Publications by authors named "Takeshi Kitai"
Background: To evaluate whether sodium zirconium cyclosilicate (SZC) enables the uptitration of spironolactone without increasing the risk of hyper- and hypokalemia in patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF and HFmrEF) and moderate/severe chronic kidney disease (CKD) who developed hyperkalemia during treatment with suboptimal spironolactone dose.
Methods: The REGISTA-K is a randomized, double-blind, placebo-controlled, multicenter trial that examined the efficacy and safety of SZC in uptitrating spironolactone without the occurrence of hyperkalemia or hypokalemia. A total of 266 patients with HFrEF and HFmrEF and hyperkalemia will be randomized in a 1:1 ratio to receive either SZC or placebo after treating hyperkalemia with SZC at 25 sites in Japan.
Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2.
JACC Cardiovasc Interv
November 2024
Background: Low-gradient (LG) aortic stenosis (AS) has not been fully characterized compared with high-gradient (HG) AS in terms of cardiac damage, frailty, aortic valve calcification, and clinical outcomes.
Objectives: The aim of this study was to compare the clinical characteristics and outcomes between each hemodynamic type of LG AS and HG AS.
Methods: The current study included 3,363 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) Registry-2 after excluding patients without indexed stroke volume or left ventricular ejection fraction (LVEF) data.
Background: There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension.
Methods And Results: Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.
Effect of Low-dose Administration of Carperitide for Acute Heart Failure: the LASCAR-AHF trial.
Eur Heart J Acute Cardiovasc Care
December 2024
Background: The effects of low-dose carperitide on long-term clinical outcomes of patients with acute heart failure (AHF) have not yet been fully elucidated. This study aimed to evaluate the effects of low-dose intravenous carperitide on the long-term clinical outcomes of patients with AHF.
Methods: In this multicentre, open-label, randomised controlled trial, 247 patients with AHF received low-dose carperitide intravenously with standard treatment or a matching standard treatment for 72 h from November 2014 to March 2021 across nine sites in Japan.
Background: Heart failure (HF) requires effective management and self-care education to improve outcomes. However, daily self-care routines necessary for managing HF can lead to psychological issues, including stress, potentially exacerbating the condition. Patient stress-coping behaviors may significantly impact prognosis.
View Article and Find Full Text PDFDespite the widespread adoption of valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) for patients with failed aortic bioprosthesis, the effectiveness of this treatment for Japanese patients frequently associated with small aortic annuli remains unclear. From December-2011 to October-2022, 41 consecutive patients undergoing VIV-TAVR were enrolled in this study. The endpoints were technical success, device success, early safety, and two-year mortality according to implanted surgical valve size (small valves: 19-mm and 21-mm, n = 23; large valves: 23-mm and 25-mm, n = 18).
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- * TAVI centers preferred aortic valve replacement (AVR) treatments, with a higher percentage opting for transcatheter aortic valve implantation (TAVI) compared to non-TAVI centers (71% vs. 23%).
- * Despite the differences in treatment frequency, both types of centers showed similar rates of all-cause death or heart failure hospitalizations over three years, indicating no significant outcome difference.
A blood cyst in the aortic root after acute myocardial infarction.
Eur Heart J Imaging Methods Pract
July 2024
Association of Low Muscle Strength With Incident Pneumonia in Older Patients With Heart Failure.
J Gerontol A Biol Sci Med Sci
December 2024
Article Synopsis
- Older patients with heart failure (HF) experience a higher risk of developing pneumonia, which contributes to increased mortality rates.
- A study of 1,266 hospitalized patients aged 65 and older found that those with low muscle strength were significantly more likely to develop pneumonia post-discharge.
- Low muscle strength was identified as a strong predictor of pneumonia and associated with a fourfold increased risk of death after pneumonia onset.
Background: Data on the impact of valve position on clinical outcomes in patients with atrial fibrillation (AF) and bioprosthetic valves (BPVs) are limited.
Methods And Results: The BPV-AF Registry was a multicenter, prospective, observational study involving 894 patients with BPVs and AF. In this post-hoc substudy, patients were classified according to BPV position: aortic (n=588; 65.
Article Synopsis
- The study explores the prevalence of cachexia, sarcopenia, and malnutrition in older patients with heart failure (HF) using definitions from the Asian Working Group for Cachexia (AWGC) and other criteria, finding that AWGC-defined cachexia was the most common condition.
- Among the 861 patients analyzed, cachexia was present in 74.1%, while other conditions showed lower prevalence rates.
- The results indicated that AWGC-defined cachexia was not significantly linked to all-cause mortality in these patients, contrasting with stronger associations found for cachexia according to Evans' criteria, sarcopenia, and malnutrition.
Article Synopsis
- A study investigated the effects of high-risk coronary artery plaques on late luminal narrowing and clinical events in patients after percutaneous coronary intervention.
- Over one year, the coronary artery lumen area decreased notably, especially in specific types of plaques, such as thin-cap and thick-cap fibroatheromas.
- Thin-cap fibroatheroma presence was linked to a higher risk of needing further revascularization procedures after ischemia, while no significant connection was found between coronary artery calcium levels and clinical outcomes within three years.
Article Synopsis
- Older patients (65+) with heart failure (HF) often experience physical frailty and malnutrition, which can worsen each other and lead to poor health outcomes.
- A study involving 862 hospitalized patients found that those with both frailty and malnutrition had the highest risk of death within a year of discharge compared to those with neither condition.
- Identifying and addressing both frailty and malnutrition in these patients is essential for improving their overall health and survival rates.
Article Synopsis
- Oxygenated haemoglobin (OHb) and total haemoglobin (THb) normally increase with exercise, but this response is lower in patients with chronic heart failure and remains unexplored post-cardiac surgery.
- The study measured cerebral oxygenation in the prefrontal cortex (PFC) of 14 patients recovering from cardiovascular surgery during a cardiopulmonary exercise test (CPX).
- Results showed that at peak exercise, OHb and regional cerebral oxygen saturation (rSO) significantly decreased while deoxygenated haemoglobin (HHb) increased, indicating reduced oxygen supply to the PFC in these patients.
This study investigated the oxygenation in the prefrontal cortex (PFC) during walking in a 75-year-old male patient in the acute phase of a left frontal lobe cerebral infarction complicated by severe left internal carotid artery stenosis. The patient regained independent ambulation on the fifth day after the onset of symptoms, and the study was conducted on the eighth day after the onset of symptoms. The patient rested for 10 s before walking for 70 s.
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- The study explored the timing for surgery in patients with asymptomatic or slightly symptomatic chronic severe aortic regurgitation but with normal heart function, involving 210 patients to assess treatment plans and outcomes.
- In two distinct studies, one group (Study A) followed a watchful waiting approach, revealing that survival rates matched those of the general population, while another group (Study B) evaluated surgical outcomes after aortic valve replacement, highlighting certain risks associated with heart chamber size.
- The findings suggest that watchful waiting is a safe option, but left ventricular size over 45 mm before surgery is a key indicator of poor postoperative results, potentially guiding future treatment decisions.
Article Synopsis
- Non-invasive imaging techniques like echocardiography and cardiac magnetic resonance (CMR) are essential for determining when to start enzyme replacement therapy in Fabry cardiomyopathy patients.
- A study of 14 patients found distinct differences in strain measurements and T1 mapping between early and advanced disease stages, highlighting that strain parameters were effective for differentiation.
- The findings suggest that using a combination of CMR T1 measurements and echocardiographic strain data could optimize patient staging and treatment decisions for Fabry cardiomyopathy.
Background: The role of activities of daily living (ADL) as a predictor of adverse outcomes in patients with pneumonia is unclear. This study aimed to assess the association between ADL, including physical and cognitive function, and death or readmission in older inpatients with pneumonia.
Methods: This retrospective, single-center, observational study included consecutive older inpatients with pneumonia between October 2018 and December 2019.
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.
Article Synopsis
- Ultrasound measurements of quadriceps muscle thickness (QMT) can be effectively used to assess muscle mass in older heart failure patients, particularly those aged 65 and above.
- *The study involved 595 hospitalized patients, where QMT was measured with high reliability, demonstrating excellent agreement between different observers.
- *Findings indicate that lower height-adjusted QMT is linked to higher mortality rates, highlighting its potential as a prognostic tool in heart failure management.*
Aims: The 6-min walk test (6MWT) is a widely accepted tool for evaluating exercise tolerance and physical capacity, and the 6-min walk distance (6MWD) is an established prognostic factor in patients with heart failure (HF). However, the prognostic implications of post-6MWT dyspnoea remain unknown. We aimed to investigate the prognostic value of Borg scores after the 6MWT in patients with HF.
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- Tricuspid regurgitation (TR) is common in acute heart failure (AHF) and impacts patient prognosis, but the changes in TR severity during hospital stays are not well understood.
- A study of 1,079 AHF patients found that over half exhibited improvement in TR severity by discharge, with those maintaining severe TR facing worse outcomes like higher mortality and rehospitalization rates.
- Persistent TR severity after treatment is a significant indicator of poor prognosis, suggesting that ongoing TR may require further treatment in AHF patients upon hospitalization.
Article Synopsis
- Hypochloremia, defined as low chloride levels in the blood, is linked to higher mortality rates in heart failure (HF) patients and was studied to see if it enhances existing prognostic models.
- In a study of 2,496 hospitalized HF patients, those with hypochloremia had a significantly higher 1-year mortality rate (12.6% of patients had hypochloremia, with 15.5% deaths observed).
- Adding hypochloremia to established risk models improved predictive accuracy, suggesting it can provide valuable insights into patient outcomes post-discharge.