Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 70, Issue 7
Displaying 1-27 of 27 articles from this issue
Clinical Investigation
  • Naoharu Iwai, Kazuaki Kajimoto, Yoshihiro Kokubo, Akira Okayama, Shuni ...
    2006 Volume 70 Issue 7 Pages 805-809
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Recently, the Framingham Heart Study reported that genetic variations in CCL2 influence serum levels of monocyte chemoattractant protein-1 (MCP-1) and the incidence of myocardial infarction (MI). The purpose of the present study was to investigate the possible involvement of CCL2 in the pathogenesis of atherosclerosis and MI in Japanese. Methods and Results Multiple regression analysis indicated that the MCP-1 levels were significantly influenced by various factors including age, body mass index, smoking, alcohol intake, high density lipoprotein-cholesterol, and systolic blood pressure. Moreover, the serum MCP-1 level was significantly correlated with intima - media thickness (p<0.0001). However, this association disappeared when other clinical confounding factors were included in the analyses. Comprehensive analysis of common polymorphisms of CCL2 in a large community-based population and in subjects with MI found that the A(-2138)T polymorphism affected the serum MCP-1 level in a subgroup of subjects 65 years and older. However, no significant differences in the frequencies of any of the polymorphisms or haplotypes were found between subjects with and without MI. None of the polymorphisms in CCL2 affected carotid atherosclerosis. Conclusions The serum MCP-1 level was a good surrogate marker of atherosclerosis in the present study population. Although genetic variations in CCL2 may have some influence on MCP-1 production, their influence does not seem to contribute appreciably to atherosclerosis in Japanese. The present results did not support the recently published findings from the Framingham Heart Study. The discrepancy between the 2 studies may be related to differences in confounding factors that contribute to MCP-1 levels and in the haplotype structure of the 2 populations. (Circ J 2006; 70: 805 - 809)
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  • Jun Sasaki, Toru Kita, Hiroshi Mabuchi, Masunori Matsuzaki, Yuji Matsu ...
    2006 Volume 70 Issue 7 Pages 810-814
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Gender differences between the risk factors for coronary heart disease and coronary events were examined in the Japan Lipid Intervention Trial, a 6-year observational study. Methods and Results Men (12,575) and women (27,013) were analyzed for risk of coronary events (acute myocardial infarction and sudden cardiac death). Simvastatin reduced serum low-density lipoprotein cholesterol (LDL-C) by 27% in both genders, and increased serum high-density lipoprotein cholesterol (HDL-C) in men (5%) and women (4%). The incidence of coronary events was lower in women (0.64/1,000 patient-years) than in men (1.57/1,000 patient-years). The risk of coronary events increased by 18% in men and 21% in women with each 10 mg/dl elevation of LDL-C, and decreased by 39% in men and 33% in women with each 10 mg/dl elevation of HDL-C. The risk increased proportionally with aging in women, but not in men. Diabetes mellitus (DM) was more strongly related to the risk of coronary events for women (relative risk 3.07) than for men (relative risk 1.58). Conclusions The incidence of coronary events is lower in women. Serum LDL-C is related to an increased risk of coronary events to the same extent in both genders. DM seems to be a more important risk factor in women, trading off the lower risk of coronary events among them. (Circ J 2006; 70: 810 - 814)
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  • Kuniaki Jitsuiki, Kiminori Yamane, Masamitsu Nakajima, Shuhei Nakanish ...
    2006 Volume 70 Issue 7 Pages 815-819
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Chlamydia pneumoniae (Cp) infection has been proposed as a risk factor for coronary artery disease (CAD), but it remains unclear whether Cp plays a role in the progression of early stage carotid atherosclerosis. Methods and Results The associations among Cp IgG/IgA antibodies, inflammation markers such as C-reactive protein (CRP) and interleukin (IL)-6, and the maximal progression of carotid intima-media wall thickness (max IMT) were evaluated using ultrasonography in 259 Japanese Americans. The presence of Cp IgG or IgA antibodies itself did not show significant correlation with max IMT after adjustment for age and sex. However, in the Cp IgG seropositive group, the subjects with high IL-6 levels showed more pronounced max IMT progression than those with low IL-6 levels after adjustment of the other CAD risk factors. Moreover, in the Cp IgA seropositive group, the subjects with high CRP or IL-6 levels had significantly higher levels of max IMT compared with those with low CRP or IL-6. Conclusions The results support the hypothesis that a chronic latent Cp infection with inflammation might accelerate the development of early stage atherosclerotic lesions. (Circ J 2006; 70: 815 - 819)
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  • Seon Mee Kim, Jee Hye Han, Hye Soon Park
    2006 Volume 70 Issue 7 Pages 820-826
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Low levels of high-density lipoprotein cholesterol (HDL-C), as well as high levels of low-densi-ty lipoprotein cholesterol, play a crucial role in the development of cardiovascular disease, which has shown a remarkable increase in Korea. Method and Results Data were obtained from the 1998 Korean National Health and Nutrition Examination Survey, which was a cross-sectional national health survey. The total study population amounted to 7,300 individuals (3,283 men, 4,617 women), aged 18 years and older. The prevalence of low HDL-C levels, as proposed by National Cholesterol Education Program Adult Treatment Panel III or International Diabetes Federation, was 23.8% in men and 47.5% in women. After adjusting for independent variables, there was a greater risk of low HDL-C with an increased body mass index, abdominal obesity, cigarette smoking, and decreased alcohol consumption. Physically inactive lifestyle in men and low fat intake in women were identified as factors associated with low HDL-C level. Conclusions The prevalence of low HDL-C levels is relatively high among Koreans, which may have important implications for public health. Identified associated factors should be considered for reducing the risk of low HDL-C levels in Koreans. (Circ J 2006; 70: 820 - 826)
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  • Where Should Automated External Defibrillator be Placed?
    Hideyuki Muraoka, Yasuo Ohishi, Hiroshi Hazui, Nobuyuki Negoro, Motono ...
    2006 Volume 70 Issue 7 Pages 827-831
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Public access defibrillation has been introduced to improve the outcome of patients experiencing out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the best location for automated external defibrillators (AED). Methods and Results All patients who were resuscitated after OHCA by emergency medical technicians in Takatsuki City over 6 years were enrolled. The annual incidence of OHCA and the number of 1-year survivors with good neurological outcome in each of 21 sub-location categories were investigated, as well as the ratio of ventricular fibrillation (VF) as the initial rhythm to the total OHCA in each of 5 location categories. In total, there were 1,112 patients with OHCA, 62 (5.6%) with VF and 14 (1.3%) with good neurological outcome. The annual incidence of cardiac arrest (CA) per site was the highest in railway stations (0.3000), followed by hospitals (0.1802), homes for the aged (0.1115), playgrounds (0.0769) and golf courses (0.0667). However, none of the patients experiencing CA at railway stations, homes for the aged and golf courses had a good neurological outcome. The ratio of VF to total CA was the highest in the workplace (35.3%). Conclusions The 6 locations, including workplace, are recommended as appropriate locations for AED. (Circ J 2006; 70: 827 - 831)
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  • Kenichi Tsujita, Hideki Shimomura, Koichi Kaikita, Hiroaki Kawano, Jun ...
    2006 Volume 70 Issue 7 Pages 832-837
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The effect of edaravone, a free radical scavenger, on long-term prognosis and its efficacy with regards to scavenging injurious free radicals in patients with acute myocardial infarction (AMI) was examined. Methods and Results One hundred and one initial AMI patients were randomly assigned to receive 30 mg edaravone (n=50) or a placebo (n=51) intravenously just before reperfusion. The infarct size, using serum biomarkers and Q-wave formations, and the incidence of reperfusion arrhythmia between the groups were compared. Cardiovascular event-free curves were estimated by using the Kaplan - Meier method. In addition, the serum thioredoxin levels, an oxidative stress marker, to assess the antioxidant effect of edaravone was determined. In all cases, successful reperfusion was obtained within 6 h after the onset of symptoms. Infarct size and reperfusion arrhythmia were significantly attenuated in the edaravone group compared with the placebo group (p=0.035 and p=0.031). The cumulative event-free rate was significantly higher in the edaravone group than in the placebo group (p=0.045). Serum thioredoxin levels were significantly lower in the edaravone group than in the placebo group throughout the acute phase. Conclusions The present study suggests that the edaravone administration just prior to reperfusion might reduce oxidative stress and improve the long-term clinical outcomes of AMI patients. (Circ J 2006; 70: 832 -837)
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  • Hon-Kan Yip, Cheuk-Kwan Sun, Li-Teh Chang, Chiung-Jen Wu
    2006 Volume 70 Issue 7 Pages 838-845
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Little is known regarding the correlation between circulating levels of inflammatory mediators and their distribution within the infarct-related coronary artery (ICA). Methods and Results Atherothrombotic tissue and blood were aspirated by export suction catheter from the ICA in 49 patients with an acute myocardial infarction (AMI) <6 h duration who underwent primary percutaneous coronary intervention (PCI). Blood samples were collected before PCI for levels of high-sensitivity (hs) C-reactive protein (CRP), soluble P-selectin (sP-selectin) and white blood cell (WBC) counts. Immunohistochemical staining was performed for localization of CRP within the ICA. Staining intensity was graded for macrophage and extracellular tissue (0: no staining; 1+: <30%, 2+: 30% to 60%, and 3+: >60%). The hs-CRP levels were markedly higher in grade 3+ compared with both grade 2+ and grade 1+ of macrophage and extracellular staining of CRP (all p values <0.0001), and in grade 2+ compared with grade 1+ (p<0.001). Additionally, the ICA had a significantly higher sP-selectin level and WBC count compared with the systemic circulation (p<0.0001). Furthermore, the ICA level of sP-selectin was noticeably higher in patients with a total atherothrombus volume ≥0.5 cm3 than in patients with total volume <0.5 cm3 (p<0.0001). Moreover, correlation analysis demonstrated that the increase in the ICA level of sP-selectin was significantly related to the increase in the WBC count in the artery (r=0.548, p<0.0001). Multiple analysis identified an increased circulating level of hs-CRP as the only independent predictor of ≥2+ in macrophage (p<0.0001) and ≥2+ in extracellular (p<0.0001) staining of CRP. Conclusions Following AMI, the sP-selectin level and WBC count were markedly higher in the ICA than in the circulation. Moreover, the circulating level of hs-CRP was strongly associated with ICA localization of CRP. (Circ J 2006; 70: 838 - 845)
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  • Angioscopic Findings
    Masaki Awata, Jun-ichi Kotani, Shinsuke Nanto, Masaaki Uematsu, Takaka ...
    2006 Volume 70 Issue 7 Pages 846-850
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The nature of the vessel lumen following vascular brachytherapy (VBT) has not been extensively explored in the clinical setting. Methods and Results By using angioscopy, 33 stents treated with percutaneous balloon angioplasty with or without VBT for in-stent restenosis after 8.9±2.1 months of the treatment were followed (VBT =14 lesions; control =19 lesions). Neointimal coverage, stent attachment, and the presence of red or white thrombi were factors that were assessed. The majority of the stents (74%) were fully covered with non-transparent neointima in the control group. In contrast, stent struts were clearly seen in 57% lesions with VBT. The absence of neointima with glittering stent struts were only seen in 29% of lesions in VBT (p=0.03). Incomplete stent attachment was not detected in the controls, whereas 14% were in VBT (p=0.17). Red thrombi were observed in 14% with VBT and in 16% in controls, which showed that there was a similar incidence regardless of the treatment. Neither exposure of stent struts (p=0.5) nor incomplete stent attachment (p=1.0) was related to thrombi. Conclusions The exposure of stent struts and incomplete stent attachment were occasionally observed by angioscopy even 9 months after VBT for the treatment of in-stent restenosis. (Circ J 2006; 70: 846 - 850)
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  • Hirofumi Soejima, Atsushi Irie, Takashi Fukunaga, Koichi Sugamura, Sun ...
    2006 Volume 70 Issue 7 Pages 851-856
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Plaque instability in patients with unstable angina (UA) is associated with stimulated CD4+ T cells, so the present study investigated whether there is a relationship among plaque instability, osteopontin and CD4+ T cells. Methods and Results Peripheral blood mononuclear cells were collected from 51 consecutive patients with UA, 60 patients with stable angina (SA), and 39 patients with chest pain syndrome (CPS). Osteopontin-producing CD4+ T cells were quantified by flow cytometry. Plasma osteopontin levels (ng/ml) were measured by ELISA and were higher in patients with UA (792.0±316.7) than in those with SA (626.0±195.0, p<0.005) or CPS (594.7±239.4, p<0.005). The frequency (%) of osteopontin-producing CD4+ T cells was higher in patients with UA (26.7±13.3) than in those with SA (19.5±11.1, p<0.05) or CPS (16.6±9.0, p<0.005). Furthermore, the plasma osteopontin level correlated with the frequency of osteopontin-producing CD4+ T cells (r=0.327, p=0.0004), as did the high-sensitivity C-reactive protein level (r=0.360, p=0.0002). Conclusions The plasma osteopontin levels are elevated in patients with UA, accompanied by an increase in the number of osteopontin-production of circulating CD4+ T cells. Circulating CD4+ T cells may play a role through osteopontin in the pathophysiology of UA. (Circ J 2006; 70: 851 - 856)
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  • Chitose Ishikawa, Takayoshi Tsutamoto, Masanori Fujii, Hiroshi Sakai, ...
    2006 Volume 70 Issue 7 Pages 857-863
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The prognostic role of serum C-reactive protein (CRP) in chronic heart failure (CHF) patients, especially those with nonischemic dilated cardiomyopathy (DCM), remains unknown. In the present study, whether CRP provides prognostic information in DCM patients was evaluated. Methods and Results Neurohumoral factors and hemodynamics in 84 consecutive DCM patients were measured and these patients were followed up for a mean period of 42 months. During the follow-up period, 23 patients developed cardiac events and 18 patients died of cardiac causes. Using stepwise multivariate Cox proportional hazards regression analyses, log brain natriuretic peptide (BNP) (p=0.007) and high-sensitivity CRP (hsCRP) >1 mg/L (p=0.008) were significant independent predictors of cardiac events. The patients were stratified into 4 groups based on the normal serum concentration of hsCRP (1 mg/L) and median plasma concentration of BNP (110 pg/ml). Survival rates were significantly higher in patients with hsCRP <1 mg/L and BNP <110 pg/ml. The hazard ratio of patients with BNP >110 pg/ml and hsCRP >1 mg/L was 15.8 (95% confidence interval, 1.9-127.2) compared with those with BNP <110 pg/ml and hsCRP <1 mg/L for cardiac death. Conclusions Serum hsCRP level is an independent prognostic predictor in patients with DCM and the combination of hsCRP and BNP may be useful for the management of CHF patients with DCM. (Circ J 2006; 70: 857 - 863)
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  • Yasuhiro Nishiyama, Motooki Minohara, Masatugu Ohe, Yuji Hirai, Atsush ...
    2006 Volume 70 Issue 7 Pages 864-867
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The effect of physical training on insulin resistance (IR) in chronic heart failure (CHF) remains unclear. Methods and Results Fourteen patients with CHF performed physical training using a bicycle ergometer; 9 patients (64%) were hyperinsulinemic and insulin resistant (HOMA IR >1.97). Exercise tolerance increased (5.1±1.7 to 6.9±2.7 METs, p<0.05) and heart rate at rest decreased (82±15 to 72±6, p<0.05) in the IR group after physical training. Physical training also decreased the insulin level (15.1 ±5.6 to 9.8±2.6 μU/ml, p<0.05) and HOMA IR (3.7±1.4 to 2.3±0.6, p<0.05) in the IR group, but not in the 5 patients (36%) without IR or in 6 control patients. Conclusion Physical training can improve hyperinsulinemia and IR in patients with CHF. (Circ J 2006; 70: 864 - 867)
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  • Ryotaro Wake, Masaaki Takeuchi, Minoru Yoshiyama, Junichi Yoshikawa
    2006 Volume 70 Issue 7 Pages 868-874
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Non-invasive diagnosis and risk stratification of coronary artery disease are important for the selection and optimization of therapeutic interventions in diabetic patients, which may improve survival. The aim of this study was to determine the incremental value of contrast-enhanced dobutamine stress echocardiography (CE-DSE) for risk stratification. Methods and Results CE-DSE was performed in 326 patients with diabetes mellitus (mean age; 66±10 years, 223 men). All patients were followed up for a mean of 29 months (1-61 months). Dobutamine was infused in a standard protocol with an intravenous contrast agent. The primary endpoints for hard cardiac events included cardiac death and nonfatal myocardial infarction. The primary endpoints for total cardiac events included hard cardiac events, unstable angina pectoris, congestive heart failure, and late coronary revascularization (>3 months). Cardiac events occurred in 74 patients. The addition of the CE-DSE results, including abnormal left ventricular end-systolic volume response and left ventricular ejection fraction at peak stress <50%, to the clinical and rest echocardiography model provided incremental information in predicting total cardiac events (increase in chi-square value for the model from 17 to 24, p<0.05) and hard cardiac events (increase in chi-square value for the model from 18 to 24, p<0.05). Conclusions Quantitative assessment of left ventricular function during CE-DSE provides incremental prognostic information in predicting cardiac events in diabetic patients. (Circ J 2006; 70: 868 - 874)
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  • Takayoshi Hirota, Hiroaki Kitaoka, Toru Kubo, Makoto Okawa, Takashi Fu ...
    2006 Volume 70 Issue 7 Pages 875-879
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Several morphologic distinctions between elderly and young patients with hypertrophic cardiomyopathy (HCM) have been reported. In particular, a crescent-shaped left ventricular (LV) cavity with reversed septal curvature, which is often seen in young patients, is rare in elderly patients. However, those studies were carried out before gene testing became available and heterogeneous causes or age-related changes may have been included. The purpose of this study was to determine the morphologic characteristics of elderly patients with HCM definitely caused by a mutation in the cardiac myosin-binding protein C (MyBPC). Methods and Results Twenty-seven patients with HCM caused by MyBPC gene abnormality were evaluated. Patients were divided into an elderly group (≥65 years of age, n=8) and a young group (<65 years of age, n=19). LV hypertrophy was milder in the elderly than in the young for maximum LV wall thickness (18±5 mm vs 24±6 mm, p=0.008) and Wigle score (5.7±1.5 vs 7.6±1.6, p<0.005). However, an abnormal crescent-shaped LV was similarly prominent in both groups (75% in the elderly vs 95% in the young, p=NS). None of the elderly patients showed a proximal septal bulge. Conclusions An abnormal crescent-shaped LV cavity was frequently present in the elderly as in the young when there are MyBPC mutations. It is possible that this morphologic feature could become useful for determining the etiology of HCM in elderly patients. (Circ J 2006; 70: 875 - 879)
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  • Josef Veselka, Radka Duchonová, Jana Páleníckov&a ...
    2006 Volume 70 Issue 7 Pages 880-884
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Alcohol septal ablation (ASA) decreases the left ventricular (LV) outflow gradient and relieves symptoms in patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to evaluate the early course of hemodynamic, morphologic and clinical changes in younger and elderly patients. Methods and Results Forty-four consecutive patients (age, 24-81 years) underwent the ASA procedure for HOCM. Clinical and echocardiographic data were obtained at baseline and periodically up to 12 months after ASA. There was a significant correlation between septum thickness and age at baseline and in the early post procedural period (p=0.004 at baseline, p=0.0033 days postoperative, p=0.0193 weeks pos operative). The dependence of septal thickness on the duration of follow-up (p<0.001) was significantly influenced by age (p=0.026), which retained statistical significance after multivariate adjustment (p=0.031). A decrease in the gradient of the LV outflow was identified in all age-related groups of patients (p<0.001). After multivariate adjustment, there was a significant influence of age (p=0.003) and creatine kinase-MB peak (p=0.016) on the course of outflow gradient reduction. Conclusions ASA is an effective treatment option for patients with HOCM, irrespective of their age. Younger patients are characterized by a thicker basal septum at baseline and a slower hemodynamic improvement within the early post procedural period. (Circ J 2006; 70: 880 - 884)
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  • Kiyoshi Matsumura, Toshio Ohtsubo, Hideyuki Oniki, Koji Fujii, Mitsuo ...
    2006 Volume 70 Issue 7 Pages 885-888
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The aim of the present study was to determine whether sex differences contribute to the association of serum uric acid and left ventricular hypertrophy in individuals with hypertension. Methods and Results Seventy participants with essential hypertension (34 men, 36 women; 54.4±1.6 years old) were enrolled to undergo echocardiography to calculate the left ventricular mass index (LVMI). Twenty-four-hour ambulatory blood pressure monitoring was done to assess blood pressure level precisely. The LVMI was significantly correlated with serum uric acid (r=0.295, p=0.013) in all participants. After controlling for factors such as age, sex, mean 24-h systolic blood pressure, creatinine clearance, and duration of hypertension, serum uric acid was still found to be significantly and independently associated with LVMI. Because serum uric acid was significantly higher in men than in women (6.8±0.3 and 5.1±0.2 mg/dl, respectively), subsequent analysis was performed by gender. Multiple regression analysis revealed that the LVMI was significantly and independently associated with serum uric acid in women, but not in men. Conclusions The potential effect of uric acid on LV hypertrophy is more pronounced in female than in males with essential hypertension. (Circ J 2006; 70: 885 - 888)
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  • Hirofumi Tasaki, Takumi Serita, Chiaki Ueyama, Kouei Kitano, Shinji Se ...
    2006 Volume 70 Issue 7 Pages 889-895
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Backgound The long-term age-related changes in circadian rhythm of heart rate variability (HRV), that is, autonomic nervous activity, remain unknown in elderly people. Methods and Results Holter monitoring was conducted twice at an interval of 15 years in 15 healthy elderly patients (age: 70.0±4.1 years, at first monitoring, female: 10) and assessed the age-related changes in 24-h mean and hourly mean normal sinus R-R interval (mean NN), HRV (high frequency (HF) component, low frequency (LF) component and LF/HF) and the circadian rhythms. As a result, 24-h mean mean NN (0.976±0.115 vs 0.903±0.117 (s), p=0.0019), LF/HF (1.681±0.731 vs 0.962±0.442, p=0.0022), and LF (278.88±176.43 vs 179.19±132.33 (ms2), p=0.0039) significantly decreased 15 years later, although 24-h mean HF (221.20±138.89 vs 310.78±296.73 (ms2), p=0.1102) increased slightly. The hourly mean NN closely correlated with hourly HF and LF/HF throughout circadian rhythms both at first and second monitoring. In the morning hours, amplitude rates of all HRV indices increased significantly 15 years later. Conclusion In elderly people, age-related changes in the 24-h mean heart rate (HR) were conversely dissociated from those of the 24-h mean HRV. However, the close correlation between hourly HR and HRV was preserved, even in very elderly patients. Additionally, the amplitude rates in HRV in the morning increased with age. These age-related changes of HR and HRV might be characteristic of elderly people. (Circ J 2006; 70: 889 - 895)
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  • Koichi Mizumaki, Akira Fujiki, Kunihiro Nishida, Masao Sakabe, Takayuk ...
    2006 Volume 70 Issue 7 Pages 896-901
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background In patients with Brugada syndrome (BS), ventricular fibrillation (VF) occurs mainly during sleep; therefore, not only vagal activity but also bradycardia dependent changes in ECG may relate to the nighttime occurrence of VF. The present study aimed to examine the difference in bradycardia-dependent changes in the ECG of symptomatic and asymptomatic BS patients. Methods and Results Twenty-one patients with BS were categorized into symptomatic (n=9) and asymptomatic (n=12) groups. During the electrophysiologic study, the ECG changes were evaluated at RR intervals of 400, 600, 750, 1,000 and 1,100 ms during extrastimulation from the right atrium. The ST levels in V2, and the QT interval in both V2 and V5 were measured. Along with an increase in the RR interval from 400 to 1,100 ms, the ST levels in V2 increased in both groups; the increase did not differ between the 2 groups. In both leads V2 and V5, the prolongation of the QT interval along with an increase in the RR interval from 400 to 1,100 ms was significantly smaller and the QT intervals at an RR interval of 1,100 ms were significantly shorter in the symptomatic than in the asymptomatic group. Conclusions In patients with BS, the ST elevation was augmented during bradycardia to a similar extent in both symptomatic and asymptomatic patients. However, a inhibited prolongation of the QT interval during bradycardia was characteristic of symptomatic patients. These unique repolarization dynamics could relate to the nighttime occurrence of VF during bradycardia in patients with BS. (Circ J 2006; 70: 896 - 901)
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  • Masaru Suzuki, Shingo Hori, Yutaka Tomita, Naoki Aikawa
    2006 Volume 70 Issue 7 Pages 902-908
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Autonomic dysfunction contributes to orthostatic intolerance in vasovagal syncope (VVS), but as it has not been identified by spectral analysis of heart rate variability (HRV) in previous studies, the present hypothesis was that nonlinear analysis of HRV would identify the orthostatic intolerance in VVS. Methods and Results Twenty-six patients with VVS and 14 matched controls were subjected to 80-degree head-up tilt test (positive: 13 patients; negative: 13 patients and 14 controls). There were no differences in the orthostatic changes in the indices of spectral analyses of HRV among the 3 groups. The Lyapunov exponent (LE) was calculated from 200 consecutive RR-intervals to investigate chaotic behavior, and cardiac chaos was defined as the incidence of the presence of a positive finite LE. Orthostatic decreases in cardiac chaos were observed in the VVS patients (both the positive and negative groups), although there was no orthostatic decrease in the control group (ANOVA: p=0.008). The receiver-operator characteristic curve indicated that cardiac chaos during the tilt identified VVS regardless of the results of the tilt (p<0.001, sensitivity: 85.7%, specificity: 96.2%). Conclusions The decrease in cardiac chaos during the tilt test was specific to patients with VVS, even if their response to the test was negative. (Circ J 2006; 70: 902 - 908)
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  • Yoshihisa Tanoue, Shigeki Morita, Yoshie Ochiai, Munetaka Masuda, Ryuj ...
    2006 Volume 70 Issue 7 Pages 909-912
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Atrial septal defect (ASD) closure is one of the most representative cardiac operations, but there have been few assessments of right ventricular (RV) performance during the perioperative period. Methods and Results Using transesophageal echocardiography with automated border detection system, the RV pressure - area (P-A) loops were measured in 6 patients immediately before and after an ASD closure. Multiple RV P-A loops obtained by the inferior vena cava occlusion technique were used to evaluate end-systolic maximal elastance (Ees), preload recruitable stroke work (MEW), external work (EW) and the systolic P-A area (PAA). Ees and MEW are indices of contractility, and PAA represents the total mechanical energy. RV Ees and MEW did not change after the operation (from 3.36±2.20 to 3.70±2.04 mmHg/cm2, p=0.4; and from 10.3±5.0 to 10.5±4.5 mmHg, p=0.8, respectively), whereas EW and PAA were significantly reduced (from 121.4±77.4 to 48.7±26.6 mmHg/cm2, p<0.05; and from 274.8±212.8 to 92.7±52.8 mmHg/cm2, p<0.05, respectively). ASD closure reduced the EW and total mechanical energy of the right ventricle without influencing contractility. Conclusions These results indicate that ASD closure preserved RV function and reduced RV myocardial oxygen consumption. Assessment of the RV P-A relationship in the operating room demonstrates the beneficial effects of ASD closure on RV performance. (Circ J 2006; 70: 909 - 912)
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Experimental Investigation
  • Tetsuya Ishikawa, Seibu Mochizuki, Satoshi Kurihara
    2006 Volume 70 Issue 7 Pages 913-918
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The aim of the present study was to indicate the cross-bridge-dependent change in the Ca2+ affinity of troponin-C (TnC) during relaxation in an intact preparation, because the intracellular mechanism of relaxation is not fully understood, although several methods of evaluating global diastolic function have been reported. Methods and Results The aequorin method was used with intact ferret papillary muscles and a tetanic contraction was induced by a repetitive electrical stimulation in the presence of ryanodine. The extra-Ca2+, the transient increase in the intracellular Ca2+ concentration in response to a rapid reduction in muscle length, which reflects the change in the Ca2+ affinity of TnC because of cross-bridge detachment, was measured, and the cross-bridge-dependent change in the Ca2+ affinity of TnC was estimated by observing the change in the slope of the extra-Ca2+-tension relation. The extra-Ca2+-tension relation measured during relaxation became steeper than that during contraction in all cases. The extra-Ca2+-tension relation became steeper in the presence of 20 mmol/L caffeine during contraction in all cases. Conclusion During relaxation, the downstream-dependent change in the Ca2+ affinity of TnC was enhanced, compared with that during contraction, because of a decrease in the number of attached cross-bridges. (Circ J 2006; 70: 913 - 918)
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  • Teruo Nakadate, Takashi Nozawa, Akira Matsuki, Makoto Nonomura, Norio ...
    2006 Volume 70 Issue 7 Pages 919-925
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background The aim of this study was to investigate the effects of brief ischemia before prolonged ischemia on cardiac sympathetic neural function. Brief ischemia inhibits the sympathetic neural release of norepinephrine (NE) during subsequent sustained ischemia. However, whether it can attenuate the neural function after sustained ischemia remains unknown. Methods and Results Sympathetic neural function was assessed using 123I-metaiodobenzylguanidine (MIBG) in patients who with (Group I) or without angina (Group II) within 3 days prior to acute myocardial infarction. In the rat experiment, cardiac interstitial NE (iNE) with or without pretreatment of 5-min coronary ligation was determined during a 30-min occlusion. Differences between MIBG and Thallium-201 for the total defect score were significantly greater in Group II than in Group I (6.1±4.0 vs 0.4±4.4). Levels of iNE were less in rats with a 5-min pretreatment (7.3±2.3 vs 18.6±5.9 ×103 pg/ml, p<0.01) and MIBG uptake of ischemic region was greater (0.061±0.029 vs 0.031±0.011 %kg dose/g, p<0.05) compared with rats without the pretreatment. Conclusion A brief episode of ischemia attenuates the sympathetic neural injury caused by subsequent prolonged ischemia and this protective effect is associated with attenuation of NE release during the prolonged ischemia. (Circ J 2006; 70: 919 - 925)
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  • Mitsuharu Kawamura, Youichi Kobayashi, Hiroyuki Ito, Tatsuya Onuki, Fu ...
    2006 Volume 70 Issue 7 Pages 926-932
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Background Transthoracic epicardial ablation can be an alternative to conventional treatment for critical pathways of ventricular tachycardia located in the epicardium. However, the usefulness and safety of epicardial ablation close to the coronary arteries (CA) is not clear. The purpose of the present experimental animal study was to analyze the efficacy and safety of epicardial radiofrequency (RF) ablation close to the CA. Methods and Results Of the left ventricle-epicardium ablated sites, 35 lesions (20 with cooling and 15 without cooling) were close to the CA (left anterior descending artery ≤15 mm) and 33 lesions (23 with cooling and 10 without cooling) were further from the CA. For sites close to the CA, epicardial ablation was effective in 77% (15/20) with cooling and in 40% (6/15) without cooling. There was a significant difference of effective ablation between with cooling and without cooling (p<0.05). For cooling, epicardial lesion size could be predicted by the change of endocardial ventricular potential using a basket catheter. No damage to major epicardial arteries was detected when the catheter tip was positioned 5 mm away from the CA. Conclusions Close to the CA, RF ablation with cooling is more effective than RF without cooling and is safe if the ablation sites are located 5 mm away from the major CA. (Circ J 2006; 70: 926 - 932)
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Case Report
  • Iori Nagaoka, Keiji Matsui, Takeshi Ueyama, Masashi Kanemoto, Jie Wu, ...
    2006 Volume 70 Issue 7 Pages 933-935
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease characterized by dilatation and akinesis of the right ventricle, and causes life-threatening ventricular arrhythmia. Mutations of plakophilin-2 (PKP2) have recently been identified as one causative abnormality in ARVC. A case of ARVC with a mutation of PKP2 is reported here. Direct sequencing of the patient's DNA revealed an insertion mutation in exon 8 of PKP2 (1728_1729insGATG). The mutation caused the frameshift and the premature termination of translation (R577DfsX5). This is the first case report of PKP2 mutation found in Japanese ARVC patients. (Circ J 2006; 70: 933 - 935)
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  • Jean-Francois Surmely, Yoshihisa Kinoshita, Debabrata Dash, Tetsuo Mat ...
    2006 Volume 70 Issue 7 Pages 936-938
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Percutaneous treatment of a bifurcation lesion still shows a significant complication rate, mainly because of restenosis at the ostial site of the side branch vessel. Different techniques, such as V-stenting, culottes-stenting or crush stenting, allow full ostial coverage and may therefore achieve uniform drug distribution within the lesion. The crush technique results in a strong mechanical constraint on the side branch stent. A case of stent strut fracture-induced restenosis in a bifurcation lesion treated with the crush stenting technique is described. (Circ J 2006; 70: 936 - 938)
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  • 10-Year Follow-up
    Osami Honjo, Kozo Ishino, Masaaki Kawada, Shin-ichi Ohtsuki, Teiji Aka ...
    2006 Volume 70 Issue 7 Pages 939-941
    Published: 2006
    Released on J-STAGE: June 25, 2006
    JOURNAL FREE ACCESS
    Despite successful surgical repair, patients with congenital aortico-left ventricular tunnel (ALVT) are at risk of developing aortic incompetence in the late postoperative period. Two cases of ALVT were followed for 10 years with special reference to aortic incompetence and geometry of the aortic root. The patients underwent repair of ALVT, one at 4 years of age and the other at 4 months of age. The first patient had a slit-like tunnel (type I) and the aortic orifice was closed with a pericardial patch. The second patient had a large tunnel with an extracardiac aneurysm (type II) and was closed with a pericardial patch at the aortic orifice and a Dacron patch at the left ventricular orifice, thereby completely obliterating the tunnel. The last echocardiographic evaluation showed no residual flow in the tunnel and no aortic incompetence in case 1, but there was mild aortic valvular regurgitation with deformity of the right sinus in case 2. Careful long-term follow-up is necessary because patients with ALVT have some inherent structural abnormalities from the left ventricular outflow tract to the aortic root. (Circ J 2006; 70: 939 - 941)
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Rapid Communication
Corrigendum
  • 2006 Volume 70 Issue 7 Pages 945
    Published: 2006
    Released on J-STAGE: September 14, 2006
    JOURNAL FREE ACCESS
    Wrong:Y Nakazato, MD (Juntendo University, Tokyo), T Tanabe, MD (Tokai University, Isehara),
    Right:Y Nakazato, MD (Juntendo University, Tokyo), S Niwano, MD (Kitasato University, Sagamihara), T Tanabe, MD (Tokai University, Isehara),
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