Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 70, Issue 5
Displaying 1-24 of 24 articles from this issue
Clinical Investigation
  • Hiroaki Kawano, Hirofumi Soejima, Sunao Kojima, Akira Kitagawa, Hisao ...
    2006 Volume 70 Issue 5 Pages 513-517
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Acute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Although the risk factors for AMI have been extensively studied in Western countries, they are less well documented in Japan. To determine the risk factors for AMI, we performed a case-control study in unselected patients with AMI. Methods and Results Risk factors were assessed in 1,925 consecutive patients with a first AMI (age, 28-103 years old; men, 1,353; women, 572), who were admitted to one of the major institutes in Japan, and in 2,279 age-and sex-matched population-based controls. Hypertension (odds ratio (OR), 4.80; 95% confidence interval (CI), 3.80 to 5.95; p<0.01), diabetes (OR, 3.44; 95% CI, 2.50 to 4.75; p<0.01), current smoking (OR, 3.39; 95% CI, 2.78 to 4.18; p<0.01), family history (OR, 1.84; 95% CI, 1.30 to 2.62; p<0.01), and hypercholesterolemia (OR, 1.28; 95% CI, 1.00 to 1.62; p<0.05) were all independent risk factors for AMI. However, obesity (OR, 1.13; 95% CI, 0.92 to 1.50; NS) was not. Hypertension (OR, 4.80; 95% CI, 3.80 to 6.02; p<0.01), current smoking (OR, 4.00; 95% CI, 3.02 to 5.00; p<0.01), and diabetes (OR, 2.9; 95% CI, 2.00 to 4.04; p<0.01) were all independent risk factors for AMI in men. In contrast, only current smoking (OR, 8.22; 95% CI, 3.98 to 18.88; p<0.01), diabetes (OR, 6.12; 95% CI, 3.78 to 12.02; p<0.01), and hypertension (OR, 5.04; 95% CI, 2.92 to 7.52; p<0.01) were independent risk factors for AMI in women. Hypercholesterolemia was an independent risk factor for AMI in men (OR, 1.52; 95% CI, 1.00 to 1.98; p<0.05), but not in women. Conclusions Hypertension, diabetes, current smoking, family history and hypercholesterolemia are associated with AMI in Japanese patients, and the importance of the risk factors for AMI differs between men and women. Hypertension, current smoking, diabetes and family history are the most important risk factors in men, whereas current smoking, diabetes, hypertension and family history are the most important risk factors in women. Hypercholesterolemia is an independent risk factor for AMI in men, but not in women. To the best of our knowledge, this is the first clinical study to define the relative importance of risk factors for AMI in Japanese patients. (Circ J 2006; 70: 513 - 517)
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  • Jun Shiraishi, Yoshio Kohno, Shinichiro Yamaguchi, Masayasu Arihara, M ...
    2006 Volume 70 Issue 5 Pages 518-524
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Data on the medium- and long-term prognosis of young Japanese patients with acute myocardial infarction (AMI) are still lacking. Methods and Results In the present study, 1,458 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2003. Of these, clinical characteristics and medium-term prognosis were retrospectively compared in 21 young patients <40 years (young group), and 190 non-young patients 60-70 years old (non-young group) who could be followed after hospital discharge. The young group was all male and had higher prevalence of current smoking and greater body mass index, but previous myocardial infarction (MI) and hypertension were more prevalent in the non-young group. The young group had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as the culprit lesion. The acquisition rates of Thrombolysis In Myocardial Infarction 3 flow after primary percutaneous coronary intervention did not differ between the 2 groups, but the data of maximal creatine kinase was significantly higher in the young group. During the follow-up period (average 2.42 years for young, 2.37 years for non-young), survival and event-free survival rates and incidence of major adverse cardiac events (MACE) did not differ between the 2 groups. The predictor of MACE during follow-up period was the presence of multivessel disease in the young group, whereas the presence of multivessel disease, history of previous MI and longer hospitalization were the predictors of MACE in the non-young group. Conclusions These results suggest that the medium-term prognosis in young AMI patients is comparable to that of non-young AMI patients in Japan. (Circ J 2006; 70: 518 - 524)
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  • Tomohisa Hirano, Kunihiko Tsuchiya, Kazuhiko Nishigaki, Kenji Sou, Tom ...
    2006 Volume 70 Issue 5 Pages 525-529
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background To diagnose left main trunk (LMT) infarction by 12-lead standard electrocardiogram (ECG) is an important emergency technique, but the features in LMT infarctions have not been clarified. Methods and Results The study enrolled 140 subjects who were divided into 4 groups according to the location of the culprit artery: 35 with LMT, 35 with left anterior descending artery (LAD), 35 with right coronary artery and 35 with left circumflex artery. Various parameters obtained from the ECGs were analyzed. Average QTc interval (0.51±0.06 s) in LMT group was markedly longer than that in the 3 other groups. Average QRS axis (-10±77 degrees) in LMT infarction showed a remarkable left deviation. ST-segment elevation in lead aVR occurred in 28 patients (80.0%) in the LMT group. The ECG features of the LMT group could be classified into 2 main groups: right bundle branch block (RBBB) with a marked left axis deviation (RBBB + LADEV type) and ST-segment elevation in leads V2-5, I and aVL without abnormal axis deviation (LAD type). Conclusion Either ST-segment elevation in lead aVR and marked prolongation of both the QRS width and QTc interval with a prominent abnormal axis deviation or ST-segment elevation in the broad anterior precordial lead with a normal QRS axis strongly suggests LMT infarction. (Circ J 2006; 70: 525 - 529)
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  • Toshiro Katayama, Hiroshi Nakashima, Chisa Takagi, Yukiharu Honda, Shi ...
    2006 Volume 70 Issue 5 Pages 530-535
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background The predictors of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) treated with successful primary coronary angioplasty have not been identified. Methods and Results Of 433 consecutive AMI subjects who underwent reperfusion by primary coronary angioplasty within 24 h of onset, CR occurred in 11 (2.5%), free wall rupture in 9, and ventricular septal perforation in 2. Rates of females, diabetes mellitus and anterior infarction were higher in the group of CR patients than in the others (p<0.05). There were no significant differences between the 2 groups in terms of left ventricular (LV) function soon after recanalization, such as LV ejection fraction, regional wall motion, or end-diastolic volume index. Plasma levels of both high-sensitivity C-reactive protein (hsCRP) and serum amyloid-A protein (SAA) were significantly higher in the CR patients than in the others (hsCRP: 6.7±6.7mg/dl vs 3.3±3.8 mg/dl, p=0.007; SAA: 699±812 μg/dl vs 208±273 μg/dl, p<0.0001). Multivariate analysis identified SAA as an independent predictor of CR (risk ratio: 8.8, 95% confidence interval: 1.7-25.6, p<0.05). Conclusions In patients with AMI treated with primary coronary angioplasty, inflammation may be closely related to CR, for which SAA is a useful predictor. (Circ J 2006; 70: 530 - 535)
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  • Shyh-Ming Chen, Yuan-Kai Hsieh, Gary Bih-Fang Guo, Chi-Yan Fang, Hon-K ...
    2006 Volume 70 Issue 5 Pages 536-541
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Because of different dosages, the efficacy of adjunctive tirofiban therapy for primary percutaneous coronary intervention (PCI) is currently unclear. The hypothesis that a double bolus regimen of tirofiban will improve angiographic and clinical outcomes in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing PCI was tested in the present study. Methods and Results Primary PCI was performed in 217 STEMI patients: 80 received standard PCI (control group) and 137 received tirofiban (tirofiban group). Tirofiban was given as a bolus (10 mg/kg) in the emergency room and again upon arrival at the cardiac catheterization laboratory, followed by infusion of 0.15 mg · kg-1 · min -1 until the total dose reached 12.5 mg. The primary endpoint was emergency target vessel revascularization, recurrent myocardial infarction, or cardiovascular mortality at 30 days and 1 year. Baseline clinical and angiographic variables of the 2 groups were similar, as were angiographic results after PCI and bleeding complications at 30 days. The primary 30-day and 1-year endpoints were 5.1% and 11.7% in the tirofiban group, respectively, vs 10.0% (p=0.171) and 18.8% (p=0.151) in the control group. Conclusion Although angiographic and clinical benefits were not demonstrated, the results suggest that research into an effective and uniform dosing regimen of adjunctive tirofiban therapy for PCI is warranted. (Circ J 2006; 70: 536 - 541)
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  • Results From an Overview of Mailed Questionnaires and a Matched Case - Control Study
    Koichiro Sugimura, Masahito Sakuma, Kunio Shirato
    2006 Volume 70 Issue 5 Pages 542-547
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background The potential risk factors for pulmonary thromboembolism (PTE) have not been examined in Japan, so the aims of the present study were to assess independent risk factors for PTE, and to estimate the recent incidence of symptomatic PTE. Methods and Results Based on a mailed questionnaire, the potential risk factors for PTE were prospectively assessed using a matched case - control study, and the number of new patients with PTE in 2004 was calculated prospectively. In multivariate analyses, increase in body mass index (odds ratio (OR) =2.85 by 10 kg/m2; 95% confidence interval (CI), 1.51-5.39), prolonged immobilization (OR, 8.14; 95% CI, 3.15-20.99), recent major surgery (OR, 6.78; 95% CI, 2.65-17.32), and cancer (OR, 2.72; 95% CI, 1.25-5.95) were identified as independent risk factors for PTE in Japan. The risks for atherosclerosis (diabetes mellitus, hypertension, hyperlipidemia, and smoking), and alcohol consumption did not affect the incidence of PTE. The calculated number of new patients with PTE per year was 4,108 (95% CI, 3,564-4,712) in 2004. Conclusion The independent risk factors for PTE in Japan are body mass index, prolonged immobilization, recent major surgery, and cancer. The number of new patients with PTE in 2004 did not demonstrate an upward trend compared with 2000. (Circ J 2006; 70: 542 - 547)
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  • Rationale and Design
    Naofumi Ikeda, Shigeyuki Nishimura, Shunei Kyo, Nobuyuki Komiyama, Kaz ...
    2006 Volume 70 Issue 5 Pages 548-552
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Despite an increase in the frequency of coronary angiography (CAG) in Japan, the exact incidence of contrast-induced nephropathy (CIN) remains unknown in the Japanese population, especially in patients with chronic renal insufficiency. In addition, the nature of pharmacological interventions that would benefit the patients before or after procedures such as coronary bypass graft (CABG) and percutaneous coronary intervention (PCI) has not been fully investigated. Methods In the trial 500 patients with renal insufficiency (defined as a glomerular filtration rate (GFR) of between 89 and 30 ml · min-1 · (1.73 m-2) following CAG will be randomly assigned to receive either valsartan, an angiotensin receptor blocker or angiotensin converting enzyme (ACE) inhibitor plus valsartan.1 The primary end-point is a change in the GFR of patients, which will be followed up for 3 years, including following CABG surgery or PCI. The incidence of cardiac events as well as the adverse effects of pharmacological intervention will be evaluated. In addition, the incidence of renal artery stenosis at the time of CAG will be reported also; however, the patients with renal artery stenosis will be excluded from the present study. Conclusion The present study will provide data on: 1) the exact incidence and course of renal function of CIN after CAG; and 2) the comparative therapeutic benefit of pharmacological intervention with valsartan alone or with valsartan and an ACE inhibitor in combination in patients with coexisting coronary artery diseases and chronic renal insufficiency, regardless of whether they receive CABG or PCI. In addition to these studies, an estimate of the incidence of renal artery stenosis in these patients will be demonstrated. (Circ J 2006; 70: 548 - 552)
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  • Shuji Kawashima, Hitoshi Takano, Yasuhiko Iino, Morimasa Takayama, Ter ...
    2006 Volume 70 Issue 5 Pages 553-558
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background In Japan, prophylactic hemodialysis has been considered useful for preventing contrast-induced nephropathy (CIN). Method and Results To assess whether hemodialysis prevented CIN, 391 patients (age: 69±8 years, 63 females) with chronic renal insufficiency (CRI, serum creatinine level (Scr) ≥1.3 mg/dl) who underwent cardiac catheterization, were retrospectively analyzed. Patients were divided into 3 categories based on Scr: L (1.3 ≤Scr <2.0 mg/dl, n=332); M (2.0 ≤Scr <3.0 mg/dl, n=49); and H (Scr ≥3.0 mg/dl, n=10). To prevent CIN, 35 category M patients and all category L patients received hydration alone, whereas 14 category M patients and all category H patients received hemodialysis. CIN developed in 48 patients. The incidence of CIN in category H was significantly higher than that in category L or M (H, 40% vs L, 11% or M, 16% (p<0.05)). In category M patients treated with hemodialysis, Scr increased from 2.4±0.3 to 3.0±0.5 mg/dl (p<0.05) within 7 days, and 29% of patients developed CIN. However, in category M patients who did not receive hemodialysis, the Scr did not change (pre, 2.3±0.2 mg/dl to post, 2.2±0.4 mg/dl), and the incidence of CIN was 11%. Conclusion Prophylactic hemodialysis for CRI patients undergoing cardiac catheterization does not prevent CIN. (Circ J 2006; 70: 553 - 558)
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  • Age-Related Variation Over Time in Japanese Subjects
    Ali Nasermoaddeli, Michikazu Sekine, Sadanobu Kagamimori
    2006 Volume 70 Issue 5 Pages 559-563
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Prospective studies have demonstrated a direct association between the baseline level of high-sensitivity C-reactive protein (hsCRP) and the risk of developing cardiovascular disease. The potential for hsCRP variability during the follow-up interval is of great interest, so the repeatability of measurements of hsCRP in men and women, and in different age groups, was investigated in the present study. Methods and Results The measurement of hsCRP was performed in 899 male and 780 female Japanese civil servants aged 18-60 years in the spring of 2004 and 2005. Within-subject repeatability and intra-class correlation coefficient of reliability were used to characterize the variation in measurements. Error of the measurement process was negligible, as the analytical variance was 0.0003 [ln(mg/L)] [ln(mg/L)] with a reliability coefficient of 0.997. In contrast, the within-subject variation of hsCRP was considerable with a reliability coefficient of 0.61 in both sexes and repeatability coefficients of 5.25 and 5.38 in men and women, respectively. The variation differed with age, especially in women, as less variation was observed in subjects over 40 years of age during the follow-up interval. Conclusions The results suggest that a single measurement of hsCRP is subject to considerable but equal within-subject variation over time in men and women, and this variation differs among the age groups, which may affect the risk assessment of hsCRP in association with future cardiovascular events. (Circ J 2006; 70: 559 - 563)
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  • Comparison With Conventional Invasive Angiography
    Mariko Ehara, Jean-Francois Surmely, Masato Kawai, Osamu Katoh, Tetsuo ...
    2006 Volume 70 Issue 5 Pages 564-571
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Multislice computed tomography (MSCT) is a promising noninvasive method of detecting coronary artery disease (CAD). However, most data have been obtained in selected series of patients. The purpose of the present study was to investigate the accuracy of 64-slice MSCT (64 MSCT) in daily practice, without any patient selection. Methods and Results Using 64-slice MSCT coronary angiography (CTA), 69 consecutive patients, 39 (57%) of whom had previously undergone stent implantation, were evaluated. The mean heart rate during scan was 72 beats/min, scan time 13.6 s and the amount of contrast media 72 mL. The mean time span between invasive coronary angiography (ICAG) and CTA was 6 days. Significant stenosis was defined as a diameter reduction of >50%. Of 966 segments, 884 (92%) were assessable. Compared with ICAG, the sensitivity of CTA to diagnose significant stenosis was 90%, specificity 94%, positive predictive value (PPV) 89% and negative predictive value (NPV) 95%. With regard to 58 stented lesions, the sensitivity, specificity, PPV and NPV were 93%, 96%, 87% and 98%, respectively. On the patient-based analysis, the sensitivity, specificity, PPV and NPV of CTA to detect CAD were 98%, 86%, 98% and 86%, respectively. Eighty-two (8%) segments were not assessable because of irregular rhythm, calcification or tachycardia. Conclusion Sixty-four-MSCT has a high accuracy for the detection of significant CAD in an unselected patient population and therefore can be considered as a valuable noninvasive technique. (Circ J 2006; 70: 564 - 571)
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  • Zhi-Hui Zhao, Zhi-Hong Liu, Qin Luo, Chang-Ming Xiong, Xin-Hai Ni, Jia ...
    2006 Volume 70 Issue 5 Pages 572-574
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background The purpose of the present study was to assess the short-term effects of positive pressure ventilation (PPV) on plasma amino terminal-pro brain natriuretic peptide (NT-proBNP) levels in patients with congestive heart failure (CHF) and sleep apnea (SA). Methods and Results Polysomnography was performed in 105 CHF patients. Twenty-six patients with CHF and SA were randomly assigned to a control group or a PPV group. Patients in the higher New York Heart Association classes had higher plasma levels of NT-proBNP. The plasma NT-proBNP concentration in the PPV group decreased. Conclusion Plasma NT-proBNP levels reflect the severity of CHF, and PPV can decrease plasma NT-proBNP levels in patients with CHF and SA. (Circ J 2006; 70: 572 - 574)
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  • Susumu Takeuchi, Toshiaki Akita, Yoshiko Takagishi, Eiichi Watanabe, C ...
    2006 Volume 70 Issue 5 Pages 575-582
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Atrial fibrillation (AF) is an arrhythmia associated with functional and morphological remodeling of atria. We investigated the distribution and the expression of connexins in atrial tissues from patients with chronic AF and left atrial dilatation (AD). Methods and Results Immunohistochemistry was performed in atrial tissues obtained during cardiac surgery from patients with chronic AF + AD (n=11), sinus rhythm (SR, n=11) and SR + AD (n=4). In SR patients (control), the connexin (Cx) 43 labeling of the intercalated disks seen en-face was characterized by small central spots surrounded by larger spots at the periphery. In the left atria from AF + AD patients, the area of the intercalated disk was significantly enlarged. Although peripheral Cx43 labeling was preserved, there was a striking loss of central labeling spots. The area occupied by gap junctions was slightly but significantly larger than that of the control. The left atria from patients with SR + AD showed gap junction disorganization analogous to AF + AD. The labeling patterns of Cx40 were essentially similar to those of Cx43. Conclusions In chronic AF with AD, gap junctions at the intercalated disk are disorganized, resulting most likely from AD but not from AF itself. This gap junction remodeling might be involved in altered atrial conduction properties, but its potential arrhythmogenic role remains unclear. (Circ J 2006; 70: 575 - 582)
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  • Hiroshi Watanabe, Masaomi Chinushi, Takashi Washizuka, Hirotaka Sugiur ...
    2006 Volume 70 Issue 5 Pages 583-587
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Suppression of implantable defibrillator discharges associated with ventricular tachyarrhythmia (VTA) has been reported for sotalol. This study aimed to investigate the efficacy of intravenous nifekalant hydrochloride in predicting the effects of oral sotalol. Methods and Results The present study included 14 patients who had sustained VTA associated with structural heart disease. All patients also had inducible VTA. To compare the effects of nifekalant and sotalol, programmed electrical stimulation was performed, in the basal state, after nifekalant administration, and after sotalol administration. Nifekalant and sotalol similarly prolonged the corrected QT interval and ventricular effective refractory periods, but the heart rate was slowed by sotalol only. In 4 of 5 patients whose VTA became non-inducible by nifekalant, subsequent treatment with sotalol also suppressed the inducible VTA. In all of the 9 patients non-responding to nifekalant, VTA remained inducible during sotalol treatment. Nifekalant accurately predicted the response to sotalol during electrophysiologic study in 13 of 14 patients. Of 11 patients who remained on sotalol, VTA recurred in 3 non-responders during a follow-up of 46±11 months. Conclusions Nifekalant and sotalol had similar effects on inducible VTA. The response of inducible VTA to nifekalant may predict the clinical efficacy of sotalol. (Circ J 2006; 70: 583 - 587)
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  • Takeshi Kotake, Mitsutaka Takada, Kazuo Komamura, Shiro Kamakura, Kuni ...
    2006 Volume 70 Issue 5 Pages 588-592
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Cibenzoline dosing is generally based on renal function, but serum concentrations might be greater than the expected therapeutic levels when standard oral dosing is used. Because heart failure might modify cibenzoline pharmacokinetics, the difference in cibenzoline pharmacokinetics between patients with and without heart failure was evaluated. Methods and Results The study enrolled 368 patients (233 men, 135 women) that had been hospitalized and received cibenzoline therapy at the National Cardiovascular Center from January 2001 to May 2005. There were 89 patients with heart failure (51 men, 38 women) and 279 patients without heart failure (182 men, 97 women). They had therapeutic drug monitoring ≥3 days after the beginning of treatment with cibenzoline. Brain natriuretic peptide (BNP) was measured in 81 patients (50 men, 31 women) concurrently with therapeutic drug monitoring of cibenzoline. The difference in serum cibenzoline concentration/(dose/weight) (C/D) values between patients with and without heart failure was analyzed using analysis of covariance (ANCOVA) with creatinine clearance (Ccr) serving as the covariate. The effects of dose/weight and the log-transformed BNP (log-BNP) values on serum cibenzoline concentrations were also assessed using ANCOVA. There were 135 and 361 measurements of serum cibenzoline concentration in patients with and without heart failure, respectively. Pearson's correlation coefficient analyses in the patients with and without heart failure revealed that the C/D values were significantly correlated with Ccr (with heart failure, y=-0.837x+169, r=-0.211, p=0.014; without heart failure, y=-0.789x+132, r=-0.393, p<0.001), and the ANCOVA model indicated that C/D values were significantly higher in patients with heart failure than without heart failure. The ANCOVA model also showed that dose/weight, Ccr and the log-BNP value were significant factors. Conclusions The selection of a cibenzoline dose based only on renal function may increase the risk of toxicity in patients with heart failure. Cardiac function should be taken into account in cibenzoline dosing. The log-BNP may be a useful index for predicting serum cibenzoline concentrations. (Circ J 2006; 70: 588 - 592)
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  • Halil Tanriverdi, Harun Evrengul, Omur Kuru, Seyhan Tanriverdi, Deniz ...
    2006 Volume 70 Issue 5 Pages 593-599
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Smoking contributes to the progression of atherosclerotic heart disease by causing endothelial dysfunction. In the present study the effect of smoking on endothelial functions and coronary flow was investigated, as well as the relationship of these factors with oxidative stress parameters, in subjects with normal coronary arteries. Materials and Results The study group comprised 87 patients with angiographically normal coronary arteries (36 smokers, 51 nonsmokers). Coronary flow patterns were determined by the Thrombolysis In Myocardial Infarction (TIMI) frame count method. Endothelial function was evaluated by high-frequency ultrasound imaging of the brachial artery. Superoxide dismutase (SOD) and reduced glutathione (GSH) and reduction of oxidative material in the body and the endproduct of lipid peroxidation, malondialdehyde (MDA), were measured as oxidative stress markers. Mean TIMI frame count was significantly higher in smokers than nonsmokers (42.2±16 vs 29.5±9.5, p=0.0001). Endothelium-dependent flow-mediated dilatation was 6.81±1.95% in nonsmokers and 5.7±2.2% in smokers (p=0.0001). The smokers had dramatically higher levels of SOD and MDA and lower levels of GSH than the nonsmoker group. Conclusion Smoking induced oxidative stress deteriorates coronary blood flow by disturbing endothelial function. (Circ J 2006; 70: 593 - 599)
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  • Natsuko Kasuya, Yukio Kishi, Mitsuaki Isobe, Masayuki Yoshida, Fujio N ...
    2006 Volume 70 Issue 5 Pages 600-604
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Inflammation and thrombosis are closely related processes, but the association between disease activity and thrombogenicity in Takayasu's arteritis (TA) is poorly understood. To investigate the link between platelet activation and disease activity, flow cytometric analyses of platelet P-selectin and activated GPIIb/IIIa expression were performed in patients with TA. Methods and Results Twenty-two patients with TA, classified into active (Group A, n=9) and inactive (Group I, n=13) according to blood-derived inflammatory markers, and 14 healthy age- and gender-matched controls (Group C) were studied. Compared with Group C, the mean fluorescence intensity of P-selectin in response to 0.1-10 μmol/L of ADP was significantly upregulated in Group A, but not in Group I. No differences in platelet GPIIb/IIIa expression in stimulated platelets were seen among the 3 groups. Standard platelet aggregation studies revealed that disease activity did not influence platelet aggregation by ADP. Conclusions P-selectin expression, but not activated GPIIb/IIIa, is enhanced in ADP-activated platelets from patients in the inflammatory stage of TA. P-selectin may play a significant role in the inflammatory and thrombotic responses associated with intractable TA, presumably by inducing platelet-leukocyte interactions. (Circ J 2006; 70: 600 - 604)
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Experimental Investigation
  • A Possible Cause of Electrical Remodeling in Diseased Hearts
    Hideaki Kawada, Shinichi Niwano, Hiroe Niwano, Yoshihiro Yumoto, Yuko ...
    2006 Volume 70 Issue 5 Pages 605-609
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Inflammatory cytokines have been reported to contribute to the progression of cardiac remodeling in various heart diseases and a remarkable prolongation of the monophasic action potential duration and reductions in the expression of Kv4.2 and K+ channel-interacting protein-2 (KChIP-2) in a rat autoimmune myocarditis model have been documented. In this study, the effect of tumor necrosis factor-α (TNF-α) on cultured cardiomyocytes was evaluated, focusing on the change in the voltage-gated outward K+ current and expression of related molecules. Methods and Results Cardiomyocytes isolated from 1-day-old Lewis rats were cultured for 72 h and treated with TNF-α (50 ng/ml) for an additional 48 h. The myocytes treated with TNF-α showed a 22% reduction in the peak K+ current, which consisted of a transient outward K+ current (Ito) and 1.4-fold enhancement of the cell-capacitance in comparison with the control. Among the cardiac ion channel related molecules evaluated in this study, Kv4.2 and KChIP-2 mRNA exhibited remarkable reductions (p<0.05). Conclusions Treatment with TNF-α induced reductions in Ito as well as cellular hypertrophy in neonatal cultured myocytes, which indicates that TNF-α might play a role in promoting electrical remodeling of cardiomyocytes under inflammatory conditions. (Circ J 2006; 70: 605 - 609)
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  • Seiji Hatano, Takeshi Yamashita, Akiko Sekiguchi, Yuki Iwasaki, Kiyosh ...
    2006 Volume 70 Issue 5 Pages 610-614
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Many pathological conditions induce electrical remodeling, possibly through intracellular Ca2+ overload, but the currently available L-type Ca2+ channel blockers may be detrimental because of their global negative inotropic effects. Methods and Results To determine whether the L-type Ca2+ channel is identical throughout the heart, the distribution of the mRNAs and proteins comprising the L-type Ca2+ channel and its electrophysiological properties were analyzed in rat atria and ventricles. The mRNA of α2δ-2 (Cacna2d2) was more abundantly expressed in the atrium (~5-fold) than in the ventricle. In contrast, α1C (Cacna1c) (Cav1.2) mRNA was significantly less abundant in the atrium. The level of the α1C (Cacna1c) (Cav1.2) protein was decreased (~0.5-fold) and that of α2 δ-1 (Cacna2d1) was increased (~2-fold) in the atrium compared with the ventricle. Although the peak ICa,L density showed no significant differences, voltage dependence of inactivation and activation of the current showed a more depolarized shift in the atrium than in the ventricle. Conclusion These results indicate that in the rat heart the L-type Ca2+ channel differs between the atrium and ventricle with regard to gene expression and electrophysiological properties. (Circ J 2006; 70: 610 - 614)
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  • Hanjun Zhao, Akihiko Ito, Naohiko Sakai, Yuji Matsuzawa, Shizuya Yamas ...
    2006 Volume 70 Issue 5 Pages 615-624
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background RECS1 is a mechanical stress responsive gene and RECS1 knockout (KO) mice (older than 14 months) are prone to cystic medial degeneration (CMD). The present study was designed to assess whether RECS1 KO mice have altered gelatinase (matrix metalloproteinase (MMP)-2 and MMP-9) levels and whether they are prone to aortic dilation. Methods and Results Aortic and plasma gelatinase levels in RECS1 KO and wild-type (WT) mice were assessed by gelatin zymography and Western blot analysis. Pro-MMP-9 (in the aorta), neutrophil gelatinase-associated lipocalin/MMP-9 complex (NGAL-MMP-9, in plasma), and active-MMP-9 protein levels were more abundant in KO mice throughout adulthood compared with WT mice. Aortic MMP-2, aortic MMP-9, and plasma MMP-9 activation increased with age, even though the aortic pro-MMP-9, plasma NGAL-MMP-9, aortic and plasma pro-MMP-2 production decreased: this was true both for the WT and KO animals. Aortic pro-MMP-2, aortic active-MMP-2, and plasma pro-MMP-2 protein levels were higher in the aged KO mice, but they were lower in the young KO mice than those in WT mice. Thoracic aortic dilation was observed only in the aged KO mice. In situ zymographic experiments confirmed that the increased aortic gelatinase activities were associated with CMD and aortic dilation observed in the aged KO mice. Conclusions RECS1 negatively regulates aortic MMP-9 production and knocking out RECS1 induces susceptibility to aortic dilation as well as CMD in the aged mice. The present study suggests that RECS1 plays protective roles in vascular remodeling. We speculate that inhibiting unfavorable deposition and extracellular matrix degradation are both important for prevention and treatment of aneurysms. (Circ J 2006; 70: 615 - 624)
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  • Yanmei Wang, Hongmei Tang, Dong Wang, Ruofan Li, Yilong Dong, Wei Liu, ...
    2006 Volume 70 Issue 5 Pages 625-630
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Background Cells transplanted into the myocardial infarct areas might be lost because of the lack of blood supply to these myocardium areas. The hypothesis that pretreatment with angiogenic therapy induced by transmyocardial revascularization (TMR) might improve ischemic myocardial function, followed by cell transplantation was tested. Methods and Results After the ligation of the left anterior descending coronary artery, rats were treated with TMR. Two weeks, embryonic stem cells were transplanted into an injured heart. Four weeks after cell transplantation, cardiac function was assessed by homodynamic measurements. Capillary density and infarct size in the infarct myocardium were measured by using a previous experimental method. Graft histology and morphology was also evaluated. Four weeks after the operation, myocardial infarct (MI) rats treated with TMR and cell transplantation showed significantly higher cardiac function in hemodynamic measurements (p<0.01) than that of MI rats receiving cell transplantation or TMR alone. A significant increase in capillary density and reduction in infarct size was observed in the MI rats that received a combined therapy (p<0.01). Conclusion Pretreatment of an infarct region of the heart with angiogenesis induced by TMR can enhance the efficacy of a cell graft and attenuate the progression of cardiac dysfunction in the rat model. (Circ J 2006; 70: 625 - 630)
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Case Report
  • Akira Takaki, Hiroshi Ogawa, Takatoshi Wakeyama, Takahiro Iwami, Masay ...
    2006 Volume 70 Issue 5 Pages 631-633
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    A 63-year-old-man with significant left hemiplegia was admitted to hospital. He had experienced a transient cerebral ischemic attack 10 years ago. Computed tomography revealed hypodensity along the right lateral ventricle, which corresponded to the left paralysis. Echocardiography and left ventricular angiography revealed an aneurysm of the membranous septum (AMS) without a ventricular septal defect (VSD). Therefore, the embolism was thought to be of cardiac origin, but surgery revealed that it was not caused by AMS. The aneurysm was created when the septal leaflet of tricupid valve formed a giant capsule during the process of natural closure of the VSD. It was a large pouch, 2.0 cm in diameter, adjacent to the septal leaflet. Anomalies of the tricuspid valve, including pouches, can resemble AMS. (Circ J 2006; 70: 631 - 633)
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  • Masaya Otsuka, Hideya Yamamoto, John Michael Criley, Osamu Oba, Kunika ...
    2006 Volume 70 Issue 5 Pages 634-637
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Noonan syndrome presents with dysmorphic facial features, short stature, and cardiac abnormalities (most commonly pulmonic stenosis and hypertrophic cardiomyopathy). This report describes a rare case accompanied by a secundum atrial septal defect (ASD) and a ventricular septal aneurysm causing right ventricular (RV) pressure gradient. A 29-year-old mentally retarded man was admitted to hospital with exertional dyspnea. His somatic features included short stature (148 cm), hypertelorism, a shield chest, and thoracic scoliosis. Echocardiogram showed a secundum ASD with bidirectional shunting and a ventricular septum bulging toward the left ventricle in diastole, and then toward the RV in systole causing obliteration of the RV. The peak pressure gradient measured across the RV outflow by continuous wave Doppler was 30 mmHg. Cardiac catheterization revealed an elevated RV pressure without pulmonary hypertension and confirmed the pressure gradient. Right ventriculography revealed the septal excursion toward the RV in systole, leaving only a small residual cavity in the inflow and outflow regions of the RV. The ASD was closed with an autologous pericardial patch. A thin, fibrous portion of the ventricular septum was resected and replaced with a Dacron patch. From the histological examination, the RV cavity obliteration turned out to be produced by the excursion of the infarcted ventricular septum. (Circ J 2006; 70: 634 - 637)
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  • Shinji Kanemitsu, Keizo Tanaka, Hitoshi Suzuki, Toshiya Tokui, Toshihi ...
    2006 Volume 70 Issue 5 Pages 638-640
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    It is necessary to use side clamps to construct proximal anastomoses in off-pump coronary artery bypass, and this can be related to neurologic complications. Recently a new device, the HEARTSTRING device, was developed. We present a 78-year-old man who underwent emergent bypass surgery using the HEARTSTRING device to avoid a side clamp. We found atherosclerotic debris from the punched hole and, unfortunately, a postoperative neurological complication resulted. We strongly suggest that it is most important that potential candidates for the HEARTSTRING device be carefully selected to reduce possible neurologic complications. We report that while this new device is useful, there is a potential pitfall in using it; that it is a possible source of atheroembolism. (Circ J 2006; 70: 638 - 640)
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  • Satoshi Kurisu, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yuji ...
    2006 Volume 70 Issue 5 Pages 641-644
    Published: 2006
    Released on J-STAGE: April 25, 2006
    JOURNAL FREE ACCESS
    Two cases of takotsubo cardiomyopathy occurred after pacemaker implantation, both in elderly women who received a dual-chamber pacemaker for complete atrioventricular block. They had persistent left ventricular dysfunction even during their convalescence. (Circ J 2006; 70: 641 - 644)
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