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INTRODUCTION: Plasma volume status (PVS), a parameter of the discrepancy between actual plasma volume (PV) and ideal PV, has been recently evaluated as a prognostic marker in patients with heart failure. This subgroup analysis of the EMBODY trial was designed to determine whether a sodium-glucose cotransporter 2 (SGLT2) inhibitor affects the alleviation of heart failure and improvement of PVS in patients after acute myocardial infarction (AMI) with congestive heart failure (CHF). METHODS: The EMBODY trial was a prospective, multicenter, randomized, double-blind, placebo-controlled trial to identify the effect of an SGLT2 inhibitor on cardiac sympathetic hyperactivity in patients with AMI and type 2 diabetes mellitus (T2DM) in Japan. In total, 105 patients were randomized (1:1) to receive 10 mg empagliflozin or a placebo (once daily), 2 weeks after the onset of AMI. In this subanalysis, we investigated the time-course of PVS at baseline and weeks 4, 12, and 24. RESULTS: Overall, 96 patients were included in the subgroup analysis set (age 64.3 ± 10.9 years, 80.2% men; 46 in the empagliflozin group and 50 in the placebo group). Body weight and PVS decreased in the empagliflozin group compared with the placebo group at 24 weeks (- 2.2 vs. + 0.1 kg, P < 0.001, and - 5.1 vs. - 0.3%, P < 0.001, respectively). Decreased PVS, defined as a change in PVS of < - 4.5%, was associated with the administration of empagliflozin (odds ratio 2.61, 95% confidence interval 1.11-6.15, P = 0.028). N-terminal pro b-type natriuretic peptide levels decreased in both the empagliflozin and placebo groups (1028.7-370.3 pg/mL, P < 0.001, and 1270.6-673.7 pg/mL, P < 0.01, respectively). CONCLUSION: Empagliflozin reduced the body weight and PVS. Early SGLT2 inhibitor administration in patients with AMI, CHF, and T2DM can therefore be effective in reducing the body weight and PVS. TRIAL REGISTRATION: UMIN 000030158.

DOI： 10.1007/s13300-021-01103-0

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Authorship：Lead author   Language：English   Publisher：Japanese Circulation Society  

Background: Given the high prevalence of heart failure (HF) in the elderly, it is essential to establish medical coordination between general practitioners (GPs) and acute care hospitals (ACHs) in an aging society. The aim of this study was to elucidate the status of acceptance of elderly patients with HF and their management requirements in a comprehensive community health system. Furthermore, we investigated GPs' interest in using information and communications technology (ICT) in patient care. Methods and Results: We sent a questionnaire survey to 1,800 GPs in January 2015 and received 392 replies. The overall prevalence of home visits was 55%, with no differences according to GP background characteristics or geographic area. However, less than half (44%) reported accepting patients with symptomatic HF for treatment in their clinic. In addition, only 3 GPs reported accepting and providing emergency visits for patients with refractory HF. In particular, GPs who were not certificated cardiologists, female, and older showed poorer acceptance of symptomatic HF patients. More than half the GPs wanted the prompt acceptance by ACHs of emergency patients, followed by strengthening of home care support at discharge and support for end-of-life care. Half the GPs were interested in telemedicine. Conclusions: ACHs must promptly accept patients with HF in cases of emergency and strengthen nursing care support at discharge. It is also necessary to consider how to support older and female GPs.

DOI： 10.1253/circrep.cr-20-0132

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BACKGROUND: Protection from lethal ventricular arrhythmias leading to sudden cardiac death (SCD) is a crucial challenge after acute myocardial infarction (AMI). Cardiac sympathetic and parasympathetic activity can be noninvasively assessed using heart rate variability (HRV) and heart rate turbulence (HRT). The EMBODY trial was designed to determine whether the Sodium-glucose cotransporter 2 (SGLT2) inhibitor improves cardiac nerve activity. METHODS: This prospective, multicenter, randomized, double-blind, placebo-controlled trial included patients with AMI and type 2 diabetes mellitus (T2DM) in Japan; 105 patients were randomized (1:1) to receive once-daily 10-mg empagliflozin or placebo. The primary endpoints were changes in HRV, e.g., the standard deviation of all 5-min mean normal RR intervals (SDANN) and the low-frequency-to-high-frequency (LF/HF) ratio from baseline to 24 weeks. Secondary endpoints were changes in other sudden cardiac death (SCD) surrogate markers such as HRT. RESULTS: Overall, 96 patients were included (46, empagliflozin group; 50, placebo group). The changes in SDANN were + 11.6 and + 9.1 ms in the empagliflozin (P = 0.02) and placebo groups (P = 0.06), respectively. Change in LF/HF ratio was - 0.57 and - 0.17 in the empagliflozin (P = 0.01) and placebo groups (P = 0.43), respectively. Significant improvement was noted in HRT only in the empagliflozin group (P = 0.01). Whereas intergroup comparison on HRV and HRT showed no significant difference between the empagliflozin and placebo groups. Compared with the placebo group, the empagliflozin group showed significant decreases in body weight, systolic blood pressure, and uric acid. In the empagliflozin group, no adverse events were observed. CONCLUSIONS: This is the first randomized clinical data to evaluate the effect of empagliflozin on cardiac sympathetic and parasympathetic activity in patients with T2DM and AMI. Early SGLT2 inhibitor administration in AMI patients with T2DM might be effective in improving cardiac nerve activity without any adverse events. TRIAL REGISTRATION: The EMBODY trial was registered by the UMIN in November 2017 (ID: 000030158). UMIN000030158; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034442 .

DOI： 10.1186/s12933-020-01127-z

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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A highly conductive textile was woven from nano-fibers coated with the PEDOT-PSS polymer. The aim of this study was to assess the usefulness of textile electrodes for ECG recording as a smart garment. Electrode textile pads and lead wires were sewn to the lining of sportswear and their tolerability to repeated washings were tested up to 150 times. The electrical conductivity of the textile electrode remained functional for up to 50 machine washes. To assess the level of motion artifacts or noise during the daily monitoring of ECG, a single lead ECG with conventional or textile electrodes was recorded during supine rest, seated rest, upright trunk rotation (i.e., twisting), and stepping movement in 66 healthy adults. A Holter system was used for data storage and analysis. ECG patterns of P, QRS, and T waves were comparable between the conventional and textile electrodes. However, the signal-to-artifact-and/or-noise ratio (SAR) during twisting was larger in the textile electrodes than in the conventional electrodes. No skin irritation was seen in the textile electrodes. The single lead textile electrodes embedded in an inner garment were usable for continuous and/or repeated ECG monitoring in daily life except during vigorous trunk movement.

DOI： 10.1007/s00380-019-01347-8

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INTRODUCTION: Protection from lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important problems after myocardial infarction. Cardiac sympathetic hyperactivity is related to poor prognosis and fatal arrhythmias and can be non-invasively assessed with heart rate variability, heart rate turbulence, T-wave alternans, late potentials, and 123I-meta-iodobenzylguanide (123I-MIBG) scintigraphy. Sodium glucose cotransporter 2 (SGLT2) inhibitors potentially reduce sympathetic nervous system activity that is augmented in part due to the stimulatory effect of hyperglycemia. The EMBODY trial is designed to determine whether the suppression of cardiac sympathetic activity induced by the SGLT2 inhibitor is accompanied by protection against adverse cardiovascular outcomes. METHODS: The EMBODY trial is a prospective, multicenter, randomized, double-blind, placebo-controlled trial in patients with acute MI and type 2 diabetes in Japan. A total of 98 patients will be randomized (1:1) to receive once-daily placebo or empagliflozin, an SGLT2 inhibitor, 10 mg. The primary end point is the change from baseline to 24 weeks in heart rate variability. Secondary end points include the change from baseline for other sudden cardiac death surrogate-markers such as heart rate turbulence, T-wave alternans, late potentials, and 123I-MIBG scintigraphy imaging. Adverse effects will be evaluated throughout the trial period. PLANNED OUTCOMES: The EMBODY trial will evaluate the potential cardioprotective effect of empagliflozin and will provide additional important new data regarding its preventative effects on sudden cardiac death. TRIAL REGISTRATION: Unique Trial Number, UMIN000030158 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000034442 ). FUNDING: Nippon Boehringer Ingelheim and Eli Lilly and Company.

DOI： 10.1007/s13300-018-0480-7

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T1 mapping using cardiac magnetic resonance (CMR) is useful for myocardial assessment. However, its prognostic value is not well defined. The aim of this study was to determine whether T1 mapping with CMR can predict reverse cardiac remodeling in patients with non-ischemic dilated cardiomyopathy (NIDCM). We also investigated the predictive prognostic value of T1 mapping with CMR in these patients. We included 33 patients with NIDCM admitted to Nippon Medical School Hospital between February 2012 and October 2015. All patients underwent CMR and echocardiography for clinical assessment within 1 month of admission (13 ± 16 days). Follow-up echocardiography was performed no sooner than 6 months after the initial echocardiogram (536 ± 304 days). We evaluated the correlations between native and post-contrast T1 values/extracellular volume fraction (ECV) and the difference in left ventricular ejection fraction (ΔLVEF) determined at baseline and follow-up echocardiography. No correlation was noted between ΔLVEF and native (p = 0.150, r = - 0.256) or post-contrast T1 values (p = 0.956, r = - 0.010). However, a significant and substantial correlation was found between ΔLVEF and ECV (p = 0.043, r = - 0.355). Four patients were hospitalized for heart failure (HF), but no cardiovascular-related deaths occurred over a median follow-up period of 34 months (interquartile range 25-49 months). Kaplan-Meier curves stratified by the median value of ECV were created. The higher ECV groups experienced a significantly higher incidence of HF-related hospitalization (p = 0.0159). ECV measured by CMR can predict improvements in LVEF in patients with NIDCM. In addition, ECV may be a predictive factor for HF-related hospitalization.

DOI： 10.1007/s00380-018-1154-0

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J04638&link_issn=&doc_id=20180927140009&doc_link_id=10.1007%2Fs00380-018-1154-0&url=https%3A%2F%2Fdoi.org%2F10.1007%2Fs00380-018-1154-0&type=Crossref&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00002_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Dove Medical Press Ltd.  

Background: COPD is concomitantly present in ~30% of patients with heart failure. Here, we investigated the pulmonary function test parameters for left ventricular (LV) diastolic dysfunction and the relationship between pulmonary function and LV diastolic function in patients with COPD. Patients and methods: Overall, 822 patients who underwent a pulmonary function test and echocardiography simultaneously between January 2011 and December 2012 were evaluated. Finally, 115 patients with COPD and 115 age- and sex-matched control patients with an LV ejection fraction of ≥50% were enrolled. Results: The mean age of the patients was 74.4±10.4 years, and 72.3% were men. No significant differences were found between the two groups regarding comorbidities, such as hypertension, diabetes mellitus, and anemia. The index of LV diastolic function (E/e') and the proportion of patients with high E/e' (defined as E/e' ≥ 15) were significantly higher in patients with COPD than in control patients (10.5% vs 9.1%, P=0.009
11.3% vs 4.3%, P=0.046). E/e' was significantly correlated with the residual volume/total lung capacity ratio. Univariate and multivariate analyses revealed severe COPD (Global Initiative for Chronic Obstructive Lung Disease III or IV) to be a significant predictive factor for high E/e' (odds ratio [OR] 5.81, 95% confidence interval [CI] 2.13-15.89, P=0.001 and OR 6.00, 95% CI 2.08-17.35, P=0.001, respectively). Conclusion: Our data suggest that LV diastolic dysfunction as a complication of COPD may be associated with mechanical exclusion of the heart by pulmonary overinflation.

DOI： 10.2147/COPD.S101082

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Language：Japanese   Publisher：(一社)日本不整脈心電学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：DOVE MEDICAL PRESS LTD  

BACKGROUND: COPD is concomitantly present in ~30% of patients with heart failure. Here, we investigated the pulmonary function test parameters for left ventricular (LV) diastolic dysfunction and the relationship between pulmonary function and LV diastolic function in patients with COPD. PATIENTS AND METHODS: Overall, 822 patients who underwent a pulmonary function test and echocardiography simultaneously between January 2011 and December 2012 were evaluated. Finally, 115 patients with COPD and 115 age- and sex-matched control patients with an LV ejection fraction of ≥50% were enrolled. RESULTS: The mean age of the patients was 74.4±10.4 years, and 72.3% were men. No significant differences were found between the two groups regarding comorbidities, such as hypertension, diabetes mellitus, and anemia. The index of LV diastolic function (E/e') and the proportion of patients with high E/e' (defined as E/e' ≥15) were significantly higher in patients with COPD than in control patients (10.5% vs 9.1%, P=0.009; 11.3% vs 4.3%, P=0.046). E/e' was significantly correlated with the residual volume/total lung capacity ratio. Univariate and multivariate analyses revealed severe COPD (Global Initiative for Chronic Obstructive Lung Disease III or IV) to be a significant predictive factor for high E/e' (odds ratio [OR] 5.81, 95% confidence interval [CI] 2.13-15.89, P=0.001 and OR 6.00, 95% CI 2.08-17.35, P=0.001, respectively). CONCLUSION: Our data suggest that LV diastolic dysfunction as a complication of COPD may be associated with mechanical exclusion of the heart by pulmonary overinflation.

DOI： 10.2147/COPD.S101082

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER HEIDELBERG  

BACKGROUNDS: To conduct a meta-analysis to investigate whether sleep-disordered breathing (SDB) is an independent risk factor for mortality and whether positive airway pressure (PAP) decreases mortality in patients with chronic heart failure (HF). The impact of SDB and the effects of PAP on mortality in patients with chronic HF remain unclear. METHODS: We searched the MEDLINE, EMBASE, and Cochrane databases. Clinical trials that addressed mortality and the effect of PAP on mortality in chronic HF patients with SDB were included in this meta-analysis. RESULTS: Eleven studies (1,944 participants in total) that addressed mortality in chronic HF patients with SDB were included in this study. Patients with SDB showed a significantly increased mortality risk compared to those without SDB [risk ratio (RR) 1.66 (1.19-2.31)]. In sub-analyses, a significant increase in risk of mortality was observed for central sleep apnea versus no-SDB [RR 1.48 (1.15-1.91)], whereas no significant increase in risk was observed for obstructive sleep apnea versus no-SDB. Five randomized controlled studies (395 participants) that assessed the effect of PAP in chronic HF patients with SDB were analyzed. Adaptive servo-ventilation (ASV) significantly reduced all-cause mortality in chronic HF patients with SDB [RR 0.13 (0.02-0.95)], whereas continuous PAP did not significantly reduce all-cause mortality [RR 0.71 (0.32-1.57)]. CONCLUSIONS: The prevalence of SDB in patients with chronic HF is associated with worse survival, and ASV reduces all-cause mortality in patients with chronic HF concomitant with SDB.

DOI： 10.1007/s00392-014-0774-3

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Background: Chronic obstructive pulmonary disease (COPD) is present in approximately one-third of all congestive heart failure (CHF) patients, and is a key cause of underprescription and underdosing of beta-blockers, largely owing to concerns about precipitating respiratory deterioration. For these reasons, the aim of this study was to evaluate the impact of beta-blockers on the long-term outcomes in CHF patients with COPD. In addition, we compared the effects of two different beta-blockers, carvedilol and bisoprolol.
Methods: The study was a retrospective, non-randomized, single center trial. Acute decompensated HF patients with COPD were classified according to the oral drug used at discharge into beta-blocker (n=86; carvedilol [n=52] or bisoprolol [n=34]) and non-beta-blocker groups (n=46). The primary endpoint was all-cause mortality between the beta-blocker and non-beta-blocker groups during a mean clinical follow-up of 33.9 months. The secondary endpoints were the differences in all-cause mortality and the hospitalization rates for CHF and/or COPD exacerbation between patients receiving carvedilol and bisoprolol.
Results: The mortality rate was higher in patients without beta-blockers compared with those taking beta-blockers (log-rank P=0.039), and univariate analyses revealed that the use of beta-blockers was the only factor significantly correlated with the mortality rate (hazard ratio: 0.41; 95% confidence interval: 0.17-0.99; P=0.047). Moreover, the rate of CHF and/or COPD exacerbation was higher in patients treated with carvedilol compared with bisoprolol (log-rank P=0.033). In the multivariate analysis, only a past history of COPD exacerbation significantly increased the risk of re-hospitalization due to CHF and/or COPD exacerbation (adjusted hazard ratio: 3.11; 95% confidence interval: 1.47-6.61; P=0.003).
Conclusion: These findings support the recommendations to use beta-blockers in HF patients with COPD. Importantly, bisoprolol reduced the incidence of CHF and/or COPD exacerbation compared with carvedilol.

DOI： 10.2147/COPD.S79942

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Dove Medical Press Ltd.  

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is present in approximately one-third of all congestive heart failure (CHF) patients, and is a key cause of underprescription and underdosing of β-blockers, largely owing to concerns about precipitating respiratory deterioration. For these reasons, the aim of this study was to evaluate the impact of β-blockers on the long-term outcomes in CHF patients with COPD. In addition, we compared the effects of two different β-blockers, carvedilol and bisoprolol. METHODS: The study was a retrospective, non-randomized, single center trial. Acute decompensated HF patients with COPD were classified according to the oral drug used at discharge into β-blocker (n=86; carvedilol [n=52] or bisoprolol [n=34]) and non-β-blocker groups (n=46). The primary endpoint was all-cause mortality between the β-blocker and non-β-blocker groups during a mean clinical follow-up of 33.9 months. The secondary endpoints were the differences in all-cause mortality and the hospitalization rates for CHF and/or COPD exacerbation between patients receiving carvedilol and bisoprolol. RESULTS: The mortality rate was higher in patients without β-blockers compared with those taking β-blockers (log-rank P=0.039), and univariate analyses revealed that the use of β-blockers was the only factor significantly correlated with the mortality rate (hazard ratio: 0.41; 95% confidence interval: 0.17-0.99; P=0.047). Moreover, the rate of CHF and/or COPD exacerbation was higher in patients treated with carvedilol compared with bisoprolol (log-rank P=0.033). In the multivariate analysis, only a past history of COPD exacerbation significantly increased the risk of re-hospitalization due to CHF and/or COPD exacerbation (adjusted hazard ratio: 3.11; 95% confidence interval: 1.47-6.61; P=0.003). CONCLUSION: These findings support the recommendations to use β-blockers in HF patients with COPD. Importantly, bisoprolol reduced the incidence of CHF and/or COPD exacerbation compared with carvedilol.

DOI： 10.2147/COPD.S79942

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Language：English   Publisher：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

DOI： 10.1016/j.cardfail.2014.07.278

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PHYSIOLOGICAL SOC  

Previously, we showed that sulfaphenazole (SUL), an antimicrobial agent that is a potent inhibitor of cytochrome P4502C9, is protective against ischemia-reperfusion (I/R) injury (Ref. 15). The mechanism, however, underlying this cardioprotection, is largely unknown. With evidence that activation of autophagy is protective against simulated I/R in HL-1 cells, and evidence that autophagy is upregulated in preconditioned hearts, we hypothesized that SUL-mediated cardioprotection might resemble ischemic preconditioning with respect to activation of protein kinase C and autophagy. We used the Langendorff model of global ischemia to assess the role of autophagy and protein kinase C in myocardial protection by SUL during I/R. We show that SUL enhanced recovery of function, reduced creatine kinase release, decreased infarct size, and induced autophagy. SUL also triggered PKC translocation, whereas inhibition of PKC with chelerythrine blocked the activation of autophagy in adult rat cardiomyocytes. In the Langendorff model, chelerythrine suppressed autophagy and abolished the protection mediated by SUL. SUL increased autophagy in adult rat cardiomyocytes infected with GFP-LC3 adenovirus, in isolated perfused rat hearts, and in mCherry-LC3 transgenic mice. To establish the role of autophagy in cardioprotection, we used the cell-permeable dominant-negative inhibitor of autophagy, Tat-Atg5(K130R). Autophagy and cardioprotection were abolished in rat hearts perfused with recombinant Tat-Atg5(K130R). Taken together, these studies indicate that cardioprotection mediated by SUL involves a PKC-dependent induction of autophagy. The findings suggest that autophagy may be a fundamental process that enhances the heart's tolerance to ischemia.

DOI： 10.1152/ajpheart.00716.2009

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPANESE CIRCULATION SOC  

Background: To present a future shortage of cardiologists, it is important for female Cardiologists to continue working. Gender differences in the professional and private lives of cardiologists. as well as the barriers to work for female cardiologists. were surveyed
Methods and Results: In August 2007. a questionnaire was mailed to all 195 facility members/fellows and 155 alumni of the Department of Cardiovascular Medicine at Nippon Medical School. More female cardiologists job than male cardiologists (34% vs 17%, P&lt;0.005). Women reported greater career were dissatisfied with their limitation by family responsibilities and housework Men and women both reported that long working hours was the most problematic issue, but significantly more women reported this than men (76% vs 94%, P&lt;0.05). Female cardiologists were more concerned about occupational radiation exposure (88% vs 59%, P&lt;0.01) and wanted opportunities for retraining after childcare leave (100% vs 76%, P&lt;0.01).
Conclusions: The following measures should be taken: (1) establishment of more family-friendly working conditions in hospitals, (2) provision of various work positions that allow more flexibility and predictability for women, (3) establishment of a retraining system. and (4) development of work and research opportunities that are attractive to women. The Japanese Circulation Society is expected to establish a retraining system at certified institutions. (Circ J 2009: 73: 2076-2083)

DOI： 10.1253/circj.CJ-09-0206

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Sphingosine-1-phosphate (S1P) has been considered to play an important role in ischemia/reperfusion (LR) injury. We used SEW2871 (SEW), a novel receptor-selective agonist for S1P1, to elucidate the role of SIPI in myocardial I/R. Isolated perfused rat hearts exposed to S1P (1 and 10 mM) or SEW (1 and 0.1 mM) were subjected to 30 minutes of global no-flow ischemia and 2 hours of repertusion. S1P at 1 and 10 mM significantly reduced infarct size and CK release compared with vehicle-control. The effect of 0.1 mu M SEW on infarct size was modest. After I/R, S1P at both doses and SEW at 0.1 mu M improved developed pressure (LVDP). SEW at 1 mM significantly prolonged the duration of ventricular tachycardia and ventricular fibrillation, leading to irreversible reperfusion tachyar-rhythmias in 60% of the hearts. This is the first demonstration of the critical role of the S1P1 receptor in I/R injury.

DOI： 10.1097/FJC.0b013e318157a5fe

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

The objective of this study was to develop an assay system that allows continuous monitoring of nitric oxide (NO) released from crystalloid perfused hearts. We utilized chemiluminescence reaction between NO and luminol-H2O2 to quantify the NO level in coronary effluent. Isolated rat hearts were subjected to ordinary Langendorff's perfusion, and the right ventricle was cannulated to sample coronary effluent. After equilibration, the coronary flow rate was set constant and the hearts were paced at 300 bpm. Coronary effluent was continuously sampled and mixed with the chemiluminescent probe containing 0.018 mmol/l luminol plus 10 mmol/l H2O2. Chemiluminescence from the mixture of coronary effluent and the probe was continuously measured. No concentration was calibrated by various concentrations (0.5-400 pmol/l) of standard NO solution. The lower detection limit of NO was 1 pmol/l. Basal NO release from isolated perfused rat heart was 0.41 +/- 0.17 pmol/min/ g of heart weight, and that was significantly suppressed by 0.1 mmol/l of L-NAME to 0.18 +/- 0.10 pmol/min/g of heart weight (n = 7). Application of 0.1 and 0.3 mumol/l acetylcholine increased NO level in the coronary effluent, in a concentration-dependent manner, from 6.6 +/- 1.7 in a baseline condition to 16.3 +/- 7.4 and 30.3 +/- 16.1 pmol/l at each peak, respectively. Thrombin at 1 and 10 U/ml also increased NO level from 17.6 +/- 4.3 in control to 35.5 +/- 10.4 and 48.7 +/- 8.7 pmol/l at each peak, respectively (n = 7). Thus, this assay system is applicable to the continuous real-time measurement of NO released from crystalloid perfused hearts, and it may be useful for the study of physiological or pathophysiological role of NO in coronary circulation. (C) 2002 Elsevier Science Inc. All rights reserved.

DOI： 10.1016/S0024-3205(02)02353-6

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING ASIA  

Renovascular hypertension occasionally manifests clinically as electrolyte disorders and albuminuria in addition to elevated blood pressure. A 49-year-old man who had renovascular hypertension also had severe hypokalemia, hyponatremia, polyuria and polydipsia that were treated by an angiotensin-converting enzyme inhibitor and resection of an atrophic kidney with a compromised blood supply. This is a case of hyponatremic-hypertensive syndrome related to renovascular hypertension and occurring as an additional abnormality.

DOI： 10.1253/circj.66.297

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Objectives. To determine the effect of macrophage colony-stimulating factor (MCSF) on atherogenesis in patients with coronary artery disease (CAD),we assessed the relation between the plasma concentration of MCSF and the incidence of acute coronary events in patients with CAD.
Background. Cytokines such as MCSF play a central role in inflammatory and proliferative responses in patients with acute coronary syndromes. However, the effect of MCSF on the clinical course in patients with CAD is still, not known.
Methods. We measured the plasma MCSF concentration in 142 patients with documented CAD (62 +/- 9 years) and followed up for a mean period of 14 +/- 6 months. The study included 97 patients with stable angina (SA), 45 patients with unstable angina (UA) and 22 age-matched control subjects. The predictors of coronary events were analyzed by using a Cox proportional hazards model.
Results. The mean plasma MCSF concentration in patients with UA was significantly higher than that in patients with SA and in control subjects (981 +/- 277 vs. 693 +/- 223 vs. 680 +/- 158 pg/ml, p &lt; 0.001). The mean plasma MCSF concentration in the 20 patients with coronary events was significantly higher than that in patients without coronary events (1,192 +/- 232 vs. 690 +/- 213 pg/ml, p &lt; 0.001). The predictors of unfavorable outcome were an increased MCSF concentration, the presence Of CAD and a low ejection fraction.
Conclusions. These findings suggest that an increased circulating:MCSF concentration reflects atherosclerotic progression in patients with CAD and predicts future cardiac events. (C) 2000 by the American College of Cardiology.

DOI： 10.1016/S0735-1097(99)00583-5

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The relationship between autonomic nervous system activity (ANA) and coronary vasoreactivity during transient myocardial ischemia was determined in patients with vasospastic angina (VA). ANA was measured by power spectral analysis of heart rate variability and humoral factors following intravenous infusion of insulin in 24 patients with VA and 6 control patients. Nine (38%) of the VA patients had significant ST segment depres sion (STD), and 4 of these patients had symptomatic STD. The frequency of anginal episodes in the 9 patients with VA and STD was significantly greater than that in the 15 VA patients without STD (3.4+/-3.1 vs 0.5+/-0.8 episodes/week, p&lt;0.05). The increase in the LF/HF ratio 30 min after insulin injection in patients with STD was significantly greater than that in patients without STD (34+/-31% vs 4+/-34%, p&lt;0.05). All of the patients with VA and STD had significant coronary vasospasm in response to the infusion of less than or equal to 20 iug of acetylcholine, higher levels of nocturnal parasympathetic activity, and greater norepinephrine production in response to insulin stimulation than the VA patients without STD. These findings suggest that increased vagal tone and hyperreactivity to adrenergic stimulation may trigger vasospasm in patients with VA.

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DOI： 10.1253/circrep.CR-24-0015

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Despite the importance of implementing the concept of social determinants of health (SDOH) in the clinical practice of cardiovascular disease (CVD), the tools available to assess SDOH have not been systematically investigated. We conducted a scoping review for tools to assess SDOH and comprehensively evaluated how these tools could be applied in the field of CVD.Methods and Results: We conducted a systematic literature search of PubMed and Embase databases on July 25, 2023. Studies that evaluated an SDOH screening tool with CVD as an outcome or those that explicitly sampled or included participants based on their having CVD were eligible for inclusion. In addition, studies had to have focused on at least one SDOH domain defined by Healthy People 2030. After screening 1984 articles, 58 articles that evaluated 41 distinct screening tools were selected. Of the 58 articles, 39 (67.2%) targeted populations with CVD, whereas 16 (27.6%) evaluated CVD outcome in non-CVD populations. Three (5.2%) compared SDOH differences between CVD and non-CVD populations. Of 41 screening tools, 24 evaluated multiple SDOH domains and 17 evaluated only 1 domain. CONCLUSIONS: Our review revealed recent interest in SDOH in the field of CVD, with many useful screening tools that can evaluate SDOH. Future studies are needed to clarify the importance of the intervention in SDOH regarding CVD.

DOI： 10.1253/circj.CJ-23-0443

PubMed

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

79歳男。約5年前に皮膚そう痒と四肢浮腫が出現し、前医で好酸球性血管性浮腫が疑われた。更に同時期に腹水貯留と腸管壁浮腫を認め、各種検査を行うも特異的な所見は認めなかった。経過より好酸球増多症候群が強く疑われ、プレドニゾロン(PSL)内服の開始にて腹水は消失した。約4年でPSLは中止したが、今回、皮膚そう痒と下腿浮腫が再発した。CTで大量の心膜液貯留を認め、血液検査で末梢血好酸球増多、血清IgEとIgG4の高値を認めた。MRIでは慢性心膜炎の所見を認めたが、心膜穿刺の細胞診で好酸球や形質細胞の増加はなく、悪性所見もなかった。経過中に突然尿閉と発熱を来たし、前立腺腫大を伴わない原発性性腺機能低下症を認めた。前立腺組織診で線維化を伴う慢性炎症を認め、IgG4/IgG形質細胞比が40%以上であったことから、臨床所見と併せてIgG4関連疾患と診断した。診断時には諸症状が軽快し、ステロイド性骨粗鬆症に起因する大腿骨頸部骨折が続発したため、ステロイドによる治療は行わず、定期的に検査を行う方針とし退院とした。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01159&link_issn=&doc_id=20180719090013&doc_link_id=10.2169%2Fnaika.107.1357&url=https%3A%2F%2Fdoi.org%2F10.2169%2Fnaika.107.1357&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)全国大学保健管理協会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese  

J-GLOBAL

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Scopus

PubMed

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Scopus

PubMed

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA  

DOI： 10.2199/jjsca.17.561

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Non-invasive assessment of ischemic heart disease requires information of both LV function and myocardial perfusion. Recently, ECG-gated myocardial SPECT with technetium-labeled radiopharmaceuticals can provide both of them. Gated myocardial SPECT were performed in thirty-three patients with cardiac disease using a two-headed rotating gamma camera system (ADAC
VERTEX), 30- 60 minutes after resting injection of 555-740 MBq of 99mTc-Tetrofosmin. Then, the SPECT data were used to determine the LV epi- and endocardial surface, and LV volume for measurement of LVEF was calculated automatically. This entire computational process required only 210 seconds per 16 frame study. Inter-observer agreement of EF values obtained from gated SPECT was excellent (r = 0.996, n = 10, p&lt
0.01). LVEFs obtained from gated SPECT showed good correlation to those calculated from radionuclide ventriculography (MUGA) (r = 0.91, p&lt
0.01). In conclusion, this automatic method using gated myocardial SPECT data was considered to be useful for assessment of LV function with reproducibility.

Scopus

PubMed

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PubMed

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Language：Japanese   Publisher：ライフサイエンス出版(株)  

血圧変動と心拍変動の関係は,HF領域では正相関関係を示すのに対し,LF領域では関連がなく両者は別の自律神経状況を示した.圧受容体反射はLF領域の血圧変動を抑制的に修飾することより,圧受容体反射の興奮は血圧変動を減少させると考えられ,このことがLF領域における血圧変動と心拍変動の違いを生じさせる機序の一つとして考えられた

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.11405/nisshoshi1964.93.114

Scopus

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED  

We investigated the role of myocardial ischemia in acute myocardial infarction and cardiac death in 253 patients with asymptomatic coronary disease (206 men, 47 women, mean age: 55 +/- 8 years). Patients were divided into two groups: those with angina pectoris with no history of myocardial infarction (AP group, 93 patients) and those with a history of myocardial infarction CMI group, 160 patients). We also examined the usefulness of exercise electrocardiographic and Holter electrocardiographic findings as prognostic indicators of cardiac events. After 24-hour Holter electrocardiograms were obtained in both groups, patients were assigned to subgroups with or without silent myocardial ischemia (SMI) based on the presence or absence of transient ST-segment depression. Prognostic indicators were evaluated by multiple regression analysis. Cardiac events occurred in 26 (10.3%) of 253 patients; in 6 patients these events were fatal. The incidence of cardiac events was significantly higher in the SMI group than in the non-SMI group (16.4% versus 5.6%, P &lt; 0.05). SMI was identified as a significant prognostic indicator in the overall population (p = 0.0088), as were the number of diseased coronary arteries in the AP group (P = 0.0152), and SMI (p = 0.0022) in the MI group. There were 3 deaths related to cardiac events in each group. The mean time from onset of angina pectoris to death was 73 +/- 41 months compared with 33 +/- 43 months in the MI group. Our findings suggest that the severity of the coronary lesion and SMI were important predictors of major cardiac events, and that the mechanism of the onset of cardiac events was different in the AP and MI groups.

DOI： 10.1536/ihj.37.59

Web of Science

Scopus

PubMed

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Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo1969.28.Supplement1_9

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Other Link： http://search.jamas.or.jp/link/ui/1996206664

Language：Japanese   Publisher：(公財)日本心臓財団  

高周波成分(HF)は負荷により低値を示したが,負荷終了後虚血性心疾患群では,負荷前値への回復が遅延した

DOI： 10.11281/shinzo1969.27.Supplement5_54

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Language：Japanese   Publisher：(株)じほう  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Although 201TlCl myocardial scintigraphy has so far been widely used for the evaluation of the viability of the myocardial infarcted area, functional evaluation using low dose dobutamine (DOB) loaded echography also became recently available. We performed 99mTc-MIBI gated SPECT on eight cases of myocardial infarction at rest and low dose (4-6 μg/kg/min) DOB-loading and related data were collected. Next, we calculated myocardial count increase rate (%WT = ES-ED/ED x 100) with left ventricular contraction from end-diastolic (ED) and end-systolic (ES) pictures in short-axial image, and made a comparative examination of regional contractilities at rest and DOB-loading. DOB-loaded echography performed on the same cases at the same dose revealed 15 segments as infarcted area (WM (+)) presenting improvement in wall movement at loading and 5 segments as infarcted area (WM (-)) presenting no such improvement, and %WT at rest and loading were 29.1 ± 6.2 and 33.2 ± 2.4 for (WM (-)) and 26.8 ± 9.8 and 40.0 ± 12.3 for (WM (+)), indicating a significant increase (p &lt
0.05) at loading. Contractility analysis using MIBI gated SPECT in combined use of DOB-loading was considered as a useful method of examination in view of its reflectionality in the evaluation of the wall movement in DOB-loaded echography and of its high quantitativity.

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Language：Japanese   Publisher：The Japanese Society of Clinical Pharmacology and Therapeutics  

DOI： 10.3999/jscpt.26.91

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Simultaneous dual-isotope SPECT with 99mTc-methoxy isobutyl isonitrile (MIBI) and 123I-β-methyl iodophenyl-pentadecanoic acid (BMIPP) was performed in 25 patients with ischemic heart disease. ECG-gated myocardial SPECT was acquired following the injection of MIBI (555 MBq) and BMIPP (148 MBq). Both MIBI and BMIPP scans provided high-quality myocardial images. Then, myocardial count increase rate (%WT = ES -ED/ED x 100) was calculated as an index of left ventricular contraction using MIBI gated SPECT data. The %WT was well correlated with severity scores of both MIBI image (r = -0.70) and BMIPP image (r = -0.72). Thus, ECG-gated dual-isotope SPECT with MIBI and BMIPP was considered to be useful method for assessment of left ventricular contraction as well as myocardial perfusion and fatty acid metabolism.

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Language：Japanese   Publisher：(一社)日本不整脈心電学会  

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Language：Japanese   Publisher：The Japanese Society of Clinical Pharmacology and Therapeutics  

DOI： 10.3999/jscpt.25.29

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

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Language：English   Publisher：(一社)日本プライマリ・ケア連合学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.53.315

CiNii Research

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Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：(株)南江堂  

＜文献概要＞▼日本人女性の寿命は男性より5歳以上長く,85歳以上の人口の約2/3を女性が占める.▼65歳以上の女性では心疾患による死亡確率が高い.注意すべき疾患は,左心駆出率の保たれた心不全(HFpEF)や深部静脈血栓症・肺動脈血栓塞栓症,たこつぼ症候群,微小血管狭心症などである.▼女性の冠動脈疾患(CAD)は男性より10歳程度遅く発症し,罹患率は低いが,一度発症すると予後はわるい.CADの危険因子は,とくに喫煙・糖尿病が重要である.ハイリスク症例やCADの二次予防に脂質異常の治療を行う.▼心房細動の罹患率は女性が男性より低く,症状が強い.心房細動の血栓性合併症や抗凝固薬の出血リスクには性差はない.▼CAD予防目的のホルモン補充療法は結論が得られておらず,critical window therapyが検討課題である.

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00974&link_issn=&doc_id=20201023160023&doc_link_id=issn%3D0022-1961%26volume%3D126%26issue%3D5%26spage%3D957&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D126%26issue%3D5%26spage%3D957&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：English   Publisher：(一社)日本不整脈心電学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(公財)鈴木謙三記念医科学応用研究財団  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：社団法人日本循環器学会  

CiNii Books

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Event date： 2022

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Event date： 2022

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Event date： 2021.11

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Event date： 2020.12

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外科系医師を中心に継続的な就労の要因としてのワーク・ライフバランスを理解し,必要な支援を考えることが本研究の目的である。大学の同窓会や地域の医師会に呼びかけ,現役の医師に対してワーク・ライフバランスとともに,職業環境,家事負担,生活や仕事への満足度,健康状態等に関する調査を行った。また,医学教育による意識の変化を測るため,医学生に対し2年時と卒業前の6年時におけるワーク・ライフバランスの価値について質問した。女性医師は男性医師に比し家事育児による負担感からワーク・ライフコンフリクトの生じる可能性が示された。特に外科系医師は,そうでない医師に比べて時間的な問題で仕事由来のコンフリクトが大きいことが示唆された。医学生のワーク・ライフバランスの重要性に関する意見は,女子医学生のほうが重要と考えるものが多かったが,卒前の6年時の調査結果で男女間の差は小さくなった。家事育児の性別役割分担への考えは,生育家庭から影響を受けることが示唆され,労働時間など職場環境の改善のほか,大学の医学教育の充実も,医師などの専門職の就労継続に効果のある可能性が示唆された。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01675&link_issn=&doc_id=20210112380006&doc_link_id=10.7248%2Fjjrhi.59.325&url=https%3A%2F%2Fdoi.org%2F10.7248%2Fjjrhi.59.325&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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