Development of risk stratification strategy based on liver congestion using MR elastography in patients with heart failure

2023 Fiscal Year Research-status Report

• Project/Area Number: 23K07174
• Research Institution: Hokkaido University
• Principal Investigator: 永井 利幸 北海道大学, 医学研究院, 准教授 (00528218)
• Co-Investigator(Kenkyū-buntansha): 常田 慧徳 北海道大学, 大学病院, 医員 (80944868)
• Project Period (FY): 2023-04-01 – 2026-03-31
• Keywords: 核磁気共鳴肝エラストグラフィー / 心不全 / うっ血 / リスク層別

Outline of Annual Research Achievements

今年度は計画通りに北海道大学病院に心不全の確定診断で入院した連続症例を前向きに登録し、年度内に250例の登録が得られ、全例に以下の検査を施行した。
肝臓MRE：3.0テスラMRI装置であるDiscovery 750W（GE Healthcare, Waukesha, WI, USA）を用いて、16および40チャネルGEMアレイコイルを使用し撮像。MRE画像は、専用のアクティブドライバー（振動源）とパッシブドライバー（振動板）を使用して患者を仰臥位として、肝臓を振動させながら撮像した。解析用の関心領域（region of interest; ROI）は、画像ビューアー（EXTREX, J-MAC System, Sapporo, Japan）を使用して描出した。原則として、ROIはモノクロ硬度画像上で、肝右葉のsegment 5（S5）領域からS8領域の間の3～4断面において波画像で平行波が伝播している領域を選択し、フリーハンドで可能な限り大きく描出した。描出したROI内の弾性率は自動計算され、計測された各断面の弾性率の平均値を、肝硬度（LS-MRE、単位: kPa）として算出した。
右心カテーテル検査：患者を仰臥位とし呼気終末で息止めを行いながら実施し、平均5心拍分の波形を取り込み、右心房圧、肺動脈楔入圧、肺動脈圧、心拍出量等を測定した。
血液検査（バイオマーカー等）：肝硬度上昇の機序を血清学液に検討するため、心不全マーカー（血清トロポニン、NT-pro BNP値）、肝線維化マーカー（ヒアルロン酸、IV型コラーゲン7Sなど7項目）を測定するための血液検体を採取・保管した。

Current Status of Research Progress

1: Research has progressed more than it was originally planned.

Reason

研究計画の1年目ですでに目標症例の8割の症例が登録されており、来年度に目標症例300例を対象とした解析が前倒しで解析できる目途が立った。

Strategy for Future Research Activity

可能であれば来年度早期に目標症例300例の登録を達成し、年度内に臨床転帰のデータを合わせて中間解析を開始できればと考えている。目標以上の症例登録数が得られれば、より統計学的に盤石な結果を得ることが可能となるため、可能な限り多数の症例登録を目指す。最終年度には当初予定の主解析のほか、肝硬度を鋭敏に検出する肝臓関連バイオマーカーを同定し、心不全患者のリスク層別に有用な新たなバイオマーカー戦略を開発する。

Causes of Carryover

バイオマーカーの測定にかかる費用は可能な限り目標症例数が揃ってから一括測定のために使用する方が測定精度も保たれると判断し、次年度に繰越の方針とした。次年度に一括バイオマーカー測定の費用に充てる予定である。

Research Products

• [Journal Article] Prolonged delirium during hospitalization is associated with worse long-term and short-term outcomes in patients with acute heart failure (2024)
  • Author(s): Aikawa Yukio、Ogata Soshiro、Honda Satoshi、Nagai Toshiyuki、Murata Shunsuke、Morii Isao、Anzai Toshihisa、Nishimura Kunihiro、Noguchi Teruo
  • Journal Title: International Journal of Cardiology Volume: 399 Pages: 131776～131776
  • DOI: 10.1016/j.ijcard.2024.131776
  • Peer Reviewed
• [Journal Article] Machine learning-based gait analysis to predict clinical frailty scale in elderly patients with heart failure (2023)
  • Author(s): Mizuguchi Yoshifumi、Nakao Motoki、Nagai Toshiyuki、Takahashi Yuki、Abe Takahiro、Kakinoki Shigeo、Imagawa Shogo、Matsutani Kenichi、Saito Takahiko、Takahashi Masashige、Kato Yoshiya、Komoriyama Hirokazu、Hagiwara Hikaru、Hirata Kenji、Ogawa Takahiro、Shimizu Takuto、Otsu Manabu、Chiyo Kunihiro、Anzai Toshihisa
  • Journal Title: European Heart Journal - Digital Health Volume: 5 Pages: 152-162
  • DOI: 10.1093/ehjdh/ztad082
  • Peer Reviewed / Open Access
• [Journal Article] Exercise Capacity and Clinical Outcomes in Chronic Heart Failure Patients with Mild Tricuspid Regurgitation (2023)
  • Author(s): Nakamura Kosuke、Ishizaka Suguru、Omote Kazunori、Yasui Yutaro、Mizuguchi Yoshifumi、Takenaka Sakae、Shimono Yui、Motoi Ko、Aoyagi Hiroyuki、Tamaki Yoji、Kazui Sho、Takahashi Yuki、Saiin Kohei、Naito Seiichiro、Tada Atsushi、Kobayashi Yuta、Sato Takuma、Kamiya Kiwamu、Nagai Toshiyuki、Anzai Toshihisa
  • Journal Title: Journal of Clinical Medicine Volume: 12 Pages: 7459～7459
  • DOI: 10.3390/jcm12237459
  • Peer Reviewed / Open Access
• [Journal Article] Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement (2023)
  • Author(s): Takahashi Yuki、Kamiya Kiwamu、Nagai Toshiyuki、Tsuneta Satonori、Naito Seiichiro、Mizuguchi Yoshifumi、Takenaka Sakae、Tada Atsushi、Ishizaka Suguru、Kobayashi Yuta、Omote Kazunori、Sato Takuma、Shingu Yasushige、Kudo Kohsuke、Wakasa Satoru、Anzai Toshihisa
  • Journal Title: Journal of Cardiovascular Magnetic Resonance Volume: 25 Pages: 60～60
  • DOI: 10.1186/s12968-023-00970-9
  • Peer Reviewed / Open Access
• [Journal Article] Impact of Cardiac Power Output on Exercise Capacity and Clinical Outcome in Patients With Chronic Heart Failure (2023)
  • Author(s): Shimono Yui、Ishizaka Suguru、Omote Kazunori、Nakamura Kosuke、Yasui Yutaro、Mizuguchi Yoshifumi、Takenaka Sakae、Aoyagi Hiroyuki、Tamaki Yoji、Sato Takuma、Kamiya Kiwamu、Nagai Toshiyuki、Anzai Toshihisa
  • Journal Title: The American Journal of Cardiology Volume: 206 Pages: 4～11
  • DOI: 10.1016/j.amjcard.2023.08.069
  • Peer Reviewed
• [Journal Article] Prognostic Value of Liver Fibrotic Markers in Patients With Heart Failure (2023)
  • Author(s): Tada Atsushi、Nagai Toshiyuki、Kato Yoshiya、Kazui Sho、Takahashi Yuki、Saiin Kohei、Naito Seiichiro、Takenaka Sakae、Mizuguchi Yoshifumi、Kobayashi Yuta、Ishizaka Suguru、Omote Kazunori、Sato Takuma、Konishi Takao、Kamiya Kiwamu、Kudo Kohsuke、Anzai Toshihisa
  • Journal Title: The American Journal of Cardiology Volume: 200 Pages: 115～123
  • DOI: 10.1016/j.amjcard.2023.05.033
  • Peer Reviewed
• [Journal Article] Heart failure with preserved ejection fraction phenogroup classification using machine learning (2023)
  • Author(s): Kyodo Atsushi、Kanaoka Koshiro、Keshi Ayaka、Nogi Maki、Nogi Kazutaka、Ishihara Satomi、Kamon Daisuke、Hashimoto Yukihiro、Nakada Yasuki、Ueda Tomoya、Seno Ayako、Nishida Taku、Onoue Kenji、Soeda Tsuneari、Kawakami Rika、Watanabe Makoto、Nagai Toshiyuki、Anzai Toshihisa、Saito Yoshihiko
  • Journal Title: ESC Heart Failure Volume: 10 Pages: 2019～2030
  • DOI: 10.1002/ehf2.14368
  • Peer Reviewed / Open Access
• [Journal Article] Trends in heart failure prevalence in Japan 2014?2019: a report from healthcare administration databases (2023)
  • Author(s): Zhang Ling、Ono Yasuhisa、Qiao Qing、Nagai Toshiyuki
  • Journal Title: ESC Heart Failure Volume: 10 Pages: 1996～2009
  • DOI: 10.1002/ehf2.14321
  • Peer Reviewed / Open Access
• [Journal Article] JCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis (2023)
  • Author(s): Nagai Toshiyuki、Inomata Takayuki、Kohno Takashi、Tajiri Kazuko、Ishikawa Yusuke、Matama Hideo、Nagano Nobutaka、Sato Kimi、Yasuda Kazushi、Sakata Yasushi、Kuwahara Koichiro、Minamino Tohru、Ono Minoru、Anzai Toshihisa、on behalf of the Japanese Circulation Society Joint Working Group
  • Journal Title: Circulation Journal Volume: 87 Pages: 674～754
  • DOI: 10.1253/circj.CJ-22-0696
  • Peer Reviewed / Open Access
• [Journal Article] Prognostic Significance of Peak Workload-to-Weight Ratio by Cardiopulmonary Exercise Testing in Chronic Heart Failure (2023)
  • Author(s): Yasui Yutaro、Nakamura Kosuke、Omote Kazunori、Ishizaka Suguru、Takenaka Sakae、Mizuguchi Yoshifumi、Shimono Yui、Kazui Sho、Takahashi Yuki、Saiin Kohei、Naito Seiichiro、Tada Atsushi、Kobayashi Yuta、Sato Takuma、Kamiya Kiwamu、Nagai Toshiyuki、Anzai Toshihisa
  • Journal Title: The American Journal of Cardiology Volume: 193 Pages: 37～43
  • DOI: 10.1016/j.amjcard.2023.01.052
  • Peer Reviewed
• [Journal Article] Association of longitudinal cardiac troponin trajectory with adverse events in patients with cardiac sarcoidosis (2023)
  • Author(s): Kazui Sho、Takenaka Sakae、Nagai Toshiyuki、Kato Yoshiya、Komoriyama Hirokazu、Kobayashi Yuta、Takahashi Akinori、Kamiya Kiwamu、Sato Takuma、Tada Atsushi、Yasui Yutaro、Nakai Michikazu、Sato Takahiro、Tsujino Ichizo、Konno Satoshi、Anzai Toshihisa
  • Journal Title: International Journal of Cardiology Volume: 389 Pages: 131268～131268
  • DOI: 10.1016/j.ijcard.2023.131268
  • Peer Reviewed
• [Presentation] Development of an Automated Frailty Assessment Program for Elderly Patients with Heart Failure through Industry-academia-government Collaboration. (2024)
  • Author(s): Nagai T.
  • Organizer: 第88回日本循環器学会学術集会
  • Int'l Joint Research / Invited
• [Presentation] 心筋炎ガイドライン改定と実臨床からみた診療の課題． (2024)
  • Author(s): 永井利幸．
  • Organizer: 第43回日本画像医学会
  • Invited
• [Presentation] ステロイド治療の適応と治療抵抗例に対するアプローチ． (2023)
  • Author(s): 永井利幸．
  • Organizer: 第43回日本サルコイドーシス/肉芽腫性疾患学会総会
  • Invited
• [Presentation] 心臓サルコイドーシスUpdate 2023. (2023)
  • Author(s): 永井利幸.
  • Organizer: 第8回日本心筋症研究会
  • Invited
• [Presentation] Key Points of JCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis: Focus on Chronic Inflammatory Cardiomyopathy. Inflammatory cardiomyopathy, pathogenesis and treatment. (2023)
  • Author(s): Nagai T.
  • Organizer: 第87回日本循環器学会学術集会
  • Int'l Joint Research / Invited
• [Presentation] Usefulness of Liver Stiffness Assessed by Magnetic Resonance Elastography in Patients with Heart Failure. (2023)
  • Author(s): Tada A, Nagai T, Kato Y, Anzai T.
  • Organizer: 第87回日本循環器学会学術集会
  • Int'l Joint Research
• [Presentation] エビデンスと実臨床から心臓サルコイドーシス診療を再考する. (2023)
  • Author(s): 永井利幸.
  • Organizer: 第27回日本心不全学会
  • Int'l Joint Research / Invited
• [Presentation] 心不全合併心房細動に対する治療戦略Up to date. (2023)
  • Author(s): 永井利幸.
  • Organizer: 第61回全国自治体病院学会
  • Invited
• [Presentation] 非心臓手術周術期の心筋傷害 ～ガイドラインから対策を考える～. (2023)
  • Author(s): 永井利幸.
  • Organizer: 日本麻酔科学会 第70回学術集会.
  • Invited
• [Presentation] Validity and Reliability of a Palliative Care Needs Assessment Tool in Japanese Patients with Heart Failure. (2023)
  • Author(s): Tatsuta D, Nagai T, Sato T, Koya J, Nishino K, Naito S, Mizuguchi Y, Temma T, Kamiya K, Narita H, Tsuruga K, Anzai T.
  • Organizer: American Heart Association Scientific Sessions 2023
  • Int'l Joint Research
• [Presentation] Differential Impact of Self-Care Behaviour on Mortality Between Patients With Stable and Recent Worsening Chronic Heart Failure. (2023)
  • Author(s): Koya T, Nagai T, Tada A, Nakao M, Ishizaka S, Mizuguchi Y, Aoyagi H, Imagawa S, Tokuda Y, Kato Y, Takahashi M, Sakai H, Machida M, Matsutani K, Saito T, Okamoto H, Anzai T.
  • Organizer: American Heart Association Scientific Sessions 2023
  • Int'l Joint Research
• [Presentation] Machine Learning-Based Prediction of Clinical Frailty Scale Based on Gait Analysis in Elderly Patients With Heart Failure. (2023)
  • Author(s): Nakao M, Nagai T, Mizuguchi Y, Takahashi Y, Abe T, Kakinoki S, Imagawa S, Matsutani K, Saito T, Takahashi M, Hirata K, Ogawa T, Shimizu T, Otsu M, Chiyo K, Anzai T.
  • Organizer: American Heart Association Scientific Sessions 2023
  • Int'l Joint Research
• [Presentation] Prognostic Value of Combined Assessment of Cardiac Magnetic Resonance and Fluorodeoxyglucose Positron Emission Tomography in Patients with Cardiac Sarcoidosis. (2023)
  • Author(s): Kazui S, Takenaka S, Nagai T, Tsuneta S, Kato Y, Komoriyama H, Kobayashi Y, Takahashi A, Kamiya K, Tenma T, Sato T, Tada A, Yasui Y, Nakai M, Sato T, Tsujino I, Kudo K, Konno S, Anzai T.
  • Organizer: American Heart Association Scientific Sessions 2023
  • Int'l Joint Research
• [Presentation] Prognostic Value of Liver Fibrotic Markers in Patients with Heart Failure. (2023)
  • Author(s): Tada A, Nagai T, Kato Y, Yasui Y, Sho K, Yuki T, Kohei S, Naito S, Takenaka S, Mizuguchi Y, Kobayashi Y, Omote K, Sato T, Kamiya K, Anzai T.
  • Organizer: European Society of Cardiology Congress 2023
  • Int'l Joint Research
• [Presentation] Association between Aortic Valve Opening During Exercise and Right Ventricular Reserve in Patients with Left Ventricular Assist Device. (2023)
  • Author(s): Takenaka S, Sato T, Nagai T, Omote K, Kobayashi Y, Kamiya K, Konishi T, Tada A, Mizuguchi Y, Takahashi Y, Naito S, Saiin K, Ishizaka S, Wakasa S, Anzai T.
  • Organizer: European Society of Cardiology Congress 2023
  • Int'l Joint Research
• [Presentation] Machine learning-based Automatic Rating of Clinical Frailty Scale in Patients with Heart Failure: A Pilot Study. (2023)
  • Author(s): Mizuguchi Y, Nakao M, Nagai T, Takahashi Y, Abe T, Imagawa S, Matsutani K, Saito T, Hirata K, Ogawa T, Shimizu S, Otsu M, Chiyo K, Anzai T.
  • Organizer: American College of Cardiology 2023
  • Int'l Joint Research
• [Presentation] Impact of COVID-19 Pandemic on Emergency Medical System and Management Strategies in Patients with Acute Coronary Syndrome: A Report from Japanese Multicenter Registry. (2023)
  • Author(s): Takenaka S, Saiin K, Nagai T, Takahashi A, Mizuguchi Y, Konishi T, Hotta D, Kamigaki M, Yamazaki S, Fujita T, Yamashita T, Kawahatsu K, Suzuki T, Nozaki Y, Sakurada T, Anzai T, Takenaka T, Igarashi Y, Makino T.
  • Organizer: American College of Cardiology 2023
  • Int'l Joint Research
• [Presentation] Hemodynamic Exercise Responses and Quality of Life in Small Body Surface Area Patients with Left Ventricular Assist Device. (2023)
  • Author(s): Sato T, Nagai T, Takenaka S, Kazui S, Yasui Y, Saiin K, Takahashi Y, Naito S, Mizuguchi Y, Tada A, Ishizaka S, Kobayashi Y, Omote K, Kamiya K, Wakasa S, Anzai T.
  • Organizer: American College of Cardiology 2023
  • Int'l Joint Research
• [Presentation] Association of Cardiac Troponin Trajectory Following Immunosuppressive Therapy With Adverse Events in Patients With Cardiac Sarcoidosis. (2023)
  • Author(s): Kazui S, Nagai T, Takenaka S, Kato Y, Komoriyama H, Kobayashi Y, Takahashi A, Kamiya K, Sato T, Omote K, Tada A, Mizuguchi Y, Naito S, Takahashi Y, Saiin K, Yasui Y, Anzai T.
  • Organizer: American College of Cardiology 2023
  • Int'l Joint Research
• [Presentation] Differences on Periprocedural Blood Flow Dynamics between Balloon-and Self-expandable Valves in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. (2023)
  • Author(s): Takahashi Y, Kamiya K, Nagai T, Tsuneta S, Kazui S, Yasui Y, Saiin K, Naito S, Mizuguchi Y, Takenaka S, Tada A, Ishizaka S, Kobayashi Y, Omote K, Sato T, Shingu Y, Wakasa S, Anzai T.
  • Organizer: American College of Cardiology 2023
  • Int'l Joint Research