Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 70 , Issue 12
Showing 1-27 articles out of 27 articles from the selected issue
Clinical Investigation
  • Differences in Gender and Age
    Jun Shiraishi, Yoshio Kohno, Takahisa Sawada, Shinya Nishizawa, Masaya ...
    2006 Volume 70 Issue 12 Pages 1525-1530
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background It remains uncertain whether obesity is an independent risk factor for coronary heart disease in young adults, as well as adults, in Japan. Methods and Results In the present study, 1,260 cases of acute myocardial infarction (AMI) and 3,775 community controls were recruited from the AMI-Kyoto Multi-Center Risk Study and Kyoto Citizen's Health and Nutrition Study, respectively. Obesity and other risk factors were retrospectively examined between cases and controls in each subgroup of young males (20-40 years), middle-aged males or females (40-60 years), older males or females (60-80 years), and very old males or females (80-100 years). In young, middle-aged, and older males, as well as in older females, cases had a higher body mass index (BMI) than controls. In young males, as well as in middle-aged and older females, cases had a higher prevalence of smoking than controls. Except for very old males, the prevalences of hypercholesterolemia, hypertension, and diabetes mellitus were higher in each subgroup of cases than in controls. Multivariate logistic regression analysis revealed that obesity (BMI ≥25) was an independent risk for AMI in young and middle-aged males, but not in females, whereas smoking was an independent risk for AMI in middle-aged and older females as well as in older males. Conclusions Obesity is significantly associated with AMI, independent of the classic coronary risk factors, in young and middle-aged males. These findings support the current emphasis on controlling obesity to prevent coronary events in young Japanese male adults. (Circ J 2006; 70: 1525 - 1530)
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  • Takatoshi Kasai, Katsumi Miyauchi, Takeshi Kurata, Hiroshi Ohta, Shiny ...
    2006 Volume 70 Issue 12 Pages 1531-1537
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background The prevalence of metabolic syndrome (MS), regarded as an important risk factor for coronary artery disease, is growing. However, the relationship between MS and long-term outcomes after percutaneous coronary intervention (PCI) in the Japanese patient population remains unknown. Methods and Results Seven-hundred and forty-eight consecutive patients who underwent PCI were assessed. Patients were categorized by the presence or absence of MS using the NCEP-ATPIII definition (for obesity, a body mass index ≥25 kg/m2 was used). Kaplan-Meier estimation and Cox proportional hazards model were used for unadjusted and adjusted analyses for all cause mortality and cardiac events. The progress of 318 (42.5%) patients with MS and 430 (57.5%) patients without MS was analyzed. The mean follow-up was 12.0±3.6 years. Overall, there were 88 (11.8%) deaths from all causes, and there were no significant differences between the 2 groups. The occurrence of cardiac events was significantly higher in the MS group than that in the no MS group (25.5% vs 15.6%, hazard ratio 2.23; 95% confidence interval 1.59-3.11; p<0.001). Conclusions The presence of MS significantly increased the risks of subsequent cardiac events among patients who underwent PCI. (Circ J 2006; 70: 1531 - 1537)
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  • Ali A. Youssef, Chiung-Jen Wu, Chi-Ling Hang, Cheng-I Cheng, Cheng-Hsu ...
    2006 Volume 70 Issue 12 Pages 1538-1542
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background The present study tested the hypothesis that when administered in conjunction with a PercuSurge device for treatment of acute myocardial infarction (AMI), intracoronary (IC) administration of nitroprusside (NTP) is safe and superior to IC administration of NTP alone or nitroglycerin (NTG) for reversing slow-flow or no-reflow, both of which occur frequently during primary percutaneous coronary intervention (PCI). Methods and Results Sixty-two patients with ST-segment elevation AMI of <12 h duration undergoing primary PCI were enrolled. When the final Thrombolysis In Myocardial Infarction (TIMI) flow was normal (TIMI-3), NTG 200 μg was administered first, followed by (5 min later) NTP 100 μg via an intra-guiding catheter. When final TIMI flow was ≤2, NTG 200 μg was given, followed by NTP 100 μg via an export suction catheter advanced into the infract-related artery (IRA). Primary endpoint was epicardial blood flow (TIMI-flow), corrected TIMI frame counts, or microvascular circulation [myocardial blush (MB) grade]. Analytical results indicated that the final TIMI-3 flow was significantly higher in patients receiving NTP than in those receiving NTG therapy (100% vs 88.7%, p=0.023). As compared with NTG, NTP therapy significantly improved final MB grade (p<0.0001) and corrected TIMI flame count time (p<0.0001). Subgroup analysis demonstrated that final MB grade (p<0.001) and corrected TIMI flame count time (p<0.01) were significantly higher in patients (n=33) with than in patients (n=29) without the PercuSurge. No significant NTP related adverse events occurred, apart from insignificant transient hypotension. Conclusion IC administration of NTP is safe and superior to NTG for improving final epicardial blood flow and microvascular circulation in patients with AMI undergoing primary PCI. Combination therapy of PercuSurge device and NTP provided an additional benefit to NTP alone for improving microvascular circulation. (Circ J 2006; 70: 1538 - 1542)
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  • Longitudinal Observation in a Rural Community
    Hiroaki Kitaoka, Toru Kubo, Makoto Okawa, Nobuhiko Hitomi, Takashi Fur ...
    2006 Volume 70 Issue 12 Pages 1543-1549
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background The purpose of the present study was to assess the clinical long-term course of hypertrophic cardiomyopathy (HCM) in a rural Japanese cohort. Methods and Results A total of 137 consecutive HCM patients (mean age at diagnosis: 52±13 years) were enrolled. During a follow-up period of 11.4±5.7 years, 28 patients died of HCM-related causes. Eleven patients died suddenly, 10 died of progressive heart failure, 6 died of stroke associated with atrial fibrillation and 1 died of a postoperative complication of alcohol septal ablation. For the overall study group, 5-, 10- and 15-year cumulative survival rates were 91%, 88% and 79%, respectively. Although sudden death was the predominant cause of HCM-related death during the follow-up period of <10 years, heart failure death increased after follow-up period of >10 years. Fifteen (13%) of 114 patients who had follow-up echocardiography became `end-stage' HCM and 8 patients died of severe and refractory heart failure. They already showed minimally dilated left ventricular (LV) dimension and lower LV fractional shortening at initial evaluation. Conclusions Although HCM patients in a Japanese rural community showed relatively benign clinical course (the same as cohorts in the developed world), heart failure death because of LV remodeling became equally important to sudden death when they were followed for more than 10 years. (Circ J 2006; 70: 1543 - 1549)
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  • A Single-Center, Prospective, and Randomized Study
    Josef Veselka, Radka Duchonová, Jana Páleníckova, ...
    2006 Volume 70 Issue 12 Pages 1550-1552
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background The impact of ethanol dose on the long-term outcome of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy was investigated. Methods and Results Fifty-four patients (age 24-82 years; 65% women) undergoing ASA were randomized into 2 groups according to the dose of injected ethanol: Group A 1-2 ml, Group B >2 ml. Clinical and echocardiographic data were obtained at baseline and during follow-up. The volume of ethanol injected was 1.50±0.4 and 2.60±0.6 ml (p<0.001) with a subsequent peak of creatine kinase-MB of 2.25±1.00 and 2.62±1.57 μkat/L (p=0.02) in Groups A and B, respectively. The median follow-up was 39 (range 6-72) months after ASA, during which 1 patient died and 1 repeat procedure was necessary in both groups of patients. Both groups had a significant and similar improvement in outflow pressure gradient, dyspnea (New York Heart Association functional class) and angina pectoris (Canadian Cardiovascular Society class) (p<0.001). There was a significant decrease in the left ventricular ejection fraction (LVEF) in Group B (81±7 vs 75±7%; p=0.002), but not in Group A (80±7 vs 79±7%; p=0.67). Thinning of the basal septum was more pronounced in Group B than in Group A (9.3±5.7 vs 6.6±3.4 mm; p=0.04). Conclusions A lower dose of ethanol injected into the target septal branch reduces both the size of necrosis and subsequent thinning of the basal septum, and preserves LVEF during long-term follow-up. Moreover, the low dose (1-2 ml) is as safe and as hemodynamically efficacious as higher doses. (Circ J 2006; 70: 1550 - 1552)
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  • Kosuke Tsukamoto, Akitoshi Ohara
    2006 Volume 70 Issue 12 Pages 1553-1556
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Sleep apnea is an important risk factor for cardiovascular diseases, but whether the severity of sleep-disordered breathing (SDB) changes in the acute phase of myocardial infarction (MI) has not been well determined, nor has it been determined what type of SDB, central or obstructive, (CSA or OSA) is exacerbated. Methods and Results Polysomnography was performed in patients with acute phase of MI during the acute (days 3-5) and chronic (day 14) phases. On the same day, the ventilatory equivalent (VE)/carbon dioxide production (VCO2) slope, urinary catecholamines secretion and arterial carbon dioxide tension were assessed before sleep. The apnea/hypopnea index was significantly decreased in the chronic phase (13.26±11.30 vs 6.97±5.67, p<0.05). The distribution of the types of SDB was unchanged, indicating both CSA and OSA can be exacerbated in the acute phase of MI. The VE/VCO2 slope and arterial carbon dioxide tension before sleep were also unchanged. Urinary norepinephrine secretion was slightly decreased, although the difference was not significant. Conclusions SDB is temporarily worsened in the acute phase of AMI and both CSA and OSA are worsened in AMI. (Circ J 2006; 70: 1553 - 1556)
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  • Tomohiro Nakamura, Hiroshi Funayama, Norifumi Kubo, Takanori Yasu, Mas ...
    2006 Volume 70 Issue 12 Pages 1557-1562
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Adiponectin, which is a collagen-like plasma protein produced by adipose tissue, has anti-atherogenic and anti-inflammatory effects. Plasma adiponectin levels in patients with congestive heart failure (CHF) were determined, as well as relationships between the plasma levels of adiponectin and other hormones. Methods and Results The study group comprised 90 patients with CHF and 20 control subjects, who were divided into 4 subgroups according to New York Heart Association (NYHA) functional class. Plasma levels of adiponectin, tumor necrosis factor (TNF)-α and brain natriuretic peptide (BNP) and cardiac hemodynamics were determined. Plasma adiponectin levels were significantly increased according to the severity of NYHA class in the patients with CHF; control: 6.2±1.0; NYHA I: 8.5±1.9, NYHA II: 12.0±2.2, NYHA III: 13.0±2.7, NYHA IV: 14.9±2.7 μg/ml (p=0.0008). Similarly, plasma BNP levels were significantly increased in accordance with the NYHA class. Plasma adiponectin levels correlated positively with BNP (r=0.40, p=0.0002) and TNF-α (r=0.49, p=0.0001), and correlated negatively with cardiac index (r=-0.27, p=0.05). In 24 of 46 patients in the NYHA III and IV subgroups, according to the prompt improvement in cardiac function, levels of both plasma adiponectin and BNP were significantly reduced (p<0.0001). Conclusion Plasma adiponectin levels increased according to the severity of CHF and, moreover, they correlated with the plasma levels of BNP and TNF-α. These results indicate that augmented release of adiponectin is involved in the pathogenesis of CHF and further study is needed to elucidate its exact role. (Circ J 2006; 70: 1557 - 1562)
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  • Hiroyasu Takano, Hitoshi Adachi, Shigeru Ohshima, Koichi Taniguchi, Ma ...
    2006 Volume 70 Issue 12 Pages 1563-1567
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Functional mitral regurgitation (MR) is common in patients with chronic heart failure (CHF) and left ventricular dysfunction. The severity of CHF is expressed in terms of exercise tolerance, so MR during exercise would affect the severity of heart failure. However, it is not well known how much MR increases during exercise, or if it is related with severity of heart failure. Methods and Results Seventeen subjects underwent dynamic cycle exercise at steady-state levels of 80% and 150% of anaerobic threshold (AT). During each exercise level, the MR jet and left atrial (LA) area were measured, and the degree of MR was expressed as the ratio (MR/LA). The MR/LA increased slightly at 80% AT (rest: 15.5±7.8%, 80% AT: 21.7±9.3%, p<0.05). It increased more at 150% AT (29.2±11.6%, p<0.01). The MR/LA at both 80% and 150% AT weakly correlated with peak oxygen consumption/heart rate (r=-0.509). They showed a weakly positive correlation with the ventilatoly equivalent/CO2 production slope (r=0.340). Conclusions MR during exercise increases as stroke volume worsens during exercise, so evaluation of MR during exercise is important in the management of patients with CHF. (Circ J 2006; 70: 1563 - 1567)
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  • A Prospective Study
    Hitoshi Otsubo, Teruhisa Yoshida, Tatsuro Hiraki, Tomohito Inage, Mana ...
    2006 Volume 70 Issue 12 Pages 1568-1573
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background In a retrospective study portable-type signal-averaged electrocardiography (SAECG) with dipyridamole stress was found to identify patients with coronary artery disease (CAD) at their bedside with high sensitivity and specificity, so the utility of this method was prospectively investigated in the present study. Methods and Results Standard 12-lead QRS wave SAECG was performed before and after dipyridamole stress at the bedside in 71 patients with chest pain (43 males, mean age 63 ±9 years). The filtered QRS duration (fQRSd) before and after dipyridamole stress was determined by multiphasic oscillation method for each of the standard 12 leads, and the maximal value of changes in fQRSd (MAX ΔfQRSd) among the 12 leads was determined. The positive test was defined as MAX ΔfQRSd ≥5 ms, and negative as MAX ΔfQRSd <5 ms based on the previous study. Selective coronary arteriography was performed next. In the positive group (n=31), 25 patients had significant stenosis of the coronary artery and 6 did not. In the negative group (n=40), 5 patients had significant stenosis and 35 did not. The sensitivity, specificity, positive predictive accuracy and negative predictive accuracy for CAD detection by SAECG was 83%, 85%, 81% and 88%, respectively. Conclusions Dipyridamole-stress portable SAECG is useful for detecting CAD at the patient's bedside with high sensitivity and specificity. (Circ J 2006; 70: 1568 - 1573)
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  • Takeshi Yamada, Ichiro Watanabe, Yasuo Okumura, Yasuhiro Takagi, Kimie ...
    2006 Volume 70 Issue 12 Pages 1574-1579
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation. Methods and Results In 15 patients with BS and Brugada-type electrocardiogram (ECG) (14 men, 1 woman; age 52.8±12.9 years) and 15 age-matched control patients (12 men, 3 women; age 50.9±18.9 years), the P-wave signal-averaged ECG was recorded, and the filtered P-wave duration was derived from the vector magnitude obtained by X, Y, Z leads. In 11 of the 15 patients with BS and Brugada-type ECG, invasive electrophysiologic testing was conducted. Filtered P-wave duration was significantly increased in patients with BS and Brugada-type ECG in comparison with control subjects (143.2±12.9 vs 129.6±10.1 ms, p<0.001). Ventricular late potential (root mean square voltage <20 μV in the last 40 ms and <40 μV at a low amplitude signal duration >38 ms) was present in 10 of the 12 BS patients in whom a QRS wave signal-averaged electrogram was also recorded. In all 11 patients with Brugada-type ECG who underwent electrophysiologic testing, sustained atrial fibrillation (>5 min) was induced by 1 or 2 atrial extrastimuli. In 10 of these 11 patients, ventricular fibrillation was also induced by 2 or 3 right ventricular extrastimuli. Conclusions The electrical abnormality in BS is not limited to the ventricular level; similar changes occur in the atria. Such abnormal conduction properties could be a substrate for re-entrant atrial tachyarrhythmias. (Circ J 2006; 70: 1574 - 1579)
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  • Yoshitaka Sakai, Shinobu Imai, Yuichi Sato, Hiroshi Yagi, Toshio Kushi ...
    2006 Volume 70 Issue 12 Pages 1580-1584
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Although coexistence of atrioventricular conduction disturbances with sick sinus syndrome (SSS), so-called binodal disease (BND), is a frequently encountered disorder, its clinical significance and electrophysiological characteristics remain unknown. Methods and Results One hundred and seven patients with SSS were divided into BND (n=30) and N-BND groups (n=77). Sinus cycle length, sinus node recovery time (SRT), sino-atrial conduction time (SACT), the number of isolated sinus node electrograms, atrio-His (AH) interval, His-ventricular (HV) interval, intra-atrial conduction time (PA intervals) and QRS width were measured. In addition, the prevalence of bundle-branch block was obtained. The parameters of sino-atrial and intra-atrial conduction were significantly longer in the BND group: SRT (5,070±2,628 vs 3,122±1,856 ms, p<0.05), SACT (115±30 vs 87±21 ms, p<0.05), PA intervals (56±13 vs 41±8 ms, p<0.05). The BND group was more likely to have atrial fibrillation than the N-BND group (83.3% vs 53.2%, p<0.01). HV interval, QRS width and the prevalence of associated bundle-branch block did not differ between the 2 groups. Conclusion BND patients not only had sino-atrial and atrioventricular node dysfunction, but also widespread atrial conduction disturbances. Thus, in the clinical setting BND should be categorized as severe SSS. (Circ J 2006; 70: 1580 - 1584)
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  • Naoya Matsumoto, Yuichi Sato, Yasuyuki Suzuki, Shunichi Yoda, Taeko Ku ...
    2006 Volume 70 Issue 12 Pages 1585-1589
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background The clinical usefulness of a rapid rest low-dose/stress high-dose (dose ratio =1:5) 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) protocol for the detection of coronary artery disease was evaluated. Methods and Results In 89 patients, rest images were obtained immediately after the injection of 99mTc-sestamibi (256.1±28.4 MBq) followed by drinking water (400 ml). Exercise or vasodilator stress test was performed immediately after the completion of rest imaging with the injection of 99mTc-sestamibi (1312.3 ±167.6 MBq). Prior to the post-stress imaging, patients were asked again to drink water (400 ml) in order to eliminate subdiaphragmatic tracer activity. The myocardial count ratio (stress/rest) of 99mTc-sestamibi was calculated. Image quality was scored using a 4-point scale system (4= excellent, 3= good, 2= poor, 1= unacceptable). Coronary angiography was performed in 56 patients within 1 month of the SPECT scan. All patients successfully performed the protocol and total examination time was 108±7 min. The myocardial count ratio of 99mTc-sestamibi was always greater than 6. The image quality was satisfactory both at rest (3.4±0.9) and after stress (3.9±0.2). The sensitivity and specificity to detect coronary artery stenosis >50% was 84% and 97%, respectively. Conclusions This rapid one-day 99mTc-sestamibi protocol provides adequate image quality and diagnostic accuracy for detecting coronary artery disease. (Circ J 2006; 70: 1585 - 1589)
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  • Dong Il Shin, Yoo Dong Won, Kiyuk Chang, Woo Seung, Pum Joon Kim, Yun ...
    2006 Volume 70 Issue 12 Pages 1590-1597
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background The study objective was to assess the efficacy of 16-slice multidetector row computed tomography (MDCT) in estimating residual stenosis and successful reperfusion after thrombolysis in patients with ST-elevation myocardial infarction (STEMI). Methods and Results A total of 31 patients with STEMI underwent MDCT scanning within 6 h (mean 4.6±1.1) after thrombolysis and the results for detection of significant residual stenosis and distal flow of the infarct-related artery were compared with those from conventional coronary angiography (CCAG) performed within 24 h (mean 12.1±5.6) after the MDCT scan. Successful reperfusion was defined as Thrombolysis In Myocardial Infarction flow 2 or 3 on CCAG and full contrast enhancement of the distal artery landmarks on MDCT. A final analysis was performed using 24 patients (312 segments). MDCT had a positive predictive value of 73.3% and a negative predictive value of 95.1% for detecting significant residual stenosis. It accurately estimated 17 of 18 patients (94.4%) with successful reperfusion and 5 of 6 (83.3%) with failed reperfusion on the basis of comparison with CCAG. Conclusions MDCT demonstrated high accuracy not only for the detecting residual stenosis, but also for assessing successful reperfusion after thrombolytic therapy in patients with STEMI. (Circ J 2006; 70: 1590 -1597)
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  • Hiroshi Hazui, Masayoshi Nishimoto, Masaaki Hoshiga, Nobuyuki Negoro, ...
    2006 Volume 70 Issue 12 Pages 1598-1601
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Previous reports indicate that D-dimer testing (DT) for acute aortic dissection (AAD) has a sensitivity of 100%, but each study comprised less than 30 patients. The aim of this study was to evaluate the positive rate and factors related to the results of DT for AAD in a larger population. Methods and Results DT (cutoff; upper normal limit) was performed for 113 consecutive AAD patients within 24 h of symptom onset. In total, 104 (92%) patients exhibited positive DT. The positive rate of DT showed a low tendency in patients aged less than 70 years and for a time interval from symptom onset to admission within 120 min, and there were significant differences between those with and without a thrombosed false lumen (TFL) (86.4% (n=59) vs 98.1% (n=54), p=0.033), complete TFL (excluding patients with ulcer-like projection (ULP) from those with a TFL) (81.1% (n=37) vs 97.4% (n=76), p=0.005) and length score (1 (n=28); 78.6%, 2 (n=40); 95.0%, 3 (n=45); 97.8%, p=0.005). Multivariate analysis demonstrated age (odds ratio =1.164, p=0.013), complete TFL (0.048, 0.030) and length score (6.271, 0.033) as independent factors. Conclusions Physicians should be aware that younger patients with short dissection length and a TFL without ULP are liable to have false-negative DT results. (Circ J 2006; 70: 1598 - 1601)
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  • Yu-Hua Sun, Yue-Jin Yang, Wei-Dong Pei, Yong-Jian Wu, Run-Lin Gao
    2006 Volume 70 Issue 12 Pages 1602-1605
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Traditional contrast coronary arteriography affords only an indirect view of aspects of atheromata related to their propensity to trigger thromboses, so it is urgent to recognize the vulnerable person who is more likely to develop myocardial infarction (MI) among patients with visible lesion or stenosis in coronary artery. Methods and Results Two hundred and eighty-eight patients (144 MI patients, 144 controls) who had either a visible lesion or differing extent of stenosis in 1 or more major coronary arteries were consecutively enrolled. Lipid profile, C-reactive protein (CRP), smoking, hypertension, dyslipidemia and diabetes were analyzed for their association with MI. No differences in the prevalence of dyslipidemia, hypertension or diabetes was found between the patients with MI and those without, and CRP, triglycerides, total cholesterol and low-density lipoprotein-cholesterol levels did not differ between the 2 groups (all p>0.05). However, high-density lipoprotein-cholesterol (HDL-C) was significantly lower in the patients with MI than in those without (1.06±0.30 vs 1.14±0.32 mmol/L, p=0.024). On multivariate analysis after adjustment for age and gender, adjusted odds ratio (95% confidence interval) of MI was 0.44 (0.20-0.96) for HDL-C, p=0.038; 2.6 (1.48-4.56, p=0.001) for smoking, which indicated that high HDL-C was protective for MI, and smoking was associated with an increased risk of MI. Conclusions The present findings indicate that among subjects with a visible lesion or stenosis in coronary arteries, those with low HDL-C or smokers are more likely to develop MI. (Circ J 2006; 70: 1602 - 1605)
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  • Wei-Dong Pei, Yan-Hong Zhang, Yu-Hua Sun, Yu-Chun Gu, Yan-Fen Wang, Ch ...
    2006 Volume 70 Issue 12 Pages 1606-1610
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Apolipoprotein E (apoE) polymorphism is associated with changes in the lipoprotein profile of individuals with familial combined hyperlipidemia (FCHL), but its effects on the lipoprotein profiles of members of Chinese families with FCHL remain uncertain. Methods and Results 43 FCHL families (n=449) and 9 normolipidemic families (n=73) were recruited to assess the influence of apoE polymorphism on plasma lipids. The relative frequency of the ε4 allele in affected and unaffected FCHL relatives, spouses and normolipidemic members was 13.8%, 5.3%, 9.1% and 6.8%, respectively, with a significantly higher frequency in affected FCHL relatives, compared with unaffected FCHL relatives or normolipidemic members (p=0.0002 or p=0.029). In FCHL relatives, the apoE4 subset (E4/4 and E4/3) exhibited significantly higher levels of apoB, total cholesterol and low-density lipoprotein-cholesterol (LDL-C) than did the apoE3 (E3/3) subset, especially in women (all p<0.05), and there was significant elevation of LDL-C concentrations in men only (p<0.05). In men, the apoE2 (E3/2) subset indicated a decreased level of apoB and increased apoA1 compared with those in the apoE3 subset (p<0.05). Conclusions ApoE polymorphism appears to be associated with variance of the lipoprotein phenotype in Chinese families with FCHL. (Circ J 2006; 70: 1606 - 1610)
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  • Jen Te Hsu, Chi Ming Chu, Shih Tai Chang, Hui Wen Cheng, Nye Jan Cheng ...
    2006 Volume 70 Issue 12 Pages 1611-1616
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background This study investigated the utility of the alveolar - arterial oxygen pressure difference (AaDO 2) in predicting the short-term prognosis of acute pulmonary embolism (PE). Methods and Results This study retrospectively enrolled 114 consecutive patients with acute PE, diagnosed by either spiral computed tomography or high probability ventilation - perfusion lung scans. During the first 24 h of admission, all patients had initial artery blood gas collected under room air. Patient exclusion criteria were chronic lung disease, septic emboli, and moderate and low probability lung scans. Patients were assigned to 2 groups based on either 30-day death or a 30-day composite event. Receiver operating characteristic analyses was used to determine the AaDO2 cut-off value for predicting primary and composite endpoints. Statistical analysis demonstrated significant differences in AaDO2 between the 30-day composite endpoint group and the 30-day composite event-free survival group (p=0.012). The AaDO2 had a strong trend between the 30-day death group and the survival group (p=0.062). The best cut-off value for AaDO2 was 53 mmHg and using this, the positive predictive value for 30-day death was 25% and the negative predictive value was 92%. For the 30-day composite endpoint, the positive predictive value for AaDO2 was 35%, and the negative predictive value was 84%. In this study, thrombocytopenia was also an indicator of poor prognosis for patients with acute PE. Conclusion The AaDO2 measurement is a highly useful and simple measurement for predicting short-term prognosis in patients with acute PE. It has high negative predictive value and moderate positive predictive value for 30-day death and 30-day composite event. Aggressive thrombolytic treatment strategies should be considered for patients with an initial poor prognostic parameter (ie, AaDO2 ≥53 mmHg). (Circ J 2006; 70: 1611 - 1616)
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  • Rationale and Design of Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD)
    Hiroyuki Tsutsui, Miyuki Tsuchihashi-Makaya, Shintaro Kinugawa, Daisuk ...
    2006 Volume 70 Issue 12 Pages 1617-1623
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Heart failure (HF), defined as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood, is a leading cause of mortality and hospitalization for adults older than 65 years in the industrialized countries. The characteristics and outcome of patients with HF have been described by several epidemiological studies and large scale clinical trials, performed mainly in the United States and Europe. Very little information is available on this issue in Japan. Methods and Results The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is designed to prospectively study the characteristics, treatment, and outcomes of a broad sample of patients hospitalized with HF at teaching hospitals throughout Japan between January 2004 to June 2005 and the outcomes, including death and hospital readmission, will be followed through 2006 (mean follow-up at least 1 year). Participating cardiologists identify patients admitted for worsening of HF symptoms. Demographics, medical history, severity, treatment, and outcome data are collected and entered into a database via secure web browser technology. As of June 2005, baseline data for 2,676 patients with HF have been registered from 164 participating hospitals. Conclusions The JCARE-CARD will provide important insights into the management of patients with HF in routine clinical practice in Japan, thus providing the framework for improved management strategies for these patients. (Circ J 2006; 70: 1617 - 1623)
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  • Rationale and Design
    Katsumi Miyauchi, Takeshi Kimura, Takeshi Morimoto, Yoshihisa Nakagawa ...
    2006 Volume 70 Issue 12 Pages 1624-1628
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Many trials have shown that 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors reduce the incidence of cardiovascular events and mortality. One method of decreasing the incidence of cardiovascular events could be to reduce the progression of coronary atherosclerosis, and a recent study found that atorvastatin can cause coronary plaque to regress. To generalize this finding, using conventional HMG-CoA reductase inhibitors at many Japanese centers, randomized trials of pitavastatin and atorvastatin will be conducted with patients with acute coronary syndrome (ACS). Methods and Results Patients with ACS who have undergone successful percutaneous coronary intervention under intravascular ultrasound guidance will be studied. They will be randomly allocated to pitavastatin or atorvastatin groups and followed up for 8-12 months. The primary endpoint will be the percent change in coronary plaque volume, and secondary endpoints will include absolute changes in coronary plaque volume, serum lipid levels and inflammatory markers. The safety profile will also be evaluated. Conclusions This study will examine the ability of HMG-CoA reductase inhibitors to regress coronary plaque in Japanese patients with ACS and the findings should help to improve the prognosis of such patients and clarify the involved mechanisms. (Circ J 2006; 70: 1624 - 1628)
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  • Yoshihiro Seo, Shigeyuki Watanabe, Tomoko Ishizu, Naoko Moriyama, Nori ...
    2006 Volume 70 Issue 12 Pages 1629-1634
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Carotid arterial ultrasound examination may be helpful for screening populations at high risk for acute coronary syndrome (ACS), so the present study was designed to identify the carotid arterial characteristics of patients with ACS. Methods and Results Carotid ultrasound examinations were performed in 172 patients with ACS, 166 patients with stable coronary artery disease (CAD), and 96 control subjects. Common carotid arterial structures were assessed by the intima - media thickness (IMT), interadventitial diameter (IAD), lumen diameter (LD), the IMT to LD ratio (IMT/LD), and the plaque burden based on the plaque score. Plaque morphology was assessed by the echogenecity based on the gray-scale median (GSM). IMT, IAD, IMT/LD, and plaque score did not differ between the ACS and stable CAD groups. The GSM in the ACS group was lower (47.5±25.3, p<0.001) than in the control (70.1±22.5) and stable CAD (73.7±23.4) groups. Multiple logistic regression analysis showed that the presence of carotid echolucent plaques (GSM ≤60) was an independent predictor of ACS. Conclusions Echolucent carotid plaques were strongly associated with ACS and may be a surrogate marker of high-risk patients. (Circ J 2006; 70: 1629 - 1634)
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Experimental Investigation
  • Takatoshi Sato, Hiroshi Suzuki, Masayuki Shibata, Taro Kusuyama, Yasut ...
    2006 Volume 70 Issue 12 Pages 1635-1642
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Tumor necrosis factor (TNF)-α is linked to the pathogenesis of cardiovascular diseases, but how it affects myocardial infarction (MI), so the present study examined the effects of TNF-α and the involvement of intercellular adhesion molecule (ICAM)-1 on MI. Methods and Results Left coronary arteries of C57BL/6 wild type (WT) and TNF-α knockout (KO) mice were ligated and the mice were killed 1, 3, and 7 days later. Fractional shortening on echocardiography of the KO mice was significantly higher than that of the WT mice from day 1 to 7 (p<0.01). The ICAM-1 mRNA in the infarcted area of the KO mice was significantly lower than that of the WT from day 1 (p<0.01) to 7. In immunohistochemistry, the expression of ICAM-1 was weaker in the KO than in the WT mice. The number of neutrophils in the KO mice peaked at day 1, but even this peak level failed to reach the levels in the infarcted (p<0.01) and peri-infarcted areas (p<0.05) in the WT. The number of macrophages in the KO mice peaked at day 7, but this peak level failed to reach the levels in the infarcted (p<0.01) and peri-infarcted areas (p<0.05) in the WT. Conclusion In a permanent occlusion model of MI TNF-α decreased cardiac function and ameliorated myocardial remodeling through the induction of ICAM-1. (Circ J 2006; 70: 1635 - 1642)
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  • Akira Matsuki, Akihiko Igawa, Takashi Nozawa, Teruo Nakadate, Norio Ig ...
    2006 Volume 70 Issue 12 Pages 1643-1649
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Three-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are known to attenuate myocardial ischemia-reperfusion (IR) injury. Fluvastatin (FV) has a potent free radical scavenging action, but it is unclear whether the timing of FV administration could affect its cardioprotective effect or if the antioxidant property of FV might attenuate IR injury. Methods and Results IR was induced in rats by left coronary artery occlusion for 30 min followed by 24-h reperfusion. The rats were divided into 4 groups: oral FV group (10 mg/kg per day for 2 weeks before ischemia); iv, FV group (10 mg/kg) before ischemia; iv, FV group (10 mg/kg) before reperfusion; and control group. Oxidative stress was evaluated by myocardial 8-hydroxydeoxyguanosine (8-OHdG) content. The area at risk did not different among the 4 groups. Pretreatment with FV for 2 weeks significantly reduced the infarct size by 28% as compared with the control group, but FV administered just before ischemia or reperfusion did not. Myocardial 8-OHdG content was not affected by FV. The infarct-sparing effect of FV was completely abolished by Nω-nitro-l-arginine methyl ester or wortmannin. Conclusions The present results indicate that pretreatment with FV, but not just before ischemia or reperfusion, attenuates IR injury primarily through the nitric oxide pathway, not through its antioxidant property. (Circ J 2006; 70: 1643 - 1649)
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  • Chuanjiang Lu, Shinya Minatoguchi, Masazumi Arai, Ningyuan Wang, Xue-H ...
    2006 Volume 70 Issue 12 Pages 1650-1654
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background Nicorandil has been reported to induce cardioprotection by opening the mitochondrial KATP channels. However, whether nicorandil affects reactive oxygen species is unclear. Methods and Results The hearts of male Sprague-Dawley rats were excised and perfused on a Langendorff apparatus with Krebs-Henseleit solution with a gas mixture of 95% O2 and 5% CO2. 1 mmol/L of nicorandil was given 10 min before ischemia. Left ventricular developed pressure (LVDP, mmHg), ±dP/dt (mmHg/s) and coronary flow (ml/min) were continuously monitored. All hearts were perfused for a total of 120 min consisting of a 30 min pre-ischemic period, followed by a 30 min global ischemia and 60 min reperfusion with and without 5-hydroxydecanoic acid sodium salt (5-HD), a mitochondrial KATP channel blocker. The concentrations of 2,3-dihydroxybenzoic acid (2,3-DHBA), an indicator of hydroxyl radicals, in the perfusate during reperfusion period were also measured. Nicorandil significantly improved LVDP and ±dP/dt, and increased coronary flow during reperfusion. Pretreatment with 5-HD abolished the improvement of LVDP and ±dP/dt, and the increase in coronary flow induced by nicorandil. Nicorandil significantly attenuated the concentrations of 2,3-DHBA during reperfusion, which were restored by 5-HD. Conclusion Nicorandil is protective against post-ischemic left ventricular dysfunction in association with opening the mitochondrial KATP channels, decreasing hydroxyl radicals and increasing coronary flow in the isolated rat heart. (Circ J 2006; 70: 1650 - 1654)
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Case Report
Rapid Communication
  • -Angiographic View-
    Masahiro Jinzaki, Kozo Sato, Yutaka Tanami, Minoru Yamada, Sachio Kuri ...
    2006 Volume 70 Issue 12 Pages 1661-1662
    Published: 2006
    Released: November 25, 2006
    JOURNALS FREE ACCESS
    Background A method of displaying coronary computed tomography (CT) angiography, which enables evaluation of coronary artery disease (CAD) with fewer images and is understandable to the third person, is preferable. Methods and Results A maximum intensity projection image was created in which contrast media in the ventricles is eliminated, enabling an overview of CAD in a single 3-dimensional (D) image that can be rotated to be viewed at various angles and is easily understood by a third person. Conclusions A novel method of displaying coronary CT angiography in a single 3-D image has been developed and we believe it should become available for many workstations. (Circ J 2006; 70: 1661 - 1662)
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Letter to the Editor
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