Faculty Profiles - MIYOSHI Toru

Papers - MIYOSHI Toru

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Coral reef aorta一連の病変と考えられた移植腎動脈狭窄に対する血管内治療の1例 Reviewed

戸田洋伸, 大塚寛昭, 江尻健太郎, 内田治仁, 杜徳尚, 中川晃志, 渡邊敦之, 三好亨, 西井伸洋, 中村一文, 森田宏, 伊藤浩

脈管学 58 ( Suppl. ) S206 - S206 2018.9

Anomalous aortic origin of the right coronary artery with functional ischemia determined with fractional flow reserve derived from computed tomography. International journal

Takashi Miki, Toru Miyoshi, Atsuyuki Watanabe, Kazuhiro Osawa, Naofumi Amioka, Hiroshi Ito

Clinical case reports 6 ( 7 ) 1371 - 1372 2018.7

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

A right coronary artery of anomalous origin is rare congenital anatomy that can be fatal. CT angiography is an excellent tool for its anatomical assessment. Noninvasive CT-based fractional flow reserve measurement can additionally evaluate the functional severity of coronary stenosis and is potentially useful for evaluating coronary anomalies.

DOI： 10.1002/ccr3.1582

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Protective Effect of Remote Ischemic Preconditioning on Myocardial Damage After Percutaneous Coronary Intervention in Stable Angina Patients With Complex Coronary Lesions - Subanalysis of a Randomized Controlled Trial.

Kentaro Ejiri, Toru Miyoshi, Kunihisa Kohno, Makoto Nakahama, Masayuki Doi, Mitsuru Munemasa, Masaaki Murakami, Atsushi Takaishi, Kazufumi Nakamura, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 7 ) 1788 - 1796 2018.6

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

BACKGROUND: The effect of remote ischemic preconditioning (RIPC) on periprocedural myocardial damage (pMD) in patients undergoing percutaneous coronary intervention (PCI) is controversial. The aim of this study was to investigate the effect of RIPC or intravenous nicorandil on pMD following elective PCI in a subgroup of patients with complex coronary lesions from a multicenter randomized controlled trial.Methods and Results:Patients with stable angina who underwent elective PCI were assigned to 3 groups: control, upper-limb RIPC or intravenous nicorandil. The major outcome was pMD incidence following PCI, with pMD defined as an elevated level of high-sensitivity cardiac troponin T or creatine kinase myocardial band at 12 or 24 h after PCI. A total of 171 patients with complex coronary lesions (ACC-AHA coronary classification type B2 or C) were analyzed. The incidence of pMD following PCI was significantly lower in the RIPC group than in the control group (44.4% vs. 66.1%; P=0.023). The adjusted odds ratio (95% confidence interval) for pMD in the RIPC vs. the controls was 0.41 (0.18-0.94). The incidence of pMD in the nicorandil group was not significantly reduced compared with the control groups. CONCLUSIONS: This substudy suggested that RIPC prior to PCI prevented pMD in patients with complex coronary lesions. Further investigation in a multicenter prospective study is needed to confirm these results.

DOI： 10.1253/circj.CJ-17-1000

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Assessment of Second- and Third-Generation Drug-Eluting Stents on Chronic Coronary Angioscopy - Multicenter Study on Intra-Coronary AngioScopy After Stent (MICASA) Prospective Data Analysis.

Toru Miyoshi, Hiroshi Matsuoka, Hideo Kawakami, Kazuoki Dai, Tetsuya Sato, Kouki Watanabe, Masaharu Ishihara

Circulation journal : official journal of the Japanese Circulation Society 82 ( 7 ) 1830 - 1835 2018.6

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

BACKGROUND: The vascular response, in terms of quality and quantity, of the second- and third-generation drug-eluting stents (2G- and 3G-DES, respectively) was assessed prospectively on coronary angioscopy (CAS).Methods and Results:The Multicenter study on Intra-Coronary AngioScopy After Stent (MICASA) is a multicenter CAS registry. A total of 107 DES (71 2G- and 36 3G-DES) were prospectively observed on CAS 8.7±2.7 months after percutaneous coronary intervention. Neointimal coverage (NC) grade was evaluated using a 4-point grading scale, from 0 (no coverage) to 3 (complete coverage). Plaque yellow color (YC) was also assessed using a 4-point grading system, from 0 (white) to 3 (bright yellow). Max-NC (2G-DES vs. 3G-DES: 2.14±0.68 vs. 2.44±0.73, P=0.023); min-NC (1.07±0.48 vs. 1.39±0.60, P=0.002), and dominant-NC (1.57±0.69 vs. 2.08±0.84, P=0.002) were significantly higher and the YC grade (1.23±0.82 vs. 0.86±0.76, P=0.031) significantly lower in the 3G-DES group than in the 2G-DES group. There was no significant difference in the presence of thrombus (28.2% vs. 22.2%, P=0.51) between the 2G- and 3G-DES groups. CONCLUSIONS: The higher NC grade and lower YC grade in 3G-DES than in 2G-DES might be associated with better long-term clinical outcome, which remains to be determined in future studies.

DOI： 10.1253/circj.CJ-17-1396

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High Baseline Lipoprotein(a) Level as a Risk Factor for Coronary Artery Calcification Progression: Sub-analysis of a Prospective Multicenter Trial.

Jun Ida, Kazuhiko Kotani, Toru Miyoshi, Kazufumi Nakamura, Kunihisa Kohno, Hirohiko Asonuma, Satoru Sakuragi, Masayuki Doi, Takashi Miki, Yasushi Koyama, Hiroshi Ito

Acta medica Okayama 72 ( 3 ) 223 - 230 2018.6

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

Lipoprotein(a), or Lp(a), is a low-density lipoprotein-like particle largely independent of known risk factors for, and predictive of, cardiovascular disease (CVD). We investigated the association between baseline Lp(a) levels and the progression of coronary artery calcification (CAC) in patients with hypercholesterolemia undergoing statin therapy. This study was a sub-analysis of a multicenter prospective study that evaluated the annual progression of CAC under intensive and standard pitavastatin treatment with or without eicosapentaenoic acid in patients with an Agatston score of 1 to 999, and hypercholesterolemia treated with statins. We classified the patients into 3 groups according to CAC progression. A total of 147 patients (mean age, 67 years; men, 54%) were analyzed. The proportion of patients with Lp(a) > 30 mg/dL significantly increased as CAC progressed (non-progression; 5.4%, 0<CAC progression ≦100; 7.7%, and CAC progression >100; 23.6%). Logistic regression analysis showed that Lp(a) > 30 mg/dL was an independent predictor of the annual change in Agatston score > 100 (OR: 5.51; 95% CI: 1.28-23.68; p=0.02), even after adjusting for age, sex, hypertension, diabetes mellitus, current smoking, body mass index, and lipid-lowering medications. Baseline Lp(a) >30 mg/dL was a predictor of CAC progression in this population of patients with hypercholesterolemia undergoing statin therapy.

DOI： 10.18926/AMO/56067

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血行再建後の末梢動脈疾患患者に対する非監視下運動療法の効果

木元朗, 中山理絵, 原賀泰誠, 戸田洋伸, 三好亨

日本下肢救済・足病学会誌 10 ( 1 ) 77 - 77 2018.6

重度低心機能患者に発症した重症下肢虚血、糖尿病性壊疽に対し集学的治療を行った一例 Reviewed

大塚寛昭, 戸田洋伸, 江尻健太郎, 奥山倫弘, 大澤晋, 山田潔, 三好亨, 中村一文, 伊藤浩

日本下肢救済・足病学会誌 10 ( 1 ) 83 - 83 2018.6

TRPM4 Mutation in Patients With Ventricular Noncompaction and Cardiac Conduction Disease. International journal

Yukihiro Saito, Kazufumi Nakamura, Nobuhiro Nishi, Osamu Igawa, Masashi Yoshida, Toru Miyoshi, Atsuyuki Watanabe, Hiroshi Morita, Hiroshi Ito

Circulation. Genomic and precision medicine 11 ( 5 ) e002103 2018.5

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery.

Hironobu Toda, Kazufumi Nakamura, Koji Nakagawa, Atsuyuki Watanabe, Toru Miyoshi, Nobuhiro Nishii, Kazuyoshi Shimizu, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 3 ) 775 - 782 2018.2

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

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

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Angioscopic Findings of Acute Myocardial Infarction After Kawasaki Disease.

Toru Miyoshi, Fumiyasu Seike, Hideo Kawakami, Akira Oshita, Hiroshi Matsuoka

Circulation journal : official journal of the Japanese Circulation Society 82 ( 3 ) 925 - 927 2018.2

Effect of Intensive and Standard Pitavastatin Treatment With or Without Eicosapentaenoic Acid on Progression of Coronary Artery Calcification Over 12 Months - Prospective Multicenter Study.

Toru Miyoshi, Kunihisa Kohno, Hirohiko Asonuma, Satoru Sakuragi, Makoto Nakahama, Yusuke Kawai, Tadahisa Uesugi, Takefumi Oka, Mitsuru Munemasa, Natsuki Takahashi, Naoki Mukohara, Seiji Habara, Yasushi Koyama, Kazufumi Nakamura, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 2 ) 532 - 540 2018.1

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

BACKGROUND: The effect of lipid-lowering agents on progression of coronary artery calcification (CAC) remains unclear. We evaluated the effects of pitavastatin 2 mg/day (PIT2), pitavastatin 4 mg/day (PIT4), and PIT2 combined with eicosapentaenoic acid (PIT2+EPA) on CAC progression.Methods and Results:This prospective multicenter study in Japan included patients with an Agatston score of 1-999, hypercholesterolemia, and no evidence of cardiovascular disease. Patients were allocated into PIT2, PIT4, or PIT2+EPA groups. The primary outcome was the annual percent change in Agatston score in all patients. In total, 156 patients who had multi-detector row computed tomography without any artifacts were included in the primary analysis. Pitavastatin did not significantly reduce the annual progression rate of the Agatston score (40%; 95% CI: 19-61%). The annual progression rate of Agatston score in the PIT2 group was not significantly different from that in the PIT4 group (34% vs. 42%, respectively; P=0.88) or the PIT2+EPA group (34% vs. 44%, respectively; P=0.80). On post-hoc analysis the baseline ratio of low- to high-density lipoprotein cholesterol was a significant predictor of non-progression of Agatston score by pitavastatin (OR, 2.17; 95% CI: 1.10-44.12; P=0.02). CONCLUSIONS: Pitavastatin does not attenuate progression of CAC. Intensive pitavastatin treatment and standard treatment with EPA does not reduce progression of CAC compared with standard treatment.

DOI： 10.1253/circj.CJ-17-0419

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Crucial role of RAGE in inappropriate increase of smooth muscle cells from patients with pulmonary arterial hypertension. International journal

Kazufumi Nakamura, Masakiyo Sakaguchi, Hiromi Matsubara, Satoshi Akagi, Toshihiro Sarashina, Kentaro Ejiri, Kaoru Akazawa, Megumi Kondo, Koji Nakagawa, Masashi Yoshida, Toru Miyoshi, Takeshi Ogo, Takahiro Oto, Shinichi Toyooka, Yuichiro Higashimoto, Kei Fukami, Hiroshi Ito

PloS one 13 ( 9 ) e0203046 2018

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

BACKGROUND: Pulmonary vascular remodeling of pulmonary arterial hypertension (PAH) is characterized by an inappropriate increase of vascular cells. The receptor for advanced glycation end products (RAGE) is a type I single-pass transmembrane protein belonging to the immunoglobulin superfamily and is involved in a broad range of hyperproliferative diseases. RAGE is also implicated in the etiology of PAH and is overexpressed in pulmonary artery smooth muscle cells (PASMCs) in patients with PAH. We examined the role of RAGE in the inappropriate increase of PASMCs in patients with PAH. METHODS AND RESULTS: PASMCs were obtained from 12 patients with PAH including 9 patients with idiopathic PAH (IPAH) and 3 patients with heritable PAH (HPAH) (2 patients with BMPR2 mutation and one patient with SMAD9 mutation) who underwent lung transplantation. Western blot analysis and immunofluorescence staining revealed that RAGE and S100A8 and A9, ligands of RAGE, were overexpressed in IPAH and HPAH-PASMCs in the absence of any external growth stimulus. PDGF-BB (10 ng/mL) up-regulated the expression of RAGE in IPAH and HPAH-PASMCs. PAH-PASMCs are hyperplastic in the absence of any external growth stimulus as assessed by 3H-thymidine incorporation. This result indicates overgrowth characterized by continued growth under a condition of no growth stimulation in PAH-PASMCs. PDGF-BB stimulation caused a higher growth rate of PAH-PASMCs than that of non-PAH-PASMCs. AS-1, an inhibitor of TIR domain-mediated RAGE signaling, significantly inhibited overgrowth characterized by continued growth under a condition of no growth stimulation in IPAH and HPAH-PASMCs (P<0.0001). Furthermore, AS-1 significantly inhibited PDGF-stimulated proliferation of IPAH and HPAH-PASMCs (P<0.0001). CONCLUSIONS: RAGE plays a crucial role in the inappropriate increase of PAH-PASMCs. Inhibition of RAGE signaling may be a new therapeutic strategy for PAH.

DOI： 10.1371/journal.pone.0203046

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Protective effect of nicorandil on myocardial injury following percutaneous coronary intervention in older patients with stable coronary artery disease: Secondary analysis of a randomized, controlled trial (RINC). International journal

Norifumi Kawakita, Kentaro Ejiri, Toru Miyoshi, Kunihisa Kohno, Makoto Nakahama, Masayuki Doi, Mitsuru Munemasa, Masaaki Murakami, Kazufumi Nakamura, Hiroshi Ito

PloS one 13 ( 4 ) e0194623 2018

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

BACKGROUND: Our previous study examined an effect of remote ischemic preconditioning (RIPC) or intravenous nicorandil on reduction of periprocedural myocardial injury (pMI) following percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD). We further investigated the effect of RIPC or nicorandil on pMI in older patients. METHODS: Patients with stable CAD who planned to undergo PCI were assigned to a 1:1:1 ratio to control, intravenous nicorandil, or upper-limb RIPC groups. This substudy analyzed patients aged >65 years (n = 282) from the principal cohort. The primary outcome was the incidence of pMI following PCI. We defined pMI as an elevated level of high-sensitive cardiac troponin T or creatine kinase myocardial band 12 or 24 hours after PCI. RESULTS: We found that pMI following PCI was significantly reduced in the nicorandil group compared with the control group (37.2% vs. 53.7%, multiplicity-adjusted p = 0.046), but not in the RIPC group compared with the control group (43.0% vs. 53.7%, multiplicity-adjusted p = 0.245). The adjusted odds ratios (95% confidence interval) for pMI in the RIPC and nicorandil groups versus the control group were 0.63 (0.34 to 1.16) and 0.51 (0.27 to 0.96), respectively. CONCLUSION: Intravenous nicorandil significantly reduces pMI following PCI in a subgroup of older patients with stable CAD. Phase 3 trials are required to validate our results. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000005607.

DOI： 10.1371/journal.pone.0194623

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Impact of Chronic Kidney Disease on Cardiovascular and Renal Events in Patients Undergoing Percutaneous Coronary Intervention with Everolimus-Eluting Stent: Risk Stratification with C-Reactive Protein. International journal

Kazuhiro Dan, Toru Miyoshi, Makoto Nakahama, Tomofumi Mizuno, Kenzo Kagawa, Yoichiro Naito, Satoshi Kawada, Hiroshi Ito

Cardiorenal medicine 8 ( 2 ) 151 - 159 2018

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

BACKGROUND: Chronic kidney disease (CKD) and inflammation play critical roles in atherosclerosis. There is limited evidence regarding the relationship between CKD and patients receiving second-generation drug-eluting stents for coronary artery disease. OBJECTIVE: This study aimed to investigate the effect of CKD on cardiovascular and renal events in patients undergoing percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). METHODS: We analyzed 504 consecutive patients with stable angina pectoris and significant coronary artery stenosis treated with EES. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 before coronary angiography. The primary outcome was the occurrence of major adverse renal and cardiovascular events (MARCE) including cardiac death, revascularization, heart failure, cerebral infarction, worsening renal function > 25% from baseline, and renal replacement therapy at 1 year. RESULTS: Patients were divided into the a MARCE (n = 126) and a non-MARCE (n = 378) group. The incidence of CKD was 51% in all subjects (including those on hemodialysis) and was significantly higher in the MARCE group than in the non-MARCE group (p = 0.00001). Multivariate logistic regression analysis identified that CKD was independently associated with MARCE (adjusted odds ratio 2.03, 95% confidence interval 1.21-3.39, p = 0.007). Patients were divided into four groups based on CKD and C-reactive protein (CRP) level prior to initial coronary angiography. Cox proportional hazards analysis revealed that patients with CKD and high CRP (≥0.3 mg/dL) had the worst prognosis (hazard ratio 4.371, 95% confidence interval 2.634-7.252, p = 0.00001) compared to patients without CKD and with low CRP. CONCLUSION: CKD combined with CRP predicted more clinical events in patients undergoing PCI with EES.

DOI： 10.1159/000486971

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Serum cystatin C levels are associated with coronary artery calcification in women without chronic kidney disease. International journal

Hiroyasu Sugiyama, Toru Miyoshi, Kazuhiro Osawa, Takashi Miki, Yuji Koide, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Journal of cardiology 70 ( 6 ) 559 - 564 2017.12

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

BACKGROUND: Chronic renal disease (CKD) is a determinant of coronary artery calcification (CAC), which is a predictor of cardiovascular events. However, in a population without CKD, the association between CAC and renal function is unclear. CAC is affected by sex. This study aimed to determine whether serum cystatin C, a sensitive marker of kidney function, or sex differences are associated with CAC in patients without CKD. METHODS: We evaluated 456 consecutive patients (61±13 years, 42% women) without CKD and evidence of coronary artery disease. The CAC (Agatston) score was examined by multidetector computed tomography. RESULTS: When patients were categorized into three CAC groups based on the Agatston score, mild (<10), moderate (11-399), and severe (≥400) in each sex, serum cystatin C levels gradually increased by severity of CAC in women, but not men. Receiver operating characteristic curve analysis showed that, in women, a cut-off value of 0.97mg/l for cystatin C discriminated patients with severe CAC with a sensitivity of 71% and specificity of 77% (area under the curve, 0.74; 95% CI: 0.62-0.86; p<0.01). Multivariate logistic analysis showed that serum cystatin C was not associated with severe CAC in all patients and men, but this association was observed in women (OR: 7.80 for cystatin C≥0.97mg/l, 95% CI: 1.76-34.6, p<0.01). CONCLUSION: Higher serum cystatin C levels are associated with greater CAC in women without CKD. Measurement of cystatin C may be useful for identifying women who are at high risk for cardiovascular disease.

DOI： 10.1016/j.jjcc.2017.05.001

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Characterization of high-intensity plaques on noncontrast T1-weighted magnetic resonance imaging by coronary angioscopy. International journal

Akira Oshita, Hideo Kawakami, Toru Miyoshi, Fumiyasu Seike, Hiroshi Matsuoka

Journal of cardiology 70 ( 6 ) 520 - 523 2017.12

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

BACKGROUND: A recent study showed that coronary high-intensity plaques (HIPs) visualized by noncontrast T1-weighted imaging (T1WI) in cardiac magnetic resonance were associated with coronary events. We used coronary angioscopy to analyze HIP plaque morphology. METHODS AND RESULTS: A total 17 lesions from 17 patients with stable or unstable angina pectoris were evaluated at the culprit lesion by noncontrast T1WI using 1.5-T magnetic resonance; of them, nine (53%) were HIPs and eight (47%) were non-HIPs, and all were analyzed by coronary angioscopy. We assessed the existence of thrombus and plaque yellow color grade (YG). YG was assessed visually according to a four-grade scale: 0, white; 1, light yellow; 2, yellow; 3, intense yellow. The frequency of thrombus was significantly higher in HIPs than in non-HIPs (89% vs. 25%, respectively; p=0.007). YG was significantly more frequent in HIPs than in non-HIPs (2.2±0.4 vs. 0.7±0.7, respectively; p=0.01). CONCLUSIONS: These data indicated that HIPs on noncontrast T1WI were associated with the presence of high-grade yellow plaque with thrombus.

DOI： 10.1016/j.jjcc.2017.04.009

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Circulating adipocyte fatty acid-binding protein is a predictor of cardiovascular events in patients with stable angina undergoing percutaneous coronary intervention. International journal

Wataru Takagi, Toru Miyoshi, Masayuki Doi, Keisuke Okawa, Kazumasa Nosaka, Tomoyuki Nishibe, Naoaki Matsuo, Satoshi Hirohata, Hiroshi Ito

BMC cardiovascular disorders 17 ( 1 ) 258 - 258 2017.10

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

BACKGROUND: Adipocyte fatty acid-binding protein (A-FABP) is expressed in both adipocytes and macrophages. Recent studies have shown that A-FABP is secreted by adipocytes and that the A-FABP concentration is associated with obesity, insulin resistance, and atherosclerosis. We have reported that the coronary atherosclerotic burden is associated with the serum A-FABP concentration. In the present study, we investigated whether the serum A-FABP concentration is associated with prognosis in patients with stable angina pectoris who have undergone percutaneous coronary intervention (PCI). METHODS: This was a prospective single-center trial. In total, 130 patients with stable angina pectoris undergoing their first PCI were enrolled from August 2008 to July 2010 at Kagawa Prefectural Central Hospital. The primary endpoints were cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, revascularization, and hospitalization for heart failure. RESULTS: During the follow-up (median, 50 months; interquartile range, 23-66 months), 49 cardiovascular events occurred. Kaplan-Meier analysis showed that the cumulative incidence of the primary endpoints in the high A-FABP group (median A-FABP concentration of ≥ 18.6 ng/ml) was greater than that in the low A-FABP group. Cox analysis showed that the A-FABP concentration was an independent predictor of cardiovascular events adjusted for age and the presence of multi-vessel disease (hazard ratio, 1.03; 95% confidence interval, 1.01-1.04; p = 0.01). CONCLUSION: The serum A-FABP concentration is associated with prognosis in patients with stable angina undergoing PCI, suggesting that the serum A-FABP concentration could be useful for risk assessment of secondary prevention. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000029283 (registration date: September 25, 2017), retrospectively registered.

DOI： 10.1186/s12872-017-0691-2

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Differences in endothelial dysfunction induced by paroxysmal and persistent atrial fibrillation: Insights from restoration of sinus rhythm by catheter ablation. International journal

Keisuke Okawa, Toru Miyoshi, Saori Tsukuda, Syouhei Hara, Naoaki Matsuo, Noriyuki Nishibe, Masahiro Sogo, Tomoaki Okada, Kazumasa Nosaka, Kousuke Sakane, Masayuki Doi, Hiroshi Morita, Hiroshi Ito

International journal of cardiology 244 180 - 185 2017.10

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

BACKGROUND: Atrial fibrillation (AF) is associated with endothelial dysfunction. Studies have shown the incidence of cardiovascular events to be greater in patients with persistent AF (PeAF) than paroxysmal AF (PAF). OBJECTIVE: The aim of this study was to investigate whether endothelial dysfunction and the impact of catheter ablation on the endothelial function differs between PAF and PeAF. METHODS: We prospectively measured the endothelial function by reactive hyperemia peripheral arterial tonometry (RH-PAT) in 103 PAF, 75 PeAF, and 51 control patients at baseline, with follow-up in the AF patients at 6 and 12months after the catheter ablation. RESULTS: The log-transformed RH-PAT index (ln RHI) was the highest in the control group, followed by the PAF and PeAF (0.67±0.23, 0.57±0.29, and 0.45±0.3, respectively, p<0.001) groups. PeAF was determined to be an independent factor of endothelial dysfunction (ln RHI <0.55) even after adjustment for the conventional cardiovascular risk factors. For 12months after the catheter ablation, 102 (99%) PAF and 72 (96%) PeAF patients maintained sinus rhythm. On average, the ln RHI in the PAF group did not change during the follow-up, but it significantly increased in the PeAF group to a level comparable to that of the PAF patients 6months after the catheter ablation (0.53±0.28, p=0.034), and maintained the same level at 12months after the catheter ablation. CONCLUSIONS: The persistent form of AF may independently contribute to endothelial dysfunction. In addition, by catheter ablation, the maintenance of sinus rhythm may protect against exacerbations of endothelial dysfunction.

DOI： 10.1016/j.ijcard.2017.06.038

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Relationship between yellow plaque grade and tissue protrusion after stent implantation: A coronary angioscopy study. International journal

Toru Miyoshi, Hideo Kawakami, Fumiyasu Seike, Akira Oshita, Hiroshi Matsuoka

Journal of cardiology 70 ( 4 ) 342 - 345 2017.10

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

BACKGROUND: Tissue protrusion detected with optical coherence tomography after percutaneous coronary intervention using stents is one of the risk factors for early stent thrombosis. However, tissue protrusion features have not been described. The aim of this study was to compare tissue morphology at stented sites with or without tissue protrusion by using coronary angioscopy. METHODS: Using optical coherence tomography and coronary angioscopy, we assessed 42 patients [31 men, 11 women; age, 70.7±7.4years; acute coronary syndrome (ACS), n=19; effort angina pectoris (EAP), n=23] after stenting. RESULTS: Twenty patients had tissue protrusion. ACS patients had a higher incidence of tissue protrusion than EAP patients (70.0% vs 29.4%; p=0.002). The plaque at the protrusion site had higher-grade yellow plaque with thrombus than those without protrusion (2.35±0.67 vs 1.40±0.67; p<0.001). The plaque at protrusion sites developed more thrombi (60.0% vs 22.7%; p=0.041). CONCLUSIONS: Tissue protrusion after stent implantation was associated with high-grade yellow plaque with thrombi.

DOI： 10.1016/j.jjcc.2016.12.007

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顕性蛋白尿をきたした腎動脈狭窄症に対するPTRAの腎保護効果についての検討 Reviewed

戸田洋伸, 内田治仁, 竹内英実, 江尻健太郎, 大塚寛昭, 中川晃志, 渡邊敦之, 西井伸洋, 三好亨, 中村一文, 森田宏, 和田淳, 伊藤浩

脈管学 57 ( Suppl. ) S138 - S138 2017.10

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Papers - MIYOSHI Toru