Publications by authors named "Takeshi Morimoto"
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.
There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and chronic kidney disease (CKD). The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1015 patients who underwent multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between patients with and without CKD.
View Article and Find Full Text PDFBackground: Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment.
Methods: Databases from 39 centers were retrospectively reviewed for unruptured DACA aneurysms treated with flow-diverting stents.
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.
Background: Thrombectomy for acute large vessel occlusion is a well-established treatment for stroke prevention. However, futile recanalization cases, where no-reflow occurs despite successful recanalization, have been reported. This study aimed to assess cerebral hemodynamics immediately after thrombectomy and their relationship with clinical outcomes.
View Article and Find Full Text PDFArticle Synopsis
- * Out of 1507 cancer patients studied, 4.7% experienced an ischemic stroke over a median follow-up of 1020 days, with a cumulative incidence of 4.0% at 1 year.
- * Key risk factors for stroke include specific cancers (pancreatic, ovarian, lung), dyslipidemia, metastasis, elevated D-dimer levels, and younger age, highlighting the need for vigilant monitoring in these patients.
Article Synopsis
- * 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.
Article Synopsis
- * A randomized trial in China involved 269 patients who were assigned to start antiplatelet therapy early (3 days post-surgery) or late (30 days post-surgery) to evaluate safety and effectiveness on major cardiovascular events.
- * The study, which involved patients mostly around 60 years old, aimed to measure occurrences of new major ischaemic events and intracranial bleeding within 90 days after surgery, and is officially registered under ClinicalTrials.gov number NCT04820972.
Background: Although endovascular therapy (EVT) is effective for large ischemic region strokes, the impact of hyperglycemia remains unclear.
Methods And Results: We analyzed data from the RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Large Ischemic Core) trial, which randomized stroke patients with Alberta Stroke Program Early Computed Tomography Score of 3 to 5 to EVT versus medical management. Outcomes were compared among patients with normoglycemia (<140 mg/dL), moderate hyperglycemia (≥140, <180 mg/dL), and severe hyperglycemia (≥180 mg/dL) on admission.
Background: To describe a rare case of infiltrative optic neuropathy (ION) caused by vitreoretinal lymphoma (VRL) with hyperreflective deposits in the intraretinal and subretinal pigment epithelial (RPE) layers before the disease onset.
Case Presentation: An 87-year-old Japanese female, previously treated for unexplained uveitis in the right eye, was referred for further evaluation. Despite the absence of intraocular inflammation or vitreous opacification (VO), yellowish-white deposits were noted in the macula, and OCT revealed hyperreflective deposits in the intraretinal and sub-RPE layers.
Background: The optimal duration of anticoagulation therapy for patients with cancer and acute low-risk pulmonary embolism (PE) is clinically relevant, but evidence is lacking. Prolonged anticoagulation therapy could have a potential benefit for prevention of thrombotic events; however, it could also increase the risk of bleeding.
Methods: In a multicenter, open-label, adjudicator-blinded, randomized clinical trial at 32 institutions in Japan, we randomly assigned patients with cancer and acute low-risk PE of the simplified version of the Pulmonary Embolism Severity Index score of 1, in a 1:1 ratio, to receive either an 18-month or a 6-month rivaroxaban treatment.
Article Synopsis
- Extracorporeal membrane oxygenation (ECMO) may be necessary for some patients with severe pulmonary embolism (PE), but its clinical outcomes are not well understood.
- *In a study analyzing data from 2035 patients with acute PE, 76 required ECMO, with findings indicating high rates of cardiac arrest (88.2%) at diagnosis and a 30-day death rate of 30.3%, all related to PE.
- *The research highlighted significant complication rates, including a 54% incidence of major bleeding, suggesting the need for improved management strategies and future clinical trials.
Aims: Safety of aspirin-free strategy immediately after percutaneous coronary intervention (PCI) for cardiovascular events in patients with diabetes was unknown.
Methods And Results: We conducted the prespecified subgroup analysis on diabetes in the STOPDAPT-3 trial, which randomly compared prasugrel (3.75 mg/day) monotherapy (2984 patients) to dual antiplatelet therapy (DAPT) with prasugrel and aspirin (2982 patients) in patients with acute coronary syndrome or high bleeding risk.
Article Synopsis
- Elevated white blood cell (WBC) counts are identified as a risk factor for adverse outcomes in patients with venous thromboembolism (VTE) who do not have active cancer.
- In a study involving 5,197 patients, those with the highest WBC counts (Q4) were more likely to experience severe forms of VTE like pulmonary embolism and had a significantly higher risk of death and major bleeding over five years.
- The findings suggest that monitoring WBC counts at VTE diagnosis can help in assessing patient risk and potential outcomes.
Article Synopsis
- * The COMMAND VTE Registry-2 study tracked 5,197 patients with venous thromboembolism in Japan, finding that 2.3% of those with acute PE developed CTEPH over an average follow-up of 747 days.
- * Identified risk factors for developing CTEPH included being female, longer time from symptom onset to PE diagnosis, experiencing hypoxemia, having right heart load, lower D-dimer levels, and having
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
- The simplified Pulmonary Embolism Severity Index (sPESI) score helps identify low-risk patients for home treatment of pulmonary embolism, but its use with direct oral anticoagulants hasn't been thoroughly studied.
- A study of 2,496 patients with stable pulmonary embolism found that only 25% had an sPESI score of 0, and among those, only 17% were treated at home, though their 30-day mortality was notably low (0% vs. 4.8% in higher risk groups).
- Factors promoting home treatment included the absence of temporary risk factors, no elevated cardiac biomarkers, and the use of direct oral anticoagulants during the acute phase.
Article Synopsis
- The JPAD trial studied the long-term effects of low-dose aspirin on gastrointestinal symptoms and bleeding in diabetic patients, comparing those taking aspirin to those not taking it.
- Among 2535 participants, the aspirin group experienced a significantly higher rate of gastrointestinal issues, with 8.8% compared to 5.7% in the no-aspirin group at 18 years.
- The risk was notably higher within the first 3 years, particularly for buffered aspirin, suggesting that these factors should influence decisions on starting and continuing low-dose aspirin for prevention.
Article Synopsis
- Endovascular therapy (EVT) is effective for treating acute large vessel occlusion (LVO), but some patients do not achieve successful recanalization, prompting this study.
- The research analyzed data from the RESCUE-Japan Registry 2, comparing outcomes of patients who had unsuccessful EVT to those who received no EVT, focusing on recovery and complications.
- Results indicated that patients with unsuccessful EVT had poorer recovery scores, increased mortality rates, and more frequent symptomatic intracranial hemorrhages compared to the no EVT group.
Article Synopsis
- * In a subgroup analysis of 601 patients, those with anemia showed significantly fewer recurrent venous thromboembolism (VTE) cases with 12-month edoxaban treatment compared to 3 months, while no such reduction was observed in patients without anemia.
- * Overall, 12-month edoxaban treatment was more effective in preventing thrombotic events for both anemia and no-anemia groups, with no significant difference in major bleeding risk between the two treatment durations.
Article Synopsis
- The ONCO DVT study found that a 12-month course of edoxaban is more effective than a 3-month course for preventing thrombotic events in cancer patients with isolated distal deep vein thrombosis (DVT).
- This analysis categorized 601 patients into three groups based on their modified Ottawa score (low, intermediate, high) to determine the effectiveness of extended anticoagulation.
- Results showed that extended treatment significantly reduced thrombotic events in the intermediate and high score groups but not in the low score group, indicating limited benefit for those with a low risk.
Article Synopsis
- A trial, STOPDAPT-3, was conducted to compare aspirin monotherapy and clopidogrel monotherapy after short-term dual antiplatelet therapy in patients who underwent percutaneous coronary intervention using drug-eluting stents.
- The study involved 5,833 patients who were followed for 30 days, focusing on cardiovascular events (like heart attacks) and bleeding complications as primary endpoints.
- Results showed that aspirin and clopidogrel monotherapy had similar rates of cardiovascular and bleeding events up to one year after the intervention, indicating both treatments are equally effective in these contexts.