Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 67 , Issue 1
Showing 1-22 articles out of 22 articles from the selected issue
  • A Message From The Japanese Circulation Society
    Hisayoshi Fujiwara
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 1-2
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    The number of deaths from cardio- and cerebro-vascular diseases (CVDs) rivals that from cancer in Japan. In the year 2000, heart disease, including coronary artery disease, claimed the lives of 147,000 Japanese persons, while cerebrovascular disease took the lives of 133,000 people, and cancer deaths were 295,000. Vascular diseases are clearly a major cause of deaths in adults. Further, a significant number of patients suffer from a variety of CVD-related illnesses. The prevention of these diseases and the improvement of quality of life through the reduction of morbidity and mortality is the ultimate goal for all researchers and physicians in cardiovascular disease. Reducing the number and severity of risk factors for heart disease and stroke should be the immediate goal of the Japanese Circulation Society (JCS).
    The JCS has been strongly involved in efforts to reduce the risk factors of hypertension, obesity, hyperlipidemia, and diabetes mellitus. Smoking is a well-recognized risk factor, and, for example, is associated with an increased risk of 1.7 to 3.0 times for coronary artery disease, 1.7 to 8.0 times for stroke, and 1.4 to 10.0 times for sudden death. For patients with CVDs, the longer the history of smoking, the more it aggravates the severity of the disease itself, and has greater affects on the activities of daily living by reducing oxygen availability in the patient. Passive smoking recently has been accepted as a major risk of coronary artery disease, stroke, and cancers. The prevalence of smoking in teenagers and women is now increasing in Japan, giving the prospect of serious consequences for the incidence, morbidity, and mortality of CVDs in the future. In particular, the combination of smoking and the oral contraceptive pill multiplies the risk of CVDs. Therefore, a national campaign to quit smoking and to eliminate passive smoking is needed. In terms of primary prevention, the excellent cost-benefit ratio of a non-smoking policy will help control the present spiraling increase in medical expenditures.
    Non-smoking measures are extremely important for the prevention and treatment of CVDs. A survey in 2002, however, revealed a high prevalence of smoking by Japanese physicians in the circulatory field (14% of men and 13% of women physicians). This prevalence is worse than in the United States 20 years ago. As for medical institutions recognized by the JCS, the same survey shows that only 5% completely ban smoking, and only 5% run a smoking cessation clinic in their cardiovascular departments. These figures clearly show that the importance of smoking issues is not recognized, and that cardiovascular physicians in Japan have been slow to act against tobacco use.
    The Japanese Circulation Society, as the leading professional association for cardiovascular specialists in Japan, hereby declares that we will vigorously fight against smoking by working to ban smoking, encouraging smoking cessation, and preventing passive smoking exposure. This effort will begin within our own membership. The JCS will promote the importance of these counter measures to the public. The JCS has defined 10 specific targets for this effort to decrease smoking and its negative effects and will focus on 3 audiences: the JCS and its membership, hospitals and medical schools, and the general public.
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Clinical Investigation
  • Review of 194 Episodes Over 20 Years
    Junya Ako, Yuji Ikari, Mitsuharu Hatori, Kazuhiro Hara, Yasuyoshi Ouch ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 3-7
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    A review of admission records identified 194 episodes of infective endocarditis (IE) from January 1980 to December 1999 at a community hospital in Tokyo. The cases were divided into decades, and the clinical picture and short-term outcomes were compared and analyzed. The mean age of patients in the 1990s was older (45.5 ±13.2 vs 55.1±12.6 years, p<0.001), and prosthetic valve endocarditis was significantly more frequently seen (14.4% vs 31.8%, p=0.004). None had a history of intravenous drug abuse (IVDA). Patients on chronic hemodialysis comprised 5.8% of IE cases in the 90s. Overall, dental procedure or caries still remained the main presumed source of infection. Staphylococcal IE showed a tendency to increase, and methicillin-resistant staphylococcal IE was significantly prominent in the 90s (0% vs 10.4%, p=0.0006). The overall in-hospital mortality was similar between the 2 groups (13.6% vs 18.8%, NS). Multivariate analysis found neurological abnormality, renal insufficiency and staphylococcal IE as predictors of in-hospital mortality. The characteristics of IE in Japan have changed, even among non-IVDA patients, and it appears to occur in a more high-risk patient population, which may warrant a more aggressive therapeutic approach to its management and treatment. (Circ J 2003; 67: 3 - 7)
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  • Hirotsugu Atarashi, Satoshi Ogawa, for the Idiopathic Ventricular Fib ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 8-10
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    To identify high-risk patients with Brugada syndrome, the present study reviewed 60 standard 12-lead electrocardiograms from 60 patients collected by the Japanese Brugada syndrome registry. Under blinded conditions, the S wave of lead V1 was measured from the tip of r to r', and the amplitude of the ST segment in lead V2 was measured at 0.08 s from the J point. In patients with ventricular fibrillation (n=17), the S wave was significantly longer in V1 (0.085±0.007 s vs 0.075 ±0.011 s, p=0.001), and ST segment elevation in V2 was significantly greater (0.323±0.133 mV vs 0.236±0.129 mV, p=0.012) than in patients without fibrillation. An S wave width of 0.08 s or more in V1 had a positive predictive value of 40.5% and negative predictive value of 100% for ventricular fibrillation, with 100% sensitivity. ST elevation of 0.18 mV or more in V2 had a positive predictive value of 37.8% and a negative predictive value of 100% for ventricular fibrillation, with 100% sensitivity. Both an S wave width ≥0.08 s in V1 and ST elevation ≥0.18 mV in V2 were highly specific indicators of ventricular fibrillation and are proposed as new criteria for high-risk Brugada syndrome. (Circ J 2003; 67: 8 - 10)
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  • Relationship Between Efficacy and the f-f Interval in Surface ECG Recordings
    Toru Yoshida, Shinichi Niwano, Kimiatsu Inuo, Junko Saito, Jisho Kojim ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 11-15
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Bepridil, a multi-ion channel blocker, is effective for some types of cardiac arrhythmias, and so its effect on the paroxysmal atrial fibrillation (PAF) was evaluated in the present study, comparing it with class Ic antiarrhythmic drugs. The relationship between efficacy and the f-f interval in the surface ECG recording was also analyzed. Sixty-one symptomatic PAF patients were randomized to a bepridil group (200 mg/day, n=23) or class Ic drug group (flecainide 100-200 mg/day or pilsicainide 75-150 mg/day, n=38). The drug was considered effective for PAF prevention when symptomatic episodes of PAF were decreased to less than 50% during the follow-up period of 2-6 months. The f-f interval in the surface 12-lead ECG trace was evaluated during a PAF episode. Both bepridil and the class Ic drugs were effectively prevented PAF (15/23 (65.2%) vs 24/38 (63.1%) patients, NS). In the class Ic drug group, the f-f interval was longer in the effective cases (114±48 ms) than in the non-effective cases (68±26 ms, p=0.0002). In contrast, in the bepridil group the f-f interval was shorter in the effective cases (85±26 ms) than in the non-effective ones (152±45 ms, p=0.0005). When comparing the non-effective cases in the 2 groups, the bepridil group showed a significantly longer f-f interval than the class Ic drug group (p=0.0003). As a result of drug administration, the class Ic drugs prolonged the f-f interval from 78±33 ms to 128±46 ms (p=0.0004) whereas bepridil showed no change (109±39 ms vs 135±47 ms). For clinical PAF prevention, the effect of bepridil matched that of class Ic antiarrhythmic drugs. Because bepridil was effective in PAF patients with relatively shorter f-f intervals without prolonging the f-f interval, bepridil is considered to work mainly as a class III antiarrhythmic drug. (Circ J 2003; 67: 11 - 15)
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  • Shuji Mukae, Shuichi Aoki, Seiji Itoh, Ryuji Sato, Kazuaki Nishio, Tos ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 16-20
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    A single nucleotide polymorphism of mitochondrial 5178A/C, causing a Met to Leu replacement within the NADH dehydrogenase subunit, is reported to be associated with longevity. The purpose of the present study was to assess the contribution of mitochondrial polymorphisms, particularly the 5178A/C genotype, to the susceptibility to acute myocardial infarction (AMI) in a Japanese study population. There were 4 groups: 150 patients with AMI, 150 with essential hypertension, 100 with diabetes mellitus, and 150 subjects matched for age and sex who served as the control group. Mitochondrial 5178A/C was detected by the polymerase chain reaction restriction fragment length polymorphism method. The allelic frequency of 5178C was significantly higher in the AMI group than in the control group, and this difference was more marked in younger patients. There were differences in allelic frequencies among the essential hypertension group, diabetes mellitus group and control group, but a higher frequency of the C allele was seen in the AMI group compared with the essential hypertension and diabetes mellitus groups. This particular polymorphism was found to be associated with development of AMI, especially in younger patients and constitutes a new risk factor for AMI. (Circ J 2003; 67: 16 - 20)
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  • Chang-Min Chung, Shigeru Nakamura, Koji Tanaka, Jun Tanigawa, Katsuya ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 21-25
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Angioplasty of small vessels is associated with a higher rate of restenosis, even in the ostium. The present study compared the acute, late results of cutting balloon vs those of stenting alone in small branch ostial lesions of native coronary arteries and the effect on the parent vessel. The study group comprised 61 patients with successful angioplasty of smaller branch ostial lesions in native coronary arteries. The reference vessel diameter was between 2.5 and 3.0 mm. Patients were divided into 2 groups: group I (cutting balloon, n=30) and group II (stenting alone, n=31). After intervention, patients in group II achieved significant acute lumen gain, larger minimal lumen diameter (MLD) and less diameter stenosis. At 3-month follow-up, the MLD and diameter stenosis of the 2 groups were almost identical; however, late loss was lower in group I. At the 6-month follow up, the cumulative restenosis rate was 41% (11/27) in group I compared with 63% (19/31) in group II (p=0.05), and the target lesion revascularization was also lower in the cutting balloon group [29% (8/27) vs 53% (16/30) p=0.05]. In group 1, the MLD of the parent vessel did not change before, after cutting balloon or at follow-up. In contrast, there were significant reductions in parent vessel MLD following stenting alone and at follow-up. Plaque shift did not occur in the cutting balloon group. Cutting balloon angioplasty is a feasible approach for the treatment of small branch ostial lesions and does not cause significant narrowing of the parent vessel. (Circ J 2003; 67: 21 - 25)
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  • Yuko Ishizaka, Nobukazu Ishizaka, Eiko Takahashi, Tadao Unuma, Ei-ichi ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 26-30
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    A link between certain infectious microorganisms and an increased risk of atherosclerotic disease has been suggested. By analyzing the data of subjects who had undergone general health-screening tests, a possible association between carotid atherosclerosis and seropositivity of antibody against hepatitis C virus (HCV) has been previously reported. In the present study, a possible link between carotid atherosclerosis and HCV core protein positivity was assessed, because it is postulated to be a better marker of viremia and thus persistent infection. Of the 1992 enrolled subjects, 496 (25%) had carotid artery plaque, and 25 (1.3%) were positive for HCV core protein. Carotid artery plaque was positive in 480/1967 (24%) and 16/25 (64%) of the core protein-negative and core protein-positive subjects, respectively (p<0.0001 by χ2 test). Serum concentrations of transaminases were higher in core protein-positive subjects, but albumin concentrations were not significantly different between the 2 groups. Multivariate logistic regression analysis showed that HCV core protein positivity is an independent predictor of carotid plaque with an odds ratio of 5.61 (95% confidence interval 2.06-15.26, p<0.001). These data further support the possible link between persistent HCV infection and carotid atherosclerosis in the subjects without severe liver dysfunction. (Circ J 2003; 67: 26 - 30)
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  • Kazuhito Imanaka, Shunei Kyo, Masanori Ogiwara, Satoshi Gojo, Masaaki ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 31-34
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Twenty-seven consecutive patients underwent surgery for ischemic mitral regurgitation (MR): papillary muscle rupture (1), papillary muscle dysfunction (11) and annular dilatation (15). The grade of MR was moderate or severe, and the ejection fraction (EF) was less than 30% in 8 patients (mean, 43%). Three cases were reoperation and 3 were emergencies. Under ventricular fibrillation (VF) and intermittent aortic cross-clamping at moderate hypothermia, coronary artery bypass grafting (CABG) was performed first, followed by the mitral procedure through a right-sided left atriotomy (repair 21, replacement 6) performed under VF with the heart perfused through the native coronary arteries and CABG grafts. Concomitant procedures were CABG (23), Dor's procedure (5), and tricuspid annuloplasty (3). In one reoperative case with cardiogenic shock, CABG was impossible because of dense adhesions and the patient died just after surgery (hospital mortality, 3.7%). Five patients required intra-aortic balloon pump (IABP) support intraoperatively, but none required prolonged (≥7 days) inotropic support or IABP use, although the serum concentrations of creatine kinase and its myocardial fraction were elevated remarkably. Other morbid events were refractory ventricular arrhythmia in one case and stroke in another. Median duration of mechanical ventilation and intensive care unit stay was 8 h and 3 days, respectively. Mean EF at hospital discharge was 48%. The extended period of VF was not associated with unfavorable clinical outcomes. Noncardioplegic surgery for ischemic MR was carried out with acceptable mortality and morbidity, and can be a good alternative, especially when clamping the aorta is undesirable. (Circ J 2003; 67: 31 - 34)
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  • Satoshi Kurisu, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yuji ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 35-39
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    The purpose of the present study was to assess the impact of intraaortic balloon pumping (IABP) in patients with persistent ST elevation who underwent revascularization within 6 h of their first acute anterior myocardial infarction (AMI). Persistent ST elevation after revascularization was defined as being ≥50% of the initial value on return to the coronary care unit. Twenty-four patients were treated without IABP (control group) and 27 patients were treated with IABP (IABP group). There was no significant difference between the 2 groups in pretreatment left ventricular ejection fraction (LVEF), end-diastolic volume index or end-systolic volume index. After 137±46 days, the change in the LVEF was significantly higher in the IABP group than in the control group (5±13% vs 13±15%, p=0.04). However, the left ventricular end-diastolic volume index was similar between the 2 groups during follow-up (pretreatment: 77±19 ml/m2 vs 74±13 ml/m2, p=0.54; follow-up: 86±22 ml/m2 vs 83±18 ml/m2, p=0.60). These data suggest that IABP enhances the improvement in LVEF independent of remodeling in AMI patients with persistent ST elevation after revascularization. (Circ J 2003; 67: 35 - 39)
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  • Naohito Tanabe, Reiko Saito, Tadashi Sato, Senji Hayashi, Hideaki Toyo ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 40-45
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Mortality from coronary heart disease in Japan is the among lowest recorded in the industrialized nations; however, little is known about the rate of events including nonfatal cases. A survey of event registration and a review of death certificates was carried out to estimate event rates of acute myocardial infarction (AMI) and coronary deaths in the largest 2 cities of the Niigata prefecture where there are 480,720 residents aged between 15 and 65 years. The definitions for these cardiac events used for the WHO - MONICA project were: (1)`definite AMI', (2) `possible AMI or coronary death' (not including unclassifiable fatal events), and (3) `unclassifiable fatal events'. Age-adjusted rates for AMI and coronary deaths (per 100,000 /year) according to the registration survey were 54.6 for men and 7.2 for women according to definition 1 and 41.9 for men, and 5.3 for women according to definition 2. When data from the death certificate review were taken into account for the estimation, these rates increased to 80.6 for men and 14.2 for women according to definition 1, and 50.0 for men and 9.0 for women according to definition 2. These estimated rates are considerably lower than those in other industrialized nations surveyed in the WHO-MONICA project, and these findings are consistent with those from other studies conducted in Japan. (Circ J 2003; 67: 40 -45)
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  • Yoshito Kamijo, Kazui Soma, Tomonori Nagai, Katsuyoshi Kurihara, Takas ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 46-48
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    To assess the contribution of antipsychotic medication in Japanese patients suffering acute massive pulmonary thromboembolism, records of patients with idiopathic pulmonary thromboembolism associated with antipsychotic medication who were seen in a Japanese Emergency Center from January 1996 to December 2000 were reviewed. Age, gender, physical status, clinical presentation, antiphospholipid antibody, outcome, psychiatric profile, and antipsychotic medication use were examined. Seven patients had acute pulmonary thromboembolism associated with antipsychotic drug use, representing 44% of all patients with idiopathic pulmonary thromboembolism. The 7 patients developed symptoms in the early morning. More women than men were affected. In 5 cases, chlorpromazine and other phenothiazines had been prescribed, whereas in 2 cases, risperidone, a mixed serotonin 5HT2A and dopamine D2 receptor antagonist, had been taken for 40 days and 6 days, respectively. In 4 cases, including the patients taking risperidone, antiphospholipid antibodies were not present. Although statistically significant conclusions can not be drawn from this study, the data suggest that patients receiving risperidone, as well as conventional phenothiazines, are at risk for acute pulmonary thromboembolism, even if otherwise healthy. Strong affinity for the 5HT2A receptor of the novel antipsychotic may increase coagulability and the risk of thromboembolism. (Circ J 2003; 67: 46 - 48)
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  • Feasibility and Applicability
    Masaaki Takeuchi, Hidetoshi Yoshitani, Chinami Miyazaki, Nobuhiko Haru ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 49-53
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Accurate interpretation of dobutamine stress echocardiography (DSE) needs expertise. Color kinesis (CK) allows objective assessment of wall motion (WM), and its feasibility and accuracy are enhanced under harmonic imaging with contrast agents. To explore its utility, CK was performed in 41 unselected patients during contrast-enhanced DSE. After bolus injection of Levovist, the CK image was acquired in the apical 4- and 2-chamber views at baseline and peak stress using the ultraharmonic mode. Quad screen format with second harmonic imaging after another injection of Levovist was also obtained as a reference. Regional WM (12 segments in the apical view) was independently assessed by both methods. Heart rate increased from 67 beats/min at baseline to 135 beats/min (88% of age predicted maximal heart rate) at peak stress. The CK image was successfully obtained in all patients at baseline and in 38/41 patients at peak stress. CK tracked endocardial motion accurately in 93% (456/492) of left ventricular segments at baseline and 87% (427/492) at peak stress. The concordance rate of normal and abnormal WM between the 2 methods was 86% (392/456, Kappa 0.61) at baseline and 85% (362/427, kappa 0.53) at peak stress. Among the 38 patients in whom both methods were completed, the standard quad screen display showed abnormal DSE results in 17 patients and 28/114 vascular territories. The sensitivity, specificity and diagnostic accuracy of CK for detecting abnormal findings were, respectively, 71% (12/17), 90% (19/21) and 82% (31/38) in patients and 57% (16/28), 97% (83/86) and 87% (99/114) in vascular territories. The application of CK was highly feasible during contrast-enhanced DSE and gave an objective assessment of WM. This method can be a valuable adjunct to the conventional interpretation of DSE. (Circ J 2003; 67: 49 - 53)
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  • Tianshu Zhang, Naohiko Koide, Yuko Wada, Katsuaki Tsukioka, Kei Takaya ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 54-60
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Angiogenesis is indispensable to tumor development and proliferation. The aim of this study was to investigate whether the expression of monocyte chemotactic protein-1 (MCP-1) and of thymidine phosphorylase (TP) correlates with the angiogenesis and clinicopathologic features in cardiac myxoma. Paraffin-embedded specimens of 17 resected cardiac myxomas were immunohistochemically stained for MCP-1, CC chemokine receptor-2 (CCR-2), TP, CD31, and CD68. Correlations among MCP-1 expression, TP expression, microvessel count (determined by CD31 staining), macrophage count (determined by CD68 staining), and the clinicopathologic features of the patients were analyzed statistically. Immunohistochemical analysis revealed that MCP-1 and TP were expressed in myxoma cells, as well as in stromal cells such as infiltrating cells, fibroblast-like cells and endothelial cells. CCR-2 was abundantly expressed in stromal infiltrating cells in all myxomas and occasionally in the endothelial cells. In the tumor stroma, the major source of MCP-1, TP and CCR-2 was macrophages, and the sites of positive staining for MCP-1, TP and CCR-2 matched in most of the myxomas. Statistical analysis revealed that the proportions of MCP-1-positive myxoma and stromal cells, and TP-positive myxoma and stromal cells significantly correlated with increased microvessel count. The proportions of MCP-1-positive myxoma and stromal cells significantly correlated with the proportion of TP-positive stromal cells. The mean microvessel count in myxomas with both high tumor and high stromal MCP-1 or TP expression was significantly higher than that in myxomas with low tumor and low stromal MCP-1 or TP expression. Small tumors (≤55 mm in diameter) exhibited high MCP-1 or TP expression, and the microvessel count in small tumors was significantly higher than in large myxomas. Although the difference was not significant, myxomas with both high tumor and high stromal MCP-1 expression had a higher macrophage count than other myxomas. These results indicate that in cardiac myxoma, MCP-1 and TP may be regarded as important angiogenic signals accompanying growth. (Circ J 2003; 67: 54 - 60)
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  • Nobuo Nakamura, Yuji Ueno, Yasuko Tsuchiyama, Yoshimitsu Koike, Masahi ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 61-67
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Postprandial hyperglycemia has been shown to increase the risk of cardiovascular disease as much as overt diabetes mellitus does. The aim of this study was to determine whether isolated post-challenge hyperglycemia during an oral glucose tolerance test (OGTT) is related to exaggerated neointimal proliferation after coronary stent implantation. Forty seven coronary lesions treated with stents in 40 patients who had normal fasting glucose levels (<110 mg/dl) were categorized into the following 2 groups according to the results of a 75-g OGTT: 29 lesions in 24 patients with normal glucose tolerance (NGT group) and 18 lesions in 16 patients with abnormal glucose tolerance (AGT group). Although there were no differences in angiographic characteristics before and immediately after stenting between the 2 groups, the minimal lumen diameter was significantly smaller (p=0.04) and the degree of stenosis and late loss were also significantly greater (p=0.01 and p=0.047) in the AGT group than in the NGT group at 6-month follow-up. Multiple regression analysis including the insulin concentrations during an OGTT revealed that the 120-min plasma glucose concentration after glucose load significantly correlated with late loss (p=0.0018) and the degree of stenosis (p=0.0100) at follow-up. It is concluded that isolated post-challenge hyperglycemia exaggerates neointimal hyperplasia after coronary stent implantation. (Circ J 2003; 67: 61 - 67)
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  • Tatsuyoshi Narumiya, Tatsuo Sakamaki, Yuichi Sato, Katsuo Kanmatsuse
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 68-72
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    The relationship between the left atrial appendage (LAA) function, as assessed by transesophageal echocardiography, and the incidence of left atrial thrombus was evaluated in 62 patients with nonvalvular chronic atrial fibrillation (AF; n=50) and atrial flutter (AFL; n=12). It was hypothesized that in both AF and AFL not only the LAA flow velocity (LAAFV), but also the frequency of the LAA movement (the LAA flow time, LAAFT) is a major contributing factor to thrombus formation. LAAFT was defined as the average duration of LAA flow with emptying and filling waves. The patients with AF were divided into 2 groups: lone AF (n=14) and non-lone AF (n=36). LAA thrombus was found in 6 patients with none-lone AF. LAAFV was lower and LAAFT was shorter in patients with thrombus as compared with patients without thrombus (12.0±2.2 cm/s vs 24.1±10.6 cm/s, 68.7±1.5 ms vs 72.9±3.3 ms, p<0.01, respectively). Patients with AFL had higher LAAFV and longer LAAFT than those with chronic AF. The present data suggest that, in addition to LAAFV, LAAFT characterized LAA function and might serve as a predictor of thrombus formation in chronic AF. With respect to LAA function, patients with lone AF or AFL are at low risk for thrombus formation. (Circ J 2003; 67: 68 - 72)
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  • Juntendo Cardiac Rehabilitation Program (J-CARP)
    Eriko Seki, Yoshiro Watanabe, Satoshi Sunayama, Yoshitaka Iwama, Kazun ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 73-77
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    The purpose of this prospective randomized controlled trial was to assess the impact of phase III comprehensive cardiac rehabilitation (CR) on health-related quality of life (HRQOL) in elderly patients with coronary artery disease (CAD). Thirty-eight elderly males (mean age, 70 years) with CAD were stratified as the intervention group (n=20) and the control group (n=18). In the intervention group, patients participated in CR for 6 months, whereas in the control group, they received standard care. Validated questionnaires were obtained to evaluate HRQOL using the Medical Outcome Study Short-Form 36 Health Status Survey (SF-36), State-trait anxiety inventory questionnaire (STAI) and Self-rating Depression Scale (SDS) at baseline and after 6 months. At baseline, scores of SF-36 except for general health, STAI and SDS were not different in either group. After 6 months, in the intervention group, scores of bodily pain, general health, vitality and mental health of SF-36 improved significantly compared with baseline. State anxiety scores also improved significantly (p<0.01), but SDS depression scores were not improved. In the control group, none of the parameters significantly changed. These results indicate that elderly patients with CAD should be vigorously encouraged to pursue CR even in chronic phase III. (Circ J 2003; 67: 73 - 77)
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Experimental Investigation
  • Masami Takagaki, Patrick M McCarthy, Marlene Goormastic, Yoshie Ochiai ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 78-82
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    The pacing-induced heart failure model provides an opportunity to assess the structural and functional determinants of mitral regurgitation (MR) in dilated cardiomyopathy. This study aimed to evaluate MR to better understand the multitude of factors contributing to its development. Heart failure was induced by rapid ventricular pacing (230 beats/min) in 40 mongrel dogs. Left ventricular (LV) size and MR were evaluated echocardiographically. LV contractility was analyzed using a conductance catheter. MR increased to mild in 12 animals (regurgitant orifice area, 0.06±0.05 cm2), moderate in 15 (0.14±0.07 cm2), and severe in 13 (0.34±0.16 cm2). The grade of MR had an inverse relationships with Emax (the slope of the end-systolic pressure - volume relationship, p<0.01) and dE/dt (the slope of the maximum rate of change of pressure - end-diastolic volume [VED] relationship, p<0.01) and positive relationships with VED and end-diastolic cross-sectional areas and lengths (p<0.05) by univariate analysis. The dE/dt had an independently significant (p<0.01) relationship by multivariable logistic regression. Many factors influence the development of MR and because of its similarity to the clinical situation, this model can be used to investigate MR and heart failure, as well as new surgical therapies. (Circ J 2003; 67: 78 - 82)
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  • Atsushi Yao, Osami Kohmoto, Tomomi Oyama, Yasuyuki Sugishita, Tatsuya ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 83-90
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Beta-adrenergic stimulation and the resultant Ca2+ load both seem to be associated with progression of heart failure as well as hypertrophy. Because the α1-, β1,2-blocker, carvedilol, has been shown to be outstandingly beneficial in the treatment of heart failure, its direct effects on intracellular calcium ion concentration ([Ca2+]i), including antagonism to isoproterenol, in ventricular myocytes were investigated and then comapred with a selective β1-blocker, atenolol, and a non-selective β1,2-blocker, timolol. At 1-300 nmol/L, carvedilol decreased the amplitude of [Ca2+] i by ~20% independently of its concentration, which was a similar effect to timolol. All the β-blockers at 10 nmol/L decreased the amount of cAMP, but atenolol had the least effect. Carvedilol in the μmol/L order further diminished the amplitude of [Ca2+]i transients, and at 10 μmol/L increased the voltage threshold for pacing myocytes. These effects were not observed with timolol or atenolol. L-type Ca2+ currents (ICa) were decreased by carvedilol in the μmol/L order in a concentration dependent manner. As for the β-antagonizing effect, the concentrations of carvedilol, timolol, and atenolol needed to prevent the effect of isoproterenol by 50% (IC50) were 1.32, 2.01, and 612 nmol/L, respectively. Furthermore, the antagonizing effect of carvedilol was dramatically sustained even after removal of the drug from the perfusate. Carvedilol exerts negative effects on [Ca2+]i, including inhibition of the intrinsic β-activity, reduction of ICa in the μmol/L order, and an increase in the threshold for pacing at ≥10 μmol/L. Data on the IC50 for the isoproterenol effect suggest that carvedilol could effectively inhibit the [Ca2+]i load induced by catecholamines under clinical conditions. (Circ J 2003; 67: 83 - 90)
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Case Report
  • Hiroyuki Tanaka, Mio Ebato, Takashi Narisawa, Takanobu Mori, Mikio Mas ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 91-92
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    A 52-year-old male with coronary artery disease had the extremely rare occurrence of a blood cyst in the right atrium. Surgical removal with coronary artery bypass grafting was performed successfully. (Circ J 2003; 67: 91 - 92)
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  • Tsutomu Araki, Tetsuo Konno, Hideki Itoh, Hidekazu Ino, Masami Shimizu
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 93-95
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    A 60-year-old man with asymptomatic Brugada syndrome and neither a history of syncope nor family history of sudden death was admitted because of bronchial asthma. Serum potassium concentration was 3.8 mmol/L on admission, and decreased to 3.1 mmol/L on the 6th day, probably as a side effect of steroid therapy. The patient was found unconscious on the 7th day, and his serum potassium concentration was 3.4 mmol/L immediately after the episode. On the 8th day, the patient was again found unconscious, and polymorphic ventricular tachycardia and fibrillation (VT/VF) was documented on electrocardiographic (ECG) monitoring. The coved type of ST-segment elevation in leads V1-3 was observed on the ECG after spontaneous recovery of sinus rhythm, and VT/VF associated with Brugada syndrome was diagnosed. The serum potassium concentration decreased to 2.9 mmol/L immediately after the episode, but QT prolongation was not observed during the clinical course. After the correcting the serum potassium concentration, there was no further recurrence of the malignant ventricular arrhythmia and syncope. An implantable cardioverter defibrillator was inserted to prevent sudden death. Hypokalemia that does not induce QT prolongation may contribute to the occurrence of VT/VF in Brugada syndrome. (Circ J 2003; 67: 93 - 95)
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  • A Case of Heparin-Induced Thrombocytopenia and Thrombosis Syndrome
    Akimitsu Nasuno, Taku Matsubara, Tomoyuki Hori, Kotaro Higuchi, Keiich ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 96-98
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is a potentially life-threatening side effect of heparin therapy, triggered by an immune response, and has been reported to be related not only to the therapeutic use of heparin but also to heparin-coated catheters. A 45-year-old woman with intrapelvic malignancy developed an acute pulmonary thromboembolism (PE) after hysterectomy despite prophylactic heparin use. Subsequent large doses of heparin for treatment of the PE exacerbated the thrombocytopenia and, moreover, a large thrombus formed around the heparin-coated central venous catheter. Anti-heparin-platelet factor 4 complex antibody and heparin-induced platelet aggregation assay were positive, so the diagnosis was HITTS, and heparin was replaced by argatroban after carrying out thrombectomy. This therapy was successful, and the patient made favorable progress. (Circ J 2003; 67: 96 - 98)
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  • First Case Reports From Japan
    Yasuhisa Matsumoto, Hideaki Nishimori, Hideo Yamada, Akira Yamamoto, Y ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 1 Pages 99-101
    Published: 2003
    Released: December 25, 2002
    JOURNALS FREE ACCESS
    Laparoscopy-assisted abdominal aortic aneurysm (AAA) repair consists of retroperitoneal laparoscopic dissection of the AAA and graft replacement performed via a mini-laparotomy. Two patients with infrarenal AAA underwent successful straight graft replacement using this hybrid approach. The retroperitoneal space was bluntly dissected under carbon dioxide pneumoretroperitoneum and further dissection was performed laparoscopically. This enabled proximal and distal control of the aneurysm, and occlusion of the lumbar arteries and the inferior mesenteric artery with hemoclips. A 7 cm mini-laparotomy was sufficient for the straight graft replacement. Laparoscopy-assisted repair is a less invasive technique for the treatment of AAA and can be regarded as the initial step towards totally endoscopic repair. (Circ J 2003; 67: 99 -101)
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