著者
Shunsuke Tamaki Yoshihiro Sato Takahisa Yamada Takashi Morita Yoshio Furukawa Yusuke Iwasaki Masato Kawasaki Atsushi Kikuchi Takumi Kondo Tatsuhisa Ozaki Masahiro Seo Iyo Ikeda Eiji Fukuhara Makoto Abe Jun Nakamura Masatake Fukunami
出版者
日本循環器学会
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-16-1122, (Released:2017-02-16)
参考文献数
39
被引用文献数
34

Background:Although the mainstay of treatment for acute decompensated heart failure (ADHF) is decongestion by diuretic therapy, it is often associated with worsening renal function (WRF). The effect of tolvaptan, a selective V2 receptor antagonist, on WRF in ADHF patients with preserved left ventricular ejection fraction (LVEF) is unknown.Methods and Results:We enrolled 50 consecutive ADHF patients whose LVEF on admission was ≥45%. Patients were randomly assigned to either tolvaptan add-on (n=26) or conventional diuretic therapy (n=24). The primary endpoint was the incidence of WRF, defined as an increase in serum creatinine (Cr) ≥0.3 mg/dL or 50% above baseline within 48 h of randomization. There was no significant difference between the 2 groups in the change in body weight or the total urine volume during 48 h. However, the change in Cr (∆Cr) at 24 and 48 h after randomization and the incidence of WRF (12% vs. 42%, P=0.0236) were significantly lower, and the fractional excretion of urea (FEUN) at 24 and 48 h after randomization was significantly higher in the tolvaptan group. There was an inverse correlation between ∆Cr and FEUN at 48 h after randomization.Conclusions:Tolvaptan can alleviate congestion with a significantly lower risk of WRF in ADHF patients with preserved LVEF, presumably through maintenance of renal perfusion.
著者
Bolrathanak Oeun Daisaku Nakatani Shungo Hikoso Takayuki Kojima Tomoharu Dohi Tetsuhisa Kitamura Katsuki Okada Akihiro Sunaga Hirota Kida Takahisa Yamada Masaaki Uematsu Yoshio Yasumura Yoshiharu Higuchi Toshiaki Mano Yoshiyuki Nagai Hisakazu Fuji Hiroya Mizuno Yasushi Sakata for the Osaka CardioVascular Conference (OCVC) Heart Failure Investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Reports (ISSN:24340790)
巻号頁・発行日
vol.2, no.8, pp.400-408, 2020-08-07 (Released:2020-08-07)
参考文献数
32
被引用文献数
4

Background:Little is known about factors associated with elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) at the convalescent stage and their effects on 1-year outcomes in patients with heart failure with preserved ejection fraction (HFpEF).Methods and Results:This study included 469 patients with HFpEF. Elevated NT-proBNP was defined as the highest quartile. The first 3 quartiles (Q1–Q3) were combined together for comparison with the fourth quartile (Q4). Median NT-proBNP concentrations in Q1–Q3 and Q4 were 669 and 3,504 pg/mL, respectively. Multivariate logistic regression analysis revealed that low albumin (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.35–4.39; P=0.003), low estimated glomerular filtration rate (OR 5.83; 95% CI 3.46–9.83; P<0.001), high C-reactive protein (OR 2.09; 95% CI 1.21–3.63; P=0.009), and atrial fibrillation at discharge (OR 2.33; 95% CI 1.40–3.89; P=0.001) were associated with elevated NT-proBNP. Cumulative rates of all-cause mortality and heart failure rehospitalization were significantly higher in Q4 than in Q1–Q3 (P=0.001 and P<0.001, respectively). Incidence and hazard ratios of these adverse events increased when the number of associated factors for elevated NT-proBNP clustered together (P<0.001 and P=0.002, respectively).Conclusions:In addition to atrial fibrillation, extracardiac factors (malnutrition, renal impairment and inflammation) were associated with elevated NT-proBNP at the convalescent stage, and led to poor prognosis in patients with HFpEF.
著者
Tetsuo Minamino Shuichiro Higo Ryo Araki Shungo Hikoso Daisaku Nakatani Hiroshi Suzuki Takahisa Yamada Masaaki Okutsu Kouji Yamamoto Yasushi Fujio Yoshio Ishida Takuya Ozawa Kiminori Kato Ken Toba Yoshifusa Aizawa Issei Komuro EPO-AMI-II Investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-17-0889, (Released:2018-02-02)
参考文献数
21
被引用文献数
13

Background:Erythropoietin (EPO) has antiapoptotic and tissue-protective effects, but previous clinical studies using high-dose EPO have not shown cardioprotective effects, probably because of platelet activation and a lack of knowledge regarding the optimal dose. In contrast, a small pilot study using low-dose EPO has shown improvement in left ventricular function without adverse cardiovascular events.Methods and Results:We performed a multicenter (25 hospitals), prospective, randomized, double-blind, placebo-controlled, dose-finding study to clarify the efficacy and safety of low-dose EPO in patients with ST-segment elevation myocardial infarction (STEMI) under the Evaluation System of Investigational Medical Care of the Ministry of Health, Labor and Welfare of Japan. In total, 198 STEMI patients with low left ventricular ejection fraction (LVEF <50%) were randomly assigned to receive intravenous administration of EPO (6,000 or 12,000 IU) or placebo within 6 h of successful percutaneous coronary intervention. At 6 months, there was no significant dose-response relationship in LVEF improvement among the 3 groups tested (EPO 12,000 IU: 5.4±9.3%, EPO 6,000 IU: 7.3±7.7%, Placebo: 8.1±8.3%, P=0.862). Low-dose EPO also did not improve cardiac function, as evaluated by 99 mTc-MIBI SPECT or NT-proBNP at 6 months and did not increase adverse events.Conclusions:Administration of low-dose EPO did not improve LVEF at 6 months in STEMI patients (UMIN000005721).
著者
Yuichi Wajiki Yoshinori Kaneko Toshie Sugiyama Takahisa Yamada Hiroaki Iwaisaki
出版者
日本家禽学会
雑誌
The Journal of Poultry Science (ISSN:13467395)
巻号頁・発行日
pp.0150040, (Released:2015-08-25)
被引用文献数
1

The Japanese captive population of Japanese crested ibis (Nipponia nippon) was established using 5 founders derived from the Chinese captive population. Its size has increased rapidly, and the maintenance phase is about to start. Thus, this study was designed to perform genetic analyses in this population with pedigree information, considering the adoption of mean kinship strategy as the breeding strategy suited to the maintenance phase. Because the relationships among the 5 founders were unknown, different assumptions were set up ranging from 0 to 0.25 of kinship coefficients between the 5 founders. Assuming that the 5 founders were non-inbred in all the assumptions, the results showed that the gene diversity and the mean inbreeding coefficient would fluctuate largely from ∼65% to ∼82% and from ∼0.07 to ∼0.29, respectively. Moreover, the genetic importance of individuals based on mean kinship shifted largely. This study suggested that the Japanese captive population had low gene diversity and high mean inbreeding coefficient even under the assumption that the 5 founders were unrelated and non-inbred. In addition, the study also suggested that it became more effective to analyze the genetic status and to introduce mean kinship strategy into this population with more credible molecular evaluation of the relationships among founders.