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Yazaki M, Nabeta T, Takigami Y, Eda Y, Maemura K, Oki T, Fujita T, Iida Y, Ikeda Y, Ishii S, Inoue Y, Ako J. Native T1 high region and left ventricular ejection fraction recovery in patients with dilated cardiomyopathy. Int J Cardiovasc Imaging 2023; 39:1785-1793. [PMID: 37291379 PMCID: PMC10520178 DOI: 10.1007/s10554-023-02888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
Native T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to identify the association between the native T1 mapping including the native T1 high region and left ventricular ejection fraction (LVEF) recovery in patients with dilated cardiomyopathy (DCM). Patients with newly diagnosed DCM (LVEF of < 45%) who underwent cardiac magnetic resonance imaging with native T1 mapping were included in the analysis. Native T1 high region was defined as a signal intensity of > 5 SD in the remote myocardium. Recovered EF was defined as a follow-up LVEF of ≥ 45% and an LVEF increase of ≥ 10% after 2 years from baseline. Seventy-one patients met the inclusion criteria for this study. Forty-four patients (61.9%) achieved recovered EF. Logistic regression analysis showed that the native T1 value (OR: 0.98; 95% CI: 0.96-0.99; P = 0.014) and the native T1 high region (OR: 0.17; 95% CI: 0.05-0.55; P = 0.002), but not late gadolinium enhancement, were independent predictors of recovered EF. Compared with native T1 value alone, combined native T1 high region and native T1 value improved the area under the curve from 0.703 to 0.788 for predicting recovered EF. Myocardial damage, which was quantified using native T1 mapping and the native T1 high region were independently associated with recovered EF in patients with newly diagnosed DCM.
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Affiliation(s)
- Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan.
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yu Takigami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuko Eda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
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Ikeda Y, Ishii S, Maemura K, Oki T, Yazaki M, Fujita T, Iida Y, Kinoshita D, Sato N, Ako J. Hemodynamic assessment and risk classification for successful weaning of Impella in patients with cardiogenic shock. Artif Organs 2022; 46:1358-1368. [PMID: 35132664 DOI: 10.1111/aor.14197] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical predictors for successful weaning of patients from Impella heart pump have not been clarified. We aimed to elucidate the relationship between pulmonary artery catheter (PAC) parameters at the time of Impella weaning and subsequent outcomes. METHODS We enrolled consecutive patients who had received Impella for cardiogenic shock. PAC data were collected immediately before Impella weaning. Patients were classified as non-survivors if they died or required any mechanical circulatory support reintroduction within 30 days of weaning. RESULTS Of 81 patients enrolled, 61 underwent Impella weaning. Of these, 16 were non-survivors. Predictive indicators of non-survival were high pulmonary artery wedge pressure (PAWP; hazard ratio [HR] per 5 mmHg 1.97, 95% CI 1.35-2.80; p < 0.001), high mean pulmonary artery pressure (MPAP; HR per 5 mmHg 1.90, 1.38-2.58; p < 0.001), and low cardiac power output (CPO; HR per 0.1 Watts 0.71, 0.52-0.92; p = 0.006). Cutoff values of PAWP 20 mmHg, MPAP 22 mmHg, and CPO 0.59 Watts showed strong associations with 30-day non-survival risk (low risk 8% in patients with low PAWP and high CPO or 4% in patients with low MPAP and high CPO; high risk 100% in patients with high PAWP and low CPO or 82% in patients with high MPAP and low CPO). CONCLUSIONS PAWP or MPAP higher than the cutoff with CPO below the cutoff at Impella weaning were associated with worse outcomes. We proposed a risk classification model for successful Impella weaning using PAC.
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Affiliation(s)
- Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Daisuke Kinoshita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuhiro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Oki T, Ishii S, Takigami Y, Eda Y, Maemura K, Yazaki M, Fujita T, Ikeda Y, Nabeta T, Maekawa E, Koitabashi T, Ako J. Re-worsening left ventricular ejection fraction after response to cardiac resynchronization therapy. J Cardiol 2021; 79:358-364. [PMID: 34756767 DOI: 10.1016/j.jjcc.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) provided functional and clinical improvement in patients with heart failure (HF) and electrical intraventricular conduction disturbances, some patients had re-worsening left ventricular (LV) function after a favorable CRT response. We analyzed the clinical variables and cardiac outcomes associated with this re-worsening LV function after CRT. METHODS In this study, 71 patients with CRT response who received CRT between 2006 and 2017 were included. CRT response was defined as a "≥ 10% improvement in LV ejection fraction (LVEF) on follow-up." Patients were classified into two groups: (i) persistent: (n = 48, 68%), defined as those with a CRT response and (ii) re-worsening: (n = 23, 32%), consisting of those who fell out of the definition of a CRT response after an initial CRT response. RESULTS Half of the patients in the re-worsening group failed to maintain a CRT response from two years upwards. A longer duration from HF diagnosis to CRT implantation, nonspecific intraventricular conduction delay (NIVCD) on electrocardiogram at CRT implantation, and a lower increased LVEF at initial CRT response were independent predictors for the re-worsening group. Patients in the re-worsening group had a higher incidence rate for HF hospitalization and cardiac deaths, compared with those in the persistent group. CONCLUSION One-third of CRT responders experienced re-worsening LVEF, which was associated with poor outcomes. CRT responders with NIVCD, longer HF duration, and a lower increased LVEF at initial CRT response should be monitored with caution.
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Affiliation(s)
- Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Yu Takigami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Yuko Eda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Toshimi Koitabashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan
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Maemura K, Ikeda Y, Eda Y, Oki T, Yazaki M, Fujita T, Iida Y, Nabeta T, Ishii S, Koriyama K, Maekawa E, Koitabashi T, Ako J. Association between lowering heart rate during IMPELLA support and favorable short-term outcome in patients with cardiogenic shock. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Impella has been increasingly used in patients with cardiogenic shock (CGS). Target values for clinical indices for appropriate management of Impella have not yet been established.
Purpose
We aimed to elucidate the association between heat rate (HR) during Impella treatment in patients with CGS and clinical outcomes.
Methods and results
We retrospectively evaluated 62 patients (68±14 years; male 77%) with CGS receiving temporary circulatory support with the Impella between February 1, 2019, and February 31, 2021. The primary end point was 30-day mortality. Clinical characteristics, laboratory and hemodynamic markers at implantation of Impella (baseline), 12, 24 hr after implantation, and removal of Impella were assessed. There were 28 patients with concomitant use of extracorporeal membrane oxygenation (ECMO). Treatment periods using Impella were 8±6 days. After excluding 11 patients who died during Impella support, the relationship between clinical indicators at each time points and 30-day mortality was evaluated. There were 22 patients (43%) with 30-day mortality. Factors associated with 30-day mortality were: female, ECMO, higher 24-hr lactate level, lower 24-hr cardiac power output, and higher HR at removal. Lower HR of ≤81 bpm at removal was found to most accurately predict lower 30-day mortality (Figure 1). Higher increases in dose of beta-blockers during Impella support and lower absolute doses of norepinephrine at removal were correlated with decreases in HR during Impella support.
Conclusions
In patients with CGS treated with Impella, lower HR at removal was associated with lower incidence of 30-day mortality. Lowering HR during Impella treatment was recognized as a simple indicator for favorable clinical outcomes in patients with CGS. It was suggested that chronotropic interventions during Impella treatment may be novel therapeutic options in patients with CGS.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- K Maemura
- Kitasato University School of Medicine, Kanagawa, Japan
| | - Y Ikeda
- Kitasato University School of Medicine, Kanagawa, Japan
| | - Y Eda
- Kitasato University School of Medicine, Kanagawa, Japan
| | - T Oki
- Kitasato University School of Medicine, Kanagawa, Japan
| | - M Yazaki
- Kitasato University School of Medicine, Kanagawa, Japan
| | - T Fujita
- Kitasato University School of Medicine, Kanagawa, Japan
| | - Y Iida
- Kitasato University School of Medicine, Kanagawa, Japan
| | - T Nabeta
- Kitasato University School of Medicine, Kanagawa, Japan
| | - S Ishii
- Kitasato University School of Medicine, Kanagawa, Japan
| | - K Koriyama
- Kitasato University School of Medicine, Kanagawa, Japan
| | - E Maekawa
- Kitasato University School of Medicine, Kanagawa, Japan
| | - T Koitabashi
- Kitasato University School of Medicine, Kanagawa, Japan
| | - J Ako
- Kitasato University School of Medicine, Kanagawa, Japan
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Fukushima T, Fukui J, Maemura K. Absence of exercise capacity improvement after in-hospital short-term cardiac rehabilitation is associated with long-term clinical outcome in heart failure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies suggest Cardiac rehabilitation (CR) improve exercise capacity and decline mortality in heart failure (HF) patients. However, some studies show there are HF patients who do not improve exercise capacity by CR and these patients have a higher risk of adverse events in long-term clinical outcome. We investigated whether absence of exercise capacity improvement after in-hospital short-term CR also has adverse effect in long-term clinical outcome.
Methods
In this retrospective study, 130 HF patients who underwent two weeks in-hospital CR after received standardized HF treatment between July 2014 and August 2020 were included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (delta-Peak VO2) measured at 1st and 14th day of CR by cardiopulmonary test. The median delta-PeakVO2 was 1.3 ml·kg-1·min-1. Patients were classified as responder if they demonstrated delta-PeakVO2 ≥1.3 ml·kg-1·min-1 and as non-responder if they demonstrated delta-PeakVO2 <1.3ml·kg-1·min-1. MeanΩ follow-up was 1236 days. The primary outcome was all-cause death.
Result
63 patients (48.4%) were classified as non-responder. Non-responders were older (75.5±10.6 vs 70.8±11.0, P=0.01) and lower estimated glomerular filtration rate (eGFR) (49.7±19.4 vs 57.9±19.2) and lower albumin (3.5±0.5 vs 3.7±0.3 g/dL, P=0.04) than responders. Transtricuspid pressure gradient (TRPG) measured by transthoracic echocardiography was also higher in non-responders (28.5±10.9 vs 22.7±6.3). Predictor of non-responders were TRPG (OR = 1.1, 95% CI 1.02–1.26) and albumin (OR =0.04, 95% CI: 0.003–0.40). In multivariate analysis including delta-PeakVO2 <1.3 ml·kg-1·min-1 (non-responder), age >75, male gender, PeakVO2 at 1st day of CR, body mass index (BMI), left ventricular ejection fraction measured by transthoracic echocardiography, medication of β-blockers showed that delta-PeakVO2 <1.3 ml·kg-1·min-1 (HR =2.8, 95% CI 1.0–7.5), age>75 (HR11.2, 95% CI 2.1–60.1), BMI (HR =0.8, 95% CI 0.6–0.96) were associated with all-cause death.
Conclusion
The absence of exercise capacity improvement after in-hospital short-term CR was the risk of all-cause death. Especially, the HF patients with higher TRPG and lower albumin have a higher probability of becoming a non-responder.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - J Fukui
- Hokusyou central hospital, Nagasaki, Japan
| | - K Maemura
- Nagasaki University, Graduate School of Biomedical Department of Cardiovascular Medicine, Nagasaki, Japan, Nagasaki, Japan
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Nabeta T, Hara M, Naruke T, Maemura K, Oki T, Yazaki M, Fujita T, Ikeda Y, Ishii S, Koitabashi T, Ako J. Clinical valuables related to resolution of complete or advanced atrioventricular block after steroid therapy in patients with cardiac sarcoidosis. J Arrhythm 2021; 37:1093-1100. [PMID: 34386137 PMCID: PMC8339084 DOI: 10.1002/joa3.12583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prediction of atrioventricular block (AVB) resolution after steroid therapy in patients with cardiac sarcoidosis (CS) is difficult. METHODS We identified 24 patients with CS and complete or advanced AVB receiving steroid therapy. AVB resolution was assessed by reviewing surface electrocardiogram and the percentage of ventricular pacing required on subsequent device interrogation reports. RESULTS AVB resolution was noted in eight (33%) patients 1 year after receiving steroid therapy. Univariate Cox regression analysis demonstrated that left ventricular ejection fraction (LVEF) (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01-1.14, P = .016), interval from recognized AVB to start of steroid therapy (HR 0.98, 95% CI 0.95-0.99, P < .001), and lysozyme (HR 1.51, 95% CI 1.12-2.19, P = .013) were significantly associated with resolution of AVB. Combination of area under the curve (AUC) of each variable that was significantly related to resolution of AVB (AUC, 0.969; 95% CI 0.921-1.000, P < .001) was tended to be higher compared with each variable alone. CONCLUSIONS A shorter interval from recognition of AVB to start of steroid therapy, higher LVEF, and higher lysozyme levels were significantly associated with resolution of AVB after steroid therapy in patients with CS. The combination of each variable could be able to distinguish patients with resolution of AVB from those without.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Masahiko Hara
- Center for Community‐based Healthcare Research and EducationShimane UniversityMatsueJapan
| | - Takashi Naruke
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Kenji Maemura
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Takumi Oki
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Mayu Yazaki
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Teppei Fujita
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Yuki Ikeda
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Shunsuke Ishii
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Toshimi Koitabashi
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
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Ikeda Y, Ishii S, Maemura K, Oki T, Yazaki M, Fujita T, Nabeta T, Maekawa E, Koitabashi T, Ako J. Association between intestinal oedema and oral loop diuretic resistance in hospitalized patients with acute heart failure. ESC Heart Fail 2021; 8:4067-4076. [PMID: 34323025 PMCID: PMC8497223 DOI: 10.1002/ehf2.13525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/05/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Intestinal oedema is one of the manifestations associated with right-sided heart failure (HF), which is known to be associated with poorer patient outcomes. We attempted to reveal the association between intestinal oedema and diuretic resistance in hospitalized patients with acute HF. METHODS AND RESULTS Among 213 hospitalized patients with acute HF, abdominal ultrasonography was performed under clinically stable conditions after initial HF treatments. The association among abdominal ultrasonographic parameters, maintenance doses of loop diuretics, and responsiveness to initial loop diuretic treatment was evaluated. Higher mean colon wall thickness (CWT) independently correlated with a higher dose of loop diuretics at enrolment (adjusted β = 0.198, P = 0.0004). Increased mean CWT also correlated with poor response to oral loop diuretics as an initial treatment, whereas it did not correlate with the response to intravenous loop diuretics. Discrimination of non-responders to initial oral loop diuretics resulted in a sensitivity of 0.772 and a specificity of 0.733 using a mean CWT cut-off value of ≥3 mm. CONCLUSIONS In hospitalized patients with acute HF, a strong correlation was identified among the severity of intestinal oedema, required quantities as maintenance loop diuretic doses, and poor responsiveness to oral loop diuretics at admission.
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Affiliation(s)
- Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Toshimi Koitabashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Minami-Ku, Sagamihara, Japan
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Yazaki M, Nabeta T, Inomata T, Maemura K, Oki T, Fujita T, Ikeda Y, Ishii S, Naruke T, Inoue Y, Ako J. Clinical significance of left atrial geometry in dilated cardiomyopathy patients: A cardiovascular magnetic resonance study. Clin Cardiol 2020; 44:222-229. [PMID: 33295044 PMCID: PMC7852162 DOI: 10.1002/clc.23529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Background Clinical significance of left atrial (LA) function and geometry in patients with dilated cardiomyopathy (DCM) remains uncertain. Hypothesis LA geometric parameters assessed by cardiac magnetic resonance (CMR) predict the prognosis in patients with DCM. Methods The present study included patients with DCM and sinus rhythm who underwent CMR between December 2007 and April 2018. LA volume was measured using CMR. LA sphericity index was computed as the ratio of the measured maximum LA volume by the volume of a sphere with maximum LA length diameter. Results We included 255 patients in this study. During the mean follow‐up of 3.92 years, hospitalization for HF occurred in 37 patients. The LA sphericity index was significantly higher in patients with hospitalization for HF than in those without (0.78 ± 0.35 vs. 0.58 ± 0.18, p < .001). Multivariable Cox regression analysis identified a higher LA sphericity index as an independent predictor of hospitalization for HF. Patients were categorized based on the median of LA sphericity index. The Kaplan–Meier curve showed that patients with a high LA sphericity index (≥0.57) had a significantly higher risk of hospitalization for HF than those with a low LA sphericity index (<0.57). Conclusion LA sphericity index was an independent predictor of hospitalization for HF. Assessment of LA geometric parameters might be useful for risk stratification in patients with DCM.
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Affiliation(s)
- Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takashi Naruke
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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9
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Nabeta T, Ishii S, Ikeda Y, Maemura K, Oki T, Yazaki M, Fujita T, Naruke T, Inomata T, Ako J. Late gadolinium enhancement for re-worsening left ventricular ejection fraction in patients with dilated cardiomyopathy. ESC Heart Fail 2020; 8:615-624. [PMID: 33270357 PMCID: PMC7835548 DOI: 10.1002/ehf2.13133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 01/14/2023] Open
Abstract
Aims This study aimed to evaluate the clinical parameters including late gadolinium enhancement (LGE) of cardiovascular magnetic resonance to predict re‐worsening of left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy (DCM). Methods and results We included 138 patients with recent‐onset DCM who had an LVEF <45% and underwent LGE of cardiovascular magnetic resonance imaging at diagnosis and echocardiography at the yearly follow‐up [median 6 (4–8.3) years]. Initial LVEF recovery was defined as LVEF increase >10% from baseline, resulting in LVEF ≧45% after treatment. The patients were divided into three groups: (i) improved (n = 83, 60%), defined as those with sustained LVEF ≧45%; (ii) re‐worsening (n = 39, 28%), those with >5% decrease and LVEF <45% after the initial LVEF recovery; and (iii) not‐improved (n = 16, 12%), those without initial LVEF recovery. The primary endpoint was a composite of hospitalization for heart failure or sudden cardiac death. In baseline, LGE was observed in 70 patients. The LGE area was significantly larger in the re‐worsening and not‐improved groups than that in the improved group (P < 0.001). Loess curves of long‐term LVEF trajectories showed that LVEF in the re‐worsening group increased in the first 2 years and slowly declined thereafter. Multivariate logistic regression analysis demonstrated that LGE area [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03–1.16, P = 0.004], B‐type natriuretic peptide (OR 1.49, 95% CI 1.05–2.21, P = 0.030) level at the initial recovery, and LVEF (OR 0.91, 95% CI 0.86–0.97, P = 0.004) at the initial LVEF recovery were independent predictors of re‐worsening of LVEF. During a median follow‐up of 2273 (interquartile range: 1634–3191) days, the primary endpoint was observed in 31 (22%) patients. Univariate Cox proportional hazards analysis demonstrated that the risk of experiencing the primary event in the re‐worsening group was significantly higher (hazard ratio: 4.30, 95% CI 1.63–11.31, P = 0.003) than that in the improved group and was lower than that in the not‐improved group (hazard ratio: 0.33, 95% CI 0.15–0.72, P = 0.006). Conclusions Re‐worsening of LVEF was observed in 28% of patients with recent‐onset DCM who showed an initial improvement in LVEF. High LGE burden, higher B‐type natriuretic peptide level, and lower LVEF at the initial LVEF recovery were independent predictors of re‐worsening of LVEF in patients with DCM. Careful observation is recommended for patients with a high risk for re‐worsening of LVEF, even in those with an initial LVEF recovery.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Takashi Naruke
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
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10
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Nabeta T, Ishii S, Ikeda Y, Maemura K, Oki T, Yazaki M, Fujita T, Naruke T, Inomata T, Ako J. Prognostic implications of late gadolinium enhancement for re-worsening left ventricular ejection fraction in patients with dilated cardiomyopathy: a longitudinal study of left ventricular function. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Re-worsening left ventricular ejection fraction (LVEF) after initial recovery occurs in some patients with dilated cardiomyopathy (DCM). However, prevalence and predictors of re-worsening LVEF in longitudinal follow-up are unclear. Late gadolinium enhancement of cardiovascular magnetic resonance (LGE-CMR) can evaluate the damage of myocardial tissue.
Purpose
This study sought to evaluate the clinical parameters including LGE-CMR to predict re-worsening LVEF in patients with recent-onset DCM.
Methods
We included patients with recent-onset DCM who had an LVEF <45% and underwent LGE-CMR at diagnosis. We performed yearly echocardiographc follow-up [median 6 [4–8.3] years]. Initial LVEF recovery defined as patients increased in >5% LVEF from baseline and had an LVEF≥45% after medical therapy. Patients were divided into three groups: (1) Improved: defined as those with sustained LVEF ≥45% after initial LVEF recovery; (2) Re-worse: those with decreased >5% and had an LVEF <45% after initial LVEF recovery. and (3) Not-improved: those with no initial LVEF recovery during follow-up. To evaluate the prognostic factors for Re-worsening LVEF after initial LVEF recovery, multivariate logistic regression analysis performed between the Improved group and the Re-worse group. Cardiac events defined as hospitalization due to heart failure and sudden death.
Results
Of 138 patents, 82 patients (59%) were the Improved group, 42 patients (30%) were the Re-worse group, and 14 (10%) were the Not-improved group. Loess curves of long-term LVEF trajectories showed that LVEF in the Re-worse group increased first 2 years and declined slowly thereafter (Fig. 1A). Re-worsening LVEF occurred 4.5±2.2 years after initial LVEF recovery. Multivariate logistic regression analysis demonstrated that LGE area at baseline (Odds ratio: 1.09, 95% confidence interval (CI) 1.02–1.18, p=0.014) and Log brain natriuretic peptide (BNP) at initial LVEF recovery (Odds ratio: 1.53, 95% confidence interval (CI) 1.01–2.31, p=0.042) were independent predictors for Re-worsening LVEF. Kaplan Meier analysis demonstrated that the risk of cardiac events in the Re-worse group was significantly higher (hazard ratio: 3.93, 95% CI 1.49–10.36, p=0.006) than in the Improved group and lower risk than in the Not-improved group (hazard ratio: 0.28, 95% CI 0.12–0.62, p=0.002) (Fig. 1B).
Conclusion
Re-worsening LVEF occurred in 30% of patients in patients with recent-onset DCM. LGE area and BNP at initial LVEF recovery were independently associated with re-worsening LVEF after initial LVEF recovery.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Nabeta
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - S Ishii
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - Y Ikeda
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - K Maemura
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - T Oki
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - M Yazaki
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - T Fujita
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - T Naruke
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - T Inomata
- Kitasato University School Kitasato Institute Hospital, Department of Cardiovascular Medicine, Tokyo, Japan
| | - J Ako
- Kitasato University School of Medicine, Department of Cardiovascular Medicine, Sagamihara, Japan
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11
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Yotsumoto T, Matsumoto Y, Zokumasu K, Ando T, Maemura K, Amano Y, Watanabe K, Kage H, Kakimi K, Nakajima J, Takai D. B19 New Potential Targets of Antibody-Drug Conjugates for Small-Cell Lung Carcinoma. J Thorac Oncol 2020. [DOI: 10.1016/j.jtho.2019.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Hata S, Sakai K, Otsuka K, Kusumoto S, Sonoda K, Muroya T, Shinboku H, Ikeda S, Maemura K. P176 Left ventricular diastolic function by gated myocardial perfusion SPECT strongly reflects NT-ProBNP. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The importance of left ventricle diastolic dysfunction (LVDD) has been recognized widely, as it is well established that heart failure with preserved ejection fraction has a poor prognosis. Furthermore, N-terminal pro–B-type natriuretic peptide (NT-ProBNP) is used as a marker of heart failure. However, the association between LVDD and NT-proBNP is unclear.
Purpose
The aim of this study was to clarify the association between LVDD and NT-ProBNP.
Methods
In this study, an index based on gated myocardial perfusion SPECT using CardioREPO software for the diagnosis of LVDD was used. Out of the 171 patients who underwent myocardial perfusion imaging (MPI) between January 2015 and December 2018, 163 individuals (116 men and 47 women) completed MPI and NT-ProBNP. Patients were classified into 4 groups: NT-ProBNP levels below 125 pg/ml (n = 52), NT-ProBNP levels 125 to 400 pg/ml (n = 33), NT-ProBNP levels 400 to 900 pg/ml (n = 23), and NT-ProBNP levels over 900 pg/ml (n = 37). CardioREPO parameters (peak filling rate (PFR), 1/3 mean filling rate (MFR), and time to peak filling rate/R-R (TTPFR)) were compared between the 4 NT-ProBNP groups.
Results
Of the 163 patients, 55 had LVDD. The PFR and 1/3MFR were associated with LVDD. There was a statistically significant difference in PFR and 1/3 MFR between the NT-ProBNP levels below 125 pg/ml group and the NT-ProBNP levels 400 to 900 pg/ml group (PFR = 2.51+/-1.11 vs. 1.80+/-0.65, p = 0.001; 1/3 MFR = 1.41+/-0.55 vs. 1.06+/-0.47, p = 0.006, Table).
Conclusions
The MPI indices obtained by CardioREPO software were useful in the diagnosis of LVDD. The evaluation of LVDD by MPI correlated with NT-Pro BNP level is thought to have a clinical utility in the diagnosis and management of LVDD.
Variable: NT-ProBNP 0-125 (n = 52) 125-400 (n = 33) 400-900 (n = 23) 900- (n = 37) p Age 66 ± 11 72 ± 11 68 ± 17 70 ± 12 0.133 Male 40 (77%) 22 (12%) 18 (78%) 23 (62%) 0.36 Left ventricular diastolic dysfunction 8 (15%) 4 (12%) 10 (43%) 27 (73%) <0.001 E/A 0.9 ± 0.3 0.8 ± 0.2 1.1 ± 0.7 1.4 ± 0.9 (35) <0.001 E/e" 10.27 ± 3.69 (20) 8.83 ± 3.56 (10) 12.46 ± 3.75 (12) 20.25 ± 8.30 (25) <0.001 rest-PFR /s 2.51 ± 1.11 2.06 ± 0.58 2.16 ± 0.65 1.80 ± 0.65 0.001 rest-1/3 MFR /s 1.41 ± 0.55 1.19 ± 0.41 1.16 ± 0.50 1.06 ±0.47 0.008 rest-TTPFR ms 177 ± 53 181 ± 69 198 ± 80 166 ± 85 0.38 rest-TTPFR / R-R 0.19 ± 0.06 0.20 ± 0.11 0.21 ±0.09 0.21 ± 0.15 0.92
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Affiliation(s)
- S Hata
- Sasebo City General Hospital, Sasebo, Japan
| | - K Sakai
- Sasebo City General Hospital, Sasebo, Japan
| | - K Otsuka
- Sasebo City General Hospital, Sasebo, Japan
| | - S Kusumoto
- Sasebo City General Hospital, Sasebo, Japan
| | - K Sonoda
- Sasebo City General Hospital, Sasebo, Japan
| | - T Muroya
- Sasebo City General Hospital, Sasebo, Japan
| | - H Shinboku
- Sasebo City General Hospital, Sasebo, Japan
| | - S Ikeda
- Nagasaki University Hospital, Nagasaki, Japan
| | - K Maemura
- Nagasaki University Hospital, Nagasaki, Japan
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13
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Yazaki M, Nabeta T, Inomata T, Maemura K, Ooki T, Fujita T, Iida Y, Ikeda Y, Ishii S, Naruke T, Ako J. Clinical Considerations When Introducing Sodium-Glucose Co-Transporter 2 Inhibition in Patients With Heart Failure. Circ Rep 2019; 2:51-59. [PMID: 33693174 PMCID: PMC7929704 DOI: 10.1253/circrep.cr-19-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022] Open
Abstract
Background: In patients with heart failure (HF), discontinued medical therapy because of adverse events (AE) is associated with high mortality. Patients with type 2 diabetes mellitus (T2DM) treated with sodium-glucose co-transporter 2 inhibitors (SGLT2i) have a lower risk of HF, but AE sometimes occur with the introduction of SGLT2i. In order to use SGLT2i safely in patients with HF, we investigated factors associated with AE following the introduction of SGLT2i. Methods and Results: AE were defined as hypotension or an increase in serum creatinine ≥0.3 mg/dL by the fifth day after SGLT2i introduction. Sixty-four hospitalized patients with HF and T2DM treated with an SGLT2i were enrolled in this study. Patients were divided into 2 groups: with AE (n=13, 20.3%) and without (n=51, 79.7%). On logistic regression analysis, female sex, hemoglobin ≥15.2 g/dL, serum creatinine ≥1.05 mg/dL, and cardiac index on echocardiography ≤2.15 L/min/m2, were significantly associated with AE. A scoring system was constructed to predict AE according to significant variables (area under the receiver operating characteristic curve, 0.83; P<0.001) and the cut-off point was 2 points. Conclusions: Female sex, hemoconcentration, kidney injury, and low cardiac output were associated with AE at SGLT2i initiation in patients with HF. Using this scoring system, introduction of SGLT2i could be done safely in patients with HF.
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Affiliation(s)
- Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takumi Ooki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Takashi Naruke
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
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14
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Koga S, Ikeda S, Akashi R, Yamagata Y, Yonekura T, Kawano H, Maemura K. P6405Potential for drug-drug interaction between vonoprazan and prasugrel on antiplatelet effect assessed by VerifyNow P2Y12 assay in patients with coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vonoprazan is a potassium-competitive acid blocker increasingly used in Japan to prevent gastrointestinal bleeding in patients under dual antiplatelet therapy (DAPT) after coronary stents implantation. Since cytochrome P450 (CYP) 3A4 is involved in the primary metabolism of vonoprazan and prasugurel, there is a possibility that CYP-mediated drug-drug interaction between them can attenuate the antiplatelet function of prasugrel.
Purpose
The aim of this study was to investigate whether antiplatelet effect of prasugrel could be attenuated upon coadministration with vonoprazan compared to conventional proton pump inhibitors (PPIs).
Method
We evaluated 72 patients (57 males, 67±11 years) with coronary artery disease who were taking either vonoprazan (n=35) or PPIs (n=37) in combination with DAPT (aspirin and prasugrel) after drug-eluting stents implantation. PPIs included 21 esomeprazole, 8 lansoprazole, and 8 rabeprazole. Antiplatelet effects of prasugrel were assessed using VerifyNow P2Y12 assay. Primary measurements were P2Y12 reaction units (PRU) and P2Y12 percent inhibition. High on-treatment platelet reactivity (HPR) on prasugrel was defined as PRU >208. Administration period of vonoprazan or PPIs in combination with DAPT ≤7 days was defined as early administration period.
Results
Median administration period of vonoprazan or PPIs in combination with DAPT was 127 days. There were no significant differences in baseline clinical characteristics between patients with vonoprazan and PPIs. In the analysis for all subjects, patients with vonoprazan showed similar PRU (166±50 vs. 167±64, p=0.93) and percent inhibition (36±18 vs. 38±23, p=0.66) compared to those with PPIs. No significant differences were observed in the prevalence of HPR between patients with vonoprazan and PPIs (17 vs. 30%, p=0.27). In the analysis for patients in early administration period [vonoprazan (n=14) vs. PPIs (n=10)], there were no significant differences in PRU (166±47 vs. 186±82, p=0.45), percent inhibition (33±17 vs. 30±26, p=0.73), and prevalence of HPR (14 vs. 50%, p=0.085) between patients with vonoprazan and PPIs. In addition, the analysis for patients over early administration period [vonoprazan (n=21) vs. PPIs (n=27)] showed that PRU (166±55 vs. 160±57, p=0.73), percent inhibition (37±19 vs. 41±21, p=0.57), and prevalence of HPR (19 vs. 22%, p=1.00) were comparable between patients with vonoprazan and PPIs.
Conclusion
Compared to PPIs, vonoprazan did not exhibit significant inhibitory effects on the antiplatelet activity of prasugrel assessed by VerifyNow assay. These findings suggest that there are possibly no clinically harmful drug-drug interactions between vonoprazan and prasugrel.
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Affiliation(s)
- S Koga
- Nagasaki University Hospital, Nagasaki, Japan
| | - S Ikeda
- Nagasaki University Hospital, Nagasaki, Japan
| | - R Akashi
- Nagasaki University Hospital, Nagasaki, Japan
| | - Y Yamagata
- Nagasaki University Hospital, Nagasaki, Japan
| | - T Yonekura
- Nagasaki University Hospital, Nagasaki, Japan
| | - H Kawano
- Nagasaki University Hospital, Nagasaki, Japan
| | - K Maemura
- Nagasaki University Hospital, Nagasaki, Japan
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Koga S, Ikeda S, Akashi R, Yamagata Y, Yonekura T, Kawano H, Maemura K. P1549Serum soluble Klotho is associated with extent of coronary artery calcification in patients with stable angina pectoris undergoing percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Klotho, which was originally identified as an aging suppressor, is a key regulator of bone and mineral metabolism. Transmembrane and soluble forms of Klotho protein have been identified. The transmembrane form serves as an obligate co-receptor for fibroblast growth factor 23 (FGF23). However, the physiological importance of soluble form of Klotho has not been determined.
Purpose
The present study aimed to test the hypothesis that circulating soluble Klotho levels can predict the presence or extent of coronary artery calcification (CAC) in patients with coronary artery disease.
Methods
We analyzed CAC of culprit lesions in patients with 75 stable angina pectoris who were not on dialysis and were scheduled for percutaneous coronary intervention (PCI) following intravascular ultrasound (IVUS). Arc and length of each calcium within the culprit lesion was measured by IVUS. The main outcome measure was the calcium index; a volumetric IVUS-derived measure which was calculated as total calcium length/lesion length × maximal calcium arc/360°. Low calcium index was defined as calcium index <0.042 of the first quartile value. Serum Klotho and FGF23 were measured before PCI. Patients were divided into two groups according to median serum Klotho value: low-Klotho (n=37, ≤460 pg/mL) and high-Klotho group (n=38, >460 pg/mL).
Results
Compared with patients with low-Klotho, those with high-Klotho had higher estimated glomerular filtration rate (eGFR) (69±20 vs. 55±16 mL/min/1.73 m2, p<0.001), lower FGF23 levels (51±24 vs. 67±41 pg/mL, p=0.010). Patients with high-Klotho had significantly lower calcium index than those with low-Klotho (0.17±0.21 vs. 0.24±0.23, p=0.043). Serum Klotho levels correlated significantly and inversely with calcium index (r=−0.31, p=0.006). The correlation between Klotho and calcium index was pronounced at analysis in patients with eGFR <60 mL/min/1.73 m2 (r=−0.52, p<0.001). Logistic regression analysis showed that high-Klotho is a sole significant independent factor associated with low calcium index (odds ratio 7.17, p=0.004). Presence of high-Klotho had high sensitivity and negative predictive value for identifying low calcium index (83% and 92%, respectively).
Conclusions
Serum Klotho values were independently and inversely associated with the degree of CAC assessed by IVUS. These findings have important clinical implications for serum Klotho as a biomarker that reflects the extent of CAC.
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Affiliation(s)
- S Koga
- Nagasaki University Hospital, Nagasaki, Japan
| | - S Ikeda
- Nagasaki University Hospital, Nagasaki, Japan
| | - R Akashi
- Nagasaki University Hospital, Nagasaki, Japan
| | - Y Yamagata
- Nagasaki University Hospital, Nagasaki, Japan
| | - T Yonekura
- Nagasaki University Hospital, Nagasaki, Japan
| | - H Kawano
- Nagasaki University Hospital, Nagasaki, Japan
| | - K Maemura
- Nagasaki University Hospital, Nagasaki, Japan
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16
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Ikeda Y, Inomata T, Maemura K, Yazaki M, Oki T, Fujita T, Nabeta T, Maekawa E, Koitabashi T, Ako J. P338Combined assessment using clinical and imaging parameters to predict response to pharmacotherapy in patients with dilated cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Normalization of left ventricular (LV) contraction is a strong surrogate marker of favorable prognosis in patients with dilated cardiomyopathy (DCM). Although several studies have reported the individual predictive significance of clinical and imaging parameters for LV recovery in patients with DCM, there have been no reports on the scoring systems that combine these multifactorial parameters.
Methods and results
In 406 idiopathic patients with DCM, there were 185 (46%) with LV recovery at 1-year follow-up after pharmacotherapy, which was defined as improvements in LV ejection fraction of ≥+10% together with absolute values of ≥50%. Multivariate analysis demonstrated that eight baseline clinical factors and the absence of late gadolinium enhancement (negative LGE) on magnetic resonance imaging were independently associated with LV recovery. The highest odds ratio for the prediction of LV recovery was negative LGE (odds ratio: 5.62, 95% confidence interval: 2.97–10.6; p<0.0001). Response score for the prediction of LV recovery that included these nine parameters had a predictive accuracy of 0.76 for LV recovery (Figure).
Conclusion
Combined assessment using clinical and imaging parameters has a high prognostic value for predicting response to pharmacotherapy in patients with DCM.
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Affiliation(s)
- Y Ikeda
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - T Inomata
- Kitasato Institute Hospital, Cardiovascular Medicine, Tokyo, Japan
| | - K Maemura
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - M Yazaki
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - T Oki
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - T Fujita
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - T Nabeta
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - E Maekawa
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - T Koitabashi
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - J Ako
- Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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17
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Chiba A, Kudo T, Ideguchi R, Altay M, Koga S, Yonekura T, Tsuneto A, Morikawa M, Ikeda S, Kawano H, Koide Y, Uetani M, Maemura K. P386Comparison of whether a beginner can be close to an expert with an artificial neural network in myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez149.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Chiba
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
| | - T Kudo
- Nagasaki University, Radioisotope Medicine, Nagasaki, Japan
| | - R Ideguchi
- Nagasaki University, Radioisotope Medicine, Nagasaki, Japan
| | - M Altay
- Nagasaki University, Radioisotope Medicine, Nagasaki, Japan
| | - S Koga
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
| | - T Yonekura
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
| | - A Tsuneto
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
| | - M Morikawa
- Nagasaki University Hospital, Radiological Sciences, Nagasaki, Japan
| | - S Ikeda
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
| | - H Kawano
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
| | - Y Koide
- Nagasaki Memorial Hospital, Nagasaki Medical Education Center, Nagasaki, Japan
| | - M Uetani
- Nagasaki University Hospital, Radiological Sciences, Nagasaki, Japan
| | - K Maemura
- Nagasaki University Hospital, Cardiovascular Medicine, Nagasaki, Japan
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18
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Akashi R, Koga S, Yonekura T, Muroya T, Koide Y, Ikeda S, Kawano H, Maemura K. P2701Cardio-ankle vascular index can predict coronary plaque characteristics assessed by iMap-intravascular ultrasound. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Akashi
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - S Koga
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - T Yonekura
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - T Muroya
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - Y Koide
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - S Ikeda
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - H Kawano
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - K Maemura
- Nagasaki University Hospital, Department of Cardiovascular Medicine, Nagasaki, Japan
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Nakashima H, Fukushima T, Muto S, Furudono S, Nunohiro T, Maemura K. P1742Effects of sleep-disordered breathing on myocardial stress and renal function in patients with acute myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Nakashima
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - T Fukushima
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - S Muto
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - S Furudono
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - T Nunohiro
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - K Maemura
- Nagasaki University, Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
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20
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Yamagata Y, Ikeda S, Nakata T, Yonekura T, Eguchi M, Koga S, Muroya T, Koide Y, Kawano H, Yao T, Seko Y, Maemura K. P1632Oxidative stress-responsive apoptosis inducing protein (ORAIP), a new oxidative stress marker, is associated with pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Yamagata
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - S Ikeda
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - T Nakata
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - T Yonekura
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - M Eguchi
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - S Koga
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - T Muroya
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - Y Koide
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - H Kawano
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
| | - T Yao
- Institute for Adult Diseases, Division of Cardiovascular Medicine, Tokyo, Japan
| | - Y Seko
- Juntendo University School of Medicine, Department of Biofunctional Microbiota, Tokyo, Japan
| | - K Maemura
- Nagasaki University Hospital, Department of cardiovascular medicine, Nagasaki, Japan
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21
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Nakashima H, Fukushima T, Muto S, Furudono S, Nunohiro T, Maemura K. P1248Impact of adherence to continuous positive airway pressure on the long-term clinical outcomes in patients with acute myocardial infarction and obstructive sleep apnea. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Nakashima
- Nagasaki Harbor Medical Center, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - T Fukushima
- Nagasaki Harbor Medical Center, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - S Muto
- Nagasaki Harbor Medical Center, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - S Furudono
- Nagasaki Harbor Medical Center, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - T Nunohiro
- Nagasaki Harbor Medical Center, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - K Maemura
- Nagasaki University, Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
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22
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Nakashima H, Fukushima T, Muto S, Furudono S, Nunohiro T, Maemura K. P1251Impact of obstructive sleep apnea on circadian variation of infarct size in patients with acute myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Nakashima
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - T Fukushima
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - S Muto
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - S Furudono
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - T Nunohiro
- Nagasaki Harbor Medical Center, Cardiovascular Medicine, Nagasaki, Japan
| | - K Maemura
- Nagasaki University, Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
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23
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Koga S, Ikeda S, Akashi R, Yamagata Y, Yonekura T, Muroya T, Koide Y, Kawano H, Maemura K. P5596Circulating soluble Klotho is inversely associated with coronary artery calcification evaluated by three-dimensional intravascular ultrasound. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Koga
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - S Ikeda
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - R Akashi
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - Y Yamagata
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - T Yonekura
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - T Muroya
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - Y Koide
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - H Kawano
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
| | - K Maemura
- Nagasaki University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Nagasaki, Japan
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24
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Hirakawa Y, Futaki S, Tanizaki H, Maemura K, Furukawa F, Moriwaki S. 130 Expression of nidogen1 in basal cell carcinoma. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Furudono S, Mashimo Y, Fukushima T, Kurobe M, Muto S, Suenaga H, Nunohiro T, Takeshita S, Nakashima H, Maemura K. P1123Impact of central and obstructive sleep apnea on long term clinical outcomes in patients with acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Furudono S, Mashimo Y, Fukushima T, Kurobe M, Muto S, Suenaga H, Nunohiro T, Takeshita S, Nakashima H, Maemura K. P4633Relationship between circadian variation and plaque characteristics in patients with ST-segment elevation myocardial Infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Maemura K, Nishinarita R. TCTAP C-202 Juvenile Onset Coronary Artery Dissection Patients with Poor Coronary Risk Factors Were Diagnosed from Typical Symptoms. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.03.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Koga S, Ikeda S, Yoshida T, Nakata T, Takeno M, Koide Y, Kawano H, Maemura K. Plaque composition analysis by iMap-intravascular ultrasound predicts peri-procedural myocardial injury in patients undergoing percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Koga S, Ikeda S, Yoshida T, Nakata T, Takeno M, Koide Y, Kawano H, Maemura K. Circulatinng high-mobility group box 1 levels are associated with presence of thin-cap fibroatheroma in coronary culprit lesion determined by optical coherence tomography. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Koga S, Ikeda S, Yoshida T, Nakata T, Takeno M, Koide Y, Kawano H, Maemura K. Evaluation of plaque composition using iMap-intravascular ultrasound predicts thin-cap fibroatheroma determined by optical coherence tomography. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Sonoda K, Hata S, Yamasa T, Ikeda S, Maemura K. The differences of neointimal coverage among bare-metal stent, zotarolimus-eluting stent and everolimus-eluting stent at 9 Months after implantation using optical coherence tomography in STEMI patents. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Nakashima H, Henmi T, Minami K, Uchida Y, Shiraishi Y, Nunohiro T, Takeshita S, Maemura K. Adiponectin is the most useful predictor for all-cause mortality and recurrence of acute coronary syndrome in patients with acute myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Nakashima H, Henmi T, Minami K, Uchida Y, Shiraisi Y, Nunohiro T, Takeshita S, Maemura K. Impact of sleep structure on long-term clinical outcomes in patients with acute myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Nakashima H, Henmi T, Minami K, Uchida Y, Shiraishi Y, Nunohiro T, Takeshita S, Maemura K. Impact of plasma renin activity on clinical outcomes and left ventricular remodeling in patients with ST-segment elevation myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Shinchi H, Maemura K, Mataki Y, Kurahara H, Natsugoe S, Takao S. A phase II trial of oral fluoropyrimidine anticancer agent (S-1) with concurrent external-beam radiotherapy for locally advanced pancreatic cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15570 Background: S-1 is a new oral fluoropyrimidine anticancer agent and has shown a good efficacy for pancreatic cancer. In the phase I trial, we evaluated the safety of S-1 combined with external-beam radiotherapy (EBRT) to determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) in unresectable pancreatic cancer patients (H. Shinchi et al,, Br J Ca 2007;96:1353). The phase I trial determined the recommended of S-1 for the phase II chemoradiotherapy trial to be 80mg/m2/day given on days 1–21. This phase II trial was conducted to evaluate the efficacy and toxicity of EBRT combined with S-1 for locally advanced pancreatic cancer. Methods: Eligible patients had locally advanced and unresectable pancreatic cancer without distant metastases, ECOG PS 0–1, adequate organ and marrow function, and no prior anticancer therapy. EBRT was delivered in fractions of 1.25Gy twice daily, totaling 50Gy per 40 fractions for 4 weeks. S-1 was given orally at a dose of 80mg/m2/day twice a day on days 1–21. The primary end-point of this trial was objective tumor response and secondary end-points included toxicity and overall survival. Results: Forty patients were enrolled in this phase II trial. Of the 40 patients, 39 (97%) completed the scheduled course of chemoradiotherapy. The objective tumor responses by RECIST criteria included 13 PR (33%), 20 SD (50%) and 7 PD (17%). The median survival time was 14 months and 1-year survival rate was 67%. Although grade 3 rash and anorexia occurred in one patient each, no grade 4 toxicities were observed. Conclusions: Combination therapy of S-1 and radiation shows favorable efficacy for locally advanced pancreatic cancer and was well tolerated with no severe toxicities. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - Y. Mataki
- Kagoshima University, Kagoshima, Japan
| | | | | | - S. Takao
- Kagoshima University, Kagoshima, Japan
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36
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Toshina K, Hirata I, Maemura K, Sasaki S, Murano M, Nitta M, Yamauchi H, Nishikawa T, Hamamoto N, Katsu K. Enprostil, a Prostaglandin-E2 Analogue, Inhibits Interleukin-8 Production of Human Colonic Epithelial Cell Lines. Scand J Immunol 2008. [DOI: 10.1111/j.1365-3083.2000.00815.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Shinchi H, Mataki Y, Kurahara H, Maeda S, Noma H, Maemura K, Takao S. Phase II study of oral fluoropyrimidine anticancer agent (S-1) with concurrent external-beam radiotherapy for locally advanced pancreatic cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Maeda S, Shinchi H, Kurahara H, Mataki Y, Noma H, Maemura K, Aridome K, Yokomine T, Natsugoe S, Aikou T, Takao S. Clinical significance of midkine expression in pancreatic head carcinoma. Br J Cancer 2007; 97:405-11. [PMID: 17622248 PMCID: PMC2360321 DOI: 10.1038/sj.bjc.6603879] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Midkine (MK) is a heparin-binding growth factor and a product of a retinoic acid-responsive gene. Midkine is overexpressed in many carcinomas and thought to play an important role in carcinogenesis. However, no studies have been focussed on the role of MK in pancreatic carcinoma. This study sought to evaluate the clinical significance of MK expression in pancreatic head carcinoma, including the relationship between immunohistochemical expression and clinicopathologic factors such as prognosis. Immunohistochemical expression of MK and CD34 was evaluated in pancreatic head carcinoma specimens from 75 patients who underwent surgical resection. Midkine was expressed in 53.3% of patients. Midkine expression was significantly correlated with venous invasion, microvessel density, and liver metastasis (P=0.0063, 0.0025, and 0.0153, respectively). The 5-year survival rate was significantly lower for patients positive for MK vs patients negative for MK (P=0.0073). Multivariate analysis revealed that MK expression was an independent prognostic factor (P=0.0033). This is the first report of an association between MK expression and pancreatic head carcinoma. Midkine may play an important role in the progression of pancreatic head carcinoma, and evaluation of MK expression is useful for predicting malignant properties of pancreatic head carcinoma.
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Affiliation(s)
- S Maeda
- Department of Surgical Oncology and Digestive Surgery, Kagoshima University, Graduate School of Medical and Dental Science, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
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39
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Shinchi H, Maemura K, Noma H, Mataki Y, Aikou T, Takao S. Phase-I trial of oral fluoropyrimidine anticancer agent (S-1) with concurrent radiotherapy in patients with unresectable pancreatic cancer. Br J Cancer 2007; 96:1353-7. [PMID: 17437021 PMCID: PMC2360168 DOI: 10.1038/sj.bjc.6603735] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this phase-I trial, we evaluated the safety of S-1, a novel oral fluoropyrimidine anticancer agent, combined with external-beam radiotherapy (EBRT) to determine the maximum-tolerated dose and dose-limiting toxicity (DLT) in unresectable pancreatic cancer patients. Patients had histologically proven unresectable locally advanced or metastatic pancreatic cancer. S-1 was administered orally twice daily. External-beam radiotherapy was delivered in fractions of 1.25 Gy × 2 per day, totalling 50 Gy per 40 fractions for 4 weeks. S-1 was given at five dose levels: 60 mg m–2 day–1 on days 1–7 and 15–21 (level 1), 1–14 (level 2), and 1–21 (level 3a) and 80 mg m–2 day–1 on days 1–21 (level 3b) and 1–28 (level 4). We studied 17 patients: dose levels 1 (four patients), 2 (four patients), 3a (three patients), 3b (three patients), and 4 (three patients). One patient in level 1 (grade 3 vomiting) and two patients in level 4 (grade 4 neutropenia and grade 3 anorexia) showed DLT. No DLT was seen for levels 2, 3a, and 3b. Clinical effects by computed tomography included 5 partial responses (35%), 11 cases of stable disease, and one case of progressive disease. CA19–9 levels of less than half the starting values were observed in 8 of 16 (50%) patients. S-1 at a dose of 80 mg m–2 day–1 given on days 1–21 is safe and recommended for phase-II study in patients with locally advanced and unresectable pancreatic cancer when given with EBRT.
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Affiliation(s)
- H Shinchi
- Department of Surgical Oncology and Digestive Surgery, Kagoshima University, Kagoshima, Japan.
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40
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Watanabe M, Maemura K, Oki K, Shiraishi N, Shibayama Y, Katsu K. Gamma-aminobutyric acid (GABA) and cell proliferation: focus on cancer cells. Histol Histopathol 2006; 21:1135-41. [PMID: 16835836 DOI: 10.14670/hh-21.1135] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In addition to its role in the adult mammalian nervous system as an inhibitory neurotransmitter, gamma-aminobutyric acid (GABA) is involved in the proliferation, differentiation, and migration of several kinds of cells including cancer cells. GABA is synthesized predominantly from glutamate by glutamate decarboxylase and exerts its effects via ionotropic GABA(A) receptors and/or metabotropic GABA(B) receptors. In this review, the current state of knowledge regarding the role of the GABAergic system in peripheral nonneuronal cell proliferation is described, and recent advances in elucidation of the mechanisms leading to cell proliferation are discussed.
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Affiliation(s)
- M Watanabe
- Department of Anatomy and Cell Biology, Osaka Medical College, Takatsuki, Osaka, Japan.
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41
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Maemura K, Takao S, Shinchi H, Noma H, Hiraki Y, Nakajo M, Aikou T. Phase II study of conventional fractionated radiotherapy versus hyper-fractionated accelerated radiotherapy concomitant with low dose gemcitabine for patients with pancreatic cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14017 Background: Concurrent radiotherapy and chemotherapy with gemcitabine (GEM) has been reported to improve the median survival of patients with unresectable pancreatic cancer. Although hyperfractionated accelerated radiotherapy (HART) was administered to pancreatic cancer recently, the efficacy is unclear. Phase II study was conducted to evaluate the efficacy and the toxicity of HART concomitant with twice-weekly low dose GEM compared with conventionally fractionated radiotherapy (CRT) for unresectable pancreatic cancer. Methods: Between April 2001 and April 2004, 34 untreated eligible patients with histologically proven unresectable pancreatic cancer were enrolled. In CRT group (n=15), 50.4Gy was delivered in 28 fractions of 1.8Gy/day. In HART group (n=19), 50Gy was delivered in 40 fractions of 1.25Gy twice a day. All patients were treated with conformal radiation using 5mm multileaf collimeter. Concurrent chemotherapy with GEM (40mg/m2) was administered twice a week to both groups. Chemotherapy was suspended for Grade 3 toxicities or increase in temperature more than 38 °C. Response evaluations were conducted at six weeks after the treatment. Maintenance chemotherapy composed of GEM (1000mg/m2/week) for 3weeks was repeated every 4 weeks thereafter. Results: The median survival time (MST) was 11.3 months in CRT group and 12.9 months in HART group. The 1- and 2-year survival rates were 42.9% and 28.6% in CRT group, 52.9% and 17.6% in HART group. There was no significant difference in response rate between CRT and HART group (35.7% vs. HART; 35.3%). The median time to progression (TTP) was significantly prolonged in HART group (9.7months) compared with CRT group (5.9 months) (p=0.02). Overall treatment time was significantly shorter in HART group (37days) than CRT group (45days) (p=0.002). There was no significant deference in toxicity between CRT and HART group. Conclusions: HART concomitant with low dose GEM was well tolerated with acceptable toxicity and prolonged median TTP and MST with shortening of treatment time compared with conventional radio-chemotherapy. This regimen appears to be one of the crucial therapies for patients with unresectable pancreatic cancer. No significant financial relationships to disclose.
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Affiliation(s)
- K. Maemura
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
| | - S. Takao
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
| | - H. Shinchi
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
| | - H. Noma
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
| | - Y. Hiraki
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
| | - M. Nakajo
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
| | - T. Aikou
- Kagoshima University Graduate School of Medical an, Kagoshima, Japan; Kagoshima University, kagoshima, Japan
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Shinchi H, Takao S, Maemura K, Noma H, Aikou T. Phase I study of oral fluoropyrimidine anticancer agent (S-1) with concurrent external-beam radiotherapy for unresectable pancreatic cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4109 Background: S-1 is an oral fluorouracil anticancer agent that was recently reported to demonstrate a response rate of 21% in 19 patients with advanced pancreatic cancer. Concurrent external-beam radiotherapy (EBRT) and 5-FU has been generally accepted as the standard treatment for locally advanced pancreatic cancer. However, there are no published data regarding the efficacy of combination therapy of S-1 and radiation in patients with pancreatic cancer. Our purpose of this study was to evaluate the safety of S-1 combined with EBRT and determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of S-1 in patients with locally advanced and unresectable pancreatic cancer. Methods: Eligible patients had UICC stage III or IV pancreatic cancer (either advanced unresectable or metastatic), adequate organ function, and no anticancer therapy in the preceding 4 weeks. S-1 was given orally at a dose of 60 mg/m2/day or 80 mg/m2/day in two divided doses after breakfast and supper. External-beam radiotherapy was delivered using a conformal technique in fraction of 1.25 Gy X 2/day, 5 days per week, totaling 50 Gy/40 fraction for 4weeks. S-1 at a dose of 60 mg/m2/day was given on days 1–7 and 15–21 in level 1, on days 1–14 in level 2, on days 1–21 in level 3a, respectively. S-1 at a dose of 80 mg/m2/day was given on days 1–21 in level 3b and on days 1–28 in level 4. DLT was defined as NCI-CTC grade 3/4 toxicity. Results: 18 patients were entered in this phase I trial: level 1 (4 patients), level 2 (5 patients), level 3a (3 patients), level 3b (3 patients), level 4 (3 patients). There were 1 of 5 patients with DLT in level 2: grade 3 vomiting. There were no DLT in levels 1, 3a, and 3b, respectively. Two of 3 patients in level 4 showed DLT: one patient developed grade 3 neutropenia and another patient developed grade 3 diarrhea. Clinical effects by CT scan included one PR, 15 SD and 2 PD. Reduced CA19–9 level less than a half of that at starting time was observed in 6 of 18 patients. Conclusions: S-1 at a dose of 80 mg/m2/day given on days 1–21 is safe and may be recommended for phase II study in patients with locally advanced and unresectable pancreatic cancer. This regimen appears to be a promising and well-tolerated approach with consideration of application to outpatients. No significant financial relationships to disclose.
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Affiliation(s)
| | - S. Takao
- Kagoshima University, Kagoshima, Japan
| | | | - H. Noma
- Kagoshima University, Kagoshima, Japan
| | - T. Aikou
- Kagoshima University, Kagoshima, Japan
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43
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Maemura K, Yanagawa Y, Obata K, Dohi T, Egashira Y, Shibayama Y, Watanabe M. Antigen-presenting cells expressing glutamate decarboxylase 67 were identified as epithelial cells in glutamate decarboxylase 67-GFP knock-in mouse thymus. ACTA ACUST UNITED AC 2006; 67:198-206. [PMID: 16573556 DOI: 10.1111/j.1399-0039.2006.00548.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Glutamate decarboxylase (GAD), which has two isoforms, GAD65, and GAD67, is responsible for synthesis of the major inhibitory neurotransmitter, gamma-aminobutyric acid. GAD is expressed predominantly in the central nervous system; recent reports suggest that GAD is also expressed in non-neuronal organs including the pancreas. In the pancreatic islets, GAD serves as one of the autoantigens in type I diabetes mellitus. Recent flow cytometric analyses have shown that a variety of self-antigens, including GAD, are ectopically transcribed and expressed in particular cell populations of the thymus, although consensus concerning the cellular phenotype has not been obtained. The aim of this study was to clarify the localization and cellular phenotype of GAD67-expressing cells in the thymus at a cellular level with a novel approach using GAD67-green fluorescent protein (GFP) knock-in mice, in which GFP is expressed specifically in GAD67-positive cells. GFP-positive cells were detected in the thymic medulla and were identified as epithelial cells by immunohistochemistry. Almost all GFP-positive cells were positive for major histocompatibility complex (MHC) class II antigen staining and were positive for both cytokeratin and Ulex Europaeus Agglutinin I, markers of medullary thymic epithelial cells, but were negative for CD11c, Gr-1, and CD45, markers of dendritic cells, macrophages, and B-lymphocytes, respectively.
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Affiliation(s)
- K Maemura
- Department of Anatomy, Osaka Medical College, Japan
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44
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Abstract
We investigated the GABAergic system within the Sprague-Dawley rat (2-3-weeks old) trigeminal ganglion (TG). Reverse transcription-polymerase chain reaction (RT-PCR) analysis revealed expression of glutamate decarboxylase (GAD) 65 and GAD67 mRNAs and mRNAs encoding GABA(A) receptor subunits alpha1-6, beta1-3, gamma1-3, and delta. In situ hybridization revealed that GAD65 and GAD67 mRNAs were expressed in neuronal cell bodies but not satellite cells. Immunohistochemical analysis showed that only GAD65 was expressed in all neuronal cell bodies, and approximately 70% of all neurons exhibited GABA immunoreactivity. Satellite cells were strongly immunopositive for GABA. GABA(A) receptor alpha1, alpha5, beta2/3 and gamma1/2/3 subunit immunoreactivities were observed in the majority of neurons, but no immunoreactivity for alpha2 was observed. Two types of cells were identified in TG based on cell size and morphology, type A and B. The percentage of cells expressing alpha3, alpha4, alpha6, and delta subunits appeared to be dependent on cell size, as delta and alpha6 expression were only observed in small (B-type) neurons. In whole-cell patch clamp experiments, GABA application induced inward Cl- currents in all neurons examined. The EC50 for GABA varied from 5.3 to 240 microm, and the Hill Coefficient (nH) varied between 0.98 and 2.6 at -60 mV. We found that GABA was released from TG cells by increasing extracellular K+ concentration to 100 mm. We speculate that GABA acts as a nonsynaptically released diffusible neurotransmitter, which may modulate somatic inhibition of neurons within the TG.
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MESH Headings
- Animals
- Animals, Newborn
- Bicuculline/pharmacology
- Cell Count/methods
- Cells, Cultured
- Dose-Response Relationship, Drug
- Dose-Response Relationship, Radiation
- Electric Capacitance
- Electric Stimulation/methods
- Epistasis, Genetic
- GABA Agonists/pharmacology
- GABA Antagonists/pharmacology
- Glutamate Decarboxylase/metabolism
- Immunohistochemistry/methods
- In Situ Hybridization/methods
- Isoenzymes/metabolism
- Male
- Membrane Potentials/drug effects
- Membrane Potentials/physiology
- Membrane Potentials/radiation effects
- Models, Neurological
- Muscimol/pharmacology
- Neural Inhibition/drug effects
- Neural Inhibition/physiology
- Neural Inhibition/radiation effects
- Neurons/classification
- Neurons/drug effects
- Neurons/metabolism
- Neurons/radiation effects
- Patch-Clamp Techniques
- Potassium/pharmacology
- Protein Subunits/genetics
- Protein Subunits/metabolism
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Receptors, GABA-A/genetics
- Receptors, GABA-A/metabolism
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Trigeminal Ganglion/cytology
- gamma-Aminobutyric Acid/metabolism
- gamma-Aminobutyric Acid/pharmacology
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Affiliation(s)
- H Hayasaki
- Department of Anatomy, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
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45
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Maemura K, Takao S, Shinchi H, Aikou T. Length and quality of survival after hyperfractionated radiotherapy concurrent with low dose gemicitabine for inoperative pancreatic cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - S. Takao
- Kagoshima Univ, Kagoshima, Japan
| | | | - T. Aikou
- Kagoshima Univ, Kagoshima, Japan
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Maemura K, Takeda N, Morita H, Imai Y, Hanada T, Nojiri T, Nagai R. 1P-0176 Peripheral biological clock regulates circadian gene expression in vascular endothelial cells. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Kawanami D, Maemura K, Harada T, Nojiri T, Imai Y, Nagai R. 4P-1168 CRP induces PAI-1 gene expression through tyrosine kinase and NFkB pathways in vascular endothelial cells. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)91424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Takeda N, Maemura K, Imai Y, Harada T, Kawanami D, Nojiri T, Manabe I, Nagai R. 3P-0647 Delivery of endothelial PAS domain protein 1 gene promotes mature angiogenesis through the transactivation of both VEGF and its receptor, Flt-1. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Nitta M, Hirata I, Toshina K, Murano M, Maemura K, Hamamoto N, Sasaki S, Yamauchi H, Katsu K. Expression of the EP4 prostaglandin E2 receptor subtype with rat dextran sodium sulphate colitis: colitis suppression by a selective agonist, ONO-AE1-329. Scand J Immunol 2002; 56:66-75. [PMID: 12100473 DOI: 10.1046/j.1365-3083.2002.01096.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Expression of the EP4 receptor, a prostaglandin (PG)E2 receptor subtype, as well as disease suppression by the administration of a selective EP4 agonist (ONO-AE1-329) was investigated in the colorectal mucosa of rats with dextran sodium sulphate (DSS)-induced colitis. Rats were given drinking water containing 3% DSS for 2 weeks. Expression of EP4 receptor mRNA was barely detectable under normal conditions according to reverse transcription-polymerase chain reaction (RT-PCR). By 1 week after the initial administration of DSS, the receptor mRNA was strongly expressed. After ONO-AE1-329 was administered intracolonically to rats with DSS colitis for 7 consecutive days, erosion and ulceration decreased. Peripheral white blood cell (WBC) counts became less elevated. Interleukin (IL)-1beta and growth-regulated gene product/cytokine-induced neutrophil chemoattractant (GRO/CINC-1) concentrations in colorectal mucosa were lower than in colitis control group (IL-1beta: 12.8 +/- 4.6 and 30.8 +/- 6.2 microg/mg protein, P < 0.05; GRO/CINC-1: 15.5 +/- 3.0 and 39.2 +/- 5.4 microg/mg protein, P < 0.05), and the expression of the corresponding cytokine mRNA was strongly suppressed. IL-10 concentration was higher than in control group (14.5 +/- 1.7 and 7.9 +/- 1.2 microg/mg, P < 0.05), and the mRNA was more strongly expressed. These results suggest that the EP4 receptor is important in colonic inflammation, and that PGE2 suppresses DSS colitis at least partly via the EP4 receptor and the above cytokine changes. Intracolonic administration of selective EP4 agonist might have therapeutic applicability in inflammatory bowel disease such as ulcerative colitis.
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MESH Headings
- Acute Disease
- Animals
- Anti-Ulcer Agents/administration & dosage
- Anti-Ulcer Agents/pharmacology
- CHO Cells
- Chemokine CXCL1
- Chemokines, CXC
- Chemotactic Factors/biosynthesis
- Chemotactic Factors/genetics
- Chemotactic Factors/immunology
- Colitis/chemically induced
- Colitis/genetics
- Colitis/immunology
- Colitis/pathology
- Colon/enzymology
- Colon/immunology
- Colon/pathology
- Cricetinae
- Dextran Sulfate/adverse effects
- Dinoprostone/metabolism
- Dose-Response Relationship, Drug
- Gene Expression
- Growth Substances/biosynthesis
- Growth Substances/genetics
- Growth Substances/immunology
- Intercellular Signaling Peptides and Proteins
- Interleukin-1/biosynthesis
- Interleukin-1/genetics
- Interleukin-1/immunology
- Interleukin-10/biosynthesis
- Interleukin-10/genetics
- Interleukin-10/immunology
- Leukocyte Count
- Male
- Methyl Ethers/administration & dosage
- Methyl Ethers/pharmacology
- Peroxidase/metabolism
- RNA, Messenger
- Rats
- Rats, Sprague-Dawley
- Receptors, Prostaglandin E/agonists
- Receptors, Prostaglandin E/genetics
- Receptors, Prostaglandin E, EP2 Subtype
- Receptors, Prostaglandin E, EP4 Subtype
- Time Factors
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Affiliation(s)
- M Nitta
- Second Department of Internal Medicine, Osaka Medical College, Japan.
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50
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Shindo T, Kurihara H, Maemura K, Kurihara Y, Ueda O, Suzuki H, Kuwaki T, Ju KH, Wang Y, Ebihara A, Nishimatsu H, Moriyama N, Fukuda M, Akimoto Y, Hirano H, Morita H, Kumada M, Yazaki Y, Nagai R, Kimura K. Renal damage and salt-dependent hypertension in aged transgenic mice overexpressing endothelin-1. J Mol Med (Berl) 2002; 80:105-16. [PMID: 11907647 DOI: 10.1007/s00109-001-0284-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2001] [Accepted: 08/28/2001] [Indexed: 10/27/2022]
Abstract
The recent development of endothelin-1 (ET-1) antagonists and their potential use in the treatment of human disease raises questions as to the role of ET-1 in the pathophysiology of such cardiovascular ailments as hypertension, heart failure, renal failure and atherosclerosis. It is still unclear, for example, whether activation of an endogenous ET-1 system is itself the primary cause of any of these ailments. In that context, the phenotypic manifestations of chronic ET-1 overproduction may provide clues about the tissues and systems affected by ET-1. We therefore established two lines of transgenic mice overexpressing the ET-1 gene under the direction of its own promoter. These mice exhibited low body weight, diminished fur density and two- to fourfold increases in the ET-1 levels measured in plasma, heart, kidney and aorta. There were no apparent histological abnormalities in the visceral organs of young (8 weeks old) transgenic mice, nor was their blood pressure elevated. In aged (12 months old) transgenic mice, however, renal manifestations, including prominent interstitial fibrosis, renal cysts, glomerulosclerosis and narrowing of arterioles, were detected. These pathological changes were accompanied by decreased creatinine clearance, elevated urinary protein excretion and salt-dependent hypertension. It thus appears that mild, chronic overproduction of ET-1 does not primarily cause hypertension but triggers damaging changes in the kidney which lead to the susceptibility to salt-induced hypertension.
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Affiliation(s)
- T Shindo
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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