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Morita T, Sasaki T, Koizumi Y, Fukushima H, Shimbashi W, Mitani H. Favourable swallowing outcomes after subtotal glossectomy with laryngeal suspension. Int J Oral Maxillofac Surg 2024; 53:191-198. [PMID: 37516548 DOI: 10.1016/j.ijom.2023.07.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
Subtotal or total glossectomy for advanced tongue cancer has an adverse impact on swallowing. The purpose of this retrospective study was to analyse postoperative swallowing outcomes and to determine the ideal reconstruction method in these patients. The clinical and swallowing data of patients with tongue cancer who underwent subtotal glossectomy at the study institution between 2005 and 2019 were reviewed retrospectively. Data were available for 101 patients. The most common reconstruction method was a free rectus abdominis musculocutaneous flap (69 cases). The postoperative feeding tube dependency rate was 11.1% at discharge and 9.4% at 1 year. During the study period, laryngeal suspension and/or a cricopharyngeal myotomy was performed in 39 patients (38.6%), with 25 of these operations performed after 2017. Patients treated in 2017-2019 were significantly more able to take thin liquid (P < 0.001) and lost less weight (P = 0.015) compared to those treated in 2005-2016. Multivariate analysis of 61 patients who did not undergo laryngeal suspension and/or cricopharyngeal myotomy showed significant feeding tube dependency in those aged 65 years and older (P = 0.004). Thin liquid intake was significantly improved after subtotal glossectomy with laryngeal suspension, which led to better postoperative swallowing and improved quality of life.
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Affiliation(s)
- T Morita
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - T Sasaki
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Koizumi
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Fukushima
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - W Shimbashi
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - H Mitani
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Kuwajima Y, Yamaguchi Y, Yamada Y, Morita T, Wiranata A, Minaminosono A, Hosoya N, Kakehi Y, Maeda S. Pocketable and Smart Electrohydrodynamic Pump for Clothes. ACS Appl Mater Interfaces 2024; 16:1883-1891. [PMID: 38096263 PMCID: PMC10788827 DOI: 10.1021/acsami.3c15274] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Seamlessly fusing fashion and functionality can redefine wearable technology and enhance the quality of life. We propose a pocketable and smart electrohydrodynamic pump (PSEP) with self-sensing capability for wearable thermal controls. Overcoming the constraints of traditional liquid-cooled wearables, PSEP with dimensions of 10 × 2 × 1.05 cm and a weight of 10 g is sufficiently compact to fit into a shirt pocket, providing stylish and unobtrusive thermal control. Silent operation coupled with the unique self-sensing ability to monitor the flow rate ensures system reliability without cumbersome additional components. The significant contribution of our study is the formulation and validation of a theoretical model for self-sensing in EHD pumps, thereby introducing an innovative functionality to EHD pump technology. PSEP can deliver temperature changes of up to 3 °C, considerably improving personal comfort. Additionally, the PSEP system features an intuitive, smartphone-compatible interface for seamless wireless control and monitoring, enhancing user interaction and convenience. Furthermore, the ability to detect and notify users of flow blockages, achieved by self-sensing, ensures an efficient and long-term operation. Through its blend of compact design, intelligent functionality, and stylish integration into daily wear, PSEP reshapes the landscape of wearable thermal control technology and offers a promising avenue for enhancing personal comfort in daily life.
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Affiliation(s)
- Yu Kuwajima
- Department
of Engineering Science and Mechanics, Shibaura
Institute of Technology, 3-7-5, Toyosu, Koto-ku, Tokyo 135-8548, Japan
| | - Yuya Yamaguchi
- Department
of Engineering Science and Mechanics, Shibaura
Institute of Technology, 3-7-5, Toyosu, Koto-ku, Tokyo 135-8548, Japan
| | - Yuhei Yamada
- Living
Systems Materialogy Research Group, International Research Frontiers
Initiative, Tokyo Institute of Technology, 4259, Nagatsuta-Cho, Midori-Ku, Yokohama, Kanagawa 226-8501, Japan
| | - Takafumi Morita
- The
University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| | - Ardi Wiranata
- Department
of Mechanical and Industrial Engineering, Universitas Gadjah Mada, Jalan Grafika No. 2, Yogyakarta 55281, Indonesia
| | - Ayato Minaminosono
- Department
of Engineering Science and Mechanics, Shibaura
Institute of Technology, 3-7-5, Toyosu, Koto-ku, Tokyo 135-8548, Japan
| | - Naoki Hosoya
- Department
of Engineering Science and Mechanics, Shibaura
Institute of Technology, 3-7-5, Toyosu, Koto-ku, Tokyo 135-8548, Japan
| | - Yasuaki Kakehi
- The
University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| | - Shingo Maeda
- Department
of Mechanical Engineering, Tokyo Institute
of Technology, Ookayama, Meguro-ku, Tokyo 152-8550, Japan
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Tsuji K, Nakanoh H, Takahashi K, Morita T, Sang Y, Fukushima K, Matsuoka-Uchiyama N, Onishi Y, Uchida HA, Kitamura S, Wada J. Kidney Veno-Muscular Characteristics and Kidney Disease Progression: A Native Kidney-Biopsy Study. Kidney Med 2023; 5:100733. [PMID: 38046910 PMCID: PMC10692955 DOI: 10.1016/j.xkme.2023.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Rationale & Objective Assessment of kidney biopsies provides crucial information for diagnosis and disease activity, as well as prognostic value. Kidney-biopsy specimens occasionally contain veno-muscular complex (VMC), which consists of muscle tissues around the kidney venous system in the corticomedullary region. However, the role of VMC and the clinical significance of VMC variants are poorly understood. In the present study, we investigated kidney prognostic values of VMC variants. Study Design Retrospective cohort study. Setting & Participants Among 808 patients who underwent a kidney biopsy from 2011 to 2019, 246 patients whose kidney biopsy specimens contained VMC were enrolled. Predictors VMC variants; inflammatory-VMC (an infiltration of ≥80 inflammatory cells/mm2-VMC area) and VMC hypertrophy (hyper-VMC, a VMC average width ≥850 μm), and the interstitial fibrosis/tubular atrophy (IFTA) score. Outcomes A decline in estimated glomerular filtration rate (eGFR) ≥40% from the baseline or commencement of kidney replacement therapy. Analytical Approach Cox proportional hazards model. Results Among 246 patients with data on VMC, mean baseline eGFR was 56.0±25.6 ml/min per 1.73 m2; 80 had high inflammatory-VMC, and 62 had VMC hypertrophy. There were 51 kidney events over median follow-up of 2.5 years. We analyzed 2 VMC variants. Multivariable logistic regression analysis revealed that eGFR negatively correlated with the presence of both inflammatory-VMC and hyper-VMC. A Cox proportional hazards analysis revealed that inflammatory-VMC (but not hyper-VMC) was independently associated with the primary outcome after adjustments for known risk factors of progression, including proteinuria, eGFR, and the interstitial fibrosis/tubular atrophy (IFTA) score (hazard ratio, 1.97; 95% confidence interval, 1.00-3.91). Limitations Single-center study and small sample size. Conclusions Assessment of inflammatory-VMC provides additional kidney prognostic information to known indicators of kidney disease progression in patients who undergo kidney biopsy. Plain-Language Summary Assessment of kidney biopsies provides crucial information for diagnosis, disease activity, and prognostic value. Kidney-biopsy specimens occasionally contain veno-muscular complex (VMC), which consists of muscle tissues around the kidney venous system. Currently, the role of VMC in kidney health and diseases and the clinical significance of VMC variants are poorly understood. In the present study, we have shown that an infiltration of ≥80 inflammatory cells/mm2-VMC area (inflammatory-VMC) is independently associated with kidney disease progression after adjustments for known risk factors of progression. Therefore, assessment of inflammatory-VMC provides additional kidney prognostic information to known indicators of kidney disease progression in patients who undergo kidney biopsy.
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Affiliation(s)
- Kenji Tsuji
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hiroyuki Nakanoh
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kensaku Takahashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takafumi Morita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yizhen Sang
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kazuhiko Fukushima
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Natsumi Matsuoka-Uchiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuhiro Onishi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Haruhito A. Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Shinji Kitamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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de Heer EC, Zois CE, Bridges E, van der Vegt B, Sheldon H, Veldman WA, Zwager MC, van der Sluis T, Haider S, Morita T, Baba O, Schröder CP, de Jong S, Harris AL, Jalving M. Correction: Glycogen synthase 1 targeting reveals a metabolic vulnerability in triple-negative breast cancer. J Exp Clin Cancer Res 2023; 42:220. [PMID: 37635223 PMCID: PMC10463864 DOI: 10.1186/s13046-023-02800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- E. C. de Heer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB The Netherlands
| | - C. E. Zois
- Department of Oncology, Weatherall Institute of Molecular Medicine, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, University of Oxford, Oxford, OX3 9DS UK
- Department of Radiotherapy and Oncology, School of Health, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Oncology, MRC Weatherall Institute of Molecular Medicine, Molecular Oncology Laboratories, John Radclife Hospital, Oxford University, Oxford, OX3 9DS UK
| | - E. Bridges
- Department of Oncology, Weatherall Institute of Molecular Medicine, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, University of Oxford, Oxford, OX3 9DS UK
| | - B. van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H. Sheldon
- Department of Oncology, Weatherall Institute of Molecular Medicine, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, University of Oxford, Oxford, OX3 9DS UK
| | - W. A. Veldman
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB The Netherlands
| | - M. C. Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T. van der Sluis
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S. Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - T. Morita
- Tokushima University Graduate School, 3-18-15, Kuramoto-Cho, Tokushima, 770-8504 Japan
| | - O. Baba
- Tokushima University Graduate School, 3-18-15, Kuramoto-Cho, Tokushima, 770-8504 Japan
| | - C. P. Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB The Netherlands
- Department of Medical Oncology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S. de Jong
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB The Netherlands
| | - A. L. Harris
- Department of Oncology, Weatherall Institute of Molecular Medicine, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, University of Oxford, Oxford, OX3 9DS UK
| | - M. Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB The Netherlands
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de Heer EC, Zois CE, Bridges E, van der Vegt B, Sheldon H, Veldman WA, Zwager MC, van der Sluis T, Haider S, Morita T, Baba O, Schröder CP, de Jong S, Harris AL, Jalving M. Glycogen synthase 1 targeting reveals a metabolic vulnerability in triple-negative breast cancer. J Exp Clin Cancer Res 2023; 42:143. [PMID: 37280675 PMCID: PMC10242793 DOI: 10.1186/s13046-023-02715-z] [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: 12/23/2022] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Hypoxia-induced glycogen turnover is implicated in cancer proliferation and therapy resistance. Triple-negative breast cancers (TNBCs), characterized by a hypoxic tumor microenvironment, respond poorly to therapy. We studied the expression of glycogen synthase 1 (GYS1), the key regulator of glycogenesis, and other glycogen-related enzymes in primary tumors of patients with breast cancer and evaluated the impact of GYS1 downregulation in preclinical models. METHODS mRNA expression of GYS1 and other glycogen-related enzymes in primary breast tumors and the correlation with patient survival were studied in the METABRIC dataset (n = 1904). Immunohistochemical staining of GYS1 and glycogen was performed on a tissue microarray of primary breast cancers (n = 337). In four breast cancer cell lines and a mouse xenograft model of triple-negative breast cancer, GYS1 was downregulated using small-interfering or stably expressed short-hairpin RNAs to study the effect of downregulation on breast cancer cell proliferation, glycogen content and sensitivity to various metabolically targeted drugs. RESULTS High GYS1 mRNA expression was associated with poor patient overall survival (HR 1.20, P = 0.009), especially in the TNBC subgroup (HR 1.52, P = 0.014). Immunohistochemical GYS1 expression in primary breast tumors was highest in TNBCs (median H-score 80, IQR 53-121) and other Ki67-high tumors (median H-score 85, IQR 57-124) (P < 0.0001). Knockdown of GYS1 impaired proliferation of breast cancer cells, depleted glycogen stores and delayed growth of MDA-MB-231 xenografts. Knockdown of GYS1 made breast cancer cells more vulnerable to inhibition of mitochondrial proteostasis. CONCLUSIONS Our findings highlight GYS1 as potential therapeutic target in breast cancer, especially in TNBC and other highly proliferative subsets.
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Affiliation(s)
- E C de Heer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - C E Zois
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK.
- Department of Radiotherapy and Oncology, School of Health, Democritus University of Thrace, Alexandroupolis, Greece.
- Department of Oncology, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Molecular Oncology Laboratories, Oxford University, Oxford, OX3 9DS, UK.
| | - E Bridges
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK
| | - B van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H Sheldon
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK
| | - W A Veldman
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - M C Zwager
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T van der Sluis
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - T Morita
- Tokushima University Graduate School, 3-18-15, Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - O Baba
- Tokushima University Graduate School, 3-18-15, Kuramoto-Cho, Tokushima, 770-8504, Japan
| | - C P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Medical Oncology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S de Jong
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - A L Harris
- Department of Oncology, Weatherall Institute of Molecular Medicine, University of Oxford, Hypoxia and Angiogenesis Group, Cancer Research UK Molecular Oncology Laboratories, Oxford, OX3 9DS, UK
| | - M Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Stone P, Buckle P, Dolan R, Feliu J, Hui D, Laird BJA, Maltoni M, Moine S, Morita T, Nabal M, Vickerstaff V, White N, Santini D, Ripamonti CI. Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:101195. [PMID: 37087198 PMCID: PMC10242351 DOI: 10.1016/j.esmoop.2023.101195] [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: 11/30/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 04/24/2023] Open
Abstract
•This ESMO Clinical Practice Guideline provides key recommendations for using prognostic estimates in advanced cancer. •The guideline covers recommendations for patients with cancer and an expected survival of months or less. •An algorithm for use of clinical predictions, prognostic factors and multivariable risk prediction models is presented. •The author group encompasses a multidisciplinary group of experts from different institutions in Europe, USA and Asia. •Recommendations are based on available scientific data and the authors’ collective expert opinion.
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Affiliation(s)
- P Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK; Palliative Care Team, Central and North West London NHS Trust, London, UK
| | | | - R Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - J Feliu
- Department of Medical Oncology, La Paz University Hospital, IdiPAZ, CIBERONC, Cátedra UAM-AMGEN, Madrid, Spain
| | - D Hui
- Departments of Palliative Care, Rehabilitation and Integrative Medicine, Houston, USA; General Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - B J A Laird
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK; St Columba's Hospice Care, Edinburgh, UK
| | - M Maltoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - S Moine
- Health Education and Practices Laboratory (LEPS EA3412), University Paris Sorbonne Paris Cité, Bobigny, Paris, France
| | - T Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - M Nabal
- Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - V Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - N White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - D Santini
- UOC Oncologia Medica Territoriale, La Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - C I Ripamonti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Osuga T, Kuroda K, Morita T, Sasaki N, Nakamura K, Takiguchi M. Prognostic value of left atrial stiffness estimated using echocardiography in dogs with myxomatous mitral valve disease. J Vet Cardiol 2023; 45:15-26. [PMID: 36608614 DOI: 10.1016/j.jvc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION No studies have investigated the prognostic value of left atrial stiffness (LASt) estimated using echocardiography in dogs with myxomatous mitral valve disease (MMVD). ANIMALS Seventy-two dogs had MMVD and 46 dogs were healthy dogs. MATERIALS AND METHODS Clinical retrospective cohort study. The survival information of MMVD dogs that underwent echocardiographic examination was obtained. The peak velocities of early diastolic transmitral flow (E) and mitral annular motion as determined by pulsed wave Doppler (E') were determined. The left atrial reservoir strain (εS) was determined by two-dimensional speckle tracking echocardiography of the left atrium. The LASt was estimated by the formula: E/E'/εS. The 95% prediction interval of LASt was computed from the data of the healthy dogs. RESULTS Seventeen dogs having MMVD died of cardiac-related causes with 55 MMVD dogs censored. The MMVD dogs with LASt > its 95% upper prediction limit (LASt > 0.56; n = 26; median survival time, 484 days; 95% confidence interval, 283 days-indeterminable) had shorter survival times (P<0.001) than those with LASt ≤ its 95% upper prediction limit (LASt ≤ 0.56; n = 46; median survival time, >1112 days; 95% confidence interval, indeterminable). Multivariable Cox's proportional hazard analysis demonstrated that the ratio of the left atrial dimension to the aortic annulus dimension and LASt were independent predictors of cardiac-related death among conventional echocardiographic indices, εS and LASt in MMVD dogs. CONCLUSIONS In dogs with MMVD, increased LASt estimated using echocardiography is an independent predictor of cardiac-related death, and LASt can be more useful for prognostication than εS.
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Affiliation(s)
- T Osuga
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, N18 W10, Sapporo, Hokkaido 060-0819, Japan
| | - K Kuroda
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - T Morita
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - N Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - K Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - M Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan.
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8
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Morita T, Kojima T, Matsuo S, Matsukiyo S, Isayama S, Yamazaki R, Tanaka SJ, Aihara K, Sato Y, Shiota J, Pan Y, Tomita K, Takezaki T, Kuramitsu Y, Sakai K, Egashira S, Ishihara H, Kuramoto O, Matsumoto Y, Maeda K, Sakawa Y. Detection of current-sheet and bipolar ion flows in a self-generated antiparallel magnetic field of laser-produced plasmas for magnetic reconnection research. Phys Rev E 2022; 106:055207. [PMID: 36559487 DOI: 10.1103/physreve.106.055207] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/23/2022] [Indexed: 06/17/2023]
Abstract
Magnetic reconnection in laser-produced magnetized plasma is investigated by using optical diagnostics. The magnetic field is generated via the Biermann battery effect, and the inversely directed magnetic field lines interact with each other. It is shown by self-emission measurement that two colliding plasmas stagnate on a midplane, forming two planar dense regions, and that they interact later in time. Laser Thomson scattering spectra are distorted in the direction of the self-generated magnetic field, indicating asymmetric ion velocity distribution and plasma acceleration. In addition, the spectra perpendicular to the magnetic field show different peak intensity, suggesting an electron current formation. These results are interpreted as magnetic field dissipation, reconnection, and outflow acceleration. Two-directional laser Thomson scattering is, as discussed here, a powerful tool for the investigation of microphysics in the reconnection region.
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Affiliation(s)
- T Morita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - T Kojima
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1, Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - S Matsuo
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1, Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - S Matsukiyo
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- International Research Center for Space and Planetary Environmental Science, Kyushu University, Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
| | - S Isayama
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - R Yamazaki
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S J Tanaka
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - K Aihara
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Sato
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - J Shiota
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Pan
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1, Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - K Tomita
- Faculty of Engineering, Hokkaido University, Kita 13 Nishi 8, Kita-ku, Sapporo 060-8628, Japan
| | - T Takezaki
- Faculty of Engineering, University of Toyama, Gofuku 3190, Toyama-shi, Toyama 930-8555, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Sakai
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Egashira
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - H Ishihara
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - O Kuramoto
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - Y Matsumoto
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - K Maeda
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka 565-0871, Japan
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9
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Sakai K, Moritaka T, Morita T, Tomita K, Minami T, Nishimoto T, Egashira S, Ota M, Sakawa Y, Ozaki N, Kodama R, Kojima T, Takezaki T, Yamazaki R, Tanaka SJ, Aihara K, Koenig M, Albertazzi B, Mabey P, Woolsey N, Matsukiyo S, Takabe H, Hoshino M, Kuramitsu Y. Author Correction: Direct observations of pure electron outflow in magnetic reconnection. Sci Rep 2022; 12:16501. [PMID: 36192592 PMCID: PMC9530177 DOI: 10.1038/s41598-022-21220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- K Sakai
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan. .,Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan.
| | - T Moritaka
- Department of Helical Plasma Research, National Institute for Fusion Science, Toki, 509‑5292, Japan
| | - T Morita
- Faculty of Engineering Sciences, Kyushu University, 6‑1 Kasuga‑Koen, Kasuga, Fukuoka, 816‑8580, Japan
| | - K Tomita
- Division of Quantum Science and Engineering, Graduate School of Engineering, Hokkaido University, Kita 13, Nishi 8, Kita‑ku, Sapporo, Hokkaido, 060‑8628, Japan
| | - T Minami
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan.,Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - T Nishimoto
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan.,Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - S Egashira
- Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - M Ota
- Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - N Ozaki
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan.,Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - R Kodama
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan.,Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan
| | - T Kojima
- Faculty of Engineering Sciences, Kyushu University, 6‑1 Kasuga‑Koen, Kasuga, Fukuoka, 816‑8580, Japan
| | - T Takezaki
- Faculty of Engineering, University of Toyama, 3190 Gofuku, Toyama, Toyama, 930‑8555, Japan
| | - R Yamazaki
- Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan.,Department of Physical Sciences, Aoyama Gakuin University, 5‑10‑1 Fuchinobe, Sagamihara, Kanagawa, 252‑5258, Japan
| | - S J Tanaka
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan.,Department of Physical Sciences, Aoyama Gakuin University, 5‑10‑1 Fuchinobe, Sagamihara, Kanagawa, 252‑5258, Japan
| | - K Aihara
- Department of Physical Sciences, Aoyama Gakuin University, 5‑10‑1 Fuchinobe, Sagamihara, Kanagawa, 252‑5258, Japan
| | - M Koenig
- LULI-CNRS, CEA, Sorbonne Universités, École Polytechnique, Institut Polytechnique de Paris, 91120, Palaiseau Cedex, France
| | - B Albertazzi
- LULI-CNRS, CEA, Sorbonne Universités, École Polytechnique, Institut Polytechnique de Paris, 91120, Palaiseau Cedex, France
| | - P Mabey
- LULI-CNRS, CEA, Sorbonne Universités, École Polytechnique, Institut Polytechnique de Paris, 91120, Palaiseau Cedex, France
| | - N Woolsey
- Department of Physics, York Plasma Institute, University of York, York, YO10 5DD, UK
| | - S Matsukiyo
- Faculty of Engineering Sciences, Kyushu University, 6‑1 Kasuga‑Koen, Kasuga, Fukuoka, 816‑8580, Japan
| | - H Takabe
- Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei, 10617, Taiwan
| | - M Hoshino
- Department of Earth and Planetary Science, University of Tokyo, 7‑3‑1 Hongo, Bunkyo, Tokyo, 113‑0033, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, 2‑1 Yamadaoka, Suita, Osaka, 565‑0871, Japan. .,Institute of Laser Engineering, Osaka University, 2‑6 Yamadaoka, Suita, Osaka, 565‑0871, Japan.
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10
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Matsukiyo S, Yamazaki R, Morita T, Tomita K, Kuramitsu Y, Sano T, Tanaka SJ, Takezaki T, Isayama S, Higuchi T, Murakami H, Horie Y, Katsuki N, Hatsuyama R, Edamoto M, Nishioka H, Takagi M, Kojima T, Tomita S, Ishizaka N, Kakuchi S, Sei S, Sugiyama K, Aihara K, Kambayashi S, Ota M, Egashira S, Izumi T, Minami T, Nakagawa Y, Sakai K, Iwamoto M, Ozaki N, Sakawa Y. High-power laser experiment on developing supercritical shock propagating in homogeneously magnetized plasma of ambient gas origin. Phys Rev E 2022; 106:025205. [PMID: 36109929 DOI: 10.1103/physreve.106.025205] [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] [Received: 09/25/2020] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
A developing supercritical collisionless shock propagating in a homogeneously magnetized plasma of ambient gas origin having higher uniformity than the previous experiments is formed by using high-power laser experiment. The ambient plasma is not contaminated by the plasma produced in the early time after the laser shot. While the observed developing shock does not have stationary downstream structure, it possesses some characteristics of a magnetized supercritical shock, which are supported by a one-dimensional full particle-in-cell simulation taking the effect of finite time of laser-target interaction into account.
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Affiliation(s)
- S Matsukiyo
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- International Research Center for Space and Planetary Environmental Science, Kyushu University, Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - R Yamazaki
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Morita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - K Tomita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- Division of Quantum Science and Engineering, Hokkaido University, Sapporo 060-8628, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Sano
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S J Tanaka
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Takezaki
- Faculty of Engineering, University of Toyama, 3190, Gofuku, Toyama 930-8555, Japan
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminamiku, Kitakyushu, Fukuoka 802-0985, Japan
| | - S Isayama
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- International Research Center for Space and Planetary Environmental Science, Kyushu University, Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
| | - T Higuchi
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - H Murakami
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - Y Horie
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - N Katsuki
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - R Hatsuyama
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - M Edamoto
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - H Nishioka
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - M Takagi
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - T Kojima
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - S Tomita
- Astronomical Institute, Tohoku University, 6-3 Aramaki, Aoba-ku, Sendai, Miyagi 980-8578, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan
| | - N Ishizaka
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Kakuchi
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Sei
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - K Sugiyama
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - K Aihara
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Kambayashi
- Department of Physical Science, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - M Ota
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - S Egashira
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - T Izumi
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - T Minami
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Nakagawa
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - K Sakai
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - M Iwamoto
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- Department of Earth and Planetary Science, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - N Ozaki
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
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11
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Morita T, Ohyagi N, Matsuura J, Kawaguchi T, Ishizaki N. Salmonella
contamination and hazard analysis in a storage facility for feed materials in Japan. J Appl Microbiol 2022; 133:2966-2978. [DOI: 10.1111/jam.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Affiliation(s)
- T. Morita
- SETTSU INC., Nishi‐ku, Sakai Osaka Japan
- Faculty of Bioscience and Bioindustry Tokushima University Tokushima Tokushima Japan
| | - N. Ohyagi
- SETTSU INC., Nishi‐ku, Sakai Osaka Japan
| | | | | | - N. Ishizaki
- Faculty of Life and Environmental Science Azabu University Sagamihara Kanagawa Japan
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12
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Sakai K, Moritaka T, Morita T, Tomita K, Minami T, Nishimoto T, Egashira S, Ota M, Sakawa Y, Ozaki N, Kodama R, Kojima T, Takezaki T, Yamazaki R, Tanaka SJ, Aihara K, Koenig M, Albertazzi B, Mabey P, Woolsey N, Matsukiyo S, Takabe H, Hoshino M, Kuramitsu Y. Direct observations of pure electron outflow in magnetic reconnection. Sci Rep 2022; 12:10921. [PMID: 35773286 PMCID: PMC9247195 DOI: 10.1038/s41598-022-14582-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Magnetic reconnection is a universal process in space, astrophysical, and laboratory plasmas. It alters magnetic field topology and results in energy release to the plasma. Here we report the experimental results of a pure electron outflow in magnetic reconnection, which is not accompanied with ion flows. By controlling an applied magnetic field in a laser produced plasma, we have constructed an experiment that magnetizes the electrons but not the ions. This allows us to isolate the electron dynamics from the ions. Collective Thomson scattering measurements reveal the electron Alfvénic outflow without ion outflow. The resultant plasmoid and whistler waves are observed with the magnetic induction probe measurements. We observe the unique features of electron-scale magnetic reconnection simultaneously in laser produced plasmas, including global structures, local plasma parameters, magnetic field, and waves.
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Affiliation(s)
- K Sakai
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - T Moritaka
- Department of Helical Plasma Research, National Institute for Fusion Science, Toki, 509-5292, Japan
| | - T Morita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka, 816-8580, Japan
| | - K Tomita
- Division of Quantum Science and Engineering, Graduate School of Engineering, Hokkaido University, Kita 13, Nishi 8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
| | - T Minami
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - T Nishimoto
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - S Egashira
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - M Ota
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - N Ozaki
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - R Kodama
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - T Kojima
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka, 816-8580, Japan
| | - T Takezaki
- Faculty of Engineering, University of Toyama, 3190 Gofuku, Toyama, Toyama, 930-8555, Japan
| | - R Yamazaki
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa, 252-5258, Japan
| | - S J Tanaka
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa, 252-5258, Japan
| | - K Aihara
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa, 252-5258, Japan
| | - M Koenig
- LULI-CNRS, CEA, Sorbonne Universités, École Polytechnique, Institut Polytechnique de Paris, F-91120, Palaiseau cedex, France
| | - B Albertazzi
- LULI-CNRS, CEA, Sorbonne Universités, École Polytechnique, Institut Polytechnique de Paris, F-91120, Palaiseau cedex, France
| | - P Mabey
- LULI-CNRS, CEA, Sorbonne Universités, École Polytechnique, Institut Polytechnique de Paris, F-91120, Palaiseau cedex, France
| | - N Woolsey
- Department of Physics, York Plasma Institute, University of York, York, YO10 5DD, UK
| | - S Matsukiyo
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka, 816-8580, Japan
| | - H Takabe
- Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei, 10617, Taiwan
| | - M Hoshino
- Department of Earth and Planetary Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka, 565-0871, Japan
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13
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Yamazaki R, Matsukiyo S, Morita T, Tanaka SJ, Umeda T, Aihara K, Edamoto M, Egashira S, Hatsuyama R, Higuchi T, Hihara T, Horie Y, Hoshino M, Ishii A, Ishizaka N, Itadani Y, Izumi T, Kambayashi S, Kakuchi S, Katsuki N, Kawamura R, Kawamura Y, Kisaka S, Kojima T, Konuma A, Kumar R, Minami T, Miyata I, Moritaka T, Murakami Y, Nagashima K, Nakagawa Y, Nishimoto T, Nishioka Y, Ohira Y, Ohnishi N, Ota M, Ozaki N, Sano T, Sakai K, Sei S, Shiota J, Shoji Y, Sugiyama K, Suzuki D, Takagi M, Toda H, Tomita S, Tomiya S, Yoneda H, Takezaki T, Tomita K, Kuramitsu Y, Sakawa Y. High-power laser experiment forming a supercritical collisionless shock in a magnetized uniform plasma at rest. Phys Rev E 2022; 105:025203. [PMID: 35291161 DOI: 10.1103/physreve.105.025203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
We present an experimental method to generate quasiperpendicular supercritical magnetized collisionless shocks. In our experiment, ambient nitrogen (N) plasma is at rest and well magnetized, and it has uniform mass density. The plasma is pushed by laser-driven ablation aluminum (Al) plasma. Streaked optical pyrometry and spatially resolved laser collective Thomson scattering clarify structures of plasma density and temperatures, which are compared with one-dimensional particle-in-cell simulations. It is indicated that just after the laser irradiation, the Al plasma is magnetized by a self-generated Biermann battery field, and the plasma slaps the incident N plasma. The compressed external field in the N plasma reflects N ions, leading to counterstreaming magnetized N flows. Namely, we identify the edge of the reflected N ions. Such interacting plasmas form a magnetized collisionless shock.
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Affiliation(s)
- R Yamazaki
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Matsukiyo
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - T Morita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
| | - S J Tanaka
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - T Umeda
- Institute for Space-Earth Environmental Research, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8602, Japan
| | - K Aihara
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - M Edamoto
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - S Egashira
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - R Hatsuyama
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - T Higuchi
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - T Hihara
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Horie
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - M Hoshino
- Department of Earth and Planetary Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - A Ishii
- Max Planck Institute for Gravitational Physics (Albert Einstein Institute), Am Mühlenberg 1, Potsdam-Golm 14476, Germany
| | - N Ishizaka
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Itadani
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - T Izumi
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - S Kambayashi
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Kakuchi
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - N Katsuki
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - R Kawamura
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Kawamura
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Kisaka
- Department of Physical Science, Hiroshima University, Higashi-Hiroshima 739-8526, Japan
| | - T Kojima
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - A Konuma
- Institute for Laser Science, University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - R Kumar
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - T Minami
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - I Miyata
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - T Moritaka
- Fundamental Physics Simulation Research Division, National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - Y Murakami
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - K Nagashima
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - Y Nakagawa
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - T Nishimoto
- School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Nishioka
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - Y Ohira
- Department of Earth and Planetary Science, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - N Ohnishi
- Department of Aerospace Engineering, Tohoku University, 6-6 Aramaki Aza Aoba, Aoba, Sendai, Miyagi 980-8579, Japan
| | - M Ota
- Graduate School of Science, Osaka University, 1-1 Machikane-yama, Toyonaka, Osaka 560-0043, Japan
| | - N Ozaki
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - T Sano
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Sakai
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - S Sei
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - J Shiota
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - Y Shoji
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - K Sugiyama
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - D Suzuki
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - M Takagi
- Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga 816-8580, Japan
| | - H Toda
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - S Tomita
- Astronomical Institute, Tohoku University, 6-3 Aramaki, Aoba-ku, Sendai, Miyagi 980-8578, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan
| | - S Tomiya
- Department of Physical Sciences, Aoyama Gakuin University, 5-10-1 Fuchinobe, Sagamihara, Kanagawa 252-5258, Japan
| | - H Yoneda
- Institute for Laser Science, University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - T Takezaki
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminamiku, Kitakyushu, Fukuoka 802-0985, Japan
- Faculty of Engineering, University of Toyama, 3190, Gofuku, Toyama 930-8555, Japan
| | - K Tomita
- Faculty of Engineering Sciences, Kyushu University, 6-1 Kasuga-Koen, Kasuga, Fukuoka 816-8580, Japan
- Division of Quantum Science and Engineering, Hokkaido University, Sapporo 060-8628, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita, Osaka 565-0871, Japan
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14
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Morita T, Nakamura K, Osuga T, Takiguchi M. Incremental predictive value of echocardiographic indices of right ventricular function in the assessment of long-term prognosis in dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 39:51-62. [PMID: 34979482 DOI: 10.1016/j.jvc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Few studies have evaluated the utility of echocardiographic indices of right ventricular (RV) function in predicting prognosis in dogs with myxomatous mitral valve disease (MMVD). ANIMALS Sixty-seven client-owned dogs were diagnosed with MMVD. MATERIALS AND METHODS clinical cohort study. Dogs diagnosed with American college of veterinary internal medicine (ACVIM) stage B2, C or D between April 2014 and March 2017 were enrolled. Long-term outcomes were assessed by telephone or from the medical record. The primary end-point was defined as cardiac-related death. Echocardiographic indices of RV function, including the RV Tei index, free wall and septal RV longitudinal strain, were obtained. Univariable and multivariable Cox proportional hazard analyses were used to identify variables predictive of cardiac-related death. RESULTS Twenty-four dogs died during the follow-up period. The median follow-up time was 482 days, and the median survival time for dogs with cardiac-related death was 230 days. For cardiac-related death, peak early diastolic mitral inflow velocity, ACVIM stage C or D, tricuspid regurgitation velocity, RV Tei index and RV end-diastolic area were predictors in univariable Cox proportional hazard analysis. In multivariable Cox proportional analysis adjusted for the left atrial to aorta ratio, peak early diastolic mitral inflow velocity and ACVIM stage, an increase in the Tei index by 0.1 increased the hazard ratio of cardiac-related death by 33% (95% confidence interval, 16-70%; P = 0.002). CONCLUSIONS In dogs with MMVD, RV dysfunction assessed by the Tei index is an independent predictor of cardiac-related death.
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Affiliation(s)
- T Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, Japan
| | - K Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, Japan.
| | - T Osuga
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki, 889-2192, Japan
| | - M Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido, 060-0818, 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. 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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16
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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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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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18
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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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19
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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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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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21
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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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22
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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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23
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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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24
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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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25
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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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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. 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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27
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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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28
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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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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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Morioka S, Mori M, Suzuki T, Yokomichi M, Hamano J, Morita T. Diversity of physicians' attitudes toward the management of infectious diseases in terminally ill patients with cancer. J Hosp Infect 2020; 105:S0195-6701(20)30213-9. [PMID: 32360358 DOI: 10.1016/j.jhin.2020.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Affiliation(s)
- S Morioka
- Disease Control and Prevention Center, National Centre for Global Health and Medicine, Tokyo, Japan.
| | - M Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - T Suzuki
- Division of Palliative Medicine, Shizuoka Cancer Center, Mishima, Shizuoka, Japan
| | - M Yokomichi
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - J Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaragi, Japan
| | - T Morita
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Saito H, Tanimoto T, Kami M, Suzuki Y, Morita T, Morita M, Yamamoto K, Shimada Y, Tsubokura M, Endo M. New physician specialty training system impact on distribution of trainees in Japan. Public Health 2020; 182:143-150. [PMID: 32305513 DOI: 10.1016/j.puhe.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/13/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The problem of uneven distribution of medical services and inequitable distribution of physicians is drawing much attention worldwide. Revealing how changes in the specialty training system in Japan have affected the distribution of doctors could help us understand this problem. In 2018, a new and standardized specialty training system was implemented by the Japanese Medical Specialty Board, which is recognized by the Ministry of Health, Labor and Welfare. The purpose of this study was to investigate how this new system has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. STUDY DESIGN Retrospective observational study. METHODS The change in the number of trainees between the control period (2012-2014) and 2018 was investigated, taking into account the prefecture and specialty selected. Population, the proportion of residents aged 65 years or older (aging rate), and the total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. We created a Lorenz curve and calculated the Gini coefficient for the distribution of trainees. RESULTS In 2018, the number of trainees per 100,000 population increased to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 increased in prefectures with a large population of ≧ 2,000,000, a low aging rate (<27%), and a high doctor density (≧ 250 doctors per 100,000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. CONCLUSIONS After the implementation of the new training system, there was an increase in the number of doctors enrolling in specialty programs, and the specialties other than internal medicine and surgery have attracted more trainees. Inequality in the distribution of doctors between urban and rural prefectures worsened. This indicates the need to explore new ways of balancing distribution while maintaining optimal opportunities for specialist training.
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Affiliation(s)
- H Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
| | - T Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - M Kami
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Y Suzuki
- Department of Obstetrics and Gynecology, Tone Central Hospital, Numata, Gunma, Japan
| | - T Morita
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - M Morita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - K Yamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Y Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
| | - M Tsubokura
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - M Endo
- Support Office for Medical Education and Trainings, Sendai Kousei Hospital, Sendai, Miyagi, Japan
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Morita T, Koda H. Difficulties in analysing animal song under formal language theory framework: comparison with metric-based model evaluation. R Soc Open Sci 2020; 7:192069. [PMID: 32257355 PMCID: PMC7062062 DOI: 10.1098/rsos.192069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- T. Morita
- Primate Research Institute, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - H. Koda
- Primate Research Institute, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
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Uneno Y, Sato K, Morita T, Nishimura M, Ito S, Mori M, Shimizu C, Horie Y, Hirakawa M, Nakajima TE, Tsuneto S, Muto M. Current status of integrating oncology and palliative care in Japan: a nationwide survey. BMC Palliat Care 2020; 19:12. [PMID: 31980015 PMCID: PMC6982384 DOI: 10.1186/s12904-020-0515-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Palliative care (PC) is increasingly recognized as essential for oncology care, and several academic societies strongly recommend integrating oncology and palliative care (IOP) in daily practice. Similarly, the Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; however, its detailed progress remains unclear. Therefore, this cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians' perception of IOP. METHODS The questionnaire was developed based on IOP indicators with international consensus. It was distributed to executive physicians at all government-designated cancer hospitals (DCHs, n = 399) and matched non-DCHs (n = 478) in November 2017 and the results were compared. RESULTS In total, 269 (67.4%) DCHs and 259 (54.2%) non-DCHs responded. The number of PC resources in DCHs was significantly higher than those in non-DCHs (e.g., full-time PC physicians and nurses, 52.8% vs. 14.0%, p < 0.001; availability of outpatient PC service ≥3 days per week, 47.6% vs. 20.7%, p < 0.001). Routine symptom screening was more frequently performed in DCHs than in non-DCHs (65.1% vs. 34.7%, p < 0.001). Automatic trigger for PC referral availability was limited (e.g., referral using time trigger, 14.9% vs. 15.3%, p = 0.700). Education and research opportunities were seriously limited in both types of hospitals. Most executive physicians regarded IOP as beneficial for their patients (95.9% vs. 94.7%, p = 0.163) and were willing to facilitate an early referral to PC services (54.7% vs. 60.0%, p < 0.569); however, the majority faced challenges to increase the number of full-time PC staff, and < 30% were planning to increase the staff members. CONCLUSIONS This survey highlighted a considerable number of IOP indicators met, particularly in DCHs probably due to the government policy. Further efforts are needed to address the serious research/educational gaps.
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Affiliation(s)
- Y Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan. .,Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - K Sato
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Morita
- Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - M Nishimura
- Geriatric Health Service Facility, You-You no Sono, Hiroshima, Japan.,Department of Health Informatics, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - S Ito
- Department of Health Informatics, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - M Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - C Shimizu
- Department of Breast Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Y Horie
- Department of Clinical Oncology, St Marianna University School of Medicine, Kawasaki, Japan
| | - M Hirakawa
- Department of Clinical Oncology, St Marianna University School of Medicine, Kawasaki, Japan
| | - T E Nakajima
- Department of Clinical Oncology, St Marianna University School of Medicine, Kawasaki, Japan
| | - S Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho Shogoin Sakyo-ku, Kyoto, 606-8507, Japan
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Nakajo M, Kitajima K, Kaida H, Morita T, Minamimoto R, Ishibashi M, Yoshiura T. The clinical value of PERCIST to predict tumour response and prognosis of patients with oesophageal cancer treated by neoadjuvant chemoradiotherapy. Clin Radiol 2020; 75:79.e9-79.e18. [DOI: 10.1016/j.crad.2019.09.132] [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] [Received: 05/03/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022]
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Kitazawa H, Aoki H, Ueda F, Morita T, Mochizuki M. Effective countermeasures for Salmonella contamination in actual oilmeal-manufacturing plant in India. J Appl Microbiol 2019; 127:1901-1906. [PMID: 31502742 DOI: 10.1111/jam.14438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/26/2019] [Accepted: 08/26/2019] [Indexed: 12/01/2022]
Abstract
AIMS Salmonella contamination in the manufacturing process of an overseas oilmeal plant was investigated and countermeasures for Salmonella contamination were evaluated. METHODS AND RESULTS Salmonella was detected from deposits and adhered materials inside the main processing equipment. Specifically high contamination was observed in the equipment associated with the meal cooler, with several Salmonella serovars being detected. A number of Salmonella serovars were also detected in the equipment of the fine powder recovery process. To prevent Salmonella contamination of oilmeal products, effective countermeasures that have been employed in Japan were implemented. By removing residues from the equipment and disinfecting the interior of the equipment, a significant decrease in the contamination rate of oilmeal products was achieved compared to before sanitation (P < 0·05). CONCLUSIONS Effective countermeasures to control Salmonella contamination in the overseas manufacturing process of oilmeal were established. SIGNIFICANCE AND IMPACT OF THE STUDY This is the first report focusing on Salmonella countermeasures in an actual oilmeal-manufacturing plant overseas.
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Affiliation(s)
- H Kitazawa
- Yokohama Isogo Plant, The Nisshin OilliO Group, Ltd., Isogo-ku, Yokohama, Japan.,Department of Applied Science, School of Veterinary Nursing, Nippon Veterinary and Life Science University, Musashino, Tokyo, Japan
| | - H Aoki
- Department of Basic Science, School of Veterinary Nursing, Nippon Veterinary and Life Science University, Musashino, Tokyo, Japan
| | - F Ueda
- Laboratory of Veterinary Public Health, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Tokyo, Japan
| | - T Morita
- Settsu Oil Mill, Inc., Sakai, Osaka, Japan
| | - M Mochizuki
- Department of Applied Science, School of Veterinary Nursing, Nippon Veterinary and Life Science University, Musashino, Tokyo, 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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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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Tamaki S, Yamada T, Morita T, Furukawa Y, Fukunami M, Yasumura Y, Abe H, Uematsu M, Higuchi Y, Hikoso S, Nakatani D, Sakata Y. P786Plasma volume status is associated with the change in nutritional status during hospitalization in acute decompensated heart failure patients with preserved left ventricular ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0385] [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
Introduction
Plasma volume (PV) expansion has an essential role in heart failure (HF). PV can be estimated by a simple formula using hematocrit and body weight, and PV status (PVS) provides prognostic information in patients (pts) with chronic HF. Nutritional status (NS) based on the prognostic nutritional index (PNI) and NS change during hospitalization have been shown to predict prognosis in pts admitted with acute decompensated HF (ADHF).
Purpose
We sought to assess the hypothesis that PVS is associated with NS change during hospitalization in pts with HF with preserved LVEF (HFpEF) who are admitted with ADHF.
Methods
We prospectively studied 411 pts who were admitted for ADHF with LVEF ≥50% and survived to discharge. Body weight measurement and venous blood sampling were performed on admission and at discharge. 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 (%). PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The pts were divided into 3 groups by PNI: normal (>38), moderate malnutrition (35–38), and severe malnutrition (<35). During admission, pts who remained in the moderate or severe malnutrition group or whose NS worsened were defined as no improvement in NS. Follow-up data was obtained in 203 cases. They were followed for up to 18 months, and the incidence of all-cause death was evaluated.
Results
On admission, PVS in the moderate (n=71, 13.3±13.9%) or severe malnutrition group (n=69, 14.8±10.8%) was significantly higher than in the normal PNI group (n=271, 5.4±10.8%, p<0.001). During hospitalization, 123 pts had no NS improvement. Admission PVS was significantly higher in pts with no NS improvement than in pts with improved NS (13.9±11.2% vs 5.9±12.8%, p<0.0001). In multivariate logistic regression analysis, admission PVS was independently associated with no NS improvement during hospitalization (OR 1.06, 95% CI 1.03–1.08, p<0.0001). Receiver operating characteristics curve analysis revealed that the optimal cut-off value of admission PVS for predicting no NS improvement was 9.4% (sensitivity: 72%, specificity: 63%). The area under the curve for predicting no NS improvement using admission PVS was significantly greater than for other independent factors (Figure 1A). During the follow-up period (median 12.4 months), 68 of 203 patients had all-cause death. Kaplan-Meier analysis showed that the patients with no NS improvement had a significantly higher risk of all-cause death (Figure 1B).
Figure 1
Conclusions
In this multicenter study, admission PVS was shown to be associated with poor improvement in NS during hospitalization in HFpEF pts admitted for ADHF.
Acknowledgement/Funding
Roche diagnostics, FUJIFILM Toyama Chemical
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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
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - H Abe
- Osaka National Hospital, Osaka, Japan
| | - M Uematsu
- Osaka National Hospital, Osaka, Japan
| | | | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, 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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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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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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Soeda T, Ishihara M, Fujino F, Ogawa H, Nakao K, Yasuda S, Noguchi T, Ozaki Y, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Hirohata A, Saito Y. P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0452] [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: 11/15/2022] Open
Abstract
Abstract
Background
Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated.
Objective
To study the characteristics and prognosis in octogenarians who presented cTn positive AMI.
Methods and results
The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure).
Conclusions
J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn.
Acknowledgement/Funding
None
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Affiliation(s)
- T Soeda
- Nara Medical University, Cardiovascular medicine, Kashihara, Japan
| | - M Ishihara
- Hyogo College of Medicine, Division of Coronary Artery Disease, Nishinomiya, Japan
| | - F Fujino
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Ozaki
- Fujita Health University, Cardiology, Toyoake, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Kumamoto, Japan
| | - Y Nakama
- Hiroshima City Hospital, Hiroshima, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | | | - A Hirohata
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Y Saito
- Nara Medical University, Cardiovascular medicine, Kashihara, Japan
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49
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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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50
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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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