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健常成人 (NL) 20名および冠動脈疾患 (CAD) 患者52名を対象とした。多段階臥位自転車ergometer運動 (MBEX) に対するR波高変化を解析し, CADの診断あるいは重症度判定におけるその有用性について検討した。NL群とCAD群においてR波高は運動につれて減少し, 最大運動時に最も小さくなった。R波増高または不変を陽性とするBonorisらのR波高診断基準を用いたCAD診断の感度は21%であるが, ST基準による感度は65%であり, R波高基準はST基準に比し有意に低感度であった (p

Retinal artery embolism that had arisen as a complication of a left atrial myxoma was diagnosed in a young man who had suddenly developed a visual disorder in his left eye. A tumor in the left atrium was surgically excised. Pathologically, retinal embolism secondary to atrial myxoma is rare. To our knowledge, only 15 cases have been documented so far. The present case was only the second case of an isolated retinal embolism that had developed without systemic involvement, and the first case of retinal artery branch embolism that had resulted from a left atrial myxoma.

To investigate hemodynamic effects of a new coronary vasodilator, 2-nicotinami doethyl nitrate (nicorandil), 12 patients with prior myocardial infarction were stu died. Patients with angina pectoris were excluded.Hemodynamic measurements were made during supine bicycle ergometer exercise testings before and 60 min after single oral administration of 15 mg of nicorandil. Symptom-limited exercise testing was performed before nicorandil, and after nicoran dil the same workload was assigned to each patient. At peak exercise, there was a significant increase in cardiac index, while stroke volume index remained unchanged after nicorandil. Both at rest and at peak exercise, there was a significant decrease in systolic and diastolic blood pressure, systemic vascular resistance, and pulmonary capillary wedge pressure after nicorandil. Coronary sinus blood flow was significant ly increased and coronary vascular resistance was significantly decreased after nicor andil both at rest and peak exercise. The average value for plasma nicorandil concen tration was 215ng/ml 60min after dosing.These data would indicate that nicorandil exhibits a beneficial effect on hemodyna mic responses to exercise in patients with prior mycoardial infarction by reduction of left ventricular preload and afterload and by increment in coronary blood flow.

To investigate the hemodynamic effects of isosorbide-5-mononitrate (ISMN), 11 patients with effort angina pectoris were studied.Hemodynamic and echocardiographic measurements were observed at rest and during angina-limited supine multi-stage bicycle ergometer exercise testings before and 120 min after oral administration of 20 mg of ISMN. Compared with the control exercise test, the mean ST-segment at peak exercise showed less depression after ISMN (P

A multicenter, double-blind study was performed in 46 patients with stable effort angina pectoris on maintenance doses of long-acting nitrate in order to evaluate the effect of levocarnitine chloride (LC-80) tablets, containing 200 mg of levocarnitine chloride, on exercise tolerance. Multistage treadmill exercise testing was performed according to the modified Bruce protocol at the pre-treatment period and after 4 and 8 wk of oral daily doses of 1800 mg of LC-80 or placebo therapy.In the pre-treatment period, there were no significant differences in treadmill exercise duration, time to the onset of angina, pressure-rate product (PRP), and ST deviation between the placebo and LC-80 groups.The time to the onset of angina was significantly longer after 4 (P

心予備能の非観血的評価法の妥当性を,観血的評価法と対比し検討した.冠動脈疾患患者55例,健常人8例を対象として多段階臥位自転老エルゴメータ運動試験を施行し,肺動脈楔入圧(PCWP),心係数(CI),心エコー図による左房径(LAD)を経時的に測定した.各計測値は運動極期と安静時の値の差(δ)として示した.観血的心予備能分類としてδPCWP=8mmHg,δCI=2.5l/min/m2を臨界値として対象を4群に分類した.δPCWPとδLAD3の間にはr=0.74 (p

Hemodynamic effects of isosorbide-5-mononitrate (ISMN) were studied in 14 patients with effort angina pectoris. Hemodynamic and echocardiographic data were obtained by angina-limited supine multistage bicycle ergometer exercise testing before and 120 minutes after single oral administration of 20 mg of ISMN. Compared with control exercise testing, the ST segment at peak exercise showed less depression after administration of ISMN (p less than 0.001). At rest, systolic and diastolic blood pressure decreased significantly after administration of ISMN (p less than 0.001 and p less than 0.01, respectively). At rest and at peak exercise, pulmonary artery wedge pressure (both p less than 0.001), left atrial volume (both p less than 0.001) and left ventricular end-diastolic volume (both p less than 0.05) decreased, whereas cardiac index, pressure-rate product and systemic vascular resistance did not change significantly after administration of ISMN. Average time to peak plasma ISMN concentration was 90 minutes and average peak plasma concentration was 460 ng/ml with an elimination half-life of 7 hours. These data suggest that the main mechanism of the antianginal action of ISMN is a reduction in left ventricular preload followed by diminution of myocardial oxygen requirements.

心房細動 (AF) および期外収縮は加齢とともに有意に増加する. 過去10年間, 人間ドック検査を受けた約24万人の12誘導心電図の検討ではAF頻度は70歳以上の高齢者においては (男性2.5%, 女性0.3%) 若年者に比し有意に高かった. 老年科診療においてはAFはより高頻度にみられ, その治療は日常診療で大きな比重を占める. 高齢AF患者の3大基礎疾患は弁膜症, 高血圧性および虚血性心疾患であり, 10%は孤立性AFであった.AFでは統一ある心房収縮はなく, 心室充満および1回拍出量は主に急速充満に依存し, 後者はRR間隔および流入抵抗により規定される. Pulse Doppler 法による研究では個々の患者では左室流入量および直続心拍の1回拍出量はRR間隔のみに依存するように思われ, RR間隔が個々の患者に固有の閾値より長い場合にはほぼ一定の値を示したが, R-R間隔が閾値以下となればその短縮に伴って直線的に減少した. R-R間隔閾値は左室流入抵抗に依存し, 僧帽弁狭窄症, 左室 compliance 低下症例では延長する. Pulse Doppler 法による検討では健常男性でも左室 compliance は加齢とともに低下することが示され, AFは, 有意な心疾患のない場合でも高齢者により大きな心血行力学的負担を課すると考えられる.発作性AF患者の treadmill 試験ではAFは洞調律に比し著しく強い心拍数反応を示し, この過剰心拍数反応がAFでみられた運動時間短縮の原因と考えられた. Digitalis は運動に対する心拍数過剰反応を軽減し, 運動耐容能を有意に改善したが, 多くのAF患者で運動時心拍数はなお過多と思われた. Digitalis 維持投与下のAF患者に verapamil 80mgまたは diltiazem 60～90mgを1回経口投与後には運動時心拍数はさらに抑制され treadmill 運動時間は有意に延長した. しかしβ遮断薬は心拍数の高度抑制にもかかわらず有意な運動耐容能の改善を示めさなかった. Digitalis とこれらのCa拮抗薬との併用はAFの運動時心拍数コントロールに有効な治療と考えられた.頭部CT検査を受けた急性脳血管障害患者432名の検討ではAFの頻度は, 脳出血に比し脳梗塞では有意に高かった (18.8% vs 2%). 脳血管写を受けた急性脳血管障害患者72名では, AF頻度は脳出血患者37名で2.7%, 脳血栓患者29名で20.7%, 脳塞栓患者5名で80%であり, 前2者に比し後者では有意に高かった. 脳血管写で確認した脳塞栓患者102名では73名がAFを示し, うち23名は孤立性AFであった. これらの所見は, 脳梗塞がAFの存在と密接に関連していることを示し, 孤立性AFも塞栓症の原因となりうることを示唆する. 脳塞栓の危険性の高い患者の同定およびその防止はAF患者の管理における緊急課題である.

Polysomnography was carried out in 11 adult outpatients with stable chronic heart failure (CHF) due to valvular heart disease in order to investigate respiratory abnormalities during sleep. The subjects consisted of 6 males and 5 females and their ages ranged from 54 to 76 years. A coexisting central dominant sleep apnea syndrome (SAS) was found in 4 males, 3 of whom had evidence of nasal obstruction. A successful mitral valve replacement in one patient with central dominant SAS was associated with a reduction in the frequency of sleep apnea. The results suggest complications caused by respiratory abnormalities during sleep are common and should be considered in the management of patients with CHF.