Faculty Profiles - NAKAGAWA Kouji

Papers - NAKAGAWA Kouji

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片頭痛のトピックス卵円孔開存に対するカテーテル閉鎖術脳梗塞再発予防と片頭痛に対する有効性

赤木禎治, 高谷陽一, 中川晃志, 高橋義秋

日本頭痛学会誌 43 ( 2 ) 228 - 228 2016.10

Deficient Surrounding Rims in Patients Undergoing Transcatheter Atrial Septal Defect Closure. International journal

Yasufumi Kijima, Teiji Akagi, Yoichi Takaya, Manabu Taniguchi, Koji Nakagawa, Kengo Kusano, Shunji Sano, Hiroshi Ito

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 29 ( 8 ) 768 - 776 2016.8

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

BACKGROUND: The influence of deficient rims surrounding atrial septal defects (ASDs) in patients undergoing transcatheter closure has yet to be clarified. The aim of this study was to assess the influence of a deficient surrounding rim on the procedural success and clinical outcome of transcatheter ASD closure using an Amplatzer septal occluder. METHODS: A total of 474 patients (mean age, 46 ± 22 years) with ostium secundum ASDs measuring ≤40 mm in diameter who had undergone attempted transcatheter closure using Amplatzer septal occluders from September 2007 to August 2013 were assessed. A comprehensive transesophageal echocardiographic examination was done to assess the morphologic characteristics of the defects in all patients. Subjects were classified into three groups by the extent and location of rim deficiency (<5 mm): patients without deficient rims (sufficient group, n = 101), patients with single deficient rims, (single group, n = 338), and patients with multiple rim deficiencies (multiple group, n = 35). RESULTS: There was a significant difference in the maximal defect diameter among the sufficient, single, and multiple groups (15 ± 6, 18 ± 6, and 29 ± 7 mm, respectively, P < .001). Transcatheter closure was successfully accomplished in 463 patients (98%). The prevalence of procedural success differed significantly among the sufficient, single, and multiple groups (100%, 98%, and 86%, respectively, P < .001). There was no significant difference in the occurrence of cardiovascular events among the three groups during a mean follow-up period of 25 ± 19 months (P = .926, log-rank test). CONCLUSIONS: In patients with ASDs with multiple rim deficiencies as determined by transesophageal echocardiography, successful transcatheter ASD closure using Amplatzer septal occluders is more difficult to accomplish. However, if closure is successful, rim deficiencies rarely affect intermediate-term outcomes.

DOI： 10.1016/j.echo.2016.04.010

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Activation Pattern of the Polymorphic Ventricular Tachycardia and Ventricular Fibrillation on Body Surface Mapping in Patients With Brugada Syndrome.

Akira Ueoka, Hiroshi Morita, Atsuyuki Watanabe, Koji Nakagawa, Nobuhiro Nishii, Satoshi Nagase, Tohru Ohe, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 80 ( 8 ) 1734 - 43 2016.7

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

BACKGROUND: Clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract (RVOT) in patients with Brugada syndrome (BrS). To evaluate the importance of the RVOT, we evaluated the activation pattern of induced ventricular tachyarrhythmias using body surface mapping (BSM) in patients with BrS. METHODS AND RESULTS: We examined 14 patients with BrS in whom ventricular tachyarrhythmias were induced by programmed electrical stimulation. The 87-lead BSM was recorded during induced ventricular tachyarrhythmias, and an activation map and an isopotential map of QRS complexes every 5 ms were constructed to evaluate the activation pattern of ventricular tachyarrhythmias. BSM during 20 episodes of ventricular tachyarrhythmias induced at the RVOT showed that repetitive excitation was generated at the RVOT and propagated to the inferior RV and left ventricle, and then returned to the RVOT. Polymorphic QRS change during ventricular tachyarrhythmias was associated with migration of the earliest activation site and rotor. BSM during 4 episodes of ventricular fibrillation (VF) showed that the excitation front moved randomly with formation of multiple wavefronts. CONCLUSIONS: Programmed stimulation initiated repetitive firing from the RVOT. Migration and competition of the earliest activation site and rotor and local conduction delay changed the QRS morphology. Degeneration of the reentrant circuit into multiple wavefronts resulted in VF. (Circ J 2016; 80: 1734-1743).

DOI： 10.1253/circj.CJ-16-0124

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小児インターベンション心臓病学の近年の進歩研究からカテーテルラボへ術前に心房細動または動悸が認められなかった40歳以上の患者におけるASD閉鎖手術後の新規心房細動の発症率と危険因子治療器具と手術による治療の比較(Incidence and risk factors of newly developed atrial fibrillation after ASD closure in patients older than 40 years without history of preoperative atrial fibrillation or flutter: device vs surgery)

藤井泰宏, 赤木禎治, 黒子洋介, 小谷恭弘, 新井禎彦, 笠原真悟, 中川晃志, 木島康文, 高谷陽一, 伊藤浩, 佐野俊二

日本小児循環器学会雑誌 32 ( Suppl.1 ) s1 - 104 2016.7

Structural Heart Disease: Current and Future 我が国における経皮的卵円孔閉鎖術の臨床的意義

赤木禎治, 高谷陽一, 麻植浩樹, 中川晃志, 伊藤浩, 佐野俊二

日本心血管インターベンション治療学会抄録集 25回 S03 - 2 2016.7

成人ASD患者における右左短絡に関する検討

中川晃志, 赤木禎治, 高谷陽一, 木島康文, 麻植浩樹, 西井伸洋, 中村一文, 伊藤浩

日本心血管インターベンション治療学会抄録集 25回 MO379 - MO379 2016.7

3D Echo-X-Ray Navigation Systemガイド下で施行したASDカテーテル閉鎖術

高谷陽一, 赤木禎治, 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 25回 MP170 - MP170 2016.7

Integrated 3D Echo-X-Ray Navigation Guided Transcatheter Closure of Complex Multiple Atrial Septal Defects. International journal

Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Hiroshi Ito

JACC. Cardiovascular interventions 9 ( 12 ) e111-e112 2016.6

Treat and Repair Strategy in Patients With Atrial Septal Defect and Significant Pulmonary Arterial Hypertension.

Yasufumi Kijima, Teiji Akagi, Yoichi Takaya, Satoshi Akagi, Koji Nakagawa, Kengo Kusano, Shunji Sano, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 80 ( 1 ) 227 - 34 2016

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

BACKGROUND: A therapeutic strategy in patients with atrial septal defect (ASD) and significant pulmonary arterial hypertension (PAH) remains controversial. This study aimed to assess the effect of PAH-specific medications and subsequent transcatheter shunt closure (ie, a treat and repair strategy) in these patients. METHODS AND RESULTS: Among 646 patients with ASD, 22 patients (mean age of 56±20 years) who had PAH [mean pulmonary artery pressure ≥25 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood units] underwent successful transcatheter ASD closure. Prior to the procedure, 8 patients received PAH-specific medications (PHM group) and 14 patients did not (non-PHM group). Initially, the PHM group had higher PVR compared with non-PHM group (9.6±3.8 vs. 4.2±1.0 Wood units, P<0.01). After treatment with PAH-specific medications, PVR in this group decreased to 4.0±0.8 Wood units (P<0.01). No adverse events were observed in either the PHM or non-PHM group during or after the transcatheter procedure. In the PHM group, during a treatment period of 52±48 months, the World Health Organization Functional Classification significantly improved (3.0±0.5 to 2.0±0.0, P<0.01), as well as in the non-PHM group (2.1±0.6 to 1.5±0.5, P<0.01). CONCLUSIONS: Treat and repair strategy provided substantial improvement and no worsening of the WHO-FC, even in patients with ASD and significant PAH. Long-term hemodynamic follow-up is mandatory to evaluate the ultimate efficacy and safety of this new strategy.

DOI： 10.1253/circj.CJ-15-0599

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奇異性脳梗塞既往者の片頭痛に対する経カテーテル心房間短絡閉鎖術の効果

赤木禎治, 高谷陽一, 麻植浩樹, 中川晃志, 出口健太郎, 高橋義秋, 阿部康二, 伊藤浩, 佐野俊二

日本頭痛学会誌 42 ( 2 ) 120 - 120 2015.11

Fate of Mitral Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adults. International journal

Yoichi Takaya, Yasufumi Kijima, Teiji Akagi, Koji Nakagawa, Hiroki Oe, Manabu Taniguchi, Shunji Sano, Hiroshi Ito

The American journal of cardiology 116 ( 3 ) 458 - 62 2015.8

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

Although the volume overload of pulmonary circulation improves after atrial septal defect (ASD) closure, the increasing left ventricular preload may contribute to mitral regurgitation (MR) deterioration. We aimed to evaluate the impact of MR after transcatheter ASD closure on clinical outcomes in adults. A total of 288 consecutive patients who underwent transcatheter ASD closure were enrolled. Changes in MR were assessed at 1 month after the procedure. The end point was defined as cardiovascular events. After the procedure, MR ameliorated in 3 patients and unchanged in 253, whereas MR deteriorated in 32. During a median follow-up of 24 months, patients with MR deterioration had no cardiovascular events, and the event-free survival rate was not different between patients with MR deterioration and those with MR amelioration or no-change (p = 0.355). Even in patients with MR deterioration, the New York Heart Association functional class improved after the procedure, with no cases of worsening functional class. Multivariate logistic regression analysis showed that MR deterioration was independently related to advanced age and female gender. The degree of enlargement of mitral valve annulus diameter after the procedure was greater in patients with MR deterioration than in those with MR amelioration or no-change, and it was correlated with the degree of MR deterioration. In conclusion, MR deterioration occurs in a minority of adult patients after transcatheter ASD closure; however, it is not linked with adverse outcomes. MR deterioration may be provoked by geometric changes in mitral valve annulus, especially in women with advanced age.

DOI： 10.1016/j.amjcard.2015.04.042

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Comprehensive assessment of morphology and severity of atrial septal defects in adults by CT

Kazuhiro Osawa, Toru Miyoshi, Yusuke Morimitsu, Teiji Akagi, Hiroki Oe, Koji Nakagawa, Yoichi Takaya, Yasufumi Kijima, Shuhei Sato, Susumu Kanazawa, Hiroshi Ito

Journal of Cardiovascular Computed Tomography 9 ( 4 ) 354 - 361 2015.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier Inc.

Background: Cardiac CT is an excellent tool for evaluating the anatomy of a secundum atrial septal defect (ASD). However, a comprehensive assessment of its usefulness, including measurement of the pulmonary to systemic blood flow ratio in secundum ASD patients, has not been performed. Objective: Therefore, this study was designed to evaluate the usefulness of CT for assessing the hemodynamics of secundum ASD in adults compared with transesophageal echocardiography (TEE), transthoracic echocardiography, and invasive catheterization. Methods: Fifty adult patients with secundum ASD were enrolled. Cardiac CT scans (128-slice multidetector CT instrument) were acquired. These were followed by 2-dimensional reconstruction of the secundum ASDs to determine the defect size, the rim length between the outer edge of the defect, and the pulmonary to systemic blood flow (Qp/Qs) ratio. Results: The maximum sizes of the secundum ASDs derived from CT and TEE studies were comparable (21.2 ± 8.0 vs 20.0 ± 7.3 mm
P = .41
r = 0.960
P &lt
.001). The rim lengths for the aortic, mitral, and tricuspid valves
the inferior vena cava
and posterior atrium were also comparable between CT and TEE measurements. The mean Qp/Qs ratio that was derived from CT measurements was comparable with that found by invasive catheterization (2.3 ± 0.7 vs 2.3 ± 0.8
P = .73
r = 0.786
P &lt
.001). Conclusion: Cardiac CT is feasible for assessing pathology and the severity of secundum ASD in adults.

DOI： 10.1016/j.jcct.2015.04.007

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Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. International journal

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Shunji Sano, Hiroshi Ito

JACC. Cardiovascular interventions 8 ( 4 ) 600 - 6 2015.4

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

OBJECTIVES: This study assessed long-term outcome after transcatheter atrial septal defect (ASD) closure in older patients, especially those older than 75 years of age. BACKGROUND: The clinical benefits of transcatheter ASD closure in this aged population are controversial. METHODS: A total of 244 patients older than 50 years of age were divided into 3 groups according to age at procedure (50 to 59 years: n=69; 60 to 74 years: n=120; 75 years and older: n=55). The primary endpoint was defined as all-cause mortality and hospitalization due to heart failure or stroke. Improvements in functional capacity and cardiac remodeling after the procedure were also assessed. RESULTS: During a median follow-up of 36 months, mortality and hospitalization due to heart failure or stroke occurred in 18 patients (7%). Among patients older than 75 years of age, 2 died of noncardiovascular disease, 2 were hospitalized due to heart failure, and 1 had a stroke. More than 90% of patients older than 75 years of age did not experience these events. Kaplan-Meier analysis showed that the event-free survival rate was not different among the 3 age groups (log-rank test, p=0.780). New York Heart Association functional class and right ventricular/left ventricular end-diastolic diameter ratio improved in patients older than 75 years of age, similar to the other age groups. CONCLUSIONS: Long-term outcome after transcatheter ASD closure in patients older than 75 years of age is similar to that in the other, relatively younger age groups. This suggests that transcatheter ASD closure can be considered a valuable therapeutic option in patients older than 75 years of age.

DOI： 10.1016/j.jcin.2015.02.002

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心臓サルコイドーシスにおける加算平均心電図による心室遅延電位(LP:Late Potential)の特徴

寒川睦子, 森田宏, 中川晃志, 西井伸洋, 永瀬聡, 中村一文, 河野晋久, 伊藤浩, 草野研吾, 大江透

心電図 35 ( Suppl.1 ) S - 23 2015.3

心房中隔欠損症患者における心房細動カテーテルアブレーション後の欠損孔の変化(Reduction of defect diameters after the catheter ablation for atrial fibrillation in patients with atrial septal defect)

中川晃志, 赤木禎治, 永瀬聡, 高谷陽一, 西井伸洋, 中村一文, 森田宏, 伊藤浩

日本成人先天性心疾患学会雑誌 4 ( 1 ) 118 - 118 2015.1

Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block.

Tadashi Wada, Satoshi Nagase, Hiroshi Morita, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Kunihisa Kohno, Hiroshi Ito, Kengo F Kusano, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 79 ( 12 ) 2568 - 75 2015

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

BACKGROUND: Brugada syndrome (BrS)-type electrocardiogram (ECG) is concealed by complete right bundle-branch block (CRBBB) in some cases of BrS. Clinical significance of BrS masked by CRBBB is not well known. METHODS AND RESULTS: We reviewed an ECG database of 326 BrS patients who had type 1 ECG with or without pilsicainide. "BrS masked by CRBBB" was defined on ECG as <2-mm elevation of the J point at the time of CRBBB in the right precordial leads, and BrS-type J-point elevation ≥2 mm at the time of normalized QRS complex on relieved CRBBB. We identified 25 BrS patients (7.7%) with persistent (n=12) or intermittent CRBBB (n=13). Relief of CRBBB by pacing was performed in patients with persistent CRBBB. The prevalence of BrS masked by CRBBB was 3.1% (10/326 patients). Three patients had type 1 ECG, and 7 patients had type 2 or 3 ECG on relief of CRBBB. Two of these 10 patients had lethal arrhythmic events during the follow-up period (mean, 86.4±57.2 months). There was no prognostic difference between BrS masked by CRBBB and other BrS. CONCLUSIONS: In a small BrS population, CRBBB can completely mask typical BrS-type ECG. BrS masked by CRBBB is associated with the same risk of fatal ventricular tachyarrhythmia as other BrS.

DOI： 10.1253/circj.CJ-15-0618

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A case of cardiac amyloidosis with ventricular flutter of first symptom

Ono Tamaki, Morita Hiroshi, Kimura Tomonari, Tokioka Koji, Nakagawa Koji, Nishii Nobuhiro, Nagase Satoshi, Nakamura Kazuhumi, Ito Hiroshi, Tanaka Takehiro, Yanai Hiroyuki, Ando Midori, Yutani Chikao

Shinzo 47 ( 1 ) S1_33 - S1_37 2015

Three-dimensional echocardiography guided closure of complex multiple atrial septal defects. International journal

Yasufumi Kijima, Teiji Akagi, Koji Nakagawa, Yoichi Takaya, Hiroki Oe, Hiroshi Ito

Echocardiography (Mount Kisco, N.Y.) 31 ( 10 ) E304-6 2014.11

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

Transcatheter closure of complex multiple atrial septal defects (ASDs) remains a challenge. We describe our clinical experience with staged device deployment in a patient with multiple ASDs using four Amplatzer septal occluder devices. Three-dimensional transesophageal echocardiography imaging contributed not only to the therapeutic guidance of successful device deployment but also to the decision making for the staged device delivery approach in a case of morphologically complex multiple ASDs.

DOI： 10.1111/echo.12731

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Transcatheter closure of right-to-left atrial shunt in patients with platypnea-orthodeoxia syndrome associated with aortic elongation.

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Manabu Taniguchi, Hayato Ohtani, Shunji Sano, Hiroshi Ito

Cardiovascular intervention and therapeutics 29 ( 3 ) 221 - 5 2014.7

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

Platypnea-orthodeoxia is a rare condition characterized by dyspnea and oxygen desaturation induced by the upright position and relieved by recumbency. The most common cause of this syndrome is right-to-left shunt through interatrial communications such as patent foramen ovale (PFO) or atrial septal defect (ASD). In addition, this syndrome can be caused by other extracardiac components, including pulmonary emphysema, pericardial disease, and prominent Eustachian valve. We experienced 3 cases of this syndrome, including 1 patient with PFO and 2 patients with ASD. Computer tomography imaging revealed aortic elongation and compression of the right atrium by ascending aorta in all of 3 patients. Transcatheter closure of PFO or ASD was successfully performed in all patients, including immediate improvements of symptoms and oxygen saturation without any complications.

DOI： 10.1007/s12928-014-0244-x

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左室側壁心外膜側に不整脈基質が存在すると考えられたJ波症候群の1例

中川晃志, 永瀬聡, 和田匡史, 田中正道, 西井伸洋, 寒川睦子, 河野晋久, 中村一文, 森田宏, 草野研吾, 伊藤浩, 湯本晃久, 向原直木, 大江透

臨床心臓電気生理 37 127 - 135 2014.5

Language：Japanese Publisher：臨床心臓電気生理研究会

症例は52歳、男性。以前より心電図にて早期再分極が認められていた。心室細動自然発作を来たしたため、当院入院。心電図ではI、II、aVl、aVf、V4-6にJ波を認めた。心臓電気生理学的検査において、多極カテーテルにて経冠静脈的に左室側壁心外膜側の電位を記録すると、単極および双極誘導において体表面心電図のJ波に相当する成分が記録され、この成分は心房頻回刺激およびisoproterenolにて減高し、pilsicainideにて増強を示した。一方、前室間静脈、中心静脈、左室側壁心内膜側からの記録ではJ波に相当する成分は記録されず、また心室プログラム刺激にて心室細動は右室心尖部、右室流出路、左室心内膜側からは誘発されず、左室側壁心外膜側からのみ誘発された。Pilsicainide投与後は左室心外膜側起源と思われる期外収縮が散発し、Brugada型波形は出現しなかった。本例はJ波症候群Type 1+2と考えられ、左室側壁心外膜側の電気的異常が病態の成因に関与することが示唆された興味深い1例と考えられたので報告する。(著者抄録)

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Papers - NAKAGAWA Kouji