Faculty Profiles - OHISHI Mitsuru

Higo Kenjuro, Kubota Kayoko, Miyanaga Sunao, Miyata Masaaki, Nakajo Masatoyo, Jinguji Megumi, Ohishi Mitsuru . Impairment of Iodine-123-Metaiodobenzylguanidine (123I-MIBG) Uptake in Patients with Pulmonary Artery Hypertension . International Heart Journal59 ( 1 ) 112 - 119 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：International Heart Journal Association

According to recent studies, lung uptake of iodine-123-metaiodobenzylguanidine (123I-MIBG) is impaired in many lung diseases and low lung uptake of 123I-MIBG suggests endothelial dysfunction of the pulmonary artery. 123I-MIBG scintigraphy in patients with pulmonary hypertension (PH) has not yet been clinically evaluated. We hypothesized that the lung uptake of 123I-MIBG is reduced in patients with PH and differs among PH subtypes. The purpose of the present study was to analyze the lung uptake of 123I-MIBG in patients with PH and compare it with the data obtained by echocardiography or right heart catheterization. 123I-MIBG scintigraphy was performed in 286 consecutive patients from 2003 to 2014. We enrolled 21 patients with PH and 8 control patients. The 21 patients with PH were categorized into those with pulmonary artery hypertension (PAH, n = 12) and those with chronic thromboembolic pulmonary hypertension (CTEPH, n = 9). The mean pulmonary artery pressure was not significantly different between patients with CTEPH and PAH (37.7 ± 6.8 versus 32.3 ± 5.3 mmHg respectively; P = 0.054). There were no significant differences in any other hemodynamic parameters between the two groups. The lung uptake of 123I-MIBG in PAH patients (early image: 1.54 ± 0.18, delayed image: 1.41 ± 0.16) was significantly lower than that of CTEPH patients (early image: 2.17 ± 0.25, P < 0.0001; delayed image: 1.99 ± 0.20, P = 0.0001, adjusted for age and World Health Organization classification) and controls (early image: 2.32 ± 0.27, P = 0.0007; delayed image: 1.92 ± 0.19, P = 0.0007). In conclusion, we found for the first time that the lung uptake of 123I-MIBG in patients with PAH is lower than that in patients with CTEPH and controls.

DOI： 10.1536/ihj.16-629

Nakao Yoko M, Miyamoto Yoshihiro, Higashi Masahiro, Noguchi Teruo, Ohishi Mitsuru, Kubota Isao, Tsutsui Hiroyuki, Kawasaki Tomohiro, Furukawa Yutaka, Yoshimura Michihiro, Morita Hideaki, Nishimura Kunihiro, Kada Akiko, Goto Yoichi, Okamura Tomonori, Tei Chuwa, Tomoike Hitonobu, Naito Hiroaki, Yasuda Satoshi . Sex differences in impact of coronary artery calcification to predict coronary artery disease . HEART104 ( 13 ) 1118 - 1124 2018

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：BMJ

<sec><title>Objective</title>To assess sex-specific differences regarding use of conventional risks and coronary artery calcification (CAC) to detect coronary artery disease (CAD) using coronary CT angiography (CCTA).

</sec><sec><title>Methods</title>The Nationwide Gender-specific Atherosclerosis Determinants Estimation and Ischemic Cardiovascular Disease Prospective Cohort study is a prospective, multicentre, nationwide cohort study. Candidates with suspected CAD aged 50–74 years enrolled from 2008 to 2012. The outcome was obstructive CAD defined as any stenosis ≥50% by CCTA. We constructed logistic regression models for obstructive CAD adjusted for conventional risks (clinical model) and CAC score. Improvement in discrimination beyond risks was assessed by C-statistic; net reclassification index (NRI) for CAD probability of low (<30%), intermediate (30%–60%) and high (≥60%); and risk stratification capacity.

</sec><sec><title>Results</title>Among 991 patients (456 women, 535 men; 65.2 vs 64.4 years old), women had lower CAC scores (median, 4 vs 60) and lower CAD prevalence (21.7% vs 37.0%) than men. CAC significantly improved model discrimination compared with clinical model in both sexes (0.66–0.79 in women vs 0.61–0.83 in men). The NRI for women was 0.33, which was much lower than that for men (0.71). Adding CAC to clinical model had a larger benefit in terms of moving an additional 43.3% of men to the most determinant categories (high or low risk) compared with −1.4% of women.

</sec><sec><title>Conclusions</title>The addition of CAC to a prediction model based on conventional variables significantly improved the classification of risk in suspected patients with CAD, with sex differences influencing the predictive ability.

</sec><sec><title>Trial registration number</title>UMIN-CTR Clinical Trial: UMIN000001577.

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DOI： 10.1136/heartjnl-2017-312151

Ikeda Yoshiyuki, Sasaki Takeshi, Kuwahata So, Imamura Masakazu, Tanoue Kanyo, Komaki Shinichirou, Hashiguchi Mamoru, Kuroda Atsushi, Akasaki Yuichi, Hamada Chikuma, Ohishi Mitsuru . Questionnaire Survey From the Viewpoint of Concordance in Patient and Physician Satisfaction Concerning Hypertensive Treatment in Elderly Patients　― Patients Voice Study ― . Circulation Journal82 ( 4 ) 1051 - 1061 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Circulation Society

Background:Patient-physician concordance is an important concern in the treatment of elderly patients with hypertension (HT). Treatment that considers concordance is necessary for mutual understanding and therapeutic satisfaction between patients and physicians. However, there have been no studies addressing concordance that objectively analyzed both patient and physician satisfaction before and after treatment.Methods and Results:An exploratory open-label, multicenter, intervention study was conducted. Patients with HT undergoing treatment with angiotensin-receptor blocker (ARB) or a calcium-channel blocker (CCB) monotherapy were enrolled. Medication was switched to an ARB/CCB combination tablet and taken for 12 weeks. Physicians and patients participated in satisfaction surveys concerning treatment. Discrepancies in satisfaction levels between patients and physicians were found at baseline for the following survey items: treatment, involvement in treatment, understanding of HT, reliance, medication, and blood pressure. After treatment, the satisfaction levels of both patients and physicians increased; discrepancies in satisfaction between the groups also improved.Conclusions:The rates of satisfaction were relatively higher for patients compared with physicians at baseline. After HT treatment addressing concordance, both patient and physician satisfaction rates and the gap in satisfaction rates between patients and physicians improved. This indicates that addressing concordance has clinical significance in the treatment of elderly HT patients. (UMIN000017270)

DOI： 10.1253/circj.cj-17-1015

Tokushige Akihiro, Miyata Masaaki, Sonoda Takeshi, Kosedo Ippei, Kanda Daisuke, Takumi Takuro, Kumagae Yuichi, Fukukura Yoshihiko, Ohishi Mitsuru . Prospective Study on the Incidence of Cerebrovascular Disease After Coronary Angiography . Journal of Atherosclerosis and Thrombosis25 ( 3 ) 224 - 232 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Atherosclerosis Society

Aim: Previous studies have reported a 10.2%–22% rate of silent cerebral infarction and a 0.1%–1% rate of symptomatic cerebral infarction after coronary angiography (CAG). However, the risk factors of cerebral infarction after CAG have not been fully elucidated. For this reason, we investigated the incidence and risk factors of CVD complications within 48 h after CAG using magnetic resonance imaging (MRI) (Diffusion-weighted MRI) at Kagoshima University Hospital.Methods: From September 2013 to April 2015, we examined the incidence and risk factors, including procedural data and patients characteristics, of cerebrovascular disease after CAG in consecutive 61 patients who underwent CAG and MRI in our hospital.Results: Silent cerebral infarction after CAG was observed in 6 cases (9.8%), and they should not show any neurological symptoms of cerebral infarction. Only prior coronary artery bypass grafting (CABG) was more frequently found in the stroke group (n=6) than that in the non-stroke group (n=55); however, no significant difference was observed (P=0.07). After adjusting for confounders, prior CABG was a significant independent risk factor for the incidence of stroke after CAG (odds ratio: 11.7, 95% confidence interval: 1.14–129.8, P=0.04).Conclusions: We suggested that the incidence of cerebral infarction after CAG was not related to the catheterization procedure per se but may be caused by atherosclerosis with CABG.

DOI： 10.5551/jat.41012