著者

Ryo Naito Katsumi Miyauchi Hirokazu Konishi Shuta Tsuboi Manabu Ogita Tomotaka Dohi Takatoshi Kasai Hiroshi Tamura Shinya Okazaki Kikuo Isoda Hiroyuki Daida

出版者

一般社団法人 日本動脈硬化学会

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

pp.32284, (Released:2015-11-11)

参考文献数

16

被引用文献数

1 5

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Aim: Current Japanese guidelines state the target level of low-density lipoprotein cholesterol (LDL-C) of <100mg/dL for secondary prevention of coronary artery disease (CAD). However, this level was set considering the results of trials mainly conducted in Western countries. In addition, the effect of achieving target LDL-C on secondary prevention is unknown. Methods: We examined the effects of achieving target LDL-C on clinical outcomes. Patients who underwent percutaneous coronary intervention at Juntendo University Hospital (Tokyo, Japan) from 2004 to 2010 and received follow-up coronary angiography (CAG) were analyzed. The study population was divided into two groups based on the follow-up LDL-C. The incidence of major adverse cardiovascular events within 3 years after the follow-up CAG was examined. Results: A total of 1321 consecutive patients were enrolled. Sixty-three percent of the patients achieved the target LDL-C. The rate of 3-year events was lower in the group that achieved the target LDL-C (achieved group). The adjusted relative risk reduction in the achieved group was 26% (p=0.02). In the sub-analysis among the four groups stratified by baseline LDL-C of 140 and follow-up LDL-C of 100, the adjusted hazard ratio for 3-year events was 1.84 (95% confidence interval; 1.10-3.24)in Group 3 (baseline <140, follow-up ≥100) and 2.05 (1.18-3.74) Group 4 (baseline ≥140, follow-up ≥100) [Group 2 (baseline ≥140, follow-up <100) as reference]. Conclusions: Our data suggested that follow-up LDL-C <100mg/dL was appropriate for secondary prevention of CAD in Japanese population.

著者

Yuji Nishizaki Shinichiro Yamagami Hitoshi Sasano Eiryu Sai Kazuhisa Takamura Toshiki Nakahara Yoshiaki Furukawa Hiroyuki Daida

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.16, no.1, pp.41-44, 2015-03-20 (Released:2015-03-27)

参考文献数

6

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A 91 year-old male who was orally receiving dabigatran and digitalis for chronic arterial fibrillation was hospitalized for cerebral infarction (CI). The complications of anemia due to gastrointestinal bleeding and the development of renal failure were also found, which enhanced the effect of digitalis. This enhanced drug action induced bradycardia and hypotension. The hypotension was improved by implanting a temporary pacemaker, and the neurological abnormal findings also disappeared with the improved blood pressure. In many cases, dabigatran is efficient in preventing CI, but in our case it in fact triggered a CI hemodynamically due to bradycardia and hypotension with gastrointestinal bleeding.

著者

Junnichi Ishii Kosuke Kashiwabara Yukio Ozaki Hiroshi Takahashi Fumihiko Kitagawa Hideto Nishimura Hideki Ishii Satoshi Iimuro Hideki Kawai Takashi Muramatsu Hiroyuki Naruse Hiroshi Iwata Sadako Tanizawa-Motoyama Hiroyasu Ito Eiichi Watanabe Yutaka Matsuyama Yoshihiro Fukumoto Ichiro Sakuma Yoshihisa Nakagawa Kiyoshi Hibi Takafumi Hiro Seiji Hokimoto Katsumi Miyauchi Hiroshi Ohtsu Hideo Izawa Hisao Ogawa Hiroyuki Daida Hiroaki Shimokawa Yasushi Saito Takeshi Kimura Masunori Matsuzaki Ryozo Nagai

出版者

Japan Atherosclerosis Society

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

vol.29, no.10, pp.1458-1474, 2022-10-01 (Released:2022-10-01)

参考文献数

33

被引用文献数

1 11

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Aim: We investigated the relationship between small dense low-density cholesterol (sdLDL-C) and risk of major adverse cardiovascular events (MACE) in patients treated with high- or low-dose statin therapy.Methods: This was a prospective case-cohort study within the Randomized Evaluation of Aggressive or Moderate Lipid-Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study, a randomized trial of high- or low-dose (4 or 1 mg/d pitavastatin, respectively) statin therapy, in patients with stable coronary artery disease (CAD). Serum sdLDL-C was determined using an automated homogenous assay at baseline (randomization after a rule-in period, >1 month with 1 mg/d pitavastatin) and 6 months after randomization, in 497 MACE cases, and 1543 participants randomly selected from the REAL-CAD study population.Results: High-dose pitavastatin reduced sdLDL-C by 20% than low-dose pitavastatin (p for interaction <0.001). Among patients receiving low-dose pitavastatin, baseline sdLDL-C demonstrated higher MACE risk independent of LDL-C (hazard ratio [95% confidence interval], 4th versus 1st quartile, 1.67 [1.04–2.68]; p for trend=0.034). High-dose (versus low-dose) pitavastatin reduced MACE risk by 46% in patients in the highest baseline sdLDL-C quartile (>34.3 mg/dL; 0.54 [0.36–0.81]; p=0.003), but increased relative risk by 40% in patients with 1st quartile (≤ 19.5 mg/dL; 1.40 [0.94–2.09]; p=0.099) and did not alter risk in those in 2nd and 3rd quartiles (p for interaction=0.002).Conclusions: These findings associate sdLDL-C and cardiovascular risk, independent of LDL-C, in statin-treated CAD patients. Notably, high-dose statin therapy reduces this risk in those with the highest baseline sdLDL-C.

著者

Akio Honzawa Miho Nishitani-Yokoyama Kazunori Shimada Mitsuhiro Kunimoto Tomomi Matsubara Rie Matsumori Hiroki Kasuya Kei Fujiwara Mayumi Doi Kana Takagi-Kawahara Abidan Abulimiti Jianying Xu Akie Shimada Taira Yamamoto Atsushi Amano Tohru Asai Hiroyuki Daida Tohru Minamino

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.4, no.7, pp.308-314, 2022-07-08 (Released:2022-07-08)

参考文献数

32

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Background: Frailty is an important prognostic factor in patients with cardiovascular diseases (CVD), and patients with CVD have a high rate of concurrent psycho-emotional stress, as well as depressive mood and anxiety symptoms. Despite this, few reports have examined the effects of the efficacy of Phase II cardiac rehabilitation (CR) in frail patients, including improvements in anxiety levels.Methods and Results: In all, 137 patients (mean [±SD] age 65.8±13.0 years; 71% male) who participated in Phase II CR and were assessed after CR completion were included in this study. Patients were evaluated using the Kihon Checklist (KCL) form at the beginning of CR and were divided into the 3 groups according to KCL scores: frail (n=34, 25%), pre-frail (n=40, 29%), and non-frail (n=63, 46%). Physical function and anxiety levels were compared among the 3 groups. The pre-frail and frail groups had significantly higher state anxiety and trait anxiety than the non-frail group (P<0.01). At the end of Phase II CR, all 3 groups showed significant improvements in the 6-min walking distance (P<0.05). State anxiety improved significantly in the non-frail and pre-frail groups, whereas trait anxiety only improved in the non-frail group.Conclusions: Physical function was improved in frail patients who participated in Phase II CR. However, there was no significant improvement in their level of anxiety.

著者

Atsushi Yamada Yasuo Takeuchi Yuji Nishizaki Hiroyuki Daida

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.12, pp.1517-1521, 2012 (Released:2012-06-15)

参考文献数

13

被引用文献数

8 8

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Objective The present study was undertaken to determine the characteristics and outcome of in-hospital cardiac arrests and the effectiveness of BVM ventilation with airway adjuncts including the oropharyngeal airways and nasopharyngeal airways. Methods Information about in-hospital cardiac arrests over a period of 6 years was retrospectively collected, and the effectiveness of BVM ventilation with airway adjuncts was analyzed using a multivariate logistic regression model. Results During the study period, 105 (male, n=70; age, 68.6±14.2 years) cardiac arrests occurred, of which 95.2% developed among inpatients and 21.0% of them were witnessed. The initial rhythm of cardiac arrests was pulseless electrical activity in 63.8% (67/105) and respiratory failure (44.8%) was the most common cause. Overall, a return of spontaneous circulation occurred in 76.2% of in-hospital cardiac arrests, 31.4% survived to discharge, and the neurological outcome was good (cerebral performance category-1) in 66.7% of them. Bag-valve-mask ventilation with airway adjuncts improved the neurological outcome (OR 3.52, 95%CI 1.07, 11.5). Conclusion Bag-valve-mask ventilation with airway adjuncts improved neurological outcomes.

著者

Toshiaki Toyota Takeshi Morimoto Satoshi Iimuro Retsu Fujita Hiroshi Iwata Katsumi Miyauchi Teruo Inoue Yoshihisa Nakagawa Yosuke Nishihata Hiroyuki Daida Yukio Ozaki Satoru Suwa Ichiro Sakuma Yutaka Furukawa Hiroki Shiomi Hirotoshi Watanabe Kyohei Yamaji Naritatsu Saito Masahiro Natsuaki Yasuo Ohashi Masunori Matsuzaki Ryozo Nagai Takeshi Kimura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0168, (Released:2022-09-14)

参考文献数

20

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Background: The relationship between very low on-treatment low-density lipoprotein cholesterol (LDL-C) level and cardiovascular event risk is still unclear in patients receiving the same doses of statins.Methods and Results: From the REAL-CAD study comparing high-dose (4 mg/day) with low-dose (1 mg/day) pitavastatin therapy in patients with stable coronary artery disease, 11,105 patients with acceptable statin adherence were divided into 3 groups according to the on-treatment LDL-C level at 6 months (<70 mg/dL, 70–100 mg/dL, and ≥100 mg/dL). The primary outcome measure was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission. The adjusted risks of the LDL-C <70 mg/dL group relative to the LDL-C 70–100 mg/dL group (reference) was not significantly different for the primary outcome measure in both 1 mg/day and 4 mg/day strata (HR 0.84, 95% CI 0.58–1.18, P=0.32, and HR 1.25, 95% CI 0.88–1.79, P=0.22). The adjusted risk of the LDL-C ≥100 mg/dL group relative to the reference group was not significant for the primary outcome measure in the 1 mg/day stratum (HR 0.82, 95% CI 0.60–1.11, P=0.21), whereas it was highly significant in the 4 mg/day stratum (HR 3.32, 95% CI 2.08–5.17, P<0.001).Conclusions: A very low on-treatment LDL-C level (<70 mg/dL) was not associated with lower cardiovascular event risk compared with moderately low on-treatment LDL-C level (70–100 mg/dL) in patients receiving the same doses of statins.

著者

Masami Goto Osamu Abe Akifumi Hagiwara Shohei Fujita Koji Kamagata Masaaki Hori Shigeki Aoki Takahiro Osada Seiki Konishi Yoshitaka Masutani Hajime Sakamoto Yasuaki Sakano Shinsuke Kyogoku Hiroyuki Daida

出版者

Japanese Society for Magnetic Resonance in Medicine

雑誌

Magnetic Resonance in Medical Sciences (ISSN:13473182)

巻号頁・発行日

pp.rev.2021-0096, (Released:2022-02-18)

参考文献数

106

被引用文献数

31

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Surface-based morphometry (SBM) is extremely useful for estimating the indices of cortical morphology, such as volume, thickness, area, and gyrification, whereas voxel-based morphometry (VBM) is a typical method of gray matter (GM) volumetry that includes cortex measurement. In cases where SBM is used to estimate cortical morphology, it remains controversial as to whether VBM should be used in addition to estimate GM volume. Therefore, this review has two main goals. First, we summarize the differences between the two methods regarding preprocessing, statistical analysis, and reliability. Second, we review studies that estimate cortical morphological changes using VBM and/or SBM and discuss whether using VBM in conjunction with SBM produces additional values. We found cases in which detection of morphological change in either VBM or SBM was superior, and others that showed equivalent performance between the two methods. Therefore, we concluded that using VBM and SBM together can help researchers and clinicians obtain a better understanding of normal neurobiological processes of the brain. Moreover, the use of both methods may improve the accuracy of the detection of morphological changes when comparing the data of patients and controls.In addition, we introduce two other recent methods as future directions for estimating cortical morphological changes: a multi-modal parcellation method using structural and functional images, and a synthetic segmentation method using multi-contrast images (such as T1- and proton density-weighted images).

著者

Hiromi Shinano Sakiko Miyazaki Kayo Miura Hiroshi Ohtsu Naohiro Yonemoto Kiyoshi Matsuoka Hakuou Konishi Hiroyuki Daida Mitsue Saito Kazuhiro Sase

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.4, pp.235-242, 2020-04-10 (Released:2020-04-10)

参考文献数

48

被引用文献数

1 2

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Background:The prognosis of cancer survivors has dramatically improved, but effective strategies for cancer treatment-related cardiovascular disorders (CTRCD) remain to be elucidated in the emerging field of cardio-oncology. In this study, we investigated risk factors for CTRCD in breast cancer patients treated with trastuzumab.Methods and Results:We performed a retrospective analysis of 141 consecutive women who received adjuvant trastuzumab, and underwent baseline (BL) and follow-up (FU) echocardiography at Juntendo University between April 2010 and December 2016. The major concomitant treatment was anthracyclines in 94% and radiotherapy in 53%. During the median treatment period of 11 months, there were 22 (15.6%) cardiology consultations, 3 (2.1%) treatment interruptions with irreversible CTRCD, and no deaths. Left ventricular ejection fraction (LVEF) was decreased from a median 67.5% (BL) to 63.4% (FU; P<0.0001), with reduced LVEF noted in 26.2% at FU<90%BL, in 13.5% at FU<BL–10%, and in 5.7% at LVEFFU<53%. A significantly greater percentage of patients with CTRCD (FU<BL–10% and LVEFFU<53%) had cardiovascular risk factors (CVRF; 42.9% vs. 8.2%, P=0.02). On multivariable analysis, CVRF were also significantly associated with CTRCD (OR, 11.96; 95% CI: 1.30–110.34).Conclusions:Adjuvant trastuzumab for early-stage breast cancer was associated with reduced LVEF; and CVRF were an independent predictor for CTRCD. The concomitant effect of anthracyclines should not be underestimated, even at lower doses.

著者

Tetsuya TAKAHASHI Tomoyuki MORISAWA Masakazu SAITOH Miho YOKOYAMA Kasunori SHIMADA Toshiyuki FUJIWARA Hiroyuki DAIDA

出版者

Japanese Society of Physical Therapy

雑誌

Physical Therapy Research (ISSN:21898448)

巻号頁・発行日

vol.23, no.1, pp.1-7, 2020-06-20 (Released:2020-06-20)

参考文献数

20

被引用文献数

9

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In recent years, the importance of early physiotherapy for rapid mental and physical functional recovery is increasing with the increasing number of older patients and high-risk patients with duplicate disorders. Increasing the effectiveness of acute physiotherapy within a shorter hospital stay is a great challenge. We published the first expert consensus of early rehabilitation in Asia in 2017. Our expert consensus will contribute to the establishment of physiotherapy in intensive care for Asian populations. The minimum standard of clinical practice for physiotherapists working in critical care settings is important to showcase physiotherapists' knowledge and abilities as medical professionals working in the intensive care unit. We are planning to release the minimum standard of clinical practice for Japanese physiotherapists working in critical care settings in 2020. Being in the forefront among nations of aging populations, Japan has a rapidly increasing number of older frail patients with heart failure. Further studies are necessary to confirm the effectiveness of task-specific exercise training considering the characteristics of frailty.

著者

Hideki Origuchi Haruki Itoh Shin-ichi Momomura Ryuji Nohara Hiroyuki Daida Takashi Masuda Masahiro Kohzuki Shigeru Makita Kenji Ueshima Masatoshi Nagayama Kazuto Omiya Hitoshi Adachi Yoichi Goto

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.84, no.3, pp.427-435, 2020-02-25 (Released:2020-02-25)

参考文献数

21

被引用文献数

17

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Background:There is little evidence regarding the effect of outpatient cardiac rehabilitation (CR) on exercise capacity or the long-term prognosis in patients after coronary artery bypass graft surgery (CABG). This study aimed to determine whether participation in outpatient CR improves exercise capacity and long-term prognosis in post-CABG Japanese patients in a multicenter cohort.Methods and Results:We enrolled 346 post-CABG patients who underwent cardiopulmonary exercise testing during early (2–3 weeks) and late (3–6 months) time points after surgery. They formed the Active (n=240) and Non-Active (n=106) CR participation groups and were followed for 3.5 years. Primary endpoint was a major adverse cardiac event (MACE): all-cause death or rehospitalization for acute myocardial infarction/unstable angina/worsening heart failure. Peak oxygen uptake at 3–5 months from baseline was significantly more increased in Active than in Non-Active patients (+26±24% vs. +19±20%, respectively; P<0.05), and the MACE rate was significantly lower in Active than Non-Active patients (3.4% vs. 10.5%, respectively; P=0.02). Multivariate Cox proportional hazard analysis showed that participation in outpatient CR was a significant prognostic determinant of MACE (P=0.03).Conclusions:This unique study showed that a multicenter cohort of patients who underwent CABG and actively participated in outpatient CR exhibited greater improvement in exercise capacity and better survival without cardiovascular events than their counterparts who did not participate.

著者

Masaru Hiki Tetsuro Miyazaki Kazunori Shimada Yurina Sugita Megumi Shimizu Tatsuro Aikawa Shohei Ouchi Tomoyuki Shiozawa Kiyoshi Takasu Shuhei Takahashi Atsutoshi Takagi Katsumi Miyauchi Hiroyuki Daida

出版者

一般社団法人 日本動脈硬化学会

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

pp.37424, (Released:2017-03-24)

参考文献数

27

被引用文献数

9

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Aim: Polyunsaturated fatty acids (PUFAs) take part in various biological events linked to the pathogenesis of venous thromboembolism (VTE), including inflammation, endothelial dysfunction, and hypercoagulability. Several studies have demonstrated the association between PUFAs and the occurrence of VTE. However, the role of PUFAs in the pathogenesis of VTE remains unclear.Methods: We enrolled 45 patients with acute VTE and 37 age-, gender-, and body mass index-matched healthy volunteers to examine their PUFA levels. Serum omega 3 (eicosapentaenoic acid: EPA and docosahexaenoic acid: DHA) and omega 6 (dihomogammalinolenic acid: DGLA and arachidonic acid: AA) fatty acids levels were measured within 24 h of admission.Results: Patients with VTE showed significantly higher AA and lower EPA levels, and lower EPA/AA ratios than the controls. Multivariate analysis revealed that AA was an independent marker for VTE. In addition, we divided the patients based on their median age (58 years old). The younger patients with VTE showed significantly lower EPA/AA levels than their age-matched controls, whereas older patients with VTE showed a significantly higher AA/DGLA levels than the older controls.Conclusions: High serum AA levels and low EPA levels are associated with the development of acute VTE, suggesting that the imbalance of PUFAs may be a potential therapeutic target for preventing acute VTE.

著者

Hiroaki Takashima Yukio Ozaki Takeshi Morimoto Takeshi Kimura Takafumi Hiro Katsumi Miyauchi Yoshihisa Nakagawa Masakazu Yamagishi Hiroyuki Daida Tomofumi Mizuno Kenji Asai Yasuo Kuroda Takashi Kosaka Yasushi Kuhara Akiyoshi Kurita Kazuyuki Maeda Tetsuya Amano Masunori Matsuzaki for the JAPAN-ACS Investigators

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.76, no.12, pp.2840-2847, 2012 (Released:2012-11-22)

参考文献数

32

被引用文献数

4 6

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Background: The JAPAN-ACS (Japan Assessment of Pitavastatin and Atorvastatin in Acute Coronary Syndrome) trial showed that intensive statin therapy could induce significant coronary plaque regression in acute coronary syndrome (ACS). We evaluated the impact of metabolic syndrome (MetS) and its components on coronary plaque regression in the JAPAN-ACS patients. Methods and Results: Serial intravascular ultrasound measurements over 8–12 months were performed in 242 ACS patients receiving pitavastatin or atorvastatin. Patients were divided into groups according to the presence of MetS or the number of MetS components. Although the percent change in plaque volume (%PV) was not significantly different between the MetS (n=119) and non-MetS (n=123) groups (P=0.50), it was significantly associated with an increasing number of MetS components (component 0: −24.0%, n=7; components 1: −20.8%, n=31; components 2: −16.1%, n=69; components 3: −18.7%, n=83; components 4: −13.5%, n=52; P=0.037 for trend). The percent change in body mass index (%BMI) significantly correlated with %PV (r=0.15, P=0.021), especially in the MetS components 4 group (r=0.35, P=0.017). In addition, %BMI was an independent predictor of plaque regression after adjustment for the changes of low- and high-density lipoprotein cholesterol, triglycerides and HbA1c. Conclusions: The clustering of MetS components, but not the presence of MetS itself, could attenuate coronary plaque regression during intensive statin therapy in ACS patients. Therefore, to achieve a greater degree of plaque regression, it is necessary to treat to each MetS component and use lifestyle modification.  (Circ J 2012; 76: 2840–2847)

著者

Tadateru Takayama Takafumi Hiro Masakazu Yamagishi Hiroyuki Daida Atsushi Hirayama Satoshi Saito Tetsu Yamaguchi Masunori Matsuzaki The COSMOS Investigators

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.73, no.11, pp.2110-2117, 2009 (Released:2009-10-23)

参考文献数

29

被引用文献数

109 153

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Background: It has been suggested that intensive lipid-lowering therapy using statins significantly decreases atheromatous plaque volume. The effect of rosuvastatin on plaque volume in patients with stable coronary artery disease (CAD), including those receiving prior lipid-lowering therapy, was examined in the present study. Methods and Results: A 76-week open-label trial was performed at 37 centers in Japan. Eligible patients began treatment with rosuvastatin 2.5 mg/day, which could be increased at 4-week intervals to ≤20 mg/day. A total of 214 patients underwent intravascular ultrasound (IVUS) at baseline; 126 patients had analyzable IVUS images at the end of the study. The change in the serum low-density lipoprotein-cholesterol level from baseline to end of follow-up was -38.6 ±16.9%, whereas that of high-density lipoprotein-cholesterol was +19.8 ±22.9% (both P<0.0001). Percent change of plaque volume, the primary endpoint, was -5.1 ±14.1% (P<0.0001). Conclusions: Rosuvastatin exerted significant regression of coronary plaque volume in Japanese patients with stable CAD, including those who had previously used other lipid-lowering drugs. Rosuvastatin might be useful in the setting of secondary prevention in patients with stable CAD. (Circ J 2009; 73: 2110-2117)