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Kawasaki M, Ambrosini YM. Differential Colonization and Mucus Ultrastructure Visualization in Bovine Ileal and Rectal Organoid-Derived Monolayers Exposed to Enterohemorrhagic Escherichia coli. Int J Mol Sci 2024; 25:4914. [PMID: 38732126 PMCID: PMC11084217 DOI: 10.3390/ijms25094914] [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: 04/02/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Enterohemorrhagic Escherichia coli (EHEC) is a critical public health concern due to its role in severe gastrointestinal illnesses in humans, including hemorrhagic colitis and the life-threatening hemolytic uremic syndrome. While highly pathogenic to humans, cattle, the main reservoir for EHEC, often remain asymptomatic carriers, complicating efforts to control its spread. Our study introduces a novel method to investigate EHEC using organoid-derived monolayers from adult bovine ileum and rectum. These polarized epithelial monolayers were exposed to EHEC for four hours, allowing us to perform comparative analyses between the ileal and rectal tissues. Our findings mirrored in vivo observations, showing a higher colonization rate in the rectum compared with the ileum (44.0% vs. 16.5%, p < 0.05). Both tissues exhibited an inflammatory response with increased expression levels of TNF-a (p < 0.05) and a more pronounced increase of IL-8 in the rectum (p < 0.01). Additionally, the impact of EHEC on the mucus barrier varied across these gastrointestinal regions. Innovative visualization techniques helped us study the ultrastructure of mucus, revealing a net-like mucin glycoprotein organization. While further cellular differentiation could enhance model accuracy, our research significantly deepens understanding of EHEC pathogenesis in cattle and informs strategies for the preventative measures and therapeutic interventions.
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Affiliation(s)
| | - Yoko M. Ambrosini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA;
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Kawasaki M, Ambrosini YM. Accessible luminal interface of bovine rectal organoids generated from cryopreserved biopsy tissues. PLoS One 2024; 19:e0301079. [PMID: 38512940 PMCID: PMC10956885 DOI: 10.1371/journal.pone.0301079] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
Developing precise species-specific in vitro models that closely resemble in vivo intestinal tissues is essential for advancing our understanding of gastrointestinal physiology and associated diseases. This is especially crucial in examining host-pathogen interactions, particularly in bovines, a known reservoir for microbes and pathogens posing substantial public health threats. This research investigated the viability of producing bovine rectal organoids from cryopreserved tissues. We compared two cryopreservation methods with a traditional technique using fresh tissues, evaluating their effectiveness through growth rates, long-term viability, and comprehensive structural, cellular, and genetic analyses. These assessments utilized phase-contrast imaging, immunofluorescence imaging, and RT-qPCR assays. Additionally, the study developed a sophisticated method for forming a functional epithelial barrier from organoid-derived bovine rectal monolayers, incorporating a wide range of epithelial cells. This methodology employed transepithelial electrical resistance (TEER), parallel artificial membrane permeability assay (Papp), confocal microscopy, and advanced imaging techniques like scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Our findings decisively show that bovine rectal organoids can be effectively generated from cryopreserved biopsy tissues. Moreover, we formulated a robust and optimized protocol for creating functional rectal monolayers from these organoids. This significant progress is particularly relevant given the susceptibility of the bovine rectum to various enteric pathogens of public health concern, marking a vital step forward in veterinary and biomedical research. The creation of accurate species specific in vitro models that faithfully mimic in vivo intestinal tissues is critical for enhancing our understanding of gut physiology and related pathologies. This is particularly relevant in studying the interactions between hosts and microbes or pathogens with significant public health risks where bovine can be the major reservoir.
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Affiliation(s)
- Minae Kawasaki
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
| | - Yoko M. Ambrosini
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, United States of America
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3
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Cantera JL, Rashid AA, Lillis LM, Peck RB, Drain PK, Shapiro AE, Wilson DPK, Pinter A, Kawasaki M, Moreau E, Boyle DS. Isolation and purification of lipoarabinomannan from urine of adults with active TB. Int J Tuberc Lung Dis 2023; 27:75-77. [PMID: 36853126 PMCID: PMC9879083 DOI: 10.5588/ijtld.22.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/12/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
| | | | | | | | - P K Drain
- Department of Global Health and Medicine, University of Washington, Seattle, WA, USA, Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A E Shapiro
- Department of Global Health and Medicine, University of Washington, Seattle, WA, USA
| | - D P K Wilson
- Umkhuseli Research and Innovation Management and University of Kwa-Zulu Natal, Pietermaritzburg, South Africa
| | - A Pinter
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | | | - E Moreau
- FIND, Geneva, Switzerland, Quotient Limited, Eysins, Switzerland
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4
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Miyauchi E, Kawasaki M. The frequency-dependent stimulation effects of rTMS on the performance of problem-solving tasks and ongoing oscillations. Eur Psychiatry 2022. [PMCID: PMC9565537 DOI: 10.1192/j.eurpsy.2022.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Recent studies suggest that online repetitive transcranial magnetic stimulation (rTMS) can induce local entrainment of ongoing endogenous oscillatory activity that impacts cognitive performance, and the effect may depend on the function of the oscillation. However, little is known about the effects of task-specific frequencies, especially when using an online rTMS paradigm. Our previous electroencephalogram (EEG) study showed that the frontal theta rhythm is associated with the cognitive giving-up processes during problem-solving tasks. Objectives In this study, we combined online rTMS and EEG to examine the frequency-dependent stimulation effects of rTMS on the performance of problem-solving tasks and ongoing oscillations. We hypothesized that rTMS at the theta frequency would induce ongoing theta activity and accelerate the giving-up behaviour. Methods rTMS was applied during problem-solving tasks with the following conditions: individual theta (4-6Hz)- and alpha (9-13Hz)-TMS, no-TMS, and sham-TMS; the order of conditions was counterbalanced across participants. Results Our results showed that theta-frequency rTMS application induced an increase in theta amplitudes and shortened the giving-up response, while a control alpha-frequency rTMS application induced an increase in alpha amplitudes, but did not change giving-up responses. Conclusions This study demonstrated the effectiveness of using specific task-relevant stimulation frequency and target location for the modulation of cognitive and behavioral performance. Furthermore, considering the close resemblance between giving-up behaviour and rumination in depression, neuromodulation of cognitive giving-up processes may lead to a new intervention to treat depression by rTMS. Disclosure No significant relationships.
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5
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Casini S, Marchal GA, Kawasaki M, Fabrizi B, Wesselink R, Nariswari FA, Neefs J, Van Den Berg NWE, Driessen AHG, De Groot JR, Verkerk AO, Remme CA. Differential sodium current remodelling in human left atrial appendage cardiomyocytes in paroxysmal and persistent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.608] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) is characterized by complex electrical, structural and metabolic remodelling. The mechanisms underlying AF progression from paroxysmal to persistent AF are not fully understood, and studies in cardiomyocytes (CMs) at the paroxysmal stage of AF are lacking. Moreover, most studies have so far investigated right atrial appendage CMs, while left atrial appendage (LAA) CMs may be more informative, as AF is predominantly a left atrial disease. Whether and to what extent electrical remodelling during various AF stages also includes alterations of the (late) sodium current (INa), remains unclear. Moreover, the functional relevance of sodium channel isoforms other than the cardiac Nav1.5, such as the "neuronal" isoform SCN10A/NaV1.8, during the various stages of AF is as yet not fully elucidated.
Purpose
To investigate peak and late INa remodelling in LAA CMs from patients with paroxysmal and persistent AF and patients in sinus rhythm (SR), as well as the potential contribution of NaV1.8-based current.
Methods
LAA were obtained from patients in SR (N=18) without a history of AF undergoing cardiac surgery, as well as from patients with paroxysmal (N=12) and persistent AF (N=30). Paroxysmal AF was defined as AF episodes terminating spontaneously within seven days and persistent as AF continuing for more than 7 days but less than 1 year. Peak INa, late INa and action potential (AP) properties were investigated through patch-clamp analysis on single LAA CMs, while qPCR was used to assess SCN5A and SCN10A expression levels in LAA tissue.
Results
In paroxysmal and persistent AF CMs, AP duration was shorter than in SR CMs. Compared to SR, peak INa (Figure 1A) and SCN5A expression (Figure 1B) were significantly decreased in paroxysmal AF, while they were restored to SR levels in persistent AF. Conversely, while late INa was undetectable in SR and paroxysmal AF, it was significantly increased in persistent AF (Figure 2). Peak and late INa Nav1.8-based current was not detected in persistent AF CMs. Similarly, expression of SCN10A was not observed in LAAs at any stage.
Conclusions
Our study is the first to show that AP shortening already occurs in LAA CMs from paroxysmal AF, potentially contributing to pro-arrhythmia in this early stage of the disease. Moreover, our findings demonstrate that INa is differentially remodelled during various stages of AF, with peak INa reduction occurring during paroxysmal AF, while late INa is increased in persistent AF only. Finally, we have shown that Nav1.8 current does not contribute to the AF-related alterations in INa. These observations are of particular relevance when considering potential pharmacological approaches targeting (late) INa in patients with distinct forms of AF.
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Affiliation(s)
- S Casini
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - GA Marchal
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - M Kawasaki
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - B Fabrizi
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - R Wesselink
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - FA Nariswari
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - J Neefs
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - NWE Van Den Berg
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - AHG Driessen
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - JR De Groot
- Amsterdam UMC - Location Academic Medical Center, Department of Cardiology, Amsterdam, Netherlands (The)
| | - AO Verkerk
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - CA Remme
- Amsterdam UMC - Location Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
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Meulendijks E, Krul SPJ, Baalman SW, Wesselink R, Al-Shama RF, Ernault CCE, Limpens J, Kawasaki M, Vries TAC, Neefs J, De Groot JR. Circulating adipokines involved in atrial fibrillation and obesity: a comprehensive scoping review. Europace 2022. [DOI: 10.1093/europace/euac053.052] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Received research grants (through institution) from Atricure Inc, Bayer, Boston Scientific, Daiichi Sankyo, Johnson&Johnson, Medtronic Received honoraria/speaker/consultancy fees from Abbott, AtriaN Medical, Atricure Inc, Bayer, Biotronik, CVOI, Daiichi Sankyo, IPP Med, Itreas, Medtronic, Novartis, Servier
Background
Obesity increases the risk of atrial fibrillation (AF). Obesity may induce or facilitate AF via adipokines, proteins secreted by metabolically active adipose tissue (AT). These adipokines potentially affect atrial electrical and structural remodeling. Therefore, adipokines could be targets in the management of AF.
Purpose
Here, we aim to give a comprehensive overview of circulating adipokines, defined as proteins expressed in adipose tissue, associated with pre-existing or new-onset AF as well as their relationship with obesity.
Methods
A systematic, explorative primary search was conducted for studies reporting corrected odds and hazard ratios (ORs, HRs) of adipokines in pre-existing AF, and in new-onset AF. Adipokine-ratios were aggregated into processes involved in AF substrate formation. Next, a secondary search was performed to investigate the association between the identified adipokines and obesity.
Results
Sixty-three distinct adipokines were identified, 49 in pre-existing AF (78 corrected ORs), and 34 in new-onset AF (76 corrected HRs). These included adipocyte specific adipokines as FABP4, and adipokines expressed by both adipocytes and other cells residing in the fat, as interleukin 6 (IL-6). The majority of identified adipokines were involved in inflammatory and fibrotic pathways. Most inflammatory adipokines were significantly increased in pre-existing AF (20/33ORs), and half in new-onset AF (14/28 HRs). Approximately half of the fibrotic adipokines were increased in pre-existing AF (12/25 ORs) and in new-onset AF (8/17 HRs). The secondary search showed that in obesity, most (33) of the 63 identified adipokines in AF were increased, including IL-6. Twenty-four were not affected, and 6 were decreased. Candidate pro-arrhythmogenic inflammatory, and fibrotic adipokines increased in both AF and obesity are shown in the figure.
Conclusion
Most pro-inflammatory and fibrotic circulating adipokines, associated with AF pathology, were either increased or showed a strong trend towards increased levels in both pre-existing and new-onset AF, as well as in obesity. Our review provides insight into the effect of obesity on circulating adipokines involved in AF substrate formation.
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Affiliation(s)
- E Meulendijks
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - SPJ Krul
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - SW Baalman
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - R Wesselink
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - RF Al-Shama
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - CCE Ernault
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - J Limpens
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - M Kawasaki
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - TAC Vries
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - J Neefs
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - JR De Groot
- University of Amsterdam, Amsterdam, Netherlands (The)
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Kawasaki M, Goyama T, Tachibana Y, Nagao I, Ambrosini YM. Farm and Companion Animal Organoid Models in Translational Research: A Powerful Tool to Bridge the Gap Between Mice and Humans. Front Med Technol 2022; 4:895379. [PMID: 35647577 PMCID: PMC9133531 DOI: 10.3389/fmedt.2022.895379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/13/2022] [Accepted: 04/26/2022] [Indexed: 12/19/2022] Open
Abstract
Animal organoid models derived from farm and companion animals have great potential to contribute to human health as a One Health initiative, which recognize a close inter-relationship among humans, animals and their shared environment and adopt multi-and trans-disciplinary approaches to optimize health outcomes. With recent advances in organoid technology, studies on farm and companion animal organoids have gained more attention in various fields including veterinary medicine, translational medicine and biomedical research. Not only is this because three-dimensional organoids possess unique characteristics from traditional two-dimensional cell cultures including their self-organizing and self-renewing properties and high structural and functional similarities to the originating tissue, but also because relative to conventional genetically modified or artificially induced murine models, companion animal organoids can provide an excellent model for spontaneously occurring diseases which resemble human diseases. These features of companion animal organoids offer a paradigm-shifting approach in biomedical research and improve translatability of in vitro studies to subsequent in vivo studies with spontaneously diseased animals while reducing the use of conventional animal models prior to human clinical trials. Farm animal organoids also could play an important role in investigations of the pathophysiology of zoonotic and reproductive diseases by contributing to public health and improving agricultural production. Here, we discuss a brief history of organoids and the most recent updates on farm and companion animal organoids, followed by discussion on their potential in public health, food security, and comparative medicine as One Health initiatives. We highlight recent evolution in the culturing of organoids and their integration with organ-on-a-chip systems to overcome current limitations in in vitro studies. We envision multidisciplinary work integrating organoid culture and organ-on-a-chip technology can contribute to improving both human and animal health.
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Affiliation(s)
- Minae Kawasaki
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Takashi Goyama
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Yurika Tachibana
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Itsuma Nagao
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
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8
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Wesselink R, Neefs J, van den Berg NWE, Meulendijks ER, Terpstra MM, Kawasaki M, Nariswari FA, Piersma FR, van Boven WJP, Driessen AHG, de Groot JR. Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial. BMJ Open 2022; 12:e056829. [PMID: 35264365 PMCID: PMC8915322 DOI: 10.1136/bmjopen-2021-056829] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the association between left atrial epicardial conduction time (LAECT), fibrosis and atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation of persistent AF. SETTING Single tertiary care centre in the Netherlands. PARTICIPANTS Patients with persistent AF from the randomised Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery (AFACT)-trial were included. Patients eligible for thoracoscopic AF ablation were included, full inclusion and exclusion criteria were previously published. All patients underwent thoracoscopic ablation, encompassing pulmonary vein isolation with an additional roof and trigone lesion. In patients with conduction block across the roof and trigone lesion, LAECT was measured. LAECT was defined as the time to local activation at one side of the roofline on pacing from the opposite side. Collagen fibre density was quantified from left atrial appendage histology. OUTCOME MEASURES Primary outcome: AF recurrence during 2 years of follow-up. RESULTS 121 patients were included, of whom 35(29%) were women, age was 60.4±7.8 and 51% (62) had at least one AF recurrence during 2 years of follow-up. LAECT was longer in patients with versus without AF recurrence (182±43 ms vs 147±29 ms, p<0.001). LAECT was longer in older patients, in patients with a higher body mass index (BMI) and in patients using class IC antiarrhythmic drugs. LAECT was shorter in patients with higher collagen fibre density. A previously failed catheter ablation, LAECT and BMI were independently associated with AF recurrence. CONCLUSION LAECT is correlated with collagen fibre density and BMI and is independently associated with AF recurrence in patients with persistent AF. In these patients, LAECT appears to reflect substrate characteristics beyond clinical AF type and left atrial volume. TRIAL REGISTRATION NUMBER NCT01091389.
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Affiliation(s)
- R Wesselink
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - J Neefs
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - N W E van den Berg
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - E R Meulendijks
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - M M Terpstra
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - M Kawasaki
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - F A Nariswari
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - F R Piersma
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - W J P van Boven
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - A H G Driessen
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - J R de Groot
- Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
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Falson J, Sodemann I, Skinner B, Tabrea D, Kozuka Y, Tsukazaki A, Kawasaki M, von Klitzing K, Smet JH. Competing correlated states around the zero-field Wigner crystallization transition of electrons in two dimensions. Nat Mater 2022; 21:311-316. [PMID: 34949813 DOI: 10.1038/s41563-021-01166-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
The competition between kinetic energy and Coulomb interactions in electronic systems leads to complex many-body ground states with competing orders. Here we present zinc oxide-based two-dimensional electron systems as a high-mobility system to study the low-temperature phases of strongly interacting electrons. An analysis of the electronic transport provides evidence for competing correlated metallic and insulating states with varying degrees of spin polarization. Some features bear quantitative resemblance to quantum Monte Carlo simulation results, including the transition point from the paramagnetic Fermi liquid to Wigner crystal and the absence of a Stoner transition. At very low temperatures, we resolve a non-monotonic spin polarizability of electrons across the phase transition, pointing towards a low spin phase of electrons, and a two-order-of-magnitude positive magnetoresistance that is challenging to understand within traditional metallic transport paradigms. This work establishes zinc oxide as a platform for studying strongly correlated electrons in two dimensions.
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Affiliation(s)
- J Falson
- Max-Planck-Institute for Solid State Research, Stuttgart, Germany.
- Department of Applied Physics and Materials Science, California Institute of Technology, Pasadena, CA, USA.
- Institute for Quantum Information and Matter, California Institute of Technology, Pasadena, CA, USA.
| | - I Sodemann
- Institut für Theoretische Physik, Universität Leipzig, Leipzig, Germany
- Max-Planck-Institute for the Physics of Complex Systems, Dresden, Germany
| | - B Skinner
- Department of Physics, Ohio State University, Columbus, OH, USA
| | - D Tabrea
- Max-Planck-Institute for Solid State Research, Stuttgart, Germany
| | - Y Kozuka
- Research Center for Magnetic and Spintronic Materials, National Institute for Materials Science, Tsukuba, Japan
- PRESTO, JST, Kawaguchi, Japan
| | - A Tsukazaki
- Institute for Materials Research, Tohoku University, Sendai, Japan
| | - M Kawasaki
- Department of Applied Physics and Quantum-Phase Electronics Center (QPEC), University of Tokyo, Tokyo, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Wako, Japan
| | - K von Klitzing
- Max-Planck-Institute for Solid State Research, Stuttgart, Germany
| | - J H Smet
- Max-Planck-Institute for Solid State Research, Stuttgart, Germany
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10
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Yamada T, Watanabe T, Morita T, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Fukunami M. Prognostic value of the combination of pulmonary-systemic pressure ratio and a new systemic inflammation-nutrition index in patients admitted for acute decompensated heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1010] [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
Concomitant presence of pulmonary hypertension in heart failure (HF) 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 HF. On the other hand, systemic inflammation plays a critical role in the outcomes of heart failure, and malnutrition is also associated with poor outcome in heart failure patients It has been recently reported that advanced lung cancer inflammation index (ALI), which is calculated as body mass index × serum albumin / neutrophil to lymphocyte ratio (NLR), is an independent prognostic marker in several types of cancer. However, there is no information available on the prognostic value of the combination of MPS ratio and ALI in patients with acute decompensated HF (ADHF).
Methods and results
We studied 219 patients admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. During a follow up period of 5.1±4.2 yrs, 57 had cardiovascular death (CVD). MPS ratio was significantly greater (0.401±0.107 vs 0.346±0.105, p=0.0009) and ALI was significantly smaller (34.2±18.7 vs 52.0±27.1, p<0.0001) in patients with than without CVD At multivariate Cox analysis, MPS ratio and ALIwere significantly associated with CVD, independently of eGFR and prior heart failure hospitalization, after the adjustment with left ventricular end-diastolic dimension and serum sodium level. The patients with both greater MPS ratio>0.350 (AUC 0.652 [0.569–0.735]) and smaller ALI <35.767 (AUC 0.714 [0.636–0.792]) had a significantly increased risk of CVD than those with either greater MPS or smaller ALI and none of them (67% vs 22% vs 11%, p<0.0001, respectively).
Conclusion
The combination of MPS ratio and ALI might be useful for stratifying ADHF patients at higher risk for CVD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- 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
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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11
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Ito S, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Kawahira M, Ueda K, Fukunami M. Prognostic value of sarcopenia and malnutrition in patients admitted for acute decompensated heart failure with reduced or preserved left ventricular ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1016] [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
Sarcopenia and malnutrition are associated with poor clinical outcome in patients with chronic heart failure. However, there is little information available on the prognostic significance of the combination of sarcopenia and malnutrition in patients with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF).
Methods
We prospectively studied 543 consecutive ADHF patients who survived to discharge (HFrEF [LVEF <45%] n=245 and HFpEF [LVEF≥45%] n=298). At the discharge, sarcopenia and malnutrition was evaluated by free-fat mass index (FFMI) and geriatric nutrition risk index (GNRI), respectively. FFMI was calculated as follows: FFMI = (7.38 + 0.02908 × urinary creatinine [mg/day])/ (height in meter)2. Sarcopenia was defined as FFMI <17 kg/m2 in men and <15 kg/m2 in women. GNRI was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × BMI/22, and malnutrition was defined as GNRI<92. The endpoint was all-cause death.
Results
During a follow-up period of 2.8±1.4 years, 161 patients had all-cause death. Multivariate Cox analysis showed that both FFMI and GNRI were independently associated with all-cause death in both HFrEF (p=0.0064 and p<0.0001, respectively) and HFpEF patients (p=0.0140 and p=0.0007, respectively) after adjustment for relevant baseline clinical and study characteristics. In HFrEF, patients with both sarcopenia and malnutrition had a significantly higher risk of the total mortality than those with either or none of them. On the other hand, in HFpEF, patients with both and either sarcopenia or malnutrition had a significantly higher risk of the total mortality than those with none of them, while there was no significant difference in the risk between both and either sarcopenia or malnutrition.
Conclusions
Sarcopenia or malnutrition at discharge was associated with all-cause death even in ADHF patients, irrespective of reduced or preserved LVEF. The combination of sarcopenia and malnutrition could provide prognostic information in ADHF patients with reduced LVEF.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- S Ito
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- 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
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Ueda
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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12
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Yamada T, Watanabe T, Morita T, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakmura J, Kayama K, Fukunami M. Prognostic value of simple risk index and plasma volume status in patients with acute decompensated heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1007] [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
Increased heart rate (HR) and low systolic blood pressure (SBP) are associated with adverse clinical outcomes in patients admitted for acute decompensated heart failure (ADHF), and simple risk index (SRI) based on easily assessed clinical characteristics (age, HR, and SBP) provides prognostic information. On the other hand, plasma volume (PV) expansion plays an essential role in heart failure, and PV status is has been reported to be associated with adverse outcomes in ADHF patients. However, there is no information available on the value of the combination of SRI and PV status in patients admitted for ADHF.
Methods and results
We studied 301 patients admitted for ADHF. At the admission, SRI was calculated as (HR x [age/10]2)/SBP. 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 patients had all-cause death (ACD) and 68 patients had cardiovascular death (CVD). At multivariate Cox analysis, SRI and PV status were significantly associated with ACD and CVD, independently of the prior history of heart failure hospitalization and serum creatinine and sodium levels, after the adjustment with serum albumin level and anemia. Patients with both greater SRI (≥35.1 by ROC analysis; AUC 0.599 [0.524–0.674]) and greater PV status (≥8.1% by ROC analysis; AUC 0.625 [0.550–0.700]) had a significantly higher risk of ACD and CVD than those with either or none of them (ACD: 49% vs 27% vs 24%, p<0.0001, CVD: 39% vs 18% vs 15%, p<0.0001,respectively).
Conclusion
The combination of SRI and PV status might be useful for stratifying patients at risk for the total mortality and cardiovascular death in patients with ADHF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- 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 Nakmura
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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13
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Watanabe T, Yamada T, Tamaki S, Yano M, Hayashi T, Yasumura Y, Hikosou S, Sotomi Y, Morita T, Furukawa Y, Kawasaki M, Kikuchi A, Kawai T, Sakata Y, Fukunami M. The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0477] [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
Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR.
Purpose
The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR.
Methods
We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial.
On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination.
Results
Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p<0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004).
Conclusions
Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Yano
- Osaka Rosai Hospital, Osaka, Japan
| | - T Hayashi
- Osaka Police Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - S Hikosou
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Suita, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- 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
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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14
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Yamada T, Watanabe T, Morita T, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Fukunami M. Prognostic value of a new systemic inflammation-nutrition index in patients admitted with acute decompensated heart failure; a comparison with malnutrition. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1037] [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
Systemic inflammation plays a critical role in the outcomes of heart failure. Malnutrition is also associated with poor outcome in heart failure patients. It has been recently reported that advanced lung cancer inflammation index (ALI), which is calculated as body mass index × serum albumin / neutrophil to lymphocyte ratio (NLR), is an independent prognostic marker in several types of cancer. However, there is no information available on the prognostic impact of ALI in patients admitted with acute decompensated heart failure (ADHF), especially in comparison with malnutrition.
Methods and results
We studied 263 ADHF patients discharged with survival. At the discharge, we measured ALI. Malnutrition was assessed by prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). During a follow up period of 5.1±4.3 yrs, 67 patients had cardiovascular death (CVD). ALI was significantly smaller in patients with than without CVD (32.5±18.2 vs 52.2±30.2, p<0.0001). At multivariate Cox regression analysis, ALI was significantly associated with CVD, independently of prior heart failure hospitalization, systolic blood pressure and eGFR, although PNI and CONUT showed the association with CVD at unvariate analysis. By receiver-operator curve analysis, AUC of ALI was 0.733 (0.664–0.803), which was significantly greater than that of PNI (0.664 [0.590–0.739]) and CONUT (0.591 [0.509–0.672]). Patients with lowest tertile of ALI (<32.0) had a increased risk of mortality than middle tertile (NLR=32.0–53.6; HR 2.06 [1.15–3.71]) and highest tertile (ALI>53.6: HR 5.80 [2.60–12.94]) (48% vs 21% vs 9%, p<0.0001, respectively).
Conclusion
ALI, a systemic inflammation-nutrition index, is more useful prognostic marker than malnutrition in patients admitted with ADHF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- 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
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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15
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Yamada T, Watanabe T, Morita T, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Fukunami M. Long-term prognostic value of the combination of malnutrition and fib-4 index in patients admitted with acute decompensated heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1011] [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
Malnutrition is associated with increased mortality risk in patients with acute decompensated heart failure (ADHF). Cardiohepatic interactions have been a focus of attention among heart failure. It was reported that liver stiffness assessed by non-invasive fibrosis marker such as Fibrosis-4 (FIB4) index provide prognostic information in ADHF patients. However, there is no information available on the long-term prognostic value of the combination of malnutrition and FIB4 index in patients admitted for ADHF.
Methods and results
We studied 294 patients admitted for ADHF, who were discharged with survival. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × BMI/22, and malnutrition was defined as GNRI <92. FIB4 index was calculated by the formula: age (yrs) × AST[U/L] / (platelets [103/μL] × (ALT[U/L])1/2), and abnormal FIB4 index was defined as >2.67. During a mean follow-up period of 4.3±3.3 yrs, 94 patients had all-cause death. At multivariate Cox regression analysis, GNRI and FIB4 index were significantly associated with the total mortality, independently of prior heart failure hospitalization, systolic blood pressure, and serum creatinine level. Patients with malnutrition and abnormal FIB4 index had a significantly higher risk of the total mortality than those with either and none of them (49% vs 32% vs 20%, p<0.0001, respectively).
Conclusions
The combination of malnutrition and FIB4 index might be useful for stratifying ADHF patients at higher risk for the total mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- 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
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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16
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Hasegawa K, Nishikawa T, Hirakawa A, Kawasaki M, Tomatsuri S, Nagasaka Y, Nakamura K, Matsumoto K, Mori M, Hirashima Y, Takehara K, Ariyoshi K, Kato T, Yagishita S, Hamada A, Yoshida H, Yonemori K. 813P Efficacy and safety of trastuzumab deruxtecan in HER2-expressing uterine carcinosarcoma (STATICE trial, NCCH1615): A multicenter, phase II clinical trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1255] [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: 10/20/2022] Open
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17
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Kawasaki M, Furujo T, Azuma K, Okamoto Y, Ito N. Keratometry in normal cats: a cross-sectional study in Japan using an automated handheld keratometer. J Vet Med Sci 2021; 83:1256-1262. [PMID: 34162774 PMCID: PMC8437713 DOI: 10.1292/jvms.21-0104] [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] [Indexed: 11/22/2022] Open
Abstract
Keratometry was performed in 73 domestic cats of varied signalment in Japan using an automated handheld keratometer. The mean corneal curvature radius was significantly lower for cats younger than 1 year than for those older than 2 years (8.04 mm vs. 8.80-8.99 mm, P<0.01). The radius was significantly greater in males than in females among the cats older than 11 years (9.22 mm vs. 8.84 mm, P=0.01), while the age distributions of the males and females were similar. Corneal astigmatism did not significantly differ across the gender and age groups. The predictability of the corneal curvature and astigmatism was approximately 41-43% and less than 3%, respectively, as a function of age and bodyweight. The results highlighted some age- and sex-related keratometric variations in domestic cats in Japan.
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Affiliation(s)
- Minae Kawasaki
- The United Graduate School of Veterinary Science, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8511, Japan.,Tottori University Veterinary Medical Center, 4-101 Koyama-cho Minami, Tottori 680-8553, Japan
| | - Tomoya Furujo
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-cho Minami, Tottori 680-8553, Japan
| | - Kazuo Azuma
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-cho Minami, Tottori 680-8553, Japan
| | - Yoshiharu Okamoto
- Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-cho Minami, Tottori 680-8553, Japan
| | - Norihiko Ito
- Tottori University Veterinary Medical Center, 4-101 Koyama-cho Minami, Tottori 680-8553, Japan.,Joint Department of Veterinary Medicine, Faculty of Agriculture, Tottori University, 4-101 Koyama-cho Minami, Tottori 680-8553, Japan
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18
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Maryenko D, Kawamura M, Ernst A, Dugaev VK, Sherman EY, Kriener M, Bahramy MS, Kozuka Y, Kawasaki M. Interplay of spin-orbit coupling and Coulomb interaction in ZnO-based electron system. Nat Commun 2021; 12:3180. [PMID: 34039969 PMCID: PMC8155003 DOI: 10.1038/s41467-021-23483-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/11/2020] [Accepted: 04/30/2021] [Indexed: 11/09/2022] Open
Abstract
Spin-orbit coupling (SOC) is pivotal for various fundamental spin-dependent phenomena in solids and their technological applications. In semiconductors, these phenomena have been so far studied in relatively weak electron-electron interaction regimes, where the single electron picture holds. However, SOC can profoundly compete against Coulomb interaction, which could lead to the emergence of unconventional electronic phases. Since SOC depends on the electric field in the crystal including contributions of itinerant electrons, electron-electron interactions can modify this coupling. Here we demonstrate the emergence of the SOC effect in a high-mobility two-dimensional electron system in a simple band structure MgZnO/ZnO semiconductor. This electron system also features strong electron-electron interaction effects. By changing the carrier density with Mg-content, we tune the SOC strength and achieve its interplay with electron-electron interaction. These systems pave a way to emergent spintronic phenomena in strong electron correlation regimes and to the formation of quasiparticles with the electron spin strongly coupled to the density.
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Affiliation(s)
- D Maryenko
- RIKEN Center for Emergent Matter Science(CEMS), Wako, Japan.
| | - M Kawamura
- RIKEN Center for Emergent Matter Science(CEMS), Wako, Japan
| | - A Ernst
- Institute for Theoretical Physics, Johannes Kepler University, Linz, Austria.,Max Planck Institute of Microstructure Physics, Halle, Germany
| | - V K Dugaev
- Department of Physics and Medical Engineering, Rzeszów University of Technology, Rzeszów, Poland
| | - E Ya Sherman
- Department of Physical Chemistry, University of the Basque Country UPV/EHU, Bilbao, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - M Kriener
- RIKEN Center for Emergent Matter Science(CEMS), Wako, Japan
| | - M S Bahramy
- Department of Applied Physics and Quantum-Phase Electronics Center (QPEC), The University of Tokyo, Tokyo, Japan.,Department of Physics and Astronomy, The University of Manchester, Manchester, UK
| | - Y Kozuka
- Research Center for Magnetic and Spintronic Materials, National Institute for Materials Science (NIMS), Tsukuba, Japan.,JST, PRESTO, Kawaguchi, Saitama, Japan
| | - M Kawasaki
- RIKEN Center for Emergent Matter Science(CEMS), Wako, Japan.,Department of Applied Physics and Quantum-Phase Electronics Center (QPEC), The University of Tokyo, Tokyo, Japan
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19
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Kawai T, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Seo M, Nakamura J, Kayama K, Kawahira M, Fukunami M. A prospective, randomized, comparison of the coronary vasomotion associated with drug-coated balloon versus drug-eluting stent. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2450] [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
It is widely known that even new-generation drug-eluting stent (DES) induce coronary vasomotion abnormality. On the other hand, recent studies reported that drug-coated balloon (DCB) for native coronary artery was non-inferior to DES in medium term outcomes. However, there is no available information about vasomotion after treatment with DCB.
Purpose
The aim of this study was to prospectively compare coronary vasomotion in patients treated with DCB versus new-generation DES.
Methods
Twenty-seven patients were randomly treated with angioplasty with DCB (n=12) versus implantation of bioabsorbable polymer everolimus-eluting stent (BP-EES, n=15) after successful predilation. At 8 months after treatment, endothelium-dependent and -independent vasomotion were evaluated by intracoronary infusion of incremental doses of acetylcholine (for right coronary artery: low-dose 5μg, high-dose 50μg and for left coronary artery: low-dose 10μg, high-dose 100μg) and nitroglycerine (200μg). Mean luminal diameter of the distal segments, beginning 5 mm and ending 15 mm distal to the edge of the treated segment was quantitatively measured by angiography.
Results
Clinical and procedural characteristics were not different between two groups. Vasoconstriction after acetylcholine infusion was less pronounced in the DCB group than the BP-EES group (low-dose: 4±13% vs −4±14%, p=0.158, high-dose: −2±14% vs −28±30%, p=0.013). The response to nitroglycerin was not different between two groups (17±13% vs 18±24%, p=0.838).
Conclusion
Vasoconstriction after acetylcholine infusion in the peri-treated region was more pronounced in the BP-EES group than in the DCB group, which suggests that endothelial function of coronary vessel treated by DCB can be more preserved than new-generation DES.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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20
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Furukawa Y, Watanabe T, Yamada T, Morita T, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Kawahira M, Fukunami M. Predictors of silent cerebral infarction associated with catheter ablation for atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Cather ablation (CA) has been identified as an effective and safe treatment option for patients with atrial fibrillation (AF). One of the serious complications associated AF is cerebral infarction (CI). Recent studies reported that CA was associated with lower incidence of ischemic stroke in patients with AF. However, CA for AF itself has a potential risk of CI. Several previous studies showed that the incidence of silent CI (SCI) assessed by magnetic resonance imaging (MRI) of the brain occurred 5 to 18% during CA for AF. Recently, CA for AF made a remarkable progress in technology. However, there are few information available that the impact of 3-dimensional electroanatomical mapping system on the incidence of SCI. This study aimed to clarify the prevalence and predictors of SCI during CA for AF.
Methods
We enrolled 893 consecutive patients (male 534, age 71±10 years), who underwent CA for AF and MRI of brain 1 day after the procedure. We collected patients data such as physical examinations, blood sampling, echo cardiography, and CA data. A brain MRI was performed the next day following the procedure to identify any CIs. One-hundred and forty-six of patients used the Rhythmia® mapping system catheter, and the other mapping system such as CARTO or EnSite system used in the remaining 747 patients.
Results
The MRI depicted acute micro-CIs in 144 (16%) patients, but neither symptoms nor abnormal neurological findings were present in these patients. Patients with SCI had significantly higher prevalence of persistent AF (60 vs 43%, p=0.0002), CHADS2 Score (2 (1–3) vs 1 (1–2), p=0.0001), higher prevalence of previous stroke (19 vs 12%, p=0.02), larger left atrial (LA) diameter (43.2±6.4 vs 41.7±6.5mm, p=0.01), lower left ventricular ejection fraction (LVEF) (59.0±13.2 vs 64.2±11.3%, p≤0.0001), higher B-type natriuretic peptide level (221±236 vs 163±225 pg/dl, p≤0.0001), more Rhythmia® mapping system use (30 vs 8%, p<0.0001), and longer procedure time (129±46 vs 108±39 min, p≤0.0001) than those without SCI, while there were no significant differences in age, LA appendage flow velocity, kind of anti-coagulant agent between the two groups. Multivariate regression analysis identified Rhythmia® use [odds ratio (OR) 4.26, (95% CI 2.32–7.84), p=0.0001], LVEF (OR 1.02, p=0.0059), CHADS2 score (OR 1.27, p=0.009), and procedure time (OR 1.005, p=0.04) as independent risk factors of acute SCI during CA for AF.
Conclusion
Acute SCI occurred about 16% after CA for AF. Rhythmia® mapping system use exhibited a higher incidence of acute SCI after catheter ablation for AF than the other mapping system use. Rhythmia® mapping system use, LVEF, CHADS2 score, and procedure time are associated with SCI relating CA for AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- 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
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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21
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Kikuchi A, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kawai T, Seo M, Yasumura Y, Hayashi T, Yano M, Hikoso S, Sakata Y. Impact of simple nutrition index on the long-term mortality of acute decompensated heart failure patients with preserved left ventricular ejection fraction: insight from PURSUIT-HFpEF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The novel nutrition index; triglyceride (TG) × total cholesterol (TG) × body weight (BW) index (TCBI) has been reported to be an easy and useful predictor for patients with coronary artery disease. However, there is no information available on the prognostic value of TCBI in patients with heart failure with preserved LVEF (HFpEF) who admitted with acute decompensated heart failure (ADHF).
Methods and results
Data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study. PURSUIT-HFpEF study is a prospective multicenter observational study in which collaborating hospitals recorded clinical, echocardiographic, and outcome data of ADHF pts with HFpEF. We enrolled consecutive 757 HFpEF patients who admitted with ADHF from June 2016 to June 2019. TCBI was calculated by the formula; TG × TC × BW / 1000 at the discharge. After we excluded patients with in-hospital death or without sufficient data, we analyzed 419 patients. The primary endpoint was all-cause mortality. During a median follow up period of 1.1 (0.9–1.9) years, 59 patients died. ROC analysis revealed that TCBI at discharge was a fair discriminator for predicting all-cause mortality (AUC 0.676, sensitivity 53%, specificity 78%). Multivariate Cox proportional analysis showed that TCBI (p=0.002) was an independent predictor for all cause death after adjustment with major confounders such as age, gender, NT-proBNP, hemoglobin and serum creatinine level. We divided patients into 4 groups according to quartiles of TCBI. Kaplan-Meier analysis showed a significantly higher risk of all-cause death in relation to the decrease in TCBI.
Conclusion
TCBI, a simple and novel nutrition index, is a useful and strong long-term prognostic indicator in ADHF patients with HFpEF.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnositics K.K.; Fuji Film Toyoma Chemical Co. Ltd.
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Affiliation(s)
- A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- 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
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Chuo Hospital, Amagasaki, Japan
| | | | - M Yano
- Osaka Rosai Hospital, Sakai, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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22
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Tamaki S, Yamada T, Watanabe T, Morita T, Furukawa Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Yamamoto K, Fukunami M. Effect of empagliflozin as add-on therapy on transtubular potassium concentration gradient in patients with type 2 diabetes hospitalized for acute decompensated heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The transtubular potassium concentration gradient (TTKG) has been reported to be a marker of renal aldosterone bioactivity, and has been shown to be a surrogate of arterial underfilling in patients with acute decompensated heart failure (ADHF). Moreover, high TTKG at discharge has been shown to be associated with poor prognosis in ADHF patients. Empagliflozin, one of the sodium glucose cotransporter 2 inhibitors, has been shown to reduce the risk of cardiovascular mortality in patients with type 2 diabetes mellitus (T2D) and cardiovascular disease. However, little is known about the effect of empagliflozin as add-on therapy on TTKG in T2D patients with ADHF.
Purpose
We sought to elucidate the effect of empagliflozin as add-on therapy on TTKG in T2D patients with ADHF.
Methods
We enrolled 58 consecutive T2D patients admitted for ADHF. On admission, enrolled patients were randomly assigned in a 1:1 ratio to either empagliflozin add-on therapy (EMPA(+)) or conventional glucose-lowering therapy (EMPA(−)). All patients in EMPA(+) group received empagliflozin (10 mg/day) throughout the study period. Left ventricular ejection fraction (LVEF) was measured at baseline using echocardiography. Body weight and vital signs, such as blood pressure and heart rate, were measured, and blood and urine samples were collected at baseline and 1, 2, 3 and 7 days after randomization. The TTKG was measured using the first morning urine samples collected on each day. TTKG was calculated according to the following equation: TTKG = (Ku/Ks)×(plasma osmolality/urine osmolality), where Ku is urine potassium concentration and Ks is serum potassium concentration, as previously reported.
Results
Thirty patients were assigned to the EMPA(+) group, and 28 patients were assigned to the EMPA(−) group. There were no significant baseline differences in LVEF, plasma B-type natriuretic peptide (BNP) level, body mass index, or serum creatinine level between the EMPA(+) and EMPA(−) groups. TTKG did not significantly differ between the two groups at baseline. However, seven days after randomization, plasma BNP level was significantly lower in the EMPA(+) group than in the EMPA(−) group (median 227 [IQR 114–381] pg/mL vs 362 [227–554] pg/mL, p=0.0294). Furthermore, TTKG of the EMPA(+) group was significantly lower at 2, 3 and 7 days after randomization (Figure).
Conclusions
This study demonstrated that empagliflozin as add-on therapy can lower TTKG in T2D patients with ADHF.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- 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 Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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23
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Kawai T, Nakatani D, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Seo M, Nakamura J, Hikoso S, Fukunami M, Sakata Y. Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status.
Methods
To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years.
Results
During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247).
Conclusion
Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan
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24
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Kayama K, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kawahira M, Fukunami M. Comparative prognostic impact of ACCI and AHEAD risk score in heart failure with reduced, mid-range and preserved left ventricular ejection fraction admitted for acute decompensated heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1162] [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 strongly associated with poor clinical outcome in heart failure patients (pts). The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure pts. On the other hand, AHEAD risk score has been recently reported as a useful long-term risk stratification score in acute decompensated heart failure (ADHF) pts. Recently, a new group of heart failure pts with mid-range ejection fraction (HFmrEF) has been defined, separated from reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We sought to compare the prognostic value of ACCI and AHEAD score in ADHF pts, relating to HFrEF, HFmrEF and HFpEF.
Methods
We prospectively studied 410 consecutive ADHF pts (HFrEF [n=143], HFmrEF [n=99] and HFpEF [n=168]) with survival discharge. ACCI contains 19 issues which was weighted according to their potential influence on mortality. AHEAD risk score is a simple index, which is 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. The endpoint of this study was all cause death (ACD).
Results
During a follow-up period of 2.4±1.4 years, 119 pts had ACD (42, 29 and 48 pts in HFrEF, HFmrEF and HFpEF, respectively). At univariate Cox analysis, ACCI and AHEAD risk score were significantly associated with ACD in each subgroup. At multivariate Cox analysis, in HFrEF pts, ACCI, but not AHEAD risk score, showed the significant and independent association with ACD. In HFmrEF, both ACCI and AHEAD risk score was significantly and independently associated with ACD and ROC analysis showed AUC of ACCI was greater than that of AHEAD risk score (0.778 [0.683–0.855] vs 0.637 [0.572–0.764], p=0.07). On the other hand, in HFpEF pts, AHEAD risk score, but not ACCI, showed the significant and independent association ACD.
Conclusion
ACCI provides more prognostic value in HFrEF pts, and AHEAD risk score has more prognostic value in HFpEF pts. In HFmrEF pts, both ACCI and AHEAD score might have prognostic values, although ACCI tends to be more associated with ACD than AHEAD score.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Kayama
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Seo M, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Fukunami M. Prognostic significance of cardiac 123I-MIBG SPECT imaging in patients with acute decompensated heart failure with preserved left ventricular ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1214] [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
Cardiac sympathetic nerve dysfunction, which is assessed by I-123 metaiodobenzylguanidine (MIBG) imaging, is associated with the poor outcomes in patients with heart failure (HF). Most of the literature on the use of 123I-MIBG imaging is based on planar images in patients with chronic HF and reduced left ventricular ejection fraction (HFrEF), because It is technically challenging to conduct precise 123I-MIBG SPECT analysis in globally denervated heart, which is frequently observed in HFrEF patients. There was no information available on cardiac sympathetic nerve dysfunction evaluated by cardiac MIBG SPECT imaging in acute decompensated HF (ADHF) patients with preserved left ventricular ejection fraction (HFpEF).
Purpose
We aimed to clarify the prognostic significance of 123I-MIBG SPECT myocardial imaging in ADHF patients with HFpEF.
Methods
We enrolled 183 patients who were admitted for ADHF with HFpEF, discharged with survival. All patients underwent cardiac MIBG imaging at the timing of discharge. The cardiac MIBG heart to mediastinum ratio (H/M) was calculated on the early image and the delayed image (late H/M). We studied 156 patients after excluding 27 patients whose MIBG SPECT reconstruction was difficult due to too low MIBG uptake or extracardiac accumulation interference. SPECT analysis on the delayed image was conducted by using CardioBull, a fully automated software for the quantification of I-123 MIBG SPECT. All of 17 regional tracer uptake were compared with normal control database. A scoring algorithm for the evaluation of low uptake employs a 5-point scoring system as 0–4 for normal, mildly abnormal, moderately abnormal, severe abnormal, and perfusion defect, respectively. The summed severity (SSS) scores were obtained by summing the score for all segments. SSS could range from 0 to 68. The endpoint of this study is cardiac events defined as the composite of unplanned heart failure hospitalization and cardiac death.
Results
During a mean follow up period of 2.4±1.6 years, 60 patients reached cardiac events. SSS was significantly high in patients with than without cardiac events (20 [10–27] vs 7 [4–16], p<0.0001). SSS (p<0.0001) was significantly associated with cardiac events after multivariable Cox adjustment of age, sex, creatinine and log-transformed BNP level, although late H/M showed the significant association with the endpoint at the univariate Cox analysis. Kaplan-Meier analysis showed that patients with high SSS (>10, defined by median) had significantly greater risk of cardiac event (56% vs 21%, Hazard ratio: 3.56 (2.00–6.33, p<0.0001). ROC curve analysis showed that area under the curve (AUC) of SSS was 0.746 [95% CI:0.670, 0.812], which was significantly higher than that of late H/M (0.618 [95% CI:0.537, 0.695]) (p=0.0159).
Conclusion
Cardiac MIBG SPECT imaging was useful for risk stratification in ADHF patients with HFpEF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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26
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Kayama K, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kawahira M, Fukunami M. Impact of comorbidity on the predictive value of cystatin-C in patients admitted for acute decompensated heart failure: insights from a prospective study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1172] [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 strongly associated with poor clinical outcome in heart failure patients. The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure patients. On the other hand, Cystatin C, as a novel and important biomarker of renal function, has been recently reported as a useful long-term risk stratification score in heart failure patients. However, there is no information available on the impact of comorbidities on the prognostic value of cystatin-C in patients admitted for acute decompensated heart failure (ADHF).
Methods
We prospectively studied 458 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Echocardiography and venous blood sampling were performed just before discharge and serum cystatin-C level was measured. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). ACCI was commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. The endpoint was all-cause death (ACD).
Results
During a follow-up period of 2.8±1.5 years, 132 patients had ACD. At multivariate Cox analysis, ACCI (p=0.0015) and cystatin-C level (p=0.0145) were significantly and independently associated with ACD. Patients with high ACCI (≥6: determined by ROC analysis) had a significantly greater risk of ACD (37.2% vs 17.8%, p<0.0001, HR 2.45 [1.61–3.70]). In the subgroup of higher ACCI, patients with higher cystatin-C level (≥1.56: determined by ROC analysis) had a significantly higher risk of ACD (50.3% vs 23.4%). Furthermore, in the subgroup of lower ACCI, patients with higher cystatin-C level had also significantly higher risk of ACD (34.2% vs 12.1%).
Conclusions
The prognostic value of cystatin-C is not affected by comorbidities and cystatin-C provide prognostic information even in patients admitted for ADHF, irrespective of comorbid burden.
All-cause death-free rate in ADHF pts
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Kayama
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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27
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Kawasaki M, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kikuchi A, Kawai T, Seo M, Fukunami M, Yasumura Y, Hayashi T, Yano M, Hikoso S, Sakata Y. Prognostic value of nutritional status in patients with heart failure with preserved ejection fraction, with and without atrial fibrillation: insights From PURSUIT-HFpEF Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0859] [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
Malnutrition is one of the most important comorbidities among heart failure (HF) patients, and serum cholinesterase (CHE) has been reported to be a prognostic factor in HF patients. On the other hand, atrial fibrillation (AF) is frequently observed in patients with HF with preserved ejection fraction (HFpEF). However, there is little information available on the prognostic value of nutritional status in HFpEF patients, with and without AF. We sought to clarify the prognostic value of CHE in HFpEF with and without AF and compare it with that of other nutrition indices such as gastric nutritional risk index (GNRI), controlling nutritional status (CONUT), and the prognostic nutritional index (PNI).
Methods and results
Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for acute decompensated heart failure patients with left ventricular ejection fraction ≥50% in Osaka. We analyzed 380 patients (median age: 80 [75–87] years, male: 46%) after exclusion of patients with in-hospital death, missing follow-up data, or missing data to calculate nutritional indices. On admission, 155 patients had AF. Laboratory data were obtained at discharge. During a mean follow up period of 1.1±0.6 years, 131 patients had a composite endpoint (CE) of all-cause death and hospitalization for worsening heart failure or cerebrovascular disorder. In multivariate Cox analysis, in patients with AF, CHE was significantly associated with CE independently of age, gender and body mass index after the adjustment with serum albumin, total cholesterol levels and total lymphocyte count, while it was not significantly associated with CE in patients without AF. C-index of CHE (0.708) was higher than that of GNRI (0.555, p=0.0028), CONUT (0.651, p=0.208) and PNI (0.635, p=0.208) in AF patients, while there were no significant differences in those nutritional indices in patients without AF. Kaplan-Meier curve analysis revealed that AF patients with lower CHE (<208 U/L = median value) had higher risk of CE than those with higher CHE (44% vs 18%, adjusted HR 3.26 95% CI [1.66–6.67], p=0.0005), while there was no significant difference in the occurrence rate of CE between patients with and without higher CHE in non-AF group (42% vs 31%, adjusted HR 1.28 95% CI [0.78–2.13], p=0.33).
Conclusions
Prognostic value of CHE would be stronger than other nutritional indices in HFpEF patients with AF, while it would be weak in HFpEF patients without AF.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnostics K.K.; Fuji Film Toyama Chemical Co. Ltd.
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Affiliation(s)
- M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- 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
| | - 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 Fukunami
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Chuo Hospital, Amagasaki, Japan
| | | | - M Yano
- Osaka Rosai Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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Seo M, Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Fukunami M. Long-term serial changes of cardiac sympathetic nerve dysfunction in acute decompensated heart failure patients with reduced, mid-range and preserved left ventricular ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1211] [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
Cardiac sympathetic nerve dysfunction, which is assessed by I-123 metaiodobenzylguanidine (MIBG) imaging, is associated with the poor outcomes in patients with chronic heart failure (CHF). Serial evaluation of cardiac MIBG imaging was shown to be useful for predicting adverse outcome in CHF. However, there was no information available on long-term serial changes of cardiac sympathetic nerve dysfunction after discharge of acute decompensated heart failure (ADHF) hospitalization.
Purpose
We aimed to clarify the serial change of cardiac MIBG imaging parameter in long-term after discharge of heart failure hospitalization, especially relating to HFrEF (LVEF<40%), HFmrEF (40%≤LVEF<50%) and HFpEF (LVEF≥50%).
Methods
We studied 112 patients (HFrEF; n=44, HFmrEF; n=23 and HFpEF; n=45) who were admitted for ADHF, discharged with survival and without heart failure hospitalization during follow-up period. All patients underwent cardiac MIBG imaging at the timing of discharge, in 6–12 months and in 18–24 months after discharge. The cardiac MIBG heart to mediastinum ratio (H/M) was calculated on the early image and the delayed image (late H/M). The cardiac MIBG washout rate (WR) was calculated from the early and delayed planar images after taking radioactive decay of I-123 into consideration.
Results
In HFrEF patients, late H/M was significantly improved from discharge to 6–12 months data (1.60±0.24 vs 1.75±0.31, p<0.0001). Late H/M of HFmrEF patients was also significantly improved from discharge to 18–24 months data (1.71±0.27 vs 1.84±0.29 p=0.043). On the other hand, late H/M of HFpEF patients was not significantly changed. As for WR, WR in HFrEF and HFmrEF patients was significantly improved from discharge to 18–24 months data, although WR of HFpEF was not significantly changed.
Conclusion
The improvement in cardiac sympathetic nerve dysfunction was observed in patients with HFrEF and HFmrEF, not in HFpEF, after the discharge of acute heart failure hospitalization.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Yamada T, Watanabe T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Fukunami M. Long-term prognostic value of the combination of malnutrition and pulmonary-systemic pressure ratio in patients admitted with acute decompensated heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1248] [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
Malnutrition is associated with increased mortality risk 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 malnutrition and MPS ratio in pts admitted for ADHF.
Methods and results
We studied 248 pts admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. Malnutrition was assessed by geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). During a mean follow-up period of 5.2±4.4 yrs, 62 pts had cardiovascular death (CVD). MPS ratio was significantly greater in pts with than without CVD (0.408±0.114 vs 0.347±0.102, p=0.0001). GNRI and PNI were significantly lower, CONUT was significantly greater in pts with than without CVD. At multivariate Cox regression analysis, GNRI and MPS ratio were significantly associated with CVD, independently of prior heart failure hospitalization, eGFR, and serum sodium level and anemia, although PNI and CONUT showed the association with CVD at unvariate analysis. Pts with malnutrition (GNRI≤median value=96.5) and greater MPS ratio (≥median value=0.346) had a significantly higher CVD risk than those with either and none of them (51% vs 20% vs 12%, p<0.0001, respectively).
Conclusions
The combination of malnutrition and MPS ratio might be useful for stratifying pts at risk for CVD in patients with ADHF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Watanabe
- 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
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Van Den Berg N, Neefs J, Kawasaki M, Jongejan A, Nariswari F, Wesselink R, Van Putte B, Van Boven W, De Jong J, Hulsman E, Havenaar H, Klaver M, Driessen A, Boersma L, De Groot J. Atrial fibrillation up to 50 days after cardiac surgery should be considered postoperative atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0510] [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
Introduction
Postoperative atrial fibrillation (POAF) occurs in up to 45% of patients following cardiothoracic surgery and is defined as any atrial tachyarrhythmia occurring ≤30 days after surgery. Consequently, atrial arrhythmias after 30 days are regarded as new-onset AF. However, biological and clinical data on the association between POAF and new-onset AF, or empirical data supporting the cut-off of 30 days, are lacking.
Purpose
We hypothesize that patients with POAF are biologically different with respect to atrial fibrosis compared to patients who develop new-onset AF.
Methods
PREDICT AF is a prospective, multicenter, observational trial that included patients with a CHA2DS2VAsc score≥2 without a history of AF. Patients underwent CABG or valve surgery and the left atrial appendage (LAA) was removed during surgery. The LAA was obtained for expression analysis of extracellular matrix (ECM) genes such as collagen 1 (COL1A1), collagen 3 (COL3A1) and fibronectin (FN1) by qPCR. Patients were monitored during hospitalisation and followed-up at 1, 6, 12 and 24 months with 24-h Holters and ECGs. The primary endpoint was any recorded atrial tachyarrhythmia lasting >30 seconds. We documented all new-onset arrhythmias over time in order to determine potential cut-offs for POAF (Figure A). We then compared the effects of using a 30-, 50- or 70-day cut-off on the rate of new-onset AF and the differences in expression of fibrosis related genes.
Results
PREDICT AF included 150 cardiac surgery patients: 115 CABG, 11 valve surgeries and 24 combined surgeries. Participants had a median follow-up of 1.9 years [1.0–2.0], were 68±7 years old and 19 (13%) were female. POAF <30 days occurred in 63 (42%) patients. New-onset AF >30 days developed in 21 (14%) patients. Of the 21 patients with new-onset AF, 20 (95%) also had had POAF. New-onset AF defined by a cut-off of 50 days, developed in 15 (10%) patients. In total, 9 patients had an episode of AF between 30 and 50 days, of whom 6 (66.6%) had no AF episodes thereafter. Most of these patients under–went (concomitant) aortic valve surgery. The gene expression of ECM components was significantly more predictive of new-onset AF when using a cut-off of 50 days or even 70 days than when using a cut-off of 30 days (Figure B).
Conclusion
With stringent monitoring we detected 42% POAF <30 days. One in three POAF patients developed new-onset AF within two years after surgery. However, the majority of the patients who developed new-onset AF between 30 and 50 days postoperatively had no later episodes of AF. Moreover, applying a 50-day cut-off to discriminate POAF from new-onset AF enhanced the prediction of new-onset AF based on the ECM gene expression levels. Our data suggest that both from a biological and a clinical perspective, the cut-off for POAF should be stretched to 50 days postoperatively.
New-onset AF prediction with ECM genes
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NWO VIDI
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Affiliation(s)
- N.W.E Van Den Berg
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - J Neefs
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - M Kawasaki
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - A Jongejan
- Academic Medical Center of Amsterdam, Bioinformatics Laboratory, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - F Nariswari
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - R Wesselink
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - B.P Van Putte
- St Antonius Hospital, Cardiology and Cardiothoracic Surgery, Nieuwegein, Netherlands (The)
| | - W.J Van Boven
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - J.S.S.G De Jong
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - E.L Hulsman
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - H Havenaar
- St Antonius Hospital, Cardiology and Cardiothoracic Surgery, Nieuwegein, Netherlands (The)
| | - M.N Klaver
- St Antonius Hospital, Cardiology and Cardiothoracic Surgery, Nieuwegein, Netherlands (The)
| | - A.H.G Driessen
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - L.V Boersma
- St Antonius Hospital, Cardiology and Cardiothoracic Surgery, Nieuwegein, Netherlands (The)
| | - J.R De Groot
- Academic Medical Center of Amsterdam, Heart Center, Departments of Cardiology, Experimental Cardiology and Cardiothoracic Surgery, Amsterdam, Netherlands (The)
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Kanazawa N, Kitaori A, White JS, Ukleev V, Rønnow HM, Tsukazaki A, Ichikawa M, Kawasaki M, Tokura Y. Direct Observation of the Statics and Dynamics of Emergent Magnetic Monopoles in a Chiral Magnet. Phys Rev Lett 2020; 125:137202. [PMID: 33034489 DOI: 10.1103/physrevlett.125.137202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
In the three-dimensional (3D) Heisenberg model, topological point defects known as spin hedgehogs behave as emergent magnetic monopoles, i.e., quantized sources and sinks of gauge fields that couple strongly to conduction electrons, and cause unconventional transport responses such as the gigantic Hall effect. We observe a dramatic change in the Hall effect upon the transformation of a spin hedgehog crystal in a chiral magnet MnGe through combined measurements of magnetotransport and small-angle neutron scattering (SANS). At low temperatures, well-defined SANS peaks and a negative Hall signal are each consistent with expectations for a static hedgehog lattice. In contrast, a positive Hall signal takes over when the hedgehog lattice fluctuates at higher temperatures, with a diffuse SANS signal observed upon decomposition of the hedgehog lattice. Our approach provides a simple way to both distinguish and disentangle the roles of static and dynamic emergent monopoles on the augmented Hall motion of conduction electrons.
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Affiliation(s)
- N Kanazawa
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan
| | - A Kitaori
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan
| | - J S White
- Laboratory for Neutron Scattering and Imaging (LNS), Paul Scherrer Institute (PSI), CH-5232 Villigen, Switzerland
| | - V Ukleev
- Laboratory for Neutron Scattering and Imaging (LNS), Paul Scherrer Institute (PSI), CH-5232 Villigen, Switzerland
| | - H M Rønnow
- Laboratory for Quantum Magnetism (LQM), Institute of Physics, École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - A Tsukazaki
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - M Ichikawa
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan
| | - M Kawasaki
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
| | - Y Tokura
- Department of Applied Physics, University of Tokyo, Tokyo 113-8656, Japan
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
- Tokyo College, University of Tokyo, Tokyo 113-8656, Japan
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Kawasaki M, Furujo T, Kuroda K, Azuma K, Okamoto Y, Ito N. Characterising keratometry in different dog breeds using an automatic handheld keratometer. Vet Rec 2020; 186:e4. [PMID: 32123011 PMCID: PMC7279203 DOI: 10.1136/vr.105393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/29/2019] [Revised: 11/19/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Background Keratometry is clinically important and is routinely performed as part of human ophthalmic examination. In veterinary ophthalmology, little is known about keratometry in dogs, and its practical application has been limited. The present study aimed to describe keratometry in some dog breeds popular in Japan using a handheld keratometer. Methods Client-owned dogs of various signalment were enrolled prospectively in the keratometry examination. Interbreed variations in mean corneal curvatures (R1R2avg) and corneal astigmatism (Δ(R1−R2)) were evaluated statistically with respect to their bodyweight based on the data which fulfilled the predetermined inclusion criteria. P<0.05 was considered statistically significant. Results On examination of 237 dogs from 16 different breeds, R1R2avg (mean±sd) ranged from 7.54±0.30 mm in Pomeranians to 9.28±0.19 mm in golden retrievers. Δ(R1−R2) (mean±sd) ranged from 0.22±0.11 mm in miniature schnauzers to 0.57±0.30 mm in French bulldogs. Conclusion The present study successfully described keratometry in 16 dog breeds. The study revealed considerable interbreed variations in both R1R2avg and Δ(R1−R2), which did not necessarily correlate with bodyweight. These results are useful both clinically in fitting contact lenses in the management of corneal diseases and non-clinically in optometric studies in dogs.
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Affiliation(s)
- Minae Kawasaki
- Veterinary Medical Center, Tottori University, Koyama-cho Minami, Tottori, Japan.,The United Graduate School of Veterinary Science, Yamaguchi University, Yoshida, Yamaguchi, Japan
| | - Tomoya Furujo
- Joint Department of Veterinary Medicine, Tottori University, Koyama-cho Minami, Tottori, Japan
| | - Kohei Kuroda
- Department of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, Japan
| | - Kazuo Azuma
- Joint Department of Veterinary Medicine, Tottori University, Koyama-cho Minami, Tottori, Japan
| | - Yoshiharu Okamoto
- Joint Department of Veterinary Medicine, Tottori University, Koyama-cho Minami, Tottori, Japan
| | - Norihiko Ito
- Veterinary Medical Center, Tottori University, Koyama-cho Minami, Tottori, Japan .,Joint Department of Veterinary Medicine, Tottori University, Koyama-cho Minami, Tottori, Japan
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33
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Yoshizane T, Tanaka R, Kawasaki M, Otsuka M, Shoji T, Nagaya M, Hattori K, Yagasaki H, Minatoguchi S, Ono K, Murata I, Deguchi T, Arai M, Noda T, Okura H. P4384Noninvasive and novel method to evaluate left ventricular contractility using pressure-volume loop area obtained by 3-dimensional speckle tracking echocardiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0789] [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
Introduction
Left ventricular (LV) pressure-volume (P-V) loop area reflects stroke work (SW), but clinical use of this index is limited by the need of invasive pressure measurement. A noninvasive method to obtain LV pressure-strain loop was recently introduced to assess myocardial work (MW). The minimum LV diastolic pressure (mLVP) was reported to have a strong correlation with Tau and we reported that Tau was noninvasively evaluated by speckle tracking echocardiography (STE).
Purpose
We sought to evaluate the impact of preload change by leg lifts on LV SW noninvasively obtained by the novel method and to examine the utility to assess LV contractility by SW and end-diastolic (ED) volume relation (SW-VED).
Methods
Thirty six controls (age 71±10) and 30 patients with heart failure with reduced ejection fraction (EF) <50% (HF) (age 73±6) were enrolled. LV pressure in a cardiac cycle was estimated using systolic blood pressure (SBP), minimum diastolic pressure (mDP) and ED pressure (EDP) by utilizing the profile of an empiric, normalized reference curve. The mDP and EDP were estimated as (Tau − 33.7)/2.06 and as 12.3 − 10.1 x Log (left atrial active emptying function/minimum volume) as we reported. LVSW was obtained by P-V loop by the combination of these pressures and LV volume using 3-D STE.
Results
LVEF and longitudinal strain in HF before leg up by 3D-STE were lower compared to normal (LVEF; normal: 58±5 vs HF: 39±10*% and strain; −12±3 vs −8±3%*, *p<0.05 vs normal). LVEF was increased after leg up by 7±6% in normal and by 8±8% in HF associated with increased LVED volume (normal: 84±24 to 90±24 and HF: 124±36* to 136±42*ml). LV MW and SW in HF before leg up were lower compared to normal (MW: 1790±412 vs 1002±432*mmHg% and SW: 3946±1682 vs 3352±1026mmHgml). LV SW increased after leg up by 26±19% in normal and by 25±20% in HF. LV SW-VED in normal was greater than HF (241±151 vs 90±54*).
Conclusion
LV SW noninvasively obtained by P-V loop area was increased after leg up in both normal and HF but SW-VED in HF was smaller than normal, indicating reduced contractility in HF. This noninvasive method may be a new echocardiographic approach for quantification of LV SW and contractility.
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Affiliation(s)
- T Yoshizane
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - R Tanaka
- Asahi University Hospital, Cardiology, Gifu, Japan
| | | | - M Otsuka
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Shoji
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - M Nagaya
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - K Hattori
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - H Yagasaki
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - S Minatoguchi
- Gifu University Graduate School of Medicine, Cardiology, Gifu, Japan
| | - K Ono
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - I Murata
- Gifu Prefectural General Medical Center, Nephrology, Gifu, Japan
| | - T Deguchi
- Asahi University Hospital, Cardiology, Gifu, Japan
| | - M Arai
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Noda
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - H Okura
- Gifu University Graduate School of Medicine, Cardiology, Gifu, 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. 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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Minatoguchi S, Tanaka R, Yoshizane T, Deguchi T, Sato H, Ono K, Nagaya M, Miwa H, Iwama M, Noda T, Watanabe S, Kawasaki M, Okura H. P3548Noninvasive estimation of left ventricular diastolic function in patients with hypertension and normal ejection fraction using 3-dimensional speckle tracking echocardiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0411] [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
Left ventricular (LV) relaxation (eTau) and pulmonary capillary wedge pressure (ePCWP) were reported to be estimated by speckle tracking echocardiography (STE). LV camber stiffness (e-c stiffness) may be estimated with the use of 2 diastolic pressure-volume coordinates. The minimum diastolic pressure (mP) is reported to have a strong correlation with Tau.
Purpose
We sought to examine the impact of hypertension on LV diastolic function and LA properties and to elucidate the feature of hypertensive heart failure with preserved EF (HFpEF).
Methods
The e', E/e', Tau, PCWP, LVEDP, LV stiffness, LAV, LA emptying function (LAEF) and LA strain were examined in 53 controls (age 66±11), 136 hypertensive patients (HTN) with normal EF (69±11) and 39 HFpEF (77±14). ePCWP and estimated EDP (eEDP) was calculated as previously reported. Tau was calculated as isovolumic relaxation time/(ln 0.9 x systolic blood pressure − ln PCWP). Myocardial stiffness (e-m stiffness) was estimated as LVED stress/LV strain. LV c-stiffness was calculated as LV pressure change (from mP to EDP) obtained by catheterization divided by LV volume change. Estimated LV c-stiffness (e-c-stiffness) was noninvasively obtained using e-mP and e-EDP. The eTau, eEDP and e-mP by STE were validated by catheterization (n=126).
Results
The mP had a good correlation with Tau (r=0.70, p<0.01). The eTau, eEDP and e-mP by STE had a good correlation with those by catheterization (r=0.75, 0.63 and 0.70, p<0.01). Multivariate analysis revealed that ePCWP and LA strain were independent predictors of HFpEF.
LV diastoric function Variables Control HTN HFpEF LVEF, % 68±6 68±8 63±9*+ LV longitudinal strain x (s–1) 19.1±3.0 16.8±4.3* 14.5±5.1*+ E/e' 9.2±2.6 11.6±4.5* 15.9±7.9*+ eTau, ms 35±12 48±17* 59±17*+ ePCWP, mmHg 7.3±2.7 8.3±4.3 15.0±4.4*+ eLVEDP, mmHg 9.4±2.2 10.4±3.5 15.9±3.7*+ LV e-myocardial stiffness, kdynes/cm 0.56±0.25 0.69±0.56 1.27±0.71*+ LV e-chamber stiffness, mmHg/ml 0.19±0.06 0.20±0.08 0.36±0.19*+ Maximum LAVI, ml/m2 42±15 50±21* 68±17*+ Total LAEF, % 55±7 51±11 36±12*+ LA peak strain 41±15 40±17 19±8*+ *p<0.05 vs Control, +p<0.05 vs HTN.
Conclusion
We demonstrated that LV diastolic function in HTN may be accurately and noninvasively evaluated by STE.
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Affiliation(s)
- S Minatoguchi
- Gifu University Graduate School of Medicine, Department of Cardiology, Gifu, Japan
| | - R Tanaka
- Asahi university Hospital, Department of Cardiology, Gifu, Japan
| | - T Yoshizane
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | - T Deguchi
- Asahi university Hospital, Department of Cardiology, Gifu, Japan
| | - H Sato
- Sawada Hospital, Gifu, Japan
| | - K Ono
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | - M Nagaya
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | - H Miwa
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | - M Iwama
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | - T Noda
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | - S Watanabe
- Gifu Prefectural General Medical Center, Department of Cardiology, Gifu, Japan
| | | | - H Okura
- Gifu University Graduate School of Medicine, Department of Cardiology, Gifu, Japan
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36
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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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Tamaki S, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Yamamoto K, Fukunami M. P762Usefulness of 2-year iodine-123 metaiodobenzylguanidine-based risk model for the post-discharge risk stratification in patients with acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0362] [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
A four-parameter risk model including cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters has been recently developed for the prediction of 2-year cardiac mortality risk in patients with chronic heart failure (CHF) using a Japanese CHF database consisting of 1322 patients. On the other hand, the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines-Heart Failure (GWTG-HF) risk scores, simple tools to predict risk of in-hospital mortality, have been reported to be predictive of post-discharge outcome in patients with acute decompensated heart failure (ADHF). However, there is no information available on the usefulness of 2-year MIBG-based cardiac mortality risk score for the prediction of post-discharge prognosis in ADHF patients and its comparison with the ADHERE and GWTG-HF risk scores.
Purpose
We sought to validate the predictability of the 2-year MIBG-based cardiac mortality risk score for post-discharge clinical outcome in ADHF patients, and to compare its prognostic value with those of ADHERE and GWTG-HF risk scores.
Methods
We studied 297 consecutive patients who were admitted for ADHF, survived to discharge, and had definitive 2-year outcomes. Venous blood sampling was performed on admission, and echocardiography and cardiac MIBG imaging were performed just before discharge. In cardiac MIBG imaging, the cardiac MIBG heart-to-mediastinum ratio (HMR) was measured from the chest anterior view images obtained at 20 and 200 min after isotope injection. The 2-year cardiac mortality risk score was calculated using four parameters, including age, left ventricular ejection fraction, NYHA functional class, and HMR on delayed image. The patients were stratified into three groups based on the 2-year cardiac mortality risk score: low- (<4%), intermediate- (4–12%), and high-risk (>12%) groups. The ADHERE and GWTG-HF risk scores were also calculated from admission data as previously reported. The predictive ability of the scores was compared using receiver operating characteristic curve analysis. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure.
Results
During a follow-up period, 110 patients reached the primary endpoint. There was significant difference in the rate of primary endpoint among the three groups stratified by 2-year cardiac mortality risk score (low-risk group: 18%, intermediate-risk group: 36%, high-risk group: 64%, Figure 1A). The 2-year cardiac mortality risk score demonstrated a greater area under the curve for the primary endpoint compared to the ADHERE and the GWTG-HF risk scores (Figure 1B).
Figure 1
Conclusions
The 2-year MIBG-based cardiac mortality risk score is also useful for the prediction of post-discharge clinical outcome in ADHF patients, and its prognostic value is superior to those of the ADHERE and the GWTG-HF risk scores.
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Affiliation(s)
- S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- 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
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Yoshizane T, Tanaka R, Kawasaki M, Otsuka M, Shoji T, Nagaya M, Hattori K, Murayama M, Yagasaki H, Minatoguchi S, Ono K, Tanihata S, Arai M, Noda T, Okura H. P2474Noninvasive estimation of pulmonary capillary wedge pressure by novel 3D speckle tracking echocardiography and validation study by cardiac catheterization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0806] [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
We previously reported that pulmonary capillary wedge pressure (PCWP) was noninvasively evaluated by 2D speckle tracking echocardiography (STE). Recently, novel software was introduced to examine volume and function of left ventricular and left atrium (LA) by 3D-STE automatically.
Purpose
We sought to compare the PCWP estimated by conventional 2D-STE (2D-ePCWP) and by novel 3D-STE (3D-ePCWP), and validate those values by cardiac catheterization.
Methods
Echocardiography and catheterization were performed in 29 patients (age 72±2) (7 ischemic heart disease, 2 hypertensive heart disease, 5 dilated cardiomyopathy, 12 valvular heart disease and 3 primary pulmonary hypertension).The ePCWP (mmHg) is noninvasively obtained as 10.8 − 12.4 x Log (left atrial active emptying function/minimum volume) as we previously reported. Echocardiography was performed just before the catheterization and we analyzed the 2D and 3D data by novel off-line software. 3D data was automatically analyzed and the border settings were fixed at default (ES60, ED30) (Figure).
Results
2D-ePCWP and 3D-ePCWP had a good correlation with PCWP invasively obtained by catheterization (r=0.87 and 0.83, respectively, both p<0.001). There was an excellent correlation between 2D-ePCWP and 3D-ePCWP (r=0.94, p<0.001) and there was a good correlation between 2D-LA volume index and 3D- LA volume index (r=0.80, p<0.001). Bland-Altman analysis revealed a good agreement between 2D-ePCWP and 3D-ePCWP, and between 2D-ePCWP and 3D-ePCWP without fixed and proportional bias.
Conclusion
This study demonstrated that PCWP might be noninvasively assessed by not only 2D-STE but also 3D-STE with reasonable accuracy and 3D-STE might have utility and value in the routine clinical practice.
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Affiliation(s)
- T Yoshizane
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - R Tanaka
- Asahi University Hospital, Cardiology, Gifu, Japan
| | | | - M Otsuka
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Shoji
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - M Nagaya
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - K Hattori
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - M Murayama
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - H Yagasaki
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - S Minatoguchi
- Gifu University Graduate School of Medicine, Cardiology, Gifu, Japan
| | - K Ono
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - S Tanihata
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - M Arai
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Noda
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - H Okura
- Gifu University Graduate School of Medicine, Cardiology, Gifu, Japan
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Kawai T, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Seo M, Fukunami M. P4552The prognostic impact of worsening and improved renal function in acute decompensated heart failure with and without plasma volume expansion. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0943] [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
Recent studies showed that both worsening renal function (WRF) and improved renal function (IRF) during hospitalization are associated with poor prognosis in patients with acute decompensate heart failure (ADHF). On the other hand, plasma volume (PV) expansion plays an essential role in ADHF. However, there is little information about the difference of prognostic impact of WRF and IRF in ADHF patients, relating to PV status (PVS).
Methods
We prospectively studied 348 patients admitted for ADHF. PVS was defined as follows: actual PV = (1 - hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] × 100 (%). WRF and IRF were defined as an increase and a decrease in serum creatinine of ≥0.3 mg/dl from admission to discharge, respectively. The endpoint was readmission for worsening heart failure (WHF) within 1 year.
Result
Median PVS was 6.7% (IQR: −4.1%–16.7%). 43 and 21 patients had WHF in groups with high PVS (PVS ≥ median) and low PVS (PVS > median), respectively. In high PVS group, multivariate Cox analysis showed that IRF was independently and significantly associated with WHF (p=0.016, HR: 2.4 [1.2–4.8]), but WRF was not (p=0.55, HR: 0.7 [0.3–2.1]). On the other hand, in low PVS group, WRF was independently associated with WHF (p=0.035, HR: 3.0 [1.1–8.1]), but IRF was not (p=0.27, HR: 2.1 [0.6–8.0]). Kaplan-Meier analysis revealed that only patients with IRF had a significantly higher risk of WHF than those with stable renal function (SRF) in high PVS group, while patients with WRF had a significantly higher risk of WHF than those with SRF in low PVS group.
Worsening heart failure-free rate curves
Conclusion
In ADHF patients with PV expansion, IRF during hospitalization could predict poor outcomes, but WRF could not. On the other hand, in ADHF patients without PV expansion, not IRF but WRF could predict poor outcomes. PVS guided-therapy may be considered in secondary prevention for WHF.
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Affiliation(s)
- T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Abe M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Yamamoto K, Fukunami M. P793Prediction of prognosis using combined objective nutritional score in the patients with acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0392] [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
It has been reported that the objective nutritional indices such as the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) are useful for the prediction of prognosis in patients with heart failure. However, there is no information available on the prognostic value of the combination of these objective nutritional indices in patients with acute decompensated heart failure (ADHF).
Purpose
We sought to assess the usefulness of the Combined Objective Nutritional Score for the prediction of post-discharge clinical outcome in ADHF patients.
Methods
We studied 361 consecutive patients who were admitted for ADHF and survived to discharge. Venous blood sampling, echocardiography, and measurement of body weight were performed just before discharge. CONUT score, GNRI and PNI were calculated as previously reported. We determined the Combined Objective Nutritional Score by assigning 1 point each for high CONUT score (2–12), low GNRI (≤98) or low PNI (≤38). Patients were followed-up for up to 5 years. The study endpoint was all-cause death.
Results
During a follow-up period of 2.4±1.3 years, 106 patients had all-cause death. Multivariate Cox analysis showed that the Combined Objective Nutritional Score was independently associated with all-cause death after adjustment for age, gender, history of coronary artery disease, left ventricular ejection fraction, brain natriuretic peptide level and estimate glomerular filtration rate (p<0.0001). When the patients were stratified into the three groups based on the Combined Objective Nutritional Score (normal nutritional status: 0 point, mild-to-moderate malnutrition: 1–2 points, severe malnutrition: 3 points), the incidence of all-cause death appeared to increase in relation to the Combined Objective Nutritional Score (normal: 0%, mild-to moderate: 23%, severe: 52%, p<0.0001, Figure). Patients with severe malnutrition showed 2.9 fold (95% CI 1.8–4.6) increase in the total mortality in comparison to patients with mild-to-moderate malnutrition.
Figure 1
Conclusion
This study showed that the Combined Objective Nutritional Score is a useful tool to risk stratify the patients hospitalized with ADHF.
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Affiliation(s)
- M Abe
- Osaka General Medical Center, Osaka, Japan
| | - 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
| | - K Yamamoto
- 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, 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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Itoh S, Satouchi M, Sato J, Okuma Y, Niho S, Mizugaki H, Murakami H, Fujisaka Y, Kozuki T, Nakamura K, Nagasaka Y, Kawasaki M, Yamada T, Kuchiba A, Yamamoto N. Durable anti-tumor activity of the multi-targeted inhibitor lenvatinib in patients with advanced or metastatic thymic carcinoma: Preliminary results from a multicenter phase II (REMORA) trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz266.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Kawasaki M, Nariswari NA, Van Den Berg NWE, Neefs J, Meulendijks ER, Wesselink R, Baalman SWE, Van Boven WJP, Driessen AHG, De Groot JR. P3500The primary cilium, a sensory apparatus of cells regulates the profibrotic capacity of fibroblasts in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0365] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrosis is a hallmark of atrial fibrillation (AF) and serves as an important arrhythmogenic substrate. It is formed by fibroblasts in response to tissue dyshomeostasis induced by multiple factors such as ageing, hypertension and inflammation. How fibroblasts phenotypically transform into an active form with enhanced profibrotic capacity in AF pathophysiology remains elusive. The primary cilium is an antenna-like small organelle, that function as a sensor to transduce external stimuli to intracellular signaling thereby potentially mediating the fibroblast's profibrotic capacity. Their involvement in AF pathophysiology is not known.
Objective
To explore the role of fibroblasts' primary cilium in the formation of the atrial fibrosis in AF.
Methods
Left atrial appendages (LAA) were obtained from persistent AF patients (AF: n=10) and patients without AF undergoing cardiac surgery (control: n=10). Primary cilia were immunostained with anti-acetylated a-tubulin in cryosections of the LAA. The loss of cilia in fibroblasts isolated from fresh LAA (AF: n=3, control: n=3) was induced by RNAi targeting IFT88, an essential factor for cilia formation. Gene expression and protein levels in LAA were quantified by qPCR and western blot, respectively (AF: n=20, control: n=20).
Results
The ratio of fibroblasts with primary cilium was significantly decreased in LAA of AF cohort (AF: 14.7%±4.6 vs control: 25.9%±3.6, p<0.01). Correspondingly, the protein levels of acetylated a-tubulin, an exclusive component of cilia, were significantly decreased both in whole LAA and fibroblast fraction of AF cohort compared to control (p<0.05). The loss of primary cilia induced by RNAi in fibroblasts resulted in increased differentiation of fibroblasts into myofibroblasts and the expression of extracellular matrix genes in response to TGF -b1.
Primary cilium is disassembled along with degradation of acetylated a-tubulin by HDAC6. Indeed, a negative correlation between the protein levels of acetylated a-tubulin and HDAC6 were observed in the LAA of AF cohort (p<0.05) but not in control. Furthermore, the gene expression of AURKA and HEF1, upstream activators of HDAC6, was increased by 1.5-fold (p=0.09) and 3-fold (p<0.001), respectively, in the LAA of AF cohort compared to control.
Conclusion
The formation of primary cilia in fibroblasts is actively suppressed in AF via HEF1/AURKA/HDAC6 cascade, which in turn enhances the profibrotic response of fibroblasts. This study provides an innovative paradigm for fibrosis formation in AF, and implicates that the primary cilium of fibroblasts potentially become a novel therapeutic target to treat the AF substrate.
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Affiliation(s)
- M Kawasaki
- Amusterdam University of Medical Centers, University of Amsterdam, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - N A Nariswari
- Amusterdam University of Medical Centers, University of Amsterdam, Department of Experimental Cardiology, Amsterdam, Netherlands (The)
| | - N W E Van Den Berg
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - J Neefs
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - E R Meulendijks
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - R Wesselink
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - S W E Baalman
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - W J P Van Boven
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - A H G Driessen
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
| | - J R De Groot
- Amsterdam University of Medical Centers, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, Netherlands (The)
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Yamamoto K, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Fukunami M. P5406Impact of the albumin level on the prognostic value of diuretic response in patients admitted for acute decompensated heart failure: a prospective study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The reduced diuretic response (DR) has been shown to be associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). In addition, hypoalbuminemia, which is related to DR, has been also reported to predict poor prognosis in ADHF patients. However, there is no information available on the impact of albumin level on the prognostic value of DR in patients with ADHF.
Methods
We prospectively studied 296 consecutive patients who were admitted for ADHF and survived to discharge. The patients were divided into 2 groups according to the presence or absence of hypoalbuminemia at the admission, defined as the serum level of albumin at admission <3.5g/dl, and DR was defined as weight loss per 40mg intravenous dose and 80mg oral dose of furosemide up to day 4. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure.
Results
There were 144 patients with hypoalbuminemia and 152 patients without hypoalbuminemia. During a mean follow-up period of 2.2±1.5 years, 88 patients with hypoalbuminemia and 53 patients without hypoalbuminemia reached the endpoint. In group with hypoalbuminemia, DR was significantly smaller in patients with than without the endpoint (0.85 [0.50–1.50] vs 1.60 [0.76–2.70] kg/40mg furosemide, p=0.003), while there was no significant difference in DR between them in group without hypoalbuminemia (1.17 [0.59–1.66] vs 1.07 [0.75–1.88] kg/40mg furosemide, p=0.381). At multivariate Cox analysis, in group with hypoalbuminemia, DR was significantly associated with the endpoint, independently of age, left ventricular ejection fraction, and serum creatinine and plasma BNP levels. On the other hand, in group without hypoalbuminemia, DR showed no significant association with the endpoint at univariate Cox analysis. Kaplan-Meier analysis showed that patients with poor DR (≤1.08 kg/40mg furosemide: median value) had a significantly higher risk of the endpoint in group with hypoalbuminemia, but not in group without hypoalbuminemia (Figure).
Figure 1
Conclusion
Our results suggested that prognostic value of DR in ADHF patients is affected by the presence or absence of hypoalbuminemia.
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Affiliation(s)
- K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - 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
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Yoshizane T, Tanaka R, Kawasaki M, Otsuka M, Shoji T, Nagaya M, Hattori K, Yagasaki H, Minatoguchi S, Ono K, Deguchi T, Tanihata S, Arai M, Noda T, Okura H. P4351Validation by cardiac catheterization of noninvasive evaluation of left ventricular chamber and myocardial stiffness as a diastolic function using speckle tracking echocardiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0758] [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
Left ventricular (LV) diastolic function is mainly composed of LV relaxation and LV stiffness. We reported that pulmonary capillary wedge pressure (ePCWP) and LV relaxation assessed by Tau (eTau) are noninvasively evaluated by speckle tracking echocardiography (STE). The minimum LV diastolic pressure (mLVP) was reported to have a strong correlation with Tau. Therefore, LV chamber stiffness (c-stiffness) may be assessed with the use of two LV diastolic pressure-volume coordinates: the mLVP and volume and the end-diastolic pressure (EDP) and volume.
Purpose
We sought to noninvasively assess LV stiffness using STE and validate the value by cardiac catheterization.
Methods
Echocardiography and catheterization were performed in 124 patients (age 72±8) (70 angina pectoris, 20 prior myocardial infarction, 19 hypertensive heart disease, 11 congestive heart failure and 4 paroxysmal atrial fibrillation). The ePCWP (mmHg) is noninvasively obtained as 10.8 − 12.4 × Log (left atrial active emptying function/minimum volume) and the eTau (ms) is obtained as isovolumic relaxation time/(ln 0.9 × systolic blood pressure − ln ePCWP) as previously reported. The mLVP (e-mLVP) was estimate using Tau. The estimated EDP (e-EDP) was calculated as 12.3 − 10.1 × Log (left atrial active emptying function / minimum volume). LV c-stiffness (mmHg/ml) was calculated as LV pressure change (from mLVP to EDP) obtained by catheterization divided by LV volume change during diastole which equals to stroke volume by echocardiography. Estimated c-stiffness (e-c-stiffness) was noninvasively obtained using e-mLVP and e-EDP. Furthermore, LV myocardial stiffness (m-stiffness) was calculated by LVED stress / LV longitudinal strain by STE, where LV stress (kdynes/cm2) was calculated as 0.334 × pressure × dimension / [thickness (1 + thickness/dimension)]. The estimated m-stiffness (e-m-stiffness) was calculated using e-EDP.
Results
The eTau and e-EDP estimated by STE had a good correlation with Tau and EDP invasively obtained by catheterization (r=0.75 and 0.63, respectively, both p<0.001). There was a good correlation between Tau and mLVP (Tau = 2.06 mLVP + 33.7, r=0.70). The estimated LVED stress had good correlation with ED stress obtained by catheterization (r=0.77, p<0.001). The e-c-stiffness and e-m-stiffness had a good correlation with those obtained by catheterization (e-c-stiffness; 0.116±0.07 and c-stiffness; 0.115±0.06, r=0.603, e-m-stiffness; 0.81±0.41 and m-stiffness; 0.85±0.45, r=0.89, respectively). Bland-Altman analysis revealed a good agreement between e-c-stiffness and c-stiffness, and between e-m-stiffness and m-stiffness without fixed and proportional bias.
Conclusion
This study demonstrated that LV stiffness may be noninvasively assessed by STE with reasonable accuracy and may have utility and value in the routine clinical practice for the diagnosis and treatment in patients with diastolic dysfunction.
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Affiliation(s)
- T Yoshizane
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - R Tanaka
- Asahi University Hospital, Cardiology, Gifu, Japan
| | | | - M Otsuka
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Shoji
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - M Nagaya
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - K Hattori
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - H Yagasaki
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - S Minatoguchi
- Gifu University Graduate School of Medicine, Cardiology, Gifu, Japan
| | - K Ono
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Deguchi
- Asahi University Hospital, Cardiology, Gifu, Japan
| | - S Tanihata
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - M Arai
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - T Noda
- Gifu Prefectural General Medical Center, Cardiology, Gifu, Japan
| | - H Okura
- Gifu University Graduate School of Medicine, Cardiology, Gifu, Japan
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46
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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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47
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Kayama K, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Fukunami M. P4523Impact of comorbiditity on the predictive value of acute kidney injury in patients admitted for acute decompensated heart failure: a prospective study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0916] [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 patients with chronic heart failure, and acute kidney injury (AKI) also provides prognostic information in patients with heart failure. However, there is no information available on the impact of comorbidities on the prognostic value of AKI in patients admitted for acute decompensated heart failure (ADHF).
Methods
We prospectively studied 357 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. AKI was defined as an absolute increase in serum creatinine of 0.3mg/dl or more during hospitalization. The endpoint was all-cause death (ACD).
Results
During a follow-up period of 2.2±1.4 years, 97 patients had ACD. At multivariate Cox analysis, ACCI (p<0.0001) and AKI (p=0.0061) were significantly and independently associated with ACD. Patients with high ACCI (≥5: determined by ROC analysis) had a significantly greater risk of ACD (39% vs 16%). In the subgroup of high ACCI, patients with AKI had a significantly higher risk of ACD (60% vs 35%), whereas there was no significant difference in the risk of ACD between with and without AKI (15% vs 16%) in the subgroup of low ACCI.
Conclusions
The presence of AKI was associated with the increased risk of mortality in ADHF patients with higher comorbidity burden but not in those without them.
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Affiliation(s)
- K Kayama
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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48
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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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49
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Kawai T, Nakatani D, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Seo M, Hikoso S, Sakata Y, Fukunami M. P842Calculated plasma volume status provides additional prognostic value to global registry of acute coronary event (GRACE) score in patients with acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0440] [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 status (PVS) has been shown to be a well-validated prognostic indicator which relate to morbidity and mortality in heart failure. However, it remains unclear whether PVS would have the prognostic significance in patients with acute myocardial infarction (AMI). Global Registry of Acute Coronary Events (GRACE) risk score is a powerful predictor of prognosis after acute coronary event, but there is no information available on the additional prognostic value of PVS to GRACE in AMI patients.
Methods
We retrospectively studied 3930 AMI patients. GRACE score and PVS was obtained on the admission. PVS was calculated as follows: actual PV = (1 - hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] × 100 (%). The endpoint was All cause of death (ACD) within 5 years.
Results
During a mean follow-up period of 2.4±1.9 years, 406 patients had ACD. PVS was significantly greater in patients with ACD than without ACD (8.1±14.9% vs −1.7±13.3%, p<0.001). Each 5% increase in PVS was linked to a 27% estimated risk of 5-year mortality (p<0.001, HR: 1.05 [1.03–1.08]). PVS was still independently associated with ACD, after adjustment with GRACE score as a potential confounding factor. Kaplan-Meier analysis revealed that patients with PV expansion (PVS>0%) were significantly higher risk of ACD than those without PV expansion in patients both with high risk in GRACE score (>140) (28% (225/803) vs 19% (78/412), p=0.01, HR: 7.5) and with low risk in GRACE score (≤140) (6% (52/894) vs 3% (51/1821), p=0.009, HR: 6.2).
Survival rate curves
Conclusion
PVS, which represents intravascular compartment and congestion, could identify poor prognosis in patients with AMI. In addition, PVS would provide additional prognostic information to GRACE score.
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Affiliation(s)
- T Kawai
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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50
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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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