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Toshihiro Tamura, Yutaka Furukawa, Ryoji Taniguchi, Yukihito Sato, Koh ...
2007 Volume 71 Issue 5 Pages
623-630
Published: 2007
Released on J-STAGE: April 25, 2007
JOURNAL
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Background Congestive heart failure (CHF) is associated with altered energy homeostasis and myocardial inflammation, hypertrophy, and fibrosis. Adiponectin, an insulin-sensitizing adipocytokine, may affect these pathogenic factors, and the circulating adiponectin level may serve as a biological marker of CHF. This study aimed to assess the significance of serum adiponectin as a prognostic marker for Japanese CHF patients.
Methods and Results The serum adiponectin levels were compared between 54 (24 ischemic and 30 non-ischemic) CHF patients with left ventricular systolic dysfunction and 55 age- and gender-matched control subjects. The CHF patients also underwent simultaneous clinical assessment and measurements for brain natriuretic peptide (BNP) and parameters of lipid or glucose metabolism. Compared with the controls, the CHF patients showed significantly increased serum adiponectin levels [6.7 (4.9-12.6) vs 14.6 (9.7-25.4) μg/ml, p<0.0001]. In the CHF patients, the log-transformed values of the serum adiponectin levels positively correlated with the log-transformed values of the plasma BNP levels (p=0.0003, r=0.48) and inversely correlated with the body mass index (p=0.0006, r=-0.46). Furthermore, an increase in the serum adiponectin level was associated with higher mortality (p<0.05), particularly in the ischemic CHF patients (p<0.005).
Conclusions An increase in the circulating adiponectin level was associated with higher mortality in the ischemic CHF patients. Adiponectin may be an informative risk marker for Japanese CHF patients. (
Circ J 2007;
71: 623 - 630)
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Yukiko Nishio, Yukihito Sato, Ryoji Taniguchi, Satoshi Shizuta, Takahi ...
2007 Volume 71 Issue 5 Pages
631-635
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Several pathologic processes can cause myocardial injury, which is followed by cardiac remodeling and congestive heart failure (CHF). Cardiac troponin T (cTnT), a specific and sensitive marker of myocardial injury, has been related to long-term outcome in patients with CHF, so the relationship between cTnT and other biochemical markers associated with the pathophysiology of CHF was investigated in the present study.
Methods and Results Between February 2004 and December 2005, 145 consecutive hospitalized patients (mean left ventricular ejection fraction (LVEF) 31.6±0.9%) with CHF were divided into low (<0.01 ng/ml) and high (≥0.01 ng/ml) serum cTnT groups. Correlations with other prognostic biochemical markers, including brain natriuretic peptide (BNP), type I collagen C-terminal telopeptide (ICTP), procollagen type III peptide (PIIIP), renin, norepinephrine (NOREPI), C-reactive protein (CRP), cholesterol, hemoglobin (Hb), uric acid and HbA1c were examined. cTnT was high in 46 (32%) and low in 99 (68%) patients at baseline. Patients with high cTnT had abnormally high blood concentrations of BNP (p<0.0001), ICTP (p<0.0001), PIIIP (p=0.0006), NOREPI (p=0.0119), CRP (p=0.0003), uric acid (p=0.0026) and HbA1c (p=0.0361). In contrast, concentrations of cholesterol and Hb were significantly lower in patients with high cTnT (p=0.0319 and 0.0005, respectively). Death from or rehospitalization for CHF occurred in 41% in the high vs 9% in the low cTnT group (p=0.0002). Univariate analysis showed that high cTnT (p=0.0005), BNP (p=0.0001), renin (p=0.0158), NOREPI (p=0.0094), old age (p=0.0390), low LVEF (p=0.0231) and high New York Heart Association (NYHA) class (p=0.0006) were predictors of death from or rehospitalization for CHF. By multivariate analysis including BNP, NOREPI, age, LVEF and NYHA class, high cTnT and renin remained as significant predictors.
Conclusions Patients with ongoing myocardial injury and high cTnT had associated findings consistent with activation of the sympathetic system, synthesis of cardiac fibrosis, inflammation and metabolic abnormalities. By multivariate analysis, high cTnT and renin remained significant predictors of death or rehospitalization. (
Circ J 2007;
71: 631 - 635)
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Analysis by Intracardiac Echocardiography
Yasuo Okumura, Ichiro Watanabe, Sonoko Ashino, Masayoshi Kofune, Kimie ...
2007 Volume 71 Issue 5 Pages
636-642
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The posterior right atrial transverse conduction capability during typical atrial flutter (AFL) is well known, but its relationship to the anatomical characteristics remains controversial.
Methods and Results Thirty-four AFL and 16 controls underwent intracardiac echocardiography after placement of a 20-polar catheter at the posterior block site during AFL or pacing. In 31 patients, the effective refractory period (ERP) at the block site was determined as the longest coupling interval that resulted in double potentials during extrastimuli from the mid-septal (SW) and free (FW) walls. The block site was located 3.0-29.0 mm posterior to the crista terminalis (CT) in each AFL and control patient. The CT area indexed to the body surface area was larger in AFL patients than in control patients (16.4±6.5 mm
2/m
2 vs 11.3±6.4 mm
2/m
2, p=0.01), and was positively correlated to age (r=0.34, p=0.02). The ERP was longer in the AFL patients than in controls (SW: median value 600 [270-725] ms vs 220 [200-253] ms; FW: 280 [230-675] ms vs 215 [188-260] ms, p<0.05 for each).
Conclusions A functional block line was located on the septal side of the CT in all patients. A limited conduction capability and age-related CT enlargement might have important implications for the pathogenesis in AFL. (
Circ J 2007;
71: 636 - 642)
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Teruyoshi Kume, Hiroyuki Okura, Takahiro Kawamoto, Takashi Akasaka, Ei ...
2007 Volume 71 Issue 5 Pages
643-647
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Several studies have shown that rotational atherectomy (RA) is associated with higher rates of the slow-flow phenomenon and that ablated particles may be the possible cause. Intravascular ultrasound (IVUS) has an intrinsic limitation in assessing plaque morphology behind the calcification because of acoustic shadowing. Therefore, the purpose of this study was to investigate plaque characteristics behind severe calcification by histological examination.
Methods and Results One hundred eight coronary arterial segments from 40 human cadavers (24 males, 16 females, mean age 74±7 years) were examined. Serial images of IVUS were obtained and 18 severe calcified lesions were collected. Experienced observers quantitatively analyzed the lesions by computerized planimetry for fibrous, fibrofatty, calcification, and necrotic tissue area. Histologically, 15 of 18 severely calcified lesions (83%) had an extensive necrotic tissue containing large numbers of cholesterol crystals and microcalcifications; 16 of same 18 severely calcified lesions (89%) had fibrofatty tissue as well as calcification. The necrotic tissue occupied 14±13% and fibrofatty tissue occupied 13±11% of severely calcified lesions.
Conclusion Necrotic core and fibrofatty tissue components "hidden" behind calcification might cause emboli-induced thrombus formation and distal flow disturbance during RA. (
Circ J 2007;
71: 643 - 647)
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An Intravascular Ultrasound Study
Hiroyuki Okura, Haruyuki Taguchi, Tomoichiro Kubo, Iku Toda, Kiyoshi Y ...
2007 Volume 71 Issue 5 Pages
648-653
Published: 2007
Released on J-STAGE: April 25, 2007
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Background No reflow following percutaneous coronary intervention (PCI) is a major concern in patients with acute coronary syndrome (ACS) and it may be influenced by the preexisting plaque type.
Methods and Results To evaluate the impact of plaque characteristics on coronary reflow following PCI in patients with ACS, a total of 110 patients (89 acute myocardial infarction, 21 unstable angina) were assessed by intravascular ultrasound. Plaque type was categorized as either atherosclerotic plaque without ultrasonic attenuation (group 1) or atherosclerotic plaque with attenuation (group 2). External elastic membrane, plaque plus media, and lumen area were measured. Coronary flow was assessed by Thrombolysis in Myocardial Infarction (TIMI) grade and TIMI frame count. Although the final TIMI frame count was similar between the 2 groups, TIMI frame count immediately after the first balloon inflation was significantly higher in group 2 (p=0.03). Despite the similar final TIMI grade and TIMI frame count, peak creatine kinase level was significantly higher (3,035±2,553 vs 1,950±1,958 IU/L, p=0.04) and fatal arrhythmia more frequently observed (16.4% vs 2.7%, p=0.04) in group 2 than in group 1.
Conclusions Atherosclerotic plaque with ultrasonic attenuation may be related to a transient deterioration in coronary flow and as a result larger infarct size and higher incidence of fatal arrhythmia following PCI in patients with ACS. These results may help in selecting lesions suitable for distal protection devices. (
Circ J 2007;
71: 648 - 653)
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An Intravascular Ultrasound Radiofrequency Analysis
Yasutomi Higashikuni, Kengo Tanabe, Hirosada Yamamoto, Jiro Aoki, Gaku ...
2007 Volume 71 Issue 5 Pages
654-660
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The relationship between coronary artery remodeling and culprit plaque composition in vivo has not been fully evaluated by spectral analysis of intravascular ultrasound (IVUS) radiofrequency (RF) data.
Methods and Results IVUS RF analyses were performed for 56 consecutive de novo culprit lesions of 52 patients undergoing percutaneous coronary intervention. Remodeling of culprit lesions was determined using the remodeling index (RI), calculated as the external elastic membrane area of the minimum lumen area (MLA) site divided by that of the proximal reference site. Positive remodeling was defined as RI >1.05, intermediate remodeling as 0.95≤ RI ≤1.05 and negative remodeling as RI <0.95. Among the 56 lesions, positive remodeling was detected in 24, intermediate remodeling in 16, and negative remodeling in 16. At MLA sites, positive remodeling lesions had a larger percentage of the fibrofatty component than negative remodeling lesions (22.5±10.3% vs 10.4±6.6%, p=0.0001), whereas the latter contained a larger percentage of the dense calcium component than the former (2.8±2.9% vs 8.4±7.0%, p=0.016).
Conclusions Culprit plaques with positive remodeling have a large lipid burden, whereas those with negative remodeling contain a large amount of calcium. (
Circ J 2007;
71: 654 - 660)
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Quantitative Assessment Utilizing a Novel Automated Tissue Tracking Technique
Eizo Akagawa, Kazuya Murata, Nobuaki Tanaka, Hirotsugu Yamada, Toshiro ...
2007 Volume 71 Issue 5 Pages
661-668
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The difference in the left ventricular (LV) torsion of the endo- and epicardium (Endo, Epi) with inotropic stimulation and its relation to radial strain (RS) remain unclear.
Methods and Results LV basal and apical short-axis images were recorded in 13 normal subjects at rest and during dobutamine infusion (5, 10 μg · kg
-1 · min
-1). A total of 8 points (anterior, lateral, posterior and septum in both Endo and Epi) were manually placed by 2-dimensional tissue tracking technique and the movement of these points during a cardiac cycle was tracked, after which the rotation angles and RS were calculated. LV torsion was defined as the net difference between the basal and apical rotations. In the LV apex, Endo-rotation increased (7.8±2.7 to 14.1±4.6 degrees, p<0.01), whereas Epi-rotation was unchanged, with dobutamine. The apical Endo-rotation was significantly greater than the Epi-rotation, although no difference was seen between the Endo and Epi in the LV base throughout the study. During dobutamine infusion, the LV Endo-torsion increased (9.5±2.8 to 19.3±4.8 degrees, p<0.01) and these values were greater than those for Epi. The apical RS increased with the dobutamine dose (39.0±9.3 to 61.9±15.5%, p<0.01), whereas basal RS initially increased at 5 μg · kg
-1 · min
-1, but thereafter showed no further increase at 10 μg · kg
-1 · min
-1 of dobutamine.
Conclusions Augmentation of LV rotation with inotropism was clearly observed in the apical Endo, thus causing increased LV endo-torsion and apical RS. (
Circ J 2007;
71: 661 - 668)
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A Hemodialysis-Related Preload Reduction Study
Jin-Oh Choi, Seung Woo Park, Dae-Hee Shin, Sung Hea Kim, Wang-Soo Lee, ...
2007 Volume 71 Issue 5 Pages
669-674
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The novel parameter T
E-E', which is the time interval between the onset of the early diastolic mitral inflow velocity (E) and the early diastolic mitral annular velocity (E'), is reported to be related to the constant of the left ventricular (LV) relaxation, and T
E-E' is also reported to be useful for predicting the LV filling pressure.
Methods and Results To investigate the effect of preload reduction via hemodialysis on T
E-E', 28 pairs of echocardiographic evaluations were performed just before and immediately after hemodialysis, including the measurement of the T
E-E' as well as measurement of the conventional echocardiographic parameters. The baseline T
E-E' was 17.9 ±28.1 ms, which correlated with the ratio of E/E' (r=0.49, p=0.008). After hemodialysis, T
E-E' was shortened to -3.2±34.1 ms, which was a significant change from baseline (p=0.001).
Conclusions As T
E-E' is a preload dependent parameter, the intravascular volume status should be taken into account when the clinical application of T
E-E' is considered as an index of LV relaxation. (
Circ J 2007;
71: 669 - 674)
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Keisuke Shioji, Soji Moriwaki, Yuzo Takeuchi, Takashi Uegaito, Satoru ...
2007 Volume 71 Issue 5 Pages
675-680
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Hypoadiponectinemia has been reported to indicate an increased risk of cardiovascular disease, so the present study investigated the significance of serum adiponectin (APN) levels for predicting clinical outcomes after percutaneous coronary intervention (PCI).
Methods and Results The APN levels were evaluated in 184 consecutive patients who underwent PCI. The patients were divided into Group A [the lowest quartile of APN levels (APN ≤4.5 μg/ml), n=46] and Group B [the upper 3 quartiles of APN levels (APN >4.5 μg/ml), n=138]. During a mean follow-up period of 27.3 months, the rate of major adverse cardiac and cerebrovascular events (MACCE: death from any cause, re-infarction, repeat coronary revascularization, hospitalization because of congestive heart failure, and cerebral infarction) was higher in Group A (58.7%) than in Group B (37.0%, p=0.0101). Moreover, when the APN levels were calculated by adjusting for sex, age, body mass index, and triglyceride levels, patients in the lowest quartile of residual APN levels had a higher risk of MACCE (p=0.0405). Multiple logistic analyses showed that hypoadiponectinemia (APN ≤4.5 μg/ml) was independently correlated with MACCE. Kaplan-Meier analysis demonstrated a higher MACCE rate in Group A than in Group B (Log-rank χ
2=7.89, p=0.0050).
Conclusion The APN level may be helpful for predicting clinical outcomes after PCI. (
Circ J 2007;
71: 675 - 680)
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Hajime Yamashita, Shoichi Ehara, Minoru Yoshiyama, Takahiko Naruko, Ka ...
2007 Volume 71 Issue 5 Pages
681-687
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Increased levels of oxidized low-density lipoprotein (ox-LDL) are related to plaque instability, so the aim of the present study was to investigate whether there is a relationship between angiographic coronary plaque morphology in patients with unstable angina pectoris (UAP) and the level of ox-LDL.
Methods and Results Plasma ox-LDL levels were measured in 149 patients with UAP and in 88 control subjects, using a highly sensitive enzyme-linked immunosorbent assay method. Angiographic morphology of the culprit lesion was classified as either simple or complex based on the Ambrose classification. Plasma ox-LDL levels in patients with Braunwald class III were significantly higher than in patients with class I (p<0.0001) or in control subjects (p<0.0001). In each of the 3 Braunwald classes, plasma ox-LDL levels in patients with a complex lesion were significantly higher than in patients with a simple lesion. Multivariate logistic regression analysis revealed that ox-LDL level and Braunwald class III were independent factors associated with angiographically detected complex lesions.
Conclusion In each Braunwald class of UAP, elevated plasma levels of ox-LDL closely relate to the presence of angiographically detected complex and thrombotic lesion morphology. (
Circ J 2007;
71: 681 - 687)
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Makoto Abe, Masahiko Iwaoka, Takamitsu Nakamura, Yoshinobu Kitta, Haji ...
2007 Volume 71 Issue 5 Pages
688-692
Published: 2007
Released on J-STAGE: April 25, 2007
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Background There is an intimate relationship between activation of the sympathetic nervous system and myocardial ischemia. This study examined whether plasma levels of dopamine, a precursor of norepinephrine, may provide prognostic information in coronary artery disease (CAD).
Methods and Results Plasma levels of free dopamine were measured by high-performance liquid chromatography in 210 consecutive patients with stable CAD. The patients were prospectively followed up for a period of ≤36 months until occurrence of a clinical coronary event. Coronary events occurred in 37 patients during follow-up. In Kaplan-Meier survival analysis, higher dopamine levels (≥30 pg/ml) resulted in a higher event probability (p<0.01). Multivariate Cox hazards analysis showed that higher dopamine levels were a significant and independent risk factor for future coronary events (hazard ratio 3.3, 95% confidence interval 1.3-8.1, p<0.01). Furthermore, patients with higher dopamine levels had lower left ventricular (LV) ejection fraction and higher levels of brain natriuretic peptide, C-reactive protein, and fibrinogen than those with lower dopamine levels.
Conclusions Plasma levels of free dopamine are increased in association with a decrease in LV function and an increase in inflammatory risk markers. Higher free dopamine levels are an independent risk factor for future coronary events in CAD patients. (
Circ J 2007;
71: 688 - 692)
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San Bao Chai, Yong Ming Hui, Xue Min Li, Chao Shu Tang
2007 Volume 71 Issue 5 Pages
693-697
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The aim of the present study was to investigate alterations in the plasma level of coupling factor 6 (CF6), a novel endogenous inhibitor of prostacyclin, in patients with coronary heart disease.
Methods and Results In total, 35 patients with coronary heart disease and 20 age-matched healthy subjects were examined. Plasma levels of CF6 and 6-keto-prostaglandin (PG)F
1a (a stable metabolite of prostacyclin) were measured using radioimmunoassay. The plasma level of CF6 was significantly increased in patients (254.1±29.8 pg/ml vs 219.4 ±36.7 pg/ml in controls, p<0.0001), whereas that of 6-keto-PGF
1a was significantly decreased (23.4 ±2.3 pg/ml vs 26.1±4.5 pg/ml in controls, p=0.001). Moreover, after percutaneous transluminal coronary angioplasty (PTCA) and stent therapy, the level of CF6 was further increased by 30% to 330.4±26.0 pg/ml, and that of 6-keto-PGF
1a was decreased by 42% to 13.5±2.0 pg/ml, compared with baseline (all p<0.01). Univariate analysis showed a significant result that the plasma level of CF6 was inversely correlated with that of 6-keto-PGF
1a in the patients. The plasma ratio of CF6 to 6-keto-PGF
1a was 8.4 in the control group and that in patients with coronary heart disease was increased to 24.4 after the therapy from 10.9 before therapy.
Conclusions The results suggest that an increased CF6 level may be responsible in part for the decreased prostacyclin level observed in patients with coronary heart disease, in particular after PTCA and stent therapy. As a potential risk factor for coronary heart disease, CF6 might have important clinical significance. (
Circ J 2007;
71: 693 - 697)
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Cevat Kirma, Mustafa Akcakoyun, Ali Metin Esen, Irfan Barutcu, Osman K ...
2007 Volume 71 Issue 5 Pages
698-702
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Results of experimental and clinical studies suggest that both coronary artery disease (CAD) itself and its traditional risk factors lead to endothelial dysfunction. The aim of the present study was to determine which CAD risk factors sustain their contribution to endothelial dysfunction despite the presence of established CAD.
Methods and Results The study group comprised 150 patients with CAD. Using a high-resolution ultrasound, the diameter of the brachial artery at rest and during reactive hyperemia (flow-mediated dilatation, FMD%: endothelial-dependent stimulus to vasodilatation), as well as after sublingual administration of nitroglycerin (NTG%: endothelium-independent vasodilatation), was measured. The relationship between FMD% and coronary risk factors [diabetes mellitus (DM), total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, age, family history of premature atherosclerosis, smoking, hypertension (HT), body mass index (BMI)] was investigated. In univariate analysis there was an inverse relationship between FMD% and age (r=-0.300, p<0.001), and BMI (r=-0.230, p<0.005) and FMD% was significantly lower in diabetic patients when compared to non-diabetic patients (p<0.001). In stepwise multivariate regression analysis; FMD still correlated with DM and advanced age, but not with BMI (β=0.065, p<0.001, β=-0.001 p=0.002, β=-0.087, p<0.284, respectively). FMD% was found to be not associated with hypercholesterolemia, family history of premature atherosclerosis, HT and smoking.
Conclusion Only aging and DM were independently associated with endothelial dysfunction in patients with established CAD. (
Circ J 2007;
71: 698 - 702)
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Ali A. Youssef, Li-Teh Chang, Chi-Ling Hang, Chiung-Jen Wu, Cheng-I Ch ...
2007 Volume 71 Issue 5 Pages
703-708
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The prognostic value of interleukin (IL)-18 in patients with ST-segment elevation acute myocardial infarction (STEMI) is currently unclear. Thus, the purpose of this study was to test whether the circulating IL-18 level can predict prognosis in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
Methods and Results A prospective cohort study was conducted with 267 consecutive patients with STEMI of onset <12 h who were undergoing primary PCI. Blood samples for plasma IL-18 level were collected in the catheterization laboratory following vascular puncture. The plasma IL-18 level was also evaluated in 25 healthy and 30 at-risk control subjects. The plasma level of IL-18 was significantly higher in acute myocardial infarction (AMI) patients than in both groups of control subjects (all p<0.0001). Patients with high plasma IL-18 level (≥560 pg/ml) had significantly higher peak creatine kinase-MB levels, higher incidence of cardiogenic shock upon presentation, significantly lower left ventricular ejection fraction (LVEF), lower successful reperfusion and significantly higher incidence of 30-day composite major adverse clinical events (MACE) (advanced congestive heart failure ≥ class 3 or 30-day mortality) than those patients with low plasma IL-18 level (<560 pg/ml) (all p<0.0001). Multiple stepwise logistic regression analysis demonstrated that high plasma IL-18 level (≥560 pg/ml) along with low LVEF (<50%) and cardiogenic shock were the most independent predictors of 30-day MACE (p<0.0001).
Conclusions In patients with STEMI, plasma IL-18 level is a major independent inflammatory predictor of 30-day MACE. Evaluation of circulating IL-18 might improve the prediction of unfavorable clinical outcomes following AMI. (
Circ J 2007;
71: 703 - 708)
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Ryuji Fukazawa, Ei Ikegam, Miki Watanabe, Miharu Hajikano, Mitsuhiro K ...
2007 Volume 71 Issue 5 Pages
709-715
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Kawasaki disease (KD) causes coronary artery disease (CAD) in children. In addition, a history of KD is suspected to be a risk factor for the development of atherosclerotic heart disease in the future. Histological senescence changes are a common denominator in atherosclerotic lesions in adults, so the present study investigated whether histological senescence changes had already occurred in KD aneurysm.
Methods and Results KD coronary aneurysms and internal mammary arteries retrieved from 5 children with KD (3, 4, 5, 6, and 11 years old, respectively) who underwent coronary artery bypass grafting, as well as giant coronary aneurysm size-reducing operations, were analyzed. Senescence-associated strong β-galactosidase activity was observed in KD aneurysms, but not in the internal mammary arteries. An immunohistochemical analysis of the KD aneurysm using anti-CD31, anti-endothelial nitric oxide synthetase (eNOS), anti-vascular adhesion molecule-1 (VCAM-1), and anti-monocyte chemoattractant protein-1 (MCP-1) showed vascular endothelium CD31 staining, decreased staining of eNOS and strong staining of MCP-1 and VCAM-1. cDNA microarray gene expression profiling revealed increased MCP-1 expression in the KD aneurysm, a finding confirmed by quantitative polymerase chain reaction.
Conclusions Histological features of senescence and active remodeling gene expression show that the KD aneurysm is not a silent vasculitis terminal. The future fate of KD aneurysms, including atherosclerosis, should be monitored carefully. (
Circ J 2007;
71: 709 - 715)
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Takao Nakahara, Yoshifumi Takata, Yoji Hirayama, Kihiro Asano, Hirotak ...
2007 Volume 71 Issue 5 Pages
716-721
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The present study examined the role of aldosterone in left ventricular hypertrophy (LVH) and geometry in patients with untreated essential hypertension (EHT), and investigated the contribution of myocardial fibrosis to the process of LVH.
Methods and Results The relationship of the plasma aldosterone concentration (PAC) to LVH and left ventricular (LV) geometry was investigated in 57 consecutive patients with untreated EHT. PAC correlated with both LV mass index (LVMI: r=0.46, p=0.0004) and relative wall thickness (RWT: r=0.33, p=0.013). In patients with LVH (LVMI ≥125 g/m
2), the serum concentration of procollagen type III amino-terminal peptide (PIIINP), a marker of myocardial fibrosis, correlated with RWT (r=0.46, p=0.029). These patients were divided into 2 groups: concentric hypertrophy (CH) with RWT ≥0.44, and eccentric hypertrophy (EH) with RWT <0.44. The serum PIIINP concentration was significantly higher in the CH group than in the EH group (0.52±0.02 ng/ml vs 0.44±0.03 ng/ml, respectively; p<0.05).
Conclusions Aldosterone may be involved in LVH and LV geometry, particularly in the development of CH. Myocardial fibrosis seems more strongly involved in the hypertrophic geometry of CH than with EH. (
Circ J 2007;
71: 716 - 721)
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Reizo Baba, Masaaki Koketsu, Masami Nagashima, Hiroshi Inasaka, Masao ...
2007 Volume 71 Issue 5 Pages
722-726
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Obesity is associated with hypertension (HT) and high resting heart rate (HR), as well as metabolic disturbances. However, little is known about how strongly these hemodynamic abnormalities are associated with the degree of obesity in adolescents.
Methods and Results Height, body weight, resting HR, and systolic and diastolic blood pressures were measured in 20,165 male and 19,683 female high-school students. Adiposity levels were classified into 6 groups by body mass index: group 1 (<20th percentile), group 2 (20th-39.9th percentile), group 3 (40th-59.9th percentile), group 4 (60th-79.9th percentile), group 5 (80th-98.9th percentile), and group 6 (≥99th percentile). Systolic and diastolic hypertensions were defined as ≥140 mmHg and ≥85 mmHg, respectively. Resting tachycardia was defined as the corresponding 95th percentile or greater. Resting HR and systolic and diastolic blood pressures increased with adiposity level in both sexes (p<0.0001). Both systolic HT and diastolic HT were associated with high resting HR, and the clustering of these unfavorable conditions increased with the degree of obesity.
Conclusion Hemodynamic abnormalities, such as HT and a high resting HR, are closely associated with adolescent obesity and are probably explained by impaired autonomic nerve function. (
Circ J 2007;
71: 722 - 726)
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Atila Bitigen, Erdem Türkyilmaz, Irfan Barutcu, Gökhan Kahve ...
2007 Volume 71 Issue 5 Pages
727-730
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The aim of this study was to evaluate whether there is a relationship between aortic elastic properties in patients with a suggestive response to treadmill exercise testing.
Methods and Results The study group comprised 32 patients suggesting hypertensive response to exercise and 20 patients suggesting normal blood pressure response to treadmill exercise testing. Baseline demographic characteristics were similar in both groups. However, the mean aortic stiffness index of patients suggesting hypertensive response to treadmill exercise testing was significantly higher (4.8±1.26 vs 2.36±1.09; p=0.001) whereas aortic distensibility was significantly lower (12.82 ±5.84 vs 22.64±14.54; p=0.001) than the control group. The aortic strain of patients with hypertensive response to exercise was lower than the control group (12±3% vs 19.2±5%, p<0.001). The left ventricular mass (LVM) of these patients was also higher than control group (206.5±46.3 vs 134.2±19.97; p=0.01). A negative correlation between LVM and distensibility was found (r=-0.64; p=0.001) well as a positive correlation between LVM and aortic stiffness index (r=0.51; p=0.004) in patients suggesting hypertensive response to exercise. Pressure - rate product was also found to be correlated with LVM (r=0.47; p=0.006).
Conclusion Elastic properties of the aorta may be impaired in subjects showing exaggerated blood pressure response to exercise long before clinically manifest hypertension, particularly if the LVM is increased. (
Circ J 2007;
71: 727 - 730)
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Tetsuro Shirai, Masashi Kasao, Miho Nozaki, Syuuya Nitta
2007 Volume 71 Issue 5 Pages
731-735
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The Cornell product (CP) improved identification of left ventricular hypertrophy (LVH) in the LIFE study, although its clinical significance is still unknown in Japanese hypertensive (HT) patients.
Methods and Results A standard 12-lead ECG was recorded in 265 HT and 363 normotensive cases (N). All ECGs were digitized, and a simple product was calculated by multiplying the Cornell voltage (CV) by the QRS duration. In 147 of the 265 HT cases, the standard 12-lead ECG and transthoracic Doppler echocardiography were examined in the same period. The mean value of CP increased in the following order: 1,426±673 mm · ms in N, 1,989±900 mm · ms in HT with treatment, 2,137±976 mm · ms in HT without treatment. The correlation with left ventricular mass index (LVMI) measured by echocardiography was improved by CP with the simple CV. With use of a partition of 2,440 mm · ms in CP, LVMI and relative wall thickness were significantly higher in HT with ≥2,440 mm · ms of CP compared with <2,440 mm · ms. Early diastolic wave in tissue Doppler imaging was significantly lower in HT with ≥2,440 mm · ms of CP compared with <2,440 mm · ms.
Conclusion The Cornell product is a useful ECG marker, reflecting not only left ventricular (LV) mass but also LV geometry and diastolic function in Japanese HT patients. (
Circ J 2007;
71: 731 - 735)
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A Comparison of Measurements in the Seated and Supine Positions
Junko Soga, Kenji Nishioka, Shuji Nakamura, Takashi Umemura, Daisuke J ...
2007 Volume 71 Issue 5 Pages
736-740
Published: 2007
Released on J-STAGE: April 25, 2007
JOURNAL
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Background Measurement of flow-mediated vasodilation (FMD) is used to assess endothelial function in humans and according to the guidelines, subjects must remain supine during the study. However, measurement of FMD while seated would be more comfortable and convenient for patients, so the purpose of this study was to determine the effect of the patient's position on FMD results.
Methods and Results High-resolution ultrasonography, a linear array transducer (13 MHz) and an arm - holding device were used to measure arterial diameter in response to reactive hyperemia (FMD, cuff inflated to 50 mmHg above systolic blood pressure for 5 min) and in response to sublingual nitroglycerine (NTG, 75 μg) in 31 subjects, which included those with cardiovascular diseases. There was no significant difference between basal or peak hyperemic blood flow in the seated or supine position. Basal brachial artery diameter, FMD and vascular response to NTG were similar in both positions (basal diameter: 3.8±0.4 vs 3.9±0.4 mm, FMD: 7.3±4.3% vs 7.2±4.5%, NTG: 13.1±5.1% vs 12.8±5.6%).
Conclusions The findings suggest that measurement of FMD in the seated position is as useful as measuring it in the supine position for assessing endothelial function. This flexibility of position is better for patients and physicians, and should lead to more widespread measurement of FMD. (
Circ J 2007;
71: 736 - 740)
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The Cardiovascular Risk in Young Finns Study
Tuomo Nieminen, Mika Kähönen, Md. Shaheenul Islam, Olli T. R ...
2007 Volume 71 Issue 5 Pages
741-745
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The present study was designed to investigate the effects of apoB
XbaI and apoA-I/C-III/A-IV
SstI polymorphisms to carotid artery intima - media thickness (IMT), carotid artery compliance (CAC) and brachial artery flow-mediated vasodilatation (FMD).
Methods and Results As part of the Cardiovascular Risk in Young Finns Study, the carotid IMT, CAC and brachial FMD of 2,265 subjects (mean age ± SD 32 ±5 years) were measured with ultrasonography, and genotyping of the apolipoprotein polymorphisms was performed. The frequencies of the genotypes did not differ between the groups with high (above median 0.57 mm) and low (below median) IMT, CAC or FMD. The average carotid IMT differed between the 3 apoB
XbaI genotypes (ANOVA, p=0.04), but not between the apoA-I/C-III/A-IV
SstI genotypes (ANOVA, p=0.53). The relationship between the polymorphisms and carotid IMT was not significant in any of the covariate-adjusted logistic and linear regression analyses. CAC and FMD were not influenced by either of the polymorphisms in ANOVA and regression analyses.
Conclusions The polymorphisms apoA-I/C-III/A-IV
SstI and apoB
XbaI do not seem to affect carotid artery characteristics or brachial artery FMD in young adulthood. (
Circ J 2007;
71: 741 - 745)
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Akira Matsunaga, Hiroaki Arishima, Hideya Niimura, Bo Zhang, Yoshinari ...
2007 Volume 71 Issue 5 Pages
746-752
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The apolipoprotein A5 gene (
ApoA5) plays an important role in modulating triglyceride metabolism. Polymorphisms of
ApoA5, including -1131T>C and c.553G>T (G185C), have been reported to correlate with hypertriglyceridemia (HTG). In the present study the relationships of 5 single nucleotide polymorphisms, including the -1131T>C, c.56C>G, IVS3+476G>A, c.553G>T, and c.1259T>C polymorphisms of
ApoA5, with HTG were investigated.
Methods and Results The study group comprised 95 Japanese patients with HTG and 119 unrelated normolipidemic subjects. Frequencies of the C allele of -1131T>C (0.511) and the T allele of c.553G>T (0.205) in the hypertriglyceridemic patients were significantly higher than in the normolipidemic subjects (0.315 and 0.105, respectively). The c.56C>G (S19W) polymorphism was not observed, and the other 4 polymorphic sites were in strong linkage disequilibrium. Five of the 8 detected haplotypes with the C allele of -1131T>C correlated with HTG. Promoter activities of
ApoA5, including that with the -1131T>C polymorphism, were estimated using a luciferase assay. Analysis of
ApoA5 promoters showed that the -1131T>C polymorphism alone had no effect. Comparison of expression of mutant G185C and wild-type ApoA5-green fluorescent protein (GFP) in HepG2 cells showed that ApoA5-GFP was abundant in punctate endosome-like structures, and ApoA5 (G185C)-GFP expression resembled that of the wild type.
Conclusions The -1131T>C and c.553G>T (G185C) polymorphisms correlated with HTG in this Japanese population, but neither polymorphism directly affected
ApoA5 expression. (
Circ J 2007;
71: 746 - 752)
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Teiichi Yamane, Taro Date, Yasuko Kanzaki, Keiichi Inada, Seiichiro Ma ...
2007 Volume 71 Issue 5 Pages
753-760
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The limited efficacy and complications of segmental ostial pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) have been discussed so, in the present study the feasibility and efficiency of performing segmental pulmonary vein (PV) antrum isolation to treat AF were assessed.
Methods and Results A total of 187 patients with drug-refractory AF (paroxysmal 120, persistent 67) underwent segmental PVI guided by circumferential 20-electrode catheters (Lasso). Radiofrequency (RF) current was delivered either at the ostium using a regular Lasso (15-20 mm in diameter, 70 patients: Group 1) or at the antrum using a larger Lasso (25-30 mm in diameter, 117 patients: Group 2). A significantly wider region had to be ablated, with a longer RF application time, to isolate all 4 PVs in Group 2 patients than in Group 1 patients. Although the rate of recurrence of AF after the initial session was equal in both groups, a significantly greater number of patients were free from AF after a mean of 1.4 procedures in Group 2 than in Group 1 (93% vs 76% for paroxysmal AF, 78% vs 48% for persistent AF).
Conclusions Segmental antral PVI using large-sized Lasso catheters was found to be more effective and safer than ostial PVI for the treatment of AF. (
Circ J 2007;
71: 753 - 760)
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Shinya Suzuki, Takeshi Yamashita, Takeshi Kato, Tadashi Fujino, Koichi ...
2007 Volume 71 Issue 5 Pages
761-765
Published: 2007
Released on J-STAGE: April 25, 2007
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Background During anticoagulation for prevention of stroke in patients with non-valvular atrial fibrillation (NVAF), bleeding is the most serious complication. In Western countries, the incidences of major bleeding and intracranial hemorrhages with low-dose warfarin are known to occur at a rate of 0.4-1.3% and 0.2% per year, respectively. The purpose of this study was to investigate the incidence and risk factors for major bleeding related with warfarin therapy in Japanese patients with NVAF.
Methods and Results From August 2004 to July 2005, 667 NVAF patients treated with warfarin for NVAF were followed-up. The target prothrombin time-international normalized ratio (PT-INR) value was set at 1.6-2.6 (low-dose warfarin). The exposure on warfarin was 503 patient-years (average PT-INR 2.00 ±0.40). During the follow-up period, 12 major bleeding complications occurred (2.38% per patient-year), which included 3 intracranial hemorrhages (0.60% per patient-year). Among the patients' characteristics, average PT-INR ≥2.27 during the study was identified as an independent risk factor for major bleeding.
Conclusions The incidence of major bleeding and intracranial hemorrhages in Japanese NVAF patients with low-dose warfarin therapy was 2.38% and 0.60% per patient-year, respectively, which is higher than in Westerners. (
Circ J 2007;
71: 761 - 765)
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Seijiro Shimada, Hajime Nakamura, Atsuhiro Kurooka, Norio Nishioka, Ke ...
2007 Volume 71 Issue 5 Pages
766-771
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Although fever is a common accompanying feature of acute aortic dissection, few reports have been published concerning the duration and character of this fever.
Methods and Results The mean duration of fever was calculated for a total of 57 patients with acute aortic dissection, who were then divided into 2 groups: those with duration of fever shorter than the mean (Group A) and those with duration of fever equal to or longer than the mean (Group B). The reduction in false lumen size and hematological parameters were compared between groups. The mean duration of fever was 15.9±11 days. The false lumen reduction ratio was significantly higher in Group A (18.3±5.0%) than in Group B (2.0±5.3%). There was a significant negative correlation between the false lumen reduction ratio and duration of fever. Hematological parameters did not differ significantly between the 2 groups except for fibrin degradation product, although the white blood cell count and platelet counts and C-reactive protein concentration tended to be higher in Group B.
Conclusions Checking for fever is important in assessing the status of individual cases of acute aortic dissection. (
Circ J 2007;
71: 766 - 771)
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Septic Pulmonary Embolism and Amniotic Fluid Embolism
Masahito Sakuma, Koichiro Sugimura, Mashio Nakamura, Tohru Takahashi, ...
2007 Volume 71 Issue 5 Pages
772-775
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Septic and amniotic fluid emboli are rare sources of pulmonary embolism (PE), so the present study sought to elucidate the background of these cases.
Methods and Results A total of 11,367 PE cases were identified from 396,982 postmortem examinations. The incidence of septic PE was 247 (2.2%) of the total. The origin of infection was found in 85.6% of the cases. Fungal embolus was detected more often than bacterial embolus. The most frequently detected fungus was aspergillus (20.8%). The primary disease associated with fungal embolus was leukemia (43.2%). The incidence of PE cases associated with pregnancy and/or delivery was 89 (0.8%) of the total PE cases. Among them, amniotic fluid embolism was found in 33 (73.3%) of 45 PE cases with vaginal delivery, and in 7 (21.2%) of 33 PE cases with cesarean delivery (p<0.0001).
Conclusion Fungal embolus was more frequent than bacterial embolus, and leukemia was most frequent as the primary disease in cases of fungal embolus. The main cause of PE in cesarean section cases was thrombotic embolism, and the main cause in vaginal delivery cases was amniotic fluid embolism. (
Circ J 2007;
71: 772 - 775)
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Yasuyuki Nakamura, Tanvir C Turin, Yoshikuni Kita, Shinji Tamaki, Yasu ...
2007 Volume 71 Issue 5 Pages
776-781
Published: 2007
Released on J-STAGE: April 25, 2007
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Background The association of obesity measures (ie, body mass index (BMI), waist circumference (WC) and waist-to hip ratio (WHR)) with metabolic risk factors in community-based populations has not been well studied.
Methods and Results In the present study 759 men and 1,255 women aged between 30 and 79 years, without histories of stroke or coronary heart diseases, were dichotomized at the medians of BMI-WHR, WC-WHR and BMI-WC. The accumulation of 4 metabolic risk factors (risk _ sum) were examined: high blood pressure (≥130/85 mmHg or on antihypertensive therapy); high triglycerides (≥170 mg/dl); low high-density lipoprotein-cholesterol (<40 mg/dl); and impaired glucose tolerance (hemoglobin A1c ≥5.6% or on antidiabetic therapy). BMI and WC correlated well in both men (r=0.871) and women (r=0.874). All 3 obesity measures related with the metabolic risk factors. The area under the receiver-operating characteristic curve for BMI, WC and WHR to predict the risk _ sum ≥2 for men was 0.683, 0.709, and 0.700, respectively, and 0.715, 0.739, and 0.746, respectively, for women.
Conclusions BMI may be used instead of WC if the latter is not available. When WC is measured, hip circumference also should be measured because the WHR may be the most valuable measure of obesity. (
Circ J 2007;
71: 776 - 781)
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Osamu Nagayama, Akira Koike, Masayo Hoshimoto, Kaori Yamaguchi, Akihik ...
2007 Volume 71 Issue 5 Pages
782-787
Published: 2007
Released on J-STAGE: April 25, 2007
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Background Although it is assumed that cerebral oxygenation during exercise is influenced by both cardiopulmonary function and cerebrovascular arteriosclerosis, the latter factor has not been fully clarified. In the present study the relationship between the degree of cerebrovascular arteriosclerosis and cerebral oxygenation during exercise was investigated.
Methods and Results A total of 109 patients (69 patients with coronary artery disease, 40 patients with hypertensive heart disease) (61.7±9.7 years) performed a symptom-limited exercise test with respiratory gas measurements (CPX). From the respiratory gas analysis, peak O
2 uptake (VO
2), the slope of the increase in VO
2 to the increase in work rate (ΔVO
2/ΔWR), and the slope of the increase in ventilation to the increase in CO
2 output (VE/VCO
2 slope) were calculated. Oxyhemoglobin (O
2Hb) at the forehead was monitored using near-infrared spectroscopy. The brain ischemic score was counted based upon fluid-attenuated inversion recovery images of magnetic resonance imaging and expressed from 0 to 4. When compared with patients with a lower ischemic score (<2, n=67), those with a higher ischemic score (≥2, n=42) had a lower increase in brain O
2Hb during exercise (-1.08 ±2.7 vs 0.77±4.1 μmol/L, p=0.011). Of brain ischemic score, left ventricular ejection fraction, peak VO
2, ΔVO
2/ΔWR, and the VE/VCO
2 slope, ΔVO
2/ ΔWR was found to be the sole independent index determining cerebral O
2Hb during exercise. The CPX parameters were also significantly related to the degree of cerebrovascular arteriosclerosis.
Conclusions Although cerebral oxygenation during exercise is mainly related to cardiopulmonary function, the degree of cerebrovascular arteriosclerosis partly influences cerebral oxygenation in patients with risk factors for atherosclerosis. (
Circ J 2007;
71: 782 - 787)
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