記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/CIRCIMAGING.122.014895

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記述言語：英語  

Pseudoxanthoma elasticum (PXE) is a rare hereditary disorder that causes elastic tissue degeneration in the skin, eyes, and cardiovascular system. Gastrointestinal bleeding and fundus hemorrhage are serious complications associated with PXE prognosis as well as cardiovascular involvement. This is a rare case of acute coronary syndrome in a PXE patient with high bleeding risk. Learning objective: Pseudoxanthoma elasticum (PXE) resulting in acute coronary syndrome (ACS) is rare. Given PXE patients are generally at very high bleeding risk, antithrombotic therapy as secondary prevention after ACS onset should be taken into full consideration.

DOI： 10.1016/j.jccase.2022.06.004

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記述言語：英語  

Pulmonary artery intimal sarcomas (PAIS) are often misdiagnosed as pulmonary embolisms (PE) as their clinical findings and imaging findings are similar. However, given the clinical outcome of both diseases is different in its prognosis, accurate and rapid diagnosis is mandatory. This is a case report of a histologically-proven PAIS which was initially treated as a PE. The color-coded iodine map using dual-energy computed tomography (dual-energy CT iodine map) well reflected the distribution of the tumor consistent with 18fluoro-2-deoxyglucose-uptake region using positron emission tomography/CT. This case demonstrates the potential of using dual-energy CT iodine map to differentiate PAIS from PE. Learning objective: Use of a dual-energy computed tomography iodine map to visualize a pulmonary artery intimal sarcoma may provide useful diagnostic information.

DOI： 10.1016/j.jccase.2022.03.011

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：英語  

In extracardiac Fontan, an epicardial pacemaker implantation has many limitations, especially given that it is highly invasive and a high-risk procedure due to repeat thoracotomy. Herein we illustrate a case with the possibility of transvenous pacing in extracardiac Fontan being less invasive and lower risk transvenous dual-chamber pacemaker implantation by electrophysiological assessment. <Learning objective: Transvenous pacemaker implantation via left superior vena cava may be a viable alternative to epicardial pacing with a minimally invasive procedure in patients with extracardiac Fontan.>.

DOI： 10.1016/j.jccase.2022.01.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-21-1001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-21-0946

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-22-0055

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We evaluated the feasibility of myocardial perfusion ratio to the aorta (MPR) in static computed tomography perfusion (CTP) for detecting myocardial perfusion abnormalities assessed by single-photon emission computed tomography (SPECT). Twenty-five patients with suspected coronary artery disease who underwent dynamic CTP and SPECT were retrospectively evaluated. CTP images scanned at a sub-optimal phase for detecting myocardial perfusion abnormalities were selected from dynamic CTP images and used as static CTP images in the present study. The diagnostic accuracy of MPR derived from static CTP was compared to those of visual assessment and conventional quantitative parameters such as myocardial CT attenuation (HU) and transmural perfusion ratio (TPR). The area under the curve of MPR (0.84; 95% confidence interval [CI], 0.76-0.90) was significantly higher than those of myocardial CT attenuation (0.73; 95% CI, 0.65-0.79) and TPR (0.76; 95% CI, 0.67-0.83) (p &lt; 0.05). Sensitivity and specificity were 67% (95% CI, 54-77%) and 90% (95% CI, 86-92%) for visual assessment, 51% (95% CI, 39-63%) and 86% (95% CI, 82-89%) for myocardial CT attenuation, 63% (95% CI, 51-74%) and 84% (95% CI, 80-88%) for TPR, and 78% (95% CI, 66-86%) and 84% (95% CI, 80-88%) for MPR, respectively. MPR showed higher diagnostic accuracy for detecting myocardial perfusion abnormality compared with myocardial CT attenuation and TPR.

DOI： 10.3390/jcm11071816

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The slow flow phenomenon is a critical complication during percutaneous coronary intervention (PCI) that leads to poor outcomes. We aimed to evaluate the mechanisms underlying the slow flow phenomenon using intravascular ultrasound (IVUS). We retrospectively analyzed IVUS data from 62 lesions in 58 consecutive patients who experienced the slow flow phenomenon during PCI. IVUS was performed immediately after the development of the slow flow phenomenon to assess its cause. No IVUS-based evidence of mechanical obstruction was categorized as distal embolization. Distal embolization was observed in 46 lesions (74%). The slow flow phenomenon occurred in all these lesions after stent implantation. In addition to distal embolization, three different mechanisms underlying the induction of the slow flow phenomenon due to mechanical obstructions (16 lesions, 26%) were detected on IVUS, namely, medial dissection/hematoma (6 lesions), intimal flap (6 lesions), and thrombus obstruction (4 lesions). Most mechanical obstructions (13 lesions, 81%) could not be identified by angiography alone. In 15/16 lesions (94%) with mechanical obstruction, deteriorated flow improved immediately after balloon dilatation or bail-out stent implantation, although intracoronary vasodilator administration could not reestablish coronary flow. The frequency of mechanical obstruction as the cause of the slow flow phenomenon was relatively high. Given the difficulty in angiographical differentiation, IVUS-guided management of slow flow may be a useful strategy.

DOI： 10.1097/MCA.0000000000001126

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記述言語：日本語   出版者・発行元：日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：日本成人先天性心疾患学会  

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記述言語：英語  

DOI： 10.1093/ehjcr/ytab439

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記述言語：英語  

DOI： 10.1093/ehjcr/ytab414

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-21-0366

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ehjci/jeab102

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Cardiac amyloidosis (CA) is an infiltrative myocardial disease that occasionally mimics hypertrophic cardiomyopathy (HCM). The aim of this study is to investigate the discriminatory ability of visual assessment of left atrial (LA) function between CA and HCM on echocardiography. METHODS AND RESULTS: In total, 93 patients with cardiac magnetic resonance imaging (CMR)-confirmed HCM and 34 with cardiac biopsy-confirmed CA were retrospectively assessed. LA dilatation was assessed via echocardiography in an apical four-chamber view. Visual assessment was performed to identify LA dilatation grade (preserved = 1, abnormal = 2, and restricted = 3) based on the extent of outward expansion in the LA reservoir phase. Regarding the reproducibility of visually assessing LA dilatation grade, the kappa values between intra- and inter-observer measurements were 0.82 and 0.70, respectively. Of 127 participants, 57 (45%), 42 (33%), and 28 (22%) presented with LA dilatation Grades 1, 2, and 3, respectively. All 57 patients with preserved LA dilatation (Grade 1) had HCM, and 20 of 28 patients (71%) with restricted LA dilatation (Grade 3) presented with CA. Patients with CA had a higher LA dilatation grade than those with HCM (P < 0.01). LA emptying fraction and reservoir strain were also quantitatively evaluated. The area under the curves of LA dilatation grade (0.88) and LA emptying fraction (0.88) for differentiation of these two diseases were higher than that of LA reservoir strain (0.73) (P < 0.01, respectively). During follow-up, nine patients with HCM and 16 with CA experienced cardiac event (cardiac death or hospitalization due to heart failure). In Kaplan-Meier analysis including both groups of HCM and CA, the incidence of cardiac events was higher in patients with restricted LA dilatation than in those with preserved or abnormal LA dilatation (log-rank test, P < 0.01). CONCLUSIONS: Restricted LA dilatation is an indicator for the diagnosis of CA. Further, visual assessment of abnormal LA motion may facilitate diagnosis in patients with CA and high-risk patients with HCM.

DOI： 10.1002/ehf2.13442

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記述言語：英語  

The management of systemic artery aneurysms secondary to Kawasaki disease (KD) in adults remains a therapeutic challenge. KD guidelines recommend the use of anticoagulation therapy with warfarin in addition to antiplatelet therapy when a giant coronary aneurysm or a history of thrombosis is documented. However, long-term use of warfarin presents several concerns. This case reports acute thrombotic occlusion due to the giant arterial aneurysm in an adult KD. A surgical resection of the aneurysm was performed because of recurrent thrombotic events, despite anticoagulant therapy with warfarin. Pathological examinations revealed a layered thrombus with inflammation in the aneurysm and Factor Xa expression mainly in newly formed thrombus. This study provides an insight into the anticoagulation therapy for cardiovascular sequelae after KD. <Learning objective: This study, along with pathological evidence, illustrates that Factor Xa might contribute to thrombotic events after Kawasaki disease.>.

DOI： 10.1016/j.jccase.2020.11.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Coronary plaques with low attenuation on computed tomography (CT) angiography may indicate vulnerable plaques. However, plaque CT attenuation is reported to be significantly affected by intracoronary attenuation. Recently, the diluted-contrast injection protocol was established to facilitate more uniform intracoronary attenuation than can be achieved with the generally used body-weight-adjusted protocol. We validated the relationship between low-attenuation plaque on CT and lipid-rich plaque using integrated backscatter-intravascular ultrasound (IB-IVUS) as the standard reference. Methods Plaques were divided into tertiles (T1, T2, and T3) according to the plaque CT attenuation, calculated as the average of five intra-plaque regions of interest, and compared with the plaque characteristics noted on IB-IVUS. Patients Patients who underwent both CT angiography using a diluted-contrast injection protocol and IB-IVUS were retrospectively analyzed. Results Thirty-nine plaques in 32 patients were analyzed by CT angiography and IB-IVUS. The median plaque CT attenuation (Hounsfield units) of each tertile was 30 (T1), 48 (T2), and 68 (T3). Although no significant difference was noted in conventional quantitative IVUS parameters (e.g. plaque burden), the T1 with lowest plaque CT attenuation had the highest percentage lipid area by IB-IVUS [75.1% (T1), 57.8% (T2), and 50.8% (T3), respectively, p<0.01]. Furthermore, the plaque CT attenuation had a significant negative correlation with the percentage lipid area (r=-0.59, p<0.01). Conclusion CT angiography-based plaque characterization using a diluted-contrast injection protocol may aid in the quantitative detection of lipid-rich plaque.

DOI： 10.2169/internalmedicine.6683-20

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記述言語：英語  

The Impella (Abiomed, Danvers, MA, USA) is a novel percutaneous heart pump device for left ventricular (LV) assistance; however, LV thrombus is a notable contraindication for this device. Contrast computed tomography assessment is useful for detecting LV thrombus and preventing thromboembolism in patients recommended for Impella use. <Learning objective: The Impella (Abiomed, Danvers, MA, USA) is a heart pump device which aspirates blood from a left ventricular (LV) cavity and ejects it into an ascending aorta. Therefore, LV thrombus should be explored before the Impella insertion to prevent systemic embolism. Generally, echocardiography is the first choice to detect LV thrombus. Given limited diagnostic sensitivity for detecting LV thrombus in echocardiography, contrast computed tomography might be a useful strategy for the patient targeting Impella insertion.>.

DOI： 10.1016/j.jccase.2020.07.016

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記述言語：英語  

DOI： 10.1161/CIRCIMAGING.120.010740

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jcin.2020.08.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Sarcoidosis is a systemic inflammatory disorder and can often affect any other organs beyond the heart. Whole-body 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is used to detect not only cardiac but also extra-cardiac involvement of sarcoidosis. However, the features and clinical impact of extra-cardiac lesions have not yet been fully elucidated. Therefore, this study aimed to clarify these using FDG-PET. Methods and results: We enrolled 120 consecutive patients with abnormal findings clinically suggesting cardiac sarcoidosis who underwent whole-body FDG-PET. In this study, a patient with suspected cardiac sarcoidosis was defined as one having both clinically suspected findings and FDG-PET positive cardiac uptake. Subsequently, a total of 36 patients with suspected cardiac sarcoidosis were found and analyzed. Extra-cardiac involvement was detected in 35 lesions of 14 patients (39% per patient). In particular, the extra-cardiac lesions were widely distributed throughout the body, and mediastinal/hilar lymph node involvement was most commonly observed. In most of the patients (93% per patient, 13/14), the extra-cardiac lesions were localized in the regions that were considered more accessible with less risk of complication compared with endomyocardial biopsy (EMB). Based on the FDG-PET findings, 8 patients underwent extra-cardiac biopsy without complication, and its diagnostic sensitivity for histological sarcoidosis was high (75%, 6/8). Moreover, FDG-PET-guided extra-cardiac biopsy could confirm histological sarcoidosis in 4 lesions that EMB failed to prove. Conclusions: Extra-cardiac involvement in patients with suspected cardiac sarcoidosis was relatively high. FDG-PET-guided extra-cardiac biopsy may be safe and useful for the imaging based diagnosis of cardiac sarcoidosis.

DOI： 10.1016/j.ijcha.2020.100587

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Traditional criteria for heart transplantation by cardiopulmonary exercise testing (CPX) include peak oxygen uptake (VO2 ) < 14 mL/kg/min. Reaching a sufficient exercise load is challenging for patients with refractory heart failure (HF) because of their exercise intolerance. Recently, a substantial impact of right ventricular (RV) dysfunction was highlighted on urgent heart transplantation and mortality. This study aims to investigate the impact of RV contractile reserve, assessed by low-load exercise stress echocardiography (ESE), on exercise intolerance defined as peak VO2  < 14 mL/kg/min, in patients with HF. METHODS AND RESULTS: We prospectively examined 67 consecutive patients hospitalized for HF who underwent ESE and CPX under a stabilized HF condition. Although low-load ESE was defined as 25 W load exercise, an increment in RV systolic (s') velocity was regarded as the preservation of RV contractile reserve. All patients completed low-load ESE. During low-load ESE, the variation in RV s' velocity significantly correlated with peak VO2 (r = 0.787, P < 0.001). The change in RV s' velocity during low-load ESE accurately identified patients with peak VO2  < 14 mL/kg/min (area under the curve, 0.95; sensitivity, 92%; specificity, 85%). The intraclass correlation coefficient for intra-observer and inter-observer agreement for the change in RV s' velocity was 0.96 (95% confidence interval, 0.88-0.99, P < 0.001) and 0.86 (95% confidence interval, 0.64-0.95, P < 0.001), respectively. The RV-to-pulmonary circulation (PC) coupling, which was assessed by the slope of the relationship between RV s' velocity and pulmonary artery systolic pressure at rest and low-load exercise, was worse in the low-peak VO2 group (<14 mL/kg/min) than the preserved-peak VO2 group (≥14 mL/kg/min). CONCLUSIONS: The change in RV s' velocity during low-load ESE could estimate the exercise capacity in HF patients. The assessments of RV contractile reserve and RV-to-PC coupling could be clinically beneficial to distinguish high-risk HF patients.

DOI： 10.1002/ehf2.12968

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circrep.CR-20-0064

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehz789

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記述言語：英語  

DOI： 10.1016/j.jcin.2019.10.001

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記述言語：英語  

DOI： 10.1016/j.jcmg.2018.12.015

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study evaluated the diagnostic capability of on-site coronary computed tomography-derived computational fractional flow reserve (CT-FFR) determinations for detecting coronary artery disease (CAD), as assessed by invasive fractional flow reserve (FFR).Methods and Results:Seventy-four patients with coronary artery calcium scores <1,500 who underwent coronary CT angiography (CTA) and invasive FFR measurements within 90 days were retrospectively reviewed. CT-FFR was computed using a prototype machine-learning (ML) algorithm in 91 vessels; 47 vessels of 42 patients were determined to have significant CAD (FFR ≤0.8). Correlation between CT-FFR and FFR was good (r=0.786, P<0.001). Per-vessel area under the curve was significantly larger for CT-FFR (0.907, 95% confidence interval: 0.828-0.958) than for CTA stenosis ≥50% (0.595, 0.487-0.697) or ≥70% (0.603, 0.495-0.705) (both P<0.001). Standard coronary CTA classifications recommended further functional tests in 57 patients with moderate or worse stenosis on CTA. CT-FFR analysis (mean analysis time: 16.4±7.5 min) corrected the standard coronary CTA classification in 18 of 74 patients and confirmed it in 45 of 74 patients. Thus, the per-patient diagnostic accuracy of the classifications was improved from 66% (54-77%) to 85% (75-92%). CONCLUSIONS: On-site CT-FFR based on a ML algorithm can provide good diagnostic performance for detecting hemodynamically significant CAD, suggesting the high value of coronary CTA for selected patients in clinical practice.

DOI： 10.1253/circj.CJ-19-0163

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1253/circj.CJ-18-0047

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes. PATIENTS AND METHODS: In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention. RESULTS: Overall, 552 patients with adequate LMCA imaging were compared according to LMCA plaque burden. The tertile with the highest plaque burden in the LMCA had the smallest LMCA minimum lumen area (17.4, 14.2, 10.5, lowest through highest tertiles, respectively, P<0.0001) and the greatest percent necrotic core volume (2.8, 5.6, 9.5%, lowest through highest tertiles, respectively, P<0.0001). Furthermore, the tertile with the highest plaque burden was also significantly associated with the highest overall non-LMCA percent atheroma volume within the major epicardial arteries (48.3, 49.2, 50.8%, lowest through highest tertiles, respectively, P<0.0001). After adjusting for patient background, the LMCA plaque burden was independently associated with non-LMCA percent atheroma volume (P=0.003). Of the three PROSPECT predictors of future nonculprit major adverse cardiac events (MACE) (minimum lumen area≤4 mm, plaque burden≥70%, and virtual histology thin-cap fibroatheroma), the tertile with the highest LMCA plaque burden had the highest number of patients with at least one of three PROSPECT predictors (P=0.03). In multivariable model, though total atheroma volume (per 1%) was an independent predictor of all MACE [hazard ratio (95% confidence interval)=1.06 (1.01-1.11), P=0.02] and strong trend for non-culprit-related MACE [hazard ratio (95% confidence interval)=1.06 (1.00-1.13), P=0.06], plaque burden at LMCA was not (all MACE, P=0.90, non-culprit-related MACE, P=0.85). CONCLUSION: The severity of atherosclerosis in LMCA predicted the overall atherosclerotic plaque burden as well as the presence of high-risk plaques in the three major epicardial coronary arteries.

DOI： 10.1097/MCA.0000000000000640

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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：BMJ PUBLISHING GROUP  

Objective Mountain districts normally have tougher geographic conditions than plain districts, which might worsen heart failure (HF) conditions in patients. Also, those places frequently are associated with social problems of ageing, underpopulation and fewer medical services, which might cause delay in detection of disease progression and require more admissions. We investigated the association of residence altitude with readmission in patients with HF.Methods We followed 452 patients with HF to determine all-cause readmissions over a median of 1.1 years. The altitude of patient residences, population, proportion of the elderly and number of hospitals or clinics in a minor administrative district (Cho-Aza district) located at the residences were examined using data from the 2010 census and Google Maps.Results All-cause readmissions were observed in 269 (60%) patients. The altitude of >= 200 m was significantly associated with readmissions (HR, 1.49; 95 % Cl 1.12 to 1.96; p=0.006) after adjustment for physical and haemodynamic parameters, left ventricular ejection fraction, brain natriuretic peptide and components of the established score for predicting readmission for HF. Altitude was significantly associated with ageing, underpopulation, fewer hospitals or clinics and lower temperature (all p<0.01), with an increased tendency for readmission during the winter season; however, it was not associated with patient clinical parameters.Conclusions High altitude residence may be an important predictor for readmission in patients with HF. This relationship may be confounded by unfavourable sociogeographic conditions at higher altitudes.

DOI： 10.1136/openhrt-2018-000865

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Lesions in the proximal left coronary artery (LCA) are associated with a poor prognosis compared with other lesional sites. Transthoracic Doppler echocardiography (TTDE) can help to detect proximal LCA flow, and an accelerated coronary flow velocity (CFV) indicates the presence of proximal LCA lesions. This study aimed to investigate the prognostic value of CFV in the proximal LCA measured by TTDE. Methods: We enrolled 1472 consecutive hemodynamically stable patients with known or suspected heart disease whose CFV was successfully detected using TTDE accompanied by routine echocardiography between 2008 and 2011. The primary outcome was cardiac death (acute myocardial infarction, heart failure, or sudden cardiac death) and patients were followed up over a median of 6.3 years. Results: Overall, 42 cardiac deaths (3%) were observed. An increased CFV was significantly associated with the outcome in several models based on potential confounders (age, rate pressure product, Framingham Risk Score, diabetes, coronary artery disease, hemoglobin, brain natriuretic peptide, estimated glomerular filtration rate, left ventricular mass, left ventricular ejection fraction, and E/e'). Using a receiver operating characteristic curve analysis, the optimal cut-off value for the CFV to the association of the outcome was 37 cm/s (area under the curve, 0.70; sensitivity, 82%; specificity, 62%). In sequential Cox proportional hazards models, the CFV added incremental prognostic information to the clinical and basic echocardiographic parameters (chi-squared: 110.7 to 146.6, P < 0.01). Conclusions: An increased CFV in the proximal LCA was associated with cardiac death, incremental to the clinical and basic echocardiographic parameters.

DOI： 10.1016/j.ijcha.2018.04.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Intravascular ultrasound (IVUS) is an intracoronary imaging method that provides information about lumen and vessel morphology. Previous studies on the expanded use of IVUS to identify functional ischemia have noted an association between anatomy and physiology, but IVUS-derived minimum lumen area (MLA) has a weak-moderate correlation with myocardial ischemia compared with FFR. We developed a method to calculate FFR using IVUS-derived anatomical information for the assessment of myocardial ischemia. The aims of this study were to investigate the relationship between wire-based FFR and IVUS-derived FFR (IVUS-FFR) and to compare the usefulness of IVUS-FFR and IVUS-derived MLA for functional assessment.Methods and Results:We retrospectively analyzed 50 lesions in 48 patients with coronary stenosis who underwent IVUS and FFR simultaneously. IVUS-FFR was calculated using our original algorithm and fluid dynamics. Mean percent diameter stenosis determined on quantitative coronary angiography and on FFR was 56.4±10.7 and 0.69±0.08, respectively. IVUS-FFR had a stronger linear correlation with FFR (R=0.78, P<0.001; root mean square error, 0.057 FFR units) than with IVUS-derived MLA (R=0.43, P=0.002). CONCLUSIONS: IVUS-FFR may be a more valuable method to identify myocardial ischemia, compared with IVUS-derived MLA.

DOI： 10.1253/circj.CJ-17-1042

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/CIRCINTERVENTIONS.116.004692

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

Objectives: Readmission is a common and serious problem associated with heart failure (HF).Unfortunately, conventional risk models have limited predictive value for predicting readmission. The recipients of long-term care insurance (LTCI) are frail and have mental and physical impairments. We hypothesised that adjustment of the conventional risk score with an LTCI certificate enables a more accurate appreciation of readmission for HF.Methods: We investigated 452 patients with HF who were followed up for 1 year to determine all-cause readmission. We obtained their clinical and socioeconomic data, including LTCI. The three clinical risk scores used in our evaluation were Keenan (2008), Krumholz (2000) and Charlson (1994). We used net reclassification improvement (NRI) to assess the incremental benefit.Results: Patients with LTCI were significantly older, and had a higher prevalence of cerebrovascular disease and dementia than those without LTCI. One-year all-cause readmission (n=193, 43%) was significantly associated with all risk scores, receiving LTCI and the category of LTCI. Receiving LTCI was associated with readmission independent of all risk scores (HR, 1.59 to 1.63; all p<0.01). Adding LTCI to all risk scores led to a significantly improved reclassification, which was observed in the subgroup of patients with HF with preserved ejection fraction (>= 50%) but not in the subgroup with reduced ejection fraction (<50%).Conclusions: Possession of an LTCI certificate was independently associated with 1-year all-cause readmission after adjusting for validated clinical risk scores in patients with HF. Adding LTCI status significantly improved the model performance for readmission risk, particularly in patients with HF and preserved ejection fraction.

DOI： 10.1136/openhrt-2016-000501

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Thin-cap fibroatheromas (TCFAs) are considered precursors for plaque rupture and subsequent acute coronary events. We investigated intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) characteristics of lesions that were histopathologic TCFAs. IVUS, NIRS, and histopathology were performed in 271 atherosclerotic lesions from 107 fresh coronary arteries from 54 patients at necropsy. The plaque burden and remodeling index calculated by IVUS and maximum lipid core burden index within any 4-mm segment (maxLCBI4mm) calculated by NIRS were compared among each plaque type based on histopathologic classifications but focusing on TCFA. Lesions classified as TCFAs had the largest plaque burden, the highest remodeling index, and the greatest maxLCBI4mm. Plaque burden ≥69% (90% sensitivity, 75% specificity, and area under the curve 0.87); remodeling index ≥1.07 (80% sensitivity, 79% specificity, and area under the curve 0.84); and maxLCBI4mm ≥323 (80% sensitivity, 85% specificity, and area under the curve 0.84) predicted a histopathologic TCFA. In conclusion, a large plaque burden and a high remodeling index assessed by IVUS and lipid-rich plaque determined by the NIRS maxLCBI4mm are useful predictive markers of TCFA.

DOI： 10.1016/j.amjcard.2016.10.031

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We investigated the independent and incremental role of worsening arterial stiffness in new-onset heart failure (HF) in patients with preclinical HF. We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. HF was observed in 30 patients (7%). The change in baPWV (∆baPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction and baPWV at baseline. Even in patients with an LV ejection fraction of ⩾40%, ∆baPWV was significantly associated with hospitalization for new-onset HF after similar adjustments. When the patients were divided into groups based on this cutoff value of ⩾15% ∆baPWV and the generally accepted external cutoff value of ⩾1750 cm s-1 for baseline baPWV, the Kaplan-Meier estimates of the time of hospitalization for new-onset HF showed that a higher rate of HF was associated with higher baPWV at baseline and higher ∆baPWV (P=0.00005). In asymptomatic patients with cardiovascular risk factors, the deterioration in arterial stiffness was associated with hospitalization for new-onset HF, independent of and incremental with the clinical LV function and increased stiffness parameters at baseline.

DOI： 10.1038/hr.2016.116

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective The underlying mechanisms of stent thrombosis are not completely understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS). Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases. Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis.

DOI： 10.2169/internalmedicine.56.7093

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The clinical significance of atrial high-rate episodes (AHREs) detected by cardiac devices among patients with implantable pacemakers has recently emerged. However, the relationship between AHREs and ischaemic stroke and systemic embolism (SE) is not well understood in the Japanese population. Methods: This study included 343 patients with pacemakers capable of continuous atrial rhythm monitoring (167 males; mean age, 80±7 years). Atrial tachyarrhythmia detection was programmed to the nominal setting of each device, and AHRE was defined as any episode of sustained atrial tachyarrhythmia lasting for more than 6 min. Thromboembolic risk was defined based on the CHADS2 score. Results: During the follow-up period (52±30 months), 165 (48%) patients had at least one episode of AHREs, and 19 (6%) patients experienced stroke/SE. Among patients who experienced stroke/SE, 14 had AHREs before the stroke/SE. AHREs were significantly associated with stroke/SE (HR 2.87; 95% CI 1.10 to 8.90; p=0.03). Subgroup analysis conducted to investigate the impact of the CHADS2 score severity on stroke/SE revealed that AHREs were not associated with stroke/SE in patients with low or intermediate thromboembolic risk (CHADS2 score 0-2; n=217). In contrast, among patients with high thromboembolic risk (CHADS2 score>2; n=126), there was a significant association between AHREs and the incidence of stroke/SE (HR 3.73; 95% CI 1.06 to 13.1; p=0.04). Conclusion: AHREs detected by pacemaker were associated with ischaemic stroke/SE in the Japanese population. However, this association was observed only in the high thromboembolic risk group.

DOI： 10.1136/heartasia-2017-010954

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jcin.2016.05.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study evaluated the relationship between platelet reactivity and plaque morphology using grayscale and radiofrequency intravascular ultrasound (IVUS) virtual histology (VH). BACKGROUND: Recent studies have reported that high on-treatment platelet reactivity (HPR) is associated with higher plaque volume and the presence of multivessel disease; however, the association between HPR and plaque morphology has not been evaluated. METHODS: The ADAPT-DES (Dual AntiPlatelet Therapy With Drug Eluting Stents) intravascular ultrasound substudy was a prospective, multicenter, observational study of 8,582 patients undergoing percutaneous coronary intervention with drug-eluting stents in whom platelet reactivity on clopidogrel was assessed routinely. The current analysis included 909 culprit lesions from 773 patients with pre-intervention grayscale IVUS and IVUS-VH. HPR was defined as platelet reactivity >208 P2Y12 reaction unit in point-of-care P2Y12 testing by the VerifyNow assay, measured during steady-state platelet inhibition in patients receiving an antiplatelet agent. RESULTS: HPR was associated with 3-vessel coronary artery disease (31.0% vs. 24.4%; p = 0.04). The incidence of fibroatheroma was higher in patients with HPR than those without HPR (77.1% vs. 68.9%; p = 0.01). The HPR group had larger percent plaque and media volume (plaque and media/external elastic membrane volume: 58.1% [95% confidence interval (CI): 57.1% to 59.0%] vs. 56.6% [95% CI: 55.8% to 57.5%]; p = 0.03) and plaque burden at the minimum lumen site (76.7% [95% CI: 75.7% to 77.8%] vs. 75.0% [95% CI: 74.0% to 76.0%]; p = 0.02). Despite a similar prevalence of attenuated plaque, patients with HPR had longer culprit lesion attenuated plaque length (8.0 [95% CI: 7.0 to 9.1] mm vs. 6.5 [95% CI: 5.9 to 7.1] mm; p = 0.01). On multivariate analysis, the presence of angiographic calcium (odds ratio [OR]: 1.85: 95% CI: 1.33 to 2.56; p = 0.0002) and HPR (OR: 1.45; 95% CI: 1.05 to 2.01; p = 0.02) were independent predictors for a culprit lesion fibroatheroma. CONCLUSIONS: HPR was associated with increased culprit lesion atherosclerotic burden and adverse plaque morphology among patients undergoing percutaneous coronary intervention. Platelet reactivity might be associated with not only blood clot formation, but also severity of atherosclerosis. (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents [ADAPT-DES]; NCT00638794).

DOI： 10.1016/j.jcmg.2015.08.019

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記述言語：英語  

DOI： 10.1016/j.jcmg.2015.02.019

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehv659

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non-ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n = 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p <0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6 mm(2) [interquartile range, 4.3 to 6.5] vs 2.4 mm(2) [1.8 to 2.9]; p <0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST.

DOI： 10.1016/j.amjcard.2015.12.026

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記述言語：英語   出版者・発行元：JAPAN SOC INTERNAL MEDICINE  

DOI： 10.2169/internalmedicine.55.6484

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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 SCI LTD  

Background: Postoperative delirium is a common and serious condition in the clinical setting that has been linked to increased mortality and worse outcomes. Some patients after pacemaker operations may suffer from delirium; however, this condition has not been clarified. The aim of this study was to investigate the prevalence and predictors of delirium after pacemaker operations such as initial permanent pacemaker implantation or pacemaker generator replacement.Methods: We retrospectively evaluated 192 consecutive patients who underwent pacemaker operations. According to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, patients were divided into two groups: patients with delirium and patients without delirium after pacemaker operation. The two groups were compared in terms of patient characteristics, clinical settings, and environmental factors.Results: Forty patients (20.8%) suffered from delirium after pacemaker operations and were significantly older than patients without delirium(85.3 +/- 6.4 years vs. 80.8 +/- 8.4 years, p=0.0014). Temporary pacing before permanent pacemaker implantation (30% vs. 11%, p=0.0019) and intensive care unit admission (28% vs. 12%, p=0.014) were more common in patients with delirium. Moreover, patients with delirium had more frequent heart failure than patients without delirium(78% vs. 41%, p < 0.0001). Multiple regression models showed heart failure as an independent predictor of delirium after pacemaker implantation.Conclusions: Delirium after pacemaker operations was not uncommon and heart failure was a strong independent predictor of such a condition. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.

DOI： 10.1016/j.ijcme.2015.07.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehu497

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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）  

OBJECTIVES: We report the prevalence and anatomical features of longitudinal stent deformation as detected by intravascular ultrasound (IVUS) BACKGROUND: Angiographic studies have recently reported longitudinal stent deformation as a mechanical complication occurring during percutaneous coronary intervention; however, there are no IVUS studies on this phenomenon METHODS: We retrospectively analyzed 1,489 consecutive stent-treated lesions in 1,057 patients who underwent IVUS post-stent implantation RESULTS: Seventeen longitudinal stent deformations in 17 lesions (1.1% per lesion) in 17 patients (1.6% per patient) were identified by IVUS. Of the 17 IVUS-detected deformations, only three deformations (17.6%) were detectable by angiography. By IVUS, there were three patterns of longitudinal stent deformation: (1) Deformation with intra-stent wrinkling and overlapping of the proximal and distal stent fragments within a single stent (n = 14), (2) deformation with elongation (n = 2), and (3) deformation with shortening (n = 1). Most of the deformations were located near to the proximal stent edge (88%), consistent with the finding that they were observed in 11 ostial (65%) and eight left main lesions (47%), and 8.3% of 96 left main stented lesions had evidence of deformation CONCLUSIONS: By IVUS, longitudinal stent deformation during percutaneous coronary intervention was seen more frequently than in previous studies; however, it is still uncommon (1.1%) except in the left main location. The most frequent pattern was intrastent wrinkling and overlapping of the proximal and distal stent fragments.

DOI： 10.1002/ccd.25411

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Mechanical complications contribute to bare metal and first-generation drug-eluting stent (DES) failure. However, the importance of the mechanical complications of second-generation DES remains unclear. We report mechanical complications associated with everolimus-eluting stent (EES) failures. METHODS AND RESULTS: We retrospectively analysed 177 consecutive EES-treated lesions in 136 patients who underwent intravascular ultrasound (IVUS) at follow-up. Mechanical complications were identified in 17 patients (five stable angina, 10 unstable angina, two non-ST-elevation myocardial infarction [NSTEMI] without angiographic thrombus). Fifteen (88.2%) were treated with repeat revascularisation. By IVUS, there were 16 focal (94.1%) and one diffuse (5.9%) in-stent restenoses. Complete stent fracture with separation was seen in only one, partial stent fracture with separation was seen in three, and in 13 there was longitudinal deformation (n=2) or stent strut fracture (n=11) with overlapping of the proximal and distal stent fragments. In 13 EES with evidence of overlapping in the setting of either fracture or deformation, there was a 35.5±12.2% smaller stent area compared to the adjacent proximal and distal stent fragments, and >50% neointimal hyperplasia in 12 (92.3%). CONCLUSIONS: We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.

DOI： 10.4244/EIJV9I11A220

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jcin.2013.06.020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Glagov proposed that remodeling delayed development of significant coronary artery stenoses until plaque occupied, on average, 40% of arterial area (40% plaque burden). The aim of the current study was to confirm the previously proposed concept of coronary remodeling as first described by Glagov who studied postmortem left main coronary arteries (LMCAs). METHODS: Using the in-vivo intravascular ultrasound data from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, we evaluated 552 LMCAs in 552 patients. RESULTS: External elastic membrane cross-sectional areas (CSAs) increased in proportion to the increase in plaque and media CSAs (r=0.61, P<0.0001), especially when the plaque burden was 20% or lower (r=0.88, P<0.0001). For more advanced atherosclerosis (>40% plaque burden), there was an inverse relationship between lumen CSA and plaque burden (r=-0.57, P<0.0001), whereas this relationship was weak in the presence of less than 40% plaque burden. The frequency of virtual histology derived thin-cap fibroatheroma increased with increasing plaque burden. In contrast, the frequency of pathological intimal thickening decreased. CONCLUSION: The previously proposed remodeling concept of Glagov was validated in vivo in the PROSPECT study patients. In addition, the present study suggested that plaque phenotype worsened with increasing LMCA plaque growth.

DOI： 10.1097/MCA.0000000000000074

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study investigated coronary artery remodeling patterns associated with clinical outcomes. BACKGROUND: In the prospective, multicenter PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree: An Imaging Study in Patients With Unstable Atherosclerotic Lesions) study, reported predictors of nonculprit lesion (NCL) major adverse cardiac events (MACE) were an intravascular ultrasound (IVUS) minimal lumen area (MLA) ≤4 mm(2), a plaque burden ≥70%, and a IVUS-virtual histology (VH) thin-cap fibroatheroma (TCFA), but not lesion site remodeling. METHODS: Overall, 697 consecutive patients with an acute coronary syndrome were enrolled and underwent 3-vessel gray-scale and IVUS-VH; 3,223 NCLs were identified by IVUS. The remodeling index (RI) was calculated as the external elastic membrane area at the MLA site divided by the average of the proximal and distal reference external elastic membrane areas. First, one third of the patients were randomly selected to determine RI cutoffs related to NCL MACE (development cohort). Receiver-operating characteristic analysis showed that there were 2 separate cut points that predicted NCL MACE: RI = 0.8789 and RI = 1.0046 (area under the curve = 0.663). These cut points were used to define negative remodeling as an RI <0.88, intermediate remodeling as an RI of 0.88 to 1.00, and positive remodeling as an RI >1.00. Second, we used the remaining two-thirds of patients to validate these cut points with respect to lesion morphology and clinical outcomes (validation cohort). RESULTS: Kaplan-Meier curve analysis in the validation cohort showed that NCL MACE occurred more frequent (and equally) in negative and positive remodeling lesions compared with intermediate remodeling lesions. In this cohort, negative remodeling lesions had the smallest MLA, positive remodeling lesions had the largest plaque burden, and VH TCFA, especially VH TCFA with multiple necrotic cores, was most common in negatively remodeling lesions. CONCLUSIONS: The present study showed the novel concept that positive and negative lesion site remodeling was associated with unanticipated NCL MACE in the PROSPECT study. ( PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions [PROSPECT]; NCT00180466).

DOI： 10.1016/j.jcmg.2013.10.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Previous studies have suggested that angiographically detected persistent contrast staining (PSS) at follow-up may predict subsequent very late stent thrombosis. The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial was a dual-arm, factorial, randomized trial in patients with ST-segment elevation myocardial infarctions. All follow-up angiograms (1,330 lesions in 1,115 patients, median time 13.3 months) without major cardiovascular events before follow-up angiography were analyzed at a core laboratory blinded to clinical events for the presence of PSS (defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter). Corresponding follow-up intravascular ultrasound (IVUS) data (275 lesions in 248 patients) were also evaluated to assess the mechanisms of PSS. PSS was present in 23 patients (2.1%) at follow-up and was not more common with paclitaxel-eluting than with bare-metal stents. All 6 PSS patients with follow-up IVUS had stent malapposition (vs 41.2% malapposition in the follow-up IVUS cohort). Comparing poststent and follow-up IVUS, 2 patients had late acquired and 4 had persistent malapposition; all 6 showed positive vessel remodeling from baseline to follow-up (mean vessel area 22.0 ± 8.0 to 32.4 ± 11.7 mm(2), p = 0.07). During 3-year follow-up, stent thrombosis developed in no patient with PSS compared with 8 PSS-negative patients (0% vs 0.8%, p = 0.68). The rates of revascularization and major adverse cardiovascular events were also not increased in PSS patients. In conclusion, in the large-scale HORIZONS-AMI trial, PSS at angiographic follow-up was infrequent and was associated with late stent malapposition and positive remodeling but was independent of stent type. Identification of PSS was not associated with subsequent stent thrombosis.

DOI： 10.1016/j.amjcard.2013.01.329

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Several studies have demonstrated that type 2 diabetes mellitus (T2DM) is associated with accelerated atherosclerosis, which results in an increased risk of coronary vascular events. However, serial changes in plaque characteristics have not been reported in vivo. We evaluated the progression of coronary atherosclerosis in patients with T2DM using an integrated backscatter intravascular ultrasound (IB-IVUS) examination. METHODS AND RESULTS: Forty-two T2DM and 48 non-diabetic patients who underwent percutaneous coronary intervention were enrolled in the study. Non-culprit 20-mm length coronary lesions with mild-to-moderate stenosis were measured using a 40-MHz (motorized pullback of 0.5 mm/s) IVUS catheter. IVUS examinations were performed on one target lesion in each patient. Six months later, a follow-up IVUS examination was repeated in the same coronary segment imaged at the baseline examination. T2DM patients demonstrated a greater total plaque volume (TPV; 139 ± 53 vs. 114 ± 45 mm(3), P = 0.02) and total lipid volume (TLV; 67 ± 26 vs. 55 ± 30 mm(3), P = 0.039) at the baseline examination. The progression of TPV (8.6 ± 15.4 vs. -2.2 ± 16.0%, P < 0.01) and TLV (10.8 ± 28.8 vs. -2.5 ± 20.0%, P < 0.05) from the baseline was observed in T2DM patients, but not in non-diabetic patients. The increase in TLV was blunted in T2DM patients who achieved HbA1c levels of <6.5%. CONCLUSION: Accelerated plaque progression with an increase in the lipid-rich component of non-culprit plaques was observed in T2DM, despite the use of standard medical treatment. Better glycaemic control ameliorated the worsening of plaque characteristics in T2DM.

DOI： 10.1093/ehjci/jes033

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (MRI) in hypertrophic cardiomyopathy (HCM) has been reported to be associated with myocardial fibrosis and cardiac events. In patients with HCM, two-dimensional (2D) strain can identify subclinical global systolic dysfunction despite normal left ventricular (LV) chamber function. Therefore, this study tested the hypothesis that global 2D strain could detect subtle myocardial fibrosis and serve as a novel prognostic parameter in HCM patients. METHODS AND RESULTS: Echocardiography and MRI were performed in 48 consecutive patients with HCM and normal chamber function. We measured global longitudinal strain (GLS) in apical two-chamber, four-chamber, and long-axis views using speckle-tracking analysis. The extent of LGE (%LGE = LGE volume/total LV volume) and LV mass index were calculated by MRI using Simpson's rule and custom software. All patients were followed up for major cardiac events. Global longitudinal strain in patients with LGE was significantly lower than that without LGE (-11.8 ± 2.8 vs. -15.0 ± 1.7%, P < 0.001). Multivariate analysis showed that GLS was an independent predictor of %LGE (standard coefficient = 0.627, P < 0.001). During a mean follow-up period of 42 ± 12 months, five patients had cardiac events. When the patients were stratified based on the median level of GLS (-12.9%), all events were observed in the worse GLS group (P = 0.018). CONCLUSION: These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function.

DOI： 10.1093/ejechocard/jer318

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ejechocard/jer310

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Two-dimensional speckle tracking echocardiography (2D-STE) is a novel technology that directly measures regional left ventricular (LV) wall contraction. This study aimed to directly measure inner-layer thickening (radial strain) of the LV using 2D-STE, and to examine the relationship between radial strain and the degree of hypertrophy. METHODS: The study enrolled 63 untreated hypertensive patients with normal geometry (N group, n=32) or concentric hypertrophy (CH group, n=31), classified according to LV mass index (LVMI) and relative wall thickness (RWT). Thirty normotensive subjects (C group, n=30) served as controls. Radial strain (ɛ) in the inner half (ɛi) and all layers of the LV wall (ɛa) were calculated from the LV short-axis view by 2D-STE. RESULTS: LV ejection fraction did not differ significantly among the groups. However, ɛi and ɛa were significantly lower in the CH group compared with the C and N groups (p<0.01). A ratio of ɛi to ɛa was significantly lower in the CH group compared with the C and N groups (p<0.01). A multivariate regression model that included midwall fractional shortening, E/e', LVMI, RWT, and LV ejection fraction showed that LVMI (p=0.002) and RWT (p=0.014) were independent predictors (R(2)=0.59) of ɛi. CONCLUSION: Radial strain in the inner half layer of the LV wall decreases in parallel with the degrees of LV concentricity and hypertrophy in hypertensive patients. Radial strain in the inner half layer may identify subtle systolic dysfunction even in hypertensive patients with preserved LV chamber function.

DOI： 10.1016/j.jjcc.2011.08.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Activity of renin substrate cleavage (renin-like activity) was measured in vitro in plasma samples obtained from healthy human volunteers. METHODS: Renin-like activity was determined using FRET (Fluorescence Resonance Energy Transfer) human renin substrate. Recombinant human renin and human plasma showed dose-dependent cleavage activity of FRET human renin substrate. RESULTS: Activity of recombinant human renin was completely inhibited by either a peptidergic or a non-peptidergic renin inhibitor. However, renin-like activity in human plasma was not inhibited by these renin inhibitors. In a mixture of recombinant renin and human plasma, renin inhibitors inhibited only that part of the activity caused by recombinant renin, while the activity in plasma still remained. Human plasma did not show cleavage activity of rat FRET renin substrate. Native human prorenin showed cleavage activity of human renin substrate. This activety was also completely inhibited by renin inhibitors. Immunoprecipitation with anti-renin or anti-prorenin antibodies did not reduce the activity in human plasma. Renin-like activity in human plasma was abolished by degeneration of protein when sample was heated to 95 degrees C. Activity of both recombinant renin and human plasma was significantly inhibited by a protease inhibitor cocktail. CONCLUSIONS: These results suggest that the activity of renin substrate cleavage in human plasma is not mainly caused by the renin or prorenin molecule, but probably by other proteases.

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記述言語：英語  

DOI： 10.1016/j.ijcard.2010.10.100

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Angiotensin-converting enzyme 2 (ACE2) generates angiotensin-(1-7) [Ang-(1-7)], a peptide highlighted as exerting a pivotal role in cardiovascular remodeling. Moreover, the ACE2/Ang-(1-7)/Mas axis directly activates endothelial nitric oxide (NO) synthase and NO generation in the heart. However, the role of ACE2 in cardiovascular remodeling induced by persistent inhibition of NO under chronic activation of the renin-angiotensin system (RAS) remains poorly understood. METHODS AND RESULTS: Chimeric hypertensive mice that exhibit activation of the human RAS were produced by mating human renin (hRN) and human angiotensinogen (hANG) transgenic mice. Persistent NO inhibition with NG-nitro-L-arginine methyl ester (L-NAME) was started at 8 weeks of age for 4 weeks. After administration of L-NAME, blood pressure (BP) markedly increased in the chimeric mice (hRN/hANG-Tg), whereas wild-type mice (C57BL/6J) showed little increase in BP. Cardiovascular remodeling with enhanced oxidative stress in hRN/hANG-Tg was markedly accelerated by NO inhibition compared with that in wild-type mice. Moreover, ACE2 mRNA expression and activity in cardiac tissue were markedly reduced in L-NAME-treated hRN/hANG-Tg. Co-administration of an angiotensin II type 1 (AT1) receptor blocker (ARB), olmesartan, inhibited L-NAME-induced cardiovascular remodeling and improved the reduction in cardiac ACE2. The preventive effect of olmesartan on cardiac hypertrophy was blunted by co-administration of a selective Ang-(1-7) antagonist, [D-Ala7]-Ang-(1-7). CONCLUSION: Our findings demonstrate that cardiovascular remodeling induced by persistent NO inhibition was enhanced in hRN/hANG-Tg. An ARB, olmesartan, blunted cardiac remodeling induced by NO inhibition with RAS activation partially through the ACE2/Ang-(1-7)/Mas axis in addition to directly through its classical ACE/Ang II/AT1 receptor axis-blocking action.

DOI： 10.1097/HJH.0b013e32834bbb4d

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

Slow/no-reflow phenomenon during emergent percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI) results in a poor prognosis. A high thrombus burden was an independent predictor of angiographic slow/no-reflow phenomenon. We experienced a case of a STEMI patient with massive intracoronary thrombus. In our case, a massive red thrombus was aspirated easily by adjunctive pulse infusion thrombolysis (PIT) after failed aspiration. Adjunctive pulse infusion thrombolysis after failed aspiration might be a useful strategy to prevent the slow/no-reflow phenomenon in STEMI patients with massive intracoronary thrombus.

DOI： 10.1016/j.cjca.2011.07.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to investigate the significance of the MOSAIC (measurement of stenosis by aliasing coronary flow) method for the detection of proximal left coronary stenosis in patients with unstable angina (UA) using transthoracic Doppler echocardiography (TTDE). METHODS: Patients (n=107) with UA were evaluated. Proximal left coronary flow was sought in the short axis (SAX) at the aortic root level using color Doppler guidance. When detected coronary flow showed color aliasing, the color velocity range was gradually increased until color aliasing nearly disappeared. Then, the color baseline was shifted until the color flow showed "isovelocity". RESULTS: Proximal coronary flow was detected in 86 (80.4%) of 107 patients. In these 86 patients, an optimal cutoff value of isovelocity ≥ 47.5 cm/s predicted significant coronary stenosis (percent diameter stenosis ≥ 70%) of the proximal left anterior descending (AHA segment 6) or left main coronary artery with a sensitivity of 88%, specificity of 97%, positive predictive value of 98%, and negative predictive value of 86%. In all 107 patients, the same cutoff value predicted significant coronary stenosis with a sensitivity of 78%, specificity of 98%, positive predictive value of 98%, and negative predictive value of 81%. CONCLUSIONS: The MOSAIC method may play a complementary role in expeditious risk stratification and decision making in patients with UA.

DOI： 10.1016/j.ijcard.2010.05.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

'Coronary steal' is frequently observed in the recipient artery supplied from collaterals. Coronary steal during stress may have an adverse effect on myocardial function even in a 'well-collateralized' territory. We experienced one case with functional occlusion in which the coronary steal phenomenon was demonstrated non-invasively using transthoracic Doppler echocardiography. The non-invasive assessment of coronary flow measurement might allow us to obtain useful information for understanding the pathophysiology of coronary steal.

DOI： 10.1093/ejechocard/jer100

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to investigate the differences in left ventricular (LV) twisting behavior between patients with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD). METHODS: Forty-four patients with HCM (mean age, 63±15 years), 35 patients with HHD (mean age, 63±13 years) and 20 age and sex-matched control subjects were evaluated. After a standard echocardiographic examination, LV twist and twisting velocity profiles from apical and basal short-axis images were analyzed using two-dimensional speckle tracking imaging. RESULTS: LV diastolic and systolic dimensions, and ejection fraction were not significantly different among the groups. LV mass index and early diastolic mitral annular velocity were not significantly different between the HCM and HHD groups. The peak torsion in the HCM and HHD groups was significantly greater than that in the control group. The peak untwisting velocity in the HCM group was comparable with that in the control group. However, when the peak untwisting velocity was corrected by peak torsion, this ratio was significantly decreased in the HCM group compared with the values in the HHD and control groups. The time to peak untwisting velocity in the HCM group was significantly longer than the values in the HHD and control groups. CONCLUSIONS: These results suggest that enhanced peak torsion in HCM may improve untwisting behavior, but this mechanism fails to fully compensate for impaired untwisting behavior compared with HHD.

DOI： 10.1016/j.ijcard.2010.04.040

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The present study examined the inhibitory action of temporary treatment with an angiotensin type 1 (AT(1)) receptor blocker (ARB) on vascular remodeling using hypertensive mice with overexpression of the human renin (hRN) and angiotensinogen (hANG) genes. METHODS: hRN/hANG transgenic mice (hRN/hANG-Tg) were treated with an ARB, valsartan, from 4 weeks of age. In some mice, valsartan treatment was stopped at 8 weeks of age (temporary treatment). Inflammatory vascular injury was induced by polyethylene-cuff placement around the femoral artery at the age of 10 weeks. RESULTS: Compared with wild-type (WT) mice, hRN/hANG-Tg showed higher blood pressure (BP) and enhancement of oxidative stress and medial thickening even before cuff placement. Inflammatory vascular remodeling and oxidative stress after cuff placement were further enhanced in hRN/hANG-Tg. Temporary treatment with valsartan continuously lowered BP even after cessation of administration, and inhibited these changes. In contrast, administration of hydralazine lowered BP to a similar level to that with valsartan, but did not inhibit medial thickening and inflammatory vascular remodeling. In contrast to the valsartan treatment, BP immediately increased to the untreated level after cessation of hydralazine. CONCLUSIONS: These results indicate that temporary ARB treatment leads to prolonged effect of BP lowering and prevents vascular remodeling in hypertensive mice induced by activation of the human renin-angiotensin system. The inhibitory action of valsartan is not due to the BP lowering but is at least in part due to a decrease in oxidative stress and inflammation.

DOI： 10.1038/ajh.2011.6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Myocardial bridging (MB) is a congenital anomaly characterized by systolic compression of the tunnelled arterial segment. MB may cause myocardial ischaemia due to abnormal coronary blood flow. We report a case of MB in which transthoracic Doppler echocardiography was used to evaluate the long-term effect of beta-blocker therapy on abnormal coronary blood flow. In this case, beta-blocker therapy with bisoprolol (5.0 mg/day) for 1 month eliminated the patient's symptoms and normalized coronary blood flow through the tunnelled arterial segment.

DOI： 10.1093/ejechocard/jeq159

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To explore the metabolic actions of nifedipine on diabetes, we examined glucose intolerance and white adipose tissue changes in type 2 diabetic KK-A(y) mice. METHODS: Male KK-A(y) mice were treated with nifedipine (1.5 mg/kg/day in lab chow) for 5 weeks, which did not affect blood pressure or feeding of KK-A(y) mice. RESULTS: After treatment with nifedipine, body weight tended to decrease and the weight of white adipose tissue was reduced. Without food restriction, nifedipine decreased plasma insulin level, while plasma glucose level tended to decrease. In oral glucose tolerance test, nifedipine suppressed the increase in glucose level after a glucose load without affecting plasma insulin concentration. Nifedipine also improved the result of insulin tolerance test. In white adipose tissue, nifedipine increased adipocyte number and the expression of peroxisome proliferator-activated receptor-γ (PPARγ) and adipocyte fatty acid-binding protein related to adipocyte differentiation. In addition, expression of adiponectin, insulin receptor, insulin receptor substrate-1, and glucose transporter type-4 was also increased by nifedipine. Nifedipine also increased the expression of NO synthase in white adipose tissue. Nifedipine did not affect expression of angiotensin II type 1 (AT₁) and type 2 (AT₂) receptors in white adipose tissue. Such changes in white adipose tissue were apparent in retroperitoneal adipose tissue. Nifedipine did not change the expression of angiotensin receptors, renin receptor, and angiotensinogen in white adipose tissue. Moreover, nifedipine attenuated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity and increased superoxide dismutase (SOD) activity in white adipose tissue. CONCLUSION: These results suggest that nifedipine can enhance insulin sensitivity and reduce white adipose tissue, possibly related to stimulation of adipocyte differentiation.

DOI： 10.1038/ajh.2010.198

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of this study was to investigate the relationship between late gadolinium enhancement (LGE) and the effect of cibenzoline (CBZ) on left ventricular (LV) diastolic function in hypertrophic cardiomyopathy (HCM) patients. Echocardiography before and after intravenous CBZ (1.4 mg/kg over 5 minutes) and magnetic resonance imaging (MRI) were performed in 22 consecutive patients with HCM [mean age: 65 ± 14 years, obstructive HCM: 14, nonobstructive HCM (HNCM): 8]. The extent of LGE (%LGE = LGE volume/total LV volume) was obtained by contrast-enhanced MRI using custom software. LGE was observed in 19 patients (mean %LGE = 5.1% ± 3.9%). The propagation velocity of LV early filling flow (Vp) increased significantly in patients with obstructive HCM (26 ± 7 to 36 ± 14 cm/s, P = 0.001) and nonobstructive HCM (25 ± 9 to 36 ± 16 cm/s, P = 0.007). A significant negative correlation was observed between the change in Vp and %LGE in patients with HCM (r = 20.542, P = 0.009). Less extensive myocardial fibrosis, as demonstrated by LGE on contrast-enhanced MRI, may predict the ability of CBZ to improve LV diastolic function in HCM.

DOI： 10.1097/FJC.0b013e318203830d

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Right ventricular (RV) pacing alters left ventricular (LV) mechanical activation, resulting in adverse impacts on LV function. This study was aimed to investigate the acute effect of RV apical (RVA) and septal pacing (RVS) on LV dyssynchrony and function using speckle tracking echocardiography. METHODS AND RESULTS: The 103 patients (749 years) with symptomatic bradyarrhythmia and preserved LV ejection fraction, and 50 age-matched control subjects were studied. All patients received a permanent pacemaker and were randomly assigned into 2 groups (RVA: n = 51, RVS: n = 52). After insertion, patients underwent an echocardiographic study during RV pacing. LV dyssynchrony and global strain parameters were analyzed using speckle tracking echocardiography. The QRS width and dyssynchrony indices by longitudinal and radial strain were significantly greater in RVA than in both the control and RVS. The LV longitudinal dyssynchrony index was significantly related to global longitudinal strain (GLS) among 103 patients receiving RV pacing (R² = 0.25, P < 0.0001). The GLS in RVA were the lowest among the 3 groups (GLS: CONTROL: -18.22.4%, RVA: -14.33.1%, P < 0.001 vs. control, RVS: -16.82.7%, P<0.01 vs. RVA). CONCLUSIONS: RVA created heterogeneous LV contraction, which resulted in deteriorated LV longitudinal contraction. RVS could be a better pacing alternative in terms of less LV dyssynchrony and better longitudinal function compared to RVA.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We experienced a case with atherosclerotic renal artery (RA) stenosis mimicking fibromuscular dysplasia (FMD). In this case, renal angiography, which is considered the 'gold standard' for diagnosing FMD, demonstrated a typical 'string-of-beads' sign. However, integrated backscatter intravascular ultrasound (IB-IVUS) showed severe atherosclerotic stenosis of the RA with a large amount of lipid pool. Therefore, we decided to perform adjunctive stent implantation which is considered optimal treatment of atherosclerotic RA stenosis. Our case suggests that IVUS evaluation might be useful for an accurate diagnosis and to help develop a treatment strategy for revascularisation. © 2011 European Society for Vascular Surgery.

DOI： 10.1016/j.ejvsextra.2011.06.011

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記述言語：英語  

We evaluated the relationship between coronary calcification and plaque characteristics using integrated backscatter-intravascular ultrasound (IB-IVUS), focusing on spotty calcification. Seventy-two patients with culprit plaques containing spotty calcification were evaluated. The average degree of all the spotty calcifications (averaged arc) negatively correlated with the % lipid volume (LV) on IB-IVUS. Multivariate analysis showed the averaged arc was an independent predictor of % LV. Our observations suggest that smaller plaque calcifications are associated with lipid-rich characteristics in patients with a spotty calcification pattern.

DOI： 10.1016/j.ijcard.2009.12.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jcin.2010.05.020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The renin-angiotensin system affects insulin sensitivity mainly through the angiotensin II type 1 receptor. In this study, the effects of renin inhibition on insulin resistance and adipose tissue dysfunction were explored in type 2 diabetic KK-A(y) mice. METHODS AND RESULTS: Male KK-A mice were treated with a direct renin inhibitor, aliskiren, administered subcutaneously at a dose of 50 mg/kg per day for 14 days using an osmotic minipump. This dose of aliskiren strongly inhibited plasma renin activity and lowered blood pressure about 17% in KK-A(y) mice. Aliskiren decreased body weight and plasma glucose level, and increased plasma insulin level in a fed condition. Aliskiren also lowered the plasma levels of cholesterol, fatty acids and triglycerides. In the oral glucose tolerant test, the plasma glucose elevation after glucose load was reduced by aliskiren, without a significant change in insulin level. Insulin tolerance test showed that aliskiren enhanced insulin's effect on plasma glucose. Aliskiren also reduced the epididymal adipose tissue mass by 25% and retroperitoneal adipose tissue mass by 35%. In adipose tissue, expression of the insulin receptor was not changed by aliskiren; however, expression of insulin receptor substrate-1, glucose transporter type 4, adiponectin, peroxisome proliferator-activated receptor-gamma and CCAAT/enhancer-binding proteindelta was increased by aliskiren. Moreover, NADPH oxidase activity and expression of inflammatory factors were reduced in adipose tissue. Aliskiren increased the pancreatic beta-cell area in KK-A(y) mice. CONCLUSION: These results suggest that renin inhibition by aliskiren improved insulin resistance and adipose tissue dysfunction in type 2 diabetic mice through an increase in insulin sensitivity, insulin secretion and adipocyte differentiation, and a reduction of oxidative stress.

DOI： 10.1097/HJH.0b013e32833bc420

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The effects of the coadministration of pravastatin and an angiotensin type 1 (AT(1)) receptor blocker, olmesartan, on glucose intolerance were examined using type II diabetic mice. Male KK-A(y) mice (8 weeks of age) were treated with pravastatin and/or olmesartan for 2 weeks. An oral glucose tolerance test (OGTT) was performed with an administration of 2 g kg(-1) glucose. Tissue glucose uptake was determined using 2-[(3)H]deoxyglucose. The treatment of mice with pravastatin attenuated the increase in the plasma glucose level during OGTT in a dose-dependent manner, without affecting the plasma insulin level. Pravastatin increased glucose uptake in insulin-sensitive tissue such as the skeletal muscle and adipose tissue after treatment at 5-20 mg kg(-1) day(-1) for 2 weeks, but not at 1 mg kg(-1) day(-1). The combination of a noneffective dose of pravastatin (1 mg kg(-1) day(-1)) and a noneffective dose of olmesartan (0.5 mg kg(-1) day(-1)) synergistically improved OGTT without affecting the plasma insulin level. This combination also increased 2-[(3)H]deoxyglucose uptake in the skeletal muscle and adipose tissue. The effects of pravastatin or olmesartan on OGTT and tissue 2-[(3)H]deoxyglucose uptake were significantly enhanced by an antioxidant, tempol, whereas the effects of a pravastatin-olmesartan combination were not further enhanced by tempol. These results indicate that the combination of pravastatin and olmesartan synergistically improves glucose intolerance through an increase in tissue glucose uptake. The effects seem to be mediated by an increase in insulin sensitivity through the inhibition of oxidative stress.

DOI： 10.1038/hr.2009.81

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Previous reports indicated that blockade of AT(1) receptor stimulation attenuated adipocyte dysfunction. However, the effects of AT(2) receptor stimulation on adipose tissue were not yet clear. In the present study, we examined the adipose tissue dysfunction in atherosclerotic apolipoprotein E knockout (ApoEKO) mice with AT(2) receptor deficiency. METHODS: Male ApoEKO and AT(2) receptor/ApoE knockout (AT(2)/ApoEKO) mice at 6 weeks of age were treated with a normal diet or a high-cholesterol diet (HCD: 1.25% cholesterol). Markers for adipocyte differentiation and inflammation in adipose tissue were assayed with real-time reverse-transcription-PCR and western blot. RESULTS: Compared with ApoEKO mice, AT(2)/ApoEKO mice with a normal diet showed only a decrease in expression of adiponectin and CCAAT/enhancer binding protein delta (C/EBPdelta) in epididymal adipose tissue without changes in body weight, adipose tissue weight, and adipocyte number even at 6 months of age. After HCD for 4 weeks, the weight of both epididymal and retroperitoneal adipose tissue in AT(2)/ApoEKO mice was greater than that in ApoEKO mice without a change in body weight. Plasma concentrations of cholesterol and fatty acids were higher in AT(2)/ApoEKO mice than in ApoEKO mice. In adipose tissue of AT(2)/ApoEKO mice, the adipocyte number was decreased and the expression of peroxisome proliferator-activated receptor gamma (PPARgamma), C/EBPalpha, and aP2 was lower than that in ApoEKO mice, in association with an increase in nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity. CONCLUSIONS: These results suggest that AT(2) receptor stimulation in adipose tissue is involved in the improvement of adipocyte differentiation and adipose tissue dysfunction in atherosclerotic model.

DOI： 10.1038/ajh.2009.85

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the possibility that continuous activation of the human brain renin-angiotensin system causes cognitive impairment, using human renin (hRN) and human angiotensinogen (hANG) gene chimeric transgenic (Tg) mice. Cognitive function was evaluated by the shuttle avoidance test once a week from 10 to 20 weeks of age. The avoidance rate in wild-type mice gradually increased. In contrast, the avoidance rate in chimeric hRN/hANG-Tg mice also increased; however, no further increase in avoidance rate was observed from 14 weeks of age, and it decreased thereafter. Cerebral surface blood flow was markedly reduced in 20-week-old hRN/hANG-Tg mice. Superoxide anion production in the brain was already higher in 10-week-old hRN/hANG-Tg mice and further increased thereafter with an increase in NADPH oxidase activity. Moreover, expression of p47(phox) and Nox4 in the brain of hRN/hANG-Tg mice also increased. Administration of an angiotensin II type 1 receptor blocker, olmesartan (5.0 mg/kg per day), attenuated the increase in blood pressure and ameliorated cognitive decline with enhancement of cerebral surface blood flow and a reduction of oxidative stress in hRN/hANG-Tg mice. On the other hand, hydralazine (0.5 mg/kg per day) did not improve the decrease in avoidance rate, and did not influence cerebral surface blood flow or oxidative stress in hRN/hANG-Tg mice, in spite of a similar reduction of blood pressure to that by olmesartan. Moreover, we observed that treatment with Tempol improved impaired cognitive function in hRN/hANG-Tg mice. These results suggest that continuous activation of the brain renin-angiotensin system impairs cognitive function via stimulation of the angiotensin II type 1 receptor with a decrease in cerebral surface blood flow and an increase in oxidative stress.

DOI： 10.1161/HYPERTENSIONAHA.108.123612

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A combination of different types of antihypertensive drugs is widely used for the treatment of hypertension. We examined the inhibitory effects of a combination of an AT(1) receptor blocker (ARB), olmesartan, with various calcium channel blockers (CCBs) on inflammatory vascular remodeling. METHODS: Inflammatory vascular remodeling was induced by polyethylene-cuff placement around the femoral artery of C57BL/6J mice at 10 weeks of age. Olmesartan (0.5 mg/kg/day) was administered intraperitoneally using an osmotic minipump. CCBs (nifedipine 1.0 mg/kg/day, amlodipine 0.1 mg/kg/day, azelnidipine 0.1 mg/kg/day), and hydrochlorothiazide (HCTZ 0.5 mg/kg/day) were administered orally. RESULTS: In the injured artery, superoxide anion production and expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits p47(phox) and Rac-1 were markedly increased, together with expression of monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor (TNF)-alpha. Administration of a single drug alone at each concentration did not significantly inhibit these changes in the injured artery. However, a combination of olmesartan with various CCBs inhibited neointimal formation as well as oxidative stress and inflammatory markers in the injured artery. Moreover, among these CCBs, inhibition of these markers by olmesartan with azelnidipine was stronger than that caused by a combination with other CCBs. On the other hand, a combination of subeffective doses of olmesartan and HCTZ did not significantly affect vascular changes after cuff placement. CONCLUSIONS: These results suggest that the combination of ARB with CCB synergistically inhibits vascular remodeling and that the inhibitory actions of ARB on vascular remodeling may vary depending on the combined CCB.

DOI： 10.1038/ajh.2008.344

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: We examined the possibility that activation of the human brain renin-angiotensin system is involved in enhancement of ischemic brain damage using chimeric transgenic mice with human renin (hRN) and human angiotensinogen (hANG) genes. METHODS: Chimeric (hRN/hANG-Tg) mice were generated by mating of hRN and hANG transgenic mice. Permanent occlusion of the middle cerebral artery (MCA) by an intraluminal filament technique induced focal ischemic brain lesions. RESULTS: hRN/hANG-Tg mice showed higher angiotensin II levels in the plasma and brain. The ischemic brain area at 24 hours after MCA occlusion was significantly enlarged in hRN/hANG-Tg mice with an enhanced neurological deficit compared to that in wild-type, hRN-Tg and hANG-Tg mice. The reduction of cerebral blood flow in the periphery region of the MCA territory after MCA occlusion was markedly exaggerated in hRN/hANG-Tg mice. Superoxide anion production in the brain and arteries was also increased significantly in hRN/hANG-Tg mice even before MCA occlusion and was further enhanced after MCA occlusion. Treatment with an AT(1) receptor blocker, valsartan (3.0 mg/kg per day), for 2 weeks significantly reduced the ischemic brain area and improved the neurological deficit after MCA occlusion in hRN/hANG-Tg mice, similar to those in wild-type, hRN-Tg, and hANG-Tg mice, with restoration of cerebral blood flow in the peripheral region and decreases in superoxide anion production and blood pressure. CONCLUSIONS: These results indicate that activation of the human renin-angiotensin system exaggerates ischemic brain damage mainly through stimulation of the AT(1) receptor and marked reduction of cerebral blood flow and enhanced oxidative stress.

DOI： 10.1161/STROKEAHA.108.519801

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Hypertension has long been recognized as a major risk factor of several cardiovascular diseases. It is well known that the renin-angiotensin system(RAS) is involved in the pathogenesis of both hypertension and hypertensive end-organ damage. Untreated hypertension is self-accelerating condition through RAS stimulation. Activation of RAS contributes to the transition from borderline hypertension to established hypertension. Recently, "the Seventh Report of Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7)" proposed a new classification of borderline blood pressure levels, as "prehypertension". The therapeutic focus has begun to shift from the therapy of established hypertension to the prevention of hypertension. This review addressed the relationship between hypertension, prehypertension and the role of RAS.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The roles of the angiotensin (Ang) II type 1 (AT(1)) receptor in the changes in white adipose tissue were explored in an animal model of atherosclerosis using apolipoprotein E-deficient (ApoEKO) mice. METHODS: Apolipoprotein E-deficient (ApoEKO) mice and KK-A(y) mice were used. Expression of markers for adipocyte differentiation and inflammation was determined by real-time reverse-transcription polymerase chain reaction. RESULTS: Adipose tissue weight and adipocyte size in epididymal white adipose tissue were increased in ApoEKO mice and KK-A(y) mice. In the adipose tissue of these models, expression of adiponectin and peroxisome proliferator-activated receptor-gamma (PPARgamma), which induce adipocyte differentiation, and expression of transcription factors of adipocyte differentiation, such as CCAAT-enhancer-binding protein-alpha (C/EBPalpha) and aP2, were decreased. Expression of inflammatory markers and nicotinamide adenine dinucleotide phosphate oxidase subunits was also increased. Deletion of AT(1)a receptor in ApoEKO mice and administration of an AT(1) receptor blocker, valsartan, to KK-A(y) mice reduced epididymal adipose tissue weight and adipocyte size significantly. Blockade of the AT(1) receptor also reduced the expression of inflammatory chemokines and oxidative stress markers. Moreover, AT(1)a receptor deletion in ApoEKO mice and AT(1) receptor blockade in KK-A(y) mice prevented the decrease in expression of adiponectin, PPARgamma, C/EBPalpha, and aP2. Valsartan also increased glucose uptake induced by insulin in adipose tissue of KK-A(y) mice. CONCLUSIONS: These results suggest that enlargement and weakened differentiation of adipocytes are observed in atherosclerosis and diabetes, and that AT(1) receptor blockade prevented adipocyte enlargement and promoted adipocyte differentiation in these models.

DOI： 10.1038/ajh.2007.50

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The effects of an angiotensin II (Ang II) type 1 (AT(1)) receptor blocker (ARB) on focal brain ischemia and atherosclerotic lesions were explored in atherosclerotic apolipoprotein E-deficient (ApoEKO) mice treated with a high-cholesterol diet (HCD). The ischemic brain area and neurological deficit 24 h after middle cerebral artery (MCA) occlusion were significantly greater in ApoEKO mice treated with HCD for 10 weeks than in those with a normal standard diet. The reduction of cerebral surface blood flow in the penumbral region and the increase in superoxide production in the ischemic area were exaggerated in HCD-treated ApoEKO mice. Histological analysis showed atherosclerotic changes in the proximal aorta and deposition of lipid droplets in the arterial wall in the brain. Administration of an ARB, telmisartan (0.3 mg/kg/day), for the last 2 weeks after 8 weeks of HCD feeding attenuated the ischemic brain area, the neurological deficit, the superoxide production in the ischemic area, and the reduction of cerebral blood flow in the penumbra, without significantly changing blood pressure or serum cholesterol level. Telmisartan also decreased atherosclerotic lesion formation in the proximal aorta of HCD-treated ApoEKO mice, although it did not remarkably change lipid deposition in the cerebral arteries. These results suggest that the blockade of the AT(1) receptor attenuates ischemic brain damage induced in an atherosclerosis model. This inhibitory action is mediated through the attenuation of the reduction in cerebral blood flow and of oxidative stress in the brain; it also mediated through telmisartan's anti-atherosclerotic effect.

DOI： 10.1291/hypres.31.161

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The effect of a calcium channel blocker (CCB) on the expression of monocyte chemoattractant protein (MCP)-1 was explored in inflammatory vascular injury, focusing on the role of nuclear factor (NF)-kappaB. METHODS: Vascular injury was induced by cuff placement. Expression of MCP-1 was determined by real-time RT-PCR. NF-kappaB expression and its activity were detected by Western blot and electrophoretic mobility shift assay. RESULTS: Polyethylene cuff placement around the mouse femoral artery increased MCP-1 expression, together with proliferation of vascular smooth muscle cells and neointimal formation in the injured artery. The content of NF-kappaB was decreased in the cytosolic fraction but increased in the nuclear fraction prepared from the injured artery. In the nuclear fraction, the binding activity of NF-kappaB to the promoter region of MCP-1 was markedly increased. On the other hand, IkappaB content in the cytosolic fraction was decreased in the injured artery after cuff placement, accompanied by an increase in IkappaB kinase (IKK) phosphorylation. Treatment of mice with a CCB, nifedipine, at a dose of 5 mg/kg/day, significantly decreased vascular smooth muscle cell proliferation and neointimal formation without affecting blood pressure. This dose of nifedipine inhibited the increase in MCP-1 expression in the injured artery. Moreover, nifedipine reduced the nuclear content and DNA-binding activity of NF-kappaB in the injured artery. In contrast, the decrease in IkappaB content and the increase in IKK phosphorylation in the cytosolic fraction were attenuated by nifedipine. CONCLUSIONS: These results indicate that MCP-1 expression in inflammatory vascular injury is regulated by activation of NF-kappaB. The results also suggest that nifedipine attenuates MCP-1 expression in the injured artery via inhibition of the nuclear translocation and DNA-binding activity of NF-kappaB, and thereby improves vascular remodeling.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cibenzoline is able to improve left ventricular (LV) diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM), but the exact mechanism remains to be determined. METHODS AND RESULTS: The present study was designed to elucidate the effect of intravenous administration of 1.4 mg/kg of cibenzoline on aortic and LV pressures, and transmitral Doppler flow pattern in 7 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 9 patients with hypertrophic nonobstructive cardiomyopathy (HNCM). Before and at the end of the administration, aortic and LV pressures, LV pressure gradient (LVPG) and transmitral Doppler velocity profiles were examined. After the administration of cibenzoline, LV minimal and end-diastolic pressures decreased from 9+/-4 mmHg to 1+/-5 mmHg (p=0.0049) and from 22+/-7 mmHg to 14+/-5 mmHg (p=0.0106) in patients with HOCM, and from 9+/-5 mmHg to 5+/-3 mmHg (p=0.0036) and from 20+/-6 mmHg to 14+/-3 mmHg (p=0.0033) in patients with HNCM. LVPG decreased in all patients with HOCM. E-wave velocity increased, A-wave velocity decreased, and thus the E/A ratio increased from 0.77+/-0.29 to 1.20+/-0.48 (p=0.0004). CONCLUSIONS: Reduction of LV diastolic pressures by intravenous administration of cibenzoline may be related to an improvement in the E/A ratio in patients with HCM.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent interventional and surgical therapies to attenuate left ventricular pressure gradient (LVPG) can be difficult to perform in patients with hypertrophic obstructive cardiomyopathy (HOCM) caused by midventricular obstruction (MVO), owing to the risk of inducing or deteriorating mitral regurgitation. METHODS AND RESULTS: The effects of the antiarrhythmic drug, cibenzoline, on LVPG and left ventricular (LV) diastolic function estimated by the change in the transmitral Doppler flow pattern were examined in 23 patients with HOCM and MVO. Hemodynamic changes 2 h after a single dose of 200 mg of cibenzoline and 3 months after oral administration of 300-450 mg of cibenzoline per day were examined. At 2 h after the treatment, LVPG decreased from 79+/-37 mmHg to 24+/-21 mmHg (p < 0.0001). E-wave velocity significantly increased and A-wave velocity significantly decreased, and thus the E/A ratio increased from 0.83+/-0.39 to 1.36+/-0.50 (p < 0.0001). After 3 months of treatment, LVPG remained decreased, and the E-wave and A-wave velocities and the E/A ratio remained improved. CONCLUSIONS: Cibenzoline can attenuate LVPG and ameliorate LV diastolic dysfunction in patients with HOCM caused by MVO, which suggests a new strategy for the management of this condition.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It was recently suggested that insulin resistance is significantly correlated with activation of the cardiac sympathetic nervous system in patients with essential hypertension. OBJECTIVES: To examine the effects of troglitazone, an agent used to treat insulin resistance, on cardiac sympathetic nervous dysfunction and insulin resistance in patients with essential hypertension. METHODS: The study participants included 34 patients (14 men, 20 women) with mild essential hypertension and 17 normal controls (group C, seven men). The patients were randomly divided into two groups, one treated with 400 mg troglitazone and antihypertensive drugs (group T, n = 17) and the other treated with antihypertensive drugs only (group N, n = 17). We evaluated insulin resistance and cardiac sympathetic nervous function before and after 6 months of treatment. Insulin resistance was evaluated using steady-state plasma glucose (SSPG; mg/dl) concentrations and cardiac sympathetic nervous function was evaluated using the heart-to-mediastinum ratio (H : M) and mean washout rate measured by 123I-meta-iodobenzylguanidine (MIBG) cardiac imaging. RESULTS: There were significant differences in SSPG (P < 0.01), early (P < 0.05) and delayed (P < 0.05) phases of H : M and washout rate (P < 0.05) between the hypertensive patients and group C. The SSPG concentration was significantly improved after treatment only in group T, from 153.3 to 123.7 mg/dl (P < 0.01). The early and delayed phases of H : M and washout rate also were significantly improved (P < 0.05) (from 2.59 to 2.63, from 2.12 to 2.27 and from 18.1 to 13.7%, respectively) in only group T.The change in SSPG was significantly correlated with the changes in H : M and washout rate (r = -0.639 and 0.577, respectively). CONCLUSION: Troglitazone had a beneficial effect on cardiac sympathetic nervous function through a decrease in insulin resistance in patients with essential hypertension.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the effects of cilostazol on impaired coronary arterial responses in patients with vasospastic angina (VSA). Thirty patients who were diagnosed with VSA based on an acetylcholine provocation test and 10 subjects with normal coronary arteries were enrolled. The patients were divided into the following 3 groups: no antiplatelet agent treatment group, aspirin treatment, or cilostazol treatment groups. Coronary flow reserve (CFR), coronary flow volume at maximum hyperemia, and epicardial coronary artery diameter after administration of N(G)-monomethyl-L-arginine (L-NMMA) were examined using a Doppler flow wire before and 6 months after the start of this study. CFR, coronary flow volume at maximum hyperemia, and diameter changes by L-NMMA were significantly increased in the cilostazol treatment group compared with the other 2 groups. In conclusion, cilostazol increased CFR and flow-dependent coronary dilation; these changes were attributable to nitric oxide. Cilostazol may improve coronary vascular endothelial dysfunction and coronary hemodynamics in patients with VSA.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

目的:経胸壁ドプラ心エコー(transthoracic Doppler echocardiography:TTDE)による左冠動脈近位部血流計測は、同部の冠動脈病変の推定に有用である。本研究の目的は、その検出率と検出時間における機種および検者依存性の検討である。対象と方法:1)機種依存性 2010年から2016年までに、同一検者によりGE社のVivid7とVivid E9でTTDEが施行された連続患者325名を対象とした。2)検者依存性 同期間に、3名の検者により(検者1、検者2:TTDE経験5年、検者3:TTDE経験2年)、同一患者にGE社のVivid7でTTDEが施行された連続患者100名を対象とした。両検討共に、対象としたTTDEの期間中に冠動脈バイパス術や左冠動脈近位部にインターベンションが行われた症例は除外した。左冠動脈近位部血流検出の定義は同部の血流速度波形を保存できた場合とし、検出時間の定義は通常の心エコー検査における最終画像保存時間から左冠動脈近位部血流の速度波形保存時間までとした。結果:1)機種依存性 検出率はVivid7に比し、Vivid E9で有意に良好であったが(60% vs 68%、p=0.01)、検出時間は両機種間に有意差を認めなかった(73秒vs72秒、p=0.10)。2)検者依存性 検出率は各検者間で有意差を認め(検者1:77%、検者2:70%、検者3:65%、p=0.0486)、検者1と検者3の間に差を認めた(p=0.03)。また、検出時間も検者間差を認め(検者1:57秒、検者2:65秒、検者3:86秒、p<0.01)、検者3と他の検者間に有意差を認めた。結論:左冠動脈近位部血流検出には機種および検者依存性が存在することが示唆された。また、検者依存性はTTDEの習熟度に関連する可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00833&link_issn=&doc_id=20180316410011&doc_link_id=%2Fed5choon%2F2018%2F004502%2F012%2F0207-0214%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fed5choon%2F2018%2F004502%2F012%2F0207-0214%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)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  

Web of Science

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は64歳、女性。2005年に完全房室ブロックのため、DDDペースメーカー植え込み術を施行された。2008年に左前脛骨部の皮膚生検からサルコイドーシスと確定診断された。2009年4月より労作時呼吸困難が出現し、徐々に増悪した。2010年1月には軽労作でも呼吸困難が出現するようになったため、精査目的で当院に紹介された。心エコー図検査で左室拡大、び漫性の壁運動低下(特に心室中隔基部と後壁の菲薄化)、Gaシンチグラフィや18F-FDG-PETで心臓への集積を認め心サルコイドーシスと診断した。心エコー図検査で右室心尖部ペーシングによる左室同期不全も認めたため、心臓再同期療法およびステロイド療法を開始した。また、終夜睡眠検査で中枢性優位の睡眠時無呼吸症候群の合併を認めたため、陽圧換気療法(adaptive servo-ventilation;ASV)も開始した。治療後、左室駆出率は22.5%から29.7%に、拡張末期左室容積も148mLから104mLに軽度改善したが、reverse remodelingは認めず心機能改善効果は軽度であった。心筋障害や左室remodelingの高度な症例での治療には一定の効果が認められたが限定的であった。このため、心不全早期からの治療介入が重要と考えられたため、文献的考察を加えて報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00679&link_issn=&doc_id=20120124160016&doc_link_id=%2Fah2sinzd%2F2012%2F004401%2F018%2F0062-0068%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2012%2F004401%2F018%2F0062-0068%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

急性心筋梗塞の約70%は冠動脈造影上50%未満の狭窄から発症することから、その発症予防には脆弱性プラークの診断が重要である。冠動脈プラークイメージングのモダリティーを用いた多くの研究から、脆弱性プラークに関して多くの知見が集積しつつある。非侵襲的モダリティーとして冠動脈CT、心臓MRI、侵襲的モダリティーとして血管内超音波、光干渉断層法、血管内視鏡によるプラークイメージングについて概説した。

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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：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

J-GLOBAL

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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：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：バイエル薬品(株)  

J-GLOBAL

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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  

J-GLOBAL

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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：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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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  

Web of Science

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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：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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J-GLOBAL

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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  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)日本医事新報社  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)先端医学社  

現在高血圧治療の中心を担うのは、食事療法・運動療法などの生活改善と薬物治療であるが、その治療コンプライアンスが十分でなく適切な治療を受けられていない患者が多い。そこで、投薬に代わる新しい高血圧患者の治療方法として、ワクチン療法が注目されている。アンジオテンシンII(Ang II)は、レニン・アンジオテンシン(RA)系のなかでも血圧上昇にかかわる重要な因子の1つであるが、近年このAng IIをターゲットとしたワクチンCYT006-AngQb(AngQb)が開発された。このワクチンは高い安全性と耐用性が得られ、年に数回の投与で降圧効果が得られることから、今後有用な治療となることが期待される。本稿では、AngQbの臨床試験の結果を中心に概説した。(著者抄録)

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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：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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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  

Web of Science

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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  

Web of Science

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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：愛媛医学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01205&link_issn=&doc_id=20080724100011&doc_link_id=40016165435&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40016165435&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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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  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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  

Web of Science

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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  

Web of Science

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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：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年医学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(株)先端医学社  

レニン・アンジオテンシン系(RAS)の主要活性物質であるアンジオテンシンII(A II)は、AT1受容体刺激を介してNAD(P)Hオキシダーゼ活性を上昇させることにより、酸化ストレスを亢進させ血管病変を誘導する。一方、病的血管において発現が増加するAT2受容体の刺激は酸化ストレスを抑制すると考えられる。ARBによる血管リモデリング抑制効果もAT1受容体のブロックに加えてAT2受容体刺激作用の二面性を含み、これらによる酸化ストレス抑制作用が重要である。また、血管病変の性差に関するこれまでの研究から、酸化ストレスに対するエストロゲンの修飾作用も明らかになってきており、今後も血管病変における酸化ストレスとRASの更なる解明が期待される。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：市立宇和島病院生活協同組合  

症例は54歳男性で、2日前より食欲不振・両下肢脱力感を認めていたが、歩行不能となり更に意識障害をきたして救急搬送された。来院時、意識レベルはJCS I-1眼瞼結膜の貧血・眼球の黄染なく、対光反射を認め、眼振・外転神経障害も認めなかった。両下肢遠位筋を中心に四肢の筋力低下と軽度知覚障害を認めた。血圧低下・頻脈を伴っており頭部MRIにて脳幹部梗塞が強く疑われたため脳梗塞として治療を開始した。ICUにて全身管理を行ったが呼吸・循環動態共に悪化し、拍出性心不全を呈したためビタミンB1欠乏によるWernick脳症・脚気心・末梢神経障害と診断してビタミンB1の投与を開始した。その結果、全身症状は速やかに改善し、両下肢筋力低下は軽度残存したが入院51日目に退院となった。ビタミンB1欠乏症では多彩な症状を呈するため本症例の診断には苦慮した。以上より本症例を疑った場合には速やかにビタミンB1投与を行うべきと変えられ、またWernicke脳症の診断には頭部MRIが特徴的所見を呈し有用であった。

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は76歳,男性.60歳ころより気管支喘息と診断され近医でテオフィリンなどの内服治療中であった.2005年1月某日から息苦しさが増悪し,夜間の呼吸困難,不眠が出現したため症状出現の3日後に当科を受診した.来院時の胸部X線写真で両側の胸水を認め,うっ血性心不全と診断し同日入院した.両肺野で聴取される湿性ラ音に加えLevine III/VIの収縮期雑音を聴取し,心電図では洞性頻脈とII,III,aVFのQSパターンとV1〜5で深いS波とR波の減高を認めた.また,心エコー図検査では閉塞性肥大型心筋症(HOCM)の所見であった.テオフィリンによる頻拍が心不全の誘因と考え投与を中止し,気管支喘息に対してはロイコトリエン受容体拮抗薬と吸入抗コリン薬を投与した.心不全に対してはシベンゾリンと少量の利尿薬の使用で約1週間後に胸水は消失し,症状も軽快した.シベンゾリン静注による効果を検討する目的でシベンゾリンの内服を3日間中止した後の心エコー図検査で72mmHgの左室内圧較差(LVPG)が確認された.シベンゾリン静注によりLVPGは20mmHgに軽減した.シベンゾリンの内服を継続し,自覚症状も消失したことから2月某日に退院した.今回われわれは気管支喘息や心不全のためにβ遮断薬の投与が不適当であるHOCM患者に対し,シベンゾリンの投与で症状,検査所見とも著明に改善した1例を経験したので報告する(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00679&link_issn=&doc_id=20060818280013&doc_link_id=10.11281%2Fshinzo1969.38.8_813&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo1969.38.8_813&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：愛媛医学会  

75歳女.四肢のしびれを自覚し,腰痛もあるため,整形外科を受診し,坐骨神経痛と診断され,芍薬甘草湯を処方された.四肢のしびれが増悪したため救急外来を受診し,血清カリウム値が高度の低K血症をきたしたため精査のため入院した.Levine III/VIの駆出性収縮期雑音を聴取,脱力感もあった.代謝性アルカローシスで,血清Kは著明な低下が認められた.尿中K値は増加せず著明な低K血症で尿中排泄量が既に減少してきた時期と思われた.低酸素血症であったのは高度脱力による換気障害と考えられた.心電図で正常洞調律,QT延長,1度の房室ブロックを認め,副腎MRIで右副腎にintensityに近い径10mmの腫瘍がみられた.芍薬甘草湯を中止し,KCl点滴投与更にアルダクトン内服に切替え血清Kが回復した.MRIで副腎腫瘍が指摘され,非機能性腫瘍と診断された.症状が消失し,外来経過観察の後第28病日に退院した

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は68歳,男性.高血圧と糖尿病で近医に通院治療中であった.2004年8月4日に全身倦怠感を主訴に当科外来を受診した.外来時のトレッドミル負荷心電図でII・III・aVFのST低下を認めたため,ATPタリウム心筋シンチグラフィを施行した.下壁の取り込み低下と後期像で同部位の再分布現象を認めたため,9月9日に心臓カテーテル検査を施行した.冠動脈造影では右冠動脈seg.1の慢性完全閉塞を認めた.ワイヤーをIntermediateからShinobi,Conquestに変更しExelsiorのバックアップ下でワイヤーを通過させた.Sprinter(1.5×15mm)で拡張後,血管内視鏡による観察を行った.病変部はワイヤーによる内膜損傷や小さなフラップが観察された.Seg.1〜2にDriver(4.0×30mm),seg.2〜3にPenta(3.5×28mm)を留置し終了した.PCI後の内視鏡ではフラップやプラークをステントが押さえつけている所見が観察された.今回われわれは慢性完全閉塞の病変部を内視鏡で観察し得た1例を経験したので報告する(著者抄録)

J-GLOBAL

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00679&link_issn=&doc_id=20060420250008&doc_link_id=10.11281%2Fshinzo1969.38.4_346&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo1969.38.4_346&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本メジフィジックス(株)  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：市立宇和島病院生活協同組合  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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A 77-year-old female was admitted to our hospital due to acute myocardial infarction. An emergency coronary angiogram revealed total obstruction in the just proximal segment of the left descending coronary artery. Because of severe residual stenosis after aspiration of thrombi and predilatation by cutting balloon, we attempted debulking of the atheromatous plaque by directional coronary atherectomy. DCA using a FLEXI-CUT system resulted in successful debulking in the culprit lesion. Coronary angiography before discharge revealed no restenosis and intimal proliferation, and these good conditions were also found at the 3-month follow-up.

Scopus

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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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  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本心血管インターベンション学会  

77歳女.胸痛を主訴とした.2002年11月,夜間に冷汗を伴う胸痛が出現し,翌日の心電図上ではI,aVL,V2〜5でST上昇を,II,III,aVFでreciprocalなST低下を認め,胸部レントゲン写真ではCTR60%,肺野にうっ血を認めた.急性前壁心筋梗塞症と診断し,緊急冠動脈造影を施行した結果,左冠動脈前下行枝近位部の完全閉塞であり,インターベンションを開始した.同部位は高度石灰化を呈し,血栓吸引とカッティングバルーンで拡張した後の冠動脈造影と血管内超音波(IVUS)にて左前下行枝のjust proximalに高度の残存狭窄を伴う偏心性プラークを認めた.病変部位の状況からFLEXI-CUTを用いて方向性粥腫切除術(DCA)を施行し,石灰化は残存したが良好なdebulkingに成功した.高率に再狭窄が予測される病変であったが,慢性期においても再狭窄や新生内膜の増殖を認めず,良好な開存が維持された.DCAは急性心筋梗塞に対する治療strategyの一つに成りうると考えられた

J-GLOBAL

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記述言語：日本語   出版者・発行元：(有)科学評論社  

57歳男.アルコール中毒で入院中に冷汗を伴う胸痛が出現した.心電図,心エコー図所見より急性下壁心筋梗塞を疑い,緊急冠動脈造影を施行した.右冠動脈は近位部で完全閉塞であったため,インターベンションを開始した.ワイヤー通過後,右冠動脈近位部の90%狭窄と房室結節枝の血栓性閉塞を認め,PerqueSurge aspiration catheterで頻回に吸引したが,十分なflowが得られず,Thrombusterに変更して右冠動脈近位部から末梢を吸引し,多量の血栓を採取した.デバイスのdeliveryは容易であった.本幹部分のflowは改善したが,4AVが再度完全閉塞となったため,繰り返し吸引を施行した.右冠動脈は末梢まで再開通したが,4AVに90%の狭窄を認めたため,2.75×10mmのcutting balloonで拡張した.引き続きPerqueSurge gurdewireでdistal protectionの後,右冠動脈中間部に4.0×28mmのBx-Velocityを留置し,TIMI-III flowで手技を終了した.以後経過順調で,慢性期も梗塞責任部位の再狭窄はなかった

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：市立宇和島病院生活協同組合  

52歳男.患者は労作時に胸部圧迫感を感じるようになった.入院時の心電図では,特に虚血を示唆するST-T変化は認められず,冠動脈造影にて左冠動脈前下行枝seg7に75%狭窄,右冠動脈seg1およびseg3近位部と遠位部に75%の狭窄部を認めた.右冠動脈近位部と遠位部proxymalが虚血責任と考えられ,遠位部のproxymalに対しMultilink Tristarを留置し,近位部の病変に対しS670の植え込みを施行した.その結果,病変拡張後の冠動脈造影では良好な拡張を得ることができ,手技終了とした.術後経過も順調で,現在,外来通院中である

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：日本心血管インターベンション学会  

2002年2月1日〜4月10日迄の期間に救急外来を受診し,心疾患を疑わせる臨床症状を有した40例における,心臓由来脂肪酸結合蛋白(H-FABP)の全血迅速診断法(ラピチェック)の早期心筋障害判定における有用性を検討した.H-FABPのACSに対する感度はTroponin Tに比し有意に高く,特異度は低かった.しかし,心筋障害を正確に反映しており,入院の必要な心筋障害が存在することを示唆した.迅速H-FABP検査は,循環器疾患鑑別の指標として救急患者の入院の必要性や循環器専門医の診察の必要性を示唆する心筋障害マーカーとして有用であると考えられた

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)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  

CiNii Books

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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  

CiNii Books

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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：日本語   出版者・発行元：(一社)日本内科学会  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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