1,757 results on '"Homma, Shunichi"'
Search Results
2. Subclinical left ventricular systolic dysfunction and incident stroke in the elderly: long-term findings from Cardiovascular Abnormalities and Brain Lesions
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Yoshida, Yuriko, Jin, Zhezhen, Russo, Cesare, Homma, Shunichi, Nakanishi, Koki, Ito, Kazato, Mannina, Carlo, Elkind, Mitchell SV, Rundek, Tatjana, Yoshita, Mitsuhiro, DeCarli, Charles, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Stroke ,Brain Disorders ,Cardiovascular ,Aging ,Prevention ,Neurosciences ,Biomedical Imaging ,Heart Disease ,Acquired Cognitive Impairment ,Clinical Research ,Aged ,Aged ,80 and over ,Female ,Humans ,Male ,Middle Aged ,Brain ,Brain Ischemia ,Cardiovascular Abnormalities ,Ischemic Stroke ,Stroke Volume ,Ventricular Dysfunction ,Left ,Ventricular Function ,Left ,stroke • left ventricular function • global longitudinal strain • speckle-tracking echocardiography ,Cardiovascular medicine and haematology - Abstract
AimsHeart disease is associated with an increased risk for ischaemic stroke. However, the predictive value of reduced left ventricular ejection fraction (LVEF) for stroke is controversial and only observed in patients with severe reduction. LV global longitudinal strain (LV GLS) can detect subclinical LV systolic impairment when LVEF is normal. We investigated the prognostic role of LV GLS for incident stroke in a predominantly elderly cohort.Methods and resultsTwo-dimensional echocardiography with speckle tracking was performed in the Cardiac Abnormalities and Brain Lesions (CABL) study. Among 708 stroke-free participants (mean age 71.4 ± 9.4 years, 60.9% women), abnormal LV GLS (>-14.7%: 95% percentile of the subgroup without risk factors) was detected in 133 (18.8%). During a mean follow-up of 10.8 ± 3.9 years, 47 participants (6.6%) experienced an ischaemic stroke (26 cardioembolic or cryptogenic, 21 other subtypes). The cumulative incidence of ischaemic stroke was significantly higher in participants with abnormal LV GLS than with normal LV GLS (P < 0.001). In multivariate stepwise logistic regression analysis, abnormal LV GLS was associated with ischaemic stroke independently of cardiovascular risk factors including LVEF, LV mass, left atrial volume, subclinical cerebrovascular disease at baseline, and incident atrial fibrillation [hazard ratio (HR): 2.69, 95% confidence interval (CI): 1.47-4.92; P = 0.001]. Abnormal LV GLS independently predicted cardioembolic or cryptogenic stroke (adjusted HR: 3.57, 95% CI: 1.51-8.43; P = 0.004) but not other subtypes.ConclusionLV GLS was a strong independent predictor of ischaemic stroke in a predominantly elderly stroke-free cohort. Our findings provide insights into the brain-heart interaction and may help improve stroke primary prevention strategies.
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- 2023
3. Identification of a tomato UDP-arabinosyltransferase for airborne volatile reception
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Sugimoto, Koichi, Ono, Eiichiro, Inaba, Tamaki, Tsukahara, Takehiko, Matsui, Kenji, Horikawa, Manabu, Toyonaga, Hiromi, Fujikawa, Kohki, Osawa, Tsukiho, Homma, Shunichi, Kiriiwa, Yoshikazu, Ohmura, Ippei, Miyagawa, Atsushi, Yamamura, Hatsuo, Fujii, Mikio, Ozawa, Rika, Watanabe, Bunta, Miura, Kenji, Ezura, Hiroshi, Ohnishi, Toshiyuki, and Takabayashi, Junji
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- 2023
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4. Aortic Arch Plaques and the Long-Term Risk of Stroke and Cardiovascular Events in the Statin Era
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Yoshida, Yuriko, Jin, Zhezhen, Mannina, Carlo, Homma, Shunichi, Nakanishi, Koki, Leibowitz, David, Elkind, Mitchell S.V., Rundek, Tatjana, and Di Tullio, Marco R.
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- 2023
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5. Aortic Arch Plaques and the Long-Term Risk of Stroke and Cardiovascular Events in the Statin Era
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Yoshida, Yuriko, Jin, Zhezhen, Mannina, Carlo, Homma, Shunichi, Nakanishi, Koki, Leibowitz, David, Elkind, Mitchell S.V., Rundek, Tatjana, and Di Tullio, Marco R.
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- 2024
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6. Left Atrial Strain and Incident Atrial Fibrillation in Older Adults
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Mannina, Carlo, Ito, Kazato, Jin, Zhezhen, Yoshida, Yuriko, Russo, Cesare, Nakanishi, Koki, Elkind, Mitchell S.V., Rundek, Tatjana, Homma, Shunichi, and Di Tullio, Marco R.
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- 2023
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7. Machine Learning Predicting Atrial Fibrillation as an Adverse Event in the Warfarin and Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial
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Gue, Ying, Correa, Elon, Thompson, John L.P., Homma, Shunichi, Qian, Min, and Lip, Gregory Y.H.
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- 2023
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8. Abstract 12424: Left Atrial Strain and Incident Heart Failure in Older Adults
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Mannina, Carlo, Ito, Kazato, Jin, Zhezhen, Yoshida, Yuriko, Russo, Cesare, Nakanishi, Koki, Elkind, Mitchell, Rundek, Tatjana, Homma, Shunichi, and Di Tullio, Marco
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- 2023
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9. Association Between Progression of Arterial Stiffness and Left Ventricular Remodeling in a Community-Based Cohort
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Yoshida, Yuriko, Nakanishi, Koki, Jin, Zhezhen, Daimon, Masao, Ishiwata, Jumpei, Sawada, Naoko, Hirokawa, Megumi, Kaneko, Hidehiro, Nakao, Tomoko, Mizuno, Yoshiko, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2023
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10. Factors associated with the progression of aortic valve calcification in older adults
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Leibowitz, David, Yoshida, Yuriko, Jin, Zhezhen, Nakanishi, Koki, Mannina, Carlo, Elkind, Mitchell S.V., Rundek, Tatjana, Homma, Shunichi, Sacco, Ralph L., and Di Tullio, Marco R.
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- 2023
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11. Long term aortic arch plaque progression in older adults
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Leibowitz, David, Yoshida, Yuriko, Jin, Zhezhen, Mannina, Carlo, Homma, Shunichi, Nakanishi, Koki, Elkind, Mitchell S.V., Rundek, Tatjana, and Di Tullio, Marco R.
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- 2023
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12. Association Between Central Blood Pressure and Subclinical Cerebrovascular Disease in Older Adults
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Matsumoto, Kenji, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell SV, Rundek, Tatjana, Mannina, Carlo, Lee, Tetz C, Yoshita, Mitsuhiro, DeCarli, Charles, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Biomedical and Clinical Sciences ,Clinical Sciences ,Biomedical Imaging ,Aging ,Clinical Trials and Supportive Activities ,Cardiovascular ,Hypertension ,Neurosciences ,Brain Disorders ,Clinical Research ,Age Factors ,Aged ,Blood Pressure ,Brain ,Cerebrovascular Disorders ,Echocardiography ,Female ,Humans ,Incidence ,Magnetic Resonance Imaging ,Male ,Risk Assessment ,Risk Factors ,United States ,brain infarction ,cardiovascular diseases ,hypertension ,stroke ,white matter ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Elevated blood pressure (BP) level is one of the most consistently identified risk factors for silent brain disease. BP values obtained at the proximal segment of the aorta (central BP) are more directly involved than brachial BP in the pathogenesis of cardiovascular disease. However, the association between central BP and silent cerebrovascular disease has not been clearly established. Participants in the CABL (Cardiovascular Abnormalities and Brain Lesions) study (n=993; mean age, 71.7±9.3 years; 37.9% men) underwent 2-dimensional echocardiography, arterial wave reflection analysis for determination of central BPs, and brain magnetic resonance imaging. Central BPs were calculated from the radial pulse waveform. Subclinical silent cerebrovascular disease was defined as silent brain infarction and white matter hyperintensity volume. Both brachial (P=0.014) and central pulse pressure (P=0.026) were independently associated with silent brain infarctions after adjustment for clinical variables, but not adjusting for each other. None of the brachial BP values was associated with upper quartile of white matter hyperintensity volume in multivariable analysis. Both central systolic BP (P
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- 2020
13. Cognitive Decline Over Time in Patients With Systolic Heart Failure Insights From WARCEF
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Lee, Tetz C, Qian, Min, Liu, Yutong, Graham, Susan, Mann, Douglas L, Nakanishi, Koki, Teerlink, John R, Lip, Gregory YH, Freudenberger, Ronald S, Sacco, Ralph L, Mohr, Jay P, Labovitz, Arthur J, Ponikowski, Piotr, Lok, Dirk J, Matsumoto, Kenji, Estol, Conrado, Anker, Stefan D, Pullicino, Patrick M, Buchsbaum, Richard, Levin, Bruce, Thompson, John LP, Homma, Shunichi, Di Tullio, Marco R, and Investigators, WARCEF
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease ,Clinical Research ,Cardiovascular ,Brain Disorders ,Aged ,Anticoagulants ,Aspirin ,Cognitive Dysfunction ,Female ,Fibrinolytic Agents ,Heart Failure ,Systolic ,Humans ,Male ,Middle Aged ,Retrospective Studies ,Stroke Volume ,Time Factors ,Warfarin ,cognitive function ,comorbidities ,dementia ,longitudinal analysis ,Mini-Mental State Examination ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
ObjectivesThis study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).BackgroundDespite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.MethodsThis study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable and a 2-point decrease. To account for a loss to follow-up, data at the baseline and at the 12-month visit were analyzed separately (sensitivity analysis).ResultsA total of 1,846 patients were included. In linear regression, MMSE decrease was independently associated with higher baseline MMSE score (p
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- 2019
14. Deep learning to detect left ventricular structural abnormalities in chest X-rays
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Bhave, Shreyas, primary, Rodriguez, Victor, additional, Poterucha, Timothy, additional, Mutasa, Simukayi, additional, Aberle, Dwight, additional, Capaccione, Kathleen M, additional, Chen, Yibo, additional, Dsouza, Belinda, additional, Dumeer, Shifali, additional, Goldstein, Jonathan, additional, Hodes, Aaron, additional, Leb, Jay, additional, Lungren, Matthew, additional, Miller, Mitchell, additional, Monoky, David, additional, Navot, Benjamin, additional, Wattamwar, Kapil, additional, Wattamwar, Anoop, additional, Clerkin, Kevin, additional, Ouyang, David, additional, Ashley, Euan, additional, Topkara, Veli K, additional, Maurer, Mathew, additional, Einstein, Andrew J, additional, Uriel, Nir, additional, Homma, Shunichi, additional, Schwartz, Allan, additional, Jaramillo, Diego, additional, Perotte, Adler J, additional, and Elias, Pierre, additional
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- 2024
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15. Night-time systolic blood pressure and subclinical cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study
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Nakanishi, Koki, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell SV, Rundek, Tatjana, Schwartz, Joseph E, Lee, Tetz C, Tugcu, Aylin, Yoshita, Mitsuhiro, DeCarli, Charles, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Hypertension ,Heart Disease ,Brain Disorders ,Cardiovascular ,Aging ,Biomedical Imaging ,Clinical Research ,Neurosciences ,Aetiology ,2.1 Biological and endogenous factors ,Aged ,Blood Pressure Monitoring ,Ambulatory ,Cerebrovascular Disorders ,Circadian Rhythm ,Echocardiography ,Female ,Florida ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,New York City ,Predictive Value of Tests ,Risk Factors ,Systole ,ambulatory blood pressure monitoring ,night-time blood pressure ,silent brain infarcts ,white matter hyperintensity ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimsAlthough ambulatory blood pressure (BP) is a better predictor of cardiovascular outcomes than office BP, its association with subclinical cerebrovascular disease is not clarified. We investigated the associations of office and ambulatory BP values with subclinical cerebrovascular disease in a population based, predominantly elderly cohort without prior stroke.Methods and resultsEight hundred and twenty-eight participants underwent 24-h ambulatory BP monitoring (ABPM), 2D echocardiography and brain magnetic resonance imaging in the Cardiac Abnormalities and Brain Lesion (CABL) study. Daytime, night-time, and 24-h BPs, nocturnal dipping pattern, morning surge (MS), and 24-h variability were assessed. Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV). The association of BP measures with the presence of SBI and upper quartile of log-WMHV (log-WMHV4) was analysed. SBIs were detected in 111 patients (13.4%). Mean log-WMHV was -0.99 ± 0.94. In multivariable analysis, only night-time systolic BP (SBP) was significantly associated with SBI [odds ratio (OR) 1.15 per 10 mmHg, P = 0.042], independent of cardiovascular risk factors, and pertinent echocardiographic parameters. Although daytime, night-time, 24-h BPs, and non-dipping pattern were all significantly associated with log-WMHV4 (all P
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- 2019
16. Association between mortality and implantable cardioverter‐defibrillators by aetiology of heart failure: a propensity‐matched analysis of the WARCEF trial
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Lee, Tetz C, Qian, Min, Mu, Lan, Di Tullio, Marco R, Graham, Susan, Mann, Douglas L, Nakanishi, Koki, Teerlink, John R, Lip, Gregory YH, Freudenberger, Ronald S, Sacco, Ralph L, Mohr, Jay P, Labovitz, Arthur J, Ponikowski, Piotr, Lok, Dirk J, Estol, Conrado, Anker, Stefan D, Pullicino, Patrick M, Buchsbaum, Richard, Levin, Bruce, Thompson, John LP, Homma, Shunichi, Ye, Siqin, and Investigators, for the WARCEF
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease ,Clinical Research ,Cardiovascular ,Aged ,Anticoagulants ,Aspirin ,Cardiomyopathies ,Cause of Death ,Defibrillators ,Implantable ,Echocardiography ,Female ,Follow-Up Studies ,Heart Failure ,Heart Ventricles ,Humans ,Male ,Middle Aged ,Platelet Aggregation Inhibitors ,Propensity Score ,Radionuclide Ventriculography ,Retrospective Studies ,Risk Factors ,Stroke Volume ,Survival Rate ,United States ,Ventricular Function ,Left ,Warfarin ,Heart failure with reduced ejection fraction ,Implantable cardioverter-defibrillator ,Non-ischaemic cardiomyopathy ,Propensity score matching ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
AimsThere is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.Methods and resultsWe performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131).ConclusionsThe presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.
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- 2019
17. Left atrial volume and cardiovascular outcomes in systolic heart failure: effect of antithrombotic treatment
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Di Tullio, Marco R, Qian, Min, Thompson, John LP, Labovitz, Arthur J, Mann, Douglas L, Sacco, Ralph L, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Graham, Susan, Lip, Gregory YH, Levin, Bruce, Mohr, Jay P, Buchsbaum, Richard, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, Anker, Stefan D, Homma, Shunichi, and Investigators, for the WARCEF
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Cardiovascular ,Heart Disease - Coronary Heart Disease ,Patient Safety ,Clinical Trials and Supportive Activities ,Hematology ,Heart Disease ,Clinical Research ,Prevention ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Stroke ,Anticoagulants ,Argentina ,Aspirin ,Canada ,Cardiac Volume ,Dose-Response Relationship ,Drug ,Echocardiography ,Female ,Heart Atria ,Heart Failure ,Systolic ,Humans ,Incidence ,Male ,Middle Aged ,Platelet Aggregation Inhibitors ,Stroke Volume ,Survival Rate ,Thromboembolism ,Treatment Outcome ,United States ,Warfarin ,Heart failure ,Left atrium ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
AimsLeft atrium (LA) dilation is associated with adverse cardiovascular (CV) outcomes. Blood stasis, thrombus formation and atrial fibrillation may occur, especially in heart failure (HF) patients. It is not known whether preventive antithrombotic treatment may decrease the incidence of CV events in HF patients with LA enlargement. We investigated the relationship between LA enlargement and CV outcomes in HF patients and the effect of different antithrombotic treatments.Methods and resultsTwo-dimensional echocardiography with LA volume index (LAVi) measurement was performed in 1148 patients with systolic HF from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial. Patients were randomized to warfarin or aspirin and followed for 3.4 ± 1.7 years. While the primary aim of the trial was a composite of ischaemic stroke, death, and intracerebral haemorrhage, the present report focuses on the individual CV events, whose incidence was compared across different LAVi and treatment subgroups. After adjustment for demographics and clinical covariates, moderate or severe LA enlargement was significantly associated with total death (hazard ratio 1.6 and 2.7, respectively), CV death (HR 1.7 and 3.3), and HF hospitalization (HR 2.3 and 2.6) but not myocardial infarction (HR 1.0 and 1.4) or ischaemic stroke (1.1 and 1.5). The increased risk was observed in both patients treated with warfarin or aspirin. In warfarin-treated patients, a time in therapeutic range >60% was associated with lower event rates, and an interaction between LAVi and time in therapeutic range was observed for death (P = 0.034).ConclusionsIn patients with systolic HF, moderate or severe LA enlargement is associated with death and HF hospitalization despite treatment with antithrombotic medications. The possibility that achieving a more consistent therapeutic level of anticoagulation may decrease the risk of death requires further investigation.
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- 2018
18. Heart Failure Severity and Quality of Warfarin Anticoagulation Control (From the WARCEF Trial)
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Lee, Tetz C, Qian, Min, Lip, Gregory YH, Di Tullio, Marco R, Graham, Susan, Mann, Douglas L, Nakanishi, Koki, Teerlink, John R, Freudenberger, Ronald S, Sacco, Ralph L, Mohr, JP, Labovitz, Arthur J, Ponikowski, Piotr, Lok, Dirk J, Estol, Conrado, Anker, Stefan D, Pullicino, Patrick M, Buchsbaum, Richard, Levin, Bruce, Thompson, John LP, Homma, Shunichi, Ye, Siqin, and Investigators, The WARCEF
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease ,Cardiovascular ,Hematology ,Clinical Research ,Anticoagulants ,Aspirin ,Atrial Fibrillation ,Double-Blind Method ,Female ,Heart Failure ,Humans ,Male ,Middle Aged ,Quality of Life ,Severity of Illness Index ,Stroke Volume ,Thromboembolism ,Treatment Outcome ,Warfarin ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
Previous studies in patients with atrial fibrillation showed that a history of heart failure (HF) could negatively impact anticoagulation quality, as measured by the average time in therapeutic range (TTR). Whether additional markers of HF severity are associated with TTR has not been investigated thoroughly. We aimed to examine the potential role of HF severity in the quality of warfarin control in patients with HF with reduced ejection fraction. Data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial were used to investigate the association between TTR and HF severity. Multivariable logistic regression models were used to examine the association of markers of HF severity, including New York Heart Association (NYHA) class, Minnesota Living with HF (MLWHF) score, and frequency of HF hospitalization, with TTR ≥70% (high TTR). We included 1,067 participants (high TTR, N = 413; low TTR, N = 654) in the analysis. In unadjusted analysis, patients with a high TTR were older and less likely to have had strokes or receive other antiplatelet agents. Those patients also had lower NYHA class, better MLWHF scores, greater 6-minute walk distance, and lower frequency of HF hospitalizations. Multivariable analysis showed that NYHA class III and/or IV (Odds ratio [OR] 0.68 [95% confidence intervals [CIs] 0.49 to 0.94]), each 10-point increase in MLWHF score (i.e., worse health-related quality of life) (OR 0.92 [0.86 to 0.99]), and higher number of HF hospitalization per year (OR0.45 [0.30 to 0.67]) were associated with decreased likelihood of having high TTR. In HF patients with systolic dysfunction, NYHA class III and/or IV, poor health-related quality of life, and a higher rate of HF hospitalization were independently associated with suboptimal quality of warfarin anticoagulation control. These results affirm the need to assess the new approaches, such as direct oral anticoagulants, to prevent thromboembolism in this patient population.
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- 2018
19. Deep Learning Electrocardiographic Analysis for Detection of Left-Sided Valvular Heart Disease
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Elias, Pierre, Poterucha, Timothy J., Rajaram, Vijay, Moller, Luca Matos, Rodriguez, Victor, Bhave, Shreyas, Hahn, Rebecca T., Tison, Geoffrey, Abreau, Sean A., Barrios, Joshua, Torres, Jessica Nicole, Hughes, J. Weston, Perez, Marco V., Finer, Joshua, Kodali, Susheel, Khalique, Omar, Hamid, Nadira, Schwartz, Allan, Homma, Shunichi, Kumaraiah, Deepa, Cohen, David J., Maurer, Mathew S., Einstein, Andrew J., Nazif, Tamim, Leon, Martin B., and Perotte, Adler J.
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- 2022
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20. Association Between Heart Rate and Subclinical Cerebrovascular Disease in the Elderly
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Nakanishi, Koki, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell SV, Rundek, Tatjana, Lee, Seitetz C, Tugcu, Aylin, Yoshita, Mitsuhiro, DeCarli, Charles, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Epidemiology ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Cardiovascular ,Biomedical Imaging ,Heart Disease ,Aging ,Brain Disorders ,Stroke ,Neurosciences ,Aged ,Aged ,80 and over ,Blood Pressure Monitoring ,Ambulatory ,Brain Infarction ,Cerebrovascular Disorders ,Female ,Heart Rate ,Humans ,Male ,Middle Aged ,Risk Factors ,echocardiography ,heart rate ,magnetic resonance imaging ,multivariate analysis ,odds ratio ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
Background and purposeAlthough increased heart rate (HR) is a predictor of cardiovascular events and mortality, its possible association with subclinical cerebrovascular disease, which is prevalent in the elderly, has not been evaluated. This study aimed to investigate the association of daytime, nighttime, 24-hour HR, and HR variability with subclinical cerebrovascular disease in an elderly cohort without history of stroke.MethodsThe study cohort consisted of 680 participants (mean age, 73±7 years; 42% men) in sinus rhythm who underwent 24-hour ambulatory blood pressure and HR monitoring, 2-dimensional echocardiography, and brain magnetic resonance imaging as part of the CABL study (Cardiac Abnormalities and Brain Lesion). Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume (WMHV). The relationship of HR measures with the presence of silent brain infarct and upper quartile of log WMHV (log WMHV4) was analyzed.ResultsPresence of silent brain infarct was detected in 93 participants (13.7%); mean log WMHV was -0.92±0.93 (median, -1.05; min, -5.88; max, 1.74). Multivariate analysis showed that only nighttime HR (adjusted odds ratio, 1.29 per 10 bpm; 95% confidence interval, 1.03-1.61; P=0.026) was significantly associated with log WMHV4, independent of traditional cardiovascular risk factors, ambulatory systolic blood pressure, and echocardiographic parameters. No similar association was observed for daytime HR and HR variability. There was no significant association between all HR measures and silent brain infarct.ConclusionsIn a predominantly elderly cohort, elevated nighttime HR was associated with WMHV, suggesting an independent role of HR in subclinical cerebrovascular disease.
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- 2018
21. GEM-IL: A highly responsive fluorescent lactate indicator
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Bekdash, Ramsey, Quejada, Jose R., Ueno, Shunnosuke, Kawano, Fuun, Morikawa, Kumi, Klein, Alison D., Matsumoto, Kenji, Lee, Tetz C., Nakanishi, Koki, Chalan, Amy, Lee, Teresa M., Liu, Rui, Homma, Shunichi, Lin, Chyuan-Sheng, Yelshanskaya, Maria V., Sobolevsky, Alexander I., Goda, Keisuke, and Yazawa, Masayuki
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- 2021
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22. Relation of Body Mass Index to Adverse Right Ventricular Mechanics
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Nakanishi, Koki, Daimon, Masao, Yoshida, Yuriko, Ishiwata, Jumpei, Sawada, Naoko, Hirokawa, Megumi, Kaneko, Hidehiro, Nakao, Tomoko, Mizuno, Yoshiko, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2021
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23. Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients From the WARCEF Trial
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Teerlink, John R, Qian, Min, Bello, Natalie A, Freudenberger, Ronald S, Levin, Bruce, Di Tullio, Marco R, Graham, Susan, Mann, Douglas L, Sacco, Ralph L, Mohr, JP, Lip, Gregory YH, Labovitz, Arthur J, Lee, Seitetz C, Ponikowski, Piotr, Lok, Dirk J, Anker, Stefan D, Thompson, John LP, Homma, Shunichi, and Investigators, WARCEF
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease ,Clinical Research ,Clinical Trials and Supportive Activities ,Cardiovascular ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Angiotensin Receptor Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,Anticoagulants ,Aspirin ,Cyclooxygenase Inhibitors ,Double-Blind Method ,Female ,Heart Failure ,Hospitalization ,Humans ,Kaplan-Meier Estimate ,Male ,Middle Aged ,Stroke Volume ,Warfarin ,aspirin ,heart failure ,hospitalization ,survival ,warfarin ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
ObjectivesThe aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB).BackgroundBecause of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue.MethodsWe compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events).ResultsAfter adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates.ConclusionsAmong patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938).
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- 2017
24. Left ventricular mass-geometry and silent cerebrovascular disease: The Cardiovascular Abnormalities and Brain Lesions (CABL) study
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Nakanishi, Koki, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell SV, Rundek, Tatjana, Tugcu, Aylin, Yoshita, Mitsuhiro, DeCarli, Charles, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Biomedical and Clinical Sciences ,Clinical Sciences ,Stroke ,Brain Disorders ,Biomedical Imaging ,Neurosciences ,Clinical Research ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Asymptomatic Diseases ,Black People ,Brain ,Brain Infarction ,Cerebrovascular Disorders ,Cohort Studies ,Diabetes Mellitus ,Echocardiography ,Female ,Heart Ventricles ,Hispanic or Latino ,Humans ,Hypertension ,Hypertrophy ,Left Ventricular ,Leukoencephalopathies ,Magnetic Resonance Imaging ,Male ,Middle Aged ,New York City ,Odds Ratio ,Organ Size ,Ventricular Remodeling ,White People ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
BackgroundAlthough abnormal left ventricular geometric patterns have prognostic value for morbidity and mortality, their possible association with silent cerebrovascular disease has not been extensively evaluated.MethodsWe examined 665 participants in the CABL study who underwent transthoracic echocardiography and brain magnetic resonance imaging. Participants were divided into 4 geometric patterns: normal geometry (n=397), concentric remodeling (n=89), eccentric hypertrophy (n=126), and concentric hypertrophy (n=53). Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV; expressed as log-transformed percentage of the total cranial volume).ResultsSilent brain infarcts were observed in 94 participants (14%). Mean log-WMHV was -0.97±0.93. Concentric hypertrophy carried the greatest risk for both SBI (adjusted odds ratio [OR] 3.39, P
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- 2017
25. Resting Heart Rate and Ischemic Stroke in Patients with Heart Failure
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Nakanishi, Koki, Di Tullio, Marco R, Qian, Min, Thompson, John LP, Labovitz, Arthur J, Mann, Douglas L, Sacco, Ralph L, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Graham, Susan, Lip, Gregory YH, Levin, Bruce, Mohr, Jay P, Buchsbaum, Richard, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, Anker, Stefan D, and Homma, Shunichi
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Heart Disease ,Brain Disorders ,Clinical Research ,Prevention ,Cardiovascular ,Stroke ,Good Health and Well Being ,Adrenergic beta-Antagonists ,Aged ,Anticoagulants ,Brain Ischemia ,Electrocardiography ,Female ,Fibrinolytic Agents ,Heart Failure ,Heart Rate ,Humans ,Incidence ,Kaplan-Meier Estimate ,Linear Models ,Male ,Middle Aged ,Multivariate Analysis ,Platelet Aggregation Inhibitors ,Prognosis ,Proportional Hazards Models ,Rest ,Risk Factors ,Time Factors ,Beta-blocker ,Heart failure ,Ischemic stroke ,Resting heart rate ,Sinus rhythm ,Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial ,WARCEF Investigators ,Clinical Sciences ,Neurosciences ,Neurology & Neurosurgery ,Clinical sciences - Abstract
BackgroundAlthough high resting heart rate (RHR) is known to be associated with an increased risk of mortality and hospital admission in patients with heart failure, the relationship between RHR and ischemic stroke remains unclear. This study is aimed at investigating the relationship between RHR and ischemic stroke in patients with heart failure in sinus rhythm.MethodsWe examined 2,060 patients with systolic heart failure in sinus rhythm from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. RHR was determined from baseline electrocardiogram, and was examined as both a continuous variable and a categorical variable using quartiles. Ischemic strokes were identified during follow-up and adjudicated by physician review.ResultsDuring 3.5 ± 1.8 years of follow-up, 77 patients (5.3% from Kaplan-Meier [KM] curve) experienced an ischemic stroke. The highest incidence of ischemic stroke (21/503 [KM 6.9%]) was observed in the lowest RHR quartile (RHR 79 beats/min (p = 0.693). Multivariable Cox proportional hazards analysis revealed that RHR was significantly associated with ischemic stroke (hazard ratio per unit decrease: 1.07, 95% CI 1.02-1.13, when RHR
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- 2017
26. Atherosclerotic Plaques in the Aortic Arch and Subclinical Cerebrovascular Disease
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Tugcu, Aylin, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell SV, Rundek, Tatjana, Yoshita, Mitsuhiro, DeCarli, Charles, Nakanishi, Koki, Shames, Sofia, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Epidemiology ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Trials and Supportive Activities ,Stroke ,Aging ,Cardiovascular ,Brain Disorders ,Clinical Research ,Biomedical Imaging ,Neurosciences ,Aged ,Aged ,80 and over ,Aorta ,Thoracic ,Aortic Diseases ,Cerebrovascular Disorders ,Comorbidity ,Echocardiography ,Female ,Humans ,Magnetic Resonance Imaging ,Male ,Middle Aged ,New York City ,Plaque ,Atherosclerotic ,Risk Factors ,atherosclerosis ,cerebrovascular diseases ,silent brain infarct ,stroke ,white matter hyperintensity ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
Background and purposeAortic arch plaque (AAP) is a risk factor for ischemic stroke, but its association with subclinical cerebrovascular disease is not established. We investigated the association between AAP and subclinical cerebrovascular disease in an elderly stroke-free community-based cohort.MethodsThe CABL study (Cardiovascular Abnormalities and Brain Lesions) was designed to investigate cardiovascular predictors of silent cerebrovascular disease in the elderly. AAPs were assessed by suprasternal transthoracic echocardiography in 954 participants. Silent brain infarcts and white matter hyperintensity volume (WMHV) were assessed by brain magnetic resonance imaging. The association of AAP thickness with silent brain infarcts and WMHV was evaluated by logistic regression analysis.ResultsMean age was 71.6±9.3 years; 63% were women. AAP was present in 658 (69%) subjects. Silent brain infarcts were detected in 138 participants (14.5%). In multivariate analysis adjusted for potential confounders, AAP thickness and large AAP (≥4 mm in thickness) were significantly associated with the upper quartile of WMHV (WMHV-Q4; odds ratio =1.17; 95% confidence interval, 1.04-1.32; P=0.009 and odds ratio =1.79; 95% confidence interval, 1.40-3.09; P=0.036, respectively), but not with silent brain infarcts (odds ratio =1.08; 95% confidence interval, 0.94-1.23; P=0.265 and odds ratio =1.46; 95% confidence interval, 0.77-2.77; P=0.251, respectively).ConclusionsAortic arch atherosclerosis was associated with WMHV in a stroke-free community-based elderly cohort. This association was stronger in subjects with large plaques and independent of cardiovascular risk factors. Aortic arch assessment by transthoracic echocardiography may help identify subjects at higher risk of subclinical cerebrovascular disease, who may benefit from aggressive stroke risk factors treatment.
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- 2016
27. CHA2DS2‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm
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Ye, Siqin, Qian, Min, Zhao, Bo, Buchsbaum, Richard, Sacco, Ralph L, Levin, Bruce, Di Tullio, Marco R, Mann, Douglas L, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Mohr, JP, Graham, Susan, Labovitz, Arthur J, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, Anker, Stefan D, Lip, Gregory YH, Thompson, John LP, Homma, Shunichi, and Investigators, on behalf of the WARCEF
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Clinical Research ,Brain Disorders ,Patient Safety ,Stroke ,Cardiovascular ,Aged ,Anticoagulants ,Aspirin ,Double-Blind Method ,Female ,Heart Failure ,Heart Rate ,Humans ,Male ,Middle Aged ,Prognosis ,Randomized Controlled Trials as Topic ,Stroke Volume ,Systole ,Warfarin ,Heart failure ,Sinus rhythm ,Bleeding ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
AimsThe aim of this study was to determine whether the CHA2 DS2 -VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm.Methods and resultsCHA2 DS2 -VASc scores were calculated for 1101 patients randomized to warfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2 DS2 -VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA2 DS2 -VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA2 DS2 -VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage.ConclusionsThe CHA2 DS2 -VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy.
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- 2016
28. The newborn Fmr1 knockout mouse: a novel model of excess ubiquinone and closed mitochondrial permeability transition pore in the developing heart
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Barajas, Matthew, Wang, Aili, Griffiths, Keren K., Matsumoto, Kenji, Liu, Rui, Homma, Shunichi, and Levy, Richard J.
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- 2021
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29. Educational status affects prognosis of patients with heart failure with reduced ejection fraction: A post‐hoc analysis from the WARCEF trial.
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Corica, Bernadette, Romiti, Giulio Francesco, Simoni, Amalie Helme, Mei, Davide Antonio, Bucci, Tommaso, Thompson, John L. P., Qian, Min, Homma, Shunichi, Proietti, Marco, and Lip, Gregory Y. H.
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HEART failure ,EDUCATIONAL attainment ,HEART failure patients ,VENTRICULAR ejection fraction ,EDUCATIONAL outcomes ,CEREBRAL hemorrhage ,CLINICAL trial registries - Abstract
Aims: The influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF. Methods: We used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended. We analysed the impact of the educational status on the risk of the primary composite outcome of all‐cause death, ischemic stroke (IS) and intracerebral haemorrhage (ICH); components of the primary outcome were also analysed as secondary outcomes. Results: 2295 patients were included in this analysis; of these, 992 (43.2%) had a low educational level, 947 (41.3%) had a medium education level and the remaining 356 (15.5%) showed a high educational level. Compared to patients with high educational level, those with low educational status showed a high risk of the primary composite outcome (adjusted hazard ratio [aHR]: 1.31, 95% confidence intervals [CI] 1.02–1.69); a non‐statistically significant association was observed in those with medium educational level (aHR: 1.20, 95%CI:.93–1.55). Similar results were observed for all‐cause death, while no statistically significant differences were observed for IS or ICH. Conclusion: Compared to patients with high educational levels, those with low educational status had worse prognosis. SDOH should be considered in patients with HFrEF. Clinical Trial Registration: NCT00041938. [ABSTRACT FROM AUTHOR]
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- 2024
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30. Impact of insulin resistance on subclinical left ventricular dysfunction in normal weight and overweight/obese japanese subjects in a general community
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Hirose, Kazutoshi, Nakanishi, Koki, Daimon, Masao, Sawada, Naoko, Yoshida, Yuriko, Iwama, Kentaro, Yamamoto, Yuko, Ishiwata, Jumpei, Hirokawa, Megumi, Koyama, Katsuhiro, Nakao, Tomoko, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2021
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31. Carotid intima-media thickness and subclinical left heart dysfunction in the general population
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Nakanishi, Koki, Daimon, Masao, Yoshida, Yuriko, Ishiwata, Jumpei, Sawada, Naoko, Hirokawa, Megumi, Kaneko, Hidehiro, Nakao, Tomoko, Mizuno, Yoshiko, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2020
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32. Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac Events in Heart Failure
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Di Tullio, Marco R, Qian, Min, Thompson, John LP, Labovitz, Arthur J, Mann, Douglas L, Sacco, Ralph L, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Graham, Susan, Lip, Gregory YH, Levin, Bruce, Mohr, JP, Buchsbaum, Richard, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, Anker, Stefan D, and Homma, Shunichi
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Epidemiology ,Biomedical and Clinical Sciences ,Health Sciences ,Brain Disorders ,Cardiovascular ,Stroke ,Heart Disease ,Clinical Research ,Clinical Trials and Supportive Activities ,Good Health and Well Being ,Aged ,Aspirin ,Cardiovascular Diseases ,Cerebral Hemorrhage ,Female ,Heart Failure ,Humans ,Incidence ,Male ,Middle Aged ,Risk Factors ,Stroke Volume ,Treatment Outcome ,Ventricular Function ,Left ,Warfarin ,aspirin ,echocardiography ,heart failure ,heart ventricles ,stroke ,warfarin ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Neurosciences ,Neurology & Neurosurgery ,Clinical sciences ,Allied health and rehabilitation science - Abstract
Background and purposeIn heart failure (HF), left ventricular ejection fraction (LVEF) is inversely associated with mortality and cardiovascular outcomes. Its relationship with stroke is controversial, as is the effect of antithrombotic treatment. We studied the relationship of LVEF with stroke and cardiovascular events in patients with HF and the effect of different antithrombotic treatments.MethodsIn the Warfarin Versus Aspirin in Reduced Ejection Fraction (WARCEF) trial, 2305 patients with systolic HF (LVEF≤35%) and sinus rhythm were randomized to warfarin or aspirin and followed for 3.5±1.8 years. Although no differences between treatments were observed on primary outcome (death, stroke, or intracerebral hemorrhage), warfarin decreased the stroke risk. The present report compares the incidence of stroke and cardiovascular events across different LVEF and treatment subgroups.ResultsBaseline LVEF was inversely and linearly associated with primary outcome, mortality and its components (sudden and cardiovascular death), and HF hospitalization, but not myocardial infarction. A relationship with stroke was only observed for LVEF of
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- 2016
33. Association between nonalcoholic fatty liver disease and subclinical left ventricular dysfunction in the general population
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Hirose, Kazutoshi, primary, Nakanishi, Koki, additional, Di Tullio, Marco R, additional, Homma, Shunichi, additional, Sawada, Naoko, additional, Yoshida, Yuriko, additional, Hirokawa, Megumi, additional, Koyama, Katsuhiro, additional, Kimura, Koichi, additional, Nakao, Tomoko, additional, Daimon, Masao, additional, Morita, Hiroyuki, additional, Kurano, Makoto, additional, and Komuro, Issei, additional
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- 2023
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34. Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin
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Ye, Siqin, Cheng, Bin, Lip, Gregory YH, Buchsbaum, Richard, Sacco, Ralph L, Levin, Bruce, Di Tullio, Marco R, Qian, Min, Mann, Douglas L, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Mohr, JP, Graham, Susan, Labovitz, Arthur J, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, Anker, Stefan D, Thompson, John LP, Homma, Shunichi, and Investigators, WARCEF
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Hematology ,Clinical Research ,Heart Disease ,Cardiovascular ,Stroke ,Prevention ,Brain Disorders ,Aged ,Anticoagulants ,Aspirin ,Female ,Heart Failure ,Hemorrhage ,Humans ,Male ,Middle Aged ,Platelet Aggregation Inhibitors ,Proportional Hazards Models ,Risk Assessment ,Stroke Volume ,Ventricular Dysfunction ,Left ,Warfarin ,WARCEF Investigators ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95% confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95% CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99 to 8.22, p
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- 2015
35. Comparison of Effectiveness of Alcohol Septal Ablation Versus Ventricular Septal Myectomy on Acute Care Use for Cardiovascular Disease in Patients With Hypertrophic Cardiomyopathy
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Shimada, Yuichi J., Goto, Tadahiro, Takayama, Hiroo, Brown, David F.M., Homma, Shunichi, Maurer, Mathew S., Reilly, Muredach P., and Hasegawa, Kohei
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- 2019
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36. Alteration of Cardiac Performance and Serum B-Type Natriuretic Peptide Level in Healthy Aging
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Yoshida, Yuriko, Nakanishi, Koki, Daimon, Masao, Ishiwata, Jumpei, Sawada, Naoko, Hirokawa, Megumi, Kaneko, Hidehiro, Nakao, Tomoko, Mizuno, Yoshiko, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2019
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37. Quality of Anticoagulation Control in Preventing Adverse Events in Patients With Heart Failure in Sinus Rhythm
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Homma, Shunichi, Thompson, John LP, Qian, Min, Ye, Siqin, Di Tullio, Marco R, Lip, Gregory YH, Mann, Douglas L, Sacco, Ralph L, Levin, Bruce, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Graham, Susan, Mohr, JP, Labovitz, Arthur J, Buchsbaum, Richard, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, and Anker, Stefan D
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Research ,Heart Disease ,Clinical Trials and Supportive Activities ,Hematology ,Cardiovascular ,Stroke ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Aged ,Anticoagulants ,Aspirin ,Brain Ischemia ,Cerebral Hemorrhage ,Chi-Square Distribution ,Double-Blind Method ,Drug Monitoring ,Female ,Heart Failure ,Heart Rate ,Humans ,Male ,Middle Aged ,Multivariate Analysis ,Platelet Aggregation Inhibitors ,Predictive Value of Tests ,Proportional Hazards Models ,Risk Factors ,Stroke Volume ,Time Factors ,Treatment Outcome ,Ventricular Function ,Left ,Warfarin ,anticoagulant ,heart failure ,hemorrhage ,stroke ,WARCEF Investigators ,Biochemistry and Cell Biology ,Cardiorespiratory Medicine and Haematology ,Medical Physiology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Medical physiology - Abstract
BackgroundThe aim of this study is to examine the relationship between time in the therapeutic range (TTR) and clinical outcomes in heart failure patients in sinus rhythm treated with warfarin.Methods and resultsWe used data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death), with death alone, ischemic stroke alone, major hemorrhage alone, and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin-treated patients, with TTR being treated as a time-dependent covariate. A total of 2217 patients were included in the analyses; among whom 1067 were randomized to warfarin and 1150 were randomized to aspirin. The median (interquartile range) follow-up duration was 3.6 (2.0-5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted P
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- 2015
38. Telemedicine Expansion During the COVID-19 Pandemic and the Potential for Technology-Driven Disparities
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Ye, Siqin, Kronish, Ian, Fleck, Elaine, Fleischut, Peter, Homma, Shunichi, Masini, David, and Moise, Nathalie
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- 2021
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39. Recurrent Stroke in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial
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Pullicino, Patrick M, Qian, Min, Sacco, Ralph L, Freudenberger, Ron, Graham, Susan, Teerlink, John R, Mann, Douglas, Di Tullio, Marco R, Ponikowski, Piotr, Lok, Dirk J, Anker, Stefan D, Lip, Gregory YH, Estol, Conrado J, Levin, Bruce, Mohr, Jay P, Thompson, John LP, and Homma, Shunichi
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Stroke ,Heart Disease ,Cardiovascular ,Clinical Research ,Brain Disorders ,Aged ,Anticoagulants ,Aspirin ,Female ,Fibrinolytic Agents ,Heart Failure ,Humans ,Male ,Middle Aged ,Recurrence ,Stroke Volume ,Warfarin ,Heart failure ,Ejection fraction ,WARCEF Investigators ,Clinical Sciences ,Neurosciences ,Neurology & Neurosurgery - Abstract
Background and purposeWARCEF randomized 2,305 patients in sinus rhythm with ejection fraction (EF) ≤ 35% to warfarin (INR 2.0-3.5) or aspirin 325 mg. Warfarin reduced the incident ischemic stroke (IIS) hazard rate by 48% over aspirin in a secondary analysis. The IIS rate in heart failure (HF) is too low to warrant routine anticoagulation but epidemiologic studies show that prior stroke increases the stroke risk in HF. In this study, we explore IIS rates in WARCEF patients with and without baseline stroke to look for risk factors for IIS and determine if a subgroup with an IIS rate high enough to give a clinically relevant stroke risk reduction can be identified.MethodsWe compared potential stroke risk factors between patients with baseline stroke and those without using the exact conditional score test for Poisson variables. We looked for risk factors for IIS, by comparing IIS rates between different risk factors. For EF we tried cut-off points of 10, 15 and 20%. The cut-off point 15% was used as it was the highest EF that was associated with a significant increase in IIS rate. IIS and EF strata were balanced as to warfarin/aspirin assignment by the stratified randomized design. A multiple Poisson regression examined the simultaneous effects of all risk factors on IIS rate. IIS rates per hundred patient years (/100 PY) were calculated in patient groups with significant risk factors. Missing values were assigned the modal value.ResultsTwenty of 248 (8.1%) patients with baseline stroke and 64 of 2,048 (3.1%) without had IIS. IIS rate in patients with baseline stroke (2.37/100 PY) was greater than patients without (0.89/100 PY) (rate ratio 2.68, p < 0.001). Fourteen of 219 (6.4%) patients with ejection fraction (EF)
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- 2014
40. Subclinical Left Ventricular Dysfunction and Ventricular Arrhythmias in Older Adults With Normal Ejection Fraction
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Yoshida, Yuriko, primary, Jin, Zhezhen, additional, Nakanishi, Koki, additional, Matsumoto, Kenji, additional, Homma, Shunichi, additional, Mannina, Carlo, additional, Shames, Sofia, additional, Elkind, Mitchell S. V., additional, Rundek, Tatjana, additional, and Di Tullio, Marco R., additional
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- 2023
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41. Correlation Between the Cohorts for Heart and Aging Research in Genomic Epidemiology–Atrial Fibrillation Risk Score and Left Atrial Remodeling in the General Population
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Hirose, Kazutoshi, Nakanishi, Koki, Daimon, Masao, Sawada, Naoko, Yoshida, Yuriko, Ishiwata, Jumpei, Hirokawa, Megumi, Koyama, Katsuhiro, Nakao, Tomoko, Fujiu, Katsuhito, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2021
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42. Subclinical Left Ventricular Dysfunction and Silent Cerebrovascular Disease
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Russo, Cesare, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell SV, Rundek, Tatjana, Yoshita, Mitsuhiro, DeCarli, Charles, Wright, Clinton B, Sacco, Ralph L, and Di Tullio, Marco R
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Biomedical Imaging ,Stroke ,Heart Disease ,Brain Disorders ,Cardiovascular ,Neurosciences ,Clinical Research ,Aging ,Aged ,Brain ,Cardiovascular Abnormalities ,Cerebral Infarction ,Cerebrovascular Disorders ,Cohort Studies ,Cross-Sectional Studies ,Female ,Humans ,Male ,Middle Aged ,Population Surveillance ,Prospective Studies ,Residence Characteristics ,Ventricular Dysfunction ,Left ,brain infarction ,echocardiography ,global longitudinal strain ,magnetic resonance imaging ,speckle-tracking ,ventricular ejection fraction ,white matter diseases ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Abstract
BackgroundSilent brain infarcts (SBIs) and white matter hyperintensities are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular ejection fraction (LVEF) is a predictor of stroke in patients with heart failure, but its association with subclinical brain disease in the general population is unknown. Left ventricular global longitudinal strain (GLS) can detect subclinical cardiac dysfunction even when LVEF is normal. We investigated the relationship of LVEF and GLS with subclinical brain disease in a community-based cohort.Methods and resultsLVEF and GLS were assessed by 2-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBIs and white matter hyperintensities were assessed by brain MRI. Mean age of the study population was 69±10 years, 61% were women, LVEF was 63.8±6.4%, GLS was -17.1±3.0%. SBIs were detected in 53 participants (12%), white matter hyperintensity volume was 0.63±0.86%. GLS was significantly lower in participants with SBI versus those without (-15.7±3.5% versus -17.3±2.9%, P
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- 2013
43. Benefit of Warfarin Compared With Aspirin in Patients With Heart Failure in Sinus Rhythm
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Homma, Shunichi, Thompson, John LP, Sanford, Alexandra R, Mann, Douglas L, Sacco, Ralph L, Levin, Bruce, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Graham, Susan, Mohr, JP, Massie, Barry M, Labovitz, Arthur J, Di Tullio, Marco R, Gabriel, André P, Lip, Gregory YH, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, and Anker, Stefan D
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Research ,Cardiovascular ,Stroke ,Brain Disorders ,Adult ,Age Factors ,Aged ,Anticoagulants ,Aspirin ,Brain Ischemia ,Cerebral Hemorrhage ,Double-Blind Method ,Female ,Heart Failure ,Heart Rate ,Humans ,Kaplan-Meier Estimate ,Male ,Middle Aged ,Proportional Hazards Models ,Risk Factors ,Stroke Volume ,Time Factors ,Treatment Outcome ,Ventricular Function ,Left ,Warfarin ,aspirin ,heart failure ,sinus rhythm ,stroke ,warfarin ,WARCEF Investigators ,Biochemistry and Cell Biology ,Cardiorespiratory Medicine and Haematology ,Medical Physiology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Medical physiology - Abstract
BackgroundThe Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial found no difference in the primary outcome between warfarin and aspirin in 2305 patients with reduced left ventricular ejection fraction in sinus rhythm. However, it is unknown whether any subgroups benefit from warfarin or aspirin.Methods and resultsWe used a Cox model stepwise selection procedure to identify subgroups that may benefit from warfarin or aspirin on the WARCEF primary outcome. A secondary analysis added major hemorrhage to the outcome. The primary efficacy outcome was time to the first to occur of ischemic stroke, intracerebral hemorrhage, or death. Only age group was a significant treatment effect modifier (P for interaction, 0.003). Younger patients benefited from warfarin over aspirin on the primary outcome (4.81 versus 6.76 events per 100 patient-years: hazard ratio, 0.63; 95% confidence interval, 0.48-0.84; P=0.001). In older patients, therapies did not differ (9.91 versus 9.01 events per 100 patient-years: hazard ratio, 1.09; 95% confidence interval, 0.88-1.35; P=0.44). With major hemorrhage added, in younger patients the event rate remained lower for warfarin than aspirin (5.41 versus 7.25 per 100 patient-years: hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P=0.005), but in older patients it became significantly higher for warfarin (11.80 versus 9.35 per 100 patient-years: hazard ratio, 1.25; 95% confidence interval, 1.02-1.53; P=0.03).ConclusionsIn patients
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- 2013
44. Adoption and Usage of Video Telehealth in a Large, Academic Department of Surgery
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Lazar, Andrew N., Nemeth, Samantha K., Kurlansky, Paul A., Patel, Virendra I., Homma, Shunichi, and Morrissey, Nicholas J.
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- 2021
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45. Usefulness of Tricuspid Annular Diameter to Predict Late Right Sided Heart Failure in Patients With Left Ventricular Assist Device
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Nakanishi, Koki, Homma, Shunichi, Han, Jiho, Takayama, Hiroo, Colombo, Paolo C., Yuzefpolskaya, Melana, Garan, Arthur R., Farr, Maryjane A., Kurlansky, Paul, Di Tullio, Marco R., Naka, Yoshifumi, and Takeda, Koji
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- 2018
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46. Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study
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Yoshida, Yuriko, Nakanishi, Koki, Daimon, Masao, Ishiwata, Jumpei, Sawada, Naoko, Hirokawa, Megumi, Kaneko, Hidehiro, Nakao, Tomoko, Mizuno, Yoshiko, Morita, Hiroyuki, Di Tullio, Marco R., Homma, Shunichi, and Komuro, Issei
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- 2020
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47. Stroke in Heart Failure in Sinus Rhythm: The Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial
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Pullicino, Patrick M, Thompson, John LP, Sacco, Ralph L, Sanford, Alexandra R, Qian, Min, Teerlink, John R, Haddad, Haissam, Diek, Monika, Freudenberger, Ronald S, Labovitz, Arthur J, Di Tullio, Marco R, Lok, Dirk J, Ponikowski, Piotr, Anker, Stefan D, Graham, Susan, Mann, Douglas L, Mohr, JP, and Homma, Shunichi
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Stroke ,Cardiovascular ,Heart Disease ,Clinical Research ,Anticoagulants ,Aspirin ,Brain Damage ,Chronic ,Brain Ischemia ,Cerebral Hemorrhage ,Heart Failure ,Humans ,Intracranial Embolism ,Multicenter Studies as Topic ,Platelet Aggregation Inhibitors ,Randomized Controlled Trials as Topic ,Recurrence ,Severity of Illness Index ,Stroke Volume ,Warfarin ,Cardiac embolism ,Heart failure ,Stroke prevention ,WARCEF Investigators ,Clinical Sciences ,Neurosciences ,Neurology & Neurosurgery ,Clinical sciences - Abstract
BackgroundThe Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial found no difference between warfarin and aspirin in patients with low ejection fraction in sinus rhythm for the primary outcome: first to occur of 84 incident ischemic strokes (IIS), 7 intracerebral hemorrhages or 531 deaths. Prespecified secondary analysis showed a 48% hazard ratio reduction (p = 0.005) for warfarin in IIS. Cardioembolism is likely the main pathogenesis of stroke in heart failure. We examined the IIS benefit for warfarin in more detail in post hoc secondary analyses.MethodsWe subtyped IIS into definite, possible and noncardioembolic using the Stroke Prevention in Atrial Fibrillation method. Statistical tests, stratified by prior ischemic stroke or transient ischemic attack, were the conditional binomial for independent Poisson variables for rates, the Cochran-Mantel-Haenszel test for stroke subtype and the van Elteren test for modified Rankin Score (mRS) and National Institute of Health Stroke Scale (NIHSS) distributions, and an exact test for proportions.ResultsTwenty-nine of 1,142 warfarin and 55 of 1,163 aspirin patients had IIS. The warfarin IIS rate (0.727/100 patient-years, PY) was lower than for aspirin (1.36/100 PY, p = 0.003). Definite cardioembolic IIS was less frequent on warfarin than aspirin (0.22 vs. 0.55/100 PY, p = 0.012). Possible cardioembolic IIS tended to be less frequent on warfarin than aspirin (0.37 vs. 0.67/100 PY, p = 0.063) but noncardioembolic IIS showed no difference: 5 (0.12/100 PY) versus 6 (0.15/100 PY, p = 0.768). Among patients experiencing IIS, there were no differences by treatment arm in fatal IIS, baseline mRS, mRS 90 days after IIS, and change from baseline to post-IIS mRS. The warfarin arm showed a trend to a lower proportion of severe nonfatal IIS [mRS 3-5; 3/23 (13.0%) vs. 16/48 (33.3%), p = 0.086]. There was no difference in NIHSS at the time of stroke (p = 0.825) or in post-IIS mRS (p = 0.948) between cardioembolic, possible cardioembolic and noncardioembolic stroke including both warfarin and aspirin groups.ConclusionsThe observed benefits in the reduction of IIS for warfarin compared to aspirin are most significant for cardioembolic IIS among patients with low ejection fraction in sinus rhythm. This is supported by trends to lower frequencies of severe IIS and possible cardioembolic IIS in patients on warfarin compared to aspirin.
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- 2013
48. Office, central and ambulatory blood pressure for predicting incident atrial fibrillation in older adults
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Matsumoto, Kenji, Jin, Zhezhen, Homma, Shunichi, Elkind, Mitchell S.V., Schwartz, Joseph E., Rundek, Tatjana, Mannina, Carlo, Ito, Kazato, Sacco, Ralph L., and Di Tullio, Marco R.
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- 2021
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49. Patent foramen ovale and cryptogenic stroke
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Nakanishi, Koki, Yoshiyama, Minoru, and Homma, Shunichi
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- 2017
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50. Association of Left Atrial Strain With Ischemic Stroke Risk in Older Adults
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Mannina, Carlo, primary, Ito, Kazato, additional, Jin, Zhezhen, additional, Yoshida, Yuriko, additional, Matsumoto, Kenji, additional, Shames, Sofia, additional, Russo, Cesare, additional, Elkind, Mitchell S. V., additional, Rundek, Tatjana, additional, Yoshita, Mitsuhiro, additional, DeCarli, Charles, additional, Wright, Clinton B., additional, Homma, Shunichi, additional, Sacco, Ralph L., additional, and Di Tullio, Marco R., additional
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- 2023
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