J Kamata

Iwate Medical University, Morioka, Iwate, Japan

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Publications (49)73.21 Total impact

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    ABSTRACT: Background: The pathogenesis of the occurrence of late potentials (LP) has not been fully elucidated. Deletion polymorphism in the Angiotensin I-converting enzyme (ACE) gene may relate the myocarclial remodeling after the myocardial infarction (Ml). The purpose of this study was to evaluate the significance of ACE gene polymorphism for the occurrence of LPs after Ml.Methods: A 287 base pair (bp) insertion/deletion polymorphism in intron 16 of the ACE gene was determined by polymerase chain reaction and LPs were also examined by signal-averaged EGC in 136 patients with Ml. Polymorphism of the ACE gene was characterized by three genotypes: II, ID, and DD. Signal-averaged ECG were recorded using X, Y, Z leads and LP were defined by time-domain analysis as low amplitude potentials exceeding 20 ms after the QRS-end and filtered QRS >115 ms.Results: Positive LPs were noted in 40 of 136 patients with Ml. No differences could be detected between patients with LP-positive and LP-negative for the location of Ml, the success rate of reperfusion therapy, and left ventricular end-diastolic volume (126 ± 40 vs 113 ± 43 mL/m2). In patients with LP-positive compared with those in LP-negative, filtered QRS was significantly higher (135 ± 8 vs 107 ± 8 ms), left ventricular ejection fraction was lower (47 ± 12 vs 54%± 11 %), and peak was higher (3602 ± 2928 vs 2614 ± 2360 IU/L). The frequency of ACE/DD genotype was associated with patients with LP-positive (18 of DD, 18 of ID, and 4 of II for patients with LP-positive, while 25 of DD, 42 of ID, and 29 of II for patients with LP-negative). In the study population, the ACE / DD genotype was associated with patients with LP-positive when compared with the ACE ID & II genotype (x2= 4.7, P = 0.03).Conclusion: ACE/DD genotype of the ACE gene may be associated with the occurrence of LP after Ml.
    Annals of Noninvasive Electrocardiology 10/2006; 1(4):405 - 410. · 1.08 Impact Factor
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    ABSTRACT: A 54-year-old female was admitted to hospital complaining of oppressive anterior chest pain during exercise. Treadmill exercise ECG testing showed significant ischemic ECG changes, and electron-beam computed tomography demonstrated patchy calcifications in the coronary artery. Coronary angiography revealed a significant stenotic lesion of the right coronary artery. On routine investigations, no classical coronary risk factors were found, although a very high concentration (209 mg/dl) of high-density lipoprotein cholesterol (HDL-C) was detected. The serum concentration of cholesteryl-ester transfer protein (CETP), which plays a central role in the reverse cholesterol transport system, was measured and found to be less than the measurable minimum. The patient showed one of the typical genetic CETP mutations (intone 14 splicing defect), and her lipid profile was improved by administration of probucol for 3 months. A very high concentration of HDL-C with a defect of CETP activity may be a specific biochemical indicator pointing to an increased risk of premature coronary artery disease, and the lipid profile can be improved by use of lipid-lowering drugs.
    Circulation Journal 06/2005; 69(5):609-12. · 3.58 Impact Factor
  • Circulation Journal - CIRC J. 01/2005; 69(5):609-612.
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    ABSTRACT: We conducted a questionnaire survey regarding quality of life (QOL) to evaluate the effects of exercise training on the QOL in patients with valvular heart disease after surgery. This study included 64 consecutive patients who underwent heart surgery. They were divided into two groups: exercise training could (EX(+) group, n = 31) and could not be performed (EX(-) group, n = 33) until 6 months after surgery. To evaluate the QOL and exercise tolerance, we employed "a questionnaire regarding disease and quality of life" developed for Japanese people and cardiopulmonary exercise testing. In our questionnaire survey, the improvement rating (Delta subjective/social index), which was calculated from the difference between the pre-and postoperative values, was greater in the EX(+) group than that in the EX(-) group (4.9 +/- 3.1 versus 1.1 +/- 4.0, P < 0.05). In the changes in exercise tolerance, Delta anaerobic threshold was greater in the EX(+) group (0.79 +/- 0.17 versus -0.02 +/- 0.28, P < 0.01). Moreover, there was a positive correlation between Delta subjective/social index and Delta peak VO(2) (r = 0.62, P < 0.05). We concluded that exercise training for patients after cardiac surgery improves the QOL and exercise tolerance. It is suggested that changes in subjective and social parameters contribute to an exercise training-related improvement in the QOL.
    Japanese Heart Journal 09/2004; 45(5):789-97. · 0.40 Impact Factor
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    ABSTRACT: It is still unknown whether or not the additional right precordial leads (RPL) during exercise testing contribute to detection of coronary artery disease (CAD). The aim of this study was to evaluate the RPL during exercise testing for the detection of CAD. The study included 157 consecutive patients (116 men and 41 women, mean age 66 years) suspected of having CAD, who underwent conclusive treadmill exercise testing (heart rate reached at least 85% of the predicted maximum or positive electrocardiogram [ECG] changes were exhibited) and coronary angiography. During exercise testing, the ECG was recorded with the standard 12 leads and 4 RPL (V3R, V4R, V5R, V6R). Of the 157 patients, 67 had CAD (> 75% stenosis in at least one major coronary artery), and 64 had positive ST changes in the standard ECG leads during exercise testing. Using the conventional 12-lead method, sensitivity and specificity were 76 and 86%, respectively. Only three patients exhibited positive changes in the RPL leads; all had > 0.1 mV ST elevation in one of the RPL leads with > 0.1 mV ST elevation in aVR. Two of these patients had significant right coronary artery lesions and the other had a lesion of the left anterior descending artery which perfused the inferior as well as the anteroseptal area. In the standard 12 leads, one of the patients with an abnormal RPL and a right coronary lesion was negative, while the other two patients were positive. Combining RPL with the conventional 12-lead method, sensitivity and specificity were 78 and 86%, respectively. Therefore, RPL did not improve the accuracy of the exercise ECG. The use of RPL during exercise testing may contribute to the detection of ischemia perfused by the right coronary artery; however, it does not improve the diagnostic accuracy of the exercise test.
    Clinical Cardiology 03/2004; 27(2):101-5. · 1.83 Impact Factor
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    ABSTRACT: We investigated the incidence and the varieties of arrhythmia during exercise training in patients who underwent cardiac surgery. Subjects were 1293 patients who underwent cardiac surgery and enrolled our cardiac rehabilitation program. According to the charts and cardiac rehabilitation records, we evaluated the incidence and the varieties of arrhythmia provoked by exercise training in patients after cardiac surgery retrospectively. The arrhythmias related to the exercise training were provoked in 12 times, and the incidence was only 0.09% (12/13646). Atrial fibrillation was the most common arrhythmia, and the incidence was 41.6% (5/12) in these patients. Moreover, these arrhythmias occurred within 2 weeks after surgery. Although most patients recovered to the sinus rhythm spontaneously, 3 patients needed medical treatment or cardioversion. We concluded that the arrhythmia provoked by exercise training in patients after cardiac surgery were rare, non-fatal, and common in the early recovery phase after surgery. However, the supervised exercise training was required in those patients, particularly in early recovery phase of cardiac surgery.
    Kyobu geka. The Japanese journal of thoracic surgery 10/2003; 56(10):836-40.
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    ABSTRACT: Repair of the bicuspid aortic valve is not generally considered the treatment of choice. Our success with this procedure leads us to report our immediate and mid-term From August 1993 to December 2000, 19 patients with aortic regurgitation due to congenital aortic valve underwent aortic valve repair (17 men and 2 women with a mean age of 42+/-17 years; range, 16 to 70 years). The mean preoperative aortic regurgitation grade was 3.1+/-0.8 on a scale of 1 to 4. Mean preoperative New York Heart Association functional class was 1.9+/-0.8. Fourteen patients had pure aortic regurgitation, 2 also had infectious endocarditis, 1 had angina pectoris, and 2 had an ascending aortic aneurysm. There was 1 hospital death (5.2%), and 1 patient required re-operation due to recurrent infectious endocarditis. Mean aortic regurgitation grade at discharge was 1.1+/-0.9, and functional class was 1.1+/-0.2. All patients were followed for a mean duration of 40+/-23 months (range, 0.5 to 84 months). There was 1 late death, and two patients required aortic valve replacement. The 5-year survival rate was 90+/-7%. The 1- and 5-year re-operation-free rates were 87+/-12% and 76+/-23%. Bicuspid aortic valve repair is a safe procedure with good early postoperative However midterm results are not satisfactory. Re-operation is a promising alternative and progress aortic regurgitation were complications. Bicuspid aortic valve repair to valve replacement that requires additional study to individualize treatment.
    The Journal of cardiovascular surgery 03/2003; 44(1):19-23. · 1.51 Impact Factor
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    ABSTRACT: Evaluation of leaflet dysfunction in aortic valve repair is important. In eccentric aortic regurgitation (AR), it is unclear whether leaflet dysfunction other than prolapse exists. The study aim was to validate the hypothesis that eccentric AR correlates with leaflet dysfunction. Both anyplane 2-D images produced by a 3-D reconstruction system and surgical views for 21 patients with eccentric AR (11 with aortic valve prolapse, group A; 10 without prolapse, group B) were analyzed prospectively. Vertical height from annulus to coaptation point (termed AC), and distance from coaptation point to sinotubular junction (CS) were measured at early diastole. For group A, AC and CS values were 1.3 +/- 2.2 mm and 25.9 +/- 3.4 mm respectively for leaflets of eccentric AR jet origin, and 3.8 +/- 0.4 mm and 22.7 +/- 2.1 mm for other leaflets. For group B, AC and CS values were 4.7 +/- 0.9 mm and 39.8 +/- 7.0 mm for leaflets of eccentric AR jet origin, and 7.8 +/- 0.9 mm and 31.9 +/- 5.7 mm for other leaflets. The AC for leaflets of eccentric AR jet origin was smaller than AC for other leaflets (p < 0.01) between both groups. There was no difference between CS for leaflets of eccentric AR jet origin and other leaflets in group A, but CS for leaflets of eccentric AR jet origin was larger than for other leaflets in group B (p <0.01). AC and CS values for leaflets of eccentric AR jet origin in group B were larger than those for group A. Leaflets of eccentric AR jet origin were always shifted toward the direction of the base in the anyplane images, and elongated in the surgical view. Anyplane 2-D images obtained by 3-D echocardiography showed that aortic leaflets of eccentric AR jet origin shifted towards the direction of the base with or without prolapse, and were accompanied by dysfunction. Color flow Doppler determination of the eccentricity of AR jet origin was useful in predicting aortic valve dysfunction.
    The Journal of heart valve disease 03/2003; 12(2):186-96. · 1.07 Impact Factor
  • Journal of Cardiopulmonary Rehabilitation 01/2002; 22(2):105-8.
  • Journal of Physical Therapy Science - J PHYS THER SCI. 01/2002; 14(1):47-50.
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    ABSTRACT: Two unusual cases of congenital bicuspid aortic valve associated with aneurysm of the ascending aorta are reported. One patient with a 7-cm ascending aortic dilatation and aortic regurgitation (AR) (II/IV), and another with a 6-cm ascending aorta and AR (III/IV), presented for treatment. Replacement of the ascending aorta and aortic valve repair were performed in both cases. Aortic valve repair included resection of the raphe, leaflet plication and subcommissural annuloplasty. Both patients had satisfactory results in the early postoperative period. Despite the promising outcomes after surgery in these patients, long-term changes in valve function and durability remain unknown. Additional close observation and monitoring are required before the procedure can be recommended as the standard of care.
    The Journal of heart valve disease 08/2001; 10(4):539-41. · 1.07 Impact Factor
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    ABSTRACT: Sinus rhythm gained after the Cox/maze procedure concomitant with mitral valve operation has demonstrated long-term attrition during the follow-up, no information exists on whether the type of mitral valve operation--(repair vs. replacement)--affects this sinus rhythm maintenance rate. We retrospectively studied patients undergoing concomitant mitral valve operation and Cox/maze procedure to answer this question. Between April 1993 and August 1995, 87 consecutive patients--35 men and 52 women (mean age: 59.3 years)--with chronic atrial fibrillation and mitral valve disease underwent the modified Cox/maze procedure and concomitant mitral valve operation, with 56 having mitral valve repair (repair group) and 31 mitral valve replacement (replacement group). Patients were followed up and changes in rhythm studied retrospectively. Follow-up for a mean 51.3 +/- 11.6 months was completed in 82 of 83 long-term survivors (99%). Repair group surgery survival was 98.1 +/- 1.9% at 1 year and 94.2 +/- 3.2% at 5 based on the Kaplan-Meier method. Replacement group surgery survival was 85.7 +/- 5.9% at 1 year and 82.9 +/- 6.4% at 5. Probability in sinus rhythm maintenance for the repair group at 1 year was 88.6 +/- 5.4% and at 5 years was 67.6 +/- 9.1%. Probability in sinus rhythm maintenance for the replacement group at 1 year was 95.7 +/- 4.3% and at 5 years was 65.0 +/- 11.1%. Medium-term results after the Cox/maze III procedure concomitant with mitral valve operation are good. The attrition of sinus rhythm maintenance appears similar by the completion of 5-year follow-up.
    The Japanese Journal of Thoracic and Cardiovascular Surgery 02/2001; 49(1):58-61.
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    ABSTRACT: It has been reported that cardiac surgery and aerobic training influence the patient's emotional response. We investigated the changes in emotional response before and after cardiac surgery and during aerobic exercise training as a cardiac rehabilitation using profile of mood states (POMS). Subjects were thirty-five patients (25 men and 10 women, average 57 years) who underwent cardiac surgery. All patients participated in the rehabilitation program which included aerobic exercise training after cardiac surgery. Aerobic training consisted of cycle ergometer or treadmill. Emotional states were evaluated by POMS score at the preoperative phase, early postoperative phase (about 10 days after surgery) and aerobic training (about 20 days after surgery). Most of the emotional state (tension, anxiety, anger and hostility) significantly improved after cardiac surgery. In particular, aerobic training has an additional effect for improving one of the emotional state which is tension and anxiety. However, several factors such as deconditioning, postoperative complications and high age delayed the improving of emotional response.
    Kyobu geka. The Japanese journal of thoracic surgery 09/2000; 53(9):742-6.
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    ABSTRACT: We evaluated the factors that determine the heart rate response to exercise in 60 patients with atrial fibrillation (25 men and 35 women, with a mean age of 61+/-10 years) who underwent symptom limited cardiopulmonary exercise testing with blood sampling of atrial natriuretic peptide (ANP), 2-dimensional echocardiography and cardiac catheterization. Atrial muscles resected during the Maze operation were examined histologically in 12 patients. The heart rate response to exercise depended on the severity of the atrial organic injury, which was expressed as left atrial diameter, ANP secretion during the maximal exercise testing and the histological findings of atrial tissue. Conversely, we believe that the severity of the atrial injury can be predicted from the heart rate response to exercise in patients with atrial fibrillation.
    Japanese Heart Journal 08/2000; 41(4):445-50. · 0.40 Impact Factor
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    ABSTRACT: "Torikabuto" is a kind of plant which contains deadly poison. Its ingredient is aconitine alkaloids. We report a case of aconitine poisoning with fatal arrhythmia and acute pulmonary edema who was saved with cardio pulmonary bypass. A 41-year-old male ate to mistake "Torikabuto" for wild plant. He developed symptoms of dysarthria and admitted to our hospital. He developed ventricular tachycardia and fibrillation soon after his admission. Then he developed cardiogenic shock. He was resuscitated and supported with a percutaneous cardio pulmonary bypass. Ventricular tachycardia disappeared 24 hours after admittion. About 1 week later, cardio pulmonary bypass was terminated and about 3 months later, he discharged from our hospital.
    Kyobu geka. The Japanese journal of thoracic surgery 08/2000; 53(7):541-4.
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    ABSTRACT: Background: Hyperhomocysteinemia, an independent and graded risk factor for coronary artery disease, can result from both environmental and hereditary factors. C677T mutation of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene [alanine/valine (A/V) polymorphism], one of the key enzymes involved in catalyzing the remethylation of homocysteine, has recently been reported. Objective: To evaluate the incidence of the MTHFR genotypes and their significance in determining the risk for myocardial infarction of Japanese men. Method: The subjects consisted of 199 healthy men (mean age, 60 years) and 230 male patients with myocardial infarction (mean age, 59 years). The coronary-artery lesions were evaluated by coronary angiography. The MTHFR genotype was analyzed by polymerase chain reaction and then by digestion with HinfI. Total plasma levels of homocysteine for each MTHFR genotype were compared with those in healthy controls. Results: The prevalences of the A and V alleles among the healthy male subjects were 0.652 and 0.348 in the Hardy-Weinberg equilibrium. The total levels of homocysteine in the plasma of the healthy male subjects were 8.6±3.3, 8.9±4.1, and 11.6±5.6 mmol/l, for AA, AV, and VV genotypes, respectively. Individuals with the VV homozygous mutant genotype thus had the highest plasma levels of homocysteine. Logistic analysis revealed that the levels of high-density lipoprotein cholesterol, hypertension, diabetes mellitus, MTHFR VV genotype, and triglycerides were all independent risk factors for myocardial infarction. The VV genotype was more prevalent among patients with myocardial infarction (mean age, 59 years) than it was among the control subjects (17.0 versus 10.6%, P <0.05). However, there were no differences in the numbers of stenotic coronary arteries among the MTHFR genotypes. Conclusion: The VV genotype of MTHFR increases plasma levels of homocysteine in healthy controls, and this mutation indicates a genetic predisposition toward a greater than normal risk of myocardial infarction for Japanese men.
    Coronary Artery Disease 01/2000; 11(1):47-51. · 1.11 Impact Factor
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    ABSTRACT: Papillary fibroelastoma is a rare cardiac tumour. We describe a patient with mitral valve regurgitation and aortic valve papillary fibroelastoma. The patient was 62-year-old woman. She was referred to us for surgical treatment of mitral valve. Preoperative echocardiography showed rheumatic mitral valve regurgitation (Sellers grade III) and it also demonstrated mobile masses of the aortic valve. At operation, mitral valve was repaired by a posterior annuloplasty. Through the aortotomy, small tumors were found to be attached to each cusps of the aortic valve and they were successfully removed. The histopathologic diagnosis was papillary fibroelastoma of the aortic valve. The postoperative course was uneventful.
    Kyobu geka. The Japanese journal of thoracic surgery 01/2000; 52(13):1124-7.
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    ABSTRACT: Recently, combined treatment using the Maze procedure for organic heart disease and atrial fibrillation has been reported, but there have been few studies of cardiac rhythm after combined treatment. Predictors of cardiac rhythm after combined surgical treatment have been unknown. Thirty patients who underwent cardiac surgery with the Maze procedure were retrospectively enrolled in this study. Two groups consisted of the patients with restoration of sinus rhythm after surgery (SR: n=15, 6 males and 9 females, mean age of 64 years), and the patients with maintenance of atrial fibrillation (AF; n=15, 5 males and 10 females, mean age of 61 years). Before cardiac surgery, all patients underwent exercise testing with measurement of atrial natriuretic peptide (ANP) before and after exercise testing, two-dimensional echocardiography, and right and left heart catheterization. The mean maximal heart rate and the ANP level after exercise testing in SR were significantly higher than those in AF. The left atrial dimension and right atrial and pulmonary capillary wedge pressures were significantly higher in AF than in SR. These findings indicate that subjects in SR exhibited less impaired atrial function which were evaluated by exercise testing with measurement of ANP, echocardiography, and cardiac catheterization. The atrial function of patients with sinus rhythm after the Maze procedure may be less impaired than that of patients remaining in atrial fibrillation.
    The Journal of cardiovascular surgery 01/2000; 40(6):793-6. · 1.51 Impact Factor
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    ABSTRACT: Long-term results after the modified Cox/Maze III procedure combined with other cardiac procedure for the treatment of organic heart disease and chronic atrial fibrillation (AF) has not been clarified. This report describes our medium-term results after such operation. Between March 1993 and August 1995, 104 consecutive patients with chronic AF underwent the modified Cox/Maze III procedure combined with other cardiac procedure. There were 100 long-term survivors. There were 45 men and 55 women, with ages ranging from 21 to 77 years (mean 59.7). Patients were followed up and changes in rhythm, need for pacemaker implantation, and the incidence of CNS (central nervous system) complications were retrospectively studied. The follow-up was complete in 103 patients and 99 long-term survivors (99%). The mean follow-up period was 44.6 +/- 1.1 months. In the immediate postoperative period, 73 patients regained sinus rhythm (SR group), 21 patients were in AF (AF group), and six patients underwent pacemaker implantation because of sick sinus syndrome (SSS). During the follow-up period, eight patients died. One- and 5-year survival rates (Kaplan-Meier) after surgery was 95.1 +/- 2.3 and 87.8 +/- 3.4% for the entire group. Preoperative NYHA class was 2.5 +/- 0.7 and medium-term NYHA class was 1.5 +/- 0.5. (P < 0.001) Changes in rhythm for the SR group were followed. Fifty-two patients of the SR group stayed in SR (72%), 16 patients converted back to AF (22%), and four patients had newly-developed SSS (6%) at follow-up period. Probability in SR maintenance for SR group at 1 year was 88.8 +/- 3.7% and at 5 years was 64.8 +/- 7.5%. Five patients experienced the CNS complication during the follow-up period. Two of the AF group and two of the SR group patients developed cerebral/cerebellar infarction. One of the SR group patients experienced small cerebral bleeding. The medium-term results after the modified Cox/Maze III procedure concomitant with other cardiac procedure are good with improved functional status and good survival rate. However, there seems to be gradual but constant attrition in the rate of SR maintenance in SR group.
    European Journal of Cardio-Thoracic Surgery 01/2000; 17(1):25-9. · 2.67 Impact Factor
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    Journal of Cardiac Failure 09/1999; 5(3):45-45. · 3.32 Impact Factor