Hiroyuki Sano

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A reduced hemodialysis dose improved nutrient metabolism in an elderly hemodialysis patient –A study of amino acid metabolism–

Nihon Toseki Igakkai Zasshi (2017)

Hiroyuki Sano Yutaka Kitagawa Katsuyo Honsho Junko Sanehiro Mikiko Matsumoto

透析中におこる血圧低下や下肢筋の硬直対策として, 今日まで, さまざまな工夫がなされてきたが, 頻度は減少していないといわれている. われわれは, 透析前半の急速な溶質除去を抑制することで, 透析中の血圧低下や下肢筋の硬直を予防できるのではないかと考え透析条件の見直しを行った. 結果, 透析中の処置回数の激減と生命予後の指標が上昇したので報告する. 【症例】81歳女性, 透析歴21か月で血圧低下や下肢筋の硬直を頻回に起こす症例である. 【方法】溶質除去を抑えるため, 透析条件はQD 200mL/min, QBは透析開始から漸増する設定 (低効率透析) とし, 血圧低下と下肢筋の硬直の発生頻度と生命予後の指標である, 血清アルブミン, %CGR, BMIについて検討した. 【結果】血圧低下に付随する処置回数は通常透析時, 下肢筋の硬直17回, 除水量の減量19回であったが, 低効率透析に変更後はそれぞれ1回と激減した. 生命予後の指標は, 血清アルブミン値, %CGR, BMIすべて上昇した.

10.4009/jsdt.50.519

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Abstract 13940: Risk Stratification of Future Left Ventricular Dysfunction in Patients With Indications for Right Ventricular Pacing Owing to Bradycardia

Circulation (2015)

Junichi Ooka Hidekazu Tanaka Yutaka Hatani Keiko Hatazawa Kumiko Dokuni

Background: Although right ventricular (RV) pacing is the only effective treatment for patients with symptomatic atrioventricular block, it creates left ventricular (LV) mechanical dyssynchrony, which can induce LV dysfunction and heart failure. Current criterion for consideration of cardiac resynchronization therapy (CRT) is LV ejection fraction (LVEF) ≤35%, but indication for CRT in patients required for RV pacing with LVEF >35% remains uncertain. Methods: We studied 35 consecutive patients with LVEF of 51±9% (all≥35%) who had undergone implantable cardioverter-defibrillator implantation (RV pacing <5%). Echocardiography was performed at baseline and during RV pacing. LV dyssynchrony was determined by the anteroseptal-to-posterior wall delay from mid-LV short-axis view using two-dimensional speckle-tracking radial strain (≥130ms as significant). Patients were divided into two groups based on baseline LVEF: preserved LVEF≥50% (n=19) and mildly reduced LVEF of 35-50% (n=16). Results: LV dyssynchrony in patients with mildly reduced LVEF was significantly worsened during RV pacing compared to that in patients with preserved LVEF (from 86.0±103.9ms to 214.6±132.1ms vs. from 21.7±29.0ms to 65.6±90.9ms, p=0.01). Furthermore, the prevalence of significant LV dyssynchrony during RV pacing in patients with mildly reduced LVEF was significantly higher than that in patients with preserved LVEF (68% vs. 16%, p<0.01). LVEF in patients with mildly reduced LVEF was also significantly worsened during RV pacing compared to that in patients with preserved LVEF (from 42.8±4.6% to 37.6±6.8% vs. from 58.3±5.7% to 57.9±6.9%, p<0.01). Conclusions: The amount of RV pacing-induced LV dysfunction may be associated with baseline LV function. Thus, these adverse effects in patients with mildly reduced LVEF of 35-50% and indications for RV pacing owing to bradycardia can be prevented by CRT.

Risk Stratification

Ventricular pacing

Ventricular Function

10.1161/circ.132.suppl_3.13940

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Abstract 14833: Ventricular Interdependence by Means of Preload Tress Echocardiography in Patients With Pulmonary Hypertension

Circulation (2017)

Hiroyuki Sano Hidekazu Tanaka Yoshiki Motoji Jun Mukai Makiko Suto

Background: Pulmonary hypertension (PH) is characterized by a marked and sustained elevation of pulmonary vascular resistance, leading to an increase in pulmonary artery pressure, and right ventricular (RV) failure. RV pressure overload in PH patients can affect left ventricular (LV) performance as a result of ventricular interdependence, however, association of functional reserve with ventricular interdependence remains uncertain. Thus, the aim of this study was to investigate the effect of preload stress echocardiography on ventricular interdependence in PH patients by means of leg-positive pressure (LPP) maneuver. Methods: We studied 43 PH patients with pulmonary arterial hypertension, and chronic thromboembolic pulmonary hypertension. All patients underwent echocardiography at rest and during LPP maneuver. RV function was calculated by averaging peak speckle-tracking longitudinal strain from RV free-wall (RV free-wall strain). RV contractile reserve was assessed as a relative change in RV free-wall st...

Preload

Pressure overload

Ventricular Function

Speckle tracking echocardiography

Stress Echocardiography

Source

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Body temperature, heart rate and long-term outcome of cooled infants: an observational study

Pediatric Research (2021)

Kennosuke Tsuda Jun Shibasaki Tetsuya Isayama Akihito Takeuchi Takeo Mukai

Univariate analysis

Neonatal Encephalopathy

10.1038/s41390-021-01502-w

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Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison

The Journal of Pediatrics (2016)

Prakesh S. Shah Kei Lui Gunnar Sjörs Lucia Mirea Brian Reichman

Bronchopulmonary Dysplasia

10.1016/j.jpeds.2016.04.083

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Citations (213)

A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma

The Journal of Medical Investigation (2010)

Masanari Watanabe Hiroyuki Sano Katsuyuki Tomita Akira Yamasaki Jun Kurai

Salivary pH is associated with esophageal acid reflux and neutralization of esophageal acid. In this study, we assessed the association between nocturnal decline of salivary pH and airway hyperresponsiveness. Salivary pH was serially assessed in 9 patients with mild asthma (7 men and 2 women; mean age 33.3 years; mean %predicted FEV(1.0) 89.4%) and 10 healthy volunteers (6 men and 4 women; mean age 31.2 years) using a pH indicator tape. The buffering capacity of saliva was defined as the median effective dose (ED(50)) for acidification of saliva with 0.01 N HCl, and airway responsiveness was defined as the dose of methacholine producing a 35% fall in Grs (PD(35)-Grs). There was a significant correlation between the values obtained from the pH indicator tape and those obtained from the electrometric pH meter. Using the indicator tape for sequential monitoring, we observed a nocturnal fall (ΔpH) in salivary pH in all subjects. A significant correlation was found between airway hyperresponsiveness (PD(35)-Grs) and either ΔpH or ED(50) in mildly asthmatic patients. Vagal reflux dysfunction might contribute to nocturnal salivary pH as well as to airway hyperresponsiveness in mild asthmatics.

Methacholine

Bronchial hyperresponsiveness

Airway hyperresponsiveness

Esophageal pH monitoring

10.2152/jmi.57.260

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Citations (21)

Right Ventricular Function and Right-Heart Echocardiographic Response to Therapy Predict Long-term Outcome in Patients With Pulmonary Hypertension

Canadian Journal of Cardiology (2015)

Hiroyuki Sano Hidekazu Tanaka Yoshiki Motoji Yuko Fukuda Takuma Sawa

Ventricular remodeling

Speckle tracking echocardiography

10.1016/j.cjca.2015.01.027

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Citations (20)

A surrogate method for assessment of β2-integrin-dependent adhesion of human eosinophils to ICAM-1

Journal of Immunological Methods (2000)

Xiangdong Zhu Ramnath Subbaraman Hiroyuki Sano Benjamin Jacobs Akiko Sano

Bovine serum albumin

10.1016/s0022-1759(00)00192-7

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Citations (57)

Association of Apical Longitudinal Rotation with Right Ventricular Performance in Patients with Pulmonary Hypertension: Insights into Overestimation of Tricuspid Annular Plane Systolic Excursion

Echocardiography (2015)

Yoshiki Motoji Hidekazu Tanaka Yuko Fukuda Hiroyuki Sano Keiko Ryo

Current guidelines recommend the routine use of tricuspid annular plane systolic excursion (TAPSE) as a simple method for estimating right ventricular (RV) function. However, when ventricular apical longitudinal rotation (apical-LR) occurs in pulmonary hypertension (PH) patients, it may result in overestimated TAPSE.We studied 105 patients with PH defined as mean pulmonary artery pressure >25 mmHg at rest measured by right heart cardiac catheterization. TAPSE was defined as the maximum displacement during systole in the RV-focused apical four-chamber view. RV free-wall longitudinal speckle tracking strain (RV-free) was calculated by averaging 3 regional peak systolic strains. The apical-LR was measured at the peak rotation in the apical region including both left and right ventricle. The eccentricity index (EI) was defined as the ratio of the length of 2 perpendicular minor-axis diameters, one of which bisected and was perpendicular to the interventricular septum, and was obtained at end-systole (EI-sys) and end-diastole (EI-dia). Twenty age-, gender-, and left ventricular ejection fraction-matched normal controls were studied for comparison.The apical-LR in PH patients was significantly lower than that in normal controls (-3.4 ± 2.7° vs. -1.3 ± 1.9°, P = 0.001). Simple linear regression analysis showed that gender, TAPSE, EI-sys, and EI-dia/EI-sys were associated with apical-LR, but RV-free was not. Multiple regression analysis demonstrated that gender, EI-dia/EI-sys, and TAPSE were independent determinants of apical-LR.TAPSE may be overestimated in PH patients with clockwise rotation resulting from left ventricular compression. TAPSE should thus be evaluated carefully in PH patients with marked apical rotation.

Excursion

Ventricular Function

Right heart

10.1111/echo.13036

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Citations (37)

Significant Prognostic Value of Acute Preload Stress Echocardiography Using Leg-Positive Pressure Maneuver for Patients With Symptomatic Severe Aortic Stenosis Awaiting Aortic Valve Intervention

Circulation Journal (2017)

Hiroki Matsuzoe Kensuke Matsumoto Hidekazu Tanaka Yutaka Hatani Keiko Hatazawa

Although aortic valve intervention is recommended for virtually all symptomatic patients with aortic stenosis (AS), how urgently the intervention should be performed remains controversial. The aim of this study was thus to determine whether the preload reserve in response to leg-positive pressure (LPP) maneuver could serve for decision-making for AS patients awaiting aortic valve intervention.Methods and Results:Sixty-eight patients with symptomatic AS, who were referred for aortic valve intervention, were recruited. Stroke volume (SV) was assessed by means of pulsed-wave Doppler, and the ratio between transmitral E wave and mitral annular velocity (e') was calculated to estimate ventricular filling pressure. While waiting for intervention, 11 patients experienced preoperative cardiac events. During acute preload stress, forward SV for patients without cardiac events increased significantly (from 43±9 to 49±10 mL/m2, P<0.01) along with a minimal change in filling pressure (E/e': from 20±8 to 21±9, NS). For patients with cardiac events, the Frank-Starling mechanism was significantly impaired (SVi: from 40±9 to 38±7 mL/m2, NS), while filling pressure increased to the critical level (E/e': from 24±8 to 31±8, P<0.001). Both the patients without flow reserve (∆SVi <4.5 mL/m2) and those without diastolic reserve (∆E/e' ≥2.9) exhibited significantly worse event-free survival than the others (P<0.05, respectively).Assessment of preload reserve during LPP stress could facilitate risk stratification of patients with severe AS waiting for aortic valve intervention.

Preload

Afterload

10.1253/circj.cj-17-0143

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Citations (4)