JAPANESE CIRCULATION JOURNAL
Online ISSN : 1347-4839
Print ISSN : 0047-1828
ISSN-L : 0047-1828
59 巻, 10 号
選択された号の論文の6件中1~6を表示しています
  • Hideyuki Sato, Masatsugu Hori, Hitoshi Ozaki, Hiroshi Yokoyama, Katsuj ...
    1995 年 59 巻 10 号 p. 647-653
    発行日: 1995/09/20
    公開日: 2008/04/14
    ジャーナル フリー
    Although a major goal in the treatment of chronic heart failure is to improve daily physical activity levels, this has not been assessed quantitatively. An increased daily activity level may be reflected by an increase in daily energy expenditure. In the present study, measurements of energy expenditure with a commercially available ambulatory calorimeter were first validated using cardiopulmonary exercise tests in 5 normal volunteers. The energy expenditure measured by the calorimeter correlated well with that estimated from oxygen uptake(r=0.89). Subsequently, the daily energy expenditure was serially measured with the calorimeter during long-term administration of the converting enzyme inhibitior ramipril for 24 weeks in 8 patients with chronic heart failure. Changes in echocardiographic parameters and exercise capacity were also studied. Peak oxygen uptake and anaerobic threshold assessed with symptomlimited maximal bicycle exercise were significantly increased 12 weeks or more after the initiation of treatment(P<0.01 and P<0.01, respectively). Left ventricular fractional shortening substantially, but not significantly, increased during this period(P<0.1). These results strongly suggest that an overall improvement in heart failure was achieved after long-term ramipril therapy. The energy expenditure during daily activities was also significantly increased after ramipril therapy for 24 weeks(P<0.01). Thus, the daily energy expenditure increased with improvement of heart failure, probably reflecting an increase in daily activity levels. We conclude that calorimetric measurement of daily energy expenditure is a novel and simple technique for quantitative evaluation of the effect of therapy on daily physical activity levels in patients with chronic heart failure.
  • Akihito Tsuji, Masami Nagashima, Seiiti Hasegawa, Noriko Nagai, Kenji ...
    1995 年 59 巻 10 号 p. 654-662
    発行日: 1995/09/20
    公開日: 2008/04/14
    ジャーナル フリー
    Clinical characteristics and long-term prognosis of 163 children with ventricular arrhythmias without underlying heart diseases(78 with ventricular premature contractions(VPC group), 39 with ventricular couplets(CPLT group), and 46 with ventricular tachycardia(VT group))were studied by Holter electrocardiographic monitoring(Holter ECG)and treadmill exercise testing The age of the subjects at the initial examination was 8.9±3.4 years in the VPC group, 9.9±3.5 years in CPLT group, and 9.4±3.1 years in the VT group. The duration of the follow-up was 71.7±32.1 months in the VPC group, 65.9±32.8 months in the CPLT group, and 84.0±31.9 months in the VT group. VPC's disappeared during the follow-up period in 22(28%)of the 78 children in the VPC group. CPLT's disappeared in 15(38%)and VPC's disappeared in 9(23%)of the 39 children in the CPLT group. In the 46 children in the VT group, VT disappeared in 30(65%), and VPC's disappeared in 17(37%). One child(2%)in the VT group died of heart failure due to drug-resistant sustained VT. The mean time until the disappearance of VPC's in the 163 patients was estimated to be 115.2±4.3 months. The mean time until the disappearance of VT in the 46 children in the VT group was estimated to be 89.0±4.9 months. Multivariate analysis of prognostic factors related to the disappearance of VPC's indicated that nighttime VPC's were significantly more likely to disappear(p=0.018), and that symptomatic VT was significantly more likely to disappear than asymptomatic VT(p=0.032), probably because more symptomatic cases received antiarrhythmic therapy. Ventricular arrhythmias in children without underlyng diseases often disappeared, and the prognosis was generally favorable. However, appropriate treatment and follow-up were required in children with sustained VT, symptomatic VT, or VT with a high rate of VT.
  • Hisao Ogawa, Hirofumi Yasue, Shuichi Oshima, Yasuhiro Ogata, Yuichi Nu ...
    1995 年 59 巻 10 号 p. 663-672
    発行日: 1995/09/20
    公開日: 2008/04/14
    ジャーナル フリー
    Coronary recanalization rate and infarct size were compared between 2 different methods of intravenously administering recombinant tissue-type plasminogen activator(rt-PA)41.4mg; 1)an initial bolus dose of 30% followed by infusion of the remainder over 60 min(30% group), and an initial bolus dose of 10% followed by infusion of the remainder over 60 min(10% group). Thirty min after beginning rt-PA infusion, the coronary recanalization rate was higher in the 30% group than in the 10% group(82.9%(34/41)vs 53.7%(22/41), p<0.01). The peak creatine kinase and peak creatine kinase-MB levels were lower in the 30% group than in the 10% group. We conclude that a higher initial boulus dose of rt-PA gives a higher rate of recanalizaiton of the infarct-related artery at the very early phase, and probably leads to a smaller infarct size.
  • Osamu Yamaoka, Masahiko Kinoshita
    1995 年 59 巻 10 号 p. 673-684
    発行日: 1995/09/20
    公開日: 2008/04/14
    ジャーナル フリー
    The role of collateral flow was evaluated in a pharmacological stress test[a combination of low-dose dobutamine(DOB)and a vasodilator]as a predictor of wall motion reversibility at rest after percutaneous transluminal coronary angioplasty(PTCA)using ultrafast computed tomography(UFCT). Segments with wall motion abnormalities before PTCA were divided into two groups; ie, either with or without collateral flow. Patients were scanned at rest for baseline and again after 5 min of intravenous administration of 4μg/kg per min of DOB after nitroglycerin(0.3 mg sublingually)or isosorbide dinitrate(2.5 mg bolus intravenous injection). Three months after PTCA, patients were scanned again and wall motion was compared with the previous findings. In collateral-dependent segments, the sensitivity of the pharmacological stress test as a predictor of wall motion reversibility was 87.5% and the specificity was 83.3%. In collateral-independent segments, the sensitivity was only 41.7%, while the specificity was 95.2%. Our findings demonstrate that the pharmacological stress test we used satisfactorily predicted wall motion reversibility in collateral-dependent segments, but tended to underestimate wall motion reversibility in collateral-independent segmentts. Therefore, collateral flow may be an important factor in accurately predicting wall motion reversibility by this pharmacological stress test.
  • Kazuaki Uchino, Satoshi Umemura, Hisao Ochiai, Yoshihiro Ishikawa, Toh ...
    1995 年 59 巻 10 号 p. 685-692
    発行日: 1995/09/20
    公開日: 2008/04/14
    ジャーナル フリー
    We evaluated the characteristics of platelet α2-adrenoceptors in 12 patients with effort angina pectoris, 11 patients with variant angina pectoris and 11 normal control subjects. α2-Adrenoceptors were quantified using a radioligand binding assay with radiolabelled rauwolscine, an α2-selective antagonist. In addition, plasma norepinephrine concentration were measured by high performance liquid chromatography. The mean value of the maximal number of binding sites(Bmax)in patients with effort angina(205.1±11.3 fmol/mg protein)was significantly lower than that in control subjects(293.0±10.2 fmol/mg protein). Bmax did not differ between patients with variant angina(322.9±45.4 fmol/mg protein)and control subjects. There was no significant difference in the dissociation constant(Kd)among the 3 groups. The plasma norepinephrine concentration tended to be higher in patients with effort angina or variant angina than in normal controls, but this difference was not statistically significant. In addition, studies in another group of young volunteers(n=20)revealde a negative correlation(r=0.05, p<0.05)between the Bmax of3H-rauwolscine binding to platelets and the percent change in the plasma norepinephrine concentration when subjects moved from the supine to the standing position. This suggests a functional correlation between platelet α2-adrenoceptors and those located at presynaptic sites. If platelet α2-adrenoceptors correlate with presynaptic α2-adrenoceptors, the current findings of decreased α2-adrenoceptor density in platelets from patients with effort angina could represent attenuated negative feedback of norepinephrine by presynaptic α2-adrenoceptors.
  • Shinji Miyamoto, Tetsuo Hadama, Yoshiaki Mori, Osamu Shigemitsu, Hiden ...
    1995 年 59 巻 10 号 p. 693-703
    発行日: 1995/09/20
    公開日: 2008/04/14
    ジャーナル フリー
    Concomitant use of venoarterial bypass(VAB)with centrifugal pump and intraaortic balloon pumping(IABP)is a common technique for cardiopulmonary resuscitation. This experimental study examines whether coronary perfusion and hemodynamics are affected by the site of the blood supply, comparing the subclavian artery and the femoral artery. VAB and IABP were performed in 11 mongrel dogs with cardiopulmonary failure induced by acute myocardial infarction and hypoventilation. Aortic root pressure(AP), left atrial pressure, central venous pressure and coronary sinus blood flow(CSF)were measured, and blood gas analysis was performed. Subclavian artery perfusion(SAP)and femoral artery perfusion(FAP)were compared at bypass ration of 25, 50, 75, 85, 100%. At bypass rations of 75% and 85% the mean systolic AP was higher with SAP than with FAP. The mean diastolic AP was higher with SAP than with FAP at a bypass ratio of 50% or higher. CSF was higher with SAP than with FAP at a bypass ratio of 50% or higher. The coronary arteriovenous O2content difference was lower with SAP than with FAP at a bypass ratio of 85% or higher. In conclusion, at a high bypass ratio, SAP was more effective than FAP in achieving diastolic augmentation, thus enhancing myocardial oxygen balance, even though SAP had less of a systolic unloading effect. These data support the use of SAP over FAP in patients with severe cardiopulmonary dysfunction requiring high-flow bypass, and especially in patients with myocardial ischemia.
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