記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. METHODS: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). RESULTS: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). CONCLUSIONS: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.

DOI： 10.3390/jcm11010262

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but the importance of which arm exhibits lower blood pressure (BP) and the mechanism underlying IADBP are not well understood. METHODS: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without AAD (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to the non-AAD group. The characteristics analyzed were patient background and IADBP-related factors, including systolic BP (SBP) in the right arm (R) and left arm (L), and R-L or L-R as IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients with an IADBP. RESULTS: In a comparison of the TAAD group and non-AAD group, the prevalences of R <130 mm Hg (38% vs. 19%, p=0.009), L-R >15 mm Hg (19% vs. 8%, p=0.047), L-R >20 mm Hg (14% vs. 4%, p=0.029) were higher in the TAAD group. Multivariate analysis showed that L-R >15 mm Hg with R <130 mm Hg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R >20 mm Hg all had TAAD, and all aortic dissection extended to the BCA just before the right common carotid artery on CT. CONCLUSIONS: IADBP was characterized by R<L with low R in TAAD but was not associated with TBAD.

DOI： 10.1272/jnms.JNMS.2021_88-605

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Because development of acute coronary syndrome (ACS) worsens the prognosis of patients with coronary artery disease, preventing recurrent ACS is crucial. However, the degree to which secondary prevention treatment goals are achieved in patients with recurrent ACS is unknown. METHODS: 214 consecutive ACS patients were classified as having First ACS (n=182) or Recurrent ACS (n=32), and the clinical characteristics of these groups were compared. Fifteen patients died or developed cardiovascular (CV) events during hospitalization, and the remaining 199 patients were followed from the date of hospital discharge to evaluate subsequent CV events. RESULTS: Patients in the Recurrent ACS group were older than those in the First ACS group (76.8±10.8 years vs 68.8±13.4 years, p=0.002) and had a higher rate of diabetes mellitus (DM) (65.6% vs 36.8%, p=0.003). The rate of achieving a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL in the Recurrent ACS group was only 28.1%, even though 68.8% of these patients were taking statins. An HbA1c level of <7.0% was achieved in 66.7% of patients with recurrent ACS who had been diagnosed with DM. Overall, 12.5% of patients with recurrent ACS had received optimal treatment for secondary prevention. CV events after hospital discharge were noted in 37.9% of the Recurrent ACS group and 21.2% of the First ACS group (log-rank test: p=0.004). However, recurrent ACS was not an independent risk factor for CV events (adjusted hazard ratio: 2.09, 95% confidence interval: 0.95 to 4.63, p=0.068). CONCLUSION: Optimal treatment for secondary prevention was not achieved in some patients with recurrent ACS, and achievement of the guideline-recommended LDL-C goal for secondary prevention was especially low in this population.

DOI： 10.1272/jnms.JNMS.2021_88-601

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: We investigated whether intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) was associated with favourable neurological outcomes for patients after the return of spontaneous circulation (ROSC). Moreover, we evaluated the aetiology of cardiac arrest on the effectiveness of this therapy in a sub-study. BACKGROUND: There is insufficient research on the optimal combination of machines for patients after ROSC is not established. METHODS: This is a large-scale, multicentre, 30-day cohort study. Among 80,716 patients who delivered to the emergency room, 935 patients treated with VA-ECMO after ROSC were included using the data from the Tokyo Cardiovascular Care Unit Network Registry between 2010 and 2017. The study patients were stratified according to the use of IABP [the ECMO + IABP group (n = 762) vs. the ECMO-alone group (n = 173)]. We also evaluated the cause of cardiac arrest [acute coronary syndrome (ACS) and non-ACS] in the sub-study. To adjust the patients' backgrounds, we used the propensity score matching for additional analyses. The endpoint was 30-day favourable neurological outcome. RESULTS: The ECMO + IABP group showed significantly better neurological outcomes than the ECMO-alone group (crude; 35% vs. 25%; log-lank P < 0.001). In the ACS subgroup, the ECMO + IABP group showed significantly better neurological outcome (crude; 34% vs. 18%; log-lank P < 0.001), but not in the non-ACS subgroup (crude; 38% vs. 32%; log-lank P = 0.11). These results are similar after adjustments to their backgrounds using propensity matching. CONCLUSIONS: Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is associated with better neurological outcomes after ROSC, especially in complicated ACS.

DOI： 10.1016/j.resuscitation.2021.07.019

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gastrointestinal (GI) bleeding worsens the outcomes of critically ill patients in the intensive care unit (ICU). Owing to a lack of corresponding data, we aimed to investigate whether GI bleeding during cardiovascular-ICU (C-ICU) admission in acute cardiovascular (CV) disease patients is a risk factor for subsequent CV events. Totally, 492 consecutive C-ICU patients (40.9% acute coronary syndrome, 22.8% heart failure) were grouped into GI bleeding (n = 27; 12 upper GI and 15 lower GI) and non-GI bleeding (n = 465) groups. Thirty-nine patients died or developed CV events during hospitalization, and 453 were followed up from the date of C-ICU discharge to evaluate subsequent major adverse CV events. The GI bleeding group had a higher Acute Physiology and Chronic Health Evaluation II score (20.2 ± 8.2 vs. 15.1 ± 6.8, p < 0.001), higher frequency of mechanical ventilator use (29.6% vs. 13.1%, p = 0.039), and longer C-ICU admission duration (8 [5-16] days vs. 5 [3-8] days, p < 0.001) than the non-GI bleeding group. The in-hospital mortality rate did not differ between the groups. Of those who were followed-up, CV events after C-ICU discharge were identified in 34.6% and 14.3% of patients in the GI and non-GI bleeding groups, respectively, during a median follow-up period of 228 days (log rank, p < 0.001). GI bleeding was an independent risk factor for subsequent CV events (adjusted hazard ratio: 2.23, 95% confidence interval: 1.06-4.71; p = 0.035). GI bleeding during C-ICU admission was independently associated with subsequent CV events in such settings.

DOI： 10.1007/s00380-021-01822-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In the modern US cardiovascular intensive care unit (CICU), the incidence of non-cardiovascular disorders has increased and non-cardiovascular disorders are associated with an increase in morbidity and mortality. In Japan, however, data regarding the association between non-cardiovascular disorders and outcomes in the CICU are limited. METHODS: This study examined 490 consecutive admissions to a closed CICU at the Nippon Medical School Hospital from January to December 2017. Characteristics, diagnoses, treatments, and outcomes of admitted patients were identified. RESULTS: The most common primary diagnosis was acute coronary syndrome (50.4%), followed by acute heart failure (20.0%), arrhythmia (6.7%), and non-cardiovascular diseases (3.7%). The mortality rate and median length of stay (LOS) in the CICU were 4.7% and 4 (interquartile range, 2-8) days, respectively. Of all patients, 42.2% (n = 207) developed non-cardiovascular complications such as acute respiratory failure, acute kidney injury, or sepsis during CICU stay. Multivariate logistic regression analysis revealed that acute respiratory failure and sepsis were significantly associated with mortality in the CICU (odds ratio, 11.014 and 25.678, respectively; both p<0.05). The multiple linear regression analysis showed that acute kidney injury was significantly associated with LOS in the CICU (β=0.144, p = 0.002). CONCLUSIONS: Approximately half of patients admitted to the CICU had non-cardiovascular disorders including non-cardiovascular disease and non-cardiovascular complications, which were significantly associated with mortality and LOS in the CICU.

DOI： 10.1016/j.jjcc.2021.03.002

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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掲載種別：研究論文（学術雑誌）  

© 2020 The Author(s). 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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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 64-year-old man was admitted for evaluation of back pain. He did not have a Marfan syndrome (MFS)-like appearance, and had a history of a type B aortic dissection and total arch replacement. A connective tissue disorder had been suspected because of the histologic findings of the resected aortic wall. On admission, a computed tomography (CT) scan demonstrated a three-channeled aortic dissection (3ch-AD) measuring 63 mm in diameter. We planned to perform elective surgery during his hospitalization. On the fourth hospital day, he complained of severe back pain, and enhanced CT scan revealed an aortic rupture. The patients with 3ch-AD often have MFS. However, even if they do not have an MFS-like appearance, clinicians should consider fragility of the aortic wall in patients with 3ch-AD. If the aortic diameter is enlarged, early surgery is recommended. In particular, if a connective tissue disorder is obvious or suspected, emergent surgery is warranted.

DOI： 10.5761/atcs.cr.17-00066

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Prasugrel is often replaced with clopidogrel after a certain period of time following coronary stenting. However, the time course of platelet aggregation during this replacement is unknown. We performed a prospective, single-arm study to monitor platelet reactivity before and after the replacement. Forty-five patients (mean age 62.6 ± 13 years, 40 male) who received coronary stenting for acute coronary syndrome were initially treated with the loading dose (20 mg) of prasugrel followed by the maintenance dose (3.75 mg/day) for 7 days, then switched to 75 mg/day of clopidogrel. The P2Y12 reaction unit (PRU) level was measured at baseline and selected time points. Prasugrel effectively suppressed PRU from 248 ± 59 at baseline to 145 ± 65 on day 1 (P < 0.001). The PRU value on the final day of prasugrel treatment (day 7) was 156 ± 68 (P < 0.001 vs. baseline). After switching to clopidogrel, PRU was consistently suppressed [146 ± 60, 139 ± 54, and 135 ± 60 on days 9, 11, and 13, respectively (P < 0.001, each point vs. baseline)]. Switching from the initial prasugrel therapy to clopidogrel using the maintenance dose does not cause a drug efficacy gap and stays effective for preventing stent thrombosis.

DOI： 10.1007/s00380-017-1016-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cardiac tamponade is an important and potentially lethal complication of acute pericarditis. However, recurrence of cardiac tamponade is rare when it is treated appropriately. We present a 49-year-old man with bacterial pericarditis and recurrent cardiac tamponade, which was caused by the rupture of an upper part of the left atrium (LA). According to the autopsy findings, bacteremia from Staphylococcus aureus developed on a substrate of poorly controlled diabetes mellitus and spread to the pericardium via the blood. Subsequently, tissue necrosis developed from the pulmonary trunk and aorta to the LA, leading to recurrence of cardiac rupture and cardiac tamponade.

DOI： 10.1272/jnms.84.133

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00679&link_issn=&doc_id=20160727210038&doc_link_id=%2Fah2sinzd%2F2016%2F004807%2F040%2F0844-0844%26dl%3D2&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2016%2F004807%2F040%2F0844-0844%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective A fever is observed in approximately one-third of cases of acute aortic dissection (AAD); however, the causes remain unclear. We investigated the mechanism of a fever in AAD by measuring the serum concentrations of inflammatory markers, mediators of coagulation and fibrinolysis, and procalcitonin, a marker of bacterial infection. Methods We retrospectively studied 43 patients with medically treated AAD without apparent infection. Patients were divided into those with (Group A; n=19) and without (Group B; n=24) a maximum body temperature >38°C. We established which patients fulfilled the criteria for systemic inflammatory response syndrome (SIRS), and its relationship with a fever was examined. Mediators of inflammation, coagulation and fibrinolysis were compared by a univariate analysis. Factors independently associated with a fever were established by a multivariate analysis. Results The criteria for SIRS were fulfilled in a greater proportion of patients in Group A (79%) than in Group B (42%, p=0.001). There was no difference in the procalcitonin concentration between Groups A and B (0.15±0.17 ng/mL vs. 0.11±0.12 ng/mL, respectively; p=0.572). Serum procalcitonin concentrations lay within the normal range in all patients in whom it was measured, which showed that the fever was caused by endogenous mediators. On the multivariate analysis, there was a borderline significant relationship between a fever and the prothrombin time-International Normalized Ratio (p=0.065), likely reflecting the extrinsic pathway activity initiated by tissue factor. Conclusion Our findings suggest that a fever in AAD could be caused by SIRS, provoked by endogenous mediators that influence the extrinsic coagulation pathway without elevating the serum procalcitonin concentration.

DOI： 10.2169/internalmedicine.55.5924

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

There is currently no reliable method of predicting the success of weaning from intra-aortic balloon pumping (IABP). The aim of this study was to investigate the ability of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level to predict the success of weaning from IABP. Consecutive patients scheduled for weaning from IABP were prospectively enrolled. NT-proBNP levels were measured at baseline (before the start of weaning) and cessation (just before cessation of IABP). Changes in NT-proBNP level between baseline and cessation were analyzed in 2 groups of patients: those who were successfully weaned and those who were not successfully weaned for any reason, including a decision to discontinue weaning, worsening of pulmonary edema after cessation of IABP, or unstable hemodynamics after cessation of IABP. A total of 30 patients were enrolled (mean age 66 ± 12 years, 16 men, 16 with acute myocardial infarctions, and 14 with acute exacerbation of chronic heart failure). Median (interquartile range) baseline NT-proBNP levels were not significantly different between the successful and unsuccessful weaning groups (4,200 [1,400 to 8,752] pg/ml vs (5,620 [2,035 to 13,950] pg/ml, p = 0.30). In the unsuccessful weaning group, the median NT-proBNP level was significantly higher at cessation (9,995 [2,920 to 15,100] pg/ml) than at baseline (p = 0.008). All patients with decreases in NT-proBNP level between baseline and cessation were successfully weaned from IABP. In conclusion, these results show that NT-proBNP levels were useful for predicting the success of weaning from IABP. If the NT-proBNP level increases during weaning from IABP, more intense management should be considered.

DOI： 10.1016/j.amjcard.2014.06.027

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1161/CIRCULATIONAHA.112.000602

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jacc.2013.01.097

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記述言語：英語  

DOI： 10.1016/j.ijcard.2012.08.037

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記述言語：英語  

Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder in patients with prostate cancer. However, renal involvement in DIC associated with prostate cancer has rarely been documented. Herein, we present a case of metastatic prostate cancer presenting with acute renal failure (RF) triggered by DIC. An 80 year old man with metastatic prostate cancer was treated with antihormone therapy at an outpatient clinic. He was admitted to our hospital because of severe dyspnea and progressive RF. A hemorrhagic tendency was not clinically evident. Laboratory tests exhibited a significant coagulation disorder, suggestive of DIC. Despite treatment, his RF and dyspnea worsened, and he eventually passed away. An autopsy study revealed hypertensive nephrosclerosis superimposed by fibrin rich thrombi formation involving glomerular capillaries and arterioles characteristic of DIC. Additionally, focal segmental glomerulosclerosis was identified, which was presumably secondary to the glomerular endothelial and/or podocyte injury augmented by DIC. Those findings showed that glomerular injury, which was induced and subsequently exacerbated by DIC associated with prostate cancer, highly contributed to the progression of RF in our case. A differential diagnosis of DIC should be considered when a patient with prostate cancer presents with renal dysfunction.

DOI： 10.2147/IJNRD.S41813

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recently, interferon gamma release assays (IGRAs) have become an important clinical tool for detecting latent tuberculosis. However, IGRA results may impede making a diagnosis. We herein present an interesting case of miliary tuberculosis with a nonspecific IGRA reaction due to hemophagocytosis.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Haemolytic anaemia due to a stenosed graft is a rare complication after surgery for aortic dissection. We present the case of a patient with haemolytic anaemia and heart failure, who had undergone emergent ascending aorta replacement for type A acute aortic dissection 5 years earlier. Chest computed tomography revealed severe graft stenosis of the proximal anastomosis and transthoracic echocardiography showed severe aortic regurgitation. Surgical treatment was necessary because of heart failure and myocardial ischaemia due to haemolytic anaemia and aortic regurgitation. During the operation, we found an inner graft surrounded by an outer graft and a dilated lumen between the double-reinforced grafts compressing the inner graft. We successfully reconstructed the aortic root with a total arch replacement. To the best of our knowledge, there are no cases in which haemolytic anaemia and AR developed in a patient with acute aortic dissection surgically treated by such a mechanism.

DOI： 10.1093/icvts/ivs272

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記述言語：英語  

DOI： 10.1016/j.ijcard.2011.10.039

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A female with chronic atrial fibrillation presented with an acute myocardial infarction. The angiogram revealed total occlusion of the right coronary artery. A combined strategy using intracoronary thrombolysis, aspiration catheter, plain old balloon angioplasty, and "Fogarty-like" procedure was performed. However, we failed to achieve good coronary flow because the thrombus was large and hard with a calcified surface revealed by intravascular ultrasound examination. Ultimately, compression of the thrombus with the AngioSculpt™ scoring balloon catheter (AngioScore, Fremont, CA) led to resolution of normal coronary flow without the need for implantation of a coronary stent. Calcified thrombus is rarely observed in a coronary artery embolism, especially one formed in the left atrial appendage. In this case, the AngioSculpt scoring balloon catheter shows efficacy in treating this calcified thrombus.

DOI： 10.1002/ccd.23073

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

When pulmonary embolism (PE) develops, circulatory collapse and hypoxia are caused at the same time. The rapid and proper use of extracorporeal life support (ECLS) can improve the mortality rate of patients with collapsed massive PE. No study has examined the influence of treatment that involved adding catheter based-intervention to ECLS with massive collapsed PE. Thirty-five patients with massive PE were examined, and 10 of these patients were placed on ECLS. Eight of the 10 patients placed on ECLS for massive PE were female, and the median age was 61 years. Seven patients had in-hospital onset PE and 3 patients out-of-hospital onset PE. Their underlying conditions were a cerebral infarction (3 patients), coronary artery disease (5 patients), collagen disease (one patient), postoperative state (3 patients), and lung disease (2 patients). Pulmonary angiographic findings showed that a filling defect or complete occlusion was observed in all 10 patients in the proximal lobular arteries, 6 of which had large thrombi stretching to the main pulmonary arteries. All patients underwent thrombolysis. Percutaneous catheter embolus fragmentation and/or thrombectomy were undertaken in 7 patients. All patients required red blood cell transfusion for cannulation site bleeding. The mean duration of ECLS bypass was 48 ± 44 hours. The 30 day mortality rate was 30%. The current study clarified the characteristics of patients with massive PE requiring ECLS. These patients have extensive pulmonary thromboemboli, thus, the aggressive use of catheter-based intervention appears to have beneficial effects for massive PE requiring ECLS.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The prevalence of coronary artery disease (CAD) in patients with peripheral arterial disease (PAD) approaches 50%. The incidence of perioperative cardiac complications is high in patients undergoing peripheral vascular surgery (PVS). However, the long-term efficacy of coronary artery revascularization in patients with PAD prior to PVS remains controversial. We retrospectively analyzed the long-term outcomes of 114 patients who underwent elective PVS. Coronary angiography (CAG) was performed routinely in all patients prior to the surgery. Preoperative CAG revealed CAD in 52 patients and no CAD in 62 patients (No-CAD group). Of the 52 patients with CAD, 15 patients with effort angina (more than CCS class 2), myocardial ischemia proven by pharmacological stress scintigraphy, and/or multivessel disease with impaired left ventricular systolic function underwent coronary revascularization (CAD-R group). The remaining 37 patients with CAD were treated medically (CAD-M group). The rates of postoperative events within 30 days were 26.7% in the CAD-R group, 10.8% in the CAD-M group, and 8.1% in the No-CAD group, respectively (P = 0.13), and the rates of long-term cardiovascular events were 33.3, 21.6, and 21.0%, respectively (P = 0.60). Therefore, the acute and long-term clinical outcomes in the CAD-R group were comparable with the other groups. In this study, the patients with CAD who showed inducible myocardial ischemia and/or multivessel disease with impaired left ventricular systolic function underwent coronary artery revascularization prior to the elective PVS. The patients who underwent coronary revascularization prior to the PVS exhibited comparable long-term outcomes compared with the patients who showed CAD but without inducible myocardial ischemia and with those without CAD. These data suggest that the evaluation of CAD and myocardial ischemia to determine the therapeutic strategy for CAD before elective PVS would be needed.

DOI： 10.1007/s12928-009-0001-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case who had confirmed tumor cells in the biopsy specimens by transvenous endomyocardial biopsy with intra-procedural consultation and fast smear cytology. A 57-year-old female was admitted to our hospital because of shortness of breath and left back pain. Transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (CT) scans demonstrated a large mass in the right atrium and multiple liver tumors thought to be due to spread of the disease. Coronary angiography showed the right coronary artery was involved in the mass. In order to confirm the histological diagnosis, we attempted transvenous endomyocardial tumor biopsy under fluoroscopic guidance. However, we failed to obtain adequate tissue material. Due to several risks associated with a surgical procedure such as an open surgical biopsy, transvenous endomyocardial tumor biopsy was again attempted with the aid of transesophageal echocardiography (TEE). Intra-procedural consultation and fast smear cytology enabled us to finish the procedure. Hematoxylin-eosin stained sections demonstrated spindle-shaped cells. Immunohistochemical stains of these cells were positive for anti-factor VIII antigen, CD31, and CD34. These findings indicated a definite diagnosis of angiosarcoma. Since there was no surgical indication for this tumor, the patient underwent chemotherapy with docetaxel and radiotherapy. Three months later, CT scans showed a reduction in the size of the cardiac tumor.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The efficacy of prophylactic coronary revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in patients with abdominal aortic aneurysm (AAA) scheduled for open repair surgery remains controversial. HYPOTHESIS: Concomitant coronary artery disease (CAD) with no inducible ischemia can be medically treated in AAA patients undergoing open repair as long as the existence of CAD is recognized. METHOD: A retrospective analysis of acute and long-term outcomes was performed for 122 patients with AAA who underwent coronary arteriography (CAG) for preoperative evaluation followed by elective open repair. RESULTS: Preoperative CAG revealed no CAD in 54 patients (non-CAD group) and the existence of CAD in 68 patients. Prophylactic PCI or CABG surgery was performed in 16 patients (CAD-PCI/CABG group) with symptomatic angina, ischemia proven by pharmacological stress scintigraphy, or coexistence of reduced cardiac contraction and coronary stenosis in multiple vessels. Medical treatment was administered to 52 patients who had no signs of ischemia (CAD-medical group). During the perioperative period, no cardiac event occurred irrespective of the existence of CAD. The long-term outcomes in the CAD-medical group were equivalent to those in the non-CAD group. In the CAD-PCI/CABG group, the cardiac event-free rate was comparable with that of other groups, although mortality was higher. CONCLUSION: In patients undergoing AAA open repair, medical treatment for concomitant CAD with no obvious inducible ischemia does not confer unfavorable outcomes. Although prophylactic coronary revascularization possibly prevents future cardiac events, it appears to be necessary in a very limited number of cases.

DOI： 10.1002/clc.20335

PubMed

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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：SAGE PUBLICATIONS INC  

Atrial fibrillation is commonly observed in patients with hypertrophic obstructive cardiomyopathy. Episodes of paroxysmal atria] fibrillation are often torturous and limit the quality of life by causing congestive heart failure, transient hypotension, or bradycardia. Control of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is considered to be important for symptomatic improvement and prevention of the development to chronic atrial fibrillation. The authors report on 3 patients with hypertrophic obstructive cardiomyopathy who suffered from paroxysmal atrial fibrillation despite receiving medical treatment using antiarrhythmic agents. However, after undergoing percutaneous transluminal septal myocardial ablation, the incidence of episodes became significantly less frequent. Percutaneous transluminal septal myocardial ablation is normally performed for attenuating left ventricular obstruction by reducing the systolic anterior motion of the mitral leaflet. However, in these patients, this procedure was also effective in preventing supraventricular arrhythmia, probably by improving left ventricular diastolic dysfunction, smooth blood inflow into the left ventricular, and decreasing the pressure stress against the left atrial wall.

DOI： 10.1177/0003319707305406

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of late multiple stent fractures following the deployment of sirolimus-eluting stents (SESs) for diffuse right coronary artery (RCA) stenosis. A 44-year-old male with hyperlipidemia was referred to our hospital for acute myocardial infarction (AMI). Percutaneous coronary intervention (PCI) was performed for total occlusion of the proximal segment of the RCA, and 5 SESs were consecutively implanted for long, diffuse stenotic lesions. A follow-up coronary angiography (CAG) performed 8 months later revealed strut fractures in the middle of all the stents, except the most proximal one. Multislice computed tomography confirmed the locations of the fractured struts inside of the stents.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a patient who first developed Brugada syndrome (BS) after the conduction in atrioventricular (AV) node and the ventricular conduction system was disturbed. A type-1 Brugada ECG was unexpectedly unmasked after administration of a class IC antiarrhythmic agent for suppressing paroxysmal atrial fibrillation (paf), which had never been documented in the absence of such conduction disturbances, even after giving antiarrhythmic agents for paf. In addition, this patient was accompanied by sick sinus syndrome. This was an intriguing overlap syndrome case in that the development of BS might have been associated with the incidence of a conduction system disturbance.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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

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

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

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Web of Science

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

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

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

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

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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

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

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

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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記述言語：日本語   出版者・発行元：日本循環制御医学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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

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

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

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

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は45歳男性。心筋梗塞に対する経カテーテルインターベンション施行6日後に同一波形の心室期外収縮(PVC)を契機として心室細動(VF)によるelectrical stormを生じ、緊急高周波カテーテルアブレーション(RFCA)を施行した。PVC(PVC-1)は右脚ブロック+下方軸型で、左脚前枝領域にPVC時のQRSに40ms先行するPurkinje potential(PP)が記録された。同部位を焼灼するとPVC-1は消失しVFも一時的に抑制された。術後、波形の異なるPVC-2(右脚ブロック+水平軸型)に続くVF stormが再発し、再度RFCAを施行。PVC-2は左室中隔領域が最早期興奮部位であり、PVC時にQRSに45ms先行するPPが記録された。同部位での焼灼でPVC-2は消失しESは抑制されたが、その後さらに波形の異なるPVC-3から再度VF stormとなったため3回目のRFCAを施行。PVC-3は僧帽弁輪0時方向の左心室基部近傍が最早期興奮部位であった。同部位を焼灼した結果PVC-3は消失し、以後VFは抑制され独歩退院した。複数のPurkinje起源PVCに対しRFCAを行うことでVF stormを抑制し得た心筋梗塞の1例を報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：日本心臓血管内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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

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

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

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記述言語：日本語   出版者・発行元：(一社)日本病院総合診療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

経口アミオダロン不耐症例に合併したelectrical stormに対する静注アミオダロンの安全性および有効性について検討した。静注アミオダロンで治療した致死性不整脈患者60例中、経口アミオダロンを減量または中止中に発症したelectrical storm 6例を対象とした。6例の減量・中止の原因として、甲状腺機能異常は甲状腺機能亢進症、破壊性甲状腺炎(バセドー病)2例、間質性肺炎またはKL-6上昇例2例、肝機能障害増悪2例であった。カテコラミン内服薬は半数に投与され、植込み型除細動器は全例に植え込まれていた。発作時の平均血中K濃度は若干低値であった。6例中4例で静注アミオダロンが有効で、残り2例が無効であった。この2例に関してもカテーテルアブレーションを追加することにより、その後不整脈の抑制が得られた。6例に有害事象は認められなかったが、1例に徐脈、1例に甲状線刺激ホルモンの上昇を認められた。

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は77歳女性で、左大腿骨頸部骨折で人工骨頭置換術を受け、退院7日後に呼吸困難および胸痛が出現した。胸部造影CTで両側肺動脈主幹部、下肢静脈エコーで左大腿静脈に血栓が認められた。心エコーでは右房内に索状の巨大浮遊血栓(42mm×35mm)を認め、推定収縮期肺動脈圧は58.1mmHgと肺高血圧を示した。右房内血栓を伴っていたが亜広範型の急性肺塞栓症であり、出血リスクは低いと考え血栓溶解療法を選択した。肺塞栓および循環不全に備えて経皮的心肺補助装置導入用のシースを右大腿動静脈に挿入後、モンテプラーゼ160万単位を全身投与した。投与2時間後の心エコーで右房内血栓に変化はなく、右心負荷所見の改善が認められた。軽度の穿刺部出血で輸血を要したが、未分画ヘパリン静注による抗凝固療法は継続した。第5病日の造影CTで両側肺動脈内の血栓は残存していたが末梢では縮小を認め、右房内血栓は第9病日に消失した。その後、順調に経過し第35病日に退院した。

DOI： 10.11281/shinzo.44.937

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00679&link_issn=&doc_id=20120723250062&doc_link_id=%2Fah2sinzd%2F2012%2F004407%2F064%2F0937-0938%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fah2sinzd%2F2012%2F004407%2F064%2F0937-0938%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

症例は39歳, 男性. 既往歴には特記すべき事項なし. 冠危険因子は喫煙のみ. 2007年7月より労作時の呼吸困難を自覚し当科受診. ホルター心電図にて労作時のST下降, トレッドミル運動負荷試験にて呼吸困難を伴うII, III, aV_F, V_4～6誘導のST下降を認めたため労作性狭心症の診断で入院. 入院時, 安静時心電図にはST変化なく, 明らかな凝固&middot;線溶系異常も認めなかった. 冠動脈造影では右冠動脈近位部の冠動脈瘤と瘤近傍の順行性側副血行路, 左前下行枝近位部の完全閉塞, 左回旋枝から右冠動脈と左前下行枝への側副血行路を認めた. 後日施行したマルチスライスCTにて, 右冠動脈の側副血管は瘤直上より瘤を回旋するように描出された. 左前下行枝の閉塞近位部には石灰化を伴う冠動脈瘤が確認され, 冠動脈造影では不十分であった冠動脈瘤の形態的評価にマルチスライスCTが有用であった. 本例は, 川崎病罹患を疑わせる既往が全く存在しないが, 若年者で冠危険因子が喫煙のみにもかかわらず, 石灰化と多発性冠動脈瘤を伴う高度な冠動脈硬化を認めたことから, 幼少時に罹患した川崎病に続発する冠動脈病変により労作性狭心症を発症したものと推測された.

DOI： 10.11281/shinzo.41.558

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：特定非営利活動法人日本臨床細胞学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：日本成人病(生活習慣病)学会  

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記述言語：日本語   出版者・発行元：日本成人病(生活習慣病)学会  

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

症例は58歳,男性.既往に特記すべきことなし.ソフトボールの試合でピッチャーをしており,キャッチャーからの返球を受けようとした際(ボールは直接患者には当たっていない),突然崩れるようにマウンド上で倒れた.直ちにチームメイトが心肺蘇生(CPR)を開始し,救急隊到着時の自動体外式除細動器(AED)モニター上は心室細動であった.AEDにて意識消失6分後に除細動を1回施行.その後心拍再開し,救急車内で意識レベルはJCSI-1まで改善した.心臓カテーテル・心臓電気生理学的検査(EPS)などを行ったが,原疾患の特定はできず,現時点では拡張型心筋症の初期である可能性が考えられた.後日,他院にて植込み型除細動器(ICD)の植え込み術を行った.本例は院外で心室細動を起こしたにもかかわらず,バイスタンダーと救急隊の適切な処置により,脳への後遺症なく発症前と変わらない状態で社会復帰が可能となった症例である.1次救命処置の重要性を改めて知りうる症例であり報告する.

DOI： 10.11281/shinzo1969.40.Supplement3_5

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

症例は29歳,男性.以前より安静時胸部違和感の自覚あり.自宅で昼寝中に意識消失し,家人が心臓マッサージを行い救急車を要請.救急隊到着時は心室細動(ventrlcular fibrillation ; VF)で,除細動後に無脈性電気活動となり心肺蘇生術を継続し当院救命センターへ搬送された.収容後もVFは再発を繰り返し血行動態維持に補助循環〔経皮的心肺補助装置(percutaneous cardiopulmonary support ; PCPS),大動脈内バルーンパンピング(intraaorticballoon pumping ; IABP)〕を要したが順次離脱できた.洞調律復帰後の心電図でST下降を認めたため冠動脈造影を施行.冠動脈に有意狭窄は認めなかったがアセチルコリン(acetylchoiine ; ACh)負荷試験にて左冠動脈に心電図変化を伴うほぼ完全閉塞にいたる冠攣縮が誘発された.諸検査でほかに基礎疾患を認めず冠攣縮性狭心症によるVFと診断した.カルシウム拮抗薬の投与後発作なく,服薬下で再施行したACh負荷試験で冠攣縮が誘発されないことを確認し,植込み型除細動器の植え込みは行わなかった.VF例では救命することに加え原疾患の診断が重要であり,若年者のVF例で原因診断と後遺症を残さず社会復帰をし得た貴重な1例を経験したので報告する.

DOI： 10.11281/shinzo1969.40.12_1113

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00679&link_issn=&doc_id=20081216100009&doc_link_id=10.11281%2Fshinzo1969.40.12_1113&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo1969.40.12_1113&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

症例は48歳,男性.2006年9月に突然の呼吸苦と胸痛を自覚,ショック状態のため当院へ入院となる.身体所見より精巣萎縮,陰毛の減少,陰茎発育不良が認められ,血液検査にてテストステロン低値,ゴナドトロピン高値が観察された.性染色体解析により47XXYが検出されKlinefelter症候群と確認された.胸部造影CTにて肺動脈主幹部に巨大な血栓を認め,肺血流シンチグラムでは右中葉と下葉の一部,左中葉の一部に陰影欠損を認めた.下肢静脈造影にて両側の下肢静脈に陰影欠損を認め,Klinefelter症候群に合併する静脈血栓症が原因の肺動脈血栓塞栓症と診断された.下肢静脈血栓と肺動脈内の多量血栓に対して,ワルファリン内服開始とウロキナーゼ96万単位/日の静脈注射を5日間施行した.治療により症状は軽快し,2週間後に施行した胸部造影CTでも肺動脈内の血栓はほぼ消失した.Klinefelter症候群は性染色体異常に起因する原発性性腺機能低下症で,その発生頻度は総人口の0.1～0.2%であるとされ,性染色体異常疾患のなかで最も頻度の高い疾患といわれている.正常健人(男性)に比べ約5～20倍の頻度で静脈血栓塞栓症が発症すると報告され,その原因として(1)下肢静脈内皮の沈下性潰瘍,(2)凝固線溶系因子の遺伝子異常により持続した凝固亢進状態が考察されている.本例は明らかな凝固線溶系因子の異常は認められず,沈下性潰瘍が原因と思われる静脈血栓塞栓症と考えられた.

DOI： 10.11281/shinzo1969.40.2_132

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00679&link_issn=&doc_id=20080218260006&doc_link_id=10.11281%2Fshinzo1969.40.2_132&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo1969.40.2_132&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：社団法人日本循環器学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

Warfarin投与患者128例(男81例・女47例)を対象に、出血性合併症について出血あり30例(A群)と出血なし98例(B群)、血栓塞栓症について血栓あり10例(C群)と血栓なし118例(D群)にそれぞれ分け、患者背景および治療内容を比較した。A群とB群とではA群で女性が多く、aspirin併用はA群53%、B群24%と有意差がみられた。基礎疾患はA群で高血圧が有意に多かった。C群とD群とでは、患者背景やaspirin併用率に有意差はなかった。出血イベントを、明らかな出血、危険な器官の出血、出血後にヘモグロビン2.0g/dlを超える減少または2単位以上の輸血、薬剤または外科的な介入または入院、の4項目を基準に判定したところ、C群で出血イベントを併発した5例は平均77歳と高齢で、高血圧を合併しており、重症出血が3例、aspirin併用が1例であった。次に、A群において出血イベントのうち、明らかな出血およびその他3項目のいずれかを満たす重症例5例と、明らかな出血のみの軽症例25例を比較したところ、重症例は男性が多く、年齢が高かった。また、重症例は高血圧および脳梗塞の合併率が80%で、40%がaspirinを併用していたが、軽症例では併用率56%であった。出血の年間発生率は重症例1.0%、軽症例7.0%であった。

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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