慢性心不全患者の非代償性心不全による再入院を予測するための臨床的評価指標の確立

2017 Fiscal Year Research-status Report

• Project/Area Number: 16K01479
• Research Institution: Toyohashi Sozo University
• Principal Investigator: 田畑 稔 豊橋創造大学, 保健医療学部, 准教授 (30508859)
• Co-Investigator(Kenkyū-buntansha): 増田 卓 北里大学, 医療衛生学部, 教授 (30165716) ; 加藤 倫卓 常葉大学, 健康科学部, 講師 (80737354)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: 慢性心不全 / 再入院 / 臨床評価指標 / 身体運動機能 / 予後予測 / 心臓リハビリテーション

Outline of Annual Research Achievements

慢性心不全患者における心不全増悪を予測する要因を心不全患者の身体運動機能の観点より検討している研究は極めて少なく、現状においても慢性心不全患者の身体運動機能から慢性心不全増悪を予測するができるの否かについては不十分である。本研究は、慢性心不全の急性増悪により入院した慢性心不全患者の入院中に計測した身体運動機能を臨床評価指標として、心不全増悪を予測するし得ることができれば、慢性心不全患者の再入院予防を入院中に慢性心不全患者の再入院リスクを層別化することができる。このため、慢性心不全の急性増悪入院した患者の入院時および退院時の握力や下肢筋力、歩行速度、運動耐容能、呼吸機能等の身体運動機能と心機能や諸検査データによる臨床評価指標を考慮した上で、慢性心不全患者が退院後２～３年間、慢性心不全による再入院の有無を調査した。この他、急性増悪入院した慢性心不全患者に対する経皮的電気刺激やストレッチの効果について検証を行い、一定の効果を認めることができた。一方、慢性心不全患者の身体運動機能と密接な関わりがある身体的フレイルについて、適切な評価方法についてトライアルを実施した。歩行速度や運動耐容能の評価指標である6分間歩行距離は、高齢心不全患者の予後を予測する強力な臨床評価指標であることを論文発表し、呼吸機能の指標である呼吸筋力も慢性心不全患者の予後を予測する強力な臨床評価指標であることを国際学会で発表を行った。

Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

2017年は、慢性心不全患者の呼吸筋力が再入院を規定する臨床評価指標であることをヨーロッパ心臓病学会にてモデレートポスター発表し、慢性心不全患者の入院中の快適歩行速度の変化量が一定量を超えると再入院リスクが減少することをアメリカ心臓病学会にてポスター発表を行い、慢性心不全患者の歩行速度や6分間歩行距離が慢性心不全の急性増悪を予測する臨床評価指標であることをEuropean Journal of Preventive Cardiology. 25(2)へ論文掲載した。

Strategy for Future Research Activity

2017年に学会報告した研究について、論文化して投稿を行う予定である。

Causes of Carryover

当初の予定よりも早めに目標とする対象患者数のデータを収集することができたため、次年度は、研究成果を国内、国際学会へ発表し、論文投稿へ使用額を振り分ける予定である。

Research Products

• [Journal Article] SARC-F questionnaire identifies physical limitations and predicts post discharge outcomes in elderly patients with cardiovascular disease. (2018)
  • Author(s): Shinya Tanaka, Kentaro Kamiya, Nobuaki Hamazaki, Ryota Matsuzawa, Kohei Nozaki, Ichinosawa Y, Harada M, Nakamura T, Emi Maekawa, Chiharu Noda, Minako Yamaoka-Tojo, Atsuhiko Matsunaga, Takashi Masuda, Junya Ako
  • Journal Title: JCSM Clinical Reports Volume: 3 Pages: 1-11
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease. (2018)
  • Author(s): Kentaro Kamiya, Nobuaki Hamazaki, Yuya Matsue, Alessandro Mezzani, Ugo Corra, Ryota Matsuzawa, Kohei Nozaki, Shinya Tanaka, Emi Maekawa, Chiharu Noda, Minako Yamaoka-Tojo, Atsuhiko Matsunaga, Takashi Masuda, Junya Ako
  • Journal Title: European Journal of Preventive Cardiology Volume: 25 Pages: 212-219
  • DOI: 10.1177/2047487317735715.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Excessive SBP elevation during moderate exercise discriminates patients at high risk of developing left ventricular Hypertrophy from hypertensive patients (2018)
  • Author(s): Shinya Tanaka, Takashi Masuda, Yumi Kamada, Nobuaki Hamazaki, Kentaro Kamiya, Misao N Ogura, Emi Maekawa, Chiharu Noda, Minako Yamaoka-Tojo, Junya Ako
  • Journal Title: J Hypertens Volume: 36 Pages: 1291-1298
  • DOI: 10.1097/HJH.0000000000001700.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Relationship between advanced glycation end-product accumulation in the skin and pulmonary function. (2018)
  • Author(s): Kubo A, Kato M, Sugioka Y, Mitusi R, Fukuhara, N Nihei F, Takeda Y
  • Journal Title: J. Phys. Ther. Sci. Volume: 30 Pages: 413-418
  • DOI: 10.1589/jpts.30.413.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Effects of acute phase intensive electrical muscle stimulation in frail elderly patients with acute heart failure (ACTIVE-EMS) (2017)
  • Author(s): Shinya Tanaka, Kentaro Kamiya, Yuya Matsue, Yonezawa R, Saito H, Nobuaki Hamazaki, Ryota Matsuzawa, Kohei Nozaki, Wakaume K, Endo Y, Emi Maekawa, Minako Yamaoka-Tojo, Shiono T, Inomata T, Takashi Masuda, Junya Ako
  • Journal Title: Clin Cardiol Volume: 40 Pages: 1189-1196
  • DOI: 10.1002/clc.22845.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Muscle Weakness is Associated with an Increase of Left Ventricular Mass through Excessive Blood Pressure Elevation during Exercise in Patients with Hypertension. (2017)
  • Author(s): Yumi Kamada, Takashi Masuda, Shinya Tanaka, Daisuke Kamekawa, Ayako Akiyama, Takeshi Nakamura, Kanae Yabu, Nobuaki Hamazaki, Michihito Okubo, Naoyuki Kobayashi, Junya Ako
  • Journal Title: International Heart Journal Volume: 58 Pages: 551-556
  • DOI: 10.1536/ihj.16-293.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Utility of SARC-F for Assessing Physical Function in Elderly Patients With Cardiovascular Disease. (2017)
  • Author(s): Shinya Tanaka, Kentaro Kamiya, Nobuaki Hamazaki, Ryota Matsuzawa, Kohei Nozaki, Emi Maekawa, Chiharu Noda, Minako Yamaoka-Tojo, Atsuhiko Matsunaga, Takashi Masuda, Junya Ako
  • Journal Title: Journal of the American Medical Directors Association Volume: 18 Pages: 176-181
  • DOI: 10.1016/j.jamda.2016.10.019.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prognostic Usefulness of Arm but not Calf Circumference in Patients <65 Years of Age with Cardiovascular Disease. (2017)
  • Author(s): Kentaro Kamiya, Takashi Masuda, Yuya Matsue, Nobuaki Hamazaki, Ryota Matsuzawa, Shinya Tanaka, Kohei Nozaki, Emi Maekawa, Chiharu Noda, Minako Yamaoka-Tojo, Atsuhiko Matsunaga, Junya Ako
  • Journal Title: American Journal of Cardiology Volume: 119 Pages: 186-191
  • DOI: 10.1016/j.amjcard.2016.09.040.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Stretching Exercises Improve Vascular Endothelial Dysfunction through Oxidative Stress Attenuation in Chronic Heart Failure Patients with an Implantable Cardioverter Defibrillator. (2017)
  • Author(s): Michitaka Kato, Takashi Masuda, Michio Ogano, Kazuki Hotta, Hisato Takagi, Shinya Tanaka, Yumi Kamada, Ayako Akiyama, Daisuke Kamekawa, Ryosuke Shimizu, Minoru Tabata, Jun Tanabe, Takuya Umemoto
  • Journal Title: Journal of Cardiopulmonary Rehabilitation and Prevention Volume: 37 Pages: 130-138
  • DOI: 10.1097/HCR.0000000000000229.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Relationship between advanced glycation end-product accumulation and low skeletal muscle mass in Japanese men and women. (2017)
  • Author(s): Kato M, Kubo A, Sugioka Y, Mitsui R, Fukuhara N, Nihei F, Takeda Y.
  • Journal Title: Geriatr Gerontol Int. Volume: 17 Pages: 785-790
  • DOI: 10.1111/ggi.12787.
  • Open Access / Int'l Joint Research
• [Journal Article] Effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation: a meta-analysis of randomized-controlled trials. (2017)
  • Author(s): Kato M, Kubo A, Nihei F, Ogano M, Takagi H.
  • Journal Title: Int J Rehabil Res. Volume: 40 Pages: 193-201
  • DOI: 10.1097/MRR.0000000000000232.
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Presentation] Exercise training in patients with atrial fibrillation; A meta-analysis of randomaized controlled study (2018)
  • Author(s): M. Kato, A. Kubo, M. Ogano, H. Takagi.
  • Organizer: The 82th Annual Scientific Meeting of the Japanese Circulation Society 2018
• [Presentation] Increase in Comfortable Walking Speed During Hospitalization Predicts the Readmission Due to Decompensated Heart Failure in Elderly Patients With Chronic Heart Failure (2017)
  • Author(s): Minoru Tabata, Michitaka Kato, Akiko Akiyama, Shinya Tanaka, Nobuaki Hamazaki, Takashi Masusa
  • Organizer: American Heart Association Scientific Session 2017
  • Int'l Joint Research
• [Presentation] 心血管理学療法における臨床評価指標の進歩 (2017)
  • Author(s): 田畑 稔
  • Organizer: 第52回日本理学療法士協会全国学術研修大会
  • Invited
• [Presentation] Pulmonary function is an independent determinant for chronotropic incompetence during exercise in patients with chronic heart failure (2017)
  • Author(s): N. Hamazaki T. Masuda K. Kamiya R. Matsuzawa K. Nozaki S. Tanaka M. Tabata E. Maekawa C. Noda M. Yamaoka-Tojo J. Ako
  • Organizer: European Society of Cardiology CONGRESS 2017
  • Int'l Joint Research
• [Presentation] The influence of postoperative atrial fibrillation on postoperative physical functional recovery in patients undergoing heart valve surgery (2017)
  • Author(s): Michitaka Kato, Kentaro Hori, Tomonori Kawamura, Kentaro Iwata, Koji Sakurada, Daisuke Okamura, Yuji Mori, Masayuki Tahara, Satoshi Yuguchi, Kenta Kamisaka, Keisuke Oura, Tomoyuki Morisawa, Masakazu Saitoh, Tetsuya Takahashi
  • Organizer: WCPT-AWP&PTAT CONGRESS 2017
  • Int'l Joint Research
• [Book] 内部障害理学療法学テキスト（改訂第3版） (2017)
  • Author(s): 細田 多穂、山﨑 裕司、川俣 幹雄、丸岡 弘、田畑 稔
  • Total Pages: 478
  • Publisher: 南江堂
  • ISBN: 978-4-524-25479-8
• [Book] 臨床の“疑問”を“研究”に変える 臨床研究 first stage (2017)
  • Author(s): 網本 和、田畑 稔
  • Total Pages: 279
  • Publisher: 医学書院
  • ISBN: 978-4-260-03227-8
• [Book] 内部障害理学療法学 循環・代謝 第2版 (2017)
  • Author(s): 木村 雅彦、田畑 稔
  • Total Pages: 208
  • Publisher: 中山書店
  • ISBN: 978-4-521-74492-6
• [Book] 身につける理学療法 内部障害の症例検討 (2017)
  • Author(s): 加藤倫卓、編集：玉木彰
  • Total Pages: 237
  • Publisher: 羊土社
  • ISBN: 978-4758102261