Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 69 , Issue 1
Showing 1-28 articles out of 28 articles from the selected issue
Clinical Investigation
  • The Kyushu Lipid Intervention Study
    Mikio Iwashita, Yasuyuki Matsushita, Jun Sasaki, Kikuo Arakawa, Sumino ...
    2005 Volume 69 Issue 1 Pages 1-6
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Risk factors for cerebral infarction have not been well clarified, except for hypertension (HT), and few studies have examined the risk factors in the elderly. Methods and Results Clinical and behavioral risk factors for cerebral infarction were examined in 4,349 Japanese men aged 45-74 years with a serum total cholesterol (TC) concentration of 220 mg/dl or greater who participated in the Kyushu Lipid Intervention Study. A total of 81 men developed definite cerebral infarction in a 5-year follow-up period. The Cox proportional hazards model was used with serum TC at baseline and during the follow-up, serum high-density lipoprotein-cholesterol (HDL-C), HT, diabetes mellitus (DM), and other factors as covariates. Serum TC during the follow-up, not at baseline, was positively associated with cerebral infarction, showing a stronger association in the elderly (≥65 years old) than in the middle-aged (<65 years old). Statin use was related to a moderate decrease in the risk of cerebral infarction when follow-up TC was not considered, but the decrease was almost nullified after adjustment for follow-up TC. A low concentration of serum HDL-C, diabetes mellitus, hypertension, and angina pectoris were each related to an increased risk. No clear association was observed for body mass index, smoking or alcohol use. Conclusions Lowering cholesterol is important in the prevention of cerebral infarction in men with moderate hypercholesterolemia. A low concentration of HDL-C, DM, and HT are independent predictors of cerebral infarction. (Circ J 2005; 69: 1 - 6)
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  • Kunihiro Kinjo, Hiroshi Sato, Yasuhiko Sakata, Daisaku Nakatani, Hiroy ...
    2005 Volume 69 Issue 1 Pages 7-12
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Cessation of smoking after a cardiovascular event has been shown in Western countries to have a beneficial effect on clinical events during long-term follow-up. However, knowledge of the effect of smoking status after acute myocardial infarction (AMI) on the long-term mortality based on a large-scale sample is still limited in Japan. Methods and Results In the present study 2,579 AMI patients were enrolled in the Osaka Acute Coronary Insufficiency Study (OACIS) between April 1998 and March 2003. Smoking status was assessed at baseline and 3 months after hospital discharge by mailed questionnaire. Patients were divided into nonsmokers (n=823), former smokers (those who had stopped smoking before AMI onset, n=332), quitters (those who stopped smoking after AMI onset, n=1,056), and persistent smokers (those who smoked before and after AMI, n=368). Quitters had lower long-term mortality rates than persistent smokers (3.0% vs 5.2%; log rank, p=0.032). Multivariate Cox regression analysis revealed that smoking cessation was independently associated with a reduction in risk of long-term mortality (hazard ratio, 0.39; 95% confidence interval, 0.20-0.77). Conclusions Patients who continue to smoke after AMI are at greater risk for death than patients who quit smoking. Cessation of smoking benefits the long-term prognosis in patients with AMI. (Circ J 2005; 69: 7 - 12)
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  • Huiming Zhang, Koji Tamakoshi, Hiroshi Yatsuya, Chiyoe Murata, Keiko W ...
    2005 Volume 69 Issue 1 Pages 13-18
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background The relation between weight fluctuation and the risk of cardiovascular disease (CVD) is fairly consistent, although the physiologic basis for the relationship is uncertain. In the present study the association between long-term weight fluctuation and the development of metabolic syndrome (MS), a potent CVD risk factor, was investigated. Methods and Results A cross-sectional study of 664 Japanese men aged 40-49 years was conducted. The root mean square error around the slope of weight on age (weight - RMSE) was calculated by a simple linear regression model, in which the subject's actual weights at ages 20, 25, 30 years and 5 years prior to the study, as well as current weight, were dependent variables against the subject's age as the independent variable. Weight-RMSE was significantly and positively associated with the prevalence of each MS components (high blood pressure, hypertriglyceridemia, low-high density lipoprotein-cholesterol, high fasting glucose, and obesity). Such associations, as well as clustering of the MS component together with RMSE increase, were apparent among subjects with body mass index (BMI) <25 kg/m2, although the prevalence of MS or its components was much higher among overweight subjects (BMI ≥25 kg/m2). Conclusions Development of MS possibly explains the risk of CVD not only in overweight or obese persons, but also in normal-weight persons with large weight fluctuation. (Circ J 2005; 69: 13 - 18)
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  • Kaoru Tanno, Fumito Miyoshi, Norikazu Watanabe, Yoshino Minoura, Mitsu ...
    2005 Volume 69 Issue 1 Pages 19-22
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background The Multicenter Automatic Defibrillator Implantation Trial (MADIT) II investigators concluded that prophylactic use of an implantable cardioverter defibrillator (ICD) improved survival in patients with prior myocardial infarction (MI) and reduced the left ventricular ejection fraction (LVEF). However, it is unclear whether MADIT II criteria for ICD implantation are appropriate for Japanese patients. Methods and Results During the period 1997 to 2001 90 (M/F: 75/15; mean age: 65±9 years) of the 3,258 patients who underwent elective cardiac catheterization met MADIT II criteria (Q-wave MI more than 4 weeks prior; LVEF ≤0.30; >21 years of age; electrophysiologic testing not required) and were selected in this retrospective study of patient prognosis after catheterization. During the 37±12-month follow-up period, 15 patients died of congestive heart failure (n=9), sudden cardiac death (n=2), acute MI (n=1), or noncardiac causes (n=3). The survival rate in the present series was comparable with that in the MADIT II defibrillator group, but higher than that in the MADIT II conventional therapy group. A significantly greater percentage of the present patients were found to be in New York Heart Association class I and have undergone percutaneous coronary intervention than in MADIT II. Conclusion These results suggest that it may be inappropriate to apply MADIT II criteria to Japanese patients. (Circ J 2005; 69: 19 - 22)
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  • Masami Kosuge, Kazuo Kimura, Toshiyuki Ishikawa, Tomoaki Shimizi, Kiyo ...
    2005 Volume 69 Issue 1 Pages 23-28
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background The relationship of changes in blood glucose concentrations after admission to left ventricular (LV) dysfunction in patients with recanalized anterior acute myocardial infarction (AMI) remains unclear. Methods and Results Blood glucose concentrations were measured on admission and 24 h after symptom onset in 210 patients with recanalized anterior AMI within 6 h of symptom onset. Of them, 142 had hyperglycemia on admission, defined as a blood glucose ≥8.9 mmol/L, and 68 patients did not. Among the patients with admission hyperglycemia, 49 had persistent hyperglycemia, defined as a blood glucose ≥8.9 mmol/L 24 h after onset, and 93 did not. The incidences of myocardial blush grade of 0/1 after recanalization indicating impaired myocardial perfusion (71%), and peak creatine kinase concentration (5,631±2,855 mU/ml) were higher and predischarge LV function (43±11%) was lower in patients with persistent hyperglycemia than in those without (p<0.01). Multivariate analysis showed that persistent hyperglycemia was independently associated with LV dysfunction, defined as a predischarge LV ejection fraction ≤40% (odds ratio 7.38, p=0.001). Conclusions Persistent hyperglycemia at 24 h after symptom onset is associated with LV dysfunction before discharge in patients with recanalized anterior AMI. (Circ J 2005; 69: 23 - 28)
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  • Kengo Tsukahara, Kazuo Kimura, Masami Kosuge, Tomoaki Shimizu, Teruyas ...
    2005 Volume 69 Issue 1 Pages 29-34
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background In the reperfusion era the clinical characteristics of intermediate QRS prolongation without bundle-branch block (BBB) remain unclear in patients with ST-segment elevation myocardial infarction (STEMI). Methods and Results A total of 465 patients with STEMI within 24 h of onset were classified into 3 groups according to QRS duration on presenting electrocardiograms: 338 patients had QRS duration <100 ms (group N), 71 had QRS duration ≥100 ms without BBB (group W), and 56 had BBB (group B). The frequency of Killip class >1 was higher in group W (28%) than in group N (12%), but lower than in group B (47%) (p<0.05, respectively). The percentages of patients with non-anterior infarction (69% vs 42%, 47%), 3-vessel disease (30% vs 9%, 16%), and coronary artery bypass graft surgery (24% vs 4%, 13%) were higher in group W than in groups N and B (all p<0.05). In group W, 6-month-mortality was similar to that in group N, but lower than that in group B (4%, 3% vs 25%, p<0.05 respectively). Conclusions In the reperfusion era, although patients with intermediate QRS prolongation without BBB have more severe coronary disease, 6-month-mortality is similar to those with normal conduction, but lower than those with BBB. (Circ J 2005; 69: 29 - 34)
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  • Kenji Sadamatsu, Hideki Tashiro, Eriko Tanaka, Kunihiko Yamamoto
    2005 Volume 69 Issue 1 Pages 35-38
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Late luminal changes beyond 6 months after thicker strut stent implantation have not been fully elucidated. The purpose of this study was to clarify the clinical and angiographic predictors of late changes in minimal lumen diameter (MLD) after 6-month follow-up of stenting. Methods and Results Fifty-one lesions from 44 patients who underwent successfully S670/660 stent (Medtronic Vascular, Santa Rosa, CA, USA) implantations without target lesion revascularization were studied at 6-month follow-up and coronary angiography was repeated after the follow-up. Late luminal loss beyond 6 months after stenting significantly correlated with late loss (r=-0.42, p=0.0025) and MLD (r=0.28, p=0.047) at 6-month follow-up. On multivariate analysis, age (p=0.005), diabetes mellitus (p=0.002), hyperlipidemia (p=0.023), smoking (p=0.015), bifurcation lesion (p=0.018), small stent diameter (p=0.001) and MLD at 6-month follow-up (p<0.001) were identified as independent predictors of late luminal loss. Conclusions This study demonstrated that older age, diabetes mellitus, hyperlipidemia, smoking and small stent diameter (<3.0 mm) were associated with late luminal loss beyond 6 months after stenting, and that a bifurcation lesion and small lumen diameter at 6 months were associated with late luminal recovery. (Circ J 2005; 69: 35 - 38)
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  • Insights From Ergonovine Stress Echocardiography
    Moo Hyun Kim, En Hee Park, Doo Kyung Yang, Tae Ho Park, Sang Gon Kim, ...
    2005 Volume 69 Issue 1 Pages 39-43
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Previous studies have shown that ergonovine stress echocardiography (ESE) may be a valuable noninvasive tool for the diagnosis of vasospasm after the confirmation of no significant fixed stenosis. Methods and Results From May 1999 to January 2002, 52 patients who presented with acute coronary syndrome (ACS) and had normal or near-normal coronary angiograms were enrolled. A 50 μg bolus of ergonovine was given intravenously at 5-min intervals, until a positive result was observed or a total dose of 350 μg was given. After the ergonovine injection, positive results were found in 25 (48%) of 52 patients: 5 (26%) of 19 with unstable angina, 10 (53%) of 19 non-ST elevation myocardial infarction (MI) and 10 (71%) of 14 patients with ST elevation MI. Using univariate analysis, the elevation of troponin concentration, clinical diagnosis of MI, and ST segment elevation on initial electrocardiographic were significantly associated with positive stress test results. Conclusions Despite the limitation that coronary spasm was not confirmed angiographically with ergonovine provocation, ESE may be a useful technique for the noninvasive diagnosis of vasospasm. (Circ J 2005; 69: 39 - 43)
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  • Yuji Nakazato, Masayuki Yasuda, Akitoshi Sasaki, Youji Iida, Yasunobu ...
    2005 Volume 69 Issue 1 Pages 44-48
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Bepridil has multiple ion-channel blocking effects similar to amiodarone and is expected to have anti-arrhythmic effects that are useful for the management of atrial fibrillation (AF). The aim of this study was to clarify the conversion of persistent AF and maintenance of sinus rhythm (SR) by oral bepridil. Methods and Results Oral bepridil was administered to 112 patients (83 males, 29 females; age: 59.010.8 years) with persistent AF lasting an average of 5 months. The conversion effects and maintenance of SR after pharmacological or direct current (DC) cardioversion, as well as the incidence of adverse complications, were evaluated. In 65 of 112 (58%) patients, SR was restored within 6 months (average: 2.1 months) following bepridil administration. DC cardioversion was carried out for 21 of the remaining 47 patients with unsuccessful pharmacological conversion, and all had restoration of SR. Eventually, of the 86 patients in total who were restored to SR by either bepridil or DC cardioversion, 70 (81%) patients maintained SR after a mean follow-up of 18 months. No serious adverse complications were observed, except for marked QT prolongation in 2 cases. Conclusion Bepridil showed favorable conversion effects in patients with persistent AF and was highly effective for maintaining SR after pharmacological or electrical cardioversion. However, careful follow-up is necessary for the prevention of torsade de pointes caused by QT prolongation. (Circ J 2005; 69: 44 - 48)
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  • Isao Taguchi, Tomoaki Kanaya, Toru Toi, Shichirou Abe, Hiroyuki Sugimu ...
    2005 Volume 69 Issue 1 Pages 49-54
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background The beneficial effect of percutaneous coronary intervention (PCI) using stents for acute myocardial infarction (AMI) has already been demonstrated, but there is the problem that mechanical microvascular occlusion can occur because of thrombus/atheroma embolization when the PCI was performed. The aim of the present study was to retrospectively test and compare the effects of an aspiration catheter or distal embolic protection with a distal occlusion balloon catheter to prevent peripheral vascular embolization. Methods and Results The subjects consisted of 135 patients who underwent PCI with stenting within 12 h of the onset of chest pain caused by their first AMI. They were divided into 2 groups; the aspiration group, consisted of 81 consecutively seen patients who underwent aspiration catheter treatment between January 2001 and May 2002, and the distal protection group was the next group of 54 consecutively seen patients treated with a distal protection device between June 2002 and February 2003. The results were as follows. Thrombolysis in Myocardial Infarction (TIMI) score of 3 was obtained significantly more frequently in the distal protection group (94.4%) than in the aspiration group (79.0%). Additionally, the intensity of the cardiac muscle stain (blush score) was evaluated on coronary angiography and the rate of cases showing a blush score of 3, which indicates favorable blood perfusion at the tissue level, in the distal protection group (56.6%) was significantly greater than in the aspiration group (33.3%, p<0.01). The time to peak blood concentration of creatinine kinase was also significantly shorter in the distal protection group. Conclusions The distal embolism protection method is superior to the aspiration method for prevention of embolization after PCI with stenting for AMI, in terms of tissue level reperfusion in myocardial recanalization therapy. (Circ J 2005; 69: 49 - 54)
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  • Koki Motobe, Hirofumi Tomiyama, Yutaka Koji, Minoru Yambe, Zaydun Guli ...
    2005 Volume 69 Issue 1 Pages 55-60
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background The present study was conducted to establish the cutoff value of the ankle - brachial pressure index (ABI) at which the accuracy of brachial - ankle pulse wave velocity (baPWV) measurement is diminished Methods and Results The baPWV and ABI were measured in 1,361 patients with an atherosclerosis-related disease and 7,889 subjects without any atherosclerotic risk factors, in order to determine the percent difference of the brachial - ankle PWV (%baPWV), the angle of the rise of the anacrotic limb (%angle) and of the amplitude of the entire waveform (%amplitude) in both sides. The %angle and %amplitude were significantly higher in subjects whose %baPWV was ≥19% than in those subjects whose %baPWV was <19% (19% was the mean value + 3SD of 7,889 healthy subjects). The %baPWV ≥19% was defined as the abnormal discrepancy of baPWV caused by arterial stenosis in both sides. The receiver operator characteristic curve discriminated the abnormal discrepancy of baPWV by ABI because the area under the curve was 0.86. The highest discriminating sensitivity and specificity were 91% and 75% at ABI =0.95. Conclusion An ABI <0.95 seems to be the marker of diminished baPWV accuracy. (Circ J 2005; 69: 55 - 60)
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  • Thailand Multicenter Study
    Kritvikrom Durongpisitkul, Duangmanee Laoprasitiporn, Thanarat Layango ...
    2005 Volume 69 Issue 1 Pages 61-64
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Congenital heart disease patients who have pulmonary hypertension (PH) require an evaluation for pulmonary vascular reactivity before surgical repair. In the present study the acute pulmonary vasodilating effects of 100% oxygen (O2), beraprost sodium (BPS) and 40 ppm inhaled nitric oxide (iNO) during cardiac catheterization were compared. Methods and Results There were 90 patients who underwent cardiac catheterization for evaluation of PH (mean age, 16.5±16 years). The baseline mean pulmonary artery (mPA) pressure was 69.6±14.8 mmHg and the pulmonary arteriolar resistance (Rpa) was 13.8±8.3 Wood unit m2. Change in pulmonary vascular reactivity was defined as a decrease in mPA or Rpa >20% from baseline. The response to 100%O2, iNO and BPS during cardiac catheterization was 84%, 72.7% and 64%, respectively. Pair comparisons among each hemodynamic parameter showed no difference between the acute vasodilating effect of BPS and iNO. In some patients BPS showed a stronger effect than iNO in lowering Rpa. Conclusions BPS has a similar pulmonary vasodilating effect to iNO and can be used as an acute pulmonary vasodilating agent during cardiac catheterization with potential benefits over iNO. (Circ J 2005; 69: 61 - 64)
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  • Hiroo Noguchi, Koichiro Kumagai, Tomoo Yasuda, Masahiro Ogawa, Hideaki ...
    2005 Volume 69 Issue 1 Pages 65-68
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Although pulmonary vein (PV) isolation is useful for curing atrial fibrillation (AF), its recurrence rate is still high, so the aim of the present study was to investigate the cause of recurrence after PV isolation. Methods and Results Eighty-five patients with paroxysmal AF underwent PV isolation and AF recurred in 48 patients after the first session. Thirty of these 48 patients who underwent a second session were evaluated. In 49 (71%) of 69 PVs ablated in 25 patients (83%), recovery of conduction was observed between the left atrium and PV. In 45 (92%) of 49 PVs, conduction recurrences were seen from the same segment or part of a segment that was ablated in the first session. However, in the other 4 PVs (8%), conduction recurrences occurred in a different segment that had not been ablated before. In the second session, the mean number of segments ablated in the PV ostium was significantly less than in the first session (2.3±5.0 vs 1.4±6.0, p<0.01). After the second session, 16 patients (53%) did not show recurrence of AF. Conclusion The major cause of recurrence of PV isolation was recovery of PV conduction from the same segment that had been ablated in the PV ostium. Therefore, an additional session may be necessary to increase the success rate. (Circ J 2005; 69: 65 - 68)
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  • Shinji Sato, Shigeru Makita, Mitsuru Majima
    2005 Volume 69 Issue 1 Pages 69-71
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Heart rate recovery (HRR) after exercise, which is thought to be a marker of vagal activity, has been reported to improve after cardiac rehabilitation (CR) with exercise in patients with coronary heart disease. The aim of this study was to determine whether or not additional physical activity outside the CR program, would accelerate improvement of the HRR in male patients after coronary artery bypass grafting (CABG). Methods and Results Twenty male patients were enrolled in a supervised CR program at 2 weeks after CABG, and divided into an active group (walking ≥5,434 steps/day) or a less-active group. The time constant of HRR immediately measured after pedaling exercise was assessed at baseline and after the 2-week CR program. After completion of the CR program, the time constant of HRR improved from 439.7±177 s to 288.6±97.4 s in the active group (p<0.01), but no changes were observed in the less-active group. Conclusions The results suggest that additional physical activity during a CR program may lead to an improved HRR in patients after CABG. Therefore, post-CABG patients should increase their level of physical activity in addition to that in the CR to improve their cardiac autonomic control. (Circ J 2005; 69: 69 - 71)
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  • Sei Komatsu, Atsushi Hirayama, Yosuke Omori, Yasunori Ueda, Isamu Mizo ...
    2005 Volume 69 Issue 1 Pages 72-77
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Previous reports suggest that plaque may be characterized by the computed tomography (CT) number, but there is not a comprehensive method for evaluating the gray-scale CT image of the coronary artery obtained by multi-detector row CT (MDCT). Methods and Results Forty-five patients with acute coronary syndrome (ACS) underwent MDCT either 3-4 weeks after the onset of acute myocardial infarction (n=24) or within 1 week after percutaneous coronary intervention in patients with unstable angina (UA; n=21). The cross-sections obtained at intervals of 5 mm were converted to numerical data and a `plaque map' was drawn using the color-based isometric line method and bird's eye view. `Plaque map' was compared with the findings of intravascular ultrasound (IVUS) and angioscopy. Of 662 slices of 78 vessels, soft, intermediate or calcified plaque was detected in 144, 134, and 84 slices, respectively. Compared with IVUS, the sensitivities were 92%, 87%, and 89%, respectively, and compared with angioscopy, sensitivity was 80% and specificity was 87%. Conclusions MDCT with the `Plaque Map' system can noninvasively characterize plaque in patients with ACS. (Circ J 2005; 69: 72 - 77)
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  • Yasue Haraguchi, Masao Yoshinaga, Jav Sarantuya, Atsushi Shimago, Juni ...
    2005 Volume 69 Issue 1 Pages 78-82
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background It has been shown experimentally that the interval from the nadir of the initial negative T wave to the end of the T wave is representative of transmural dispersion of repolarization (TDR) when complex T waves are present. In the clinical setting, however, the interval representative of TDR in patients with long QT syndrome (LQTS) is a controversial subject. Methods and Results Five symptomatic patients (3 boys, 2 girls; 3 LQT1, 2 LQT2) were evaluated by a face immersion test before and after treatment to compare the configuration of the T wave. When the notch disappeared after treatment, the single peak of the T wave after treatment coincided with the nadir of the notch before treatment. When the notch remained the same after treatment as before treatment and when the QTc decreased, the corrected interval from the nadir of the notch to the end of the T wave was for the most part shortened. Conclusions The present study showed that the interval representative of the TDR in the clinical surface electrocardiogram can be obtained from the nadir of the notch to the end of the T wave in children and adolescents with LQTS, as was shown in the experimental study. (Circ J 2005; 69: 78 - 82)
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  • Toshiro Katayama, Hiroshi Nakashima, Chisa Takagi, Yukiharu Honda, Shi ...
    2005 Volume 69 Issue 1 Pages 83-88
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Although cardiogenic shock (CS) is the leading cause of death for acute myocardial infarction (AMI) patients, reliable predictive factors in the acute stage, such as cardiovascular peptides, have not yet been identified. Methods and Results In 42 consecutive AMI patients with CS on admission, successfully treated by primary percutaneous coronary intervention (PCI) within 12 h of onset, related factors including brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, catecholamines, and adrenomedullin, were investigated 24 h from onset, as well as the 1-year mortality rates. During the 12-month follow-up period, 15 patients died from cardiovascular causes (group D). There were no significant differences in patient characteristics, angiographic findings, and left ventricular systolic function between group D subjects and the survivors (group S: n=27). Multivariate analysis identified high levels of adrenomedullin as an independent predictor of 1-year mortality (risk ratio: 6.42, 95% confidence interval, 1.49-43.31, p<0.05). Conclusions The acute-phase plasma concentration of adrenomedullin may be a reliable predictor of mortality in patients with AMI complicated by CS and successfully treated by direct PCI, as may be BNP concentration, peak-creatine kinase value, and ventricular fibrillation. (Circ J 2005; 69: 83 - 88)
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  • Masaru Inoue, Masami Shimizu, Hidekazu Ino, Masato Yamaguchi, Hidenobu ...
    2005 Volume 69 Issue 1 Pages 89-94
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background There has not been a comparison of the electrocardiographic (ECG) finding of ST-segment elevation in the precordial leads in patients with takotsubo cardiomyopathy (TC) and those with anterior acute myocardial infarction (AMI), with regard to the location of the culprit lesion. Methods and Results The present study evaluated 18 patients with TC, and 85 with anterior AMI who were divided into 3 groups: group A had the culprit lesion proximal to both the first septal branch (S1) and the first diagonal branch (D1), group B had the culprit lesion proximal to either S1 or D1, and group C had the culprit lesion distal to both S1 and D1. In patients with TC, reciprocal ST-segment depression in the inferior leads was observed less frequently than in patients in groups A (p<0.0001) and B (p=0.0002), and abnormal Q waves and ST-segment elevation in the inferior leads were observed more frequently than in group A (p=0.0007, p=0.0057, respectively). The ECG findings in TC did not differ from those in group C. Conclusion Electrocardiographic findings may differentiate TC from AMI with a proximal lesion of left anterior descending coronary artery, but not those with distal lesions. (Circ J 2005; 69: 89 - 94)
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  • Susumu Ui, Masao Chino, Takaaki Isshiki
    2005 Volume 69 Issue 1 Pages 95-100
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Primary percutaneous coronary intervention (PCI) is at present the most effective procedure for reducing the mortality rate of patients with acute myocardial infarction (AMI). However, there is a great difference between Japan and other countries in the rate of primary PCI. Methods and Results Registration period, number of patients with AMI, rates of primary PCI or thrombolysis and in-hospital or 30-day mortality rates were analyzed in 3 Japanese, 4 European, 4 American and 2 world-wide databases of AMI. The primary PCI rate is higher (75-94%) in Japan than in the other countries (5.5-49.6%), particularly in low-volume hospitals, and the mortality rates at these centers were similar to those in high-volume hospitals (approximately 4-10%). The primary PCI rate has recently been rising (25-50%) worldwide and most PCI procedures are performed in large-volume centers, except in Japan. Conclusions Comparison of the AMI databases suggest there is a relationship between the primary PCI rate and annual PCI caseload in each country. It is interesting that in Japan even low-volume PCI hospitals have comparable numbers of primary PCI cases. (Circ J 2005; 69: 95 - 100)
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Experimental Investigation
  • Weon Kim, Myung Ho Jeong, Kwang Soo Cha, Dae Woo Hyun, Seung Ho Hur, K ...
    2005 Volume 69 Issue 1 Pages 101-106
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background The long-term clinical efficacy of intracoronary stenting is limited by restenosis and delivery by the stent of agents inhibiting cell cycle progression should prevent in-stent neointimal hyperplasia. Carvedilol is an antioxidant that inhibits smooth muscle cell proliferation and migration, whereas probucol is a vascular protectant and reduces stent restenosis by improving the lumen dimension at the stent placement site. Methods and Results BiodivYsio® phosphorylcholine-coated stents were dip-coated with carvedilol (5 mg/ml) or probucol (50 mg/ml) by immersion in respective methanol solutions. Twenty-four stents (carvedilol =8, probucol =8, control =8) were placed in 12 pigs and histopathologic analysis was done 4 weeks later. Histomorphometry of the carvedilol-coated stent group compared with the control groups showed that the neointimal area decreased by 42% (1.12±0.55 mm2 in the carvedilol group vs 1.9240.52 mm2 in the control, p=0.004) and the lumen area increased by 20% (5.1540.90 mm2 vs 4.1740.87 mm2, p=0.008), resulting in a 43% reduction of the percent area stenosis (18.2249.6% vs 31.949.2%, p=0.002). In the probucol-coated stent group, the lumen area, neointimal area, and %area stenosis did not different significantly from the control group. There were 7.742.97% proliferating nuclear cell antigen-positive cells in the carvedilol-coated stent group compared with 17.841.45% in the control group (p=0.0001) and 15.941.91% in the probucol group (vs control, p=NS). Conclusions The carvedilol-coated stent, but not the probucol-coated one, inhibited neointimal hyperplasia in a porcine stent restenosis model. (Circ J 2005; 69: 101 - 106)
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  • Masahiro Nishida, Tetsuya Hayashi, Miyuki Ieshima, Keiko Eshiro, Kenji ...
    2005 Volume 69 Issue 1 Pages 107-113
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background Endothelin-1 (ET-1) receptor antagonist is expected to improve the prognosis of patients with heart failure, but the role of the ETB receptor in cardiac function and structure is complicated. In the present study the NADPH diaphorase activity and ET-1 content in the failing heart treated with ETA or ETB receptor antagonist were evaluated in a model of dilated cardiomyopathy. Methods and Results Selective ETA receptor antagonist, ABT-627 (10 mg/kg per day), or selective ETB antagonist, A-192621 (30 mg/kg per day), was given to 22-week-old J2N-k cardiomyopathic hamsters for 8 weeks. The effects of ABT-627 and A-192621 on cardiac function, left ventricular (LV) histology, ET-1 content and NADPH diaphorase activity in the LV were evaluated. Treatment with ABT-627, but not A-192621, significantly decreased ET-1 content and NADPH diaphorase activity. Although the improvement of LV function was modest, ABT-627 prevented tissue damage in J2N-k hamsters. In contrast, A-192621 worsened the degeneration of cardiomyocytes despite improving hemodynamic parameters. Conclusions Selective ETA antagonist, but not ETB antagonist, reduced the ET-1 content as well as the NADPH diaphorase activity, and preserved the fine structure of LV myocardium in cardiomyopathic hamsters. Long-term blockade of ETB receptor might worsen the degeneration of cardiomyocytes through the ET-1/ETA system even if LV function could be improved. (Circ J 2005; 69: 107 - 113)
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Case Report
  • A Case Report
    Kiyohiro Oshima, Toru Takahashi, Yasushi Sato, Jun Mohara, Susumu Ishi ...
    2005 Volume 69 Issue 1 Pages 114-115
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    A 20-year-old man was admitted to hospital because of general fatigue during exercise. He had had a heart murmur since the age of 6 years. Echocardiography showed severe mitral regurgitation (MR, IV), probably caused by an anterior leaflet cleft or tendon rupture. During surgery, a cleft measuring 9 mm in length was found in the center of the anterior leaflet of the mitral valve. The cleft was closed directly, together with annuloplasty using the bilateral Kay's method. A Cosgrove ring (32 mm) was added because the mitral valve annulus was dilated. The patient's postoperative course was uneventful and echocardiography after surgery demonstrated no MR. An isolated cleft of the anterior mitral leaflet is a rare cause of MR and in this case, direct closure of the cleft with additional annuloplasty gave a good functional result. (Circ J 2005; 69: 114 - 115)
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  • Goran Milasinovic, Vera Jelic, Dragutin Savic, Sinisa U. Pavlovic, Mil ...
    2005 Volume 69 Issue 1 Pages 116-118
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    There are more than 20 years of experience with implantation of defibrillator devices in humans and the procedure is an important therapeutic option for patients at high risk of life-threatening ventricular arrhythmias. The incidence of new defibrillator implantation has gradually increased, being used even in children, 1 although pediatric use is associated with several complications, especially with epicardial systems,2 including fracture of the subcutaneous patch,3-5 mainly because of growth.3 We present a case of subcutaneous patch electrode fracture in the left axillary pectoral region of a patient who needed the patch for effective defibrillation, and we discuss the methods of treatment. (Circ J 2005; 69: 116 -118)
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  • Rika Shimada, Yasuyuki Shimada, Hitoshi Yaku, Nobuo Kitamura
    2005 Volume 69 Issue 1 Pages 119-120
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    An aortic valve was replaced in a schizophrenic patient with violent behaviour. The usual protocol was altered and strategies to prevent accidents before and after surgery were devised. Minimally invasive surgery, administering sedation during the critical recovery period, and therapeutic use of communication as a psychological intervention were effective strategies. The patient recovered well and was discharged on day 14 after surgery. (Circ J 2005; 69: 119 - 120)
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  • Kazunori Ishikawa, Shuichiro Takanashi, Wahei Mihara, Toshihiro Fukui, ...
    2005 Volume 69 Issue 1 Pages 121-123
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    A 55-year-old man was admitted to another hospital because of dry cough and dyspnea that rapidly worsened before admission. Chest computed tomography revealed a low-density mass that nearly obstructed the main pulmonary arterial trunk. Pulmonary thromboembolism was suspected and treated with catheter-directed thrombolysis therapy. Despite optimal thrombolysis and anticoagulant therapy, his symptoms persisted. He was referred for further examination and possible surgery for presumed pulmonary thromboembolism. The mass appeared more likely to be a tumor than a thrombus on careful analysis of the magnetic resonance imaging. At surgery, the anterior wall of the main pulmonary arterial trunk, the pulmonary valve, annulus, and the right ventricular outflow tract were all invaded by what was found to be a tumor and were resected under conventional cardiopulmonary bypass. The resected area was reconstructed with a 25-mm-diameter bioprosthetic valve and Xenomedica patch. Final pathological diagnosis was primary cardiac leiomyosarcoma involving the pulmonary valve. Postoperative course was uneventful, and he was discharged 11 days after surgery without adjuvant therapy because he refused it. Ten months later, the patient was well, but a chest X-ray revealed some coin lesions in the bilateral lung fields that were thought to be metastatic tumor. (Circ J 2005; 69: 121 - 123)
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Rapid Communication
  • Hidetsuna Watanabe, Tetsuo Katoh, Masaaki Eiro, Masaya Iwamoto, Fumita ...
    2005 Volume 69 Issue 1 Pages 124-126
    Published: 2005
    Released: December 25, 2004
    JOURNALS FREE ACCESS
    Background This study examined whether targeted disruption of the genes for the prostacyclin receptor (IP) or the thromboxane A2 receptor (TP) confers a susceptibility to salt-dependent hypertension. Methods and Results Eight female IP- or TP-deficient mice were examined. Baseline systolic blood pressure (SBP) did not differ between TP(-/-) and TP(+/+), but was significantly lower in the IP(-/-) group than in the IP(+/+). With a high salt diet, SBP in IP(-/-) gradually increased. In contrast, SBP in the IP(+/+), TP(-/-), or TP(+/+) groups remained unchanged. Conclusions The prostacyclin receptor may participate in the maintenance of baseline BP. With salt loading, BP adaptation may take place, at least in part, via IP mediated signals. (Circ J 2005; 69: 124 -126)
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