Updated on 2024/08/19

写真a

 
sawatani tomofumi
 
Affiliation
Chibahokusoh Hospital, Intensive Care Unit, Assistant Professor
Title
Assistant Professor
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Papers

  • Ten-year trends in non-surgical patients requiring intensive care: Long-term prognostic differences by year of admission. International journal

    Shota Shigihara, Akihiro Shirakabe, Masato Matsushita, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Riku Toguchi, Shohei Kawakami, Yu Michiura, Mana Sawahata, Nobuaki Kobayashi, Kuniya Asai

    Journal of cardiology   2024.6

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    BACKGROUND: The aim of the present study is to elucidate prognostic impact of temporal trends of non-surgical patients requiring intensive care over a 10-year period. METHODS AND RESULTS: A total of 4276 non-surgical patients requiring intensive care from 2012 to 2021 were enrolled. Patients' backgrounds, in-hospital management, and prognoses were compared between five groups [2012-2013 (n = 825), 2014-2015 (n = 784), 2016-2017 (n = 864), 2018-2019 (n = 939), and 2020-2021 (n = 867)]. During the study period, mean age significantly increased from 69 years in 2012-2013 to 72 years in 2020-2021. Mean Acute Physiology and Chronic Health Evaluation scores significantly increased from 10 points in 2012-2013 to 12 points in 2020-2021. The median duration of intensive care unit stays increased from 3 to 4 days. Kaplan-Meier survival curve analysis showed that survival rates during 30- and 365-days were significantly lower in 2020-2021 than in 2012-2013, but it was not significantly different by a Cox proportional hazards regression model in 30 days. A Cox proportional hazards regression model revealed that the risks of 365-day all-cause death were significantly higher in patients enrolled in 2016-2017 (HR: 1.324, 95 % CI: 1.042-1.680, p = 0.021), in 2018-2019 (HR: 1.329, 95 % CI: 1.044-1.691, p = 0.021), and in 2020-2021 (HR: 1.409, 95 % CI: 1.115-1.779, p = 0.004). CONCLUSION: The condition of patients requiring intensive care is becoming more critical year by year, leading to poorer long-term prognoses despite improvements in treatment strategies. These findings emphasize the importance of additional care management after admission into non-surgical intensive care units, particularly for the aging society of Japan.

    DOI: 10.1016/j.jjcc.2024.06.003

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  • Clinical Background and Coronary Artery Lesions Characteristics in Japanese Patients With Acute Coronary Syndrome Suffering Major Bleeding

    Nobuaki Kobayashi, Yusaku Shibata, Osamu Kurihara, Takahiro Todoroki, Masayuki Tsutsumi, Akihiro Shirakabe, Shota Shigihara, Tomofumi Sawatani, Kazutaka Kiuchi, Masamichi Takano, Kuniya Asai

    Circulation Reports   6 ( 3 )   64 - 73   2024.3

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    DOI: 10.1253/circrep.cr-24-0003

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  • Clinical Significance of the Triglyceride-Glucose Index in Patients Requiring Nonsurgical Intensive Care.

    Suguru Nishigoori, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Nobuaki Kobayashi, Kuniya Asai

    International heart journal   65 ( 2 )   180 - 189   2024

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    The evaluation of triglyceride-glucose (TyG) index has not been sufficient in patients requiring nonsurgical intensive care.A total of 3,906 patients who required intensive care were enrolled. We computed the TyG index using the value on admission by the following formula: ln [triglyceride (mg/dL) × glucose (mg/dL) /2]. Patients were divided into three groups according to the TyG index quartiles: low (quartile 1 [Q1]; TyG index ≤ 8.493, n = 977), middle (Q2/Q3; 8.494 ≤ TyG index ≤ 9.536, n = 1,953), and high (Q4; TyG index > 9.537, n = 976). The median (interquartile range) TyG index was 9.00 (8.50-9.54); acute coronary syndrome (ACS) had the highest TyG index among all etiologies at 9.12 (8.60-9.68). A multivariate logistic regression model showed that ACS (odds ratio [OR], 2.133; 95% confidence interval [CI], 1.783-2.552) were independently correlated with high TyG index. A Cox proportional hazards regression model revealed that, in ACS, the Q2/Q3 and Q4 groups were independent predictors of 30-day all-cause mortality (hazard ratio [HR], 1.778; 95% CI, 1.014-3.118; HR, 2.986; 95% CI, 1.680-5.308; respectively) and that in acute heart failure [AHF], the Q4 group was a converse independent predictor of 30-day all-cause mortality (HR, 0.488; 95% CI, 0.241-0.988).High TyG index was linked to ACS and negative outcomes in the ACS group; in contrast, low TyG index was associated with adverse outcomes in the AHF group.

    DOI: 10.1536/ihj.23-409

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  • Late Kidney Injury After Admission to Intensive Care Unit for Acute Heart Failure.

    Masaki Morooka, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Shohei Kawakami, Yu Michiura, Shogo Kamitani, Nobuaki Kobayashi, Kuniya Asai

    International heart journal   65 ( 3 )   433 - 443   2024

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    Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, n = 509), Class R (risk; ≥ 1.5, n = 214), Class I (injury; ≥ 2.0, n = 78), and Class F (failure; ≥ 3.0, n = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, P = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, P < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, P < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, P = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (P = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (P = 0.017).The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.

    DOI: 10.1536/ihj.23-603

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  • Timing and Degree of Acute Kidney Injury in Patients Requiring Non-Surgical Intensive Care.

    Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Nobuaki Kobayashi, Kuniya Asai

    Circulation journal : official journal of the Japanese Circulation Society   87 ( 10 )   1392 - 1402   2023.9

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    BACKGROUND: The degree and timing of acute kidney injury (AKI) on admission and during hospitalization in patients requiring non-surgical intensive care remain unclear.Methods and Results: In this study, 3,758 patients requiring intensive care were analyzed retrospectively. AKI was defined based on the ratio of serum creatinine concentrations recorded at each time point (i.e., on admission and during the first 5 days in the intensive care unit and during hospitalization) to those measured at baseline. Patients were grouped by combining AKI severity (RIFLE class) and timing (i.e., from admission to 5 days [A-5D]; from 5 days to hospital discharge [5D-HD]) as follows: No-AKI; New-AKI (no AKI to Class R [risk; ≥1.5-fold increase in serum creatinine], I [injury; ≥2.0-fold increase in serum creatinine], and F [failure; ≥3.0-fold increase in serum creatinine or receiving dialysis during hospitalization]); Stable-AKI (Class R to R; Class I to I); and Worsening-AKI (Class R to I or F; Class I to F). Multivariate logistic regression analysis indicated that 730-day mortality was independently associated with Class R, I, and F on admission; Class I and F during the 5D-H period; and New-AKI and Worsening-AKI during A-5D and 5D-HD. CONCLUSIONS: AKI on admission, even Class R, was associated with a poor prognosis. An increase in RIFLE class during hospitalization was identified as an important factor for poor prognosis in patients requiring intensive care.

    DOI: 10.1253/circj.CJ-23-0320

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  • Organ dysfunction, injury, and failure in cardiogenic shock. International journal

    Akihiro Shirakabe, Masato Matsushita, Yusaku Shibata, Shota Shighihara, Suguru Nishigoori, Tomofumi Sawatani, Kazutaka Kiuchi, Kuniya Asai

    Journal of intensive care   11 ( 1 )   26 - 26   2023.6

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    BACKGROUND: Cardiogenic shock (CS) is caused by primary cardiac dysfunction and induced by various and heterogeneous diseases (e.g., acute impairment of cardiac performance, or acute or chronic impairment of cardiac performance). MAIN BODY: Although a low cardiac index is a common finding in patients with CS, the ventricular preload, pulmonary capillary wedge pressure, central venous pressure, and systemic vascular resistance might vary between patients. Organ dysfunction has traditionally been attributed to the hypoperfusion of the organ due to either progressive impairment of the cardiac output or intravascular volume depletion secondary to CS. However, research attention has recently shifted from this cardiac output ("forward failure") to venous congestion ("backward failure") as the most important hemodynamic determinant. Both hypoperfusion and/or venous congestion by CS could lead to injury, impairment, and failure of target organs (i.e., heart, lungs, kidney, liver, intestines, brain); these effects are associated with an increased mortality rate. Treatment strategies for the prevention, reduction, and reversal of organ injury are warranted to improve morbidity in these patients. The present review summarizes recent data regarding organ dysfunction, injury, and failure. CONCLUSIONS: Early identification and treatment of organ dysfunction, along with hemodynamic stabilization, are key components of the management of patients with CS.

    DOI: 10.1186/s40560-023-00676-1

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  • Effect of sacubitril/valsartan on natriuretic peptide in patients with compensated heart failure.

    Akihiro Shirakabe, Masato Matsushita, Tomofumi Sawatani, Satsuki Noma, Tsutomu Takayasu, Hideki Kanai, Miwako Asano, Akiko Nomura, Kuniya Asai

    Heart and vessels   38 ( 6 )   773 - 784   2023.6

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    The time-dependent changes in the natriuretic peptide families during sacubitril/valsartan (S/V) treatment remain obscure in the Asian heart failure (HF) cohort. Eighty-one outpatients with compensated HF were analyzed. The patients were divided into two groups based on the administration of S/V (n = 42) or angiotensin converting enzyme inhibitor (ACE-I; n = 39). Changes to the natriuretic peptide families and the daily dose of loop diuretics were evaluated 3 and 6 months after the intervention. The atrial natriuretic peptide (ANP) level was significantly increased (102 [63-160] pg/mL to 283 [171-614] pg/mL [3 months]; 409 [210-726] pg/mL [6 months]) in the S/V group but not in the ACE-I group. The dose of furosemide was significantly decreased during the six-month follow-up period in the S/V group (40 [20-40] mg to 20 [10-20] mg) but not in the ACE-I group. A multivariate logistic regression model showed that the presence of persistent atrial fibrillation (AF) and HF with a preserved left ventricular ejection fraction (HFpEF) was independently associated with a high delta-ANP ratio (≥ 4.5 ANP value on the start date/ANP value at 6 months; the mean value was used as the cutoff value) (odds ratio [OR]: 4.649, 95% CI 1.032-20.952 and OR: 7.558, 95% CI 1.427-40.042). The plasma level of ANP was increased, and the loop diuretic dose was decreased by the addition of neprilysin inhibitor therapy in patients with compensated HF. In patients with HFpEF and complicated persistent AF, neprilysin inhibitor therapy was associated with an increase in ANP.

    DOI: 10.1007/s00380-022-02230-9

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  • The Prognostic Impact of Fibrinogen-to-Albumin Ratio in Patients with Acute Heart Failure(タイトル和訳中)

    澤谷 倫史, 白壁 章宏, 松下 誠人, 柴田 祐作, 鴫原 祥太, 西郡 卓, 木内 一貴, 高橋 應仁, 小林 宣明, 浅井 邦也

    日本循環器学会学術集会抄録集   87回   PJ077 - 6   2023.3

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  • Evaluation of Plasma Xanthine Oxidoreductase (XOR) Activity in Patients with Cardiopulmonary Arrest.

    Yusaku Shibata, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Kazutaka Kiuchi, Masahito Takahashi, Takayo Murase, Takashi Nakamura, Nobuaki Kobayashi, Kuniya Asai

    International heart journal   64 ( 2 )   237 - 245   2023

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    Plasma xanthine oxidoreductase (XOR) activity in patients with cardiopulmonary arrest (CPA) has not yet been studied.A total of 1,158 patients who required intensive care and 231 control patients who attended a cardiovascular outpatient clinic were prospectively analyzed. Blood samples were collected within 15 minutes of admission from patients in intensive care patients, which were divided into a CPA group (n = 1,053) and a no-CPA group (n = 105). Plasma XOR activity was compared between the 3 groups and factors independently associated with extremely elevated XOR activity were identified using a multivariate logistic regression model. Plasma XOR activity in the CPA group (median, 1,030.0 pmol/hour/mL; range, 233.0-4,240.0 pmol/hour/mL) was significantly higher than in the no-CPA group (median, 60.2 pmol/hour/mL; range, 22.5-205.0 pmol/hour/mL) and control group (median, 45.2 pmol/hour/mL; range, 19.3-98.8 pmol/hour/mL). The regression model showed that out-of-hospital cardiac arrest (OHCA) (yes, odds ratio [OR]: 2.548; 95% confidence interval [CI]: 1.098-5.914; P = 0.029) and lactate levels (per 1.0 mmol/L increase, OR: 1.127; 95% CI: 1.031-1.232; P = 0.009) were independently associated with high plasma XOR activity (≥ 1,000 pmol/hour/mL). Kaplan-Meier curve analysis indicated that the prognosis, including all-cause death within 30 days, was significantly poorer in high-XOR patients (XOR ≥ 6,670 pmol/hour/mL) than in the other patients.Plasma XOR activity was extremely high in patients with CPA, especially in OHCA. This would be associated with a high lactate value and expected to eventually lead to adverse outcome in patients with CPA.

    DOI: 10.1536/ihj.22-584

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  • Time-Dependent Changes in N-Terminal Pro-Brain Natriuretic Peptide and B-Type Natriuretic Peptide Ratio During Hospitalization for Acute Heart Failure.

    Tomofumi Sawatani, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Suguru Nishigoori, Nozomi Sasamoto, Kazutaka Kiuchi, Nobuaki Kobayashi, Wataru Shimizu, Kuniya Asai

    International heart journal   64 ( 2 )   213 - 222   2023

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    The time-dependent changes in the simultaneous evaluation of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels during hospitalization for acute heart failure (AHF) remain obscure.A total of 356 AHF patients were analyzed. Blood samples were collected within 15 minutes of admission (Day 1), 48-120 hours (Day 2-5) and between days 7 and 21 (Before-discharge). Plasma BNP and serum NT-proBNP were significantly decreased on Days 2-5 and Before-discharge in comparison to Day 1, but the NT-proBNP/BNP ratio was not changed. Patients were divided into 2 groups according to the median NT-proBNP/BNP (N/B) ratio on Day 2-5 (Low-N/B versus High-N/B). A multivariate logistic regression model showed that age (per 1-year increase), serum creatinine (per 1.0-mg/dL increase), and serum albumin (per 1.0-mg/dL decrease) were independently associated with High-N/B (odds ratio [OR]: 1.071, 95%confidence interval [CI]: 1.036-1.108, OR: 1.190, 95%CI: 1.121-1.264 and OR: 2.410, 95%CI: 1.121-5.155, respectively). Kaplan-Meier curve analysis showed that the High-N/B group had a significantly poorer prognosis than the Low-N/B group, and a multivariate Cox regression model revealed that High-N/B was an independent predictor of 365-day mortality (hazard ratio [HR]: 1.796, 95%CI: 1.041-3.100) and HF events (HR: 1.509, 95%CI: 1.007-2.263). The same trend in prognostic impact was significantly observed in both low and high delta-BNP cohorts (< 55% and ≥ 55% BNP value on the start date/BNP value at 2-5-days).A high NT-proBNP/BNP ratio on Day 2-5 was associated with non-cardiac conditions and was associated with adverse outcomes even if BNP was adequately decreased by the treatment of AHF.

    DOI: 10.1536/ihj.22-350

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  • Trends in Sudden Death Following Admission for Acute Heart Failure. International journal

    Suguru Nishigoori, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shighihara, Tomofumi Sawatani, Kazutaka Kiuchi, Nozomi Sasamoto, Nobuaki Kobayashi, Wataru Shimizu, Kuniya Asai

    The American journal of cardiology   178   89 - 96   2022.9

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    Few studies on sudden death (SD) after admission for acute heart failure (AHF) have been published. A total of 1,664 patients with AHF were enrolled in this study, and 1,261 patients who were successfully followed up during the first year after admission were analyzed. The primary end point was SD, which was defined as out-of-hospital cardiac arrest. The median follow-up period from admission was 1,008 days (range 408 to 2,132). In total, 505 patients (40.0%) died: 341 (67.5%) died of cardiovascular causes and 55 (10.9%) died of other causes. Of the 505 who died, 80 (15.8%) experienced SD. The proportion of SDs increased in the later phases of follow-up (0 to 1 year, 10.3%; 1 to 2 years, 18.0%; 2 to 5 years, 18.8%; ≥5 years, 28.2%; p &lt;0.001). A multivariate logistic regression model showed that younger age was independently associated with SD (60 to 69 years: odds ratio 2.249, 95% confidence interval 1.060 to 4.722; &lt;60 years: odds ratio 3.863, 95% confidence interval 1.676 to 8.905). Kaplan-Meier curves showed that the incidence of cardiovascular death was highest during the acute phase, whereas the incidence of SD increased gradually over the entire follow-up period. In conclusion, the incidence of SD was surprisingly high in patients with AHF, accounting for 16% of long-term mortality. The proportion of SDs increased during the very late follow-up phases.

    DOI: 10.1016/j.amjcard.2022.05.024

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  • Type III procollagen peptide level can indicate liver dysfunction associated with volume overload in acute heart failure. International journal

    Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Nozomi Sasamoto, Kazutaka Kiuchi, Masanori Atsukawa, Norio Itokawa, Taeang Arai, Nobuaki Kobayashi, Kuniya Asai

    ESC heart failure   9 ( 3 )   1832 - 1843   2022.6

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    AIM: The role of serum type III procollagen peptide (P3P) level in the acute phase of acute heart failure (AHF) requires clarification. We hypothesized that serum P3P level is temporarily higher during the acute phase, reflecting liver dysfunction due to congestion. METHODS AND RESULTS: A total of 800 AHF patients were screened, and data from 643 patients were analysed. Heart failure was diagnosed by the treating physician according to the European Society of Cardiology (ESC) guidelines, and included patients being treated with high-concentration oxygen inhalation (including mechanical support) for orthopnea, inotrope administration, or mechanical support for low blood pressure, and various types of diuretics for peripheral or pulmonary oedema. In all cases, diuretics or vasodilators were administered to treat AHF. The patients were divided into three groups according to their quartile (Q) serum P3P level: low-P3P (Q1, P3P ≤ 0.6 U/mL), mid-P3P (Q2/Q3, 0.6 < P3P <1.2 U/mL), and high-P3P (Q4, P3P ≥ 1.2 U/mL). The plasma volume status (PVS) was calculated using the following formula: ([actual PV - ideal PV]/ideal PV) × 100 (%). The primary endpoint was 365 day mortality. A Kaplan-Meier curve analysis showed that prognoses, including all-cause mortality and heart failure events within 365 days, were significantly (P < 0.001) worse in the high-P3P group when compared with the mid-P3P and low-P3P groups. A multivariate logistic regression analysis showed that high PVS (Q4, odds ratio [OR]: 4.702, 95% CI: 2.012-20.989, P < 0.001), high fibrosis-4 index (Q4, OR: 2.627, 95% CI: 1.311-5.261, P = 0.006), and low estimated glomerular filtration rate per 10 mL/min/1.73 m2 decrease (OR: 1.996, 95% CI: 1.718-2.326, P < 0.001) were associated with high P3P values. The Kaplan-Meier curve analysis demonstrated a significantly lower survival rate, as well as a higher rate of heart failure events, in the high-P3P and high-PVS groups when compared with the other groups. A multivariate Cox regression model identified high P3P level and high PVS as an independent predictor of 365 day all-cause mortality (hazard ratio [HR]: 2.249; 95% CI: 1.081-3.356; P = 0.026) and heart failure events (HR: 1.586, 95% CI: 1.005-2.503, P = 0.048). CONCLUSION: A high P3P level during the acute phase of AHF served as a comprehensive biomarker of liver dysfunction with volume overload (i.e. liver congestion) and renal dysfunction. A high P3P level at admission may be able to predict adverse outcomes in AHF patients.

    DOI: 10.1002/ehf2.13878

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  • Successful Treatment of Thrombocytopenia, Anasarca, Fever, Reticulin Myelofibrosis/Renal Insufficiency, and Organomegaly Syndrome Using Plasma Exchange Followed by Rituximab in the Intensive Care Unit. International journal

    Yusuke Otsuka, Akihiro Shirakabe, Toshio Asayama, Hirotake Okazaki, Yusaku Shibata, Shota Shigihara, Tomofumi Sawatani, Norio Yokose, Kuniya Asai

    Journal of medical cases   12 ( 12 )   474 - 480   2021.12

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    Thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly (TAFRO) syndrome is treated using corticosteroids and/or immunosuppressive agents as first-line therapy. We report the case of a 69-year-old female with TAFRO syndrome in which the patient presented multiple organ failure and steroid resistance, which was successfully treated using plasma exchange (PE) followed by rituximab. Decisions regarding the next treatment, including PE, are urgent for patients with steroid-resistant TAFRO syndrome. Since it is considered that immunosuppressive agents may be removed by PE, the performance of PE before treatment with immunosuppressive agents might be an option for steroid-resistant TAFRO syndrome.

    DOI: 10.14740/jmc3784

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  • Clinical Significance of Low-Triiodothyronine Syndrome in Patients Requiring Non-Surgical Intensive Care - Triiodothyronine Is a Comprehensive Prognostic Marker for Critical Patients With Cardiovascular Disease.

    Shota Shigihara, Akihiro Shirakabe, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Suguru Nishigoori, Tomofumi Sawatani, Fumitaka Okajima, Kuniya Asai, Wataru Shimizu

    Circulation reports   3 ( 10 )   578 - 588   2021.10

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    Background: Low-triiodothyronine (T3) syndrome is a known complication in intensive care unit (ICU) patients, but the underlying mechanisms and prognostic impact are unclear. Methods and Results: This study retrospectively enrolled 2,976 patients who required care in the ICU. Of these patients, 2,425 were euthyroid and were divided into normal (n=1,666; free T3 [FT3] ≥1.88 µIU/L) and low-FT3 (n=759; FT3 <1.88 µIU/L) groups. Multivariate logistic regression analysis revealed that prognostic nutritional index >46.03 (odds ratio [OR] 2.392; 95% confidence interval [CI] 1.904-3.005), age (per 1-year increase; OR 1.022; 95% CI 1.013-1.031), creatinine (per 0.1-mg/dL increase; OR 1.019; 95% CI 1.014-1.024), and C-reactive protein (per 1-mg/dL increase; OR 1.123; 95% CI 1.095-1.151) were independently associated with low FT3. Survival rates (within 365 days) were significantly lower in the low-FT3 group. A multivariate Cox regression model showed that low FT3 was an independent predictor of 365-day mortality (hazard ratio 1.785; 95% CI 1.387-2.297). Low-T3 syndrome was significantly more frequent in patients with non-cardiovascular than cardiovascular diseases (73.5% vs. 25.8%). Prognosis was significantly poorer in the low-FT3 than normal group for patients with cardiovascular disease, particularly those with acute coronary syndrome and acute heart failure. Conclusions: Low-T3 syndrome was associated with aging, inflammatory reaction, malnutrition, and renal insufficiency and could lead to adverse outcomes in patients admitted to a non-surgical ICU.

    DOI: 10.1253/circrep.CR-21-0040

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  • Clinical significance of the N-terminal pro-brain natriuretic peptide and B-type natriuretic peptide ratio in the acute phase of acute heart failure. International journal

    Tomofumi Sawatani, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Yusuke Otsuka, Kazutaka Kiuchi, Nobuaki Kobayashi, Noritake Hata, Wataru Shimizu, Kuniya Asai

    European heart journal. Acute cardiovascular care   10 ( 9 )   1016 - 1026   2021.8

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    AIMS: Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) levels are rarely evaluated simultaneously in the acute phase of acute heart failure (AHF). METHOD AND RESULTS: A total of 1207 AHF patients were enrolled, and 1002 patients were analysed. Blood samples were collected within 15 min of admission. Patients were divided into two groups according to the median value of the NT-proBNP/BNP ratio [low-NT-proBNP/BNP group (Group L) vs. high-NT-proBNP/BNP group (Group H)]. A multivariate logistic regression model showed that the C-reactive protein level (per 1-mg/dL increase), Controlling Nutrition Status score (per 1-point increase), and estimated glomerular filtration rate (eGFR, per 10-mL/min/1.73 m2 increase) were independently associated with Group H [odds ratio (OR) 1.049, 95% confidence interval (CI) 1.009-1.090, OR 1.219, 95% CI 1.140-1.304, and OR 1.543, 95% CI 1.401-1.698, respectively]. A Kaplan-Meier curve analysis showed that the prognosis was significantly poorer in Group H than in Group L, and a multivariate Cox regression model revealed Group H to be an independent predictor of 180-day mortality [hazard ratio (HR) 3.084, 95% CI 1.838-5.175] and HF events (HR 1.963, 95% CI 1.340-2.876). The same trend in the prognostic impact was significantly observed in the low-BNP (<810 pg/mL, n = 501), high-BNP (≥810 pg/mL, n = 501), and low-eGFR (<60 mL/min/1.73 m2, n = 765) cohorts, and tended to be observed in normal-eGFR (≥60 mL/min/1.73 m2, n = 237) cohort. CONCLUSION: A high NT-proBNP/BNP ratio was associated with a non-cardiac condition (e.g. inflammatory reaction, nutritional status, and renal dysfunction) and is independently associated with adverse outcomes in AHF.

    DOI: 10.1093/ehjacc/zuab068

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  • Clinical Significance of the Fibrosis-4 Index in Patients with Acute Heart Failure Requiring Intensive Care.

    Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Yusuke Otsuka, Masanori Atsukawa, Norio Itokawa, Taeang Arai, Nobuaki Kobayashi, Kuniya Asai, Wataru Shimizu

    International heart journal   62 ( 4 )   858 - 865   2021.7

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    The Fibrosis-4 (FIB4) index could indicate the liver fibrosis in patients with chronic hepatic diseases. It was calculated using the following formula: (age × aspartate aminotransferase [U/L]) / (platelet count [103/μL] × √alanine aminotransferase [U/L]). However, the clinical impact of the FIB4 index in the acute phase of acute heart failure (AHF) has not been sufficiently investigated.A total 1,468 AHF patients were analyzed. The median FIB4 index was 2.71 [1.85-4.22]. The patients were divided into three groups according to the quartiles of their FIB4 index (low-FIB4 [Q1, ≤ 1.847], middle-FIB4 [Q2/Q3, 1.848-4.216], and high-FIB4 [Q4, ≥ 4.216] groups). A Kaplan-Meier curve analysis showed that the prognosis, such as all-cause mortality and HF events within 365 days, was significantly poorer in the high-FIB4 group than in the middle-FIB4 and low-FIB4 groups. A multivariate Cox regression model identified high FIB4 index as an independent predictor of 365-day all-cause death (hazard ratio (HR): 1.660, 95% CI: 1.136-2.427) and HF events (HR: 1.505, 95% CI: 1.145-1.978). The multivariate logistic regression analysis showed that the high plasma volume status (PVS) (Q4, odds ratio [OR]: 2.099, 95% CI: 1.429-3.082), low systolic blood pressure (SBP) (< 100 mmHg, OR: 3.825, 95% CI: 2.504-5.840), and low left ventricular ejection fraction (< 40%, OR: 1.321, 95% CI: 1.002-1.741) were associated with a high FIB4 index.A high FIB4 index can predict adverse outcomes in AHF patients, which indicate that congestive liver and liver hypoperfusion occur due to low cardiac output in the acute phase of AHF.

    DOI: 10.1536/ihj.20-793

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  • The prognostic impact of the serum heart-type fatty acid-binding protein level in patients with sepsis who were admitted to the non-surgical intensive-care unit.

    Kenichi Tani, Akihiro Shirakabe, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Tomofumi Sawatani, Yusuke Otsuka, Tsutomu Takayasu, Miwako Asano, Akiko Nomura, Noritake Hata, Kuniya Asai, Wataru Shimizu

    Heart and vessels   36 ( 11 )   1765 - 1774   2021.5

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    Ongoing myocardial damage at the acme of the sepsis status has not been sufficiently evaluated. The clinical data of 160 sepsis patients who require intensive care and 127 outpatients with chronic heart failure (HF) were compared as a retrospective cohort study. Thereafter, the sepsis patients were divided into 3 groups according to the serum heart-type fatty acid-binding protein (H-FABP) quartiles [low H-FABP = Q1 (n = 39), middle H-FABP = Q2/Q3 (n = 81), and high H-FABP = Q4 group (n = 40)]. The H-FABP level was measured within 15 min of admission. The serum H-FABP levels in the sepsis patients [26.6 (9.3-79.0) ng/ml] were significantly higher than in the choric HF patients [6.6 (4.6-9.7) ng/ml]. A Kaplan-Meier curve showed that the survival rate of the high-H-FABP group was significantly lower than that of the middle- and low-H-FABP groups. The multivariate Cox regression analysis for the 365-day mortality showed that the high-H-FABP group (hazard ratio: 6.544, 95% confidence interval [CI] 2.026-21.140; p = 0.002) was an independent predictor of the 365-day mortality. The same trend in the prognostic impact was significantly (p = 0.015) observed in the cohort that had not been suffering from the cardiac disease before admission. The serum H-FABP level was an independent predictor of the 365-day mortality in the patients who were emergently hospitalized in the intensive-care unit due to sepsis. Ongoing myocardial damage was detected in the majority of patients with sepsis, suggesting that ongoing myocardial damage might be a candidate predictor of adverse outcomes in sepsis patients.

    DOI: 10.1007/s00380-021-01865-4

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  • Clinical Significance of the Low Triiodothyronine Syndrome in Patients Who Require Cardiovascular Intensive Care(和訳中)

    鴫原 祥太, 白壁 章宏, 岡崎 大武, 松下 誠人, 柴田 祐作, 西郡 卓, 澤谷 倫史, 大塚 悠介, 小林 宣明, 畑 典武, 浅井 邦也, 清水 渉

    日本循環器学会学術集会抄録集   85回   OJ31 - 2   2021.3

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  • 急性心不全の急性期におけるN末端プロ脳性ナトリウム利尿ペプチド/B型ナトリウム利尿ペプチド比の臨床的意義(Clinical Significance of N-terminal Pro-Brain Natriuretic Peptide and B-type Natriuretic Peptide Ratio at the Acute Phase of Acute Heart Failure)

    澤谷 倫史, 白壁 章宏, 岡崎 大武, 松下 誠人, 柴田 祐作, 鴫原 祥太, 西郡 卓, 大塚 悠介, 木内 一貴, 小林 宣明, 畑 典武, 浅井 邦也, 清水 渉

    日本循環器学会学術集会抄録集   85回   OJ55 - 6   2021.3

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  • 心臓血管集中治療を要する患者におけるlow Triiodothyronine syndromeの臨床的意義(Clinical Significance of the Low Triiodothyronine Syndrome in Patients Who Require Cardiovascular Intensive Care)

    鴫原 祥太, 白壁 章宏, 岡崎 大武, 松下 誠人, 柴田 祐作, 西郡 卓, 澤谷 倫史, 大塚 悠介, 小林 宣明, 畑 典武, 浅井 邦也, 清水 渉

    日本循環器学会学術集会抄録集   85回   OJ31 - 2   2021.3

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  • Time-dependent changes in plasma xanthine oxidoreductase during hospitalization of acute heart failure. International journal

    Hirotake Okazaki, Akihiro Shirakabe, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Tomofumi Sawatani, Kenichi Tani, Kazutaka Kiuchi, Yusuke Otsuka, Takayo Murase, Takashi Nakamura, Nobuaki Kobayashi, Noritake Hata, Kuniya Asai, Wataru Shimizu

    ESC heart failure   8 ( 1 )   595 - 604   2021.2

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    AIMS: The aim of present study is to evaluate the clinical significance of the time-dependent changes in xanthine oxidoreductase (XOR) activity during hospitalization for acute heart failure (AHF). METHODS AND RESULTS: A total of 229 AHF patients who visited to emergency room were prospectively enrolled, and 187 patients were analysed. Blood samples were collected within 15 min of admission (Day 1), after 48-72 h (Day 3), and between Days 7 and 21 (Day 14). The AHF patients were divided into two groups according to the XOR activity on Day 1: the high-XOR group (≥100 pmol/h/mL, n = 85) and the low-XOR group (<100 pmol/h/mL, n = 102). The high-XOR patients were assigned to two groups according to the rate of change in XOR from Day 1 to Day 14: the decreased group (≥50% decrease; n = 70) and the non-decreased group (<50% decrease; n = 15). The plasma XOR activity significantly decreased on Days 3 and 14 [23.6 (9.1 to 63.1) pmol/h/mL and 32.5 (10.2 to 87.8) pmol/h/mL, respectively] in comparison with Day 1 [78.5 (16.9 to 340.5) pmol/h/mL]. A Kaplan-Meier curve indicated that the prognosis, including heart failure (HF) events (all-cause death and readmission by HF) within 365 days, was significantly poorer in the low-XOR patients than in the high-XOR patients and was also significantly poorer in the non-decreased group than in the decreased group. CONCLUSIONS: The plasma XOR activity was rapidly decreased by the appropriate treatment of AHF. Although high-XOR activity on admission was not associated with increased HF events in AHF, high-XOR activity that was not sufficiently reduced during appropriate treatment was associated with increased HF events.

    DOI: 10.1002/ehf2.13129

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  • The Prognostic Impact of Hospital Transfer after Admission due to Acute Heart Failure.

    Kazutaka Kiuchi, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Suguru Nishigoori, Tomofumi Sawatani, Yusuke Otsuka, Hiroto Kokubun, Tomoyo Miyakuni, Nobuaki Kobayashi, Kuniya Asai, Wataru Shimizu

    International heart journal   62 ( 6 )   1310 - 1319   2021

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    The prognostic impact of transfer to another hospital among acute heart failure (AHF) patients has not been well elucidated.Of the 800 AHF patients analyzed, 682 patients were enrolled in this study for analysis. The subjects were divided into two groups according to their discharge location: discharge home (Group-H, n = 589) or transfer to another hospital for rehabilitation (Group-T, n = 93). The Kaplan-Meier curves revealed a poorer prognosis, including all-cause death and heart failure (HF) events (death, readmission-HF), in Group-T than that in Group-H (P < 0.001, respectively). A multivariate Cox regression model showed that Group-T was an independent predictor of 365-day all-cause death (hazard ratio: 2.618, 95% confidence interval [CI]: 1.510-4.538, P = 0.001). The multivariate logistic regression analysis showed that aging (per 1-year-old increase, odds ratio [OR]: 1.056, 95% CI: 1.028-1.085, P < 0.001), female gender (OR: 2.128, 95% CI: 1.287-3.521, P = 0.003), endotracheal intubation during hospitalization (OR: 2.074, 95% CI: 1.093-3.936, P = 0.026), and increased Controlling Nutritional Status score on admission (per 1.0-point increase, OR: 1.247, 95% CI: 1.131-1.475, P < 0.001) were associated with transfer to another hospital after AHF admission. The prognosis, including all-cause death, was determined to be significantly poorer in patients who were transferred to another hospital, as their activities of daily living were noted to lessen before discharge (n = 11) compared to others (n = 82).Elderly AHF patients suffering from malnutrition were difficult to discharge home after AHF admission, and transfer to another hospital only led to adverse outcomes. Appropriate rehabilitation during definitive hospitalization appears necessary for managing elderly patients in the HF pandemic era.

    DOI: 10.1536/ihj.21-126

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  • Importance of the Corrected Calcium Level in Patients With Acute Heart Failure Requiring Intensive Care.

    Akihiro Shirakabe, Kazutaka Kiuchi, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Shota Shigihara, Tomofumi Sawatani, Kenichi Tani, Yusuke Otsuka, Kuniya Asai, Wataru Shimizu

    Circulation reports   3 ( 1 )   44 - 54   2020.12

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    Background: Serum calcium (Ca) concentrations in the acute phase of acute heart failure (AHF) have not been not sufficiently investigated. Methods and Results: This study enrolled 1,291 AHF patients and divided them into 3 groups based on original and corrected Ca concentrations: (1) hypocalcemia (both original and corrected Ca ≤8.7 mg/dL; n=651); (2) pseudo-hypocalcemia (original and corrected Ca ≤8.7 and >8.7 mg/dL, respectively; n=300); and (3) normal/hypercalcemia (both original and corrected Ca >8.7 mg/dL; n=340). AHF patients were also divided into 2 groups based on corrected Ca concentrations: (1) corrected hypocalcemia (corrected Ca ≤8.7 mg/dL; n=651); and (2) corrected normal/hypercalcemia (corrected Ca >8.7 mg/dL; n=640). Of the 951 patients with original hypocalcemia (≤8.7 mg/dL), 300 (31.5%) were classified as corrected normal/hypercalcemia after correction of Ca concentrations by serum albumin. The prognoses in the pseudo-hypocalcemia, low albumin, and corrected normal/hypercalcemia groups, including all-cause death within 730 days, were significantly poorer than in the other groups. Multivariate Cox regression analysis showed that classification into the pseudo-hypocalcemia, hypoalbumin, and corrected normal/hypercalcemia groups independently predicted 730-day all-cause death (hazard ratios [95% confidence intervals] of 1.497 [1.153-1.943], 2.392 [1.664-3.437], and 1.294 [1.009-1.659], respectively). Conclusions: Corrected normal/hypercalcemia was an independent predictor of prognosis because this group included patients with pseudo-hypocalcemia, which was affected by the serum albumin concentration.

    DOI: 10.1253/circrep.CR-20-0068

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  • The prognostic impact of the uric acid level in patients who require cardiovascular intensive care - is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit? International journal

    Yusaku Shibata, Akihiro Shirakabe, Hirotake Okazaki, Masato Matsushita, Tomofumi Sawatani, Saori Uchiyama, Kenichi Tani, Nobuaki Kobayashi, Toshiaki Otsuka, Noritake Hata, Kuniya Asai, Wataru Shimizu

    European heart journal. Acute cardiovascular care   9 ( 6 )   636 - 648   2020.9

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    BACKGROUND: The prognostic impact of hyperuricemia and the factors that induce hyperuricemia in cardiovascular intensive care patients remain unclear. METHODS AND RESULTS: A total of 3257 emergency department patients were screened, and data for 2435 patients who were admitted to an intensive care unit were analyzed. The serum uric acid level was measured within 15 min of admission. The patients were assigned to a low-uric acid group (uric acid ⩽7.0 mg/dl, n=1595) or a high-uric acid group (uric acid >7.0 mg/dl, n=840) according to their uric acid level on admission. Thereafter, the patients were divided into four groups according to the quartiles of their serum uric acid level (Q1, Q2, Q3 and Q4), and uric acid levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. A Kaplan-Meier curve showed a significantly lower 365-day survival rate in a high-uric acid group than in a low-uric acid group, and in Q3 than in Q1 or Q2 and in Q4 than in the other groups. The multivariate logistic regression model for 30-day mortality identified Q4 (odds ratio: 1.856, 95% confidence interval (CI) 1.140-3.022; p=0.013) as an independent predictor of 30-day mortality. The area under the receiver-operating characteristic curve values of the serum uric acid level and APACHE II score for the prediction of 30-day mortality were 0.648 and 0.800, respectively. The category-free net reclassification improvement and integrated discrimination improvement showed that the calculated risk shifted to the correct direction by adding the serum uric acid level to the APACHE II score (0.204, 95% CI 0.065-0.344; p=0.004, and 0.015, 95% CI 0.005-0.025; p=0.004, respectively). The prognosis, including the 365-day mortality, among patients with a high uric acid level and a high APACHE II score was significantly poorer in comparison with other patients. CONCLUSION: The serum uric acid level, which might be elevated by the various critical stimuli on admission, was an independent predictor in patients who were emergently hospitalized in the intensive care unit. The serum uric acid level is therefore useful as a surrogate biomarker for critical patients in the intensive care unit.

    DOI: 10.1177/2048872618822473

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  • Plasma xanthine oxidoreductase activity in patients with decompensated acute heart failure requiring intensive care. International journal

    Hirotake Okazaki, Akihiro Shirakabe, Masato Matsushita, Yusaku Shibata, Tomofumi Sawatani, Saori Uchiyama, Kennichi Tani, Takayo Murase, Takashi Nakamura, Tsutomu Takayasu, Miwako Asano, Nobuaki Kobayashi, Noritake Hata, Kuniya Asai, Wataru Shimizu

    ESC heart failure   6 ( 2 )   336 - 343   2019.4

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    AIMS: Plasma xanthine oxidoreductase (XOR) activity during the acute phase of acute heart failure (AHF) requires further elucidation. METHODS AND RESULTS: One hundred eighteen AHF patients and 231 control patients who attended a cardiovascular outpatient clinic were prospectively analysed. Blood samples were collected within 15 min of admission from AHF patients (AHF group) and control patients who visited a daily cardiovascular outpatient clinic (control group). Plasma XOR activity was compared between the two groups, and factors independently associated with extremely elevated XOR activity were identified using a multivariate logistic regression model. Plasma XOR activity in the AHF group (median, 104.0 pmol/h/mL; range, 25.9-423.5 pmol/h/mL) was significantly higher than that in the control group (median, 45.2 pmol/h/mL; range, 19.3-98.8 pmol/h/mL). The multivariate logistic regression model showed that serum uric acid (per 1.0 mg/dL increase, odds ratio: 1.280; 95% confidence interval: 1.066-1.536; P = 0.008) and lactate levels (per 1.0 mmol/L increase, odds ratio: 1.239; 95% confidence interval: 1.040-1.475; P = 0.016) were independently associated with high plasma XOR activity (>300 pg/h/mL) during the acute phase of AHF. CONCLUSIONS: Plasma XOR activity was extremely high in patients with severely decompensated AHF. This would be associated with a high lactate value and would eventually lead to hyperuricaemia in patients with AHF.

    DOI: 10.1002/ehf2.12390

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  • Worsening renal failure in patients with acute heart failure: the importance of cardiac biomarkers. International journal

    Akihiro Shirakabe, Noritake Hata, Nobuaki Kobayashi, Hirotake Okazaki, Masato Matsushita, Yusaku Shibata, Saori Uchiyama, Tomofumi Sawatani, Kuniya Asai, Wataru Shimizu

    ESC heart failure   6 ( 2 )   416 - 427   2019.4

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    AIMS: The importance of true worsening renal failure (WRF), which is associated with a poor prognosis, had been suggested in patients with acute heart failure (AHF). The aim of the present study was to establish the biomarker strategy for the prediction of true WRF in AHF. METHODS AND RESULTS: Two hundred eighty-one patients with AHF were analysed. Their biomarkers were measured within 30 min of admission. Patients were assigned to the non-WRF (n = 168), pseudo-WRF (n = 56), or true-WRF (n = 57) groups using the criteria of both acute kidney injury on admission and increasing serum creatinine value during the first 7 days. A Kaplan-Meier curve showed that the survival and heart failure event rate of the true-WRF group within 1000 days was significantly lower than that of the non-WRF and pseudo-WRF groups (P ≤ 0.001). The multivariate Cox regression model also indicated that true WRF was an independent predictor of 1000 day mortality and heart failure events [hazard ratio: 4.315, 95% confidence interval (CI): 2.466-7.550, P ≤ 0.001, and hazard ratio: 2.834, 95% CI: 1.893-4.243, P ≤ 0.001, respectively]. The serum heart-type fatty acid-binding protein (s-HFABP) levels were significantly higher in the true-WRF group than in the non-WRF and pseudo-WRF groups (P ≤ 0.001). The multivariate logistic regression model indicated that the predictive biomarker for the true-WRF group was the s-HFABP level (odds ratio: 5.472, 95% CI: 2.729-10.972, P ≤ 0.001). The sensitivity and specificity for indicating the presence of true WRF were 73.7% and 76.8% (area under the curve = 0.831) for s-HFABP in whole patients, respectively, and 94.7% and 72.7% (area under the curve = 0.904) in non-chronic kidney disease (CKD) patients, respectively. CONCLUSIONS: Cardiac biomarkers, especially the s-HFABP, might predict the development of true WRF in AHF patients. Furthermore, the predictive value was higher in AHF patients without CKD than in those with CKD.

    DOI: 10.1002/ehf2.12414

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  • Feasibility and safety of non-occlusive coronary angioscopic observation using a 4 Fr guiding catheter. International journal

    Masato Matsushita, Masamichi Takano, Ryo Munakata, Tomofumi Sawatani, Osamu Kurihara, Hidenori Komiyama, Daisuke Murakami, Akihiro Shirakabe, Nobuaki Kobayashi, Noritake Hata, Yasushi Miyauchi, Yoshihiko Seino, Wataru Shimizu

    AsiaIntervention   4 ( 2 )   110 - 116   2018.9

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    AIMS: Coronary angioscopy (CAS) is a robust imaging methodology for evaluation of vascular healing response after stenting. However, the procedure requires a guiding catheter with a diameter of more than 6 Fr, which is rather invasive at follow-up angiography. Recently, coronary angioscopes of a smaller diameter have been able to pass through a 4 Fr guiding catheter. This study aimed to investigate the feasibility and safety of slender CAS observation using a 4 Fr guiding catheter. METHODS AND RESULTS: Thirty-three consecutive patients who underwent follow-up angiography were evaluated. Following usual angiography via the radial artery, the stent segment was observed by non-occlusive CAS through a 4 Fr guiding catheter. Low molecular weight dextran-L (4 mL/sec) was flushed from a guiding catheter to replace coronary blood. The success rate, anatomical or procedural factors related to the success, and incidence of adverse events were examined. The success rate was 84.8% (n=28/33). The luminal diameter at the orifice of the target vessel was larger in the successful than in the failed group (4.03±0.61 mm vs. 3.39±0.61 mm, respectively; p=0.009). The presence of deep engagement of the guiding catheter into the target vessel was a key factor for sufficient observation (100% in the successful group vs. 0% in the failed group; p<0.0001). No adverse events, such as dissection or acute coronary syndrome, were reported. CONCLUSIONS: The new method of CAS through a 4 Fr guiding catheter demonstrated high feasibility and safety. This less invasive observation via CAS may be useful for stent follow-up.

    DOI: 10.4244/AIJ-D-18-00003

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  • 第2世代エベロリムス溶出ステントにおける新規動脈硬化による超遅発性ステント再狭窄(Very Late In-stent Restenosis due to Neoatherosclerosis in the Second-generation Everolimus-eluting Stent)

    Komiyama Hidenori, Takano Masamichi, Sawatani Tomofumi, Shibata Yusaku, Matsushita Masato, Kurihara Osamu, Kato Katsuhito, Munakata Ryo, Murakami Daisuke, Hata Noritake, Seino Yoshihiko, Mizuno Kyoichi, Shimizu Wataru

    心臓血管内視鏡   2 ( 1 )   25 - 28   2016.12

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    症例は85歳女性で、脂質異常症、高血圧症、慢性腎臓病に罹患しており、労作時胸痛を訴え当院に入院となった。患者は2年前に安定狭心症のためステント植込み術を行っており、左前下行枝中部の責任病変をコバルトクロムエベロリムス溶出ステントで治療していた。冠状動脈造影でステント遠位部にステント内再狭窄が認められた。冠動脈内視鏡検査では、再狭窄病変の黄色プラークがステントを完全に覆っているのが確認された。そのため、non-slip element balloonによる治療を行い、stent-in-stentを避けるため薬剤被覆バルーンによる補助的血管形成術を施行した。胸痛は完全に消失し、臨床経過は良好であった。

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    Other Link: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J06603&link_issn=&doc_id=20170619250005&doc_link_id=10.15791%2Fangioscopy.cr.16.0009&url=https%3A%2F%2Fdoi.org%2F10.15791%2Fangioscopy.cr.16.0009&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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    <文献概要>70歳,男性。既往に糖尿病性腎臓病があった。左手の冷感と疼痛が出現し,精査加療のため当院循環器内科に入院した。左手指尖に潰瘍と暗紫色斑が出現し,外用加療するも,示指〜環指の壊死が進行した。その後疼痛が強く,手指を切断した。皮膚症状はさらに悪化し,足趾・陰茎部壊死,陰嚢部潰瘍も出現した。切断部位の病理,Ca・P積高値,X線で血管石灰化が著明であり,カルシフィラキシスと診断した。チオ硫酸ナトリウム投与,透析導入となったが,全身状態が悪化し死亡した。自験例ではカルシフィラキシスに陰茎壊死を伴っていた。本疾患の認知度は高くなく,臨床診断に苦慮すると考えられる。現在有効な治療法は確立されていない。カルシフィラキシスの一症状として,陰茎壊死がおこりうることを認識し,疑わしい症例では積極的に本症を考える必要がある。今後疾患の認知度の上昇を期待したい。

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