Faculty Profiles - IMAIZUMI Takahiro

Papers - IMAIZUMI Takahiro

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Assessment of patients’ characteristics associated with the efficacy and safety of oral valganciclovir treatment for infants with symptomatic congenital cytomegalovirus disease

Kakei Y., Morioka I., Imai T., Itohara K., Yano I., Takahashi N., Yoshikawa T., Moriuchi H., Ito Y., Fujioka K., Oka A., Okahashi A., Nagano N., Hijikata M., Fuwa K., Aoki R., Seimiya A., Imaizumi T., Akimoto T., Hara K., Katayama D., Abe S., Ashina M., Nakasone R., Kyouno Y., Takumi K., Takenaka S., Kakiuchi S., Kakimoto Y., Kozawa K., Funato Y., Miura H., Kawamura Y., Ogata T., Nakashima Y., Kawada J.i., Torii Y., Suzuki T., Fukuda Y., Haruta K., Yamaguchi M., Masaaki T.

Journal of Infection and Chemotherapy Vol. 30 ( 10 ) page： 971 - 977 2024.10

Publisher：Journal of Infection and Chemotherapy

Introduction: Insurance coverage for oral valganciclovir (VGCV) began in Japan in April 2023 on the basis of results, including our clinical trials for symptomatic congenital cytomegalovirus (CMV) disease. The VGCV treatment is available throughout Japan, so clinicians must consider the likelihood of hearing improvement and the possibility of neutropenia before dosing. Materials and methods: We performed a substudy of an investigator-initiated, single-arm, prospective, multicenter, clinical trial in which 24 infants with symptomatic congenital CMV disease were orally administered 16 mg/kg VGCV twice daily for 6 months as an intervention. We examined the infants’ baseline characteristics associated with improved hearing impairment or a severely reduced neutrophil count. Results: Of the 24 patients, 4 had normal hearing on assessment of their ear with the best hearing. Hearing impairment improved in 14 patients and did not respond to VGCV treatment in 6 patients at the 6-month hearing assessment. CMV DNA levels in plasma at baseline were higher in patients in whom hearing did not respond to treatment. A neutrophil count <500/mm<sup>3</sup> occurred in 5 (21%) patients for the first 6 weeks and in 8 (33%) patients for the first 6 months. A neutrophil count at screening and the lowest neutrophil count over the 6 months showed the highest correlation (r = 0.477, p = 0.019). Conclusions: Infants with a low plasma viral load at screening tend to have an improvement in hearing impairment. Clinicians should be aware of neutropenia during VGCV treatment particularly in patients with a low neutrophil count during screening.

DOI： 10.1016/j.jiac.2024.03.006

Association of Hemoglobin Level with Mortality and Its Effect Modifiers in Patients Undergoing Maintenance Hemodialysis: A Nationwide Cohort Study

Kosugi, T; Hasegawa, T; Imaizumi, T; Nishiwaki, H; Honda, H; Ito, Y; Tsuruya, K; Abe, M; Hanafusa, N; Kuragano, T

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Vol. 35 ( 10 ) 2024.10

Increased Mortality Risk Is Associated with Abnormal Iron Status in Japanese Patients on Hemodialysis: A Nationwide Cohort Study

Nishiwaki, H; Imaizumi, T; Hasegawa, T; Kosugi, T; Maruyama, Y; Tsuruya, K; Ito, Y; Honda, H; Kuragano, T

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Vol. 35 ( 10 ) 2024.10

Lower Parathyroid Hormone Levels are Associated With Reduced Fracture Risk in Japanese Patients on Hemodialysis

Komaba H., Imaizumi T., Hamano T., Fujii N., Abe M., Hanafusa N., Fukagawa M.

Kidney International Reports Vol. 9 ( 10 ) page： 2956 - 2969 2024.10

Publisher：Kidney International Reports

Introduction: Secondary hyperparathyroidism (SHPT) affects bone metabolism and may lead to bone fragility. However, there is conflicting evidence as to whether parathyroid hormone (PTH) levels are associated with fracture risk and whether the relationship is linear or U-shaped. Methods: We examined the association between PTH levels and the risk of any fracture and site-specific fractures in a nationwide cohort of 180,333 patients on hemodialysis. We also examined the association between the percent change in PTH levels during the preceding 1 year and subsequent fracture. Results: At baseline, the median intact PTH level was 141 pg/ml (interquartile range, 78–226 pg/ml). During 1 year of follow-up, there were a total of 3762 fractures requiring hospitalization (1361 hip, 551 vertebral, and 1850 other). In an adjusted analysis, higher baseline PTH levels were associated with an incrementally increased risk of any fracture (odds ratio [OR] per doubling of intact PTH, 1.06; 95% confidence interval, 1.03–1.09). The association between PTH levels and fracture risk was more pronounced for hip fractures but not found for vertebral fractures. The absolute risk difference associated with higher PTH levels appeared to be more pronounced in older individuals, females, and those with lower body mass index (BMI). Change in PTH levels was also associated with fracture risk: the adjusted OR for fracture decreased linearly with decreasing PTH levels over 1 year, regardless of the preceding PTH levels. Conclusion: Lower PTH levels are associated with a graded reduction in fracture risk. Further studies are needed to determine whether intensive PTH control reduces fracture risk.

DOI： 10.1016/j.ekir.2024.07.008

Predicting survival after Impella implantation in patients with cardiogenic shock: The J-PVAD risk score

Kondo, T; Yoshizumi, T; Morimoto, R; Imaizumi, T; Kazama, S; Hiraiwa, H; Okumura, T; Murohara, T; Mutsuga, M

EUROPEAN JOURNAL OF HEART FAILURE 2024.9

Publisher：European Journal of Heart Failure

Aims: Impella has become a new option for mechanical circulatory support in patients with cardiogenic shock (CS); however, prognostic models for patients after Impella are lacking. We aimed to identify the factors that predict in-hospital mortality in patients with CS requiring Impella and develop a new risk prediction model. Methods and results: We utilized the J-PVAD registry, which includes all cases where Impella was implanted in Japan. Two-thirds of the patients in the J-PVAD registry were randomly assigned to the derivation cohort (n = 1701), and the other third was assigned to the validation cohort (n = 850). A backward stepwise logistic regression model was developed to identify factors associated with in-hospital mortality. In the derivation cohort, 956 patients were discharged alive, and 745 patients (43.8%) died during hospitalization. Among 29 candidate variables, 12 were independently associated with in-hospital mortality and were applied as components of the risk model, including age, sex, body mass index, fulminant myocarditis aetiology, cardiac arrest in hospital, baseline veno-arterial extracorporeal membrane oxygenation use, mean arterial pressure, lactate, lactate dehydrogenase, total bilirubin, creatinine, and albumin levels. The comparison of predicted and observed in-hospital mortality according to the 7th quantiles using the J-PVAD risk score showed good calibration. The area under the curve for the J-PVAD risk score was 0.76 (95% confidence interval 0.73–0.78). In the validation cohort, the J-PVAD risk score showed good calibration and discrimination ability. Conclusions: The J-PVAD risk score can be calculated using variables easily obtained in routine clinical practice. It helps the accurate stratification of mortality risk and facilitates clinical decision-making.

DOI： 10.1002/ejhf.3471

Clinical Impact of Malnutrition According to the Global Leadership Initiative on Malnutrition Criteria Combined With Kidney Dysfunction to Determine Mortality in Inpatients

Yamaguchi, M; Sugiyama, H; Asai, A; Kitamura, F; Nobata, H; Kinashi, H; Katsuno, T; Banno, S; Ito, Y; Imaizumi, T; Ando, M; Kubo, Y; Keisuke, M; Ishida, Y; Mori, N; Ishimoto, T

JOURNAL OF RENAL NUTRITION Vol. 34 ( 5 ) page： 418 - 426 2024.9

Publisher：Journal of Renal Nutrition

Objective: The clinical impact of malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with kidney dysfunction remains poorly understood. This study investigated the usefulness of GLIM criteria for malnutrition in predicting mortality in patients with kidney dysfunction and different clinical renal states, including no kidney disease (NKD), acute kidney injury (AKI), and chronic kidney disease (CKD). Methods: This single-center retrospective cohort study included 6,712 patients aged ≥18 admitted between 2018 and 2019. The relationship between the estimated glomerular filtration rate (eGFR) groups, nutritional status based on the GLIM criteria, and the incidence of all-cause mortality was evaluated using a multivariate Cox proportional hazards model. Malnutrition was defined as at least one phenotype (weight loss, low body mass index, or reduced muscle mass) and one etiological criterion (reduced intake/assimilation or disease burden/inflammation). Results: Multivariate Cox proportional hazards model showed that eGFR ≤29 (vs. eGFR: 60-89, adjusted hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.52-2.22), 30-59 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.20-1.64), and ≥90 (vs. eGFR: 60-89, adjusted HR = 1.40, 95% CI: 1.14-1.71), moderate and severe malnutrition (vs. without malnutrition, adjusted HR = 1.38 [1.18-1.62] and 2.18 [1.86-2.54], respectively) were independently associated with the incidence of death. The all-cause mortality rate was higher in patients with malnutrition or eGFR ≤29 (adjusted HR, 3.31; 95% CI: 2.51-4.35) than in patients without malnutrition or eGFR 60-89. Furthermore, moderate and severe malnutrition (vs. no malnutrition) was independently associated with death in patients with NKD, AKI, and CKD. Conclusion: Malnutrition based on the GLIM criteria was associated with increased all-cause mortality in inpatients, and malnutrition combined with kidney dysfunction was associated with a higher risk of mortality. Furthermore, patients with NKD, AKI, and CKD showed an association between malnutrition based on GLIM criteria and mortality.

DOI： 10.1053/j.jrn.2024.03.010

Recipients of public assistance with advanced chronic kidney disease: insights into receiving a presentation of kidney replacement therapy options and polypharmacy from Japanese investigators with innovative network about kidney disease study

Nakamura, Y; Sasaki, S; Imaizumi, T; Nishiwaki, H; Murakami, M; Yazawa, M; Raita, Y; Kawarazaki, H; Shimizu, H; Saka, Y; Takizawa, N; Fujita, Y

CLINICAL AND EXPERIMENTAL NEPHROLOGY 2024.8

Publisher：Clinical and Experimental Nephrology

Background: The characteristics of patients with advanced chronic kidney disease (CKD) who are recipients of public assistance in Japan, and the adequacy of their medical care have not been reported previously. Methods: The records of patients with CKD stage G5 who visited nine facilities in Japan from April to June 2013 were retrospectively reviewed to compare the characteristics and care of recipients of public assistance with those of non-recipients. Receiving a presentation of kidney replacement therapy (KRT) options and polypharmacy were used as indicators of suboptimal medical care. Results: Of the 592 patients included in this analysis (mean age, 69.6 years; male, 59.3%), 56 (9.5%) were recipients of public assistance and 536 (90.5%) were non-recipients of public assistance. The prevalence of diabetes mellitus, unmarried status, and living alone were higher in recipients of public assistance. In multivariable logistic regression analysis, compared with non-recipients of public assistance, recipients of public assistance were less likely to receive a presentation of KRT options (adjusted odds ratio [aOR], 0.31; 95% confidence interval [CI], 0.17–0.56), and were more likely to receive ≥ 10 (aOR, 1.92; 95% CI, 1.05–3.51), and ≥ 15 (aOR, 2.78; 95% CI, 1.23–6.26) types of medication. Conclusions: Patients with advanced CKD receiving public assistance were less likely to receive a presentation of KRT options and more likely to receive ≥ 10 and ≥ 15 types of medication, suggesting that recipients of public assistance are more likely to receive suboptimal medical care.

DOI： 10.1007/s10157-024-02549-9

Annual trends in atypical haemolytic uremic syndrome management in Japan and factors influencing early diagnosis and treatment: a retrospective study

Tatematsu, Y; Imaizumi, T; Michihata, N; Kato, N; Kumazawa, R; Matsui, H; Fushimi, K; Yasunaga, H; Maruyama, S

SCIENTIFIC REPORTS Vol. 14 ( 1 ) 2024.8

Publisher：Scientific Reports

Atypical haemolytic uremic syndrome (aHUS) is a rare disorder characterised by complement-mediated thrombotic microangiopathy (TMA). Despite clinical guidelines, the diagnosis and treatment of aHUS in its early stages remains challenging. This study examined the annual trends in aHUS clinical practices in Japan and explored factors influencing early diagnosis and treatment. Using data from the 2011–2020 Diagnosis Procedure Combination database, 3096 cases with the HUS disease code were identified, of which 217 were confirmed as aHUS and treated with eculizumab or plasma exchange. Early initiation, defined as starting eculizumab or plasma exchange within 7 days of admission, was the focus of the study. Our study revealed no significant changes over time in the number of aHUS diagnoses, cases treated with eculizumab, or early initiation cases. Early initiation cases underwent haemodialysis earlier and had ADAMTS13 activity measured earlier, shorter hospital stays, and lower hospitalisation costs than late initiation cases. In conclusion, we found no increase in the number of newly diagnosed aHUS cases or early treatment initiation over time. Early recognition of TMA and differentiation of the causative disease are crucial for identifying potential aHUS cases, which may lead to better patient prognoses.

DOI： 10.1038/s41598-024-68736-6

Preliminary study of the effect of the web application on caregiver burden in dementia and behavioural and psychological symptoms of dementia

Goto, Y; Suematsu, M; Imaizumi, T; Suzuki, Y

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 3 ) page： 383 - 391 2024.8

Publisher：Nagoya Journal of Medical Science

This study aimed to investigate if our web application could be a viable intervention for providing caregivers with information on resilient coping strategies for the reduction of their burden, thereby leading to the alleviation of behavioural and psychological symptoms of dementia (BPSD). We recruited outpatients with dementia and informal caregiver dyads at Nagoya University Hospital from April 2022 to October 2022. The caregivers were asked to have the web application installed on their smartphones during the study period and answer the following two self-administered questionnaires once a month for 3 months: (a) Abe’s BPSD Score (ABS), which assesses BPSD, and (b) the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) score, which measures caregiver burden. Thirteen patients and informal caregiver dyads were enrolled in this study. The caregivers exchanged information on the care of patients with dementia in the virtual community using the web application during the study period. Upon entry, J-ZBI scores were correlated with ABSs (r = 0.65). Linear mixed-effects model revealed the average J-ZBI scores decreased over time with significance (p = 0.013), however, the average ABSs did not change during the study period. This is the first study to show that our web application reduces caregiver burden. However, to confirm the efficacy of our web application, further investigations are required.

DOI： 10.18999/nagjms.86.3.383

Predictive Models for Palliative Care Needs of Advanced Cancer Patients Receiving Chemotherapy (vol 67, pg 306, 2024)

Kawashima, A; Furukawa, T; Imaizumi, T; Morohashi, A; Hara, M; Yamada, S; Hama, M; Kawaguchi, A; Sato, K

JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Vol. 68 ( 2 ) page： 204 - 204 2024.8

Publisher：Journal of Pain and Symptom Management

The authors regret that the affiliation of M.H., S.Y., M.H., and A.K. was listed as the Department of Clinical Oncology and Chemotherapy at Nagoya University Hospital in Nagoya, Japan. This should have been listed as the Department of Nursing at Nagoya University Hospital in Nagoya, Japan. The authors would like to apologize for any inconvenience caused.

DOI： 10.1016/j.jpainsymman.2024.05.019

Prognosis of microscopic polyangiitis is well predictable in the first 2 weeks of treatment

Owaki, A; Tanaka, A; Furuhashi, K; Watanabe, Y; Koshi-Ito, E; Imaizumi, T; Maruyama, S

CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol. 28 ( 7 ) page： 701 - 706 2024.7

Publisher：Clinical and Experimental Nephrology

Background: Kidney and life outcomes remain unsatisfactory in patients with microscopic polyangiitis (MPA). Appropriate treatment intensity must be provided to the appropriate patients. To identify severe cases early, we investigated the factors related to kidney and life outcomes. Methods: We included patients diagnosed with MPA based on myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) positivity and kidney histopathology results after kidney biopsies between January 1, 2021, and May 11, 2023, at 10 affiliated centers, including our hospital. Death, maintenance dialysis, and estimated glomerular filtration rate (eGFR) < 15 after 6 months of treatment were defined as poor prognosis groups, and factors associated with these conditions were investigated. Results: We included 84 (36 men and 48 women) patients in this study. Median age was 73.8 (interquartile range: 71–81) years. After 6 months of treatment, the proportion of patients in the poor prognosis group was 16.7 %, with a mortality of 7.1 % and a poor kidney prognosis rate of 9.5 %. Area under the receiver operating characteristic curve showed that eGFR at 2 weeks had a comparable prognostic performance equal as eGFR at 4 weeks (area under the curve: 0.875 and 0.896, respectively). After adjustment by various factors, eGFR at 2 weeks was related with prognosis significantly (p = 0.031). Conclusion: Kidney function 2 weeks after the start of treatment for MPA can predict prognosis.

DOI： 10.1007/s10157-024-02522-6

Cytokine profiling in 128 patients with transient abnormal myelopoiesis: a report from the JPLSG TAM-10 trial

Yamato, G; Tsumura, Y; Muramatsu, H; Shimada, A; Imaizumi, T; Tsukagoshi, H; Kaburagi, T; Shiba, N; Yamada, Y; Deguchi, T; Kawai, T; Terui, K; Ito, E; Watanabe, K; Hayashi, Y

BLOOD ADVANCES Vol. 8 ( 12 ) page： 3120 - 3129 2024.6

Publisher：Blood Advances

Transient abnormal myelopoiesis (TAM) occurs in 10% of neonates with Down syndrome (DS). Although most patients show spontaneous resolution of TAM, early death occurs in ~20% of cases. Therefore, new biomarkers are needed to predict early death and determine therapeutic interventions. This study aimed to determine the association between clinical characteristics and cytokine levels in patients with TAM. A total of 128 patients with DS with TAM enrolled in the TAM-10 study conducted by the Japanese Pediatric Leukemia/Lymphoma Study Group were included in this study. Five cytokine levels (interleukin-1b [IL-1b], IL-1 receptor agonist, IL-6, IL-8, and IL-13) were significantly higher in patients with early death than in those with nonearly death. Cumulative incidence rates (CIRs) of early death were significantly associated with high levels of the 5 cytokines. Based on unsupervised consensus clustering, patients were classified into 3 cytokine groups: hot-1 (n = 37), hot-2 (n = 42), and cold (n = 49). The CIR of early death was significantly different between the cytokine groups (hot-1/2, n = 79; cold, n = 49; hot-1/2 CIR, 16.5% [95% confidence interval (CI), 7.9-24.2]; cold CIR, 2.0% [95% CI, 0.0-5.9]; P = .013). Furthermore, cytokine groups (hot-1/2 vs cold) were independent poor prognostic factors in the multivariable analysis for early death (hazard ratio, 15.53; 95% CI, 1.434-168.3; P = .024). These results provide valuable information that cytokine level measurement was useful in predicting early death in patients with TAM and might help to determine the need for therapeutic interventions. This trial was registered at UMIN Clinical Trials Registry as #UMIN000005418.

DOI： 10.1182/bloodadvances.2023011628

Association of calciprotein particles with serum phosphorus among patients undergoing conventional and extended-hours haemodialysis

Nishibori, N; Okazaki, M; Miura, Y; Hishida, M; Kurasawa, S; Imaizumi, T; Kato, N; Kosugi, T; Kuro-o, M; Kasuga, H; Kaneda, F; Maruyama, S

CLINICAL KIDNEY JOURNAL Vol. 17 ( 6 ) 2024.6

Publisher：Clinical Kidney Journal

Background and hypothesis: Extended-hours haemodialysis (HD) is associated with better clinical outcomes than conventional HD. We investigated whether extended-hours HD and conventional HD have varying effects on blood levels of calciprotein particles (CPPs) and phosphorus, which have been identified as major pathogenic molecules for vascular calcification. Methods: Patients who underwent conventional or extended in-centre daytime HD between January and March 2020 were included. Plasma CPP levels, representing only secondary CPPs (CPP-II), were measured in pre-dialysis samples. Linear and non-linear associations between CPPs and serum phosphorus levels were examined across dialysis modalities. Results: A total of 382 participants (185 undergoing extended-hours HD and 197 undergoing conventional HD) were included in the analysis. The median age of participants was 71 years, 65% of the patients were men and the mean phosphorus level was 5.4 mg/dl. Plasma CPP (CPP-II) levels were lower in the extended-hours HD group than in the conventional HD group [40 018 (arbitrary units) AU versus 75 728 AU; P <. 01]. Multivariable linear regression analysis showed that extended-hours HD was associated with lower natural logarithmic plasma CPP (CPP-II) levels: -0.64 (95% confidence interval -0.74 to -0.55). A restricted cubic spline function indicated that extended-hours HD was associated with lower plasma CPP (CPP-II) levels across levels of serum phosphorus, with significant differences observed between groups, especially in hyperphosphataemic conditions (P for interaction <.01). Conclusions: The extended-hours HD group had lower CPP levels than the conventional HD group despite no significant differences in serum phosphorus levels, which may contribute to better clinical outcomes in patients on extended-hours HD.

DOI： 10.1093/ckj/sfae121

Management of anaemia and prognosis of patients undergoing maintenance peritoneal dialysis: A nationwide cohort study

Imaizumi, T; Hasegawa, T; Kosugi, T; Nishiwaki, H; Honda, H; Tsuruya, K; Ito, Y; Kuragano, T

PERITONEAL DIALYSIS INTERNATIONAL 2024.6

Publisher：Peritoneal Dialysis International

Background: Clinical data supporting the target haemoglobin range in patients undergoing peritoneal dialysis (PD) are scarce. This study investigated the association between haemoglobin levels and all-cause mortality in Japanese patients undergoing PD using data from a nationwide dialysis registry. Methods: A total of 4875 patients aged ≥18 years who were undergoing PD at the end of 2012 were analysed. Patients receiving combination therapy with haemodialysis or missing haemoglobin data were excluded. Haemoglobin values were categorised into six groups (<9.0, 9.0–9.9, 10.0–10.9, 11.0–11.9, 12.0–12.9 and ≥13.0 g/dL) and their association with mortality evaluated. Results: Patients’ mean age was 63 years, and 62% were men. The mean haemoglobin level was 10.7 g/dL, and 14% were anuric. Erythropoiesis-stimulating agents were used in 89%. During a median follow-up of 3.5 years, 1586 patients died. Haemoglobin levels <9.0 and ≥13.0 g/dL were significantly associated with mortality, as compared with levels of 10.0–10.9 g/dL (adjusted hazard ratios [95% confidence intervals]: 1.25 [1.06–1.48] and 1.45 [1.13–1.88], respectively). Restricted cubic spline analysis revealed a U-shaped association between haemoglobin levels and mortality. A haemoglobin level ≥12 g/dL was associated with mortality in patients with a history of cardiovascular disease (p interaction = 0.023). Conclusion: We provide important insights into the target haemoglobin in patients undergoing PD. Our findings suggest that setting a lower upper limit for haemoglobin levels may be beneficial for patients with a history of cardiovascular disease.

DOI： 10.1177/08968608241244995

Association between stopping renin-angiotensin system inhibitors immediately before hemodialysis initiation and subsequent cardiovascular events.

Nakamura Y, Inaguma D, Imaizumi T, Kurasawa S, Hishida M, Okazaki M, Fujishima Y, Nishibori N, Suzuki K, Takeda Y, Maruyama S

Hypertension research : official journal of the Japanese Society of Hypertension 2024.3

Language：English Publisher：Hypertension Research

It is controversial whether renin-angiotensin system inhibitors (RASIs) should be stopped in patients with advanced chronic kidney disease (CKD). Recently, it was reported that stopping RASIs in advanced CKD was associated with increased mortality and cardiovascular (CV) events; however, it remains unclear whether stopping RASIs before dialysis initiation affects clinical outcomes after dialysis, which this study aimed to evaluate. In this multicenter prospective cohort study in Japan, we included 717 patients (mean age, 67 years; 68% male) who had a nephrology care duration ≥90 days, initiated hemodialysis, and used RASIs 3 months before hemodialysis initiation. The multivariable adjusted Cox models were used to compare mortality and CV event risk between 650 (91%) patients who continued RASIs until hemodialysis initiation and 67 (9.3%) patients who stopped RASIs. During a median follow-up period of 3.5 years, 170 (24%) patients died and 228 (32%) experienced CV events. Compared with continuing RASIs, stopping RASIs was unassociated with mortality (adjusted hazard ratio [aHR]: 0.82; 95% confidence interval [CI]: 0.50–1.34) but was associated with higher CV events (aHR: 1.59; 95% CI: 1.06–2.38). Subgroup analyses showed that the risk of stopping RASIs for CV events was particularly high in patients aged <75 years, with a significant interaction between stopping RASIs and age. This study revealed that patients who stopped RASIs immediately before dialysis initiation were associated with subsequent higher CV events. Active screening for CV disease may be especially beneficial for these patients. (Figure presented.).

DOI： 10.1038/s41440-024-01616-8

Clinical Value of Troponin Levels to Cardiac Function and Prognosis in Patients with Fulminant Myocarditis

Shibata Naoki, Kondo Toru, Okumura Takahiro, Imaizumi Takahiro, Dohi Kaoru, Izawa Hideo, Ohte Nobuyuki, Amano Tetsuya, Murohara Toyoaki, on behalf of CHANGE PUMP 2 investigators

International Heart Journal Vol. 65 ( 2 ) page： 218 - 229 2024.3

Language：English Publisher：International Heart Journal Association

<p>Troponin (Tn) is a biomarker related to myocardial necrosis and is elevated in patients with myocarditis. This study aimed to investigate the association between cardiac Tn levels and the course of cardiac function, and prognosis in patients with fulminant myocarditis (FM) receiving percutaneous mechanical circulatory support (MCS).</p><p>We used data from a multicenter retrospective registry, CHANGE PUMP 2, which included 216 patients with FM who required MCS. Among them, 141 patients whose Tn levels were available were analyzed. The patients were divided into low and high Tn groups according to the median values of TnT and TnI.</p><p>The median age was 54 years, and 59.6% were male. The TnT and TnI on day 1 (at MCS initiation) were 3.8 (1.4-10.0) and 21.4 (8.4-68.8) ng/mL. While the left ventricular ejection fraction (LVEF) was similar on day 1 (25.0% versus 24.5%), the low Tn group showed better LVEF improvement on day 7 than the high Tn group (45.0% versus 25.3%, P < 0.001). LVEF at 1 year after admission was higher in the low Tn group (65.0% versus 59.7%, P = 0.039). The low Tn group had a better 90-day composite endpoint in death, durable left ventricular assist device implantation, and heart transplantation compared to the high Tn group (hazard ratio 0.47, 95% CI 0.23-0.95).</p><p>Tn levels were associated with short- and long-term cardiac recovery and adverse outcomes in patients with FM receiving MCS due to cardiogenic shock.</p>

DOI： 10.1536/ihj.23-589

Relationship between peak aortic jet velocity and progression of aortic stenosis in patients undergoing hemodialysis.

Kurasawa S, Imaizumi T, Kondo T, Hishida M, Okazaki M, Nishibori N, Takeda Y, Kasuga H, Maruyama S

International journal of cardiology page： 131822 2024.2

Language：English Publisher：International Journal of Cardiology

Background: The natural history of aortic stenosis (AS) progression, especially before severe AS development, is not well documented. We aimed to investigate the time course of peak aortic jet velocity (Vmax) and AS progression risk according to baseline Vmax, particularly whether there is a Vmax threshold. Methods: In a retrospective multicenter cohort study of patients on hemodialysis with aortic valve calcification, we investigated the time series of Vmax and the relationship between the baseline Vmax and progression to severe AS by analyzing longitudinal echocardiographic data. Results: Among 758 included patients (mean age, 71 years; 65% male), patients with Vmax <1.5, 1.5–1.9, 2.0–2.4, 2.5–2.9, and 3.0–3.9 m/s were 395 (52%), 216 (29%), 85 (11%), 39 (5.1%), and 23 (3.0%), respectively. The Vmax slope was gradual (mean 0.05–0.07 m/s/year) at Vmax <2 m/s, but steeper (mean 0.13–0.21 m/s/year) at Vmax ≥2 m/s. During a median 3.2-year follow-up, 52 (6.9%) patients developed severe AS. While patients with Vmax <2 m/s rarely developed severe AS, the risk of those with Vmax ≥2 m/s increased remarkably with an increasing baseline Vmax; the adjusted incidence rates in patients with Vmax <1.5, 1.5–1.9, 2.0–2.4, 2.5–2.9, and 3.0–3.9 m/s were 0.59, 0.57, 4.25, 13.8, and 56.1 per 100 person-years, respectively; the adjusted hazard ratio per 0.2 m/s increase in the baseline Vmax was 1.49 (95% confidence interval: 1.32–1.68) when Vmax ≥2 m/s. Conclusions: The risk of progression to severe AS increased with the baseline Vmax primarily at ≥2 m/s; a Vmax threshold of 2 m/s was observed.

DOI： 10.1016/j.ijcard.2024.131822

Predictive Models for Palliative Care Needs of Advanced Cancer Patients Receiving Chemotherapy.

Kawashima A, Furukawa T, Imaizumi T, Morohashi A, Hara M, Yamada S, Hama M, Kawaguchi A, Sato K

Journal of pain and symptom management 2024.1

Language：English Publisher：Journal of Pain and Symptom Management

Context: Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging due to understaffing and time constraints. Objectives: To develop and evaluate machine learning models for predicting specialist palliative care needs in advanced cancer patients undergoing chemotherapy, and to investigate if predictive models could substitute screening tools. Methods: We conducted a retrospective cohort study using supervised machine learning. The study included patients aged 18 or older, diagnosed with metastatic or stage IV cancer, who underwent chemotherapy and distress screening at a designated cancer hospital in Japan from April 1, 2018, to March 31, 2023. Specialist palliative care needs were assessed based on distress screening scores and expert evaluations. Data sources were hospital's cancer registry, health claims database, and nursing admission records. The predictive model was developed using XGBoost, a machine learning algorithm. Results: Out of the 1878 included patients, 561 were analyzed. Among them, 114 (20.3%) exhibited needs for specialist palliative care. After under-sampling to address data imbalance, the models achieved an Area Under the Curve (AUC) of 0.89 with 95.8% sensitivity and a specificity of 71.9%. After feature selection, the model retained five variables, including the patient-reported pain score, and showcased an 0.82 AUC. Conclusion: Our models could forecast specialist palliative care needs for advanced cancer patients on chemotherapy. Using five variables as predictors could replace screening tools and has the potential to contribute to earlier palliative care.

DOI： 10.1016/j.jpainsymman.2024.01.009

CYTOKINE PROFILING IN 128 PATIENTS WITH TRANSIENT ABNORMAL MYELOPOIESIS: JPLSG TAM-10 STUDY

Yamato, G; Muramatsu, H; Shimada, A; Imaizumi, T; Tsukagoshi, H; Shiba, N; Terui, K; Ito, E; Watanabe, K; Hayashi, Y

PEDIATRIC BLOOD & CANCER Vol. 71 page： S19 - S19 2024.1

Thromboelastographic evaluation after cardiac surgery optimizes transfusion requirements in the intensive care unit: a single-center retrospective cohort study using an inverse probability weighting method

Tamura, T; Suzuki, S; Fujii, T; Hirai, T; Imaizumi, T; Kubo, Y; Shibata, Y; Narita, Y; Mutsuga, M; Nishiwaki, K

GENERAL THORACIC AND CARDIOVASCULAR SURGERY Vol. 72 ( 1 ) page： 15 - 23 2024.1

Language：English Publisher：General Thoracic and Cardiovascular Surgery

Objective: There are no reports from Japan showing the effects of using the thromboelastography algorithm on transfusion requirements after Intensive Care Unit (ICU) admission, and post-implementation knowledge regarding the thromboelastography algorithm under the Japanese healthcare system is insufficient. Therefore, this study aimed to clarify the effect of the TEG6s thromboelastography algorithm on transfusion requirements for patients in the ICU after cardiac surgery. Methods: We retrospectively compared the requirements for blood transfusion up to 24 h after ICU admission using the thromboelastography algorithm (January 2021 to April 2022) (thromboelastography group; n = 201) and specialist consultation with surgeons and anesthesiologists (January 2018 to December 2020) (non-thromboelastography group; n = 494). Results: There were no significant between-group differences in terms of age, height, weight, body mass index, operative procedure, duration of surgery or cardiopulmonary bypass, body temperature, or urine volume during surgical intervention. Moreover, there was no significant between-group difference in the amount of drainage at 24 h after ICU admission. However, crystalloid and urine volumes were significantly higher in the thromboelastography group than in the non-thromboelastography group. Additionally, fresh-frozen plasma (FFP) transfusion volumes were significantly lower in the thromboelastography group. However, there were no significant between-group differences in red blood cell count or platelet transfusion volume. After variable adjustment, the amount of FFP used from the operating room to 24 h after ICU admission was significantly reduced in the thromboelastography group. Conclusions: The thromboelastography algorithm optimized transfusion requirements at 24 h after admission to the ICU following cardiac surgery.

DOI： 10.1007/s11748-023-01941-8

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