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  • Ovid Technologies (Wolters Kluwer Health)  (6)
  • Jujo, Kentaro  (6)
  • 1
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    Abstract 12149: Prognostic Benefit of Heart Rate Reduction of Hospitalized Heart Failure Patients is Different Between Atrial Fibrillation and Sinus Rhythm
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Heart rate (HR) reduction is a key strategy for improving clinical prognosis of patients with heart failure (HF) regardless of presenting atrial fibrillation (AF) or sinus rhythm (SR). However, the prognostic impact of HR reduction during hospitalization is still unclear. Hypothesis: The degree of HR reduction during hospitalization between HF patients with AF and SR differently contributes to the prognosis after discharge. Methods: This observational study included 1,930 hospitalized HF patients who were discharged alive. After excluding patients who were implanted pacing devices, those presenting paroxysmal AF, and those with missing data of HR, 1,137 patients were ultimately analyzed. Of them, 456 patients presented AF and 681 presented SR at admission. Change of HR was defined as the difference between HR at admission and discharge. We evaluated the association between in-hospital HR change and the incidence of a composite of cardiovascular death after discharge and HF re-hospitalization in patients with AF and SR, respectively. Results: During the observation period (median 528 (IQR: 135-736) days), the composite endpoint developed in 169 (37%) and 187 (27%) patients with AF and SR, respectively. The ROC curves for the composite endpoint showed the cut-off values of HR reduction were 0 bpm and 28 bpm in patients with AF and SR, respectively. Kaplan-Meier analysis showed a significantly lower incidence of a composite endpoint in patients who achieved HR reduction greater than the cut-off value in both groups (log-rank test: p 〈 0.05). HR reduction greater than the cut-off value was still an independent predictor for a composite endpoint in patients with AF after adjusting age, sex, HR at admission and LVEF (hazard ratio: 0.65, 95% confidence interval: 0.45-0.96). However, this finding was not observed in patients with SR (hazard ratio: 0.81, 95% confidence interval: 0.50-1.33). Conclusions: The ideal HR reduction level during hospitalization was different between AF and SR. Target HR reduction in HF patients with AF could lead to better clinical outcomes, but the benefit is limited in patients with SR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.12149
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 2
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    Online Resource
    Edoxaban for 12 Months Versus 3 Months in Cancer Patients With Isolated Distal Deep Vein Thrombosis (ONCO DVT study): An Open-label, Multicenter, Randomized Clinical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health)
    Abstract: Background: The optimal duration of anticoagulation therapy for isolated distal deep vein thrombosis (DVT) in patients with cancer is clinically relevant, but the evidence is lacking. The prolonged anticoagulation therapy could have a potential benefit for prevention of thrombotic events, however, it could also increase the risk of bleeding. Methods: In a multicenter, open-label, adjudicator-blinded, randomized clinical trial at 60 institutions in Japan, we randomly assigned cancer patients with isolated distal DVT, in a 1-to-1 ratio, to receive either a 12-month or 3-month edoxaban treatment. The primary endpoint was a composite of a symptomatic recurrent venous thromboembolism (VTE) or VTE-related death at 12 months. The major secondary endpoint was major bleeding at 12 months, according to the criteria of the International Society on Thrombosis and Hemostasis. The primary hypothesis was that a 12-month edoxaban treatment was superior to a 3-month edoxaban treatment with respect to the primary endpoint. Results: From April 2019 through June 2022, 604 patients were randomized, and after excluding 3 patients who withdrew consent, 601 patients were included in the intention-to-treat population: 296 patients in the 12-month edoxaban group and 305 patients in the 3-month edoxaban group. The mean age was 70.8 years, 28% of the patients were men, and 20% of the patients had symptoms of DVT at baseline. The primary endpoint of a symptomatic recurrent VTE event or VTE-related death occurred in 3 of the 296 patients (1.0%) in the 12-month edoxaban group and in 22 of the 305 (7.2%) in the 3-month edoxaban group (odds ratio, 0.13; 95% CI, 0.03 to 0.44). The major secondary endpoint of major bleeding occurred in 28 of the 296 patients (9.5%) in the 12-month edoxaban group and in 22 of the 305 (7.2%) in the 3-month edoxaban group (odds ratio, 1.34; 95% CI, 0.75 to 2.41). The prespecified subgroups did not affect the estimates on the primary endpoint. Conclusions: In cancer patients with isolated distal DVT, 12 months was superior to 3 months for an edoxaban treatment with respect to the composite outcome of a symptomatic recurrent VTE or VTE-related death.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.123.066360
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 3
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    Abstract 16345: Increase in Serum Chloride Level During Hospitalization Leads to Improved Clinical Outcomes in Patients With Heart Failure
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: Serum chloride levels both at admission and at discharge in patients with heart failure (HF) are independently associated with the incidence of adverse clinical outcomes. However, there has been few reports focusing on the prognostic impact of the change in serum chloride level during the hospitalization on the long-term prognosis after discharge. Hypothesis: We thus hypothesized that changes in serum chloride during the hospitalization is an independent prognostic predictor after discharge in HF patients. Methods: This observational study included 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive in a single university hospital. After excluding patients who received regular hemodialysis, 1,762 patients were ultimately analyzed. The primary endpoint of this study was death from any cause. Result: Overall serum chloride level was significantly decreased from the admission to discharge (103 [100-106] mEq/L to 102 [99-105] mEq/L, P 〈 0.001). During the observation period with 512 days of median follow-up, 286 patients (16.2%) died. Multivariate Cox regression analysis revealed that increase in serum chloride level during the index hospitalization was independently associated with lower rates of mortality, even after the adjustment of diverse covariates including serum chloride level at admission (hazard ratio (HR): 0.94, 95% confidence interval: 0.90-0.98). When dividing the study population into tertiles by chloride levels at admission, patients with the lower baseline chloride level had the greater reduction in HR of the primary endpoint by the increase of chloride level during the hospitalization (Figure). Conclusion: Increase in serum chloride level during hospitalization may be associated with better post-discharge prognosis in HF patients. This could be a new therapeutic target for heart failure to improve long-term prognosis.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.16345
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 4
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    Online Resource
    Abstract 9916: Evaluation of the Best Cut-off Value of Ischemia in Instantaneous Wave-Free Ratio in Patients With Aortic Valve Stenosis
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Background: Instantaneous wave-free ratio (iFR) is a vasodilator free index calculated using trans-lesional pressure ratio during a specific period of diastole that is called “wave-free period”, and reported to have a good correlation with fractional flow reserve (FFR). In patients with severe aortic valve stenosis (AS), evaluation of intermediate coronary stenosis by FFR using vasodilators is thought to be a contraindication in some situations. Moreover, previous studies reported unique coronary flow pattern during diastolic phase in patients with AS. To date, there is no report claiming the correlation of iFR and FFR in this population. The purpose of the present study was to examine the clinical value of iFR in patients with AS. Method and Results: We examined consecutive 154 patients (with 214 stenosis) whose iFR and FFR were measured simultaneously. The mean age of AS patients (n=10, mean aortic valve area: 0.75 ± 0.42cm2) was higher than non-AS patients (n=144). Other patients’ characteristics are shown in Table 1. The mean iFR value in AS patients was significantly lower than that of non-AS patients, despite no significant difference was observed in the mean FFR value and % diameter stenosis (Table 2). iFR showed a good correlation with FFR in AS patients (Figure 1) and the best cut-off value of iFR in receiver operator curve analysis to predict FFR ≤ 0.8 was 0.73 in AS patients (AUC 0.84, sensitivity 0.8, specificity 0.86, p=0.016; Figure 2), whereas, 0.90 in non-AS patients. Conclusion: The present study demonstrated the good correlation between iFR and FFR in AS patients. Besides, the value below 0.73 of iFR was thought to be a predictor of myocardial ischemia in AS patients, which was lower than standard predictive range of ischemia in iFR. Vasodilator-free assessment by iFR may have potential benefits in evaluating intermediate coronary stenosis in patients with AS.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.9916
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 5
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    Abstract 13457: Renin-Angiotensin System Inhibitor Exerts Prognostic Effect in HFpEF Patients With Low Chloride Level
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Background: Hypochloremia is associated with a poor prognosis of heart failure (HF) patients. Serum chloride level is known to be affected by serum renin secretion; however, this relationship is one of the least investigated field in HF patients. Renin-angiotensin system inhibitor (RASi) is recommended as a first-line medication for HF patients with reduced left ventricular ejection fraction (LVEF), but its prognostic effect is still controversial in HF patients with preserved EF (HFpEF). Hypothesis: The prognostic benefit of RASi depends on the baseline serum chloride level in HFpEF patients. Methods: This observational study included 1,913 consecutive patients who admitted to hospital due to worsening of HF and discharged alive. After excluding patients who received regular hemodialysis and those whose LVEF 〈 50%, 506 HFpEF patients were ultimately analyzed. They were divided into two groups by serum chloride levels at admission (Low-Chloride group: -101 mEq/L; High-Chloride group: 102- mEq/L), referred to prior reports. Death from any cause as the primary endpoint was compared between patients who received RASi at discharge and those who did not, in each chloride group. Results: During the observation period with 479 days of median follow-up, 77 (15%) died. Patients who received RASi had significantly lower mortality than those who did not, only in the Low-Chloride group (Log-rank: p=0.001, Figure ). In the multivariate Cox regression analysis with diverse covariates, the rate of risk reduction by RASi for the mortality was greater in patients in the Low-Chloride group than High-Chloride group (HR: 0.35 and 0.71, respectively). The prognostic advantages of RASi were evident in patients with low chloride level, but not in those with high chloride level at admission (P for interaction=0.027). Conclusion: In this observational study, the administration of RASi was associated with an improved prognosis of HFpEF patients only in low serum chloride level at admission.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.13457
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
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    Abstract 15512: Predictors of Normalization of Left Ventricular Systolic Function After Acute Myocarditis -multicenter Observational Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: The clinical presentation of acute myocarditis is highly variable, and its prognosis is occasionally unpredictable. Even the patients discharge alive, left ventricular (LV) remodeling occurs during the follow-up period in some cases, which causes the progression of dilated cardiomyopathy or sudden cardiac death. Purpose: We aimed to investigate the predictors of the recovery of LV ejection fraction (LVEF) in patients with acute myocarditis. Methods: This multicenter observational study included 20 patients [average age 38 years, 18 (90%) male] suffering acute myocarditis who were urgently hospitalized between 2007 and 2019. Enrolled patients were assigned into 2 groups depending on a recovery of LV function that was defined as LVEF ≥55% by transthoracic echocardiography (TTE) within 12 months after the onset; the Recovery group (n=8) and Non-recovery group (n=12). Results: Overall, LVEF increased from 37% to 52% (p 〈 0.001) during the follow-up period (median interval: 180 (IQR: 42-332) days). There was no statistically differences in baseline clinical profiles or medications at discharge between the groups. However, LVEF at admission was significantly higher in the Recovery group than Non-recovery group (47±13% vs. 31±13%, p=0.014). The univariate logistic regression analysis showed that baseline LVEF was related to a recovery of LV function (odds ratio, 1.12; 95% confidence interval, 1.00-1.26). The ROC curve for a recovery of LV function revealed that the cut-off value of LVEF at admission was 42% (sensitivity: 75%, specificity: 83%, area under the curve: 0.83, Figure A ). Patients with baseline LVEF ≥42% achieved significantly higher rates of LV functional recovery after acute myocarditis than those with LVEF 〈 42% (17% vs 75%, p=0.019, Figure B ). Conclusions: Baseline LVEF could predict a normalization of LV function in patients with acute myocarditis. Close observation and TTE follow-up should be considered in such a refractory population.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.15512
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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