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H Daida

Publications and source records attributed to H Daida.

54 records · Page 3Linked to original sources
PubMed1996

Sequential assessment of exercise tolerance in heart transplantation compared with coronary artery bypass surgery after phase II cardiac rehabilitation.

To investigate the improvement in exercise capacity of transplant patients after an early postoperative (phase II) cardiac rehabilitation program during the first year after surgery, we analyzed retrospectively exercise capacity within 3 months (at the completion of phase II rehabilitation) and 1 year after surgery in 17 orthotopic heart transplantation patients (15 men and 2 women) and 17 age- and gender-matched coronary artery bypass graft (CABG) patients. All patients participated in a phase II cardiac rehabilitation exercise program followed by a home-based exercise program. At the completion of phase II cardiac rehabilitation, mean peak oxygen (VO2) adjusted for body weight in heart transplant patients was not significantly different from that in CABG patients (19.7 +/- 3.7 vs 21.9 +/- 4.1 ml/kg/min), and oxygen pulse at peak exercise did not differ between the 2 groups (11.5 +/- 2.5 vs 12.6 +/- 2.4 ml/beat). Between 3 months and 1 year after surgery, CABG patients had a marked increase in exercise time, increase in heart rate from rest to peak exercise (heart rate reserve), peak VO2, and oxygen pulse. In contrast, heart transplant patients had a significant but only modest increase in peak VO2, and were much more limited in exercise capacity at 1 year than were CABG patients (21.3 +/- 3.9 vs 27.4 +/- 4.7 ml/kg/min, p <0.0001). In our limited patient population, usual phase I rehabilitation with subsequent home-based exercise training was inadequate to improve the exercise capacity of heart transplant patients, and different rehabilitation protocols, such as long-term supervised exercise training, specific to this patient group may be indicated.

Blood Pressure↗
PubMed1996

Further increase in oxygen uptake during early active recovery following maximal exercise in chronic heart failure.

STUDY OBJECTIVE: Some patients with chronic heart failure manifest a further increase in oxygen uptake (VO2) after maximal exercise whereas others do not. The purpose of this study was to determine the characteristics of chronic heart failure patients with further increase in VO2 in early active recovery following maximal exercise. DESIGN: Retrospective analysis of clinical and exercise testing characteristics in patients with or without a further increase in VO2 during early active recovery. PATIENTS: One hundred forty-two patients with a history of congestive heart failure and left ventricular ejection fraction of 45%, or less who performed a symptom-limited graded treadmill exercise test. MEASUREMENTS AND RESULTS: Expired gases were monitored breath by breath from rest throughout exercise and during 1 min of active recovery. Patients were defined as having a further increase in VO2 if the average VO2 during the initial 30 s of active recovery was greater than or equal to VO2 during the final 30 s of graded exercise and the instantaneous VO2 (from the breath-by-breath plot) at 30 s of active recovery was greater than or equal to the instantaneous VO2 at peak exercise. Thirty patients (21%) showed a further increase in VO2 following peak exercise (group 1), and 112 had decreased VO2 at 30 s after peak exercise (group 2). In group 1, treadmill time was significantly shorter, peak VO2 was significantly lower (16.6 +/- 3.6 vs 21.6 +/- 6.4 mL/kg/min), and peak ventilatory equivalent for carbon dioxide (VE/VCO2) was significantly higher than those in group 2. There was no difference in etiology of heart failure or functional class and medication status. CONCLUSION: A further increase in VO2 during early active recovery was associated with poorer exercise tolerance, lower peak VO2, and higher peak VE/VCO2 in chronic heart failure patients. This sign may be a new functional variable for assessment of chronic heart failure. Further investigations are warranted to clarify the mechanisms and clinical implications of this phenomenon.

Carbon Dioxide↗
PubMed1996

Effectiveness of probucol in preventing restenosis after percutaneous transluminal coronary angioplasty.

Lipid lowering therapies were employed to prevent restenosis following elective percutaneous transluminal coronary angioplasty (PTCA). The effect of probucol was compared to that of Pravastatin in 141 coronary atherosclerosis patients. Probucol (750 mg/day) was administered for at least 30 days prior to PTCA (34 patients, group P-1) or less than 14 days prior to PTCA (27 patients, group P-2). Pravastatin (10 mg/day) was administered for at least 30 days prior to PTCA (38 patients, group V-1) or less than 14 days prior to PTCA (42 patients, group V-2). In group P-1, the patient restenosis rate was 17.6% and lesion restenosis rate was 14%. These rates were significantly lower than those of group V-1, which were 44.7% and 40.4% respectively (p < 0.05). The respective values were 48.1% and 51.8% in group P-2 (p < 0.05, vs group P-1) and 35.7% and 34% (p < 0.05, vs group P-1) in group V-2. Probucol seems to work, not only by lowering cholesterol but also by its antioxidative properties when administered for a sufficient period prior to PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1996

Peak exercise blood pressure stratified by age and gender in apparently healthy subjects.

OBJECTIVE: To determine the peak blood pressure responses during symptom-limited exercise in a large sample of apparently healthy subjects, including both men and women over a wide range of ages. DESIGN: We retrospectively studied the blood pressure response during maximal treadmill exercise testing with use of the Bruce protocol in apparently healthy subjects. MATERIAL AND METHODS: Peak exercise blood pressures in 7,863 male and 2,406 female apparently healthy subjects who underwent a screening treadmill exercise test with the Bruce protocol between 1988 and 1992 were analyzed by age and gender. RESULTS: In this large referral population of apparently healthy subjects, peak exercise systolic and diastolic blood pressures and delta systolic blood pressure (rest to peak exercise) were higher in men than in women and were positively associated with age. In men, the 90th percentile of systolic blood pressure increased from 210 mm Hg for the age decade 20 to 29 years to 234 mm Hg for ages 70 to 79 years; the corresponding increase among women was from 180 mm Hg to 220 mm Hg. Delta diastolic blood pressure also increased with advancing age. The difference in peak and delta systolic blood pressures between men and women seemed to decrease after age 40 to 49 years. Exercise hypotension, defined as peak exercise systolic pressure less than rest systolic pressure, occurred in 0.23% of men and 1.45% of women and was not significantly related to age. CONCLUSION: Overall, peak exercise systolic and diastolic, as well as delta systolic, blood pressures were higher in men than in women and increased with advancing age. The reported data will enable clinicians to interpret more accurately the significance of peak exercise blood pressure response in a subject of a specific age and gender and will allow investigators to define exercise hypertension in statistical terms stratified by age and gender.

Adult↗
PubMed1996

[Reasonable indication for PTCA or CABG in Japanese patients with coronary artery disease--on the basis of 11 years follow-up].

The principle of our treatment choices for either PTCA or CABG is as follows; 1) 1VD is mainly indicated for PTCA or medical treatment except for very proximal or complicated LAD lesion, 2) 3VD is absolutely indicated for CABG, 3) 2VD involving LAD is positively indicated for CABG, 4) Special indications were set aside for critical lesion(s) in limited groups of patients such as those with prior CABG, and those with other serious or fatal disease, and also senile but active patients (male > 80 years old, female > 75 years old). Proper medial treatment was always conducted in all cases. During the period of 11 years between 1984 and 1994, 1050 PTCA procedures (760 individual patients) and 1484 CABG's were done at our university hospital. The annual ratio between CABG and PTCA (CABG/PTCA) was higher than 2.0 in the first 4 years but it has settled on a level of 1.0 +/- 0.2 in the last 5 years even with a significant increase in the number of PTCA patients. As to the characteristics of our PTCA group, patients with single vessel lesion comprised 57%, only single target PTCA did 78% and only LAD did 47%. Patients with prior CABG and multi lesion PTCA comprised 10% and 22%, respectively. The lesion success rare was 89%. As the major complications in 1050 PTCA's, one death (0.1%), seven (0.7%) emergency CABG's and eleven (1.0%) Q wave MI patients were recognized. The overall angiographical lesion restenosis rate was 44% of 657 lesions in 550 patients who underwent CAG within 6 months after PTCA. In 1484 CABG's, hospital mortality was 1.5% and non fatal major complications 6%. The survival rates (free of cardiac death) for PTCA patient appeared equivalent between single and multi vessel groups. However, their event free survival rates even for 1VD significantly dropped, from 99% to 68% in one year and below 60% at 5 years. For 3VD it became as low as 26% at 10 years. On the contrary, the even free survival rates for CABG patients with 3VD keep as high as 93% at 5 years and 75% at 10 years, respectively. As a conclusion, the timely use of PTCA considering an indication of CABG may be a wise and practical treatment choice for CAD, but the reasonable ratio of PTCA vs CABG seems to be about fifty-fifty as indicated in our study results. Our treatment decisions of either PTCA or CABG as mentioned above yielded acceptable outcomes in the prognosis of patients with CAD.

Aged↗
PubMed1995

Relation of saphenous vein graft obstruction to serum cholesterol levels.

OBJECTIVES: To determine the potential of lipid-lowering therapy to reduce saphenous vein graft obstruction, we retrospectively studied the association between graft obstruction and serum cholesterol levels. BACKGROUND: Atherosclerosis is the major cause of vein graft obstruction. Approximately 50% of grafts are occluded by 10 years after operation. It remains to be established whether lipid control affects long-term graft survival. METHODS: We carried out a retrospective review of all 284 patients who had undergone coronary artery bypass graft surgery at Juntendo University Hospital between 1976 and 1991 and met the following additional criteria: at least one saphenous vein graft, repeat coronary arteriography at some point after coronary artery bypass graft surgery and a serum cholesterol level > or = 200 mg/dl before operation. Saphenous vein graft obstruction rates were compared among three groups classified by serum cholesterol levels at follow-up arteriography: group I < 200 mg/dl; group II 200 to 239 mg/dl; group III > or = 240 mg/dl. A vein graft was considered obstructed if it was narrowed by > or = 70%. RESULTS: In group I, 88% of grafts were not obstructed 7 years after operation. The respective rates were 61% in group II and 57% in group III (p < 0.005). This relation was true for vein grafts to the left anterior descending and other coronary arteries. CONCLUSIONS: Lower serum cholesterol levels are associated with lower rates of vein graft obstruction for up to 7 years. This suggests that cholesterol-lowering therapy may improve long-term saphenous vein graft survival after coronary artery bypass surgery.

Aged↗
PubMed1994

Prevention of restenosis after percutaneous transluminal coronary angioplasty by reducing lipoprotein (a) levels with low-density lipoprotein apheresis. Low-Density Lipoprotein Apheresis Angioplasty Restenosis Trial (L-ART) Group.

This study was designed to test the hypothesis that high plasma lipoprotein (a) (Lp[a]) levels are associated with an increase incidence of restenosis after angioplasty. Elective transluminal coronary angioplasty was performed in 66 patients (58 men and 8 women) aged 57 +/- 9 years (mean +/- SD). Two days before and 5 days after angioplasty, all patients underwent low-density lipoprotein (LDL) apheresis with a dextran sulfate cellulose column as an Lp(a) absorbent; 39 patients also received 10 mg of pravastatin and 1,500 mg of niacin daily. Restenosis was defined as a recurrent luminal stenosis of > or = 50% in a previously dilated segment. Median Lp(a) levels were reduced from 23.3 mg/dl before apheresis to 10.9 mg/dl after apheresis (p < 0.0001). Angiography performed 2 to 9 months after angioplasty revealed restenosis in at least 1 site in 38% of the 137 control patients and in 32% of the 66 patients who underwent apheresis. Restenosis also occurred in 37% of the patients who underwent apheresis alone and in 28% of the patients who also received pravastatin and niacin in combination with LDL apheresis. The restenosis rate was 21% in the 42 patients whose Lp(a) levels were significantly reduced > or = 50%, and in 50% of the 24 patients whose Lp(a) levels were significantly reduced < 50% (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Effectiveness of LDL-apheresis in preventing restenosis after percutaneous transluminal coronary angioplasty (PTCA): LDL-apheresis angioplasty restenosis trial (L-ART).

To investigate the efficacy of reducing plasma lipoprotein(a) (Lp(a)) as well as low density lipoprotein cholesterol (LDL-C) levels on the prevention of restenosis after PTCA, LDL-apheresis was attempted on a total of 54 patients at six institutions. LDL-apheresis using a dextran sulfate cellulose column has been proven to be an effective method for reducing both plasma Lp(a) and LDL-C levels. As a subgroup (apheresis-drug combined group), 29 of the 54 patients were given Pravastatin (HMG CoA reductase inhibitor) and Niceritrol (Nicotinic Acid) in addition to LDL-apheresis to maintain low plasma levels of both Lp(a) and LDL-C through the follow-up period of 5 months after PTCA. Patients whose plasma Lp(a) levels were reduced by more than 50% showed a lower restenosis rate than those whose plasma Lp(a) levels were reduced by less than 50% (21.2% vs. 52.4%, P = 0.0179), especially in patients with high plasma Lp(a) levels above 30 mg/dl where a much lower restenosis rate (15.0%) was observed. Furthermore, in the apheresis-drug combined group, the restenosis rate was 11.8% regardless of baseline plasma Lp(a) levels, including even those below 30 mg/dl. In conclusion, in patients with high plasma Lp(a) levels, a greater than 50% reduction in Lp(a) levels by LDL-apheresis is effective in preventing restenosis after PTCA. If the plasma Lp(a) reduction rate is greater than 50%, LDL-apheresis combined with lipid-lowering drugs such as niceritrol and pravastatin seems to be more effective, even in patients with low plasma Lp(a) levels.

Aged↗
PubMed1994

Evaluating the effectiveness of dyslipidemia control strategies.

While cost-effectiveness analyses of anti-hyperlipidemia programs featuring drug treatment suggest that the best use of public dollars is to delay treatment until an individual develops coronary heart disease, a comprehensive hyperlipidemia treatment policy must take a broader perspective. The high case-fatality rates of patients exhibiting first manifestations of coronary heart disease, the limited population impact of interventions aimed solely at high risk groups, the cost of testing to identify the high risk segment of the population, the social origins of the behavioral risk factors for coronary heart disease, and the perspective of the individual must also be considered. Available data suggest that the best public policy to control the burden of heart disease is one with two components: On the one hand, all individuals without clinically manifest heart disease would be encouraged to adopt healthy behaviors without an attempt to sort the population into 'high' and 'not high' risk groups. On the other hand, the risk factors of individuals who already have coronary heart disease would be treated aggressively with a case-management system of follow-up. The data that support this conclusion are presented in this paper.

Adult↗
PubMed1993

[Ischemic heart disease].

During the progression of early atherosclerotic lesions, atherosclerotic plaque rupture, with intraluminal thrombosis superimposed, which is one of the principle mechanisms of evolving atherosclerosis, may lead to thrombotic occlusion and ischemic coronary syndrome. Pathologic studies suggest that plaque rupture and overlying thrombi, which are dynamic and repetitive may frequently occur. In most cases, healed ruptures and incorporation of thrombi produce plaque progression without manifestation of clinical symptoms. However, acute mural occlusive thrombi, overlying plaque ruptures, cause unstable angina and acute myocardial infarction. The different pathogenesis between unstable angina and acute myocardial infarction might depend on the composition and stability of the thrombus resulting from the degree of vessel injury and blood flow. Soft lipid-rich plaques appear more prone to rupture, particularly when the lipid pool is localized eccentrically within the intima. Macrophages in the plaque may also facilitate plaque rupture by releasing proteases.

Angioscopy↗
PubMed1991

[Residual stenosis after intracoronary thrombolysis: its clinical significance].

The effects of residual stenosis after intracoronary thrombolysis (ICT) on the hospital course and on left ventricular function were investigated in 94 patients with acute myocardial infarction. The in-patient hospital events including death, post-infarction angina, and re-infarction occurred in 6 of 24 (25%) patients with 100-99% residual stenosis (Group I), 18 of 55 (32.7%) patients with 95-90% stenosis (Group II) and one of 15 (7%) patients with 75% or less stenosis (Group III), suggesting that the presence of severe residual stenosis could be associated with the occurrence of in-patient hospital events. However, re-infarction occurred in only 3.6% of Group II patients. In an analysis of left ventricular function, global and regional wall motion was significantly improved in this group of patients, compared with patients who had no reperfusion (Group I). What is more, the degree of the improvement in wall motion in Group II, despite the severe stenosis, was the same as that in Group III with 75% or less stenosis. It was concluded that further intervention following thrombolysis may not be necessarily required for patients who underwent reperfusion without filling delay, even if the residual stenosis is greater than 90%.

Aged↗
PubMed1989

[Clinical diagnosis and pathogenesis of myocardial infarction complicated by hypertrophic cardiomyopathy: review of eight cases].

Among 144 patients with hypertrophic cardiomyopathy, eight (58.3 +/- 7.0 years, M:F = 7:1) had complicating myocardial infarction, which was diagnosed clinically and by elevated cardiac enzymes or new Q-waves on electrocardiography. Coronary occlusion or stenosis evidenced by coronary angiography and nuclear cardiological findings were investigated. In six of the eight patients, coronary atherosclerosis caused infarction. These patients had many coronary risk factors compared to the other two patients. Sixteen of the 144 patients (11%) with hypertrophic cardiomyopathy had coronary atherosclerosis, the rate of which is reportedly 10 to 20%. Two of the eight patients had no coronary atherosclerosis. One patient had a diffusely spastic diathesis provoked by the intravenous administration of ergonovine maleate during coronary angiography, suggesting that coronary spasm caused myocardial infarction. The other patient had recurrent episodes of supraventricular tachyarrhythmia and no evidence of spasm during coronary angiography, suggesting coronary embolism as a cause of myocardial infarction. Myocardial infarction in patients with hypertrophic cardiomyopathy and normal coronary arteries as advocated by Maron et al. may have such pathogenesis. We conclude that coronary angiography may be mandatory in patients with hypertrophic cardiomyopathy, especially those who have many coronary risk factors and anginal symptoms. In these patients, ST-T changes and abnormal Q-waves on electrocardiography sometimes may be misleading when diagnosing the occurrence of acute myocardial infarction by electrocardiography alone. In such cases, infarct-avid scintigraphy with 99 m-Tc pyrophosphate is preferable.

Adult↗
PubMed1985

[Coronary collaterals in patients with total obstruction of the proximal left anterior descending artery: their pathways and functional significance].

The relationship of patterns of collateral pathways and the functions of collaterals in patients with proximal occlusion of the left anterior descending artery (LAD) was analyzed by coronary arteriography and left ventriculography. Forty-seven patients with dominant right coronary artery (RCA) as anatomic variations had nearly the same filling areas from three major collateral pathways from the RCA to the LAD via conus branches, marginal branches, and septal perforator. The grades of collateral flows were classified as good, fair and poor according to the sizes and numbers of collateral channels, and the filling density of contrast in each collateral and three (basal, mid and apical) segments of the main trunk of the LAD. On left ventriculography in the right anterior oblique projection, the anterior wall was divided into five segments, and the regional ejection fraction in each segment was measured from end-diastolic and end-systolic areas. Three main collateral pathways and connections to the LAD were observed from the RCA. Those were the conus branches to the basal-mid LAD, the marginal branches to the mid-apical LAD, and the posterior descending branches to the basal-mid LAD via the septal perforators. Only seven patients showed normal contraction in all of the segments (Group I). In seven patients with normal contraction in the basal-mid segments and reduced contraction in the apical segment of the anterior wall, the main collateral pathways from the RCA to the LAD were the posterior descending branches via the septal perforators (Group II). In 10 patients with reduced contraction in the basal-mid segments and normal contraction in the apical segment of the anterior wall, the main collateral pathways from the RCA were the conus branches and/or the marginal branches to the LAD (Group III). In the other 23 patients with reduced contraction in entire segments (Group IV), the patterns of segmental contraction were similar to those of either Group II or Group III. These findings indicate that in the majority of cases collateral circulation from the RCA did not preserve wall contraction in all segments perfused by the occluded LAD at rest, and suggest that various patterns of segmental contraction may be influenced by the dominant of collateral pathways.

Collateral Circulation↗
PubMed1985

[Left ventricular diverticulum: a report of two cases].

Left ventricular diverticulum is a rare congenital cardiac malformation, and is classified as muscular and fibrous. Muscular diverticula are usually associated with thoracoabdominal defects and arise from the cardiac apex. We encountered two cases of muscular left ventricular diverticulum without other congenital anomalies during the review of 3,000 left ventriculograms. Both patients were men and their diverticula were located along the inferior left ventricular wall. No symptoms were associated with the diverticula. In both cases, two-dimensional echocardiography detected the diverticula, thus this is regarded as a useful method for the diagnosis and screening of this anomaly. In one of our cases, thallium myocardial imaging also demonstrated a characteristic abnormal bulge corresponding to the diverticulum. We subsequently detected two more cases of muscular left ventricular diverticula among 300 left ventriculograms. Thus, we detected four cases of left ventricular diverticula among 3,300 left ventriculograms. Although only 11 cases of muscular left ventricular diverticulum previously have been reported, this anomaly is not so rare as previously supposed, and it should be distinguished from left ventricular aneurysm.

Adult↗
PubMed1983

Rapid improvement of thyroid function by using glucocorticoid indicated for the preoperative preparation of subtotal thyroidectomy in Graves' disease.

Glucocorticoid therapy is not considered as an authentic method for obtaining euthyroid in Graves' disease. We tried the administration of prednisolone as a preoperative preparation for subtotal thyroidectomy in 4 hyperthyroid patients with Graves' disease who had suffered adverse effects of thionamide antithyroid drugs, including agranulocytosis, liver damage and skin eruptions. Following oral administration of a 30 mg daily dose of prednisolone, with or without other antithyroid reagents, both serum T4 and T3 concentrations decreased rapidly and reached the normal range within 2 weeks. The clinical signs and symptoms of hyperthyroidism also improved rapidly and subtotal thyroidectomies were performed uneventfully in all cases. These results suggest that 1) glucocorticoid medication can normalize the circulating hormone levels rapidly in Graves' disease, 2) it is a useful method as preoperative preparation for subtotal thyroidectomy, especially when other conventional methods are not available or effective in obtaining euthyroid, and 3) mechanisms other than thyroid stimulation by circulating immunoglobulin seem to play an important role in causing hyperfunction of the gland.

Adult↗
PubMedDate not supplied

Histopathological study of cardiac rupture following myocardial infarction with and without thrombolytic therapy.

The characteristics of cardiac rupture associated with thrombolytic therapy for acute myocardial infarction (MI) were studied in the hearts of 10 autopsy patients, 7 men and 3 women aged 41-80 years (mean 59.9 +/- 13.2 years), who died of rupture of the free wall of the left ventricle following acute MI. The site of rupture was examined histologically and the percentage areas of living myocytes, the processes of organization, necrosis and degeneration, and hemorrhage were compared in four patients who received thrombolytic therapy (group R) and six patients without thrombolytic therapy (group N). There were four pathological findings at the site of rupture: necrosis, neutrophil infiltration, hemorrhage, and evidence of the process of absorption. Group R consisted of two patients with hemorrhage, one with absorption, and one with unsuccessful reperfusion and neutrophilic infiltration. Group N included three patients with necrosis, two with neutrophilic infiltration, and one with hemorrhage. The percentage area involved by necrosis and degeneration was significantly lower in group R than in group N. Therefore, local stress produced by more surviving myocardium around the smaller necrosis area and the weakness of myocardium due to hemorrhage and absorption may provoke cardiac rupture in acute MI patients receiving thrombolytic agent.

Adult↗