Kazuhiro Shinozaki

Tsurumi Hospital, Бэппу, Ōita, Japan

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Publications (15)43.04 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Obtaining the right chest electrocardiogram (ECG) is essential for diagnosing concomitant right ventricular infarction in patients with inferior wall acute myocardial infarction (AMI). A software program to synthesize right chest ECG waveforms from 12-lead ECG waveforms is available in Japan. However, its reliability has not been fully investigated. Accordingly, we examined the reliability of ST-segment shifts in the synthesized V3R–V5R leads. ST-segment shifts in actual and synthesized V3R–V5R leads were compared during the last 10 seconds of 131 balloon inflations while performing elective percutaneous coronary intervention in 56 patients with coronary artery disease. The ST-segment shifts in the actual and synthesized V3R–V5R leads were correlated (r = 0.96, p <0.001; r = 0.94, p <0.001; r = 0.91, p <0.001, respectively). A Bland-Altman analysis showed that the bias between the ST-segment shifts in the actual and synthesized V3R–V5R leads was -3.1 μV, -5.4 μV and -4.2 μV, respectively, while the limit of agreement between the ST-segment shifts in the actual and synthesized V3R–V5R leads was -59.2 – 52.9 μV, -61.9 – 51.1 μV and -59.7 – 51.3 μV, respectively. The kappa coefficients for ST-segment elevation of ≥50 μV and ≥100 μV in the actual and synthesized V3R–V5R leads were 0.83 and 0.81, 0.66 and 0.83 and 0.57 and 0.80, respectively. In conclusion, this study indicates that ST-segment shifts in the synthesized V3R–V5R leads have acceptable reliability, suggesting that the synthesized right chest ECG can be used to diagnose concomitant right ventricular infarction in patients with inferior wall AMI.
    The American Journal of Cardiology. 01/2014;
  • Journal of Cardiology Cases. 01/2014;
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    ABSTRACT: Previous investigations have demonstrated the presence of gender differences in the symptoms of angina pectoris and acute coronary syndrome. However, most of these investigations have had certain limitations, including being retrospective, an interview-related bias, a various duration of myocardial ischemia, and a lack of multivariate analysis, all of which would have affected the results. Accordingly, we prospectively examined the presence or absence of chest pain and non-chest pain symptoms during a 60-second balloon inflation in the setting of percutaneous coronary intervention, which provides a unique model of transient myocardial ischemia, in 110 men and 80 women with coronary artery disease. Chest pain and/or non-chest pain symptoms (occipital pain, jaw pain, neck/throat pain, shoulder pain, upper arm pain, back pain, and nausea) were observed during the balloon inflation in 72 men and 52 women. In the 124 patients with any symptoms during the balloon inflation, non-chest pain symptoms were more common in women than in men (31% vs 14%, p = 0.02); however, the incidence of chest pain did not differ between the men and women. After adjustment for covariables, including age, body mass index, hypertension, diabetes mellitus, current smoking, previous myocardial infarction, target vessels, β-blocker use, and calcium antagonist use, female gender remained significantly associated with non-chest pain symptoms (odds ratio 3.3, 95% confidence interval 1.2 to 9.9, p = 0.02). In conclusion, non-chest pain symptoms during the 60-second balloon occlusion of the coronary artery were more common in women than in men, supporting the presence of the gender difference in myocardial ischemic symptoms.
    The American journal of cardiology 03/2013; · 3.58 Impact Factor
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    ABSTRACT: The aim of this study was to clarify the prognostic significance of P-wave terminal force in lead V(1) (PTFV(1)) in patients with prior myocardial infarction (MI). We retrospectively examined 185 patients with prior MI. The primary end point was cardiac death or hospitalization for heart failure. Abnormal PTFV(1) was defined as PTFV(1) ≥ 40 mm × ms. During a follow-up period of 6.4 ± 2.9 years, 39 patients developed the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in 79 patients with abnormal PTFV(1) than in 106 patients with normal PTFV(1) (P < 0.001). When we classified 79 patients with abnormal PTFV(1) into 31 with a purely negative P wave in lead V(1) and 48 with a biphasic negative P wave in lead V(1), the primary event-free rate did not differ between the two groups of patients. A multivariate Cox regression analysis selected age (hazard ratio (HR) 1.09, 95 % confidence interval (CI) 1.04-1.14, P < 0.001), multivessel coronary disease (HR 2.33, 95 % CI 1.02-5.28, P = 0.04), and abnormal PTFV(1) (HR 2.72, 95 % CI 1.24-5.99, P = 0.01) as independent predictors of the primary end point. In conclusion, abnormal PTFV(1) is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI. The analysis of P waves in lead V(1) should provide useful prognostic information in patients with prior MI.
    Heart and Vessels 11/2012; · 2.13 Impact Factor
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    ABSTRACT: No information is currently available on the prognostic significance of the number of leads with fragmented QRS (fQRS). The objective of the study was to clarify the prognostic significance of the number of leads with fQRS in prior myocardial infarction (MI). We retrospectively examined 170 patients with prior MI. The primary end point was cardiac death or hospitalization for heart failure. During a mean follow-up period of 6.4 ± 2.9 years, 37 patients developed the primary end point. Univariate Cox proportional hazards regression analyses showed that age, male gender, chronic kidney disease, anterior wall MI, number of leads with fQRS, left ventricular ejection fraction, loop diuretic use, and spironolactone use were significantly associated with the primary end point. A multivariate Cox proportional hazards regression analysis selected age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.04-1.14, p<0.001) and the number of leads with fQRS (HR 1.33, 95% CI 1.11-1.60, p=0.002) as predictors of the primary end point. A receiver operating characteristic curve analysis showed that the presence of ≥3 leads with fQRS was most useful for distinguishing between patients with and without the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in patients with ≥3 leads with fQRS than in those with <3 leads with fQRS. The number of leads with fQRS, especially the presence of ≥3 leads with fQRS, is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI.
    Journal of Cardiology 01/2012; 59(1):36-41. · 2.30 Impact Factor
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    ABSTRACT: The aim of the present study was to clarify the prognostic significance of upright T waves (amplitude > 0 mV) in lead aVR in patients with a prior myocardial infarction (MI). We retrospectively examined 167 patients with a prior MI. The primary end point was cardiac death or hospitalization for heart failure. During a follow-up period of 6.5 ± 2.8 years, 34 patients developed the primary end point. A Kaplan-Meier analysis showed a lower primary event-free rate in patients with upright T waves in lead aVR than in those with nonupright T waves in lead aVR (P = 0.001). Univariate Cox proportional hazards regression analyses showed that age, gender, chronic kidney disease, anterior wall MI, upright T waves in lead aVR, left ventricular ejection fraction, loop diuretic use, and spironolactone use were significantly associated with the primary end point. A multivariate Cox proportional hazards regression analysis selected age [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.05-1.16, P < 0.001], upright T waves in lead aVR (HR 3.10, 95% CI 1.23-7.82, P = 0.017), and loop diuretic use (HR 4.61, 95% CI 1.55-13.67, P = 0.006) as independent predictors of the primary end point. In conclusion, the presence of upright T waves in lead aVR is an independent predictor of cardiac death or hospitalization for heart failure in patients with a prior MI. The analysis of T-wave amplitude in lead aVR provides useful prognostic information in patients with a prior MI.
    Heart and Vessels 10/2011; · 2.13 Impact Factor
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    ABSTRACT: Several studies have examined the ability of electrocardiography to differentiate between takotsubo cardiomyopathy (TC) and anterior wall acute ST-segment elevation myocardial infarction (AA-STEMI). In those studies, the magnitude of ST-segment elevation was not measured at the J point. The American Heart Association, American College of Cardiology Foundation, and Heart Rhythm Society guidelines recommend that the magnitude of ST-segment elevation should be measured at the J point. Accordingly, the aim of this study was to retrospectively examine whether electrocardiography, using the magnitude of ST-segment elevation measured at the J point, could differentiate 62 patients with TC from 280 with AA-STEMI. Patients with AA-STEMI were divided into following subgroups: 140 with left anterior descending coronary artery occlusions proximal to the first diagonal branch (AA-STEMI-P), 120 with left anterior descending occlusions distal to the first diagonal branch and proximal to the second diagonal branch (AA-STEMI-M), and 20 with left anterior descending occlusions distal to the second diagonal branch (AA-STEMI-D). TC had a much lower prevalence of ST-segment elevation ≥1 mm in lead V(1) (19.4%) compared to AA-STEMI (80.4%, p <0.01), AA-STEMI-P (80.7%, p <0.01), AA-STEMI-M (80%, p <0.01), and AA-STEMI-D (80%, p <0.01). ST-segment elevation ≥1 mm in ≥1 of leads V(3) to V(5) without ST-segment elevation ≥1 mm in lead V(1) identified TC with sensitivity of 74.2% and specificity of 80.6%. Furthermore, this criterion could differentiate TC from each AA-STEMI subgroup, with similar diagnostic values. In conclusion, using the magnitude of ST-segment elevation measured at the J point, a new electrocardiographic criterion is proposed with an acceptable ability to differentiate TC from AA-STEMI.
    The American journal of cardiology 06/2011; 108(5):630-3. · 3.58 Impact Factor
  • Kazuhiro Shinozaki, Akira Tamura, Junichi Kadota
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    ABSTRACT: No information is available on the clinical significance of a positive T wave in lead aVR in myocardial infarction (MI). Accordingly, in the present study, we sought to clarify the associations of the positive T wave in lead aVR with hemodynamic, coronary angiographic, and left ventriculographic findings in anterior wall old MI. We examined 122 patients with anterior wall old MI who underwent diagnostic or follow-up cardiac catheterization including coronary angiography and left ventriculography. The patients were classified into the following 2 groups: patients with a positive (≥ 1mm) T wave in lead aVR (n=20, group A) and those without (n=102, group B). Group A had higher pulmonary arterial, pulmonary capillary wedge, and left ventricular (LV) end-diastolic pressures and a lower cardiac index than group B. The prevalence of a long left anterior descending coronary artery (LAD) was higher in group A than in group B (60% vs 30.4%, p=0.01), and none of group A patients had an LAD that did not reach the apex. Group A had a lower LV ejection fraction than group B (36.4 ± 11.6% vs 48.4 ± 12.7%, p<0.001). The positive T wave in lead aVR is related to severely reduced cardiac function, with an LAD wrapping the apex, in anterior wall old MI. Further studies are needed to clarify whether the positive T wave in lead aVR is associated with an adverse outcome in patients with anterior wall old MI.
    Journal of Cardiology 02/2011; 57(2):160-4. · 2.30 Impact Factor
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    ABSTRACT: The association between sleep-disordered breathing (SDB) assessed by polysomnography and cardiac sympathetic nerve activity (SNA) assessed by cardiac iodine-123 metaiodobenzylguanidine (123I-MIBG) imaging has not been investigated in patients with chronic heart failure (CHF). We performed cardiac 123I-MIBG scintigraphy and overnight polysomnography in 59 patients with stable CHF. The patients were classified into the 3 groups: 19 with no or mild SDB (NM-SDB, apnea-hypopnea index <15); 21 with central sleep apnea (CSA), and 19 with obstructive sleep apnea (OSA). The cardiac washout rate (WR) of 123I-MIBG was obtained from initial and delayed planar 123I-MIBG images. The WR was higher in patients with CSA (54.2 + or - 11.6%) than in those with OSA (37.9 + or - 8.6%, P < .05) or NM-SDB (40.8 + or - 8.8%, P < .05). The WR correlated positively with central apnea index (rho = 0.40, P = .002). A stepwise multiple regression analysis selected CSA and plasma brain natriuretic peptide levels as independent variables associated with the WR. The WR was higher in CHF patients with CSA than in those with OSA or NM-SDB, and CSA was independently associated with the WR, suggesting a link of CSA to increased cardiac SNA in CHF.
    Journal of cardiac failure 09/2010; 16(9):728-33. · 3.25 Impact Factor
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    ABSTRACT: We sought to electrocardiographically distinguish ST-segment elevation (STE)-acute myocardial infarction (AMI) caused by occlusion of the first diagonal branch (D1) from STE-AMI caused by occlusion of the left anterior descending coronary artery (LAD). We examined 28 patients with STE-AMI caused by D1 occlusion (G-D) and 342 with STE-AMI caused by LAD occlusion (G-L). G-D had a higher prevalence of STE > or = 0.5 mm in each of leads I and aVL and a lower prevalence of STE > or = 1 mm in each of leads V(1) through V(6) than G-L. The prevalence of STE > or = 0.5 mm in lead aVL without STE > or = 1 mm in lead V(1) was higher in G-D (82.1%) than in G-L (9.4%, P < .01). ST-segment elevation > or = 0.5 mm in lead aVL without STE > or = 1 mm in lead V(1) may be useful to distinguish STE-AMI caused by occlusion of the D1 from STE-AMI caused by occlusion of the LAD.
    Journal of electrocardiology 06/2009; 42(5):440-4. · 1.08 Impact Factor
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    ABSTRACT: The efficacy and safety of sarpogrelate, a selective 5-hydroxytryptamine receptor subtype 2A antagonist, have not yet been established in bare metal coronary stenting. Accordingly, we sought to clarify whether treatment with sarpogrelate is clinically useful in bare metal coronary stenting. A total of 450 patients who underwent successfully planned or unplanned bare metal coronary stenting were randomly divided into the following 2 groups: the sarpogrelate (300 mg/day) plus aspirin (100 mg/day) group (group S, n=225) and the ticlopidine (200 mg/day) plus aspirin (100 mg/day) group (group T, n=225). Either sarpogrelate or ticlopidine was administered for at least 4 weeks after the procedure. Follow-up coronary arteriography was performed at 6 months after the procedure. The primary endpoints were the incidence of adverse drug reactions requiring a withdrawal of treatment and the rate of binary restenosis. The secondary endpoint was the incidence of stent thrombosis. The incidence of adverse drug reactions requiring a withdrawal of treatment was significantly lower in group S than in group T (0.44% vs 8%, p=0.002). The rate of binary restenosis did not differ significantly between groups S and T (16.9% vs 18.2%). In addition, the incidence of subacute stent thrombosis did not differ between groups S and T (0.44% vs 0.44%). The incidence of adverse drug reactions requiring a withdrawal of treatment was significantly lower with sarpogrelate use than with ticlopidine use. The rate of binary restenosis and the incidence of subacute stent thrombosis did not differ between both drug groups.
    International journal of cardiology 06/2008; 126(1):79-83. · 6.18 Impact Factor
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    ABSTRACT: The investigators prospectively examined 625 consecutive patients who underwent coronary multislice computed tomography (MSCT) for suspected coronary artery disease (CAD) and evaluated the presence or absence of cancers and other noncardiac abnormalities on the original transverse sectional images of MSCT. Eight patients with known cancers were excluded from the analysis. The remaining 617 patients (344 men, 273 women; mean age 66 +/- 12 years) were analyzed. Cancers were found in 7 patients (1.13%) on the multislice computed tomographic images, including 4 lung cancers (0.65%), 2 thyroid cancers (0.32%), and 1 hepatic cancer (0.16%). In addition, nonmalignant abnormalities (nodules, tumors, or lymphadenopathies) were also found in 142 patients (23.01%), consisting of 58 postinflammatory lung nodules (9.40%), 49 hepatic cysts or hemangiomas (7.94%), 18 benign thyroid tumors (2.92%), 12 mediastinal lymphadenopathies (1.94%), 4 benign mammary gland tumors (0.65%), and 1 esophageal submucosal tumor (0.16%). In conclusion, cancers and other noncardiac abnormalities are often found in patients who undergo coronary MSCT for suspected CAD. Because patients who undergo coronary MSCT for suspected CAD are mostly elderly and therefore may have unrecognized cancers or other noncardiac abnormalities, care should thus be taken not to overlook these abnormalities when analyzing the multislice computed tomographic images.
    The American Journal of Cardiology 07/2007; 99(11):1608-9. · 3.21 Impact Factor
  • International journal of cardiology 02/2007; 115(1):e3-4. · 6.18 Impact Factor
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    ABSTRACT: The aim of the present study was to clarify the effect of preinfarction angina pectoris (PIA) on myocardial blush grade (MBG), a simple marker of myocardial tissue-level reperfusion, in acute myocardial infarction (AMI). One hundred forty-two patients with first anterior wall AMI who were admitted within 6 h after onset of symptoms were examined. PIA was defined as typical chest pain within 48 h before onset of symptoms. MBG was evaluated by coronary angiography after reperfusion. Patients with MBG 2 or 3 (n=103) had a higher frequency of PIA and a lower frequency of diabetes mellitus than those with MBG 0 or 1 (n=39) (57% vs 28%, p=0.004, and 23% vs 44%, p=0.03, respectively). The former had a lower peak creatine kinase level and a greater left ventricular ejection fraction at predischarge than the latter (3,652+/-2,440 vs 5,507+/-3,058 IU/L, p=0.0002, and 57+/-12% vs 45+/-11%, p<0.0001, respectively). Multivariate logistic regression analysis showed that PIA (p=0.004) and diabetes mellitus (p=0.03) were independently associated with MBG 2 or 3 after reperfusion. PIA has beneficial effects on myocardial tissue-level reperfusion evaluated by MBG in first anterior wall AMI.
    Circulation Journal 06/2006; 70(6):698-702. · 3.58 Impact Factor
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    ABSTRACT: Previous studies have demonstrated that an elevated neutrophil count on admission is associated with a higher risk of adverse events after acute myocardial infarction (AMI). However, the significance of the neutrophil count after reperfusion therapy has not been elucidated. The association of the neutrophil count on admission and days 2 and 3 with peak creatine kinase (CK) concentration, ST-segment resolution (a marker of myocardial tissue-level reperfusion), and left ventricular (LV) function at predischarge were examined in 122 patients (102 men, 20 women, mean age 61+/-11 years) with a first anterior wall AMI. Neutrophil counts were increased on day 2 and decreased on day 3 compared with admission (8,768+/-3,005 mm3, 6,617+/-2,424 mm3, and 7,725+/-3,388 mm3, respectively). Patients with ST-segment resolution (n=52) had lower neutrophil counts on days 2 and 3 than those without it (n=70), but neutrophil counts on admission did not differ significantly between patients with and without ST-segment resolution. Neutrophil counts on admission and days 2 and 3 were weakly but significantly correlated with peak CK concentration (r=0.31, p=0.0004; r=0.43, p<0.0001; r=0.32, p=0.003, respectively) and with LV ejection fraction at predischarge (r=-0.18, p=0.04; r=-0.26, p=0.003; r=-0.27, p=0.003; respectively). The neutrophil count after reperfusion is weakly but significantly correlated with infarct size, myocardial tissue-level reperfusion, and LV function at predischarge in a first anterior wall AMI. These correlations were slightly stronger than the correlations with the neutrophil count on admission.
    Circulation Journal 05/2005; 69(5):526-9. · 3.58 Impact Factor

Publication Stats

64 Citations
43.04 Total Impact Points

Institutions

  • 2009–2014
    • Tsurumi Hospital
      Бэппу, Ōita, Japan
  • 2005–2013
    • Oita University
      • • Faculty of Medicine
      • • Second Department of Internal Medicine
      Ōita-shi, Oita-ken, Japan