著者

Eitaro Kodani Hirotsugu Atarashi Hiroshi Inoue Ken Okumura Takeshi Yamashita Hideki Origasa on behalf of the J-RHYTHM Registry 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-16-0066, (Released:2016-03-18)

参考文献数

35

被引用文献数

2 39

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Background:The J-RHYTHM Registry 2 was a multicenter, prospective observational study that extended the follow-up period of the J-RHYTHM Registry in order to investigate long-term outcomes and effects of non-vitamin K antagonist oral anticoagulants (NOACs) in Japanese patients with atrial fibrillation (AF).Methods and Results:Among 6,616 patients with nonvalvular AF (NVAF) (men 71.0%, 69.7±9.9 years, CHADS2score 1.7±1.2), event rates were compared among patients receiving warfarin (n=3,964), NOACs (n=923), and no anticoagulation therapy (No-OAC, n=753) at the end of follow-up, except for 976 patients lacking anticoagulant data. During the 5-year follow-up period, thromboembolism occurred in 196 (4.9%), 19 (2.1%), and 45 (6.0%) patients, respectively; major hemorrhage in 233 (5.9%), 22 (2.4%), and 36 (4.8%); all-cause death in 230 (5.8%), 13 (1.4%), and 105 (13.9%), (P<0.001 for each). After adjusting for the components of the CHA2DS2-VASc score and antiplatelet drug use, the odds ratio (OR) in the Warfarin group was significantly lower for all-cause death compared with that in the No-OAC group (OR 0.30, 95% confidence interval [CI] 0.23–0.39, P<0.001), whereas ORs in the NOACs group were significantly lower for all events (OR 0.42, 95% CI 0.24–0.74, P=0.003 for thromboembolism; OR 0.53, 95% CI 0.31–0.93, P=0.027 for major hemorrhage; and OR 0.10, 95% CI 0.06–0.18, P<0.001 for all-cause death, respectively).Conclusions:NOACs could be beneficial for reducing event rates of all types in Japanese NVAF patients.

著者

Chuwa Tei Teruhiko Imamura Koichiro Kinugawa Teruo Inoue Tohru Masuyama Hiroshi Inoue Hirofumi Noike Toshihiro Muramatsu Yasuchika Takeishi Keijiro Saku Kazumasa Harada Hiroyuki Daida Youichi Kobayashi Nobuhisa Hagiwara Masatoshi Nagayama Shinichi Momomura Kazuya Yonezawa Hiroshi Ito Satoshi Gojo Makoto Akaishi Masaaki Miyata Mitsuru Ohishi WAON-CHF 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-16-0051, (Released:2016-03-18)

参考文献数

32

被引用文献数

42

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Background:Waon therapy improves heart failure (HF) symptoms, but further evidence in patients with advanced HF remains uncertain.Methods and Results:In 19 institutes, we prospectively enrolled hospitalized patients with advanced HF, who had plasma levels of B-type natriuretic peptide (BNP) >500 pg/ml on admission and BNP >300 pg/ml regardless of more than 1 week of medical therapy. Enrolled patients were randomized into Waon therapy or control groups. Waon therapy was performed once daily for 10 days with a far infrared-ray dry sauna maintained at 60℃ for 15 min, followed by bed rest for 30 min covered with a blanket. The primary endpoint was the ratio of BNP before and after treatment. In total, 76 Waon therapy and 73 control patients (mean age 66 years, men 61%, mean plasma BNP 777 pg/ml) were studied. The groups differed only in body mass index and the frequency of diabetes. The plasma BNP, NYHA classification, 6-min walk distance (6MWD), and cardiothoracic ratio significantly improved only in the Waon therapy group. Improvements in NYHA classification, 6MWD, and cardiothoracic ratio were significant in the Waon therapy group, although the change in plasma BNP did not reach statistical significance. No serious adverse events were observed in either group.Conclusions:Waon therapy, a holistic soothing warmth therapy, showed clinical advantages in safety and efficacy among patients with advanced HF.

著者

Hayato Tada Masa-aki Kawashiri Taiji Yoshida Ryota Teramoto Atsushi Nohara Tetsuo Konno Akihiro Inazu Hiroshi Mabuchi Masakazu Yamagishi Kenshi Hayashi

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-15-0999, (Released:2015-12-02)

参考文献数

39

被引用文献数

7 62

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Background:It has been shown that serum lipoprotein(a) [Lp(a)] is elevated in familial hypercholesterolemia (FH) with mutation(s) of the LDL receptor (LDLR) gene. However, few data exist regarding Lp(a) levels in FH with gain-of-function mutations of the PCSK9 gene.Methods and Results:We evaluated 42 mutation-determined heterozygous FH patients with aPCSK9gain-of-function mutation (FH-PCSK9, mean age 52, mean LDL-C 235 mg/dl), 198 mutation-determined heterozygous FH patients with aLDLRmutation (FH-LDLR, mean age 44, mean LDL-C 217 mg/dl), and 4,015 controls (CONTROL, mean age 56, mean LDL-C 109 mg/dl). We assessed their Lp(a), total cholesterol, triglycerides, HDL-C, LDL-C, use of statins, presence of hypertension, diabetes, chronic kidney disease, smoking, body mass index (BMI) and coronary artery disease (CAD). Multiple regression analysis showed that HDL-C, use of statins, presence of hypertension, smoking, BMI, and Lp(a) were independently associated with the presence of CAD. Under these conditions, the serum levels of Lp(a) in patients with FH were significantly higher than those of the CONTROL group regardless of their causative genes, among the groups propensity score-matched (median Lp(a) 12.6 mg/dl [IQR:9.4–33.9], 21.1 mg/dl [IQR:11.7–34.9], and 5.0 mg/dl [IQR:2.7–8.1] in the FH-LDLR, FH-PCSK9, and CONTROL groups, respectively, P=0.002 for FH-LDLR vs. CONTROL, P=0.002 for FH-PCSK9 vs. CONTROL).Conclusions:These data demonstrate that serum Lp(a) is elevated in patients with FH caused by PCSK9 gain-of-function mutations to the same level as that in FH caused by LDLR mutations.

著者

Satoyo Ikehara Hiroyasu Iso Yasuhiko Wada Naohito Tanabe Yoshiyuki Watanabe Shogo Kikuchi Akiko Tamakoshi JACC Study Group

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-14-1335, (Released:2015-09-07)

参考文献数

31

被引用文献数

1 16

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Background:No study has examined the association between television (TV) viewing time and mortality from stroke and coronary artery disease (CAD) in Japanese.Methods and Results:A total of 35,959 men and 49,940 women aged 40–79 years without a history of cardiovascular disease (CVD) and cancer were followed from 1988–1990 until 2009. During 19.2 median years of follow-up, there were 2,553 deaths from stroke, 1,206 from CAD and 5,835 from total CVD. Compared with viewing TV for <2 h/day, mortality from stroke, CAD and total CVD were higher for ≥6 h/day of TV viewing. The multivariable hazard ratios (HRs) for ≥6 h/day of TV viewing were 1.15 (95% confidence interval: 0.96–1.37) for stroke, 1.33 (1.03–1.72) for CAD and 1.19 (1.06–1.34) for total CVD. The corresponding HRs for each 1-h/day increment in TV viewing time were 1.01 (0.99–1.04), 1.04 (1.01–1.08) and 1.02 (1.01–1.04), respectively. The excess risk of mortality from CAD and total CVD was somewhat attenuated after further adjustment for potential mediators such as history of hypertension and diabetes: the multivariable HRs for ≥6 h/day of TV viewing were 1.24 (0.96–1.61) and 1.14 (1.02–1.28). The corresponding HRs for each 1-h/day increment in TV viewing time were 1.03 (1.00–1.07) and 1.01 (1.00–1.03).Conclusions:Prolonged TV viewing was associated with a small but significant increase in mortality from CAD and total CVD in Japanese.

著者

Eitaro Kodani Hirotsugu Atarashi Hiroshi Inoue Ken Okumura Takeshi Yamashita Hideki Origasa on behalf of the J-RHYTHM Registry 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-15-0621, (Released:2015-09-01)

参考文献数

30

被引用文献数

11 32

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Background:To clarify the effects of warfarin therapy in very old patients with non-valvular atrial fibrillation (NVAF), a post-hoc analysis was performed using the data of the J-RHYTHM Registry.Methods and Results:A consecutive series of AF outpatients was enrolled from 158 institutions. Of 7,937 patients, 7,406 with NVAF (men, 70.8%; 69.8±10.0 years) were followed for 2 years or until an event occurred. Patients were divided into 3 age groups (<70, 70–84, and ≥85 years) and 5 subgroups according to international normalized ratio (INR; <1.6, 1.6–1.99, 2.0–2.59, 2.6–2.99, and ≥3.0). Prevalence of female sex, permanent AF, hypertension, coronary artery disease, heart failure, and history of ischemic stroke/transient ischemic attack was higher in the older groups. In the oldest group, 79.7% of patients received warfarin and their time in therapeutic range, using the Japanese target INR of 1.6–2.6, was 67.1%. Rate of thromboembolic events was lower in the age groups <70 and 70–84 years (P=0.027 and P<0.001, respectively) for patients receiving warfarin compared with those who were not. In the oldest group, the rate of thromboembolism plus major hemorrhage was lower at INR 1.6–2.59.Conclusions:Warfarin could have beneficial effects even in very old NVAF patients if INR is kept between 1.6 and 2.59.

著者

Hirofumi Tomita Ken Okumura Hiroshi Inoue Hirotsugu Atarashi Takeshi Yamashita Hideki Origasa Eiki Tsushima on behalf of the J-RHYTHM Registry 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-15-0095, (Released:2015-05-13)

参考文献数

35

被引用文献数

9 42

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Background:Because the current Japanese guideline recommends CHADS2score-based risk stratification in nonvalvular atrial fibrillation (NVAF) patients and does not list female sex as a risk for thromboembolic events, we designed the present study to compare the CHA2DS2-VASc and CHA2DS2-VA scores in the J-RHYTHM Registry.Methods and Results:We prospectively assessed the incidence of thromboembolic events for 2 years in 997 NVAF patients without warfarin treatment (age 68±12 years, 294 females). The predictive value of the CHA2DS2-VASc and CHA2DS2-VA scores for thromboembolic events was evaluated by c-statistic difference and net reclassification improvement (NRI). Thromboembolic events occurred in 7/294 females (1.2%/year) and 23/703 males (1.6%/year) (odds ratio 0.72 for female to male, 95% confidence interval (CI) 0.28–1.62, P=0.44). No sex difference was found in patient groups stratified by CHA2DS2-VASc and CHA2DS2-VA scores. There were significant c-statistic difference (0.029, Z=2.3, P=0.02) and NRI (0.11, 95% CI 0.01–0.20, P=0.02), with the CHA2DS2-VA score being superior to the CHA2DS2-VASc score. In patients with CHA2DS2-VASc scores 0 and 1 (n=374), there were markedly significant c-statistic difference (0.053, Z=6.6, P<0.0001) and NRI (0.11, 95% CI 0.07–0.14, P<0.0001), again supporting superiority of CHA2DS2-VA to CHA2DS2-VASc score.Conclusions:In Japanese NVAF patients, the CHA2DS2-VA score, a risk scoring system excluding female sex from CHA2DS2-VASc, may be more useful in risk stratification for thromboembolic events than CHA2DS2-VASc score, especially in identifying truly low-risk patients.

著者

Hiroshi Yamagami Kazunori Toyoda

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-15-0212, (Released:2015-03-09)

参考文献数

14

被引用文献数

3

著者

Tuomas Kiviniemi Marja Puurunen Axel Schlitt Andrea Rubboli Pasi Karjalainen Wail Nammas Paulus Kirchhof Fausto Biancari Gregory YH Lip KE Juhani Airaksinen

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-14-0792, (Released:2014-10-09)

参考文献数

31

被引用文献数

9 21

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Background:We explored 12-month clinical outcomes of 929 patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with bare-metal stents (BMS) vs. drug-eluting stents (DES) from the prospective multicenter AFCAS (Atrial Fibrillation undergoing Coronary Artery Stenting) registry.Methods and Results:Endpoints included the first occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of all-cause death, myocardial infarction (MI), target vessel revascularization, definite/probable stent thrombosis (ST), transient ischemic attack or stroke. Bleeding events were defined according to the Bleeding Academic Research Consortium criteria. Altogether, 673 (72.4%) patients received BMS and 220 (23.7%) at least one DES. Patients treated with DES more often had diabetes and prior ischemic events, and a longer stent length (P<0.05 for all), whereas patients treated with BMS more often had heart failure and were more likely to present with acute ST-elevation MI (P<0.05 for both). At 12-month follow-up, rates and risks of MACCE and total bleeding events were comparable between the groups (22.0% with BMS vs. 19.5% with DES, P=0.51, hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.63–1.25 for DES) and (19.5% vs. 15.0%, respectively, P=0.16, HR 0.75, 95% CI 0.51–1.09 for DES). Definite/probable ST was more frequent in the BMS group (1.9% vs. 0%, respectively, P=0.046).Conclusions:In real-world patients with AF undergoing PCI, DES use was associated with outcomes comparable to those with BMS without excess bleeding complications. More ST was seen in BMS-treated patients.

著者

Masateru Takigawa Atsushi Takahashi Taishi Kuwahara Yoshihide Takahashi Kenji Okubo Emiko Nakashima Yuji Watari Jun Nakajima Katsumasa Takagi Kazuya Yamao Tadashi Fujino Tomoyo Sugiyama Shigeki Kimura Hiroyuki Hikita Takashi Irioka Kenzo Hirao Mitsuaki Isobe

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-14-0525, (Released:2014-08-21)

参考文献数

22

被引用文献数

2 6

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Background:The aim of this study was to investigate the incidence and predictors (which have not previously been fully elucidated) of late-phase thromboembolism (TE) after catheter ablation (CA) for paroxysmal atrial fibrillation (AF).Methods and Results:We studied 1,156 consecutive patients (61±10 years; 891 men; CHADS2score, 0.8±1.0) after CA for symptomatic paroxysmal AF and examined the details of late-phase TE. During a follow-up of 49.5±21.9 months (median, 47 months; range, 6–113 months) after CA, 9 patients (0.78%) developed late-phase TE, all of which were ischemic stroke. Of these, 5 patients with AF recurrence experienced cardioembolism; the AF was asymptomatic at recurrence. The remaining 4 without AF recurrence experienced cardioembolism (n=1), small-vessel occlusion (n=1), large-artery atherosclerosis (n=1), and stroke of other determined etiology (n=1). On Kaplan-Meier analysis patients with structural heart disease (P=0.003), AF recurrence after the final CA (P=0.01), prior stroke (P=0.002), CHADS2score ≥2 (P=0.0002), left ventricular ejection fraction <50% (P<0.0001), and spontaneous echo contrast on transesophageal echocardiogram (P=0.0004) had a significantly higher risk of late-phase TE. Multivariate analysis indicated that CHADS2score ≥2 (HR, 4.49; 95% CI: 1.08–22.56; P=0.04) independently predicted late-phase TE.Conclusions:The incidence of TE was low after CA for paroxysmal AF, but CHADS2score ≥2 independently increased the risk of late-phase TE.

著者

NIPPON DATA80 Research Group

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.70, no.10, pp.1249-1255, 2006 (Released:2006-09-25)

参考文献数

35

被引用文献数

112 193

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Background Based on the NIPPON DATA80, risk charts for the probability of death from coronary heart disease (CHD), stroke, and all cardiovascular disease (CVD) were constructed by sex and 10-year age groups. Methods and Results The 9,638 participants were followed-up for 19 years from 1980, excluding 28 individuals without the necessary baseline data and 257 participants with past history of stroke or CHD. Final analysis was performed on 9,353 participants (4,098 men, mean age 50.3 years; 5,255 women, mean age 50.8) using a Cox proportional hazards model. Death probabilities over a 10-year period from CHD, stroke, and all CVD were calculated and displayed as color coding on each chart by combining 10-year age, systolic blood pressure, smoking, and serum total cholesterol and glucose levels. Six different colors corresponding to probabilities of death were displayed on each chart. Conclusions The original charts based on the findings from NIPPON DATA80 are suitable for assessing CHD, stroke, and all CVD death risk in the general Japanese population. These charts should be used as a health-education tool for lifestyle modification targeting individuals with CVD risk factors. (Circ J 2006; 70: 1249 - 1255)

著者

Atsushi Hirayama Norio Tanahashi Hiroyuki Daida Naoki Ishiguro Motohiko Chachin Toshihiko Sugioka Shinichi Kawai on behalf of all ACCEPT study investigators in Japan

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.78, no.1, pp.194-205, 2014 (Released:2013-12-25)

参考文献数

35

被引用文献数

4 23

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Background: A prospective, 3-year comparative observational study compared the risk of cardiovascular events in patients with osteoarthritis or rheumatoid arthritis prescribed celecoxib or a nonsteroidal antiinflammatory drug (NSAID). Methods and Results: Patients prescribed celecoxib (n=5,470) or NSAIDs (n=5,059) between November 1, 2007, and July 31, 2008 in 1,084 hospitals and clinics in Japan were eligible for safety analysis. Mean (standard deviation) observation for the celecoxib group was 716 (420) days and 692 (426) days for the NSAID group (P=0.004). Composite I (adjudicated cardiovascular adverse events of myocardial infarction, angina pectoris, heart failure, cerebral infarction, cerebral hemorrhage) number of events (percentage) and rate/1,000 person years was 66 (1.2%) and 6.2 (10,745 person years), respectively, for the celecoxib and 65 (1.3%) and 6.8 (9,601 person years) for the NSAID (P=0.58) groups. Composite II (all cardiovascular events) number of events (percentage) and rate/1,000 person years was 79 (1.4%) and 7.4, respectively, for the celecoxib and 84 (1.7%) and 8.8 for the NSAID (P=0.26) group. Adjusted Cox hazards ratio (95% confidence interval) was 0.89 (0.63–1.27; P=0.52) for Composite I, 0.87 (0.63–1.19; P=0.39) for Composite II and 1.03 (0.75–1.41; P=0.87) for death from all causes. Conclusions: After adjustment for confounding variables, celecoxib was not associated with an increase of cardiovascular risk in comparison with nonselective NSAID in Japanese patients with rheumatoid arthritis or osteoarthritis in an observational setting.  (Circ J 2014; 78: 194–205)

著者

Yoichi Takaya Reon Kumasaka Tetsuo Arakawa Takahiro Ohara Michio Nakanishi Teruo Noguchi Masanobu Yanase Hiroshi Takaki Yuhei Kawano Yoichi Goto

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.78, no.2, pp.377-384, 2014 (Released:2014-01-24)

参考文献数

36

被引用文献数

6 42

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Background: Although there is a general fear that exercise training might deteriorate renal function in chronic kidney disease (CKD) patients, the effect of cardiac rehabilitation (CR) on renal function in acute myocardial infarction (AMI) patients with CKD remains unknown. We sought to determine whether CR is associated with amelioration or deterioration of renal function in such patients. Methods and Results: We enrolled 528 AMI patients who participated in a 3-month CR program. Clinical data before and after CR were compared according to participation in CR and comorbidities. In patients without CKD (estimated glomerular filtration rate [eGFR] ≥60ml·min−1·1.73m−2, n=348), peak oxygen uptake (VO2) and B-type natriuretic peptide (BNP) improved without a change in eGFR. In contrast, in patients with CKD (eGFR <60ml·min−1·1.73m−2, n=180), eGFR improved (48±12 to 53±15ml·min−1·1.73m−2, P<0.001), together with improvements in peak VO2 and BNP. When patients with CKD were divided into non-active (≤1time/week, n=70) and active participants (≥1.1time/week, n=110) according to attendance in CR, active participants showed an improvement in eGFR (50±10 to 53±13ml·min−1·1.73m−2, P<0.001), whereas eGFR did not change in non-active participants. Similar results were obtained in each subgroup of patients with hypertension, dyslipidemia, or diabetes mellitus. Conclusions: In AMI patients with CKD, active participation in CR was associated with improved peak VO2, BNP, and eGFR.  (Circ J 2014; 78: 377–384)

著者

Fumio Terasaki Hiroshi Okamoto Katsuya Onishi Akira Sato Hiroaki Shimomura Bin Tsukada Kyoko Imanaka-Yoshida Michiaki Hiroe Toshimichi Yoshida Yasushi Kitaura Akira Kitabatake Study Group for Intractable Diseases by a Grant from the Ministry of Health Labor and Welfare of Japan

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.71, no.3, pp.327-330, 2007 (Released:2007-02-25)

参考文献数

29

被引用文献数

60 72

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Background Tenascin-C (TN-C), an extracellular matrix glycoprotein, is specifically expressed at high levels during embryonic development, but not in the adult heart. TN-C reappears at sites of inflammatory tissue remodeling or wound healing under various pathologic conditions, such as acute myocardial infarction, acute myocarditis, and some cases of cardiomyopathy. Therefore, the expression of TN-C might be useful for detecting the clinical characteristics of, and ventricular remodeling in, dilated cardiomyopathy (DCM). Methods and Results Circulating serum TN-C levels in 107 patients with DCM were measured using an ELISA kit. Clinical data were also assessed by Pearson's or Spearman's correlation analysis to estimate correlations between variables. Serum TN-C levels in DCM patients were higher than those in normal controls (p<0.001). TNC levels showed a significantly positive correlation with New York Heart Association functional class (p<0.001), B-type natriuretic peptide level (p<0.001), cardiothoracic ratio on chest X-ray (p<0.01), left ventricular end-diastolic diameter (p<0.05) and left ventricular end-systolic diameter (p<0.01), and a significantly negative correlation with left ventricular ejection fraction (p<0.01). Conclusions The findings suggest that increased serum TN-C levels indicate the severity of heart failure, left ventricular dysfunction and remodeling in patients with DCM. (Circ J 2007; 71: 327 - 330)

著者

Atsushi Mizuno Keita Masuda Koichiro Niwa

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.78, no.11, pp.2774-2775, 2014-10-24 (Released:2014-10-24)

参考文献数

10

被引用文献数

4 5

著者

Ryosuke Honda Yasuhisa Nakao Yuya Masuda Kiyotaka Ohshima Shota Koike Tamami Kono Akiyoshi Ogimoto

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0844, (Released:2024-01-06)

参考文献数

1

著者

Takuya Takahashi Hirofumi Saiki Akira Sato Seiko Kuwata Satoshi Nakano Yumi Sato Manami Akasaka Junichi Koizumi Hideaki Senzaki Kotaro Oyama

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0147, (Released:2023-09-28)

参考文献数

21

被引用文献数

1

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Background: Although right ventricular (RV) enlargement may affect RV diastolic dysfunction assessed by end-diastolic forward flow (EDFF) in patients with repaired tetralogy of Fallot (TOF), EDFF may also be modified by left ventricular (LV) hemodynamics. We hypothesized that EDFF is affected by LV hemodynamics, not limited to RV diastolic stiffening.Methods and Results: Among 145 consecutive patients with repaired TOF who underwent catheterization, hemodynamic properties in 47 with consistent EDFF and 75 without EDFF were analyzed. Compared with patients without EDFF, those with EDFF had a large RV volume with a high regurgitant fraction. Although cardiac index and central venous pressure (CVP) were similar, contrast injection augmented CVP and LV end-diastolic pressure (EDP) in patients with vs. those without EDFF, suggesting compromised diastolic reserve. In patients with EDFF, the velocity–time integral (VTI) of EDFF was positively correlated with LVEDP and systemic vascular resistance, in addition to RV EDP. EDFF-VTI was correlated with hepatic venous wedge pressure and markers of hepatic dysfunction. Subanalysis of the older (≥6 years) half of the study cohort revealed that EDFF was associated with bi-atrial enlargement independent of RV volume, highlighting the pronounced role of EDFF on the diastolic property in the aged cohort.Conclusions: EDFF-VTI in patients with repaired TOF reflects RV diastolic dysfunction, affected by the left heart system. EDFF-VTI indicates blood stagnation, which may be attributed to end-organ damage.

著者

Katsura Soma Atsushi Yao

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0822, (Released:2023-12-01)

参考文献数

9

著者

Masami Nishino Yasuyuki Egami Shodai Kawanami Masaru Abe Mizuki Ohsuga Hiroaki Nohara Kohei Ukita Akito Kawamura Koji Yasumoto Masaki Tsuda Naotaka Okamoto Yasuharu Matsunaga-Lee Masamichi Yano

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0470, (Released:2023-10-05)

参考文献数

31

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Background: Acute decompensated heart failure (ADHF) is the main cause of hospitalization and death of octogenarians, but no data on the 1-year post-discharge mortality rate. We evaluated the clinical status and predictors of 1-year mortality in octogenarians with ADHF.Methods and Results: From the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) study, we examined 1,246 hospitalized ADHF patients. We compared the in-hospital mortality rate and the proportion of heart failure (HF) with preserved ejection fraction (HFpEF) between octogenarians and non-octogenarians. After discharge we compared the 1-year mortality rate between these groups, and we also evaluated the predictors of death in both groups. The proportion of HFpEF among the in-hospital deaths of octogenarians was significantly higher than in non-octogenarians (46.2% vs. 15.0%, P=0.031). The 1-year mortality rate after discharge was significantly higher in the octogenarians than non-octogenarians (P=0.014). Multivariable Cox regression analysis revealed that albumin ≤3.0 g/dL and antiplatelet agents were useful predictors of 1-year death after discharge of octogenarians whereas chronic kidney disease was a predictor in the non-octogenarians.Conclusions: The proportion of HFpEF among in-hospital deaths of octogenarians with ADHF was high as compared with non-octogenarians. When octogenarians with ADHF have severe hypoalbuminemia and antiplatelet agents, early nutritional and medical interventions after discharge may be important to improve the 1-year prognosis.

著者

Wataru Fujimoto Manabu Nagao Makoto Nishimori Masakazu Shinohara Makoto Takemoto Koji Kuroda Soichiro Yamashita Junichi Imanishi Masamichi Iwasaki Takafumi Todoroki Masanori Okuda Hidekazu Tanaka Tatsuro Ishida Ryuji Toh Ken-ichi Hirata

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0577, (Released:2023-11-14)

参考文献数

32

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Background: Diabetes increases the risk of heart failure (HF). 3-Hydroxyisobutyric acid (3-HIB) is a muscle-derived metabolite reflecting systemic insulin resistance. In this study, we investigated the prognostic impact of 3-HIB in patients with chronic HF.Methods and Results: The KUNIUMI Registry chronic cohort is a community-based cohort study of chronic HF in Awaji Island, Japan. We analyzed the association between serum 3-HIB concentrations and adverse cardiovascular (CV) events in 784 patients from this cohort. Serum 3-HIB concentrations were significantly higher in patients with than without diabetes (P=0.0229) and were positively correlated with several metabolic parameters. According to Kaplan-Meier analysis, rates of CV death and HF hospitalization at 2 years were significantly higher among HF patients without diabetes in the high 3-HIB group (3-HIB concentrations above the median; i.e., >11.30 μmol/L) than in the low 3-HIB group (log-rank P=0.0151 and P=0.0344, respectively). Multivariable Cox proportional hazard models adjusted for established risk factors for HF revealed high 3-HIB as an independent predictor of CV death (hazard ratio [HR] 1.82; 95% confidence interval [CI] 1.16–2.85; P=0.009) and HF hospitalization (HR 1.72; 95% CI 1.17–2.53, P=0.006) in HF patients without diabetes, whereas no such trend was seen in subjects with diabetes.Conclusions: In a community cohort, circulating 3-HIB concentrations were associated with prognosis in chronic HF patients without diabetes.

著者

Yuichi Sawayama Shunsuke Kubo Masanobu Ohya Sachiyo Ono Hiroyuki Tanaka Takeshi Maruo Yoshihisa Nakagawa Kazushige Kadota

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0529, (Released:2023-10-27)

参考文献数

25

被引用文献数

1

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Background: Evidence is limited regarding long-term clinical outcomes after alcohol septal ablation (ASA) for patients with hypertrophic obstructive cardiomyopathy and its periprocedural predictive factors in Japan.Methods and Results: This retrospective observational study included 44 patients who underwent ASA between 1998 and 2022 in a single center. We evaluated the periprocedural change in variables and long-term clinical outcomes after the procedure. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. The secondary outcome was all-cause death. Using multivariable Poisson regression with robust error variance, we predicted underlying periprocedural factors related to primary outcome development. ASA decreased the median pressure gradient at the left ventricular outflow tract from 88 to 33 mmHg and reduced moderate or severe mitral regurgitation (MR), present in 53% of patients before ASA, to 16%. Over a median 6-year follow-up, the cumulative incidence of the primary outcome at 5 and 10 years was 16.5% and 25.6%, respectively. After multivariable analysis, moderate or severe MR after ASA was significantly associated with the primary outcome (relative risk 8.78; 95% confidence interval 1.34–57.3; P=0.024). All-cause mortality after ASA was 15.1% and 28.9% at 5 and 10 years, respectively.Conclusions: This study presents long-term clinical outcomes after ASA in Japan. Moderate or severe MR after ASA was significantly associated with the composite of cardiovascular death or hospitalization for heart failure.