We assessed the influence of aging bone calcium metabolism on mitral annular calcification (MAC) and aortic valve calcification (AVC) in 239 septua- and octogenarians (62 men, 177 women; 80.2±4.4 years). Osteoporosis was diagnosed by vertebral bone fracture. Both MAC and AVC were derived by 2-dimensional echocardiography. Bone mineral content (BMC) of the lumbar vertebral body was obtained by single-energy quantitative computed tomography using a calibration phantom. Serum calcium, phosphorus, parathyroid hormone, calcitonin, and osteocalcin were examined. Patients were classified into 3 age-matched groups in each sex: Group-C included patients with MAC (-) and AVC (-) (n=96); Group-A was those with AVC (+) and MAC (-) (n=80); Group-M consisted of those with MAC (+) and AVC (-) or AVC (+) (n=63). Osteoporosis-frequency and BMC in women were significantly higher (p<0.01) and lower (p<0.001) respectively than those in men. Among men, osteoporosis-frequency and BMC showed no difference between the 3 groups. Among women, osteoporosis-frequency (52%) and BMC (32±23 mg/cm³) in Group-M were higher (NS) and significantly less (p<0.01) than those (37%, 49±36) in Group-C, respectively. In both sexes, serum examinations revealed no differences between the 3 groups. These results suggest that: 1) MAC in elderly women can be attributed to ectopic calcium deposits, related to the severe bone loss caused by postmenopausal osteoporosis; 2) there is no significant relationship between the incidence of MAC or AVC and the humor-al factors of calcium metabolism; and 3) AVC may be mainly caused by pressure or stress loading.

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This study aimed investigate whether thallium-201 and technetium-99m pyrophosphate dual rest-redistribution emission computed tomography early after intracoronary thrombolysis may provide supplementary information for the management of patients with acute myocardial infarction. Fifty patients who re-ceived intracoronary thrombolysis underwent simultaneous dual emission computed tomography 3 days after first acute myocardial infarction. A11 patients who had a technetium-99m pyrophosphate accumulation were selected. Thallium-201/technetium-99m pyrophosphate overlap in the initial and delayed images early after intracoronary thrombolysis identified successful recanalization with sensitivities of 68% and 90% (p<0.05), specificities of 47% 79% (p<0.05), positive predictive accuracies of 68% and 88%, negative predictive accuracies of 47% and 80% (p<0.05), and overall accuracy of 60% and 86% (p<0.01), respectively. The patients were divided into 3 groups according to the change in thallium-201 uptake from the initial image to the delayed image on dual emission computed tomography: 20 patients had no change in thallium-201 uptake (fixed type), 16 had increases in thallium-201 uptake (redistribution type), and 14 had decreases in thallium-201 uptake (reverse redistribution type). The number of patients with successful recanalization was significantly higher in the redistribution type than in the other types (redistribution type vs reverse redistribution type or fixed type; p<0.01, respectively). In the redistribution type a frequency of reinfarction in the same infarcted area during the hospital course was significantly higher than in the other types (redistribution type vs reverse redistribution type or fixed type; p<0.05, respectively), which was mainly due to the patients having high grade residual stenosis. Thus, a thallium-201/technetium-99m pyrophosphate overlap in the delayed image early after acute myocardial infarction can be used as an index for predicting successful early recanalization and probably viable myocardium. In addition, the redistribution patterns on thallium-201 emission computed tomography early after intracoronary thrombolysis can be helpful in identifying patients with successful early recanalization and a high risk subset.

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In order to elucidate the immunological aspects of acute myocardial infarction (AMI), we studied lymphocyte subpopulations, immunoglobulin levels, and natural killer (NK) cell activity in 21 patients serially after admission within 24 h of AMI onset. The percent T cells, T cell count, and percent CD4-positive cells were significantly decreased on the 1st hospital day, compared to days 7 and 28. The CD4 / CD8 ratio on the 1st day was also significantly lower than on day 7, and was significantly lower than that of normal subjects. Natural killer (NK) cell activity and serum immunoglobulin G (IgG) levels showed substantial decreases each test day, compared with those in normal subjects. However, there were no significant serial changes in the percent B cells, the B cell count, or in the serum IgG, IgA, or IgM levels. Thus, not only T cell function, but also immunoglobulin levels and NK cell activity were depressed in the acute stage of myocardial infarction. Therefore, active measures should be taken to prevent infection in the acute stage of myocardial infarction in which invasive procedures such as insertion of indwelling catheters are often necessary.

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In our previous study, we reported that the left atrial contribution to left ventricular filling was decreased to a greater extent in patients with hypertrophic cardiomyopathy than in those with myocardial infarction or normal subjects during lower body negative pressure (LBNP)-induced preload reduction. To clarify the factors responsible for this difference in response, we examined changes in left atrial hemodynamic and M-mode echocardiographic indices during LBNP in patients with hypertrophic cardiomyopathy and myocardial infarction. The same degree of decrease in left atrial preload and afterload was found in both groups. Moreover, we detected no change in the left atrial fractional shortening during left atrial systole (%LAFS) in patients with hypertrophic cardiomyopathy, in contrast to a significant increase found in patients with myocardial infarction. These results showed that the greater decrease in the left atrial contribution in hypertrophic cardiomyopathy during LBNP could not result from differences in changes in left atrial preload or afterload, suggesting that it may be closely related to limitations in the compensatory augmentation of left atrial contractility.

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The effects of the washout of antiarrhythmic drugs on the frequency of ventricular premature contraction (VPC) were investigated in 64 patients (VPCs > 2000/day) . Included were patients on mexiletine (300-600 mg/day; 23 patients), disopyramide (300-600 mg/day; 19 patients) and atenolol (50 mg/day; 22 patients). Holter monitoring was repeated before, during and after the treatment with the above 3 drugs and the efficacies of the drugs were evaluated based on the spontaneous variability before the treatment. VPC reduction exceeding the calculated spontaneous variability during drugs therapy (drug-responders) and after the washout of the drugs (wash-responders) was noted in 17 (63%) and 3 (13%) of the mexiletine group; 11 (58%) and 5 (26%) of the disopyramide group; and 13 (59%) and 8 (36%) of the atenolol group, respectively. For the entire group of 64 patients, wash-responders were noted significantly (p<0.05) more among drug-responders (14 of 41 patients; 34%) than drug-nonresponders (2 of 23 patients; 9%). Therefore, the antiarrhythmic effects of drugs observed during drugs therapy seem to continue even after the discontinuation of antiarrhythmic drugs in 34% of patients those whose VPC reduction exceeded the spontaneous variability (drug-responders).

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A therapy consisting of a combination of an anticoagulant and a vasodilator was investigated to determine its effects on the long-term prognosis of primary pulmonary hypertension (PPH). Twenty patients with PPH who had undergone diagnostic catheterization in our hospital were studied. The mean follow-up period after the initial catheterization was 6 years, with the longest follow-up being 24.4 years. Seven patients were treated with warfarin as an anticoagulant, combined with either isoproterenol (3 patients) or nifedipine (4 patients) as a vasodilator (AV group). The remaining 13 patients were not treated (control group). Although there were no significant differences in the physical activity or hemodynamics between the groups, improvement was seen in 43% of the AV group and in only 7.6% of the controls. The 5 year survival rate was significantly higher in the AV group (57% vs 15%; P<0.05). Hemodynamics were evaluated repeatedly in 8 patients and improvement was seen only in the AV group. These results suggest that a therapy consisting of a combination of an anticoagulant and a vasodilator may improve the long-term prognosis of PPH.

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Doppler echocardiography was recently developed for obtaining a flow velocity profile at any point in the cardiac chamber. A pulsed Doppler technique combined with cross sectional echocardiography was used to examine the flow velocity pattern in the right ventricular outflow tract in 32 patients with chronic pulmonary disease (CPD) and in 15 healthy subjects as controls. All patients underwent cardiac catheterization. Pulmonary flow velocity profiles in the right ventricular outflow tract were recorded simultaneously with electrocardiograms and pre-ejection periods (PEP), right ventricular ejection time (RVET), acceleration time (AT), and calculated PEP/RVET, AT/RVET were determined. All normal subjects had "dome-like" flow velocity patterns with a peak flow at the midsystole. In patients with CPD, there was a significant correlation between log₁₀MPAP (mean pulmonary arterial pressure) and AT/RVET, the coefficient being r= -0.623, between PVR (pulmonary vascular resistance) and AT/RVET (r=-0.52), and between SVI (stroke volume index) and PEP (r = - 0.645). Complications of pulmonary hypertension in CPD were relatively mild, but the pulsed Doppler technique was found useful for evaluating pulmonary arterial pressure and other right heart hemodynamics of CPD patients.

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Four term infants with transient murmurs resembling that of pulmonary artery stenosis were examined. A grade 3/6 systolic ejection murmur was transmitted clearly to the entire precordium and the back. This murmur was first detected 7 days after birth in 1 infant and at a 1-month medical check in the other 3. The murmur continued for 7 to 22 weeks, with an average of 12 weeks. It gradually localized in the region of the left sternal border, and eventually disappeared. At the first medical examination, peak velocities of over 2.0 m/s, in the left or right pulmonary artery, were detected by a pulsed Doppler. The diameter of the right pulmonary artery was small (mean, 58±8% ; range, 46 to 64% of predicted normal) . When the heart murmur disappeared, the diameter of the right pulmonary artery (mean, 97±28%; range, 70 to 126%) had increased significantly (p<0.05). Peak velocities in the right pulmonary arteries had decreased significantly (2.22±0.37 m/s vs 1.13±0.10 m/s, p<0.01). We suggest that hypoplasia of pulmonary artery branches, in relation to the main trunk, is the main cause of the murmur resembling pulmonary artery stenosis.

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We encountered a case of pheochromocytoma which was characterized by the sudden onset of acute renal failure and pulmonary edema. Acute renal failure was rapidly improved after surgical removal of the tumor. This patient was also found to have a hypertrophied, dilated and hypokinetic left ventricle as assessed by echocardiography. Two years after tumor resection, cardiac size and function were normalized. This shows that a catecholamine-induced cardiomyopathy is reversible.

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