Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 69 , Issue 5
Showing 1-20 articles out of 20 articles from the selected issue
Clinical Investigation
  • Masa-aki Kawashiri, Toshinori Higashikata, Atsushi Nohara, Junji Kobay ...
    2005 Volume 69 Issue 5 Pages 515-520
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Colestimide, a 2-methylimidazole-epichlorohydrin polymer, is a new bile-acid-sequestering resin, that is 4-fold as powerful at lowering low-density lipoprotein cholesterol (LDL-C) as the conventional resin (cholestyramine). Moreover, colestimide has excellent patient compliance because it is available in tablet form. Methods and Results The clinical efficacy of colestimide coadministered with atorvastatin on lipid and apolipoprotein concentrations was examined in 15 patients (M/F =10/5, mean ± SE age =54±9 years) with heterozygous familial hypercholesterolemia (FH). After a period of wash-out of any lipid-lowering drugs, atorvastatin (20-40 mg) was administered to patients for at least 8 weeks, and then 3 g of colestimide was administered for a further 8 weeks. Total and LDL-C significantly (<0.0001) decreased by 35% from 361 to 233 mg/dl and 41% from 274 to 161 mg/dl, respectively. Addition of colestimide caused a further significant 12% and 20% reduction, respectively, from the initial values to 205 and 129 mg/dl, respectively. Colestimide was also effective in reducing serum LDL-C concentrations in heterozygous FH patients with hypertriglyceridemia (triglycerides ≥150 mg/dl). Conclusions When monotherapy with atorvastatin is insufficient to treat severely hypercholesterolemic patients, such as those with heterozygous FH, colestimide acts to reinforce the action of statins. (Circ J 2005; 69: 515 - 520)
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  • Keiichi Tsuchida, Tomoyuki Hori, Naohito Tanabe, Yashiro Makiyama, Tak ...
    2005 Volume 69 Issue 5 Pages 521-525
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Elevated lipoprotein(a) (Lp(a)) concentrations are reported to impair endothelium-dependent vasodilatation of the epicardial coronary artery. However, the effects on vasomotor abnormalities in coronary spastic angina (CSA) have not been thoroughly investigated. Methods and Results In the present study 80 sites of spasm (spastic sites) without significant organic stenosis (% diameter stenosis <50%) were assessed in 80 patients with CSA diagnosed by intracoronary ergonovine (EM) test. Spastic sites were divided into 2 groups: Group 1 included 30 sites provoked by the full dose (=50 μg) of EM, and Group 2 included 50 sites provoked with less than 50 μg (34.7±8.2 μg). Control subjects (n=22) did not show coronary spasm with the EM test. Serum Lp(a) concentrations were measured in all patients. Group 2 had a significantly greater basal coronary artery tone in the spastic sites than Group 1 (p<0.001). Lp(a) level in Group 2 was significantly higher compared with both the control group and Group 1 (p<0.05 by analysis of variance). Multivariate analysis confirmed that only serum Lp(a) concentration was associated with low-dose EM spasm provocation. Conclusions Serum Lp(a) concentration could be a marker for high disease activity in CSA. (Circ J 2005; 69: 521 - 525)
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  • Kazuhiro Shinozaki, Akira Tamura, Toru Watanabe, Toru Nakaishi, Kimiak ...
    2005 Volume 69 Issue 5 Pages 526-529
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Previous studies have demonstrated that an elevated neutrophil count on admission is associated with a higher risk of adverse events after acute myocardial infarction (AMI). However, the significance of the neutrophil count after reperfusion therapy has not been elucidated. Methods and Results The association of the neutrophil count on admission and days 2 and 3 with peak creatine kinase (CK) concentration, ST-segment resolution (a marker of myocardial tissue-level reperfusion), and left ventricular (LV) function at predischarge were examined in 122 patients (102 men, 20 women, mean age 61±11 years) with a first anterior wall AMI. Neutrophil counts were increased on day 2 and decreased on day 3 compared with admission (8,768±3,005 mm3, 6,617±2,424 mm3, and 7,725±3,388 mm3, respectively). Patients with ST-segment resolution (n=52) had lower neutrophil counts on days 2 and 3 than those without it (n=70), but neutrophil counts on admission did not differ significantly between patients with and without ST-segment resolution. Neutrophil counts on admission and days 2 and 3 were weakly but significantly correlated with peak CK concentration (r=0.31, p=0.0004; r=0.43, p<0.0001; r=0.32, p=0.003, respectively) and with LV ejection fraction at predischarge (r=-0.18, p=0.04; r=-0.26, p=0.003; r=-0.27, p=0.003; respectively). Conclusion The neutrophil count after reperfusion is weakly but significantly correlated with infarct size, myocardial tissue-level reperfusion, and LV function at predischarge in a first anterior wall AMI. These correlations were slightly stronger than the correlations with the neutrophil count on admission. (Circ J 2005; 69: 526 - 529)
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  • Mustafa Yazici, Sabri Demircan, Kenan Durna, Erdogan Yasar, Mahmut Sah ...
    2005 Volume 69 Issue 5 Pages 530-535
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background The relationships among troponin concentration, early phase coagulation activation and soluble P-selectin concentration was evaluated in this study. Methods and Results Troponin-l, soluble P-selectin, von Willebrand factor (vWF), fibrinogen, plasminogen, plasminogen activator inhibitor 1 (PAI-1) and tissue plasminogen activator (t-PA) concentrations of 202 consecutive patients with non-ST elevation acute coronary syndrome (NSTE-ACS) were measured at the time of admission. Patients were classified into 2 groups as troponin-negative (<0.2 ng/ml, n=129) or positive (≥0.2 ng/ml, n=73). Soluble P-selectin concentrations were found to be higher (p<0.001) and correlated with troponin concentrations (r=0.313, p<0.005) in troponin-positive patients with NSTE-ACS. In these patients fibrinogen (p<0.001), plasminogen (p<0.001) and PAI-1 (p<0.026) concentrations were higher and t-PA concentrations were lower (p<0.013) and all these parameters correlated with P-selectin concentrations (p<0.001). There was no difference between the groups according to vWF concentrations (p=0.379). Soluble P-selectin concentrations were found to be an independent predictor of troponin positivity (β=0.295, odds ratio =1.05, p<0.001). Analysis of regression revealed a significant effect of troponin on soluble P-selectin concentrations (r=0.52, r2=0.27, p<0.001). Conclusions The results suggest that higher soluble P-selectin concentrations might be involved in increased coagulation activation and myocardial injury development in patients with NSTE-ACS. (Circ J 2005; 69: 530 - 535)
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  • Toshihiro Honda, Hiroyuki Shono, Junjiro Koyama, Takeshi Tsuchiya, Mas ...
    2005 Volume 69 Issue 5 Pages 536-542
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Effective alternatives to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) remain unestablished. Dual-chamber (DDD) pacing was evaluated in these patients using right atrial (RA) and epicardial left ventricular (LV) leads. Methods and Results In 6 patients with HOCM refractory to medical therapy and conventional RA-right ventricular (RV) DDD pacing, we implanted DDD pacemakers using RA and epicardial LV leads. The baseline intraventricular pressure gradient before pacemaker implantation was 103±44 mmHg. The pressure gradient decreased significantly to 8±16 mmHg by temporary RA-LV DDD pacing (p=0.006), while it decreased only to 68±25 mmHg by temporary RA-RV pacing (NS). It was nearly eliminated to 1±2 mmHg (p=0.027) 3 months after RA-LV DDD pacemaker implantation. LV end-diastolic pressure, cardiac index and systolic aortic pressure did not change significantly. New York Heart Association class improved in all patients (p=0.023). Brain and atrial natriuretic peptide concentrations, respectively 516±286 and 143±34 pg/ml at baseline, decreased significantly to 230±151 and 93±44 pg/ml 3 months after implantation (p=0.027 and 0.028). Conclusion RA-LV DDD pacemaker implantation is a useful option for patients with symptomatic HOCM. (Circ J 2005; 69: 536 - 542)
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  • A Study Using Integrated Backscatter Intravascular Ultrasound
    Keiji Sano, Masanori Kawasaki, Munenori Okubo, Haruko Yokoyama, Yoko I ...
    2005 Volume 69 Issue 5 Pages 543-549
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Autopsy studies have shown atherosclerotic changes in angiographically normal coronary lesions (ANCL), and conventional intravascular ultrasound shows intimal thickening in these lesions, but cannot differentiate the lipid core. Accurate characterization of ANCL is essential to prevent progression to coronary artery disease. Methods and Results ANCL (n=120) were analyzed by integrated backscatter intravascular ultrasound (IB-IVUS) in 30 patients with stable angina pectoris. Of the 120 arterial segments analyzed by IB-IVUS, 78 (65%) showed lipid cores of 0.69±0.35 mm2 with fibrous caps of 200±100 μm thick, 44 (37%) had intimal hyperplasia with a thickness of 350±100 μm, and 65 (54%) showed fibrosis in the intimal wall without lipid core with a thickness of 450±150 μm. The diabetes mellitus (DM) group (n=14) had significantly (p<0.05) bigger lipid cores (0.62±0.38 mm2) and thinner intimal hyperplasia (100±100 μm) compared with the non-DM group (0.31±0.33 mm2, 150±150 μm, respectively). The hypertension (HT) group (n=23) had significantly more intimal hyperplasia (150±150 μm) compared with the non-HT group (50±100 μm). Hyperlipidemia (n=16) or smoking (n=6) did not significantly affect tissue characteristics. Conclusion IB-IVUS showed various types of plaque in ANCL and the plaque characteristics were affected by DM and HT. The results provide new clinical insight into the early stage of human coronary atherosclerosis. (Circ J 2005; 69: 543 - 549)
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  • Alternative to Stress Myocardial Perfusion Scintigraphy
    Akira Kurata, Teruhito Mochizuki, Yasushi Koyama, Toyoaki Haraikawa, J ...
    2005 Volume 69 Issue 5 Pages 550-557
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background The present study was designed to: (i) detect myocardial ischemia in contrast enhanced multi-slice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP) pharmacological stress test; and (ii) evaluate the potential of ATP stress CE-MSCT in a clinical setting. Methods and Results Twelve patients underwent ATP stress CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS) and 9 of the patients received conventional coronary angiography (CAG). Dual CE-MSCT scans were performed for stress and rest images, with and without intravenous infusion of ATP (0.16 mg · kg-1 · min-1) at intervals of 20 min. Myocardial perfusion and coronary artery were visually evaluated using MSCT and compared the results obtained from MPS and CAG. Of 36 territories, stress images of CE-MSCT described 26 hypo-perfusion areas and MPS described 22 redistributions. The agreement between MSCT and MPS was 83% (30/36, p<0.05). In 141 coronary artery segments of 9 patients undergoing CAG, rest images of CE-MSCT, which had significantly higher assessability than stress images (89% vs 48%, p<0.05), described 76% (13/17) of culprit coronary stenoses. Conclusions Although CT-angiography should be currently assessed using rest images, ATP stress CE-MSCT can describe both ATP-induced myocardial ischemia and coronary artery stenoses in patients with coronary artery disease. (Circ J 2005; 69: 550 - 557)
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  • Katsufumi Harafuji, Taishiro Chikamori, Satoshi Kawaguchi, Yukio Obits ...
    2005 Volume 69 Issue 5 Pages 558-563
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Aortic surgery is an invasive, high-risk noncardiac procedure and the patients who require it have a high prevalence of coronary artery disease. Therefore, preoperative risk stratification for this subset is essential. Methods and Results To assess the perioperative risk for aortic surgery, pharmacologic stress single-photon emission computed tomography (SPECT) was performed in 302 patients: aortic dissection in 56, thoracic aortic aneurysm in 124, and abdominal aortic aneurysm in 122. Not only was the presence or absence of perfusion defects analyzed, but also the 20-segment model. Pharmacologic thallium SPECT revealed negative findings in 210 patients and positives in 92. Perioperative cardiac events occurred in 9 patients: 7 occurred in patients with positive SPECT, and in only 2 of those with negative SPECT (2/210 vs 7/92; p<0.05). Multivariate analysis using logistic regression model revealed that a summed stress score ≥14 was the most important factor to identify patients who subsequently had perioperative cardiac events. Conclusions Pharmacologic stress SPECT has significant value in the risk stratification of patients before aortic surgery. In patients with positive SPECT, an aggressive approach to reduce the preoperative risk is necessary, whereas aortic surgery can be performed safely in patients with negative SPECT. (Circ J 2005; 69: 558 - 563)
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  • Kenji Ueshima, Takashi Suzuki, Masataka Nasu, Masahiko Saitoh, Noboru ...
    2005 Volume 69 Issue 5 Pages 564-566
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background This study investigated the influence of exercise training on left ventricular (LV) function in patients with acute myocardial infarction (AMI) using a new index of cardiac function, the Tei index. Methods and Results The study enrolled 53 consecutive patients (36 males, 17 females; mean age: 65±10 years) with AMI. Exercise training was performed for 6 months; peak VO2 and the Tei index were measured at the start of the cardiac rehabilitation program and 1, 3, and 6 months later. The peak VO2 improved from 14.3±3.3 to 18.5±5.2 ml · min -1 · kg-1 after 6 months (p<0.01). Although there were no significant changes in LV ejection fraction over the 6 months, the Tei index improved from 0.50±0.18 to 0.41±0.19 (p<0.05). When the ΔTei index was compared among the 3 groups classified by the Tei index at baseline, the values improved in the groups with high/slightly high values compared with the normal group. Conclusion Both cardiac function, as evaluated by the Tei index, and exercise capacity improved after exercise training in patients with AMI. The greater improvement was seen in the population with the higher value (lower cardiac function) according to this index. (Circ J 2005; 69: 564 - 566)
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Experimental Investigation
  • Simulation Study
    Shunichiro Miyoshi, Hideo Mitamura, Yukiko Fukuda, Kojiro Tanimoto, Yo ...
    2005 Volume 69 Issue 5 Pages 567-575
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background The specific changes in the gating kinetics of the sodium current (INa) responsible for its phenotype have remained to be elucidated. In the present study the effect of changes in the gating kinetics of INa on early repolarization (ER) and initiation of phase 2 reentry (P2R) were evaluated in a theoretical epicardial ventricular fiber model. Methods and Results Miyoshi-ICaL was incorporated into the modified Luo-Rudy dynamic (LRd) model. Dispersion at Ito-density was set within a theoretical fiber composed of serially arranged epicardial cells with gap junctions. The following changes in INa kinetics were made: (1) a -10 mV shift in steady-state inactivation, (2) a +10 mV shift in steady-state activation curve, (3) a small inactivation time constant (DEC); P2R and ER were observed. A conduction disturbance within the fiber was simulated and only when the INa-density was decreased did DEC, especially, show a marked increase in the likelihood of causing ER and P2R. Conduction disturbance significantly increased the likelihood causing ER or P2R. Conclusions In this one-dimension model with Ito-density dispersion, DEC-INa precipitates INa-blocker inducible ER. This suggests that the characteristic ST-segment elevation in the Brugada syndrome with SCN5A mutation can be interpreted in part by DEC-INa. Concomitant conduction disturbance may be required to cause P2R at physiological Ito density. (Circ J 2005; 69: 567 - 575)
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  • Mari Amino, Masatoshi Yamazaki, Harumichi Nakagawa, Haruo Honjo, Yusuk ...
    2005 Volume 69 Issue 5 Pages 576-584
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Spiral re-entry plays the principal role in the genesis of ventricular tachycardia and ventricular fibrillation (VT/VF). The specific IKr blocker, nifekakant (NIF) has, often in combination with lidocaine (LID), recently been used in Japan to prevent recurrent VT/VF, but the combined effects of these drugs on spiral re-entry had never been investigated. Methods and Results A ventricular epicardial sheet was obtained from 13 Langendorff-perfused rabbit hearts by means of a cryoprocedure, and epicardial excitations were analyzed with a high-resolution optical mapping system. Nifekakant (0.5 μmol/L) caused significant prolongation of action potential duration (APD) and LID (3 μmol/L) attenuated the APD prolongation without affecting the conduction velocity. VT were induced in 6 hearts by cross-field stimulation, and single- or double-loop spirals circulating around variable functional block lines were visualized during the VT. Nifekakant reduced VT cycle length and caused early termination in association with destabilization of the spiral dynamics (prolongation of functional block line, frequent local conduction block, and extensive meandering). These modifications of spiral-type re-entrant VT by NIF were prevented by addition of LID. Conclusions The effects of NIF on the spiral excitations are reversed by LID. This interaction should be taken into account when these drugs are used in combination to treat VT/VF. (Circ J 2005; 69: 576 - 584)
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  • Nobusada Funabashi, Katsuya Yoshida, Hiroyuki Tadokoro, Keiichi Nakaga ...
    2005 Volume 69 Issue 5 Pages 585-589
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background In both cardiac and hepatic disorders it is desirable to accurately visualize the direction and scale of blood flow in the whole organ in pulsating 3-dimensional (D) images, which are known as 4-D images. Methods and Results The present study used 256-slice cone-beam computed tomography (CT) (Athena, Sony-Toshiba) at one rotation per second and a section thickness of 0.5 mm to show the dynamics of cardiovascular circulation and hepatic perfusion by contrast injection in 4-D films of pigs. Four pigs (20 kg each) were anesthetized with isoflurane. The distal tips of the catheters were positioned in the inferior vena cava (IVC) (pigs 1-3) and in the proper hepatic artery (pig 4). Volumetric scanning and injection of contrast material were started simultaneously and continued for 25 s with image reconstruction at 1-s intervals. In pigs 1-3, 4-D filming revealed the dynamics of cardiovascular circulation, first in the IVC, followed by the right ventricle and pulmonary artery, then the left ventricle, left atrium, pulmonary vein, and finally, the right heart disappeared and only the left heart and aorta remained visible. In pig 4, the hepatic arterial trees, followed by the venous trees, could be easily visualized in turn on the 4-D images. Conclusions This technology successfully demonstrated cardiovascular circulation and hepatic perfusion in 4-D and will have clinical applicability. (Circ J 2005; 69: 585 - 589)
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  • Makoto Nonomura, Takashi Nozawa, Akira Matsuki, Teruo Nakadate, Norio ...
    2005 Volume 69 Issue 5 Pages 590-595
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Norepinephrine (NE)-derived free radicals may contribute to myocyte injury after ischemia -reperfusion, so the influence of sympathetic denervation on myocardial ischemia - reperfusion injury was investigated in the present study. Methods and Results Cardiac sympathetic denervation was produced in Wistar rats by a solution of 10% phenol 1 week before ischemia. Atenolol (0.5 mg/kg) was intravenously administered 10 min before the coronary occlusion. The left coronary artery was occluded for 30 min and thereafter reperfused. Cardiac interstitial fluid was collected by a microdialysis probe and free radicals in dialysate were determined by electron paramagnetic resonance (EPR) spin trapping, using 5,5-dimethyl-1-pyrroline-N-oxide as a spin trap. The ratio of infarct size to the ischemic area at risk (I/R) was decreased in both the phenol and atenolol groups compared with control (28.5±11.3, 31.8±10.7 vs 50.6±14.7%, p<0.05). During the coronary occlusion, concentrations of interstitial NE increased markedly in the control and atenolol groups, but was unchanged in the phenol group. EPR signal intensity (relative value to internal standard) was maximal at 1 h after reperfusion and was similar in the phenol and control groups (0.32±0.15 vs 0.45±0.19). Conclusions Cardiac denervation protected myocyte against ischemia - reperfusion injury through decreasing direct NE toxicity, but not through decreasing NE-derived free radicals. (Circ J 2005; 69: 590 - 595)
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  • Tatsuhiko Mori, Tetsuya Hayashi, Koichi Sohmiya, Nobuaki Okuda, Hiroak ...
    2005 Volume 69 Issue 5 Pages 596-602
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Both β-adrenergic blockers and angiotensin-II receptor blockers were reported to improve the prognosis of patients with heart failure, but the efficacy of combination therapy with these agents has not been fully elucidated. Also the efficacy of celiprolol, a β1-selective adrenoceptor antagonist with partial β2-agonist properties, for heart failure treatment is still controversial. We examined the cardioprotective effects and mechanisms of the therapy with celiprolol or candesartan, an angiotensin-II receptor blockers and their combination in heart failure induced by isoproterenol (ISO). Methods and Results ISO 300 mg/kg was injected in rats to produce heart failure. Two months after the injection, the ISO-injected rats were divided into 4 groups (8 rats each) and treated for 4 weeks as follows: (a) vehicle; (b) celiprolol 10 mg/kg per day (BB); (c) candesartan 0.2 mg/kg per day (ARB); and (d) their combination BB + ARB. ISO significantly elevated left ventricular (LV) end-diastolic pressure, decreased peak-negative dP/dt and LV ejection fraction. BB and ARB similarly ameliorated cardiac dysfunction due to ISO, but BB + ARB were more potent than the individual therapies. Separately, ARB preserved the histological structure in LV myocardium. In contrast, BB ameliorated calcium handling, as shown by the increased ratio of SERCA2 to phospholamban protein, despite having little effect on the histology. Conclusion Both celiprolol and candesartan showed cardioprotective effects in this heart failure model. The potential use of the combination treatment in heart failure might result in a synergistic effect through the different cardioprotective mechanisms of celiprolol and candesartan. (Circ J 2005; 69: 596 - 602)
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  • Du Junbao, Yan Hui, Wei Bing, Li Jian, Qi Jianguang, Tang Chaoshu
    2005 Volume 69 Issue 5 Pages 603-608
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    Background Pulmonary hypertension (PH) is a common complication of congenital heart disease and pulmonary vascular structural remodeling due to the high pulmonary blood flow is considered as the key pathologic process. In the present study the effects of L-arginine on the collagen metabolism of pulmonary arteries in rats with high pulmonary blood flow-induced PH were investigated to elucidate its mechanism. Methods and Results The rat model of PH was established with an abdominal aorta and inferior vena cava shunt. L-arginine (1 g/kg per day) was given directly into the stomachs of the rats with the shunt (L-arginine + shunt group) and 11 weeks later, the pulmonary hemodynamics were studied. Collagen I and collagen III expressions were detected by immunohistochemical assay. The expressions of procollagen I mRNA, procollagen III mRNA, the tissue inhibitor of metalloproteinase-1 mRNA and the matrix metalloproteinase-1 mRNA were detected by in situ hybridization. The expressions of pulmonary artery collagen I, collagen III, procollagen I mRNA and procollagen III mRNA in the shunt rats were obviously elevated compared with the control rats (p<0.01). The positive signals were mainly located in the media and adventitia of median and small pulmonary arteries. The expressions of the pulmonary artery tissue inhibitor of metalloproteinase-1 mRNA, metalloproteinase-1 mRNA and the ratio of tissue inhibitor of metalloproteinase-1/metalloproteinase-1 were elevated in the shunt rats (p<0.01). However, the expressions of pulmonary artery collagen I, collagen III, procollagen I mRNA and procollagen III mRNA were significantly reduced in the shunt rats of the L-arginine group (p<0.01). L-arginine also downregulated the expressions of tissue inhibitor of metalloproteinase-1 mRNA and metalloproteinase-1 mRNA, as well as the ratio of tissue inhibitor of metalloproteinase-1/metalloproteinase-1 (p<0.05). Conclusions L-arginine can reduce the synthesis of extracellular matrix-collagen and increase its degradation, thus having an important modulating effect on pulmonary vascular matrix remodeling induced by high pulmonary blood flow. (Circ J 2005; 69: 603 - 608)
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Case Report
  • A Case of Cholesteryl-Ester Transfer Protein Deficiency
    Masahide Nagano, Motoyuki Nakamura, Noboru Kobayashi, Junya Kamata, Ka ...
    2005 Volume 69 Issue 5 Pages 609-612
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    A 54-year-old female was admitted to hospital complaining of oppressive anterior chest pain during exercise. Treadmill exercise ECG testing showed significant ischemic ECG changes, and electron-beam computed tomography demonstrated patchy calcifications in the coronary artery. Coronary angiography revealed a significant stenotic lesion of the right coronary artery. On routine investigations, no classical coronary risk factors were found, although a very high concentration (209 mg/dl) of high-density lipoprotein cholesterol (HDL-C) was detected. The serum concentration of cholesteryl-ester transfer protein (CETP), which plays a central role in the reverse cholesterol transport system, was measured and found to be less than the measurable minimum. The patient showed one of the typical genetic CETP mutations (intone 14 splicing defect), and her lipid profile was improved by administration of probucol for 3 months. A very high concentration of HDL-C with a defect of CETP activity may be a specific biochemical indicator pointing to an increased risk of premature coronary artery disease, and the lipid profile can be improved by use of lipid-lowering drugs. (Circ J 2005; 69: 609 - 612)
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  • Satoshi Kurisu, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yuji ...
    2005 Volume 69 Issue 5 Pages 613-616
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    A-55-year-old man with diabetes mellitus was admitted to hospital because of chest pain. He was diagnosed as anterior acute myocardial infarction and treated with stent placement. After 7 days, ventricular fibrillation occurred because of a subacute reocclusion and balloon angioplasty was performed. Despite reperfusion therapy, intraaortic balloon pumping, antiarrhythmic drugs and β-blocker, ventricular tachycardia or fibrillation relapsed and cardioversion was performed 29 times during 32 h. Temporary overdrive atrioventricular sequential pacing was initiated and the malignant arrhythmia finally disappeared. Even after stoppage of 25 h overdride pacing, it never recurred. Temporary overdrive pacing is an easy and feasible therapy for a drug-resistant electrical storm associated with AMI and should be performed in the early stage. (Circ J 2005; 69: 613 - 616)
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  • Kazunobu Ishikawa, Satoshi Kimura, Atsushi Kobayashi, Takamasa Sato, H ...
    2005 Volume 69 Issue 5 Pages 617-620
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    A 60-year-old woman was admitted for treatment of congestive heart failure. She had been diagnosed with diabetes mellitus when she was 23 years old, and she began to go deaf when she was 34 years old. She showed symptoms of heart failure at age 51 and was diagnosed with hypertrophic cardiomyopathy. Echocardiography showed progressive diffuse hypokinetic motion of the left ventricle and the left ventricular hypertrophy had gradually regressed. A mitochondrial transition mutation, A3243G, was detected in her peripheral leukocytes (9%) and in those of her 27-year-old son, who also has diabetes and deafness. Electron microscopy of an endomyocardial biopsy specimen showed proliferation and swelling of the mitochondria, and significant generation of reactive oxygen species (ROS), as well as marked induction of heme oxygenase-1, which is an adaptive enzyme to oxidative damage, were also observed in the myocardial tissue. These observations were more prominent than in other patients with heart failure of different etiology, which suggests that the increased ROS generation and anti-oxidative response were involved in the development of the mitochondrial cardiomyopathy. (Circ J 2005; 69: 617 - 620)
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  • Yoshikazu Ohara, Yoshikazu Hiasa, Shinobu Hosokawa, Takeshi Tomokane, ...
    2005 Volume 69 Issue 5 Pages 621-623
    Published: 2005
    Released: April 25, 2005
    JOURNALS FREE ACCESS
    A 79-year-old woman presented with chest pain. Her symptoms, combined with the results of an electrocardiogram, echocardiogram and laboratory investigations were compatible with an extensive acute anterior myocardial infarction. However, emergency coronary angiography showed no stenotic lesion in any coronary artery, but left ventriculography revealed apical ballooning akinesis and basal hyperkinesis and she was diagnosed as having transient left ventricular apical ballooning. After 7 days, she suddenly went into cardiopulmonary arrest because of cardiac tamponade. The autopsy revealed a free wall rupture. Generally, the prognosis in transient left ventricular apical ballooning is good; left ventricular free wall rupture is very rare. (Circ J 2005; 69: 621 - 623)
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