Publications by authors named "Yasuaki Takeji"
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.
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
- Hypertension is linked to worse health outcomes in patients with familial hypercholesterolemia (FH), prompting an investigation into how managing blood pressure affects cardiovascular events.
- The study involved 1,273 patients with clinically diagnosed heterozygous FH, categorizing them based on their hypertension status and blood pressure control over a median follow-up of 10.9 years.
- Results indicated that better blood pressure management significantly reduced the occurrence of cardiovascular events, with higher risk associated with uncontrolled hypertension.
Current Management and Therapy of Severe Aortic Stenosis and Future Perspective.
J Atheroscler Thromb
October 2024
Intervention for severe aortic stenosis (AS) has dramatically progressed since the introduction of transcatheter aortic valve replacement (TAVR). Decades ago, controversies existed regarding comparing clinical outcomes between TAVR and surgical aortic valve replacement (SAVR) in various risk profiles. Recently, we discussed the durability of transcatheter heart valves and their lifetime management after aortic valve replacement (AVR).
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- A study investigated the prevalence and effects of cerebrovascular disease found on pre-procedure CT scans in patients undergoing aortic valve replacement (AVR) due to severe aortic stenosis.
- Out of 567 patients, 35.3% had cerebrovascular disease, but only 28.5% of these patients reported prior strokes.
- The findings revealed that those with cerebrovascular disease had a significantly higher 3-year incidence of death or stroke (40.7%) compared to those without (24.1%), indicating they faced worse clinical outcomes regardless of their history of symptomatic stroke.
Aims: Little data exists for evaluating the prevalence and patient characteristics of familial hypercholesterolemia (FH) according to the latest 2022 guidelines for FH published by the Japan Atherosclerosis Society (JAS), which revised the Achilles tendon thickness (ATT) threshold from 9.0 mm in both sexes to 8.0 mm in men and 7.
View Article and Find Full Text PDFBackground: There is a scarcity of data on the prevalence of abnormal findings on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with aortic stenosis (AS).
Methods: Among consecutive 593 patients with severe AS who were planned to undergo AVR, we evaluated the prevalence of clinically significant incidental noncardiac findings on preprocedural CT. Clinically significant incidental noncardiac findings were defined as newly detected abnormalities that required therapy, consultation for expert, further investigation, or clinical follow-up.
Article Synopsis
- The study analyzed the presence of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) and how it relates to different treatment methods: TAVI, SAVR, and conservative management.
- Among the 3,365 patients examined, 384 (11.4%) had moderate/severe MR, and this group showed a significantly higher 3-year incidence of death or heart failure (HF) hospitalization compared to those with no/mild MR.
- The risk of death or HF hospitalization was notably higher in patients treated with SAVR and conservative strategies, while this risk was less clear in those who underwent TAVI.
Background: Achilles tendon thickening (ATT) can be ameliorated by lowering low-density lipoprotein (LDL) levels in patients with familial hypercholesterolemia (FH). The Japan Atherosclerosis Society (JAS) defines ATT as ≥8.0 mm in males and ≥7.
View Article and Find Full Text PDFBackground: It remains unclear if remnant cholesterol is associated with atherosclerotic cardiovascular disease (ASCVD) (myocardial infarction, angina pectoris and stroke), heart failure (HF), and atrial fibrillation (AF) under primary prevention settings.
Objective: We aimed to clarify this issue among a general population without a history of ASCVD, HF or AF.
Methods: Analyses were conducted with a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2022 (n = 1,313,722; median age, 42 years; 54.
Background: Familial hypercholesterolemia (FH) is associated with atherosclerotic cardiovascular disease (ASCVD). However, the prevalence of FH among a general population remains unknown, and it is unclear if FH is associated with other cardiovascular complications, including heart failure (HF) and atrial fibrillation (AF).
Methods: Analyses were conducted on individuals without a prior history of cardiovascular disease using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2022 (n = 4,126,642; median age, 44 years; 57.
Background: Polypharmacy was reported to be associated with major bleeding in various populations. However, there are no data on polypharmacy and its association with bleeding in patients undergoing percutaneous coronary intervention (PCI).
Methods and results: Among 12,291 patients in the CREDO-Kyoto PCI Registry Cohort-3, we evaluated the number of medications at discharge and compared major bleeding, defined as Bleeding Academic Research Consortium Type 3 or 5 bleeding, across tertiles (T1-3) of the number of medications.
Article Synopsis
- The study focused on the effects of mitral regurgitation (MR) on long-term health outcomes in acute myocardial infarction (AMI) patients who had a percutaneous coronary intervention (PCI).
- In a cohort of 5,266 patients, those with more severe MR had higher rates of hospitalization for heart failure (HF), but their risk of all-cause and cardiovascular death did not significantly increase over time.
- Although severity of MR did not correlate with increased mortality risk, both mild and moderate/severe MR were linked to significantly higher hospitalization rates for HF during a median follow-up of 5.6 years.
In-hospital outcomes after SAVR or TAVI in patients with severe aortic stenosis.
Cardiovasc Interv Ther
January 2024
There were no data comparing the in-hospital outcomes after transcatheter aortic valve implantation (TAVI) with those after surgical aortic valve replacement (SAVR) in Japan. Among consecutive patients with severe AS between April 2018 and December 2020 in the CURRENT AS Registry-2, we identified 1714 patients who underwent aortic valve replacement (TAVI group: 1134 patients, and SAVR group: 580 patients). Patients in the TAVI group were much older (84.
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- The study investigates life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS), highlighting a lack of existing data on this topic.
- Data from 3815 patients in the CURRENT AS registry revealed that those who underwent AVR had better survival rates than those using a conservative treatment strategy, especially among younger patients.
- The findings suggest that assessing surgical risk based on age and STS score can help estimate life expectancy post-AVR, which is crucial for deciding between surgical and transcatheter approaches.
Background: Diabetes is a well-known risk factor for adverse outcomes after coronary revascularization.
Objectives: This study sought to determine high-risk subgroups in whom the excess risks of diabetes relative to nondiabetes are particularly prominent and thus may benefit from more aggressive interventions.
Methods: The study population consisted of 39,427 patients (diabetes: n = 15,561; nondiabetes: n = 23,866) who underwent first percutaneous coronary intervention (n = 33,144) or coronary artery bypass graft (n = 6,283) in the pooled CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Graft) registry.
Background: There is a scarcity of studies comparing the clinical outcomes after percutaneous coronary intervention (PCI) for women and men stratified by the presentation of acute coronary syndromes (ACS) or stable coronary artery disease (CAD).
Methods and results: The study population included 26,316 patients who underwent PCI (ACS: n=11,119, stable CAD: n=15,197) from the CREDO-Kyoto PCI/CABG registry Cohort-2 and Cohort-3. The primary outcome was all-cause death.
Background: There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES.
Objectives: This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES.
Methods: The study group consisted of 15,009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5,382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9,627).
Article Synopsis
- - The study compares the long-term outcomes of percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in 2,464 patients with multi-vessel coronary artery disease.
- - Although the 5-year risk of combined events like death, heart attack, or stroke was not significantly different between the two groups, adjusted analysis showed that PCI had a higher risk of myocardial infarction and the need for additional revascularization compared to CABG.
- - The findings suggest that while both procedures have similar outcomes regarding death and stroke, PCI with new-generation DES may carry a greater long-term risk for major cardiovascular issues in patients requiring complex multi-vessel treatments
Article Synopsis
- The study investigates the relationship between the CHADS score and the long-term risk of ischemic stroke in patients with coronary artery disease (CAD), both with and without atrial fibrillation (AF).
- It analyzes data from 11,516 CAD patients who underwent a specific heart procedure, showing that higher CHADS scores correlate with increased stroke risk: 2.1% to 17.1% in patients without AF and 4.2% to 40.7% in those with AF over five years.
- The findings reveal that increased CHADS scores are linked to a higher likelihood of severe strokes, irrespective of the presence of AF, indicating the score’s relevance in assessing stroke risk in CAD patients.
Article Synopsis
- The CURRENT AS Registry-2 is a comprehensive study analyzing the management and outcomes of patients with severe aortic stenosis (AS) across 21 centers in Japan from April 2018 to December 2020.
- The registry collected data from 3,394 patients, with an average age of 81.6 years, focusing on their symptoms, echocardiographic evaluations, and treatment approaches, including surgical and conservative management.
- The findings suggest that the registry is a valuable resource for understanding when to intervene in severe AS cases, helping to improve clinical practices in managing the condition.