Ryoko Tabata

Imaging of phosphoenergetic state and intracellular pH in human calf muscles after exercise by 31P NMR spectroscopy.

Phosphoenergetic and pH images in human calf muscles before and after ischemic exercise were generated by 31P NMR chemical shift imaging (CSI) with a 1.5 T standard clinical MR machine using a home-built volume coil. Acquisition of data was repeated four times with 8 x 8 phase-encoding steps and 1 s repetition time. The total acquisition time was 4 min 16 s. After 3-dimensional (3D) Fourier transformation with zero-filling, 2-dimensional (2D) images with 32 x 32 matrices of phosphocreatine (PCr), inorganic phosphate (Pi), PCr/(PCr + Pi) and pH were constructed. These metabolic images were overlaid with concurrently observed 1H MRI to locate the areas showing metabolic response. After 3 min exercise consisting of repeated plantarflexion of the foot under ischemic conditions, decreases in phosphoenergetic levels and acidosis were the most severe in the peroneus muscles, moderate in the tibialis anterior muscle, and slight in the triceps muscle of the calf. Under maintained ischemic conditions, phosphoenergetic level further decreased, but the acidosis in each muscle did not progress further. Heterogeneous metabolic and pH changes throughout the entire calf muscle were clearly demonstrated in detail by these images.

Arterial ketone body ratio as a prognostic indicator in acute heart failure.

The arterial ketone body ratio (AKBR), an established clinical tool that reflects hepatic mitochondrial oxidation-reduction potential, predicts the outcome of patients with shock and multiple organ failure and the postoperative outcome in patients who have undergone major liver or heart surgery. The purpose of this study was to determine the prognostic significance of AKBR in patients with acute heart failure. The subjects of this study were 52 patients with acute heart failure. The following parameters were analyzed after Cox univariate hazard analysis was performed: AKBR, plasma norepinephrine, left ventricular ejection fraction, cardiac index, pulmonary arterial wedge pressure, sex, age, human atrial natriuretic peptide, endothelin-1, and cholesterol. The follow-up period was 30 weeks with cardiac death as the end point. Stepwise multivariate proportional hazard analysis revealed that AKBR was the most significant predictor of death, followed by norepinephrine and human atrial natriuretic peptide. Curve-fitting analysis revealed that the relationship between log (norepinephrine) and AKBR could best be described by two distinct lines, with their intersection at AKBR = 0.7 and norepinephrine = 418. With these results we conducted Kaplan-Meier analysis for AKBR > or = 0.7 and AKBR <0.7. The survival rate in patients with AKBR > or = 0.7 was 100%, whereas that in patients with AKBR <0.7 was 15% (p < 0.0001, log-rank analysis). These results indicate that AKBR is a novel independent predictor of death in heart failure.

Ketone body ratios of the superior and inferior vena cava and of pulmonary arterial blood compared to that of arterial blood: central venous ketone body ratio as a substitute for the arterial ketone body ratio.

To investigate the ketone body ratio (acetoacetate/3-hydroxybutyrate) of central venous blood compared to that of peripheral arterial blood, the acetoacetate and 3-hydroxybutyrate concentrations in paired peripheral arterial and central venous or pulmonary arterial blood were measured. The ketone body concentrations in superior and inferior vena cava blood were significantly (P < 0.0001) lower than those in peripheral arterial blood, whereas those in pulmonary arterial blood were almost the same as those in peripheral arterial blood. These results indicate that ketone bodies were metabolized in the muscles, which reduced their levels in vena cava blood, but ketone bodies newly produced by the liver were transported to the right side of the heart via the hepatic vein, giving concentrations in pulmonary arterial blood that were almost the same as those in peripheral arterial blood. On the other hand, the correlation coefficients (r2) of the arterial blood ketone body ratio to the ratio of superior and inferior vena cava and pulmonary arterial blood were 0.897, 0.767 and 0.882, respectively. The ratios of central venous ketone body ratio/arterial blood ketone body ratio were 0.89 +/- 0.15 in the superior vena cava, 0.64 +/- 0.18 in the inferior vena cava and 1.01 +/- 0.15 in the pulmonary artery.

Clinical significance of reverse redistribution phenomenon after coronary artery bypass grafting

The reverse redistribution (RR) phenomenon is a decrease in thallium 201 uptake during redistribution compared with 201Tl uptake immediately after exercise. We evaluated RR in 23 patients after coronary artery bypass grafting. Postoperative RR was present in 48% and was significantly more common in patients with a history of myocardial infarction (62%). The patients were classified according to the presence (+) or absence (-) of RR. An analysis of left ventricular wall motion showed significant improvement after coronary artery bypass grafting in the RR+ group (n = 12) but not in the RR- group (n = 11). Quantitative myocardial viability was evaluated using the defect volume ratio, mean defect severity, and defect severity index. The preoperative defect volume ratio was higher in the RR+ group than in the RR- group (p < 0.05). In the RR- group, no improvement in these indices was observed after operation. In contrast, the RR+ group showed significant improvement in all three indices (p < 0.05). These results indicate that after coronary artery bypass grafting, an adequate blood supply to the remaining myocardium may induce RR. This phenomenon, therefore, may be a significant indicator of postoperative myocardial viability.

A preliminary study on the influence of obstructive sleep apnea upon cumulative parasympathetic system activity

OBJECTIVE Although the autonomic nervous system plays a key role in mediating cardiovascular changes during obstructive sleep apnea (OSA), parasympathetic nervous system (PNS) activity during sleep apnea has not yet been sufficiently investigated. This study is to discuss the relationship between PNS activity and OSA. METHODS Polysomnography recording was carried out in 76 patients (71 male and 5 female) with OSA. Cumulative PNS activity during sleep for each patient was derived from time series data of electrocardiogram (ECG) and analyzed by coarse graining spectral analysis of heart rate variability. The correlation between cumulative PNS activity and apnea-hypopnea index (AHI) was then discussed. RESULTS Cumulative PNS activity and PNS peaks during sleep were lowly but significantly correlated with OSA severity (r=-0.344, p<0.005; and r=-0.266, p<0.05 respectively), and a linear regression equation could be established. Furthermore, significant correlation was also observed in the adult groups and in the moderate and severe groups, but not in the juvenile and the elderly and mild groups. CONCLUSION These findings indicated that PNS function was obviously influenced by OSA during sleep. Cumulative PNS activity level might also serve as a useful parameter for the evaluation of OSA.

Spinal Cord Damage after Aorto-bifemoral Bypass Operation.

腹部大動脈手術時の脊髄障害は希だが, 患者の quality of life の上からも重大な合併症である. 今回, われわれは腹部大動脈・腸骨動脈領域の閉塞性動脈硬化症術後に右下肢麻痺を発症した1例を経験した. 症例は59歳の男性. 左総腸骨動脈, 右外腸骨動脈の閉塞性動脈硬化症に対する腹部大動脈・両側大腿動脈バイパス術後に右側の第2腰髄 (L2) から第1仙髄 (S1) にかけての運動および痛覚麻痺が出現した. 脊髄障害は内科的治療などによりS1は改善したもののL2-L5は改善せず, 患者は術後3か月目に退院した. 腹部大動脈-大腿動脈バイパス術において, 粥状硬化の強い腹部大動脈に対する side clamp は腰動脈の開口部を閉塞させる可能性があり, 脊髄障害発症の危険性を高めると考えられる.