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Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk factors of readmission and the impact of outpatient management in heart failure patients: A national study in Japan. ESC Heart Fail 2023; 10:3299-3310. [PMID: 37658614 PMCID: PMC10682852 DOI: 10.1002/ehf2.14498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS Heart failure is a significant disease, and its high readmission rate is a big concern. We must identify readmission risk factors and optimize outpatient management to prevent them. This study aims to investigate the readmission risk factors, including outpatient management represented by the number of outpatient visits, and to identify the factors related to frequent outpatient visits. METHODS AND RESULTS We used the diagnosis-procedure-combination database between April 2016 and March 2022. Based on the number of outpatient visits within 60 days after discharge, we categorized patients into <1 visits/month, (1<, ≦2) visits/month, and <2 visits/month and observed the occurrence of 60 days readmission. We performed multiple logistic regression analyses to reveal the readmission risk factors and the association between the number of outpatient visits and readmission. As a subgroup analysis, we conducted the same research in the low- and high-readmission risk groups. We compared medical contents between (1<, ≦2) visits/month and <2 visits/month. We analysed 101 239 patients and identified the following factors as a risk of readmission: older age (P < 0.001), female (P = 0.009), longer length-of-hospital-stay (P < 0.001), artificial ventilator (P < 0.001), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P = 0.036), bottom 50% dosage of class III antiarrhythmic agents (P < 0.001), hypertension (P = 0.005), atrial fibrillation (P < 0.001), dilated cardiomyopathy (P < 0.001), valvular disease (P = 0.021), myocardial infarction (P < 0.001), diabetes (P < 0.001), and renal disease (P < 0.001). We revealed that the risk of readmission increases in <2 visits/month compared to (1<, ≦2) visits/month (P < 0.001), whereas the risk of readmission decreases in ≦1 visits/month compared with (1<, ≦2) visits/month (P < 0.001). In the subgroup analysis, we found the possibility that some risk factors are specific to the subgroup. We identified that the following factors were related to frequent outpatient visits: older age (P < 0.001), home medical care (P = 0.007), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P < 0.001), diabetes (P < 0.001), renal disease (P = 0.009), 0-2 weeks follow-up (P < 0.001), 2-4 weeks follow-up (P < 0.001), cardiac rehabilitation (P < 0.001), and echocardiography (P < 0.001). CONCLUSIONS This study comprehensively identified risk factors for readmission and found outpatient visit is personalized by readmission risk. There is still room to optimize outpatient management. We suggest optimizing outpatient management according to our identified characteristics.
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Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
| | - Kunio Tarasawa
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of Medical and Dental SciencesTokyoJapan
| | - Kenji Fujimori
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
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Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database. TOHOKU J EXP MED 2023; 259:151-162. [PMID: 36543246 DOI: 10.1620/tjem.2022.j114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Heart failure is a major disease, and its 30-day readmission (readmission within 30-day after discharge) negatively impacts patients and society. Thus, we need to stratify the risk and prevent readmission. We aimed to investigate risk factors associated with 30-day readmission and examine the impact of length of hospital stay (LOS) on 30-day readmission. Using the Diagnosis-Procedure-Combination database from April 2018 to March 2021, we conducted multiple logistic regression to investigate risk factors with 30-day readmission. Also, we conducted subgroup analysis in the short LOS group. To examine the association between LOS and 30-day readmission, we performed propensity score matching between the short and middle LOS groups. As a result, we categorized 10,283 patients and 169,842 patients into the readmission group and the no-readmission group. We identified the following factors as the risk of readmission: short LOS, female, smoking, older age, lower body mass index, lower barthel index, artificial ventilator, beta-blockers, thiazides, tolvaptan, loop diuretics, carperitides, class Ⅲ antiarrhythmic agents, myocardial infarction, diabetes, renal disease, atrial fibrillation, dilated cardiomyopathy, and discharge to home. As a subgroup analysis in the short LOS group, we revealed that the short LOS group risk factors differed from overall. After propensity score matching in the short LOS group and middle LOS group, 37,199 pairs were matched, and we revealed that shorter LOS increases the risk of readmission. These results demonstrated that shortened LOS increases 30-day readmission, and risk factors are unique to each LOS. We suggest stratifying the readmission risk and being careful with early discharge.
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Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
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Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure - Digest Version. Circ J 2019; 83:2084-2184. [PMID: 31511439 DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 446] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women's Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
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Asanuma H, Sanada S, Yoshitomi T, Sasaki H, Takahama H, Ihara M, Takahama H, Shinozaki Y, Mori H, Asakura M, Nakano A, Sugimachi M, Asano Y, Minamino T, Takashima S, Nagasaki Y, Kitakaze M. Novel Synthesized Radical-Containing Nanoparticles Limit Infarct Size Following Ischemia and Reperfusion in Canine Hearts. Cardiovasc Drugs Ther 2017; 31:501-510. [DOI: 10.1007/s10557-017-6758-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Pulmonary hypertension due to left heart disease: The prognostic implications of diastolic pulmonary vascular pressure gradient. J Cardiol 2016; 67:555-9. [DOI: 10.1016/j.jjcc.2015.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/18/2015] [Accepted: 07/23/2015] [Indexed: 11/23/2022]
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Kuga K, Yamasaki H, Hattori A, Xu DZ, Watanabe S, Arimoto T, Aonuma K, Kohro T, Yamazaki T, Nagai R. Prognosis of myocardial infarction with left ventricular dysfunction in the coronary revascularization era.Subanalysis of the Japanese Coronary Artery Disease (JCAD) Study. Circ J 2014; 78:2483-91. [PMID: 25143319 DOI: 10.1253/circj.cj-14-0301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Indications of implantable cardioverter-defibrillator (ICD) for patients with an old myocardial infarction (OMI) and left ventricular dysfunction (LVD) were expanded in Western countries after the results of MADIT II. However, the prognosis of OMI patients with LVD and the merits of prophylactic implantation of ICD, based on evidence in Japan, have not yet been clarified. This subanalysis of the Japanese Coronary Artery Disease (JCAD) Study focused on MADIT II-compatible patients to clarify the prognosis of OMI patients with LVD in Japan. METHODS AND RESULTS Consecutive 6,868 OMI patients were prospectively followed up for 3 years or until clinical events occurred. 291 patients had left ventricular ejection fraction (LVEF) ≤30%. Clinical events, congestive heart failure, cardiopulmonary arrest on arrival and vascular events were significantly more frequent in patients with LVEF ≤30% than in those with better LVEF. In the LVEF ≤30% group, cardiopulmonary arrest on arrival comprised 33% of all-cause deaths, and the survival curves at 2 years of the LVEF ≤30% group were almost compatible with those of the MADIT II ICD group. CONCLUSIONS In this subanalysis, LVD was less frequent than in Western countries. The annual death rate in JCAD was better than for the MADIT II ICD group. The prophylactic use of ICD seemed to be less effective than in Western countries but still expected to be useful for OMI patients with LVD in Japan.
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Affiliation(s)
- Keisuke Kuga
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
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7
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Asanuma H, Sanada S, Asakura M, Asano Y, Kim J, Shinozaki Y, Mori H, Minamino T, Takashima S, Kitakaze M. Carperitide induces coronary vasodilation and limits infarct size in canine ischemic hearts: role of NO. Hypertens Res 2014; 37:716-23. [PMID: 24694647 DOI: 10.1038/hr.2014.70] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/05/2014] [Accepted: 02/07/2014] [Indexed: 11/09/2022]
Abstract
Carperitide is effective for heart failure (HF) owing to its diuretic and vasodilatory effects. This recombinant peptide may also have direct cardioprotective effects because carperitide reduces the severity of heart failure and limits infarct size. Because coronary vasodilation is an important cardioprotective treatment modality, we investigated whether carperitide increased coronary blood flow (CBF) and improved myocardial metabolic and contractile dysfunction during ischemia in canine hearts. We also tested whether carperitide is directly responsible for limiting the infarct size. We infused carperitide at 0.025-0.2 μg kg(-1) min(-1) into the canine coronary artery. A minimum dose of 0.1 μg kg(-1) min(-1) was required to obtain maximal vasodilation. To test the effects of carperitide on ischemic hearts, we reduced perfusion pressure in the left anterior descending coronary artery such that CBF decreased to one-third of the baseline value. At 10 min after carperitide was infused at a dose of 0.1 μg kg(-1) min(-1), we observed increases in CBF, fractional shortening (FS) and pH levels in coronary venous blood without concomitant increases in cardiac nitric oxide (NO) levels; these changes were attenuated using either the atrial natriuretic peptide receptor antagonist HS-142-1 or the NO synthase inhibitor L(ω)-nitroarginine methyl ester (L-NAME). Cyclic guanosine monophosphate (GMP) levels in the coronary artery were elevated in response to carperitide that also limited the infarct size after 90 min of ischemia and subsequent reperfusion. Again, these effects were blunted by L-NAME. Carperitide increases CBF, reduces myocardial contractile and metabolic dysfunction and limits infarct size. In addition, NO is necessary for carperitide-induced vasodilation and cardioprotection in ischemic hearts.
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Affiliation(s)
- Hiroshi Asanuma
- 1] Department of Cardiovascular Science and Technology, Kyoto Prefectural University School of Medicine, Kyoto, Japan [2] Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoji Sanada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masanori Asakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Asano
- 1] Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan [2] Department of Medical Biochemistry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jiyoong Kim
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiro Shinozaki
- Department of Physiology, Tokai University Graduate School of Medicine, Isehara, Japan
| | - Hidezo Mori
- Department of Physiology, Tokai University Graduate School of Medicine, Isehara, Japan
| | - Tetsuo Minamino
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiji Takashima
- 1] Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan [2] Department of Medical Biochemistry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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8
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Karpov AA, Uspenskaya YK, Minasian SM, Puzanov MV, Dmitrieva RI, Bilibina AA, Anisimov SV, Galagudza MM. The effect of bone marrow- and adipose tissue-derived mesenchymal stem cell transplantation on myocardial remodelling in the rat model of ischaemic heart failure. Int J Exp Pathol 2013; 94:169-77. [PMID: 23560418 DOI: 10.1111/iep.12017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/11/2013] [Indexed: 12/27/2022] Open
Abstract
This study aimed to investigate the effect of bone marrow- and adipose tissue-derived mesenchymal stem cell (BM-MSC and AD-MSC respectively) transplantation on left ventricular function and infarct area (IA) in the rat model of ischaemic heart failure. In anaesthetized Wistar rats, the left coronary artery (LCA) was occluded for 40 min with subsequent reperfusion for 7 days. Seven days following surgery, the animals with LCA occlusion/reperfusion were randomized into three groups: (i) Controls received intramyocardial injection of vehicle at three different locations within the peri-infarct zone, (ii) BM-MSC: cells were injected in the same way as in previous group (10(6) ), (iii) AD-MSC: using the same protocol as used in the BM-MSC group. In addition there was also a sham-treated group that had no injection. Two weeks following MSC transplantation, the hearts were isolated and perfused according to the Langendorff method followed by 30-min global ischaemia and 90-min reperfusion. After this IA was determined histologically. During Langendorff perfusion initial and postischaemic LV functions were the same in all groups although LV pressure at the 10th minute of reperfusion was higher in the AD-MSC group compared to controls. However, LV pressure during 30-min global ischaemia was significantly higher in BM-MSC as compared to controls and AD-MSC. The sham treated animals showed the same results as those seen with BM-MSC. Thus, BM-MSC transplantation, in contrast to transplantation of AD-MSC, resulted in better preservation of the LV ability to contract during ischaemia. Furthermore, IA was significantly smaller in BM-MSC group as compared to the controls and the AD-MSC groups. Thus this study has demonstrated that treatment with BM-MSC both ameliorates LV function and reduces histological scar size.
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Affiliation(s)
- Andrey A Karpov
- Department of Pathophysiology, IP Pavlov Federal Medical University, St-Petersburg, Russia. a–
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9
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Cai M, Wang F, Zhang J, He ZX. Body mass index and rest myocardial perfusion defect predicts cardiac death in patients with chronic heart failure. Int J Cardiovasc Imaging 2012; 28 Suppl 1:77-85. [PMID: 22327940 DOI: 10.1007/s10554-012-0023-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/21/2012] [Indexed: 12/20/2022]
Abstract
Gated single photon emission computed tomography (SPECT) myocardial perfusion imaging has proven to be invaluable not only in assessing myocardial perfusion, but also in providing functional and volumetric information. The aim of this study was to investigate the value of clinical variables and rest gated SPECT myocardial perfusion imaging for predicting cardiac death in patients with chronic heart failure (CHF). Seventy-three consecutive hospitalized patients with CHF (aged 50.7 ± 16.5 years, 60 men and 13 women; 25 ischemic CHF and 48 non-ischemic CHF) and left ventricular ejection fraction on echocardiography <40%, who underwent rest gated SPECT myocardial perfusion imaging, were followed up for this study. Univariate and multivariate analysis of clinical characteristics and gated SPECT parameters for prediction of cardiac death were performed. During the follow-up period (18.6 ± 8.5 months), 14 (19.2%) cardiac deaths occurred. Multivariate Cox analysis showed that body mass index (BMI, 23.3 ± 4.1 kg/m(2), hazard ratio = 0.85, P = 0.025) and summed rest score (SRS, 11.8 ± 11.5, hazard ratio = 1.05, P = 0.021) were predictive for cardiac death. The optimal threshold of BMI was 25 kg/m(2) and patients with BMI < 25 kg/m(2) had lower survival rate (P = 0.013). The optimal threshold of SRS was set as 11 and patients with SRS > 11 had lower survival rate (P = 0.009). Rest gated SPECT myocardial perfusion imaging provides prognostic information in patients with CHF. BMI and SRS are both predictors of cardiac death in patients with CHF.
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Affiliation(s)
- Min Cai
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Bei Li Shi Lu, Beijing100037, China
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Shiba N, Shimokawa H. Prospective care of heart failure in Japan: lessons from CHART studies. EPMA J 2011; 2:425-38. [PMID: 23199179 PMCID: PMC3405413 DOI: 10.1007/s13167-011-0097-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/20/2011] [Indexed: 01/14/2023]
Abstract
There are approximately 23 million patients with heart failure (HF) worldwide. The prognosis of patients with HF is still poor and a prospective approach for preventing and treating HF is necessary. The number of HF patients in Japan has been increasing since 1950 mainly because of a rapidly aging population. Furthermore, westernized dietary pattern, reduced physical activity, and obesity have become prominent, particularly in younger Japanese men. There is an increasing trend of diabetes and dyslipidemia, and the prevalence of smoking and hypertension continues to remain high. One of the largest HF cohorts in Japan, the CHART Studies, showed that coronary artery disease (CAD) was the most frequent etiology of HF currently. Thus, prospective strategies including accurate risk stratification, effective prevention of disease progression through evidence-based treatments, optimally personalized treatment particularly in elderly individuals, and life-long control of CAD risk factors are required to manage HF in Japan.
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Affiliation(s)
- Nobuyuki Shiba
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8574 Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8574 Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8574 Japan
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8574 Japan
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11
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Shiba N, Nochioka K, Miura M, Kohno H, Shimokawa H, on behalf of the CHART-2 Investigators. Trend of Westernization of Etiology and Clinical Characteristics of Heart Failure Patients in Japan - First Report From the CHART-2 Study -. Circ J 2011; 75:823-33. [DOI: 10.1253/circj.cj-11-0135] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nobuyuki Shiba
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kotaro Nochioka
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masanobu Miura
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Haruka Kohno
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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12
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Kato N, Kinugawa K, Ito N, Yao A, Watanabe M, Imai Y, Takeda N, Hatano M, Kazuma K. Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan. Heart Lung 2009; 38:398-409. [DOI: 10.1016/j.hrtlng.2008.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 10/20/2008] [Accepted: 11/24/2008] [Indexed: 11/25/2022]
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13
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Hebert K, Lopez B, Macedo FYB, Gomes CR, Urena J, Arcement LM. Peripheral Vascular Disease and Erectile Dysfunction as Predictors of Mortality in Heart Failure Patients. J Sex Med 2009; 6:1999-2007. [DOI: 10.1111/j.1743-6109.2009.01278.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Miura T, Yuda S. Are Treatment Effects of ACEI and ARB in Post-MI Patients Homogeneous? Circ J 2009; 73:820-1. [DOI: 10.1253/circj.cj-09-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Satoshi Yuda
- Department of Clinical Laboratory Medicine, Sapporo Medical University School of Medicine
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Yamamoto K, Sakata Y, Ohtani T, Takeda Y, Mano T. Heart Failure With Preserved Ejection Fraction What is Known and Unknown. Circ J 2009; 73:404-10. [DOI: 10.1253/circj.cj-08-1073] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuhiro Yamamoto
- The Center for Advanced Medical Engineering and Informatics, Osaka University
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomohito Ohtani
- The Center for Advanced Medical Engineering and Informatics, Osaka University
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasuharu Takeda
- The Center for Advanced Medical Engineering and Informatics, Osaka University
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshiaki Mano
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Shiba N, Nochioka K, Kohno H, Matsuki M, Takahashi J, Tada T, Kagaya Y, Shimokawa H. Emerging problems of heart failure practice in Japanese women: lessons from the CHART study. Circ J 2008; 72:2009-14. [PMID: 18948671 DOI: 10.1253/circj.cj-07-1000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognosis of patients with chronic heart failure (CHF) is poor in both men and women. However, the characteristics of, and effective treatment strategy for, female CHF patients still remain unclear. This study was designed to evaluate the prognosis and characteristics of female patients in a CHF cohort termed the Chronic Heart Failure Analysis and Registry in the Tohoku District. METHODS AND RESULTS Of 1,278 patients registered in the cohort, the study population comprised 1,166 symptomatic CHF patients with sufficient data. As compared with male patients, female patients were more likely to be older, have preserved systolic function and non-ischemic etiology of CHF, and underuse standard CHF medications. Although a previous study showed that sex-difference was not a significant prognostic factor in CHF patients, the unadjusted survival analysis revealed an increased event rate in female patients in the present study. Multivariate analysis revealed that older age, diabetes, ventricular tachycardia and anemia were significant prognostic risks in both men and women with CHF. CONCLUSIONS Female sex had a significant link with elderly CHF patients. Given the explosive increase in elderly patients in Westernized countries, further studies are needed to elucidate the evidence for treatment of female CHF patients.
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Affiliation(s)
- Nobuyuki Shiba
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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17
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Abstract
The prognosis of patients with chronic heart failure (CHF) still remains poor, despite the recent advances in medical and surgical treatment. Furthermore, CHF is a major public health problem in most industrialized countries where the elderly population is rapidly increasing. Although the prevalence and mortality of CHF used to be relatively low in Japan, the disorder has been markedly increasing due to the rapid aging of the society and the Westernization of lifestyle that facilitates the development of coronary artery disease. The Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 study was one of the largest cohorts in Japan. The study has clarified the characteristics and prognosis of Japanese patients with CHF, demonstrating that their prognosis was similarly poor compared with those in Western countries. However, we still need evidence for the prevention and treatment of CHF based on the large cohort studies or randomized treatment trials in the Japanese population. Since the strategy for CHF management is now changing from treatment to prevention, a larger-size prospective cohort, called the CHART-2 study, has been initiated to evaluate the risk factors of CHF in Japan. This review summarizes the current status of CHF studies in Japan and discusses their future perspectives.
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Affiliation(s)
- Nobuyuki Shiba
- Department of Cardiovascular Medicine, Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai City, Japan.
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18
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Shiba N, Matsuki M, Takahashi J, Tada T, Watanabe J, Shimokawa H. Prognostic Importance of Chronic Kidney Disease in Japanese Patients With Chronic Heart Failure Implications of the CHART Study. Circ J 2008; 72:173-8. [DOI: 10.1253/circj.72.173] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nobuyuki Shiba
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Mika Matsuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiro Tada
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Watanabe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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19
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Kitakaze M, Asakura M, Kim J, Shintani Y, Asanuma H, Hamasaki T, Seguchi O, Myoishi M, Minamino T, Ohara T, Nagai Y, Nanto S, Watanabe K, Fukuzawa S, Hirayama A, Nakamura N, Kimura K, Fujii K, Ishihara M, Saito Y, Tomoike H, Kitamura S. Human atrial natriuretic peptide and nicorandil as adjuncts to reperfusion treatment for acute myocardial infarction (J-WIND): two randomised trials. Lancet 2007; 370:1483-93. [PMID: 17964349 DOI: 10.1016/s0140-6736(07)61634-1] [Citation(s) in RCA: 345] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients who have acute myocardial infarction remain at major risk of cardiovascular events. We aimed to assess the effects of either human atrial natriuretic peptide or nicorandil on infarct size and cardiovascular outcome. METHODS We enrolled 1216 patients who had acute myocardial infarction and were undergoing reperfusion treatment in two prospective, single-blind trials at 65 hospitals in Japan. We randomly assigned 277 patients to receive intravenous atrial natriuretic peptide (0.025 microg/kg per min for 3 days) and 292 the same dose of placebo. 276 patients were assigned to receive intravenous nicorandil (0.067 mg/kg as a bolus, followed by 1.67 microg/kg per min as a 24-h continuous infusion), and 269 the same dose of placebo. Median follow-up was 2.7 (IQR 1.5-3.6) years for patients in the atrial natriuretic peptide trial and 2.5 (1.5-3.7) years for those in the nicorandil trial. Primary endpoints were infarct size (estimated from creatine kinase) and left ventricular ejection fraction (gauged by angiography of the left ventricle). FINDINGS 43 patients withdrew consent after randomisation, and 59 did not have acute myocardial infarction. We did not assess infarct size in 50 patients for whom we had fewer than six samples of blood. We did not have angiographs of left ventricles in 383 patients. Total creatine kinase was 66,459.9 IU/mL per h in patients given atrial natriuretic peptide, compared with 77,878.9 IU/mL per h in controls, with a ratio of 0.85 between these groups (95% CI 0.75-0.97, p=0.016), which indicated a reduction of 14.7% in infarct size (95% CI 3.0-24.9%). The left ventricular ejection fraction at 6-12 months increased in the atrial natriuretic peptide group (ratio 1.05, 95% CI 1.01-1.10, p=0.024). Total activity of creatine kinase did not differ between patients given nicorandil (70 520.5 IU/mL per h) and controls (70 852.7 IU/mL per h) (ratio 0.995, 95% CI 0.878-1.138, p=0.94). Intravenous nicorandil did not affect the size of the left ventricular ejection fraction, although oral administration of nicorandil during follow-up increased the left ventricular ejection fraction between the chronic and acute phases. 29 patients in the atrial natriuretic peptide group had severe hypotension, compared with one in the corresponding placebo group. INTERPRETATION Patients with acute myocardial infarction who were given atrial natriuretic peptide had lower infarct size, fewer reperfusion injuries, and better outcomes than controls. We believe that atrial natriuretic peptide could be a safe and effective adjunctive treatment in patients with acute myocardial infarction who receive percutaneous coronary intervention.
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Affiliation(s)
- Masafumi Kitakaze
- Cardiovascular Division of Medicine, National Cardiovascular Centre, Suita, Osaka, Japan.
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20
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Tani S, Nagao K, Watanabe I, Kikushima K, Watanabe K, Anazawa T, Kawamata H, Tachibana E, Matsumoto M, Kumabe T, Kanmatsuse K, Kushiro T. Increasingly well-preserved left ventricular function in hospital survivors with acute myocardial infarction: effect of early and complete reperfusion strategy on left ventricular remodeling. Circ J 2007; 71:180-5. [PMID: 17251663 DOI: 10.1253/circj.71.180] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Progress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced acute phase mortality, but few data exist regarding the time trends in left ventricular (LV) remodeling in hospital survivors of AMI. METHODS AND RESULTS The study enrolled 813 patients with AMI who had received reperfusion therapy and survived to hospital discharge. The patients were divided into chronological groups: first treatment received between 1989 and 1992, n=196; 1993 and 1995, n=193; 1996 and 1998, n=211; and 1999 and 2002, n=213. A comparison was made of LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) at 6 months after symptom onset. Along with the temporal improvements reperfusion therapy, LVEF and LVEDVI improved over time (55+/-14, 58+/-13, 59+/-13, 61+/-13%, p<0.001; 98+/-30, 94+/-27, 90+/-31, 76+/-27 ml/m2, p<0.0001). Multiregression analysis revealed that shortening of the door-to-Thrombolysis In Myocardial Infarction (TIMI)-3 time (time interval from arrival at the emergency room until patients achieved TIMI-3 flow) and achieving substantial TIMI-3 flow were independent predictors for LV remodeling. CONCLUSION Although this was a retrospective analysis, the results demonstrated that the change in reperfusion therapy aiming at complete reperfusion at an earlier stage after AMI onset has contributed to improving post-MI remodeling.
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Affiliation(s)
- Shigemasa Tani
- Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
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21
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Hong YJ, Jeong MH, Ahn Y, Yoon NS, Lee SR, Hong SN, Moon JY, Kim KH, Park HW, Kim JH, Cho JG, Park JC, Kang JC. Relationship Between Peripheral Monocytosis and Nonrecovery of Left Ventricular Function in Patients With Left Ventricular Dysfunction Complicated With Acute Myocardial Infarction. Circ J 2007; 71:1219-24. [PMID: 17652884 DOI: 10.1253/circj.71.1219] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although ischemic heart failure is a major cause of mortality after acute myocardial infarction (AMI), the factors that may influence the nonrecovery of left ventricular function (LVF) after an AMI are still unclear. The aim of this study was to identify predictors of nonrecovery of LVF in patients with left ventricular (LV) dysfunction (defined as an echocardiographic ejection fraction (EF)<40%) complicated with AMI who undergo successful primary percutaneous coronary intervention (PCI). METHODS AND RESULTS LVF recovery was defined as improvement of LVEF more than 10% compared with baseline LVEF at follow-up. One hundred and eight patients with LV dysfunction after AMI were divided into 2 groups according to the LVF recovery at follow-up: patients with LVF recovery (n=64) vs patients without LVF recovery (n=44). The follow-up LVEF was measured at 8+/-4 months after PCI. Patients without LVF recovery were older (76+/-13 years vs 59+/-14 years, p=0.023) and the baseline peak monocyte count, creatine kinase, and troponin I levels were significantly higher in patients without LVF recovery than in patients with LVF recovery. Delta LVEF (follow-up LVEF-baseline LVEF) correlated with baseline peak monocyte count (r=-0.417, p<0.001), baseline peak creatine kinase (r=-0.269, p=0.005), and baseline peak troponin I levels (r=-0.256, p=0.007). Multivariate analyses showed that baseline peak monocyte count and old age were the independent predictors of nonrecovery of LVF (hazard ratio; 3.38, 95% confidence interval (CI): 1.16-5.43, p=0.012, and hazard ratio; 2.38, 95% CI: 1.09-4.87, p=0.025, respectively). CONCLUSION Peripheral monocytosis is associated with nonrecovery of LVF in patients with LV dysfunction complicating an AMI who underwent successful primary PCI. These results suggest an important role of monocytes in the expansion of the infarct and the development of chronic ischemic heart failure after reperfusion therapy.
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Affiliation(s)
- Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
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Amiya E, Tanabe K, Ikari Y, Nakajima Y, Hara K. Prolonged QRS duration and severity of mitral regurgitation are unfavorable prognostic markers of heart failure in patients with nonischemic dilated cardiomyopathy. Circ J 2006; 70:57-62. [PMID: 16377925 DOI: 10.1253/circj.70.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The goal of the present study was to identify predictors of event-free survival in nonischemic dilated cardiomyopathy (NIDCM) patients after administration of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and beta-blockers. METHODS AND RESULTS The study group comprised 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was defined as ejection fraction (EF) <0.40 and left ventricular end-diastolic diameter (LVEDD) >55 mm on echocardiography and normal coronary angiography. The mean EF and LVEDD was 26.3 +/- 10.5%, and 62.9 +/- 7.1 mm, respectively. Patients were treated with optimal medical therapy including ACEI/ARBs and/or beta-blockers and followed up for 35.6 +/- 27.8 months. The primary endpoint was either cardiac death or hospitalization because of deterioration of heart failure. Cox's regression analysis was used to establish the association of age, sex, EF, LVEDD, left atrial diameter, cardiac index, pulmonary capillary wedge pressure, QRS duration, severity of mitral regurgitation, body mass index, New York Heart Association class and the presence of atrial fibrillation with these events. During follow-up, 23 patients reached the primary endpoint. In a multivariate analysis, EF (chi-square 5.74, p=0.0166), severity of mitral regurgitation (chi-square 12.31, p=0.0004), and QRS duration (chi-square 11.20, p=0.0008) remained significant predictors. CONCLUSION In NIDCM patients, prolonged QRS duration is a high risk factor for remodeling and unfavorable events. The severity of mitral regurgitation was also a strong risk predictor.
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Affiliation(s)
- Eisuke Amiya
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
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Yamazaki T. Proposed New Score to Rate the Strength of Evidence and Its Application to Large-Scale Clinical Trials of Angiotensin-Receptor Blockers. Circ J 2006; 70:1155-8. [PMID: 16936428 DOI: 10.1253/circj.70.1155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Many large-scale clinical studies appear to be interpreted with bias and with hindsight. To select the best treatment, accurate evaluation of randomized controlled trials (RCTs) and fair comparison of the results using the concept of evidence-based medicine are critical. A scoring system has been developed to rate the scientific strength of evidence and thereby provide guidance for best clinical practice and for large-scale RCTs of angiotensin-receptor blockers (ARBs). METHOD AND RESULTS Positive evidence scores (ESs) were given based on whether specified study endpoints were proven and whether treatments tested made significant progress over current usual therapy. Retrospective ad hoc analyses data were not counted, in order to simplify the system and to avoid hindsight interpretations, even in cases that were medically significant. In fact, in more than half of the large-scale trials with ARBs examined, ad-hoc analyses had been retroactively performed. When such post-hoc analyses were not used, the ESs were positive with candesartan and valsartan for treatment of heart failure, irbesartan and losartan for nephropathy and losartan for hypertension. Applying the ES system, losartan was judged to be an ARB with the strongest evidence covering a wide range of clinical relevance. CONCLUSION ES is useful for quantifying and comparing the strength of evidence obtained in large-scale RCTs of ARBs. Several problems related to rating the evidence obtained from clinical trials were recognized in this study.
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Affiliation(s)
- Tsutomu Yamazaki
- Department of Clinical Bioinformatics, Graduate School of Medicine, University of Tokyo, Japan.
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24
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Tsutsui H, Tsuchihashi-Makaya M, Kinugawa S, Goto D, Takeshita A. Clinical Characteristics and Outcome of Hospitalized Patients With Heart Failure in Japan Rationale and Design of Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 2006; 70:1617-23. [PMID: 17127810 DOI: 10.1253/circj.70.1617] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Heart failure (HF), defined as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood, is a leading cause of mortality and hospitalization for adults older than 65 years in the industrialized countries. The characteristics and outcome of patients with HF have been described by several epidemiological studies and large scale clinical trials, performed mainly in the United States and Europe. Very little information is available on this issue in Japan. METHODS AND RESULTS The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is designed to prospectively study the characteristics, treatment, and outcomes of a broad sample of patients hospitalized with HF at teaching hospitals throughout Japan between January 2004 to June 2005 and the outcomes, including death and hospital readmission, will be followed through 2006 (mean follow-up at least 1 year). Participating cardiologists identify patients admitted for worsening of HF symptoms. Demographics, medical history, severity, treatment, and outcome data are collected and entered into a database via secure web browser technology. As of June 2005, baseline data for 2,676 patients with HF have been registered from 164 participating hospitals. CONCLUSIONS The JCARE-CARD will provide important insights into the management of patients with HF in routine clinical practice in Japan, thus providing the framework for improved management strategies for these patients.
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Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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25
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Nishinaka T, Schima H, Roethy W, Rajek A, Nojiri C, Wolner E, Wieselthaler GM. The DuraHeart VAD, a Magnetically Levitated Centrifugal Pump The University of Vienna Bridge-to-Transplant Experience. Circ J 2006; 70:1421-5. [PMID: 17062964 DOI: 10.1253/circj.70.1421] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical application of the DuraHeart (Terumo Heart Inc, USA) has begun in Europe as a clinical trial of a third-generation implantable centrifugal blood pump. Four successful clinical implants are presented. METHODS AND RESULTS Four male patients had end-stage left heart failure and received a DuraHeart VAD as a left ventricular assist device for bridge-to-transplantation. The pump showed good performance with flow rates of 4.9+/-0.5 L/min after gradual weaning of extracorporeal circulation. The pump flow was then maintained at 6.1+/-0.5, 5.5+/-0.3, 5.5+/-0.1, 5.7+/-0.1, 5.5, 6.4 and 6.5 L/min at the 1st, 4th, 8th, 12th, 16th, 20th and 24th postoperative week, respectively. No significant elevation of mean plasma-free hemoglobin was detected. The patients were discharged on the 18th, 42nd, 41st and 31st postoperative day, respectively, and all were successfully transplanted on the 202nd, 84th, 128th and 96th postoperative day, respectively. At the time of transplant surfaces of the removed pumps were free from thrombus formation, although intraventricular pannus growth was observed around the inflow cannulae in all patients. CONCLUSION The DuraHeart VAD showed stable and sufficient circulatory support for the bridge-to-transplant procedure in this cohort of 4 patients.
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Affiliation(s)
- Tomohiro Nishinaka
- Department of Cardiothoracic Surgery, Medical University of Vienna, A-1090 Vienna, Austria
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Matsumura Y, Takata J, Kitaoka H, Kubo T, Baba Y, Hoshikawa E, Hamada T, Okawa M, Hitomi N, Sato K, Yamasaki N, Yabe T, Furuno T, Nishinaga M, Doi Y. Long-Term Prognosis of Dilated Cardiomyopathy Revisited An Improvement in Survival Over the Past 20 Years. Circ J 2006; 70:376-83. [PMID: 16565551 DOI: 10.1253/circj.70.376] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because of their favorable prognostic effects, angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and beta blockers have become background therapy in dilated cardiomyopathy (DCM). However, there are few reports concerning the long-term prognosis of Japanese patients with DCM in relation to these treatments. METHODS AND RESULTS One hundred and fifty patients with DCM were divided into 2 groups: group A (n=46) (diagnosis: 1982-1989) and group B (n=104) (diagnosis: 1990-2002). During follow-up period of 6.9+/-4.8 years, 62 patients died and 1 patient had a heart transplant. The survival rate at 5 and 10 years was 60.9% and 34.8%, respectively, in group A patients, and 80.9% and 65.3%, respectively, in group B patients (p=0.0079). In group A patients, ACEI/ARB or beta blockers were less frequently used (p<0.0001), whereas antiarrhythmics (class Ia or Ib) were more often used (p<0.0001). The patients treated with ACEI/ARB and beta blockers showed a better survival rate than those without (p<0.0001). The patients with antiarrhythmics showed a worse survival rate than those without (p<0.0001). CONCLUSION The prognosis of Japanese patients with DCM has significantly improved over the past 20 years. This improvement may be explained partly through the increased use of ACEI/ARB and beta blockers and a declining use of antiarrhythmics.
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Affiliation(s)
- Yoshihisa Matsumura
- Department of Medicine and Geriatrics, Kochi Medical School, Kochi University, Nankoku-shi, Japan
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