心臓・血管（循環器）研究部
部長 加地 修一郎
Director Shuichiro Kaji, MD, PhD
関西電力医学研究所 心臓・血管（循環器）研究部 部長
関西電力病院 循環器内科 主任部長
関西電力病院 心臓血管センター長
研究テーマ
急性大動脈症候群の病態解明
急性大動脈解離は致死的疾患であり、迅速な診断と治療を必要とする。解離部位や範囲、合併症の有無から治療方針を決定することが多いが、近年、偽腔の血栓化の有無や程度が予後に大きく影響することが明らかになってきた。いわゆる典型的な大動脈解離（欧米ではclassic
aortic
dissectionと呼称される）は、“偽腔開存型解離”と呼ばれるが、内膜破綻とそれに伴って生じた中膜の解離を原因とし、血流のある偽腔と可動性のあるフラップを認めるのが特徴である。これに対して血栓化により、偽腔内に血流を認めず完全に閉塞した例は、“偽腔閉塞型解離”と呼称される。欧米ではこの病態を、大動脈壁を栄養する血管の破裂による大動脈壁内血腫が病因と考えAortic
intramural
hematoma（大動脈壁内血腫）と呼称し、異なった病態のように扱ってきた。このような背景において、Vilacostaらは偽腔閉塞型解離、偽腔開存型解離に、穿通性粥状硬化性潰瘍(penetrating
atherosclerotic
ulcer)を加えた三つの疾患群を大動脈解離の類縁疾患としてとらえ、急性大動脈症候群（Acute
aortic syndrome）という呼称を提唱し、広く使用されるようになった。
我々はこれまで急性大動脈症候群のなかでも偽腔閉塞型解離に注目し、病態や予後の解明を行ってきた。まずA型偽腔閉塞型解離に対して内科治療が可能であることを世界で初めて報告した。1さらにA型偽腔閉塞型例は、偽腔開存型に比べて臨床像が異なり2、内科治療の長期成績が良好であることを報告し、手術リスクが高い場合に有効な治療法であることを明らかにした。3一方、B型偽腔閉塞型例ではUlcer-like
projectionという画像所見が予後不良因子であることを明らかにした。4また偽腔閉塞型解離について、大動脈の内膜破綻が主な病因であることを提唱し5、破綻部位の大きさが予後に影響することを明らかにした。6今後、偽腔閉塞型解離に対して、多施設大規模登録試験や海外施設との共同研究（メタアナリシス）を検討中である。
1. Kaji S, Nishigami K, Akasaka T, Hozumi T, Takagi T, Kawamoto T, et al.
Prediction of progression or regression of type A aortic intramural hematoma by
computed tomography. Circulation. 1999;100:II281-86 2. Kaji S, Akasaka T,
Horibata Y, Nishigami K, Shono H, Katayama M, et al. Long-term prognosis of
patients with type a aortic intramural hematoma. Circulation. 2002;106:I248-52
3. Kitai T, Kaji S, Yamamuro A, Tani T, Tamita K, Kinoshita M, et al. Clinical
outcomes of medical therapy and timely operation in initially diagnosed type a
aortic intramural hematoma: a 20-year experience. Circulation. 2009;120:S292-98
4. Kitai T, Kaji S, Yamamuro A, Tani T, Kinoshita M, Ehara N, et al. Impact of
new development of ulcer-like projection on clinical outcomes in patients with
type B aortic dissection with closed and thrombosed false lumen. Circulation.
2010;122:S74-80 5. Kitai T, Kaji S, Yamamuro A, Tani T, Kinoshita M, Ehara N, et
al. Detection of intimal defect by 64-row multidetector computed tomography in
patients with acute aortic intramural hematoma. Circulation. 2011;124:S174-78 6.
Ishizu K, Kaji S, Nakashima M, Kitai T, Kim K, Ehara N, et al. Focal Intimal
Disruption Size at Multidetector CT and Disease Progression in Type B Aortic
Intramural Hematoma. Radiology. 2021;301:311-19
最近の代表的な論文
| 著者 | 論文題目 |
|
Vilacosta I, San Roman JA, di Bartolomeo R, Eagle K, Estrera AL, Ferrera C, Kaji S*, Nienaber CA, Riambau V, Schafers HJ, Serrano FJ, Song JK, Maroto L. |
Acute Aortic Syndrome Revisited: JACC State-of-the-Art Review. |
|
Tsujisaka Y, Kaji S*, Kim K, Pak M, Sasaki Y, Kitai T, Kobori A, Furukawa Y. |
Mechanism of improvement in atrial functional mitral regurgitation after catheter ablation for atrial fibrillation: Three-dimensional analysis using multislice computed tomography. |
|
Ishizu K, Kaji S*, Nakashima M, Kitai T, Kim K, Ehara N, Kinoshita M, Furukawa Y. |
Focal Intimal Disruption Size at Multidetector CT and Disease Progression in Type B Aortic Intramural Hematoma. |
|
Miyoshi Y, Kaji S*, Masumoto A, Kim K, Kitai T, Kinoshita M, Furukawa Y. |
Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome. |
|
Masumoto A, Azumi Y, Kaji S*, Miyoshi Y, Kim K, Kitai T, Furukawa Y. |
Impact of antithrombotic therapy on clinical outcomes in patients with type B acute aortic syndrome |
*責任著者
2024年度業績
原著論文（英語／日本語）
| 著者 | タイトル | 掲載誌名 |
| 掲載号等・掲載年 | ||
|
Yamamoto K, Yamamoto E, Morimoto T, Shiomi H, Domei T, Taniguchi R, Sakai H, Toyofuku M, Kaji S, Nawada R, Yokomatsu T, Suwa S, Furukawa Y, Kadota K, Ando K, Kimura T; CREDO-Kyoto PCI/CABG Registry Investigators. |
Long-Term Effects of Proton Pump Inhibitors in Patients Undergoing Percutaneous Coronary Intervention in High-Risk Subgroups. |
Circ J |
| 88(11):1778-1787, 2024 | ||
|
Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, Yaku H, Akiyama E, Ando M, Izumi C, Ide T, Iwasaki YK, Ohno Y, Okumura T, Ozasa N, Kaji S, Kashimura T, Kitaoka H, Kinugasa Y, Kinugawa S, Toda K, Nagai T, Nakamura M, Hikoso S, Minamisawa M, Wakasa S, Anchi Y, Oishi S, Okada A, Obokata M, Kagiyama N, Kato NP, Kohno T, Sato T, Shiraishi Y, Tamaki Y, Tamura Y, Nagao K, Nagatomo Y, Nakamura N, Nochioka K, Nomura A, Nomura S, Horiuchi Y, Mizuno A, Murai R, Inomata T, Kuwahara K, Sakata Y, Tsutsui H, Kinugawa K; Japanese Circulation Society and the Japanese Heart Failure Society Joint Working Group. |
JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure. | Circ J |
| doi: 10.1253/circj.CJ-25-0002, 2025 | ||
|
Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, Yaku H, Akiyama E, Ando M, Izumi C, Ide T, Iwasaki YK, Ohno Y, Okumura T, Ozasa N, Kaji S, Kashimura T, Kitaoka H, Kinugasa Y, Kinugawa S, Toda K, Nagai T, Nakamura M, Hikoso S, Minamisawa M, Wakasa S, Anchi Y, Oishi S, Okada A, Obokata M, Kagiyama N, Kato NP, Kohno T, Sato T, Shiraishi Y, Tamaki Y, Tamura Y, Nagao K, Nagatomo Y, Nakamura N, Nochioka K, Nomura A, Nomura S, Horiuchi Y, Mizuno A, Murai R, Inomata T, Kuwahara K, Sakata Y, Tsutsui H, Kinugawa K; Japanese Circulation Society and the Japanese Heart Failure Society Joint Working Group. |
JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure. | J Card Fail. |
| S1071-9164(25), 2025 | ||
|
Ogihara Y, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Sato T, Nishikawa R, Kimura T, Dohi K; COMMAND VTE Registry-2 Investigators. |
Fragility and long-term clinical outcomes in patients with venous thromboembolism receiving direct oral anticoagulants: From the COMMAND VTE REGISTRY-2. |
Thromb Res. |
| 236:191-200, 2024 | ||
|
Ikeda S, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Ono K, Kimura T. |
Subclass phenotypes in patients with unprovoked venous thromboembolisms using a latent class analysis. |
Thromb Res. |
| 238:27-36, 2024 | ||
|
Mabuchi H, Nishikawa R, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Ono K, Nakagawa Y, Kimura T. |
Statins use and recurrent venous thromboembolism in the direct oral anticoagulant era: insight from the COMMAND VTE Registry-2. |
J Thromb Thrombolysis. |
| 57(6):907-917, 2024 | ||
|
Kaneda K, Yamashita Y, Morimoto T, Chatani R, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Ono K, Kimura T. |
Temporal Changes in Long-Term Outcomes of Venous Thromboembolism From the Warfarin Era to the Direct Oral Anticoagulant Era. |
J Am Heart Assoc. |
| 13(15):e034412, 2024 | ||
|
Nishimoto Y, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Sato Y, Watanabe T, Yamada T, Fukunami M, Kimura T; COMMAND VTE Registry-2 Investigators. |
External validation of the Pulmonary Embolism-Syncope, Anemia, and Renal Dysfunction bleeding score for early major bleeding in patients with acute pulmonary embolism: from the COMMAND VTE Registry-2. |
J Thromb Haemost. |
| (10):2784-2796, 2024 | ||
|
Nishikawa R, Yamashita Y, Morimoto T, Kaneda K, Chatani R, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Ono K, Kimura T; COMMAND VTE Registry‐2 Investigators. |
Selection of Home Treatment and Identification of Low-Risk Patients With Pulmonary Embolism Based on Simplified Pulmonary Embolism Severity Index Score in the Era of Direct Oral Anticoagulants. |
J Am Heart Assoc. |
| (19):e034953, 2024 | ||
|
Sueta D, Yamashita Y, Morimoto T, Chatani R, Nishimoto Y, Kaneda K, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Shioyama W, Dohke T, Nishikawa R, Kimura T, Tsujita K; COMMAND VTE Registry-2 Investigators. |
Edoxaban, Rivaroxaban, or Apixaban for Cancer-Associated Venous Thromboembolism in the Real World: Insights from the COMMAND VTE Registry-2. |
Thromb Haemost. |
| 124(11):1013-1023, 2024 | ||
|
Sato T, Ogihara Y, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Kimura T, Dohi K; Contemporary Management and Outcomes in Patients With Venous Thromboembolism Registry-2 Investigators. |
Incidence and risk factors of ischemic stroke in patients with cancer-associated venous thromboembolism: from the Contemporary Management and Outcomes in Patients With Venous Thromboembolism Registry-2. |
Res Pract Thromb Haemost. |
| 8(8):102617, 2024 | ||
|
Ikeda N, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Kimura T; COMMAND VTE Registry‐2 Investigators. |
Incidence of Chronic Thromboembolic Pulmonary Hypertension After Pulmonary Embolism in the Era of Direct Oral Anticoagulants: From the COMMAND VTE Registry-2. |
J Am Heart Assoc. |
| 13(21):e035997, 2024 | ||
|
Takabayashi K, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Ono K, Kimura T; COMMAND VTE Registry-2 Investigators. |
Clinical characteristics and short-term outcomes of patients with critical acute pulmonary embolism requiring extracorporeal membrane oxygenation: from the COMMAND VTE Registry-2. |
J Intensive Care. |
| 12(1):45, 2024 | ||
|
Obayashi Y, Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Ohno N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Watanabe S, Shiomi H, Watanabe H, Yoshikawa Y, Nishikawa R, Yamamoto K, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Nakazeki F, Togi K, Inuzuka Y, Ando K, Komiya T, Ono K, Minatoya K, Kimura T; CURRENT AS Registry-2 Investigators. |
Concomitant Mitral Regurgitation in Severe Aortic Stenosis -Insights From the CURRENT AS Registry-2. |
Circ J. |
| 88(12):1996-2007, 2024 | ||
|
Yamamoto K, Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Ohno N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Watanabe S, Shiomi H, Watanabe H, Yoshikawa Y, Nishikawa R, Obayashi Y, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Nakazeki F, Togi K, Inuzuka Y, Ando K, Komiya T, Ono K, Minatoya K, Kimura T; CURRENT AS Registry-2 Investigators. |
Safety of Calcium Channel Blockers in Patients With Severe Aortic Stenosis and Hypertension. |
Circ J. |
| doi: 10.1253/circj.CJ-24-0771, 2024 | ||
|
Yamashita Y, Morimoto T, Chatani R, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Kim K, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Kaneda K, Ono K, Kimura T; COMMAND VTE Registry-2 Investigators. |
Newly Diagnosed Cancer After Diagnosis of Venous Thromboembolism - Insights From the COMMAND VTE Registry-2. |
Circ J. |
| doi: 10.1253/circj.CJ-24-0786, 2024 | ||
|
Takeji Y, Taniguchi T, Morimoto T, Shirai S, Kitai T, Tabata H, Ohno N, Murai R, Osakada K, Murata K, Nakai M, Tsuneyoshi H, Tada T, Amano M, Watanabe S, Shiomi H, Watanabe H, Yoshikawa Y, Nishikawa R, Obayashi Y, Yamamoto K, Toyofuku M, Tatsushima S, Kanamori N, Miyake M, Nakayama H, Nagao K, Izuhara M, Nakatsuma K, Inoko M, Fujita T, Kimura M, Ishii M, Usami S, Nakazeki F, Togi K, Inuzuka Y, Ando K, Komiya T, Ono K, Minatoya K, Kimura T; CURRENT AS registry-2 Investigators. |
Availability of transcatheter aortic valve implantation across hospitals and differences in strategies and clinical outcomes in patients with severe aortic stenosis. |
Cardiovasc Interv Ther. |
| 40(1):152-163, 2025 | ||
|
Shigeno R, Kim K, Yamashita Y, Morimoto T, Chatani R, Kaneda K, Nishimoto Y, Ikeda N, Kobayashi Y, Ikeda S, Inoko M, Takase T, Tsuji S, Oi M, Takada T, Otsui K, Sakamoto J, Ogihara Y, Inoue T, Usami S, Chen PM, Togi K, Koitabashi N, Hiramori S, Doi K, Mabuchi H, Tsuyuki Y, Murata K, Takabayashi K, Nakai H, Sueta D, Shioyama W, Dohke T, Nishikawa R, Furukawa Y, Kimura T; COMMAND VTE Registry-2 Investigators. |
Initial anticoagulation therapy with single direct oral anticoagulant in patients with intermediate-high risk acute pulmonary embolism: From the COMMAND VTE Registry-2. |
Int J Cardiol. |
| 15;419:132680, 2024 | ||
|
Taniguchi T, Morimoto T, Takeji Y, Shirai S, Ando K, Tabata H, Yamamoto K, Murai R, Osakada K, Sakamoto H, Tada T, Murata K, Obayashi Y, Amano M, Kitai T, Izumi C, Toyofuku M, Kanamori N, Miyake M, Nakayama H, Izuhara M, Nagao K, Nakatsuma K, Furukawa Y, Inoko M, Kimura M, Ishii M, Usami S, Nakazeki F, Shirotani M, Inuzuka Y, Ono K, Minatoya K, Kimura T; CURRENT AS Registry-2 Investigators. |
Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2. |
JACC Cardiovasc Interv. |
| 18(4):471-487, 2025 |
総説（日本語）
| 著者 | タイトル | 掲載誌名 |
| 掲載号等・掲載年 | ||
| 東 長輝、加地 修一郎 | B型大動脈解離の急性期管理と治療方針 | ICUとCCU |
| 49（3）：129-135、2025 |
学会（国内）招待講演、シンポジウムのみ記載
| 会名称 | 発表テーマ | 発表者 | |
| 日時 | 場所 | ||
| 第137回日本循環器学会近畿地方会 |
TEVAR 時代における急性Ｂ型大動脈解離の治療戦略 ～どのような症例に治療介入すべきか～ |
加地修一郎 | |
| 2024年5月25日 | 神戸 | ||
| 第72回日本心臓病学会シンポジウム | 三次元畳み込みニューラルネットワークモデルを用いた深層学習システムによる心臓MRI動画からの心筋症診断 | 加地修一郎、島袋誠地、村井亮介、金 基泰、古川 裕 | |
| 2024年9月28日 | 仙台 | ||
メンバー
| 部長 | 加地 修一郎 |
| 上席特別研究員 | 浅田 聡 |
| 上席特別研究員 | 宮川 浩太郎 |
| 上席特別研究員 | 宇佐美 俊輔 |
| 上席特別研究員 | 羽溪 健 |
| 上席特別研究員 | 平間 大介 |
| 客員研究員 | 石井 克尚 |
| 客員研究員 | 佐藤 洋 |
| 客員研究員 | 吉田 和弘 |