80 results on '"Soichiro Ebisawa"'
Search Results
2. Intensive exercise therapy for restenosis after superficial femoral artery stenting: the REASON randomized clinical trial
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Tamon, Kato, Takashi, Miura, Shuhei, Yamamoto, Yusuke, Miyashita, Naoto, Hashizume, Kyoko, Shoin, Shinya, Sasaki, Yusuke, Kanzaki, Hisanori, Yui, Shusaku, Maruyama, Ayumu, Nagae, Takahiro, Sakai, Tatsuya, Saigusa, Soichiro, Ebisawa, Ayako, Okada, Hirohiko, Motoki, Uichi, Ikeda, and Koichiro, Kuwahara
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Coronary Restenosis ,Femoral Artery ,Peripheral Arterial Disease ,Treatment Outcome ,Humans ,Popliteal Artery ,Stents ,Constriction, Pathologic ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Vascular Patency ,Exercise Therapy - Abstract
Endovascular treatment (EVT) is the main treatment for peripheral artery disease (PAD). Despite advances in device development, the restenosis rate remains high in patients with femoropopliteal lesions (FP). This study aimed to evaluate the effectiveness of exercise training in reducing the 1-year in-stent restenosis rate of bare metal nitinol stents for FPs. This prospective, randomized, open-label, multicenter study was conducted from January 2017 to March 2019. We randomized 44 patients who had claudication with de novo stenosis or occlusion of the FP into an intensive exercise group (n = 22) and non-intensive exercise group (n = 22). Non-intensive exercise was defined as walking for less than 30 min per session, fewer than three times a week. We assessed exercise tolerance using an activity meter at 1, 3, 6, and 12 months, and physiotherapists ensured maintenance of exercise quality every month. The primary endpoint was instant restenosis defined as a peak systolic velocity ratio > 2.5 on duplex ultrasound imaging. Kaplan–Meier analysis was used to evaluate the data. There were no significant differences in background characteristics between the groups. Six patients dropped out of the study within 1 year. In terms of the primary endpoint, intensive exercise significantly improved the patency rate of bare nitinol stents at 12 months. The 1-year freedom from in-stent restenosis rates were 81.3% in the intensive exercise group and 47.6% in the non-intensive exercise group (p = 0.043). No cases of stent fracture were observed in the intensive exercise group. Intensive exercise is safe and reduces in-stent restenosis in FP lesions after endovascular therapy for PAD. Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry (No. UMIN 000025259).
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- 2022
3. Comparison of prognostic impact of anticoagulants in heart failure patients with atrial fibrillation and renal dysfunction: direct oral anticoagulants versus vitamin K antagonists
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Takahiro Sakai, Hirohiko Motoki, Aya Fuchida, Takahiro Takeuchi, Kyuhachi Otagiri, Masafumi Kanai, Kazuhiro Kimura, Masatoshi Minamisawa, Koji Yoshie, Tatsuya Saigusa, Soichiro Ebisawa, Ayako Okada, Hiroshi Kitabayashi, and Koichiro Kuwahara
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Heart Failure ,Vitamin K ,Administration, Oral ,Anticoagulants ,Prognosis ,Stroke ,Fibrinolytic Agents ,Atrial Fibrillation ,Humans ,Kidney Diseases ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
Although high thromboembolic risk was assumed in elderly patients with heart failure (HF) and atrial fibrillation (AF), inadequate control of prothrombin time/international normalized ratio was often observed in patients using vitamin K antagonists (VKAs). We hypothesized that patients treated with direct oral anticoagulants (DOAC) would have a better outcome than those treated with VKAs. The aim of this study was to compare the efficacies of DOACs and VKAs in elderly patients with HF and AF. We retrospectively analyzed data from a multicenter, prospective observational cohort study. A total of 1036 patients who were hospitalized for acute decompensated HF were enrolled. We assessed 329 patients aged > 65 years who had non-valvular AF and divided them into 2 groups according to the anticoagulant therapy they received. A subgroup analysis was performed using renal dysfunction based on estimated glomerular filtration rate (eGFR; mL/min/1.73 m2). The primary outcome was all-cause mortality, and the secondary outcomes were non-cardiovascular death or stroke. The median follow-up period was 730 days (range 334–1194 days). The primary outcome was observed in 84 patients; non-cardiovascular death, in 25 patients; and stroke, in 14 patients. The Kaplan–Meier analysis revealed that all-cause mortality was significantly lower in the DOAC group than in the VKA group (log-rank p = 0.033), whereas the incidence rates of non-cardiovascular death (log-rank p = 0.171) and stroke (log-rank p = 0.703) were not significantly different in the crude population. DOAC therapy was not associated with lower mortality in the crude population (log-rank p = 0.146) and in the eGFR ≥ 45 mL/min/1.73 m2 subgroup (log-rank p = 0.580). However, DOAC therapy was independently associated with lower mortality after adjustments for age, diabetes mellitus, and albumin level (hazard ratio, 0.55; 95% confidence interval, 0.30–0.99; p = 0.045) in the eGFR 2 subgroup. Compared with VKA therapy, DOAC therapy was associated with lower risk of all-cause mortality in the elderly HF patients with AF and renal dysfunction.
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- 2022
4. Impact of Frailty and Age on Clinical Outcomes in Patients Who Underwent Endovascular Therapy
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Ken Nishikawa, Soichiro Ebisawa, Takashi Miura, Tamon Kato, Kanzaki Yusuke, Naoyuki Abe, Daisuke Yokota, Takashi Yanagisawa, Keisuke Senda, Tadamasa Wakabayashi, Yushi Oyama, Kenichi Karube, Tadashi Itagaki, Hisanori Yui, Shusaku Maruyama, Ayumu Nagae, Takahiro Sakai, Yoshiteru Okina, Shun Nakazawa, Shunichi Tsukada, Tatsuya Saigusa, Ayako Okada, Hirohiko Motoki, Mitsuru Kagoshima, and Koichiro Kuwahara
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Peripheral Arterial Disease ,Fatigue Syndrome, Chronic ,Treatment Outcome ,Frailty ,Risk Factors ,Endovascular Procedures ,Humans ,Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
Purpose: Information on the relationship between frailty and the outcome of endovascular therapy (EVT) in elderly patients with lower extremity peripheral artery disease (PAD) is scarce. This study aimed to reveal the impact of frailty on the prognosis of super-elderly patients who underwent EVT. Materials and Methods: From August 2015 to August 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we categorized 323 patients into 4 groups according to age and the presence or absence of frailty as follows: elderly with frailty (age ≥ 75, Clinical Frailty Scale [CFS] ≥ 5), elderly without frailty (age ≥ 75, CFS ≤ 4), young with frailty (age < 75, CFS ≥ 5), and young without frailty (age < 75, CFS ≤ 4); we analyzed them accordingly. The primary endpoints were major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation, and revascularization. The secondary endpoint was cardiovascular death. Results: The median follow-up period was 2.7 years. In the elderly with frailty, elderly without frailty, young with frailty, and young without frailty groups, the freedom rates from MACLE were 34.9%, 55.7%, 35.4%, and 63.0%, respectively (pConclusion: Frailty as defined by CFS might be a predictor of MACLE incidence in patients with PAD who underwent EVT. By considering treatment indications for patients with PAD by focusing on frailty rather than age, we may examine whether EVT policies are appropriate and manage patient and caregiver expectations for potential improvement in functional outcomes. Further studies are expected to investigate whether changes in frailty after EVT change prognosis.
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- 2021
5. Body composition and mortality in patients undergoing endovascular treatment for peripheral artery disease
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Yoshiteru Okina, Yushi Oyama, Keisuke Senda, Tadamasa Wakabayashi, Takahiro Takeuchi, Kyuhachi Otagiri, Soichiro Ebisawa, Daisuke Yokota, Hiroshi Kitabayashi, Tamon Kato, Takashi Yanagisawa, Tatsuya Saigusa, Takashi Miura, Koichiro Kuwahara, Naoyuki Abe, Yusuke Kanzaki, Kenichi Karube, Tadashi Itagaki, Keisuke Machida, and Hirohiko Motoki
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medicine.medical_specialty ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,Body composition ,Gastroenterology ,Amputation, Surgical ,Body Mass Index ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Endovascular treatment ,030212 general & internal medicine ,Mortality ,Survival rate ,Retrospective Studies ,Peripheral artery disease ,business.industry ,Endovascular Procedures ,Hazard ratio ,Confidence interval ,Cardiac surgery ,Treatment Outcome ,Adipose Tissue ,Lean body mass ,Original Article ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
An inverse correlation between body mass index and mortality in patients with peripheral artery disease (PAD) has been reported. However, little information is available regarding the impact of body composition on the clinical outcomes in patients with PAD. This study evaluated the relationships between the lean body mass index (LBMI), body fat % (BF%), and mortality and major amputation rate in patients with PAD. We evaluated 320 patients with PAD after endovascular treatment (EVT) enrolled from August 2015 to July 2016 and divided them into low and high LBMI and BF% groups based on their median values (17.47 kg/m2and 22.07%, respectively). We assessed 3-year mortality and major amputation for the following patient groups: Low LBMI/Low BF%, Low LBMI/High BF%, High LBMI/Low BF%, and High LBMI/High BF%. During the median 3.1-year follow-up period, 70 (21.9%) patients died and 9 (2.9%) patients experienced major amputation. The survival rate was lower in the Low LBMI than in the High LBMI group, and was not significantly different between the Low and High BF% groups. Survival rates were lowest in the Low LBMI/Low BF% group (57.5%) and highest in the High LBMI/High BF% group (94.4%). There were no significant differences in major amputation rate between the Low LBMI and High LBMI groups, and between the Low BF% and High BF% groups. The Low LBMI and Low BF% groups were associated with an increased risk of mortality after adjustment for age, sex, frailty and conventional risk factors [hazard ratio (HR): 4.02; 95% confidence interval (CI) 2.10–7.70;p p = 0.005, respectively], for age, sex, hemodialysis, and prior cerebral cardiovascular disease (HR: 3.63; 95% CI 1.93–6.82;p p = 0.009, respectively) and for age, sex, and laboratory date (HR: 3.97; 95% CI 1.88–8.37;p p = 0.026, respectively). In conclusion, Low LBMI and Low BF% were associated with poor prognosis in patients undergoing EVT for PAD, and mortality was the lowest in the High LBMI/High BF% group compared with other body composition groups.
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- 2021
6. Multisystem Inflammatory Syndrome in Children ― A New Syndrome Complicated With Acute Heart Failure Following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection ―
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Kotaro Mori, Yuichiro Kashima, Hiroto Sakamoto, Soichiro Ebisawa, Kanako Takeshige, Katsunori Mochizuki, Hiroshi Imamura, Kenichi Nitta, Koichiro Kuwahara, and Momoko Uchida
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Pediatrics ,medicine.medical_specialty ,Myocarditis ,endocrine system diseases ,business.industry ,General Medicine ,medicine.disease ,Respiratory failure ,Fibrosis ,Predictive value of tests ,Heart failure ,Circulatory system ,otorhinolaryngologic diseases ,medicine ,Kawasaki disease ,Differential diagnosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare syndrome temporally related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares similarities with Kawasaki disease, but left ventricular dysfunction is more common in MIS-C.MethodsâandâResults:This study reports the case of a 16-year-old Japanese male patient with MIS-C. Although the initial presentation was severe with circulatory and respiratory failure, the patient recovered completely. Endomyocardial biopsy showed active myocarditis with fibrosis. Immunoglobulin treatment was useful for recovery. CONCLUSIONS: This is the first reported case of MIS-C in Japan. Cardiologists should be aware of MIS-C, a new disease, occurring during the global SARS-CoV-2 pandemic.
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- 2021
7. A case of Dressler’s syndrome successfully treated with colchicine and acetaminophen
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Naoto Hashizume, Yusuke Kanzaki, Sho Suzuki, Ayako Okada, Kumiko Yahikozawa, Hirohiko Motoki, Tatsuya Saigusa, Soichiro Ebisawa, Takuya Maruyama, Ayako Kozuka, Koichiro Kuwahara, and Fumika Nomoto
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medicine.medical_specialty ,Case Report ,030204 cardiovascular system & hematology ,Chest pain ,03 medical and health sciences ,0302 clinical medicine ,Reperfusion therapy ,Acute pericarditis ,Internal medicine ,Medicine ,ST segment ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Dressler's syndrome ,Aspirin ,business.industry ,Atrial fibrillation ,medicine.disease ,Cardiology ,medicine.symptom ,Dressler’s syndrome ,Colchicine ,Cardiology and Cardiovascular Medicine ,business ,Recent myocardial infarction ,medicine.drug - Abstract
The incidence of Dressler’s syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler’s syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler’s syndrome.
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- 2021
8. Usefulness of the controlled-rotation dilator sheath 'Evolution RL' for extraction of old leads in two Japanese centers - An experience in use
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Hiroaki Tabata, Ayako Okada, Hideki Kobayashi, Wataru Shoin, Takahiro Okano, Satoshi Higuchi, Daigo Yagishita, Soichiro Ebisawa, Hirohiko Motoki, Morio Shoda, and Koichiro Kuwahara
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Male ,Pacemaker, Artificial ,Treatment Outcome ,Japan ,Humans ,Female ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Device Removal ,Defibrillators, Implantable ,Retrospective Studies - Abstract
Transvenous lead extraction (TLE) is an established procedure for the management of cardiovascular implantable electronic devices. However, some difficulties and risks of complications still exist, especially in old and adhered leads. Evolution RL (Cook Medical, Bloomington, IN, USA) is a newly introduced device for TLE; however, no clinical results have been reported in Japan, and the results with older leads are unknown. We investigated the efficacy and safety of Evolution RL and its usefulness for old leads at two TLE centers in Japan.A total of 27 consecutive patients who underwent lead extraction using Evolution RL at Shinshu University Hospital and Tokyo Women's Medical University Hospital from September 2017 to December 2019 were retrospectively enrolled. We examined the backgrounds of the patients and leads and investigated the efficacy and safety of the procedures. We divided the leads into two groups according to the number of years of implantation (10 years) and compared the results.Among the 27 patients, 20 (74.1%) were men, and the median age was 62 (14-91) years. The total number of leads was 58, and the median implantation duration was 136 months (8-448). We achieved clinical success in all patients and complete procedural success in 24 patients (88.9%). In three patients, the broken tip of the lead remained in the heart. No major complications were noted. Of the 58 leads, there were 34 leads with more than 10 years of implantation, with significantly more Evolution RLs used (94.1% vs. 54.2%, p = 0.001) and significantly higher percentages of Evolution 11Fr, 13Fr, and steady sheaths used (79.4% vs. 33.3%, p = 0.001, 52.9% vs. 16.7%, p = 0.006, and 64.7% vs. 20.8%, p = 0.001, respectively).In two TLE centers in Japan, Evolution RL was shown to be safe and effective, even in leads older than 10 years.
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- 2022
9. Early vascular response of ultra-thin bioresorbable polymer sirolimus-eluting stents assessed by optical frequency domain imaging: the EVALUATION study
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Takahiro Tachibana, Yasushi Ueki, Tatsuya Saigusa, Soichiro Ebisawa, Takashi Miura, Keisuke Senda, Hirohiko Motoki, Koichiro Kuwahara, Uichi Ikeda, and Kyuhachi Otagiri
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Male ,Target lesion ,medicine.medical_specialty ,Time Factors ,Polymers ,medicine.medical_treatment ,Bioresorbable polymers ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Absorbable Implants ,medicine ,Clinical endpoint ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Lead (electronics) ,Aged ,Aged, 80 and over ,Sirolimus ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Interventional radiology ,General Medicine ,equipment and supplies ,Clinical trial ,Treatment Outcome ,surgical procedures, operative ,cardiovascular system ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents ,Tomography, Optical Coherence ,Follow-Up Studies ,medicine.drug - Abstract
This study aimed to evaluate the early vascular response of ultra-thin strut bioresorbable polymer sirolimus-eluting stents (BP SES) using optical frequency domain imaging (OFDI). Ultra-thin strut BP SES have superior outcomes in terms of efficacy and safety endpoints when compared to other thin strut new-generation stents. However, the factors contributing to the superiority of BP SES over other thin strut new-generation stents are unclear. A total of 32 patients with multivessel disease requiring staged procedures at 1 month were enrolled from 3 cardiovascular institutions; of these, 31 were immediately assessed by OFDI (n = 31). All patients were assessed at 1 month after ultra-thin strut BP SES implantation. The primary endpoint was % of uncovered struts. A total of 1723 cross sections (17,014 struts) were analyzed at baseline and 1 month after percutaneous coronary intervention. The % uncovered struts at 1-month follow-up was 7.7% (4.0, 13.8). Furthermore, the covered strut % (88.4% and 80.4%, P = 0.013) and malapposition rate (2.7% and 4.3%, P = 0.012) were significantly different between the 60-μm and 80-μm stents. Ultra-thin strut BP SES implantation may feasibly achieve early vascular responses due to the ultra-thin struts. This may ultimately lead to lower stent thrombosis and target lesion failure rates. Clinical trial registration University Hospital Medical Information Network Clinical Trials Registry (No. UMIN000033406).
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- 2020
10. Impact of changes in body mass index after percutaneous coronary intervention on long-term outcomes in patients with coronary artery disease
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Hirohiko Motoki, Soichiro Ebisawa, Chie Nakamura, Takahiro Sakai, Takashi Miura, Tatsuya Saigusa, Daisuke Kashiwagi, Koichiro Kuwahara, Ayumu Nagae, Tamon Kato, Ayako Okada, Hisanori Yui, and Shusaku Maruyama
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Male ,medicine.medical_specialty ,Time Factors ,Obesity paradox ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Weight Gain ,Risk Assessment ,Body Mass Index ,Percutaneous coronary intervention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Weight Loss ,medicine ,Humans ,Cumulative incidence ,Prospective Studies ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Aged ,business.industry ,Incidence ,Hazard ratio ,Middle Aged ,Prognosis ,medicine.disease ,Stroke ,Treatment Outcome ,Heart Disease Risk Factors ,Conventional PCI ,Cardiology ,Body-Weight Trajectory ,Female ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Mace - Abstract
Little is known about the impact of changes in body mass index (BMI) after the percutaneous coronary intervention (PCI) on long-term outcomes in patients with coronary artery disease (CAD). Therefore, this study aimed to clarify this issue. We investigated data on CAD obtained from the SHINANO Registry, a prospective, observational, multicenter cohort study, from 2012 to 2013 in Nagano, Japan. One year after PCI, the enrolled patients were divided into the following three groups based on changes in BMI by tertiles: reduced, maintained, and elevated BMI. The associations among the groups and the 4-year outcomes [major adverse cardiac events (MACEs), all-cause death, Q-wave myocardial infarction, and stroke] were examined. Five hundred seventy-two patients were divided into the reduced, maintained, and elevated BMI groups. Over the 4-year follow-up period, the cumulative incidence of MACEs was 10.5% (60 cases). In the Kaplan–Meier analysis, the incidence rates of MACE were significantly higher in the reduced BMI group than in the maintained and elevated BMI groups [17.7% versus (vs.) 7.3% vs. 9.0%, p = 0.004]. Multivariable cox regression analysis showed that the reduced group showed increased risks of MACEs (hazard ratio 2.15; 95% confidence interval 1.29–3.57; p = 0.003). The long-term clinical outcomes of patients with CAD who underwent PCI were affected by the reduction in BMI after PCI. Furthermore, the elevation of BMI after PCI was not a poor prognostic factor.
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- 2020
11. The Impact of Hyperuricemia on Patients With Low Body Mass Index After Endovascular Treatments: Data From the I-PAD Registry
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Ayumu Nagae, Soichiro Ebisawa, Tatsuya Saigusa, Ken Nishikawa, Koki Fujimori, Hisanori Yui, Shusaku Maruyama, Chie Nakamura, Daisuke Kashiwagi, Hideki Kobayashi, Takahiro Sakai, Keisuke Senda, Tamon Kato, Takashi Miura, Ayako Okada, Hirohiko Motoki, and Koichiro Kuwahara
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musculoskeletal diseases ,congenital, hereditary, and neonatal diseases and abnormalities ,Peripheral Arterial Disease ,Treatment Outcome ,Risk Factors ,Endovascular Procedures ,Weight Loss ,nutritional and metabolic diseases ,Humans ,Hyperuricemia ,Registries ,Cardiology and Cardiovascular Medicine ,Body Mass Index - Abstract
We investigated the prognostic effects of hyperuricemia and high or low body mass index (BMI) in peripheral artery disease (PAD) after endovascular therapy (EVT). Between July 2015–2016, 357 consecutive patients with PAD who underwent EVT were enrolled. Patients were divided into 2 groups: BMI < 25 kg/m2 (low BMI) and ≥ 25 kg/m2 (high BMI); they were also divided into 2 more groups based on the presence/absence of hyperuricemia. The primary and secondary endpoints were major adverse cardiovascular and limb events (MACLE), and all-cause death at 3 years post-EVT. Patients with hyperuricemia had significantly lower freedom from MACLE than patients without hyperuricemia at 3 years (57.0 vs 71.9%, p = .0068). The overall survival of patients with hyperuricemia was significantly lower than that of patients without hyperuricemia (63.9 vs 81.7%, p = .0012). Patients with hyperuricemia who had low BMI experienced significantly lower freedom from MACLE than those without hyperuricemia who had low BMI (48.2 vs 69.9%, p = .002). The overall survival of patients with hyperuricemia who had low BMI was significantly lower than that of patients without hyperuricemia who had low BMI (55.2 vs 77.1%, p = .003). Patients with hyperuricemia had significantly more MACLE and a lower survival at 3 years than patients without hyperuricemia, even if they had a low BMI.
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- 2022
12. Biopsy detection and clinical management of acute lymphocytic myocarditis in pregnancy
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Hirohiko Motoki, Midori Sato, Ayako Okada, Tatsuya Saigusa, Daisuke Sunohara, Koichiro Kuwahara, Hirofumi Ando, and Soichiro Ebisawa
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medicine.medical_specialty ,Pregnancy ,Myocarditis ,medicine.diagnostic_test ,business.industry ,ST elevation ,Cardiomyopathy ,Hemodynamics ,030204 cardiovascular system & hematology ,medicine.disease ,Article ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,Internal medicine ,Biopsy ,medicine ,Cardiology ,Gestation ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Acute lymphocytic myocarditis in pregnancy is rare, with no established management guidelines to date. A 40-year-old woman at 34 weeks of gestation complained of shortness of breath upon exertion. An electrocardiogram revealed broad ST elevation, and echocardiography showed diffuse impairment of left ventricular contractility. The patient was immediately transferred to our hospital for suspected takotsubo cardiomyopathy. We considered myocarditis based on the patient’s prior cold-like symptoms and additional examination. Myocardial biopsy revealed lymphocyte infiltration, which confirmed acute lymphocytic myocarditis. Although there were no signs of heart failure or conduction disturbance under catecholamine, her hemodynamics were weak. Emergency cesarean section was performed because of possible hemodynamic failure during the remaining course of pregnancy. Both the mother and baby were discharged without any subsequent events. If acute myocarditis is suspected during pregnancy, prompt myocardial biopsy is crucial for timely pathological diagnosis and treatment decisions. Clinicians should consider premature delivery prior to a possible failure in maternal hemodynamics.
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- 2019
13. Gender difference in heart failure with preserved ejection fraction: clinical profiles, examinations, and prognosis
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Takahiro Sakai, Hirohiko Motoki, Sho Suzuki, Aya Fuchida, Takahiro Takeuchi, Kyuhachi Otagiri, Masafumi Kanai, Kazuhiro Kimura, Masatoshi Minamisawa, Koji Yoshie, Tatsuya Saigusa, Soichiro Ebisawa, Ayako Okada, Hiroshi Kitabayashi, and Koichiro Kuwahara
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Cohort Studies ,Heart Failure ,Male ,Sex Factors ,Aminobutyrates ,Biphenyl Compounds ,Humans ,Female ,Stroke Volume ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Prognosis - Abstract
Heart failure with preserved ejection fraction (HFpEF) has currently become a major concern in the aging society owing to its substantial and growing prevalence. Recent investigations regarding sacubitril/valsartan have suggested that there is a gender difference in the efficacy of the medication in HFpEF cohort. However, information of gender difference in clinical profiles, examination, and prognosis have not been well investigated. The present study aimed to evaluate the differences in baseline characteristics and outcomes between women and men in a Japanese HFpEF cohort. We analyzed the data from our prospective, observational, and multicenter cohort study. Overall, 1036 consecutive patients hospitalized for acute decompensated heart failure were enrolled. We defined patients with an ejection fraction (EF) of ≥ 50% as HFpEF. Patients with severe valvular disease were excluded; the remaining 379 patients (women: n = 201, men: n = 178) were assessed. Women were older than men [median: 85 (79–89) years vs. 83 (75–87) years, p = 0.013]. Diabetes mellitus, hyperuricemia, and coronary artery disease were more prevalent in men than in women (34.8% vs. 23.9%, p = 0.019, 23.6% vs. 11.4%, p = 0.002, and 23.0% vs. 11.9%, p = 0.005, respectively). EF was not significantly different between women and men. The cumulative incidence of cardiovascular death or hospitalization for congestive heart failure (CHF) was significantly lower in women than in men (log-rank p = 0.040). Women with HFpEF were older and less often exhibited an ischemic etiology; further, they were associated with a lower risk for cardiovascular death or hospitalization for CHF compared with men in the Japanese population.
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- 2021
14. Which plantar region can predict peripheral arterial disease by using laser speckleflowgraphy?
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Shigetoshi Tsuzuki, Soichiro Ebisawa, Kazuhiro Tsunekawa, Ikkei Takashimizu, Shunsuke Yuzuriha, and Tamon Kato
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medicine.medical_specialty ,Heel ,Arterial disease ,business.industry ,Lasers ,Significant difference ,Cardiovascular Abnormalities ,Area under the curve ,Blood flow ,Peripheral ,Cardiac surgery ,body regions ,Peripheral Arterial Disease ,medicine.anatomical_structure ,Regional Blood Flow ,Ophthalmology ,medicine ,Humans ,Ankle Brachial Index ,Plantar region ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Abstract
Laser speckle flowgraphy (LSFG) is a new device that can measure skin blood flow and capture the movement of erythrocytes. However, there are a few reports on the use of LSFG to estimate skin blood flow, especially in the lower extremities. We aimed to compare plantar skin blood flow between patients with and without peripheral arterial disease (PAD) to discern the extent to which LSFG could accurately predict PAD. We prospectively measured the plantar skin blood flow in 28 patients with PAD and 37 participants without PAD at two hospitals from 2017 to 2021, using the ankle-brachial index (ABI) and LSFG. We partitioned the plantar into 12 parts: digits 1-5, medial metatarsal, middle metatarsal, lateral metatarsal, medial arch, middle arch, lateral arch, and heel, and compared the difference between the two groups and the area under the curve (AUC) of each point. Statistical analyses were performed to determine the sensitivity, specificity, false-positive rate, and false-negative rate at high accuracy points of AUC and ABI. There was a significant difference among the 12 points between the two groups, and the ratio using toe 1 and toe 5 was highly accurate. The ratio using toe 1 indicated higher sensitivity (89 vs. 82%), higher false-positive rate (22 vs. 4%), lower specificity (81 vs. 97%), and an equivalent false-negative rate (9 vs. 12%) to that of the ABI. These findings could facilitate the use of LSFG to estimate the skin blood flow condition in the plantar skin. Our results indicate that measuring toe 1 using LSFG could be used to somewhat assess PAD.
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- 2021
15. Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry
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Chie Nakamura, Soichiro Ebisawa, Takashi Miura, Hidetomo Nomi, Yusuke Kanzaki, Hisanori Yui, Shusaku Maruyama, Ayumu Nagae, Yasushi Ueki, Takahiro Sakai, Tamon Kato, Tatsuya Saigusa, Ayako Okada, Hirohiko Motoki, and Koichiro Kuwahara
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Cohort Studies ,Percutaneous Coronary Intervention ,Treatment Outcome ,Myocardial Infarction ,Humans ,ST Elevation Myocardial Infarction ,Coronary Artery Disease ,Prospective Studies ,Registries ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine - Abstract
Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (−) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p p p p p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.
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- 2021
16. Successful inferior vena cava filter removal using pacemaker lead extraction methods
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Hideki Kobayashi, Ayako Okada, Wataru Shoin, Tomoaki Mochidome, Takahiro Okano, Tadashi Itagaki, Tatsuya Saigusa, Morio Shoda, Yasutaka Oguchi, Hiroaki Tabata, Koichiro Kuwahara, Soichiro Ebisawa, and Hirohiko Motoki
- Subjects
medicine.medical_specialty ,business.industry ,Removal procedure ,Deep vein ,Perforation (oil well) ,Inferior vena cava filter ,Adhesion (medicine) ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombosis ,Inferior vena cava ,Article ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine.vein ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Lead extraction - Abstract
Inferior vena cava (IVC) filters are often used to treat deep vein thrombosis. IVC filters may become difficult to extract because of adhesion around the device, and those permanently left inside the patient may cause injurious complications. We describe a novel IVC filter extraction technique using pacemaker lead extraction tools. A 26-year-old woman, diagnosed with deep vein thrombosis by computed tomography, received an IVC filter (Gunther Tulip, Cook Medical, Bloomington, IN, USA) implantation for prevention of pulmonary thromboembolism. Eleven weeks later, extraction of the IVC filter by a manual method and snaring technique was unsuccessful because of adhesion to the blood vessel wall. The patient was referred to our hospital for filter removal using pacemaker lead extraction tools. Extraction was performed in an operation room under general anesthesia in the presence of a cardiovascular surgeon, to manage inadvertent perforation. Part of the adhered tissue around the four limbs of the filter was dissected using a 12 Fr laser sheath; protruding anchors were carefully dissected with a telescoping mechanical sheath using a counter-traction technique. Her postoperative course was uneventful, and she was discharged without complications. A sophisticated removal procedure with pacemaker lead extraction tools can be used to remove problematic IVC filters.
- Published
- 2019
17. Prognostic significance of high-sensitivity cardiac troponin in patients with heart failure with preserved ejection fraction
- Author
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Ayako Okada, Yukari Okuma, Hirohiko Motoki, Kazuhiro Kimura, Wataru Shoin, Takahiro Okano, Soichiro Ebisawa, Masatoshi Minamisawa, Sho Suzuki, and Koichiro Kuwahara
- Subjects
Male ,medicine.medical_specialty ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Troponin T ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Adverse effect ,Stroke ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,business.industry ,Stroke Volume ,Prognosis ,musculoskeletal system ,medicine.disease ,Cardiac surgery ,Heart failure with preserved ejection fraction ,High-sensitivity troponin T ,ROC Curve ,Heart failure ,Multivariate Analysis ,Cardiology ,Original Article ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
The aim of this study was to investigate the prognostic significance of high-sensitivity troponin T (hs-TnT) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). We enrolled consecutive patients admitted to Shinshu University Hospital for HF treatment between July 2014 and March 2017 and stratified them into HF with reduced ejection fraction and HFpEF groups (left ventricular ejection fraction
- Published
- 2019
18. Establishment of a Healthcare System for Patients With Adult Congenital Heart Disease in Collaboration With Children’s Hospital ― The Nagano Model ―
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Toru Okamura, Kohta Takei, Tatsuya Saigusa, Hirohiko Motoki, Tatsuichiro Seto, Ayako Okada, Kenji Okada, Soichiro Ebisawa, Satoshi Yasukochi, Morio Shoda, Koichiro Kuwahara, Masatoshi Minamisawa, Kazuhiro Kimura, and Kiyohiro Takigiku
- Subjects
Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,Cardiology ,Psychological intervention ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Cardiologists ,0302 clinical medicine ,Health care ,medicine ,Humans ,Outpatient clinic ,030212 general & internal medicine ,Child ,Intersectoral Collaboration ,Pregnancy ,Adult patients ,business.industry ,General Medicine ,Hospitals, Pediatric ,University hospital ,medicine.disease ,Emergency medicine ,Female ,Cardiology Service, Hospital ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Healthcare system - Abstract
Background Despite the best efforts of pediatricians, healthcare for adult patients with congenital heart disease (ACHD) has proven challenging because of the increased numbers. This study presents the process of establishing an ACHD care system as a collaborative effort between Shinshu University Hospital and Nagano Children's Hospital. Methods and Results: Establishing an outpatient clinic for transition, a cooperation agreement for in-patient care between the 2 hospitals, and quality management of diagnostic imaging and educational meetings for adult cardiologists were the 3 major challenges. Of the 99 patients who visited the transition clinic in the children's hospital between May 2014 and December 2016, 3 returned to the pediatrician's clinic. Between June 2013 and December 2017, 273 patients visited the ACHD center in Shinshu University Hospital. Until December 2017, mortality and fatal arrhythmia were noted in 3 and 2 cases, respectively. Catheter ablation for arrhythmia was performed in 12 cases, and 4 cases of pregnancy with moderate/severe ACHD or estimated as high risk were managed with healthy livebirths. Surgical interventions for moderate/severe ACHD were performed in collaboration with the children's hospital or Sakakibara Heart Institute. Conclusions Patients were successfully transferred to adult cardiology departments. Surgical and nonsurgical interventions for ACHD were provided. Collaboration between adult and pediatric cardiologists assists in the establishment of healthcare systems for ACHD.
- Published
- 2019
19. A case of thrombolytic therapy with recombinant tissue plasminogen activator for mechanical valve thrombosis at 9 weeks of pregnancy in a Japanese woman
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Yusuke Yokokawa, Takashi Ichino, Kazuhiro Kimura, Koichiro Kuwahara, Soichiro Ebisawa, Toshinori Komatsu, Hirohiko Motoki, Tatsuya Saigusa, and Hirofumi Ando
- Subjects
medicine.medical_specialty ,Pregnancy ,business.industry ,medicine.medical_treatment ,Warfarin ,Heparin ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombosis ,Article ,Surgery ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,medicine ,Cardiology ,Caesarean section ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business ,medicine.drug - Abstract
A 29-year-old woman was admitted to our hospital due to diagnosis of pregnancy at 5 weeks and a day. She underwent valve replacement with mechanical heart valve (MHV: SJM valve) for congenital mitral valve regurgitation, when 11 years old. Warfarin 4 mg was used for anticoagulation. After admission, warfarin was replaced by unfractionated heparin (UFH). She developed exertional dyspnea at 8 weeks of pregnancy. Echocardiogram and fluoroscopy showed an immobile leaflet in the closed position. She was diagnosed with mechanical valve thrombosis. Cardiac surgery or thrombolytic therapy (TT) were treatment options. TT is not established, but is reported to be safer than cardiac surgery. Recently, low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) therapy showed acceptable results. About 2.5 h after an intravenous injection of rt-PA, diastolic rumble improved to the normal range of leaflet. Thereafter, warfarin was restarted and there was no recurrence of symptoms and no abortion. She was readmitted for the scheduled Caesarean section (CS) at 32 weeks of pregnancy, and warfarin was replaced with UFH. At 34 weeks of pregnancy, a baby was delivered by CS. She suffered hemostasis after surgery under the anticoagulation. Postoperative day 31, both mother and a child were healthy and left the hospital.
- Published
- 2019
20. Predictive Value of Abdominal Fat Distribution on Coronary Artery Disease Severity Stratified by Computed Tomography-Derived SYNTAX Score
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Yusuke Tsujinaka, Hisanori Yui, Takahiro Takeuchi, Kyuhachi Otagiri, Soichiro Ebisawa, Tamon Kato, Koichiro Kuwahara, Keisuke Machida, Tatsuya Saigusa, Chie Nakamura, Hiroshi Kitabayashi, Takahiro Sakai, Tadashi Itagaki, and Hirohiko Motoki
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Iohexol ,Abdominal Fat ,Adipose tissue ,Contrast Media ,030209 endocrinology & metabolism ,Computed tomography ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Positive correlation ,Coronary Angiography ,Severity of Illness Index ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Abdominal fat ,Humans ,Risk factor ,Aged ,medicine.diagnostic_test ,business.industry ,nutritional and metabolic diseases ,Middle Aged ,medicine.disease ,Predictive value ,Cardiology ,Female ,Subcutaneous adipose tissue ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study aimed to evaluate the association between abdominal fat distribution (AFD) and coronary artery disease (CAD) complexities using the computed tomography (CT)-derived SYNTAX score (CT-SXscore). Coronary computed tomographic angiography (CCTA) was performed in patients with suspected CAD. Plain abdominal CT was performed to measure visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. To assess AFD, VAT/SAT (V/S) ratios were calculated. The CT-SXscore was calculated in patients with significant stenoses assessed by CCTA. Of 942 enrolled patients, 310 (32.9%) had 1 or more significant stenoses. The CT-SXscore showed a positive correlation with the V/S ratio (r = 0.33, p < 0.001). In the multivariate regression analysis, the V/S ratio was the only independent predictor for CAD severity based on the CT-SXscore (β = 0.25; t = 4.14; p < 0.001), even though the absolute SAT and VAT areas showed no relationship to the CT-SXscore. Regarding the 4 CAD-patient groups divided according to their median VAT and SAT areas, the CT-SXscore was significantly higher for the high VAT/low SAT group than for any other group (19.6 ± 11.5 vs 13.3 ± 9.6 in the low VAT/low SAT, 10.1 ± 8.5 in the low VAT/high SAT, and 12.2 ± 8.7 in the high VAT/high SAT groups; p < 0.001 for all). In conclusion, it was found that the V/S ratio is a useful index for predicting CAD severity and that AFD may be a more important risk factor for CAD than the absolute amount of each abdominal fat.
- Published
- 2021
21. Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry
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Masanori Kobayashi, Takahiro Sakai, Takashi Yanagisawa, Takahiro Kobayashi, Koichiro Kuwahara, Yoshiteru Okina, Noboru Watanabe, Keisuke Machida, Kyoko Shoin, Minami Taki, Hiroyuki Nakajima, Naoto Hashizume, Soichiro Ebisawa, Keisuke Senda, Yusuke Miyashita, Tatsuya Saigusa, Hidetomo Nomi, Kyuhachi Otagiri, Takuya Maruyama, Takahiro Tachibana, Masafumi Kanai, Yusuke Kanzaki, Naoyuki Abe, Kenichi Karube, Hisanori Yui, Toshio Kasai, Tomoaki Mochidome, Takashi Miura, Daisuke Kashiwagi, Uichi Ikeda, and Yukari Okuma
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Renal function ,030204 cardiovascular system & hematology ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Coronary vascular disease ,030212 general & internal medicine ,Myocardial infarction ,cardiovascular diseases ,Registries ,Renal Insufficiency, Chronic ,Renal insufficiency ,Heart Failure ,Prognostic factor ,business.industry ,Major adverse cardiovascular event (MACE) ,Acute kidney injury ,Percutaneous coronary intervention ,Acute Kidney Injury ,medicine.disease ,Prognosis ,Heart failure ,Conventional PCI ,Cardiology ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Kidney disease - Abstract
Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p p p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p p p
- Published
- 2020
22. Safe and effective transvenous lead extraction for elderly patients utilizing non-laser and laser tools: a single-center experience in Japan
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Hirohiko Motoki, Tatsuya Saigusa, Takahiro Okano, Wataru Shoin, Morio Shoda, Hideki Kobayashi, Ayako Okada, Hiroaki Tabata, Ken Kato, Koji Yoshie, Koichiro Kuwahara, and Soichiro Ebisawa
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Pacemaker, Artificial ,Percutaneous ,Time Factors ,Adolescent ,030204 cardiovascular system & hematology ,Single Center ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Japan ,Cardiac tamponade ,Medicine ,Humans ,030212 general & internal medicine ,Lead (electronics) ,Device Removal ,Aged ,Retrospective Studies ,business.industry ,Vascular surgery ,Middle Aged ,medicine.disease ,Surgery ,Cardiac surgery ,Defibrillators, Implantable ,Treatment Outcome ,Cohort ,Female ,Lasers, Excimer ,Laser Therapy ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Follow-Up Studies - Abstract
Transvenous lead extraction (TLE) for cardiac implantable electric device (CIED) infection is becoming increasingly common, but is believed to be particularly risky in elderly patients. This study aimed to clarify the safety and effectiveness of TLE in the elderly, evaluating the use of both non-laser and laser extraction tools. We retrospectively analyzed the characteristics, device type, indications, procedures, and clinical results in younger (YG; age: 15–79 years; n = 48) and elderly groups (EG; age: ≥ 80 years; n = 27) of patients who underwent percutaneous TLE between April 2014 and December 2019 at our hospital. The average age was 68 and 88 years in the YG and EG, respectively. Indications for TLE were infection in 33 (68.8%) patients and other in 15 (30.6%) patients in the YG, and infection in all 27 (100%) EG patients. Bloodstream infection was detected in 9 and 4 patients in the YG and EG, respectively, with methicillin-resistant Staphylococcus epidermidis being the most common causative pathogen. All TLE procedures were performed under general anesthesia in an operating room with cardiovascular surgeon backup. An excimer laser sheath (76 leads), a laser followed by a mechanical sheath (45 leads), Evolution RL® (17 leads), a mechanical sheath (9 leads), and manual traction (one lead) were employed to extract a total of 148 leads (98 and 50 in the YG and EG, respectively). A mechanical sheath or Evolution RL® was more frequently used in the YG. The respective average implantation durations in the YG and EG were 5.3 and 5.0 years, respectively, which were comparable (p = 0.46). Procedural success rates were identical between the YG and EG (99% vs. 100%, respectively). There was only one procedure-related complication in the entire cohort (cardiac tamponade in a YG patient). Taken together, the success rates of TLE were high in the EG, with no complications, with extraction being the indication for infection in all EG patients. Percutaneous TLE was safe and effective in elderly patients using both non-laser and laser techniques.
- Published
- 2020
23. Dual Antiplatelet Therapy for 6 Versus 18 Months After Biodegradable Polymer Drug-Eluting Stent Implantation
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Masato Nakamura, Raisuke Iijima, Junya Ako, Toshiro Shinke, Hisayuki Okada, Yoshiaki Ito, Kenji Ando, Hitoshi Anzai, Hiroyuki Tanaka, Yasunori Ueda, Shin Takiuchi, Yasunori Nishida, Hiroshi Ohira, Katsuhiro Kawaguchi, Makoto Kadotani, Hiroyuki Niinuma, Kazuto Omiya, Takashi Morita, Kan Zen, Yoshinori Yasaka, Kenji Inoue, Sugao Ishiwata, Masahiko Ochiai, Toshimitsu Hamasaki, Hiroyoshi Yokoi, Hidehiko Hara, Yoshinori Yaita, Itaru Takamisawa, Junji Yajima, Takayuki Ishihara, Shigeru Nakamura, Kenshi Fujii, Kazuhiro Ashida, Hiroshi Ota, Masaaki Okutsu, Masao Oshima, Ken Kongoji, Yasushi Jinno, Ryu Shutta, Nobuo Shiode, Tetsuo Oumi, Tatsuki Doijiri, Yoshiaki Yokoi, Takayuki Ogawa, Keizo Kimura, Mitsuru Munemasa, Hiroaki Mukawa, Kota Komiyama, Takeshi Suzuki, Takumi Inoue, Takafumi Ueno, Teruyasu Sugano, Jun Yamashita, Yoshio Yasumura, Haruo Kamiya, Hiroshi Fujita, Kazushi Urasawa, Shiro Ono, Masayoshi Ajioka, Jiro Ando, Koichi Mizuno, Haruo Hirayama, Taiki Tojo, Yuichiro Maekawa, Tomohiro Kawasaki, Takayuki Okamura, Fumitoshi Toyota, Yutaka Hikichi, Ichiro Michishita, Takafumi Yagi, Hiroshi Kamihata, Naohisa Shindo, Nobukazu Ishizaka, Takashi Ashikaga, Yukio Ozaki, Hisao Hara, Hiroshi Sakamoto, Kenji Kada, Naofumi Doi, Junko Honye, Hitoshi Takano, Masahito Kawata, Hidenori Houzawa, Toru Ozawa, Arifumi Kikuchi, Kazushige Kadota, Yoichi Kijima, Tomokazu Ikemoto, Yoshihisa Shimada, Kazuhiko Yumoto, Kenji Kawajiri, Yoichi Nozaki, Masayoshi Sakakibara, Atsushi Tosaka, Shigetaka Noma, Yasushi Wakabayashi, Masaharu Okada, Mizuki Hirose, Yuichiro Takagi, Takuro Takagi, Katsumi Miyauchi, Kazuhiko Misu, Satoshi Yasuda, Ryohei Yoshikawa, Ichiro Inoue, Minoru Yoshiyama, Toru Masuyama, Yoshiaki Tomobuchi, Seiji Yamazaki, Kengo Tanabe, Kenji Wagatsuma, Masayuki Kato, Kazuya Kawai, Yuji Hamazaki, Masakazu Yamagishi, Yoshisato Shibata, Kouki Watanabe, Koichi Tachibana, Hiroshi Wada, Kenji Ninomiya, Hiroshi Suzuki, Jiro Yoshioka, Chikara Mori, Masahiro Sonoda, Toru Kataoka, Hidenobu Terai, Yuko Onishi, Masanao Toma, Takeshi Serikawa, Yoritaka Otsuka, Shoji Yano, Soichiro Ebisawa, Hiroaki Takashima, Hideki Shimomura, Yoko Kurumatani, Shinjo Sonoda, and Hiroki Uehara
- Subjects
Male ,Time Factors ,Polymers ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Japan ,Randomized controlled trial ,Risk Factors ,law ,Absorbable Implants ,Clinical endpoint ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Hazard ratio ,Drug-Eluting Stents ,Middle Aged ,Clopidogrel ,Intention to Treat Analysis ,Treatment Outcome ,Drug-eluting stent ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Ticlopidine ,animal structures ,Hemorrhage ,Prosthesis Design ,Drug Administration Schedule ,03 medical and health sciences ,Percutaneous Coronary Intervention ,medicine ,Humans ,Acute Coronary Syndrome ,Aged ,Proportional Hazards Models ,Aspirin ,business.industry ,Stent ,medicine.disease ,Surgery ,Conventional PCI ,business ,Platelet Aggregation Inhibitors - Abstract
Objectives The NIPPON (Nobori Dual Antiplatelet Therapy as Appropriate Duration) study was a multicenter randomized investigation of the noninferiority of short-term versus long-term dual antiplatelet therapy (DAPT) in patients with implantation of the Nobori drug-eluting stent (DES) (Terumo, Tokyo, Japan), which has a biodegradable abluminal coating. Background The optimum duration of DAPT for patients with a biodegradable polymer-coated DES is unclear. Methods The subjects were 3,773 patients with stable or acute coronary syndromes undergoing Nobori stent implantation. They were randomized 1:1 to receive DAPT for 6 or 18 months. The primary endpoint was net adverse clinical and cerebrovascular events (NACCE) (all-cause mortality, myocardial infarction, stroke, and major bleeding) from 6 to 18 months after stenting. Intention-to-treat analysis was performed in 3,307 patients who were followed for at least 6 months. Results NACCE occurred in 34 patients (2.1%) receiving short-term DAPT and 24 patients (1.5%) receiving long-term DAPT (difference 0.6%, 95% confidence interval [CI]: 1.5 to 0.3). Because the lower limit of the 95% CI was inside the specified margin of −2%, noninferiority of short-term DAPT was confirmed. Mortality was 1.0% with short-term DAPT versus 0.4% with long-term DAPT, whereas myocardial infarction was 0.2% versus 0.1%, and major bleeding was 0.7% versus 0.7%, respectively. The estimated probability of NACCE was lower in the long-term DAPT group (hazard ratio: 1.44, 95% CI: 0.86 to 2.43). Conclusions Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227)
- Published
- 2017
24. Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure
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Uichi Ikeda, Koji Yoshie, Wataru Shoin, Yasushi Ueki, Hitoshi Nishimura, Naoto Hashizume, Kunihiko Shimizu, Naoyuki Abe, Mikiko Harada, Soichiro Ebisawa, Yasutaka Oguchi, Takashi Miura, Hirohiko Motoki, Masatoshi Minamisawa, Atsushi Izawa, Tomoaki Mochidome, and Jun Koyama
- Subjects
medicine.medical_specialty ,Diastole ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Retrospective Studies ,Heart Failure ,Ejection fraction ,business.industry ,Proportional hazards model ,Hazard ratio ,General Medicine ,Prognosis ,medicine.disease ,humanities ,Confidence interval ,Echocardiography ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Diastolic wall strain (DWS) is based on the linear elastic theory, according to which decreased wall thinning during diastole reflects reduced left ventricular compliance and thus increased diastolic stiffness. Increased diastolic stiffness as assessed by DWS is associated with a worse prognosis in patients who have heart failure (HF) with preserved ejection fraction. However, there are no data about the prognostic value of DWS derived by M-mode echocardiography in patients at risk for HF. We retrospectively enrolled 1829 consecutive patients without prior HF who were hospitalized for cardiovascular (CV) diseases in our hospital between 2005 and 2012. Patients were divided into two groups stratified by DWS (median value 0.34). The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for HF. Over a 4.2-year median follow-up, adverse events were observed in 322 patients (17.6%). In Kaplan-Meier analysis, patients with low DWS (≤ 0.34, n = 915) showed worse prognoses than those with high DWS (> 0.34, n = 914) (MACE incidence 39.4% versus 31.9%, P = 0.011). In multivariate Cox proportional hazards analysis after the adjustment for age, sex, and echocardiographic parameters, low DWS (≤ 0.34) was significantly associated with the incidence of MACE (hazard ratio: 1.26, 95% confidence interval: 1.01-1.59; P = 0 .045). In patients without prior HF, DWS is an independent predictor of MACE. Simple assessment of DWS might improve risk stratification for CV events in those patients.
- Published
- 2017
25. Successful bailout of stent graft stuck in stent occlusion lesion
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Koichiro Kuwahara, Ayumu Nagae, Tatsuya Saigusa, Tamon Kato, Takahiro Sakai, and Soichiro Ebisawa
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Images in Cardiovascular Intervention ,medicine.medical_treatment ,Graft Occlusion, Vascular ,MEDLINE ,Stent ,Interventional radiology ,General Medicine ,Coronary Angiography ,Stent occlusion ,Surgery ,Lesion ,Treatment Outcome ,Text mining ,medicine ,Humans ,Stents ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Bailout - Published
- 2020
26. Efficacy and Safety of Percutaneous Coronary Intervention for Elderly Patients in the Second-Generation Drug-Eluting Stent Era: The SHINANO Registry
- Author
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Yuichi Kamiyoshi, Uichi Ikeda, Hikaru Kimura, Takayuki Eisawa, Takuya Maruyama, Noboru Watanabe, Toshio Sato, Soichiro Ebisawa, Hiroyuki Nakajima, Hirohiko Motoki, Naoto Hashizume, Yusuke Miyashita, Shoji Hotta, Takashi Miura, Hiroshi Akanuma, Masanori Kobayashi, Shinichi Aso, Eiichiro Mawatari, and Hideki Kobayashi
- Subjects
Male ,medicine.medical_specialty ,Endpoint Determination ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Japan ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Prospective cohort study ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Treatment Outcome ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: We evaluated the 1-year outcomes of percutaneous coronary intervention (PCI) for elderly patients (aged ≥ 80 years) in the second-generation drug-eluting stent (DES) era. Methods and Results: Between August 2012 and July 2013, 1923 consecutive patients (mean age, 71 ± 11 years; ≥80 years, 23%; men, 77%) who underwent 2250 elective/urgent PCI procedures were enrolled in the Shinshu Prospective Multicenter Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention registry. The primary end point was major adverse cardiovascular events (MACEs; cardiovascular death, myocardial infarction, and stroke) at 1 year. The 1-year incidence of MACEs, cardiac death, and stroke was significantly higher in elderly patients than in nonelderly patients (12.4% vs 5.3%, P < .0001; 7.8% vs 2.2%, P < .0001; and 2.8% vs 1.3%, P = .033, respectively). However, no significant difference in elective PCI procedures was detected. In elderly patients, the incidence of cardiac death and target lesion revascularization was significantly lower for DES than for non-DES (2.7% vs 10.5%, P = .0001 and 4.1% vs 8.6%, P = .029, respectively). Conclusion: Although elderly patients had a significantly poorer prognosis than younger patients, the adverse events rate was comparable in those patients who underwent elective PCI in the second-generation DES era.
- Published
- 2016
27. Regression of left ventricular hypertrabeculation is associated with improvement in systolic function and favorable prognosis in adult patients with non-ischemic cardiomyopathy
- Author
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Takashi Miura, Soichiro Ebisawa, Masatoshi Minamisawa, Hirohiko Motoki, Ayako Kozuka, Ayako Okada, Uichi Ikeda, Atsushi Izawa, and Jun Koyama
- Subjects
medicine.medical_specialty ,Ejection fraction ,Adult patients ,business.industry ,Cardiomyopathy ,Non ischemic cardiomyopathy ,Systolic function ,030204 cardiovascular system & hematology ,Favorable prognosis ,medicine.disease ,Regression ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Left ventricular hypertrabeculation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background We sometimes experience regression of left ventricular hypertrabeculation (LVHT), which is compatible with the diagnosis of LV non-compaction cardiomyopathy (LVNC) in adult patients. However, little is known about the association between LVHT regression and LV systolic function in adult patients. Methods We prospectively examined 23 consecutive adult patients who fulfilled the echocardiographic criteria for LVNC. LV reverse remodeling (RR) was defined as an absolute increase in LV ejection fraction of >10% at 6 months follow-up. LVHT area was calculated by subtraction from the outer edge to the inner edge of the LVHT at end-systole. Results The mean follow-up period was 61 months. LVRR was observed in 9 patients (39%). The changes in the mean LVHT area showed significant correlation with the changes in LV ejection fraction (r = −0.78, p Conclusions Regression of LVHT is associated with improvement in LV systolic function. LVRR might be associated with a favorable prognosis in patients with LVHT.
- Published
- 2016
28. Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure
- Author
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Shuhei Yamamoto, Soichiro Ebisawa, Musashi Nishimura, Ayako Okada, Tatsuya Saigusa, Masafumi Kanai, Masatoshi Minamisawa, Kazuhiro Kimura, Hirohiko Motoki, and Koichiro Kuwahara
- Subjects
Male ,medicine.medical_specialty ,Acute decompensated heart failure ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Severity of illness ,medicine ,Aerobic exercise ,Humans ,030212 general & internal medicine ,Mortality ,Exercise ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,Cardiac Rehabilitation ,business.industry ,Retrospective cohort study ,Resistance Training ,medicine.disease ,Prognosis ,Hospitalization ,Heart failure ,Cohort ,Acute Disease ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study ,Follow-Up Studies - Abstract
Background Although cardiac rehabilitation (CR) can improve exercise capacity and quality of life in patients with chronic heart failure (HF), the long-term prognostic influence of inpatient CR on patients with acute decompensated HF (ADHF) is not well established. We examined the impact of inpatient CR on disability and prognosis in patients with ADHF. Methods A total of 171 patients admitted for ADHF underwent CR that included resistance training and aerobic exercise. Patient disability was evaluated using Barthel Index (BI) scores at pre- (BIpre) and post- (BIpost) rehabilitation. All-cause mortality was retrospectively recorded after discharge. Results In the study cohort (median age: 76 years), 46 patients experienced all-cause mortality during a median of 478 days of follow-up. Impaired BIpost (i.e., BI 15) among patients with impaired baseline BI. BIpost was an independent predictor of all-cause mortality after adjusting for age, sex, eGFR, BNP, hemoglobin, albumin, and left ventricular ejection fraction. Conclusions Inpatient CR led to improvements in disabilities among patients with ADHF. Baseline disabilities were associated with a poor prognosis. Greater improvements in BI to inpatient CR were significantly related to better outcomes in patients with impaired baseline BI. CR should be indicated for patients with ADHF.
- Published
- 2019
29. Prognostic value of ankle brachial index for future incident heart failure in patients without previous heart failure: data from the impressive predictive value of ankle brachial index for clinical long term outcome in patients with cardiovascular disease examined by ABI study
- Author
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Hitoshi Nishimura, Naoto Hashizume, Yasutaka Oguchi, Koji Yoshie, Hirohiko Motoki, Masatoshi Minamisawa, Jun Koyama, Naoyuki Abe, Soichiro Ebisawa, Wataru Shoin, Yasushi Ueki, Uichi Ikeda, Tomoaki Mochidome, Atsushi Izawa, Mikiko Harada, Takashi Miura, and Kunihiko Shimizu
- Subjects
Male ,medicine.medical_specialty ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Risk Assessment ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Ankle Brachial Index ,Cumulative incidence ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,business.industry ,Incidence ,Hazard ratio ,Middle Aged ,Prognosis ,medicine.disease ,Confidence interval ,Hospitalization ,body regions ,Log-rank test ,Echocardiography ,Heart failure ,Multivariate Analysis ,Cohort ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Follow-Up Studies ,Cohort study - Abstract
The ankle brachial index (ABI) is regarded as a predictor of future cardiovascular events. However, the relationship between ABI and incident heart failure (HF) in patients without previous HF is poorly understood. This study aimed to assess the prognostic value of ABI for incident HF in patients without previous HF. The IMPACT–ABI study was a retrospective, single-center, cohort study that enrolled and measured ABI in 3131 patients hospitalized for cardiovascular disease between January 2005 and December 2012. From this cohort, 307 patients were excluded because of previous HF and high (>1.4) ABI. The remaining 2824 patients were stratified into three groups: low ABI (≤0.9), borderline ABI (0.91–0.99), and normal ABI (1.0–1.4). The primary endpoint was hospitalization for HF. Over a mean 4.8-year follow-up, 105 cases of HF occurred. The cumulative incidence of HF was significantly higher in patients with low and borderline ABIs than in those with normal ABI (19.3 vs. 21.0 vs. 10.4 %, log rank P
- Published
- 2016
30. Long-Term Prognostic Implications of the Admission Shock Index in Patients With Acute Myocardial Infarction Who Received Percutaneous Coronary Intervention
- Author
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Naoyuki Abe, Toshio Katagiri, Naoto Hashizume, Yusuke Miyashita, Soichiro Ebisawa, Takashi Miura, Masaaki Uematsu, Ryuma Ishihara, Uichi Ikeda, Hirohiko Motoki, Takuya Tsujimura, Takayuki Ishihara, and Atsushi Tosaka
- Subjects
Male ,medicine.medical_specialty ,Systole ,medicine.medical_treatment ,Myocardial Infarction ,Blood Pressure ,030204 cardiovascular system & hematology ,Severity of Illness Index ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Heart Rate ,Predictive Value of Tests ,Internal medicine ,Heart rate ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Risk factor ,Aged ,Retrospective Studies ,Ejection fraction ,biology ,business.industry ,Percutaneous coronary intervention ,Prognosis ,medicine.disease ,Hospitalization ,Blood pressure ,Cardiology ,biology.protein ,Female ,Creatine kinase ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
The admission shock index (SI) enables prediction of short-term prognosis. This study investigated the prognostic implications of admission SI for predicting long-term prognoses for acute myocardial infarction (AMI). The participants were 680 patients with AMI who received percutaneous coronary intervention. Shock index is the ratio of heart rate and systolic blood pressure. Patients were classified as admission SI
- Published
- 2016
31. Comparison of mid-term outcomes between patients with and without atrial fibrillation undergoing coronary stenting in the second-generation drug-eluting stent era: from the SHINANO registry
- Author
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Noboru Watanabe, Takayuki Eizawa, Hiroshi Akanuma, Masanori Kobayashi, Shinichi Aso, Uichi Ikeda, Eiichiro Mawatari, Soichiro Ebisawa, Keisuke Senda, Takehiro Morita, Naoto Hashizume, Yusuke Miyashita, Shoji Hotta, Atsushi Izawa, Takuya Maruyama, Hideki Kobayashi, Hirohiko Motoki, Hiroyuki Nakajima, Hikaru Kimura, Yuichi Kamiyoshi, Toshio Sato, Takashi Miura, Shin-ichiro Uchikawa, and Jun Koyama
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Disease ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Stent ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Atrial fibrillation ,General Medicine ,medicine.disease ,Blood Vessel Prosthesis ,Treatment Outcome ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Little is known about the mid-term outcomes of patients with atrial fibrillation (AF) who undergo coronary stenting in the second-generation drug-eluting stent (DES) era. We evaluated the 1-year outcomes of AF patients undergoing percutaneous coronary intervention (PCI) with second-generation DES. This retrospective cohort analysis used integrated data from the SHINANO registry, a prospective observational multicenter cohort study, which enrolled 1923 consecutive patients undergoing PCI for any coronary artery disease. We retrospectively recruited 917 of these patients (mean age, 71.3 ± 10.0 years; male, 77 %) who received PCI with 2nd generation DES. The primary endpoint was net adverse clinical events (NACE: cardiac death, stroke, MI, stent thrombosis, and major bleeding) at 1 year. The secondary endpoints were major adverse cardiovascular events (MACE: cardiac death, stroke, and MI), stroke, MI, and major bleeding at 1 year. One-year follow-up was completed in 871 (94.9 %) patients, of whom 85 had AF. The incidence of NACE (15.4 vs. 7.3 %, P = 0.008), MACE (10.6 vs. 5.4 %, P = 0.047), and major bleeding (6.0 vs. 2.3 %, P = 0.049) were all significantly higher in AF compared to non-AF patients. On multivariate analysis, AF was an independent predictor of NACE (HR 2.32, 95 % CI 1.24-4.34, P = 0.008). In the second-generation DES era, patients with AF undergoing PCI still have a poorer prognosis, with more thrombotic and bleeding events, than those without AF. More attention should be paid to the thrombotic and bleeding risk in AF patients undergoing PCI.
- Published
- 2016
32. Comparison of Inflammatory Biomarkers in Outpatients With Prior Myocardial Infarction
- Author
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Hirofumi Hioki, Masatoshi Minamisawa, Soichiro Ebisawa, Takashi Miura, Jun Koyama, Yuichiro Kashima, Yusuke Miyashita, Uichi Ikeda, Atsushi Izawa, Hirohiko Motoki, and Naoyuki Abe
- Subjects
Male ,medicine.medical_specialty ,Growth Differentiation Factor 15 ,Time Factors ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,Outpatients ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Inflammation ,Ejection fraction ,biology ,business.industry ,Hazard ratio ,C-reactive protein ,General Medicine ,Prognosis ,medicine.disease ,Confidence interval ,C-Reactive Protein ,Cardiology ,biology.protein ,Myocardial infarction complications ,Female ,GDF15 ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Follow-Up Studies ,Kidney disease - Abstract
Inflammatory biomarkers have been proposed for use in the risk stratification of patients with acute myocardial infarction (AMI). We examined the value of inflammatory biomarkers over clinical features for predicting cardiovascular (CV) events in stable outpatients with MI. We enrolled 430 post-MI patients and measured their levels of high-sensitivity C reactive protein (hs-CRP), growth differentiation factor-15 (GDF-15), and the interleukin-1 receptor family member called ST2 (ST2), one month after AMI. Patients were prospectively followed for 3 years. In our study cohort (mean age, 66 ± 12 years; left ventricular ejection fraction, 55 ± 13%), CV events were observed in 39 patients (9.1%). Kaplan- Meier analysis revealed that patients with high levels of GDF-15 (≥ 1221.0 ng/L) showed poorer prognoses than those with low levels of GDF-15 (< 1221.0 ng/L) (20.4% versus 3.6%, P < 0.001); hs-CRP and ST2 did not show a similar correlation with prognoses. GDF-15 remained associated with CV events after adjusting for age, chronic kidney disease, and B-type natriuretic peptide (hazard ratio, 1.001; 95% confidence interval, 1.000 - 1.001; P = 0.046). GDF-15 provided an incremental predictive value for CV events over clinical features (incremental value in global χ(2) = 43.81, P < 0.001). In outpatients with prior MI, GDF-15 was an independent indicator of CV events, unlike hs-CRP and ST2. GDF15 provided an incremental prognostic value over clinical features.
- Published
- 2016
33. Predictive Value of Combining the Ankle-Brachial Index and SYNTAX Score for the Prediction of Outcome After Percutaneous Coronary Intervention (from the SHINANO Registry)
- Author
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Takashi Miura, Naoto Hashizume, Takayuki Eisawa, Yusuke Miyashita, Shoji Hotta, Hikaru Kimura, Kentaro Shimada, Noboru Watanabe, Hirohiko Motoki, Toshio Sato, Soichiro Ebisawa, Eiichiro Mawatari, Noriyuki Sekimura, Takehiro Morita, Shinichi Aso, Yasushi Ueki, Hiroyuki Nakajima, Takuya Maruyama, Yuichi Kamiyoshi, Atsushi Izawa, Uichi Ikeda, Hiroshi Akanuma, Jun Koyama, Masanori Kobayashi, and Shin-ichiro Uchikawa
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Coronary Angiography ,Risk Assessment ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Japan ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Ankle Brachial Index ,Prospective Studies ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Prospective cohort study ,Aged ,business.industry ,Hazard ratio ,Percutaneous coronary intervention ,Drug-Eluting Stents ,medicine.disease ,humanities ,Survival Rate ,Treatment Outcome ,Predictive value of tests ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
The Synergy Between PCI With TAXUS and Cardiac Surgery (SYNTAX) score is effective in predicting clinical outcome after percutaneous coronary intervention (PCI). However, its prediction ability is low because it reflects only the coronary characterization. We assessed the predictive value of combining the ankle-brachial index (ABI) and SYNTAX score to predict clinical outcomes after PCI. The ABI-SYNTAX score was calculated for 1,197 patients recruited from the Shinshu Prospective Multi-center Analysis for Elderly Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention (SHINANO) registry, a prospective, observational, multicenter cohort study in Japan. The primary end points were major adverse cardiovascular and cerebrovascular events (MACE; all-cause death, myocardial infarction, and stroke) in the first year after PCI. The ABI-SYNTAX score was calculated by categorizing and summing up the ABI and SYNTAX scores. ABI ≤ 0.49 was defined as 4, 0.5 to 0.69 as 3, 0.7 to 0.89 as 2, 0.9 to 1.09 as 1, and 1.1 to 1.5 as 0; an SYNTAX score ≤ 22 was defined as 0, 23 to 32 as 1, and ≥ 33 as 2. Patients were divided into low (0), moderate (1 to 2), and high (3 to 6) groups. The MACE rate was significantly higher in the high ABI-SYNTAX score group than in the lower 2 groups (low: 4.6% vs moderate: 7.0% vs high: 13.9%, p = 0.002). Multivariate regression analysis found that ABI-SYNTAX score independently predicted MACE (hazards ratio 1.25, 95% confidence interval 1.02 to 1.52, p = 0.029). The respective C-statistic for the ABI-SYNTAX and SYNTAX score for 1-year MACE was 0.60 and 0.55, respectively. In conclusion, combining the ABI and SYNTAX scores improved the prediction of 1-year adverse ischemic events compared with the SYNTAX score alone.
- Published
- 2016
34. Comparison of leg loader and treadmill exercise for evaluating patients with peripheral artery disease
- Author
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Yasushi Ueki, Takashi Miura, Tatsuya Saigusa, Jun Koyama, Keisuke Senda, Ayako Okada, Soichiro Ebisawa, Koichiro Kuwahara, Hirohiko Motoki, and Tomoaki Mochidome
- Subjects
Male ,medicine.medical_specialty ,Arterial disease ,Treadmill exercise ,Blood Pressure ,Walking ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,Ankle Brachial Index ,cardiovascular diseases ,030212 general & internal medicine ,Treadmill ,Aged ,Retrospective Studies ,Ultrasonography, Doppler, Duplex ,medicine.diagnostic_test ,business.industry ,Angiography ,Intermittent claudication ,Cardiac surgery ,body regions ,Loader ,Lower Extremity ,Cardiology ,Exercise Test ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Follow-Up Studies - Abstract
The exercise ankle-brachial index (ABI) helps diagnose lower extremity peripheral artery disease (PAD). Patients with comorbidities may be unable to perform treadmill exercise, the most common stress loading test. While the active pedal plantar flexion (APP) test using the leg loader, simple and easy stress loading device, could be an alternative, there are no data comparing the leg loader and treadmill exercise. Therefore, we aimed to compare APP using the leg loader and treadmill exercise to evaluate PAD. A total of 27 patients (54 limbs) diagnosed with PAD with intermittent claudication and considered for angiography and/or endovascular treatment were recruited prospectively, and both the leg loader and treadmill were performed. There was a strong correlation (r = 0.925, p
- Published
- 2018
35. THE IMPACT OF DIABETES AND HBA1C ON ELDER-PATIENTS AFTER PERCUTANEOUS CORONARY INTERVENTION: FROM SHINANO REGISTRY
- Author
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Shusaku Maruyama, Hisanori Yui, Tatsuya Saigusa, Chie Nakamura, Minami Taki, Keisuke Senda, Masanori Kobayashi, Ayako Okada, Daisuke Sunohara, Masafumi Kanai, Koichiro Kuwahara, Takashi Yanagisawa, Takahiro Sakai, Tamon Katou, Takashi Miura, Koki Fujimori, Ken Nishikawa, Ayumu Nagae, Kyoko Shoin, Soichiro Ebisawa, Daisuke Kashiwagi, Naoto Hashizume, Yusuke Miyashita, Kyuhachi Otagiri, and Hirohiko Motoki
- Subjects
Secondary prevention ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Arteriosclerosis ,medicine.disease ,Therapeutic goal ,Diabetes mellitus ,Conventional PCI ,Emergency medicine ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Diabetes is known to be one of the risks of arteriosclerosis. However, the therapeutic goal of HbA1c in diabetic elderly is still unclear, in particular, in secondary prevention after percutaneous coronary intervention (PCI). Between August 2012 and July 2013, a total of 1665 consecutive patients
- Published
- 2019
36. Geriatric Nutritional Risk Index Predicts Cardiovascular Events in Patients at Risk for Heart Failure
- Author
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Mikiko Harada, Uichi Ikeda, Kunihiko Shimizu, Soichiro Ebisawa, Koji Yoshie, Tatsuya Saigusa, Hitoshi Nishimura, Wataru Shoin, Takashi Miura, Atsushi Izawa, Keisuke Senda, Koichiro Kuwahara, Yasutaka Oguchi, Masatoshi Minamisawa, Hirohiko Motoki, Naoyuki Abe, Jun Koyama, Tomoaki Mochidome, Naoto Hashizume, and Yasushi Ueki
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,In patient ,Mass index ,030212 general & internal medicine ,Stage (cooking) ,Geriatric Assessment ,Aged ,Retrospective Studies ,Heart Failure ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,Hazard ratio ,General Medicine ,medicine.disease ,Prognosis ,Confidence interval ,Nutrition Assessment ,Cardiovascular Diseases ,Heart failure ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND The geriatric nutritional risk index (GNRI) is a simple and objective nutritional assessment tool for elderly patients. Lower GNRI values are associated with a worse prognosis in patients with heart failure (HF). However, few data are available regarding the prognostic effect of the GNRI value for risk stratification in patients at risk for HF.Methods and Results:We retrospectively investigated 1,823 consecutive patients at risk for HF (Stage A/B) enrolled in the IMPACT-ABI Study. GNRI on admission was calculated as follows: 14.89×serum albumin (g/dL)+41.7×body mass index/22. Patients were divided into 2 groups according to the median GNRI value (107.1). The study endpoint was a composite of cardiovascular (CV) events, including CV death and hospitalization for worsening HF. Over a 4.7-year median follow-up, CV events occurred in 130 patients. In the Kaplan-Meier analysis, patients with low GNRI (
- Published
- 2017
37. Predictive Value of Underweight Status for Patients With Peripheral Artery Disease With Claudication
- Author
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Tatsuya Saigusa, Masatoshi Minamisawa, Atsushi Izawa, Keisuke Senda, Hitoshi Nishimura, Satoko Higuchi, Jun Koyama, Koichiro Kuwahara, Yasutaka Oguchi, Yasushi Ueki, Hirohiko Motoki, Tomoaki Mochidome, Uichi Ikeda, Wataru Shoin, Hidetomo Nomi, Takashi Miura, and Soichiro Ebisawa
- Subjects
Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Overweight ,Gastroenterology ,Body Mass Index ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Thinness ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,business.industry ,Hazard ratio ,nutritional and metabolic diseases ,Critical limb ischemia ,Intermittent Claudication ,Middle Aged ,Prognosis ,Intermittent claudication ,Surgery ,Female ,medicine.symptom ,Underweight ,Cardiology and Cardiovascular Medicine ,business ,Claudication ,Weight gain ,Body mass index - Abstract
We evaluated whether underweight status is associated with poor prognosis in patients with peripheral artery disease (PAD) with claudication, excluding critical limb ischemia. We identified 441 claudicants hospitalized for cardiovascular disease between 2005 and 2012. Patients were divided into 4 groups according to body mass index (BMI): an underweight group (BMI < 18.5 kg/m2; n = 48), a normal group (BMI = 18.5-25.0 kg/m2; n = 286), an overweight group (BMI = 25.0-30.0 kg/m2; n = 92), and an obese group (BMI ≥ 30.0 kg/m2; n = 15). The mean follow-up period was 3.5 ± 1.9 years. The underweight group had significantly lower levels of hemoglobin, albumin, estimated glomerular filtration rate, triglycerides, and hemoglobin A1c; higher levels of C-reactive protein and B-type natriuretic peptide; and a higher prevalence of hemodialysis. The incidence of all-cause death and cardiovascular death was significantly higher in the underweight group (underweight vs normal, 77.1% vs 33.0%; P < .001 and 43.3% vs 14.4%; P < .001, respectively). In a multivariate Cox analysis, underweight status was an independent predictor of all-cause death (hazard ratio, 2.53; 95% confidence interval, 1.58-4.18; P < .001). Therefore, promoting weight gain, as well as managing cardiovascular disease, may be important for underweight patients with PAD.
- Published
- 2017
38. Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry
- Author
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Soichiro Ebisawa, Naoto Hashizume, Yusuke Miyashita, Uichi Ikeda, Hirohiko Motoki, Jun Koyama, Atsushi Izawa, Takashi Miura, and Koichiro Kuwahara
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Japan ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Ankle Brachial Index ,cardiovascular diseases ,030212 general & internal medicine ,Registries ,Aged ,business.industry ,Incidence ,Hazard ratio ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,medicine.disease ,Prognosis ,Confidence interval ,body regions ,Predictive value of tests ,Conventional PCI ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication ,human activities - Abstract
Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle–brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups—low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.
- Published
- 2017
39. In-Hospital Clinical Outcomes of Elderly Patients (≥80 Years) Undergoing Percutaneous Coronary Intervention
- Author
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Kentaro Shimada, Toshio Sato, Jun Koyama, Eiichiro Mawatari, Takeshi Tomita, Shin-ichiro Uchikawa, Naoto Hashizume, Takehiro Morita, Hiroyuki Nakajima, Yusuke Miyashita, Hiroshi Akanuma, Masanori Kobayashi, Shoji Hotta, Noriyuki Sekimura, Hikaru Kimura, Takuya Maruyama, Takayuki Eisawa, Noboru Watanabe, Atsushi Izawa, Shinichi Aso, Uichi Ikeda, Yuichi Kamiyoshi, Hirohiko Motoki, Takashi Miura, and Soichiro Ebisawa
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Coronary artery disease ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Hospital Mortality ,Prospective Studies ,Prospective cohort study ,Aged ,Aged, 80 and over ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,Conventional PCI ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Cohort study - Abstract
Background: The clinical outcomes of elderly patients (≥80 years old) undergoing percutaneous coronary intervention (PCI) has not been well established, despite recent advances in both devices and techniques. Methods and Results: We recruited patients from the SHINANO Registry, a prospective, observational, multicenter, cohort study. From August 2012 to July 2013, a total of 1,923 consecutive patients with 2,250 elective/urgent PCIs (2,105 admissions) (mean age, 71±11 years; ≥80 years, 23%; men, 77%) were enrolled. The primary endpoint was procedural success. The secondary endpoints were in-hospital death and in-hospital major adverse cardiovascular events (MACE). The procedural success rate was significantly lower (83.7% vs. 89.1%, P=0.0001), and the rates of in-hospital mortality and MACE were significantly higher in elderly than in non-elderly patients (3.6% vs. 1.5%, P=0.005; 4.4% vs. 2.3%, P=0.016, respectively). For elective PCI, the rates of procedural success and in-hospital MACE were similar between groups (90.3% vs. 91.3%, P=0.65, 2.3% vs. 1.2%, P=0.2, respectively). On multivariate analysis, being elderly was not an independent predictor of procedural failure (OR, 1.15; CI, 0.81–1.61; P=0.43). Conclusions: In elderly patients, PCI is safe and feasible. The presence of comorbidities is a more important factor than age alone. (Circ J 2014; 78: 1097–1103)
- Published
- 2014
40. IMPACT OF THE CLINICAL SYNTAX SCORE ON 5-YEAR CLINICAL OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION FROM SHINANO REGISTRY
- Author
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Takahiro Sakai, Keisuke Senda, Ayako Okada, Koichiro Kuwahara, Tatsuya Saigusa, Ayumu Nagae, Hirohiko Motoki, Hisanori Yui, Soichiro Ebisawa, Shusaku Mruyama, Daisuke Kashiwagi, Tamon Kato, Takashi Miura, and Chie Nakamura
- Subjects
medicine.medical_specialty ,Ejection fraction ,Syntax (programming languages) ,business.industry ,medicine.medical_treatment ,Renal function ,Percutaneous coronary intervention ,Predictive value ,humanities ,Lesion ,Internal medicine ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The SYNTAX score stratifies risk among drug-eluting stent-treated patients and is based on lesion characteristics alone. The Clinical SYNTAX Score (CSS) combines the SYNTAX score with age, ejection fraction, and creatinine clearance. We evaluated the predictive value of combining clinical factors
- Published
- 2019
41. PROGNOSTIC IMPACT OF GERIATRIC NUTRITIONAL RISK INDEX IN ELDERLY PATIENTS WITH HEART FAILURE
- Author
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Takahiro Okano, Koichiro Kuwahara, Ayako Okada, Soichiro Ebisawa, Masatoshi Minamisawa, Morio Shoda, Hirohiko Motoki, and Kazuhiro Kimura
- Subjects
medicine.medical_specialty ,business.industry ,Nutritional status ,social sciences ,medicine.disease ,Predictive value ,humanities ,Heart failure ,Nutritional risk index ,medicine ,In patient ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
The geriatric nutritional risk index (GNRI) is a simple and accurate tool for evaluating the nutritional status of in elderly patients. Although a lower GNRI score is associated with a worse prognosis in patients with heart failure (HF), the predictive value of GNRI in elderly hospitalized HF
- Published
- 2019
42. IMPACT OF ONSITE CARDIAC SURGICAL COVER ON LONG-TERM OUTCOMES OF PATIENTS WHO UNDERWENT PERCUTANEOUS CORONARY INTERVENTION: FROM SHINANO 5-YEARS REGISTRY
- Author
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Tatsuya Saigusa, Takahiro Sakai, Takashi Yanagisawa, Keisuke Senda, Shusaku Maruyama, Noboru Watanabe, Hiroaki Tabata, Kyoko Shoin, Hiroyuki Nakajima, Soichiro Ebisawa, Masanori Kobayashi, Kyuhachi Otagiri, Yukari Okuma, Masahumi Kanai, Takashi Miura, Chie Nakamura, Naoto Hashizume, Yusuke Miyashita, Daisuke Kashiwagi, Minami Taki, Kenichi Karube, Ayumu Nagae, Hirohiko Motoki, Koichiro Kuwahara, and Tamon Kato
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,medicine.medical_treatment ,medicine ,Long term outcomes ,Percutaneous coronary intervention ,Cover (algebra) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
43. IMPACT OF HYPERURICEMIA ON PATIENTS WITH DIABETES MELLITUS WHO UNDERWENT PERCUTANEOUS CORONARY INTERVENTION
- Author
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Hirohiko Motoki, Hisanori Yui, Soichiro Ebisawa, Koichiro Kuwahara, Takashi Miura, Chie Nakamura, Keisuke Senda, Tamon Katoh, Daisuke Kashiwagi, Hiroaki Tabata, Ayako Okada, Shusaku Maruyama, Tatsuya Saigusa, Takahiro Sakai, Ayumu Nagae, Daisuke Sunohara, Hideki Kobayashi, Ken Nishikawa, and Koki Fujimori
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,nutritional and metabolic diseases ,Percutaneous coronary intervention ,Disease ,medicine.disease ,Increased risk ,Internal medicine ,Diabetes mellitus ,medicine ,In patient ,Hyperuricemia ,Cardiology and Cardiovascular Medicine ,business - Abstract
The current understanding is that hyperuricemia(HUA) is associated with an increased risk of cardiovascular disease. However, it remains unclear whether HUA carries a risk of cardiovascular disease in patients with diabetes mellitus(DM). Three hundred five patients underwent percutaneous coronary
- Published
- 2019
44. THE PROGNOSIS OF WORSENING RENAL FUNCTION AFTER PERCUTANEOUS CORONARY INTERVENTION: FROM SHINANO 5 YEAR REGISTRY
- Author
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Hiroyuki Nakajima, Yoshiteru Okina, Kyoko Shoin, Noboru Watanabe, Masanori Kobayashi, Minami Taki, Tatsuya Saigusa, Masafumi Kanai, Soichiro Ebisawa, Keisuke Senda, Kyuhachi Otagiri, Takashi Miura, Takashi Yanagisawa, Naoto Hashizume, Yusuke Miyashita, Yukari Ookuma, and Kenichi Karube
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Cardiology ,Percutaneous coronary intervention ,Renal function ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
45. IMPACT OF HISTORY OF CEREBRO-VASCULAR DISEASE TO THE LONG-TERM OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE SHINANO 5 YEARS REGISTRY
- Author
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Hiroyuki Nakajima, Noboru Watanabe, Takashi Yanagisawa, Shusaku Maruyama, Naoto Hashidume, Soichiro Ebisawa, Daisuke Kashiwagi, Hirohiko Motoki, Masanori Kobayashi, Kenichi Karube, Ayumu Nagae, Yukari Okuma, Chie Nakamura, Keisuke Senda, Minami Taki, Ayako Okada, Hisanori Yui, Kyoko Shoin, Yusuke Miyashita, Masafumi Kanai, Takashi Miura, Kyuhachi Otagiri, Koichiro Kuwahara, and Tatsuya Saigusa
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Emergency medicine ,Long term outcomes ,Medicine ,Percutaneous coronary intervention ,Cerebro vascular disease ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
46. Duration of myocardial early systolic lengthening for diagnosis of coronary artery disease
- Author
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Takashi Miura, Tatsuya Saigusa, Ayako Kozuka, Uichi Ikeda, Soichiro Ebisawa, Hirohiko Motoki, Jun Koyama, Ayako Okada, Koichiro Kuwahara, and Masatoshi Minamisawa
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Speckle tracking echocardiography ,Coronary Artery Disease ,Fractional flow reserve ,030204 cardiovascular system & hematology ,QT interval ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,fractional flow reserve ,speckle tracking echocardiography ,Prospective cohort study ,business.industry ,Gold standard ,Percutaneous coronary intervention ,medicine.disease ,myocardial ischaemia ,Stenosis ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
ObjectiveMyocardial early systolic lengthening (ESL) duration is prolonged in patients with coronary artery disease (CAD). However, the relationship between the fractional flow reserve (FFR), the current gold standard for evaluating physiological myocardial ischaemia, and ESL has not been studied. The aims of this study were to investigate whether left ventricular (LV) ESL duration could identify patients with CAD, and to examine the relationship between FFR and LV ESL duration.MethodsIn this single-centre, cross-sectional, prospective study of 75 patients with suspected or known CAD, we performed two-dimensional speckle tracking echocardiography at rest on the day before coronary angiography or percutaneous coronary intervention. Apical 3 views were used to examine ESL duration, defined as time from onset of the Q wave to maximum myocardial systolic lengthening.ResultsThirty-five patients had non-significant stenosis. Forty patients with CAD underwent FFR testing: 17 had an FFR≥0.8 and 23 had an FFRConclusionAlthough myocardial ESL duration was significantly prolonged in patients with CAD compared with patients without CAD, ESL at rest showed poor reproducibility, and this new parameter did not predict FFR in patients with suspected CAD.
- Published
- 2018
47. Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: A sub-analysis of the SHINANO registry
- Author
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Naoto Hashizume, Yuichi Kamiyoshi, Mikiko Harada, Yusuke Miyashita, Shoji Hotta, Toshio Sato, Soichiro Ebisawa, Noboru Watanabe, Takashi Miura, Takuya Maruyama, Hiroyuki Nakajima, Takayuki Eisawa, Uichi Ikeda, Hikaru Kimura, Eiichiro Mawatari, Hideki Kobayashi, Hiroshi Akanuma, Masanori Kobayashi, and Takahiro Kobayashi
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Coronary artery disease ,Cohort Studies ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Myocardial Revascularization ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Registries ,Aged ,Aged, 80 and over ,business.industry ,Age Factors ,Percutaneous coronary intervention ,medicine.disease ,Survival Analysis ,Treatment Outcome ,Drug-eluting stent ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (≥75years old) with multi-vessel CAD.The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke).Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29-4.80; p=0.007, HR, 0.40; 95% CI, 0.20-0.77; p=0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p=0.015).Even in elderly patients over 75years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.
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- 2016
48. Comparison of platelet aggregation response in switching regimen from prasugrel to clopidogrel between CYP2C19 extensive versus non-extensive metabolizers
- Author
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Yasushi Ueki, Keisuke Senda, Uichi Ikeda, Soichiro Ebisawa, Hitoshi Nishimura, Takashi Miura, Tatsuya Saigusa, Jun Koyama, Hirohiko Motoki, and Tomoaki Mochidome
- Subjects
Blood Platelets ,Male ,Acute coronary syndrome ,medicine.medical_specialty ,Prasugrel ,Genotype ,Platelet Aggregation ,Platelet Function Tests ,medicine.medical_treatment ,CYP2C19 ,030204 cardiovascular system & hematology ,Loading dose ,03 medical and health sciences ,0302 clinical medicine ,P2Y12 ,Percutaneous Coronary Intervention ,Internal medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Prospective Studies ,Acute Coronary Syndrome ,Aged ,business.industry ,Maintenance dose ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Clopidogrel ,Cytochrome P-450 CYP2C19 ,Anesthesia ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Little is known about the response of platelet aggregation in patients with acute coronary syndrome (ACS) when prasugrel is changed to clopidogrel. In this study, we evaluated the pharmacodynamic effects of this medication switch. Twenty-one consecutive ACS patients received prasugrel 20 mg as a loading dose before emergent percutaneous coronary intervention and 3.75 mg as a maintenance dose on days 2-7 (prasugrel phase). From day 8, prasugrel was switched to clopidogrel 75 mg/day (clopidogrel phase). P2Y12 reaction units (PRU) were measured 2-4 h after prasugrel loading, and on days 7, 11, 13, 15, and 42. Eight patients had the CYP2C19 extensive metabolizer (EM) genotype variant, while 13 were non-EM. In the EM group, no changes were observed in PRU level between days 7 and 15 (136.8 ± 51.2 vs. 166.2 ± 41.9, P = 0.07). However, in the non-EM group, a significant increase in PRU levels was observed between days 7 and 15 (165.8 ± 57.2 vs. 223.6 ± 60.9, P = 0.002). However, 2 patients in the non-EM group (15%) showed high on-clopidogrel treatment platelet reactivity (HTPR) 2-4 h after prasugrel loading, and during the clopidogrel phase there were significant differences in the incidence of HTPR between the EM and non-EM groups. Ischemic and bleeding events were not observed during this period. In the acute phase of ACS, changing from prasugrel to clopidogrel therapy decreased the effects of suppressing platelet aggregation. However, this change was not associated with increased ischemic or bleeding events.
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- 2016
49. Comparison of the standard and speckle tracking echocardiographic features of wild-type and mutated transthyretin cardiac amyloidoses
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Soichiro Ebisawa, Uichi Ikeda, Yoshiki Sekijima, Shu-ichi Ikeda, Jun Koyama, Hirohiko Motoki, Masatoshi Minamisawa, Ayako Okada, Ayako Kozuka, Atsushi Izawa, and Takashi Miura
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Cardiac function curve ,Male ,medicine.medical_specialty ,Pathology ,Biopsy ,Cardiomyopathy ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Basal (phylogenetics) ,0302 clinical medicine ,Internal medicine ,Image Interpretation, Computer-Assisted ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Amyloid Neuropathies, Familial ,Ejection fraction ,biology ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Transthyretin ,Cross-Sectional Studies ,Echocardiography ,biology.protein ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies ,Radial stress ,030217 neurology & neurosurgery - Abstract
Aims To compare cardiac function in patients with the two types of transthyretin (TTR)-related amyloidoses [wild-type (wt) and mutated (m) TTR amyloidoses (ATTR)] using standard and speckle tracking echocardiography (STE). Methods and results Twenty-one consecutive patients with biopsy-proved ATTRwt were compared with 21 patients with ATTRm from the database, matched by age and left ventricular (LV) wall thickness ( n = 135, ATTRm). All patients were examined using 2D echocardiography. Apical four- and two-chamber, and long-axis views and basal, mid, and apical short-axis views were used to examine LV longitudinal, circumferential, and radial strains. LV ejection fraction (EF), LV basal circumferential/radial strain, and mid-radial strain were significantly lower in patients with ATTRwt compared with patients with ATTRm. There was no significant difference between the two groups in the other parameters. In the receiver-operating characteristic curve analysis, LVEF and LV basal mean radial strain were the best parameters for distinguishing between the two groups. Conclusion Patients with ATTRwt are characterized by lower LVEF, LV basal, and LV mid-radial strains compared with patients with ATTRm. LVEF and LV radial strain are useful in distinguishing between ATTRwt and ATTRm when TTR has been proved in biopsy specimens.
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- 2015
50. TCT-338 Head-to-Head Comparison of Two Commercially Available Automated Detection Algorithms for Lumen Contour in Optical Coherence Tomography Analysis
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Soichiro Ebisawa, Kyuhachi Otagiri, Kozo Okada, Shigemitsu Tanaka, Hiroshi Kitabayashi, Yasuhiro Honda, Takashi Miura, Hideki Kitahara, Uichi Ikeda, Paul G. Yock, Yuhei Kobayashi, Yusuke Miyashita, and Peter J. Fitzgerald
- Subjects
genetic structures ,Optical coherence tomography ,medicine.diagnostic_test ,business.industry ,Head to head ,Medicine ,business ,Cardiology and Cardiovascular Medicine ,respiratory tract diseases ,Biomedical engineering ,Lumen (unit) - Published
- 2015
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