Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium, resulting in external impedance of cardiac filling. In the developed world, CP is most frequently encountered as a consequence of previous cardiac surgery, thoracic irradiation, viral or idiopathic causes. Tuberculosis still remains a common cause of CP in the developing world, immigrants from underdeveloped nations, and immunosuppressed patients. Clinical signs and symptoms of right heart failure coupled with risk factors for pericardial disease should raise suspicion for CP. Echocardiographic evaluation and often cardiac catheterization are essential components of accurate diagnosis of CP. Enhanced interventricular dependence, with respiratory variation in the ventricular pressures, and ventricular discordance are the pathophysiologic hallmarks of CP. Imaging findings such as increased pericardial thickness or pericardial calcification on computed tomography can be supportive, but are not necessary for the diagnosis of CP. Pericardiectomy remains the most effective therapy for symptomatic CP. (Circ J 2008; 72: 1555 - 1562)

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Background The Japan Arteriosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC) is a pooled study based on individual participant data from existing prospective cohort studies in Japan. Its purpose was to consider associations between risk factors and cardiovascular disease (CVD) outcomes, as well as differences between subgroups, defined by age, gender or geographical region, which could not be detected in the smaller samples. Methods and Results Individual records for 66,691 participants in 21 cohort studies were pooled, accounting for a total of 575,628 person-years. From this data, there were 409 deaths attributed to stroke and 169 deaths attributed to coronary heart disease (CHD). Total stroke and CHD events were 1,478 and 178, respectively. Of the 1,424 total stroke events with a reported stroke subtype, 975 were classified as ischemic, 267 as hemorrhagic, and 178 as subarachnoid hemorrhage. Conclusion The JALS-ECC collected data from existing cohort studies covering a diverse Japanese population, which has provided information about the effects of modifiable factors on the risks of the CVD. Such information should provide a reliable basis for establishing prevention strategies. (Circ J 2008; 72: 1563 - 1568)

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Background A simple and practical risk prediction tool for coronary heart disease (CHD) to determine the specific risk level in each patient that fits the true clinical practice setting is needed and would be valuable in Japan. Methods and Results A 5-year risk prediction score and chart for CHD based on the MEGA study data was developed in the present study. The MEGA risk prediction score and chart were constructed based on the coefficient of each risk factor. The risk factors included in these risk prediction tools were: treatment (diet, diet plus pravastatin), sex, age, baseline high-density lipoprotein-cholesterol, baseline low-density lipoprotein-cholesterol, glucose abnormality (diabetes and impaired fasting glucose), hypertension, and smoking. The MEGA risk prediction score comprised the risk score for each risk factor, and it can predict 5-year risk for CHD with 5 levels of risk, based on the total risk score. The MEGA risk prediction chart more accurately predicts risk, by reflecting the accumulation of risk factors and using an 8-color visual chart. Conclusions The MEGA risk prediction score and chart, developed from the MEGA study data, more easily and accurately assesses the 5-year CHD risk in mild to moderate hypercholesterolemic patients in the usual clinical practice setting in Japan. (Circ J 2008; 72: 1569 - 1575)

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Background Several epidemiologic studies in Japan have shown the risk factors for coronary heart disease (CHD) in the general population. The present analysis determined the risk factors for CHD in the MEGA Study, a large primary prevention trial with pravastatin in Japanese with hypercholesterolemia. Methods and Results The relationship between each baseline characteristic and the risk of CHD for the 5-year study period were evaluated using the Cox proportional hazard model. The multivariable predictors of CHD were sex, age, high-density lipoprotein-cholesterol (HDL-C), diabetes mellitus (DM), hypertension (HT), and history of smoking. Serum total and low-density lipoprotein-cholesterol were not independent risk factors for CHD in the current analysis. In addition, the effect of pravastatin was evaluated by subgroups in each risk factor using the interaction in a Cox model. Diet plus pravastatin treatment reduced CHD risk by 14-43% compared with diet alone, regardless of the presence or absence of risk factors. Conclusions The risk factors for CHD were sex, age, DM, HT, smoking, and low HDL-C in the MEGA Study. The pravastatin treatment was effective for reducing the risk of CHD, regardless of the presence of risk factors. (Circ J 2008; 72: 1576 - 1582)

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Background Ongoing low-grade inflammation and endothelial dysfunction persist in patients late after Kawasaki disease (KD). Statins not only reduce cholesterol, but also improve surrogate markers of atherosclerosis and endothelial dysfunction, but their effects for children late after KD complicated with coronary arterial abnormality (CAA) has not been evaluated. Methods and Results The 11 KD children complicated with CAA (mean age 12.9±2.5 years, mean interval from episode 10.77±3.01 years) and 11 age- and gender-matched healthy controls were studied. The KD group received oral simvastatin 10 mg/day for 3 months. Lipid profiles, high-sensitivity C-reactive protein (hs-CRP) and flow-mediated dilation (FMD) of the brachial artery were performed at baseline in both groups and 3 months later in the KD group. At baseline, the KD group had significantly higher hs-CRP level and decreased FMD than the control group. After 3 months' treatment, the KD group showed a significant reduction in the hs-CRP level and a significant increase in FMD. Conclusions In this small study, short-term statin therapy appeared to significantly improve chronic vascular inflammation and endothelial dysfunction with no adverse effects in children complicated by CAA late after KD. However, long-term and randomized studies are still needed to make further conclusions. (Circ J 2008; 72: 1583 - 1587)

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Background Although dipyridamole is no longer used as a mainstream medication for coronary artery disease because of the coronary steal phenomenon, recent studies have shown that the elevation of serum adenosine levels caused by dipyridamole improves cardiac function in heart failure patients. In the present study it was investigated whether use of dipyridamole at the time of complete revascularization affects long-term mortality in patients with impaired left ventricular (LV) function. Methods and Results The 1,836 consecutive patients who underwent complete revascularization between 1984 and 1992 were assessed; 254 patients with impaired LV function (ejection fraction <50%) were enrolled. Cox proportional hazards regression adjusted for baseline covariates and the propensity score were used to compare the risks for mortality between patients who did and did not take dipyridamole. The mean follow-up period was 12 years; 178 patients (70.1%) took dipyridamole and there were 66 (37.1%) all-cause and 22 (12.4%) cardiac deaths in that group. In the multivariate analysis, the dipyridamole group had a lower risk for both all-cause (hazard ratio (HR) 0.54; p=0.005) and cardiac mortality (HR 0.42; p=0.010). Conclusion The use of dipyridamole reduced both all-cause and cardiac mortality in patients with impaired LV function. (Circ J 2008; 72: 1588 - 1593)

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Background Little is known regarding the association between numbers of cardiovascular (CV) risk factors and the level of each risk factor in elementary school children based on a longitudinal study. Methods and Results A descriptive study of 319 obese children aged 6-11 years who participated in a screening program for comorbidity of obesity between 2003 and 2005, and who participated in consecutive years thereafter, was performed. Abdominal obesity, hypertension, dyslipidemia (low high-density lipoprotein-cholesterol levels and/or high triglyceride levels), and raised fasting glucose levels were used as the CV risk factors. Metabolic syndrome and each CV risk factor were defined using the criteria newly established by a Task Force financed by the Health and Labour Science Research in Japan. An increase in the total number of CV risk factors implied a worsening of each CV risk factor level over a 1-year interval, and vice versa. Abdominal obesity in males and insulin resistance in females were prevalent in children who were at elementary school level. Conclusions We should assess not only obesity but all CV risk factor levels, because a cluster of risk factors implies a worsening of the individual risk factor levels in children as young as those in elementary school. (Circ J 2008; 72: 1594 - 1597)

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Background Acute ST-segment elevation myocardial infarction (STEMI) caused by left main coronary artery (LMCA) obstruction is uncommon. Although the link between this catastrophic disease and very high mortality is well recognized, even after undergoing emergent revascularization, the systemic risk stratification and long-term outcome are currently unclear. The clinical presentation, parameter-related in-hospital death and long-term outcomes of these patients with acute LMCA obstruction undergoing emergency revascularization were carefully reviewed. Methods and Results From January 2000 through December 2007, 1,588 patients were diagnosed to have STEMI and received emergent cardiac catheterization. The 38 (2.4%) of these 1,588 patients were enrolled into the present study due to LMCA obstruction. The analytical results identified the 30-day mortality rate as 42.1% (16/38). Multivariate analysis demonstrated that renal insufficiency was independently predictive of in-hospital mortality (odds ratio (OR): 5.642; p=0.029), whereas successful revascularization was independently predictive of freedom from in-hospital mortality (OR: 0.174; p=0.044). The cut-off value of a Parsonnet score >20 was strongly associated with 30-day mortality (p=0.002). Conclusions Even undergoing emergency revascularization for patients with acute LMCA obstruction, the in-hospital mortality remains very high. Additionally, the worse clinical outcome was observed in those with renal insufficiency and Parsonnet score of >20. (Circ J 2008; 72: 1598 - 1604)

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Background To investigate the efficacy of intracoronary tirofiban during primary percutaneous coronary intervention (PCI) for patients with acute coronary syndrome (ACS). Methods and Results The 118 patients aged 70 years and above (average age 75±2) were divided into study (n=58, intracoronary bolus tirofiban) and control (n=57, intravenous tirofiban) groups. The culprit vessels were targeted with primary PCI in all patients. Compared with the control group, the study group showed better Thrombolysis In Myocardial Infarction (TIMI) flow grades and TIMI myocardial perfusion grades (TMPG) immediately after PCI (p=0.016 and 0.026, respectively). The 14-day composite major adverse cardiac events rate was lower in the study group (3.5% vs 17.5%, p=0.030), but was similar between the 2 groups at 30 days following PCI (7.0% vs 1.7%, p=0.350). The left ventricular ejection fraction in the study group was higher than in the control group 30 days following PCI (67.4±6.2% vs 60.7±4.6%, p=0.033). The 14-day bleeding complication (p=0.201) and platelet reduction rates (p=0.984) were similar between the 2 groups. Conclusion In patients with ACS undergoing primary PCI, intracoronary bolus administration of tirofiban is superior to intravenous bolus injection for improving coronary flow, myocardial perfusion and short-term clinical outcomes. (Circ J 2008; 72: 1605 - 1609)

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Background Contrast-induced nephropathy is associated with increased in-hospital and long-term adverse clinical outcomes. Methods and Results To investigate whether hydration with sodium bicarbonate improves long-term clinical outcomes compared with sodium chloride, patients with chronic kidney disease undergoing an emergent coronary procedure were enrolled in a randomized clinical trial with ≥1 year of follow-up. The 59 patients with chronic kidney disease (serum creatinine concentration >1.1 mg/dl or estimated glomerular filtration rate <60 ml/min) were randomly assigned to receive a 154 mmol/L intravenous infusion of either sodium bicarbonate (n=30) or sodium chloride (n=29). The electrolytes were given as a bolus of 3 ml ·kg^-1 · h^-1 for 1 h before the administration of contrast, followed by an infusion of 1 ml ·kg^-1 · h^-1 for 6 h during and after the procedure. During a mean follow-up period of 15.9±4.5 months, the incidence of renal replacement therapy or death was significantly lower in the sodium bicarbonate group than in the sodium chloride group (3% vs 21%, respectively; p=0.037). Conclusions Hydration with sodium bicarbonate reduces the incidence of renal replacement therapy and death in patients with chronic kidney disease undergoing an emergent coronary procedure. (Circ J 2008; 72: 1610 - 1614)

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Background Few investigators have studied the anatomy of the sinus node artery (SNA) using noninvasive imaging modalities, so the objective of this study was to visualize the in-vivo 3-dimensional anatomical relations of the SNA using dual-source computed tomography (DSCT). Methods and Results In the 101 patients included in this study, the visualization rate, anatomical type and diameter of the SNA, the distance between the orifice and coronary artery, and the terminal type of SNA were recorded. The visualization rate was 95.2% (96/101). Of 96 patients, 106 SNAs were detected among which 51 (48.1%, 51/106) originated from the right coronary artery, 52 (49.1%, 52/106) from the left circumflex artery, and 3 (2.7%, 3/106) from other branches. There were 3 types of SNA: right (n=52), left (n=45), and posterior (n=9). The distance between the orifice of the right SNA and the right coronary sinus was 14.2±15.2 mm, for the left SNA it was 5.5±3.5 mm, and for the posterior SNA, 33.7±12.8 mm. The average diameter was 1.27±0.29 mm. The SNA approached the nodal tissue by 1 of 3 routes: retrocaval (51.5%), precaval (25.2%), or pericaval (22.3%). Conclusion The SNA can be visualized in vivo using DSCT, which is important for preoperative knowledge of its origin, course, termination, and anatomical type. (Circ J 2008; 72: 1615 - 1620)

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Background The aim of the present study was to determine whether the parameters of cardiac magnetic resonance imaging (CMRI) might correlate with early ST-segment resolution (STR) after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). Methods and Results CMRI was performed in 45 STEMI patients (age: 56.6±13.0 years) at 8.2±8.0 days (early phase) and 3.3±1.1 months (late phase) after successful PCI. CMRI parameters were compared between 2 groups: ≥70% STR (group 1, n=21) and <70% STR (group 2, n=24). Both groups had similar baseline characteristics, except for a higher frequency of ≥2 myocardial blush grade and shorter pain-to-balloon time in group 1. Early-phase CMRI showed that persistent microvascular obstruction (PMO) (38.1% vs 91.7%, p<0.001) occurred less frequently and the percent infarct mass against total left ventricular (LV) mass (17.7±8.7% vs 29.1±13.4%, p=0.001) was smaller in group 1. Late-phase CMRI revealed a significant increase in LV end-diastolic volume (-1.5±8.7 vs 14.5±25.5 ml, p=0.026) and reduced ejection fraction (55.0±9.9% vs 47.8±11.1%, p=0.027) in group 2. Conclusions CMRI demonstrated that early STR might be related to PMO and infarct size, and predicts LV dysfunction and adverse LV remodeling. Also, early-phase CMRI findings are comparable to late-phase CMRI in association with early STR. (Circ J 2008; 72: 1621 - 1626)

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Background The association between a gadolinium-based contrast material and nephrogenic systemic fibrosis has been discussed. The purpose of our study was to evaluate whether non-contrast enhanced magnetic resonance angiography (MRA) might provide sufficient information of renal artery stenosis. Methods and Results The non-contrast MRA of 26 patients with hypertension was retrospectively reviewed in the present study. The significant renal artery stenosis was visually evaluated by comparing non-contrast MRA with computed tomography or conventional angiographic finding. Difference of the intensities between the proximal and distal aorta was quantitatively evaluated. The sensitivity, specificity, positive predictive value and negative predictive value of non-contrast MRA in the evaluation of the renal artery stenosis was 78%, 91%, 64% and 96%, respectively. The distal abdominal aorta showed less signal intensity than the proximal aorta by 16.9±12.2%. Conclusions Non-contrast MRA is a non-invasive and effective method that allows evaluation of the renal artery stenosis. (Circ J 2008; 72: 1627 - 1630)

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Background Integrated backscatter (IB) intravascular ultrasound (IVUS) and IVUS Virtual Histology (VH) have been developed for tissue characterization, but have never been compared directly. The purpose of this study was to compare the overall agreement between IB-IVUS and IVUS-VH in the tissue characterization of plaques from the same coronary arterial cross-section. Methods and Results Images were acquired from 46 coronary arteries from 25 cadavers. Of a total of 392 histology/IVUS image pairs, 152 pairs were diagnosed as Stary's type III, IV, Va, Vb and Vc, and compared for IB-IVUS, IVUS-VH and histology. In the qualitative comparison, the overall agreement between histological and IB-IVUS diagnoses was higher (κ=0.81, 95% confidence interval (CI): 0.74-0.89) than that of the IVUS-VH diagnoses (κ=0.66, 95%CI: 0.56-0.75). The % fibrosis area determined by IB-IVUS was significantly correlated with the relative area of fibrosis based on histology (r=0.67, p<0.001). In the quantitative comparison, the overall agreement between the histological and IB-IVUS diagnoses was higher (κ=0.83, 95% CI: 0.75-0.91) than that of the IVUS-VH diagnoses (κ=0.73, 95% CI: 0.63-0.83). Conclusion Based on histology as the gold standard, IB-IVUS provided higher diagnostic accuracy than IVUS-VH for tissue characterization of coronary plaques. (Circ J 2008; 72: 1631 - 1639)

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Background In the present study it was examined whether transthoracic Doppler echocardiography (TTDE) would be useful for noninvasive diagnosis of coronary spastic angina (CSA) by assessing coronary arterial tone in the morning. Methods and Results The study population comprised 21 CSA patients and 27 control subjects. All diagnoses were angiographically confirmed by provocation test using acetylcholine. Coronary flow velocity reserve (CFVR) was measured at the distal left anterior descending artery with a frequency of 5.0 MHz ultrasound at baseline and after sublingual administration of nitroglycerin (NTG). Coronary arterial tone was assessed by obtaining the change of CFVR induced by NTG administration (CFVR_NTG/Pre). Basal CFVR tended to be lower in CSA patients (2.13±0.63, 2.71±0.67, respectively, p=0.05). CFVR after NTG was significantly higher in CSA patients (3.91±1.10, 3.07±0.74, p=0.003). The CFVR_NTG/Pre was significantly higher in CSA patients than in the control subjects (1.90±0.49, 1.15±0.22, p<0.0001). Using a cut-off value of 1.4 in CFVR_NTG/Pre, the sensitivity and specificity for the diagnosis of CSA were 91% and 90%, respectively. Conclusion TTDE appeared to be useful for the noninvasive diagnosis of CSA by assessing the coronary arterial tone. (Circ J 2008; 72: 1640 - 1644)

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Background Secondary tricuspid regurgitation (TR) as a result of pulmonary hypertension and/or left-sided heart disease is caused by tricuspid valve (TV) annular dilatation and tethering of the tricuspid leaflet after right ventricular (RV) dilatation. However, the mechanism of isolated TR without significant pulmonary hypertension remains unknown. The present study investigated the RV function and TV deformations in patients with isolated TR to find out the mechanism and etiology of the disease. Methods and Results Twelve patients with isolated, severe TR were included. RV area, volume, ejection fraction (EF), tenting distance and tenting area were measured. These parameters were compared with 12 age-and gender-matched controls and 12 patients with secondary TR. The cause of isolated TR was incomplete coaptation associated with annular dilatation without other problems. Compared with the controls, RV end-diastolic volumes and annular diameters were significantly larger and RVEF was significantly lower in patients with isolated TR. Tenting area and tenting distance were also significantly higher. However, there were no significant differences in these parameters between patients with isolated and secondary TR. Conclusions Isolated TR was associated with RV remodeling, systolic dysfunction and resultant annular dilatation and tethering of tricuspid leaflets. (Circ J 2008; 72: 1645 - 1649)

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Background It was hypothesized that atrial premature contractions (APCs) originating in the pulmonary veins (PVs) or superior vena cava (SVC) can be localized by evaluating characteristics of the P wave. Methods and Results Thirty-eight patients with paroxysmal atrial fibrillation were studied. P wave polarity and morphology of the ECGs during pacing from PVs were analyzed and compared to those of APCs originating from PVs. The P wave angle and notch in lead II during pacing from the right superior (RS) PV and SVC was compared to those of spontaneous APCs originating from those veins. A positive P wave in lead I was helpful in predicting right PV origin. A positive P wave in lead II distinguished superior PV origin. A notched P wave was helpful in predicting left PV origin. P wave polarity in lead II was positive during RSPV and SVC pacing. P waves in lead II during RSPV pacing had notching in 80%, but all P waves were smooth during SVC pacing. A P wave angle of >40° and notching in lead II showed RSPV origin. Conclusions These criteria are helpful in selecting which of the 4 PVs should be isolated when APCs cannot be recorded after transseptal puncture. (Circ J 2008; 72: 1650 - 1657)

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Background The ratio of peak early diastolic mitral inflow to annular velocity (E/E') and left atrial size could provide prognosis on congestive heart failure (CHF). N-terminal Pro B-type natriuretic peptide (NT-ProBNP) has also been useful for predicting adverse cardiac events. However, it is not clear how these parameters compare with conventional risk factors. Thus, we investigated whether E/E', left atrial dimension index (LADI) and NT-ProBNP would predict adverse events and add incremental value to conventional risk factors, even in non-ischemic advanced dilated cardiomyopathy (DCM). Methods and Results Both NT-ProBNP and echocardiography were evaluated in 105 patients. The cardiac events were defined as the composite of cardiac death and re-admission for CHF. At follow up, cardiac events occurred in 24 patients who had high NT-ProBNP and showed higher LADI and E/E'. In multivariate analysis, both NT-ProBNP and LADI, but not E/E', remained as independent predictors; patients with both increased LADI and NT-ProBNP had a 27-fold higher risk of cardiac events than those without any risk factors (p=0.003). Moreover, LADI and NT-ProBNP showed a better incremental prognostic value over conventional risk factors (global chi-square increase from 7 to 17 to 49, p=0.003, p<0.001, respectively). Conclusions Both NT-ProBNP and LADI might have the most predictable power, particularly in non-ischemic advanced DCM. (Circ J 2008; 72: 1658 - 1665)

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Background There is little knowledge on comparisons of cardiovascular risk factors between prehypertension and hypertension in Mongolian populations, Inner Mongolia, China. Methods and Results A total of 2,589 Mongolians aged 20 years and over were recruited as study participants. Demographic data, lifestyle factors, family history of hypertension, blood pressure measurements, physical examination and blood samples were obtained and analyzed for all individuals. Prehypertensives and hypertensives accounted for 38.39% and 37.39%, respectively, in all participants. Multivariate logistic regression using proportional odds model showed that hypertension was significantly associated with age (odds ratio was 5.79, 8.84, 30.05 and 32.28 for age 40-, 50-, 60- and 70-, respectively), family history of hypertension (7.12), alcohol drinking (2.03), overweight (4.69) and hyperlipidemia (3.49), and prehypertension significantly associated with age (3.65 for age 70-84), hyperlipidemia (1.80) in males. In females, hypertension was significantly associated with age (8.58, 14.40, 33.00, 63.67 for age 40-, 50-, 60- and 70-, respectively), family history of hypertension (5.65), overweight (3.16) and high C-reactive protein (≥10.356 mg/L), and prehypertension significantly associated with age (1.72, 2.00, 2.74 and 6.67 for age 40-, 50-, 60- and 70-, respectively) and overweight (1.68). Conclusions Prevalence of some cardiovascular risk factors and number of risk factors in hypertensives were higher than that in prehypertensives. (Circ J 2008; 72: 1666 - 1673)

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Background The aim of this analysis was to define the risk factors associated with the problematic dose titration of unfractionated heparin (UFH) in high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients. Methods and Results The study group comprised 267 patients with high-risk NSTE ACS managed with an early invasive strategy and treated with the recommended dose of UFH. The subsequent dose was adjusted after measurement of activated partial thromboplastin time (aPTT), using the nomogram. The goal for aPTT was 1.5-2.5-fold of the control value. At 6 h after starting therapy 29% of patients had a therapeutic initial aPTT value; half of them were over-anticoagulated, and 22% were undertreated. By continuing therapy, the proportion of optimally treated patients increased; after 12 h of treatment 40% of patients reached the therapeutic dose, and 58% after 24 h. Undertreatment was a problem in ≤65-year-old men. Women and older patients have a higher risk of overdose. The patients with a therapeutic dose of UFH had the lowest occurrence of major ischemic adverse events. Conclusions Expert consensus on more precise dose guidelines for UFH is needed. The dose needs to be not only weight, but also age and sex, adjusted. (Circ J 2008; 72: 1674 - 1679)

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Background There is controversy about longevity-associated factors, including environmental and genetic factors. Clinical and epidemiological studies suggest that multiple risk factors decrease life-span, but there has not been a definitive report regarding the association of risk factors with longevity. The ultimate aim of the present study was to prevent the overwhelming increase in life-style-related diseases by evaluating this association in 2 districts in Japan. Methods and Results Plasma glucose levels, hemoglobin (Hb) A_1c, lipids, dehydroepiandrosterone-sulfate, adiponectin and physical activity were examined in 133 subjects (M/F 47/86, 67±1 years) in Kokufu, a longevity district (mean life span: 80.4 years according to 2000 Japanese census) and 69 subjects (M/F 29/40, 62±1 years) in Miyama, a non-longevity district (mean life span 77.4 years, 2000 census). There were significant differences in systolic and diastolic blood pressures (BPs, p<0.001), exercise capacity (p<0.0001) and plasma adiponectin levels (p<0.04) between the districts. Plasma adiponectin level was significantly correlated with high-density lipoprotein-cholesterol (HDL-C) (r=0.333, p<0.0001), triglyceride (TG) (r=-0.161, p<0.04), HbA_1c (r=-0.163, p<0.03) and HOMA-R (r=-0.163, p<0.03). Conclusion Life-style-related factors such as BP, exercise capacity and plasma adiponectin levels might play an important role in longevity, and those of HDL-C and TG, as well as glucose tolerance, might be associated with adiponectin levels. (Circ J 2008; 72: 1680 - 1684)

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Background Monocyte chemoattractant protein-1 (MCP-1) is a key mediator of left ventricular (LV) remodeling during the early phase of myocardial infarction (MI). The hypothesis tested was that myocardial MCP-1 expression would increase during the chronic phase of MI and an angiotensin-II type 1 receptor blocker (ARB) would attenuate macrophage infiltration through decreased myocardial MCP-1 expression. Methods and Results MI was produced by ligation of the left coronary artery in Wistar rats, which were then randomized to treatment with vehicle (MI/C), candesartan (10 mg · kg^-1 ·day^-1) for 6 weeks (MI/ARB0-6W), or candesartan for 2 weeks, starting 4 weeks after MI (MI/ARB4-6W). LV systolic and end-diastolic pressures 6 weeks after MI were decreased in MI/ARB0-6W compared with MI/C or MI/ARB4-6W, however, there were no differences in other hemodynamic or echocardiographic parameters among infarcted rat groups. Both long- and short-term treatments with ARB similarly reduced mRNA expressions of MCP-1, transforming growth factor-β1, and procollagen type I and III, macrophage infiltration, and myocardial fibrosis in the border zone. Conclusions In post-MI heart failure, ARB attenuated MCP-1 expression and macrophage infiltration in the border zone, resulting in less myocardial fibrosis. ARB may exert its beneficial effect, at least in part, by inhibiting myocardial macrophage-related inflammation. (Circ J 2008; 72: 1685 - 1692)

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Background Basic fibroblast growth factor (bFGF) is a potent mitogen; however, diabetes mellitus might impair its angiogenic property. Prostaglandin E₁ (PGE₁) is a potent vasodilator and improves endothelial function. Thus, PGE₁ could potentiate the angiogenic properties of bFGF in patients with diabetes mellitus. Methods and Results Streptozotocin-induced diabetic mice with unilateral hindlimb ischemia were randomly treated as follows: no treatment, 0.2 μg of PGE₁, 10 μg of bFGF, and combined administration of PGE₁ and bFGF. Blood perfusion was evaluated by the ratio of ischemic-to normal-limb blood perfusion. Four weeks after the treatment, the combined administration of bFGF and PGE₁ increased the blood perfusion ratio as compared with single bFGF or PGE₁ (77±10% vs 56±10% and 58±10%; p<0.05, respectively). A histological evaluation showed that vascular density in the combined therapy was higher than single bFGF or PGE₁ (418±59 vs 306±69 and 283±71 vessels/mm²; p<0.01, respectively); the maturity in combined therapy was also higher than single bFGF or PGE₁ (46±14 vs 30±14 and 28±6 vessels/mm²; p<0.01, respectively). Conclusions PGE₁ potentiated the impaired angiogenic properties of bFGF in diabetic murine hindlimb ischemia. This new strategy might contribute to more effective therapeutic angiogenesis for ischemic limb in patients with diabetes. (Circ J 2008; 72: 1693 - 1699)

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Background Stenoses of venous grafts represent a major limitation in coronary artery bypass surgery. The use of viral vectors to facilitate over-expression of factors within the graft to promote long-term patency is a promising new therapeutic concept. One of the viral vector systems is the adeno-associated virus (AAV); a non-pathogenic single stranded DNA virus, which elicits only low immunological responses. Methods and Results Recombinant AAV vector coding for β-galactosidase was produced and transferred ex vivo using intraluminal application to previously harvested rabbit internal jugular vein grafts (n=8). The 30 min after application, an end-to-end anastomosis of each graft as a bypass to the carotid artery was performed in a previously established rabbit bypass model. X-Gal-staining of the grafts was performed after killing the animals to quantify gene expression. AAV transduction was successful in 100% of the grafts. After 30 days, β-galactosidase gene expression could be assessed in the medial layer of the graft. Furthermore, no signs of inflammation could be detected. Conclusions These findings suggest that recombinant AAV vectors are an alternative to the widely used adenoviral based vectors. These data support the further use of AAV vectors to overcome intimal hyperplasia after vein graft coronary artery bypass surgery. (Circ J 2008; 72: 1700 - 1704)

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Brugada syndrome is an inherited arrhythmic disorder, and mutations in the SCN5A gene, encoding cardiac sodium channels, are identified in approximately 15% of cases. A novel causative gene (glycerol-3 phosphate dehydrogenase-1 like; GPD1L) has been reported, and in the present study, 80 unrelated Japanese patients were screened for GPD1L mutations: 1 synonymous mutation was identified, as well as 1 intronic variant, both of which were absent in 220 control alleles. Additionally, a single-nucleotide polymorphism was detected in 4 patients. No non-synonymous mutations were found. GPD1L does not appear to be a major cause of Brugada syndrome in the Japanese population. (Circ J 2008; 72: 1705 - 1706)

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Background A lower maintenance dose of clopidogrel may be appropriate in Japanese patients because the maintenance dose of ticlopidine is lower in Japan than that used in the United States. Methods and Results A total of 126 patients with 153 lesions who consented to take 50-mg clopidogrel to prevent stent thrombosis were enrolled. There was 1 case of early stent thrombosis (0.65%). Side-effects of clopidogrel occurred in 5 patients (4.0%). Conclusion This preliminary study shows that 50 mg clopidogrel may be acceptable in Japanese patients. (Circ J 2008; 72: 1707 - 1708)

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An extremely rare case of myxomas originating from the mitral leaflets was diagnosed in a 64-year-old man presented with a history of exertion dyspnea and palpitations. Two masses originating from the anterior and posterior mitral leaflets in the left ventricular (LV) cavity, causing LV outflow obstruction, were detected by echocardiography. The myxomas were successfully removed with the mitral leaflets via left atriotomy and mitral valve replacement. No embolic events occurred in the preoperative or postoperative period. In this article, we wanted to present. (Circ J 2008; 72: 1709 - 1711)

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Venous hemangioma is a rare, benign cardiac tumor, usually in young or adult males. A 61-year-old woman with a clinical history of radiofrequency catheter ablation had venous hemangioma of the right atrium diagnosed after an episode of acute pain in the precordial region. The incidental discovery of the mass, clinical evaluation, operative procedure, pathologic findings and follow-up are reported, as well as the epidemiology, natural history, and diagnostic and therapeutic approaches. Etiology may be related to damage to endothelial cells of the interatrial septum or to endocardial cells. (Circ J 2008; 72: 1712 - 1714)

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Pregnancy carries significant physiological changes that demand more cardiac output, so structural cardiac disease can cause life-threatening complications. A woman had rheumatic mitral stenosis and underwent mitral valve replacement (MVR) with bioprosthesis 8 years prior to admission. She presented with dyspnea and leg edema at 30 weeks of gestation. Severe mitral stenosis caused by xenograft failure was noted on echocardiography. Management was conservative until a sudden onset of hemodynamic compromise requiring emergency redo MVR under normothermic cardiopulmonary bypass with intra-aortic balloon pump. Monitoring of fetal heartbeat and uterine contractions showed no significant abnormalities and the woman gave birth to a full-term baby by Cesarean section with postoperative warfarin therapy. (Circ J 2008; 72: 1715 - 1717)

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A 26-year-old male patient was diagnosed with an isolated recurrent intramyocardial - extracardiac hydatid cyst with pericardial protrusion after being admitted with chest pain and palpitation. He had undergone surgical resection of an intramyocardial pericardial hydatid cyst without cardiopulmonary bypass 10 years earlier. In the current admission, the results from transthoracic and transesophageal echocardiography and multislice computed tomography were confirmed by serological and histopathological tests. The cyst was excised under cardiopulmonary bypass, and the patient was treated postoperatively with albendazole for 9 months. His clinical status improved postoperatively and he was asymptomatic without signs of recurrence as determined by echocardiography. (Circ J 2008; 72: 1718 - 1720)

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The author (T. Kume) apologizes for errors which appeared in the Table 2, page 1266, Vol 72. Aortic cross-sectional area was 5.8±1.5 cm² in group A and 5.5±0.8 cm² in group B. The corrected Table 2 is given below. (Circ J 2008; 72: 1265-1269)

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