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ビクター エフ フロエリヒャ 博士

米国 スタンフォード大学

心電図負荷試験及び

メタボリック指標の父

ACC及びAHAのガイドライン

の原案作成者

主な文献

March 14 2002
N Engl J Med Vol 346 No 11 793-801
運動試験による 男性の
運動限界と生存率

Oct 2 2001
Circulation Vol 104 1694-1740
試験と訓練に対する運動の基準
エアロビックの効果    グッドケア    デュナ    デュナの実例   ブルーツース  ラブテック製品 心電・血圧ホルタ記録器  Labtech products

冠動脈疾患にはステント治療より心臓リハビリの運動の方が効果的
8月29日から9月2日のスペイン・バルセロナで開催された
欧州循環器学会のトピックとして注目される発表及び意見が出された。
それは、現在広く行われている血管造影及びバルーンPTCAやステント という診断及び治療方法は、
心臓リハビリなどで行われる運動の方が より患者に優しく、効果的であるとの多数の発表があった。
ワイヤレス12誘導負荷心電計は、日本でも認可されてご用意されて います。

Exercise beats angioplasty for some heart patients
. BARCELONA, Spain . Working up a sweat may be even better than angioplasty for some heart patients,
experts say. Studies have shown heart patients benefit from exercise, and some have even shown
it works better than surgical procedures. At a meeting of the European Society of Cardiology
on Sunday, several experts said doctors should focus moreon persuading their patients to exercise
rather than simply doing angioplasties. Angioplasty is the top treatment for people
having a heart attack or hospitalized with worsening symptoms. It involves using a tiny balloon
to flatten a blockage and propping the heart artery open with a mesh tube called a stent.
Most angioplasties are done on a nonemergency basis, to relieve chest pain caused
by clogged arteries cutting off the heart's blood supply. "
It's difficult to convince people to exercise instead of having an angioplasty,
but it works," said Rainer Hambrecht of Klinikum Links der Weser in Bremen,
Germany. Hambrecht published a study in 2004 that found that nearly 90 percent of heart patients
who rode bikes regularly were free of heart problems one year after they started their exercise regimen.
Among patients who had an angioplasty instead, only 70 percent were problem-free after a year.
Hambrecht is now conducting a similar trial, which he expects to confirm his initial findings:
that for some heart patients, exercise is more effective than a surgical procedure.
Other experts agreed that would likely be the case. An angioplasty "only opens up one vessel blockage,"
said Dr. Christopher Cannon, an associate professor of medicine at Harvard University and
spokesman for the American College of Cardiology. He was not linked to Hambrecht's research. "
Exercise does a lot more than fixing one little problem."
Among other benefits, exercise lowers bad cholesterol while raising good cholesterol, helps
the body process sugar better, improves the lining of the blood vessels and
gets rid of waste material faster. Exercise also lowers blood pressure and
prevents plaque buildup in the arteries. Previous research has estimated one third
of heart disease and stroke could be prevented if patients
did two-and-a-half hours of brisk walking every week.
In the U.S., that would mean 280,000 fewer heart-related deaths every year.
Joep Perk, a professor of health sciences at Sweden's Kalmar University and spokesman
for the European Society of Cardiology, said two thirds of heart patients in line
for an angioplasty could probably get better benefits by regularly working up a sweat.
Experts say less than 20 percent of heart patients get the recommended amount of exercise .
about 30 minutes of moderate activity five times a week. Perk said doctors who performed
angioplasties on their patients without asking them to change their lifestyles were ignoring
the fundamental problem. "It would be like getting rid of the most troubled rust spots
on a car without doing anything to stop more rust from appearing tomorrow."
Still, doctors admitted that persuading patients to exercise instead of simply going in
for an angioplasty, which can take less than a day, would be a tough sell. "
Most patients want the quick fix," Cannon said. Exercise may improve patients' hearts
better than an angioplasty, but it may also take months or even longer for patients to feel the benefits. "
It's a lot easier to get your artery fixed than it is to exercise every day." ____
On the Net: http://www.escardio.org

引用 上記

MET メタボリック換算運動量

縦軸 生存率

横軸 経過年数

 
引用 上記

縦軸 相対的危険度

横軸 危険度の原因

左から

高血圧、
慢性的閉鎖性肺疾患
糖尿病、
喫煙、
体脂肪率、
コレステロール、
引用 上記

デューク式トレッドミル指標

負荷試験中のST部位下降

虚血判読線

負荷試験中の老化度

予後平均
五年生存  年率生存率

運動の許容量

左記のラインは、55才男性の例


ワイヤレス12誘導心電計(メタボリック指標付き) で、世界へ文献を発信されませんか


2007年4月厚生労働省から認可された、最新のブルーツース無線の 方法で

全く新しく開発された心電計です。 安静時、歩行、エアロビクス、マスターステップ、エルゴメータ、トレッドミル、

などの動作中に、一貫して、同じ患者或いは健常人の心電図を一連に リアルタイム、同時に、監視、記憶、

記録、転送ができます。 不整脈、冠疾患など心の臓疾患、高血圧、糖尿病、内分泌、透析、

自律神経疾患等の病態解析、薬効効果、運動療法、リハビリ等の 医学文献の解析方法としてご提案申し上げます。

更に、当心電計からは、RR間隔、心電図波形のディジタル化データが 得られますので、自律神経や、

関連周波数解析などが可能です。 当心電計は、不整脈解析の心電計、負荷試験の心電計、リアルタイム解析の 心電計、

連続波形モニターの心電計、遠隔同時表示の心電計、 心電図データマネイジメント、等の機能を有します。

同じ会社からの、非観血血圧計付ホルタ心電計も近々発売します。



 
Medical Teknika Medical Teknika Medical Teknika Medical Teknika Medical Teknika
Medical Teknika Medical Teknika Medical Teknika Medical Teknika Medical Teknika
Medical Teknika Medical Teknika
Medical Teknika Medical Teknika Medical Teknika Medical Teknika Medical Teknika
画像例は下記をご参照願います。

http://www.din.or.jp/~meditekn/medi_hp/
上記の一番下部に解説付きで、応用例を掲載

http://www.din.or.jp/~meditekn/medi_hp/duna/
http://www.din.or.jp/~meditekn/medi_hp/masterblue/
ラブテック社製マスターステップの使用例掲載

http://www.din.or.jp/~meditekn/medi_hp/duna2/
医大検査室での使用例、画面例及び記録例も掲載

http://www.din.or.jp/~meditekn/medi_hp/remoterunning12ecgs/
ソニーの超小型パソコンを利用したランニング仕様の用途例

http://www.din.or.jp/~meditekn/medi_hp/aerobicacc/
米国循環器学会で推奨された心臓病患者への心臓リハビリ法としての
エアロビックの効能についての発表

http://www.din.or.jp/~meditekn/medi_hp/gtec/
出力のRR間隔データの解析例、これは別売のソフトウエアとなります。

http://www.din.or.jp/~meditekn/medi_hp/stressdata/
負荷試験での重要な医学的指標、米国心臓病学会のスタンダードとして発布

http://www.din.or.jp/~meditekn/medi_hp/labtechholter/
ラブテックパソコンホルタのご紹介

http://www.din.or.jp/~meditekn/medi_hp/labtech1/
ラブテック社製品としてのパソコン式の利用価値 等を掲載しております。

Theory of the P wave detection

The algorithm first finds the  the possible positive and negative wave peaks based on zero transition searching, then validates them with comparing to reference P waves.

The P wave detection needs high amplitude resolution. This value is better, than 0.6 uV / bit in the Cardiospy system.  With this resolution and the effective filter system which uses wavelet transformation, the Cardiospy system is able to detect P waves less than 50 uV of amplitude.

 

Validation of the P wave detector

The validation is carried out on 10 pcs 12 channel and 10 pcs 3 channel ECG reference records. The reference records include the P wave  annotation.  12 of the 20 records are taken from the MitBih database, 8 records are taken from the Labtech database (30000 – 30007). 

12 ch records

s0014lre, s0292lre, s0302lre, s0331lre, s0364lre, s0422_re, s0431_re, s0437_re, s0549_re, s0550_re

3 ch records

mgh001, mgh007, 30000, 30001, 30002, 30003, 30004, 30005, 30006, 30007

 

Validation result:

Sensitivity:                       95.42%

Positive predictivity:         97.16%


アルテリオグラフ24

血管脈波検査装置

中心血圧及び関連パラメータは検証が必要です


Central blood pressure: current evidence

and clinical importance

Carmel M. McEniery1*, John R. Cockcroft2, Mary J. Roman3,

Stanley S. Franklin4, and Ian B.Wilkinson1

1Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital, Box 110, Cambridge CB22QQ, UK; 2Department of Cardiology,Wales Heart Research Institute, Cardiff

CF14 4XN, UK; 3Division of Cardiology,Weill Cornell Medical College, New York, NY 10021, USA; and 4University of California, UCI School of Medicine, Irvine, CA 92697-4101, USA

Received 29 April 2013; revised 27 November 2013; accepted 17 December 2013; online publish-ahead-of-print 23 January 2014

and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications

for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively

targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.

Keywords Central pressure Blood pressure Anti-hypertensive treatment Cardiovascular risk

Introduction

The brachial cuff sphygmomanometer was introduced into medical

practice well over 100 years ago, enabling the routine, non-invasive,

measurement of arterial blood pressure. Life insurance companies

were among the first to capitalize on the information provided by

cuff sphygmomanometry, by observing that blood pressure in

largely asymptomatic individuals relates to future cardiovascular

risk—observations that are nowsupported by a wealth of epidemiological

data.1 The most recent Global Burden of Disease report2

identified hypertension as the leading cause of death and disability

worldwide. Moreover, data from over 50 years of randomized controlled

trials clearly demonstrate that lowering brachial pressure,

in hypertensive individuals, substantially reduces cardiovascular

events.1,3 For these reasons, measurement of brachial blood pressure

has become embedded in routine clinical assessment throughout the

developed world, and is one of the most widely accepted ‘surrogate

measures’ for regulatory bodies.

The major driving force for the continued use of brachial blood

pressure has been its ease of measurement, and the wide variety of

devices available for clinical use. However, we have known for over

half a century that brachial pressure is a poor surrogate for aortic

pressure, which is invariably lower than corresponding brachial

values. Recent evidence suggests that central pressure is also more

strongly related to future cardiovascular events4 7 than brachial

pressure, and responds differently to certain drugs.8,9 Appreciating

this provides an ideal framework for understanding the much publicized

inferiority of atenolol and some other beta-blockers,10 compared

with other drug classes, in the management of essential

hypertension. Although central pressure can now be assessed noninvasively

with the same ease as brachial pressure, clinicians are unlikely

to discard the brachial cuff sphygmomanometer without

robust evidence that cardiovascular risk stratification, and monitoring

response to therapy, are better when based on central rather

than peripheral pressure. Central pressure assessment and accuracy

will also have to be standardized, as it has been for brachial pressure

assessment with oscillometric devices. This review will discuss our

current understanding about central pressure and the evidence

required to bring blood pressure measurement, and cardiovascular

risk assessment into the modern era.

Physiological concepts

Arterial pressure varies continuously over the cardiac cycle, but in

clinical practice only systolic and diastolic pressures are routinely

reported. These are invariably measured in the brachial artery

using cuff sphygmomanometry—a practice that has changed little

over the last century. However, the shape of the pressure waveform

* Corresponding author. Tel: +44 1223 336806, Fax: +44 1223 216893, Email: cmm41@cam.ac.uk

Published on behalf of the European Society of Cardiology. All rights reserved. &The Author 2014. For permissions please email: journals.permissions@oup.com

European Heart Journal (2014) 35, 1719–1725 doi:10.1093/eurheartj/eht565

 

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk.However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.As discussed earlier, a full synthesis of the available evidence concerning

central pressure and the risk of future cardiovascular events is now required. However, it will also be necessary to determine the clinical relevance of differences between brachial and central pressure

for the individual patient, especially given the relatively high correlation between the two. Emerging data support the prognostic superiority of both 24-h ambulatory blood pressure monitoring

(ABPM)79 81 andhomemonitoring81 in comparison with office measurements. Interestingly, a recent study82 demonstrated that 24-h ambulatory cuff pressures were comparable with office central pressure

measurements in the prediction of risk, although the significance of this study awaits confirmation.83 As yet, there are no data comparing the predictive value ofhomemonitoring vs. central pressure in the

prediction of risk. Ultimately, it will be necessary to evaluate the prognostic value of 24-h ambulatory central pressure.With the recent development of ambulatory central pressure systems,84,85 this is now

possible and it may be reasonable to hypothesize that 24-h central, rather than brachial ABPM would be superior in terms of risk prediction.

Medical Teknika 高血圧、動脈硬化、脳卒中、心筋梗塞 ウエアラブル生体モニター
ホルター心電計 先天性心疾患ソフトウエア 多種類ワイヤレス
マイクロセンサー
ワイヤレス心電計 動脈硬化指標、中心血圧、非観血血 12誘導心電図伝送
非観血血圧波形連続測定
解析付きワイヤレス
救命救急用生体情報モニタ 医工連携

非観血血圧付き心電図ホルタの文献   負荷心電図検査の医学文献   

 エアロビックの効果   心電・血圧ホルタ記録器 ブルーツース     デュナ 

 デュナの実例     遠隔同時表示    ラブテック製品    Labtech products