Curriculum Vitaes

motoyama sadako

  (元山 貞子)

Profile Information

Affiliation
School of Medicine Faculty of Medicine, Fujita Health University
Degree
博士(医学)

Other name(s) (e.g. nickname)
Sadako Tanizawa
J-GLOBAL ID
201501002543871264
researchmap Member ID
7000012706

Research Areas

 1

Papers

 78
  • Hideki Kawai, Sadako Motoyama, Masayoshi Sarai, Yoshihiro Sato, Takahiro Matsuyama, Ryota Matsumoto, Hiroshi Takahashi, Akio Katagata, Yumi Kataoka, Yoshihiro Ida, Takashi Muramatsu, Yoshiharu Ohno, Yukio Ozaki, Hiroshi Toyama, Jagat Narula, Hideo Izawa
    European radiology, 34(4) 2647-2657, Apr, 2024  
    OBJECTIVES: Evaluation of in-stent restenosis (ISR), especially for small stents, remains challenging during computed tomography (CT) angiography. We used deep learning reconstruction to quantify stent strut thickness and lumen vessel diameter at the stent and compared it with values obtained using conventional reconstruction strategies. METHODS: We examined 166 stents in 85 consecutive patients who underwent CT and invasive coronary angiography (ICA) within 3 months of each other from 2019-2021 after percutaneous coronary intervention with coronary stent placement. The presence of ISR was defined as percent diameter stenosis ≥ 50% on ICA. We compared a super-resolution deep learning reconstruction, Precise IQ Engine (PIQE), and a model-based iterative reconstruction, Forward projected model-based Iterative Reconstruction SoluTion (FIRST). All images were reconstructed using PIQE and FIRST and assessed by two blinded cardiovascular radiographers. RESULTS: PIQE had a larger full width at half maximum of the lumen and smaller strut than FIRST. The image quality score in PIQE was higher than that in FIRST (4.2 ± 1.1 versus 2.7 ± 1.2, p < 0.05). In addition, the specificity and accuracy of ISR detection were better in PIQE than in FIRST (p < 0.05 for both), with particularly pronounced differences for stent diameters < 3.0 mm. CONCLUSION: PIQE provides superior image quality and diagnostic accuracy for ISR, even with stents measuring < 3.0 mm in diameter. CLINICAL RELEVANCE STATEMENT: With improvements in the diagnostic accuracy of in-stent stenosis, CT angiography could become a gatekeeper for ICA in post-stenting cases, obviating ICA in many patients after recent stenting with infrequent ISR and allowing non-invasive ISR detection in the late phase. KEY POINTS: • Despite CT technology advancements, evaluating in-stent stenosis severity, especially in small-diameter stents, remains challenging. • Compared with conventional methods, the Precise IQ Engine uses deep learning to improve spatial resolution. • Improved diagnostic accuracy of CT angiography helps avoid invasive coronary angiography after coronary artery stenting.
  • Yoshihiro Sato, Sadako Motoyama, Keiichi Miyajima, Hideki Kawai, Masayoshi Sarai, Takashi Muramatsu, Hiroshi Takahashi, Hiroyuki Naruse, Amir Ahmadi, Yukio Ozaki, Hideo Izawa, Jagat Narula
    JACC. Cardiovascular imaging, Sep 11, 2023  
    BACKGROUND: Coronary computed tomography angiography (CTA) followed by computed tomography angiography-derived fractional flow reserve (FFRCT) is now commonly used for the management of chronic coronary syndrome (CCS). CTA-verified high-risk plaque (HRP) characteristics have also been reported to be associated with a greater likelihood of adverse cardiac events but have not been used for management decisions. OBJECTIVES: The aim of this study was to evaluate clinical outcomes based on a combination of point-of-care computed tomography angiography-derived fractional flow reserve (POC-FFRCT) and the presence of HRP in CCS patients initially treated medically or with revascularization based on invasive coronary angiography findings. METHODS: CTA was performed as the initial test in 5,483 patients presenting with CCS between September 2015 and December 2020 followed by invasive coronary angiography and revascularization as necessary. POC-FFRCT assessment and HRP characterization were obtained subsequently in 745 consecutive patients. We investigated how HRP and POC-FFRCT, which were not available during the original clinical decision making, correlated with the endpoint defined as a composite of cardiac death, acute coronary syndrome, and a need for unplanned revascularization. RESULTS: Cardiac events occurred in 20 patients (2.7%) during a median follow-up of 744 days. The event rate was significantly higher in patients with POC-FFRCT <0.80 compared with POC-FFRCT ≥0.8 (5.4 vs 0.5 per 100 vessel years; log-rank P < 0.0001) and in patients with HRP compared to those without HRP (3.6 vs 0.8 per 100 vessel years; log-rank P = 0.0001). POC-FFRCT <0.80 and the presence of HRP were the independent predictors of cardiac events (HR: 16.67; 95% CI: 2.63-105.39; P = 0.002) compared with POC-FFRCT ≥0.8 and absent HRP. For the vessels with POC-FFRCT <0.80 and HRP, a significantly higher rate of adverse events was observed in patients who did not undergo revascularization compared with those revascularized (16.4 vs 1.4 per 100 vessel years; log-rank P = 0.006). CONCLUSIONS: POC-FFRCT <0.80 and the presence of HRP were the independent predictors of cardiac events, and revascularization of HRP lesions with abnormal POC-FFRCT was associated with a lower event rate.
  • Yoshihiro Sato, Masahiro Kumada, Hideki Kawai, Sadako Motoyama, Masayoshi Sarai, Tsutomu Nakagawa, Hideo Izawa
    Fujita medical journal, 9(3) 211-217, Aug, 2023  
    OBJECTIVES: Malnutrition is associated with an increased risk of hospital readmission for heart failure in patients with acute decompensated heart failure (ADHF). Therefore, evaluation of the nutritional status in patients with ADHF may be important. The geriatric nutritional risk index (GNRI), the controlling nutritional status (CONUT) score, and the prognostic nutritional index (PNI) are widely used objective indexes for evaluation of the nutritional status. The present study was performed to determine the best nutritional index for predicting the prognosis in older adults with ADHF. METHODS: We retrospectively studied 167 older adults (>65 years of age) who were admitted with ADHF from January 2012 to December 2015 and discharged alive. The objective nutritional status was evaluated using the GNRI, CONUT score, and PNI at admission. The endpoint of this study was unplanned hospitalization for worsening heart failure (WHF) within 1 year after discharge. RESULTS: During the follow-up period, 58 patients were readmitted for WHF. In the multivariate Cox analysis, only the GNRI (p<0.0001) was independently associated with readmission for WHF among the three nutritional indexes. Kaplan-Meier analysis revealed that patients in the low-GNRI group (<90 as determined by receiver operating characteristic curve analysis) had a significantly greater risk of 1-year hospital readmission for WHF (p<0.0001; hazard ratio, 6.1; 95% confidence interval, 3.5-10.5). CONCLUSION: Among the objective nutritional indexes, the GNRI is the best predictor of readmission for WHF within 1 year after discharge in older adults with ADHF.
  • Ken Kozuma, Taishiro Chikamori, Jun Hashimoto, Junko Honye, Takanori Ikeda, Sugao Ishiwata, Mamoru Kato, Hiroshi Kondo, Kosuke Matsubara, Kazuma Matsumoto, Naoya Matsumoto, Sadako Motoyama, Kotaro Obunai, Hajime Sakamoto, Kyoko Soejima, Shigeru Suzuki, Koichiro Abe, Hideo Amano, Hirofumi Hioki, Takashi Iimori, Hideki Kawai, Hisanori Kosuge, Tatsuya Nakama, Yasuyuki Suzuki, Kazuya Takeda, Akiko Ueda, Takashi Yamashita, Kenzo Hirao, Takeshi Kimura, Ryozo Nagai, Masato Nakamura, Wataru Shimizu, Nagara Tamaki
    Circulation journal : official journal of the Japanese Circulation Society, 86(7) 1148-1203, Jun 24, 2022  
  • Sadako Motoyama, Yasuomi Nagahara, Masayoshi Sarai, Hideki Kawai, Keiichi Miyajima, Yoshihiro Sato, Ryota Matsumoto, Hiroshi Takahashi, Hiroyuki Naruse, Junnichi Ishii, Yukio Ozaki, Hideo Izawa
    Circulation journal : official journal of the Japanese Circulation Society, 86(5) 831-842, Apr 25, 2022  
    BACKGROUND: Omega-3 fatty acids have been proposed to be useful in the prevention of cardiac events. High-risk plaque (HRP) and plaque progression on serial coronary computed tomography angiography (CTA) have been suggested to be the predecessor of acute coronary syndrome (ACS). The purpose of this study was to investigate whether addition of omega-3 fatty acids to statin therapy for secondary prevention would lead to change in plaque characteristics detected by using serial CTA.Methods and Results: This study enrolled 210 patients with ACS: no eicosapentaenoic acid (EPA)/ docosahexaenoic acid (DHA; EPA/DHA), low-dose EPA+DHA, high-dose EPA+DHA, and high-dose EPA alone. HRP was significantly more frequent in patients with plaque progression (P=0.0001). There was a significant interaction between plaque progression and EPA dose regardless of the DHA dose; 20.3% in EPA-none (no EPA/DHA), 15.7% in EPA-low (low-dose EPA+DHA), and 5.6% in EPA-high (high-dose EPA+DHA and high-dose EPA alone). On multivariate logistic regression analysis, HRP (OR 6.44, P<0.0001), EPA-high (OR 0.13, P=0.0004), and Rosvastatin (OR 0.24, P=0.0079) were the independent predictors for plaque progression. In quantitative analyses (n=563 plaques), the interval change of low attenuation plaque (LAP) volume was significantly different based on EPA dose; LAP was significantly increased in the EPA-none group and significantly decreased in the EPA-high group. CONCLUSIONS: In patients with ACS, addition of high-dose EPA (EPA-high) to statin therapy, compared to statin therapy without EPA, was associated with a lower rate of plaque progression.

Misc.

 92
  • 河合 秀樹, 皿井 正義, 加藤 靖周, 成瀬 寛之, 渡邉 あゆみ, 松山 貴裕, 元山 貞子, 森本 紳一郎, 外山 宏, 尾崎 行男
    核医学, 56(Suppl.) S137-S137, Oct, 2019  
  • 西村 豪人, 石井 潤一, 河合 秀樹, 村松 崇, 原田 将英, 元山 貞子, 成瀬 寛之, 渡邉 英一, 林 睦晴, 井澤 英夫, 尾崎 行男
    日本循環器学会学術集会抄録集, 83回 OJ03-2, Mar, 2019  
  • 成瀬 寛之, 石井 潤一, 西村 豪人, 大田 将也, 河合 秀樹, 村松 崇, 原田 将英, 山田 晶, 元山 貞子, 林 睦晴, 皿井 正義, 井澤 英夫, 渡邉 英一, 尾崎 行男
    日本循環器学会学術集会抄録集, 83回 OJ03-3, Mar, 2019  
  • 西村 豪人, 石井 潤一, 河合 秀樹, 村松 崇, 原田 将英, 成瀬 寛之, 元山 貞子, 渡邉 英一, 林 睦晴, 井澤 英夫, 尾崎 行男
    日本循環器学会学術集会抄録集, 83回 OJ15-4, Mar, 2019  
  • 皿井正義, 加藤靖周, 石黒雅伸, 宮島桂一, 永原康臣, 河合秀樹, 菊川薫, 元山貞子, 外山宏, 尾崎行男
    臨床放射線, 62(13) 1805‐1810, Dec 10, 2017  
  • 元山 貞子, 松本 良太, 皿井 正義
    内科 = Internal medicine : 臨床雑誌, 120(6) 1249-1253, Dec, 2017  
  • Fumihiko Kitagawa, Junnichi Ishii, Shinya Hiramitsu, Hiroshi Takahashi, Ryuunosuke Okuyama, Hideki Kawai, Takashi Muramatsu, Masahide Harada, Sadako Motoyama, Hiroyuki Naruse, Shigeru Matsui, Masayoshi Sarai, Mutsuharu Hayashi, Eiichi Watanabe, Hideo Izawa, Yukio Ozaki
    HEART AND VESSELS, 32(5) 609-617, May, 2017  
    Whether trough-phase rivaroxaban concentrations provide sufficient anticoagulation needs more study. We evaluated levels of coagulation activation markers in the trough concentration phase in nonvalvular atrial fibrillation (NVAF) patients, and the correlation between these markers and rivaroxaban concentration. Fifty-five Japanese NVAF patients received 24-week rivaroxaban treatment of either 15 or 10 mg once-daily in the morning. Of these, 26 patients had no history of anticoagulant therapy (naive group) and 29 had switched from warfarin (warfarin group). D-dimer and prothrombin fragment 1 + 2 (F1 + 2) levels, and protein C activities were measured at 0 (baseline), 12 and 24 weeks of rivaroxaban treatment just before the patient's regular dosing time (trough phase). For 49 patients, D-dimer, F1 + 2, and rivaroxaban concentrations were also measured twice between 28 and 32 weeks of rivaroxaban treatment at non-trough times to achieve a range of drug concentrations for correlation analysis. For the naive group, D-dimer and F1 + 2 levels were significantly reduced (p &lt; 0.01) from baseline at 12 and 24 weeks. For the warfarin group, these values were unchanged for D-dimer but significantly increased (p &lt; 0.01) for F1 + 2. Protein C activity was unchanged in the naive group and was increased (p &lt; 0.01) in the warfarin group. Prothrombin time (r = 0.92, p &lt; 0.0001) and activated partial thromboplastin time (r = 0.54, p &lt; 0.0001) correlated with rivaroxaban concentration, but not D-dimer and F1 + 2 levels. In conclusion, rivaroxaban in the trough phase is comparable to warfarin in reducing D-dimer levels. Although trough level rivaroxaban suppresses F1 + 2 less than warfarin, the higher activities of protein C with rivaroxaban treatment compared to warfarin treatment may counterbalance this. Lack of correlation between rivaroxaban concentration and D-dimer and F1 + 2 levels suggests that trough concentrations of rivaroxaban reduce their concentrations as effectively as higher levels do.
  • Yasuomi Nagahara, Sadako Motoyama, Masayoshi Sarai, Hajime Ito, Hideki Kawai, Yoko Takakuwa, Meiko Miyagi, Daisuke Shibata, Hiroshi Takahashi, Hiroyuki Naruse, Junichi Ishii, Yukio Ozaki
    Atherosclerosis, 250 30-37, Jul 1, 2016  
    © 2016 Elsevier Ireland Ltd. Background and aims: Coronary computed tomography angiography (CCTA)-verified high risk plaque (HRP) characteristics including positive remodeling and low attenuation plaque have been associated with acute coronary syndromes. Several studies reported that the n-3 polyunsaturated fatty acids have been associated with cardiovascular events. However, the relationship between serum eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio and CCTA-verified HRP in patients without known coronary artery disease (CAD) is unclear. We aimed at investigating the relation between EPA/AA and CCTA-verified HRP in patients without known CAD. Methods: We included 193 patients undergoing CCTA without known CAD (65.5 ± 12.0 years, 55.0% male). No patient has been treated with EPA. The relation of coronary risk factors, lipid profile, high-sensitivity C-reactive protein, coronary artery calcification score (CACS), number of vessel disease, plaque burden, and EPA/AA with the presence of HRP was evaluated by logistic regression analysis. Incremental value of EPA/AA to predict HRP was also analyzed by C-index, NRI, and IDI. A Cox proportional hazards model was used to estimate the time to cardiovascular event. Results: HRP was observed in 37 (19%) patients. Multivariable logistic regression analysis revealed that current smoking (OR 2.58; p = 0.046), number of vessel disease (OR 1.87; p = 0.031), and EPA/AA ratio (OR 0.65; p = 0.0006) were independent associated factors of HRP on CCTA. Although the addition of EPA/AA to the baseline model did not significantly improve C-index, both NRI (0.60, p = 0.0049) and IDI (0.054, p = 0.0072) were significantly improved. Patients with HRP had significantly higher rate of events compared with patients without HRP (14% vs. 3%, Logrank p = 0.0004). On multivariable Cox hazard analysis, baseline EPA/AA ratio was an independent predictor (HR 0.57, p = 0.047). Conclusions: Low EPA/AA was an associated factor of HRP on CCTA in patients without CAD. In addition to conventional coronary risk factors and CACS, EPA/AA and CCTA might be useful for risk stratification of CAD.
  • Sadako Motoyama, Hajime Ito, Masayoshi Sarai, Yukio Ozaki, Jagat Narula
    Journal of the American College of Cardiology, 67 459-460, Feb 2, 2016  
  • Hideki Kawai, Yoko Takakuwa, Hiroyuki Naruse, Masayoshi Sarai, Sadako Motoyama, Hajime Ito, Masatsugu Iwase, Yukio Ozaki
    HEART AND VESSELS, 30(4) 549-553, Jul, 2015  Peer-reviewed
    Two patients after Kawasaki disease (KD) developed acute myocardial infarction in their thirties, though coronary artery follow-up were deemed unnecessary because of apparently angiographic normal coronary arteries in their children more than 1-year after acute KD. Angiographic findings of apparently normal coronary arteries in the late period after acute KD are possible to mislead their prognoses. It should be recognized that coronary aneurysms can often regress in the late period. There is ongoing controversy about the therapeutic strategy in patients whose coronary aneurysms regressed within several years after acute KD. Coronary computed tomography angiography and flow-mediated dilatation might be useful for the detection of mild sequelae of KD non-invasively.
  • Annapoorna Subhash Kini, Sadako Motoyama, Yuliya Vengrenyuk, Jacobo Pena, Usman Baber, Arjun Bhat, Pedro Moreno, Jason Kovacic, Jagat Narula, Samin Sharma
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 65(10) A1810-A1810, Mar, 2015  
  • Hideki Kawai, Eiichi Watanabe, Mayumi Yamamoto, Hiroto Harigaya, Kan Sano, Hidemaro Takatsu, Takashi Muramatsu, Hiroyuki Naruse, Yoshihiro Sobue, Sadako Motoyama, Masayoshi Sarai, Hiroshi Takahashi, Tomoharu Arakawa, Shino Kan, Atsushi Sugiura, Toyoaki Murohara, Yukio Ozaki
    Journal of Cardiology, 65 197-202, Mar 1, 2015  
    © 2014 Japanese College of Cardiology. Background and purpose: Many patients with atrial fibrillation (AF) and coronary artery stent deployment are given both antiplatelet drug and warfarin. Little information is available as to the relationship between the antithrombotic therapies in the late phase after stenting and the clinical outcomes of these patients. We examined the clinical outcomes of AF patients 12 months after coronary artery stenting. Methods: We retrospectively examined 146 patients and classified them into three groups according to the antithrombotic therapies [dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT) plus warfarin, and DAPT plus warfarin] 12 months after stenting. We defined the primary endpoint as Thrombolysis in Myocardial Infarction major bleeding and the secondary endpoint as a composite of adverse events (CAE: all-cause death, nonfatal myocardial infarction, intracranial bleeding, and cerebral infarction). Results: During a median follow-up of 37 months, major bleeding and CAE were observed in 14 (9.6%) and 46 (31.5%) patients, respectively. DAPT plus warfarin was an independent risk factor for major bleeding in a multivariate Cox hazard regression model after adjustment for age, gender, and the type of AF (hazard ratio: 4.20; 95% confidence interval: 1.13-17.27; p=. 0.033). No significant clinical variables were found for CAE. Conclusions: Prolonged use of DAPT with warfarin significantly increases the risk of major bleeding in AF patients after coronary artery stenting. Individualized antithrombotic treatment is required in these patients to prevent major bleeding.
  • Sadako Motoyama, Hajime Ito, Masayoshi Sarai, Takeshi Kondo, Hideki Kawai, Yasuomi Nagahara, Hiroto Harigaya, Shino Kan, Hirofumi Anno, Hiroshi Takahashi, Hiroyuki Naruse, Junichi Ishii, Harvey Hecht, Leslee J. Shaw, Yukio Ozaki, Jagat Narula
    Journal of the American College of Cardiology, 66 337-346, Jan 1, 2015  
    © 2015 American College of Cardiology Foundation. Background Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS). Objectives This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS. Methods The presence of HRP and significant stenosis (SS) of ≥70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 ± 2.4 years). Results ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(-) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(-) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(-) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(-) patients, the cumulative number of patients with ACS developing from HRP(-) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p &lt; 0.0001) and without HRP (10%) compared with HRP(-)/PP(-) patients (0.3%). Conclusions CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.
  • Hajime Ito, Sadako Motoyama, Masayoshi Sarai, Hideki Kawai, Hiroto Harigaya, Shino Kan, Shigeru Kato, Hirofumi Anno, Hiroshi Takahashi, Hiroyuki Naruse, Junichi Ishii, Jagat Narula, Yukio Ozaki
    HEART AND VESSELS, 29(6) 743-749, Nov, 2014  Peer-reviewed
    We previously reported that serial coronary computed tomography angiography (CTA) had a potential to evaluate the interval change of plaque morphology of coronary arteries. The aim of this study was to evaluate variables associated with the plaque progression by serial CTA. We included 148 patients (age 66.3 +/- 9.8 years, male 81.1 %, median scan interval 12 months) with coronary artery disease undergoing serial CTA. Each coronary artery was compared visually between baseline and follow-up CTA to detect plaque progression. Baseline characteristics between progression and nonprogression patients did not demonstrate any significant differences. Logistic analysis revealed that only low-density lipoprotein cholesterol (LDL-C) a parts per thousand yen100 mg/dl at follow-up was associated with plaque progression (odds ratio 2.59, 95 % confidence interval 1.12-6.34, P = 0.0263). Cutoff value of LDL-C for plaque progression at follow-up was 103.0 mg/dl based on receiver-operator characteristic curves analyses. Of the 36 progressive lesions in 32 patients, plaque composition at baseline included 13 lesions (36.1 %) of noncalcified plaque, 1 lesion (2.8 %) of calcified plaque, 12 lesions (33.3 %) of partially calcified plaque, and the remaining 10 lesions (27.8 %) had no plaque at baseline and revealed de novo plaques at follow-up. There were 9 lesions (25 %) with high-risk plaque (HRP) characteristics at baseline and 18 lesions (50 %) with HRP at follow-up. Plaque progression of coronary arteries by serial CTA was associated with LDL-C a parts per thousand yen100 mg/dl at follow-up regardless of baseline LDL-C level. There was no specific finding to predict plaque progression on the baseline plaque characteristics.
  • 元山 貞子, 皿井 正義, 尾崎 行男
    循環器専門医 : 日本循環器学会専門医誌, 22(1) 55-61, Mar 25, 2014  
  • Hideki Kawai, Sadako Motoyama, Masayoshi Sarai, Yukio Ozaki
    JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, 7(6) 417-418, Nov, 2013  Peer-reviewed
    An 80-year-old asymptomatic man presented with ST-segment elevation in leads V1 to V5. Coronary CT angiography showed that microfistulae arising from multiple arteries may have led to myocardial infarction from intracoronary thromboembolism within the dilated left anterior descending (LAD). (C) 2013 Society of Cardiovascular Computed Tomography. All rights reserved.
  • Hideki Kawai, Yasuchika Kato, Sadako Motoyama, Masayoshi Sarai, Yukio Ozaki
    JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, 7(5) 326-327, Sep, 2013  Peer-reviewed
    A 62-year-old woman Underwent percutaneous transhepatic obliteration of a giant portal-systemic shunt. Just after inserting a coil into the shunt, it slipped through the giant shunt and migrated to the right atrium. CT showed coil migration into the coronary sinus. (C) 2013 Society of Cardiovascular Computed Tomography. All rights reserved.
  • Sadako Motoyama, Masayoshi Sarai, Kaori Inoue, Hideki Kawai, Hajime Ito, Hiroto Harigaya, Kayoko Takada, Yoshihiro Sanda, Hirofumi Anno, Hiroyuki Naruse, Junnichi Ishii, Yukio Ozaki
    CIRCULATION JOURNAL, 77(2) 411-417, Feb, 2013  Peer-reviewed
    Background: The role of combined evaluation of myocardial perfusion imaging (MPI; by single-photon emission computed tomography) and computed tomography angiography (CTA) for risk stratification of coronary artery disease was evaluated. For CTA, the extent of luminal stenosis, and also the features of high-risk plaques (HRP, including positive remodeling and low attenuation) were evaluated. Methods and Results: A total of 304 patients (65 +/- 11 years, male 72%, median follow-up: 24 months) who underwent CTA and MPI were enrolled in the study. Summed stress scores and summed difference scores (SDS) for MPI, stenosis, and HRP were evaluated, and event rates were compared. Cardiac events were defined as acute coronary event including cardiac death or non-fatal acute myocardial infarction, and unstable angina requiring revascularization. Of 304 patients, 51 (16.8%) underwent early revascularization. In the remaining 253 patients, an event occurred in 11 (4.3%). HRP (hazard ratio [HR], 4.75, P=0.00171) and stenosis (+) with SDS &gt;0 (HR, 4.58, P=0.0461) were). HRP (hazard ratio [HR], 4.75, P=0.00171) and stenosis (+) with SDS &gt;0 (HR, 4.58, P=0.0461) were significant independent predictors of cardiac event. The event rate for stenosis (+) with SDS &gt;0 was significantly higher than others (log-rank P=0.0490). The event rates were significantly different between HRP(+) and HRP(-) (16.1% vs. 2.7%, log-rank P=0.0013). Conclusions: HRP on CTA was an independent predictor of acute coronary events, as was stenosis (+) with SDS &gt;0, and HRP had increased prognostic value over stenosis and abnormal MPI findings. (Circ J 2013; 77: 411-417)
  • Sadako Motoyama, Masayoshi Sarai, Jagat Narula, Yukio Ozaki
    Cardiovascular Intervention and Therapeutics, 28(1) 1-8, 2013  Peer-reviewed
    Computed tomography angiography (CTA) is commonly employed for exclusion of coronary artery disease and demonstration of the extent of coronary vascular involvement. It has been recently proposed that coronary artery plaques could be visualized noninvasively. This review article focused on the high risk plaque detected by CTA. Plaque characteristics of acute coronary syndrome (ACS) was compared to sable angina pectoris (SAP). The presence of positive remodeling (ACS 87 %, SAP 12 %, p &lt 0. 0001), low attenuation plaque (LAP) (ACS 79 %, SAP 9 %, p &lt 0. 0001), and spotty calcification (ACS 63 %, SAP 21 %, p = 0. 0005) were significantly more frequent in the culprit ACS lesions. Furthermore, in asymptomatic patients, presence of positively remodeling and LAP portends a greater risk for development of acute coronary events (hazard ratio = 22. 8, CI = 6. 9-75. 2, p &lt 0. 001). Possibility of drug intervention to high risk plaque was also reported. Serial CTA assessment allows for evaluation of interval change in morphological plaque characteristics and can be employed for assessment of efficacy of therapeutic intervention. Use of statin results in substantial reduction in LAP volume (follow-up: 4. 9 ± 7. 8 versus baseline: 1. 3 ± 2. 3 mm3, p = 0. 02) forwards stabilization of plaques. Although not recommended currently as a population-based strategy, CT angiographic examination may help identify very high risk asymptomatic subjects. © 2013 Japanese Association of Cardiovascular Intervention and Therapeutics.
  • Sarai M, Motoyama S, Kato Y, Kawai H, Ito H, Takada K, Yoda R, Toyama H, Morimoto SI, Ozaki Y
    Asia Oceania J Nucl Med Biol, 1(2) 4-9, 2013  Peer-reviewed
  • Hideki Kawai, Masayoshi Sarai, Sadako Motoyama, Hajime Ito, Kayoko Takada, Hiroto Harigaya, Hiroshi Takahashi, Shuji Hashimoto, Yasushi Takagi, Motomi Ando, Hirofumi Anno, Junichi Ishii, Toyoaki Murohara, Yukio Ozaki
    BMJ OPEN, 3(11), 2013  Peer-reviewed
    Objective To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG). Design A retrospective, observational, single centre study. Setting and patients 204 patients (84.3% men, mean age 68.77.6) undergoing CTA and MPI. Main outcome measures CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk 50% diameter stenosis, other native vessel stenosis 70% or graft stenosis 70%. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)&lt;4), group B (UCT1, SSS&lt;4), group C (UCT=0, SSS4) and group D (UCT1, SSS4). Results Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction, unstable angina requiring revascularisation and heart-failure hospitalisation, were observed in 27 patients for a median follow-up of 27.5months. The annual event rates were 1.1%, 2%, 5.7% and 12.9% of patients in groups A, B, C and D, respectively (log rank p value &lt;0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement. Conclusions The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG.
  • Hiroyuki Naruse, Junnichi Ishii, Tousei Hashimoto, Tomoko Kawai, Kousuke Hattori, Masanori Okumura, Sadako Motoyama, Shigeru Matsui, Ikuko Tanaka, Hideo Izawa, Masanori Nomura, Yukio Ozaki
    CIRCULATION JOURNAL, 76(8) 1848-1855, Aug, 2012  Peer-reviewed
    Background: The incidence, risk factors, and outcome of contrast-induced acute kidney injury (CI-AKI) in 730 patients with acute coronary syndrome (ACS) undergoing emergency percutaneous coronary intervention (PCI), whose contrast volume was below maximum allowable contrast dose (MACD) was prospectively investigated. Methods and Results: MACD was defined as (5 mlxbody weight [kW/baseline creatinine [mg/dl]). CI-AKI was defined as a greater than 25% increase in creatinine from the baseline or an absolute increase of &gt;= 0.5 mg/dl within 48 h after the procedure. CI-AKI occurred in 212 (29%) patients. Patients with CI-AKI had a higher risk for in-hospital mortality (9.4% vs. 1.5%, P&lt;0.001) and a longer stay in the coronary care unit (median, 4.0 vs. 3.0 days, P&lt;0.001) compared with those without CI-AKI. In a multivariate logistic analysis including 20 clinical variables, elevated glucose levels as variables categorized into quartiles were independently (P&lt;0.001) associated with the development of CI-AKI. In addition, this relationship was seen in both the subgroup of patients with known diabetes and that of those without known diabetes. Conclusions: CI-AKI might occur commonly and could be be associated with a more complicated clinical course in ACS patients undergoing emergency PCI whose contrast volume does not exceed MACD. Elevated pre-procedural glucose might be a powerful and independent risk factor for the development of CI-AKI in this population. (Circ J 2012; 76: 1848-1855)
  • Hideki Kawai, Masayoshi Sarai, Sadako Motoyama, Hiroto Harigaya, Hajime Ito, Yoshihiro Sanda, Shankar Biswas, Hirofumi Anno, Junichi Ishii, Toyoaki Murohara, Yukio Ozaki
    CIRCULATION JOURNAL, 76(6) 1436-1441, Jun, 2012  Peer-reviewed
    Background: The differences in the coronary plaque characteristics between patients with mild chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] 30-59 ml . min(-1) . 1.73 m(-2)) and those without CKD (eGFR &gt;= 60) by 320-row area detector computed tomography (CT) have not been studied. Methods and Results: We enrolled 487 patients undergoing coronary CT angiography with suspected stable coronary artery disease (mean age: 66.6 +/- 10.8 years, 131 with mild CKD) and analyzed 6,352 segments. All coronary plaques were characterized for the presence of vessel remodeling, plaque consistency and the disposition of coronary calcification, and a plaque with positive vessel remodeling and/or low-attenuation was defined as high risk. The number of diseased segments per patient was higher in mild CKD patients than in those without CKD (4.61 +/- 3.83 vs. 2.95 +/- 3.11, P&lt;0.0001). The prevalence of severe stenosis (&gt;= 70% luminal diameter) was significantly higher in cases of mild CKD than in no CKD (35.1% vs. 19.4%, P=0.0003), but there was no significant difference in the prevalence of high-risk plaque (13.0% vs. 9.8%, P=0.3189). Conclusions: The severity of coronary artery stenosis was higher in the patients with mild CKD, though there was no significant difference in the prevalence of high-risk plaque. We suggest that the high risk of coronary events in patients with CKD is related to the severity of stenosis rather than to the characteristics of plaque. (Circ J 2012; 76: 1436-1441)
  • Tousei Hashimoto, Junnichi Ishii, Fumihiko Kitagawa, Shingo Yamada, Kousuke Hattori, Masanori Okumura, Hiroyuki Naruse, Sadako Motoyama, Shigeru Matsui, Ikuko Tanaka, Hideo Izawa, Ikuro Maruyama, Masanori Nomura, Yukio Ozaki
    ATHEROSCLEROSIS, 221(2) 490-495, Apr, 2012  Peer-reviewed
    Objective: High-mobility group box 1 (HMGB1) is a damage-associated molecular pattern molecule, which suggests a potential role of this protein in the pathophysiology of acute coronary syndrome (ACS). Circulating HMGB1 has been shown to be independently associated with cardiac mortality in ST-segment elevation myocardial infarction. However, its prognostic value remains unclear in unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI). Methods: HMGB1, high-sensitivity C-reactive protein (hsCRP), cardiac troponin I and B-type natriuretic peptide concentrations were measured on admission in 258 consecutive patients (mean age of 67 years) hospitalized for UA/NSTEMI within 24 h (mean, 7.4 h) of the onset of chest symptoms. Results: A total of 38 (14.7%) cardiovascular deaths, including 10 in-hospital deaths, occurred during a median follow-up period of 49 months after admission. In a stepwise Cox regression analysis including 19 well-known clinical predictors of ACS, HMGB1 [relative risk (RR) 3.24 per 10-fold increment; P = 0.0003], cardiac troponin I (RR 1.83 per 10-fold increment, P = 0.0007), Killip class &gt; 1 (RR 4.67, P = 0.0001) and age (RR 1.05 per 1-year increment, P = 0.03), but not hsCRP, were independently associated with cardiovascular mortality. In-hospital and cardiovascular mortality rates were higher in patients with increased HMGB1 (&gt;= 2.4 ng/mL of median value) than those without increased HMGB1 (6.3% vs. 1.5%, P = 0.04; and 23% vs. 6.9%, P = 0.0003). Conclusion: Circulating concentration of HMGB1 on admission may be a potential and independent predictor of cardiovascular mortality in patients hospitalized for UA/NSTEMI within 24 h of onset. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
  • Yukio Ozaki, Masanori Okumura, Tevfik F. Ismail, Sadako Motoyama, Hiroyuki Naruse, Kousuke Hattori, Hideki Kawai, Masayoshi Sarai, Yasushi Takagi, Junichi Ishii, Hirofumi Anno, Renu Virmani, Patrick W. Serruys, Jagat Narula
    EUROPEAN HEART JOURNAL, 32(22) 2814-2823, Nov, 2011  Peer-reviewed
    Aims Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. Methods and results Seventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29%) and RFC in the remaining 25 (71%); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 +/- 12, 131 +/- 57, and 321 +/- 146 mu m, respectively; P = 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18%; P = 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14%; P = 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. Conclusion In contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.
  • Hiroto Harigaya, Sadako Motoyama, Masayoshi Sarai, Kaori Inoue, Tomonori Hara, Masanori Okumura, Hiroyuki Naruse, Junnichi Ishii, Hitoshi Hishida, Yukio Ozaki
    HEART AND VESSELS, 26(4) 363-369, Jul, 2011  Peer-reviewed
    Coronary computed tomography angiography (CTA) can assess plaque characteristics and plaque size noninvasively. The purpose of this study was to investigate whether coronary CTA before percutaneous coronary intervention (PCI) can predict the no-reflow phenomenon during PCI. Seventy-eight patients [acute coronary syndrome (ACS) = 43, stable angina pectoris (SAP) = 35, male/female = 72/6, age: 65 +/- A 10 years] who underwent 16- or 64-slice CTA in the 4 weeks before PCI were enrolled. The low attenuation plaque size on CTA was compared between patients with (NR+) and without the no-reflow phenomenon (NR-). No-reflow phenomenon was observed in 11 patients, including 10 patients with ACS and 1 patient with SAP. Low attenuation plaque was detected in 9 (82%) NR(+) lesions and 35 (52%) NR(-) lesions. The length of low attenuation plaque was significantly longer in NR(+) than in NR(-) patients (9.0 +/- A 6.5 vs. 1.6 +/- A 2.7 mm, p &lt; 0.0001). On step-wise regression analysis, ACS (p = 0.036, 95% CI = 0.009-0.258) and the presence of low attenuation plaque with a length &gt; 4.7 mm (p &lt; 0.001, 95% CI = 0.447-0.778) were significant independent predictors of NR(-) no-reflow phenomenon. Low attenuation plaque with lesion length of &gt; 4.7 mm on coronary CTA and ACS were the significant predictors for the no-reflow phenomenon during PCI. Coronary CTA assessment before PCI would be useful to predict coronary events during PCI in advance.
  • 三田祥寛, 安野泰史, 元山貞子, 皿井正義, 尾崎行男, 片田和広
    藤田学園医学会誌, 35(1) 91-93, 2011  Peer-reviewed
  • Kaori Inoue, Sadako Motoyama, Masayoshi Sarai, Takahisa Sato, Hiroto Harigaya, Tomonori Hara, Yoshihiro Sanda, Hirofumi Anno, Takeshi Kondo, Nathan D. Wong, Jagat Narula, Yukio Ozaki
    JACC-CARDIOVASCULAR IMAGING, 3(7) 691-698, Jul, 2010  Peer-reviewed
    OBJECTIVES This study sought to assess, by serial computed tomography angiography (CTA), the effect of statin treatment on coronary plaque morphology. BACKGROUND In addition to the assessment of luminal stenosis, CTA also allows characterization of plaque morphology. Large, positively remodeled plaques with large necrotic cores have been reported as indicators of plaque instability. METHODS CTA was performed in 32 patients (26 men, ages 64.3 +/- 8.5 years). Of these, 24 received fluvastatin after the baseline study; 8 subjects who refused statin treatment were followed as the control subjects. Serial imaging was performed after a median interval of 12 months. All vessels were examined in every subject, and a 10-mm-long segment was identified for comparison before and after intervention. Total plaque volume, low attenuation plaque (LAP) volume, lumen volume, and remodeling index were calculated. RESULTS In the statin-treated patients, the total plaque volume (92.3 +/- 37.7 vs. 76.4 +/- 26.5 mm(3), p &lt; 0.01) and LAP volume (4.9 +/- 7.8 vs. 1.3 +/- 2.3 mm(3), p = 0.01) were significantly reduced over time; however, there was no change in the lumen volume (63.9 +/- 25.3 vs. 65.2 +/- 26.2 mm(3), p = 0.59). On the other hand, no change was observed in the CTA characteristics in the control subjects, including total plaque volume (94.4 +/- 21.2 vs. 98.4 +/- 28.6 mm(3), p = 0.48), LAP volume (2.1 +/- 3.0 vs. 2.3 +/- 3.6 mm(3), p = 0.91), and lumen volume (80.5 +/- 20.7 vs. 75.0 +/- 16.3 mm(3), p = 0.26). The plaque volume change (-15.9 +/- 22.2 vs. 4.0 +/- 14.0 mm(3), p +/- 0.01) and LAP volume change (-3.7 +/- 7.0 vs. 0.2 +/- 1.5 mm(3), p = 0.01) were significantly greater in the statin than the control group. The lumen volume (1.3 +/- 15.6 vs. -5.5 +/- 13.1 mm(3), p = 0.24) and remodeling index (-2.4 +/- 6.8% vs. -0.3 +/- 6.5%, p = 0.53) did not show the significant differences between the 2 groups. The decrease in the plaque volume was due to reduction in the LAP volume (R = 0.83, p &lt; 0.01), and was not related to any changes in the lumen volume (R = 0.21, p = 0.24). CONCLUSIONS This preliminary study suggests that serial CTA evaluation of coronary plaques allows for the assessment of interval change in the plaque morphology. Statin treatment results in decreases in the plaque and necrotic core volume. The features known to be associated with plaque instability. (J Am Coll Cardiol Img 2010;3:691-8) (c) 2010 by the American College of Cardiology Foundation
  • Sadako Motoyama, Yukio Ozaki, Jagat Narula
    Journal of the American College of Cardiology, 55 1163-1164, Mar 16, 2010  
  • MOTOYAMA S, OZAKI Y
    16(1) 55-63, Feb 25, 2010  
  • Shankar K. Biswas, Masayoshi Sarai, Akira Yamada, Hiroshi Toyama, Sadako Motoyama, Hiroto Harigaya, Tomonori Hara, Hiroyuki Naruse, Hitoshi Hishida, Yukio Ozaki
    INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, 26 155-164, Feb, 2010  Peer-reviewed
    The evolution of the oxidative metabolism of C-11 acetate parallels the recovery of left ventricular (LV) contraction following acute myocardial infarction (AMI). This study was designed to unravel, for the first time, the impact of the global washout rate (WR) of I-123-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) on the recovery of LV function following AMI, as evidenced from conventional echocardiography. Twenty consecutive patients (age: 58 +/- 13 years; 16 males and 4 females) with ST-segment elevation myocardial infarction (STEMI) were enrolled and all of them underwent successful percutaneous coronary intervention (PCI). I-123-BMIPP cardiac scintigraphy was performed at 7 +/- 3 days after admission. The WR was calculated from the polar map and the regional BMIPP defect score was calculated using a 17 segment model. Echocardiography was performed within 24 h of admission and at 3 months to record the ejection fraction (EF), the wall motion score index (WMSI), the ratio of the mitral inflow velocity to the early diastolic velocity (E/E&apos;) and the myocardial performance index (MPI). The mean global WR of the BMIPP was 22.12 +/- 7.22%, and it was significantly correlated with the improvement of the WMSI (r = 0.61, P &lt; 0.004). However, the relative changes of the EF, E/E&apos; and MPI were not correlated with the WR. The BMIPP defect score (18 +/- 10) was significantly correlated with the WMSI on admission (r = 0.74, P = 0.0002), but the defect score was not correlated with the relative changes of any of the echocardiographic parameters. We proved that the WR of the BMIPP is a promising indicator of improvement of the LV wall motion (WMSI) following ST-segment elevation myocardial infarction and successful reperfusion.
  • Shankar Kumar Biswas, Masayoshi Sarai, Akira Yamada, Sadako Motoyama, Hiroto Harigaya, Tomonori Hara, Kunihiko Sugimoto, Hiroshi Toyama, Hitoshi Hishida, Yukio Ozaki
    INTERNATIONAL JOURNAL OF CARDIOLOGY, 138(3) 290-299, Feb, 2010  Peer-reviewed
    Background: Myocardial fatty acid metabolic imaging with beta-methyl iodophenyl pentadecanoic acid (BMIPP) and perfusion imaging with tetrofosmin (TF) combined can predict post ischemic salvageable myocardium and persistent left ventricular (LV) dysfunction. This study was designed for the first time to assess systolic, diastolic and global LV dysfunction considering BMIPP and TF mismatched defect score (MMDS), and comparing this approach with the conventional Doppler echocardiography. Methods: Thirty four patients with first acute myocardial infarction (AMI) were enrolled, and all of them underwent percutaneous coronary intervention (PCI). BMIPP and Tetrofosmin (TF) scans were performed at 7+/-3.5 days of admission. Echocardiography was performed within 24 h of admission, at an interval of 1 and 3 months. MMDS was compared with systolic: ejection fraction (EF), wall motion score index (WMSI), fractional shortening (FS); diastolic: mitral valve deceleration time (MVDT), E/E&apos;, left atrial volume index (LAVI); combined systolic and diastolic parameter: left ventricular myocardial performance index (LVMPI). Results: A good correlation was observed between BMIPP and TF defect score (p&lt;0.00001), and in 31 (91%) patients BMIPP defect score was higher than that of TF. The MMDS showed significant correlation with EF (r=-0.64, p=&lt;0.00001), WMSI (r=0.61, p&lt;0.0001), and FS(r=-0.65, p&lt;0.00001), LAVI (r=-0.32, p&lt;0.05), and LVMPI (r=0.37, p&lt;0.02) during follow up echocardiography at 1 month. MVDT and E/E&apos; did not correlate with MMDS. Conclusion: Perfusion-metabolism mismatched defect score was well correlated with the evolution of global left ventricular dysfunction following AMI evidenced from conventional Doppler echocardiography. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
  • Sadako Motoyama, Yukio Ozaki
    Nippon rinsho. Japanese journal of clinical medicine, 68 584-586, Jan 1, 2010  
  • 針谷浩人, 元山貞子, 皿井正義, 河合英樹, 井上薫里, 成瀬寛之, 石井潤一, 尾崎行男
    藤田学園医学会誌, 34(1) 113-116, 2010  Peer-reviewed
  • Shankar K. Biswas, Masayoshi Sarai, Hiroshi Toyama, Akira Yamada, Sadako Motoyama, Hiroto Harigaya, Tomonori Hara, Masatsugu Iwase, Hitoshi Hishida, Yukio Ozaki
    INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, 25(8) 765-775, Dec, 2009  Peer-reviewed
    I-123-beta-methyl-iodophenyl pentadecanoic acid (BMIPP) and Tc-99m-Tetrofosmin (TF) mismatch designated as stunned myocardium having both systolic and diastolic components. The degree of mismatch might reflect subsequent functional improvement, and this study was designed to unravel the impact of mismatched defect score (MMDS) on recovery of both systolic and diastolic function following acute myocardial infarction (AMI). Forty patients with recent AMI were recruited, and all of them underwent emergency percutaneous coronary intervention. Echocardiography and BMIPP and TF cardiac scintigraphy were performed on 7 +/- A 3 days of admission. Follow up echocardiography was performed after 3 months. MMDS were compared with the systolic [ejection fraction (EF) and wall motion score index (WMSI)] and diastolic [peak velocity of early diastolic filling of mitral inflow/peak early diastolic velocity of the mitral annulus(E/E&apos;) and left atrial volume index(LAVI)] parameters. BMIPP defect score was significantly higher than the TF defect score and there was a strong positive correlation between them (r = 0.90, P &lt; 0.00001). Thirty-two (80%) patients showed mismatched defect and rest 8(20%) showed matched defect. Of 32 patients 24(75%), 22(69%), 19(59%), and 20(62.5%) showed improved EF, WMSI, E/E&apos; and LAVI respectively. Conversely out of 8 only 2(25%), 1(12.5%), and 2(25%) patients showed improvement of EF, WMSI and LAVI, respectively. E/E&apos; was not improved in patients with matched defect. MMDS were significantly correlated with the improvement of EF (r = -0.46, P = 0.002), WMSI (r = 0.41, P = 0.007), E/E&apos; (r = 0.56, P &lt; 0.0002), and LAVI (r = 0.44, P = 0.004). Mismatched defect score could predict the approximate amount of viable dysfunctional myocardium, and the degree of mismatch showed a significant correlation with the improvement of both systolic and diastolic function.
  • Sadako Motoyama, Masayoshi Sarai, Hiroto Harigaya, Hirofumi Anno, Kaori Inoue, Tomonori Hara, Hiroyuki Naruse, Junichi Ishii, Hitoshi Hishida, Nathan D. Wong, Renu Virmani, Takeshi Kondo, Yukio Ozaki, Jagat Narula
    JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 54(1) 49-57, Jun, 2009  Peer-reviewed
    Objectives In a computed tomographic (CT) angiography study, we identified the characteristics of atherosclerotic lesions that were associated with subsequent development of acute coronary syndrome (ACS). Background The CT characteristics of culprit lesions in ACS include positive vessel remodeling (PR) and low-attenuation plaques (LAP). These 2 features have been observed in the lesions that have already resulted in ACS, but their prospective relation to ACS has not been previously described. Methods In 1,059 patients who underwent CT angiography, atherosclerotic lesions were analyzed for the presence of 2 features: PR and LAP. The remodeling index, and plaque and LAP areas and volumes were calculated. The plaque characteristics of lesions resulting in ACS during the follow-up of 27 +/- 10 months were evaluated. Results Of the 45 patients showing plaques with both PR and LAP (2-feature positive plaques), ACS developed in 10 (22.2%), compared with 1 (3.7%) of the 27 patients with plaques displaying either feature (1-feature positive plaques). In only 4 (0.5%) of the 820 patients with neither PR nor LAP (2-feature negative plaques) did ACS develop. None of the 167 patients with normal angiograms had acute coronary events (p &lt; 0.001). ACS was independently predicted by PR and/or LAP (hazard ratio: 22.8, 95% confidence interval: 6.9 to 75.2, p &lt; 0.001). Among 2- or 1-feature positive segments, those resulting in ACS demonstrated significantly larger remodeling index (126.7 +/- 3.9% vs. 113.4 +/- 1.6%, p = 0.003), plaque volume (134.9 +/- 14.1 mm(3) vs. 57.8 +/- 5.7 mm(3), p &lt; 0.001), LAP volume (20.4 +/- 3.4 mm(3) vs. 1.1 +/- 1.4 mm(3), p &lt; 0.001), and percent LAP/total plaque area (21.4 +/- 3.7 mm(2) vs. 7.7 +/- 1.5 mm(2), p = 0.001) compared with segments not resulting in ACS. Conclusions The patients demonstrating positively remodeled coronary segments with low-attenuation plaques on CT angiography were at a higher risk of ACS developing over time when compared with patients having lesions without these characteristics. (J Am Coll Cardiol 2009; 54: 49-57) (C) 2009 by the American College of Cardiology Foundation
  • Biswas Shankar, Sarai Masayoshi, Hara Tomonori, Harigaya Hiroto, Motoyama Sadako, Yamada Akira, Okumura Masanori, Naruse Hiroyuki, Inoue Kaori, Hishida Hitoshi, Ozaki Yukio
    Circulation journal : official journal of the Japanese Circulation Society, 73 253-254, Mar 1, 2009  
  • Okumura Masanori, Ozaki Yukio, Hattori Kosuke, Kan Shino, Ishikawa Makoto, Gohchi Tomoko, Naruse Hiroyuki, Matsui Shigeru, Harigaya Hiroto, Motoyama Sadako, Sarai Masayoshi, Ishii Junichi, Nomura Masanori, Hishida Hitoshi
    Circulation journal : official journal of the Japanese Circulation Society, 73 614-614, Mar 1, 2009  
  • Ishikawa Makoto, Ozaki Yukio, Naruse Hiroyuki, Okumura Masanori, Kan Shino, kawai Tomoko, Hattori Kosuke, Harigaya Hiroto, Motoyama Sadako, Matsui Shigeru, Sarai Masayoshi, Ishii Junichi, Hishida Hitoshi
    Circulation journal : official journal of the Japanese Circulation Society, 73 648-648, Mar 1, 2009  
  • Harigaya Hiroto, Motoyama Sadako, Inoue Kaori, Hara Tomonori, Sarai Masayoshi, Hishida Hitoshi, Ozaki Yukio
    Circulation journal : official journal of the Japanese Circulation Society, 73 369-369, Mar 1, 2009  
  • Motoyama S, Ozaki Y, Narula J
    Current Cardiovascular Imaging Reports, 2 418-426, 2009  Peer-reviewed
  • 祖父江 嘉洋, 渡邊 英一, 原 智紀, 椎野 憲二, 針谷 浩人, 山田 晶, 成瀬 寛之, 元山 貞子, 平光 伸也, 石井 潤一, 菱田 仁士, 尾崎 行男, 高木 靖, 安藤 太三
    Circulation journal : official journal of the Japanese Circulation Society, 72 1084-1084, Oct 20, 2008  
  • Harigaya Hiroto, Motoyama Sadako, Sarai Masayoshi, Inoue Kaori, Hara Tomonori, Okumura Masanori, Sobue Yoshihiro, kann shino, yamada akira, Naruse Hiroyuki, Matsui Shigeru, Hiramitsu Shinya, Ishii Junichi, Hishida Hitoshi, Ozaki Yukio
    Circulation journal : official journal of the Japanese Circulation Society, 72 629-629, Mar 1, 2008  
  • Okumura Masanori, Ozaki Yukio, Naruse Hiroyuki, Kan Shino, Hattori Kosuke, Gohchi Tomoko, Harigaya Hiroto, Ishikawa Makoto, Hara Tomonori, Matsui Shigeru, Motoyama Sadako, Sarai Masayoshi, Ishii Junichi, Nomura Masanori, Hishida Hitoshi
    Circulation journal : official journal of the Japanese Circulation Society, 72 719-720, Mar 1, 2008  
  • Hara Tomonori, Sarai Masayoshi, Katoh Yasuchika, Miyagishima Kenji, Harigaya Hiroto, Ueda Tomoya, Yoda Ryuji, Kimura Hisashi, Inoue Kaori, Biswas Shankar, Motoyama Sadako, Hiramitsu Shinya, Morimoto Shinichiro, Hishida Hitoshi, Ozaki Yukio
    Circulation journal : official journal of the Japanese Circulation Society, 72 418-418, Mar 1, 2008  
  • Hattori Kosuke, Ozaki Yukio, Okumura Masanori, Kan Shino, Ishikawa Makoto, Gohchi Tomoko, Harigaya Hiroto, Hara Tomonori, Matsui Shigeru, Naruse Hiroyuki, Motoyama Sadako, Sarai Masayoshi, Ishii Junichi, Nomura Masanori, Hishida Hitoshi
    Circulation journal : official journal of the Japanese Circulation Society, 72 522-522, Mar 1, 2008  
  • Motoyama Sadako, Sarai Masayoshi, Harigaya Hiroto, Inoue Kaori, Hara Tomonori, Hishida Hitoshi, Ozaki Yukio
    Circulation journal : official journal of the Japanese Circulation Society, 72 221-221, Mar 1, 2008  
  • Sadako Motoyama, Hirofumi Anno, Masayoshi Sarai, Takahisa Sato, Yoshihiro Sanda, Yukio Ozaki, Teruhito Mochizuki, Kazuhiro Katada, Hitoshi Hishida
    Journal of the American College of Cardiology, 51 773-775, Feb 19, 2008  

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