Embryonic stem cells and bone marrow mesenchymal stem cells can be induced to differentiate into cardiomyocytes. Techniques to purify and transplant regenerated cardiomyocytes have been developed, and transplanted regenerated cardiomyocytes are capable of residing in the heart of recipients for long periods. Advances in tissue engineering technology have enabled the production of cardiomyocyte cell sheets for transplantation treatment of heart failure, without the need for a donor, and this has now reached the preclinical stage. The treatment of heart failure using cytokines to mobilize stem cells has also been explored. (Circ J 2005; 69: 1431 - 1446)

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Background A nationwide survey of the process and outcome of treatment for acute myocardial infarction (AMI) has not been conducted in Japan. Methods and Results In the present study 2,007 patients with AMI admitted to 22 national hospitals were registered between July 1999 and January 2002 for CAMPAIGN Study 1; an additional 206 and 238 cases were registered between October and December 2002 (CAMPAIGN 2) and between October and December 2003 (CAMPAIGN 3), respectively. In CAMPAIGN 1, the length of stay varied from 15 to 35 days among hospitals (mean: 24.8 days), and was mainly determined by the schedule of follow-up examinations rather than clinical course. Of the prescriptions at discharge, β-blockers and angiotensin-converting enzyme inhibitors varied widely; the use of β-blockers was very low (25%). Nitrates were frequently used (68%) although there is no evidence for secondary prevention. In CAMPAIGNs 2 and 3, the use of β-blockers increased (36%, 47%) and that of nitrates decreased (24%, 21%). Conclusion CAMPAIGN Study 1 revealed considerable variation in the treatment of AMI during the acute phase among the hospitals. The use of β-blocker and nitrates as discharge medication was inappropriate. CAMPAIGNs 2 and 3 showed some improvement in the problems revealed by CAMPAIGN 1. (Circ J 2005; 69: 1447 - 1453)

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Background The prevalence and clinical manifestations of acute myocardial infarction (AMI) in young patients in Japan have not been fully investigated. Methods and Results In the present study, 1651 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and June 2004. Of these, the clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI) and in-hospital outcomes for 27 young patients <40 (young group), and 338 non-young patients 60≤, <70 years old (non-young group) were retrospectively compared. The young AMI patients were all male. Current smoking, hypercholesterolemia and family history were the most common risk factors in young patients, while hypertension and diabetes mellitus were more prevalent in non-young patients. Young patients had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as a culprit lesion. The young group had high acquisition rates of Thrombolysis In Myocardial Infarction 3 flow just after primary PCI (95.8%) and no in-hospital deaths, which was not significantly different from the non-young group. Conclusions These results suggest that young AMI patients have different clinical characteristics from those in non-young AMI patients, and acute results of primary PCI and in-hospital prognosis in young AMI patients are comparable to those in non-young AMI patients in Japan. (Circ J 2005; 69: 1454 - 1458)

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Background Fatty acid metabolism in patients with myocardial infarction (MI) who undergo coronary reperfusion has not been fully elucidated and was investigated in the present study using positron emission tomography. Methods and Results The clearance rate constant of ¹¹C-acetate (acetate-K _mono) and that of ¹¹C-palmitate (palmitate-K _mono) from the myocardium were calculated using a monoexponential equation in 14 patients with MI. A total of 155 regions of interest were classified based on coefficient of determination (R²) values of monoexponential curves for ¹¹C-palmitate clearance: well fitted regions (R² ≥0.5) and poorly fitted regions (R² <0.5). Regional relative myocardial blood flow calculated from the initial distribution of ¹¹C-acetate and left ventricular (LV) wall motion were also evaluated. Peak ¹¹C-palmitate uptake (14,434 ±3,052 vs 12,016±3,088 counts/s, p<0.001) and percent clearance during acquisition (38.2±10.1 vs 23.6±11.4%, p<0.001) were significantly greater in the well fitted regions (n=111) than in the poorly fitted regions (n=44). Acetate-K_mono was significantly higher in the former than in the latter (0.0641±0.0099 vs 0.0476±0.0103 min^-1, p<0.001). LV wall motion and regional relative blood flow were also significantly greater in the former regions. Palmitate-K_mono in the well fitted regions was significantly higher in normal LV wall motion areas than in hypokinesis areas (0.0363±0.0062 vs 0.0274±0.0057 min^-1, p<0.001) Conclusions Maintenance of myocardial fatty acid β-oxidation with better myocardial blood flow is substantial in the preservation of total myocardial oxidative metabolism and LV wall motion in patients with MI. The finding that the early-phase clearance of ¹¹C-palmitate is fitted with a monoexponential curve may provide important information in the evaluation of myocardial fatty acid β-oxidation. (Circ J 2005; 69: 1459 - 1465)

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Background Ethnicity and smoking are well-known risk factors for the pathogenesis of coronary vasospasm. Oxidative stress induced by smoking plays a crucial role in coronary vasospasm, but is not enough to account for the pathogenesis of coronary vasospasm, indicating that genetic factors are strongly involved. Methods and Results The study group comprised 162 vasospastic angina patients (VSAs), 61 microvascular angina patients (MVAs) and 61 non-responders (NRs) diagnosed by acetylcholine provocation test. Four polymorphisms of the oxidative stress related genes, cytochrome b-245, α polypeptide gene (CYBA) C242T and A640G, paraoxonase 1 gene (PON1) A632G, phospholipase A2 group VII gene (PLA2G7) G994T were genotyped. Allele frequency of PON1 632-G was significantly higher in both the VSA with dominant fashion and the MVA with recessive fashion compared with NR. This association was strongly influenced by gender in the MVA only. There were no significant associations between the other polymorphisms and coronary vasospasm. In addition, the allele frequency of PON1 632-G in the Japanese was higher than in Caucasians. Conclusions There was a significant association between PON1 A632G polymorphism and MVA as well as VSA, but the impact of this on VSA and MVA is different in the Japanese. (Circ J 2005; 69: 1466 - 1471)

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Background Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are not specific for ventricular dysfunction and other cardiac processes, such as myocardial ischemia, may also cause elevation of these markers. Methods and Results To determine whether elevation of NT-proBNP without elevation of cardiac specific markers can predict coronary artery disease (CAD), the serum level of NT-proBNP was measured in 161 patients with unstable angina (61.0±8.1 years, male 54.0%) with normal ventricular function (left ventricular ejection fraction >55% and no regional wall motion abnormality by echocardiography) and normal troponin I level (<0.05 ng/ml). In these patients, levels of C-reactive protein and myoglobin were normal and none had Q wave on electrocardiographic (ECG). The NT-proBNP level was higher in patients with CAD (n=74) than in patients without CAD (n=87) (173.1±231.6 vs 68.1±62.5 pg/ml, p<0.001). At the standard cut-off point of >200 pg/ml, elevated NT-proBNP level shows high probability of CAD (odds ratio, 10.1; 95% confidence interval, 2.6-38.7, p=0.001). The NT-proBNP level positively correlated with the extent of CAD (r=0.329, p=0.001). In multivariate analysis, the NT-proBNP was an independent predictor of CAD. Conclusion These results suggested that NT-proBNP is a useful screening test for CAD in the unstable angina patients with normal ECG, echocardiogram and cardiac enzyme levels. (Circ J 2005; 69: 1472 - 1476)

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Background Recent data indicate that an elevated serum level of high-sensitivity C-reactive protein (hs-CRP) predicts the risk of recurrent coronary events, and that statin therapy decreases the risk of coronary events. This study assessed the relationship between the pre-procedural hs-CRP level and in-stent neointimal hyperplasia (NIH) after stenting and the effects of statins on the relationship between restenosis after stenting and the serum hs-CRP levels of patients with coronary artery disease. Methods and Results This study included 100 patients who underwent stent implantation for angiographically significant stenosis. Patients were divided into a normal C-reactive protein (CRP) group (<0.5 mg/dl, n=59) and elevated CRP group (≥0.5 mg/dl, n=41). All patients underwent angiographic and intravascular ultrasound follow-up at 6 months. The baseline CRP level was 0.29±0.08 mg/dl in the normal CRP group and 2.90±2.31 mg/dl in the elevated CRP group. The NIH cross-sectional area (CSA) in the minimal lumen CSA at follow-up was significantly larger in the elevated CRP group compared with the normal CRP group (1.9±1.3 mm² vs 3.0±1.5 mm², p=0.001). A significant positive correlation was found between pre-interventional CRP level and NIH area (r=0.52, p<0.001). In patients with normal CRP, an association between statin therapy and restenosis was not observed. However, when the analysis was confined to patients with elevated CRP, statin therapy significantly reduced the restenosis rate (20% vs 37.5%, p=0.031). In the normal CRP group, the intra-stent neointimal area at 6 months was not different between the non-statin and statin groups (2.2±1.4 mm² vs 1.8±1.1 mm²). However, in the elevated CRP group, statin therapy significantly decreased the neointimal area at 6-month follow-up (3.6±1.7 mm² vs 2.4±1.3 mm², p<0.001). Conclusion Measuring the pre-interventional hs-CRP level may help predict the development of restenosis after stenting and statin therapy will significantly reduce the restenosis rate in patients with an elevated hs-CRP. (Circ J 2005; 69: 1477 - 1483)

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Background Monocyte chemoattractant protein-1 (MCP-1) is involved in the recruitment of monocytes into the arterial vessel wall as one of the major events leading to atherosclerotic vascular diseases, such as coronary artery disease (CAD). Methods and Results The study group comprised 263 volunteers aged between 18 and 85 years who were admitted to hospital or clinic for scheduled invasive and non-invasive diagnostic procedures. MCP-1 serum levels were determined using a sandwich-enzyme-linked immunosorbent assay. In each patient, the coronary risk factors (CRF), such as hypertension, high cholesterol, diabetes mellitus, obesity, positive family history, and smoking were evaluated. Low-density lipoprotein-cholesterol, lipoprotein(a), and hemoglobinA_1C levels were determined. Patients with CAD proven by angiography had significantly increased MCP-1 levels. In patients without CAD, the increase in MCP-1 depended on the number of CRF. As a marker for endothelial activation the soluble adhesion molecules, soluble intercellular adhesion molecule and soluble E-selectin were measured and both markers were significantly elevated in patients with CAD or multiple CRF when compared with patients without CRF. Although this is not a direct proof, endothelial activation could contribute to elevated MCP-1 levels in atherosclerosis. Conclusion Elevated MCP-1 serum levels could serve as a direct marker of the inflammatory activity in patients at risk for coronary artery and other atherosclerotic vascular diseases. (Circ J 2005; 69: 1484 - 1489)

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Background Although cytokines are known to be pivotal in the development of atherosclerotic diseases, few data exist regarding their expressions in the established stages such as aneurysmal or occlusive lesions. Therefore, in the present study the gene expression levels of cytokine-related substances in abdominal aortic aneurysm (AAA) and carotid artery stenosis (CAS) were determined using cDNA macroarray and real-time reverse transcriptase polymerase chain reaction (RT-PCR) methods. Methods and Results Tissue samples were obtained from 31 patients with AAA and 24 with CAS. The array-specific [³³P]-labeled cDNA probe mixture synthesized from 2.5 μg total RNA with gene-specific primers was hybridized with nylon membranes containing 375 cDNA clones. Densitometric analysis confirmed differences in expression (>5-fold) for 97 of the cytokine-related gene products between AAA and adjacent control tissue. Among these, simultaneous upregulation was found in the expression of interleukin (IL)-8 (9-fold) and its receptor, CXCR-2 (11-fold). Thus, the expressions of IL-8 and CXCR-2 were further quantified by real-time RT-PCR. The expression of both the genes was significantly upregulated in both AAA and CAS compared with control regions as followed: IL-8 =0.53±0.16 vs 0.11±0.04 (p<0.01); CXCR-2 =2.04±0.75 vs 0.29±0.10 (p<0.01) in AAA, and IL-8 =1.35 ±0.25 vs 0.60±0.16; CXCR-2 =2.00 ±0.51 vs 0.58±0.21 (p<0.05) in CAS. Under these conditions, the gene expressions of monocyte chemotactic protein-1 and its receptor, CCR-2, were not significantly different in the control and diseased regions of both AAA and CAS. Conclusions Sustained upregulation of IL-8 and CXCR-2 was observed in both AAA and CAS, suggesting the inflammatory process is still active in established dilated and occlusive atherosclerotic diseases. Whether upregulation of this system could be protective or not protective for disease development requires further study. (Circ J 2005; 69: 1490 - 1495)

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Background Pulmonary vein (PV) isolation using a circular catheter (CC) creates an entrance block from the left atrium (LA) to PV to eliminate paroxysmal atrial fibrillation (PAF). We describe a new approach for PV isolation during distal PV pacing using a basket catheter (BC). The purpose of the present study was to compare 2 mapping strategies for PV isolation. Methods and Results Of 100 consecutive patients with PAF, 50 underwent CC-guided PV isolation and 50 underwent BC-guided PV isolation. During CC-guided ablation, the endpoint was the elimination of PV potentials based on the entrance block from the LA to PV. During BC-guided ablation during distal PV pacing, the endpoint was the elimination of bidirectional PV - LA conduction. At 12 months, 62% of patients who underwent CC ablation and 80% of patients who underwent BC ablation were free of symptomatic PAF without the use of antiarrhythmic drugs (p<0.05). The incidence of mild (<50%) PV stenosis in BC ablation was significantly lower than that in CC ablation (12 vs 24%, p<0.01). Conclusions This new approach for PV isolation during distal PV pacing using BC is useful for confirming a bidirectional PV - LA conduction block and is more effective than CC ablation. (Circ J 2005; 69: 1496 - 1502)

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Background Pulmonary vein (PV) isolation is commonly performed in patients with drug-refractory atrial fibrillation (AF) and in cases of unsuccessful ablation, antiarrhythmic agents that were ineffective before the ablation sometimes become effective afterward. Therefore, the effects and mechanisms of hybrid therapy with pilsicainide and PV isolation for AF were assessed in the present study. Methods and Results Seventy-four patients with paroxysmal AF in whom pilsicainide was ineffective underwent PV isolation. If AF recurred, a second procedure was performed and if AF recurred again, pilsicainide was re-administered. After the first procedure, AF recurred in 42 patients, and a second procedure was performed in 31 patients, of whom 28 had recovery of left atrial (LA)-PV conduction and non-PV foci were identified in 3. After the second session, ablation eliminated AF without drugs in 53 (72%) patients. Pilsicainide suppressed the conduction properties at the LA-PV junction. In 21 patients with recurrence of AF, pilsicainide was re-administered and eliminated AF in 11 patients (success with pilsicainide: 86%). Conclusions In cases of unsuccessful PV isolation, pilsicainide may prevent AF by modifying the LA-PV conduction properties. Hybrid therapy with pilsicainide and PV isolation may be an effective therapeutic approach for AF. (Circ J 2005; 69: 1503 - 1507)

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Background Some patients with an implantable cardioverter-defibrillator (ICD) suffer from burst of inappropriate multiple discharges (severe electrical storm), and because the current therapeutic options are limited, the effect of nifekalant hydrochloride, a new class III drug, on severe electrical storm was investigated in the present study. Methods and Results Ninety-one consecutive patients treated with ICD were included in the study (M 70; mean age 58 years; left ventricular ejection fraction 45±15%). Severe electrical storm was defined as more than 10 ICD discharges within 1 h. During a mean follow-up period of 30±13 months, 41/91 (45%) patients had appropriate ICD therapy for arrhythmias and severe electrical storm occurred in 11 of them (12%) at 20±18 months after ICD implantation. The mean number of ICD discharges/h during severe electrical storm was 18±12. In 4 of 10 patients, severe electrical storm was successfully suppressed by a combination of deep sedation and β-blocking agent; 6 other patients were refractory to this treatment, but severe electrical storm was successfully suppressed by intravenous administration of nifekalant hydrochloride with no adverse effects. Conclusions Nifekalant hydrochloride is an effective and safe treatment for severe electrical storm. (Circ J 2005; 69: 1508 -1513)

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Background The purpose of this study was to determine whether the extent of atrial electrical remodeling affects the recurrence of atrial fibrillation (AF) after cardioversion of persistent AF (PAF). Methods and Results Internal atrial cardioversion was performed in 47 patients with PAF. The right atrial monophasic action potential duration (RA-MAPD) at pacing cycle lengths (PCLs) of 800-300 ms and P wave signal-averaged electrocardiogram were recorded after cardioversion. Bepridil (150-200 mg/day) and carvedilol (10 mg/day) were administered to all patients after cardioversion. Of the 47 patients, 20 had recurrent AF within 3 months. No relation was observed between age, left atrial dimension, left ventricular ejection fraction, and AF recurrence. The AF duration was significantly longer (p<0.05) and RA-MAPD at PCLs of 800 to 300 ms were significantly shorter (p<0.05) in patients with AF recurrence than in those without recurrence. The mean slope of the RA-MAPD for PCLs between 600 and 300 ms did not differ between the patients with and without AF recurrence. The filtered P-wave duration (FPD) was significantly longer in the patients with AF recurrence than in those without (p<0.05). Multivariate analysis also showed that the RA-MAPD at a PCL of 300 ms and FPD were predictors of AF recurrence (RAMAPD: p=0.038; FPD: p=0.052). Conclusion These results suggest that electrical remodeling related to the repolarization and depolarization may be the main contributors to early AF recurrence after cardioversion under the administration of bepridil and carvedilol. (Circ J 2005; 69: 1514 - 1520)

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Background Although cardiac resynchronization therapy (CRT) improves quality of life and survival for patients with heart failure, exact methods to estimate the effect of cardiac asynchrony have not yet been defined. Methods and Results Initially, to examine whether the phase analysis images in the Fourier analysis using gated cardiac pool single photon emission computed tomography (POOL-SPECT) could be used to evaluate cardiac asynchrony, 19 consecutive patients with dilated cardiomyopathy were studied. Interventricular asynchrony was defined by whether the peak of the picture elements of the right ventricle in the phase histogram fitted that of the left ventricle and intraventricular asynchrony by whether the phase image was described homogenously or not. The patients with both inter- and intraventricular asynchrony had significant deterioration in both left ventricular ejection fraction (p<0.01) and New York Heart Association functional class (p<0.01). To evaluate the efficacy of these phase images for CRT setting, 7 patients were tested before and after CRT. During a 3.9±3.6 month follow-up period, all patients had an improvement in their condition, and the inter- and intraventricular asynchrony significantly improved after CRT. The degrees of the inter- and intraventricular asynchrony were related to the degree of cardiac depression pre CRT. Conclusion These results have shown that the phase images from POOL-SPECT are useful for assessing the effect of CRT in patients with heart failure, which suggests that it may provide information about the indication for CRT. (Circ J 2005; 69: 1521 - 1526)

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Background Measures assessing quality of life (QOL) in patients participating in comprehensive cardiac rehabilitation (CCR) have not been established in Japan. Methods and Results To compare different types of QOL scales and to determine the impact of CCR on QOL in Japanese cardiac patients, 5 different types of questionnaires were assessed in 44 patients participating in CCR after acute myocardial infarction (AMI). After 3-month CCR, peak oxygen uptake (PVO₂, p<0.01), Sickness Impact Profile (SIP) total score (p<0.05) and physical function-related QOL scores (Specific Activity Scale (SAS), p<0.01; SIP physical score, p<0.01) significantly improved, whereas psychosocial/mental aspect-related QOL scores (Ministry of Health and Welfare (MHW)-QOL score, SIP psychosocial score, State-Trait Anxiety Inventory, Self-rating Depression Scale) did not change on the average. However, patients with low PVO₂ (<21.7 ml · min ^-1 · kg^-1) showed significant improvements in all scores after CCR, whereas patients with preserved exercise capacity showed improvements only in physical function-related scores (SAS and physical SIP). Furthermore, patients with anxiety and depression showed significant improvements in these respective measures after CCR. Conclusion In patients with AMI, physical function-related QOL scores improve after a 3-month CCR program, but psychosocial/mental aspect-related QOL scores improve only in those with impaired exercise tolerance or anxiety/depression. Thus, changes in QOL after CCR depend on type of QOL scale used and the baseline status of the patient. In addition, in Japanese cardiac patients MHW-QOL mainly reflects psychosocial/mental aspect-related QOL, as well as overall QOL. (Circ J 2005; 69: 1527 - 1534)

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Background Progression of aortic stenosis (AS) influences the prognosis in chronic dialysis (CD) patients, but there have been few studies in Japanese patient populations. Methods and Results The progression of AS was examined in 16 CD patients (68±10 years) and 82 non-dialysis patients (73±11 years). The mean follow-up was 32 and 40 months, respectively. The calcium - phosphate product was increased in CD patients (49±14 mg/dl vs 30±5 mg/dl; p<0.0001). At entry, the peak transaortic gradient detected by Doppler echocardiography was lower in CD patients (42±12 mmHg vs 57±22 mmHg; p<0.05). At follow-up, there was no difference between the 2 groups in that value (69±31 mmHg vs 71±27 mmHg). Decreasing rate of calculated aortic valvular area was increased in CD patients (0.14±0.13 cm²/year vs 0.06±0.09 cm²/year; p<0.05) and the calcification of the aortic valve was more severe at follow up in CD patients. The mortality was higher in CD patients (75 vs 28%; p<0.001). Conclusions AS appeared to progress rapidly in CD patients and therefore early aortic valve replacement may be necessary. (Circ J 2005; 69: 1535 - 1539)

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Background The effect of hormone replacement therapy (HRT) on plasma adenosine levels was investigated in climacteric women experiencing hot flushes. Methods and Results Plasma adenosine levels were measured in 13 peri-menopausal women with frequent hot flushes (>5 per day) before and 3-4 months after initiating HRT. Thirteen healthy pre-menopausal, 9 peri-menopausal women with few hot flushes (<1 or 2 per day) and 10 healthy postmenopausal women were enrolled as controls. The average plasma adenosine level in the peri-menopausal women was 0.20±0.09 μmol/L, which was significantly higher than in the pre-menopausal (0.12±0.07 μmol/L, p<0.05), peri-menopausal with few hot flushes (0.10±0.09 μmol/L, p<0.05) and postmenopausal women (0.13±0.06 μmol/L, p<0.05). Both the increased adenosine level and the hot flushes were decreased by HRT (plasma adenosine: 0.13±0.06 μmol/L). Conclusions Increased plasma adenosine in peri-menopausal women may be associated with frequent hot flushes. (Circ J 2005; 69: 1540 - 1542)

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Background Although immunoglobulin treatment, beginning simultaneously with the initiation of atherosclerosis, suppresses experimental atherosclerosis in apolipoprotein E-deficient mice, it remains unclear whether the treatment at a subsequent stage of atherosclerosis would be effective. Methods and Results Experimental atherosclerosis was induced in mice fed a high-fat diet containing 0.3% cholesterol. After confirming the presence of atherosclerotic lesions at 11 weeks, the mice were treated with an intraperitoneal injection of either intact type of immunoglobulin or F(ab')₂ fragments of immunoglobulin (both, 1 g · kg ^-1 · day^-1) on alternate days over 4 weeks. Fatty streak lesion was suppressed by intact immunoglobulin administration, but not by F(ab')₂ fragments of immunoglobulin. Immunohistochemical analysis showed that macrophage and CD4⁺ T-cell accumulation in the fatty streak lesion was suppressed in mice that received intact immunoglobulin but not in those that received F(ab')₂ fragments. Conclusions Immunoglobulin treatment, even at a later stage of atherosclerosis, suppresses the development of lesions associated with the reduced expression of immune-activated cells in fatty streak plaques, demonstrating the benefits of immunoglobulin therapy for prevention of atherosclerosis. (Circ J 2005; 69: 1543 - 1546)

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Background HMG-CoA reductase inhibitors (statins) have pleiotropic effects beyond their cholesterol-lowering effect. However, consensus on the effect of statins on endothelial cells and angiogenesis has not yet been reached. Methods and Results The effects of pitavastatin on the migration, proliferation and viability of human epidermal microvessel endothelial cells (HMVECs) were examined using scratch assay, chemotaxis chamber, bromodeoxyuridine incorporation, trypan blue dye exclusion test, and nuclear DNA staining. Pitavastatin enhanced the migration, proliferation and viability of HMVECs at a low concentration (0.01 μmol/L) but inhibited them at high concentration (1 μmol/L). The inhibitory effect on cell viability by high concentration of pitavastatin was recovered by geranylgeranyl pyrophosphate, but the effect on migration and proliferation was not. The cell activating effect of a low concentration of pitavastatin was reversed by both farnesyl pyrophosphate and geranylgeranyl pyrophosphate. A quail chorioallantoic membrane assay showed that high concentration (1 μmol/L) of pitavastatin reduced fibroblast growth factor-2-induced angiogenesis, whereas low concentration (0.3 μmol/L) tended to increase angiogenesis. Conclusion Pitavastatin has a biphasic effect on HMVECs and on angiogenesis through at least 2 different pathways that include the mevalonate pathway. (Circ J 2005; 69: 1547 - 1555)

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Delayed enhancement magnetic resonance imaging (DE-MRI) has excellent spatial resolution and compared with other cardiac imaging techniques it can detect a small myocardial infarction (MI) or a subendocardial infarction. A 76-year-old man was admitted for loss of consciousness because of cardiac tamponade. The cause of tamponade was unknown, but electrocardiography and blood test suggested a recent MI. The removal of 100 ml bloody fluid by immediate pericardiocentesis normalized his hemodynamics, and he regained consciousness. Neither echocardiography nor scintigraphy could determine the location of the MI or rupture, but DE-MRI clearly demonstrated a transmural enhancement in a very narrow range of the lateral wall of the left ventricle. Coronary angiography revealed a severely stenotic lesion in the obtuse marginal branch of the left circumflex artery. DE-MRI is a powerful tool for diagnosing small MI that are undetectable with other imaging. Therefore, DE-MRI should be applied in cases with cardiac tamponade by unknown causes. (Circ J 2005; 69: 1556 - 1559)

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Anomalous mitral arcade is a rare congenital malformation and few survive to adulthood. A 65-year-old man presented with mild dyspnea and cardiac murmur. Transthoracic and transesophageal echocardiography showed an arc-like configuration of the papillary muscles, constrained by an interconnecting fibrous band in direct continuity with the anterior mitral leaflet, and mitral insufficiency caused by the restricted mobility of the mitral valve. Multidetector computed tomography confirmed these findings. (Circ J 2005; 69: 1560 - 1563)

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Anomalous coronary arteries are usually identified incidentally by angiography or autopsy, but some "malignant" coronary anomalies are associated with a high incidence of syncope, arrhythmia, myocardial infarction, and sudden death. So far, the pathogenesis of the coronary events in such cases has only been revealed by autopsy. In the present case report, a patient with anomalous origin of the right coronary artery from the left sinus of Valsalva developed acute myocardial infarction, and visualization of the anomaly and assessment of the culprit plaque in the artery were done by multidetector row computed tomography and intravascular ultrasound. (Circ J 2005; 69: 1564 - 1567)

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Background The potency and usefulness of capillary isotachophoresis (cITP) for assessing whole-serum lipoprotein profiles and quantifying electronegative low-density lipoprotein (LDL) has been previously reported. Methods and Results A new cITP method to measure electronegative LDL in the small dense LDL fraction has been established. Both electronegative LDL and electronegative LDL in the small dense LDL fraction decreased after treatment with fenofibrate. Conclusions This method appears to be useful for analyzing a marker of coronary heart disease risk and may be suitable for evaluating the effects of hypolipidemic agents. (Circ J 2005; 69: 1568 - 1570)

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