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| 1.
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Nakajima, Kenichi ; Yamasaki, Yoshimitsu ; Kusuoka, Hideo ; Izumi, Tohru ; Kashiwagi, Atsunori ; Kawamori, Ryuzo ; Shimamoto, Kazuaki ; Yamada, Nobuhiro ; Nishimura, Tsunehiko
概要:
金沢大学医薬保健研究域医学系<br />Purpose Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusi
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on imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0–3, 4–8, 9–13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. Conclusion The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients.
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| 2.
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Nakajima, Kenichi ; Yamasaki, Yoshimitsu ; Kusuoka, Hideo ; Izumi, Tohru ; Kashiwagi, Atsunori ; Kawamori, Ryuzo ; Shimamoto, Kazuaki ; Yamada, Nobuhiro ; Nishimura, Tsunehiko
概要:
金沢大学医薬保健研究域医学系<br />Purpose: Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfus
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ion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods: A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results: Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. Conclusion: The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients. © 2009 Springer-Verlag.
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Nitta, Y. ; Yamamoto, R. ; Yamaguchi, Y. ; Katsuda, S. ; Kaku, B. ; Taguchi, T. ; Takabatake, S. ; Nakahama, K. ; Yamagishi, Masakazu ; 山岸, 正和
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金沢大学医薬保健研究域医学系<br />Calcium channel blockers (CCBs) can prevent cardiovascular events in patients with coronary artery d
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isease (CAD). This study looked retrospectively at the prognosis of CAD in hypertensive patients with CAD who had undergone a coronary angiograph, had been given a CCB (benidipine [n = 66], amlodipine [n = 45], or long-acting nifedipine [n = 31]) on hospital discharge and were then followed up for a mean ± SD of 5.2 ± 2.9 years. Systolic/diastolic blood pressure for all 142 patients decreased significantly from a mean ± SD of 137 ± 20/74 ± 15 mmHg to 129 ± 20/71 ± 12 mmHg. Major adverse cardiovascular events (MACE) occurred in 15 patients. Chronic kidney disease (CKD) was a significant risk factor for MACE (hazard ratio 2.35, 95%confidence intervals 1.45, 3.80). Benidipine was superior to nifedipine in preventing MACE in patients both with and without CKD. In conclusion, benidipine and amlodipine reduced the frequency of MACE in hypertensive patients with CAD, particularly in those with complicating CKD. © 2010 Field House Publishing LLP.
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Nakajima, Kenichi ; Matsuo, Shinro ; Okuda, Koichi ; Wakabayashi, Hiroshi ; Tsukamoto, Kazumasa ; Nishimura, Tsunehiko
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Background:Myocardial perfusion imaging (MPI) has been used to estimate cardiac event risk. The aim of the present study
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is to achieve stable risk estimation based on perfusion scoring and a multi-center prognostic database. Methods and Results:Multivariate logistic regression analysis was performed to estimate cardiac event risk based on a J-ACCESS study. A stress-MPI was performed in 45 patients with coronary artery disease (CAD) and in 25 non-CAD patients. Perfusion defect scoring of summed stress score (SSS) was performed by 5 methods: (1) visual scoring; (2) automatic scoring of 3 short-axis and 1 vertical long-axis slices; (3) visual modification of Method 2; (4) automatic polar map scoring based on a Japanese multi-center database; and (5) visual modification of Method 4. Agreement of SSS between 2 observers was good (r=0.87-0.97). Agreement of estimated cardiac event risk between observers and among 5 methods was very good (r=0.99-1.00). Regarding diagnostic accuracy for CAD, Method 5 showed optimal diagnostic yields (sensitivity 84%, accuracy 77%). Conclusions:Estimation of cardiac event risk in conjunction with polar map segmentation and common normal databases resulted in stable risk values, and might be used for risk stratification in patients suspected of having CAD. © All rights are reserved to the Japanese Circulation Society.
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Daida, Hiroyuki ; Takayama, Tadateru ; Hiro, Takafumi ; Yamagishi, Masakazu ; Hirayama, Atsushi ; Saito, Satoshi ; Yamaguchi, Tetsu
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Background: The incidence of cardiac events is higher in patients with diabetes than in people without diabetes. The Cor
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onary Atherosclerosis Study Measuring Effects of Rosuvastatin Using Intravascular Ultrasound in Japanese Subjects (COSMOS) demonstrated significant plaque regression in Japanese patients with chronic coronary disease after 76 weeks of rosuvastatin (2.5 mg once daily, up-titrated to a maximum of 20 mg/day to achieve LDL cholesterol <80 mg/dl).Methods: In this subanalysis of COSMOS, we examined the association between HbA1c and plaque regression in 40 patients with HbA1c ≥6.5% (high group) and 86 patients with HbA1c <6.5% (low group).Results: In multivariate analyses, HbA1c and plaque volume at baseline were major determinants of plaque regression. LDL cholesterol decreased by 37% and 39% in the high and low groups, respectively, while HDL cholesterol increased by 16% and 22%, respectively. The reduction in plaque volume was significantly (p = 0.04) greater in the low group (from 71.0 ± 39.9 to 64.7 ± 34.7 mm3) than in the high group (from 74.3 ± 34.2 to 71.4 ± 32.3 mm3). Vessel volume increased in the high group but not in the low group (change from baseline: +4.2% vs -0.8%, p = 0.02). Change in plaque volume was significantly correlated with baseline HbA1c.Conclusions: Despite similar improvements in lipid levels, plaque regression was less pronounced in patients with high HbA1c levels compared with those with low levels. Tight glucose control during statin therapy may enhance plaque regression in patients with stable coronary disease.Trial registration: ClinicalTrials.gov, Identifier NCT00329160. © 2012 Daida et al.; licensee BioMed Central Ltd.
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| 6.
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Nakajima, Kenichi ; Matsuo, Shinro ; Wakabayashi, Hiroshi ; Yokoyama, Kunihiko ; Bunko, Hisashi ; Okuda, Koichi ; Kinuya, Seigo ; Nyström, Karin ; Edenbrandt, Lars
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Background:The purpose of this study was to apply an artificial neural network (ANN) in patients with coronary artery di
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sease (CAD) and to characterize its diagnostic ability compared with conventional visual and quantitative methods in myocardial perfusion imaging (MPI).Methods and Results:A total of 106 patients with CAD were studied with MPI, including multiple vessel disease (49%), history of myocardial infarction (27%) and coronary intervention (30%). The ANN detected abnormal areas with a probability of stress defect and ischemia. The consensus diagnosis based on expert interpretation and coronary stenosis was used as the gold standard. The left ventricular ANN value was higher in the stress-defect group than in the no-defect group (0.92±0.11 vs. 0.25±0.32, P<0.0001) and higher in the ischemia group than in the no-ischemia group (0.70±0.40 vs. 0.004±0.032, P<0.0001). Receiver-operating characteristics curve analysis showed comparable diagnostic accuracy between ANN and the scoring methods (0.971 vs. 0.980 for stress defect, and 0.882 vs. 0.937 for ischemia, both P=NS). The relationship between the ANN and defect scores was non-linear, with the ANN rapidly increased in ranges of summed stress score of 2–7 and summed defect score of 2–4.Conclusions:Although the diagnostic ability of ANN was similar to that of conventional scoring methods, the ANN could provide a different viewpoint for judging abnormality, and thus is a promising method for evaluating abnormality in MPI. (Circ J 2015; 79: 1549–1556)
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| 7.
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Nakajima, Kenichi ; Nishimura, Tsunehiko
概要:
The multicenter Japanese-Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS), which involved 117 institutions and 4,629 patients, was the first attempt to quantify cardiac events and survival using
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stress-rest-gated single-photon emission computed tomography myocardial perfusion images (MPI) and QGS software in Japan. A 3-year follow-up study showed a relatively lower incidence of hard events than in the USA and some European countries, but a similar role of perfusion and left ventricular (LV) function. A low event risk with normal MPI and a higher incidence of major cardiac events in patients with large perfusion defects and LV dysfunction were defined. MPI was useful even among patients with proven coronary artery stenosis. The association between diabetes and chronic kidney disease (CKD) was an important predictor of cardiac events and the risk was evaluated using new software and risk charts. Additional studies were extended to include asymptomatic diabetes (J-ACCESS 2) and CKD (J-ACCESS 3). Because risk estimation is linked to the national healthcare system and clinical practice, optimal risk stratification and guidance for therapeutic strategies are recommended. (Circ J 2012; 76: 1313-1321)
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| 8.
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Nakajima, Kenichi ; Matsuo, Shinro ; Kawano, Masaya ; Matsumoto, Naoya ; Hashimoto, Jun ; Yoshinaga, Keiichiro ; Taki, Junichi ; Okuda, Koichi
概要:
金沢大学医薬保健研究域医学系<br />Purpose The Japanese Society of Nuclear Medicine (JSNM) working group has created a myocardial perfu
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sion imaging database applicable to standard acquisition protocol. The aim of this study is to validate the diagnostic accuracy of the common normal database compared with the expert interpretation of each institute. Methods Five institutions participated in this study and used different acquisition settings which included 360°/ 180° rotation, camera configuration and camera orbits. The software and its version used in each institution also varied. The working group database was applied to detect the culprit coronary territory from a total of 166 patients with coronary artery disease (CAD) and 145 patients with lowlikelihood of CAD. Results When summed stress score C4 was defined as significant abnormality, overall sensitivity, specificity and accuracy of patient-based analysis were 77, 72 and 75%, respectively, based on quantitative analysis using the common database, whereas those by institutional visual expert reading were 72, 79 and 75%, respectively. Conclusion The common database, which was created by a multi-center working group and separated between male/ female with 180/360° acquisitions, demonstrated comparable diagnostic accuracy to expert interpretation by each institute, and it may be applicable to multi-center studies.
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| 9.
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論文
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Nakajima, Kenichi ; Nishimura, Tsunehiko
概要:
The multicenter Japanese-Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS), which involved 117 institutions and 4,629 patients, was the first attempt to quantify cardiac events and survival using
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stress-rest-gated single-photon emission computed tomography myocardial perfusion images (MPI) and QGS software in Japan. A 3-year follow-up study showed a relatively lower incidence of hard events than in the USA and some European countries, but a similar role of perfusion and left ventricular (LV) function. A low event risk with normal MPI and a higher incidence of major cardiac events in patients with large perfusion defects and LV dysfunction were defined. MPI was useful even among patients with proven coronary artery stenosis. The association between diabetes and chronic kidney disease (CKD) was an important predictor of cardiac events and the risk was evaluated using new software and risk charts. Additional studies were extended to include asymptomatic diabetes (J-ACCESS 2) and CKD (J-ACCESS 3). Because risk estimation is linked to the national healthcare system and clinical practice, optimal risk stratification and guidance for therapeutic strategies are recommended. (Circ J 2012; 76: 1313-1321)
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| 10.
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論文
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Nakajima, Kenichi ; Nishimura, Tsunehiko
概要:
The multicenter Japanese-Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS), which involved 117 institutions and 4,629 patients, was the first attempt to quantify cardiac events and survival using
…
stress-rest-gated single-photon emission computed tomography myocardial perfusion images (MPI) and QGS software in Japan. A 3-year follow-up study showed a relatively lower incidence of hard events than in the USA and some European countries, but a similar role of perfusion and left ventricular (LV) function. A low event risk with normal MPI and a higher incidence of major cardiac events in patients with large perfusion defects and LV dysfunction were defined. MPI was useful even among patients with proven coronary artery stenosis. The association between diabetes and chronic kidney disease (CKD) was an important predictor of cardiac events and the risk was evaluated using new software and risk charts. Additional studies were extended to include asymptomatic diabetes (J-ACCESS 2) and CKD (J-ACCESS 3). Because risk estimation is linked to the national healthcare system and clinical practice, optimal risk stratification and guidance for therapeutic strategies are recommended.
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