Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 72 , Issue 12
Showing 1-33 articles out of 33 articles from the selected issue
Special Article
  • Masao Endoh
    2008 Volume 72 Issue 12 Pages 1915-1925
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: November 04, 2008
    JOURNALS FREE ACCESS
    The role of Ca2+ in cardiac excitation - contraction (E-C) coupling has been established by simultaneous measurements of contractility and Ca2+ transients by means of aequorin in intact myocardium and Ca2+ sensitive fluorescent dyes in single myocytes. The E-C coupling process can be classified into 3 processes: upstream (Ca2+ mobilization), central (Ca2+ binding to troponin C) and downstream mechanism (thin filament regulation and crossbridge cycling). These mechanisms are regulated differentially by various inotropic interventions. Positive force-frequency relationship and effects of β-adrenoceptor stimulation, phosphodiesterase 3 inhibitors and digitalis are essentially exerted via upstream mechanism. Alpha-adrenoceptor stimulation, endothelin-1, angiotensin II, and clinically available Ca2+ sensitizers, such as levosimendan and pimobendan, act by a combination of the upstream and central/downstream mechanism. The Frank-Starling mechanism and effects of Ca2+ sensitizers such as EMD 57033 and Org 30029 are primarily induced via the central/downstream mechanism. Whereas the upstream and central mechanisms are markedly suppressed in failing myocytes and under acidotic conditions, Ca2+ sensitizers such as EMD 57033 and Org 30029 can induce cardiotonic effects under such conditions. Ca2+ sensitizers have high therapeutic potential for the treatment of contractile dysfunction in congestive heart failure and ischemic heart diseases, because they have energetic advantages and less risk of Ca2+ overload and can maintain effectiveness under pathological conditions. (Circ J 2008; 72: 1915 - 1925)
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  • Wataru Shimizu
    2008 Volume 72 Issue 12 Pages 1926-1936
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: November 04, 2008
    JOURNALS FREE ACCESS
    Over the past decade, molecular genetic studies have established a link between a number of inherited cardiac arrhythmias, including congenital long QT syndrome (LQTS) and Brugada syndrome (BrS), and mutations in genes encoding for ion channels or other membrane components. Twelve forms of LQTS have been identified in 50-70% of clinically affected patients. Genotype - phenotype correlations have been rigorously investigated in LQT1, LQT2 and LQT3 syndromes, which constitute more than 90% of genotyped LQTS patients, enabling stratification of risk and effective treatment of genotyped patients. Genotype-specific triggers for both the cardiac events and the clinical course have been reported, and genotype-specific therapy has been already introduced. More recently, mutation site-specific differences in the clinical phenotype have been reported in LQT1 and LQT2 patients, indicating the possibility of mutation site-specific management or treatment. In contrast, only one-third of BrS patients can be genotyped, and data on genotype - phenotype relationships in clinical studies are limited. A Haplotype B consisting of 6 individual DNA polymorphisms within the proximal promoter region of the SCN5A gene was recently identified only in Asians (frequency 22%). Individuals with Haplotype B show significantly longer duration of both PQ and QRS than those without Haplotype B, indicating that Haplotype B likely contributes to the higher incidence of BrS in Asian populations. (Circ J 2008; 72: 1926 - 1936)
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Clinical Investigation
  • Yutaka Furukawa, Ryoji Taniguchi, Natsuhiko Ehara, Neiko Ozasa, Yoshis ...
    2008 Volume 72 Issue 12 Pages 1937-1945
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 24, 2008
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    Background The importance of statins in cardiovascular prevention has been demonstrated in various patient subsets. This study aimed to evaluate the effects of statins on long-term outcomes of Japanese patients undergoing their first coronary revascularization. Methods and Results A total of 9,225 patients undergoing their first coronary revascularizations during 2000-2002 were divided into 2 groups according to the use of statins at discharge; patients with acute myocardial infarction were not included. Statins was administered to only 28.5% (n=2,630) of the patients. The median follow-up period was 3.5 years. Patients on statin therapy showed lower all-cause (5.2% vs 10.0%; p<0.0001) and cardiovascular (3.2% vs 6.2%; p<0.0001) mortality than those without statins (n=6,595) by Kaplan-Meier analysis and log-rank test. After adjustment by multivariate analysis according to 29 variables, statin therapy remained as an independent predictor of reduced all-cause (relative risk ratio (RR) 0.71, 95% confidence interval (CI) 0.59-0.86, p=0.0005) and cardiovascular (RR 0.72, 95% CI 0.56-0.91, p=0.0067) mortality. The validity of RR of statin therapy in multivariate analysis was further confirmed by risk adjustment using propensity scores (all-cause mortality: propensity-adjusted RR 0.70, 95% CI 0.58-0.85, p=0.0003; cardiovascular mortality: propensity-adjusted RR 0.70, 95% CI 0.54-0.89, p=0.0038). Conclusions Statin therapy started at hospital discharge was associated with increased chance of survival in Japanese patients undergoing their first coronary revascularization. (Circ J 2008; 72: 1937 - 1945)
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  • Motoji Sawabe, Akihiko Hamamatsu, Kouji Chida, Tomio Arai, Kazumasa Ha ...
    2008 Volume 72 Issue 12 Pages 1946-1952
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 17, 2008
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    Background The presence of discordances between common carotid and coronary atherosclerosis in the same individual has not been previously reported. Methods and Results The subjects of the present study were 1,518 consecutive autopsy cases at a general geriatric hospital. All were aged 60 years or older (821 men, 697 women) with an average age of 80 years. The atherosclerotic index of the common carotid artery (CC-AI) and coronary stenotic index (CSI) were semi-quantitatively evaluated. The simple correlation coefficient between the CC-AI and CSI was 0.456 (p<0.0001). Among 689 cases with minimal common carotid atherosclerosis (CC-AI ≤2), 74 (11%) had severe coronary atherosclerosis (CSI ≥12), 68 (10%) had coronary heart disease, and 80 (12%) had pathologically-verified myocardial infarction (MI). Among those with minimal common carotid atherosclerosis, the serum total cholesterol level, diabetes mellitus, and history of smoking were significantly higher or more frequent in cases with a CSI ≥12 than in the patients with a CSI <12. Conclusions A considerable proportion of cases with minimal common carotid atherosclerosis had severe coronary atherosclerosis and MI. This discordance can potentially lead to an underestimation of coronary risks if normal common carotid morphology is obtained by ultrasound. (Circ J 2008; 72: 1946 - 1952)
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  • Tatsuya Nakachi, Masami Kosuge, Kiyoshi Hibi, Toshiaki Ebina, Katsutak ...
    2008 Volume 72 Issue 12 Pages 1953-1959
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 29, 2008
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    Background In non-ST-segment elevation acute coronary syndromes (NSTE-ACS), the relation of the level of high-sensitivity C-reactive protein (CRP) to the progression of atherosclerosis remains unclear. Methods and Results The study group comprised 153 patients with NSTE-ACS who underwent percutaneous coronary interventions (PCI) and follow-up (mean interval, 7 months) coronary angiography. Rapid progression was defined as ≥10% diameter reduction of a preexisting stenosis ≥50%, ≥30% diameter reduction of a stenosis <50%, development of a new stenosis ≥30% in a previously normal segment, or progression of any stenosis to total occlusion. Progressors had higher CRP levels on admission and at 48 h after PCI, a higher level of low-density lipoprotein cholesterol at follow-up, a higher rate of multiple complex lesions, and a lower frequency of statin use at follow-up than nonprogressors. Multivariate analysis showed that admission CRP elevation (CRP level on admission ≥0.166 mg/dl, median value; odds ratio (OR) 2.92, p=0.010), post-PCI CRP elevation (CRP level 48 h after PCI ≥1.586 mg/dl, median value; OR 2.67, p=0.022), and multiple complex lesions (OR 2.66, p=0.017) were independent predictors of rapid progression of nonculprit lesions. Conclusions Enhanced inflammatory response to PCI, as well as baseline inflammatory activity as reflected by CRP level, may be involved in the progression of atherosclerosis in NSTE-ACS. (Circ J 2008; 72: 1953 - 1959)
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  • Omer Alyan, Fehmi Kacmaz, Ozcan Ozdemir, Bulent Deveci, Ramazan Astan, ...
    2008 Volume 72 Issue 12 Pages 1960-1965
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 29, 2008
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    Background The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. Methods and Results The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly higher in the HCV seropositive group (p<0.001) and the Reardon severity score was higher (8.75±1.69 vs 6.01±1.80, p<0.001). After adjustment, HCV seropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher Reardon severity score with an odds ratio of 2.018 (95% confidence interval 1.575-2.579, p<0.001). Conclusion HCV infection is an independent predictor for increased coronary atherosclerosis, as demonstrated by higher Reardon severity score. (Circ J 2008; 72: 1960 - 1965)
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  • Suk-Won Song, Gijong Yi, Sak Lee, Young-Nam Youn, Soon-Young Sul, Kyun ...
    2008 Volume 72 Issue 12 Pages 1966-1974
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 21, 2008
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    Background Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed. Methods and Results The study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index. Conclusions Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored. (Circ J 2008; 72: 1966 - 1974)
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  • Qiang Ji, Yunqing Mei, Xisheng Wang, Jing Feng, Jiangzhi Cai, Yifeng S ...
    2008 Volume 72 Issue 12 Pages 1975-1980
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 17, 2008
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    Background To investigate 576 patients undergoing coronary artery bypass grafting (CABG) and to evaluate independent high risk factors of postoperative hypoxemia following CABG. Methods and Results The pre-, intra-, and post-operative materials in patients who had CABG performed on them from March 2004 to March 2008 in our hospital were analyzed retrospectively. The relative factors of postoperative hypoxemia were tested through descriptive analysis and logistic regression, and the independent risk factors were obtained. Among the 576 patients investigated, 156 cases suffered from postoperative hypoxemia, and the incidence rate of postoperative hypoxemia was 27.08%. Through descriptive analysis and logistic regression, the independent risk factors of postoperative hypoxemia were as follows: preoperative chronic pulmonary diseases (odds ratio (OR)=8.531, 95% confidence interval (CI) 3.136-23.210), preoperative acute myocardial infarction (OR=3.351, 95% CI 1.539-7.296), and preoperative diabetes (OR=3.108, 95% CI 1.439-6.713). Preoperative acute myocardial infarction (OR=2.091, 95% CI 1.520-4.416) is the independent risk factor during assisted ventilation after surgery, and preoperative chronic pulmonary diseases (OR=7.19, 95% CI 2.807-18.413), pre-operative diabetes (OR=3.605, 95% CI 1.631-7.967), and preoperative acute myocardial infarction (OR=3.604, 95% CI 1.518-8.543) are the 3 independent risk factors after decannulation following CABG. Conclusions Preoperative chronic pulmonary diseases, preoperative acute myocardial infarction, and preoperative diabetes are 3 independent risk factors of postoperative hypoxemia following CABG. (Circ J 2008; 72: 1975 - 1980)
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  • I-Ming Chen, Fei-Yi Wu, Chun-Che Shih
    2008 Volume 72 Issue 12 Pages 1981-1985
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: November 04, 2008
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    Background Endovascular repair of thoracic aortic aneurysms is an attractive alternative to surgical graft replacement, but many patients are excluded because of unsuitable proximal landing zones wider than 38 mm in diameter. Arch aneurysms can be repaired with less invasive hybrid surgery, combining endovascular stent grafting with banding of the proximal landing aorta. Methods and Results Since November 2006, 6 of 88 patients underwent hybrid aortic arch repair with presumptive zone 0 as the proximal landing site where the median maximal diameter was 42.5 mm (from 39 to 44 mm). After partial sternotomy, relocation of the supra-aortic branches, the ascending aorta was banded with a 2-layer Dacron strip and reduced to 36±1 mm in diameter where the stent graft was inserted and incorporated securely. All patients were uncomplicated, with complete exclusion of the arch lesion and without endoleaks or migration during an average 9 months' follow-up. Conclusions Secure fixation of an unsuitable ascending aorta can be solved via aortic banding and will not only improve the short-term stability of the endovascular intervention, but may become the preferred therapeutic modality in patients with multiple comorbidities. (Circ J 2008; 72: 1981 - 1985)
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  • Ivana Hollan, Richard Prayson, Kjell Saatvedt, Sven M. Almdahl, Hans C ...
    2008 Volume 72 Issue 12 Pages 1986-1992
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: November 04, 2008
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    Background The main aim of the present study was to compare the occurrence of inflammatory cell infiltrates in the aorta, a vessel with a high occurrence of atherosclerosis, with that in the saphenous vein (SV) and internal mammary artery (IMA), which are protected from atherosclerosis. Methods and Results Samples from the aorta, SV, and IMA of 65 patients with inflammatory rheumatic diseases (IRD) and from 51 control patients undergoing coronary artery bypass graft surgery were examined for the presence and location of inflammatory cell infiltrates and atherosclerotic lesions. Mononuclear cell infiltrates (MCIs) in the media or adventitia were observed in 2% IMAs, 17% SVs, and 35% aortic specimens (SV vs IMA: p=0.006; SV vs aorta: p=0.001). Atherosclerotic lesions were present in none IMA, 3% SVs and 18% aortic specimens. IRD and smoking increased the odds of MCI in the aorta (odds ratio (OR)=3.6, 95% confidence interval (CI): 1.6-8.5 and OR=4.0, 95% CI: 1.5-10.9), but not in the SV or IMA. Conclusions The occurrence of medial and adventitial MCI in the aorta, SV, and IMA paralleled each vessel's susceptibility to atherosclerosis: it was highest in the aorta and lowest in IMA. Local vascular inflammation may be involved in atherogenesis, and influence the patency of vascular grafts. (Circ J 2008; 72: 1986 - 1992)
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  • Atsuhito Takeda, Tomoaki Murakami
    2008 Volume 72 Issue 12 Pages 1993-1997
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 24, 2008
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    Background Little is known about the precise morphometric data of the aortic arch at which the transcatheter pressure gradient is relieved in patients with aortic coarctation (CoA). Methods and Results Twenty-nine morphometric data were obtained from patients with CoA including the body surface area (BSA) adjusted angiographic diameter of the narrowest vessel, the ratio of the angiographic diameter to that of the descending aorta and BSA-adjusted narrowest cross-sectional area (CSA) using intravascular ultrasound imaging. The transcatheter peak-to-peak pressure gradient of the aortic arch was measured using a manometer tipped catheter. A linear regression analysis showed CSA to have the strongest correlation with the pressure gradient (r=0.92, p=0.0002) among any pressure gradient group (n=10). A receiver-operating characteristic curve (ROC) analysis was performed to determine the morphometric cut-off point at which the pressure gradient occurs. CSA had the highest areas under the ROC (1.0) and the cut-off point of 81 mm2/m2 showed a sensitivity of 100% and specificity of 100% to predict the relief of a pressure gradient. Conclusions In patients with CoA, the vessel size that can relieve a pressure gradient is a CSA of 81 mm2/m2 (10 ×BSA0.5 mm in diameter). This data may provide useful information for catheter intervention and surgery. (Circ J 2008; 72: 1993 - 1997)
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  • Aya Miyazaki, Hideo Ohuchi, Ken-ichi Kurosaki, Shiro Kamakura, Toshika ...
    2008 Volume 72 Issue 12 Pages 1998-2003
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 17, 2008
    JOURNALS FREE ACCESS
    Background Sotalol is a class III antiarrhythmic agent that is highly effective for tachyarrhythmias in adults, but its efficacy in patients with congenital heart disease (CHD) remains unclear. The purpose of this study was to assess the efficacy and safety of sotalol for refractory tachyarrhythmias in patients with CHD. Methods and Results Forty four-patients with CHD and refractory tachyarrhythmias (age, 23±12 years; follow-up period, 13±12 months) were administered sotalol orally during the period December 2002 to May 2007, resulting in complete control of tachyarrhythmias in 18 patients (41%), partial control in 15 patients (34%), and no control in 11 patients (25%). Non-pharmacological intervention (eg, surgery, pacemaker implantation, catheter ablation) was performed in 9 patients and resulted in an augmented response to sotalol in 6 patients. Tachyarrhythmia combined with atrial fibrillation was a risk factor for treatment failure with sotalol (odds ratio, 18.3; 95% confidence interval, 1.8-189.6; p=0.0053). Conclusion Sotalol is partially or completely effective for refractory tachyarrhythmias in patients with CHD, and non-pharmacological interventions improve the efficacy of sotalol. This multimodal approach should be considered in patients with refractory tachyarrhythmias and CHD. (Circ J 2008; 72: 1998 - 2003)
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  • Kimiaki Komukai, Hidenori Yagi, Takayuki Ogawa, Taro Date, Satoshi Mor ...
    2008 Volume 72 Issue 12 Pages 2004-2008
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 29, 2008
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    Background Approximately half of the patients with chronic heart failure (CHF) show preserved systolic function, but less is known about CHF with preserved ejection fraction (EF). Methods and Results In a retrospective analysis, patients with CHF who had been admitted to hospital were divided into 2 groups: reduced EF (EF 40%) and preserved EF (EF >40%). The rate of preserved EF was 53.5% and those with preserved EF were older, more likely to be female, and had a lower serum hemoglobin concentration than those in the reduced EF group. In the multivariate analysis, only older age was independently related to CHF with preserved EF. CHF patients with preserved EF who were successfully discharged from hospital and then followed at the outpatient clinic were reviewed and re-hospitalization for CHF was examined by Cox hazard univariate analysis, which showed that prior CHF hospitalization, absence of hypertension, and non-use of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin-receptor blocker (ARB) were predictors. In the multivariate analysis, non-use of ACEI/ARB was the sole predictor for CHF re-hospitalization. Conclusions CHF patients with preserved EF are older than those with reduced EF and use of ACEI/ARB prevents their re-hospitalization. (Circ J 2008; 72: 2004 - 2008)
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  • Nobuyuki Shiba, Kotaro Nochioka, Haruka Kohno, Mika Matsuki, Jun Takah ...
    2008 Volume 72 Issue 12 Pages 2009-2014
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 24, 2008
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    Background The prognosis of patients with chronic heart failure (CHF) is poor in both men and women. However, the characteristics of, and effective treatment strategy for, female CHF patients still remain unclear. This study was designed to evaluate the prognosis and characteristics of female patients in a CHF cohort termed the Chronic Heart Failure Analysis and Registry in the Tohoku District. Methods and Results Of 1,278 patients registered in the cohort, the study population comprised 1,166 symptomatic CHF patients with sufficient data. As compared with male patients, female patients were more likely to be older, have preserved systolic function and non-ischemic etiology of CHF, and underuse standard CHF medications. Although a previous study showed that sex-difference was not a significant prognostic factor in CHF patients, the unadjusted survival analysis revealed an increased event rate in female patients in the present study. Multivariate analysis revealed that older age, diabetes, ventricular tachycardia and anemia were significant prognostic risks in both men and women with CHF. Conclusions Female sex had a significant link with elderly CHF patients. Given the explosive increase in elderly patients in Westernized countries, further studies are needed to elucidate the evidence for treatment of female CHF patients. (Circ J 2008; 72: 2009 - 2014)
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  • Naomi Kawashiro, Hiroshi Kasanuki, Hiroshi Ogawa, Naoki Matsuda, Nobuh ...
    2008 Volume 72 Issue 12 Pages 2015-2020
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 17, 2008
    JOURNALS FREE ACCESS
    Background Heart failure (HF) represents a major public health issue in an aging population. Although HF is a leading cause of morbidity and mortality in developed countries, the clinical features of HF in Japan remain unclear. Methods and Results This observational cohort study analyzed data from the Heart Institute of Japan - Department of Cardiology (HIJC)-HF Registry, which is based on a nationwide survey by the HIJC, Tokyo Women's Medical University and its affiliated hospitals. Of 3,578 consecutive patients (average age, 69.8 years; females 40.7%) hospitalized for HF between January 2001 and December 2002, 95.0% were followed up until the end of 2005 (median, 2.8 years). The 1- and 3-year mortality rates were 11.3% and 29.2%, respectively. Multivariate analysis revealed that advanced age (hazard ratio 1.71 [95% confidence interval 1.38-2.12]; p<0.001), symptomatic HF at hospital discharge (3.76 [2.30-6.17]; p<0.001), renal impairment (1.96 [1.50-2.57]; p=0.008), anemia (1.46 [1.18-1.80]; p=0.02) and low pulse pressure (2.88 [1.62-5.13]; p=0.0003) were significantly associated with total death. Conclusion Although the long-term mortality rate for Japanese patients with HF is lower than in other countries, several markers are modifiable. The data demonstrate that continued improvements in the treatment of Japanese patients with HF are still needed. (Circ J 2008; 72: 2015 - 2020)
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  • Takuhiro Okuyama, Shoichi Ehara, Nobuyuki Shirai, Kenichi Sugioka, Haj ...
    2008 Volume 72 Issue 12 Pages 2021-2027
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 29, 2008
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    Background With multislice computed tomography (MSCT) it is possible to visualize the coronary arteries, as well as the aorta, in a single computed tomography scan. Using MSCT, atherosis and sclerosis of the descending thoracic aorta (DTA) were quantified and differences between patients with and without coronary artery disease (CAD) were analyzed. Methods and Results The population comprised 89 patients who underwent ECG-gated MSCT: 40 patients with suspected CAD by MSCT underwent invasive coronary angiography, and had documented significant stenoses (CAD group), 49 patients did not have significant stenoses (control group). Twenty cross-sectional images of DTA were reconstructed every 5% (0-95%) of the RR interval, and the largest and smallest luminal areas were traced. Atheromatous score and stiffness β of DTA were quantified; both were significantly higher in the CAD group than in the controls. Multivariate analysis revealed that the average atheromatous score was an independent factor associated with CAD (p<0.005). Conclusion This study demonstrates that atherosis and sclerosis of DTA are associated with CAD. In cases with image quality that is unsatisfactory for interpretation of coronary stenoses, additional assessment of atherosclerosis of the DTA will be useful for identifying patients with CAD. (Circ J 2008; 72: 2021 - 2027)
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  • Wataru Higashiura, Shoji Sakaguchi, Nobuoki Tabayashi, Shigeki Taniguc ...
    2008 Volume 72 Issue 12 Pages 2028-2034
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 21, 2008
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    Background Compared with open surgery, imaging is considered to be important for planning and device selection of endovascular aneurysm repair (EVAR). The present study evaluated the usefulness of a 3-dimensional (3D)-computed tomography (CT) workstation in planning EVAR. Methods and Results A prospective study was conducted in 8 patients who underwent EVAR using Zenith endograft between February and August 2007. Endograft size and optimized deployment projection were decided using a 3D-CT workstation. The primary endpoint was defined as successful deployment of a same size endograft as preoperatively selected without type I or III endoleak or inadvertent arterial occlusion. The following parameters were investigated: (a) incidence of use of an alternative endograft; (b) prevalence of type I or III endoleak; and (c) distance from lowest renal artery to tip of graft. Successful deployment of endograft was achieved in all 8 patients. Use of alternative endograft or type I or III endoleak was not detected in 8 patients. Distance from the lowest renal artery to the tip of the graft was 2.8mm. Conclusions Assessment using a 3D-CT workstation appears to allow accurate endograft selection and precise deployment of the Zenith endograft without type I or III endoleak, even in institutes with a small number of patients. (Circ J 2008; 72: 2028 - 2034)
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  • Naoya Matsumoto, Yuichi Sato, Yasuyuki Suzuki, Shu Kasama, Yoshimochi ...
    2008 Volume 72 Issue 12 Pages 2035-2039
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 24, 2008
    JOURNALS FREE ACCESS
    Background The prognostic value of ECG-gated rest 201Tl/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese. Methods and Results The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9±15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors ≥2), significant ischemia (SDS ≥4) and low EF (EF <45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS. Conclusion Poststress EF added incremental prognostic value for the prediction of ACS. (Circ J 2008; 72: 2035 - 2039)
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  • Dayi Hu, Jue Li, Xiankai Li, for the China Cholesterol Education Prog ...
    2008 Volume 72 Issue 12 Pages 2040-2045
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 21, 2008
    JOURNALS FREE ACCESS
    Background The aim of the China Cholesterol Education Program is to investigate the blood lipid levels, the statin intervention and the rates of achieving the goal of low-density lipoprotein-cholesterol (LDL-C) level in Chinese outpatients with coronary heart disease (CHD). Methods and Results The multicenter study recruited 4,778 outpatients with CHD. The mean level of LDL-C for the total outpatients was 2.93±1.00 mmol/L; 82.2% of the participants received statin therapy. The LDL-C levels were 3.06±1.08 mmol/L and 2.89±0.97 mmol/L in outpatients with high risk and very high risk, respectively (p<0.001). No significant difference was found about the rates of statin intervention in outpatients at high risk and very high risk (81.4% vs 82.5%, p>0.05). Though they had higher rates of statin intervention, only 36.2% of the high-risk outpatients achieved the target LDL-C level (<2.6 mmol/L); 10.9% of the very high risk outpatients achieved the optimal LDL-C level (<1.82 mmol/L) suggested by NCEP ATP III. The rate of achieving the target level was only 42.2%, even though LDL-C <2.6mmol/L was the goal for patients at very high risk. Conclusions Although the outpatients received a higher rate of statin therapy, the rates of achieving the target cholesterol level were lower. There is a significant gap between the guidelines and clinical practice in China. (Circ J 2008; 72: 2040 - 2045)
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  • Yoshiki Matsuo, Toshikazu Hashizume, Shusaku Shioji, Takashi Akasaka
    2008 Volume 72 Issue 12 Pages 2046-2050
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 21, 2008
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    Background The dual goals of low-density lipoprotein-cholesterol (LDL-C) and C-reactive protein (CRP) reduction are important for secondary prevention of cardiovascular disease. However, the relevant factors of subclinical inflammation in patients with optimal LDL-C were not clearly demonstrated. This study sought to test the hypothesis that the metabolic syndrome (MetS) is associated with subclinical inflammation in patients achieving optimal LDL-C. Methods and Results A total of 227 Japanese subjects with a prior history of ischemic heart disease and optimal LDL-C (LDL-C <100 mg/dl) were enrolled. When compared with patients with low CRP (<0.1 mg/dl), those with a high CRP (≥0.1 mg/dl) had a significantly higher prevalence of visceral obesity, elevated triglyceride, lower high-density lipoprotein-cholesterol (HDL-C), hypertension, impaired fasting glucose, and a higher prevalence of MetS. A linear relationship between an increase in number of MetS components and CRP was observed (trend, p<0.001). In multivariate logistic analysis, visceral obesity (odds ratio 6.54; 95% confidence interval 2.99-14.3), low HDL-C (2.78; 1.09-7.12) and impaired fasting glucose (6.72; 3.30-13.7), and MetS (10.4; 5.18-20.7) were associated with higher CRP. Conclusions MetS is well associated with higher CRP concentrations in patients who achieved optimal LDL-C levels. (Circ J 2008; 72: 2046 - 2050)
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  • Jong-Il Choi, Seong Mi Park, Jae Seok Park, Soon Jun Hong, Hui-Nam Pak ...
    2008 Volume 72 Issue 12 Pages 2051-2057
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 24, 2008
    JOURNALS FREE ACCESS
    Background The aim of this study was to assess whether the morphological and functional changes of the left atrium (LA) differ after catheter ablation (ABL) from those after electrical cardioversion (ECV) in atrial fibrillation (AF). Methods and Results AF patients who had maintained sinus rhythm for 3 months after either ECV (n=30) or ABL (n=33) were studied. Both 2-dimensional and Doppler echocardiography were performed at baseline, 1 week, 1 month, and 3 months after these procedures. LA dimensions, mitral inflow velocity, and tissue Doppler imaging of the mitral annulus were examined. LA dimensions decreased in both groups. The mean late mitral annulus velocity increased from 1 week to 3 months in both groups, but the mean late transmitral peak velocity increased only in the ECV group (42.1±14.4 cm/s to 56.7±14.8 cm/s, p<0.001 vs 38.7±12.5 cm/s to 44.8±16.7 cm/s, p=NS). Conclusion Reverse morphological remodeling of the LA occurred after successful ABL and ECV for AF. However, because LA function was lower in the ABL group than in the ECV group and did not recover to the baseline levels until 3 months after ABL, a meticulous anticoagulation program should be considered. (Circ J 2008; 72: 2051 - 2057)
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  • Hiroshi Furusho, Masayuki Takamura, Shigeo Takata, Satoru Sakagami, Mo ...
    2008 Volume 72 Issue 12 Pages 2058-2061
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 14, 2008
    JOURNALS FREE ACCESS
    Background The number of the elderly patients with atrial fibrillation (AF) is increasing, but the current status of anticoagulation therapy for elderly patients with AF in Japan is not clear. Methods and Results Among the patients registered in the "Hokuriku Atrial Fibrillation Trial (HAT) 1", 365 AF patients aged ≥65 years were enrolled in this study. Warfarin was used for significantly less patients in the oldest group aged ≥85 years (36%) than in younger populations, but the percentage of antiplatelet use in this oldest population was largest (40%). The elderly group (≥85 years) was compared with a younger group aged between 75 and 84 years. Warfarin was given to 61% of the younger group compared with 36% in the elderly group. In the younger group, the more thromboembolic risks they had according to CHADS2 score, the more warfarin was used, whereas there was no clear trend in the usage of warfarin in the elderly group. Conclusions The number of elderly Japanese patients with AF taking warfarin is currently low, but because the population of elderly AF patients will increase in the future, there is a need for safe and suitable anticoagulation therapy for elderly patients. (Circ J 2008; 72: 2058 - 2061)
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  • Makoto Hanai, Kazuhiro Hashimoto, Kenoh Mashiko, Tatsuumi Sasaki, Yosh ...
    2008 Volume 72 Issue 12 Pages 2062-2068
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: November 04, 2008
    JOURNALS FREE ACCESS
    Background This study was performed to identify risk factors for hospital death in patients with acute and active infective endocarditis (AAIE) after surgical intervention. Methods and Results From 1980 to 2004, 94 patients underwent surgery for AAIE (age range, 3-77 years; 76% males). Congestive heart failure (CHF) was present in 44 patients, as well as vegetations in 64, septicemia in 16, abscesses in 17, and emboli in 22; 16 patients had prosthetic valve endocarditis. Streptococci were the most common bacteria (34 patients), followed by staphylococci (17 patients). Mechanical valves were selected for 73 patients and bioprosthetic valves for 16. Mitral valve plasty was performed in 4 patients. Aortic root or aorto-mitral discontinuity was repaired in 17 patients, including Manouguian's double valve replacement in 6 and aortic root replacement in 4. Overall hospital mortality was 15% (14 patients). Univariate analysis identified CHF (p=0.016), abscess (p=0.014), and prosthetic valve endocarditis (p=0.043) as risk factors. However, multivariate analysis only identified CHF (p=0.019) as an independent risk factor. Conclusion In AAIE, early surgical intervention is advisable before the occurrence of complications such as root abscess and CHF, particularly before the onset of CHF. (Circ J 2008; 72: 2062 - 2068)
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  • Ayako Shigeta, Nobuhiro Tanabe, Hidefumi Shimizu, Susumu Hoshino, Miki ...
    2008 Volume 72 Issue 12 Pages 2069-2074
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 17, 2008
    JOURNALS FREE ACCESS
    Background The predominance of chronic thromboembolic pulmonary hypertension (CTEPH) in females and association of HLA-B*5201 with CTEPH have been reported in Japan. However, the clinical characteristics of female CTEPH remain uncertain. The purpose of the present study is to clarify the clinical phenotype of female CTEPH in Japan. Methods and Results The 150 consecutive patients (female 103, male 47; age 52.8±12.4 years SD) were admitted to Chiba University Hospital, and diagnosis was confirmed using right cardiac catheterization and pulmonary angiography. Among these patients, 78 underwent pulmonary endarterectomy. Clinical characteristics, pulmonary hemodynamics, extent of central disease and surgical outcome in females were compared with those in males. The female patients were elderly and had less deep vein thrombosis, less acute embolic episodes, better cardiac function, lower arterial oxygen tension and more peripheral thrombi, and showed less improvement through surgery than males. When the patients were identified using HLA-B*5201, HLA-B*5201-positive female patients had less embolic episodes and better cardiac function with lower operative mortality. In contrast, HLA-B*5201-negative female patients had less embolic episodes, and more peripheral thrombi, resulting in less improvement by surgery. Conclusion The clinical phenotype of female CTEPH differed from that of male CTEPH. Additionally, gender differences of HLA-B*5201-positive type were dissimilar to those of HLA-B*5201-negative type. (Circ J 2008; 72: 2069 - 2074)
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Experimental Investigation
  • Shu-Lan Qin, Tao-Sheng Li, Masayuki Kubo, Mako Ohshima, Akira Furutani ...
    2008 Volume 72 Issue 12 Pages 2075-2080
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 29, 2008
    JOURNALS FREE ACCESS
    Background Implantation of bone marrow cells (BMCs) is a treatment of ischemic disease. It is well known that many inflammatory cytokines are released in ischemic tissue, especially in the acute phase, so in the present study it was investigated if the transient increase of cytokines in the acute ischemic tissue influences cell-based therapeutic angiogenesis. Methods and Results Ischemic limb models were created in C57BL/6 mice as 24 h (acute) or 2 weeks (chronic) after ischemia. BMCs were cultured with total tissue protein, which was extracted from the acute and chronic ischemic muscles. The survival, adhesion, and migration of BMCs were significantly better after culture with 1 mg/ml total tissue protein extracted from the acute ischemic limbs than from the chronic ischemic limbs (p<0.001). For the in-vivo study, 8×106 BMCs, collected from green fluorescent protein (GFP) transgenic mice, were implanted into the acute or chronic ischemic limbs of the mice. The survival of implanted cells and blood flow were significantly better when BMCs were implanted into the acute ischemic limbs than into the chronic ischemic limbs (p<0.001). Conclusions A transient increase of cytokines in the acute ischemic tissue is beneficial for cell-based therapeutic angiogenesis. (Circ J 2008; 72: 2075 - 2080)
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  • Masayoshi Oikawa, Hiroyuki Yaoita, Kenichi Watanabe, Yukio Maruyama
    2008 Volume 72 Issue 12 Pages 2081-2086
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 21, 2008
    JOURNALS FREE ACCESS
    Background The aim of this study was to assess whether and how infarct size (IS) reduction by postconditioning is modified in the heart with coronary stenosis (CS), and how β-blocker treatment affects it. Methods and Results The IS was assessed by 30-min acute coronary occlusion and 24-h reperfusion in rat hearts in which CS had been induced. Modification of IS by postconditioning and the effects of daily carvedilol treatment were measured, together with reperfusion injury - salvage kinase activities. Four weeks after CS induction, any reduction of IS by postconditioning was lost, whereas it reduced IS in rats without CS. In the hearts without CS, postconditioning activated both the ERK and Akt pathway. However, in the hearts with CS, postconditioning failed to do so. In hearts with CS plus daily carvedilol treatment, postconditioning reduced IS compared with the hearts without carvedilol, although postconditioning did not activate the Akt and ERK pathways. Conclusion CS impaired Akt and ERK activation, resulting in a failure to reduce IS by postconditioning. Carvedilol treatment restored the IS reduction by postconditioning, possibly via other mechanism(s) of the ERK and Akt pathways. (Circ J 2008; 72: 2081 - 2086)
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Case Report
  • Kazuyuki Ozaki, Ikki Sakuma, Koko Mitsuma, Tomoyasu Suzuki, Keiichi Ts ...
    2008 Volume 72 Issue 12 Pages 2087-2091
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 14, 2008
    JOURNALS FREE ACCESS
    Obstruction of the left ventricular outflow tract (LVOT) is usually complicated by hypertrophic cardiomyopathy or left ventricular hypertrophy. It occurs rarely in cases of sigmoid-shaped septum (SS), which are considered as a normal part of the aging process. The 2 cases of SS with obstruction of the LVOT were observed. Their complaints were dyspnea on effort and exercise increased the left ventricular pressure gradient. In both cases, atenolol administration decreased rest pressure gradient. Moreover, additional cibenzoline administration decreased the pressure gradient caused by exercise. It is emphasized that dual therapy with cibenzoline and atenolol is effective in resolving the obstruction of the LVOT caused by SS. (Circ J 2008; 72: 2087 - 2091)
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  • Masaru Araki, Masaharu Miyamoto
    2008 Volume 72 Issue 12 Pages 2092-2095
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 14, 2008
    JOURNALS FREE ACCESS
    A case of acute myocardial infarction (AMI) of the distal left circumflex, near the origin of an aberrant right coronary artery is presented. Coronary stenting was successfully performed. According to several reports, this anomaly is a common site for coronary atherosclerosis, but this is the first report of AMI. (Circ J 2008; 72: 2092 - 2095)
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  • Mustafa Tuncer, Hasan Ekim, Yilmaz Günes, Ünal Güntekin
    2008 Volume 72 Issue 12 Pages 2096-2097
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 14, 2008
    JOURNALS FREE ACCESS
    Brucellosis is a zoonosis that behaves as a systemic infection with various clinical signs and symptoms. Brucella endocarditis, although a rare complication of Brucella infection, is nevertheless responsible for the majority of deaths related to this illness. Brucella endocarditis was associated with an atrial septal defect (ASD) in a 45-year-old woman. Echocardiography showed a secundum ASD with vegetations of 0.5×0.8 cm arising from the border of the defect, and serologic analysis was positive for Brucella agglutinin, thus confirming the diagnosis. She was initially treated with a 1-month preoperative course of antibiotics. At surgery, the vegetations were excised and the defect was closed with polypropylene. Postoperative recovery was uneventful and she was discharged on the 10th postoperative day. (Circ J 2008; 72: 2096 - 2097)
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  • Guillaume Cayla, Jean Christophe Macia, François Roubille, Heri ...
    2008 Volume 72 Issue 12 Pages 2098-2100
    Published: 2008
    Released: November 25, 2008
    [Advance publication] Released: October 14, 2008
    JOURNALS FREE ACCESS
    In the case of stent thrombosis and resistance to clopidogrel, choices of an alternative drug remain limited. In 2 cases of subacute stent thrombosis associated with clopidogrel resistance, an adequate response was obtained in these patients after repeated loading doses of clopidogrel. (Circ J 2008; 72: 2098 - 2100)
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