著者

Miyako Yuasa-Kawase Daisaku Masuda Taiji Yamashita Ryota Kawase Hajime Nakaoka Miwako Inagaki Kazuhiro Nakatani Kazumi Tsubakio-Yamamoto Tohru Ohama Akifumi Matsuyama Makoto Nishida Masato Ishigami Toshiharu Kawamoto Issei Komuro Shizuya Yamashita

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

vol.20, no.5, pp.514-515, 2013 (Released:2013-05-29)

参考文献数

48

著者

Koshiro Kanaoka Satoshi Okayama Michikazu Nakai Yoko Sumita Kunihiro Nishimura Rika Kawakami Hiroyuki Okura Yoshihiro Miyamoto Satoshi Yasuda Hiroyuki Tsutsui Issei Komuro Hisao Ogawa Yoshihiko Saito

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.5, pp.1025-1031, 2019-04-25 (Released:2019-04-25)

参考文献数

21

被引用文献数

31 46

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Background: With aging of the population, the economic burden associated with heart failure (HF) is expected to increase. However, little is known about the hospitalization costs associated with HF in Japan. Methods and Results: In this cross-sectional study, using data from The Japanese Registry of All Cardiac and Vascular Diseases (JROAD) and JROAD-Diagnosis Procedure Combination databases between 2012 and 2014, we evaluated hospitalization costs for acute cardiovascular diseases (CVDs), including HF. A total of $1,187 million/year (44% of the hospitalization costs for acute CVDs) was spent on patients with HF. We identified 273,865 patients with HF and the median cost per patient was $8,089 ($5,362–12,787) per episode. The top 1% of spenders accounted for 8% ($80 million/year), and the top 5% of spenders accounted for 22% ($229 million/year) of the entire cost associated with HF. The costs associated with HF for patients over 75 years of age accounted for 68% of the total cost. Conclusions: The costs associated with HF were higher than the hospitalization cost for any other acute CVD in Japan. Understanding how the total hospitalization cost is distributed may allow health providers to utilize limited resources more effectively for patients with HF.

著者

Keigo Iwazaki Toshiya Kojima Takahide Murasawa Jun Yokota Hikaru Tanimoto Jun Matsuda Nobuaki Fukuma Takumi Matsubara Yu Shimizu Gaku Oguri Eriko Hasumi Hitoshi Kubo Kyungho Chang Katsuhito Fujiu Issei Komuro

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.59, no.3, pp.626-629, 2018-05-31 (Released:2018-05-30)

参考文献数

8

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A cardiac resynchronization therapy defibrillator (CRT-D) (Medtronic Inc. Protecta XT) was implanted in a 67-year-old man who had cardiac sarcoidosis with extremely low cardiac function. He had ventricular tachycardia which was controlled by catheter ablation, medication and pacing. The programmed mode was DDI, lower rate was 90 beats/minute, paced AV delay was 150 ms, and the noncompetitive atrial pacing (NCAP) function was programmed as 300 ms.After his admission for pneumonia and heart failure, we changed his DDI mode to a DDD mode because he had atrial tachycardia, which led to inadequate bi-ventricular pacing. After a while, there were cycle lengths which were longer than his device setting and alternately varied. We were able to avoid this phenomenon with AV delay of 120 ms and NCAP of 200 ms.NCAP is an algorithm which creates a gap above a certain period after the detection of an atrial signal during the postventricular atrial refractory period of the pacemaker. This is to prevent atrial tachycardia and repetitive non-reentrant ventriculoatrial (VA) synchrony in the presence of retrograde VA conduction. But in this case, NCAP algorithm induced much lower rate than the programmed basic lower rate. This situation produced some arrhythmias and exacerbated symptoms of heart failure. This had to be paid attention to, especially when the device was programmed at high basic heart rate.

著者

Takumi J Matsubara Katsuhito Fujiu Satoshi Kodera Kunihiro Kani Kohsaku Goto Yu Shimizu Gaku Oguri Eriko Hasumi Toshiya Kojima Issei Komuro

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.63, no.3, pp.486-491, 2022-05-30 (Released:2022-05-31)

参考文献数

13

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Asymptomatic or silent atrial fibrillation (AF) has long been a clinical problem due to the incidence of ischemic stroke. A method is needed to predict the development of silent AF before the occurrence of ischemic stroke. This study was focused on the symptoms of AF, especially palpitation, in pacemaker patients. We assessed the hypothesis that absence of palpitation during rapid ventricular pacing could be a predictor of future onset AF being asymptomatic.In this study, we assessed the presence of symptoms during RV pacing and AF symptoms on 145 pacemaker patients at the outpatient clinic by VVI pacing at 120 ppm. The relationship between symptoms during RV pacing and symptom during AF was assessed. The predictive value of absence of symptom during RV pacing on AF being asymptomatic was assessed.Of 145 patients, 74 had previous AF episode. Among the AF patients, absence of symptom during VVI pacing was associated with AF being asymptomatic.Of 145 patients, 71 had no previous AF events. There were 14 patients who had new-onset AF or atrial flutter (AFL) after the device implantation. Four of the 14 patients (28.6%) were symptomatic during first AF/AFL episode, and 10 (71.4%) were asymptomatic during first-onset AF. All ten patients who were asymptomatic during cardiac pacing test were asymptomatic during their initial episodes of AF as well.This study showed that absence of symptoms during rapid ventricular pacing was associated with first-onset AF being asymptomatic.

著者

Koichiro Miura Katsuhisa Matsuura Yu Yamasaki Itoyama Daisuke Sasaki Takuma Takada Yoshiyuki Furutani Emiko Hayama Masamichi Ito Seitaro Nomura Hiroyuki Morita Masashi Toyoda Akihiro Umezawa Kenji Onoue Yoshihiko Saito Hiroyuki Aburatani Toshio Nakanishi Nobuhisa Hagiwara Issei Komuro Tatsuya Shimizu

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.63, no.2, pp.338-346, 2022-03-30 (Released:2022-03-30)

参考文献数

35

被引用文献数

5

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Dilated cardiomyopathy (DCM) is caused by various gene variants and characterized by systolic dysfunction. Lamin variants have been reported to have a poor prognosis. Medical and device therapies are not sufficient to improve the prognosis of DCM with the lamin variants. Recently, induced pluripotent stem (iPS) cells have been used for research on genetic disorders. However, few studies have evaluated the contractile function of cardiac tissue with lamin variants. The aim of this study was to elucidate the function of cardiac cell sheet tissue derived from patients with lamin variant DCM. iPS cells were generated from a patient with lamin A/C (LMNA) -mutant DCM (LMNA p.R225X mutation). After cardiac differentiation and purification, cardiac cell sheets that were fabricated through cultivation on a temperature-responsive culture dish were transferred to the surface of the fibrin gel, and the contractile force was measured. The contractile force and maximum contraction velocity, but not the maximum relaxation velocity, were significantly decreased in cardiac cell sheet tissue with the lamin variant. A qRT-PCR analysis revealed that mRNA expression of some contractile proteins, cardiac transcription factors, Ca2+-handling genes, and ion channels were downregulated in cardiac tissue with the lamin variant.Human iPS-derived bioengineered cardiac tissue with the LMNA p.R225X mutation has the functional properties of systolic dysfunction and may be a promising tissue model for understanding the underlying mechanisms of DCM.

著者

Teruhiko Imamura Koichiro Kinugawa Shun Minatsuki Hironori Muraoka Naoko Kato Toshiro Inaba Hisataka Maki Taro Shiga Masaru Hatano Atsushi Yao Shunei Kyo Issei Komuro

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.77, no.5, pp.1208-1213, 2013 (Released:2013-04-25)

参考文献数

29

被引用文献数

39 41

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Background: Urine osmolality (U-OSM) is valuable to predict response to tolvaptan (TLV) in decompensated heart failure patients, but measurement of U-OSM is not always available on site. Methods and Results: Data were collected from 66 hospitalized patients with decompensated heart failure who had received TLV at 3.75–15mg/day. U-OSM, which was estimated using the following formula: 1.07×{2×[(urine sodium (mEq/L)]+[urine urea nitrogen (mg/dl)]/2.8+[urine creatinine (mg/dl)]×2/3}+16, was well correlated with the actual measurement (r=0.938, P<0.001). Criteria consisting of C1 (estimated baseline U-OSM >358mOsm/L) and C2 (%decrease in estimated U-OSM >24% at 4–6h after the first TLV dose) significantly discriminated responders from non-responders (P<0.05). Conclusions: Response to TLV can be predicted using U-OSM, which can be estimated using urine urea nitrogen, sodium, and creatinine concentration data.  (Circ J 2013; 77: 1208–1213)

著者

Ryu Shutta Daisaku Nakatani Yasuhiko Sakata Shungo Hikoso Hiroya Mizuno Shinichiro Suna Tetsuhisa Kitamura Katsuki Okada Tomoharu Dohi Takayuki Kojima Bolrathanak Oeun Akihiro Sunaga Hirota Kida Hiroshi Sato Masatsugu Hori Issei Komuro Masami Nishino Yasushi Sakata on behalf of the Osaka Acute Coronary Insufficiency Study (OACIS) Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.5, pp.280-287, 2020-05-08 (Released:2020-05-08)

参考文献数

25

被引用文献数

1

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Background:Studies comparing the cardiac consequences of hydrophilic and lipophilic statins in experimental and clinical practice settings have produced inconsistent results. In particular, evidence focusing on diabetic patients after acute myocardial infarction (AMI) is lacking.Methods and Results:From the Osaka Acute Coronary Insufficiency Study (OACIS) registry database, 1,752 diabetic patients with AMI who were discharged with a prescription for statins were studied. Long-term outcomes were compared between hydrophilic and lipophilic statins, including all-cause death, recurrent myocardial infarction (re-MI) and admission for heart failure (HF) and a composite of these (major adverse cardiac events; MACE). During a median follow-up period of 1,059 days, all-cause death, non-fatal re-MI, admission for HF, and MACE occurred in 95, 89, 112 and 249 patients, respectively. Although there was no significant difference between statins in the risk of all-cause death, re-MI and MACE, the risk of HF admission was significantly lower in patients with hydrophilic than lipophilic statins before (adjusted hazard ratio [aHR], 0.560; 95% CI: 0.345–0.911, P=0.019) and after (aHR, 0.584; 95% CI: 0.389–0.876, P=0.009) propensity score matching. Hydrophilic statin use was consistently associated with lower risk for HF admission than lipophilic statins across the subgroup categories.Conclusions:In the present diabetic patients with AMI, hydrophilic statins were associated with a lower risk of admission for HF than lipophilic statins.

著者

Seitetsu L. Lee Masao Daimon Takayuki Kawata Takahide Kohro Koichi Kimura Tomoko Nakao Daisuke Koide Masafumi Watanabe Tsutomu Yamazaki Issei Komuro

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.78, no.4, pp.962-966, 2014 (Released:2014-03-25)

参考文献数

15

被引用文献数

10 12

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Background: Right atrial pressure (RAP) is commonly estimated using inferior vena cava (IVC) diameter and its respirophasic variations. Although a guideline has been provided for estimation of RAP due to variation in IVC dimensions based on studies in Western subjects, echocardiographic values in Asian subjects are unknown. Methods and Results: We studied 369 patients who underwent IVC ultrasound within 24h of right heart catheterization (RHC). The maximum and minimum IVC diameter during a respiratory cycle and the percent collapse after a sniff test were measured. These IVC parameters were compared with mean RAP measured on RHC. Receiver operating characteristic curves were generated for each IVC parameter to determine the optimal cut-off to detect RAP >10mmHg. The IVC maximum diameter cut-off for detecting RAP >10mmHg was 19mm (sensitivity, 75%; specificity, 78%) and the percent collapse cut-off was 30% (sensitivity, 75%; specificity, 83%). Both cut-offs were smaller than those previously reported in patients from Western countries. When the cut-off values from the existing guideline were applied to the present cohort, the sensitivity and specificity for normal RAP (0–5mmHg) were 38.6% and 74.2%, respectively, and 60.0% and 92.0% for elevated RAP (>10mmHg). Conclusions: The optimal IVC maximum diameter and percent collapse cut-offs to detect elevated RAP were smaller in Asian subjects than in a previously reported Western cohort.  (Circ J 2014; 78: 962–966)

著者

Eiichi Araki Atsushi Tanaka Nobuya Inagaki Hiroshi Ito Kohjiro Ueki Toyoaki Murohara Kenjiro Imai Masataka Sata Takehiro Sugiyama Hideki Ishii Shunsuke Yamane Takashi Kadowaki Issei Komuro Koichi Node on behalf of the Directors of the JCS and JDS

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.85, no.1, pp.82-125, 2020-12-25 (Released:2020-12-25)

参考文献数

293

被引用文献数

16

著者

Mizuki Miura Masao Yamasaki Yukari Uemura Masatomo Yoshikawa Katsumi Miyauchi Hiroyuki Tanaka Hideki Miyachi Jun Yamashita Makoto Suzuki Takeshi Yamamoto Ken Nagao Issei Komuro Morimasa Takayama

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.80, no.2, pp.461-468, 2016-01-25 (Released:2016-01-25)

参考文献数

22

被引用文献数

14 18

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Background:Previous trials have found that low low-density lipoprotein-cholesterol (LDL-C) on admission was associated with increased mortality in patients with acute myocardial infarction (AMI). There are few reports, however, on the effect of low LDL-C with or without in-hospital statin treatment on short-term prognosis in AMI patients.Methods and Results:A total of 9,032 AMI patients underwent primary PCI in 68 centers in the Tokyo CCU Network Registry during 2009–2012, in whom LDL-C was measured in 6,486. We divided them into 4 groups: statin-treated/LDL-C <100 mg/dl (n=1,236), statin-treated/LDL-C ≥100 mg/dl (n=3,671), statin-naïve/LDL-C <100 mg/dl (n=662), and statin-naïve/LDL-C ≥100 mg/dl (n=917). We assessed hospital mortality within 30 days. In-hospital all-cause mortality was significantly lower in the statin-treated/LDL-C ≥100-mg/dl group (3.2%, P<0.001). On multivariate Cox regression analysis, adjusted for age, gender, hypertension, diabetes mellitus, dyslipidemia and other clinical factors, the combination of statin treatment and LDL-C ≥100 mg/dl was an independent predictor of lower in-hospital mortality (adjusted HR, 0.211; 95% CI: 0.096–0.462; P<0.001). In the LDL-C <100-mg/dl patients, statin treatment also independently reduced in-hospital mortality (adjusted HR, 0.467; 95% CI: 0.223–0.976; P=0.043). Spontaneously low LDL-C was associated with increased short-term mortality.Conclusions:Statin treatment was associated with better short-term outcome in patients with AMI, even in patients with low LDL-C. (Circ J 2016; 80: 461–468)

著者

Hidetoshi Sugihara Koichi Kimura Keitaro Yamanouchi Naomi Teramoto Tomoko Okano Masao Daimon Hiroyuki Morita Katsu Takenaka Takanori Shiga Jun Tanihata Yoshitsugu Aoki Tokiko Inoue-Nagamura Hiroshi Yotsuyanagi Issei Komuro

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

pp.20-372, (Released:2020-11-13)

参考文献数

25

被引用文献数

8

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Duchenne muscular dystrophy (DMD) is X-linked recessive myopathy caused by mutations in the dystrophin gene. Although conventional treatments have improved their prognosis, inevitable progressive cardiomyopathy is still the leading cause of death in patients with DMD. To explore novel therapeutic options, a suitable animal model with heart involvement has been warranted.We have generated a rat model with an out-of-frame mutation in the dystrophin gene using CRISPR/Cas9 genome editing (DMD rats). The aim of this study was to evaluate their cardiac functions and pathologies to provide baseline data for future experiments developing treatment options for DMD.In comparison with age-matched wild rats, 6-month-old DMD rats showed no significant differences by echocardiographic evaluations. However, 10-month-old DMD rats showed significant deterioration in left ventricular (LV) fractional shortening (P = 0.024), and in tissue Doppler peak systolic velocity (Sa) at the LV lateral wall (P = 0.041) as well as at the right ventricular (RV) free-wall (P = 0.004). These functional findings were consistent with the fibrotic distributions by histological analysis.Although the cardiac phenotype was milder than anticipated, DMD rats showed similar distributions and progression of heart involvement to those of patients with DMD. This animal may be a useful model with which to develop effective drugs and to understand the underlying mechanisms of progressive heart failure in patients with DMD.

著者

Mitsuaki Isobe Koichi Amano Yoshihiro Arimura Akihiro Ishizu Shuichi Ito Shinya Kaname Shigeto Kobayashi Yoshinori Komagata Issei Komuro Kimihiro Komori Kei Takahashi Kazuo Tanemoto Hitoshi Hasegawa Masayoshi Harigai Shouichi Fujimoto Tatsuhiko Miyazaki Tetsuro Miyata Hidehiro Yamada Akitoshi Yoshida Takashi Wada Yoshinori Inoue Haruhito A. Uchida Hideki Ota Takahiro Okazaki Mitsuho Onimaru Tamihiro Kawakami Reiko Kinouchi Atsushi Kurata Hisanori Kosuge Ken-ei Sada Kunihiro Shigematsu Eiichi Suematsu Eijun Sueyoshi Takahiko Sugihara Hitoshi Sugiyama Mitsuhiro Takeno Naoto Tamura Michi Tsutsumino Hiroaki Dobashi Yoshikazu Nakaoka Kenji Nagasaka Yasuhiro Maejima Hajime Yoshifuji Yoshiko Watanabe Shoichi Ozaki Takeshi Kimura Hiroshi Shigematsu Keiko Yamauchi-Takihara Toyoaki Murohara Shin-ichi Momomura on behalf of the JCS Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.84, no.2, pp.299-359, 2020-01-24 (Released:2020-01-24)

参考文献数

368

被引用文献数

3 54

著者

Naoko Kato Koichiro Kinugawa Etsuko Nakayama Takako Tsuji Yumiko Kumagai Teruhiko Imamura Hisataka Maki Taro Shiga Masaru Hatano Atsushi Yao Chikako Miura Issei Komuro Ryozo Nagai

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.54, no.6, pp.382-389, 2013 (Released:2013-12-03)

参考文献数

36

被引用文献数

26 45

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Self-care is a cornerstone for the successful management of heart failure (HF). The purpose of this study was to examine the impacts of HF self-care on prognosis in Japanese patients with HF. A total of 283 HF outpatients (age 64 ± 14, 70% male, 52% HFrEF) were enrolled. We asked patients to answer about their adhevence to 5 self-care behaviors (medication, eating a low-sodium diet, regular exercise, daily weight check, and treatment seeking behavior). On the basis of the results, we classified patients into a good self-care group and a poor self-care group. The primary outcome was HF hospitalization and/or cardiac death. In total, 65% of patients were classifi ed into the poor self-care group. During a median follow-up of 2 years, cardiac events occurred more frequently in the poor self-care group (22% versus 9.6%, P = 0.013). Poor self-care was an independent risk factor for cardiac events in Cox regression analysis adjusted for clinical parameters (hazard ratio = 2.86, P = 0.005). Poor self-care was also associated with an increased number of HF hospitalizations as well as an extended length of hospital stay for HF. Poor knowledge about HF was an independent determinant for poor self-care in multivariate logistic regression analysis (odds ratio = 0.92, P = 0.019). Insufficient self-care is an independent risk factor for cardiac events in Japanese patients with HF.

著者

Naoko Kato Koichiro Kinugawa Etsuko Nakayama Akiko Hatakeyama Takako Tsuji Yumiko Kumagai Issei Komuro Ryozo Nagai

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.54, no.4, pp.228-233, 2013 (Released:2013-08-06)

参考文献数

31

被引用文献数

9 18

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Knowledge about their own condition is important for patients with heart failure (HF). No valid, reliable, and easily administered instrument is available to measure this knowledge in clinical practice. In this study, a HF knowledge scale was developed, and its psychometric properties were tested. Items related to knowledge about HF were extracted from relevant guidelines. Content validity of the items was confirmed by an expert panel including a cardiologist and nurses specialized in treatment and care of patients with HF. A self-administered questionnaire was then distributed to 187 patients with HF (64.0 ± 12.1 years, males 69%). In 62% patients, a left ventricular ejection fraction of < 50% was identified. Exploratory factor analysis demonstrated the one-dimensionality of the 15-item HF knowledge scale. Mean score was 10.7 ± 3.0 (range, 0–15). Known-group validity testing revealed a significant difference in HF knowledge score between patients newly diagnosed with HF and patients experienced with HF (9.4 ± 3.2 versus 10.8 ± 2.9, P = 0.043). In addition, HF knowledge scale scores were correlated with HF self-care scores assessed by the European Heart Failure Self-Care Behavior Scale for evaluation of criterion validity (ρ = −0.304, P < 0.001). Cronbach’s alpha was 0.79, and item-total correlation was 0.22–0.51, thereby suggesting that the reliability of the scale was acceptable. Acceptable validity and reliability were demonstrated for the HF knowledge scale developed in this study. This instrument could be useful in evaluation of patient knowledge about HF.

著者

Satoshi Kodera Arihiro Kiyosue Jiro Ando Hiroshi Akazawa Hiroyuki Morita Masafumi Watanabe Issei Komuro

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.58, no.6, pp.847-852, 2017-11-01 (Released:2017-12-12)

参考文献数

47

被引用文献数

20

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The quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER) are important concepts in cost-effectiveness analysis, which is becoming increasingly important in Japan. QALY is used to estimate quality of life (QOL) and life years, and can be used to compare the efficacies of cancer and cardiovascular treatments. ICER is defined as the difference in cost between treatments divided by the difference in their effects, with a smaller ICER indicating better cost-effectiveness. Here, we present a review of cost-effectiveness analyses in Japan as well other countries. A number of treatments were shown to be cost-effective, e.g., statin for secondary prevention of cardiovascular disease, aspirin for primary prevention of cardiovascular disease, DOAC for high-risk atrial fibrillation, beta blockers, ACE inhibitors, and ARB for heart failure, sildenafil and bosentan for pulmonary hypertension, CABG for multi-vessel coronary disease, ICD for ventricular tachycardia, and CRT for heart failure with low ejection fraction, while others were not cost-effective, e.g., epoprostenol for pulmonary hypertension and LVAD for end-stage heart failure. Further investigations are required regarding some treatments, e.g., PCSK-9 inhibitors for familial hypercholesterolemia, PCI for multi-vessel coronary disease, catheter ablation for atrial fibrillation, and TAVI for severe aortic stenosis. Ethical aspects should be taken into consideration when utilizing the results of cost-effectiveness analysis in medical policy.

著者

Takuya Kishi Teruyuki Hirano Atsushi Mizuno Yoichiro Hashimoto Chisa Matsumoto Memori Fukuda Shoji Sanada Mari Ishida Koichi Node Susumu Miyamoto Issei Komuro on behalf of Directors of the Japan Stroke and Japanese Circulation Societies

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.6, pp.343-344, 2020-06-10 (Released:2020-06-10)

被引用文献数

5

著者

Hidetaka Itoh Hidehiro Kaneko Hiroyuki Kiriyama Yuriko Yoshida Koki Nakanishi Yoshiko Mizuno Masao Daimon Hiroyuki Morita Yutaka Yatomi Nobutake Yamamichi Issei Komuro

出版者

Japan Atherosclerosis Society

雑誌

Journal of Atherosclerosis and Thrombosis (ISSN:13403478)

巻号頁・発行日

pp.48728, (Released:2019-06-22)

参考文献数

40

被引用文献数

23

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Aim: Obesity and metabolic syndrome (MetS) frequently coexist and are both important risk factors for cardiovascular disease. However, the pathophysiological role of obesity without MetS, also referred to as metabolically healthy obesity (MHO), remains unclear. In this study, we aim to clarify the effect of MHO on the development of carotid plaque using a community-based cohort.Methods: We examined 1,241 subjects who underwent health checkups at our institute. Obesity was defined by a body mass index of ≥ 25.0 kg/m2. Subjects were divided into three groups: non-obese, MHO, and metabolically unhealthy obesity (MUO).Results: The prevalence of carotid plaque, defined as intima-media thickness (IMT) ≥ 1.1 mm, was higher in subjects with MUO and MHO than in non-obese subjects. Multivariable analysis demonstrated that MHO (odds ratio 1.6, p=0.012) and MUO (odds ratio 1.9, p=0.003) as well as age of ≥ 65 years, male sex, hypertension, and diabetes mellitus were independently associated with carotid plaque formation. A similar trend was observed in each subgroup according to age and sex.Conclusions: MHO increased the prevalence of carotid plaque when compared with non-obese subjects, suggesting the potential significance of MHO in the development of subsequent cardiovascular diseases.

著者

Satoshi Kodera Hiroyuki Morita Arihiro Kiyosue Jiro Ando Issei Komuro

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0148, (Released:2019-06-05)

参考文献数

35

被引用文献数

11

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Background:The cost-effectiveness of percutaneous coronary intervention (PCI) for ischemic heart disease is undetermined in Japan. The aim of this study was to analyze the cost-effectiveness of PCI compared with medical therapy for ST-elevation myocardial infarction (STEMI) and angina pectoris (AP) in Japan.Methods and Results:We used Markov models for STEMI and AP to assess the costs and benefits associated with PCI or medical therapy from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as quality-adjusted life-years (QALY), and ICER <¥5 m per QALY gained was judged to be cost-effective. The impact of PCI on cardiovascular events was based on previous publications. In STEMI patients, the ICER of PCI over medical treatment was ¥0.97 m per QALY gained. The cost-effectiveness probability of PCI was 99.9%. In AP patients, the ICER of fractional flow reserve (FFR)-guided PCI over medical treatment was ¥4.63 m per QALY gained. The cost-effectiveness probability of PCI was 50.4%. The ICER of FFR-guided PCI for asymptomatic patients was ¥23 m per QALY gained.Conclusions:In STEMI patients, PCI was cost-effective compared with medical therapy. In AP patients, FFR-guided PCI for symptomatic patients could be cost-effective compared with medical therapy. FFR-guided PCI for asymptomatic patients with myocardial ischemia was not cost-effective.

著者

Shiro Uemura Hiroshi Okamoto Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Satoshi Yasuda Nobuhiro Tanaka Shun Kohsaka Kazushige Kadota Yoshihiko Saito Hiroyuki Tsutsui Issei Komuro Yuji Ikari Hisao Ogawa Masato Nakamura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0004, (Released:2019-04-24)

参考文献数

33

被引用文献数

17

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Background:Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear.Methods and Results:The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI.Conclusions:Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

著者

Shigeru Miyagawa Kyongsun Pak Shungo Hikoso Tomohito Ohtani Eisuke Amiya Yasushi Sakata Shinichiro Ueda Masahiro Takeuchi Issei Komuro Yoshiki Sawa

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.1, no.1, pp.29-34, 2019-01-10 (Released:2019-01-10)

参考文献数

20

被引用文献数

7

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Background: Accurate prognosis for heart failure (HF) survival is important for quality of life, treatment decisions, and early evaluation of new therapies and devices. Here, we developed a multivariate risk model for predicting survival in Japanese patients with HF, using parameters that are readily observable in a clinical setting. Methods and Results: We analyzed data for 1,214 adults with HF (EF <35%). Of 424 available clinical baseline factors in the derivation dataset, 17 candidate predictors were identified on Cox proportional hazards regression. These predictors were assessed for clinical relevance and tested in candidate models using cross-validated 5-year C-statistics. This process yielded a set of 14 covariates with good accuracy for predicting actual 5-year survival: age; LVEF; albumin; BMI; Hb; sodium; history of renal dysfunction, diabetes, or chronic dialysis; times HF recurred or required readmission to the hospital; use of cardiac drip, thiazide diuretic, or per oral inotropic agent; and loop diuretic dosage. These 14 variables were used to establish the Japan Heart Failure Model (JHFM) for predicting survival in patients with HF. When applied to an independent validation dataset, the results from the JHFM were closer to actual survival than those of the Seattle Heart Failure Model. Conclusions: JHFM predictions for 5-year survival had good accuracy for Japanese patients with HF. The JHFM uses parameters that can be measured at any hospital.