文献一覧: THE JAPANESE CIRCULATION SOCIETY (出版者)

2 0 0 0 OA Impact of Recurrent Ventricular Tachyarrhythmia on Outcome in Japanese Heart Transplant Candidates With a Left Ventricular Assist Device

著者: Hidetoshi Hattori Atsushi Suzuki Tsuyoshi Shiga Tomohiro Nishinaka Satoshi Saito Kenji Yamazaki Shinichi Nunoda Nobuhisa Hagiwara
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.82, no.9, pp.2305-2310, 2018-08-24 (Released:2018-08-24)
参考文献数: 22
被引用文献数: 1

Background: Recurrent ventricular tachyarrhythmias (VTA) are “A factor” modifiers in the Interagency Registry for Mechanically Assisted Circulatory Support profile. The effect of recurrent VTA on clinical outcome, however, is controversial. We evaluated the impact of recurrent VTA on outcome in Japanese heart transplant candidates with a left ventricular assist device (LVAD). Methods and Results: Sixty-six adult patients with advanced heart failure who were listed for heart transplantation between January 2005 and October 2017 were enrolled in the study. Recurrent VTA (modifier A status) was defined as a sustained ventricular tachycardia or fibrillation that required implantable cardioverter defibrillator shocks or an external defibrillator more than twice weekly. The primary outcome was death from any cause. The secondary outcomes were the first occurrence of VTA and recurrent VTA after LVAD implantation. Sixteen patients (24%) met the criteria for modifier A status, and 15 patients had an LVAD implanted. During a median follow-up of 1,124 days, 21 of 60 patients with an LVAD died. There was a significantly higher mortality rate in LVAD patients with modifier A status than in those who did not meet the modifier A criteria. On multivariate analysis, patients with modifier A status had an increased risk of mortality (HR, 3.43; 95% CI: 1.30–8.61, P=0.001). Conclusions: Recurrent VTA might be a marker for worse outcome in Japanese heart transplant candidates with an LVAD.

2019-03-30 12:16:40
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2 0 0 0 OA Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

著者: Takeshi Tsuda Abdul M. Bhat Bradley W. Robinson Jeanne M. Baffa Wolfgang Radtke
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.79, no.11, pp.2372-2379, 2015-10-23 (Released:2015-10-23)
参考文献数: 36
被引用文献数: 8 38

Background:The incidence of late coronary artery abnormalities after arterial switch operation (ASO) for d-loop transposition of the great arteries may be underestimated.Methods and Results:We retrospectively reviewed coronary artery morphology in 40 of 97 patients who survived the first year after ASO. Seven asymptomatic patients developed significant late coronary artery abnormalities. One patient died suddenly at home with severe left coronary artery (LCA) ostial stenosis at age 3.8 years. The second patient collapsed during exercise at age 9.6 years due to ventricular fibrillation and severe LCA ostial stenosis despite prior negative exercise stress test (EST) and myocardial perfusion imaging (MPI). The third patient was found to have moderate ostial stenosis of the LCA with negative EST and MPI. The fourth patient with exercise-induced ST-T depression and myocardial perfusion defect was shown to have complete LCA occlusion with collateral vessel formation. Three other patients had complete proximal obliteration of either of the coronary arteries with collateral supply. An additional 4 asymptomatic patients had trivial-mild narrowing of the LCA on routine selective coronary angiogram.Conclusions:Incidence of late coronary stenosis or occlusion was not infrequent after ASO (11.3%) and presented usually without preceding symptoms and often after negative non-invasive screening. We advocate routine coronary imaging in all patients after ASO before they participate in competitive sports. (Circ J 2015; 79: 2372–2379)

2019-03-09 10:32:56
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2 0 0 0 OA Outcomes of Redo Transcatheter Aortic Valve Implantation for Structural Valve Degeneration of Transcatheter Aortic Valve

著者: Masaki Tsuda Isamu Mizote Yasuhiro Ichibori Takashi Mukai Koichi Maeda Toshinari Onishi Toru Kuratani Yoshiki Sawa Yasushi Sakata
出版者: The Japanese Circulation Society
雑誌: Circulation Reports (ISSN:24340790)
巻号頁・発行日: vol.1, no.3, pp.142-148, 2019-03-08 (Released:2019-03-08)
参考文献数: 29
被引用文献数: 3

Background: The outcome of redo transcatheter aortic valve (TAV) implantation (TAVI) is unknown for TAV structural valve degeneration (SVD). This paper reports the initial results of redo TAVI for TAV-SVD in Japanese patients. Methods and Results: Of 630 consecutive patients, 6 (1.0%) underwent redo TAVI for TAV-SVD (689–1,932 days after the first TAVI). The first TAV were 23-mm balloon-expandable valves (BEV, n=5) and a 26-mm self-expandable valve (SEV, n=1). All patients underwent multidetector computed tomography (MDCT) before redo TAVI, which showed first-TAV under-expansion (range, 19.1–21.0 mm) compared with the label size. Two BEV and 4 SEV were successfully implanted as second TAV, without moderate/severe regurgitation or 30-day mortality. One of 2 patients with a BEV-inside-BEV implantation had a high transvalvular mean pressure gradient post-procedurally (34 mmHg) and required surgical valve replacement 248 days after the redo TAVI. This, however, was unnoted in patients with SEV implantation during redo TAVI. Planned coronary artery bypass grafting was concomitantly performed in 1 patient with a small sino-tubular junction and SEV-inside-SEV implantation because of the risk of coronary malperfusion caused by the first TAV leaflets. Five of the 6 patients survived during the follow-up period (range, 285–1,503 days). Conclusions: Redo TAVI for TAV-SVD appears safe and feasible, while specific strategies based on MDCT and device selection seem important for better outcomes.

2019-03-08 18:12:47
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2 0 0 0 OA Progressive Mobilization Program for Patients With Acute Heart Failure Reduces Hospital Stay and Improves Clinical Outcome

著者: Naoya Kakutani Arata Fukushima Shintaro Kinugawa Takashi Yokota Tatsuya Oikawa Mikito Nishikawa Risako Nakamura Takanori Tsukada Shigeki Mori Ichiro Yoshida Toshihisa Anzai
出版者: The Japanese Circulation Society
雑誌: Circulation Reports (ISSN:24340790)
巻号頁・発行日: pp.CR-19-0004, (Released:2019-02-19)
参考文献数: 30
被引用文献数: 14

Background: Early ambulation has been shown to be associated with shorter hospital stay and better clinical outcomes in patients with acute heart failure (HF). Early mobilization program in combination with structured exercise training is recommended, but has yet to be developed and implemented in HF. Methods and Results: We developed a progressive mobilization program for HF patients that classifies the mobilization process into 7 stages based on disease condition and physical function. We retrospectively analyzed 136 patients with acute HF (80±11 years), who were assigned either to the mobilization program (intervention group, n=75) or to usual care (control group, n=61). The program was safely implemented without any adverse events. Hospital stay was significantly reduced in the intervention group compared with the control group (33±25 vs. 51±36 days, P<0.01). The intervention group had higher activities of daily living (ADL) score at discharge evaluated using the Barthel index (64±38 vs. 49±36, P<0.05). The intervention group also had a higher percentage of discharge to home (71% vs. 52%, P<0.05) and a lower rate of HF-related readmission (16% vs. 36%, P<0.05) compared with the control group. Conclusions: The progressive mobilization program for acute HF was feasible and was associated with better ADL and reduced hospital stay, leading to improvement of clinical outcome.

2019-03-03 22:20:12
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2 0 0 0 OA Incidence Rates of Postoperative Pulmonary Embolisms in Symptomatic and Asymptomatic Patients, Detected by Diagnostic Images ― A Single-Center Retrospective Study ―

著者: Yoshikazu Matsuoka Hiroshi Morimatsu
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.83, no.2, pp.432-440, 2019-01-25 (Released:2019-01-25)
参考文献数: 29
被引用文献数: 2

Background: Pulmonary embolism (PE) is a serious complication during the perioperative period. However, because most previous studies on the incidence of postoperative PE are based on symptoms, asymptomatic occurrences of PE have been overlooked, and the absolute incidence of postoperative PE remains unknown. The aim of this study was to investigate the incidence of perioperative PE, regardless of its symptoms, by reviewing the clinical interpretations of the diagnostic images obtained during the postoperative period. Methods and Results: This study included all patients aged at least 18 years who underwent operations under general and/or neuraxial anesthesia in our institution from 2013 to 2016. We reviewed all interpretations of the diagnostic imaging performed in the postoperative period. We analyzed the 90-day cumulative incidence of postoperative PE and the characteristics, risk factors, and symptoms of patients with and without postoperative PE. Among 21,763 operations, postoperative diagnostic imaging was performed in 1,168 patients, which found PE in 217 patients. Symptoms appeared in 11.1% (24/217) of the PE patients, and 66.7% of these symptoms were decreased levels of SpO2alone. Mortality from PE was 0.5% (1/217). Conclusions: Diagnostic imaging found a number of postoperative PE cases, regardless of the presence of symptoms. Although symptomatic PE was not a frequent occurrence, these findings suggest that clinicians should be aware of postoperative PE even under current prophylaxis.

2019-02-28 02:47:28
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2 0 0 0 OA Prognostic Importance of Multiple Nutrition Screening Indexes for 1-Year Mortality in Hospitalized Acute Decompensated Heart Failure Patients

著者: Tomonobu Takikawa Takuya Sumi Kunihiko Takahara Yoshihiro Kawamura Shioh Ohguchi Mitsutoshi Oguri Hideki Ishii Toyoaki Murohara
出版者: The Japanese Circulation Society
雑誌: Circulation Reports (ISSN:24340790)
巻号頁・発行日: vol.1, no.2, pp.87-93, 2019-02-08 (Released:2019-02-08)
参考文献数: 31
被引用文献数: 11

Background: The purpose of the study was to evaluate the impact of nutritional status on 1-year mortality in hospitalized patients with acute decompensated heart failure (ADHF). Methods and Results: We enrolled 457 hospitalized ADHF patients. Previously established objective nutritional indexes (controlling nutritional status [CONUT], prognostic nutritional index [PNI], geriatric nutritional risk index [GNRI], and subjective global assessment [SGA]) were evaluated at hospital admission. Malnutrition was defined as CONUT score ≥5, PNI score <38, GNRI score <92, and SGA scores B and C. The frequencies of malnutrition based on CONUT, PNI, GNRI, and SGA were 31.5%, 21.4%, 44.9%, and 27.8%, respectively. All indexes were related to the occurrence of 1-year mortality on univariate Cox regression analysis (P<0.05). We constructed a reference model using age, body mass index, systolic blood pressure, sodium concentration, and renal function on multivariable Cox regression analysis. Adding SGA to the reference model significantly improved both net reclassification improvement (NRI) and integrated discrimination improvement (0.344, P=0.002; 0.012, P=0.049; respectively). Other indexes (CONUT, PNI, and GNRI scores) significantly improved NRI (0.254, P=0.019; 0.273, P=0.013; 0.306, P=0.006; respectively). Conclusions: Nutritional screening assessed at hospital admission was appropriate for the prediction of 1-year mortality in hospitalized patients with ADHF.

2019-02-08 17:33:01
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2 0 0 0 OA Effect of Alirocumab and Rosuvastatin or Rosuvastatin Alone on Lipid Core Plaque in Coronary Artery Disease Seen on Near-Infrared Spectroscopy Intravascular Ultrasound (ANTARES)

著者: Hiromasa Otake Kosuke Tanimura Yoichiro Sugizaki Takayoshi Toba Hiroyuki Kawamori Toshiro Shinke Ken-ichi Hirata
出版者: The Japanese Circulation Society
雑誌: Circulation Reports (ISSN:24340790)
巻号頁・発行日: vol.1, no.2, pp.107-111, 2019-02-08 (Released:2019-02-08)
参考文献数: 21
被引用文献数: 2

Background: Despite evidence of the effects of alirocumab on the incidence of acute coronary events, its impact on plaque stabilization remains uncertain. The present study will investigate the effect of alirocumab on fibroatheroma in patients who underwent recent percutaneous coronary intervention (PCI). Methods and Results: This phase IV, open-label, randomized, blinded near-infrared spectroscopy plus intravascular ultrasound (NIRS-IVUS) analysis, parallel-group, single-center study will enroll Japanese adults recently hospitalized for PCI with suboptimal low-density lipoprotein cholesterol (LDL-C) control (>70 mg/dL) despite stable statin therapy. Thirty patients will be randomized to receive either alirocumab or standard of care. The alirocumab group will receive alirocumab 75 mg every 2 weeks plus 10 mg rosuvastatin per day. The standard-of-care group will receive 10 mg rosuvastatin per day with dose adjustment to achieve LDL-C <70 mg/dL. Post-treatment NIRS-IVUS will be performed at week 36. The primary endpoint is the change in maximum lipid core burden index in 4-mm pullback compartments (maxLCBI[4 mm]) between baseline and week 36. Secondary endpoints include change in LCBI (lesion), angle of lipid core, plaque burden, and serum lipids and biomarkers related to atherosclerosis and inflammation. Conclusions: The study will clarify the effects of alirocumab on thin-cap fibroatheroma in patients who underwent recent PCI and who have suboptimal LDL-C control with stable statin therapy.

2019-02-08 17:32:32
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2 0 0 0 OA Clinical Features of Acute Heart Failure During Sleep ― Prognostic Impact of a Prodrome in Patients With Severely Decompensated Acute Heart Failure Admitted at Midnight or Early Morning ―

著者: Masato Matsushita Akihiro Shirakabe Nobuaki Kobayashi Hirotake Okazaki Yusaku Shibata Hiroki Goda Saori Uchiyama Kenichi Tani Kazutaka Kiuchi Noritake Hata Kuniya Asai Wataru Shimizu
出版者: The Japanese Circulation Society
雑誌: Circulation Reports (ISSN:24340790)
巻号頁・発行日: vol.1, no.2, pp.61-70, 2019-02-08 (Released:2019-02-08)
参考文献数: 20

Background: The features of sleep-associated acute heart failure (AHF) patients admitted at midnight or early morning (M/E) are unclear. Methods and Results: Of 1,268 AHF patients screened, 932 were analyzed, and divided into 2 groups by admission time (M/E group, 23:00–06:59, n=399; daytime group, 07:00–22:59, n=533). Those in the M/E group were further divided by the presence of a prodrome: with (n=176; prodrome group) or without (n=223; sudden onset group). The median time from symptom onset to hospitalization was significantly shorter in the M/E group (98 min; range, 65–170 min) than in the daytime group (123 min; range, 68–246 min). The 365-day HF event rate in the M/E group was significantly lower than that of the daytime group. On multivariate logistic regression modeling the M/E group was independently associated with a better outcome than the daytime group (OR, 0.673; 95% CI: 0.500–0.905). In the M/E group, the 365-day HF event rate was significantly lower in the prodrome group than in the sudden onset group. On multivariate logistic regression modeling, inclusion in the prodrome group was independently associated with a better outcome (OR, 0.544; 95% CI: 0.338–0.877). Conclusions: AHF patients admitted during sleeping hours were not sicker than those admitted during the daytime. The absence of a prodrome, however, might be associated with future repeated HF events.

2019-02-08 17:32:15
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2 0 0 0 OA Depletion of Uric Acid Due to SLC22A12 (URAT1) Loss-of-Function Mutation Causes Endothelial Dysfunction in Hypouricemia

著者: Shinobu Sugihara Ichiro Hisatome Masanari Kuwabara Koichiro Niwa Nani Maharani Masahiko Kato Kazuhide Ogino Toshihiro Hamada Haruaki Ninomiya Yukihito Higashi Kimiyoshi Ichida Kazuhiro Yamamoto
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.79, no.5, pp.1125-1132, 2015-04-24 (Released:2015-04-24)
参考文献数: 41
被引用文献数: 24 82

Background:Uric acid (UA) serves as an antioxidant in vascular endothelial cells. UA transporter 1 (URAT1) encoded by SLC22A12 is expressed in the kidney and vessels and its loss of function causes hypouricemia. The purpose of this study was to examine whether there is any endothelial dysfunction in patients with hypouricemia.Methods and Results:Twenty-six patients with hypouricemia (<2.5 mg/dl) and 13 healthy control subjects were enrolled. Endothelial function was evaluated using flow-mediated dilation (FMD). mRNA of UA transporters expressed in cultured human umbilical endothelial cells (HUVEC) was detected on RT-PCR. There was a positive correlation between FMD and serum UA in the hypouricemia group. URAT1 loss-of-function mutations were found in the genome of 21 of 26 patients with hypouricemia, and not in the other 5. In the hypouricemia groups, serum UA in homozygous and compound heterozygous patients was significantly lower than in other groups, suggesting that severity of URAT1 dysfunction may influence the severity of hypouricemia. Thirteen of 16 hypouricemia subjects with homozygous and compound heterozygote mutations had SUA <0.8 mg/dl and their FMD was lower than in other groups. HUVEC do not express mRNA of URAT1, suggesting the null role of URAT1 in endothelial function.Conclusions:Depletion of UA due to SLC22A12/URAT1 loss-of-function mutations causes endothelial dysfunction in hypouricemia patients. (Circ J 2015; 79: 1125–1132)

2019-01-29 01:58:18
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2 0 0 0 OA Prasugrel for Japanese Patients With Ischemic Heart Disease in Long-Term Clinical Practice (PRASFIT-Practice II) ― A 3-Month Interim Analysis of a Postmarketing Observational Study ―

著者: Masato Nakamura Ken Kozuma Takanari Kitazono Tomoko Iizuka Toru Sekine Kazuhito Shiosakai Isao Usui Seiji Kogure
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: pp.CJ-18-0956, (Released:2019-01-24)
参考文献数: 19
被引用文献数: 10

Background: A unique dose of prasugrel has been approved exclusively for Japanese patients, but real-world data for prasugrel at that dose in patients with ischemic heart disease (IHD) are limited. Therefore, large-scale, real-world data are needed. Methods and Results: A 2-year observational study of Japanese patients with IHD undergoing percutaneous coronary intervention and being treated with prasugrel to evaluate safety and effectiveness. This report is an interim analysis of data from case report forms (CRFs) after 3 months. CRFs were collected from 4,270 patients, 4,157 of whom were eligible for the safety and effectiveness analysis sets (mean age, 68.3 years; male, 76.5%). The median treatment period was 112 days, and 92.3% of patients continued treatment with prasugrel. The incidence of non-coronary artery bypass grafting-related bleeding adverse events (AEs) was 3.1%, of which Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeding accounted for 0.5% and 0.6%, respectively. The most common bleeding AEs were gastrointestinal disorders, which accounted for 43.2% of the sum of “TIMI major and minor bleeding AEs”. The incidence of major adverse cardiovascular events (MACE) was 1.0%, and the cumulative incidence of MACE was 1.4%. The incidence of stent thrombosis was 0.2%. Conclusions: Interim study results indicated that prasugrel was safe and effective during the early phase of treatment in Japanese patients with IHD in real-world clinical settings.

2019-01-24 23:39:33
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2 0 0 0 OA Circulation Reports (Circ Rep) Vol. 1 Message From the Editor-in-Chief

著者: Masataka Sata
出版者: The Japanese Circulation Society
雑誌: Circulation Reports (ISSN:24340790)
巻号頁・発行日: vol.1, no.1, pp.1-3, 2019-01-10 (Released:2019-01-10)

2019-01-11 18:14:28
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2 0 0 0 OA Specific Problems With Accidental Deaths in Japan – Cardiac Arrest From Hot Baths and Foreign Body Airway Obstruction in Elders –

著者: Hiroyuki Hanada
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.80, no.7, pp.1523-1524, 2016-06-24 (Released:2016-06-24)
参考文献数: 10
被引用文献数: 2 4

2019-01-03 14:18:32
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2 0 0 0 OA Infective Endocarditis in Cancer Patients ― Causative Organisms, Predisposing Procedures, and Prognosis Differ From Infective Endocarditis in Non-Cancer Patients ―

著者: Kyu Kim Darae Kim Sang-Eun Lee In Jeong Cho Chi Young Shim Geu-Ru Hong Jong-Won Ha
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: pp.CJ-18-0609, (Released:2018-12-15)
参考文献数: 22
被引用文献数: 12

Background: Infective endocarditis (IE) in cancer patients is increasing, but because little is known about it in these patients, we analyzed patient characteristics and outcomes and compared these factors in IE patients with and without cancer. Methods and Results: This retrospective cohort study included 170 patients with IE newly diagnosed between January 2011 and December 2015. Among 170 patients, 30 (17.6%) had active cancer. The median age of IE patients with cancer was higher than that of non-cancer patients. Nosocomial IE was more common in cancer patients. Non-dental procedures, such as intravenous catheter insertion and invasive endoscopic or genitourinary procedures, were more frequently performed before IE developed in cancer patients. Staphylococcus was the most common pathogen in cancer patients, whereas Streptococcus was the most common in non-cancer patients. In-hospital mortality was significantly higher in cancer patients with IE (34.4% vs. 12.4%, P<0.001). IE was an important reason for discontinuing antitumor therapy and withholding additional aggressive treatment in nearly all deceased cancer patients. Conclusions: IE is common in cancer patients and is associated with poorer outcomes. Patients with IE and cancer have different clinical characteristics. Additional studies regarding antibiotic prophylaxis before non-dental invasive procedures in cancer patients are needed, as cancer patients are not considered to be at higher risk of IE.

2018-12-15 22:26:08
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2 0 0 0 OA Myocardial T1 Mapping

著者: Heerajnarain Bulluck Viviana Maestrini Stefania Rosmini Amna Abdel-Gadir Thomas A Treibel Silvia Castelletti Chiara Bucciarelli-Ducci Charlotte Manisty James C. Moon
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.79, no.3, pp.487-494, 2015-02-25 (Released:2015-02-25)
参考文献数: 82
被引用文献数: 37 65

Cardiovascular magnetic resonance is a well-established tool for the quantification of focal fibrosis. With the introduction of T1 mapping, diffuse myocardial processes can be detected and quantified. In particular, infiltration and storage disorders with large disease-related changes, and diffuse fibrosis where measurement is harder but the potential impact larger. This has added a new dimension to the understanding and assessment of various myocardial diseases. T1 mapping promises to detect early disease, quantify disease severity and provide prognostic insights into certain conditions. It also has the potential to be a robust surrogate marker in drug development trials to monitor therapeutic response and be a prognostic marker in certain diseases. T1 mapping is an evolving field and numerous factors currently preclude its standardization. In this review, we describe the current status of T1 mapping and its potential promises and pitfalls. (Circ J 2015; 79: 487–494)

2018-12-05 21:55:02
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2 0 0 0 OA Strategy of Cardiovascular Surgery for Patients With Dementia as Evaluated by Mini-Mental State Examination

著者: Sachie Terazawa Hideki Oshima Yuji Narita Kazuro Fujimoto Masato Mutsuga Yoshiyuki Tokuda Tomo Yoshizumi Hideki Ito Wataru Uchida Akihiko Usui
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.82, no.12, pp.2998-3004, 2018-11-24 (Released:2018-11-24)
参考文献数: 28
被引用文献数: 9

Background: The strategy for cardiovascular surgery in dementia patients is controversial, so we aimed to investigate whether preoperative dementia and its severity might affect the outcomes of cardiovascular surgery by evaluating with the Mini-Mental State Examination (MMSE). Methods and Results: The study group comprised 490 patients undergoing cardiovascular surgery. Their preoperative cognitive status was evaluated using the MMSE, and analysis was performed to compare the patients with MMSE score <24 (dementia group, n=51) or MMSE score 24–30 (non-dementia group, n=439). Furthermore, the effect of the severity of dementia was analyzed with a cut-off MMSE score of 19/20. Risk factors for surgical outcomes were explored using multivariate logistic regression analysis. Hospital mortality was 11.8% in the dementia group and 2.1% in the non-dementia group (P=0.002). Regarding the postoperative morbidities, the incidence of cerebrovascular disorder (P=0.001), pneumonia (P=0.039), delirium (P=0.004), and infection (P=0.006) was more frequent in dementia group. Among the patients with MMSE <20, hospital mortality was as high as 25%, and the rate of delirium was 58%. Multivariate logistic regression analysis revealed that MMSE score <24 (P=0.003), lower serum albumin (P=0.023) and aortic surgery (P=0.036) were independent risk factors for hospital death. Conclusions: Preoperative dementia affects the outcomes of cardiovascular surgery with regard to hospital death and delirium. The surgical indication for patients with MMSE <20 might be difficult, but surgery with an appropriate strategy should be considered for patients with MMSE <24.

2018-11-29 14:46:46
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2 0 0 0 OA Current Status, Time Trends and Outcomes of Combination Therapy With Oral Anticoagulant and Antiplatelet Drug in Patients With Atrial Fibrillation ― The Fushimi AF Registry ―

著者: Nobutoyo Masunaga Mitsuru Abe Hisashi Ogawa Yuya Aono Syuhei Ikeda Kosuke Doi Yoshimori An Mitsuru Ishii Moritake Iguchi Masahiro Esato Hikari Tsuji Hiromichi Wada Koji Hasegawa Gregory Y.H. Lip Masaharu Akao on behalf of the Fushimi AF Registry Investigators
出版者: The Japanese Circulation Society
雑誌: Circulation Journal (ISSN:13469843)
巻号頁・発行日: vol.82, no.12, pp.2983-2991, 2018-11-24 (Released:2018-11-24)
参考文献数: 28
被引用文献数: 16

Background: The combination of oral anticoagulant (OAC) and antiplatelet drug (APD) increases the bleeding risk in atrial fibrillation (AF). Non-vitamin K antagonist OAC (NOAC) have been increasingly used since 2011. We investigated current status, time trends and outcomes of AF patients using combination therapy in 2011–2017. Methods and Results: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. Of 2,378 patients with OAC at enrollment, 521 (22%) received combination therapy, while 1,857 (78%) received OAC alone. When compared with OAC alone, combination therapy patients had more comorbidities, but approximately 30% had no atherosclerotic disease. From 2011 to 2017, the prevalence of combination therapy decreased from 26% to 14%. The prevalence of NOAC increased in those on combination therapy. Off-label under-dosing of NOAC increased year by year, especially in combination therapy. During follow-up, the incidence of major bleeding (hazard ratio [HR], 1.42; 95% CI: 1.03–1.95) and stroke/systemic embolism (HR, 1.48; 95% CI: 1.09–2.00) was higher in the combination therapy than in the OAC alone group. Conclusions: In Japanese AF patients receiving OAC, the prevalence of combination therapy decreased, with the proportion of NOAC use increasing in 2011–2017. Many patients, however, received off-label NOAC under-dosing, especially in the combination therapy group. Patients with combination therapy had higher incidences of major bleeding as well as stroke/systemic embolism, compared with OAC monotherapy.