SHIRAISHI Yasuyuki

写真a

Affiliation

School of Medicine, Department of Internal Medicine (Cardiology) Department of Cardiology (Shinanomachi)

Position

Instructor (None)

Related Websites

External Links

Profile Summary 【 Display / hide

  • 医学の進歩に伴い、個々の心不全患者さんの病態の理解が深まり、がん治療と同様な個別化医療の実現を目指すとともに、患者のニーズに合わせた「患者中心の医療」を実践するための現代的な枠組み構築にも力を注いでいます。

Academic Degrees 【 Display / hide

  • 博士(医学), Keio University, 2017.03

 

Research Areas 【 Display / hide

  • Life Science / Cardiology (Heart Failure)

  • Life Science / Cardiology (循環器救急)

  • Life Science / Cardiology (腫瘍循環器学)

  • Life Science / Sports sciences (心臓リハビリテーション)

Research Keywords 【 Display / hide

  • Heart Failure

  • Personalized Medicine

  • Patient Centered Care

  • Patient Reported Outcome [PRO]

  • 腫瘍循環器学(Onco-Cardiology)

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Books 【 Display / hide

  • 循環器診療エッセンシャル

    永井 利幸(共著), 南江堂, 2022.03,  Page: 260

    Scope: 治療編:エビデンスを踏まえた治療アプローチ「4. 急性心不全」

  • 最新主要文献とガイドラインでみる 循環器内科学レビュー 2022-'23

    清水 渉(共著), 総合医学社, 2021.11,  Page: 413

    Scope: III章 慢性心不全:LVEFの保たれた心不全(HFpEF)患者の治療戦略

  • 心不全診療アップグレード

    佐藤 幸人(共著), 日本医事新報社, 2021.03,  Page: 283

    Scope: 1章 心不全の疫学データの読み方・考え方

  • 心不全治療薬の考え方, 使い方

    大石 醍悟, 北井 豪, 末永 祐哉(共著), 中外医学社, 2019.10,  Page: 295

    Scope: 3章 利尿薬:1. ループ利尿薬 および 2. サイアザイド系利尿薬

  • 内科学書 改訂第9版

    南学 正臣, 伊藤 裕 他(共著), 中山書店, 2019.08

    Scope: 循環器疾患:薬物性・医原性疾患

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Papers 【 Display / hide

  • Machine learning models for prediction of adverse events after percutaneous coronary intervention

    Niimi N., Shiraishi Y., Sawano M., Ikemura N., Inohara T., Ueda I., Fukuda K., Kohsaka S.

    Scientific Reports (Scientific Reports)  12 ( 1 ) 6262 2022.12

     View Summary

    An accurate prediction of major adverse events after percutaneous coronary intervention (PCI) improves clinical decisions and specific interventions. To determine whether machine learning (ML) techniques predict peri-PCI adverse events [acute kidney injury (AKI), bleeding, and in-hospital mortality] with better discrimination or calibration than the National Cardiovascular Data Registry (NCDR-CathPCI) risk scores, we developed logistic regression and gradient descent boosting (XGBoost) models for each outcome using data from a prospective, all-comer, multicenter registry that enrolled consecutive coronary artery disease patients undergoing PCI in Japan between 2008 and 2020. The NCDR-CathPCI risk scores demonstrated good discrimination for each outcome (C-statistics of 0.82, 0.76, and 0.95 for AKI, bleeding, and in-hospital mortality) with considerable calibration. Compared with the NCDR-CathPCI risk scores, the XGBoost models modestly improved discrimination for AKI and bleeding (C-statistics of 0.84 in AKI, and 0.79 in bleeding) but not for in-hospital mortality (C-statistics of 0.96). The calibration plot demonstrated that the XGBoost model overestimated the risk for in-hospital mortality in low-risk patients. All of the original NCDR-CathPCI risk scores for adverse periprocedural events showed adequate discrimination and calibration within our cohort. When using the ML-based technique, however, the improvement in the overall risk prediction was minimal.

  • Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure

    Kitakata H., Kohno T., Kohsaka S., Fujisawa D., Nakano N., Sekine O., Shiraishi Y., Kishino Y., Katsumata Y., Yuasa S., Fukuda K.

    Journal of the American Heart Association (Journal of the American Heart Association)  11 ( 21 ) e026645 2022.11

     View Summary

    Background The implementation of advance care planning (ACP) in heart failure management is insufficient. Social isolation (SI) could be a barrier to ACP initiation, albeit the relationship between SI and patients' preference for ACP or end-of-life care remains unknown. Methods and Results We conducted a questionnaire survey, including assessments of SI using the 6-item Lubben Social Network Scale as well as patients' perspectives on ACP and end-of-life care. Of the 160 patients approached by our multidisciplinary heart failure team during admission, 120 patients (75.0%) completed the survey (median age, 73.0 years; men, 74.2%). A Cox proportional hazard model was constructed to elucidate the short-term (180-day) prognostic impact of SI. Overall, 28.3% of participants were at high risk for SI (6-item Lubben Social Network Scale score <12). High-risk patients had more negative attitudes toward ACP than those without (61.8% versus 80.2%; P=0.035). The actual performance of ACP conversation in patients with and without high risk were 20.6% and 30.2%, respectively. Regarding preference in end-of-life care, "Saying what one wants to tell loved ones" (73.5% versus 90.6%; P=0.016) and "Spending enough time with family" (58.8% versus 77.9%; P=0.035) were less important in high-risk patients. High risk for SI was associated with higher 180-day risk-adjusted all-cause mortality (hazard ratio, 7.89 [95% CI, 1.53-40.75]). Conclusions In hospitalized patients with heart failure, high risk for SI was frequently observed. High-risk patients were associated with a negative attitude toward ACP, despite higher mortality. Further research is required to establish an ideal approach to provide ACP in socially vulnerable patients.

  • Low blood pressure and guideline-directed medical therapy in patients with heart failure with reduced ejection fraction.

    Izumi K, Kohno T, Goda A, Takeuchi S, Shiraishi Y, Saji M, Nagatomo Y, Tanaka TD, Takei M, Nakano S, Soejima K, Kohsaka S, Yoshikawa T, West Tokyo Heart Failure Registry Investigators.

    International journal of cardiology (International Journal of Cardiology)   2022.10

    ISSN  0167-5273

     View Summary

    Background: Patients with heart failure (HF) presenting with low blood pressure (BP) have been underrepresented in large-scale clinical trials. We investigated the characteristics and implementation of conventional guideline-directed medical therapy (GDMT; renin-angiotensin system inhibitors and β-blockers) in patients with low BP hospitalized for HF with systolic dysfunction. Methods: Conventional GDMT was evaluated by discharge BP among 2043 consecutive patients with HF and left ventricular ejection fraction (LVEF) < 50% in the WET-HF registry. Among the 708 (34.7%) patients with lower discharge BP (≤ 100 mmHg; the lower tertiles), exploratory subgroups included patients with previous HF hospitalization, inotrope use, New York Heart Association (NYHA) III–IV class, and lower estimated glomerular filtration rate (eGFR) and LVEF (lower than median value). We evaluated the risk-adjusted association between GDMT implementation and 2-year adverse events (all-cause mortality or HF rehospitalization). Results: Among the 2043 patients (age 74 [63–82] years), the median systolic BP was 108 (98–120) mmHg. Among patients with lower BP, GDMT prescription rate was 62.7%, and GDMT use was associated with decreased adverse events (HR:0.74, 95%CI:0.58–0.94). GDMT prescription rates were lower among higher-NYHA class and lower-eGFR subgroups compared with their reference subgroups, and directionally similar outcomes were noted in all subgroups (favoring GDMT use); however, this association was somewhat attenuated in the lower-eGFR group (HR:0.87, 95%CI:0.64–1.17). Conclusions: Conventional GDMT use was associated with decreased adverse outcomes in most patients with HF compounded by systolic dysfunction and low BP, albeit caution is warranted in patients with renal dysfunction.

  • Malnutrition in real-world patients hospitalized for heart failure with preserved ejection fraction and its potential impact on generalizability of EMPEROR-Preserved trial.

    Takeuchi S, Kohno T, Goda A, Shiraishi Y, Saji M, Nagatomo Y, Tanaka TD, Takei M, Nakano S, Soejima K, Kohsaka S, Yoshikawa T, West Tokyo Heart Failure Registry Investigators.

    International journal of cardiology (International Journal of Cardiology)   2022.10

    ISSN  0167-5273

     View Summary

    Background: Despite the benefits of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin, its suitability for patients with heart failure (HF) in the real-world setting remains unclear. Considering the unique pharmacological profile of SGLT2i (e.g., glucose excretion leading to calorie loss) and increasingly aging patients with HF, applicability of trials' finding in patients with malnutrition is important. Methods: We examined 1633 consecutive patients with a preserved left ventricular ejection fraction (LVEF; >40%) enrolled in a multicenter-based acute HF registry. After applying the EMPEROR-Preserved eligibility criteria, we compared the baseline characteristics of trial-eligible and actual trial participants, and patients with and without malnutrition among the trial-eligible group. Malnutrition was assessed by the geriatric nutritional risk index (GNRI). The trial-eligible patients were divided into high (GNRI≥92) and low (GNRI<92) nutritional groups, and a composite endpoint comprising all-cause death and HF rehospitalization was evaluated. Results: Majority (70.2%) of the analyzed patients were eligible for the EMPEROR-Preserved trial (age: 77 ± 12 years and body mass index [BMI]: 22.0 ± 4.1 kg/m2), but were older and had lower BMIs than the actual trial participants. Notably, 51.9% of the eligible patients were at high risk for malnutrition and had a higher rate of the composite endpoint than non-malnourished counterparts (HR 1.27, 95%CI 1.04–1.56, P = 0.020). The difference in outcomes was predominantly due to mortality from non-cardiac causes. Conclusions: Mostly patients with HF in a real-world setting met the EMPEROR-Preserved criteria; however, approximately half were at high risk for malnutrition with poorer outcomes owing to non-cardiac-related causes.

  • Confidence in self-care after heart failure hospitalization.

    Hashimoto S, Kitakata H, Kohsaka S, Fujisawa D, Shiraishi Y, Nakano N, Sekine O, Kishino Y, Katsumata Y, Yuasa S, Fukuda K, Kohno T

    Journal of cardiology  2022.10

    ISSN  0914-5087

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Reviews, Commentaries, etc. 【 Display / hide

  • 【避けて通れない心不全診療】患者中心の心不全診療を目指して ~予後予測モデルの上手な使い方~

    白石 泰之

    medicina (医学書院)  59 ( 12 ) 2118 - 2122 2022.11

    Joint Work, Lead author,  ISSN  0025-7699

  • 【循環器学2021年の進歩】心不全診療の進歩 ~心不全の新規薬物療法と心筋再生医療への期待~

    白石 泰之, 福田 恵一

    循環器専門医 ((一社)日本循環器学会)  30   88 - 94 2021.08

    Lead author,  ISSN  0918-9599

  • 【臨床各科】難渋症例から学ぶ診療のエッセンス「eclipsed MR」

    梅井 智彦, 白石 泰之, 福田 恵一

    日本医事新報 ((株)日本医事新報社)   ( 5066 ) 10 - 11 2021.05

    Corresponding author,  ISSN  0385-9215

  • 【心不全急性期治療の循環管理】時間軸に基づく急性心不全治療

    白石 泰之

    INTENSIVIST(特集: 循環器集中治療 Critical Care Cardiology) ((株)メディカル・サイエンス・インターナショナル)  13 ( 1 ) 17 - 27 2021.01

    ISSN  1883-4833

     View Summary

    <文献概要>心不全診療にかかる医療面および社会・経済面での負担は莫大であり,今後しばらくは増えることはあっても減ることはない。心不全は増悪と好転を繰り返しながら慢性的に進行する症候群であり,安定期(慢性期)と増悪期(急性期)でその治療に対する考え方は異なる。心不全の急性期治療の選択肢はここ四半世紀で大きな変化はないが,ほかの循環器救急疾患と同様に「時間軸」の重要性が徐々に認識され,日本を含む世界の心不全診療ガイドラインのなかで早期診断・早期介入が強調されるに至っている。心不全急性期においては,うっ血と組織低灌流という2つの病態に対して的確な把握と対応をし,すみやかに血行動態を安定化させ,その後の慢性期治療(予後改善をめざした)へつなげていくことが肝要である。

  • 【心不全の疫学】心不全予後予測スコアとその使い方 ~効果的かつ効率的な医療を実践するために~

    白石 泰之

    Hospitalist(特集:心不全) ((株)メディカル・サイエンス・インターナショナル)  6 ( 4 ) 793 - 805 2018.12

    ISSN  2188-0409

     View Summary

    <文献概要>Summary ●心不全患者数は向こう10〜20年間は増加の一途をたどり,さらに患者の高齢化が劇的に進んでいる。日本の心不全患者の入院期間は依然として世界標準よりも長いが(15日前後),長期予後は欧米諸国に比べると良好である。●年齢や血圧,尿素窒素,血中ナトリウム濃度,そしてBNP/NT-proBNP値などが心不全患者における単独の強力な予後予測因子である。●心不全リスクモデルのなかで,GWTG-HF Risk ScoreあるいはSeattle Heart Failure Model, MAGGIC Heart Failure Risk Scoreは,日本人における当てはまりが確認されており,実際に臨床現場で使用することも可能である。●いかに熟練の医師といえども,心不全患者の予後予測は困難な場合も多く,リスクモデルによる客観的な予後予測は有用である。予後予測(リスク評価)は医療者,患者の治療方針あるいは意思決定の支柱であり,効果的かつ効率的な医療の実践のためには,リスクモデルを用いた評価が不可欠である。

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Presentations 【 Display / hide

  • 観察研究からランダム化比較試験へ ~Pragmatic trial への挑戦~

    白石 泰之

    第70回 日本心臓病学会学術集会, 

    2022.09

    Symposium, workshop panel (nominated)

  • Electrocardiography-Based Prediction of Sudden Cardiac Death in Heart Failure Patients: Application of Artificial Intelligence

    白石 泰之

    第86回 日本循環器学会学術集会, 

    2022.03

    Symposium, workshop panel (public)

  • 心不全診療の進歩2020-薬物治療から心移植まで-

    白石 泰之

    第40回 東京CCU研究会, 

    2020.12

    Symposium, workshop panel (nominated)

  • 絶対リスクに基づく急性心不全診療

    白石 泰之, 香坂 俊, 合田 あゆみ, 長友 祐司, 佐地 真育, 西畑 庸介, 武井 眞, 河野 隆志, 福田 恵一, 吉川 勉

    第24回 日本心不全学会学術集会, 

    2020.10

    Symposium, workshop panel (nominated)

  • 心不全患者へ対する非侵襲的生体センサを用いた多角的生体情報遠隔モニタリング

    白石 泰之, 川久保 裕美子, 片岡 雅晴, 勝俣 良紀, 中野 直美, 香坂 俊, 福田 恵一

    第24回 日本心不全学会学術集会, 

    2020.10

    Symposium, workshop panel (nominated)

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Research Projects of Competitive Funds, etc. 【 Display / hide

  • 運動支援プログラムを含む遠隔生体情報モニタリング基盤の開発研究

    2023.04
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    Present

    Keio University, 若手研究者のための健康科学研究助成, 明治安田厚生事業団 , Principal investigator

  • 心血管疾患に対する、運動支援プログラムに関する研究開発

    2022.10
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    Present

    慶應義塾大学, 循環器疾患・糖尿病等生活習慣病対策実用化研究事業 生活習慣病の予防・診断・治療のための医療機器開発に関する研究, 国立研究開発法人 日本医療研究開発機構, Commissioned research, Coinvestigator(s)

  • 心不全患者に対する、身体診察動画とAIを用いた非侵襲的うっ血評価技術の開発

    2022.04
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    Present

    Keio University, 橋渡し研究プログラム・シーズA, Japan Agency for Medical Research and Development (AMED), Principal investigator

  • 心房細動患者に対する抗凝固療法による消化管出血性合併症の臨床像と重症度同定

    2021.04
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    Present

    Keio University, Grant-in-Aid for Scientific Research (C), Coinvestigator(s)

     View Summary

    心房細動の抗凝固療法は、脳卒中抑制効果と出血性合併症の安全性が証明されている新規経口抗凝固薬 (DOAC) が世界的に主流となってきている。我が国ではDOACを服用した心房細動患者の消化管出血発症率は年間 1.9% と高頻度であることが報告されているに留まり、本合併症発症時における薬剤の休薬・再開基準においては、さらなる実臨床での検証が急務であるとされている。本研究では、申請者自らが構築してきたレジストリシステムを発展的に活用し、日本人患者における抗凝固療法中の消化管出血の頻度、特徴、さらに出血イベントの予後に関する検証を行う。

  • 画像情報と深層学習を応用した心疾患患者の予後予測と革新的な治療戦略の開発

    2021.04
    -
    2022.03

    上原記念生命科学財団, 研究奨励金(新領域 4.0), Research grant, Principal investigator

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Intellectual Property Rights, etc. 【 Display / hide

Awards 【 Display / hide

  • 第86回 日本循環器学会学術集会 Young Investigator's Award: Clinical Research

    2022.03

    Type of Award: Award from Japanese society, conference, symposium, etc.

  • 第38回 東京CCU研究会 殊勲賞

    2018.12

    Type of Award: Award from Japanese society, conference, symposium, etc.

  • 第13回 日本心臓リハビリテーション学会学術集会 Young Investigator's Award

    2016.09

    Type of Award: Award from Japanese society, conference, symposium, etc.

  • 第33回 東京CCU研究会 最優秀演題賞

    2013.12

    Type of Award: Award from Japanese society, conference, symposium, etc.

 

Courses Taught 【 Display / hide

  • LECTURE SERIES, INTERNAL MEDICINE (CARDIOLOGY)

    2022

  • LECTURE SERIES, INTERNAL MEDICINE (CARDIOLOGY)

    2021

  • 医学概論(大学院修士課程)講義

    2020, Graduate (liberal arts), Lecture, Within own faculty

  • 学生自主学習

    2018

  • 学生自主学習

    2017

 

Memberships in Academic Societies 【 Display / hide

  • 日本内科学会, 

    2010.04
    -
    Present
  • 日本循環器学会, 

    2011.04
    -
    Present
  • 日本心臓病学会, 

    2012.04
    -
    Present
  • 日本心不全学会, 

    2016.04
    -
    Present
  • 日本心臓リハビリテーション学会, 

    2017.04
    -
    Present

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Committee Experiences 【 Display / hide

  • 2020.10
    -
    Present

    関東甲信越支部 学術委員会 委員, 日本循環器学会