Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 73 , Issue 7
Showing 1-40 articles out of 40 articles from the selected issue
Reviews
  • James M. Downey, Michael V. Cohen
    2009 Volume 73 Issue 7 Pages 1171-1177
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: June 09, 2009
    JOURNALS FREE ACCESS
    Despite thousands of publications describing agents that limit infarct size in animals, all we have available today is reperfusion therapy. In this review, we examine why these drugs have not been translated into clinical practice. Many of the first interventions tested in clinical trials were very controversial in animal trials and their actual efficacy is still in question. Interventions based on the preconditioning mechanism have been very reproducible in animals, but clinical testing of them has just begun. Only approximately 25% of reperfused patients have infarcts large enough to put them at risk of heart failure and would require additional treatment. Inclusion of the 75% of patients with small infarcts in treatment groups has greatly diluted the significance of data in past clinical trials. Size of the risk zone has emerged as a reliable way to identify the vulnerable 25%. Recent small-scale clinical trials using risk stratification algorithms have shown clear infarct size limitation using ischemic and pharmacological postconditioning, confirming that the human heart responds like hearts of animal models. Most cardioprotectants have been studied in healthy animals, but recent studies indicate that aging and diabetes, common in coronary patients, do interfere with preconditioning-based interventions in animals. Clearly more study is needed to identify which interventions are adversely affected by comorbidities. (Circ J 2009; 73: 1171-1177)
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  • Junjiro Kobayashi
    2009 Volume 73 Issue 7 Pages 1178-1183
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: June 09, 2009
    JOURNALS FREE ACCESS
    The radial artery (RA) graft was revived in late 1980 s when it was found that the graft was patent 13-18 years after coronary artery bypass grafting (CABG) after improvement of the technique in harvesting and the use of calcium-channel blockers. Recently, the RA became a reasonable alternative to the saphenous vein (SV) graft with the trend toward complete arterial revascularization and more frequent off-pump CABG to avoid aortic manipulation. To improve the quality of the RA conduit, harvesting technique and topical and systemic antispasmodic medication are important. The RA should be grafted to severe proximal stenosis (>90%) in the native coronary arteries to avoid flow competition, especially in the right coronary territory. The RA graft could be used as an aortocoronary or composite configuration with similar graft patency. Early graft patency of the RA conduit was as good as other arterial grafts, and better than SV graft in the circumflex and right coronary territories, in many studies, especially in diabetic patients. Long-term results of graft patency and cardiac-event-free survival compared with SV graft are still controversial in randomized controlled trials, probably because the incidence of flow competition and the definition of graft patency varied. (Circ J 2009; 73: 1178-1183)
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  • Tetsuji Miura, Takayuki Miki
    2009 Volume 73 Issue 7 Pages 1184-1192
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: June 09, 2009
    JOURNALS FREE ACCESS
    Glycogen synthase kinase-3β (GSK-3β) is a multifunctional Ser/Thr kinase that plays important roles in necrosis and apoptosis of cardiomyocytes. A major mechanism of cell necrosis is the opening of the mitochondrial permeability transition pore (mPTP), which consists of multiple protein subunits, including adenine nucleotide translocase (ANT). The threshold for mPTP opening is elevated by phosphorylation of GSK-3β at Ser9, which reduces activity of this kinase. How inactivation of GSK-3β suppresses mPTP opening has not been fully understood, but evidence to date suggests that preservation of hexokinase-II in the mPTP complex, inhibition of cyclophilin-D-ANT binding, inhibition of p53 and inhibition of ANT into the mitochondria are contributory. GSK-3β phosphorylation is a step to which multiple protective signaling pathways converge, and thus GSK-3β phosphorylation is crucial in cardioprotection of a variety of interventions against ischemia/reperfusion injury. Apoptosis of cardiomyocytes by pressure overload or ischemia/reperfusion is also suppressed by inactivation of GSK-3β, in which reduced phosphorylation of p53, heat shock factor-1 and myeloid cell leukemia sequence-1 and inhibition of Bax translocation might be involved. Considering predominant roles of GSK-3β in cardiomyocyte death, manipulation of this protein kinase is a promising strategy for myocardial protection in coronary artery disease and heart failure. (Circ J 2009; 73: 1184-1192)
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Editorials
Original Articles
Aortic Disease
  • Masateru Takigawa, Naoyuki Yokoyama, Tsuyoshi Yoshimuta, Satoshi Takes ...
    2009 Volume 73 Issue 7 Pages 1203-1209
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 15, 2009
    JOURNALS FREE ACCESS
    Background: According to the AHA/ACC guideline 2002, patients with abdominal aortic aneurysm (AAA) with minor or no clinical risk for perioperative cardiovascular events require no preoperative coronary assessment if they have functional capacity greater than 4 METS. Further coronary assessment is not often performed, even after the operation, because of absence of symptoms. The aim of this study was to clarify the prevalence, and prognosis of asymptomatic coronary artery disease (CAD) in such AAA patients. Methods and Results: From 2002 to 2006, 201 patients (161 men; mean age 73.1 ±7.7 years) were classified as minor or no clinical risk for perioperative cardiovascular events. Medical history, and physical, laboratory, plus imaging examinations were evaluated. Prognosis was assessed by telephone canvass. Asymptomatic CAD was found in 59 patients (29.4%). By multivariate analysis, advanced age (≥75 years: odds ratio (OR) 2.43, P=0.018) and family history of CAD (OR 5.27, P=0.001) independently predicted asymptomatic CAD. Asymptomatic CAD did not significantly affect death or cardiac events when treated appropriately. Conclusions: A high prevalence of asymptomatic CAD requiring treatment was shown in these AAA patients. Under appropriate therapies, prognosis was as well preserved as in patients without asymptomatic CAD, which underscored the importance of appropriate assessment and management of asymptomatic CAD. (Circ J 2009; 73: 1203-1209)
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Arrhythmia/Electrophysiology
  • Shinichi Niwano, Takeshi Sasaki, Sayaka Kurokawa, Michiro Kiryu, Hideh ...
    2009 Volume 73 Issue 7 Pages 1210-1218
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 13, 2009
    JOURNALS FREE ACCESS
    Background: Spectral analysis of the fibrillation waves was performed in patients with persistent atrial fibrillation (PAF) to clarify the usefulness of this method of predicting the efficacy of antiarrhythmic agents. Methods and Results: The 59 patients with PAF were randomly assigned to pilsicainide (150 mg/day) or bepridil (200 mg/day) therapy for 4 weeks under optimal anticoagulation therapy. When the first therapy did not interrupt PAF, the drugs were changed in a cross-over manner. The fibrillation cycle length (FCL) was calculated using spectral analysis of the fibrillation waves on the body-surface ECG every 2 weeks. Pilsicainide and bepridil were effective in 19 and 20 patients, respectively. The FCL at the basic state was longest in the pilsicainide-effective group, moderate in the bepridil-effective group and shortest in the failure group (P<0.05). The change in FCL with drug administration (ΔFCL) was larger in the effective than in the ineffective cases (P<0.01). Successful interruption of the atrial fibrillation (AF) with pilsicainide could be expected for patients with a FCL >148 ms (sensitivity =0.917, specificity =0.612, P=0.007) and ΔFCL >41 ms (sensitivity =0.875, specificity =0.833, P=0.001). Conclusions: The FCL reflects the electrophysiological properties of the AF substrate and is considered useful for predicting the efficacy of antiarrhythmic agents. (Circ J 2009; 73: 1210-1218)
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Cardiovascular Intervention
  • Yu Kataoka, Satoshi Yasuda, Isao Morii, Atsushi Kawamura, Shunichi Miy ...
    2009 Volume 73 Issue 7 Pages 1219-1227
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: April 28, 2009
    JOURNALS FREE ACCESS
    Background: The angiographic characteristics and prognosis in elderly women in relation to the therapeutic impact of sirolimus-eluting stents (SES) need to be clarified. Methods and Results: Quantitative coronary angiography analysis was performed in 1,374 patients with coronary artery disease: 670 patients were treated with a bare metal stent (BMS) and the remaining 704 were treated with SES. Patients were divided into 4 groups according to gender and age (<75 years M/F, ≥75 years M/F), and major adverse cardiovascular events (MACE) were compared among them. Women ≥75 years old tended to have 3-vessel disease with small vessel size and the incidence of MACE in this group was high in the BMS era. However, in the SES era, this prognosis improved by reducing all-cause death and target vessel revascularization. Conclusions: Using SES has a therapeutic advantage for the high-risk population of elderly women with angiographically unsuitable lesions for percutaneous coronary intervention. (Circ J 2009; 73: 1219-1227)
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  • Zhi Jian Wang, Yu Jie Zhou, Yu Yang Liu, Dong Mei Shi, Ying Xin Zhao, ...
    2009 Volume 73 Issue 7 Pages 1228-1234
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 15, 2009
    JOURNALS FREE ACCESS
    Background: Chronic kidney disease (CKD) is a strong predictor of mortality after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), but the relative efficacy of the 2 revascularization strategies in this context remains unknown. Methods and Results: The 1,069 patients with CKD undergoing revascularization for multivessel coronary disease were evaluated. Of them, 532 patients were treated for 2-vessel disease (97 CABG, 435 PCI) and 537 for 3-vessel disease (248 CABG, 289 PCI). CKD was defined as estimated glomerular filtration rate <60 ml/min. No differences between the PCI and CABG groups in the 2-vessel population were observed in the composite of death, myocardial infarction (MI) or cerebrovascular events (10.6% vs 8.2%, P=0.493) and repeat revascularization (6.7% vs 3.1%, P=0.181) during the 2-year follow-up. In the 3-vessel population, patients undergoing PCI showed similar rate for the composite endpoint (6.7% vs 3.1%, P=0.181), but had a higher incidence of repeat revascularization (12.5% vs 4.4%, P=0.001) compared with the CABG group. After multivariate adjustment, revascularization strategy was not an independent predictor of the composite endpoint. Conclusions: Compared with PCI with a drug-eluting stent, CABG showed a similar incidence of death, MI or cerebrovascular events in patients with multivessel disease and CKD, but was associated with decreased repeat revascularization in the 3-vessel population. (Circ J 2009; 73: 1228-1234)
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Cardiovascular Surgery
  • Soichiro Kitamura, Takeshi Nakatani, Tomoko Kato, Masanobu Yanase, Jun ...
    2009 Volume 73 Issue 7 Pages 1235-1239
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: April 28, 2009
    JOURNALS FREE ACCESS
    Background: The purpose of this study was to evaluate the hemodynamic and echocardiographic function of hearts transplanted with the modified bicaval anastomosis technique (mBCAT). Methods and Results: Twenty consecutive patients (14 males, 6 females, age range 14-61 [41.3 ±11.5 years]) were evaluated 3.4 ±2.2 years after heart transplantation using the mBCAT. All patients were in status I on the waiting list, and 18 (90%) had had a left ventricular assist device. The donor age was 39 ±12 years. Triple immunosuppressive regimen and cardiac biopsy were routinely performed. There was no hospital mortality. One death occurred 4.2 years after the operation because of bone marrow dysplasia and infection. The 8-year survival was 89% (95%confidence interval: 0.43-0.98). All the hemodynamic variables returned to the normal range. Low right atrial pressure (3.2 ±1.5 mmHg) and low pulmonary wedge pressure (6.7 ±2.1 mmHg) were associated with an excellent cardiac index (3.9 ±0.7 L · min-1 · m-2). Echocardiography revealed an excellent late peak velocity (52 ±19 cm/s) and an E/A ratio (1.4 ±0.6) of tricuspid flow. The grade (0-4) of tricuspid regurgitation averaged 1.5 ±0.8. Conclusions: Hemodynamic and echocardiographic results for mBCAT were excellent. The 8-year survival was 89% with all surviving patients in New York Heart Association class I. The mBCAT is easy to perform and further facilitates cardiac transplantation. (Circ J 2009; 73: 1235-1239)
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  • Susumu Ishikawa, Keisuke Ueda, Akio Kawasaki, Kazuo Neya, Keiko Abe, H ...
    2009 Volume 73 Issue 7 Pages 1240-1242
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 18, 2009
    JOURNALS FREE ACCESS
    Background: Mitral valve plasty for functional ischemic mitral regurgitation (MR) is still a controversial procedure. Methods and Results: The present study was a review of 23 patients who underwent an original technique known as "papillary muscle sandwich plasty" in which the mitral valve is approached via either the left atrium or left ventricle. The heads of the papillary muscles of the anterior leaflet and leaflets are plicated using Teflon-pledgeted 3-0 Ticron sutures in both the anterolateral and posteromedial commissural portions. Postoperative residual mild MR occurred in 1 patient (4%), but moderate or severe MR was not observed. In the follow-up study, prominent MR occurred in 1 patients and the MR-free rate at 2 years after surgery was 93%. Late cardiac death was significantly (P<0.05) fewer in patients without prominent MR than that in patients with MR. Conclusions: "Sandwich plasty" is an effective technique for patients requiring left ventricular plasty and may improve the prognosis of ischemic heart failure. (Circ J 2009; 73: 1240-1242)
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Epidemiology
  • Masayuki Tsuchida, Masa-aki Kawashiri, Ryota Teramoto, Mutsuko Takata, ...
    2009 Volume 73 Issue 7 Pages 1243-1247
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 13, 2009
    JOURNALS FREE ACCESS
    Background: Although acute coronary syndrome (ACS) and stroke are known to increase after earthquake, few data exist regarding the effect of earthquake on these cardiovascular events in rural areas. Methods and Results: The Noto Peninsula earthquake with a magnitude of 6.9 occurred at 9:45 a.m. on 25 March 2007. The first case of ACS occurred approximately 15 min later, whereas cerebral hemorrhage (CH) occurred 72 h after the onset of earthquake. During the 35 days after earthquake, among 49 patients who were attended by local ambulance, 5 patients with ACS (10.2%) and 8 with CH (16.3%) were documented and 4 died. The total number of both ACS and CH cases was greater than the averages for the same period of the past 3 years in this area (2.0 vs 5 and 2.3 vs 8, P<0.01). Interestingly, the most cases of ACS had occurred within 7 days after earthquake and for CH not until 35 days later. Conclusions: Even in rural areas a severe earthquake results in increased incidence of ACS and CH, which can occur at different times after the event, although the effects of other environmental factors should be further investigated. (Circ J 2009; 73: 1243-1247)
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  • Kayo Ueda, Hiroshi Nitta, Masaji Ono
    2009 Volume 73 Issue 7 Pages 1248-1254
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 08, 2009
    JOURNALS FREE ACCESS
    Background: It is thought that biological responses to air pollutants affect various heart diseases, with the magnitude of the effect dependent on the specific disease. The short-term effects of fine particulate matter (PM2.5) on mortality for heart diseases were examined in 9 Japanese cities from 2002 to 2004. Methods and Results: Mortality data obtained from the Ministry of Health, Labour and Welfare of Japan and PM2.5 data from the National Institute for Environmental Studies were used in a generalized linear model to evaluate the association between PM2.5 concentration and the mortality, adjusted for ambient temperature, relative humidity, seasonality, and day of the week. The area-specific results were combined using meta-analysis with a random-effects model. Of 67,897 deaths from heart disease, a significantly positive association was observed between heart disease mortality and PM2.5 at lag 0. In the age-stratified analyses, the effect of PM2.5 on acute myocardial infarction, and cardiac arrhythmia and conduction disorders was stronger at lag 0 for the younger population (0-64 years). The associations were not clear in mortality of the elderly. Conclusions: Positive associations between PM2.5 and heart disease mortality in Japan were observed. The effects of PM2.5 may vary by disease and age. (Circ J 2009; 73: 1248-1254)
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Heart Failure
  • Shigetake Sasayama, Tohru Izumi, Masunori Matsuzaki, Akira Matsumori, ...
    2009 Volume 73 Issue 7 Pages 1255-1262
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 18, 2009
    JOURNALS FREE ACCESS
    Background: Previously, we reported the benefit of 12 weeks of home oxygen therapy (HOT) in patients with central sleep apnea (CSA) and heart failure (HF). In the present study, we attempted to confirm the sustained efficacy of HOT in the long term treatment. Methods and Results: In the present study, 51 patients with CSA and HF (New York Heart Association (NYHA) functional classes II-III) were assigned to receive either nocturnal oxygen (HOT group n=26) or usual breathing (control group n=25) for 52 weeks. In the HOT group, greater reduction in apnea and hypopnea and greater increase in nocturnal oxygen saturation were observed. These changes were associated with greater improvement in the Specific Activity Scale (0.82 ±1.17 vs -0.11 ±0.73 Mets, P=0.009) in NYHA functional class (P=0.007) and in ejection fraction (5.45 ±11.94 vs 1.28 ±9.77%). There were no significant differences in the cardiac event rates; however, the later divergence favored the HOT group. Conclusions: The 52-week HOT was well tolerated and the benefit observed in the 12-week trial was sustained over a prolonged period of time. HOT was considered to be a valuable non-pharmacological therapeutic addition for HF patients with CSA. (Circ J 2009; 73: 1255-1262)
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Imaging
  • Shiori Amemiya, Hidemasa Takao
    2009 Volume 73 Issue 7 Pages 1263-1270
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 12, 2009
    JOURNALS FREE ACCESS
    Background: To evaluate the lifetime potential benefits and cost-effectiveness of using 64 multidetector-row computed tomography coronary angiography (CTCA) as a noninvasive imaging modality for patients at risk for coronary artery disease (CAD). Methods and Results: A decision and cost-effective analysis using a Markov model was performed to compare 4 strategies: (1) no examination, (2) routine coronary angiography (CAG), (3) CTCA, or (4) medication without CAG or CTCA in persons at risk for stable CAD. Compared with the no examination and no treatment strategies, CTCA gained 0.551 quality-adjusted life-years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$15,581 (in 2007) per QALY. Routine CAG gained 0.012 QALYs compared with the CTCA strategy, with an ICER of US$445,276 per QALY. Conclusions: Using CTCA as the first-line examination for 60-year-old men at risk for stable CAD achieved gains of QALY comparable to that of routine CAG, but at a lower cost. (Circ J 2009; 73: 1263-1270)
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Ischemic Heart Disease
  • Mizuhiro Arima, Tatsuji Kanoh, Shinya Okazaki, Yoshitaka Iwama, Shiger ...
    2009 Volume 73 Issue 7 Pages 1271-1277
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 08, 2009
    JOURNALS FREE ACCESS
    Background: Isolated ostial stenosis (IOS) of the left coronary artery is a rare disease of unknown etiology, and the long-term prognosis and angiographic characteristics of affected patients have not been fully studied. Methods and Results: The present study investigated 57 patients with stenosis of the left main trunk (LMT) who underwent coronary artery bypass grafting (CABG). They were categorized into 3 groups, based on the angiographic findings: Group I comprised 9 patients with IOS; Group II comprised 12 patients with left coronary ostial stenosis in the presence of distal vessel obstructions; Group III comprised 36 patients with stenosis of LMT excluding ostial stenosis and associated with distal vessel obstruction. The patients underwent serial angiography at 1, 5, and 10 years after CABG. Middle aged women with fewer coronary risk factors were more common in Group I compared with Groups II and III (P<0.01). The patency rate of the internal thoracic artery grafts was significantly higher in Groups II and III than in Group I (P<0.05). In Group I, the percentage stenosis of LMT lesions decreased significantly (P<0.05), but there was no difference in the other groups. Conclusions: IOS had clinical characteristics and time course distinct from those of atherosclerotic LMT disease. (Circ J 2009; 73: 1271-1277)
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  • Takuji Katayama, Takanori Yasu, Nozomi Kinoshita, Akihiro Kakehashi, N ...
    2009 Volume 73 Issue 7 Pages 1278-1282
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: April 28, 2009
    JOURNALS FREE ACCESS
    Background: A unique transient retinopathy characterized by soft exudates around the optic disc after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has been reported, so in the present study the risk factors for retinopathy associated with AMI (RAMI) were investigated. Methods and Results: The study group comprised 62 patients with their first AMI who underwent successful PCI within 24 h of onset (48 men, 14 women; age 63 ±10 years). The fundus of each eye was assessed on days 3-5, and again at 4 weeks after AMI onset. New soft exudates developed in 29 patients (47%) at 4 weeks. The frequency of diabetes mellitus (DM), and the hemoglobinA1c and peak creatine kinase concentrations were higher in patients with than in those without RAMI (55% vs 21%, P=0.008; 7.0 ±2.0% vs 5.9 ±1.4%, P=0.013; and 3,428 ±2,210 IU/L vs 2,352 ±1,652 IU/L, P=0.036, respectively). Multivariate analysis identified DM as an independent predictive factor for the occurrence of RAMI (odds ratio, 6.60; 95% confidence interval, 1.68-25.90; P=0.007). Conclusions: DM might be a risk factor for RAMI. (Circ J 2009; 73: 1278-1282)
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  • Masunori Matsuzaki, Mitsuhiro Yokoyama, Yasushi Saito, Hideki Origasa, ...
    2009 Volume 73 Issue 7 Pages 1283-1290
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 08, 2009
    JOURNALS FREE ACCESS
    Background: Results from JELIS (Japan EPA Lipid Intervention Study) demonstrated the efficacy of pure eicosapentaenoic acid (EPA) in preventing coronary artery disease (CAD) in hypercholesterolemic patients under statin treatment. The present study examined in detail whether EPA is effective for the secondary prevention of CAD. Methods and Results: Patients with established CAD and a total cholesterol level ≥250 mg/dl were observed with a mean follow-up of 4.6 years. They were randomly assigned to receive either 1,800 mg of EPA + statin (EPA group) or statin alone (control group). The incidence of major coronary events (MCE) were compared in the 2 groups. The incidence of MCE was significantly lower in the EPA group (8.7% vs 10.7%, adjusted hazard ratio =0.77, 95% confidence interval (CI) 0.63-0.96, P=0.017, number needed to treat (NNT) =49). Among 1,050 patients with prior myocardial infarction (MI), the incidence of MCE in the EPA group (15.0%) was significantly lower than that in the control group (20.1%, adjusted hazard ratio =0.73, 95%CI 0.54-0.98, P=0.033, NNT =19). Conclusions: EPA is effective for secondary prevention of CAD, especially in individuals with prior MI, and should be added to conventional treatment. (Circ J 2009; 73: 1283-1290)
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  • Manabu Kashiwagi, Atsushi Tanaka, Hironori Kitabata, Hiroto Tsujioka, ...
    2009 Volume 73 Issue 7 Pages 1291-1295
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 12, 2009
    JOURNALS FREE ACCESS
    Background: Thin-capped fibroatheroma (TCFA) is a recognized precursor lesion for acute coronary syndrome (ACS). Positive remodeling (PR) is the predominant pattern of arterial remodeling in patients with ACS. The aim of this study was to evaluate the relationship between coronary arterial remodeling, fibrous cap thickness and high-sensitivity C-reactive protein (hs-CRP) concentration in patients with ACS. Methods and Results: The 47 consecutive ACS patients were enrolled in this study. Arterial remodeling of culprit plaque was assessed by intravascular ultrasound, and fibrous cap thickness was measured by optical coherence tomography. The remodeling index (RI) was calculated as lesion divided by the reference external elastic membrane cross-sectional area, and PR was defined as RI >1.05 (PR group). TCFA were observed more frequently in the PR group than in the intermediate and negative remodeling (IR/NR) groups (59% vs 17%, P<0.01). RI was inversely correlated with fibrous cap thickness (r=0.47, P=0.02). hs-CRP levels were higher in the PR group than in the IR/NR groups (0.32 ±0.26 vs 0.18 ±0.14 mg/dl, P=0.02). Conclusions: Coronary arterial remodeling, fibrous cap thickness and hs-CRP level in patients with ACS are associated with each other. This result suggests that inflammation simultaneously contributes to both plaque growth and plaque instability. (Circ J 2009; 73: 1291-1295)
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  • John A. Linton, Heejin Kimm, Heechoul Ohrr, Il Su Park, Sun Ha Jee
    2009 Volume 73 Issue 7 Pages 1296-1301
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 15, 2009
    JOURNALS FREE ACCESS
    Background: Although many epidemiological studies have suggested that a decreased level of high-density lipoprotein-cholesterol (HDL-C) is a risk factor for heart disease; this relationship remains uncertain in relation to triglycerides (TG). This study examined the effects of serum TG and HDL-C on the incidence of ischemic heart disease (IHD) in Korean men. Methods and Results: A 14-year prospective cohort study was carried out with 29,171 Korean men who received insurance from the National Health Insurance Corporation and underwent a second screening for their cardiovascular risks. The main outcome measures were incidence of IHD. During 379,539 person-years of follow-up, 1,634 IHD (227 fatal IHD) events occurred. In the age-adjusted models, men in the lowest level of HDL-C (<30 mg/dl) showed a higher risk [hazard ratio (HR) 1.57; 95% confidence interval (CI) 1.26-1.95] when compared with men with the highest concentration (HDL-C ≥60 g/dl), defined as the reference group. When TG were included in the multivariate adjusted Cox model, the relationship of HDL-C with IHD was weakened but remained (HR 1.38; 95%CI 1.10-1.73). The results were similar for TG in the multivariate model including HDL-C. Conclusions: These findings indicate that elevated TG and reduced HDL-C are independent risk factors for IHD risk in Korean men with cardiovascular risks. (Circ J 2009; 73: 1296-1301)
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Molecular Cardiology
  • Kenneth J. Mukamal, Jennifer K. Pai, Majken K. Jensen, Eric B. Rimm
    2009 Volume 73 Issue 7 Pages 1302-1307
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 15, 2009
    JOURNALS FREE ACCESS
    Background: Previous studies of genetic variants of paraoxonase 1 (PON1) and coronary heart disease (CHD) have been conflicting and the modifying effects of lifestyle factors that affect PON1 activity are uncertain. Methods and Results: In parallel nested case-control studies, the prospective associations between PON1 polymorphisms Q192R and L55M and incident CHD were examined among participants in the Nurses' Health and Health Professionals Follow-up Studies. Women were followed for 8 years and men for 6 years, and 249 women and 266 men were documented with incident CHD. Neither polymorphism was associated with risk of CHD in either sex, and neither monounsaturated fat intake nor smoking interacted with genotype. Among women, there was a possible interaction of Q192R with alcohol intake (P interaction 0.06) and a suggestion of a similar interaction with the L55M genotype (P interaction 0.11). In analyses of both polymorphisms, alcohol intake ≥2.5 g/day was associated with lower risk among all women (odds ratio 0.45), except those with the Q192Q/L55M genotype (OR 1.33; P 3-way interaction 0.07). Conclusions: PON1 polymorphisms are not associated with the risk of CHD nor do they interact with smoking or monounsaturated fat intake. A possible gene-alcohol interaction should be considered in future studies of PON1 and CHD. (Circ J 2009; 73: 1302-1307)
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Pediatric Cardiology and Adult Congenital Heart Disease
  • Lili Dong, Feng Zhang, Xianhong Shu, Lihua Guan, Haozhu Chen
    2009 Volume 73 Issue 7 Pages 1308-1314
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: April 28, 2009
    JOURNALS FREE ACCESS
    Background: Recently, assessment of left ventricular (LV) torsional deformation has become an important approach for quantifying LV function. This study sought to evaluate LV torsion using speckle tracking imaging in patients with atrial septal defect (ASD). Methods and Results: Basal and apical LV short-axis images were analyzed in 45 asymptomatic adults with isolated secundum ASD and 45 matched normal subjects. The apical rotation parameters were similar between 2 groups; however, the peak basal clockwise rotation was significantly depressed (-5.4 ±2.8° vs -6.9 ±2.6°, P<0.001) and time to the peak was significantly delayed (118.3 ±18.8% vs 96.1 ±12.6% of systolic period, P<0.001) in patients with ASD. The peak basal initial counterclockwise rotation in the ASD group was significantly higher (5.1 ±3.3° vs 1.8 ±1.4°, P<0.001) and longer (75.4 ±26.7% vs 42.5 ±24.4% of systolic period, P<0.001) than that in the control group. LV peak twist was also reduced significantly in patients with ASD (11.9 ±5.9° vs 14.6 ±3.5°, P<0.05) in comparison with the controls. Conclusions: LV systolic twist was significantly reduced in patients with ASD mainly because of the heterogeneous basal rotation. (Circ J 2009; 73: 1308-1314)
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  • Shinichi Takatsuki, Yuka Ito, Daiji Takeuchi, Hiroshi Hoshida, Tomotak ...
    2009 Volume 73 Issue 7 Pages 1315-1318
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 13, 2009
    JOURNALS FREE ACCESS
    Background: Oxidative stress (OS) contributes to the acute phase of Kawasaki disease (KD) in a manner that is as yet unknown. In the present study OS in the acute phase of KD was investigated by measuring urinary 8-iso-prostaglandin F2α (8-iso-PG) and evaluating its correlation to the efficacy of intravenous immunoglobulin (IVIG) administration. Methods and Results: The 62 patients with acute phase of KD were enrolled, as well as 20 healthy children (HC) and 20 with acute febrile illness (FI). Urinary samples were obtained before and after administration of IVIG. The HC and FI groups also had inflammatory markers evaluated at the same time. The 8-iso-PG was significantly elevated in the 62 KD patients (719 ±335 pg/mg Cr) without IVIG administration compared with those with FI (583 ±213 pg/mg Cr) as well as HC (443 ±288 pg/mg Cr) (P<0.01). 40 patients were given 3 different regimens of IVIG: 16 received 2 g/kg for 1 day; 17 received 1 g/kg for 1 day; 7 received 400 mg · kg-1 · day-1 for 5 days. All regimens of IVIG reduced the 8-iso-PG level at 7 days after initiation. Conclusions: OS provokes vasculitis in KD, the activation of which was reduced by IVIG. The urinary level of 8-iso-PG is a useful marker of the effectiveness of IVIG in the acute phase of KD. (Circ J 2009; 73: 1315-1318)
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  • Kenji Suda, Yoshiyuki Kudo, Takashi Higaki, Yuichi Nomura, Masaru Miur ...
    2009 Volume 73 Issue 7 Pages 1319-1323
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 12, 2009
    JOURNALS FREE ACCESS
    Background: To determine the prognosis of patients with giant coronary aneurysms (GA) caused by Kawasaki disease (KD) treated with combined oral warfarin and aspirin. Methods and Results: A multicenter follow-up study of 83 patients (65 males, 18 females) with GA who had been treated for ≥3 months with warfarin. Most patients were placed on the combination therapy as soon as the GA was detected and remained on it for 6.0 ±5.3 years, giving a total of 482 patient-years. Target international normalized ratio of prothrombin time ranged from 1.5 to ≥2.5. During this observational period, 5 patients suffered from 8 episodes of acute myocardial infarction and 1 died. Coronary thrombus formation enforced 6 courses of intracoronary thrombolysis in 3 patients (1-4 times). Consequently, freedom of cardiac events was 92.5% at 1 year and 91% at 10 years and the linearized cardiac event rate was 2.9% patient-year. Hemorrhagic complications occurred on 8 occasions (1 subdural hematoma) in 5 patients, giving 1.7% patient-year. Conclusions: The combination of warfarin and aspirin has an acceptably high cardiac-event-free survival in patients with GA caused by KD, though it has a certain risk of hemorrhagic complications. (Circ J 2009; 73: 1319-1323)
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Vascular Medicine
  • Manabu Miura, Yasushi Numaguchi, Masakazu Ishii, Ryuji Kubota, Toyonar ...
    2009 Volume 73 Issue 7 Pages 1324-1329
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 08, 2009
    JOURNALS FREE ACCESS
    Background: Endothelial progenitor cells (EPCs) have been assumed to maintain vascular endothelial integrity, so the present study investigated whether the functional capacity of EPCs correlates with endothelial function in healthy young subjects, as has been confirmed in aged subjects with atherosclerotic disease. Methods and Results: EPCs in 41 healthy, young male nonsmokers (age 33.1 ±3.9 years, mean ± SD) were characterized. The correlation between flow-mediated vasodilation (FMD) and the number of EPCs or the plasma concentrations of growth factors, such as vascular endothelial growth factor, did not reach statistical significance. However, FMD was significantly correlated with the EPC differentiation index, defined as the ratio of the number of EPCs to the total number of adherent cells (r=0.391, P=0.011) and the abundance of endothelial nitric oxide synthase mRNA (r=0.340, P=0.030). Conclusions: In healthy young men, despite a lack of correlation of the number or colony counts of EPCs, the ability of circulating progenitor cells to differentiate into an endothelial lineage is closely correlated with endothelial function. This cell function assay may serve as a novel biomarker for vascular function in healthy subjects in the pre-atherosclerotic stage. (Circ J 2009; 73: 1324-1329)
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  • Jiro Esaki, Hisashi Sakaguchi, Akira Marui, Shyamal Chandra Bir, Yoshi ...
    2009 Volume 73 Issue 7 Pages 1330-1336
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 13, 2009
    JOURNALS FREE ACCESS
    Background: Although intravenous administration of prostaglandin E1 (PGE1) is commonly used in the treatment of peripheral arterial disease, it rapidly becomes inactivated in the lung. Whether local administration of sustained-release (SR) PGE1 enhances neovascularization in murine hindlimb ischemia was investigated. Methods and Results: Poly lactide-co-glycolide (PLGA) microspheres were the 4-week SR carrier of PGE1. C57BL/6 mice with unilateral hindlimb ischemia were randomly treated as follows: no treatment (Group N); single administration of 100 μg/kg PGE1 solution (Group L) into the ischemic muscles; daily systemic administration of PGE1 for 2 weeks at a total dose 100 μg/kg (Group S); and single administration of PGE1-100 μg/kg-loaded PLGA (Group P100) into the ischemic muscles. The blood perfusion in Group P100 was higher than in Groups N, L and S (ischemic/nonischemic blood perfusion ratio 88 ±11% vs 73 ±11% (P<0.01), 77 ±9% (P<0.05), 79 ±11% (P<0.05), respectively). Vascular density and αSMA-positive-vessel density in Group P100 were higher than in Groups N, L and S (vascular density (vessels/m2): 241 ±39 vs 169 ±49 (P<0.01), 169 ±54 (P<0.01), 201 ±42 (P<0.05), respectively; αSMA-positive-vessel density (vessels/m2): 34 ±10 vs 18 ±6 (P<0.01), 21 ±11 (P<0.01), 22 ±10 (P<0.01), respectively) Conclusions: Local administration of a single dose of SR PGE1 enhances neovascularization in mice hindlimb ischemia more efficiently than daily systemic administration. (Circ J 2009; 73: 1330-1336)
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  • Kana Shimada, Toshinori Murayama, Masayuki Yokode, Toru Kita, Hiroyasu ...
    2009 Volume 73 Issue 7 Pages 1337-1341
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 12, 2009
    JOURNALS FREE ACCESS
    Background: Oxidative stress may play an important role in the development of atherosclerosis. Because N-acetylcysteine (NAC) is able to reduce oxidative stress, the present study assessed the hypothesis that NAC may reduce the severity of atherosclerosis in apolipoprotein (apo) E-deficient mice. Methods and Results: Atherosclerosis was induced in apoE-deficient mice fed a high-fat diet containing 0.3% cholesterol. Mice were injected intraperitoneally with NAC (20 mg · kg-1 · day-1) 3 times per week over 8 weeks. Fatty streak plaque developed in the apoE-deficient mice, but not in mice treated with NAC. In addition, NAC reduced superoxide production in the aortic walls, as detected by ethidium staining. NAC treatment did not significantly modify the serum lipid profiles. Conclusions: In this animal model NAC may suppress atherosclerosis via reducing superoxide production. (Circ J 2009; 73: 1337-1341)
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Rapid Communication
  • Xin Chen, Xujun Chen, Kaihui Shi, Ming Xu, Liming Wang, Yingshuo Jiang
    2009 Volume 73 Issue 7 Pages 1342-1343
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: May 29, 2009
    JOURNALS FREE ACCESS
    Background: Cerebral embolization as a result of aortic manipulation has emerged as an important risk factor for the incidence of stroke after off-pump coronary artery bypass grafting (OPACB). Methods and Results: A new surgical technique for proximal anastomosis without using a side-biting clamp or any proximal anastomotic device in OPACB has been developed and successfully used for proximal anastomosis between a great saphenous vein or radial artery graft and the aorta in OPCAB of 138 patients, with good short-term results. Conclusions: This novel technique proximal anastomosis in OPACB can be completed in a safe, easy and economical fashion. (Circ J 2009; 73: 1342-1343)
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Case Reports
  • Kenki Enko, Takeshi Tada, Keiko O. Ohgo, Satoshi Nagase, Kazufumi Naka ...
    2009 Volume 73 Issue 7 Pages 1344-1348
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: December 27, 2008
    JOURNALS FREE ACCESS
    A 19-year-old man was transferred to hospital because of myocarditis with cardiogenic shock. Echocardiography showed a left ventricular ejection fraction of 23.8% and an intermediate amount of pericardial effusion. The patient immediately received an intra-aortic balloon pump and percutaneous cardiopulmonary support. Right ventricular endomyocardial biopsy was performed in the acute phase and showed extensive eosinophilic inflammatory cell infiltration, severe interstitial edema and moderate myocardial necrosis. High-dose corticosteroids were administered. Because the patient's antibody titer against Toxocara canis was high and his symptoms had appeared after eating raw deer meat, the diagnosis was fulminant eosinophilic myocarditis caused by a hypersensitivity reaction to visceral larval migrans. After starting high-dose corticosteroids, the ejectionfraction dramatically improved, the eosinophilia decreased and the patient made a full recovery. (Circ J 2009; 73: 1344-1348)
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  • Atsuhiko Yagishita, Shuzou Tanimoto, Kengo Tanabe, Akihiro Isogawa, Ma ...
    2009 Volume 73 Issue 7 Pages 1349-1351
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: December 27, 2008
    JOURNALS FREE ACCESS
    A 75-year-old man with cardiac amyloidosis was presumptively diagnosed as having cardiac syndrome X. Early clinical presentation was repeated episodes of angina pectoris without angiographically significant stenosis of the coronary arteries, so the diagnosis of cardiac syndrome X was initially given. However, his anginal symptoms worsened despite appropriate medication. He developed congestive heart failure and died 8 years after his first anginal symptoms. Autopsy revealed amyloid deposits in the intramyocardial coronary arteries with luminal obstruction, with little in the epicardial coronary arteries or myocardium. Therefore, the definitive diagnosis was cardiac amyloidosis. (Circ J 2009; 73: 1349-1351)
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  • Masataka Watanabe, Yoshifumi Takata, Shinya Fukasawa, Kunihiro Sakota, ...
    2009 Volume 73 Issue 7 Pages 1352-1355
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: December 27, 2008
    JOURNALS FREE ACCESS
    Two patients developed bepridil-induced interstitial pneumonia during treatment of arrhythmia. The first patient was a 69-year-old man who received bepridil to maintain sinus rhythm in atrial fibrillation and who developed dyspnea on the 20th day after administration. The second patient was a 72-year-old man who received bepridil for paroxysmal atrial fibrillation and who developed dyspnea on the 60th day after administration. They were diagnosed with interstitial pneumonia on the basis of physical and imaging findings. The first patient was discharged after steroid pulse therapy, and the second patient after improvement of physical and imaging findings when bepridil was discontinued. Although a limited number of cases of bepridil-induced interstitial pneumonia have been reported, the disorder should be kept in mind as an important adverse reaction when breathlessness or dyspnea develops during administration of the drug. (Circ J 2009; 73: 1352-1355)
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  • Ming-Shyan Lin, Lung-Sheng Wu, Nai-Jen Cheng, Pi-Chi Lin, Chi-Jen Chan ...
    2009 Volume 73 Issue 7 Pages 1356-1358
    Published: 2009
    Released: June 25, 2009
    [Advance publication] Released: December 27, 2008
    JOURNALS FREE ACCESS
    Percutaneous coronary intervention (PCI) is the preferred treatment modality for patients with acute coronary syndrome, but the "no-reflow" phenomenon, primarily caused by distal embolism, has hampered the effectiveness of PCI as regards reperfusion of the myocardium. Thrombus aspiration is sometimes used to reduce the incidence of distal embolism, but potentially the procedure may be complicated by upstream thrombus migration and systemic embolism. Two cases of systemic embolism during thrombus aspiration are presented. One patient had embolism of the cerebral artery and the other embolism of the left radial artery. It is suggested that a large-lumen guiding catheter with a deep-seated position and gentle injection of contrast medium should be used for thrombus aspiration. (Circ J 2009; 73: 1356-1358)
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