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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Nakamura J, Liang S, Gardner GC, Manfra MJ. Half-Integer Conductance Plateau at the ν=2/3 Fractional Quantum Hall State in a Quantum Point Contact. Phys Rev Lett 2023; 130:076205. [PMID: 36867801 DOI: 10.1103/physrevlett.130.076205] [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] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The ν=2/3 fractional quantum Hall state is the hole-conjugate state to the primary Laughlin ν=1/3 state. We investigate transmission of edge states through quantum point contacts fabricated on a GaAs/AlGaAs heterostructure designed to have a sharp confining potential. When a small but finite bias is applied, we observe an intermediate conductance plateau with G=0.5(e^{2}/h). This plateau is observed in multiple QPCs, and persists over a significant range of magnetic field, gate voltage, and source-drain bias, making it a robust feature. Using a simple model that considers scattering and equilibration between counterflowing charged edge modes, we find this half-integer quantized plateau to be consistent with full reflection of an inner counterpropagating -1/3 edge mode while the outer integer mode is fully transmitted. In a QPC fabricated on a different heterostructure which has a softer confining potential, we instead observe an intermediate conductance plateau at G=(1/3)(e^{2}/h). These results provide support for a model at ν=2/3 in which the edge transitions from a structure having an inner upstream -1/3 charge mode and outer downstream integer mode to a structure with two downstream 1/3 charge modes when the confining potential is tuned from sharp to soft and disorder prevails.
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Affiliation(s)
- J Nakamura
- Department of Physics and Astronomy, Purdue University, West Lafayette, Indiana 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907, USA
| | - S Liang
- Department of Physics and Astronomy, Purdue University, West Lafayette, Indiana 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907, USA
| | - G C Gardner
- Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907, USA
- Microsoft Quantum Lab West Lafayette, West Lafayette, Indiana 47907, USA
| | - M J Manfra
- Department of Physics and Astronomy, Purdue University, West Lafayette, Indiana 47907, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, Indiana 47907, USA
- Microsoft Quantum Lab West Lafayette, West Lafayette, Indiana 47907, USA
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana 47907, USA
- School of Materials Engineering, Purdue University, West Lafayette, Indiana 47907, USA
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Nakamura J, Liang S, Gardner GC, Manfra MJ. Impact of bulk-edge coupling on observation of anyonic braiding statistics in quantum Hall interferometers. Nat Commun 2022; 13:344. [PMID: 35039497 PMCID: PMC8763912 DOI: 10.1038/s41467-022-27958-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Quantum Hall interferometers have been used to probe fractional charge and statistics of quasiparticles. We present measurements of a small Fabry-Perot interferometer in which the electrostatic coupling constants which affect interferometer behavior can be determined experimentally. Near the center of the ν = 1/3 state this device exhibits Aharonov-Bohm interference interrupted by a few discrete phase jumps, and Φ0 oscillations at higher and lower magnetic fields, consistent with theoretical predictions for detection of anyonic statistics. We estimate the electrostatic parameters KI and KIL by two methods: using the ratio of oscillation periods in compressible versus incompressible regions, and from finite-bias conductance measurements. We find that the extracted KI and KIL can account for the deviation of the phase jumps from the theoretical anyonic phase θa = 2π/3. At integer states, we find that KI and KIL can account for the Aharonov-Bohm and Coulomb-dominated behavior of different edge states.
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Affiliation(s)
- J Nakamura
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, USA
| | - S Liang
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, USA
| | - G C Gardner
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, USA
- Microsoft Quantum Lab West Lafayette, West Lafayette, IN, USA
| | - M J Manfra
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA.
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN, USA.
- Microsoft Quantum Lab West Lafayette, West Lafayette, IN, USA.
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA.
- School of Materials Engineering, Purdue University, West Lafayette, IN, USA.
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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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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, 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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Nano T, Morin O, Ziemer B, Raleigh D, Boreta L, Nakamura J, Fogh S, Sneed P, Harvey-Jumper S, Theodosopoulos P, Braunstein S, Ma L. PH-0378 How to achieve the sharpest dose fall-off for hypo-fractionated radiosurgery of large brain lesions? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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11
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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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12
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Oka S, Kai T, Hoshino K, Watanabe K, Nakamura J, Abe M, Watanabe A. A comparison of rate control and rhythm control in tachycardia induced cardiomyopathy patients with persistent atrial flutter. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0693] [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: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Tachycardia induced cardiomyopathy (TIC) is a potentially reversible dysfunction of the left ventricle (LV) caused by tachyarrhythmias. Early recognition of TIC and treatment of the culprit arrhythmia using pharmacological therapy or catheter ablation results in the recovery of LV function. For atrial flutter (AFL)-induced TIC, rhythm control strategy, such as catheter ablation has been recommended. On the other hand, the efficacy of rate control strategy has remained unclear due to the difficulty of control with arrhythmic medications. However, not all patients can take rhythm control treatments due to their backgrounds.
Purpose
The aim of this cohort study was to establish whether rate control strategy using β-blocker is as effective as invasive rhythm control strategy for the recovery of LV function in patients with TIC due to AFL.
Methods
We prospectively assessed 47 symptomatic non-ischaemic heart failure (HF) patients with left ventricular ejection fraction (LVEF) below 50% and suspected TIC induced by persistent AFL. Patients were divided into rhythm control strategy group (n=22, treatment: catheter ablation, electrical cardioversion) and rate control strategy group (n=25, treatment: bisoprolol). As a sub-group study, the rate control strategy group was divided into the strict rate control group (n=12, average heart rate below 80 bpm) and lenient rate control group (n=13, average heart rate below 110 bpm). The primary outcome was the recovery of LV function, defined as an increase of LVEF over 20% or to a value of 55% or greater after 6 months.
Results
There were no significant differences in baseline AFL heart rate, New York Heart Association class, LVEF, estimated glomerular filtration rate, and brain natriuretic peptide between the two groups. A greater proportion of patients who showed the recovery of LVEF after 6 months belonged to the rhythm control strategy group (90.9% vs. 52.0%, p=0.004). The cumulative incidence of HF re-hospitalization was significantly higher in the rate control strategy group than in the rhythm control strategy group (hazard ratio: 4.90, 95% CI: 1.06–22.69). As a result of sub-group study, LVEF recovery was greater in the strict rate control group compared to the lenient rate control group (75.0% vs. 30.8%, p=0.027)
Conclusion
Rate control strategy was significantly inferior to rhythm control strategy for the recovery of LVEF in TIC patients with persistent AFL. Rhythm control should be the first choice in the management of TIC with AFL, and strict rate control should be an alternative if rhythm control is not available.
Primary outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Oka
- Fujieda Municipal General Hospital, Fujieda, Japan
| | - T Kai
- Fujieda Municipal General Hospital, Fujieda, Japan
| | - K Hoshino
- Fujieda Municipal General Hospital, Fujieda, Japan
| | - K Watanabe
- Fujieda Municipal General Hospital, Fujieda, Japan
| | - J Nakamura
- Fujieda Municipal General Hospital, Fujieda, Japan
| | - M Abe
- Fujieda Municipal General Hospital, Fujieda, Japan
| | - A Watanabe
- Fujieda Municipal General Hospital, Fujieda, Japan
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13
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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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14
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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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15
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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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16
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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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17
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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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18
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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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19
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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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20
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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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21
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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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22
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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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23
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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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24
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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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25
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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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26
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Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Fukunami M. P795Long-term prognostic value of the combination of plasma volume status and pulmonary-systemic pressure ratio in patients admitted with acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Plasma volume (PV) expansion plays an essential role in heart failure and PV status provides prognostic information in patients (pts) with acute decompensated heart failure (ADHF). On the other hand, concomitant presence of pulmonary hypertension in heart failure is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency. It has recently been shown that an increased mean pulmonary artery pressure to mean systemic arterial pressure ratio (MPS ratio), a marker of interventricular coupling and efficiency, is associated with worse clinical outcomes in patients with advanced heart failure. However, there is no information available on the long-term prognostic value of the combination of PV status and MPS ratio in pts admitted for ADHF.
Methods
We studied 248 pts admitted for ADHF, who underwent right heart catheterization at the admission and were discharged with survival. PV status and MPS ratio were obtained at the admission. PV status was calculated as the following: Actual PV = (1 − hematocrit) x [a + (b x body weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV = c x body weight (c=39 in males and c=40 in females), and PV status = [(actual PV − ideal PV)/ideal PV] x 100(%). The study endpoint was cardiovascular death (CVD).
Results
During a mean follow-up period of 5.2±4.4 yrs, 62 pts had CVD. PV status (10.0±16.2 vs 5.0±15.3%, p=0.03) and MPS ratio (0.408±0.114 vs 0.347±0.102, p=0.0001) were significantly greater in patients with than without CVD. At multivariate Cox regression analysis, PV status and MPS ratio were significantly associated with CVD, independently of prior heart failure hospitalization, eGFR, and serum sodium level and anemia. Patients with greater PV status (> median value = 4.6%) and MPS ratio (> median value = 0.346) had a significantly higher CVD risk than those with either and none of them (44% vs 22% vs 14%, p<0.0001, respectively).
Conclusions
The combination of PV status and MPS ratio might be useful for stratifying patients at risk for CVD in patients with ADHF.
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Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Yamamoto
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Furukawa Y, Yamada T, Morita T, Tamaki S, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Kayama K, Kawahira M, Tanabe K, Fukunami M. P1031The impact of the duration of atrial fibrillation persistence for arrhythmia free survival in patients undergoing catheter ablation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation (CA) for atrial fibrillation (AF) is a curable treatment option. However, AF recurrence after CA remains an important problem. Although the success rate has been improved after catheter ablation (CA) in patients with paroxysmal AF (PAF), outcome data after CA for persistent AF (PeAF) are highly variable. Previous studies showed the PeAF is one of independent predictors for AF recurrence in comparison to PAF. However, there are little information available on the prognostic significance of AF duration after CA for AF. The aim of this study is to evaluate the impact of AF duration on long-term outcomes of AF ablation in patients with PeAF compared with PAF.
Methods
We enrolled 778 consecutive patients, who were referred our institution between August 2015 and December 2017 for undergoing the first time CA for AF. We divided 5 groups (Group 1; PAF (n=442), Group 2; PeAF duration ≤6 months (n=198), Group 3; PeAF duration of 6 months to 2 years (n=87), Group 4; PeAF duration of 2–5 years (n=30) and Group 5; PeAF duration ≥5 years (n=21)). All patients followed up for at least 1 year. Outcome data on recurrence of AF after ablation were collected.
Results
There were no significant differences in baseline clinical characteristics before CA among 5 groups, except for the prevalence of congestive heart failure, left atrial diameter and left ventricular ejection fraction. During a mean follow-up period of 511±298 days, 217 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (31% vs 20%, p=0.002) and in group 4 compared to group 3 (83% vs 30%, p<0.0001). However, AF recurrence was no significantly differences between groups 2 and 3 (31% vs 30%, p=0.76) and between groups 4 and 5 (83% vs 81%, p=0.45). Of 217 patients with AF recurrence, 154 patients had undergone multiple procedures. After last procedures, during a mean follow-up period of 546±279 days, 61 patients had AF recurrence. Kaplan-Meier analysis revealed that AF recurrence was significantly higher in group 2 compared to group 1 (10% vs 3%, P=0.0005) and in group 4 compared with group 3 (35% vs 10%, p=0.0001). However, AF recurrence was no significantly difference between groups 2 and 3 (10% vs 10%, p=0.91) and between groups 4 and 5 (47% vs 35%, p=0.47).
AF Free Survival Curve
Conclusion
Although patients with PeAF within 2 years had significantly higher AF recurrence compared to PAF, AF ablation might still be a good contributor as the first line approach to improve outcomes in patient with PeAF within 2 years.
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Affiliation(s)
- Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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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. P5413Effect of empagliflozin as add-on therapy on serum uric acid level in patients with type 2 diabetes hospitalized for acute decompensated heart failure: a prospective randomized controlled study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0371] [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
Elevated serum uric acid (UA) level has been shown to be associated with reduced survival among patients (pts) with heart failure. Sodium glucose cotransporter 2 (SGLT2) inhibitors have been reported to lower serum uric acid level in pts with type 2 diabetes mellitus (T2D). Empagliflozin, one of the SGLT2 inhibitors, has been shown to reduce the risk of cardiovascular mortality in T2D pts with cardiovascular disease, and involvement of UA lowering effect by empagliflozin in the reduction of cardiovascular mortality has been suggested. However, little is known about the effect of empagliflozin as add-on therapy on serum UA level in T2D pts with acute decompensated heart failure (ADHF).
Purpose
We sought to elucidate the effect of empagliflozin as add-on therapy on serum UA level in T2D pts with ADHF.
Methods
We enrolled 38 consecutive T2D pts admitted for ADHF. On admission, enrolled pts were randomly assigned in a 1:1 ratio to either empagliflozin add-on therapy (EMPA(+)) or conventional glucose-lowering therapy (EMPA(−)). All pts 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. Renal handling of UA was evaluated by fractional excretion of UA (FEUA).
Results
Twenty pts were assigned to the EMPA(+) group, and 18 pts were assigned to the EMPA(−) group. There were no significant baseline differences in LVEF, plasma brain natriuretic peptide level, body mass index, or serum creatinine level between the EMPA(+) and EMPA(−) groups. In addition, prevalence rate of hyperuricemia, serum UA level, and FEUA did not significantly differ between the two groups at baseline. However, there was significant difference in the change in serum UA level from baseline at 2, 3 and 7 days after randomization between the two groups (Figure A). As a result, serum UA level was significantly lower in the EMPA(+) group than in the EMPA(−) group at 7 days after randomization (6.2±1.8 mg/dL vs 7.8±1.8 mg/dL, p=0.0127). Moreover, FEUN of the EMPA(+) group was significantly higher at 1, 2 and 7 days after randomization (Figure B), which suggested that serum UA level was lowered in the EMPA(+) group by increased urinary excretion of UA.
Figure 1
Conclusions
This study demonstrated that empagliflozin as add-on therapy can lower serum UA level in T2D pts with ADHF through the effect on the urinary excretion rate of UA.
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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, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Yamamoto K, Fukunami M. 4330Effect of empagliflozin as add-on therapy on decongestion and renal function in diabetic patients hospitalized for acute decompensated heart failure: a prospective randomized controlled study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The mainstay of treatment of acute decompensated heart failure (ADHF) is decongestion by diuretic therapy. Empagliflozin has been shown to reduce the risk of hospitalization for heart failure in patients (pts) with type 2 diabetes mellitus (T2D) and cardiovascular disease. This may be explained by natriuresis and osmotic diuresis caused by empagliflozin, leading to plasma volume (PV) contraction and decongestion. However, little is known about the therapeutic effect of empagliflozin on decongestion and its association with renal function in T2D pts with ADHF.
Purpose
We sought to elucidate the effect of empagliflozin as add-on therapy on plasma B-type natriuretic peptide (BNP) level, hemoconcentration, PV contraction and renal function in T2D pts with ADHF.
Methods
We enrolled 38 consecutive T2D pts admitted for ADHF. On admission, enrolled pts were randomly assigned in a 1:1 ratio to either empagliflozin add-on therapy (EMPA(+)) or conventional glucose-lowering therapy (EMPA(−)). All pts in EMPA(+) group received empagliflozin (10mg/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. Hemoconcentration was defined as a ≥3% absolute increase in hematocrit (Hct). Percent change in PV between admission and subsequent timepoints (%ΔPV) was calculated using the Strauss formula as follows: %ΔPV = ([(Hb1/Hb2) × ((100 − Hct2)/(100 − Hct1))] − 1) × 100 (%), where 1 = baseline values and 2 = subsequent values. Worsening renal function (WRF) was defined as an increase in serum creatinine ≥0.3 mg/dL above baseline within 7 days of randomization.
Results
Twenty pts were assigned to the EMPA(+) group, and 18 pts were assigned to the EMPA(−) group. There were no significant baseline differences in LVEF, plasma BNP level, Hct or serum creatinine level between the EMPA(+) and EMPA(−) groups. Seven days after randomization, plasma BNP level was significantly lower in the EMPA(+) group than in the EMPA(−) group (median 213 [IQR 116–360] pg/mL vs 362 [226–776] pg/mL, p=0.0437) and hemoconcentration was more frequently observed in the EMPA(+) group than in the EMPA(−) group (53% vs 12%, p=0.0105). The decrease in %ΔPV was larger in the EMPA(+) group than in the EMPA(−) group 2 days (−8.74±9.92% vs 1.14±14.71%, p=0.0228), 3 days (−11.28±10.65% vs −0.02±14.70%, p=0.0121) and 7 days after randomization (−10.62±14.89% vs 0.97±13.72%, p=0.0211). The incidence of WRF did not significantly differ between the EMPA(+) and EMPA(−) groups (15% vs 22%).
Conclusions
This study demonstrated that empagliflozin as add-on therapy can achieve effective decongestion without an increased risk of WRF in T2D pts with ADHF.
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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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Ohira H, Yoshinaga K, Sakiyama S, Nakaya T, Nakamura J, Hayashishita A, Aikawa T, Furuya S, Manabe O, Hirata K, Naya M, Watanabe T, Tsujino I. P307Efficacy and adverse effects of strict pretest preparation for 18F-FDG PET/CT for assessment of cardiac sarcoidosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez148.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Ohira
- Hokkaido University, First Department of Medicine, Sapporo, Japan
| | - K Yoshinaga
- National Institutes for Quantum and Radiological Science, Diagnostic and Therapeutic Nuclear Medicine, Chiba, Japan
| | - S Sakiyama
- Hokkaido University, First Department of Medicine, Sapporo, Japan
| | - T Nakaya
- Hokkaido University, First Department of Medicine, Sapporo, Japan
| | - J Nakamura
- Hokkaido University, First Department of Medicine, Sapporo, Japan
| | - A Hayashishita
- Hokkaido University, First Department of Medicine, Sapporo, Japan
| | - T Aikawa
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - S Furuya
- Hokkaido University, Nuclear Medicine, Sapporo, Japan
| | - O Manabe
- Hokkaido University, Nuclear Medicine, Sapporo, Japan
| | - K Hirata
- Hokkaido University, Nuclear Medicine, Sapporo, Japan
| | - M Naya
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Watanabe
- Hokkaido University, First Department of Medicine, Sapporo, Japan
| | - I Tsujino
- Hokkaido University, First Department of Medicine, Sapporo, Japan
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31
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Nakamura J, Boeder J, Graham L. GOING GRAY? USING EXPERIENCE SAMPLING METHODS WITH OLDER CIVIC ENGAGEMENT EXEMPLARS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2819] [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: 11/12/2022] Open
Affiliation(s)
- J Nakamura
- Claremont Graduate University, Claremont, California, United States
| | - J Boeder
- Claremont Graduate University, Claremont, CA, USA
| | - L Graham
- Claremont Graduate University, Claremont, CA, USA
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Nakamura J, Procter Finley K, Axner M, Ringler N, Tse DCK. AN EXPERIENCE SAMPLING STUDY OF MEANING, PURPOSE, AND SOCIAL CONTRIBUTION IN OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2925] [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: 11/13/2022] Open
Affiliation(s)
- J Nakamura
- Claremont Graduate University, Claremont, California, United States
| | | | - M Axner
- Claremont Graduate University, Claremont, CA, USA
| | - N Ringler
- Claremont Graduate University, Claremont, CA, USA
| | - D C K Tse
- Claremont Graduate University, Claremont, CA, USA
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Nakamura J. PURPOSE OR PRODUCTIVITY: FRAMING THE DISCUSSION OF OLDER ADULT CONTRIBUTION TO THE GREATER GOOD. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2923] [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: 11/12/2022] Open
Affiliation(s)
- J Nakamura
- Claremont Graduate University, Claremont, California
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34
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Nakamura J, Tse D, Emerman J. SUCCESSFUL AGING: THE MOMENTARY EXPERIENCE OF CIVIC ENGAGEMENT EXEMPLARS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2818] [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: 11/13/2022] Open
Affiliation(s)
- J Nakamura
- Claremont Graduate University, Claremont, California
| | - D Tse
- Claremont Graduate University, Claremont, California
| | - J Emerman
- Encore.org, San Francisco, California
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35
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Seo M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Ikeda I, Fukuhara E, Nakamura J, Abe M, Fukunami M. P589Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Seo
- 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
| | - I Ikeda
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - E Fukuhara
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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36
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Seo M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Ikeda I, Fukuhara E, Nakamura J, Abe M, Fukunami M. P6215Prognostic value of advanced lung cancer inflammation index in patients with chronic heart failure: a prospective comparative study with cardiac I-123 metaiodobenzylguanidine imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Seo
- 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
| | - I Ikeda
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - E Fukuhara
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Kawahira M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuti A, Kawai T, Seo M, Ikeda I, Fukuhara E, Makoto M, Nakamura J, Fukunami M. P4748Prognostic value of Fibrosis-4 index in patients admitted for acute decompensated heart failure with reduced or preserved LVEF: a comparative study with nonalcoholic fatty liver disease fibrosis score. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Kawahira
- 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 Kikuti
- 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
| | - I Ikeda
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - E Fukuhara
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Makoto
- 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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38
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Furukawa Y, Yamada T, Morita T, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. P6610The effect of maintenance of sinus rhythm after catheter ablation on renal function in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - 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
| | - I Ikeda
- Osaka General Medical Center, Osaka, Japan
| | - E Fukuhara
- 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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Tamaki S, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. P2819Prediction of mode of death by calculated plasma volume status in patients admitted for acute decompensated heart failure: a prospective study of Osaka Prefectural Acute heart failure Registry (OPAR). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S 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
| | - I Ikeda
- Osaka General Medical Center, Osaka, Japan
| | - E Fukuhara
- 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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Kawasaki M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kikuchi A, Kawai T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. P1021Modified ADMIRE-HF risk score predicts serious arrhythmic events in patients with implantable cardioverter defibrillator, regardless of left ventricular ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Kawasaki
- 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
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - I Ikeda
- Osaka General Medical Center, Osaka, Japan
| | - E Fukuhara
- 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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Tamaki S, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. P2820Comparison of the prognostic values of formulas for the estimation of plasma volume in patients admitted for acute decompensated heart failure: a prospective study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S 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
| | - I Ikeda
- Osaka General Medical Center, Osaka, Japan
| | - E Fukuhara
- 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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Kawasaki M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kikuchi A, Kawai T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. P6603Impact of paroxysmal atrial fibrillation ablation on cardiac sympathetic nervous system: a prospective randomized comparative study with cryoballoon catheter or radiofrequency ablation catheter. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Kawasaki
- 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
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - I Ikeda
- Osaka General Medical Center, Osaka, Japan
| | - E Fukuhara
- 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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Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Kayama K, Kawahira M, Tanabe K, Fukunami M. P4747Long-term prognostic value of the serial change of pulse pressure during hospitalization in patients admitted for acute decompensated heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Seo M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Ikeda I, Fukuhara E, Nakamura J, Abe M, Fukunami M. 4937Prognostic value of serum cholinesterase in patients with acute decompensated heart failure: a prospective comparative study with other nutritional indexes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Seo
- 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
| | - I Ikeda
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - E Fukuhara
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Kayama K, Kawahira M, Tanabe K, Fukunami M. P922Model of end-stage liver disease excluding INR score provides additional prognostic information to the get with the guidelines-heart failure risk score in acute decompensated heart failure patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Seo M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Ikeda I, Fukuhara E, Nakamura J, Abe M, Fukunami M. P5358Prognostic impact of cardiac MIBG imaging in heart failure with reduced, mid-range and preserved left ventricular ejection fraction admitted for acute decompensated heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Seo
- 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
| | - I Ikeda
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - E Fukuhara
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Kayama K, Kawahira M, Tanabe K, Fukunami M. P4745Long-term prognostic value of cardiorenohepatic syndrome in patients admitted for acute decompensated heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Seo M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Ikeda I, Fukuhara E, Nakamura J, Abe M, Fukunami M. 4942Serum cholinesterase level provides the additional long-time prognostic information to AHEAD risk score in patients with acute decompensated heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Seo
- 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
| | - I Ikeda
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - E Fukuhara
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
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Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Abe M, Kayama K, Kawahira M, Tanabe K, Fukunami M. P918Prognostic value of the combination of plasma volume status and acute kidney injury in acute decompensated heart failure patients with preserved left ventricular ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - Y Iwasaki
- Osaka General Medical Center, Osaka, Japan
| | - M Kawasaki
- Osaka General Medical Center, Osaka, Japan
| | - A Kikuchi
- Osaka General Medical Center, Osaka, Japan
| | - T Kawai
- Osaka General Medical Center, Osaka, Japan
| | - M Seo
- Osaka General Medical Center, Osaka, Japan
| | - J Nakamura
- Osaka General Medical Center, Osaka, Japan
| | - M Abe
- Osaka General Medical Center, Osaka, Japan
| | - K Kayama
- Osaka General Medical Center, Osaka, Japan
| | - M Kawahira
- Osaka General Medical Center, Osaka, Japan
| | - K Tanabe
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
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Tamaki S, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. P2818Incremental prognostic value of plasma volume status and I-123 MIBG imaging in patients admitted for acute decompensated heart failure with reduced or preserved left ventricular ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S 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
| | - I Ikeda
- Osaka General Medical Center, Osaka, Japan
| | - E Fukuhara
- 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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