Publications by authors named "Takuya Kishi"

135 Publications

New Era of Machine Learning Prediction of the Development of Cardiac Events in Heart Failure and Preserved Ejection Fraction.

Authors:
Takuya Kishi

Circ J 2021 Sep 14. Epub 2021 Sep 14.

Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare.

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http://dx.doi.org/10.1253/circj.CJ-21-0694DOI Listing
September 2021

External validation of the 4C Mortality Score for patients with COVID-19 and pre-existing cardiovascular diseases/risk factors.

BMJ Open 2021 09 8;11(9):e052708. Epub 2021 Sep 8.

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan

Objectives: Predictive algorithms to inform risk management decisions are needed for patients with COVID-19, although the traditional risk scores have not been adequately assessed in Asian patients. We aimed to evaluate the performance of a COVID-19-specific prediction model, the 4C (Coronavirus Clinical Characterisation Consortium) Mortality Score, along with other conventional critical care risk models in Japanese nationwide registry data.

Design: Retrospective cohort study.

Setting And Participants: Hospitalised patients with COVID-19 and cardiovascular disease or coronary risk factors from January to May 2020 in 49 hospitals in Japan.

Main Outcome Measures: Two different types of outcomes, in-hospital mortality and a composite outcome, defined as the need for invasive mechanical ventilation and mortality.

Results: The risk scores for 693 patients were tested by predicting in-hospital mortality for all patients and composite endpoint among those not intubated at baseline (n=659). The number of events was 108 (15.6%) for mortality and 178 (27.0%) for composite endpoints. After missing values were multiply imputed, the performance of the 4C Mortality Score was assessed and compared with three prediction models that have shown good discriminatory ability (RISE UP score, A-DROP score and the Rapid Emergency Medicine Score (REMS)). The area under the receiver operating characteristic curve (AUC) for the 4C Mortality Score was 0.84 (95% CI 0.80 to 0.88) for in-hospital mortality and 0.78 (95% CI 0.74 to 0.81) for the composite endpoint. It showed greater discriminatory ability compared with other scores, except for the RISE UP score, for predicting in-hospital mortality (AUC: 0.82, 95% CI 0.78 to 0.86). Similarly, the 4C Mortality Score showed a positive net reclassification improvement index over the A-DROP and REMS for mortality and over all three scores for the composite endpoint. The 4C Mortality Score model showed good calibration, regardless of outcome.

Conclusions: The 4C Mortality Score performed well in an independent external COVID-19 cohort and may enable appropriate disposition of patients and allocation of medical resources. UMIN000040598.
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http://dx.doi.org/10.1136/bmjopen-2021-052708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438580PMC
September 2021

Updates on renin-angiotensin system blockers in hypertensive patients with COVID-19.

Am J Hypertens 2021 Aug 18. Epub 2021 Aug 18.

Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, Okawa, Fukuoka, Japan.

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http://dx.doi.org/10.1093/ajh/hpab130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385983PMC
August 2021

Relationship Between Official Twitter Ambassadors and the Number of Retweets in the Annual Congress - "Tweet the Meeting".

Circ Rep 2021 Jul 30;3(7):414-418. Epub 2021 Jun 30.

Information and Communication Committee, The Japanese Circulation Society Tokyo Japan.

The relationship between Twitter ambassadors and retweets has not been fully evaluated for "tweet the meeting" activity. We collected data on the number of tweets and retweets during the Japanese Circulation Society's (JCS) annual meetings in 2019, 2020, and 2021. After adjustment, JCS Twitter Ambassadors, selected by the JCS to increase the meeting's visibility, increased the total number of retweets by 9%. This is the first report on the numerical relationship between JCS Twitter Ambassadors and the total number of retweets during an annual congress. Original tweets by JCS Twitter Ambassadors increased the number of retweets, but retweets by influencers were more effective at stimulating social media engagement.
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http://dx.doi.org/10.1253/circrep.CR-21-0063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258185PMC
July 2021

Nationwide Survey of Japanese Cardiac Rehabilitation Training Facilities During the Coronavirus Disease 2019 Outbreak.

Circ Rep 2021 May 27;3(6):311-315. Epub 2021 May 27.

Department of Health Science, Kansai Medical University Hirakata Japan.

Since the reporting of a cluster outbreak of coronavirus disease 2019 (COVID-19) in sports gyms, the Japanese Association of Cardiac Rehabilitation (CR) shared a common understanding of the importance of preventing patients and healthcare providers from contracting COVID-19. This questionnaire survey aimed to clarify the status of CR in Japan during the COVID-19 outbreak. An online questionnaire survey was conducted in 37 Japanese CR training facilities after the national declaration of a state of emergency in 7 prefectures. Among these facilities, 70% suspended group ambulatory CR and 43% suspended cardiopulmonary exercise testing (CPX). In contrast, all facilities maintained individual inpatient CR. Of the 37 facilities, 95% required CR staff to wear a surgical mask during CR. In contrast, 50% of facilities did not require patients to wear a surgical mask during CR. Cardiac telerehabilitation was only conducted by a limited number of facilities (8%), because this method was still under development. In our survey, 30% of the facilities not providing cardiac telerehabilitation had specific plans for its future use. Our data demonstrate that ambulatory CR and CPX were suspended to avoid the spread of COVID-19. In the future, we need to consider CR resumption and develop new technologies for cardiovascular patients, including cardiac telerehabilitation.
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http://dx.doi.org/10.1253/circrep.CR-21-0042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180369PMC
May 2021

[Role of the gastrointestinal tract on therapeutic approach to obesity].

Nihon Shokakibyo Gakkai Zasshi 2021 ;118(6):500-504

International University of Health and Welfare, Graduate School of Medicine.

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http://dx.doi.org/10.11405/nisshoshi.118.500DOI Listing
June 2021

Clinical and Biomarker Profiles and Prognosis of Elderly Patients With Coronavirus Disease 2019 (COVID-19) With Cardiovascular Diseases and/or Risk Factors.

Circ J 2021 05 29;85(6):921-928. Epub 2021 Apr 29.

Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.

Background: This study investigated the effects of age on the outcomes of coronavirus disease 2019 (COVID-19) and on cardiac biomarker profiles, especially in patients with cardiovascular diseases and/or risk factors (CVDRF).Methods and Results:A nationwide multicenter retrospective study included 1,518 patients with COVID-19. Of these patients, 693 with underlying CVDRF were analyzed; patients were divided into age groups (<55, 55-64, 65-79, and ≥80 years) and in-hospital mortality and age-specific clinical and cardiac biomarker profiles on admission evaluated. Overall, the mean age of patients was 68 years, 449 (64.8%) were male, and 693 (45.7%) had underlying CVDRF. Elderly (≥80 years) patients had a significantly higher risk of in-hospital mortality regardless of concomitant CVDRF than younger patients (P<0.001). Typical characteristics related to COVID-19, including symptoms and abnormal findings on baseline chest X-ray and computed tomography scans, were significantly less prevalent in the elderly group than in the younger groups. However, a significantly (P<0.001) higher proportion of elderly patients were positive for cardiac troponin (cTn), and B-type natriuretic peptide (BNP) and N-terminal pro BNP (NT-proBNP) levels on admission were significantly higher among elderly than younger patients (P<0.001 and P=0.001, respectively).

Conclusions: Elderly patients with COVID-19 had a higher risk of mortality during the hospital course, regardless of their history of CVDRF, were more likely to be cTn positive, and had significantly higher BNP/NT-proBNP levels than younger patients.
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http://dx.doi.org/10.1253/circj.CJ-21-0160DOI Listing
May 2021

Association Between Statin Use Prior to Admission and Lower Coronavirus Disease 2019 (COVID-19) Severity in Patients With Cardiovascular Disease or Risk Factors.

Circ J 2021 05 29;85(6):939-943. Epub 2021 Apr 29.

Department of Cardiovascular Medicine, Toho University Graduate School of Medicine.

Background: Cardiovascular diseases and/or risk factors (CVDRF) have been reported as risk factors for severe coronavirus disease 2019 (COVID-19).Methods and Results:In total, we selected 693 patients with CVDRF from the CLAVIS-COVID database of 1,518 cases in Japan. The mean age was 68 years (35% females). Statin use was reported by 31% patients at admission. Statin users exhibited lower incidence of extracorporeal membrane oxygenation (ECMO) insertion (1.4% vs. 4.6%, odds ratio [OR]: 0.295, P=0.037) and septic shock (1.4% vs. 6.5%, OR: 0.205, P=0.004) despite having more comorbidities such as diabetes mellitus.

Conclusions: This study suggests the potential benefits of statins use against COVID-19.
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http://dx.doi.org/10.1253/circj.CJ-21-0087DOI Listing
May 2021

Cardiology Department Practices in the First Wave of the Coronavirus Disease Pandemic - A Nationwide Survey in Japan by the Japanese Circulation Society.

Circ Rep 2021 Feb 5;3(3):137-141. Epub 2021 Feb 5.

Department of Cardiovascular Medicine, Saga University Saga Japan.

From the early phase of the Coronavirus disease-2019 (COVID-19) pandemic, cardiologists have paid attention not only to COVID-19-associated cardiovascular sequelae, but also to treatment strategies for rescheduling non-urgent procedures. The chief objective of this study was to explore confirmed COVID-19 cardiology case experiences and departmental policies, and their regional heterogeneity in Japan. We performed a retrospective analysis of a nationwide survey performed by the Japanese Circulation Society on April 13, 2020. The questionnaire included cardiology department experience with confirmed COVID-19 cases and restriction policies, and was sent to 1,360 certified cardiology training hospitals. Descriptive analysis and spatial autocorrelation analysis of each response were performed to reveal the heterogeneity of departmental policies. The response rate was 56.8% (773 replies). Only 16% of all responding hospitals experienced a COVID-19 cardiology case. High-risk procedures were restricted in more than one-fifth of hospitals, including transesophageal echocardiography (34.9%) and scheduled catheterization (39.5%). The presence of a cardiologist in the COVID-19 team, the number of board-certified cardiologists, any medical resource shortage and a state of emergency were positively correlated with any type of restriction. We found both low clinical case experiences with COVID-19 and restrictions of cardiovascular procedures during the first COVID-19 wave in Japan. Restrictions arising as a result of COVID-19 were affected by hospital- and country-level variables, such as a state of emergency.
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http://dx.doi.org/10.1253/circrep.CR-21-0002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956880PMC
February 2021

Cardiology Department Policy in Japan After Coronavirus Disease-2019 (COVID-19) - Descriptive Summary of 2nd Nationwide Survey by the Japanese Circulation Society.

Circ Rep 2021 Jan 29;3(2):100-104. Epub 2021 Jan 29.

Department of Cardiovascular Medicine, Saga University Saga Japan.

Cardiovascular department restriction policies on procedures resulting from the COVID-19 pandemic have not been fully evaluated. We performed a retrospective analysis of a nationwide survey performed by the Japanese Circulation Society in August 2020. The total response rate was 48.9% (651/1,331). The rate of restriction of cardiovascular procedures peaked in April. Exacerbations of heart failure due to hospital restrictions were noted in 43.8% of departments. Many departments restricted their cardiological procedures, and this rate changed according to the pandemic situation. The exacerbation of cardiovascular disease resulting from pandemic restrictions should not be ignored.
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http://dx.doi.org/10.1253/circrep.CR-21-0003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939954PMC
January 2021

Two-Year Experience in "Tweeting the Meeting" During the Scientific Sessions - Rapid Report From the Japanese Circulation Society.

Circ Rep 2020 Sep 25;2(11):691-694. Epub 2020 Sep 25.

Department of Cardiovascular Medicine, Saga University Saga Japan.

Twitter has become increasingly popular at annual medical congresses as a platform to communicate to attendees. The aim of this study is to reveal the twitter usage in the annual congress of the Japanese Cirsulation Society. We compared the total number of tweets during the Japanese Circulation Society's annual meetings in 2019 and 2020. The total number of tweets increased from 7,587 in 2019 to 23,867 in 2020. Most tweets were retweets (>70%), and approximately half of Twitter users tweeted only once. Twitter usage during the Japanese Circulation Society's annual meeting increased from 2019 to 2020, and a large number of tweets were from Twitter ambassadors of the Japanese Circulation Society. However, further evaluation is needed, with future studies investigating the usefulness of this platform.
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http://dx.doi.org/10.1253/circrep.CR-20-0093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937497PMC
September 2020

Recommendations for Maintaining the Cardiovascular Care System Under the Conditions of the COVID-19 Pandemic - 1st Edition, April 2020.

Circ J 2020 10 25;84(11):2023-2026. Epub 2020 Sep 25.

Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.

Background: The Japanese Circulation Society proposes recommendations for all healthcare professionals involved in cardiovascular medicine to protect them from infection and ensure that seriously ill patients requiring urgent care receive proper treatment.Methods and Results:Patients are divided into "Positive or suspected coronavirus disease 2019 (COVID-19)" and "All others". Furthermore, tests and treatments are divided into emergency or standby. For each category, we propose recommendations.

Conclusions: To maintain the cardiovascular care system, The Japanese Circulation Society recommends completely preventing nosocomial COVID-19 infections, ensuring adequate PPE necessary for healthcare personnel, and learning and implementing standard precautions.
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http://dx.doi.org/10.1253/circj.CJ-20-0518DOI Listing
October 2020

Selexipag for Chronic Thromboembolic Pulmonary Hypertension in Japanese Patients - A Double-Blind, Randomized, Placebo-Controlled, Multicenter Phase II Study.

Circ J 2020 09 3;84(10):1866-1874. Epub 2020 Sep 3.

Kuriyama Clinic.

Background: Selexipag is an oral prostacyclin receptor (IP receptor) agonist with a non-prostanoid structure. This study examined its efficacy and safety in Japanese patients with non-operated or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH).Methods and Results:This Phase II study was a randomized, double-blind, placebo-controlled parallel-group comparison. The primary endpoint was a change in pulmonary vascular resistance (PVR) from baseline to week 17. The main analysis involved a per-protocol set group of 28 subjects. The change in PVR (mean±SD) after 17 weeks of treatment in the selexipag group was -104±191 dyn·s/cm, whereas that in the placebo group was 26±180 dyn·s/cm. Thus, the treatment effect after 17 weeks of selexipag treatment was calculated as -130±189 dyn·s/cm(P=0.1553). Although the primary endpoint was not met, for the group not concomitantly using a pulmonary vasodilator the PVR in the selexipag group was significantly decreased compared with placebo group (P=0.0364). The selexipag group also showed improvement in total pulmonary resistance and cardiac index.

Conclusions: Selexipag treatment improved pulmonary hemodynamics in Japanese patients with CTEPH, but PVR did not show a significant difference between the selexipag and placebo groups. (Trial registration: JAPIC Clinical Trials Information [JapicCTI-111667]).
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http://dx.doi.org/10.1253/circj.CJ-20-0438DOI Listing
September 2020

Prediction of haemodynamics after interatrial shunt for heart failure using the generalized circulatory equilibrium.

ESC Heart Fail 2020 10 4;7(5):3075-3085. Epub 2020 Aug 4.

Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Aims: Interatrial shunting (IAS) reduces left atrial pressure in patients with heart failure. Several clinical trials reported that IAS improved the New York Heart Association score and exercise capacity. However, its effects on haemodynamics vary depending on shunt size, cardiovascular properties, and stressed blood volume. To maximize the benefit of IAS, quantitative prediction of haemodynamics under IAS in individual patients is essential. The generalized circulatory equilibrium framework determines circulatory equilibrium as the intersection of the cardiac output curve and the venous return surface. By incorporating IAS into the framework, we predict the impact of IAS on haemodynamics.

Methods And Results: In seven mongrel dogs, we ligated the left anterior descending artery and created impaired cardiac function with elevated left atrial pressure (baseline: 7.8 ± 1.0 vs. impaired: 11.9 ± 3.2 mmHg). We established extracorporeal left-to-right atrial shunting with a centrifugal pump. After recording pre-IAS haemodynamics, we changed IAS flow stepwise to various levels and measured haemodynamics under IAS. To predict the impact of IAS on haemodynamics, we modelled the fluid mechanics of IAS by Newton's second law and incorporated IAS into the generalized circulatory equilibrium framework. Using pre-IAS haemodynamic data obtained from the dogs, we predicted the impact of IAS flow on haemodynamics under IAS condition using a set of equations. We compared the predicted haemodynamic data with those measured. The predicted pulmonary flow [r = 0.88, root mean squared error (RMSE) 11.4 mL/min/kg, P < 0.001), systemic flow (r = 0.92, RMSE 11.2 mL/min/kg, P < 0.001), right atrial pressure (r = 0.92, RMSE 0.71 mmHg, P < 0.001), and left atrial pressure (r = 0.83, RMSE 0.95 mmHg, P < 0.001) matched well with those measured under normal and impaired cardiac function. Using this framework, we further performed a simulation study to examine the haemodynamic benefit of IAS in heart failure with preserved ejection fraction. We simulated the IAS haemodynamics under volume loading and exercise conditions. Volume loading and exercise markedly increased left atrial pressure. IAS size-dependently attenuated the increase in left atrial pressure in both volume loading and exercise. These results indicate that IAS improves volume and exercise intolerance.

Conclusions: The framework developed in this study quantitatively predicts the haemodynamic impact of IAS. Simulation study elucidates how IAS improve haemodynamics under volume loading and exercise conditions. Quantitative prediction of IAS haemodynamics would contribute to maximizing the benefit of IAS in patients with heart failure.
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http://dx.doi.org/10.1002/ehf2.12935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524226PMC
October 2020

Hypertension and related diseases in the era of COVID-19: a report from the Japanese Society of Hypertension Task Force on COVID-19.

Hypertens Res 2020 10 31;43(10):1028-1046. Epub 2020 Jul 31.

Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.

Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected more than seven million people worldwide, contributing to 0.4 million deaths as of June 2020. The fact that the virus uses angiotensin-converting enzyme (ACE)-2 as the cell entry receptor and that hypertension as well as cardiovascular disorders frequently coexist with COVID-19 have generated considerable discussion on the management of patients with hypertension. In addition, the COVID-19 pandemic necessitates the development of and adaptation to a "New Normal" lifestyle, which will have a profound impact not only on communicable diseases but also on noncommunicable diseases, including hypertension. Summarizing what is known and what requires further investigation in this field may help to address the challenges we face. In the present review, we critically evaluate the existing evidence for the epidemiological association between COVID-19 and hypertension. We also summarize the current knowledge regarding the pathophysiology of SARS-CoV-2 infection with an emphasis on ACE2, the cardiovascular system, and the kidney. Finally, we review evidence on the use of antihypertensive medication, namely, ACE inhibitors and angiotensin receptor blockers, in patients with COVID-19.
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http://dx.doi.org/10.1038/s41440-020-0515-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393334PMC
October 2020

Appropriate selection of a mouse strain in accordance with the vascular properties.

Authors:
Takuya Kishi

Hypertens Res 2020 11 27;43(11):1311-1312. Epub 2020 Jul 27.

Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, Okawa, Fukuoka, Japan.

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http://dx.doi.org/10.1038/s41440-020-0520-3DOI Listing
November 2020

Heart rate Is the Clinical Indicator of Sympathetic Activation and Prognostic Value of Cardiovascular Risks in Patients With Hypertension.

Authors:
Takuya Kishi

Hypertension 2020 08 8;76(2):323-324. Epub 2020 Jul 8.

From the Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, Okawa, Fukuoka, Japan.

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.14898DOI Listing
August 2020

Clinical implication of left ventricular preload and afterload reduction during venoarterial extracorporeal membrane oxygenation.

Authors:
Takuya Kishi

Int J Cardiol 2020 12 20;320:124-125. Epub 2020 Jun 20.

Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, 137-1 enokizu, Okawa, Fukuoka 8318501, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2020.06.013DOI Listing
December 2020

Coronavirus Disease 2019 (COVID-19) Information for Cardiologists - Systematic Literature Review and Additional Analysis.

Circ J 2020 05 29;84(6):1039-1043. Epub 2020 Apr 29.

Executive Committee, The Japanese Circulation Society.

Background: Despite the rapidly increasing attention being given to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, more commonly known as coronavirus disease 2019 (COVID-19), the relationship between cardiovascular disease and COVID-19 has not been fully described.Methods and Results:A systematic review was undertaken to summarize the important aspects of COVID-19 for cardiologists. Protection both for patients and healthcare providers, indication for treatments, collaboration with other departments and hospitals, and regular update of information are essentials to front COVID-19 patients.

Conclusions: Because the chief manifestations of COVID-19 infection are respiratory and acute respiratory distress syndrome, cardiologists do not see infected patients directly. Cardiologists need to be better prepared regarding standard disinfection procedures, and be aware of the indications for extracorporeal membrane oxygenation and its use in the critical care setting.
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http://dx.doi.org/10.1253/circj.CJ-20-0302DOI Listing
May 2020

Astrocytes in paraventricular nucleus is a potential therapeutic target for ventricular arrhythmia with sympathoexcitation after acute myocardial infarction.

Authors:
Takuya Kishi

Int J Cardiol 2020 06 6;308:52-53. Epub 2020 Mar 6.

Department of Graduate School of Medicine (Cardiology), International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka 8318501, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2020.03.010DOI Listing
June 2020

Increased fibroblast growth factor-21 in chronic kidney disease is a trade-off between survival benefit and blood pressure dysregulation.

Sci Rep 2019 12 17;9(1):19247. Epub 2019 Dec 17.

Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan.

Circulating levels of fibroblast growth factor-21 (FGF21) start increasing in patients with chronic kidney disease (CKD) since early stages during the cause of disease progression. FGF21 is a liver-derived hormone that induces responses to stress through acting on hypothalamus to activate the sympathetic nervous system and the hypothalamus-pituitary-adrenal endocrine axis. However, roles that FGF21 plays in pathophysiology of CKD remains elusive. Here we show in mice that FGF21 is required to survive CKD but responsible for blood pressure dysregulation. When introduced with CKD, Fgf21 mice died earlier than wild-type mice. Paradoxically, these Fgf21 CKD mice escaped several complications observed in wild-type mice, including augmentation of blood pressure elevating response and activation of the sympathetic nervous system during physical activity and increase in serum noradrenalin and corticosterone levels. Supplementation of FGF21 by administration of an FGF21-expressing adeno-associated virus vector recapitulated these complications in wild-type mice and restored the survival period in Fgf21 CKD mice. In CKD patients, high serum FGF21 levels are independently associated with decreased baroreceptor sensitivity. Thus, increased FGF21 in CKD can be viewed as a survival response at the sacrifice of blood pressure homeostasis.
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http://dx.doi.org/10.1038/s41598-019-55643-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917750PMC
December 2019

Systemic hemodynamic atherothrombotic syndrome (SHATS) - Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia.

Prog Cardiovasc Dis 2020 Jan - Feb;63(1):22-32. Epub 2019 Dec 4.

Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Japan; Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) but the association between HTN and CVD cannot be explained by average blood pressure (BP) alone. BP variability (BPV) is another important factor, along with the effects of HTN on the vasculature. The concept of systemic hemodynamic atherothrombotic syndrome (SHATS) has been proposed, describing an age-related and synergistic vicious cycle of hemodynamic stress and vascular disease. The importance of SHATS is based on the assumption that the assessment of BPV and arterial disease is likely to provide an effective opportunity to intervene early to reduce progression to HTN in younger patients or to CVD events and organ damage in older patients. In addition to providing an overview of current evidence for the mechanisms and clinical data related to SHATS, this article proposes a new SHATS score for use to diagnose and assess the severity of SHATS. The score includes two components - a BP score and a vascular score - which are multiplied to generate the SHATS score. This reflects the synergistic, rather than additive, effects of BP and vascular disease on target organ damage and CVD events. Although it requires refinement and validation in future studies, early detection of SHATS using tools such as the proposed score, combined with population-based stratification and technology-based anticipation medicine incorporating real-time individual data, has the potential to contribute to meaningful reductions in rates of CVD events and target organ damage.
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http://dx.doi.org/10.1016/j.pcad.2019.11.002DOI Listing
May 2020

Potential Role of Twitter at an Annual Congress in Japan - Narrative Literature Review of "Tweet the Meeting".

Circ Rep 2019 Sep 19;1(10):401-404. Epub 2019 Sep 19.

Department of Cardiovascular Medicine, Saga University Saga Japan.

Twitter has become increasingly popular at annual medical congresses as a platform to communicate to attendees. In contrast, Twitter is not as frequently used in Japan as compared with other countries. Herein, we reviewed the literature and discuss the potential role and risks of "tweet the meeting" in Japan. We performed a literature review to consider the recent trend of tweeting the meeting, including benefits and how to tweet, as well as potential risks. Upon officially deciding to tweet the meeting, a number of societies and professional organizations developed strategies to enhance the attendees' experience using multiple modalities and guides. Although there are several risks, we provide a concise guide to tweeting the meeting for the Japanese audience, which could be useful for understanding what should be done before and during a conference. The use of Twitter at medical congresses has many possibilities, and there are numerous potentials in many areas. We should discuss this in the light of the benefits for congress attendees in Japan.
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http://dx.doi.org/10.1253/circrep.CR-19-0046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897545PMC
September 2019

Suppressed baroreflex peripheral arc overwhelms augmented neural arc and incapacitates baroreflex function in rats with pulmonary arterial hypertension.

Exp Physiol 2019 08 13;104(8):1164-1178. Epub 2019 Jun 13.

Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.

New Findings: What is the central question of this study? The impact of pulmonary arterial hypertension on open-loop baroreflex function, which determines how powerfully and rapidly the baroreflex operates to regulate arterial pressure, remains poorly understood. What is the main finding and its importance? The gain of the baroreflex total arc, indicating the baroreflex pressure-stabilizing function, is markedly attenuated in rats with monocrotaline-induced pulmonary arterial hypertension. This is caused by a rightward shift of the baroreflex neural arc and a downward shift of the peripheral arc. These findings contribute greatly to our understanding of arterial pressure regulation by the sympathetic nervous system in pulmonary arterial hypertension.

Abstract: Sympathoexcitation has been documented in patients with established pulmonary arterial hypertension (PAH). Although the arterial baroreflex is the main negative feedback regulator of sympathetic nerve activity (SNA), the way in which PAH impacts baroreflex function remains poorly understood. In this study, we conducted baroreflex open-loop analysis in a rat model of PAH. Sprague-Dawley rats were injected with monocrotaline (MCT) s.c. to induce PAH (60 mg kg ; n = 11) or saline as a control group (CTL; n = 8). At 3.5 weeks after MCT injection, bilateral carotid sinuses were isolated, and intrasinus pressure (CSP) was controlled while SNA at the coeliac ganglia and arterial pressure (AP) were recorded. To examine the static baroreflex function, CSP was increased stepwise while steady-state AP (total arc) and SNA (neural arc) responses to CSP and the AP response to SNA (peripheral arc) were measured. Monocrotaline significantly decreased the static gain of the baroreflex total arc at the operating AP compared with CTL (-0.80 ± 0.31 versus -0.22 ± 0.22, P < 0.05). Given that MCT markedly increased plasma noradrenaline, an index of SNA, by approximately 3.6-fold compared with CTL, calibrating SNA by plasma noradrenaline revealed that MCT shifted the neural arc to a higher SNA level and shifted the peripheral arc downwards. Monocrotaline also decreased the dynamic gain of the baroreflex total arc (-0.79 ± 0.16 versus -0.35 ± 0.17, P < 0.05), while the corner frequencies that reflect the speed of the baroreflex remained unchanged (0.06 ± 0.02 versus 0.08 ± 0.02 Hz, n.s.). In rats with MCT-induced PAH, the suppressed baroreflex peripheral arc overwhelms the augmented neural arc and, in turn, attenuates the gain of the total arc, which determines the pressure-stabilizing capacity of the baroreflex.
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http://dx.doi.org/10.1113/EP087253DOI Listing
August 2019

Carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications.

Hypertens Res 2019 04 5;42(4):496-503. Epub 2019 Apr 5.

Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan.

Although beta blockers have been used as initial therapy for ischemic heart diseases and heart failure, the beneficial effects of beta blockers are controversial compared with other antihypertensive agents as initial therapy for hypertension without compelling indications. Moreover, atenolol has been most commonly used with beta blockers. The objective of the present systematic review associated with the Japanese Society of Hypertension (JSH) 2019 Hypertension Guideline (Clinical Question 6) was to assess the outcomes (cardiocerebrovascular mortality, total cause mortality, hypotension, bradycardia, other adverse effects, and changes in systolic blood pressure (SBP)) of currently used carvedilol and bisoprolol as initial therapy for adult hypertension without compelling indications. Two independent systematic reviewers searched randomized controlled trials (RCTs) up to October 2017 in the Cochrane Hypertension Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, EMBASE Ovid, and ClinicalTrials.gov. Finally, eight RCTs with 2494 participants were identified to meet our inclusion criteria. There were no RCTs in which cardiocerebrovascular mortality, total cause mortality, hypotension, and bradycardia were assessed between carvedilol or bisoprolol and placebo. SBP-lowering effects were significantly increased for bisoprolol compared with placebo. Here, 50 mg carvedilol significantly reduced SBP compared with placebo, whereas 12.5 mg or 25 mg did not. Regarding adverse effects, no differences were noted between carvedilol and placebo (two RCTs, 286 participants, moderate certainly evidence). In conclusion, current evidence does not support carvedilol or bisoprolol as first-line therapy for adult hypertension without compelling indications.
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http://dx.doi.org/10.1038/s41440-018-0174-6DOI Listing
April 2019

Estimation of the baroreflex total loop gain by the power spectral analysis of continuous arterial pressure recordings.

Am J Physiol Heart Circ Physiol 2019 04 4;316(4):H828-H839. Epub 2019 Jan 4.

Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan.

Baroreflex dysfunction contributes to the pathogenesis of cardiovascular diseases. The baroreflex comprises a negative feedback loop to stabilize arterial pressure (AP); its pressure-stabilizing capacity is defined as the gain ( G) of the transfer function ( H) of the baroreflex total loop. However, no method exists to evaluate G in a clinical setting. A feedback system with H attenuates pressure disturbance (PD) to PD/(1 + H). We hypothesized that the baroreflex attenuates the power spectrum density (PSD) of AP in the baroreflex functioning frequency range. We created graded baroreflex dysfunction in rats using a modified sinoaortic denervation (SAD) method [SAD; control (no SAD): n = 9; partial SAD (SAD in the right carotid sinus): n = 6, and total SAD (SAD in the bilateral carotid sinuses): n = 6] and evaluated the PSD of 12-h telemetric AP recordings in the light phase. Using the ratio of PSD at 0.01-0.1 Hz (PSD slope), we normalized them with the PSD in rats with complete baroreflex failure and derived the baroreflex index (BRI), which directly reflects G. We compared BRI and G obtained from a baroreflex open-loop experiment (reference G). The PSD slope became steeper with progression of baroreflex dysfunction. BRI (control: 2.00 ± 0.31, partial SAD: 1.28 ± 0.30, and total SAD: 0.06 ± 0.10, P < 0.05) was linearly correlated with reference G ( R = 0.91, P < 0.01). BRI accurately estimated G of the baroreflex and may serve as a novel tool for estimating the pressure-stabilizing capacity of the baroreflex in clinical settings. NEW & NOTEWORTHY This study proposed a novel method to estimate the gain of the baroreflex total loop, the so-called "baroreflex index" (BRI). BRI focuses on action potential variability in the frequency domain, considering baroreflex low-pass filter characteristics within 0.01-0.1 Hz. We demonstrated that BRI was linearly correlated with the reference gain of baroreflex in rats. Thus, BRI may contribute greatly to the development of a clinical tool for estimating baroreflex pressure-stabilizing capacity.
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http://dx.doi.org/10.1152/ajpheart.00681.2018DOI Listing
April 2019

Nav1.6 in the vasomotor center is a promising key molecule in the pathophysiology of stress-induced hypertension.

Authors:
Takuya Kishi

Hypertens Res 2019 02 4;42(2):143-144. Epub 2018 Dec 4.

Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan.

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http://dx.doi.org/10.1038/s41440-018-0141-2DOI Listing
February 2019
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