Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 72 , Issue 11
Showing 1-31 articles out of 31 articles from the selected issue
Special Article
  • Priyesh A. Patel, Douglas G. Tilley, Howard A. Rockman
    2008 Volume 72 Issue 11 Pages 1725-1729
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 07, 2008
    JOURNALS FREE ACCESS
    Beta-arrestin is a multifunctional adapter protein well known for its role in G-protein-coupled receptor (GPCR) desensitization. Exciting new evidence indicates that β-arrestin is also a signaling molecule capable of initiating its own G-protein-independent signaling at GPCRs. One of the best-studied β-arrestin signaling pathways is the one involving β-arrestin-dependent activation of a mitogen-activated protein kinase cascade, the extracellular regulated kinase (ERK). ERK signaling, which is classically activated by agonist stimulation of the epidermal growth factor receptor (EGFR), can be activated by a number of GPCRs in a β-arrestin-dependent manner. Recent work in animal models of heart failure suggests that β-arrestin-dependent activation of EGFR/ERK signaling by the β-1-adrenergic receptor, and possibly the angiotensin II Type 1A receptor, are cardioprotective. Hence, a new model of signaling at cardiac GPCRs has emerged and implicates classical G-protein-mediated signaling with promoting harmful remodeling in heart failure, while concurrently linking β-arrestin-dependent, G-protein-independent signaling with cardioprotective effects. Based on this paradigm, a new class of drugs could be identified, termed "biased ligands", which simultaneously block harmful G-protein signaling, while also promoting cardioprotective β-arrestin-dependent signaling, leading to a potential breakthrough in the treatment of chronic cardiac disease. (Circ J 2008; 72: 1725 - 1729)
    Download PDF (351K)
Clinical Investigation
  • Koji Takeda, Goro Matsumiya, Taichi Sakaguchi, Hajime Matsue, Takafumi ...
    2008 Volume 72 Issue 11 Pages 1730-1736
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 18, 2008
    JOURNALS FREE ACCESS
    Background Left ventricular restoration (LVR) is increasingly used for treatment of chronic heart failure following myocardial infarction. The present multi-institutional retrospective study analyzed the long-term efficacy and limitations of LVR. Methods and Results Seventy-two (58 males, mean age 62±10) patients who underwent LVR between January 1999 and June 2007 were included. Preoperatively, 50 (68.5%) were in New York Heart Association (NYHA) functional class III or IV. Mean left ventricular end-diastolic and end-systolic volume indexes were 145±43 ml/m2 and 111±40 ml/m2, respectively, and ejection fraction was 25±7.4%. Other concomitant operative procedures included coronary artery bypass grafting in 55 (76.4%), and mitral valve procedures in 38 (52.8%). Thirty-day mortality was 2.8%. Actuarial survival at 1, 3, and 5 years was 95.3%, 80.45 and 71.0% respectively. Mean ejection fraction significantly improved to 39±11%, and left ventricular volumes were significantly reduced in the early postoperative period. During a mean of 3.3±2.4 years of follow up, these improvements were still significant in the late period. Of the survivors, 90% were in NYHA functional class I or II. Conclusion LVR can be performed with a low operative mortality and provide satisfactory long-term survival by restoring the dilated left ventricle and improving systolic function. (Circ J 2008; 72: 1730 - 1736)
    Download PDF (304K)
  • Tetsuya Ueno, Ryuzo Sakata, Yoshifumi Iguro, Hiroyuki Yamamoto, Masahi ...
    2008 Volume 72 Issue 11 Pages 1737-1743
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 18, 2008
    JOURNALS FREE ACCESS
    Background Procedures on the subvalvular apparatus are an etiology-based treatment for ischemic mitral regurgitation (IMR). Methods and Results Fifty-nine patients with IMR were divided into 3 groups: mitral annuloplasty (MAP) (M group, n=27), MAP+left ventricular reconstruction (LVR) (LV group, n=18), and MAP+LVR+subvalvular procedure (S group, n=14). Tenting height and area, angle between the annular line and the line connecting leaflet base to the bending- or tip-point of either the anterior or posterior leaflet, and leaflet mobility were measured echocardiographically preoperatively and at immediate- and mid-term postoperative follow-up. The angles at the bending-point of the anterior leaflet in mid-systole remained greater than those at its tip-point in the M and LV groups, but became significantly smaller postoperatively only in the S group (p<0.05). Postoperative leaflet mobility at the bending-point in the S group became significantly greater than in the other groups (p<0.01). The grade of MR, after significant reduction by the procedure, increased again in the M and LV groups, but remained almost unchanged in the S group. Conclusion Subvalvular procedures improved the configuration and mobility of the anterior leaflet, and can be expected to reduce the recurrence of IMR. (Circ J 2008; 72: 1737 - 1743)
    Download PDF (327K)
  • Takashi Miura, Kiyoyuki Eishi, Shiro Yamachika, Koji Hashizume, Seiich ...
    2008 Volume 72 Issue 11 Pages 1744-1750
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 18, 2008
    JOURNALS FREE ACCESS
    Background A preoperative coaptation depth (CD) ≥11 mm is apparently a predictive factor for persistent mitral regurgitation (MR) after undersized mitral annuloplasty for functional MR. The results of studies of isolated undersized mitral annuloplasty in non-ischemic dilated cardiomyopathy (DCM) are reported, including the relationship between the preoperative CD and recurrent MR. Methods and Results Six patients (mean age, 61 years) with severe functional MR in non-ischemic DCM underwent isolated undersized mitral annuloplasty. There were no hospital deaths. At intermediate follow-up of 2.2±1.9 years, New York Heart Association functional class improved significantly from 3.3±0.5 before surgery to 2.2±0.4 after surgery (p=0.0016). At a mean echocardiographic follow-up of 1.9±1.7 years, MR grade improved significantly from 4.0±0.0 before surgery to 1.0±0.6 after surgery (p<0.001). In 4 of 5 patients with a preoperative CD ≥11 mm, functional MR improved to mild or less than mild after surgery. Conclusions Isolated undersized mitral annuloplasty improved clinical symptoms and functional MR in non-ischemic DCM. These results suggest that preoperative CD ≥11 mm does not always predict recurrent MR after isolated undersized mitral annuloplasty for functional MR in cases of non-ischemic DCM. (Circ J 2008; 72: 1744 - 1750)
    Download PDF (318K)
  • Naoyuki Kimura, Masashi Tanaka, Koji Kawahito, Masamitsu Sanui, Atsush ...
    2008 Volume 72 Issue 11 Pages 1751-1757
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 29, 2008
    JOURNALS FREE ACCESS
    Background The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes. Methods and Results A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%). Conclusions Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients. (Circ J 2008; 72: 1751 - 1757)
    Download PDF (166K)
  • Satoshi Takeshita, Shingo Sakamoto, Shuichi Kitada, Koichi Akutsu, Hid ...
    2008 Volume 72 Issue 11 Pages 1758-1761
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 29, 2008
    JOURNALS FREE ACCESS
    Background Medical therapy gives excellent short-term outcomes for patients with Stanford type B acute aortic dissection. However, the affected aorta is often compromised by aneurysmal dilatation and rupture, resulting in poor long-term outcome. The present study investigated which antihypertensive treatment may prevent long-term aortic events in these patients. Methods and Results The study group comprised 78 consecutive patients with Stanford type B acute aortic dissection who were treated medically and followed-up for an average of 873±548 days. The optimal hypertensive drug regimen to reduce aortic events was determined by multivariate analyses. Of the 78 patients, 73 (94%) were discharged from hospital with medical therapy, and aortic events occurred in 13 (18%) of them (aortic rupture/recurrent dissection in 2 (3%); aortic expansion ≥60 mm in 7 (10%), rapid aortic expansion ≥10 mm/year in 3 (4%), and development of visceral/limb ischemia in 1 (1%)) during follow-up. By multivariate analysis, patients given angiotensin-converting enzyme inhibitor (ACEI) were less likely to have long-term aortic events than those without (odds ratio: 0.18, 95% confidence interval: 0.04-0.85). Conclusions Use of ACEI is associated with a reduced risk of long-term aortic events in patients with medically treated type B aortic dissection. (Circ J 2008; 72: 1758 - 1761)
    Download PDF (71K)
  • Masayasu Izuhara, Keisuke Shioji, Shin Kadota, Osamu Baba, Yuzo Takeuc ...
    2008 Volume 72 Issue 11 Pages 1762-1767
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 18, 2008
    JOURNALS FREE ACCESS
    Background The cardio-ankle vascular index (CAVI) has been recently reported as a new index of aortic stiffness, which is less influenced by blood pressure than pulse wave velocity (PWV). The present study investigated the relationship between the levels of CAVI and carotid and coronary arteriosclerosis. Methods and Results The 443 consecutive patients who underwent CAVI, carotid sonography, and coronary angiography in hospital were examined. Intima - media thickness (IMT) and carotid plaque were evaluated by ultrasonography. The severity of coronary artery disease (CAD) was evaluated by coronary angiography and the subjects were divided into 4 groups (0, no significant organic stenosis: 1, 1-vessel disease: 2, 2-vessel disease: 3, 3-vessel disease). Univariate analyses showed that both CAVI and brachial-ankle PWV (baPWV) were associated with IMT and the presence of carotid plaque. Multiple stepwise regression analyses revealed that CAVI (p=0.0427), but not baPWV, was associated with the IMT. Both CAVI (p<0.0001) and baPWV (p=0.0140) were significantly associated with the severity of CAD. Multiple logistic analyses revealed that CAVI (p=0.0342), but not baPWV (p=0.8027), was associated with the presence of multivessel disease. Conclusion High CAVI implies progression of carotid and coronary arteriosclerosis. CAVI may be more closely linked with arteriosclerosis than baPWV. (Circ J 2008; 72: 1762 - 1767)
    Download PDF (85K)
  • Ayuko Fujiu, Tetsuya Ogawa, Nami Matsuda, Yoshitaka Ando, Kosaku Nitta
    2008 Volume 72 Issue 11 Pages 1768-1772
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 18, 2008
    JOURNALS FREE ACCESS
    Background Because cardiovascular disease is the major cause of death in dialysis patients, the correlation between diastolic left ventricular (LV) dysfunction and arterial sclerosis, including thoracic aortic calcification, was studied in chronic hemodialysis (HD) patients. Methods and Results The enrolled study subjects were 142 (73 men, 69 women) maintenance HD patients. Aortic arch calcification volume (AoACV) was measured by MDCT scan, arterial stiffness was estimated by brachial - ankle pulse wave velocity (PWV) and diastolic LV function was estimated as E/E' by tissue Doppler imaging with cardiac ultrasonography. E/E' correlated significantly with systolic blood pressure (r=0.29, p=0.037), age (r=0.19, p=0.02), LV mass index (r=0.18, p=0.036), dialysis vintage (r=0.19, p=0.037), AoACV (r=0.37, p<0.0001) and PWV (r=0.33, p=0.0002). Multiple regression analysis indicated that AoACV (β=0.26, p=0.005) and PWV (β=0.22, p=0.03) were independent determinants of E/E'. Conclusion Diastolic LV dysfunction may be induced by increased vascular calcification and reduced arterial stiffness in chronic HD patients. (Circ J 2008; 72: 1768 - 1772)
    Download PDF (172K)
  • John Barbetseas, Nikolaos Alexopoulos, Stella Brili, Constadina Aggeli ...
    2008 Volume 72 Issue 11 Pages 1773-1776
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 03, 2008
    JOURNALS FREE ACCESS
    Background The role of atherosclerosis in thoracic aortic dissection has not been established yet. Transesophageal echocardiography (TEE) is an imaging modality widely used in the diagnostic evaluation of thoracic aortic dissection, and it can detect aortic atherosclerotic plaques and assess their size and specific characteristics. Methods and Results One hundred consecutive patients with thoracic aortic dissection and adequate imaging of the thoracic aorta by TEE were studied. The type of dissection (proximal or distal) and the presence and the degree of aortic atherosclerosis were defined. Proximal aortic dissection (Stanford type A) was found in 64 patients. Patients with proximal dissection were younger than those with distal (type B; 58±13 vs 67±11 years, p<0.001). The prevalence of arterial hypertension was higher in patients with distal dissection compared with those with proximal. Aortic atherosclerosis was present in less patients with proximal than with distal dissection (67% vs 94%, p<0.002). Logistic regression analysis revealed that patients with severe atherosclerosis were 7.6-fold more probable to have type B than type A dissection (p<0.001). Conclusion Aortic atherosclerosis is more associated with distal than with proximal aortic dissection. (Circ J 2008; 72: 1773 - 1776)
    Download PDF (126K)
  • Fumihiro Nomura, Nobushige Kurobe, Yoshihiro Mori, Atsushi Hikita, Mas ...
    2008 Volume 72 Issue 11 Pages 1777-1786
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 03, 2008
    JOURNALS FREE ACCESS
    Background Recently, vasodilators have been increasingly being recognized as useful for the treatment of acute heart failure syndromes (AHFS). Although carperitide (α-human atrial natriuretic peptide) has vasodilatory, diuretic and organ-protective effects, its efficacy and safety for the first-line drug treatment of AHFS have not been reported. Methods and Results A prospective observational study was performed in AHFS patients with preserved systolic blood pressure (SBP ≥120 mmHg), pulmonary congestion and dyspnea who were receiving carperitide monotherapy. The analysis was conducted in 1,832 patients (male: 52.7%; mean age: 75.1±12.7 years). The initial SBP was 151.1±25.7 mmHg; 62.0% were diagnosed as having acutely decompensated chronic heart failure and 78.8% were assessed as functional class III-IV according to New York Heart Association classification. Carperitide was administered at an initial dosage of 0.025-0.05 μg · kg-1 · min-1 in 50.4% of patients. In 1,524 patients (83.2%), carperitide monotherapy restored the acute phase and improved the degree of dyspnea as assessed using the modified Borg scale. The incidence of adverse drug reactions was 4.64%; the most frequently reported adverse reaction was hypotension (3.55%). Conclusion In the present study, following carperitide monotherapy, 83.2% of AHFS patients recovered from the acute phase. Based on these findings, carperitide seems useful for the first-line drug treatment of AHFS in patients with pulmonary congestion and preserved blood pressure. (Circ J 2008; 72: 1777 -1786)
    Download PDF (174K)
  • Noritake Hata, Yoshihiko Seino, Takayoshi Tsutamoto, Shinya Hiramitsu, ...
    2008 Volume 72 Issue 11 Pages 1787-1793
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 24, 2008
    JOURNALS FREE ACCESS
    Background Carperitide is used to treat acute decompensated heart failure (ADHF), but its effects on long-term prognosis have not been studied. Methods and Results A multicenter randomized controlled study of 49 patients with ADHF was performed to clarify the drug's effects on long-term prognosis. Low-dose carperitide (0.01-0.05 μg · kg-1 ·min-1) was infused for 72h as the initial treatment (n=26), whereas in the control group (n=23), standard medical treatment other than carperitide was given without limitation. Anti-aldosterone drugs were prohibited in both groups. During carperitide infusion, significant increases of the atrial natriuretic peptide and cyclic GMP levels and a significant decrease in the heart-type fatty acid-binding protein/serum creatinine ratio were observed, suggesting inhibition of myocyte cell membrane damage. On the other hand, no significant differences in the plasma brain natriuretic peptide, troponin T, and creatinine levels were noted in either group. During 18-month follow-up, significant reductions of death and rehospitalization occurred in the carperitide vs control group (11.5% vs 34.8%; p=0.0359). Cox regression analysis revealed that randomization to carperitide (p=0.020), pretreatment systolic blood pressure ≥140 mmHg (p=0.043), and β-blocker therapy (p=0.016) were independent predictors for freedom from cardiac events. Conclusions Acute-phase low-dose carperitide infusion improved the long-term prognosis of patients with ADHF. (Circ J 2008; 72: 1787 - 1793)
    Download PDF (107K)
  • Shinpei Kimura, Masahiro Ito, Masaomi Chinushi, Komei Tanaka, Yasutaka ...
    2008 Volume 72 Issue 11 Pages 1794-1799
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 07, 2008
    JOURNALS FREE ACCESS
    Background Cardiac resynchronization therapy (CRT) has recently been introduced as a new option for patients with severe heart failure, but its effect on renal function remains unclear. Methods and Results Twenty-three patients receiving CRT were studied. Responders were those who showed >0% increase in left ventricular ejection fraction after CRT by echocardiography. Clinical parameters, echocardiographic measurement, renal function, and prescriptions were examined before and 3 months after CRT, and the relationship between the response to CRT and renal function was examined. The responders had a better prognosis than the non-responders (p<0.05). There was a significant difference in the change in the estimated glomerular filtration rate between the responders and non-responders (p<0.05), even in patients with renal dysfunction before CRT (p<0.01). Prescriptions of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) were 100% in the CRT responders and 60% in the non-responders (p<0.05). Up-titration of β-blockers could be significantly achieved in the CRT responders compared with the non-responders (p<0.05). Conclusions Preservation of renal function was observed in the responders to CRT, even in patients with renal dysfunction. Prescription of ACEI/ARB and up-titration of β-blockers increased in the CRT responders. These results may contribute to the beneficial effects of CRT. (Circ J 2008; 72: 1794 - 1799)
    Download PDF (100K)
  • Mitsunori Ishino, Yasuchika Takeishi, Takeshi Niizeki, Tetsu Watanabe, ...
    2008 Volume 72 Issue 11 Pages 1800-1805
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 03, 2008
    JOURNALS FREE ACCESS
    Background B-type natriuretic peptide (BNP), heart-type fatty acid-binding protein (H-FABP), and pentraxin 3 (PTX3) each predict adverse cardiac events in chronic heart failure (CHF) patients. For prognostic evaluation from different aspects, the utility of combined measurement of the 3 biomarkers in patients with CHF was examined in the present study. Methods and Results Levels of BNP (associated with left ventricular dysfunction, positive if >200 pg/ml), H-FABP (marker of myocardial damage, positive if >4.1 ng/ml), and PTX3 (marker of inflammation, positive if >4.0 ng/ml) were measured in 164 consecutive CHF patients, and patients were prospectively followed with endpoints of cardiac death or rehospitalization. When patients were categorized on the basis of the number of elevated biomarkers, patients with 1, 2, and 3 elevated biomarkers had a 5.4-fold (not significant), 11.2-old (p<0.05), and 34.6-fold increase (p<0.01), respectively, in the risk of adverse cardiac events compared with those without elevated biomarkers. Kaplan-Meier analysis revealed that patients with 3 elevated biomarkers had a significantly higher cardiac event rate than patients with a lower number of elevated biomarkers. Conclusion The combination of these 3 biomarkers could reliably risk-stratify CHF patients for prediction of cardiac events. (Circ J 2008; 72: 1800 - 1805)
    Download PDF (162K)
  • Wei-Chun Huang, Ming-Ting Wu, Kuan-Rau Chiou, Guang-Yuan Mar, Shih-Hun ...
    2008 Volume 72 Issue 11 Pages 1806-1813
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 24, 2008
    JOURNALS FREE ACCESS
    Background Accurate, non-invasive characterization of culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. In this prospective study, multidetector row computed tomography (MDCT) is used to assess culprit and active complex lesions in patients early after AMI. Methods and Results We enrolled 103 patients with first non ST-elevation AMI who underwent 64-slices MDCT and conventional coronary angiography (CCAG). The definition of culprit lesion, stable non-culprit lesions and non-culprit active complex lesions was based on the findings of CCAG. The lesions were analyzed with MDCT data. In culprit lesions (n=103), luminal artery stenosis, remodeling index, plaque area and burden were significantly higher than non-culprit lesions (n=129). Multivariate discriminant analysis showed that MDCT density could discriminate culprit from non-culprit lesions. Receiver-operator characteristic curve analysis identified the optimal cutoff value of lesion density for discrimination between culprit and non-culprit lesion as 49.6 Hounsfield units (HU); this value was associated with a sensitivity, specificity and accuracy of 88.4%, 87.4%, and 87.9%, respectively. The MDCT in the stable non-culprit lesions (81.8±15.5 HU) was significantly higher than that in culprit lesions or non-culprit active complex lesions (33.2±13.8 and 48.3±15.7 HU, p<0.001). Conclusions MDCT can predict culprit lesions in patients early after AMI, and identify multiple complex lesions. (Circ J 2008; 72: 1806 - 1813)
    Download PDF (6286K)
  • Satoshi Isobe, Kimihide Sato, Kaichiro Sugiura, Takeo Mimura, Mikiko K ...
    2008 Volume 72 Issue 11 Pages 1814-1820
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 29, 2008
    JOURNALS FREE ACCESS
    Background The feasibility of using landiolol hydrochloride in multislice computed tomography (MSCT) coronary angiography (CAG) was investigated in the present study. Methods and Results Landiolol hydrochloride was continuously administered intravenously to 145 patients before starting MSCT CAG. Hemodynamic changes [blood pressure (BP), heart rate (HR)], adverse effects, image quality using a 5-point scale, and accuracy of detecting significant stenoses (≥50% reduction in lumen diameter) were evaluated. HR was significantly reduced during injection, and quickly recovered after cessation of administration, of landiolol hydrochloride. Neither significant changes in BP nor adverse effects occurred. Among visible segments, 1,869 (94%) displayed an excellent (83%) or good (11%) image quality. Diagnostic accuracy was evaluated in 39 of 145 patients who underwent invasive CAG within 3 weeks after MSCT. The sensitivity, specificity, positive predictive value, and negative predictive value of MSCT CAG for detection of significant stenoses in assessable segments were excellent (per artery: 94%, 98%, 92%, and 100%; per segment: 92%, 98%, 94%, and 96%, respectively). Conclusions Intravenous administration of landiolol hydrochloride reduces HR without a significant reduction in BP, which enables favorable image quality and diagnostic accuracy without adverse effects, making this agent feasible as a premedication for MSCT CAG. (Circ J 2008; 72: 1814 - 1820)
    Download PDF (472K)
  • Cosmo Godino, Cristina Messa, Luigi Gianolli, Claudio Landoni, Alberto ...
    2008 Volume 72 Issue 11 Pages 1821-1828
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 29, 2008
    JOURNALS FREE ACCESS
    Background Inflammation appears to be important in the pathogenesis of acute myocardial infarction (AMI). Methods and Results Cardiac [18-F]-fluoro-deoxy-glucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT)-scan was investigated in 12 fasting patients with first AMI (FAMI) single-vessel disease after successful primary percutaneous coronary intervention and at 9 weeks follow-up, and in 12 controls. The average FDG uptake (aFDGu) of the 28 left ventricular (LV) wall segments defined on the PET/CT images of the 12 FAMI patients was 1.28±0.57-fold higher than the activity present in the LV cavity. By contrast, the aFDGu of the 12 controls was 0.70±22 (p<0.001). The segmental aFDGu in the FAMI was multifocal in both the culprit and non-culprit segments; it was less than LV cavity activity in 38%, 1-2-fold greater in 51.8% and more than 2-fold greater in 10.2%. At follow-up, aFDGu was significantly increased in both culprit and non-culprit segments (1.69±1.15, p<0.001). Statistically significant differences between FAMI and controls patients were only found for interleukin-6 plasma levels on admission (11.3±7.7 pg/ml vs 2.2±1.3 pg/ml; p<0.004). Conclusion Multifocal, non-infarct related, cardiac-FDG-uptake occurred immediately after AMI and persisted at follow-up. The cause of these striking and consistent findings is still speculative. (Circ J 2008; 72: 1821 - 1828)
    Download PDF (504K)
  • Tomotaka Kasamatsu, Jun Hashimoto, Hitoshi Iyatomi, Tadaki Nakahara, J ...
    2008 Volume 72 Issue 11 Pages 1829-1835
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 24, 2008
    JOURNALS FREE ACCESS
    Background Myocardial perfusion single-photon emission computed tomography (SPECT) has been used for risk stratification before non-cardiac surgery. However, few authors have used mathematical models for evaluating the likelihood of perioperative cardiac events. Methods and Results This retrospective cohort study collected data of 1,351 patients referred for SPECT before non-cardiac surgery. We generated binary classifiers using support vector machine (SVM) and conventional linear models for predicting perioperative cardiac events. We used clinical and surgical risk, and SPECT findings as input data, and the occurrence of all and hard cardiac events as output data. The area under the receiver-operating characteristic curve (AUC) was calculated for assessing the prediction accuracy. The AUC values were 0.884 and 0.748 in the SVM and linear models, respectively in predicting all cardiac events with clinical and surgical risk, and SPECT variables. The values were 0.861 (SVM) and 0.677 (linear) when not using SPECT data as input. In hard events, the AUC values were 0.892 (SVM) and 0.864 (linear) with SPECT, and 0.867 (SVM) and 0.768 (linear) without SPECT. Conclusion The SVM was superior to the linear model in risk stratification. We also found an incremental prognostic value of SPECT results over information about clinical and surgical risk. (Circ J 2008; 72: 1829 - 1835)
    Download PDF (85K)
  • Masayuki Ueeda, Takenori Doumei, Yoichi Takaya, Ryoko Shinohata, Yusuk ...
    2008 Volume 72 Issue 11 Pages 1836-1843
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 24, 2008
    JOURNALS FREE ACCESS
    Background The relationship between serum fatty acid levels and the extent of coronary plaques and calcification was examined in patients with acute myocardial infarction (AMI). Methods and Results The serum levels of the n-3 polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and the n-6 polyunsaturated fatty acids (arachidonic acid (AA) and dihomo-gamma-linolenic acid (DGLA)) were determined using gas chromatography on admission of 95 consecutive patients with their first AMI and 17 controls. Using multidetector-row computed tomography, soft plaques and calcification lesions were scored according to the extent of coronary involvement. Serum logarithmic transformed (log) EPA and logDHA levels were inversely correlated with soft plaque scores (r=-0.546, p<0.0001 and r=-0.377, p<0.0001, respectively). Serum logAA and logDGLA levels were not significantly correlated with soft plaque scores. Serum logEPA and logDHA levels were significantly, but weakly, correlated with calcification scores. Multivariate analysis with clinical characteristics and risk factors selected serum n-3 polyunsaturated fatty acid levels as independent factors associated with the extent of coronary soft plaques. Conclusion The present study demonstrates a significant correlation between serum n-3 polyunsaturated fatty acid levels and the extent of coronary soft plaques and calcification in AMI patients. (Circ J 2008; 72: 1836 - 1843)
    Download PDF (247K)
  • Hiromi Yamamoto, Kanako Takahashi, Haruyo Watanabe, Yuka Yoshikawa, Ry ...
    2008 Volume 72 Issue 11 Pages 1844-1851
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 03, 2008
    JOURNALS FREE ACCESS
    Background Cilostazol, a phosphodiesterase 3 inhibitor, is an antiplatelet drug that is widely used for preventing cardiovascular events, although, to date, there are few methods for evaluating its effects. Methods and Results Blood samples were taken at baseline and at 3 and 12 h in 10 healthy male subjects after 100 mg cilostazol intake. Each sample was examined by Western blot for phosphorylation levels of vasodilator-stimulated phosphoprotein (VASP), an abundant cAMP-dependent kinase substrate in platelets, and by the optical aggregometer for ADP- and collagen-induced aggregation, before and after 8 nmol/L prostaglandin E1 (PGE1) treatment. Cilostazol intake did not affect VASP phosphorylation levels or the maximal aggregation rates without PGE1 treatment. However, cilostazol intake apparently enhanced PGE1-induced VASP phosphorylation and PGE1-mediated reduction of ADP-and collagen-induced maximal aggregation rates. Levels of VASP phosphorylated at Ser157 were correlated and the maximal aggregation rates induced by ADP were inversely correlated with cilostazol concentrations in the plasma. Conclusion The antiplatelet effects of cilostazol intake could be evaluated by measuring VASP phosphorylation levels and maximal aggregation rates in platelets by ex vivo treatment with a low concentration of PGE1. (Circ J 2008; 72: 1844 - 1851)
    Download PDF (1277K)
  • Akira Koike, Osamu Nagayama, Masayo Hoshimoto-Iwamoto, Takeya Suzuki, ...
    2008 Volume 72 Issue 11 Pages 1852-1858
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 03, 2008
    JOURNALS FREE ACCESS
    Background Recent investigations have demonstrated that cerebral oxyhemoglobin (O2Hb) decreases during exercise in patients with left ventricular dysfunction, reflecting a cerebral hypoxia. We sought to establish a prognostic value of decreased cerebral O2Hb during exercise in cardiac patients, and to compare it with those of indexes obtained from cardiopulmonary exercise testing (CPX). Methods and Results A total of 344 consecutive patients with coronary artery disease were enrolled in the study. All the patients performed CPX, during which cerebral O2Hb was continuously monitored using near-infrared spectroscopy. There were 13 cardiac deaths and 78 cardiovascular events during the prospective follow-up period of 1,231±538 days. The change of O2Hb measured at the forehead from rest to peak exercise (ΔO2Hb) was significantly lower in non-survivors than in survivors (-1.5±3.3 vs 1.7±3.2 μmol/L, p=0.0004). By multivariate Cox proportional hazards analysis, ΔO2Hb and left ventricular ejection fraction (LVEF) were found to be independent prognostic markers for cardiac deaths. The ΔO2Hb, LVEF and peak oxygen uptake were found to be significant prognostic markers for cardiovascular events, mainly for heart failure worsening and sudden cardiac death. Conclusion The present findings suggest that a decrease in cerebral O2Hb during exercise predicts future cardiovascular events in patients with coronary artery disease. (Circ J 2008; 72: 1852 - 1858)
    Download PDF (165K)
  • Masao Daimon, Hiroyuki Watanabe, Yukio Abe, Kumiko Hirata, Takeshi Hoz ...
    2008 Volume 72 Issue 11 Pages 1859-1866
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 29, 2008
    JOURNALS FREE ACCESS
    Background Normal values for echocardiographic measurements and the relationship between these parameters and age in a large Japanese population are still unknown. Methods and Results A total of 700 healthy Japanese aged 20-79 years underwent 2-dimensional and Doppler echocardiography at collaborating institutions. The respective mean values obtained in men and women were as follows: septal wall thickness, 0.9±0.1 and 0.8±0.1 cm; posterior wall thickness, 0.9±0.1 and 0.8±0.1 cm; left ventricular (LV) diastolic diameter, 4.8±0.4 and 4.4±0.3 cm; LV systolic diameter, 3.0±0.4 and 2.8±0.3 cm; LV diastolic volume, 93±20 and 74±17 ml; LV systolic volume, 33±20 and 25±7 ml; LV ejection fraction, 64±5 and 66±5%; maximum left atrial (LA) volume, 42±14 and 38±12 ml. Aortic root diameter, LV wall thickness, and LV mass slightly increased with age, whereas indexed LA volume did not vary with age. Diastolic parameters assessed by mitral inflow and mitral annular velocities declined with age, as previously reported. Conclusions Normal values of echocardiographic measurements in a large Japanese population are reported for the first time; several systolic and diastolic parameters varied with age. These results provide important reference values that should be useful in routine clinical practice as well as in clinical trials. (Circ J 2008; 72: 1859 - 1866)
    Download PDF (1263K)
  • Motohisa Osaka, Hiroshige Murata, Yoshitaka Fuwamoto, Shinji Nanba, Ka ...
    2008 Volume 72 Issue 11 Pages 1867-1873
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 07, 2008
    JOURNALS FREE ACCESS
    Background Approximately 5% of motor vehicle deaths are assumed to be occur because of a cardiac event thought to be triggered by multiple factors. One important factor is an imbalance of sympathetic and parasympathetic nervous activities, which can be measured by analyzing heart rate variability (HRV). Therefore, a system has been developed to make electrocardiographic (ECG) recordings outside the driver's awareness from the steering wheel (steering-ECG) with an algorithm to remove noise. Methods and Results Steering-ECG and ECG from a chest lead (chest-ECG) were recorded simultaneously in 10 normal subjects while they were driving for 90 min. For each of 4 parameters (instantaneous heart rate, low- and high-frequency components of HRV, and the ratio of these components in all subjects), mutual information was used to examine whether the fluctuation from the steering-ECG resembled that from the chest-ECG. The mutual information of each parameter was larger than 0.047 with 95% confidence interval (mutual information values vary from 0 to 1; threshold of significance: 0.047). Hence, the fluctuation of each steering-ECG parameter resembled its chest-ECG counterpart. Conclusions This system heralds a new driver-safety strategy by reporting alteration of autonomic nervous activity during driving. (Circ J 2008; 72: 1867 - 1873)
    Download PDF (1709K)
  • Masao Yoshinaga, Koji Sameshima, Yuji Tanaka, Akihiro Wada, Jun Hashig ...
    2008 Volume 72 Issue 11 Pages 1874-1878
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 24, 2008
    JOURNALS FREE ACCESS
    Background Information is limited about how adipokines predict the accumulation of cardiovascular (CV) risk factors or the presence of metabolic syndrome (MS) in children. Methods and Results The subjects were 321 children (200 boys and 121 girls; 109 normal and 212 obese) aged 6-12 years. Obesity was defined as a body mass index of ≥ the 95th percentile for age and sex. MS was defined by using the newly established Task Force criteria. The levels of the adipokines - adiponectin, leptin, ghrelin, high sensitive C-reactive protein (CRP) and resistin -were measured. Regression analyses revealed that high leptin levels were predictive of the accumulation of CV risk factors in normal weight, obese, and entire (normal weight and obese) group of subjects. High CRP in the normal weight group and low adiponectin in the obese and the entire groups were also independently predictive of the accumulation of risk factors. A high leptin level was solely predictive of the presence of MS in obese and entire groups. Conclusions Leptin was the most sensitive marker for predicting the accumulation of CV risk factors and the presence of MS in elementary school children. Primary prevention is important because both leptin and adiponectin levels abruptly worsened when children obtained any 1 risk factor. (Circ J 2008; 72: 1874 - 1878)
    Download PDF (89K)
  • Pirjo Valtonen, Tomi Laitinen, Tiina Lyyra-Laitinen, Olli T. Raitakari ...
    2008 Volume 72 Issue 11 Pages 1879-1884
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 18, 2008
    JOURNALS FREE ACCESS
    Background Normal pregnancy is associated with enhanced vasodilatation because of the increased nitric oxide (NO) production. Because L-homoarginine can act as a substrate for NO production, concentrations of L-homoarginine in normal pregnancy were assessed in the present study to test whether L-homoarginine is associated with endothelial function. Methods and Results Healthy non-pregnant (n=61) and pregnant women (n=58) were studied in a cross-sectional study. L-homoarginine, L-arginine, asymmetric dimethylarginine and symmetric dimethylarginine concentrations were determined simultaneously by high-performance liquid chromatography. Endothelium-dependent brachial artery flow-mediated dilation (FMD) was measured by ultrasound. The serum L-homoarginine concentration was significantly higher during the second and the third trimesters compared with the levels in the non-pregnant women (4.8±1.7 and 5.3±1.5 vs 2.7±1.0 μmol/L, p<0.001, respectively). In line with this, FMD increased in response to pregnancy (p<0.05). Three months after delivery, the L-homoarginine concentrations and FMD were comparable to those recorded in the non-pregnant females. The concentration of L-homoarginine correlated significantly with gestational age (r=0.426, p=0.001) and brachial artery diameter and FMD (r=0.362, p=0.006 and r=0.306, p=0.022, respectively) in pregnancy. Conclusions L-homoarginine appears to be increased during the second and third trimesters of pregnancy and may contribute to the enhanced endothelial function in normal pregnancies. (Circ J 2008; 72: 1879 - 1884)
    Download PDF (139K)
Experimental Investigation
  • Makoto Shoji, Yoshitaka Iso, Taro Kusuyama, Yasutoshi Omori, Teruko So ...
    2008 Volume 72 Issue 11 Pages 1885-1893
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 07, 2008
    JOURNALS FREE ACCESS
    Background Granulocyte-colony stimulating factor (G-CSF) affects injured arteries through early endothelialization. Some reports, however, have cautioned that the restenosis rate may increase after G-CSF injection. In the present study, high-dose G-CSF was administered to mice with vascular injury to clarify its effect. Methods and Results Mice were received daily subcutaneous injections of saline or a high dose (300 μg/kg) of G-CSF for 5 days after vascular injury. In the FACS analysis, CD34-/Sca-1-positive progenitor cells were more abundant in the G-CSF group (p<0.05). Neointimal hyperplasia was more evident in the G-CSF group at 1 week (p<0.05), whereas at 4 weeks it was more evident in the control group (p<0.01). TUNEL-positive cells in the arterial wall were more numerous in the G-CSF group at day 1 (p<0.01). CD34-positive cells were observed in the G-CSF group at 1 week. Re-endothelialization appeared earlier in the G-CSF group (at 4 weeks; p<0.01). An increased number of 1A4-positive smooth muscle cells were found in bone marrow cell culture treated with G-CSF. Conclusion High-dose G-CSF induced neointimal proliferation through excessive inflammation and bone marrow cell mobilization in the early phase. In the late phase, however, it induced early re-endothelialization and thereby inhibited neointimal hyperplasia. (Circ J 2008; 72: 1885 - 1893)
    Download PDF (3078K)
  • Zhan-Qiang Shao, Michio Kawasuji, Kentaro Takaji, Yukihiro Katayama, M ...
    2008 Volume 72 Issue 11 Pages 1894-1899
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: October 07, 2008
    JOURNALS FREE ACCESS
    Background The liver produces various angiogenic and cytoprotective growth factors and the omentum has potent angiogenic properties that promote wound healing. The ability of hepatic tissue implantation plus omental wrapping to induce angiogenesis and restore cardiac function was investigated in a rat model of infarction. Methods and Results Myocardial infarction was induced in rats using coronary artery ligation. The omentum was wrapped (omentopexy group), hepatic tissue implantation was combined with omental wrapping (hepatic tissue implantation (H) group) or no other treatment was applied (control (C) group), and then ventricular function was evaluated by echocardiography 4 weeks later. Infarct size, ventricular remodeling, vascular density and collagen density were morphometrically and histologically evaluated. The expression of angiogenic growth factors in implanted tissues was examined using RT-PCR. The H group had thicker (p<0.05) and less expanded infarcts (p<0.001), as well as higher capillary (p<0.01) and arteriolar (p<0.05) density in the infarct border zone, than the C group. Hepatocyte growth factor was obviously expressed and the expression of both basic fibroblast growth factor and vascular endothelial growth factor was increased in the H group. Conclusions Hepatic tissue implantation combined with omental wrapping stimulated angiogenesis, attenuated left ventricular remodeling and improved cardiac function. (Circ J 2008; 72: 1894 - 1899)
    Download PDF (674K)
Case Report
  • Kenji Kitaizumi, Kazushi Yukiiri, Hisashi Masugata, Kaori Shinomiya, M ...
    2008 Volume 72 Issue 11 Pages 1900-1903
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 11, 2008
    JOURNALS FREE ACCESS
    A 65-year-old man with a history of coronary artery bypass grafting was admitted because of severe heart failure. Echocardiography showed diffuse severe hypokinesis of the left ventricle (ejection fraction 25%) and severe mitral regurgitation caused by tethering of the leaflet secondary to left ventricular (LV) dilation. He underwent mitral valve annuloplasty and LV papillary muscle imbrication, but postoperative sustained ventricular tachycardia developed and echocardiography showed ventricular dyssynchrony with a long septal-to-posterior wall motion delay (>130 ms). Cardiac resynchronization therapy (CRT) was performed using a biventricular pacing system with an implantable cardioverter defibrillator, but biventricular pacing prolonged the QRS duration from 130 to 160 ms, so 11C-acetate positron emission tomography was performed to evaluate the CRT. During biventricular pacing, myocardial oxidative consumption decreased by 15% and cardiac efficiency increased by 33%. The plasma brain natriuretic peptide level, which was 9,500 pg/ml preoperatively, decreased to 173 pg/ml just before discharge from hospital. (Circ J 2008; 72: 1900 - 1903)
    Download PDF (1274K)
  • Rishi Puri, Benjamin K. Dundon, Matthew I. Worthley, Stephen G. Worthl ...
    2008 Volume 72 Issue 11 Pages 1904-1906
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 11, 2008
    JOURNALS FREE ACCESS
    A 62-year-old man underwent radiotherapy to the left upper chest for treatment of Pancoast syndrome on a background of previous coronary artery bypass grafting 12 years earlier. Within 1 year, he developed significant stenoses of both the left internal mammary artery (LIMA) graft and ostial left vertebral artery, presumably related to therapeutic radiation exposure. Initially diagnosed using computed tomography coronary angiography, the patient underwent percutaneous coronary intervention and insertion of a drug-eluting stent (DES) to the ostium of the LIMA graft via a left radial approach. He remains clinically well at 6-month follow-up. This is the first reported case in the literature of DES treatment of a radiation-induced vascular stenosis; however, the incidence of cardiovascular disease is elevated in such cases. In patients with a prior history of mantle radiation, consideration should be given to the routine assessment of internal mammary conduits prior to coronary artery bypass surgery. (Circ J 2008; 72: 1904 - 1906)
    Download PDF (180K)
  • Hideki Kitahara, Yoshio Kobayashi, Masashi Yamaguchi, Kenji Ohkubo, Ta ...
    2008 Volume 72 Issue 11 Pages 1907-1908
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 11, 2008
    JOURNALS FREE ACCESS
    The polymer of paclitaxel-eluting stents (PES) plays an important role in controlling the release of paclitaxel. Damage to the polymer of a PES that is used in a patient has not been demonstrated, although in-vitro studies report disruption of it. The present case report describes damage to a PES as delivery through a calcified coronary artery was being attempted. (Circ J 2008; 72: 1907 - 1908)
    Download PDF (291K)
  • Jen Te Hsu, Shigeru Nakamura, Ryuji Yamamoto, Tomoko Kobayashi, Atsush ...
    2008 Volume 72 Issue 11 Pages 1909-1913
    Published: 2008
    Released: October 24, 2008
    [Advance publication] Released: September 11, 2008
    JOURNALS FREE ACCESS
    A 70-year-old man presented with acute massive pulmonary embolism (PE). His clinical condition deteriorated despite regular heparin and thrombolytic agent treatment, and he eventually developed cardiogenic shock. A thrombus originating from the inferior vena cava was detected and acute-on-chronic embolization resulted, with an unusual clinical course. Aggressive catheter thrombectomy with pigtail rotation failed to fragment the organized thrombus, but it was successfully removed by a 3-loop snare device combined with guiding catheter under percutaneous cardiopulmonary support. (Circ J 2008; 72: 1909 - 1913)
    Download PDF (1496K)
Retraction
  • Hidenobu Okuyama, Osamu Hirono, Harutoshi Tamura, Satoshi Nishiyama, Y ...
    2008 Volume 72 Issue 11 Pages 1914
    Published: 2008
    Released: October 24, 2008
    JOURNALS FREE ACCESS
    The Editorial Team of Circulation Journal has recently confirmed that the paper written by Hidenobu Okuyama et al, published in the August 2008 issue of the Journal (Circ J 2008; 72: 1296 - 1302), contains serious plagiarism from the paper by Kenichi Sugioka et al, published in the April 2002 issue of Stroke (Stroke 2002; 33: 2077 - 2081). Therefore, we have had to take the decision to retract the offending paper from Circulation Journal.
    Hidenobu Okuyama, Osamu Hirono, Harutoshi Tamura, Satoshi Nishiyama, Yasuchika Takeishi, Takamasa Kayama, Isao Kubota. Impact of Aortic Arch Stiffness on Recurrence of Stroke in Patients With Acute Ischemic Stroke (Circ J 2008; 72: 1296 - 1302)
    As the Editor-in-Chief, I deeply regret that such misconduct has happened in our Journal, and would like to express the sincere hope and determination that it will never happen again in the future.
    Download PDF (25K)
feedback
Top