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1.
ESC Heart Fail ; 4(4): 409-416, 2017 11.
Article in English | MEDLINE | ID: mdl-29154420

ABSTRACT

AIMS: This study aimed to investigate the relationship between skeletal muscle mass and cardiac functional parameters in older adults during cardiopulmonary exercise testing (CPET). METHODS AND RESULTS: Sixty-three Japanese community-dwelling older adults were enrolled (20 men and 43 women; mean age 80 years, range 65-97 years). Cardiac functional parameters during exercise were assessed using CPET. Skeletal muscle mass index (SMI) was calculated by dividing the appendicular lean mass (measured using dual-energy X-ray absorptiometry) by height in metres squared. Subjects were divided into two groups: men with SMI ≥ 7.0 kg/m2 and women with SMI ≥ 5.4 kg/m2 (non-sarcopenic group); or men with SMI < 7.0 kg/m2 and women with SMI < 5.4 kg/m2 (sarcopenic group). There were significant positive correlations between SMI and peak oxygen uptake (VO2 ) (r = 0.631, P < 0.001), and between SMI and peak VO2 /heart rate (HR) (r = 0.683, P < 0.001). However, only peak VO2 /HR significantly differed between groups in both sexes. Multiple linear regression analyses with peak VO2 /HR as a dependent variable showed that SMI was the only independent determinant after adjusting for potential confounders. After 4 month follow-up of 47 participants, there was still a significant positive correlation between SMI and peak VO2 /HR (r = 0.567, P < 0.001), and between percent change of SMI and percent change of peak VO2 /HR (r = 0.305, P < 0.05). CONCLUSIONS: Peak VO2 /HR, an index of stroke volume at peak exercise, was associated with SMI. This indicates that skeletal muscle mass might affect cardiac function during exercise.


Subject(s)
Cardiovascular Diseases/physiopathology , Exercise/physiology , Independent Living , Muscle, Skeletal/physiopathology , Sarcopenia/physiopathology , Absorptiometry, Photon , Aged , Aged, 80 and over , Ankle Brachial Index , Body Mass Index , Cardiovascular Diseases/complications , Cardiovascular Diseases/mortality , Exercise Test , Female , Humans , Japan/epidemiology , Male , Morbidity/trends , Muscle, Skeletal/diagnostic imaging , Sarcopenia/complications , Sarcopenia/epidemiology , Survival Rate/trends
2.
Geriatr Gerontol Int ; 17(10): 1636-1641, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28124816

ABSTRACT

AIM: To examine the relationship between lower limb muscle (femoral muscle, calf muscle) mass and exercise capacity, and frailty components in community-dwelling older people. METHODS: Participants included 121 community-dwelling individuals. There were 42 men and 79 women, and the mean age was 77.7 years (range 56-97 years). Appendicular skeletal muscle mass was determined using dual-energy X-ray absorptiometry, and the skeletal muscle index was calculated using the following formula: appendicular skeletal muscle / body height2 . Femoral muscle mass and calf muscle mass were determined, respectively, by dividing the femoral bone and tibial bone at the knee joint space. A symptom-limited cardiopulmonary exercise testing was carried out and peak oxygen uptake was measured. Functional exercise performance was evaluated using the handgrip strength measurement, comfortable walking speed, and the Timed Up and Go test. All patients gave written, informed consent before data collection. RESULTS: Peak oxygen uptake correlated positively with the skeletal muscle index (r = 0.491). Only femoral muscle mass that was corrected with the whole body muscle mass was positively correlated with peak oxygen uptake (r = 0.473), handgrip strength (r = 0.382), comfortable walking speed (r = 0.427), and the Timed Up and Go test (r = 0.379). Calf muscle mass that was corrected with the whole-body muscle mass showed no correlation with exercise capacity and frailty components. A similar tendency was observed in both men and women. CONCLUSIONS: Femoral muscle mass influenced exercise capacity and physical frail components compared with calf muscle mass. These results suggest the importance of the femoral muscle in physical frailty. Geriatr Gerontol Int 2017; 17: 1636-1641.


Subject(s)
Frailty/diagnosis , Sarcopenia/diagnosis , Absorptiometry, Photon , Aged , Aged, 80 and over , Exercise Tolerance , Female , Geriatric Assessment , Hand Strength , Humans , Independent Living , Leg , Male , Middle Aged , Muscle Strength , Muscle, Skeletal
3.
J Heart Lung Transplant ; 33(6): 599-608, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24746637

ABSTRACT

BACKGROUND: The EVAHEART left ventricular assist device was approved in 2010 by the Japanese Pharmaceuticals and Medical Devices Agency (PMDA) for bridge to heart transplantation (BTT). However, its effectiveness has not been evaluated since approval. In this study we evaluated the EVAHEART device in a commercial setting in Japan. METHODS: Ninety-six consecutive patients enrolled in the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS), who were listed for transplant or likely to be listed and who received an EVAHEART device, were enrolled from 2011 to 2013 at 14 Japanese centers. Patients' survival rates, adverse events and quality-of-life data were obtained from the J-MACS Registry. RESULTS: Patients' median age was 43 years (85% male). The Interagency Registry for Mechanically Assisted Circulatory Support profiles revealed 12 patients in Level 1, 45 in Level 2, 37 in Level 3 and 1 in Level 4. The mean support duration was 384.7 days, with a cumulative duration of 101.2 years. The Kaplan-Meier survival rate during support was 93.4% at 6 months, 87.4% at 1 year and 87.4% at 2 years. Seventy-seven patients (80.2%) currently remain on support, 7 received a transplant and 10 died during support. Major adverse events included drive-line infection (14.6%) and neurologic events such as ischemic stroke (17.7%), hemorrhage (13.5%), transient ischemic attack (3.1%), pump thrombosis (1%) and hemolysis (1%). There was no gastrointestinal (GI) bleeding or right heart failure requiring right ventricular assist device (RVAD). There was no pump exchange due to mechanical failure. CONCLUSIONS: The EVAHEART device provides safe, reliable and long-term circulatory support with improved survival in commercial settings of BTT in Japan, where the transplant waiting period is much longer. Incidences of GI bleeding, hemolysis, right ventricular failure, device thrombosis and mechanical failure were extremely rare in patients on EVAHEART devices.


Subject(s)
Heart Failure/therapy , Heart-Assist Devices/adverse effects , Registries , Adult , Cohort Studies , Equipment Design , Female , Heart Failure/mortality , Heart Failure/physiopathology , Heart Transplantation , Heart-Assist Devices/statistics & numerical data , Humans , Japan , Male , Middle Aged , Product Surveillance, Postmarketing , Quality of Life , Survival Analysis
4.
Minim Invasive Ther Allied Technol ; 22(6): 372-80, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23992385

ABSTRACT

INTRODUCTION: Cardiac electrophysiology aims to describe and treat the electrical activity of the heart. Although an epicardial approach is valuable in many surgical treatments such as coronary artery bypass grafting, maze ablation, and cell transplantation, very few techniques suited for minimally invasive surgery are available for measurement of epicardial electrophysiology. MATERIAL AND METHODS: We developed a novel endoscopically-deployable expanding electrode array that can be applied for minimally invasive surgery. Our device consists of a flexible electrode array attached to arms which open and close the electrode sheet. Furthermore, we also developed a computer program to overlay an epicardial electrophysiological map on an endoscopic image. We performed both laboratory and in vivo experiments to examine the feasibility in clinical situations. RESULTS: Evaluation experiments demonstrated that our novel mapping process that assumes spherical deformation of the electrode array enables us to overlay each electrode position with an accuracy of < 1 mm. Results of animal experiments using large animals (one dog and two pigs) demonstrated that our system enables construction of epicardial electrophysiological maps. CONCLUSION: A novel endoscopically deployable expanding electrode array was developed. Evaluation experiments demonstrated that our device can be manipulated in simulated minimally invasive surgery, and enables construction of epicardial electrophysiological maps.


Subject(s)
Electrophysiologic Techniques, Cardiac/methods , Endoscopy/methods , Epicardial Mapping/methods , Minimally Invasive Surgical Procedures/methods , Animals , Cardiac Surgical Procedures/methods , Dogs , Electrodes , Feasibility Studies , Pericardium/physiology , Swine
5.
Nihon Rinsho ; 68(12): 2347-50, 2010 Dec.
Article in Japanese | MEDLINE | ID: mdl-21174703

ABSTRACT

We arranged the main problem and the background factor of the transplantation from a viewpoint of health economics. As a result, we guessed that the people's recognition to public value of the transplantation system was low. And it was one of the fundamental factors to disturb the transplantation. In addition, we researched the explanation method and the case report about a health economics value of transplantation. According to the review, health economics value of transplantation should be accounted by cost-effectiveness (performance). Our country have to promote positively the transplantation, because the cost-effectiveness (USA$/QALY and USA$/DALY) of the transplantation is high.


Subject(s)
Economics, Medical , Organ Transplantation/economics , Cost-Benefit Analysis , Humans
6.
J Cardiol ; 47(2): 91-4, 2006 Feb.
Article in Japanese | MEDLINE | ID: mdl-16515359

ABSTRACT

A 28-year-old female developed infective endocarditis in the tricuspid valve and multiple lung abscesses due to septic pulmonary emboli early after intensive therapy for ulcerative colitis. The pathogen was methicillin-resistant Staphylococcus aureus. Usual antibiotic agents and linezolid were administered. Three weeks later, she fell into cardiopulmonary arrest due to further pulmonary emboli and required mechanical circulatory assist. Fatal brain damage was suggested at first. Two days later, she fully regained consciousness and underwent tricuspid valve replacement using mechanical valve and extirpation of septic pulmonary embolus. Mechanical circulatory assist was discontinued on the next day. After strenuous administration of linezolid and other drugs for 9 weeks, she was discharged from hospital on foot. We believe that early surgical intervention should be considered in patients with infective endocarditis in the right heart and subsequent septic pulmonary emboli. Linezolid was very useful in this patient.


Subject(s)
Endocarditis, Bacterial/complications , Heart Arrest/etiology , Heart Arrest/therapy , Lung Abscess/complications , Pulmonary Embolism/complications , Salvage Therapy , Staphylococcal Infections/complications , Tricuspid Valve , Acetamides/therapeutic use , Adult , Anti-Infective Agents/therapeutic use , Extracorporeal Circulation , Female , Heart Valve Prosthesis , Humans , Linezolid , Lung Abscess/etiology , Methicillin Resistance , Oxazolidinones/therapeutic use
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