The oxidizing nature of the extracellular environment is vastly different from the highly reducing nature of the intracellular compartment. The redox potential of the cytosolic compartment of the intracellular environment limits disulfide bond formation, whereas the oxidizing extracellular environment contains proteins rich in disulfide bonds. If not for an extracellular antioxidant system to eliminate reactive oxygen and nitrogen species, lipid peroxidation and protein oxidation would become excessive, resulting in cellular damage. Many reviews have focused on the role of intracellular antioxidants in the elimination of oxidative stress, but this one will focus on the coordinated action of both intracellular and extracellular antioxidants in limiting cellular oxidant stress. (Circ J 2008; 72: 1 - 16)

抄録全体を表示

Background It is unclear whether early initiation of low-dose pravastatin therapy can reduce the occurrence of major adverse cardiac events after acute myocardial infarction (AMI). Methods and Results The study group comprised 353 patients with AMI who had plasma total cholesterol levels of 200-250 mg/dl and triglyceride levels <300 mg/dl. The patients were randomly assigned to either receive pravastatin (10 mg/daily, n=176) or not (n=177). The primary endpoint was a composite of death, nonfatal myocardial infarction (MI), unstable angina (UA), stroke, revascularization, and rehospitalization because of other cardiovascular disease. The follow-up period was 9 months. The primary endpoint occurred in 31 patients (17.9%) in the pravastatin group and 55 patients (31.4%) in the non-pravastatin group (relative risk, 0.56; 95% confidence interval, 0.36-0.87). There were no significant differences in the risk of death, nonfatal MI, UA, and stroke between the 2 groups, although the pravastatin group had a lower risk of need for revascularization. Conclusion For patients with AMI, early and low-dose pravastatin therapy (10 mg/daily) reduces recurrent major adverse cardiac events, mostly the requirement for revascularization. (Circ J 2008; 72: 17 - 22)

抄録全体を表示

Background It has been reported previously that the measurement of plasma total adiponectin level is clinically useful to estimate the risk of coronary artery disease (CAD). Here, the relevance of high molecular weight (HMW) adiponectin with risk factors for atherosclerosis is investigated Methods and Results A total of 186 consecutive male CAD patients participated in the study and were categorized into quartiles based on their total adiponectin level. The interquartile cut-off points were 4.0, 5.5 and 7.0 μg/ml. The HMW adiponectin levels were significantly lower in the quartile of lower total adiponectin levels both in non-diabetic and diabetic patients. In contrast, low molecular weight adiponectin levels (which were calculated as the Total - HMW) were constant. In univariate analysis, total adiponectin correlated negatively with body mass index and hemoglobin (Hb) A_1c, and HMW adiponectin correlated negatively with HbA_1c in non-diabetic patients. On the other hand, total and HMW adiponectin correlated positively with high-density lipoprotein-cholesterol (HDL-C) in diabetic patients. Multiple regression analysis revealed that HMW adiponectin correlated negatively with HbA_1c in non-diabetic patients, and total and HMW adiponectin correlated positively with HDL-C in diabetic patients. Conclusions Change in the HMW isoform reflects a change in total adiponectin level. Measurement of total and HMW adiponectin were equally useful in assessing metabolic risk in CAD patients. (Circ J 2008; 72: 23 - 28)

抄録全体を表示

Background Carotid artery intima-media thickness (IMT), which is measured by ultrasound, is used in the assessment of early atherosclerotic changes, and has been associated with apolipoprotein E (APOE) polymorphism in many studies comprising elderly subjects. However, results are still inconclusive and data relating to young adults are missing. Whether common APOE polymorphism is related to carotid IMT was studied in a population of young adults. Also brachial flow-mediated dilatation (FMD) and carotid artery compliance (CAC) were determined to clarify their relation to this genetic factor. Methods and Results A total of 1,188 young adults (aged 24-39 years) participating in the Cardiovascular Risk in Young Finns Study with complete data of common APOE polymorphism underwent a carotid and brachial ultrasound. Patients' lipid levels and blood pressure were also examined. There was no significant association between the APOE phenotypes and carotid IMT, brachial FMD or CAC either in young men or in young women. The results were similar for systolic and diastolic blood pressure. In the same population, the well-known association between APOE phenotypes and lipids was seen. Conclusions Common APOE polymorphism does not seem to be an independent genetic determinant of carotid IMT, brachial FMD or CAC. (Circ J 2008; 72: 29 - 34)

抄録全体を表示

Background Previous studies have shown that cilostazol may not only prevent stent thrombosis, but may also have positive effect in the prevention of restenosis. However, the effect of cilostazol on restenosis after successful deployment of drug-eluting stent (DES) in patients with diabetes mellitus has not been evaluated. Methods and Results A total of 280 patients at 8 clinical sites were randomized. The patients (61.7±9.9 years old, 163 males) who underwent successful stenting were randomized to aspirin and cilostazol (group I, n=141, 61.2±9.6 years old) vs aspirin and clopidogrel (group II, n=139, 62.0±10.0 years old) after 1 month of aspirin, cilostazol, and clopidogrel combination treatment. There were no significant differences in baseline characteristics of the groups. The type of DES implanted did not differ between the groups. There were no differences in angiographic and procedural characteristics of the groups. Major adverse cardiac events, including acute and subacute stent thrombosis within 1 month, did not occur in either group. Cases of angiographic late stent thrombosis were 1 (0.9%) in group I and 1 (0.8%) in group II. Follow-up coronary angiography was performed in 237 patients (84.6%). Mean follow-up duration was 7.1 months. The rate of angiographic restenosis (stent plus 5-mm borders) was 9 (8.0%) in group I and 20 (16.1%) in group II, p=0.041). The minimal luminal diameter at follow-up period in group I was 2.55±0.63 mm compared with 2.41±0.83 mm in group II (p=NS). Conclusions Combination therapy with aspirin and cilostazol for the prevention of stent restenosis is comparable or superior to that of aspirin and clopidogrel in diabetic patients who undergo DES implantation. (Circ J 2008; 72: 35 - 39)

抄録全体を表示

Background Metabolic syndrome consists of multiple risk factors that are increasing the cardiovascular mortality. The T-1131C variant of the apolipoprotein A5 gene, associated with increased triglycerides, has been found to confer risk for cardiovascular diseases and metabolic syndrome. Because other naturally occurring variants of the gene also correlate with elevated triglycerides, the possible role of 2 common variants, the IVS3+G476A and T1259C, with metabolic syndrome was investigated. Methods and Results A total of 213 metabolic syndrome patients and 142 healthy controls were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Serum triglycerides were increased in carriers compared with non-carriers in both groups (p<0.001); serum cholesterol levels were similar in all genotypes. The IVS3+476A allele frequency was increased in metabolic syndrome patients compared with controls (8.05 vs 2.47%; p<0.05), whereas the 1259C allele frequency did not differ between the groups. Multiple logistic regression analyses adjusted for age, gender, serum total cholesterol, acute myocardial infarction and stroke revealed that the IVS3+476A variant confers risk for development of metabolic syndrome (odds ratio =3.529, 95% confidence interval 1.308-9.029, p=0.009), but the 1259C allele had no such an effect. Conclusions Carrying the IVS3+473A allele is associated with elevated triglycerides and confers risk for development of metabolic syndrome, a combination that represents increased risk for development of atherogenic vascular diseases. (Circ J 2008; 72: 40 - 43)

抄録全体を表示

Background The Western diet plays a role for the epidemics of obesity and related diseases. This study examined a possible association between peripheral arterial disease (PAD) and the dietary components of Japanese immigrants living in Brazil. Methods and Results In this cross-sectional study, 1,267 subjects (aged ≥30 years) with complete dietary, clinical and laboratory data were studied according to a standardized protocol. Ankle-to-brachial index was used to identify subjects with PAD. The overall prevalence of PAD was 14.6%. Subjects with PAD were older, had lower education and higher mean values of blood pressure, triglycerides, and fasting and 2-h plasma glucose levels compared with those without the disease. Among the subjects with PAD, the consumption of fiber from whole grains (3.0 vs 3.4 g, p=0.001) and linoleic acids (11.0 vs 11.7 g, p=0.017) were lower and intake of total (72.8 vs 69.1 g, p=0.016) and saturated fatty acids (17.4 vs 16.3 g, p=0.012) were higher than those without PAD. Results of multiple logistic regression analysis showed a significant association between PAD with high total fat intake, low intake of fiber from fruit and oleic acid, independently of other variables. Conclusions Despite limitations in examining the cause - effect relationship, the data support the notion that diet could be important in reducing the occurrence of PAD. (Circ J 2008; 72: 44 - 50)

抄録全体を表示

Background Asymptomatic acute ischemic stroke (aAIS) following primary percutaneous coronary intervention (p-PCI) in patients with acute coronary syndrome (ACS) has not been studied in detail. Methods and Results Of 75 patients who underwent p-PCI, 26 (34.7%) developed aAIS as determined by diffusion-weighted magnetic resonance imaging (MRI). Including the approach to the coronary artery (via lower limb or right upper limb), 23 factors were compared between patients with (n=26) and without (n=49) aAIS. Age, hypertension, smoking, plasma glucose levels, Killip grade, right coronary artery (RCA) as culprit vessel, percutaneous coronary intervention (PCI) time, and the frequency of device insertion into the coronary artery differed in a statistically significant manner. However, multivariate analysis showed that the RCA (odds ratio 3.477) and the frequency of device insertion (1.375) were independent factors linked to the incidence of aAIS. Moreover, anterior or posterior location and left or right cerebral circulation of aAIS were equivalent in both approaches. Conclusions Cranial MRI images following emergency PCI revealed that 34.7% of the patients with ACS had aAIS that might be caused by manipulating the catheter or devices in the ascending aorta, micro-air bubble embolism during injection, or micro-thrombus embolism derived from the ACS lesions during the PCI procedure. (Circ J 2008; 72: 51 - 55)

抄録全体を表示

Background Accelerated atherosclerosis is a major risk for long-term survivors receiving hemodialysis (HD), with coronary events being the leading cause of mortality. Methods and Results A total of 88 consecutive patients on HD (121 lesions) who underwent percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) were compared with 78 patients on HD (95 lesions) who received bare metal stents (BMS) in the preceding 1 year. The primary endpoint was angiographic restenosis defined as ≥50% diameter stenosis at 6-8 months follow-up after PCI. The angiographic restenosis rate at follow-up was 22.2% in the SES group and 24.4% in the BMS group. No difference was detected in the restenosis rate between the 2 groups (p=0.73). When including both HD and non-HD patients, the independent predictors for restenosis after SES implantation were treatment with HD (hazard ratio (HR) 3.12; 95% confidence interval (CI) 1.23-7.95; p=0.016), incidence of hyperlipidemia (HR 3.93; 95%CI 1.12-13.7; p=0.032), coronary calcification (HR 2.78; 95%CI 1.12-6.91; p=0.027), and implantation of multi-stents (HR 4.14; 95%CI 1.70-10.1; p=0.0017). Conclusions Even if treated with SES, patients with end-stage renal failure on HD are at high risk of restenosis after PCI. (Circ J 2008; 72: 56 - 60)

抄録全体を表示

Background Current evidence supports the central role of inflammation in all phases of the atherosclerotic process, including its thrombotic complications. Increased serum sCD40L may trigger platelet activation, so the aim of the present study was to determine the relation between sCD40L levels and aspirin-resistant platelet aggregation in patients with coronary atherosclerosis. Methods and Results A total of 167 consecutive patients (39-85 years old, 35.9% women) with stable coronary artery disease was enrolled in the study. Platelet function was evaluated by a Platelet Function Analyzer 100 device (PFA-100) with collagen and epinephrine (Col/Epi) and collagen and adenosine diphosphate (ADP) (Col/ADP) cartridges. Aspirin resistance was defined as a closure time (CT) <186 s with Col/Epi cartridges, despite regular aspirin therapy. Serum sCD40L level was determined quantitatively with an ELISA method. Fifty-seven (34.1%) patients had aspirin resistance according to the PFA-100. Mean CT measured with the Col/ADP cartridges was 83±18 s (65-101 s). Mean serum sCD40L was 157 pg/ml (6-700 pg/ml) in the entire cohort. Patients with aspirin resistance had a mean serum sCD40L level of 166 pg/ml and patients with aspirin-sensitive platelet aggregation had an sCD40L level of 152 pg/ml (p=0.582). Conclusion The sCD40L level is similar in patients with aspirin-resistant and aspirin-sensitive platelet aggregation according to the PFA-100. There is still need for further studies to elucidate the relationship between aspirin-resistant platelet aggregation and sCD40L, which is now known to be prothrombotic, proinflammatory and to be a risk factor for cardiovascular events. (Circ J 2008; 72: 61 - 66)

抄録全体を表示

Background Although octogenarians constitute a fast growing portion of cardiovascular patients, few data are available on the outcome of very old patients (age >80 years) with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. Methods and Results Short- and long-term outcomes of 88 consecutive very old (age ≥85 years) patients with STEMI undergoing primary angioplasty were evaluated. In-hospital mortality was 17%, significantly higher in patients with cardiogenic shock (90%; p<0.001), with failure of percutaneous coronary intervention (PCI; p=0.016), with Killip class ≥III on admission (p=0.018), or with chronic renal failure (p=0.033). Major bleeding complications occurred in 11 patients (12%). Multivariable logistic regression analysis identified 3 independent predictors of in-hospital death: age ≥90 years (p=0.018), Killip ≥III on admission (p=0.018), and PCI failure (p=0.025). Multivariable logistic regression analysis identified age ≥90 years (p=0.008), Killip ≥III on admission (p=0.015), and time from symptoms to PCI >12 h (p=0.04) as independent predictors of mortality at long-term follow-up. Conclusions The low incidence of procedural complications, together with good long term survival, suggest that primary PCI in STEMI patients ≥85 years is safe and efficacious, with a low rate of PCI failure in the presence of a low Killip class on admission, whereas primary PCI is unable to affect the poor prognosis for very old patients with cardiogenic shock. (Circ J 2008; 72: 67 - 70)

抄録全体を表示

Background Atherosclerosis is considered to be an inflammatory disease in which the initial process is augmented infiltration of monocytes into the vessel wall and their subsequent differentiation from macrophages into lipid-laden foam cells. Chitotriosidase is one of the most quantitative proteins secreted by activated macrophages, so the aim of this study was to investigate the association of the level of serum chitotriosidase activity with atherosclerotic coronary artery disease (CAD). Methods and Results A total of 200 subjects undergoing coronary angiography were divided into 4 subgroups according to the number of diseased vessels and their serum chitotriosidase activity levels were measured. Serum chitotriosidase activity in patients with CAD was significantly higher than in normal control subjects (p<0.001). Serum chitotriosidase activity was also significantly associated with the extent of CAD as defined by the number of stenosed vessels (p<0.001). Conclusion Serum chitotriosidase activity can be considered a strong inflammatory marker of CAD. Moreover, plasma chitotriosidase activity may be also regarded as a quantitative indicator of disease extent, as well as being a marker of disease presence. (Circ J 2008; 72: 71 - 75)

抄録全体を表示

Background Antiarrhythmic agents are considered to have significant effects on the defibrillation energy requirement, so this study investigated the effects of nifekalant on defibrillation. Methods and Results Forty-two patients with persistent atrial fibrillation (AF) underwent electrical cardioversion via intracardiac electrode catheters prior to and after the intravenous administration of nifekalant. The success rate of the defibrillation and change in the defibrillation threshold using sequential incremental defibrillation energy deliveries was investigated. In addition, the parameters that could predict the beneficial effects of nifekalant were also assessed. Nifekalant significantly decreased the defibrillation energy requirement in 13 of the 42 cases, and nifekalant also converted AF to sinus rhythm with an identical energy to that of the last unsuccessful defibrillation in 21 of 42 cases. The success of defibrillation seemed to be dependent on significant prolongation of the intracardiac atrial electrogram intervals during AF by the nifekalant. Conclusions Intravenous nifekalant significantly improved the electrical defibrillation efficacy in patients with persistent AF that was resistant to defibrillation, without any serious adverse effects. (Circ J 2008; 72: 76 - 80)

抄録全体を表示

Background Few investigators have examined the outcome of patients with isolated congenital complete atrioventricular block (CCAVB) paced from the neonatal period. The present study follows the clinical course and describes the outcome of patients who have been paced with CCAVB since they were neonates. Methods and Results The medical records of 20 patients with CCAVB paced as neonates between 1981 and 2006 were retrospectively studied and reviewed; 18 were diagnosed in utero and 2 at birth. SS-A antibodies were detected in 9 of 14 (64%) mothers tested. The median age at follow-up was 5.6 years (range, 2 days to 21.9 years). Three (15%) of the early neonates died and 3 (15%) died later: 2 from dilated cardiomyopathy (DCM) and 1 from pneumonia. The total mortality rate was 30%. The cumulative probability of survival at 10 years was 73%. Of the 14 survivors, 4 developed DCM, representing a total morbidity of 30%. The cumulative probability of freedom from DCM at 10 years was 59%. Conclusions Patients with CCAVB who undergo pacing as neonates have high mortality and high morbidity because of DCM. Left ventricular pacing or resynchronization can benefit patients who develop DCM and left ventricular epicardial pacing is recommended for neonates with CCAVB. (Circ J 2008; 72: 81 - 87)

抄録全体を表示

Background Although an electrophysiologic study (EPS) and Holter-monitoring are often helpful in evaluating the efficacy of antiarrhythmic drugs in patients with ventricular tachyarrhythmias (ventricular tachycardia/fibrillation (VT/VF)), the efficacy of EPS- or Holter-guided oral amiodarone therapy in Japanese patients is still unclear. Methods and Results EPS was performed 1 month after starting amiodarone, and Holter-monitoring was recorded before and 1 month after amiodarone in 188 patients with sustained VT/VF because of structural heart diseases. In spite of the judgment of EPS (n=89) or Holter (n=75), all patients continued amiodarone. Patients were followed up to 3 years and the primary endpoint was VT/VF recurrence and secondary endpoint was death by all cause. Kaplan-Meier estimated the risk of VT/VF recurrence was significantly smaller with EPS-guided amiodarone (p<0.01) but not with Holter-guided amiodarone. Multivariate Cox hazard analysis revealed that EPS-guided amiodarone was an independent factor suppressing the recurrence of VT/VF (p<0.05, 95% confidence interval =0.15 to 0.96). In the subgroup analysis, EPS-guided amiodarone was effective in patients with relatively well-preserved left ventricular ejection fraction (LVEF ≥0.30) but not in patients with lower LVEF (LVEF <0.30). Conclusion EPS-guided amiodarone was useful for preventing recurrence of VT/VF in patients with a relatively well-preserved LVEF, but not always beneficial in patients with a lower LVEF. (Circ J 2008; 72: 88 - 93)

抄録全体を表示

Background Magnetocardiography (MCG) is a new noninvasive modality for recording cardiac depolarization and repolarization and was used in the present study to evaluate abnormalities in patients with Brugada syndrome (BS). Methods and Results The MCG findings of 10 BS, 21 right bundle branch block (RBBB), and 34 normal patients were compared. On the horizontal spatiotemporal activation graph (STAG), the r' waves were more frequently located on the right side in the RBBB than in the normal (p=0.001) or BS groups (p=0.001). The maximum current angles of the r' wave fell into the northwest axis in all BS patients as compared to having a right axis deviation in 19 of 21 RBBB patients (90.4%, p=0.001). In the magnetic field and current density vector maps during late repolarization, the BS group had a non-dipole pattern more frequently and a higher number of poles compared with the normal (p=0.001) and RBBB groups (p=0.001). Conclusions During depolarization, the horizontal STAG location and maximum current angle of the r' wave were beneficial in differentiating BS from RBBB and normal. The magnetic dispersion was a more frequently observed finding in BS patients than in RBBB and normal patients during late repolarization. (Circ J 2008; 72: 94 - 101)

抄録全体を表示

Background Patients with atrial fibrillation (AF) or congestive heart failure (CHF) are more vulnerable to inappropriate shocks from implantable cardioverter-defibrillators (ICDs), but the effect of antiarrhythmic drugs in these patients remains unknown. Methods and Results A total of 55 patients with AF and/or CHF (New York Heart Association functional class ≥III) who had ICDs were divided into 3 groups [amiodarone (n=24), sotalol (n=12), β-blocker (n=19)] and the cumulative rates of inappropriate shocks were compared. The baseline characteristics of the 3 groups were not significantly different. The 4-year event rate of inappropriate shocks was 27.3% in the amiodarone group, 54.3% in the sotalol group, and 70.6% in the β-blocker group (amiodarone vs β-blocker: log-rank p=0.003; sotalol vs β-blocker: log-rank p=0.16; amiodarone vs sotalol: log-rank p=0.29). Amiodarone reduced the risk of inappropriate shocks significantly as compared with β-blockers (hazard ratio (HR) 0.17; 95% confidence interval (CI) 0.05-0.64; p=0.008), whereas sotalol did not (HR 0.57; 95%CI 0.19-1.68; p=0.3). Amiodarone was discontinued in 4 patients (16.7%) because of pulmonary toxicity and the dose was reduced in 4 patients (16.7%) because of a thyroid function abnormality. Conclusions Amiodarone is more effective than sotalol or β-blockers in preventing inappropriate ICD shocks in patients with AF or CHF, but it has a significant risk of drug-related adverse effects. (Circ J 2008; 72: 102 - 105)

抄録全体を表示

Background The precise mechanism of tako-tsubo-like left ventricular (LV) dysfunction remains unclear, although recent studies have shown that activation of sympathetic tone might be involved. However, local release of catecholamines from cardiac sympathetic efferent neurons in patients with tako-tsubo-like LV dysfunction remains poorly understood. The purpose of this study was to investigate evidence of local release of catecholamines from the hearts of patients with tako-tsubo-like LV dysfunction. Methods and Results Five consecutive patients with tako-tsubo-like LV dysfunction were studied. After confirming LV apical ballooning and a normal coronary angiogram, sampling of blood for the measurement of plasma catecholamine levels was performed at the aortic root (Ao) and coronary sinus (CS). In all 5 cases, increased local release of norepinephrine from the heart was documented (597, 4,238, 2,121, 486, 371 pg/ml at the Ao; 836, 5,719, 3,386, 658, 472 pg/ml at the CS, respectively). Conclusions Increased cardiac catecholamines might cause the transient LV apical ballooning in patients with tako-tsubo-like LV dysfunction. (Circ J 2008; 72: 106 - 108)

抄録全体を表示

Background Heart-type fatty acid-binding protein (H-FABP) is a small cytosolic protein that is released into the circulation when the myocardium is injured. This study examined whether serial measurement of the H-FABP level provides additional prognostic information. Methods and Results Serum H-FABP levels were measured in 113 consecutive chronic heart failure (CHF) patients at both admission and discharge. The following 3 patterns of changes were identified. In 41 patients, H-FABP levels (<4.3 ng/ml) at both admission and discharge were normal (Group 1). The remaining 72 patients had high initial H-FABP levels (≥4.3 ng/ml) at admission, and in 21 of them (29%), H-FABP decreased to the normal range at discharge (Group 2), whereas 51 had persistently high H-FABP levels despite improvement in symptoms and signs of CHF (Group 3). There were 33 cardiac events (29%) during the follow-up period, and Group 3 had significantly higher cardiac event rates than Groups 1 and 2 (p=0.0002). Group 3 had the highest cardiac risk among the groups (hazard ratio 5.68, p=0.012). Conclusion Serial measurement of the H-FABP level is a new monitoring tool that provides information to guide optimal therapy and management of CHF patients. (Circ J 2008; 72: 109 - 114)

抄録全体を表示

Background Functional mitral regurgitation (MR) is common in patients with chronic heart failure (CHF). During exercise, hemodynamic changes such as elevation of blood pressure and an increase in the left ventricular end-diastolic dimension may increase MR. Severity of CHF is reflected by exercise tolerance and, therefore, MR during exercise is supposed to indicate the severity of heart failure. The degree of MR increase and left ventricle (LV) shape was quantified during exercise in CHF patients and were compared with exercise tolerance. Methods and Results Twenty patients with CHF (mean age: 63 years) underwent dynamic cycle exercise at steady-state levels of 80% and 150% of the anaerobic threshold (AT). The MR jet area and left atrial (LA) area were measured during exercise and the ratio of MR/LA was calculated. The LV shape was assessed by calculating the ratio of the major to the minor axis. The MR/LA ratio increased during exercise (rest: 16.9±6.5%, 80% AT: 21.9±8.9%, 150% AT: 30.9±11.2%; p<0.01) and the LV shape became more spherical (rest: 1.34±0.10, 80% AT: 1.31±0.10, 150% AT: 1.23±0.11; p<0.05). There was a negative correlation between MR/LA ratio and the ratio of the major to the minor axis (-0.722, r<0.01). Conclusions MR during exercise increases as the severity of CHF increases. Functional MR is correlated with the shape of the LV. (Circ J 2008; 72: 115 - 119)

抄録全体を表示

Background The indications and efficacy of cardiac resynchronization therapy (CRT) have not been sufficiently clarified in patients with right bundle branch block (RBBB). Methods and Results This study included 55 patients with normal QRS morphology and duration (Control-Gr) and 49 patients with complete RBBB (CRBBB-Gr). Using tissue Doppler imaging, the time difference (TD) between the electromechanical delay of the septal wall, left ventricular (LV) lateral wall, and right ventricular free wall were measured. Using tissue tracking imaging, the coefficient of the time variation from the beginning of the QRS to the peak displacement time of 6 regions of the LV (CV-PMD_LV) was calculated. The TD between the septal wall and that of the LV lateral wall (TD_SEPT-LAT) did not differ between the Control-Gr and RBBB-Gr. However, a significant difference was found in the TD_SEPT-LAT between the CRBBB patients with LV systolic dysfunction (ejection fraction (EF) ≤50%) and those with normal LV function (EF >50%; p<0.001). The CV-PMD_LV was greater in the CRBBB patients with LV systolic dysfunction than in those with a normal LV function (p<0.05). The RBBB-Gr patients with LV dysfunction and a great TD_SEPT-LAT, improved clinically after the CRT. Conclusions The presence of RBBB and LV dysfunction may indicate LV dyssynchrony and a heterogeneous mechanical dysfunction. (Circ J 2008; 72: 120 - 126)

抄録全体を表示

Background Mutations of the bone morphogenetic protein receptor II gene (BMPR2), and 1 mutation of the activin receptor-like kinase 1 gene (ALK1) have been reported in patients with pulmonary arterial hypertension (PAH). Methods and Results A genomic study of ALK1 and BMPR2 was conducted in 21 PAH probands under 16 years of age to study the relationship between the clinical features of the patients and these genes. In all 4 familial aggregates of PAH, 3 ALK1 or 1 BMPR2 mutations were identified. Among 17 probands aged between 4 and 14 years with idiopathic PAH, 2 ALK1 mutations (2/17: 11.8%) and 3 BMPR2 mutations (3/17: 17.6%; 5 mutations in total: 5/17: 29.4%) were found. Conclusion Each proband with the ALK1 mutation developed PAH, as did the probands with the BMPR2 mutation. Hence, it is proposed that ALK1 plays as notable a role as BMPR2 in the etiology of PAH. Furthermore, asymptomatic carriers with the ALK1 mutation within the serine - threonine kinase domain are at risk of developing PAH and hereditary hemorrhagic telangiectasia, so close follow-up is recommended for those individuals. (Circ J 2008; 72: 127 - 133)

抄録全体を表示

Background The long-term prognosis of those having a history of Kawasaki disease (KD) is still unknown. Methods and Results Between July 1982 and December 1992, 52 collaborating hospitals collected data on all patients having a new definite diagnosis of KD. Patients were followed-up until December 31, 2004 or their death. Standardized mortality ratios (SMRs) were calculated based on the Japanese vital statistics data. Of 6,576 patients enrolled, 36 (27 males, 9 females) died and the SMR was 1.14. Despite the high SMRs during the acute phase, the mortality rate was not high after the acute phase for the entire group of patients. Although the SMR after the acute phase was 0.71 for those without cardiac sequelae, 10 males (but none of the females) with cardiac sequelae died during the observation period; and the SMR for the male group with cardiac sequelae was 2.55 (95% confidence interval: 1.23-4.70). Conclusions The mortality rate among males with cardiac sequelae because of KD was significantly higher in this cohort than in the general population. On the other hand, those for females with the sequelae and for both males and females without sequelae were not elevated. (Circ J 2008; 72: 134 - 138)

抄録全体を表示

Background Periodic acceleration in the direction of the spinal axis through repetitive movement increases the shear stress on the vascular endothelium. In the present study it was assessed whether whole-body periodic acceleration with a new device would enhance endothelial function in sedentary adult volunteers. Methods and Results Twenty-six sedentary subjects (44±3 years) were randomly assigned to remain sedentary or perform exercise training for 4 weeks, followed by crossover. Periodic acceleration was applied with a horizontal motion platform at 2-3 Hz and approximately ±2.2 m/s² for 45 min. Increases in the brachial artery diameter were examined at rest, during reactive hyperemia (flow-mediated dilatation: %FMD) and after sublingual administration of 0.3 mg nitroglycerin (%NTG) using high-resolution ultrasound. All subjects completed the study with no adverse side-effects. There were no significant changes in the resting heart rate or arterial pressure, body weight, or lipid profiles during the study. Although %FMD did not change during the non-training period with periodic acceleration, it significantly increased from 7.3±0.4% at baseline to 8.4±0.4% after the training period (p<0.05), while %NTG remained unchanged. Conclusions Whole-body periodic acceleration with a horizontal motion platform improved vascular endothelial function in sedentary adults. This device might offer an alternative to active exercise for patients whose medical condition limits physical activity. (Circ J 2008; 72: 139 -143)

抄録全体を表示

Background A link between exposure to fine particulate matter and cardiovascular events has been established. Inhaled nanoparticles are thought to pass through the lungs to reach other tissues via systemic circulation and to induce cell or tissue injuries. It was recently shown that long-term exposure to intra-tracheal dispersion of nano-sized carbon black (CB) exacerbates atherosclerotic lesions in low-density lipoprotein receptor-deficient mice. Because intra-tracheal dispersion of CB may be associated with aggregate formation and may not be an ideal method for CB exposure, whole-body inhalation exposure was used in the present study, the aim of which was to examine whether exposure of rats to nano-sized CB particles by inhalation leads to translocation of these particles into the circulation, exerting direct adverse effects on extrapulmonary tissues. Methods and Results Sprague-Dawley rats were exposed to a high dose of CB or filtered air for 6 h/day, 5 days a week for a total of 4 weeks. Although the presence of CB was confirmed in pulmonary macrophages, electron microscopic survey did not detect CB in other tissues including liver, spleen and aorta. CB exposure raised blood pressure levels in an exposure-time dependent manner. Levels of circulating inflammatory marker proteins, including monocyte chemoattractant protein-1, interleukin-6, and C-reactive protein, were higher in the CB-treated group than in the controls. Conclusion Evidence of translocation of inhaled CB was not obtained. It is likely that inhaled nano-sized CB particles form aggregations in the lung and do not exert direct adverse effects on extrapulmonary tissues. Air-pollution-mediated cardiovascular events appear to be induced by the low-grade inflammatory response to the accumulation of aggregated nano-sized particles in the lung. (Circ J 2008; 72: 144 - 149)

抄録全体を表示

Background This study tested the hypothesis that shock wave (SW) therapy applied to bone marrow-derived mononuclear cells (BMDMNCs) enhances the formation of vascular endothelial growth factor (VEGF) and positively stained CD31 (CD31+) cells, an endothelial phenotype. Methods and Results The BMDMNCs (~1.2×10⁶ cells/2 femoral bones) were obtained from adult male Sprague-Dawley rats and SW therapy was applied once to BMDMNCs in group I (140 SW: defined as 140 shots in total, given at 0.09 mJ/mm²), group II (280 SW), and group III (560 SW). Group IV was not treated by SW and served as the control group. Six experiments were done in each group. The BMDMNCs were cultured following SW therapy and the supernatants were collected on days 1, 3, 7 and 14 for assessment of VEGF levels. Immunocytochemical staining and flow cytometric measurement were performed on days 0 and 14. Experimental results demonstrated that VEGF levels were significantly higher in groups I-III than in group IV, and in group II than in group I at all intervals, and in group II than in group III on day 14 (all p values <0.005). Additionally, the number of positively stained VEGF cells on days 1, 3 and 14 and the number of newly formed CD31+ cells on day 14 were significantly higher in group II than in group IV (all p values <0.001). Conclusions These data suggest that application of SW to BMDMNCs significantly enhanced VEGF production and promoted differentiation of BMDMNCs into endothelial phenotype cells. (Circ J 2008; 72: 150 - 156)

抄録全体を表示

Heavily calcified lesions (HCL) continue to present challenges that are not always solved by modern low-profile, non-compliant high-pressure balloons, or bladed balloons. Uncrossable or unexpandable lesions need lesion modification, using ablating devices such as rotational atherectomy. Three cases of HCL treated with drug-eluting stents, using a new intravascular imaging device, Optical Coherence Tomography with 10-fold superior resolution and fewer artifacts compared with conventional intravascular ultrasound, are presented. Insights from using this highly sensitive imaging technique outline the high prevalence of persistent stent strut malapposition in this group, despite the use of high-pressure dilatation or rotational atherectomy. (Circ J 2008; 72: 157 - 160)

抄録全体を表示

An 82-year-old man with a mycotic aortic aneurysm of the distal arch underwent urgent surgery because of sepsis. The infected aortic arch was excised, replaced with a rifampicin-bonded prosthetic graft, and covered with omentum. Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was intraoperatively carried out in parallel with the cardiopulmonary circuit. Intraoperative PMX-DHP dramatically reduced the level of plasma endotoxin, and ameliorated hemodynamic instability and oxygenation, resulting in smooth weaning from cardiopulmonary bypass. Intraoperative endotoxin adsorption is technically simple and easy, effective in hemodynamic stabilization, and so could be a new therapeutic option for mycotic aortic aneurysm. (Circ J 2008; 72: 161 - 163)

抄録全体を表示

A woman with skin findings of a connective tissue disorder, typical of Ehlers-Danlos syndrome, was admitted to the Cardiology Division because of signs of congestive heart failure. Electrocardiogram showed sinus tachycardia, signs of right ventricular enlargement and hypertrophy. Echocardiogram showed right ventricular dilatation, and severe tricuspid regurgitation with indirect signs of severe pulmonary systolic hypertension. Chest computed tomography revealed bilateral and diffuse involvement of the peripheral pulmonary arteries, with kinking and elongation of the pulmonary vessels associated with multiple stenoses and post-stenotic dilatation. On artery angiography an elongation of the aortic root with kinking and coiling of the carotid and vertebral vessels was also detected. This young patient exhibited features of arterial tortuosity syndrome, an uncommon connective tissue disorder, with peculiar dysmorphism and clinical signs overlapping Ehlers-Danlos syndrome. (Circ J 2008; 72: 164 - 167)

抄録全体を表示

Background There is little information about the efficacy of ticlopidine plus aspirin after sirolimus-eluting stent (SES) implantation. Methods and Results The incidence of stent thrombosis was evaluated in 1,029 patients receiving ticlopidine and aspirin after SES deployment. Clinical follow-up was obtained in 98.9% (mean follow-up 17.0±7.9 months). Early stent thrombosis was observed in 5 patients (0.49%). There was 1 case each of late (0.1%) and very late stent thrombosis (0.1%). Conclusion Late and very late stent thrombosis in Japanese patients receiving ticlopidine and aspirin after SES deployment occurs infrequently. (Circ J 2008; 72: 168 - 169)

抄録全体を表示