on behalf of the CHART-2 Investigators Background: Hospitalization due to acute heart failure syndrome (AHFS) is an indicator of worsened prognosis for patients with cardiovascular disease (CVD). The Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) Study was designed to elucidate characteristics and prognosis of patients at high risk for CVD progression due to AHFS. Methods and Results:The CHART-2 Study is a prospective observational multicenter cohort study. Patients with overt HF, structural cardiac disorder but without HF, or with coronary artery disease (CAD) have been consecutively enrolled from October 2006. As of March 2010, a total of 10,219 patients have been recruited, making the Study the largest multicenter prospective cohort of HF patients in Japan. The mean patient age was 68.2± 12.3 years and male patients accounted for 69.8%. Overt HF was observed in 46.3% of patients; and 53.7% did not have HF but were at high risk for AHFS. As HF stage progressed, the prognostic risks (eg, chronic kidney disease, reduced ejection fraction, and increased B-type natriuretic peptide level) became more prominent. Compared with the previous CHART-1 study, the prevalence of ischemic etiology and risk factors (hypertension, diabetes) have increased, as in Western studies. Conclusions:This first report demonstrates the trend of westernization of ischemic etiology and clinical characteristics of HF patients in Japan, indicating the importance of appropriate management and prevention of CAD to prevent AHFS. (Circ J 2011; 75: 823 - 833)

Background: Worldwide, the rate of aging is highest in Japan, especially the female population. To explore the trends for acute myocardial infarction (AMI) in Japan, the MIYAGI-AMI Registry Study has been conducted for 30 years since 1979, whereby all AMI patients in the Miyagi prefecture are prospectively registered. In 1979,551 AMI patients (male/female 16,238/6,313) were registered from 43 hospitals. The age-adjusted incidence of AMI (/100,000 persons/year) increased from 7.4 in 1979 to 27.0 in 2008 (P<0.001). Although control of coronary risk factors remained insufficient, the rates of ambulance use and primary percutaneous coronary intervention (PCI) have increased, and the overall in-hospital mortality (ageadjusted) has decreased from 20.0% in 1979 to 7.8% in 2008 (P<0.0001). However, the in-hospital mortality remains relatively higher in female than in male patients (12.2% vs 6.3% in 2008). Female patients were characterized by higher age and lower PCI rate. Methods and Results: Conclusions:The MIYAGI-AMI Registry Study demonstrates the steady trend of an increasing incidence, but decreasing mortality, for AMI in Japan over the past 30 years, although the female population still remains at higher risk for in-hospital death, despite improvements in the use of ambulances and primary PCI. (Circ J 2010; 74: 93 - 100)

No abstract

No abstract

These data suggest that a high endogenous EPO level can predict a smaller infarct size in patients with acute MI subjected to successful primary PCI. This might be attributed to the potentially protective effect of endogenous EPO against ischemia-reperfusion injury in humans.

Chronic kidney disease (CKD) is common and the estimated prevalence is about 9-13% in the general adult population. CKD is defined by the presence of kidney damage or decreased glomerular filtration rate. Individuals with CKD have a far greater likelihood of cardiovascular death than progression to end-stage renal disease. Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder and the prevalence is reported to be 2-3% in the general population. The prognosis of HF patients is still poor despite recent advances in HF treatment. Both diseases are major and growing public health problems because aging of the population contributes to the increasing incidence of those diseases. More than 40% of HF patients have CKD and the close relationship between CKD and HF worsens their prognoses. All physicians must evaluate kidney function using estimated glomerular filtration rate calculated by the new Japanese equation in patients with HF. Accurate evaluation of pathophysiology between the two diseases and appropriate intervention are necessary to improve the prognosis of patients with the diseases.

Aims Heart failure with preserved ejection fraction (HFpEF) is characterized by multiple co‐morbidities, including chronic kidney disease that is one of the prognostic risks for these patients. This study was performed to evaluate the value of determination of albuminuria using a urine dipstick test (UDT), combined with estimated glomerular filtration rate (eGFR), for predicition of mortality in HFpEF. Methods and results We enrolled 2465 consecutive patients with overt HF with EF ≥50% in our Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART‐2) study (NCT00418041). We defined trace or more UDT as positive. We divided the patients into the following four groups based on eGFR and UDT; group 1 (G1) (eGFR ≥60, negative UDT), G2 (eGFR ≥60, positive UDT), G3 (eGFR <60, negative UDT), and G4 (eGFR <60, positive UDT). In total, 29.5% of the HFpEF patients had a positive UDT. HFpEF patients with a positive UDT were characterized by higher brain natriuretic peptide levels and frequent histories of hypertension or diabetes. During a mean follow‐up of 2.5 years, HFpEF patients with a positive UDT showed higher mortality in each stratum of eGFR levels. A multivariable adjusted Cox model showed that when compared with G1 (reference), the hazard ratio of all‐cause death for G2, G3, and G4 was 2.44 (95% confidence interval 1.47–4.05, P=0.001), 1.43 (0.92–2.23, P=0.12), and 2.71 (1.72–4.27, P<0.001), respectively. Furthermore, the prognostic value of a positive UDT was robust for both cardiovascular and non‐cardiovascular deaths. Conclusions These results indicate that measurement of albuminuria in addition to eGFR is useful for appropriate risk stratification in HFpEF patients.

Abstract:The prognosis of patients with chronic heart failure (CHF) still remains poor, despite the recent advances in medical and surgical treatment. Furthermore, CHF is a major public health problem in most industrialized countries where the elderly population is rapidly increasing. Although the prevalence and mortality of CHF used to be relatively low in Japan, the disorder has been markedly increasing due to the rapid aging of the society and the Westernization of lifestyle that facilitates the development of coronary artery disease. The Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-1 study was one of the largest cohorts in Japan. The study has clarifi ed the characteristics and prognosis of Japanese patients with CHF, demonstrating that their prognosis was similarly poor compared with those in Western countries. However, we still need evidence for the prevention and treatment of CHF based on the large cohort studies or randomized treatment trials in the Japanese population. Since the strategy for CHF management is now changing from treatment to prevention, a larger-size prospective cohort, called the CHART-2 study, has been initiated to evaluate the risk factors of CHF in Japan. This review summarizes the current status of CHF studies in Japan and discusses their future perspectives.