Details of a Researcher - SHIRAISHI Yasuyuki

Papers - SHIRAISHI Yasuyuki

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Physician-Reported Reasons for Not Prescribing Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction: A Prospective Registry Analysis

Ichihara-Kawakubo Y, Shiraishi Y, Sawano M, Kohno T, Nagatomo Y, Kitamura M, Sakamoto M, Nomoto M, Mizuno A, Takei M, Shoji S, Soejima K, Ieda M, Kohsaka S, Yoshikawa T.

European Journal of Heart Failure 2025.09

Research paper (scientific journal), Joint Work, Corresponding author, Accepted, ISSN 1388-9842

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Residual pulmonary hypertension and clinical outcomes in acute decompensated heart failure patients stratified by left ventricular ejection fraction

Tanaka DT, Shiraishi Y, Kang R, Kohno T, Shoji S, Okuyama T, Oi Y, Goda A, Nakamaru R, Nagatomo Y, Kitamura M, Sakamoto M, Nomoto M, Mizuno A, Nagoshi T, Kohsaka S, Yoshikawa T.

European Journal of Heart Failure 27 ( 12 ) 3342 - 3351 2025.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 1388-9842

Aims: The precise outcomes for patients with residual pulmonary hypertension (PH) following the optimized treatment of acute decompensated heart failure (ADHF) remain poorly understood. This study aimed to investigate the prognostic association of PH, categorized according to left ventricular ejection fraction (LVEF), in hospitalized ADHF patients.

Methods and results: The WET-HF registry is a multicentre, prospective cohort ADHF registry. Patients were classified into four groups according to tricuspid regurgitation velocity (TRV) and LVEF. PH was defined as peak TRV >2.8 m/s. The primary endpoint was a composite of all-cause mortality and heart failure (HF) rehospitalization at 2 years. In total, 1702 patients had nonPH-HF with LVEF <50% (n = 689 [40.5%]), PH-HF with LVEF <50% (n = 291 [17.1%]), nonPH-HF with LVEF ≥50% (n = 453 [26.6%]), and PH-HF with LVEF ≥50% (n = 269 [15.8%]). A significant difference in the composite endpoint was observed between patients with and without PH (42.3% vs. 30.4%, p < 0.001), with no significant interaction between PH and LVEF. Notably, in the nonPH-HF group, there were significant differences in clinical outcomes between patients with more than 30% B-type natriuretic peptide (BNP) improvement and those with less (composite endpoint 27.5% vs. 41.8%, p < 0.001; all-cause mortality 9.4% vs. 24.6%, p < 0.001; HF rehospitalization 20.2% vs. 32.8%, p = 0.001). However, no such difference was evident in the PH-HF group.

Conclusions: The prognostic importance of residual PH was comparable across both HF with reduced and preserved ejection fraction patients. While the prognostic significance of BNP improvement on clinical outcomes was attenuated in the presence of residual PH, utilizing residual PH for risk stratification effectively identified patients at increased risk of mortality and rehospitalization following ADHF, irrespective of their LVEF.

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Hospital Variability in the Use of Vasoactive Agents in Patients Hospitalized for Acute Decompensated Heart Failure for Clinical Phenotypes

Shiraishi Y, Niimi N, Kohsaka S, Harada K, Kohno T, Takei M, Jimba T, Nakano H, Matsuda J, Shindo A, Kitano D, Tsukamoto S, Koba S, Yamamoto T, Takayama M

Circulation: Cardiovascular Quality and Outcomes 18 ( 3 ) e011270 2024.12

Research paper (scientific journal), Joint Work, Lead author, Accepted, ISSN 19417713

BACKGROUND: The absence of practice standards in vasoactive agent usage for acute decompensated heart failure has resulted in significant treatment variability across hospitals, potentially affecting patient outcomes. This study aimed to assess temporal trends and institutional differences in vasodilator and inotrope/vasopressor utilization among patients with acute decompensated heart failure, considering their clinical phenotypes.
METHODS: Data were extracted from a government-funded multicenter registry covering the Tokyo metropolitan area, comprising consecutive patients hospitalized in intensive/cardiovascular care units with a primary diagnosis of acute decompensated heart failure between January 2013 and December 2021. Clinical phenotypes, that is, pulmonary congestion or tissue hypoperfusion, were defined through a comprehensive assessment of clinical signs and symptoms, vital signs, and laboratory findings. We assessed the frequency and temporal trends in phenotype-based drug utilization of vasoactive agents and investigated institutional characteristics associated with adopting the phenotype-based approach using generalized linear mixed-effects models, with random intercepts to account for hospital-level variability.
RESULTS: Among 37 293 patients (median age, 80 years; 43.7% female), 88.6% and 21.2% had pulmonary congestion and tissue hypoperfusion status, respectively. Throughout the study period, both overall and phenotype-based vasodilator utilizations showed significant declines, with overall usage dropping from 61.4% in 2013 to 48.6% in 2021 (Ptrend<0.001). Conversely, no temporal changes were observed in overall inotrope/vasopressor utilization from 24.6% in 2013 to 25.8% in 2021 or the proportion of phenotype-based utilization. Notably, there was considerable variability in phenotype-based drug utilization among hospitals, with a median ranging from 48.3% to 77.8%. In multivariable-adjusted models, a higher number of board-certified cardiologists were significantly associated with lower rates of phenotype-based vasodilator utilization and reduced inappropriate inotrope/vasopressor utilization, while tertiary care hospitals were linked to more appropriate inotrope/vasopressor utilization.
CONCLUSIONS: Substantial variability existed among hospitals in phenotype-based drug utilization of vasoactive agents for patients with acute decompensated heart failure, highlighting the need for standardized treatment protocols.

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Improved prediction of sudden cardiac death in patients with heart failure through digital processing of electrocardiography.

Shiraishi Y, Goto S, Niimi N, Katsumata Y, Goda A, Takei M, Saji M, Sano M, Fukuda K, Kohno T, Yoshikawa T, Kohsaka S

EP Europace : Journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 25 ( 3 ) 922 - 930 2023.01

Research paper (scientific journal), Lead author, Corresponding author, Accepted, ISSN 1099-5129

Aims: Available predictive models for sudden cardiac death (SCD) in heart failure (HF) patients remain suboptimal. We assessed whether the electrocardiography (ECG)-based artificial intelligence (AI) could better predict SCD, and also whether the combination of the ECG-AI index and conventional predictors of SCD would improve the SCD stratification among HF patients.
Methods and results: In a prospective observational study, 4 tertiary care hospitals in Tokyo enrolled 2559 patients hospitalized for HF who were successfully discharged after acute decompensation. The ECG data during the index hospitalization were extracted from the hospitals' electronic medical record systems. The association of the ECG-AI index and SCD was evaluated with adjustment for left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and competing risk of non-SCD. The ECG-AI index plus classical predictive guidelines (i.e. LVEF ≤35%, NYHA Class II and III) significantly improved the discriminative value of SCD [receiver operating characteristic area under the curve (ROC-AUC), 0.66 vs. 0.59; P = 0.017; Delong's test] with good calibration (P = 0.11; Hosmer-Lemeshow test) and improved net reclassification [36%; 95% confidence interval (CI), 9-64%; P = 0.009]. The Fine-Gray model considering the competing risk of non-SCD demonstrated that the ECG-AI index was independently associated with SCD (adjusted sub-distributional hazard ratio, 1.25; 95% CI, 1.04-1.49; P = 0.015). An increased proportional risk of SCD vs. non-SCD with an increasing ECG-AI index was also observed (low, 16.7%; intermediate, 18.5%; high, 28.7%; P for trend = 0.023). Similar findings were observed in patients aged ≤75 years with a non-ischaemic aetiology and an LVEF of >35%.
Conclusion: To improve risk stratification of SCD, ECG-based AI may provide additional values in the management of patients with HF.

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Validation and Recalibration of Seattle Heart Failure Model in Japanese Acute Heart Failure Patients

Shiraishi Y, Kohsaka S, Nagai T, Goda A, Mizuno A, Nagatomo Y, Sujino Y, Fukuoka R, Sawano M, Kohno T, Fukuda K, Anzai T, Shadman R, Dardas T, Levy W, Yoshikawa T

Journal of Cardiac Failure 25 ( 7 ) 561 - 567 2019.07

Research paper (scientific journal), Joint Work, Lead author, Accepted, ISSN 10719164

Background: Precise risk stratification in heart failure (HF) patients enables clinicians to tailor the intensity of their management. The Seattle Heart Failure Model (SHFM), which uses conventional clinical variables for its prediction, is widely used. We aimed to externally validate SHFM in Japanese HF patients with a recent episode of acute decompensation requiring hospital admission.
Methods and Results: SHFM was applied to 2470 HF patients registered in the West Tokyo Heart Failure and National Cerebral And Cardiovascular Center Acute Decompensated Heart Failure databases from 2006 to 2016. Discrimination and calibration were assessed with the use of the c-statistic and calibration plots, respectively, in HF patients with reduced ejection fraction (HFrEF; <40%) and preserved ejection fraction (HFpEF; ≥40%). In a perfectly calibrated model, the slope and intercept would be 1.0 and 0.0, respectively. The method of intercept recalibration was used to update the model. The registered patients (mean age 74 ± 13 y) were predominantly men (62%). Overall, 572 patients (23.2%) died during a mean follow-up of 2.1 years. Among HFrEF patients, SHFM showed good discrimination (c-statistic = 0.75) but miscalibration, tending to overestimate 1-year survival (slope = 0.78; intercept = −0.22). Among HFpEF patients, SHFM showed modest discrimination (c-statistic = 0.69) and calibration, tending to underestimate 1-year survival (slope = 1.18; intercept = 0.16). Intercept recalibration (replacing the baseline survival function) successfully updated the model for HFrEF (slope = 1.03; intercept = −0.04) but not for HFpEF patients.
Conclusions: In Japanese acute HF patients, SHFM showed adequate performance after recalibration among HFrEF patients. Using prediction models to tailor the care for HF patients may improve the allocation of medical resources.

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Prognostic Implications of Hemoglobin Drop With and Without Overt Bleeding After Percutaneous Coronary Intervention

Suzuki T., Kohsaka S., Shoji S., Shiraishi Y., Sawano M., Ohata T., Yoneoka D., Asano T., Nakamaru R., Noma S., Ueda I., Numasawa Y., Ieda M.

Jacc Asia 5 ( 12 ) 1590 - 1601 2025.12

Background Although most established bleeding definitions primarily emphasize overt bleeding, endpoints from major clinical trials and studies have historically defined major bleeding to include a periprocedural hemoglobin drop of ≥3.0 g/dL. However, the clinical relevance of this laboratory-based criterion, particularly without overt bleeding, remains uncertain. Objectives The authors investigated the prognostic implication of a periprocedural hemoglobin drop of ≥3.0 g/dL, especially without overt bleeding. Methods Consecutive patients were analyzed from a Japanese registry between 2008 and 2021 after percutaneous coronary intervention (PCI). Patients were classified by hemoglobin drop (≥3.0 g/dL decrease between pre- and post-PCI) and overt bleeding. Cox regression assessed associations between these groups and 2-year major adverse cardiac events (MACE, such as all-cause mortality, acute coronary syndrome, heart failure hospitalization, and stroke). Results Among 7,145 patients (mean age: 69 years; 77.0% male), 73 (1.0%) had both overt bleeding and hemoglobin drop; 85 (1.2%) had overt bleeding only; 590 (8.3%) had hemoglobin drop only; and 6,397 (89.5%) had no bleeding (reference). MACE occurred in 872 (12.2%; 95% CI: 11.5-13.0) patients during the median follow-up period of 730 (Q1-Q3: 730-730) days. MACE incidence was 30.1% (95% CI: 19.9-42.0) in patients with overt bleeding and hemoglobin drop, with higher risk than those without bleeding (adjusted HR: 2.16; 95% CI: 1.37-3.42). Only those patients with hemoglobin drop were not at increased risk of MACE (adjusted HR: 1.20; 95% CI: 0.89-1.60). Conclusions Hemoglobin drop with overt bleeding after PCI was associated with increased 2-year MACE risk, whereas hemoglobin drop without overt bleeding had less prognostic relevance, highlighting the importance of clinical context in evaluating post-PCI bleeding.

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Inhaled Treprostinil: Improvements in Hemodynamics and Quality of Life for Patients with Pulmonary Arterial Hypertension on Dual or Triple Therapy

Ikegami S., Hiraide T., Maeda T., Momoi M., Shinya Y., Anzai A., Shiraishi Y., Katsumata Y., Ieda M.

Journal of Clinical Medicine 14 ( 24 ) 2025.12

ISSN 2077-0383

Background: Pulmonary arterial hypertension (PAH) leads to right ventricular failure and death. Inhaled treprostinil, a tricyclic benzindene prostacyclin analog, has become available, but evidence regarding its clinical efficacy and quality-of-life (QoL) benefits—particularly in patients already receiving optimized combination vasodilator therapy—remains limited. Methods: Inhaled treprostinil was introduced to nine patients with PAH already receiving combination therapy with pulmonary vasodilators. Acute hemodynamic effects were assessed during initial right heart catheterization, and long-term effects were evaluated at baseline and 3 months after treatment. Exercise tolerance was assessed by the 6-minute walking distance (6MWD) test and cardiopulmonary exercise testing, while QoL was evaluated using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Results: Mean pulmonary arterial pressure significantly improved both acutely (48.9 ± 17.8 to 43.7 ± 14.5 mmHg, p = 0.036) and at 3 months (46.4 ± 16.1 to 39.8 ± 14.1 mmHg, p = 0.014). Pulmonary vascular resistance tended to decrease, while 6MWD outcomes remained unchanged. QoL improved, with KCCQ-12 overall and clinical summary scores increasing from 59.1 ± 27.4 to 67.1 ± 26.5 and 78.1 ± 26.3 to 87.5 ± 21.2, respectively. Conclusions: Treprostinil inhalation improved hemodynamics and patient-reported outcomes despite prior combination improved hemodynamics and tended to enhance QoL in patients with PAH receiving combination vasodilator therapy.

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【新しい心不全診療ガイドラインに学ぶ-救急・集中治療領域で知っておいてほしいこと-】急性非代償性心不全　薬物療法

山崎雄友, 池上翔梧, 白石泰之

救急・集中治療 ((株)総合医学社) 37 ( 4 ) 641 - 649 2025.11

ISSN 1346-0935

上行結腸癌再発に対するBRAF/MEK阻害薬の投与中に左室機能障害を呈したが,心保護薬導入とMEK阻害薬中止により化学療法を継続し得た1例

醍醐恭平, 白石泰之, 浜本康夫, 関根乙矢, 岸野喜一, 香坂俊, 家田真樹

心臓 ((公財)日本心臓財団) 57 ( 11 ) 1192 - 1199 2025.11

ISSN 0586-4488

背景:大腸癌においてBRAF V600E変異は予後不良因子であり,BRAF/MEK阻害薬による予後改善が期待される反面,左室機能障害の有害事象が報告されている.がん治療を継続する上で腫瘍科との連携を含めた心血管系疾患のマネジメントが必須である.症例:83歳男性.BRAF V600E変異陽性の再発上行結腸癌に対して,BRAF/MEK阻害薬による加療目的に紹介された.X年7月よりEncorafenib,Binimetinib,Cetuximabが開始されたが,低血圧,頻脈を契機に9月に中止となり,その際の12誘導心電図検査で新規陰性T波が認められた.左室駆出率低下および心バイオマーカー上昇があり,がん治療関連心筋障害として入院した.冠動脈疾患や原発性および他の二次性心筋症を示唆する検査所見はなく,BRAF/MEK阻害薬による心筋障害と考えられ,心保護薬を導入後に退院した.その間に大腸癌の進行が認められたため,腫瘍科との協議の結果,MEK阻害薬は中止した上でBRAF阻害薬とCetuximabが再開された.以後,約10ヵ月にわたり化学療法を継続することができたが,X+1年10月のCT検査でリンパ節転移増大が認められ,best supportive careの方針となった.結語:がん診療において治療の継続は予後改善のために重要であり,腫瘍科と循環器科の緊密な協議による治療方針選択が必要である.(著者抄録)

Patient-centered medical tools for sustained motivation in cardiac rehabilitation of patients with heart failure: protocol of a multicenter randomized controlled trial (EXERCISE-HF trial)

Yamaoka K., Katsumata Y., Kohsaka S., Shiraishi Y., Kondo M., Nagashima K., Onoue T., Kataoka M., Watanabe T., Nakashima D., Muramoto Y., Sato Y., Sato K., Nakamura M., Ieda M.

Contemporary Clinical Trials Communications 47 101522 2025.10

Introduction: Heart failure substantially affects the quality of life of patients and imposes notable social and economic burdens. Despite the beneficial effects of cardiac rehabilitation, global participation rates remain low. Recent advances in wearable biometric technologies may improve patient adherence through real-time monitoring and personalized feedback. This study aimed to develop and evaluate an exercise-support program that integrates wearable devices to enhance rehabilitation outcomes in patients with heart failure. Methods: An innovative and practical cardiac rehabilitation program combined with a wearable device was developed based on patients and physicians’ feedback. A multicenter randomized controlled clinical trial was designed to evaluate the safety and effectiveness of the application in patients with heart failure in Japan from October 2022 to January 2025. Compared with traditional exercise-monitoring applications, the developed application offers an array of features that are designed to foster patient engagement and promote long-term adherence. These features include (1) individualized goal setting, (2) direct communication with healthcare providers, (3) education on heart failure through instructional videos, (4) automated motivational feedback, and (5) a curated library of research summaries on cardiac rehabilitation and self-care. Patients who meet the inclusion criteria (including those aged ≥18 years with a clinical diagnosis of heart failure) will be randomly assigned to one of two groups as follows: the integrated exercise-support app group or the standard care group, in which only a wearable device was implemented. The change in peak VO<inf>2</inf> at 12 weeks, adjusted for baseline and allocation factors, will be analyzed as the primary endpoint. The secondary outcomes include quality-of-life measures and re-hospitalization rates. Data analysis will follow the intention-to-treat principle, with results reported as two-tailed 95 % confidence intervals and corresponding p-values. This study was approved by the relevant institutional ethics committee (approval number: DB23-001; iRCT: 2032230388). Informed consent will be obtained from all participants before study participation. The results of the study will be disseminated through peer-reviewed publications and presented at relevant scientific meetings.

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Evolution and Challenges of Physician-Led Home Visits in Japan.

Daigo K, Kohsaka S, Shiraishi Y, Ieda M

International journal for quality in health care : journal of the International Society for Quality in Health Care 2025.09

ISSN 1353-4505

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Vericiguat and hypotension in patients with heart failure and reduced ejection fraction: VERIFY-HF registry.

Matsumoto S, Nasu T, Fujimoto W, Kagiyama N, Shiraishi Y, Ishii S, Ijichi T, Nakazawa G, Ikeda T, Kanaoka K, VERIFY-HF investigators

American heart journal 292 107281 2025.09

ISSN 0002-8703

Background Real-world characteristics and outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF) treated with vericiguat remain unclear. We investigated patient characteristics, hypotension—the most relevant clinical event—, and outcomes after initiating vericiguat in patients with HFrEF. Methods In this nationwide, multicentre retrospective study involving 22 hospitals in Japan, we examined symptomatic or asymptomatic hypotension and drug discontinuation within 90 days after initiation of vericiguat in patients with left ventricular ejection fraction <45%. The association between hypotension and HF outcomes was also examined. Results Among the 799 patients with HFrEF, the mean age was 69.6 years, and 218 (27.3%) were female. Of them, 316 (39.5%) had New York Heart Association classification III or IV, and 329 (41.8%) had systolic blood pressure (sBP) <100 mm Hg. Hypotension was observed in 25.3% of patients within 90 days, with asymptomatic hypotension being the most common (17.9%). By contrast, drug discontinuation related to hypotension was less frequent (4.4%). After adjustment, sBP <100 mm Hg, low body mass index, and in-hospital vericiguat initiation were associated with the incidence of hypotension within 90 days. Patients who experienced hypotension had a greater risk of cardiovascular death or HF hospitalization than those who did not ( P = .01). Conclusions Although hypotension was relatively common soon after starting vericiguat, they were not often associated with drug discontinuation. Patients experiencing hypotension had a greater risk of HF outcomes, but this would be primarily associated with their vulnerability, given the infrequent discontinuation.

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経食道心エコー図検査で疑われた左心耳血栓を腹臥位遅延相CTで否定し得た1例

杉本遼太, 平出貴裕, 白石泰之, 安西淳, 木村雄弘, 林田健太郎, 香坂俊, 家田真樹

日本内科学会関東地方会 (日本内科学会-関東地方会) 707回 33 - 33 2025.09

Association Between Mineralocorticoid Receptor Antagonist Use With Worsening Renal Function and Prognosis in Patients With Acute Heart Failure.

Fujimoto Y, Shiraishi Y, Nogi K, Kohsaka S, Kohno T, Kitamura M, Nagatomo Y, Ueda T, Nogi M, Ishihara S, Nakada Y, Kawakami R, Kitai T, Oishi S, Akiyama E, Suzuki S, Yamamoto M, Kida K, Okumura T, Yoshikawa T, Saito Y, Matsue Y

Journal of the American Heart Association 14 ( 14 ) e040252 - 10 2025.07

BACKGROUND: Prognostic implications of mineralocorticoid receptor antagonist (MRA) initiation in the context of worsening renal function (WRF) in patients with acute heart failure (AHF) remain unknown. METHODS: This was a post hoc analysis using data from Japanese AHF registries (NARA-HF [Nara Registry and Analyses for Heart Failure], WET-HF [West Tokyo Heart Failure], REALITY-AHF [Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure]). MRA-naïve patients at baseline were included, comprising 1632 patients with HF with reduced ejection fraction (HFrEF) and 2407 with heart failure with mildly reduced or preserved ejection fraction (HFmr/pEF). They were divided into 3 groups: MRA initiated without WRF (HFrEF, n=590; HFmr/pEF, n=572), MRA initiated with WRF (HFrEF, n=74; HFmr/pEF, n=100), and no MRA initiation (HFrEF, n=968; HFmr/pEF, n=1735). WRF was defined as a 0.3 mg/dL increase from admission to discharge. The composite of death or HF hospitalization after discharge was assessed. RESULTS: During the 1-year follow-up, 369 and 593 events occurred in patients with HFrEF and HFmr/pEF, respectively. Overall, MRA initiation during hospitalization of AHF was independently associated with better prognosis (hazard ratio [HR], 0.81), mainly driven by HF hospitalization. Among patients with HFrEF, the groups with MRA with and without WRF showed a lower incidence of the outcome than the no-MRA group, even after adjusting for risk factors (HR, 0.75 and 0.49, respectively). Among patients with HFmr/pEF, MRA initiation without WRF was independently associated with better prognosis (HR, 0.78), but MRA initiation with WRF was not. CONCLUSIONS: Initiating an MRA during AHF hospitalization was associated with better postdischarge outcomes in HFrEF, irrespective of creatinine elevation, whereas no such consistent association was observed in HFmr/pEF.

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Risk-Stratified Prognostic Implications of Contrast-Associated Acute Kidney Injury After Percutaneous Coronary Intervention

Suzuki T., Kohsaka S., Spertus J.A., Shoji S., Shiraishi Y., Ikemura N., Nakamaru R., Ohata T., Kodaira M., Ueda I., Noma S., Numasawa Y., Ieda M.

Jacc Advances 4 ( 7 ) 101899 2025.07

Background: The clinical importance of contrast-associated acute kidney injury (CA-AKI), the most common complication after percutaneous coronary intervention (PCI), is debated. Objectives: We aimed to assess the association between CA-AKI and long-term outcomes, overall and across the National Cardiovascular Data Registry (NCDR) AKI risk categories. Methods: We analyzed patients undergoing PCI between September 2008 and October 2021 from a Japanese registry aligned with the NCDR and categorized them by the NCDR AKI risk score tertiles (low-risk [<4.9%], intermediate-risk [4.9%-6.7%], and high-risk [≥6.7%]) groups. CA-AKI was defined as a 0.3 mg/dL increase or 50% increase in creatinine or the initiation of dialysis. Cox regression analyses assessed the association between CA-AKI and 2-year major adverse cardiovascular events (MACE; all-cause mortality, acute coronary syndrome, heart failure hospitalization, or stroke), and interactions were tested to examine whether preprocedural risk modified the association of CA-AKI with outcomes. Results: Of 7,916 patients, 723 (9.1%) developed CA-AKI; its incidence for low-risk, intermediate-risk, and high-risk groups was 2.3%, 7.3%, and 17.9%, respectively. CA-AKI was associated with an increased risk of MACE (adjusted HR [aHR]: 1.64; 95% CI: 1.37-1.97). The interaction between AKI risk profile and MACE was not significant (P interaction = 0.14), and a consistent association of CA-AKI and MACE across risk categories was observed (high-risk, aHR: 1.60; 95% CI: 1.30-1.98; intermediate, aHR: 1.64; 95% CI: 1.10-2.44; and low, aHR: 2.84; 95% CI: 1.43-5.65, respectively). Conclusions: CA-AKI was associated with long-term outcomes across all AKI risk profiles in PCI patients, underscoring the importance of interventions to reduce periprocedural CA-AKI.

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【令和時代の循環器薬の使い方-処方の意図と治療戦略】心不全・心筋症　急性非代償性心不全に対するカテコラミンと血管拡張薬の使い分けについて教えてください

池上翔梧, 白石泰之

循環器ジャーナル ((株)医学書院) 73 ( 3 ) 381 - 388 2025.07

ISSN 2432-3284

Revised Definition of Pulmonary Hypertension Subtypes Enhances Prognostic Stratification in Hospitalized Heart Failure Patients.

Fukushi K, Goda A, Kohno T, Takeuchi S, Nakamaru R, Shiraishi Y, Shoji S, Tanaka TD, Nagatomo Y, Kitamura M, Sakamoto M, Nomoto M, Mizuno A, Soejima K, Kohsaka S, Yoshikawa T, West Tokyo Heart Failure Registry Investigators

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 45 ( 1 ) 7 - 15 2025.06

Research paper (scientific journal), Accepted, ISSN 1053-2498

Background: Pulmonary hypertension (PH) is a common complication of heart failure (HF) that has two subtypes: isolated postcapillary PH (IpcPH) and combined postcapillary and precapillary PH (CpcPH). The definitions of these subtypes were revised in 2022, but the prognostic impacts of this change in hospitalized patients with HF remain unclear. Therefore, this study aimed to investigate how the current definitions of PH subtypes affect patient prognosis. Methods: Among 4,762 patients in the West Tokyo Heart Failure 2 registry, we analyzed 975 patients (age: 69 ± 14 years; 33% female). We analyzed patients who underwent right heart catheterization following clinical stabilization. Patients were divided into NonPH, IpcPH, or CpcPH groups according to the 2018 and 2022 definitions. We assessed the impact of PH subtypes on adverse events, defined as cardiac mortality or HF rehospitalization among those hospitalized for HF. Results: The proportion of patients with CpcPH increased to 34.8% in 2022 (from 19.8% under the 2018 definition). The 2018 definition stated that CpcPH and IpcPH were associated with an increased risk of the adverse events (CpcPH: HR 1.62, 95%CI 1.14-2.31; IpcPH: HR 1.50, 95%CI 1.07-2.10). However, according to the 2022 definition, only CpcPH was an independent risk factor for the adverse events (CpcPH: HR 1.75, 95%CI 1.30-2.36; IpcPH: HR 1.03, 95%CI 0.64-1.65). Conclusions: The prognostic impact of CpcPH was more evident with the 2022 definition among hospitalized patients with HF. This information will help create more personalized disease management strategies.

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Association of Tricuspid Regurgitation With Mortality in Heart Failure With Left-Sided Heart Disease

Kitamura M., Amami K., Yaguchi T., Okabe K., Shiraishi Y., Nakamaru R., Nagatomo Y., Goda A., Nomoto M., Mizuno A., Sakamoto M., Ichihara Y.K., Kohno T., Kohsaka S., Yoshikawa T.

Jacc Advances 4 ( 6P1 ) 101832 2025.06

Background: Left-sided heart disease is the leading etiology of tricuspid regurgitation (TR) in heart failure (HF); however, the association between different HF phenotypes and the adverse effects of TR remains unclear. Objectives: The authors aimed to elucidate the association between TR and outcomes across the subtypes of left-sided heart disease in patients hospitalized for HF. Methods: We analyzed data from the multicenter West Tokyo Heart Failure registry between January 2006 and December 2021. Moderate or severe mitral or aortic valve disease was defined as left-sided valve dysfunction (LVD). Patients with congenital heart disease, secondary cardiomyopathy, systemic conditions related to HF, or those with incomplete datasets were excluded. Using a multivariable Cox hazard model, the survival effect of TR on mortality in patients with LVD was examined. Results: Overall, 3,040 presented with LVD (median age, 80 years; 45.9% female), and 2,438 had no LVD (median age, 74 years; 27.8% female). The prevalence of moderate and severe TR was 27.6% and 6.5% in patients with LVD and 9.2% and 1.5% in those without LVD, respectively. The adjusted HRs of moderate and severe TR for mortality were 1.25 (95% CI: 1.03-1.52) and 1.72 (95% CI: 1.30-2.29) in those with LVD, respectively, and 2.15 (95% CI: 1.62-2.84) and 3.09 (95% CI: 1.87-5.09) in those without LVD, respectively. Significant interactions between the subtypes were observed (P = 0.005). Conclusions: TR severity stratified mortality after acute decompensated HF better in patients without LVD than in those with LVD.

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Exercise hemodynamic evaluation in the management of dasatinib-related pulmonary arterial hypertension: a case report.

Yamashita S, Hiraide T, Shiraishi Y, Katsumata Y, Kataoka M, Fukui S, Kawakami M, Yuasa S, Okamoto S, Fukuda K, Ieda M

Journal of medical case reports 19 ( 1 ) 209 2025.05

Background: Dasatinib-related pulmonary arterial hypertension is a rare complication of chronic therapy for hematological malignancies. Pulmonary hypertension often persists despite drug discontinuation and might require vasodilators. Normalizing pulmonary hemodynamics and avoiding the long-term use of vasodilators is challenging. Case presentation: Patient was a 55-year-old Japanese man complaining of progressive dyspnea on effort and fatigue. He had a history of hypertension and chronic myeloid leukemia treated with dasatinib. He was diagnosed with dasatinib-related pulmonary arterial hypertension by a right heart catheterization at rest, demonstrating a mean pulmonary artery pressure of 31 mmHg and a normal pulmonary arterial wedge pressure of 6 mmHg. Symptoms and hemodynamics significantly improved after the discontinuation of dasatinib and the initiation of upfront combination therapy of vasodilators. An exercise right heart catheterization, performed more than 2 years after the initiation of vasodilators, showed a mean pulmonary artery pressure of 15 mmHg at rest and 29 mmHg at peak exercise (normal reference value, < 30 mmHg), suggesting normal pulmonary microcirculation. On the basis of these findings, pulmonary vasodilators were discontinued. Notably, a repeat exercise right heart catheterization demonstrated preserved pulmonary microcirculation, and the patient has remained asymptomatic for more than 2 years after discontinuing pulmonary-arterial-hypertension-targeted therapy. Conclusions: The evaluation of pulmonary microcirculation by exercise right heart catheterization can be useful for withdrawing pulmonary vasodilators safely in the management of patients with dasatinib-related pulmonary arterial hypertension.

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JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure

Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, Yaku H, Akiyama E, Ando M, Izumi C, Ide T, Iwasaki YK, Ohno Y, Okumura T, Ozasa N, Kaji S, Kashimura T, Kitaoka H, Kinugasa Y, Kinugawa S, Toda K, Nagai T, Nakamura M, Hikoso S, Minamisawa M, Wakasa S, Anchi Y, Oishi S, Okada A, Obokata M, Kagiyama N, Kato NP, Kohno T, Sato T, Shiraishi Y, Tamaki Y, Tamura Y, Nagao K, Nagatomo Y, Nakamura N, Nochioka K, Nomura A, Nomura S, Horiuchi Y, Mizuno A, Murai R, Inomata T, Kuwahara K, Sakata Y, Tsutsui H, Kinugawa K, Japanese Circulation Society and the Japanese Heart Failure Society Joint Working Group

Circulation Journal : Official journal of the Japanese Circulation Society 89 ( 8 ) 1278 - 1444 2025.03

Research paper (scientific journal), ISSN 1346-9843

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