Background The cardiovascular event rate in Japanese populations is strikingly lower than that in Caucasian populations and it has been postulated that this difference might be because of variations in atherosclerosis progression in patients with coronary artery disease (CAD). However, the rate of angiographically assessed progression and its response to statins has not been well described in Japanese patients. Methods and Results The angiographic intervention trial using an HMG-CoA reductase inhibitor to evaluate the retardation of obstructive multiple atheroma (ATHEROMA) study was a multicenter, randomized, controlled clinical trial investigating the effects of pravastatin on coronary atherosclerosis in Japanese patients with CAD using quantitative coronary angiography. In total, 361 patients with mild to moderate elevated serum total cholesterol concentrations (195-265 mg/dl) received diet only (n=179) or diet plus pravastatin 10-20 mg/dl (n=182). Over 3 years, low-density lipoprotein-cholesterol in the pravastatin group decreased by 19.5% (p<0.0001). A per-patient analysis showed that minimum lumen diameter increased by 0.034±0.17 mm in the pravastatin group, but decreased by 0.006±0.16 mm in the diet only group (p=0.04). The mean difference between the treatment groups was 0.040 mm (95% confidence interval 0.020, 0.070 mm). Conclusion The ATHEROMA study indicates that pravastatin 10-20 mg/day for 3 years improves hyperlipidemia, then suppresses progression and induces regression of focal coronary atherosclerosis in Japanese CAD patients with elevated serum cholesterol. (Circ J 2005; 69: 875 - 883)

View full abstract

Background Many clinicians have seen the reperfusion phenomenon, a paradoxical response that includes a transient increase of chest pain, additional ST-segment elevation or ventricular arrhythmias immediately after coronary reperfusion, in patients with acute myocardial infarction (AMI). The aim of the present study was to investigate the impact of this phenomenon during coronary reperfusion on left ventricular (LV) remodeling in patients with AMI. Methods and Results One hundred and thirty-eight consecutive patients with a first anterior-wall AMI, undergoing coronary reperfusion treatment within 24 h of onset were prospectively evaluated for reperfusion phenomenon and followed up with scheduled evaluations of LV function and morphology with left ventriculography for 1 year. Of the 138 enrolled patients, 77 underwent serial left ventriculography at the acute, subacute and 1-year phases. Of these 77 patients, 39 demonstrated the reperfusion phenomenon. The LV end-diastolic volume index significantly increased from the acute to subacute phase and to the 1-year phase, but was unchanged in the 38 patients without reperfusion phenomenon. In multivariate analysis, reperfusion phenomenon was the only determinant of LV dilatation after AMI. Conclusions Reperfusion phenomenon was a strong predictor of LV remodeling after reperfusion therapy for AMI. (Circ J 2005; 69: 884 - 889)

View full abstract

Background This study tested the hypothesis that serum concentrations of high-sensitivity C-reactive protein (hs-CRP) and soluble CD40 ligand (sCD40L) significantly reflect serial changes in patients with unstable angina, and thus the serum concentrations of these inflammatory biomarkers may be good candidates for predicting late restenosis after coronary stenting. Methods and Results The circulating concentrations of sCD40L and hs-CRP were prospectively measured (both pre-procedure, and on days 21, 90, and 180 after the procedure) in 77 consecutive patients with unstable angina undergoing coronary stenting. These inflammatory mediators were also evaluated in 30 healthy volunteers. The serum concentrations of sCD40L and hs-CRP were significantly higher pre-procedure in study patients than in normal control subjects (all p values <0.0001). These inflammatory markers then declined to a substantially lower concentration by day 21 (all p values <0.05). Circulating concentrations of hs-CRP in each patient then differed little from each other afterwards. However, the sCD40L concentration was once again raised significantly on days 90 and 180 as compared to day 21 (both p values <0.05). This study found no significant link between raised circulating concentrations of sCD40L and hs-CRP and late restenosis. Conclusions Circulating concentrations of sCD40L and hs-CRP were significantly increased in unstable angina patients pre-procedure and declined substantially thereafter. However, the circulating concentrations of these 2 inflammatory mediators were not useful in predicting late restenosis following coronary stenting. (Circ J 2005; 69 : 890 - 895)

View full abstract

Background The long-term prognosis and serial angiographic follow-up beyond 10 years in patients who underwent coronary artery bypass grafting (CABG) have not been fully studied in Japan. Methods and Results In the present study data from 71 patients who underwent CABG before 1992 were analyzed. Thirty patients had a saphenous vein graft (SVG) only group, and the remaining 41 had a left internal thoracic artery graft to the left anterior descending coronary artery (LITA) group; 6 patients died from malignancy, which was the most common cause of death after CABG. The major adverse cardiac events (MACE) were defined as cardiac death, Q-wave or nonQ-wave myocardial infarction, and congestive heart failure. The MACE-free rate was significantly higher in the LITA group than in the SVG group (p<0.05). However, among the patients with an ejection fraction <0.40, there was no significant difference in MACE-free rate between the 2 groups. The LITA patency rate was significantly higher than that for SVG (p<0.05) and the SVG patency rate was lower in the patients with hyperlipidemia (p<0.05); cholesterol-lowering therapy improved the SVG patency rate. Conclusion The long-term outcome of CABG was favorable, particularly if using an arterial graft. Although the patency rate was lower for the SVG than LITA, the patient's lipid profile might be an important factor in the SVG patency rate. (Circ J 2005; 69: 896 - 902)

View full abstract

Background Optical coherence tomography (OCT) is a new imaging method. With a resolution of approximately 10-20 Ém, which is approximately 10-fold higher than that of intravascular ultrasound (IVUS). Methods and Results This study compared the coronary intima - media thickness (IMT) and the intimal thickness of 54 coronary arterial segments evaluated by histological examination with the results of OCT and IVUS. There was better agreement in IMT between OCT and histological examination than between IVUS and histological examination (r=0.95, p<0.001, mean difference =-0.01±0.07 mm for OCT; r=0.88, p<0.001, mean difference =-0.03±0.10 mm for IVUS). There was good agreement in the intimal thickness between OCT and histological examination (r=0.98, p<0.001, mean difference =0.01±0.04 mm). Conclusions IMT could be measured more accurately by OCT than IVUS. In addition, the intimal thickness could be evaluated by OCT and correlated well with the histological examination. (Circ J 2005; 69: 903 - 907)

View full abstract

Background Various methods are used to induce maximal hyperemia for physiologic studies, but the feasibility and efficacy of continuous intracoronary (IC) infusion of adenosine for measurement of fractional flow reserve (FFR) has not been well-defined. Methods and Results Patients with intermediate coronary artery stenosis were consecutively enrolled. In the phase I study, FFR was measured after 3 dosages of IC adenosine infusion (180, 240 and 300 μg/min) in 30 patients. The phase II study was performed to compare the hyperemic efficacy of IC infusion (240 μg/min) with IC bolus injection (40, 80 μg) and intravenous (IV) infusion (140 μg · kg ^-1 · min^-1) of adenosine in 20 patients. In the phase I study, no significant differences in FFR were observed with the 3 different doses of IC infusion (p=0.06). In the phase II study, FFR after an IC bolus injection (0.83±0.06) was significantly higher than with IV (0.79±0.07) or IC (0.78±0.09) infusion (p<0.01). However, no difference in FFR was observed for IC and IV infusions. Conclusion IC infusion of adenosine seems to be a safe and effective method of inducing maximal hyperemia for FFR measurement. (Circ J 2005; 69: 908 - 912)

View full abstract

Background Cheyne - Stokes respiration with central sleep apnea (CSR-CSA) contributes to the poor prognosis in patients with congestive heart failure (CHF). Bi-level positive airway pressure (bi-level PAP) may be an effective alternative for treating CSR-CSA and CHF. Methods and Results Fourteen patients with CSR-CSA were divided into 2 groups, a control group that included 7 patients who decided to receive only conventional medications and a group of 7 patients that received bi-level PAP. Left ventricular ejection fraction (LVEF), mitral regurgitation (MR) area, plasma brain natriuretic peptide (BNP) concentration and the New York Heart Association (NYHA) functional class were evaluated initially (baseline) and 3 months later. In the control group, there were no significant changes in cardiac function during the study period. In contrast, in the group that received bi-level PAP, there were significant improvements in LVEF (from 36.3±2.9% to 46.0±4.0%, p=0.02), MR area (from 30.4±7.6% to 20.0±5.1%, p=0.02), BNP (from 993.6±332.0 pg/ml to 474.0±257.6 pg/ml, p=0.02) and NYHA functional class (from 3.1±0.1 to 2.1±0.1, p=0.03). Conclusion Treatment with bi-level PAP improved cardiac functions in CHF patients with CSR-CSA. (Circ J 2005; 69: 913 - 921)

View full abstract

Background The aim of the present study was to prospectively study whether a combination of markers for myocardial cell injury and left ventricular overload at admission can reliably risk stratify patients hospitalized for chronic heart failure (CHF). Methods and Results Serum concentrations of heart-type fatty acid binding protein (H-FABP) and plasma concentrations of brain natriuretic peptide (BNP) were measured at admission in 186 consecutive patients hospitalized for CHF. During a mean follow-up period of 534±350 days, there were 44 cardiac events, including 16 cardiac deaths and 28 readmissions for worsening heart failure. Normal upper limits for H-FABP and BNP values were determined from the receiver operating characteristic curves (4.3 ng/ml for H-FABP and 200 pg/ml for BNP). A stepwise Cox regression analysis demonstrated that high H-FABP (hazard ratio 5.416, p=0.0002) and high BNP (hazard ratio 2.411, p=0.0463) were independent predictors of cardiac events. High concentrations of both H-FABP and BNP at admission were associated with the highest incidence of cardiac mortality and cardiac events. Kaplan-Meier analysis also showed that the combination of H-FABP and BNP concentrations could reliably stratify patients for cardiac events. Conclusion Combined measurement of H-FABP and BNP concentrations at admission may be a highly reliable evaluation for risk stratifying patients hospitalized for CHF. (Circ J 2005; 69: 922 - 927)

View full abstract

Background Associations between hyperuricemia, cardiovascular diseases and diabetes have been reported, but few of the studies have been conducted in the Korean population. The present study examined a Korean adult population with respect to the relationships between serum uric acid concentrations and hypertension, insulin resistance, and the risk factors of metabolic syndrome. Methods and Results A total of 53,477 subjects were divided into 4 groups according to serum uric acid quartiles. The incidence of hypertension in all subjects was higher in the first quartile than in the third plus fourth quartile (odds ratio (OR) 1.192, p<0.001). Homeostasis model assessment index was found to be associated with serum uric acid concentration in all subjects (OR 1.193, p<0.001), and the serum uric acid concentration was positively correlated with the risk factors of metabolic syndrome. In addition, the number of metabolic syndrome variables increased as serum uric acid concentration increased. Conclusions Serum uric acid concentration was found to be independently correlated with hypertension, insulin resistance and the risk factors of metabolic syndrome. In addition, even those with a serum uric acid concentration in the normal range showed an increased risk of metabolic syndrome as serum uric acid concentration increased. (Circ J 2005; 69: 928 -933)

View full abstract

Background The precise mechanism of takotsubo-like left ventricular (LV) dysfunction remains unclear. Methods and Results Eight consecutive patients with takotsubo-like LV dysfunction were studied. In the acute phase and 3 weeks later, the coronary flow velocity spectrum and coronary flow velocity reserve (CFVR) were recorded by Doppler guidewire. The deceleration time of diastolic velocity (DDT; ms) was measured from the peak diastolic velocity to the point where the extrapolated line intersected the baseline. In all cases, CFVR of the 3 coronary arteries increased during follow-up (1.7±0.5 to 2.4±0.5 for the left anterior descending artery (p<0.05), 1.7±0.5 to 2.7±0.8 for the left circumflex artery (p<0.05) and 1.7±0.3 to 2.5±0.4 for the right coronary artery (p<0.05)). In addition, the DDT of all coronary arteries increased during follow-up. Conclusions Decreased CFVR and short DDT were demonstrated in patients with takotsubo-like transient LV dysfunction in the acute phase, and these findings improved 3 weeks later, which suggests that coronary microvascular dysfunction may be a causative mechanism. (Circ J 2005; 69: 934 - 939)

View full abstract

Background Recent interventional and surgical therapies to attenuate left ventricular pressure gradient (LVPG) can be difficult to perform in patients with hypertrophic obstructive cardiomyopathy (HOCM) cuased by midventricular obstruction (MVO), owing to the risk of inducing or deteriorating mitral regurgitation. Methods and Results The effects of the antiarrhythmic drug, cibenzoline, on LVPG and left ventricular (LV) diastolic function estimated by the change in the transmitral Doppler flow pattern were examined in 23 patients with HOCM and MVO. Hemodynamic changes 2 h after a single dose of 200 mg of cibenzoline and 3 months after oral administration of 300-450 mg of cibenzoline per day were examined. At 2 h after the treatment, LVPG decreased from 79±37 mmHg to 24±21 mmHg (p<0.0001). E-wave velocity significantly increased and A-wave velocity significantly decreased, and thus the E/A ratio increased from 0.83±0.39 to 1.36±0.50 (p<0.0001). After 3 months of treatment, LVPG remained decreased, and the E-wave and A-wave velocities and the E/A ratio remained improved. Conclusions Cibenzoline can attenuate LVPG and ameliorate LV diastolic dysfunction in patients with HOCM caused by MVO, which suggests a new strategy for the management of this condition. (Circ J 2005; 69: 940 - 945)

View full abstract

Background A genetic correlation between Brugada syndrome (BS) and sinus node dysfunction (SND) has been proposed, although the clinical and electrophysiologic characteristics of this concomitant condition are unknown. Methods and Results The study comprised 5 patients with symptomatic BS (4 with spontaneous episodes of ventricular fibrillation (VF) and 1 with syncope) of whom 3 had a documented sinus pause >3 s (a 42- and 62-year-old man, and a 49-year-old woman). Only 1 of them had a family history of sudden death; 2 of them had also had an episode of atrial fibrillation or flutter. Electrophysiologic study demonstrated prolonged sinus node recovery time in 2 patients (2.6 s and >5 s), in whom a cardiac pacemaker had been implanted before the diagnosis of BS was made after episodes of VF. Finally, all 3 patients received an implantable cardioverter defibrillator, including 2 upgrades from pacemaker. Conclusions SND is not a rare concomitant disorder in BS and there is a possible genetic connection. (Circ J 2005; 69: 946 - 950)

View full abstract

Background Hypertrophic cardiomyopathy (HCM) might exhibit not only diastolic, but also latent systolic dysfunction. Therefore combined assessment of both systolic and diastolic function using myocardial performance index (Tei index) can be useful in HCM. Plasma brain natriuretic peptide (BNP) level is reported to be elevated in HCM, but the mechanism of BNP elevation in HCM remains to be established. Methods and Results The value of Tei index in 45 HCM patients was compared with that of 20 normal control subjects. The HCM patients showed a higher value of Tei index (0.55±0.12 vs 0.36±0.08, p<0.0001) and longer isovolumic relaxation and contraction times than control subjects. The plasma BNP level correlated with Tei index in non-obstructive HCM (n=35, r=0.61, p<0.0001), although the correlation was mild when overall HCM patients were included (r=0.34, p=0.02). The correlation was still significant after adjusting for age, or the extent and severity of left ventricular hypertrophy. Multiple stepwise regression analysis identified mitral E/A ratio (r=0.49, F=13.1) and Tei index (r=0.37, F=7.6) as independent predictors of higher plasma BNP level in non-obstructive HCM. Conclusions Myocardial performance index was abnormal in HCM, reflecting both systolic and diastolic dysfunction in this disorder. Plasma BNP level correlated with functional assessment by Tei index in non-obstructive HCM. (Circ J 2005; 69: 951 - 957)

View full abstract

Background Patients with aortic dissection (AD) often demonstrate positive heart-type fatty acid-binding protein (H-FABP), but its significance is unclear. Methods and Results In 63 of 64 consecutive AD patients, the serum H-FABP concentration was measured and the H-FABP positive rate calculated (cutoff value: 6.2 ng/ml) for each of following factors: (1) with or without dissection of the ascending aorta; and (2) a thrombosed false lumen; (3) length score; (4) presence of shock; (5) malperfusion of limbs; (6) ST elevation and/or depression on electrocardiogram; and (7) renal dysfunction. In total 36 AD patients had a positive H-FABP test. Statistically significant differences in the H-FABP positive rate were observed between those with and without ascending AD (76.7% vs 39.4%, p=0.003), and in the length score (p<0.001). Multivariate logistic regression test demonstrated that the most significant factor was the length score (odds ratio: 2.239 (95% confidence interval: 1.119-4.481), p=0.023). Moreover, a significant correlation was observed between length score and absolute H-FABP value (r=0.420, p=0.001). Conclusions In patients with AD, an increased serum H-FABP concentration is caused by the protein being released not only from the cardiac muscle but also from skeletal muscle, or possibly the aortic wall. Physicians using H-FABP for detection of myocardial injury need to be aware that patients with a long or ascending AD will show an elevation of H-FABP. (Circ J 2005; 69: 958 - 961)

View full abstract

Background Intravenous immunoglobulin therapy, widely used for various autoimmune and systemic inflammatory diseases including Kawasaki disease (KD), is occasionally associated with thromboembolic adverse effects caused by an abrupt increase in blood viscosity. Scarce information is available, however, regarding the effect of single high-dose immunoglobulin therapy for KD on blood viscosity. Methods and Results Eleven boys and 5 girls (mean age: 2.1 years) with acute-phase KD underwent single high-dose immunoglobulin therapy. Plasma viscosity before the treatment was 1.18 centipoises (SD =0.06), but it significantly rose to 1.34 centipoises (SD =0.06) (p<0.001). Multiple regression analysis revealed that, among various factors including hematocrit, plasma concentrations of total protein, immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM), only plasma IgG concentration was included in the model to explain plasma viscosity (R² =0.59, p<0.001). Conclusions Single high-dose regimen for acute-phase KD increases blood viscosity and therefore might increase the risk of thromboembolism. (Circ J 2005; 69: 962 - 964)

View full abstract

Background The aim of the present study was to examine the impact of the clinical use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on the association between the urinary albumin/creatinine ratio (ACR) and ankle-brachial index (ABI) or peripheral arterial disease (PAD) in elderly Taiwanese patients with type 2 diabetes mellitus. Methods and Results Two-hundred and ninety patients (108 men, 182 women) aged ≥65 years (mean ± SD, 71.6 ±4.9) were cross-sectionally studied. ACR was expressed as the natural logarithm [ln(ACR)] and divided into normoalbuminuria (<30.0 μg/mg) and albuminuria (≥30.0 μg/mg). ABI was evaluated both continuously and as peripheral arterial disease (PAD) (-) and PAD (+) using the cutoff of 0.9. Statistical analyses were performed with consideration of covariates and the use of ACEI/ARB. Results showed that in patients not using ACEI/ARB, ln (ACR) negatively correlated with ABI (r=-0.261, p<0.01) and was associated with ABI with adjusted regression coefficient of -0.0213 (p<0.05). PAD patients had a significantly higher level of ln (ACR) than those without PAD (4.83±1.34 vs 3.73±1.29, p<0.001) and PAD prevalence was significantly higher in those with albuminuria than in those with normoalbuminuria (22.6% vs 4.9%, p<0.001). The multivariate-adjusted odds ratio for PAD for every 1 unit increment of ln (ACR) was 2.10 (1.31-3.38), and for albuminuria vs normoalbuminuria 3.86 (1.04-14.31) in patients not using ACEI/ARB. In patients using ACEI/ARB, none of these analyses was significant. Patients using ACEI/ARB had a significantly lower risk of PAD with a multivariate-adjusted odds ratio of 0.34 (0.12-0.97). Conclusions ACR negatively correlates with ABI and is associated with PAD in elderly diabetic patients not treated with ACEI/ARB. The use of ACEI/ARB attenuates this association and may be associated with a lower risk of PAD. (Circ J 2005; 69: 965 - 970)

View full abstract

Background The objective of this study was to evaluate the diagnostic value of the head-up-tilt (HUT) test for detecting cerebral hemodynamic insufficiency in patients with major cerebral artery occlusion disease because such patients may benefit from extracranial - intracranial bypass surgery. Methods and Results In 13 cases of transient ischemic attacks in patients with carotid or middle cerebral artery occlusive disease, the HUT test was used to determine whether or not the symptoms appear during induced hypotension before investigating cerebral hemodynamics with positron emission tomography. Three of the 13 patients showed focal symptoms such as hemiparesis and limb shaking during the HUT test. In all 3 patients, the oxygen extraction fraction (OEF) increased beyond 53.3% (ie, misery perfusion), whereas only 2 of the other 10 patients without focal symptoms showed an increase in OEF during HUT. Conclusions The HUT test was highly useful for screening patients with cerebral hemodynamic insufficiency in carotid occlusive disease. (Circ J 2005; 69: 971 - 975)

View full abstract

Background The aim of the present study was to investigate the effect of a single bout of mild exercise on autonomic nervous system activity in healthy subjects. Methods and Results The study group comprised 18 healthy males, aged between 20 and 24 years, who had not been training regularly for the last 3 months. A supine recording of systolic arterial pressure (SAP) and RR interval and the administration of the phenylephrine test were performed at baseline and repeated after a 60-min recovery period following treadmill exercise training for 30 min at 65% of maximal heart rate. Mean SAP and RR interval, heart rate variability (HRV) indices (the standard deviation of normal-to-normal RR intervals (SDNN), the square root of the mean of squared differences between successive intervals and the percentage of adjacent RR intervals differing more than 50 ms), noninvasive spectral baroreflex sensitivity (Spe-BRS) and phenylephrine baroreflex sensitivity (Phe-BRS) were assessed before and after training. Mean SAP measured after exercise was lower than baseline (120±12 mmHg vs 128±12 mmHg, p=0.05). Spe-BRS and Phe-BRS increased significantly after exercise, from 11.8±6.1 ms/mmHg to 16.0±7.8 ms/mmHg (p=0.034), and from 16.0±8.8 ms/mmHg to 21.9±9.3 ms/mmHg (p=0.022), respectively. A parallel increase was also observed in SDNN (from 81±44 ms to 96±53 ms, p=0.02), but the other HRV indices showed no significant differences between pre- and post-exercise. Conclusions A single session of mild exercise performed by sedentary young men leads to significant autonomic nervous system improvement, which suggests that even mild physical activity is beneficial for neural cardiac regulation and should be recommended to sedentary healthy subjects. (Circ J 2005; 69: 976 - 980)

View full abstract

Background In order to better define the clinical characterization of pulmonary embolism (PE) in the elderly, the clinical and laboratory findings were compared in older (≥65 years old) and younger (<65 years old) patients. Methods and Results The study group comprised 149 patients (58 older and 91 younger) who received a final diagnosis of PE and were retrospectively evaluated. The severity of PE was assessed by calculating the pulmonary vascular obstruction scores (PVOs) scintigraphically: PVOs ≥50% was defined as severe disease. Dyspnea was the most frequent symptom in both groups. Chest pain and hemoptysis were less frequent in older patients (48.3% vs 79.1%, p=0.001; 6.9% vs 20.9%, p=0.021, respectively) whereas syncope occurred more often in the older group (27.6% vs 9.9%, p=0.005). PVOs ≥50% occurred in 55.1% of older and 32.9% of younger patients (odds ratio: 1.67, 95%confidence interval: 1.118-2.507, p=0.013). Conclusions The clinical presentation of PE can be subtle or atypical in elderly patients and hence they may have more severe disease. Therefore, a high clinical suspicion is required in order to prevent delays in diagnostic work-up and initiation of appropriate treatment. (Circ J 2005; 69: 981 - 986)

View full abstract

Background Enhanced expression of G protein-coupled receptor kinase (GRK) has been reported in failing hearts and in the present study the stability of enhanced GRK mRNA expression, and the correlation between the expression level of GRK mRNA in peripheral lymphocytes and in the heart were both evaluated. Methods and Results Isoproterenol was injected into rats for 2 weeks, and then GRK5 mRNA was assessed by quantitative reverse transcriptase-palymerase chain reaction. An enhanced expression of cardiac GRK5 mRNA was observed even after 4 weeks of recovery. The isoproterenol-induced increased expression of GRK2 and GRK5 mRNA was equally observed in the heart and lymphocytes, and there was a close correlation between the heart and lymphocytes in the level of expression of each GRK mRNA. Conclusions The GRK mRNA level is maintained at a high level for a long period without continuous β-adrenergic receptor stimulation. The level in circulating lymphocytes could be used as a surrogate marker to estimate the level of cardiac GRK expression and, presumably, the β-adrenergic receptor function of cardiomyocytes. (Circ J 2005; 69: 987 - 990)

View full abstract

Background Cardiac function is difficult to evaluate in small animal models of heart disease. The Doppler Tei index is a simple and non-invasive measure that can express global cardiac function even in small animal models of congestive heart failure. However, its ability to predict prognosis has not been evaluated. Methods and Results We tested the hypothesis that cardiac functional indices, such as the Tei index, can predict the prognosis of hamsters with cardiac dysfunction. The Tei index, defined as the sum of the isovolume contraction and relaxation time divided by ejection time, and the percent fractional shortening of the left ventricle was measured in 48 anesthetized male hamsters (19.7±0.4 weeks old) with cardiac dysfunction (UM-X7.1), using Doppler and 2-dimensional echocardiography. The hamsters were separated into 2 groups based on the median Tei index (0.50) and % fractional shortening (FS) (21%). Kaplan-Meier analysis determined the survival rates of the groups. Both the Tei index and %FS enabled significant distinction of better and poorer survival (p<0.01), and the survival curves were less overlapped when the animals were separated according to the Tei index. Conclusion The Tei index can predict prognosis in a small animal model of heart failure. (Circ J 2005; 69: 991 - 993)

View full abstract

A 60 year-old male was referred for treatment of a cardiac myxoma in the right atrium. He had a past history of left atrial cardiac myxoma at age 49 and pituitary microadenoma related to acromegaly at age 55. He did not have a family history of cardiac neoplasm or endocrinopathy. The intracardiac tumor was resected and its pathology was compatible with myxoma. A diagnosis of Carney complex (CNC) was made because the diagnostic criteria of this neoplastic syndrome were satisfied by the presence of recurrent cardiac myxoma, endocrine tumor and spotty skin pigmentation. In genetic analysis novel frame shift mutation was detected in exon 2 in a heterozygous fashion in the causative gene of CNC, protein kinase A regulatory subunit 1 α (PRKAR1A). This genetic mutation is thought to cause haplo-insufficiency of PRKAR1A resulting in tumorigenesis. Although it is the most common, usually benign, cardiac tumor, myxoma can cause a critical clinical situation and thus detecting the PRKAR1A mutation can assist with prognosis. (Circ J 2005; 69: 994 - 995)

View full abstract

A 70-year-old male patient with arrhythmogenic right ventricular dysplasia/cardiomyopathy demonstrating frequent attacks of ventricular tachycardia (VT) as well as heart failure underwent surgical treatment. Although the patient had severe regurgitation at the mitral and tricuspid valves, the contractility of the right and left ventricles was almost maintained. Annuloplasty of both valves abolished the regurgitation and very effectively controlled heart failure. Surgical cryoablation was performed on the lesion showing the earliest potential before the ORS complex during VT and the arrhythmia was terminated. However, a cardioverter defibrillator was implanted to prevent new VT caused by disease progression. (Circ J 2005; 69: 996 - 999)

View full abstract

A 65-year-old woman with essential thrombocythemia (ET) was admitted to hospital where she was diagnosed as acute myocardial infarction (AMI). Because of abundant thrombus of right coronary arteries, percutaneous transluminal coronary recanalization by administration of urokinase was selected as the reperfusion therapy, resulting in successful revascularization with Thrombolysis in Myocardial Infarction grade III coronary flow. The maximum creatine kinase reached 507 IU/L, and left ventriculography performed at 1 month after initiation of both anticoagulant and antiplatelet therapies revealed reduced motion in the inferior wall with an ejection fraction of 57%. Despite good recovery of left ventricular function, bleeding complications, such as epistaxis or ecchymoma, which did not require blood transfusion, occurred during the clinical course. Because ET causes not only thrombus formation but also bleeding tendency, it is very important to carefully follow-up any clotting abnormality in AMI patients with ET. (Circ J 2005; 69: 1000 -1002)

View full abstract

This case report describes a patient with the permanent form of junctional reciprocating tachycardia coexisting with atrial tachycardia. A detailed electrophysiological study established the diagnosis, and radiofrequency catheter ablation abolished both arrythmias. (Circ J 2005; 69: 1003 - 1006)

View full abstract

Wrong:Table 1
Right:Table 1

View full abstract