著者

Hirofumi Tsuru Hidekazu Ishida Jun Narita Ryo Ishii Hidehiro Suginobe Yoichiro Ishii Renjie Wang Shigetoyo Kogaki Masaki Taira Takayoshi Ueno Yohei Miyashita Hidetaka Kioka Yoshihiro Asano Yoshiki Sawa Keiichi Ozono

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.85, no.5, pp.677-686, 2021-04-23 (Released:2021-04-23)

参考文献数

38

被引用文献数

8

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Background:Restrictive cardiomyopathy (RCM) is characterized by impaired ventricular relaxation. Although several mutations were reported in some patients, no mutations were identified in cardiomyocyte expressing genes of other patients, indicating that pathological mechanisms underlying RCM could not be determined by cardiomyocytes only. Cardiac fibroblasts (CFs) are a major cell population in the heart; however, the pathological roles of CFs in cardiomyopathy are not fully understood.Methods and Results:This study established 4 primary culture lines of CFs from RCM patients and analyzed their cellular physiology, the effects on the contraction and relaxation ability of healthy cardiomyocytes under co-culture with CFs, and RNA sequencing. Three of four patients hadTNNI3mutations. There were no significant alterations in cell proliferation, apoptosis, migration, activation, and attachment. However, when CFs from RCM patients were co-cultured with healthy cardiomyocytes, the relaxation velocity of cardiomyocytes was significantly impaired both under direct and indirect co-culture conditions. RNA sequencing revealed that gene expression profiles of CFs in RCM were clearly distinct from healthy CFs. The differential expression gene analysis identified that several extracellular matrix components and cytokine expressions were dysregulated in CFs from RCM patients.Conclusions:The comprehensive gene expression patterns were altered in RCM-derived CFs, which deteriorated the relaxation ability of cardiomyocytes. The specific changes in extracellular matrix composition and cytokine secretion from CFs might affect pathological behavior of cardiomyocytes in RCM.

著者

Kenichi Watanabe Hiroshi Suzuki Meizi Jiang Shinya Tsukano Satoshi Kataoka Sueshi Ito Takatsugu Sakai Toru Hirokawa Hisanori Haniu Fujito Numano Satoshi Hoshina Satoshi Hasegawa Masamichi Matsunaga Kousei Chiba Naka Saito Hiroshi Yoshida Satoru Takami Soichiro Okubo Harunobu Hirano Akihiko Saitoh Hideaki Bujo

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-1271, (Released:2021-09-16)

参考文献数

23

被引用文献数

1

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Background:Intimal smooth muscle cells (SMCs) play an important role in the vasculitis caused by Kawasaki disease (KD). Lipoprotein receptor 11 (LR11) is a member of the low-density lipoprotein receptor family, which is expressed markedly in intimal vascular SMCs and secreted in a soluble form (sLR11). sLR11 has been recently identified as a potential vascular lesion biomarker. sLR11 is reportedly elevated in patients with coronary artery lesions long after KD, but there is no description of sLR11 in acute KD. Our aim was to determine the sLR11 dynamics in acute KD and to assess its usefulness as a biomarker.Methods and Results:106 acute KD patients and 18 age-matched afebrile controls were enrolled. KD patients were classified into the following subgroups: intravenous immunoglobulin (IVIG) responders (n=85) and non-responders (n=21). Serum sLR11 levels before IVIG therapy were higher in non-responders (median, 19.6 ng/mL; interquartile range [IQR], 13.0–24.9 ng/mL) than in controls (11.9 ng/mL, 10.4–14.9 ng/mL, P<0.01) or responders (14.3 ng/mL, 11.7–16.5 ng/mL, P<0.01). Using a cutoff of >17.5 ng/mL, non-responders to initial IVIG therapy were identified with 66.7% sensitivity and 78.8% specificity.Conclusions:sLR11 can reflect the state of acute KD and might be a biomarker for patient response to IVIG therapy.

著者

Stefania Angela Di Fusco Antonella Spinelli Lorenzo Castello Gaetano Marino Ilaria Maraschi Michele Massimo Gulizia Domenico Gabrielli Furio Colivicchi

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-21-0459, (Released:2021-09-17)

参考文献数

82

被引用文献数

3

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Growing evidence has shown a bidirectional link between the cardiologic and oncologic fields. Several investigations support the role of unhealthy behaviors as pathogenic factors of both cardiovascular disease and cancer. We report epidemiological and research findings on the pathophysiological mechanisms linking unhealthy lifestyle to cardiovascular disease and cancer. For each unhealthy behavior, we also discuss the role of preventive measures able to affect both cardiovascular disease and cancer occurrence and progression.

著者

Tomoya Hasegawa Yoshikazu Yazaki

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.86, no.4, pp.723, 2022-03-25 (Released:2022-03-25)

参考文献数

3

被引用文献数

2

著者

Tomoko Takahashi Yasuhiro Yokoyama Hiroki Arase Kozue Ogasawara Takashi Yamamoto Akiyoshi Kakutani

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-21-0919, (Released:2021-12-25)

参考文献数

1

被引用文献数

1

著者

Masato Nakamura Hitoshi Yaku Junya Ako Hirokuni Arai Tohru Asai Taishiro Chikamori Hiroyuki Daida Kiyoshi Doi Toshihiro Fukui Toshiaki Ito Kazushige Kadota Junjiro Kobayashi Tatsuhiko Komiya Ken Kozuma Yoshihisa Nakagawa Koichi Nakao Hiroshi Niinami Takayuki Ohno Yukio Ozaki Masataka Sata Shuichiro Takanashi Hirofumi Takemura Takafumi Ueno Satoshi Yasuda Hitoshi Yokoyama Tomoyuki Fujita Tokuo Kasai Shun Kohsaka Takashi Kubo Susumu Manabe Naoya Matsumoto Shigeru Miyagawa Tomohiro Mizuno Noboru Motomura Satoshi Numata Hiroyuki Nakajima Hirotaka Oda Hiromasa Otake Fumiyuki Otsuka Ken-ichiro Sasaki Kazunori Shimada Tomoki Shimokawa Toshiro Shinke Tomoaki Suzuki Masao Takahashi Nobuhiro Tanaka Hiroshi Tsuneyoshi Taiki Tojo Dai Une Satoru Wakasa Koji Yamaguchi Takashi Akasaka Atsushi Hirayama Kazuo Kimura Takeshi Kimura Yoshiro Matsui Shunichi Miyazaki Yoshitaka Okamura Minoru Ono Hiroki Shiomi Kazuo Tanemoto on behalf of the Japanese Circulation Society Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-1282, (Released:2022-01-31)

参考文献数

1179

被引用文献数

38

著者

Akihiko Nogami Takashi Kurita Kengo Kusano Masahiko Goya Morio Shoda Hiroshi Tada Shigeto Naito Teiichi Yamane Masaomi Kimura Tsuyoshi Shiga Kyoko Soejima Takashi Noda Hiro Yamasaki Yoshifusa Aizawa Tohru Ohe Takeshi Kimura Shun Kohsaka Hideo Mitamura on behalf of the Japanese Circulation Society / the Japanese Heart Rhythm Society Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-21-0162, (Released:2022-01-06)

参考文献数

183

被引用文献数

20

著者

Atsushi Sugiyama Sue Duval Yuji Nakamura Katsunori Yoshihara Demetris Yannopoulos

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.80, no.10, pp.2124-2132, 2016-09-23 (Released:2016-09-23)

参考文献数

42

被引用文献数

7 22

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Background:The quality of cardiopulmonary resuscitation (CPR) has been recently shown to affect clinical outcome. The Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis (PRIMED) trial showed no differences in outcomes with an active vs. sham impedance threshold device (ITD), a CPR adjunct that enhances circulation. It was hypothesized the active ITD would improve survival with favorable neurological outcomes in witnessed out-of-hospital cardiac arrest patients when used with high-quality CPR.Methods and Results:Using the publicly accessible ROC PRIMED database, a post-hoc analysis was performed on all witnessed subjects with both compression rate and depth data (n=1,808) who received CPR within the study protocol definition of adequate CPR quality (compression rate 80–120/min and depth 4–6 cm; n=929). Demographics were similar between sham and active ITD groups. In witnessed subjects who received quality CPR, survival with favorable neurological function was 11.9% for the active ITD subjects (56/470) vs. 7.4% for the sham (34/459) (odds ratio 1.69 [95% confidence interval 1.08, 2.64]). There were no statistically significant differences for this primary outcome when CPR was performed outside the boundaries of the definition of adequate CPR quality. Multivariable models did not change these associations.Conclusions:An active ITD combined with adequate-quality conventional CPR has the potential to significantly improve survival after witnessed cardiac arrest. (Circ J 2016; 80: 2124–2132)

著者

Yumiko Imai Keiji Kuba Takayo Ohto-Nakanishi Josef M. Penninger

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.74, no.3, pp.405-410, 2010 (Released:2010-02-25)

参考文献数

66

被引用文献数

29 145

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Angiotensin-converting enzyme 2 (ACE2), a first homolog of ACE, regulates the renin-angiotensin system by counterbalancing ACE activity. Accumulating evidence in recent years has demonstrated a physiological and pathological role of ACE2 in the cardiovascular, renal and respiratory systems. For instance, in the acute respiratory distress syndrome (ARDS), ACE, AngII, and AT1R promote the disease pathogenesis, whereas ACE2 and the AT2R protect from ARDS. Importantly, ACE2 has been identified as a key SARS-coronavirus receptor and plays a protective role in SARS pathogenesis. Furthermore, the recent explosion of research into the ACE2 homolog, collectrin, has revealed a new physiological function of ACE2 as an amino acid transporter, which explains the pathogenic role of gene mutations in Hartnup disorder. This review summarizes and discusses the recently unveiled roles for ACE2 in disease pathogenesis. (Circ J 2010; 74: 405 - 410)

著者

Yasuo Suehiro Ayaka Satoh Hisashi Uemura Takaya Nakagawa Hajime Matsue Hisashi Satoh

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0830, (Released:2023-11-29)

参考文献数

1

著者

Ko Yamamoto Hiroki Shiomi Takeshi Morimoto Hiroki Watanabe Akiyoshi Miyazawa Kyohei Yamaji Masanobu Ohya Sunao Nakamura Satoru Mitomo Satoru Suwa Takenori Domei Shojiro Tatsushima Koh Ono Hiroki Sakamoto Kiyotaka Shimamura Masataka Shigetoshi Ryoji Taniguchi Yuji Nishimoto Hideki Okayama Kensho Matsuda Kenji Nakatsuma Yohei Takayama Jun Kuribara Hidekuni Kirigaya Kohei Yoneda Yuta Imai Umihiko Kaneko Hiroshi Ueda Kota Komiyama Naotaka Okamoto Satoru Sasaki Kengo Tanabe Mitsuru Abe Kiyoshi Hibi Kazushige Kadota Kenji Ando Takeshi Kimura on behalf of the OPTIVUS-Complex PCI Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0837, (Released:2023-03-11)

参考文献数

11

被引用文献数

5

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Background: There is a paucity of data on the effect of optimal intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with standard PCI or coronary artery bypass grafting (CABG) in patients with multivessel disease.Methods and Results: The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1,021 patients undergoing multivessel PCI including the left anterior descending coronary artery using IVUS aiming to meet the prespecified criteria for optimal stent expansion. We conducted propensity score matching analyses between the OPTIVUS group and historical PCI or CABG control groups from the CREDO-Kyoto registry cohort-3 (1,565 and 899 patients) fulfilling the inclusion criteria for this study. The primary endpoint was a composite of death, myocardial infarction, stroke, or any coronary revascularization. In the propensity score-matched cohort (OPTIVUS vs. historical PCI control: 926 patients in each group; OPTIVUS vs. historical CABG control: 436 patients in each group), the cumulative 1-year incidence of the primary endpoint was significantly lower in the OPTIVUS group than in the historical PCI control group (10.4% vs. 23.3%; log-rank P<0.001) or the historical CABG control group (11.8% vs. 16.5%; log-rank P=0.02).Conclusions: IVUS-guided PCI targeting the OPTIVUS criteria combined with contemporary clinical practice was associated with superior clinical outcomes at 1 year compared with not only the historical PCI control, but also the historical CABG control.

著者

Hiroki Uehara Masaki Okuyama Yutaro Oe Takaki Yoshimura Takahiro Gunji

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0436, (Released:2023-08-30)

参考文献数

1

著者

Ayumu Fujioka Kenji Yanishi Arito Yukawa Kojiro Imai Isao Yokota Kei Fujikawa Ayumu Yamada Akari Naito Keisuke Shoji Hirofumi Kawamata Yukihito Higashi Tomoaki Ishigami Ken-ichiro Sasaki Syuhei Tara Koichiro Kuwahara Satoshi Teramukai Satoaki Matoba

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0046, (Released:2023-03-10)

参考文献数

24

被引用文献数

3

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Background: Thromboangiitis obliterans (TAO) can lead to the development of critical limb-threatening ischemia (CLTI). Despite conventional treatments, such as smoking cessation or revascularization, young patients (<50 years) still require limb amputation. Therapeutic angiogenesis using bone marrow-derived mononuclear cell (BM-MNC) implantation has been tested and shown to have reasonable efficacy in CLTI. In this multicenter prospective clinical trial, we evaluated the safety and efficacy of BM-MNC implantation in CLTI patients with TAO.Methods and Results: We enrolled 22 CLTI patients with skin perfusion pressure (SPP) <30 mmHg. The primary endpoint of this trial is the recovery of SPP in the treated limb after a 180-day follow-up period. Secondary endpoints include the pain scale score and transcutaneous oxygen pressure (TcPO2). One patient dropped out during follow-up, leaving 21 patients (mean age 48 years, 90.5% male, Fontaine Class IV) for analysis. BM-MNC implantation caused no serious adverse events and increased SPP by 1.5-fold compared with baseline. Surprisingly, this effect was sustained over the longer term at 180 days. Secondary endpoints also supported the efficacy of this novel therapy in relieving pain and increasing TcPO2. Major amputation-free and overall survival probabilities at 3 years among all enrolled patients were high (95.5% and 89.5%, respectively).Conclusions: BM-MNC implantation showed safety and significant efficacy in CLTI patients with TAO.

著者

Kenta Tanaka Yusuke Katayama Tetsuhisa Kitamura Hisaya Dohmi Jun Masui Tomoya Hirose Shunichiro Nakao Jotaro Tachino Ling Zha Tomotaka Sobue Jun Oda Tetsuya Matsuoka

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0298, (Released:2023-08-01)

参考文献数

11

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Background: Little is known about the transport and outcomes of emergency patients with cardiocerebrovascular diseases in Japan before and during the COVID-19 pandemic.Methods and Results: Data were extracted from a population-based registry in Osaka, Japan, from 2019 to 2021. There were almost no differences in the numbers of emergency patients hospitalized with myocardial infarction, stroke, or heart failure or their deaths. However, the number of cases of difficulty obtaining patient acceptance by hospitals increased in 2020 and 2021 compared with 2019.Conclusions: The numbers of emergency patients hospitalized with cardiocerebrovascular diseases and their deaths in Osaka were not affected by the COVID-19 epidemic.

著者

Yen-Ting Yeh Jung-Chung Hsu Pen-Chih Liao Ai-Hsien Li Yuan-Hung Liu Kuo-Chin Chen Wenpo Chuang Shin-Rong Ke Yu-Wei Chiu Yen-Wen Wu

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.85, no.2, pp.166-174, 2021-01-25 (Released:2021-01-25)

参考文献数

21

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Background:Studies investigating the modulators of mortality benefit conferred by peri-angioplasty glycoprotein IIb/IIIa inhibitors in ST-elevation myocardial infarction (STEMI) are still lacking.Methods and Results:A prospective database (n=1,025) of consecutive cases undergoing primary percutaneous coronary intervention for STEMI was retrospectively analyzed. For patients in Killip class I, II or III, IV, the multivariate-adjusted hazard ratios of 30-day all-cause mortality associated with adjunctive tirofiban were 3.873 (95% CI 0.504–29.745; P=0.193), 0.550 (95% CI 0.188–1.609; P=0.275), and 0.264 (95% CI 0.099–0.704; P=0.008), respectively. The P value for a linear trend was 0.032. Patients who had a body mass index (BMI) within 22.9–25.0 kg/m2had a significant benefit from tirofiban (adjusted HR 0.344; 95% CI 0.145–0.814; P=0.015) compared to other BMI groups. The P value for a quadratic trend was 0.012. A novel Killip−BMI score (KBS = 2.5 × Killip category − | BMI − 24 |) was calculated to select the beneficial population. A KBS ≥2 was associated with significant mortality benefit, whereas a KBS <0 predicted increased 30-day mortality with tirofiban use.Conclusions:Survival benefit from peri-angioplasty tirofiban therapy for STEMI was positively correlated with the Killip class. Tirofiban should be used cautiously in either underweight or overweight patients. The novel KBS used in this study can guide peri-angioplasty use of adjunctive tirofiban in patients with STEMI undergoing primary angioplasty.

著者

Yasuyuki Hayashi Taku Iwami Tetsuhisa Kitamura Tatsuya Nishiuchi Kentaro Kajino Tomohiko Sakai Chika Nishiyama Masahiko Nitta Atsushi Hiraide Tatsuro Kai

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.76, no.7, pp.1639-1645, 2012 (Released:2012-06-25)

参考文献数

35

被引用文献数

51 89

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Background: The effectiveness of epinephrine administration for cardiac arrests has been shown in animal models, but the clinical effect is still controversial. Methods and Results: A prospective, population-based, observational study in Osaka involved consecutive out-of-hospital cardiac arrest (OHCA) patients from January 2007 through December 2009. We evaluated the outcomes among adult non-traumatic bystander-witnessed OHCA patients for whom the local protocol directed the emergency medical service personnel to administer epinephrine. After stratifying by first documented cardiac rhythm, outcomes were compared among the following groups: non-administration, ≤10, 11-20 and ≥21min as the time from emergency call to epinephrine administration. A total of 3,161 patients were eligible for our analyses, among whom 1,013 (32.0%) actually received epinephrine. The epinephrine group had a significantly lower rate of neurologically intact 1-month survival than the non-epinephrine group (4.1% vs. 6.1%, P=0.028). In cases of ventricular fibrillation (VF) arrest, patients in the early epinephrine group who received epinephrine administration within 10min had a significantly higher rate of neurologically intact 1-month survival compared with the non-epinephrine group (66.7% vs. 24.9%), though other epinephrine groups did not. In cases of non-VF arrest, the rate of neurologically intact 1-month survival was low, irrespective of epinephrine administration. Conclusions: The effectiveness of epinephrine after OHCA depends on the time of administration. When epinephrine is administered in the early phase, there is an improvement in neurological outcome from OHCA with VF.  (Circ J 2012; 76: 1639–1645)

著者

Kazumasa Orihashi

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0957, (Released:2020-03-19)

参考文献数

15

被引用文献数

6

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Background:To take full advantage of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation (CPR), we propose a flowchart derived from representative cases.Methods and Results:TEE was used in patients requiring CPR to obtain information potentially helpful for rescue. TEE navigated the CPR procedures (navigation TEE), identified the possible cause of arrest (focus TEE), and optimized treatment while checking for pitfalls (secure TEE). In addition, TEE corrected prehospital misdiagnoses and detected new complications caused by CPR.Conclusions:TEE provides valuable information without interrupting CPR procedures. It is hoped that our flowchart may facilitate goal-directed, efficient assessment.

著者

Takashi Kuragaichi Yuma Kurozumi Shogo Ohishi Yasuo Sugano Akihiro Sakashita Norihiko Kotooka Makoto Suzuki Taiki Higo Dai Yumino Yasuko Takada Seiko Maeda Saori Yamabe Koichi Washida Tomonori Takahashi Tomohito Ohtani Yasushi Sakata Yukihito Sato

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.82, no.5, pp.1336-1343, 2018-04-25 (Released:2018-04-25)

参考文献数

45

被引用文献数

16 26

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Background:Palliative care for heart failure (HF) patients is recommended in Western guidelines, so this study aimed to clarify the current status of palliative care for HF patients in Japan.Methods and Results:A survey was sent to all Japanese Circulation Society-authorized cardiology training hospitals (n=1,004) in August 2016. A total of 544 institutions (54%) returned the questionnaire. Of them, 527 (98%) answered that palliative care is necessary for patients with HF. A total of 227 (42%) institutions held a palliative care conference for patients with HF, and 79% of the institutions had <10 cases per year. Drug therapy as palliative care was administered at 403 (76%) institutions; morphine (87%) was most frequently used. Among sedatives, dexmedetomidine (33%) was administered more often than midazolam (29%) or propofol (20%). Regarding the timing of end-of-life care, most institutions (84%) reported having considered palliative care when a patient reached the terminal stage of HF. Most frequently, the reason for the decision at the terminal stage was “difficulty in discontinuing cardiotonics.” A major impediment to the delivery of palliative care was “difficulty predicting an accurate prognosis.”Conclusions:This large-scale survey showed the characteristics of palliative care for HF in Japan. The present findings may aid in the development of effective end-of-life care systems.

著者

Masahiro Kamouchi

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0284, (Released:2022-05-28)

参考文献数

13

著者

Satoshi Kodera Hiroyuki Morita Hiroshi Nishi Norifumi Takeda 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-22-0086, (Released:2022-09-06)

参考文献数

43

被引用文献数

2

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Background: The cost-effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors for chronic kidney disease (CKD) has not been evaluated in Japan, so we analyzed the cost-effectiveness of dapagliflozin, an SGLT2 inhibitor, for CKD stages 3a and 3b.Methods and Results: We used the Markov model for CKD to assess the costs and benefits associated with and without dapagliflozin from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as per quality-adjusted life-years (QALYs). An ICER <5 million Japanese yen (JPY)/QALY was judged to be cost-effective. The effect of dapagliflozin on renal and cardiovascular events was based on published clinical trials. In patients with CKD stage 3a, the ICER of dapagliflozin over standard treatment was 4.03 million JPY/QALY gained. With a cost-effectiveness threshold of 5 million JPY/QALY gained, the cost-effectiveness probability of dapagliflozin over standard treatment was 52.6%. In patients with CKD stage 3b, the ICER of dapagliflozin over standard treatment was 0.12 million JPY/QALY gained. The cost-effectiveness probability of dapagliflozin over standard treatment was 75.2%.Conclusions: The results seemed to show acceptable cost-effectiveness when dapagliflozin was used for CKD stage 3b. On the other hand, cost-effectiveness of dapagliflozin for CKD stage 3a was ambiguous, and further validation is needed.