Implantation of a paclitaxel- or sirolimus-eluting stent (SES) may be associated with endothelial dysfunction. In the present sudy, we compared coronary endothelial function after zotarolimus-eluting stent (ZES) implantation to that after SES implantation.
Patients who had one stent implantation for a single lesion in the left anterior descending artery were enrolled. After 6 to 9 months, coronary endothelial function was assessed in patients who showed no angiographic restenosis. Endothelium-dependent vasomotion was determined after intracoronary infusion of acetylcholine. Also, endothelium-independent vasomotion was assessed after nitrate infusion. A total of 23 patients (11 in the ZES group, 12 in the SES group) were included. In distal and far distal segments, the SES group showed significant vasoconstriction by acetylcholine. However, no significant vasomotion was observed in the ZES group (SES versus ZES: -36.1% versus -3.3% for distal; P = 0.003, -34.7% versus -3.4% for far distal; P = 0.003). Endothelium-independent vasodilatation by nitrates was preserved in all subjects.
SES implantation may induce significant impairment of the endothelium-dependent vasomotor function in the distal portion of the treated vessel, while ZES implantation may not. Our results suggest that the change in coronary endothelial function after stent implantation could be different according to the type of DES.

抄録全体を表示

This study tested the feasibility and safety of next day hospital discharge after successful primary PCI for uncomplicated STEMI. Twenty-three p-PCI patients (out of 271 consecutive patients) who fulfilled the study inclusion criteria were enrolled in the pilot nonrandomized phase (transfer of patients from the coronary unit to a standard ward within 24 hours after their admission) of the study. The randomized phase of the study screened a total of 1946 consecutive STEMI patients undergoing p-PCI in the two participating centers. Only 56 (ie, 2.9% from all p-PCI) very low risk patients residing less than 20 km from the PCI center were selected. They were randomized 1:2 to either a standard hospital stay (group A, n = 19, age, 58 ± 8) or first day discharge (group B, n = 37, age, 56 ± 10; NS). There were no serious complications among 79 study patients within 30 days. The duration of hospital stay was 105 ± 45 hours (group A) and 29 ± 3 hours (P < 0.0001) in group B. Ejection fraction after 30 days was 56.8 ± 6.5% in group A versus 57.3 ± 7% in group B (NS). A patient comfort questionnaire showed a clear preference of first day discharge in all patients randomized into group B.
The results indicate that next day discharge after successful p-PCI is feasible and safe in selected uncomplicated STEMI patients.

抄録全体を表示

This study was designed to determine whether endocardial high-frequency stimulation at the pulmonary vein (PV) antrums can localize cardiac autonomic ganglionated plexi (GP) and whether ablation at these sites can evoke a vagal response and provide a long-term benefit after PV isolation (PVI) for atrial fibrillation (AF).
Radiofrequency ablation of each PV antrum was performed in 21 patients with paroxysmal AF (n = 17) or persistent (n = 4) AF. In 8 patients with paroxysmal AF, a ring electrode catheter was placed at each PV antrum. High-frequency stimulation prolonged the R-R interval in 6 of 8 patients at the left superior (LS) PV, in 3 of 8 patients at the left inferior (LI) PV, in 3 of 8 patients at the right superior (RS) PV, and in 3 of 8 patients at the right inferior (RI) PV. A decrease in sinus rate > 20% was observed in 4 of 21 patients during LS PVI, in 2 of 21 patients during RS PVI, and in 1 of 2 patients during RI PVI. Atrioventricular block or a > 5 second pause was observed in 5 of 21 patients during LS PVI. AF recurred during the follow-up period in 5 of the 16 patients (31%) who had no atrioventricular block or > 5 second pause during PVI but did not recur in 5 patients in whom atrioventricular block or a > 5 second pause developed during PVI.
GP can be identified by endocardial stimulation. The AF recurrence rate is decreased when a vagal response is achieved by radiofrequency ablation.

抄録全体を表示

White coat hypertension (WCH) is most likely a disorder associated with metabolic syndrome.
The study was performed at the Internal Medicine Polyclinic of Dumlupinar University on routine check-up patients. WCH cases who were overweight or obese and desiring weight loss were divided into two subgroups according to whether they preferred to achieve weight loss by medication or diet therapy.
The study included 324 cases (204 females) with WCH, 45 of whom were in normal weight range. Therefore, 86.1% (279) of cases with WCH were either overweight or obese, and 41.3% (134) of all WCH cases had dyslipidemia. Twenty-five cases (14.7%) stopped metformin therapy due to excessive anorexia. At the end of a 6-month period, there were highly significant differences between the two groups with respect to the prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight and obesity, and decreased fasting plasma glucose below 110 mg/dL (P < 0.001 for all).
Due to gradually increased prevalences of impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, excess body weight, and obesity-like disorders from sustained normotension towards WCH and hypertension (HT) cases, and very high prevalences of excess weight and dyslipidemia in the WCH group, WCH may be an associated disorder of metabolic syndrome rather than just being a predisposing factor of atherosclerosis or HT alone. Thus, the management of WCH should not focus solely on the regulation of blood pressure with antihypertensive medications, but rather on the prevention of future excess weight and various associated disorders, and metformin alone is an effective therapeutic option, most likely due to its powerful inhibitory effect on appetite.

抄録全体を表示

Although it has been reported that angiotensin II receptor blockers inhibited the formation and accumulation of advanced glycation endproducts (AGEs) in vitro and in vivo, whether they can do so clinically is not clear. We investigated the effects of 12-month valsartan therapy on various markers of inflammation, glycation, and oxidation in type 2 diabetic subjects with hypertension.
We started 40 mg/day valsartan treatment in 15 type 2 diabetic patients with hypertension. In 6 patients, the dose of valsartan was increased to 80 mg/day after 6 months and maintained until 12 months. Metabolic parameters including BMI and serum high molecular weight (HMW)-adiponectin, high-sensitivity C-reactive protein (hs-CRP) as an inflammation marker, AGEs, paraoxonase activity, platelet-activating factor (PAF)- acetylhydrolase activity, and urine 8-isoprostane levels were measured at baseline and after 6 and 12 months of treatment. Urine microalbumin level and carotid artery intima-media thickness (IMT) were also measured.
Even after valsartan therapy, the blood pressure levels of the patients were not decreased significantly. Serum AGEs and urine 8-isoprostane levels decreased at both 6 and 12 months (P < 0.05 for both), although other metabolic and oxidative markers were unchanged. Though urine microalbumin levels tended to be decreased after 6 and 12 months of valsartan treatment, the changes were not significant. Mean IMT at 12 months was not changed from the baseline value. In conclusion, the findings suggest that treatment with valsartan, even at a low dose, may ameliorate some glycation and oxidative stress markers independently of an effect on blood pressure in hypertensive type 2 diabetic subjects.

抄録全体を表示

The aim of the present prospective, single centre observational study was to describe the profile and prognosis of patients hospitalised with chronic heart failure and to determine the value of discharge blood pressure and cholesterol for long-term survival.
From among 2,346 hospitalised patients, 320 (13.6%) suffered from chronic heart failure and 28 (8.8%) died during hospitalisation. The in-patient mortality rate was similar to that in patients not suffering from chronic heart failure (P = 0, 3). Of 292 patients who were discharged, 162 (55%) died during the subsequent 5 years. The predetermined parameters of pure prognosis were associated with lower diastolic blood pressure (P = 0.008) and lower cholesterol (P = 0.012). A poor prognosis was associated with lower systolic blood pressure plus lower cholesterol and lower diastolic blood pressure and lower cholesterol. Other independent prognostic parameters were older age (P < 0.001), higher heart rate (P = 0.02), higher creatinine (P < 0.001), higher urea (P < 0.001), higher uric acid (P < 0.001), lower hemoglobin (P = 0.02), lower ejection fraction (P = 0.080), and a history of ischemic heart disease (P < 0.01).
Patients suffering from chronic heart failure and discharged home have a worse prognosis if their systolic and/or diastolic blood pressures and/or cholesterol levels are too low. The optimal values seem to be levels that are around the recommended targets, that is a systolic BP of 140 mmHg, diastolic BP of 90 mmHg, and a cholesterol level of 5 mmol/L.

抄録全体を表示

Recently orthostatic training has been proposed as an effective treatment for vasovagal syncope, even though some patients may relapse. This study was undertaken to assess the effect of orthostatic training on patients with vasovagal syncope and its influencing factors.
The study group comprised 125 consecutive patients (51 males and 74 females), aged 40 ± 19 years, with a history of syncope and a positive head-up tilt test. They were randomized into an orthostatic training group (64 patients) and a no treatment group (controls, 61 patients). The training programme consisted of daily 30-minute sessions of upright standing against a vertical wall 6 days a week for at least 4 weeks.
After one year of follow-up, 45 (72.6%) of 62 orthostatic trained patients reported no syncopal recurrence, while only 22 of 61 controls (36.1%, P < 0.05) reported the same. Furthermore, in the training group, the patients with recurrence were older, and the number of syncopal spells in the preceding year was less than in the patients with no recurrence in the same group.
Orthostatic training is an effective therapy for the prevention of vasovagal syncope. This kind of therapy was of greater benefit to patients who were younger or experienced frequent spells of syncope.

抄録全体を表示

We studied the clinical courses of patients with deep vein thrombus (DVT) who underwent insertion of temporary inferior vena cava filters (tIVCF) and evaluated the effectiveness of the tIVCF.
From January 2003 to March 2008, tIVCF were placed in 12 patients with a diagnosis of DVT in the Intensive Care Unit (ICU) of Gunma University Hospital. The mean age of the patients was 52 ± 16 years (range, 18-82). Eight were medical patients who had not undergone any prior surgery, and 4 were postoperative patients, including 3 with a malignancy. The diagnosis of DVT was made using enhanced computed tomography. The Toray Neuhaus Protect catheter (6Fr, Toray Medical, Tokyo) was used as a tIVCF in all 12 patients. We evaluated the clinical course of the patients before and after placement of a tIVCF and studied their prognosis.
DVT occurred on 15 ± 9 days after surgery or admission to hospital. Pulmonary thromboembolism (PTE) was detected in 7 patients prior to the placement of a tIVCF, 3 of whom required cardiopulmonary resuscitation. The mean duration of tIVCF placement was 18 ± 9 days; no episodes of PTE occurred after tIVCF placement. DVT completely or almost completely disappeared during the period of tIVCF placement; subsequently, tIVCFs were successfully removed in 10 patients (83%). A permanent IVCF was placed in only 1 patient, and the tIVCF was removed in the remaining patient because of suspected catheter infection. There were 2 complications related to tIVCF placement: infection at the insertion site and suspected catheter infection.
tIVCF placement could prevent the occurrence of PTE without provoking life-threatening complications. The results suggest that tIVCF is useful in the prevention of PTE in patients with DVT.

抄録全体を表示

Cilnidipine is a dihydropyridine calcium channel blocker that acts on both L-type and N-type calcium channels.
The effects of cilnidipine given intravenously at doses of 2.5, 5.0, and 10 μg/kg were studied using an ex vivo hydronephrosis model in spontaneously hypertensive rats. The effects of nifedipine at a dose of 10 μg/kg were also studied using the same model as a reference.
Cilnidipine caused dose-dependent blood pressure reduction and dilatation of the glomerular afferent arterioles; the arteriolar diameter after cilnidipine infusion at 2.5, 5.0, and 10 μg/kg was 101% ± 3%, 112% ± 4%, and 123% ± 6% relative to baseline, respectively. With cilnidipine, dilatation of the efferent arterioles was also observed; it was maximal after 5 to 10 minutes. Five minutes after administration of 2.5, 5.0, and 10 μg/kg of cilnidipine, the efferent arteriolar diameter was 103% ± 2%, 109% ± 4%, and 119% ± 4% of baseline, respectively. This efferent arteriolar dilating action of cilnidipine was abolished after pretreatment with ω-conotoxin, a selective N-type calcium channel blocker. A dose-dependent increase of glomerular blood flow volume was also observed after cilnidipine infusion. Nifedipine, an L-type calcium channel blocker, at a dose of 10 μg/kg reduced systolic blood pressure to a similar extent as cilnidipine at a dose of 10 μg/kg, but only dilated the afferent arterioles and had no significant effect on efferent arterioles.
Cilnidipine dilated both the afferent and efferent glomerular arterioles. The efferent arteriolar dilating effect of cilnidipine may be attributed to its inhibition of the N-type calcium channel.

抄録全体を表示

A 44-year-old man who had suffered multiple episodes of syncope presented with ventricular fibrillation (VF). Structural heart disease was ruled out. Programmed stimulation induced VF at the right ventricular apex (RVA) but not at the outflow tract (RVOT). Monophasic action potential duration (MAPD) at a basic cycle length of 400 msec was shorter at the RVA than at the RVOT (208 versus 231 ms). The maximum slope of the MAPD restitution curve at the 400-msec cycle length was much steeper at the RVA than at the RVOT (1.4 versus 1.0). Such spatial heterogeneity of the MAPD and of its restitution may facilitate wavebreak and functional reentry, predisposing to VF.

抄録全体を表示