52 results on '"Aiko Ogawa"'
Search Results
2. Treatment of Vascular Injury During Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension
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Kentaro Ejiri, Aiko Ogawa, Hiroto Shimokawahara, and Hiromi Matsubara
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Cardiology and Cardiovascular Medicine - Published
- 2022
3. Outcome of mean pulmonary arterial pressure-based intensive treatment for patients with pulmonary arterial hypertension
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Yoichi, Sugiyama, Hiromi, Matsubara, Hiroto, Shimokawahara, and Aiko, Ogawa
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Carbon Monoxide ,Pulmonary Arterial Hypertension ,Hypertension, Pulmonary ,Hemodynamics ,Humans ,Arterial Pressure ,Familial Primary Pulmonary Hypertension ,Cardiology and Cardiovascular Medicine - Abstract
Mean pulmonary arterial pressure (mPAP) has not been recognized as a therapeutic target for pulmonary arterial hypertension (PAH). However, previous reports demonstrated that the survival of patients with some types of pulmonary hypertension was associated with mPAP. Therefore, we treated all subsets of PAH patients with the aim of lowering mPAP and evaluated the efficacy of the treatment algorithm.From September 2014 to August 2019, 43 consecutive patients with PAH on treatment3 months on referral were enrolled in this study. They were treated according to our treatment algorithm mainly based on World Health Organization functional class, mPAP, and percent predicted diffusing capacity of the lung for carbon monoxide. The therapeutic goal was the achievement of mPAP40 mmHg at follow-up. We evaluated clinical parameters, survival rate, and its determinants. Survival analyses were conducted using the Kaplan-Meier method and the relationship between all-cause death and selected variables was analyzed using the Cox proportional hazards model for mortality.mPAP significantly improved at the last follow-up [45 (35-55) mmHg to 24 (19-30) mmHg, p 0.05], and the therapeutic goal was achieved in 37 patients (86%). The 5-year survival rate of all patients was 90.7%. The survival rate of patients who achieved the therapeutic goal (3- and 5-year survival: 97.3%) was significantly better than that of the patients who did not achieve the therapeutic goal (3-year survival: 50.0%, p 0.05). The 5-year survival rates of the patients were the same among different treatment regimens (p = 0.985). mPAP40 mmHg at follow-up was the independent predictor of survival.Lowering mPAP resulted in favorable outcomes in all subsets of PAH patients, making it a therapeutic goal.
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- 2022
4. Low incidence of restenosis after successful balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension
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Isao Tabuchi, Aiko Ogawa, Masataka Shigetoshi, Hiroto Shimokawahara, Hiroshi Ito, and Hiromi Matsubara
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Balloon pulmonary angioplasty (BPA) is now a treatment option for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the incidence of restenosis and long-term changes in vessel diameters in pulmonary arteries after BPA are unknown. The present study investigated the incidence of restenosis by measuring changes in vessel diameter after BPA. We reviewed 58 patients (168 lesions) with CTEPH who underwent single dilation for the target lesion (type A/B/C lesions) during BPA procedure followed by selective pulmonary angiography more than 6 months after the final BPA procedure. The outcomes of BPA were assessed in terms of pulmonary artery diameters. In a median follow-up of 1.9 (1.2-2.7) years, restenosis occurred in only one case with a type C lesion after BPA (0.6%). In type A/B lesions, the minimal lumen diameter was significantly enlarged at follow-up after BPA [3.48 (2.59-4.34) to 4.22 (3.31-4.90) mm]. In type C lesions, the minimal lumen diameter was unchanged at follow-up after BPA [3.15 (1.96-3.64) to 3.28 (2.38-4.61) mm]. The present results revealed that restenosis after BPA rarely occurs in type A/B/C lesions. Minimal lumen diameters for type A/B lesions continually increased and those for type C lesions did not decrease. Stent implantation in type A/B/C lesions would be unnecessary after BPA.
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- 2022
5. Oxygen inhalation can selectively dilate pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension before balloon angioplasty
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Hiroshi Ito, Isao Tabuchi, Hiroto Shimokawahara, Kunihiko Hatanaka, Mitsuru Munemasa, Aiko Ogawa, Masataka Shigetoshi, and Hiromi Matsubara
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medicine.medical_specialty ,Inhalation ,business.industry ,Hypertension, Pulmonary ,medicine.medical_treatment ,Hemodynamics ,Vasodilation ,Pulmonary Artery ,Lung injury ,medicine.disease ,Balloon ,Dilatation ,Thrombosis ,Oxygen ,Internal medicine ,Angioplasty ,Chronic Disease ,Cardiology ,Breathing ,Humans ,Medicine ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
Pulmonary injury is a major complication of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Lung injury after BPA can be exacerbated by a high mean pulmonary arterial pressure (PAP). Although oxygen inhalation is expected to lower mean PAP in patients with CTEPH, no relevant investigation has been conducted.Consecutive patients with CTEPH who underwent BPA were enrolled in this study. We evaluated the hemodynamics using right heart catheterization while breathing ambient air and with administration of 5 L/min oxygen for 10 min.This study included 52 consecutive patients with CTEPH, of whom 23 (44%) were treated with specific pulmonary vasodilators. Exposure to oxygen was well tolerated. Oxygen administration significantly decreased mean PAP by 3.8 ± 3.2 mmHg (p0.001) and pulmonary vascular resistance by 0.8 ± 1.8 Wood units (p0.001). Moreover, the ratio of pulmonary vascular resistance to systemic vascular resistance was significantly reduced by 13.5% (p0.001). Multivariate regression analysis identified baseline mean PAP (β = -0.427, p = 0.006) as the only significant predictor of decreased mean PAP under oxygen administration. No significant difference in oxygen effect on mean PAP was found between patients with and without vasodilators.In patients with CTEPH, 5 L/min supplemental oxygen inhalation could decrease mean PAP significantly by selective pulmonary artery dilatation, regardless of the usage of vasodilators, and thus could be helpful to maximize the safety of BPA.UMIN Clinical Trials Registry (No.: UMIN000026882); URL: https://www.umin.ac.jp/ctr/index.htm.
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- 2022
6. Continual Improvement in Pressure Gradient at the Lesion After Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
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Shinya Nagayoshi, Aiko Ogawa, Hiromi Matsubara, and Hiroto Shimokawahara
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Male ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Lung injury ,Balloon ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Restenosis ,Angioplasty ,Internal medicine ,Humans ,Medicine ,Arterial Pressure ,030212 general & internal medicine ,Pressure gradient ,Retrospective Studies ,business.industry ,Angiography ,Middle Aged ,medicine.disease ,Chronic Disease ,Cardiology ,Balloon dilation ,Female ,medicine.symptom ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Angioplasty, Balloon - Abstract
Lung injury is a serious complication of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Selecting a smaller balloon might minimize the occurrence of lung injury; however, it could also increase the risk of restenosis.We analyzed the first target lesions in the initial BPA procedure in 34 consecutive patients with CTEPH. We measured proximal pressure with a guiding catheter and distal pressure with a pressure wire. We retrospectively investigated pressure gradients at the lesions before and immediately after the initial dilation with a smaller balloon and before the second procedure.The proximal pressure decreased, and the distal pressure increased immediately after the initial balloon dilation. The pressure gradient at the lesion diminished significantly by the second procedure (from 26.4 ± 10.7 to 18.2 ± 9.9 mm Hg, P0.001) without serious complications. The residual pressure gradient had further diminished (to 9.8 ± 6.5 mm Hg, P = 0.02) until the second procedure. The reduction in pressure gradient at the lesion from immediately after the initial balloon dilation to the second procedure was positively correlated with both the baseline mean pulmonary arterial pressure (rThe residual pressure gradient at the lesion diminished continually after dilation with a smaller balloon. This strategy could decrease pulmonary arterial pressure safely. It would be reasonable to dilate the lesions sequentially in 2 procedures.
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- 2021
7. Survival of Japanese Patients With Idiopathic/Heritable Pulmonary Arterial Hypertension
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Toru Satoh, Keiichi Fukuda, Hiromi Matsubara, Aiko Ogawa, and Yuichi Tamura
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Adult ,Endothelin Receptor Antagonists ,Male ,medicine.medical_specialty ,Adolescent ,Cardiac index ,Hemodynamics ,Walk Test ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,Familial Primary Pulmonary Hypertension ,Survival rate ,Antihypertensive Agents ,Retrospective Studies ,Univariate analysis ,Exercise Tolerance ,business.industry ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Epoprostenol ,Pulmonary hypertension ,Survival Rate ,medicine.anatomical_structure ,030228 respiratory system ,Cardiology ,Vascular resistance ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,Endothelin receptor ,business - 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/m 2 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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- 2017
8. Rapid and high-dose titration of epoprostenol improves pulmonary hemodynamics and clinical outcomes in patients with idiopathic and heritable pulmonary arterial hypertension
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Naoto Tokunaga, Hiromi Matsubara, Aiko Ogawa, and Hiroshi Ito
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Adult ,Male ,medicine.medical_specialty ,Dose titration ,Hemodynamics ,Walk Test ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,Humans ,Heritable pulmonary arterial hypertension ,Medicine ,Familial Primary Pulmonary Hypertension ,Infusions, Intravenous ,Survival rate ,Antihypertensive Agents ,Retrospective Studies ,Dose-Response Relationship, Drug ,business.industry ,Retrospective cohort study ,medicine.disease ,Epoprostenol ,Pulmonary hypertension ,030228 respiratory system ,Concomitant ,Pulmonary artery ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Intravenous epoprostenol is an effective treatment for idiopathic and heritable pulmonary arterial hypertension. We aimed to clarify factors that determine the survival of patients with severe pulmonary hypertension who received epoprostenol treatment. Methods This is a retrospective observational study consisting of 46 patients with idiopathic and heritable pulmonary arterial hypertension in World Health Organization (WHO) functional class III or IV and undergoing intravenous epoprostenol treatment. We compared the following factors between survivors and non-survivors: clinical characteristics, exercise capacity, hemodynamics, interval between diagnosis and treatment initiation, concomitant pulmonary arterial hypertension-targeted drugs, maximum dose of epoprostenol, and the speed of up-titration. We defined a rapid increase group as those receiving epoprostenol ≥20 ng/kg/min at 3 months and ≥45 ng/kg/min at 1 year of treatment. Results Thirty-two patients (70%) survived and 14 patients died during an average follow-up period of 2100 days. Mean pulmonary artery pressure, concomitant pulmonary arterial hypertension-targeted drugs, and the maximum epoprostenol dose were comparable between the two subsets of patients. WHO functional class III was more common than class IV, and the 6-min walking distance was longer in the survivor than the non-survivor group. The survivors typically showed a rapid increase in epoprostenol dose during the first year of treatment. This rapid increase group was associated with a continuous reduction in mean pulmonary artery pressure during the follow-up period, whereas the slow increase group showed no reduction in mean pulmonary artery pressure after 6 months of treatment. The 9.5-year survival rate was also significantly better in the rapid increase group compared with the slow increase group (100% vs. 64%, p = 0.022). Conclusions In idiopathic and heritable pulmonary arterial hypertension patients, a rapid increase in epoprostenol dose soon after the initiation of treatment seems to be important to achieve a continuous reduction in mean pulmonary artery pressure and to improve survival.
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- 2016
9. Guidelines for the Treatment of Pulmonary Hypertension (JCS 2017/JPCPHS 2017)
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Hiroshi Ito, Shigetoyo Kogaki, Atsushi Yao, Keiichi Fukuda, Masaharu Nishimura, Hatsue Ishibashi-Ueda, Takeshi Ogo, Masaru Hatano, Mashio Nakamura, Ichizo Tsujino, Norikazu Yamada, Tomotaka Nakayama, Motomi Ando, Takayuki Kuriyama, Takashi Akasaka, Shozaburo Doi, Kohtaro Abe, Koichiro Tatsumi, Hiroyuki Tsutsui, Nobuhiro Tanabe, Takeshi Kimura, Norifumi Nakanishi, Norihide Fukushima, Shunji Yoshida, Yoshihiro Fukumoto, Koichiro Sugimura, Masataka Kuwana, Takashi Kawakami, Hiromi Matsubara, Toshio Nakanishi, Hitoshi Ogino, Hiroshi Date, Keiko Yamauchi-Takihara, Masaharu Kataoka, Takatoshi Kasai, Hiroaki Shimokawa, Toru Satoh, Aiko Ogawa, Shin-ichi Momomura, and Mari Nishizaki
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medicine.medical_specialty ,business.industry ,Hypertension, Pulmonary ,MEDLINE ,General Medicine ,medicine.disease ,Pulmonary hypertension ,Text mining ,Japan ,medicine ,Humans ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2019
10. Vascular Injury Is a Major Cause of Lung Injury After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension
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Aiko Ogawa, Hiromi Matsubara, Kentaro Ejiri, Shinya Fujii, and Hiroshi Ito
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Male ,endocrine system ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,Pleural effusion ,Hypertension, Pulmonary ,medicine.medical_treatment ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Lung injury ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine.artery ,Angioplasty ,Multidetector Computed Tomography ,medicine ,Humans ,Arterial Pressure ,In patient ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,urogenital system ,business.industry ,Lung Injury ,Middle Aged ,Vascular System Injuries ,medicine.disease ,Respiration, Artificial ,Treatment Outcome ,030228 respiratory system ,Chronic Disease ,Pulmonary artery ,Angiography ,Cardiology ,Female ,Chronic thromboembolic pulmonary hypertension ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,hormones, hormone substitutes, and hormone antagonists - 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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- 2018
11. P2615Ages are not a determinant of favorable outcome of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
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Mitsuru Munemasa, M Shigetoshi, Hiromi Matsubara, T Iwano, T Nishihara, H Shimokawahara, Aiko Ogawa, I Tabuchi, T Naito, and M Tsuji
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medicine.medical_specialty ,business.industry ,Internal medicine ,Angioplasty ,medicine.medical_treatment ,Cardiology ,medicine ,Chronic thromboembolic pulmonary hypertension ,Favorable outcome ,Cardiology and Cardiovascular Medicine ,Balloon ,business ,A determinant - Published
- 2018
12. After the Dawn - Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension
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Aiko Ogawa and Hiromi Matsubara
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endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Hypertension, Pulmonary ,Endarterectomy ,030204 cardiovascular system & hematology ,Lung injury ,Balloon ,Pulmonary endarterectomy ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,Thromboembolism ,medicine ,Humans ,Intensive care medicine ,urogenital system ,business.industry ,Gold standard ,General Medicine ,medicine.disease ,Thrombosis ,Pulmonary hypertension ,030228 respiratory system ,Chronic Disease ,Chronic thromboembolic pulmonary hypertension ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism ,Angioplasty, Balloon - 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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- 2018
13. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
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Masayuki Hanaoka, Nobuhiro Tanabe, Hitoshi Ogino, Atsushi Yao, Toru Satoh, Noriaki Emoto, Tetsuya Fukuda, Hiroshi Ito, Yoshihiro Fukumoto, Kenji Minatoya, Koichiro Sugimura, Motomi Ando, Aiko Ogawa, Ichizo Tsujino, Norikazu Yamada, and Hiromi Matsubara
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Male ,Reoperation ,Cardiac Catheterization ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,Endarterectomy ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Lung injury ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Angioplasty ,medicine.artery ,medicine ,Humans ,Registries ,Retrospective Studies ,Cardiac catheterization ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Surgery ,Pulmonary embolism ,Survival Rate ,Treatment Outcome ,030228 respiratory system ,Chronic Disease ,Pulmonary artery ,Female ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - 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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- 2017
14. Epoprostenol sodium for treatment of pulmonary arterial hypertension
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Aiko Ogawa, Yukihiro Saito, Kazufumi Nakamura, Kentaro Ejiri, Toshihiro Sarashina, Aya Miura, Hiromi Matsubara, Hiroshi Ito, and Satoshi Akagi
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Endocrinology, Diabetes and Metabolism ,Hypertension, Pulmonary ,Treatment outcome ,Hemodynamics ,Prostacyclin ,Review ,law.invention ,Randomized controlled trial ,law ,pulmonary arterial hypertension ,Medicine ,Humans ,Pharmacology (medical) ,In patient ,Infusions, Intravenous ,Epoprostenol sodium ,Antihypertensive Agents ,business.industry ,prostacyclin ,Public Health, Environmental and Occupational Health ,apoptosis ,Hematology ,General Medicine ,Exercise capacity ,medicine.disease ,Pulmonary hypertension ,Epoprostenol ,respiratory tract diseases ,Treatment Outcome ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
The release of endogenous prostacyclin (PGI2) is depressed in patients with pulmonary arterial hypertension (PAH). PGI2 replacement therapy by epoprostenol infusion is one of the best treatments available for PAH. Here, we provide an overview of the current clinical data for epoprostenol. Epoprostenol treatment improves symptoms, exercise capacity, and hemodynamics, and is the only treatment that has been shown to reduce mortality in patients with idiopathic PAH (IPAH) in randomized clinical trials. We have reported that high-dose epoprostenol therapy (>40 ng/kg/min) also results in marked hemodynamic improvement in some patients with IPAH. High-dose epoprostenol has a pro-apoptotic effect on PAH-PASMCs via the IP receptor and upregulation of Fas ligand (FasL) in vitro. However, long-term intravenous administration of epoprostenol is sometimes associated with catheter-related infections and leads to considerable inconvenience for the patient. In the future, the development of new routes of administration or the development of powerful PGI2 analogs, IP-receptor agonists, and gene and cell-based therapy enhancing PGI2 production with new routes of administration is required.
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- 2015
15. Delivery of Imatinib-Incorporated Nanoparticles into Lungs Suppresses the Development of Monocrotaline-Induced Pulmonary Arterial Hypertension
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Daiji Miura, Satoshi Akagi, Yukihiro Saito, Kensuke Egashira, Kazufumi Nakamura, Aiko Ogawa, Hiroshi Ito, Hiromi Matsubara, and Tetsuya Matoba
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Male ,inorganic chemicals ,medicine.drug_class ,Hypertension, Pulmonary ,Myocytes, Smooth Muscle ,Pharmacology ,Muscle, Smooth, Vascular ,Piperazines ,Tyrosine-kinase inhibitor ,Rats, Sprague-Dawley ,Right ventricular hypertrophy ,medicine.artery ,medicine ,Animals ,Humans ,Receptors, Platelet-Derived Growth Factor ,Cells, Cultured ,health care economics and organizations ,Monocrotaline ,biology ,business.industry ,technology, industry, and agriculture ,Imatinib ,General Medicine ,respiratory system ,medicine.disease ,Pulmonary hypertension ,Rats ,Disease Models, Animal ,Pyrimidines ,Imatinib mesylate ,Benzamides ,Drug delivery ,Pulmonary artery ,Imatinib Mesylate ,biology.protein ,Nanoparticles ,Cardiology and Cardiovascular Medicine ,business ,Platelet-derived growth factor receptor ,medicine.drug - Abstract
Platelet-derived growth factor (PDGF) is implicated in the pathogenesis of pulmonary arterial hypertension (PAH). Imatinib, a PDGF-receptor tyrosine kinase inhibitor, improved hemodynamics, but serious side effects and drug discontinuation are common when treating PAH. A drug delivery system using nanoparticles (NPs) enables the reduction of side effects while maintaining the effects of the drug. We examined the efficacy of imatinib-incorporated NPs (Ima-NPs) in a rat model and in human PAH-pulmonary arterial smooth muscle cells (PASMCs). Rats received a single intratracheal administration of PBS, FITC-NPs, or Ima-NPs immediately after monocrotaline injection. Three weeks after monocrotaline injection, intratracheal administration of Ima-NPs suppressed the development of pulmonary hypertension, small pulmonary artery remodeling, and right ventricular hypertrophy in the rat model of monocrotaline-induced PAH. We also examined the effects of imatinib and Ima-NPs on PDGF-induced proliferation of human PAH-PASMCs by (3)H-thymidine incorporation. Imatinib and Ima-NPs significantly inhibited proliferation after 24 hours of treatment. Ima-NPs significantly inhibited proliferation compared with imatinib at 24 hours after removal of these drugs. Delivery of Ima-NPs into lungs suppressed the development of MCT-induced PAH by sustained antiproliferative effects on PAS-MCs.
- Published
- 2015
16. Clinical prediction score for identifying patients with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis
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Hiromi Matsubara, Yukari Takahashi, and Aiko Ogawa
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Adult ,Male ,medicine.medical_specialty ,High-resolution computed tomography ,Lung Neoplasms ,Hypertension, Pulmonary ,Vasodilator Agents ,Pulmonary Edema ,Walk Test ,Pulmonary capillary hemangiomatosis ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Sensitivity and Specificity ,Ground-glass opacity ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Hemangioma, Capillary ,Pathological ,Lung ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Smoking ,Middle Aged ,Pulmonary edema ,medicine.disease ,Pulmonary hypertension ,Early Diagnosis ,030228 respiratory system ,Area Under Curve ,Cardiology ,Pulmonary Veno-Occlusive Disease ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Background Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are rare causes of pulmonary hypertension. Although diagnosis is based on pathological findings, an early diagnosis is crucial because of poor prognosis compared to other types of pulmonary hypertension. Furthermore, vasodilators may cause fatal pulmonary edema in patients with PVOD/PCH. This study aimed to identify specific characteristics for patients with PVOD/PCH to clinically diagnose PVOD/PCH. Methods Clinical data were obtained at baseline and were compared between 19 patients with PVOD/PCH and 55 patients with idiopathic/heritable pulmonary arterial hypertension. Receiver operating characteristic analyses were used to determine characteristics specific for patients with PVOD/PCH and a scoring system to diagnose PVOD/PCH was developed. Results Patients with PVOD/PCH had a smoking history and were predominantly male. Six-minute walk distance was significantly lower and oxygen desaturation was severe during the walk. Diffusion capacity of carbon monoxide was significantly low. Radiological findings included ground glass opacity on chest high-resolution computed tomography (CT) in all patients with PVOD/PCH, and thickened septal lines in 90% of the patients. Lung perfusion scintigraphy showed defect in >70% of the patients. Pulmonary edema after initiation of vasodilation therapy was frequently observed in PVOD/PCH patients. Based on these results, we identified nine important clinical characteristics and a novel scoring system was designed to clinically diagnose PVOD/PCH: male sex, smoking history, 6-minute walk distance Conclusions Our novel prediction rule for diagnosing PVOD/PCH may offer an early clinical diagnosis of these diseases.
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- 2017
17. Vessel Stretching Is a Cause of Lumen Enlargement Immediately After Balloon Pulmonary Angioplasty: Intravascular Ultrasound Analysis in Patients With Chronic Thromboembolic Pulmonary Hypertension
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Hiromi Matsubara, Hiroki Yagi, Hidekazu Ikemiyagi, Aiko Ogawa, Hiroto Shimokawahara, and Hiroki Mizoguchi
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Hypertension, Pulmonary ,Lumen (anatomy) ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Vascular Remodeling ,Balloon ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Vascular Stiffness ,Predictive Value of Tests ,Internal medicine ,Angioplasty ,Intravascular ultrasound ,medicine ,Humans ,Arterial Pressure ,Stenosis, Pulmonary Artery ,030212 general & internal medicine ,Ultrasonography, Interventional ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Angiography ,Equipment Design ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Thrombosis ,Fibrosis ,Stenosis ,Treatment Outcome ,Chronic Disease ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon ,Vascular Access Devices - 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 mm 2 ; P 2 ; P r 2 =0.762; P 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.
- Published
- 2017
18. Effectiveness and Outcome of Pulmonary Arterial Hypertension-Specific Therapy in Japanese Patients With Pulmonary Arterial Hypertension
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Aiko Ogawa, Nobuhiro Tanabe, Koichiro Tatsumi, Masaru Hatano, Toru Satoh, Keiichi Fukuda, Yuichi Tamura, Kohtaro Abe, Atsushi Yao, Hiroaki Miyata, Hiraku Kumamaru, Hiroshi Kimura, Masataka Kuwana, Hiromi Matsubara, and Ichizo Tsujino
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Adult ,Male ,medicine.medical_specialty ,Combination therapy ,Hypertension, Pulmonary ,Hemodynamics ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,parasitic diseases ,Medicine ,Initial treatment ,Humans ,Registries ,Intensive care medicine ,Survival analysis ,Antihypertensive Agents ,Retrospective Studies ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,equipment and supplies ,medicine.disease ,Pulmonary hypertension ,Survival Analysis ,Treatment Outcome ,030228 respiratory system ,NYHA classification ,Cohort ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,business - 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-naive 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-naive 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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- 2017
19. Spontaneous enlargement of pulmonary artery after successful balloon pulmonary angioplasty in a patient with chronic thromboembolic pulmonary hypertension
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Shinya Nagayoshi, Hiromi Matsubara, and Aiko Ogawa
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hypertension, Pulmonary ,Treatment outcome ,MEDLINE ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Balloon ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Angioplasty ,medicine ,Humans ,030212 general & internal medicine ,Aged ,business.industry ,Chronic disease ,Treatment Outcome ,Pulmonary artery ,Chronic Disease ,Cardiology ,Chronic thromboembolic pulmonary hypertension ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism ,Angioplasty, Balloon - Published
- 2016
20. Chronic thromboembolic pulmonary hypertension in Austria and Japan
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Stella Chausheva, Bernhard Moser, Shahroukh Taghavi, Smriti Sharma, Keiichi Ishida, Seiichiro Sakao, Aiko Ogawa, Hiromi Matsubara, Ioana-Alexandra Campean, Roela Sadushi-Kolici, Irene M. Lang, Walter Klepetko, Akira Naito, Max-Paul Winter, and Veronika Seidl
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Cardiac output ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,Population ,Hemodynamics ,Vasodilation ,Endarterectomy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Angioplasty ,Internal medicine ,medicine ,Humans ,Thrombus ,education ,Aged ,education.field_of_study ,business.industry ,Middle Aged ,medicine.disease ,Thrombosis ,Pulmonary embolism ,030228 respiratory system ,Austria ,Chronic Disease ,Cardiology ,Female ,Surgery ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by one or more of the following features: intraluminal thrombus organization, fibrous stenosis, and complete obliteration of major pulmonary arteries, amenable to significant improvement by pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty, and medical treatments with vasodilators. Because treatment practices and outcomes differ in Europe versus Japan, we hypothesized that population-based characteristics of pulmonary vascular phenotypes may exist in Austria compared with Japan. The objectives of this study were to analyze clinical characteristics, hemodynamics, and PEA specimens in consecutive patients with CTEPH undergoing PEA in Austria and Japan. Methods Clinical features, hemodynamics, and PEA specimens were collected and analyzed in patients with CTEPH undergoing PEA, and clinical features and hemodynamics were collected and analyzed in patients with not-operated CTEPH and in patients with nonthromboembolic pulmonary arterial hypertension. Results Apart from key differences between Austrian and Japanese patients regarding body size, lung function vital capacity, cardiac output, and serum high-density lipoprotein levels, Austrian patients were more likely to be obese, have greater hematocrits and greater white blood cells counts, greater C-reactive protein levels, and significantly elevated serum myeloperoxidase levels compared with Japanese patients with CTEPH. Analysis of PEA specimens demonstrated more proximal thrombus and more fresh red thrombus components in Austrian patients. Conclusions This study documents an inflammatory thrombotic phenotype in Austrian compared with Japanese patients with CTEPH that may be a determinant of differential treatment outcomes.
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- 2019
21. Histological Changes of Pulmonary Arteries Treated by Balloon Pulmonary Angioplasty in a Patient With Chronic Thromboembolic Pulmonary Hypertension
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Masashi Kitani, Ichiro Yamadori, Aiko Ogawa, Hiromi Matsubara, and Toshihiro Sarashina
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Adult ,Male ,endocrine system ,medicine.medical_specialty ,Biopsy ,Hypertension, Pulmonary ,Pulmonary Artery ,Vascular Remodeling ,Fatal Outcome ,Risk Factors ,Intensive care ,Internal medicine ,medicine.artery ,Pulmonary angiography ,medicine ,Humans ,Arterial Pressure ,Lung ,business.industry ,Vascular System Injuries ,medicine.disease ,Right pulmonary artery ,Pulmonary hypertension ,Radiography ,Treatment Outcome ,Blood pressure ,medicine.anatomical_structure ,Chronic Disease ,Pulmonary artery ,Vascular resistance ,Cardiology ,Autopsy ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
A 41-year-old man was referred to our hospital for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). On admission, he was in World Health Organization functional class III. Right heart catheterization demonstrated that pulmonary arterial pressure (systolic/diastolic/mean) was 140/42/71 mm Hg, cardiac index was 1.6 L/min/m2 and pulmonary vascular resistance was 1663 dyn ·s·cm–5. The patient had severe pulmonary hypertension and was considered inoperable because of peripheral organized thrombi and coexisting seminoma; therefore, balloon pulmonary angioplasty (BPA) was performed. After BPA, pulmonary angiography showed improvement of pulmonary arterial flow (Figure 1A). Pulmonary arterial pressure was 108/42/67 mm Hg and cardiac index was 2.5 L/min/m2 when he returned to the cardiac care unit after BPA. His condition temporarily improved; however, 2 hours later, it deteriorated because of reperfusion pulmonary injury and gastrointestinal bleeding. He required mechanical ventilation and percutaneous cardiopulmonary support. To improve hemodynamics, another session of BPA was tried 9 days later (Figures 2A and 3A) and pulmonary arterial pressure seemed to improve to 83/48/58 mm Hg. However, he died from right heart failure on day 26 after BPA despite intensive care. Figure 1. Representative images of pulmonary angiography and histology of pulmonary arteries of the upper lobe of the right lung. A , Angiographic images before (a) and after (b) BPA. A web lesion of the right pulmonary artery (arrow) was treated by BPA. Angiography after BPA showed a dilated vessel and increased flow in the distal arteries. Arrows indicate the areas where specimen for B was obtained. B , Histology of a pulmonary artery treated by BPA (arrow in A ). This lesion was treated by BPA at the initial session and second session (26 and 17 days before death). (a) Hematoxylin–eosin stain, low magnification. A large …
- Published
- 2014
22. Different sizes of centrilobular ground-glass opacities in chest high-resolution computed tomography of patients with pulmonary veno-occlusive disease and patients with pulmonary capillary hemangiomatosis
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Hiromi Matsubara, Kazufumi Nakamura, Hiroshi Ito, Katsushi Hashimoto, Aiji Ohtsuka, Tohru Ohe, Shinichi Toyooka, Kunihisa Kohno, Takahiro Oto, Aya Miura, Kengo Kusano, Satoshi Nagase, Keiko Ohta-Ogo, Satoshi Akagi, and Aiko Ogawa
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Adult ,Male ,medicine.medical_specialty ,High-resolution computed tomography ,Lung Neoplasms ,Adolescent ,Hypertension, Pulmonary ,medicine.medical_treatment ,Autopsy ,Pulmonary capillary hemangiomatosis ,Pathology and Forensic Medicine ,Diagnosis, Differential ,Young Adult ,Imaging, Three-Dimensional ,Predictive Value of Tests ,medicine ,Humans ,Replica Techniques ,Lung transplantation ,Familial Primary Pulmonary Hypertension ,Hemangioma, Capillary ,Child ,Lung ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Pulmonary hypertension ,Capillaries ,Respiratory Function Tests ,medicine.anatomical_structure ,Pulmonary Veno-Occlusive Disease ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Radiology ,Differential diagnosis ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Centrilobular ground-glass opacity (GGO) is one of the characteristic findings in chest high-resolution computed tomography (HRCT) of patients with pulmonary veno-occlusive disease (PVOD) and patients with pulmonary capillary hemangiomatosis (PCH). However, clinical differential diagnosis of these two diseases is difficult and has not been established. In order to clarify their differences, we compared the sizes of GGOs in chest HRCT and the sizes of capillary assemblies in pulmonary vascular casts between patients diagnosed pathologically with PVOD and PCH.We evaluated chest HRCT images for four patients with idiopathic pulmonary arterial hypertension (IPAH), three patients with PVOD and three patients with PCH, and we evaluated pulmonary vascular casts of lung tissues obtained from those patients at lung transplantation or autopsy.Centrilobular GGOs in chest HRCT were observed in patients with PVOD and patients with PCH but not in patients with IPAH. We measured the longest diameter of the GGOs. The size of centrilobular GGOs was significantly larger in patients with PCH than in patients with PVOD (5.60±1.43 mm versus 2.51±0.79 mm, P.01). We succeeded in visualization of the 3-dimensional structures of pulmonary capillary vessels obtained from the same patients with PVOD and PCH undergoing lung transplantation or autopsy and measured the diameters of capillary assemblies. The longest diameter of capillary assemblies was also significantly larger in patients with PCH than in patients with PVOD (5.44±1.71 mm versus 3.07±1.07 mm, P.01).Measurement of the sizes of centrilobular GGOs in HRCT is a simple and useful method for clinical differential diagnosis of PVOD and PCH.
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- 2013
23. Prostaglandin I2 induces apoptosis via upregulation of Fas ligand in pulmonary artery smooth muscle cells from patients with idiopathic pulmonary arterial hypertension
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Masashi Yoshida, Hiromi Matsubara, Noriyuki Kataoka, Kengo Kusano, Satoshi Akagi, Hiroshi Ito, Chikao Yutani, Hatsue Ueda-Ishibashi, Aiko Ogawa, Aya Miura, Katsumasa Miyaji, Takahiro Oto, and Kazufumi Nakamura
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Adult ,Male ,medicine.medical_specialty ,Fas Ligand Protein ,Adolescent ,medicine.drug_class ,Hypertension, Pulmonary ,medicine.medical_treatment ,Myocytes, Smooth Muscle ,Prostaglandin ,Apoptosis ,Pulmonary Artery ,Fas ligand ,chemistry.chemical_compound ,Downregulation and upregulation ,Internal medicine ,medicine ,Humans ,Familial Primary Pulmonary Hypertension ,Child ,Receptor ,Cells, Cultured ,business.industry ,Infant ,Receptor antagonist ,Epoprostenol ,Up-Regulation ,Cytokine ,Endocrinology ,chemistry ,Child, Preschool ,Female ,lipids (amino acids, peptides, and proteins) ,Tumor necrosis factor alpha ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Pulmonary vascular remodeling with idiopathic pulmonary arterial hypertension (IPAH) is associated with impaired apoptosis of pulmonary artery smooth muscle cells (PASMCs). We have reported that high-dose prostaglandin I 2 (PGI 2 ) therapy markedly improved hemodynamics in IPAH patients. The therapy is thought to reverse vascular remodeling, though the mechanism is unclear. The aim of this study is to assess proapoptotic effects of PGI 2 on PASMCs obtained from IPAH patients. Methods We investigated proapoptotic effects of PGI 2 in PAH-PASMCs by TUNEL assays, caspase-3,-7 assays and transmission electron microscopy. We examined the expression of Fas ligand (FasL), an apoptosis-inducing member of the TNF cytokine family, in PAH-PASMCs. We measured the serum FasL levels in IPAH patients treated with PGI 2 . Results TUNEL-positive, caspase-3, 7-active cells and fragmentation of the nucleus were detected in PAH-PASMCs treated with PGI 2 . The percentage of apoptotic cells induced by PGI 2 at a high concentration was higher than that induced by PGI 2 at a low concentration. PCR-array analysis revealed that PGI 2 upregulated the FasL gene in PAH-PASMCs, and we measured the FasL expression by quantitative RT-PCR and Western blotting. PGI 2 significantly increased the mRNA level of FasL by 3.98 fold and the protein level of FasL by 1.70 fold. An IP receptor antagonist inhibited the induction of apoptosis, elevation of cyclic AMP and upregulation of FasL by PGI 2 . Serum FasL level had a significant positive correlation with PGI 2 dose in IPAH patients treated with PGI 2 . Conclusions PGI 2 has proapoptotic effects on PAH-PASMCs via the IP receptor and upregulation of FasL.
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- 2013
24. Refined Balloon Pulmonary Angioplasty for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension
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Hiroshi Ito, Hiroshi Mikouchi, Aiko Ogawa, Hiromi Matsubara, Hiroki Mizoguchi, and Mitsuru Munemasa
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Balloon ,Revascularization ,medicine.disease ,Pulmonary hypertension ,World health ,Surgery ,Internal medicine ,medicine.artery ,Angioplasty ,Pulmonary artery ,Intravascular ultrasound ,medicine ,Cardiology ,Chronic thromboembolic pulmonary hypertension ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— Although balloon pulmonary angioplasty (BPA) for inoperable patients with chronic thromboembolic pulmonary hypertension was first reported over a decade ago, its clinical application has been restricted because of limited efficacy and complications. We have refined the procedure of BPA to maximize its clinical efficacy. Methods and Results— Sixty-eight consecutive patients with inoperable chronic thromboembolic pulmonary hypertension underwent BPA. We evaluated pulmonary artery diameters and determined the appropriate balloon size by using intravascular ultrasound. We performed BPA in a staged fashion over multiple, separate procedures to maximize efficacy and reduce the risk of reperfusion pulmonary injury. A total of 4 (2–8) sessions were performed in each patient, and the number of vessels dilated per session was 3 (1–14). The World Health Organization functional class improved from 3 to 2 ( P P Conclusions— Our refined BPA procedure improves clinical status and hemodynamics of inoperable patients with chronic thromboembolic pulmonary hypertension, with a low mortality. A refined BPA procedure could be considered as a therapeutic approach for patients with inoperable chronic thromboembolic pulmonary hypertension.
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- 2012
25. Novel Angiographic Classification of Each Vascular Lesion in Chronic Thromboembolic Pulmonary Hypertension Based on Selective Angiogram and Results of Balloon Pulmonary Angioplasty
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Katsumasa Miyaji, Takashi Oka, Takashi Kawakami, Hiroki Mizoguchi, Hiroto Shimokawahara, Aiko Ogawa, Mitsuru Munemasa, Kei Yunoki, Takanori Naito, and Hiromi Matsubara
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Male ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Balloon ,Lesion ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Terminology as Topic ,Angioplasty ,medicine ,Humans ,Stenosis, Pulmonary Artery ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Angiography ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Stenosis ,Treatment Outcome ,Blood pressure ,030228 respiratory system ,Chronic Disease ,Female ,Radiology ,medicine.symptom ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - 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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- 2016
26. Safety and Efficacy of Epoprostenol Therapy in Pulmonary Veno-Occlusive Disease and Pulmonary Capillary Hemangiomatosis
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Hiroshi Ito, Aya Miura, Yoko Shinno, Hiromi Matsubara, Ichiro Yamadori, Hiroshi Date, Kengo Kusano, Katsumasa Miyaji, and Aiko Ogawa
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Adult ,Male ,medicine.medical_specialty ,Lung Neoplasms ,Time Factors ,Adolescent ,Hypertension, Pulmonary ,Vasodilator Agents ,medicine.medical_treatment ,Blood Pressure ,Pulmonary capillary hemangiomatosis ,Japan ,Internal medicine ,medicine.artery ,Natriuretic Peptide, Brain ,medicine ,Humans ,Lung transplantation ,Hemangioma, Capillary ,Child ,Antihypertensive Agents ,Exercise Tolerance ,business.industry ,Recovery of Function ,General Medicine ,medicine.disease ,Pulmonary edema ,Epoprostenol ,Pulmonary hypertension ,respiratory tract diseases ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary venoocclusive disease ,Pulmonary artery ,Vascular resistance ,Cardiology ,Pulmonary Veno-Occlusive Disease ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Lung Transplantation - Abstract
Background: Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are rare causes of pulmonary hypertension. There is no proven medical therapy to treat these diseases, and lung transplantation is thought to be the only cure. Administration of vasodilators including epoprostenol sometimes causes massive pulmonary edema and could be fatal in these patients. Methods and Results: Eight patients were treated with epoprostenol for 387.3±116.3 days (range, 102-1,063 days), who were finally diagnosed with PVOD or PCH by pathological examination. The maximum dose of epoprostenol given was 55.3±10.7ng·kg-1·min-1 (range, 21.0-110.5ng·kg-1·min-1). With careful management, epoprostenol therapy significantly improved the 6-min walk distance (97.5±39.2 to 329.4±34.6m, P
- Published
- 2012
27. Altered nano/micro-order elasticity of pulmonary artery smooth muscle cells of patients with idiopathic pulmonary arterial hypertension
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Hiroshi Date, Noriyuki Kataoka, Tetsuya Ikeda, Juichiro Shimizu, Hiroshi Morita, Seiichi Mochizuki, Fumihiko Kajiya, Aya Miura, Kazufumi Nakamura, Ken Hashimoto, Satoshi Mohri, Kengo Fukushima Kusano, Satoshi Nagase, Aiko Ogawa, Katsushi Hashimoto, Keiko Ohta-Ogo, Hiromi Matsubara, Hideki Fujio, and Tohru Ohe
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Hypertension, Pulmonary ,Vasodilator Agents ,Myocytes, Smooth Muscle ,Vasodilation ,Microscopy, Atomic Force ,Nitric Oxide ,Nitric oxide ,Young Adult ,chemistry.chemical_compound ,medicine.artery ,Humans ,Medicine ,Myocyte ,Elasticity (economics) ,Child ,Cells, Cultured ,business.industry ,Respiratory disease ,Free Radical Scavengers ,medicine.disease ,Pulmonary hypertension ,Elasticity ,Nanostructures ,chemistry ,Pulmonary artery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Muscle Contraction ,Muscle contraction - Abstract
Background Idiopathic pulmonary arterial hypertension (IPAH) is a disease characterized by progressively increased resistance of pulmonary arteries. In this study, we evaluated the mechanical property of single pulmonary artery smooth muscles cells (PASMC) from patients with IPAH and tested whether the PASMC showed abnormal response to a vasodilator by use of an atomic force microscope (AFM). Methods PASMC were isolated and cultured from explanted lungs of 7 patients with IPAH (IPAH-PASMC). Normal vascular specimens from 3 patients with bronchogenic carcinoma were used as normal controls (normal PASMC). The nano/micro-order elasticity of five to ten living PASMC in each sample was measured by parabolic force curves of cantilever deflection/indentation obtained by using an AFM. The elasticity measurements were performed under control conditions and under condition of nitric oxide (NO) treatment (190 and 380 nmol/L). Results There was no significant difference between nano/micro-order elasticity of normal PASMC and that of IPAH-PASMC under the control conditions. In normal PASMC, NO (190 and 380 nmol/L) significantly reduced (i.e., softened) the nano/micro-order elasticity. However, NO did not reduce elasticity in IPAH-PASMC, indicating higher vasodilator-resistive nano/micro-order rigidity in IPAH-PASMC. Conclusion Nano/micro-order elasticity change in PASMC in response to vasodilation induced by NO is reduced in patients with IPAH.
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- 2010
28. Marked Hemodynamic Improvements by High-Dose Epoprostenol Therapy in Patients With Idiopathic Pulmonary Arterial Hypertension
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Aiko Ogawa, Kengo Fukushima Kusano, Kazufumi Nakamura, Satoshi Akagi, Hiroshi Ito, Katsumasa Miyaji, and Hiromi Matsubara
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Adult ,Male ,Adolescent ,Maximum Tolerated Dose ,Hypertension, Pulmonary ,Hemodynamics ,Blood Pressure ,Pulmonary Artery ,Young Adult ,medicine.artery ,medicine ,Humans ,In patient ,Antihypertensive Agents ,business.industry ,Idiopathic Pulmonary Arterial Hypertension ,General Medicine ,Wood units ,Epoprostenol ,respiratory tract diseases ,Clinical trial ,medicine.anatomical_structure ,Blood pressure ,Anesthesia ,Pulmonary artery ,Vascular resistance ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The appropriate dose range of epoprostenol is thought to be 25-40 ng · kg-1 · min-1 based on the results of previous studies showing that epoprostenol therapy reduced mean pulmonary artery pressure (mPAP) by 12-22% and pulmonary vascular resistance (PVR) by 32-53% compared with baseline values in patients with idiopathic pulmonary arterial hypertension (IPAH). However, the efficacy of treatment of IPAH patients with epoprostenol >40 ng · kg-1 · min-1 has not been determined and this was the aim of the present study. Methods and Results: The study group comprised 16 consecutive patients, none of whom died; 2 dropped out because they could not be titrated up as needed to the highest effective epoprostenol dose. Hemodynamics were evaluated in 14 IPAH patients who received high-dose epoprostenol monotherapy. The mean epoprostenol dosage was 107±40 ng · kg-1 · min-1 (range, 54-190 ng · kg-1 · min-1) and the mean duration of high-dose epoprostenol therapy was 1,355±627 days (range, 582-2,410 days). Significant decreases from baseline values were seen in mPAP (from 66±16 to 47±12 mmHg, P
- Published
- 2010
29. Living-Donor Lobar Lung Transplantation for Pulmonary Arterial Hypertension After Failure of Epoprostenol Therapy
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Masaomi Yamane, M. Okazaki, Keiji Goto, Tohru Ohe, Kengo Kusano, Shunji Sano, Hiroshi Date, Motohiko Hanazaki, Hideki Fujio, Katsumasa Miyaji, Aiko Ogawa, Yoshifumi Sano, Hiromi Matsubara, Shinichi Toyooka, Motoi Aoe, and Shingo Kasahara
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Hypertension, Pulmonary ,medicine.medical_treatment ,FEV1/FVC ratio ,medicine.artery ,Living Donors ,Humans ,Medicine ,Lung transplantation ,Prospective Studies ,Treatment Failure ,Child ,Antihypertensive Agents ,Lung ,business.industry ,Respiratory disease ,medicine.disease ,Epoprostenol ,Pulmonary hypertension ,Respiratory Function Tests ,Surgery ,Transplantation ,medicine.anatomical_structure ,Pulmonary artery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation ,Artery - Abstract
ObjectivesThe aim of this study was to evaluate the long-term effects of living-donor lobar lung transplantation (LDLLT) for critically ill patients with pulmonary arterial hypertension (PAH) who failed in epoprostenol treatment.BackgroundAlthough continuous epoprostenol infusion has markedly improved survival in patients with PAH, some patients do not benefit from this therapy.MethodsFrom July 1998 to December 2003, 28 consecutive PAH patients who were treated with epoprostenol and accepted as candidates for lung transplantation were enrolled. All data were prospectively collected. As of July 2006, LDLLT was performed in 11 of those patients whose condition was deteriorating. Cadaveric lung transplantation (CLT) was performed in 2 patients. Medical treatment was continued in 15 patients.ResultsThere was no mortality in patients receiving LDLLT during a follow-up period of 11 to 66 months (average 48 months), and all patients returned to World Health Organization functional class I. Mean pulmonary artery pressure decreased from 62 ± 4 mm Hg to 15 ± 2 mm Hg (p < 0.001) at discharge and remained normal at 3 years. One CLT patient died of primary graft failure. Among medically treated patients, 6 patients died of disease progression. The survival rate was 100% at 5 years for patients receiving LDLLT, and 80% at 1 year, 67% at 3 years, and 53% at 5 years for patients medically treated (p = 0.028). All living donors have returned to their previous lifestyles.ConclusionsThese follow-up data support the option of LDLLT in patients with PAH who would die soon otherwise.
- Published
- 2007
30. Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension
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Tohru Ohe, Aiko Ogawa, Hiromi Matsubara, Kengo Kusano, Yoshihisa Fujimoto, Kenichi Hisamatsu, Mitsuru Munemasa, Yusuke Kawai, Katsumasa Miyaji, and Satoshi Akagi
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Adult ,Male ,Catheterization, Central Venous ,Group based ,medicine.medical_specialty ,Adolescent ,Hypertension, Pulmonary ,Kaplan-Meier Estimate ,Pulmonary Artery ,Catheters, Indwelling ,Bloodstream infection ,medicine ,Humans ,In patient ,Tunnel infection ,Antihypertensive Agents ,business.industry ,Incidence (epidemiology) ,Bacterial Infections ,General Medicine ,Middle Aged ,Epoprostenol ,Catheter-Related Infections ,Surgery ,Catheter hub ,Catheter ,Anesthesia ,Equipment Contamination ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Most of the patients with pulmonary arterial hypertension (PAH) receiving intravenous epoprostenol have experienced catheter-related infections during long-term treatment. Catheter hub was reported to be the most important source of catheter-related infections. To prevent the catheter-related infections, we have introduced a closed hub system and compared the incidence of catheter-related infections with that in patients using a non-closed hub system. Methods and Results We evaluated the results obtained on 24 occasions in 20 patients with PAH between June 1999 and December 2005. On 11 occasions, a non-closed hub system was used and on 13 cases a closed hub system. We classified the catheter-related infection into a catheter-related bloodstream infection (CRBSI) group or a tunnel infection group based on the pathway of bacteria. The CRBSI rate was 0.89 per 1,000 catheter days in the non-closed hub system group vs 0.10 per 1,000 catheter days in the closed hub system group. Kaplan - Meier analysis showed that the risk of CRBSI significantly decreased in the closed hub system group. None of the patients died as a direct consequence of catheter-related infection during the study period. Conclusions We successfully prevented CRBSI by using a closed hub system. (Circ J 2007; 71: 559 - 564)
- Published
- 2007
31. Balloon Pulmonary Angioplasty: A Treatment Option for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension
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Hiromi Matsubara and Aiko Ogawa
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,medicine.medical_treatment ,Lung injury ,Cardiovascular Medicine ,Balloon ,Lesion ,medicine.artery ,Angioplasty ,Internal medicine ,pulmonary hypertension ,Reviews in Medicine ,Medicine ,lung injury ,thrombosis ,business.industry ,fungi ,food and beverages ,angioplasty ,medicine.disease ,Thrombosis ,Pulmonary hypertension ,Surgery ,lcsh:RC666-701 ,Pulmonary artery ,Cardiology ,Chronic thromboembolic pulmonary hypertension ,pathology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.
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- 2015
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32. Carvedilol Inhibits Proliferation of Cultured Pulmonary Artery Smooth Muscle Cells of Patients with Idiopathic Pulmonary Arterial Hypertension
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Tohru Ohe, Hiroshi Date, Katsumasa Miyaji, Hiromi Matsubara, Kazufumi Nakamura, Daiji Miura, Tetsuya Ikeda, Hideki Fujio, Aiko Ogawa, Aya Miura, Keiko Ohta-Ogo, Satoshi Nagase, Masahiro Miyazaki, and Kengo Kusano
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Hypertension, Pulmonary ,Carbazoles ,Calcium channel blocker ,Propranolol ,Pulmonary Artery ,Muscle, Smooth, Vascular ,Propanolamines ,Nifedipine ,medicine.artery ,Internal medicine ,Prazosin ,Humans ,Medicine ,Child ,Carvedilol ,Adrenergic alpha-Antagonists ,Cells, Cultured ,Aged ,Cell Proliferation ,Pharmacology ,Dose-Response Relationship, Drug ,business.industry ,Calcium channel ,Middle Aged ,medicine.anatomical_structure ,Endocrinology ,Pulmonary artery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cell Division ,medicine.drug ,Artery - Abstract
Idiopathic pulmonary arterial hypertension (IPAH) is associated with proliferation of smooth muscle cells (SMCs) in small pulmonary arteries. Inhibition of proliferation of pulmonary artery smooth muscle cells (PASMCs) may be an effective treatment of patients with idiopathic pulmonary arterial hypertension. Recent studies have shown that carvedilol, an alpha- and beta-blocker with antioxidant and calcium channel blocking properties, inhibits the proliferation of cultured normal human pulmonary artery smooth muscle cells. In this study, we tested the hypothesis that carvedilol has antiproliferative effects on pulmonary artery smooth muscle cells of patients with idiopathic pulmonary arterial hypertension. Pulmonary artery smooth muscle cells from six idiopathic pulmonary arterial hypertension patients who had undergone lung transplantation were cultured. To determine cell proliferation, H-thymidine incorporation was measured. Platelet-derived growth factor-induced proliferation of IPAH-PASMCs was significantly greater than that of normal control pulmonary artery smooth muscle cells. Carvedilol (0.1 microM to 10 microM) inhibited the proliferation of idiopathic pulmonary arterial hypertension-pulmonary artery smooth muscle cells in a concentration-dependent manner. Prazosin (an alpha-blocker) and N-acetyl L cysteine (an antioxidant agent) (0.1 microM to 10 microM) did not inhibit their proliferation, but the high concentration of propranolol (a beta-blocker) and nifedipine (a calcium channel blocker) (10 microM) inhibited the proliferation. The combination of propranolol and nifedipine inhibited the proliferation but only at a high concentration (10 microM) combination. Cell cycle analysis revealed that carvedilol (10 microM) significantly decreased the number of cells in S and G2/M phases. These results indicate that carvedilol inhibits the exaggerated proliferation of pulmonary artery smooth muscle cells of patients with idiopathic pulmonary arterial hypertension partially via its beta-blocking [corrected] and calcium channel blocking effects in vitro.
- Published
- 2006
33. Risk of Alveolar Hemorrhage in Patients With Primary Pulmonary Hypertension-Anticoagulation and Epoprostenol Therapy
- Author
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Aiko Ogawa, Hideki Fujio, Hiromi Matsubara, Katsumasa Miyaji, Kazufumi Nakamura, Tohru Ohe, Kengo Fukushima Kusano, Hironori Saito, Hiroshi Morita, Tetsuro Emori, and Hiroshi Date
- Subjects
Respiratory distress ,medicine.drug_class ,business.industry ,Standard treatment ,medicine.medical_treatment ,Anticoagulant ,Retrospective cohort study ,General Medicine ,medicine.disease ,Pulmonary hypertension ,respiratory tract diseases ,Concomitant ,Anesthesia ,medicine ,Lung transplantation ,Platelet aggregation inhibitor ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Anticoagulation therapy and continuous intravenous infusion of epoprostenol are the standard treatment for primary pulmonary hypertension (PPH). Because epoprostenol has an antiplatelet effect, concomitant use of an anticoagulant could increase the likelihood of hemorrhagic complications. Methods and Results In the present study, 31 consecutive patients with PPH (10 men, 21 women, mean ± SD age, 28.5±10.1 years) treated with anticoagulation and epoprostenol between April 1999 and December 2003 were retrospectively evaluated. Clinical and hematological data at the time of the bleeding episode were retrieved from the medical records. Nine patients (22.6%) experienced 11 bleeding episodes: 9 episodes (81.8%) were alveolar hemorrhage and 2 patients were in severe respiratory distress. The mean dose of epoprostenol at the time of the first bleeding episode was 89.0 ±40.5 ng · kg-1 · min-1 (range, 28.1-164.0). More of the patients who did not have a bleeding episode remain alive than did patients with bleeding episodes (59% vs 33%) nor did they require lung transplantation. Conclusions A considerable number of patients with PPH who received combined anticoagulant and high-dose epoprostenol therapy developed alveolar hemorrhage, which can be fatal. (Circ J 2005; 69: 216 - 220)
- Published
- 2005
34. TCTAP A-134 Novel Interventional Therapeutic Approach for Patients with Peripheral Pulmonary Artery Stenosis in Adulthood
- Author
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Mitsutaka Nakashima, Hiromi Matsubara, Hiroto Shimokawahara, Takanori Naito, Mitsuru Munemasa, Aiko Ogawa, and Masataka Shigetoshi
- Subjects
medicine.medical_specialty ,business.industry ,Disease ,Surgery ,Therapeutic approach ,Peripheral pulmonary artery stenosis ,Curative treatment ,Internal medicine ,medicine.artery ,Pulmonary artery ,medicine ,Cardiology ,Chronic thromboembolic pulmonary hypertension ,Cardiology and Cardiovascular Medicine ,business - Abstract
Peripheral pulmonary artery stenosis (PPS) presenting in adulthood is an uncommon disease and may be misdiagnosed as idiopathic pulmonary artery hypertension or chronic thromboembolic pulmonary hypertension. Standard curative treatment has not fully established because of the limited experience of
- Published
- 2017
35. Letter by Ogawa and Matsubara Regarding Article, 'Anticoagulation and Survival in Pulmonary Arterial Hypertension: Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)'
- Author
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Hiromi Matsubara and Aiko Ogawa
- Subjects
medicine.medical_specialty ,business.industry ,Idiopathic Pulmonary Arterial Hypertension ,Prostacyclin ,medicine.disease ,Pulmonary hypertension ,Survival benefit ,Physiology (medical) ,Internal medicine ,Cohort ,Cardiology ,Medicine ,In patient ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
We read with interest the article by Olsson et al,1 which showed that anticoagulation was associated with a survival benefit in patients with idiopathic pulmonary arterial hypertension. However, we noted that their study group included a small number of patients with idiopathic pulmonary arterial hypertension who were taking prostacyclin analogs: 2% of all patients included in the entire cohort …
- Published
- 2014
36. Treatment of idiopathic/hereditary pulmonary arterial hypertension
- Author
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Hiromi Matsubara and Aiko Ogawa
- Subjects
medicine.medical_specialty ,Survival ,Hypertension, Pulmonary ,Vasodilator Agents ,Ventricular Dysfunction, Right ,Vasodilation ,Treatment goals ,Pulmonary function testing ,Pulmonary hypertension ,Internal medicine ,medicine.artery ,medicine ,Heritable pulmonary arterial hypertension ,Humans ,Familial Primary Pulmonary Hypertension ,Antihypertensive Agents ,medicine.diagnostic_test ,Ventricular Remodeling ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Prognosis ,Blood pressure ,Pulmonary artery ,Cardiology ,Right ventricle ,Cardiology and Cardiovascular Medicine ,business - Abstract
Treatment of pulmonary hypertension has progressed by recently developed pulmonary arterial hypertension-targeted drugs. However, long-term survival of the patients with idiopathic/heritable pulmonary arterial hypertension is still suboptimal. To improve the outcomes, treatment goals of pulmonary hypertension were proposed at the 5th World Symposium on Pulmonary Hypertension held at Nice, France in 2013; parameters were obtained from cardiopulmonary exercise test, blood tests, echocardiography, and magnetic resonance imaging. In particular, parameters evaluating right ventricular function have been highlighted because survival of the patients with pulmonary arterial hypertension is closely related to right ventricular function. However, treatment specifically targeted to improve right ventricular function in pulmonary hypertension is not yet established. In this setting, we need to maintain or improve right ventricular function with available vasodilators. In this review, we focus on the following two points: (1) Why can pulmonary arterial hypertension-targeted drugs improve right ventricular function without an apparent decrease in pulmonary artery pressure? (2) Are proposed goals sufficient to improve long-term prognosis of the patients? Further, we will discuss what would be the appropriate goal in treating patients with pulmonary arterial hypertension.
- Published
- 2014
37. Reverse remodeling of pulmonary arteries by high-dose prostaglandin I2 therapy: A case report
- Author
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Takahiro Oto, Kazufumi Nakamura, Satoshi Akagi, Kengo Kusano, Hiroshi Ito, Chikao Yutani, Aiko Ogawa, Keiko Ohta-Ogo, Hiromi Matsubara, Katsumasa Miyaji, and Hatsue Ishibashi-Ueda
- Subjects
medicine.medical_specialty ,Pathology ,Prostaglandin ,Hemodynamics ,Apoptosis ,Article ,chemistry.chemical_compound ,Internal medicine ,medicine.artery ,Medial hypertrophy ,Medicine ,In patient ,High-dose epoprostenol ,Reverse remodeling ,Idiopathic pulmonary arterial hypertension ,Lung ,business.industry ,Remodeling ,Peripheral ,medicine.anatomical_structure ,chemistry ,Pulmonary artery ,Cardiology ,cardiovascular system ,lipids (amino acids, peptides, and proteins) ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Idiopathic pulmonary arterial hypertension (IPAH) is characterized by pulmonary vascular remodeling. We have reported that high-dose prostaglandin I 2 (PGI 2 ) therapy markedly improved hemodynamics in IPAH patients and that PGI 2 induced apoptosis of pulmonary artery smooth muscle cells obtained from IPAH patients. PGI 2 is thought to have reverse remodeling effects, although it has not been histologically confirmed. In a case series, we examined the reverse pulmonary vascular remodeling effects of PGI 2 in lung tissues obtained from an IPAH patient treated with high-dose PGI 2 and an IPAH patient not treated with PGI 2 . Apoptotic cells were detected in small pulmonary arteries of the IPAH patient treated with high-dose PGI 2 but not in those from the IPAH patient not treated with PGI 2 . Media of peripheral pulmonary arteries were thick in the IPAH patient not treated with PGI 2 . On the other hand, media of peripheral pulmonary arteries were thin in the IPAH patient treated with high-dose PGI 2 . The single case report suggested that high-dose PGI 2 therapy has the potential for reverse pulmonary vascular remodeling by induction of apoptosis and reduction of medial hypertrophy. Accumulation of cases is needed for the application to generalized effect of high-dose PGI 2 . Learning objective: Reverse pulmonary vascular remodeling would provide further improvement in patients with IPAH. High-dose PGI 2 therapy has the potential for reverse pulmonary vascular remodeling in patients with IPAH.>
- Published
- 2014
38. Bail-Out Technique for Pulmonary Artery Rupture With a Covered Stent in Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
- Author
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Aiko Ogawa, Kentaro Ejiri, and Hiromi Matsubara
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,pulmonary artery rupture ,Hypertension, Pulmonary ,medicine.medical_treatment ,complication ,Pulmonary Artery ,Balloon ,covered stent ,Angioplasty ,Internal medicine ,medicine.artery ,medicine ,balloon angioplasty ,Humans ,Covered stent ,Aged ,Rupture ,urogenital system ,business.industry ,stenosis ,Vascular System Injuries ,medicine.disease ,Surgery ,Radiography ,Stenosis ,Treatment Outcome ,Male patient ,Pulmonary artery ,Cardiology ,Stents ,Chronic thromboembolic pulmonary hypertension ,Pulmonary Embolism ,business ,Complication ,Cardiology and Cardiovascular Medicine ,Angioplasty, Balloon ,hormones, hormone substitutes, and hormone antagonists - Abstract
A 76-year-old male patient with inoperable chronic thromboembolic pulmonary hypertension was referred to our hospital for treatment with balloon pulmonary angioplasty (BPA). He was in World Health Organization functional class III and pulmonary artery pressure was 69/6 (34) mm Hg. We performed BPA
- Published
- 2015
- Full Text
- View/download PDF
39. Pro-apoptotic effects of imatinib on PDGF-stimulated pulmonary artery smooth muscle cells from patients with idiopathic pulmonary arterial hypertension
- Author
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Tohru Ohe, Satoshi Akagi, Hiroshi Ito, Hiromi Matsubara, Kazufumi Nakamura, Hiroshi Morita, Daiji Miura, Kunihisa Kohno, Takahiro Oto, Soichiro Fuke, Aiko Ogawa, Aya Miura, Fumio Otsuka, Chikao Yutani, Satoshi Nagase, Ryutaro Yamanaka, Kengo Kusano, and Nobuhiro Nishii
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,medicine.medical_treatment ,Hypertension, Pulmonary ,Myocytes, Smooth Muscle ,Becaplermin ,Apoptosis ,Pulmonary Artery ,Tyrosine-kinase inhibitor ,Piperazines ,Young Adult ,medicine.artery ,Internal medicine ,Medicine ,Humans ,Familial Primary Pulmonary Hypertension ,Child ,Protein kinase B ,Cell Proliferation ,biology ,business.industry ,Growth factor ,Imatinib ,Proto-Oncogene Proteins c-sis ,Imatinib mesylate ,Endocrinology ,Pyrimidines ,Treatment Outcome ,Pulmonary artery ,Benzamides ,Cancer research ,biology.protein ,Imatinib Mesylate ,Phosphorylation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet-derived growth factor receptor ,medicine.drug - Abstract
Background Remodeling of the pulmonary artery by an inappropriate increase of pulmonary artery smooth muscle cells (PASMCs) is problematic in the treatment of idiopathic pulmonary arterial hypertension (IPAH). Effective treatment that achieves reverse remodeling is required. The aim of this study was to assess the pro-apoptotic effects of imatinib, a platelet-derived growth factor (PDGF)-receptor tyrosine kinase inhibitor, on PASMCs obtained from patients with IPAH. Methods PASMCs were obtained from 8 patients with IPAH undergoing lung transplantation. Cellular proliferation was assessed by 3 H-thymidine incorporation. Pro-apoptotic effects of imatinib were examined using TUNEL and caspase-3,7 assays and using transmission electron microscopy. Results Treatment with imatinib (0.1 to 10μg/mL) significantly inhibited PDGF-BB (10ng/mL)-induced proliferation of PASMCs from IPAH patients. Imatinib (1μg/mL) did not induce apoptosis in quiescent IPAH-PASMCs, but it had a pro-apoptotic effect on IPAH-PASMCs stimulated with PDGF-BB. Imatinib did not induce apoptosis in normal control PASMCs with or without PDGF-BB stimulation. PDGF-BB induced phosphorylation of Akt at 15min, and Akt phosphorylation was inhibited by imatinib in IPAH-PASMCs. Akt-I-1/2 (1μmol/L), an Akt inhibitor, in the presence of PDGF-BB significantly increased apoptotic cells compared with the control condition. Thus, Akt-I-1/2 could mimic the effects of imatinib on PASMCs. Conclusion Imatinib has anti-proliferative and pro-apoptotic effects on IPAH-PASMCs stimulated with PDGF. The inhibitory effect of imatinib on Akt phosphorylation induced by PDGF plays an important role in the pro-apoptotic effect.
- Published
- 2010
40. Three-dimensional structure of pulmonary capillary vessels in patients with pulmonary hypertension
- Author
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Hiroshi Ito, Tohru Ohe, Hiromi Matsubara, Kengo Fukushima Kusano, Takuro Murakami, Takahiro Oto, Aiko Ogawa, Chikao Yutani, Kazufumi Nakamura, Aiji Ohtsuka, Satoshi Akagi, and Aya Miura
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Lung Neoplasms ,Adolescent ,medicine.medical_treatment ,Hypertension, Pulmonary ,Hemodynamics ,Pulmonary capillary hemangiomatosis ,Young Adult ,Imaging, Three-Dimensional ,Physiology (medical) ,Internal medicine ,Occlusion ,medicine ,Lung transplantation ,Humans ,Pulmonary pathology ,Hemangioma, Capillary ,Lung ,business.industry ,medicine.disease ,Pulmonary hypertension ,Pathophysiology ,Capillaries ,Pulmonary Alveoli ,medicine.anatomical_structure ,Carcinoma, Bronchogenic ,Cardiology ,Microscopy, Electron, Scanning ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation - Abstract
Pulmonary arterial hypertension, pulmonary veno-occlusive disease, and pulmonary capillary hemangiomatosis are included in the same group (group 1) of clinical classification of pulmonary hypertension.1 Histological changes in the small pulmonary arteries (ie, intimal fibrosis and medial hypertrophy) are similar in these 3 diseases, and clinical presentations of the 3 diseases are often indistinguishable.1 However, it is estimated that the hemodynamics of capillary vessels are quite different in each disease. The hemodynamics of capillary vessels (ie, capillary occlusion) play an important role in cardiovascular diseases.2 Thus, clarification of the differences in the hemodynamics is essential to understand the pathophysiology of these 3 diseases. We obtained lung segments from patients with pulmonary hypertension who underwent living-donor lung transplantation and from patients with …
- Published
- 2010
41. Inhibitory effects of simvastatin on platelet-derived growth factor signaling in pulmonary artery smooth muscle cells from patients with idiopathic pulmonary arterial hypertension
- Author
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Hiroshi Date, Tetsuya Ikeda, Kengo Fukushima Kusano, Aiko Ogawa, Hiromi Matsubara, Fumio Otsuka, Kazufumi Nakamura, Hiroshi Ito, Aya Miura, Ryutaro Yamanaka, Satoshi Akagi, Tohru Ohe, Daiji Miura, Hideki Fujio, and Takahiro Oto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Simvastatin ,Platelet-derived growth factor ,Statin ,Adolescent ,medicine.drug_class ,medicine.medical_treatment ,Hypertension, Pulmonary ,Pulmonary Artery ,Muscle, Smooth, Vascular ,chemistry.chemical_compound ,Young Adult ,Cell Movement ,Internal medicine ,medicine.artery ,medicine ,Humans ,Child ,Aged ,Cell Proliferation ,Pharmacology ,Platelet-Derived Growth Factor ,biology ,Cell growth ,business.industry ,Growth factor ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Endocrinology ,chemistry ,Pulmonary artery ,biology.protein ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,Platelet-derived growth factor receptor ,Cyclin-Dependent Kinase Inhibitor p27 ,medicine.drug ,Signal Transduction - Abstract
Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disease characterized by inappropriate increase of pulmonary artery smooth muscle cells (PASMCs) leading to occlusion of pulmonary arterioles. Inhibition of platelet-derived growth factor (PDGF) signaling is starting to garner attention as a targeted therapy for IPAH. We assessed the inhibitory effects of simvastatin, a 3-hydroxy-3-methylglutanyl coenzyme A reductase inhibitor, on PDGF-induced proliferation and migration of PASMCs obtained from 6 patients with IPAH who underwent lung transplantation. PDGF stimulation caused a significantly higher growth rate of PASMCs from patients with IPAH than that of normal control PASMCs as assessed by (3)H-thymidine incorporation. Simvastatin (0.1 micromol/L) significantly inhibited PDGF-induced cell proliferation of PASMCs from patients with IPAH but did not inhibit proliferation of normal control cells at the same concentration. Western blot analysis revealed that simvastatin significantly increased the expression of cell cycle inhibitor p27. PDGF significantly increased the migration distance of IPAH-PASMCs compared with that of normal PASMCs, and simvastatin (1 micromol/L) significantly inhibited PDGF-induced migration. Immunofluorescence staining revealed that simvastatin (1 micromol/L) inhibited translocation of Rho A from the cytoplasm to membrane and disorganized actin fibers in PASMCs from patients with IPAH. In conclusion, simvastatin had inhibitory effects on inappropriate PDGF signaling in PASMCs from patients with IPAH.
- Published
- 2009
42. Abstract 1637: Difference of Pulmonary Arterial Microvasculature in Patients with Pulmonary Hypertension Using Scanning Electron Microscope
- Author
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Aya Miura, Kazufumi Nakamura, Kengo F Kusano, Hiromi Matsubara, Daiji Miura, Ryuji Miura, Aiko Ogawa, Tetsuya Ikeda, Hideki Fujio, Katsumasa Miyaji, Nobuhiro Nishii, Hiroshi Morita, Takefumi Oka, Aiji Ohtsuka, Hiroshi Date, and Tohru Ohe
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background and Objectives: Pulmonary vascular diseases (pulmonary arterial hypertension: PAH, pulmonary veno-occlusive disease: PVOD and pulmonary capillary hemangiomatosis: PCH) are well-known diseases that cause pulmonary hypertension (PH). However, the differences of structural characteristics of pulmonary microvasculature in these diseases have not been elucidated enough. We examined the morphological differences among these diseases by methacrylate resin (Mercox) perfusion using scanning electron microscope. Methods and Results: Ten lung samples were 8 patients with PH and 2 control subjects without PH. These were obtained at lung transplantations or autopsies. Microvascular corrosion replicas were made by Mercox perfusion from the pulmonary artery. Pathological diagnosis revealed 5 PAH, 2 PVOD and 1 PCH in patients with PH. In PAH samples, small arteries or arterioles showed twisted and tortuous courses, but such vessels were not observed in samples from control, PVOD and PCH. Binary branching was observed in control, but not in PVOD and PCH. In PVOD and PCH, several branching was commonly observed. Moreover, the loss of capillary network and the disruption of arterioles were more severe in samples from PVOD and PCH patients than in samples from PAH patients. Conclusion: Pulmonary microvascular morphology is seriously different among the type of underlying diseases in PH patients.
- Published
- 2008
43. Abstract 659: Simvastatin Inhibits Proliferation and Migration of Pulmonary Artery Smooth Muscle Cells from Patients with Idiopathic Pulmonary Arterial Hypertension
- Author
-
Kazufumi Nakamura, Tetsuya Ikeda, Hideki Fujio, Aiko Ogawa, Kaoru Kobayashi, Aya Miura, Daiji Miura, Satoshi Nagase, Soichiro Fuke, Takefumi Oka, Satoshi Mohri, Kengo F Kusano, Hiromi Matsubara, Masahiro Miyazaki, Hiroshi Date, and Tohru Ohe
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disease characterized by inappropriate increase of pulmonary artery smooth muscle cells (PASMCs) leading to occlusion of pulmonary arterioles and causing pulmonary hypertension. In this study, we assessed the inhibitory effects of simvastatin, an HMG-CoA reductase inhibitor, on proliferation and migration of PASMCs obtained from patients with IPAH. Methods and Results: PASMCs were obtained from 6 patients with IPAH who underwent lung transplantation, and PASMCs were obtained as control cells from 6 patients with bronchogenic carcinoma who underwent lung lobectomy. Platelet-derived growth factor (PDGF) (10 ng/mL) stimulation caused a significantly higher growth rate of PASMCs from patients with IPAH than that of control cells assessed by 3 H-thymidine incorporation ( P< 0.05). Simvastatin at 0.1 Â113>mol/L significantly inhibited PDGF-induced cell proliferation of PASMCs from IPAH patients but did not inhibit proliferation of control cells at the same concentration. Simvastatin at 1 Â113>mol/L also inhibited PDGF-induced migration of PASMCs from IPAH patients assessed by a transwell migration assay ( P< 0.05). Immunofluorescence staining revealed that simvastatin at 1 Â113>mol/L inhibited translocation of Rho A from the cytoplasm to membrane and disorganized actin fibers in PASMCs from IPAH patients. Conclusions: Simvastatin had an inhibitory effect on the inappropriate proliferation and migration of PASMCs from IPAH patients. Simvastatin may be useful for treatment of patients with IPAH.
- Published
- 2007
44. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis
- Author
-
Aiko Ogawa, Fuyo Ohtsuka, Satoru Sakuragi, Kazufumi Nakamura, Kimikazu Banba, Hiroshi Morita, Kengo Kusano, Satoshi Nagase, Tohru Ohe, Atsuyuki Watanabe, Keiko Ohta Ogo, and Nobuhiro Nishii
- Subjects
Tachycardia ,Adult ,Male ,medicine.medical_specialty ,Sarcoidosis ,medicine.drug_class ,Heart block ,Biopsy ,Hemodynamics ,Administration, Oral ,Gallium ,In Vitro Techniques ,Peptidyl-Dipeptidase A ,Ventricular tachycardia ,Drug Administration Schedule ,Electrocardiography ,Adrenal Cortex Hormones ,Physiology (medical) ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,Citrates ,Radionuclide Imaging ,Aged ,medicine.diagnostic_test ,business.industry ,Myocardium ,Middle Aged ,medicine.disease ,Heart Block ,cardiovascular system ,Cardiology ,Atrioventricular Node ,Disease Progression ,Electrocardiography, Ambulatory ,Tachycardia, Ventricular ,Corticosteroid ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies ,Atrioventricular block ,Endocardium - Abstract
Background In patients with cardiac sarcoidosis, ventricular arrhythmias and/or conduction disturbances are frequently observed and sometimes fatal. However, few reports on disease activity and arrhythmic events in cardiac sarcoidosis are available. Objective The purpose of this study was to investigate the relationship between disease activity and arrhythmic events in cardiac sarcoidosis and the effect of corticosteroid therapy. Methods The study population consisted of 15 cardiac sarcoidosis patients with new-onset symptomatic arrhythmia, including eight patients admitted once for complete atrioventricular block (CAVB), five patients admitted once for sustained ventricular tachycardia (VT), and two patients admitted twice for two arrhythmic events (one for CAVB and the other for sustained VT). Disease activity was evaluated by gallium-67 citrate (Ga) scintigraphy. All patients with positive Ga uptake were treated with corticosteroids, and arrhythmic events were evaluated by repeat Holter recordings. Results Positive uptake of Ga was observed in 8 (80%) of the 10 CAVB events and in 1 (14%) of the 7 sustained VT events (80% vs 14%, P = .02). Corticosteroids abolished myocardial Ga uptake in all nine patients with positive Ga uptake. After corticosteroid therapy was started, AV conduction improved in 5 of 9 CAVB patients (including 8 patients with new-onset CAVB and one patient with history of CAVB). However, ventricular arrhythmias were not improved after corticosteroid therapy. Conclusion In cardiac sarcoidosis patients, CAVB develops mainly during the active phase of the disease. Early treatment with corticosteroids might improve AV conduction disturbance. However, sustained VT is not closely linked with disease activity and frequently develops in the advanced stage of disease.
- Published
- 2007
45. Prednisolone inhibits proliferation of cultured pulmonary artery smooth muscle cells of patients with idiopathic pulmonary arterial hypertension
- Author
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Kazufumi Nakamura, Hideki Fujio, Kengo Fukushima Kusano, Tetsuya Ikeda, Aiko Ogawa, Tohru Ohe, Hiroshi Date, Katsumasa Miyaji, Kaoru Kobayashi, Daiji Miura, Ikuko Miyazaki, Hiromi Matsubara, and Masato Asanuma
- Subjects
DNA Replication ,Pathology ,medicine.medical_specialty ,Cell Survival ,medicine.medical_treatment ,Hypertension, Pulmonary ,Prednisolone ,Becaplermin ,Cell Separation ,Pulmonary Artery ,Muscle, Smooth, Vascular ,Physiology (medical) ,medicine.artery ,Medicine ,Lung transplantation ,Myocyte ,Humans ,Lung ,Cells, Cultured ,Platelet-Derived Growth Factor ,biology ,business.industry ,Respiratory disease ,Proto-Oncogene Proteins c-sis ,medicine.disease ,Pulmonary hypertension ,Recombinant Proteins ,medicine.anatomical_structure ,Circulatory system ,Pulmonary artery ,biology.protein ,Cardiology and Cardiovascular Medicine ,business ,Platelet-derived growth factor receptor ,Cell Division ,Blood vessel - Abstract
Background— Idiopathic pulmonary arterial hypertension (IPAH) is associated with proliferation of smooth muscle cells (SMCs) in small pulmonary arteries. There is no therapy that specifically inhibits SMC proliferation. Recent studies reported that prednisolone (PSL) inhibits the postangioplasty proliferation of SMCs in atherosclerotic arteries. In this study, we tested the hypothesis that PSL has antiproliferative effects on pulmonary artery SMCs of patients with IPAH. Methods and Results— Pulmonary artery SMCs were harvested from the pulmonary arteries of 6 patients with IPAH who underwent lung transplantation. Control SMCs were obtained from 5 patients with bronchogenic carcinoma who underwent lung lobectomy. After incubation in the presence of platelet-derived growth factor (PDGF), PSL was added at different concentrations and cell proliferation was assessed by 3 H-thymidine incorporation. PSL (2×10 −4 and 2×10 −3 mol/L) significantly inhibited PDGF-stimulated proliferation ( P 0 /G 1 to the S phase. This inhibition was associated with increased p27 expression level. PSL (2×10 −4 mol/L) also inhibited PDGF-induced SMC migration. Conclusions— Our results indicate that PSL has an antiproliferative effect on cultured SMCs of pulmonary arteries from patients with IPAH and suggest that PSL may be potentially useful therapeutically in patients with IPAH.
- Published
- 2005
46. Importance of differential diagnosis of pulmonary hypertension
- Author
-
Aiko Ogawa
- Subjects
medicine.medical_specialty ,business.industry ,Intravascular lymphoma ,medicine.disease ,Pulmonary hypertension ,Treatment ,Editorial ,Internal medicine ,medicine ,Cardiology ,Differential diagnosis ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
47. Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment
- Author
-
Shin-ichirou Nishiyama, Takanobu Yamamoto, Takashi Iwase, Koji Narui, Aiko Ogawa, and Shin-ichi Momomura
- Subjects
Male ,medicine.medical_specialty ,Central sleep apnea ,Polysomnography ,Positive pressure ,Cardiomegaly ,Cheyne–Stokes respiration ,Hypoxemia ,Positive-Pressure Respiration ,Electrocardiography ,Sleep Apnea Syndromes ,Internal medicine ,Positive airway pressure ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,Cheyne-Stokes Respiration ,Heart Failure ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,respiratory tract diseases ,Radiography ,Treatment Outcome ,Echocardiography ,Anesthesia ,Heart failure ,cardiovascular system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.
- Published
- 2004
48. How Long Can We Leave Patients With Pulmonary Arterial Hypertension on Oral Drug Monotreatment?
- Author
-
Aiko Ogawa and Hiromi Matsubara
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Hypertension, Pulmonary ,MEDLINE ,General Medicine ,Phosphodiesterase 5 Inhibitors ,Piperazines ,Sildenafil Citrate ,Purines ,medicine ,Humans ,Female ,Sulfones ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Oral retinoid - Published
- 2012
49. Independent predictor for severe reperfusion pulmonary injury after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension
- Author
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H. Mizoguchi, Mitsuru Munemasa, S. Ikemiyagi, Aiko Ogawa, H Shimokawahara, Katsumasa Miyaji, and Hiromi Matsubara
- Subjects
Mechanical ventilation ,medicine.medical_specialty ,Lung ,business.industry ,medicine.medical_treatment ,Hemodynamics ,Balloon ,Preoperative care ,Reperfusion therapy ,medicine.anatomical_structure ,Internal medicine ,Angioplasty ,Cardiology ,Medicine ,Systole ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
50. Clinical prediction rule for identifying patients with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis
- Author
-
Aiko Ogawa, Hiromi Matsubara, and Katsumasa Miyaji
- Subjects
medicine.medical_specialty ,Walking exercise test ,business.industry ,Pulmonary capillary hemangiomatosis ,Clinical prediction rule ,medicine.disease ,Pulmonary hypertension ,law.invention ,law ,Internal medicine ,Clinical diagnosis ,medicine ,Cardiology ,Radionuclide imaging ,Pulmonary Veno-Occlusive Disease ,Cardiology and Cardiovascular Medicine ,business ,Ground glass - Published
- 2013
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