Therapeutic target in patients with heart failure complicated by chronic kidney disease

2016 Fiscal Year Annual Research Report

• Project/Area Number: 26461088
• Research Institution: Japan Research Promotion Society for Cardiovascular Diseases
• Principal Investigator: 吉川 勉 公益財団法人日本心臓血圧研究振興会(臨床研究施設・研究部門), 内科医局, 副院長・部長 (20174906)
• Co-Investigator(Kenkyū-buntansha): 香坂 俊 慶應義塾大学, 医学部(信濃町), 講師 (30528659)
• Project Period (FY): 2014-04-01 – 2017-03-31
• Keywords: 心不全 / 慢性腎臓病 / 長期予後

Outline of Annual Research Achievements

＜目的＞ ADHF患者における入院時腎機能及び入院中の変化が臨床転帰に及ぼす影響について明らかにする。＜方法＞ 2014年9月まで慶應義塾大学病院、榊原記念病院、杏林大学病院および聖路加国際病院に入院したADHF患者を前向きに登録した。入院時腎機能及びその変化が臨床転帰に及ぼす影響について検討した。急性期クレアチニン値0.3㎎/dl以上の上昇を腎機能悪化(WRF)と定義した。左室駆出率(LVEF)<40%を収縮不全(rEF)、LVEF>40%を収縮機能の保たれた心不全(pEF)と定義した。
＜結果＞ 1732例のADHF患者を解析対象とした。入院時eGFR中央値は49.5mL/min/m2であった。平均観察期間は559日であった。WRFはeGFR低値群に多かった。短期予後を観察したカプラン・マイアー生存曲線ではWRFは腎機能の変動がなかった群に比べて生存率が低値であった。院内死亡を従属変数にしたロジステイック解析では、強心薬使用とWRFは独立した予後予測因子となった。長期予後解析では、eGFR低値群は高値群に比べて死亡あるいは心不全による入院件数が多かった。この結果は、rEFでもpEFでも同様であった。Cox比例ハザード解析で、入院時eGFR低値が独立した予後予測因子となった。WRFは長期予後予測因子とはならなかった。
＜結論＞4施設に入院した ADHF患者を前向きに登録したデータベースを用いて、入院時腎機能及びその変化が臨床転帰に及ぼす影響について検討した。急性期腎機能悪化は院内死亡の予測因子となったが、長期予後とは関連しなかった。一方、入院時eGFR低値は短期予後予測因子とはならないが、長期予後の予測因子となることが明らかとなった。

Research Products

• [Journal Article] Predictive Value of QRS Duration at Admission for In-Hospital Clinical Outcome of Takotsubo Cardiomyopathy. (2017)
  • Author(s): Yamaguchi T, Yoshikawa T, Isogai T, Miyamoto T, Maekawa Y, Ueda T, Sakata K, Murakami T, Yamamoto T, Nagao K, Takayama M
  • Journal Title: Circ J Volume: 81 Pages: 62-68
  • DOI: 10.1253/circj.CJ-16-0912
  • Peer Reviewed / Open Access
• [Journal Article] Effect of obesity on the prognostic impact of atrial fibrillation in heart failure with preserved ejection fraction. (2017)
  • Author(s): Yagawa M, Nagatomo Y, Izumi Y, Mahara K, Tomoike H, Shiraishi Y, Kohno T, Mizuno A, Goda A, Kohsaka S, Yoshikawa T
  • Journal Title: Circ J Volume: 999 Pages: 999-999
  • DOI: doi:10.1253/circj.CJ-16-1130
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Current use of guideline-based medical therapy in elderly patients admitted with acute heart failure with reduced ejection fraction and its impact on event-free survival. (2017)
  • Author(s): Akita K, Kohno T, Kohsaka S, Shiraishi Y, Nagatomo Y, Izumi Y, Goda A, Mizuno A, Sawano M, Inohara T, Fukuda K, Yoshikawa T
  • Journal Title: Int J Cardiol Volume: 235 Pages: 162-168
  • DOI: 10.1016/j-ijcard.2017.02.070
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] Early vs. Late Reverse Ventricular Remodeling in Patients with Cardiomyopathy (2016)
  • Author(s): Banno A, Kohsaka S, Inohara T, Koide K, Shiraishi Y, Kohno T, Sano M, Yoshikawa T, Fukuda K
  • Journal Title: J Cardiol Volume: 18 Pages: 57-63
  • DOI: 10.1016/j.jjcc.2015.07.021
  • Peer Reviewed
• [Journal Article] Validation of the Get With The Guideline Heart Failure risk score in Japanese patients and the potential improvement of its discrimination ability by the inclusion of B-type natriuretic peptide level. (2016)
  • Author(s): Shiraishi Y, Kohsaka S, Abe T, Mizuno A, Goda A, MD, Izumi Y, Yagawa M, Akita K, Sawano M, Inohara T, MD, Takei M, Kohno T, Higuchi S, Yamazoe M, Mahara K, Fukuda K, MD, Yoshikawa T
  • Journal Title: Am Heart J Volume: 171 Pages: 33-39
  • DOI: 10.1016/j.ahj.2015.10.008
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] Extent of Late Gadolinium Enhancement on Cardiac Magnetic Resonance Images in Japanese Hypertrophic Cardiomyopathy Patients. (2016)
  • Author(s): Hen Y, Iguchi N, Utanohara Y, Takada K, Machida H, Takara A, Teraoka K, Sumiyoshi T, Takamisawa I, Takayama M, Yoshikawa T
  • Journal Title: Circ J Volume: 80 Pages: 950-957
  • DOI: 10.1253/circj.CJ-15-1100
  • Peer Reviewed / Open Access
• [Journal Article] Enhanced Oxidative Stress is Associated with Sleep-Disordered Breathing and Obesity in Patients with Heart Failure. (2016)
  • Author(s): Kondo M, Kohno T, Kohsaka S, Fukuoka R, Shiraishi Y, Sawano M, Inohara T, Sano M, Yoshikawa T, Fukuda K
  • Journal Title: Int J Cardiol (letter) Volume: 209 Pages: 133-135
  • DOI: 10.1016/j.ijcard.2016.02.042
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] Immunoadsorption therapy for dilated cardiomyopathy using tryptophan column-A prospective, multicenter, randomized, within-patient and parallel-group comparative study to evaluate efficacy and safety (2016)
  • Author(s): Yoshikawa T, Baba A, Akaishi M, Wakabayashi Y, Monkawa T, Kitakaze M, Izumi T, Tomoike H
  • Journal Title: J Clin Apher Volume: 31 Pages: 535-544
  • DOI: 10.1002/jca.21446
  • Peer Reviewed / Open Access
• [Presentation] Impact of body mass index on ih-hospital prognosis in patients with Takotsubo cardiomyopathy: Multicenter cohort study (2017)
  • Author(s): Isogai T, Yoshikawa T, Ueda T, Maekawa Y, Sakata K, Yamaguchi T, Imori Y, Murakami T, Teraoka K, Mochizuki H, Nagao K, Yamamoto T, Takayama M
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-19
• [Presentation] Newly detected atrial fibrillation is associated with poor clinical outcome in heart failure with preserved ejection fraction (2017)
  • Author(s): Ieki H, Nagatomo Y, Nagai T, Sugano Y, Saito Y, Yoshikawa T, Anzai T
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-19
• [Presentation] Atrial fibrillation has a differential prognostic impact in obese vs. non-obese patients with heart failure with preserved ejection fraction (2017)
  • Author(s): Yoshikawa T, Nagatomo Y, Yagawa M, Izumi Y, Mahara K, Tomoike H, Shiraishi Y, Inohara T, Mizuno A, Goda A, Kohsaka S
  • Organizer: Late Breaking Cohort Studies 3 “Heart Failure: Its Clinical Background and Treatment”, 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Underweight is an independent predictor of outcomes in heart failure with preserved ejection fraction: A report from JASPER Study (2017)
  • Author(s): Matsumoto J, Kinugawa S, Fukushima A, Yokota T, Yoshikawa T, Saito Y, Nagai T, Anzai T
  • Organizer: Late Breaking Cohort Studies 3 “Heart Failure: Its Clinical Background and Treatment”, 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Monthly variations of incidence of Takotsubo cardiomyopathy in the Tokyo CCU Network Registry (2017)
  • Author(s): Murakami T, Yoshikawa T, Maekawa Y, Ueda T, Sakata K, Isogai T, Yamaguchi T, Mochizuki H, Imori Y, Teraoka K, Yamamoto T, Nagao K, Takayama M
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Additional change of renal function during hospitalization predicts adverse outcome in HFpEF with renal dysfunction (2017)
  • Author(s): Matsumoto Y, Nagatomo Y, Nagai T, Sugano Y, Saitou Y, Yoshikawa T, Anzai T
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Different contribution of modifiable patient characteristics to early and late adverse outcomes in patients with acute heart failure (2017)
  • Author(s): Kimura M, Kohno T, Kohsaka S, Shiraishi Y, Fukuoka R, Nagatomo Y, Yagawa M, Goda A, Mizuno A, Sujino Y, Fukuda K, Yoshikawa T
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Lower body mass index is a risk factor of blunted response to beta-blocker therapy using carvedilol: Insight from J-CHF Study (2017)
  • Author(s): Nagatomo Y, Yoshikawa T, Okamoto H, Kitabatake A, Hori M
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Relationship between elevated peripheral leukocyte counts and in-hospital outcomes in patients with Takotsubo cardiomyopathy (2017)
  • Author(s): Maekawa Y, Yoshikawa T, Ueda T, Sakata K, Isogai T, Yamaguchi T, Imori Y, Teraoka K, Murakami T, , Mochizuki H, Nagao K, Yamamoto T, Takayama M
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-18
• [Presentation] Anemia is associated with the blunted response to beta-blocker therapy using carvedilol: Insight from Japanese Chronic Heart failure (J-CHF) Study (2017)
  • Author(s): 長友祐司 吉川勉 岡本洋 堀正二
  • Organizer: Late Breaking Clinical Trials 2 “Advance in Prevention and Treatment of Heart Failure”, 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-17
• [Presentation] Signal intensity pattern on MW T2-weight imaging after PTSMA predicts wall thickness reduction in HOCM (2017)
  • Author(s): 高良綾子 辺泰樹 寺岡邦彦 井口信雄 町田治彦 薄井秀美 上田みどり 堀川良史 高見澤格 高山守正 吉川勉
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-17
• [Presentation] Validation of the Seattle Heart Failure Model in heart failure patients: A report from the West Tokyo Heart Failure Registry (2017)
  • Author(s): Shiraishi Y, Kohsaka S, Kohno T, Shoji S, Goda A, Higuchi S, Mizuno A, Sugino Y, Yagawa M, Nagatomo Y, Mahara K, Yoshikawa T
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-17
• [Presentation] Characterization of the patients who were admitted for acute decompensated heart failure by clinical scenario (2017)
  • Author(s): Komuro J, Nagatomo Y, Yagawa M, Mahara K, Goda A, Sujino Y, Mizuno A, Kohno T, Kohsaka S, Yoshikawa T
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-17
• [Presentation] Usefulness of psoas muscle area to predict clinical events in pateints with acute decompensated heart failure (2017)
  • Author(s): Funamizu T, Nagatomo Y, Saji M, Yagawa M, Mahara K, Tomoike H, Kohsaka S, Yoshikawa T
  • Organizer: 81th Japanese Circulation Society Meeting
  • Place of Presentation: Kanazawa
  • Year and Date: 2017-03-17
• [Presentation] 日本人急性心不全患者の予後予測におけるGWTG Risk Scoreの有用性 (2016)
  • Author(s): 白石泰之 香坂俊 合田あゆみ 水野篤 筋野容守 吉川勉
  • Organizer: 第30回日本冠疾患学会学術集会ハートチームシンポジウム「データベース関連の合同シンポジウム」
  • Place of Presentation: 東京
  • Year and Date: 2016-12-11
• [Presentation] The significance of serum phosphorus level at admission for acute decompensated heart failure (2016)
  • Author(s): Ieki H, Nagatomo Y, Yagawa M, Mahara K, Tomoike H, Kohsaka S, Yoshikawa T
  • Organizer: 20th Japanese Heart Failure Society Meeting
  • Place of Presentation: Sapporo
  • Year and Date: 2016-10-08
• [Presentation] 高齢者心不全の薬物治療 (2016)
  • Author(s): 吉川勉
  • Organizer: 第20回日本心不全学会 特別企画1「高齢者心不全患者の治療に関するステートメント」
  • Place of Presentation: 札幌
  • Year and Date: 2016-10-07
• [Presentation] 高齢者心不全におけるガイドライン推奨薬物治療の遵守率と心不全再入院との関連 (2016)
  • Author(s): 河野隆志 香坂俊 秋田敬太郎 白石泰之 長友祐司 合田あゆみ 水野篤 福田恵一 吉川勉
  • Organizer: 第20回日本心不全学会シンポジウム5「高齢者心不全の治療と限界」
  • Place of Presentation: 札幌
  • Year and Date: 2016-10-07
• [Presentation] Serum uric acid increase through the treatment of ADHF might predict adverse outcome in patients with chronic heart failure (2016)
  • Author(s): Yamamoto H, Nagatomo Y, Yagawa M, Mahara K, Tomoike H, Kohsaka S, Yoshikawa T
  • Organizer: 20th Japanese Heart Failure Society Meeting
  • Place of Presentation: Sapporo
  • Year and Date: 2016-10-07
• [Presentation] Effects of febuxostat on cardiorenal function in patients with heart failure and hyperuricemia (2016)
  • Author(s): Nagatomo Y, Fukamizu T, Izumi Y, Yagawa M, Mahara K, Hen Y, Ito H, Ueda M, Suzuki M, Yoshikawa T
  • Organizer: 3rd World Congress of Acute Heart Failure
  • Place of Presentation: Florence
  • Year and Date: 2016-05-22
  • Int'l Joint Research
• [Presentation] Differential prognostic impact of atrial fibrillation in non-obese vs. obese patients with heart failure with preserved ejection fraction (2016)
  • Author(s): Yagawa M, Nagatomo Y, Izumi Y, Mahara K, Shiraishi Y, Inohara T, Mizuno A, Goda A, Kohsaka S, Yoshikawa T
  • Organizer: 3rd World Congress of Acute Heart Failure
  • Place of Presentation: Florence
  • Year and Date: 2016-05-22
  • Int'l Joint Research