Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 69, Issue 2
Displaying 1-25 of 25 articles from this issue
Clinical Investigation
  • Shigetake Sasayama, Takeyoshi Kunieda, Hitonobu Tomoike, Masunori Mats ...
    2005 Volume 69 Issue 2 Pages 131-137
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Endothelin (ET)-1 has a pathogenic role in pulmonary arterial hypertension (PAH). Recent clinical studies carried out in Western populations showed that blockade of the ET receptors by bosentan improves pulmonary hemodynamics and exercise capacity. In the present study, the efficacy of bosentan was assessed in Japanese patients with PAH. Method and Results Because the pharmacokinetics of bosentan and its metabolites are similar in Japanese and Caucasian subjects, the same dose of bosentan, 125 mg twice daily, was administered in the Japanese open-label clinical trial. In 18 patients, mean pulmonary arterial pressure decreased from 52.4±13.8 to 46.8±13.8 mmHg (p=0.003) and cardiac index increased from 2.20±0.74 to 2.61 ±0.72 L · min-1 · m-2 (p=0.002). The 6-min walking distance increased from 410±89.5 to 494±86.0 m (p<0.0001). The dyspnea index (Borg scale) decreased from 3.2±2.4 to 2.2±1.7 (p=0.02). The specific activity scale (SAS) gradually increased throughout the study period from 2.9±0.8 to 4.6±1.9 METs (p=0.0005). WHO Class improved in 10 patients. Conclusion Bosentan was well tolerated and improved the hemodynamics, symptoms, exercise capacity, and quality of life of Japanese patients with PAH. Thus, bosentan can be a valuable therapeutic option in Japanese patients. (Circ J 2005; 69: 131 - 137)
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  • The Suita Study
    Yoshihiro Kokubo, Naoharu Iwai, Naomi Tago, Nozomu Inamoto, Akira Okay ...
    2005 Volume 69 Issue 2 Pages 138-142
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Reproducibility of results is important for the validity of genetic association studies. Recently, 3 functional polymorphisms, G(-930)A in CYBA, T481S in CLCNKB, and E65K in KCNMB1, were reported to be associated with blood pressure (BP) status and the aim of this study was to confirm those findings using a large cohort representing the general Japanese population. Methods and Results The study population consisted of 3,652 subjects recruited from the Suita study as representive of the general population in Japan. The genotypes of the 3 polymorphisms were determined by the TaqMan method. Logistic analysis indicated that the CYBA/G(-930)A polymorphism was associated with hypertension in male subjects. In the male population, the odds ratio of the GG genotype over GA + AA was 1.27 (95% confidence interval 1.01-1.57, p=0.034). Moreover, residuals of systolic and diastolic BP values were significantly higher in subjects with the GG genotype than in those with the GA or AA genotype (p=0.0007). However, such significant effects of the genotype on BP status were not observed in the female population. The significance of the CLCNKB/T481S and KCNMB1/E65K polymorphisms were not replicated in the present study. Conclusion The significance of the G(-930)A polymorphism of CYBA was confirmed in the present study with adequate statistical power, which strengthens the hypothesis that this polymorphism is important in the pathogenesis of hypertension and confers susceptibility. (Circ J 2005; 69: 138 - 142)
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  • Comparison With Nonischemic Cardiomyopathy
    Nobuyuki Shiba, Jun Watanabe, Tsuyoshi Shinozaki, Yoshito Koseki, Masa ...
    2005 Volume 69 Issue 2 Pages 143-149
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Myocardial infarction (MI) is one of the major etiologies of chronic heart failure (CHF) in Japan. Methods and Results The prognoses of CHF patients after MI (n=283) were investigated by comparing them with those of CHF patients with nonischemic cardiomyopathy (NICM, n=310) from the CHF registry (CHART; n=1,154). The Kaplan-Meier (KM) analyses revealed that the 3-year all-cause mortality was significantly higher in the MI cohort compared with the NICM cohort (29.0% vs 12.4%, p<0.0005). Age/gender/treatment-adjusted KM analysis revealed significant differences only in the cohorts with preserved left ventricular ejection fraction (LVEF), defined as LVEF >45%, or in less symptomatic patients (New York Heart Association I or II). Multivariate Cox regression analysis showed that β-blocker (BB) was associated with a significant reduction in mortality from cardiac causes, and either angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) was significantly related to the improvement of survival in the MI cohort (adjusted hazard ratio: 0.222 and 0.497, p<0.05), even though these medicines were used significantly less often in the MI cohort. Conclusions Underlying MI has a significant impact on the survival of Japanese CHF patients, especially those with preserved LVEF or with fewer symptoms. The appropriate expansion of ACEI/ARB or BB therapy might be necessary to improve their survival. (Circ J 2005; 69: 143 - 149)
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  • Masami Shimizu, Hidekazu Ino, Toshihiko Yasuda, Noboru Fujino, Katsuha ...
    2005 Volume 69 Issue 2 Pages 150-153
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Some patients with dilated cardiomyopathy (DCM) have mutations of the genes that encode sarcomeric or cytoskeletal proteins of cardiomyocytes, but the prevalence of these mutations in Japan remains unclear. Methods and Results A group of 99 unrelated adult patients with DCM (familial n=27, sporadic n=72) were screened for the following genes: cardiac β-myosin heavy chain, cardiac myosin-binding protein C (MYBPC3), regulatory and essential myosin light chains, α cardiac actin, α tropomyosin, cardiac troponin T, cardiac troponin I, cardiac troponin C, dystrophin, and lamin A/C. A mutation (R820Q) in MYBPC3 was found in an aged patient. In addition, dystrophin mutations were identified in 3 male patients (2 with exon 45-48 deletion and 1 with exon 48-52 deletion). The prevalence of dystrophin mutations in male patients with DCM was 4.4% (3 of 68). No mutations involving amino acid changes were identified in the other genes. Conclusions Although cases of adult patients with DCM caused by mutations of the genes encoding sarcomeric or cytoskeletal proteins of cardiomyocytes are infrequent in Japan, it may be advisable to screen older DCM patients for MYBPC3 mutations, and male patients with familial DCM for dystrophin mutations. (Circ J 2005; 69: 150 - 153)
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  • Sang Yup Lim, Myung Ho Jeong, Eun Hui Bae, Weon Kim, Ju Han Kim, Young ...
    2005 Volume 69 Issue 2 Pages 154-158
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background The aim of this study was to assess in-hospital mortality and major adverse cardiac events (MACE) during long-term clinical follow-up of patients who developed cardiogenic shock (CS) after acute myocardial infarction (AMI) and who underwent primary percutaneous coronary intervention (PCI). Methods and Results The data from 147 patients with CS after AMI (61.7 ±10.4 years, M:F =156:99) who underwent primary PCI at Chonnam National University Hospital between January 1999 and December 2002 were analyzed: clinical characteristics, coronary angiographic findings and mortality during admission, and MACE during a 1-year clinical follow-up. Of the enrolled patients, 121 patients survived (group I, M:F =94:27) and 26 died (group II, M:F =14:12) during admission. By binary logistic regression analysis, in-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization (p=0.02, odds ratio (OR) =1.3). Eighty-nine patients (60.5%) survived without MACE during the 1-year clinical follow-up and MACE was associated with a C-reactive protein (CRP) of more than 1 mg/dl (p=0.002, OR =6.3) and low TIMI flow after coronary revascularization (p<0.001, OR =7.8). Conclusions Primary PCI achieving TIMI 3 flow reduces in-hospital death in AMI with CS. High concentration of CRP and low TIMI flow are associated with MACE during long-term clinical follow-up. (Circ J 2005; 69: 154 - 158)
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  • Ju Han Kim, Myung Ho Jeong, Jay Young Rhew, Ji Hyun Lim, Kyung Ho Yun, ...
    2005 Volume 69 Issue 2 Pages 159-164
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Platelet activation and aggregation with resultant arterial thrombus formation play a pivotal role in the pathophysiology of acute coronary syndrome (ACS). In the present study the efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin or low-molecular-weight heparin (dalteparin), was evaluated for the management of ACS. Methods and Results One hundred and sixty patients (60.9±11.1 years, 104 male) with unstable angina or non-ST elevation myocardial infarction and who had ST-T changes and elevated troponin were randomly assigned to 4 groups: group I (n=40: heparin alone), group II (n=40: dalteparin alone), group III (n=40: tirofiban + heparin) and group IV (n=40: tirofiban + dalteparin). The occurrence of major adverse cardiac events (MACE) was compared prospectively during a 6-month clinical follow-up. Percutaneous coronary intervention or coronary artery bypass graft was performed in 32 cases in group I, 29 in group II, 28 in group III and 31 in group IV (p=0.72). Minor bleeding complication developed in 2 patients (5.0%) in group I, 2 (5.0%) in group II, 4 (10.0%) in group III and 3 (7.5%) in group IV (p=0.78). During the follow-up MACE occurred in 10 patients (31.3%) in group I, 9 (31.0%) in group II, 4 (14.3%) in group III and 4 (12.9%) in group IV (p=0.02: Group I and II vs Group III and IV). Conclusions Tirofiban combined with dalteparin was associated with relatively more bleeding complications in the short term, but was effective in reducing the incidence of MACE during long-term clinical follow-up in patients with ACS. (Circ J 2005; 69: 159 - 164)
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  • Hiroshi Tada, Kenji Kurosaki, Shigeto Naito, Keiko Koyama, Kazuhiro It ...
    2005 Volume 69 Issue 2 Pages 165-170
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background This study was undertaken to investigate the applicability and image quality of contrast-enhanced visualization of the coronary venous system (CVS) by multidetector row computed tomography (MDCT). Methods and Results A total of 70 patients underwent MDCT and for each patient, 6 data sets were created throughout the cardiac cycle. The number and location of coronary veins were evaluated in 3-dimensional images using the 6 data sets. The quality of all images reconstructed from the 6 data sets was too poor to evaluate the CVS in 6 patients (9%). In the remaining 64 patients (91%), the diameter of the CVS was usually greater in the images reconstructed from data acquired during systole than in those reconstructed from data acquired during diastole. However, artifacts were observed more often in images from systole than from diastole. The coronary sinus and middle cardiac vein were visible in all 64 patients. The left marginal and posterior veins also were identified in 54 (84%) and 60 patients (94%), respectively. Conclusions MDCT can be used as a non-invasive modality for evaluating the CVS anatomy in most patients. (Circ J 2005; 69: 165 - 170)
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  • Kazuyuki Sakata, Kei Iida, Masahiro Kudo, Hiroshi Yoshida, Osamu Doi
    2005 Volume 69 Issue 2 Pages 171-176
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Myocardial imaging is widely used to detect coronary artery disease and to assess its prognosis. In vasospastic angina (VA), cardiac imaging can provide information on disease activity, which is related to cardiac events. The aim of this study was to clarify whether exercise thallium-201 imaging (Tl-SPECT) and 123I-metaiodobenzylguanidine imaging (MIBG) have prognostic value for patients with VA, but without significant coronary artery stenosis. Methods and Results One hundred and 5 patients who showed acetylcholine-induced coronary spasm, normal left ventricular function and no significant stenosis (<50%) underwent both symptom-limited Tl-SPECT and MIBG within 1 month. All patients were prescribed calcium antagonist during the follow-up period (mean 4.7 years). Exercise-induced ischemia was detected by Tl-SPECT in 53 patients and multivessel coronary spasm by coronary angiography in 33 patients. During the follow-up period, 1 patient died suddenly and another died of acute myocardial infarction (MI). Two patients developed nonfatal acute MI and 7 patients underwent emergency coronary angiography because of unstable angina. According to the baseline characteristics, VA with cardiac events showed a significantly higher heart-to-mediastinum ratio (H/M ratio) and a significantly lower MIBG washout rate than those without cardiac events (p<0.03 and p<0.02, respectively). Among 8 clinical variables, including coronary risk factors, exercise parameters and exercise-induced ischemia on Tl-SPECT and the MIBG delayed H/M ratio and washout rate, univariate Cox proportional hazard regression analysis showed that the high H/M ratio and reduced washout rate of MIBG were significant predictors of future cardiac events (relative risk (RR) =4, confidence interval (CI) =1.21-13.29, p<0.02 for H/M ratio and RR 0.92, CI 0.85-0.99, p<0.02 for washout rate). However, exercise-induced ischemia did not show any statistical significance. By multivariate Cox proportional hazard regression analysis, a reduced MIBG washout rate was the only significant predictor of future cardiac events (odds ratio =0.90, CI =0.82-1.00, p<0.04). Conclusion MIBG imaging can identify high-risk patients, even among those with VA who were previously regarded as low risk. This result strongly supports the idea that cardiac sympathetic dysfunction contributes to coronary artery spasm leading to cardiac events. (Circ J 2005; 69: 171 - 176)
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  • Sugako Kanayama, Ichiro Matsunari, Akira Hirayama, Michihiko Kitayama, ...
    2005 Volume 69 Issue 2 Pages 177-182
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Electrocardiographic gated 13N-ammonia positron emission tomography (PET) enables simultaneous assessment of myocardial blood flow and left ventricular (LV) function. The aim of this study was to assess the accuracy of gated 13N-ammonia PET for evaluating global and regional LV function in patients with coronary artery disease (CAD) in comparison with conventional left ventriculography (LVG). Methods and Results Fifty-four patients with CAD underwent gated 13N-ammonia PET and LVG. The LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) by gated 13N-ammonia PET were calculated using Cedars-Sinai automated quantitative gated single photon emission computed tomography (QGS) and compared with those obtained by LVG. The regional wall motion (RWM) was visually scored, and compared with that on LVG. There were good correlations between the 2 methods for LVEF, LVEDV and LVESV (R=0.828, R=0.821 and R=0.874 respectively). The RWM assessed by gated 13N-ammonia PET also agreed well with that by LVG (complete agreement was 70.4%, κ=0.58). Conclusions Gated 13N-ammonia PET combined with QGS works reasonably well for the assessment of both global and regional LV function in CAD patients, although additional calibration may be necessary. (Circ J 2005; 69: 177 - 182)
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  • Assessment Using the ECG-Gated Polar Map With 99mTc-Methoxy-Isobutyl Isonitrile
    Hideki Sugihara, Yoshiharu Yonekura, Takehiro Matsumoto, Yasushi Sasak ...
    2005 Volume 69 Issue 2 Pages 183-187
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background To quantitate the degree of 3-dimensional asynchronous myocardial contraction, an ECG-gated polar map method was developed with 99mTc-methoxy-isobutyl isonitrile, and used to investigate the relationship between asynchrony and left ventricular (LV) function. Methods and Results Twelve normal subjects and 38 patients with an old myocardial infarction were studied with ECG-gated single-photon emission computed tomography (SPECT). In each frame, a myocardial perfusion polar map was reconstructed and the peak contraction phase in each pixel was displayed (phase map). The degree of asynchronous contraction was assessed from the standard deviations of the peak contraction phase (SDP) on the phase map. Ejection fraction (EF), peak ejection rate (PER), 1/3EF, peak filling rate (PFR) and 1/3 filling fraction (1/3FF) were calculated by the quantitative gated SPECT software, and E/A from Doppler echocardiography. The SDP was compared with these parameters. Correlation coefficients and p values between the SDP and parameters of cardiac function were as follows: EF, r=-0.69 (p<0.001); PER, r=-0.54 (p<0.001); 1/3EF, r=-0.57 (p<0.001); PFR, r=-0.29 (p<0.05); 1/3FF, r=-0.63 (p<0.001); E/A, r=-0.11 (p=0.51). Conclusions There was a negative correlation between the SDP and LV systolic and diastolic function, which confirmed the functional significance of asynchrony on cardiac function. (Circ J 2005; 69: 183 - 187)
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  • Comparison With Results of O-15 Water PET
    Takahiro Tsukamoto, Yoshinori Ito, Kazuyuki Noriyasu, Koichi Morita, C ...
    2005 Volume 69 Issue 2 Pages 188-193
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background The aims of this study were to develop a method for quantitative estimation of the myocardial blood flow index (MBFI) and myocardial flow reserve (MFR) of the whole left ventricle using 99mtechnetium (Tc-99m)-sestamibi imaging. Methods and Results Twenty-two patients with suspected coronary artery disease and 7 controls underwent both Tc-99m-sestamibi imaging and O-15 water positron emission tomography (PET). The global MBFI was calculated on the basis of the microsphere model from the ratio of the myocardial count to the area under the time - activity curve on the aortic arch. The regional MBFI was calculated from the relative distributions of Tc-99m-sestamibi uptake values. The regional MBFI and MFR (Tc-MFR) obtained using single-photon emission computed tomography were compared with the myocardial blood flow (MBF) and MFR (PET-MFR) obtained using PET as the gold standard. Regional MBFI significantly correlated with the MBF obtained using PET. Regional Tc-MFR also correlated with the regional PET-MFR, with some underestimation. Conclusion These results indicate that regional MBF and MFR may be estimated by dynamic Tc-99m-sestamibi imaging and can be used for the early detection and estimation of the functional severity of coronary lesions without the need for a PET camera. (Circ J 2005; 69: 188 - 193)
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  • Hiroshi Tada, Hiroyuki Toide, Shigeto Naito, Kenji Kurosaki, Sachiko I ...
    2005 Volume 69 Issue 2 Pages 194-200
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background The purpose of this study was to determine the utility and efficacy of tissue Doppler imaging (TDI) and strain Doppler imaging (SDI) for evaluating ventricular synchrony and function, and for predicting the long-term clinical improvement in patients undergoing biventricular pacing (BVP). Methods and Results TDI and SDI were performed before and <1 month after initiating BVP in 17 patients with advanced heart failure. An intraventricular conduction delay between the left ventricular (LV) septal and lateral walls was measured by TDI. The average LV strain (LV-strain) was calculated from data obtained at the center of 6 regions of the LV (base and mid-point between the basal and apical portions, and the mid-point between these 2 points on the septal and lateral walls). During a 23±7 month follow-up period, 12 patients improved clinically and did not require re-hospitalization for heart failure (responder group), but the remaining 5 did not improve (nonresponder group). Before BVP, the intraventricular conduction delay was greater in the responder group than in the nonresponder group (p<0.01), but after BVP, it did not differ between the 2 groups. LV-strain improved after BVP in the responder group but not in the nonresponder group (p<0.05). Conclusion A high intraventricular conduction delay before BVP and decreased strain shortly after BVP may predict long-term clinical improvement in patients undergoing this treatment. (Circ J 2005; 69: 194 - 200)
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  • Noriko Inoue, Toshiyuki Ishikawa, Shinichi Sumita, Takeshi Nakagawa, T ...
    2005 Volume 69 Issue 2 Pages 201-204
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Atrioventricular (AV) delay optimization may be important in patients with biventricular pacing and the optimal AV delay can be predicted using Doppler echocardiography and the formula: optimal AV delay = AV delay - the interval between the end of A wave and complete closure of the mitral valve when the AV delay is set at slightly prolonged AV delay. Methods and Results In the present study the efficacy of this method was evaluated in 5 patients (67.4±8.0 (SD) years old) with biventricular pacing. Cardiac output (CO) and diastolic filling time were measured by Doppler echocardiography. When the AV delay was set at the predicted optimal AV delay -25 ms, the predicted optimal AV delay (133±66 ms) and predicted optimal AV delay + 25 ms, the respective CO were 4.5±0.9, 5.3±1.0, 4.8±1.0 L/min (p<0.05, ANOVA) and the diastolic filling times were 364 ±100, 373±105, 335±84 ms (p<0.05, ANOVA). Congestive heart failure improved from New York Heart Association class 3.6±0.5 to 1.4±0.5 (p<0.001). Conclusions AV delay optimization is important in patients with biventricular pacing and can be easily achieved by the new method. (Circ J 2005; 69: 201 - 204)
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  • Hitoshi Hachiya, Sabine Ernst, Feifan Ouyang, Hercules Mavrakis, Julia ...
    2005 Volume 69 Issue 2 Pages 205-210
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Detailed information about the topographic distribution of focal left atrial tachycardias (FLATs) is limited. Methods and Results A total of 143 atrial tachycardia (AT) foci were successfully ablated in 140 patients (56 men, mean age 44.6{|±17.9 years). In 36.4% (52/143 ATs), a left atrial (LA) origin of the tachycardia was identified from the site of successful ablation. In 46% (24/52) of FLATs, the site of origin (SO) was near the ostium of a pulmonary vein (PV), and in 36.5% (19/52), the SO was near the mitral annulus (MA). In the remaining ATs, the SO was in the left atrial appendage (LAA), septum, LA roof and inside the coronary sinus. P waves in V1 showed biphasic morphology with an initial negative component in most FLATs originating from the septal MA, superior MA, and LAA. However, P waves in V1 were positive in all patients with FLATs originating from PVs. Negative P waves in aVL were always observed in FLATs originating from left PVs. The mean cycle length of FLATs from PVs was significantly shorter than that from the MA. Conclusion Knowledge of the topographic distribution, P-wave morphology, and tachycardia cycle length facilitates successful ablation of FLATs. (Circ J 2005; 69: 205 - 210)
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  • Onder Ozturk, Mehmet S Ulgen, Selahattin Tekes, Unal Ozturk, Nizametti ...
    2005 Volume 69 Issue 2 Pages 211-215
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background The genetic influence on the myocardial performance index is uncertain, so the aim of the present study was to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on the right ventricular myocardial performance index (RVMPI) after a first acute anterior myocardial infarction (MI). Methods and Results The subjects were 116 patients with a first acute anterior MI. Based on the polymorphism of the ACE gene, they were classified into 3 groups: deletion/deletion (DD) genotype (group 1, n=45), insertion/deletion (ID) genotype (group 2, n=58), insertion/insertion (II) genotype (group 3, n=13). Echocardiograms were used to determine the RVMPI, left ventricular myocardial performance index (LVMPI), tricuspid E/A, tricuspid deceleration time and the left ventricular diameter diastolic and diameter systolic (LVDd and LVDs). RVMPI and LVMPI were significantly higher in the ACE DD group. Tricuspid E/A, DT, LVDd and LVDs showed no differences among the 3 groups. Conclusion The ID polymorphism of the ACE gene may affect RVMPI and LVMPI after a first acute anterior MI. (Circ J 2005; 69: 211 - 215)
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  • Anticoagulation and Epoprostenol Therapy
    Aiko Ogawa, Hiromi Matsubara, Hideki Fujio, Katsumasa Miyaji, Kazufumi ...
    2005 Volume 69 Issue 2 Pages 216-220
    Published: 2005
    Released on J-STAGE: January 25, 2005
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    Background Anticoagulation therapy and continuous intravenous infusion of epoprostenol are the standard treatment for primary pulmonary hypertension (PPH). Because epoprostenol has an antiplatelet effect, concomitant use of an anticoagulant could increase the likelihood of hemorrhagic complications. Methods and Results In the present study, 31 consecutive patients with PPH (10 men, 21 women, mean ± SD age, 28.5±10.1 years) treated with anticoagulation and epoprostenol between April 1999 and December 2003 were retrospectively evaluated. Clinical and hematological data at the time of the bleeding episode were retrieved from the medical records. Nine patients (22.6%) experienced 11 bleeding episodes: 9 episodes (81.8%) were alveolar hemorrhage and 2 patients were in severe respiratory distress. The mean dose of epoprostenol at the time of the first bleeding episode was 89.0 ±40.5 ng · kg-1 · min-1 (range, 28.1-164.0). More of the patients who did not have a bleeding episode remain alive than did patients with bleeding episodes (59% vs 33%) nor did they require lung transplantation. Conclusions A considerable number of patients with PPH who received combined anticoagulant and high-dose epoprostenol therapy developed alveolar hemorrhage, which can be fatal. (Circ J 2005; 69: 216 - 220)
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  • Possible Involvement of Nitric Oxide and Asymmetric NG, NG-Dimethylarginine
    Yumiko Ohike, Koichi Kozaki, Katsuya Iijima, Masato Eto, Taro Kojima, ...
    2005 Volume 69 Issue 2 Pages 221-226
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Asymmetric NG,NG-dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide (NO) synthase and its plasma concentration is elevated in patients with cardiovascular risk factors, including hyperlipidemia, hypertension, diabetes, and hyperhomocysteinemia. Obstructive sleep apnea syndrome (OSAS) has been attracting attention as a risk factor for cardiovascular disorders because it often accompanies hypertension, obesity, glucose impairment, and dyslipidemia, all of which are factors in metabolic syndrome and risk factors for cardiovascular disease. Methods and Results In the present study, flow-mediated vasodilatation (FMD) of the brachial artery and plasma concentrations of ADMA were measured before and after nasal continuous positive airway pressure (nCPAP) therapy, which abrogates apnea, in 10 male patients aged 36-69 years old, who were given a diagnosis of OSAS by polysomnography. The percent FMD (%FMD) improved significantly from 3.3±0.3% to 5.8±0.4% (p<0.01) and 6.6±0.3% (p<0.01), before, 1 week, and 4 weeks after nCPAP, respectively. At the same time, the plasma NOx concentrations, metabolites of NO, tended to increase, but the plasma ADMA concentration decreased inversely to %FMD and NOx. A negative correlation between %FMD and plasma ADMA concentration, and a positive correlation between %FMD and plasma NOx concentrations were observed. Conclusion Nasal CPAP improves endothelial function, in part by the decreasing ADMA concentration, thereby potentiating NO production. (Circ J 2005; 69: 221 - 226)
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  • Tetsuya Ishikawa, Hidenori Yagi, Takashi Ogawa, Chikara Mori, Hiroshi ...
    2005 Volume 69 Issue 2 Pages 227-231
    Published: 2005
    Released on J-STAGE: January 25, 2005
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    Background Although smoking cessation is widely encouraged because of the associated risk of cardiovascular events, the impact of smoking on target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) is controversial. Therefore, the present study retrospectively investigated the effect of smoking on TLR after plain-old balloon angioplasty (POBA; n=376) and stenting (STENT; n=434) in patients undergoing secondary coronary angiography at a single center. Methods and Results A smoker was defined as current smoking or quitting within 2 years of the first PCI. In the POBA group, the predictors for TLR, as calculated by multiple logistic regression analysis, were a complex type of lesion (p<0.0001) and the left anterior descending artery (LAD) as affected vessel (p<0.05). In the STENT group, the predictors were the final % diameter of stenosis after stenting, measured by quantitative coronary arteriography (p<0.0005), LAD (p<0.01), and smoking (p=0.049). When the STENT group was divided into 2 groups according to the diameter of the implanted stent, smoking was a predictive factors for TLR in the group that received relatively small stents (diameter ≤3.0 mm) (p<0.02), but not in the group that received larger stents (diameter ≥3.5 mm). Conclusion Smoking has a deteriorative effect on TLR after implantation of relatively small coronary stents with a diameter of 3.0 mm or less. (Circ J 2005; 69: 227 - 231)
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  • Satoru Tanaka, Masao Yoshinaga, Koji Sameshima, Junichiro Nishi, Yukih ...
    2005 Volume 69 Issue 2 Pages 232-236
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Currently, a generalizable conclusion on the effectiveness of treatment programs for childhood obesity cannot be drawn, and how practical and effective the intervention strategies are remains a controversial subject. Methods and Results In the present study 36 obese elementary school children who visited an intervention program at least 4 times were followed for 12 months or more. A stepwise regression analysis was performed using the decrease in the percent relative body weight (%RBW) at 12 months after the first visit as a dependent variable, and the decrease in the %RBW and nutritional data between 2 successive visits as independent variables. The analysis revealed 4 significant predictive factors: (1) a higher ratio of energy intake from protein (20%) recommended at the first visit, (2) a greater decrease in the %RBW between the first and second visits, (3) higher age, and (4) a higher concentration of alanine aminotransferase at the first visit. Conclusion Providing a strong motivation to change eating and activity behavior at the early stage of intervention and recommending diets with higher ratios of energy intake from protein are the most practical and effective strategies for treating obesity. (Circ J 2005; 69: 232 - 236)
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  • Yuko Igarashi, Taishiro Chikamori, Hirofumi Tomiyama, Yasuhiro Usui, S ...
    2005 Volume 69 Issue 2 Pages 237-242
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    Background Although the simultaneous measurement of brachial and ankle blood pressure is a simple method of evaluating atherosclerosis, its diagnostic value for coronary artery disease (CAD) is undetermined. Methods and Results To evaluate the diagnostic value of ankle - brachial pressure index (ABI) and brachial-to-ankle pulse wave velocity (baPWV), 334 consecutive patients with suspected CAD were evaluated. Patients with a previous myocardial infarction or coronary intervention were not included. The magnitude of myocardial ischemia was evaluated by myocardial perfusion imaging. Using a 20-segment model, the percent of ischemic segments to total segments was expressed as %myocardium ischemic. In patients with ≤1, 2 and ≥3 coronary risk factors, %myocardium ischemic was 2.7±0.4, 4.0±0.5, 7.9±0.8%, respectively (p<0.0001 for trend). Performing ABI with a cutoff of 1, the %myocardium ischemic was similar in patients with ≤1 or 2 risk factors. In patients with ≥3 coronary risk factors, however, an ABI <1 reflected greater %myocardium ischemic than an ABI ≥1 (10.1±1.3, 6.6±1.0%; p=0.03). No such additional value was observed with baPWV. Conclusions The addition of simultaneous brachial and ankle blood pressure measurements will help further stratify patients with multiple risk factors. Although this approach is simple, it facilitates the identification of high-risk patients who require aggressive treatment because >10% myocardium ischemic is regarded as a scintigraphic indicator for coronary revascularization. (Circ J 2005; 69: 237 - 242)
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Case Report
  • Noriaki Iwahashi, Satoshi Nakatani, Hiroyuki Kakuchi, Masakazu Yamagis ...
    2005 Volume 69 Issue 2 Pages 243-245
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    A cardiac tumor was the first manifestation of acquired immunodeficiency syndrome (AIDS) in a female patient in a state of severe immunodeficiency caused by human immunodeficiency virus (HIV) infection. The extensive cardiac and extracardiac involvement shown by various imaging modalities, including echocardiography and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), suggested that she was in the critical stage of non-Hodgkin's lymphoma (NHL). AIDS was treated by highly active-antiretroviral therapy and the NHL was treated by a combination of rituximab - cyclophosphamide - vincristine - doxorubicine - predonisolone. After 6 cycles of chemotherapy, she was in complete remission. Her cardiac tumor dramatically reduced in size and FDG-PET showed no positive uptake on whole body imaging. Generally, an AIDS-related cardiac tumor tends to be diagnosed at the late stage of the disease because of its nonspecific clinical findings, resulting in an extremely poor prognosis. In the present case, the cardiac tumor was detected by echocardiography and treated with appropriate chemotherapy. Early diagnosis and prompt treatment may improve a patient's prognosis. (Circ J 2005; 69: 243 - 245)
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  • Shinsuke Miyazaki, Takashi Hirai, Noriyo Hosokawa, Eiichiro Hattori, M ...
    2005 Volume 69 Issue 2 Pages 246-248
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    There is increasing emphasis on the role of interatrial septal abnormalities, including patent foramen ovale and atrial septal aneurysm, in the genesis of stroke. However, a transseptal thrombus located in both atria is rarely visualized by echocardiography or other cardiac imaging techniques. It is also difficult to prove the mechanism of stroke in most clinical settings. In the present case of impending paradoxical cerebral embolism, the thrombus penetrating the atrial septal wall was visualized by transesophageal echocardiography. (Circ J 2005; 69: 246 - 248)
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  • Joji Fujisaki, Takahiro Tanaka, Jyundai Kato, Tetsuya Saito, Kohei Yan ...
    2005 Volume 69 Issue 2 Pages 249-252
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    An unusual case of primary cardiac lymphoma presenting as restrictive cardiomyopathy with arrhythmia is reported in a 72-year-old woman who was admitted for evaluation of exertional dyspnea and palpitations. Electrocardiography (ECG) showed atrioventricular dissociation and right heart cardiac catheterization revealed a typical `dip-and-plateau' waveform. Restrictive cardiomyopathy was suspected because computed tomography (CT) did not reveal pericardial thickening, calcifications, or an effusion. Heart failure initially improved with diuretic therapy, but subsequently worsened, and the patient experienced a syncopal episode. ECG showed atrial fibrillation, and CT revealed a large mass in the right atrium and multiple tumors in the liver, which needle biopsy confirmed as diffuse large B-cell lymphoma. Chemotherapy induced complete remission, and her heart failure markedly improved. The `dip-and-plateau' waveform was no longer detected on repeat cardiac catheterization and the ECG showed restoration of sinus rhythm. Clinically, the diagnosis was primary cardiac lymphoma. (Circ J 2005; 69: 249 - 252)
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  • Masao Yoshitatsu, Fumikazu Nomura, Hironori Izutani, Koichi Toda, Akir ...
    2005 Volume 69 Issue 2 Pages 253-256
    Published: 2005
    Released on J-STAGE: January 25, 2005
    JOURNAL FREE ACCESS
    As ostial stenoses of internal thoracic artery (ITA) grafts rarely occur after coronary artery bypass grafting, little is known about their Doppler flow profile. This report describes changes in the Doppler flow of ITA grafts with ostial stenosis after surgical repair of the stenosis. A 54-year-old male underwent coronary artery bypass grafting (CABG) in which the left ITA was anastomosed to the left anterior descending coronary artery. The follow-up coronary angiography revealed an ostial 90% stenosis of the ITA. The patient underwent elective surgery during which the radial artery was interposed between the left subclavian artery and the ITA. Intraoperative ultrasonography was performed immediately before cut down of the ITA graft and again immediately after completion of all anastomoses. Both diastolic and systolic velocities and the velocity time integral increased more than 2-fold after the repair. Neither the diastolic-to-systolic peak velocity ratio nor the diastolic velocity time integral fraction showed remarkable change. These profiles were different from those reported previously for distal stenosis. (Circ J 2005; 69: 253 - 256)
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