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| 1.
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Nitta, Y. ; Yamamoto, R. ; Yamaguchi, Y. ; Katsuda, S. ; Kaku, B. ; Taguchi, T. ; Takabatake, S. ; Nakahama, K. ; Yamagishi, Masakazu ; 山岸, 正和
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金沢大学医薬保健研究域医学系<br />Calcium channel blockers (CCBs) can prevent cardiovascular events in patients with coronary artery d
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isease (CAD). This study looked retrospectively at the prognosis of CAD in hypertensive patients with CAD who had undergone a coronary angiograph, had been given a CCB (benidipine [n = 66], amlodipine [n = 45], or long-acting nifedipine [n = 31]) on hospital discharge and were then followed up for a mean ± SD of 5.2 ± 2.9 years. Systolic/diastolic blood pressure for all 142 patients decreased significantly from a mean ± SD of 137 ± 20/74 ± 15 mmHg to 129 ± 20/71 ± 12 mmHg. Major adverse cardiovascular events (MACE) occurred in 15 patients. Chronic kidney disease (CKD) was a significant risk factor for MACE (hazard ratio 2.35, 95%confidence intervals 1.45, 3.80). Benidipine was superior to nifedipine in preventing MACE in patients both with and without CKD. In conclusion, benidipine and amlodipine reduced the frequency of MACE in hypertensive patients with CAD, particularly in those with complicating CKD. © 2010 Field House Publishing LLP.
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新屋, 智之 ; 笠原, 寿郎 ; 藤村, 政樹 ; 丹保, 裕一 ; 田森, 俊一 ; 曽根, 崇 ; 中尾, 眞二 ; Araya, Tomoyuki ; Kasahara, Kazuo ; Fujimura, Masaki ; Tanbo, Yuichi ; Tamori, Shunichi ; Sone, Takashi ; Nakao, Shinji
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金沢大学医薬保健研究域医学系<br />Background. Skeletal muscle metastases from lung cancer are considered to be extremely rare. We enco
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untered 3 cases of lung cancer associated with skeletal muscle metastases on initial medical examination or during disease progression. Cases. Case 1: A 46-year-old man was trismic due to metastasis of lung adenocarcinoma to the lateral pterygoid muscle. He was resistant to radiotherapy and chemotherapy, and died 9 months after the occurrence of symptoms. Case 2: A 57-year-old man had a large cell lung carcinoma or poorly differentiated lung adenocarcinoma. He had metastasis to the right femoral muscle in addition to multiple metastases to many other organs. His disease was also resistant to any treatment, and died 7 months after he became symptomatic. Case 3: A 64-year-old man with adenocarcinoma had a single metastasis to the biceps muscle. He died 3 months after the diagnosis of muscle metastasis due to resistance to therapy. Conclusion. Upon diagnosis of tumorous lesions of skeletal muscles, whole body examination and subsequent percutaneous biopsy of muscle involvement are required to determine the possibility of skeletal muscle metastasis of lung cancer. 背景.肺癌の骨格筋転移は極めて稀とされているが,今回我々は,初診時もしくは経過中に骨格筋転移を来した非小細胞肺癌の3症例を経験した.症例.症例1は46歳男性,肺腺癌の外側翼突筋転移のために開口障害を来した.放射線及び化学療法に対して抵抗性であり,原疾患の悪化により症状発現から約9ヶ月の経過で死亡した.症例2は57歳男性,肺大細胞癌もしくは低分化腺癌の症例で右大腿部の筋転移に加え,他臓器への広範な転移を認めた.治療抵抗性で症状出現より約7ヶ月の経過で死亡した.症例3は64歳男性,腺癌の症例で,右上腕二頭筋に転移を来し,治療抵抗性の経過で筋転移出現より約3ヶ月で死亡した.結論.骨格筋の腫瘤性病変の診断の際には転移性悪性腫瘍,特に肺癌の骨格筋転移を念頭に置き,全身精査と病変部位の生検により速やかな確定診断が必要と考えられた.
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Oe, Kotaro ; Shimizu, Masami ; Ino, Hidekazu ; Yamaguchi, Masato ; Terai, Hidenobu ; Hayashi, Kenshi ; Kiyama, Masaru ; Sakata, Kenji ; Hayashi, Tatsumi ; Inoue, Masaru ; Kaneda, Tomoya ; Mabuchi, Hiroshi
概要:
金沢大学大学院医学系研究科<br />It has been reported that women with acute myocardial infarction (AMI) have a higher short-term morta
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lity rate than men, but the reason is unclear and it is not known if it also applies to unstable angina pectoris (UAP). In addition, most previous studies have not presented angiographic findings. In the present study, the findings from 1,408 patients with AMI (group A: 361 women, 1,047 men) and 332 patients with UAP (group B: 103 women, 229 men) who underwent coronary angiography within 30 days of onset were analyzed. In both groups, the women were older and had a higher rate of hypertension and a lower rate of smoking than the men. There was no significant difference in Killip class or the number of diseased vessels between the women and men in both groups. Interventions (coronary angioplasty and coronary artery bypass grafting) were performed less frequently in the women than in the men (87.2% vs 91.8%, p=0.04) in group A, but not in group B (80.6% vs 81.2%, NS). In both groups, the overall mortality rate during hospitalization was higher in women than in men (group A: 14.4% vs 7.4%, p<0.0001, group B: 7.8% vs 1.7%, p=0.007). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality in group B (odds ratio (OR): 6.4, 95% confidence interval (CI) 1.1-37.0, p=0.04), but not in group A (OR: 1.7, 95% CI 0.98-2.9, p=0.06). The independent predictors of in-hospital mortality, other than female gender were age, prior congestive heart failure, prior cerebrovascular disease and a higher Killip class in group A, and in both groups a higher number of diseased vessels. In conclusion, Japanese women with acute coronary syndromes present with similar angiographic findings and hemodynamics, but have a higher in-hospital mortality than male patients. Our results suggest that older age may be a potential explanation for the higher in-hospital mortality in women with AMI, but female gender itself may be an important predictor for it among those with UAP.
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4. Clinical features and prognosis of Japanese patients with anomalous origin of the coronary artery
Kaku, Bunji ; Shimizu, Masami ; Yoshio, Hiroyuki ; Ino, Hidekazu ; Mizuno, Sumio ; Kanaya, Honin ; Ishise, Shozo ; Mabuchi, Hiroshi
概要:
金沢大学大学院医学系研究科 <br />Anomalous origin of the coronary artery can lead to angina pectoris, acute myocardial infarction or
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even sudden death in the absence of atherosclerosis. However, in Japan, this anomaly is usually treated medically rather than surgically. To clarify the clinical features of anomalous origin of the coronary artery in Japanese and the prognosis of such patients who are treated medically, we reviewed 56 patients with anomalous origin of the coronary arteries, The mean age of these patients was 55.9±11.5 years. Anomalous origin of the right coronary artery from the left sinus of Valsalva was seen most frequently (78.6%). In contrast, we found no cases of anomalous origin of the left corolnary artery from the right sinus of Valsalva traversing between the aorta and the pulmonary trunk. A history of syncope (14.3%) and aortic regurgitation (21.4%) was frequent and serious complications during exercise stress testing occurred in 5 patients. These patients were treated medically, such as by limiting exercise or by the oral administration of medicine. During the follow up period (mean 5.64.2 years), death directly related to anomalous origin of the coronary artery was not found despite the lack of surgical treatment. Our results suggest that the prognosis of these middle-aged-tolelderly patients without atherosclerosis is relatively good, despite the lack of surgical treatment.
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Nakajima, Kenichi ; Yamasaki, Yoshimitsu ; Kusuoka, Hideo ; Izumi, Tohru ; Kashiwagi, Atsunori ; Kawamori, Ryuzo ; Shimamoto, Kazuaki ; Yamada, Nobuhiro ; Nishimura, Tsunehiko
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金沢大学医薬保健研究域医学系<br />Purpose Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusi
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on imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0–3, 4–8, 9–13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. Conclusion The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients.
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Nakajima, Kenichi ; Kusuoka, Hideo ; Nishimura, Shigeyuki ; Yamashina, Akira ; Nishimura, Tsunehiko
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金沢大学医薬保健研究域医学系<br />Objective: To determine the prognostic value of myocardial ischemia, function and coronary risk fact
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ors on total and hard cardiac events using myocardial perfusion imaging in a Japanese population. Methods: A prospective cohort study was performed in 117 Japanese hospitals, each with a nuclear cardiology facility. A total of 4,031 patients with suspected or confirmed ischemic heart disease were registered. The patients were followed up for a year to investigate total and hard events, and those who had any events were followed up for 3 years to evaluate subsequent hard events. A stress-rest gated myocardial perfusion study was performed with 99mTc-tetrofosmin using gated single-photon emission computed tomography (SPECT) and analyzed by semi-quantitative scores. Results: During the 1-year follow-up period, 263 (6.5%) patients had total events comprising all-cause death, non-fatal myocardial infarction (MI), heart failure, unstable angina, angina pectoris and coronary revascularization. Cardiac death occurred in 23 patients (0.6%) and non-fatal MI in 11 (0.3%). Among patients with ejection fraction (EF) of <45% and a summed difference score (SDS) of ≥2, 18.7% (2.4% for cardiac death and 0.6% for non-fatal MI) experienced total events compared with 3.9% (0.3% for cardiac death and 0.2% for non-fatal MI; P < 0.0001) of those with EF ≥ 45% and SDS < 2. Multivariate analysis identified EF, SDS, age, history of revascularization and diabetes as significant predictors of all events, while the significant predictors were age and EF for hard events. When the patients who had heart failure in the first year were followed up, 9 of 41 (22.0%) experienced cardiac death in the subsequent 3-year follow-up period. Conclusions: Myocardial ischemia defined by SDS and ventricular function were the main predictors of total events despite the relatively low incidence of hard events in this Japanese population. In patients with cardiac events in a year, closer attention should be paid to subsequent hard events particularly in patients with heart failure. © 2009 The Japanese Society of Nuclear Medicine.
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| 7.
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Nakajima, Kenichi ; Yamasaki, Yoshimitsu ; Kusuoka, Hideo ; Izumi, Tohru ; Kashiwagi, Atsunori ; Kawamori, Ryuzo ; Shimamoto, Kazuaki ; Yamada, Nobuhiro ; Nishimura, Tsunehiko
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金沢大学医薬保健研究域医学系<br />Purpose: Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfus
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ion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. Methods: A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Results: Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. Conclusion: The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients. © 2009 Springer-Verlag.
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Yamamoto, Norio ; Hayashi, Katsuhiro ; Tanzawa, Yoshikazu ; Kimura, Hiroaki ; Takeuchi, Akihiko ; Igarashi, Kentaro ; Inatani, Hiroyuki ; Shimozaki, Shingo ; Kitamura, Seiko ; Tsuchiya, Hiroyuki
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This study examined 45 patients with welldifferentiated liposarcoma who were surgically treated at our hospital (initial surgery in 41 patients and reoperation in 4). Only one patient had recurrence among patients who underwent
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initial surgery, and the recurrence was localised in the retroperitoneal space. For patients who underwent reoperation, the mean time between the initial surgery and the recurrence was 16.5 years. None of the 45 patients developed distant metastasis. It is important to preserve not only neurovascular bundles but also lower limb muscles in order to maintain ambulatory ability in the elderly patients. For well-differentiated liposarcomas of the limbs, it is important to establish a surgical margin beyond the marginal resection border and to perform muscle resection to the extent that would not greatly reduce the muscle strength.
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Nakajima, Kenichi ; Jacobson, Arnold F.
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Since the advent of 123I-meta-iodobenzylguanidine（MIBG）in 1990s, it has been widely used in clinical practice in Japan.
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Based on the wide range of clinical applications, 123I MIBG is now incorporated in Japanese Circulation Society)s guidelines of nuclear cardiology. The major role of 123I MIBG has been in determination of severity and prognostic evaluation of heart failure. In addition, assessment of the treatment by various types of medications has been the second major role of 123 I MIBG imaging. Compared with the conventional clinical parameters of heart failure, additive values of 123I MIBG depend on how it reflects the patient condition more accurately, and how it relates to improvement in the patient outcome. 123 I MIBG is also now available for cardiac imaging in the USA and Europe. Unified methodology and further studies focusing on clinical decision-making are the next required steps to document MIBG utility.
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Matsuo, Shinro ; Nakajima, Kenichi ; Nakata, Tomoaki
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Background:Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can
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vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac 123I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies.Methods and Results:All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome.Conclusions:Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death. (Circ J 2016; 80: 435–441)
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Kojima, Sunao ; Matsui, Kunihiko ; Sakamoto, Tomohiro ; Ishihara, Masaharu ; Kimura, Kazuo ; Miyazaki, Shunichi ; Yamagishi, Masakazu ; Tei, Chuwa ; Hiraoka, Hisatoyo ; Sonoda, Masahiro ; Tsuchihashi, Kazufumi ; Shimoyama, Nobuo ; Honda, Takashi ; Ogata, Yasuhiro ; Ogawa, Hisao ; The Japanese Acute Coronary Syndrome Study (JACSS) Investigators ; 山岸, 正和
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Background There is conflicting information about whether nitrate treatment aggravates long-term prognosis, so the prese
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nt retrospective study was designed to determine the effects of long-term nitrate therapy on major adverse events after acute myocardial infarction (AMI) in the coronary interventional era. Methods and Results Using the Japanese Acute Coronary Syndrome Study database, 1,236 consecutive patients who were hospitalized within 48 h of onset of symptoms of AMI from January to December 2003 were evaluated. All-cause mortality, cardiac events and cardiovascular events were lower in patients treated with nitrates than in the untreated controls. However, these crude comparisons included several confounding factors on nitrate prescription. To minimize the effect of selection bias on outcomes, the technique of propensity score matching for clinical characteristics was used and distortion of effective nitrate treatment was excluded as much as possible. The results of propensity score matching showed that nitrate therapy had no impact on all-cause mortality, cardiac events and cardiovascular events at 30, 60 or 90 days, 6 months, 1 year, and 2 years follow-up. Conclusions Long-term nitrate therapy after AMI neither improves nor aggravates prognosis. Prospective randomized clinical trials are warranted to determine the effects of long-term nitrate therapy for secondary prevention of AMI. (Circ J 2007; 71: 301 - 307)<br />出版者照会後に全文公開
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Kosuge, Masami ; Kimura, Kazuo ; Kojima, Sunao ; Sakamoto, Tomohiro ; Ishihara, Masaharu ; Asada, Yujiro ; Tei, Chuwa ; Miyazaki, Shunichi ; Sonoda, Masahiro ; Tsuchihashi, Kazufumi ; Yamagishi, Masakazu ; Shirai, Mutsunori ; Hiraoka, Hisatoyo ; Honda, Takashi ; Ogata, Yasuhiro ; Ogawa, Hisao ; The Japanese Acute Coronary Syndrome Study (JACSS) Investigators ; 山岸, 正和
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Background The impact of body mass index (BMI) on outcomes after primary percutaneous coronary intervention (PCI) for ac
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ute myocardial infarction (AMI) remains unclear. Methods and Results A total of 3,076 patients undergoing PCI for AMI within 48 h after symptom onset were studied. Patients were divided into 4 groups according to baseline BMI: lean (<20 kg/m2), normal weight (20.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2). Obese patients were younger and had a higher frequency of diabetes mellitus, hyperlipidemia, hypertension and smoking. Lean patients were older, usually women and had a lower frequency of the aforementioned risk factors. Killip class on admission, renal insufficiency, and final Thrombolysis In Myocardial Infarction (TIMI) flow grade did not differ among the 4 groups. In lean, normal weight, overweight and obese patients, in-hospital mortality was 9.2%, 4.4%, 2.5% and 1.8%, respectively (p<0.01). Multivariate analysis showed that compared with normal weight patients, odds ratios for in-hospital death in lean, overweight and obese patients were 1.92, 0.79 and 0.40, respectively (p=NS). Independent predictors were age, Killip class on admission, renal insufficiency and final TIMI flow grade. Conclusion BMI itself had no impact on in-hospital mortality in patients undergoing primary PCI for AMI. The phenomenon `obesity paradox' may be explained by the fact that obese patients were younger at presentation. (Circ J 2008; 72: 521 - 525)<br />出版者照会後に全文公開
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川田, 秀樹
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Matsuo, Shinro ; Nakajima, Kenichi ; Nakata, Tomoaki
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Background:Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can
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vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac 123I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies.Methods and Results:All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome.Conclusions:Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death. (Circ J 2016; 80: 435–441)<br />出版者照会後に全文公開
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Matsuo, Shinro ; Nakajima, Kenichi ; Nakata, Tomoaki ; 松尾, 信郎 ; 中嶋, 憲一
概要:
Background:Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can
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vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac 123I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies.Methods and Results:All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome.Conclusions:Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death. (Circ J 2016; 80: 435–441)
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Matsuo, Shinro ; Nakajima, Kenichi ; Yamasaki, Yoshimitsu ; Kashiwagi, Atsunori ; Nishimura, Tsunehiko
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金沢大学附属病院核医学診療科<br />Background: This study was designed to determine the clinical risk for hard events after normal sing
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le-photon emission computed tomography (SPECT) and to identify the predictors of increased risk in asymptomatic patients with diabetes mellitus, based on a Japanese Assessment of Cardiac Events and Survival Studies by quantitative gated SPECT (J-ACCESS)-2 study. Methods and Results: A total of 513 consecutive asymptomatic patients who underwent stress 99 mTc-tetrofosmin SPECT in Japan were included in this study. Based on SPECT image and QGS data, 319 had a summed stress score ≤3, a summed difference score <2 and normal cardiac function (end-systolic volume ≤60 ml, males, ≤40 ml, females; left ventricular ejection fraction ≥49%, males, ≥50%, females). Myocardial perfusion was normal in 62% of this study population. During a 3-year follow-up, there were a total of 8 cardiac major events (2.5%): 2 cases of sudden death, 5 of acute coronary syndrome, and 1 of hospitalization because of congestive heart failure. The annual major event rate was 0.8%. Subjects undergoing coronary angiography had significantly more major events than those who did not among normal SPECT subjects (P=0.01). Kaplan-Meier analysis showed that the cardiac major events rate was very low, and subjects with normal SPECT can be considered as low risk among asymptomatic patients with diabetes. Conclusions: An excellent prognosis was associated with a normal SPECT in asymptomatic patients with diabetes, so these patients can be exempted from further invasive procedure.
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