研究者詳細 - 古澤　健司

Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF CARDIOVASCULAR PHARMACOLOGY 74 巻 ( 3 ) 頁： 210 - 217 2019年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiovascular Pharmacology

Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score-matched pairs (hazard ratio 6.21, 95% confidence interval 3.29-11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68-14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.

DOI： 10.1097/FJC.0000000000000702

Left Ventricular Relaxation Half-Time as a Predictor of Cardiac Events in Idiopathic Dilated Cardiomyopathy and Hypertrophic Cardiomyopathy With Left Ventricular Systolic and/or Diastolic Dysfunction

Yokoi, T; Morimoto, R; Oishi, H; Kato, H; Arao, Y; Yamaguchi, S; Kuwayama, T; Haga, T; Hiraiwa, H; Kondo, T; Furusawa, K; Fukaya, K; Sawamura, A; Okumura, T; Hirashiki, A; Murohara, T

AMERICAN JOURNAL OF CARDIOLOGY 124 巻 ( 3 ) 頁： 435 - 441 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：American Journal of Cardiology

Purpose: Diastolic dysfunction preceding systolic dysfunction is considered an important interaction in cardiomyopathy with poor prognosis. The aim of this study was to compare left ventricular (LV) isovolumic relaxation with the other parameters as a potential prognostic marker for patients with idiopathic dilated cardiomyopathy (IDC) and hypertrophic cardiomyopathy (HC). Methods: A total of 145 patients with IDC and 116 with HC were evaluated for hemodynamic parameters; LV pressure was directly measured by a micromanometer catheter, and relaxation half-time (T1/2) was used to determine LV isovolumic relaxation. The median follow-up period was 4.7 years. Results: The mean ages of the patients with IDC and HC were 52.0 ± 12.0 and 57.1 ± 12.4 years, respectively. Each patient group was further divided into 2 groups based on the median value of T1/2: (1) <41.0 ms (D-L group) and ≥41.0 ms (D-H group) (2) <38.5 ms (H-L group) and ≥38.5 ms (H-H group). Kaplan-Meier analysis showed a significantly higher probability of cardiac events in the D-H group than in the D-L group (p = 0.001) and in the H-H group than in the H-L group (p = 0.028). Further, Cox proportional hazard regression analysis revealed that T1/2 was an independent predictor of cardiac events for patients with IDC (hazard ratio 1.109; p = 0.007) and HC (hazard ratio 1.062; p = 0.041). In conclusion, regardless of the type of cardiomyopathy, T1/2 as a measure of LV isovolumic relaxation function was found to be associated with the occurrence of cardiac events.

DOI： 10.1016/j.amjcard.2019.05.005

Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention Open Access

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF CARDIOLOGY 73 巻 ( 6 ) 頁： 479 - 487 2019年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: No standardized tool exists for weighting bleeding risk before selecting an antithrombotic regimen in patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet agents. Methods: We performed PCI in 3718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OAC and antiplatelet agents. We retrospectively evaluated the predictive performance of four major bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS score). Patients were followed for up to 3 years for bleeding events, defined as a composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and the Bleeding Academic Research Consortium (BARC) criteria. Results: TIMI significant bleedings (major, minor, and requiring medical attention) were seen in 90 patients (29.8%); whereas the BARC class ≥3 bleedings were seen in 53 patients (17.5%). Regarding TIMI significant bleedings, HAS-BLED, ORBIT, and PRECISE-DAPT scores equally categorized high-risk patients, but the PARIS score could not [high-risk versus non-high-risk: hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.15–2.64; p = 0.01; HR, 1.63; 95% CI, 1.08–2.48; p = 0.02; HR, 1.62; 95% CI, 1.06–2.51; p = 0.03; HR, 1.05; 95% CI, 0.70–1.63; p = 0.79, respectively); regarding BARC class ≥3 bleeding, all four scores could stratify high-risk patients (high-risk versus non-high-risk: HR, 2.23; 95% CI, 1.30–3.88; p = 0.004; HR, 2.25; 95% CI, 1.31–3.96; p = 0.003; HR, 3.87; 95% CI, 2.06–7.91; p < 0.0001; HR, 1.85; 95% CI, 1.04–3.47; p = 0.04, respectively). Conclusions: In patients taking an OAC undergoing PCI, HAS-BLED, ORBIT, and PRECISE-DAPT scores predicted TIMI significant bleeding events better than the PARIS score; whereas all four scores could predict BARC class ≥3 bleeding events.

DOI： 10.1016/j.jjcc.2018.10.013

Impact of Nutritional and Inflammation Status on Long-Term Bleeding in Patients Undergoing Percutaneous Coronary Intervention with an Oral Anticoagulant Open Access

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 26 巻 ( 8 ) 頁： 728 - 737 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Atherosclerosis and Thrombosis

Aim: Patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet therapy (APT) are exposed to a serious risk of bleeding. The aim of this study was to clarify the relationship among nutritional and inflammation status and long-term bleeding in patients requiring both OACs and APT after PCI. Methods: We performed PCI in 3,718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OACs and APT. Patients were followed for up to 3 years for bleeding events, defined as the Bleeding Academic Research Consortium (BARC) class ≥ 3 bleeding. We retrospectively evaluated the ability of the Geriatric Nutritional Risk Index (GNRI) and high-sensitivity C-reactive protein (hs-CRP) to detect bleeding events. Results: During a median follow-up of 1,080 days, bleeding events were observed in 53 (17.5%) patients. Bleeding events were associated with a low GNRI (≤ 98) (hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.84 – 5.45; p＜0.0001) and hs-CRP level ≥ 2.5 mg/L (HR, 2.75; 95% CI, 1.61 – 4.78; p=0.0003). A low GNRI＋ high hs-CRP showed a 5.12-fold increase in the incidence of BARC class ≥ 3 bleeding (95% CI, 2.68 – 9.91; p＜ 0.0001) compared with a normal GNRI＋low hs-CRP. The addition of the GNRI and hs-CRP to the PRECISE-DAPT score improved C-statistics from 0.67 to 0.71 and enhanced the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.36, p＜0.0001; IDI, 0.066, p＜0.0001). Conclusions: The GNRI and hs-CRP were novel predictors of the long-term bleeding risk in patients requiring both OACs and APT after PCI.

DOI： 10.5551/jat.47654

頸動脈超音波検査が契機となり診断された硬膜動静脈瘻の1例

笹木優賢, 松原宏紀, 金沙玲, 弘津有沙, 古澤健司

超音波検査技術抄録集 44 巻 ( 0 ) 頁： S189 - S189 2019年

Assessment of abdominal aortic calcification by computed tomography for prediction of latent left ventricular stiffness and future cardiovascular risk in pre-dialysis patients with chronic kidney disease: A single center cross-sectional study Open Access

Furusawa, K; Takeshita, K; Suzuki, S; Tatami, Y; Morimoto, R; Okumura, T; Yasuda, Y; Murohara, T

INTERNATIONAL JOURNAL OF MEDICAL SCIENCES 16 巻 ( 7 ) 頁： 939 - 948 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Journal of Medical Sciences

Introduction: There is general interest in finding clinical markers for left ventricular diastolic dysfunction (LVDD), a major cause of cardiorenal syndrome leading to heart failure in chronic kidney disease (CKD) patients. The aim was to assess the utility of computed tomography (CT)-based abdominal aortic calcification (AAC) for the prediction of LVDD and prognosis of asymptomatic pre-dialysis CKD patients. Materials and methods: We prospectively evaluated 218 pre-dialysis CKD patients [median estimated glomerular filtration rate (eGFR); 40.9 mL/min/1.73m2]. Non-contrast CT scan and echocardiography were performed to determine the aortic calcification index (ACI) as a semi-quantitative measure of AAC. Results: The median ACI was 11.4. AAC and LVDD were diagnosed in 193 patients (89%) and 75 patients (34%), respectively. Using receiver operating characteristic curve analysis for the estimation of LVDD, ACI of 20 showed optimal sensitivity (52.0%) and specificity (62.8 %) (AUC = 0.664, p <.001). High ACI group included more patients with LVDD-related factors, such as old age, hypertension, diabetes, and more severe CKD. LVDD was significantly more common in patients with high ACI group [39 (50%) and 36 (26%), respectively, p<0.001]. Multivariate analysis showed that ACI correlated significantly with E/A (β=-0.993, p=0.003), E/e' (β=0.077, p<0.001), and cardio-ankle vascular index (β=0.209, p=0.001). Correspondingly, E/e' correlated with logBNP and log(ACI+1), and increased proportionately and significantly with the quartiles of ACI values. Cox proportional hazard models showed that ACI was an independent predictor of CV outcome (hazard ratio 1.03, 95% confidence interval 1.00-1.06, p=0.029). Conclusion: The results would suggest the usefulness of AAC assessment by CT to predict latent LVDD and future CV risk in asymptomatic pre-dialysis CKD patients.

DOI： 10.7150/ijms.32629

The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy (vol 71, pg 284, 2018) Open Access

Hiraiwa, H; Okumura, T; Sawamura, A; Sugiura, Y; Kondo, T; Watanabe, N; Aoki, S; Ichii, T; Kitagawa, K; Kano, N; Fukaya, K; Furusawa, K; Morimoto, R; Takeshita, K; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 72 巻 ( 1-2 ) 頁： 178 - 178 2018年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

There is an error in the section of methods of statistical analysis. Correctly, the covariates with p < 0.01 in univariate analysis were retested for multivariate analysis. In addition, Table 3 is incorrect. Please see the corrected Table 3 here.

DOI： 10.1016/j.jjcc.2018.02.001

Sokolow-Lyon voltage is suitable for monitoring improvement in cardiac function and prognosis of patients with idiopathic dilated cardiomyopathy Open Access

The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy Open Access

Hiraiwa, H; Okumura, T; Sawamura, A; Sugiura, Y; Kondo, T; Watanabe, N; Aoki, S; Ichii, T; Kitagawa, K; Kano, N; Fukaya, K; Furusawa, K; Morimoto, R; Takeshita, K; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 71 巻 ( 3-4 ) 頁： 284 - 290 2018年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: Myocardial fibrosis is associated with poor prognosis in nonischemic dilated cardiomyopathy (NIDCM) patients. The Selvester QRS score on 12-lead electrocardiogram is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its use in NIDCM patients is limited. We investigated the prognostic value of the QRS score and its association with collagen volume fraction (CVF) in NIDCM patients. Methods: We enrolled 91 consecutive NIDCM patients (66 men, 53 ± 13 years) without permanent pacemakers or cardiac resynchronization therapy devices. The Selvester QRS score was calculated by two expert cardiologists at NIDCM diagnosis. All patients were followed up over 4.5 ± 3.2 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening heart failure, and lethal arrhythmia. We also evaluated CVF using endomyocardial biopsy samples. Results: At baseline, the left ventricular ejection fraction was 32 ± 9%, plasma brain natriuretic peptide level was 80 [43–237] pg/mL, and mean Selvester QRS score was 4.1 points. Twenty cardiac events were observed (cardiac death, n = 1; hospitalization for worsening heart failure, n = 16; lethal arrhythmia, n = 3). Cox proportional hazard regression analysis revealed that the Selvester QRS score was an independent determinant of cardiac events (hazard ratio, 1.32; 95% confidence interval, 1.05–1.67; p = 0.02). The best cut-off value was determined as 3 points, with 85% sensitivity and 47% specificity (area under the curve, 0.688, p = 0.011). In Kaplan–Meier survival analysis, the QRS score ≥3 group had more cardiac events than the QRS score <3 group (log-rank, p = 0.007). Further, there was a significant positive correlation of Selvester QRS score with CVF (r = 0.46, p < 0.001). Conclusions: The Selvester QRS score can predict future cardiac events in NIDCM, reflecting myocardial fibrosis assessed by CVF.

DOI： 10.1016/j.jjcc.2017.09.002

Fukaya, K; Takeshita, K; Okumura, T; Hiraiwa, H; Aoki, S; Ichii, T; Sugiura, Y; Kitagawa, K; Kondo, T; Watanabe, N; Kano, N; Furusawa, K; Sawamura, A; Morimoto, R; Bando, Y; Murohara, T

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY 22 巻 ( 5 ) 2017年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Annals of Noninvasive Electrocardiology

Background: The clinical significance of electrocardiogram in the assessment of patients with idiopathic dilated cardiomyopathy (IDCM) is currently unknown. The aim of this study was to determine the feasibility of recording serial changes in Sokolow–Lyon voltage (∆%QRS-voltage) in one year to estimate left ventricular reverse remodeling (LVRR) and predict a prognosis of IDCM patients under tailored medical therapy. Methods: Sixty-eight consecutive patients with mild symptoms (52.1 ± 13 years old; 69% men; NYHA I/II/III/IV; 33/29/6/0) underwent electrocardiography and echocardiography at baseline and 12 month follow-up (follow-up period: 3.9 years). Results: LVRR was observed in 30 patients (44.1%). The ∆%QRS-voltage was significantly lower in the LVRR group (LVRR; −26.9%, non-LVRR: −9.2%, p <.001). Univariate analysis showed that ∆%QRS-voltage correlated with ∆%LV end-diastolic diameter (r =.634, p <.001), and with ∆%LV ejection fraction and ∆%LV mass index (r = −.412, p <.001; r =.429, p <.001 respectively). Using receiver operating characteristic curve analysis for the estimation of LVRR, ∆%QRS of −14.7% showed optimal sensitivity (63.2%) and specificity (83.3%) (AUC = 0.775, p <.001). The composite endpoints of cardiac death (n = 0), hospitalization for advanced heart failure (n = 11) and fatal arrhythmia (n = 2) were observed in 13 patients during the follow-up period. Kaplan–Meier analysis showed significantly higher event-free rate in patients of the low ∆%QRS-voltage group (<−14.7%) (83%) than those of the high group (66%, p =.022). Conclusions: The present study showed that decrease in Sokolow–Lyon voltage is associated with improvement in cardiac function and favorable prognosis in IDCM patients on medical therapy, suggesting that this index is a feasible marker for response to treatment of IDCM.

DOI： 10.1111/anec.12431

Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy Open Access

Morimoto, R; Okumura, T; Hirashiki, A; Ishii, H; Ichii, T; Aoki, S; Furusawa, K; Hiraiwa, H; Kondo, T; Watanabe, N; Kano, N; Fukaya, K; Sawamura, A; Takeshita, K; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 70 巻 ( 3-4 ) 頁： 303 - 309 2017年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events. Methods There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55 mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10 μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmax from the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n = 15) and who did not receive follow-up echocardiography (n = 2), 83 patients were enrolled (52.5 ± 12.3 years). Results During the follow-up period (4.7 ± 2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax (hazard ratio: 1.024, p = 0.007) and the symptom duration (hazard ratio: 0.977, p = 0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmax cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax ≥ 75.1% group (p = 0.045). Conclusions ΔLVdP/dtmax estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.

DOI： 10.1016/j.jjcc.2017.02.005

The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy

Hiraiwa, H; Okumura, T; Sawamura, A; Sugiura, Y; Kondo, T; Watanabe, N; Aoki, S; Ichii, T; Kano, N; Fukaya, K; Furusawa, K; Morimoto, R; Takeshita, K; Bando, Y; Murohara, T

EUROPEAN HEART JOURNAL 38 巻頁： 143 - 144 2017年8月

Cholesterol metabolism as a prognostic marker in patients with mildly symptomatic nonischemic dilated cardiomyopathy Open Access

Sawamura, A; Okumura, T; Hiraiwa, H; Aoki, S; Kondo, T; Ichii, T; Furusawa, K; Watanabe, N; Kano, N; Fukaya, K; Morimoto, R; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 69 巻 ( 5-6 ) 頁： 888 - 894 2017年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background Little is known about whether the alteration of cholesterol metabolism reflects abdominal organ impairments due to heart failure. Therefore, we investigated the prognostic value of cholesterol metabolism by evaluating serum campesterol and lathosterol levels in patients with early-stage nonischemic dilated cardiomyopathy (NIDCM). Methods We enrolled 64 patients with NIDCM (median age 57.5 years, 31% female) with New York Heart Association functional class I/II. Serum campesterol and lathosterol levels were measured in all patients. The patients were then divided into four subsets based on the median non-cholesterol sterol levels (campesterol 3.6 μg/mL, lathosterol 1.4 μg/mL): reference (R-subset), high-campesterol/high-lathosterol; absorption-reduced (A-subset), low-campesterol/high-lathosterol; synthesis-reduced (S-subset), high-campesterol/low-lathosterol; double-reduced (D-subset), low-campesterol/low-lathosterol. Endpoint was a composite of cardiac events, including cardiac-related death, hospitalization for worsening heart failure, and lethal arrhythmia. Results Median brain natriuretic peptide (BNP) level was 114 pg/mL. Mean left ventricular ejection fraction was 31.4%. D-subset had the lowest total cholesterol level and cardiac index and the highest BNP level and pulmonary capillary wedge pressure. D-subset also had the highest cardiac event rate during the mean 3.8 years of follow-up (log-rank p = 0.001). Multivariate regression analysis showed that D-subset was an independent determinant of cardiac events. The receiver operating characteristic curve analysis revealed that total cholesterol <153 mg/dL was a best cut-off value for discrimination of the D-subset. Conclusions The combined reduction of campesterol and lathosterol that indicated intestinal cholesterol absorption and liver synthesis predicts future cardiac events in patients with mildly symptomatic NIDCM.

DOI： 10.1016/j.jjcc.2016.08.012