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Komatsu T, Sato Y, Kuroki Y, Yoshida Y, Aoyama N, Iijima Y, Nakamoto Y, Kato M, Kiyokawa H, Tanabe K, Matsunaga K, Maehata T, Yasuda H, Matsumoto N, Tateishi K. Impact of the COVID-19 pandemic on the time to emergency endoscopy and clinical outcomes in patients with upper gastrointestinal bleeding. DEN Open 2024; 4:e310. [PMID: 37954400 PMCID: PMC10638502 DOI: 10.1002/deo2.310] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/27/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023]
Abstract
Objectives To investigate endoscopic management and clinical outcomes in patients with non-variceal upper gastrointestinal (GI) bleeding during the coronavirus disease 2019 pandemic. Methods We retrospectively analyzed the data of 332 patients with non-variceal upper GI bleeding who underwent emergency upper GI endoscopy at three hospitals during the pandemic (April 2020-June 2021) and before the pandemic (January 2019-March 2020). The number of emergency upper GI endoscopies, time from hospital arrival to endoscopy, mortality within 30 days, rebleeding within 30 days, interventional radiology (IVR)/surgery requirement, composite outcome, rates of endoscopic hemostasis procedures, and second-look endoscopy were investigated using logistic regression. Results Overall, 152 and 180 patients underwent emergency upper GI endoscopies during and before the pandemic, respectively. The mean time from arrival to endoscopy was longer during the pandemic than before it (11.7 vs. 6.1 h, p < 0.01). Multivariate analysis revealed that mortality within 30 days (odds ratio [OR]: 2.27, p = 0.26), rebleeding within 30 days (OR: 0.43, p = 0.17), IVR/surgery requirement (OR: 1.79, p = 0.33), and composite outcome (OR: 0.98, p = 0.96) did not differ significantly between the periods; conversely, endoscopic hemostasis procedures (OR: 0.38, p < 0.01) and second-look endoscopies (OR: 0.04, p < 0.01) were less likely to be performed during the pandemic than before it. Conclusions Although the time from arrival to endoscopy was significantly longer during the pandemic, it did not affect mortality and rebleeding.
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Affiliation(s)
- Takumi Komatsu
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
- Department of GastroenterologySt Marianna University School of Medicine, Yokohama Seibu HospitalKanagawaJapan
| | - Yoshinori Sato
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
| | - Yuichiro Kuroki
- Department of GastroenterologySt Marianna University School of Medicine, Yokohama Seibu HospitalKanagawaJapan
| | - Yoshihito Yoshida
- Department of GastroenterologySt Marianna University School of Medicine, Yokohama Seibu HospitalKanagawaJapan
| | - Natsumi Aoyama
- Department of GastroenterologyKawasaki Municipal Tama HospitalKanagawaJapan
| | - Yoshihiko Iijima
- Department of GastroenterologyKawasaki Municipal Tama HospitalKanagawaJapan
| | - Yusuke Nakamoto
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
| | - Masaki Kato
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
| | - Hirofumi Kiyokawa
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
| | - Kenichiro Tanabe
- Pathophysiology and BioregulationSt. Marianna University Graduate School of MedicineKanagawaJapan
| | - Koutaro Matsunaga
- Department of GastroenterologyKawasaki Municipal Tama HospitalKanagawaJapan
| | - Tadateru Maehata
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
| | - Hiroshi Yasuda
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
| | - Nobuyuki Matsumoto
- Department of GastroenterologySt Marianna University School of Medicine, Yokohama Seibu HospitalKanagawaJapan
| | - Keisuke Tateishi
- Department of GastroenterologySt Marianna University School of MedicineKanagawaJapan
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Maruyama S, Kurasawa S, Hayashi T, Nangaku M, Narita I, Hirakata H, Tanabe K, Morita S, Tsubakihara Y, Imai E, Akizawa T. Higher hemoglobin levels using darbepoetin alfa and kidney outcomes in advanced chronic kidney disease without diabetes: a prespecified secondary analysis of the PREDICT trial. Clin Exp Nephrol 2023; 27:757-766. [PMID: 37289335 PMCID: PMC10432358 DOI: 10.1007/s10157-023-02362-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/14/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND In the primary analysis of the PREDICT trial, a higher hemoglobin target (11-13 g/dl) with darbepoetin alfa did not improve renal outcomes compared with a lower hemoglobin target (9-11 g/dl) in advanced chronic kidney disease (CKD) without diabetes. Prespecified secondary analyses were performed to further study the effects of targeting higher hemoglobin levels on renal outcomes. METHODS Patients with an estimated glomerular filtration rate (eGFR) 8-20 ml/min/1.73 m2 without diabetes were randomly assigned 1:1 to the high- and low-hemoglobin groups. The differences between the groups were evaluated for the following endpoints and cohort sets: eGFR and proteinuria slopes, assessed using a mixed-effects model in the full analysis set and the per-protocol set that excluded patients with off-target hemoglobin levels; the primary endpoint of composite renal outcome, evaluated in the per-protocol set using the Cox model. RESULTS In the full analysis set (high hemoglobin, n = 239; low hemoglobin, n = 240), eGFR and proteinuria slopes were not significantly different between the groups. In the per-protocol set (high hemoglobin, n = 136; low hemoglobin, n = 171), the high-hemoglobin group was associated with reduced composite renal outcome (adjusted hazard ratio: 0.64; 95% confidence interval: 0.43-0.96) and an improved eGFR slope (coefficient: + 1.00 ml/min/1.73 m2/year; 95% confidence interval: 0.38-1.63), while the proteinuria slope did not differ between the groups. CONCLUSIONS In the per-protocol set, the high-hemoglobin group demonstrated better kidney outcomes than the low-hemoglobin group, suggesting a potential benefit of maintaining higher hemoglobin levels in patients with advanced CKD without diabetes. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov (identifier: NCT01581073).
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Affiliation(s)
- Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
| | | | - Kenichiro Tanabe
- Division of Health Data Science, Translational Research Center for Medical Innovation, Kobe, Japan
- Pathophysiology and Bioregulation, St. Marianna University Graduate School of Medicine, Kanagawa, Japan
| | - Satoshi Morita
- Biomedical Statistics and Bioinformatics, Kyoto University, Kyoto, Japan
| | | | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Japan
| | - Tadao Akizawa
- Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
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Tanabe K, Uehara S, Katsumura S, Konishi T, Noro A. The controlling nutritional status (CONUT) score may predict the development of febrile urinary tract infection after ureterorenoscopic lithotripsy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01250-2] [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: 02/12/2023]
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Narita I, Hayashi T, Maruyama S, Masaki T, Nangaku M, Nishino T, Sato H, Sofue T, Wada T, Imai E, Iwasaki M, Mizuno K, Hase H, Kamouchi M, Yamamoto H, Kagimura T, Tanabe K, Kato H, Wada T, Usui T, Akizawa T, Hirakata H, Tsubakihara Y. Hyporesponsiveness to erythropoiesis-stimulating agent in non-dialysis-dependent CKD patients: The BRIGHTEN study. PLoS One 2022; 17:e0277921. [PMID: 36445882 PMCID: PMC9707758 DOI: 10.1371/journal.pone.0277921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Among non-dialysis-dependent chronic kidney disease (ND-CKD) patients, a low hematopoietic response to erythropoiesis-stimulating agents (ESAs) is a predictor for poor renal and cardiovascular outcome. To assess the method for evaluating hyporesponsiveness to ESA in patients with ND-CKD, a multicenter, prospective, observational study of 1,980 adult patients with ND-CKD with renal anemia was conducted. Darbepoetin alfa (DA) and iron supplement administrations were provided according to the recommendation of the attached document and the guidelines of JSDT (Japanese Society of Dialysis and Transplantation). The primary outcomes were progression of renal dysfunction and major adverse cardiovascular events. ESA responsiveness was assessed using pre-defined candidate formulae. During the mean follow-up period of 96 weeks, renal and cardiovascular disease (CVD) events occurred in 683 (39.6%) and 174 (10.1%) of 1,724 patients, respectively. Among pre-set candidate formulae, the one expressed by dividing the dose of DA by Hb level at the 12-week DA treatment was statistically significant in predicting renal (hazard ratio [HR], 1.449; 95% confidence interval [CI], 1.231-1.705; P<0.0001) and CVD events (HR, 1.719; 95% CI, 1.239-2.386; P = 0.0010). The optimum cut-off values for both events were close to 5.2. In conclusion, hyporesponsiveness to ESA in ND-CKD cases, which is associated with a risk for renal and CVD events, may be evaluated practicably as the dose of DA divided by the Hb level at the 12-week DA treatment, and the cut-off value of this index is 5.2. A search for the causes of poor response and measures for them should be recommended in such patients. Trial registration: ClinicalTrials. gov Identifier: NCT02136563; UMIN Clinical Trial Registry Identifier: UMIN000013464.
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Affiliation(s)
- Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- * E-mail:
| | - Terumasa Hayashi
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shoichi Maruyama
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takao Masaki
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masaomi Nangaku
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tomoya Nishino
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Sato
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadashi Sofue
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Enyu Imai
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Manabu Iwasaki
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kyoichi Mizuno
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroki Hase
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Kamouchi
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroyasu Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuo Kagimura
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenichiro Tanabe
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hideki Kato
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takehiko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tomoko Usui
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadao Akizawa
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hideki Hirakata
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshiharu Tsubakihara
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Roberts H, Hong T, Ly L, Yeap B, Ben-Josef E, Zhu A, Goyal L, Franses J, Ryan D, Allen J, Clark J, Drapek L, Tanabe K, Ferrone C, Koay E, Crane C, DeLaney T, Wo J. Long-Term Results of a Multi-Institutional Phase II Study of Hypofractionated Proton Beam Irradiation of Unresectable Primary Liver Tumors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.563] [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: 11/30/2022]
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Sanuki T, Oridate N, Tateya I, Nito T, Mizoguchi K, Tanabe K. Validity of intraoperative voice monitoring undergoing type 2 thyroplasty with titanium bridges for adductor spasmodic dysphonia. Laryngoscope Investig Otolaryngol 2022; 7:1481-1490. [PMID: 36258849 PMCID: PMC9575097 DOI: 10.1002/lio2.898] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives The success of type 2 thyroplasty (TP2) for adductor spasmodic dysphonia (AdSD) depends on the selection of optimally sized titanium bridges, which requires accurate assessment of intraoperative vocal changes. While this procedure has traditionally been performed according to the laryngologist's experience, the most appropriate method for voice monitoring and selection of titanium bridge size remains to be determined. This study aimed to investigate evaluation parameters useful for voice monitoring, as these may allow less experienced surgeons to perform TP2 properly. Methods In this prospective study, voice monitoring was performed in 18 patients with AdSD patients undergoing TP2. Evaluations were performed preoperatively, intraoperatively, 13 weeks postoperatively, and 52 weeks postoperatively using GRBAS (grade, roughness, breathiness, asthenia, and strain), as well as perceptual judgment and acoustic analyses. Results Preoperative and intraoperative assessments of the G, R, B, and S parameters, perceptual judgment, and harmonic‐to‐noise ratio (HNR) were in moderate or better agreement. Intraoperative and 13‐ or 52‐week postoperative measurements of the R, B, and G parameters and strangulation, tremor, and HNR were also in high agreement. When two different sizes of titanium bridges were compared (unselected vs. selected), ratings for G, R, S, strangulation, tremor, jitter, shimmer, HNR, standard deviation of F0, and degree of voice breaks were better for the selected width than the unselected width. Conclusion The candidate items for intraoperative voice monitoring during TP2 for AdSD are G, R, strangulation, tremor, and HNR. The use of these items may help to ensure successful TP2 and contribute to the advancement of laryngeal framework surgery. Level of evidence Level 4.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology – Head and Neck Surgery Nagoya City University Graduate School of Medical Sciences Nagoya Aichi Japan
| | - Nobuhiko Oridate
- Department of Otolaryngology – Head and Neck Surgery Yokohama City University Yokohama Kanagawa Japan
| | - Ichiro Tateya
- Department of Otolaryngology – Head and Neck Surgery School of Medicine, Fujita Health University Toyoake Aichi Japan
| | - Takaharu Nito
- Department of Otolaryngology Saitama Medical Center, Saitama Medical University Kawagoe Saitama Japan
| | - Kenji Mizoguchi
- Department of Otorhinolaryngology National Hospital Organization Hokkaido Medical Center Sapporo Hokkaido Japan
| | - Kenichiro Tanabe
- Pathophysiology and Bioregulation, St. Marianna University Graduate School of Medicine Kawasaki Kanagawa Japan
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Wada Y, Sato T, Hasegawa H, Matsudaira T, Nao N, Coler-Reilly ALG, Tasaka T, Yamauchi S, Okagawa T, Momose H, Tanio M, Kuramitsu M, Sasaki D, Matsumoto N, Yagishita N, Yamauchi J, Araya N, Tanabe K, Yamagishi M, Nakashima M, Nakahata S, Iha H, Ogata M, Muramatsu M, Imaizumi Y, Uchimaru K, Miyazaki Y, Konnai S, Yanagihara K, Morishita K, Watanabe T, Yamano Y, Saito M. RAISING is a high-performance method for identifying random transgene integration sites. Commun Biol 2022; 5:535. [PMID: 35654946 PMCID: PMC9163355 DOI: 10.1038/s42003-022-03467-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractBoth natural viral infections and therapeutic interventions using viral vectors pose significant risks of malignant transformation. Monitoring for clonal expansion of infected cells is important for detecting cancer. Here we developed a novel method of tracking clonality via the detection of transgene integration sites. RAISING (Rapid Amplification of Integration Sites without Interference by Genomic DNA contamination) is a sensitive, inexpensive alternative to established methods. Its compatibility with Sanger sequencing combined with our CLOVA (Clonality Value) software is critical for those without access to expensive high throughput sequencing. We analyzed samples from 688 individuals infected with the retrovirus HTLV-1, which causes adult T-cell leukemia/lymphoma (ATL) to model our method. We defined a clonality value identifying ATL patients with 100% sensitivity and 94.8% specificity, and our longitudinal analysis also demonstrates the usefulness of ATL risk assessment. Future studies will confirm the broad applicability of our technology, especially in the emerging gene therapy sector.
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Kimura M, Yamauchi J, Sato T, Yagishita N, Araya N, Aratani S, Tanabe K, Horibe E, Watanabe T, Coler-Reilly A, Nagasaka M, Akasu Y, Kaburagi K, Kikuchi T, Shibata S, Matsumoto H, Koseki A, Inoue S, Takata A, Yamano Y. Health-Related Quality of Life Evaluation Using the Short Form-36 in Patients With Human T-Lymphotropic Virus Type 1-Associated Myelopathy. Front Med (Lausanne) 2022; 9:879379. [PMID: 35479934 PMCID: PMC9036434 DOI: 10.3389/fmed.2022.879379] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) is a neuroinflammatory disease, causing various neurological symptoms, including motor, sensory, and bladder and bowel dysfunctions. This study was designed to reveal the impact of HAM and related symptoms on health-related quality of life (HRQoL). Methods We analyzed the Short Form-36 (SF-36) and clinical data of 538 patients with HAM registered in the HAM-net, a nationwide patient registry for HAM in Japan. HRQoL was evaluated using the SF-6D (a health state utility value calculated from the SF-36) and eight SF-36 subscales. A general liner model was used to estimate the impact of major HAM-related symptoms, including gait dysfunction, sensory disturbance in the legs (pain and numbness), urinary dysfunction, and constipation, on the SF-6D and SF-36 subscale scores. Results The mean age and disease duration were 62.0 and 16.5 years, respectively. Of the patients, 73.2% needed walking aid; 42.7 and 67.1% had leg pain and numbness, respectively; 92.1% had urinary dysfunction; and 77.9% had constipation. The mean SF-6D score was 0.565, which was significantly lower than the national average (0.674 in the 60–69 years age group; p < 0.001), exceeding the minimal important difference (0.05–0.1). All the major symptoms were significantly associated with a decrease in the SF-6D score. The SF-36 subscale scores were significantly lower than the national standard of 50 (p ≤ 0.001), except for mental health (MH). Gait dysfunction was associated with lower scores in physical functioning (PF), limitations on role functioning because of physical health, bodily pain, general health perception (GH), vitality (VT), and social functioning; however, no association was observed between gait dysfunction and limitations on role functioning because of emotional problems and MH. Meanwhile, sensory disturbance in the legs was associated with a decrease in scores in all subscales. Urinary dysfunction was associated with worse PF, GH, VT, and MH. Constipation was associated only with PF. Conclusion HRQoL of patients with HAM was worse than that of the general population and was associated with all major symptoms. Thus, patients should be comprehensively managed to achieve better HRQoL.
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Affiliation(s)
- Miyuna Kimura
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junji Yamauchi
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Sato
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoko Aratani
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
- LSI Medience Co., Tokyo, Japan
| | - Kenichiro Tanabe
- Department of Frontier Medicine, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Erika Horibe
- Department of Practical Management of Medical Information, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Toshiki Watanabe
- Department of Practical Management of Medical Information, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Ariella Coler-Reilly
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Misako Nagasaka
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Hematology and Oncology, Department of Medicine, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Yukari Akasu
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Kaburagi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takayuki Kikuchi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Soichiro Shibata
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirofumi Matsumoto
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akihito Koseki
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Neurology, Yaizu City Hospital, Yaizu, Japan
| | - Soichiro Inoue
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Yoshihisa Yamano,
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Tsubaki M, Takeda T, Mastuda T, Kimura A, Yanae M, Maeda A, Hoshida T, Tanabe K, Nishida S. Combination treatment with statins and bezafibrate induces myotoxicity via inhibition of geranylgeranyl pyrophosphate biosynthesis and Rho activation in L6 myoblasts and myotube cells. J Physiol Pharmacol 2022; 73. [PMID: 35793766 DOI: 10.26402/jpp.2022.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
Statins and fibrates are frequently used to treat hyperlipidemia; however, these drugs may have adverse effects such as rhabdomyolysis. The incidence of rhabdomyolysis due to fibrates and statins is low (0.0028-0.0096%) when administered as monotherapy, however it increases to 0.015-0.021% when the drugs are used in combination. The mechanism underlying myotoxicity induced by the combination of statins and fibrates is yet unclear. Here, we investigated the mechanisms underlying induced myotoxicity in rat myoblasts L6 and differentiated L6 cells (myotubes) using a combination of statins and fibrates. We found that cell death induced by a combination of fluvastatin or simvastatin with bezafibrate or fenofibrate in L6 myoblasts and myotubes was mediated by inhibition of geranylgeranyl pyrophosphate (GGPP) production. Additionally, the drug combination inhibited Rho activation in L6 myoblasts and myotube cells. In L6 myoblasts, the combination of statins and bezafibrate enhanced p27 expression and induced G1 arrest and apoptosis. Furthermore, combined treatment suppressed Akt activation and enhanced Bim expression in L6 myotubes but did not affect extracellular regulated protein kinase 1/2 activation. These results suggested that combined administration of statins and fibrates induced death of L6 myoblasts and myotube cells by inhibiting GGPP biosynthesis and Rho pathway activation. Supplementation with GGPP may be therapeutically beneficial for preventing myotoxicity associated with combined statin and fibrates treatment.
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Affiliation(s)
- M Tsubaki
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - T Takeda
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - T Mastuda
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - A Kimura
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - M Yanae
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
- Department of Pharmacy, Kindai University Hospital, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - A Maeda
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
| | - T Hoshida
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - K Tanabe
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - S Nishida
- Division of Pharmacotherapy, Kindai University School of Pharmacy, Kowakae, Higashi-Osaka, Japan.
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12
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Nakanishi Y, Matsumoto S, Okubo N, Tanabe K, Kataoka M, Yajima S, Masuda H. Significance of position of vesico-urethral anastomosis together with postoperative membranous urethral length for short term continence recovery following robot-assisted laparoscopic radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01212-x] [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: 11/24/2022]
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13
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Yajima S, Nakanishi Y, Okubo N, Matsumoto S, Tanabe K, Kataok M, Masuda H. Mini-Cog to predict postoperative delirium in patients who underwent Transurethral Resection of Bladder Tumor (TURBT) under spinal anesthesia. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00107-5] [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: 11/25/2022]
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14
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Smart A, Wo J, Ferrone C, Tanabe K, Lillemoe K, Clark J, Blaszkowsky L, Allen J, Weekes C, Ryan D, Warshaw A, Fernandez-del Casti C, Hong T, Keane F. Clinical Correlates of Portal Venous or Superior Mesenteric Vein Thrombosis Following Neoadjuvant Therapy with Dose Escalated Radiation for Borderline Resectable or Locally Advanced Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.442] [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: 10/20/2022]
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15
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Endo A, Yasuda Y, Kawahara H, Kagawa Y, Sakamoto T, Ouchi T, Watanabe N, Yamaguchi K, Yoshitomi H, Tanabe K. The effectiveness of strict low-density lipoprotein cholesterol management in secondary prevention of Japanese patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2564] [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
In Japanese guidelines, target value of low-density lipoprotein cholesterol (LDL-C) <100mg/dL is recommended as standard management for secondary prevention of coronary artery disease. On the other hand, the guidelines also state that LDL-C targeting <70mg/dL should be considered in high-risk patients. However, the effectiveness of strict LDL-C management in the prevention of long-term coronary event recurrence in Japanese patients remains unclear.
Purpose
The purpose of the present study was to evaluate whether the strict management of LDL-C targeting <70 mg/dL was effective to prevent recurrence of acute coronary syndrome (ACS) than standard management in patients with previous percutaneous coronary intervention (PCI).
Methods
From January 2007 to August 2020, we performed coronary angiography in 359 patients with previous PCI who were suspected of having signs of recurrent cardiac ischemia. Patients were stratified into three groups according to achieved LDL-C value; <70mg/dL (n=57), 70 to <100mg/dL (n=135) and ≥100mg/dL (n=167). In addition, patients who had previous ACS and/or diabetes mellitus were defined as high-risk group, and sub-analysis by their achieved LDL-C values was performed in high-risk group and non-high-risk group. Endpoint was recurrence of ACS. Moreover, risk factors associated with recurrent-ACS were examined in patients with LDL-C <100 mg/dL.
Results
After follow-up (median 6.1 years), 99 patients (28%) had recurrent-ACS. Recurrent-ACS was significantly lower in patients with LDL-C <70mg/dL than LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p<0.01 and p<0.001, respectively). In sub-analysis, high-risk group with LDL-C <70 mg/dL had lower incidence of recurrent-ACS than LDL-C 70 to <100 mg/dL (p=0.03). Similar tendency was found in non-high-risk group (p=0.08). There was no difference of recurrent-ACS between high-risk group and non-high-risk group in patients with LDL-C <70mg/dL (p=0.41). Moreover, in patients with achieved LDL-C <100mg/dL (n=192), multivariate analysis identified that LDL-C (HR: 1.032, p<0.01) and HbA1c (HR: 1.330, p<0.01) were independent predictors of recurrent-ACS. In these patients, whether or not they were in the high-risk group was not a significant predictor (p=0.61).
Conclusions
Strict management of LDL-C targeting <70 mg/dL should be considered for a wider range of Japanese patients as well as for Westerners to prevent recurrence of ACS in secondary prevention.
Funding Acknowledgement
Type of funding sources: None. Probability of freedom from ACS
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Affiliation(s)
- A Endo
- Shimane University Faculty of Medicine, Izumo, Japan
| | - Y Yasuda
- Shimane University Faculty of Medicine, Izumo, Japan
| | - H Kawahara
- Shimane University Faculty of Medicine, Izumo, Japan
| | - Y Kagawa
- Shimane University Faculty of Medicine, Izumo, Japan
| | - T Sakamoto
- Shimane University Faculty of Medicine, Izumo, Japan
| | - T Ouchi
- Shimane University Faculty of Medicine, Izumo, Japan
| | - N Watanabe
- Shimane University Faculty of Medicine, Izumo, Japan
| | - K Yamaguchi
- Shimane University Faculty of Medicine, Izumo, Japan
| | | | - K Tanabe
- Shimane University Faculty of Medicine, Izumo, Japan
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Lin Z, Sojoodi M, Tang H, Wang Y, Tanabe K, Lanuti M. P68.02 Losartan Enhances Lung Squamous Cell Carcinoma’s Sensitivity to Cisplatin Treatment By Promoting Mesenchymal to Epithelial Transformation. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.689] [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: 10/20/2022]
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17
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Komeda M, Toh Y, Tanabe K, Kitamura Y, Misawa T. First demonstration experiment of the neutron rotation method for detecting nuclear material. ANN NUCL ENERGY 2021. [DOI: 10.1016/j.anucene.2021.108300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Iijima N, Yamauchi J, Yagishita N, Araya N, Aratani S, Tanabe K, Sato T, Takata A, Yamano Y. Clinical course of neurogenic bladder dysfunction in human T-cell leukemia virus type-1-associated myelopathy/tropical spastic paraparesis: a nationwide registry study in Japan. Orphanet J Rare Dis 2021; 16:355. [PMID: 34372895 PMCID: PMC8351405 DOI: 10.1186/s13023-021-01990-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most patients with human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) develop neurogenic bladder dysfunction. However, longitudinal changes and treatment effects remain poorly understood. This study aimed to characterize the clinical course of urinary dysfunction in this population. METHODS This prospective observational study included 547 patients enrolled in HAM-net, a nationwide registry for HAM/TSP in Japan. Urinary dysfunction severity was evaluated using the HAM/TSP-bladder dysfunction symptom score (HAM-BDSS) and the HAM/TSP-bladder dysfunction severity grade (HAM-BDSG). These specific measures were recently developed for assessing urinary dysfunction in HAM/TSP. We analyzed longitudinal changes over a 6-year follow-up period, associations between urinary and gait dysfunction, and treatment efficacy of urinary catheterization and mirabegron (a β3-adrenergic agonist for overactive bladder symptoms). RESULTS The mean (standard deviation [SD]) age and disease duration at enrollment were 61.9 (10.7) years and 16.6 (11.6) years, respectively, and 74.6% of patients were women. Only 8.0% were free from urinary symptoms (HAM-BDSG 0), 65.4% had urinary symptoms or were on medication (HAM-BDSG I), and 23.2% and 3.3% used intermittent and indwelling catheters (HAM-BDSG II and III), respectively. HAM-BDSG and BDSS were worse in patients with greater gait dysfunction (p < 0.001 for both). During the 6-year follow-up, 66.7% of patients with HAM-BDSG 0 developed new urinary symptoms. Of those with HAM-BDSG I at enrollment, 10.8% started using urinary catheters. Importantly, HAM-BDSS significantly improved after initiating catheterization (mean [SD] change, - 8.93 [10.78], p < 0.001). The number of patients receiving mirabegron increased in the fourth year. Multivariable linear regression analysis significantly associated mirabegron with improvement in HAM-BDSS (- 5.82, 95% confidence interval - 9.13 to - 2.51, p = 0.001). CONCLUSIONS Urinary dysfunction affected 92% of patients and progressed over the 6-year follow-up. Urinary symptoms were more severe in patients with poorer gait function. Urinary catheterization and mirabegron were effective in relieving symptoms. Effective utilization of real-world data is key to establishing evidence for rare diseases, such as HAM/TSP.
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Affiliation(s)
- Naoki Iijima
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan
| | - Junji Yamauchi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan.,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoko Yagishita
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Natsumi Araya
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Satoko Aratani
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.,LSI Medience Co., Tokyo, Japan
| | - Kenichiro Tanabe
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Sato
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan.,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ayako Takata
- Department of Preventive Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, 2168511, Japan. .,Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan.
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Arai H, Bujo H, Masuda D, Ishibashi T, Nakagawa S, Tanabe K, Kagimura T, Kang HJ, Kim MH, Sung J, Kim SH, Kim CH, Park JE, Ge J, Oh BH, Kita T, Saito Y, Fukushima M, Matsuzawa Y, Yamashita S. Integrated Analysis of Two Probucol Trials for the Secondary Prevention of Atherosclerotic Cardiovascular Events: PROSPECTIVE and IMPACT. J Atheroscler Thromb 2021; 29:850-865. [PMID: 33867420 PMCID: PMC9174092 DOI: 10.5551/jat.62821] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims: In this study, we integrated two randomized control trials, PROSPECTIVE and IMPACT, to address the effect of probucol on cerebrocardiovascular events and carotid intima-media thickness (IMT) in Japanese, Korean, and Chinese patients with coronary artery disease (CAD).
Methods: A total of 1,025 patients from the PROSPECTIVE and IMPACT studies were enrolled. The time to the first major adverse cerebrocardiovascular event, in addition to carotid IMT and lipid levels, was compared between the control and probucol groups.
Results: In the integrated analysis, the adjusted hazard ratio (HR) and 95% confidence interval (CI) were 0.67 and 0.44–1.03, respectively, indicating a tendency to show the effect of probucol on cerebrocardiovascular events in secondary prevention. We also found no significant differences between the control and probucol groups in the mean IMT of the carotid arteries and its changes. However, we found a significant decrease in cerebrocardiovascular events in patients with reduced levels of HDL cholesterol (HDL-C) (≥ 6.25 mg/dL) compared with those with levels <6.25 mg/dL (p=0.024), without any increase in adverse events such as severe ventricular arrhythmias.
Conclusion: We demonstrated a marginal effect of probucol on cerebrocardiovascular events in Asian patients with CAD, with reasonable safety profiles. A larger study may be needed to support the effect of probucol for cardiovascular prevention.
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Affiliation(s)
| | - Hideaki Bujo
- Department of Clinical Laboratory and Experimental Research Medicine, Toho University, Sakura Medical Center
| | - Daisaku Masuda
- Rinku Innovation Center for Wellness Care and Activities (RICWA), Rinku General Medical Center
| | | | - Satoshi Nakagawa
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | - Kenichiro Tanabe
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | - Tatsuo Kagimura
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital and University College of Medicine, Seoul National University
| | | | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center
| | - Sang-Hyun Kim
- Department of Internal Medicine, Seoul Boramae Hospital and Seoul National University College of Medicine
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | | | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University
| | - Byung-Hee Oh
- Department of Cardiology, Incheon Sejong Hospital, Incheon
| | | | | | - Masanori Fukushima
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
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Kobayashi K, Okuno N, Arai G, Nakatsu H, Maniwa A, Kamiya N, Satoh T, Kikukawa H, Nasu Y, Uemura H, Nakashima T, Mikami K, Iinuma M, Tanabe K, Furukawa J, Kobayashi H. Efficacy and safety of abiraterone acetate plus prednisolone in patients with early metastatic castration-resistant prostate cancer who failed first-line androgen-deprivation therapy: a single-arm, phase 4 study. Jpn J Clin Oncol 2021; 51:544-551. [PMID: 33324967 PMCID: PMC8012350 DOI: 10.1093/jjco/hyaa225] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
Aim The aim was to evaluate the efficacy and safety of abiraterone acetate plus prednisolone in patients with chemotherapy-naïve early metastatic castration-resistant prostate cancer who failed first-line androgen deprivation therapy. Methods Patients with early metastatic castration-resistant prostate cancer with confirmed prostate-specific antigen progression within 1-year or prostate-specific antigen progression without having normal prostate-specific antigen level (<4.0 ng/mL) during first-line androgen deprivation therapy were enrolled and administered abiraterone acetate (1000 mg) plus prednisolone (10 mg). A minimum of 48 patients were required according to Simon’s minimax design. The primary endpoint was prostate-specific antigen response rate (≥50% prostate-specific antigen decline by 12 weeks), secondary endpoints included prostate-specific antigen progression-free survival and overall survival. Safety parameters were also assessed. Results For efficacy, 49/50 patients were evaluable. Median age was 73 (range: 55–86) years. The median duration of initial androgen deprivation therapy was 32.4 (range: 13.4–84.1) weeks and 48 patients experienced prostate-specific antigen progression within 1-year after initiation of androgen deprivation therapy. prostate-specific antigen response rate was 55.1% (95% confidence interval: 40.2%–69.3%), median prostate-specific antigen–progression-free survival was 24.1 weeks, and median overall survival was 102.9 weeks (95% confidence interval: 64.86 not estimable [NE]). Most common adverse event was nasopharyngitis (15/50 patients, 30.0%). The most common ≥grade 3 adverse event was alanine aminotransferase increased (6/50 patients, 12.0%). Conclusions Abiraterone acetate plus prednisolone demonstrated a high prostate-specific antigen response rate of 55.1%, suggesting tumor growth still depends on androgen synthesis in patients with early metastatic castration-resistant prostate cancer. However, prostate-specific antigen–progression-free survival was shorter than that reported in previous studies. Considering the benefit–risk profile, abiraterone acetate plus prednisolone would be a beneficial treatment option for patients with chemotherapy-naive metastatic prostate cancer who show early castration resistance.
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Affiliation(s)
- K Kobayashi
- Department of Urology, Federation of National Public Service Personnel Mutual Aid Associations Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - N Okuno
- Department of Urology, Independent Administrative Institution National Hospital Organization Sagamihara Hospital, Kanagawa, Japan
| | - G Arai
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - H Nakatsu
- Department of Urology, Asahi General Hospital, Chiba, Japan
| | - A Maniwa
- Department of Urology, Independent Administrative Institution National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - N Kamiya
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - T Satoh
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - H Kikukawa
- Department of Urology, Independent Administrative Institution National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Y Nasu
- Department of Urology, Japan Organization of Occupational Health and Safety Okayama Rosai Hospital, Okayama, Japan
| | - H Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Kanagawa, Japan
| | - T Nakashima
- Department of Urology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - K Mikami
- Department of Urology, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - M Iinuma
- Department of Urology, Independent Administrative Institution National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - J Furukawa
- Department of Urology, National University Corporation Kobe University Hospital, Hyogo, Japan
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Morimoto K, Matsui M, Samejima K, Kanki T, Nishimoto M, Tanabe K, Murashima M, Eriguchi M, Akai Y, Iwano M, Shiiki H, Yamada H, Kanauchi M, Dohi K, Tsuruya K, Saito Y. Renal arteriolar hyalinosis, not intimal thickening in large arteries, is associated with cardiovascular events in people with biopsy-proven diabetic nephropathy. Diabet Med 2020; 37:2143-2152. [PMID: 32276289 DOI: 10.1111/dme.14301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
AIMS Diabetic nephropathy, a pathologically diagnosed microvascular complication of diabetes, is a strong risk factor for cardiovascular events, which mainly involve arteries larger than those affected in diabetic nephropathy. However, the association between diabetic nephropathy pathological findings and cardiovascular events has not been well studied. We aimed to investigate whether the pathological findings in diabetic nephropathy are closely associated with cardiovascular event development. METHODS This retrospective cohort study analysed 377 people with type 2 diabetes and biopsy-proven diabetic nephropathy, with a median follow-up of 5.9 years (interquartile range 2.0 to 13.5). We investigated how cardiovascular events were impacted by two vascular diabetic nephropathy lesions, namely arteriolar hyalinosis and arterial intimal thickening, and by glomerular and interstitial lesions. RESULTS Of the 377 people with diabetic nephropathy, 331 (88%) and 295 (78%) had arteriolar hyalinosis and arterial intimal thickening, respectively. During the entire follow-up period, those with arteriolar hyalinosis had higher cardiovascular event rates in the crude Kaplan-Meier analysis than those without these lesions (P = 0.005, log-rank test). When fully adjusted for clinically relevant confounders, arteriolar hyalinosis independently predicted cardiovascular events [hazard ratio (HR) 1.99; 95% confidence interval (CI) 1.12, 3.86], but we did not find any relationship between arterial intimal thickening and cardiovascular events (HR 0.89; 95% CI 0.60, 1.37). Additionally, neither glomerular nor interstitial lesions were independently associated with cardiovascular events in the fully adjusted model. CONCLUSIONS Arteriolar hyalinosis, but not intimal thickening of large arteries, was strongly associated with cardiovascular events in people with diabetic nephropathy.
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Affiliation(s)
- K Morimoto
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - M Matsui
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - K Samejima
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - T Kanki
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - M Nishimoto
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - K Tanabe
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - M Murashima
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - M Eriguchi
- Department of Nephrology, Nara Medical University, Nara, Japan
| | - Y Akai
- Department of Nephrology, Nara Medical University, Nara, Japan
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - M Iwano
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - H Shiiki
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - H Yamada
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - M Kanauchi
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - K Dohi
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - K Tsuruya
- Department of Nephrology, Nara Medical University, Nara, Japan
| | - Y Saito
- First Department of Internal Medicine, Nara Medical University, Nara, Japan
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22
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Endo A, Kagawa Y, Sato H, Morita Y, Kawahara H, Yasuda Y, Ouchi T, Watanabe N, Yamaguchi K, Yoshitomi H, Tanabe K. Effectiveness of more strict managements after achievement of standard target value of low-density lipoprotein cholesterol in secondary prevention of Japanese patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2987] [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
In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL is recommended as standard management in Japanese guideline. The guideline also stated that strict management of LDL-C targeting <70 mg/dL is considered in some high risk patients. However, in Japanese patients, effectiveness of more strict management of LDL-C lowering therapy for prevention of long-term cardiovascular events remains unclear.
Purpose
The purpose of the present study was to evaluate whether the strict management of LDL-C targeting <70 mg/dL was effective to prevent recurrence of long-term coronary events than standard management in patients with previous percutaneous coronary intervention (PCI).
Methods
We investigated 344 patients with previous PCI who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C <70mg/dL (n=53), 70 to <100mg/dL (n=130) and ≥100mg/dL (n=161). Endpoints of this study were recurrence of cardiac ischemia presenting as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.
Results
During average 7.1 years follow-up, 200 patients (58%) underwent any late coronary revascularization. In 94 of those patients, recurrence-ACS was observed. The incidence of recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.009 and p=0.001, respectively), however, there was no difference between patients with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.140). Any late revascularization was significantly lower in patients with achieved LDL-C <70mg/dL and in those with LDL-C 70 to <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.002 and p<0.001, respectively), however, no difference was found between patients with LDL-C <70mg/dL and LDL-C 70 to <100mg/dL (p=0.119). Moreover, in patients with achieved LDL-C <100mg/dL (n=183), multivariate analysis identified that LDL-C (HR 1.035, p=0.007) and HbA1c (HR 1.338, p=0.001) were independent predictors of recurrence-ACS. In contrast, only using statins (HR 0.461, p=0.009) was an independent predictor of recurrence-ACS in patients with achieved LDL-C ≥100mg/dL.
Conclusions
LDL-C was the important residual risk of recurrence-ACS even after recommended standard LDL-C lowering management had been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered to prevent recurrence-ACS for wider range of Japanese patients in secondary prevention.
Incidence of late coronary events
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Endo
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - Y Kagawa
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - H Sato
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - Y Morita
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - H Kawahara
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - Y Yasuda
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - T Ouchi
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - N Watanabe
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - K Yamaguchi
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | | | - K Tanabe
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
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23
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Sakamoto T, Ito S, Endo A, Yoshitomi H, Tanabe K. Classification of HFrEF based on echocardiography using machine learning to predict future HFrecEF events. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0923] [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
In recent years, there have been sporadic reports of heart failure with recovered ejection fraction (HFrecEF), wherein the left ventricular EF (LVEF) has been improved by considering temporal changes in the LVEF. Although patients with HFrecEF are known to have a better prognosis than other groups, the type of heart failure associated with reduced EF (HFrEF) that subsequently transitions to HFrecEF is yet to be determined.
Purpose
In this study, we examined whether it is possible to predict future HFrecEF events by stratifying the HFrEF using machine learning based on previously recorded echocardiographic indices.
Methods
For 162 patients, with HFrEF and a history of hospitalization owing to heart failure, who underwent echocardiography in a stable hemodynamic state, stratification was performed via machine learning. Regarding temporal changes in the LVEF, 73 patients who underwent another echocardiography under stable conditions were investigated (52 with continued HFrEF and 21 with HFrecEF, with a median follow up of 397 days). HFrEF was defined as a condition for patients with an LVEF of less than 50%, and HFrecEF was defined as a condition for patients who initially had an LVEF of less than 50% but later improved. Patients with severe valvular disease, acute myocardial infarction, acute myocarditis, acute pulmonary embolism, post-cardiac surgery, and pericardial disease were excluded from this group. The random forest method was used as a classification method for machine learning.
Results
When 162 patients with HFrEF were stratified using machine learning, 63 were classified into Cluster 1 and 99 into Cluster 2. Cluster 1 patients showed a significantly higher tendency to transition to HFrecEF than Cluster 2 patients (p=0.001). The Gini coefficient was calculated to identify echocardiographic indices that are important for the purpose of stratification. As a result, LVEF, left ventricular endo-diastolic volume (LVEDV), the thickness of interventricular septum (IVSth), E/A ratio, and the maximum diameter of the inferior vena cava were found to be particularly important. Compared to Cluster 2 patients, Cluster 1 patients exhibited a significantly higher LVEF (41.5±5.9% vs 27.0±7.6%, p<0.001), lower LVEDV (93.6±36.8 mL vs 141.1±51.7 mL, p<0.001), and a higher IVSth (10.8±2.6 mm vs 9.4±2.5 mm, p<0.001).
Conclusion
Stratifying HFrEF via machine learning based on echocardiographic indices can help predict temporal changes in the LVEF and deduce the echocardiographic indices useful for improving LVEF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Sakamoto
- Shimane University Hospital, Izumo, Japan
| | - S Ito
- Shimane University Hospital, Izumo, Japan
| | - A Endo
- Shimane University Hospital, Izumo, Japan
| | | | - K Tanabe
- Shimane University Hospital, Izumo, Japan
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24
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Mikami M, Tanabe K, Matsuo K, Ikeda M, Hayashi M, Yasaka M, Machida H, Shida M, Hirasawa T, Imanishi T. Early ovarian cancer detection by deep learning: Two-dimensional comprehensive serum glycopeptide spectra analysis. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Yoshida K, Takagi T, Kondo T, Iizuka J, Kobayashi H, Fukuda H, Ishihara H, Okumi M, Ishida H, Tanabe K. Usefulness of robot-assisted laparoscopic partial nephrectomy using trifecta criteria. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33923-9] [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: 11/29/2022] Open
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26
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Toshio T, Morita S, Toguchi M, Ogawa Y, Yoshida K, Iizuka J, Kondo T, Fukuda H, Ishihara H, Nagashima Y, Tanabe K. Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy, using enhanced CT. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33082-2] [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: 10/23/2022] Open
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27
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Hayashi T, Maruyama S, Nangaku M, Narita I, Hirakata H, Tanabe K, Morita S, Tsubakihara Y, Imai E, Akizawa T. Darbepoetin Alfa in Patients with Advanced CKD without Diabetes: Randomized, Controlled Trial. Clin J Am Soc Nephrol 2020; 15:608-615. [PMID: 32245781 PMCID: PMC7269223 DOI: 10.2215/cjn.08900719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/30/2019] [Accepted: 03/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Large, randomized, controlled trials targeting higher hemoglobin level with erythropoiesis-stimulating agents for Western patients with CKD showed harm. However, the effect of anemia correction using erythropoiesis-stimulating agents may differ between CKD subpopulations. The Prevention of ESKD by Darbepoetin Alfa in CKD Patients with Non-diabetic Kidney Disease study, a multicenter, randomized, open-label, parallel-group study, aimed to examine the effect of targeting hemoglobin levels of 11-13 g/dl using darbepoetin alfa with reference to a low-hemoglobin target of 9-11 g/dl on kidney outcome in patients with advanced CKD without diabetes in Japan. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled 491 patients with CKD without diabetes, and an eGFR of 8-20 ml/min per 1.73 m2. Of these 491 patients, 239 and 240 were ultimately assigned to the high- and low-hemoglobin groups, respectively (12 patients were excluded). The primary outcome was a kidney composite end point (starting maintenance dialysis, kidney transplantation, eGFR≤6 ml/min per 1.73 m2, and 50% reduction in eGFR). RESULTS Mean hemoglobin levels were 11.2±1.1 and 10.0±0.9 g/dl in the high- and low-hemoglobin groups, respectively, during the mean study period of 73.5±29.7 weeks. The kidney composite end point occurred in 105 (44%) and 116 (48%) patients in the high- and low-hemoglobin groups, respectively (log-rank test; P=0.32). The adjusted Cox proportional hazards model showed that the hazard ratio for the high- versus low-hemoglobin group was 0.78 (95% confidence interval, 0.60 to 1.03; P=0.08). Cardiovascular events occurred in 19 (8%) and 16 (7%) patients in each group, respectively, with no significant between-group difference (log-rank test; P=0.66). CONCLUSIONS Targeting a higher hemoglobin level (11-13 g/dl) with darbepoetin alfa did not improve kidney outcome compared with targeting a lower hemoglobin level (9-11 g/dl) in patients with advanced CKD without diabetes. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Prevention of ESKD by Darbepoetin Alfa in CKD Patients with Non-diabetic Kidney Disease (PREDICT), NCT01581073.
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Affiliation(s)
- Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | | | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University, Niigata, Japan
| | | | - Kenichiro Tanabe
- Division of Health Data Science, Translational Research Center for Medical Innovation, Kobe, Japan
| | - Satoshi Morita
- Biomedical Statistics and Bioinformatics, Kyoto University, Kyoto, Japan
| | | | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Japan
| | - Tadao Akizawa
- Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
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28
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Yamashita S, Arai H, Bujo H, Masuda D, Ohama T, Ishibashi T, Yanagi K, Doi Y, Nakagawa S, Yamashiro K, Tanabe K, Kita T, Matsuzaki M, Saito Y, Fukushima M, Matsuzawa Y. Probucol Trial for Secondary Prevention of Atherosclerotic Events in Patients with Coronary Heart Disease (PROSPECTIVE). J Atheroscler Thromb 2020; 28:103-123. [PMID: 32336695 PMCID: PMC7957028 DOI: 10.5551/jat.55327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Although intensive statin therapy reduced cardiovascular risks, cardiovascular events have not been completely prevented. Probucol is a potent antioxidant and reduces tendon xanthomas in familial hypercholesterolemia patients despite reduction of high-density lipoprotein (HDL)-cholesterol (HDL-C). We investigated whether probucol can reduce cardiovascular events on top of conventional lipid-lowering therapy in patients with coronary heart disease (CHD). METHODS PROSPECTIVE is a multicenter, randomized, prospective study that recruited 876 Japanese patients with CHD and dyslipidemia with a low-density lipoprotein (LDL)-cholesterol (LDL-C) level of ≥ 140 mg/dL without medication or those treated with lipid-lowering drugs. Lipid-lowering agents were administered during the study period in the control group (n=438), and probucol 500 mg/day was added to lipid-lowering therapy in the probucol group (n=438). Patients were randomly assigned to two treatment groups by adjusting the LDL-C level and presence of diabetes and hypertension and followed up for more than 3 years. The primary end point was a composite of cerebrovascular and cardiovascular events (cardiovascular disease death including sudden death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina, hospitalization for heart failure, or coronary revascularization). The secondary end point was carotid intima-media thickness in a subset of patients. RESULTS The incidence of the primary end point showed a trend to be lower in the probucol group compared with that in the control group despite reduced HDL-C without serious adverse events. Anti-atherogenic effects of probucol may be attributed to its potent antioxidative function and enhancement of reverse cholesterol transport. CONCLUSION Since there was no statistical significance between the probucol and control groups despite a marked reduction of HDL-C, further studies on the clinical outcomes of probucol on top of conventional therapy may be necessary in the future (UMIN000003307).
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Affiliation(s)
- Shizuya Yamashita
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Community Medicine, Osaka University Graduate School of Medicine
| | | | - Hideaki Bujo
- Department of Clinical Laboratory and Experimental Research Medicine, Toho University, Sakura Medical Center
| | - Daisaku Masuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tohru Ohama
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry
| | | | | | | | - Satoshi Nakagawa
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | - Koichi Yamashiro
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | - Kenichiro Tanabe
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
| | | | | | | | - Masanori Fukushima
- Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe
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29
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Koshino K, Yamaguchi N, Oshima T, Hiroe K, Ohta Y, Okada S, Ohta T, Tanabe K. P1354 Prognostic value of the left ventricular longitudinal and circumferential function in patients with takotsubo syndrome during the acute phase. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.789] [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
Takotsubo syndrome is generally considered a benign disease with a reversible condition; however, hemodynamic and electrical instability during the acute phase exposes patients to the risk of serious adverse in-hospital events. The purpose of this study was to investigate the prognostic value of the left ventricular longitudinal and circumferential function in patients with TTS during the acute phase.
Methods
We divided the 27 patients with TTS (77.4 ± 10.2 years old, 21 females) into two groups; the severe group (SG) of 9 patients (in-hospital death, mechanical assist devices such as IABP or ECMO, oozing rupture) and non-severe group (NSG) of 18 patients. The echocardiographic examination on admission, catheter hemodynamic assessment, and laboratory data, and ST-T change in electrocardiogram were compared between two groups.
Results
There were no differences in age, laboratory data, electrocardiogram findings between the two groups. The LVEF was lower in SG (35.3 ± 6.1% vs. 45.9 ± 13.5%, p = 0.03). The index of Ballooning, the ratio of the systolic left ventricular diameter of ballooning segments to that of basal segments, was higher in SG (2.07 ± 0.61% vs.1.60 ± 0.32%, p = 0.016). The circumferential fractional shortening (CFS) of ballooning segments was lower in SG (4.6 ± 3.2% vs. 18.2 ± 8.2%, p = 0.00007), CFS of basal segments was not different between the two groups, and the ratio of CFS of ballooning segments to CFS of basal segments (CFS imbalance index) was lower in SG (5.60 ± 3.84 vs. 10.83 ± 3.92, p = 0.00003). The left ventricular longitudinal fractional shortening was lower in SG (0.12 ± 0.09 vs. 0.46 ± 0.19, p = 0.00003). The absolute value of GLS was lower in SG (7.6 ± 4.3% vs. 13.0 ± 3.6%, p = 0.002). In all three cases of in-hospital death, the CFS imbalance index was lower than 0.14.
Conclusion
In patients with TTS, left ventricular longitudinal and circumferential function could be related to serious adverse in-hospital events.
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Affiliation(s)
- K Koshino
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - N Yamaguchi
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - T Oshima
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - K Hiroe
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - Y Ohta
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - S Okada
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - T Ohta
- Matsue City Hospital, Cardiology, Matsue, Japan
| | - K Tanabe
- Shimane University, Cardiology, Izumo, Japan
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30
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Yamaguchi K, Yoshitomi H, Nakamura T, Okazaki K, Morita Y, Kawahara Y, Kagawa Y, Ouchi T, Sato H, Watanabe N, Endo A, Tanabe K. P1520 Aortic flow reversal caused by aortic regurgitation deteriorates renal function. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.943] [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
Chronic kidney disease is a growing public health problem. Renal dysfunction is known as a strong risk factor for cardiovascular disease and end-stage renal failure. The presence of pan-diastolic flow reversal in the abdominal aorta is a very specific sign of severe aortic regurgitation (AR). A higher aortic reverse/forward flow ratio is associated with lower intrarenal forward flow. However, the influence of AR on renal function has been poorly understood. We hypothesized that the aortic flow reversal reduces the renal artery forward flow and accordingly leads to renal dysfunction in patients with severe AR.
Methods
The study consisted of 21 consecutive patients (mean age 69 ± 11 years) with severe AR who underwent aortic valve replacement (AVR). We compared echocardiographic indices and the glomerular filtration rate (GFR) before and 603 ± 541 days after AVR.
Results
Blood pressure was 122 ± 16/54 ± 8 mmHg before AVR and 123 ± 16/76 ± 11 mmHg after AVR. After AVR, left ventricular (LV) end-diastolic dimension decreased from 57 ± 9 to 44 ± 5 mm and LV ejection fraction increased from 58 ± 12 to 60 ± 11 %. Estimated GFR significantly increased from 62.9 ± 18.9 to 71.8 ± 18.1 mL/min per 1.73 m2 after AVR (p = 0.003).
Conclusions An increase in aortic flow reversal caused by severe AR reduces forward flow into the kidney and thereby deteriorates renal function. This study demonstrated a key mediating role of central hemodynamic factors, particularly an exaggerated aortic flow reversal in renal dysfunction and severe AR.
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Affiliation(s)
- K Yamaguchi
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - H Yoshitomi
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - T Nakamura
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - K Okazaki
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - Y Morita
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - Y Kawahara
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - Y Kagawa
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - T Ouchi
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - H Sato
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - N Watanabe
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - A Endo
- Shimane University, Faculty of Medicine, Izumo, Japan
| | - K Tanabe
- Shimane University, Faculty of Medicine, Izumo, Japan
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31
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Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Fukunami M. P794Long-term prognostic value of the combination of AHEAD score and wasting syndrome in patients admitted for acute decompensated heart failure with reduced or preserved LV ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0393] [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
Comorbidities are associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in acute decompensated heart failure (ADHF) pts. On the other hand, heart failure is one of a number of disorders associated with the development of wasting syndrome. Previous studies have reported reduced mortality rates in heart failure patients with increased body mass index (BMI), so-called, obesity paradox. We sought to investigate the prognostic value of the combination of AHEAD score and the cachectic state in ADHF pts, relating to reduced or preserved LVEF (HFrEF or HFpEF).
Methods and results
We studied 303 pts admitted for ADHF and discharged with survival (HFrEF (LVEF <50%); n=163, HFpEF (LVEF ≥50%; n=140). We evaluated AHEAD score (range 0–5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) and wasting syndrome was defined as BMI <20 kg/m2 and serum albumin level (Alb) <3.2 g/dl at the discharge. During a follow-up period of 5.1±4.2 years, 121 pts died. At multivariate Cox analysis, AHEAD score and wasting syndrome was significantly and independently associated with the total mortality, in pts with not only HFrEF but also HFpEF. Pts with both high AHEAD score (≥3: AUC 0.625 [0.542–0.709] in HFrEF and ≥3: AUC 0.611 [0514–0.708] in HFpEF, by ROC curve analysis) and wasting syndrome had a higher risk of mortality than those with either and none of them in HFrEF (71% vs 51% vs 40%, p<0.0001, respectively) and HFpEF (78% vs 33% vs 24%, p<0.0001, respectively).
Conclusion
The combination of AHEAD score and wasting syndrome would be useful for stratifying patients at risk for the mortality in ADHF pts, regardless of HFrEF or HFpEF.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Endo A, Okada T, Kagawa Y, Sato H, Morita Y, Pak M, Ouchi T, Watanabe N, Yamaguchi K, Yoshitomi H, Tanabe K. P642What is the most important residual risk after achievement of appropriate low-density lipoprotein cholesterol lowering therapy in secondary prevention of Japanese patients? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0249] [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
In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100mg/dL with using statins is recommended as standard therapy in Japanese guideline. However, impact of residual risks after achievement of standard LDL-C lowering therapy was not fully examined. Furthermore, there is little information whether more strict management of LDL-C lowering is effective to prevent long-term cardiovascular events than standard management.
Purpose
The purpose of this study was to evaluate the relationship between residual risks after achievement of standard LDL-C lowering therapy and long-term coronary events in secondary prevention of Japanese patients.
Methods
From January 2007 to August 2018, 333 patients with previous percutaneous coronary intervention underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis. We defined appropriate LDL-C lowering therapy as achieved LDL-C <100mg/dL with using statins. Patients whose achieved LDL-C was <100mg/dL with using statins were classified as Appropriate-group (n=139), and patients who were not using statins or whose achieved LDL-C was ≥100mg/dL were classified as Inappropriate-group (n=194). Endpoints of the study were recurrence of cardiac ischemia as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.
Results
During average 7.1 years follow-up, 195 patients (59%) underwent any late coronary revascularization. In 91 of those patients, clinical presentation of recurrence-ACS was observed. Kaplan-Meier curve analysis revealed that the incidence of recurrence-ACS and any late coronary revascularization were significantly lower in Appropriate-group than in Inappropriate-group (p=0.017 and p<0.001, respectively). In Appropriate-group, recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL (p=0.042), however, any late revascularization was not different between the two groups. On the other hand, in Inappropriate-group, recurrence-ACS was significantly lower in patients with using statins than in those without using statins (p=0.038), and any late revascularization was less frequent in patients with achieved LDL-C <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.035). Moreover, multivariate analysis identified that only LDL-C was an independent predictor of recurrence-ACS in Appropriate-group (HR: 1.047, p=0.006), in contrast, LDL-C (HR: 1.008, p=0.020), using statins (HR: 0.555, p=0.034) and triglyceride (HR: 1.003, p=0.038) were independent predictors of recurrence-ACS in Inappropriate-group.
Conclusions
LDL-C was the most important residual risk of recurrence-ACS even after recommended standard therapy has been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered in secondary prevention of Japanese patients.
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Affiliation(s)
- A Endo
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - T Okada
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - Y Kagawa
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - H Sato
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - Y Morita
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - M Pak
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - T Ouchi
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - N Watanabe
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | - K Yamaguchi
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
| | | | - K Tanabe
- Shimane University Faculty of Medicine, Division of Cardiology, Izumo, Japan
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Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Fukunami M. P787Long-term prognostic value of the combination of fibrosis-4 index and acute kidney injury in patients with admitted for acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0386] [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
Liver dysfunction in patients with heart failure (HF) is caused by liver congestion, which is related to liver stiffness. It was reported that liver stiffness assessed by non-invasive fibrosis marker such as Fibrosis-4 (FIB4) index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) predicts mortality in HF pts. Acute kidney injury (AKI) during HF treatment is associated with poor outcome in pts admitted for acute decompensated heart failure (ADHF). However, there is no information available on the long-term prognostic significance of the combination of FIB4 index and AKI in ADHF pts.
Methods and results
We studied 299 ADHF pts with survival discharge. FIB4 index was calculated by the formula: age (yrs) × AST[U/L]/(platelets [103/μL] × (ALT[U/L])1/2). AKI during ADHF treatment was defined according to AKI Network criteria (stage 1: mild, stage 2: moderate, stage 3: severe). During a follow-up period of 4.3±3.3 yrs, 94 pts died. At multivariate Cox analysis, FIB4 index and stage2/3 AKI, but not stage1 AKI, significantly associated with total mortality, independently of prior HF hospitalization and serum sodium and blood urea nitrogen levels after adjustment with BMI, systolic blood pressure, hemoglobin, serum creatinine and albumin levels, left ventricular end-diastolic and left atrial dimension indexes. Pts with both greater FIB4 index (>2.674: median) and stage 2/3 AKI had a significantly higher risk of total mortality than those with none of them. Adjusted hazard ratio in pts with both greater FIB4 index and stage 2/3 AKI was 3.5 (95% CI 1.6–7.7), which was two-fold of that in pts with either of them (1.7 [95% CI 1.1–2.7]).
Conclusion
The combination of FIB4 index and moderate to severe AKI might identify higher risk subset for total mortality in ADHF pts.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Hayashi T, Yoshikawa T, Sakamaki K, Nishikawa K, Fujitani K, Tanabe K, Ito Y, Matsui T, Miki A, Fukunaga T, Nemoto H, Kimura Y, Hirabayashi N. Subgroup analyses of a randomized two-by-two factorial phase II trial comparing neoadjuvant chemotherapy with 2 and 4 courses of cisplatin/S-1 (CS) and docetaxel/cisplatin/S-1 (DCS) as neoadjuvant chemotherapy for locally advanced gastric cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.104] [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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35
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Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Yamamoto K, Kiyomi K, Kawahira M, Tanabe K, Fukunami M. P791Long-term prognostic value of pulmonary-systemic pressure ratio in patients admitted for acute decompensated heart failure with reduced or preserved left ventricular ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0390] [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
Concomitant presence of pulmonary hypertension in heart failure is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency. It has recently been shown that an increased mean pulmonary artery pressure to mean systemic arterial pressure ratio (MPS ratio), a marker of interventricular coupling and efficiency, is associated with worse clinical outcomes in patients with advanced heart failure. However, there is little information available on the long-term prognostic value of MPS ratio in patients with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF).
Methods and results
We studied 240 patients admitted for ADHF, who underwent right heart catheterization and were discharged with survival (HFrEF (LVEF≤40%); n=110, HFpEF (LVEF>40%); n=130). MPS ratio was obtained at the admission. During a mean follow-up period of 5.2±4.4 yrs, 59 patients had cardiovascular death (CVD). In both groups with HFrEF and HFpEF, MPS ratio was significantly greater in patients with than without CVD (HFrEF; 0.453±0.101 vs 0.382±0.116, p=0.0035, HFpEF; 0.374±0.118 vs 0.323±0.083, p=0.0091). At multivariate Cox regression analysis, MPS ratio was significantly associated with CVD, independently of eGFR and serum sodium level in HFrEF and HFpEF groups. Patients with high MPS ratio (>0.386 in HFrEF and >0.415 in HFpEF determined by ROC curve analysis) had a significantly increased risk of CVD than those with low MPS ratio in both groups.
Conclusions
MPS ratio could provide the long-term prognostic information in patients admitted for ADHF, regardless of reduced or preserved LVEF.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - K Kiyomi
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Fukunami M. P5409Plasma volume status provides the additional prognostic information to the Get With the Guidelines-Heart Failure risk score in acute decompensated heart failure patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0367] [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
The Get with The Guidelines (GWTG) heart failure (HF) risk score was developed in the GWTG inpatient HF registry to predict in-hospital mortality and also reported to be associated with post-discharge long-term outcomes. Plasma volume (PV) expansion plays an essential role in HF. Recently, it has been reported that PV is estimated by a simple formula based on hematocrit and body weight, not using radioisotope assays, and PV status provides prognostic information in patients (pts) with acute decompensated heart failure (ADHF). However, there is no information available on the long-term prognostic value of the combination of PV status and GWTG-HF risk score in pts admitted for ADHF.
Methods and results
We studied 301 ADHF pts discharged with survival. Variables required for the GWTG-HF risk score were race, age, systolic blood pressure, heart rate, serum levels of blood urea nitrogen and sodium, and the presence of chronic obstructive pulmonary disease. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). During a follow-up period of 4.3±3.2 yrs, 95 pts had all-cause death (ACD). At multivariate Cox analysis, GWTG-HF risk score and PV status were significantly associated with the total mortality, independently of eGFR and the prior history of heart failure hospitalization, after the adjustment with serum albumin level and anemia. Pts with both high GWTG-HF risk score (≥39 by ROC analysis; AUC 0.655 [0.586–0.724]) and greater PV status (≥8.1% by ROC analysis; AUC 0.624 [0.566–0.692]) had a significantly higher risk of ACD than those with either or none of them (58% vs 30% vs 21%, p<0.0001, respectively).
Conclusion
PV status would provide the additional long-term prognostic information to GWTG-HF risk score in ADHF pts.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Hibi K, Kozuma K, Sonoda S, Endo T, Tanaka H, Koshida R, Ishihara T, Kume T, Tanabe K, Morino Y, Ikari Y, Fujii K, Yamanaka T, Kimura K, Isshiki T. P2810Clinical outcomes 1 year after filter protection during percutaneous coronary intervention in patients with attenuated plaque identified by intravascular ultrasound. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1122] [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
In the VAMPIRE 3 (VAcuuM asPIration thrombus REemoval 3) trial, we have previously shown that selective use of distal filter protection during percutaneous coronary intervention (PCI) decreased the incidence of no-reflow phenomenon and was associated with fewer in-hospital serious adverse cardiac events than conventional PCI in patients with attenuated plaque ≥5mm. However, whether the early efficacy of distal embolic protection translate into long term clinical benefit is unknown.
Methods
Patients with acute coronary syndrome (ACS) with attenuated plaque ≥5mm were assigned to distal protection (DP) (n=98) or conventional treatment (CT) (n=96). The primary end point of the incidence of no-reflow phenomenon during PCI and the secondary end point of in-hospital serious adverse cardiac events has been reported previously. The rate of a major adverse events, a composite of death from any cause, non-fatal myocardial infarction, or unplanned target vessel revascularization (TVR) at 1 year was the prespecified secondary end point of the trial. All clinical endpoint events were adjudicated by an independent Clinical Event Committee.
Results
Major adverse events at 1 year occurred in 12 patients (12.2%) in the DP group and in 3 patients (3.1%) in the CT group (P=0.029). The difference was driven by a higher risk of TVR (11 [11.2%] vs. 2 [2.1%], p=0.018) in the DP group compared with the CT group. In patients treated with bare metal stents (n=42), major adverse events occurred in 25.0% of the patients in the DP group and in none of the patients in the CT group (P=0.029), whereas in patients treated with drug eluting stents (n=152), rates of major adverse events were similar between the groups (8.1% vs. 3.9%, p=0.32). Rates of cardiac death were not significantly different (1.0% vs. 1.0%, p=1.00). No definite stent thrombosis was observed in either group.
Conclusions
In the VAMPIRE 3 trial of patients with ACS with attenuated plaque ≥5mm, the 1-year rates of major adverse events in the distal protection group were higher than in the conventional treatment group. This effect could be mitigated by the use of drug eluting stents.
Acknowledgement/Funding
This work was supported in part by a grant from Nipro, Boston Scientific Corporation, and Japan Lifeline.
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Affiliation(s)
- K Hibi
- Yokohama City University Medical Center, Yokohama, Japan
| | - K Kozuma
- Teikyo University School of Medicine, Division of Cardiology, Tokyo, Japan
| | - S Sonoda
- University of Occupational and Environmental Health, Second Department of Internal Medicine, School of Medicine, Kitakyushu, Japan
| | - T Endo
- Saiseikai Yokohamashi Nanbu Hospital, Division of Cardiology, Yokohama, Japan
| | - H Tanaka
- Tokyo Metropolitan Tama Medical Center, Department of Cardiology, Tokyo, Japan
| | - R Koshida
- Toyohashi Heart Center, Department of Cardiovascular Medicine, Toyohashi, Japan
| | - T Ishihara
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - T Kume
- Kawasaki Medical School, Department of Cardiology, Okayama, Japan
| | - K Tanabe
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - Y Morino
- Iwate Medical University School of Medicine, Division of Cardiology, Department of Internal Medicine, Morioka, Japan
| | - Y Ikari
- Tokai University, Department of Cardiology, Isehara, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Department of Cardiology, Osaka, Japan
| | - T Yamanaka
- Yokohama City University, Department of Biostatistics, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - T Isshiki
- Ageo Central General Hospital, Division of Cardiology, Ageo, Japan
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Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Fukunami M. P795Long-term prognostic value of the combination of plasma volume status and pulmonary-systemic pressure ratio in patients admitted with acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0394] [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
Plasma volume (PV) expansion plays an essential role in heart failure and PV status provides prognostic information in patients (pts) with acute decompensated heart failure (ADHF). On the other hand, concomitant presence of pulmonary hypertension in heart failure is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency. It has recently been shown that an increased mean pulmonary artery pressure to mean systemic arterial pressure ratio (MPS ratio), a marker of interventricular coupling and efficiency, is associated with worse clinical outcomes in patients with advanced heart failure. However, there is no information available on the long-term prognostic value of the combination of PV status and MPS ratio in pts admitted for ADHF.
Methods
We studied 248 pts admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. PV status and MPS ratio were obtained at the admission. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). The study endpoint was cardiovascular death (CVD).
Results
During a mean follow-up period of 5.2±4.4 yrs, 62 pts had CVD. PV status (10.0±16.2 vs 5.0±15.3%, p=0.03) and MPS ratio (0.408±0.114 vs 0.347±0.102, p=0.0001) were significantly greater in patients with than without CVD. At multivariate Cox regression analysis, PV status and MPS ratio were significantly associated with CVD, independently of prior heart failure hospitalization, eGFR, and serum sodium level and anemia. Patients with greater PV status (> median value = 4.6%) and MPS ratio (> median value = 0.346) had a significantly higher CVD risk than those with either and none of them (44% vs 22% vs 14%, p<0.0001, respectively).
Conclusions
The combination of PV status and MPS ratio might be useful for stratifying patients at risk for CVD in patients with ADHF.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Furukawa Y, Yamada T, Morita T, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Kayama K, Kawahira M, Tanabe K, Fukunami M. P1031The impact of the duration of atrial fibrillation persistence for arrhythmia free survival in patients undergoing catheter ablation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0622] [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
Catheter ablation (CA) for atrial fibrillation (AF) is a curable treatment option. However, AF recurrence after CA remains an important problem. Although the success rate has been improved after catheter ablation (CA) in patients with paroxysmal AF (PAF), outcome data after CA for persistent AF (PeAF) are highly variable. Previous studies showed the PeAF is one of independent predictors for AF recurrence in comparison to PAF. However, there are little information available on the prognostic significance of AF duration after CA for AF. The aim of this study is to evaluate the impact of AF duration on long-term outcomes of AF ablation in patients with PeAF compared with PAF.
Methods
We enrolled 778 consecutive patients, who were referred our institution between August 2015 and December 2017 for undergoing the first time CA for AF. We divided 5 groups (Group 1; PAF (n=442), Group 2; PeAF duration ≤6 months (n=198), Group 3; PeAF duration of 6 months to 2 years (n=87), Group 4; PeAF duration of 2–5 years (n=30) and Group 5; PeAF duration ≥5 years (n=21)). All patients followed up for at least 1 year. Outcome data on recurrence of AF after ablation were collected.
Results
There were no significant differences in baseline clinical characteristics before CA among 5 groups, except for the prevalence of congestive heart failure, left atrial diameter and left ventricular ejection fraction. During a mean follow-up period of 511±298 days, 217 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (31% vs 20%, p=0.002) and in group 4 compared to group 3 (83% vs 30%, p<0.0001). However, AF recurrence was no significantly differences between groups 2 and 3 (31% vs 30%, p=0.76) and between groups 4 and 5 (83% vs 81%, p=0.45). Of 217 patients with AF recurrence, 154 patients had undergone multiple procedures. After last procedures, during a mean follow-up period of 546±279 days, 61 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (10% vs 3%, P=0.0005) and in group 4 compared with group 3 (35% vs 10%, p=0.0001). However, AF recurrence was no significantly difference between groups 2 and 3 (10% vs 10%, p=0.91) and between groups 4 and 5 (47% vs 35%, p=0.47).
AF Free Survival Curve
Conclusion
Although patients with PeAF within 2 years had significantly higher AF recurrence compared to PAF, AF ablation might still be a good contributor as the first line approach to improve outcomes in patient with PeAF within 2 years.
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Affiliation(s)
- Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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40
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Sakamoto T, Ito S, Uchida K, Kuroda H, Minoji T, Endo A, Yoshitomi H, Tanabe K. P2478Prognostic impact and severity assessment of combinational elastography in heart failure patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0809] [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
Heart failure (HF) causes liver congestion, which is thought to increase liver stiffness. Elastography is a noninvasive method of measuring organ stiffness that was originally developed to evaluate fibrosis caused by liver diseases such as cirrhosis. There are two main techniques of elastography: shear wave imaging and strain imaging. Shear wave imaging varies significantly due to the influence of not only fibrosis but also congestion, inflammation, and jaundice. In contrast, strain imaging in chronic liver disease reflects only the progression of liver fibrosis. We previously presented a method that is measuring both shear wave and strain imaging (combinational elastography) for assessing liver congestion. This study demonstrates the prognostic impact and severity assessment of combinational elastography in HF patients.
Methods
This study included 144 HF patients (age 76.4±12.3, men 67). The velocity of shear wave (Vs) values was measured with shear wave imaging. Fibrosis index (F Index) was calculated by measuring both shear wave and strain imaging.
Results
During a median follow-up of 161 days, 14 deaths or hospitalization for HF was observed. A multivariable cox regression analysis demonstrated that high vs values was dependently correlated with higher mortality rate and HF hospitalization (hazard ratio: 2.31; 95% confidence interval: 1.09–4.89; p=0.029). The Kaplan-Meier analysis demonstrated that high vs (>1.87 m/s) was associated with higher hospitalization rates for HF compared with low vs (≤1.87 m/s, log rank test, p<0.001). F index showed graded elevation as stage of HF progressed (stage A or B, C, D: 1.19±0.43, 1.38±0.56, 2.8±1.32; p<0.001).
Conclusion
Combinational elastography can predict the severity of HF.
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Affiliation(s)
- T Sakamoto
- Shimane University Hospital, Izumo, Japan
| | - S Ito
- Shimane University Hospital, Izumo, Japan
| | - K Uchida
- Masuda Red Cross Hospital, Masuda, Japan
| | - H Kuroda
- Masuda Red Cross Hospital, Masuda, Japan
| | - T Minoji
- Masuda Red Cross Hospital, Masuda, Japan
| | - A Endo
- Shimane University Hospital, Izumo, Japan
| | | | - K Tanabe
- Shimane University Hospital, Izumo, Japan
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Smart A, Hong T, Petkovska N, Noe B, Zhu A, Ferrone C, Tanabe K, Allen J, Drapek L, Qadan M, Murphy J, Goyal L, Wo J. Hypofractionated Radiation Therapy for Unresectable/Locally Recurrent Intrahepatic Cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1987] [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: 10/26/2022]
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42
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Imamura H, Sakai N, Ito Y, Sakai C, Hyodo A, Miyachi S, Matsumaru Y, Yoshimura S, Abe T, Yamagami H, Hayakawa M, Sato H, Fujinaka T, Tanabe K. Prospective Registry of Embolization of Intracranial Aneurysms Using HydroSoft Coils: Results of the Japanese HydroSoft Registry. World Neurosurg 2019; 127:e631-e637. [PMID: 30947007 DOI: 10.1016/j.wneu.2019.03.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/06/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The effect of HydroSoft coils on the prevention of recanalization and thrombosis after embolization is unclear. We herein report the results of the single-armed prospective Japanese HydroSoft Registry. METHODS Aneurysms with a diameter of <10 mm that were treated with a ≥50% length of HydroSoft coils were registered. We evaluated the safety and recanalization rate and analyzed the factors related to their recanalization and thrombosis 1 year later. RESULTS In total, 122 aneurysms were registered. Their mean maximum diameter and neck length were 6.4 and 3.9 mm, respectively. The mean length of the HydroSoft coils was 84.3%. No intracranial hemorrhage occurred, but 2 patients developed minor ischemic strokes. Angiographic examination immediately after the procedure showed complete obliteration, neck remnant (NR), and body filling (BF) in 20 (16.4%), 32 (26.2%), and 67 (54.9%) cases, respectively. One-year follow-up angiography showed complete obliteration, NR, and BF in 68 (55.7%), 15 (12.3%), and 15 (12.3%) cases, respectively, and 5 aneurysms (4.1%) were recanalized (4 and 1 with BF and NR as their initial angiographic result, respectively). Another 11 aneurysms still showed BF, although their thrombosis was promoted. No significant factors related to recanalization were identified. A high volume embolization ratio and small neck were significantly associated with thrombosis 1 year after embolization with HydroSoft coils. CONCLUSIONS The safety and prevention of recanalization 1 year after the treatment appeared acceptable. The high volume embolization ratio associated with HydroSoft coils could induce progression of thrombosis for aneurysms characterized by NR and BF during the follow-up period.
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Affiliation(s)
- Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan.
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Shinrakuen Hospital, Niigata, Japan
| | - Chiaki Sakai
- Department of Neurosurgery, Hyogo College of Medicine Hospital, Hyogo, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shigeru Miyachi
- Department of Neurological Surgery, Aichi Medical University, Aichi, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine Hospital, Hyogo, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroshi Yamagami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroaki Sato
- Department of Neuroendovascular Therapy, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kenichiro Tanabe
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Hyogo, Japan
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Takahashi Y, Matsushima M, Nishida T, Tanabe K, Kawabe T, Tamakoshi K. Obstetric factors associated with salivary cortisol levels of healthy full-term infants immediately after birth. CLIN EXP OBSTET GYN 2018. [DOI: 10.12891/ceog4088.2018] [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: 11/01/2022]
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44
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Freret M, Horick N, Raldow A, Noe B, Goyal L, Zhu A, Clark J, Allen J, Ferrone C, Fernandez-del Casti C, Tanabe K, Drapek L, Hong T, Wo J. Patterns of Failure and Need for Biliary Intervention among Patients with Biliary Tract Cancers Treated with Definitive Surgery and Adjuvant Chemoradiation. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.471] [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: 12/01/2022]
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45
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Sakamoto T, Ito S, Uchida K, Kuroda H, Minoji T, Endo A, Yoshitomi H, Tanabe K. P1500Evaluation of hepatic congestion on liver stiffness in patients with heart failure by shear wave and strain imaging (combinational elastography). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1500] [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 Sakamoto
- Shimane University Hospital, Izumo, Japan
| | - S Ito
- Shimane University Hospital, Izumo, Japan
| | - K Uchida
- Masuda Red Cross Hospital, Masuda, Japan
| | - H Kuroda
- Masuda Red Cross Hospital, Masuda, Japan
| | - T Minoji
- Masuda Red Cross Hospital, Masuda, Japan
| | - A Endo
- Shimane University Hospital, Izumo, Japan
| | | | - K Tanabe
- Shimane University Hospital, Izumo, Japan
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Yano S, Notsu Y, Yamaguchi K, Abe T, Yamada K, Nagai A, Tanabe K, Nabika T. Plasma level of trimethylamine-N-oxide is not correlated to the intima-media thickness in Japanese; Shimane cohre study. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.041] [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: 11/16/2022]
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47
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Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Kayama K, Kawahira M, Tanabe K, Fukunami M. P4747Long-term prognostic value of the serial change of pulse pressure during hospitalization in patients admitted for acute decompensated heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4747] [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 Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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48
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Komiyama K, Nakamura M, Tanabe K, Niikura H, Fujimoto H, Oikawa K, Daida H, Yamamoto T, Nagao K, Takayama M. P6421Development of the clinical scoring system to predict in-hospital mortality in patients with acute myocardial infarction; comparison with the GRACE risk score. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6421] [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)
- K Komiyama
- Tokyo CCU Network, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - K Tanabe
- Mitsui Memorial Hospital, Tokyo, Japan
| | | | | | | | - H Daida
- Tokyo CCU Network, Tokyo, Japan
| | | | - K Nagao
- Tokyo CCU Network, Tokyo, Japan
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49
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Okuno T, Koseki K, Nakanishi T, Ninomiya K, Tanaka T, Sato Y, Osanai A, Sato K, Koike H, Yahagi K, Komiyama K, Aoki J, Yokozuka M, Miura S, Tanabe K. P1669Prognostic impact of computed tomography-derived abdominal fat area in patients undergoing transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1669] [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 Okuno
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - K Koseki
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - T Nakanishi
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - K Ninomiya
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - T Tanaka
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - Y Sato
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - A Osanai
- Mitsui Memorial Hospital, Division of Cardiovascular Surgery, Tokyo, Japan
| | - K Sato
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - H Koike
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - K Yahagi
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - K Komiyama
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - J Aoki
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
| | - M Yokozuka
- Mitsui Memorial Hospital, Division of Anesthesia, Tokyo, Japan
| | - S Miura
- Mitsui Memorial Hospital, Division of Cardiovascular Surgery, Tokyo, Japan
| | - K Tanabe
- Mitsui Memorial Hospital, Division of Cardiology, Tokyo, Japan
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50
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Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Kayama K, Kawahira M, Tanabe K, Fukunami M. P922Model of end-stage liver disease excluding INR score provides additional prognostic information to the get with the guidelines-heart failure risk score in acute decompensated heart failure patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p922] [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 Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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