The association of epicardial fat volume with coronary characteristics and clinical outcome.

Recent studies have demonstrated the relationship between epicardial fat volume (EFV) and coronary atherosclerosis, but their association is modest at best. Our purpose is to elucidate the association of epicardial fat with coronary characteristics and clinical outcome. We performed coronary computed tomographic angiography in 651 patients and divided them into three groups according to tertiles of EFV; low-tertile (n = 215), 36-123 ml; middle-tertile (n = 218), 124-165 ml; high-tertile (n = 218), 166-489 ml.

Relationship between coronary calcium score and high-risk plaque/significant stenosis.

Aim: To investigate the relationship between coronary calcium score (CCS) and vulnerable plaque/significant stenosis using coronary computed tomographic angiography (CCTA).

Methods: CCTA was performed in 651 patients and these patients were divided into the four groups (CCS 0, 1-100, 101-400 and > 400). We studied the incidence of high-risk plaque, including positive remodeling, low attenuation plaque, spotty calcification, and napkin-ring sign, and significant stenosis in each group.

Dynamic change of high-risk plaque detected by coronary computed tomographic angiography in patients with subclinical coronary artery disease.

We studied the dynamic change of high-risk plaque detected by coronary computed tomographic angiography (CCTA) in patients with subclinical coronary artery disease. We analyzed paired CCTA findings in 103 patients. The follow-up period was 1.

Potential Utility of Multidetector Computed Tomography to Identify both Cardiac Embolic Sources and Coronary Artery Disease in Patients with Embolic Stroke.

Objectives: Our objective was to study the potential utility of multidetector computed tomography (MDCT) to identify both cardiac embolic sources and coronary artery disease (CAD) in embolic-stroke patients.

Methods: We performed MDCT for 184 patients with embolic stroke but without known CAD. Twenty-six patients had atrial fibrillation.

Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.

Background: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear.

Objectives: The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization.

Methods: Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement.

Prevalence of subclinical coronary artery disease in ischemic stroke patients.

Background: Recently, ischemic stroke has emerged as a new coronary artery disease (CAD) risk equivalent. Our purpose is to study the prevalence of CAD in ischemic stroke patients compared with that in non-stroke patients.

Methods And Results: We measured coronary calcium score (CCS) in 151 ischemic stroke patients without known CAD (stroke group) and compared it with 151 age- and sex-matched non-stroke patients (control group).

Myocardial ischemia is a key factor in the management of stable coronary artery disease.

Previous studies demonstrated that coronary revascularization, especially percutaneous coronary intervention (PCI), does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease. Many studies using myocardial perfusion imaging (MPI) showed that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit, whereas for patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality. There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia, which is associated with increased mortality.

Myocardial perfusion defect in patients with coronary artery disease demonstrated by 64-multidetector computed tomography at rest.

Background: The first-pass imaging of 64-multidetector computed tomography (MDCT) using pharmacological stress has been used to assess myocardial perfusion. However, detection of myocardial ischemia at rest using MDCT has yet to be elucidated. We studied the incidence of myocardial perfusion defect (MPD) by 64-MDCT at rest and the effect of coronary revascularization therapy on MPD in patients with coronary artery disease.

Relationship between epicardial fat measured by 64-multidetector computed tomography and coronary artery disease.

Background: Epicardial fat (EF) is the visceral fat of the heart deposited under the visceral layer of the pericardium and has the same origin as abdominal visceral fat, which is shown to be strongly related to the development of coronary artery disease (CAD). We measured the volume of EF (EFV) by 64-multidetector computed tomography (MDCT) and studied the relationship between EFV and the severity of CAD.

Hypothesis: Epicardial fat volume increases steeply in patients with significant coronary artery stenosis and in those with severe coronary artery calcification.

Coronary pressure measurement identifies patients with diffuse coronary artery disease who benefit from coronary revascularization.

Objective: We analyzed the pressure drop pattern in patients with diffuse coronary artery disease and treated these patients according to their pressure drop pattern.

Methods: We measured pullback coronary pressure from the distal to the proximal left anterior descending coronary artery in 83 patients with diffuse coronary artery disease. Coronary pressure pattern was divided into two types: the abrupt and gradual pressure drop patterns.

Prevalence of subclinical atherosclerosis in asymptomatic patients with low-to-intermediate risk by 64-slice computed tomography.

Background: Recent research has shown that cardiovascular risk scoring significantly underestimates or misclassifies risk in key subsets of the population. There is a growing need for a noninvasive imaging to detect a subclinical atherosclerosis. Thus we hypothesized that 64-slice computed tomography (CT) could effectively detect subclinical atherosclerosis in asymptomatic patients with low-to-intermediate risk.

Coronary pressure measurement based decision making for percutaneous coronary intervention.

The fractional flow reserve (FFR) is a simple, reliable, and reproducible physiologic index of lesion severity. In patients with intermediate stenosis, FFR≥0.75 can be used to safely defer percutaneous coronary intervention (PCI), and patients with FFR≥0.

[Clinical experience with intravenous administration of nifekalant hydrochloride for ventricular tachycardia in a hemodialysis patient after open heart surgery].

A 78-year-old man with chronic renal failure (CRF) on hemodialysis (HD) was diagnosed as having severe aortic regurgitation with left ventricular dysfunction. Aortic valve replacement with a 21 mm ATS mechanical bileaflet prosthesis was performed without intraoperative complications. Sustained ventricular tachycardia suddenly occurred 1 day after surgery, then intravenous administration of nifekalant hydrochloride (NIF) was started at a dose of 0.

Prevalence of non-calcified coronary plaque on 64-slice computed tomography in asymptomatic patients with zero and low coronary artery calcium.

Objectives: To study the prevalence of noncalcified plaque in asymptomatic low-risk patients with no or mild coronary artery calcium (CAC).

Methods: From 502 patients with coronary risk factors who underwent 64-slice computed tomography, 224 asymptomatic patients were identified with no CAC (n=117) or mild CAC (n=107; defined as patients with Agatston scores from 1 to 100).

Results: Patients with no CAC were younger and had diabetes less often.

Distribution of coronary atherosclerosis in patients with coronary artery disease.

The distribution of coronary atherosclerosis has not been fully clarified. We measured coronary artery calcium score (CACS) in 624 consecutive patients for the right coronary artery (RCA), left main trunk (LMT), left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCx), then calculated total CACS. Coronary artery calcium score was measured using the Agatston method.

Prevention of coronary slow flow/no reflow during percutaneous coronary intervention by the use of embolic protection device, 'Filtrap'.

A 68 year-old man underwent percutaneous coronary intervention (PCI). A 64 multi-slice computed tomography (MSCT) demonstrated a non-calcified plaque with positive remodeling. Intravascular ultrasound showed severe attenuation which suggested high risk of coronary no reflow during PCI.

Prevalence of subclinical atherosclerosis in asymptomatic diabetic patients by 64-slice computed tomography.

Objectives: Patients with diabetes have a 2-fold to 4-fold higher risk of a cardiovascular event than nondiabetic patients. Thus there is a need to identify patients with diabetes who are at risk of cardiovascular events before the onset of symptoms. We studied the prevalence of coronary artery disease in asymptomatic diabetic patients compared with asymptomatic nondiabetic patients by 64-slice computed tomography (CT).

Comparison of the effects of nicorandil versus verapamil on the incidence of slow flow/no reflow during rotational atherectomy.

In rotational atherectomy, the slow-flow/no-reflow phenomenon is a common complication, which usually results in myocardial injury. We prospectively randomized 111 patients with successful rotational atherectomy into a verapamil group (group V, n = 56) and a nicorandil group (group N, n = 55). We compared final burr size, total ablation time, maximum decrease in revolutions per minute, incidence of slow flow/no reflow, creatine kinase-MB increase, and cardiac troponin T increase between the 2 groups.

Changes in escape rhythms several years after radiofrequency ablation of the atrioventricular junction combined with pacemaker implantation.

Objective: Escape rhythm is thought to play a considerable role in protection against adverse outcome due to pacemaker malfunction. We studied the escape rhythms in 32 patients with supraventricular tachyarrhythmia refractory to medical therapy who underwent radiofrequency ablation of the atrioventricular junction combined with implantation of a pacemaker.

Methods And Results: We performed the escape rhythm analysis immediately and 2.

Coronary pressure measurement to identify the lesion requiring percutaneous coronary intervention in equivocal tandem lesions.

Objectives: No reliable methods are available for determining application of percutaneous coronary intervention for treatment of equivocal tandem lesions. We investigated whether coronary pressure measurement is useful for determining the lesion that requires percutaneous coronary intervention in tandem lesions.

Methods: We measured coronary pressure in 72 consecutive patients with tandem lesions.

Nicorandil reduces the incidence of minor cardiac marker elevation after coronary stenting.

Background: Minor cardiac marker elevation after percutaneous coronary intervention has long-term prognostic significance. We examined whether nicorandil, a nicotinamide-nitrate ester, reduces the incidence of minor cardiac marker elevation after coronary stenting.

Methods: Patients (n=192) undergoing coronary stenting were randomly assigned to receive nicorandil (nicorandil group, n=91) or vehicle (control group, n=101).

Coronary pressure measurement to determine treatment strategy for equivocal left main coronary artery lesions.

It is often hard to select a treatment strategy for equivocal left main coronary artery (LMCA) disease. We investigated the usefulness of coronary pressure (CP) measurement for determining the treatment strategy in intermediate LMCA disease. We measured CP in 15 consecutive patients with equivocal LMCA disease (age 67.

Significant correlation of recruitable coronary collateral blood flow determined by coronary wedge pressure with ST-segment elevation during coronary occlusion.

Objectives: Quantitative assessment of coronary collateral blood flow can be archived by measuring coronary pressure. We studied the relationships between recruitable coronary collateral blood flow and electrocardiographic changes during percutaneous coronary intervention (PCI).

Methods: We measured coronary pressure during coronary occlusion with PCI in 119 patients with left anterior descending coronary artery stenosis.