著者
Shinya Goto Darren K. McGuire Shinichi Goto
出版者
Japan Atherosclerosis Society
雑誌
Journal of Atherosclerosis and Thrombosis (ISSN:13403478)
巻号頁・発行日
pp.RV17062, (Released:2021-10-02)
参考文献数
17
被引用文献数
4

Advances in High-performance computing (HPC) technology have reached the capacity to inform cardiovascular (CV) science in the realm of both inductive and constructive approaches. Clinical trials allow for the comparison of the effect of an intervention without the need to understand the mechanism. This is a typical example of an inductive approach. In the HPC field, training an artificial intelligence (AI) model, constructed by neural networks, to predict future CV events with the use of large scale multi-dimensional datasets is the counterpart that may rely on as well as inform understanding of mechanistic underpinnings for optimization. However, in contrast to clinical trials, AI can calculate event risk at the individual level and has the potential to inform and refine the application of personalized medicine.Despite this clear strength, results from AI analyses may identify otherwise unidentified/unexpected (i.e. non-intuitive) relationships between multi-dimensional data and clinical outcomes that may further unravel potential mechanistic pathways and identify potential therapeutic targets, therebycontributing to the parsing of observational associations from causal links. The constructive approach will remain critical to overcome limitations of existing knowledge and anchored biases to actualize a more sophisticated understanding of the complex pathobiology of CV diseases.HPC technology has the potential to underpin this constructive approach in CV basic and clinical science. In general, even complex biological phenomena can be reduced to combinations of simple biological/chemical/physical laws. In the deductive approach, the focus/intent is to explain complex CV diseases by combinations of simple principles.
著者
Masatsugu Hori Masayasu Matsumoto Norio Tanahashi Shin-ichi Momomura Shinichiro Uchiyama Shinya Goto Tohru Izumi Yukihiro Koretsune Mariko Kajikawa Masaharu Kato Hitoshi Ueda Kazuya Iwamoto Masahiro Tajiri on behalf of the J-ROCKET AF study investigators
出版者
日本循環器学会
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-12-0454, (Released:2012-06-05)
参考文献数
13
被引用文献数
164 507

Background: The global ROCKET AF study evaluated once-daily rivaroxaban vs. warfarin for stroke and systemic embolism prevention in patients with atrial fibrillation (AF). A separate trial, J-ROCKET AF, compared the safety of a Japan-specific rivaroxaban dose with warfarin administered according to Japanese guidelines in Japanese patients with AF. Methods and Results: J-ROCKET AF was a prospective, randomized, double-blind, phase III trial. Patients (n=1,280) with non-valvular AF at increased risk for stroke were randomized to receive 15mg once-daily rivaroxaban or warfarin dose-adjusted according to Japanese guidelines. The primary objective was to determine non-inferiority of rivaroxaban against warfarin for the principal safety outcome of major and non-major clinically relevant bleeding, in the on-treatment safety population. The primary efficacy endpoint was the composite of stroke and systemic embolism. Non-inferiority of rivaroxaban to warfarin was confirmed; the rate of the principal safety outcome was 18.04% per year in rivaroxaban-treated patients and 16.42% per year in warfarin-treated patients (hazard ratio [HR] 1.11; 95% confidence interval 0.87–1.42; P<0.001 [non-inferiority]). Intracranial hemorrhage rates were 0.8% with rivaroxaban and 1.6% with warfarin. There was a strong trend for a reduction in the rate of stroke/systemic embolism with rivaroxaban vs. warfarin (HR, 0.49; P=0.050). Conclusions: J-ROCKET AF demonstrated the safety of a Japan-specific rivaroxaban dose and supports bridging the global ROCKET AF results into Japanese clinical practice.
著者
Eri Toda Kato Shinya Goto
出版者
Japan Atherosclerosis Society
雑誌
Journal of Atherosclerosis and Thrombosis (ISSN:13403478)
巻号頁・発行日
pp.RV17049, (Released:2021-04-13)
参考文献数
37
被引用文献数
1

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality across the world, warranting continuous research in this field. The elucidation of the atherogenesis mechanism is considered one of the most relevant scientific accomplishments of the last century. This has led to the clinical development of various novel therapeutic interventions for patients with or at risk of ASCVD, in which randomized clinical trials played a crucial role.The Thrombolysis in Myocardial Infarction (TIMI) Study Group was initially established to conduct a clinical trial studying thrombolysis for treatment of myocardial infarction. However, over the years, the TIMI Study Group has expanded their research interests to include antithrombotic therapy, lipid lowering, anti-diabetes, anti-obesity, and even heart failure. By leading large-scale, international, randomized, controlled trials of novel therapeutics, the TIMI Study Group has helped shape the very practice of cardiovascular medicine for over a quarter of a century, and decades of research continue to provide future promise for further advancement. Through a mutual goal to improve the care of ASCVD patients, the Japanese scientific community has become one of the important contributors to the TIMI Study Group's clinical research.In this review article, the authors aim to summarize major research lead by the TIMI Study Group in the ASCVD field.
著者
Shinichi Goto Shinya Goto
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
vol.1, no.11, pp.481-486, 2019-11-08 (Released:2019-11-08)
参考文献数
40
被引用文献数
13

The 12-lead electrocardiogram (ECG) is a fast, non-invasive, powerful tool to diagnose or to evaluate the risk of various cardiac diseases. The vast majority of arrhythmias are diagnosed solely on 12-lead ECG. Initial detection of myocardial ischemia such as myocardial infarction (MI), acute coronary syndrome (ACS) and effort angina is also dependent upon 12-lead ECG. ECG reflects the electrophysiological state of the heart through body mass, and thus contains important information on the electricity-dependent function of the human heart. Indeed, 12-lead ECG data are complex. Therefore, the clinical interpretation of 12-lead ECG requires intense training, but still is prone to interobserver variability. Even with rich clinically relevant data, non-trained physicians cannot efficiently use this powerful tool. Furthermore, recent studies have shown that 12-lead ECG may contain information that is not recognized even by well-trained experts but which can be extracted by computer. Artificial intelligence (AI) based on neural networks (NN) has emerged as a strong tool to extract valuable information from ECG for clinical decision making. This article reviews the current status of the application of NN-based AI to the interpretation of 12-lead ECG and also discusses the current problems and future directions.
著者
Eri Toda Kato Shinya Goto
出版者
Japan Atherosclerosis Society
雑誌
Journal of Atherosclerosis and Thrombosis (ISSN:13403478)
巻号頁・発行日
vol.28, no.6, pp.563-572, 2021-06-01 (Released:2021-06-01)
参考文献数
37
被引用文献数
1

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality across the world, warranting continuous research in this field. The elucidation of the atherogenesis mechanism is considered one of the most relevant scientific accomplishments of the last century. This has led to the clinical development of various novel therapeutic interventions for patients with or at risk of ASCVD, in which randomized clinical trials played a crucial role.The Thrombolysis in Myocardial Infarction (TIMI) Study Group was initially established to conduct a clinical trial studying thrombolysis for treatment of myocardial infarction. However, over the years, the TIMI Study Group has expanded their research interests to include antithrombotic therapy, lipid lowering, anti-diabetes, anti-obesity, and even heart failure. By leading large-scale, international, randomized, controlled trials of novel therapeutics, the TIMI Study Group has helped shape the very practice of cardiovascular medicine for over a quarter of a century, and decades of research continue to provide future promise for further advancement. Through a mutual goal to improve the care of ASCVD patients, the Japanese scientific community has become one of the important contributors to the TIMI Study Group’s clinical research.In this review article, the authors aim to summarize major research lead by the TIMI Study Group in the ASCVD field.
著者
Hiroto Yabushita Shinichi Goto Sunao Nakamura Hideki Oka Masamitsu Nakayama Shinya Goto
出版者
Japan Atherosclerosis Society
雑誌
Journal of Atherosclerosis and Thrombosis (ISSN:13403478)
巻号頁・発行日
pp.59675, (Released:2020-10-02)
参考文献数
31
被引用文献数
5

Aim: The clinically meaningful coronary stenosis is diagnosed by trained interventional cardiologists. Whether artificial intelligence (AI) could detect coronary stenosis from CAG video is unclear. Methods: The 199 consecutive patients who underwent coronary arteriography (CAG) with chest pain between December 2018 and May 2019 was enrolled. Each patient underwent CAG with multiple view resulting in total numbers of 1,838 videos. A multi-layer 3-dimensional convolution neural network (CNN) was trained as an AI to detect clinically meaningful coronary artery stenosis diagnosed by the expert interventional cardiologist, using data from 146 patients (resulted in 1,359 videos) randomly selected from the entire dataset (training dataset). This training dataset was further split into 109 patients (989 videos) for derivation and 37 patients (370 videos) for validation. The AI developed in derivation cohort was tuned in validation cohort to make final model. Results: The final model was selected as the model with best performance in validation dataset. Then, the predictive accuracy of final model was tested with the remaining 53 patients (479 videos) in test dataset. Our AI model showed a c-statistic of 0.61 in validation dataset and 0.61 in test dataset, respectively. Conclusion: An artificial intelligence applied to CAG videos could detect clinically meaningful coronary atherosclerotic stenosis diagnosed by expert cardiologists with modest predictive value. Further studies with improved AI at larger sample size is necessary.
著者
Masatsugu Hori Masayasu Matsumoto Norio Tanahashi Shin-ichi Momomura Shinichiro Uchiyama Shinya Goto Tohru Izumi Yukihiro Koretsune Mariko Kajikawa Masaharu Kato Hitoshi Ueda Kazuya Iwamoto Masahiro Tajiri on behalf of the J-ROCKET AF study investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.76, no.9, pp.2104-2111, 2012 (Released:2012-08-24)
参考文献数
13
被引用文献数
304 507

Background: The global ROCKET AF study evaluated once-daily rivaroxaban vs. warfarin for stroke and systemic embolism prevention in patients with atrial fibrillation (AF). A separate trial, J-ROCKET AF, compared the safety of a Japan-specific rivaroxaban dose with warfarin administered according to Japanese guidelines in Japanese patients with AF. Methods and Results: J-ROCKET AF was a prospective, randomized, double-blind, phase III trial. Patients (n=1,280) with non-valvular AF at increased risk for stroke were randomized to receive 15mg once-daily rivaroxaban or warfarin dose-adjusted according to Japanese guidelines. The primary objective was to determine non-inferiority of rivaroxaban against warfarin for the principal safety outcome of major and non-major clinically relevant bleeding, in the on-treatment safety population. The primary efficacy endpoint was the composite of stroke and systemic embolism. Non-inferiority of rivaroxaban to warfarin was confirmed; the rate of the principal safety outcome was 18.04% per year in rivaroxaban-treated patients and 16.42% per year in warfarin-treated patients (hazard ratio [HR] 1.11; 95% confidence interval 0.87–1.42; P<0.001 [non-inferiority]). Intracranial hemorrhage rates were 0.8% with rivaroxaban and 1.6% with warfarin. There was a strong trend for a reduction in the rate of stroke/systemic embolism with rivaroxaban vs. warfarin (HR, 0.49; P=0.050). Conclusions: J-ROCKET AF demonstrated the safety of a Japan-specific rivaroxaban dose and supports bridging the global ROCKET AF results into Japanese clinical practice.  (Circ J 2012; 76: 2104–2111)
著者
Yukihiro Koretsune Takuma Etoh Yousuke Katsuda Tetsuro Suetsugu Kenshi Kumeda Ichiro Sakuma Kenichi Eshima Mitsuhiro Shibuya Shin-ichi Ando Naoto Yokota Shinya Goto Karen S. Pieper Jagan Allu Ajay K. Kakkar for the GARFIELD-AF Investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-18-0655, (Released:2018-12-04)
参考文献数
20
被引用文献数
11

Background: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective non-interventional study of stroke prevention in patients with newly diagnosed non-valvular AF (NAVF) that is being conducted in 35 countries. Methods and Results: A total of 52,081 patients with a new diagnosis of NVAF were enrolled prospectively in GARFIELD-AF. Of these, 4859 (9.3%) were recruited in Japan (2010–2016). In cohort 1 (2010–2011), few patients were on non-vitamin K antagonist oral anticoagulants (NOAC) globally. From cohort 2 onwards (2011–2016), however, there was a rapid increase in NOAC use around the globe, especially in Japan. By the last year of enrolment (2015–2016), 67.9% of patients in Japan and 43.1% of patients globally were on NOAC±antiplatelet therapy (AP). In Japan and globally, 17.0% and 12.2% of patients, respectively, did not receive stroke prevention treatment. Few patients in Japan (5.7%) received AP only. Compared with the other countries, the unadjusted rates of all-cause mortality and major bleeding were low, while rates of stroke/systemic embolism were similar after 1 year of follow-up. Conclusions: GARFIELD-AF continues to provide important information on the homogeneity and heterogeneity of baseline characteristics and treatment patterns in patients with newly diagnosed NVAF. This diversity reflects the differences in outcomes in Japan compared with the rest of the world.
著者
Masamitsu Nakayama Shinichi Goto Teppei Sakano Shinya Goto
出版者
Japan Atherosclerosis Society
雑誌
Journal of Atherosclerosis and Thrombosis (ISSN:13403478)
巻号頁・発行日
pp.63798, (Released:2022-10-21)
参考文献数
33

Aims: Whether the multi-dimensional data of serially measured blood pressure contains information for predicting the future risk of death in elderly individuals in nursing homes is unclear. Methods: Of the elderly individuals staying in a nursing home, 19,740 and 40,055 individuals with serially measured blood pressure from day 1 to 365 (for AI-long) and 1 to 90 (for AI-short) along with the death information at day 366 to 730 and 91-365 were included. The neural network-based artificial intelligence (AI) was applied to find the relationship between BP time-series and the future risks of death in both populations. Results: AI-long found a significant relationship between the serially measured BP from day 1 to day 365 days and the risk of death occurring 366-730 days with c-statistics of 0.57 (95% CI: 0.51-0.63). AI-short also found a significant relationship between the serially measured BP from day 1 to day 90 and the rate of death occurring 91-365 days with c-statistics of 0.58 (95%CI: 0.52-0.63). Conclusion: Our results suggest that neural network-based AI could find the hidden subtle relationship between multi-dimensional data of serially measured BP and the future risk of death in apparently healthy elderly Japanese individuals under nursing care.
著者
Masamitsu Nakayama Shinichi Goto Shinya Goto
出版者
JAPANESE SOCIETY OF BIORHEOLOGY
雑誌
Journal of Biorheology (ISSN:18670466)
巻号頁・発行日
vol.36, no.2, pp.68-75, 2022 (Released:2022-10-25)
参考文献数
42

A1 domain of von Willebrand factor (VWF) binding with platelet glycoprotein (GP) Ibα play crucial roles in platelet adhesion and subsequent passive shape changes in the platelets such as pseudopod formation under high wall shear rate conditions. However, the effects of specific inhibitors of VWF binding with GPIbα on the length of pseudopods supporting platelet adhesion on VWF are still to be elucidated. Here we measured the length of pseudopods in the presence of VWF-GPIbα inhibitor of caplacizumab. The length of pseudopods was 6.5 ± 0.2 μm (mean ± 95% confidential interval [CI]) and 6.9 ± 0.2 μm (mean ± 95% CI) at 100 and 200 nM of caplacizumab concentrations and was longer than those formed in its absence (5.2 ± 0.2 μm, p < 0.05). Our experiments also revealed that the surface area coverage by platelets in the presence of caplacizumab at a concentration of 200 nM of 26.1 ± 6.4% after 60-second blood perfusion was smaller than its absence (45.2 ± 7.5%, p < 0.05). Our results suggest that fewer numbers of VWF-GPIbα bonds generating larger binding force with a longer length of pseudopods, support the platelet adhesion on VWF in the presence of caplacizumab at a wall shear rate of 1,500 s–1.
著者
Shinichi Goto Noriko Tamura Kengo Ayabe Eri Kato Terumitsu Hasebe Shu Takagi Yota Kawamura Shinya Goto
出版者
JAPANESE SOCIETY OF BIORHEOLOGY
雑誌
Journal of Biorheology (ISSN:18670466)
巻号頁・発行日
vol.31, no.2, pp.30-34, 2017 (Released:2018-02-23)
参考文献数
19
被引用文献数
4 4

Formation of thrombi is a complex biological event involving platelets and coagulation cascades. The both have been well investigated individually. However, the inter-relationship between them is still to be elucidated. The recent progresses in computer technology may allow us to simulate complex biological phenomena in silico. Here we report a novel method to reproduce the complex system of the inter-relationship between platelet and coagulation by combining the previous simulation model of platelet adhesion with the model of coagulation cascade. We have reproduced the biological process of thrombus growth occurring in the mice cremasteric artery induced by endothelial injury by FeCl3 with our newly developed computer simulator.
著者
Shinya Goto Chien-Hua Huang Seung-Jung Park Håkan Emanuelsson Takeshi Kimura
出版者
日本循環器学会
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-15-0112, (Released:2015-09-16)
参考文献数
37
被引用文献数
9 194

Background:Few data on the relative efficacy and safety of new P2Y12inhibitors such as prasugrel and ticagrelor in Japanese, Taiwanese and South Korean patients with acute coronary syndromes (ACS) exist.Methods and Results:The multicenter, double-blind, randomized PHILO trial compared the safety and efficacy of ticagrelor vs. clopidogrel in 801 patients with ACS (Japanese, n=721; Taiwanese, n=35; South Korean, n=44; unknown ethnicity, n=1). All were planned to undergo percutaneous coronary intervention and randomized within 24 h of symptom onset. Primary safety and efficacy endpoints were time to first occurrence of any major bleeding event and to any event from the composite of myocardial infarction, stroke or death from vascular causes, respectively.At 12 months, overall major bleeding occurred in 10.3% of ticagrelor-treated patients and in 6.8% of clopidogrel-treated patients (hazard ratio (HR), 1.54; 95% confidence interval (CI): 0.94–2.53); the composite primary efficacy endpoint occurred in 9.0% and in 6.3% of ticagrelor- and clopidogrel-treated patients, respectively (HR, 1.47; 95% CI: 0.88–2.44). For both analyses, the difference between groups was not statistically significant.Conclusions:In ACS patients from Japan, Taiwan and South Korea, event rates of primary safety and efficacy endpoints were higher, albeit not significantly, in ticagrelor-treated patients compared with clopidogrel-treated patients. This observation could be explained by the small sample size, imbalance in clinical characteristics and low number of events in the PHILO population.
著者
Shinya Goto Chien-Hua Huang Seung-Jung Park Håkan Emanuelsson Takeshi Kimura
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.79, no.11, pp.2452-2460, 2015-10-23 (Released:2015-10-23)
参考文献数
37
被引用文献数
59 194

Background:Few data on the relative efficacy and safety of new P2Y12inhibitors such as prasugrel and ticagrelor in Japanese, Taiwanese and South Korean patients with acute coronary syndromes (ACS) exist.Methods and Results:The multicenter, double-blind, randomized PHILO trial compared the safety and efficacy of ticagrelor vs. clopidogrel in 801 patients with ACS (Japanese, n=721; Taiwanese, n=35; South Korean, n=44; unknown ethnicity, n=1). All were planned to undergo percutaneous coronary intervention and randomized within 24 h of symptom onset. Primary safety and efficacy endpoints were time to first occurrence of any major bleeding event and to any event from the composite of myocardial infarction, stroke or death from vascular causes, respectively.At 12 months, overall major bleeding occurred in 10.3% of ticagrelor-treated patients and in 6.8% of clopidogrel-treated patients (hazard ratio (HR), 1.54; 95% confidence interval (CI): 0.94–2.53); the composite primary efficacy endpoint occurred in 9.0% and in 6.3% of ticagrelor- and clopidogrel-treated patients, respectively (HR, 1.47; 95% CI: 0.88–2.44). For both analyses, the difference between groups was not statistically significant.Conclusions:In ACS patients from Japan, Taiwan and South Korea, event rates of primary safety and efficacy endpoints were higher, albeit not significantly, in ticagrelor-treated patients compared with clopidogrel-treated patients. This observation could be explained by the small sample size, imbalance in clinical characteristics and low number of events in the PHILO population. (Circ J 2015; 79: 2452–2460)
著者
Yukihiro Koretsune Takuma Etoh Yousuke Katsuda Tetsuro Suetsugu Kenshi Kumeda Ichiro Sakuma Kenichi Eshima Mitsuhiro Shibuya Shin-ichi Ando Naoto Yokota Shinya Goto Karen S. Pieper Jagan Allu Ajay K. Kakkar for the GARFIELD-AF Investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.83, no.1, pp.67-74, 2018-12-25 (Released:2018-12-25)
参考文献数
20
被引用文献数
11

Background: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective non-interventional study of stroke prevention in patients with newly diagnosed non-valvular AF (NAVF) that is being conducted in 35 countries. Methods and Results: A total of 52,081 patients with a new diagnosis of NVAF were enrolled prospectively in GARFIELD-AF. Of these, 4859 (9.3%) were recruited in Japan (2010–2016). In cohort 1 (2010–2011), few patients were on non-vitamin K antagonist oral anticoagulants (NOAC) globally. From cohort 2 onwards (2011–2016), however, there was a rapid increase in NOAC use around the globe, especially in Japan. By the last year of enrolment (2015–2016), 67.9% of patients in Japan and 43.1% of patients globally were on NOAC±antiplatelet therapy (AP). In Japan and globally, 17.0% and 12.2% of patients, respectively, did not receive stroke prevention treatment. Few patients in Japan (5.7%) received AP only. Compared with the other countries, the unadjusted rates of all-cause mortality and major bleeding were low, while rates of stroke/systemic embolism were similar after 1 year of follow-up. Conclusions: GARFIELD-AF continues to provide important information on the homogeneity and heterogeneity of baseline characteristics and treatment patterns in patients with newly diagnosed NVAF. This diversity reflects the differences in outcomes in Japan compared with the rest of the world.
著者
Hisao Ogawa Shinya Goto Masunori Matsuzaki Shintaro Hiro Daisuke Shima on behalf of the APPRAISE-J investigators
出版者
日本循環器学会
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-13-0209, (Released:2013-06-07)
参考文献数
30
被引用文献数
11 27

Background: Concomitant anticoagulant therapy may further reduce the risk of thrombotic events in patients with acute coronary syndrome (ACS) when given in addition to current standard antiplatelet therapies. This Phase II, randomized, double-blind, placebo-controlled study in Japanese patients with ACS assessed the bleeding risk of apixaban compared with placebo when given in combination with standard antiplatelet therapy, and followed a similar design to APPRAISE-1, the larger global Phase II study. Methods and Results: Patients with recently diagnosed ACS were randomized to receive apixaban 2.5mg twice daily (BID; n=49), apixaban 5mg BID (n=50), or placebo (n=52) in addition to standard antiplatelet therapy for 24 weeks. The composite primary endpoint of major or clinically relevant nonmajor bleeding occurred in 2 patients (4.1%) in each apixaban treatment group and 1 patient (2.0%) in the placebo group, and a dose-dependent increase was seen in all bleeding events. No hemorrhagic strokes occurred in either apixaban treatment group. This study was terminated before completion because the APPRAISE-2 global Phase III trial was stopped based on the recommendation of the Data Monitoring Committee, following an increase in bleeding events without a counterbalancing reduction in ischemic events. Conclusions: The bleeding profile of apixaban in Japanese patients with ACS was similar to that found in the global APPRAISE-1 study, supporting the safety of apixaban in Japanese patients.