. The VT was unmappable because of intolerable hemodynamics. However, we could speculate the exit or isthmus of the VT by pace mapping or local potential and eliminate the VT.>.

DOI： 10.1016/j.jccase.2021.09.012

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奇異性脳塞栓症患者における卵円孔開存(PFO)形態について年齢や心形態による検討

中山理絵, 高谷陽一, 赤木禎治, 三木崇史, 横濱ふみ, 中川晃志, 杜徳尚, 伊藤浩

超音波医学 49 ( Suppl. ) S700 - S700 2022.4

潜因性脳梗塞の再発予防を目指した経皮的卵円孔開存閉鎖術の初期経験患者プロファイルと手術成績(Initial Experiences of Transcatheter Patent Foramen Ovale Closure for Prevention of Recurrent Cryptogenic Stroke: Patient's Profile and Procedure Outcome)

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本循環器学会学術集会抄録集 86回 PJ23 - 4 2022.3

Impact of Transvenous Pacing Leads on Systemic Thromboemboli in patients with Intracardiac Shunts

中島充貴, 杜徳尚, 西井伸洋, 高谷陽一, 川田哲史, 中川晃志, 森田宏, 赤木禎治, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 11 ( 1 ) 197 - 197 2022.1

Outcomes and complications after transcatheter device closure for patent foramen ovale: a single-center experience

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 11 ( 1 ) 253 - 253 2022.1

Left atrial appendage morphology with the progression of atrial fibrillation. International journal

Yoichi Takaya, Rie Nakayama, Fumi Yokohama, Norihisa Toh, Koji Nakagawa, Masakazu Miyamoto, Hiroshi Ito

PloS one 17 ( 11 ) e0278172 2022

Language：English Publishing type：Research paper (scientific journal)

Left atrial appendage (LAA) size is crucial for determining the indication of transcatheter LAA closure. The aim of this study was to evaluate the differences in LAA morphology according to the types of atrial fibrillation (AF). A total of 299 patients (mean age: 67 ± 13 years) who underwent transesophageal echocardiography (TEE) were included. Patients were classified into non-AF (n = 64), paroxysmal AF (n = 86), persistent AF (n = 87), or long-standing persistent AF (n = 62). LAA morphology, including LAA ostial diameter and depth, was assessed using TEE. Patients with long-standing persistent AF had larger LAA ostial diameter and depth and lower LAA flow velocity. The maximum LAA ostial diameter was 19 ± 4 mm in patients with non-AF, 21 ± 4 mm in patients with paroxysmal AF, 23 ± 5 mm in patients with persistent AF, and 26 ± 5 mm in patients with long-standing persistent AF. LAA ostial diameter was increased by 2 or 3 mm with the progression of AF. LAA ostial diameter was correlated with LA volume index (R = 0.37, P < 0.01) and the duration of continuous AF (R = 0.30, P < 0.01), but not with age or the period from the onset of AF. In conclusion, LAA size was increased with the progression of AF.

DOI： 10.1371/journal.pone.0278172

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Fragmented QRS as a predictor of cardiac events in patients with cardiac sarcoidosis. International journal

Soichiro Ogura, Kazufumi Nakamura, Hiroshi Morita, Koji Nakagawa, Nobuhiro Nishii, Satoshi Akagi, Norihisa Toh, Yoichi Takaya, Masashi Yoshida, Toru Miyoshi, Atsuyuki Watanabe, Hiroshi Ito

Journal of cardiology 79 ( 3 ) 446 - 452 2021.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Multiple spikes within the QRS complex, known as fragmented QRS (fQRS), are associated with the occurrences of ventricular arrhythmic events (VAEs) in patients with Brugada syndrome and hypertrophic cardiomyopathy. However, the association between fQRS and occurrence of VAEs in patients with cardiac sarcoidosis (CS) has not been elucidated. METHODS: We evaluated the associations between fQRS and cardiac events including VAEs [non-sustained ventricular tachycardia (NSVT), sustained ventricular tachycardia (VT), and ventricular fibrillation (VF)], hospitalization for heart failure, and all-cause death in 68 patients with CS (30 patients with fQRS vs. 38 patients without fQRS) over a 5-year period. RESULTS: Cardiac events occurred in 22 patients with fQRS and 18 patients without fQRS (73% vs. 47%, p=0.009). Of the cardiac events that occurred in CS patients, VAEs occurred more frequently in patients with fQRS than in patients without fQRS (VAEs: 70% vs. 45%, p=0.017; NSVT: 70% vs. 45%, p=0.010; VT: 43% vs. 18%, p=0.011, and VF: 6.7% vs. 2.6%, p=0.34), whereas there was no significant difference in hospitalization for heart failure or all-cause death between patients with and those without fQRS (hospitalization for heart failure: 6.7% vs. 5.3%, p=0.75; all-cause death: 6.7% vs. 5.3%, p=0.64). Multivariate analysis showed that fQRS in the baseline electrocardiogram was independently associated with VAEs (hazard ratio: 2.21, 95% confidence interval: 1.15-4.25, p=0.017). CONCLUSION: fQRS is a predictor of VAEs in patients with CS.

DOI： 10.1016/j.jjcc.2021.10.022

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Importance of direct right-to-left shunt as high-risk patent foramen ovale associated with cryptogenic stroke. International journal

Yoichi Takaya, Rie Nakayama, Teiji Akagi, Fumi Yokohama, Takashi Miki, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

Echocardiography (Mount Kisco, N.Y.) 38 ( 11 ) 1887 - 1892 2021.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Because transcatheter closure of patent foramen ovale (PFO) has become effective for preventing cryptogenic stroke (CS), it is necessary to determine high-risk PFO associated with CS. This study aimed to clarify the importance of direct right-to-left (RL) shunt through the PFO for identifying high-risk PFO. METHODS: We analyzed 137 patients with and without CS who were confirmed to have PFO. The timing of RL shunt through the PFO was evaluated by cardiac cycles after right atrium (RA) opacification on saline contrast transesophageal echocardiography. Direct RL shunt was defined as microbubbles crossing the PFO before and at the same time of RA opacification. RESULTS: Cardiac cycles of microbubbles crossing the PFO were shorter in patients with CS than in those without CS (2.0 ± 2.2 vs .5 ± 1.1, p < 0.01). Direct RL shunt was more frequently observed in patients with CS than in those without CS (77% vs 29%, p < 0.01), with a sensitivity of 79% and a specificity of 71% for the association with CS. Multivariate analysis revealed that direct RL shunt was related to atrial septal aneurysm and low-angle PFO. Regarding functional features of PFO, the detection rate of CS was 50% for large RL shunt alone, and was increased to 83% when direct RL shunt was added. CONCLUSION: Direct RL shunt was associated with CS and had the incremental value in detecting PFO associated with CS for large RL shunt. The timing of RL shunt can be valuable for identifying high-risk PFO.

DOI： 10.1111/echo.15234

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Successful ablation of a superior fast-slow atrioventricular reentrant tachycardia in a patient with congenitally corrected transposition of great arteries. International journal

Satoshi Kawada, Nobuhiro Nishii, Saori Asada, Koji Nakagawa, Hiroshi Morita, Hiroshi Ito

HeartRhythm case reports 7 ( 10 ) 698 - 701 2021.10

Importance of saline contrast transthoracic echocardiography for evaluating large right-to-left shunt in patent foramen ovale associated with cryptogenic stroke. International journal

Yoichi Takaya, Rie Nakayama, Teiji Akagi, Fumi Yokohama, Takashi Miki, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

The international journal of cardiovascular imaging 38 ( 3 ) 515 - 520 2021.9

Language：English Publishing type：Research paper (scientific journal)

Transcatheter closure of patent foramen ovale (PFO) is an effective therapy for preventing recurrent stroke in very specific patient cohorts, such as cryptogenic stroke (CS). The identification of high-risk PFO, which is more likely to be linked to CS, is essential. This study aimed to assess the accuracy of saline contrast transthoracic echocardiography (TTE) for evaluating large right-to-left (RL) shunt. We enrolled 119 patients with or without CS who were confirmed to have PFO by transesophageal echocardiography (TEE) or catheterization. The severity of RL shunt evaluated by TTE and TEE was classified as follows: small (< 10 microbubbles), moderate (10-20 microbubbles), and large (> 20 microbubbles). With TTE, large RL shunt was observed in 94 (79%) of 119 patients, including 66 of 74 with CS and 28 of 45 without CS. With TEE, large RL shunt was observed in 33 (28 %) patients, including 26 with CS and 7 without CS. TTE showed large RL shunt more frequently than TEE (p < 0.01). Large RL shunt evaluated by TTE had a sensitivity of 89 % and an accuracy of 70 % for the association with CS, whereas large RL shunt evaluated by TEE had a sensitivity of 35% and an accuracy of 56 %. Accuracy was significantly greater in TTE than in TEE (p = 0.02). In conclusion, TTE identified large RL shunt associated with CS with higher sensitivity and accuracy compared to TEE. Our findings suggest that the decision for device closure should be made based on the severity of RL shunt by TTE.

DOI： 10.1007/s10554-021-02418-6

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Pathological and clinical effects of interleukin-6 on human myocarditis. International journal

Naofumi Amioka, Kazufumi Nakamura, Tomonari Kimura, Keiko Ohta-Ogo, Takehiro Tanaka, Tomohiro Toji, Satoshi Akagi, Koji Nakagawa, Norihisa Toh, Masashi Yoshida, Toru Miyoshi, Nobuhiro Nishii, Atsuyuki Watanabe, Ryotaro Asano, Takeshi Ogo, Yoshikazu Nakaoka, Hiroshi Morita, Hiroyuki Yanai, Hiroshi Ito

Journal of cardiology 78 ( 2 ) 157 - 165 2021.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Numerous basic studies have shown a relationship between interleukin-6 (IL-6) and the development or severity of myocarditis. However, there has been no study in which the effect of IL-6 levels in patients with myocarditis was evaluated. METHODS: We enrolled control patients (n = 12) and consecutive patients with acute myocarditis (n = 13), including lymphocytic, eosinophilic, and giant cell myocarditis, and investigated the pathological and clinical effects of IL-6 on human myocarditis. RESULTS: The serum IL-6 level in patients with myocarditis (16.7 [9.9, 103.8] pg/mL) was significantly higher than that in the control patients (1.4 [1.0, 1.9] pg/mL) (P<0.001). Immunohistochemical analysis showed that IL-6 was expressed in infiltrating inflammatory cells of endomyocardial biopsy samples from all patients with myocarditis. Moreover, the log-transformed value of serum IL-6 level showed significant positive correlations with serum creatine kinase (CK) level, CK-MB level, peak CK level, peak CK-MB level and C-reactive protein level (all P ≤ 0.005) and a negative correlation with the left ventricular (LV) ejection fraction (p = 0.014). We divided the patients with myocarditis into a low IL-6 group (9.9 [4.5, 14.2] pg/dL, n = 7) and a high IL-6 group (108.9 [51.1, 130.9] pg/dL, n = 6). The degree of infiltration of IL-6-expressing inflammatory cells in myocardial samples obtained from patients in the high IL-6 group was significantly more severe than that in samples obtained from patients in the low IL-6 group. Furthermore, patients in the high IL-6 group significantly more frequently received catecholamine therapy (P = 0.005), venoarterial extracorporeal membrane oxygenation (P = 0.029), and artificial respirator support (P = 0.021) in the acute phase of myocarditis. CONCLUSION: The results suggest that there is a strong impact of IL-6 on cardiac injury and dysfunction in patients with myocarditis.

DOI： 10.1016/j.jjcc.2021.03.003

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An Evaluation of the Safety and Feasibility of Adenosine-assisted Clipping Surgery for Unruptured Cerebral Aneurysms: Study Protocol.

Tomohito Hishikawa, Satoshi Murai, Masafumi Hiramatsu, Jun Haruma, Kazuhiko Nishi, Yuki Ebisudani, Yu Sato, Takao Yasuhara, Kenji Sugiu, Kazuyoshi Shimizu, Motomu Kobayashi, Koji Nakagawa, Aya Kimura-Ono, Katsuyuki Hotta, Hiroshi Morimatsu, Isao Date

Neurologia medico-chirurgica 61 ( 7 ) 393 - 396 2021.7

Language：English Publishing type：Research paper (scientific journal)

The effectiveness of adenosine-induced flow arrest in surgical clipping for the cerebral aneurysms with difficulties in temporary clip placement to the proximal main trunk has been reported. This is the first clinical trial to evaluate the safety and feasibility of adenosine-assisted clipping surgery for unruptured cerebral aneurysms (UCAs) in Japan. The inclusion criteria are as follows: patients over 20 years old, patients who agree to be enrolled in this study after providing informed consent, patients who undergo clipping surgery for UCA in our institute, and patients in whom the surgeons (T.H. or I.D.) judge that decompression of the aneurysm is effective. The primary endpoint is a modified Rankin Scale (mRS) score 30 days after surgery. We plan to enroll 10 patients in this study. The original protocol of adenosine administration was established in this trial. Herein, we present the study protocol.

DOI： 10.2176/nmc.st.2021-0018

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Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension. International journal

Yoichi Takaya, Teiji Akagi, Ichiro Sakamoto, Hideaki Kanazawa, Gaku Nakazawa, Tsutomu Murakami, Atsushi Yao, Mamoru Nanasato, Mike Saji, Mitsugu Hirokami, Yasushi Fuku, Shinobu Hosokawa, Norio Tada, Kensuke Matsumoto, Masao Imai, Koji Nakagawa, Hiroshi Ito

Heart (British Cardiac Society) 108 ( 5 ) 382 - 387 2021.6

Language：English

OBJECTIVE: Therapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes. METHODS: We enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH. RESULTS: At baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1-126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure. CONCLUSIONS: The treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.

DOI： 10.1136/heartjnl-2021-319096

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Papers - NAKAGAWA Kouji