Shinichi Fujimoto

Nara Medical University, Nara, Nara, Japan

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Publications (99)213.26 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background:Inflammatory processes are suggested to play a pathogenic role in the development and progression of non-rheumatic aortic stenosis (AS). Major surgery causes an inflammatory reaction. With the increasing prevalence of non-rheumatic AS, the number of affected patients undergoing major surgery increases. We hypothesized that major non-cardiac surgery (MNCS) could accelerate the progression of non-rheumatic AS.Methods and Results:We enrolled 218 consecutive patients with non-rheumatic AS who underwent transthoracic echocardiography (TTE) at least twice more than 6 months apart. Study patients were divided into the MNCS group and the non-MNCS group. The MNCS group consisted of patients who underwent MNCS during the TTE follow-up interval. At baseline, peak pressure gradient across the aortic valve (AVG) was similar between the groups. Also baseline clinical characteristics and TTE follow-up interval were similar. The annual rate of peak AVG increase was much higher in the MNCS group than in the non-MNCS group. The proportion of patients with rapid hemodynamic progression was much higher in the MNCS group than in the non-MNCS group. Multiple logistic regression analysis showed that MNCS was an independent predictor of rapid hemodynamic progression of non-rheumatic AS.Conclusions:The present study indicates for the first time that MNCS is associated with the rapid progression of non-rheumatic AS.
    Circulation Journal 01/2015; 79(4). DOI:10.1253/circj.CJ-14-1111 · 3.69 Impact Factor
  • Reiko Mizuno, Shinichi Fujimoto, Yoshihiko Saito
    Circulation Journal 11/2013; 77(12). DOI:10.1253/circj.CJ-13-1294 · 3.69 Impact Factor
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    ABSTRACT: Evaluation of left ventricular (LV) diastolic function is essential for the management of heart failure. We verified whether LV diastolic function could be evaluated by measuring the fractional area change (FAC) using cine cardiovascular magnetic resonance (CMR). We collected clinical data from 59 patients who underwent echocardiography and cine CMR. Normal, impaired relaxation, pseudonormal, and restrictive LV filling were observed in 15, 28, 11, and 5 patients, respectively. We calculated FAC during the first 30% of diastole (diastolic-index%) in the short-axis view, by tracing the contours on only three MR cine images. The diastolic index was significantly lower (p < 0.0001) in patients with impaired relaxation (32.4 +/- 7.5), pseudonormal filling (25.4 +/- 5.6), and restrictive filling (9.5 +/- 1.5) compared to those with normal diastolic function (67.7 +/- 10.8), and the index decreased significantly with worsening of diastolic dysfunction. The diastolic index correlated positively with early diastolic mitral annular velocity measured by tissue Doppler imaging (r = 0.75, p < 0.0001), respectively. Measurement of FAC can be useful for the evaluation of LV diastolic function using cine CMR.
    Journal of Cardiovascular Magnetic Resonance 09/2013; 15(1):87. DOI:10.1186/1532-429X-15-87 · 5.11 Impact Factor
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    ABSTRACT: Although cardiotoxicity is a well-known side effect of anthracycline, detection of subclinical impairment of myocardial contractility at the latent stage is difficult. The left ventricular end-systolic wall stress (WS)-velocity of circumferential fiber-shortening (VCF) relationship reflects the load-independent myocardial contractility and can detect sensitively intrinsic abnormalities in myocardial contractility. Usefulness of this relationship in detecting subclinical anthracycline-induced cardiotoxicity has not yet been established. We investigated whether latent anthracycline-induced cardiotoxicity at the subclinical state can be detected by using the WS-VCF relationship in patients receiving anthracycline therapy. We studied 45 patients who had received anthracycline therapy and 40 healthy controls. All patients had preserved left ventricular ejection fraction (LVEF). WS and VCF were measured using echocardiography. VCF was corrected by heart rate. The WS-VCF relationship was derived by linear regression. Patients with data points lying below -2 SD derived from controls were regarded as having impaired intrinsic myocardial contractility. Although VCF was within normal limits in all patients, it was significantly reduced in the patient group overall compared with the control group. On the other hand, WS was significantly increased in the patient group overall compared with the control group. The WS-VCF relationship demonstrated impaired intrinsic myocardial contractility in 24 patients (53.3 %). In more than half of patients with preserved LVEF, impairment of intrinsic myocardial contractility was detected using the WS-VCF relationship, suggesting the presence of latent anthracycline-induced cardiotoxicity. The WS-VCF relationship may be able to detect sensitively latent anthracycline-induced cardiotoxicity at the subclinical stage.
    Heart and Vessels 06/2013; DOI:10.1007/s00380-013-0375-5 · 2.11 Impact Factor
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    ABSTRACT: A 63-year-old man was referred to our hospital because of a cardiac tumor. Transthoracic echocardiography revealed a rough, mobile tumor in the dilated right atrium, and transesophageal echocardiography showed that the tumor consisted of small, botryoidal masses. Catheter-based biopsy carried a high risk of embolism. Therefore, we used F-18-fluorodeoxyglucose positron emission tomography (FDG-PET), which revealed an abnormal accumulation in the right cervical lymph nodes, as well as in the heart. We safely performed biopsy of the lymph nodes and diagnosed the patient with primary cardiac lymphoma. We concluded that echocardiography and FDG-PET are useful for selecting an appropriate biopsy site in primary cardiac lymphoma.
    Echocardiography 10/2012; 30(1). DOI:10.1111/echo.12006 · 1.25 Impact Factor
  • Reiko Mizuno, Shinichi Fujimoto, Yasuyuki Okamoto
    Case Reports 08/2012; 2012. DOI:10.1136/bcr-2012-006530
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    ABSTRACT: Recently, coronary microvascular function was documented to be impaired even in patients with prehypertension. However, the impact of antihypertensive level on improvement of coronary microvascular dysfunction in hypertensive patients remains to be established. We investigated the optimal blood pressure achieved with treatment of antihypertensive agents for improvement of coronary microvascular dysfunction in hypertensive patients. We prospectively studied 108 untreated hypertensive patients. All patients were treated with antihypertensive agents for approximately 12 months. Coronary flow reserve (CFR) was measured before and after treatment. The patients were divided into hypertensive, prehypertensive, and normal groups based on their average blood pressure during the treatment period. Pretreatment CFR was similar among all groups. CFR increased significantly in the normal group during the treatment period, but decreased significantly in the prehypertensive and hypertensive groups. This decrease was significantly greater in the hypertensive group than in the prehypertensive group. Multivariate analysis showed lowering blood pressure to normal level to be an independent determinant of improvement in CFR. The normal group was divided into normal-higher and normal-lower subgroups based on their average diastolic blood pressure during the treatment period. Increase in CFR was significantly greater in the normal-higher group than in the normal-lower group. These findings indicate that lowering blood pressure to a normal level is necessary to improve coronary microvascular dysfunction in hypertensive patients. Furthermore, raising diastolic blood pressure to a higher level within normal range has the most beneficial effect. However, as this study is based on observational design, it may have several limitations.
    Hypertension 07/2012; 60(2):326-32. DOI:10.1161/HYPERTENSIONAHA.111.189209 · 7.63 Impact Factor
  • Internal Medicine 01/2012; 51(18):2669. DOI:10.2169/internalmedicine.51.8385 · 0.97 Impact Factor
  • Shinichi Fujimoto
    Circulation Journal 12/2011; 76(2):295-6. DOI:10.1253/circj.CJ-11-1377 · 3.69 Impact Factor
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    ABSTRACT: This report describes a case of giant left atrial myxoma in a 43-year-old woman. She presented with general malaise and dyspnea. Electrocardiogram showed severe right-axis deviation. Transthoracic echocardiography demonstrated a giant mobile mass with size of 6.5 × 4.5 cm in the left atrium. This mass protruded into the left ventricle in diastole and disturbed transmitral left ventricular filling flow. Bilateral atrium and right ventricle were dilated. Severe tricuspid regurgitation was demonstrated with peak pressure gradient of 91 mmHg. This mass was surgically excised and was diagnosed as benign atrial myxoma by histological analysis. Pulmonary hypertension was improved after surgery.
    Journal of Echocardiography 12/2011; 9(4). DOI:10.1007/s12574-011-0097-6
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    ABSTRACT: Contrast-enhanced cardiac magnetic resonance imaging (MRI) can depict papillary muscle (PM) necrosis or fibrosis by late enhancement (LE) of PM, but its clinical significance in old myocardial infarction (OMI) has been little understood. Myocardial LE and PM-LE were detected with contrast imaging in 60 patients with OMI caused by a single culprit coronary artery lesion. Left ventricular (LV) morphology and function, mitral valve geometry, and severity of mitral regurgitation were also evaluated by cine imaging. Sphericity index was calculated for the assessment of LV remodeling. PM-LE was detected in 32 of 60 (53.3%) OMI patients. Unilateral PM-LE was detected in 22 patients and bilateral PM-LE in 10 patients. Patients with bilateral PM-LE demonstrated more severe LV remodeling and functional mitral regurgitation than those with unilateral or no PM-LE (sphericity index; bilateral PM-LE, 1.60±0.15, unilateral PM-LE, 1.71±0.29, no PM-LE, 1.85±0.27, p≤0.05) (mitral regurgitation; bilateral PM-LE, 1.10±0.57, unilateral PM-LE, 0.41±0.73, no PM-LE, 0.54±0.84, p≤0.05). In cases of unilateral PM-LE, posteromedial PM-LE resulting from right coronary artery-related OMI was accompanied by less severe mitral regurgitation, while anterolateral PM-LE resulting from left coronary artery-related OMI was not associated with severity of mitral regurgitation. More than half of patients with OMI showed unilateral or bilateral PM-LE, and bilateral PM-LE was closely related to more severe LV remodeling and functional mitral regurgitation.
    International journal of cardiology 01/2011; 146(1):73-9. DOI:10.1016/j.ijcard.2010.04.037 · 6.18 Impact Factor
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    ABSTRACT: Echocardiography and magnetic resonance imaging revealed biventricular non-compaction cardiomyopathy with ventricular (VSD) and atrial (ASD) septal defects in an unconscious, 23-year-old hypoxemic man. Doppler echocardiography showed a left-to-right shunt across the VSD and a right-to-left shunt across the ASD. Cardiac catheterization revealed elevated right atrial pressure, although pulmonary pressure was normal. We considered that the atrial right-to-left shunt had induced the hypoxemia, which was related mainly to right ventricular dysfunction in this biventricular non-compaction cardiomyopathy, but it was not related to pulmonary hypertension.
    Internal Medicine 01/2011; 50(16):1747-51. DOI:10.2169/internalmedicine.50.5290 · 0.97 Impact Factor
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    ABSTRACT: A 13-year-old girl was admitted to our hospital because mitral P wave and ST depression in leads II, III, aVF, and V3-6 were incidentally detected on electrocardiography at a school health examination. Although she had noted no cardiac symptoms during club volley ball games, the treadmill exercise test induced chest discomfort in the absence of obvious electrocardiographic changes. B-type natriuretic peptide was elevated at 685 pg/ml. Echocardiography revealed left mid-ventricular hypertrophy and obstruction, sparing of the apical ventricle at end-systole, and severe left atrial dilatation. Continuous-wave Doppler echocardiography clarified a peak pressure gradient of about 40 mmHg between the apical and basal sites of the left ventricle. Swan-Ganz catheterization suggested elevated atrial pressure and left ventricular end-diastolic pressure. Left ventriculography showed an “hourglass” appearance. Endomyocardial biopsy revealed cardiac muscle cell disarray. We diagnosed a rare pediatric case of hypertrophic cardiomyopathy with mid-ventricular obstruction. This case reconfirms that electrocardiography during school health examinations is a very important screening tool for the detection of asymptomatic or mild symptomatic cardiac diseases.
    Journal of Cardiology Cases 04/2010; 1(2). DOI:10.1016/j.jccase.2009.08.006
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    ABSTRACT: The clinical importance of cold-induced reversible myocardial ischaemia, known as cardiac Raynaud's phenomenon (C-Raynaud), has not been established in systemic sclerosis (SSc). This prospective study investigated the impact of C-Raynaud on long-term irreversible left ventricular (LV) functional and morphologic deterioration in SSc. Fifty-one SSc patients with no clinical evidence of cardiac involvement were prospectively followed up for 7.1 +/- 2.2 years. Systolic LV dysfunction was defined as a LV ejection fraction <50%. Left ventricular remodelling was defined as an increase in LV volume during follow-up of more than 20% compared with baseline values. At the initial evaluation, C-Raynaud was found in 15 patients (29.4%). Of these, eight patients had severe C-Raynaud. None of the patients had systolic LV dysfunction. At the final evaluation, five patients had developed systolic LV dysfunction. In four of these five patients, the development of systolic LV dysfunction was associated with LV remodelling. At multivariate analysis, severe C-Raynaud was a strong independent determinant of the development of long-term systolic LV dysfunction. This study documents for the first time that severe C-Raynaud is a strong long-term predictor of systolic LV dysfunction in SSc patients. Detection of C-Raynaud is clinically important for identifying SSc patients at high risk of cardiac deterioration at latent stage.
    European Journal of Heart Failure 03/2010; 12(3):268-75. DOI:10.1093/eurjhf/hfp198 · 6.58 Impact Factor
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    ABSTRACT: The initiation of ventricular diastole is an energy-dependent phase of cardiac cycle. Delayed onset of left ventricular (LV) relaxation has been proposed to identify myocardial ischemia. Diabetes mellitus (DM) is known to be associated with coronary microangiopathy, but its influence on LV early relaxation is not established. Ninety-two subjects consisting of 70 DM patients without overt cardiac disease and 22 normal controls were evaluated. Using strain rate imaging, time from R-wave on the electrocardiogram to onset of LV relaxation (Tr) was measured at rest and peak exercise. Using myocardial contrast echocardiography, myocardial blood flow (MBF) was measured at rest and peak exercise, enabling MBF reserve. Tr at rest was similar between DM patients and controls, but Tr at peak exercise was significantly longer in DM patients than controls. MBF reserve was significantly reduced in DM patients compared with controls. There was a significant negative correlation between Tr at peak exercise and MBF reserve. In a multivariate analysis, MBF reserve was an independent determinant of Tr at peak exercise. This study demonstrates that DM patients have exercise-induced delayed onset of LV relaxation in association with impaired coronary microcirculatory function in the absence of coexistent heart disease.
    Journal of cardiac failure 03/2010; 16(3):211-7. DOI:10.1016/j.cardfail.2009.10.024 · 3.07 Impact Factor
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    ABSTRACT: This report describes a case of accessory mitral valve in an elderly patient on maintenance hemodialysis. Transesophageal echocardiography revealed a mobile sac-like structure with size of 12×10mm2, which attached to the left ventricular surface of base of the anterior mitral valve leaflet. Mobile stick-like structure with diameter of 21mm was extending from this sac-like structure toward the left ventricular outflow tract and had a floating free edge. Peak pressure gradient across the left ventricular outflow tract was 32mmHg. There were no other congenital cardiac anomalies. No clinical findings suggestive of bacterial or nonbacterial vegetation were seen. Also other possibilities of mobile thrombus or calcification were unlikely. These abnormal structures were diagnosed as accessory mitral valve with rudimentary chordae.
    Journal of Echocardiography 12/2009; 7(4):80-81. DOI:10.1007/s12574-009-0021-5
  • R Mizuno, S Fujimoto, Y Saito, S Nakamura
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    ABSTRACT: To investigate the relation between myocardial perfusion and heart failure (HF) status after revascularisation in patients with HF due to hibernating myocardium (HM) in diabetic and non-diabetic subjects. 31 diabetic and 33 non-diabetic subjects with HF due to HM, who were already scheduled for complete revascularisation, were studied. Before and after revascularisation, left ventricular function and regional perfusion in subendocardial and subepicardial portions of the left ventricular wall were evaluated. Before revascularisation, left ventricular function and regional perfusion were similar in diabetic and non-diabetic subjects. At 6 months after revascularisation, subepicardial perfusion was markedly improved both in diabetic and non-diabetic subjects. However, subendocardial perfusion was markedly improved only in non-diabetic subjects and was little changed in diabetic patients. Thus, subendocardial perfusion was much lower in diabetic than non-diabetic subjects. Left ventricular function was improved more in non-diabetic than in diabetic subjects. Persistent HF was found much more often in diabetic than non-diabetic subjects. At multivariate analysis, subendocardial perfusion at 6 months independently contributed to persistent HF. This study describes the intramural heterogeneity of recovery of myocardial perfusion with depressed improvement in the subendocardial portion and its relation with persistent HF after complete revascularisation in diabetic patients with HF due to HM.
    Heart (British Cardiac Society) 05/2009; 95(10):830-4. DOI:10.1136/hrt.2008.155044 · 6.02 Impact Factor
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    ABSTRACT: We compared the enhancement effects of three different echo contrast agents (ECAs); Levovist, YM454, and MRX-815H as artificial microbubbles on ultrasound mediated gene transfection (USMGT) with 1MHz ultrasound at 0.2MPa using a luciferase expression vector in PC3 cells and elucidated the mechanisms of differences of USMGT facilitation by these ECAs. At a concentration of each ECA that induced iso-survival, ECAs with lipid shell (YM454 and MRX-815H) facilitated USMGT higher than those without shell (Levovist), and the order of the ECAs facilitating free radical formation by sonication was; YM454>MRX-815H>Levovist. These results suggested that the lipid shell type ECAs facilitated gene transfer higher than that by the non-shell type ECA.
    Cancer Letters 07/2008; 265(1):107-12. DOI:10.1016/j.canlet.2008.02.004 · 5.02 Impact Factor
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    ABSTRACT: The present study was conducted to examine the thermal and non-thermal effects of ultrasound on apoptosis induced by anti-CD20 monoclonal antibody (rituximab). SU-DHL-4 cells, a CD20-positive cell line derived from B cell lymphomas with a BCL2 gene rearrangement, were exposed to continuous 1 MHz ultrasound for therapeutic use under an air- or CO(2)-saturated condition to control cavitation. Early apoptosis (EA) and secondary necrosis (SN) were examined by flow cytometry. Cavitation was determined by detecting the hydroxyl radicals derived from pyrolysis of water molecules using electron paramagnetic resonance-spin trapping. To assess thermal effects, cells were treated in a temperature-controlled water bath. There was a significant additive increase in EA and EA+SN observed in cells treated with rituximab combined with heat at 42 degrees C or non-thermal ultrasound at 0.5 W/cm(2) under an air-saturated condition, where heat or ultrasound induced some cell death. A significant synergistic increase in EA and EA+SN was observed in cells treated with rituximab and ultrasound at 2.5 W/cm(2) under CO(2)-saturated conditions, where inertial cavitations were completely suppressed. No enhancement was observed at a temperature less than 40 degrees C or ultrasound at 0.5 W/cm(2) under CO(2)-saturated conditions. These results suggest that the immuno-therapeutic application of ultrasound at relatively high-intensities combined with rituximab thus produces synergistic effects under conditions where the non-thermal and non-cavitational effects are predominant.
    Ultrasonics Sonochemistry 05/2008; 15(4):463-71. DOI:10.1016/j.ultsonch.2007.08.004 · 3.82 Impact Factor
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    ABSTRACT: As the reason for insufficient control of blood pressure (BP), poor compliance of taking antihypertensive agents is an important issue. In Japan, no prospective study on the compliance of antihypertensive agents has been done. In this study we prospectively investigated the details of the relationship between the compliance of taking antihypertensive agents and living style and situation in hypertensive patients. We prospectively examined 121 outpatients with essential hypertension treated with antihypertensive agents for 12 months. Using an oral interview based on the questionnaire sheet, the factors about living style and situations which worsen the compliance were assessed. Also we evaluated the relationship of BP control and season, which was compared between patients with poor compliance and those with good compliance. As for the background of the poor compliance, many factors related to the patients' living style and situation were clarified. On average for 12 months the levels of the compliance and BP showed a significant negative correlation and BP was significantly higher in patients with poor compliance than those with good compliance. However, in the summer season BP did not differ between patients with poor and good compliance, Many factors regarding the patients' living style and situation were related to poor compliance. The development of strategy that changes these factors is a future task for improving compliance. This study may also imply that unnecessary antihypertensive agents are prescribed in some patients with poor compliance in the summer season. Determination of the suitable prescription by which to attain optimal individual patients' compliance is important in the treatment of hypertensive patients.
    Internal Medicine 02/2008; 47(19):1655-61. DOI:10.2169/internalmedicine.47.1016 · 0.97 Impact Factor

Publication Stats

591 Citations
213.26 Total Impact Points


  • 1993–2013
    • Nara Medical University
      • • Education Development Center
      • • Department of General Medicine
      • • Department of Internal Medicine
      Nara, Nara, Japan
  • 2000
    • Kanazawa University
      Kanazawa, Ishikawa, Japan
  • 1999
    • Tamagawa University
      Machida, Tōkyō, Japan