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  2. 小林 欣夫

小林 欣夫

コバヤシ ヨシオ  (Yoshio Kobayashi)

基本情報

所属
千葉大学 大学院医学研究院循環器内科学 教授
学位
博士(医学）(千葉大学)
J-GLOBAL ID
200901031812437900
researchmap会員ID
5000068706

研究キーワード

 1

研究分野

 1

経歴

 2

論文

 868
  • Takumi Harada, Noritaka Ariyoshi, Hitoshi Shimura, Yasunori Sato, Iichiro Yokoyama, Kaori Takahashi, Shin-ichi Yamagata, Mizuho Imamaki, Yoshio Kobayashi, Itsuko Ishii, Masaru Miyazaki, Mitsukazu Kitada
    THROMBOSIS RESEARCH 126(3) 183-190 2010年9月  査読有り
    Introduction: Several factors responsible for inter-individual differences in response to warfarin have been confirmed; however, unidentified factors appear to remain. The purpose of this study was to examine a simple method to evaluate whether optional variables are appropriate as factors to improve dosing algorithms. Materials and Methods: All patients were Japanese. Genotyping of selected genes was conducted, and other information was obtained from medical record. Dosing algorithms were constructed by multivariate linear regression analyses and were evaluated by the Akaike Information Criterion (AIC). Results and Conclusions: Multivariate analysis showed that white blood-cell count (WBC), concomitant use of allopurinol, and CYP4F2 genotype are apparently involved in warfarin dose variation, in addition to well-known factors, such as age and VKORC1 genotype. We evaluated the adequacy of these variables as factors to improve the dosing algorithm using the AIC. Addition of WBC, allopurinol administration and CYP4F2 genotype to the basal algorithm resulted in decreased AIC, suggesting that these factor candidates may contribute to improving the prediction of warfarin maintenance dose. This study is the first to evaluate the warfarin dosing algorithm by AIC. To further improve the dosing algorithm, AIC may be a simple and useful tool to evaluate both the model itself and factors to be incorporated into the algorithm. (C) 2010 Elsevier Ltd. All rights reserved.
  • Tomoki Morino, Yoshio Kobayashi, Yoshihide Fujimoto, Toshiharu Himi, Issei Komuro
    INTERNATIONAL HEART JOURNAL 51(4) 227-230 2010年7月  査読有り
    Recently, several studies have showed that bare metal stent (BMS) restenosis is not a benign clinical entity. However, clinical presentation of BMS restenosis in Japanese patients has not been fully evaluated. Follow-up coronary angiography after BMS implantation was performed in 473 patients with 523 lesions. Of these, BMS restenosis was observed in 167 lesions (31.9%). Clinical presentation of BMS restenosis was classified into 4 categories: 1) acute myocardial infarction, 2) unstable angina, 3) stable angina, and 4) no symptom. Acute myocardial infarction (0%) and unstable angina (3.8%) were infrequent clinical presentations in patients with BMS restenosis compared to stable angina (26.9%) and no symptom (69.2%). BMS restenosis may be a benign clinical entity in Japanese patients. (Int Heart J 2010; 51: 227-230)
  • Kenichi Fukushima, Yoshio Kobayashi, Hideki Kitahara, Yo Iwata, Nakabumi Kuroda, Masayuki Ooyama, Fumio Nomura, Issei Komuro
    HEART AND VESSELS 25(3) 182-186 2010年5月  査読有り
    Usefulness of higher (> 300 mg) loading doses of clopidogrel has been demonstrated in studies from the United States and Europe. The present study evaluated platelet aggregation after the administration of a 450-mg loading dose of clopidogrel in Japanese patients undergoing coronary stenting. Platelet aggregation was serially measured at baseline, and 2, 4, 6, and 8 h after 450-mg clopidogrel loading in 25 patients undergoing coronary stenting. Platelets were stimulated with 5 and 20 mu mol/l adenosine diphosphate (ADP) and aggregation was assessed by optical aggregometry. Platelet aggregation (5 mu mol/l ADP 42.8% +/- 13.5% and 20 mu mol/l ADP 51.2% +/- 11.6%) was significantly suppressed a parts per thousand currency sign4 h after 450-mg clopidogrel loading. There were no adverse events except one minor nasal bleed. The present study shows that platelet inhibition is achieved a parts per thousand currency sign4 h after the administration of a 450-mg clopidogrel loading dose in Japanese patients.
  • Hiroyuki Takaoka, Hiroyuki Takano, Keiichi Nakagawa, Yoshio Kobayashi, Kenzo Hiroshima, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 140(2) E23-E26 2010年4月  査読有り
    A 46-year-old man was first diagnosed as Buerger's disease according to his clinical and radiological features because he had no evidence of parasitic, allergic and connective tissue disease. Soft subcutaneous nodules suspected of lymphadenopathy on the bilateral inguinal regions were recognized after admission. Positron emission tomography scan showed the increased uptake of (18)F-fluoro-2-deoxyglucose in the bilateral inguinal regions. We finally diagnosed him as Kimura's disease based on pathologic findings and laboratory data, and started steroid therapy. The uptake of (18)F-fluoro-2-deoxyglucose disappeared and his leg pain was improved after the treatment. This is the first case report presenting a patient of Kimura's disease with Buerger's disease-like vasculitis who was demonstrated by positron emission tomography. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
  • Eiji Ichimoto, Yoshio Kobayashi, Yoshihiro Iijima, Nakabumi Kuroda, Yukinori Kohno, Issei Komuro
    INTERNATIONAL HEART JOURNAL 51(2) 92-97 2010年3月  査読有り
    There is little information about long-term (> 1 year) outcomes after sirolimus-eluting stent (SES) implantation in dialysis patients. Percutaneous coronary intervention (PCI) using SES was performed in 63 dialysis patients with 77 lesions. A control group for comparison was composed of 45 consecutive dialysis patients with 62 lesions who received PCI using bare metal stents (BMS). Clinical follow-up duration was 21.7 +/- 8.4 months in the SES group and 32.1 +/- 9.2 months in the BMS group (P < 0.01). There was no significant difference in the in-segment restenosis rate (30% versus 40%, P = 0.20) between the 2 groups. The 3-year mortality (22.5% versus 22.2%, P = 0.75), myocardial infarction (3.8% versus 4.9%, P = 0.93), target lesion revascularization (24.7% versus 31.0%, P = 0.61), and stent thrombosis rates (3.8% versus 2.4%, P = 0.73) were not significantly different between the SES and BMS groups. Compared to BMS. SES do not improve long-term clinical outcomes in dialysis patients. (Int Heart J 2010; 51: 92-97)
  • Takashi Nakayama, Nobuyuki Komiyama, Masaki Yokoyama, Susumu Namikawa, Nakabumi Kuroda, Yoshio Kobayashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 138(2) 157-165 2010年1月  査読有り
    Background: A large clinical trial clarified that pioglitazone reduces cardiovascular events in diabetic patients. However, effects of pioglitazone on structure of coronary atherosclerotic plaques have not been demonstrated. We examined whether pioglitazone reduces volumes of coronary atherosclerotic plaques using intravascular ultrasound (IVUS). Methods: Twenty-six consecutive patients with type 2 diabetes mellitus (DM) or impaired glucose tolerance (IGT) undergoing percutaneous coronary intervention (PCI) were enrolled. Echolucent plaques without significant stenosis were selected in IVUS video images at non-PCI-influenced coronary segments and volumetric analysis of the targeted plaques was performed. The patients were randomly assigned into 2 groups: pioglitazone group consisted of 13 patients taking pioglitazone 15 mg/day for initial 14 days after PCI and subsequent 30 mg/day during 6-month follow-up, and control group with 13 patients as control. The plaque volumes and some parameters such as plasma lipid profiles and high-sensitive C-reacting protein (hs-CRP) levels were compared between baseline and the follow-up in those groups. Results: In the pioglitazone group after 6 months, the plaque volume was significantly reduced (101.3 +/- 32.1 to 94.6 +/- 33.6 mm(3), -7.2%; p=0.0023), plasma triglyceride was significantly decreased (-14.9%) and high density lipoprotein cholesterol was substantially increased (+20.0%) without any significant change in low density lipoprotein cholesterol (LDL-C). Also, hs-CRP level tended to be decreased. However, no significant change in plaque volumes and those parameters was observed in the control group. Conclusions: Pioglitazone may induce regression of coronary atherosclerotic plaques without LDL-C reduction in patients with DM and IGT. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
  • Naoki Ishio, Yoshio Kobayashi, Yo Iwata, Hideki Kitahara, Kenichi Fukushima, Tatsuhiko Asano, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    HEART AND VESSELS 25(1) 35-40 2010年1月  査読有り
    Previous intravascular ultrasound (IVUS) studies have shown coronary artery atherosclerosis even in angiographically normal reference segment. However, IVUS has not been performed in all of the three major coronary arteries. A total of 50 patients with single-vessel disease underwent IVUS evaluation in the proximal two-thirds of the three major coronary arteries. Lumen and external elastic membrane cross-sectional areas were measured at 1-mm intervals. To compensate the difference in pullback length among coronary arteries, normalized total plaque and media volume (TPV) was calculated as TPV/number of slices in pullback x median number of slices in study population. Percent plaque and media volume (PPV) was calculated as TPV/I pound external elastic membrane cross-sectional area x 100. A cross section was defined as atherosclerotic if maximum intimal thickness exceeded 0.5 mm at any point in the vessel circumference. There was no significant difference in normalized TPV, PPV, and the incidence of abnormal intimal thickness between coronary arteries with and without significant stenosis. Frequency distribution of plaque burden was similar. Atherosclerosis is ubiquitous even in coronary arteries without angiographically significant stenosis. The extent of atherosclerosis is similar between coronary arteries with and without significant stenosis.
  • Kenichi Fukushima, Yoshio Kobayashi, Hideki Kitahara, Yo Iwata, Nakabumi Kuroda, Masayuki Ooyama, Yoichi Kuwabara, Fumio Nomura, Issei Komuro
    HEART AND VESSELS 25(1) 41-44 2010年1月  査読有り
    In the United States and Europe, patients with coronary stents are maintained on 75 mg clopidogrel. Because the maintenance dose of ticlopidine in patients with coronary stents is 100 mg twice daily in Japan and 250 mg twice daily in the United States and Europe, in Japanese patients a lower dose of clopidogrel may achieve an antiplatelet effect comparable to 200 mg ticlopidine. Platelet aggregation was evaluated in 104 consecutive patients on 50 mg clopidogrel plus aspirin (n = 54) and 200 mg ticlopidine plus aspirin (n = 50). Platelets were stimulated with adenosine diphosphate (5 and 20 mu mol/l) and aggregation was assessed by optical aggregometry. There was no significant difference in platelet aggregation induced with 5 (37% +/- 11% vs 38% +/- 15%, not significant) and 20 mu mol/l adenosine diphosphate (48% +/- 13% vs 51% +/- 12%, not significant) between 50 mg clopidogrel and 200 mg ticlopidine. In Japanese patients, there is the possibility that a maintenance dose of 50 mg clopidogrel on platelet inhibition is comparable to 200 mg ticlopidine.
  • Kazumasa Sugimoto, Yoshio Kobayashi, Nakabumi Kuroda, Issei Komuro
    INTERNATIONAL HEART JOURNAL 50(6) 723-730 2009年11月  査読有り
    The cost-effectiveness of drug-eluting stents (DES) has been evaluated ill the United States and Europe, however, there is little information from Japan. The present study evaluated the cost-effectiveness of sirolimus-eluting stents (SES) in Japan. In-hospital and follow-up costs of 25 consecutive patients undergoing SES implantation in a de novo lesion were evaluated. A control group for comparison was composed of 25 consecutive patients undergoing bare metal stent (BMS) implantation in a de novo lesion before the introduction of SES. There was no significant difference in resource use between the SES and BMS groups. Procedural cost ((sic)1,049,200 +/- 208,793 versus (sic)896,590 +/- 117,984, P = 0.01) was higher in the SES group than in the BMS group because of the higher reimbursement price of SES ((sic)378,000 versus (sic)258,000). In-hospital cost ((sic)1,202,891 +/- 208,793 versus (sic)1,050,280 +/- 177,984, P < 0.01) was higher in patients treated with SES. Less target lesion revascularization (4% versus 20%, P = 0.2) in patients with SES reduced the difference aggregate 1-year cost was not significantly different ((sic) 1,479,481 +/- 284,343 versus (sic)1,463,640 +/- 495,803, P = 0.9). It is concluded that SES may be cost-effective even in Japan. (Int Heart J 2009; 50: 723-730)
  • Kazumasa Sugimoto, Yoshio Kobayashi, Hirofumi Miyahara, Nakabumi Kuroda, Nobusada Funabashi, Issei Komuro
    CIRCULATION JOURNAL 73(9) 1759-1761 2009年9月  査読有り
    Stent thrombosis is one of the most feared complications after coronary stenting, because it often presents in a catastrophic way, triggering death or acute myocardial infarction. Previous studies report mechanical risk factors of stent thrombosis such as stent underexpansion and vessel dissection. This is a case report of early stent thrombosis associated with bare metal stent dislodgement because of dissolution of a mural thrombus in all Unappreciated coronary artery aneurysm. (Circ J 2009; 73: 1759-1761)
  • Takashi Nakayama, Yoshio Kobayashi, Hiroyuki Takano, Nakabumi Kuroda, Kenzo Hiroshima, Issei Komuro
    CIRCULATION JOURNAL 73(9) 1762-1764 2009年9月  査読有り
    Stent thrombosis is defined as thrombotic occlusion of a stent resulting in acute coronary syndrome (ACS). However, all thrombotic occlusions of stents might not result in ACS. The present case report describes silent, very late thrombotic occlusion of a drug-eluting stent that was confirmed from specimens removed by directional coronary atherectomy. (Circ J 2009; 73: 1762-1764)
  • Eiji Ichimoto, Kigen Jo, Yoshio Kobayashi, Toshihisa Inoue, Yoshitake Nakamura, Nakabumi Kuroda, Akira Miyazaki, Issei Komuro
    CIRCULATION JOURNAL 73(9) 1669-1673 2009年9月  査読有り
    Background: Cystatin C is reportedly a better endogenous marker of glomerular filtration rate than serum creatinine, so the prognostic value of cystatin C in patients with ST-elevation myocardial infarction (MI) was evaluated in the present study. Methods and Results: A total of 71 patients who underwent percutaneous coronary intervention for ST-segment elevation MI < 24h from symptom onset were included. According to cystatin C level, patients were classified into 2 groups: (1) higher cystatin C group (n=33) and (2) lower cystatin C group (n=38). There was a trend toward more in-hospital deaths in patients with the higher cystatin C level compared with the lower cystatin C level group (15.2% vs 2.6%, P=0.06). Mean duration of clinical follow-up was 5.6 +/- 2.8 months. There was no significant difference in death, reinfarction, disabling stroke or target lesion revascularization between the 2 groups. However, a higher incidence of rehospitalization for congestive heart failure was observed in patients, with the higher cystatin C level than in those with the lower cystatin C level (15.2% vs 0%, P=0.01). Conclusions: Cystatin C may be associated with more cardiovascular events, mainly rehospitalization for congestive heart failure, after percutaneous coronary intervention in patients with ST-elevation MI. (Circ J 2009; 73: 1669-1673)
  • Tatsuhiko Asano, Yoshio Kobayashi, Kenichi Fukushima, Yo Iwata, Hideki Kitahara, Naoki Ishio, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    HEART AND VESSELS 24(5) 335-339 2009年9月  査読有り
    There is little information about the relationship between balloon inflation time and sirolimus-eluting stent (SES) expansion. In this randomized intravascular ultrasound (IVUS) study, 92 de novo lesions in native coronary arteries that underwent SES implantation were enrolled. Sirolimus-eluting stent was implanted using an inflation pressure of 14 atm. Stent balloon was gradually inflated until 14 atm in 10 s. In the short inflation group, it was deflated immediately after an image of the balloon inflated at 14 atm was taken. Stent balloon inflation lasted 60 s in the long inflation group. Intravascular ultrasound was then performed. The long balloon inflation resulted in a larger stent cross-sectional area (4.9 +/- 1.6 mm(2) vs 4.3 +/- 1.4 mm(2), P < 0.05) and expansion (71% +/- 13% vs 60% +/- 13%, P < 0.001) compared to the short balloon inflation, although stent expansion was relatively low in both groups. The relatively longer balloon inflation time using an inflation pressure of 14 atm results in better SES expansion. However, in the majority of lesions, adequate stent expansion is not achieved even using long balloon inflation, if it is inflated at 14 atm.
  • Tadayuki Kadohira, Yoshio Kobayashi, Yuriko Niitsuma, Mizuho Imamaki, Issei Komuro
    INTERNATIONAL HEART JOURNAL 50(4) 539-542 2009年7月  査読有り
    Cardiac rupture is a life-threatening complication during diagnostic cardiac catheterization, however, it rarely Occurs nowadays. The present case report describes cardiac rupture during diagnostic cardiac catheterization using a 4F pigtail catheter and a 0.035 '' flexible guidewire, and global ST-segment elevation associated with impending cardiac rupture. (hit Heart J 2009; 50: 539-542)
  • Takagi T, Okura H, Kobayashi Y, Kataoka T, Taguchi H, Toda I, Tamita K, Yamamuro A, Sakanoue Y, Ito A, Yanagi S, Shimeno K, Waseda K, Yamasaki M, Fitzgerald PJ, Ikeno F, Honda Y, Yoshiyama M, Yoshikawa J, POPPS Investigators
    JACC. Cardiovascular interventions 2(6) 524-531 2009年6月  査読有り
  • Hideki Kitahara, Yoshio Kobayashi, Hideo Takebayashi, Yoshihide Fujimoto, Yoshitake Nakamura, Nakabumi Kuroda, Toshiharu Himi, Akira Miyazaki, Seiichi Haruta, Issei Komuro
    CIRCULATION JOURNAL 73(5) 867-871 2009年5月  査読有り
    Background: There is limited information about Optimal management of drug-eluting stent (DES) restenosis. This Study evaluated the incidences of re-restenosis and re-target lesion revascularization (TLR) after the treatment of sirolimus-eluting stent (SES.) restenosis. Methods and Results: A total of 102 lesions in 10 1 patients who underwent TLR for SES restenosis were classified according to: (1) focal (lesion length <= 10mm) or non-focal restenosis (>10mm); and (2) use of DES for TLR: ( 1) focal restenosis treated with DES (focal-DES, n=40); (2) focal restenosis treated by balloon angioplasty by (focal-balloon, n=31); (3) non-focal restenosis with DES (non-focal-DES, n=17); and (4) non-focal restenosis by balloon angioplasty (non-focal-balloon, n=14). Re-restenosis and re-TLR were observed in 6 (19.4%) and 5 lesions (12.5%) of the focal-DES group, in 13 (65.0%) and 11 (35.5%) of the focal-balloon group, in 7 (50.0%) and 6 (35.3%) of the non-focal-DES group, and in 8 (61.5%) and 7 (50.0%) of the non-focal-balloon group, respectively (P<0.05 for restenosis and TLR between the focal-DES group and other group). Conclusions: Re-DES implantation for focal DES restenosis results in lower re-restenosis and re-TLR rates compared to re-DES implantation for non-focal DES restenosis or conventional balloon angioplasty either for focal or non-focal DES restenosis. (Circ J 2009; 73: 867-871)
  • 近藤 祐介, 船橋 伸禎, 上原 雅恵, 高岡 浩之, 小林 欣夫, 小室 一成
    Circulation Journal 73(Suppl.II) 983-983 2009年4月  
  • 岸 幹夫, 宮山 友明, 桜井 玲, 上田 希彦, 上原 雅恵, 高岡 浩之, 三上 陽子, 村山 太一, 山崎 道子, 小林 欣夫, 高野 博之, 舘野 馨, 船橋 伸禎, 小室 一成
    Circulation Journal 73(Suppl.II) 984-984 2009年4月  
  • Hideki Kitahara, Yoshio Kobayashi, Hideo Takebayashi, Yoshitake Nakamura, Nakabumi Kuroda, Akira Miyazaki, Seiichi Haruta, Issei Komuro
    CIRCULATION JOURNAL 73(3) 508-511 2009年3月  査読有り
    Background: Large-scale randomized trials demonstrate a high proportion of focal restenosis after drug-eluting stent (DES) implantation. On the other hand, recent reports have shown that in real-world practice a significant proportion of the restenosis is non-focal when DESs are used in unselected lesions. The present study evaluated angiographic patterns of restenosis after sirolimus-eluting stent (SES) implantation in Japan. Methods and Results: Angiographic restenosis patterns of all consecutive restenotic lesions (n=124) after SES implantation were evaluated and classified according to the following scheme: focal (<= 10mm in length), diffuse (restenosis >10mm within the stent), proliferative (restenosis >10mm in length extending outside the stent), and occlusive. There were 98 focal (79.0%), 15 diffuse (12.1%), and 5 proliferative restenoses (4.0%) and 6 total occlusions (4.8%). Focal intrastent restenosis was most dominant (42.7%). Proximal edge restenosis occurred in 22 lesions (17.7%). Multivariate analysis demonstrated diabetes mellitus (P<0.01) as an independent predictor of non-focal restenosis. Conclusions: Focal restenosis is predominant after SES implantation in real-world practice in Japan. (Circ J 2009; 73: 508-511)
  • Hiroyuki Okura, Yoshio Kobayashi, Satoru Sumitsuji, Mitsuyasu Terashima, Toru Kataoka, Motomaru Masutani, Mitsumasa Ohyanagi, Kenei Shimada, Haruyuki Taguchi, Yuji Yasuga, Yoshihiro Takeda, Yoshitaka Ohashi, Kojiro Awano, Kenichi Fujii, Gary S. Mintz
    AMERICAN JOURNAL OF CARDIOLOGY 103(6) 791-795 2009年3月  査読有り
    To investigate intravascular ultrasound predictors of long-term clinical outcome in patients with acute coronary syndrome, 94 patients with a first acute coronary syndrome with both preintervention intravascular ultrasound imaging and long-term follow-up were enrolled in this study. Remodeling index was defined as external elastic membrane cross-sectional area at the target lesion divided by that at the proximal reference. Arterial remodeling was defined as either positive (PR: remodeling index > 1.05) or intermediate/negative remodeling (remodeling index <= 1.05). Clinical events were death, myocardial infarction, and target-lesion revascularization. Patients were followed up for a mean of 3 years. PR was observed in 50 (53%), and intermediate/negative remodeling, in 44 (47%). During the 3-year follow-up, there were 20 target-lesion revascularization events and 5 deaths (2 cardiac and 3 noncardiac), but no myocardial infarctions. Patients with PR showed significantly lower major adverse cardiac event (MACE; death, myocardial infarction, and target-lesion revascularization)-free survival (log-rank p = 0.03). However, patients with plaque rupture showed a nonsignificant trend toward lower MACE-free survival (p = 0.13), but there were no significant differences in MACE-free survival between those with single versus multiple plaque ruptures. Using multivariate logistic regression analysis, only culprit lesion PR was an independent predictor of MACEs (p = 0.04). In conclusion, culpri-tension remodeling rather than the presence or absence of culprit-lesion plaque rupture was a strong predictor of long-term (3-year) clinical outcome in patients with acute coronary syndrome. (C) 2009 Elsevier Inc. (Am J Cardiol 2009;103:791-795)
  • Hideki Kitahara, Yoshio Kobayashi, Masashi Yamaguchi, Kenji Ohkubo, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    CIRCULATION JOURNAL 72(11) 1907-1908 2008年11月  査読有り
    The polymer of paclitaxel-eluting stents (PES) plays an important role in controlling the release of paclitaxel. Damage to the polymer of a PES that is used in a patient has not been demonstrated, although in-vitro studies report disruption of it. The present case report describes damage to a PES as delivery through a calcified coronary artery was being attempted. (Circ J 2008; 72: 1907-1908)
  • Hiroyuki Takano, Keiichi Nakagawa, Naoki Ishio, Michiko Daimon, Masao Daimon, Yoshio Kobayashi, Kenzo Hiroshima, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 130(1) E11-E13 2008年10月  査読有り
    Chronic active Epstein-Barr virus (CAEBV) infection is characterized by chronic or recurrent infectious mononucleosis-like symptoms and the prognosis of CAEBV infection is quite poor. The incidence of myocarditis as a complication of EBV infection is not so high and it is unusual that heart failure appears as the initial symptom. However, it is very important to detect and treat chronic active myocarditis in the early phase of CAEBV infection because chronic active myocarditis disorganizes and decreases cardiomyocytes, resulting in the progression to heart failure. We report a case of a 45-year-old man with CAEBV infection for 5 years. Echocardiography revealed moderate left ventricular systolic dysfunction with mild pericardial effusion. Endomyocardial biopsies demonstrated massive lymphocytic infiltration with adjacent myocytolysis and necrosis of cardiomyocytes suggesting active myocarditis. Immunohistological analysis of biopsies revealed that the infiltrating cells were mainly T lymphocytes. And some of the infiltrating cells showed a positive signal for the EBV-encoded small nuclear RNA by in situ hybridization. Positron emission tomography using (18)F-fluoro-2-deoxyglucose ((18)F-FDG) performed revealed increased uptake of (18)F-FDG of whole left ventricular wall with mild heterogeneity. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
  • Tatsuhiko Asano, Yoshio Kobayashi, Kenichi Fukushima, Yo Iwata, Hideki Kitahara, Naoki Ishio, Nakabumi Kuroda, Issei Komuro
    CIRCULATION JOURNAL 72(10) 1707-1708 2008年10月  査読有り
    Background A lower maintenance dose of clopidogrel may be appropriate in Japanese patients because the maintenance dose of ticlopidine is lower in Japan than that used in the United States. Methods and Results A total of 126 patients with 153 lesions who consented to take 50-mg clopidogrel to prevent stern thrombosis were enrolled. There was 1 case of early stent thrombosis (0.65%). Side-effects of clopidogrel occured in 5 patients (4.0%). Conclusion This preliminary Study shows that 50mg clopidogrel may be acceptable in Japanese patients.
  • Honjo S, Yokote K, Fujimoto M, Takemoto M, Kobayashi K, Maezawa Y, Shimoyama T, Satoh S, Koshizaka M, Takada A, Irisuna H, Saito Y
    Rejuvenation research 11(4) 809-19 2008年8月  
    Werner syndrome (WS) is an autosomal recessive progeroid disorder caused by mutations in RecQ DNA helicase. Ectopic soft tissue calcification is one of the well known symptoms in WS. However, the prevalence, clinical outcome, and mechanism of such calcification remain to be elucidated. The clinical features and mechanism of ectopic calcification were examined in seven patients with WS whose diagnosis were confirmed by a genomic DNA analysis. X-ray examinations revealed subcutaneous calcification in 35 of 41 major joints (85.3%). The patients complained of dermal pain at 23 joints among 35 joints (65.7%) with calcification. Refractory skin ulcers were found at the area of the skin overlaying the calcification in 16 joints (45.7%). In contrast, no pain or ulcers were observed in the joints without calcification. The presence of ectopic calcification could not be explained by a systemic hormonal abnormality. Cultured fibroblasts from WS patients underwent spontaneous mineralization in vitro in the normal phosphate condition, and overexpressed Pit-1, a transmembrane type III Na-Pi cotransporter both at the mRNA and protein levels. Phosphonophormic acid, a specific inhibitor for Pit-1, inhibited mineralization in the WS fibroblasts. Both calcification and Pit-1 overexpression were detected in the skin of WS in situ. WS showed a high prevalence of ectopic calcification, which was associated with dermal pain and refractory skin ulcers. An overexpression of Pit-1 therefore seems to play a key role in the formation of soft tissue calcification in this syndrome.
  • Kenichi Fukushima, Yoshio Kobayashi, Hideki Kitahara, Yo Iwata, Takashi Nakayama, Nakabumi Kuroda, Masayuki Ooyama, Fumio Nomura, Issei Komuro
    CIRCULATION JOURNAL 72(8) 1282-1284 2008年8月  査読有り
    Background The loading dose of ticlopidine is 500mg in both the US and Europe and 200mg in Japan. A lower loading dose of clopidogrel might achieve adequate platelet inhibition in Japanese patients. Methods and Results Platelet aggregation was serially measured at baseline, and 2, 4, 6, and 8h after 150-mg (n=20) and 300-mg (n=20) clopidogrel loading. Platelets were stimulated with 5 and 20 mu mol/L adenosine diphosphate (ADP) and aggregation was assessed by optical aggregometry. Pretreatment ADP-induced platelet aggregation in the 150-mg clopidogrel group did not differ from that of the 300-mg group. The administration of 300-mg clopidogrel loading dose resulted in lower platelet aggregation 2h after the administration (5 mu mol/L ADP: 53 +/- 9% vs 61 +/- 12%, p<0.05 and 20 mu mol/L ADP: 61 +/- 10% vs 68 +/- 9%, p<0.05). A lower platelet aggregation induced with 20 mu mol/L ADP was still observed 4h after the 300-mg clopidogrel loading (58 +/- 10% vs 65 +/- 9%, p<0.05). Conclusions The 150-mg clopidogrel loading does not achieve rapid platelet inhibition. The 300-mg loading dose should be used to suppress platelet function rapidly even in Japanese patients undergoing coronary stent placement.
  • Koki Nakamura, Nobusada Funabashi, Hideyuki Miyauchi, Mari Aminaka, Masae Uehara, Marehiko Ueda, Taichi Murayama, Yasuhiko Hori, Takashi Nakayama, Michiko Daimon, Nakabumi Kuroda, Yoshio Kobayashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 127(3) 437-441 2008年7月  査読有り
    We report the case of a 38-year-old Asian man with a pericardial hemangioma on the left main coronary artery. The patient presented initially at our hospital after cardiopulmonary resuscitation following an episode of ventricular fibrillation (VF). Because of spontaneous coved-type ST segment elevation on the higher intercostal space V1 to V2 in a 12-lead electrocardiogram, documented VF in the absence of structural heart disease, and a family history of sudden death, he was diagnosed with Brugada syndrome. Transesophageal echocardiography showed a smooth-surfaced mass with well-demarcated borders, directly above the left main coronary artery. Computed tomography confirmed the presence of the mass, which showed no enhancement at early phase, but did demonstrate homogenous enhancement at delay phase by contrast material. There were no findings from either the nuclear medicine or the tumor marker investigations which indicated that the mass located just above the main coronary arteries was malignant. Therefore, taken together, these findings suggested that the tumor might be a pericardial hemangioma. The relationship between the location of the hemangioma just above the left main coronary artery and the occurrence of VF was not clear, i.e. whether the presence of the hemangioma caused the stimulation of the left main coronary artery and as a result, led to the spasm of the left main coronary artery and the occurrence of VF. Furthermore, as the tumor did not extend into any of the adjacent structures, such as the coronary arteries or the right ventricular outflow tract, surgical resection was not performed; instead, the patient received a dual chamber implantable cardioverter-defibrillator. (C) 2007 Published by Elsevier Ireland Ltd.
  • Tadayuki Kadohira, Yoshio Kobayashi, Tatsuhiko Asano, Masae Uehara, Nobusada Funabashi, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    INTERNATIONAL HEART JOURNAL 49(4) 507-513 2008年7月  査読有り
    Stent thrombosis is an infrequent event but a potentially fatal complication of coronary stenting. Adherence to long-term antiplatelet therapy plays an important role in the prevention of late stent thrombosis after drug-eluting stent (DES) implantation. Poor glycemic control due to nonadherence to diabetic treatments is likely to result in severely diffuse coronary atherosclerosis and diabetic microvascular complications. This case report describes fatal very late stent thrombosis in a Young diabetic patient, which teaches us about the potential risk of DES in patients with acute myocardial infarction and the importance of patient education about long-term dual antiplatelet therapy after DES implantation. Furthermore, it demonstrates severely diffuse atherosclerosis in a young diabetic patient with nonadherence to diabetic treatments. (Int Heart J 2008 49: 507-513)
  • Kenji Ohkubo, Yoshio Kobayashi, Issei Komuro
    AMERICAN JOURNAL OF CARDIOLOGY 101(10) 1519-1519 2008年5月  査読有り
  • 金枝 朋宜, 野島 愛佳, 宮内 秀行, 三上 陽子, 関根 有希子, 椎名 由美, 李 光浩, 上原 雅恵, 鳴海 浩也, 小林 欣夫, 高野 博之, 船橋 伸禎, 小室 一成
    Circulation Journal 72(Suppl.II) 894-894 2008年4月  
  • Hideki Kitahara, Yoshio Kobayashi, Masashi Yamaguchi, Yoshihide Fujimoto, Mizuo Nameki, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    JOURNAL OF INVASIVE CARDIOLOGY 20(3) 130-133 2008年3月  査読有り
    Background. Damage to the polymer coating on sirolimus-eluting stents (SES) may occur when it is delivered through complex lesions such as calcified lesions. The present study evaluated damage to the polymer of SES that could not be delivered into lesions. Methods. SES that could not be delivered into lesions were prospectively collected and examined using a scanning electron microscope. Results. There were 5 undelivered SES. In all cases, moderate or severe calcification with and without vessel tortuosity were reasons for unsuccessful delivery. Scanning electron microscopy demonstrated damage to the polymer of 4 out of the 5 undelivered SES. Conclusion. Damage to the polymer coating of SES may occur when delivered through a calcified coronary artery.
  • Yo Iwata, Yoshio Kobayashi, Kenichi Fukushima, Hideki Kitahara, Tatsuhiko Asado, Naoki Ishio, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    CIRCULATION JOURNAL 72(2) 340-341 2008年2月  査読有り
    Background Antiplatelet therapy in patients with sirolimus-eluting stents (SES) may be stopped because of bleeding or an invasive procedure. Methods and Results In 254 patients with SES, the incidence of discontinuation of antiplatelet therapy and subsequent adverse cardiac events was evaluated. Follow-up was complete for 97.2% of the population and mean follow-up was 15.6 8.9 months. Discontinuation of antiplatelet therapy occurred for 46 patients (18.1%): 1 case of late stent thrombosis (2.2%) occurred 10 days after cessation of therapy because of pulmonary hemorrhage 7 months after SES deployment. Conclusion Discontinuation of antiplatelet therapy in patients with SES is not infrequent.
  • Hideki Kitahara, Yoshio Kobayashi, Yoshihide Fujimoto, Yoshitake Nakamura, Takashi Nakayama, Nakabumi Kuroda, Toshiharu Himi, Akira Miyazaki, Issei Komuro
    CIRCULATION JOURNAL 72(1) 168-169 2008年1月  査読有り
    Background There is little information about the efficacy of ticlopidine plus aspirin after sirolimus-eluting stent (SES) implantation. Methods and Results The incidence of stent thrombosis was evaluated in 1,029 patients receiving ticlopidine and aspirin after SES deployment. Clinical follow-up was obtained in 98.9% (mean follow-up 17.0 +/- 7.9 months). Early stent thrombosis was observed in 5 patients (0.49%). There was 1 case each of late (0.1%) and very late stent thrombosis (0.1%). Conclusion Late and very late stent thrombosis in Japanese patients receiving ticlopidine and aspirin after SES deployment occurs infrequently.
  • Yasuhiko Hori, Nobusada Funabashi, Hideyuki Miyauchi, Keiichi Nakagawa, Hitoshi Shimura, Masaru Miyazaki, Hideaki Kozono, Yuichiro Nagai, Hiroshi Ishikura, Toshio Nagai, Yoshio Kobayashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 123(1) E15-E17 2007年12月  査読有り
    Primary cardiac tumors are rare. In this report, using fusion images of multislice computed tomography (MSCT) and positron emission tomography (PET) using F-18 Fluoro-Deoxyglucose, we could diagnose, morphologically, the location, size and extent of the tumor, and degree of blood flow from the feeding artery (by MSCT) and establish that this cardiac tumor was malignant (by PET) before surgical operation. Histologically, the tumor was diagnosed as a cardiac angiosarcoma. (C) 2007 Published by Elsevier Ireland Ltd.
  • Tateno Kaoru, Moriya Junji, Minamino Tohru, Miura Kentaro, Shimizu Naomi, Kobayashi Yoshio, Komuro Issei
    CIRCULATION 116(16) 748 2007年10月16日  査読有り
  • Hiroyuki Takano, Hiroshi Hasegawa, Yoichi Kuwabara, Takashi Nakayama, Koki Matsuno, Yoshiya Miyazaki, Masashi Yamamoto, Yoshihide Fujimoto, Hisayuki Okada, Shinji Okubo, Miwa Fujita, Satoshi Shindo, Yoshio Kobayashi, Nobuyuki Komiyama, Noboru Takekoshi, Kamon Imai, Toshiharu Himi, Iwao Ishibashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 122(1) 41-47 2007年10月  査読有り
    Background: This study examined feasibility and safety of granulocyte colony- stimulating factor ( G- CSF) treatment for patients with acute myocardial infarction ( AMI). Methods: Forty patients with AMI related with the left anterior descending coronary artery, who underwent successful percutaneous coronary intervention ( PCI), were randomized into G- CSF group ( n= 18) or Control group ( n= 22). G- CSF treatment was started within 24 h after PCI. Tc-99m- tetrofosmin single- photon emission computed tomography ( SPECT) was performed at 4 days and 6 months after AMI. SPECT data was analyzed for LV end- diastolic volume ( LVEDV), LV end- systolic volume ( LVESV), LV ejection fraction ( LVEF) and myocardial perfusion. Results: LVEF at 6 months was significantly better than that at 4 days in G- CSF group ( p= 0.013), but not changed in Control group ( p= 0.245). Although no significant difference was observed for LVEDV between the two groups, LVESV tended to be decreased only in G-CSF group. In G- CSF group, defect score ( DS) was significantly decreased from 4 days to 6 months after AMI. Restenosis rate at 6 months after AMI was not significantly different between the two groups. Conclusions: G- CSF treatment for patients with AMI was effective and did not have any clinical and angiographic adverse effects. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
  • Yoko Mikami, Nobusada Funabashi, Tsunetaka Kijima, Masae Uehara, Yumi Shiina, Kwangho Lee, Takashi Nakayama, Masao Daimon, Nakabumi Kuroda, Yoshio Kobayashi, Hiroyuki Takano, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 122(1) 72-75 2007年10月  査読有り
    Cardiac amyloidosis is generally a progressive disease with a poor prognosis, so early diagnosis and appropriate treatments are important. Although cardiac amyloidosis can be diagnosed definitively by endomyocardial biopsy, non- invasive methods of diagnosis are desired because of a great risk in biopsy. In ECG- gated enhanced multislice computed tomography, not only clear images of the cardiac morphology but also the character of myocardium indicating fibrosis can be identified. We demonstrate two patients with cardiac amyloidosis who showed marked thickening of left ventricular wall with partial fibrotic changes by enhanced multislice computed tomography. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
  • Naoki Ishio, Yoshio Kobayashi, Hideo Takebayashi, Yoshihiro Iijima, Junji Kanda, Takashi Nakayama, Nakabumi Kuroda, Joseph De Gregorio, Yukinori Kouno, Masaru Suzuki, Seiichi Haruta, Issei Komuro
    CIRCULATION JOURNAL 71(10) 1525-1529 2007年10月  査読有り
    Background It remains unclear whether sirolimus-eluting stents (SES) have an advantage over bare metal stents (BMS) in patients on dialysis. Methods and Results Percutaneous coronary intervention (PCI) using SES was performed in 54 dialysis patients with 69 lesions. A control group for comparison comprised 54 consecutive dialysis patients with 58 lesions who underwent PCI using BMS. Angiographic and clinical follow-ups were scheduled at 9 months. After the procedure, minimum lumen diameter (MLD) was similar between the 2 groups. At follow-up, the SES group had a higher NILD than the BMS group (1.98 +/- 0.83 mm vs 1.50 +/- 0.78 mm, p < 0.01). In-stent restenosis rate was lower in lesions treated with SES than in those with BMS (22% vs 40%, p=0.048). However, there was no significant difference between the 2 groups for in-segment restenosis (31% vs 43%, p=0.3). During follow-up, there was no significant difference in the incidence of death, myocardial infarction or target lesion revascularization (TLR) (14% vs 21 %, p=0.4) between the SES and BMS groups. Conclusions In this retrospective study, SES, in comparison with BMS, reduced in-stent restenosis in patients on dialysis. However, in-segment restenosis and TLR were not statistically different between lesions treated with SES and those with BMS.
  • Tatsuhiko Asano, Yoshio Kobayashi, Masaki Ohno, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    ANGIOLOGY 58(5) 636-639 2007年10月  査読有り
    This case report describes multivessel coronary artery spasm refractory to oral nifedipine, intravenous isosorbide dinitrate, diltiazem and nicorandil, and intracoronary nitroglycerin. Intracoronary administration of nicorandil only transiently relieved coronary artery spasm. Prednisolone was effective in preventing coronary artery spasm.
  • Masashi Ohtsuka, Eiji Uchida, Hiroyuki Yamaguchi, Toru Nakajima, Hiroshi Akazawa, Nobusada Funabashi, Yoshio Kobayashi, Ichiro Shiojima, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 121(1) 76-77 2007年9月  査読有り
    We describe as case of a 70-year-old man who underwent a percutaneous coronary intervention with stenting, for a severe stenosis complicated by a coronary aneurysm just distal to the stenotic site. Notably, coronary angiogram showed an immediate and progressive reduction in the size of coronary aneurysm. Curved planar reconstruction images of the enhanced CT showed no thrombus and no dissection of the coronary aneurysm. We speculate that coronary stenting might decrease the velocity of coronary flow through the stenosis. Consequently, stenting might attenuate the hydrodynamic wall stress on the aneurysm, and, in addtion, improve the degradation of the extracellular matrix structure through the regulation of matrix metalloproteinases. Regression of coronary aneurysm after stenting requires further investigations, because stenting may become a potential means for treating post-stenotic aneurysms. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
  • Yoshihito Kameda, Nobusada Funabashi, Miyuki Kawakubo, Masae Uehara, Hiroshi Hasegawa, Yoshio Kobayashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 120(2) 269-272 2007年8月  査読有り
  • Hiroya Narumi, Nobusada Funabashi, Hiroyuki Takano, Tai Sekine, Marehiko Ueda, Yasuhiko Hori, Taisuke Fukawa, Tohru Minamino, Yoshio Kobayashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 119(2) 222-224 2007年7月  査読有り
    We observed a 63-year old male with cardiac amyloidosis who presented with the clinical symptoms of sick sinus syndrome and dyspnea and abnormal thickening of the right atrial wall, which extended to the junction of the superior vena cava. This may explain the relationship of abnormal thickening of the right atrium which extends to the junction of the superior vena cava and right atrium with amyloid deposits in the sinus node and occurrence of sick sinus syndrome. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
  • Yasuhiko Hori, Marehiko Ueda, Takashi Nakayama, Noriko Saegusa, Masae Uehara, Kwangho Lee, Tai Sekine, Masao Daimon, Yoshio Kobayashi, Nobusada Funabashi, Issei Komuro
    INTERNATIONAL JOURNAL OF CARDIOLOGY 119(3) 403-407 2007年7月  査読有り
    We report here a 75-year-old male with hypertrophic obstructive cardiomyopathy of de novo sustained monomorphic ventricular tachycardia (VT) after successful percutaneous transluminal alcohol septal myocardial ablation (PTSMA). In this case history, the necrotic induced by the PTSMA procedure might represent a region of slow conduction that is a circuit of re-entry and therefore stimulation might be spread around. Therefore, the basis of the sustained monomorphic VT was thought to be the presence of a focal necrotic area, itself a complication arising from the PTSMA procedures. In conclusion, the PTSMA procedure may have caused a de novo episode of ventricular arrhythmia. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
  • Koki Nakamura, Nobusada Funabashi, Hideyuki Miyauchi, Mari Aminaka, Masae Uehara, Marehiko Ueda, Takashi Nakayama, Nakabumi Kuroda, Yoshio Kobayashi, Hiroyuki Takano, Issei Komuro
    CIRCULATION 115(25) E640-E642 2007年6月  査読有り
  • Ehara S, Kobayashi Y, Kataoka T, Yoshiyama M, Ueda M, Yoshikawa J
    Circulation journal : official journal of the Japanese Circulation Society 71(4) 530-535 2007年4月  査読有り
    Background Previous intravascular ultrasound (IVUS) studies have shown that calcification can be quantified by the determination of the arc on one cross-section. However, because calcium levels change along the length of lesions, it is important to assess the length of calcium using serial cross-sectional images. The correlation between the largest arc and length of each calcium deposit in patients with coronary artery disease (CAD) has not been determined. The present study was performed to determine this correlation. Methods and Results Preinterventional IVUS images of 194 patients with CAD were studied. The largest arc and length of all calcium within the 10-mm-long culprit lesion segment were quantified using serial cross-sectional images. One hundred and ninety-four patients had 277 calcium deposits. In all patients, the length of each calcium exhibited a strong correlation with the largest arc of calcium (R=0.750, p<0.0001). Conclusions Our findings revealed the quantitative characteristics of each calcium within the culprit lesion segment. They will be useful in interpreting results of previous and future IVUS studies, which deal only with the arc of calcium, as well as studies using new modalities such as computed tomography that assess calcium mainly along the long axis of the coronary artery. (Circ J 2007; 71: 530 - 535)<br>
  • Kenichi Fukushima, Yoshio Kobayashi, Tomonobu Okuno, Yoshitake Nakamura, Masayoshi Sakakibara, Takashi Nakayama, Nakabumi Kuroda, Akira Miyazaki, Youichi Shimizu, Issei Komuro
    CIRCULATION JOURNAL 71(4) 617-619 2007年4月  査読有り
    Background Because of its side-effects, long-term administration of ticlopidine limits the use of the sirolimuseluting stent (SES) in Japan. Methods and Results Side-effects of ticlopidine occurred in 41 (9.3%) of 440 patients who underwent SES implantation. The majority were liver dysfunction (4.5%) and rash (3.6%). One patient died from severe liver dysfunction. Neutropenia occurred in 3 patients (0.7%). It is remarkable that 28% of side-effects occurred &gt; 8 weeks after the initiation of ticlopidine. Conclusions Ticlopidine has a relative high rate of side-effects. Clopidogrel should be approved for prevention of stent thrombosis as soon as possible.
  • Nehiro Kuriyama, Yoshio Kobayashi, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    CIRCULATION 114(20) E586-E587 2006年11月  査読有り
  • Tatsuhiko Asano, Yoshio Kobayashi, Gary S. Mintz, Naoki Ishio, Shigenori Fujimaki, Yasuhide Ogawa, Takashi Nakayama, Nakabumi Kuroda, Issei Komuro
    AMERICAN JOURNAL OF CARDIOLOGY 98(8) 1041-1044 2006年10月  査読有り
    Serial (baseline and 9-month follow-up) intravascular ultrasound analysis was performed at 5-mm reference segments immediately proximal and distal to the sirolimus-eluting stent (SES) in 33 lesions. Proximal and distal reference segments were divided into 1-mm subsegments. Between postintervention and follow-up intravascular ultrasound studies, there were significant decreases in the lumen and increases in plaque & media areas in the subsegment closest to the distal edge, with no change in external elastic membrane area. There was no significant change in external elastic membrane, lumen, and plaque & media areas within the other subsegments. At the nearest 1-mm subsegment from the proximal and distal edges, baseline plaque & media area was associated with subsequent vessel remodeling. In conclusion, a large amount of plaque at the SES edge may be a risk of negative remodeling at follow-up (stent edge restenosis). It supports the importance of "normal-to-normal" SES deployment. (c) 2006 Elsevier Inc. All rights reserved.
  • T Yoshida, Y Kobayashi, T Nakayama, N Kuroda, N Komiyama, Komuro, I
    CIRCULATION JOURNAL 70(6) 800-801 2006年6月  査読有り
    Previous studies have shown that coronary stents have radial strength above the pressure induced by coronary artery spasm. This case report describes a stent deformity caused by coronary artery spasm during percutaneous coronary intervention.
  • K Tateno, T Minamino, H Toko, H Akazawa, N Shimizu, S Takeda, T Kunieda, H Miyauchi, T Oyama, K Matsuura, J Nishi, Y Kobayashi, T Nagai, Y Kuwabara, Y Iwakura, F Nomura, Y Saito, Komuro, I
    CIRCULATION RESEARCH 98(9) 1194-1202 2006年5月  査読有り
    The discovery of bone marrow - derived endothelial progenitors in the peripheral blood has promoted intensive studies on the potential of cell therapy for various human diseases. Accumulating evidence has suggested that implantation of bone marrow mononuclear cells effectively promotes neovascularization in ischemic tissues. It has also been reported that the implanted cells are incorporated not only into the newly formed vessels but also secrete angiogenic factors. However, the mechanism by which cell therapy improves tissue ischemia remains obscure. We enrolled 29 " no- option" patients with critical limb ischemia and treated ischemic limbs by implantation of peripheral mononuclear cells. Cell therapy using peripheral mononuclear cells was very effective for the treatment of limb ischemia, and its efficacy was associated with increases in the plasma levels of angiogenic factors, in particular interleukin- 1 beta ( IL- 1 beta). We then examined an experimental model of limb ischemia using IL- 1 beta - deficient mice. Implantation of IL- 1 beta - deficient mononuclear cells improved tissue ischemia as efficiently as that of wild- type cells. Both wild- type and IL- 1 beta - deficient mononuclear cells increased expression of IL- 1 beta and thus induced angiogenic factors in muscle cells of ischemic limbs to a similar extent. In contrast, inability of muscle cells to secrete IL- 1 beta markedly reduces induction of angiogenic factors and impairs neovascularization by cell implantation. Implanted cells do not secret angiogenic factors sufficient for neovascularization but, instead, stimulate muscle cells to produce angiogenic factors, thereby promoting neovascularization in ischemic tissues. Further studies will allow us to develop more effective treatments for ischemic vascular disease.
  • K Fujii, SG Carlier, GS Mintz, Y Kobayashi, D Jacoboff, H Nierenberg, H Takebayashi, T Yasuda, Moussa, I, G Dangas, R Mehran, AJ Lansky, EM Kreps, M Collins, GW Stone, MB Leon, JW Moses
    AMERICAN JOURNAL OF CARDIOLOGY 95(3) 355-359 2005年2月  査読有り
    Patients with acute coronary syndrome are at increased risk of acute and long-term events after stent implantation. We compared the impact of intravascular ultrasound defected plaque rupture on creatine kinase-MB (CK-MB) isoenzyme release and clinical outcomes by comparing 62 patients with ruptured plaques with 62 matched control patients who underwent stent implantation. Two thirds of the patients in each group presented with an acute coronary syndrome. There were no differences in procedural complications between groups, although patients with ruptured plaque had higher CK-MB elevation rates than those without ruptured plaque (I to 3 times the upper limit of normal CK-MB, 35% vs 10%, p &lt;0.001; &gt;3 times the upper limit, 15% vs 2%, p = 0.02). Independent predictors of CK-MB elevation were presence of ruptured plaque (p = 0.03) and unstable angina (p = 0.04). Patients with ruptured plaque had higher composite rates of late events (target lesion revascularizations/myocardial infarctions/cardiac deaths) than controls (25% vs 9%, p = 0.03). These results were similar when only patients with acute coronary syndrome were studied. Plaque rupture morphology is associated with higher periprocedural CK-MB release and worse 1-year clinical outcome in patients treated with coronary stenting. (C)2005 by Excerpta Medica Inc.

MISC

 395
  • Yuichi Saito, Yoshio Kobayashi, Kenichi Tsujita, Koichiro Kuwahara, Yuji Ikari, Hiroyuki Tsutsui, Koichiro Kinugawa, Ken Kozuma
    Circulation Journal 88(11) 1727-1736 2024年11月  
    In patients with acute myocardial infarction (MI), heart failure (HF) is one of the most common complications that is associated with a significant burden of mortality and healthcare resources. The clinical benefits of key HF drugs, the so-called “4 pillars” or “fantastic 4”, namely β-blockers, mineralocorticoid receptor antagonists, angiotensin receptor-neprilysin inhibitor, and sodium-glucose cotransporter 2 inhibitors, have been established in patients with HF with reduced ejection fraction, whereas the effects of these drugs are not comprehensively appreciated in patients with acute MI. This review summarizes current evidence on pharmacological and device-based interventions for preventing HF after acute MI.
  • Yoshiyasu Minami, Junya Ako, Kenichi Tsujita, Hiroyoshi Yokoi, Yuji Ikari, Yoshihiro Morino, Yoshio Kobayashi, Ken Kozuma
    Cardiovascular Intervention and Therapeutics 39(3) 223-233 2024年7月  
    Abstract: Non-culprit lesion-related coronary events are a significant concern in patients with coronary artery disease (CAD) undergoing coronary intervention. Since several studies using intra-coronary imaging modalities have reported a high prevalence of vulnerable plaques in non-culprit lesions at the initial coronary event, the immediate stabilization of these plaques by intensive pharmacological regimens may contribute to the reduction in the adverse events. Although current treatment guidelines recommend the titration of statin and other drugs to attain the treatment goal of low-density lipoprotein cholesterol (LDL-C) level in patients with CAD, the early prescription of strong LDL-C lowering drugs with more intensive regimen may further reduce the incidence of recurrent cardiovascular events. In fact, several studies with intensive regimen have demonstrated a higher percentage of patients with the attainment of LDL-C treatment goal in the early phase following discharge. In addition to many imaging studies showing plaque stabilization by LDL-C lowering drugs, several recent reports have shown the efficacy of early statin and proprotein convertase subtilisin/kexin type 9 inhibitors on the immediate stabilization of non-culprit coronary plaques. To raise awareness regarding this important concept of immediate plaque stabilization and subsequent reduction in the incidence of recurrent coronary events, the term ‘Drug Intervention’ has been introduced and gradually applied in the clinical field, although a clear definition is lacking. The main target of this concept is patients with acute coronary syndrome as a higher prevalence of vulnerable plaques in non-culprit lesions in addition to the worse clinical outcomes has been reported in recent imaging studies. In this article, we discuss the backgrounds and the concept of drug intervention. Graphical Abstract: (Figure presented.)
  • AOKI Shuhei, TAKAOKA Hiroyuki, KINOSHITA Makiko, YASHIMA Satomi, SUZUKI Katsuya, NISHIKAWA Yusei, NOGUCHI Yoshitada, YOSHIDA Kazuki, SASAKI Haruka, SUZUKI Noriko, KOBAYASHI Yoshio
    日本循環器学会学術集会(Web) 88th 2024年  
  • 與子田一輝, 與子田一輝, 佐々木晴香, 佐々木晴香, 佐々木晴香, 高岡浩之, 鎌田知子, 川崎健治, 江口紀子, 江口紀子, 江口紀子, 小林欣夫, 松下一之, 松下一之
    超音波医学 Supplement 51 2024年  
  • YASHIMA Satomi, TAKAOKA Hiroyuki, TAKAHASHI Manami, KINOSHITA Makiko, AOKI Shuhei, KOBAYASHI Yoshio
    日本循環器学会学術集会(Web) 87th 2023年  
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