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  • 1.
    Hatano, Masaru
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Hisagi, Motoyuki
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Less frequent opening of the aortic valve and a continuous flow pump are risk factors for postoperative onset of aortic insufficiency in patients with a left ventricular assist device2011In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 75, no 5, p. 1147-1155Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Postoperative development of aortic insufficiency (AI) after implantation of left ventricular assist devices (LVADs) has recently been recognized, but the devices in the previous reports have been limited to the HeartMate I or II. The purposes of this study were to determine whether AI develops with other types of LVADs and to elucidate the factors associated with the development of AI.

    METHODS AND RESULTS:

    Thirty-seven patients receiving LVADs without evident abnormalities in native aortic valves were enrolled (pulsatile flow LVAD [TOYOBO]: 76%, continuous flow LVAD [EVAHEART, DuraHeart, Jarvik2000, HeartMate II]: 24%). Frequency of aortic valve opening and grade of AI were evaluated by the most recent echocardiography during LVAD support. None of the patients had more than trace AI preoperatively. During LVAD support AI >- grade 2 developed in 9 patients (24%) across all 5 types of devices. More severe grade of AI correlated with higher plasma B-type natriuretic peptide concentration (r = 0.53, P < 0.01) and with less frequent of the aortic valve (r = 0.45, P < 0.01). Multivariate analysis revealed that lower preoperative left ventricular ejection fraction and a continuous flow device type were independent risk factors for higher incidence of AI.

    CONCLUSIONS:

    AI, which is hemodynamically significant, develops after implantation of various types of LVADs. Physicians need to be more alert to the development of AI particularly with continuous flow devices.

  • 2.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Kimura, Mitsutoshi
    University of Tokyo, Japan .
    Kinoshita, Osamu
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Acute pulmonary vasoreactivity test with sildenafil or nitric monoxide before left ventricular assist device implantation2013In: Journal of Artificial Organs, ISSN 1434-7229, E-ISSN 1619-0904, Vol. 16, no 3, p. 389-392Article in journal (Refereed)
    Abstract [en]

    There has been no established medical therapy to ameliorate pulmonary hypertension (PH) owing to left heart disease (LHD-PH). It has recently been shown that the left ventricular assist device (LVAD) can improve LHD-PH and therefore has the potential to become a major bridge tool for heart transplantation (HTx). However, some patients still have persistent PH even after LVAD treatment. It is essential to demonstrate the reversibility of end-organ dysfunction, including PH, prior to implantable LVAD treatment, especially in Japan, because implantable LVAD treatment is indicated only as bridge to transplantation. Here we report a patient with LHD-PH whose PH was demonstrated to be reversible by the acute pulmonary vasoreactivity test (APVT) with nitrogen monoxide (NO) and the phosphodiesterase-5 inhibitor sildenafil. Both inhaled NO and sildenafil reduced pulmonary vascular resistance, but pulmonary capillary wedge pressure was increased by NO, which was conversely decreased under increased cardiac output by sildenafil. After the patient was listed as an HTx recipient, pulmonary vascular resistance recovered down to an acceptable range with LVAD treatment. Based on these findings, we suggest that the APVT with sildenafil may be a useful and safe tool to predict improvement of PH after LVAD treatment.

  • 3.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichi Medical University, Japan .
    Bosentan improved persistent pulmonary hypertension in a case after implantation of a left ventricular assist device2013In: Journal of Artificial Organs, ISSN 1434-7229, E-ISSN 1619-0904, Vol. 16, no 1, p. 101-104Article in journal (Refereed)
    Abstract [en]

    No medical treatment has been established to ameliorate pulmonary hypertension (PH) due to left heart disease. Heart transplantation (HTx) is thus far the definitive therapy for stage D heart failure, but concomitant PH is one of the major risk factors for death after HTx. Recently, implantation of a left ventricular assist device (LVAD) has been reported to improve PH and has become a major bridge tool for HTx. We experienced a rare case with persistent PH even after the implantation of a continuous-flow LVAD. The administration of an endothelin receptor antagonist, bosentan, significantly decreased pulmonary vascular resistance. Combination therapy with LVAD implantation and anti-PH medication may be useful for patients with stage D heart failure complicated with severe PH.

  • 4.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Kagami, Yukie
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Kaneko, Nobuyuki
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Doi, Kent
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Takazawa, Yutaka
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Successful treatment of hemodynamic compromise caused by antibody-mediated and cellular rejection in a recipient 12 years after heart transplantation2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 5, p. 328-331Article in journal (Refereed)
    Abstract [en]

    Heart transplantation (HTx) is an established therapy for stage D heart failure due to recent advances in immunosuppressive regimens. However, antibody-mediated rejection remains an unsolved problem because of its refractoriness to standard immunosuppressive therapy with high mortality and graft loss. We experienced a 16-year old patient with hemodynamic compromise caused by both cellular and antibody-mediated rejection 12 years after HTx. The rejection was refractory to repeated steroid pulse treatment, intravenous immunoglobulin administration, and intensifying immunosuppression including addition of everolimus. Eventually, she was successfully treated with repeated plasma exchange accompanied by a single administration of the anti-CD20 monoclonal antibody rituximab.

  • 5.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Hosoya, Yumiko
    University of Tokyo, Japan .
    Takahashi, Masao
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    A case with recovery of response to tolvaptan associated with remission of acute kidney injury and increased urine osmolality2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 2, p. 115-118Article in journal (Refereed)
    Abstract [en]

    Tolvaptan (TLV), a vasopressin type 2 receptor antagonist, has been demonstrated to be effective in patients with decompensated heart failure (HF) refractory to incremental doses of diuretics, but the responsiveness has not always been predictable. We have recently proposed that urine osmolality (U-OSM) is a valuable parameter for the prediction of responses to TLV, because U-OSM reflects the activity of the collecting ducts, where TLV plays its unique role. Acute kidney injury (AKI) is often associated with severe tubular dysfunction, including the collecting ducts, and in such cases a response to TLV may not be expected. We here experienced a patient with HF and AKI in whom TLV was not effective during AKI. We also observed recovery of responsiveness to TLV along with remission of AKI as well as increased U-OSM later on. We believe that this is the first report on the reversibility of the TLV response in relation to U-OSM.

  • 6.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Successful Conversion From Thiazide to Tolvaptan in a Patient With Stage D Heart Failure and Chronic Kidney Disease Before Heart Transplantation2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 1, p. 48-50Article in journal (Refereed)
    Abstract [en]

    Chronic kidney disease (CKD) is often complicated with advanced heart failure because of not only renal congestion and decreased renal perfusion but also prolonged use of diuretics at higher doses, which sometimes results in hyponatremia. Preoperative CKD is known to be associated with poor prognosis after heart transplantation (HTx). We experienced a stage D heart failure patient with CKD and hyponatremia who was switched from trichlormethiazide to tolvaptan. His hyponatremia was normalized, and his renal function was improved after conversion to tolvaptan. In patients with stage D heart failure, it may be useful to administer tolvaptan with a concomitant reduction in the dose of diuretics in order to preserve renal function and avoid hyponatremia before HTx.

  • 7.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Fujino, Takeo
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Kinoshita, Osamu
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Late-onset right ventricular failure in patients with preoperative small left ventricle after implantation of continuous flow left ventricular assist device2014In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 78, no 3, p. 625-633Article in journal (Refereed)
    Abstract [en]

    Background: The continuous flow (CF) left ventricular assist device (LVAD) has replaced the pulsatile flow (PF) LVAD because of its advantages of better patient survival and higher quality of life. However, "late-onset right ventricular failure (RVF)" after CF LVAD implantation has emerged as an increasing concern, but little is known about the mechanism. Methods and Results: We retrospectively analyzed the 3-month hemodynamic and echocardiographic data from 38 consecutive patients who had received CF LVADs, and from 22 patients who had received PF LVADs. Late-onset RVF was defined as persistent right ventricular stroke work index (RVSWI) less than4.0 g/m(2) at any rotation speed and after saline infusion test at 5 weeks after implantation of CF LVAD. Patients with late-onset RVF had significantly impaired exercise tolerance indicated by shorter 6-min walking distance and lower peak (V) over dot O-2, and worsened tricuspid regurgitation, together with enlargement of the RV under CF LVAD treatment (all Pless than0.05). Univariable analyses demonstrated that preoperative smaller LV diastolic diameter (LVDd) was the risk factor for late-onset RVF with a cutoff value of 64 mm calculated by ROC analysis (area under curve, 0.925). In contrast, there was no correlation between preoperative LVDd and postoperative RVSWI in the PF LVAD group, though their preoperative background was worse than that of the CF group. Conclusions: In the setting of preoperative small LVDd, CF LVAD may cause late-onset RVF by leftward shift of the interventricular septum.

  • 8.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Tolvaptan Can Improve Clinical Course in Responders Validation Analysis for the Definition of Responsiveness by Urine Volume2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 6, p. 377-381Article in journal (Refereed)
    Abstract [en]

    We previously defined "responders" as patients with increases in urine volume (UV) on day 1 after the administration of tolvaptan (TLV), and demonstrated that responders to TLV could be predicted with considerable accuracy by urine osmolality (U-OSM) levels. Responders and non-responders to TLV should be associated with different clinical courses after a certain time following TLV administration. Therefore, the aim of the present study was to validate our definition of responders by clinical parameters 1 week after administration of TLV. Data (n = 85) were obtained from in-hospital patients with decompensated heart failure (HF) who had received TLV at 3.75-15 mg daily, and clinical data at 1 week after the administration of Thy were compared with those of baseline. Sixty patients (70.6%) were "responders", in whom UV on day 1 increased after the administration of TLV compared with day 0. "Non-responders" were older, and had higher serum creatinine concentration and lower baseline U-OSM than "responders". Serum creatinine concentration increased significantly in "non-responders", but was unchanged in "responders". Body weight, plasma B-type natriuretic peptide concentration, and HF symptom score decreased significantly in "responders", but remained unchanged in "non-responders". Increases in UV after the first administration of TLV were closely correlated with improvement of congestive HF after 1 week of TLV treatment, which verified our definition of "responders" to TLV.

  • 9.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Urine sodium excretion after tolvaptan administration is dependent upon baseline serum sodium levels: a possible explanation for the improvement of hyponatremia with scarce chance of hypernatremia by a vasopressin receptor antagonist2014In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 55, no 2, p. 131-137Article in journal (Refereed)
    Abstract [en]

    Several studies have demonstrated that tolvaptan (TLV) can improve hyponatremia in advanced heart failure (BF) patients with rare chance of hypernatremia. However, changes in serum sodium concentrations (S-Na) in patients with or without hyponatremia during TLV treatment have not been analyzed. Ninety-seven in-hospital patients with decompensated HF who had received TLV at 3.75-15 mg/day for 1 week were enrolled. Among 68 "responders", who had achieved any increases in urine volume (UV) during the first day, urinary sodium excretion during 24 hours (U-NaEx(24)) increased significantly during one week of TLV treatment along with higher baseline S-Na (P less than 0.05 and r = 0.325). Considering a cut-off value (S-Na, 132 mEq/L; AUC, 0.711) for any increases in U-NaEx(24), we defined "hyponatremia" as S-Na less than 132 mEq/L. In hyponatremic responders (n = 25), S-Na increased significantly, although 1 week was not sufficient for normalization (125.8 +/- 5.0 versus 128.9 +/- 4.3 mEq/L, P less than 0.05), along with unchanged U-NaEx(24) (2767 +/- 2703 versus 2972 +/- 2950 mg/day, NS). In contrast, in normonatremic responders (n = 43), S-Na remained unchanged (136.6 +/- 3.1 versus 137.4 +/- 2.9 mEq/L, NS) along with increased U-NaEx(24) (2201 +/- 1644 versus 4198 +/- 3550 mg/day, P less than 0.05). TLV increased S-Na only in hyponatemic responders by way of pure aquaresis, but increased U-NaEx(24) only in nonnonatremic responders, which explains the scarcity of hypernatremia. Epithelial Na-channels in the distal nephrons, whose repression by TLV increases urinary sodium excretion, may be attenuated by reduced ATP-supply in worse hemodynamics under hyponatremia.

  • 10.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Urine osmolality estimated using urine urea nitrogen, sodium and creatinine can effectively predict response to tolvaptan in decompensated heart failure patients2013In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 77, no 5, p. 1208-1213Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Urine osmolality (U-OSM) is valuable to predict response to tolvaptan (TLV) in decompensated heart failure patients, but measurement of U-OSM is not always available on site.

    METHODS AND RESULTS:

    Data were collected from 66 hospitalized patients with decompensated heart failure who had received TLV at 3.75-15 mg/day. U-OSM, which was estimated using the following formula: 1.07×{2×[(urine sodium (mEq/L)]+[urine urea nitrogen (mg/dl)]/2.8+[urine creatinine (mg/dl)]×2/3}+16, was well correlated with the actual measurement (r=0.938, P<0.001). Criteria consisting of C1 (estimated baseline U-OSM>358 mOsm/L) and C2 (%decrease in estimated U-OSM>24% at 4-6 h after the first TLV dose) significantly discriminated responders from non-responders (P<0.05).

    CONCLUSIONS:

    Response to TLV can be predicted using U-OSM, which can be estimated using urine urea nitrogen, sodium, and creatinine concentration data. 

  • 11.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Kagami, Yukie
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Everolimus-incorporated immunosuppressant strategy improves renal dysfunction while maintaining low rejection rates after heart transplantation in Japanese patients2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 4, p. 222-227Article in journal (Refereed)
    Abstract [en]

    The long-term survival of heart transplantation (HTx) recipients has increased significantly in recent years, however, the nephrotoxic adverse effects of calcineurin inhibitors (CNIs) are still a major concern. Recently, an inhibitor of mammalian target of rapamycin, everolimus (EVL), has emerged as an alternative immunosuppressant drug that may allow CM dosage reduction and thereby spare renal function. Data were collected from 20 HTx recipients who had received EVL (target trough level 3-8 ng/mL) along with a dose reduction of CNIs and/or mycophenolate mophetil (MMF) and had been followed for 1 year. Estimated glomerular filtration rate increased significantly with a reduction in the CM dosage in a dose-dependent manner (P less than 0.001, r = -0.807). Neutrophil count increased significantly (P less than 0.05) with a reduction in the dosage of MMF (P = 0.009, r = -0.671). Cytomegalovirus antigenemia remained negative after EVL administration among all candidates without any antiviral agents (P = 0.001). There were no significant increases in the acute rejection rates among recipients with EVL compared to those without EVL (P = 0.132). An immunosuppressant strategy incorporating EVL could reduce the CM and MMF dosages, which resulted in improvements in renal dysfunction and neutropenia while maintaining low rejection rates among HTx recipients.

  • 12.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan.
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Novel risk scoring system with preoperative objective parameters gives a good prediction of 1-year mortality in patients with a left ventricular assist device.2012In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 76, no 8, p. 1895-1903Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    As we have previously reported, the preoperative profile defined by INTERMACS is a good predictor for the prognosis after left ventricular assist device (LVAD) implantation, but is largely dependent on the physician's decision. Several other risk stratification systems including objective parameters (eg, Leitz-Miller, Columbia, Seattle Heart Failure Model, APACHE II) have been proposed to estimate patient's mortality after LVAD implantation.

    METHODS AND RESULTS:

    According to the preoperative data from 59 patients who received LVAD (10 implantable, 49 extracorporeal) since 2002 through 2010, we performed a logistic analysis and constructed a new scoring system (ie, the TODAI VAD score (TVAD score), assigning 8 points to serum albumin <3.2mg/dl (odds ratio [OR] 8.475), 7 points to serum total bilirubin >4.8mg/dl (OR 7.300), 6 points to left ventricular end-diastolic diameter <55mm (OR 5.917), 5 points to central venous pressure >11mmHg (OR 5.128)). The receiver-operating characteristic analysis showed that the area under the curve of our new scoring system (0.864) was significantly larger than any of the abovementioned 5 scoring methods (all P<0.05). With the TVAD score, low (0-8 points), intermediate (9-17 points), and high (18-26 points) risk strata had significantly different 1-year survival rates of 95%, 54%, and 14%, respectively (all P<0.001).

    CONCLUSIONS:

    The TVAD score can predict the prognosis after LVAD implantation much better than the previously known methods.

  • 13.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan.
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichi Medical University, Japan .
    Preoperative Levels of Bilirubin or Creatinine Adjusted by Age Can Predict Their Reversibility After Implantation of Left Ventricular Assist Device2013In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 77, no 1, p. 96-104Article in journal (Refereed)
    Abstract [en]

    Background: It is often difficult to predict reversibility of liver or renal function after left ventricular assist device (LVAD) implantation in patients with stage D heart failure. Methods and Results: Data were obtained for 69 patients who had received a LVAD (18 continuous-flow, 51 pulsatile). Persistent hepatic or renal dysfunction was defined as levels of total bilirubin (TB) or creatinine (Cre) greater than1.5 mg/dl at 6 months after LVAD implantation. TB score or Cre score was calculated: 0.15 x age+ 1.1x (preoperative TB) or 0.2 x age + 3.6 x (preoperative Cre), in which coefficients were determined on the basis of odds ratios for persistent hepatic or renal dysfunction, respectively. Receiver-operating characteristics analyses showed good predictabilities for persistent end-organ dysfunction (area under curve: 0.794 for TB score and 0.839 for Cre score). High-risk strata of TB score (greater than11.0 points) or Cre score (greater than14.1 points) were associated with persistently higher levels of TB or Cre (TB, 1.32 +/- 0.51; Cre, 1.23 +/- 0.41 mg/dl; both Pless than0.001 vs. low-risk strata). Conclusions: Reversibility of end-organ function with LVAD implantation can be well predicted by our new risk scoring system that consists of the preoperative TB or Cre level adjusted by the patients age. The scoring system would be beneficial, especially in considering the indication of a bridge to candidacy.

  • 14.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Akahane, Masaaki
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichi Medical University, Japan .
    How to demonstrate the reversibility of end-organ function before implantation of left ventricular assist device in INTERMACS profile 2 patients?2012In: Journal of Artificial Organs, ISSN 1434-7229, E-ISSN 1619-0904, Vol. 15, no 4, p. 395-398Article in journal (Refereed)
    Abstract [en]

    For the time being, in Japan, two recently approved implantable ventricular assist devices (VADs) are indicated only when a patient has been listed for heart transplantation or approved to be eligible for heart transplantation by in-hospital committee. The reversibility of end-organ dysfunction must be expected before VAD implantation, but it is often hard to prove during worsening clinical status. We report two patients whose end-organ dysfunction had been eventually demonstrated to be reversible by invasive procedures such as transluminal liver biopsy or transient insertion of intra-aortic balloon pumping.

  • 15.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichi Medical University, Japan .
    Correction of hyponatremia by tolvaptan before left ventricular assist device implantation2012In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 53, no 6, p. 391-393Article in journal (Refereed)
    Abstract [en]

    Hypervolemic hyponatremia is often complicated with advanced heart failure together with increased excretion of sodium by diuretics. Tolvaptan, an oral vasopressin-2-receptor antagonist, has been previously reported to improve congestion and correct hyponatremia through increased excretion of free water. However, there is little evidence concerning the administration of tolvaptan in patients with stage D heart failure. We experienced 2 patients with stage D heart failure who received 3.75 mg/day of tolvaptan to correct hyponatremia before ventricular assist device implantation. It may be useful, even for patients with stage D heart failure, to administer a low dose of tolvaptan to treat hyponatremia before ventricular assist device implantation to avoid a drastic alteration in serum sodium concentration perioperatively.

  • 16.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichi Medical University, Japan .
    Novel criteria of urine osmolality effectively predict response to tolvaptan in decompensated heart failure patients--association between non-responders and chronic kidney disease2013In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 77, no 2, p. 397-404Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    A newly-developed vasopressin type 2 receptor antagonist, tolvaptan (TLV), has a unique feature of diuresis, but the response to this drug can be unpredictable.

    METHODS AND RESULTS:

    Data were collected from hospitalized patients with decompensated congestive heart failure who were administered TLV at 3.75-15 mg/day (n=61). A responder/non-responder to TLV was determined as having any increase/decrease in urine volume (UV) during the next 24h after TLV treatment on the first day. Logistic regression analyses for increases in UV were performed, and independent predictors of the responder were the following: C1, baseline urine osmolality (U-OSM) >352 mOsm/L; and C2, %decrease in U-OSM >26% at 4-6h after TLV administration. Criteria consisting of C1 and C2 had a good predictability for responders by receiver-operating characteristic analysis (area under the curve=0.960). Kidneys of the non-responders no longer had diluting ability (%decrease of U-OSM at 4-6h=2.7 ± 14.6%*), but also barely kept concentrating ability (baseline U-OSM=296.4 ± 68.7*mOsm/L) with markedly reduced estimated glomerular filtration ratio (35.5 ± 29.4 m l · min(-1) · 1.73 m(-2)*) (*P<0.05 vs. patients who had at least 1 positive condition [n=42]).

    CONCLUSIONS:

    More than 26% decrease in U-OSM from a baseline >352 mOsm/L for the first 4-6h predicts responders to TLV. Unresponsiveness to TLV is attributable to nephrogenic diabetes insipidus complicated by chronic renal disease.

  • 17.
    Imamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Endo, Miyoko
    Tokyo University Hospital, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Successful conversion to everolimus after cytomegalovirus infection in a heart transplant recipient2012In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 53, no 3, p. 199-201Article in journal (Refereed)
    Abstract [en]

    Cytomegalovirus (CMV) infection remains a major problem in recipients with heart transplantation (HTx), because it may play a significant role in the development of cardiac allograft vasculopathy, which is one of the major causes of death after HTx. Valganciclovir (VGC) is effective for the treatment of CM V infection, but is often associated with neutropenia, especially when used with mycophenolate mophetil (MMF). We experienced an HTx recipient with positive CMV antigenemia who suffered progressive neutropenia after administration of VGC. We switched MMF to everolimus (EVL) and assay for CM V antigenemia was constantly negative even after discontinuation of VGC. In all other 14 HTx recipients who received EVL for any reason, we found that assay for CMV antigenemia remained negative throughout the period of EVL administration. Considering the prophylactic effect on CMV, EVL can not only be an alternative to rescue from comorbidity, but might also be indicated earlier especially in CMV-seronegative HTx recipients. 

  • 18.
    Irnamura, Teruhiko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    An elevated ratio of early to late diastolic filling velocity recovers after heart transplantation in a time-dependent manner2012In: Journal of Cardiology, ISSN 0914-5087, E-ISSN 1876-4738, Vol. 60, no 4, p. 295-300Article in journal (Refereed)
    Abstract [en]

    Background

    Several groups have reported that an elevated ratio of early (E) to late (A) diastolic filling velocities is observed in patients after heart transplantation. However, the mechanism has not been fully analyzed.

    Methods

    Serial echocardiography and hemodynamic study were performed in 16 patients who had received heart transplantation and had no evidence of rejection during 1 month after the operation.

    Results

    On Day 1 after the surgery, E/A ratio was higher and peak velocity of A wave was lower than normal range among the patients after heart transplantation. E/A ratio and peak velocity of A wave gradually normalized during 1 moth after the surgery. Meanwhile, early mitral annular velocity and pulmonary capillary wedge pressure remained within normal range during the study period.

    Conclusions

    Longer ischemic time during heart transplantation procedure may cause atrial stunning, but it appears to recover within 1 month. We have to be alert to misinterpretation of this “psuedo-psuedonormal” mitral inflow pattern early after transplantation.

  • 19.
    Jaarsma, Tiny
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ben Gal, Tuvia
    Rabin Medical Centre, Israel.
    Cameron, Jan
    Australian Catholic University, Australia.
    Driscoll, Andrea
    Deakin University, Australia.
    Duengen, Hans-Dirk
    Charite, Germany.
    Inkrot, Simone
    Charite, Germany.
    Huang, Tsuey-Yuan
    Chang Gung University of Science and Technology, Taiwan.
    Ngoc Huyen, Nguyen
    University of Tokyo, Japan.
    Kato, Naoko
    University of Tokyo, Japan.
    Koeberich, Stefan
    University of Heart Centre Freiburg Bad Krozingen, Germany.
    Lupon, Josep
    Hospital University of Germans Trios and Pujol, Spain.
    Moser, Debra K.
    University of Kentucky, KY USA.
    Pulignano, Giovanni
    S Camillo Forlanini Hospital, Italy.
    Rejane Rabelo, Eneida
    University of Federal Rio Grande do Sul, Brazil.
    Suwanno, Jom
    Walailak University, Thailand.
    Thompson, David R.
    Australian Catholic University, Australia.
    Vellone, Ercole
    Tor Vergata University, Rome, Italy.
    Alvaro, Rosaria
    Tor Vergata University, Rome, Italy.
    Yu, Doris
    Chinese University of Hong Kong, Hong Kong.
    Riegel, Barbara
    University of Penn, USA.
    Comparison of self-care behaviors of heart failure patients in 15 countries worldwide2013In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 92, no 1, p. 114-120Article in journal (Refereed)
    Abstract [en]

    Objective

    Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents.

    Methods

    Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale.

    Results

    In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries.

    Conclusion

    Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide.

    Practice implications

    Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

  • 20.
    Kato, Naoko
    et al.
    University of Tokyo, Japan .
    Ito, Naomi
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Validity and reliability of the Japanese version of the European Heart Failure Self-Care Behavior Scale2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 4, p. 284-289Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    It is important to assess the self-care behavior of patients with heart failure. However, in Japan, there is no valid and reliable scale for this purpose. The European Heart Failure Self-Care Behavior Scale (EHFScBS) is used to measure the self-care behavior of heart failure patients. The purpose of this study was to translate the EHFScBS into Japanese and evaluate its validity and reliability.

    METHODS AND RESULTS:

    A convenience sample of 116 outpatients with heart failure completed the Japanese version of the EHFScBS. Confirmatory factor analysis demonstrated the one-dimensionality of the scale. The Japanese version of the EHFScBS was significantly correlated with another scale, which was considered to evaluate the concept linked with the self-care behavior theoretically. These confirm its construct validity. Cronbach's alpha was 0.71, suggesting that internal consistency was satisfactory. Test-retest reliability was evaluated. The intraclass correlation coefficient of the scale was 0.69 and weighted kappa for individual items was 0.33-0.87, suggesting that test-retest reliability is adequate.

    CONCLUSIONS:

    The Japanese version of the EHFScBS was showed acceptable validity and reliability. It can be used to evaluate self-care behavior of Japanese patients with heart failure.

  • 21.
    Kato, Naoko
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. University of Tokyo, Japan JSPS Postdoctoral Fellow for Research Abroad, Tokyo, Japan .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Ben Gal, Tuvia
    Rabin Medical Center, Petah Tikva, Israel; Tel Aviv University, Israel .
    Learning self-care after left ventricular assist device implantation2014In: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 11, no 3, p. 290-298Article in journal (Refereed)
    Abstract [en]

    The number of heart failure (HF) patients living with a left ventricular assist device (LVAD) as destination therapy is increasing. Successful long-term LVAD support includes a high degree of self-care by the patient and their caregiver, and also requires long-term support from a multidisciplinary team. All three components of self-care deserve special attention once an HF patient receives an LVAD, including activities regarding self-care maintenance (activities related both to the device and lifestyle), self-care monitoring (e.g., monitoring for complications or distress), and self-care management (e.g., handling alarms or coping with living with the device). For patients to perform optimal self-care once they are discharged, they need optimal education that focuses on knowledge and skills through a collaborative, adult learning approach.

  • 22.
    Kato, Naoko
    et al.
    University of Tokyo, Japan; The Japan Society for the Promotion of Science, Tokyo, Japan.
    Kinugawa, K.
    University of Tokyo, Japan.
    Yao, A.
    University of Tokyo, Japan.
    Hatano, M.
    University of Tokyo, Japan.
    Shiga, T.
    University of Tokyo, Japan.
    Kazuma, K.
    University of Tokyo, Japan.
    Relationship of depressive symptoms with hospitalization and death in Japanese patients with heart failure2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 10, p. 912-919Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Depressive symptoms are risk factors for poor outcomes and are positively associated with disease severity in patients with heart failure (HF). However, little is known about this association in the Japanese population. Therefore, we evaluated the prevalence of depressive symptoms and whether depressive symptoms predicted hospitalization for HF and death independent of disease severity and other factors in HF patients.

    METHODS AND RESULTS:

    A 2-year prospective cohort study was conducted on 115 outpatients with HF (73.9% males; mean age 64.7 years) in Tokyo. Of these, 27 patients (23.5%) were classified as having depressive symptoms (Center for Epidemiologic Studies Depression Scale score >or=16). Patients with depressive symptoms had higher rates of 2-year cardiac death or HF hospitalization (34.0% vs. 10.3%; P < .01), HF hospitalization (27.4% vs. 9.2%; P = .01), and all-cause death (27.4% vs. 7.2%; P < .01). Multivariate Cox regression analyses indicated that depressive symptoms were predictors of cardiac death or HF hospitalization (hazard ratio [HR], 3.29; P = .02), HF hospitalization (HR, 3.36; P = .04), and all-cause death (HR, 5.52; P = .01), independent of age and brain natriuretic peptide.

    CONCLUSIONS:

    Depressive symptoms were common and independent predictors of poor outcomes in Japanese patients with HF.

  • 23.
    Kato, Naoko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Imamura, Teruhiko
    University of Tokyo, Japan .
    Muraoka, Hironori
    University of Tokyo, Japan .
    Minatsuki, Shun
    University of Tokyo, Japan .
    Inaba, Toshiro
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Trend of clinical outcome and surrogate markers during titration of β-blocker in heart failure patients with reduced ejection fraction: relevance of achieved heart rate and β-blocker dose2013In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 77, no 4, p. 1001-1008Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The aim of this study was to examine trends of clinical outcome and to clarify surrogate markers when titrating β-blocker in heart failure patients with reduced left ventricular ejection fraction (HFrEF, LVEF <50%).

    METHODS AND RESULTS:

    Consecutive HFrEF patients starting on β-blocker were divided into 2 groups according to time of dose fixation attainment: before 31 December 2005 (group 1, n=108) or after 1 January 2006 (group 2, n=119). There were no significant differences in patient characteristics between the 2 groups at baseline. Beta-blocker fixed dose was higher with lower resting heart rate in group 2 (6.2±5.7mg/day vs. 9.5±9.1mg/day in carvedilol equivalent dose, P=0.001; 74.2±11.1beats/min vs. 70.2±9.7beats/min, P=0.004). The rate of HF hospitalization and/or all-cause death after 36 months was lower in group 2 than in group 1 (22% vs. 38%, P=0.011; hazard ratio, 0.90; P=0.012). Cox regression analysis showed that β-blocker ≥10mg/day and achieved heart rate ≤71beats/min predicted a better outcome (both P<0.05).

    CONCLUSIONS:

    Recent improvement of clinical outcome among HFrEF patients may be attributable to the up-titration policy accompanying lowered heart rate. Resting heart rate ≤71beats/min and β-blocker ≥10mg/day (ie, 50% of the target dose for Japanese patients) could be surrogate markers when titrating β-blocker.

  • 24.
    Kato, Naoko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Nakayama, Etsuko
    Sakakibara Heart Institute, Japan .
    Hatakeyama, Akiko
    Sakakibara Heart Institute, Japan .
    Tsuji, Takako
    Sakakibara Heart Institute, Japan .
    Kumagai, Yumiko
    Sakakibara Heart Institute, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichii Medical University, Japan .
    Development and psychometric properties of the Japanese heart failure knowledge scale2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 4, p. 228-233Article in journal (Refereed)
    Abstract [en]

    Knowledge about their own condition is important for patients with heart failure (HF). No valid, reliable, and easily administered instrument is available to measure this knowledge in clinical practice. In this study, a HF knowledge scale was developed, and its psychometric properties were tested. Items related to knowledge about HF were extracted from relevant guidelines. Content validity of the items was confirmed by an expert panel including a cardiologist and nurses specialized in treatment and care of patients with HF. A self-administered questionnaire was then distributed to 187 patients with BY (64.0 +/- 12.1 years, males 69%). In 62% patients, a left ventricular ejection fraction of less than 50% was identified. Exploratory factor analysis demonstrated the one-dimensionality of the 15-item HF knowledge scale. Mean score was 10.7 +/- 3.0 (range, 0-15). Known-group validity testing revealed a significant difference in HF knowledge score between patients newly diagnosed with HF and patients experienced with HF (9.4 +/- 3.2 versus 10.8 +/- 2.9, P = 0.043). In addition, HF knowledge scale scores were correlated with HF self-care scores assessed by the European Heart Failure Self-Care Behavior Scale for evaluation of criterion validity (rho = 0.304, P less than 0.001). Cronbachs alpha was 0.79, and item-total correlation was 0.22-0.51, thereby suggesting that the reliability of the scale was acceptable. Acceptable validity and reliability were demonstrated for the HF knowledge scale developed in this study. This instrument could be useful in evaluation of patient knowledge about HF.

  • 25.
    Kato, Naoko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Nakayama, Etsuko
    Sakakibara Heart Institute, Japan .
    Tsuji, Takako
    Sakakibara Heart Institute, Japan .
    Kumagai, Yumiko
    Sakakibara Heart Institute, Japan .
    Imamura, Teruhiko
    University of Tokyo, Japan .
    Maki, Hisataka
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Miura, Chikako
    Sakakibara Heart Institute, Japan .
    Komuro, Issei
    University of Tokyo, Japan .
    Nagai, Ryozo
    Jichi Medical University, Japan .
    Insufficient Self-Care Is an Independent Risk Factor for Adverse Clinical Outcomes in Japanese Patients With Heart Failure2013In: International Heart Journal, ISSN 1349-2365, E-ISSN 1349-3299, Vol. 54, no 6, p. 382-389Article in journal (Refereed)
    Abstract [en]

    Self-care is a cornerstone for the successful management of heart failure (UP). The purpose of this study was to examine the impacts of HF self-care on prognosis in Japanese patients with HF. A total of 283 HF outpatients (age 64 14, 70% male, 52% HFrEF) were enrolled. We asked patients to answer about their adhevence to 5 self-care behaviors (medication, eating a low-sodium diet, regular exercise, daily weight check, and treatment seeking behavior). On the basis of the results, we classified patients into a good self-care group and a poor self-care group. The primary outcome was HF hospitalization and/or cardiac death. In total, 65% of patients were classified into the poor self-care group. During a median follow-up of 2 years, cardiac events occurred more frequently in the poor self-care group (22% versus 9.6%, P = 0.013). Poor self-care was an independent risk factor for cardiac events in Cox regression analysis adjusted for clinical parameters (hazard ratio = 2.86, P = 0.005). Poor self-care was also associated with an increased number of HF hospitalizations as well as an extended length of hospital stay for HF. Poor knowledge about HF was an independent determinant for poor self-care in multivariate logistic regression analysis (odds ratio = 0.92, P = 0.019). Insufficient self-care is an independent risk factor for cardiac events in Japanese patients with HF.

  • 26.
    Kato, Naoko
    et al.
    University of Tokyo, Japan.
    Kinugawa, Koichiro
    University of Tokyo, Japan.
    Sano, Miho
    Tokyo University Hospital, Japan .
    Seki, Satomi
    University of Tokyo, Japan .
    Kogure, Asuka
    Tokyo University Hospital, Japan .
    Kobukata, Kihoko
    Tokyo University Hospital, Japan .
    Ochiai, Ryota
    University of Tokyo, Japan .
    Wakita, Sanae
    Tokyo University Hospital, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Development of self-care educational material for patients with heart failure in Japan: a pilot study2012In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 14, no 2, p. 156-164Article in journal (Refereed)
    Abstract [en]

    This study assessed the need for information regarding heart failure and self-care, developed self-care educational material, and investigated the feasibility of the material. A total of 22 hospitalized heart failure patients (mean age: 63 years) completed a self-administered questionnaire. We found that more than 90% of patients desired information, particularly about heart failure symptoms, time to notify healthcare providers, prognosis, and exercise/physical activity. After examining the eight existing brochures for Japanese heart failure patients, we developed self-care educational material. This was based on heart failure guidelines and on the results of our inquiry regarding information needs. Finally, a pilot study was conducted in nine hospitalized heart failure patients (mean age: 57 years). None of the patients had difficulty reading or understanding the educational material. The self-administrated questionnaire survey revealed that comprehension of the following improved after the educational sessions with the material: heart failure symptoms, medication, weighing, sodium intake, and fluid intake (P less than 0.05). In conclusion, heart failure patients have a great need for information about heart failure. Our pilot study suggests that the material was readable and had a beneficial effect on heart failure comprehension.

  • 27.
    Kato, Naoko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Seki, Satomi
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Quality of life as an independent predictor for cardiac events and death in patients with heart failure2011In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 75, no 7, p. 1661-1669Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Little is known about health-related quality of life (QOL) in Japanese patients with heart failure. The purpose of this study was to identify factors related to QOL using a disease-specific QOL instrument, and to clarify whether QOL independently predicts clinical outcomes among Japanese patients with heart failure.

    METHODS AND RESULTS:

    A total of 114 outpatients with heart failure were enrolled (mean age 64.7 ± 15.8 years; 73.7% males). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) to assess patient's QOL was used. At baseline, depressive symptoms and chronic kidney disease were significantly associated with worse QOL in multiple regression analysis. During a 2-year follow up, patients with a MLHFQ score ≥ 26, indicating worse QOL, had a higher incidence of the combined endpoint of cardiac death or hospitalization for heart failure, and a higher all-cause mortality than those with a score < 26 (25.3% vs. 7.5%, P = 0.011; 18.5% vs. 6.4%, P = 0.018; respectively). Multivariate Cox proportional hazard models demonstrated that a higher MLHFQ score was significantly associated with increased risks of cardiac events (hazard ratio, 1.02, 95% confidential interval, 1.001-1.05, P = 0.038) and of all-cause death (hazard ratio, 1.04, 95% confidential interval, 1.02-1.07, P = 0.001).

    CONCLUSIONS:

    Depressive symptoms and chronic kidney disease are major determinants of impaired QOL, and the MLHFQ score is an independent predictor of both cardiac events and death among Japanese patients with heart failure.

     

  • 28.
    Kato, Naoko
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Shiga, Taro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Takeda, Norihiko
    University of Tokyo, Japan .
    Imai, Yasushi
    University of Tokyo, Japan .
    Watanabe, Masafumi
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction2012In: Journal of Cardiology, ISSN 0914-5087, E-ISSN 1876-4738, Vol. 60, no 1, p. 23-30Article in journal (Refereed)
    Abstract [en]

    Background

    Little is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF ≥50%). We aimed to assess the prevalence of depression, to clarify the impact of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with reduced EF (HFrEF, EF <50%) and HFpEF.

    Methods and results

    A total of 106 HF outpatients were enrolled. Of them, 61 (58%) had HFpEF. Most patients were male (HFrEF 80%, HFpEF 70%) and the mean of plasma B-type natriuretic peptide (BNP) level in the HFrEF group was similar to that in the HFpEF group (164.8 ± 232.8 vs. 98.7 ± 94.8 pg/mL). HFrEF patients were treated more frequently with beta-blockers compared with HFpEF patients (71% vs. 43%, p = 0.004). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The prevalence of depression (CES-D score ≥16), and CES-D score did not significantly differ between HFrEF and HFpEF (24% vs. 25%, 14.1 ± 8.3 vs. 12.1 ± 8.3, respectively). During the 2-year follow-up, depressed patients had more cardiac death or HF hospitalization in HFrEF (55% vs. 12%, p = 0.002) and HFpEF (35% vs. 11%, p = 0.031). Cox proportional hazard analysis revealed that a higher CES-D score, indicating increased depressive symptoms, predicted cardiac events independent of BNP in HFrEF [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01–1.13] and HFpEF (HR 1.09, 95%CI 1.04–1.15). Multiple regression analyses adjusted for BNP showed that independent predictors of depressive symptoms were non-usage of beta-blockers and being widowed or divorced in HFrEF. On the other hand, usage of warfarin was the only independent risk factor for depressive symptoms in HFpEF (all, p < 0.05).

    Conclusions

    Depressive symptoms are common and independently predict adverse events in HFrEF/HFpEF patients. This study suggests that beta-blockers reduce depressive symptoms in HFrEF. In contrast, treatment for depression remains to be elucidated in HFpEF.

  • 29.
    Naoko, Kato
    et al.
    University of Tokyo, Japan .
    Koichiro, Kinugawa
    University of Tokyo, Japan .
    Teruhiko, Imamura
    University of Tokyo, Japan .
    Hironori, Muraoka
    University of Tokyo, Japan .
    Hisataka, Maki
    University of Tokyo, Japan .
    Toshiro, Inaba
    University of Tokyo, Japan .
    Masaru, Hatano
    University of Tokyo, Japan .
    Atsushi, Yao
    University of Tokyo, Japan .
    Ryozo, Nagai
    Jichii Medical University, Japan .
    Differential impacts of achieved heart rate and achieved dose of β-blocker on clinical outcomes in heart failure with and without atrial fibrillation2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 173, no 2, p. 331-333Article in journal (Other academic)
    Abstract [en]

    n/a

  • 30.
    Nishigaki, Masakazu
    et al.
    University of Tokyo, Japan .
    Kobayashi, Koji
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Seki, Naoto
    Social Insurance Funabashi Central Hospital, Japan .
    Yokomura, Taeko
    Social Insurance Funabashi Central Hospital, Japan .
    Yokoyama, Mitsunao
    Social Insurance Funabashi Central Hospital, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Preventive advice given by patients with type 2 diabetes to their offspring2009In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 59, no 558, p. 37-42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Patients' advice-giving behaviour could be a useful preventive strategy for type 2 diabetes.

    AIM:

    To investigate the conditions under which patients offer advice to their offspring and to assess the factors that facilitate advice giving.

    DESIGN OF STUDY:

    Cross-sectional observational study.

    SETTING:

    A general hospital with a diabetes clinic in a metropolitan suburb in Japan.

    METHOD:

    Parents with type 2 diabetes (n = 221) who had offspring aged 20-49 years inclusive without diabetes completed a self-administered questionnaire containing items relating to advice-giving behaviour, demographic characteristics, risk perception, and their disease status.

    RESULTS:

    A total of 184 (83.3%) patients responded that parental advice-giving behaviour is needed for their offspring, while 138 (62.4%) actually advised their offspring. Multiple logistic regression analysis showed that patients who were female (odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.03 to 3.65, P = 0.041), living with their offspring (OR =1.92, 95% CI = 1.04 to 3.57, P = 0.038), had complications (OR = 2.74, 95% CI = 1.25 to 6.00, P = 0.029), or perceived that their offspring had a high risk of developing diabetes (OR =1.45, 95% CI = 1.09 to 1.93, P = 0.011) were most likely to advise their offspring.

    CONCLUSION:

    Patients with type 2 diabetes recognised the need to give advice about preventive behaviour to their offspring but were not necessarily engaging in advice-giving behaviour. Advice-giving behaviour was affected by the parents' own disease status, their perception of their offspring's risk of developing diabetes, and the relationship between the patients and their offspring.

  • 31.
    Perkiö Kato, Naoko
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. University of Tokyo, Japan; Research Abroad, Japan.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Okada, Ikuko
    University of Tokyo, Japan.
    de Vries, Arjen E.
    University of Medical Centre Groningen, Netherlands.
    Kinugawa, Koichiro
    University of Tokyo, Japan.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey2015In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 17, no 11, p. e258-Article in journal (Refereed)
    Abstract [en]

    Background: Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries. Objective: We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden. Methods: This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring. Results: The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6%, 82/378; in Sweden: 30.0%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1%, 352/374) and Sweden (88.7%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9%, 100/115) and to do remote drug titration (79.1%, 91/115). Just under a quarter of Japanese (22.4%, 85/378) and over a third of Swedish (38.1%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers "how are we going to do it?" (categories include structure and resource), health care professionals themselves "what do we need to know and do" (reservation), and barriers related to patients "not everybody would benefit" (internal and external shortcomings). Conclusions: Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring.

  • 32.
    Seki, Satomi
    et al.
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Ito, Naomi
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Motomura, Noboru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Watanabe, Masafumi
    University of Tokyo, Japan .
    Imai, Yasushi
    University of Tokyo, Japan .
    Takeda, Norihiko
    University of Tokyo, Japan .
    Inoue, Masashi
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Translation and validation study of the Japanese versions of the Coronary Revascularisation Outcome Questionnaire (CROQ-J)2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 1, p. 22-30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS:

    Assessing the health related quality of life (HRQOL) in patients with a disease specific scale is essential. The purpose of this study was to develop the Japanese version of the coronary revascularisation outcome questionnaire (CROQ), a disease-specific scale to measure HRQOL before and after coronary revascularisation.

    METHODS:

    The English version of the questionnaire was translated into Japanese; some terms were revised, and some items were eliminated to suit the Japanese medical environment. Eight patients filled out the questionnaire, which was then analyzed for face validity. In the field study, subjects were recruited from a university hospital in Tokyo, and questionnaires were given to fill out. In terms of statistical analysis, factor analysis, internal consistency, known-groups validity, concurrent validity with using Short-Form36 (SF-36) and Seattle Angina Questionnaire-Japanese version (SAQ-J), and test-retest reliability were assessed.

    RESULTS:

    Informed consents were obtained from 356 patients, and out of 325 patients responded in the field study (91.3%). The factor structure of CROQ-Japanese version (CROQ-J) was similar to that of the original version. Cronbach's α ranged from 0.78 to 0.92. The concurrent validity was mostly supported by the pattern of association between CROQ-J, SAQ-J, and SF-36. Patients without chest symptoms had significantly higher scores of CROQ-J than those with chest symptoms. On the basis of analysis of the test-retest reliability, intra-class correlation coefficients were close to 0.70.

    CONCLUSIONS:

    The Japanese translation of CROQ is a valid and reliable scale for assessing the patient's HRQOL in CAD.

  • 33.
    Seki, Satomi
    et al.
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Ito, Naomi
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Motomura, Noboru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Watanabe, Masafumi
    University of Tokyo, Japan .
    Imai, Yasushi
    University of Tokyo, Japan .
    Takeda, Norihiko
    University of Tokyo, Japan .
    Inoue, Masashi
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Kazuma, Keiko
    University of Tokyo, Japan .
    Validity and reliability of Seattle angina questionnaire Japanese version in patients with coronary artery disease2010In: Asian Nursing Research, ISSN 1976-1317, Vol. 4, no 2, p. 57-63Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease.

    Methods

    Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed.

    Results

    A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items.

    Conclusions

    The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.

  • 34.
    Shiga, Taro
    et al.
    University of Tokyo, Japan .
    Kinugawa, Koichiro
    University of Tokyo, Japan .
    Hatano, Masaru
    University of Tokyo, Japan .
    Yao, Atsushi
    University of Tokyo, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Endo, Miyoko
    University of Tokyo, Japan .
    Kato, Naoko
    University of Tokyo, Japan .
    Hirata, Yasunobu
    University of Tokyo, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    University of Tokyo, Japan .
    Nagai, Ryozo
    University of Tokyo, Japan .
    Age and preoperative total bilirubin level can stratify prognosis after extracorporeal pulsatile left ventricular assist device implantation2011In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 75, no 1, p. 121-128Article in journal (Refereed)
    Abstract [en]

    Background: In Japan, the TOYOBO left ventricular assist device (LVAD) has been commercially available for heart failure patients as of 2010, but clinical risk stratification before implantation has not been widely performed. Methods and Results: In the present study data from 47 patients (age 38.6 +/- 14.6 [SD] years, male 74.5%, non-ischemic 74.5%) implanted with a TOYOBO LVAD between November 2002 and February 2010 were analyzed. Kaplan-Meier survival analysis showed significantly higher mortality in the patients who had cardiogenic shock preoperatively (P=0.031). Multivariate analysis revealed that the preoperative total bilirubin level (odds ratio [OR] 1.312, Pless than0.001) and age (OR 1.076, P=0.013) were independent risk factors for death. Perioperative necessity of a right ventricular assist device was also an independent risk factor for poor prognosis. Conclusions: LVAD implantation is preferable before the patient experiences hemodynamic collapse. The preoperative total bilirubin level can be used to predict prognosis after device implantation in end-stage heart failure patients.

  • 35.
    Shiga, Taro
    et al.
    Tokyo University Hospital, Japan .
    Kinugawa, Koichiro
    Tokyo University Hospital, Japan .
    Imamura, Teruhiko
    Tokyo University Hospital, Japan .
    Kato, Naoko
    Tokyo University Hospital, Japan .
    Endo, Miyoko
    Tokyo University Hospital, Japan .
    Inaba, Toshiro
    Tokyo University Hospital, Japan .
    Maki, Hisataka
    Tokyo University Hospital, Japan .
    Hatano, Masaru
    Tokyo University Hospital, Japan .
    Yao, Atsushi
    Tokyo University Hospital, Japan .
    Nishimura, Takashi
    University of Tokyo, Japan .
    Hirata, Yasunobu
    Tokyo University Hospital, Japan .
    Kyo, Shunei
    University of Tokyo, Japan .
    Ono, Minoru
    Tokyo University Hospital, Japan .
    Nagai, Ryozo
    Tokyo University Hospital, Japan .
    Combination evaluation of preoperative risk indices predicts requirement of biventricular assist device2012In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 76, no 12, p. 2785-2791Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Patients with biventricular assist device (BiVAD) placement have a poor prognosis, but preoperative risk factors for the necessity of BiVAD have not been fully elucidated.

    METHODS AND RESULTS:

    Data from 79 patients who received left ventricular assist device (LVAD) between November 2002 and December 2011 were retrospectively reviewed. Overall, 9 patients (11.4%) required BiVAD, and the survival rate of BiVAD patients was significantly lower than that of LVAD patients (P<0.001). Multivariate analysis for BiVAD requirement showed left ventricular diastolic diameter (LVDd) ≤62 mm (odds ratio [OR], 10.97; P=0.009) to be significantly associated with BiVAD requirement. Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; P=0.028) was also significantly associated with BiVAD requirement. A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4 m(2)), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200 pg/ml) and LVDd (≤62 mm), and this had a significantly larger area under the curve (0.909; P=0.003) than right ventricular stroke work index on receiver operating characteristic analysis. A score >20 using the new scoring method indicated significantly high probability of BiVAD requirement (OR, 16.00; P=0.019).

    CONCLUSIONS:

    The new scoring method, which includes CVP/PCWP ratio, is a novel risk stratification tool for BiVAD therapy.

  • 36.
    Yamamoto, Yuko
    et al.
    University of Tokyo, Japan.
    Nishigaki, Masakazu
    University of Tokyo, Japan.
    Kato, Naoko
    University of Tokyo, Japan.
    Hayashi, Michio
    Kanto Medical Center, Tokyo, Japan.
    Shiba, Teruo
    Mitsui Memorial Hospital, Tokyo, Japan.
    Mori, Yasumichi
    Toranomon Hospital, Tokyo, Japan.
    Kobayashi, Tetsuro
    University of Yamanashi, Japan.
    Kazuma, Keiko
    University of Tokyo, Japan.
    Knowledge and Demand for Information about Islet Transplantation in Patients with Type 1 Diabetes2011In: Journal of Transplantation, ISSN 2090-0007, E-ISSN 2090-0015, Vol. 2011, p. 136298-Article in journal (Refereed)
    Abstract [en]

    This cross-sectional study based on self-administrated questionnaire was conducted to investigate knowledge, related factors, and sources of information regarding islet transplantation in patients with type 1 diabetes in Japan. Among 137 patients who provided valid responses, 67 (48.9%) knew about islet transplantation. Their main source of information was newspapers or magazines (56.7%) and television or radio (46.3%). However, 85.8% of patients preferred the attending physician as their source of information. Although more than half of the patients were correctly aware of issues related to islet transplantation, the following specific issues for islet transplantation were not understood or considered, and there was little knowledge of them: need for immunosuppressants, lifestyle and dietary adaptations, fewer bodily burdens, and complications. The experience of hypoglycaemia, a high level of academic background, frequent self-monitoring of blood glucose, and the use of continuous subcutaneous insulin infusion were related to higher knowledge about islet transplantation.

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