Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 70 , Issue 10
Showing 1-23 articles out of 23 articles from the selected issue
Review Article
  • Kozo Hirata, Masanobu Kawakami, Michael F O'Rourke
    2006 Volume 70 Issue 10 Pages 1231-1239
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    The pulsatile component of blood pressure (ie, pulse pressure) has received considerable attention as an important risk factor for cardiovascular disease. In particular, central blood pressure measurements in the ascending aorta or in the carotid artery are expected to be more useful than conventional brachial pressure measurements for predicting cardiovascular events because central pressure, not the brachial pressure, is the pressure that target organs encounter. Due to wave reflection, the blood pressure in the upper limb does not represent the central blood pressure; therefore, leading researchers have enthusiastically promoted a noninvasive method of measuring central blood pressure and the resulting aortic stiffness. Until now, there has been an increasing body of evidence to support the accuracy and superiority of central blood pressure measurements as well as the assessment of aortic properties over classical brachial pressure measurements. In this review, the information regarding these "central" indices derived from 2 main methods, namely "pulse wave analysis" and "pulse wave velocity", for the application of central blood pressure measurements and arterial stiffness to clinical study and practice, has been summarized. (Circ J 2006; 70: 1231 - 1239)
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Special Article
  • Yoshiji Yamada
    2006 Volume 70 Issue 10 Pages 1240-1248
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Polymorphisms of GJA4 and CYBA and of PAI1 and MMP3 are associated with myocardial infarction (MI) in men and women, respectively. In addition, several polymorphisms associated with restenosis after percutaneous coronary intervention, coronary artery spasm, or hypertension have been identified. More recently, a large genetic epidemiological study was performed to identify additional gene polymorphisms that confer susceptibility to cardiovascular diseases, stroke, and other complex diseases. Methods and Results The relationship of 202 polymorphisms in 152 candidate genes to MI, hypertension, ischemic or hemorrhagic stroke, metabolic syndrome, type 2 diabetes mellitus, obesity, or in-stent restenosis were examined in 5,000 unrelated Japanese individuals. Of these, 14 polymorphisms related to MI, 8 to atherothrombotic cerebral infarction, 9 to intracerebral hemorrhage, and 10 to subarachnoid hemorrhage were identified. This information was then used to develop risk diagnosis systems to predict the future risk for development of each disease in a given individual. Conclusions Identification of gene polymorphisms that confer susceptibility to cardiovascular diseases or stroke and the development of genetic risk diagnosis systems may contribute to the personalized prevention of these conditions. (Circ J 2006; 70: 1240 - 1248)
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Clinical Investigation
  • NIPPON DATA80 Research Group
    2006 Volume 70 Issue 10 Pages 1249-1255
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Based on the NIPPON DATA80, risk charts for the probability of death from coronary heart disease (CHD), stroke, and all cardiovascular disease (CVD) were constructed by sex and 10-year age groups. Methods and Results The 9,638 participants were followed-up for 19 years from 1980, excluding 28 individuals without the necessary baseline data and 257 participants with past history of stroke or CHD. Final analysis was performed on 9,353 participants (4,098 men, mean age 50.3 years; 5,255 women, mean age 50.8) using a Cox proportional hazards model. Death probabilities over a 10-year period from CHD, stroke, and all CVD were calculated and displayed as color coding on each chart by combining 10-year age, systolic blood pressure, smoking, and serum total cholesterol and glucose levels. Six different colors corresponding to probabilities of death were displayed on each chart. Conclusions The original charts based on the findings from NIPPON DATA80 are suitable for assessing CHD, stroke, and all CVD death risk in the general Japanese population. These charts should be used as a health-education tool for lifestyle modification targeting individuals with CVD risk factors. (Circ J 2006; 70: 1249 - 1255)
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  • The Japanese Coronary Artery Disease (JCAD) Study Investigators
    2006 Volume 70 Issue 10 Pages 1256-1262
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Although the morbidity and mortality of coronary artery disease (CAD) vary widely with race and lifestyle, Japanese CAD patients have been clinically managed according to the guidelines of Western countries. To draft guidelines specifically for Japanese CAD patients, a database that describes how Japanese CAD patients are currently managed and the outcomes of those managements practices is required. Methods and Results Patients diagnosed as having 75% or higher stenosis according to the American Heart Association classification in at least 1 branch of the coronary arteries by cardiac catheterization were enrolled in the study. Of 15,628 patients screened from April 2000 to March 2001, 13,812 of them met the inclusion criteria and were followed up for a mean period of 2.7 years. The incident rate of events was 62.8 per 1,000 patients-year including all-cause mortality of 17.5 and total cardiac events of 47.4 per 1,000 patients-year which is much higher than previous reports in Japan. The incident rate of acute myocardial infarction in this study cohort was 7.5 events per 1,000 patients-year. Conclusion The database provides a large body of information on Japanese CAD patients who have significant coronary atherosclerosis diagnosed by coronary angiography, which will be useful for planning future randomized controlled trials. (Circ J 2006; 70: 1256 - 1262)
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  • Nobutaka Masunaga, Akio Kimura, Masaru Miyataka, Norio Nishioka, Yutak ...
    2006 Volume 70 Issue 10 Pages 1263-1268
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background In Western countries, many studies have shown that among healthy people moderate drinkers have a lower incidence of cardiovascular events than abstainers and heavy drinkers. However, it is not clear whether this is true in patients with a healed myocardial infarction (MI). Methods and Results In the present study cardiovascular events were defined as cardiac events or strokes. Male patients only were included because the incidence of cardiovascular events is low in females. In patients younger than 65 years, the incidence of cardiovascular events was 34.6 persons per year (54 cases: 3.9%) of abstainers, 17.4 persons per year (20 cases: 1.9%) of moderate drinkers (p<0.01 vs abstainers) and 30.3 s persons per year (18 cases: 3.2%) of heavy drinkers. However, in those aged 65 years or older, the incidence was 47.8 persons per year (24 cases: 4.5%) of abstainers, 58.4 persons per year (14 cases: 5.6%) of moderate drinkers, and 314.8 persons per year (12 cases: 19.7%) of heavy drinkers. In this age group, cardiovascular events were significantly higher in heavy drinkers than in the other 2 groups (p<0.01), and the incidence was not lower in the moderate drinkers than in abstainers as shown in the younger group. In patients younger than 65 years with a healed MI, drinking limited less than 30 ml/day (moderate intake) reduces the incidence of cardiovascular events, but not in those aged 65 years or older. (Circ J 2006; 70: 1263 - 1268)
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  • Young Joon Hong, Myung Ho Jeong, Sun Ho Hwang, Nam Sik Yun, Sang Rok L ...
    2006 Volume 70 Issue 10 Pages 1269-1274
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background This study assessed the effects of combination therapy with simvastatin and carvedilol on clinical outcome in patients with left ventricular (LV) dysfunction after acute myocardial infarction (AMI). Methods and Results The study retrospectively analyzed the data from 672 patients with LV dysfunction [LV ejection fraction (LVEF) <40%] complicated with AMI who underwent percutaneous coronary intervention (PCI). The patients were divided into 4 treatment groups: combination group (n=160), simvastatin only group (n=216), carvedilol only group (n=242), neither treatment group (n=54). At 6 months after PCI, the LVEF had improved most significantly in the combination group. During 1-year follow-up, cardiac death occurred most frequently in the neither treatment group compared with the other 3 groups (combination: 4%, simvastatin alone: 7%, carvedilol alone: 8%, neither: 17%, p<0.001 between neither treatment and other 3 groups). The results on major adverse cardiovascular events (MACE) showed that the combination of simvastatin and carvedilol was associated with a relative risk reduction of 53% (p<0.001), treatment with simvastatin alone with a relative risk reduction of 44% (p=0.001), and carvedilol alone with a relative risk reduction of 40% (p=0.003) compared with neither treatment. The independent predictors of 1-year MACE were neither treatment, elevated high sensitivity C-reactive protein (≥0.5 mg/dl), and old age (>70 years). Conclusion Combination therapy with simvastatin and carvedilol had a positive impact on the endpoints of cardiovascular death and MACE and seems to have an additive beneficial effect on these endpoints in patients with LV dysfunction complicated with AMI who underwent PCI. (Circ J 2006; 70: 1269 - 1274)
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  • Mehmet S Ulgen, Onder Ozturk, Mehmet Yazici, Mehmet Kayrak, Sait Alan, ...
    2006 Volume 70 Issue 10 Pages 1275-1279
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Although there have been several association studies of angiotensin II type 1 receptor (AT1R, A/C1166) gene polymorphism in clinical endpoints such as myocardial infarction (MI), hypertension, aortic stiffness, and left ventricular mass, the relationship between AT1R polymorphism and biventricular function in acute anterior MI has not been studied before. Methods and Results The study group comprised 132 consecutive patients who were admitted to the coronary care unit with their first acute anterior MI. Systolic and diastolic diameters, volumes, inflow properties, ejection fraction and myocardial performance index of both ventricles were measured. AT1R polymorphism was determined using polymerase chain reaction amplification. Based on A/C1166 polymorphism of AT1R, the patients were classified into 3 groups: group 1, A/A (n=91) genotype, group 2 A/C (n=28), and group 3 C/C (n=13) genotype. When the left ventricular and right ventricular echocardiographic functions were compared, all parameters of the 3 groups were found to be similar. No difference was detected in either the genotype distribution or allele frequencies between the patients and the controls for AT1R. Conclusions The results suggest that A/C1166 polymorphism of AT1R did not influence the risk of either acute MI or biventricular function after anterior MI. (Circ J 2006; 70: 1275 - 1279)
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  • Kyeong Ho Yun, Myung Ho Jeong, Seok Kyu Oh, Eun Mi Park, Yun Kyung Kim ...
    2006 Volume 70 Issue 10 Pages 1280-1283
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Chest radiography is a routine examination evaluating those patients with chest pain. There are few data about the correlation between aortic knob width, calcification and coronary atherosclerosis. Methods and Results The aortic knob width was measured and the presence of aortic knob calcification was assessed via a chest posteroanterior view in 178 consecutive patients. The aortic knob width and calcification were compared to the risk factor and the extent of coronary artery disease. Patient's age (69.5±7.95 vs 61.1±10.29 years, p=0.010), the prevalence of hypertension (65.9 vs 46.3%, p=0.024) and diabetes (43.2 vs 26.1%, p=0.033), the level of total cholesterol (196.8±63.21 vs 188.6±44.45 mg/dl, p=0.049) and the incidence of multi-vessel disease (65.9 vs 38.1%, p<0.001) were higher in patients with aortic knob calcification than in patients without calcification. The aortic knob width and the prevalence of aortic knob calcification were significantly correlated with the severity of coronary artery disease. Multivariate analysis demonstrated that aortic knob calcification and diabetes were independent factors for multi-vessel disease (p=0.018 and p=0.012). Conclusions The observation of aortic knob on a chest radiograph can provide important predictive information of coronary atherosclerosis. (Circ J 2006; 70: 1280 - 1283)
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  • Myeong-Ho Yoon, Seung-Jea Tahk, So-Yeon Choi, Tae-Young Choi, Byoung-J ...
    2006 Volume 70 Issue 10 Pages 1284-1289
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The use of a distal protection device during primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) may preserve the microvascular integrity of the myocardium. Methods and Results A total of 58 consecutive patients with AMI, who had undergone primary PCI within 24 h after onset, were enrolled (30 patients with the PercuSurge GuardWire ® System, 28 without). The coronary flow velocity reserve was not different between the 2 groups. In patients with a distal protection device, the post-PCI Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMP) were more favorable (TMP 0/1: 13.3%, TMP 2: 23.3%, TMP 3: 63.4% vs TMP 0/1: 35.7%, TMP 2: 35.7%, TMP 3: 28.6%, p=0.023). These patients also exhibited lower basal and hyperemic microvascular resistance index levels (4.33±2.22 vs 5.55±2.36 mmHg · cm-1 · s, p=0.047; 2.39±1.40 vs 3.14±1.36 mmHg · cm-1 · s, p=0.045, respectively), and longer basal diastolic deceleration time (679±273 vs 519±289 ms, p=0.035) after PCI. Conclusion Distal protection with the PercuSurge GuardWire® system may effectively preserve the microvascular integrity of the myocardium during primary PCI in AMI patients. (Circ J 2006; 70: 1284 - 1289)
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  • Yoshihiro Seo, Hiroshi Maeda, Tomoko Ishizu, Toshiyuki Ishimitsu, Shig ...
    2006 Volume 70 Issue 10 Pages 1290-1296
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Wall motion abnormality in the apical legion of the left ventricle (LV) with stagnant flow alone is not sufficient to identify patients at high risk for LV thrombus formation among those with first anterior acute myocardial infarction (AMI). The aim of this study was to identify the determinants of LV thrombus formation using contrast echocardiography. Methods and Results In 75 patients with first anterior AMI, standard and contrast echocardiography was performed to detect LV thrombus. Although LV thrombus was found in 10 patients (13%) using standard echocardiography, it was found in 15 patients (20%) using contrast echocardiography. Apical stagnant flow was observed in 14 patients (93%) with LV thrombus. In addition, patients with LV thrombus had a higher peak C-reactive protein (CRP) concentration (18.2±4.3 vs 7.9±5.5 mg/dl, p<0.0001). In multivariate analysis, only peak CRP concentration was identified as an independent predictor of LV thrombus (p=0.02, odds ratio: 1.400, confidence interval: 1.040-1.884). The receiver-operating characteristics (ROC) analysis revealed the best cutoff value of a peak CRP concentration >10.7 mg/dl to identify patients with LV thrombus (sensivity 0.93, specificity 0.75, area under ROC curve 0.91). Conclusions The peak CRP concentration is a useful marker of patients with first anterior AMI who are at high risk for LV thrombus. (Circ J 2006; 70: 1290 - 1296)
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  • Kenichi Nakashiki, Akira Kisanuki, Yutaka Otsuji, Shiro Yoshifuku, Tos ...
    2006 Volume 70 Issue 10 Pages 1297-1302
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The feasibility of a novel ultrasound probe, which can be attached to the left ventricular (LV) apex chest wall and allows free rotation around its long axis direction for the continuous monitoring of LV wall motion, was tested. Methods and Results There were 36 subjects who had coronary artery disease (CAD). By attaching a novel ultrasound probe to the chest wall, the LV apical views were recorded during treadmill exercise stress echocardiography (Echo). The continuous monitoring of LV wall motion was satisfactorily feasible in 30 of 36 patients. The visualization rate of the overall LV segments was higher at rest (90%) compared to that during peak exercise (77%). The segments were better visualized in apical portions (90-100%) than in mid (77-96%) or basal portions (68-87%). The sensitivity, specificity, and accuracy for detecting CAD were 61, 100 and 77%, respectively. The wall motion score index 3 and 6 min after exercise decreased significantly compared to those at peak exercise. The number of segments with dyssynergy was highest at the peak exercise. Ischemic ST-T depression on electrocardiography was observed only at peak stress periods. Conclusions Continuous monitoring treadmill exercise Echo using a novel ultrasound probe seems feasible for the non-invasive and physiological assessment of CAD. (Circ J 2006; 70: 1297 - 1302)
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  • Hideaki Takai, Junjiro Kobayashi, Osamu Tagusari, Ko Bando, Kazuo Niwa ...
    2006 Volume 70 Issue 10 Pages 1303-1306
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The aim of this study was to evaluate the surgical results of off-pump coronary artery bypass grafting (OPCAB) for patients with acute myocardial infarction (AMI) within 14 days of the infarction. Methods and Results From April 2000 to January 2005 among 841 patients who underwent OPCAB, 43 consecutive patients (5.1%) were examined. Mean age at operation was 69.5 years and mean time from the onset of AMI to surgery was 4.6 days. Seventeen patients (39.5%) had left main trunk disease. Three patients (7.0%) underwent OPCAB following unsuccessful percutaneous coronary intervention, and 1 patient (2.3%) underwent redo procedure 9 years after previous coronary artery bypass grafting (CABG). Six patients (14%) were admitted in cardiogenic shock. Intraaortic balloon pumping was inserted preoperatively in 20 patients (46.5%). The average maximum creatine kinase-myocardial band was 139±181 (U/L). The mean number of grafts was 3.2 and the rate of complete revascularization was 91%. Two of six patients with preoperative cardiogenic shock were converted to on-pump beating CABG due to ventricular arrythmia. The early graft patency rate was 98%. All patients survived except 2 with preoperative cardiogenic shock. Conclusions OPCAB can be performed after AMI as a relativly low-risk procedure with an acceptable mortality rate, even within 14 days of the infarction. (Circ J 2006; 70: 1303 - 1306)
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  • Kyoichi Wada, Mitsutaka Takada, Takashi Ueda, Hiroyuki Ochi, Hideki Mo ...
    2006 Volume 70 Issue 10 Pages 1307-1311
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The purpose of this study was to characterize the pharmacokinetics of cyclosporine (CsA) in Japanese heart transplant patients, and to optimise the monitoring strategy based on measurements of the area under the curve of plasma concentration absorption phase or 2 h post-dose concentrations (C2). Methods and Results At defined time periods during the first year after transplantation, the area under the curve for the CsA serum concentration from 0 to 4 h (AUC0-4 h) was evaluated. Pharmacokinetic parameters and renal function at 1 month and 12 months after transplantation were compared in 7 Japanese patients. The highest coefficient of determination between CsA AUC0-4 h and a single concentration was observed using C2 (r 2 =0.838). For CsA pharmacokinetics, the mean measurement of whole blood trough levels value at 12 months was significantly lower than at 1 month after transplantation (p=0.026). The mean serum creatinine level at 12 months was significantly higher than at 1 month (1.00 mg/dl vs 0.73 p=0.0194). Conclusion A single-time-point model that includes C2 is useful for predicting CsA AUC0-4 h in Japanese heart transplant patients. Mean C2 values >1,000 ng/ml were obtained in patients with no rejection at 1 month and 12 months after transplantation; however, renal impairment may occur. (Circ J 2006; 70: 1307 - 1311)
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  • Akira Funada, Sumio Mizuno, Kazuo Ohsato, Tatsuaki Murakami, Ikuo Mori ...
    2006 Volume 70 Issue 10 Pages 1312-1317
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery. Case Reports In the present 3 cases pre-operative coronary angiography confirmed normal coronary arteries and they underwent uncomplicated AVR. Coronary lesions were clinically manifest within 4 months after surgery, and repeat coronary angiography demonstrated bilateral ostial stenosis in 1 patient and left main trunk stenosis in the other 2. Two cases were detected by multidetector computed tomography (MDCT) before angiography. MDCT and Virtual Histology suggested fibrous tissue formation in the lesions. All 3 patients were successfully underwent percutaneous coronary intervention (PCI) and stenting. The post-procedure clinical course has been uneventful, except for elective stenting of a recurrent lesion in 1 asymptomatic patient. Conclusions The incidence of ICOS after AVR is low. Noninvasive MDCT is useful for early diagnosis and PCI is a possible alternative treatment. ICOS may be caused by fibrous tissue formation, and therefore be distinct from conventional atherosclerosis. (Circ J 2006; 70: 1312 - 1317)
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  • Takeshi Yamashita, Satoshi Ogawa, Yoshifusa Aizawa, Hirotsugu Atarashi ...
    2006 Volume 70 Issue 10 Pages 1318-1321
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Mega trials of rhythm vs rate control could not demonstrate the usefulness of available antiarrhythmic drugs, so a more effective and safer therapy for atrial fibrillation (AF) is now required. One candidate is the so-called "upstream therapy", which refers to the blockade of upstream modifying elements (renin - angiotensin system, cathecholamines, oxidative stress etc) that contribute to the arrhythmogenic substrate. Methods and Results The Japanese Rhythm Management Trial II for Atrial Fibrillation (J-RHYTHM II study) is a randomized comparative evaluation of an angiotensin II type 1 blocker (candesartan) and a dihydropiridine calcium blocker (amlodipine), both combined with antithrombotic therapy, as an antiarrhythmic therapy for the treatment of paroxysmal AF (PAF) associated with hypertension. To test the usefulness of this therapy, this study will reveal the recurrence rate of asymptomatic as well as symptomatic PAF during 1-year of treatment with candesartan or amlodipine, using daily transtelephonic monitoring. Conclusions The J-RHYTHM II study will follow 400 patients with PAF and hypertension who were treated at approximately 50 sites throughout Japan, and will provide clinically important information. (Circ J 2006; 70: 1318 - 1321)
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  • Takuya Ono, Hirokazu Saitoh, Shioto Itakura, Katsuhiko Tateoka, Isuzu ...
    2006 Volume 70 Issue 10 Pages 1322-1326
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Total cosine R-to-T (TCRT) is a descriptor of T-wave morphology analysis based on singular value decomposition of 12-lead electrocardiograms (ECGs), which is useful in risk stratification of patients with myocardial infarction (MI). A new marker of standard ECG substituted for TCRT is proposed and the aim of this study was to evaluate the correlation between the new index and TCRT in patients with cardiomyopathy and MI. Methods and Results Patients were divided into 2 groups: patients with cardiomyopathy (group CM, n=21, male =13), and patients with MI (group MI, n=36, male =28). TCRT was calculated using a custom software package. The ventricular gradient (VG)-index was defined as the total number of leads with opposite vectors for the QRS and T-wave. The value of TCRT was significantly lower in group CM than in group MI (-0.50±0.51 vs -0.04±0.65, p<0.01). The value for the VG-index was significantly greater in group CM than in group MI (5.9±3.4 vs 4.2±2.4, p<0.05). There was a significant correlation between TCRT and the VG-index in all of the patients (r2=0.47). Conclusion The VG-index is significantly correlated with TCRT, and both descriptors distinguish patients with MI from those with cardiomyopathy. (Circ J 2006; 70: 1322 - 1326)
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  • Nobuhiro Tanaka, Kenji Takazawa, Naohisa Shindo, Hideyuki Kobayashi, T ...
    2006 Volume 70 Issue 10 Pages 1327-1331
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The aim of the present study was to quantitatively assess the physiological acute recoil after percutaneous coronary intervention (PCI), and to determine the relation between it and target lesion revascularization (TLR) in the chronic phase. Methods and Results This study evaluated 76 patients who underwent elective PCI between May 1997 and December 2001: plain old balloon angioplasty (POBA) in 50 patients and bare metal stent implantation in 26 patients. Fractional flow reserve (FFR) was measured immediately (FFR0m) and 15 min (FFR15m) after the final dilation, and the difference (dif-FFR) was calculated. In POBA patients with TLR, FFR15m was significantly low (0.79±0.05 vs 0.87 ±0.08, p<0.001) and dif-FFR was significantly high (0.06±0.04 vs -0.01±0.04, p<0.001) compared with the patients without TLR. The patients with a larger dif-FFR value (≥0.05) had a higher rate of TLR (92%). Dif-FFR was the strongest independent predictor of TLR. Conclusions The changes in FFR during the time course shortly after coronary intervention can be detected and a decrease in the first 15 min after PCI is associated with a higher rate of TLR. (Circ J 2006; 70: 1327 - 1331)
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  • Hideki Tsurugaya, Hitoshi Adachi, Masahiko Kurabayashi, Shigeru Ohshim ...
    2006 Volume 70 Issue 10 Pages 1332-1336
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The minute ventilation/carbon-dioxide output (VE/VCO2) slope as a marker of cardiac events has been established in patients with severe heart failure, but it is not known whether it is useful for other heart diseases. Methods and Results The present study investigated 215 patients with various heart diseases (age 59±11 years; ischemic heart disease, n=89; dilated cardiomyopathy, n=38; valvular disease, n=37; hypertensive heart disease, n=33; others, n=18) who underwent cardiopulmonary exercise testing to determine the VE/VCO2 slope. Patients were divided into 2 groups according to the VE/VCO2 slope and were followed-up for 3 years. Forty-eight cardiac events (6 deaths, 42 re-hospitalizations) occurred during the observation period. Patients with a VE/VCO2 slope >34 had a significantly higher 3-year cardiac event rate (32.1%) than patients with VE/VCO2 slope <34 (18.9%, p<0.05). When patients were selected with relatively preserved peak oxygen uptake values (>16 ml · kg -1 · min-1), patients with VE/VCO2 slope >34 still demonstrated a significantly higher cardiac event rate than other patients (35.0% vs 13.3%, p<0.01). Conclusion The VE/VCO2 slope may be a prognostic indicator of cardiac events in a heterogeneous group of patients with heart disease, independent of exercise tolerance. (Circ J 2006; 70: 1332 - 1336)
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  • Shin-Shin Chuang, Chun-Che Shih, Jen-Lin Yang, Steven Y Lee, Cheng-Den ...
    2006 Volume 70 Issue 10 Pages 1337-1343
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The aim of the present study was to assess the clinical significance of spectral analysis of plethysmographic waveform in patients with coronary artery disease (CAD) and after coronary artery bypass graft (CABG) surgery. Methods and Results The study group comprised 26 healthy subjects, 15 CAD patients, and 24 CAD patients after CABG. Finger plethysmographic waveforms from both right and left index fingers were recorded and analyzed using power spectral analysis. The total power of the right pulse was found to be higher than that of left pulse in the 3 groups of subjects. In CABG patients, the total power of both pulses was increased, the right-to-left ratio of bilateral total power was decreased, and the power of the harmonics of the right pulse shifted from high-frequency to low-frequency. The normalized power of the 4th harmonic of the left pulse and of the 3rd and 4th harmonics of right pulse decreased, whereas that of the 1st harmonic of right pulse increased in CABG patients. Several harmonics correlated significantly to some heart rate variability measures in both controls and CAD patients, but not in CABG patients. Conclusions The increase in the total power of both pulses, the shift of the normalized power of harmonics of the right pulse from high- to low-frequency, and the decrease in the right-to-left ratio of the total power of both pulses are the 3 significant changes in the power spectra of the pulses in CAD patients after CABG. The plethysmographic waveform of normal controls and CAD patients may be modulated by the autonomic nervous system, and in CAD patients the CABG surgery may have diminished the effect of autonomic nervous modulation on the pulse waveforms. (Circ J 2006; 70: 1337 - 1343)
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Experimental Investigation
  • Hajime Otani, Seiji Matsuhisa, Yuzo Akita, Shiori Kyoi, Chiharu Enoki, ...
    2006 Volume 70 Issue 10 Pages 1344-1355
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background The hypothesis that mechanical stress during reperfusion produces myocyte oncosis and inhibits apoptosis was tested in the present study. Methods and Results Isolated and perfused rat hearts were subjected to 30 min ischemia followed by 150 min reperfusion. In the control-reperfusion heart, the form of myocyte death was a mixture of apoptosis only, oncosis only, and both apoptosis and oncosis. Apoptotic myocytes contained mitochondria that maintained membrane potential (Δψm), whereas oncotic myocytes contained only Δψm-collapsed mitochondria. Treatment with the contractile blocker 2,3-butanedione monoxime (BDM) during reperfusion increased caspase-3 activity and produced predominantly apoptosis. However, withdrawal of BDM provoked oncosis in terminal deoxynucleotide nick-end labeling (TUNEL)-positive myocytes. Myocardial stretch by inflating an intraventricular balloon at the time of reperfusion with BDM increased only oncotic myocytes, whereas the same mechanical stress 120 min after reperfusion increased oncotic myocytes positive for TUNEL. Increased mechanical stress at the time of reperfusion by treatment with isoproterenol or hyposmotic buffer inhibited caspase-3 activity and increased only oncotic myocytes. Co-treatment with the caspase-3 inhibitor, Ac-DEVD-CHO, and BDM during reperfusion inhibited myocyte apoptosis and oncosis but did not inhibit oncosis after withdrawal of BDM. Conclusions These results suggest that mechanical stress is a critical determinant of the form of myocyte death during the early phase of reperfusion. (Circ J 2006; 70: 1344 - 1355)
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  • Fumiaki Kuma, Norihiro Ueda, Hiroyuki Ito, Toru Maruyama, Yoshikazu Ka ...
    2006 Volume 70 Issue 10 Pages 1356-1361
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Background Although ultrasound (US) is widely used in cardiology, little is known about the effects of US energy on cardiac performance. This study aimed to investigate the mechanical effects of high-intensity continuous US energy (1.0 MHz with 3 different intensities) on cardiac performance. Methods and Results Either left ventricular (LV) pressure or aortic blood flow (ABF) was evaluated in open-chest guinea pigs (n=30) under surface ECG monitoring. LV systolic pressure and ABF increased significantly (ie, maximum percent increases in these parameters were 2.5%, 3.1% and 7.1% for LV systolic pressure and 9.4%, 4.9% and 8.8% for mean ABF at intensities of 0.06, 0.67 and 2.90 W/cm2, respectively). LV end-diastolic pressure was reduced significantly by US (5.3±0.9 to 4.8±0.8, 5.5 ±1.3 to 4.8±1.0 and 5.8±2.0 to 5.0±1.2 mmHg, respectively), indicating positive inotropic and lusitropic effects and resultant ABF augmentation. Local temperature was not significantly changed. ECG showed neither chronotropic action nor arrhythmogenesis. Conclusions Although the basic mechanisms of these phenomena remain unclear, this pilot study of the short-term effects of US energy on cardiac performance suggests the possibility of physical therapy for heart failure. (Circ J 2006; 70: 1356 - 1361)
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Case Report
Corrigendum
  • 2006 Volume 70 Issue 10 Pages 1365
    Published: 2006
    Released: September 25, 2006
    JOURNALS FREE ACCESS
    Wrong:Role of the Low Amplitude Potential in the Initial P Wave Signal-Averaged Elestrogram in Sick Sinus Syndrome
    Right:Role of the Low Amplitude Potential in the Initial P Wave Signal-Averaged Electrocardiogram in Sick Sinus Syndrome
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