研究者詳細 - 大石　充

湯淺敏典, 大石充 . 【厳格な降圧療法の有効性と意義を熟考する】心疾患治療の観点からみた厳格降圧療法 . 血圧25 ( 1 ) 35 - 39 2018年1月

記述言語：日本語出版者・発行元：(株)先端医学社

高血圧症は様々な心臓、あるいは心臓以外の他臓器疾患に合併し、その合併疾患ごとに病態を考慮しながら降圧治療しなければならない。今回は代表的な心疾患、心臓の病態である心不全、虚血性心疾患、弁膜症(大動脈弁疾患)、不整脈(心房細動)における降圧治療、厳格降圧療法に関して、これまでの論文報告、大規模研究の結果報告を交えて解説する。(著者抄録)

湯淺敏典, 大石充 . 【循環器診療　薬のギモン-エキスパートに学ぶ薬物治療のテクニック】高血圧診療でのギモン　拡張期血圧がなかなか下がらない人　どの薬剤を使ったらいいの? . 循環器ジャーナル66 ( 1 ) 62 - 65 2018年1月

記述言語：日本語出版者・発行元：(株)医学書院

赤崎雄一, 大石充 . 【家庭血圧に基づく高血圧管理-近未来の最新高血圧診療へ】高齢者高血圧患者の高血圧治療の実際 . カレントテラピー36 ( 1 ) 52 - 58 2018年1月

Higo Kenjuro, Kubota Kayoko, Miyanaga Sunao, Miyata Masaaki, Nakajo Masatoyo, Jinguji Megumi, Ohishi Mitsuru . 肺動脈高血圧症患者におけるヨード123-メタヨードベンジルグアニジン(123I-MIBG)の取り込み低下(Impairment of Iodine-123-Metaiodobenzylguanidine(123I-MIBG) Uptake in Patients with Pulmonary Artery Hypertension) . International Heart Journal59 ( 1 ) 112 - 119 2018年1月

記述言語：英語出版者・発行元：(一社)インターナショナルハートジャーナル刊行会

肺高血圧症(PH)患者では肺の123-メタヨードベンジルグアニジン(123I-MIBG)取り込みが低下しているとの仮説を立て、PH患者の肺123I-MIBG取り込みを評価し、心エコー検査や右心カテーテル法で得られた各指標と比較検討した。2003年12月～2014年12月に123I-MIBGシンチを施行されたPH患者21例と、性別・年齢を一致させた対照8例を対象とした。心エコー、6分間歩行試験、B型ナトリウム利尿ペプチド測定、肺機能検査、右心カテーテル法を施行した。PH患者を慢性血栓塞栓性肺高血圧症(CTEPH)9例(男性2例、女性7例、平均69.1±7.5歳)と肺動脈高血圧症(PAH)12例(男性3例、女性9例、平均54.1±13.4歳)に分けた。平均肺動脈圧はCTEPH群が37.7±6.8mmHg、PAH群が32.3±5.3mmHgで有意差はなかった。両群間でその他の血行動態パラメーターに有意差はなかった。123I-MIBGの肺取り込みはPAH群ではearly image(EI)1.54±0.18、delayed image(DI) 1.41±0.16で、CTEPH群のEI 2.17±0.25、DI 1.99±0.20、対照群のEI2.32±0.27、DI 1.92±0.19よりも有意に低かった。PAH患者では肺血管内皮機能が低下している可能性が示唆された。

Itakura S, Miyata M, Kuroda A, Setoguchi M, Kusumoto A, Hokonohara D, Ohishi M . The Association of Bite Instability and Comorbidities in Elderly People . Internal Medicine57 ( 11 ) 1569 - 1576 2018年査読

出版者・発行元：一般社団法人日本内科学会

Objective The purpose was to evaluate the association between bite instability and comorbidities, comprehensive geriatric evaluations, or disabilities in elderly people. Methods A dentist examined the oral function, such as the bite stability, number of teeth, and the use of dentures, in 119 patients (93 women, mean age: 86.7±7.8) in 2 nursing homes for the elderly. The association between the oral function and the prevalence of diseases, including hypertension, diabetes mellitus, and dementia, was analyzed. Results The median number of teeth was 0 [0, 4]. The patients were divided into a bite-stable group (n=78, 66%) and bite-unstable group (n=41, 34%). The prevalence of hypertension was significantly higher in the bite-stable group than in the bite-unstable group (83% vs. 63%, respectively; p=0.0149), whereas the prevalence of diabetes mellitus was significantly lower in the bite-stable group than in the bite-unstable group (10% vs. 27%, respectively; p=0.0190). The prevalence of a cognitive function decline was significantly lower in the bite-stable group as well (59% vs. 83%, p=0.0082). According to the simplified comprehensive geriatric assessment 7, the bite-stable group scored significantly higher for instrumental activities of daily living (ADL) than the bite-unstable group (54% vs. 24%, respectively; p=0.0021). A multivariate logistic regression analysis demonstrated that bite instability was independently correlated with hypertension, diabetes mellitus, and instrumental activities of daily living. Conclusion Bite instability was independently associated with a decreased prevalence of hypertension or increased prevalence of diabetes mellitus and low levels of instrumental ADL in the elderly.

DOI： 10.2169/internalmedicine.9830-17

Higo K., Kubota K., Miyanaga S., Miyata M., Nakajo M., Jinguji M., Ohishi M. . Impairment of iodine-123-metaiodobenzylguanidine (123I-MIBG) uptake in patients with pulmonary artery hypertension . International Heart Journal59 ( 1 ) 112 - 119 2018年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人インターナショナル・ハート・ジャーナル刊行会

According to recent studies, lung uptake of iodine-123-metaiodobenzylguanidine (123I-MIBG) is impaired in many lung diseases and low lung uptake of 123I-MIBG suggests endothelial dysfunction of the pulmonary artery. 123I-MIBG scintigraphy in patients with pulmonary hypertension (PH) has not yet been clinically evaluated. We hypothesized that the lung uptake of 123I-MIBG is reduced in patients with PH and differs among PH subtypes. The purpose of the present study was to analyze the lung uptake of 123I-MIBG in patients with PH and compare it with the data obtained by echocardiography or right heart catheterization. 123I-MIBG scintigraphy was performed in 286 consecutive patients from 2003 to 2014. We enrolled 21 patients with PH and 8 control patients. The 21 patients with PH were categorized into those with pulmonary artery hypertension (PAH, n = 12) and those with chronic thromboembolic pulmonary hypertension (CTEPH, n = 9). The mean pulmonary artery pressure was not significantly different between patients with CTEPH and PAH (37.7 ± 6.8 versus 32.3 ± 5.3 mmHg respectively; P = 0.054). There were no significant differences in any other hemodynamic parameters between the two groups. The lung uptake of 123I-MIBG in PAH patients (early image: 1.54 ± 0.18, delayed image: 1.41 ± 0.16) was significantly lower than that of CTEPH patients (early image: 2.17 ± 0.25, P < 0.0001; delayed image: 1.99 ± 0.20, P = 0.0001, adjusted for age and World Health Organization classification) and controls (early image: 2.32 ± 0.27, P = 0.0007; delayed image: 1.92 ± 0.19, P = 0.0007). In conclusion, we found for the first time that the lung uptake of 123I-MIBG in patients with PAH is lower than that in patients with CTEPH and controls.

DOI： 10.1536/ihj.16-629

Tomiyama H., Ohkuma T., Ninomiya T., Mastumoto C., Kario K., Hoshide S., Kita Y., Inoguchi T., Maeda Y., Kohara K., Tabara Y., Nakamura M., Ohkubo T., Watada H., Munakata M., Ohishi M., Ito N., Nakamura M., Shoji T., Vlachopoulos C., Yamashina A. . Simultaneously measured interarm blood pressure difference and stroke: An individual participants data meta-analysis . Hypertension71 ( 6 ) 1030 - 1038 2018年査読国際誌

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Hypertension

We conducted individual participant data meta-analysis to examine the validity of interarm blood pressure difference in simultaneous measurement as a marker to identify subjects with ankle-brachial pressure index <0.90 and to predict future cardiovascular events. We collected individual participant data on 13 317 Japanese subjects from 10 cohorts (general population-based cohorts, cohorts of patients with past history of cardiovascular events, and those with cardiovascular risk factors). Binary logistic regression analysis with adjustments identified interarm blood pressure difference >5 mm Hg as being associated with a significant odds ratio for the presence of ankle-brachial pressure index <0.90 (odds ratio, 2.19; 95% confidence interval, 1.60-3.03; P<0.01). Among 11 726 subjects without a past history of cardiovascular disease, 249 developed stroke during the average follow-up period of 7.4 years. Interarm blood pressure difference >15 mm Hg was associated with a significant Cox stratified adjusted hazard ratio for subsequent stroke (hazard ratio, 2.42; 95% confidence interval, 1.27-4.60; P<0.01). Therefore, interarm blood pressure differences, measured simultaneously in both arms, may be associated with vascular damage in the systemic arterial tree. These differences may be useful for identifying subjects with an ankle-brachial pressure index of <0.90 in the overall study population, and also a reliable predictor of future stroke in subjects without a past history of cardiovascular disease. These findings support the recommendation to measure blood pressure in both arms at the first visit.

DOI： 10.1161/HYPERTENSIONAHA.118.10923

Web of Science

Nakao Y.M., Miyamoto Y., Higashi M., Noguchi T., Ohishi M., Kubota I., Tsutsui H., Kawasaki T., Furukawa Y., Yoshimura M., Morita H., Nishimura K., Kada A., Goto Y., Okamura T., Tei C., Tomoike H., Naito H., Yasuda S. . Sex differences in impact of coronary artery calcification to predict coronary artery disease . Heart104 ( 13 ) 1118 - 1124 2018年

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Heart

Objective to assess sex-specific differences regarding use of conventional risks and coronary artery calcification (cac) to detect coronary artery disease (caD) using coronary ct angiography (ccta). Methods the nationwide gender-specific atherosclerosis Determinants estimation and ischemic cardiovascular Disease Prospective cohort study is a prospective, multicentre, nationwide cohort study. candidates with suspected caD aged 50–74 years enrolled from 2008 to 2012. the outcome was obstructive caD defined as any stenosis ≥50% by ccta. We constructed logistic regression models for obstructive caD adjusted for conventional risks (clinical model) and cac score. improvement in discrimination beyond risks was assessed by c-statistic; net reclassification index (nri) for caD probability of low (<30%), intermediate (30%–60%) and high (≥60%); and risk stratification capacity. results among 991 patients (456 women, 535 men; 65.2 vs 64.4 years old), women had lower cac scores (median, 4 vs 60) and lower caD prevalence (21.7% vs 37.0%) than men. cac significantly improved model discrimination compared with clinical model in both sexes (0.66–0.79 in women vs 0.61–0.83 in men). the nri for women was 0.33, which was much lower than that for men (0.71). adding cac to clinical model had a larger benefit in terms of moving an additional 43.3% of men to the most determinant categories (high or low risk) compared with −1.4% of women. Conclusions the addition of cac to a prediction model based on conventional variables significantly improved the classification of risk in suspected patients with caD, with sex differences influencing the predictive ability.

DOI： 10.1136/heartjnl-2017-312151

Ikeda Y., Sasaki T., Kuwahata S., Imamura M., Tanoue K., Komaki S., Hashiguchi M., Kuroda A., Akasaki Y., Hamada C., Ohishi M. . Questionnaire survey from the viewpoint of concordance in patient and physician satisfaction concerning hypertensive treatment in elderly patients: ― Patients voice study ― . Circulation Journal82 ( 4 ) 1051 - 1061 2018年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本循環器学会

Background: Patient-physician concordance is an important concern in the treatment of elderly patients with hypertension (HT). Treatment that considers concordance is necessary for mutual understanding and therapeutic satisfaction between patients and physicians. However, there have been no studies addressing concordance that objectively analyzed both patient and physician satisfaction before and after treatment. Methods and Results: An exploratory open-label, multicenter, intervention study was conducted. Patients with HT undergoing treatment with angiotensin-receptor blocker (ARB) or a calcium-channel blocker (CCB) monotherapy were enrolled. Medication was switched to an ARB/CCB combination tablet and taken for 12 weeks. Physicians and patients participated in satisfaction surveys concerning treatment. Discrepancies in satisfaction levels between patients and physicians were found at baseline for the following survey items: treatment, involvement in treatment, understanding of HT, reliance, medication, and blood pressure. After treatment, the satisfaction levels of both patients and physicians increased; discrepancies in satisfaction between the groups also improved. Conclusions: The rates of satisfaction were relatively higher for patients compared with physicians at baseline. After HT treatment addressing concordance, both patient and physician satisfaction rates and the gap in satisfaction rates between patients and physicians improved. This indicates that addressing concordance has clinical significance in the treatment of elderly HT patients. (UMIN000017270)

DOI： 10.1253/circj.cj-17-1015

Tokushige A., Miyata M., Sonoda T., Kosedo I., Kanda D., Takumi T., Kumagae Y., Fukukura Y., Ohishi M. . Prediction of Stroke After Cardiac Catheterization: No Reason, No Stroke . Ｊｏｕｒｎａｌ　ｏｆ　Ａｔｈｅｒｏｓｃｌｅｒｏｓｉｓ　ａｎｄ　Ｔｈｒｏｍｂｏｓｉｓ25 ( 3 ) 224 - 232 2018年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本動脈硬化学会

Previous studies have reported a 10.2%-22% rate of silent cerebral infarction and a 0.1% -1% rate of symptomatic cerebral infarction after coronary angiography (CAG). However, the risk factors of cerebral infarction after CAG have not been fully elucidated. For this reason, we investigated the incidence and risk factors of CVD complications within 48 h after CAG using magnetic resonance imaging (MRI) (Diffusion-weighted MRI) at Kagoshima University Hospital. Methods: From September 2013 to April 2015, we examined the incidence and risk factors, including procedural data and patients characteristics, of cerebrovascular disease after CAG in consecutive 61 patients who underwent CAG and MRI in our hospital. Results: Silent cerebral infarction after CAG was observed in 6 cases (9.8%), and they should not show any neurological symptoms of cerebral infarction. Only prior coronary artery bypass grafting (CABG) was more frequently found in the stroke group (n = 6) than that in the non-stroke group (n = 55); however, no significant difference was observed (P = 0.07). After adjusting for confounders, prior CABG was a significant independent risk factor for the incidence of stroke after CAG (odds ratio: 11.7, 95% confidence interval: 1.14-129.8, P = 0.04). Conclusions: We suggested that the incidence of cerebral infarction after CAG was not related to the catheterization procedure per se but may be caused by atherosclerosis with CABG.

DOI： 10.5551/jat.41012

Yuasa T., Takenaka T., Higuchi K., Uchiyama N., Horizoe Y., Cyaen H., Mizukami N., Takasaki K., Kisanuki A., Miyata M., Ohishi M. . Fabry disease . Journal of Echocardiography15 ( 4 ) 151 - 157 2017年12月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Echocardiography

Fabry disease resulting from a deficiency of α-galactosidase A leads to the accumulation of globotriaosylceramide in various organs. Because the disease is an X-linked recessive disorder, males tend to develop more symptoms and more severe symptoms than females. There are also some variants of Fabry disease, and cardiac variant (cardiac Fabry disease) has the dysfunctions only in heart. Cardiac manifestations in Fabry disease are initially symmetrical and concentric left ventricular hypertrophy, and later progressive cardiac dysfunction with localized thinning of the basal posterior wall. In recent years, enzyme replacement therapy has been performed as a treatment for Fabry disease, and the initiation of this therapy is expected before the cardiac fibrosis develops. Therefore, early diagnosis of Fabry disease is essential, and echocardiography is an indispensable tool for clinical practice of this disease. Then, it is necessary to remember this disease as a differential diagnosis when encountering unexplained left ventricular hypertrophy.

DOI： 10.1007/s12574-017-0340-x