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Kawakami T, Matsubara H, Abe K, Kataoka M, Kohsaka S, Sato Y, Shinke T, Fukuda K. Multicentre randomised controlled trial of balloon pulmonary angioplasty and riociguat in patients with chronic thromboembolic pulmonary hypertension: protocol for the MR BPA study. BMJ Open 2020; 10:e028831. [PMID: 32034015 PMCID: PMC7045190 DOI: 10.1136/bmjopen-2018-028831] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Management of inoperable chronic thromboembolic pulmonary hypertension (CTEPH) remains a clinical challenge. Currently, medical treatment involving pulmonary vasodilators (such as soluble guanylate-cyclase stimulators) is recommended, primarily for ameliorating symptoms. More recently, balloon pulmonary angioplasty (BPA) has been developed as alternative treatment for inoperable CTEPH. This study aimed to compare the efficacy and safety of BPA and riociguat (a soluble guanylate-cyclase stimulator) as treatments for inoperable CTEPH. METHODS AND ANALYSIS This study is a multicentre randomised controlled trial. Subjects with inoperable CTEPH were randomised (1:1) into either a BPA or riociguat group, and observed for 12 months after initiation of treatment. The primary endpoint will be the change in mean pulmonary arterial pressure from baseline to 12 months after initiation of treatment. For primary analysis, we will estimate the least square means difference and 95% CI for the change of pulmonary arterial pressure between the groups at 12 months using the analysis of covariance adjusted for allocation factors. ETHICS AND DISSEMINATION This study and its protocols were approved by the institutional review board of Keio University School of Medicine and each participating institution. Written informed consent was obtained from all participants. Results will be disseminated at medical conferences and in journal publications. TRIAL REGISTRATION NUMBER University Hospital Medical Information Network Clinical Trial Registry (UMIN000019549); Pre-results.
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Affiliation(s)
- Takashi Kawakami
- Department of Cardiology, Keio University, School of Medicine, Tokyo, Japan
| | - Hiromi Matsubara
- Department of Cardiology and Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Masaharu Kataoka
- Department of Cardiology, Keio University, School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University, School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Showa University, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University, School of Medicine, Tokyo, Japan
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Akagi S, Matsubara H, Nakamura K, Oto T, Ejiri K, Ito H. Marked Reduction of Pulmonary Artery Pressure After Registration for Lung Transplantation Is Associated With Long-Term Survival in Patients With Pulmonary Arterial Hypertension ― Cohort Study ―. Circ J 2020; 84:245-251. [DOI: 10.1253/circj.cj-19-0784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
| | | | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
| | - Takahiro Oto
- Department of Organ Transplant Center, Okayama University Hospital
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
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Barco S, Klok FA, Konstantinides SV, Dartevelle P, Fadel E, Jenkins D, Kim NH, Madani M, Matsubara H, Mayer E, Pepke-Zaba J, Simonneau G, Delcroix M, Lang IM. Sex-specific differences in chronic thromboembolic pulmonary hypertension. Results from the European CTEPH registry. J Thromb Haemost 2020; 18:151-161. [PMID: 31479557 DOI: 10.1111/jth.14629] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Women are more susceptible than men to several forms of pulmonary hypertension, but have better survival. Sparse data are available on chronic thromboembolic pulmonary hypertension (CTEPH). METHODS We investigated sex-specific differences in the clinical presentation of CTEPH, performance of pulmonary endarterectomy (PEA), and survival. RESULTS Women constituted one-half of the study population of the European CTEPH registry (N = 679) and were characterized by a lower prevalence of some cardiovascular risk factors, including prior acute coronary syndrome, smoking habit, and chronic obstructive pulmonary disease, but more prevalent obesity, cancer, and thyroid diseases. The median age was 62 (interquartile ratio, 50-73) years in women and 63 (interquartile ratio, 53-70) in men. Women underwent PEA less often than men (54% vs 65%), especially at low-volume centers (48% vs 61%), and were exposed to fewer additional cardiac procedures, notably coronary artery bypass graft surgery (0.5% vs 9.5%). The prevalence of specific reasons for not being operated, including patient's refusal and the proportion of proximal vs distal lesions, did not differ between sexes. A total of 57 (17.0%) deaths in women and 70 (20.7%) in men were recorded over long-term follow-up. Female sex was positively associated with long-term survival (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.94). Short-term mortality was identical in the two groups. CONCLUSIONS Women with CTEPH underwent PEA less frequently than men, especially at low-volume centers. Furthermore, they had a lower prevalence of cardiovascular risk factors and were less often exposed to additional cardiac surgery procedures. Women had better long-term survival.
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Affiliation(s)
- Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Frederikus A Klok
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, University General Hospital, Alexandroupolis, Greece
| | - Philippe Dartevelle
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Paris, France
| | - Elie Fadel
- Faculté de Médecine, University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - David Jenkins
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Nick H Kim
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA
| | - Michael Madani
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, CA, USA
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | | | - Gérald Simonneau
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marion Delcroix
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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Wada H, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Nakamura T, Fujimoto K, Matsubara H, Kato T, Unoki T, Takagi D, Ura S, Wada K, Iguchi M, Masunaga N, Ishii M, Yamakage H, Shimatsu A, Kotani K, Satoh-Asahara N, Abe M, Akao M, Hasegawa K. VEGF-C and Mortality in Patients With Suspected or Known Coronary Artery Disease. J Am Heart Assoc 2019; 7:e010355. [PMID: 30554564 PMCID: PMC6404168 DOI: 10.1161/jaha.118.010355] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The lymphatic system has been suggested to play an important role in cholesterol metabolism and cardiovascular disease. However, the relationships of vascular endothelial growth factor‐C (VEGF‐C), a central player in lymphangiogenesis, with mortality and cardiovascular events in patients with suspected or known coronary artery disease are unknown. Methods and Results We performed a multicenter, prospective cohort study of 2418 patients with suspected or known coronary artery disease undergoing elective coronary angiography. The primary predictor was serum levels of VEGF‐C. The primary outcome was all‐cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events defined as a composite of cardiovascular death, non‐fatal myocardial infarction, and non‐fatal stroke. During the 3‐year follow‐up, 254 patients died from any cause, 88 died from cardiovascular disease, and 165 developed major adverse cardiovascular events. After adjustment for established risk factors, VEGF‐C levels were significantly and inversely associated with all‐cause death (hazard ratio for 1‐SD increase, 0.69; 95% confidence interval, 0.60–0.80) and cardiovascular death (hazard ratio, 0.67; 95% confidence interval, 0.53–0.87), but not with major adverse cardiovascular events (hazard ratio, 0.85; 95% confidence interval, 0.72–1.01). Even after incorporation of N‐terminal pro‐brain natriuretic peptide, contemporary sensitive cardiac troponin‐I, and high‐sensitivity C‐reactive protein into a model with established risk factors, the addition of VEGF‐C levels further improved the prediction of all‐cause death, but not that of cardiovascular death or major adverse cardiovascular events. Consistent results were observed within 1717 patients with suspected coronary artery disease. Conclusions In patients with suspected or known coronary artery disease, a low VEGF‐C value may independently predict all‐cause mortality.
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Affiliation(s)
- Hiromichi Wada
- 1 Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Masahiro Suzuki
- 2 Department of Clinical Research National Hospital Organization Saitama National Hospital Saitama Japan
| | - Morihiro Matsuda
- 3 Division of Preventive Medicine Institute for Clinical Research National Hospital Organization Kure Medical Center Hiroshima Japan
| | - Yoichi Ajiro
- 4 Department of Cardiology National Hospital Organization Yokohama Medical Center Kanagawa Japan
| | - Tsuyoshi Shinozaki
- 5 Department of Cardiology National Hospital Organization Sendai Medical Center Sendai Japan
| | - Satoru Sakagami
- 6 Institute for Clinical Research National Hospital Organization Kanazawa Medical Center Kanazawa Japan
| | - Kazuya Yonezawa
- 7 Division of Clinical Research National Hospital Organization Hakodate Hospital Hakodate Japan
| | - Masatoshi Shimizu
- 8 Department of Cardiology National Hospital Organization Kobe Medical Center Kobe Japan
| | - Junichi Funada
- 9 Department of Cardiology National Hospital Organization Ehime Medical Center Ehime Japan
| | - Takashi Takenaka
- 10 Division of Cardiology National Hospital Organization Hokkaido Medical Center Sapporo Japan
| | - Yukiko Morita
- 11 Department of Cardiology National Hospital Organization Sagamihara National Hospital Kanagawa Japan
| | - Toshihiro Nakamura
- 12 Department of Cardiology National Hospital Organization Kyushu Medical Center Fukuoka Japan
| | - Kazuteru Fujimoto
- 13 Department of Cardiology National Hospital Organization Kumamoto Medical Center Kumamoto Japan
| | - Hiromi Matsubara
- 14 Department of Cardiology and Department of Clinical Science National Hospital Organization Okayama Medical Center Okayama Japan
| | - Toru Kato
- 15 Department of Clinical Research National Hospital Organization Tochigi Medical Center Utsunomiya Japan
| | - Takashi Unoki
- 1 Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Daisuke Takagi
- 16 Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Shuichi Ura
- 1 Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kyohma Wada
- 1 Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Moritake Iguchi
- 16 Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Nobutoyo Masunaga
- 16 Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Mitsuru Ishii
- 16 Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hajime Yamakage
- 17 Department of Endocrinology, Metabolism, and Hypertension National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Akira Shimatsu
- 18 Clinical Research Institute National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kazuhiko Kotani
- 19 Division of Community and Family Medicine Jichi Medical University Shimotsuke Japan
| | - Noriko Satoh-Asahara
- 17 Department of Endocrinology, Metabolism, and Hypertension National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Mitsuru Abe
- 16 Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Masaharu Akao
- 16 Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Koji Hasegawa
- 1 Division of Translational Research National Hospital Organization Kyoto Medical Center Kyoto Japan
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Nakamura K, Akagi S, Ejiri K, Yoshida M, Miyoshi T, Toh N, Nakagawa K, Takaya Y, Matsubara H, Ito H. Current Treatment Strategies and Nanoparticle-Mediated Drug Delivery Systems for Pulmonary Arterial Hypertension. Int J Mol Sci 2019; 20:ijms20235885. [PMID: 31771203 PMCID: PMC6928621 DOI: 10.3390/ijms20235885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/10/2019] [Accepted: 11/21/2019] [Indexed: 12/20/2022] Open
Abstract
There are three critical pathways for the pathogenesis and progression of pulmonary arterial hypertension (PAH): the prostacyclin (prostaglandin I2) (PGI2), nitric oxide (NO), and endothelin pathways. The current approved drugs targeting these three pathways, including prostacyclin (PGI2), phosphodiesterase type-5 (PDE5) inhibitors, and endothelin receptor antagonists (ERAs), have been shown to be effective, however, PAH remains a severe clinical condition and the long-term survival of patients with PAH is still suboptimal. The full therapeutic abilities of available drugs are reduced by medication, patient non-compliance, and side effects. Nanoparticles are expected to address these problems by providing a novel drug delivery approach for the treatment of PAH. Drug-loaded nanoparticles for local delivery can optimize the efficacy and minimize the adverse effects of drugs. Prostacyclin (PGI2) analogue, PDE5 inhibitors, ERA, pitavastatin, imatinib, rapamycin, fasudil, and oligonucleotides-loaded nanoparticles have been reported to be effective in animal PAH models and in vitro studies. However, the efficacy and safety of nanoparticle mediated-drug delivery systems for PAH treatment in humans are unknown and further clinical studies are required to clarify these points.
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Affiliation(s)
- Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
- Correspondence: ; Tel.: +81-86-235-7351; Fax: +81-86-235-7353
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
| | - Hiromi Matsubara
- Division of Cardiology, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan;
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (S.A.); (K.E.); (M.Y.); (T.M.); (N.T.); (Y.T.); (H.I.)
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Ejiri K, Ogawa A, Fujii S, Ito H, Matsubara H. Vascular Injury Is a Major Cause of Lung Injury After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension. Circ Cardiovasc Interv 2019; 11:e005884. [PMID: 30545259 DOI: 10.1161/circinterventions.117.005884] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) has become an alternative treatment for inoperable patients with chronic thromboembolic pulmonary hypertension. Lung injury (LI) is a major complication of BPA and may attenuate the benefits of BPA. Therefore, we conducted a retrospective study to evaluate the association between patient and procedural characteristics and LI in patients with chronic thromboembolic pulmonary hypertension. METHODS AND RESULTS We reviewed 76 patients with chronic thromboembolic pulmonary hypertension who underwent BPA and multidetector computed tomography scanning pre- and post-BPA procedures. We performed BPA on 1247 vessels during 297 BPA procedures and reviewed 594 multidetector computed tomography scans. By comparing pre- and post-BPA multidetector computed tomography images, we diagnosed LI as follows: newly appeared ground-glass opacity, consolidation, and pleural effusion. LI was detected using multidetector computed tomography scans during 138 procedures (47%), and mechanical ventilation was required during 40 procedures (13%). Angiographic findings of extravasation with or without simultaneous clinical symptoms (BPA-related vascular injury) occurred during 50 procedures (17%). In mixed-effect logistic regression models, the BPA-related vascular injury was an independent predictor of LI after BPA, odds ratio, 20.1 (6.43-63.1). High mean pulmonary artery pressure before BPA procedure and BPA-related vascular injury were independent predictors of mechanical ventilation after BPA, odds ratio, 1.13 (1.03-1.24) and 10.8 (3.77-30.9), respectively. CONCLUSIONS Vascular injury during BPA could be a triggering factor of LI after BPA, and its severity could be exacerbated by a high pulmonary artery pressure.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiology (K.E., S.F., H.M.), National Hospital Organization Okayama Medical Center, Japan.,Department of Cardiovascular Medicine, Okayama University, Japan (K.E., H.I.)
| | - Aiko Ogawa
- Department of Clinical Science (A.O., H.M.), National Hospital Organization Okayama Medical Center, Japan
| | - Shinya Fujii
- Department of Cardiology (K.E., S.F., H.M.), National Hospital Organization Okayama Medical Center, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University, Japan (K.E., H.I.)
| | - Hiromi Matsubara
- Department of Cardiology (K.E., S.F., H.M.), National Hospital Organization Okayama Medical Center, Japan.,Department of Clinical Science (A.O., H.M.), National Hospital Organization Okayama Medical Center, Japan
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57
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Lang IM, Matsubara H. Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension: is Europe behind? Eur Respir J 2019; 54:54/4/1901639. [PMID: 31649148 DOI: 10.1183/13993003.01639-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Irene M Lang
- Dept of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Hiromi Matsubara
- National Hospital Organization, Okayama Medical Center, Okayama, Japan
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Taniguchi Y, Matsubara H. Erratum to "Novelties in balloon pulmonary angioplasty" [Respir. Med. Res. 75 (2019) 26-28]. Respir Med Res 2019; 76:54. [PMID: 31606609 DOI: 10.1016/j.resmer.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Y Taniguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - H Matsubara
- Department of Cardiology and Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan
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Nishihara T, Shimokawahara H, Matsubara H, Hayashi K, Tsuji M, Naito T, Shigetoshi M, Tabuchi I, Ogawa A, Munemasa M. P4678The hemodynamic improvement with balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension depends on the lesion location. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Pulmonary endarterectomy (PEA) is a treatment of choice for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Patients with proximal pulmonary artery disease are considered to be good candidates for PEA because of their generally excellent outcomes. However, not all patients can be operated because of patients' advanced age, comorbidities and poor general condition. Balloon pulmonary angioplasty (BPA) has become an alternative treatment for CTEPH patients especially whose lesions locate in the distal site. The effectiveness of BPA in patients who have lesions in the proximal pulmonary arteries but cannot be a candidate for PEA remains unclear.
Purpose
The aim of this study was to investigate the outcome of BPA in CTEPH patients whose lesions appears operable but ineligible for PEA.
Methods
A total of 370 patients who underwent BPA in our institute from November 2004 to January 2018 were enrolled. All the patients were divided into operable group and inoperable group according to the difference of lesion location based on the findings of perfusion scintigraphy, computed tomography and pulmonary angiography. Hemodynamic effects of BPA in both groups were investigated. We also conducted survival analyses using the Kaplan-Meier method with the log-rank test.
Results
Among 370 patients, 90 patients deemed operable. The main reasons why not operated in the PEA operable group were patient's refusal (44%), advanced age (14%), and comorbidities (27%). There were no baseline characteristic differences between two groups except for the history of acute pulmonary embolism. Mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) equally improved after BPA in both groups (operable: 38.2±10.8 mmHg to 21.5±4.7mmHg, inoperable: 42.4±11.3 mmHg to 21.8±4.8 mmHg, p<0.001, operable: 8.0±4.2 wood unit to 3.5±1.5 wood unit, inoperable: 9.1±4.6 wood unit to 3.4±1.3 wood unit, p<0.001). Furthermore, five-year cumulative survival rates were not different between two groups (inoperable vs. operable: 93% vs. 88%, p=0.23, median follow-up period was 23.0 months (range: 5–136 months)). Meanwhile, the absolute change of mPAP and PVR in inoperable group were greater than those in operable group (inoperable: 20.7±11.2 mmHg, operable: 16.6±11.0 mmHg, p=0.010, inoperable: 5.6±4.4 wood unit, operable: 4.5±3.9 wood unit, p=0.015).
Conclusions
Although the outcome of BPA for CTEPH patients with operable lesions appears acceptable, absolute change in hemodynamics was lower than that of the patients with inoperable lesions. CTEPH with proximal lesions should be treated with PEA rather than BPA.
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Affiliation(s)
| | | | | | - K Hayashi
- Okayama Medical Center, Okayama, Japan
| | - M Tsuji
- Okayama Medical Center, Okayama, Japan
| | - T Naito
- Okayama Medical Center, Okayama, Japan
| | | | - I Tabuchi
- Okayama Medical Center, Okayama, Japan
| | - A Ogawa
- Okayama Medical Center, Okayama, Japan
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Shimokawahara H, Matsubara H, Hayashi K, Tsuji M, Nishihara T, Naito T, Shigetoshi M, Tabuchi I, Munemasa M. P4675The utility of additional balloon pulmonary angioplasty for residual hypoxemia in normohemodynamic chronic thromboembolic pulmonary hypertension patients after invasive treatments. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Balloon pulmonary angioplasty (BPA) improves hemodynamics, symptoms and exercise capacity in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy (PEA). However, certain patients still have hypoxemia after BPA or PEA despite normalization of hemodynamics. In CTEPH, hypoxemia is related increased dead space ventilation caused by vascular obstruction.
Purpose
This study was aimed to clarify whether additional BPA can improve hypoxemia of CTEPH patients after normalization of hemodynamics.
Methods
A total of 335 patients who underwent initial series of BPA in our institute were followed up. Sixty-four patients with mean pulmonary artery pressure (mPAP) <30mmHg and percutaneous oxygen saturation (SpO2) <95% without oxygen inhalation at more than 6 months after the initial series of BPA and of patients who could reevaluate hemodynamics and oxygenation after additional BPA were enrolled. These patients were divided into two groups with or without additional BPA procedures. Change of hemodynamics and SpO2 were retrospectively investigated.
Results
Thirty-three of 64 patients underwent additional BPA procedures. Patients' age was older in BPA group than those in non-BPA group (71.3±10.4 vs. 66.5±9.4 years old, p=0.02). mPAP and pulmonary vascular resistance (PVR) was significantly higher in BPA group (mPAP: 23.9±3.2 vs. 20.7±3.8 mmHg, p=0.001, PVR: 4.2±1.2 vs. 3.5±1.4 wood unit, p=0.03, respectively). Among the 1.8±1.4 BPA procedures per person, total 6.6±3.8 segmental pulmonary arteries per person were treated. While no obvious improvements were observed in non-BPA group, PVR and SpO2 in BPA group were significantly improved (4.2±1.2 to 3.7±1.3 wood unit, p=0.002, 90.7±3.1% to 94.1±3.6%, p<0.001, respectively). In the multivariate logistic regression analysis, additional BPA procedures were associated with further improvement of SpO2 (hazard ratio, 3.7; 95% confidence interval, 1.2–11.5; P=0.02).
Conclusions
Additional BPA procedure was associated with improvement of hypoxemia in CTEPH patients after normalization of hemodynamics. Treating as many lesions as possible in BPA might relieve the patients' residual dyspnea.
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Affiliation(s)
- H Shimokawahara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - H Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - K Hayashi
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - M Tsuji
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - T Nishihara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - T Naito
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - M Shigetoshi
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - I Tabuchi
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - M Munemasa
- National Hospital Organization Okayama Medical Center, Okayama, Japan
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Chausheva S, Naito A, Ogawa A, Seidl V, Winter MP, Sharma S, Sadushi-Kolici R, Campean IA, Taghavi S, Moser B, Klepetko W, Ishida K, Matsubara H, Sakao S, Lang IM. Chronic thromboembolic pulmonary hypertension in Austria and Japan. J Thorac Cardiovasc Surg 2019; 158:604-614.e2. [DOI: 10.1016/j.jtcvs.2019.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
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Shimokawahara H, Ogawa A, Mizoguchi H, Yagi H, Ikemiyagi H, Matsubara H. Vessel Stretching Is a Cause of Lumen Enlargement Immediately After Balloon Pulmonary Angioplasty: Intravascular Ultrasound Analysis in Patients With Chronic Thromboembolic Pulmonary Hypertension. Circ Cardiovasc Interv 2019; 11:e006010. [PMID: 29643129 DOI: 10.1161/circinterventions.117.006010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) has become an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy. We retrospectively investigated intravascular ultrasound measurements to elucidate how the lumen enlarges immediately after BPA. METHODS AND RESULTS A total of 326 lesions in 71 patients with chronic thromboembolic pulmonary hypertension were analyzed. The cross-sectional areas (CSAs) of the external elastic membrane and lumen measured by intravascular ultrasound before and after BPA were assessed for each lesion type (type A, ring-like stenosis lesions; type B, web lesions; type C, subtotal occlusion lesions). Comparing the lesion types, the proportion of the area occupied by fibrous tissue was smallest in the type A lesions and largest in the type C lesions. The mean lesion lumen CSA was increased after BPA because of an increase in external elastic membrane CSA (from 23.2±12.9 to 27.2±14.3 mm2; P<0.001) with a slight decrease in fibrous tissue plus media CSA (from 17.7±11.7 to 17.3±11.1 mm2; P<0.001). The change in lumen CSA correlated strongly with the change in external elastic membrane CSA (r2=0.762; P<0.001). CONCLUSIONS Lumen enlargement immediately after BPA was obtained by the overall vessel expansion induced by a stretch of the arterial wall. In addition, the amount of fibrous tissue depended on each lesion type. Thus, it might be beneficial to change the balloon size to correspond with the lesion type.
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Affiliation(s)
- Hiroto Shimokawahara
- From the Departments of Cardiology (H.S., H. Mizoguchi, H.Y., H.I., H. Matsubara) and Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Aiko Ogawa
- From the Departments of Cardiology (H.S., H. Mizoguchi, H.Y., H.I., H. Matsubara) and Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hiroki Mizoguchi
- From the Departments of Cardiology (H.S., H. Mizoguchi, H.Y., H.I., H. Matsubara) and Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hiroki Yagi
- From the Departments of Cardiology (H.S., H. Mizoguchi, H.Y., H.I., H. Matsubara) and Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hidekazu Ikemiyagi
- From the Departments of Cardiology (H.S., H. Mizoguchi, H.Y., H.I., H. Matsubara) and Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hiromi Matsubara
- From the Departments of Cardiology (H.S., H. Mizoguchi, H.Y., H.I., H. Matsubara) and Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
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63
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Kataoka M, Satoh T, Matsubara H, Yamamoto K, Inada T, Umezawa K, Takahashi T, Nakano A, Fukuda K. Safety and Efficacy of Ambrisentan-Phosphodiesterase Type 5 (PDE5) Inhibitor Combination Therapy for Japanese Pulmonary Arterial Hypertension Patients in Real-World Clinical Practice. Circ Rep 2019; 1:268-275. [PMID: 33693149 PMCID: PMC7889478 DOI: 10.1253/circrep.cr-19-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
This retrospective study was conducted to evaluate the safety and efficacy of ambrisentan combination therapy with phosphodiesterase type 5 (PDE5) inhibitors in Japanese patients with pulmonary arterial hypertension (PAH). Methods and Results:
PAH patients who received ambrisentan for the first time in combination with a PDE5 inhibitor between January 2013 and the end of August 2015 were included in this study. Adverse drug reaction (ADR) safety analysis, as well as the efficacy analysis focusing on changes in clinical parameters, were investigated for overall cases and cases stratified by patient background. Forty-eight consecutive patients (n=21, 43.8% with idiopathic PAH; male/female, 18/30; average age, 43.3±17.4 years; World Health Organization functional class III/IV, n=22, 45.8%) who were treated with ambrisentan and a PDE5 inhibitor in Japan underwent the safety analysis. A total of 14 ADR occurred in 10 patients (20.8%). ADR included headache (8.3%), face edema (4.2%), angina pectoris (2.1%), hyperemia (2.1%), dyspnea (2.1%), pulmonary hypertension (i.e., worsening of PAH, 2.1%), nausea (2.1%), hepatic function abnormal (2.1%), edema (2.1%), and sudden death (2.1%). On analysis of hemodynamics parameters, there was a significant improvement in the mean pulmonary arterial pressure (−13.5 mmHg, P=0.0001) and pulmonary vascular resistance (−563.53 dyn·s·cm−5, P=0.0033). Conclusions:
Ambrisentan combination therapy is safe and effective in hemodynamics improvement.
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Affiliation(s)
- Masaharu Kataoka
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Toru Satoh
- Department of Cardiology, Kyorin University School of Medicine Tokyo Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center Okayama Japan
| | - Koji Yamamoto
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences Aichi Japan
| | - Tsukasa Inada
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital Osaka Japan
| | | | | | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
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64
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Lang IM, Matsubara H. Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension: is Europe behind? Eur Respir J 2019; 53:53/5/1900843. [DOI: 10.1183/13993003.00843-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/06/2019] [Indexed: 11/05/2022]
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65
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Uno T, Kobayashi H, Watanabe-Nemoto M, Harada R, Saito M, Kanazawa A, Iwai Y, Murakami K, Matsubara H. EP-1401 Practice-based clinical outcome of definitive radiation therapy for superficial esophageal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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66
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Fukuda K, Date H, Doi S, Fukumoto Y, Fukushima N, Hatano M, Ito H, Kuwana M, Matsubara H, Momomura SI, Nishimura M, Ogino H, Satoh T, Shimokawa H, Yamauchi-Takihara K, Tatsumi K, Ishibashi-Ueda H, Yamada N, Yoshida S, Abe K, Ogawa A, Ogo T, Kasai T, Kataoka M, Kawakami T, Kogaki S, Nakamura M, Nakayama T, Nishizaki M, Sugimura K, Tanabe N, Tsujino I, Yao A, Akasaka T, Ando M, Kimura T, Kuriyama T, Nakanishi N, Nakanishi T, Tsutsui H. Guidelines for the Treatment of Pulmonary Hypertension (JCS 2017/JPCPHS 2017). Circ J 2019; 83:842-945. [PMID: 30853682 DOI: 10.1253/circj.cj-66-0158] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University
| | - Shozaburo Doi
- Department of Pediatrics, Perinatal and Maternal Medicine, Graduate School, Tokyo Medical and Dental University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Masaru Hatano
- Department of Cardiovascular Medicine/Therapeutic Strategy for Heart Failure, The University of Tokyo Hospital
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Field of Functional Physiology, Okayama University Graduate School of Medicine
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center
| | - Shin-Ichi Momomura
- Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Hokkaido University Graduate School of Medicine
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Toru Satoh
- Internal Medicine II, Kyorin University School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Keiko Yamauchi-Takihara
- Health and Counseling Center and Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University
| | | | | | - Shunji Yoshida
- Department of Rheumatology and Infectious Diseases, Fujita Health University Hospital
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine/Department of Advanced Medicine for Pulmonary Hypertension, National Cerebral and Cardiovascular Center
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | | | | | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | | | - Tomotaka Nakayama
- Department of Pediatrics, Toho University Medical Center Omori Hospital
| | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization, Okayama Medical Center
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Nobuhiro Tanabe
- Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Atsushi Yao
- Division for Health Service Promotion, The University of Tokyo
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Motomi Ando
- Daiyukai General Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | | | | | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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Ogawa A, Sakao S, Tanabe N, Matsubara H, Tatsumi K. Use of vasodilators for the treatment of pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis: A systematic review. Respir Investig 2019; 57:183-190. [PMID: 30473253 DOI: 10.1016/j.resinv.2018.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/02/2018] [Accepted: 10/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There are several medications available to treat pulmonary arterial hypertension (PAH): PAH-targeted drugs. However, in patients with pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis (PVOD/PCH), rare diseases that cause pulmonary hypertension, the effectiveness and safety of vasodilators, including PAH-targeted drugs, are unclear. METHODS We searched English-language publications listed in three electronic databases (PubMed, Cochrane Library, and the Japan Medical Abstracts Society). Reports with efficacy outcomes (survival, improvement in 6-minute walk distance, and pulmonary vascular resistance) and data on development of pulmonary edema after administration of vasodilators to patients with PVOD/PCH were selected (1966 to August 2015). RESULTS We identified 20 reports that met our criteria. No randomized controlled or prospective controlled studies were reported. The survival time ranged from 71 minutes to 4 years or more after initiation of vasodilators. Most of the reported cases showed an improvement in the 6-minute walk distance and pulmonary vascular resistance. Pulmonary edema was reported in 15 articles, some cases of which were lethal. CONCLUSIONS The present study demonstrates the potential efficacy and difficulties in the use of vasodilators in patients with PVOD/PCH; however, drawing a firm conclusion was difficult because of the lack of randomized controlled trials. Further research is needed to ascertain if vasodilator use is beneficial and safe in patients with PVOD/PCH.
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Affiliation(s)
- Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan.
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama 701-1192, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
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68
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Kim NH, Delcroix M, Jais X, Madani MM, Matsubara H, Mayer E, Ogo T, Tapson VF, Ghofrani HA, Jenkins DP. Chronic thromboembolic pulmonary hypertension. Eur Respir J 2019; 53:13993003.01915-2018. [PMID: 30545969 PMCID: PMC6351341 DOI: 10.1183/13993003.01915-2018] [Citation(s) in RCA: 395] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic PH leading to right heart failure and death. Lung ventilation/perfusion scintigraphy is the screening test of choice; a normal scan rules out CTEPH. In the case of an abnormal perfusion scan, a high-quality pulmonary angiogram is necessary to confirm and define the pulmonary vascular involvement and prior to making a treatment decision. PH is confirmed with right heart catheterisation, which is also necessary for treatment determination. In addition to chronic anticoagulation therapy, each patient with CTEPH should receive treatment assessment starting with evaluation for pulmonary endarterectomy, which is the guideline recommended treatment. For technically inoperable cases, PH-targeted medical therapy is recommended (currently riociguat based on the CHEST studies), and balloon pulmonary angioplasty should be considered at a centre experienced with this challenging but potentially effective and complementary intervention.
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Affiliation(s)
- Nick H Kim
- Dept of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Marion Delcroix
- Dept of Respiratory Diseases, University Hospitals of Leuven and Respiratory Division, Dept CHROMETA, KU Leuven - University of Leuven, Leuven, Belgium
| | - Xavier Jais
- Université Paris-Sud, AP-HP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Michael M Madani
- Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Hiromi Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Eckhard Mayer
- Kerckhoff Clinic Bad Nauheim, University of Giessen, Bad Nauheim, Germany
| | - Takeshi Ogo
- Division of Advanced Medical Research in Pulmonary Hypertension, Dept of Pulmonary Circulation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Victor F Tapson
- Dept of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hossein-Ardeschir Ghofrani
- Kerckhoff Clinic Bad Nauheim, University of Giessen, Bad Nauheim, Germany.,University of Giessen and Marburg Lung Centre (UGMLC), Justus-Liebig University Giessen and Member of the German Center for Lung Research (DZL), Giessen, Germany.,Dept of Medicine, Imperial College London, London, UK.,These two authors contributed equally to this work
| | - David P Jenkins
- Royal Papworth Hospital, Cambridge, UK.,These two authors contributed equally to this work
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69
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Klok FA, Barco S, Konstantinides SV, Dartevelle P, Fadel E, Jenkins D, Kim NH, Madani M, Matsubara H, Mayer E, Pepke-Zaba J, Delcroix M, Lang IM. Determinants of diagnostic delay in chronic thromboembolic pulmonary hypertension: results from the European CTEPH Registry. Eur Respir J 2018; 52:13993003.01687-2018. [PMID: 30409820 DOI: 10.1183/13993003.01687-2018] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/23/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Frederikus A Klok
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philippe Dartevelle
- Dept of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud Univ., Paris, France
| | - Elie Fadel
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - David Jenkins
- Dept of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Nick H Kim
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, CA, USA
| | - Michael Madani
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Hiromi Matsubara
- Dept of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | | | - Marion Delcroix
- Dept of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Irene M Lang
- Dept of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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70
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Akagi S, Matsubara H, Nakamura K, Ito H. Modern treatment to reduce pulmonary arterial pressure in pulmonary arterial hypertension. J Cardiol 2018; 72:466-472. [DOI: 10.1016/j.jjcc.2018.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 11/30/2022]
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71
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Kawakami T, Ogawa A, Miyaji K, Mizoguchi H, Shimokawahara H, Naito T, Oka T, Yunoki K, Munemasa M, Matsubara H. Response by Kawakami et al to Letter Regarding Article, "Novel Angiographic Classification of Each Vascular Lesion in Chronic Thromboembolic Pulmonary Hypertension Based on Selective Angiogram and Results of Balloon Pulmonary Angioplasty". Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.004962. [PMID: 28193682 DOI: 10.1161/circinterventions.117.004962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Takashi Kawakami
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan
| | - Katsumasa Miyaji
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Hiroki Mizoguchi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Hiroto Shimokawahara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Takanori Naito
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Takashi Oka
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Kei Yunoki
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Mitsuru Munemasa
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
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72
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Shimokawahara H, Matsubara H. TCT-164 Balloon Pulmonary Angioplasty for Total Occlusion Lesions: The Success Rate and Long-term Patency Rates Depends on the Difficulty in Penetrating the Guide Wire of the Occlusion Site. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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73
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Shimokawahara H, Iwano T, Nishihara T, Tsuji M, Naito T, Munemasa M, Matsubara H. P568Balloon pulmonary angioplasty for total occlusion lesions: long-term patency for total occlusion lesions depends on the flow grade at immediately after balloon pulmonary angioplasty. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Shimokawahara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - T Iwano
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - T Nishihara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - M Tsuji
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - T Naito
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - M Munemasa
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - H Matsubara
- National Hospital Organization Okayama Medical Center, Okayama, Japan
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74
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Naito T, Shimokawahara H, Matsubara H, Iwano T, Tsuji M, Nishihara T, Tabuchi I, Shigetoshi M, Ogawa A, Munemasa M. P2615Ages are not a determinant of favorable outcome of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Naito
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - H Shimokawahara
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - H Matsubara
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - T Iwano
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - M Tsuji
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - T Nishihara
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - I Tabuchi
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - M Shigetoshi
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - A Ogawa
- Okayama Medical Center, Department of cardiology, Okayama, Japan
| | - M Munemasa
- Okayama Medical Center, Department of cardiology, Okayama, Japan
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75
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Tanabe N, Kawakami T, Satoh T, Matsubara H, Nakanishi N, Ogino H, Tamura Y, Tsujino I, Ogawa A, Sakao S, Nishizaki M, Ishida K, Ichimura Y, Yoshida M, Tatsumi K. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: A systematic review. Respir Investig 2018; 56:332-341. [PMID: 30008295 DOI: 10.1016/j.resinv.2018.03.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/16/2018] [Accepted: 03/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) has been performed for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual pulmonary hypertension after pulmonary endarterectomy (PEA). We performed a systematic review to assess the efficacy and safety of BPA, especially compared to medical treatment or PEA. METHODS We reviewed all studies investigating pre- and post-treatment pulmonary hemodynamics, mortality, or complications from three electronic databases (PubMed, Cochrane Library, Japan Medical Abstracts Society) prior to February 2017. From 26 studies retrieved, we selected 13 studies (493 patients): the 10 most recent ones including complete data from each institution, one study of residual pulmonary hypertension, and two studies comparing BPA with medical treatment or PEA. RESULTS No randomized controlled or prospective controlled studies comparing BPA with medical treatment or PEA were reported. The early mortality of BPA ranged from 0% to 14.3%; lung injury occurred in 7.0% to 31.4% (average sessions, 2.5-6.6). Mean pulmonary arterial pressure decreased from 39.4-56 to 20.9-36 mm Hg, and the 6-min walk distance increased from 191-405 to 359-501 m. The 2-year mortality of 80 patients undergoing BPA was significantly lower compared to 68 patients receiving medical treatment (1.3% vs. 13.2%); the risk ratio was 0.14 (95% confidence interval: 0.03-0.76). No significant difference was observed in the 2-year mortality between BPA (n=97) and PEA (n=63) patients. CONCLUSIONS This systematic review suggests that BPA improves hemodynamics, has acceptable early mortality, and may improve long-term survival compared with medical treatment in inoperable CTEPH patients.
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Affiliation(s)
- Nobuhiro Tanabe
- Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Takashi Kawakami
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Toru Satoh
- Division of Cardiology Department of Medicine, Kyorin University Hospital, Mitaka, Japan.
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
| | - Norifumi Nakanishi
- Department of Cardiovascular Medicine, Minami Osaka Hospital, Osaka, Japan.
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Yuichi Tamura
- Division of Cardiovascular Internal Medicine, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan.
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
| | - Keiichi Ishida
- Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Yasunori Ichimura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan.
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
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76
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Affiliation(s)
- H. Matsubara
- Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu, Japan
| | - M. Kitahara
- Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu, Japan
| | - T. Takeda
- Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu, Japan
| | - Y. Yazawa
- Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu, Japan
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77
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Noji S, Sakai H, Aoi N, Baba H, Berg GPA, Doornenbal P, Dozono M, Fukuda N, Inabe N, Kameda D, Kawabata T, Kawase S, Kikuchi Y, Kisamori K, Kubo T, Maeda Y, Matsubara H, Michimasa S, Miki K, Miya H, Miyasako H, Sakaguchi S, Sasamoto Y, Shimoura S, Takaki M, Takeda H, Takeuchi S, Tokieda H, Ohnishi T, Ota S, Uesaka T, Wang H, Yako K, Yanagisawa Y, Yokota N, Yoshida K, Zegers RGT. Excitation of the Isovector Spin Monopole Resonance via the Exothermic ^{90}Zr(^{12}N,^{12}C) Reaction at 175 MeV/u. Phys Rev Lett 2018; 120:172501. [PMID: 29756826 DOI: 10.1103/physrevlett.120.172501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/09/2018] [Indexed: 06/08/2023]
Abstract
The (^{12}N, ^{12}C) charge-exchange reaction at 175 MeV/u was developed as a novel probe for studying the isovector spin giant monopole resonance (IVSMR), whose properties are important for better understanding the bulk properties of nuclei and asymmetric nuclear matter. This probe, now available through the production of ^{12}N as a secondary rare-isotope beam, is exothermic, is strongly absorbed at the surface of the target nucleus, and provides selectivity for spin-transfer excitations. All three properties enhance the excitation of the IVSMR compared to other, primarily light-ion, probes, which have been used to study the IVSMR thus far. The ^{90}Zr(^{12}N,^{12}C) reaction was measured and the excitation energy spectra up to about 70 MeV for both the spin-transfer and non-spin-transfer channels were deduced separately by tagging the decay by γ emission from the ^{12}C ejectile. Besides the well-known Gamow-Teller and isobaric analog transitions, a clear signature of the IVSMR was identified. By comparing with the results from light-ion reactions on the same target nucleus and theoretical predictions, the suitability of this new probe for studying the IVSMR was confirmed.
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Affiliation(s)
- S Noji
- Department of Physics, University of Tokyo, Hongo, Bunkyo, Tokyo 113-0033, Japan
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - H Sakai
- Department of Physics, University of Tokyo, Hongo, Bunkyo, Tokyo 113-0033, Japan
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - N Aoi
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - H Baba
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - G P A Berg
- Department of Physics, University of Notre Dame, Nieuwland Science Hall, Notre Dame, Indiana 46556, USA
- The JINA Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Doornenbal
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - M Dozono
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - N Fukuda
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - N Inabe
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - D Kameda
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - T Kawabata
- Department of Physics, Kyoto University, Kitashirakawa, Oiwakecho, Sakyo, Kyoto 606-8502, Japan
| | - S Kawase
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - Y Kikuchi
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - K Kisamori
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - T Kubo
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - Y Maeda
- Department of Applied Physics, University of Miyazaki, Miyazaki, Miyazaki 889-2192, Japan
| | - H Matsubara
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - S Michimasa
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - K Miki
- Department of Physics, University of Tokyo, Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - H Miya
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - H Miyasako
- Department of Applied Physics, University of Miyazaki, Miyazaki, Miyazaki 889-2192, Japan
| | - S Sakaguchi
- Department of Physics, Kyushu University, Nishi, Fukuoka 819-0395, Japan
| | - Y Sasamoto
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - S Shimoura
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - M Takaki
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - H Takeda
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - S Takeuchi
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - H Tokieda
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - T Ohnishi
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - S Ota
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - T Uesaka
- Center for Nuclear Study, University of Tokyo, RIKEN Campus, Wako, Saitama 351-0198, Japan
| | - H Wang
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - K Yako
- Department of Physics, University of Tokyo, Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - Y Yanagisawa
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - N Yokota
- Department of Physics, Kyoto University, Kitashirakawa, Oiwakecho, Sakyo, Kyoto 606-8502, Japan
| | - K Yoshida
- RIKEN Nishina Center, Hirosawa, Wako, Saitama 351-0198, Japan
| | - R G T Zegers
- The JINA Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
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78
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Abstract
Clinical guidelines for pulmonary hypertension recommend evaluating treatment response through various methods; however, electrocardiography (ECG) is not included as one of the methods of choice. We aimed to identify ECG parameters that correlated with prognosis in patients with pulmonary arterial hypertension (PAH). A total of 112 consecutive patients with PAH were enrolled in this study. Among them, 83 with treatment escalation were studied for further analysis. Survival analyses were conducted using the Kaplan-Meier method with the log-rank test. Cox proportional hazards regression modeling was used to identify predictors of survival. Receiver operating characteristic analysis was used to determine cut-off values for selected variables. ECG parameters were changed from baseline to three months after treatment. Patients in whom the R wave amplitude in lead V1 decreased by ≥1 mm (0.1 mV) within three months demonstrated significantly better survival ( P = 0.017). Our results suggest that evaluation of ECG parameters can contribute to assessments of survival in patients with PAH.
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Affiliation(s)
- Shinji Sato
- 1 Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Aiko Ogawa
- 2 Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- 1 Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.,2 Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
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79
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Aoyama H, Ebata T, Hattori M, Takano M, Yamamoto H, Inoue M, Asaba Y, Ando M, Nagino M, Aoba T, Kaneoka Y, Arai T, Shimizu Y, Kiriyama M, Sakamoto E, Miyake H, Takara D, Shirai K, Ohira S, Kobayashi S, Kato Y, Yamaguchi R, Hayashi E, Miyake T, Mizuno S, Sato T, Suzuki K, Hashimoto M, Kawai S, Matsubara H, Kato K, Yokoyama S, Suzumura K. Reappraisal of classification of distal cholangiocarcinoma based on tumour depth. Br J Surg 2018; 105:867-875. [DOI: 10.1002/bjs.10869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 02/02/2023]
Abstract
Abstract
Background
In the eighth edition of the AJCC cancer staging classification, the T system for distal cholangiocarcinoma (DCC) has been revised from a layer-based to a depth-based approach. The aim of this study was to propose an optimal T classification using a measured depth in resectable DCC.
Methods
Patients who underwent pancreatoduodenectomy for DCC at 32 hospitals between 2001 and 2010 were included. The distance between the level of the naive bile duct and the deepest cancer cells was measured as depth of invasion (DOI). Invasive cancer foci were measured as invasive tumour thickness (ITT). Log rank χ2 scores were used to determine the cut-off points, and concordance index (C-index) to assess the survival discrimination of each T system.
Results
Among 404 patients, DOI was measurable in 182 (45·0 per cent) and ITT was measurable in all patients, with median values of 2·3 and 5·6 mm respectively. ITT showed a positive correlation with DOI (rs = 0·854, P < 0·001), and the cut-off points for prognosis were 1, 5 and 10 mm. Median survival time was shorter with increased ITT: 12·4 years for ITT below 1 mm, 5·2 years for ITT at least 1 mm but less than 5 mm, 3·0 years for ITT at least 5 mm but less than 10 mm, and 1·5 years for ITT 10 mm or more (P < 0·001). This classification exhibited more favourable prognostic discrimination than the T systems of the seventh and eighth editions of the AJCC (C-index 0·646, 0·622 and 0·624 respectively).
Conclusion
ITT is an accurate approach for depth assessment in DCC. The four-tier ITT classification with cut-off points of 1, 5 and 10 mm seems to be a better T system than those in the seventh and eighth editions of the AJCC classification.
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Affiliation(s)
- H Aoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Hattori
- Department of Surgery, Nishichita General Hospital, Tokai, Japan
| | - M Takano
- Department of Surgery, Asahi Rousai Hospital, Owariasahi, Japan
| | - H Yamamoto
- Department of Surgery, Tokai Hospital, Nagoya, Japan
| | - M Inoue
- Department of Surgery, Tokoname City Hospital, Tokoname, Japan
| | - Y Asaba
- Department of Surgery, JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu, Japan
| | - M Ando
- Centre for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - M Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Aoba
- Toyohashi Municipal Hospital, Toyohashi
| | | | - T Arai
- Anjo Kosei Hospital, Anjo
| | - Y Shimizu
- Aichi Cancer Centre Hospital, Nagoya
| | | | - E Sakamoto
- Japanese Red Cross Nagoya Daini Hospital, Nagoya
| | - H Miyake
- Japanese Red Cross Nagoya Daiichi Hospital, Nagoya
| | - D Takara
- Kiryu Kosei General Hospital, Kiryu
| | | | | | | | - Y Kato
- Nagoya Ekisaikai Hospital, Nagoya
| | | | - E Hayashi
- Japan Community Health Care Organization Chukyo Hospital, Nagoya
| | | | - S Mizuno
- Shizuoka Welfare Hospital, Shizuoka
| | - T Sato
- Hekinan Municipal Hospital, Hekinan
| | - K Suzuki
- Japan Community Health Care Organization Kani Tono Hospital, Kani
| | | | - S Kawai
- Tsushima City Hospital, Tsushima
| | | | - K Kato
- Inazawa Municipal Hospital, Inazawa
| | | | - K Suzumura
- Shizuoka Saiseikai General Hospital, Shizuoka
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80
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Abstract
In the past 5 years, balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are deemed inoperable has undergone significant refinement. As a result, the procedure is now used worldwide and has become a promising therapeutic option for those patients. However, pulmonary endarterectomy remains the gold standard treatment for patients with CTEPH because the techniques and strategies for BPA are not yet unified. The best therapeutic option for each patient should be determined based on discussion among a multidisciplinary team of experts. For BPA to become an established treatment for CTEPH, further data are needed. This review summarizes the techniques and strategies of BPA at present and discusses the future development of the procedure.
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Affiliation(s)
- Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center
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81
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Nishi T, Itahashi K, Berg GPA, Fujioka H, Fukuda N, Fukunishi N, Geissel H, Hayano RS, Hirenzaki S, Ichikawa K, Ikeno N, Inabe N, Itoh S, Iwasaki M, Kameda D, Kawase S, Kubo T, Kusaka K, Matsubara H, Michimasa S, Miki K, Mishima G, Miya H, Nagahiro H, Nakamura M, Noji S, Okochi K, Ota S, Sakamoto N, Suzuki K, Takeda H, Tanaka YK, Todoroki K, Tsukada K, Uesaka T, Watanabe YN, Weick H, Yamakami H, Yoshida K. Spectroscopy of Pionic Atoms in ^{122}Sn(d,^{3}He) Reaction and Angular Dependence of the Formation Cross Sections. Phys Rev Lett 2018; 120:152505. [PMID: 29756883 DOI: 10.1103/physrevlett.120.152505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/07/2018] [Indexed: 06/08/2023]
Abstract
We observed the atomic 1s and 2p states of π^{-} bound to ^{121}Sn nuclei as distinct peak structures in the missing mass spectra of the ^{122}Sn(d,^{3}He) nuclear reaction. A very intense deuteron beam and a spectrometer with a large angular acceptance let us achieve a potential of discovery, which includes the capability of determining the angle-dependent cross sections with high statistics. The 2p state in a Sn nucleus was observed for the first time. The binding energies and widths of the pionic states are determined and found to be consistent with previous experimental results of other Sn isotopes. The spectrum is measured at finite reaction angles for the first time. The formation cross sections at the reaction angles between 0° and 2° are determined. The observed reaction-angle dependence of each state is reproduced by theoretical calculations. However, the quantitative comparison with our high-precision data reveals a significant discrepancy between the measured and calculated formation cross sections of the pionic 1s state.
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Affiliation(s)
- T Nishi
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - K Itahashi
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - G P A Berg
- Department of Physics and the Joint Institute for Nuclear Astrophysics Center for the Evolution of the Elements, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - H Fujioka
- Department of Physics, Kyoto University, Kitashirakawa-Oiwakecho, Sakyo-ku, Kyoto, 606-8502 Kyoto, Japan
| | - N Fukuda
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - N Fukunishi
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - H Geissel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - R S Hayano
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - S Hirenzaki
- Department of Physics, Nara Women's University, Kita-Uoya Nishimachi, Nara, 630-8506 Nara, Japan
| | - K Ichikawa
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - N Ikeno
- Department of Life and Environmental Agricultural Sciences, Faculty of Agriculture, Tottori University, 4-101 Koyamacho-Minami, Tottori, 680-8551 Tottori, Japan
| | - N Inabe
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - S Itoh
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - M Iwasaki
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - D Kameda
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - S Kawase
- Center for Nuclear Study, The University of Tokyo, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - T Kubo
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - K Kusaka
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - H Matsubara
- Center for Nuclear Study, The University of Tokyo, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - S Michimasa
- Center for Nuclear Study, The University of Tokyo, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - K Miki
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - G Mishima
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - H Miya
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - H Nagahiro
- Department of Physics, Nara Women's University, Kita-Uoya Nishimachi, Nara, 630-8506 Nara, Japan
| | - M Nakamura
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - S Noji
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - K Okochi
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - S Ota
- Center for Nuclear Study, The University of Tokyo, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - N Sakamoto
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - K Suzuki
- Stefan Meyer Institute for Subatomic Physics, Austrian Academy of Sciences, Boltzmanngasse 3, A-1090 Vienna, Austria
| | - H Takeda
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - Y K Tanaka
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - K Todoroki
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - K Tsukada
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - T Uesaka
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
| | - Y N Watanabe
- Department of Physics, School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
| | - H Weick
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Planckstrasse 1, D-64291 Darmstadt, Germany
| | - H Yamakami
- Department of Physics, Kyoto University, Kitashirakawa-Oiwakecho, Sakyo-ku, Kyoto, 606-8502 Kyoto, Japan
| | - K Yoshida
- Nishina Center for Accelerator-Based Science, RIKEN, 2-1 Hirosawa, Wako, 351-0198 Saitama, Japan
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82
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Mihara K, Ogawa A, Matsubara H, Terao T, Ichikawa Y. Investigation of safety and efficacy of the new more thermostable formulation of Flolan (epoprostenol) in Japanese patients with pulmonary arterial hypertension (PAH)-An open-label, single-arm study. PLoS One 2018; 13:e0195195. [PMID: 29608587 PMCID: PMC5880383 DOI: 10.1371/journal.pone.0195195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/23/2018] [Indexed: 11/18/2022] Open
Abstract
Objective This study was conducted to evaluate the safety and efficacy of a new more thermostable Flolan (epoprostenol) solution prepared with the reformulated pH 12.0 diluent in Japanese patients with pulmonary arterial hypertension (PAH) receiving higher doses of Flolan than those typically administered in Western countries. Methods This open-label, single-arm study was conducted in 10 Japanese PAH patients. During the run-in period, patients were intravenously infused with Flolan (45 ng/kg/min or higher doses) solution prepared with the existing pH 10.5 diluent. The patients were then switched to a new more thermostable Flolan solution prepared with the reformulated pH 12.0 diluent and observed for a 4-week treatment period. As a primary endpoint, safety after switching to the new Flolan solution was evaluated. Secondary endpoints included hemodynamics and the necessity for dose adjustment of Flolan in these patients. Results All 10 patients completed the study period. Observed adverse events were nausea and hepatic function abnormal in 1 patient each, and both events were mild. No patients required dose adjustment due to the change from baseline in mean pulmonary artery pressure (mPAP) measured 3 hrs after switching to Flolan solution prepared with the reformulated diluent. No major changes from baseline in mPAP, pulmonary vascular resistance, or right atrial pressure were observed at 24 hrs and at 4 weeks after switching to the Flolan solution prepared with pH 12.0 diluent. Although some patients showed increases in cardiac output (CO) from baseline at 24 hrs and 4 weeks, no patients required dose reduction as a result of an increase in CO. Conclusion Neither safety/efficacy concerns nor any dose adjustments of Flolan after switching to a more thermostable Flolan solution prepared with the reformulated pH 12.0 diluent could be required in Japanese patients with PAH receiving higher doses of Flolan. Trial registration ClinicalTrials.gov Identifier: NCT02705807
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Affiliation(s)
- Kazuko Mihara
- Medicines Development, GlaxoSmithKline K.K., Tokyo, Japan
- * E-mail:
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takumi Terao
- Biomedical Data Sciences Department, GlaxoSmithKline K.K., Tokyo, Japan
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Karyofyllis P, Papadopoulou V, Voudris V, Matsubara H. Balloon Pulmonary Angioplasty in Patients With Thromboembolic Pulmonary Hypertension. Curr Treat Options Cardio Med 2018; 20:13. [DOI: 10.1007/s11936-018-0604-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kawakami T, Ogawa A, Miyaji K, Mizoguchi H, Shimokawahara H, Naito T, Oka T, Yunoki K, Munemasa M, Matsubara H. Novel Angiographic Classification of Each Vascular Lesion in Chronic Thromboembolic Pulmonary Hypertension Based on Selective Angiogram and Results of Balloon Pulmonary Angioplasty. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003318. [PMID: 27729418 DOI: 10.1161/circinterventions.115.003318] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 09/20/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for standard therapy, pulmonary endarterectomy. Although there are several classifications of vascular lesions, these classifications are based on the features of the specimen removed during pulmonary endarterectomy. Because organized thrombi are not removed during balloon pulmonary angioplasty, we attempted to establish a new classification of vascular lesions based on pulmonary angiographic images. We evaluated the success and complication rate of BPA in accordance with the location and morphology of thromboembolic lesions. METHODS AND RESULTS We reviewed 500 consecutive procedures (1936 lesions) of BPA in 97 patients with chronic thromboembolic pulmonary hypertension and investigated the outcomes of BPA based on the lesion distribution and the angiographic characteristics of the thromboembolic lesions, as follows: type A, ring-like stenosis lesion; type B, web lesion; type C, subtotal lesion; type D, total occlusion lesion, and type E, tortuous lesion. The success rate was higher, and the complication rate was lower in ring-like stenosis and web lesions. The total occlusion lesions had the lowest success rate. Tortuous lesions were associated with a high complication rate and should be treated only by operators with extensive experience with BPA. CONCLUSIONS We modified the previous angiographic classification and established a new classification for each vascular lesion. We clarified that the outcome and complication rate of the BPA are highly dependent on the lesion characteristics.
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Affiliation(s)
- Takashi Kawakami
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Aiko Ogawa
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Katsumasa Miyaji
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hiroki Mizoguchi
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hiroto Shimokawahara
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Takanori Naito
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Takashi Oka
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Kei Yunoki
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Mitsuru Munemasa
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan
| | - Hiromi Matsubara
- From the Department of Cardiology (T.K., K.M., H. Mizoguchi, H.S., T.N., T.O., K.Y., M.M., H. Matsubara) and Department of Clinical Science (A.O., H. Matsubara), National Hospital Organization Okayama Medical Center, Japan.
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Ogawa A, Satoh T, Fukuda T, Sugimura K, Fukumoto Y, Emoto N, Yamada N, Yao A, Ando M, Ogino H, Tanabe N, Tsujino I, Hanaoka M, Minatoya K, Ito H, Matsubara H. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004029. [DOI: 10.1161/circoutcomes.117.004029] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/27/2017] [Indexed: 12/21/2022]
Abstract
Background—
Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy—the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry.
Methods and Results—
A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent follow-up right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%–98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%–97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients.
Conclusions—
This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
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Affiliation(s)
- Aiko Ogawa
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Toru Satoh
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Tetsuya Fukuda
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Koichiro Sugimura
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Yoshihiro Fukumoto
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Noriaki Emoto
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Norikazu Yamada
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Atsushi Yao
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Motomi Ando
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Hitoshi Ogino
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Nobuhiro Tanabe
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Ichizo Tsujino
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Masayuki Hanaoka
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Kenji Minatoya
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Hiroshi Ito
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
| | - Hiromi Matsubara
- From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular
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Affiliation(s)
- Mitsutaka Nakashima
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Kei Yunoki
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
| | - Katsumasa Miyaji
- Department of Emergency Medicine, National Hospital Organization Okayama Medical Center, Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan
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Ogawa A, Miyaji K, Matsubara H. Efficacy and safety of long-term imatinib therapy for patients with pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis. Respir Med 2017; 131:215-219. [PMID: 28947033 DOI: 10.1016/j.rmed.2017.08.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are categorized as Group 1' in the clinical classification of pulmonary hypertension. No medical therapy has been proven to be effective in patients with PVOD/PCH. Imatinib is a molecular targeted drug and was expected to be effective in patients with pulmonary arterial hypertension. We evaluated its efficacy and safety in patients with PVOD/PCH. METHODS In the present observational study, 9 patients with PVOD/PCH received imatinib. Clinical data including exercise capacity and hemodynamics at baseline and at follow-up were compared. Survival rate of patients treated with imatinib was compared to those of 7 patients who did not treated with imatinib. RESULTS Imatinib was prescribed at doses of 100-400 mg/day and was well-tolerated. At follow-up, World Health Organization functional class and brain natriuretic peptide levels significantly improved. Mean pulmonary arterial pressure was significantly reduced (from 56.8 ± 8.3 to 43.7 ± 9.0 mmHg) with preserved cardiac index. Patients were treated with imatinib for 797.2 ± 487.0 days. Seven patients (77.8%) died and 2 patients (22.2%) underwent lung transplantation. Mean survival time in patients treated with imatinib therapy was 1493.7 ± 196.3 days (95% confidence interval, 1108.9-1878.5 days), significantly longer than those without imatinib treatment (713.0 ± 258.1 days, log-rank test, P = 0.04). CONCLUSIONS Imatinib improved exercise capacity, hemodynamics and survival in patients with PVOD/PCH. In patients with PVOD/PCH, who have no effective medical therapy available, imatinib might function as a bridge to lung transplantation, and may become a potential therapeutic option to improve their survival.
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Affiliation(s)
- Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Katsumasa Miyaji
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan; Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
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88
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Tamura Y, Kumamaru H, Satoh T, Miyata H, Ogawa A, Tanabe N, Hatano M, Yao A, Abe K, Tsujino I, Fukuda K, Kimura H, Kuwana M, Matsubara H, Tatsumi K. Effectiveness and Outcome of Pulmonary Arterial Hypertension-Specific Therapy in Japanese Patients With Pulmonary Arterial Hypertension. Circ J 2017; 82:275-282. [PMID: 28747612 DOI: 10.1253/circj.cj-17-0139] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The trend of the initial treatment strategy for pulmonary arterial hypertension (PAH) has changed from monotherapies to upfront combination therapies. This study analyzed treatments and outcomes in Japanese patients with PAH, using data from the Japan PH Registry (JAPHR), which is the first organized multicenter registry for PAH in Japan.Methods and Results:We studied 189 consecutive patients (108 treatment-naïve and 81 background therapy patients) with PAH in 8 pulmonary hypertension (PH) centers enrolled from April 2008 to March 2013. We performed retrospective survival analyses and analyzed the association between upfront combination and hemodynamic improvement, adjusting for baseline NYHA classification status. Among the 189 patients, 1-, 2-, and 3-year survival rates were 97.0% (95% CI: 92.1-98.4), 92.6% (95% CI: 87.0-95.9), and 88.2% (95% CI: 81.3-92.7), respectively. In the treatment-naïve cohort, 33% of the patients received upfront combination therapy. In this cohort, 1-, 2-, and 3-year survival rates were 97.6% (95% CI: 90.6-99.4), 97.6% (95% CI: 90.6-99.4), and 95.7% (95% CI: 86.9-98.6), respectively. Patients on upfront combination therapy were 5.27-fold more likely to show hemodynamic improvement at the first follow-up compared with monotherapy (95% CI: 2.68-10.36). CONCLUSIONS According to JAPHR data, initial upfront combination therapy is associated with improvement in hemodynamic status.
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Affiliation(s)
- Yuichi Tamura
- Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Toru Satoh
- Department of Cardiology, Kyorin University School of Medicine
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo.,Department of Health Policy and Management, Keio University School of Medicine
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center
| | - Nobuhiro Tanabe
- Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University
| | - Masaru Hatano
- Department of Cardiology, The University of Tokyo Hospital
| | - Atsushi Yao
- Division for Health Service Promotion, The University of Tokyo
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University Hospital
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University School of Medicine
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Hiroshi Kimura
- Second Department of Internal Medicine, Nara Medical University
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University
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89
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Hu X, Akutsu Y, Suganami A, Qin W, Hanari N, Murakam K, Kano M, Usui A, Suito H, Takahashi M, Matsumoto Y, Otsuta R, Tamura Y, Matsubara H. Low-dose hyperthermia enhances the antitumor effects of chemotherapy in squamous cell carcinoma. Dis Esophagus 2017; 30:1-7. [PMID: 30052898 DOI: 10.1093/dote/dow026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Indexed: 12/11/2022]
Abstract
Esophageal squamous cell carcinoma is a highly aggressive neoplasm and the sixth leading cause of global cancer-related death; the 5-year survival rate for esophageal cancer is only about 20%-25% for all stages. Therefore, improving the therapeutic effect is important. This study assessed whether low-dose hyperthermia (LDH) enhances the antitumor effects of chemotherapy. The antitumor effect of chemotherapy with/without LDH in the squamous cell carcinoma cell line SCCVII was evaluated. A comprehensive analysis was performed with real-time polymerase chain reaction (PCR) to study the hyperthermia-induced changes in the gene expression of SCCVII cell lines. In addition, the cytotoxic and apoptotic changes in the cells treated with LDH combined with/without 5-fluorouracil (5-FU) were measured. LDH combined with 5-FU (10 nM) strongly inhibited the cell growth of SCCVII, with flow cytometry showing an increased population of apoptotic cells. PCR showed that LDH promoted a 25.22-fold increase of p53 mRNA and 18.08-fold increase of Bax mRNA in vitro. MDR1 expression was decreased to 28.7% after LDH. This treatment can result in much higher efficacy of antitumor drugs. After LDH, the expressions of TS decreased to 12.06%, OPRT increased by 4.17-fold, and DPD did not change (1.03-fold). This transformations will induce susceptibility to 5-FU. LDH may be a useful enhancer of chemotherapy drugs for squamous cell carcinoma.
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Affiliation(s)
- X Hu
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Akutsu
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - A Suganami
- Departments of Bioinformatics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - W Qin
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - N Hanari
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Murakam
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - M Kano
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - A Usui
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Suito
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - M Takahashi
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Matsumoto
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - R Otsuta
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Tamura
- Departments of Bioinformatics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Matsubara
- Departments of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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90
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Birkhan J, Miorelli M, Bacca S, Bassauer S, Bertulani CA, Hagen G, Matsubara H, von Neumann-Cosel P, Papenbrock T, Pietralla N, Ponomarev VY, Richter A, Schwenk A, Tamii A. Electric Dipole Polarizability of ^{48}Ca and Implications for the Neutron Skin. Phys Rev Lett 2017; 118:252501. [PMID: 28696765 DOI: 10.1103/physrevlett.118.252501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Indexed: 06/07/2023]
Abstract
The electric dipole strength distribution in ^{48}Ca between 5 and 25 MeV has been determined at RCNP, Osaka from proton inelastic scattering experiments at forward angles. Combined with photoabsorption data at higher excitation energy, this enables the first extraction of the electric dipole polarizability α_{D}(^{48}Ca)=2.07(22) fm^{3}. Remarkably, the dipole response of ^{48}Ca is found to be very similar to that of ^{40}Ca, consistent with a small neutron skin in ^{48}Ca. The experimental results are in good agreement with ab initio calculations based on chiral effective field theory interactions and with state-of-the-art density-functional calculations, implying a neutron skin in ^{48}Ca of 0.14-0.20 fm.
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Affiliation(s)
- J Birkhan
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
| | - M Miorelli
- TRIUMF, 4004Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - S Bacca
- TRIUMF, 4004Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
| | - S Bassauer
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
| | - C A Bertulani
- Department of Physics and Astronomy, Texas A&M University-Commerce, Commerce, Texas 75429, USA
| | - G Hagen
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - H Matsubara
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
- Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - P von Neumann-Cosel
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
| | - T Papenbrock
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - N Pietralla
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
| | - V Yu Ponomarev
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
| | - A Richter
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
| | - A Schwenk
- Institut für Kernphysik, Technische Universität Darmstadt, 64289 Darmstadt, Germany
- ExtreMe Matter Institute EMMI, GSI Helmholtzzentrum für Schwerionenforschung GmbH, 64291 Darmstadt, Germany
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - A Tamii
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
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91
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Matsubara H, Ogawa A. A long way to go after the initial experience with balloon pulmonary angioplasty. Eur Respir J 2017; 49:49/6/1700718. [PMID: 28596430 DOI: 10.1183/13993003.00718-2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Hiromi Matsubara
- Dept of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan .,Dept of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Aiko Ogawa
- Dept of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
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Kurzyna M, Darocha S, Pietura R, Pietrasik A, Norwa J, Mańczak R, Wieteska M, Biederman A, Matsubara H, Torbicki A. Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience. Kardiol Pol 2017; 75:645-654. [PMID: 28553870 DOI: 10.5603/kp.a2017.0091] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve "web" and "ring" lesions using reduced tip load guidewires and less intensive anticoagulation. RESULTS There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001). CONCLUSIONS Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.
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Affiliation(s)
- Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Education Medical, European Health Centre Otwock, Otwock, Poland, Poland.
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93
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Ogawa A, Satoh T, Tamura Y, Fukuda K, Matsubara H. Survival of Japanese Patients With Idiopathic/Heritable Pulmonary Arterial Hypertension. Am J Cardiol 2017; 119:1479-1484. [PMID: 28267959 DOI: 10.1016/j.amjcard.2017.01.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
Abstract
Idiopathic/heritable pulmonary arterial hypertension has a poor prognosis despite the available therapeutic options. Survival of Japanese patients with this disease entity has not been reported in the multicenter setting. A retrospective study of 141 patients with idiopathic/heritable pulmonary arterial hypertension treated at 3 pulmonary hypertension centers in Japan from 1992 to 2012 investigated survival and determinants of survival. Mean survival time from treatment initiation was 14.7 ± 0.8 years (95% confidence interval, 13.1 to 16.3 years) and the 1-, 3-, 5-, and 10-year survival rates were 97.9%, 92.1%, 85.8%, and 69.5%, respectively. Patients showed significant improvement in exercise capacity and hemodynamics after treatment. Patients with 6-minute walk distance >372 m, mean pulmonary arterial pressure ≤46 mm Hg, and cardiac index >2.5 L/min/m2 at follow-up had a significantly better prognosis. Most patients (99.2%) were receiving pulmonary hypertension-targeted drugs at follow-up. Use of endothelin receptor antagonists and intravenous epoprostenol were related to survival in the univariate analysis. Among the patients who were on intravenous epoprostenol therapy, those with endothelin receptor antagonists had a significantly better prognosis, whereas patients on warfarin had a significantly worse prognosis. In conclusion, survival of Japanese patients with idiopathic/heritable pulmonary arterial hypertension in this study was good, showing improvement in hemodynamic parameters supported by pulmonary hypertension-targeted drugs.
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94
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Nakamura K, Matsubara H, Akagi S, Sarashina T, Ejiri K, Kawakita N, Yoshida M, Miyoshi T, Watanabe A, Nishii N, Ito H. Nanoparticle-Mediated Drug Delivery System for Pulmonary Arterial Hypertension. J Clin Med 2017; 6:jcm6050048. [PMID: 28468233 PMCID: PMC5447939 DOI: 10.3390/jcm6050048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 11/16/2022] Open
Abstract
Nanoparticles have been used as a novel drug delivery system. Drug-incorporated nanoparticles for local delivery might optimize the efficacy and minimize the side effects of drugs. The efficacy and safety of intratracheal administration of prostacyclin analog (beraprost) -incorporated nanoparticles and imatinib (a PDGF-receptor tyrosine kinase inhibitor) -incorporated nanoparticles in Sugen-hypoxia-normoxia or monocrotaline rat models of pulmonary arterial hypertension (PAH) and in human PAH-pulmonary arterial smooth muscle cells have been reported. The use of inhaled drug-incorporated nanoparticles might be a novel approach for the treatment of PAH.
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Affiliation(s)
- Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hiromi Matsubara
- Division of Cardiology, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan.
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Toshihiro Sarashina
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Norifumi Kawakita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
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Higasa K, Ogawa A, Terao C, Shimizu M, Kosugi S, Yamada R, Date H, Matsubara H, Matsuda F. A burden of rare variants in BMPR2 and KCNK3 contributes to a risk of familial pulmonary arterial hypertension. BMC Pulm Med 2017; 17:57. [PMID: 28388887 PMCID: PMC5383973 DOI: 10.1186/s12890-017-0400-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/24/2017] [Indexed: 12/13/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is a severe lung disease with only few effective treatments available. Familial cases of PAH are usually recognized as an autosomal dominant disease, but incomplete penetrance of the disease makes it difficult to identify pathogenic variants in accordance with a Mendelian pattern of inheritance. Methods To elucidate the complex genetic basis of PAH, we obtained whole exome- or genome-sequencing data of 17 subjects from 9 families with heritable PAH and applied gene-based association analysis with 9 index patients and 300 PAH-free controls. Results A burden of rare variants in BMPR2 significantly contributed to the risk of the disease (p = 6.0 × 10−8). Eight of nine families carried four previously reported single nucleotide variants and four novel insertion/deletion variants in the gene. One of the novel variants was a large 6.5 kilobase-deletion. In the remaining one family, the patient carried a pathogenic variant in a member of potassium channels, KCNK3, which was the first replicative finding of channelopathy in an Asian population. Conclusions The variety of rare pathogenic variants suggests that gene-based association analysis using genome-wide sequencing data from increased number of samples is essential to tracing the genetic heterogeneity and developing an appropriate panel for genetic testing. Electronic supplementary material The online version of this article (doi:10.1186/s12890-017-0400-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koichiro Higasa
- Human Disease Genomics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kawara-cho 53, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Aiko Ogawa
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Chikashi Terao
- Human Disease Genomics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kawara-cho 53, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masakazu Shimizu
- Human Disease Genomics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kawara-cho 53, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinji Kosugi
- Department of Medical Ethics/Medical Genetics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryo Yamada
- Statistical Genetics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromi Matsubara
- Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Fumihiko Matsuda
- Human Disease Genomics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kawara-cho 53, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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96
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Shimokawahara H, Nakashima M, Naito T, Shigetoshi M, Ogawa A, Munemasa M, Matsubara H. TCTAP A-134 Novel Interventional Therapeutic Approach for Patients with Peripheral Pulmonary Artery Stenosis in Adulthood. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.03.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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97
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Lang I, Meyer BC, Ogo T, Matsubara H, Kurzyna M, Ghofrani HA, Mayer E, Brenot P. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2017; 26:26/143/160119. [PMID: 28356406 PMCID: PMC9489135 DOI: 10.1183/16000617.0119-2016] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 01/26/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH. Balloon pulmonary angioplasty is an emerging percutaneous vascular intervention for non-operable CTEPHhttp://ow.ly/tIN3309hys3
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Affiliation(s)
- Irene Lang
- Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Bernhard C Meyer
- Dept of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Dept of Advanced Medicine for Pulmonary Hypertension, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiromi Matsubara
- Dept of Clinical Science, National Hospital Organization, Okayama Medical Centre, Okayama, Japan
| | - Marcin Kurzyna
- Dept of Pulmonary Circulation and Thromboembolic Diseases, Medical Centre of Postgraduate Education, European Health Centre Otwock, Otwock, Poland
| | - Hossein-Ardeschir Ghofrani
- Universities of Giessen and Marburg Lung Center, Giessen, Germany, Member of the German Center for Lung Research (DZL).,Dept of Medicine, Imperial College London, London, UK
| | - Eckhard Mayer
- Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
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Sarashina T, Nakamura K, Akagi S, Oto T, Oe H, Ejiri K, Nakagawa K, Nishii N, Matsubara H, Kobayashi M, Morimatsu H, Miyoshi S, Ito H. Reverse Right Ventricular Remodeling After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Under Combination Therapy of Targeted Medical Drugs. Circ J 2017; 81:383-390. [PMID: 28100891 DOI: 10.1253/circj.cj-16-0838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated.Methods and Results:A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly. CONCLUSIONS Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.
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Affiliation(s)
- Toshihiro Sarashina
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Ohira G, Miyauchi H, Narushima K, Kagaya A, Mutou Y, Saitou H, Hayano K, Matsubara H. Predicting difficulty in extending the ileal pouch to the anus in restorative proctocolectomy: investigation of a simple predictive method using computed tomography. Colorectal Dis 2017; 19:O34-O38. [PMID: 27943576 DOI: 10.1111/codi.13575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to assess the ability of preoperative axial computed tomography (CT) to predict surgical difficulty in bringing the ileal pouch to the level of the anus during restorative proctocolectomy (RPC). METHOD Patients who underwent RPC with an ileal pouch-anal anastomosis (or ileal pouch-anal canal anastomosis) in our institution between January 2008 and April 2014 were enrolled. The patients were divided into two groups, including those in whom CT indicated potential difficulty in extending the pouch downwards (extension difficult (ED) group) and patients with no CT evidence of potential difficulty (normal group). The groups were compared for clinical factors and the thickness of the slices of CT showing the root of the superior mesenteric artery, the point of communication of the ileocaecal artery with the marginal artery (tICA) and the anal verge (AV). Receiver-operating characteristic analysis was performed, and a cut-off value was calculated for predicting the degree of difficulty in bringing the ileal pouch down to the anal canal. RESULTS Thirty-four patients were entered in the study. The ED group included significantly taller patients and more with familial adenomatous polyposis than the normal group. The distance between tICA and AV was significantly longer in the ED group, with a cut-off of 21 cm giving a sensitivity of 100% and a specificity of 83.3%. CONCLUSION The distance between tICA and AV measured by axial CT can be a useful predictor for the difficulty in bringing the ileal pouch down to the anus during RPC.
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Affiliation(s)
- G Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Miyauchi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Narushima
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - A Kagaya
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Mutou
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Saitou
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - H Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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100
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Nagayoshi S, Ogawa A, Matsubara H. Spontaneous enlargement of pulmonary artery after successful balloon pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension. EUROINTERVENTION 2016; 12:e1435. [PMID: 27934612 DOI: 10.4244/eij-d-15-00484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Shinya Nagayoshi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
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