Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 74 , Issue 7
Showing 1-41 articles out of 41 articles from the selected issue
Massage From the Editor-in-Chief
Reviews
  • Vera Regitz-Zagrosek, Sabine Oertelt-Prigione, Ute Seeland, Roland Het ...
    2010 Volume 74 Issue 7 Pages 1265-1273
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 15, 2010
    JOURNALS FREE ACCESS
    Heart failure (HF) is a leading cause of cardiovascular mortality and morbidity in the Western world. It affects men at younger age than women. Women have more frequently diastolic HF, associated with the major risk factors of diabetes and hypertension and men have more frequently systolic HF because of coronary artery disease. Under stress, male hearts develop more easily pathological hypertrophy with dilatation and poor systolic function than female hearts. Women with aortic stenosis have more concentric hypertrophy with better systolic function, less upregulation of extracellular matrix genes and better reversibility after unloading. Stressed female hearts maintain energy metabolism better than male hearts and are better protected against calcium overload. Estrogens and androgens and their receptors are present in the myocardium and lead to coordinated regulation of functionally relevant pathways. Atrial fibrillation (AF) is a more ominous sign in women than in men. Men with end-stage cardiomyopathy more frequently have auto-antibodies than women. Women receive less guideline-based diagnostics and therapy. Expensive and invasive therapies such as advanced pacemakers and transplantation are underused in women. Drug studies point at sex differences in efficacy. Despite worse diagnostics and therapy, prognosis is better in women than in men.  (Circ J 2010; 74: 1265 - 1273)
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  • Yoshitaka Iwanaga, Shunichi Miyazaki
    2010 Volume 74 Issue 7 Pages 1274-1282
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 15, 2010
    JOURNALS FREE ACCESS
    Chronic kidney disease (CKD) is frequently associated with a progressive decrease in the glomerular filtration rate, which leads to endstage renal disease (ESRD). Heart failure (HF) is a complex syndrome rather than a primary diagnosis, and considered as the endpoint of all cardiovascular disorders. It is the leading cause of death among the cardiovascular diseases in patients with CKD and ESRD. There is some interaction between the heart and kidney (the so-called "cardiorenal syndrome"), and HF patients with the complication of CKD or ESRD show a worse prognosis. Thus, early diagnosis and aggressive management of HF are needed in patients with CKD and ESRD. A number of biomarkers appear to have growing clinical importance and are reported for detection and stratification of HF. Although HF and CKD have a close interrelationship, the utility of the biomarkers has not been adequately studied with regard to the relationship with renal dysfunction. This paper reviews of the current evidence about laboratory biomarkers in patients with HF or CKD, emphasizing the emerging cardiac biomarkers (ie, BNPs and cardiac troponins), and the biomarkers of renal injury (ie, cystatin C and neutrophil gelatinase-associated lipocalin). Furthermore, it discusses the potential role of these markers in terms of heart - kidney interactions and their utility in the diagnostic and therapeutic strategies for cardiorenal syndrome.  (Circ J 2010; 74: 1274 - 1282)
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  • Masatoshi Fujita, Shigetake Sasayama
    2010 Volume 74 Issue 7 Pages 1283-1289
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 15, 2010
    JOURNALS FREE ACCESS
    There is a tremendous body of data concerning the coronary collateral circulation in both experimental animals and humans. The functional importance of a well-developed coronary collateral circulation has now been documented. The paradigm regarding the principal stimulus for coronary collateral growth has shifted from myocardial ischemia to increased shear stress at the site of pre-existing collateral arterioles. Numerous experimental and clinical studies have contributed to elucidation of the mechanisms of coronary collateral growth. Stimulation of coronary collateral growth is an alternative therapeutic approach to patients with intractable angina pectoris who are not indicated for percutaneous coronary intervention and/or coronary artery bypass grafting. Pharmacological and mechanical modulations accelerating coronary collateral growth have been challenged. Because it is conceivable that a well-developed coronary collateral circulation attenuates myocardial ischemia upon exercise, further research addressing coronary collateral growth is needed in both experimental models of myocardial ischemia and human coronary artery disease.  (Circ J 2010; 74: 1283 - 1289)
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Editorials
Original Articles
Arrhythmia/Electrophysiology
  • Takayuki Nagai, Kazuhiro Satomi, Takashi Noda, Hideo Okamura, Yuko Yam ...
    2010 Volume 74 Issue 7 Pages 1302-1307
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 18, 2010
    JOURNALS FREE ACCESS
    Background: This study evaluated the efficacy of amiodarone for avoiding inappropriate therapies by implantable cardioverter defibrillators (ICDs). Methods and Results: A total of 232 patients with structural heart disease (58±13 years; 78% males) who underwent an initial ICD implantation were retrospectively investigated to compare baseline characteristics and event rates of inappropriate ICD therapy delivery between patients with oral amiodarone therapy (amiodarone group, n=116) and those without (non-amiodarone group, n=116). During a mean follow-up of 29±21 months, inappropriate therapies occurred less frequently in the amiodarone group than in the non-amiodarone group (12% vs 27%, P=0.0068). As a cause of inappropriate ICD therapy, only atrial fibrillation (AF) significantly differed between the groups (3% vs 12%, P=0.01). The results of multivariate logistic regression analysis showed that amiodarone therapy (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.19-0.77, P=0.0073) and no history of spontaneous AF (OR 0.27, 95%CI 0.13-0.57, P=0.0007) were independent predictors of a lower risk of inappropriate ICD therapy. Conclusions: In the present group of ICD patients with structural heart disease, inappropriate therapy delivery occurred predominantly in those with spontaneous AF and/or without amiodarone.  (Circ J 2010; 74: 1302 - 1307)
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  • Alicja Dabrowska-Kugacka, Ewa Lewicka-Nowak, Piotr Rucinski, Dariusz K ...
    2010 Volume 74 Issue 7 Pages 1308-1315
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 18, 2010
    JOURNALS FREE ACCESS
    Background: It has been proposed that multisite atrial pacing (MSAp) restores atrial electrical activation and prevents atrial fibrillation recurrence; however, single-site Bachmann's bundle pacing (BBp) has also been reported as providing effective atrial resynchronization. Coronary sinus pacing (CSp) leads to reversed impulse propagation within the atria. Methods and Results: Acute echocardiographic examination was performed in 15 healthy subjects, and in 25 patients with sinus node dysfunction and recurrent atrial fibrillation during MSAp (atrial leads in the BB area and CS ostium), and single-site BBp and CSp. Regional atrial synchrony was assessed by tissue Doppler echocardiography. Pacing mode had no effect on stroke volume. CSp resulted in right atrial filling diminution, shortened mechanical atrioventricular delay in the right heart and diminished right ventricular inflow. The magnitude of reversion of the physiological right-to-left atrial contraction sequence was most prominent during CSp (15±11, 12±23, 3±21, 42±23 ms; control, MSAp, BBp, CSp respectively, P<0.0001). BBp provided the best atrial contraction synchrony, and had a comparable effect on global cardiac function to MSAp. Conclusions: Single-site BBp provides comparable hemodynamics to MSAp and is sufficient to restore atrial contraction synchrony. Single-site CSp induced echocardiographic pacemaker syndrome in the right heart.  (Circ J 2010; 74: 1308 - 1315)
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  • Ri-Bo Tang, Dong-Ling Liu, Jian-Zeng Dong, Xing-Peng Liu, De-Yong Long ...
    2010 Volume 74 Issue 7 Pages 1316-1321
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 27, 2010
    JOURNALS FREE ACCESS
    Background: It has been shown that the concentration of serum free thyroxine (FT4) is independently associated with atrial fibrillation (AF), even in euthyroid persons. This study investigated the effect of a high-normal level of FT4 on recurrence after catheter ablation of AF. Methods and Results: The 244 consecutive patients with paroxysmal AF and who underwent circumferential pulmonary vein isolation (PVI) were prospectively enrolled. Exclusion criteria included prior or current thyroid dysfunction on admission, amiodarone medication for 3 months before admission. After a mean follow-up of 416±204 (91-856) days, the recurrence rates were 14.8%, 23.0%, 33.3%, 38.7% from the lowest FT4 quartile to the highest FT4 quartile, respectively (P=0.016). After adjustment for age, sex, left atrial diameter, and PVI, there was an increased risk of recurrence in the subjects with the highest FT4 quartile compared with those with the lowest quartile (hazard ratio 3.31, 95% confidence interval 1.45-7.54, P=0.004). As a continuous variable, FT4 was also an independent predictor of recurrence (hazard ratio 1.10, 95% confidence interval 1.02-1.18, P=0.016). Conclusions: Patients with high-normal thyroid function were at an increased risk of AF recurrence after catheter ablation.  (Circ J 2010; 74: 1316 - 1321)
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  • Koji Miyamoto, Takeshi Tsuchiya, Sumito Narita, Yasutsugu Nagamoto, Ta ...
    2010 Volume 74 Issue 7 Pages 1322-1331
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 14, 2010
    JOURNALS FREE ACCESS
    Background: EnSite array (EA) provides virtual activation of ventricular tachycardia (VT) and premature ventricular contraction (PVC) on a beat-to-beat basis. Methods and Results: Fifty-five consecutive patients (age 52±16 years) with 79 VTs/PVCs undergoing EA-guided radiofrequency catheter ablation (RFA) were studied, of whom 7 patients had organic heart diseases. A virtual activation map showed that 66 VTs/PVCs originated from the right ventricle (RV), including the RV outflow tract in 57, lateral wall of RV in 4, His bundle region in 3 and tricuspid annulus in 2. Ten VTs/PVCs originated from the left ventricle (LV), including the LV endocardium in 7 and aortic sinus cusp in 3. The origins of 3 PVCs, one each in 3 patients, were not identified. Six of 38 VTs were sustained and the remaining 32 VTs were non-sustained. RFA eliminated all but 3 focal PVCs, and all macroreentrant VTs at a critical conducting pathway, which was identified by the combined use of contact voltage and virtual activation maps. There were 11±9 applications, and the radiofrequency energy and fluoroscopy time were 11,354±13,360 J and 30±21 min, respectively. All patients with acute success were free of any symptoms during a follow up of 21±11 months. Conclusions: EA-guided RFA is safe and effective for VT/PVC, irrespective of its origin, mechanism, sustainability, hemodynamic condition, and underlying heart disease.  (Circ J 2010; 74: 1322 - 1331)
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Cardiovascular Surgery
  • Hyungtae Kim, Pyo Won Park, Kiick Sung, Young-Tak Lee, Tae-Gook Jun, W ...
    2010 Volume 74 Issue 7 Pages 1332-1338
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 18, 2010
    JOURNALS FREE ACCESS
    Background: The purpose of the present study was to evaluate the mid-term results of the Cox maze III procedure (CM-III) combined with open mitral commissurotomy (OMC) for the treatment of rheumatic mitral stenosis (MS) associated with persistent atrial fibrillation (AF). Methods and Results: Cardiac rhythm was determined before and after surgery in 50 patients with MS presenting with AF who underwent OMC with modified CM-III using cryoablation between May 2001 and April 2009. At late follow up among 50 patients, 45 patients (90%) maintained sinus rhythm (SR) for 6-97 months after surgery. The maintenance rates of SR were 91.7%, 89.2%, and 89.2% at 1, 3, and 5 years after surgery, respectively. Preoperative left atrial dimension (P=0.016) and AF or junctional rhythm at discharge (P<0.001) were found to significantly influence the maintenance of SR after CM-III. Late follow-up echocardiography performed after a mean interval of 28.7 months (range, 1-85 months) showed mitral valve areas ranging from 1.20 to 2.60 cm and pressure gradients across the mitral valve ranging from 1.80 to 7.0 mmHg. There were 2 late deaths, but no early death, and no reoperation was required during the follow-up period. Conclusions: The addition of CM-III to OMC was safe and effective for selected patients. A preoperative large left atrial size was found to be significantly associated with AF treatment failure.  (Circ J 2010; 74: 1332 - 1338)
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Critical Care
  • Genji Shimpuku, Naoto Morimura, Tetsuya Sakamoto, Takaaki Isshiki, Shi ...
    2010 Volume 74 Issue 7 Pages 1339-1345
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 27, 2010
    JOURNALS FREE ACCESS
    Background: External chest compression is considered to play a significant role in cardiopulmonary resuscitation (CPR), but during a rhythm check, chest compressions must be discontinued to avoid artifacts. A new multifunctional electrocardiograph (ECG; RadarcircTM) has been developed for use in clinical settings. Methods and Results: The performance of the RadarcircTM and conventional ECG (CoECG) during CPR was compared in a single-center, non-randomized, sequential self-controlled study. CPR was performed on 41 out-of-hospital cardiac arrest patients. Cardiac rhythm with and without chest compressions during a rhythm check was measured using leads I and II. When the rhythm changed during CPR, it was measured as another waveform. Fifty ECG recordings were obtained, of which 27 were asystole, 18 pulseless electrical activity, and 5 ventricular fibrillation (VF). The area under the receiver-operating characteristic curve (AUC) for VF was 0.448 (95% confidence interval (CI) 0.274-0.622) for lead II of the CoECG, and 0.797 (95%CI 0.684-0.910) for lead II of the RadarcircTM. The AUC for VF was 0.422 (95%CI 0.219-0.626) for lead I of the CoECG, and 0.987 (95%CI 0.975-1.00) for lead I of the RadarcircTM. Conclusions: Diagnoses based on the data from RadarcircTM were more accurate in predicting rhythm during chest compressions than those based on data from the CoECG.  (Circ J 2010; 74: 1339 - 1345)
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Epidemiology
  • Naohito Tanabe, Hiroyasu Iso, Katsutoshi Okada, Yasuyuki Nakamura, Aki ...
    2010 Volume 74 Issue 7 Pages 1346-1356
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 04, 2010
    JOURNALS FREE ACCESS
    Background: Few Japanese studies have compared serum non-high-density lipoprotein (non-HDL) cholesterol with serum total cholesterol as factors for predicting risk of cardiovascular events. Currently, few tools accurately estimate the probability of developing cardiovascular events for the Japanese general population. Methods and Results: A total of 22,430 Japanese men and women (aged 40-89 years) without a history of cardiovascular events from 10 community-based cohorts were followed. In an average 7.6-year follow up, 104 individuals experienced acute myocardial infarction (AMI) and 339 experienced stroke. Compared to serum total cholesterol, serum non-HDL cholesterol was more strongly associated with risk of AMI in a dose-response manner (multivariable adjusted incidence rate ratio per 1 SD increment [95% confidence interval] =1.49 [1.24-1.79] and 1.62 [1.35-1.95], respectively). Scoring systems were constructed based on multivariable Poisson regression models for predicting a 5-year probability of developing AMI; the non-HDL cholesterol model was found to have a better predictive ability (area under the receiver operating curve [AUC] =0.825) than the total cholesterol model (AUC =0.815). Neither total nor non-HDL serum cholesterol levels were associated with any stroke subtype. Conclusions: The risk of AMI can be more reliably predicted by serum non-HDL cholesterol than serum total cholesterol. The scoring systems are useful tools to predict risk of AMI. Neither total nor non-HDL serum cholesterol can predict stroke risk in the Japanese general population.  (Circ J 2010; 74: 1346 - 1356)
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  • Sun-Ja Choi, Bhumsuk Keam, Sung-Hee Park, Hyun-Young Park
    2010 Volume 74 Issue 7 Pages 1357-1363
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 01, 2010
    JOURNALS FREE ACCESS
    Background: Waist circumference (WC) has been recommended as a screening test to identify individuals at high risk for diabetes. The aim of the present study was to identify the optimal WC cut-off to predict the development of diabetes in non-diabetic Korean subjects. Methods and Results: The Korean Genome and Epidemiology Study is a community-based prospective cohort study of 10,038 individuals over the age of 40, and biennial follow ups were conducted. In the present study 6,206 non-diabetic individuals (2,947 men and 3,259 women) participated. The incidence of diabetes was 22.1 cases/1,000 person-years for men and 17.0 cases/1,000 person-years for women. The incidence rate of diabetes was significantly increased as WC increased in both genders. The sensitivity, specificity, and the distance in the receiver operating characteristic curve indicated that the optimal WC cut-offs to predict diabetes were 85 cm for men and 80 cm for women. Conclusions: WC may serve as a simple, precise marker for individuals who are at risk of developing diabetes. The results suggest that a WC of 85 cm for men and 80 cm for women is an appropriate cut-off to predict diabetes in the Korean population.  (Circ J 2010; 74: 1357 - 1363)
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Heart Failure
  • Miyuki Tsuchihashi-Makaya, Shintaro Kinugawa, Hisashi Yokoshiki, Sanae ...
    2010 Volume 74 Issue 7 Pages 1364-1371
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 22, 2010
    JOURNALS FREE ACCESS
    Background: Previous studies demonstrated that β-blocker use at the time of hospital discharge significantly increased postdischarge treatment rates, associated with an early (60- to 90-day) survival benefit in patients with heart failure (HF). However, it is unknown whether this therapeutic approach can also improve the long-term survival. We thus examined the long-term effects of β-blocker use at discharge on outcomes in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) (ejection fraction <40%). Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) enrolled HF patients hospitalized with worsening symptoms and they were followed during an average of 2.2 years. A total of 947 patients had LVSD, among whom 624 (66%) were eligible to receive a β-blocker at discharge. After adjustment for covariate and propensity score, discharge use of β-blocker, when compared to no β-blocker use, was associated with a significant reduced risk of all-cause mortality (hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.358-0.889, P=0.014) and cardiac mortality (HR 0.489, 95%CI 0.279-0.859, P=0.013) after hospital discharge. Conclusions: Beta-blocker use at the time of discharge was associated with a long-term survival benefit in a diverse cohort of patients hospitalized with HF.  (Circ J 2010; 74: 1364 - 1371)
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  • Akiyasu Baba, Makoto Akaishi, Megumi Shimada, Toshiaki Monkawa, Yasuhi ...
    2010 Volume 74 Issue 7 Pages 1372-1378
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 22, 2010
    JOURNALS FREE ACCESS
    Background: Cardiodepressant IgG3 autoantibodies (CD-Abs) can be targeted by apheresis. Using blinded measurements of CD-Abs before and after immunoadsorption (IA), the cardiac function of patients who did or did not achieve complete CD-Abs elimination was compared. Methods and Results: Autoantibodies were completely removed from 18 patients with heart failure (New York Heart Assocation class 3 or 4, left ventricular ejection fraction (LVEF) <30%) using a selective IgG3 adsorption column. All patients had anti-β1-adrenergic and/or M2-muscarinic autoantibodies before IA, and all LVEF were measured on radionuclide ventriculography. CD-Abs were measured before and after IA, and patient status was blinded until all measurements were collected. Treatment was defined as complete when CD-Abs status changed from positive to negative after IA. Other instances were defined as incomplete. Six-min walk test results and brain natriuretic peptide levels improved significantly after IA (P<0.01). The increase in LVEF 3 months after IA was significantly greater after complete treatment in comparison to the incomplete treatment group (19±8-29±9% vs 18±9-17±8%, P<0.01). Cardiac insufficiency events were also more frequent in the incomplete treatment group. Conclusions: Complete elimination of CD-Abs with apheresis may be related to improved cardiac function in the treatment of heart failure.  (Circ J 2010; 74: 1372 - 1378)
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Hypertension and Circulatory Control
  • Norihiro Okada, Naohiko Takahashi, Kunio Yufu, Yukichi Murozono, Osamu ...
    2010 Volume 74 Issue 7 Pages 1379-1383
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: April 29, 2010
    JOURNALS FREE ACCESS
    Background: Cardiovascular autonomic neuropathy is a major complication in patients with diabetes mellitus (DM). However, the relationship between cardiovascular autonomic neuropathy and the incidence of cardiovascular events has been poorly investigated in type 2 DM. The present study aimed to assess the long-term cardiovascular predictive value of baroreflex sensitivity (BRS) in Japanese patients with type 2 DM without structural heart disease. Methods and Results: BRS was evaluated using the phenylephrine method in 210 patients with type 2 DM who did not have structural heart disease or other severe complications. BRS was considered depressed if <6 ms/mmHg. Accurate follow-up information for 3-10 years (mean 4.7 years) was obtained in 184 patients (90 females, 94 males; mean age 58±12 years). The initial onset of a major adverse cardiovascular event (MACE) was investigated. During follow-up, 19 patients presented with a MACE (4 cardiovascular deaths, 3 nonfatal myocardial infarctions, 4 coronary revascularizations, 5 strokes, 2 congestive heart failures). Cox proportional hazards regression analysis revealed that depressed BRS was independently associated with the incidence of MACE (hazard ratio 1.93, 95% confidence interval 1.09-3.82, P=0.0236). Conclusions: Depressed BRS at baseline has long-term cardiovascular predictive value in Japanese patients with type 2 DM without structural heart disease.  (Circ J 2010; 74: 1379 - 1383)
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Ischemic Heart Disease
  • Naoki Nozawa, Kiyoshi Hibi, Mitsuaki Endo, Teruyasu Sugano, Toshiaki E ...
    2010 Volume 74 Issue 7 Pages 1384-1391
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 14, 2010
    JOURNALS FREE ACCESS
    Background: Monocytes and macrophages have been shown to play major roles in the progression of atherosclerosis. This study examined whether the circulating monocyte count can be used to predict coronary plaque progression of non-culprit intermediate lesions in acute myocardial infarction (AMI). Methods and Results: Intravascular ultrasound findings of non-culprit intermediate plaque in 90 patients were analyzed in the acute phase and at a 7-month follow up. A higher peak monocyte count after AMI was associated with a greater plaque volume change (r=0.32, P=0.002). Multivariate analysis showed that a peak monocyte count of ≥800 /mm3 was an independent predictor of plaque progression (odds ratio 5.02, P=0.005). High monocyte (≥800 /mm3) at baseline had a higher monocyte count at 7-month follow up than did those with a lower count (368±109 vs 263±64 /mm3, P<0.0001). Moreover, the monocyte count at the 7-month follow up was also associated with plaque volume change (r=0.29, P=0.006). Conclusions: The results suggest that circulating monocytes play an important role in the progression of coronary plaque in AMI and that the peak monocyte count during hospitalization might be a predictor of plaque progression.  (Circ J 2010; 74: 1384 - 1391)
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  • Takumi Kimura, Tomonori Itoh, Tetsuya Fusazaki, Hiroki Matsui, Shoma S ...
    2010 Volume 74 Issue 7 Pages 1392-1398
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 18, 2010
    JOURNALS FREE ACCESS
    Background: The relationship between blood lipid profile and coronary plaque tissue characteristics, and differences in the tissue characteristics between acute coronary syndrome (ACS) and chronic coronary artery disease (CCAD) are unclear. The purpose of the present study was to compare the plaque tissue characteristics in patients with ACS and CCAD and to examine the relationship between the tissue characteristics and blood lipid profile. Methods and Results: Integrated backscatter intravascular ultrasound (IVUS) and conventional IVUS were performed in patients with ACS (n=24) and CCAD (n=68) at the time of coronary intervention. Percent tissue volume and cross-section area of lipid pool, fibrous tissue, dense fibrous and calcification were defined in target lesions. The lipid pool area (LPA) in the ACS patients was significantly higher than in the CCAD patients (LPA, 7.0±3.4 vs 5.1±3.2 mm2, P=0.01). In the CCAD group, LPA/non-LPA ratio tended to be higher in the ACS than in the CCAD patients (1.4±0.9 vs 1.1±0.8; P=0.08), and LDL/HDL ratio was an independent predictor for LPA/non-LPA ratio (P=0.002). In addition, LDL/HDL ratio was a useful index for the prediction of a high LPA/non-LPA ratio (area under the receiver operating characteristic curve = 0.79).Conclusions: Elevated LDL/HDL ratio may be a positive predictor for coronary lipid-rich plaque and plaque vulnerability in patients with CCAD.  (Circ J 2010; 74: 1392 - 1398)
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  • Noriaki Kume, Hirokazu Mitsuoka, Kazutaka Hayashida, Masaru Tanaka, To ...
    2010 Volume 74 Issue 7 Pages 1399-1404
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 14, 2010
    JOURNALS FREE ACCESS
    Background: Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is implicated in atherosclerotic plaque vulnerability. It is shed, in part, by proteases and released as soluble LOX-1 (sLOX-1), which is a specific and sensitive biomarker of acute coronary syndrome (ACS). The present study explored if sLOX-1 can also predict prognosis after ACS. Methods and Results: ACS patients undergoing emergency percutaneous coronary intervention and measurement of circulating sLOX-1 were followed (median: 896 days). Among 94 patients, 13 had ACS recurrence or died (re-ACS/death group). None of age, sex, lipid profile or prevalence of diabetes, smoking or hypertension was significantly different between the re-ACS/death group and the event-free survival group. Circulating sLOX-1 levels, but not those of high-sensitivity C-reactive protein (hs-CRP) or troponin T (TnT), were significantly (P<0.005) higher in the re-ACS/death group than in the event-free survival group. Kaplan-Meier survival curves showed that ACS patients with sLOX-1 values in the highest quartile or tertile had more frequent and earlier ACS recurrence or death. Receiver-operating characteristic curves for prediction of re-ACS or death showed higher sensitivity and specificity for sLOX-1 (area under the curve for sLOX-1, hs-CRP and TnT: 0.764, 0.658 and 0.524, respectively). Conclusions: Circulating sLOX-1, a diagnostic biomarker of ACS, also predicts ACS recurrence or death.  (Circ J 2010; 74: 1399 - 1404)
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  • Dong-Hyeon Lee, Ho-Joong Youn, Yun-Seok Choi, Chul-Soo Park, Jeong-Hwa ...
    2010 Volume 74 Issue 7 Pages 1405-1414
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 18, 2010
    JOURNALS FREE ACCESS
    Background: The aim of the present study was to analyze the parameters related to baseline coronary flow velocity (CFV) and coronary flow reserve (CFR) using Doppler transthoracic echocardiography (TTE), and to assess their associations with components of the Framingham risk score (FRS), which estimates 10-year risk of coronary heart disease, in subjects with chest pain and a normal coronary angiogram. Methods and Results: A total of 354 individuals (mean age: 55±11 years, M:F ratio =186:168) with angina or angina-like chest pain and a normal coronary arteriogram were enrolled. CFR, using TTE and adenosine or dipyridamole, was measured within 2 weeks after coronary angiogram. The clinical, electrocardiographic, echocardiographic and laboratory parameters related to baseline CVF and CFR were analyzed, and CFR was compared with FRS. There was an inverse correlation between baseline CFV and CFR (r=-0.374, P<0.001). On multivariate analysis the fulfilling of left ventricular hypertrophy criteria on electrocardiography was an independent predictor of baseline CFV for the upper 75% quartile (23.2≥cm/s; odds ratio (OR) = 2.840, 95% confidence interval (CI) =1.155-6.983, P=0.023). On multivariate analysis hemoglobin A1c level was independently related to a CFR <2.0 (OR = 2.195, 95%CI = 0.920-1.005, P=0.013). CFR had an inverse correlation with FRS (r=-0.222, P<0.001). On multiple regression analysis among the components of the FRS system (FRSS), independent factors related to a CFR <2.0 included age (OR =1.033, 95%CI =1.000-1.067, P=0.041), high-density lipoprotein-cholesterol level (OR = 0.961, 95%CI = 0.933-0.991, P=0.012) and smoking status (OR = 2.461, 95%CI =1.078-5.618, P=0.033), respectively. Conclusions: CFR can be a comprehensive indicator of cardiovascular risk factors, including parameters of the FRSS, in subjects with chest pain and a normal coronary angiogram.  (Circ J 2010; 74: 1405 - 1414)
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  • Takuya Ozawa, Ken Toba, Hiroshi Suzuki, Kiminori Kato, Yoshitaka Iso, ...
    2010 Volume 74 Issue 7 Pages 1415-1423
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 22, 2010
    JOURNALS FREE ACCESS
    Background: Erythropoietin (EPO) has been found to have anti-apoptotic and tissue protective effects on the myocardium. The aim of the present pilot study was to observe the safety and efficacy of EPO administration for patients with acute myocardial infarction (AMI). Methods and Results: Patients admitted with AMI had all undergone successful percutaneous coronary intervention (PCI). Patients were randomly assigned to 2 groups (control and EPO groups), and given 12,000 IU EPO iv or saline after PCI. The primary endpoints were the difference between the acute phase and chronic phase (6 months after the attack) regarding left ventricular function as measured on electrocardiogram-gated single-photon emission computed tomography. Thirty-six patients (control 16, EPO 20) were eligible for analysis. Left ventricular ejection fraction (LVEF) significantly increased in the EPO group (from 51.0±19.6% to 58.5±15.0%, P=0.0238), but not in the control group. Further analysis was separately undertaken in patients with occlusion in the left anterior descending artery (LAD) and others (non-LAD). LVEF was <50% in most patients in the LAD subgroup, and LVEF significantly increased in the EPO group (37.5±13.0 to 52.7±15.8, P=0.0049), but not in the control group. EPO administration did not trigger any adverse clinical events. Conclusions: EPO administration is a promising treatment for AMI.  (Circ J 2010; 74: 1415 - 1423)
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  • Hyukchan Kwon, Kiwoong Kim, Yong-Ho Lee, Jin-Mok Kim, Kwon Kyu Yu, Nam ...
    2010 Volume 74 Issue 7 Pages 1424-1430
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 27, 2010
    JOURNALS FREE ACCESS
    Background: Accurate identification of patients with acute coronary syndrome (ACS) is often difficult especially when an electrocardiogram (ECG) does not show typical elevation of ST segment. The aim of the present study was therefore to evaluate the efficacy of magnetocardiography (MCG) for diagnosis of ACS in patients with acute chest pain presenting without ST segment elevation. Methods and Results: In the present retrospective study 364 patients with the suspected ACS without ST segment elevation were selected. Significant coronary artery disease (CAD) was defined as a stenosis ≥50% in at least one of 16 segments of the 3 major coronary arteries and their branches. The MCG recordings were obtained at resting state using a 64-channel MCG system in a magnetically shielded room. The patients were classified on the basis of the probability distribution. The presence of significant CAD was identified with a sensitivity of 84.0% and a specificity of 85.0%, compared to 44.7% and 89.8% on ECG. In the subgroup of patients without specific findings on ECG or biomarker test, MCG had a sensitivity of 73.5% and a specificity of 82.3%. Conclusions: MCG was acceptably sensitive and specific in identifying patients with ACS even in the absence of specific findings on ECG and positive biomarker tests. Thus, MCG seems beneficial for the early triage of patients with acute chest pain.  (Circ J 2010; 74: 1424 - 1430)
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Myocardial Disease
  • Masaaki Shoji, Takeshi Yamashita, Tokuhisa Uejima, Kazuo Asada, Hiroak ...
    2010 Volume 74 Issue 7 Pages 1431-1435
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 27, 2010
    JOURNALS FREE ACCESS
    Background: Isolated non-compaction of ventricular myocardium (INVM) is characterized by persistent embryonic myocardial morphology without other cardiac anomalies. Congestive heart failure, critical arrhythmias, and systemic thromboemboli are known as major manifestations during childhood. Recently it was reported that there are some patients who seem apparently healthy in adult INVM. Clinical characteristics including that for electrocardiograms (ECG) of adult INVM, however, are unknown for Japanese subjects. Methods and Results: From 24,082 patients who underwent echocardiography between June 2000 and June 2007, 187 patients (0.78%, 41.3±16.8 years, 122 male) were identified as having INVM according to the criteria proposed by Oechslin et al. Although fatal ventricular arrythmias and thromboembolic events occurred in 2 patients and in 1 patient, respectively, the rest had no severe cardiac complications. Normal ECG findings were found only in 24.6% of the patients. Most of the ECG abnormalities, however, were non-specific: ST-T changes in 35.2% and bundle branch block in 14.9%. Notably, Brugada-like ECG was frequently seen in the present Japanese INVM patients (3.2%). The incidence of these ECG findings was not dependent upon the extent of non-compaction. Conclusions: The prevalence and ECG findings of adult Japanese INVM patients in a hospital-based clinical practice have been identified.  (Circ J 2010; 74: 1431 - 1435)
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Pediatric Cardiology and Adult Congenital Heart Disease
  • Mariëlle GJ Duffels, Karlijn M Mulder, Mieke D Trip, Erik de Groo ...
    2010 Volume 74 Issue 7 Pages 1436-1441
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 04, 2010
    JOURNALS FREE ACCESS
    Background: Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. Methods and Results: Atherosclerotic risk factors and carotid intima - media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age- and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81±6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55±0.1 mm vs 0.58±0.08 mm: ΔIMT =0.04 mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4±1 mmol/L vs 4.9±1 mmol/L; P=0.02), as well as lower thrombocyte levels (173±81×109 /L vs 255±54×109 /L; P<0.01), higher bilirubin levels (18.6±11 μmol/L vs 12.7±6 μmol/L; P<0.01), and lower diastolic and systolic blood pressure (71±9 mmHg vs 76±9 mmHg, P<0.01; 113±14 mmHg vs 124±12 mmHg, P<0.01, respectively). Conclusions: In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels.  (Circ J 2010; 74: 1436 - 1441)
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  • Yoichi Kawamura, Takahiro Ishiwata, Mari Takizawa, Hideyuki Ishida, Yu ...
    2010 Volume 74 Issue 7 Pages 1442-1450
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 04, 2010
    JOURNALS FREE ACCESS
    Background: It is generally accepted that Ca2+-induced Ca2+ release is not the predominant mechanism during embryonic stages. Most studies have been conducted either on primary cultures or acutely isolated cells, in which an apparent reduction of ryanodine receptor density and alterations in the cell shape have been reported. The aim of the present study was to investigate developmental changes in Ca2+ transients using whole hearts of mouse embryos and neonates. Methods and Results: Fluo-3 fluorescence signals from stimulated whole hearts were detected using a photomultiplier and stored as Ca2+ transients. The upstroke and decay of Ca2+ transients became more rapid from the late embryonic stages to the neonatal stage. After thapsigargin application (an inhibitor of the sarcoplasmic Ca2+-ATPase [SERCA]), time to 50% relaxation (T50) of Ca2+ transients was significantly prolonged. There were no significant changes in T50 after Ru360 application (an inhibitor of mitochondrial Ca2+ uniporter). The rate of increase in the amplitude of Ca2+ transients after caffeine application became larger during developmental stages. Conclusions: Ca2+ homeostasis developmentally changes from a slow rise and decay of Ca2+ transients to rapid kinetics after the mid-embryonic stage. SERCA began to contribute significantly to Ca2+ homeostasis at early embryonic stages and sarcoplasmic reticulum Ca2+ contents increased from embryonic to neonatal stages, whereas mitochondrial Ca2+ uptake did not contribute to Ca2+ transients on a beat-to-beat basis.  (Circ J 2010; 74: 1442 - 1450)
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Peripheral Vascular Disease
  • Yuichi Ishikawa, Mitsuhiro Yokoyama, Yasushi Saito, Masunori Matsuzaki ...
    2010 Volume 74 Issue 7 Pages 1451-1457
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: May 18, 2010
    JOURNALS FREE ACCESS
    Background: The JELIS trial examined the preventive effects of eicosapentaenoic acid (EPA) on coronary artery disease (CAD) in hypercholesterolemia. Previous investigators have reported that patients with peripheral artery disease (PAD) have a poor prognosis due to the potential risk for CAD. We conducted a subanalysis to examine whether the incidence of CAD was high in patients with PAD and whether EPA prevented the occurrence of CAD. Methods and Results: Of 18,645 the Japan EPA lipid intervention study (JELIS) patients, 223 had PAD (control group; complicated (n=77), newly diagnosed (n=29), EPA group; complicated (n=96), newly diagnosed (n=21)). We analyzed the incidence of major coronary events (MCE) in the 2 groups. Cox proportional hazard ratio adjusted for baseline risk factor levels was used to test differences between the 2 groups. The incidence of MCE in the control group was significantly higher in patients complicated with PAD and in those newly diagnosed with PAD than in patients without PAD (complicated: hazard ratio 1.97, P=0.039; newly diagnosed: hazard ratio 2.88, P=0.030). As for patients with PAD, the EPA group had a significantly lower MCE hazard ratio than the control group (hazard ratio 0.44, 95% confidence interval 0.19-0.97, P=0.041). Conclusions: Subanalysis of the JELIS trial demonstrated that in patients with PAD the incidence of CAD was higher than in controls, and that EPA markedly reduced the occurrence of CAD in those patients.  (Circ J 2010; 74: 1451 - 1457)
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Pulmonary Circulation
  • Bing He, Fengwen Zhang, Xueying Li, Chaoshu Tang, Guosheng Lin, Junbao ...
    2010 Volume 74 Issue 7 Pages 1458-1464
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 01, 2010
    JOURNALS FREE ACCESS
    Background: The aim of the present meta-analysis was to evaluate the efficacy and safety of treating pulmonary arterial hypertension (PAH) with inhaled iloprost, oral bosentan and sildenafil. Methods and Results: The randomized controlled trials on the 3 drugs and placebo were retrieved from the databases MEDLINE, EMBASE, BIOSIS Previews and CNKI up to August 2009. In total 11 studies and 1,391 patients were selected. Compared with placebo, iloprost, bosentan and sildenafil reduced clinical worsening significantly (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.22-0.49, P<0.00001), improved New York Heart Association/World Health Organization functional class (OR =2.81, 95%CI =1.95-4.03, P<0.00001), increased the 6-min walk test by 33.19 m, reduced systolic pulmonary arterial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance, increased the cardiac index by 0.40 L · min-1 · m-2 and increased the cardiac output by 0.53 L/min. The incidence of serious adverse events was similar in the medication groups and the placebo group (OR =1.09, 95%CI =0.69-1.71, P=0.72). In terms of the clinical worsening and functional class amelioration, insignificant differences were found among iloprost, bosentan and sildenafil, but iloprost had the highest incidence of serious adverse events among the 3 drugs. Conclusions: Inhaled iloprost and oral bosentan and sildenafil are effective and safe in treating PAH.  (Circ J 2010; 74: 74: 1458 - 1464)
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Vascular Medicine
  • In Jeong Cho, Chi Young Shim, Woo-In Yang, Sung-Ai Kim, Hyuk-Jae Chang ...
    2010 Volume 74 Issue 7 Pages 1465-1470
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: April 20, 2010
    JOURNALS FREE ACCESS
    Background: Alteration of arterial elastic properties is known to occur in patients with arteritis. Velocity vector imaging (VVI) is a new technology to assess multi-dimensional regional mechanics in terms of velocity, strain, strain rate and displacement. The aim of the present study was to investigate the mechanical properties of the common carotid artery using VVI in patients with Takayasu's arteritis (TA). Methods and Results: Vascular properties of the carotid artery were assessed in 12 patients with TA (11 female, age 38±10 years) and 12 healthy age- and sex-matched controls. Velocity, strain, strain rate and displacement were decreased significantly in TA compared with controls. Standard deviations, however, of time to peak velocity (Tv), strain (Ts), strain rate (Tsr), and displacement (Td) of multiple arterial wall segments were significantly higher in TA (P<0.0001), suggesting disturbance of symmetric arterial expansion during systole. The severity of carotid stenosis was also positively correlated with standard deviations of Tv, Ts, Tsr and Td. Conclusions: Arterial assessment using VVI may represent a new noninvasive method for quantifying vascular alteration associated with arteritis.  (Circ J 2010; 74: 1465 - 1470)
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  • Makoto Hiki, Kazunori Shimada, Takashi Kiyanagi, Kosuke Fukao, Kuniaki ...
    2010 Volume 74 Issue 7 Pages 1471-1478
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 01, 2010
    JOURNALS FREE ACCESS
    Background: Post-prandial hyperglycemia, hyperlipidemia, and endothelial dysfunction play an important role in the pathogenesis of atherosclerosis. Improvement in post-prandial hyperglycemia on α-glucosidase inhibitors (α-GIs) is associated with a risk reduction of cardiovascular diseases, but the post-prandial effects of α-GIs on endothelial function and incretin secretion in type 2 diabetic patients with coronary artery disease (CAD) remain unclear. Methods and Results: The post-prandial effects of a single administration of miglitol and voglibose on endothelial function and changing levels of glucose, insulin, lipids, glucagon-like peptide (GLP)-1, and gastric inhibitory polypeptide (GIP) were compared after a standard meal loading in 11 diabetic patients with CAD, using a placebo-controlled cross-over design. The changing levels of glucose, insulin and triglycerides at 60 min were significantly lower in the miglitol group than in the voglibose and placebo groups (all P<0.01). GLP-1 levels were significantly higher at 120 min (P<0.05) and GIP levels were significantly lower at 30 min and 60 min (P<0.05) in the miglitol group compared to other treatments. The reactive hyperemia duration at 120 min was significantly maintained in the miglitol group compared to the other groups. Conclusions: A single administration of miglitol significantly improved post-prandial glucose/lipid metabolism, incretin secretion, and endothelial dysfunction in diabetic patients with CAD, suggesting that miglitol may be a useful anti-atherogenic agent (UMIN000002264).  (Circ J 2010; 74: 1471 - 1478)
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  • Juha Ketonen, Jin Shi, Essi Martonen, Eero Mervaala
    2010 Volume 74 Issue 7 Pages 1479-1487
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 04, 2010
    JOURNALS FREE ACCESS
    Background: Biological substances derived from perivascular fat modulate vascular tone, thus alterations in periadventitial adipose tissue (PVAT) may aggravate endothelial dysfunction in obesity. Methods and Results: Male C57Bl/6 mice were fed either a high-fat diet or standard laboratory chow for 8 months. Vascular responses were studied in organ bath chambers from abdominal aortic ring preparations in the absence or presence of PVAT. The amount of PVAT as well as the cross-sectional area of adipocytes were increased in obese mice. In the presence of PVAT, obese aortas displayed impaired endothelium-dependent vasodilation whereas endothelium-independent vasodilatation was unaltered. Endothelium-dependent vasodilatation was restored after removal of PVAT and after reducing superoxide and hydrogen peroxide formation in the vascular wall by Tiron or polyethylene-glycol-catalase, respectively. PVAT from obese mice showed increased formation of hydrogen peroxide and superoxide. The PVAT-derived oxidative stress was abolished by pretreatment with the reduced nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase inhibitor, apocynin. The anti-contractile function of PVAT found in lean mice was completely abolished in obese mice, but partially restored after pretreatment with Tiron. The mRNA expressions of monocyte chemotactic protein-1, leptin and NADPH oxidase were markedly higher in the PVAT of obese than lean mice. Conclusions: PVAT promotes endothelial dysfunction in diet-induced obese C57Bl/6 mice via mechanisms that are linked to increased NADPH oxidase-derived oxidative stress and increased production of pro-inflammatory cytokines.  (Circ J 2010; 74: 1479 - 1487)
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  • Eiji Oda, Ryu Kawai
    2010 Volume 74 Issue 7 Pages 1488-1493
    Published: 2010
    Released: June 25, 2010
    [Advance publication] Released: June 01, 2010
    JOURNALS FREE ACCESS
    Background: Cutoff points for high-sensitivity C-reactive protein (hs-CRP) as a component of metabolic syndrome (MetS) in Japanese have been proposed as 0.40-0.45 mg/L for men and 0.25-0.35 mg/L for women. However, there are some concerns about the reproducibility of hs-CRP. Methods and Results: Reproducibility of hs-CRP as a component of MetS was examined using receiver-operating characteristic (ROC) curves for diagnosing MetS in 1,274 men and 673 women whose serum levels of hs-CRP were measured twice at annual health screening tests. The Spearman's correlation coefficient between baseline hs-CRP and hs-CRP at the next year's test was 0.68 in men and 0.71 in women. The area under the ROC curves of baseline hs-CRP, hs-CRP at the next year's test, and the mean of the 2 hs-CRP tests for diagnosing baseline MetS were 0.71, 0.71, and 0.72, respectively, in men and 0.75, 0.74, and 0.74, respectively, in women. Optimal cutoff points of baseline hs-CRP, hs-CRP at the next year's test, and the mean of 2 tests for diagnosing baseline MetS were all 0.40 mg/L in men and 0.35 mg/L in women. Conclusions: The serum level of hs-CRP was stable enough for use as a measure of the inflammatory component of MetS, and the optimal cutoff point of hs-CRP was 0.40 mg/L for men and 0.35 mg/L for women in a Japanese health-screening population.  (Circ J 2010; 74: 1488 - 1493)
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