1
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Natsume M, Niwa M, Ichikawa S, Okamoto T, Tsutsui H, Usukura D, Murata T, Abe R, Shimonaka M, Nishida T, Shiina I, Obata Y. Brefeldin A and M-COPA block the export of RTKs from the endoplasmic reticulum via simultaneous inactivation of ARF1, ARF4, and ARF5. J Biol Chem 2024:107327. [PMID: 38679330 DOI: 10.1016/j.jbc.2024.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/20/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Normal receptor tyrosine kinases (RTKs) need to reach the plasma membrane (PM) for ligand-induced activation, whereas its cancer-causing mutants can be activated before reaching the PM in organelles, such as the Golgi/trans-Golgi network (TGN). Inhibitors of protein export from the endoplasmic reticulum (ER), such as brefeldin A (BFA) and 2-methylcoprophilinamide (M-COPA), can suppress the activation of mutant RTKs in cancer cells, suggesting that RTK mutants cannot initiate signaling in the ER. BFA and M-COPA block the function of ADP-ribosylation factors (ARFs) that play a crucial role in ER-Golgi protein trafficking. However, among ARF family proteins, the specific ARFs inhibited by BFA or M-COPA, that is, the ARFs involved in RTKs transport from the ER, remain unclear. In this study, we showed that M-COPA blocked the export of not only KIT but also PDGFRA/EGFR/MET RTKs from the ER. ER-retained RTKs could not fully transduce anti-apoptotic signals, thereby leading to cancer cell apoptosis. Moreover, single knockdown of ARF1, ARF3, ARF4, ARF5, or ARF6 could not block ER export of RTKs, indicating that BFA/M-COPA treatment cannot be mimicked by knockdown of only one ARF member. Interestingly, simultaneous transfection of ARF1, ARF4, and ARF5 siRNAs mirrored the effect of BFA/M-COPA treatment. Consistent with these results, in vitro pulldown assays showed that BFA/M-COPA blocked the function of ARF1, ARF4, and ARF5. Taken together, these results suggest that BFA/M-COPA targets at least ARF1, ARF4, and ARF5; in other words, RTKs require the simultaneous activation of ARF1, ARF4, and ARF5 for their ER export.
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Affiliation(s)
- Miyuki Natsume
- Laboratory of Intracellular Traffic & Oncology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Applied Chemistry
| | - Mariko Niwa
- Laboratory of Intracellular Traffic & Oncology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Chemistry, Faculty of Science, Tokyo University of Science, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Sho Ichikawa
- Laboratory of Intracellular Traffic & Oncology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Applied Chemistry
| | - Takuma Okamoto
- Laboratory of Intracellular Traffic & Oncology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Applied Chemistry
| | | | | | | | - Ryo Abe
- Tokyo University of Science, Noda Chiba 278-8510, Japan
| | - Motoyuki Shimonaka
- Department of Chemistry, Faculty of Science, Tokyo University of Science, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Toshirou Nishida
- National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Laboratory of Nuclear Transport Dynamics, National Institutes of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka 567-0085, Japan
| | | | - Yuuki Obata
- Laboratory of Intracellular Traffic & Oncology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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2
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Murata T, Tsutsui H, Yoshida T, Kubota H, Hiraishi S, Natsukawa H, Suzuki Y, Hiraga D, Mori T, Maekawa Y, Tateyama S, Toyoyama K, Ito K, Suzuki K, Yonekura K, Shibata N, Sato T, Tasaki Y, Inohana T, Takano A, Egashira N, Honda M, Umezaki Y, Shiina I. Correction to "First Total Synthesis of Tanzawaic Acid B". ACS Omega 2023; 8:30789. [PMID: 37636937 PMCID: PMC10448632 DOI: 10.1021/acsomega.3c05579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Indexed: 08/29/2023]
Abstract
[This corrects the article DOI: 10.1021/acsomega.3c03634.].
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3
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Murata T, Tsutsui H, Yoshida T, Kubota H, Hiraishi S, Natsukawa H, Suzuki Y, Hiraga D, Mori T, Maekawa Y, Tateyama S, Toyoyama K, Ito K, Suzuki K, Yonekura K, Shibata N, Sato T, Tasaki Y, Inohana T, Takano A, Egashira N, Honda M, Umezaki Y, Shiina I. First Total Synthesis of Tanzawaic Acid B. ACS Omega 2023; 8:27703-27709. [PMID: 37546667 PMCID: PMC10399178 DOI: 10.1021/acsomega.3c03634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023]
Abstract
The first total synthesis of (+)-tanzawaic acid B, a natural polyketide bearing a pentadienoic ester and octalin moiety, has been accomplished. The synthetic improvement from previous synthetic conditions facilitated our gram-scale synthesis of the chiral octalin that possesses seven stereogenic centers and that is the core skeleton of almost all of the tanzawaic acid family.
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Affiliation(s)
- Takatsugu Murata
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Hisazumi Tsutsui
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Takumi Yoshida
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Hirokazu Kubota
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Shintaro Hiraishi
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Hiyo Natsukawa
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Yuki Suzuki
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Daiki Hiraga
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Takahiro Mori
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Yutaro Maekawa
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Satoru Tateyama
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Kiyotaka Toyoyama
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Keiichi Ito
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Kyohei Suzuki
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Keita Yonekura
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Natsumi Shibata
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Teruyuki Sato
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Yasutaka Tasaki
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Takehiko Inohana
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Atsuhiro Takano
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Naoki Egashira
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Masaki Honda
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Yuma Umezaki
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
| | - Isamu Shiina
- Department of Applied Chemistry,
Faculty of Science, Tokyo University of
Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601, Japan
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4
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Tsutsui H, Lam CSP, Zhang J, Godoy-Palomino A, Tziakas D, Cohen-Solal A, Freitas C, Patel MJ, Ezekowitz JA, Hernandez AF, Pieske B, O'Connor CM, Westerhout CM, Alemayehu W, Armstrong PW. Geographic variation in heart failure with reduced ejection fraction: insights from the VICTORIA trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Geographic differences and background therapy have not been explored in the global VICTORIA trial, which enrolled high-risk patients with recent worsening heart failure with reduced ejection fraction (HFrEF).
Methods and results
Among 5050 patients enrolled in 5 pre-specified geographic regions, 34% were from Eastern Europe, 18% Western Europe, 23% Asia Pacific, 14% Latin and South America, and 11% North America (Table 1). Patients from Western Europe were older, had more atrial fibrillation, and lower glomerular filtration rates. Patients from Eastern Europe had more coronary artery disease and exhibited more advanced symptoms (∼50% New York Heart Association [NYHA] class III), whereas those from Latin and South America were less symptomatic (∼70% NYHA class II). North American patients had the largest body mass index as well as more diabetes and hypertension. Levels of NT-proBNP at randomization and MAGGIC risk scores were highest in Western European patients. Evidence-based triple medication therapy was used most frequently in Latin and South America and less frequently in North America; conversely, cardiac resynchronization therapy and implantable cardioverter defibrillators were most frequently used in North America and least frequently in Latin and South America. The overall primary composite event rate (cardiovascular death or HF hospitalization) in the placebo arm was 36.6/100 person-years over a median of 10.8 months and after adjusting for the MAGGIC score. When examined by region, these event rates were nominally highest in North America and lowest in Western Europe.
Conclusion
Substantial regional differences exist in characteristics and treatments among patients in this global trial of patients with HFrEF and a recent worsening event. These findings demonstrate the continuing unmet needs and opportunities for enhancing care in HFrEF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): VICTORIA was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
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Affiliation(s)
- H Tsutsui
- Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - C S P Lam
- National Heart Centre Singapore, Duke-NUS , Singapore , Singapore
| | - J Zhang
- Fuwai Hospital Chinese Academy of Medical Sciences , Beijing , China
| | | | - D Tziakas
- Democritus University of Thrace , Alexandroupolis , Greece
| | | | | | - M J Patel
- Merck & Co., Inc. , Kenilworth , United States of America
| | - J A Ezekowitz
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine , Durham , United States of America
| | - B Pieske
- Charité - University Medicine Berlin , Berlin , Germany
| | - C M O'Connor
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - C M Westerhout
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - W Alemayehu
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
| | - P W Armstrong
- University of Alberta, Canadian VIGOUR Centre , Edmonton , Canada
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5
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Hiasa K, Ikeda S, Tsutsui H. Echocardiographic parameters of left atrial structure and function in elderly patients with atrial fibrillation, and clinical outcomes at 2 years: the ANAFIE echocardiographic substudy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have shown an association between echocardiographic parameters of cardiac structure and function and prognosis in patients with atrial fibrillation (AF). However, only limited data are available for elderly patients (age, ≥75 years).
Purpose
The All Nippon Atrial Fibrillation In the Elderly (ANAFIE) Registry (UMIN000024006) was a prospective, multicenter, observational study which collected real-world data on the clinical status and prognosis of 33,062 Japanese patients aged ≥75 years and with non-valvular AF (NVAF). A prospective substudy of 1,474 patients who underwent transthoracic echocardiography at baseline was conducted to investigate relations between echocardiographic parameters of left atrial structure and function and clinical outcomes at 2 years.
Methods
Cumulative incidences and adjusted hazard ratios (HRs) of clinical outcomes were calculated using Kaplan–Meier analysis and the Cox proportional-hazards model, respectively. The data were analysed by left atrial volume index (LAVi) category, left atrial emptying fraction (LAEF) category, and direct oral anticoagulant (DOAC) use vs warfarin (WF) use. Cardiovascular (CV) events was a composite of stroke, myocardial infarction (MI), cardiac interventions, heart failure (HF) hospitalization, CV death. Cardiac events was a composite of MI, cardiac intervention, HF hospitalization, and CV death.
Results
Baseline characteristics were mean age of 80.7 years; male, 59.2%; paroxysmal AF, 45.9%; mean CHA2DS2-VASc score, 4.3; mean HAS-BLED score, 1.9; median LAVi, 48.7 mL/m2; median LAEF, 26.6%; comorbidity or history of HF, 32.2%; oral anticoagulant use, 92.7%; DOAC use, 68.7%; and WF use, 24.0%. Incidences (/100 patient-years) and HRs (95% CIs) for each clinical outcome according to LAVi and LAEF category are summarized in Table. Compared with patients with LAEF >45.0% (n=224), those with LAEF ≤45.0% (n=1,213) were at higher risk of CV events (2.19 [1.13–4.27], p=0.021) and HF hospitalization (2.25 [1.02–4.96], p=0.045). Risk of all-cause death was higher in patients with LAVi >48.0 mL/m2 (n=656) than in those with LAVi ≤48.0 mL/m2 (n=621) (1.69 [1.00–2.83], p=0.048). In the subgroups with LAEF ≤45.0% or LAVi >48.0 mL/m2, patients receiving a DOAC had significantly lower risk of cardiac events, CV events, and HF hospitalization than patients receiving warfarin.
Conclusion
In elderly Japanese patients with NVAF, those with LAEF ≤45.0% are at higher risk of CV events and HF hospitalization, and those with LAVi >48.0 mL/m2 are at higher risk of all-cause death. Thus, the higher risk differs between patients with LAEF ≤45.0% and those with LAVi >48.0 mL/m2.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.
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Affiliation(s)
- K Hiasa
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine , Fukuoka , Japan
| | - S Ikeda
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine , Fukuoka , Japan
| | - H Tsutsui
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine , Fukuoka , Japan
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6
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Oba Y, Kohro T, Sato H, Nochioka K, Nakayama M, Fujita H, Mizuno Y, Kiyosue A, Iwanaga Y, Miyamoto Y, Matoba T, Tsutsui H, Nakamura T, Usuku K, Nagai R. The relationships among the pulse rate, use of beta-blockers, and prognosis in patients with ischemic heart disease in a real-world database using a storage system. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of β-blockers has the effect of improving the prognosis of patients with ischemic heart disease (IHD). One of the underlying mechanisms is a decrease in the cardiac load due to a reduction in the heart rate.
Purpose
To clarify the relationships among the pulse rate, the use of β-blockers, and the prognosis in patients with IHD in a multicenter study using a storage system.
Methods
The Clinical Deep Data Accumulation System (CLIDAS) collects (1) basic patient information, prescriptions, and laboratory data from electronic medical records from the Standardized Structured Medical Information eXchange (SS-MIX2) standard storage, and (2) the results of physiological tests, cardiac catheterization, and cardiac catheter intervention reports from the SS-MIX2 extended storage. 8540 cases who underwent cardiac catheterization from 6 university hospitals and the national cardiovascular center in Japan were registered (male: 77%, average age: 70.2 years). We evaluated these patients' pulse rate at admission and at the discharge of cardiac catheterization in 6,598 patients. We divided the pulse rates at discharge into quartiles (Q1: <60, Q2: 60–66, Q3: 67–75, Q4: ≥76 bpm), and we analyzed the relationship between the pulse rate and the prognosis by dividing the patients into the stable angina group (n=2,631) and the acute coronary syndrome (ACS) group (n=2,394). Regarding the use of β-blockers, we compared the pulse rates of the patients taking carvedilol (n=1,728) and those taking bisoprolol (n=2,761) at admission and discharge. Major adverse cardiovascular events (MACE) were defined as cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other hospitalized cardiovascular events.
Results
A total of 600 MACEs occurred during an average observation period of 890 days. The incidence of cardiovascular events was significantly higher in the Q4 patients in the stable angina group (hazard ratio 1.79, 95% confidence interval 1.32–2.41, but there was no significant difference among the four pulse rate subgroups in the ACS group. The bisoprolol-treated patients had lower pulse rates at discharge (67.4±12.2 vs. 68.8±11.8 bpm, p<0.001) and a lower percentage of patients in the Q4 group (21.2 vs. 24.9%, p=0.005) compared to the carvedilol-treated patients. The pulse rate at admission was similar in the bisoprolol- and carvedilol-treated patients (74.3±19.3 vs. 73.2±29.5 bpm, p=0.328).
Conclusion
In a real-world database using a storage system, a pulse rate of ≤75 bpm was associated with a good prognosis in patients with ACS. Compared to carvedilol, bisoprolol was associated with a decreased pulse rate at discharge.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Kowa Company, Ltd.
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Affiliation(s)
- Y Oba
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| | - T Kohro
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| | - H Sato
- Precision Inc., Tokyo, Japan
| | | | | | - H Fujita
- Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Y Mizuno
- University of Tokyo, Tokyo, Japan
| | | | - Y Iwanaga
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - T Matoba
- Kyushu University, Fukuoka, Japan
| | | | | | - K Usuku
- Kumamoto University, Kumamoto, Japan
| | - R Nagai
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
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7
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Ikeda S, Hiasa K, Tsutsui H. Real-world clinical outcomes and anticoagulant therapy in elderly non-valvular atrial fibrillation patients with heart failure: sub-analysis of the ANAFIE Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) and heart failure (HF) are bidirectionally correlated; the more severe the NYHA classification, the higher the incidence rate of atrial fibrillation, and vice versa. HF is included in the items of CHA2DS2-VASc score used to calculate stroke risk in patients with AF, and is itself a risk factor for thromboembolism in such patients. Anticoagulant management in AF patients with HF is thus a key concern that remains to be sufficiently examined, especially in elderly patients aged ≥75 y.
Purpose
The All Nippon Atrial Fibrillation In the Elderly (ANAFIE) Registry enrolled more than 30,000 elderly (≥75 y) patients with non-valvular AF (NVAF), aiming to produce real-world data on their clinical status and prognosis. This sub-analysis of the ANAFIE Registry assessed the 2-year outcomes and status of anticoagulant treatment in elderly NVAF patients with HF.
Methods
A total of 32,275 patients from the ANAFIE Registry were divided into two groups according to whether they had HF (HF group and reference group). The incidence rates and adjusted hazard ratios (HR) of clinical outcomes were determined using Kaplan-Meier analysis and the Cox proportional-hazards model, respectively.
Results
A total of 20,159 (62.5%) patients were included in the reference group, and 12,116 (37.5%) in the HF group. Compared with the reference group, the HF group had higher mean age (82.4 vs 80.9 y), female ratio (46.6% vs 40.4%), non-paroxysmal AF (69.8% vs 50.8%), and had lower mean CrCL (43.3 vs 51.6 mL/min). In the HF group, the rate control drugs were frequently used (50.1% vs 35.8%), and the rhythm control drugs were less used (14.2% vs 22.7%) than in the reference group. More patients in the HF group were using anticoagulants (93.9% vs 91.6%; warfarin (WF), 29.6% vs 23.0%; direct oral anticoagulants (DOAC), 64.2% vs 68.5%) than those in the reference group. The HF group had a numerically higher incidence of stroke or systemic embolic events (SEE) (3.28% vs 2.84%, HR 0.96, p=0.558) and major bleeding (2.35% vs 1.79%, HR 1.14, p=0.130) than the reference group, but the differences were not statistically significant. The HF group had a significantly higher incidence rate of HF requiring hospitalization (12.99% vs 4.59%, HR 1.94, p<0.001) and all-cause mortality (9.83% vs 5.21%, HR 1.32, p<0.001). In the HF group, patients receiving DOAC had significantly lower incidence rates for major bleeding, HF requiring hospitalization, and all-cause mortality than those receiving WF, while there was no difference for stroke/SEE between both groups.
Conclusions
Elderly NVAF patients with HF had higher risk of HF requiring hospitalization and mortality than those without. Differences were seen in the incidence rates of major bleeding, HF requiring hospitalization, and all-cause mortality between patients on DOAC and those on WF. This study will explore relevant factors affecting clinical outcomes in elderly NVAF patients with HF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.
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Affiliation(s)
- S Ikeda
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Hiasa
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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8
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Matoba T, Fujita H, Kohro T, Kabutoya T, Kiyosue A, Mizuno Y, Nakayama M, Nochioka K, Miyamoto Y, Iwanaga Y, Tsujita K, Nakamura T, Sato H, Tsutsui H, Nagai R. Clinical Deep Data Accumulation System (CLIDAS) reveals lipid paradox in guideline-defined high risk Japanese patients after PCI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Japanese clinical guidelines recommend a stratification of the risks and LDL-cholesterol (LDL-C) treatment goals for patients with coronary artery disease after percutaneous coronary intervention (PCI), i.e. <100 mg/dL for normal risk patients and <70 mg/dL for high risk patients; however, less is known about the association between baseline LDL-C values and long-term prognosis.
Purpose
To investigate the association between LDL-C goals and baseline LDL-C levels in relation to major adverse cardiovascular events (MACE) among high-risk patients after PCI, using a real-world database.
Methods
We developed the Clinical Deep Data Accumulation System (CLIDAS) that acquires clinical data directly from hospital information system, and implemented the system in 6 university hospitals and the national cardiovascular center in Japan. The CLIDAS database accumulates data regarding patient background, laboratory data, prescriptions, electrocardiogram, echocardiogram, PCI report, and long-term prognosis. We retrospectively analyzed 8540 consecutive patients who underwent PCI during April 2014 and March 2020 in participating hospitals, and classified them into the normal risk group (n=3712, 43%) and the high risk group [n=4828, 57%, with any of acute coronary syndrome (ACS), familial hypercholesterolemia (FH), or diabetes with additional risk factor(s)], for which LDL-C goals are <100 mg/dL and <70 mg/dL, respectively, according to the Japanese Atherosclerosis Society guidelines or the diagnosis and prevention of atherosclerotic cardiovascular diseases. The primary outcome was the time to first occurrence of MACE, a composite of cardiovascular death, stroke, myocardial infarction, and coronary revascularization in associations with baseline LDL-C levels and patient background.
Results
Proportion of male (77% vs. 77%) and age (71±11 vs. 70±11) were similar between 2 groups. The prevalence of ACS at the index PCI (0% vs. 62%), FH (0% vs. 2%), hypertension (61% vs. 86%), diabetes (11% vs. 67%), dyslipidemia (73% vs. 84%), hemodialysis (4% vs. 9%), peripheral artery disease (5% vs. 9%), smoking (16% vs. 30%), and prescription of statins (79% vs. 86%) were significantly higher in the high risk group. Among patients in the high risk group, but not in the normal risk group, baseline LDL-C <70 mg/dL was paradoxically associated with higher risk of MACE (P<0.0001 by Log-rank test) (Figure). The Cox proportional hazard model confirmed that the high risk group (risk ratio 1.54, 95% CI [1.31–1.81]), baseline LDL-C <70mg/dL (risk ratio 1.44, 95% CI [1.18–1.75]), baseline age (risk ratio 1.36, 95% CI [1.28–1.45] per 10 year), and prescription of statins (risk ratio 0.80, 95% CI [0.66–0.96]) were significantly associated with the risk of MACE in this population.
Conclusion
The CLIDAS real-world database revealed that baseline low LDL-C paradoxically associated with an increased risk of MACE among guideline-defined high risk patients after PCI.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jichi Medical University, Tochigi, Japan, and Kowa
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Affiliation(s)
- T Matoba
- Kyushu University, Cardiovascular Medicine, Fukuoka, Japan
| | - H Fujita
- Jichi Medical University Saitama Medical Center, Cardiology, Saitama, Japan
| | - T Kohro
- Jichi Medical University, Medical Informatics, Tochigi, Japan
| | - T Kabutoya
- Jichi Medical University, Cardiology, Tochigi, Japan
| | - A Kiyosue
- University of Tokyo Hospital, Cardiology, Tokyo, Japan
| | - Y Mizuno
- University of Tokyo Hospital, Cardiology, Tokyo, Japan
| | - M Nakayama
- Tohoku University Graduate School of Medicine, Medical Informatics, Sendai, Japan
| | - K Nochioka
- Tohoku University Graduate School of Medicine, Medical Informatics, Sendai, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Cerebral and Cardiovascular Disease Information, Osaka, Japan
| | - Y Iwanaga
- National Cerebral and Cardiovascular Center Hospital, Cerebral and Cardiovascular Disease Information, Osaka, Japan
| | - K Tsujita
- Kumamoto University Hospital, Cardiovascular Center, Kumamoto, Japan
| | - T Nakamura
- Kumamoto University Hospital, Medical Informatics, Kumamoto, Japan
| | | | - H Tsutsui
- Kyushu University, Cardiovascular Medicine, Fukuoka, Japan
| | - R Nagai
- Jichi Medical University, Tochigi, Japan
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9
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Enzan N, Matsushima S, Ide T, Tohyama T, Funakoshi K, Higo T, Tsutsui H. The use of angiotensin receptor blockers is associated with greater recovery of cardiac function than angiotensin-converting-enzyme inhibitors among patients with dilated cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
We previously showed that angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) were associated with heart failure with recovered ejection fraction (HFrecEF) in patients with dilated cardiomyopathy (DCM). However, the different effects of these drugs on cardiac reverse remodeling have not been fully elucidated. The aim of this study was to assess comparative effectiveness of ACEi versus ARB on recovery of left ventricular ejection fraction (LVEF) among patients with DCM.
Methods
We analyzed the clinical personal records of DCM, a national database of Japanese Ministry of Health, Labour and Welfare, from 2003 to 2014. Patients with LVEF <40% and on either ACEi or ARB were included. Eligible patients were divided into two groups according to the use of ACEi or ARB. A one-to-one propensity case-matched analysis was used. A propensity score was estimated by fitting a logistic-regression model which adjusted for age, sex, duration of HF, NYHA functional class (I-II vs. III-IV), systolic blood pressure, diastolic blood pressure, heart rate, atrial fibrillation, pacing, left bundle branch block, LVEF, hypertension, diabetes mellitus, hyperuricemia, chronic kidney disease, B-type natriuretic peptide (BNP), beta-blockers, mineralocorticoid receptor antagonists, loop diuretics, thiazides, digitalis, amiodarone, and oral inotropes. The primary outcome was defined as LVEF ≥40% at 3 years of follow-up.
Results
Out of 4,618 eligible patients, 2,238 patients received ACEi and 2,380 patients received ARB. Propensity score matching yielded 1,341 pairs. Mean age was 56.0 years and 2,041 (76.1%) was male. Mean LVEF was 27.6%, and median duration of HF was 1 year. The primary outcome was observed more frequently in ARB group than in ACEi group (59.8% vs. 54.1%; odds ratio [OR] 1.26; 95% confidence interval [CI] 1.08–1.47; P=0.003). The change in LVEF from baseline to 3 years of follow-up was greater in ARB group than in ACEi group (15.8±0.4 vs. 14.0±0.4%, P=0.002). In the ACEi group, 946 patients (70.6%) continued to receive ACEi at 3 years of follow-up, while 1,088 patients (81.3%) continued to receive ARB in the ARB group. Per-protocol analysis consistently showed that ARB increased the prevalence of HFrecEF (62.0% vs. 54.0%; OR 1.39; 95% CI 1.17–1.66; P<0.001). Subgroup analysis showed that ARB increased frequency of HFrecEF regardless systolic blood pressure, heart rate, LVEF, chronic kidney disease, and concomitant use of beta-blockers and mineralocorticoid receptor antagonists.
Conclusions
The use of ARB was associated with HFrecEF more frequently than ACEi among patients with DCM and reduced LVEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Sciences Research Grants from the Japanese Ministry of Health, Labour and Welfare (Comprehensive Research on Cardiovascular Diseases)Japan Agency for Medical Research and Development (AMED) grant
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Affiliation(s)
- N Enzan
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka, Japan
| | - T Tohyama
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - K Funakoshi
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - T Higo
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
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10
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Yamamoto T, Matsushima S, Okabe K, Ikeda S, Ishikita A, Enzan N, Sada M, Tsutsui Y, Miyake R, Tsutsui H. Cyclin dependent kinase 1 (CDK1) positively regulates cardiac hypertrophy and fibrosis via TGF-beta pathway. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transforming growth factor beta (TGF-β) critically mediates cardiac fibrosis by transforming fibroblasts to myofibroblasts in pathological conditions. Cyclin dependent kinases (CDKs), cell cycle-regulating proteins, are known to be intimately involved in cardiac fibrosis. Among CDK isoforms, CDK1 is essential for cell cycle progression and cell division. It is reported some interphase CDKs such as CDK4 or CDK6 were involved in cardiac fibrosis, however, detailed mechanisms of cardiac fibrosis through CDK1 and its interactions with TGF-β in cardiac fibrotic process haven't been elucidated. We hypothesize that CDK1 is involved in cardiac fibrotic process via TGF-β pathway and its suppression decreases TGF-β expression and transformation to myofibroblasts from fibroblasts presenting antifibrotic effect.
Methods and results
Isolated neonatal rat cardiac fibroblasts were treated with angiotensin II (ANG II, 1 μM, 24 h) or phosphate-buffered saline (PBS). ANG II increased CDK1 and TGF-β in cardiac fibroblasts, by 97% and 292%, respectively (p<0.05). Administration of Ro-3306, a specific CDK1 inhibitor (1 μM, 24 h), suppressed TGF-β protein levels in ANG II-treated cardiac fibroblasts by 58% (p<0.05). Similarly, knockdown of CDK1 by RNA silencing also inhibited ANG II-induced increases in TGF-β in cardiac fibroblasts by 39% (p<0.05). ANG II increased alpha-smooth muscle actin (α-SMA), which is a marker of myofibroblasts, and knockdown of CDK1 significantly suppressed it by 49% (p<0.05). In vivo study, 11-week-old male C57BL/6J mice were administered ANG II continuously with infusion pump, at a dose of 1000 ng/kg/min, for a week. Also, Ro-3306 was intraperitoneally injected at a dose of 2 mg/kg/day, every other day, for a week. First, Ro-3306 attenuated ANG II-mediated cardiac hypertrophy indicated by heart weight and echocardiographic parameter as to left ventricular wall thickness. Second, CDK1 and TGF-β expression were significantly augmented in ANG II-infused mice by 404% and 113%, respectively (p<0.05). Injection of Ro-3306 suppressed TGF-β protein levels by 48%, although the difference wasn't statistically significant (p=0.09). Finally, histopathological examination (Masson's trichrome stain) demonstrated remarkable repression of ANG II-induced cardiac fibrosis by Ro-3306.
Conclusions
CDK1 positively controls cardiac fibrotic process by regulating transformation to cardiac myofibroblasts from fibroblasts via TGF-β pathway. It also presents an antihypertrophic effect on ANG II stimulation. CDK1 is a potential therapeutic target of cardiac fibrosis and hypertrophy.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): KAKENHI
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Affiliation(s)
- T Yamamoto
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - K Okabe
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - S Ikeda
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - A Ishikita
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - N Enzan
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - M Sada
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Y Tsutsui
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - R Miyake
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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11
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Watanabe T, Abe K, Ishikawa M, Ishikawa T, Imakiire S, Ohtsubo T, Kaneko K, Fukuuchi T, Tsutsui H. Hyperuricemia impaired nitric oxide bioavailablity and deteriorated pulmonary arterial hypertension via a uric acid transporter, URATv1 in xanthine oxidoreductase (XOR)-independent manner. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperuricemia occurs in approximately 80% in patients with pulmonary arterial hypertension (PAH) and is positively correlated with pulmonary arterial pressure (PAP). It has been reported that uric acid (UA) reduced endothelium derived nitric oxide (NO) production in porcine pulmonary arterial endothelial cells (PAEC). However, the effects of UA and xanthine oxidoreductase (XOR), catalytic enzyme of UA, on the development of PAH have not been fully elucidated.
Purpose
We examined the followings; (1) the effects of hyperuricemia on the endothelial function and the development of PAH in rats (2) the therapeutic effects of UA transporter inhibitor on PAH in rats, and (3) the role of XOR in PAH in mice.
Methods
We used normal and 5-wk Sugen5416/Hypoxia/Normoxia-exposed (SU/Hx/Nx) rats. Gene expression levels of URATv1, a UA transporter, were measured by RT-PCR. We determined the isometric tension of PA rings isolated from normal rats. The study with the isolated perfused lung preparation was performed in SU/HX/Nx rats. To investigate the chronic effect of UA on the development of PAH, hyperuricemia was induced by the administration of 2% oxonic acid (OA) in diet for 6-wk. Benzbromarone (BBR, 10mg/kg/day, diet, from weeks 0 to 5), a URATv1 transporter inhibitor, was administered in the SU/Hx/Nx-rats with or without 2%OA. To examine the role of XOR in PAH, XOR+/− and wild type (WT) mice were exposed to 3-wk Nx or Hx (10% O2).
Results
The mRNA of URATv1 was detected in the normal lungs. Isometric tension study showed that UA (8 mg/dl) inhibited acetylcholine-induced vasorelaxation. In perfused lung preparations, UA acutely increased estimated PVR in a dose-dependent manner (1.6–16.0mg/dl) with reducing cGMP levels in the lungs. BBR significantly attenuated the pressor response to UA. UA levels in the plasma and the lung tissues were significantly elevated in SU/Hx/Nx-rats with 2%OA (normal vs. vehicle vs. 2%OA, plasma: 0.24±0.01 vs. 0.80±0.14 and 1.44±0.17 mg/dl; lung tissues: 68±3 vs. 142±3 and 377±46 pmol/g tissue). They exhibited further elevation of right ventricle systolic pressure (RVSP) (31±2 vs. 72±6 vs. 101±3 mmHg) and Ea (a marker of RV afterload) (0.24±0.04 vs. 0.97±0.15 vs. 2.36±0.49 mmHg/μL) with the exacerbation of occlusive lesions of PAs. BBR had no changes in the UA levels in the plasma (1.93±0.30 mg/dL), but significantly reduced the UA levels in the lung tissues (101±10 pmol/g tissue) and attenuated the increase in RVSP (53±8mmHg) and Ea (0.21±0.05 mmHg/mL) in the SU/Hx/Nx-rats with 2%OA. On the other hand, BBR had no effects on RVSP (76±7 mmHg) and Ea (0.91±0.15 mmHg/mL) in the SU/Hx/Nx-rats without 2%OA. There were no significant differences in RVSP between XOR+/− mice with Hx and WT with Hx (26±2 vs. 26±2 mmHg).
Conclusions
Hyperuricemia itself impairs endothelial function and deteriorates PAH via URATv1 in a XOR-independent manner. UA can be a novel therapeutic target for PAH.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Watanabe
- Kyushu University Hospital, Fukuoka, Japan
| | - K Abe
- Kyushu University Hospital, Fukuoka, Japan
| | - M Ishikawa
- Fukuoka Children's Hospital, Fukuoka, Japan
| | - T Ishikawa
- Kyushu University Hospital, Fukuoka, Japan
| | - S Imakiire
- Kyushu University Hospital, Fukuoka, Japan
| | - T Ohtsubo
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - K Kaneko
- Teikyo University, Faculty of Pharma-Science, Tokyo, Japan
| | - T Fukuuchi
- Teikyo University, Faculty of Pharma-Science, Tokyo, Japan
| | - H Tsutsui
- Kyushu University Hospital, Fukuoka, Japan
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12
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Ide T, Kaku H, Matsushima S, Tohyama T, Enzan N, Funakoshi K, Sumita Y, Nakai M, Nishimura K, Fukuda H, Hatano M, Komuro I, Tsutsui H. The nationwide registry of hospitalized heart failure patients in Japan: Japanese Registry Of Acute Decompensated Heart Failure (JROADHF). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
Heart failure (HF) is a growing healthcare problem worldwide. This study aimed to describe clinical characteristics and long-term outcomes of HF patients in Japan.
Methods and results
JROADHF (the Japanese Registry Of Acute Decompensated Heart Failure) is a retrospective, multicentre, nationwide observational database of 13,238 patients hospitalized due to HF in 128 hospitals randomly selected from Japanese Circulation Society (JCS)-certified teaching hospitals during 2013. At inclusion, demographic and clinical data were collected from medical records with linkage to a nationwide claim-based database, the Japanese Diagnosis Procedure Combination (DPC). Patients were followed up to 5 years after discharge at each participating site. Patients were old as the median age of 81 years and women were older (74.8±12.8 vs 81.6±11.1 y.o). Mean left ventricular ejection fraction (LVEF) was 47%, and 45% were HF with preserved ejection fraction of >50% (HFpEF). Causes of HF included ischemic in 27%, valvular in 19%, arrhythmia in 17%, and hypertensive in 16%. Median length of hospital stay was 18 days and in-hospital mortality was 7.7%. All-cause mortality during 1 and 4 years were 22.3% and 48.4%, respectively. Hospitalization rates due to HF within 1 and 4 years were as high as 30.5 and 48.4%, respectively.
Conclusions
Contemporary nationwide registry revealed that hospitalized HF patients were elder and had more HFpEF, and their prognosis was still poor compared to the data shown in prior registries.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development (AMED) Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus
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Affiliation(s)
- T Ide
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Kaku
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - T.I Tohyama
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - N Enzan
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - K Funakoshi
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Y Sumita
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - M Nakai
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Fukuda
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - M Hatano
- University of Tokyo, Tokyo, Japan
| | - I Komuro
- University of Tokyo, Tokyo, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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13
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Kawai S, Nagaoka K, Takase S, Sakamoto K, Ikuta H, Toyohara T, Okahara A, Tokutome M, Kuribayashi Y, Matsura H, Matsukawa R, Masuda S, Chishaki A, Tsutsui H, Mukai Y. Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established.
Methods
Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity.
Results
AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P<0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%.
Conclusions
Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF.
Extent of LVA and burst positivity
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Kawai
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - K Nagaoka
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - S Takase
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Sakamoto
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - H Ikuta
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - T Toyohara
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - A Okahara
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - M Tokutome
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - H Matsura
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - S Masuda
- Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - A Chishaki
- Kyushu University Hospital, Health Sciences, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - Y Mukai
- Fukuoka Red Cross Hospital, Fukuoka, Japan
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14
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Yagi T, Nagao K, Tachibana E, Yonemoto N, Tahara Y, Nonogi H, Ikeda T, Sato N, Tsutsui H. Assessment of the 2015 cardiopulmonary resuscitation guidelines for patients with out-of-hospital cardiac arrest: results from the All-Japan Utstein registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).
Methods
From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2015 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines or 2015 CPR guidelines. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR in this registry. Study patients were divided into five groups based on different years (figure). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, instructed by dispatcher or not, and time interval from call EMS to scene.
Results
The figure showed favorable neurological outcomes at 30 days. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in 2016 as compared to in 2011 was 1.32 (95% CI: 1.04–1.68, p=0.022). On the other hands, there were no significant differences from 2011 to 2014.
Conclusion
In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Yagi
- Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - K Nagao
- Nihon University, Tokyo, Japan
| | - E Tachibana
- Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | | | - Y Tahara
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - H Nonogi
- Shizuoka General Hospital, Shizuoka, Japan
| | - T Ikeda
- Toho University, Tokyo, Japan
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
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15
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Enzan N, Matsushima S, Ide T, Kaku H, Tohyama T, Funakoshi K, Higo T, Tsutsui H. Use of direct oral anticoagulants is associated with better long-term outcomes in patients with atrial fibrillation and heart failure as compared with vitamin K antagonists. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Direct oral anticoagulants (DOACs) have been shown to be safe and effective in patients with atrial fibrillation (AF) as compared with warfarin, a vitamin K antagonist. However, the safety and efficacy of DOACs in patients with AF and heart failure (HF) have been unclear.
Purpose
The purpose of this study was to determine whether DOACs can improve long-term outcomes in patients with AF and HF as compared with warfarin.
Methods
We analyzed the JROADHF registry, which was a multicenter registry of patients hospitalized for the worsening HF in Japan. Baseline data were collected during the episode of index hospitalization from April 2013 to March 2014. Follow-up data were collected up to 4.5 years after the index hospitalization. Patients with AF and creatinine clearance ≥15 ml/min/1.73m2 were included. Valvular heart disease, congenital heart disease, and constrictive pericarditis were excluded. Eligible patients were divided into two groups according to the use of warfarin or DOACs. The primary outcome was defined as all-cause death. The secondary outcomes were defined as cardiovascular death, composite of all-cause death or cardiovascular hospitalization, and composite of stroke death or stroke related hospitalization. A one to one propensity case-matched analysis was used. Complete case analysis and multiple imputation analysis were also conducted as sensitivity analyses.
Results
Out of the 14,847 patients in this registry, 2,175 had AF, creatinine clearance ≥15 ml/min/1.73m2 and discharged alive. Propensity score matching yielded 475 pairs. In matching cohort, mean age was 76.5 years and 513 (54.0%) was male. Mean left ventricular ejection fraction was 48.6±16.4%. During a mean follow-up of 3.2 years, patients with DOACs had a lower incidence rate of all-cause death than those with warfarin (75.2 vs. 99.9 death per 1000 patient-years; rate ratio (RR) 0.75; 95% confidence interval [CI] 0.59–0.96; P=0.022). The incidence of cardiovascular death tended to be lower in DOAC group (30.9 vs. 43.1; incidence rate ratio 0.72; 95% CI 0.49–1.04; P=0.081). There were no significant differences in the incidence of composite of all cause death or cardiovascular hospitalization (252.3 vs. 269.4; RR 0.94; 95% CI 0.79–1.11; P=0.45) or composite of stroke death or stroke related hospitalization (13.1 vs. 16.7; RR 0.79; 95% CI 0.39–1.59; P=0.50). Cox regression model showed that DOAC was associated with lower mortality than warfarin (hazard ratio (HR) 0.75; 95% CI 0.59–0.96; P=0.023). Complete case analysis (HR 0.78; 95% CI 0.63–0.98; P=0.035) and multiple imputation analysis (HR 0.78; 95% CI 0.68–0.84; P<0.001) also showed the same results. A restricted cubic spline analysis demonstrated that the effectiveness of DOACs over warfarin waned with age, and DOACs were effective in patients younger than 80 years old.
Conclusion
Use of DOACs was associated with better long-term outcome in patients with HF as compared with warfarin.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development
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Affiliation(s)
- N Enzan
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Kaku
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - T Tohyama
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - K Funakoshi
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - T Higo
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
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Tohyama T, Funakoshi K, Kaku H, Enzan N, Ikeda M, Matsushima S, Ide T, Todaka K, Tsutsui H. Artificial intelligence-based analysis of payment system data can predict one-year mortality of hospitalized patients with heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Individual risk stratification is fundamental in the care of heart failure (HF) patients. However, the prediction performance of risk scores, such as MAGGIC and SHFM, is not adequate and, more importantly, they need additional predictors including various biomarkers, imaging data, and environmental factors. Data from a case-mix payment system including diagnosis and procedures with outcomes can be used to develop the risk prediction models, allowing the use of big data for a more accurate prediction of mortality.
Purpose
This study aimed to develop artificial intelligence (AI) models for predicting 1-year mortality in patients hospitalized due to HF.
Methods
We analyzed the data from 10175 patients enrolled in the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF). Candidate variables included the data obtained from a payment system introduced by the Japanese government, the Diagnosis Procedure Combination (DPC), which included each patient profile (age, sex, height, weight), principal diagnosis for hospitalization, comorbidities, procedures, length of hospital stay, and discharge status. They did not include clinical data available from patients such as vital status, laboratory data including bio-makers, electrocardiographic and echocardiographic data. The collected data were divided into the training set and the validation set (80%: 20%). With the training set, 5 AI models (logistic regression, random forest, support vector machine, neural network, and ensemble classifier) learned the one-year mortality results. AI models were evaluated by using the validation set with ROC analysis. The training and validation steps were repeated 10 times with different seed values to calculate the C-statistic of each model. We also identified the predictors for one-year prognosis acquired from the AI models.
Results
At 1-year of follow-up, a total of 1727 patients had died (17%). Among the machine learning models, the ensemble classifier showed the highest C-statistic of 0.76 (95% confidence interval: 0.75 to 0.77) for predicting mortality. Top predictors acquired from the random forest classifier was ADL (Barthel Index) at discharge, age, body mass index, and length of hospital stay.
Conclusion
By using AI-based analysis of a national case-mix payment system data, the present risk stratification model could predict the one-year mortality of hospitalized HF patients without any quantitative laboratory and physiological data. Furthermore, the present results could emphasize the advantage of this approach using the claim-based data that are routinely collected in a usual daily practice with no need to collect any additional information.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development
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Affiliation(s)
- T Tohyama
- Kyushu University Hospital, Fukuoka, Japan
| | | | - H Kaku
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | - N Enzan
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | - M Ikeda
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | | | - T Ide
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | - K Todaka
- Kyushu University Hospital, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
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Enzan N, Matsushima S, Ide T, Kaku H, Higo T, Tsutsui H. Beta-blocker use is associated with prevention of left ventricular remodeling in recovered dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Withdrawal of optimal medical therapy has been reported to relapse cardiac dysfunction in patients with dilated cardiomyopathy (DCM) whose cardiac function had improved. However, it is unknown whether beta-blockers can prevent deterioration of cardiac function in those patients.
Purpose
We examined the effect of beta-blockers on left ventricular ejection fraction (LVEF) in recovered DCM.
Methods
We analyzed the clinical personal records of DCM, a national database of Japanese Ministry of Health, Labor and Welfare, between 2003 and 2014. Recovered DCM was defined as a previously documented LVEF <40% and a current LVEF ≥40%. Patients with recovered DCM were divided into two groups according to the use of beta-blockers. The primary outcome was defined as a decrease in LVEF >10% at two years of follow-up. A one to one propensity case-matched analysis was used. A per-protocol analysis was also performed. Considering intra- and inter-observer variability of echocardiographic evaluations, we also examined outcomes by multivariable logistic regression model after changing the inclusion criteria as follows; (1) previous LVEF <40% and current LVEF ≥40%; (2) previous LVEF <35% and current LVEF ≥40%; (3) previous LVEF <30% and current LVEF ≥40%; (4) previous LVEF <40% and current LVEF ≥50%. Outcomes were also changed as (1) decrease in LVEF ≥5% (2) decrease in LVEF ≥10% (3) decrease in LVEF ≥15%. The analysis of outcomes by using combination of multiple imputation and inverse probability of treatment weighting was also conducted to assess the effects of missing data and selection bias attributable to propensity score matching on outcomes.
Results
From 2003 to 2014, 40,794 consecutive patients with DCM were screened. Out of 5,338 eligible patients, 4,078 received beta-blockers. Propensity score matching yielded 998 pairs. Mean age was 61.7 years and 1,497 (75.0%) was male. Mean LVEF was 49.1±8.1%. The primary outcome was observed less frequently in beta-blocker group than in no beta-blocker group (18.0% vs. 23.5%; odds ratio [OR] 0.72; 95% confidence interval [CI] 0.58–0.89; P=0.003). The prevalence of increases in LVDd (11.5% vs. 15.8%; OR 0.70; 95% CI 0.54–0.91; P=0.007) and LVDs (23.1% vs. 27.2%; OR 0.80; 95% CI 0.65–0.99; P=0.041) was also lower in the beta-blocker group. Similar results were obtained in per-protocol analysis. These results were robust to several sensitivity analyses. As a result of preventing a decrease in LVEF, the deterioration to HFrEF was also prevented by the use of beta-blocker (23.6% vs. 30.6%). Subgroup analysis demonstrated that beta-blocker prevented decrease in LVEF regardless of atrial fibrillation.
Conclusion
Use of beta-blocker was associated with prevention of decrease in left ventricular ejection fraction in patients with recovered DCM.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Health Sciences Research Grants from the Japanese Ministry of Health, Labour and Welfare (Comprehensive Research on Cardiovascular Diseases)
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Affiliation(s)
- N Enzan
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Kaku
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - T Higo
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
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18
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Ikeda S, Matsushima S, Okabe K, Ishikita A, Tadokoro T, Enzan N, Yamamoto T, Sada M, Deguchi H, Ikeda M, Ide T, Tsutsui H. P6283Downregulation of Tim44 exacerbates oxidative stress-induced ROS production and cardiomyocytes death by reducing mitochondrial SOD2. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mitochondrial dysfunction has been highlighted as a critical driver of cardiac remodeling and failure. Mitochondria contains about 1500 proteins, 99% of which are encoded in the nuclear genome. Therefore, protein import into mitochondria is essential to maintain mitochondrial function. Previous reports suggest that nuclear-encoded mitochondrial precursor proteins import into mitochondria by multiple complex; translocase of outer membrane (TOM), translocase of inner membrane (TIM), and protein associated motor (PAM). However, the role of these protein import machineries of mitochondria in cardiac remodeling remains to be elucidated.
Objective
The purpose of this study was to elucidate the role of TOM, TIM, and PAM complex in cardiac remodeling and cardiomyocyte death.
Methods and results
C57BL/6J mice were subjected to myocardial infarction (MI) by permanent ligation of left anterior descending artery. Four weeks after operation, MI-mice demonstrated left ventricular (LV) dilation (LV end-diastolic dimension: 3.91 vs. 5.54 mm, n=8–11, p<0.05) and dysfunction (LV fractional shortening: 33.3 vs. 7.7%, n=8–11, p<0.05). Tim44 protein levels, a component of PAM complex, in mitochondrial fraction from non-infarcted left ventricle were significantly decreased compared with those in the heart from sham-operated mice by 39% (p<0.05), whereas other proteins related to TOM, TIM and PAM complex such as Tom20, Tom22, Tom40, Tom70, Tim22, Tim23 and mtHSP70 were not altered between MI-mice and sham-mice. In addition, blue-native polyacrylamide gel electrophoresis revealed that a protein complex associated to Tim44 was significantly decreased in non-infarcted LV by 40% (p<0.05). Superoxide dismutase 2 (SOD2), a mitochondrial matrix protein, was decreased in mitochondrial fraction from non-infarcted LV by 20% (p<0.05), accompanied by enhancing protein carbonylation, a marker of oxidative stress, by 40% (p<0.05). To assess the role of Tim44, it was downregulated by small interfering RNA in cultured neonatal rat ventricular myocytes (NRVMs). Knockdown of Tim44 significantly decreased SOD2 protein levels in mitochondrial fractionation (22%, p<0.05), with no significant changes in its mRNA levels. Furthermore, knockdown of Tim44 significantly increased protein carbonylation (20%, p<0.05) and cleaved caspase 3 (47%, p<0.05) and decreased cell viability (69%, p<0.05), assessed by cell titer assay, in H2O2-treatred NRVMs.
Conclusions
Downregulation of Tim44 exacerbates oxidative stress-induced ROS production and cardiomyocytes death, which is associated with a decrease in mitochondrial SOD2. Endogenous Tim44 might play a protective role in cardiac remodeling by attenuating oxidative stress and cardiomyocyte death via SOD2 import into mitochondria.
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Affiliation(s)
- S Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular medicine, Fukuoka, Japan
| | - K Okabe
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - A Ishikita
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - N Enzan
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - T Yamamoto
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - M Sada
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - H Deguchi
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Faculty of Medical Sciences, Department of Experimental and Clinical Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
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19
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Ishikita A, Matsushima S, Ikeda S, Okabe K, Tadokoro T, Enzan N, Yamamoto T, Sada M, Deguchi H, Ikeda M, Ide T, Tsutsui H. P1606Glutamine-fructose-6-phosphate amidotransferase 2 mediates isoproterenol-induced cardiac hypertrophy by increasing Akt O-GlcNAcylation through hexosamine biosynthesis pathway. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac hypertrophy is an independent risk factor for heart failure and cardiac death. Hexosamine biosynthesis pathway (HBP), an accessory pathways of glycolysis, is known to be involved in the attachment of O-linked N-acetylglucosamine motif (O-GlcNAcylation) to proteins, a post-translational modification. However, the role of HBP has not been determined in pathological cardiac hypertrophy.
Purpose
The purpose of this study to examine whether glutamine-fructose-6-phosphate amidotransferase 2 (GFAT2), a critical enzyme of HBP, mediates cardiac hypertrophy by protein O-GlcNAcylation and activating hypertrophic signaling in cardiomyocytes.
Methods and results
C57BL/6J mice were treated with isoproterenol (ISO: 15 mg/kg/day, 1 week) with or without 6-Diazo-5-oxo-L-norleucine (DON, an inhibitor of GFAT: 500 μg/kg/day, 1week). ISO-treated mice (ISO+vehicle) showed cardiac hypertrophy, which were attenuated in ISO and DON-treated mice (ISO+DON) (heart weight to tibial length ratio: 7.70±0.09 vs. 7.11±0.15 mg/mm, n=12, p<0.05, left ventricular wall thickness: 1.05±0.02 vs. 0.86±0.03 mm, n=6, p<0.05). Cardiomyocyte cross-sectional area was also decreased in ISO+DON compared with ISO+vehicle (309±25 vs. 252±13 mm2, n=,3 p<0.05). Whereas expression levels of GFAT2 and protein O-GlcNAcylation in the heart were increased in ISO+vehicle compared with control+vehicle by 3.3 and 1.5 folds, respectively (n=9 and n=9, p<0.05), expression levels of O-GlcNAc transferase (OGT) and the β-N-acetylglucosaminidase (OGA), other enzymes regulating O-GlcNAcylation, were not altered in both groups, indicating that ISO activated HBP by GFAT2. Protein O-GlcNAcylation in ISO+DON was lower than that in ISO+vehicle by 83% (n=9, p<0.05). In addition, phosphorylation of Akt, a critical mediator of cardiac hypertrophy, but not other mediators of cardiac hypertrophy such as ERK, JNK, or p38MAPK, was significantly decreased in ISO+DON by 76% (n=9, p<0.05). In cultured neonatal rat ventricular myocytes, treatment with ISO (1μM, 12h) increased the expression levels of GFAT2 and protein O-GlcNAcylation by 1.3 and 1.5 folds, respectively (n=6 and n=6, p<0.05), but not GFAT1. Furthermore, ISO stimulation increased a direct O-GlcNAcylation of Akt by 1.4 folds (n=3, p<0.05). Downregulation of GFAT2 by RNA silencing decreased cell size by 82% (n=6, p<0.05) and protein O-GlcNAcylation and phosphorylation of Akt by 76% and 54%, respectively (n=9 and n=9, p<0.05) in cardiomyocyte treated with ISO. Conversely, administration of glucosamine, a substrate of HBP, increased protein of O-GlcNAcylation and phosphorylation of Akt by 1.3 and 1.8 folds, respectively (n=6 and n=6, p<0.05).
Conclusions
GFAT2, a limiting enzyme of HBP, mediates pathological cardiac hypertrophy by Akt activation probably due to its O-GlcNAcylation. GFAT2-O-GlcNAcylation-Akt pathway might be a potential novel therapeutic target for cardiac hypertrophy.
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Affiliation(s)
- A Ishikita
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Okabe
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - N Enzan
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Yamamoto
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - M Sada
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Deguchi
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Faculty of Medical Sciences, Department of Experimental and Clinical Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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20
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Hosokawa K, Abe K, Tsutsui H. P5594Comparison of non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist on changes in pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Chronic thromboembolic pulmonary hypertension (CTEPH) requires a lifelong anticoagulation therapy. However, the efficacy or safety of non-vitamin K antagonist oral anticoagulants (NOACs) have not been established in CTEPH.
Purpose
We aimed to evaluate the effects of NOACs on the changes in pulmonary vascular resistance (PVR) and their adverse events such as bleeding and clinical worsening in CTEPH.
Methods
We retrospectively compared the changes in PVR among CTEPH patients taking vitamin-K antagonists (VKA) (n=38) and those taking NOACs (n=46) to evaluate the effectiveness of NOACs for the prophylaxis of thrombotic disease progression in CTEPH. Also, we extracted incidence of clinically relevant bleeding and clinical worsening in CTEPH as an exploratory outcome measures. Clinical worsening in CTEPH was defined as composite outcome of death from any cause, lung transplantation and worsening pulmonary hypertension that resulted in hospitalization, addition of specific drug for pulmonary hypertension, or rescue pulmonary endarterectomy or balloon pulmonary angioplasty. Clinically relevant bleeding was defined as composite major bleeding and/or clinically relevant non-major bleeding, which is defined as bleeding associated with the need for medical intervention, contact with a physician, interruption of anticoagulation therapy, discomfort or impairment of activities of daily life.
Results
The changes in PVR (VKA group; −0.17±0.82 woods unit/year, NOACs group; −0.44±0.89 woods unit/year, p=0.32) were comparable between VKA and NOACs groups. The incidence of clinical worsening in CTEPH (VKA group; 1.8% per patient-year, NOACs group; 0% per patient-year) and clinically relevant bleeding (VKA group; 2.8% per patient-year, NOACs group; 2.8% per patient-year) was comparable between the VKA and NOACs groups. D-dimer levels (VKA group; 0.58±0.22 μg/ml, NOACs group; 0.67±0.47 μg/ml, p=0.41) were also comparable between the groups.
Conclusions
Our study revealed that NOACs had a similar effectiveness in the prevention of thrombotic disease progression in CTEPH as compared with VKA. The result suggest that NOACs might have similar efficacy and safety as VKA in daily clinical practice.
Acknowledgement/Funding
Japan Agency for Medical Research and Development
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Affiliation(s)
- K Hosokawa
- Kyushu University Hospital, Cardiovascular Medicine, Fukuoka, Japan
| | - K Abe
- Kyushu University Hospital, Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Hospital, Cardiovascular Medicine, Fukuoka, Japan
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21
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Sada M, Matsushima S, Ikeda S, Okabe K, Ishikita A, Tadokoro T, Enzan N, Yamamoto T, Deguchi Y, Ikeda M, Ide T, Tsutsui H. P6305Activation of invariant natural killer T cells ameliorates doxorubicin-induced cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Invariant natural killer T (iNKT) cells orchestrate tissue inflammation via regulating various cytokine productions, especially strongly upregulating interferon (IFN)-γ. Activation of iNKT cells have been previously reported to exert protective effects against post-infarcted cardiac remodeling and cardiac ischemia/reperfusion injury. However, the role of iNKT cells has not been determined in doxorubicin (DOX)-induced cardiomyopathy.
Purpose
The purpose of this study was to examine whether the activation of iNKT cells by α-galactosylceramide (αGC), which specifically activates iNKT cells, could affect DOX-induced cardiomyopathy, and if so, to elucidate its downstream target.
Methods
C57BL/6J mice were received the intraperitoneal injection of either αGC (0.1μg/g, n=11) or vehicle (n=13). After 1 week, these mice were treated with a low dose of DOX (18mg/kg via intravenous 3 injections over 1 week), and were followed during 14 days.
Results
DOX mice (DOX+vehicle) showed left ventricular (LV) dysfunction and dilatation, which were significantly ameliorated in DOX mice receiving αGC (DOX+αGC) (LV fractional shortening: 27.4±4.31 vs. 31.5±4.62%, p<0.05, LV end-diastolic diameter: 3.70±0.16 vs. 3.32±0.23mm, p<0.05), with no significant changes in arterial pressure, body weight, and food consumption, 14 days after DOX injection. DOX+vehicle demonstrated a significant decrease in myocardial gene expression of Vα14Jα18, a specific marker of iNKT cells, and IFN-γ compared with control mice. Vα14Jα18 expression levels were higher in DOX+αGC than DOX+vehicle by 9.2 folds (p<0.05). Consistent with this change, IFN-γ was higher in DOX+αGC than DOX+vehicle by 4.4 folds (p<0.05), whereas interleukin (IL)-1, IL-4, IL-6, IL-10, IL-17, IL-23, and tumor necrosis factor (TNF)-α were not altered in both groups. Phosphorylation of Akt, its active form, in the heart was significantly increased in DOX+αGC compared with DOX+vehicle by 1.8 folds (p<0.05).
Conclusions
Activation of iNKT cells by αGC play a protective role against DOX-induced cardiac dysfunction, which was associated with enhancing expression of IFN-γ and activating Akt. Therapies designed to activate iNKT cells might be beneficial to protect the heart from DOX injury.
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Affiliation(s)
- M Sada
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Cardiovascular Medicine, Fukuoka, Japan
| | - S Ikeda
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Okabe
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - A Ishikita
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - N Enzan
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Yamamoto
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - Y Deguchi
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University Graduate School of Medical Sciences, Exerimental and Clinical Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
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22
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Kato K, Otsuka T, Seino Y, Tahara Y, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H. P2666Association of out-of-hospital cardiac arrest occurrence time and the survival in all-Japan utstein registry: difference between international resuscitation guidelines 2005 and 2010. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Previous studies have shown that out-of-hospital cardiac arrest (OHCA) occurring at night have poor outcomes compared with OHCA occurring during daytime. On the other hand, nationwide OHCA outcomes have gradually improved in Japan.
Purpose
We sought to examine whether one-month survival of OHCA differed between daytime and nighttime occurrences, and they differed between the periods of International Resuscitation Guidelines 2005 and 2010.
Methods
Using the All-Japan Utstein Registry between 2005 and 2015, adult OHCA patients whose collapse was witnessed by a bystander and the call-to-hospital admission interval was shorter than 120 min were included in this study. OHCA patients were divided by period of the International Resuscitation Guideline 2005 and 2010. Guideline 2005 included years from 2006 to 2010, while Guideline 2010 included years from 2011 to 2015. The primary outcome was one-month survival with favorable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. Daytime, evening, and night were defined as 0700 to 1459 h, 1500 to 2259 h, and 2300 to 0659 h, respectively.
Results
Among 479,046 cases, 20.3% revealed OHCA occurring at night. OHCA patients occurring at night had lower rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use than those occurring at both daytime and evening. In addition, of those who received bystander CPR, higher rate of patients received CPR by family members. OHCA patients occurring at night in both guideline periods had significantly worse one-month survival than those occurring during daytime (reference) (adjusted odds ratio, 0.69, 0.64; 95% confidence interval 0.65–0.72, 0.61–0.67; P<0.001, P<0.001, Guideline 2005 and 2010 respectively). OHCA patients occurring during daytime in Guideline 2010 had better one-month survival than those in Guideline 2005 (adjusted odds ratio, 1.29; 95% confidence interval 1.24–1.34; P<0.001).
Conclusions
One-month survival with favorable neurological outcome in OHCA patients occurring at night remains to be significantly worse than those occurring during daytime, even improved by the periods during daytime. CPR training for the family members should be more expanded and strengthened against the night time imperfection.
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Affiliation(s)
- K Kato
- Nippon Medical School, Department of Hygiene and Public Health, Tokyo, Japan
| | - T Otsuka
- Nippon Medical School, Department of Hygiene and Public Health, Tokyo, Japan
| | - Y Seino
- Nippon Medical School Chiba Hokusoh Hospital, Cardiovascular Center, Chiba, Japan
| | - Y Tahara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - N Yonemoto
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - H Nonogi
- Shizuoka General Hospital, Intensive Care Center, Shizuoka, Japan
| | - K Nagao
- Nihon University Hospital, Cardiovascular Center, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Cardiology, Kanagawa, Japan
| | - H Tsutsui
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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23
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Nagaoka K, Mukai Y, Kawai S, Takase S, Sakamoto K, Inoue S, Yakabe D, Ikeda S, Chishaki A, Tsutsui H. P3764Morphological mechanisms of atrial functional mitral regurgitation in patients with atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial functional mitral regurgitation (AFMR) occurs in patients with atrial fibrillation. However, morphological mechanisms of AFMR are poorly understood.
Purpose
The purpose of this study was to examine the morphological characteristics in patients with AFMR.
Methods
Among consecutive 795 patients undergoing initial radiofrequency catheter ablation (RFCA) at our hospital, twenty-five patients with persistent AF accompanied by AFMR (≥ moderate) before RFCA (AFMR group) were studied. Age-matched 25 patients with persistent AF without MR were defined as a control group.
Results
Left ventricular ejection fraction (LVEF) was lower and left atrium volume index was larger in the AFMR group (Table). Mitral valve annulus diameter and length of anterior mitral leaflet (AML) were similar between groups, whereas length of posterior mitral leaflet (PML) was significantly shorter in the AFMR group. Smaller tethering angle of AML (γ in the figure) and shorter tethering height were significantly associated with the occurrence of AFMR, which were different from morphology of functional mitral regurgitation in patients with dilated LV. Multiple regression analysis revealed that less tenting height (p<0.05) and LA dilatation toward the posterior (p<0.01) were significantly related to AFMR.
Echocardiographic parameters AFMR (n=25) Control (n=25) P value Age, y 69±8 66±10 NS Male, n (%) 9 (36) 20 (80) P=0.001 LVEF,% 60±9 67±6 P=0.004 LAD, mm 44±5 41±7 NS LAVI, ml/m2 56±17 41±13 P<0.001 MV diameter, mm 3.9±0.4 3.8±0.5 NS α angle, ° 34±9 35±7 NS β angle, ° 48±9 50±8 NS γ angle, ° 32±5 37±5 P=0.0005 AML length, mm 3.0±0.5 3.0±0.5 NS PML length, mm 2.1±0.1 2.4±0.1 P=0.03 Tenting height, mm 1.5±0.1 1.8±0.1 P=0.02 D, mm 0.8±0.3 0.5±0.3 P=0.001 LVEF: left ventricular ejection fraction; LAD: left atrial diameter; LAVI: left atrial volume index; AML: anterior mitral leaflet; PML: posterior mitral leaftlet.
Conclusions
AFMR occurs in patients with unique morphological features, such as less tethering height and LA dilatation toward the posterior.
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Affiliation(s)
- K Nagaoka
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - Y Mukai
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Kawai
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Takase
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Sakamoto
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Inoue
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - D Yakabe
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Ikeda
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - A Chishaki
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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24
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Ishikawa T, Abe K, Ishikawa M, Yoshida K, Watanabe T, Tsutsui H. P4691Chronic blockade of toll-like receptor 9 ameliorated pulmonary arterial hypertension by reducing perivascular inflammation in rats. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Perivascular inflammation plays an important role in the pathogenesis of pulmonary arterial hypertension (PAH). Recent studies have demonstrated that damaged mitochondrial DNA induces sterile inflammation by activating toll-like receptor (TLR)9 in spontaneous hypertensive rats. However, it remains unclear whether TLR9 is involved in perivascular inflammation and subsequent development of PAH.
Purpose
The purpose of the present study is to investigate whether chronic inhibition of TLR9 can ameliorate monocrotaline (MCT)-induced PAH in rats.
Methods
Male Sprague-Dawley rats were injected with MCT (60 mg/kg). First, we conducted immunohistochemistory to examine which cell types express TLR9 in lungs of normal rats and MCT-exposed rats. Second, we extracted cell-free DNA from plasma of rats and amplified genes of COX2 by real-time PCR to detect circulating cell-free mitochondrial DNA, a ligand of TLR9. Third, the administration of a selective TLR9 inhibitor (E6446, 10mg/kg/day, drinking water) or non-selective TLR9 inhibitor (chloroquine: 50mg/kg/day, ip) started three days before MCT injection and sacrificed on day 21. We assessed hemodynamic data and histopathological analysis (EVG stain for medial wall thickness (MWT) in pulmonary arteries (outer diameter: 50 ∼ 100 μm) and CD68 for macrophage accumulation around pulmonary arteries (outer diameter: <50 μm)), and measured the levels of interleukin-6 (IL-6) in lungs by real time PCR. Finally, we investigated survival rate in the reversal protocol, where we started the administration of E6446 on day 14.
Results
TLR9 was expressed dominantly in pulmonary endothelial cells and macrophages in the lungs of both normal rats and MCT-exposed rats. Compared with normal rats, MCT-exposed rats showed increased gene expression of COX2 (0.048±0.001 vs. 0.052±0.001 expressed by 1/Ct) in plasma on day 14. MCT-exposed rats also had increased right ventricular systolic pressure (RVSP: 21±1 vs. 60±2 mmHg), total pulmonary vascular resistance index (TPRI: 0.07±0.01 vs. 0.43±0.02 mmHg/min/mL/kg), MWT (0.07±0.01 vs. 0.26±0,02) and accumulation of macrophages (1.6±0.3 vs. 20.0±1.7 cells/HPF) on day 21. In the prevention protocol, either E6446 or chloroquine significantly prevented the elevations of RVSP (49±4 or 48±3 mmHg) and TPRI (0.29±0.04 or 0.27±0.03 mmHg/min/mL/kg) with reducing MWT (0.18±0.01 or 0.18±0.01) and macrophage accumulation (9.7±1.3 or 9.8±2.5 cell/HPF) on day 21. In addition, these drugs significantly reduced the levels of IL-6 mRNA compared with MCT group (4.4±1.0 or 4.8±1.4 vs. 11.9±1.0). In the reversal protocol, the treatment of E6446 had significantly increased the survival rate (50 vs. 10%).
Conclusions
TLR9 largely contributes to the development of PAH by reducing perivascular inflammation. Inhibition of TLR9 could be a novel therapeutic target for PAH.
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Affiliation(s)
- T Ishikawa
- Kyushu University Hospital, Fukuoka, Japan
| | - K Abe
- Kyushu University Hospital, Fukuoka, Japan
| | - M Ishikawa
- Kyushu University Hospital, Fukuoka, Japan
| | - K Yoshida
- Kyushu University Hospital, Fukuoka, Japan
| | - T Watanabe
- Kyushu University Hospital, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Hospital, Fukuoka, Japan
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25
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Ichihara S, Hirayama A, Tahara Y, Yasuda S, Noguchi T, Nishimura K, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H. P1701Sex-related difference in receiving bystander cardiopulmonary resuscitation and clinical outcome among out-of-hospital cardiac arrest patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Early studies from US and Europe have reported that female out-of-hospital cardiac arrest (OHCA) patients were less likely to receive bystander cardiopulmonary resuscitation (CPR). However, little is known about sex-related difference in receiving CPR and clinical outcome among adult OHCA patients in Japan.
Methods
This study was a nation-wide, population-based observational study of OHCA in Japan from 2011 to 2015. We included all adult cardiogenic OHCA patients. We excluded patients witnessed by emergency medical services (EMS) from the present analysis. To account for the age-related difference, we stratified by age category: 18–39, 40–64, 65–79, and ≥80. To examine the association between patient sex and neurological outcome at 30-day, we fitted multivariable logistic regression model with adjustment for age, bystander CPR status, first document rhythm, dispatcher instruction and EMS response time.
Results
There were 339,317 adult cardiogenic, not EMS-witnessed OHCA patients (median age, 80; female, 43.5%) in Japan from 2011 to 2015. Overall, 171,122 (50.4%) received CPR by citizen, 34,283 (10.1%) had initial shockable rhythm, and 11,421 (3.4%) had favorable neurological status at 30-day. Female patients were more likely to receive bystander CPR (vs. male; 53.8% vs. 47.8%), and were less likely to have initial shockable rhythm (5.2% vs. 13.9%) and favorable neurological status at 30-day (1.8% vs. 4.6%) (all; p<0.001). With stratification by age category, elderly female patients (aged ≥65) were more likely to received bystander CPR (P<0.001), whereas male patients were more likely to received bystander CPR among patients aged <40. Multivariable logistic regression analysis showed that female patients had a lower rate of favorable neurological status at 30-day, compared to male patients in all age categories (all; P<0.05).
Sex difference in bystander CPR Overall Male (n=191,672) Female (n=147,645) p-value All (n=339,317) 50.4% 47.8% 53.8% <0.001 Aged 18–39 (n=6,216) 56.0% 56.9% 53.5% 0.02 Aged 40–64 (n=50,320) 48.5% 48.5% 48.3% 0.69 Aged 65–80 (n=105,141) 46.5% 45.5% 48.3% <0.001 Aged ≥80 (n=177,640) 53.2% 49.0% 56.7% <0.001
OR for neurological outcome at 30-day
Conclusion
Unlike the situation in Europe and US, female OHCA patients, especially elderly female, were more likely to receive bystander CPR in Japan. However, female patients had worse clinical outcome after OHCA. Further investigations including in-hospital treatment are needed to clarify the sex-difference in clinical outcome after OHCA.
Acknowledgement/Funding
None
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Affiliation(s)
- S Ichihara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - A Hirayama
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - Y Tahara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center, Department of Preventive Medicine and Epidemiology, Osaka, Japan
| | - N Yonemoto
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - H Nonogi
- Shizuoka General Hospital, Intensive Care Center, Shizuoka, Japan
| | - K Nagao
- Nihon University, Cardiovascular Center, Tokyo, Japan
| | - T Ikeda
- Toho University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Sato
- Nippon Medical School, Department of Cardiology, Tokyo, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Fukuoka, Japan
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26
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Nagaoka K, Mukai Y, Kawai S, Takase S, Sakamoto K, Inoue S, Ikeda S, Chishaki A, Tsutsui H. P1025Clinical predictors for the improvement of left ventricular ejection fraction and prognosis after catheter ablation of atrial fibrillation in patients with systolic dysfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) and clinical outcomes in patients with left ventricular systolic dysfunction (LVSD). However, predictors of the improvement of LV function and clinical outcomes by CA were poorly understood.
Purpose
We examined the efficacy of CA in AF patients with LVSD and predictive factors associated with clinical outcomes.
Method
Among consecutive 795 patients undergone initial RFCA at our hospital, we studied 51 patients with LVSD (LVEF ≤50%). Improved LVEF more then 5% at 1-year after CA was classified as “responder” to CA. We analyzed clinical variables and echocardiographic parameters before and after the CAs.
Results
In the responder group, LVEF was significantly improved 1-year after catheter ablation compared with the non-responder group. (ΔLVEF 22±12% vs. −1±4%, p<0.001). The responder group was significantly younger, had more non-paroxysmal AF, smaller LV systolic diameter and lower plasma BNP level before CA (Table). Late gadolinium enhancement (LGE)-positive rate in cardiovascular magnetic resonance imaging (CMR) before CA was higher in the non-responder group than in the responder group (100% [6/6] vs. 38% [5/13], p<0.005). After CAs of AF, event-free survival from hospitalization for heart failure was significantly higher in the responder group (Figure) with less AF recurrence (27% vs. 47%, p=0.04) than in the non-responder group.
Baseline characteristics Responder (N=35) Non-Responder (N=16) P value Age, y 62±11 69±8 p<0.01 Male, n (%) 26 (74) 13 (76) NS Non-pAF 26 (74) 4 (24) p<0.01 LAD, mm 48±7 48±8 NS LAVI, ml/m2 54±17 58±20 NS LVDd, mm 54±7 58±10 NS LVDs, mm 43±7 48±10 p=0.05 EF, % 37±8 38±8 NS BNP (pg/ml) 278±225 684±848 p<0.05
Conclusion
Younger age, absence of LV dilatation, lower plasma BNP, or absence of LGE may well predict favorable clinical outcomes after CA in patients with LVSD.
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Affiliation(s)
- K Nagaoka
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - Y Mukai
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Kawai
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Takase
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Sakamoto
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Inoue
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Ikeda
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - A Chishaki
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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27
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Umemoto S, Abe K, Horimoto K, Hosokawa K, Tsutsui H. P4677Balloon pulmonary angioplasty improves pulmonary arterial compliance in patients with inoperable chronic thromboembolic pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) pressure overload is directly related to the increase in mortality in pulmonary hypertension. Pulmonary arterial compliance (CPA; stroke volume/pulmonary pulse pressure) was reported to be an independent determinant of RV systolic afterload in patients with pulmonary arterial hypertension (PAH). Recently, balloon pulmonary angioplasty (BPA) has been reported to reduce mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (RPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the effects of BPA on CPA remain unclear.
Purpose
The aim of this study was to investigate the impact of BPA on CPA in patients with inoperable CTEPH.
Methods
We retrospectively analyzed 78 patients (388 BPA sessions) with inoperable CTEPH who underwent BPA in our hospital from September 2012 to June 2018. Total number of BPA sessions was 5.0±1.8 (range 1–10). The pressure values were obtained from right heart catheterization at baseline (n=78), just after the final BPA (n=78) and follow-up (n=19) periods. The intervals from baseline to the final BPA and the final BPA to follow-up were 593±498 days and 397±276 days, respectively.
Results
Mean age was 60.5±12.6 years old, and 64 (82%) were female. All patients were symptomatic (WHO functional class II/III/IV 16/55/7). Patients who had pulmonary vasodilators decreased from 70 (90%) at baseline to 23 (28%) at the final BPA and 2 (15%) at follow-up. BPA reduced mPAP and RPA significantly from baseline to the final BPA and follow-up periods. BPA also improved CPA with significant reduction of pulse pressure despite no significant changes in stroke volume between baseline and follow-up (Table). CPA between the final BPA and follow-up was equivalent (p=0.95).
Conclusions
BPA improved CPA just after the final BPA in inoperable CTEPH patients. In addition, CPA was preserved during the follow-up after the final BPA sessions. These data suggest that BPA consistently unloads RV systolic afterload in those patients.
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Affiliation(s)
- S Umemoto
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Abe
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Horimoto
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Hosokawa
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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28
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Ishii M, Seki T, Kaikita K, Nakai M, Sumita Y, Nishimura K, Miyamoto Y, Noguchi T, Yasuda S, Tsutsui H, Komuro I, Saito Y, Ogawa H, Tsujita K, Kawakami K. P884Short-term exposure to asian dust is associated with myocardial infarction with nonobstructive coronary arteries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Asian dust (AD) is considered as one of air pollution that increases risk of acute myocardial infarction (AMI). However, it has not been elucidated whether AD might increase the risk of myocardial infarction with nonobstructive coronary arteries (MINOCA).
Methods
A time-stratified case-crossover design and conditional logistic regression models was used to investigate the association between short-term exposure to AD and admission of AMI during the spring months in a nationwide administrative Diagnostic Procedure Combination (DPC) database, the Japanese Of All cardiac and vascular Diseases (JROAD)-DPC, between April 2012 through March 2016. MINOCA was defined as AMI having angiography without revascularization and coronary atherosclerosis, whereas myocardial infarction with obstructive coronary artery disease (MI-CAD) was AMI with revascularization and/or coronary atherosclerosis. Data for AD events, air pollutants (PM2.5, Ox, NO2, SO2), and meteorological variables were obtained from the nearest monitoring station of the hospital.
Results
During the study period, 3,233 MINOCA and 27,202 MI-CAD patients were identified from 30,435 AMI patients. Although the occurrence of AD events 2 days before the admission was not associated with the admission of AMI and MI-CAD, the AD events was significantly associated with the admission of MINOCA with adjustment for meteorological variables and each air pollutant. In subgroup analysis of MINOCA, patients without low ADL was associated with higher risk of the admission due to AD exposure than those with low ADL, with significant interaction.
Conclusions
AD events might be more likely to trigger onset of MINOCA than MI-CAD.
Acknowledgement/Funding
None
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Affiliation(s)
- M Ishii
- Kumamoto University Hospital, Kumamoto, Japan
| | - T Seki
- Kyoto University, Kyoto, Japan
| | - K Kaikita
- Kumamoto University Hospital, Kumamoto, Japan
| | - M Nakai
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Sumita
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - I Komuro
- University of Tokyo, Tokyo, Japan
| | - Y Saito
- Nara Medical University, Nara, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - K Tsujita
- Kumamoto University Hospital, Kumamoto, Japan
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29
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Matsuura T, Shinohara K, Hirooka Y, Tsutsui H. P1862Preeclampsia induces the acquired salt-sensitivity characteristics via the increased vasopressin secretion in postpartum. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Matsuura
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Shinohara
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - Y Hirooka
- International University of Health and Welfare, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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30
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Yoshida K, Saku K, Kamada K, Abe K, Akashi T, Kishi T, Tsutsui H, Sunagawa K. 1205Vagal nerve stimulation restores autonomic balance, super-normalizes right ventricular function and prevents the worsening of right heart failure in chronic pulmonary arterial banding model rats. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Yoshida
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Saku
- Kyushu University, Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - K Kamada
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Abe
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Akashi
- Kyushu University, Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - T Kishi
- Kyushu University, Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Sunagawa
- Kyushu University, Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
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31
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Akiyama Y, Matoba T, Uwatoku T, Mukai Y, Hayashidani S, Ooi K, Tsutsui H. P5532Biodegradable polymer drug-eluting stents are associated with better coronary endothelial function in stented vessels compared with non-target vessels in patients after coronary stenting. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Akiyama
- Kyushu University Graduate School of Medical Sciences, Cardiology, Fukuoka, Japan
| | - T Matoba
- Kyushu University Graduate School of Medical Sciences, Cardiology, Fukuoka, Japan
| | - T Uwatoku
- Kyushu University Hospital, Cardiology, Fukuoka, Japan
| | - Y Mukai
- Kyushu University Hospital, Cardiology, Fukuoka, Japan
| | - S Hayashidani
- Kyushu University Hospital, Cardiology, Fukuoka, Japan
| | - K Ooi
- Kyushu University Hospital, Cardiology, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiology, Fukuoka, Japan
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Umezu R, Koga J, Tsutsui H, Egashira K. P3785Deletion of cyclophilin d inhibits atherosclerotic plaque formation in apolipoprotein-e deficient mice. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Umezu
- Kyushu University Graduate School of Medical Sciences, the department of cardiovascular medicine, Fukuoka, Japan
| | - J Koga
- Kyushu University, Cardiovascular Research, Development, and Translational Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, the department of cardiovascular medicine, Fukuoka, Japan
| | - K Egashira
- Kyushu University, Cardiovascular Research, Development, and Translational Medicine, Fukuoka, Japan
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Kawai S, Mukai Y, Yakabe D, Nagaoka K, Chishaki A, Tsutsui H. P2880Circumferential conduction delay within the pulmonary veins (PV) rather than the PV-LA conduction delay has a key role in the onset of atrial fibrillation - A quantitative analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Kawai
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - Y Mukai
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - D Yakabe
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - K Nagaoka
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - A Chishaki
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Hospital, cardiology, Fukuoka, Japan
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Yamasaki K, Sawatari H, Konagai N, Kamiya C, Yoshimatsu J, Muneuchi J, Watanabe M, Fukuda T, Mizuno A, Sakamoto I, Yamamura K, Ohkusa T, Tsutsui H, Niwa K, Chishaki A. P5475Predictors of cardiovascular events in pregnant women with congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Yamasaki
- Ube Frontier University, Nursing, Faculty of Health Sciences, Ube, Japan
| | - H Sawatari
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Health Care for Adults, Hiroshima, Japan
| | - N Konagai
- National cerebral and Cardiovascular Center, Perinatology and Gynecology, Osaka, Japan
| | - C Kamiya
- National cerebral and Cardiovascular Center, Perinatology and Gynecology, Osaka, Japan
| | - J Yoshimatsu
- National cerebral and Cardiovascular Center, Perinatology and Gynecology, Osaka, Japan
| | - J Muneuchi
- Japan Community Healthcare Organization Kyushu Hospital, Pediatrics, Kitakyushu, Japan
| | - M Watanabe
- Japan Community Healthcare Organization Kyushu Hospital, Pediatrics, Kitakyushu, Japan
| | - T Fukuda
- St. Luke's International University Hospital, Cardiology Cardiovascular Center, Tokyo, Japan
| | - A Mizuno
- St. Luke's International University Hospital, Cardiology Cardiovascular Center, Tokyo, Japan
| | - I Sakamoto
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Yamamura
- Kyushu University Graduate School of Medical Sciences, Pediatrics, Fukuoka, Japan
| | - T Ohkusa
- Ube Frontier University, Nursing, Faculty of Health Sciences, Ube, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Niwa
- St. Luke's International University Hospital, Cardiology Cardiovascular Center, Tokyo, Japan
| | - A Chishaki
- Kyushu University Graduate School of Medical Sciences, Health Sciences, Fukuoka, Japan
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Nagai T, Iwakami N, Nakai M, Nishimura K, Sumita Y, Mizuno A, Tsutsui H, Ogawa H, Anzai T. 4362Effect of intravenous carperitide versus nitrates as first-line vasodilators on in-hospital outcomes in hospitalized patients with acute heart failure: insight from a nationwide claim-based database. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Nagai
- Hokkaido University Graduate School of Medicine, Cardiovascular Medicine, Sapporo, Japan
| | - N Iwakami
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiovascular Medicine, Suita, Osaka, Japan
| | - M Nakai
- National Cerebral and Cardiovascular Center, Department of Statistics and Data Analysis, Suita, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center, Department of Statistics and Data Analysis, Suita, Japan
| | - Y Sumita
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiovascular Medicine, Suita, Osaka, Japan
| | - A Mizuno
- St. Luke's International Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - H Tsutsui
- Kyushu University, Cardiovascular Medicine, Fukuoka, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiovascular Medicine, Suita, Osaka, Japan
| | - T Anzai
- Hokkaido University Graduate School of Medicine, Cardiovascular Medicine, Sapporo, Japan
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Iyonaga T, Shinohara K, Hirooka Y, Tsutsui H. 1204Brain perivascular macrophages contribute to the development of hypertension via sympathetic activation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Iyonaga
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Shinohara
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - Y Hirooka
- International University of Health and Welfare, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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Okabe K, Matsushima S, Ikeda M, Ikeda S, Ishikita A, Tadokoro T, Ide T, Tsutsui H. P2826Teneligliptin attenuated AngII-induced cardiac hypertrophy by inhibiting Nox4-HDAC4 axis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Okabe
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Matsushima
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Ikeda
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - A Ishikita
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Mannoji H, Saku K, Nishikawa T, Tohyama T, Kamada K, Abe K, Sunagawa G, Kishi T, Tsutsui H, Sunagawa K. 3031Noninvasive identification of baroreflex function from continuous arterial pressure waveform and its clinical application. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Mannoji
- Kyushu University Graduate School of Medical Sciences, cardiology, Fukuoka, Japan
| | - K Saku
- Kyushu University, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - T Nishikawa
- Kyushu University Graduate School of Medical Sciences, cardiology, Fukuoka, Japan
| | - T Tohyama
- Kyushu University Graduate School of Medical Sciences, cardiology, Fukuoka, Japan
| | - K Kamada
- Kyushu University Graduate School of Medical Sciences, cardiology, Fukuoka, Japan
| | - K Abe
- Kyushu University Graduate School of Medical Sciences, anesthesiology, Fukuoka, Japan
| | - G Sunagawa
- Kyushu University Graduate School of Medical Sciences, cardiology, Fukuoka, Japan
| | - T Kishi
- Kyushu University, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, cardiology, Fukuoka, Japan
| | - K Sunagawa
- Kyushu University, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
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Fujiwara M, Matoba T, Koga J, Okahara A, Funamoto D, Nakano K, Tsutsui H, Egashira K. 2422Nanoparticle-mediated delivery of toll-like receptor 4 antagonist to monocytes and ischemic myocardium enhances cardioprotection against ischemia-reperfusion injury in mice. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Fujiwara
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Matoba
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - J Koga
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
| | - A Okahara
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - D Funamoto
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
| | - K Nakano
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Egashira
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
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Ikeda S, Matsushima S, Ikeda M, Ishikita A, Tadokoro T, Ide T, Tsutsui H. P5694L-type calcium channel blocker attenuates doxorubicine-induced cardiomyopathy by inhibiting CaMKII-NF-kB axis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Ikeda
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - M Ikeda
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - A Ishikita
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - T Ide
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
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Abe K, Saku K, Mannoji H, Sunagawa G, Kamada K, Kishi T, Hoka S, Sunagawa K, Tsutsui H. P912The presence of baroreflex failure augments the variability of left atrial pressure and triggers acute pulmonary edema in a rat with chronic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Abe
- Kyushu University Graduate School of Medical Sciences, Department of Anesthesiology and Critical Care Medicine, Fukuoka, Japan
| | - K Saku
- Kyushu University, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - H Mannoji
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - G Sunagawa
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Kamada
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Kishi
- Kyushu University, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - S Hoka
- Kyushu University Graduate School of Medical Sciences, Department of Anesthesiology and Critical Care Medicine, Fukuoka, Japan
| | - K Sunagawa
- Kyushu University, Center for Disruptive Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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Okahara A, Matoba T, Koga J, Fujiwara M, Funamoto D, Nakano K, Tsutsui H, Egashira K. P1270Nanoparticle-mediated simultaneous targeting of mitochondria and inflammatory monocytes protects the brain from ischemia-reperfusion injury in mice. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Okahara
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Matoba
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - J Koga
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
| | - M Fujiwara
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - D Funamoto
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
| | - K Nakano
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Egashira
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Research, Development, and Translational Research, Fukuoka, Japan
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Yoshida K, Saku K, Kamada K, Abe K, Tanaka M, Akashi T, Kishi T, Sunagawa K, Tsutsui H. 5023Vagal nerve stimulation ameliorates severe pulmonary arterial hypertension via anti-inflammatory effects in rats. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Honda K, Matoba T, Koga J, Nakano K, Tsutsui H, Egashira K. P698High cholesterol diet and angiotensin II induce spontaneous atherothrombotic occlusion of balloon-injured rabbit femoral arteries; effects of lipid-lowering therapies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Umezu R, Koga J, Wang L, Nomura M, Tsutsui H, Egashira K. P691Macrophage dynamin-related protein1 promotes neointima formation after mechanical injury in mouse femoral arteries. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kawai S, Mukai Y, Inoue S, Chishaki A, Tsutsui H. 58Location and coupling interval of ectopic beats have key roles in the onset of atrial fibrillation from the pulmonary veins. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Kawai
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - Y. Mukai
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - S. Inoue
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - A. Chishaki
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - H. Tsutsui
- Kyushu University Hospital, cardiology, Fukuoka, Japan
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Sunagawa G, Saku K, Arimura T, Akashi T, Murayama Y, Sakamoto T, Kishi T, Sunagawa K, Tsutsui H. P1574Mechano-chronotropic unloading during the acute phase of myocardial infarction markedly reduces the infarct size and prevents the development of heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kawai S, Mukai Y, Inoue S, Chishaki A, Tsutsui H. P1726Non-pulmonary vein trigger of atrial fibrillation is likely to arise from low voltage area in the left atrium. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Kawai
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - Y. Mukai
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - S. Inoue
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - A. Chishaki
- Kyushu University Hospital, cardiology, Fukuoka, Japan
| | - H. Tsutsui
- Kyushu University Hospital, cardiology, Fukuoka, Japan
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Tenma T, Mitsuyama H, Watanabe M, Mizukami K, Kamada R, Takahashi M, Takada S, Tsutsui H, Yokoshiki H. P1590Ischemia-induced small-conductance calcium-activated potassium channel activation deteriorates ventricular arrhythmias in cardiac hypertrophy through the CaMKII-dependent pathway. Europace 2017. [DOI: 10.1093/ehjci/eux158.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tsuzuki K, Kimura H, Kusama Y, Sato M, Kawashima H, Kamiya K, Shinohara K, Ogawa H, Uehara K, Kurita G, Kasai S, Hoshino K, Isei N, Miura Y, Yamamoto M, Kikuchi K, Shibata T, Bakhtiari M, Hino T, Hirohata Y, Yamauchi Y, Yamaguchi K, Tsutsui H, Shimada R, Amemiya H, Nagashima Y, Ido T, Hamada Y. Characteristics of Plasma Operation with the Ferritic inside Wall and Its Compatibility with High-Performance Plasmas in JFT-2M. Fusion Science and Technology 2017. [DOI: 10.13182/fst06-a1095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- K. Tsuzuki
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - H. Kimura
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - Y. Kusama
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - M. Sato
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - H. Kawashima
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - K. Kamiya
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - K. Shinohara
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - H. Ogawa
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - K. Uehara
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - G. Kurita
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - S. Kasai
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - K. Hoshino
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - N. Isei
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - Y. Miura
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - M. Yamamoto
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - K. Kikuchi
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - T. Shibata
- Japan Atomic Energy Research Institute Naka Fusion Research Establishment, Naka-shi, Inaraki 319-0193, Japan
| | - M. Bakhtiari
- University of Wisconsin, Madison, Wisconsin 53706
| | - T. Hino
- Hokkaido University Sapporo, Hokkaido 060-8628, Japan
| | - Y. Hirohata
- Hokkaido University Sapporo, Hokkaido 060-8628, Japan
| | - Y. Yamauchi
- Hokkaido University Sapporo, Hokkaido 060-8628, Japan
| | - K. Yamaguchi
- Hokkaido University Sapporo, Hokkaido 060-8628, Japan
| | - H. Tsutsui
- Tokyo Institute of Technology, Meguro-ku Tokyo 152-8550, Japan
| | - R. Shimada
- Tokyo Institute of Technology, Meguro-ku Tokyo 152-8550, Japan
| | - H. Amemiya
- The Institute of Physical and Chemical Research, Wako, Saitama 351-0198, Japan
| | - Y. Nagashima
- National Institute for Fusion Science, Toki-shi 509-5292, Japan
| | - T. Ido
- National Institute for Fusion Science, Toki-shi 509-5292, Japan
| | - Y. Hamada
- National Institute for Fusion Science, Toki-shi 509-5292, Japan
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