Faculty Profiles - AKAGI Satoshi

Papers - AKAGI Satoshi

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Additional effects of bosentan in patients with idiopathic pulmonary arterial hypertension already treated with high-dose epoprostenol. Reviewed

Satoshi Akagi, Hiromi Matsubara, Katsumasa Miyaji, Etsuko Ikeda, Kazuhiro Dan, Naoto Tokunaga, Kenichi Hisamatsu, Mitsuru Munemasa, Yoshihisa Fujimoto, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 72 ( 7 ) 1142 - 6 2008.7

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Combination therapy has been proposed in treatment algorithms for idiopathic pulmonary arterial hypertension (IPAH), so the additional effects of bosentan in IPAH patients already treated with high-dose epoprostenol (EPO) was evaluated in the present study. METHODS AND RESULTS: Bosentan (62.5 mg twice daily) was administered to 8 IPAH patients already being treated with high-dose EPO (average dose 99.6+/-43.4 ng . kg(-1) . min(-1)). Hemodynamics were assessed at baseline and at 2 days and then 1 year after the initiation of bosentan. Because a remarkable elevation of mixed venous oxygen saturation was observed at the initiation of bosentan, the dosage of EPO was reduced in 7 patients (from 99.6+/-43.4 to 82.8+/-31.3 ng . kg(-1) . min(-1), p<0.05). There was a significant decrease from the baseline value for systolic pulmonary artery pressure (80.1+/-19.3 to 66.8+/-16.5 mmHg, p<0.05). These effects were maintained for 1 year without progression of PAH in 6 patients whose condition had been stabilized at baseline. CONCLUSIONS: The additional use of bosentan for IPAH patients whose condition has been stabilized by high-dose EPO is safe and effective.

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Epoprostenol infusion therapy changes angiographic findings of pulmonary arteries in patients with idiopathic pulmonary arterial hypertension. Reviewed

Masahito Sakuma, Jun Demachi, Jun Nawata, Jun Suzuki, Tohru Takahashi, Hiromi Matsubara, Satoshi Akagi, Kunio Shirato

Circulation journal : official journal of the Japanese Circulation Society 72 ( 7 ) 1147 - 51 2008.7

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

BACKGROUND: The pulmonary vascular changes induced by epoprostenol in patients with idiopathic pulmonary artery hypertension (IPAH) have not been reported by a clinical study. METHODS AND RESULTS: Analysis 1 compared the wedged pulmonary angiography (PAG) findings prior to initiation of epoprostenol therapy (n=24) with those after initiation (n=16). Analysis 2 compared the PAG findings prior to and after initiation of epoprostenol therapy (n=9) in the same pulmonary arteries in the same subjects. In analysis 1, a "cotton grass-like" stain originating from the peripheral pulmonary vessels (each vessel could not be distinguished on angiography) was not observable in any of 24 cases before initiation of epoprostenol therapy, but was visible in 13 of 16 cases after (p<0.0001). In analysis 2, the diameter of subsegmental arteries changed from 3.0+/-0.9 mm (mean +/- standard deviation) to 3.7+/-1.2 mm (p=0.004) between the 2 time periods. Cotton grass-like stain was not found in any cases before epoprostenol, but in all 9 cases after chronic use (p=0.004). CONCLUSIONS: After initiating epoprostenol therapy, cotton grass-like stain appeared in most patients with IPAH. The possible reason for this is release of severe vasoconstriction and/or emergence of neovascularization.

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Prevention of catheter-related infections using a closed hub system in patients with pulmonary arterial hypertension. Reviewed

Satoshi Akagi, Hiromi Matsubara, Aiko Ogawa, Yusuke Kawai, Kenichi Hisamatsu, Katsumasa Miyaji, Mitsuru Munemasa, Yoshihisa Fujimoto, Kengo Fukushima Kusano, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 71 ( 4 ) 559 - 64 2007.4

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Most of the patients with pulmonary arterial hypertension (PAH) receiving intravenous epoprostenol have experienced catheter-related infections during long-term treatment. Catheter hub was reported to be the most important source of catheter-related infections. To prevent the catheter-related infections, we have introduced a closed hub system and compared the incidence of catheter-related infections with that in patients using a non-closed hub system. METHODS AND RESULTS: We evaluated the results obtained on 24 occasions in 20 patients with PAH between June 1999 and December 2005. On 11 occasions, a non-closed hub system was used and on 13 cases a closed hub system. We classified the catheter-related infection into a catheter-related bloodstream infection (CRBSI) group or a tunnel infection group based on the pathway of bacteria. The CRBSI rate was 0.89 per 1,000 catheter days in the non-closed hub system group vs 0.10 per 1,000 catheter days in the closed hub system group. Kaplan-Meier analysis showed that the risk of CRBSI significantly decreased in the closed hub system group. None of the patients died as a direct consequence of catheter-related infection during the study period. CONCLUSIONS: We successfully prevented CRBSI by using a closed hub system.

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Images in cardiovascular medicine. Right-sided heart failure due to compression of the right atrium by remarkable ascending aortic elongation. Reviewed International journal

Satoshi Akagi, Eiji Taguchi, Kazuhiro Dan, Yoko Ikeda, Yusuke Kawai, Kenichi Hisamatsu, Mitsuru Munemasa, Yoshihisa Fujimoto, Hiromi Matsubara, Hiroshi Mikouchi

Circulation 112 ( 14 ) e252 2005.10

[A case of splenic hemorrhage in the course of malignant mesothelioma]. Reviewed

Satoshi Akagi, Shinji Ozaki, Takumi Kishimoto

Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 42 ( 3 ) 253 - 6 2004.3

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal)

A 56-year-old man was admitted to our hospital because of mass lesions at the levels of the right upper and lower lung regions on a chest plain radiograph. Chest computed tomography showed tumors which projected from the pleura of the right upper and lower lung fields. One particular point of interest was the complete separation of the tumors from each other. Malignant mesothelioma was diagnosed by biopsy of the pleura via echogram. Both chemotherapy and radiotherapy were administered because of brain metastasis and direct rib invasion. Under this combined therapy, sudden anemia and hypotension appeared due to splenic hemorrhage, which suggested splenic metastasis of the malignant mesothelioma. Multiple metastases in, for example, the spleen, brain, lung, liver, duodenum, small intestine, kidney, adrenal gland, vertebra, thyroid gland, and lymph nodes were confirmed by autopsy. Distant metastasis is rare for malignant mesothelioma, and we report here a case of splenic metastasis with splenic hemorrhage in malignant mesothelioma.

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