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Biomedical subjects

J Sanada

Publications and source records attributed to J Sanada.

13 recordsLinked to original sources
PubMed1992

Changes in serum lipoprotein(a) and C4b-binding protein levels after acute myocardial infarction.

We investigated changes in serum lipoprotein(a) (Lp(a)) and C4b-binding protein (C4bp) levels following acute myocardial infarction (AMI). Serum lipids, apolipoproteins, C-reactive protein (CRP), sialic acid and haptoglobin (Hp) were also measured and evaluated. The study involved 16 patients (11 men, 5 women, mean age 68.2 +/- 8.4 years) with AMI admitted within 12 h after the onset of illness. CRP rose sharply and immediately after the onset of AMI, reaching its maximum level on the 3rd day of illness. This was followed by temporary increases in sialic acid and Hp, both of which peaked on the 7th day of illness. The Apo A-I level was significantly lower on the 14th day, while the Apo B level was significantly lower on the 3rd day. Serum total cholesterol (T-Ch), HDL-Ch and LDL-Ch showed temporary decreases after the onset of illness. Serial examination of the serum of patients with AMI yielded the following findings; 1) Both Lp(a) and C4bp levels rose temporarily with similar patterns of variation, and 2) they took longer time to peak (around the 14th day) and lasted longer than the increases in the other acute reactive proteins.

Aged↗
PubMed1992

Risk factors in normolipidemic male patients with coronary artery disease in Japanese.

We examined serum lipids, lipoproteins, apolipoproteins (Apo), lipoprotein(a) (Lp(a)), C4b-binding protein (C4bp) and lathosterol in 22 normolipidemic (serum total cholesterol less than 220 mg/dl and serum triglycerides less than 150 mg/dl) male patients with coronary artery disease (CAD) and 33 normal male subjects. Many of the patients in the CAD group with normal total cholesterol (T-Ch) and triglycerides (TG) had higher TG, low-density lipoprotein (LDL)-Ch, beta-lipoprotein (Lipo) and Apo B values and lower high-density lipoprotein (HDL)-Ch, Apo A-I and Apo A-II values than those of the control group. Differences were also observed in the beta-Lipo/HDL-Ch, Apo B/Apo A-I, and HDL-Ch ratios and the atherogenic index [A.I. = (T-Ch--HDL-Ch)/HDL-Ch], all of which are generally accepted as indices for atherosclerosis. Even in CAD patients with normolipidemia, the HDL-Ch/T-Ch ratio and A.I. seemed to be important risk factors. In addition, Lp(a) and lathosterol, an accepted indicator of whole-body cholesterol synthesis, were higher in the CAD group. The CAD group also appeared to have a higher C4bp value, suggesting that this parameter is correlated with other lipids.

Carrier Proteins↗
PubMed1992

[Left ventricular volume decrease during isovolumic relaxation period in gated blood pool scintigraphy: observations in patients with old myocardial infarction].

We studied left ventricular (LV) volume decrease, namely, the downward displacement of the LV volume curve, during the isovolumic relaxation period on the time-activity curves obtained from gated blood pool scintigraphy in patients with old myocardial infarction (OMI). To evaluate the mechanism and clinical significance of this phenomenon, 113 consecutive patients with OMI undergoing gated blood pool scintigraphy, left ventriculography, and Doppler echocardiography were studied. 1. This phenomenon was observed only in patients with anterior OMI (13 of 51 patients: 25%). Presence (Group I) or absence (Group II) of this phenomenon was examined. 2. On left ventriculography, dyskinetic or aneurysmal wall motion was observed in the anterior or apical region more frequently in Group I (11 of 13 patients: 85%) than in Group II (20 of 51 patients: 39%) (p < 0.001). 3. Doppler echocardiography showed that the presence of abnormal LV reversed flow over 20 cm/sec from the apex to the base during the isovolumic relaxation period is more frequent in Group I (7 of 13: 54%) than in Group II (4 of 51: 8%) (p < 0.001). These results suggested that this blood shift in the left ventricle is attributed to asynchronous LV relaxation occurring simultaneously with LV volume decrease on gated blood pool scintigraphy. In conclusion, this phenomenon suggests the presence of asynchronous LV relaxation.

Echocardiography, Doppler↗
PubMed1989

[Left ventricular blood flow dynamics caused by ventricular premature contraction: pulsed Doppler echocardiographic study].

Cardiac function at the time of ventricular premature contractions (VPC) is influenced by the coupling interval or the site of those origin. Clinical and experimental studies of the effects of VPC on intracardiac pressure dynamics have been performed; however, little is known about left ventricular blood flow dynamics. This study was attempted to determine the characteristics of blood flow dynamics in respect to the site of origin of VPC using pulsed Doppler echocardiography. The subjects consisted of 18 cases with VPC but without apparent organic heart disease. Seven cases had VPCs with a left bundle branch block pattern suggesting possible origin in the right ventricle. The other 11 cases had VPCs with a right bundle branch block pattern indicating the left ventricular origin. With the probe in the apical position, the blood flow patterns of the left ventricular outflow, central and inflow tracts were examined. The results were as follows; 1. Except for one case with shortened coupling interval, all six cases with VPCs originated from the right ventricle showed preservation of left ventricular ejection flow. 2. In two of the three cases with VPC which originated from the left ventricle and with left axis deviation, systolic flow in the left ventricular central area showed "back flow" to the apex. Ejection flow at the outflow tract was markedly diminished or disappeared in all three cases. 3. In all eight cases with VPC which originated from the left ventricle and with right axis deviation, ejection flow was slightly disturbed both in the left ventricular outflow and in the central area. 4. Ejection flow volume assessed by velocity integral indicated similar dynamics as did the ejection flow velocity. 5. In left ventriculography, asynchrony due to dyskinetic motion of the anteroapical wall was observed at the times of VPCs with left axis deviation. In conclusion, the patterns of left ventricular ejection flow dynamics depend on the site of origin of VPCs. This disturbed flow is more apparent in VPCs originating from the left ventricle compared to the right ventricle. This is especially true in cases with left axis deviation, in which VPCs arise from the posterior site of the left ventricle.

Adolescent↗
PubMed1988

[Mechanism of production of pulse deficit in atrial fibrillation: assessment by blood flow dynamics].

Pulse deficit in patients with atrial fibrillation is caused by the reduction of preload. The purpose of this study was to visualize the mechanism in view of blood flow dynamics using pulsed Doppler echocardiography. The subjects were 15 cases with atrial fibrillation and pulse deficit, and the results were as follows: 1. Simultaneous recordings of the carotid pulse wave (CPW) and blood flow at the left ventricular inflow tract indicated that, in nine of the total 15 cases, CPW disappeared from the cardiac cycle even with sufficient preceding RF in the other six cases (Group B). 2. In Group A, %RF correlated well with %CPW; however, there was poor correlation between them in Group B. Moreover, CPW was always greater than 26% if RF was greater than 50% of each mean value in Group A, but less than 25% in Group B, suggesting poor left ventricular ejection in the latter group. 3. The left ventricular ejection fraction (EF) and %fractional shortening (%FS) decreased significantly in Group B compared to those in Group A (EF; 59 +- 7 vs 41 +- 12%, p less than 0.01, %FS; 31 +- 5 vs 20 +- 6, p less than 0.01). These findings indicate that left ventricular contractility was significantly reduced in the cases with pulse deficit in Group B. 4. Systolic backward flow in the mid-ventricle caused by left ventricular asynchrony due to localized apical wall motion abnormalities was observed in all 15 cases. The heart rate during pulsed Doppler echocardiography was significantly increased in Group A as compared to that in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1987

Late diastolic mitral regurgitation studied by pulsed Doppler echocardiography.

To evaluate the usefulness of pulsed Doppler echocardiography in assessing late diastolic mitral regurgitation (MR) and to clarify the pathophysiology of MR, 226 consecutive patients who had undergone left ventriculography were studied. By investigating blood flow patterns at the left atrial outflow tract, late diastolic disturbed flow suggesting MR was detected in 15 patients (7%), including 10 (4%) with positive left ventriculographic findings. Among these 15 patients, 14 (93%) had atrial fibrillation and had late diastolic MR in the cardiac cycle with prolonged RR interval. The limitation in number of cardiac cycles that could be analyzed and the rapid heart rate eliminating appearance of the beat with prolonged RR interval may be the reasons for the paucity of late diastolic MR by left ventriculography. Ten patients (66%) with late diastolic MR, including 1 with sinus rhythm, had aortic regurgitation, 3 had high-grade systolic MR and 2 had atrial septal defect. Simultaneous recording of pulmonary artery wedge pressure and left ventricular pressure in 3 patients showed a reversal of pressure gradient in late diastole when the RR interval was prolonged. In conclusion, pulsed Doppler echocardiography was useful for detecting late diastolic MR and in reducing overestimation of systolic MR in left ventriculography induced by erroneous addition of late diastolic MR. The difference of the incidence of this flow between left ventriculography and Doppler examination indicated that this flow depends primarily on heart rate and may come and go in a patient.

Adolescent↗
PubMed1987

[Assessment of abnormal left ventricular systolic blood flow in atrial fibrillation].

In atrial fibrillation, it is known that hemodynamics vary according to the preceding R-R intervals. However, the informations of blood flow dynamics have not been available because of the methodological limitations. In this study, blood flow dynamics of atrial fibrillation were assessed using pulsed Doppler echocardiography. The subjects were 160 consecutive patients with atrial fibrillation and without left ventricular asynergy. Using a commercially-available pulsed Doppler instrument (Aloka SSD-910), blood flow patterns in the left ventricle were investigated from the apical long-axis view. The results were as follows: 1. In 22 of the 160 cases (14%), systolic blood flow in the central or apical region of the left ventricle directed towards the apex (termed "back flow"). 2. In the cardiac cycle with "back flow", the preceding R-R interval was shorter; whereas it was longer when "back flow" was absent (591 +/- 103 vs 817 +/- 179 msec, p less than 0.01). Moreover, when a long R-R interval (PPI) followed by a short R-R interval (PI) was observed (greater PPI/PI ratios), the next beat showed distinct "back flow". 3. Left ventricular ejection fraction decreased significantly in patients with "back flow" compared to those without it (42 +/- 15 vs 66 +/- 12%, p less than 0.01). 4. On left ventriculography, the motion of the base of the heart was preserved; however, with "back flow", the motion of the apical area was abnormal, extending towards the apex along the longitudinal axis. 5. Left ventricular ejection flow at the outflow tract disappeared in 13 of the 22 cases with "back flow" in cardiac cycles with short preceding R-R intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1986

[Effect of age on left ventricular relaxation: pulsed Doppler echocardiographic evaluation].

There is no noninvasive index to assess the left ventricular relaxation property during the isovolumic relaxation period except for the isovolumic relaxation time, which is derived from M-mode echocardiography or phonocardiography. The intracardiac blood flow can now be precisely observed using pulsed Doppler echocardiography. We evaluated the left ventricular relaxation property and studied the effect of age on the relaxation property using this method. Cardiac catheterization and pulsed Doppler echocardiography were performed for 27 patients with various heart diseases, none of whom had wall motion abnormalities on left ventriculography, to determine the relationships between invasive and noninvasive parameters. The effects of age were examined in 25 normal healthy persons ranging in age from 26 to 69 years. In all cases, the intracardiac blood flow during the isovolumic relaxation period (isovolumic relaxation flow) as obtained by pulsed Doppler echocardiography was laminar, and directed from the base toward the apex of the left ventricle. The duration of this flow (the time interval from the beginning to the end of this flow; IRT), the acceleration time (the time interval from the beginning to the peak velocity; ACT) and the acceleration rate (the slope of the beginning to the peak velocity; AcR) were measured, and IRT, ln AcT (natural logarithm of AcT) and ln AcR (natural logarithm of AcR) were compared with the parameters obtained by cardiac catheterization. The time constant T of the fall in left ventricular pressure during the isovolumic relaxation period, which was proposed as an index of the left ventricular relaxation property, correlated well with IRT (r = 0.82, p less than 0.001), ln AcT (r = 0.69, p less than 0.001) and ln AcR (r = -0.77, p less than 0.001), but there were no significant correlations with maximum blood pressure, left ventricular ejection fraction, maximal positive dp/dt or the left ventricular end-diastolic volume index. Age and these three Doppler indexes in normal healthy persons correlated significantly as follows; IRT (r = 0.80, p less than 0.001), ln AcT (r = 0.60, p less than 0.001) and ln AcR (r = -0.61, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

[Isovolumic relaxation flow patterns evaluated by pulsed Doppler echocardiography: comparison with invasive parameters].

Left ventricular relaxation property was evaluated by pulsed Doppler echocardiography. The indices obtained from Doppler signals within the left ventricle (LV) during the isovolumic relaxation period (IRF) were compared with the hemodynamic parameters obtained from cardiac catheterization studies. Subjects of this study were four patients with hypertrophic cardiomyopathy, four with hypertensive heart disease, three with angina pectoris, and seven normal subjects. All of them had no wall motion abnormalities and their ejection fractions were more than 0.60. The three indices of IRF were the time interval from the start of IRF to the time immediately before the rapid filling flow (isovolumic relaxation time; IRT), the time interval from the start to the peak (acceleration time; AcT), and the slope from the start to the peak (acceleration rate; AcR). The peak pressure (peak P) was measured at the same time. The positive and negative deflections of the first derivative of left ventricular (LV) pressure (+dp/dt and -dp/dt) and the time constant of LV pressure fall (time constant T) were calculated from LV pressure using a micromanometer-tipped angiocatheter. The end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction (EF) were calculated from the LV angiogram. There were no significant correlations between the three IRF indices (IRT, AcT and AcR) and the hemodynamic parameters (peak P, EDVI, +dp/dt and -dp/dt). However, the time constant T, which is a good index of LV relaxation property and which is relatively free from afterload and preload, correlated well with IRT (r = 0.75, p less than 0.001), AcT (r = 0.60, p less than 0.01), and AcR (r = -0.66, p less than 0.01). It was concluded that the indices obtained from the blood flow patterns of the left ventricle during isovolumic relaxation were useful for estimating left ventricular relaxation property non-invasively and quantitatively.

Adult↗
PubMed1985

[Late diastolic mitral regurgitation: pulsed Doppler echocardiographic study].

Since the description of late diastolic mitral regurgitation (MR) detected by left ventriculography, the risk of overestimating systolic MR has been pointed out. However, it has not been well studied by pulsed Doppler echocardiography, though this method is thought to be extremely useful to analyze systolic MR. The purpose of this study was to evaluate the usefulness of pulsed Doppler echocardiography in assessing late diastolic MR and to clarify the pathophysiology of this MR. With the probe in the apical position, the blood flow pattern at the left atrial outflow tract was investigated in 226 consecutive cases who underwent left ventriculography. Late diastolic MR, which could not be attributed to ventricular premature contraction, was observed in 10 cases (4.4%) by left ventriculography. Meanwhile, by pulsed Doppler echocardiography, late diastolic disturbed flow directing towards the left atrial cavity in late diastole was detected in 15 cases (6.6%) including 10 cases with positive left ventriculographic MR. Among these 15 cases, 14 (93%) had atrial fibrillation and exhibited this MR only in the cardiac cycle with prolonged R-R intervals. The limitation in number of cardiac cycles which could be analyzed and the rapid heart rate eliminating the appearance of the beat with prolonged R-R intervals may be the reasons for the paucity of late diastolic MR by left ventriculography. Ten cases (66%) of late diastolic MR, including one with sinus rhythm, had aortic regurgitation, three cases showed high-grade systolic MR, and two had atrial septal defect. The simultaneous recording of pulmonary arterial wedge pressure and left ventricular pressure in three patients show a reversal of pressure gradient across the mitral valve in late diastole when the R-R interval was prolonged. In conclusion, pulsed Doppler echocardiography is useful in detecting late diastolic MR, and in reducing overestimates of systolic MR by ventriculography which was induced by erroneous addition of late diastolic MR, because Doppler method has better time resolution in phase analysis. We believe that incomplete premature mitral valve closure caused by a delay in left ventricular contraction following prolonged R-R intervals, and the reversal of left atrial-left ventricular pressure gradient induced by left ventricular over-filling played important roles in the occurrence of late diastolic MR.

Adult↗