Publications by authors named "Koichiro Kuwahara"

Acute kidney injury (AKI), typically caused by ischemia, is a common clinical complication with a poor prognosis. Although proteinuria is an important prognostic indicator of AKI, the underlying causal mechanism remains unclear. In vitro studies suggest that podocytes have high ATP demands to maintain their structure and function, however, analyzing their ATP dynamics in living kidneys has been technically challenging.

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Introduction: Long hospital stay is associated with high costs and poor quality of life in elderly patients with heart failure (HF). This study aimed to investigate the association of early administration of tolvaptan with length of hospital stay among elderly patients with HF.

Methods: The cohort included elderly patients (age ≥ 75 years) admitted to Shinonoi General Hospital between July 2016 and December 2018 with a primary diagnosis of acute decompensated HF treated with tolvaptan.

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Article Synopsis
  • Most heart failure patients show signs of congestion, which can impact prognosis differently based on their left ventricular ejection fraction (LVEF).
  • This study analyzed data from 3,787 patients to evaluate how varying levels of congestion affect outcomes like death and rehospitalization, revealing that severe congestion on admission is linked to worse outcomes in those with LVEF ≥ 40%.
  • The results suggest that while clinical congestion severity affects patients with higher LVEF, it does not have the same effect on those with lower LVEF, indicating a need for further research into congestion's role across different LVEF levels.
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Background: Optimal lesion preparation for coronary lesions has been reappraised in the interventional community, given the increasing use of drug-coated balloons for de novo lesions; however, whether multiple ballooning could achieve more favorable angiographic results compared with single ballooning remains unknown. We aimed to investigate the incremental effect of multiple ballooning on de novo coronary lesions over single ballooning as assessed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS) among patients undergoing percutaneous coronary intervention (PCI).

Methods: Patients with chronic coronary syndrome (CCS) undergoing PCI were enrolled.

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In patients with acute myocardial infarction (MI), heart failure (HF) is one of the most common complications that is associated with a significant burden of mortality and healthcare resources. The clinical benefits of key HF drugs, the so-called "4 pillars" or "fantastic 4", namely β-blockers, mineralocorticoid receptor antagonists, angiotensin receptor-neprilysin inhibitor, and sodium-glucose cotransporter 2 inhibitors, have been established in patients with HF with reduced ejection fraction, whereas the effects of these drugs are not comprehensively appreciated in patients with acute MI. This review summarizes current evidence on pharmacological and device-based interventions for preventing HF after acute MI.

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Background: Transvenous lead extraction (TLE) for cardiovascular implantable electronic device (CIED)-related infections has increased. The incidence of TLE in nonagenarians is low, with limited reports outlining the outcomes of this procedure. Therefore, in this study, we aimed to clarify the outcomes of TLE in nonagenarians.

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Background: Clinical evidence regarding predictors of successful weaning from mechanical circulatory support (MCS) is lacking. This study aimed to create a simple risk score to predict successful weaning from MCS in patients with cardiogenic shock.

Methods And Results: This retrospective single-center cohort study included 114 consecutive patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation or IMPELLA between January 2013 and June 2023.

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Article Synopsis
  • - This study examines the connection between the hemoglobin to red blood cell distribution width (Hb/RDW) ratio and mortality in patients recovering from acute decompensated heart failure (ADHF), highlighting its potential as a predictive tool.
  • - Researchers analyzed data from 250 patients hospitalized for ADHF, finding that those with a lower Hb/RDW ratio (<0.24) had significantly worse outcomes in terms of all-cause mortality compared to those with a higher ratio (≥0.24).
  • - After adjusting for factors like demographics and heart failure severity, a lower Hb/RDW ratio was shown to nearly double the risk of mortality, suggesting its importance in identifying patients at higher risk for future cardiovascular issues.
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The prognosis of congenital heart disease (CHD) has improved, and most patients now reach adulthood. Owing to residual disease and comorbidities, it is recommended that adult CHD (ACHD) patients transition to adult care for lifelong monitoring and treatment. However, this transition period can be challenging for CHD patients owing to obstacles such as independence from their parents and establishing self-management.

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Lipid-lowering therapy plays a central role in reducing cardiovascular events. Over the past few decades, clinical trials utilizing several imaging techniques have consistently shown that lipid-lowering therapy can reduce the coronary plaque burden and improve plaque composition. Although intravascular ultrasound has been the most extensively used modality to assess plaque burden, other invasive modalities, such as optical coherence tomography and near-infrared spectroscopy, provide relevant data on plaque vulnerability, and computed tomography angiography detects both plaque volume and characteristics non-invasively.

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  • The study focused on factors influencing the effectiveness of esaxerenone in lowering blood pressure (BP) and the risk of elevated potassium levels in hypertensive patients.
  • Results showed that factors like male sex, high pulse rate, and use of calcium channel blockers were linked to a weaker BP-lowering effect, while lower urine albumin-to-creatinine ratios indicated a stronger effect.
  • Additionally, patients with higher baseline serum potassium levels were at a greater risk of experiencing elevated potassium levels after treatment with esaxerenone.
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  • The study aimed to determine the optimal time limit for successfully weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in cases of cardiogenic shock, aiding decisions on heart failure treatment and care withdrawal.
  • Conducted from January 2013 to June 2023, the retrospective study analyzed 100 patients who received VA-ECMO, excluding those with out-of-hospital cardiac arrests, and evaluated the relationship between support duration and weaning success.
  • Results showed that shorter durations of ECMO support (≤7 days) significantly correlated with higher success rates of weaning (58%), compared to longer durations (≥15 days), with successful weaning in only 43% of
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Background: Lower limb artery disease (LEAD) is accompanied by multiple comorbidities; however, the effect of hyperpolypharmacy on patients with LEAD has not been established. This study investigated the associations between hyperpolypharmacy, medication class, and adverse clinical outcomes in patients with LEAD.

Methods: This study used data from a prospective multicenter observational Japanese registry.

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  • Remote cardiac rehabilitation (RCR) is a method designed for patients recovering from cardiovascular diseases, utilizing real-time monitoring and technology for safety and effectiveness.
  • A study in Japan involved 53 RCR patients exercising at home for 2-3 months, with real-time support, and compared their results to 103 patients who underwent traditional center-based rehabilitation.
  • The findings showed that RCR was just as safe and effective in improving exercise capacity as traditional methods, with no significant complications reported in the RCR group.
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Aims: Many patients with heart failure (HF) have chronic kidney disease (CKD) and may not tolerate mineralocorticoid receptor antagonists. We investigated the efficacy and safety of the novel mineralocorticoid receptor modulator balcinrenone in combination with dapagliflozin in a phase 2b study.

Methods And Results: From January 2021 to October 2023, we randomized 133 adults with symptomatic HF, ejection fraction <60%, estimated glomerular filtration rate (eGFR) ≥30 to ≤60 ml/min/1.

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Aims: In recent years, there has been remarkable development in machine learning (ML) models, showing a trend towards high prediction performance. ML models with high prediction performance often become structurally complex and are frequently perceived as black boxes, hindering intuitive interpretation of the prediction results. We aimed to develop ML models with high prediction performance, interpretability, and superior risk stratification to predict in-hospital mortality and worsening heart failure (WHF) in patients with acute heart failure (AHF).

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Background: The clinical application of human induced pluripotent stem cell-derived cardiomyocytes (CMs) for cardiac repair commenced with the epicardial delivery of engineered cardiac tissue; however, the feasibility of the direct delivery of human induced pluripotent stem cell-derived CMs into the cardiac muscle layer, which has reportedly induced electrical integration, is unclear because of concerns about poor engraftment of CMs and posttransplant arrhythmias. Thus, in this study, we prepared purified human induced pluripotent stem cell-derived cardiac spheroids (hiPSC-CSs) and investigated whether their direct injection could regenerate infarcted nonhuman primate hearts.

Methods: We performed 2 separate experiments to explore the appropriate number of human induced pluripotent stem cell-derived CMs.

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  • The ALIMENT-HF trial tests the safety and benefits of high-calorie and high-protein oral nutritional supplements (ONS) for older adults with heart failure (HF).
  • It involves 80 participants aged 65 and older who are at risk of malnutrition and anorexia, receiving specific ONS for up to 120 days.
  • The trial aims to assess changes in body weight and overall nutritional status, which could inform future studies on treating malnutrition in heart failure patients.
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A 25-year-old woman with left ventricular (LV) dysfunction became pregnant during the diagnostic period. Decompensated heart failure with frequent ventricular arrhythmias necessitated hospitalization in the 21st week of pregnancy. Under careful monitoring, diuretics and sotalol were added to her ongoing treatment of carvedilol and spironolactone due to the risk of hemodynamic collapse.

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The prognostic value of bone mineral content (BMC) for the clinical outcomes of patients with coronary artery disease (CAD) remains unknown. The present study evaluated the association between BMC index (BMCI) and cardiovascular events between January 2020 to June 2021, in consecutive patients (n = 257) with CAD undergoing percutaneous coronary intervention (PCI) at the Nagano Municipal Hospital. BMCI was measured using bioelectrical impedance analysis and calculated as the BMC divided by height squared.

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Introduction: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), is superior to enalapril for chronic heart failure (CHF) with reduced ejection fraction (EF). However, its efficacy and safety in older Japanese patients in clinical practice are poorly understood. We aimed to investigate the efficacy and safety of ARNI compared with angiotensin receptor blocker (ARB) in older patients with CHF in real-world clinical practice.

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