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Inada Y, Suematsu Y, Matsuda T, Yano Y, Morita K, Bando K, Teshima R, Fukuda H, Fujimi K, Miura SI. Effect of Left Ventricular Diastolic Dysfunction on the Cardiopulmonary Exercise Test in Patients With Cardiovascular Disease. Am J Cardiol 2024:S0002-9149(24)00336-9. [PMID: 38703885 DOI: 10.1016/j.amjcard.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Left ventricular diastolic dysfunction exists in patients with heart failure with reduced ejection fraction and causes activity restriction and a poor prognosis, but there have been few reports about exercise tolerance in patients with diastolic dysfunction, regardless of left ventricular ejection fraction (LVEF). In this study, 294 cardiovascular disease patients who performed a cardiopulmonary exercise test (CPX) with an adequate examination by echocardiography at Fukuoka University Hospital from 2011 to 2020 were investigated. Patients were divided into groups with grade I and grade II or III diastolic dysfunction according to diagnostic criteria, regardless of LVEF, by echocardiography. After adjusting for age, gender, body mass index, smoking, and LVEF by propensity score matching, we compared the results of CPX between the grade I and grade II/III groups. There were no significant differences in hemodynamic parameters, or in the respiratory exchange ratio, oxygen uptake per body weight, oxygen uptake per heart rate, or parameters of ventilatory volume. Ventilatory equivalents per oxygen uptake and per carbon dioxide output were significantly worse in the grade II/III group from the rest to peak periods during CPX. In conclusion, left ventricular diastolic dysfunction worsens ventilatory efficacy during CPX. This effect potentially contributes to a poor prognosis in left ventricular diastolic dysfunction.
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Affiliation(s)
- Yuki Inada
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | - Takuro Matsuda
- Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | | | | | - Kakeru Bando
- Department of Cardiology, Hakujyuji Hospital, Fukuoka, Japan
| | - Reiko Teshima
- Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Kanta Fujimi
- Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan; Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan.
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Kawakami S, Yasuno T, Kawakami S, Ito A, Fujimi K, Matsuda T, Nakashima S, Masutani K, Uehara Y, Higaki Y, Michishita R. Reply to "letter to the editor: Measuring renal hemodynamics during exercise using Doppler ultrasound". Physiol Rep 2024; 12:e16018. [PMID: 38627222 PMCID: PMC11021189 DOI: 10.14814/phy2.16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Shotaro Kawakami
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
- Center for Liberal Arts and Sciences, Faculty of EngineeringToyama Prefectural UniversityImizuJapan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
| | - Saki Kawakami
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Ai Ito
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Kanta Fujimi
- Department of RehabilitationFukuoka University HospitalFukuokaJapan
| | - Takuro Matsuda
- Department of RehabilitationFukuoka University HospitalFukuokaJapan
| | - Shihoko Nakashima
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
| | - Yoshinari Uehara
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Yasuki Higaki
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Ryoma Michishita
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
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Kawakami S, Yasuno T, Kawakami S, Ito A, Fujimi K, Matsuda T, Nakashima S, Masutani K, Uehara Y, Higaki Y, Michishita R. Effects of high-intensity intermittent exercise versus moderate-intensity continuous exercise on renal hemodynamics assessed by ultrasound echo. Physiol Rep 2024; 12:e15925. [PMID: 38262710 PMCID: PMC10805622 DOI: 10.14814/phy2.15925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
High-intensity intermittent exercise (HIIE) has become attractive for presenting a variety of exercise conditions. However, the effects of HIIE on renal function and hemodynamics remain unclear. This study aimed to compare the effects of HIIE and moderate-intensity continuous exercise (MICE) on renal hemodynamics, renal function, and kidney injury biomarkers. Ten adult males participated in this study. We allowed the participants to perform HIIE or MICE to consider the impact of exercise on renal hemodynamics under both conditions. Renal hemodynamic assessment and blood sampling were conducted before the exercise (pre) and immediately (post 0), 30 min (post 30), and 60 min (post 60) after the exercise. Urine sampling was conducted in the pre, post 0, and post 60 phases. There was no condition-by-time interaction (p = 0.614), condition (p = 0.422), or time effect (p = 0.114) regarding renal blood flow. Creatinine-corrected urinary neutrophil gelatinase-associated lipocalin concentrations increased at post 60 (p = 0.017), but none exceeded the cut-off values for defining kidney injury. Moreover, there were no significant changes in other kidney injury biomarkers at any point. These findings suggest that high-intensity exercise can be performed without decreased RBF or increased kidney injury risk when conducted intermittently for short periods.
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Affiliation(s)
- Shotaro Kawakami
- Graduate School of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
| | - Saki Kawakami
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Ai Ito
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Kanta Fujimi
- Department of RehabilitationFukuoka University HospitalFukuokaJapan
| | - Takuro Matsuda
- Department of RehabilitationFukuoka University HospitalFukuokaJapan
| | - Shihoko Nakashima
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
| | - Yoshinari Uehara
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Yasuki Higaki
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Ryoma Michishita
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
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Kawakami S, Yasuno T, Kotoku K, Kawakami S, Ito A, Fujimi K, Matsuda T, Nakashima S, Masutani K, Uehara Y, Higaki Y, Michishita R. The differences in renal hemodynamic response following high-intensity exercise between younger and older males. Clin Exp Nephrol 2023; 27:972-980. [PMID: 37450106 DOI: 10.1007/s10157-023-02381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Renal blood flow (RBF) decreases with exercise, but this change is only temporary, and habitual exercise may be an effective method to improve renal function. The kidney shows structural and functional changes with aging, but it is unclear how aging affects the hemodynamic response of the kidneys to exercise. Therefore, we evaluated the differences in the hemodynamic response of the kidneys to high-intensity exercise between younger and older men. METHODS Sixteen men (8 young and 8 older) underwent an incremental exercise test using a cycle ergometer with a 1-min warm up followed by exercise at 10-20 W/min until the discontinuation criteria were met. Renal hemodynamics were assessed before exercise, immediately after exercise, and at 60-min after exercise using ultrasound echo. RESULTS High-intensity exercise significantly reduced RBF in both groups (younger: ∆ - 53 ± 16%, p = 0.0005; older: ∆ - 53 ± 19%, p = 0.0004). In the younger group, RBF returned to the pre-exercise level 60-min after exercise (∆ - 0.4 ± 5.7%, p > 0.9999). In contrast, RBF 60-min after exercise was significantly lower than that before exercise in the older group (∆ - 24 ± 19%, p = 0.0006). The older group had significantly lower RBF than younger adults 60-min after exercise (423 ± 32 vs. 301 ± 98 mL/min, p = 0.0283). CONCLUSIONS Our findings demonstrate that RBF following high-intensity exercise recovered 60-min after exercise in younger group, whereas RBF recovery was delayed in the older group.
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Affiliation(s)
- Shotaro Kawakami
- Graduate School of Sports and Health Science, Fukuoka University, Fukuoka, Japan
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kazuko Kotoku
- Faculty of Fukuoka Medical Technology, Teikyo University, 6-22, Misaki-Machi, Omuta-Shi, Fukuoka, Japan
| | - Saki Kawakami
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan
| | - Ai Ito
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shihoko Nakashima
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshinari Uehara
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan
| | - Yasuki Higaki
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan
| | - Ryoma Michishita
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan.
- The Fukuoka University Institute for Physical Activity, Fukuoka, Japan.
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Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, Ishihara S, Iso Y, Ohuchi H, Omiya K, Ohya Y, Okita K, Kimura Y, Koike A, Kohzuki M, Koba S, Sata M, Shimada K, Shimokawa T, Shiraishi H, Sumitomo N, Takahashi T, Takura T, Tsutsui H, Nagayama M, Hasegawa E, Fukumoto Y, Furukawa Y, Miura SI, Yasuda S, Yamada S, Yamada Y, Yumino D, Yoshida T, Adachi T, Ikegame T, Izawa KP, Ishida T, Ozasa N, Osada N, Obata H, Kakutani N, Kasahara Y, Kato M, Kamiya K, Kinugawa S, Kono Y, Kobayashi Y, Koyama T, Sase K, Sato S, Shibata T, Suzuki N, Tamaki D, Yamaoka-Tojo M, Nakanishi M, Nakane E, Nishizaki M, Higo T, Fujimi K, Honda T, Matsumoto Y, Matsumoto N, Miyawaki I, Murata M, Yagi S, Yanase M, Yamada M, Yokoyama M, Watanabe N, Itoh H, Kimura T, Kyo S, Goto Y, Nohara R, Hirata KI. CORRIGENDUM: JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 2023; 87:937. [PMID: 37225499 DOI: 10.1253/circj.cj-66-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, Ishihara S, Iso Y, Ohuchi H, Omiya K, Ohya Y, Okita K, Kimura Y, Koike A, Kohzuki M, Koba S, Sata M, Shimada K, Shimokawa T, Shiraishi H, Sumitomo N, Takahashi T, Takura T, Tsutsui H, Nagayama M, Hasegawa E, Fukumoto Y, Furukawa Y, Miura SI, Yasuda S, Yamada S, Yamada Y, Yumino D, Yoshida T, Adachi T, Ikegame T, Izawa KP, Ishida T, Ozasa N, Osada N, Obata H, Kakutani N, Kasahara Y, Kato M, Kamiya K, Kinugawa S, Kono Y, Kobayashi Y, Koyama T, Sase K, Sato S, Shibata T, Suzuki N, Tamaki D, Yamaoka-Tojo M, Nakanishi M, Nakane E, Nishizaki M, Higo T, Fujimi K, Honda T, Matsumoto Y, Matsumoto N, Miyawaki I, Murata M, Yagi S, Yanase M, Yamada M, Yokoyama M, Watanabe N, Ito H, Kimura T, Kyo S, Goto Y, Nohara R, Hirata KI. JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 2022; 87:155-235. [PMID: 36503954 DOI: 10.1253/circj.cj-22-0234] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University of Medicine
| | - Shunichi Ishihara
- Department of Psychology, Bunkyo University Faculty of Human Sciences
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Hospital
| | - Hideo Ohuchi
- Department of Pediatrics, National Cerebral and Cardiovascular Center
| | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus
| | - Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University
| | - Yutaka Kimura
- Department of Health Sciences, Kansai Medical University Hospital
| | - Akira Koike
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Emiko Hasegawa
- Faculty of Psychology and Social Welfare, Seigakuin University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital
| | | | | | - Takuji Adachi
- Department of Physical Therapy, Nagoya University Graduate School of Medicine
| | | | | | | | - Neiko Ozasa
- Cardiovascular Medicine, Kyoto University Hospital
| | - Naohiko Osada
- Department of Physical Checking, St. Marianna University Toyoko Hospital
| | - Hiroaki Obata
- Division of Internal Medicine, Niigata Minami Hospital.,Division of Rehabilitation, Niigata Minami Hospital
| | | | - Yusuke Kasahara
- Department of Rehabilitation, St. Marianna University Yokohama Seibu Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Yasuyuki Kobayashi
- Department of Medical Technology, Gunma Prefectural Cardiovascular Center
| | | | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University
| | - Shinji Sato
- Department of Physical Therapy, Teikyo Heisei University
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Tamaki
- Department of Nutrition, Showa University Fujigaoka Hospital
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization Okayama Medical Center
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tasuku Honda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare
| | | | - Ikuko Miyawaki
- Department of Nursing, Kobe University Graduate School of Health Sciences
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | | | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Syunei Kyo
- Tokyo Metropolitan Geriatric Medical Center
| | | | | | - Ken-Ichi Hirata
- Department of Internal Medicine, Kobe University Graduate School of Medicine
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Kawakami S, Yasuno T, Kawakami S, Ito A, Fujimi K, Matsuda T, Nakashima S, Masutani K, Uehara Y, Higaki Y, Michishita R. The moderate-intensity continuous exercise maintains renal blood flow and does not impair the renal function. Physiol Rep 2022; 10:e15420. [PMID: 35924347 PMCID: PMC9350468 DOI: 10.14814/phy2.15420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/30/2022] Open
Abstract
Exercise is restricted for individuals with reduced renal function because exercising reduces blood flow to the kidneys. Safe and effective exercise programs for individuals with reduced renal function have not yet been developed. We previously examined the relationship between exercise intensity and renal blood flow (RBF), revealing that moderate-intensity exercise did not reduce RBF. Determining the effects of exercise duration on RBF may have valuable clinical applications. The current study examined the effects of a single bout of continuous exercise at lactate threshold (LT) intensity on renal hemodynamics. Eight adult males participated in this study. Participants underwent 30 min of aerobic exercise at LT intensity using a cycle ergometer. Evaluation of renal hemodynamics was performed before and after exercise, in the recovery phase using ultrasound echo. Furthermore, blood and urine samplings were conducted before and after exercise, in the recovery phase. Compared with resting, RBF was not significantly changed immediately after continuous exercise (319 ± 102 vs. 308 ± 79 ml/min; p = 0.976) and exhibited no significant changes in the recovery phase. Moreover, urinary kidney injury molecule-1 (uKIM-1) level exhibited no significant change immediately after continuous exercise (0.52 ± 0.20 vs. 0.46 ± 0.27 μg/g creatinine; p = 0.447). In addition, the results revealed no significant change in urinary uKIM-1 in 60-min after exercise. Other renal injury biomarkers exhibited a similar pattern. These findings indicate that a single bout of moderate-intensity continuous exercise maintains RBF and does not induce renal injury.
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Affiliation(s)
- Shotaro Kawakami
- Graduate School of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
| | - Saki Kawakami
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Ai Ito
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Kanta Fujimi
- Department of RehabilitationFukuoka University HospitalFukuokaJapan
| | - Takuro Matsuda
- Department of RehabilitationFukuoka University HospitalFukuokaJapan
| | - Shihoko Nakashima
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
| | - Yoshinari Uehara
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Yasuki Higaki
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
| | - Ryoma Michishita
- Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
- The Fukuoka University Institute for Physical ActivityFukuokaJapan
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8
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Sakamoto M, Suematsu Y, Yano Y, Kaino K, Teshima R, Matsuda T, Fujita M, Tazawa R, Fujimi K, Miura SI. Depression and Anxiety Are Associated with Physical Performance in Patients Undergoing Cardiac Rehabilitation: A Retrospective Observational Study. J Cardiovasc Dev Dis 2022; 9:jcdd9010021. [PMID: 35050231 PMCID: PMC8781943 DOI: 10.3390/jcdd9010021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Cardiac rehabilitation (CR) combined with stress management training has been shown to be associated with fewer clinical events than CR alone. However, there have been no reports on the associations of CR with the psychological condition and detailed physical activities evaluated on the same day. Method: One hundred outpatients who participated in a CR program were graded on the hospital anxiety and depression scale (HADS). We divided them into a high HADS group (n = 32) and a normal HADS group (n = 68) and investigated by whole patients, ischemic heart disease (IHD) patients, and heart failure patients. Results: Overall, the patient age was 70.5 ± 9.6 years, the percentage of males was 73.0%, and the body mass index was 23.4 (21.7–26.0) kg/m2. In the high HADS group, overall functional mobility was poor and the distance in a two-minute walking test was short. Especially in IHD patients, the high HADS group showed high fat mass in body composition and low exercise tolerance and ventilator equivalents in cardiopulmonary exercise test. Conclusions: Depression and anxiety involved poor physical performance in CR outpatients and particularly involved low exercise tolerance in IHD patients. To evaluate accurate physical performance, it is necessary to investigate psychological condition.
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Affiliation(s)
- Maaya Sakamoto
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.S.); (Y.S.); (Y.Y.); (K.F.)
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan; (K.K.); (R.T.); (T.M.); (M.F.)
| | - Yasunori Suematsu
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.S.); (Y.S.); (Y.Y.); (K.F.)
| | - Yuiko Yano
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.S.); (Y.S.); (Y.Y.); (K.F.)
| | - Koji Kaino
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan; (K.K.); (R.T.); (T.M.); (M.F.)
| | - Reiko Teshima
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan; (K.K.); (R.T.); (T.M.); (M.F.)
| | - Takuro Matsuda
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan; (K.K.); (R.T.); (T.M.); (M.F.)
| | - Masaomi Fujita
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan; (K.K.); (R.T.); (T.M.); (M.F.)
| | - Rie Tazawa
- Division of Nutrition, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Kanta Fujimi
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.S.); (Y.S.); (Y.Y.); (K.F.)
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan; (K.K.); (R.T.); (T.M.); (M.F.)
| | - Shin-ichiro Miura
- Department of Cardiology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan; (M.S.); (Y.S.); (Y.Y.); (K.F.)
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka 814-8522, Japan
- Correspondence: ; Tel.: +81-92-801-1011
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9
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Kawahira Y, Shiga Y, Inoue H, Suematsu Y, Tashiro K, Kato Y, Fujimi K, Takamiya Y, Kuwano T, Sugihara M, Miura SI. Association between high-density lipoprotein cholesterol levels and major adverse cardiovascular events in patients who underwent coronary computed tomography angiography: FU-CCTA registry. Heart Vessels 2021; 36:1457-1465. [PMID: 33744994 DOI: 10.1007/s00380-021-01831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
It is unclear whether higher levels of serum high-density lipoprotein cholesterol (HDL-C) prevent major adverse cardiovascular events (MACE). We prospectively evaluated 501 patients who had undergone coronary computed tomography angiography at Fukuoka University Hospital and either were clinically suspected of having coronary artery disease (CAD) or had at least one cardiovascular risk factor with a follow-up of up to 5 years. The primary endpoint was MACE (cardiovascular death, ischemic stroke, acute myocardial infarction and coronary revascularization). The patients were divided into tertiles according to the HDL-C level: 47 mg/dl ≥ HDL-C level [n = 167, lower HDL-C level (L-HDL)], 58 mg/dl ≥ HDL-C level ≥ 48 mg/dl [n = 167, middle HDL-C level (M-HDL)] and HDL-C level ≥ 59 mg/dl [n = 167, higher HDL-C level (H-HDL)] groups. There were significant differences in %CAD among the L-HDL, M-HDL and H-HDL groups. Unexpectedly, there was no difference in %MACE between M-HDL and H-HDL, although %MACE in M-HDL was significantly lower than that in L-HDL (p < 0.05). By a multivariate logistic regression analysis, MACE in H-HDL-C was independently associated with diabetes mellitus (DM) (p = 0.03). A Kaplan-Meier curve according to the HDL subgroup indicated that M-HDL, not H-HDL, enjoyed the greatest freedom from MACE among the 3 groups (log-rank test p = 0.047). Finally, the results of a Cox regression model indicated that L-HDL and H-HDL had significantly higher risk of MACE than M-HDL. In conclusions, patients with middle HDL-C levels, not higher HDL-C levels, showed the greatest freedom from MACE. Patients with higher HDL-C levels need to be strictly managed for DM to prevent MACE.
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Affiliation(s)
- Yuto Kawahira
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroko Inoue
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Cardiac Rehabilitation Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Yosuke Takamiya
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. .,Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan. .,Cardiac Rehabilitation Center, Fukuoka University Hospital, Fukuoka, Japan.
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10
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Kitajima K, Fujimi K, Matsuda T, Fujita M, Kaino K, Teshima R, Ujifuku Y, Horita T, Sakamoto M, Arimura T, Shiga Y, Shiota E, Miura SI. Possibility of Cardio-renal Protection by Long-term Cardiac Rehabilitation in Elderly Patients with Cardiovascular Diseases. Intern Med 2019; 58:2133-2138. [PMID: 30996165 PMCID: PMC6709314 DOI: 10.2169/internalmedicine.2281-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective Cardiac rehabilitation (CR) improves the mortality in patients with cardiovascular disease (CVD). Even in elderly patients with CVD, CR may improve the activities of daily living (ADL). Methods Eighty-eight outpatients over 65 years of age at the beginning of a CR program (baseline) at Fukuoka University Hospital who had CVD and could be followed-up for up to 5 years were enrolled. CVD included ischemic heart disease, postoperative valvular heart disease, dissecting aneurysm of the aorta and peripheral artery disease. The patients were divided into 2 groups according to the average estimated glomerular filtration rate (eGFR) at baseline (55.4±14.8 mL/min/1.73 m2): high (≥55.4, n=44) and low (<55.4, n=44)-eGFR groups. The anaerobic threshold (AT) during exercise and left ventricular ejection fraction (LVEF) were measured by cardiopulmonary exercise (CPX) and ultrasound cardiography, respectively. The serum brain natriuretic protein (BNP) was also measured every year. Results The average age at baseline in all patients was 73±6 years. In all patients, the level of eGFR did not significantly change for 5 years (55±15 mL/min/1.73 m2 at baseline vs. 48±14 at the end of the study). The AT (3.7±1.0 METs at baseline vs. 3.3±0.5), LVEF (57±13% vs. 64±10%) and BNP (260±452 pg/mL vs. 308±345) were also maintained for 5 years. In both the low- and high-eGFR groups, the eGFR, AT during exercise, LVEF and BNP at the end of the study were not significantly changed compared to the baseline values, although some changes were observed during the follow-up period. Conclusion Long-term CR in CVD outpatients over 65 years of age helped maintain the AT, LVEF, BNP and eGFR for 5 years. CR afforded cardio-renal protection in elderly patients with CVD.
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Affiliation(s)
- Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Japan
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Reiko Teshima
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Yuki Ujifuku
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Tomoe Horita
- Department of Nutrition, Fukuoka University Hospital, Japan
| | - Maaya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Japan
| | - Etsuji Shiota
- Department of Rehabilitation, Fukuoka University School of Medicine, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Japan
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11
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Fujimi K, Imaizumi T, Suematsu Y, Kitajima K, Ueda T, Ishida T, Futami M, Ujifuku Y, Matsuda T, Sakamoto M, Horita T, Teshima R, Kaino K, Fujita M, Arimura T, Shiga Y, Shiota E, Miura SI. Differential prognostic impact between completion and non-completion of a 5-month cardiac rehabilitation program in outpatients with cardiovascular diseases. Int J Cardiol 2019; 292:13-18. [PMID: 31242969 DOI: 10.1016/j.ijcard.2019.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/11/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an essential component of care for patients with cardiovascular diseases (CVD). We aimed to evaluate clinical outcomes in outpatients with CVD who did and did not complete a 5-month CR program. METHODS Three hundred thirty-two outpatients with CVD who participated in a 5-month CR program and were followed-up for maximum 5 years were registered. We divided the patients into two groups: those who completed the CR program (success group, n = 175) and those who could not (non-success group, n = 157). Both long-term (5 years) and short-term (5 months) clinical outcomes were compared between the two groups. RESULTS There were no significant differences in patient characteristics at baseline between the success and non-success groups. With regard to both long-term and short-term clinical outcomes, the rates of all-cause death and hospital admission in the success group were significantly lower than those in the non-success group by a Kaplan-Meier analysis. There was a significant difference in short-term CVD death and hospital admission between the groups, but not for long-term CVD death and hospital. In long-term period, all-cause death and hospital admission was independently associated with completion of the CR program in addition to the presence of peripheral artery disease and VE vs. VCO2 slope after adjusting for age, gender, body mass index, types of CVD and medications. CONCLUSIONS Completion of a 5-month CR program was associated with the prevention of all-cause death and hospital admission, but not CVD death and hospital admission in the long-term, which suggests that we need to reconsider this issue.
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Affiliation(s)
- Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan; Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Tomoki Imaizumi
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Ueda
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Toshihisa Ishida
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Makito Futami
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuta Ujifuku
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maaya Sakamoto
- Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Reiko Teshima
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University Hospital, Fukuoka, Japan; Center for Cardiac Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan.
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12
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Kotoku K, Yasuno T, Kawakami S, Fujimi K, Matsuda T, Nakashima S, Uehara Y, Tanaka H, Saito T, Higaki Y. Effect of exercise intensity on renal blood flow in patients with chronic kidney disease stage 2. Clin Exp Nephrol 2019; 23:621-628. [PMID: 30729347 DOI: 10.1007/s10157-018-01685-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Acute exercise reduces renal blood flow (RBF). However, the effect of exercise intensity on RBF in patients with chronic kidney disease (CKD) stage 2 is not known. We investigated the association between RBF and exercise intensity in patients with CKD stage 2 using pulsed Doppler ultrasonography. METHODS Eight men with CKD stage 2 (cystatin C-based estimate of glomerular filtration rate: 60-89 ml/min/1.73 m2) participated in this study. Using a bicycle ergometer, participants undertook a maximal graded exercise test (MGET) (experiment 1) and a multi-stage exercise test (experiment 2) to determine their lactate threshold (LT). Participants undertook a multi-stage exercise test for 4-min each. Workloads of 60%, 80%, 100%, 120%, and 140% of LT were used in experiment 3. RBF was measured by pulsed Doppler ultrasonography at rest, immediately after exercise, and 1 h after exercise in experiment 1, and at rest and immediately after each exercise bout in experiment 3. RESULTS Renal blood flow after the MGET was 52% lower than at rest, and did not recover as well as after the exercise test. Cross-sectional area (CSA) was significantly lower after graded exercise. RBF tended to be lower at 100% of LT and was significantly lower at 120% of LT. CSA was significantly lower at 100% of LT. CONCLUSIONS Renal blood flow does not change during exercise until the LT is reached. These findings may assist in making appropriate exercise recommendations to patients with CKD stage 2.
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Affiliation(s)
- Kazuko Kotoku
- Graduate School of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan.,Faculty of Medicine and Health Science, Yamaguchi University, 1-1-1, Minamiogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0133, Japan
| | - Shotaro Kawakami
- Department of Rehabilitation, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-0067, Japan
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0133, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0133, Japan
| | - Shihoko Nakashima
- Laboratory of Exercise Physiology, Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Yoshinari Uehara
- Laboratory of Exercise Physiology, Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan.,Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Hiroaki Tanaka
- Laboratory of Exercise Physiology, Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan.,Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan
| | - Takao Saito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0133, Japan
| | - Yasuki Higaki
- Laboratory of Exercise Physiology, Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan. .,Fukuoka University Institute for Physical Activity, 8-19-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan.
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13
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Abstract
Smoking cessation reduces the risk of cardiovascular disease and improves clinical outcomes. We studied the effect of smoking cessation on plasma levels of α-klotho, which is an antiaging protein. We treated 28 smokers (male:female = 23:5, 46 ± 12 years) with varenicline (n = 14) or a transdermal nicotine patch (n = 14) as part of a 12-week smoking cessation program (the VN-SEESAW Study). Pulse rate, blood pressure, plasma levels of α-klotho, fibroblast growth factor (FGF)-19, FGF-21, hemoglobin (Hb), and expiratory carbon monoxide (CO) concentration were measured before and after the antismoking intervention. Smoking cessation significantly decreased pulse rate, α-klotho, Hb, and CO concentration, but not FGF-19 or FGF-21 in all subjects. On the contrary, body mass index significantly increased after the intervention. Changes in α-klotho levels (values at week 12 - values at week 0) were negatively associated with α-klotho levels at week 0 and positively associated with changes in Hb levels. In addition, the successful smoking cessation group (n = 21) showed significant reductions in pulse rate, systolic blood pressure, α-klotho, Hb, and CO concentration. In conclusion, smoking cessation significantly decreased serum levels of the antiaging molecule α-klotho. Our results are consistent with a previous report that an increase in α-klotho might be a compensatory response to smoking stress.
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Affiliation(s)
- Yoko Kamizono
- International University of Health and Welfare
- Department of Cardiology
| | | | | | - Satoshi Imaizumi
- Department of Cardiology
- Clinical Research and Ethics Center, Fukuoka University School of Medicine
| | | | | | | | - Kanta Fujimi
- Department of Cardiology
- Division of Rehabilitation, Fukuoka University Hospital
| | - Keijiro Saku
- Department of Cardiology
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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14
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Ueda Y, Shiga Y, Idemoto Y, Tashiro K, Motozato K, Koyoshi R, Kuwano T, Fujimi K, Ogawa M, Saku K, Miura SI. Association Between the Presence or Severity of Coronary Artery Disease and Pericardial Fat, Paracardial Fat, Epicardial Fat, Visceral Fat, and Subcutaneous Fat as Assessed by Multi-Detector Row Computed Tomography. Int Heart J 2018; 59:695-704. [DOI: 10.1536/ihj.17-234] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yoko Ueda
- Department of Cardiology, Fukuoka University School of Medicine
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine
| | | | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine
| | - Kota Motozato
- Department of Cardiology, Fukuoka University School of Medicine
| | - Rie Koyoshi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Rehabilitation, Fukuoka University Hospital
| | - Masahiro Ogawa
- Department of Cardiology, Fukuoka University School of Medicine
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
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15
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Morito N, Suematsu Y, Koyoshi R, Shiga Y, Kuwano T, Iwata A, Fujimi K, Kawamura A, Miura SI. The Current Conditions and Lifestyles of Obese University Students. J Clin Med Res 2018; 10:240-246. [PMID: 29416584 PMCID: PMC5798272 DOI: 10.14740/jocmr3329w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background The prevalence of cardiovascular diseases in Japan remains high, and the onset becomes early. Studies on the current conditions and lifestyles of obese university students may support early interventions to achieve lifestyle modification. Methods and Results The results of periodic health examinations in 32,262 first-year university students revealed that 2,036 (6.3%) were obese. We performed a more detailed examination in 221 of these obese students (165 males and 56 females, age 19 ± 1 years) with study agreement from 2014 to 2016. In this study cohort, the percentage of students who exercised regularly was significantly higher among males than females. Body fat in males with well-exercised was lower than that in males with no exercise. In addition, serum level of high-density cholesterol in males with well-exercised was higher. Among females, there were no significant differences in these parameters between exercisers and non-exercisers. Forty-two obese students (40 males and two females) met the diagnostic criteria of metabolic syndrome (MetS). Among males, levels of body fat, uric acid, liver enzyme and insulin resistance in the MetS group were significantly higher than those in the non-MetS group. The average ratio of eicosapentaenoic acid to arachidonic acid (EPA/AA) was low (0.14). Conclusions Although the proportions of students with obesity and/or MetS were not high, the EPA/AA ratio in obese young males was low, which may be associated with a high risk of coronary atherosclerosis. To prevent the onset of cardiovascular diseases early intervention to achieve lifestyle modification may be important.
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Affiliation(s)
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Koyoshi
- Division of Medical Safety Management, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Akira Kawamura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Post-Graduate Education Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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16
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Koyoshi R, Shiga Y, Idemoto Y, Ueda Y, Tashiro K, Kuwano T, Kitajima K, Fujimi K, Kawamura A, Ogawa M, Miura SI. Safety of Landiolol Hydrochloride as a Premedication for Producing an Appropriate Heart Rate for Multidetector-Row Computed Tomography Coronary Angiography. J Clin Med Res 2017; 10:22-26. [PMID: 29238430 PMCID: PMC5722041 DOI: 10.14740/jocmr3213w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/12/2017] [Indexed: 11/11/2022] Open
Abstract
Background We evaluated the safety of a bolus injection of landiolol hydrochloride, an ultrashort-acting β1-selective antagonist, as a premedication prior to multidetector-row computed tomography coronary angiography (CTA). Methods The subjects consisted of 176 patients (M/F = 64:112, 67 ± 11 years) who had heart rate (HR) at rest ≥ 70 beats/min (bpm) and underwent CTA. Systolic/diastolic blood pressure (SBP/DBP) and HR were measured before and after the administration of landiolol. Results SBP/DBP and HR upon entry to the CT room were 136 ± 17/80 ± 11 mm Hg and 83 ± 10 bpm, respectively. HR was significantly reduced at the time of CTA scan (62 ± 7 bpm). Next, we divided the patients into three groups according to HR upon entry to the CT room: 70 - 79 bpm (n = 76), 80 - 89 bpm (n = 60) and ≥ 90 bpm (n = 40). HR at the time of CTA scan was significantly lower than that upon entry to the CT room in all three groups: 70 - 79 bpm (74 ± 3 bpm upon entry to the CT room to 61 ± 6 bpm at the time of CAT scan), 80 - 89 bpm (84 ± 3 to 63 ± 7 bpm) and ≥ 90 bpm (98 ± 6 to 65 ± 7 bpm). Although SBP/DBP was significantly decreased after the CTA scan (123 ± 18/72 ± 12 mm Hg), landiolol had no severe adverse events throughout CTA. Conclusion In conclusion, a bolus injection of landiolol reduced HR by about 20 bpm without any severe adverse effects. Thus, a bolus injection of landiolol hydrochloride may be a suitable pretreatment for controlling HR in CTA.
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Affiliation(s)
- Rie Koyoshi
- Division of Medical Safety Management, Fukuoka University Hospital, Fukuoka, Japan.,These authors contributed equally to this work
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,These authors contributed equally to this work
| | - Yoshiaki Idemoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoko Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Division of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Akira Kawamura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masahiro Ogawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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17
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Sako H, Miyazaki M, Suematsu Y, Koyoshi R, Shiga Y, Kuwano T, Kitajima K, Iwata A, Yorinaga K, Fujimi K, Miura SI. A Case of Multifaceted Assessment in an Elderly Patient With Acute Decompensated Heart Failure. Cardiol Res 2017; 8:339-343. [PMID: 29317979 PMCID: PMC5755668 DOI: 10.14740/cr640w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a common health problem worldwide, including in Japan. Unfortunately, patient outcomes remain poor, with a 5-year survival rate of approximately 50%. Therefore, we need to assess the precise conditions, including cardiac function, in patients with HF, particularly in the elderly. We performed a multifaceted assessment in an elderly patient with HF on admission and at discharge using eight different evaluations (the mean life expectancy using the Seattle Heart Failure Model (SHFM), the severity of dementia, nutrition, medication adherence, biomarker (the level of brain natriuretic peptide in blood), sociality, performance and comorbidity). Each parameter was scored on a 5-point scale (excellent = 5 points; good = 4 points; fair (average) = 3 points; poor = 2 points; failure = 1 point; maximum total points of 40) (Fukuoka University Heart Failure Scoring System, FUFS). An 86-year-old male patient who complained of dyspnea and lower-leg edema was admitted to our university hospital due to acute decompensated HF. After treatment, his symptoms improved, as did his cardiothoracic ratio, plural effusion and pulmonary congestion, and he exhibited compensated HF. His total score improved from 28 to 32 points, and his mean life expectancy using SHFM increased from 4.9 to 5.4 years. We evaluated the precise conditions using a multifaceted assessment strategy in an elderly patient with HF. The strategy was useful for evaluate the patient's condition in this case.
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Affiliation(s)
- Hideto Sako
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Midori Miyazaki
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Koyoshi
- Division of Medical Safety Management, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Katsura Yorinaga
- Division of Nursing, Fukuoka University Hospital, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Division of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Futami M, Fujimi K, Ueda T, Matsuda T, Fujita M, Kaino K, Sakamoto M, Horita T, Koyoshi R, Arimura T, Shiga Y, Kuwano T, Kitajima K, Saku K, Miura SI. Cardiac rehabilitation in patients with cardiovascular disease leads various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels. Int J Cardiol Heart Vasc 2017; 17:23-29. [PMID: 29201997 PMCID: PMC5699897 DOI: 10.1016/j.ijcha.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022]
Abstract
We evaluated whether comprehensive cardiac rehabilitation (CR) in patients with cardiovascular disease (CVD) could improve various hemodynamic parameters obtained using simple non-invasive tests. We analyzed 48 CVD patients with (n = 38, CR group) or without (n = 10, non-CR group) a CR program, and prospectively followed them for 12 months. Various parameters were measured at baseline and after 12 months using 3 simple non-invasive tests: blood pressure (BP) and severity of atherosclerosis [arterial velocity pulse index (AVI) and atrial pressure volume index] were determined using PASESA®, an index of total autonomic nerve activity and a coefficient of variation of the R-R interval (CVRR) were determined using eHEART®, and the total peripheral resistance, stroke volume and cardiac index (CI) were determined using nico®. The main hemodynamic parameters did not change between baseline and 12 months in both groups. Patients in the CR group were divided into higher (H-) and lower (L-) systolic BP (SBP) or AVI according to the average value of SBP or AVI at baseline in the CR group. Patients with H-SBP or H-AVI in the CR group showed a significant reduction of SBP or AVI at 12 months. In addition, patients in the CR group were divided into H- and L- CI or CVRR according to the average value of CI or CVRR at baseline in the CR group. Patients with L-CI or L-CVRR in the CR group significantly improved after 12 months. In conclusion, CR may lead various hemodynamic parameters obtained using simple non-invasive tests to their appropriate levels.
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Affiliation(s)
- Makito Futami
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maaya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Rie Koyoshi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
- Corresponding author at: Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.Department of CardiologyFukuoka University School of MedicineFukuokaJapan
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Komaki T, Miura SI, Arimura T, Shiga Y, Morii J, Kuwano T, Imaizumi S, Kitajima K, Iwata A, Morito N, Yahiro E, Fujimi K, Matsunaga A, Saku K. The Change in Body Weight During Hospitalization Predicts Mortality in Patients With Acute Decompensated Heart Failure. J Clin Med Res 2017; 9:200-206. [PMID: 28179967 PMCID: PMC5289139 DOI: 10.14740/jocmr2890w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 12/22/2022] Open
Abstract
Background In our experience, the change in body weight (BW) during hospitalization varies greatly in patients with acute decompensated heart failure (HF). Since the clinical significance of a change in BW is not clear, we investigated whether a change in BW could predict mortality. Methods We retrospectively enrolled 130 patients (72 males; aged 68 ± 10 years) who were hospitalized due to acute decompensated HF and followed for 2 years after discharge. The change in the BW index during hospitalization (ΔBWI) was calculated as (BW at hospital admission minus BW at hospital discharge)/body surface area at hospital discharge. Results The patients were divided into quartiles according to ΔBWI, and the 2-year mortality rates in the quartiles with the lowest, second, third and highest ΔBWI were 18.8%, 12.1%, 3.1% and 9.1%, respectively. In a multivariate Cox proportional hazards analysis after adjusting for variables with a P value less than 0.05, ΔBWI was independently associated with 2-year mortality (P = 0.0002), and the quartile with the lowest ΔBWI had a higher relative risk (RR) for 2-year mortality than the quartile with the highest ΔBWI (RR: 7.46, 95% confidence interval: 1.03 - 53.99, P = 0.04). Conclusion In conclusion, ΔBWI was significantly associated with 2-year mortality after discharge, which indicates that ΔBWI might be a simple predictor of prognosis in acute decompensated HF.
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Affiliation(s)
- Tomo Komaki
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Laboratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Joji Morii
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Satoshi Imaizumi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Natsumi Morito
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiji Yahiro
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Akira Matsunaga
- Department of Laboratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Ishida T, Miura SI, Fujimi K, Futami M, Ueda Y, Ueda T, Arimura T, Koyoshi R, Shiga Y, Kitajima K, Saku K. Significance of Cardiac Rehabilitation on Visit-to-Visit Variability of Blood Pressure in Patients With Cardiovascular Disease in a 12-Month Follow-Up. J Clin Med Res 2017; 9:345-352. [PMID: 28270895 PMCID: PMC5330778 DOI: 10.14740/jocmr2915w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Toshihisa Ishida
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
- Corresponding Author: Shin-ichiro Miura, Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan. Email
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Makito Futami
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoko Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Rie Koyoshi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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21
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Adachi S, Miura SI, Shiga Y, Arimura T, Morii J, Kuwano T, Kitajima K, Iwata A, Morito N, Fujimi K, Yahiro E, Nishikawa H, Saku K. Effects of Tolvaptan With or Without the Pre-Administration of Renin-Angiotensin System Blockers in Hospitalized Patients With Acute Decompensated Heart Failure. Int Heart J 2017; 58:385-392. [DOI: 10.1536/ihj.16-220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sen Adachi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine
| | - Joji Morii
- Department of Cardiology, Fukuoka University School of Medicine
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine
| | - Natsumi Morito
- Department of Cardiology, Fukuoka University School of Medicine
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine
| | - Eiji Yahiro
- Department of Cardiology, Fukuoka University School of Medicine
| | | | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
- Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine
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22
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Ishida T, Miura SI, Fujimi K, Ueda T, Ueda Y, Matsuda T, Sakamoto M, Arimura T, Shiga Y, Kitajima K, Saku K. Visit-to-Visit Variability and Reduction in Blood Pressure After a 3-Month Cardiac Rehabilitation Program in Patients With Cardiovascular Disease. Int Heart J 2016; 57:607-14. [PMID: 27628416 DOI: 10.1536/ihj.16-026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Visit-to-visit variability (VVV) in blood pressure (BP) has been shown to be a predictor of cardiovascular events. It is unknown whether CR can improve VVV in BP as well as reducing BP. We enrolled 84 patients who had cardiovascular disease (CVD) and participated in a 3-month CR program. We measured systolic and diastolic BP (SBP and DBP), pulse pressure (PP), and heart rate (HR) before exercise training at each visit and determined VVV in BP or HR expressed as the standard deviation of the average BP or HR. Patients who had uncontrolled BP at baseline and who did not change their antihypertensive drugs throughout the study period showed a significant reduction of both SBP and DBP with a decrease in PP after 3 months. Patients who did not change their antihypertensive drugs were divided into larger (L-) and smaller (S-) VVV in the SBP groups and L- and S-VVV in the DBP groups according to the average value of VVV in SBP or DBP. In the L-VVV in the SBP and DBP groups, VVV in SBP and DBP in the 1st month was significantly decreased after the 3rd month in both groups. HR at baseline was significantly decreased after 3 months. In addition, CR induced a significant increase in the level of high-density lipoprotein cholesterol (HDL-C) in blood. In conclusion, CR improved VVV in BP in patients with L-VVV in BP and evoked a significant reduction in HR and an increase in HDL-C. These effects due to the CR program may be cardioprotective.
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23
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Ueda T, Miura SI, Fujimi K, Ishida T, Matsuda T, Fujita M, Ura Y, Kaino K, Sakamoto M, Horita T, Arimura T, Shiga Y, Kuwano T, Kitajima K, Saku K. Assessment of various parameters using simple non-invasive tests in patients with cardiovascular diseases with or without cardiac rehabilitation. Int J Cardiol Heart Vasc 2016; 12:63-67. [PMID: 28616545 PMCID: PMC5454171 DOI: 10.1016/j.ijcha.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
Cardiac rehabilitation (CR) improves cardiac function and exercise capacity in patients with cardiovascular disease (CVD). Simpler techniques are needed for use by physicians in the examination room to assess the usefulness of CR. We enrolled 46 consecutive CVD patients in a CR program (CR group) and prospectively followed them for 3 months. We compared them to 18 age-, gender- and body mass index-matched CVD patients without CR (non-CR group). Various parameters were measured at baseline and after 3 months using 3 simple non-invasive tests: severity of atherosclerosis [arterial velocity pulse index and arterial pressure volume index (API)] were determined using PASESA®, an autonomic nerve total activity amount index and a coefficient of variation of the R–R interval (CVRR) were determined using eHEART®, and peripheral resistance index, pressure rate product, stroke volume and cardiac index were determined using nico®]. There were no significant differences in patient characteristics including percentages (%) of ischemic heart disease and heart failure between the non-CR and CR groups. Systolic blood pressure (SBP), diastolic BP, heart rate and API at baseline significantly decreased and CVRR at baseline significantly increased after 3 months in the CR group, but not in the non-CR group. In addition, ΔAPI (Δ = the value after 3 months minus the value at baseline) was positively associated with ΔSBP in the CR group. In conclusion, CR significantly decreased BP and improved atherosclerosis and sympathetic nerve activity. These findings suggest that simple non-invasive tests may be useful for assessing the effects of CR.
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Affiliation(s)
- Takashi Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Toshihisa Ishida
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshiyuki Ura
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.,Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Fujimi K, Saku K. [Prognosis of silent myocardial infarction]. Nihon Rinsho 2016; 74 Suppl 6:328-331. [PMID: 30547496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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25
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Ueda T, Miura SI, Suematsu Y, Shiga Y, Kuwano T, Sugihara M, Ike A, Iwata A, Nishikawa H, Fujimi K, Saku K. Association of Arterial Pressure Volume Index With the Presence of Significantly Stenosed Coronary Vessels. J Clin Med Res 2016; 8:598-604. [PMID: 27429681 PMCID: PMC4931806 DOI: 10.14740/jocmr2615w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 01/11/2023] Open
Abstract
Background A blood pressure (BP) monitoring system (PASESA®) can be used to easily analyze the characteristics of central and peripheral arteries during the measurement of brachial BP. Methods We enrolled 108 consecutive patients (M/F = 86/22, age 70 ± 10 years) who underwent coronary angiography (CAG) due to suspected coronary artery disease (CAD) in whom we could measure various parameters using PASESA® in addition to brachial-ankle pulse wave velocity (baPWV). The patients were divided into two groups: patients who did not have significantly stenosed coronary vessel disease (n = 33, non-SVD group) and those who had at least one significantly stenosed coronary vessel (n = 75, SVD group). The characteristics of central and peripheral arteries (arterial velocity pulse index (AVI) and arterial pressure volume index (API), respectively) and baPWV were measured. Estimated central BP (eCBP) was calculated from the data obtained from PASESA®, and CBP was also measured simultaneously by invasive catheterization. Results API, but not AVI and baPWV, in the SVD group was significantly higher than that in the non-SVD group. Although eCBP was significantly associated with CBP, there was no difference in eCBP between the groups. There were significant associations among API, AVI and baPWV, albeit these associations were relatively weak. A multivariate logistic regression revealed that API and β-blocker were significant independent variables that were associated with the presence of significant coronary stenosis. The cut-off level of API that gave the greatest sensitivity and specificity for the presence of SVD was 24 units (sensitivity 0.636 and specificity 0.667). Conclusion In conclusion, API, but not AVI or baPWV, is associated with the presence of significant coronary stenosis.
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Affiliation(s)
- Takashi Ueda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Amane Ike
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Nishikawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Rehabilitation, Fukuoka University Hospital, Fukuoka 814-0180, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Arimura T, Miura SI, Morito N, Shiga Y, Kitajima K, Morii J, Iwata A, Fujimi K, Yahiro E, Saku K. Recent Patient Characteristics and Medications at Admission and Discharge in Hospitalized Patients With Heart Failure. J Clin Med Res 2016; 8:97-104. [PMID: 26767077 PMCID: PMC4701064 DOI: 10.14740/jocmr2402w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To improve the clinical outcome of heart failure (HF), it is important to evaluate the etiology and comorbidities of HF. We previously reported the baseline clinical characteristics and medications in hospitalized patients with HF in years 2000 - 2002 (group 2000) and 2007 - 2009 (group 2008). METHODS We conducted a retrospective study of 158 patients who were hospitalized due to HF between 2012 and 2014 (group 2013) in the Department of Cardiology, Fukuoka University Hospital. We analyzed the clinical characteristics and medications at admission and discharge, and compared the findings in group 2013 to those in group 2000 and group 2008. RESULTS The major causes of HF were ischemic heart disease, hypertensive cardiomyopathy, valvular heart disease, and dilated cardiomyopathy. The New York Heart Association classification in group 2013 was significantly higher than those in group 2000 and group 2008. There was no difference in the level of brain natriuretic peptide at admission between group 2008 and group 2013. Tolvaptan began to be administered in group 2013. The median dose of furosemide just before the use of tolvaptan was 40 mg/day. At discharge, group 2013 showed higher rates of β-blocker and aldosterone antagonist. There was no difference in the frequency of loop diuretics. The dose of carvedilol at discharge was only 6.2 ± 4.0 mg/day. Antiarrhythmic drugs and β-blocker were used more frequently in HF with reduced ejection fraction (EF) than in HF with preserved EF. CONCLUSIONS We may be able to improve the clinical outcome of HF by examining the differences in the clinical characteristics and medications at admission and discharge in hospitalized patients with HF.
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Affiliation(s)
- Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Natsumi Morito
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken Kitajima
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Joji Morii
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiji Yahiro
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
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Fujimi K, Miura SI, Matsuda T, Fujita M, Ura Y, Kaino K, Sakamoto M, Horita T, Arimura T, Shiga Y, Saku K. Influence of a Cardiac Rehabilitation Program on Renal Function in Patients With Cardiovascular Disease in a One-Year Follow-Up. Cardiol Res 2015; 6:311-315. [PMID: 28197248 PMCID: PMC5295569 DOI: 10.14740/cr440e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/11/2022] Open
Abstract
Background Exercise training may improve renal function in patients with chronic kidney disease (CKD). The effect of cardiac rehabilitation (CR) with exercise training on renal function has not yet been established. We evaluated the effects of CR on renal function in patients with cardiovascular disease (CVD). Methods Twenty-three CVD patients in a 1-year CR program (CR group) who had ischemic heart disease (IHD) and/or heart failure were compared with 26 age- and gender-matched CVD patients without CR (non-CR group, standard pharmacological care alone). At baseline and after 1 year, urea nitrogen (UN), creatinine (Cr), potassium (K), estimated glomerular filtration rate (eGFR) and hematocrit (Hct) in blood were assessed. Results There were no differences in the patient characteristics at baseline between the CR and non-CR groups except for the percentages of heart failure and the use of calcium channel blocker. After 1 year, there were no significant changes in UN, Cr, K, eGFR or Hct in either the CR or non-CR groups. The patients in the CR group were divided into two groups according to the eGFR level at baseline: low (n = 12, eGFR < 51 mL/minute/1.73 m2, indicating mild-to-moderate CKD) and high (n = 11, eGFR ≥ 51 mL/minute/1.73 m2) eGFR groups. Although there were no differences in the patient characteristics at baseline between the low and high eGFR groups, the low eGFR group showed a significant increase in eGFR after the 1-year CR program. Conclusions CR may improve renal function in patients with mild-to-moderate CKD.
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Affiliation(s)
- Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takuro Matsuda
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaomi Fujita
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshiyuki Ura
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Kouji Kaino
- Department of Rehabilitation, Fukuoka University Hospital, Fukuoka, Japan
| | - Maya Sakamoto
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tomoe Horita
- Division of Nutrition, Fukuoka University Hospital, Fukuoka, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Kawamura A, Matsunaga A, Fukuda Y, Fujimi K, Kanaya H, Matsuda T. [Report from Kyushu Chapter Educational Seminar: what is cardiac rehabilitation? Case report and short lectures]. Nihon Naika Gakkai Zasshi 2013; 102:2723-2732. [PMID: 24400557 DOI: 10.2169/naika.102.2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Akira Kawamura
- Department of Cardiology, Fukuoka University Hospital, Japan
| | - Akira Matsunaga
- Department of Laboratory Medicine, Fukuoka University, Faculty of Medicine, Japan
| | - Yusuke Fukuda
- Department of Cardiology, Fukuoka University Hospital, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University Hospital, Japan
| | - Hideki Kanaya
- Department of Cardiology, Fukuoka Teishin Hospital, Japan
| | - Takuro Matsuda
- Department of Sports and Health Science, Fukuoka University, Japan
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Fukuda Y, Miura SI, Fujimi K, Yano M, Nishikawa H, Yanagisawa J, Hiratsuka M, Shiraishi T, Iwasaki A, Saku K. Effects of treatment with a combination of cardiac rehabilitation and bosentan in patients with pulmonary Langerhans cell histiocytosis associated with pulmonary hypertension. Eur J Prev Cardiol 2013; 21:1481-3. [PMID: 23897898 DOI: 10.1177/2047487313497603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pulmonary hypertension (PH), which is classified as group 5 in the clinical classification of PH, is sometimes a complication of Pulmonary langerhans cell histiocytosis (PLCH), and is associated with high mortality. A 36-year-old woman had suffered from severe dyspnea 9 years previously and was diagnosed with PLCH and was on a waiting list for a lung transplant. Right heart failure had been observed and the mean pulmonary artery pressure was over 40 mmHg. The patient was diagnosed as PLCH with PH. After combined treatment with exercise rehabilitation and bosentan for 6 months, the cardiothoracic ratio, brain natriuretic peptide, and bodyweight were significantly decreased (cardiothoracic ratio from 43 to 38%, brain natriuretic peptide from 284 to10 pg/ml and bodyweight from 63 to 58 kg). Six-minute walk test also improved from 214 to 275 meters and the SF36 score for screening of depressive and anxiety disorders was improved. This is the report demonstrating the efficacy and safety of cardiac rehabilitation in combination with bosentan in a single patient with PLCH associated with PH.
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Affiliation(s)
- Yusuke Fukuda
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanta Fujimi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masaya Yano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Nishikawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Jun Yanagisawa
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masafumi Hiratsuka
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
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Uehara Y, Fujimi K, Yahiro E, Abe S, Devarajan S, Saku K, Urata H. Induction of tissue angiotensin II-forming activity in two-kidney, one-clip hypertensive hamster model. World J Hypertens 2013; 3:9-17. [DOI: 10.5494/wjh.v3.i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/09/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the role of chymase in blood pressure regulation and its actions on tissue renin-angiotensin system.
METHODS: A two-kidney, one-clip (2K1C) hypertension model was developed in Syrian hamsters, which have a human-type chymase. Either an angiotensin (Ang) converting enzyme (ACE) inhibitor (ACE-I; temocapril, 30 mg/kg per day), Ang II type 1 receptor antagonist (ARB; CS866, 10 mg/kg per day), or vehicle was administered, beginning 2 wk after renal artery clipping and continued for 16 wk. At the end of this protocol, hearts, aortas, and lungs were removed, and total Ang II-forming activities and ACE- and chymase-dependent Ang II-forming activities were determined.
RESULTS: After renal artery clipping, systolic blood pressure in the vehicle group was significantly higher compared with that in a sham-operated group throughout the experimental period. Both ACE-I and ARB treatments revealed similar antihypertensive effects. Moreover, in the vehicle group, cardiac total and chymase-dependent Ang II-forming activities significantly increased at 18 wk after clipping. Further, cardiac total and chymase-dependent Ang II-forming activities decreased significantly after ACE-I or ARB treatment for 16 wk. In addition, chymase-dependent Ang II-forming activity significantly increased in the aorta, although these changes were inhibited only by ARB. ARB treatment was more effective compared with ACE-I treatment in reversing the changes in tissue Ang II formation, particularly in the aorta, despite their similar antihypertensive effects.
CONCLUSION: Chymase does not play a major role in maintaining blood pressure and tissue ACE and chymase are regulated in a tissue-dependent manner in 2K1C hamster.
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Matsuzaki T, Sasaki K, Hata J, Hirakawa Y, Fujimi K, Ninomiya T, Suzuki SO, Kanba S, Kiyohara Y, Iwaki T. Association of Alzheimer disease pathology with abnormal lipid metabolism: the Hisayama Study. Neurology 2011; 77:1068-75. [PMID: 21911734 DOI: 10.1212/wnl.0b013e31822e145d] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The relationship between lipid profiles and Alzheimer disease (AD) pathology at the population level is unclear. We searched for evidence of AD-related pathologic risk of abnormal lipid metabolism. METHODS This study included brain specimens from a series of 147 autopsies performed between 1998 and 2003 of residents in Hisayama town, Japan (76 men and 71 women), who underwent clinical examinations in 1988. Lipid profiles, such as total cholesterol (TC), triglycerides, and high-density lipoprotein cholesterol (HDLC), were measured in 1988. Low-density lipoprotein cholesterol (LDLC) was calculated using the Friedewald formula. Neuritic plaques (NPs) were assessed according to the Consortium to Establish a Registry for Alzheimer's Disease guidelines (CERAD) and neurofibrillary tangles (NFTs) were assessed according to Braak stage. Associations between each lipid profile and AD pathology were examined by analysis of covariance and logistic regression analyses. RESULTS Adjusted means of TC, LDLC, TC/HDLC, LDLC/HDLC, and non-HDLC (defined as TC-HDLC) were significantly higher in subjects with NPs, even in sparse to moderate stages (CERAD = 1 or 2), compared to subjects without NPs in multivariate models including APOE ε4 carrier and other confounding factors. The subjects in the highest quartiles of these lipid profiles had significantly higher risks of NPs compared to subjects in the lower respective quartiles, which may suggest a threshold effect. Conversely, there was no relationship between any lipid profile and NFTs. CONCLUSION The results of this study suggest that dyslipidemia increases the risk of plaque-type pathology.
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Affiliation(s)
- T Matsuzaki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Matsuzaki T, Sasaki K, Tanizaki Y, Hata J, Fujimi K, Matsui Y, Sekita A, Suzuki SO, Kanba S, Kiyohara Y, Iwaki T. Insulin resistance is associated with the pathology of Alzheimer disease: the Hisayama study. Neurology 2010; 75:764-70. [PMID: 20739649 DOI: 10.1212/wnl.0b013e3181eee25f] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We examined the association between diabetes-related factors and pathology of Alzheimer disease (AD) to evaluate how diabetes affects the pathogenic process of AD. METHODS This study included specimens from a series of 135 autopsies of residents of the town of Hisayama in Fukuoka prefecture (74 men and 61 women) performed between 1998 and 2003, who underwent a 75-g oral glucose tolerance test in clinical examinations in 1988. We measured diabetes-related factors including fasting glucose, 2-hour post-load plasma glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in 1988. Neuritic plaques (NPs) were assessed according to the Consortium to Establish a Registry for Alzheimer's Disease guidelines and neurofibrillary tangles (NFTs) were assessed according to Braak stage. The associations between each factor and AD pathology were examined by analysis of covariance and logistic regression analyses. RESULTS Higher levels of 2-hour post-load plasma glucose, fasting insulin, and HOMA-IR were associated with increased risk for NPs after adjustment for age, sex, systolic blood pressure, total cholesterol, body mass index, habitual smoking, regular exercise, and cerebrovascular disease. However, there were no relationships between diabetes-related factors and NFTs. Regarding the effects of APOE genotype on the risk of AD pathology, the coexistence of hyperglycemia and APOE epsilon4 increased the risk for NP formation. A similar enhancement was observed for hyperinsulinemia and high HOMA-IR. CONCLUSION The results of this study suggest that hyperinsulinemia and hyperglycemia caused by insulin resistance accelerate NP formation in combination with the effects of APOE epsilon4.
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Affiliation(s)
- T Matsuzaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Yanagi D, Shirai K, Takamiya Y, Fukuda Y, Kuwano T, Ike A, Mori K, Kubota K, Iwata A, Fujimi K, Kawamura A, Nishikawa H, Miller N, Zhang B, Tsuchiya Y, Urata H, Saku K. Results of provisional stenting with a Sirolimus-eluting stent for bifurcation lesion: Multicenter study in Japan. J Cardiol 2008; 51:89-94. [DOI: 10.1016/j.jjcc.2007.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 11/28/2007] [Accepted: 12/04/2007] [Indexed: 11/24/2022]
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Morito N, Ogawa M, Matsuo S, Mihara H, Miyoshi K, Yahiro E, Fujimi K, Ohta T, Kodama S, Yamanouchi Y, Urata H, Hiroki T, Saku K. Atrial septal defect in apical hypertrophic cardiomyopathy associated with coronary spasm. Int J Cardiol 2004; 93:339-42. [PMID: 14975579 DOI: 10.1016/s0167-5273(03)00218-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2003] [Revised: 05/26/2003] [Accepted: 06/02/2003] [Indexed: 11/22/2022]
Abstract
Apical hypertrophic cardiomyopathy (HCM) is a well-known myocardial disease, but the additional coexistence of an atrial septal defect (ASD) and coronary spasm is quite rare. We report here on a 62-year-old man suffering from congestive heart failure due to apical HCM complicated by coronary spasm and secundum-type ASD. The transthoracic, transesophageal echocardiography and cardiac catheterization were useful for diagnosing and evaluating of the patient's status. A calcium channel blocker was given to prevent coronary spasm, and a surgical patch closure operation was successfully performed. Afterwards, his symptoms were alleviated.
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Ogawa M, Miyoshi K, Morito N, Kodama S, Yahiro E, Fujimi K, Ohta T, Mihara H, Yamanouchi Y, Urata H, Hiroki T, Saku K. Successful catheter ablation of ventricular tachycardia originating from the idiopathic saccular apical left ventricular aneurysm. Int J Cardiol 2004; 93:343-6. [PMID: 14975580 DOI: 10.1016/s0167-5273(03)00222-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Revised: 06/19/2003] [Accepted: 06/30/2003] [Indexed: 10/26/2022]
Abstract
Left ventricular (LV) aneurysm has been recognized to frequently become a substrate of ventricular tachyarrhythmias. We report a case of a 66-year-old woman with symptomatic sustained monomorphic ventricular tachycardia (SMVT) originating from saccular apical LV aneurysm without definite underlying diseases. We performed catheter ablation using electroanatomical and conventional bipolar potential mapping. During SMVT, we found an area of fragmented potential -40 ms preceding the earliest wide QRS complex in the area of the apical LV aneurysm. Radiofrequency applications were delivered to this area. Since then, SMVT was no longer inducible by programmed electrical stimulation. The patient has remained free of VT recurrences during a subsequent 12-month follow-up period.
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Nishida Y, Tokuyama K, Nagasaka S, Higaki Y, Fujimi K, Kiyonaga A, Shindo M, Kusaka I, Nakamura T, Ishikawa SE, Saito T, Nakamura O, Sato Y, Tanaka H. S(G), S(I), and EGP of exercise-trained middle-aged men estimated by a two-compartment labeled minimal model. Am J Physiol Endocrinol Metab 2002; 283:E809-16. [PMID: 12217899 DOI: 10.1152/ajpendo.00237.2001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To examine the effects of physical training on glucose effectiveness (S(G)), insulin sensitivity (S(I)), and endogenous glucose production (EGP) in middle-aged men, stable-labeled frequently sampled intravenous glucose tolerance tests (FSIGTT) were performed on 11 exercise-trained middle-aged men and 12 age-matched sedentary men. The time course of EGP during the FSIGTT was estimated by nonparametric stochastic deconvolution. Glucose uptake-specific indexes of glucose effectiveness (S(2*)(G) x 10(2): 0.81 +/- 0.08 vs. 0.60 +/- 0.05 dl. min(-1). kg(-1), P < 0.05) and insulin sensitivity [S(2*)(I) x 10(4): 24.59 +/- 2.98 vs. 11.89 +/- 2.36 dl. min(-1). (microU/ml)(-1). kg(-1), P < 0.01], which were analyzed using the two-compartment minimal model, were significantly greater in the trained group than in the sedentary group. Plasma clearance rate (PCR) of glucose was consistently greater in the trained men than in sedentary men throughout FSIGTT. Compared with sedentary controls, EGP of trained middle-aged men was higher before glucose load. The EGP of the two groups was similarly suppressed by approximately 70% within 10 min, followed by an additional suppression after insulin infusion. EGP returned to basal level at approximately 60 min in the trained men and at 100 min in the controls, followed by its overshoot, which was significantly greater in the trained men than in the controls. In addition, basal EGP was positively correlated with S(2*)(G) . The higher basal EGP and greater EGP overshoot in trained middle-aged men appear to compensate for the increased insulin-independent (S(2*)(G)) and -dependent (S(2*)(I)) glucose uptake to maintain glucose homeostasis.
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Affiliation(s)
- Yuichiro Nishida
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya 464-8601, 814-0180 Japan
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Abstract
OBJECTIVE To detect whether mild exercise training improves glucose effectiveness (S(G)), which is the ability of hyperglycemia to promote glucose disposal at basal insulin, in healthy men. RESEARCH DESIGN AND METHODS Eight healthy men (18-25 years of age) underwent ergometer training at lactate threshold (LT) intensity for 60 min/day for 5 days/week for 6 weeks. An insulin-modified intravenous glucose tolerance test was performed before as well as at 16 h and 1 week after the last training session. S(G) and insulin sensitivity (S(I)) were estimated using a minimal-model approach. RESULTS After the exercise training, VO(2max) and VO(2) at LT increased by 5 and 34%, respectively (P < 0.05). The mild exercise training improves S(G) measured 16 h after the last training session, from 0.018 +/- 0.002 to 0.024 +/- 0.001 min(-1) (P < 0.05). The elevated S(G) after exercise training tends to be maintained regardless of detraining for 1 week (0.023 +/- 0.002 min(-1), P = 0.09). S(I) measured at 16 h after the last training session significantly increased (pre-exercise training, 13.9 +/- 2.2; 16 h, 18.3 +/- 2.4, x10(-5). min(-1). pmol/l(-1), P < 0.05) and still remained elevated 1 week after stopping the training regimen (18.6 +/- 2.2, x10(-5). min(-1). pmol/l(-1), P < 0.05). CONCLUSIONS Mild exercise training at LT improves S(G) in healthy men with no change in the body composition. Improving not only S(I) but also S(G) through mild exercise training is thus considered to be an effective method for preventing glucose intolerance.
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Affiliation(s)
- Y Nishida
- Research Center of Health, Physical Fitness, and Sports, Nagoya University, Nagoya, Japan
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Fujimi K, Urata H. [Comparison between AngII receptor antagonist and ACE inhibitor]. Nihon Rinsho 2001; 59:999-1003. [PMID: 11392005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Angiotensin II(AII) accelerates the progress of cardiovascular diseases. This was proved by the fact that the blockade of renin-angiotensin system provided clinical benefits for patients with cardiovascular diseases. This review focuses on the differences between AT1-receptor antagonist and ACE inhibitor in basic and clinical aspects. Beside decreased AII concentration, increased tissue bradykinin concentration may contribute to the beneficial effect of ACE inhibitor, on the other hand, this increases the rate of cough to decrease the compliance. Increased AII concentration by AII receptor antagonist may antagonize the binding of the drug as well as stimulate AT2 receptor subtype. ACE inhibitor can not block the effect of non-ACE AII formation, but AII receptor does. These differences should be considered for their clinical use.
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Affiliation(s)
- K Fujimi
- Second Department of Internal Medicine, School of Medicine, Fukuoka University
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Kudo M, Ibuki Y, Fujimi K, Tomita S, Komori H, Orino A, Todo A, Hino M, Ikekubo K. [Is a liver scintigram necessary for diagnosis of hepatocellular carcinoma?]. Rinsho Hoshasen 1987; 32:901-8. [PMID: 2828720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Komori H, Hirasa M, Takakuwa H, Ibuki Y, Kudo M, Fujimi K, Miyamura M, Tomita S, Todo A. Concept of the clinical stages of acute hepatic failure. Am J Gastroenterol 1986; 81:544-9. [PMID: 3717116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serial medical diagnostic imagings were performed on 15 patients with acute hepatic failure to compare liver size and clinical picture. In patients showing hepatatrophy at the onset of coma, the interval between the onsets of disease and coma was long, ascites and edema supervened, high total bilirubin and low glutamic pyrubic transaminase levels tended to be found, and prothrombin time did not respond to treatment. All of these patients died. Based on liver size changes in patients who survived acute hepatic failure, acute hepatic failure was assumed to be classified into swelling, reduction, and recovery stages. The shorter the interval between the onsets of disease and coma, the earlier coma and prolonged prothrombin time occurred before hepatatrophy. In acute hepatic failure, signs of hepatic failure develop with various histological pictures and it is very important to institute the treatment before the liver is atrophied.
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Kudo M, Hirasa M, Takakuwa H, Ibuki Y, Fujimi K, Miyamura M, Tomita S, Komori H, Todo A, Kitaura Y. Small hepatocellular carcinomas in chronic liver disease: detection with SPECT. Radiology 1986; 159:697-703. [PMID: 2422678 DOI: 10.1148/radiology.159.3.2422678] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Single-photon emission computed tomography (SPECT) performed using a rotating gamma camera was compared with alpha 1-fetoprotein (AFP) assay, conventional liver scintigraphy, ultrasound (US) imaging, computed tomography (CT), and selective celiac angiography in 40 patients with a total of 50 small hepatocellular carcinomas (HCCs; less than 5 cm). The detection rates of US and CT were determined on an initial screening study and on a second, more precisely focused study. The detection rate of small HCCs by the various modalities was as follows: AFP, 13%; liver scintigraphy, 36%; SPECT, 72%; initial screening US, 80%; second, more precise US studies, 94%; initial screening CT, 64%; second, more precise CT study, 82%; angiography, 88%. Although SPECT was inferior to the initial screening US examination in detecting HCCs less than 2 cm in size, its sensitivity was identical to that of the initial screening US study for detecting HCCs of 2-5 cm. The combination of SPECT and US was an excellent method for the early detection of HCCs, yielding a detection rate of 94%.
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Ibuki Y, Hirasa M, Takakuwa H, Kudo M, Fujimi K, Ueda S, Miyamura M, Tomita S, Komori H, Todo A. [A case of suppurative pyelophlebitis with development of hepatoportal collaterals (cavernous transformation of the portal vein)]. Nihon Shokakibyo Gakkai Zasshi 1985; 82:1406-11. [PMID: 3897674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sasaki E, Inumaru M, Shimokawabe M, Fujimi K, Kunisaki T, Tanikawa K, Tibana H, Abe K, Kurihara K. [Case report of pneumopericardium caused by perforation of gastric ulcer]. Rinsho Hoshasen 1982; 27:1461-4. [PMID: 7166861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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44
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Komori H, Kudo M, Fujimi K, Tomita S, Endo Y, Okimoto Y, Todo A, Kitaura Y, Uchida H. [Clinical and histological study on prognosis of patients survived from acute hepatic failure. Investigation of 6 cases and review of literature (author's transl)]. Nihon Shokakibyo Gakkai Zasshi 1981; 78:2384-94. [PMID: 7341798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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45
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Tachiiri H, Fujimi K, Mori S, Kotake T, Sato T. [Radiologic study on the mechanism of the esophageal voice of laryngectomized patients. 2]. Z Laryngol Rhinol Otol 1972; 51:539-49. [PMID: 5076580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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46
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Tachiiri H, Fujimi K, Mori S, Kotake T, Sato T. [Radiographic study of the mechanism of esophageal voice production following laryngectomy. I]. Z Laryngol Rhinol Otol 1972; 51:462-79. [PMID: 5053118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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47
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Yamazaki T, Fujimi K, Hamada T, Makino T. [Low-voltage radiography of the chest with industrial x-ray film and its magnified view]. Nihon Igaku Hoshasen Gakkai Zasshi 1970; 30:642-51. [PMID: 5275013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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48
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Sato T, Nakajima R, Fujii K, Fujimi K. [Mechanism of esophageal speech]. Nihon Jibiinkoka Gakkai Kaiho 1969; 72:1242-52. [PMID: 5387762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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49
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Sato T, Fujii K, Utsumi S, Takayama M, Fujimi K. [Esophageal speech mechanism]. Nihon Jibiinkoka Gakkai Kaiho 1969; 72:446-7. [PMID: 5388809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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50
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Fujimi K. [The roentgencinematographic study on the mechanism of esophageal speech following laryngectomy]. Nihon Igaku Hoshasen Gakkai Zasshi 1969; 28:1439-64. [PMID: 5253929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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