Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 67 , Issue 10
Showing 1-21 articles out of 21 articles from the selected issue
Special Article
  • Donald D. Heistad
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 805-809
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    Many risk factors for cardiovascular disease generate superoxide in the blood vessels and thereby impair endothelial function. To emphasize the critical role of oxygen radicals, this is a `radical view' of those risk factors. It will be useful to organize risk factors into a `superfamily', with consideration of mediators, mechanisms, and target organs. Studies are summarized which suggest that, in parallel with the impairment of endothelial vasomotor function, the thrombin/thrombomodulin/activated protein C anticoagulant mechanism, which requires endothelial thrombomodulin, is also impaired by atherosclerosis and improves during regression of atherosclerosis. Impairment of the anticoagulant mechanism may contribute to thrombosis in atherosclerotic arteries, and improvement of the anticoagulant mechanism during regression of atherosclerosis may reduce the risk of cardiovascular events. (Circ J 2003; 67: 805 - 809)
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Clinical Investigation
  • Hiroyuki Kakugawa, Akihiko Shimizu, Toshihiko Yamagata, Masahiro Esato ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 810-815
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    Atrial electrograms were recorded from the high right atrium, coronary sinus, and right lateral wall in 15 patients with induced atrial fibrillation (AF). Intravenous cibenzoline terminated AF in 8 patients (T group), but not in 7 patients (non-T group). The cycle length of the AF (AFCL) obtained by the autocorrelation function was measured every 5 s during the 30 s prior to the cibenzoline administration, and just before the termination of AF or at the end of the cibenzoline infusion in the non-T group. The mean AFCL, and spatial and temporal dispersion of the AFCL were then compared between the 2 groups (dispersion = standard deviation × 100 /mean AFCL). Cibenzoline significantly increased the mean AFCL and decreased the spatial dispersion in both groups. No significant difference in either the mean AFCL or temporal dispersion before or after cibenzoline was observed between the 2 groups. In addition, no significant difference in the spatial dispersion before the cibenzoline was observed, but the spatial dispersion after the cibenzoline was significantly smaller in the T group than in the non-T group. The mean AFCL, and the spatial and temporal dispersion before the cibenzoline did not predict the termination of AF. The decrease in the spatial dispersion may be the most important mechanism by which intravenous cibenzoline terminates AF. (Circ J 2003; 67: 810 - 815)
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  • Akira Tamura, Toru Watanabe, Masaru Nasu
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 816-820
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    The aim of the present study was to compare the effects of atorvastatin and pravastatin on lipid parameters and the concentration of malondialdehyde-modified low-density lipoprotein (MDA-LDL) in hypercholesterolemic patients. A total of 17 patients (10 men, 7 women; mean age, 68±9 years) who were indicated for drug therapy based on the National Cholesterol Education Program II underwent an 8-week regimen of atorvastatin (10 mg/day) or pravastatin (10 mg/day) with a 4-week washout period between drugs. After an overnight fast, lipid parameters and MDA-LDL concentration were measured before and after the 8-week treatment with each drug. Both atorvastatin and pravastatin produced significant reductions in low-density lipoprotein (LDL) cholesterol and MDA-LDL concentrations, with a significant increase in high-density lipoprotein cholesterol concentration. The percent reductions in LDL cholesterol and MDA-LDL concentration were significantly greater with atorvastatin than pravastatin (46 ±6% vs 24±10%, p<0.0001, and 44±10% vs 14±13%, p<0.0001, respectively). The ratios of percent reductions in MDA-LDL concentrations and percent reductions in LDL cholesterol concentrations were significantly greater for atorvastatin than pravastatin (0.96±0.19 vs 0.59±0.55, p<0.0001). In conclusion, atorvastatin reduced serum concentrations of LDL cholesterol and MDA-LDL to a greater degree than pravastatin, indicating that atorvastatin not only has stronger lipid-lowering effects, but also stronger antioxidative effects than pravastatin. (Circ J 2003; 67: 816 -820)
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  • Mariko Murata, Masahiko Harada, Akihiko Shimizu, Makoto Kubo, Reo Mita ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 821-825
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    The purpose of this study was to test a hypothesis that T-wave alternans (TWA) is improved in association with an improvement in cardiac sympathetic nervous system and systolic function by oral β-blocker therapy in patients with non-ischemic heart disease (NIHD). TWA testing, 123I-metaiodobenzylguanidine (MIBG) imaging and echocardiography were performed at the baseline and 3 months after β-blocker therapy in 26 patients with NIHD and positive TWA. The alternans voltage (Valt), the heart-to mediastinal-ratio on the early (e-H/M) and delayed (d-H/M) images, the washout rate (WR), the left ventricular ejection fraction (LVEF), and the calculated rate of change by β-blocker therapy in each parameter (ie, ΔValt, Δe-H/M, Δd-H/M, ΔWR and ΔLVEF) were measured. After therapy, TWA turned negative in 8 patients (group A) and remained positive in 18 (group B); Valt was significantly decreased in group B (p<0.001). In group A, e-H/M, d-H/M and LVEF were significantly increased (e-H/M: p<0.05, d-H/M and LVEF: p<0.01), as were e-H/M and LVEF in group B (p<0.05). There were significant correlations between ΔValt and Δe-H/M (r=-0.61, p<0.01), Δd-H/M (r=-0.82, p<0.0001), ΔWR (r=0.60, p<0.01) and ΔLVEF (r=-0.70, p<0.01). In patients with NIHD, the TWA is improved in association with the improvement in cardiac sympathetic nervous system abnormalities and left veantricular systolic dysfunction by β-blocker therapy. (Circ J 2003; 67: 821 - 825)
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  • Yuji Hara, Mareomi Hamada, Yuji Shigematsu, Tomoaki Ohtsuka, Akiyoshi ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 826-829
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    The aim of this study was to evaluate whether β-blocker therapy can be safely administered to and improve cardiac function of elderly patients with dilated cardiomyopathy (DCM). Echocardiography and measurement of the concentrations of natriuretic peptides were carried out in 67 patients with DCM before and after 6 months of β-blocker therapy: 20 patients ≥65 years of age (older group); 47 <65 years of age (younger group). In all patients, β-blocker was safely administered and well tolerated. There was no significant difference in the dose of β-blocker between 2 groups. A reduction in the left ventricular dimensions and an associated increase in ejection fraction occurred in both treatment groups. The β-blocker treatment resulted in a significant decrease in the concentrations of natriuretic peptides in both groups. In conclusion, β-blocker therapy is well-tolerated and has similar effects on cardiac function in older and younger patients with DCM. (Circ J 2003; 67: 826 - 829)
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  • Kazuyuki Kurokawa, Nobuyuki Ohte, Hiromichi Miyabe, Sachie Akita, Kazu ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 830-834
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    The purpose of this study was to investigate the clinical significance of the reverse redistribution (RR) phenomenon on technetium-99m (99mTc)-tetrofosmin myocardial single photon emission computed tomography (SPECT) performed at rest. Twenty-five patients underwent myocardial SPECT 3 weeks after the onset of acute myocardial infarction. Myocardial images were acquired at 40 min (early) and 4 h (delayed) after the injection of 740 MBq of 99mTc-tetrofosmin. The regional myocardial uptake of the tracer in 26 segments of the left ventricular (LV) wall was visually scored from 0 (no activity) to 3 (normal activity), and then the RR was defined as a decrease of more than 1 point in the activity score on the delayed image compared with that on the early image. Regions with an activity score of 3 on both the early and delayed images were defined as normal, and those with a score of 0 or 1 on the early image were considered to have a fixed defect. The regional myocardial 99mTc-tetrofosmin uptake and washout rate were also quantitatively assessed in each region. In addition, exercise stress electrocardiograph-gated SPECT with 99mTc-tetrofosmin was performed within 1 week of the rest study, and the percent count increase (%CI) during myocardial contraction in each corresponding region was studied. RR was observed in 18 of the 25 patients. The regional washout rate of 99mTc-tetrofosmin was significantly higher in the RR regions (45.0±3.8%) than in either the normal regions (36.4±4.1%, p<0.001) or in those with a fixed defect (39.7±3.9%, p<0.001). The %CI in the RR regions (10.4±10.4%) was significantly less than that in the normal regions (23.5±10.1%, p<0.001); however, no significant difference was found between the RR regions and those with a fixed defect (8.0±7.2%). In patients with acute myocardial infarction, the regions showing the RR phenomenon on 99mTc-tetrofosmin SPECT have severely impaired LV wall contraction after exercise. (Circ J 2003; 67: 830 - 834)
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  • Kazuro Sugishita, Etsuko Shiono, Takao Sugiyama, Terunao Ashida
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 835-838
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    It is well known that diabetes mellitus (DM) masks the cardiac symptoms during an ischemic heart attack, but there have not been reports of whether DM influences the subjective symptoms of atrial fibrillation (AF). The present study retrospectively assessed 65 patients who were revealed to be in sinus rhythm at their first visit to hospital and who had experienced episodes of AF (or paroxysmal AF) during the follow-up period. Compared with non-DM cases (n=50), DM patients (n=15) had a tendency to a more rapid heart rate in sinus rhythm (73±4 vs 66±2, p=0.07) and higher averaged ventricular response at the first-recorded episode of AF (111±7 vs 99±3, p=0.10). However, the ratio of symptomatic cases at first-recorded AF tended to be lower in DM cases (33% vs 58%, p=0.08). When patients with β-blockers or other antiarrhythmic agents were excluded, the ratio of symptomatic patients at first-recorded AF was significantly lower in the DM cases (25% vs 61%, p=0.04), although there was not a significant difference in averaged ventricular response at first-recorded AF (112±8 vs 106±5). The prevalence of DM neuropathy was significantly higher in asymptomatic patients (70% vs 0%, p=0.01). DM may mask the cardiac symptoms of the first-recorded episode of AF, possibly because of DM neuropathy. (Circ J 2003; 67: 835 - 838)
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  • Hiroyuki Yamagishi, Minoru Yoshiyama, Naoya Shirai, Kaname Akioka, Kaz ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 839-845
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    It remains uncertain whether factors other than the severity of coronary artery disease (CAD) are associated with the worsening of the left ventricular ejection fraction (LVEF) by exercise. In the present study the impact of coronary risk factors on the worsening of LVEF by exercise was investigated in 391 patients with known or suspected CAD using exercise-gated 201Tl scanning to calculate the LVEF. Significant worsening of the LVEF by exercise was defined as >4.7% (mean plus 1 SD of the value in 116 patients without CAD). Multivariate analysis revealed that diabetes mellitus (DM) was an independent risk factor for the worsening of LVEF by exercise in patients with multivessel (2- or 3-vessel) CAD with an odds ratio (95% confidence interval) of 2.2 (1.1-4.5, p=0.037). In 157 patients with 2- or 3-vessel CAD, 20 (23.5%) of 85 nondiabetic patients and 31 (43.1%, p=0.009 vs nondiabetic patients) of 72 diabetic patients showed significant worsening of LVEF by exercise. In patients with 2- or 3-vessel CAD, there was no significant difference in Gensini score or reversibility of perfusion defects between nondiabetic and diabetic patients. Thus, DM is a risk factor for worsening LVEF by exercise in addition to the severity of CAD. (Circ J 2003; 67: 839 - 845)
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  • Tsuyoshi Konta, John Hugh Nicholas Bett
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 846-850
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    Mechanical stress in coronary arteries has been postulated to cause endothelial injury and atherosclerotic lesions, but the relationship between the pattern of coronary artery movement (CAM) and lesion severity is not known. In the present study CAM was classified into 10 patterns, which were grouped into 3 classes: (1) bend type = coronary artery flexes into a curve; (2) compression type = segmental length is shortened without vertical deviation of the artery; (3) displacement type = location of the coronary artery shifts without change of segmental length or shape. Assessment of CAM was made for 6 segments from the left anterior descending artery and 3-5 segments from the left circumflex artery, and in total 673 segments were analyzed. Coronary arterial segments with the compression type had a significantly higher percent stenosis than those without it (Compression 57.9±29.4 % vs Bend 7.9±19.0 %, Displacement 4.3±13.0 %; p<0.00001). The compression type was seen frequently in the proximal and mid left anterior descending artery, ostial diagonal branch, obtuse marginal branch and mid left circumflex artery. The critical CAM (eg, compression pattern) may be an important mechanical stress inducing coronary atherosclerosis. (Circ J 2003; 67: 846 - 850)
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  • Akira Kawamura, Shin-ichiro Miura, Masahiro Fujino, Hiroaki Nishikawa, ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 851-854
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    In rat models of transplant vasculopathy, the strongest staining of CXCR3 is observed in the innermost layer of the neointima and because neointimal hyperplasia is seen after coronary angioplasty, the CXC chemokines may be targets for preventing stenosis. The expression of leukocyte surface chemokine receptors (CCR2/CCR5/CXCR2/CXCR3), as determined by flow cytometry, and plasma concentrations of monocyte chemoattractant protein (MCP)-1 and interferon-inducible protein (IP)10, as determined by enzyme immunoassays, were investigated in 55 patients with coronary artery disease (CAD) who underwent percutaneous transluminal coronary angioplasty (PTCA) and 20 patients without significant coronary stenosis based on the results of coronary catheterization during the same period (C group). The patients with CAD were divided into 3 groups: 20 with de novo stenosis (D group), 15 with restenosis (R group) and 20 without restenosis (N group) after PTCA. CXCR3 expression on lymphocytes, but not monocytes, in the R group was significantly lower than that in the C group. Although the plasma concentrations of IP10 in the D and N groups did not differ from that in the C group, the concentration in the R group was significantly higher. Increased plasma concentrations of IP10 were accompanied by a compensatory decrease in the CXCR3 expression on lymphocytes, but not monocytes, suggesting that a high plasma concentration of IP10 strongly induces monocytes signaling. The CXCR3 - plasma IP10 chemokine receptor - chemokine interaction on monocytes may affect the development of coronary restenosis, but not de novo stenosis, in patients with CAD. (Circ J 2003; 67: 851 - 854)
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  • Masatoshi Shimizu, Hiroya Kawai, Yoshiyuki Yokota, Mitsuhiro Yokoyama
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 855-860
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    Echocardiography was used to evaluate the incidence, flow dynamics and morphological characteristics of right ventricular obstruction in 91 patients with hypertrophic cardiomyopathy. Color flow mapping was used to define the sites of obstruction in the left and right ventricles. Ventricular obstruction was considered to be present if the flow velocity was less than 2.0 m/s as measured by continuous wave Doppler. The thickness of both the right ventricular free wall and anterior ventricular septum was measured to assess the magnitude and extent of hypertrophy. Right ventricular obstruction was present in 14 patients of whom 6 (43%) had left ventricular obstruction also. The right ventricular obstructions were found in the outflow tract (9 patients), mid-base septal bulge (2 patients) and apical trabecular region (3 patients). Doppler waveform was confined to systole in all patients with obstruction in the outflow tract and in one of the patients with mid-base septal bulge. Moreover, the flow wave persisted into early diastole in 4 patients, including 2 with apical trabecular obstruction. The thickness of both the right ventricular free wall and anterior ventricular septum suggested that these hypertrophied regions were the sites of right ventricular obstruction. Thus, echocardiography was useful in evaluating right ventricular obstruction in hypertrophic cardiomyopathy. (Circ J 2003; 67: 855 - 860)
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  • Hiroshi Tada, Shigeto Naito, Kenji Kurosaki, Marehiko Ueda, Sachiko It ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 861-865
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    The purpose of this study was to clarify the change in the quality of life (QOL) and clinical outcomes following segmental pulmonary vein (PV) isolation for paroxysmal atrial fibrillation (AF) in 50 patients with drug-refractory, paroxysmal AF. The left superior, left inferior, and right superior PVs were targeted for isolation in all patients, and the right inferior PV was isolated in 4 patients. AF recurred in 22 of 50 patients, and these patients were treated with class I or class III antiarrhythmic drugs that had been ineffective before the ablation procedure. The symptom severity and frequency was scored and the QOL was assessed using the Short-Form-36 questionnaire (SF-36) before the PV isolation and at the end of the follow-up period (6.0±3.0 months). PV isolation resulted in a reduction in the symptom severity (p<0.001) and symptom frequency (p<0.001) scores as compared with the pre-ablation values. Ninety percent of the patients had a >90% reduction in the frequency of symptomatic episodes of AF after the ablation procedure. The mean SF-36 physical and mental component summary scores also significantly improved after PV isolation as compared with the pre-ablation values (both for p<0.001). With a segmental isolation approach that targets at least 3 PVs, satisfactory improvement in the symptoms and QOL can be achieved in patients with drug-refractory, paroxysmal AF. (Circ J 2003; 67: 861 - 865)
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  • Koichi Sakabe, Nobuo Fukuda, Katsunori Wakayama, Teru Nada, Hisanori S ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 866-870
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    The short- and intermediate-term pleiotropic effects of atorvastatin were investigated in 18 hypercholesterolemic patients, as well as the temporal differences in these pleiotropic effects. Atorvastatin was given for 3 months and fasting lipid concentrations, thiobarbituric acid reactive substances (TBARS), fibrinolytic parameters, and flow-mediated dilation of the brachial artery (FMD) were measured at baseline and after 2 weeks and 3 months of therapy. Atorvastatin reduced the total cholesterol (273±34 vs 188±31 mg/dl, p<0.0001), low-density lipoprotein-cholesterol (LDL-C: 174±28 vs 111±23 mg/dl, p<0.0001), small, dense LDL-C (34±22 vs 18±20%, p<0.01), remnant-like particles cholesterol (RLP-C: 8.8±6.0 vs 5.1±2.6 mg/ml, p<0.01), and TBARS (3.3±1.0 vs 3.1±0.9 nmol/ml, p<0.05) after 2 weeks. Atorvastatin decreased the concentration of small, dense LDL-C again after 3 months (8±13%, p<0.0001). The plasma concentrations of the fibrinolytic parameters did not change significantly after 3 months of atorvastatin therapy. FMD increased significantly after 2 weeks (5.6±2.1 vs 6.3±2.0%, p<0.01) and additionally increased after 3 months of therapy (8.3±1.9%, p<0.0001). There were no correlations between the pleiotropic effects and the improvement in the lipid profile. The results indicate some short-term pleiotropic effects of atorvastatin therapy within 2 weeks, which may be important with respect to the early benefits of statin therapy. (Circ J 2003; 67: 866 - 870)
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  • Hiroyuki Tanaka, Takashi Narisawa, Takanobu Mori, Mikio Masuda, Daizir ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 871-875
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    In the present study it was examined whether myocardial revascularization with multiple arterial grafts improves the prognosis of dialysis patients. The 20 subjects underwent coronary artery bypass grafting over 2 vessels (extra-corporeal circulation in 11 patients, off-pump bypass in 9 patients) and were divided into 2 groups according the number of arterial grafts. Group A consisted of 9 patients in whom more than 2 arterial grafts were used and Group B, 11 patients requiring 1 internal thoracic artery and additional saphenous vein grafts. The surgical procedure was examined, as well as the short-term and long-term results of both groups. There were no differences in the profiles of the 2 groups. The mean arterial graft number in group A was 2.2±0.6 and 1.0±0.0 in group B. There was neither mediastinitis nor brain complication in either group. There were no operative deaths in group A and 1 in group B. The 55-month actuarial survival rate including all deaths, and estimated by cardiac deaths, was, respectively, 0.53±0.21 and 0.80±0.18 in group A and 0.42±0.21 and 0.53±0.23 in group B. The survival rate estimated by cardiac death in group A was better, but there was not a significant difference. Myocardial revascularization with multiple arterial grafts for dialysis patients had good short-term results without increased operative risk and may improve the long-term results related to cardiac death. However, there was no significant difference in survival including all deaths because of the numerous non-cardiac deaths. (Circ J 2003; 67: 871 - 875)
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Experimental Investigation
  • Teiji Tatewaki, Masashi Inagaki, Toru Kawada, Toshiaki Shishido, Yusuk ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 876-880
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    Although certain roles of the sympathetic nervous system have been suggested as possible mechanisms of life-threatening arrhythmias and sudden cardiac death, the dynamic electrophysiological response to sympathetic activation remains unclear. The aim of this study was to investigate the dynamic response of action potential duration (APD) to sudden sympathetic stimulation (SYM) using monophasic action potential (MAP) recording. In 10 anesthetized cats, MAPs were continuously recorded from the right ventricular endocardium under constant pacing. The dynamic response of the APD to SYM (3 Hz) were examined before and after the administration of propranolol (0.5 mg/kg iv) (n=5) or phentolamine (1.0 mg/kg iv) (n=5). In response to SYM, the APD was transiently prolonged by 5.5±3.2 ms at 7.0±1.3 s, and monotonically shortened toward a steady-state level (-14.5±6.9 ms). Propranolol almost abolished both the transient prolongation (6.6±4.5 to 0.2±0.4 ms, p<0.05) and the steady-state shortening (-13.7±3.6 to -1.1±2.4 ms, p<0.005), whereas phentolamine did not have a significant effect on the response of APD to SYM. These findings might partly account for the propensity of ventricular arrhythmias to occur immediately after sudden sympathetic activation. (Circ J 2003; 67: 876 - 880)
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  • Katsura Kitaura-Inenaga, Masatake Hara, Kazuhiro Higuchi, Kanjo Yamamo ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 10 Pages 881-884
    Published: 2003
    Released: September 25, 2003
    JOURNALS FREE ACCESS
    This study examined the gene expression of mouse mast cell proteases to clarify their role in the pathophysiology of viral myocarditis. Male DBA/2 mice were inoculated intraperitoneally with the encephalomyocarditis virus and the gene expression of mast cell chymase, mouse mast cell protease (mMCP)-4 and -5, and tryptase, mMCP-6, matrix metalloproteinase (MMP)-9 and type-I procollagen was measured by real-time quantitative RT-PCR analysis. The gene expression of mMCP-4, -5 and -6 mRNA was increased at 5 days, and continued to increase to day 14, coinciding with a prominent inflammatory reaction and extensive myocardial necrosis and fibrosis. The gene expression of MMP-9 was also increased, and there was a significant correlation between upregulation of mast cell proteases and MMP-9. The gene expression of type-I procollagen was increased at 5 days and continued to increase to day 14, suggesting that a fibrotic process had already begun during the acute stage of viral myocarditis. These findings suggest that mast cell chymase and tryptase participate in the acute inflammation and remodeling process of viral myocarditis. (Circ J 2003; 67: 881 - 884)
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