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Tanaka K, Miwa K, Koga M, Yoshimura S, Kamiyama K, Yagita Y, Nagakane Y, Hoshino H, Terasaki T, Okada Y, Yakushiji Y, Takahashi S, Ueda T, Hasegawa Y, Shiozawa M, Sasaki M, Kudo K, Tanaka J, Nishihara M, Yamaguchi Y, Fujita K, Honda Y, Kawano H, Ide T, Yoshimoto T, Ihara M, Hirano T, Toyoda K. Cerebral Small Vessel Disease Burden for Bleeding Risk during Antithrombotic Therapy: Bleeding with Antithrombotic Therapy 2 Study. Ann Neurol 2024; 95:774-787. [PMID: 38146238 DOI: 10.1002/ana.26868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study was undertaken to determine the excess risk of antithrombotic-related bleeding due to cerebral small vessel disease (SVD) burden. METHODS In this observational, prospective cohort study, patients with cerebrovascular or cardiovascular diseases taking oral antithrombotic agents were enrolled from 52 hospitals across Japan between 2016 and 2019. Baseline multimodal magnetic resonance imaging acquired under prespecified conditions was assessed by a central diagnostic radiology committee to calculate total SVD score. The primary outcome was major bleeding. Secondary outcomes included bleeding at each site and ischemic events. RESULTS Of the analyzed 5,250 patients (1,736 women; median age = 73 years, 9,933 patient-years of follow-up), antiplatelets and anticoagulants were administered at baseline in 3,948 and 1,565, respectively. Median SVD score was 2 (interquartile range = 1-3). Incidence rate of major bleeding was 0.39 (per 100 patinet-years) in score 0, 0.56 in score 1, 0.91 in score 2, 1.35 in score 3, and 2.24 in score 4 (adjusted hazard ratio [aHR] for score 4 vs 0 = 5.47, 95% confidence interval [CI] = 2.26-13.23), that of intracranial hemorrhage was 0.11, 0.33, 0.58, 0.99, and 1.06, respectively (aHR = 9.29, 95% CI = 1.99-43.35), and that of ischemic event was 1.82, 2.27, 3.04, 3.91, and 4.07, respectively (aHR = 1.76, 95% CI = 1.08-2.86). In addition, extracranial major bleeding (aHR = 3.43, 95% CI = 1.13-10.38) and gastrointestinal bleeding (aHR = 2.54, 95% CI = 1.02-6.35) significantly increased in SVD score 4 compared to score 0. INTERPRETATION Total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting the broader clinical relevance of cerebral SVD as a marker for safe implementation of antithrombotic therapy. ANN NEUROL 2024;95:774-787.
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Affiliation(s)
- Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Tadashi Terasaki
- Department of Neurology, Kumamoto Red Cross Hospital, Kumamoto, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Yakushiji
- Department of Neurology, Kansai Medical University, Hirakata, Japan
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Shinichi Takahashi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Toshihiro Ueda
- Department of Strokology, Stroke Center, St Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Yasuhiro Hasegawa
- Division of Neurology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Sasaki
- Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Masashi Nishihara
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Yoshitaka Yamaguchi
- Department of Neurology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kyohei Fujita
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Honda
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Ikeda S, Inoue Y, Suzuyama K, Ide T, Eriguchi M. Haemorrhagic and ischemic stroke following posterior reversible encephalopathy syndrome and thrombotic microangiopathy in a patient with malignant hypertension. Acta Neurol Belg 2024; 124:339-341. [PMID: 37407871 DOI: 10.1007/s13760-023-02328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Shuhei Ikeda
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
- Department of Neurology, Kansai Medical University, Osaka, 573-1191, Japan.
| | - Yukako Inoue
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Kohei Suzuyama
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
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Ide T, Yakushiji Y, Suzuyama K, Nishihara M, Eriguchi M, Ogata A, Matsumoto A, Hara M, Hara H. Associations for progression of cerebral small vessel disease burden in healthy adults: the Kashima scan study. Hypertens Res 2024; 47:302-310. [PMID: 37673959 DOI: 10.1038/s41440-023-01419-3] [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] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 09/08/2023]
Abstract
To investigate the association between vascular risk factors and progression of cerebral small vessel disease (SVD), we conducted a longitudinal study with neurologically healthy cohort composed mostly of middle-aged adults (n = 665, mean age, 57.7 years). Subjects, who had both baseline data of brain health examinations including MRI and follow-up MRI at least 1 year after the baseline MRI, were included this study. The presence of features of SVD, including lacunes, cerebral microbleeds, white matter hyperintensity, and basal ganglia perivascular spaces were summed to obtain "total SVD score" (range, 0-4). Progression of SVD was evaluated among subjects with a total SVD score of ≤ 3 and was defined as a ≥ 1 point increase in that score at follow-up relative to baseline. As the primary analysis, multivariate logistic regression analyses were performed to determine the associations of progression of SVD at baseline. The median follow-up period was 7.3 years and progression of SVD was observed in 154 subjects (23.2%). Even after adjustment with confounders multivariate logistic regression analyses showed that progression of SVD was associated with age (per 10-year increase, odds ratio [OR]: 2.08, 95% confidence interval [CI] 1.62-2.67), hypertension (OR 1.55, 95%CI 1.05-2.29), systolic blood pressure (BP) (per standard deviation [SD] increase, OR 1.27, 95%CI 1.04-1.54), diastolic BP (per SD increase, OR 1.23, 95%CI 1.01-1.50), and mean arterial pressure (per SD increase, OR 1.27, 95%CI 1.04-1.55). Age and high blood pressure appear to play key roles in the progression of cerebral small vessel burden after mid-life.
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Affiliation(s)
- Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
- Department of Neurology, Kansai Medical University, Hirakata, Japan.
| | - Kohei Suzuyama
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Masashi Nishihara
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Atsushi Ogata
- Department of Neurosurgery, Saga University Faculty of Medicine, Saga, Japan
| | - Akiko Matsumoto
- Department of Social Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
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Araki T, Kanda S, Ide T, Sonehara K, Komatsu M, Tateishi K, Minagawa T, Kiniwa Y, Kawakami S, Nomura S, Okuyama R, Hanaoka M, Koizumi T. Antiplatelet drugs may increase the risk for checkpoint inhibitor-related pneumonitis in advanced cancer patients. ESMO Open 2023; 8:102030. [PMID: 37852033 PMCID: PMC10774871 DOI: 10.1016/j.esmoop.2023.102030] [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] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/31/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are indicated for various cancers and are the mainstay of cancer immunotherapy. They are often associated with ICI-related pneumonitis (CIP), however, hindering a favorable clinical course. Recently, non-oncology concomitant drugs have been reported to affect the efficacy and toxicity of ICIs; however, the association between these drugs and the risk for CIP is uncertain. The aim of this study was to assess the impact of baseline concomitant drugs on CIP incidence in ICI-treated advanced cancer patients. PATIENTS AND METHODS This was a single-center retrospective study that included a cohort of 511 patients with advanced cancer (melanoma and non-small-cell lung, head and neck, genitourinary, and other types of cancer) treated with ICIs. Univariable analysis was conducted to identify baseline co-medications associated with CIP incidence. A propensity score matching analysis was used to adjust for potential CIP risk factors, and multivariable analysis was carried out to assess the impact of the identified co-medications on CIP risk. RESULTS Forty-seven (9.2%) patients developed CIP. In these patients, the organizing pneumonia pattern was the dominant radiological phenotype, and 42.6% had grade ≥3 CIP, including one patient with grade 5. Of the investigated baseline co-medications, the proportion of antiplatelet drugs (n = 50, 9.8%) was higher in patients with CIP (23.4% versus 8.4%). After propensity score matching, the CIP incidence was higher in patients with baseline antiplatelet drugs (22% versus 6%). Finally, baseline antiplatelet drug use was demonstrated to increase the risk for CIP incidence regardless of cancer type (hazard ratio, 3.46; 95% confidence interval 1.21-9.86). CONCLUSIONS An association between concomitant antiplatelet drug use at baseline and an increased risk for CIP was seen in our database. This implies the importance of assessing concomitant medications for CIP risk management.
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Affiliation(s)
- T Araki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Kanda
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan.
| | - T Ide
- Department of Pharmacy, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - M Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - K Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Minagawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Y Kiniwa
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Kawakami
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - S Nomura
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - R Okuyama
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - M Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - T Koizumi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
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Ide T, Goto Y, Nishihara M, Eriguchi M, Koike H. Co-occurrence of subacute combined degeneration of the spinal cord and neuromyelitis optica spectrum disorder. Acta Neurol Belg 2023:10.1007/s13760-023-02422-8. [PMID: 37980328 DOI: 10.1007/s13760-023-02422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga, 849-8501, Japan.
| | - Yuta Goto
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga, 849-8501, Japan
| | - Masashi Nishihara
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga, 849-8501, Japan
| | - Haruki Koike
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga, 849-8501, Japan
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Yamamoto S, Kuroki Y, Ide T, Tanaka S, Hirahara R, Takamori A, Nishimura T, Suzuma K, Kadonosono K, Enaida H. Customization of a passive surgical support robot to specifications for ophthalmic surgery and preliminary evaluation. Jpn J Ophthalmol 2023; 67:637-644. [PMID: 37561308 DOI: 10.1007/s10384-023-01017-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To customize a passive surgery support robot for ophthalmic surgery and preliminarily evaluate its performance. STUDY DESIGN Prospective observational study. METHODS The range of motion of the arm was analyzed during ophthalmic surgery and, based on this analysis, a commercially available passive robot was customized for surgical support for ophthalmic surgery; following which a prototype robot was constructed. To examine the effects on the brachial muscle during surgical operations with and without the prototype robot, surface electromyograms of the biceps and triceps were analyzed after performing continuous curvilinear capsulorrhexis (CCC) and suturing the sclerocorneal wound in a cataract surgery simulation. Six surgeons performed cataract surgery, and the degree of arm stability and muscle fatigue during surgery were evaluated using a visual analog scale. RESULTS During surgery, the prototype robot enabled fixation of the elbow and wrist at any position within the surgeon's range of motion, expanding the range of motion of the hand and fingers and stabilizing operability. Surface electromyography showed a significant decrease in the mean amplitude value of the biceps brachii during both CCC and suturing (p < 0.0001). No significant difference was observed in the triceps brachii. The arm stability and muscle fatigue were improved by 83.3% on the visual analog scale with the prototype robot compared with that without protpotype robot. CONCLUSION The use of a passive prototype robot may improve arm stability and reduce muscle fatigue during ophthalmic surgery.
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Affiliation(s)
- Soichiro Yamamoto
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yohei Kuroki
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shin Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Rintaro Hirahara
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Tomohisa Nishimura
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
- Mikawa Eye Clinic, Saga, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Hiroshi Enaida
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
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Ide T, Kawanami T, Tada Y, Eriguchi M. Overlapping rheumatoid meningitis with anti-N-methyl-D-aspartate receptor encephalitis: A case report. Clin Case Rep 2023; 11:e7199. [PMID: 37155424 PMCID: PMC10122683 DOI: 10.1002/ccr3.7199] [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: 01/16/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 05/10/2023] Open
Abstract
A 66-year-old woman in treatment for rheumatoid meningitis was found to be positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies in the cerebrospinal fluid, and intravenous immunoglobulin improved her psychiatric symptoms. The co-existence of NMDAR antibodies should be considered in cases of poor response to treatments or atypical symptoms in rheumatoid meningitis.
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Affiliation(s)
- Toshihiro Ide
- Department of Internal Medicine, Division of NeurologySaga University, Faculty of MedicineSagaJapan
| | - Takeru Kawanami
- Department of Internal Medicine, Division of NeurologySaga University, Faculty of MedicineSagaJapan
| | - Yoshifumi Tada
- Department of Internal Medicine, Division of RheumatologySaga University, Faculty of MedicineSagaJapan
| | - Makoto Eriguchi
- Department of Internal Medicine, Division of NeurologySaga University, Faculty of MedicineSagaJapan
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Tezuka T, Okuzumi S, Nakashima C, Ide T, Imai S, Mitsuboshi S, Kuwahara Y, Takizawa T, Seki M, Minematsu N, Aragane N, Nakahara J, Hori S, Nakane S, Suzuki S. Dysautonomia associated with immune checkpoint inhibitors. J Neurol 2023:10.1007/s00415-023-11667-5. [PMID: 36939931 DOI: 10.1007/s00415-023-11667-5] [Citation(s) in RCA: 2] [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: 01/25/2023] [Revised: 02/15/2023] [Accepted: 03/14/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE The purpose of this study is to report the clinical characteristics of dysautonomia associated with immune checkpoint inhibitors (ICIs). METHODS We reported two patients with autoimmune autonomic ganglionopathy (AAG) occurring as immune-related adverse events (irAEs). We also performed a review of previous case reports presenting dysautonomia during ICI therapy. Moreover, we conducted pharmacovigilance analyses using the US Food and Drug Administration Adverse Events Reporting System (FAERS) to investigate dysautonomia associated with ICI. RESULTS Two patients in our care developed both AAG and autoimmune encephalitis following ICI therapy for lung cancers. We comprehensively reviewed 13 published cases (M:F = 11:2, mean onset age of 53 years) with ICI-associated dysautonomia including AAG (n = 3) and autonomic neuropathy (n = 10). Of these, ICI monotherapy was performed in seven and combination ICI use in six. In 6 of 13 patients, dysautonomia appeared within one month after the start of ICIs. Orthostatic hypotension was observed in 7 and urinary incontinence or retention in five. All patients except three showed gastrointestinal symptoms. Anti-ganglionic acetylcholine receptor antibodies were undetectable. All but two patients received immune-modulating therapy. Immuno-modulating therapy was effective in three patients with AAG and two patients with autonomic neuropathy, but ineffective in the others. Five patients died, of either the neurological irAE (n = 3) or cancer (n = 2). The pharmacovigilance analyses using FAERS showed that ipilimumab monotherapy and the combination of nivolumab and ipilimumab constituted significant risks for developing dysautonomia, consistent with the review of literature. CONCLUSION ICIs can cause dysautonomia including AAG, and autonomic neuropathy is a neurological irAE.
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Affiliation(s)
- Toshiki Tezuka
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Okuzumi
- Department of Internal Medicine, Hino Municipal Hospital, Tokyo, Japan
| | - Chiho Nakashima
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shungo Imai
- Division of Drug Informatics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Satoru Mitsuboshi
- Division of Drug Informatics, Faculty of Pharmacy, Keio University, Tokyo, Japan.,Department of Pharmacy, Kaetsu Hospital, Niigata, Japan
| | - Yuki Kuwahara
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Morinobu Seki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Naoto Minematsu
- Department of Internal Medicine, Hino Municipal Hospital, Tokyo, Japan
| | - Naoko Aragane
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Shunya Nakane
- Department of Neurology, Nippon Medical University, Tokyo, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
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Tanaka K, Miwa K, Yoshimura S, Kamiyama K, Yagita Y, Nagakane Y, Hoshino H, Terasaki T, Okada Y, Yakushiji Y, Takahashi S, Ueda T, Hasegawa Y, Shiozawa M, Sasaki M, Kudo K, Tanaka J, Nishihara M, Yamaguchi Y, Fujita K, Honda Y, Kawano H, Ide T, Yoshimoto T, Ihara M, Koga M, Hirano T, Toyoda K. Abstract 3: Cerebral Small Vessel Disease Burden For Bleeding Risk During Antithrombotic Therapy -BAT2-. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.3] [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: 02/05/2023]
Abstract
Background:
Cerebral small vessel disease (SVD) has received attention as a risk stratification tool for antithrombotic-related intracranial hemorrhage but may also be a predictor for bleeding in other organs.
Purpose:
To determine the excess risk of antithrombotic-related bleeding due to cerebral SVD burden.
Methods:
Patients with cerebrovascular or cardiovascular diseases taking oral antithrombotic agents were prospectively enrolled from 52 hospitals across Japan between 2016 and 2019. Multimodal brain MRI was acquired at baseline for all patients under prespecified conditions. All MRI examinations were interpreted by a central diagnostic radiology committee for cerebral microbleeds, lacunes, white matter hyperintensities, and enlarged basal ganglia perivascular spaces, for calculation of a total SVD score (range 0-4). The primary outcome was major bleeding during 2-year follow-up. Secondary outcomes included bleeding in each site and ischemic events. Event risks according to SVD score were estimated with multivariable Cox proportional hazards models.
Results:
Of the analyzed 5250 patients (1736 women; median age, 73 years; 9933 patient-years follow-up), antiplatelets and anticoagulants were administered at baseline in 3948 and 1565, respectively. Median of the total SVD score was 2 (IQR 1-3). As SVD score increased, advanced age, hypertension, anemia, and chronic kidney disease were more prevalent (P<0.001 for each). A unit increase of SVD score was associated with a higher risk of major bleeding (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.29-1.85) and intracranial hemorrhage (adjusted HR 1.61, 95% CI 1.28-2.03). With SVD score 4 compared to score 0, extracranial major bleeding (adjusted HR 3.37, 95% CI 1.12-10.15) and gastrointestinal bleeding (adjusted HR 2.54, 95% CI 1.02-6.35) were also significantly increased. A higher SVD score was associated with a mild but significant elevation of ischemic event risk (adjusted HR per unit increase 1.17, 95% CI 1.06-1.29).
Conclusions:
The total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting a broader clinical relevance of cerebral SVD as a marker for safe implementation of antithrombotic therapy.
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Affiliation(s)
- Kanta Tanaka
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kaori Miwa
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Sohei Yoshimura
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | | | | | | | | | | | - Yasushi Okada
- National Hosp Organization Kyushu Med Cntr, Fukuoka, Japan
| | | | | | | | | | | | | | - Kohsuke Kudo
- Dept of Diagnostic Imaging, Hokkaido Univ Graduate Sch of Medicine, Sapporo, Japan
| | - Jun Tanaka
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
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10
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Ikeda S, Yakushiji Y, Tanaka J, Nishihara M, Ogata A, Eriguchi M, Ono S, Kosugi M, Suzuyama K, Mizoguchi M, Shichijo C, Ide T, Nagaishi Y, Mori H, Ono N, Yoshikawa M, Ide K, Minagawa H, Iida K, Kawamoto K, Katsuki Y, Irie H, Abe T, Hara H. Hypertension, cerebral Amyloid, aGe Associated Known neuroimaging markers of cerebral small vessel disease Undertaken with stroke REgistry (HAGAKURE) prospective cohort study: Baseline characteristics and association of cerebral small vessel disease with prognosis in an ischemic stroke cohort. Front Aging Neurosci 2023; 15:1117851. [PMID: 36936499 PMCID: PMC10018806 DOI: 10.3389/fnagi.2023.1117851] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Cerebral small vessel disease (SVD) is one of the leading causes of stroke; each neuroimaging marker of SVD is correlated with vascular risk factors and associated with poor prognosis after stroke. However, longitudinal studies investigating the association between comprehensive SVD burden scoring system, "total SVD score" - which encompasses the established neuroimaging markers of lacunae, cerebral microbleeds (CMBs), white matter hyperintensities (WMH) including periventricular hyperintensities, and perivascular spaces in basal ganglia- and clinical outcomes are limited. The aim of this study is to determine the association between SVD burden and long-term prognosis in patients with ischemic stroke. Methods and design This prospective, single-center, observational study enrolled patients with acute ischemic stroke, including cerebral infarction and transient ischemic attack. Magnetic resonance imaging scans were performed, and then total SVD score (range, 0-4) was calculated. We recorded baseline characteristics and evaluated the relationships of long-term outcomes to SVD neuroimaging markers and total SVD score. Stroke recurrence was thought as primary outcome. Hazard ratios (HRs) of events during follow-up were calculated using Cox proportional hazards modeling with adjustments for age, sex, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and smoking. Cumulative event rates were estimated using the Kaplan-Meier method. Results Consecutive 564 acute ischemic stroke patients were enrolled according to inclusion and exclusion criteria. A total of 467 participants with first-ever ischemic stroke were analyzed (median age 75.0 [interquartile range, 64.0-83.0] years, 59.3% male). Total SVD score was 0 point in 47 individuals (12.0%), 1 point in 83 (21.2%), 2 points in 103 (26.3%), 3 points in 85 (21.7%), and 4 points in 73 (18.7%). Twenty-eight recurrent stroke events were identified during follow-up. Total SVD score ≥ 2, presence of CMBs, and moderate-to-severe WMH were associated with increased risk of recurrent stroke events (HR 9.31, 95% confidence interval [CI] 2.33-64.23; HR 2.81, 95% CI 1.08-7.30; HR 2.90, 95% CI 1.22-6.88, respectively). Conclusion The accumulation of SVD biomarkers as determined by total SVD score offered a reliable predictor of stroke recurrence. This study established a firm understanding of SVD prognosis in clinical settings.
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Affiliation(s)
- Shuhei Ikeda
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
- Department of Neurology, Kansai Medical University, Hirakata, Japan
- *Correspondence: Yusuke Yakushiji,
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masashi Nishihara
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Atsushi Ogata
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shohei Ono
- Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Masafumi Kosugi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohei Suzuyama
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Megumi Mizoguchi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Chika Shichijo
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yukiko Nagaishi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hodo Mori
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Natsuki Ono
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Yoshikawa
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kiku Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiromu Minagawa
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kotaro Iida
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuhiro Kawamoto
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshiko Katsuki
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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11
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Abstract
We herein report a case of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old woman developed unilateral optic neuritis 3 weeks after contracting coronavirus disease 2019 (COVID-19), followed by intracranial demyelinating lesions and myelitis. Since serum anti-MOG antibody was positive, we diagnosed MOG antibody-associated disease. Immunotherapy with steroids resulted in the rapid improvement of neurological symptoms. This is a suggestive case, as there are no reports of MOG antibody-associated disease with multiple neurological lesions occurring after COVID-19. The response to immunotherapy was favorable. This case suggests that it is important to measure anti-MOG antibodies in patients who develop inflammatory neurological disease after COVID-19.
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Affiliation(s)
- Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Japan
| | - Takeru Kawanami
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Japan
| | - Makoto Eriguchi
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Japan
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12
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Tanaka K, Miwa K, Takagi M, Sasaki M, Yakushiji Y, Kudo K, Shiozawa M, Tanaka J, Nishihara M, Yamaguchi Y, Fujita K, Honda Y, Kawano H, Ide T, Yoshimura S, Koga M, Hirano T, Toyoda K. Increased Cerebral Small Vessel Disease Burden With Renal Dysfunction and Albuminuria in Patients Taking Antithrombotic Agents: The Bleeding With Antithrombotic Therapy 2. J Am Heart Assoc 2022; 11:e024749. [PMID: 35253443 PMCID: PMC9075282 DOI: 10.1161/jaha.121.024749] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to determine the associations of cerebral small vessel disease (SVD) burden with renal dysfunction and albuminuria in patients taking oral antithrombotic agents. Methods and Results Patients who newly started or continued taking oral antiplatelets or anticoagulants were enrolled in a prospective, multicenter, observational study. Obligatorily acquired multimodal magnetic resonance imaging at registration with prespecified imaging conditions was assessed for cerebral microbleeds, white matter hyperintensities, enlarged basal ganglia perivascular spaces, or lacunes, and an ordinal SVD score was calculated (range, 0–4). Multivariable adjusting covariates were age, sex, hypertension, diabetes, dyslipidemia, current smoking, drinking, and estimated glomerular filtration rate (eGFR). Of 5324 patients (1762 women; median age, 73 years), 4797 (90.1%) patients were taking oral antithrombotic agents for secondary stroke prevention. Cerebral microbleeds were present in 32.7%, confluent white matter hyperintensities in 51.8%, extensive basal ganglia perivascular spaces in 38.9%, and lacunes in 59.4%. Median SVD score was 2. Compared with eGFR category G1 (eGFR ≥90 mL/min per 1.73 m2), adjusted odds ratios for SVD score increment were 1.63 (95% CI, 1.11–2.39) at category G4 (eGFR 15–<30 mL/min per 1.73 m2) and 2.05 (95% CI, 1.33–3.16) at G5 (eGFR <15 mL/min per 1.73 m2). Corresponding odds ratios relative to urinary albumin‐to‐creatinine ratio (ACR) category A1 (ACR <30 mg/g) were 1.29 (95% CI, 1.12–1.49) for category A2 (ACR 30–<300 mg/g) and 1.37 (95% CI, 1.05–1.77) for A3 (ACR ≥300 mg/g). When combined eGFR and ACR categories were assessed, risks for SVD score increment generally increased as eGFR decreased and ACR increased. Conclusions Both reduced eGFR and albuminuria were independently associated with increased cerebral SVD burden in patients requiring oral antithrombotic medication mainly for secondary stroke prevention. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01581502; URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000023669.
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Affiliation(s)
- Kanta Tanaka
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masahito Takagi
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Makoto Sasaki
- Institute for Biomedical SciencesIwate Medical University Yahaba Japan
| | - Yusuke Yakushiji
- Division of Neurology Department of Internal Medicine Saga University Faculty of Medicine Saga Japan
- Department of Neurology Kansai Medical University Hirakata Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Jun Tanaka
- Division of Neurology Department of Internal Medicine Saga University Faculty of Medicine Saga Japan
| | - Masashi Nishihara
- Department of Radiology Saga University Faculty of Medicine Saga Japan
| | - Yoshitaka Yamaguchi
- Department of Neurology Yamagata Prefectural Central Hospital Yamagata Japan
| | - Kyohei Fujita
- Department of Neurology and Neurological Science Tokyo Medical and Dental University Tokyo Japan
| | - Yuko Honda
- Department of Stroke and Cerebrovascular Medicine Kyorin University Mitaka Japan
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine Kyorin University Mitaka Japan
| | - Toshihiro Ide
- Division of Neurology Department of Internal Medicine Saga University Faculty of Medicine Saga Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine Kyorin University Mitaka Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
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13
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Ide T, Iida K, Katsuya H, Ito H, Aishima S, Hara H. [Central nervous system involvement of graft versus host disease after allogeneic hematopoietic stem cell transplantation for adult T cell leukemia]. Rinsho Shinkeigaku 2022; 62:33-38. [PMID: 34924471 DOI: 10.5692/clinicalneurol.cn-001665] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 54-year-old woman was diagnosed with acute adult T-cell leukemia (ATL) in November 2015 and underwent allogeneic hematopoietic stem cell transplantation in March 2016. Cognitive impairment appeared suddenly around May 2019, and MRI of the brain showed cerebral white matter lesions. Cerebrospinal fluid examination showed no significant findings other than elevated protein. Brain biopsy showed inflammatory cells, (mainly CD8-positive T lymphocytes), infiltrating the white matter. Based on the pathological findings and the history of chronic graft versus host disease (GVHD) in the lungs and intestines, we diagnosed central nervous system involvement of GVHD (CNS-GVHD). Immunotherapy with steroids and mycophenolate mofetil resulted in improvement of the cognitive dysfunction and inflammatory findings in the spinal fluid. This case is the first report of CNS-GVHD in ATL, suggesting the importance of diagnosis by brain biopsy and the efficacy of immunotherapy.
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Affiliation(s)
- Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University, Faculty of Medicine
| | - Kotaro Iida
- Division of Neurology, Department of Internal Medicine, Saga University, Faculty of Medicine
| | - Hiroo Katsuya
- Division of Hematology, Department of Internal Medicine, Saga University, Faculty of Medicine
| | - Hiroshi Ito
- Department of Neurosurgery, Saga University, Faculty of Medicine
| | - Shinichi Aishima
- Department of Pathology and Microbiology, Saga University Faculty of Medicine
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University, Faculty of Medicine
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14
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Enzan N, Matsushima S, Ide T, Tohyama T, Funakoshi K, Higo T, Tsutsui H. The use of angiotensin receptor blockers is associated with greater recovery of cardiac function than angiotensin-converting-enzyme inhibitors among patients with dilated cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0782] [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
We previously showed that angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) were associated with heart failure with recovered ejection fraction (HFrecEF) in patients with dilated cardiomyopathy (DCM). However, the different effects of these drugs on cardiac reverse remodeling have not been fully elucidated. The aim of this study was to assess comparative effectiveness of ACEi versus ARB on recovery of left ventricular ejection fraction (LVEF) among patients with DCM.
Methods
We analyzed the clinical personal records of DCM, a national database of Japanese Ministry of Health, Labour and Welfare, from 2003 to 2014. Patients with LVEF <40% and on either ACEi or ARB were included. Eligible patients were divided into two groups according to the use of ACEi or ARB. A one-to-one propensity case-matched analysis was used. A propensity score was estimated by fitting a logistic-regression model which adjusted for age, sex, duration of HF, NYHA functional class (I-II vs. III-IV), systolic blood pressure, diastolic blood pressure, heart rate, atrial fibrillation, pacing, left bundle branch block, LVEF, hypertension, diabetes mellitus, hyperuricemia, chronic kidney disease, B-type natriuretic peptide (BNP), beta-blockers, mineralocorticoid receptor antagonists, loop diuretics, thiazides, digitalis, amiodarone, and oral inotropes. The primary outcome was defined as LVEF ≥40% at 3 years of follow-up.
Results
Out of 4,618 eligible patients, 2,238 patients received ACEi and 2,380 patients received ARB. Propensity score matching yielded 1,341 pairs. Mean age was 56.0 years and 2,041 (76.1%) was male. Mean LVEF was 27.6%, and median duration of HF was 1 year. The primary outcome was observed more frequently in ARB group than in ACEi group (59.8% vs. 54.1%; odds ratio [OR] 1.26; 95% confidence interval [CI] 1.08–1.47; P=0.003). The change in LVEF from baseline to 3 years of follow-up was greater in ARB group than in ACEi group (15.8±0.4 vs. 14.0±0.4%, P=0.002). In the ACEi group, 946 patients (70.6%) continued to receive ACEi at 3 years of follow-up, while 1,088 patients (81.3%) continued to receive ARB in the ARB group. Per-protocol analysis consistently showed that ARB increased the prevalence of HFrecEF (62.0% vs. 54.0%; OR 1.39; 95% CI 1.17–1.66; P<0.001). Subgroup analysis showed that ARB increased frequency of HFrecEF regardless systolic blood pressure, heart rate, LVEF, chronic kidney disease, and concomitant use of beta-blockers and mineralocorticoid receptor antagonists.
Conclusions
The use of ARB was associated with HFrecEF more frequently than ACEi among patients with DCM and reduced LVEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Sciences Research Grants from the Japanese Ministry of Health, Labour and Welfare (Comprehensive Research on Cardiovascular Diseases)Japan Agency for Medical Research and Development (AMED) grant
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Affiliation(s)
- N Enzan
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka, Japan
| | - T Tohyama
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - K Funakoshi
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - T Higo
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
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15
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Iida K, Yakushiji Y, Ide T, Tsuruoka N, Shichijo C, Hara H. [Multiple cerebral infarctions in the deep perforator regions in a case of idiopathic hypereosinophilic syndrome]. Rinsho Shinkeigaku 2021; 61:319-324. [PMID: 33867416 DOI: 10.5692/clinicalneurol.cn-001561] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 61-year-old man was admitted to our hospital due to cerebral infarction in the pons and the right putamen. On admission (day 3 from symptom onset), laboratory testing showed a white blood cell count of 13,100/μl with hypereosinophilia of 3,734/μl. As deep vein thrombosis was detected on contrast-enhanced CT, we started anticoagulation therapy. There were no cardio-embolic sources, including right-to-left shunt, but eosinophil infiltration was found in biopsy specimens of the gastric mucosa. These findings allowed us to diagnose multiple perforator infarction due to idiopathic hypereosinophilic syndrome (idiopathic HES). After the administration of oral prednisolone was started on day 10, his hypereosinophilia rapidly improved, and no recurrence of deep perforator infarction occurred other than a symptomatic infarction in the left putamen at day 19. There are a few reports of idiopathic HES with multiple infarctions developing in deep perforator regions. The current case suggests that idiopathic HES could cause multiple cerebral infarction restricted to deep perforator areas.
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Affiliation(s)
- Kotaro Iida
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine.,Department of Neurology, Kansai Medical University
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
| | - Nanae Tsuruoka
- Division of Gastroenterology, Department of Internal Medicine, Saga University Faculty of Medicine
| | - Chika Shichijo
- Department of Pathology and Microbiology, Saga University Faculty of Medicine
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
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16
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Ide T, Kaku H, Matsushima S, Tohyama T, Enzan N, Funakoshi K, Sumita Y, Nakai M, Nishimura K, Fukuda H, Hatano M, Komuro I, Tsutsui H. The nationwide registry of hospitalized heart failure patients in Japan: Japanese Registry Of Acute Decompensated Heart Failure (JROADHF). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1182] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
Heart failure (HF) is a growing healthcare problem worldwide. This study aimed to describe clinical characteristics and long-term outcomes of HF patients in Japan.
Methods and results
JROADHF (the Japanese Registry Of Acute Decompensated Heart Failure) is a retrospective, multicentre, nationwide observational database of 13,238 patients hospitalized due to HF in 128 hospitals randomly selected from Japanese Circulation Society (JCS)-certified teaching hospitals during 2013. At inclusion, demographic and clinical data were collected from medical records with linkage to a nationwide claim-based database, the Japanese Diagnosis Procedure Combination (DPC). Patients were followed up to 5 years after discharge at each participating site. Patients were old as the median age of 81 years and women were older (74.8±12.8 vs 81.6±11.1 y.o). Mean left ventricular ejection fraction (LVEF) was 47%, and 45% were HF with preserved ejection fraction of >50% (HFpEF). Causes of HF included ischemic in 27%, valvular in 19%, arrhythmia in 17%, and hypertensive in 16%. Median length of hospital stay was 18 days and in-hospital mortality was 7.7%. All-cause mortality during 1 and 4 years were 22.3% and 48.4%, respectively. Hospitalization rates due to HF within 1 and 4 years were as high as 30.5 and 48.4%, respectively.
Conclusions
Contemporary nationwide registry revealed that hospitalized HF patients were elder and had more HFpEF, and their prognosis was still poor compared to the data shown in prior registries.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development (AMED) Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus
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Affiliation(s)
- T Ide
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Kaku
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - T.I Tohyama
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - N Enzan
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - K Funakoshi
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Y Sumita
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - M Nakai
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Fukuda
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - M Hatano
- University of Tokyo, Tokyo, Japan
| | - I Komuro
- University of Tokyo, Tokyo, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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17
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Enzan N, Matsushima S, Ide T, Kaku H, Tohyama T, Funakoshi K, Higo T, Tsutsui H. Use of direct oral anticoagulants is associated with better long-term outcomes in patients with atrial fibrillation and heart failure as compared with vitamin K antagonists. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1060] [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
Direct oral anticoagulants (DOACs) have been shown to be safe and effective in patients with atrial fibrillation (AF) as compared with warfarin, a vitamin K antagonist. However, the safety and efficacy of DOACs in patients with AF and heart failure (HF) have been unclear.
Purpose
The purpose of this study was to determine whether DOACs can improve long-term outcomes in patients with AF and HF as compared with warfarin.
Methods
We analyzed the JROADHF registry, which was a multicenter registry of patients hospitalized for the worsening HF in Japan. Baseline data were collected during the episode of index hospitalization from April 2013 to March 2014. Follow-up data were collected up to 4.5 years after the index hospitalization. Patients with AF and creatinine clearance ≥15 ml/min/1.73m2 were included. Valvular heart disease, congenital heart disease, and constrictive pericarditis were excluded. Eligible patients were divided into two groups according to the use of warfarin or DOACs. The primary outcome was defined as all-cause death. The secondary outcomes were defined as cardiovascular death, composite of all-cause death or cardiovascular hospitalization, and composite of stroke death or stroke related hospitalization. A one to one propensity case-matched analysis was used. Complete case analysis and multiple imputation analysis were also conducted as sensitivity analyses.
Results
Out of the 14,847 patients in this registry, 2,175 had AF, creatinine clearance ≥15 ml/min/1.73m2 and discharged alive. Propensity score matching yielded 475 pairs. In matching cohort, mean age was 76.5 years and 513 (54.0%) was male. Mean left ventricular ejection fraction was 48.6±16.4%. During a mean follow-up of 3.2 years, patients with DOACs had a lower incidence rate of all-cause death than those with warfarin (75.2 vs. 99.9 death per 1000 patient-years; rate ratio (RR) 0.75; 95% confidence interval [CI] 0.59–0.96; P=0.022). The incidence of cardiovascular death tended to be lower in DOAC group (30.9 vs. 43.1; incidence rate ratio 0.72; 95% CI 0.49–1.04; P=0.081). There were no significant differences in the incidence of composite of all cause death or cardiovascular hospitalization (252.3 vs. 269.4; RR 0.94; 95% CI 0.79–1.11; P=0.45) or composite of stroke death or stroke related hospitalization (13.1 vs. 16.7; RR 0.79; 95% CI 0.39–1.59; P=0.50). Cox regression model showed that DOAC was associated with lower mortality than warfarin (hazard ratio (HR) 0.75; 95% CI 0.59–0.96; P=0.023). Complete case analysis (HR 0.78; 95% CI 0.63–0.98; P=0.035) and multiple imputation analysis (HR 0.78; 95% CI 0.68–0.84; P<0.001) also showed the same results. A restricted cubic spline analysis demonstrated that the effectiveness of DOACs over warfarin waned with age, and DOACs were effective in patients younger than 80 years old.
Conclusion
Use of DOACs was associated with better long-term outcome in patients with HF as compared with warfarin.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development
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Affiliation(s)
- N Enzan
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Kaku
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - T Tohyama
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - K Funakoshi
- Kyushu University Hospital, Center for Clinical and Translational Research, Fukuoka, Japan
| | - T Higo
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
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Tohyama T, Funakoshi K, Kaku H, Enzan N, Ikeda M, Matsushima S, Ide T, Todaka K, Tsutsui H. Artificial intelligence-based analysis of payment system data can predict one-year mortality of hospitalized patients with heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3492] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Individual risk stratification is fundamental in the care of heart failure (HF) patients. However, the prediction performance of risk scores, such as MAGGIC and SHFM, is not adequate and, more importantly, they need additional predictors including various biomarkers, imaging data, and environmental factors. Data from a case-mix payment system including diagnosis and procedures with outcomes can be used to develop the risk prediction models, allowing the use of big data for a more accurate prediction of mortality.
Purpose
This study aimed to develop artificial intelligence (AI) models for predicting 1-year mortality in patients hospitalized due to HF.
Methods
We analyzed the data from 10175 patients enrolled in the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF). Candidate variables included the data obtained from a payment system introduced by the Japanese government, the Diagnosis Procedure Combination (DPC), which included each patient profile (age, sex, height, weight), principal diagnosis for hospitalization, comorbidities, procedures, length of hospital stay, and discharge status. They did not include clinical data available from patients such as vital status, laboratory data including bio-makers, electrocardiographic and echocardiographic data. The collected data were divided into the training set and the validation set (80%: 20%). With the training set, 5 AI models (logistic regression, random forest, support vector machine, neural network, and ensemble classifier) learned the one-year mortality results. AI models were evaluated by using the validation set with ROC analysis. The training and validation steps were repeated 10 times with different seed values to calculate the C-statistic of each model. We also identified the predictors for one-year prognosis acquired from the AI models.
Results
At 1-year of follow-up, a total of 1727 patients had died (17%). Among the machine learning models, the ensemble classifier showed the highest C-statistic of 0.76 (95% confidence interval: 0.75 to 0.77) for predicting mortality. Top predictors acquired from the random forest classifier was ADL (Barthel Index) at discharge, age, body mass index, and length of hospital stay.
Conclusion
By using AI-based analysis of a national case-mix payment system data, the present risk stratification model could predict the one-year mortality of hospitalized HF patients without any quantitative laboratory and physiological data. Furthermore, the present results could emphasize the advantage of this approach using the claim-based data that are routinely collected in a usual daily practice with no need to collect any additional information.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development
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Affiliation(s)
- T Tohyama
- Kyushu University Hospital, Fukuoka, Japan
| | | | - H Kaku
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | - N Enzan
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | - M Ikeda
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | | | - T Ide
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
| | - K Todaka
- Kyushu University Hospital, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Cardiovascular disease, Fukuoka, Japan
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19
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Enzan N, Matsushima S, Ide T, Kaku H, Higo T, Tsutsui H. Beta-blocker use is associated with prevention of left ventricular remodeling in recovered dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0911] [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
Withdrawal of optimal medical therapy has been reported to relapse cardiac dysfunction in patients with dilated cardiomyopathy (DCM) whose cardiac function had improved. However, it is unknown whether beta-blockers can prevent deterioration of cardiac function in those patients.
Purpose
We examined the effect of beta-blockers on left ventricular ejection fraction (LVEF) in recovered DCM.
Methods
We analyzed the clinical personal records of DCM, a national database of Japanese Ministry of Health, Labor and Welfare, between 2003 and 2014. Recovered DCM was defined as a previously documented LVEF <40% and a current LVEF ≥40%. Patients with recovered DCM were divided into two groups according to the use of beta-blockers. The primary outcome was defined as a decrease in LVEF >10% at two years of follow-up. A one to one propensity case-matched analysis was used. A per-protocol analysis was also performed. Considering intra- and inter-observer variability of echocardiographic evaluations, we also examined outcomes by multivariable logistic regression model after changing the inclusion criteria as follows; (1) previous LVEF <40% and current LVEF ≥40%; (2) previous LVEF <35% and current LVEF ≥40%; (3) previous LVEF <30% and current LVEF ≥40%; (4) previous LVEF <40% and current LVEF ≥50%. Outcomes were also changed as (1) decrease in LVEF ≥5% (2) decrease in LVEF ≥10% (3) decrease in LVEF ≥15%. The analysis of outcomes by using combination of multiple imputation and inverse probability of treatment weighting was also conducted to assess the effects of missing data and selection bias attributable to propensity score matching on outcomes.
Results
From 2003 to 2014, 40,794 consecutive patients with DCM were screened. Out of 5,338 eligible patients, 4,078 received beta-blockers. Propensity score matching yielded 998 pairs. Mean age was 61.7 years and 1,497 (75.0%) was male. Mean LVEF was 49.1±8.1%. The primary outcome was observed less frequently in beta-blocker group than in no beta-blocker group (18.0% vs. 23.5%; odds ratio [OR] 0.72; 95% confidence interval [CI] 0.58–0.89; P=0.003). The prevalence of increases in LVDd (11.5% vs. 15.8%; OR 0.70; 95% CI 0.54–0.91; P=0.007) and LVDs (23.1% vs. 27.2%; OR 0.80; 95% CI 0.65–0.99; P=0.041) was also lower in the beta-blocker group. Similar results were obtained in per-protocol analysis. These results were robust to several sensitivity analyses. As a result of preventing a decrease in LVEF, the deterioration to HFrEF was also prevented by the use of beta-blocker (23.6% vs. 30.6%). Subgroup analysis demonstrated that beta-blocker prevented decrease in LVEF regardless of atrial fibrillation.
Conclusion
Use of beta-blocker was associated with prevention of decrease in left ventricular ejection fraction in patients with recovered DCM.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Health Sciences Research Grants from the Japanese Ministry of Health, Labour and Welfare (Comprehensive Research on Cardiovascular Diseases)
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Affiliation(s)
- N Enzan
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Experimental and Clinical Cardiovascular Medicine, Graduate School of Medical Sciences, Fukuoka, Japan
| | - H Kaku
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
| | - T Higo
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Faculty of Medical Sciences, Fukuoka, Japan
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20
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Yakushiji Y, Tanaka J, Wilson D, Charidimou A, Noguchi T, Kawashima M, Nishihara M, Best J, Ide T, Nagaishi Y, Mizoguchi M, Hara H, Werring DJ. Proportion of intracerebral haemorrhage due to cerebral amyloid angiopathy in the East and West: Comparison between single hospital centres in Japan and the United Kingdom. J Neurol Sci 2020; 416:117037. [PMID: 32711192 DOI: 10.1016/j.jns.2020.117037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/05/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated whether the proportion of intracerebral haemorrhage (ICH) due to cerebral amyloid angiopathy (CAA) differs between patients admitted to hospitals in the East and the West. METHODS This international cross-sectional study included consecutive spontaneous ICH patients admitted to one stroke centre in the United Kingdom (Western centre origin) and one in Japan (Eastern centre origin) during the same period. We classified spontaneous ICH into "CAA-related" or "other" using the Edinburgh CT-based diagnostic criteria. We used multivariable logistic regression analyses to assess the relationship between CAA-related ICH and geographical location or ethnicity (White vs. East Asian or other ethnicities). Sensitivity analyses were performed using the modified Boston MRI-based diagnostic criteria for CAA-related ICH. RESULTS Of 433 patients (median age, 72 years; Western centre origin, 55%), 15% were classified as CAA-related ICH. In the multivariable logistic regression model, Eastern centre and ethnicity had a lower proportion of CAA-related ICH (odds ratio [OR] vs Western centre origin 0.55, 95%CI 0.31-0.98; OR [vs. White] 0.47, 95%CI 0.25-0.87); these findings remained robust in sensitivity analyses. The estimated incidence of "other" (non-CAA) ICH (attributed to hypertensive arteriopathy) was 2.5-fold higher in East Asian populations. CONCLUSIONS The proportion CAA-related ICH is lower in an Eastern compared to a Western hospital ICH population; this might be explained by a higher incidence of ICH related to hypertensive arteriopathy in East Asian populations, suggesting that optimal ICH prevention strategies might differ between the East and West.
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Affiliation(s)
- Yusuke Yakushiji
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK; Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan; Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan.
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Duncan Wilson
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
| | - Andreas Charidimou
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
| | - Tomoyuki Noguchi
- Department of Radiology, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masatou Kawashima
- Department of Neurosurgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Masashi Nishihara
- Department of Radiology, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Jonathan Best
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Yukiko Nagaishi
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Megumi Mizoguchi
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - David J Werring
- Stroke Research Centre, UCL Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
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21
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Yakushiji Y, Tanaka J, Wilson D, Charidimou A, Noguchi T, Kawashima M, Nishihara M, Best J, Ide T, Nagaishi Y, Mizoguchi M, Hara H, Werring DJ. Abstract TP330: Proportion of Intracerebral Haemorrhage Due to Cerebral Amyloid Angiopathy in the East and West. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp330] [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: 11/16/2022]
Abstract
Objectives:
We investigated whether the proportion of intracerebral haemorrhage (ICH) due to cerebral amyloid angiopathy (CAA) differs between patients of Eastern and Western origin.
Methods:
This is a retrospective international cross-sectional study of consecutive first-ever spontaneous ICH patients (including patients with surgical intervention) admitted to one stroke centre in the United Kingdom (Western centre origin) and one in Japan (Eastern centre origin) during the same period. We classified spontaneous ICH into “CAA-related ICH” defined by the Edinburgh CT diagnostic criteria, and “other ICH”. We used multivariable logistic regression analyses to assess the relationship between CAA-ICH and geographical location (Western or Eastern centre origin) or ethnicity (Western [reference], East Asian, or other) with adjustment for confounders.
Results:
Of 334 patients (median age, 71 years; male, 54%; Western centre origin, 58%), 15% were classified as CAA-ICH, and 85% were defined as other ICH. In multivariable logistic regression analysis, Eastern centre and ethnicity had a lower proportion of CAA-ICH (odds ratio [OR] vs Western centre origin 0.47, 95%CI 0.23-0.98; OR [vs. white] 0.41, 95%CI 0.20-0.97, respectively).The estimated incidence of CAA-related ICH in East Asian was similar to that in White populations, but the rate of other ICH was 2.5-fold higher in East Asian populations. Sensitivity analyses using the modified Boston criteria for diagnosis of CAA-related ICH showed similar results.
Conclusions:
The proportion CAA-ICH is lower in an Eastern compared to a Western population; this appears to be explained by a higher incidence of ICH due to hypertensive (deep perforator) arteriopathy in East Asian populations.
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Affiliation(s)
- Yusuke Yakushiji
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | - Jun Tanaka
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | - Duncan Wilson
- Stroke Rsch Cntr, Dept of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hosp for Neurology and Neurosurgery, London, United Kingdom
| | - Andreas Charidimou
- Stroke Rsch Cntr, Dept of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hosp for Neurology and Neurosurgery, London, United Kingdom
| | | | | | | | - Jonathan Best
- Stroke Rsch Cntr, Dept of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hosp for Neurology and Neurosurgery, London, United Kingdom
| | - Toshihiro Ide
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | - Yukiko Nagaishi
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | - Megumi Mizoguchi
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | - Hideo Hara
- Div of Neurology, Dept of Internal Medicine, Saga Univ Faculty of Medicine, Saga, Japan
| | - David J Werring
- Stroke Rsch Cntr, Dept of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hosp for Neurology and Neurosurgery, London, United Kingdom
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22
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Ikeda S, Matsushima S, Okabe K, Ishikita A, Tadokoro T, Enzan N, Yamamoto T, Sada M, Deguchi H, Ikeda M, Ide T, Tsutsui H. P6283Downregulation of Tim44 exacerbates oxidative stress-induced ROS production and cardiomyocytes death by reducing mitochondrial SOD2. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0881] [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
Mitochondrial dysfunction has been highlighted as a critical driver of cardiac remodeling and failure. Mitochondria contains about 1500 proteins, 99% of which are encoded in the nuclear genome. Therefore, protein import into mitochondria is essential to maintain mitochondrial function. Previous reports suggest that nuclear-encoded mitochondrial precursor proteins import into mitochondria by multiple complex; translocase of outer membrane (TOM), translocase of inner membrane (TIM), and protein associated motor (PAM). However, the role of these protein import machineries of mitochondria in cardiac remodeling remains to be elucidated.
Objective
The purpose of this study was to elucidate the role of TOM, TIM, and PAM complex in cardiac remodeling and cardiomyocyte death.
Methods and results
C57BL/6J mice were subjected to myocardial infarction (MI) by permanent ligation of left anterior descending artery. Four weeks after operation, MI-mice demonstrated left ventricular (LV) dilation (LV end-diastolic dimension: 3.91 vs. 5.54 mm, n=8–11, p<0.05) and dysfunction (LV fractional shortening: 33.3 vs. 7.7%, n=8–11, p<0.05). Tim44 protein levels, a component of PAM complex, in mitochondrial fraction from non-infarcted left ventricle were significantly decreased compared with those in the heart from sham-operated mice by 39% (p<0.05), whereas other proteins related to TOM, TIM and PAM complex such as Tom20, Tom22, Tom40, Tom70, Tim22, Tim23 and mtHSP70 were not altered between MI-mice and sham-mice. In addition, blue-native polyacrylamide gel electrophoresis revealed that a protein complex associated to Tim44 was significantly decreased in non-infarcted LV by 40% (p<0.05). Superoxide dismutase 2 (SOD2), a mitochondrial matrix protein, was decreased in mitochondrial fraction from non-infarcted LV by 20% (p<0.05), accompanied by enhancing protein carbonylation, a marker of oxidative stress, by 40% (p<0.05). To assess the role of Tim44, it was downregulated by small interfering RNA in cultured neonatal rat ventricular myocytes (NRVMs). Knockdown of Tim44 significantly decreased SOD2 protein levels in mitochondrial fractionation (22%, p<0.05), with no significant changes in its mRNA levels. Furthermore, knockdown of Tim44 significantly increased protein carbonylation (20%, p<0.05) and cleaved caspase 3 (47%, p<0.05) and decreased cell viability (69%, p<0.05), assessed by cell titer assay, in H2O2-treatred NRVMs.
Conclusions
Downregulation of Tim44 exacerbates oxidative stress-induced ROS production and cardiomyocytes death, which is associated with a decrease in mitochondrial SOD2. Endogenous Tim44 might play a protective role in cardiac remodeling by attenuating oxidative stress and cardiomyocyte death via SOD2 import into mitochondria.
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Affiliation(s)
- S Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular medicine, Fukuoka, Japan
| | - K Okabe
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - A Ishikita
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - N Enzan
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - T Yamamoto
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - M Sada
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - H Deguchi
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Faculty of Medical Sciences, Department of Experimental and Clinical Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular medicine, Fukuoka, Japan
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23
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Ishikita A, Matsushima S, Ikeda S, Okabe K, Tadokoro T, Enzan N, Yamamoto T, Sada M, Deguchi H, Ikeda M, Ide T, Tsutsui H. P1606Glutamine-fructose-6-phosphate amidotransferase 2 mediates isoproterenol-induced cardiac hypertrophy by increasing Akt O-GlcNAcylation through hexosamine biosynthesis pathway. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0365] [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
Cardiac hypertrophy is an independent risk factor for heart failure and cardiac death. Hexosamine biosynthesis pathway (HBP), an accessory pathways of glycolysis, is known to be involved in the attachment of O-linked N-acetylglucosamine motif (O-GlcNAcylation) to proteins, a post-translational modification. However, the role of HBP has not been determined in pathological cardiac hypertrophy.
Purpose
The purpose of this study to examine whether glutamine-fructose-6-phosphate amidotransferase 2 (GFAT2), a critical enzyme of HBP, mediates cardiac hypertrophy by protein O-GlcNAcylation and activating hypertrophic signaling in cardiomyocytes.
Methods and results
C57BL/6J mice were treated with isoproterenol (ISO: 15 mg/kg/day, 1 week) with or without 6-Diazo-5-oxo-L-norleucine (DON, an inhibitor of GFAT: 500 μg/kg/day, 1week). ISO-treated mice (ISO+vehicle) showed cardiac hypertrophy, which were attenuated in ISO and DON-treated mice (ISO+DON) (heart weight to tibial length ratio: 7.70±0.09 vs. 7.11±0.15 mg/mm, n=12, p<0.05, left ventricular wall thickness: 1.05±0.02 vs. 0.86±0.03 mm, n=6, p<0.05). Cardiomyocyte cross-sectional area was also decreased in ISO+DON compared with ISO+vehicle (309±25 vs. 252±13 mm2, n=,3 p<0.05). Whereas expression levels of GFAT2 and protein O-GlcNAcylation in the heart were increased in ISO+vehicle compared with control+vehicle by 3.3 and 1.5 folds, respectively (n=9 and n=9, p<0.05), expression levels of O-GlcNAc transferase (OGT) and the β-N-acetylglucosaminidase (OGA), other enzymes regulating O-GlcNAcylation, were not altered in both groups, indicating that ISO activated HBP by GFAT2. Protein O-GlcNAcylation in ISO+DON was lower than that in ISO+vehicle by 83% (n=9, p<0.05). In addition, phosphorylation of Akt, a critical mediator of cardiac hypertrophy, but not other mediators of cardiac hypertrophy such as ERK, JNK, or p38MAPK, was significantly decreased in ISO+DON by 76% (n=9, p<0.05). In cultured neonatal rat ventricular myocytes, treatment with ISO (1μM, 12h) increased the expression levels of GFAT2 and protein O-GlcNAcylation by 1.3 and 1.5 folds, respectively (n=6 and n=6, p<0.05), but not GFAT1. Furthermore, ISO stimulation increased a direct O-GlcNAcylation of Akt by 1.4 folds (n=3, p<0.05). Downregulation of GFAT2 by RNA silencing decreased cell size by 82% (n=6, p<0.05) and protein O-GlcNAcylation and phosphorylation of Akt by 76% and 54%, respectively (n=9 and n=9, p<0.05) in cardiomyocyte treated with ISO. Conversely, administration of glucosamine, a substrate of HBP, increased protein of O-GlcNAcylation and phosphorylation of Akt by 1.3 and 1.8 folds, respectively (n=6 and n=6, p<0.05).
Conclusions
GFAT2, a limiting enzyme of HBP, mediates pathological cardiac hypertrophy by Akt activation probably due to its O-GlcNAcylation. GFAT2-O-GlcNAcylation-Akt pathway might be a potential novel therapeutic target for cardiac hypertrophy.
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Affiliation(s)
- A Ishikita
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - S Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - K Okabe
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - N Enzan
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Yamamoto
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - M Sada
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - H Deguchi
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University, Faculty of Medical Sciences, Department of Experimental and Clinical Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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24
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Sada M, Matsushima S, Ikeda S, Okabe K, Ishikita A, Tadokoro T, Enzan N, Yamamoto T, Deguchi Y, Ikeda M, Ide T, Tsutsui H. P6305Activation of invariant natural killer T cells ameliorates doxorubicin-induced cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0902] [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
Invariant natural killer T (iNKT) cells orchestrate tissue inflammation via regulating various cytokine productions, especially strongly upregulating interferon (IFN)-γ. Activation of iNKT cells have been previously reported to exert protective effects against post-infarcted cardiac remodeling and cardiac ischemia/reperfusion injury. However, the role of iNKT cells has not been determined in doxorubicin (DOX)-induced cardiomyopathy.
Purpose
The purpose of this study was to examine whether the activation of iNKT cells by α-galactosylceramide (αGC), which specifically activates iNKT cells, could affect DOX-induced cardiomyopathy, and if so, to elucidate its downstream target.
Methods
C57BL/6J mice were received the intraperitoneal injection of either αGC (0.1μg/g, n=11) or vehicle (n=13). After 1 week, these mice were treated with a low dose of DOX (18mg/kg via intravenous 3 injections over 1 week), and were followed during 14 days.
Results
DOX mice (DOX+vehicle) showed left ventricular (LV) dysfunction and dilatation, which were significantly ameliorated in DOX mice receiving αGC (DOX+αGC) (LV fractional shortening: 27.4±4.31 vs. 31.5±4.62%, p<0.05, LV end-diastolic diameter: 3.70±0.16 vs. 3.32±0.23mm, p<0.05), with no significant changes in arterial pressure, body weight, and food consumption, 14 days after DOX injection. DOX+vehicle demonstrated a significant decrease in myocardial gene expression of Vα14Jα18, a specific marker of iNKT cells, and IFN-γ compared with control mice. Vα14Jα18 expression levels were higher in DOX+αGC than DOX+vehicle by 9.2 folds (p<0.05). Consistent with this change, IFN-γ was higher in DOX+αGC than DOX+vehicle by 4.4 folds (p<0.05), whereas interleukin (IL)-1, IL-4, IL-6, IL-10, IL-17, IL-23, and tumor necrosis factor (TNF)-α were not altered in both groups. Phosphorylation of Akt, its active form, in the heart was significantly increased in DOX+αGC compared with DOX+vehicle by 1.8 folds (p<0.05).
Conclusions
Activation of iNKT cells by αGC play a protective role against DOX-induced cardiac dysfunction, which was associated with enhancing expression of IFN-γ and activating Akt. Therapies designed to activate iNKT cells might be beneficial to protect the heart from DOX injury.
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Affiliation(s)
- M Sada
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Hospital, Cardiovascular Medicine, Fukuoka, Japan
| | - S Ikeda
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - K Okabe
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - A Ishikita
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - N Enzan
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Yamamoto
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - Y Deguchi
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
| | - T Ide
- Kyushu University Graduate School of Medical Sciences, Exerimental and Clinical Cardiovascular Medicine, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Faculty of Medical Sciences, Cardiovascular Medicine, Fukuoka, Japan
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Wada S, Koga M, Makita N, Nakamura Y, Miwa K, Ide T, Yi K, Mizoguchi T, Yamaguchi Y, Ihara M, Toyoda K. Detection of Stenosis Progression in Intracranial Vertebral Artery Dissection Using Carotid Ultrasonography. J Stroke Cerebrovasc Dis 2019; 28:2201-2206. [PMID: 31122713 DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess whether carotid ultrasonography indices detect arterial stenosis progression in patients with vertebral artery (VA) dissection. METHODS This was a retrospective, single-center, observational study that enrolled patients with intracranial VA dissection who were admitted from January 2011 to June 2017. Magnetic resonance angiography (MRA) was done on admission and followed up at a median 20 days after onset (interquartile range [IQR] 9-58 days), and ultrasonography was performed at a median of 22 (interquartile range 7-56) days. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), and pulsatility index (PI) were measured by ultrasonography, and the ratio of each follow-up value to the baseline (follow-up/baseline) value was calculated. Two stroke neurologists categorized into 3 groups by morphological changes of the dissected vessel: patients with stenosis progression (progression group: P-group); those with no remarkable change or dilatation improved (stable group: S-group); and those with stenosis regression or dilatation enlargement (enlargement group: E-group). Ultrasonography indices were compared among the groups. RESULTS Of the 42 patients who were enrolled to this study, 39 patients underwent ultrasonography and MRA on both admission and follow-up. The PI ratio was significantly higher in the P-group than in the S-group (1.96 ± .80 versus .98 ± .44, P = .02) and in the E-group (versus .65 ± .35, P < .01). There were no significant differences in the PSV ratio, EDV ratio, and MV ratio. CONCLUSIONS In patients with VA dissection, the PI ratio on ultrasonography is a promising index to detect stenosis progression.
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Affiliation(s)
- Shinichi Wada
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Nakamura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihiro Ide
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichiro Yi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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26
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Fujita K, Tanaka K, Yamagami H, Ide T, Ishiyama H, Sonoda K, Satow T, Takahashi JC, Ihara M, Koga M, Yokota T, Toyoda K. Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke. Stroke 2019; 50:1751-1757. [PMID: 31233392 DOI: 10.1161/strokeaha.119.025142] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation. Methods- Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3-4) or poor (grade 0-2) collateral status for analysis. Results- Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08-7.70; P=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications ( P for trend <0.001). Conclusions- Our data suggest that chronic hypertension has a detrimental effect on acute leptomeningeal collateral flow in patients with cerebral large-vessel occlusion. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02251665.
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Affiliation(s)
- Kyohei Fujita
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan (K.F., T.Y.)
| | - Kanta Tanaka
- Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihiro Ide
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan.,Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan (T.I.)
| | - Hiroyuki Ishiyama
- Department of Neurology (H.I., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazutaka Sonoda
- Division of Stroke Care Unit (K. Tanaka, H.Y., K.S.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tetsu Satow
- Department of Neurosurgery (T.S., J.C.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun C Takahashi
- Department of Neurosurgery (T.S., J.C.T.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology (H.I., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan (K.F., T.Y.)
| | - Kazunori Toyoda
- From the Department of Cerebrovascular Medicine (K.F., T.I., M.K., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
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27
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Nakamura Y, Yamaguchi Y, Makita N, Morita Y, Ide T, Wada S, Mizoguchi T, Ikenouchi H, Miwa K, Yi K, Irie K, Shimohama S, Ihara M, Toyoda K, Koga M. Clinical and Radiological Characteristics of Intracranial Artery Dissection Using Recently Proposed Diagnostic Criteria. J Stroke Cerebrovasc Dis 2019; 28:1691-1702. [PMID: 30898444 DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/25/2018] [Revised: 12/28/2018] [Accepted: 02/16/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data on the clinical and radiological characteristics of intracranial artery dissection (IAD) have remained limited. Our purpose was to reveal the clinical and radiological characteristics of IAD according to diagnostic criteria for IAD as recently reported by a group of international experts. METHODS Patients were retrospectively enrolled using a prospective single-center stroke registry between 2011 and 2016. Baseline characteristics and radiological findings including conventional magnetic resonance imaging (MRI) sequences, magnetic resonance angiography (MRA), high-resolution 3-dimensional T1-weighted imaging (HR-3D-T1WI), and digital subtraction angiography were reviewed. We performed statistical comparisons to determine which findings from which modalities are useful. RESULTS We identified 118 patients with suspected artery dissection, with 64 patients (median age, 51 [interquartile range, 45-56) years; 16 women) finally meeting the criteria for definite (n = 47), probable (n = 15), or possible (n = 2) idiopathic IAD. Ischemic stroke alone was found in 31 patients (48%) on admission. There were 36 patients (56%) suffering from hypertension and 39 (61%) with smoking history. The vertebral artery alone was the most affected in 42 patients (66%). Intramural hematoma (IMH) was more frequently detected on HR-3D-T1WI than on conventional MRI/MRA (odds ratio, 4.72; 95% confidence interval, 1.71-13.00). In 54 patients (84%), the modified Rankin Scale score after 3 months was 0-1. CONCLUSIONS Male dominance and age at IAD onset were similar to previous studies, and more than half had hypertension and smoking history. We confirmed that HR-3D-T1WI is useful for detecting IMH in the diagnostic criteria.
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Affiliation(s)
- Yuki Nakamura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Toshihiro Ide
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Wada
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ikenouchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichiro Yi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Irie
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shun Shimohama
- Department of Neurology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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28
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Yamaguchi Y, Koga M, Sato S, Yamagami H, Todo K, Okuda S, Okada Y, Kimura K, Shiokawa Y, Kamiyama K, Itabashi R, Hasegawa Y, Kario K, Fujita K, Kumamoto M, Kamimura T, Ando D, Ide T, Yoshimoto T, Shiozawa M, Matsubara S, Yoshimura S, Nagatsuka K, Toyoda K. Early Achievement of Blood Pressure Lowering and Hematoma Growth in Acute Intracerebral Hemorrhage: Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study. Cerebrovasc Dis 2018; 46:118-124. [PMID: 30199854 DOI: 10.1159/000492728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/19/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have revealed that hematoma growth mainly occurs during the first 6 h after the onset of spontaneous intracerebral hemorrhage (ICH). Early lowering of blood pressure (BP) may be beneficial for preventing hematoma growth. However, relationships between timing of BP lowering and hematoma growth in ICH remain unclear. We investigated associations between timing of BP lowering and hematoma growth for ICH. METHODS The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH Study was a multicenter, prospective, observational study investigating the safety and feasibility of early (within 3 h from onset) reduction of systolic BP (SBP) to < 160 mm Hg with intravenous nicardipine for acute hypertension in cases of spontaneous ICH. The present study was a post hoc analysis of the SAMURAI-ICH study. We examined relationships between time from onset, imaging, and initiation of treatment to target SBP achievement and hematoma growth (absolute growth ≥6 mL) in ICH patients. Target SBP achievement was defined as the time at which SBP first became < 160 mm Hg. RESULTS Among 211 patients, hematoma growth was seen in 31 patients (14.7%). The time from imaging to target SBP and time from treatment to target SBP were significantly shorter in patients without hematoma growth than in those with (p = 0.043 and p = 0.032 respectively), whereas no significant difference was seen in time from onset to SBP < 160 mm Hg between groups (p = 0.177). Patients in the lower quartiles of time from imaging to target SBP and time from treatment to target SBP showed lower incidences of hematoma growth (p trend = 0.023 and 0.037 respectively). The lowest quartile of time from imaging to target SBP (< 38 min) was negatively associated with hematoma growth on multivariable logistic regression (OR 0.182; 95% CI 0.038-0.867; p = 0.032). CONCLUSIONS Early achievement of target SBP < 160 mm Hg is associated with a lower risk of hematoma growth in ICH.
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Affiliation(s)
- Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka,
| | - Masatoshi Koga
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Yamagami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Todo
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Okuda
- Department of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiaki Shiokawa
- Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan
| | - Ryo Itabashi
- Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kyohei Fujita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaya Kumamoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Teppei Kamimura
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Daisuke Ando
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihiro Ide
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soichiro Matsubara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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29
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Okabe K, Matsushima S, Ikeda M, Ikeda S, Ishikita A, Tadokoro T, Ide T, Tsutsui H. P2826Teneligliptin attenuated AngII-induced cardiac hypertrophy by inhibiting Nox4-HDAC4 axis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2826] [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)
- K Okabe
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Matsushima
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Ikeda
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Ikeda
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - A Ishikita
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Ide
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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30
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Ikeda S, Matsushima S, Ikeda M, Ishikita A, Tadokoro T, Ide T, Tsutsui H. P5694L-type calcium channel blocker attenuates doxorubicine-induced cardiomyopathy by inhibiting CaMKII-NF-kB axis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5694] [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)
- S Ikeda
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - S Matsushima
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - M Ikeda
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - A Ishikita
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - T Tadokoro
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - T Ide
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
| | - H Tsutsui
- Kyushu University Graduate School of Medical Sciences, Department of cardiology, Fukuoka, Japan
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31
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Yoshimura S, Koga M, Sato S, Todo K, Yamagami H, Kumamoto M, Itabashi R, Terasaki T, Kimura K, Yagita Y, Shiokawa Y, Kamiyama K, Okuda S, Okada Y, Takizawa S, Hasegawa Y, Kameda T, Shibuya S, Nagakane Y, Ito Y, Matsuoka H, Takamatsu K, Nishiyama K, Fujita K, Kamimura T, Ando D, Ide T, Yoshimoto T, Shiozawa M, Matsubara S, Yamaguchi Y, Kinoshita N, Matsuki T, Takasugi J, Tokunaga K, Higashida K, Homma K, Kario K, Arihiro S, Toyoda K. Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation ― SAMURAI-NVAF Study ―. Circ J 2018; 82:1935-1942. [DOI: 10.1253/circj.cj-18-0067] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 11/09/2022]
Affiliation(s)
- Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichi Todo
- Department of Neurology, Kobe City Medical Center General Hospital
| | - Hiroshi Yamagami
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Masaya Kumamoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School Hospital
| | | | - Yoshiaki Shiokawa
- Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine
| | | | | | - Yasushi Okada
- Department of Neurology and Cerebrovascular Medicine, NHO Kyushu Medical Center
| | - Shunya Takizawa
- Department of Neurology, Tokai University School of Medicine
| | | | - Tomoaki Kameda
- Division of Neurology, Jichi Medical University School of Medicine
| | | | | | - Yasuhiro Ito
- Department of Neurology, TOYOTA Memorial Hospital
| | - Hideki Matsuoka
- Department of Cerebrovascular Medicine, NHO Kagoshima Medical Center
| | | | | | - Kyohei Fujita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teppei Kamimura
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Daisuke Ando
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihiro Ide
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Soichiro Matsubara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshitaka Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Naoto Kinoshita
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Takayuki Matsuki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Junji Takasugi
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Keisuke Tokunaga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kyoko Higashida
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Kazunari Homma
- Department of Neurology, Tokai University School of Medicine
| | - Kazuomi Kario
- Division of Neurology, Jichi Medical University School of Medicine
| | - Shoji Arihiro
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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32
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Makita N, Koga M, Nakamura Y, Ide T, Wada S, Yamaguchi Y, Ihara M, Toyoda K. Abstract 69: Long-term Vascular Morphological Changes and Clinical Events in Intracranial Artery Dissection. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.69] [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: 11/16/2022]
Abstract
Background and purpose:
The morphological change of intracranial artery dissection (IAD) is important in the diagnosis and therapeutic management. Long-term follow-up data of IAD patients are limited. We aimed to elucidate long-term morphological changes and clinical events in IAD patients.
Methods:
From a prospective single-center stroke registry between 2011 and 2016, we identified consecutive patients with idiopathic IAD based on the recently proposed criteria (Debette S, et al. Lancet Neurol 2015;14:640-654) who had follow-up MRA at 180 days of onset or later. Serial vascular morphological changes on follow-up MRA, and dissection associated ischemic and hemorrhagic stroke events during follow-up were analyzed.
Results:
We enrolled 51 patients (13 women; mean age, 52±13 years) who met the criteria of definite (n=39) and probable (n=12) idiopathic IAD. The vertebral artery was the leading dissected artery in 73% followed by anterior cerebral artery in 12%. The median follow-up period was 1.8 years (range 0.6 - 6.1). The initial MRA showed stenosis without dilation or occlusion in 27 patients, pearl and string sign in 16, dilation without stenosis in seven and almost normal finding in one. During the follow-up period, Ischemic stroke recurred within 15 days (median 11 days) for seven and at 686 days in another patient, and none had hemorrhagic stroke. Serial vascular morphological change occurred in 46 (90%). Of those, 37 (80%) had morphological improvement (stenosis regression >50% in 20, aneurysm diameter reduction >20% in two and both in 15) and nine (20%) had morphological progression (stenosis progression >50% in five and aneurysm enlargement >20% in four) from baseline. After 90 days of onset, morphological improvement and progression were still observed in 30 (65%) and five (11%) patients, respectively. There was no significant association between ischemic stroke events and vascular morphological progressions (P = 0.667).
Conclusions:
Ninety percent of patients with IAD had serial vascular morphological change, in particular one tenth had the morphological progression after 90 days of onset. In contrast, ischemic stroke events mainly occurred within 15 days of onset.
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Affiliation(s)
- Naoki Makita
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | | | - Yuki Nakamura
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Toshihiro Ide
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Sinichi Wada
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Yoshitaka Yamaguchi
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masafumi Ihara
- Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
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Wada S, Koga M, Nakamura Y, Makita N, Ide T, Yamaguchi Y, Ihara M, Toyoda K. Abstract WMP67: Arterial Velocity on Carotid Ultrasonography Can Predict the Stenosis Progression in Patients With Vertebro-basillar Dissection. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wmp67] [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: 11/16/2022]
Abstract
Purpose:
Morphological changes of affected arteries in intracranial artery dissection often occur in the acute phase. The usefulness of carotid ultrasonography (CU) to evaluate the changes is not well investigated. The purpose of this study was to assess the value of CU indexes to detect artery stenosis progression on magnetic resonance angiography (MRA).
Methods:
This is a retrospective, single-center, observational study. We enrolled patients with intracranial vertebro-basilar artery dissection diagnosed based on criteria by the expert group (Debette S, et al: Lancet Neurol 2015) who were admitted within 30 days after onset from 2011 January to 2017 June. Carotid ultrasonography was performed on admission (median 0 days after onset) and follow-up (median, 40 days after onset; interquartile range, 11-106) to examined the flow velocity of both vertebral arteries. MRA was done on admission and follow-up just before or after the follow-up CU. Two stroke neurologists who were blinded to patients’ information assessed the change of vessel forms on MRA; stenosis progression was defined as an follow-up arterial diameter of <50% as compared to that at baseline on MRA. Patients were divided into two groups: those with stenosis progression (P group ) and the others (non-P group). Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI) were measured by CU and each baseline to follow-up ratio (follow-up/baseline) was compared between the two groups.
Result:
Of 26 patients (11 women, 53±8 years old) who were enrolled, 10 (28%) showed stenosis progression (P group). The P group had lower EDV ratio (0.34±0.63 vs 1.05±0.39, P<0.01) and higher PI ratio (1.95±0.76 vs 0.85±0.30, P<0.01) than the non-P group. Using Receiver Operating Characteristic (ROC) curve analysis, the area under the curve (AUC) of EDV ratio to predict stenosis progression was 0.87 (P<0.01) with the cut-off value of 0.54, sensitivity of 87.5% and specificity of 93.3% and that of PI ratio was 0.93 (P<0.01) with 1.17, 88.9% and 82.3%, respectively.
Conclusion:
Carotid ultrasonography is useful to predict the chrocnic stenosis progression of vertebra-basilar artery dissection.
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Affiliation(s)
- Shinichi Wada
- National Cerebral and Cardiovascular Cntr, Osaka, Japan
| | | | - Yuki Nakamura
- National Cerebral and Cardiovascular Cntr, Osaka, Japan
| | - Naoki Makita
- National Cerebral and Cardiovascular Cntr, Osaka, Japan
| | - Toshihiro Ide
- National Cerebral and Cardiovascular Cntr, Osaka, Japan
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Mizoguchi T, Takagi M, Sato S, Yamagami H, Ide T, Yoshimoto T, Shiozawa M, Todo K, Yagita Y, Itabashi R, Terasaki T, Koga M, Toyoda K. Abstract WP398: Timing of Starting Doacs and Short- and Long-Term Clinical Outcomes for Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation: The Samurai-nvaf Study. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp398] [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: 11/16/2022]
Abstract
Background and Purpose:
Direct oral anticoagulants (DOACs) are widely used for the prevention of ischemic events with non-valvular atrial fibrillation (NVAF). However, it is unknown when DOACs should be started after acute ischemic stroke (AIS) or transient ischemic attack (TIA). The aim of this study was to compare the short- and long-term stroke outcomes between earlier initiation and later initiation of DOACs after onset of AIS.
Methods:
Patients with NVAF who developed AIS/TIA were enrolled from the database of the prospective, multicenter, observational SAMURAI-NVAF study, and they were divided into two groups according to the date of starting DOACs after stroke onset: within 3 days (E-group) and 4 or more days (L-group). The frequency of ischemic event, bleeding, and death up to 2 years was compared.
Result:
DOACs were started as the first oral anticoagulants after AIS/TIA in 499 (42%) of 1192 NVAF patients. Of these, 223 patients were assigned to E-group (74±6 years of age, 78 women) and 276 patients to L-group (75±6 years of age, 101 women). E-group had lower scores of National Institutes of Health Stroke Scale (median 3, interquartile range [IQR] 1-8 vs 5, 2-14; P=0.001) and CHAD
2
S-VASc (median 5, IQR, 4-6 vs 5, 4-6; P=0.04) than L-group. No significant difference was observed in the rate of ischemic events (at 3 months: E 4.0% vs L 2.5%, harzard ratio [HR] 1.59, 95% confidence interval [CI] 0.58-4.48; at 2 years: E 9.4% vs L 10.9%, 0.89, 0.50-1.56), bleeding (at 3 months: E 1.4% vs L 2.2%, HR 0.48, 95% CI 0.10-1.88; at 2 years: E 3.6% vs. L 4.0%, 0.97, 0.36-2.51), and death (at 3 months: E 0.5% vs L 0.4%, HR 1.22, 95% CI 0.05-31.52; at 2 years: E 4.5% vs L 8.7%, 0.57, 0.26-1.17) after multivariable adjustment.
Conclusion:
Early starting of DOACs within 3 days after the onset of AIS/TIA had comparable outcome to later starting of them regarding ischemic events, bleeding, and death.
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Affiliation(s)
- Tadataka Mizoguchi
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masahito Takagi
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Shoichiro Sato
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Hiroshi Yamagami
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Toshihiro Ide
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Takeshi Yoshimoto
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masayuki Shiozawa
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kenichi Todo
- Dept of Neurology, Kobe City Med Cntr General Hosp, Kobe, Japan
| | - Yoshiki Yagita
- Dept of Stroke Medicine, Kawasaki Med Sch, Kurashiki, Japan
| | - Ryo Itabashi
- Dept of Stroke Neurology, Kohnan Hosp, Sendai, Japan
| | - Tadashi Terasaki
- Dept of Neurology, Japanese Red Cross Kumamoto Hosp, Kumamoto, Japan
| | - Masatoshi Koga
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
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Nakamura Y, Yamaguchi Y, Koga M, Morita Y, Makita N, Ide T, Wada S, Shimohama S, Ihara M, Toyoda K. Abstract WMP68: Clinical and Radiological Characteristics of Intracranial Artery Dissection Using Recently Proposed Diagnostic Criteria. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wmp68] [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: 11/16/2022]
Abstract
Background and purpose:
A group of international experts on intracranial artery dissection (IAD) recently reported a consensus statement and criteria about the diagnosis of IAD (Debette S, et al: Lancet Neurol 2015). But there are little data showing clinical features of IAD based on the new criteria. We aimed to elucidate clinical and radiological characteristics based on the criteria.
Methods:
Patients with suspected IAD were retrospectively enrolled using a prospective single-center stroke registry between 2011 and 2016. Baseline characteristics and radiological findings including conventional MRI sequences, MRA, 3D-T1 weighted TSE blood black (3DT1BB) sequence and digital subtraction angiography (DSA) were reviewed.
Results:
Of 147 patients with suspected IAD, 63 patients (15 women; mean age, 51±12 years) finally met the criteria of definite (n=47), probable (n=14) or possible (n=2) idiopathic IAD. Thirty-five (56 %) had a history of hypertension, 21 (33 %) had dyslipidemia, and 39 (62 %) had smoking habit. Ischemic stroke alone was found in 50 %, subarachnoid hemorrhage plus ischemic stroke in 6 %, TIA in 3 %, and head or neck pain alone in 41 % on admission. Vertebral artery was affected in 66 %, basilar artery in 2 %, posterior inferior cerebral artery in 5 %, anterior cerebral artery in 11 %, middle cerebral artery in 6 %, intracranial internal carotid artery in 2 % and multi-vessels in 8 %. Intimal flap, double lumen and aneurysmal dilatation were similarly observed between 3DT1BB and MRI/MRA/DSA. Intramural hematoma was more frequently detected in 3DT1BB sequence than conventional MRI/MRA (initial image, 53 % vs. 14 %, P < 0.001; follow-up image, 59 % vs. 22 %, P < 0.001). Follow-up image was essential to fulfill the criteria in 12 patients; rapid morphological change of aneurysmal dilation in 3, a newly detection of intramural hematoma in 3, double lumen in 2, pearl and string sign in 2, and aneurysmal dilation without change in morphology in 2 on follow-up images. Modified Rankin Scale score of ≤ 1 at 90 days was observed in 54 patients (86 %).
Conclusions:
Intracranial vertebral artery was most frequently affected. 3DT1BB sequence was apparently useful in detecting intraluminal hematoma in the recently proposed diagnostic criteria of idiopathic IAD.
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Affiliation(s)
- Yuki Nakamura
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Yoshitaka Yamaguchi
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masatoshi Koga
- Div of Stroke Care Unit, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Yoshiaki Morita
- Dept of Radiology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Naoki Makita
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Toshihiro Ide
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Shinichi Wada
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | | | - Masafumi Ihara
- Dept of Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
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Fujita K, Sato S, Yoshimura S, Ide T, Yoshimoto T, Shiozawa M, Matsubara S, Arihiro S, Yamagami H, Koga M, Toyoda K. Abstract WP211: Prognostic Significance of White Blood Cell Count in Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation: The SAMURAI-NVAF Study. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp211] [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: 11/16/2022]
Abstract
Background and Purpose:
White blood cell count (WBC), a marker of the atherosclerotic burden, has reportedly been a predictor of poor outcome in the general stroke population. The purpose of this study was to clarify associations between WBC on admission and outcomes among patients having acute ischemic stroke with nonvalvular atrial fibrillation (NVAF), that was principally cardioembolic.
Methods:
Of those enrolled in the multicenter observational Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-NVAF study, acute ischemic stroke/TIA patients (within 7 days of onset) with NVAF with premorbid modified Rankin Scale (mRS) score of 0-2 were included in the analysis. WBC on admission was categorized into quartiles. Associations between WBC count and major disability or death (mRS score of 3-6) at 90 days and 2 years were analyzed using logistic and proportional odds regression models.
Results:
A total of 789 patients were studied (306 women, 76.2±9.5 years old, the median NIHSS score was 6 [IQR, 2-16], the median WBC count was 6700 [IQR, 5475-8300], the median mRS score at 90 days was 2 [IQR, 1-4], the median mRS score at 2 years was 2 [IQR, 0-5]). WBC had a significant linear association with major disability or death at 90 days (adjusted odds ratio [OR] for highest versus lowest quartile 3.53; 95% confidence interval [CI] 2.07-6.13; P for trend<0.001). Associations were similar for the outcome at 2 years (adjusted OR for highest versus lowest quartile 2.16; 95% CI 1.31-3.56; P for trend<0.001).
Conclusions:
Higher WBC count on admission seems to predict a short- and long-term poor outcome in acute ischemic stroke patients with NVAF.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01581502.
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Affiliation(s)
- Kyohei Fujita
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Shoichiro Sato
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Sohei Yoshimura
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Toshihiro Ide
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | | | - Masayuki Shiozawa
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Soichiro Matsubara
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Shoji Arihiro
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Hiroshi Yamagami
- Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masatoshi Koga
- Div of Stroke Care Unit, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
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Shiozawa M, Sato S, Yoshimura S, Fujita K, Ide T, Yoshimoto T, Matsubara S, Arihiro S, Yamagami H, Koga M, Toyoda K. Abstract 179: Determinants of Cerebral Microbleeds in Acute Ischemic Stroke Patients With Non-valvular Atrial Fibrillation: SAMURAI-NVAF Study. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.179] [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: 11/16/2022]
Abstract
Background and Purpose:
Cerebral microbleeds (CMBs) are now considered to be one of the neuroimaging markers of cerebral small vessel disease. It has been reported that CMBs are associated with age, hypertension, cognitive impairment, and use of antithrombotic drugs. We aimed at identifying factors associated with the presence of CMBs among acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF) who participated in the multicenter Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-NVAF study.
Methods:
Acute ischemic stroke/transient ischemic attack (within 7 days of onset) patients with NVAF who underwent T2*-weighted images on magnetic resonance imagings at baseline were included in the analysis. Factors associated with the presence of CMBs were assessed in univariable and multivariable logistic regression models.
Results:
Of 1,099 (77.6±10.0 years, 620 male) participants, 256 (23.2%) had CMBs: single CMB in 96 (8.7%), 2-4 of CMBs in 109 (9.9%), and ≥5 CMBs in 51 (4.6%). The presence of CMBs was associated with age [per 10 years, odds ratio (OR) 1.21; 95% confidence interval (CI) 1.02-1.44], past history of stroke (OR 1.52; 95% CI 1.09-2.11), and advanced cognitive impairment (OR 1.64; 95% CI 1.02-2.61) in multivariable analysis adjusted for sex, hypertension, arterial disease, ever smoking, premorbid antithrombotic medications, and estimated glomerular filtration rate. Among 514 patients (46.8% of the participants) with the data of urinary albumin, clinical albuminuria (urinary albumin ≥300 mg/gCr) and past history of stroke were identified as independent factors associated with CMBs (OR 1.91; 95% CI 1.06-3.42 and 1.67; 1.04-2.66, respectively).
Conclusions:
Approximately one fourth of acute ischemic stroke patients with NVAF had CMBs. Past history of stroke and clinical albuminuria were identified as independent determinants of CMBs on top of established ones.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01581502.
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Affiliation(s)
- Masayuki Shiozawa
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Shoichiro Sato
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Sohei Yoshimura
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kyohei Fujita
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Toshihiro Ide
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | | | - Soichiro Matsubara
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Shoji Arihiro
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Hiroshi Yamagami
- Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masatoshi Koga
- Div of Stroke Care Unit, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- cerebrovascular medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
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Yamaguchi Y, Koga M, Todo K, Sato S, Yamagami H, Kamiyama K, Okuda S, Okada Y, Kimura K, Shiokawa Y, Furui E, Hasegawa Y, Kario K, Yoshimura S, Ide T, Yoshimoto T, Nagatsuka K, Toyoda K. Abstract WP347: Early Achievement of Blood Pressure Lowering on Hematoma Growth in Hyperacute Intracerebral Hemorrhage: the SAMURAI-ICH Study. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp347] [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: 11/16/2022]
Abstract
Background:
Little has been investigated about associations between timing of blood pressure lowering and clinical outcome of intracerebral hemorrhage (ICH).
Methods:
The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH Study is a multicenter, prospective, observational study investigating the safety and feasibility of early (within 3 hours from symptom onset) systolic blood pressure (SBP) reduction to less than 160 mmHg with intravenous nicardipine for acute hypertension in patients with spontaneous ICH. We retrospectively examined the relationship between time from onset, CT imaging, and initiation of antihypertensive treatment to target SBP achievement and hematoma growth in ICH patients. Hematoma growth was defined as an absolute growth of ≥ 6 ml from baseline to second imaging at 24 (±6) hours after the initiation of antihypertensive treatment.
Results:
Among 211 patients (81 women (38.4%), mean age 66 years), mean baseline hematoma volume was 13 ml and hematoma growth was seen in 36 (17.1%) patients. Time from image to target SBP and time from treatment to target SBP were significantly shorter in patients without hematoma growth than those with (
P
= 0.043 and
P
= 0.032, respectively), whereas there was not significant difference in time from onset to target SBP between the two groups (
P
= 0.177). Lower quartiles of time from image to target SBP and time from treatment to target SBP had lower incidences of hematoma growth (P trend = 0.023 and 0.037, respectively, Cochran-Armitage test), whereas there was not significant trend in time from onset to target SBP (
P
= 0.074). The lowest quartile of time from image to target SBP was negatively associated with hematoma growth on multivariate logistic regression (odds ratio 0.182, 95% confidential interval 0.038-0.867,
P
= 0.032).
Conclusions:
Early achievement to target SBP <160 mmHg was negatively associated with hematoma growth in ICH patients.
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Affiliation(s)
- Yoshitaka Yamaguchi
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Masatoshi Koga
- Div of Stroke Care Unit, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kenichi Todo
- Dept of Neurology, Kobe City Med Cntr General Hosp, Kobe, Japan
| | - Shoichiro Sato
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Hiroshi Yamagami
- Dept of Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kenji Kamiyama
- Dept of Neurosurgery, Nakamura Memorial Hosp, Sapporo, Japan
| | - Satoshi Okuda
- Dept of Neurology, National Hosp Organization Nagoya Med Cntr, Nagoya, Japan
| | - Yasushi Okada
- Dept of Cerebrovascular Medicine and Neurology, National Hosp Organization Kyushu Med Cntr, Fukuoka, Japan
| | - Kazumi Kimura
- Dept of Stroke Medicine, Kawasaki Med Sch, Kurashiki, Japan
| | - Yoshiaki Shiokawa
- Dept of Neurosurgery and Stroke Cntr, Kyorin Univ Sch of Medicine, Mitaka, Japan
| | - Eisuke Furui
- Dept of Stroke Neurology, Kohnan Hosp, Sendai, Japan
| | - Yasuhiro Hasegawa
- Dept of Neurology, St Marianna Univ Sch of Medicine, Kawasaki, Japan
| | - Kazuomi Kario
- Div of Cardiovascular Medicine, Dept of Medicine, Jichi Med Univ Sch of Medicine, Shimotsuke, Japan
| | - Sohei Yoshimura
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Toshihiro Ide
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Takeshi Yoshimoto
- Dept of Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazuyuki Nagatsuka
- Dept of Neurology, National Cerebral and Cardiovascular Cntr, Suita, Japan
| | - Kazunori Toyoda
- Dept of Cerebrovascular Medicine, National Cerebral and Cardiovascular Cntr, Suita, Japan
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Nonaka T, Yakushiji Y, Ide T, Ito H, Kawamoto K, Hara H. Pre-critical MRI findings of an Alzheimer's disease patient with pathologically proven cerebral amyloid angiopathy related lobar hemorrhage. Rinsho Shinkeigaku 2016; 56:338-43. [PMID: 27151228 DOI: 10.5692/clinicalneurol.cn-000860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 85-year-old woman with untreated hypertension was admitted with a disturbance of consciousness. On admission, brain CT revealed a lobar intracerebral hemorrhage with a midline shift. An intracranial hematoma was evacuated via a life-saving craniotomy. Definite pathological findings of amyloid-β deposition in the excised hematoma (strong in anti-amyloid β40 immunostain, but weak in anti- amyloid β42) indicated cerebral amyloid angiopathy (CAA). She had been diagnosed with Alzheimer's disease at a regional memory clinic one month before symptom onset based on MRI findings of medial temporal lobe atrophy as well as CAA-related features of multiple strictly lobar cerebral microbleeds in the occipital lobe, cortical superficial siderosis and >20 enlarged perivascular spaces in the centrum semiovale. This experience suggests that comprehensive interpretation of such CAA-related findings on MRI might help to improve the management of cardiovascular risk factors for Alzheimer's disease.
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Affiliation(s)
- Toshihiro Nonaka
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
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Ando M, Akiyama M, Okuno D, Hirano M, Ide T, Sawada S, Sasaki Y, Akiyoshi K. Liposome chaperon in cell-free membrane protein synthesis: one-step preparation of KcsA-integrated liposomes and electrophysiological analysis by the planar bilayer method. Biomater Sci 2016; 4:258-64. [DOI: 10.1039/c5bm00285k] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chaperoning functions of liposomes were investigated using cell-free membrane protein synthesis.
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Affiliation(s)
- M. Ando
- Department of Polymer Chemistry
- Graduate School of Engineering
- Kyoto University
- Kyoto
- Japan
| | - M. Akiyama
- Department of Polymer Chemistry
- Graduate School of Engineering
- Kyoto University
- Kyoto
- Japan
| | - D. Okuno
- Laboratory for Cell Dynamics Observation
- Quantitative Biology Center
- RIKEN
- Osaka 565-0874
- Japan
| | - M. Hirano
- Laboratory for Cell Dynamics Observation
- Quantitative Biology Center
- RIKEN
- Osaka 565-0874
- Japan
| | - T. Ide
- Graduate School of Natural Science and Technology
- Okayama University
- Okayama 700-8530
- Japan
| | - S. Sawada
- Department of Polymer Chemistry
- Graduate School of Engineering
- Kyoto University
- Kyoto
- Japan
| | - Y. Sasaki
- Department of Polymer Chemistry
- Graduate School of Engineering
- Kyoto University
- Kyoto
- Japan
| | - K. Akiyoshi
- Department of Polymer Chemistry
- Graduate School of Engineering
- Kyoto University
- Kyoto
- Japan
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Morisawa T, Takahashi T, Hori N, Ohashi N, Ide T, Takeda K, Nishi S. Effects of lower limbs and trunk passive exercise on intestinal movement after cardiovascular surgery. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1907] [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: 10/23/2022]
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Sakawa Y, Kuramitsu Y, Morita T, Kato T, Tanji H, Ide T, Nishio K, Kuwada M, Tsubouchi T, Ide H, Norimatsu T, Gregory C, Woolsey N, Schaar K, Murphy C, Gregori G, Diziere A, Pelka A, Koenig M, Wang S, Dong Q, Li Y, Park HS, Ross S, Kugland N, Ryutov D, Remington B, Spitkovsky A, Froula D, Takabe H. High-power laser experiments to study collisionless shock generation. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20135915001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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43
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Nishio K, Sakawa Y, Kuramitsu Y, Morita T, Ide T, Kuwada M, Koga M, Kato T, Norimatsu T, Gregory C, Woolsey N, Murphy C, Gregori G, Schaar K, Diziere A, Koenig M, Pelka A, Wang S, Dong Q, Li Y, Takabe H. Laboratory experiments on plasma jets in a magnetic field using high-power lasers. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20135915005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Saku K, Kakino T, Sakamoto K, Sakamoto T, Akashi T, Hata Y, Kishi T, Ide T, Sunagawa K. Total unloading of the Left Ventricle by circulatory Assist Device (LVAD) strikingly reduces the infract size in ischemia-reperfusion injury. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3692] [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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Saku K, Sakamoto K, Onitsuka K, Tobushi T, Oga Y, Nishizaki A, Kakino T, Kishi T, Ide T, Sunagawa K. Afferent vagal nerve stimulation induced sympathoinhibition may in part attribute to the beneficial impact of vagal nerve stimulation on heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5033] [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: 11/14/2022] Open
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Kakino T, Sakamoto K, Saku K, Sakamoto T, Akashi T, Oga Y, Nishizaki A, Kishi T, Ide T, Sunagawa K. Prediction of hemodynamic impact of the venoarterial Extracorporeal Membrane Oxygenation (ECMO). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5456] [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: 11/14/2022] Open
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Ide T, Sakawa Y, Kuramitsu Y, Morita T, Tanji H, Nishio K, Kuwada M, Ide H, Tsubouchi K, Shimazaki S, Taguchi T, Gregory C, Diziere A, Nakatsutsumi M, Koenig M, Ohnishi N, Takabe H. Formation of counterstreaming plasmas for collisionless shock experiment. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20135915002] [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: 11/14/2022] Open
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Morita T, Sakawa Y, Kuramitsu Y, Ide T, Nishio K, Kuwada M, Ide H, Tsubouchi K, Yoneda H, Nishida A, Namiki T, Norimatsu T, Tomita K, Nakayama K, Inoue K, Uchino K, Nakatsutsumi M, Pelka A, Koenig M, Dong Q, Yuan D, Gregori G, Takabe H. High Mach-number collisionless shock driven by a laser with an external magnetic field. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20135915004] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tsutsui T, Tanaka Y, Ushimura A, Ide T, Matsumura M, Barrett JC. In vitro cytotoxicity of diverse preparations used in dental practice to human gingival keratinocytes. Toxicol In Vitro 2012; 11:393-8. [PMID: 20654326 DOI: 10.1016/s0887-2333(97)00030-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/1997] [Indexed: 11/16/2022]
Abstract
The cytotoxicities of diverse preparations used for dental practice were examined with normal human keratinocytes from gingival tissues by the uptake of neutral red (NR assay). Cultures from different individuals were established, and secondary cultures in serum-free medium were used. The cytotoxicities to cells treated for 2 days with gargles, mouthwashes, gingival massages, fluoride preparations, dentifrices and local anaesthetics were determined from the dose-response curves of inhibition of NR uptake. As a quantitative measure of cytotoxicity, NR(50) (the concentration of the preparations that resulted in a 50% decrease in NR uptake relative to untreated controls) was interpolated from dose-response curves. Dentifrices examined showed cytotoxicity similar to gingival massages but were more cytotoxic than any fluoride preparations, local anaesthetics, and most gargles and mouthwashes. The cytotoxicities of dentifrices were at least 6.5-fold those of fluoride preparations and 7.9-fold those of local anaesthetics. The results provide useful estimates of relative toxicities of dental preparations to human oral mucosa and are useful as a standard for cytotoxic assessment of newly developed preparations for dental use.
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Affiliation(s)
- T Tsutsui
- Laboratory of Molecular Carcinogenesis, Environmental Carcinogenesis Program, National Institute of Environmental Health Sciences, National Institutes of Health, PO Box 12233, Research Triangle Park, NC 27709, USA
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Morita T, Sakawa Y, Kuramitsu Y, Dono S, Ide T, Shibata S, Aoki H, Tanji H, Sano T, Shiroshita A, Waugh JN, Gregory CD, Woolsey NC, Takabe H. Optical pyrometer system for collisionless shock experiments in high-power laser-produced plasmas. Rev Sci Instrum 2012; 83:10D514. [PMID: 23126856 DOI: 10.1063/1.4733738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A temporally and spatially resolved optical pyrometer system has been fielded on Gekko XII experiments. The system is based on the self-emission measurements with a gated optical imager (GOI) and a streaked optical pyrometer (SOP). Both detectors measure the intensity of the self-emission from laser-produced plasmas at the wavelength of 450 nm with a bandpass filter with a width of ~10 nm in FWHM. The measurements were calibrated with different methods, and both results agreed with each other within 30% as previously reported [T. Morita et al., Astrophys. Space Sci. 336, 283 (2011)]. As a tool for measuring the properties of low-density plasmas, the system is applicable for the measurements of the electron temperature and density in collisionless shock experiments [Y. Kuramitsu et al., Phys. Rev. Lett. 106, 175002 (2011)].
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Affiliation(s)
- T Morita
- Institute of Laser Engineering, Osaka University, 2-6 Yamada-oka, Suita, Osaka 565-0871, Japan.
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