著者

Yamashita Takeshi Ogawa Satoshi Aizawa Yoshifusa Atarashi Hirotsugu Inoue Hiroshi Ohe Tohru Okumura Ken Kato Takao Kamakura Shiro Kumagai Koichiro Kurachi Yoshihisa Kodama Itsuo Koretsune Yukihiro Saikawa Tetsunori Sakurai Masayuki Sugi Kaoru Nakaya Haruaki Nakayama Toshio Hirai Makoto Fukatani Masahiko Mitamura Hideo Yamazaki Tsutomu

出版者

社団法人日本循環器学会

雑誌

Circulation journal : official journal of the Japanese Circulation Society (ISSN:13469843)

巻号頁・発行日

vol.67, no.9, pp.738-741, 2003-08-20

被引用文献数

22 50

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The Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM study) is a randomized comparative evaluation of rate control and rhythm control, both combined with antithrombotic therapy, as therapeutic strategies for the treatment of atrial fibrillation (AF). This study differs from the earlier AFFIRM and RACE studies in that it has a composite primary end-point representing mortality and also physical/psychological disablement (total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure requiring intravenous administration of diuretics, and patient disablement). Patients' will to change the therapeutic strategy to the other is also considered as an end-point representing disablement under the assigned strategy. The secondary end-point includes quality of life scores and the efficacy and safety of drugs used in treating AF. The J-RHYTHM study emphasizes patient-reported experience and perception of AF-specific disablement, and the safety of antiarrhythmics available in Japan; it will follow 2,600 patients treated at more than 150 sites in Japan for a 3-year period. (Circ J 2003; 67: 738-741)

著者

Koike Akira Hoshimoto Masayo Tajima Akihiko Nagayama Osamu Yamaguchi Kaori Goda Ayumi Yamashita Takeshi Sagara Koichi Itoh Haruki Aizawa Tadanori

出版者

社団法人日本循環器学会

雑誌

Circulation journal : official journal of the Japanese Circulation Society (ISSN:13469843)

巻号頁・発行日

vol.70, no.11, pp.1457-1461, 2006-10-20

被引用文献数

6 20

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Background In a recent study the indexes of cerebral oxygenation decreased during maximal exercise in nearly half of all patients with left ventricular dysfunction. Whether these levels decrease severely enough to influence mental status or level of consciousness was evaluated in the present study. Methods and Results Forty-two patients with idiopathic dilated cardiomyopathy (IDC) and 29 healthy subjects underwent a symptom-limited maximal exercise test. The cerebral oxyhemoglobin (O_2Hb) and tissue oxygenation index (TOI) were continuously monitored using near-infrared spectroscopy. The changes in O_2Hb and TOI were also measured in 7 subjects: 2 who experienced episodes of reduced consciousness caused by sudden decreases in blood pressure during exercise recovery and 5 who exhibited sustained ventricular tachycardia during an electrophysiological study. The change in cerebral O_2Hb during exercise in patients with IDC averaged 0.38±3.39μmol/L, significantly lower than in the normal subjects (4.30±4.47μmol/L, p<0.0001). The cerebral O_2Hb decreased during exercise in 18 of 42 patients with IDC. The change in cerebral TOI in the IDC patients during exercise was significantly less than that in the normal subjects (-2.0±4.7 vs 2.1±5.8%, p=0.002). The mean decreases in cerebral O_2Hb and TOI were -5.34μmol/L and -9.7%, respectively, in the patients with reduced consciousness during exercise recovery, and -2.52μmol/L and -16.5%, respectively, in those with ventricular tachycardia. Conclusion The indexes of cerebral oxygenation may drop severely enough during maximal exercise in some patients with severe IDC that consciousness is affected.