Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 67 , Issue 11
Showing 1-15 articles out of 15 articles from the selected issue
Clinical Investigation
  • An Analysis of 848 Cases in 2000 and 2001
    Satoshi Nakatani, Kotaro Mitsutake, Takeshi Hozumi, Junichi Yoshikawa, ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 901-905
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    The Japanese Circulation Society appointed a committee to develop guidelines for the prevention, diagnosis and management of infective endocarditis in Japan. In making such guidelines, the committee required information on the current clinical characteristics of infective endocarditis and therefore performed a nationwide questionnaire survey of cases from 2000 and 2001. In total, data were received for 848 cases from 277 of the 817 hospitals surveyed. Mean age was 55±18 years and most patients were aged in their 50 s or 60 s; 53.9% of the patients had infective endocarditis of unknown origin (without any prior predisposing conditions or procedures) and the second most common etiology was post dental procedures. The most common microorganism was Gram-positive cocci (345 streptococci and 221 staphylococci) and methicillin resistant Staphylococcus aureus (MRSA) was found in 7.3%. Although more than 90% of cases with Streptococcus viridans were sensitive to penicillin G, 6.6% were resistant. All MRSAs were sensitive to vancomycin. The information obtained from the survey assisted in the making of the guidelines, which should become an indispensable tool for all clinicians. (Circ J 2003; 67: 901 - 905)
    Download PDF (191K)
  • Shoh Tatebe, Shigenori Nagakura, Edward M Boyle Jr, Brian W Duncan
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 906-912
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    Although the valved homograft is widely used to establish a connection between the right ventricle (RV) and the pulmonary artery (PA), its durability remains controversial. In the present study, the data on 141 valved homograft implantations in 107 consecutive patients performed from January 1990 to June 2000 were analyzed. The mean follow-up period was 4.6 years (range, 0.2-9.4 years). The clinical data, including clinic records, operative notes, follow-up visits, and letters from referring physicians, were analyzed with particular reference to variables associated with early and late mortality, deterioration of the homograft, and risk factors for patient survival and homograft failure. Early death occurred in 7.5% (n=8) of the cases, and each of these patients died without leaving the hospital. Late death occurred in 2 patients, for whom the cause of death was suggested to be related to arrhythmia. Thirteen patients underwent catheter intervention (ie, balloon dilatation and/or stenting) and 8 of these did not require homograft replacement following catheterization. The overall survival rate at both 3 years and 5 years was 88.9±3.4%. Cumulative freedom from total homograft failure was 82.5±3.6% at 1 year; 61.6±5.0% at 3 years; and 42.4±6.2% at 5 years. In comparison with 2 criteria of homograft failure (ie, total homograft failure and homograft failure including catheter intervention), the incidence of freedom from homograft failure including catheter intervention was lower than that of total homograft failure, although the difference was not statistically significant. In the multivariate analysis, significant risk factors with respect to patient survival were homograft replacement and the use of expanded polytetrafluoroethylene (ePTFE); those judged to be significant with respect to homograft failure were total repair with first homograft implantation and diagnosis of truncus arteriosus. The valved homograft was thus considered an appropriate choice of conduit between the RV and the PA, and it provided excellent patient survival. However, this type of homograft did not provide a completely permanent solution for the repair of complex cardiac anomalies. Therefore, the use of ePTFE for homograft extensions should be avoided. Finally, the results suggest that catheter intervention plays an important role in the longevity of the implanted homograft. (Circ J 2003; 67: 906 - 912)
    Download PDF (213K)
  • Masaki Kawamura, Yoshiko Ohta, Kenichi Katoh, Shigeyuki Nishimura
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 913-917
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    Dipyridamole thallium-201 single-photon emission computed tomography (SPECT) has not been extensively evaluated for risk stratification and the medium- to long-term prognostic value in elderly cardiac patients who are unable to exercise. The present study group comprised 210 consecutive patients aged at least 70 years with known or suspected coronary artery disease (CAD). The SPECT findings were classified as a reversible, fixed, or combined (reversible and fixed) defect. Of the 210 patients, 201 (77±5 years, 85 male) were successfully followed for 49±26 months. Thirteen (7%) patients had cardiac events: cardiac death (n=10), non-fatal myocardial infarction (n=1), or coronary artery bypass grafting (n=2). Cardiac events occurred in 3 of 112 patients with normal SPECT and in 10 of 89 patients with an abnormal scan (0.7% /year vs 2.8% /year, p=0.01). Stepwise Cox regression analysis revealed that the significant predictors of cardiac events were combined defects (relative risk 7.3) and the number of defect areas (relative risk 4.4). The predictive value of dipyridamole thallium-201 SPECT is maintained over 4 years in mixed populations of elderly CAD patients who are unable to exercise. (Circ J 2003; 67: 913 - 917)
    Download PDF (167K)
  • Ryu Sasaki, Isao Mitani, Takashi Usui, Yutaka Kitamura, Yuzuru Yoshii, ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 918-924
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    In the present study, the effectiveness of 123I-β-methyliodophenyl pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT) for predicting cardiac death of patients with chronic heart failure was evaluated. Abnormalities of fatty acid metabolism are found in patients with chronic heart failure and BMIPP was developed as a tracer for scintigraphic assessment of myocardial fatty acid utilization. The study group comprised 74 patients with chronic heart failure with a left ventricular ejection fraction (LVEF) <45% on left ventriculography or radionuclide angiocardiography. They underwent both 201Tl SPECT and BMIPP SPECT. The uptake of tracer was scored semiquantitatively from 0 (normal) to 4 (defect) in 20 segments and a total defect score (TDS) for all 20 segments was calculated. On planar images the mediastinum to heart count ratio (H/M) was calculated for the BMIPP and Tl studies, and the H/MBMIPP:H/MTl (H/MBMIPP divided by H/MTl) was also calculated. The mean follow-up period was 660 days and there were 17 cases of cardiac death. Multivariate analysis identified H/MBMIPP:H/MTl (p<0.05) and LVEF (p<0.05) as independent predictors of cardiac death. The receiver-operating characteristic curve of H/MBMIPP:H/M Tl was situated to the left relative to LVEF. Analysis of the myocardial metabolism by BMIPP SPECT can predict the high-risk patients with chronic heart failure. (Circ J 2003; 67: 918 - 924)
    Download PDF (338K)
  • Yongkeun Cho, Taein Park, Dong Heon Yang, Hun-Sik Park, Jongmin Chae, ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 925-928
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    The aim of this study was to assess the frequency and clinical characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC) in young victims of sudden cardiac death (SCD). From January 1999 to December 2000, postmortem studies were conducted in 38 cases of SCD (age ≤35 (27±7) years old, 26 male) from the Taegu-Kyungpook region of southeastern Korea. Cases of sudden infant death syndrome were excluded. The causes of SCD were ARVC in 42%, acute myocardial infarction in 11%, myocarditis in 11%, pulmonary embolism in 8%, hypertrophic cardiomyopathy in 5%, aortic rupture in 3%, aortic stenosis in 3%, and unknown in 18%. The mean age of the 16 ARVC victims was 27±5 years and 10 were male. None were competitive athletes, or had been suspected of having cardiovascular disease before death. SCD was not related to vigorous physical or competitive activity and occurred during sleep in 7 cases, during work in 4, during bathing in 2, while driving, praying and eating in 1 case each. ARVC is an important cause of SCD in young people in this area of Korea. (Circ J 2003; 67: 925 - 928)
    Download PDF (337K)
  • Naoyuki Yokoyama, Satoshi Takeshita, Ken Kozuma, Hanako Nishimura, Iku ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 929-933
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    Doxorubicin (DXR) is one of the most effective antineoplastic agents, but its use is limited by its myocardial toxicity. Myocardial injury reduces the cyclic variation of integrated backscatter (CV-IBS) and so the present study was designed to investigate whether CV-IBS can be used to detect the early phase of myocardial damage in patients receiving DXR. Thirty-four subjects constituted the study population, none of whom showed clinically evident heart failure. CV-IBS was obtained for both the interventricular septum and the left ventricular posterior wall in the parasternal short-axis view. Standard echographic measures of left ventricular function were also made. Subjects without DXR exposure or evident cardiac diseases served as controls. The total dose of DXR administered per patient was 339±164 mg/m2 (range: 95-680 mg/m2). Conventional echographic parameters, including left ventricular wall thickness, dimensions, fractional shortening, and ejection fraction, showed no significant differences between the 2 groups. In contrast, CV-IBS was significantly decreased in the DXR group compared with the control group (septum: 4.7±1.7 vs 7.2±1.9 dB, p<0.0001; posterior wall: 6.7 ±2.2 vs 8.0±1.6 dB, p<0.05). CV-IBS can be used as an early indicator of DXR-induced myocardial damage in patients demonstrating normal left ventricular systolic function. (Circ J 2003; 67: 929 - 933)
    Download PDF (209K)
  • Duk-Woo Park, Gi-Byoung Nam, Kyoung-Suk Rhee, Gi-Hoon Han, Kee-Joon Ch ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 934-939
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    The objective of this study was to investigate the clinical features of Korean patients with Brugada syndrome (BS). Between June 1998 and April 2002, 15 consecutive patients with BS (13 men, 2 women; mean age, 44±10 years) were identified. Eight patients had experienced at least 1 episode of aborted sudden death, 5 patients had had an episode of syncope or chest pain, and 2 patients were asymptomatic at diagnosis. The electrocardiographics (ECGs) of all patients showed spontaneous ST-segment elevation in leads V1-3 at baseline and 13 patients (87%) showed transient normalization of the ST-segment elevation during follow-up. Twelve patients received an implantable cardioverter-defibrillator (6 patients with aborted sudden death, 5 patients with syncope or chest pain, 1 asymptomatic patient). During a mean follow-up of 19±14 months, arrhythmic events occurred in 5 of the 6 patients with aborted sudden death and in 1 of the 5 patients with syncope or chest pain. None of the asymptomatic patients developed any symptoms suggestive of an arrhythmic event. The clinical and ECG manifestation of BS in Korean patients is diverse, but the dynamic nature of the ST segment provides an important clue to the diagnosis of BS. Recurrence of malignant arrhythmia is extremely high in those patients who initially present with aborted sudden death. (Circ J 2003; 67: 934 - 939)
    Download PDF (1954K)
  • Akihiko Ishida, Akihiro Yoshida, Hidetsuna Kitamura, Shinya Kubo, Koji ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 940-944
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    The crista terminalis (CT) is reportedly a critical barrier for maintaining typical atrial flutter (AFL), but recent observations have suggested the presence of posteromedial functional block, as well as crista conduction. Therefore, this study was designed to identify the correlation between the posterior boundary of AFL and anatomical architecture in the human right atrium (RA) using 3-dimensional (D) intracardiac echocardiography (ICE). In 11 patients with AFL (typical 9, reverse typical 2), mapping with a 10-pole (n=5) or 32-pole (n=6) catheter was performed during AFL. ICE was used to determine the catheter's position relative to the intra-atrial structures. In all patients, double potentials were recorded at the posteromedial RA and the catheter positions were recognized as posterior to the CT by 3-D ICE. Double potentials were not recorded on the CT, and the activation sequence revealed a craniocaudal direction in the 9 patients with typical AFL and caudocranial direction in the 2 patients with reverse typical AFL. These findings demonstrate that the posterior boundary of the AFL circuit is in the sinus venosa region posterior to the CT, which may provide an important insight into the mechanism of maintaining AFL. (Circ J 2003; 67: 940 - 944)
    Download PDF (524K)
  • Demonstration by Transthoracic Doppler Echocardiography
    Chinami Miyazaki, Masaaki Takeuchi, Hidetoshi Yoshitani, Shinichiro Ot ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 945-950
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    The purpose of this study was to determine whether the elimination or the alleviation of hyperglycemia would improve coronary flow velocity reserve (CFVR) using transnsthoracic Doppler echocardiography (TTDE). CFVR was measured by TTDE in the left anterior descending coronary artery in 49 poorly controlled diabetic patients before and after antidiabetic treatment and 15 well controlled diabetic patients also underwent the same measurements. The fasting blood glucose level in the poorly controlled patients reduced from 270 ±106 mg/dl to 116±39 mg/dl at 20±15 days after the intensive treatment. Although baseline coronary flow velocity (CFV) did not change between the 2 measurements (19.9±6.9 cm/s vs 19.0±5.4 cm/s, p=NS), the hyperemic CFV increased significantly after the treatment (47.3±13.4 cm/s vs 55.4±13.2 cm/s, p<0.001). Thus, the CFVR improved significantly after the treatment (2.47±0.55 vs 2.98±0.56, p<0.001). Although there was minimal improvement in the control group (2.37±0.38 vs 2.50±0.37, p<0.05), the improvement in CFVR was significantly greater in the poorly controlled patients with intensive treatment (0.51±0.33 vs 0.12±0.19, p<0.001) than that in the control group. These results suggest that optimal hypoglycemic therapy is important to improve the CFVR in poorly controlled diabetic patients. (Circ J 2003; 67: 945 - 950)
    Download PDF (180K)
  • Ren Kawaguchi, Hiroshi Hoshizaki, Shigeru Oshima, Tomoya Hirathuji, Hi ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 951-954
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    Percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) may cause distal embolization, with deterioration of distal flow and further extension of the infarct. The purpose of the present study was to evaluate the effectiveness of pretreatment by thrombectomy on myocardial salvage after stent implantation in patients with AMI. From January 2000 to July 2002, 209 consecutive patients with AMI successfully underwent emergency stent implantation. They were divided into 2 groups: those treated in the year before the introduction of the thrombectomy device (Group A; n=109), and those treated the year after introduction of the device (Group B; n=100). Follow-up quantitative coronary angiography (QCA) and left ventriculography were carried out 6 months after PCI. Microvascular circulation after revascularization was assessed by Thrombolysis in myocardial infarction (TIMI) flow grade analysis, the maximum creatine kinase concentration was recorded, and the follow-up left ventricular ejection fraction and ST segment score were assessed on the 12-lead electrocardiography just before revascularization and on return to the coronary care unit. The QCA data, rate of restenosis (% restenosis) and rate of target lesion revascularization were also compared between the 2 groups. The results demonstrated that the introduction of thrombectomy had increased the number of patients who displayed blush-3 after primary angioplasty, which suggests that thrombectomy before stent implantation has the potential to minimize myocardial ischemic insult, presumably by protecting the coronary microvasculature. (Circ J 2003; 67: 951 - 954)
    Download PDF (62K)
Experimental Investigation
  • Tatsuhiko Ooie, Naohiko Takahashi, Tomoko Nawata, Masaya Arikawa, Kuni ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 955-961
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    The present study investigated the role of translocation of protein kinase C (PKC) during ischemia/reperfusion in cardioprotection in the streptozotocin (STZ)-induced diabetic rat. Twelve weeks after injection of STZ or vehicle, male Wister-King rat hearts were isolated and perfused in the presence or absence of 50 nmol/L staurosporine or 2 μmol/L chelerythrine using a Langendorff apparatus. Thirty minutes of global ischemia was followed by the same period of reperfusion. The time to onset of contracture was determined during ischemia. The recovery of left ventricular function, incidence of ventricular tachycardia/fibrillation (VT/VF), and amount of released creatine kinase (CK) were determined during the reperfusion period. Translocation of the PKC-α, -β, -δ and -ε isoforms was determined by immunoblotting. Development of contracture was delayed, the recovery of left ventricular function was greater, and the incidence of VT/VF and amount of released CK were lower in diabetic than in control hearts. Ischemia caused an increase in the particulate/cytosolic fraction ratio of the PKC- ε isoform in the diabetic and control hearts. However, this translocation of PKC-ε during ischemia was transient in the control heart, but was persistent in the diabetic heart. The ischemia-induced translocation of PKC-ε was abolished by chelerythrine perfusion. These results suggest that persistent translocation of PKC-ε during ischemia plays a major role in cardioprotection against ischemia/reperfusion injury in STZ-induced diabetic rats. (Circ J 2003; 67: 955 - 961)
    Download PDF (683K)
Case Report
  • Hirokazu Shiraishi, Norifumi Urao, Masaki Tsukamoto, Masayuki Hyogo, N ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 962-964
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    Subepicardial aneurysm is a rare complication of acute myocardial infarction and the present case was associated with ventricular septal perforation. Echocardiography showed the subepicardial aneurysm adjoining the true apico-anteroseptal aneurysm, with the former being discontinuous with the myocardium at its neck, which was narrower than the diameter of the aneurysm. In addition, color Doppler imaging showed shunt flow from the aneurysm to the right ventricle. Coronary angiography revealed extension only of the anterior descending artery without any discernible stenosis. The apical aneurysm was excised and the defect closed with an epicardial patch. The myocardial infarction was probably caused by coronary spasm. Echocardiography was useful for diagnosing the anatomy and hemodynamic condition of the subepicardial aneurysm. (Circ J 2003; 67: 962 - 964)
    Download PDF (481K)
  • Takuroh Imamura, Masamitsu Nakazato, Yukari Date, Hiroyuki Komatsu, Sh ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 965-968
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    A 40-year-old man presented with initial symptoms of syncope caused by restrictive cardiomyopathy and autonomic nervous system impairment, but it was confirmed that he had a novel transthyretin (TTR) variant, aspartic acid-18 glutamic acid (Glu), and a de novo gene mutation. A polymerase chain reaction-induced mutation restriction analysis with a mismatched sense primer demonstrated that he was heterozygous for TTR Glu 18. Liver transplantation was not performed because of profound weakness and severe postural hypotension. Right-sided heart failure predominated in association with low output syndrome and a gradual decrease in total QRS voltage on electrocardiogram over 5 years of follow-up. Autonomic neuropathy developed and he eventually died of both-sided heart failure at the age of 45 years. Immunohistochemical and DNA studies are important to diagnose and treat TTR-related cardiac amyloidosis. (Circ J 2003; 67: 965 - 968)
    Download PDF (367K)
  • Case Report
    Noriko Sasaki, Yoshio Yasumura, Nobuyuki Uemura, Akihisa Hanatani, Sat ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 969-971
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    A 44-year-old woman with restrictive cardiomyopathy showed right-sided dominant heart failure after conversion to sinus rhythm from paroxysmal atrial fibrillation (AF). During cardiac catheterization, the hemodynamics were compared before and after cardioversion; that is, with AF and with sinus rhythm. The hemodynamic parameters worsened after conversion to sinus rhythm, with a significant decrease in heart rate, but improved with atrial pacing. Pacemaker implantation was performed to avoid bradycardia while keeping the sinus rhythm with amiodarone. As a result, the patient has been free from symptoms of heart failure for almost 1 year and her serum brain natriuretic peptide level also improved remarkably. (Circ J 2003; 67: 969 - 971)
    Download PDF (434K)
  • A Case Report
    Masaki Takahashi, Toshio Nishikimi, Kouichi Tamano, Suomi Hara, Tsutom ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 11 Pages 972-974
    Published: 2003
    Released: October 25, 2003
    JOURNALS FREE ACCESS
    A 51-year-old Japanese man was admitted to hospital for evaluation of anterior chest pain at rest. He had a past history of cerebellar infarction when he was 47 years old. A conventional 2-dimensional echocardiogram revealed normal left ventricular function, and no abnormal findings. However, second harmonic imaging demonstrated 2 noncontractile diverticula at the submitral annular portion of the posterior wall of the left ventricle. Second harmonic imaging revealed another contractile diverticulum at the anterior wall of left ventricle in the short-axis view. These findings were confirmed by left ventriculography. After confirming the diagnosis of multiple left ventricular diverticula, a rare type of congenital anomaly, anticoagulant therapy was started and he is well to date. Left ventricular diverticula are clinically very important because they are often associated with serious complications such as systemic thromboembolism. Enhancement of the left ventricular endocardial borders by second harmonic imaging is useful for the diagnosis of left ventricular diverticula. (Circ J 2003; 67: 972 - 974)
    Download PDF (930K)
feedback
Top