Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 71 , Issue 8
Showing 1-31 articles out of 31 articles from the selected issue
Review Article
  • AI Kakafika, DP Mikhailidis
    2007 Volume 71 Issue 8 Pages 1173-1180
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Cigarette smoking is a major vascular risk factor and in this context, it is an independent risk factor for the development of aortic disease, especially the formation and growth of abdominal aortic aneurysms (AAA). Medline was searched up to January 31, 2007 for the relevant literature for this review of the mechanisms by which smoking causes aortic wall damage and its subsequent impact on the clinical manifestation of this process. Idiopathic AAAs and aortic dissection are considered, as well as other aortic diseases (eg, Takayasu, Kawasaki, Behcet and Buerger). There is evidence suggesting an abnormal homeostasis between proteolytic and antiproteolytic activity in the vascular wall during the development of AAAs, and these mechanisms can be influenced by smoking. Smoking cessation plays an important role in the management of aortic disease. (Circ J 2007; 71: 1173 - 1180)
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Clinical Investigation
  • Akira Marui, Yasuhiko Tabata, Shinsuke Kojima, Masaya Yamamoto, Keiich ...
    2007 Volume 71 Issue 8 Pages 1181-1186
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Limb ischemia remains a challenge. To overcome shortcomings or limitations of gene therapy or cell transplantation, a sustained release system of basic fibroblast growth factor (bFGF) using biodegradable gelatin hydrogel has been developed. Methods and Results A phase I-IIa study was performed, in which 7 patients had critical limb ischemia. They were intramuscularly injected with 200 μg of bFGF-incorporated gelatin hydrogel microspheres into the gastrocnemius of the ischemic limb. End-points were safety and feasibility of treatment after 4 and 24 weeks. One patient was excluded from the study for social reasons, but only after symptomatic improvements. In the evaluation of the other 6 patients, significant improvements were observed in the distance walked in 6 min (295±42 m vs 491±85 m for pretreatment vs after 24 weeks, p=0.023) and in transcutaneous oxygen pressure (53.5±5.2 mmHg vs 65.5±4.0 mmHg, p=0.03). The rest pain scale also improved (3.5±0.2 vs 1.0±0.6, p=0.022). The ankle-brachial pressure index improved at 4 weeks but not at 24 weeks. Among 5 patients who had a non-healing foot ulcer, the ulcer was completely healed in 3 patients, reduced in 1, and there was no change in 1 patient at 24 weeks. The blood levels of bFGF were undetected or within the normal level in all patients. Conclusions The sustained release of bFGF from gelatin hydrogel might be simple, safe, and effective to achieve therapeutic angiogenesis because it did not need genetic materials or collection of implanted cells, and because it did not have any general effects, which was supported by there being no elevation of the bFGF serum level. (Circ J 2007; 71: 1181 - 1186)
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  • Yutaka Saito, Ken-ichiro Sasaki, Yousuke Katsuda, Toyoaki Murohara, Yo ...
    2007 Volume 71 Issue 8 Pages 1187-1192
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Thromboangiitis obliterans, also known as Buerger's disease, is characterized by peripheral occlusive changes in the arteries of the upper and lower limbs and treatment is often ineffective. Intramuscular transplantation of autologous bone marrow-mononuclear cells (BM-MNC) has been recently reported as improving the symptoms and clinical manifestations in patients with severely ischemic limbs, mostly caused by arteriosclerosis obliterans. The present study focused on the patients with Buerger's disease presenting with rest pain and/or skin ulcer uncontrolled by conventional treatments. Methods and Results Fourteen patients with Buerger's disease (Fontaine III: n=2, Fontaine IV: n=12) underwent transplantation of autologous BM-MNC into ischemic skeletal muscles of either the upper or lower limb. After 4 weeks, rest pain was significantly reduced. In 19 skin ulcers of 9 patients, 8 ulcers were healed and 8 were diminished in the size. These improvements were maintained for 24 weeks without complications. Conclusions In patients with Buerger's disease, intramuscular transplantation of autologous BM-MNC improved symptoms and clinical manifestations, especially skin ulcer. (Circ J 2007; 71: 1187 - 1192)
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  • Junichi Hoshino, Yoshifumi Ubara, Shigeko Hara, Yoko Sogawa, Tatsuya S ...
    2007 Volume 71 Issue 8 Pages 1193-1198
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Severe arteriosclerosis obliterans (ASO) can be intractable, especially in diabetic patients on hemodialysis (HD). Recently, the transplantation of autologous peripheral blood mononuclear cells (PBMNCs) has been reported to have beneficial effects, but the long-term effects and impact on quality of life (QOL) have not been studied. Methods and Results Autologous PBMNCs were transplanted into 7 diabetic patients on HD who had severe ASO (5 cases with Fontaine IV and 2 with Fontaine III) after administration of 5 μg/kg granulocyte colony stimulating factor; QOL and degree of ischemia was assessed by measuring skin temperature, skin perfusion pressure (SPP), ankle - brachial index (ABI), and ulcer size, and from angiographic findings. At 4 weeks after the procedure, skin temperature was significantly improved, and SPP and ABI also were increased. These beneficial effects persisted for up to 24 weeks. Angiographic findings and ulcer size improved in 3 of 7 and 3 of 4 patients, respectively. SF-36v2 analysis revealed significant improvements in pain scores. No serious complications were detected. Conclusion Transplantation of PBMNCs resulted in improvement in pain and leg ischemia for over 6 months without serious complications. This therapy is safe and effective for severe ASO in diabetic patients on HD. (Circ J 2007; 71: 1193 - 1198)
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  • Tetsuya Tatsumi, Eishi Ashihara, Toshihide Yasui, Shinsaku Matsunaga, ...
    2007 Volume 71 Issue 8 Pages 1199-1207
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) enhances neovessel formation in ischemic myocardium and limbs by releasing angiogenic factors. This study was designed to examine whether intracoronary transplantation of PBMNCs improves cardiac function after acute myocardial infarction (AMI). Methods and Results After successful percutaneous coronary intervention (PCI) for a ST-elevation AMI with occlusion of proximal left anterior descending coronary artery within 24 h, patients were assigned to either a control group or the PBMNC group that received intracoronary infusion of PBMNCs within 5 days after PCI. PBMNCs were obtained from patients by COBE spectra-apheresis and concentrated to 10 ml, 3.3 ml of which was infused via over-the-wire catheter. The primary endpoint was the global left ventricular ejection fraction (LVEF) change from baseline to 6 months' follow-up. The data showed that the absolute increase in LVEF was 7.4% in the control group and 13.4% (p=0.037 vs control) in the PBMNC group. Cell therapy resulted in a greater tendency of ΔRegional ejection fraction (EF) or significant improvement in the wall motion score index and Tc-99m-tetrofosmin perfusion defect score associated with the infarct area, compared with controls. Moreover, intracoronary administration of PBMNCs did not exacerbate either left ventricular (LV) end-diastolic and end-systolic volume expansion or high-risk arrhythmia, without any adverse clinical events. Conclusion Intracoronary infusion of non-expanded PBMNCs promotes improvement of LV systolic function. This less invasive and more feasible approach to collecting endothelial progenitor cells may provide a novel therapeutic option for improving cardiac function after AMI. (Circ J 2007; 71: 1199 - 1207)
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  • Jun Shiraishi, Yoshio Kohno, Takahisa Sawada, Shinya Nishizawa, Masaya ...
    2007 Volume 71 Issue 8 Pages 1208-1212
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is performed in hospitals without on-site coronary artery bypass graft surgery in the `real world'. However, data on the in-hospital outcomes of primary PCI performed at hospitals with and without on-site cardiac surgery are still lacking in Japan. Methods and Results In the present study, 2,230 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Of these, 1,817 patients underwent primary PCI. Excluding patients without adequate data, we retrospectively compared clinical background, coronary risk factors, angiographic findings, acute results of primary PCI and in-hospital prognosis between patients undergoing primary PCI in hospitals without on-site cardiac surgery (without surgery group, n=792) and those in hospitals with (with surgery group, n=993). The without surgery group had higher prevalence of previous myocardial infarction, Killip class ≥3 at admission and multivessels as a culprit lesion than the with surgery group. The without surgery group was more likely to have lower frequency of stent usage and lower thrombolysis in myocardial infarction flow grade just after PCI, whereas it was more likely to have intra-aortic balloon pumping and temporary pacing during procedures. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class ≥3 at admission, multivessels or left main trunk (LMT) as culprit lesions, number of diseased vessels ≥2 or diseased LMT, and age were the independent predictors of the in-hospital mortality, but the presence of on-site cardiac surgery was not. Conclusions These results suggest that in-hospital outcomes in AMI patients undergoing primary PCI at hospitals without on-site cardiac surgery are comparable to those at hospitals with on-site cardiac surgery in Japan. (Circ J 2007; 71: 1208 - 1212)
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  • Hon-Kan Yip, Pei-wen Wang, Li-Teh Chang, Ali A. Youssef, Jiunn-Jye She ...
    2007 Volume 71 Issue 8 Pages 1213-1218
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Cytotoxic T lymphocyte antigen 4 (CTLA-4) is a particularly important molecule in down-regulating T-cell expansion and cytokine production. The purpose of the present study was to determine the frequency distribution of an A/G single nucleotide polymorphism at position 49 in exon 1 of the CTLA-4 gene, which may be a functional related-genetic risk marker for the development of ST-segment elevation (ST-se) acute myocardial infarction (AMI). Methods and Results A total of 503 consecutive patients, consisting of 250 ST-se AMI patients undergoing primary coronary angioplasty (group 1), 203 angina pectoris patients undergoing elective coronary angioplasty (group 2) and 50 patients with chest pain and normal coronary angiographic findings (group 3), were enrolled in the present study. The frequency of the G/G genotype was significantly higher in group 1 (53.2%) than in groups 2 (33.0%) and 3 (36.0%) (p=0.0005). In group 1, patients with a G/G genotype had significantly higher levels of high-sensitivity C-reactive protein and white blood cell counts, and much higher incidences of multi-vessel disease, greater lesion lengths, advanced congestive heart failure (≥ class 3) and 30-day mortality, than patients with G/A or A/A genotypes (p values<0.05 in all cases). Multivariate analysis of the enrolled baseline variables (age, gender, diabetes mellitus, smoking, hypertension and hypercholesterolemia) and the genotypes (G/G, A/G and A/A) demonstrated that G/G genotype is the only independent predictor of development of AMI (p<0.0001). Conclusion The G/G genotype polymorphism of the CTLA-4 gene is associated with increased risk of AMI. (Circ J 2007; 71: 1213 - 1218)
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  • Young Joon Hong, Myung Ho Jeong, Youngkeun Ahn, Nam Sik Yoon, Sang Rok ...
    2007 Volume 71 Issue 8 Pages 1219-1224
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Although ischemic heart failure is a major cause of mortality after acute myocardial infarction (AMI), the factors that may influence the nonrecovery of left ventricular function (LVF) after an AMI are still unclear. The aim of this study was to identify predictors of nonrecovery of LVF in patients with left ventricular (LV) dysfunction (defined as an echocardiographic ejection fraction (EF) <40%) complicated with AMI who undergo successful primary percutaneous coronary intervention (PCI). Methods and Results LVF recovery was defined as improvement of LVEF more than 10% compared with baseline LVEF at follow-up. One hundred and eight patients with LV dysfunction after AMI were divided into 2 groups according to the LVF recovery at follow-up: patients with LVF recovery (n=64) vs patients without LVF recovery (n=44). The follow-up LVEF was measured at 8±4 months after PCI. Patients without LVF recovery were older (76±13 years vs 59±14 years, p=0.023) and the baseline peak monocyte count, creatine kinase, and troponin I levels were significantly higher in patients without LVF recovery than in patients with LVF recovery. Delta LVEF (follow-up LVEF - baseline LVEF) correlated with baseline peak monocyte count (r=-0.417, p<0.001), baseline peak creatine kinase (r=-0.269, p=0.005), and baseline peak troponin I levels (r=-0.256, p=0.007). Multivariate analyses showed that baseline peak monocyte count and old age were the independent predictors of nonrecovery of LVF (hazard ratio; 3.38, 95% confidence interval (CI): 1.16-5.43, p=0.012, and hazard ratio; 2.38, 95% CI: 1.09-4.87, p=0.025, respectively). Conclusion Peripheral monocytosis is associated with nonrecovery of LVF in patients with LV dysfunction complicating an AMI who underwent successful primary PCI. These results suggest an important role of monocytes in the expansion of the infarct and the development of chronic ischemic heart failure after reperfusion therapy. (Circ J 2007; 71: 1219 - 1224)
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  • Masayoshi Kinoshita, Shin-ichirou Matsumura, Kouichirou Sueyoshi, Sato ...
    2007 Volume 71 Issue 8 Pages 1225-1228
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Minor myocardial damage after percutaneous coronary intervention (PCI) is associated with cardiac risks, which statins seem to reduce. The aim of this study was to examine whether intensive lipid-lowering therapy is more effective in decreasing the risk of cardiac injury after PCI than moderate lipid-lowering therapy. Methods and Results Subjects comprised 42 patients with stable angina without previous statin treatment, randomly assigned to either an intensive lipid-lowering group (Group A: target low-density lipoprotein-cholesterol (LDL-C) <70 mg/dl) or a moderate lipid-lowering group (Group B: target LDL-C <100 mg/dl) 2 weeks before PCI. All patients took statins to reach target LDL-C levels. Incidence of periprocedural myocardial injury was assessed by analyzing levels of creatine kinase myocardial isozyme (CK-MB) and cardiac troponin T (TnT) before and 6, 12 and 24 h after PCI. Minor myocardial damage was defined as TnT elevation to >0.01 ng/ml. Frequency of minor myocardial damage was 14.2% in Group A and 47.6% in Group B (p=0.043). CK-MB was above the upper limit of normal (ULN) in 19% of Group A and 33.3% of Group B (p=0.44), and CK-MB was >3× ULN in 9.5% of Group A and 19% of Group B (p=0.66). Conclusions Intensive lipid-lowering therapy before PCI reduces minor myocardial damage during PCI with stenting compared with moderate lipid-lowering therapy. (Circ J 2007; 71: 1225 - 1228)
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  • Masaya Kato, Keigo Dote, Shota Sasaki, Kentaro Ueda, Osamu Matsuda, Yo ...
    2007 Volume 71 Issue 8 Pages 1229-1233
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background The aim of the present study was to investigate the clinical implication of metabolic syndrome and carotid artery morphologies on coronary plaque vulnerability in Japanese men with acute coronary syndrome (ACS). Methods and Results Consecutive ACS Japanese men (n=225) underwent emergent coronary angiography and B-mode ultrasonography within 1 week of the acute coronary event. With a 11.3-MHz linear array transducer, the morphologies of common carotid artery were examined. Common carotid arteries with an intima-media thickness >1.1 mm and interadventitial diameter >8.0 mm were considered to be undergoing carotid artery remodeling. Patients were divided into 2 groups based on the number of complex plaques identified by coronary angiography. Abdominal obesity, low level of high-density lipoprotein and carotid artery remodeling were more often observed in patients with multiple, complex coronary plaques than in patients with a single, complex plaque (p<0.03, p<0.03 and p=0.0001, respectively). Metabolic syndrome and carotid artery remodeling were independent predictors of multiple, complex coronary plaques (odds ratio 1.86, p<0.05; odds ratio 5.96, p<0.0001). Conclusion Metabolic syndrome and carotid artery remodeling might be useful indicators to assess the efficacy of aggressive treatments for secondary prevention of cardiovascular events in ACS Japanese men. (Circ J 2007; 71: 1229 - 1233)
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  • Makoto Nishida, Toshiki Moriyama, Yoshiro Sugita, Keiko Yamauchi-Takih ...
    2007 Volume 71 Issue 8 Pages 1234-1238
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Inflammation and the metabolic syndrome (MetS) are important risk factors in cardiovascular disease. There is accumulating evidence that decreased adiponectin levels are associated with MetS. Recently, it was shown that adiponectin induces the expression of a potent anti-inflammatory cytokine, interleukin (IL)-10, in vitro. The aim of this study is to investigate the association of IL-10 levels with other pro-inflammatory and anti-inflammatory factors including adiponectin levels in vivo. Methods and Results MetS components were assessed in 117 drug-naïve middle-aged men. Serum levels of high-sensitive C-reactive protein (hs-CRP), IL-6, adiponectin, IL-10 and tumor necrosis factor-α (TNF-α) were measured in these subjects. A significant decrease in adiponectin (5.15±1.79 μg/ml vs 6.87±3.55 μg/ml, p<0.02) and an increase in IL-6 (1.50±1.50 pg/ml vs 1.06 ±0.78 pg/ml, p<0.05) levels were associated with MetS. The serum IL-10 level exhibited a significant positive correlation with IL-6, hs-CRP, and TNF-α levels, but not with adiponectin in healthy individuals. However, IL-10 exhibited a significant correlation with adiponectin, especially in the subjects with MetS. Conclusions Serum IL-10 levels correlated with inflammatory proteins, but not with adiponectin. However, IL-10 positively associated with adiponectin especially in the subjects with MetS. IL-10 might be involved in the inflammatory network of MetS in relation to adiponectin. (Circ J 2007; 71: 1234 - 1238)
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  • Eiji Oda, Masahiro Abe, Punniyakoti T Veeraveedu, Kenichi Watanabe
    2007 Volume 71 Issue 8 Pages 1239-1243
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background The purpose of the present study is to examine the agreement of various existing definitions of metabolic syndrome for Japanese. Methods and Results One hundred thirty-two apparently healthy men and 147 apparently healthy women underwent testing and diagnosis for metabolic syndrome using 5 different definitions of metabolic syndrome for Japanese, including a newly proposed definition: a modified National Cholesterol Education Program definition replacing abdominal obesity with C-reactive protein. The agreement of these various definitions of metabolic syndrome was studied using an agreement index defined as the number of subjects who met both definitions divided by the number of subjects who met either of the 2 definitions. Agreement indices among these various definitions of metabolic syndrome for Japanese were between 0.19 and 0.6 in men and between 0.31 and 0.89 in women. The average agreement index was 0.41 in men and 0.51 in women, and the overall agreement index was 0.15 in men and 0.21 in women. Conclusions There was considerable disagreement among various definitions of metabolic syndrome for Japanese. Therefore, diagnosis with this syndrome should not be made until a truly consensual definition of metabolic syndrome can be established. (Circ J 2007; 71: 1239 - 1243)
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  • Hiromi Nakai, Masaaki Takeuchi, Tomoko Nishikage, Toshiki Nagakura, Sh ...
    2007 Volume 71 Issue 8 Pages 1244-1249
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background The prominent mid-diastolic filling wave (mitral L wave) indicates advanced diastolic dysfunction in patients in sinus rhythm. The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety-nine consecutive non-valvular chronic persistent AF patients were enrolled. The mitral L wave was defined as a distinct mid-diastolic flow velocity following the E wave with a peak velocity >20 cm/s. The prevalence of the L wave in AF patients (34/99, 34%) was significantly higher than that observed in patients in sinus rhythm during the same study period (23/946, 2.4%, p<0.001). Patients with AF and L wave were older, more frequently female and had a slower heart rate, shorter isovolumic relaxation times, larger E wave velocities and lower early diastolic mitral annulus velocity (E') resulting in the higher E/E' compared to those without L waves. The left atrial volume index was significantly larger in patients with an L wave. The Valsalva maneuver decreased, and leg elevation increased, the amplitude of the L wave in the subset of patients who received these procedures. Conclusions The appearance of the mitral L wave in AF is relatively common, and its presence indicates advanced diastolic dysfunction, including elevated filling pressures and distended noncompliant LA. (Circ J 2007; 71: 1244 - 1249)
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  • Kohei Miyaji, Hiroshi Tada, Kengo Fukushima Kusano, Tohru Hashimoto, K ...
    2007 Volume 71 Issue 8 Pages 1250-1257
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Bepridil has multiple ion-channel blocking effects and is expected to be useful for managing atrial fibrillation (AF). The purpose of this study was to clarify the efficacy and safety of additional treatment with bepridil in patients with AF who had been treated with class I antiarrhythmic drugs (AADs). Methods and Results Bepridil (50-200 mg/day) was given to 76 patients with either paroxysmal (n=49) or persistent AF (n=27). All patients had been treated with class I AADs (1.9±0.9 drugs/patient) that failed to control the AF. With the addition of bepridil, the frequency of symptomatic AF episodes decreased to less than 10% in 38 (78%) patients with paroxysmal AF, and sinus rhythm was restored within 3 months and maintained during the follow-up in 20 (74%) patients with persistent AF. Efficacy was usually obtained with a small to moderate dose (50-150 mg/day) of bepridil. During a mean follow-up period of 27±22 months, no potential complications occurred in any of the patients. Conclusions The addition of bepridil to class I AADs is effective and safe for AF, but careful observation using periodic ECG recordings is essential for avoiding torsades de pointes caused by QT prolongation. (Circ J 2007; 71: 1250 - 1257)
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  • Kimie Ohkubo, Ichiro Watanabe, Yasuhiro Takagi, Yasuo Okumura, Sonoko ...
    2007 Volume 71 Issue 8 Pages 1258-1262
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background The pathogenesis of Brugada syndrome (BS) is reported to be phase 2 reentry resulting from shortening of the action potential duration at the epicardial site of the right ventricular outflow tract (RVOT). However, several reports have shown a high incidence of ventricular late potentials (LPs) and a high rate of induction of ventricular fibrillation (VF) by programmed ventricular stimulation (PVS) among patients with BS. The aim of this study was to investigate the role of slow conduction for the initiation of VF by PVS in these patients. Methods and Results Endocardial mapping of the RVOT was conducted in 17 patients in whom VF was induced by PVS from the RV apex or RVOT; 11 patients had a positive LP. In 10 patients, RV mapping showed that low-amplitude fragmented and delayed potentials (DPs) were recorded at the RVOT below the pulmonary valve (PV) or between the PV and His bundle electrogram recording site. Electrograms recorded after PVS showed a high incidence of fractionated and disorganized DPs that lead to VF. Conclusions Slow conduction at the RVOT may contribute to the induction of VF by PVS. However, the role of slow conduction in spontaneous VF remains controversial. (Circ J 2007; 71: 1258 - 1262)
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  • Tsuyoshi Honda, Seigo Sugiyama, Tomohiro Sakamoto, Koichi Kaikita, His ...
    2007 Volume 71 Issue 8 Pages 1263-1267
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Patients with hypertrophic cardiomyopathy (HCM) frequently complain of angina-like symptoms in the absence of organic coronary stenoses. Coronary spasm might cause myocardial ischemia in HCM patients. Delta-sarcoglycan plays a crucial role in the pathogenesis of HCM and coronary spasm in a mouse model. Methods and Results This is a retrospective, single-center study with a small sample size. Seventy patients with HCM underwent coronary angiography and received acetylcholine provocation test. Coronary risk factors and 5'-untranslated region (UTR) G to C polymorphism on delta-sarcoglycan gene (n=64) were evaluated in the HCM patients. In 31 (44.3%) of 70 HCM patients, coronary spasm was induced by the provocation. None of the coronary risk factors was significantly different between the coronary spasm group and the non-coronary spasm group. The 5'-UTR gene polymorphism was associated with the occurrence of coronary spasm with an additive effect on the coexistence (p=0.025). Multiple logistic regression analysis showed that the C allele of 5'-UTR polymorphism was a significant risk factor for coronary spasm in patients with HCM (odds ratio, 3.1; 95% confidence interval, 1.0 to 9.5; p=0.045) that was independent of traditional coronary risk factors. Conclusions The 5'-UTR polymorphism on delta-sarcoglycan gene was associated with coronary spasm in Japanese patients with HCM. (Circ J 2007; 71: 1263 - 1267)
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  • Soichiro Ohta, Toshiro Shinke, Katsuya Hata, Hideyuki Takaoka, Junya S ...
    2007 Volume 71 Issue 8 Pages 1268-1273
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Increased nitric oxide (NO) in the failing heart attenuates the myocardial contractile response to β-adrenergic receptor stimulation. However, the physiological effects of NO on the β-adrenergic post-receptor signaling system are unknown. The objective of the present study was to examine the effects of cardiac NO synthase (NOS) inhibition on left ventricular (LV) hemodynamics and mechanoenergetics in response to adenylyl cyclase stimulation in human heart failure. Methods and Results The study group comprised 13 patients with heart failure because of idiopathic cardiomyopathy (IDC). Emax was examined as an index of LV contractility, LV external work (EW), pressure - volume area (PVA), myocardial oxygen consumption (MVO2), and mechanical efficiency (EW/MVO2) with the use of conductance and coronary sinus thermodilution catheters before and during colforsin daropate infusion, and during concurrent infusion of colforsin daropate with the NOS inhibitor, NG-monomethyl-L-arginine (L-NMMA; 200 μmol). Colforsin daropate increased Emax by 53% and EW by 18%, and reduced PVA by 14%, without altering MVO2 or mechanical efficiency. The combination of colforsin daropate with L-NMMA further increased Emax by 26% and reduced PVA by 9%, without altering MVO2 or mechanical efficiency. Conclusions These findings suggest endogenous NO may modulate β-adrenergic post-receptor pathways and preserve myocardial efficiency in patients with IDC. (Circ J 2007; 71: 1268 - 1273)
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  • Yasuyuki Hadano, Kazuya Murata, Nobuaki Tanaka, Aiko Muro, Eizo Akagaw ...
    2007 Volume 71 Issue 8 Pages 1274-1278
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Although previous investigators reported that mitral annular velocity predicts mean pulmonary capillary wedge pressure (PCWP), it is unknown whether the lateral or septal mitral annular velocity more faithfully predicts PCWP after cardiac surgery. Methods and Results To assess the effect of cardiac surgery on the predictive values for PCWP by measuring mitral annular velocity, 52 consecutive patients undergoing cardiac surgery were studied. All patients underwent transthoracic echocardiography and right-sided cardiac catheterization both before and after surgery. The peak early diastolic velocity of transmitral flow (E) was measured by pulsed-wave Doppler and the peak early diastolic velocities of the lateral (LEa) and septal (SEa) mitral annulus by pulsed-wave tissue Doppler imaging. The ratios of E to LEa (E/LEa) and SEa (E/SEa) were calculated. Immediately after echocardiography, PCWP was measured using a balloon-tipped pulmonary artery catheter. After surgery, LEa was significantly increased (6.4±2.7 vs 8.6 ±3.3 cm/s, p<0.001), but SEa was unchanged (6.0±2.5 vs 5.5±2.3 cm/s, p=0.09). E/LEa correlated well with PCWP both before and after surgery (r=0.79 and r=0.69, respectively, p<0.001). Although E/SEa correlated well before surgery (r=0.67, p<0.001), it correlated only weakly after surgery (r=0.44, p<0.01). Conclusions E/LEa has the best correlation with PCWP both before and after cardiac surgery and may be more useful than E/SEa in the noninvasive estimation of PCWP. (Circ J 2007; 71: 1274 - 1278)
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  • Mitsumasa Hata, Akira Sezai, Tetsuya Niino, Masataka Yoda, Shinji Waku ...
    2007 Volume 71 Issue 8 Pages 1279-1282
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background The long-term outcome of medical treatment in patients with type B acute aortic dissection (BAD) was assessed and predictors of early in-hospital death were investigated, as well as the need for surgical intervention. Methods and Results In the past 11 years, 180 patients were admitted to hospital and medically treated at the time of onset. If the maximum diameter of the dissected aorta exceeded 60 mm, or rapid enlargement or vital organ ischemia were identified, early or elective surgery was performed. Emergency operation was required in 7 patients. Elective surgery was required for 31 patients (19.1%). The operation-free rate was 76.0% at 10 years. Actuarial survival rate was 89.4% at 5 years and 71.8% at 10 years. Multivariate analysis indicated that refractory hypertension (odds ratio (OR), 4.08, 95% confidence interval (CI), 3.06-21.44, p=0.0434) and rupture (OR 5.87, 95% CI, 2.21-9.12, p=0.0154) were predictors of early hospital mortality. The only significant predictor for elective surgery was a maximum diameter exceeding 40 mm at the time of onset (OR 13.4, 95% CI, 1.93-6.89, p=0.0003). Conclusions Medical treatment for BAD produced good results. Strict control of blood pressure is important for patients with a dissected aortic diameter exceeding 40 mm at the time of onset. (Circ J 2007; 71: 1279 - 1282)
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  • Byung Jin Kim, Hyun Jong Lee, Ki Chul Sung, Bum Soo Kim, Jin Ho Kang, ...
    2007 Volume 71 Issue 8 Pages 1283-1287
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Subjects with high normal blood pressure (BP: systolic, 130-139 mmHg or diastolic, 85-89 mmHg) have higher cardiovascular risks compared with individuals with normal BP (systolic BP, 120-129 mmHg or diastolic BP, 80-84 mmHg). In the present study the prevalence of microalbuminuria and cardiovascular risk factors, as well as factors that influence microalbuminuria, were assessed in 2 groups of subjects with prehypertension. Methods and Results Of 2,678 prehypertensive subjects (1,689 men, 989 women), none had a history of diabetes or hypertension. Urine albumin excretion was measured by an immunoradiometric assay in a morning urine sample. The prevalence of microalbuminuria in the high normal BP group was higher than in the normal BP group (4.9% vs 2.8%, p=0.009). Subjects with high normal BP were older, and had higher prevalence of males and metabolic syndrome; larger waist circumference and body mass index, higher levels of triglycerides, fasting blood glucose, uric acid and ferritin, and lower levels of high-density lipoprotein-cholesterol were more common in subjects with high normal BP than in those with normal BP. Multiple logistic regression analysis showed that the high normal BP category had an independently significant association with microalbuminuria (odds ratio =1.692, 95%confidence interval 1.097-2.611). Conclusions Subjects with high normal BP have greater risk factors for cardiovascular disease, including microalbuminuria, than those with normal BP. Further investigations are needed to ascertain whether more positive treatment strategies for the early prevention of cardiovascular disease might be needed for individuals with high normal BP. (Circ J 2007; 71: 1283 - 1287)
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  • Min Woong Kim, Bum Soo Kim, Hun Sub Shin, Byung Jin Kim, Ki Chul Sung, ...
    2007 Volume 71 Issue 8 Pages 1288-1292
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Cardiovascular events are known to occur more frequently in patients with a high morning surge in blood pressure (BP), but the correlation between a morning BP surge and corrected QT dispersion (QTc) has not been confirmed to date. Methods and Results The correlation between the morning BP surge and QTc was studied in 82 patients recently diagnosed with high BP (47 males, 35 females). Twenty-four-hours BP monitoring was conducted to classify patients into dipper (n=45) or nondipper (n=37) groups according to the degree of nocturnal BP reduction. QTc was found to be significantly longer in the nondippers compared with the dippers (36.1±17.2 vs 47.6±20.7, p<0.001). In addition, there was a significant increase in the end-diastolic interventricular septum thickness (IVSd), left ventricular posterior wall thickness in diastole (PWT) and left ventricular mass index (LVMI) in the nondippers vs the dippers (respectively, 0.93±0.09 vs 1.03±0.05, p<0.001, 0.94±0.09 vs 1.01±0.04, p<0.01, 109.7±12.8 vs 129.1±20.9, p<0.001). QTc had a significant positive correlation with nighttime BP, IVSd, PWT, and LVMI, but negatively correlated with the nocturnal BP reduction rate. These results were maintained even after adjusting for age and gender. However, a significant correlation between the morning BP surge and QTc was not confirmed. Conclusion In the present nondipper hypertensive patients, QTc, nighttime BP, LVMI, and wall thickness were significantly greater than in the dipper patients. However, there was no significant correlation between the morning BP surge and QTc. (Circ J 2007; 71: 1288 - 1292)
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  • Ken Iesato, Koichiro Tatsumi, Toshiji Saibara, Akira Nakamura, Jiro Te ...
    2007 Volume 71 Issue 8 Pages 1293-1298
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Lipoprotein lipase (LPL) might play a major role in lipid metabolism by hydrolyzing triglyceride-rich lipoproteins. Decreased LPL activity can trigger early inflammatory responses central to atherosclerosis. However, whether repeated apnea-related hypoxemia influences lipid metabolism in patients with obstructive sleep apnea syndrome (OSAS) remain undefined. This investigation determined whether circulating LPL was influenced by repeated apnea-related hypoxemia, and the effect of nasal continuous positive airway pressure (CPAP) therapy on LPL concentrations in OSAS patients. Methods and Results The participants of the study were 155 men with OSAS and 39 men without OSAS. Circulating LPL concentrations decreased with the severity of OSAS. They correlated negatively with serum triglyceride, and the linear regression lines between LPL concentrations and triglyceride in OSAS patients were shifted downward compared with those in non-OSAS patients, suggesting that any pathophysiological factor might decrease LPL activity in OSAS patients. Some OSAS patients were subjected to CPAP therapy for 3 months. CPAP therapy increased LPL concentrations and decreased C-reactive protein (CRP) concentrations. Conclusions The present study suggests that repeated apnea-related hypoxemia might affect lipid metabolism and augment inflammatory responses, and CPAP therapy could be effective to decrease inflammatory responses and ameliorate lipid metabolism in patients with OSAS. (Circ J 2007; 71: 1293 - 1298)
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  • Qiang Zhang, Chang-Sheng Ma, Shao-Ping Nie, Xin Du, Qiang Lv, Jun-Ping ...
    2007 Volume 71 Issue 8 Pages 1299-1304
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Patients with renal insufficiency are more likely to die after coronary revascularization, but mild renal insufficiency is neglected and little is known about its clinical effects. Methods and Results In the present study 3,025 patients grouped by estimated creatinine clearance (CrCl) were analyzed to evaluate the association between CrCl and clinical outcome. The mean serum creatinine was 1.0±0.4 mg/dl, with 4.3% above normal; in 65.8% CrCl was <90 ml/min. During hospitalization, there were significant differences in mortality among the groups stratified by CrCl (p<0.0001). During follow-up after hospital discharge, there were significant differences in mortality (p<0.0001), new-onset myocardial infarction (p=0.007), and stroke (p=0.032). In patients with severe renal insufficiency, the in-hospital and follow-up mortality reached 15.4% and 31.3%, respectively. The independent risk factors for all-cause death after revascularization were the mode of revascularization, age and the CrCl level. In patients with mild renal insufficiency or normal renal function, the all-cause mortality after percutaneous coronary intervention was significantly lower than that after CABG. Conclusions Renal insufficiency is not rare in patients undergoing coronary revascularization and in the present study even mild renal insufficiency correlated with adverse clinical outcomes after revascularization. In patients with normal renal function or mild renal insufficiency, the mode of revascularization might lead to a prognostic difference. (Circ J 2007; 71: 1299 - 1304)
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  • Koichi Akutsu, Hiroko Morisaki, Satoshi Takeshita, Shingo Sakamoto, Yu ...
    2007 Volume 71 Issue 8 Pages 1305-1309
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Mutations in the genes for transforming growth factor-β receptor (TGFBR) have been identified in patients with Marfan syndrome (MFS) and Marfan-like connective tissue disorders. There are several syndromes associated with mutations in TGFBR genes, including Loeys-Dietz syndrome (LDS), MFS2, Furlong syndrome, and Shprintzen-Goldberg syndrome. However, with the exception of the first report by Loeys et al, the phenotypic features of patients with TGFBR gene mutations have not been precisely reported. Methods and Results A total of 18 patients suspected of having MFS were recruited and 7 were diagnosed with MFS and mutations in FBN1. Among the remaining 11 patients, 1 patient had mutations in TGFBR1, 2 had mutations in TGFBR2, and 1 had mutations in COL3A1. The clinical manifestations of the 3 patients with TGFBR gene mutations were examined according to the list of 36 clinical features described in the first report by Loeys et al. The clinical manifestations of these 3 patients differed from those previously observed in patients with MFS2, Furlong syndrome, and Shprintzen-Goldberg syndrome. Thus, the most probable diagnosis of these 3 patients was LDS, despite the fact that they presented with only a fraction of the 36 clinical features associated with LDS. Conclusions Although the number of the patients was limited, the findings support the notion that mutations in the TGFBR gene may be associated with greater phenotypic heterogeneity than previously reported. (Circ J 2007; 71: 1305 - 1309)
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Experimental Investigation
  • Michio Nakanishi, Masaki Harada, Ichiro Kishimoto, Koichiro Kuwahara, ...
    2007 Volume 71 Issue 8 Pages 1310-1316
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Aortic regurgitation (AR) causes left ventricular (LV) volume overload, leading to progressive LV dilatation and dysfunction. In the present study it was examined whether blockade of angiotensin II type 1 receptor (AT1) could improve survival in cases of chronic severe AR. Methods and Results AR was induced by puncturing the aortic valves of wild-type (WT) and AT1a knockout (KO) mice. Mice that survived for 4 weeks after the operation were deemed to be a model of chronic severe AR and were followed up for 50 weeks (WT, n=29; KO, n=31). Baseline measurements made 4 weeks after surgery showed similar LV cavity and function in both genotypes. These conditions progressively worsened in both genotypes, but 16 weeks after baseline, KO mice showed significantly less LV dilatation, hypertrophy and interstitial fibrosis than WT mice. Cardiac mRNA expression of B-type natriuretic peptide and type I collagen was lower in KO than WT mice. The 50-week mortality rate was significantly lower among KO (45.2%) than WT (86.2%) mice, and postmortem findings indicated that the lower mortality was attributable to a lower incidence of congestive heart failure. Conclusions In cases of chronic severe AR, blockade of AT1 attenuates the progression of LV dilatation, hypertrophy and fibrosis, thereby mitigating heart failure and improving long-term survival. (Circ J 2007; 71: 1310 - 1316)
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Case Report
  • Toshinori Totsugawa, Masahiko Kuinose, Hidenori Yoshitaka, Yoshimasa T ...
    2007 Volume 71 Issue 8 Pages 1317-1320
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Mycotic aortic aneurysm caused by Klebsiella pneumoniae (K. pneumoniae) is extremely rare and 3 cases of K. pneumoniae-induced mycotic aortic aneurysm are present, 2 of which were located in the aortic arch and the other in the suprarenal abdominal aorta. Urgent surgery was performed for 2 cases because of impending aneurysmal rupture and progressive septic shock, whereas elective surgery was performed after radical antibiotic chemotherapy for the other case. In-situ reconstruction with rifampicin-bonded prosthetic grafts was performed, and no infective complications have occurred in any of the cases. (Circ J 2007; 71: 1317 - 1320)
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  • Tatsuya Ogawa, Toshihiko Saga, Susumu Nakamoto
    2007 Volume 71 Issue 8 Pages 1321-1322
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Myotonic dystrophy is a well-known hazard of anesthesia for various kinds of surgery. A 47-year-old male who had an increased CTG repeat of approximately 700 copies in the 3'-untranslated region of the myotonic dystrophy protein kinase gene underwent closure of an atrial septal defect under normothermic beating heart. A strong correlation between reduced left ventricular ejection fraction and stroke volume, and the number of CTG repeats, has been reported. Because this correlation is not completely understood, even if the preoperative cardiac function is normal, it is important to check the number of CTG repeats and the patients who have a large number of them should be carefully treated. (Circ J 2007; 71: 1321 - 1322)
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  • Junko Okamoto, Masatake Fukunami, Hidetaka Kioka
    2007 Volume 71 Issue 8 Pages 1323-1325
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Itraconazole is widely used to treat onychomycosis because of its significant therapeutic effects. An otherwise healthy 30-year-old man treated with itraconazole developed frequent premature ventricular contractions (PVC). He presented with a dry cough and palpitation. The results of 12-lead electrocardiography (ECG) were essentially normal, but Holter ECG revealed 17,484 (18%) uniform PVC, including 4 short runs among 96,930 beats/day. Another Holter ECG after withdrawing itraconazole revealed 1,032 premature atrial contractions but no PVC. The corrected QT interval was 0.39 s without itraconazole, 0.41 s with itraconazole, and 0.43 s when multiple PVC were documented. Itraconazole inhibits the fungal cytochrome P450 that is involved in fungal cell membrane formation, interrupts human cytochrome P450A4 in the liver and causes adverse interactions with various drugs such as antiarrythmics, but its cardiac side-effects are obscure. Both patients and physicians should be aware that itraconazole can cause PVC as a side-effect. (Circ J 2007; 71: 1323 - 1325)
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  • Yun-Hyeong Cho, Sungha Park, Jung-Sun Kim, Seung-Yul Lee, Donghoon Cho ...
    2007 Volume 71 Issue 8 Pages 1326-1327
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Entrapment of a guidewire is a rare event, but it could happen especially in severe calcified stenotic lesion. This complication is life-threatening because it can lead to myocardial ischemia, infarction, or lethal arrhythmia due to intracoronary thrombosis. In the event of failed retrieval and persistent signs of ischemia, patients should be urgently referred to surgery. During percutaneous coronary intervention, the Tornus catheter has been applied to patients with severe coronary artery disease when balloon catheter or microcatheter cannot be crossed across the lesion after successful wire crossing. This is a case of a patient that a Tornus catheter rescued an entrapped guidewire in severe calcified coronary disease. (Circ J 2007; 71: 1326 - 1327)
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Rapid Communication
  • Makoto Mutoh, Tetsuya Ishikawa, Toshio Hasuda, Hisayuki Okada, Akira E ...
    2007 Volume 71 Issue 8 Pages 1328-1331
    Published: 2007
    Released: July 25, 2007
    JOURNALS FREE ACCESS
    Background Outcomes after sirolimus-eluting stent (SES: Cypher®) implantation remained to be elucidated in Japan. Methods and Results Among 1,070 consecutive angiographic follow-up lesions, 99 lesions underwent target lesion revascularization (TLR) with in-stent restenosis (ISR). Retrospective estimation by multivariate analysis including 50 variables showed that the ostiums of right coronary and left circumflex arteries, hemodialysis, calcification, non-direct stenting, ISR of SES, and non-eccentric lesion were the predictors of TLR. There was no documented late stent thrombosis (LST) among 2,166 lesions and very LST (VLST) among 1,423 lesions. Conclusion Further revises are needed to implant SES to these predictive lesions. LST and VLST were very rare. (Circ J 2007; 71: 1328 -1331)
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