Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 73, Issue 4
Displaying 1-38 of 38 articles from this issue
Reviews
  • The First Step Toward Coronary Arteriosclerosis
    Paul M. Vanhoutte
    2009 Volume 73 Issue 4 Pages 595-601
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 18, 2009
    JOURNAL FREE ACCESS
    The endothelium causes relaxations of the underlying vascular smooth muscle, by releasing nitric oxide (NO). The endothelial cells also can evoke hyperpolarization of the vascular smooth muscle cells (endothelium-dependent hyperpolarizations, endothelium-derived hyperpolarizing factors-mediated responses). Endothelium-dependent relaxations involve both pertussis toxin-sensitive Gi and pertussis toxin-insensitive Gq coupling proteins. The endothelial release of NO is reduced in diabetes and hypertension. Arteries covered with regenerated endothelium lose the pertussis-toxin sensitive pathway for NO-release. This dysfunction favors vasospasm, thrombosis, penetration of macrophages, cellular growth and the inflammatory reaction leading to atherosclerosis. Endothelial cells also release endothelium-derived contracting factors (EDCF). Most endothelium-dependent contractions are mediated by vasoconstrictor prostanoids (endoperoxides and prostacyclin), which activate thromboxane-prostanoid (TP)-receptors of the underlying vascular smooth muscle cells. EDCF-mediated responses are augmented by aging, hypertension and diabetes. Thus, endothelial dysfunction is the first step toward coronary arteriosclerosis. (Circ J 2009; 73: 595 - 601)
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  • Tsutomu Yoshikawa, Akiyasu Baba, Yuji Nagatomo
    2009 Volume 73 Issue 4 Pages 602-607
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 26, 2009
    JOURNAL FREE ACCESS
    Autoimmune abnormalities, as well as viral infection and genetic abnormalities, appear to be major predisposing factors for dilated cardiomyopathy (DCM). Abnormalities of cell-mediated immunity are mainly involved in the onset of cardiomyopathy secondary to myocarditis. However, various antimyocardial antibodies are detected in the serum of patients with DCM. The appearance of these antibodies was considered to be an epiphenomenon associated with myocyte injury resulting from myocarditis, but recent findings have suggested that at least some of them are directly related to the pathophysiology of DCM. In particular, an autoantibody targeting the β1-adrenergic receptor that exhibits an agonist-like effect is related to the persistent myocardial damage resulting in DCM and provides substrates for fatal ventricular arrhythmias. In addition, an antibody for the muscarinic M2 receptor is related to atrial fibrillation, an antibody targeting Na-K-ATPase is closely related to sudden cardiac death as a result of fatal ventricular arrhythmias, and an autoantibody for troponin I increases the L-type calcium current and is related to the myocardial damage. Based on these findings, immunoadsorption therapy was developed to remove such autoantibodies in patients with refractory heart failure as a result of DCM. (Circ J 2009; 73: 602 - 607)
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  • Rei Shibata, Noriyuki Ouchi, Toyoaki Murohara
    2009 Volume 73 Issue 4 Pages 608-614
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: March 03, 2009
    JOURNAL FREE ACCESS
    Obesity is strongly associated with metabolic and cardiovascular disorders. Adiponectin is an adipose-derived plasma protein that is downregulated in subjects with obesity-related disorders. Low levels of adiponectin are associated with the increased prevalence of obesity-linked cardiovascular diseases, including ischemic heart disease and peripheral artery disease. Experimental findings have shown that adiponectin has beneficial effects in the cardiovascular system by directly acting on the component cells of the heart and blood vessels. Adiponectin protects cardiovascular tissues under conditions of stress through a number of mechanisms: inhibition of pro-inflammatory and hypertrophic responses, and stimulation of endothelial cell responses. These effects of adiponectin are mainly attributed to the modulation of signaling molecules, including AMP-activated protein kinase. Thus, adiponectin could be a promising therapeutic target for cardiovascular diseases. (Circ J 2009; 73: 608 - 614)
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  • Teruo Inoue, Koichi Node
    2009 Volume 73 Issue 4 Pages 615-621
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: March 13, 2009
    JOURNAL FREE ACCESS
    Restenosis after stent deployment is an overreaction of the wound healing response after vascular injury, and is characterized by the sequence of inflammation, granulation, extracellular matrix remodeling, and smooth muscle cell (SMC) proliferation and migration. In contrast, reendothelialization of at least part of the injured vessel surface, which is essential in the wound healing process, may occur at the site of stenting. Recent advances in drug-eluting stents (DES) have substantially reduced restenosis, but do not contribute to improve long-term prognosis, compared with bare metal stents (BMS). One of the reasons may be that reendothelialization is impaired after DES stenting. Regenerated endothelial cells and proliferated SMCs in the neointima are both in part derived from their progenitor cells, which are mobilized from bone marrow to injured vessel sites and differentiate into both vascular endothelial cells and SMCs. DES inhibits mobilization and differentiation of endothelial and smooth muscle progenitor cells, and thus not only inhibits restenosis but also impairs reendothelialization, which may lead to late stent thrombosis. To improve long-term prognosis in the DES era, adjunctive medical treatments inducing early reendothelialization, but inhibiting SMC proliferation, would be required. (Circ J 2009; 73: 615 - 621)
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Editorials
Original Articles
Arrhythmia/Electrophysiology
  • Naoki Yoshida, Takumi Yamada, Yoshimasa Murakami, Taro Okada, Yuichi N ...
    2009 Volume 73 Issue 4 Pages 632-638
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 19, 2009
    JOURNAL FREE ACCESS
    Background: The relationship between vagal modification and paroxysmal atrial fibrillation (PAF) recurrence after segmental pulmonary vein (PV) isolation (S-PVI) was investigated. Methods and Results: S-PVI was performed in 77 PAF patients using a multielectrode basket or circular catheter to achieve electrical disconnection of all 4 PVs independent of eliminating vagal reflexes. Serial Holter-recordings were obtained at baseline, immediately and 1, 3, 6, and 12 months after S-PVI to analyze the heart rate variability. Fifty-one patients were free from symptomatic PAF (Group A) and 26 had late PAF recurrences (Group B) at 12-month follow-up. Immediately after S-PVI, the root mean square of the successive differences (rMSSD) and high-frequency (HF) power, which reflected parasympathetic nervous activity, were significantly lower in Group A than in Group B (rMSSD: 33.6 ±26.0 vs 60.6 ±23.2 ms, P<0.05; ln HF: 8.73 ±0.84 vs 9.31 ±0.95 ms2, P<0.05). There were no significant differences in the average heart rate or ratio of the low-frequency to HF powers between the 2 groups. By multivariate analysis, only the HF immediately after S-PVI was an independent predictor of PAF recurrence (hazard ratio 1.707, 95% confidence interval 1.057-2.756, P<0.05). Conclusions: Vagal modification after S-PVI could also help prevent late recurrence of PAF. (Circ J 2009; 73: 632 - 638)
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  • Yasuhiro Hirasawa, Akihiro Nakagomi, Yoshinori Kobayashi, Takao Katoh, ...
    2009 Volume 73 Issue 4 Pages 639-646
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 19, 2009
    JOURNAL FREE ACCESS
    Background: Increased expression of cytokines and chemokines has been observed in chronic heart failure (CHF). Amiodarone reduces circulating cytokine levels, so it may attenuate the production of monocyte cytokines and chemokines by C-reactive protein (CRP) and thus improve the left ventricular ejection fraction (LVEF) in dilated cardiomyopathy (DCM) patients with ventricular tachycardia (VT). Methods and Results: Peripheral blood mononuclear cells (PBMCs) were stimulated by 25 μg/ml CRP in 23 patients with DCM, who were divided into 2 groups based on whether or not amiodarone was included in their treatment (Amiodarone group n=8; No amiodarone group n=15). Tumor necrosis factor (TNF)-α and monocyte chemoattractant protein (MCP)-1 on monocytes at baseline and after 4 weeks of treatment was measured by ELISA and expressed as mean ± SD (pg · ml-1 · 10-6 PBMCs). The LVEF and the CRP-induced monocyte cytokine and chemokine production were unchanged in the No amiodarone group after 4 weeks; however, LVEF in the Amiodarone group was increased (32.7 ±6.9 to 39.2 ±6.9%; P=0.005), and TNF-α and MCP-1 production in the Amiodarone group were decreased (P=0.012, respectively). Conclusions: Amiodarone attenuates the production of monocyte cytokines and chemokines by CRP, and improves LVEF in CHF patients with VT. (Circ J 2009; 73: 639 - 646)
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  • Masahide Harada, Toshiyuki Osaka, Eriko Yokoyama, Yoshio Takemoto, Ats ...
    2009 Volume 73 Issue 4 Pages 647-653
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 27, 2009
    JOURNAL FREE ACCESS
    Background: A functional line of conduction block is often observed in the sinus venosa (SV) during typical atrial flutter (AFL). Little information, however, is available as to the action potential characteristics in the SV with respect to the functional block. Methods and Results: Monophasic action potentials (MAPs) from the SV and lateral wall of the right atrium were recorded in 7 patients with paroxysmal AFL and 11 control patients. For both the control and AFL patients, the MAP duration at 90% repolarization (MAPD90) in the SV was longer, and the MAPD90 restitution slope was less steep than in the lateral wall. The MAPD90 in the SV in the AFL patients was slightly longer than that in the controls at the shortest cycle length (CL) tested (300 ms). However, the MAPD90s at longer CLs (350-700 ms), as well as the MAPD90 restitution slopes in the SV were comparable between the 2 groups. Conclusions: The MAPs in the SV are characterized by a long duration and flat restitution kinetics in humans. MAP properties to facilitate the development of conduction block in the SV are not appreciable in patients with paroxysmal typical AFL. (Circ J 2009; 73: 647 - 653)
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  • Yuko Miki, Toshiyuki Ishikawa, Kohei Matsushita, Youhei Yamakawa, Kats ...
    2009 Volume 73 Issue 4 Pages 654-657
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 26, 2009
    JOURNAL FREE ACCESS
    Background: The optimal atrioventricular (AV) delay setting is important for achieving optimal AV synchrony in patients with an implanted DDD pacemaker. Using pulsed Doppler echocardiography is the most common method of predicting the optimal AV delay, but it is a complicated and time-consuming method. Therefore, an automatic optimizing function of the AV delay at different atrial rates is desirable for achieving a favorable hemodynamic state. This study aimed to predict the optimal AV delay using phonocardiography. Methods and Results: The amplitude of the first heart sound (S1) recorded on the phonocardiogram was measured with different AV delays in 6 patents with complete AV block, normal left ventricular function and an implanted DDD pacemaker. The correlation between the amplitude of S1 and the length of the AV delay was a cubic curve (y=974.15x3-23.084x2-8.0074x+0.7495, R2=0.9511). The length of the AV delay at the inflection point of the curve showed a significant positive correlation with the optimal AV delay determined by pulsed Doppler echocardiography (R=0.9254, P<0.01). Conclusions: This study demonstrated a novel simple method of predicting the optimal AV delay using phono-cardiography. (Circ J 2009; 73: 654 - 657)
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Cardiovascular Surgery
  • Masanori Murakami, Yoshitoyo Miyauchi, Masahiko Nishida, Haruhiko Okad ...
    2009 Volume 73 Issue 4 Pages 658-661
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 27, 2009
    JOURNAL FREE ACCESS
    Background: The factors contributing to the efficacy and outcome of direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP) after cardiac surgery were investigated. Methods and Results: In 23 patients who received PMX-DHP for shock related to infection after cardiac surgery, there were no differences in the pre- and intraoperative clinical data of survivors (n=14) and non-survivors (n=9). Before the PMX-DHP treatment, the clinical assessment values of the survivors and non-survivors, respectively, showed the following significant differences: sepsis-related organ failure assessment score, 9.46 ±2.84 vs 12.89 ±3.37 (P<0.05); number of failed organs, 1.8 ±0.9 vs 3.1 ±1.1 (P<0.05); partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, 194 ±118 vs 102 ±29 (P<0.05); and total bilirubin, 2.7 ±2.8 vs 8.7 ±6.5 mg/dl (P<0.05). The systolic blood pressure and catecholamine index in the survivors improved significantly 12 h after PMX-DHP treatment, from 83 ±19 mmHg to 118 ±14 mmHg (P<0.01), and from 20.7 ±11.5 to 14.9 ±8.0 (P<0.05). Conversely, in the non-survivors, only the systolic blood pressure improved significantly, from 74 ±17 mmHg to 118 ±33 mmHg (P<0.001). Conclusions: Prompt initiation of PMX-DHP with drug treatment during the postoperative course of patients with septic shock caused by systemic inflammatory response syndrome related to infection and who are refractory to vasopressor treatment, can improve the disease state before multiple organ failure develops. (Circ J 2009; 73: 658 - 661)
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Heart Failure
  • Daisaku Nakatani, Yasuhiko Sakata, Hiroya Mizuno, Masahiko Shimizu, Sh ...
    2009 Volume 73 Issue 4 Pages 662-666
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 19, 2009
    JOURNAL FREE ACCESS
    Background: There is little data regarding the clinical impact of diabetes mellitus (DM) on heart failure (HF) among survivors of acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era. Methods and Results: The present study group comprised 4,035 survivors who underwent PCI within 24 h of the onset of symptoms. DM was an independent predictor of rehospitalization for HF by multivariate analysis (hazard ratio (HR) 1.576, P=0.010). The risk of rehospitalization for HF was similar between patients with DM who did not have an enlarged left ventricular diastolic diameter (LVDd <51 mm) before discharge and patients without DM who showed an increase in LVDd (≥51 mm) (HR 1.020, P=0.959). In the DM group, the hemoglobin A1c level before discharge was similar between patients with and without rehospitalization for HF (7.5 ±1.9% vs 7.4 ±1.6%, P=0.455), whereas high-sensitivity C-reactive protein (hs-CRP) was higher in patients with than without rehospitalization for HF (1.80 ±3.63 vs 0.75 ±2.03 mg/dl, P=0.001). Conclusions: DM is an independent predictor of rehospitalization for HF after AMI in the PCI era. Diabetic patients without left ventricular remodeling should be treated as a high-risk group for HF. Measurement of hs-CRP level may be useful for predicting rehospitalization because of HF in diabetic patients after AMI. (Circ J 2009; 73: 662 - 666)
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  • Hirotsugu Mitsuhashi, Hiroshi Yatsuya, Kunihiro Matsushita, Huiming Zh ...
    2009 Volume 73 Issue 4 Pages 667-672
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 19, 2009
    JOURNAL FREE ACCESS
    Background: Experimental studies have reported that allopurinol protects hypertensive rats from left ventricular hypertrophy (LVH) with negligible effects on blood pressure (BP). Uric acid (UA) was thought to induce cardiomyocyte growth and interstitial fibrosis of the heart, partly via activation of the renin-angiotensin system. In the present study, the relationship between serum UA levels and electrocardiographically-diagnosed LVH (ECG-LVH) was examined in Japanese men not taking medication for hypertension (HTN), which could confound the association. Methods and Results: A total of 3,305 male workers aged 35-66 years (mean age ± SD, 48.0 ±7.1) were studied. LVH was defined as meeting the ECG criteria (ie, Sokolow-Lyon voltage and/or Cornell voltage QRS duration product). Subjects were divided into 3 groups by tertile of serum UA level. The highest tertile (UA range 0.39-0.65 mmol/L or 6.6-11.0 mg/dl) had a significantly increased prevalence of LVH compared with the lowest tertile independent of age, body mass index, serum creatinine level, HTN, diabetes and hyperlipidemia (odds ratio 1.58, 95% confidence interval 1.23-2.02, P<0.001). Similar results were obtained in both the normal and high BP subgroups. Conclusions: UA concentration independently and positively associated with ECG-LVH in Japanese men. (Circ J 2009; 73: 667 - 672)
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  • Tomomi Meguro, Yuji Nagatomo, Atsushi Nagae, Chiori Seki, Nobusuke Kon ...
    2009 Volume 73 Issue 4 Pages 673-680
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 27, 2009
    JOURNAL FREE ACCESS
    Background: Arterial stiffness is used as an index of arteriosclerosis. The goal of this study was to clarify whether increased arterial stiffness, evaluated by measuring the brachial-ankle pulse wave velocity (baPWV), is a risk factor for the prognosis of heart failure (HF) patients. Methods and Results: After examination of the baPWV, as well as the levels of neurohumoral factors, the 72 enrolled HF patients were followed up for a survival study, which had a primary endpoint of re-admission because of HF. The secondary endpoint was cardiac death. Results of Cox proportional hazards modeling revealed that baPWV, systolic blood pressure (BP) and brain natriuretic peptide level were factors that affected survival (P<0.05). The patients were divided into 2 groups according to the cutoff baPWV value (1,750 cm/s). Although hemodynamic factors were similar between the groups, the high-baPWV group had a lower event-free survival rate for the primary and secondary endpoints than the low-baPWV group (P<0.05). BP at re-admission was higher in the high-baPWV group (174 ±30 mmHg) than in the low-baPWV group (121 ±33 mmHg, P<0.01). Conclusions: Elevated arterial stiffness is a risk factor for re-admission or cardiac death of HF patients. (Circ J 2009; 73: 673 - 680)
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Imaging
  • Eriko Matsunaga, Norihide Takaya, Takayuki Yokoyama, Yoshinori Akimoto ...
    2009 Volume 73 Issue 4 Pages 681-685
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 26, 2009
    JOURNAL FREE ACCESS
    Background: Recent studies have demonstrated the quantitative ability of contrast-enhanced multidetector computed tomography (MDCT) to evaluate not only the vessel lumen but also coronary plaque. The aim of this study was to assess the association between coronary wall thickness quantified by 64-slice MDCT and cardiovascular risk factors. Methods and Results: A total of 149 subjects with suspected coronary artery disease were scanned by contrast-enhanced 64-slice MDCT. The maximum coronary wall thickness of each proximal segment was measured and associations with baseline coronary risk factors were analyzed. The mean maximum wall thickness of all 149 patients was 0.7 ±0.3 mm and there was a significant positive correlation with age (P<0.001) and hemoglobin (Hb) A1c (P=0.001). Patients with hypertension (0.8 ±0.3 vs 0.7 ±0.3 mm, P=0.024) and diabetes (0.9 ±0.4 vs 0.7 ±0.3 mm, P=0.002) had thicker walls than those without. Multivariate linear regression analysis demonstrated that both risk factors were independently correlated with mean maximum wall thickness. Conclusions: Coronary wall thickness measured by 64-slice MDCT is associated with age and HbA1c, so may add useful information to cardiovascular risk stratification. (Circ J 2009; 73: 681 - 685)
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  • Shuji Nanjo, Yoshihiro Yamashiro, Shinichiro Fujimoto, Shohei Yamashin ...
    2009 Volume 73 Issue 4 Pages 686-690
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: March 05, 2009
    JOURNAL FREE ACCESS
    Background: Because increased sympathetic nervous activity (SNA) in patients with dilated cardiomyopathy (DCM) associated with sleep breathing disorder (SBD) is known to deteriorate the prognosis of cardiac failure, 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was used as the investigative tool in the present study. Methods and Results: The study group comprised 53 patients (47 men, 6 women; mean age 56 ±3 years) with chronic stable DCM. Patients were divided into SBD(+) or SBD(-) group according to 24-h pulse oximetry results. SBD(+) was defined when the 3% oxygen desaturation index was more than 15/h during sleep. In total, 32 patients were SBD(-) and 21 were SBD(+). In both groups, pulse oximetry were performed during sleep and awakening pulse rate, and measurement of the blood levels of catecholamines and B-type natriuretic peptide was performed. MIBG myocardial scintigraphy and echocardiography were performed at the same time. No significant difference was found between the 2 groups in catecholamine levels or left ventricular ejection fraction. However, MIBG had a significantly increased washout rate and a significantly decreased delayed heart to mediastinum ratio in the SBD(+) group compared with the SBD(-) group. Conclusions: SNA is increased in DCM patients when associated with SBD. MIBG myocardial scintigraphy may be a sensitive method of detecting increased SNA. (Circ J 2009; 73: 686 - 690)
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  • A Pilot Study Comparison With Conventional Post-Processing Methods and Axial Images Alone
    Masahiro Jinzaki, Kozo Sato, Yutaka Tanami, Minoru Yamada, Toshihisa A ...
    2009 Volume 73 Issue 4 Pages 691-698
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 18, 2009
    JOURNAL FREE ACCESS
    Background: The angiographic view (AGV) image is a new post-processing method that is similar to conventional coronary angiography (CAG). The purpose of this study was to evaluate its accuracy for coronary stenosis detection by 64-detector row computed tomography (CT). Methods and Results: CT evaluation results of 17 patients were compared with the results of invasive CAG on a coronary segment basis concerning the presence of stenoses >50% diameter reduction. All images of the 3 viewing methods (combination of conventional methods, AGV image alone, and axial images alone) were evaluated in consensus by 3 cardiovascular radiologists. Among 196 assessable segments, invasive CAG showed significant coronary artery stenoses in 44 segments. 43 of 44 lesions were detected with the AGV image, and absence of significant stenosis was correctly identified in 135 of 152 segments (sensitivity 98%; specificity 89%; accuracy 91%; positive predictive value 72%, negative predictive value 99%). The sensitivity of the AGV image was the same as that of conventional methods (98%). There was no significant difference in accuracy between the AGV image (91%) and conventional methods (94%). The accuracy of the AGV image was significantly higher than the axial images alone (78%). Conclusions: AGV image shows promise as a post-processing method for identifying coronary artery stenosis with high accuracy. (Circ J 2009; 73: 691 - 698)
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Ischemic Heart Disease
  • Shinya Nishizawa, Jun Shiraishi, Sayuki Torii, Kotaro Miyagawa, Masaya ...
    2009 Volume 73 Issue 4 Pages 699-704
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 18, 2009
    JOURNAL FREE ACCESS
    Background: Organic coronary artery stenosis is a significant prognostic factor in patients with coronary spastic angina (CSA), so the present study was focused on assessing the impact of intermediate fixed stenosis at sites of provoked spasm on the long-term outcomes of CSA patients. Methods and Results: CSA patients diagnosed on the basis of ergonovine-provoked spasm were enrolled and the clinical background and long-term prognosis of CSA patients with intermediate fixed stenosis at the site of provoked spasm (with-fixed-stenosis group, n=37) and those without fixed stenosis (without-fixed-stenosis group, n=126) were retrospectively compared. During the follow-up period (average 4.01 years for with-fixed-stenosis, 4.47 years for without-fixed-stenosis), the with-fixed-stenosis group had a significantly lower event-free survival rate, as well as a higher frequency of admission for unstable angina and percutaneous coronary intervention than the without-fixed-stenosis group, whereas the survival rate did not differ significantly between the 2 groups. In the multivariate analysis, intermediate fixed stenosis at the site of provoked spasm was a predictor of long-term major adverse cardiac events (MACE). Conclusions: Intermediate fixed stenosis at the site of ergonovine-provoked spasm is an independent risk factor for MACE during the long-term period in CSA patients. (Circ J 2009; 73: 699 - 704)
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  • Coronary Stenting vs Coronary Artery Bypass Grafting
    Cheng-I Cheng, Fan-Yen Lee, Jen-Ping Chang, Shu-Kai Hsueh, Yuan-Kai Hs ...
    2009 Volume 73 Issue 4 Pages 705-712
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: March 03, 2009
    JOURNAL FREE ACCESS
    Background: Although recent studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) achieves clinical outcomes comparable to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease, long-term studies are rarely performed. Methods and Results: This study reviewed outcomes in 363 patients undergoing CABG (n=216), PCI with DES (n=94) or PCI with bare-metal stent (BMS) (n=53) for ULMCA stenosis between January 2000 and March 2007. The CABG group had more patients with diabetes (50.5%) and 3- or 4-vessel disease (77.3%) than the PCI group. Kaplan-Meier survival estimates showed higher TLR-free survival and revascularization-free survival in CABG group. Although cardiac-death-free survival did not significantly differ between the 3 groups, the DES group had the highest overall survival. Age (hazard ratio (HR): 1.060; 95% confidence interval (CI): 1.017-1.104) and diffuseness score (HR: 1.157; 95%CI: 1.019-1.313) were significant independent risk factors for cardiac death. Conclusions: There was higher TLR in the PCI group with either DES or BMS, but cardiac death did not significantly differ between the 3 groups. Advanced age and diffuse coronary atherosclerosis may increase the risk of cardiac death following revascularization. (Circ J 2009; 73: 705 - 712)
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  • Yoichi Miwa, Hiroyuki Masai, Masatoshi Shimizu
    2009 Volume 73 Issue 4 Pages 713-717
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 17, 2009
    JOURNAL FREE ACCESS
    Background: The effects of the 3 classes of L-type calcium-channel blockers (CCBs) on vascular endothelial function have not been clarified in patients with coronary vasospasm. Methods and Results: Twenty-five normotensive patients (age 64.0±1.4 years) with coronary vasospasm were randomly treated for 3 months with benidipine, diltiazem, and verapamil, which belong to the dihydropyridine, benzothiazepine, and phenylalkylamine classes of CCBs, respectively. Endothelium-dependent flow-mediated dilatation (FMD), endothelium-independent nitroglycerin-induced dilatation in the brachial arteries, and plasma cyclic guanosine 3',5'-monophosphate (cGMP), a nitric-oxide-related product, were assessed before and after treatment. At baseline, the patients with vasospasm had significantly lower FMD as compared with normal subjects (n=8). Blood pressure did not differ among the 3 groups before and after treatment. Benidipine significantly increased FMD (from 4.7±0.6 to 7.4±1.1%, P<0.05) and plasma cGMP levels. In contrast, neither diltiazem nor verapamil affected FMD and cGMP levels. None of the treatments affected nitroglycerin-induced dilatation. Conclusions: Benidipine, but not diltiazem or verapamil, improves endothelial dysfunction beyond blood pressure lowering effects in patients with coronary vasospasm. Upregulation of the nitric oxide - cGMP system by benidipine may partly contribute to the improvement. The dihydropyridine class may be more beneficial for vascular endothelial function than the non-dihydropyridine classes of CCBs. (Circ J 2009; 73: 713 - 717)
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  • Atsushi Hirayama, Satoshi Saito, Yasunori Ueda, Tadateru Takayama, Jun ...
    2009 Volume 73 Issue 4 Pages 718-725
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 18, 2009
    JOURNAL FREE ACCESS
    Background: The aim of this study was to elucidate the time course of atorvastatin-induced changes in vulnerable plaque using angioscopy and intravascular ultrasound (IVUS). Methods and Results: Fifty-seven hypercholesterolemic patients with coronary artery disease (CAD) were treated with atorvastatin (10-20 mg/day) for 80 weeks and then coronary plaques were evaluated with angioscopy and IVUS. Angioscopic images were classified into 6 grades (0-5) based on yellow color intensity. A 20-mm segment containing angioscopically-identified yellow plaque was also examined by IVUS to measure atheroma volume. The mean angioscopic grade of 58 yellow plaques significantly decreased from 1.5 (95% confidence interval [CI] 1.2 to 1.8) to 1.1 (95%CI 0.9 to 1.3, P=0.012) at week 28 and 1.2 (95%CI 0.9 to 1.4, P=0.024) at week 80. Mean volume of 30 lesions, including the 58 yellow plaques, significantly reduced -8.3% (95%CI -11.5 to -5.2) at week 28 (P<0.001 for baseline vs week 28) and -17.8% (95%CI -23.9 to -11.8) at week 80 (P<0.001 for baseline vs week 80). Conclusions: In patients with CAD treated with atorvastatin, serial analysis with angioscopy demonstrated early loss of yellow color in plaques, and IVUS volumetric analysis showed subsequent plaque regression. Both changes possibly indicate reduction of plaque vulnerability in an additive manner. (Circ J 2009; 73: 718 - 725)
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  • Li-Teh Chang, Sarah Chua, Jiunn-Jye Sheu, Chiung-Jen Wu, Kuo-Ho Yeh, C ...
    2009 Volume 73 Issue 4 Pages 726-731
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 26, 2009
    JOURNAL FREE ACCESS
    Background: This study tested the hypothesis that the baseline plasma level of myeloperoxidase (MPO) independently predicts risk of patients with ST-segment elevation (ST-se) acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods and Results: Plasma MPO levels in 128 patients were examined by ELISA. They were significantly higher in AMI patients than in normal controls (P<0.0001). Patients with a high plasma MPO level (≥1,150 ng/ml) had significantly higher white blood cell counts, a higher plasma level of oxidized low-density lipoprotein, higher peak MB fraction of creatine kinase level, significantly lower left ventricular ejection fraction, and significantly higher incidence of 30-day composite major adverse clinical events (MACE) (defined as Killip score ≥3, re-infarction, repeat PCI, or 30-day mortality) than those patients with low plasma MPO level (<1,150 ng/ml) (all P<0.001). Multiple stepwise logistic regression analysis demonstrated that high plasma MPO level (≥1,150 pg/ml) was the most independent predictor of 30-day MACE (P<0.0001). Conclusions: Plasma MPO level is a major independent inflammatory predictor of 30-day MACE in ST-se AMI patients. Evaluation of the circulating MPO level might improve the prediction of unfavorable clinical outcome following AMI. (Circ J 2009; 73: 726 - 731)
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Molecular Cardiology
  • Kei Kamide, Jin Yang, Tetsutaro Matayoshi, Shin Takiuchi, Takeshi Hori ...
    2009 Volume 73 Issue 4 Pages 732-740
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 17, 2009
    JOURNAL FREE ACCESS
    Background: The response of blood pressure (BP) to L-type dihydropyridine calcium-channel blockers (dCCBs) differs among individuals. Methods and Results: A pharmacogenomic analysis was undertaken in 161 patients with essential hypertension who were treated with dCCBs to study whether genetic polymorphisms of the calcium channel α1C and α1D subunit genes, CACNA1C and CACNA1D, are associated with the antihypertensive effects of dCCBs. Responders were defined as those in whom systolic BP (SBP) was lowered by more than 20 mmHg or diastolic BP (DBP) was lowered by more than 10 mmHg after treatment with dCCBs. Eleven sequence-proven polymorphisms of CACNA1C and 5 common polymorphisms of CACNA1D chosen from a public database were subjected to genotypic analysis. The comparison of polymorphism prevalence between responders and nonresponders showed significant differences in CACNA1D rs312481G>A and rs3774426C>T, and in CACNA1C 527974G>A. There were significant differences in SBP or DBP between alleles in these single nucleotide polymorphisms (SNPs). A much more significant reduction in BP was observed for the combined presence of these SNPs. Conclusions: Three SNPs in CACNA1D or CACNA1C are genetic polymorphisms conferring sensitivity to the antihypertensive effects of L-type dCCBs in patients with hypertension. The BP reduction by L-type dCCBs might be predicted by evaluating these polymorphisms. (Circ J 2009; 73: 732 - 740)
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Myocardial Disease
  • Yu-Wen Su, Chen Liang, Hong-Fang Jin, Xiu-Ying Tang, Wei Han, Li-Jun C ...
    2009 Volume 73 Issue 4 Pages 741-749
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 27, 2009
    JOURNAL FREE ACCESS
    Background: The present study was designed to investigate if hydrogen sulfide (H2S), a novel gasotransmitter, might have a regulatory effect on cardiac function and structure, as well as oxidative stress, in adriamycin (ADR)-induced cardiomyopathy. Methods and Results: Hemodynamic measurements, histopathological examination and stereological ultrastructural analysis of mitochondria in ADR-treated rats showed characteristics of cardiomyopathy with remarkable greater size and smaller number of cardiomyocytic mitochondria and a significantly low H2S content in plasma and myocardium, but increased levels of thiobarbituric acid reactive substance (TBARs) and decreased superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in plasma and myocardium compared with controls (P<0.01). However, administration of the H2S donor, NaHS, markedly improved cardiac function, as demonstrated by elevated left ventricular developed pressure (+/-LVdp/dtmax; P<0.01) with ameliorated morphological alterations in the myocardium. Myocardial TBARs content decreased, whereas the activities of SOD and GSH-Px increased (P<0.01 and P<0.05, respectively). Conclusions: Downregulation of endogenously-generated H2S is probably involved in the pathogenesis of ADR-induced cardiomyopathy, whereby H2S reduces lipid peroxidation, increases antioxidation, and inhibits oxidative stress injury. (Circ J 2009; 73: 741 - 749)
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Vascular Medicine
  • Masayoshi Hashimoto, Yoshitomo Miyamoto, Chikao Iwai, Yasuaki Matsuda, ...
    2009 Volume 73 Issue 4 Pages 750-754
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 17, 2009
    JOURNAL FREE ACCESS
    Background: Estrogen is considered to be cardioprotective, but estrogen replacement therapy for postmenopausal women has not shown results for either primary or secondary cardiovascular event prevention. During normal pregnancy, women have significantly higher levels of estrogen and it may be endogenous estrogen that helps prevent atherosclerosis. Methods and Results: The present cross-sectional study examined the association between pregnancy followed by delivery and clinical atherosclerosis using the brachial-ankle pulse wave velocity (PWV). A total of 2,560 women undergoing annual health screening at the Institute of Hyogo Prefecture Health Promotion Association in Japan were recruited. Pregnancy history (the age of menarche/menopause and the number of gravida/para), conventional coronary risk factors, and brachial-ankle PWV were recorded. Multivariate linear regression by stepwise selection analysis demonstrated that women who had 1 or more deliveries had a significantly lower PWV, independent of age and other conventional coronary risk factors. Conclusions: Pregnancy followed by delivery may decrease arterial stiffness and prevent the progress of atherosclerosis in women. The contribution of such a pregnancy followed by delivery-related decrease in arterial stiffness to the reduction of cardiovascular disease in women should be further evaluated. (Circ J 2009; 73: 750 - 754)
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  • Eiji Oda, Ryu Kawai
    2009 Volume 73 Issue 4 Pages 755-759
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: February 17, 2009
    JOURNAL FREE ACCESS
    Background: High-sensitivity C-reactive protein (hs-CRP) is an independent risk factor of diabetes and cardiovascular disease, and is proposed as a component of metabolic syndrome (MetS). An optimal cut point of hs-CRP as a component of MetS was previously reported as 0.65 mg/L based on data from a small-sized study. Methods and Results: Medical check-up data of 1,062 men and 647 women whose plasma levels of hs-CRP were <10 mg/L were examined using a receiver-operating characteristic (ROC) curve for diagnosing MetS, which was defined by revised NCEP criteria for Japanese. An optimal cut point was defined as the point on a ROC curve nearest to the point where both sensitivity and specificity were 1. The area under the ROC curve of hs-CRP was 0.74 (95% confidence interval (CI) 0.70-0.79) in men and 0.73 (95%CI 0.66-0.79) in women. The optimal cut point of hs-CRP and its sensitivity-specificity were, respectively, 0.45 mg/L and 0.67-0.72 in men and 0.25 mg/L and 0.71-0.62 in women. Conclusions: Among Japanese patients, a tentative cut point of hs-CRP as a component of MetS may be 0.45 mg/L in men and 0.25 mg/L in women. However, standardization of the measurement of hs-CRP is required. (Circ J 2009; 73: 755 - 759)
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  • Nilda Espinola-Zavaleta, María Elena Soto-López, Elizabe ...
    2009 Volume 73 Issue 4 Pages 760-766
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: March 05, 2009
    JOURNAL FREE ACCESS
    Background: Takayasu's arteritis (TA) is an idiopathic chronic inflammatory disease that causes occlusion of large arteries, but little is known about whether affected patients are characterized by endothelial dysfunction, different high-density lipoproteins (HDL) subclasses and paraoxonase-1 (PON1) activity. Methods and Results: In the present study, 30 patients with TA, 30 age- and gender-matched volunteers (controls) and 15 patients with essential hypertension were studied. Flow-mediated vasodilation (FMD) and maximal blood flow velocity, assessed in the brachial artery by high-resolution ultrasound, were significantly lower in patients. HDL subclass distribution was determined by polyacrylamide gradient gel electrophoresis. HDL-cholesterol, HDL3b subclass and PON1 activity, assessed spectrophotometrically using phenylacetate as the substrate, were also lower in patients compared with controls. In a multiple regression analysis, the use of prednisone and systolic blood pressure were independent variables that predicted the FMD. Conclusions: A low FMD, abnormal size distribution of HDLs, and low PON1 activity are observed in TA patients. These abnormalities appear independently and constitute a cluster that may contribute to the vascular dysfunction of TA arteritis. (Circ J 2009; 73: 760 - 766)
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Rapid Communication
  • Yusuke Takagi, Satoshi Yasuda, Jun Takahashi, Morihiko Takeda, Masahar ...
    2009 Volume 73 Issue 4 Pages 767-769
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: March 03, 2009
    JOURNAL FREE ACCESS
    Background: The pathogenesis of out-of-hospital cardiac arrest (OHCA) without organic heart disease has not been fully investigated. Methods and Results: Induction tests were performed in 12 consecutive patients with OHCA for both coronary vasospasm with intracoronary acetylcholine and ventricular fibrillation (VF) with programmed stimulation at 1 month after the event. All patients were positive for 1 of the tests: coronary vasospasm alone in 3, VF alone in 2, and both in 7. All patients underwent implantable cardioverter defibrillator (ICD) implantation and appropriate ICD shock was documented in 1 patient. Conclusions: OHCA has a heterogeneous pathogenesis and so dual induction tests are necessary. (Circ J 2009; 73: 767 - 769)
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Case Reports
  • A Case Report
    Tzu-Yu Lin, Kuan-Ming Chiu, Jiann-Shing Shieh, Shu-Hsun Chu
    2009 Volume 73 Issue 4 Pages 770-771
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: December 15, 2008
    JOURNAL FREE ACCESS
    Left main (LM) coronary artery aneurysm is rare and usually found incidentally during coronary angiography. Except for rare Kawasaki disease, iatrogenic and mycotic aneurysms, atherosclerosis is the primary cause of coronary aneurysm. In most clinical scenarios, coronary artery disease is accompanied with LM coronary aneurysm. Although coronary artery aneurysm does not confer added risk in patients with coexisting obstructive coronary artery disease, LM coronary aneurysm itself remains a significant clinical concern. Thrombosis and distal embolization are the most likely reasons to cause morbidities. Aggressive surgical treatment should be considered. Here, we report a 65-year-old man presenting with effort angina. LM coronary aneurysm was noted in coronary angiogram and images including computed tomography, transesophageal echocardiography and operative photography were presented. (Circ J 2009; 73: 770 - 771)
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  • Eiji Kunita, Takashi Fujii, Youji Urabe, Syuuji Tsujiyama, Kouji Maeda ...
    2009 Volume 73 Issue 4 Pages 772-775
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: December 15, 2008
    JOURNAL FREE ACCESS
    A 61-year-old woman with hypercholesterolemia, hypertension and diabetes mellitus was referred to hospital for the evaluation of chest pain at rest. Eccentric 50% stenosis in the proximal right coronary artery was detected by 64-slice multidetector row computed tomography (MDCT). The plaque morphology was considered as soft by Color Code PlaqueTM (CCP) analysis. Seven days after MDCT, chest pain continued and transient ST-elevation was detected on the II-lead ECG monitor during echocardiography. Therefore, emergecy coronary angiography was performed and confirmed the 50% stenosis as shown on MDCT. Her disease was diagnosed as vasospastic angina. For the purpose of plaque stabilization, lipid-lowering therapy with atorvastatin was instituted and her symptoms improved. After 11 months, serum total cholesterol and LDL-cholesterol levels were reduced. A second MDCT was performed and plaque morphology had changed from soft to intermediate. Cross-sectional multiplanar reconstruction of MDCT images indicated reduction of total vessel area, expansion of the lumen area and improvement of the remodeling index at the site of stenosis. The lipid-lowering therapy contributed to plaque stabilization, and CCP analysis by noninvasive MDCT was useful for plaque characterization. This case suggests that differences between vulnerable and stable plaques can be classified using MDCT to predict acute coronary syndrome. (Circ J 2009; 73: 772 - 775)
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  • Shunya Shindo, Yoshihiro Honda, Masatake Katsu, Shigeaki Kaga, Hidenor ...
    2009 Volume 73 Issue 4 Pages 776-778
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: December 15, 2008
    JOURNAL FREE ACCESS
    Circulatory distress can occur in the long term after the formation of a traumatic arteriovenous fistula (AVF), but cardiac failure rarely occurs in a patient with an AVF in the lower extremity. The present patient underwent surgery to treat a traumatic popliteal AVF 9 years after sustaining the injury. Although the patient was asymptomatic with regard to cardiac circulation, cardiomegaly was noted and it resolved promptly after the surgical treatment. Cardiac insufficiency should be borne in mind even when a patient is asymptomatic because young patients have a high tolerance for cardiac overload. (Circ J 2009; 73: 776 - 778)
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  • Sun Hwa Lee, Won Ho Kim, Jong Bum Choi, Sang Rok Lee, Kyoung Suk Rhee, ...
    2009 Volume 73 Issue 4 Pages 779-782
    Published: 2009
    Released on J-STAGE: March 25, 2009
    Advance online publication: December 15, 2008
    JOURNAL FREE ACCESS
    Primary cardiac leiomyosarcoma is an extremely rare disease entity that is associated with very poor prognosis. We describe here a 45-year-old man who had a huge pleomorphic leiomyosarcoma in the right ventricle (RV) that presented with signs of acute pressure and volume overload and impending obstruction of both outflow and inflow tracts of the RV. The tumor was attached to the RV apex and the interventricular septum, and extended into the main pulmonary trunk just above the pulmonary valve as well as into the right atrium through the tricuspid valve. We evaluated the extent of the tumor using various imaging modalities including transthoracic and transesophageal echocardiography, magnetic resonance imaging, computed tomography, and positron emission tomography-computed tomography. Although he underwent urgent debulking surgery to relieve the obstruction, the tumor could not be resected completely because of its extensive local invasion. The tumor has shown aggressive regrowth after surgery despite adjuvant chemotherapy. (Circ J 2009; 73: 779 - 782)
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