Papers - SHIRAISHI Yasuyuki

Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan

Nagai T., Sundaram V., Shoaib A., Shiraishi Y., Kohsaka S., Rothnie K., Piper S., McDonagh T., Hardman S., Goda A., Mizuno A., Sawano M., Rigby A., Quint J., Yoshikawa T., Clark A., Anzai T., Cleland J.

European Journal of Heart Failure (European Journal of Heart Failure)  20 ( 8 ) 1179 - 1190 2018.08

ISSN  13889842

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© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology Aims: Prognostic models for hospitalized heart failure (HHF) were developed predominantly for patients of European origin in the United States of America; it is unclear whether they perform similarly in other health care systems or for different ethnicities. We sought to validate published prediction models for HHF in the United Kingdom (UK) and Japan. Methods and results: Patients in the UK (n =894) and Japan (n =3158) were prospectively enrolled and were similar in terms of sex (∼60% men) and median age (∼77 years). Models predicted that British patients would have a higher mortality than Japanese, which was indeed true both for in-hospital (4.8% vs. 2.5%) and 180-day (20.7% vs. 9.5%) mortality. The model c-statistics for the published/derivation (range 0.70–0.76) and Japanese (range 0.75–0.77) cohorts were similar and higher than for the UK (0.62–0.75) but models consistently overestimated mortality in Japan. For in-hospital mortality, the OPTIMIZE-HF model performed best, providing similar discrimination in published/derivation, UK and Japanese cohorts [c-indices: 0.75 (0.74–0.77); 0.75 (0.68–0.81); and 0.77 (0.70–0.83), respectively], and least overestimated mortality in Japan. For 180-day mortality, the c-statistics for the ASCEND-HF model were similar in published/derivation (0.70) and UK [0.69 (0.64–0.74)] cohorts but higher in Japan [0.75 (0.71–0.79)]; calibration was good in the UK but again overestimated mortality in Japan. Conclusion: Calibration of published prediction models appears moderately accurate and unbiased when applied to British patients but consistently overestimates mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest.

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Incidence of hospital-acquired hyponatremia by the dose and type of diuretics among patients with acute heart failure and its association with long-term outcomes

Yamazoe M., Mizuno A., Kohsaka S., Shiraishi Y., Kohno T., Goda A., Higuchi S., Yagawa M., Nagatomo Y., Yoshikawa T.

Journal of Cardiology (Journal of Cardiology)  71 ( 6 ) 550 - 556 2018.06

ISSN  09145087

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© 2018 Background: Diuretics are the cornerstone therapy for acute heart failure (AHF) but can lead to various electrolyte disturbances and inversely affect the patients’ outcome. We aimed to evaluate whether (1) the dose of loop diuretics could predict hospital-acquired hyponatremia (HAH) during AHF treatment, (2) addition of thiazide diuretics could affect development of HAH, and (3) assess their impact on long-term outcomes. Methods: We analyzed the subjects enrolled in the multicenter AHF registry (WET-HF). Risk of HAH, defined as hyponatremia at discharge with normonatremia upon admission, was evaluated based on oral non-potassium-sparing diuretics via multivariate logistic regression analysis. Additionally, we performed one-to-one matched analysis based on propensity scores for thiazide diuretics use and compared long-term mortality. Results: Of total 1163 patients (mean age 72.6 ± 13.6 years, male 62.6%), 92 (7.9%) had HAH. Compared with low-dose loop diuretics users (<40 mg; without thiazide diuretics), risks for developing HAH were significantly higher in patients with thiazide diuretics, regardless of the dose of loop diuretics (OR 2.67, 95% CI 1.13–6.34 and OR 2.31, 95% CI 1.50–5.13 for low- and high-dose loop diuretics, respectively). The association was less apparent in patients without thiazide diuretics (OR 1.29, 95% CI 0.73–2.27 for high-dose loop diuretics alone). Among 206 matched patients, all-cause and cardiac mortality rate was 27% and 14% in non thiazide diuretics users and 50% and 30% in thiazide diuretics users, respectively (HR 2.46, 95% CI 1.29–4.69, p = 0.006 and HR 2.50, 95% CI 1.10–5.67, p = 0.028, respectively) during a mean 19.3 months of follow-up. Conclusions: Thiazide diuretics use, rather than loop diuretics dose, was independently associated with HAH; and mortality was higher in thiazide diuretics users even after statistical matching.

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Long-Term Prognostic Significance of Plasma B-Type Natriuretic Peptide Level in Patients With Acute Heart Failure With Reduced, Mid-Range, and Preserved Ejection Fractions

Hamatani Y., Nagai T., Shiraishi Y., Kohsaka S., Nakai M., Nishimura K., Kohno T., Nagatomo Y., Asaumi Y., Goda A., Mizuno A., Yasuda S., Ogawa H., Yoshikawa T., Anzai T.

American Journal of Cardiology (American Journal of Cardiology)  121 ( 6 ) 731 - 738 2018.03

ISSN  00029149

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© 2017 Elsevier Inc. Plasma B-type natriuretic peptide (BNP) is an important prognostic marker in patients with acute heart failure (AHF). However, it is unclear which BNP parameter, on admission, at discharge, or change during hospitalization, has the highest predictive performance for long-term adverse outcomes, and whether its prognostic impact differs according to the new European heart failure (HF) phenotype classification by left ventricular ejection fraction: heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). We examined 1,792 patients with AHF consisting of 860 (48%) HFrEFs, 318 (18%) HFmrEFs, and 614 (34%) HFpEFs. Prognostic performance of each BNP parameter was assessed by the Harrell c-index. During a median follow-up of 664 days, 344 (19%) patients died. Discharge BNP had the highest c-index (0.69) for mortality among all BNP parameters (p <0.001). In multivariate Cox proportional hazard modeling, discharge BNP was associated with mortality in HFrEF, HFmrEF, and HFpEF patients with significant interaction (hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.57 to 2.41; HR 1.76, 95% CI 1.10 to 2.82; HR 1.46, 95% CI 1.12 to 1.91, respectively; p = 0.011 for interaction). Moreover, the c-index of discharge BNP for mortality in HFrEF patients (0.72) was higher than that in HFmrEF patients (0.68) and HFpEF patients (0.65). Similar results were obtained for mortality or HF rehospitalization as alternative outcomes, except there was no statistically significant interaction among HF phenotypes. In conclusion, discharge BNP is a more reliable marker than other BNP parameters on long-term outcome prediction in patients with AHF, but its prognostic impact may be weakened in HFmrEF and HFpEF compared with HFrEF.

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Impact of Triggering Events on Outcomes of Acute Heart Failure

Shiraishi Y, Kohsaka S, Abe T, Harada K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Yagawa M, Takei M, Nagatomo Y, Hosoda T, Yamamoto T, Nagao K, Takayama M

American Journal of Medicine 131 ( 2 ) 156 - 164.e2 2018.02

Research paper (scientific journal), Lead author, Accepted,  ISSN  00029343

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Background: The onset of acute heart failure is known to be associated with increased physical activity and other specific behaviors that can trigger hemodynamic deterioration. This analysis aimed to describe the distribution of triggers in patients hospitalized for acute heart failure, and investigate their effects on in-hospital outcomes. Methods: Consecutive patients hospitalized for acute heart failure between 2010 and 2014 were registered in a multicenter data registration system (72 institutions within Tokyo, Japan). Baseline demographics and in-hospital mortality were extracted from 17,473 patients. Patients with a trigger were grouped based on their triggering event: those with onset during (a) physical activity; (b) sleeping; (c) eating or watching television; (d) bathing or excretion (use of restrooms); and (e) engaging in other activities. These patients were compared with patients without identifiable triggers. Multiple imputation was used for missing data. Results: Patients were predominantly men (57.1%), with a mean age of 76.0 ± 13.0 years; a triggering event was present in 49.1%. No significant difference in baseline characteristics was noted between groups except for younger age, higher blood pressure, and prevalence of signs of congestion in the trigger-positive group. In-hospital mortality rate was 7.9%. Presence of triggers was positively associated with a reduced risk of in-hospital mortality (adjusted odds ratio 0.79; 95% confidence interval, 0.70-0.90; P =.0003). In a delta-adjusted pattern mixture model, the effect of a triggering event on in-hospital mortality remained consistently significant. Conclusion: Triggering events for acute heart failure can provide additional information for risk prediction. Efforts to identify the triggers should be made to classify patients according to risk group.

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Real-time analysis of the heart rate variability during incremental exercise for the detection of the ventilatory threshold

Shiraishi Y, Katsumata Y, Sadahiro T, Azuma K, Akita K, Isobe S, Yashima F, Miyamoto K, Nishiyama T, Tamura Y, Kimura T, Nishiyama N, Aizawa Y, Fukuda K, Takatsuki S

Journal of the American Heart Association 7 ( 1 )  2018.01

Research paper (scientific journal), Lead author, Accepted

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Background: It has never been possible to immediately evaluate heart rate variability (HRV) during exercise. We aimed to visualize the real-time changes in the power spectrum of HRV during exercise and to investigate its relationship to the ventilatory threshold (VT). Methods and Results: Thirty healthy subjects (29.1±5.7 years of age) and 35 consecutive patients (59.0±13.2 years of age) with myocardial infarctions underwent cardiopulmonary exercise tests with an RAMP protocol ergometer. The HRV was continuously assessed with power spectral analyses using the maximum entropy method and projected on a screen without delay. During exercise, a significant decrease in the high frequency (HF) was followed by a drastic shift in the power spectrum of the HRV with a periodic augmentation in the low frequency/HF (L/H) and steady low HF. When the HRV threshold (HRVT) was defined as conversion from a predominant high frequency (HF) to a predominant low frequency/HF (L/H), the VO2 at the HRVT (HRVT-VO2) was substantially correlated with the VO2 at the lactate threshold and VT) in the healthy subjects (r=0.853 and 0.921, respectively). The mean difference between each threshold (0.65 mL/kg per minute for lactate threshold and HRVT, 0.53 mL/kg per minute for VT and HRVT) was nonsignificant (P > 0.05). Furthermore, the HRVT-VO2 was also correlated with the VT-VO2 in these myocardial infarction patients (r=0.867), and the mean difference was -0.72 mL/kg per minute and was nonsignificant (P > 0.05). Conclusions: A HRV analysis with our method enabled real-time visualization of the changes in the power spectrum during exercise. This can provide additional information for detecting the VT.

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Identification of left atrial appendage thrombi in patients with persistent and long-standing persistent atrial fibrillation using intra-cardiac echocardiography and cardiac computed tomography

Ikegami Y., Tanimoto K., Inagawa K., Shiraishi Y., Fuse J., Sakamoto M., Momiyama Y., Takatsuki S.

Circulation Journal (Circulation Journal)  82 ( 1 ) 46 - 52 2018

ISSN  13469843

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© 2017, Japanese Circulation Society. All rights reserved. Background: Intracardiac echocardiography (ICE) and cardiac computed tomography (CCT), in addition to standard transesophageal echocardiography (TEE), have been used to identify left atrial (LA) thrombi prior to ablation for atrial fibrillation (AF). The clinical advantages of this, however, remain unclear. This study therefore investigated the advantages of additional pre-procedural LA appendage (LAA) thrombus evaluation using ICE and the clinical value of CCT in persistent and long-standing persistent AF. Methods and Results: We analyzed data from 108 consecutive patients with persistent and long-standing persistent AF who were scheduled to undergo AF ablation. TEE was performed within 24 h prior to ablation. ICE was performed for 97 patients in whom a thrombus was not detected on TEE. CCT was performed in 95 patients. Thrombus or sludge was detected on TEE in 11 patients (10.3%), for whom ablation was cancelled. Four additional patients were diagnosed with LAA thrombus on ICE. When TEE and ICE were used as the reference for thrombus detection, the sensitivity, specificity, positive predictive value, and negative predictive value of CCT for identifying contrast defects in the LAA were 100%, 81.0%, 40.7%, and 100%, respectively. Conclusions: ICE combined with TEE increased the detection rate of LAA thrombi in patients with persistent and long-standing persistent AF. Moreover, CCT had high sensitivity and negative predictive value for LAA thrombus detection.

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Stroke after percutaneous coronary intervention in the era of transradial intervention report from a Japanese multicenter registry

Shoji S., Kohsaka S., Kumamaru H., Sawano M., Shiraishi Y., Ueda I., Noma S., Suzuki M., Numasawa Y., Hayashida K., Yuasa S., Miyata H., Fukuda K.

Circulation: Cardiovascular Interventions (Circulation: Cardiovascular Interventions)  11 ( 12 ) e006761 2018

ISSN  19417640

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© 2018 American Heart Association, Inc. BACKGROUND: Periprocedural stroke is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Transradial intervention (TRI) is more beneficial than transfemoral intervention for periprocedural bleeding and acute kidney injuries, but its effect on periprocedural stroke has not been fully investigated. Our study aimed to assess risk predictors of periprocedural stroke according to PCI access site. METHODS AND RESULTS: Between 2008 and 2016, 17966 patients undergoing PCI were registered in a prospective multicenter database. Periprocedural stroke was defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms lasting at least 24 hours after onset. Periprocedural stroke was observed in 42 patients (0.3%). Stroke patients were older and had a higher incidence of chronic kidney disease, peripheral artery disease, and acute coronary syndrome but were less likely to undergo TRI. Multivariable logistic regression analysis revealed TRI (odds ratio; 0.33; 95% CI, 0.16-0.71; P=0.004) was significantly associated with a lower occurrence of periprocedural stroke. Finally, propensity score-matching analysis showed that TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention (0.1% versus 0.4%; P=0.014). According to our sensitivity analysis, this finding was robust to the presence of an unmeasured confounder in almost all plausible scenarios. CONCLUSIONS: TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention. Increased TRI use may reduce overall PCI complications and should be recommended as the optimal access site for both urgent/emergent and elective PCIs.

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Effect of Heart Failure Secondary to Ischemic Cardiomyopathy on Body Weight and Blood Pressure.

Matsushita K, Harada K, Miyazaki T, Miyamoto T, Kohsaka S, Iida K, Tanimoto S, Yagawa M, Shiraishi Y, Yoshino H, Yamamoto T, Nagao K, Takayama M

The American journal of cardiology 120 ( 9 ) 1589 - 1594 2017.11

ISSN  0002-9149

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Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction.

Yagawa M, Nagatomo Y, Izumi Y, Mahara K, Tomoike H, Shiraishi Y, Kohno T, Mizuno A, Goda A, Kohsaka S, Yoshikawa T, West Tokyo Heart Failure (WET-HF) Registry Collaborative Group.

Circulation journal : official journal of the Japanese Circulation Society 81 ( 7 ) 966 - 973 2017.06

ISSN  1346-9843

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The Effects of Hydrogen Gas Inhalation on Adverse Left Ventricular Remodeling After Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction　- First Pilot Study in Humans.

Katsumata Y, Sano F, Abe T, Tamura T, Fujisawa T, Shiraishi Y, Kohsaka S, Ueda I, Homma K, Suzuki M, Okuda S, Maekawa Y, Kobayashi E, Hori S, Sasaki J, Fukuda K, Sano M

Circulation journal : official journal of the Japanese Circulation Society 81 ( 7 ) 940 - 947 2017.06

ISSN  1346-9843

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Rapid Improvement of thyroid storm-related hemodynamic collapse by aggressive anti-thyroid therapy including steroid pulse: A case report.

Kiriyama H, Amiya E, Hatano M, Hosoya Y, Maki H, Nitta D, Saito A, Shiraishi Y, Minatsuki S, Sato T, Murakami H, Uehara M, Manaka K, Makita N, Watanabe M, Komuro I

Medicine 96 ( 22 ) e7053 2017.06

ISSN  0025-7974

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Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice.

Ikemura N, Sawano M, Shiraishi Y, Ueda I, Miyata H, Numasawa Y, Noma S, Suzuki M, Momiyama Y, Inohara T, Hayashida K, Yuasa S, Maekawa Y, Fukuda K, Kohsaka S

Circulation journal : official journal of the Japanese Circulation Society 81 ( 6 ) 815 - 822 2017.05

ISSN  1346-9843

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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.

Akita K, Kohno T, Kohsaka S, Shiraishi Y, Nagatomo Y, Izumi Y, Goda A, Mizuno A, Sawano M, Inohara T, Fukuda K, Yoshikawa T, West Tokyo Heart Failure Registry Investigators.

International journal of cardiology 235   162 - 168 2017.05

ISSN  0167-5273

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A Novel SCN5A Mutation Found in a Familial Case of Long QT Syndrome Complicated by Severe Left Ventricular Dysfunction.

Kimura M, Kohno T, Aizawa Y, Inohara T, Shiraishi Y, Katsumata Y, Egashira T, Fukushima H, Kosaki K, Fukuda K

The Canadian journal of cardiology 33 ( 4 ) 554.e5 - 554.e7 2017.04

ISSN  0828-282X

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Three novel <i>BMPR2</i> mutations associated with advanced pulmonary arterial hypertension.

Hara H, Takeda N, Morita H, Hatano M, Amiya E, Maki H, Minatsuki S, Taki M, Shiraishi Y, Fujiwara T, Maemura S, Komuro I

Human genome variation 4   17010 2017

ISSN  2054-345X

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Increased Hematocrit During Sodium-Glucose Cotransporter 2 Inhibitor Therapy Indicates Recovery of Tubulointerstitial Function in Diabetic Kidneys.

Sano M, Takei M, Shiraishi Y, Suzuki Y

Journal of clinical medicine research 8 ( 12 ) 844 - 847 2016.12

ISSN  1918-3003

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Degree of dyspnoea in patients with non-ST-elevation acute coronary syndrome: A report from Japanese multicenter registry.

Shiraishi Y, Kohsaka S, Ueda I, Inohara T, Sawano M, Numasawa Y, Hayashida K, Maekawa Y, Momiyama Y, Fukuda K

International Journal of Clinical Practice 70 ( 12 ) 978 - 987 2016.12

Research paper (scientific journal), Lead author, Accepted,  ISSN  1368-5031

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Correlation of Pre- and In-Hospital Systolic Blood Pressure in Acute Heart Failure Patients and the Prognostic Implications　- Report From the Tokyo Cardiac Care Unit Network Emergency Medical Service Database.

Shiraishi Y, Kohsaka S, Harada K, Miyamoto T, Tanimoto S, Iida K, Sakai T, Miyazaki T, Yagawa M, Matsushita K, Furihata S, Sato N, Fukuda K, Yamamoto T, Nagao K, Takayama M, Tokyo CCU Network Scientific Committee.

Circulation Journal 80 ( 12 ) 2473 - 2481 2016.11

Research paper (scientific journal), Lead author, Accepted,  ISSN  1346-9843

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Endomyocardial fibrosis: missing tricuspid valve and Fontan-like circulation.

Shiraishi Y, Kohno T, Fujii-Nishimura Y, Shimoda M, Ikeda Y, Nakajima K, Nishiyama T, Nishiyama N, Murata M, Maekawa Y, Sano M, Fukuda K

Heart and Vessels 31 ( 9 ) 1579 - 82 2016.09

Research paper (scientific journal), Lead author, Accepted,  ISSN  0910-8327

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Early vs. late reverse ventricular remodeling in patients with cardiomyopathy.

Banno A, Kohsaka S, Inohara T, Koide K, Shiraishi Y, Kohno T, Sano M, Yoshikawa T, Fukuda K

Journal of cardiology 68 ( 1 ) 57 - 63 2016.07

ISSN  0914-5087

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