Goal-Oriented Therapy Evaluated By Cardiopulmonary Exercise Testing For Pulmonary Arterial Hypertension

• Project/Area Number: 15K09074
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: National Center for Geriatrics and Gerontology (2016-2018); Nagoya University (2015)
• Principal Investigator: HIRASHIKI Akihiro 国立研究開発法人国立長寿医療研究センター, 病院, 医長 (10418741)
• Co-Investigator(Kenkyū-buntansha): 近藤 隆久 名古屋大学, 医学系研究科, 寄附講座教授 (00303644) ; 竹下 享典 埼玉医科大学, 医学部, 准教授 (70444403)
• Project Period (FY): 2015-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000); Fiscal Year 2017: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2016: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2015: ¥3,380,000 (Direct Cost: ¥2,600,000、Indirect Cost: ¥780,000)
• Keywords: 肺高血圧 / 運動耐容能 / 心肺運動負荷試験 / Quality of Life / 併用療法 / 右心不全 / 右心機能 / 肺動脈性肺高血圧症

Outline of Final Research Achievements

For pulmonary arterial hypertension which is intractable disease, therapeutic effect is carried out mainly by repeating non-invasive testing method, the severity and presence of side effects are confirmed, and it is appropriate combination treatment for individual. The treatment results of sequential additional combination therapy, which provides excellent treatment, could be presented in comparison with conventional empiric treatments. It has been shown that such treatment strategies can improve the quality of life, exercise capacity, and prognosis.

Academic Significance and Societal Importance of the Research Achievements

本研究成果の学術的意義は、心肺運動負荷試験を定期的に行うことにより、心肺予備能、治療効果判定が可能となり、心臓カテーテル検査を施行せずとも、治療効果が十分かを評価しながら治療を進めていけることを示したことである。
肺高血圧症は希少疾病の難病かつ様々な病態があり、無治療であれば進行性の致死的な疾患である。また肺高血圧特異的治療薬は非常に高額でもある。社会的意義として、本治療戦略を用いることにより、不要に高額な治療を重ねずに、一方で治療不十分な患者を選別して適切な肺高血圧特異的治療薬の併用治療を行うことができる。患者のQOL、予後の改善のみならず、医療費の削減にも貢献できる。

Research Products

• [Journal Article] Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension (2018)
  • Author(s): Kamimura Y, Okumura N, Adachi S, Shimokata S, Tajima F, Nakano Y, Hirashiki A, Murohara T, Kondo T . i:
  • Journal Title: Heart Vessels. Volume: 33 Issue: 10 Pages: 1220-1228
  • DOI: 10.1007/s00380-018-1168-7
  • Peer Reviewed / Open Access
• [Journal Article] Abnormal Circadian Blood Pressure Profile as a Prognostic Marker in Patients with Nonischemic Dilated Cardiomyopathy (2017)
  • Author(s): Sawamura A, Okumura T, Takeshita K, Watanabe N, Kano N, Mori H, Fukaya K, Morimoto R, Hirashiki A, Bando YK, Murohara T..
  • Journal Title: Cardiology Volume: 136 Issue: 1 Pages: 1-9
  • DOI: 10.1159/000446868
  • NAID: 120005981219
  • Peer Reviewed / Open Access
• [Journal Article] Biphasic Force-Frequency Relation Predicts Primary Cardiac Events in Patients With Hypertrophic Cardiomyopath (2017)
  • Author(s): Morimoto R, Okumura T, Bando YK, Fukaya K, Sawamura A, Kawase H, Shimizu S, Shimazu S, Hirashiki A, Takeshita K, Murohara T
  • Journal Title: Circ J Volume: 81 Pages: 368-375
  • Peer Reviewed / Open Access
• [Journal Article] Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy (2017)
  • Author(s): Morimoto R, Okumura T, Hirashiki A, Ishii H, Ichii T, Aoki S, Furusawa K, Hiraiwa H, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Takeshita K, Bando YK, Murohara T.
  • Journal Title: J Cardiol Volume: 70 Issue: 4 Pages: 303-309
  • DOI: 10.1016/j.jjcc.2017.02.005
  • Peer Reviewed / Open Access
• [Journal Article] Circulatory power and ventilatory power over time under goal-oriented sequential combination therapy for pulmonary arterial hypertension (2017)
  • Author(s): Hirashiki A, Adachi S, Nakano Y, Kamimura Y, Shimokata S, Takeshita K, Shimizu A, Toba K, Murohara T, Kondo T
  • Journal Title: Pulm Circ Volume: 7 Issue: 2 Pages: 448-454
  • DOI: 10.1177/2045893217703954
  • Peer Reviewed / Open Access
• [Journal Article] Repeated Assessment of Exercise Capacity under Goal-Oriented Sequential Combination Therapy for Pulmonary Arterial Hypertension. (2017)
  • Author(s): Hirashiki A, Shimizu A, Toba K, Murohara T and Kondo T.
  • Journal Title: J Card Pulm Rehabil Volume: 2017 Pages: 103-103
  • Peer Reviewed / Open Access
• [Journal Article] Left main coronary artery compression by a dilated main pulmonary artery and left coronary sinus of Valsalva aneurysm in a patient with heritable pulmonary arterial hypertension and FLNA mutation. (2017)
  • Author(s): Hirashiki A, Adachi S, Nakano Y, Kamimura Y, Ogo T, Nakanishi N, Morisaki T, Morisaki H, Shimizu A, Toba K, Murohara T, Kondo T
  • Journal Title: Pulm Circ Volume: 7 Issue: 3 Pages: 734-740
  • DOI: 10.1177/2045893217716107
  • Peer Reviewed / Open Access
• [Journal Article] Biphasic Force-Frequency Relation Predicts Primary Cardiac Events in Patients With Hypertrophic Cardiomyopathy (2017)
  • Author(s): Morimoto R, Okumura T, Bando YK, Fukaya K, Sawamura A, Kawase H, Shimizu S, Shimazu S, Hirashiki A, Takeshita K, Murohara T
  • Journal Title: Circulation Journal Volume: 81 Issue: 3 Pages: 368-375
  • DOI: 10.1253/circj.CJ-16-1007
  • NAID: 130005243014
  • ISSN: 1346-9843, 1347-4820
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Circulatory power and ventilatory power over time under goal-oriented sequential combination therapy for pulmonary arterial hypertension (2017)
  • Author(s): Hirashiki A, Adachi S, Nakano Y, Kamimura Y, Shimokata S, Takeshita K, Murohara T, and Kondo T.
  • Journal Title: Pulm Circ Volume: －
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Cardiopulmonary Exercise Testing as a Tool for Diagnosing Pulmonary Hypertension in Patients with Dilated Cardiomyopathy. (2016)
  • Author(s): Hirashiki A, Kondo T, Okumura T, Kamimura Y, Nakano Y, Fukaya K, Sawamura A, Morimoto R, Adachi S, Takeshita K, Murohara T.
  • Journal Title: Ann Noninvasive Electrocardiol. Volume: - Issue: 3 Pages: 263-271
  • DOI: 10.1111/anec.12308
  • Peer Reviewed / Open Access
• [Journal Article] Effects of bosentan on peripheral endothelial function in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. (2016)
  • Author(s): Hirashiki A, Adachi S, Nakano Y, Kamimura Y, Shimokata S, Takeshita K, Murohara T, Kondo T.
  • Journal Title: Pulm Circ Volume: 6 Issue: 2 Pages: 168-173
  • DOI: 10.1086/685715
  • Peer Reviewed / Open Access
• [Journal Article] Endomyocardial radial strain rate imaging during dobutamine stress echocardiography for the evaluation of contractile reserve in patients with dilated cardiomyopathy (2016)
  • Author(s): Minoshima M, Noda A, Kobayashi M, Miyata S, Hirashiki A, Okumura T, Izawa H, Ishii H, Kondo T, Murohara T.
  • Journal Title: J Clin Ultrasound Volume: 44 Issue: 9 Pages: 555-560
  • DOI: 10.1002/jcu.22376
  • Peer Reviewed / Open Access
• [Journal Article] Ortner's syndrome caused by pulmonary arterial hypertension associated with mixed connective tissue disease. (2016)
  • Author(s): Ogawa-Momohara M, Muro Y, Hirashiki A, Fujimoto Y, Kondo T, Akiyama M
  • Journal Title: Clin Exp Rheumatol Volume: 34 Pages: 1125-1125
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Magnetic resonance imaging of cardiac sarcoidosis : an evaluation of the cardiac segments and layers that exhibit late gadolinium enhancement (2016)
  • Author(s): Tomohiro Komada, Kojiro Suzuki, Hiroaki Ishiguchim Hisashi Kawai, Takahiro Okumura, Akihiro Hirashikim, Shinji Naganawa
  • Journal Title: Nagoya Journal of Medical Science Volume: 78 Issue: 4 Pages: 437-446
  • DOI: 10.18999/nagjms.78.4.437
  • NAID: 120005889981
  • ISSN: 2186-3326
  • URL: https://nagoya.repo.nii.ac.jp/records/22944
  • Peer Reviewed / Open Access
• [Journal Article] 肺動脈性肺高血圧症におけるエンドセリン受容体拮抗薬による治療初期の変化 －生活の質と運動耐容能との関連－ (2016)
  • Author(s): 安川悠仁，平敷安希博，服部慶子，鈴木謙太郎，清水美帆，小林聖典，上村佳大，中野嘉久，足立史郎，奥村貴裕，近藤隆久，山田純生，室原豊明.
  • Journal Title: 心臓リハビリテーション(JJCR) Volume: 21(1,2,3) Pages: 42-46
  • NAID: 40021135317
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] 肺動脈性肺高血圧症における運動耐容能に基づく積極的併用療法の検討. (2016)
  • Author(s): 平敷安希博，近藤隆久，清水美帆，小林聖典，上村佳大，中野嘉久，足立四郎，奥村貴裕，山田純生，室原豊明.
  • Journal Title: 心臓リハビリテーション(JJCR). Volume: 21(4) Pages: 170-173
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] 肺高血圧症における非侵襲的検査の有用性 －CPXを中心に－. (2016)
  • Author(s): 平敷安希博，近藤隆久，足立四郎，奥村貴裕，山田純生，室原豊明.
  • Journal Title: 日本臨床生理学会雑誌 Volume: 46(2) Pages: 63-67
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] 心不全に対するループ利尿薬の静脈内投与―持続投与がよいとの立場から vs 間歇的ボーラス投与がよいとの立場から. 持続投与がよいとの立場から (2016)
  • Author(s): 平敷安希博.
  • Journal Title: Fluid Management Renaissance. Volume: 6(4) Pages: 80-82
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] フレイルと循環器疾患. (2016)
  • Author(s): 平敷安希博，清水敦哉，荒井秀典.
  • Journal Title: 循環器内科 Volume: 80(5) Pages: 386-390
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] Effects of bosentan on peripheral endothelial function in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. (2016)
  • Author(s): Hirashiki A, Adachi S, Nakano Y, Kamimura Y, Shimokata S, Takeshita K, Murohara T, and Kondo T.
  • Journal Title: Pulm Circ Volume: 印刷中
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] The Roles of Classic and Current Prognostic Factors in Pulmonary Hypertension Due to Left Heart Disease (2016)
  • Author(s): Hirashiki A, Kondo T, Murohara T.
  • Journal Title: Circulation Journal Volume: 80 Issue: 1 Pages: 72-73
  • DOI: 10.1253/circj.CJ-15-1241
  • NAID: 130005117013
  • ISSN: 1346-9843, 1347-4820
  • Peer Reviewed / Open Access
• [Journal Article] Impact of preoperative regular physical activity on postoperative course after open abdominal aortic aneurysm surgery. (2016)
  • Author(s): 49.Hayashi K, Hirashiki A, Kodama A, Kobayashi K, Yasukawa Y, Shimizu M, Kondo T, Komori K, Murohara T
  • Journal Title: Heart Vessels. Volume: 31 Issue: 4 Pages: 578-83
  • DOI: 10.1007/s00380-015-0644-6
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Assessment of respiratory disturbance index determined with a non-restrictive monitor and of autonomic nervous system parameters in heart failure patients: A pilot study. (2015)
  • Author(s): Shimazu S, Hirashiki A, Kamimura Y, Nakano Y, Adachi S, Kondo T, Murohara T.
  • Journal Title: J Cardiol. Volume: 1 Issue: 3 Pages: 218-23
  • DOI: 10.1016/j.jjcc.2014.12.018
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Presentation] フレイルを合併した高齢心不全患者のStage分類による栄養状態と抑うつについての検討 (2019)
  • Author(s): 飯塚祐美子、平敷安希博、橋本 駿、佐竹 昭介、服部 加世子、石河 貴大 、冨田 沙希 、若松 俊孝 、清水 敦哉、志水 正明
  • Organizer: 第22回日本病態栄養学会年次学術集会
• [Presentation] フレイル合併高齢心不全患者におけるCPX の意義 (2018)
  • Author(s): 平敷 安希博、野本 憲一郎、橋本 駿、佐藤 健二、伊藤 直樹、小久保 学、清水 敦哉
  • Organizer: 第24回 日本心臓リハビリテーション学会学術集会
• [Presentation] ロボットによるバランス練習機器を用いた心臓リハビリテーションの試み (2018)
  • Author(s): 平敷安希博
  • Organizer: 第66回日本心臓病学会学術集会
• [Presentation] 高齢心不全患者におけるフレイル評価と心肺運動負荷試験 (2018)
  • Author(s): 平敷安希博 川島一博 野本憲一郎 小久保学 清水敦也
  • Organizer: 第66回日本心臓病学会学術集会
• [Presentation] 高齢心不全患者における心肺運動負荷試験によるフレイルの検出 (2018)
  • Author(s): 平敷安希博 川島一博 野本憲一郎 小久保学 清水敦也
  • Organizer: 第22回 日本心不全学会学術集会
• [Presentation] 高齢心不全患者の生活活動に関連する因子の検討 (2018)
  • Author(s): 橋本駿, 平敷安希博, 谷奥俊也, 西崎成紀, 小原伊都子, 相本啓太, 川村皓生, 植田郁恵, 伊藤直樹, 松尾 宏, 清水敦也, 近藤和泉
  • Organizer: 第22回 日本心不全学会学術集会
• [Presentation] 心不全の治療と終末期ケア (2017)
  • Author(s): 平敷安希博
  • Organizer: 第59回 日本老年医学会学術集会
  • Invited
• [Presentation] 心不全の心臓リハビリテーション標準プログラム (2017)
  • Author(s): 平敷安希博
  • Organizer: 第23回 日本心臓リハビリテーション学会学術集会
  • Invited
• [Presentation] 呼気ガス分析併用運動負荷試験からみた肺高血圧リハビリテーション (2017)
  • Author(s): 平敷安希博、近藤隆久、室原豊明
  • Organizer: 第65回日本心臓病学会学術集会
  • Invited
• [Presentation] Hirashiki A, Kondo T, Shimizu A, Murohara T. Impact of exercise capacity for right and left heart failure. INTERNATIONAL ACADEMY OF CARDIOLOGY ANNUAL SCIENTIFIC SESSIONS (2016)
  • Author(s): Hirashiki A, Kondo T, Shimizu A, Murohara T
  • Organizer: 21st WORLD CONGRESS ON HEART DISEASE.
  • Place of Presentation: ボストン
  • Year and Date: 2016-08-01
  • Int'l Joint Research / Invited
• [Presentation] Six-mimute walk distance and cardiopulmonary exercise testing in patients with pulmonary artery hypertension: Similarities and Differences (2016)
  • Author(s): Kamimura Y, Nakano Y, Shimokata S, Adachi S, Okumura T, Takeshita K, Hirashiki A, Murohara T, Kondo T. .
  • Organizer: 第80 回日本循環器学会学術集会
  • Place of Presentation: 宮城県仙台市 仙台国際センター
  • Year and Date: 2016-03-20
• [Presentation] H ealth-care quality of life over time during sequential combination therapy in pulmonary arterial hypertension. (2016)
  • Author(s): Hirashiki A, Shimokata S, Kamimura Y, Nakano Y, Adachi S, Okumura T, Takeshita K, Murohara T, Kondo T.
  • Organizer: 第80 回日本循環器学会学術集会
  • Place of Presentation: 宮城県仙台市 仙台国際センター
  • Year and Date: 2016-03-20
• [Presentation] Circulatory power and exercise ventilatory power during exercise over time during sequential combination therapy in pulmonary arterial hypertension (2016)
  • Author(s): Hirashiki A, Shimokata S, Kamimura Y, Nakano Y, Adachi S, Okumura T, Takeshita K, Murohara T, Kondo T.
  • Organizer: 第80 回日本循環器学会学術集会
  • Place of Presentation: 宮城県仙台市 仙台国際センター
  • Year and Date: 2016-03-20
• [Presentation] ボセンタンによる末梢血管内皮機能の効果 -肺動脈性肺高血圧症と慢性血栓塞栓性肺高血圧症での比較-. (2015)
  • Author(s): 平敷安希博, 近藤隆久, 下方茂毅, 上村佳大, 中野嘉久, 足立史郎, 室原豊明.
  • Organizer: 第23回日本血管生物医学会学術集会
  • Place of Presentation: 兵庫県神戸市 神戸国際会議場
  • Year and Date: 2015-12-10
• [Presentation] シンポジウム１：肺高血圧領域における近年の治療の進歩と今後の展望」 肺高血圧症における非侵襲的検査の有用性 ーCPXを中心にー (2015)
  • Author(s): 平敷安希博，近藤隆久，室原豊明.
  • Organizer: 第52回日本臨床生理学会総会
  • Place of Presentation: 埼玉県大宮市 大宮ソニックシティ
  • Year and Date: 2015-10-31
  • Invited
• [Presentation] 門脈圧亢進症性肺高血圧症におけるボセンタンの安全性と効果 (2015)
  • Author(s): 平敷安希博，近藤隆久，下方茂毅， 上村佳大， 中野嘉久， 足立史郎， 室原豊明.
  • Organizer: 第3回日本肺高血圧学会（JPHS）第4回日本肺循環学会（JPCS）合同学術集会
  • Place of Presentation: 東京都千代田区 ステーションコンファレンス東京
  • Year and Date: 2015-10-03
• [Presentation] Circulatory power and exercise ventilatory power during exercise over time during sequential combination therapy in pulmonary arterial hypertension. (2015)
  • Author(s): Hirashiki A, Shimokata S., Kamimura Y, Nakano Y, Adachi S, Okumura T, Takeshita K, T Murohara, Kondo T.
  • Organizer: ESC congress
  • Place of Presentation: London イギリス ExCeL London
  • Year and Date: 2015-09-01
  • Int'l Joint Research
• [Presentation] Circulatory power and exercise ventilatory power during exercise over time during sequential combination therapy in pulmonary arterial hypertension (2015)
  • Author(s): Hirashiki A, Shimokata S., Kamimura Y, Nakano Y, Adachi S, Okumura T, Takeshita K, T Murohara, Kondo T
  • Organizer: ESC congress
  • Place of Presentation: London イギリス ExCeL London
  • Year and Date: 2015-09-01
  • Int'l Joint Research
• [Presentation] 肺動脈性肺高血圧症における運動耐容能に基づく積極的併用療法の検討. (2015)
  • Author(s): 平敷安希博 近藤隆久 奥村貴裕 清水美帆 小林聖典 室原豊明.
  • Organizer: 第21回心臓リハビリテーション学会学術集会
  • Place of Presentation: 福岡県福岡市 福岡国際会議場
  • Year and Date: 2015-07-19
  • Invited
• [Book] 心不全患者に寄り添う 包括的心臓リハビリテーションを極める 心不全に対する心臓リハビリテーションのエビデンス (2016)
  • Author(s): 平敷安希博，室原豊明
  • Total Pages: 7
  • Publisher: 文行堂
• [Book] 心不全患者に寄り添う 包括的心臓リハビリテーションを極める (2016)
  • Author(s): 平敷安希博，室原豊明
  • Total Pages: 160
  • Publisher: 文行堂