(1) Ischemic Heart Disease Group
The Ischemic Heart Disease (IHD) Group performs approximately ~700 cardiac catheterization and ~300 percutaneous coronary interventions in a year. Since launching Tohoku University Hospital Emergency Center in October 2006, the number of patients with acute covonary syndrome have been increasing. We actively work on the clinical researches to clarify the pathology of IHD and advanced treatment (e.g., external shockwave treatment) for patients.
Serial changes in the number of cardiac catheterization and PCIs
1. The Pathology of Vasospastic Angina
A coronary spasm temporarily reduces the blood flow by the sudden narrowing of the coronary artery and induces myocardial ischemia (supply/primary ischemia). Coronary spasm is particularly important in the pathogenesis of IHD in Japanese. Coronary Spasm Association (CSA) was launched in August 2006 conducts the research from basic to clinical perspectives. Under the direction of Tohoku University (Professor Hiroaki Shimokawa) and Kumamoto University (Professor Hisao Ogawa), 68 facilities are participating nationwide in this research group. The CSA is funded by the Japan Heart Foundation and its secretarial office is located in our department. (Figure 1). In the basic researches, it has been revealed that Rho-kinase activation plays an important role as a molecular mechanism of coronary vasospasm and it has been expected to apply the Rho-kinase inhibitor for the clinical setting.
2. Evidence-Based Medicine (EBM) for Percutaneous Coronary Intervention
Percutaneous coronary intervention including coronary artery stents is rapidly developed over 30 years in the treatment of IHD. Today, we can use two different types of stents. One is bare metal stent (BMS) and the other is drug eluting stent (DES). We scientifically evaluate advantages and disadvantages of these two types of stents to make a right choice and to perform procedural assessment (Figure 2) by using intravascular ultrasound (IVUS) and/or quantitative coronary angiography (QCA). It is also important to evaluate myocardial ischemia and perform ischemia-oriented coronary interventions. Moreover, we conduct researches on evaluation for myocardial ischemia and myocardial viability using magnetic resonance imaging(MRI).
3. Pathology of Out-of-hospital Cardiac Arrest
In Japan there are 30,000 to 50,000 deaths of out-of-hospital cardiac arrest per a year, which is 3 to 4 times of the number of traffic accident victims. The survival rate of these patients has been increased because of the recent spread of by-stander cardiopulmonary resuscitation and automated external defibrillators (AED). It is a very important issue to elucidate the pathology of out-of-hospital cardiac arrest. In our department, when we can not find organic abnormalities, we perform functional evaluations by provoking coronary spasm (acetylcholine provocation test) and inducing ventricular fibrillation (electrophysiological study).
Fig.3: Out-of-hospital Cardiac Arrest and Fuctional Assessment
4. Low-energy External Shockwave Treatment for Severe Ischemic Heart Disease
We are conducting clinical trials of a new angiogenesis therapy using external shockwaves. The low-energy shockwaves radiates externally on ischemic myocardium to promote angiogenesis as a non-invasive treatment. With the approval of the University Review Board, clinical trials were begun in November 2005 for cases of severe angina (Figure 4) and in February 2007 for cases of acute myocardial infarction (Figure 5).
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Fig. 4: Improvement of Myocardial Blood Flow using External Shockwave Treatment
Fig. 5:
Publications (since 2000)
- Shimokawa H, Ito K, Fukumoto Y, Yasuda S. Extracorporeal cardiac shock wave therapy for ischemic heart disease. Shock Waves. 2008;17:449-455.
- Kokusho Y, Komaru T, Takeda S, Takahashi K, Koshida R, Shirato K, Shimokawa H. Hydrogen peroxide derived from beating heart mediates coronary microvascular dilation during tachycardia. Arterioscler Thromb Vasc Biol. 2008;27:1057-1063.
- Fukumoto Y, Yasuda S, Ito A, Shimokawa H. Prognostic effects of benidipine in patients with vasospastic angina: comparison with diltiazem and amlodipine. J Cardiovasc Pharmacol. 2008;51:253-257.
- Uwatoku T, Ito K, Abe K, Oi K, Hizume T, Sunagawa K, Shimokawa H. Extracorporeal cardiac shock wave therapy ameliorates left ventricular remodeling after acute myocardial infarction in pigs. Coron Artery Dis. 2007;18:397-404.
- Asaumi Y, Kagaya Y, Takeda M, Yamaguchi N, Tada H, Ito K, Ohta J, Shiroto T, Shirato K, Minegishi N, Shimokawa H. Protective role of endogenous erythropoietin system in nonhematopoietic cells against pressure overload-induced left ventricular dysfunction in mice. Circulation. 2007;115:2022-2032.
- Minatoya Y, Ito K, Kagaya Y, Asaumi Y, Takeda M, Nakayama M, Takahashi J, Iguchi A, Shirato K, Shimokawa H. Depressed contractile reserve and impaired calcium handling of cardiac myocytes from chronically unloaded hearts are ameliorated with the administration of physiological treatment dose of T3 in rats. Acta Physiol (Oxf). 2007;189:221-231.
- Tada H, Kagaya Y, Takeda M, Ohta J, Asaumi Y, Satoh K, Ito K, Karibe A, Shirato K, Minegishi N, Shimokawa H. Endogenous erythropoietin system in non-hematopoietic lineage cells plays a protective role in myocardial ischemia/reperfusion.Cardiovasc Res. 2006;71:466-477.
- Satoh K, Kagaya Y, Nakano M, Ito Y, Ohta J, Tada H, Karibe A, Minegishi N, Suzuki N, Yamamoto M, Ono M, Watanabe J, Shirato K, Ishii N, Sugamura K, Shimokawa H. Important role of endogenous erythropoietin system in recruitment of endothelial progenitor cells in hypoxia-induced pulmonary hypertension in mice. Circulation. 2006;113:1442-1450.
- Namiuchi S, Kagaya Y, Ohta J, Shiba N, Sugi M, Oikawa M, Kunii H, Yamao H, Komatsu N, Yui M, Tada H, Sakuma M, Watanabe J, Ichihara T, Shirato K. High serum erythropoietin level is associated with smaller infarct size in patients with acute myocardial infarction who undergo successful primary percutaneous coronary intervention. J Am Coll Cardiol. 2005;45:1406-1412.
(Text by Jun Takahashi)