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  • Ovid Technologies (Wolters Kluwer Health)  (13)
  • Yagi, Shusuke  (13)
  • 1
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    Acute Hospital Mortality of Venous Thromboembolism in Patients With Cancer From Registry Data
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Heart Association Vol. 10, No. 11 ( 2021-06)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 11 ( 2021-06)
    Abstract: The prognosis of patients with cancer‐venous thromboembolism (VTE) is not well known because of a lack of registry data. Moreover, there is also no knowledge on how specific types are related to prognosis. We sought to evaluate the clinical characteristics and outcomes of patients with cancer‐associated VTE, compared with a matched cohort without cancer using real‐world registry data of VTE. Methods and Results This study was based on the Diagnosis Procedure Combination database in the JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination). Of 5 106 151 total patients included in JROAD‐DPC, we identified 49 580 patients who were first hospitalized with VTE from April 2012 to March 2017. Propensity score was estimated with a logistic regression model, with cancer as the dependent variable and 18 clinically relevant covariates. After propensity matching, there were 25 148 patients with VTE with or without cancer. On propensity score‐matched analysis with 25 148 patients with VTE, patients with cancer had higher total in‐hospital mortality within 7 days (1.3% versus 1.1%, odds ratio [OR], 1.66; 95% CI, 1.31–2.11; P 〈 0.0001), 14 days (2.5% versus 1.5%, OR, 2.07; 95% CI, 1.72–2.49; P 〈 0.0001), and 30 days (4.8% versus 2.0%, OR, 2.85; 95% CI, 2.45–3.31; P 〈 0.0001). On analysis for each type of cancer, in‐hospital mortality in 11 types of cancer was significantly high, especially pancreas (OR, 12.96; 95% CI, 6.41–26.20), biliary tract (OR, 8.67; 95% CI, 3.00–25.03), and liver (OR, 7.31; 95% CI, 3.05–17.50). Conclusions Patients with cancer had a higher in‐hospital acute mortality for VTE than those without cancer, especially in pancreatic, biliary tract, and liver cancers.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.120.019373
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 2
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    Abstract 13607: Differential Response of Local Coagulation after Implantation of New Generation Drug-Eluting Stents Compared with Sirolimus-Eluting Stent
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Purpose: We have previously demonstrated local persistent hypercoagulation after sirolimus-eluting stent (SES) implantation by measuring plasma prothrombin fragment F1+2(frF1+2) levels. The aim of this study is to examine local coagulation response after biolimus-eluting stent (BES) and everolimus-eluting stent (EES) implantation. Methods: Sixty-eight patients who were treated with stents about eight months earlier to the mid-segment of the left anterior descending coronary artery, with no evidence of restenosis, were studied (BES: 12pts, EES: 15pts, SES: 23pts, and BMS: 18pts). We measured plasma levels of frF1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V). The transcardiac frF1+2 gradients (ΔfrF1+2) were defined as CS level minus V level. The patients were divided into 2 groups according to total stent length [longer stent group (≥24mm) or shorter stent group ( 〈 24mm)]. Results: A larger percent diameter stenosis was observed in the BMS group than in the SES, EES, and BES groups (25.1±15.6 vs 7.1±16.5, 12.5±12.8, 10.3±14.2%, p 〈 0.05, respectively). The ΔfrF1+2 was greater in the SES group than in the BMS, EES, and BES groups, and no significant differences were observed among the BMS, EES, and BES groups (23.4±21.1 vs 4.7±13.4, 3.2±11.7, 1.5±11.1 pmol/l, p 〈 0.05, respectively). The ΔfrF1+2 in longer stent group (n=11) was significantly greater than in shorter stent group (n=12) (27.4±12.1 vs 19.2±10.1 pmol/l, p 〈 0.05) only in the SES group, however, no significant differences were observed according to total stent length in other groups. Conclusions: A lower response of local coagulation after BES and EES implantation was shown, and significant correlation between local hypercoagulation and total stent length was observed only after SES implantation. These findings might be associated with lower strut thickness and unique characteristics of polymer in second-generation drug-eluting stents.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.13607
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 3
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    Abstract 19088: Atrial Late Potentials and Atrial Substrate Remodeling in Patients With Atrial Fibrillation
    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: Backgrounds: Patients with atrial fibrillation (AF) often have a low-amplitude potential in the terminal part of filtered P-wave (atrial late potential: aLP). However, it remains unknown what aLP reflects in AF patients. On the other hand, electrical remodeling of the atria can be precisely evaluated by the quantitative voltage map analysis using 3D mapping system. In this study, we hypothesized that we could substitute "non-invasive" aLP for "invasive" 3D mapping system to evaluate the atrial electrical remodeling and investigated the relationship between aLP and atrial substrate remodeling in AF patients. Methods: The P-wave single-averaged electrocardiogram (P-SAECG) was recored in 60 patients with paroxysmal AF who underwent PV isolation. Filtered P-wave duration (fPWD) and root-mean-squared voltage of the terminal 20ms of ≤2.0 μV (RMS20) were assessed by P-SAECG. The left atrial (LA) global contact mapping during sinus rhythm was performed and LA voltage zone index (LAVZI) was defined as an area with voltage 〈 0.5mV divided by total LA surface area. Results: LAVZI showed a strong positive correlation with fPWD and a strong negative correlation with RMS20 (r=-0.82, p 〈 0.01; r=0.68, p 〈 0.01, respectively). LV volume by echocardiography was also positively correlated with fPWD and negatively correlated with RMS20 (r=0.57, p 〈 0.05; r=-0.69, p 〈 0.01, respectively). In addition, LA appendage flow was negatively correlated with fPWD (r=-0.49, p 〈 0.05). fPWD was significantly longer and RMS20 was lower in patients with AF for more than 1 year than those for less than 1 year. However, there were no significant correlations between aLP parameters and other echocardiographic findings such as left ventricular ejection fraction or plasma BNP concentration. Conclusions: aLP reflects precisely atrial substrate remodeling in AF patients. aLP might serve as non-invasive tool for monitoring the atrial substrate remodeling in patients with AF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.19088
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 4
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    Abstract 13145: Differences of Cancer Types in Hospital Mortality in Patients With Venous Thromboembolism
    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: We sought to evaluate the clinical characteristics and outcomes of patients with cancer-associated VTE, compared with the matched cohort without cancer using real-world big data of VTE. Background: Cancer is associated with a high incidence of Venous Thromboembolism (VTE) and there are many guidelines/recommendations about VTE. However, the prognosis of cancer-VTE patients is not well known because of a lack of big data. Moreover, there is also no knowledge on how cancer type is related to prognosis. Methods: This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). We identified 28,247 patients who were first hospitalized with VTE from April 2012 to March 2017. 26.0% were cancer patients. Compared with national statistics of cancer incidence in 2015 from National Cancer Center of Japan, the proportion of gynecological cancer patients was higher, but other cancer types had similar prevalence rates. Propensity score (PS) was estimated with logistic regression model, with cancer as the dependent variable and 18 clinically relevant covariates. Results: We included 24,576 patients after exclusion. The median age was 71years (range: 59-80 years), and 42.0% were male. On PS-matched analysis with 12,418 patients, patients with cancer had higher total in-hospital mortality (9.5% vs. 3.8%, P 〈 0.001; OR, 2.72, 95% CI: 2.33-3.19) and in-hospital mortality within 30days (6.8% vs. 3.2%, P 〈 0.001; OR, 2.20, 95% CI: 1.85-2.62). On analysis for each type of cancer, in-hospital mortality in 10 types of cancer was significantly high, especially pancreas (OR: 9.65, 95%CI: 4.31-21.64), biliary tract (OR: 8.36, 95%CI: 2.42-28.89) and liver (OR: 7.33, 95%CI: 1.92-28.02). Conclusions: Patients with cancer had a higher in-hospital mortality for VTE than those without cancer, especially in pancreatic, biliary tract and liver cancers.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13145
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 5
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    Serial Imaging Changes During Treatment of Immunoglobulin G4–Related Disease With Multiple Pseudotumors
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 131, No. 21 ( 2015-05-26), p. 1882-1883
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. 21 ( 2015-05-26), p. 1882-1883
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.115.015638
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 6
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    Toll‐Like Receptor 9 Plays a Pivotal Role in Angiotensin II–Induced Atherosclerosis
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Heart Association Vol. 8, No. 7 ( 2019-04-02)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 7 ( 2019-04-02)
    Abstract: Toll‐like receptor ( TLR ) 9 recognizes bacterial DNA , activating innate immunity, whereas it also provokes inflammation in response to fragmented DNA released from mammalian cells. We investigated whether TLR 9 contributes to the development of vascular inflammation and atherogenesis using apolipoprotein E–deficient ( Apoe −/− ) mice. Methods and Results Tlr9 ‐deficient Apoe −/− ( Tlr9 −/− Apoe −/− ) mice and Apoe −/− mice on a Western‐type diet received subcutaneous angiotensin II infusion (1000 ng/kg per minute) for 28 days. Angiotensin II increased the plasma level of double‐stranded DNA, an endogenous ligand of TLR 9, in these mice. Genetic deletion or pharmacologic blockade of TLR 9 in angiotensin II–infused Apoe −/− mice attenuated atherogenesis in the aortic arch ( P 〈 0.05), reduced the accumulation of lipid and macrophages in atherosclerotic plaques, and decreased RNA expression of inflammatory molecules in the aorta with no alteration of metabolic parameters. On the other hand, restoration of TLR 9 in bone marrow in Tlr9 −/− Apoe −/− mice promoted atherogenesis in the aortic arch ( P 〈 0.05). A TLR 9 agonist markedly promoted proinflammatory activation of Apoe −/− macrophages, partially through p38 mitogen‐activated protein kinase signaling. In addition, genomic DNA extracted from macrophages promoted inflammatory molecule expression more effectively in Apoe −/− macrophages than in Tlr9 −/− Apoe −/− macrophages. Furthermore, in humans, circulating double‐stranded DNA in the coronary artery positively correlated with inflammatory features of coronary plaques determined by optical coherence tomography in patients with acute myocardial infarction ( P 〈 0.05). Conclusions TLR 9 plays a pivotal role in the development of vascular inflammation and atherogenesis through proinflammatory activation of macrophages. TLR 9 may serve as a potential therapeutic target for atherosclerosis.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.010860
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 7
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    Abstract 12350: Pressure-flow Relationship of Pulmonary Circulation Determines Six-minute Walk Distance in Connective Tissue Disease
    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: Introduction: The 6-minute walk distance (6MWD) as a surrogate of exercise capacity is often shown to be the best predictor of mortality in pulmonary hypertension (PH). Recent studies have described that mean pulmonary artery pressure (mPAP) - cardiac output (CO) relationships have a potential to assess the detail of pulmonary circulation. Hypothesis: We hypothesized that pressure-flow relationships of the pulmonary circulation (mPAP/CO) would be associated with 6MWD in connective tissue disease (CTD). Methods: We prospectively performed 6-minute walk test and echocardiographic studies in 202 CTD patients (56±14 years; 11% male) with measurements of cardiac output using electric cardiometry. We have calculated the pulmonary artery pressure-cardiac output relationships as mPAP divided by CO (mPAP/CO). Results: Firstly, we have checked the accuracy of CO by electric cardiometry. In our cohort with invasive data, there is a good correlation between right heart catheter and electric cardiometry values of cardiac output (r=0.85; p 〈 0.001) with electric cardiometry measurements slightly underestimating cardiac output (bias -14% of the mean). Correlates of 6MWD were age (partial R= -0.19, p=0.009), early-diastolic mitral annular motion velocity (e’, partial R= 0.20, p=0.005), E/e’ (partial r= -0.16, p=0.028) and CO (partial r= 0.21, p=0.019) in the univariate analysis. In multivariate analysis, the mPAP/CO was strongly associated with 6MWD (t= -2.06, p= 0.042). Male gender and early-diastolic tricuspid annular motion velocity were also associated with 6MWD (t= 2.09, p=0.038 and t =2.92, p =0.004, respectively). Conclusions: Elevated mPAP/CO was associated with reduced 6MWD independent from LV and RV diastolic function. These results may recommend that we would assess not only the pressure but also the pressure-flow relationships of the pulmonary circulation in high risk group of PH.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.12350
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 8
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    Abstract 13566: Clinical Utility of Noninvasive Assessment of Flow-pressure Relationship in Scleroderma
    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: Cardiac involvement in Systemic sclerosis (SSc), especially left ventricular diastolic dysfunction (DD), is high prevalence and associated with high mortality. Thus, the early detection of left ventricular DD might be important to manage SSc. Recent study has shown that exercise stress test may evaluate an early stage of heart failure in patients with normal resting echocardiogram. Hypothesis: We hypothesized that SSc patients with normal resting hemodynamics may present early phase of left ventricular DD by exercise echocardiogram, leading to the model of predicting long-term outcomes. Methods: Between January 2014 and December 2018, we prospectively enrolled 140 SSc patients who underwent 6-minute walk (6MW) stress echocardiographic studies with normal range of estimated mean pulmonary arterial pressure (mPAP) ( 〈 25mmHg) and mean pulmonary artery wedge pressure (mPAWP) ( 〈 15mmHg) at rest. We used ΔmPAP/Δcardiac output (CO) to assess pulmonary vascular reserve and ΔmPAWP/ΔCO to assess left ventricular (LV) reserve between resting and post-6MW point. Results: During a median period of 3.6 years, 25 patients (18%) reached the composite outcome. Both ΔmPAP/ΔCO and ΔmPAWP/ΔCO in patients with events were significantly higher than in ones without events (8.9±3.8mmHg/l/min vs. 3.0±1.7mmHg/l/min; p=0.002, and 2.2±0.9mmHg/l/min vs. 0.9±0.5mmHg/l/min; p 〈 0.001, respectively). In addition, ΔmPAWP/ΔCO is strongly associated with events (p=0.04) in patients with normal ΔmPAP/ΔCO (≤median value), although ΔmPAWP/ΔCO had weak impact in patients with abnormal ΔmPAP/ΔCO ( 〉 median value) (p=0.23). Conclusions: Exercise echocardiography revealed impaired LV functional reserve in SSc patients with normal resting hemodynamics. Furthermore, in the group of normal pulmonary vascular function, the patients with impaired LV functional reserve had significantly shorter event-free survival than the ones with non-impaired LV function. Thus, the evaluation of early left ventricular DD with 6MW may detect high-risk group in SSc patients.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13566
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 9
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    Abstract 13438: Rivaroxaban, a Direct Factor Xa Inhibitor, Attenuates Neointima Formation after Mechanical Vascular Injury
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Bachground: Activated factor X (FXa) is a key member in the coagulation cascade responsible for thrombin generation, although accumulating evidence suggests it also has various biological functions in many cell types, contributing to the pathogenesis of neointima formation after vascular injury. In this study, we assessed the hypothesis that rivaroxaban, a direct FXa inhibitor, attenuates neointima formation after mechanical vascular injury by inhibiting both pro-inflammatory activation of macrophages and proliferative activation of vascular smooth muscle cells (VSMCs). Methods and Results: Rivaroxaban (5 mg/kg/day) was administered for 4 weeks to C57BL/6 mice after wire-mediated vascular injury. Plasma lipid levels and blood pressure were similar between rivaroxaban group and the control group. Rivaroxaban significantly reduced neointima area (30452 ± 2531 μm2 vs. 19582 ± 2531 μm2; P 〈 0.05) and intima/media ratio (4.37 ± 0.50 vs. 2.60 ± 0.50; P 〈 0.05) in the injured arteries at four weeks after injury, as determined by elastica van Gieson staining, compared with the control group. In vitro experiments using mouse peritoneal macrophages or murine macrophage cell line RAW264.7 demonstrated that FXa increased mRNA expression of inflammatory molecules (e.g., IL-1β and TNF-α) and vasoproliferative molecules (e.g., PDGF and BMP-2), which was blocked in the presence of rivaroxaban. In vitro experiments using rat VSMCs demonstrated that FXa stimulation promoted both mitogenesis and migration of this cell type, as determined by MTS assay and scratch-wound assay, respectively. Rivaroxaban attenuated these FXa-induced mitogenesis and migration. Conclusions: Rivaroxaban attenuates neointima formation in a mouse model of vascular injury. Our analyses suggest that FXa contributes to both pro-inflammatory activation of macrophages and proliferative activation of VSMCs, participating in the progression of neointima formation after vascular injury. FXa may serve as a potential therapeutic target for neointima formation after vascular injury.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.13438
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 10
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    Preload Stress Echocardiography Predicts Outcomes in Patients With Preserved Ejection Fraction and Low-Gradient Aortic Stenosis
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation: Cardiovascular Imaging Vol. 10, No. 10 ( 2017-10)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 10 ( 2017-10)
    Abstract: The projected aortic valve area (AVA proj ) at a normal transvalvular flow rate using dobutamine is helpful to determine the actual severity of aortic stenosis (AS) and to predict risk of adverse events in low-gradient AS cases with unclear surgical indication. Our study aimed to identify the independent and incremental value of preload stress echocardiography-derived AVA proj to predict outcomes in patients with preserved ejection fraction and low-gradient AS. Methods and Results— We prospectively performed echocardiographic studies in 79 patients with low-gradient AS (age, 77±7 years; 30% men) with preload stress echocardiography using leg positive pressure. AVA proj was calculated using AVA and transvalvular flow rate at baseline and during leg positive pressure. The primary end point was the decision for aortic valve surgery or cardiac death. During a median period of 19 months, 23 patients had the decision for aortic valve surgery, and none died during follow-up. In a stepwise multivariable analysis, indexed AVA proj (AVAi proj ; hazard ratio, 2.00 per 0.1 cm 2 /m 2 decrease; 95% confidence interval, 1.36–2.96; P 〈 0.001) was associated with the primary end point. Using a receiver operating characteristic curve analysis, the best cutoff value of AVAi proj for predicting cardiac events was 〈 0.72 cm 2 /m 2 . By incorporating AVAi proj into AVAi at baseline, continuous net reclassification index for cardiac events was 0.48 ( P =0.04). Conclusions— In patients with low-gradient AS, indexed AVA proj derived from preload stress echocardiography can be useful to predict risk of adverse events. The present article should be considered as a proof of concept study, and we think that larger multicenter studies are warranted.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.117.006690
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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