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Carigi S, Gentile P, Gori M, Tinti D, De Gennaro L, Leonardi G, Orso F, Felici AR, Catalano MR, Floresta M, Rizzello V, Lucci D, Gonzini L, De Maria R, Marini M. Clinical characteristics, treatment, trajectories and outcome of patients with dilated cardiomyopathy in a national heart failure registry. Int J Cardiol 2024; 407:131986. [PMID: 38513737 DOI: 10.1016/j.ijcard.2024.131986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/23/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Available data on the clinical characteristics and prognosis of patients with heart failure (HF) due to dilated cardiomyopathy (DCM) derive mainly from tertiary care centres for cardiomyopathies or from drug trial sub-studies, which may entail a referral bias. METHODS From 2008 to 2021, we enrolled in a nationwide HF Registry 1886 DCM patients and 3899 with ischemic heart disease (IHD). RESULTS Patients with DCM were younger, more often female, had more commonly recent onset HF, left bundle branch block, and showed higher LV end-diastolic volume and lower LVEF than IHD. With respect to IHD, DCM patients received more often mineralocorticoid receptor antagonists, renin angiotensin system inhibitors and betablockers, the latter more commonly at doses ≥50% of target, and triple guideline-directed medical therapy (GDMT) (adjusted OR 1.411, 95% CI 1.247-1.595, p < .0001). During one-year follow-up, 819 patients (14.2%) died or were hospitalized for HF [187 (9.9%) DCM, 632 (16.2%) IHD]; DCM was associated with lower risk of the combined end-point (adjusted HR 0.745, 95% CI 0.625- 0.888, p = .0011). Among the 1954 patients with 1-year echocardiograms available, 1483 had LVEF≤40% at baseline; of these,166 (30.6%) DCM and 165 (17.5%) IHD improved their LVEF to >40% (p < .0001). DCM aetiology was associated with higher likelihood of LVEF improvement (adjusted OR 1.722, 95% CI 1.328 -2.233, p < .0001). CONCLUSIONS DCM patients have a different clinical profile, greater uptake of GDMT and better outcomes than IHD subjects. A comprehensive management approach is needed to further address the risk of unfavorable outcomes in DCM.
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Affiliation(s)
- Samuela Carigi
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Cardiology Unit, Infermi Hospital, Rimini, Italy
| | - Piero Gentile
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; De Gasperis Cardio ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Gori
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Denitza Tinti
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Unit of Cardiology, San Camillo Hospital, Rome, Italy
| | - Luisa De Gennaro
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Cardiology Department, San Paolo Hospital, Bari, Italy
| | - Giuseppe Leonardi
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; SSD Severe Heart Failure, PO "G. Rodolico", Catania, Italy
| | - Francesco Orso
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Heart Failure Unit, Division of Geriatric Medicine and Intensive Care Unit, Department of Medicine and Geriatrics, Careggi University Hospital, Florence, Italy
| | - Anna Rita Felici
- UOC di Cardiologia e UTIC, Ospedale dei Castelli, Ariccia, Italy
| | | | - Marina Floresta
- UOC Cardiologia e UTIC Villa Sofia, AOR Villa Sofia-Cervello, Palermo, Italy
| | - Vittoria Rizzello
- UOC Cardiologia d'urgenza e UTIC, AO San Giovanni Addolorata, Roma, Italy
| | - Donata Lucci
- ANMCO Research Centre, Heart Care Foundation, Florence, Italy
| | - Lucio Gonzini
- ANMCO Research Centre, Heart Care Foundation, Florence, Italy
| | - Renata De Maria
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy.
| | - Marco Marini
- Heart Failure Working Group, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Florence, Italy; Department of Cardiovascular Sciences Cardiology, Ospedali Riuniti, Ancona, Italy
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Cesareo M, Ródenas-Alesina E, Guala A, Lozano-Torres J, Casas G, Vallelonga F, Airale L, Ferreira-González I, Milan A, Rodriguez-Palomares JF. Echocardiography-Derived Hemodynamic Forces Are Associated with Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy. J Clin Med 2024; 13:3862. [PMID: 38999432 PMCID: PMC11242817 DOI: 10.3390/jcm13133862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: Non-ischemic dilated cardiomyopathy (NIDCM) is characterized by a reduced left ventricular (LV) ejection fraction (LVEF, <50%) and a high risk for heart failure (HF) and death. Echocardiography-derived hemodynamic forces (HDFs) may provide important information on LV mechanics, but their prognostic value is unknown. Aim: To explore the features of echocardiography-derived HDFs in NIDCM and their association with clinical endpoints. Methods: Asymptomatic, non-hospitalized NIDCM patients free from coronary artery disease and moderate or severe valvular heart disease were included in this single-center observational retrospective longitudinal study. Those with atrial fibrillation and a follow-up <12 months were excluded. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, HF hospitalization, and ambulatory intravenous diuretics administration. LV HDFs were analyzed with a prototype software. Apex-base (HDFs-ab), lateral-septal (HDFs-ls), and HDFs-angle were computed. Results: Ninety-seven patients were included, sixty-seven (69%) were males, mean age was 62 ± 14 years, and mean LVEF was 39.2 ± 8.6%. During a median follow-up of 4.2 (3.1-5.1) years, 19 (20%) patients experienced MACE. These patients had a higher HDFs-angle (71.0 (67.0-75.0) vs. 68.0 (63.0-71.0)°, p = 0.005), lower HDFs-ls (1.36 (1.01-1.85) vs. 1.66 ([1.28-2.04])%, p = 0.015), but similar HDFs-ab (5.02 (4.39-6.34) vs. 5.66 (4.53-6.78)%, p = 0.375) compared to those without MACE. in a Cox regression analysis, HDFs-angle (HR 1.16 (95%-CI 1.04-1.30), p = 0.007) was associated with MACE, while other conventional echocardiography parameters, including LVEF and LV longitudinal strain, were not. Conclusions: HDFs-angle is associated with clinical endpoints in NIDCM. A higher HDFs-angle may be a marker of impaired myocardial performance in patients with reduced LVEF.
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Affiliation(s)
- Marco Cesareo
- Hypertension Unit, Division of Internal Medicine, University Hospital Città della Salute e della Scienza of Turin, Via Genova 3, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andrea Guala
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
- Vall d'Hebrón Research Institute (VHIR), Pg. de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Jordi Lozano-Torres
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Guillem Casas
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Fabrizio Vallelonga
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
- Division of Internal Medicine, Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia (FPO)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Strada Provinciale 142, KM 3.95, 10060 Turin, Italy
| | - Lorenzo Airale
- Hypertension Unit, Division of Internal Medicine, University Hospital Città della Salute e della Scienza of Turin, Via Genova 3, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Alberto Milan
- Department of Medical Sciences, University of Turin, Via Verdi 8, 10124 Turin, Italy
- Division of Internal Medicine, Candiolo Cancer Institute-Fondazione del Piemonte per l'Oncologia (FPO)-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Strada Provinciale 142, KM 3.95, 10060 Turin, Italy
| | - Jose F Rodriguez-Palomares
- Cardiology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovaculares (CIBERCV), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
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Liu Y, Wang W, Song J, Wang J, Fu Y, Tang Y. Circulating biomarker- and magnetic resonance-based nomogram predicting long-term outcomes in dilated cardiomyopathy. Chin Med J (Engl) 2024; 137:73-81. [PMID: 38178323 PMCID: PMC10766284 DOI: 10.1097/cm9.0000000000002688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) has a high mortality rate and is the most common indication for heart transplantation. Our study sought to develop a multiparametric nomogram to assess individualized all-cause mortality or heart transplantation (ACM/HTx) risk in DCM patients. METHODS The present study is a retrospective cohort study. The demographic, clinical, blood test, and cardiac magnetic resonance imaging (CMRI) data of DCM patients in the tertiary center (Fuwai Hospital) were collected. The primary endpoint was ACM/HTx. The least absolute shrinkage and selection operator (LASSO) Cox regression model was applied for variable selection. Multivariable Cox regression was used to develop a nomogram. The concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. RESULTS A total of 218 patients were included in the present study. They were randomly divided into a training cohort and a validation cohort. The nomogram was established based on eight variables, including mid-wall late gadolinium enhancement, systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-diastolic volume index, free triiodothyronine, and N-terminal pro-B type natriuretic peptide. The AUCs regarding 1-year, 3-year, and 5-year ACM/HTx events were 0.859, 0.831, and 0.840 in the training cohort and 0.770, 0.789, and 0.819 in the validation cohort, respectively. The calibration curve and DCA showed good accuracy and clinical utility of the nomogram. CONCLUSIONS We established and validated a circulating biomarker- and CMRI-based nomogram that could provide a personalized prediction of ACM/HTx for DCM patients, which might help risk stratification and decision-making in clinical practice.
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Affiliation(s)
- Yupeng Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wenyao Wang
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Jingjing Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jiancheng Wang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing 100083, China
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100083, China
| | - Yida Tang
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
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Fujita Y, Yano T, Kanamori H, Nagahara D, Muranaka A, Kouzu H, Mochizuki A, Koyama M, Nagano N, Fujito T, Nishikawa R, Kamiyama N, Tanaka M, Kuno A, Tanno M, Miura T. Enhanced nuclear localization of phosphorylated MLKL predicts adverse events in patients with dilated cardiomyopathy. ESC Heart Fail 2022; 9:3435-3451. [PMID: 35851586 PMCID: PMC9715765 DOI: 10.1002/ehf2.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS The role of necroptosis in dilated cardiomyopathy (DCM) remains unclear. Here, we examined whether phosphorylation of mixed lineage kinase domain-like protein (MLKL), an indispensable event for execution of necroptosis, is associated with the progression of DCM. METHODS AND RESULTS Patients with DCM (n = 56, 56 ± 15 years of age; 68% male) were enrolled for immunohistochemical analyses of biopsies. Adverse events were defined as a composite of death or admission for heart failure or ventricular arrhythmia. Compared with the normal myocardium, increased signals of MLKL phosphorylation were detected in the nuclei, cytoplasm, and intercalated discs of cardiomyocytes in biopsy samples from DCM patients. The phosphorylated MLKL (p-MLKL) signal was increased in enlarged nuclei or nuclei with bizarre shapes in hypertrophied cardiomyocytes. Nuclear p-MLKL level was correlated negatively with septal peak myocardial velocity during early diastole (r = -0.327, P = 0.019) and was correlated positively with tricuspid regurgitation pressure gradient (r = 0.339, P = 0.023), while p-MLKL level in intercalated discs was negatively correlated with mean left ventricular wall thickness (r = -0.360, P = 0.014). During a median follow-up period of 3.5 years, 10 patients (18%) had adverse events. To examine the difference in event rates according to p-MLKL expression levels, patients were divided into two groups by using the median value of nuclear p-MLKL or intercalated disc p-MLKL. A group with high nuclear p-MLKL level (H-nucMLKL group) had a higher adverse event rate than did a group with low nuclear p-MLKL level (L-nucMLKL group) (32% vs. 4%, P = 0.012), and Kaplan-Meier survival curves showed that the adverse event-free survival rate was lower in the H-nucMLKL group than in the L-nucMLKL group (P = 0.019 by the log-rank test). Such differences were not detected between groups divided by a median value of intercalated disc p-MLKL. In δ-sarcoglycan-deficient (Sgcd-/- ) mice, a model of DCM, total p-MLKL and nuclear p-MLKL levels were higher than in wild-type mice. CONCLUSION The results suggest that increased localization of nuclear p-MLKL in cardiomyocytes is associated with left ventricular diastolic dysfunction and future adverse events in DCM.
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Affiliation(s)
- Yugo Fujita
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Hiromitsu Kanamori
- Department of CardiologyGifu University Graduate School of MedicineGifuJapan
| | - Daigo Nagahara
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
- Department of Public HealthSapporo Medical University School of MedicineSapporoJapan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Atsushi Kuno
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
- Department of PharmacologySapporo Medical University School of MedicineSapporoJapan
| | - Masaya Tanno
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic MedicineSapporo Medical University School of MedicineSapporo060‐8543Japan
- Department of Clinical Pharmacology, Faculty of Pharmaceutical SciencesHokkaido University of ScienceSapporoJapan
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Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy. Sci Rep 2022; 12:7730. [PMID: 35545653 PMCID: PMC9095619 DOI: 10.1038/s41598-022-11740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
This Korean nationwide, multicenter, noninterventional, prospective cohort study aimed to analyze physician adherence to guideline-recommended therapy for heart failure (HF) with reduced ejection fraction (HFrEF) and its effect on patient-reported outcomes (PROs). Patients diagnosed with or hospitalized for HFrEF within the previous year were enrolled. Treatment adherence was considered optimal when all 3 categories of guideline-recommended medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors; beta-blockers; and mineralocorticoid receptor antagonists) were prescribed and suboptimal when ≤ 2 categories were prescribed. The 36-Item Short Form Survey (SF-36) scores were compared at baseline and 6 months between the 2 groups. Overall, 854 patients from 30 hospitals were included. At baseline, the optimal adherence group comprised 527 patients (61.7%), whereas during follow-up, the optimal and suboptimal adherence groups comprised 462 (54.1%) and 281 (32.9%) patients, respectively. Patients in the suboptimal adherence group were older, with a lower body mass index, and increased comorbidities, including renal dysfunction. SF-36 scores were significantly higher in the optimal adherence group for most domains (P < 0.05). This study showed satisfactory physician adherence to contemporary treatment for HFrEF. Optimal adherence to HF medication significantly correlated with better PROs.
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Oishi H, Okumura T, Ohashi K, Kimura Y, Kazama S, Shibata N, Arao Y, Kato H, Kuwayama T, Yamaguchi S, Tatsumi M, Kondo T, Hiraiwa H, Morimoto R, Takefuji M, Ouchi N, Murohara T. Prognostic impact of transcardiac gradient of follistatin-like 1 reflecting hemodynamics in patients with dilated cardiomyopathy. J Cardiol 2021; 78:524-532. [PMID: 34334268 DOI: 10.1016/j.jjcc.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Follistatin-like 1 (FSTL1) is a myocyte-secreted glycoprotein that could play a role in myocardial maintenance in response to harmful stimuli. We investigated the association between serum FSTL1 levels, especially focused on transcardiac gradient and the hemodynamics, to explore the prognostic impact of FSTL1 levels in patients with dilated cardiomyopathy (DCM). METHODS Thirty-two ambulatory patients with DCM (23 men; mean age 59 years) were prospectively enrolled. Blood samples were simultaneously collected from the aortic root (Ao), coronary sinus (CS), as well as from the peripheral vein during cardiac catheterization in stable conditions. The transcardiac gradient of FSTL1 was calculated by the difference between serum FSTL1 levels of CS and Ao (FSTL1CS-Ao). Patients were divided into two groups based on the median of FSTL1CS-Ao: Low FSTL1CS-Ao group, <0 ng/mL; High FSTL1CS-Ao group, ≥0 ng/mL. Cardiac events were defined as a composite of cardiac deaths and hospitalizations for worsening heart failure. RESULTS Mean left ventricular ejection fraction and median plasma B-type natriuretic peptide levels were 30.9% and 92.3 pg/mL, respectively. FSTL1CS-Ao was negatively correlated with pulmonary capillary wedge pressure (r = -0.400, p = 0.023). Kaplan-Meier survival analysis showed that event-free survival rate was significantly lower in the Low FSTL1CS-Ao group than in the High FSTL1CS-Ao group (p = 0.013). Cox regression analyses revealed that the transcardiac gradient of FSTL1 was an independent predictor for cardiac events. Receiver operating characteristic curve analysis showed that the cut-off value of FSTL1CS-Ao for the prediction of cardiac events was -4.09 ng/mL with sensitivity of 82% and specificity of 86% (area under the curve, 0.87). CONCLUSIONS Fifty percent of patients had negative transcardiac gradient of FSTL1. Reduced transcardiac gradient of FSTL1 might be a novel prognostic predictor in DCM patients with impaired hemodynamics.
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Affiliation(s)
- Hideo Oishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Koji Ohashi
- Department of Molecular Medicine and Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Yoshihito Arao
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hiroo Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Tasuku Kuwayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Shogo Yamaguchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Minako Tatsumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Mikito Takefuji
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Noriyuki Ouchi
- Department of Molecular Medicine and Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
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Sammani A, Baas AF, Asselbergs FW, te Riele ASJM. Diagnosis and Risk Prediction of Dilated Cardiomyopathy in the Era of Big Data and Genomics. J Clin Med 2021; 10:921. [PMID: 33652931 PMCID: PMC7956169 DOI: 10.3390/jcm10050921] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a leading cause of heart failure and life-threatening ventricular arrhythmias (LTVA). Work-up and risk stratification of DCM is clinically challenging, as there is great heterogeneity in phenotype and genotype. Throughout the last decade, improved genetic testing of patients has identified genotype-phenotype associations and enhanced evaluation of at-risk relatives leading to better patient prognosis. The field is now ripe to explore opportunities to improve personalised risk assessments. Multivariable risk models presented as "risk calculators" can incorporate a multitude of clinical variables and predict outcome (such as heart failure hospitalisations or LTVA). In addition, genetic risk scores derived from genome/exome-wide association studies can estimate an individual's lifetime genetic risk of developing DCM. The use of clinically granular investigations, such as late gadolinium enhancement on cardiac magnetic resonance imaging, is warranted in order to increase predictive performance. To this end, constructing big data infrastructures improves accessibility of data by using electronic health records, existing research databases, and disease registries. By applying methods such as machine and deep learning, we can model complex interactions, identify new phenotype clusters, and perform prognostic modelling. This review aims to provide an overview of the evolution of DCM definitions as well as its clinical work-up and considerations in the era of genomics. In addition, we present exciting examples in the field of big data infrastructures, personalised prognostic assessment, and artificial intelligence.
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Affiliation(s)
- Arjan Sammani
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, 3582 CX Utrecht, The Netherlands; (A.S.); (F.W.A.)
| | - Annette F. Baas
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, University of Utrecht, 3582 CX Utrecht, The Netherlands;
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, 3582 CX Utrecht, The Netherlands; (A.S.); (F.W.A.)
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London WC1E 6BT, UK
| | - Anneline S. J. M. te Riele
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, 3582 CX Utrecht, The Netherlands; (A.S.); (F.W.A.)
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8
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Enzan N, Matsushima S, Ide T, Kaku H, Tohyama T, Funakoshi K, Higo T, Tsutsui H. Clinical Characteristics and Contemporary Management of Patients With Cardiomyopathies in Japan - Report From a National Registry of Clinical Personal Records. Circ Rep 2021; 3:142-152. [PMID: 33738347 PMCID: PMC7956877 DOI: 10.1253/circrep.cr-21-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background:
The clinical features of patients with cardiomyopathy, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), or restrictive cardiomyopathy (RCM), have not been recently elucidated in Japan. Methods and Results:
We collected individual patient data regarding demographics, echocardiogram, and treatment in DCM from 2003 to 2014 and in HCM and RCM from 2009 to 2014 from the national registry of clinical personal records organized by the Japanese Ministry of Health, Labour and Welfare. In all, 44,136 patients were included in this registry: 40,537 with DCM, 3,553 with HCM, and 46 with RCM. The median age at diagnosis was older for DCM and HCM than RCM (54 and 55 vs. 42 years, respectively). Male patients accounted for 74.6%, 58.7%, and 60.9% of the DCM, HCM, and RCM groups, respectively. NYHA functional Class III–IV was found in 26.9%, 11.3%, and 58.1% of patients in the DCM, HCM, and RCM groups, respectively. In the DCM group, the rates of β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription were 69% and 76%, respectively. In regional subgroup analysis, the median age at diagnosis of DCM and HCM was younger in the Kanto region. A family history of HCM was less frequent in the Hokkaido/Tohoku region. Conclusions:
The national registry of clinical personal records of cardiomyopathy could provide important information regarding the demographics, clinical characteristics, and management of cardiomyopathy throughout Japan.
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Affiliation(s)
- Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Tomomi Ide
- Department of Experimental and Clinical Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Hidetaka Kaku
- Department of Cardiology, Japan Community Healthcare Organization, Kyushu Hospital Kitakyushu Japan
| | - Takeshi Tohyama
- Center for Clinical and Translational Research, Kyushu University Hospital Fukuoka Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital Fukuoka Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University Fukuoka Japan
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9
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Merlo M, Cannatà A, Pio Loco C, Stolfo D, Barbati G, Artico J, Gentile P, De Paris V, Ramani F, Zecchin M, Gigli M, Pinamonti B, Korcova R, Di Lenarda A, Giacca M, Mestroni L, Camici PG, Sinagra G. Contemporary survival trends and aetiological characterization in non‐ischaemic dilated cardiomyopathy. Eur J Heart Fail 2020; 22:1111-1121. [DOI: 10.1002/ejhf.1914] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Antonio Cannatà
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Carola Pio Loco
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Davide Stolfo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | | | - Jessica Artico
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Piero Gentile
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Valerio De Paris
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Federica Ramani
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Massimo Zecchin
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Marta Gigli
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Renata Korcova
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Andrea Di Lenarda
- Cardiovascular Centre Azienda Sanitaria Universitaria Integrata of Trieste (ASUITS), University of Trieste Trieste Italy
| | - Mauro Giacca
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital Milan Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
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10
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Clinical characteristics, treatment and prognosis of patients with idiopathic dilated cardiomyopathy: a tertiary center experience. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:320-328. [PMID: 31105752 PMCID: PMC6503477 DOI: 10.11909/j.issn.1671-5411.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However, limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM), particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016, 1441 consecutive patients (age: 55±14 years, 68% men, LVEF: 33% ± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics, treatment and prognosis were analyzed, and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers, β-blockers, aldosterone receptor antagonists and diuretics increased from 55%, 45%, 58%, 51% in 2009 to 67%, 69%, 71%, 64% in 2016, respectively (P < 0.05); whereas, the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%; however, that rate increased from 33% in 2009 to 41%, 49% and 56% in 2012, 2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without, but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However, it remains suboptimal, and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover, the following patient category also had an improved prognosis: patients with LVEF ≥ 40%, with device therapy, and those admitted to a cardiology ward.
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11
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Kano N, Okumura T, Isobe S, Sawamura A, Watanabe N, Fukaya K, Mori H, Morimoto R, Kato K, Bando YK, Murohara T. Left ventricular phase entropy: Novel prognostic predictor in patients with dilated cardiomyopathy and narrow QRS. J Nucl Cardiol 2018; 25:1677-1687. [PMID: 28176257 DOI: 10.1007/s12350-017-0807-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prognostic impact and pathophysiology of global left ventricular mechanical dyssynchrony (LVMD), namely mechanical dyssynchrony of whole left ventricle, as assessed by phase analysis of electrocardiographically gated (ECG-gated) myocardial perfusion SPECT has not been clearly elucidated in patients with dilated cardiomyopathy (DCM) and narrow QRS complex (<120 ms). METHODS AND RESULTS Forty-six patients with DCM underwent ECG-gated myocardial 99mTc-sestamibi perfusion SPECT and endomyocardial biopsy. LV phase entropy was automatically calculated using a phase analysis of ECG-gated myocardial perfusion SPECT. The patients were divided into two groups according to the median phase entropy value: low-phase entropy (<0.61) (N = 23: LE group) and high-phase entropy (≥0.61) (N = 23: HE group). In the Kaplan-Meier survival analysis, the event-free survival rate was significantly lower in the HE group (log-rank P = 0.015). Moreover, high-phase entropy was an independent predictor of adverse cardiac events (hazard ratio, 5.77%; 95% confidence interval, 1.02-108.32; P = 0.047). Interestingly, the mRNA expression levels of sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) in endomyocardial biopsy specimens were significantly lower in the HE group (P = 0.015). CONCLUSION LV phase entropy, which may reflect impairment of Ca2+ handling caused by decreased SERCA2a mRNA levels, is a novel prognostic predictor in patients with DCM and narrow QRS complex.
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Affiliation(s)
- Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Satoshi Isobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Mori
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
- Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiko Kato
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuko K Bando
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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12
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Minamisawa M, Miura T, Motoki H, Ueki Y, Shimizu K, Shoin W, Harada M, Mochidome T, Yoshie K, Oguchi Y, Hashizume N, Nishimura H, Abe N, Ebisawa S, Izawa A, Koyama J, Ikeda U. Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure. Int Heart J 2017; 58:250-256. [PMID: 28320997 DOI: 10.1536/ihj.16-315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diastolic wall strain (DWS) is based on the linear elastic theory, according to which decreased wall thinning during diastole reflects reduced left ventricular compliance and thus increased diastolic stiffness. Increased diastolic stiffness as assessed by DWS is associated with a worse prognosis in patients who have heart failure (HF) with preserved ejection fraction. However, there are no data about the prognostic value of DWS derived by M-mode echocardiography in patients at risk for HF. We retrospectively enrolled 1829 consecutive patients without prior HF who were hospitalized for cardiovascular (CV) diseases in our hospital between 2005 and 2012. Patients were divided into two groups stratified by DWS (median value 0.34). The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for HF. Over a 4.2-year median follow-up, adverse events were observed in 322 patients (17.6%). In Kaplan-Meier analysis, patients with low DWS (≤ 0.34, n = 915) showed worse prognoses than those with high DWS (> 0.34, n = 914) (MACE incidence 39.4% versus 31.9%, P = 0.011). In multivariate Cox proportional hazards analysis after the adjustment for age, sex, and echocardiographic parameters, low DWS (≤ 0.34) was significantly associated with the incidence of MACE (hazard ratio: 1.26, 95% confidence interval: 1.01-1.59; P = 0 .045). In patients without prior HF, DWS is an independent predictor of MACE. Simple assessment of DWS might improve risk stratification for CV events in those patients.
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13
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Miyata S, Sakata Y, Miura M, Yamauchi T, Onose T, Tsuji K, Abe R, Oikawa T, Kasahara S, Sato M, Nochioka K, Shiroto T, Takahashi J, Shimokawa H. Long-term prognostic impact of the Great East Japan Earthquake in patients with cardiovascular disease - Report from the CHART-2 Study. J Cardiol 2017; 70:286-296. [PMID: 28341543 DOI: 10.1016/j.jjcc.2016.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND We and others have previously reported that the Great East Japan Earthquake (GEJE) caused a significant but transient increase in cardiovascular diseases and deaths in the disaster area. However, it remains to be examined whether the GEJE had a long-term prognostic influence in large-scale cohort studies. This point is important when analyzing the data before and after the GEJE in the cohort studies in the disaster area. METHODS We examined 8676 patients registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study (N=10,219) between 2006 and 2010 and were alive after March 10, 2011. RESULTS There were 48 GEJE-related deaths, causing a sharp and transient increase in all-cause death within a month after the GEJE. However, after excluding the GEJE-related deaths, the cubic polynomial spline smoothing showed no significant increase in all-cause death, heart failure admission, non-fetal acute myocardial infarction, or non-fetal stroke during the median 3-year follow-up after the GEJE. The extrapolation curves beyond the GEJE, which were obtained by the parametric survival models based on the survival data censored on the GEJE, were not significantly different from the Kaplan-Meier curves estimating the survival functions of deaths and cardiac events during the total follow-up period without considering the impacts of the GEJE. Furthermore, the multivariate Cox proportional hazard model applied to the matched cohort of the baseline data and the data after the GEJE showed no significant differences in the impacts of prognostic factors on all-cause mortality before and after the GEJE. CONCLUSIONS These results indicate that the GEJE had no significant long-term prognostic impact after the earthquake in cardiovascular patients in the disaster area.
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Affiliation(s)
- Satoshi Miyata
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Masanobu Miura
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeshi Yamauchi
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Onose
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kanako Tsuji
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ruri Abe
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Oikawa
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine and Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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14
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Konishi M, Ishida J, Springer J, von Haehling S, Akashi YJ, Shimokawa H, Anker SD. Heart failure epidemiology and novel treatments in Japan: facts and numbers. ESC Heart Fail 2016; 3:145-151. [PMID: 27840692 PMCID: PMC5096253 DOI: 10.1002/ehf2.12103] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 12/11/2022] Open
Abstract
Japan has the highest proportion of older people in the world, 25.9% of the population were aged 65 or above in 2014. Although there have been no population‐based studies that precisely examined the prevalence of heart failure in Japan, one report estimated the number of Japanese outpatients with left ventricular dysfunction was 979, 000 (0.8% of total population), which was projected to increase gradually as the population ages, reaching 1.3 million by 2030. Ischemic etiology was less frequently observed in Japan (31–47%) than in western population (54–57%). The prevalence of HF with preserved ejection fraction was similar between Japan (34–68%) and western countries (34–51%). Non‐cardiac co‐morbidities such as chronic obstructive pulmonary diseases and anemia were observed in 6–9% in Japan and 19–31% in western countries, and 35–58% in Japan and 37–56% in western countries, respectively. The definition of chronic kidney disease widely differed among studies. A relatively good survival prognosis in Japanese patients has been discussed. One‐year mortality after discharge from initial hospitalization was 9–12%, which seems to be better than the western cohort. Although length of stay was remarkably longer in Japan (15–21 days) than western countries (4–9 days), it will have to be shortened, as Japan is now being faced with an upcoming HF pandemic. Some treatments in Japan are not approved outside Japan. Such treatments include carperitide infusion (used in 58% of hospitalized HF), nicorandil infusion (9.6%), and oral pimobendan (5%). More recently, landiolol and tolvaptan have been approved. Although these drugs might have a potential to be an effective therapeutic option, lack of corroborating evidence in many of such treatments would emphasize the need for larger clinical trials.
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Affiliation(s)
- Masaaki Konishi
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Junichi Ishida
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
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15
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Satake H, Sugimura K, Fukumoto Y, Fukuda K, Nakano M, Kondo M, Fukui S, Ogawa H, Shinozaki T, Shimokawa H. Effect of Respiratory Therapy on the Prognosis of Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing – A Pilot Efficacy Trial –. Circ J 2016; 80:130-8. [DOI: 10.1253/circj.cj-15-0702] [Citation(s) in RCA: 12] [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)
- Hiroyuki Satake
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Koji Fukuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masateru Kondo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine
| | - Tsuyoshi Shinozaki
- Division of Cardiology, National Hospital Organization Sendai Medical Center
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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16
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Matsuo S, Nakajima K, Nakata T. Prognostic Value of Cardiac Sympathetic Nerve Imaging Using Long-Term Follow-up Data - Ischemic vs. Non-Ischemic Heart Failure Etiology. Circ J 2015; 80:435-41. [PMID: 26638869 DOI: 10.1253/circj.cj-15-0952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac (123)I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies. METHODS AND RESULTS All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome. CONCLUSIONS Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death.
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Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital
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17
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Sadahiro T, Kohsaka S, Okuda S, Inohara T, Shiraishi Y, Kohno T, Yoshikawa T, Fukuda K. MRI and serum high-sensitivity C reactive protein predict long-term mortality in non-ischaemic cardiomyopathy. Open Heart 2015; 2:e000298. [PMID: 26512328 PMCID: PMC4620229 DOI: 10.1136/openhrt-2015-000298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/30/2015] [Accepted: 08/02/2015] [Indexed: 01/05/2023] Open
Abstract
Objective Myocardial fibrosis related to non-specific inflammation can be detected using late gadolinium-enhancement cardiovascular MR (LGE-CMR), which is an important prognostic indicator for dilated cardiomyopathy (DCM). The aims of this study were to define the prognostic factors for DCM with LGE-CMR, and to evaluate the impact of the prognostic factors on adverse effects. Methods We performed a retrospective analysis of a prospectively maintained single centre registry. We analysed the data from 76 patients with DCM who had been admitted for acute heart failure. The primary combined end point was defined as all-cause mortality and rehospitalisation. Results LGE-CMR was present in 39 patients (51%), and the mean follow-up period was 813±54 days. The primary end point occurred in 20 patients (5 (13.5%) patients without LGE-CMR and 15 (38.5%) patients with LGE-CMR, p=0.006). Sixteen of 39 patients with LGE-CMR exhibited elevated high-sensitivity C reactive protein (hs-CRP >0.3 mg/dL). Patients with elevated hs-CRP and LGE-CMR had a significantly higher incidence of the primary end point compared with patients with normal hs-CRP and LGE-CMR (62.5%; 10 patients, 22.7%; 5 patients, respectively, p=0.001). Elevated hs-CRP was significantly associated with the primary end point (HR: 4.04; 95% CI 1.67 to 9.76; p=0.002). After elevated hs-CRP was adjusted for known predictors of DCM, it was still associated with the primary end point (HR: 2.91; 95% CI 1.19 to 7.15; p=0.02). Conclusions Among patients with DCM, LGE-CMR and elevated hs-CRP are associated with a higher incidence of the long-term combined end point of all-cause mortality and hospitalisation. Trial registration number: UMIN000001171.
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Affiliation(s)
- Taketaro Sadahiro
- Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
| | - Shun Kohsaka
- Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
| | - Shigeo Okuda
- Department of Diagnostic Radiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
| | - Taku Inohara
- Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
| | - Takashi Kohno
- Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
| | | | - Keiichi Fukuda
- Department of Cardiology , Keio University School of Medicine , Tokyo, Shinjuku-ku , Japan
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Abstract
Heart failure (HF) is an epidemic in healthcare worldwide, including Asia. It appears that HF will become more serious in the near future, with the epidemiological transition and ageing of the population. However, in contrast to Western countries, information on HF epidemiology is still limited in Asia, particularly in South Asia. In this review, we will briefly summarize available information regarding the current and future burden of HF in Asia, which indicates the importance of both primary prevention of underlying diseases of HF and secondary prevention, including management of ischaemic HF, HF with preserved EF, and HF in the elderly.
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Affiliation(s)
- Hiroaki Shimokawa
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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19
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Seo Y, Aonuma K. New Index Obtained From Intrathoracic Impedance Measurements - Could MOMOTARO Find the Key to Heart Failure Management in the Modern Treasure Chest? - . Circ J 2015; 79:1209-10. [PMID: 25912806 DOI: 10.1253/circj.cj-15-0421] [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)
- Yoshihiro Seo
- Cardiovascular Division, Faculty of Clinical Medicine, University of Tsukuba
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20
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Ushigome R, Sakata Y, Nochioka K, Miyata S, Miura M, Tadaki S, Yamauchi T, Sato K, Onose T, Tsuji K, Abe R, Oikawa T, Kasahara S, Takahashi J, Shimokawa H. Temporal Trends in Clinical Characteristics, Management and Prognosis of Patients With Symptomatic Heart Failure in Japan – Report From the CHART Studies –. Circ J 2015; 79:2396-407. [DOI: 10.1253/circj.cj-15-0514] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryoichi Ushigome
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Satoshi Miyata
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Soichiro Tadaki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Takeshi Yamauchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kenjiro Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Takeo Onose
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kanako Tsuji
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Ruri Abe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Takuya Oikawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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