The role of plasma levels of oxidized low density lipoprotein (OxLDL) in the development of coronary heart disease (CHD) has not been fully elucidated. We examined the relationship among plasma levels of OxLDL, measured by an enzyme immunoassay using an antibody against OxLDL (FOH1a/DLH3) and apolipoprotein B, CHD, and modalities at the onset of acute coronary syndrome (ACS). A total of 115 individuals who underwent coronary angiography were studied. Of these, 21 patients complicated with extracoronary cardiovascular diseases were excluded. Consequently, 94 patients (63 men) (ACS: 23, stable angina pectoris (SAP): 46, and normal coronary artery (NCA):25) were eligible for inclusion in the study.
Elevated plasma levels of OxLDL were associated with CHD, especially with ACS. In patients with NCA, hypertension was associated with plasma OxLDL. Plasma levels of OxLDL were significantly higher in patients with new-onset type ACS than in those with worsening type ACS (2.98 versus 1.53 mg/dL, P = 0.002). In conclusion, plasma levels of OxLDL are associated with CHD and significantly higher in patients with new-onset ACS. The findings of the present study suggest that plasma OxLDL can be a marker of the development of CHD and modalities of ACS.

View full abstract

The relation between conduction disturbances and coronary pathology is often uncertain. The aim of this study was to examine the location of coronary lesions in patients who have an indication for a permanent pacemaker.
Between 2001 and 2006, 203 consecutive patients (121 men (59%), mean age, 65 ± 10) who had severe conduction disturbance underwent coronary angiography before pacemaker implantation. Third degree AV block was present in 172 (84%), sick sinus syndrome in 21 (11%), and Mobitz II, second degree AV block in 10 (5%). The coronary angiographic study included stenosis severity and classification of pathological anatomy. Sixty-two age-matched subjects with coronary artery lesions > 50% but without conduction disturbance made up the control group. The locations of coronary lesions were classified as follows: Type I: Lesions not related to septal branches or AV node (AVN) artery; Type II: Lesions involving the septal perforators of LAD but not RCA; Type III: Lesions compromising blood supply to SAN or AVN (No LAD septal involvement); and Type IV: Combination of Type II and Type III.
Of 203 patients, insignificant coronary pathology was found in 141 (70%- group X). Sixty-two patients (30%) had coronary stenoses > 50% (group I) and Type II coronary anatomy was the most prevalent (n = 24, 38.7%), followed by Type IV (n = 22, 35%). Type III was found in 10 (16%) and Type I in 6 (9.6%). This distribution of CAD was significantly different from the control group in whom the most prevalent lesion locations were Type III and I (39% and 31%, respectively) (P < 0.05).
Patients with severe conduction disturbances tend to have a specific coronary lesion distribution that involves either proximal LAD branches or a combination of this with significant RCA disease, compromising supply to sinoatrial or AV nodes.

View full abstract

It is still unclear whether the presence of dementia has a negative effect on survival in elderly patients with acute myocardial infarction (AMI). Therefore, using data from the Tokai Acute Myocardial Infarction Study II (TAMIS-II), we set out to clarify the differences in in-hospital and long-term mortality between AMI patients with and without dementia. The study was a prospective study of all consecutive patients admitted to 15 acute care hospitals in the Tokai region with a diagnosis of AMI between 2001 and 2003. A total of 1837 patients (62 with dementia and 1775 without dementia) with AMI, aged 65 and over, were included in the present analysis. Patients with dementia were in general older, female, and impaired in their daily activities. They were also more likely to have a history of myocardial infarction, heart failure, cerebrovascular disease, and less likely to have a history of angina or smoking. They were less likely to have chest pain on arrival and lateral myocardial infarction. The percentage of patients with dementia who were transferred to an intensive care unit/coronary care unit or who were given percutaneous coronary intervention was lower. At discharge, the percentage of patients with dementia treated with aspirin was lower, and that of patients with dementia treated with diuretics was higher. In-hospital death rates for patients with and without dementia were 17.7% and 11.1% during hospitalization, respectively (P = 0.101). Long-term mortality after AMI was higher among patients with dementia before adjustment (24.2% versus 14.6%, P = 0.004). However, we were unable to detect differences after adjustment for potential confounders. Thus, our findings suggest that dementia has minimal effects on long-term mortality in patients with AMI.

View full abstract

Direct stenting without predilatation is a well-defined, feasible method with bare metal stents. Direct stenting has also been shown to be safe and feasible with drug-eluting stents, however, there is much less evidence with this type of device when compared with bare metal stents.
Three hundred and sixty-four coronary lesions in 257 consecutive patients (mean age, 57.4 ± 9.8 years; 63 women) who had undergone elective stenting either with or without predilatation via a paclitaxel-eluting stent between March 2003 and March 2006 were retrospectively analyzed. Quantitative coronary angiography analysis was compared between the two groups of procedures; stenting with predilatation and direct stenting.
All procedures were uneventful. No deaths occurred during the follow-up period. Direct stenting when compared with the predilatation technique, significantly decreased both procedure time (32.1 ± 17.9 minute versus 41.2 ± 18.6 minute, P < 0.0001) and fluoroscopy time (10.6 ± 7.8 minute versus 15.5 ± 7.6 minute, P < 0.0001). There was no difference in quantitative analysis parameters of coronary angiography during follow-up or the rates of stent thrombosis and restenosis.
Direct stenting seems to be as feasible and safe as conventional predilatation and stenting in selected cases. Direct stenting seems to decrease procedural time and radiation exposure without any negative effect on quantitative analysis parameters of coronary angiography with approximately a one-year follow-up period.

View full abstract

During implantable cardioverter-defibrillator (ICD) implantation, ventricular defibrillation testing (DFT) is considered a standard procedure. This procedure often requires multiple ventricular fibrillation (VF) inductions. These repeated short episodes of circulatory arrest with global cerebral ischemia may cause neurological damage. In the present study, patients undergoing initial ICD implantation and limited induction of VF for defibrillation safety margin testing were evaluated for pre- and postoperative cognitive and neurologic functions. In addition, the serum neuron specific enolase (NSE) level, which is a biochemical marker of cerebral injury, was evaluated.
The study was performed on 16 patients undergoing initial elective transvenous insertion of an ICD. A neurologic examination and cognitive assessment tests were performed 24 to 48 hours before and after ICD. NSE was determined before (NSE 1) and at the end of the surgery (NSE 2), as well as 2 hours (NSE 3), 24 hours (NSE 4), and 48 hours (NSE 5) after implantation.
A total of 29 internal shocks (average, 1.8 ± 0.4) with energy ranging from 14 to 41 J (mean, 20 ± 5; median, 20 J ) were delivered in the ICD group patients. In one patient, 3 external (50, 200 and 360 J) shocks were required for fast VT induced during ICD lead positioning. The mean duration of VF was 10 ± 4 seconds and the mean cumulative time in VF was 16 ± 5 seconds. The mean recovery time between VFs was 5.3 ± 0.6 minutes. NSE levels were not different from the baseline at any time point in the patients of the group that completed the 48-hour observation period (P > 0.05). The patients did not report any new neurological symptoms after ICD implantation, and repeat examination after the procedure showed no abnormal findings other than those detected in the previous one. There were no statistically significant differences between the preoperative and postoperative scores obtained in the cognitive assessment.
Single or two VF inductions and the brief arrest of cerebral circulation during ICD implantation are not associated with permanent neurological injury. However, further studies are needed to confirm this finding.

View full abstract

Mitral repair is feasible for patients with degenerative or ischemic heart disease, however, the appropriateness of repair for rheumatic heart disease remains controversial. We compared our outcomes for primary isolated mitral repair versus replacement in an elderly population. From November 1997 to July 2005, mitral repair (group I) was performed in 33 patients while 59 underwent replacement (group II). Survival and risk factors were evaluated by Kaplan-Meier and Cox regression analysis. Mean age at operation for groups I and II was 49.7 ± 13.2 versus 58.1 ± 11.2 (P = 0.002). No statistically significant differences with regards to demographic parameters were observed except for there being fewer percutaneous transvenous mitral commissurotomy procedures and a lower severity of pulmonary hypertension in group I. Patients with a greater Wilkins score and more valvular calcification underwent replacement more often (P < 0.001). In-hospital mortality, ICU/hospital stay, and postoperative congestive heart failure functional class did not differ significantly. Major adverse cardiac events occurred in 13 and 19 patients, respectively (P = 0.50). There were 4 versus 6 late deaths (P = 0.74). Only two from group I underwent subsequent mitral reoperation. Kaplan-Meier overall survival and event-free survival at 5 years for groups I and II were 0.81 ± 0.08 versus 0.81 ± 0.06 (P = 0.90) and 0.52 ± 0.10 versus 0.51 ± 0.10 (P = 0.21), respectively. Old age, renal insufficiency, LVEF < 40%, and a history of stroke were poor predictors of patient survival. Compared with replacement, mitral repair for rheumatic heart disease was associated with a lower surgical mortality, higher repeat-surgery rate, and good survival. Rheumatic mitral valves should be repaired in select patients with appropriate valvular pathology.

View full abstract

Plasma brain natriuretic peptide (BNP) is widely used as a biomarker of heart failure (HF); however, its concentration is often found to be high even in apparently healthy subjects and little is known about which factors contribute to physiological change in plasma BNP concentration in subjects without HF. We examined the effects of gender, age, and anemia on plasma BNP concentration in apparently healthy subjects. The study population consisted of 1036 healthy subjects who underwent an annual health examination at their company in 2005. There were 874 women, ranging in age from 30 to 63 years (mean, 41 years). Plasma BNP concentration was abnormal (> 18.4 pg/mL) in 292 subjects. The incidence was significantly higher in women than in men (31% versus 14%, P < 0.01). Mean plasma BNP concentration was higher in women than in men. The difference in plasma BNP concentration was associated with the difference in blood hemoglobin and age. Logarithmically transformed BNP concentration correlated inversely with blood hemoglobin (r = -0.30, P < 0.01 for all; r = -0.21, P < 0.01 for women; r = -0.20, P < 0.01 for men). By multiple regression analysis, logarithmically transformed BNP concentration correlated with hemoglobin, age, and gender. In conclusion, anemia is likely a critical determinant that elevates plasma BNP concentration in apparently healthy subjects.

View full abstract

The aim of the present study was to determine if prednisone, a glucocorticoid, added to conventional treatment for patients with decompensated congestive heart failure (DCHF) refractory to the conventional care, results in significant relief of congestive symptoms and improvement of clinical status.
Diuretic-based strategies, as the mainstay in DCHF management, are not always effective in eliciting diuresis. However, the addition of prednisone to standard care may induce potent diuresis in this clinical setting.
Thirty-five patients with DCHF were enrolled in the study, and prednisone (1 mg/kg/day with maximum dosage of 60 mg/day) was added to the standard treatment. Primary endpoints were the effects on daily urine volume, patient and physician assessed dyspnea and global clinical status, and changes in renal function.
The addition of prednisone induced potent diuresis with time. As a result of the diuresis, congestive symptoms improved markedly in 80% and global clinical status improved markedly in 68.6% of the DCHF patients at the end of the study (P < 0.001). The change in serum creatinine from baseline was -12.21 μmol/L (P < 0.05).
Adding prednisone to conventional care in the patients with refractory DCHF induced potent diuresis accompanied by a dramatic relief of congestive symptoms and improvements in clinical status and renal function.

View full abstract

Primary cultured rat aortic vascular smooth muscle cells (VSMCs) were exposed to different intensities of low-frequency electromagnetic fields (LFEMFs) at 20, 40, and 60 mT for different time periods (10, 20, and 30 minutes). Furthermore, osteopontin (OPN) mRNA and protein expressions were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting, respectively. Matrix metalloproteinase-2 (MMP-2) activity was measured using gelatin zymography. The results showed that the OPN mRNA and protein expressions and MMP-2 activity of VSMCs were inhibited by exposure to LFEMFs of different intensities in a dose-dependent manner (P < 0.05) but not in a time-dependent manner. In conclusion, exposure to LFEMFs of appropriate intensity for a suitable time period can result in the inhibition of the OPN expression and MMP-2 activity of VSMCs, indicating the potential prophylactic and therapeutic effects of LFEMFs on restenosis (RS) following percutaneous coronary intervention (PCI).

View full abstract

We compared the effects of losartan and carvedilol on preserving left ventricular (LV) function in an experimental model of dilated cardiomyopathy (DCM) and examined the mechanisms of their pharmacological effects. The rats were divided into group 1 (normal control), group 2 (DCM), group 3 (DCM plus carvedilol 8 mg/kg/day bid orally), and group 4 (DCM plus losartan 20 mg/kg/day orally). All rats were sacrificed on day 90 following DCM induction. The results indicated that connexin43 protein expression and mRNA expressions of peroxisome proliferator-activated receptor-γ coactivator-1α, endo-thelial nitric oxide synthase, and interleukin-10 were significantly lower, whereas mRNA expressions of endothelin-1 and matrix metalloproteinase-9 were significantly higher in group 2 than in groups 1, 3, and 4 in LV myocardium (all P < 0.05). Additionally, cytochrome C levels in LV myocardium and LV contractility were significantly lower, whereas fibrosis area, cellular apoptosis, and mitochondrial oxidative response of LV myocardium were significantly higher in group 2 than in groups 1, 3, and 4 (all P < 0.005). In conclusion, losartan is comparable to carvedilol in attenuating inflammation, oxidative response, myocardial fibrosis and apoptosis, as well as in preserving energy transcription factors and LV function in DCM.

View full abstract

Stent deployment during coronary intervention has become more and more common recently. Inappropriate stent deployment may lead to unexpected high mortality and morbidity rates. A 62 year-old man with unstable angina presented with a bifurcation lesion after diagnostic coronary angiography. A drug-eluting stent was successfully deployed across the bifurcation lesion. However, after wire exchange and rewiring followed by high pressure balloon postdilatation, the stent was accidentally crushed under IVUS guidance. We used a looping wire technique and successfully redilated the crushed instent portion. This case suggests interventionists should not always change the wire before stent well deployment and should bear in mind the value of IVUS in managing such a complication.

View full abstract

This is the first report of a case of Takotsubo cardiomyopathy with a hyperglycemic hyperosmolar state (HHS). This case presented with marked ST-segment elevation and electrical alternans, uncommon findings in Takotsubo cardiomyopathy. We believe that hyperosmolarity-induced myocardial dehydration and consequent increase in intracellular calcium concentration may be the mechanism of Takotsubo cardiomyopathy and electrical alternans in HHS.

View full abstract