25 results on '"Yukihiko Matsuno"'
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2. Characteristics of left ventricular hypertrophy estimated by MIBG and BMIPP cardiac scintigraphy in patients undergoing peritoneal dialysis
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Yasunori Kotoo, Hiroshi Oda, Hiroshige Ohashi, Michiya Ohno, Sachirow Watanabe, and Yukihiko Matsuno
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Cardiology ,In patient ,Cardiac scintigraphy ,business ,Left ventricular hypertrophy ,medicine.disease ,Peritoneal dialysis - Abstract
腹膜透析 (PD) は血液透析 (HD) に比較して体液量の急激な変化が少なく, 心機能が低下した透析患者の血液浄化法としてすぐれた方法である. しかしながら, PD患者で心肥大は頻度の高い合併症であり, 心血管系合併症による脱落例はHD患者と同様に多く認められる. 今回, PD患者を対象に非観血的な方法である123I metaiodobenzylguanidine (MIBG) ならびに123I β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) 心筋シンチグラフィーを施行し, その心肥大の特徴について検討した.持続携行式腹膜透析法 (CAPD) を中心としたPD患者45名 (平均年齢52.6歳) を対象とした. 基礎疾患は全例, 慢性糸球体腎炎である. また, 心臓超音波検査を行うとともに心房性ナトリウム利尿ペプチド (ANP), 脳性ナトリウム利尿ペプチド (BNP), 遊離カルニチンを測定した.左室心筋重量の増大しているPD症例は84.4%で収縮機能は比較的良好に保たれていた. 左室心筋重量はMIBGならびにBMIPP心筋シンチグラムの心臓/上縦隔集積比 (H/M) と負の相関を, 年齢, ANP, BNPと正の相関を示した. 心筋シンチグラムでの欠損はMIBGで37.8%に, BMIPPで62.2%に認められた. 広範な欠損 (diffuse defect) を呈するPD症例の左室収縮機能は低下し, とくにBMIPP心筋シンチグラムでdiffuse defectを示した症例で遊離カルニチンが低下していた.以上の結果より, 心肥大を有するPD患者では心臓交感神経機能と心筋脂肪酸代謝が障害され, 予後に大きな影響を与えている可能性が示唆された.
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- 2002
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3. Evidence of a Cellular Protective Effect by Antecedent Angina Independent of Collateral Flow Recruitment During Coronary Angioplasty in Humans
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Hisayoshi Fujiwara, Takahiko Yamaki, Masaaki Tomita, Tomonori Segawa, Shuusaku Miyata, Yukihiko Matsuno, Takeshi Hirose, Sachiro Watanabe, Makoto Iwama, Tohru Kadosaki, Hitoshi Matsuo, Shinichiro Tanaka, and Shinya Minatoguchi
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Ischemia ,Ischemia ,Collateral Circulation ,Severity of Illness Index ,Angina Pectoris ,Angina ,Electrocardiography ,Internal medicine ,Angioplasty ,medicine ,Humans ,cardiovascular diseases ,Angioplasty, Balloon, Coronary ,Aged ,business.industry ,ST elevation ,General Medicine ,Middle Aged ,medicine.disease ,Collateral circulation ,Stenosis ,Coronary occlusion ,Ischemic Preconditioning, Myocardial ,Cardiology ,Ischemic preconditioning ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The main aim of this study was to elucidate whether the beneficial effect of antecedent angina is a cellular protective effect or the result of an increase of collateral flow. Of 42 patients with angina who underwent percutaneous transluminal coronary angioplasty (PTCA) for proximal left anterior descending artery (LAD) stenosis, 22 had experienced antecedent anginal pain (AP) within 7 days prior to PTCA. 99mTc-sestamibi was injected during balloon inflation, and quantitative analysis of ischemic severity during coronary occlusion was calculated (SS). An electrocardiogram was recorded during ballooning to calculate the sum of ST elevation (ΣST). ΣST was significantly reduced in patients with AP compared with patients without AP (1.88±0.89 mV vs 1.18±0.74 mV, p=0.0088); however, no difference was observed in defect severity. A close correlation was observed between SS and ΣST in both groups. The multivariate regression model demonstrated that both a large SS (p
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- 2002
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4. Lipoprotein(a) and apolipoprotein(a) phenotype as a risk factor of coronary artery disease in chronic hemodialysis patients
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Michiya Ohno, Yukihiko Matsuno, Yasunori Kotoo, Sachirow Watanabe, Hiroshi Oda, and Hiroshige Ohashi
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medicine.medical_specialty ,biology ,Apolipoprotein B ,business.industry ,Lipoprotein(a) ,medicine.disease ,Phenotype ,Coronary artery disease ,Internal medicine ,medicine ,biology.protein ,Cardiology ,lipids (amino acids, peptides, and proteins) ,Chronic hemodialysis ,Risk factor ,business - Abstract
冠動脈疾患 (coronary artery disease, CAD) の発症頻度が慢性血液透析 (hemodialysis, HD) 症例で高いことが問題になっている. HD症例では中性脂肪 (triglyceride, TG) の上昇とHDL-コレステロール (high density lipoprotein cholesterol, HDL-C) の低下が脂質代謝異常の特徴と考えられてきたが, 近年, lipoprotein (a) 〔Lp(a)〕 の上昇しているHD症例の多いことが報告されるようになり, なかでもCADとの関連が注目されるようになった. また, apolipoprotein (a) 〔apo(a)〕 phenotypeのうちlow molecular weight (LMW) がHD症例でのCAD発症に関与していることが報告されるようになった. このような背景をもとに本研究では冠動脈疾患の既往が明らかでないHD症例を5年間, 前向きに (prospective) に経過観察し, Lp(a) ならびにLMWがHD症例でのCAD発症の危険因子となるかを検討した.268名のHD症例のうち37名 (13.8%) にCADが発症した. その内訳は心筋梗塞22名, 狭心症7名, 無症状であったが何らかの機会に冠動脈造影 (coronary angiography, CAG) が施行され, 75%以上の有意狭窄を認めたもの8名であった. また今回の検討では年齢が高く, 基礎疾患が糖尿病性腎症 (diabetic nephropathy, DN) であり, LMWでLp(a) が高値を示すHD症例にCADが多く出現した. 多変量解析による検討からはLp(a) が30mg/dl以上, DN, LMW, 年齢65歳以上がCADの独立した危険因子であった.以上により, HD症例では年齢, DNという基礎疾患を背景に, 遺伝的に決定されているapo(a) phenotypeのLMWならびにLp(a) が高値を示す症例でCADの発症する可能性の高いことが示唆された.
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- 2001
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5. Three minute, but not one minute, ischemia and nicorandil have a preconditioning effect in patients with coronary artery disease
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Masazumi Arai, Hisayoshi Fujiwara, Kenji Hayakawa, Masanori Kawasaki, Shinya Minatoguchi, Sachiro Watanabe, Tetsuo Matsubara, Toshiyuki Noda, Hitoshi Matsuo, Genzou Takemura, Kazuhiko Nishigaki, Tomonori Segawa, Yukihiko Matsuno, and Yoshihiro Uno
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Male ,Time Factors ,medicine.medical_treatment ,Vasodilator Agents ,Ischemia ,Hemodynamics ,Isosorbide Dinitrate ,Coronary Angiography ,Angina Pectoris ,Coronary artery disease ,Electrocardiography ,Angioplasty ,Medicine ,ST segment ,Humans ,Angioplasty, Balloon, Coronary ,Nicorandil ,business.industry ,Middle Aged ,medicine.disease ,Treatment Outcome ,Anesthesia ,Injections, Intravenous ,Ischemic Preconditioning, Myocardial ,Ischemic preconditioning ,Female ,Isosorbide dinitrate ,business ,Cardiology and Cardiovascular Medicine ,medicine.drug - Abstract
OBJECTIVES This study focused on 1) the determination of the optimal preconditioning (PC) duration, and 2) the protective effect of nicorandil (NC), a hybrid nitrate with a K atp channel opening effect, during a percutaneous transluminal coronary angioplasty (PTCA) model in humans. BACKGROUND The ischemic PC effect is induced in 180 s ischemia, but not in 120 s ischemia in rabbit hearts. However, the duration of ischemia that induces PC effect and the role of the K atp channel in the PC effect in humans are still unclear. METHODS Forty-six patients with stable angina were randomly allocated to four groups: the duration of the first inflation as PC ischemia was 60 s in the PC60 group (n = 12), and 180 s in the PC180 group (n = 12). In the other groups, NC (80 μg/kg) was intravenously given for 1 min in the NC group (n = 12), and isosorbide dinitrate (ISDN) (40 μg/kg) was given in the ISDN group (n = 10). Five minutes after first inflation or drug administration, a second inflation was conducted for 120 s in each group. In the ECG, the lead with the largest shift in ST segment (deltaST max), and the sum of elevated ST levels in all leads (sigmaST) were determined. RESULTS In the PC60 group, no significant difference was observed in either deltaST max or sigmaST between the first and second inflation. However, the second inflation in the PC180 group showed significantly lower levels of deltaST max and sigmaST compared with those of the first inflation. In the NC group, both deltaST max and sigmaST measured at 30 s and 60 s after balloon inflation were significantly lower than those of the first inflation in the PC60 and PC180 control groups. In the ISDN group, no significant difference was observed in deltaST max or sigmaST. CONCLUSION In human PTCA models, a PC effect is observed in 180 s ischemia, but not in 60 s ischemia. A pharmacological PC effect is induced by NC, a K atp channel opener with a nitrate-like effect but not ISDN. This suggests that the opening of K atp channels plays an important role in the protecting effect of NC.
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- 2000
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6. Lipoprotein(a) as an independent risk factor of coronary artery disease in patients on hemodialysis
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Hitomi Yokoyama, Shigeki Sawada, Michiya Ohno, Hiroshi Oda, Toshio Okuma, Hagime Araki, Yasunori Kotoo, Takahiro Hirano, Sachirow Watanabe, Motoyuku Ishiguro, Hiroshige Ohashi, Yukihiko Matsuno, and Hiroyasu Ito
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medicine.medical_specialty ,biology ,business.industry ,medicine.medical_treatment ,Lipoprotein(a) ,medicine.disease ,Coronary artery disease ,Internal medicine ,medicine ,biology.protein ,Cardiology ,In patient ,Hemodialysis ,Risk factor ,business - Abstract
冠動脈疾患 (CAD) などの心血管系合併症の発症頻度が維持血液透析 (HD) 患者で高いことが問題になっている. HD患者の脂質代謝異常が動脈硬化の発症, 進展に大きな役割を演じていることが報告され, 高中性脂肪 (TG) 血症と低HDL-コレステロール (HDL-C) 血症がその特徴と考えられている. 近年, リポプロテイン (a) (Lp(a)) の上昇しているHD患者の多いことが報告されるようになり, 心血管系合併症, なかでもCADとの関連が注目されるようになった. 今回, 我々は5年間経過を観察し, HD患者のLp (a) が心血管系合併症, なかでもCADの独立した危険因子となるか, 検討した.5年間でHD患者268名 (慢性腎炎: CGN212名, 糖尿病性腎症: DN56名) のうち70名が死亡した. 内訳は心血管系合併症, 悪性腫瘍, 感染症の順であった. 心血管系合併症による死亡例は脳血管障害 (CVD) 26名, CAD22名, 胸部大動脈瘤破裂1名の計49名であった. 心血管系合併症で死亡した症例は, 非心血管系合併症で死亡した症例に比較して, Lp (a) が有意に上昇していた. また心血管系合併症のうちCVDに比較してCADでLp (a) はさらに上昇していた.しかしながら, Lp (a) 30mg/dl以上の症例は未満の症例に比較して生存率が低いという結果は得られなかった.CADで死亡した症例はLp (a) のオッズ比4.13 (95%信頼区間1.25-15.0), 相対危険度0.71で, HD患者でLp (a) はCADの独立した危険因子となることが示唆された.以上より5年間の経過観察から, 心血管系合併症で死亡したHD患者のLp (a) は上昇しており, Lp (a) はCADの独立した危険因子となる可能性が高い.
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- 1998
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7. Assessment of cardiac sympathetic nerve abnormalities by 123I-MIBG (metaiodobenzylguanidine myocardial scintigraphy in diabetic patients undergoing hemodialysis
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Yasunori Kotoo, Toshio Okuma, Shintarou Tanihata, Motoo Kanou, Sachirou Watanabe, Yoshio Nishida, Takahiro Hirano, Motoyuki Ishiguro, Hitoshi Matsuo, Hiroshi Oda, Tetsuo Matsubara, Hiroshige Ohashi, and Yukihiko Matsuno
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medicine.medical_specialty ,Myocardial scintigraphy ,business.industry ,123i mibg ,Cardiac sympathetic nerve ,medicine.medical_treatment ,Internal medicine ,Cardiology ,Medicine ,Hemodialysis ,business - Abstract
糖尿病性腎症による透析導入患者は年々増加の一途を辿っているが, その生存率は低く, 心血管系合併症による死亡例が多い. 糖尿病血液透析患者 (DN) の心合併症は慢性腎炎血液透析患者 (CGN) に比較して, 無痛性心筋虚血や左室拡張機能障害を呈する症例が多く, また冠動脈病変はびまん性で多枝にわたるという特徴を有している. またDNでの予後に心臓自律神経障害の関与している可能性も示唆されているが, 定量的な試みは未だ行われていない. 今回, 我々は心臓交感神経障害の評価に有効であると報告されている123I-metaiodobenzylguanidine (MIBG) を用い, DNでの心臓交感神経障害について検討した.CGN (平均年齢52.6歳) 21名とDN (平均年齢53.9歳) 18名を対象に123I-MIBG心筋シンチグラフィーを施行し, 心臓交感神経障害について検討した. いずれの症例も心筋梗塞の既往がなく, また現在, 明らかな狭心症を呈さず, しかも安静時の201Thallium (TI) 心筋シンチグラムでdefectが証明されない症例である. なお両群の年齢, 透析期間に有意差を認めていない.CGNに比較してDNではSPECT (single-photon emission computed tomography) でdefectを呈する症例が多く認められ, 心臓/上縦隔 (H/M) は低値を示した.以上より, CGNに比較してDNでは心臓交感神経障害が高度かつ高頻度に認められた.
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- 1995
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8. Identification of asynergic but viable myocardium in patients with chronic coronary artery disease by gated blood pool scintigraphy during isosorbide dinitrate and low-dose dobutamine infusion: Comparison with thallium-201 scintigraphy with reinjection
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Sachiro Watanabe, Hiroshi Oda, Hiroshige Oohashi, Tetsuo Matsubara, Shintaro Tanihata, Motoyuki Ishiguro, Hitoshi Matsuo, Yoshio Nishida, Yasunori Kotoo, Yukihiko Matsuno, Motoo Kano, and Yoshihiro Uno
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Adult ,Male ,medicine.medical_specialty ,Asynergy ,Systole ,medicine.medical_treatment ,chemistry.chemical_element ,Coronary Disease ,Isosorbide Dinitrate ,Revascularization ,Coronary artery disease ,Ventricular Dysfunction, Left ,Diastole ,Dobutamine ,Internal medicine ,Myocardial Revascularization ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Infusions, Intravenous ,Aged ,Tomography, Emission-Computed, Single-Photon ,business.industry ,Blood pool scintigraphy ,Gated Blood-Pool Imaging ,Heart ,General Medicine ,Middle Aged ,medicine.disease ,Thallium Radioisotopes ,chemistry ,Cardiology ,Thallium ,Female ,Isosorbide dinitrate ,business ,Perfusion ,medicine.drug - Abstract
To evaluate the ability of low-dose dobutamine and isosorbite dinitrate (ISDN) gated blood pool scintigraphy (GBPS) and thallium SPECT with reinjection to identify viability in asynergic myocardium, both procedures were performed in 38 consecutive patients with chronic coronary artery disease and left ventricular dysfunction. Twenty-two of the 38 patients with successful revascularization were analyzed. GBPS was performed at the baseline and during continuous infusion of low dose dobutamine (5 micrograms/kg/min) and ISDN (2 micrograms/kg/min). Cine mode GBPS wall motion was scored from normal (0) to dyskinesis (4) semiquantitatively. Forty-seven of 110 segments with severe asynergy at the baseline were analyzed. Viability determined by GBPS was defined as wall motion score improvement by more than 1 grade. Thallium viability was defined as the segment with redistribution or fill in with severe initial perfusion defect. GBPS was 76.7% sensitive and 70.6% specific for predicting post vascularization wall motion improvement (p0.005). Of 47 segments with severe asynergy, concordance of judgement was obtained in 40 segments (85.1%), and reversibility was correctly diagnosed in 34 of 40 patients (85.0%), but thallium with reinjection correctly identified tissue viability in 6 of 7 segments with discordance between 2 studies. These data suggest that most cases of reversible asynergy (hibernating myocardium) respond to ISDN and dobutamine, suggesting the possibility of predicting improvement by revascularization, although some underestimation of tissue viability remained to be resolved. Thallium with reinjection is superior to low-dose dobutamine + ISDN GBPS for the assessment of myocardial viability.
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- 1994
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9. Double filtration plasmapheresis was effective in the treatment of a case of pemphigus vulgaris with multiple organ failure
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Hiroshige Ohashi, Sachirou Watanabe, Michihiro Otani, Yasunori Kotoo, Hiromi Aoyama, Yukihiko Matsuno, Kazuko Osada, and Hiroshi Oda
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medicine.medical_specialty ,business.industry ,Pemphigus vulgaris ,Medicine ,business ,medicine.disease ,Dermatology ,Double filtration plasmapheresis - Abstract
尋常性天疱瘡は種々の弛緩性水疱を生じる難治性の自己免疫疾患であるが, 抗表皮細胞膜抗体の血中における高低が臨床症状と強い相関を示すことが報告されている. 今回, 抗表皮細胞膜抗体が極めて高く, 多臓器不全を呈した尋常性天疱瘡に二重濾過血漿交換療法 (DFPP) を施行し, 救命しえた1例を経験したので報告する. 症例は57歳の女性で, 全身に弛緩性水疱とびらんがあり, ステロイド剤の投与を受けていたが, 症状改善せず多臓器不全の状態で入院した. 皮膚よりの出血, 下血による貧血, 肝機能障害, 皮膚感染症と敗血症, 腎不全, 心不全ならびに呼吸不全の状態であった. 上記病態のため大量のステロイド剤を投与することが困難で, 1万倍以上の高値を示した抗表皮細胞膜抗体除去の目的でDFPPを併用した. 計6回のDFPPを施行していくなかで皮膚病変ならびに臓器不全も次第に軽快し, 救命しえた. 現在, 外来通院中であるが, 少量のステロイド剤の投与下で水疱の出現を認めていない. DFPPは尋常性天疱瘡をはじめとする各種自己免疫疾患に有効で, 難治例に対して積極的に試みられるべき血液浄化療法の一つと思われる.
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- 1994
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10. Lipid abnormalities in CAPD patients. A study including Lp(a) lipoprotein
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Motoo Kano, Hiroshi Oda, Sachiro Watanabe, Akira Sugiyama, Hitoshi Matsuo, Yoshio Nishida, Shoichiro Mori, Hiroshige Ohashi, Yasunori Kotoo, Yukihiko Matsuno, and Tetsuo Matsubara
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medicine.medical_specialty ,A lipoprotein ,Endocrinology ,Biochemistry ,Apolipoprotein B ,biology ,business.industry ,Internal medicine ,medicine ,biology.protein ,business - Abstract
慢性血液透析 (HD) 患者の脂質代謝異常が動脈硬化症の進展に関与していることが報告されているが, 持続性自己管理腹膜透析 (CAPD) 患老ではHD患者の脂質代謝異常の特徴である高中性脂肪 (TG) 血症, 低HDL-コレステロール (HDL-C) 血症に透析膜によるブドウ糖の負荷と透析膜としての腹膜の特性が加味された病態が予想される.本研究ではIgA腎症, HD患者を対照にCAPD患者の脂質代謝異常について検討した. また高脂血症, 血栓症, 動脈硬化症との関係から注目されているLp(a) についても検討し, 以下の結論が得られた.CAPD患者では, IgA腎症, HD患者に比較して総コレステロール (TC), TG, LDL-コレステロール (LDL-C), 動脈硬化指数, アポリポタンパクB (Apo B), Apo B/A-Iが高く, HDL-CはHD患者と同様に低値を示した. またCAPD患者のLp(a) は高値を示し, 血清アルブミンと逆相関を認めたことから, 肝での合成亢進による可能性が考慮されるが, その機序の詳細は不明である. なおペルサンチン負荷心筋タリウムシンチグラムで心筋虚血が認められたCAPD患者のLp(a) は認められなかった患者に比較して高値を示さなかった.以上よりCAPD患者はIgA腎症, HD患者に比較して脂質代謝の面より動脈硬化促進的であることが示唆された.
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- 1992
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11. Clinical significance of .ALPHA.-human atrial natriuretic peptide in patients on maintenance dialysis
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Yasunori Kotoo, Tetsuo Matsubara, Hiroshi Oda, Nobuyoshi Sugishita, Sachiro Watanabe, Hitoshi Matsuo, Katsumi Ueno, Hiroshige Ohashi, Masazumi Arai, Akira Sugiyama, Kunihiro Okada, and Yukihiko Matsuno
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,Medicine ,In patient ,Clinical significance ,Alpha-human atrial natriuretic peptide ,business ,Dialysis - Abstract
心房性Na利尿ペプチド (α-hANP) の慢性血液透析 (HD) 患者と持続性自己管理腹膜透析 (CAPD) 患者の臨床的意義, とくにドライウエイトとの関係について検討した.健常者10例 (男性5例, 女性5例, 平均年齢45.6歳), CAPD患者11例 (男性7例, 女性4例, 平均透析歴20.9か月), HD患者10例 (男性5例, 女性5例, 平均透析歴25.4か月) を対象とした. GAPDならびにHD患者の基礎疾患は全例, 慢性糸球体腎炎である. CAPD患者では心臓超音波検査施行日にα-hANPと限外濾過指数 (UFI) を測定した. HD患者ではHD前後に心臓超音波検査を, またHD前後ならびに次回HD前にα-hANPを測定した. また心エコー図法により左房径, 左室心筋重量を求めた.以下の結論が得られた. 1. HD患者のα-hANPは健常者, CAPD患者に比較して上昇していた. 2. 左室心筋重量はCAPDとHD患者で増大していた. CAPD患者に比較してHD患者でその増大傾向は顕著であった. 3. 左房径とα-hANPとの間に有意の正相関が認められた. 4. HDによりα-hANPは減少した. α-hANPの減少率と体重減少率との間に有意の相関が認められた. 5. HD後と次回HD前のα-hANP増加率と体重増加率との間に有意な正相関が認められた. 6. UFIの低下しているCAPD患者のα-hANPは高値を示した.以上よりα-hANPは慢性維持透析患者のドライウエイトの指標になり得るものと思われた. 具体的には, HD後ならびにCAPD中のα-hANP値が50ng/ml以下であればドライウエイトに到達している可能性が高いものと思われる.
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- 1991
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12. Evidence of pharmacologic preconditioning during PTCA by intravenous pretreatment with ATP-sensitive K+ channel opener nicorandil
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Hitoshi Matsuo, Sachiro Watanabe, Shinya Minatoguchi, Makoto Iwama, Shinji Yasuda, Tomonori Segawa, Yukihiko Matsuno, Takeshi Hirose, Masaaki Tomita, Hisayoshi Fujiwara, Takahiko Yamaki, and Shinichiro Tanaka
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Vasodilator Agents ,Ischemia ,Myocardial Ischemia ,Collateral Circulation ,Angina ,Organophosphorus Compounds ,Angioplasty ,Internal medicine ,medicine ,Myocardial Revascularization ,Humans ,Angioplasty, Balloon, Coronary ,Nicorandil ,Radionuclide Imaging ,Saline ,Aged ,business.industry ,ST elevation ,Coronary Stenosis ,Organotechnetium Compounds ,Middle Aged ,medicine.disease ,Collateral circulation ,Calcium Channel Agonists ,Anesthesia ,Ischemic Preconditioning, Myocardial ,cardiovascular system ,Cardiology ,Ischemic preconditioning ,Female ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background It is not known whether pretreatment with nicorandil, an ATP-sensitive K+ channel (KATPchannel) opener, induces a preconditioning effect independent of increased collateral recruitment. Methods Forty-four patients with angina who underwent percutaneous transluminal coronary angioplasty (PTCA) to proximal left anterior descending artery (LAD) stenosis were randomly allocated for pretreatment with an intravenous injection of 80g/kg nicorandil 5min before initial ballooning ( n =22) or saline ( n =22). 99mTc tetrofosmin was injected during balloon inflation, quantitative analysis of occlusion images by SPECT was conducted, and the defect severity score (SS) was calculated. An ECG was recorded during the 2-min inflation to calculate the sum of ST elevation (ΣST). Results ΣST levels were significantly reduced in patients with nicorandil pretreatment compared with control patients (control:1.89±0.85mV nicorandil:1.24±0.57mV, p =0.0052). However, no difference was observed in defect severity (control: 79.0±32.5, nicorandil: 98.7±48.9 ns). A close correlation was observed between SS and ΣST in both groups (nicorandil group R2=0.505, control group R2=0.599). A multivariate regression model demonstrated that both defect severity ( p
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- 2003
13. Validation of collateral fractional flow reserve by myocardial perfusion imaging
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Tomonori Segawa, Yukihiko Matsuno, Shuusaku Miyata, Sachiro Watanabe, Hitoshi Matsuo, Shinichiro Tanaka, Masaaki Tomita, Hisayoshi Fujiwara, Takahiko Yamaki, and Tohru Kadosaki
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Male ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Collateral Circulation ,Blood Pressure ,Fractional flow reserve ,Coronary Angiography ,Severity of Illness Index ,Angina Pectoris ,Myocardial perfusion imaging ,Electrocardiography ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Coronary Circulation ,Medicine ,Humans ,Angioplasty, Balloon, Coronary ,Pulmonary wedge pressure ,Radionuclide Imaging ,Aorta ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Central venous pressure ,Coronary Stenosis ,Reproducibility of Results ,Blood flow ,Middle Aged ,Collateral circulation ,Coronary Vessels ,Coronary occlusion ,Aortic pressure ,Cardiology ,Linear Models ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Abstract
Background — Collateral fractional flow reserve (FFR coll ) is an index to quantify collateral blood flow, derived from coronary pressure measurements. Although well defined theoretically, its direct validation by myocardial perfusion imaging has not been established so far. Validating this index by myocardial perfusion imaging is the main aim of this study. Methods and Results — Twenty-four consecutive patients with stable angina and single left anterior descending artery stenosis underwent simultaneous measurement of aortic pressure (P a ), coronary wedge pressure (P w ), and central venous pressure (P v ) during balloon inflation. FFR coll was calculated and compared with the extent and severity of the defect during coronary occlusion using 99m Tc-sestamibi imaging at balloon inflation of the respective coronary artery. Although the pressure-derived collateral indexes (P w , P w /P a , and FFR coll ) ranged widely, they were closely correlated with extent and severity scores of the nuclear occlusion images and superior to the ECG for that purpose. Of all parameters, FFR coll correlated best with the severity score at imaging ( r =−0.88), followed by the P w /P a ratio ( r =−0.74) or P w alone ( r =−0.69). Conclusions — FFR coll , calculated from coronary pressure during balloon occlusion, is highly correlated with the extent and severity of the defect at myocardial perfusion of the territory of the occluded artery and can be used for quantitative assessment of collateral blood flow in conscious humans.
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- 2002
14. Assessment of area at risk and efficacy of treatment in patients with acute coronary syndrome using 99mTc tetrofosmin imaging in humans
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Motoo Kano, Hitoshi Matsuo, Yoshio Nishida, Hiroshige Oohashi, Akira Goto, Tetsuo Matsubara, Takeyoshi Imaeda, Yukihiko Matsuno, Hiroshi Oda, Hiroshi Watanabe, Kazunari Makita, Sachiro Watanabe, Akira Sugiyama, Taketoshi Mizutani, Hiroshi Miyake, and Yasunori Kotoo
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Myocardial Infarction ,Area at risk ,Organophosphorus Compounds ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Myocardial infarction ,Wall motion ,Angina, Unstable ,Angioplasty, Balloon, Coronary ,Radionuclide Imaging ,Aged ,Aged, 80 and over ,Unstable angina ,business.industry ,General Medicine ,Blood flow ,Organotechnetium Compounds ,Middle Aged ,medicine.disease ,Cardiology ,Female ,business ,Perfusion - Abstract
The determination of the myocardium at risk before intervention and the change in that region after intervention constitute a promising measurement tool for the assessment of acute therapy. A new 99mTc labeled myocardial blood flow tracer, 99mTc tetrofosmin, is expected to enable the evaluation of myocardium at risk because of the absence of redistribution. This preliminary study was performed in 9 patients with acute coronary syndrome (4 unstable angina and 5 acute myocardial infarction) to investigate whether recovery of perfusion by tetrofosmin imaging parallels mechanical improvement. Tetrofosmin imaging was performed acutely and 3-30 days later. Visual analysis of defect severity was assessed in both studies. Segments with improvement in perfusion were accompanied by significant wall motion recovery compared with normal and unimproved segments (delta WMI: normal segments 0.40 +/- 0.67, improved segments 1.79 +/- 0.68, unimproved segments -0.15 +/- 0.16, p0.01 for improved segments compared with other groups), suggesting the efficacy of this tracer for the assessment of the acute therapy. These data suggest that 99mTc tetrofosmin imaging is a useful method for the assessment of the myocardial area at risk and the efficacy of acute therapy in acute myocardial infarction and unstable angina.
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- 1993
15. The clinical significance of QS wave formation before reperfusion therapy for the recovery of reperfusion by coronary revascularization in acute myocardial infarction
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Shintaro Tanihata, Tetsuo Matsubara, K Hayakawa, Sachiro Watanabe, Y Hashimoto, Yukihiko Matsuno, H Ohashi, Hiroshi Oda, I Murata, Yasunori Kotoo, K Watanabe, and Hitoshi Matsuo
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medicine.medical_specialty ,business.industry ,Electrocardiography in myocardial infarction ,medicine.disease ,Coronary revascularization ,Reperfusion therapy ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Published
- 1997
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16. The scintigraphical evaluation of the effect of preinfarction angina on the amount of myocardial salvage by reperfusion therapy
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Yukihiko Matsuno, H Ohashi, K Hayakawa, Yasunori Kotoo, I Murata, Tetsuo Matsubara, Sachiro Watanabe, Y Hashimoto, Hiroshi Oda, Motoyuki Ishiguro, K Watanabe, Hitoshi Matsuo, and Shintaro Tanihata
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medicine.medical_specialty ,Reperfusion therapy ,business.industry ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Preinfarction angina ,business - Published
- 1997
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17. The influence of ST re-elevation at the time of recanalization on myocardial salvage effect in acute myocardial infarction
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H Ohashi, Y Hashimoto, I Murata, K Watanabe, Hitoshi Matsuo, Yukihiko Matsuno, Tetsuo Matsubara, Yasunori Kotoo, K Hayakawa, Sachiro Watanabe, Hiroshi Oda, and Shintaro Tanihata
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medicine.medical_specialty ,business.industry ,Internal medicine ,Elevation ,medicine ,Cardiology ,Electrocardiography in myocardial infarction ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 1997
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18. Myocardial salvage effect by IV bolus injection of a novel modified t-PA E6010 in patients with acute anteroseptal myocardial infarction. A comparison with primary PTCA
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Hitoshi Matsuo, Motoo Kano, Sachiro Watanabe, Hiroshi Oda, Tetsuo Matsubara, Yoshio Nishida, Yukihiko Matsuno, Shintaro Tanihata, and Hiroshige Oohashi
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medicine.medical_specialty ,Acute anteroseptal myocardial infarction ,business.industry ,Internal medicine ,medicine ,Cardiology ,Electrocardiography in myocardial infarction ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Bolus injection - Published
- 1995
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19. Myocardial perfusion during transient slow-flow in the patient with old vein graft intervention: Assessment by serial measurement of pressure-derived fractional flow reserve and thermodilution-derived coronary flow reserve.
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Hitoshi Matsuo, Sachiro Watanabe, Shinji Yasuda, Takeshi Hirose, Makoto Iwama, Shinichiro Tanaka, Takahiko Yamaki, Kouji Ono, Haruki Takahashi, Tomonori Segawa, Yukihiko Matsuno, Shinya Minatoguchi, and Hisayoshi Fujiwara
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- 2003
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20. Response of plasma ADH and α-hANP to changes in extracellular volume and/or plasma osmolality in patients on maintenance hemodialysis
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Nobuyoshi Sugishita, Yasunori Kotoo, Hitoshi Matsuo, Kunihiro Okada, Sachiro Watanabe, Akira Sugiyama, Hiroshi Oda, Yukihiko Matsuno, Tetsuo Matsubara, Hiroshige Ohashi, and Kathui Ueno
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Plasma osmolality ,medicine.medical_specialty ,Endocrinology ,Chemistry ,Internal medicine ,Extracellular fluid ,medicine ,In patient ,Maintenance hemodialysis - Abstract
慢性血液透析患者の細胞外液量ならびに血漿浸透圧の変化に対する抗利尿ホルモンと心房性Na利尿ホルモンの反応を検討した.対象は10例の慢性糸球体腎炎を基礎疾患とする慢性血液透析患者で, 平均年齢57.2歳, 週3回, 計15時間の血液透析を受け, いずれも体液平衡は良好に保たれている症例である. 早朝空腹時の血液透析直前, 1時間のECUM後ならびに4時間の血液透析後に採血し, 抗利尿ホルモン, 心房性Na利尿ホルモン, 血漿浸透圧, クレアチニン, 尿素窒素, Na, K, Clを測定した. また同時に体重, 血圧を測定した. なお健常者10名 (平均年齢45.6歳) より早朝空腹時に採血し, 抗利尿ホルモン, 心房性Na利尿ホルモンを測定し対照とした. 以下の結論が得られた.1) 慢性血液透析患者の早朝時の抗利尿ホルモン, 心房性Na利尿ホルモンは健常者に比べ高値を示した.2) 抗利尿ホルモンは血漿浸透圧の低下により軽度に低下したが, 血漿浸透圧, 細胞外液量, 平均血圧との間に相関は認められなかった.3) 心房性Na利尿ホルモンは細胞外液量の減少により低下し, 平均血圧との間に有意の相関が認められた.
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- 1989
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21. Serial change of sympathetic nerve activity of the patients with HOCM treated with PTSMA
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Makoto, Iwama, Hitoshi, Matsuo, Tomonori, Segawa, Tai, Kojima, Shunichiro, Warita, Shiraki, Takeru, Koji, Ono, Haruki, Takahashi, Yukihiko, Matsuno, and Sachiro, Watanabe
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Background:PTSMA is a effective non-surgical technique for achieving the reduction of the pressure gradients of LV outflow and patients symptoms dramatically. However, the effect of this approach to the sympathetic activity is not well known.Purpose and Methods:To investigate the time course of the sympathetic nerve activity, we evaluate the sympathetic activity by MIBG scintigraphy performed just before, 1week after, and 3 months after the procedure in 6 patients with severe HOCM. H/M ratio in early and delayed images and washout rate was used as the indexes showing sympathetic function.Results:The procedures were all successful without severe complications. CPK release ranged from 976 to 3642 IU. LV outflow PG decreased markedly from 110 ± 16mmHg to 45 ± 31mmHg and concomitant improvement of NYHA classification was evident ( pre-PTSMA:2.5 ± 0.8 post-PTSMA:1.2 ± 0.4). MIBG demonstrates the transient increase of washout (pre:34 ± 5% post:44 ± 6%) and decrease of H/M ratio of delayed images (pre:1.9 ± 0.8, post:1.7 ± 0.2) at 1week after procedures. 3 months after procedure, significant decrease of washout(3M:30 ± 8%) and increase of H/M ratio(3M:2.0 ± 0.3) was observed.Conclusion:Transient overactivation of sympathetic nerve probably associated with iatrogenic infarction was observed early after PTSMA. However, sympathetic activity was gradually reduced at chronic phase suggesting the favorable effect of this therapy on loading conditions of the hypertrophied heart.
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- 2004
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22. The influence of the permanent pacemaker on myocardial tissue characterization
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Tomonori, Segawa, Hitosi, Matsuo, Yukihiko, Matsuno, Syunichiro, Warita, Tai, Kojima, Takeru, Siraki, Takesi, Hirose, Makoto, Iwama, Koji, Ono, and Sachiro, Watanabe
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This study was designed to investigate how pacemaeker would influence the myocardial tissue, accessing tissue characterization by ultrasonic integrated backsatter (IBS). Study Group included 30 cases underwent pacemaker implantation from Jan. 1 1988 to Apr. 30 2002. The group was divided into two subgroups; one group included patients implanted DDD mode pacemaker (DDD:16cases) and the other included patients implanted VVI mode pacemaker (VVI:14cases). Parasternal short axis view was shown using SONOS 5500 and recorded with IBS mode. The ROI was set in the interventricular anteroseptum (AS) and the posterior wall (PW) and measured the value of IBS (IB), then was corrected to reduce the IB of left ventricular cavity as standard value from IB (CIB). The amplitude of cyclic variation (CVIB) was defined the difference between enddiastolic IB and endsystolic IB. There was no correlation between CIB and CVIB in AS or PW and the term during pacing but CIB in both AS and PW in VVI was greater than that in DDD (15.3 ± 2.1:12.5 ± 3.4 p < 0.05). CVIB in AS and PW in VVI was not different from that in DDD (7.1 ± 0.6:7.8 ± 2.7).The increase of CIB signifies the fibrous change. So this result suggested unphysiological hemodynamics induced by pacing with VVI mode pacemaker, might cause the myocardial fibrosis.
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- 2004
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23. The impact of functional risk area severity on LV dilatation and occurrence of heart failure after acute anterior MI
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Watanabe, Takatomo, Hitoshi, Matsuo, Tomonori, Segawa, Warita, Shunichiro, Tai, Kojima, Takeru, Shiraki, Koji, Ono, Takeshi, Hirose, Yukihiko, Matsuno, and Sachiro, Watanabe
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Functional risk area assessed by 99mTc tetrofosmin (TF) measured on arrival is most powerful determinant of infarct size. However, the impact of AAR on LV dilatation and heart failure is not known. We studied 51 patients with anterior AMI who were recanalized by PTCA. Pts were divided into 3 groups according to the size of AAR (small AAR(n=17), moderate AAR(n=17), large AAR(n=17)). LVG and TF imaging were performed on arrival and 6 months after onset. The LVEDVI increased in large AAR than small and moderate AAR (deltaLVEDVI small:.−4.7 ± 10.5, moderate: 13.1 ± 17.8, large 24.6 ± 25.7 p < 0.05). There were 2 deaths in-hospital, 2 out-hospital death and 4 admission due to HF during mean F/U of 3 years. These data suggest strong impact of the severity of AAR on the patients long term prognosis.
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- 2004
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24. Human atrial natrieuretic polypeptide protect against LV remodeling in patients with AMI -prospective randomized trial assessed by QGS-
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Kojima, Tai, Hitoshi, Matsuo, Tomonori, Segawa, Shunichiro, Warita, Takatomo, Watanabe, Takeru, Shiraki, Takeshi, Hirose, Makoto, Iwama, Yukihiko, Matsuno, and Sachiro, Watanabe
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Backgrounds:The aim of this study is to demonstrate HANP administration combined with acute revascularization prevent LV remodeling independent of myocardial salvage. Methods:Consecutive 44 patients with acute anteroseptal myocardial infarction were randomly assigned to either continuous infusion of HANP at a dose of 0.025 microgram/kg/min for 3 days, or control. Myocardial salvage, infarct size, and LV volume was assessed by 99mTc-tetrofosmin imaging. Results:No differences in patients backgrounds were observed. HANP suppressed LVEDVI increase in comparison with placebo (HANP:3.2 ± 16.8 control:16.0 ± 23.4 p < 0.05) with no difference in salvage index(HANP:55.6 ± 24.9% control:55.5 ± 34.1%). The relationship between the infarct size and delta-LVEDVI were shown in the figure.Conclusion:This study clearly demonstrate that HANP can suppress LV volume expansion despite no difference of infarct size.
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- 2004
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25. ST resolution after mechanical reperfusion closely correlates with myocardial salvage and associtated with patients prognosis after acute anteroseptal MI
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Tai, Kojima, Hitoshi, Matsuo, Tomonori, Segawa, Takeru, Shiraki, Makoto, Iwama, Takeshi, Hirose, Koji, Ono, Haruki, Takahashi, Yukihiko, Matsuno, and Sachiro, Watanabe
- Abstract
Background:Early resolution of ST-segment elevation is an indicator of final infarct size and clinical outcomes. However, the relationship between the degree of ST resolution and the indexes derived from perfusion scintigraphy such as area at risk(AAR), infarct size(IR), and salvaged myocardium(SI) is unclear.Methods:Consecutive 65 patients with anteroseptal myocardial infarction with successful mechanical reperfusion, whose AAR, IS, and SI could be assessed by myocardial perfusion imaging, were studied. Serial 12 leads electrocardiograms were performed at baseline, 90 minutes after reperfusion. ST resolution was defined as complete (70%, n=16), partial (<70% to 30%, n=36), or no resolution (<30%, n=13). Results:Patients with no resolution group tended to be longer time to reperfusion (complete: 4.0 ± 7.5 partial: 6.5 ± 8.2 No: 7.4 ± 6.6). Peak CPK inversely correlated with level of ST resolution(complete:1689 ± 1395 partial:3078 ± 2577 No:5252 ± 2537 p < 0.01). As for the scintigraphical indexes such as AAR, IR, and SI, all these indexes had significant association with the level of ST resolution(AAR: complete 114 ± 54 partial 145 ± 58 no 178 ± 51 p < 0.05, IS:complete 21 ± 26 partial 66 ± 60 no 131 ± 31 p < 0.001, SI: complete 81.9 ± 16.2 partial 57.6 ± 29.4 no 27.7 ± 23.9 p < 0.001). Furthermore, patients with no resolutions experienced high prevalence of the occurrence of congestive heart failure than partial and complete resolution groups.Conclusion:Early resolution of ST-segment elevation closely correlated with AAR, IS, and SI as assessed by scintigraphy and closely associated with patients prognosis.
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- 2004
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