記述言語：英語  

Incisional atrial tachycardia (AT) with multiple penetrating points on one surgical incision has not been reported yet. We present a case of incisional AT following mitral valve annuloplasty with a superior transseptal approach, in which two reconduction sites were parts of the reentrant circuit. Radiofrequency ablation at the reconduction site successfully terminated the tachycardia. A total of four penetrating points were found on the incision line, and radiofrequency ablation at these sites was completed. Detailed mapping of possible reconduction sites along the incision line should be performed to avoid further instances of AT following open heart surgery.

DOI： 10.1111/jce.14690

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background:
Although management of obstructive sleep apnea (OSA) has been recommended to improve outcomes of catheter ablation (CA) in patients with symptomatic atrial fibrillation (AF), the most cost-effective way of preprocedural OSA screening is undetermined. This study assessed the cost-effectiveness of OSA management before CA for symptomatic AF.
Methods and Results:
A Markov model was developed to assess the cost-effectiveness of 3 OSA detection strategies before CA: no screening; Type 3 portable monitor (PM)-guided screening; and polysomnography (PSG)-guided screening. The target population consisted of a hypothetical cohort of patients aged 65 years with symptomatic AF, with 50% prevalence of OSA. We used a 5-year horizon, with sensitivity analyses for significant variables and scenario analyses for lower and higher OSA prevalence (30% and 70%, respectively). In the base-case, both types of OSA screening were dominant (less costly and more effective) relative to no screening. Although PSG-guided management was more effective than PM-guided management, it was more costly and therefore did not show clear benefit. These findings were replicated in cohorts with lower and higher OSA risks.
Conclusions:
OSA screening before CA is cost-effective in patients with symptomatic AF, with PM screening being the most cost-effective. Physicians should consider OSA management using this simple tool in the decision making for treatment of symptomatic AF.

DOI： 10.1253/circrep.CR-20-0074

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記述言語：英語  

AIMS: Although both left atrial (LA) and ventricular (LV) dysfunction has been accepted as an important risk factor of atrial fibrillation (AF), usefulness of LA and LV strain has not been fully compared for prediction of AF. The aims of this study were to clarify the associations of both LA and LV strain with AF and to compare their predictive values in the risk stratification for AF. METHODS AND RESULTS: We evaluated 531 consecutive patients (median age 67 years, 56% male), with no history of AF who underwent echocardiography after cryptogenic stroke. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir, pump, and conduit strain) and LV strain (global longitudinal strain, GLS). The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared. Median 36 months of follow-up, 61 patients (11%) had newly diagnosed AF. LA pump strain and GLS were significantly and independently associated with AF and provided incremental predictive value over clinical and standard echocardiographic parameters. Areas under the receiver-operating curves for GLS (0.841) were comparable to LA pump (0.825) and reservoir (0.851) strain. However, predictive value of both strains was different between patients with and without LA enlargement at the time of transthoracic echocardiography screening. LA strain was more useful than LV strain in patients with normal LA volumes, while LV strain was more useful than LA strain in patients with abnormal LA volumes. CONCLUSION: Both LA and LV strain are significantly and independently associated with AF and provide incremental predictive value over clinical and standard echocardiographic parameters. However, priorities of strain assessment are different depends on patients' condition at the time of echocardiography.

DOI： 10.1093/ehjci/jez240

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記述言語：英語  

OBJECTIVES: The aim of this study was to assess the association between left ventricular mechanical dispersion (LVMD) and the incidence of ventricular arrhythmias (VAs). BACKGROUND: Recent, mainly single-center, studies have demonstrated that LVMD assessed using speckle tracking might be a powerful marker in risk stratification for VA. A systematic review and meta-analysis provides a means of understanding the prognostic value of this parameter, relative to other parameters, the most appropriate cutoff for designating risk. METHODS: A systemic review of studies reporting the predictive value of LVMD for VA was undertaken from a search of MEDLINE and Embase. VA events were defined as sudden cardiac death, cardiac arrest, documented ventricular tachyarrhythmia, and appropriate implantable cardioverter-defibrillator (ICD) therapy. Hazard ratios were extracted from univariate and multivariate models reporting on the association of LVMD and VA and described as pooled estimates with 95% confidence intervals. In a meta-analysis, the predictive value of LVMD was compared with that of left ventricular ejection fraction and global longitudinal strain. RESULTS: Among 3,198 patients in 12 published studies, 387 (12%) had VA events over follow-up ranging from 17 to 70 months. Patients with VAs had greater LVMD than those without (weighted mean difference -20.3 ms; 95% confidence interval: -27.3 to -13.2; p < 0.01). Each 10 ms increment of LVMD was significantly and independently associated with VA events (hazard ratio: 1.19; 95% confidence interval: 1.09 to 1.29; p < 0.01). The predictive value of LVMD was superior to that of left ventricular ejection fraction or global longitudinal strain. CONCLUSIONS: LVMD assessed using speckle tracking provides important predictive value for VA in patients with a number of cardiac diseases and appears to have superior predictive value over left ventricular ejection fraction and global longitudinal strain for risk stratification.

DOI： 10.1016/j.jcmg.2019.03.025

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記述言語：英語  

BACKGROUND: Although atrial fibrillation (AF) is a significant population health burden, and an avoidable cause of stroke, AF screening remains controversial. The aim of this study was to investigate whether coincidental echocardiography could provide information about patients at risk for AF. METHODS: Asymptomatic participants ≥65 years of age with more than one AF risk factor (N = 445) undergoing echocardiography for risk evaluation were followed over a median of 15 months for incident AF. Left atrial volume index (LAVi), left ventricular (LV) global longitudinal strain (GLS; absolute value), left atrial (LA) strain, and LV mass were measured. During the follow-up period, AF was diagnosed clinically by primary care physicians or by using a single-lead portable electrocardiographic monitoring device (five 60-sec recordings performed by participants over 1 week). RESULTS: AF was diagnosed in 45 patients (10%; mean age, 70.5 ± 4.2 years; 55% women). AF detection was higher in those with LV hypertrophy, GLS < 16%, LAVi > 34 mL/m2, and LA reservoir strain < 34%. GLS, LAVi, and LA reservoir strain were independently associated with AF (P < .05). Those with AF had reduced GLS, higher LAVi, and higher LV mass (P < .05), but LA strain was similar in both groups (P > .05). GLS and LAVi were the strongest predictors, and cut points of 14.3% for GLS and 39 mL/m2 were associated with increased risk for developing AF. Those with all four risk parameters (LV hypertrophy, GLS < 16%, LA reservoir strain < 34%, and LAVi > 34 mL/m2) had a 60% AF detection rate, compared with 7% without these features (P = .004). CONCLUSION: Echocardiography is widely used in patients at risk for AF, and simple LV and LA measurements may be used to enrich the process of AF screening.

DOI： 10.1016/j.echo.2019.07.003

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記述言語：英語  

BACKGROUND: Left atrial (LA) enlargement is associated with atrial fibrillation (AF), but new-onset AF often occurs in the absence of LA enlargement. AF may be related to myocardial fibrosis, and even though left ventricular fibrosis is associated with mechanical dispersion, this phenomenon is not well studied in AF. We hypothesized that detection of LA dysfunction and mechanical dispersion using strain echocardiography is useful for predicting new-onset AF. METHODS: Baseline echocardiography was performed at entry in 576 community-based participants at risk of heart failure or AF. In this case-control study, we compared 35 individuals with new-onset AF (age 70 ± 4 years; 57% men) over 2 years of follow-up with 35 age- and sex-matched individuals who did not develop AF from the same cohort. Using speckle-tracking echocardiography, we measured the LA strain in each of 12 segments in the two- and four-chamber views. LA mechanical dispersion was defined as the SD of time to peak positive strain corrected by the R-R interval (SD-TPS, %). RESULTS: There was no significant difference in LA volume index (32.5 ± 9.2 mL/m2 vs 29.5 ± 8.3 mL/m2; P = .16); patients with new-onset AF had significantly worse LA pump strain (16.6% ± 4.3% vs 20.6% ± 4.3%; P < .01) and reservoir strain (31.4% ± 7.7% vs 38.0% ± 7.3%; P < .01) than those without AF. SD-TPS was significantly higher in patients with AF than in those without it (6.3% ± 2.3% vs 3.9% ± 1.6%; P < .01). SD-TPS was independently associated with new-onset AF after adjustment for patient characteristics, LA volume, and strain (hazard ratio = 1.26; 95% CI, 1.10-1.45; P < .01). In the nested Cox models, the model based on the LA volume and strain for predicting new onset AF was significantly improved by adding SD-TPS (P < .01). CONCLUSIONS: LA dispersion obtained from strain echocardiography seems to provide incremental information about LA volume and function in the prediction of new-onset AF and warrants testing in a larger study.

DOI： 10.1016/j.echo.2019.06.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Mutation in the lamin A/C gene (LMNA) is associated with several cardiac phenotypes, such as cardiac conduction disorders (CCD), atrial arrhythmia (AA), malignant ventricular arrhythmia (MVA) and left ventricular dysfunction (LVD), leading to sudden cardiac death (SCD) and/or end-stage heart failure. We investigated how these phenotypes are associated with each other and which of them are most important for total mortality. Methods and Results: A multicenter registry included 110 LMNA mutation carriers (age, 43±15 years, male: 62%) from 60 families. After genetic diagnosis of LMNA mutation (missense: 27%, non-missense: 73%), patients or subjects were followed to evaluate the manifestations of their phenotypes and the risk of total mortality; 90 patients could be followed (median: 5 [0-35] years). Prevalence of the 4 clinical phenotypes was significantly increased during follow-up. Among these phenotypes, AA was significantly associated with MVA. CCD was significantly associated with LVD. LVD, meanwhile, was significantly associated with CCD and MVA. Male sex was significantly associated with MVA. Furthermore, during follow-up, 17 patients died: 12 end-stage heart failure, 4 SCD and 1 stroke. LVD was the only independent predictor for all-cause death (OR: 41.7, 95% CI: 4.1-422.3; P=0.0016). CONCLUSIONS: Several cardiac phenotypes were age-dependently increased in LMNA mutation carriers, suggesting that ICD or CRT-D could suppress SCD after middle age; however, LVD leading to end-stage heart failure was the only independent predictor for total mortality.

DOI： 10.1253/circj.CJ-18-0339

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The cardiac phenotype of laminopathies is characterized by cardiac conduction disorders (CCDs) and dilated cardiomyopathy (DCM). Although laminopathies have been considered monogenic, they exhibit a remarkable degree of clinical variability. This case series aimed to detect the causal mutation and to investigate the causes of clinical variability in a Japanese family with inherited CCD and DCM.Of the five family members investigated, four had either CCD/DCM or CCD alone, while one subject had no cardiovascular disease and acted as a normal control. We performed targeted resequencing of 174 inherited cardiovascular disease-associated genes in this family and pathological mutations were confirmed using Sanger sequencing. The degree of clinical severity and variability were also evaluated using long-term medical records. We discovered a novel heterozygous truncating lamin A/C (LMNA) mutation (c.774delG) in all four subjects with CCD. Because this mutation was predicted to cause a frameshift mutation and premature termination (p.Gln258HisfsTer222) in LMNA, we believe that this LMNA mutation was the causal mutation in this family with CCD and laminopathies. In addition, gender-specific intra-familiar clinical variability was observed in this Japanese family where affected males exhibited an earlier onset of CCD and more severe DCM compared to affected females. Using targeted resequencing, we discovered a novel truncating LMNA mutation associated with CCD and DCM in this family characterized by gender differences in clinical severity in LMNA carriers. Our results suggest that in patients with laminopathy, clinical severity may be the result of multiple factors.

DOI： 10.1536/ihj.17-377

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s12574-017-0348-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Verapamil-sensitive idiopathic left ventricular tachycardia (verapamil-ILVT) is thought to be due to a reentry within the LV fascicular system. Radiofrequency catheter ablation (RFCA) is effective for elimination of the VT; however, a long-term prognosis of patients with verapamil-ILVT is still unclear. METHODS AND RESULTS: Eighty consecutive verapamil-ILVT patients (62 men, 31 ± 12 years of age, LVEF: 65 ± 4%) were enrolled. Seventy-six (95%) cases of VT involved right bundle branch block and left axis deviation. We retrospectively analyzed changes in the QRS duration (ΔQRS-d) and QRS axis (ΔQRS-axis) during follow-up and compared them with recurrence of VT. During a mean follow-up period of 10 years (2-32 years), no sudden death or heart failure occurred. Fifty-one (64%) patients underwent RFCA, and 46 (90%) of them had no VT without any medication after RFCA. The ΔQRS-d (16 ± 2 vs. 8 ± 1 ms, P = 0.24) and ΔQRS-axis (20 ± 4 vs. 4 ± 3 degrees, P = 0.23) were not different in patients with no VT (VT[-]) and those with recurrence of VT (VT[+]). However, in the remaining 29 patients without RFCA, VT was spontaneously eliminated in 16 patients. The ΔQRS-d (30 ± 6 vs. 6 ± 1 ms, P = 0.002) and ΔQRS-axis (23 ± 4 vs. 5 ± 2 degrees, P = 0.001) were significantly larger in VT(-) patients compared to VT(+) patients during follow-up. CONCLUSIONS: Some verapamil-ILVT patients who show QRS morphology changes over the follow-up period may become free from VT without any invasive or pharmacological treatments, suggesting that further altered LV fascicular conduction might eliminate the reentry of verapamil-ILVT.

DOI： 10.1111/jce.13403

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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  

Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Optical coherence tomography (OCT) provides accurate visualization of coronary artery morphology. The aim of this study was to investigate the relation between FFR and OCT-derived FFR. We retrospectively analyzed 31 lesions (25 left anterior descending arteries, 2 left circumflex arteries, and 4 right coronary arteries) in 31 patients with moderate-to-severe coronary stenosis, who underwent OCT and FFR measurements simultaneously. OCT-derived FFR was calculated by the original algorithm, which was calculated using the following equation based on fluid dynamics: ΔP = FV + SV2, where V is the flow velocity, F is the coefficient of pressure loss because of viscous friction (Poiseuille resistance), and S is the coefficient of local pressure loss because of abrupt enhancement (flow separation). Mean values of % diameter stenosis by quantitative coronary angiography and FFR were 55.2 ± 14.0% and 0.70 ± 0.14, respectively. OCT-derived FFR showed a stronger linear correlation with FFR measurements (r = 0.89, p <0.001; root mean square error = 0.062 FFR units) than quantitative coronary angiography % diameter stenosis (r = -0.65, p <0.001), OCT measurements of minimum lumen area (r = 0.68, p <0.001), and % area stenosis (r = -0.70, p <0.001). OCT-derived FFR has the potential to become an alternative method for the assessment of functional myocardial ischemia, and may elucidate the relation between coronary morphology and FFR.

DOI： 10.1016/j.amjcard.2017.07.083

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

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

DOI： 10.1002/ccr3.947

Web of Science

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記述言語：英語  

DOI： 10.1016/j.hrcr.2017.02.001

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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  

PURPOSE: The relationship between atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) and sleep-disordered breathing (SDB) evaluated using type-3 portable monitoring (PM) is still unknown. We investigated high-risk patients with AF recurrence after initial PVI using the apnea-hypopnea index (AHI) measured by type-3 PM. METHODS: One hundred twenty-four (85 males; age 62 ± 10 years) AF patients undergoing initial PVI were enrolled: 83, paroxysmal AF; 41, persistent AF. At baseline, all patients were subjected to in-hospital unattended overnight polygraphy using type-3 PM for SDB. RESULTS: During 13 ± 7 months following initial PVI, 47 patients (38 %) experienced AF recurrence. AHI and left atrial volume index (LAVI) were significantly greater in patients with than in those without AF recurrence (AHI P = 0.011; LAVI P < 0.001). LAVI was an independent predictor of AF recurrence following initial PVI in patients with both paroxysmal AF and persistent AF (paroxysmal AF P = 0.008; persistent AF P = 0.002). However, AHI was an independent predictor of AF recurrence following initial PVI in patients with paroxysmal AF (P = 0.034) but not in those with persistent AF. The optimal cutoff value was defined as AHI = 14.1. AF recurrence following PVI is three times higher in patients with AHI ≥14.1 than in patients with AHI < 14.1. CONCLUSIONS: AHI measured using type-3 PM is a useful predictor of outcome following initial PVI in patients with paroxysmal AF.

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記述言語：英語  

Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. However, it has the disadvantage of cost and invasive complication risks. We investigated the usefulness of quantitative coronary angiography-derived translesional pressure (QCA-TP) for predicting functional myocardial ischemia, using FFR as the gold standard. We retrospectively analyzed 152 coronary narrowings (98 left anterior descending arteries, 28 left circumflex arteries, and 26 right) in 132 patients with mild-severe coronary stenosis who underwent coronary angiography and FFR measurements simultaneously. QCA-TP was calculated using software implemented in the QCA software. Coronary morphology was calculated using both densitometry and lumen edges. Functional myocardial ischemia was defined as an FFR of 0.8 or less. The mean values of diameter stenosis by QCA and FFR were 48.9% ± 14.9 and 0.76 ± 0.14, respectively. QCA-TP was significantly correlated with FFR (r = 0.76, p <0.01). The cut-off values of QCA-TP for predicting functional myocardial ischemia based on FFR were 72.8 mm Hg for the left anterior descending arteries (accuracy, 86.7%; area under the curve [AUC], 0.93), 60.5 mm Hg for the left circumflex arteries (accuracy, 89.3%; AUC, 0.88), and 64.4 mm Hg for the right (accuracy, 88.5%; AUC, 0.94). Therefore, our data suggest that QCA-TP can predict myocardial ischemia with high diagnostic accuracy.

DOI： 10.1016/j.amjcard.2016.07.026

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

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記述言語：英語  

DOI： 10.1016/j.hrcr.2015.11.003

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記述言語：英語  

This case report describes sustained monomorphic ventricular tachycardia (VT) caused by a large epicardial scar, related to dilated-phase hypertrophic cardiomyopathy mimicking VT originating from the apical septum. VT resolved with epicardial catheter ablation. The exit of the VT circuit suggested that a 12-lead electrocardiogram can be remote with respect to the critical isthmus in this case. In patients with structural heart disease, it is difficult to identify the VT reentrant circuit by surface electrocardiography, which shows only the exit site. VT originating in the epicardium should be considered, even if the suspected origin is another ventricular site.

DOI： 10.1016/j.joa.2015.06.003

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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 Inc.  

DOI： 10.1016/j.hrcr.2014.12.011

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

症例は66歳女性. 心室頻拍 (VT1 : 右脚ブロック・下方軸) のstormにてカテーテルアブレーションを施行. 左室後側壁および心尖部に心室瘤を認め, 後日心臓サルコイドーシスと診断. 心内・外膜とも心室瘤に一致して低電位領域を認め, 頻拍中は後側壁瘤に最早期興奮部位を示す巣状興奮パターンを呈した. 心外膜最早期部位では著明な分裂電位を認め, 同部位への通電で頻拍は停止. その後, VT2 (右脚ブロック・上方軸) が出現. VT2はエントレイメント現象を認め, 心尖部瘤の心外膜側で必須緩徐伝導部位が同定された. 挟部への通電でVT2は停止. 以後経過良好であったが, 数カ月後にslow VTが出現. 再度経皮的アプローチも検討したが, 外科的瘤切除の方針とした. 心内膜はpatchyに線維変性を認め, 心尖部瘤形成, 後側壁瘤パッチ閉鎖および心室瘤-僧帽弁輪間のCryoアブレーションを施行した. 以後心室性不整脈は出現せず経過良好である.

DOI： 10.11281/shinzo.46.S3_191

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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

Loss-of-function mutations in the cardiac sodium channel α-subunit gene SCN5A result in multiple inherited arrhythmic syndromes. This case report describes 2 unrelated probands carrying an identical SCN5A frameshift mutation, V1764fsX1786, who exhibited distinct clinical manifestations: progressive cardiac conduction defect (PCCD)/Brugada syndrome (patient #1) and idiopathic ventricular fibrillation (IVF) (patient #2). Using a whole-cell patch clamp technique, cells expressing V1764fsX1786 showed no observable Na+ current. Therefore, a significant phenotypic overlap was found between IVF and PCCD/Brugada syndrome in the 2 probands with the V1764fsX1786, loss-of-function frameshift mutation of the cardiac sodium channel gene SCN5A. © 2013 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.joa.2013.04.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A rapid, sensitive convenient method for determination of aflatoxin M1 (AFM1) in cheese and butter by HPLC was developed and validated. The method employs a safe extraction solution (mixture of acetonitrile, methanol and water) and an immunoaffinity column (IAC) for clean-up. Compared with the widely used method employing chloroform and a Florisil column, the IAC method has a short analytical time and there are no interference peaks. The limits of quantification (LOQ) of the IAC method were 0.12 and 0.14 μg/kg, while those of the Florisil column method were 0.47 and 0.23 μg/kg in cheese and buffer, respectively. The recovery and relative standard deviation (RSD) for cheese (spiked at 0.5 μg/kg) in the IAC method were 92% and 7%, respectively, while for the Florisil column method the corresponding values were 76% and 10%. The recovery and RSD for butter (spiked at 0.5ng/kg) in the IAC method were 97% and 9%, and those in the Florisil method were 74% and 9%, respectively. In the IAC method, the values of in-house precision (n = 2, day = 5) of cheese and butter (spiked at 0.5 μg/kg) were 9% and 13%, respectively. The IAC method is superior to the Florisil column method in terms of safety, ease of handling, sensitivity and reliability. A survey of AFM 1 contamination in imported cheese and butter in Japan was conducted by the IAC method. AFM 1 was not detected in 60 samples of cheese and 30 samples of butter.

DOI： 10.3358/shokueishi.52.220

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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：英語   掲載種別：研究論文（学術雑誌）  

A 71-year-old man with a history of Sleep Apnea Syndrome (SAS) was admitted to our hospital because of recurrent syncopal episode. Hyperventilation test in electroencephalography (EEG) was performed suspected of epilepsy. Ventricular fibrillation (VF) suddenly occurred during the test, and was immediately converted to sinus rhythm without resuscitation. His electrocardiogram (ECG) at rest showed normal sinus rhythm with coved-type ST-segment elevation in leads V1 and V2. The coronary angiogram revealed no stenotic lesion. We observed that recurrent VF was reproduced by hyperventilation test. He underwent coronary spasm provocation test. The right coronary and the conus branch were occluded and further ST-segments elevation of V1 to V3 were observed after the right coronary injection of acetylcholine. Several coexistent cases of Brugada syndrome and vasospastic angina have been reported in Japan. This case suggested that hyperventilation might lead to VF easily in patients with Brugada syndrome accompanied by vasospastic angina. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.OP16_3

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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：(一社)中部日本整形外科災害外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Iron absorption from iron-saturated lactoferrin was compared to that from ferrous sulfate in iron-deficient anemic rats. One group of rats was given 50 μg of iron orally once a day and changes in red blood cell density, hematocrit, and hemoglobin values were measured at 14-day intervals for 70 days. A statistically significant increase in these values was demonstrated for the rats fed ironsaturated lactoferrin (50 μg Fe/35mg lactoferrin/day), while the ferrous sulfate group showed no improvement in these values. The results suggest that iron from iron-saturated lactoferrin is absorbed across the intestinal mucosa by a mechanism other than the one by which soluble iron salts are absorbed. © 1988, Japan Society for Bioscience, Biotechnology, and Agrochemistry. All rights reserved.

DOI： 10.1271/bbb1961.52.903

Scopus

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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：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

Web of Science

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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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：ELSEVIER SCIENCE INC  

Web of Science

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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  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

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

DOI： 10.1016/S0735-1097(15)60473-9

Web of Science

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記述言語：日本語   出版者・発行元：一般社団法人 日本不整脈心電学会  

発作性心房細動（PAF）に対する肺静脈隔離術（PVI）の有用性は確立されている．しかし，複数回のPVIを行ったにもかかわらず，再発をきたす症例は存在する．今回われわれは，当施設でPAFに対し2度目のカテーテルアブレーション（セカンドセッション）を行った連続61例を対象に，その患者背景，最終アブレーション成績，再発因子を後ろ向きに検討した．セカンドセッション後1年間で，61例のうち，21例に再発（AF 12例，心房頻拍9例）を認めた．再発群（n＝21）と非再発群（n＝40）の間に，年齢・性別・AF罹患期間・CHADS<SUB>2</SUB>スコア・心房径などの患者背景に差は認めなかった．しかし，セカンドセッション時にPV再伝導を認めた割合は，非再発群で有意に多かった（非再発群：39/40；97.5％ vs. 再発群：17/21；80.9％, p＝0.025）．また，両群間でNon-PV fociの合併率には差はなかったが（再発群：14/21；66.7％vs. 非再発群：17/40；42.5％, p＝0.073），Non-PV fociの起源を特定し，最終的に消失し得た割合は非再発群に有意に多かった（再発群：7/14；50％ vs. 非再発群：15/17；88％, p＝0.019）．結論として，Non-PV fociの存在はAFアブレーションの成績に大きく関与しており，可能な限りその起源を特定し，消失を目指すことが重要であることが示された．

DOI： 10.5105/jse.35.15

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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：日本サルコイドーシス/肉芽腫性疾患学会  

DOI： 10.7878/jjsogd.34.57-2

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

症例は54歳, 男性. 胸痛を主訴に来院した. 心電図にて胸部V1～4誘導のST上昇を認めST上昇型急性心筋梗塞 (ST segment elevation myocardial infarction ; STEMI) と診断し, 緊急冠動脈造影 (coronary angiography ; CAG) を行った. 左冠動脈前下行枝近位部の完全閉塞を認めたため, 緊急経皮的冠動脈インターベンション (percutaneous coronary intervention ; PCI) を施行した. PCI後は内服調整や心臓リハビリテーションを行い経過は良好であった. しかし, 第16病日に突然持続性心室頻拍 (ventricular tachycardia ; VT) が出現した. 緊急CAGで亜急性ステント血栓症 (subacute stent thrombosis ; SAT) を認めた. PCIを行い血行再建に成功したがelectrical stormの状態に陥った. ニフェカラントおよびアミオダロンで対応したが, アミオダロンを減量するとVTが再発するため, ソタロール併用を開始した. 併用開始後にVTは消失し, Electrical stormから離脱後に植込み型除細動器 (implantable cardioverter defibrillator ; ICD) 移植術を行い退院した. 退院後もICDの作動は認めていない. 亜急性ステント血栓症が契機になり, 血行再建後も持続した治療抵抗性electrical stormに対し, アミオダロンとソタロール併用療法が著効した症例を経験したため, 文献的考察を加え報告する.

DOI： 10.11281/shinzo.45.287

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

組織プラスミノーゲン活性化因子(tissue plasminogen activator；tPA)は強力な血栓溶解薬である．深部静脈血栓に対してtPAの有用性が示唆されるが，出血などの合併症をきたし得る．今回，われわれは若年発症の深部静脈血栓症に対して局所的血栓溶解療法が奏功したアンチトロンビンⅢ(ATⅢ)欠損症の1症例を経験したので報告する．症例は19歳，男性．急激に右下肢の疼痛と歩行困難が出現．深部静脈血栓症および右肺動脈内血栓と診断され，直ちに入院した．血栓は両下肢深部静脈から下大静脈の腎静脈分岐部付近まで広範囲に認められ，右肺動脈下葉枝には塞栓が認められた．入院後の検査で本症例は先天性ATⅢ欠損症患者であることが判明した．第1病日に下大静脈フィルターを留置し，FOUNTAIN^TM INFUSION SYSTEMを用いた後，遺伝子組み換え型tPA(モンテプラーゼ)による局所的血栓溶解療法と未分画ヘパリンおよびワルファリンの併用による抗凝固療法を開始した．局所的血栓溶解療法は約1カ月間で計9回施行した．これらの治療により大腿径は改善し肺動脈内血栓は消失した．出血などの合併症は認められず，治療は有効であったと考えられた．

DOI： 10.11281/shinzo.45.713

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

症例は42歳，男性．2004年7月に急性心筋梗塞のため，左前下行枝6番にベアメタルステント(bare metal stent；BMS)を留置された．2009年より通院を自己中断していた．2012年1月，胸痛を主訴に前医を受診し，心電図で前胸部誘導のST上昇を認めたため，当院へ救急搬送された．緊急冠動脈造影検査(coronary angiography；CAG)では，BMS留置部位の完全閉塞を認めた．血栓吸引後に施行した光干渉断層法(optical coherence tomography；OCT)では，BMS内にplaque rupture像を伴うlipid-laden neointimaを認めた．同部位に対しscoring balloonによる拡張を行い，手技を終了した．以後急性期は経過良好であり，3カ月後のfollow up CAGでは再狭窄は認めなかった．OCT 所見からin-stent neoatherosclerosisが破綻し，atherothrombosisによるステント血栓症を発症したと推測された興味深い症例と考えられたため，文献的考察を加えて報告する．

DOI： 10.11281/shinzo.45.990

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記述言語：日本語   出版者・発行元：一般社団法人 日本不整脈心電学会  

心室頻拍（VT）を合併する特殊心筋疾患は，催不整脈性右室心筋症（ARVC）や心サルコイドーシスが主である．【方法】VTを合併するARVC 84例，および心サルコイドーシス17例におけるアブレーション成績と長期予後を検討した．【結果】ARVCでは，平均9.2±6.5年の経過観察中に，VTの再発は31例（37％），心不全での入院は18例（21％），心原性死亡は7例（8％），心臓突然死は5例（6％），心不全死は2例（2％）に認めた．アブレーションは48例に施行し，81％でVTの誘発不能となった．経過観察中31％でVTの再発を認めた．心サルコイドーシスに伴うVT 17例に対し，アブレーションを施行したところ，9例（53％）で成功，１例は心外膜アプローチが必要であった．平均49±58ヵ月の経過観察期間中，アブレーション成功例9例中2例（22％）でVTが再発した．【結果】ARVCおよび心サルコイドーシス患者に対するVTアブレーション成績はいまだ不十分であり，今後の成績改善が待たれる．

DOI： 10.5105/jse.33.263

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

症例は70歳代，男性．睡眠時無呼吸症候群，アルツハイマー型認知症にて当院へ通院中であった．2010年10月下旬，車内で意識消失，全身性の痙攣発作を約5分間認め，救急要請し当院搬送された．来院時意識清明で神経内科受診となり，てんかん疑いにて脳波検査を施行した．過呼吸賦活試験中に意識消失し，モニター上，心室細動（VF) を認めた．心肺蘇生処置を行いつつ自動体外式除細動器（AED) が装着されたが，洞調律へ自然復帰し循環器科を紹介された．身体所見としてJCS1-1 血圧：130/70 mmHg，HR：45/分，SpO₂：99％（room air) で明らかな神経学的異常所見認めなかった．検査所見上，心電図: 脈拍45/分，V_{1, 2} coved型のST上昇を認めた．緊急冠動脈造影検査では有意狭窄を認めず，過換気負荷にてVFが誘発された．Brugada症候群の疑いあり，翌日植込み型除細動器（ICD) 植え込み術を施行した．以降VFの発生は認めなかった．冠攣縮性狭心症（VSA) の鑑別目的に第14病日にアセチルコリン負荷試験を施行したが，右冠動脈の攣縮が誘発され，心電図上II，III，aV_FのST低下とV₁，V₂誘導のST上昇を認め，冠攣縮性狭心症と診断した．Brgada症候群において過呼吸による副交感神経が亢進されVFが誘発された可能性と，過換気にて冠攣縮が誘発され虚血によるVFが誘発された可能性が考えられた．

DOI： 10.11281/shinzo.44.S2_48

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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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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  

CiNii Books

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記述言語：日本語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：Japanese Society for Food Science and Technology  

DOI： 10.3136/nskkk.51.641

Scopus

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