記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients. © 2013 Japanese Association of Cardiovascular Intervention and Therapeutics.

DOI： 10.1007/s12928-013-0193-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diastolic dysfunction of the heart is correlated with cardiac mortality. Serum cystatin C (CysC) is an endogenous marker of kidney function. It is not clear whether serum CysC is associated with diastolic dysfunction in patients with varying cardiac conditions with concomitant diastolic abnormalities and preserved ejection fraction (EF). The authors measured serum CysC levels in patients with cardiac diseases and examined the relationships between serum CysC levels and diastolic function. Serum CysC was measured and echocardiography was performed in 124 consecutive patients with cardiac diseases. Transmitral flow (TMF) patterns surrogating diastolic function were categorized into two groups: a normal group and an abnormal group. Serum CysC and BNP showed a significant positive correlation. There were no significant differences in serum CysC among those cardiac diseases. Seventy-eight patients with cardiac disease and preserved EF (left ventricular EF ≥50%) and without renal dysfunction (estimated glomerular filtration rate ≥60 mL/minute/1.73 m2) were examined. Multivariate linear regression analysis demonstrated that left atrium diameter and abnormal TMF patterns were independent determinants of serum CysC. Furthermore, patients with elevated serum CysC levels had poor prognosis. Serum CysC is associated with diastolic dysfunction in patients with various cardiac diseases and preserved EF. Serum CysC might be a biomarker of cardiac diastolic dysfunction in patients with preserved EF. © 2013 Wiley Periodicals, Inc.

DOI： 10.1111/chf.12039

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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：BMC  

Background: Postprandial hyperlipidemia impairs endothelial function and participates in the development of atherosclerosis. We investigated the postprandial effects of a dipeptidyl peptidase IV inhibitor, alogliptin, on endothelial dysfunction and the lipid profile.Methods: A randomized cross-over trial design in 10 healthy volunteers (8 males and 2 females, 35 +/- 10 years) was performed. The postprandial effects before and after a 1-week treatment of 25 mg/day alogliptin on endothelial function were assessed with brachial artery flow-mediated dilation (FMD) and changing levels of lipids, apolipoprotein B48 (apoB-48), glucose, glucagon, insulin, and glucagon-like peptide-1 (GLP-1) during fasting and at 2, 4, 6, and 8 h after a standard meal loading test.Results: Alogliptin treatment significantly suppressed the postprandial elevation in serum triglyceride (incremental area under the curve [AUC]; 279 +/- 31 vs. 182 +/- 32 mg h/dl, p = 0.01), apoB-48 (incremental AUC; 15.4 +/- 1.7 vs. 11.7 +/- 1.1 mu g h/ml, p = 0.04), and remnant lipoprotein cholesterol (RLP-C) (incremental AUC: 29.3 +/- 3.2 vs. 17.6 +/- 3.3 mg h/dl, p = 0.01). GLP-1 secretion was significantly increased after alogliptin treatment. Postprandial endothelial dysfunction (maximum decrease in% FMD, from -4.2 +/- 0.5% to -2.6 +/- 0.4%, p = 0.03) was significantly associated with the maximum change in apoB-48 (r = -0.46, p = 0.03) and RLP-C (r = -0.45, p = 0.04).Conclusion: Alogliptin significantly improved postprandial endothelial dysfunction and postprandial lipemia, suggesting that alogliptin may be a promising anti-atherogenic agent.

DOI： 10.1186/1475-2840-12-8

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

DOI： 10.1016/j.jacc.2012.05.063

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

Background-We investigated the acute effects of implantable cardioverter-defibrillator shock on myocardium, cardiac function, and hemodynamics in relation to left ventricular systolic function.
Methods and Results-We studied 50 patients who underwent implantable cardioverter-defibrillator implantation and defibrillation threshold (DFT) testing: 25 patients with left ventricular ejection fraction (LVEF) >= 45% and 25 patients with LVEF <45%. We measured cardiac biomarkers (creatine kinase, creatine kinase-MB, myoglobin, cardiac troponin T and I, and N-terminal probrain natriuretic peptide). Left ventricular relaxation was assessed by global longitudinal strain rate during the isovolumetric relaxation period using speckle-tracking echocardiography. Blood sampling and echocardiography were performed before, immediately after, and 5 minutes and 4 hours after DFT testing. Mean arterial pressure was measured directly during DFT testing. Cardiac biomarkers showed no significant changes in either group. LVEF was decreased until 5 minutes after DFT testing and had recovered to the baseline at 4 hours in the group with reduced LVEF (P<0.001), whereas LVEF reduction was not observed in the group with preserved LVEF (P=0.637). Global isovolumetric relaxation period was decreased until 5 minutes after DFT testing and had recovered to the baseline at 4 hours in both groups (preserved LVEF: 0.39 +/- 0.14 versus 0.23 +/- 0.13* versus 0.23 +/- 0.13* versus 0.40 +/- 0.13 s-1, *P<0.001 versus baseline; reduced LVEF: 0.15 +/- 0.05 versus 0.08 +/- 0.04 dagger versus 0.09 +/- 0.04 dagger versus 0.15 +/- 0.05 s(-1), dagger P<0.001 versus baseline, repeated-measures ANOVA). Time to recovery of mean arterial pressure to the baseline was prolonged in the group with reduced LVEF (P<0.001).
Conclusions-Implantable cardioverter-defibrillator shock transiently impairs cardiac function and hemodynamics especially in patients with systolic dysfunction, although significant tissue injury is not observed. (Circ Arrhythm Electrophysiol. 2012;5:898-905.)

DOI： 10.1161/CIRCEP.111.970285

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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：NATURE PUBLISHING GROUP  

As the plasma level of adiponectin is related to metabolic syndrome and cardiovascular events, a low plasma adiponectin level may either cause or trigger cardiovascular disorders. The purpose of this study was to determine whether a low adiponectin level contributes to cardiovascular events, and to investigate the factors influencing adiponectin in the Japanese Arita-cho cohort study. We followed about 2000 subjects in Arita-cho, Saga, Japan as a cohort study, and we enrolled 637 subjects (205 men; 65.1 +/- 8.3 years old) who participated in annual health checks from 2005 to 2008 and underwent measurement of the plasma adiponectin level and an oral glucose tolerance test. We monitored the incidence of cardiovascular or cerebrovascular events in these subjects until the end of 2010, discontinuing follow-up at 3 years after the start of enrollment. Subjects with low plasma adiponectin levels (<10.5 ng ml(-1)) had a higher incidence of newly diagnosed cardiovascular diseases such as acute heart failure or acute myocardial infarction than those with high plasma adiponectin levels (>= 10.5 ng ml(-1)) over an average of 2.95 years of follow-up. Multivariate analysis showed that the adiponectin level was predicted by the following parameters in all subjects: age (beta = 0.16), male gender (beta = -0.267), homeostasis model assessment of insulin resistance (beta = -0.140) and the plasma levels of high-density lipoprotein cholesterol (beta = 0.104), uric acid (beta = -0.13), triglycerides (beta = -0.169) and brain natriuretic peptide (beta = 0.151). The difference in plasma glucose before and 120 min after the intake of a 75-g glucose load did not influence the plasma adiponectin level. The plasma adiponectin level is useful for predicting cardiovascular events, and is a measure of the risk of lifestyle-related diseases. Hypertension Research (2012) 35, 843-848; doi:10.1038/hr.2012.42; published online 5 April 2012

DOI： 10.1038/hr.2012.42

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

BACKGROUND Syncope in patients with Brugada syndrome is usually associated with ventricular tachyarrhythmia, but some episodes of syncope can be related to autonomic disorders.
OBJECTIVE The purpose of this study was to investigate the characteristics of syncope to differentiate high-risk syncope episodes from low-risk events in patients with Brugada syndrome.
METHODS We studied 84 patients with type 1 electrocardiogram and syncope. Patients were divided into 2 groups: patients with prodrome (prodromal group; n = 41) and patients without prodrome (nonprodromal group; n = 43).
RESULTS Ventricular fibrillation (VF) was documented at index event in 19 patients: 4 patients (21%) with documented VF experienced a prodrome prior to the onset of VF, whereas 15 patients (79%) did not have symptoms prior to documented VF (P <.01). Twenty-seven patients in the prodromal group and 7 patients in the nonprodromal group were considered to have syncope related to autonomic dysfunction. Syncope in other patients was defined as unexplained syncope. During the follow-up period (48 +/- 48 months), recurrent syncope due to VF occurred in 13 patients among patients with only unexplained syncope and was more frequent in the nonprodromal group (n = 10) than in the prodromal group (n = 3; P = .044). In multivariate analysis, blurred vision (hazard ratio [HR] 0.20) and abnormal respiration (HR 2.18) and fragmented QRS (HR 2.39) were independently associated with the occurrence of VF.
CONCLUSION Syncope with prodrome, especially blurred vision, suggests a benign etiology of syncope in patients with Brugada syndrome.

DOI： 10.1016/j.hrthm.2011.11.045

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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：MOSBY-ELSEVIER  

Background: The aim of this study was to demonstrate the feasibility and usefulness of addition of the right parasternal approach to the conventional left parasternal and apical approaches using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE) for morphologic evaluation in cases of transcatheter closure of atrial septal defects (ASDs).
Methods: In 112 consecutive patients with ASDs, the morphology of the defects was evaluated for transcatheter closure in the right parasternal view in addition to the conventional left views using 2D and 3D TTE. Measurements of the maximal ASD diameter and detection of deficient rim obtained on 2D TTE were compared with those obtained by 2D transesophageal echocardiography. The shapes and locations of ASDs visualized by 3D TTE were compared with those visualized by 3D transesophageal echocardiography.
Results: In 88 patients (80.0%), optimal images from the right parasternal approach for morphologic evaluation of ASDs were obtained. Although there was a significant difference in maximal ASD diameter obtained only in the conventional left approach compared with transesophageal echocardiographic measurements (P < .05), when the right parasternal approach was applied, a significant difference was not found (P = .18), and the diagnostic concordance of the rim deficiency was improved from 85.2% to 90.9%. Three-dimensional TTE from the right parasternal approach improved visualization of the shape and location of ASDs from 65.5% to 74.5%.
Conclusions: Additional use of the right parasternal approach enables detailed morphologic evaluation for transcatheter closure of ASDs. In patients with suboptimal images on 3D TTE in the left conventional approach, additional 3D TTE in the right parasternal approach can improve the feasibility of obtaining optimal 3D images to evaluate the shapes and locations of ASDs. (J Am Soc Echocardiogr 2012;25:376-82.)

DOI： 10.1016/j.echo.2012.01.002

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

Intermittent arm ischemia before percutaneous coronary intervention induces remote ischemic preconditioning (RIPC) and attenuates myocardial injury in patients with myocardial infarction. Several studies have shown that intermittent arm ischemia increases coronary flow and is related to autonomic nerve system. The aim of this study was to determine whether intermittent arm ischemia induces vasodilatation of other arteries and to assess changes in the autonomic nerve system during intermittent arm ischemia in humans. We measured change in the right brachial artery diameter during intermittent left arm ischemia through three cycles of 5-min inflation (200 mmHg) and 5-min deflation of a blood-pressure cuff using a 10-MHz linear array transducer probe in 20 healthy volunteers. We simultaneously performed power spectral analysis of heart rate. Ischemia-reperfusion of the left arm significantly dilated the right brachial artery time-dependently, resulting in a 3.2 +/- A 0.4% increase after the 3rd cycle. In the power spectral analysis of heart rate, the high-frequency domain (HF), which is a marker of parasympathetic activity, was significantly higher after the 3rd cycle of ischemia-reperfusion than baseline HF (P = 0.02). Intermittent arm ischemia was accompanied by vasodilatation of another artery and enhancement of parasympathetic activity. Those effects may play an important role in the mechanism of RIPC.

DOI： 10.1007/s12576-011-0172-9

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

BACKGROUND Patients with Brugada syndrome (BS) often have spontaneous changes in their electrocardiogram (ECG).
OBJECTIVE To evaluate the significance of ECG alterations, we investigated the relationships between the ECG and the occurrence of ventricular fibrillation (VF) in both patients and an experimental model of BS.
METHODS In study 1, we evaluated ECG alterations in BS patients with (VF+, n = 33) and without (VF-, n = 41) spontaneous VF. We defined type 0 ECG as coved-type ST elevation without a negative T wave, which represents the existence of loss-of-dome (LOD) type action potentials (APs). In study 2, we optically mapped epicardial APs and recorded transmural ECGs in 34 canine right ventricular tissues with a drug-induced BS model by a combination of pinacidil and pilsicainide.
RESULTS In study 1, changes in ST level >= 0.2 mV were more frequent in the VF+ group than in the VF- group (P < .01). Spontaneous ECG alterations and appearances of types 1 and 0 ECGs were more frequent in the VF+ group than in the VF- group (P < .01). In study 2, BS model with spike-and-dome (SAD) epicardial APs exhibited type 1 ECG. Deepening of the phase 1 notch of the APs induced heterogeneous conversion of the APs (SAD -> LOD) and resulted in ECG conversion from type 1 to type 0. Significant AP heterogeneity often appeared during AP alterations and initiated phase 2 reentry. Tissues having ventricular tachycardia (VT; n = 20) had more frequent alterations in APs and ECG than in tissues without VT (n = 14; P < .01).
CONCLUSION ECG alterations, especially conversion between types 0 and 1, are associated with significant AP heterogeneity that can initiate VF in BS.

DOI： 10.1016/j.hrthm.2011.02.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000333801

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記述言語：英語  

Oxidative stress has been implicated in the pathogenesis of heart failure. Reactive oxygen species (ROS) are produced in the failing myocardium, and ROS cause hypertrophy, apoptosis/cell death and intracellular Ca2+ overload in cardiac myocytes. ROS also cause damage to lipid cell membranes in the process of lipid peroxidation. In this process, several aldehydes, including 4-hydroxy-2-nonenal (HNE), are generated and the amount of HNE is increased in the human failing myocardium. HNE exacerbates the formation of ROS, especially H2O2 and OH, in cardiomyocytes and subsequently ROS cause intracellular Ca2+ overload. Treatment with beta-blockers such as metoprolol, carvedilol and bisoprolol reduces the levels of oxidative stress, together with amelioration of heart failure. This reduction could be caused by several possible mechanisms. First, the beta-blocking effect is important, because catecholamines such as isoproterenol and norepinephrine induce oxidative stress in the myocardium. Second, anti-ischemic effects and negative chronotropic effects are also important. Furthermore, direct antioxidative effects of carvedilol contribute to the reduction of oxidative stress. Carvedilol inhibited HNE-induced intracellular Ca2+ overload. Beta-blocker therapy is a useful antioxidative therapy in patients with heart failure. © 2011 by the authors
licensee MDPI, Basel, Switzerland.

DOI： 10.3390/ph4081088

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

BACKGROUND Acquired long QT syndrome (LQTS) is a disease due to a secondary repolarization abnormality induced by various predisposing factors. In contrast to congenital LQTS, risk factors that produce acquired LQTS include organic heart diseases that often exhibit depolarization abnormality. Although various repolarization parameters have been evaluated in acquired LQTS, the existence of depolarization abnormality in association with torsades de pointes (TdP) has not been reported.
OBJECTIVE The purpose of this study was to evaluate both repolarization (QT components) and depolarization parameters (fragmented QRS [fQRS]) in acquired LQTS patients with markedly prolonged QT interval.
METHODS Seventy patients with acquired severe QT prolongation (QTc >= 550 ms) were studied. Thirty-two patients had syncope or TdP (syncope group). Thirty-eight patients did not have any symptoms (asymptomatic group). The existence of fQRS and QT components (QT, QTc, Tpe [interval between peak and end of T wave] intervals, and U-wave voltage) was analyzed.
RESULTS The syncope group had more frequent fQRS (81%) than did the asymptomatic group (21%, P < .01) and the incidence of fQRS was not different before and after removal of predisposing factors. The incidence of organic heart disease was not different between the two groups. No differences in QTc interval were noted between the syncope and asymptomatic groups, although the syncope group had longer QT and Tpe intervals and higher U wave than the asymptomatic group (P < .01).
CONCLUSION Acquired predisposing factors promoted repolarization abnormality (especially prolongation of QT and Tpe intervals), and the existence of fQRS had an important role in the development of TdP in patients with acquired LQTS.

DOI： 10.1016/j.hrthm.2010.09.008

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

It has been reported that bepridil prevents ventricular fibrillation (VF) in patients with Brugada syndrome, but the comparative efficacy with and without mutation in the SCN5A gene has not been elucidated. The purpose of this study was to assess the efficacy of low-dose bepridil (100 mg/day) for VF prevention in patients with Brugada syndrome with and without SCN5A mutation. Among 130 patients with Brugada-type electrocardiogram (ECG), low-dose bepridil was administered to seven patients because of repetitive VF episodes, including three with and four without SCN5A mutation. Preventive effect for VF recurrence and changes of the ECG and the signal-averaged ECG were evaluated. Frequencies of VF episodes were reduced after treatment with low-dose bepridil in all three patients with the SCN5A mutation (before: 0.33 versus after: 0.02 episodes/month, P < 0.01), but not in all four patients without the SCN5A mutation (before: 0.43 versus after: 2.94 episodes/month, P = nonsignificant). Levels of ST-segment elevation at J points and duration of low-amplitude signals less than 40 mu V in the terminal filtered QRS complex (LAS(40)) in signal-averaged ECG were improved exclusively in patients with the SCN5A mutation. Treatment with bepridil prevented recurrence of VF along with improvement of ST elevation and LAS(40) in patients with Brugada syndrome with the SCN5A mutation.

DOI： 10.1097/FJC.0b013e3181f03c2f

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

Identifying patients at high risk for the occurrence of atrial fibrillation is one means by which subsequent thromboembolic complications may be prevented. Left atrial enlargement is associated with progression of atrial remodeling, which is a substrate for atrial fibrillation, but impaired atrial pump function is also another aspect of the remodeling. Our objective was to differentiate patients with a history of paroxysmal atrial fibrillation using echocardiography. We studied 280 hypertensive patients (age: 66 7 years; left ventricular ejection fraction: 65 +/- 8%), including 140 consecutive patients with paroxysmal atrial fibrillation and 140 age- and sex-matched control subjects. Left atrial volume was measured using the modified Simpson method at both left ventricular end systole and preatrial contraction and was indexed to body surface area. Peak late-diastolic mitral annular velocity was measured during atrial contraction using pulsed tissue Doppler imaging as an atrial pump function. Left atrial volume index measured at left ventricular end systole had a 74% diagnostic accuracy and a 71% positive predictive value for identifying patients with paroxysmal atrial fibrillation; these values for the ratio of left atrial volume index at left ventricular end systole to the peak late-diastolic mitral annular velocity were 82% and 81%, respectively, and those for the ratio of left atrial volume index at preatrial contraction to the peak late-diastolic mitral annular velocity were 86% and 90%, respectively. In conclusion, left atrial size combined with atrial pump function enabled a more accurate diagnosis of a history of paroxysmal atrial fibrillation than conventional parameters. (Hypertension. 2010;55:1150-1156.)

DOI： 10.1161/HYPERTENSIONAHA.109.137760

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

BACKGROUND: Atrial fibrillation (AF) often occurs in Brugada syndrome (BrS), and BrS patients with spontaneous AF often experience ventricular fibrillation (VF) attacks. Atrial vulnerability providing a substrate for AF is known to be enhanced in BrS, but there are no data on atrial structural attributes.
OBJECTIVE: The objective of this study was to assess atrial electrophysiological and structural characteristics in BrS and their relationships with gene mutations.
METHODS: We studied 57 patients with BrS. Intra-atrial conduction time (CT) was defined as the interval from the stimulus at the high right atrium to atrial deflection at the distal portion of the coronary sinus. Left atrial volume index (LAVI) was measured by the modified Simpson method at left ventricular end-systole using echocardiography. SCN5A mutations were analyzed in all patients.
RESULTS: In patients with documented VF, spontaneous AF frequently occurred and prolonged CT and increased LAVI were observed compared with those in patients without VF (all P < .05; LAVI: 22 +/- 5 vs. 32 +/- 7 ml/m(2)). Even among patients without AF, CT and LAVI were still increased in patients with VF (all P < .05; LAVI: 22 +/- 5 vs. 29 +/- 5 ml/m(2)). The presence of SCN5A mutation was associated with prolonged CT (P < .05) and increased LAVI (P < .01), but not with arrhythmic episodes.
CONCLUSION: Both atrial vulnerability and structural remodeling are enhanced in high-risk patients with BrS, even in those without AF. These morphological characteristics suggest that BrS is a form of genetic myocardial disease.

DOI： 10.1016/j.hrthm.2009.10.035

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

Background: Progression of hypertrophic cardiomyopathy (HCM) to left ventricular dilatation and systolic dysfunction sometimes occurs. However, the mechanism of the transition from hypertrophy to dysfunction has not been elucidated. It has been reported that circulating levels of monocyte chemoattractant protein-1 (MCP-1), which is a major factor promoting the accumulation of macrophages, are increased in patients with congestive heart failure. We measured circulating levels of MCP-1 in patients with HCM and examined whether MCP-1 was expressed in the myocardium of HCM patients. We also examined whether circulating levels of MCP-1 were correlated with left ventricular dysfunction. Methods: Circulating levels of MCP-1 were measured by an enzyme immunoassay in 26 patients with HCM (60 2 years old) and 20 control subjects (57 2 years old). Cardiac function was evaluated by two-dimensional echocardiography and cardiac catheterization. Results: HCM patients had significantly elevated levels of MCP-1 (HCM: 309+/-30 vs. control: 178+/-8 pg/ml, P<001). MCPI levels in patients with systolic dysfunction were significantly higher than those in patients without systolic dysfunction (P<05) and were also significantly higher than those in patients with outflow obstruction (P<05). Immunohistochemical analysis revealed that MCP-1 was expressed in endomyocardial biopsy samples obtained from HCM patients with systolic dysfunction. Furthermore, MCP-1 levels were inversely correlated with fractional shortening (r=-.4011, P<05) and correlated with left ventricular end-diastolic pressure (r=-.579, P<01). Conclusion: These results show that MCP-1 is associated with, and might be involved in the pathogenesis of, left ventricular systolic dysfunction in patients with HCM. (C) 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.carpath.2008.12.004

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

Background: The aim of this study was to demonstrate the utility of real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) using a matrix array 3D transesophageal echocardiographic probe for morphologic evaluation and guidance of transcatheter closure of atrial septal defects (ASDs).
Methods: Forty-eight consecutive patients scheduled for the intervention were included. Two-dimensional (2D) transesophageal echocardiography (2D-TEE) and RT3D-TEE were performed before and during the procedures. Measurements of maximal ASD diameter and surrounding rims obtained on RT3D-TEE were compared with those obtained on 2D-TEE.
Results: In 46 patients (96%), optimal 3D images for the morphologic evaluation of ASDs were obtained. RT3D-TEE facilitated the evaluation of ASD morphology and surrounding rims and was able to provide intra-procedural information clearly. A Bland-Altman plot showed a mean maximal diameter difference of -0.12 mm between the means (95% limits of agreement, -2.2 to 2.5 mm).
Conclusion: RT3D-TEE is a clinically useful, complementary option to 2D-TEE for evaluation of ASD morphology and for interventional guidance. (J Am Soc Echocardiogr 2009; 22: 1114-20.)

DOI： 10.1016/j.echo.2009.06.008

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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-LISS  

Objectives: The aim of this study is to evaluate the feasibility and efficacy of device closure of atrial septal defect (ASD) in elderly patients with permanent atrial fibrillation. Background: Little is known about the feasibility of device closure of ASD in those patients. Methods: Nine consecutive patients (mean age 68.1 years) with permanent atrial fibrillation (>1 year persistent) underwent catheter closure using the Amplatzer septal occluder. Transthoracic echocardiography and plasma B-type natriuretic peptide (BNP) level were assessed before and at 24 hours; and 1, 3, and >6 months after the closure. Before the procedure, appropriate dose of warfarin was used in all, diuretics was used in 8/9. Same amount of medications were continued after the procedure. Results: ASD could be closed in all (mean device size 27.3 mm) without hemodynamic and thromboembolic complications. New York Heart Association (NYHA) functional classification was significantly improved in all patients after device closure. No hemodynamic and thromboembolic complications were observed during the follow-up period (mean 10.6 months). Although permanent atrial fibrillation did not change in all after the procedure, resting heart rate decreased from 76.2 +/- 16.0 to 68.3 +/- 13.2 beats/min (P = 0.015). There was statistically significant improvement in right ventricular/left ventricular diameter ratio (1.08 +/- 0.16 to 0.73 +/- 0.10, P = 0.008) and plasma BNP level (183.7 +/- 90.5 to 94.6 +/- 47.4 pg/mL, P = 0.008) after >6 months device closure. Conclusions: Even in the patients complicated with permanent fibrillation, transcatheter closure of ASD can contribute to symptomatic improvement as well as cardiac geometric remodeling. (C) 2009 Wiley-Liss, Inc.

DOI： 10.1002/ccd.21870

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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：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

It has remained unclear why functional mitral regurgitation (MR), even if it is of a mild degree, has prognostic importance in patients with idiopathic dilated cardiomyopathy (IDC). Exercise-induced changes in functional MR, which might be a clue to this question, have not been fully clarified. Thus, in this study, semisupine exercise echocardiography was performed on 32 asymptomatic or mildly symptomatic patients with IDC (29 men, mean age 45 +/- 14 years). The mean ejection fraction was 28 +/- 10% (range 13% to 45%). The effective regurgitant orifice (ERO) area of MR was measured, as well as echocardiographic parameters including mitral valve geometry. ERO at rest was associated best with systolic mitral tenting area (r(S) = 0.85, p < 0.001). Functional MR did not newly appear during exercise in 9 subjects without MR at rest. In the remaining 23 subjects with functional MR at rest, all showed exacerbations of MR, with a median ERO of 10.5 mm(2) (interquartile range 6.3 to 16.5) to 18.7 mm(2) (interquartile range 9.5 to 29.3) (p < 0.001). An increase in ERO was correlated best with the enlargement of tenting area (rs = 0.90, p < 0.001) and was the strongest independent determinant of exercise duration (P = -0.55, p = 0.002, multiple R-2 = 0.46). In conclusion, functional MR complicated with IDC was significantly exacerbated during exercise, with mitral valve deformation, which was strongly related to exercise intolerance; thus, the clinical impact of functional MR in patients with IDC could be more serious than can be expected by its degree at rest. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2008.03.086

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 48-year-old woman was admitted with a heart murmur and increased difficulty in breathing. Two-dimensional echocardiography revealed a defect in the lower part of the atrial septum [(primum atrial septal defect (ASD)] and a pouch at the interventricular septum. Color Doppler echocardiography detected grade 3/4 mitral regurgitation. Real-time three-dimensional echocardiography (RT-3DE) revealed a cleft in the anterior leaflet of the mitral valve toward the tricuspid valve, and the ASD located near the atrioventricular valves with 14mm in minor axis. Color Doppler three-dimensional echocardiography disclosed left-to-right ASD shunt toward the atrial posterior wall. No shunt through the pouch at the membranous part, left ventricular outflow obstruction, or partial anomalous pulmonary venous connection was observed. RT-3DE is quite useful to describe complicated congenital heart disease.

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記述言語：日本語   出版者・発行元：医学書院  

DOI： 10.11477/mf.1542201532

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

妊娠に伴う循環血液量や心拍数の増加は弁膜症の症状を悪化させ,特に重症例ではその診療に細心の注意を要する。さらに後天性と先天性のいずれであれ弁膜症は母胎と胎児死亡のきわめて大きなリスクとなりうるので,診療にガイドラインを含めて熟知しておかなくてはならない。弁膜症のなかでも閉鎖不全症よりも狭窄症のほうが,さらに右心系より左心系の弁膜疾患のほうがより大きなリスクとなる。さらに機械弁植込み後の症例では抗凝固療法に関連する問題が大きく,いまだに議論の絶えない領域である。本稿ではまず修復前の弁膜症での妊娠,出産管理上の注意点について述べた後,人工弁,特に機械弁における抗凝固療法の注意点について述べる。(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2017201297

記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)ライフメディコム  

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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：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

近年、多くの先天性心疾患が成人期に達するようになってきた。しかし、例え生存率が向上したとはいえ先天性心疾患はその複雑さから手術によって完全に治癒できない症例も多く、そのような症例では成人期に再手術や不整脈、そして本稿で取り上げる心不全が問題となる。成人先天性心疾患を基礎に持つ心不全では容量負荷もしくは圧負荷の異常、心室の機能低下、リズムの異常、心臓以外の要因などの心不全発症因子が単独で存在することもあるが、複数が存在し病態を複雑にしていることが多い。したがって、症例ごとに解剖学的特徴や血行動態を理解し、心不全の原因を解明しなくてはならない。成人先天性心疾患でも後天性の心不全と同様に神経体液性因子の賦活化が報告されており、従来の心不全治療で有用な薬剤が応用できる可能性があるが、これらの薬剤の成人先天性心疾患におけるエビデンスは確立されておらず、治療に関しては不透明な部分が多い。(著者抄録)

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記述言語：日本語   出版者・発行元：科学評論社  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：一般社団法人 日本循環器学会  

DOI： 10.1253/jjcsc.21.2_205

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記述言語：日本語   出版者・発行元：(株)最新医学社  

近年,人口の高齢化と動脈硬化性疾患の増加に伴い,左室駆出率が正常の心不全,いわゆる拡張不全が増加してきている.拡張不全については現時点で確立された治療法はなく,少なくとも予後良好の症候群ではなさそうであるが,その一方で,これまでの報告の解釈を含め不明な点が多い.その原因の1つとして,曖昧な疾患概念ゆえに診断基準が統一されていなかったことが挙げられる.本稿では,現時点で判明している拡張不全治療のエビデンスについて述べたい.(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2012297412

記述言語：日本語   出版者・発行元：最新医学社  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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その他リンク： http://search.jamas.or.jp/link/ui/2011282966

記述言語：日本語   出版者・発行元：(株)北隆館  

近年、心不全症例の中に左室駆出率が保持されたいわゆる拡張不全が増加してきている。拡張不全の発症機序は不明な点が多いが、高血圧、慢性腎臓病、糖尿病などが基礎疾患として多いことが分かっており、もはや心臓疾患としてだけではなく全身疾患として捉えて治療に望まねばならない症例が多い。拡張不全に対する治療を検討した大規模臨床研究はこれまでにいくつか報告されている。その全てが収縮不全にも効果がある、ACE阻害薬、ATII受容体拮抗薬、β遮断薬、ジギタリスの拡張不全に対する効果を検討しているが、いずれの薬剤も満足のいく結果は得られていない。疾患概念の曖昧さも結果に関与していると思われるが、現時点では高血圧患者に対する積極的高圧を含めた予防医療が重要であることは確かなようである。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)永井書店  

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記述言語：日本語   出版者・発行元：メディカ出版  

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記述言語：日本語   出版者・発行元：永井書店  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

拡張期心不全の慢性期治療に関する大規模臨床試験として、V-HeFT II、DIG、CHARM-Preserved Trial、SENIORS、PEP-CHF、I-PRESERVEを紹介した。また、比較的小規模であるが、より詳細に経過を追ったものや左室拡張能を観察した研究を、以下の薬剤ごとにまとめた。1)アンジオテンシン変換酵素(ACE)阻害薬、2)ACE阻害薬、アンジオテンシンII受容体拮抗薬(ARB)、3)β遮断薬、4)ACE阻害薬、ARB、β遮断薬、5)抗アルドステロン薬、6)スタチン。

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記述言語：日本語   出版者・発行元：(株)羊土社  

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記述言語：日本語   出版者・発行元：羊土社  

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記述言語：日本語   出版者・発行元：(株)永井書店  

感染性心内膜炎は比較的まれな疾患です。循環器科以外では遭遇する機会も少ないと思われます。しかし、反対に循環器科からみると、他科で不明熱と診断され、抗生剤を漫然と投与され、そのうちに心不全や動脈塞栓などの重篤な合併症が起きてから紹介される症例が少なくないのも事実です。最初は非典型的な症状であり、しかもその頻度がまれであるがゆえに、"疑わないと"診断できないのが感染性心内膜炎です。本稿では始めに感染性心内膜炎の概論、次に心エコー図所見と臨床シナリオを記載しています。最後に、本書を読まれている先生方が扱うことが多いと思われます経胸壁心エコー図検査を中心に、実際の症例を呈示しながら解説していきます。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)永井書店  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：へるす出版  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(株)インナービジョン  

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