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Goto, Yoshikazu ; Funada, Akira ; Goto, Yumiko ; 後藤, 由和 ; 舟田, 晃
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金沢大学医薬保健研究域医学系<br />Embargo Periods 12 Months
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Funada, Akira ; Konno, Tetsuo ; Fujino, Noboru ; Muramoto, Akihiko ; Hayashi, Kenshi ; Tsubokawa, Toshinari ; Sakata, Kenji ; Kawashiri, Masa-aki ; Takeda, Yoshiyu ; Ino, Hidekazu ; Yamagishi, Masakazu ; 舟田, 晃 ; 今野, 哲雄 ; 藤野, 陽 ; 林, 研至 ; 坂田, 憲治 ; 川尻, 剛照 ; 武田, 仁勇 ; 井野, 秀一 ; 山岸, 正和
概要:
金沢大学医薬保健研究域医学系<br />Background: Although the renin - angiotensin system (RAS) can affect the development of left ventric
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ular (LV) hypertrophy, few data exist regarding the relationships between RAS polymorphisms and alteration of LV function. The effect of RAS polymorphisms on LV function in genotyped hypertrophic cardiomyopathy (HCM) was examined in the present study. Methods and Results: The study group comprised 126 carriers with sarcomere gene mutations from 49 HCM families (64 males, mean age 51±21 years). LV morphology and function were evaluated by echocardiography. In angiotensin-converting enzyme (ACE) insertion/deletion (I/D), the D allele (n=81) exhibited significantly larger LV end-systolic dimension (LVDs) (32±11 mm) and lower ejection fraction (56±15%) than those with the II genotype (28±7 mm and 62±12%, respectively, P<0.05; n=45). Although angiotensin II type 1 receptor (AT1-R) A/C1166 polymorphism did not affect echocardiographic parameters, the presence of the ACE D allele with the AT1-R C1166 allele (n=9) was associated with larger LVDs (37±17 mm) and lower ejection fraction (48±20%) compared with other genotypes (30±9 mm and 58±14%, respectively, P<0.05; n=117). Under these conditions, severe LV hypertrophy was frequently associated with LV wall thinning. Conclusions: The presence of both the ACE D and AT1-R C1166 allele is associated with LV dilation with systolic dysfunction in genotyped HCM. In addition to the severity of LV hypertrophy, screening for these RAS polymorphisms could contribute to further risk stratification of patients with HCM, although other genetic polymorphisms should be further examined.<br />出版者照会後に全文公開
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三澤, 克史 ; 大里, 和雄 ; 村上, 達明 ; 守内, 郁夫 ; 嶋田, 佳文 ; 小門, 宏全 ; 石田, 健太郎 ; 舟田, 晃 ; 水野, 清雄
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パネルディスカッション
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舟田, 晃 ; Funada, Akira
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消防庁の院外心停止全国前向き全例登録を用いて、高齢院外心停止の神経学的転帰を検討した。65-74、75-89歳の神経学的転帰良好の割合は年々改善傾向にあったが、90歳以上では改善を認めなかった。神経学的転帰良好に関連のある因子として、初期波
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形種別、目撃の有無、年齢を同定し、『院外心停止後神経学的転帰良好予測率層別化モデル』を作成した。初期波形が除細動非適応波形で目撃がない場合には、1ヶ月後の神経学的転帰良好は1%未満と予測され、特に高齢者において蘇生処置の差し控えを検討する根拠となると考えられた。一方で、神経学的転帰良好の割合は年々改善しており、適宜、モデルのアップデートが必要と考えられた。<br />Using Japanese nationwide out-of-hospital cardiac arrest (OHCA) registry, we analyzed the rate and trend of neurologically intact survival in elderly patients with OHCA. The rate of neurologically intact survival significantly improved in patients aged 65-74 and 75-89 years. However, in patients aged 90 years or over, no improvement was observed. We developed a prediction chart using variables significantly associated with increased chances of neurologically intact survival, such as initial documented rhythm, witnessed status, and age, to estimate the neurologically intact survival rate after OHCA. The estimated neurologically intact survival rate in patients with unwitnessed OHCA with a non-shockable rhythm was <1% in all age groups. Particularly, in elderly patients with OHCA, this information can help in deciding whether to withhold or terminate resuscitation efforts. However, as the neurologically intact survival rate has improved annually, the prediction chart needs to be updated.<br />研究課題/領域番号:16K19171, 研究期間(年度):2016-04-01 - 2019-03-31<br />出典：「高齢院外心肺停止傷病者における心肺蘇生および予後に関する研究」研究成果報告書 課題番号16K19171（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （https://kaken.nii.ac.jp/report/KAKENHI-PROJECT-16K19171/16K19171seika/）を加工して作成
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