記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語  

Minimally invasive direct coronary artery bypass is preferred due to its less invasive nature; however, it carries the risk of graft failure owing to inherent technical challenges. We present a case where minimally invasive direct coronary artery bypass grafting was performed and graft failure was detected via coronary angiography 3 days post-operation. Successful percutaneous coronary intervention was subsequently performed on the failed graft itself to salvage myocardial cellular damage. Consequently, the combination of minimally invasive direct coronary artery bypass and percutaneous coronary intervention, both less-invasive revascularization approaches, effectively achieved the primary treatment objective.

DOI： 10.1093/jscr/rjad420

PubMed

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記述言語：英語  

A male 15-year-old promising gymnast suffered palpitations, which emerged only after landing a round-off back somersault. The performance induced an attack of regular narrow QRS complex tachycardia that was highly reproducible. Not a single element of the performance, but a whole sequence of round-off back somersault was required to induce the attack. An electrophysiologic study revealed an intra-nodal dual pathway causing atrioventricular nodal reentrant tachycardia (AVNRT). A complication of a tiny atrial septal defect (ASD) was incidentally detected, thus we initially suspected a causal relation of ASD as the platypnea-orthodeoxia syndrome. However, it was denied as the major mechanism of attack because of a very faint shunt flow and no-induction of hypoxemia during a round-off back somersault. The major triggering mechanisms of a whole sequence of round-off back somersaults were speculated to be related to transient atrial overload and autonomic imbalance induced by a swift postural-axial change together with an intense Valsalva maneuver with the maximal level of breath holding. The AVNRT attack was successfully treated by radiofrequency catheter ablation and has never recurred even by a whole sequence of round-off back somersaults. Currently he is a healthy and active gymnast with no symptoms. <Learning objective: The individual trigger of an atrioventricular nodal reentrant tachycardia (AVNRT) attack varies. The unique and sole trigger of the attack in the present gymnast case was a whole sequence of round-off back somersaults. A swift postural-axial change together with an intense Valsalva maneuver with the maximal level of breath holding increased the atrial overload with stretching the atrial wall, which might have induced atrial extrasystole and played a trigger role initiating the AVNRT attack.>.

DOI： 10.1016/j.jccase.2020.12.004

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report an unusual case of acute myocardial infarction in a high school girl. The patient was 17 years of age and had multiple coronary risk factors, including marked obesity with a body mass index (BMI) of 42.7 kg/m2, dyslipidemia and glucose intolerance. She had been an on and off smoker since she was 13 years of age. Due to the recent Westernization of the lifestyle, the prevalence of metabolic syndrome in the young generation has been increasing in Japan. Cardiovascular disease based on lifestyle-related diseases may become more common in young people.

DOI： 10.2169/internalmedicine.5437-20

PubMed

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掲載種別：研究論文（学術雑誌）  

© 2020 Wiley Periodicals LLC Unattended automated office blood pressure (AOBP) measurement has been endorsed as the preferred in-office measurement modality in recent Canadian and American clinical practice guidelines. However, the difference between AOBP and conventional office blood pressure (CBP) under the environment of a health checkup remains unclear. We aimed to identify the clinical significance of AOBP as compared to CBP under the environment of a health checkup. There were 491 participants (333 females, mean age of 62.5 years) who were at least 20 years old, including 179 participants who were previously diagnosed with hypertension. Mean AOBPs were 131.8 ± 20.9/76.6 ± 11.7 mm Hg, and CBPs were 135.6 ± 21.6/77.3 ± 11.5 mm Hg. There was a difference of 3.9 mm Hg in systolic blood pressure (SBP) and 0.8 mm Hg in diastolic BP between AOBP and CBP. In all participants, SBP and pulse pressure, as well as the white coat effect (WCE), increased with age. The cutoff value used was 140/90 mm Hg for CBP and 135/85 mm Hg for AOBP, and the prevalence of WCE and masked hypertension effect (MHE) was 12.4% and 14.1%, respectively. Even in a health checkup environment of the general population, there was a difference between the AOBP and CBP, and the WCE was observed more strongly in the elderly with a history of hypertension, suggesting that a combination of AOBP with CBP may be useful in detecting WCE and MHE in all clinical scenarios including health checkups, and help solve the “hypertension paradox” not only in Japan but in all over the world.

DOI： 10.1111/jch.14008

Scopus

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掲載種別：研究論文（学術雑誌）  

©2020 Wiley Periodicals LLC Angiotensin receptor blockers (ARBs) plus calcium channel blockers (CCBs) are a widely used combination therapy for hypertensive patients. In order to determine which combination was better as the next-step therapy for standard-dose combination of ARBs and CCBs, a combination with high-dose CCBs or a triple combination with diuretics, the authors conducted a prospective, randomized, open-label trial to determine which of the following combination is better as the next-step treatment: a combination with high-dose CCBs or a triple combination with diuretics. Hypertensive outpatients who did not achieve their target blood pressure (BP) with usual dosages of ARBs and amlodipine 5 mg were randomly assigned to treatment with irbesartan 100 mg/amlodipine 10 mg (Group 1: n = 48) or indapamide 1 mg in addition to ARBs plus amlodipine 5 mg (Group 2: n = 46). The primary end point was changes in the systolic BP (SBP) and diastolic BP (DBP) after the 12-week treatment period, while secondary end points were changes in BP after the 24-week treatment period and laboratory values. At 12 weeks, the SBP/DBP significantly decreased from 152.1/83.4 mm Hg to 131.5/76.1 mm Hg in Group 1 and 153.9/82.1 mm Hg to 132.7/75.9 mm Hg in Group 2. Although both groups produced a similar efficacy in reducing the SBP/DBP (−19.2/-9.2 mm Hg in Group 1 and −21.6/-8.8 mm Hg in Group 2; SBP P =.378, DBP P =.825), high-dose CCBs combined with ARBs controlled hypertension without elevation of serum uric acid. These results will provide new evidence for selecting optimal combination therapies for uncontrolled hypertensive patients.

DOI： 10.1111/jch.13977

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記述言語：英語  

Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by abnormalities in the α-galactosidase (Gal) A gene (GLA; MIM:300644). The reduced activity of the lysosomal enzyme, α-galactosidase A (α-Gal A) leads to classic early manifestations and vascular disease of the heart, kidneys, and brain. As a high-risk screening for symptomatic AFD using an enzymatic assay on dried blood spot samples, we enrolled 2325 individuals (803 females and 1522 males; median age: 66 years) with cardiac, renal, or neurological manifestations that met at least one of the following criteria: (a) family history of early-onset cardiovascular diseases; (b) typical classic manifestations, such as acroparesthesias, clustered angiokeratoma, cornea verticillata, and hypo-anhidrosis; (c) proteinuria; (d) receiving dialysis; (e) left ventricular hypertrophy on electrocardiography or echocardiography; or (f) history of stroke. Ninety-two patients displayed low α-Gal A activity. Four males and two females had different pathogenic GLA mutations (0.26%) including a novel mutation c.908-928del21. Four males (0.17%) harbored the GLA c.196G>C (p.E66Q) variant. This simple screening protocol using dried blood spot samples is useful for early diagnosis of AFD in high-risk and underdiagnosed patients suffering from various cardiac, renal, or neurological manifestations.

DOI： 10.1038/s10038-019-0633-1

PubMed

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DOI： 10.1253/circj.CJ-18-0734

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Acute limb ischemia (ALI) is associated with high morbidity and mortality rates, even with the advent of technical advances. Although myocardial infarction is one of the causes of ALI along with intraventricular thrombus formation and subsequent embolism, ALI with concomitant acute myocardial infarction (AMI) is extremely rare. Here, we report a complicated ALI case with concurrent AMI and prolonged limb ischemic duration. The cause may be attributed to thrombosis with atherosclerotic disease of the coronary and peripheral arteries triggered by dehydration. We successfully treated the patient using simultaneous revascularization in a hybrid operating room with the aid of intraoperative hemodialysis for preventing life-threatening reperfusion syndrome.

DOI： 10.3400/avd.cr.18-00059

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本高血圧学会  

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記述言語：日本語   出版者・発行元：(NPO)日本高血圧学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Background: Cerebral microbleeds (CMBs) are refined neuroimaging findings detected on T2*-weighted gradient echo (GRE) magnetic resonance imaging (MRI) and are widely accepted as an important marker of the vulnerability of cerebral small vessels. It is necessary to further clarify the natural history of CMBs by a longitudinal study. This study aimed to reveal the natural history of CMBs and find a better way to track CMBs by a prospective long-term observation. Methods: We performed yearly brain MRI assessments for 7 or more years in 8 nonvalvular atrial fibrillation Japanese outpatients with CMBs detected in the baseline MRI. We began to use a 3.0T MRI scanner from 2012 as well. Results: We followed up 3 patients for 9 years, 2 for 8 years, and 3 for 7 years. In all patients, the CMBs at baseline did not disappear during the follow-up period. Importantly, the CMB in 1 patient seemed to disappear during the sixth imaging using 1.5T T2*-weighted GRE but was detected again during the seventh imaging with 3.0T susceptibility weighted imaging and ninth imaging with 3.0T T2* GRE. Moreover, in a patient implanted with a pacemaker, which is only applicable for 1.5T MRI at present, the CMB seemed to disappear and appeared once again with a 1.5T T2*-weighted GRE at a slice thickness of 2.5 mm instead of 5 mm. Conclusions: From this prospective study, we obtained 2 absolutely new findings that CMBs remained for as long as 9 years and a high-field or thin-slice MRI can detect concealed CMBs.

DOI： 10.1016/j.jstrokecerebrovasdis.2017.09.001

Scopus

PubMed

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

症例は51歳，男性．6歳時に心疾患の指摘があり，学童期より激しい運動時にチアノーゼを認めることがあったが経過観察をしていた．数日前より咳嗽，発熱，呼吸困難が出現し，近医を受診したところ著明な低酸素血症を認め，胸部X線，CT検査より肺炎および心不全が疑われ同院に緊急入院した．心エコーを行ったところ心室中隔欠損（VSD）＋肺動脈閉鎖（PA）が認められ，体外式膜型人工肺（ECMO）で呼吸管理の下，精査治療を目的に当院へ搬送された．集中治療室にて集学的治療を行い，心不全および呼吸不全は順調に改善した．造影CTでは下行大動脈より右へ3本，左へ1本の主要体肺動脈側副血行路（MAPCAs）が認められ，心臓カテーテル検査にて圧測定を行ったところ，右中MAPCAの平均圧は36 mmHg，左MAPCAおよび右上と右下MAPCAは平均圧で28～29 mmHgであった．本症例におけるMAPCAの外科的統合は解剖学的に困難であり，また患者は手術を希望されず，在宅酸素療法を導入したところ症状の改善を認めたため，外来で経過観察する方針となった．MAPCAsを伴ったVSD＋PAの非手術成人例は稀であり報告する．

DOI： 10.11281/shinzo.49.1261

CiNii Research

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The pro-arrhythmic triggers in Brugada and early repolarization syndromes (BrS, ERS) have not been analyzed systematically except for case reports. We clinically investigated the circumstances which precede/predispose to arrhythmic events in these syndromes during long-term follow-up. A detailed history from the patients/witnesses was taken to investigate the antecedent events in the last few hours that preceded syncope/ventricular fibrillation (VF); medical records, ECG and blood test from the emergency room (ER) were reviewed. 19 patients that fulfilled the investigation criteria were followed up for 71 +/- A 49 months (34-190 months). Prior to the event (syncope/VF), the patients were partaking different activities in the following decreasing order; drinking alcoholic beverage, having meal, and getting up from sleep, exercise. 3 patients reported mental/physical stress prior to the event and 2 patients developed VF several days after starting oral steroid for treatment of bronchial asthma. In the ER, elevated J-wave amplitude (0.27 +/- A 0.15 mV) was found with 58 % of the patients having hypokalemia. After electrolyte correction and cessation of steroids, the following day plasma K+ (4.2 +/- A 0.3 mEq/L, P &lt; 0.001) was significantly increased and J-wave amplitude (0.13 +/- A 0.1 mV, P &lt; 0.001) was remarkably reduced. Three patients were kept on oral spironolactone/potassium supplements. During follow-up for 71 +/- A 49 (34-190) months, among 4 patients with VF recurrence, one patient developed VF after taking oral steroid. In ERS and BrS, hypokalemia and corticosteroid therapy add substantial pro-arrhythmic effects, but potentially treatable. Stopping steroid therapy and avoiding hypokalemia had excellent long-term outcome.

DOI： 10.1007/s00380-016-0828-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The most common complication of coronary artery perforation, a rare complication of percutaneous coronary intervention (PCI), is hemopericardium with cardiac tamponade. However, localized extra-coronary bleeding can lead to epicardial hematoma, which is a rare phenomenon. We report the case of an unusual delayed presentation of post-PCI hematoma with unrecognized guidewire perforation.
Case presentation: A 70-year-old man with idiopathic thrombocytopenic purpura (ITP) and a history of coronary artery bypass grafting (CABG) underwent PCI. A bare metal stent was implanted in left main coronary artery (LMCA) after balloon dilation. The procedure was performed without any complications, and the patient was discharged 5 days later. However, the patient was unexpectedly admitted by ambulance with cardiogenic shock and new-onset chest pain the next day. Echocardiography did not show any wall motion abnormalities, but a large mass on the right ventricle outflow tract was detected. Contrast-enhanced computed tomography showed a hematoma compressing the main pulmonary artery trunk and the right ventricle. The patient developed sudden cardiopulmonary arrest and cardiopulmonary resuscitation was successful. The patient died during emergent surgical removal of the hematoma. Large, dark red clots between the pulmonary artery trunk and aorta were observed. The suspected origin of the epicardial hematoma was blood oozing from the stent site in LMCA.
Conclusion: This is an unusual case with delayed development of localized hematoma following PCI in the absence of guidewire perforation. Furthermore, this case illustrated the potential of occasional critical complications in patients with impaired blood clotting undergoing PCI.

DOI： 10.1186/s12872-016-0378-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

Background: The distribution of late gadolinium enhancement (LGE) on the cardiac MRI (CMR) indicates myocardial fibrosis and provides information of possible reentry substrates. QT dynamicity reflecting repolarization abnormalities has gained attention as a potential prognostic predictive factor.
Objective: To clarify the correlation between the LGE distribution on CMR and QT dynamicity represented by the QT/RR relationship.
Methods: CMR and QT/RR analyses using Holter monitoring were performed in 34 patients (24 males, 60 +/- 11 years) with ventricular tachycardia (VT) and/or ventricular fibrillation (VF). The LGE on CMR was scored using a 4-point score in 17 left ventricular segments. The sum of the LGE scores was calculated for each patient. The QT/RR slope and daytime/nighttime QT/RR ratio (day/night ratio) were calculated. The correlation between the slope or the day/night QT/RR ratio and late enhancement findings was analyzed.
Results: All patients were divided into 23 LGE positive (LGE(+)) and 11 LGE negative (LGE(-)) patients. The slopes of the QTe/RR and QTa /RR were significantly steeper in the LGE(+) than in LGE(-) patients (0.21 +/- 0.03 vs 0.13 +/- 0.02; P &lt; 0.001, 0.19 +/- 0.03 vs 0.13 +/- 0.02; P &lt; 0.001, respectively), and both slopes were significantly correlated with the total LGE scores (r = 0.83, P &lt; 0.001; r = 0.71, P &lt; 0.001, respectively). In the LGE(+) patients, the QTe day/night (1.37 +/- 0.38 vs 0.91 +/- 0.33; P = 0.002) and QTa day/night ratios (1.33 +/- 0.26 vs 1.06 +/- 0.30; P = 0.011) were significantly greater than those in the LGE(-) patients.
Conclusion: The LGE distribution was closely related to the QT dynamicity, suggesting that a combination of these markers can be a powerful tool for understanding the background pathophysiology.

DOI： 10.1111/anec.12280

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND The presence of myocardial scar detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging has been described as a good independent predictor of mortality in patients with hypertrophic cardiomyopathy (HCM). Time-domain T-wave alternans (TWA) is also a potential predictor of cardiac mortality in patients with Left ventricular dysfunction.
OBJECTIVE The purpose of this study was to elucidate the relationship between LGE distribution and TWA in patients with HCM.
METHODS CMR and TWA analyses using Holler monitoring were performed in 42 patients with HCM. The average transmural extent of LGE was scored as 1-4 in each segment, and the sum of the LGE scores (total LGE score) was calculated for each patient. The correlation between the maximal time-domain TWA voltage and LGE findings was analyzed, and the differences in time-domain TWA voltage, total LGE score, and cardiac function assessed by CMR imaging in the presence or absence of ventricular tachycardia (VT) were also compared.
RESULTS The total LGE score was significantly and positively correlated with the maximal time-domain TWA voltage (r = 0.59; P &lt; .001). Furthermore, the total LGE score and maximal time-domain TWA voltage were significantly greater in patients who had episodes of VT (n = 21) than in those without VT (23 +/- 7 vs 10 +/- 8; P &lt; .001 and 87 +/- 26 mu V vs 62 +/- 12 mu V; P &lt; .001, respectively). However, the left ventricular ejection fraction did not statistically differ between patients with VT and those without VT (56% +/- 14% vs 61% 7%; P = .102).
CONCLUSION The magnitude of the localized LGE was significantly correlated with abnormalities in ventricular repolarization as assessed by TWA and QT dispersion.

DOI： 10.1016/j.hrthm.2015.04.028

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier  

Background The presence of a myocardial scar detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been described as a predictor of all-cause mortality in hypertrophic cardiomyopathy (HCM). However, the detailed spatial relationship between LGE site and electrical abnormality is unclear in high-risk HCM with malignant arrhythmia. Objective The purpose of this study was to elucidate the detailed relationship between the site on CMR imaging and the electrically damaged site, a potential origin of ventricular arrhythmias in patients with HCM. Methods Fifty consecutive HCM patients underwent contrast-enhanced CMR. Of those patients, 18 patients with ventricular tachycardia underwent electrophysiology study including endocardial mapping of the left ventricle (LV). The LGE area was calculated at 12 different LV sites: anterior, lateral, posterior, and septal segments of the basal, middle, and apical portions. At each LV site, the bipolar electrogram, effective refractory period (ERP), and monophasic action potential were recorded. Results LGE-positive segments demonstrated a significantly lower amplitude (4.0 ± 2.8 mV vs 7.3 ± 3.6 mV
P &lt
.001), longer duration (54.7 ± 17.8 vs 40.6 ± 7.8 ms
P &lt
.001), longer ERP (320 ± 42 ms vs 284 ± 37 ms
P =.001), and longer monophasic action potential duration measured at 90% repolarization (321 ± 19 ms vs 283 ± 25 ms
P &lt
.001) than did LGE-negative segments. The LGE area negatively correlated with the amplitude (r = -0.59
P &lt
.001) and positively correlated with the duration (r = 0.64
P &lt
.001), ERP (r = 0.44
P &lt
.001), and action potential duration measured at 90% repolarization (r = 0.63
P &lt
.001). All the observed VTs originated from LGE-positive segments. Conclusion The spatial distribution of LGE significantly correlates with depolarizing and repolarizing electrical damage in high-risk HCM with malignant ventricular arrhythmia.

DOI： 10.1016/j.hrthm.2015.02.004

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PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PUBLIC LIBRARY SCIENCE  

Objective
Relationship between microalbuminuria and worse outcome of coronary artery disease patients is discussed, but its underlying pathophysiological mechanism remains unclear. We investigated the role of microalbuminuria to the function of endothelial progenitor cells (EPCs), that might affect to outcome of acute myocardial infarction (AMI) patients.
Methods
Forty-five AMI patients were divided into two groups according to their urinary albumin excretion: normal (n = 24) and microalbuminuria (&gt;30 mg/day, n = 21). At day-2 and day-7 after AMI onset, circulating-EPCs (CD34(+)Flk1(+)) were quantified by flow cytometry. The number of lectin-acLDL-positive cultured-EPCs immobilized on fibronectin was determined. To assess the cellular senescence of cultured-EPCs, the expression level of sirtuin-1 mRNA and the number of SA-beta-gal positive cell were evaluated. Angiographic late in-stent loss after percutaneous coronary intervention (PCI) was evaluated at a six-month follow-up.
Results
No significant differences in coronary risk and the extent of myocardial damage were observed between the two groups. Late in-stent loss at the six-month follow-up was significantly higher in the microalbuminuria group (normal : microalbuminuria = 0.76 +/- 0.34 : 1.18 +/- 0.57 mm, p=0.021). The number of circulating-EPCs was significantly increased in microalbuminuria group at day-7, however, improved adhesion of EPCs was observed in normal group but not in microalbuminuria group from baseline to day-7 (+3.1 +/- 8.3 : -1.3 +/- 4.4 %: p&lt;0.05). On the other hand, in microalbuminuria group at day-7, the level of sirtuin-1 mRNA expression of cultured-EPCs was significantly decreased (7.1 +/- 8.9 : 2.5 +/- 3.7 fold, p&lt;0.05), which was based on the negative correlation between the level of sirtuin-1 mRNA expression and the extent of microalbuminuria. The ratio of SA-beta-gal-positive cells in microalbuminuria group was increased compared to that of normal group.
Conclusions
Microalbuminuria in AMI patients is closely associated with functional disorder of EPCs via cellular senescence, that predicts the aggravation of coronary remodeling after PCI.

DOI： 10.1371/journal.pone.0123733

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Renovascular hypertension is an important cause of secondary hypertension. We present the case of a 61-year-old man with renovascular hypertension caused by chronic total occlusion of the left renal artery resulting in an atrophic kidney. Although renography indicated almost no residual function of the left kidney, renal vein sampling showed a significant increase of renin secretion in the left kidney. The endocrine function of the left kidney was believed to be preserved; thus, we performed percutaneous transluminal renal angioplasty with stent placement. After the procedure, the patient's blood pressure decreased gradually to within the normal range without adverse events. The laboratory data on endocrine function and the renography findings drastically improved. Percutaneous transluminal renal angioplasty is a promising therapeutic procedure for renovascular hypertension with an atrophic kidney.

DOI： 10.1007/s00380-013-0457-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS LTD  

Background: Combination antihypertensive therapy with an angiotensin receptor blocker (ARB) and a calcium channel blocker (CCB) or diuretics is common. This subanalysis investigated blood pressure (BP) variability in patients receiving ARB-based combination therapy. Methods: In a prospective, randomized, open-label trial, hypertensive outpatients (&gt;= 65 years) who did not achieve their target BP with ARB monotherapy switched to losartan 50 mg/hydrochlorothiazide 12.5mg (ARB + D) or ARB plus amlodipine 5mg (ARB + C) for 12 months. Clinic BP and heart rate (HR), measured every 3 months, visit-to-visit variability and seasonal variation were evaluated. Results: No significant between-group differences in average, maximum, or minimum systolic or diastolic BP, or HR, were found. Visit-to-visit BP variability (systolic) was significantly higher in the ARB + D group than in the ARB + C group. When each group was subdivided into two seasonal groups (summer and winter), no significant between-group differences in BP were found. Multivariate regression analyses showed a tendency toward negative correlation between outdoor temperature and urinary albumin: creatinine ratio and estimated glomerular filtration rate at 12 months in the ARB + D group. Conclusion: Combination therapy with an ARB plus a CCB may be preferable to that with an ARB plus diuretics for decreasing BP variability. As for seasonal variability, both treatments can be used safely regardless of season.

DOI： 10.3109/10641963.2014.995802

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Repolarization Indices in ER and Brugada Syndromes. Introduction: We reported impaired QT-rate dependence in early repolarization syndrome (ERS); however, contemporary data have shown peak incidence of sudden cardiac death (SCD) in ERS and Brugada syndrome (BrS) at mid-night and early morning. Taken together, we analyzed the nocturnal QT-rate dependence in both syndromes.
Methods and Results: A total of 172 subjects were enrolled: 11 ERS, 11 BrS patients, 50 subjects with an uneventful ER pattern (ERP), and 100 non-J-wave control subjects. Ambulatory ECG-derived parameters (QT, QTc, and QT/RR slope) and day-night QT difference were analyzed and compared. Among the groups, there was no significant difference in the average QT or QTc; however, the 24-hour QT/RR slope was significantly smaller in ERS and BrS patients (0.103 +/- 0.01 and 0.106 +/- 0.01, respectively) than in the control group (0.156 +/- 0.03, P &lt; 0.001). Detailed analysis showed a lower day-night QT difference in ERS and BrS patients (19 +/- 18.7 and 24 +/- 14 milliseconds, respectively) than in the controls (40 +/- 22 milliseconds, P = 0.007) with the lowest QT/RR slopes seen in the ERS and BrS groups from 0 to 3: 00 am (QT/RR; 0.076 +/- 0.02 vs. 0.092 +/- 0.04 vs. 0.117 +/- 0.04, for the ERS, BrS, and controls, respectively, P = 0.004) and from 3 to 6 am (QT/RR 0.074 +/- 0.03 vs. 0.079 +/- 0.02 vs. 0.118 +/- 0.04, P &lt; 0.001).
Conclusion: In a large population of age-and gender-matched groups, both ERS and BrS patients showed attenuated QT-rate dependence and impaired QT day-night modulation that may provide a baseline reentrant substrate. Importantly, QT/RR maladaptation was most evident at mid-night and early morning, which may explain the propensity of such patients to develop SCD during this critical period.

DOI： 10.1111/jce.12566

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記述言語：英語  

出版社版 オープンアクセスBACKGROUND:It remains unclear whether administration of ARB with reactive oxygen species (ROS) scavenging effects improves the prognosis of patients undergoing PCI.OBJECTIVES:This study investigated whether the pre-intervention antioxidant effect of angiotensin receptor blocker (ARB) affects long-term outcomes in patients after successful percutaneous coronary intervention (PCI) without early adverse events.METHODS:Fifty-two patients who underwent elective PCI were randomly assigned for treatment with or without ARB, which was administered within 48 hours before PCI. ROS levels in mononuclear cells (MNCs) and serum superoxide dismutase (SOD) activity were measured pre-PCI and 6 months post-PCI. After exclusion of unexpected early adverse events during angiographic follow-up period, the long-term outcome (major adverse cerebro-cardiovascular event; MACCE) was assessed in eligible patients.RESULTS:Forty-three patients (non-ARB n = 22, ARB n = 21) were followed up in this study. During angiographic follow-up period, ROS formation in MNCs was significantly increased in the non-ARB group (from 29.4 [21.6-35.2] to 37.2 [30.7-45.1] arbitrary units; p = 0.031) compared to that in the ARB group. Meanwhile, SOD activity was significantly impaired in the non-ARB group alone (from 24.0 ± 17.0 to 16.3 ± 13.8%, p = 0.004). During the follow-up period (median, 63.3 months), MACCEs were observed in 6 patients. The cumulative event ratio of MACCE was significantly higher in the non-ARB group than in the ARB group (p = 0.018).CONCLUSIONS:Concomitant administration of ARB effectively reduced ROS production of PCI patients during angiographic follow-up period. Initial ROS inhibition following ARB administration may contribute to improvement of worse outcomes in patients who have undergone successful PCI.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We describe three cases of J-wave syndrome in which ventricular fibrillation (VF) was probably induced by corticosteroid therapy. The patients involved were being treated with prednisolone for concomitant bronchial asthma. One of the three patients had only one episode of VF during her long follow-up period (14 years). Two patients had hypokalemia during their VF episodes. Corticosteroids have been shown to induce various types of arrhythmia and to modify cardiac potassium channels. We discuss the possible association between corticosteroid therapy and VF in J-wave syndrome based on the cases we have encountered.

DOI： 10.1007/s00380-013-0443-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER IRELAND LTD  

Background: Proteinuria and reduced estimated glomerular filtration rate (eGFR) are associated with an increased risk of mortality from acute myocardial infarction (AMI). However, it is unknown whether there is a difference in prognostic value for all-cause mortality between proteinuria and eGFR during post-AMI.
Methods: A consecutive series of 101 patients admitted with AMI who received angioplasty were enrolled. Dipstick proteinuria and eGFR were assessed on admission: (i) the patients were divided into 2 groups according to the presence of proteinuria (proteinuria, n = 25), or not (negative, n = 76), (ii) the patients were divided into 2 groups according to lower eGFR (GFR &lt;60 mL/min/1.73 m(2), n = 31) or higher (GFR &gt; 60 mL/min/1.73 m(2), n = 70). Clinical characteristics and 3-year all-cause mortality estimated by Kaplan-Meier method were evaluated in each group. Additionally, a multivariate Cox proportional hazards model was applied to evaluate which factor was associated with all-cause mortality.
Results: Mean follow-up period was 914 days. Higher brain natriuretic peptide (BNP) levels were shown in the proteinuria and lower eGFR groups, respectively (proteinuria, 301 324 pg/mL; negative, 146 159 pg/mL; p = 0.02; lower eGFR, 294 305 pg/mL; higher eGFR, 142 161 pg/mL; p = 0.02). Threeyear all-cause mortality was higher in the proteinuria group than in the normal group (p &lt; 0.001) and in the lower eGFR group than in the higher group (p = 0.006). In a Cox proportional hazards model, the presence of proteinuria [hazard ratio (95% confidence interval), 4.51 (1.07-18.96); p = 0.04] was selected as one of the predictors for all-cause mortality.
Conclusions: Dipstick proteinuria and lower eGFR in the early phase of AMI follow-up were related to increased plasma BNP level during the sub-acute phase and long-term adverse outcome. Dipstick proteinuria may be a prognostic marker for long-term all-cause mortality. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2013.05.002

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記述言語：日本語   出版者・発行元：(一社)日本マグネシウム学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Objective: Combination therapy with angiotensin receptor blockers (ARBs) and calcium channel blockers or diuretics is common for hypertensive patients. This study aimed to determine which combination is better for elderly hypertensive patients.
Methods: In this prospective, randomized, open-label trial, hypertensive outpatients aged at least 65 years who had not achieved their target blood pressure (BP) with standard ARB dosages were randomly assigned to receive either a fixed-dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg) (ARB+D; n = 72) or a combination of amlodipine (5 mg) and the typical dosage of ARBs (ARB+C; n = 68) to evaluate the change in the BP, laboratory values and cognitive function.
Results: At 3 months, the SBP/DBP was found to have significantly decreased from 156/83 +/- 15/11 mmHg to 139/76 +/- 14/10 mmHg in the ARB+D group and 155/83 +/- 11/10 mmHg to 132/72 +/- 14/10 mmHg in the ARB+C group. The BP reduction efficacy was greater in the ARB+C group than in the ARB+D group. At 6 months, the SBP/DBP reached the same level in both groups. At 12 months, the urine albumin/creatinine ratio was significantly decreased from the geometric mean of 17.1 to 9.6 mg/g in the ARB+D group, whereas it was increased from 19.8 to 23.7 mg/g in the ARB+C group. Conversely, the estimated glomerular filtration rate tended to show a decrease in the ARB+D group. There was no significant difference in minimental state examination after 1 year.
Conclusion: ARB+amlodipine (5 mg) yielded a greater BP reduction, whereas ARB+HCTZ (12.5 mg) resulted in a greater reduction in the albuminuria, suggesting that each combination therapy is advantageous in a different manner for elderly hypertensive patients.

DOI： 10.1097/HJH.0b013e32835fdf60

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

QT Dynamics in Early Repolarization Syndrome Introduction Almost all current investigations on early repolarization syndrome (ERS) have focused on the J-wave characteristics and ST-segment configuration; however, few have reported on ventricular repolarization indexes in ERS. Methods and Results A total of 145 subjects were enrolled: 10 ERS patients, 45 uneventful ER pattern (ERP) subjects, and 90 healthy controls without J waves or ST-segment elevation. Ambulatory ECG-derived parameters (QT, QTc(B), QTc(F), T peak-Tend(Tpe), and QT/RR slope) were measured and statistically compared. Among the groups, there was no significant difference in the average QT and QTc(B); however, ERS patients had the shortest QTc(F) and longest Tpe (QTc(F): 396.2 +/- 19 vs 410.4 +/- 20 vs 419.2 +/- 19 milliseconds, P = 0.036, Tpe: 84.9 +/- 12 vs 70.4 +/- 11 vs 66.9 +/- 15 milliseconds, P &lt; 0.001, for the ERS, ERP, and control groups, respectively). Importantly, the 24-hour QT/RR slope was significantly smaller in the ERS than ERP and control groups (QT/RR: 0.105 +/- 0.01 vs 0.154 +/- 0.02 vs 0.161 +/- 0.03, respectively; P &lt; 0.001). When analyzing the diurnal and nocturnal QT/RR slopes, ERS patients had small diurnal and nocturnal QT/RR slopes while the ERP and control groups had large diurnal and small nocturnal QT/RR slopes (diurnal QT/RR: 0. 077 +/- 0.01 vs 0.132 +/- 0.03 vs 0.143 +/- 0.03, P &lt; 0.001; nocturnal QT/RR: 0.093 +/- 0.02 vs 0.129 +/- 0.03 vs 0.130 +/- 0.04, P = 0.02 in the ERS, ERP, and control groups, respectively). Conclusion ERS patients had a continuously depressed diurnal and nocturnal adaptation of the QT interval to the heart rate. Such abnormal repolarization dynamics might provide a substrate for reentry and be an important element for developing ventricular fibrillation in the ERS cohort.

DOI： 10.1111/jce.12074

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

J Wave Syndromes. Introduction: Recently, great attention has been paid to the risk stratification of asymptomatic patients with an electrocardiographic early repolarization (ER) pattern. We investigated several repolarization parameters including the Tpeak-Tend interval and Tpeak-Tend/QT ratio in healthy individuals and patients with J wave syndrome who were aborted from sudden cardiac death. Methods and Results: Ninety-two subjects were enrolled: 12 patients with ventricular fibrillation associated with J waves, 40 healthy subjects with an uneventful ER pattern and 40 healthy control subjects (C) without any evident J waves. Using ambulatory electrocardiogram recordings, the average QT interval, corrected QT interval (QTc), Tpeak-Tend (Tp-e) interval, which is the interval from the peak to the end of the T wave, and Tp-e/QT ratio were calculated. Using ANOVA and post hoc analysis, there was no significant difference in the average QT and QTc in all 3 groups (QT; 396 +/- 27 vs 405 +/- 27 vs 403 +/- 27 m, QTc; 420 +/- 26 vs 421 +/- 21 vs 403 +/- 19 milliseconds in the C, ER pattern and J groups, respectively). The Tp-e interval and Tp-e/QT ratio were significantly more increased in the J wave group than the ER Pattern group (Tp-e: 86.7 +/- 14 milliseconds vs 68 +/- 13.2 milliseconds, P &lt; 0.001, Tp-e/QT; 0.209 +/- 0.04 vs 0.171 +/- 0.03, P &lt; 0.001), but they did not significantly differ between the C and ER pattern groups (Tp-e: 68.6 +/- 7.5 vs 68 +/- 13.2, P = 0.97, Tp-e/QT 0.174 +/- 0.02 vs 0.171 +/- 0.03, P = 0.4). Conclusion: As novel markers of heterogeneity of ventricular repolarization, Tpeak-Tend interval and Tp-Te/QT ratio are significantly increased in patients with J wave syndromes compared to age and sex-matched uneventful ER. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1109-1114, October 2012)

DOI： 10.1111/j.1540-8167.2012.02363.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT HEART JOURNAL ASSOC  

Large infarcts are associated with a terminal QRS-distortion in ST-elevation myocardial infarction (STEM I) patients. Late gadolinium enhancement (LGE) on the cardiac MRI (CMR) can depict an infarct distribution. However, less is known about the relationship between the LGE findings and QRS-distortion on admission, including the best ECG-lead location to reveal the QRS-distortion (DIS-lead) in STEMI patients. Fifty STEMI patients successfully treated with percutaneous coronary intervention were classified into two groups according to whether the QRS-distortion was positive (+) or negative (-). The LGE on a recent CMR was classified into 12 left ventricular segments (Basal-Middle-Apical x Anterior-Septal-Inferior-Lateral). The coincidences between the segmental LGE scores and DIS-lead were investigated. All patients were divided into 23 QRS-distortion (+) and 27 QRS-distortion (-) groups. The total LGE score was significantly greater in the QRS-distortion (+) group (14.7 +/- 6.8 versus 9.6 +/- 6.2, P &lt; 0.01). The highest LGE score in 96% of QRS-distortion (+) patients was 4, and a score 4 segment indicated a good selection of the DIS-lead (86.4%). QRS-distortion in the ECG on admission represents severe transmural infarction in the LGE using CMR, which represents large infarcts in STEMI patients. (Int Heart J 2012; 53: 270-275)

DOI： 10.1536/ihj.53.270

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

We describe a case of early repolarization syndrome in which augmented J waves were documented during an electrical storm associated with hypokalemia. The patient was referred to our hospital for therapy to treat recurrent ventricular fibrillation (VF). The 12-lead electrocardiogram showed giant J waves associated with hypokalemia during multiple episodes of VF. Although antiarrhythmic agents or deep sedation were not effective for the VF, an intravenous supplementation of potassium completely suppressed the VF with a reduction in the J-wave amplitude. Our report discusses the possible relationship between hypokalemia and VF in early repolarization syndrome. (PACE 2012; 35:e234e238)

DOI： 10.1111/j.1540-8159.2012.03460.x

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記述言語：日本語   出版者・発行元：北海道医学会  

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記述言語：日本語   出版者・発行元：日本臨床社  

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その他リンク： http://search.jamas.or.jp/link/ui/2012113134

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：5  

DOI： 10.1536/ihj.52.308

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Several animal experiments on acute myocardial infarction (AMI) have shown that the cardioprotective effects of ischemic preconditioning are more significant in hypertensive subjects. However, because there are no clinical data on the impact of hypertension on ischemic preconditioning in patients with AMI, whether clinical ischemic preconditioning of prodromal angina was beneficial in AMI patients with hypertension was investigated in the present study.
Methods and Results: 125 patients with a first anterior AMI who had undergone successful reperfusion therapy were divided into 2 groups, with or without hypertension, and into 2 further subgroups based on the presence or absence of prodromal angina. Dual-isotope (thallium-201 (TL)/Tc-99 m pyrophosphate) single-photon emission computed tomography (SPECT) was performed within 1 week of reperfusion therapy. Left ventricular (LV) function and LV mass index (LVMI) were measured by left ventriculography and echocardiography, respectively. In patients without hypertension, prodromal angina resulted in significantly less myocardial damage on TL-SPECT, better LV ejection fraction and a greater myocardial blush grade compared to patients without prodromal angina. However, these cardioprotective effects of prodromal angina were significantly diminished in hypertensive patients. Importantly, the myocardial salvage effects of prodromal angina showed a significant negative correlation with LVMI, which was significantly greater in hypertensive patients.
Conclusions: The cardioprotective effects of prodromal angina were attenuated in patients with hypertension. Hypertensive LV hypertrophy may crucially limit the effects of ischemic preconditioning in AMI. (Circ J 2011; 75: 1192-1199)

DOI： 10.1253/circj.CJ-10-0906

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Systemic capillary leak syndrome (SCLS) is a life-threatening disorder which presents with periodic episodes of hypovolemic shock, due to plasma leakage to the extra-vascular space reflected by accompanying hypoalbuminemia, hemoconcentration and edema often with associated monoclonal gammopathy. We describe a 28-year-old woman with SCLS who required aggressive fluid resuscitation and was successfully treated with corticosteroid, terbutaline, and theophylline. At exacerbation, the levels of serum granulocyte colony-stimulating factor (G-CSF) were increased. Thus, G-CSF might play an important role and can be a useful biomarker for the severity of attacks in SCLS.

DOI： 10.2169/internalmedicine.50.4857

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

We describe a case of advanced atrioventricular (AV) block, in which treatment with cilostazol was effective in recovering the AV conduction. The patient was referred to our hospital for close examination of the advanced AV block and permanent pacemaker implantation. Although the patient had experienced third-degree AV block with occasional AV synchrony for more than two days, the AV conduction completely recovered after treatment with oral cilostazol at 200 mg/day. Here we discuss the possible mechanism of the improvement in the AV conduction by cilostazol.

DOI： 10.2169/internalmedicine.50.5228

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT HEART JOURNAL ASSOC  

Recent evidence suggests an association between vasospastic angina and Brugada syndrome. Here we present two cases of coronary artery disease who presented with ECG abnormalities which might have been provoked or enhanced by ischemia of the conus branch of the right coronary artery. The 12-lead ECGs demonstrated normal sinus rhythm in these two cases. Interestingly, a saddle back or coved type ST segment elevation in leads V1-V3 was documented either in the percutaneous transluminal angioplasty procedure of the proximal right coronary artery or with an intracoronary acetylcholine (Ach) administration into the right coronary artery. These Brugada type ECG changes were restored to the baseline ECG waveform after improvement in the ischemia. In the second case, vasospasms of the conus branch of the right coronary artery were associated with a coved type ST segment elevation in leads V1 to V2. We discuss the possible interaction between ischemia caused by conus branch lesions and Brugada type electrocardiographic changes. (Int Heart J 2010; 51: 68-71)

DOI： 10.1536/ihj.51.68

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

In December 2007, a woman was involved in a traffic accident. At first, her vital signs were normal, but electrocardiogram showed ST-segment elevation in the inferior leads. She was diagnosed as a blunt chest trauma-induced myocardial infarction. Her right coronary angiography showed total occlusion. She underwent an emergency coronary artery bypass surgery; 64-multi-detector-row computed tomography (64-MDCT) demonstrated an intravascular protruding lesion, which suggested subintimal hematoma. One month later, repeat coronary angiogram showed spontaneous recanalization, and 64-MDCT showed no discontinuous vessel wall. Coronary artery occlusion secondary to blunt chest trauma is rare, and it&apos;s even rarer to have spontaneous recanalization.

DOI： 10.2169/internalmedicine.49.4286

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We describe a thought-provoking case of Brugada syndrome in which a relationship between the diurnal electrocardiogram (ECG) changes and sex hormone levels was observed. A 36-year-old man who experienced cardiac arrest was referred to our hospital. He had a family history of sudden cardiac death. The 12-lead ECG exhibited a mild coved type ST-segment elevation in leads V1 and V2, which was enhanced by intravenous pilsicainide injection. Hence, this case was diagnosed as Brugada syndrome. The circadian rhythm of the serum testosterone level revealed low levels in the daytime (1.66-1.99 ng/mL) and high levels (2.52-3.42 ng/mL) in the nighttime. Interestingly, augmentation of the ST segment elevation and widening of the P wave were observed at around 2:00 AM, when the serum testosterone was recorded at its highest. Our report discusses the influence of the circadian rhythms of sex hormones oil the ECG changes in Brugada syndrome. (Int Heart J 2009; 50: 669-676)

DOI： 10.1536/ihj.50.669

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

Objective In the present study, we tried to clarify the prevalence of selective serotonin reuptake inhibitor (SSRI) prescription and early discontinuation of SSRI in a outpatient unit where primary care physicians are working in Japan.
Materials and Methods Consecutive outpatients who newly visited the Department of General Medicine, Asahikawa Medical College Hospital, Asahikawa, Japan between April 2004 and March 2008 were analyzed. Each parameter such as age, sex, diagnosis, period of continuation of SSRI or reason why they discontinued SSRI was investigated.
Results Among 4670 patients, 126 patients (2.7%) had been prescribed SSRI because of depressive state (n=117) or panic disorder (n = 9). Female patients with depression received SSRI (84/2714 = 3.10%) more frequently than male patients (33/1956 = 1.69%). Out of 117 patients with depression who had been prescribed SSRI, 28 (23.9%) patients discontinued SSRI within 4 weeks. Male patients (30.5%) discontinued SSRI within 4 weeks due to patient&apos;s decision more frequently than female patients (11.1%). The rate of patients who discontinued SSRI within 4 weeks due to patient&apos;s decision was particularly high (6/9; 67%) in male patients aged 20 to 29 years.
Conclusion These results suggest for the first time that there is a high prevalence of early discontinuation of SSRI in young male patients in Japan.

DOI： 10.2169/internalmedicine.48.2018

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

We describe a case of Brugada syndrome, in which recurrent syncope with convulsive seizures was induced after antidepressant treatment. The patient had been treated With five kinds of psychotropic drugs, The twelve-lead ECG after the syncope exhibited an RSR&apos;-pattern in the precordial leads, however, a coved type ST-segment elevation was induced by a pilsicainide test. Although ventricular fibrillation was not induced in the electrophysiologic study, an TCD implantation was considered as the recommended therapy since Brugada syndrome unmasked by antidepressants could not be ruled out. The possible contribution of antidepressants to Brugada type ST-segment changes is discussed.

DOI： 10.2169/internalmedicine.48.2370

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

We describe a case of Brugada syndrome, in which a coved type ST-segment elevation was enhanced by antihistamines and antiallergenic drugs. The patient had been treated with four kinds of antihistamines and antiallergenic drugs. The twelve-lead ECG exhibited a coved type ST-segment elevation in leads V(1) and V(2), and their enhancement was induced by pilsicainide. After discontinuing those drugs, the ST segment elevation in leads V1 and V2 became reduced. An ICD implantation was selected for the therapy since ventricular fibrillation was induced. Our report discusses the possible contribution of antihistamines and antiallergenic drugs to the Brugada type ST-segment changes.

DOI： 10.2169/internalmedicine.48.2067

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We describe a case of a 67-year-old woman with a history of cerebral infarction and pulmonary embolism that presented with chest pain. Subsequent evaluation resulted in a diagnosis of acute myocardial infarction and occult DVT, and imaging revealed a rare congenital absence of the infra-renal portion of the inferior vena cava, with lower extremity venous drainage diverted via an ascending lumbar vein. Associations between congenital absence of the inferior vena cava and thrombosis are discussed.

DOI： 10.1007/s11239-005-1380-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

PURPOSE. To examine the relation between intima - media thickness ( IMT) in the common carotid artery, which is generally recognized as a marker of early atherosclerosis, and retinal circulatory parameters.
METHODS. The vessel diameter and blood velocity of retinal arterioles were measured with laser Doppler velocimetry ( LDV) in 33 patients with coronary artery disease ( CAD), because they were thought to have general atherosclerosis. The retinal blood flow ( RBF) and wall shear rate ( WSR), an index of wall shear stress in retinal vessels, were calculated from the two parameters. The carotid IMT was evaluated with B- mode ultrasonography.
RESULTS. The patients were divided into two groups: those with an IMT &gt; 0.70 mm and those with an IMT less than or equal to 0.70 mm. The blood velocity, WSR, and upstroke time in the retinal arterioles were significantly higher in the group with an IMT &gt; 0.70 mm compared with the group with an IMT less than or equal to 0.70 mm. There were no significant differences in vessel diameter and RBF between the groups. Positive correlations were found between the carotid IMT and blood velocity ( r = 0.51, P = 0.002) and WSR ( r = 0.60, P = 0.0001). Multiple regression analysis showed that the retinal WSR and blood velocity correlated independently with the IMT in patients with CAD.
CONCLUSIONS. The present findings from this pilot study suggest that the retinal circulatory parameters measured by LDV may be associated with systemic atherosclerosis. These results support recent studies showing an association between retinal microvascular changes and cardiovascular disease.

DOI： 10.1167/iovs.04-0906

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

The effect of insulin resistance (IR) on the fatty acid metabolism of myocardium, and therefore on the recovery of left ventricular (LV) wall motion, has not been established in patients with acute myocardial infarction (AMI). A total of consecutive 58 non-diabetic AMI patients who had successfully undergone emergency coronary angioplasty were analyzed retrospectively. They were categorized into 2 groups, normal glucose tolerance (NGT) and impaired glucose tolerance (IGT), based on a 75-g oral glucose tolerance test (OGTT). The parameters of OGTT, myocardial scintigraphy (n=58) (thallium-201 (Tl) and iodine- 123-beta-methyl-iodophenylpentadecanoic acid (BMIPP)) and left ventriculography (n=24) were compared in the 2 groups after reperfusion (acute phase) and 3-4 weeks after the AMI (chronic phase). The insulin resistance (IR), estimated by the serum concentration of insulin at 120min (IRI 120') of the OGTT and by the HOMA (the homeostasis model assessment) index, was higher in the IGT group than in NGT group. An inverse correlation was found between the recovery of regional LV wall motion in the ischemic lesion and the IRI 120' and HOMA index. Although the recovery of BMIPP uptake from the acute to the chronic phase was higher in the IGT group, it was only correlated with the degree of IRI 120', not with the HOMA. IR accompanied by IGT can negatively influence the recovery of regional LV wall motion.

DOI： 10.1253/circj.67.757

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：FUTURA PUBL CO  

This case report describes a short-coupled variant of Torsades de Pointes with a characteristic ECG pattern consisting of a prominent J wave in leads V-3-V-6, in which an electrical storm was evoked with autonomic receptor stimulation and a blockade test. The patient's frequent VF attacks were triggered by short-coupled premature ventricular contractions with a right bundle branch block morphology and left-axis deviation, and were suppressed by deep sedation followed by a combination therapy using verapamil and mexiletine. Interestingly, with the use of those drugs, the prominent J wove diminished. The mechanism underlying this syndrome is discussed.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

We investigated the effects of an angiotensin-converting enzyme inhibitor (temocapril) and an angiotensin H type I receptor blocker (olmesartan) on changes in myocardial sympathetic nervous activity, fatty acid metabolism and myocardial blood flow using I-131-meta-iodobenzylguanidine, I-125-beta-methyl-iodophenyl pentadecanoic acid and Tc-99m-tetrofosmin, respectively, in rats with isoproterenol-induced cardiac hypertrophy. Male Sprague-Dawley rats underwent isoproterenol administration (3 mg/kg per day) for 1 week by osmotic mini-pump. The hearts were excised and analyzed for the uptake of meta-iodobenzylguanidine, beta-methyl-iodophenyl pentadecanoic acid and tetrofosmin in 11 segments in four groups; sham group (saline), isoproterenol group (isoproterenol alone), angiotensin-converting enzyme inhibitor group (isoproterenol and temocapril), and angiotensin II type 1 receptor blocker group (isoproterenol and olmesartan). Isoproterenol significantly increased the heart weight compared with the sham group, whereas it was significantly blunted in the angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor blocker groups. The ratio of the percent kilogram dose per gram of meta-iodobenzylguanidine to tetrofosmin, an index of myocardial sympathetic nervous activity, was significantly decreased in the isoproterenol group (0.18 +/- 0.01) compared with the sham group (0.41 +/- 0.03). Importantly, these changes were significantly improved in the angiotensin-converting enzyme inhibitor (0.28 +/- 0.01) and the angiotensin II type 1 receptor blocker groups (0.32 +/- 0.01). The ratio of the percent kilogram dose per gram of beta-methyl-iodophenyl pentadecanoic acid to tetrofosmin, an index of myocardial fatty acid metabolism, was significantly decreased in the isoproterenol group (1.30 +/- 0.03) compared with the sham group (1.60 +/- 0.10). In contrast, there were no significant differences in beta-methyl-iodophenyl pentadecanoic acid to tetrofosmin ratios between the sham and angiotensin-converting enzyme inhibitor groups, or the angiotensin II type 1 receptor blocker group. Cardiacby hypertrophy induced by chronic beta-adrenergic stimulation is accompanied by impairment of sympathetic nervous activity and fatty acid metabolism. These abnormalities are effectively prevented by the angiotensin-converting enzyme inhibitor and the angiotensin II type 1 receptor blocker.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Hypertension  

A sixty eight-year-old man was referred to our hospital for evaluation of hypertension and hypokalemia. His chief complaints were fatigability and weakness of the lower extremities. Atrophy of the right kidney was noted on computed tomography. The laboratory findings demonstrated massive proteinuria, markedly elevated plasma renin activity, hypokalemia, and renal insufficiency. Angiography showed total occlusion of the right renal artery. The patient was diagnosed as having nephrotic syndrome associated with renovascular hypertension. Treatment with candesartan, an angiotensin-II-receptor blocker (ARB), controlled both hypertension and proteinuria satisfactorily without worsening of his renal function. This is the first report on the effect of ARB on nephrotic syndrome associated with renovascular hypertension. Based on the results, ARB can be considered a promising agent for the treatment of patients with renovascular hypertension with massive proteinuria and renal insufficiency.

DOI： 10.1291/hypres.26.123

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Internal Medicine  

We describe a rare case of secondary amyloidosis associated with usual interstitial pneumonia (UIP), who died from spontaneous rupture of the amyloid spleen. A 68-year-old man was admitted to evaluate to his interstital lung disease. Chest radiography showed reticular shadow in bilateral lower lung fields. Two years later, he suddenly felt severe abdominal pain. In spite of maximum therapy, he died from hypovolemic shock. Postmortem examination revealed massive intraabdominal hemorrhage. The diagnosis of lung disease was UIP and amyloid A type deposits were observed in various organs including the ruptured spleen.

DOI： 10.2169/internalmedicine.40.428

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PubMed

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記述言語：日本語   著書種別：学術書

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記述言語：日本語   著書種別：学術書

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記述言語：日本語   著書種別：学術書

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記述言語：日本語   著書種別：学術書

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記述言語：日本語   著書種別：学術書

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記述言語：日本語   出版者・発行元：医歯薬出版  

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その他リンク： http://search.jamas.or.jp/link/ui/2017009481

担当区分：筆頭著者   記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）   出版者・発行元：日本臨牀  

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担当区分：筆頭著者   記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）   出版者・発行元：先端医学社  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCIENCE INC  

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記述言語：日本語   出版者・発行元：メディカルレビュー社  

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その他リンク： http://search.jamas.or.jp/link/ui/2015095675

担当区分：筆頭著者   記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）   出版者・発行元：先端医学社  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCIENCE INC  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

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記述言語：日本語  

雑誌掲載版高齢者では心不全症状が出現しにくく典型的ではないため、BNPやNT-proBNPといった客観的な生化学マーカーを用いた心不全管理が注目されている。簡便な心不全の早期診断・治療介入が可能となったが、再発予防に有用な使用法に関するエビデンスの構築が今後の課題である。また薬物治療に関しては、高齢者においてもACE阻害薬、ARB、β遮断薬などが有効で広く用いられているが、使用薬物とその用量については安全面に配慮した個別の対応が必要である。また、合併疾患や社会的・経済的背景まで考慮した包括的な疾患管理プログラムの導入が日本でも始まりつつあり、高齢者心不全の再発防止に期待されている。

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記述言語：日本語   出版者・発行元：日本臨床社  

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記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）   出版者・発行元：医学出版  

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記述言語：日本語   出版者・発行元：医学図書出版  

著者最終原稿版肺血栓塞栓症の予防ガイドラインに則し、リスクに応じた積極的な一次予防が行われているにも関わらず、不幸な転帰を招いた経験を踏まえ、新たに肺塞栓対策チームを立ち上げた。チーム構成は循環器内科、呼吸器内科、心臓血管外科、麻酔・蘇生科、放射線科、救急・集中治療部の6名。対象は何らかの軽微な予兆を認めた症例からショックによって発症した症例、また画像検査にて発見された症例を、診断・治療に関してのサポート、および緊急時の経皮的心肺補助の導入や下大静脈フィルター挿入を含めた対応を行うこととした。チーム発足後約1年間での対応症例数は14例。従来の専門診療科受診と比較し、1)診断・治療までの対応が短縮できたこと、2)専門的対応を内科系・外科系を含め統一できたこと、3)アクシデントが発生した場合の責任の所在が担当医師ではなく病院として対応できることがあげられ、有害事象の軽減に寄与するものと期待される。

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記述言語：日本語   出版者・発行元：Japan Heart Foundation  

症例は63歳, 男性. 高血圧, 高尿酸血症にて近医通院中だったが, 内服中のCa拮抗薬を数日間自己中断していた. 2009年3月上旬, 12時30分頃から前胸部痛が出現し近医を受診. 13時頃, 心電図を記録中に心肺停止状態となり, そばに付き添っていた元看護師の妻が心臓マッサージを開始, 救急隊到着時の意識状態はJCS III-300, 自発呼吸は認めず. 自動体外除細動器で心室細動と診断され, DC 360J×1回で心拍再開後, 前医に搬送された. 13時20分, 前医到着時の意識は清明, 自発呼吸も認められており, 心電図も近医で認められたST上昇は回復していた. 冠攣縮性狭心症, 致死性不整脈の疑いで当院に再搬送となった. 硝酸薬の点滴, Ca拮抗薬の再開で入院後は胸痛発作は認めず, 不整脈も出現しなかった. 内服継続下でのAch負荷試験, 心室頻拍誘発試験はいずれも陰性であり, 今回は植込み型除細動器の使用は見送った. 冠攣縮自然発作の心電図が記録されている稀な心室細動からの救命例であり報告する.

DOI： 10.11281/shinzo.42.807

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記述言語：日本語   出版者・発行元：診断と治療社  

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記述言語：日本語   出版者・発行元：診断と治療社  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

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記述言語：日本語  

DOI： 10.11281/shinzo.41.S3_119

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：南江堂  

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記述言語：日本語   出版者・発行元：南江堂  

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出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語  

雑誌掲載版

J-GLOBAL

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

通常のヘッドアップティルト試験は陰性で,アルコール摂取下のヘッドアップティルト試験時にのみ高度房室ブロックを呈し失神を生じた症例を経験したので報告する.症例は54歳,男性.2002年から3回飲酒後に失神発作を生じ,3度目の発作では下顎骨骨折をきたしたため近医に入院.入院後のホルター心電図上,夜間に最長4 .4秒のpauseを伴う3:1伝導の発作性房室ブロックを認めたため当科に紹介された.電気生理学的検査上,特記すべき異常はなく通常のヘッドアップティルト試験は陰性であったが,アルコール摂取下ヘッドアップティルト試験にて徐脈傾向に続く一過性III度房室ブロック(心拍数40bpm)を呈し失神した.アルコール誘発性失神のなかで,とくに起立性低血圧,神経調節性失神をきたす例においては,アルコール摂取による下肢の血管収縮不全が主要な機序である可能性が示唆されている.一方,一般に神経調節性失神における心抑制形式は,洞結節に対する作用(洞房ブロックや洞停止)が主たる形式で,房室伝導に抑制効果をおよぼすことは稀とされている.本症例のような,心拍数減少型のAHブロックによると推察される高度房室ブロックは,副交感神経活性を高める誘発法がほとんど存在しないため電気生理学的検査室での誘発は一般に難しいとされる.しかしアルコール+ヘッドアップティルト試験は失神の機序の一つである迷走神経依存型房室伝導障害を誘発し得る一検査手技として有用である可能性が示唆され,ここに報告する.

DOI： 10.11281/shinzo1969.38.9_951

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語  

雑誌掲載版高血圧は圧負荷により左室肥大・左室リモデリングから心不全を,また他の危険因子との相乗効果により冠動脈硬化を発症させ,心血管イベントのリスクを高める.長時間作用型Ca拮抗薬は降圧効果が的確で,冠拡張作用,抗酸化作用,抗動脈硬化作用を有する.一方,アンジオテンシンII受容体拮抗薬(ARB)はアンジオテンシン変換酵素(ACE)阻害薬とともに心肥大退縮,心室リモデリング抑制,新規糖尿病・心房細動発症抑制効果に優れている.最近のエビデンスから,心疾患合併高血圧に対してはまず病態に応じた降圧薬の併用による確実な降圧を優先し,次いでさらなる心血管保護を考慮することが勧められる

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記述言語：日本語  

雑誌掲載版

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   出版者・発行元：社団法人日本循環器学会  

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出版社版可及的全例にジピリダモール負荷心筋シンチグラフィー(DTS)を施行する方針とした1999年以降に下肢動脈バイパス手術を行った下肢閉塞性動脈硬化症(ASO)69例を対象とした.52例中20例(38%)がstress-induced ischemia陽性と判定し,うち11例に冠動脈有意狭窄病変を認めた.11例中8例は心電図,ホルダー心電図,及び心エコーで異常を認めない無症候性の冠動脈病変(CAD)であった.2例でPTCAを先行し,1例でCABGを先行して,二期的に下肢血行再建を施行した.残る1例はLADに90%狭窄を伴った重症虚血肢を有する症例であったため,LADへのoff-pump CABGと下肢血行再建を同時に施行した.DTSは無症候性のCADの検出に有用であった

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

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J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語  

DOI： 10.11389/jjrs1963.34.449

Scopus

PubMed

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語  

Scopus

PubMed

J-GLOBAL

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記述言語：日本語  

Scopus

PubMed

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開催年月日： 2014年10月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2014年7月

記述言語：日本語   会議種別：ポスター発表  

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開催年月日： 2014年3月

記述言語：日本語   会議種別：ポスター発表  

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開催年月日： 2013年10月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

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開催年月日： 2013年9月

記述言語：日本語   会議種別：ポスター発表  

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開催年月日： 2013年3月

記述言語：英語   会議種別：ポスター発表  

開催地：San Francisco  

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開催年月日： 2012年11月

記述言語：英語   会議種別：口頭発表（一般）  

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開催年月日： 2012年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2012年8月

記述言語：英語   会議種別：ポスター発表  

開催地：Munich  

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開催年月日： 2012年8月

記述言語：英語   会議種別：ポスター発表  

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開催年月日： 2011年9月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：神戸  

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開催年月日： 2010年8月

記述言語：日本語   会議種別：ポスター発表  

開催地：（仙台）  

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開催年月日： 2010年3月

記述言語：英語   会議種別：ポスター発表  

開催地：（京都）  

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開催年月日： 2009年6月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（指名）  

開催地：(札幌）  

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開催年月日： 2004年6月

記述言語：英語   会議種別：ポスター発表  

開催地：Nice  

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開催年月日： 2002年11月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Chicago  

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開催年月日： 2002年6月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：Plaque  

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プログラム委員、座長

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プログラム委員、座長

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講演

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講演

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【教員評価対象外項目：地方学会】

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【教員評価対象外項目：地方学会】

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【教員評価対象外項目：地方学会】

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【教員評価対象外項目：地方学会】

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【教員評価対象外項目：地方学会】

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【教員評価対象外項目：地方学会】

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【教員評価対象外項目：地方学会】

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